HomeMy WebLinkAbout07-13-10 (2)~ COMIGONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX111-96)
NO. CD 013049
BEARS LLOYD A SR
498 BRANDY RUN ROAD
NEWVILLE, PA 17241
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ESTATE INFORMATION: SSN: 167-60-9642
FILE NUMBER: 2110-0700
DECEDENT NAME: BEARS LLOYD A
DATE OF PAYMENT: 07/ 1 3/2010
POSTMARK DATE: 07/08/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 06/07/2010
REMARKS:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10138592 ~ $13.64
TOTAL AMOUNT PAID:
$13.64
CHECK# 3169
INITIALS: CJ
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES ~,_ A N D
PD Box zao6ol ~` ~-`` ~~'';~;~- t_'~'AXPAYER RESPONSE
HARRISBURG PA 17128-0601 !,, _.
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FILE N0. 21 y 1t~ "~ ~~~'h
ACN 10138592
DATE 07-01-2010
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LLOYD A BEARE SR''~'
498 BRANDY RUN ROAD
NEWVILLE PA 17241
EST. OF LLOYD A BEARE
SSN 167-60-9642
DATE OF DEATH 06-07-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiiary of this account
If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copv to this form
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of
Pennsylvania. Please call :717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
c lete to the best of my knowledge and belief.
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,X A ER SIGNATURE TELEPHONE NUMBER DATE
ioIAL (Enter on Line 5 of Tax Computation) $
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