HomeMy WebLinkAbout07-16-10COMMONWEALTH 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 EX(11-96)
NO. CD 013060
BEARS SHIRLEY R
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 6/2010
POSTMARK DATE: 07/ 1 0/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 06/07/2010
REMARKS:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10138593 $13.64
TOTAL AMOUNT PAID:
$13.64
CHECK# 3168
INITIALS: SAP
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES (~
PO BOX 280601
HARRISBURG PA 17128-0601
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REY-1543 EX AFP (OB-08)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
~~"It'd ~ ,, .. AND
TAXPAYER RESPONSE
FILE N0. 21'~ ~'~~ d
ACN 10138593
DATE 07-01-2010
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SHIRLEY tom' BEARE
498 BRA DY 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 copy 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
rennsylvania. 'lease call c717) YS7-8SZ/ witn 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, corrE~ct and/,
complete to the best of m~owledge and belief. HOME C'~~/~ ) ~j~f~r~~ ~1~. (~~'
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TAXPAYER SI ATURE TELEPHONE NUMBER DATE
IUTAL ~tnter on Line 5 of Tax Computation) $
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