HomeMy WebLinkAbout09-27-10 (3)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX~11-96)
NO. CD 013417
CARPENTER DENISE A
98 BOOT ROAD
NEWTOWN SQUARE, PA 19073
-------- fold
ESTATE INFORMATION: SSN: 184-10-7688
FILE NUMBER: 2110-0281
DECEDENT NAME: MIRRA EDWARD
DATE OF PAYMENT: 09/ 27/ 2010
POSTMARK DATE: 09/25/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 02/02/2010
REMARKS: RECEIPT TO ATTY
SEAL
CHECK# 1008
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10131580 ~ 51,379.76
TOTAL AMOUNT PAID:
$'I ,379.76
INITIALS: HMW
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
PN C BANK NA 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/beneficiary 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. Flease tail 1717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
BUREAU OF INDIVIDUAL TAXES
PD Box z8o6o1
HARRISBURG PA 17128-0601
REY-1543 EX AFP (OB-OB) INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
N0. 21 10-02$1
10131580
06-08-2010
~~ --- TYPE OF ACCOUNT
U ~,, ., ~J
a-:
EST. OF EDWARD MIRRA
~ SAVINGS
4`:, -~_~ ~ ~
, ~ $SN 184-10-7688 ® CHECKING
r DATE OF DEATH 02-02-2010 ~ TRUST
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~ COUNTY CUMBERLAND ~ CERTIF.
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~ REMIT PAYMENT AND FORMS T0:
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CiGREGORY REGISTER OF WILLS
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1 PA 17 1 COURTHOUSE SgUARE
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055-6181 CARLISLE PA 17013
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C'y
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief. H O M E C
WORK
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
~~~.+~ « n~er vn pine 5 or lax computation) $