HomeMy WebLinkAbout09-27-10 (4)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
CARPENTER DENISE A
98 BOOT ROAD
NEWTOWN SQUARE, PA 19073
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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
AMOUNT
ACN
ASSESSMENT
CONTROL
NUMBER
10131581 ~ x'1,791.00
TOTAL AMOUNT PAID:
REMARKS: RECEIPT TO ATTY
CHECK# 1007
SEAL
$1,791.00
INITIALS: HMW
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REV-1162 EX;11-96)
NO. CD 013418
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
PNC 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/benefic:iary 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. Please call C717) /si-8317 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
complete to the best of my knowledge and belief. H O M E C )
BUREAU OF INDIVIDUAL TAXES
Po Box 2so6ol
HARRISBURG PA 17128-0601
REV-1543 EX AFP (OB-OB) INFORMATION NOTICE
AND
TAXPAYER RESPONSE
F I L E
ACN
DATE
NO. 21 l p - 02$1
10131581
06-08-2010
N TYPE OF ACCOUNT
_
~-~~ ~'' ~' O ~ EST. OF EDWARD MIRRA ® SAVINGS
::.`_ ` CV
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$SN 184 - 1 0 - 7688
~ CHECKING
~_~ ~ ~-~--~~::~ DATE OF DEATH 02-02-2010 ~ TRUST
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WORK C )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
ivit~~ inter on Llne 5 of Iax Computation) $