HomeMy WebLinkAbout01-20-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
MARCHI BONNIE L
505 GARRETT ROAD
DILLSBURG, PA 17019
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: SSN: 196-14-5340
FILE NUMBER: 2110-1270
DECEDENT NAME: UPHOLD MYRTLE Y
DATE OF PAYMENT: 01 /20/201 1
POSTMARK DATE: 01 / 19/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1 /07/2010
IREV-1162 EX~11-96)
NO. CD 013920
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
11500037 ~ x771.55
TOTAL AMOUNT PAID:
REMARKS:
$771 .55
CHECK# 9289
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES t~~1,-,,~, M-w, ~x
PO BOX 280601 ~t~ ~ ~~- ,F ~_' `
HARRISBURG PA 17128-0601
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INFORMATION NOTICE FILE N0. 21 ~' ~ U _ `~~V
AND ACN 11500037
TAXPAYER RESPONSE
DATE O1-Ob-2011
o~PN~~t~ ~;~u~T
GU~~~P~a ~:.i, r,~,:~:? ~.~~~.. PA
BONNIE L MARCHI
505 GARRETT ROAD
DILLSBURG PA 17019
TYPE OF ACCOUNT
EST. OF MRYTLE Y UPHOLD ^ SECURITY
S.S. N0. 196-14-5340 X^ sEC ACCT
DATE OF DEATH 11- 0 7 - 2010 ^ sTOCK
COUNTY CUMBERLAND ^ soNDs
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
AMERIPRISE has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset.
If you feel this information is incorrect, please obtain written correction from the transfer agent, 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 Pennsylvania
Questions may be answered by ~allin9 C717? 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
~ Under penalties of perjury, I declare that the facts I have reported above/afire true, correct and
mplete t best my knowledge and belief. HOME C ~ ~~ ) S~~D~~~
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