HomeMy WebLinkAbout01-20-11 (2)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 013919
MARCHI BONNIE L
505 GARRETT ROAD
DILLSBURG, PA 17019
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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
REMARKS:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
1 1500035 ~ S 3, 836.41
TOTAL AMOUNT PAID:
X3,836.41
CHECK# 9288
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO BDX 280601 ~-
HARRISBURG PA 17128-0601 ~ "`~~M ~ ~ '"'
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BONNIE L MARCF~'~~'~R'~~k~-:,;,~`°~~ V:~' ~ `
505 GARRETT ROAD
DILLSBURG PA 17019
INFORMATION NOTICE FILE N0. 21 •- `~' ~~}~
AND ACN 11500035
TAXPAYER RESPONSE
DATE 01-06-2011
TYPE OF ACCOUNT
EST. OF MRYTLE Y UPHOLD ^ SECURITY
S.S. N0. 196-14-5340 X^ sEC ACCT
DATE OF DEATH 11- 07 -2010 ^ s-rocK
COUNTY CUMBERLAND ^ BDNDs
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 ba answered by calling 1717) 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
ltnder penalties of per' ry, I declare that the facts I have reported above are true, correct and
plete .to the best of my owledge and belief . HOME C'~ ~~ ) S~Ip~. ~ 0~~~
WORK C ~ 1 ~~ ~ ~
4YER SIG AT E TELEPHONE NUMBER DAT
TDTAL (Enter on Line 5 of Tax Computations ~