HomeMy WebLinkAbout04-18-11 (4)BUREAU OF INDIVIDUAL TAXES
Po Box 2so6o1 r~~^~~~-~.
HARRISBURG PA 17128-0601~'i-~..-~~~ ~...'-
~.i~ .,. ~~~W~15F3-_EX ASP '~~IBiO
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
TAX
FILE N0. 21 `' j~'Q~Q~
ACN 11117754
DATE 03-17-2011
~, ~ r
O~Pi~~~'' ~.
FRANCIS I EWING
201 E MAIN STREET
LANDISBURG PA 17040
EST. OF AMBER M LEIBIG
SSN 187-44-9172
DATE OF DEATH 02-25-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
FIRST NB OF MIFFLINT OWN 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 instiitution, 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. Please call (717) 787-8327 with questions. _.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Under penalties of per 1 r~ t the facts I have reported above sire true, correct and
complete to the best oy kno e e a belief. H O M E C )
PAYER SIGNATURE
David H.
Esq.
WORK c 717 ) 774-7435
TELEPHONE NUMBER
DATE
TOTAL CEnter on Line 5 of Tax Computation) ~