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HomeMy WebLinkAbout05-20-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT F~EV-1 162 EX(1 1-96) N0. CD 014493 ANDREOLI MICHAEL A 106 S 18TH STREET CAMP HILL, PA 1701 1 -------- fold ESTATE INFORMATION: SSN: 184-12-2668 FILE NUMBER: 211 1-0599 DECEDENT NAME: ANDREOLI ROSEALIE DATE OF PAYMENT: 05/20/201 1 POSTMARK DATE: 05/19/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 04/20/201 1 REMARKS: ACN ASSESSMENT AMOUNT CONTROL NUMBER 11130290 ~ X44.91 TOTAL AMOUNT PAID: X44.91 CHECK# 5671 INITIALS: DB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PO BOX 280601 ,- - . '~`~ HARRISBURG PA 17128-0601~~ ~ `Jr- .REV-1543 E% AFP f08-Og) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21 - i1-~~C~~ ACN 11130290 DATE 05-04-2011 :.. 1-1 ,-, r, r, _ `:_ _ i ~ T .~J~.~R ~f, . -- _ ~~~ rA MICHAEL A ANDREOLI 106 S 18TH STREET CAMP HILL PA 17011 EST. OF ROSALIE ANDREOLI SSN 184-12-2668 DATE OF DEATH 04-20-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. MEMBERS 1ST FCU 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 Pennsylvania. Please call (717) 787-8327 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 . HOME C ~ ~ ~ ) ~~~~ ? 7~~j ~. WORK t ~ ~ -- ~ ! ~ TAXPAYER SIG ATURE TELEPHONE NUMBER DATE TOTAL (Enter on Line 5 of Tax Computation) ~ \ © "~ f'~ a ~ _4- r ~ ~ ~, ~ `~ i ~ e,. ~ J ~~ d _ ~. ~ ~ -.~j ~~..~ ~`~~f iw.i ;h~i ~:3 ~{~ ~y.~ ~ ~~ ~ ~ n /~'r _r ~ ~' 1%~ c3 ~ ~ (, r~ ~` ` 1 '~..., r Y ' ~, (~ ~ ~...- --~ r ~, ~ r ~~~ +r. ~~ S t ,_ r~, ~x ~°"• '~` f t'~"°j i ~::~ _: ~~ fj{N j.± ^+./~yti. {~1 fem. ~y~ ~L. '.'1~.'. !n'.Y