HomeMy WebLinkAbout09-05-12 (2)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
REV-1162 EX~11-96)
NO. CD 016471
KOONS MICHELLE C
121 N SAINT JOHNS DRIVE
CAMP HILL, PA 1701 1
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ESTATE INFORMATION:
FILE NUMBER: 2112-0686
DECEDENT NAME: PFLUGER MAGDALEN M
DATE OF PAYMENT: 09/05/201 2
POSTMARK DATE: 09/05/201 2
COUNTY: CUMBERLAND
DATE OF DEATH: 06/08/2012
REMARKS:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 ~ $3,326.00
TOTAL AMOUNT PAID:
$3,326.00
CHECK# 108
INITIALS: HMW
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
REV-548 EX (12-03)
INHERITANCE TAX JOINT BANK ACCOUNT COUNTY FILE NUMBER
ADVANCE PAYMENT WORKSHEET INHERITANCE TAX RECEIPT NUMBER
DECEDENT'S NAME (LAST) (FIRST) (MIDDLE INITIAL)
~FL~~1Z i'h AC, D~ L~IV ~~ .
DECEDENT DECEDENT'S SOCIAL SECURITY NUMBER DATE OF DEATH
INFORMATION ~~ ~ - ~Z '' S"Z ~ ~ ~ °0~3 ' Z~l~
ADDRESS OF DECEDENT c CITY STATE ZIP
l2-i( N., csf ~ ~v~~s X11 v~ ~~rr ~r/I / 7011
NAME OF FINANCIAL INSTITUTION
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FINANCIAL '
INSTITUTION ADDRESS CITY ~ STATE ZIP
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INFORMATION TELEPHONE NUMBER
~~~~~~7-Z32~
TYPE OF ACCOUNT
^ SAVINGS ^ CHECKING ^ TRUST [~ CERTIFICATE OF DEPOSIT ^ OTHER ___ _
ACCOUNT ACCOUNT BALANCE (INCLUDE INTEREST TO DATE OF DEATH)
~
` ACCOUNT NUMBER
INFORMATION ~
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ACCOUNT TITLE AS APPEARS ON SIGNATURE CARD OR CD ORIGINAL DATE ESTABLISHED
NAME (Last) (First) (Middle Initial) ~ .
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SURVIVING ADDRESS
i ~' ~ ~ ~~ ~~~ ~~ ~~' U/~ PERCENTTAXABLE
JOINT OWNER
INFORMATION CITY ' STATE ZIP CODE
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RELATIONSHIP TO DECEDENT TELEPHONE NUMBER °//~ 7 TAX RATE
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NAME (Last) (First)
(Middle Initial)
SURVIVING ADDRESS PERCENTTAXABLE
JOINT OWNER
CITY STATE ZIP CODE
INFORMATION
RELATIONSHIP TO DECEDENT TELEPHONE NUMBER TAX RATE
NAME (Last) (First) (Middle Initial)
SURVIVING ADDRESS PERCENTTAXABLE
JOINT OWNER
CITY STATE ZIP CODE
INFORMATION
RELATIONSHIP TO DECEDENT TELEPHONE NUMBER TAX RATE
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Date Paid Payee Description ~='Amouaid'_~~ ~ ~ ~-
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Note: Please attach to receipt
Total $
0.00