HomeMy WebLinkAbout09-28-12 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXE$„~~L~~~iti f^,~i
PO BOX 280601 IIFFJJ~~ ~ ~ ~ ;
HARRISBURG PA 17128-0601 p
INFORMATION NOTICE FILE N0. 21-IZ 'I~~U
AND ACN 12503580
TAXPAYER RESPONSE
DATE 08-22-2012
~~ 12 SEP 28 P~! 12~ 4 !
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c~Ma~R~o ca.,
JUDY A CHRONISTER
570 DOGWOOD DR
MECHANICSBURG PA 17055-6176
TYPE OF ACCOUNT
EST. OF PAULINE F CHRONISTER ^ SECURITY
S.S. N0. Q sEC accT
DATE OF DEATH 07 - O 1- 2012 ^ srocK
COUNTY CUMBERLAND ^ BONDS
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
AMERIPRISE FINANCIAL has provided the Departwent with the inforeation 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 inforeation is incorrect, please obtain written correction frog the transfer agent, attach a copy to this fora and
return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coswonwealth of Pennsylvania
Questions nay be answered by calling C717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
PART DEBTS AND DEDUCTIONS CLAIMED
Under penalties of perjury, I declare that the facts I have repor~lted above are true, correct and
ompl to to the st of my owledge and belief. HOME f J~ ) 7' ~~a
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XP ER SIGNATURE TELEPHONE NUMBER D TE
DATE PAID PAYEE DESCRIPTION AMOUNT PAID