HomeMy WebLinkAbout12-28-12COMMONWEALTH OF PENNSV LV ANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280001
HARRISBURG, PA 1 ] 1 ZB-0601
RECEIVED FROM:
RICHARDS GREGORY K
134 SIPE AVE
HUMMELSTOWN, PA 17036
REV-1162 EXI11-961
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ACN
ASSESSMENT
CONTROL
NUMBER
-- - gold
ESTATE INFORMATION:
FILE NUMBER:
DECEDENT NAME: EVANS MARGARET W
DATE OF PAYMENT: 12/28/2012
POSTMARK DATE: 1 2/28/2012
COUNTV: CUMBERLAND
DATE OF DEATH: 10/02/2012
NO. CD 016978
AMOUNT
101 ~ 518,000.00
TOTAL AMOUNT PAID:
REMARKS: RECEIPT TO CARRIER SERVICE
SEAL
CHECK# 4013488004
INITIALS: HEA
RECEIVED BY:
S 18, 000.00
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
VL9 HAND DELIVERY
December 27, 2012
Glenda Famer Strasbaugh, Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
Re: Margaret W. Evans, deceased
Date of Death: 10/02/2012
Dear Ms. Strasbaugh:
Enclosed is a check in the amount of Eighteen Thousand Dollars and 00 Cents
($18,000.00) which represents the prepayment of inheritance tax for the above
referenced decedent and Estate Information Sheet.
Please contact me if you should have any questions.
Thank you.
Sincerely,
JAMES, MITH, DIETTERICK B: CONNELLY LLP
~~
Denise M. Long
Enclosures
THE
ESTATE
SECURITY
FORM[JLA
Denise M. Long
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134 SIPE AVENUE
HUMMELSTOWN, PA 1]036
MAILING ADDRESS
P O. BOX 650
HERSHEY, PA 1]033
TOLL FREE 1.800.942.3660
TEL. 717.533.3280
FAX ]17.533.7771
www.lstlacom
J REV-396E%(63-09) 3460007120
ESTATE INFORMATION
SHEET FOR REGISTER'S OFFICE USE ONLY
pennsylvania
P RT T County Coda Vear File Number
DECEDENT INFORMATION: Enter data as it will appear on all
documents submitted to the Department. 21
Date of Birth
Decedent's Social Security Number Date of Death
1 10 02 2012 O1 11 1922
Suffix First Name MI
Last Name
MARGARET W
EVANS
TYPE FILING: Enter mark (x) to Indicate the nature of the return to be filed with the department.
^ Non-probate Assets Only ^ Litigation Purposes (No Other Assets)
Probate Return ^ Joinf Assets Only ^
LETTERS GRANTED: Enter mark (x) to indicate thenature of the proceedings at the register of wills office.
(Attach additional sheets if explanation is necessary.)
^ Administration ^ No Letters ^ Other (Please Explain)
Testamentary ^
ATTORNEY /CORRESPONDENT INFORMATION: Enter all data concerning the attorney or other individual to receive all tax
information and correspondence.
Suffix First Name MI
Last Name
ESQ. GREGORY K
RICHARDS
Supreme Cour11.D.#
69335
First line of address
134 SIPE AVENUE
Sewnd line of address
City or Post Office
HU(vQ~.'LSTOWN
Telephone Number
Attorney / Corrresponde nt's a-mail address:
717 533 3280 akrCilisd~com ~~~ -
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State ZIP Code 4~ ~ ., _.,) _-3 ~ ~~~t
PA 17036 , ~'
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PERSONAL REPRESENTATIVE INFORMATION:
ExecutorlAdministrator
Social Security Number Telephone Number
(610) 866 0776
Last Name
FLECK
First line of address
3308 MORAVIAN COURT
Second line of address
OFFICIAL USE O-N~L`Y-~
TRANSACTION COUNT(
State ZIP Code
City or Post Office
BETHLEHEM PA 18020
Complete generel estate information questions, and indicate additional personal representatives on reverse side.
PLEASE USE ORIGINAL FORM ONLY
Enter all data concerning the personal ei~resentati36(s) of the estate
authorized by the Register of Wills.
Suffix First Name MI
BARBARA p'
Side 1
~, 3460007120 3460007120