HomeMy WebLinkAbout05-11-05
REV-346 Ex (8-92) ~~,
PA DEPARTMENT OF REVENUE ~
ESTATE INFORMATION SHEET
FOR REGISTER'S OFFICE USE ONLY
County Code Year File Number
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DECEDENT INFORMATION: Enter data as it will appear on all documents submitted to the department.
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Decedje;s ~OCi~1 s:~u2ty N~mb,~ !! '7 Date of ~a=- ;' C; _ .2:. 0(::> s:- Date ~ Birth .2. .:- ! ':; '2___
TYPE FILING: Enter check k) mark to indicate the nature of the return to be filed with the department.
[] Probate Return
DJoint Assets Only
o Estate Tax Only
o Litigation Purposes (No Other Assets)
LETTERS GRANTED: Enter check (....) mark to indicate the nature of the proceedings at the Register of Wills
Office. (Attach additional sheets if explanation is necessary.)
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lLf Testamentary
o Administration
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DOther (Please explain)
ATTORNEY!CORRESPONDENT
INFORMA TION:
Enter all data concerning the attorney or other individual to receive all
tax information and correspondence.
Name (Last) (First) (Middle) Supreme Court 1.0. II
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Street Address ~-;~. -
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City State Zip Code relePhone Number
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PERSONAL REPRESENTATIVE
INFORMATION:
Executor! Administrator
Enter all data concerning the personal representative(s) of the estate
authorized by the Register of Wills
Namtast) (First) (Middle) Social Security Number
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Street Address
Cil)l State Zip Code Telephone Number
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Co-Executor! Administrator
Name (Last) (First) (Middle) Social Security Number
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St",et Address
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City State Zip Code Telephone Number
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Co-Executor! Administrator
Name (Last)
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(First)
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(Middle)
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Social Security Number
Street Address
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City
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State
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Zip Code
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Telephone Number
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I Date
repared By
CCMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HA,RRISBURG, PA 17128-0601
REV-1162 EX(11-961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NEWCOMB PETER E
8707 182 NO STREET
PUYAllUP, WA 98375
nnnn fold
ESTATE INFORMATION: SSN: 156-38-3117
FILE NUMBER: 2105-0433
DECEDENT NAME: NEWCOMB KATHRYN T
DATE OF PAYMENT: 05/11/2005
POSTMARK DATE: 05/11/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 02/19/2005
NO. CD 005311
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $27 ,000.00
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TOTAL AMOUNT PAID:
$27,000.00
REMARKS:
CHECK# 388
SEAL
INITIALS: CCP
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS