HomeMy WebLinkAbout04-26-05
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1 162 EX!1 1-961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
MATOS YOLANDA l
3812 CHESTNUT ST
CAMP Hill, PA 17011
nn_n_ fold
ESTATE INFORMATION: SSN: 089-20-5678
FILE NUMBER: 2105-0387
DECEDENT NAME: MATOS YOLANDA
DATE OF PAYMENT: 04/26/2005
POSTMARK DATE: 04/13/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/22/2004
NO. CD 005250
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $54.62
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TOTAL AMOUNT PAID:
$54.62
REMARKS: YOLANDA l MATOS
CHECK# 2133
SEAL
INITIALS: RSK
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
s '-I:-
Q.;:
CDIDIIEALTH OF PENNSYLVANIA _
IEPARTIENT OF AEVEII.E
IIUAEAU OF INDIVIDUAL TAXES
IEPT. 281601 <-;'f' ilf'-' 1\r-~
HARRISBURG.. PA 171!8-~ti~fOr1LJED uri-l .
\!'~El""[U-11J
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. ZI D5 -srT
05115ZZ9
04~08-Z005
TYPE OF ACCOUNT
EST. OF YOLANDA MATOS D SAVI_
S.S. NO. 089-Z0-5678 IX] CHECKIIlIl
DATE OF DEATH lZ-ZZ-Z004 D TllllST
COUllTY CUMBERLAND D CERTIF.
IEIIIT PAYllENT AND FOIlllS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ZOU5 APR 26 PH 4: 00
0::1PH'\\1'S CC)URT
rl:'
YOLANDA LVMATOS
381Z CHESTNUT ST
CAMP HILL PA 17011
PNC BANK t.. provlcMd tM o.p.rbant with t:ha info....t1on lbt.i bIIIDlf _dah .... a..n u..d in
celcul.tfng thII pot8ntl.1 t8M .... Their r8CGrd.- lndioaa th8t 8t the dllatll of tIw IIbavIl ~t.. yau ..... . joint ClWI8rlbMllflcillry of
this 1lDDDIInt. If YOU ....1 thl. Info,...t1on Is Incarr8ct.. pi... .mbdn writt.1 correction froll t:ha fm.ncl.l in.tltutlan.. Iltbch . copy
to this fo,.. ... return It to the IIbovtI 1lddr8SS. This account is 'tIne.bl. In I!ICcordlmce IIIIlth the IriHlrltllllClll Tn L... of ttwr. L1 .___Uh
!:If PIIlI'1nQ'I",..de. Questions IlQ bII ........-.d ~ OII11lng(71.1) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5000967708 Date 1O-30-Z000
EsUbl1_
A_t Ilol1_
Percent T.x.bl.
_t _J..,t to T_
T_ I.t.
Pot~tl.1 Tax Du.
Z,4Z7.74
50.000
I,ZI3.87
.045
54.6Z
x
x
To In...... proper ern! t to your IICCOUI'tt.. bID
(2) capi.. of this notice .,.t . . _Q" yaur
~t to the Register of tlllls. ..... ah-.k
peyllble tD: "'Reglstllir of Wllls..- "'-"t-.
linE: If tax .......ts .... .... wl:thln thr..
(3) -.nths of the dHedent". cilia af d_th..
yOU ., ~t . S2: dbcOUftt.of .. tax...
_ InhIlrltMoll tax m- .ill bM_ daUnlII*'It
nine (,) .-w"". after the .... of ....th.
Pffii
1. ...... _. to .--It _t to _ ....Istor 0< Will. _lth _ _1.. .. this notl.. to ""toin
CHECK . discount Dr Bvoid inuAst.. Dr you IIIIY chKk bole "AW .m return this notlctl to the "'in.r of
[ONE ] NUb l!Ind ... official useSgent IIIIIlI b. issued by the PA -'r1:llent of Revenue.
BLOCK B. D TM above asset has bHn Dr l1li111 tHl reported and tax paid with the PennQlv_l. Im.rl'bncll TIIX retum
ONLY to be. f1led by thII dllcedent"s MlpreHntaUv..
c. D The &bow inforllaUon is Incorr8Ct -..lIar debts 8Iid deductions ..,.. paid by you.
You ...t CDIllpI.a PART 0 BrKII'or PART ~ below.
PART
[!]
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. ht. EsUbl..'.... 1
2. Account ..1_ 2
3. P....,.,t T_J.e 3 X
'I. _t _~t to T_ 'I
5. llabts _ _Uon. 5-
6. _t T_l. 6
7. T_ I.t. 7 X
8. T_ _ 8
If you lndlC8ta. dlff.~t tax rat., pI.... .t.t. your
~l.tlonshlp to decadent:
PART
[!]
DATE PAID
AlioliNTPAID
PAYEE
DESCRIPTION
I
TOTAL lEnt... on Line 5 o~ T_ ~teUon)
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fect.
I..... __ __ _ t....., ~ _
HOM! (~~). itl-ggS
WORK (71. ) - 15S1 -<<WK
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