HomeMy WebLinkAbout12-26-06
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL. TAXES
DEPT. 280601
HARRISBURG, PA 1712:3-0601
REV-1162 EXI11-96)
RECEIVED FROM:
PENNSYLV ANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
HERSHEY ROBERT
613 SUNSET DRIVE
DlllSBURG, PA 17019
-------- lold
ESTATE INFORMATION: SSN: 174-20-8570
FILE NUMBER: 2106-0900
DECEDENT NAME: HERSHEY VIRGINIA M
DATE OF PAYMENT: 12/26/2006
POSTMARK DATE: 12/26/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 09/28/2006
NO. CD 007601
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $ 3,408.48
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$3,408.48
REMARI<S: HERSHEY ROBERT S
CHECK# 4
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
REV-548 EX (12-03)
INHERITANCE TAX JOINT BANK ACCOUNT
ADVANCE PAYMENT WORKSHEET
COUNTY FILE NUMBER
21-06-0900
INHERITANCE TAX RECEIPT NUMBER
DECEDENT
INFORMATION
FINANCIAL
INSTITUTION
INFORMATION
ACCOUNT
INFORMATION
SURVIVING
JOINT OWNER
INFORMATION
SURVIVING
JOINT OWNER
INFORMATION
SURVIVING
JOINT OWNER
INFORMATION
DECEDENT'S NAME (LAST)
Hershey
DECEDENT'S SOCIAL SECURITY NUMBER
174-20-8570
(FIRST)
Virignia
DATE OF DEATH
09/28/2006
18103
(MIDDLE INITIAL)
M
STATE
PA
ZIP
17055
ADDRESS OF DECEDENT
100 Mt. Allen Dr.
CITY
Mechanicsburg
STATE
TX
o
-,
1~--
TYPE OF ACCOUNT
o SAVINGS 0 CHECKING
o TRUST
o CERTIFICATE OF DEPOSIT
ACCOUNT NUMBER_
Payee
Description
Attorney Fee
NAME OF FINANCIAL INSTITUTION
Bank of America
ADDRESS
CITY
San Antonio
B
Date Paid
LIST DEBTS & DEDUCTIONS BELOW
Amount Paid
12/15/2006
TELEPHONE NUMBER
ACCOUNT BALANCE (INCLUDE INTEREST TO DATE OF DEATH)
82,230.66
ACCOUNT TITLE AS APPEARS ON SIGNATURE CARD OR CD
Betsy B. Brunick and Robert S. Hershey Anna M. Ruhl
NAME (Last) (First)
Brunick Betsy
ADDRESS
11 Progress Dr.
CITY
East Earl
RELATIONSHIP TO DECEDENT
Daughter
NAME (Last)
Hershey
ADDRESS
613 Sunset Drive
(Middle Initial)
STATE
ZIP CODE
17519
PA
TELEPHONE NUMBER
(Middle Initial)
S
(First)
Robert
CITY
Dillsburg
RELATIONSHIP TO DECEDENT
Son
~~TATE
PA
ZIP CODE
17019
TELEPHONE NUMBER
(717) 991-9735
NAME (Last)
Ruhl
(First)
Anna
(Middle Initial)
M
ADDRESS
1017 Oldstone Rd.
CITY
STATE
ZIP CODE
Allentown
RELATIONSHIP TO DECEDENT
Daughter
PA
TElEPHONE NUMBER
John C. Zepp, III
2,500.00
Note: Please attach to receipt
$ 8 2 , 2 3 0 . 6 6 1 e s s $ 2 , 5 0 0 . 0 0 Total $ 2,500.00
$79,730.66 x 4.5% = 3,587.87 less 5% (1/~.3~)
$3,408.48