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RCC-144 (10-68)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
CERTIFICATION -
NO ASSETS IN ESTATE
.
TO:' The Register of Wi lis
[umbulttnoL
County
Date:
Estate of MiriaM 1<. Dfardorrr
Date of Death rf2 /3/2005
I
County File No. .2005 - 00111
Bureau File No.
On
, 19_ , I filed a petition for letters 1eS+~Jlleflfa.r~
in the above estate for the sole purpose of
Se#-llYlj deceJenfS esl-tde tJnJer fhe- rnis~ Ken belief fhCJ..J deucleilf
owned aS5e-fs
This is to certify that there were never any assets, reportable for Pennsylvania Inheritance Tax
purposes, in the estate of the decedent either at the date of death or subsequent thereto.
I certify that the statements contained herein are true and correct, to the best of my knowledge
and belief.
Signature~~~;o~~
Title fXUiA /-or
Receipt Acknowledged
(Register of Wills)
(Date)
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(PREPARE IN TRIPLICATE)