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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 008955
HOFFMAN JEAN
809 EAST WALNUT ST
HANOVER, PA 17331
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
-------- fold
101
$80,784.00
ESTATE INFORMATION: SSN: 160-16-0839
FILE NUMBER: 2107-0225
DECEDENT NAME: DERICKSON MELVA A
DATE OF PAYMENT: 11/13/2007
POSTMARK DATE: 11/13/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 02/11/2007
TOTAL AMOUNT PAID:
$80,784.00
REMARKS: RECEIPT GIVEN TO A TTY
CHECK# 2001
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
Law Offices of
Michael Cherewka
624 North Front Street
Wormleysburg, Pennsylvania 17043
(717) 232.4701
(717) 901.3770
Fax (717) 232-4774
November 9,2007
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, P A 17013
Re: Estate of Melva A. Derickson
Estate No. 21-07-0225
Our File No. 2118.00
Enclosed please fmd REV 1500, Inheritance Tax Return for Resident Decedent,
Inventory and a check in the amount of $80,784.00, representing the full payment of the
Pennsylvania Inheritance Tax in the above referenced Estate. Also enclosed is our check in the
amount of $30.00 to cover the cost of filing the Inventory and the Return.
If you have any questions, please call the undersigned. Thank you for your consideration
in this matter.
Very truly yours,
~~~ Q
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Enclosures
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