HomeMy WebLinkAbout12-17-09
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HAflRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX111-961
N0. CD 012117
HAZEN DAVID B
1622 QUAKER LANE
SALEM, OH 44460
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
fold
ESTATE INFORMATION: ssN: 269-i 8-4996
FILE NUMBER: 2109-0888
DECEDENT NAME: HAZEN GERALDINE M
DATE OF PAYMENT: 12/17/2009
POSTMARK DATE: 12/15/2009
couNTY: CUMBERLAND
DATE OF DEATH: 09/20/2009
REMARKS:
SEAL
CHECK# 1659
101 ~ S'5,000.00
TOTAL AMOUNT PAID:
INITIALS: DM
RECEIVED BY:
S 5, 000.00
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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