HomeMy WebLinkAbout06-17-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
-~~ _
REV-1162 EX111-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. OD 012934
KIRK SHIRLEY A
308 WOODRUFF WAY
HARRISBURG, PA 17112
1aa
ESTATE INFORMATION: SSN: 203-05-2255
FILE NUMBER: 2110-0399
DECEDENT NAME: SMITH KATHLEEN M
DATE OF PAYMENT: 06/ 17/2010
POSTMARK DATE: 06/ 17/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 03/28/2010
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 ~ X1!1,893.20
TOTAL AMOUNT PAID:
REMARKS:
CHECK#104
SEAL
INITIALS: SAP
RECEIVED BY:
REGISTER OF WILLS
S 1 h ,893.20
GLENDA EARNER STR~SBAUGH
REGISTER OF WILLS
_.
~_L__
~.,,
INVENTORY
REGISTER OF WILLS OF CUMBERLAND CO~Ty~ PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA 1
COUNTY of CUMBERLAND f ss
FileNtunber 21-10-00399
i 1 r and Shirle A. Kirk
Personal Representative(s) of the Estate of Kathleen M. Smith
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation pplac~ed p ~s ~ each item of said
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no to 1 estate outside of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory!
I verify that the statements made in this Inven- /~,
tory are true and correct. I understand that false state- /~ vG-
ments herein are made subject to the penalties of ~,
18 Pa.C.S. § 4904 relating to unsworn falsification to -
attthorities.
Attorney -- (Name) Keith 0. Brenneman
(Supreme Court LD.', No.) 47077
(Address) 44 West Main Street, Mechanicsburg, PA 17055
uwre DF DEATH
March 29, 2010
LAST RESIDENCE
37 Sample Bridge Road, Mechanicsburg, PA
FIGURES MUST BE TOTALED
I. Real Estate
Land improved with a residential dwelling known as 37 Sample Bridge
Road, Mechanicsburg, Pennsylvania
II. Personalty
A. Medicare refund
B. ADT account refund
C. Verizon refund
D. Aero Oil refund
E. Penn National hazard insurance refund
F. Penn Waste refund
G. Miscellaneous personal property, furniture and
furnishings
H. Spring Creek, account refund
(Attach addlhtonol sheets as needed
Total:
SOC. SEC. NO.
'S-2255
~~o,ooo.oo
n
~~
0
a
z
v
a
iv
w
~v
:-:
~_,~. 2....~
,;{_
c:-.y .~-
.,
~~ r~
~;- -t
_,.~
-:c~
r~
~'~ C~
:,
'2,096.67
"TOTAL: 096.67
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each
item, but soh figures should not be exter-ded into the tots( of the Inventory. (See 20 Pa C.S. 3301
~ (b))
Fon» RW-09 sev. 10.13.06
$ 397.80
19.81
3.57
19.96
134.00
37.53
500.00
984.00