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09-08-10
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: SMITH JULIA F 3910 LONG GROVE ROAD BROOKFIELD, WI 53045 -------- fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV~1162 EX(11-96) NO. CD ©13323 ACN ASSESSMENT AMOUNT CONTROL NUMBER ---------- -------- ESTATE INFORMATION: SSN: 172-36-1707 FILE NUMBER: 2109-1 158 DECEDENT NAME: FURST DOUGLASS E DATE OF PAYMENT: 09/08/2010 POSTMARK DATE: 09/07/2010 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/08/2009 101 ( $40,857.62 TOTAL AMOUNT PAID: REMARKS: RECEIPT TO ATTY CHECK# 2474 SEAL $40,857.62 INITIALS: HMW RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS