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HomeMy WebLinkAbout95-0062\ .. ~K_ I/- /D `~°) ~ REV-1500 EX+ (7.94) INHERITANCE TAX RETURN FOR DAT[>j Of DlATN AR[R 1ZIJ 1191 GM~GR IY~Rf iF a srouslu ^ D1T is tLAtMtD • RESIDENT DECEDENT Fiu NuMani . COMHONWEAITH OF PENNSYLVANIA (TO BE FILED IN DUPLICATE ~ DEPART EPNT200~EVENUf WITH REGISTER OF WILLS ~ COUNTY CODE YEAR NUMlER HARRISBURG, PA 17128.0001 DECEDENT'S NAME MAST, FlRSi, ANO MAOLE INITIAL) CED N ' A KING, Pauline C. 50 Moreland Avenue SOCIAL SECURITY NUMBER DATE of DEATH DATE Of FIRTH Carlis le ~ PA 17 013 ~ 198-34-7165 0/29/94 10/22/03 cwn CLIIIiber~.and p ,IF AfTIIURE) SURVIVING SROVSE'3 NAZI[ BAST, FIRST AND MIODLL INITIAL) SOCIAL SECVRITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) s++ c [~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (for dates of death prior to 12-13-82) sn x ',~'$`v ^ d. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Fedoral Estate Tax Return Required ~ ¢ o ~ t° (for dates of death aher 12-12-82) ^ b. Decadent Died Testate ^ 7. Decedent Maintained a Living Truat n ~j Total ~mber of~ Deposh °oxss vT (Attach ropy of WiIIJ (Attach copy of Trvst) _ ~p n y ` o .. ~ COM E [ 1 Murrel R. Walters, III, Esq.. 54 East Main ~ _ Stl~et lv - - vg TELEPHONE NUMBER Mecharilcsburg, ~~ 17VJ5 _ J _S 7I7~ 697-4650 `-- 1. Real Estate (Schedule A) (1) - ~ - ~ -p C N _ ., v' C, 2. Stocks and Bonds (Schedule B) (2) - ~ A ~ W ~ 3. Closely Held StocklPartner:hip lntsrest (Schudule C') (3 ) d. Mortgogos and Notes Receivable (Schedule D) (d) - 0 - S. Cash, Bank Deposits & Miscellaneous Personal Property (5) 9 ~ • ~ 8 a (Schedule E) 2 6 , 4 0 3.3 2 b. Jointly Owned Property (Schedule F) (b) ~ 7. Transfers (Schedule G) (Schedule L) (7) - ~ - a 8. Total Gross Assets (total Lines 1-7) (8 ) 26,493.40 W ~ 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 425.00 l H h d u ) Expenses (Sc e e 10. Dsbts, Mortgage liabilities, liens (Schedule IJ (10) 3 s 7 9 4.3 2 219.3 2 4 11. Total Deductions (total Lines 9 3 10) (11) , 12. Net Value of Estate (line 8 minus Line 11) (12) 22, 274' 08 13. Charitable and Governmental Bequestt (Schedule J) (13) -~- 14. Net Value Subject to Tax (Line 12 minus line 13) (14) 22, 274' O8 1S. Spousal Transfers {for dales of death after 6-30-94) See Instructions for Applicable Percentage on Rtvsne (1S) Side. (Include values from Schedule K or Schedule M.) x.-x 16. Amount of line 14 taxable at b% rare (16) 22, 274 • 08 x O6`= 1, 336.44 (Include vetoes from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 15% rate (17) x .15 = _ (Include values From Schedule K or Schedule M.) 0 c 18. Principal fax due (Add tax from Lines 15, 16 and 17.) (18) a 19. Credits Spousal Poverty Credit Prior Payments Discount Interost 82 66 p + + 66:82 - (t9) . a 20. If Line 19 is greater than Line 18, enter the diffsronu on line 20. This is tM OVERPAVMENi. (20) r ~ ^ 21. If Line 18 is greater than line 19, enter the difFeronce on Lins ~21. This it the TAX DUE. (21) 1 , 2 6 9 • 6 2 A. Enter the interest on the balance due on Lins 21A. (21A) B. Enter the Total of Line 21 and 21A on Line 218. This is the BALANCE DUE. (218) 1 ~ 269.62 Make Check Payokfe to: Rplster of WfM, Agent Under penalties of perjury, I declare that I have examined this return, inducting aocompanYing sdssduNs and statements, and to the best of my knowledge and barer, it is True, correct and complete. i declare that all real estate has been reported aT trw market value. Dscloration of preparor other than the personal representative it based on all information of which preparer any knowledge. SIGNAi OPJPERSON ilESPONSIBLE FOR FILING RN ADDRESS avi e - Or ~r~n~. ~ ~- ~' ~~ Leland E. Kin Gardners PA 17324 ~ - Z 3 - ~ s ;IGNAT-1RE F PREPARER OT}EER E NiATIVE ADDRESS DATE J ,, ;~ `/ ~ Murrel R. Walters, III, :Esq. - ~ 3 - 4'e' p~~ ~~ ~, 'v a n ree ~ - - Mechanicsburg, PA 17055 -- .. Y ,..,. .. ,~. 7. r R`..d. ffi in..F M"Sw"°' . r C"`."yY.',4• Y k Z +v(7M Z'Y~' t.<•~'~.'~:*,~,~/y+.,"'*^~E"A • ~iT"i ~ 1 ~' a~~st ,~~:~ r,~ 1 ~9~ gsro .-idsar~ fair the redesstion of the tax rsetos iereposad oes the seat ~®~g~ of transferrs teo or fur the s~~ of t~s~ sposs~. a raster as pe~s~ceibed by the stzatsiire ~il~ bas ~ ~~.~ ~.~av~ ~i~i ba a~s~+Eicaa~s~e for as4eates of deeedaaeta dyiaeg ors or saffeer 7/1/94 asod beirore 1/1/96 ® 2~ ~.~4~~ ~i99 r~ op~,i3~fuBe i:+sr estates o~ dasedee~}s xiying ore or ®fta~r 1/1196 and be$ere 1/i/97 ._ e ~~n ~~~1~ en~i~e a~~,aia:~^~~e for ~frestcs of d~edee~s d~ies~ oQe er aver ~/i/97 aced befog ~#~/9~ e ~~~,+naa~i ~;~~sfasx o~~~aa~rin~ ¢ase or ®ftar i!1/98 ~esiBi ba axant~s~ froere ie+has~i4ae~ee t®x. ~ ('°, ~~.~~~~ A~~wE~ g~~ ~`~®vur~~ ~u~sT~~a~s ~ ~~.~°~~~ ~ ~~~~~ Ric ~~~ ~~ Tie ~~~~®~~'~T~ ~~.~c~c~. ~~ o 1. f;,'id das.-edsnt raaa~e a transfer and: X a. ra;tain ~e use or ensorno o$ the property trans$erred, .. ..................................................... $a, re;a7 °hm ri~~t tcs designate who steal! use the property transferred or its ineame, . .............. R r. P~~::,ir, •r r~aYars'sg~ury 6~4a~rest; or ................................................................................... d. s~~,:a;~e~ thai pronaE~g €or dife of either paynsents, benefits or careg ....................................... 2. i$ deny ~~;srrssd on gar bafcsre Decomber 12, 1'982, did decedent within two years precedeng death tata~:xfer pro~rt+, withoec! receiving adequate considee-ation~ 1# death occurred aFter s/ecar.~ner 12, 145, did decedent transfer property within one year of death without receiving zsr~rsez+~ax~ conaid~ratia;~~ ....................:...........................................................:...:.............. ~?. p~;e~ ~a ce~r_,,r" cdvn a~ `ast firust for'. ban6c aeeaunt at his or her death ...................................... ~ ~~ TIDE AI~~ER T® ~htY' ~~ ~E A~01d6 GtUEST1~N3 OS '1~E~b `~~~ ~'~~~' :C~~'~.ETE SCE®ULE Cs ~!-Id~ ~1`E IT AS PART ~1° TIHE RET~lRE~~ ~~~5 '-~ u. 2b "s T.a'$'riS~'!i~"''P`F°u ~31*:7.w"''i" °"fi''~'="+fi2`u'~S+a'" ~ .rfi~w"'TI~t .-..~.. .A h - ^A^c.: ., .._ _ _ __ __ _ ,._ , -. T - _ _. .,._... . ~. $!~ f: ;s; .; r:. ; :,r.. .~, ~ :..rr6,ro*c~;,: ~nuwt'~.M v ?.x"":~es.~ri arr "e7ece;e:Srz ~4 -'~- ------- --- - -- ------__ ... - ------ --- ------ -'-j- ---- ~, a._.~,.:.:_.; .._.,:±~ral ~?c~m~ .. Y~%und ~~ ~repa:;.~ s~~-~ice~ a(~,0& i i ~ a a d r. i ~° M ~,, ~: ~... h :~ .:::r_!r ,. r..:f ; Y: 3: 1 i siibb,E ir' .--'~"= :n;: ~9 ' rt a^~.) __.. i .,~'bTx 't~:~,yrt .~~y '+" :?,.; ~T^ ~ -`r i "- i ,r r F ,i.-^+^~},'.~•a~. .. rC t ' w..r >..> d r 17},,,e::a S^.~~ rriK. ~~+l"y~~'.-~ :~ fiy,r~ifi „'. " j ~ I ~. p (~ t' _ _._. _ __.____....._._._w__..~__~.._...__ ~______._~___.Y._~._...~ ~ ,, i~ } ?', , _ _ .._ 1. ., ~• ~~~`s_r3.11c' i. ..:~~~, :i2(~ ?davit ~ F _ Yo,_k ~ .~i~f ink:. ~.t~. ~.*_ ;see:?- ^ T r'.fi:. 17 ~ 2 ti S can .~ . ~,__~~~~,~: ~,-~ wN~:;~: - ;- - ~- ~ ~ `~ ~ ~`` ~ I w~~ tt ~ ~' r~~n r ~„?~!~ ~ E3~S~tt49~Sl~W C3F P~(3~ZR?'; TC37 ZL `4°atRi! c r Fl ~c~~i?',^~. L'~t 8.~,~: 1lALRlE C!F ' , j r~ ~qy~ :ate ~ ~t:~~ a- c ~, Aas_~ l;a;Y. ~ ~ . ~E:C:I~t,~Eh9e S EF7YERES7 ~ .':! ~ Vazx Y:~ ~ ~ m en Merrl tt X29 Z~ S0 ~~ 2~; i? ~' 6D .:. _ . . p . ~ , . , . ~ +. I ~~ a30~i1273©-6 ,. ~ i ~ ~~. tit ~ ~i2 i':>?2C~ ff~~si:ur (~.7~^~~.~ ~.i OTSL .I _• ~ u~)Jb0-~®U (~IVYX>.~v%~ ~ ~w..41 SQ i~~.71 ,. ~ .. ~:: ~ i ~ `sc'I?1~£?~ u i 1r5~ v?"t°Cli.t I?.. G2~ ~ i r4~~bb-~.1 (checl~i.ngi 2 ~s9~.8£i ~0 ~ z~.`3 1 ~?~ P .$ . tt c ; .. ~ ` = 6 ~ I•iEnber y ~'ixst Gz edit Uri on ~ ~ ~. ~ ~ ~ ~~a56b-05 (~avin~~~ •'+i,13 ~ i ~0 i 23,57 :~ , i6 ~ ~ ~ ~. ~ ~ ~ ~ r. ~ ~ A~ t: I ~ r ~ ~ %_ Z j } a a -----~_- TsA''e~~ (,his~^ ertmr an 'i^~ ~, ~:au~n +~~i.,.i.:ri _ . ~.__ - '~ a ! .) , 'f i% '' „ . /.."~~ , ~ '" .._ _.__ ~ ~~i uiar~ spvtF a, ..^•.~yaf ir~~R;f cd~ifie~an~xi ;}.r..,s r,{ s~:,rae _._ _~„_._~------ - ... , .. ,. , ... , ,. . .µ ~ .~_ __ - ~ _. ~~ f , ~- ~ ~ . ~ L yr. ...:l rl ~~in<^ t ~h . ..~- .r :..: ~l-..hl ter.,-..C- •~ .. ti _ _ _ _ __ _ _ _ _ _ __ -- - v , tx. q p~~+~d~qf~~i1e~A~.¢`~p~~!~~+~~~qs7~~S, CC's ~~ \\4'x.4 ~ rJ .~fidtdSYLV,7NIA 6l~:VA~~~.TVi ROb9 Y V G: 'Sr9eY.~.91y ~~~ !r::tEnlr-+.t.ree °,nr. azrua" 1'd~~S~~S.$ii~~'.1195 ~~P~~dS~S a~<,i;;~„T :~ec.na!~rr P~caaun Pr€nt or 5'Yp® Gnu i?47~ `~~'~9~~S~d!~' ,~ - f 3 'r '4 ~-, .;,y _--.----,_ State yip CodQ _ I t Ya~ar C~anmissions paid _ _- ~;~.±;:..^ey i~-"e. i°Il~z-rEl R, WaltFrs, III, Esq. ., ... ~ Fam:.y .:.yrr~~;livn C!~^imar,4 Relafionahip ,+~~~r~;ss ©r Gafmont a! decedent's death r •'sP!e~?' r'1:~-;ass ~- ! mss--,,i:~?sr?.rarix;a ;.:~o~Y Y'@ri0UI1CEC~ .. ! i'erscanri i2epresontative Commissions _ _ Sccicl Sflcurity dumber of Personal RepresenPative• ~ ~nZ.cs.rt-~_a~ +JQ~1'1.: L• lsr~+ J-,~ i i 1. i. ,: ~,, ~. f 1 'SS ...~.trn ~ecsr.~ ._ s:w,n~~sl. x az:.r~ es.e~"a?•i~cl ~fA.tx P^F ~~azerssc F.- t ~'` ~ ., ~' '~ - ""~ ' - - . - . ~.~~ ~-. ~.,:~,- .,,r:a „,:w; ~ W.7i_ F«d+"«y"±a ,!~K'!ti igyys ~~:~~ 1`4+.5 ~'y2ra. :;a.'~"~~."~.' 7r' r*... Thy,. p.-,....,~ ' ..,. ~. `=t .. :?5000 385,00 -~ r n n v tS ~ 1 4"' ~ ~ -------~ --i ~-_•-- --=-= ~~ - ----- ~'~Y'4. ~ -------------- i3$~CR~E'F4~h6 ---- - '~~ AFfiCiiS4~'T -- .l... ~ 'rcr~d ric~.~, Carlisle, P.~~. - ?°~:sidential care _ a ~ `~>r~"~;,T~~Z~re ,'Vled~.ca1 C~r~. -- ~edLcsl i 4~ ; :'aW,~ i.yc~t~ecaru -medical i 5. :~r~1L, ~ acxency Physicians -medical 5, i C<~r.~"~a:~e lms;in~ -medical 2,685.40 ~ 'I' [} , 5 fi I 773.72 i I 68.78 14.73 I 3h.33 ;< .. »; __ 7C85,~~ ;liiso Denier an Iirn 1C, nr~ccr~ii~aacioc~j ~~ ~. cif mc~: a s~,cc~ is f~a~sciac;, inss~! a~~l;tiaraJ s`~,s~}x o3 s~9ma siz~.1 ."rJ*.:. r '+b:ayRfd, +tlw. m:. rY 4ya.~,.,,y ,,,ea ~ ^~K>,rr~ ~. ~ U'7 `5 sr. 4am ~`y~'y .. 1 Y ;'N~4+E e~u 1"Y.~?/~s~' ~.~'f~IEZ` yY. F,~"Ty m,1~vJ' fe9".~.~~. '1q~~ ;, ;/" .n~r} F'~ T'~Y, Srtr. ~:' Gi, - - __ _. _ __'. .. .:'~~`. rH~kF`~:TRO' ,e~i,4'.~-,r~t~7wv, ~:l~d,~, My wail i i' !. , p a:. is 'i A3i ~ F-. ~.. ~, _(. ~_ , .71 .. ~ a." -~~{.' ~ a'~r~5 ni3 ~5u ~i:n ~ ~ ~~ _.u 1£M'4 ~ L'1 r c;Y/,":. F. I yer~ p ~nl~ 'j7y p ~ y ~~1F E$~3 ~~S~~d~~' '~ . cr WN ~._.._ .. 7 .....~...d..A_...e....._.~ ~..............-..o.....~.~.,_._ . ....r... . ...»... ... __ i ,. ? i.« ~ .~ ~ c.` ._. iiin~ _~{J .,:~.~ai;.le ~ York Springs ?~.~. ~~ 17324 __~Ydn~~ ~ .. a son & solo heir :3~Oa i - - .f. -------- u------------- - - --~L N ----,--- a>? ____~~_~C. ~ _ ~~:~elr s~~~ l'~~~(AEJ~ ~~~ ~~~~~"~~.54~~`Sr ~ ~~~~~~i ~SS4 .. wRQP1~C':;~~ ^r,-'.~ •7'7Y@Cii ^tCti}Ol PM1S L`q'U95}5: ~---- ,~ I I 1hF i . I ~ .. ~ fI i 1 i i ~+ 9 ~ ~ ~- ~~ ~ _, ....'~.N~~a~J~~+'a?.+~{t~W7r;1 4;~G??S~~ta (~lsa ~r~~r ::n line i 3, Ra~cwr.9u?.,;a ;r~} ,,~ .__._~___.._._.. __.~~_._._ g.. ~ e.':~eirS. L'~~'4"5" !m usY i~Zl -Ir fife:'{~R'~f ~'::~L. §°i F. ~'.t.:f"{''A: ~~ ..:t^5'. ., ..v~ t~-......~___.~~.~_~.v~. -. _.. ....~n ~;. J ~~ ~~~ s~ 4'4s~'i~T.`~iFs ~~Q.~ ~a ~1~~~12 / `1 f / / S yy~~ 22 ~~'~°n~'S3~ Yi. sl GM1F'~ fi~~8e.~~tiay) ~ ~/ b¢¢ 2 ~ ACPd 1 C 1 GEPG artEtfr Qr ~+_~a!~ - NOTICE OF IKHERITAPXrE TA)( j eu~£n~ ~~ Ibatd ~.:.~~ r :~'s ( APT'RAISEP",ESa"f, ALLQ~(dA.t(CE OR DTSALLQKASdCE ''~ nc~r z~usel L OF ()€DUCTIO3~>:i ASdD ASSESSRSFI~IT CF TA)( '~ ' HAFRIG6Jtq, PA 17i28-G501 HAVE 04-03`95 , ^,~,~,~: _~a_-~oE~~i-._.~`,~-,~, ~° FILE X53. ~_ ' ' , F~~ t .~ f)~ LE~a`c€ 10-Z9-'~4 CL-Ci(~Tl' CUMiBERLANP , { ?6CTS:: TG IM:IdXE t~FrR CRtDIT TO YOUR ACCOIA~IT, SUBi9ZT TPSf: UPPER PORTION OF THIS FORlB 61ITH YOUR TAX :'PaY(4E((T T9 TPi£ Rf=DIST[R GF BILLS, RAKE CHECK PAYA9LE TO °'PEQIS'ER Ors' HILL4, ABENT^ PtEP9Y'P' PAYP~d~?dT ~i) : ~~ :3l:4€?vL t~ ~:iALTERS III ES~d REGIST~(;11F '~II.LS ~~~D s4 c E~38°.I~: Si' CUP4BER ~ CO~OURT 7~SE ~EGNAhSICS2U~G PA 17055 CARLIS PA 17013.`-`= o , ~. c a w O HS' - ~ W L R A R ~ A ~t~:! 14'7 ~X A~t~i~ t 12° 343 PdOT1CE ®F IN~HEPITAMCE TAX APPRAISEMENTC P ', ~ ~}A~~i .~'®R T~ISALL044e3ldCE flF DEDtiCTIONS AKD AS8E5SMEPiT ~-9AlS Q;, [^a'FAi"E fFF NiFlC' ~~ PAULINE C FILE PIO. 21 95-0062 ACM 101 DATE 04-03-45 TAX RETURN 6dAS: f X) ACCEPTED AS FILED ( ) CHANSED RE~C;?'~,9TI£5Pd COAiCER;~IId FUTURE INTEREST - 3EE REVERSE a;awrrclvED ~'l~LUE OF :ETilRN S&SED OPd: ORIGINAL t: 1. Baal Fatafie (Schedule A) (1) .00 ~ . ~. 'StOCita anSB ~On~3 (Schedule $) (Q) .OO P 3. Closely F9ald Stock/1°artncrahia Ynterest (Sohsdule C) (3) .00 ~' 4. HartSages/Piatea R®ceivable (Sehsdule D) (4) .OO ~~ 5. Crth/Asrk ®e~ASaits/Misc. Personal Property (Schedatlle E) (5) 90.08 s 6. Jain.ly Oeense9 ProFrrty (Sehadule F) (A) 26.403.32 7. Tra:~slmrs (ScFA±,4tlc O) (7) .OO t' t,?. Ta'ccrl Rsro$a (b) 26 , 493.40 _ .a'.'~(~!Zr~vEb DEDE.,Ia°`.T3D&~.^x e"`i^~' £XEI~JPTIO~dB: 'l. Fu;eerrrtll Ex~ans,sc/A~tl. Caata/!(1sc. Expenses (Sehodula N) (q) 425.00 .i^. i~abts/SiortSaapla+ Lictl3Aliti9s/Liana (Sehsdule I) (10)„_~1,~, Il. 7ofa1 D¢sh.tetiont (11) 4 . ] 4.31 lC. "1~,t 4Aaalu ~ a'~ i ~x Rcnturn (121 22, 274.08 ~3. Chttritss.L+a/~,owe~rr:w®nfal Logae®ats (Schoalulo J) (13) .00 t~ ~" LEA. c{~': ttl.9ii,;t$ aP ..ata:.~c Suhjcnet to Tax (141 22,274.08 ; . ~~ ~~ ~:^~ r~~"ei$ &~~~ i~s~~d Pi'®~iou~ly' , T3ra~rs 14r 1'3 ~t(lsssf• I6r IT ~ra(~ I~ b(~BI 7 }~ ~ 7 a+n. u~R+~~ Zry 3~r 9~~ ~e itlM~°. ~,?S ~r ~.(1(i® ~~~ ~(S'~$!1 ~ ~~ P4lE~L:P~~ ~~~~~~a`~Jai ~® M1~da'Q:~. /, _ +l.I~: P~~:a 4..7 t15;S'~~f~ "tip '~,:~2.ae a 'S. :Isrsoas,~t c,~ Li-m 1~'~Tt 5~usa1 rate (15) .00 X .03_ .00 3.;s. ~,c:at!si: a9' Lins 1~~, $:uc~lo et Linoal/Class A rato (16) 22,274.08 X .06a 1,336.44 ;4?. Ao,,o~; oS' L1~:9 lfi i~xm4,lm at Collateral/class b rate tIa) . 00 X .15a~ , 00 1L. F:rirci(aa). Coax ~:~ (1(1) 1,.136.44 TliX CREDIT: ,. ~;~±tExT :~~c::~.~a DISCOUi~T (~) ~! 'SATE ~ i•~~taaER i)i-24- 5 ' ' ' INTEREST (-) ls'~.itdT PAID ~ , : ~ G6 i a~~l~'~~ ~7 ~S6.k~2 i,26~T.62 4=~. TOTAL TAX CREDIT 1,336.44 SALAi~Cl~ OF TAX AljE .00 `h' BFaTEE3LaT . ai 0 3, ' ~ ,p~ +«j a~` : $1~ F €''f €i~s3'~ Cea:t;A1 LLa. ~w~ FE.AFRSE ( dF T6iAL XLtdE i"; Lam. T6Ea3;9 Gin ~ PAYKEEaf TS naf)"u?RE.^.. A~~ r ~:~' r+._:_~.±,^,.,,~:? zr :.ZT?(:~q`?.. 3(a~T":PiEST• TF Td)rAL DLtlE ESl"gFi_ECTC)J P;$ A KCR£9IT'0 !CF?), "y~y PSAy C£ €A.~,1f° '~'~ ~. ~: RCF S:£ Fs"ee"FR~¢ S`aDE GA~ Tf-~.r..°~ Fw~9 FD«^.i .T~~'3"~'+T~". ~TIOI~.) k'" y - ` '" rna c ti ", £. ~ ~ _ `'a.-•:-~ X'0f'i ~ `~:,~eer,~4'~:,~.j 1~JiL5~' r~i~ '~ s+ -~°€+~-~' j ~ ~ ~~ '~ .~ \ ~ _ _~ '~` _ - ~~ ' - - ~~ i REU71G2 EY. ~a-4a! YiM. :. ~' Pii~~ii ~~R~Til~'~ P~I~'Y.4 Ai+tis~G ~aa~~a ~ ~ .. ~~ ® ACN RE:~E;~IEJ FROM: ASSESSMENT CONTROL ' AMOUNT NUMBER ;~ s 4 P^~C~'a1I ~~~2d3E~I~ Phi 170°,S:S ~ i --~O:U NE9E _ fjr FOIC HFRF ; , t REMARtCS • TOTAL AMOUNT PAID '~`Y •~Ea9.~t' SEAL +L:n3~ICY 4*~Sv~ ~ - 'i RECEIVES 9Y ~ ,,I~~G~' ATUitE ~t~~yT~~~i of ~~.~ ~_aat~^• "~tii.#W~-. '*p y~ ... ` ++Y. i~ .": .~ ~..n:-...... e... .v. _.. ._.. _.,-... .-,-.. ...,..~-. .. ', FL .. 1w14r ~, a!~.{~~ 0!'~Tw +e~....~~'^~ .. ~'r T^.T.T'II[~~ . r+ ` . a +A4! .. ~r., ~ .w.~ ~~S ~1TE INFORMATION: FILE NUMBER ~:: 2 ~' 1 ~~~•-fJ06~ ~ 1'4~-~'4-~71 bbl NAME OF DECeDENT (LAST) (FIRST) (MI) it I iel~ F"P~,~.. I G a DATc OF VAYMENT ~rOtiTMARK DATE ~ COUNTY -- C~ir'~~ v~t~4~1:3~J DATE OF DEATN -- .~~Ls __.