HomeMy WebLinkAbout08-21-14 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES -
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 019577
KLINE ALEX
2703 KICH HAVEN SR
IJAMSVILLE, MD 21754-8815
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
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14505150 $105.33
ESTATE INFORMATION: SSN:
FILE NUMBER: 2113-1248
DECEDENT NAME: DERSIN DORIS L
DATE OF PAYMENT: 08/21/2014
POSTMARK DATE: 08/19/2014
COUNTY: CUMBERLAND
DATE OF DEATH: 10/22/2013
TOTAL AMOUNT PAID: $105.33
REMARKS:
CHECK# 648
INITIALS: DMB
SEAL RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX
INHERITANCE TAX OIVISIOn RECOP:�� ,, Qr�l^ PRAISENENT ALLONANCE OR DISALLONANCE pennsylvanla
PO BOX 28060I L IIF DEDUCTION6 AND ASSESSMENT OF TAX ON DEPARTMENT OF REVENUE
HARRISBURG, PA In2B-0601 "i n" '-. - . ,15,' C• SEA BENEFICIARY FORM D IN
h�ua i L I Y
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DATE 08-04-2014
ZQ�� AUG 2 P(q ��; & ESTATE OF DERSIN DORIS L
DATE OF DEATH 10-22-2013
FILE NUMBER 21 13-1248
�. OF COUNTY CUMBERLAND
�RPFtfU�1S „�T SSN/DC
JESSICA COMA- ('O pq ACN 14505150
2703 LOCH HAVEN DR APPEAL BY DATE: 10-03-2014
IJAMSVILLE MD 21754-8815 (See reverse side under Objections)
Amount Remitted t °r"
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
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