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12-05-14
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OFREVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 019992 SMITH PHILLIP N 554 ROYER DRIVE LANCASTER, PA 17601 ACN ASSESSMENT AMOUNT CONTROL NUMBER ------- fold __""'__' ""___' 101 � $6,000.00 ESTATE INFORMATION: ssN: I FILE NUMBER: 2114-099$ I DECEDENT NAME: SMITH ELBERT N I DATE OF PAYMENT: 12/05/2014 I POSTMARK DATE: 1 2/04/2014 I COUNTY: CUMBERLAND I DATE OF DEATH: 1 O/1 9/201 4 I � TOTAL AMOUNT PAID: 56,000.00 REMARKS: CHECK# 104 INITIALS: HMW SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS VERNON M. MARTIN, Jr. Member Certified Public Accountant Member 674 Willow Way AMERICAN INSTITUTE OF PENNSYLVANIA INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS Mechanicsburg, PA 17055 CERTIFIED PUBLIC ACCOUNTANTS 717-766-8156 I �.�3����� �L G-I S�L 2 o C= �.J�c,�s � ,���� 5 ��� P� f-�� r3 � (�CCC.�S C-7 ( S 1�K �S`_"c_c Ulti �"TC—_3 ��'� �/4`(U�,c-E(�t""r �7 C �� p�d To �� �10 LL L� '"�� `._�-.-<��c �5�� cf���- i (�CC�wE.�c e-- C= �L- �L�-� � ° �JV��--r t-�- l�(�, �;L�--��`f — �^� `� �'�' ,�� (`�o, ��-( — (�— �1 `� � �. �- �' � :r- � � � .-�-� c'�� ca.. �...,_�_.� ��{�� `�.ocA. c... �` � <:;� c�. �.. � Q c, c_:. e3 c� °-�� � c_*, i,`�..i � � �=`.` `� �w c�-t— � ,� �a c� cr,+ � c.� � � W W � � � � � «-�-. � � � V �Ecor���� ���icE aF - - ��c�s��� c� ��j��.is - -. 20Iy DEC 5 ?�I 12 `€y j< . ° c���,:ti �� =� T ORPNrh`,�' C�`Ji7 ., CUM���, �,"�� "�,.; ;'ft ,..:. ....� �-� ,::r. ��S r�y f;$ n � t r� t h (I�' i•�} ,�, � (�.. �, t�r �, � C � �-, r n � � � � j `n � �, �: � �, .;. c.� ,� ��� :�.;� `� � �1 ,:_ �;�.- — E� s;� � � ��. �: � � � ,': ��1 � � � �; u`; � `�' €��^: ; ,.. ;:,;: � w �� >.� x � ::: �.� ;�� > �5 k V � x , :x re� E> � '=��i;� �cs:,�','{ r: �:, �� ..�,,,;,a�s:. � ni i«SI `,3 ,"'��• , •�, ��