HomeMy WebLinkAbout09-03-15 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX01-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 021214
FORNEY DAVID L
1601 K STREET NW
WASHINGTON, DC 20006-1600
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
------- fold
__________ --------
101 $342.68
ESTATE INFORMATION: SSN:
FILE NUMBER: 2114-0005
DECEDENT NAME: FORNEY RAY K
DATE OF PAYMENT: 09/03/2015
POSTMARK DATE: 08/31/2015
COUNTY: CUMBERLAND
DATE OF DEATH: 12/18/2013
TOTAL AMOUNT PAID: $342.68
REMARKS:
CHECK# 540
INITIALS: DB1
SEAL RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WILLS
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CARLISLE PA 17013
NOTE: To ensure Proper credit to Your account, submit the upper Portion of this form with Your tax Payment.
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