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May 12, 2005
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
I Courthouse Square
Carlisle, P A 17013-3387
~..I....'.I J..r:
f'"1f"
ESTATE
SECURITY
FORM1Jl.A..
Re: Trust Estate of Richard W. Dillahey, deceased
Cheryl L. Baker, CP
Certified Paralegal
c1b@jsdc.com
Dear Ms. Strasbaugh:
Enclosed are an original and two (2) copies of the Pennsylvania Inheritance Tax
Return and two (2) originals of the Estate Information Sheet to be filed for the above-
referenced Estate, along with a check for Fifteen Dollars ($15.00) representing the
filing fee for the Return and a check in the amount of Two Thousand Nine Hundred
Twenty-five Dollars ($2,925.00) representing the Pennsylvania Inheritance Tax due.
Please time-stamp the extra copies of the Return and Estate Information Sheet and
return them to me in the enclosed self-addressed, stamped envelope.
If you have any questions, please feel free to contact me.
(",)
Very truly yours,
C ryl L. Baker, CP
Certified Paralegal
Enclosures
co
cc: Irene E. Dillahey, Trustee
134 SIPE AVENUE
HUMMELSTOWN, PA 17036
MAJlING ADDRESS
P.O, BOX 650
HERSHEY, PA 17033
TOLL FREE 1800,9423660
TEL. 717533,3280
FAX 717,5337771
www.jsdc.com
REV-1500 I OFFICIAL USE ONLY
COMMONWEALTH OF
DEPA::~~;~'1'~~~ENUE INHERITANCE TAX RETURN IIFILENUM2BE1R-O~- /,( 111-':>-
DEPT. 280601 ~ U '1 'i--J
HARRISBURG. PA 17,2B-0601 RESIDENT DECEDENT I_COUNTY cOOL. YEAlL._._NUMBER__
I DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) r SOCIAL' SECURITY NUMBffi--------- --
Dillahey, Richard W.________j-.!78-24-207-"-------
DATE OF DEATH (MM-DD-YEAR) TMTE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
08-13-2004 I 01-08-1931 REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) - - - - 1- SOCIAL SECURITY NUMBER .---
Dillahey, Irene E.
[!J 1. Original Return 0 2. Supplemental Retu~;---- -.-- -- D3."R"email'lder Retu~ (date of death prior to 12-13~B2)-
O 4. limited Estate IL.J 4a. Future Interest Compromise (date of death after D- 5. Federal Estate Tax Return Requirecl
.. 12-12-82)
'L!] 6. Decedent Died Testate (Attach ~ 7. Decedent Maintained a Living Trust (Attach
copyof'vVil\) oopy of Trusl)
[i 9. Litigation Proceeds Received II 10. SpOusal pove/}Y. Credit (dale ofdealh between If] 11.Election to tax under Sec. 9113{A) (Attach Sch 0)
J I~ 1:2:-31-91 and 1-1-95) I.
m:~!$/#,~Ik!MI!t!ii8~IRI#J;Ji~~Ji~jlj~..i!!..Itil!lkliiilli!/ilil#.l!Hi!l.......Uilf1/!jii~iilll'flli!iji$ij~~Iti.1ti!~if.ii!iHiHiWi!imWii!imii!im
!Z NAME COMPLETE MAILING ADDRESS
~ Gary L. James________ _ _ _ _ _ J
2 I FIRM NAME (If applicable) - I 3 S.
~ f.ocJames....sm.i!~~ietteric~~ Co-,,-nl!Hy,~LP __I ~u"m~~~s~Ov:~u~A 17036
8 4iTELEPHONE NUMBER I'
717-533-3280
-- --
--- --
11. Real Estate (Schedule A) (') ____~--<>-~_
2. StockB and Bonds (Schedule B) (2) 10,993.60
----.----.-.-
(3) None
--_.__._,~
(4) None
-----
(5) 4,000.00
------.----.-
(6) None
-,.------.--
(7) 653,612.12
REV-1500 EX + (6-00)
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) 0 Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
8. Total Number of Safe Deposit Boxes
nOFFICIAIZWSE ONLY
~:'- s:1 ,:~r.l :,,-<~
-(..,
-""1.0
>,-,."
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, o. Debts of Decedent. Mortgage liabilities. & Liens (Schedule I)
, 1. Total Deductions (total Lines 9 & , 0)
12. Net Value of Estate (Line 8 minus Line 11)
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(8)
668,605.72
(9)
(10)
17,162.62
_._.-._.._~,-
733.22
('1)
17,895.84
650,709.88
(12)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has (13) 0 00
not been made (Schedule J) .
'4.NetValueSubjecltoTax(Line'2 minus Line 13) ________"4) __ 65020~88
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, 585,709.88 x .00 (15) 0.00
z or transfers under Sec. 9116(a)(1.2)
0
;: 16.Amount of Line 14 taxable at lineal rate 65,000.00 x .045 (16) 2,925.00
;!: -.-..----..---
::l
l1- 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) 0.00
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0 16. Amount of Line 14 taxable at collateral rate 0.00 .15
>< x ('8) 0.00
;!: 19. Tax Due
(19) 2,925.00
200
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00:
Decedent's Complete Address:
STREET ADDRESS
400 Spring House Road
CITY Camp Hill
ISTATE PA
I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. Credits/Payments
A, Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
2,925.00
0.00
Total Credits (A . B . C)
(2)
0.00
3. InterestIPenalty if applicable
D. Interest
E, Penalty
TotallnteresVPenalty (D . E) (3)
4. If Une 2 is greater than Line 1 + Une 3. enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund
5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax dUe. (SA)
B, Enter the total of Line 5 + 5A. This is the BALANCE DUE, (5B)
2,925.00
2,925.00
Make Check Payable to: REGISTER OF WILLS, AGENT
,)i1.,5jS~c;,~"~~ I' ;, L!lJll ]~m"'n ~"L,,,;;,~:rl";;",;;.i.;,:&;;tl,;';;;;;I;-;;:J';1L ;rm~''i'-'!'
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;...................................................................,.............. ~
b. retain the right to designate who shall use the property transferred or its income;.................................... 0
c. retain a reversionary interest; or .......,............................................ ............." ................................,.............. 0
d. receive the promise for life of either payments, benefits or care?................. ............................................ 0
2, If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? .."............."......."............., ............... ....,....."...... .........................."..."..."...
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .........
4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?"..."............".,..................................,..........,........"....................,................. 0 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under penalties of perjury, I declare that I have examined this return, including acr:ompanying schedules and statements, and to the best of my knowledge and belief. it is trulJ, correct
and
complete. Declaration of prepat9I" other than the personal representative is based on all information of which preparer has any knowlectge.
SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN ADDRESS DATE
Ire e E. Dillahey
H
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B
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,
400 Spring House Road
Camp Hill, PA 17011
5-IO-os-
DATE
N
AD
R R
lVE
D
-(0 -3--~-
D
134 Slpe Avenue
Hummelstown, PA 17036
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate Imposed on the net value of transfers to or for the use of the
sulViving spouse is 3% [72 P,S, ~9116 (a) (1,1) (i)J,
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P,S. ~9116 (a) (1.1) {ii)1. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and tiling a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty--one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 39116 (a) (1 ,2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S.
~9116 1,2) [72 P,S, ~9116 (a}(l)j,
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. S9116 (a) (1.3)1. A sibling is
defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
, .
Rev-1SQ3 EX+ (tHI)
.
SCHEDULE B
STOCKS & BONDS
COMMCltIIWEAL T1i OF PENNSYl. VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
D/IIahey, Richard W.
FILE NUMBER
21-
AU property jointJ)'-owned with right of survivorship must be dlselosfJd on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 11 Series EE U.S. Savings Bonds - valued per Savings 10,993.60
Bond Wizard
TOTAL (Also enter on LIne 2, Recepltulatlon) 10,993.60
(If more space Is needed. addiUonai pages of the same size)
Copyright (c) 2002 ronn software only The Lackner Group, Ino.
Fonn PA-1500 Schedule B (Rev. 6-98)
.' .
Rev.15OB EX+ (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTIi OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dillahey, Richard W.
FILE NUMBER
21-
Include the pl'OCEI&ds of litigation and the dale the proceeds W6R11'9C8ived by the eetale.
Ail property JoIntty.owned wfth the rlghr of aurvlVOIShJp must be dlSdOMd on scf1edule f.
ITEM
NUMBER DESCRIPTION
1 2000 Saturn LS Sedan 4D - valued per Kelley Blue Book
VALUE AT DATE
OF DEATH
4,000.00
TOTAL (Also antsr on Una 5, Recepltuletlon)
4,000.00
(If mote space Is needed. addltJonal pages of the same SIze)
Copyright (c) 2002 ronn software only The Lackner Group, Inc.
Fonn PA.1500 Schedule E (Rev. 6-98)
Rev-1510 EX+ (6-98)
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONVVEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Dillahey, Richard W.
FILE NUMBER
21--
ESTATE OF
This sche<:IuIe must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV.1500 COVER SHEET is yes
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 Mass Mutual Annuity No. 64175957 - beneficiary 86.915.00 100.000 0.00 86.915.00
is spouse; valued per spreadsheet
2 Mass Mutual Pan Premier Annuity No. 75.000.00 100.000 0.00 75.000.00
PAN9314067 - beneficiary is spouse; valued per
spreadsheet
3 American Funds Account - titled in the name of 20.156.36 100.000 0.00 20.156.36
the Richard W. Dillahey Living Trust dated
6/19/1995 - valued per spreadsheet
4 Charles Schwab Account - titled in the name of 84.882.32 100.000 0.00 84.882.32
the Richard W. Dillahey Living Trust dated
6/19/1995 - valued per spreadsheet
5 Citizens Bank Certificate of Deposit No. 16.811.84 100.000 0.00 16.811.84
6140820863 - titled in the name of the Richard W.
Dillahey Living Trust dated 6/19/1995 . valued
. -- . . . .-.-..-.
6 Citizens Bank Certificate of Deposit No. 39.68 100.000 0.00 39.68
6140820863, accrued interest - titled in the name
of the Richard W. Dillahey Living Trust dated
6/19/1995 - valued per letter dated 12/31/04
7 Commerce Bank Checking Account No. 4.153.36 100.000 0.00 4.153.36
513145029. titled in the name of the Richard W.
Dillahey Living Trust dated 6/19/1995 - valued
per letter dated 12/21/04
8 Commerce Bank Checking Account No. 0.43 100.000 0.00 0.43
513145029, accrued interest - titled in the name
of the Richard W. Dillahey Living Trust dated
6/19/1995 - valued per letter dated 12/21/04
Total of Continuation Schedule{s) ee attached page
TOTAL (Also enter on Line 7. Recapitulation) 653.612.12
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 Schedule G (Rev. 6-98)
Rev-1610 EX-to (6-98)
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
continued
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dillahey, Richard W.
FILE NUMBER
21--
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHJP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE.
9 Integrity Bank Savings Account No. 0401007062 . 42.071.68 100.000 0.00 42.071.68
titled in the name of the Richard W. Dillahey
Living Trust dated 6/19/1995 - valued per
statement dated 9122/04
10 Real estate located at 400 Spring House Road, 205.449.90 100.000 0.00 205.449.90
Hampden Township, Cumberland County, PA .
titled in the name of the Richard W. Dillahey
Living Trust dated 6119/1995 - valued per county
tax assesment times common level ratio (185,090
. 1.11)
11 Treasury Direct Bond - titled in the name of the 10.000.00 100.000 0.00 10.000.00
Richard W. Dillahey Living Trust dated 6/19/1995
. valued per spreadsheet
12 Vanguard Funds Account - titled in the name of 73.030.99 100.000 0.00 73.030.99
the Richard W. Dillahey Living Trust dated
611911995 - valued per spreadsheet
13 Vartan National Bank Certificate of Deposit No. 16.509.59 100.000 0.00 16.509.59
3010992 - titled in the name of the Richard W.
Dillahey Living Trust dated 6/19/1995 - valued
per statement dated 12/16/04
14 Vartan National Bank Certificate of Deposit No. 16.509.56 100.000 0.00 16.509.56
3011001 - titled in the name of the Richard W.
Dillahey Living Trust dated 6/1911995 - valued
per statement dated 12/16/04
15 Wasatch Funds Account - titled in the name of 2.081.41 100.000 0.00 2.081.41
the Richard W. Dillahey Living Trust dated
6/19/1995 - valued per spreadsheet
TOTAL (Also enter on Line 7. Recapitulation) 653.612.12
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleG (Rev. 6-98)
REV-1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYlVANiA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dlllahey, Richard W.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 8,408.12
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Sacurtty Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attomey's Fa.. James, Smith, Dletterlck & Connelly, LLP 5,000.00
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) 3,500.00
Claimant Irene E. Dillahey
Street Address 400 Spring House Road
City Camp Hill State PA Zip 17011
Raiationship of Claimant to Dacedent Spouse
4. Probate Fees
5. Accountanfs Fees
6. Tax RebJm Preparer's Fees
7. Other Administrative Costs 254.50
See contInuation schedule(s) attached
TOTAL (AlBa enter on IIn8 9, Recapitulation) 17,162.62
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
'.
Rev.1502 EX+ (6-98)
'*
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTIi OF PENNSYlVN(IA
INHERITANCE TAA RETURN
RESIDENT DECEDENT
ESTATE OF
Dlllahey, RIchard W.
FILE NUMBER
21-
ITEM
NUMBER
1
DESCRIPTION
Keefer's Food Market - food for reception
AMOUNT
78.74
2
Malpezzl Funeral Home - funeral services
8,329.38
Subtotal
8,408.12
Copytight (0) 2002 form software only The Leckner Group,lnc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-15Q2 EX+ (6-91)
.
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
!NHE:RITANC€ TAl( RETURN
R€S10ENT DECEDENT
Dlllahey, Richard W.
FILE NUMBER
21-
ESTATE OF
ITEM
NUMBER
1
DESCRIPTION
James, Smith, Dletlerlck & Connelly, LLP - reservation for trust administration
closing cost
AMOUNT
200.00
2
Recorder of Deeds, Cumberland County - filing fee for deed
39.50
3
Register of Wills, Cumberland County - filing fee for Return
15.00
Subtotal
254.50
Copyright (c) 2002 fonn sollware only The Lackner Group, Ine.
Fonn PA-1S00 Schedule H.B7 (Rev. 6-08)
Rcw-1512 EX+ (8-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEAllH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESiDENT DECEDENT
Dlllahey, Richard W.
FILE NUMBER
21-
ESTATE OF
Include un....mbursed medical expen....
1
DESCRIPTION
MS Hershey Medical Center - unrelmbursed medical bill
VALUE AT DATE
OF DEATH
ITEM
NUMBER
524.61
2
MS Hershey Medical Center - unrelmbursed medical bill
192.22
3
Watkin, Freshman & Nipple, Assoc - unrelmbursed medical bill
16.39
TOTAL (Also enter on Line 10, RecapitulatIon)
733.22
(If more space Is needed. additional pages of the same size)
Copyright (c) 2002 foRn soflware only The Lackner Group, Inc.
FORn PA-1S00 Schedule I (Rev. 6-98)
REV 1513 EX (9.00)
*'
+
SCHEDULE ..
COMMON\'VEAl TH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dillahey, Richard W. 21--
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Truste.lsI
I. TAXABLE DISTRIBUTIONS [include outright sr,ousal
O'istributions, and ransfers
under Sec. 9116(a)(1.2)]
1 Amy L. DeMaio Granddaughter 4,166.67
3348 Berger Street
Allentown, PA 18103
2 Jessica A. DeMaio Granddaughter 4,166.67
3348 Berger Street
Allentown, PA 18103
3 Laura D. DeMaio Daughter 20,000.00
3348 Berger Street
Allentown, PA 18103
4 Sarah M. DeMaio Granddaughter 4,166.67
3348 Berger Street
Allentown, PA 18103
5 Irene E. Dillahey Spouse 585,709.86
400 Spring House Road
Camp Hill, PA 17011
See continuation schedule attached Continuation 32,499.99
Total 650,709.86
Enter dollar amounts for distributions shown above on lines 5 through 18, as appropnate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleJ (Rev. 6-9B)
SCHEDULE .J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Richard W. Dillahey 178-24-2078 08113/2004
Item Name and Address of Person(s} Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
6 Stacy L. Dlllahey Granddaughter 4,166.67
776 Fawn Hili Road
Broomall, PA 19008
7 ConnorA.Paashaus Grandson 4,166.66
1141 Pennsylvania Street
Whitehall, PA 18052
8 Jacob W. Paashaus Grandson 4,166.66
1141 Pennsylvania Street
WhItehall, PA 18052
9 Susan D. Paashaus Daughter 20,000.00
1141 PennsylvanlaStreel
Whitehall, PA 18052
Total 32,499.99
1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
JAMES GARY L
134 SIPE AVENUE
HUMMELSTOWN, PA 17036
_uuu_ fold
EST A TE INFORMATION: SSN: 178-24-2078
FILE NUMBER: 2105-0443
DECEDENT NAME: DILLAHEY RICHARD W
DATE OF PAYMENT: 05/13/2005
POSTMARK DATE: 05112/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 08/13/2004
NO. CD 005320
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2,925.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 513
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$2,925.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS