HomeMy WebLinkAbout07-15-05
REV.1500 EX 16-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
OFFICIAL USE ONL'(
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FILE NUMBER
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COUNTY CODE YEAR
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Q!L~'i--
NUMBER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
-T/JL.L6 E1.6N m~
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
04- 15' - J-DO.<J /0- z.3-J
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
1%4
- 7...b - 3 '7
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ t Original Return
D 4, limited Estate
D 6, Decedent Died Testate (Attoch capy olWill)
D 9, litigation Proceeds Received
D 3. Remainder Return (dale of death prior to 12-13-82)
o 5, Federal Estate Tax Return Required
8, Total Number of Safe Deposit Boxes
o 11 Election to tax under See, 9113(A) (Attach Soh 0)
o 2, Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
07, Decedent Maintained a living Trust (AttochcopyalTmst)
D 10. Spousal Poverty Credit (date of death between 12.31.91 and 1-1-95)
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NAME ~S +e=LlG
FIRM NAME (II Applicable)
COMPLETE MAILING ADDRESS
/193 J</~~)t'1 hcd
& fJ ;J.,- /1 PA-
I1J. /70 I
TELEPHONE NUMBER
--'13'7- bfo4 -
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1, Real Estate (Schedule A)
2, Stocks and Bonds (Schedule B)
(1)
(2)
(3) .-
(4) -
(5)
J 2.. 2. 5'''2$''1
l L3~
-5FFICLA~.fSE ONLY
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;0:32 c:: C)
ILfJ;;:I:~p r- ;~J,
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i.}>...::O U1 rn
I ~,/: en ^ 0
! ~=-! (") 0 <::? 0
00." :x>o 1 , =?l
DC :x 0
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule 0)
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)
8. Total Gross Assets (total Lines 1-7)
(6)
(7) fI} A
(8)
/41 t;;,) 0
9. Funeral Expenses & Administrative Costs (Schedule H)
(9) /)q) I
(10) 3 0<67
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(11)
(12)
(13)
IIOS-<O
/ 3'1r~ I 2-
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14, Net Value Subject to Tax (Line 12 minus Line 13)
(14)
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x.O_ (15)
x .0 <IS.. (16)~ ~ '2.. 3 c:a
x .12 (17)
x .15 (18)
(19)_ 02.3<&
16. Amount of Line 14 taxable at lineal rate
,) 3 '3_ ~ 11-
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS L q II ' ,f
_ I-Inc.~ TOT"}
A-oc:'....
CITY
Ca.
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
3J1:...
Total Credits ( A + 8 + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
ZIP
I 70 I
b 2-3 ~)
:3 /2-
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
(5A)
(58)
A. Enter the interest on the tax due.
S,2to
8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
592.~
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;........................... ........................... .................................. 0
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? . .. 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 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.
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SIGNATURE OF PREPARER OTHER"rHAN R~RESENTATIVE
{~hl-LJ ;/, 1/ jJ /J
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/70 1/
DATE
ADDRESS
DATE
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 surviving spouse is 3%
[72 PS. 39116 (a) (1.1) (i)].
'\\ ~ rr>
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. 39116 (a) (1.1) (ii)].
3 surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
l=nr r{.....~....- -~ '
msfers from a deceased chiid twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
116(a)(1.2)].
sfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 PS. 39116(1.2) [72 P.S. 39116(a)(1)].
lnsfers to or for the use of the decedent's siblings is 12% [72 P.S. 39116(a)(1.3)]. A sibling is defined, under Section 9102, as an
non with the decedent, whether by blood or adoption.
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B. I T....~ vI" LOAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1-DFHA 2-DFmHA 3.0CONV. UNINS. 4. OVA 5.~CONV.INS.
6. FILE : 1 t. -LOAN :
SETTLEMENT STATEMENT 05384 010-6111396
8. MORTGAGE INS CASE NUMBER:
L;. NV I 1:: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement !'{IfHIt ere shown.
Items marked "fPOCr wem paid outside the closing; they am shown hem for infonnationa/ purposes and am not included in the totals.
1.0 3/911 (ll53llW5384I16)
D. NAMI: AND iOF~~ R: E. NAME ; vI' SELLER: 11-. NAMI:AND i OF LENDER:
Michael C. Williams Estate of Helen M. Talley Sovereign Bank
1130 Berkshire Blvd.
Wyomissing, PA 19610
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1878915 I. SETTLEMENT DATE:
1911 Princeton Avenue Keystone Land Transfer, Ltd.
Camp Hill, PA 17011 July 8, 2005
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
3421 Market Street
Camp Hili, PA 17011
... ' VI" ~~.v,~ n:i N ". vI" "",'-'-'On.., illvN
100. II DUE FROM BORROWER: 400. " lJut: I :
lUl. ~ ales pnce 131, 4Ul. [ :;ares Price 131,9OO.0C
102. I"'ersonall"'ropeny 402. personal
lU3. ;;;ememem L;narges to Borrower (Une 1400) Il;LOf .Of 403.
104. 4U4.
100. 405.
AOJusrmanrs rOT /lems raId By Seller m adVance s For Items I'a rm
1 Ub. Lltyl I own Taxes to 400. Uty/l own I axes to
101. L;ounty I axes to 201.33 4U t. L;OUnty I axes to U IfU IfUU 201.33
1 vo. ;;;alOOl Tax UH",",,"" to 1 ,2lJ4.:Kl 4lRl. ;;;m00l lax to UHU If .,-;204.56
lUll. 401I.
11V. 41U.
111. 1411.
112. 1412.
120. GROSS AMOUNT DUE FROM BORROWER 141,573.76 420. GROSS AMOUNT DUE TO SELLER 133,305.89
200. .'" PAID BY OR 'OFI : I 500. R~UU"'llUNl:IIN, II lJut: I' :
LV1. ueposlt or eamest money 1,500W I 001. 1:XC8SS \.,ee InstrUCUOOS)
W2. I"'nnClpal Amount at New L08n(S) 131,900.00 IOU;':. [ LnargBS to Seller (Line 14UO) 10;714.31
W3. t:Xlsong l08n(S) laKen subject to 503. I:XISDng Ioan(s) taken SUbject to
204. 004. t-'ayon OT nrst
lOo. 000. t-'ayorr 0 . MUll1lage
Wb. 506.
207. 507. (lJepoSit disb. as Proceeds)
lOO. ooll.
~VlI. ooll.
AOJustments For Items Unpaid By seller AOjustments ror /lems Unpaid By seller
OV. L;lty/lown I axes to I 01 U. L;ltyll own I axes to
211. county Taxes to 511. county Taxes to
212. ::;cnOOI I ax to 012. ::;cnOOl I ax to
213. ::;ewer ,to 2.28 013. ::;ewer v, J{ f\JOfUO 2.28
/14. - 514.
210. 010.
'10. 010.
!1 I. 011.
!18. 1518.
!lll. I 0111.
120. TOTAL PAID BY/FOR BORROWER 133.402.28 520. TOTAL REDUCTION AMOUNT DUE SELLER 10,716.59
IUU. GA5H A I ;;;t:. I Lt:M~N I : bUU. "'A;;;n AI ::;1: I" :
JV1. Ijross AIT10unt lJUe trnm tlorrower (Line 120) I 141,573.76 liOl. uross AlIlountlJue TO ::;eller (Une 420) 1 133,305.88
IV<!. Less Amount Paid By/For Borrower (Line 220) II 133,402.28J OU;':. Less Keauclions uue ;;;eller lune 5<!0) II 10;716.59
103. CASH ( X FROM) ( TO) BORROWER i 8,171.48 603. CASH ( X TO) ( FROM) SELLER I 122,589.30
OMB NO 2502-0265 ".;0..
The underSIgned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein.
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REV-1502 EX+ (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
;I c./l'!/}
/JJ~//c.
FILE NUMBER
All real property owned solely or as a tenant in common st be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, bolh having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
Resldenc..e..
DESCRIPTION
ICf II j),...,-"ce-.for} ,4,:.) c:.....
dcu'J7~ )/;1 ~A 1}tJ1/
VALUE AT DATE
OF DEATH
/ J. ~ S-?f1
TOTAL (Also enter on line 1, Recapifulation) $
(If more space is needed, insert additional sheets of the same size)
I :J.J-Sc:,Jc;
REV-1508 EX" (1-97)
ESTATE OF
fie-Ie/]
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
/7J ~/k~
FILE NUMBER 'I '
d. -05' - 0469
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Include the proceedS of litigation and the date the proceeds were rece' ed by the estate, All property jointly-owned with the right of survivorship must be disclosed on Schedule F,
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE
OF DEATH
11/a~~o)q
LbrJ -leY? '+:5
'800
~
f)ruderl+:a.O ~\*'e.- -rh5C/1-C\.I?GE!-- PO/;C1 :it /lJ5/4b7'B33
P"ud'ei').fIJ k, ~e--y.,.,Sor-O'I?Le !bJicj:lf /}11J 044 ?J 4 I
.;1S52-
3.)0 b
).
TOTAL (Also enter on line 5, Recapitulation) $ ? /5<;(
(If more space is needed, insert additional sheets of the same size)
-,~".,:. *
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
;/elt-n /JJ '/CA-//~9
If an asset was made joint within one year of the decedent's date of deat{it must be reported on Schedule G.
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
FILE NUMBER
~I -o5'-o~t7
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. 5feve') 'S 're.....11 ell
1193 ;I.'~?fsJf?7 Rd. C1"J,tJ Ik//
/7(;1/
So/7
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JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF OA TE OF DEATH
ITEM FOR JOINT MADE Include name of financial Institution and bank account number or similar Identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate, VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A, ;'112- 50 tk... e...;4 .. .6tVl K SxVi~.j 1>\74 5'0% 40~?
d";).. 33Ljo24 136
.f- A 1't9L Scoere\~ YJ fjo..", 'K'-
c.hec..~\'''"'J :tJ: /o5/073Mb 133b So ?o 66 )5
3 It IC(ill /Yl e.r""'~ I} J-- '111 c-~ crnA
J;t jjtR.. -;2.oS0~ ~ 7T>5"~ SO <7D i 39 30
TOTAL (Also enter on line 6, Recapitulation) $ J~b<jf.s-.OO
"
(If more space IS needed, Insert additional sheets of the same size)
REV-1511 EX+ (12-99) "
.. .9..; '.J.~ ". '~...
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
;I~/e'/}
/lJ, ~I/e~
Debts of dece ent must be reported on Schedule I.
FILE NUMBER ""I I /1
oL- - oS- -0-,'67
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
/n'lCf-S- JlC:U-17er hJ7ero-C tl6hJt:- (j)LIJ--;~ ')
RD 1 \ ""'l Gl-eeY\ C("'me...+o..J.-7 ( C:,.........u.e..- 1YIo..1-}C.e#-
r; 43':),DO
.)J-l ' 0 0
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Sfet/en
S .la.t \ e4
1?J1-4L-)hZ'J
Street Address J I q '~
City ----L2-CLfl}fJ
Social Security Number(s)/EIN Number of Personal Representative(s)
StateP.IJ Zip I /6 j J
Year(s) Commission Paid:
2. Attorney Fees
3 Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
__ State _ Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
3JS,oo
6. Tax Return Pre parer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
I) 9 I} I ~ 00
=E.--:~: E.( - "-,:'"
tN.~ fJ
?1$;7~
",,- ~.~
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
Illt.LEY
"
J-I-OS-ty!tc;
:;:~/~f::."..-N~..A;"T,"':;: =~\nsY:"''J;'_~~:;'
:~~:-:~q'.;,!.,~iC~ T.t-X R::-rUR~,
ESTATE OF
;:ES:-E.'l~ DE-:~:~~~T
FILE NUMBER
!. " --- 1
!'-I ~ L EN fl;
'EM
Include unreimbursed medical expenses.
AMOUNT
~>iUM8CR
1
2.....
q
~
'-I
S-
f..::,
7
<is'
9
/0
//
J2..
13
1<-1
IS
/Ie
17
JYJ
J9
20
d-\
;1d.-
2-3
d-'1
!
I DESCRIPTION
! c~ f.Je n ~ j b..-o<-><-j ~ f4 ""1fW Jo."'Le..-
/J i-O<~ji., ~ (:o-~jJ t-f, II
pp~' t-
"
eomc~
pAw c.. w r.-::t-
U-C;I
35.00
be) .0 C.J
3-5".3'-/
.;t.1./2..
S-I. 'C-O
J/q,so
33", i I
ll~ ,SO
a.h. % J
413 . :Jcj
v~\-\ LC,,",
CA G-:r:
PPEJ-
I
Pen/l WCL~+C-- .
A.550C-~~..J-.-d a...oJ I~/ t>'j/~ t
C6I-nC<.~
PAw c...
Ve\.--l "20...,
&'71 fcr+ CO-I-"t.--
r;; ~\ -e.- T n"S ore... nC. e
IID,OO
d-I , Ie.
~(,. <is,)
;z..4,1"L
/2..1. 0 Z-
//y.06
~c ,q L
.;IS,'=>)3-
bC/. "if 3
/0 , S- '-
~C;Z , 3<:/
(. Horne 6l1J11(:> --5 ')
PPe, L
PAW c..
j-/ om e../c>".., cl Ce VI -I e 1-
Co,,.,c~
U- G-T p~ 71-6vcI7c::t
}-..o...w.... c.c,...rc.. '-4./1 S '- 1) 1\
CieO-n ~"'/ SeJ.-v'Ic-e....
LL- h.o-ve II--uc-K-
300. 00
Soe> ' () 0
ISc; .-a2-
TOTAL (Also enter on line 10, Recapitulation) $ ). 3 i 7 ,L <6
(If more space is needed. insert additional sheets or the same size)
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
I J? 1--L E V
"
FILE NUMBER -f I
~ -OS-016Cj
::,C"r.i':'''I';~_J.':''7:...;: :; ~-::W,SY:"'V;'.~~;'.
:~~:-;=q'T':'!';C~ T.t.J. R2iJR~';
ESTATE OF
~.=S.,:E,'1T C;':=:~~~7
/-1 z: L E rJ J),'1
.:EM
Include unreimbursed medical expenses.
AMOUNT
\",~HPC;:j
,'1...-"._ l
2S
2~
d-(
,~<6
d.-'1
30
31
! DESCRIPTION
j f-h-h-~o-t IDe \.V.5 C JU.:.~'<-e. )
(!vh>b(:>,...-/Cf..,c/ J..-O-Q) Aov.-~
~Pi:L l-\,,~ ~
PA-w c.. /I t I
/l)d ..j." ~ F~"C-
;t)o k "<7 r"C e.....
&0 i \ l4.' +'15
1'9.0'L
7Y.OO
bl. Z-Z-
/7~73
s.OG
iO- 00
L/3/. cgS-
/) '10 . o-:b
d-.3 17, -
.
TOTAL (Also enter on line 10. Recapitulation) $ 30 ~7
(If more space is needed. insert additional sheets of the same size)
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
I
J/ ~/e/) /l} J o.-lleq
NAME AND ADDRESS OF PERSON(S) RECEIVING PROP~TY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
FILE NUMBER
~/-OS-oC;b9
RELATIONSHIP TO DECEDENT
Do Not ListTrustee(s)
AMOUNT OR SHARE
OF ESTATE
1.
$+~ve-,.., S' .le.- tI e.1
II <J 3 J.<. I ;'7 5 )'t:'7 Al
C~J?J/J )-/-, II jJ,4 J 70))
Son
So 70
.5 0- 2..O--n n ~ d /; e J--
02- ~J e)d Slone LJJ-,
&)/J~ ~';)7e /U.~
oryqZo
00..0 hie J--
So /0
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, 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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
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
NO. CD 005570
TALLEY STEVEN S
1193 KINGSLEY ROAD
CAMP HILL, PA 17011
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
~n_.~_~ fuld
101
$5,926.00
ESTATE INFORMATION: SSN: 184~26~3770
FILE NUMBER: 2105-0469
DECEDENT NAME: TALLEY HELEN M
DATE OF PAYMENT: 07/15/2005
POSTMARK DATE: 07/15/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 04/15/2005
TOTAL AMOUNT PAID:
$5,926.00
REMARKS:
CHECK# 551
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS