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COMMONWEALTH OF PENNSYLVANIA DEPARTMENT or REVENUE BUREAU OF INDIVIDUAL TAXES DE'PT.280601 HARRISBURG. PA 17128.0601 REV-1162 EXI11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005585 SLA TICK PATRICIA J 32 HAZEL CIR MECHANICSBURG, PA 17050 ACN ASSESSMENT CONTROL NUMBER AMOUNT ------- tolrl ESTATE INFORMATION: SSN: 194-09-2345 04136239 04136240 $337.78 $671.19 FILE NUMBER: 2105-0448 MITCHELL JACK C 07/18/2005 07/15/2005 CUMBERLAND OS/20/2004 DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: TOTAL AMOUNT PAID: $1,008.97 REMARKS: CHECK# 1585 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS