HomeMy WebLinkAbout10-20-05
Hill";},;!)"; I{J.:V I/O.";
This is to certify that the information here given is correctly copied from an original certificate of death duly fil'd with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filin
Fee for this certificate, $6.00
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 11969894
No.
Date
t,.)
c::::.')
r:--_.~
C"t
I
~
C':-l
(~)
--;
[".)
o
i : ::C?
1t105.1431l1W.2117
..2--1 - OSoq 31
COMMOMWEALTH OF PENN8YLVAJIA ...QEPARTMeNT OF HEALTH' VITAL RECORDS
CERnFlCATE OF DEATH
r"
CO
(.)
~
II
..-
It.ACll He
NAME OF DECEI8tT (FhI. _ Lnl)
1.
-.1\UI1IlrIlIIoIl
. .. 92 VII.
COllNTY OF DEAtH
:::"'1 0
"..tt
...
..
11..
129 E. Green St.
Shiremanstwon. PA 17011
Iwp.
1"
FA__jRnII.-.LIIIII
11.
dIyo1laro.
William W. Wert
DavId Wert
..
..
1Lt.-1--..:J~ Co
&,t'.....
~
F
V-D
_~""1H
-,0
- 0
-- 0
-
....... .........
~.....-
lMlEOF_ '/IECIF_
0-.....-
0.. 1&
o I'lAClI OF _ .,........... _ -,._
_...........
1100
I
~
I
-fCIIooII...,-.)
.~~-==C-=-.....~...........-..~-IlJ. _
---___CIInI"IIIICI___--._.....,....lt_"...... 0 ~'UU~
To..._".,...........__...._-......... ........-.....___._ _ MD::fL)lXPr ~- Jt<I.
___ca_ ='L-~IMIio6~-'IIIltD 4-c;
~.:...~.~~.!,~~~~~~~~~~~~~~~O ~~, :1:;;,.,,4;r'.
11.. u. ,.,..
~ _1IIIIl!_ DATE FlLElllUanl/l. Do)'. Yw<<l
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WERT DAVID
______u fold
ESTATE INFORMATION: SSN: 183-07-8851
FILE NUMBER: 2105-0931
DECEDENT NAME: WERT ELWOOD W
DATE OF PAYMENT: 10/20/2005
POSTMARK DATE: 10/20/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/13/2005
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 00872-01716
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
I
REV-1162 E 111-96)
NO. CD 005318
AMOU~ T
--------
I $61,750 00
I
I
I
I
I
I
I
I
$61,750.00
GLENDA FARNER STRASB ~UGH
REGISTER OF WILLS