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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.2B0601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 006108
2429 JERICO DRIVE
HARRISBURG, PA 17110
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
___nn_ fold ---------- --------
101 I $7,835.61
ESTATE INFORMATION: SSN: 149-05-0549 I
FILE NUMBER: 2105-0907 I
DECEDENT NAME: LUNDGREN FRANCES M I
DATE OF PAYMENT: 12/15/2005 I
POSTMARK DATE: 12/15/2005 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 08/23/2005 I
I
TOT AL AMOUNT PAID: $7,835.61
REMARKS: M L DAVIS
CHECK# 606
INITIALS: VZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
DAVIS MARY L
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of: Frances M. Lundgren, Deceased
No.: 21-05-0907
Date of Death: August 23,2005
Social Security No.: 149-05-0549
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following
inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of
Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its
fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of the Inventory, I
verify that the statements made in this Inventory are true and correct. I understand that false statements
herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to
authorities.
Name of Attorney: Francis A. Zulli, Esquire
ID.No.: PA 15316
Personal Representative:
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Mary L. D#s, Executrix
Address: 109 Locust Street
Harrisburg, PA 17101
Dated: /62)'/4/0)
/ /
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Telephone: 717-232-1488
Description
Value
Checking account #56572247 at M&T Bank
$10,423.56
Certificat~f DeposiL~031 003913919345 at M&T Bank
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Checking ~OUJ;1t ~3622- 70678 at Fulton Bank
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5,625.15
55,163.15
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1.'.1
o
Total
$72,211.86
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