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HomeMy WebLinkAbout04-28-06 REV.1.')00 EX (6-001 *"' . COMMONWEALTH OF ~ A . " PENNSYLVANIA , ~ " '.' , DEPARTMENT OF REVENUE . " DEPT. 280601 .~ ,- ,"' HARRISBURG, PA 17128-0601 REV-1500 OFFICIAL USE ONLY FILE NUMBER 21 05 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W () W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) LAURA BEATRICE YOHE DATE OF DEATH (MM:DD-YEAR) 08/01/05 0979 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER I 178-50-4929 DATE OF BIRTH (MM-DD-YEAR) 10/10/58 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL) N/A w I- :.::5:cn uC:::':: w(LU ::1:00 uC::...J (Llll a. <{ ~ 1. Original Return [J 4. Limrted Estate [J 6. Decedent Died Testate (Attach copy or Will) [J g. Lrtigation Proceeds Received D 2. Supplemental Return o 4a. Future Interest Compromise (date" death after '2.'2-8~ D 7. Decedent Maintained a living Trust (Altach copy of Tru't) D 10. Spousal Poverty Credit (dale or death hetween 12.31.91 and '.'.95) o 3. Remainder Return (date of death prior to '2.13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach SchO) I- Z w c Z o a. rn w c:: c:: o u tl-lI$$/Et'l'IONMtJ$tt:l~qQMPy;'tl:b,Aijl;(';9RRl:$#ONP~NtgANo'CoNflP~NTmWtAXINfQRMA1t()N$f-<<)Ul;I)t:l~I)IR.#tt~[)'f()~ NAME COMPLETE MAILING ADDRESS KARL M. LEDEBOHM, ESQUIRE P.O. BOX 173 FIRM NAME (lfAp~icMlel NEW CUMBERLAND, PA 17070-0173 TELEPHONE NUMBER (717) 938-6929 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation. Partnership or Sole-Proprietorship z o ~ .....J ::> t:: a.. <( () W 0:: 4. Mortgages & Notes ReceIVable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total GrDss Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent. Mortgage Liabilrties. & Liens (Schedule I) 11. TDtal DeductiDns (total Lines g & 10) 12. Net Value Df Estate (Line 8 minus Line 11) (1) (2) (3) (4) (5) 39,247.50 0.00 ____________________________________________._______b......_.._____.._._....-..._.___ 0.00 0.00 0.00 . -()FFICIALI.i'$E ONL.Y' (6) ~-;.~.) C' ) (7) 0.00 (9) (10) (8) 13,889.03 0.00 39,247.50 (11) 13,889.03 (12) 25,358.47 (13) 0.00 (14) 25,358.47 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject tD Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES x .0 _..~ (15) z o i= ~ ::> a.. := o () ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line ~-' ~~xable at sibling rate 18. Amount of Line 14 taxable at cDllateral rate 19. Tax Due 20.D >'.>BESURETOANSWERAU:..QUES"".ONSONREVERsESfllEANORECHSCKMAfl-l.o;<.> ...-..-...-..'....,.,.,.-.---.-.-.....-..........-........,-.........-....-...-....,......-.......-...-.-.......-....,','.-.........._.__.'_._'..-.",'...'.'.._'...'..,.,',.,',.,.,.,..............'.'.'.'.','..'.'...','..,.,.............-.".-..,-..------""".,... m mm..?8,3~8A7 x .0 45 1,141.13 (16) .. m..m X .12 (17) nnn nnnnn X .15 (18) (19) mmm.____m__m..__................_____...__.........1_'-H:1:.nm____ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS 69 WEST MAIN STREET ----. P.O. BOX 69 CITY NEW KINGSTOWN -~-- I STATE I ZIP PA 17072 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 1,141.13 Total Credits (A + B + C ) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty 4. TotallnteresUPenalty ( D + E ) 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 (3) 0.00 5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) (5) 1,141.13 A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SA) (5B) 0.00 1,141.13 Make Check Payable to: REGISTER OF WILLS, AGENT 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; ................................................................................ 0 [i] b. retain the right to designate who shall use the property transferred or Its Income; ............................................ 0 [K] c. retain a reversionary interest; or....................................................... ................. ................................................ 0 [K] d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [K] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D [i] 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 [K] 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 pe~ury. I declare that I have examined this return, induding accompanying schedules and statements, and to tl)e best of my knowledge and belief, It is true, correct and complete. Dedaration of pre parer other than the personal representative is based on all Information of which pre parer has any knowledge SIGNATURE OF PERSON RESPONS!BL~ FO~FILlNG RETURN ~~ If: &-IlL ADDRESS ~----_.. 69 WEST MAIN STREET,' P,O. BOX 69, NEW KINGSTOWN, PA 17072 SIG.N........ OF.....\\REVfiH.E~T.'.R. Pf1SENTATivE' ~ -", ,-,'.: ~- ""--- DATE 1/-:_ ,;Z Ie -- .;< (j [5 tP DATE '1- 2. '-f-c) 6 17070-0173 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 P.S. 99116 (a) (1.1) (i)]. ' 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. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer,to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing 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 parenl, an adoptive parent. or a stepparent of the child is 0% [72 P.S. 99116(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. 99116(1.2) [72 P.S. 99116(a)(1)]. 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. 99116(a)(13)]. 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. ~EV-1502 EX+ (6-9B) ~. '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE FILE NUMBER 21-05-0979 ESTATE OF LAURA BEATRICE YOHE All real property owned solely or as a tenant in common must 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, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. 1. DESCRIPTION APPROXIMATELY TWENTY-ONE ACRES SITUATE IN SILVER SPRING TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA, KNOWN AS PARCEL #38-06-00009-010, BEING UNIMPROVED LAND. ASSESSED VALUE AS OF THE DATE OF DEATH IS $156,99000 FOR THE PROPERTY. DECEDENT OWNED A 1/4 UNDIVIDED INTEREST ALONG WITH CHARLES W. YOHE, JR., LINDA K. KING AND EDGAR G. YOHE. A COPY OF THE LEGAL DESCRIPTION FOR THE PROPERTY IS ATTACHED HERETO AS EXHIBIT 'A' AND MADE PART HEREOF. VALUE AT DATE OF DEATH 39247.50 ITEM NUMBER TOTAL (Also enter on line 1, Recapitulation) $ 39,247.50 (If more space is needed, insert additional sheets of the same size) KI::V-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF LAURA BEATRICE YOHE FILE NUMBER 21-05-0979 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship mu-;t be disclosed on Schedule F ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH NONE TOTAL (Also. enter on line 5, Recapitulation) $ 0.00 (If more space is needed, Insert additional sheets of the same size) REV-1509 EX+ (6-98)~",cQ. ~- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF LAURA BEATRICE YOHE FILE NUMBER 21-05-0979 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A NONE B. c JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUM3ER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD_~~,~_~_~!'.!ATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A NONE TOTAL (Also enter on line 6, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) ~EV-1510 EX+ (6-98) \' W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-05-0979 ESTATE OF LAURA SEA TRICE YOHE This schedule 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 INCLUDE THE NAME of THE TIWlSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATIACH A copy OF THE DEED FOR REAl ESTATE VALUE OF ASSET INTEREST I'F APPlICABLEI VALUE 1 NONE TOTAL (Also enter on Ime 7 Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF LAURA BEATRICE YOHE FILE NUMBER 21-05-0979 ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1. MYERS FUNERAL HOME 8023.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions '~:Jme of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _Zip Year(s) Commission Paid: 2. Attorney Fees 2,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's. attach explanation) 3,500.00 Claimant ANNA E. YOHE Street Address 69 WEST MAIN STREET, P.O. BOX 69 City NEW KINGSTOWN State ~ Zip 17072 Relationship of Claimant to Decedent MOTHER 4. Probate Fees 154.00 5. Accountant's Fees 6. Tax Return Pre parer's Fees 7. ADVERTISE ESTATE TO PATRIOT NEWS 137.03 8. ADVERTISE ESTATE TO CUMBERLAND LAW JOURNAL 75.00 TOTAL (Also enter on line 9, Recapitulation) $ 13,889.03 Debts of decedent must be reported on Schedule 1. (If more space is needed. insert additional sheets of the same size) ,V-1512 EX. (6-98) '*' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVP.NIP. INHERITP.NCE TAX RETURN RESIDENT DECEDENT STATE OF AURA BEATRICE YOHE FILE NUMBER 21-05-0979 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH NONE TOTAL (Also enter on line 10, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) :EV-1513 EX+ (9-DO) ~.,~~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES :STATE OF .AURA BEATRICE YOHE FILE NUMBER 21-05-0979 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(sl OF ESTATE [ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2}) 1. ANNA E. YOHE MOTHER 100% 69 WEST MAIN STREET, P.O. BOX 69 NEW KINGSTOWN. PA 17072 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more soace is needed. insert additional sheets of the same size) i j '1 1 '\ ..: .., '. J ,-- , J . \> I { ; .r v I t t\.i 0' ~ -, ,-y "-U ~ f ~ ~ ~ <V ""J ~> C M J t'l). t '.) D i' , HI ."" ~.' I, . 10,. . If' II RII 18TATS 01' LUTU A. YOH.!:, .. LATS OF THe TOW)lOIP OF MOIIROJ/:, 11 COUNTY 01-' QUMSl!3'It.ANI> UP S'l'ATS or .. PENJlaYLVUIA. I>EOU~EI>. I. .. IN 'HE OOUR't UP COKMOI JlLIAI 0' CtIMBlRUNP oouln. lJUlJIaltl.VAIXA ORPHANS' COURT DIVI8tOI. NO. 21 · 14 · 111 AD~Pt(l~TIO!i MID'l)EC'fIE'e AWA.RDING J\pL,!8TAH AKD MOll. tb.!.(M 4&7 or R~v ' ' '. 1"$, ~, 0' aloole. H.. .ea.,.... O&,U:,bt S&Y11l& 'fl_. no obj.lttona haylnR bten tl1e4to the '1.., and Pinal "OOUbt aD6 at"'~nt ot Propo..4 Otltribu~lon or An~Kae Yobe. S.eout.lX or the Lut V111 and'r..hllllU\\ ot Lute. A. Yob.. !tea....... yUbl" W UN fix.d 'by tbo Rul.. ot 001U't, ui4 AOOOU1'lt la hlt'eb, oollt1rM4 ab.olut.17 and the Sohedule or Pro~'e4 Dlltplbutlon 11 bet'e'bJ .ppro9.4 anA Dl.'rlbutton t. awarded in aoeordMno. t~r.wl'b. IT IS ruRTHSa ADJUDGEDAKD DECREED. tbat 11l ..oordan.. wltb .-. ..i4 tlnal Aooount and St...ment ot propo..4 Dl.t~lbU'lon .. ..ftt~ b7 ttw OWl", t;ba' t;bII Dlatl'lbuUon ot' th_ toll.ovlnS hal .a.at. of th.d...4'nt '0 CHARLE8 W. YOKE, JR., LINDA K. YOBB, lWOAR O. YOU , ' / and LAtmA a.. 'talUS, abare an4.hare alUc.\!. '.nant. in OOllllllOII. it M'l'Ibl oonfll"M4 an4 tha .... II hereb,. a"aJ"<11d to. thl .dd OHAftLU v. Yon,n., LINDAX. YOKE, EDGAR O.YOHI and t..\tIRA 8. YOKE. a d..orip'lon ot wblah 1. al tollow., to "It' ALL 'l'HK UlIDIVIPKtl I'lv.:ht. tl tie anll lnt....ttI wbat.on.r or the <<...4.nt. ln a!14 to tho.. tvo (2) adJaoent ton (1,0) aon traot"ot woodland. .1tuat. in the Town.hip ot 811,.r aprlDe. Count,ot cumberland and 8t.,. ot P.nn'J1vant.. 'bound.. &n4 dnorllMd .. tollow', to v1tt '. '. 'rRAC'r 110. 1. .. liEG!1U{tlfO at . point on tn. ConocloplM' CH, .Ie. IUId lan4foJ'NJ"l,. ot Chl'llthn Jtaurr.n. now or ~'o at tM hank .K. Stolle. helr., thence '}los-tll 69 4lt8"" 10""1 18 1'''.'' to .. po.t. thence SQUtb 10")/4 d.egr... Jl:..t. along undo now or late ot Jo..pb Ebel'll! 77.2 parollel to .. Red O.k, th.no. " 8out~27 dogr... JJ:.... ia.' p41rQhea,o .. atoM, tben_ Sou'b . 13~)/4 d.~.. w..t. 22.' perone. to the Conodosulnet C...., : :, ,'thano. along .ald Cl'.ele" llortb. l~ c1I1P..' ....". 34.0 perabea ~ .. to a. pOln'. theno.Nortn 12~ degree. W.." 32.0 p.robtl \0 . po,tntl theM. ~C)..th 12")14 degre.. Welt, 26.0 peroh.. to . AolntJ tneno. North 2) d.egr... We.t. 5.0 perOh.. to 'he pboll of 8l:.'Q~NNINQ.~Qll1'A:UllllO 1.0 '0):'0' and 4.6 P'l'obe.. 1Il0l"tl..-'Op.. H...... It. ., . . .....~...> ~~..~,t t 14 .". I l . I i' J' ,~ J I , J I j: " " : IOOiZJ26 'ACE 13 -1- ld W~!S:60 S00G !0 '^ON ,.....;""" i ,- "j( t-,:~~,., I) f: !996SvcL!L: 'ON X~d stlUlOM: j,.()~.:l 1OJ!02ht 14. .1 '" ,-,~._._.,',..........._.._-~~ .. t<UI'l : WUL;- r RS FAX NO. :7172459661 Nov. 1211 2'<M':> \il'::j:::'lHI'1 ...'" '" . \~";-:--::'" , .~"."'-'.'.,- - ...--.-,----............:......".'.. '~- ^.,- . ~:~... ...., r I, I TRAe! we. 2 . BEOtJNIJO ., . polnt on the a..t Ban~ of ~ Conodogut.n.t Or.ele, at oorn.. ot land to~..17 ot '..ank L. atok.., now T.aot No. 1 he...thabove de.orl~od, thine. up tlM bank 01' .at4 Cr.ek, t.be following OOUl'.o. e.n4 dl.tano... to vltls No~tb 23\ de~ee. W.at, 2$.0 perohelJ KOI'~h )" <<.~.. "..t, 30,0 peron-a, and llorth So..)/4 4egre.. W.at, 20.0 perohel to .. potnt) tbeno. by land. tormerl;r of Oh:t'l.Uu Rupj), now or tOJ'1llel'11 of tbe MUton C. I>1.n Mi.r., KOl"tb ~6 It 4.pe.. Bu" 20.S peroM' to . Whit. OeJc 6twa.p1 tMn_ 'bJ land of tl>> aa"., Soutb ,oa. d.g..... ia.t. 19.2 perobe. ,. . *OM' and thenOt! South 36-'14 4egren Ka", 29.2 peNh.. .. . .flone a1l oorner or land. hCN oS' tomer'll of )bo.. Ol,'er" BeU'., 'heM' -.,..1\\ llndo, 201s1 de~..' a..." 23.7,ol'Obll. t. .. pine ,..... an4 'bltno. South 10-3/4 d.&l"" Bad. 10.8 "l'Obe' '- .. poat.. OOI'Mr' or land fOrMl'1, ot hank L. 1\0'-.. now TJo..tlo. 1 be"1asabqve d..\l.iMcll 'beDO' _, 1&16 1-' aw'b " lSepM' W.... 18.0 pel'Clwtl to 'bII pla.. of UODJaIO. OOJl'l'AIlIIO 10 "'HO all4 ~6 peI'O"'I. ' ~ .A- I, tal. GO\1J". " ~1 ,~ ']. ~~d-:r. 1) , '.. J ..~.. ...t4. . , " '. 5" 1 ~~.. ~ ,.r'..Jtt'.. ...~ lilt .. ~ ...... ..... "" .,It ~ ....."'~ ~ w "'_'" ~ ,.q t~:r,.,),a'l A-\-W~).,"'.-'CS !'.~ .... ....... .... ~..'- ~ ~ " , ~~~ '" ':, $~'~d~ ,.tl~ \ '~J'" ,!It'f.~': J.$i'."i '.'L~ mi 'I, "- ~ ( , '!'~ I " !II -, ~ A TRUE cqi~'4R&~~!RE~oftO;:; In T'ltl~\1Ihel'eOtl:\ ~IoMt"'Y IIIncI lIIICl '" ..... Wd ~ ~t CMI4III, ",. , :AlIt. .;.~ Ll-' '~' . ' , "i'f:~;'1l , . ,.,. . . .ic.-...l~tf,~~ ( , ~,... "'"'U' ~~. , ~ "~A;.:~.: ~ic'.\f'~:I,. , ('\ h.:\..... tfi':""'" CbWt.......t. 'UtI \ .' , Ilf,CNIlIl -..... . ...., ..., .. 1M ....... .. ... ... tI ...... c....... ~~=~'.{~h~ . , .~'. ...N',1J' , , ' " " ""*'J" -a. I , l! i \ j r \ l ; i : - ~. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 REV-1162 EX(11-96) PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RECEIVED FROM: YOHE ANNA E PO BOX 68 69 W MAIN ST NEW KINGSTOWN, PA 17072 ------- fold ESTATE INFORMATION: SSN: 178-50-4929 FILE NUMBER: 2105-0979 DECEDENT NAME: YOHE LAURA BEATRICE DATE OF PAYMENT: 04/28/2006 POSTMARK DATE: 0010010000 COUNTY: CUMBERLAND DATE OF DEATH: 08/01/2005 NO. CD 006623 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,141.13 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: ANNA E YOHE CHECK# 2646 SEAL INITIALS: GFS RECEIVED BY: REGISTER OF WILLS $1,141.13 GLENDA FARNER STRASBAUGH REGISTER OF WILLS