HomeMy WebLinkAbout07-13-06
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
Estate of Lena M. Bender, Deceased
21-0u-lo''B'
PETITION UNDER SECTION 3102 OF THE
PROBATE. ESTATES AND FIDUCIARIES CODE
FOR SETTLEMENT OF SMALL ESTATE
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TO THE HONORABLE JUDGES OF SAID COURT:
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SUSAN K. GRIBBLE, your petitioner, files this, her Petition for Settlement of a Small
Estate, under the provisions of Section 3102 of the Probate, Estates and Fiduciaries Code and in
support thereof avers that:
1. Your petitioner, Susan K. Gribble, is a competent adult residing at 5287 East Trindle
Road, Mechanicsburg, Cumberland County, Pennsylvania, and is the daughter of the
above decedent.
2. Lena M. Bender, widowed, died on May 11, 2006, a resident of Cumberland County,
Commonwealth of Pennsylvania. A death certificate is attached hereto.
3. Lena M. Bender is the owner of Circle Money Market Account 620647-205-5 at Citizens
Bank with a date of death value of $5,641.08.
4. The gross value of decedent's Estate does not exceed Twenty-five Thousand Dollars
($25,000).
5. The Pennsylvania Transfer Inheritance Tax Return reporting said Circle Money Market
Account 620647-205-5 at Citizens Bank has been filed with the Register of Wills, and
petitioner has paid the inheritance tax shown to be due; the Inheritance Tax Return and
the tax receipt are attached hereto.
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6. There are no unpaid claimants of whom petitioner has notice or knowledge.
7. The heirs and next of kin and their relationship to the decedent are as follows:
Name
Patricia A Fickett
Susan K Gribble
Charles L Bender Jr
Date of Birth
3/11/1947
11/13/1951
10/19/1962
Relationship to Decedent
Daughter
Daughter
Son
WHEREFORE, your petitioner prays that an order be made authorizing liquidation and
distribution of the Circle Money Market Account 620647-205-5 at Citizens Bank to Patricia A.
Fickett, Susan K. Gribble and Charles L. Bender, Jr. in equal amounts pursuant to Section 3102
of the Probate, Estates and Fiduciaries Code.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 10th day of July,
2006.
, J}II-1Jd-O, 'r ,/ ~cuJ;-
WItness ~
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S AN K. GRIBB
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF DAUPHIN
SUSAN K. GRIBBLE, being duly sworn according to law, deposes and says that the
facts contained in the foregoing Petition are true and correct to the best of her knowledge,
information and belief.
Sworn to and subscribed before me this 10th day of July, 2006.
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Notary Public
NOTARiAl SEAl
PAULA It WHITE, NOTARY PUBLIC
lOWER PAXTON TWP., DAUPHIN COUNlY
MY COMMISSION EXPIRES APRIL 5. 2001
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
Estate of Lena M. Bender, Deceased
DECREE
AND NOW, this
day of
, 2006, upon consideration
of the annexed petition, the Circle Money Market Account 620647-205-5 at Citizens Bank and
titled to Lena M. Bender who died on May 11, 2006, is awarded under the provisions of
Section 3102 of the Probate, Estates and Fiduciaries Code as follows:
One-third thereof, to Patricia A. Fickett, daughter
One-third thereof to Susan K. Gribble, daughter
One-third thereof to Charles L. Bender, Jr., son
AND the said Susan K. Gribble is authorized to execute the necessary paperwork
therefore on behalf of the estate.
BY THE COURT,
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This is to certify that the information here given is cOlTectly copied from an original certificate of death d~ly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. .
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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Local
Fee for this certificate. $6.00
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12593789
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
STATtO filE NUMBER
TYPE/PRINT
IN
PERMANENT
BLACK INK
SEX
SOCIAL SECURITY NUMBER
5.
COUNTY OF DEATH
78 y"
2. F 3. 20 2
BIRTHPLACE (City and PLACE F ATH Ch k nl on
Stale Of Foreign Country) HOSPITAl'
Worml ey.sburg ~;"""10
20
1
AGE (last Birthday)
stru Ii n
8b Cumberl and
DECEDENT'S USUAl. OCCUPATION
(~v:;~~n:"'h.~~,;:~"u~~nr~~'Ir;gl"
Homemaker
~:~~) 0
RACE - American IndNin, Black, While, et
(Specify)
White
SURVIVING SPOUSE
(lfwl/l,glvlmJlldlnna.ml)
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5287 East Trindle Road
l~echanicsbur PA 17050
FATHER'S NAME (Filst. Middle, last)
a Frank N. Rhoads
INfORMANT'S NAME (TypefPrint)
20. Susan K. Gribble
METHOD OF DISPOSITION
BUllal IX] Cremalion ~cmovi;lIlrom State 0
Other ( city)
OF FUNE SERVI
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17b. Counlv
Cumberland
17d. 0 ~~hi~e~~~~~~i~i~ of
city/bora
MOTHER'S NAME (First, Middle, Maiden Surname)
,. Ann i t
INFORMANTS MAILING ADDRESS (Street, CityJTown, State. Zip Code)
20b5287 East Trindle Road Mechanicsbur
PLACE OF DISPOSITION- Name 01 Cemetery, Crematory
Of Other Place
28.
: Approximate
. interval between
: onset and death
l :
OUi: 10 (OR AS A CONStOOUENCE OF)
WERE AUTOPSY FINDINGS
AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
MANNER OF DEATH
DATE OF INJURY
{Monlh.Da~. Year)
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED
Ye~ 0 No 12!l
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NoD
Suil.;ide
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Homicide
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30a 30b. M 30c.
o PLACE OF INJURY - At home, farm. street. tactory, office
bu,lding.8lc (Speclfr')
30e.
3'.
Natural
Acddent
Pending Investigation
Could not be determined
2811 28b
CERTIFIER (Check only one)
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20.
'PRONOUNCING AND CERTIFYING PHYSICIAN (phYSician both ~onOtJncing death and certifying to cause at death)
To the beal ot my knowledge, death occurred at the time. date, and piau, and due to the <;aua..(.) and manner... .taled....
'MEDICAL EXAMINER/CORONER
On the b,ilSl. 01 ....mln..Uoo andJor lov..tlgatlon, in my opinion, de..th occurred at the time, date. ..nd place, and due to the cau.e.(a) and
manner .e etaled,.
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. REGIS
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Jl5056041125
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OFFICIAL USE ONLY
County Code Year
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REV-1500 EX (06-05)
PA Department of Revenue '*
~~e:~~~~3~~~uaITaxes . INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
File Number
Date of Birth
202200461
o 5 1 120 0 6
10191927
Decedent's Last Name
Suffix
Decedent's First Name
BENDER
LEN A
MI
M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
00 1. Original Retum
o 4. Limited Estate
o
o
2. Supplemental Return
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Retum Required
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
o
o
o
8. Total Number of Safe Deposit Boxes
JANLBROWN
71754 1 555 0
Firm Name (If Applicable)
REGISTER OF WILLS USE>ONL Y
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J A N L B ROW N ASS 0 C
First line of address
845 SIR THO MAS C T S TEl 2
Second line of address
City or Post Office
State ZIP Code
DA TEtFILED
H A R R I S BUR G
PA 17109
en
en
Correspondent's e-mail address:BRENDAJLB@2VERIZON.NET
Under pe
it is true,
SIGNAT
MECHANICSBURG
PA 17050
DATE
7/10/2006
PA 17109
REPRESENTATIVE
ADD
845 SIR THOMAS CT STE 12 HARRISBURG
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056041125
15056041125
---1
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15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: LENA M. BEN DER
RECAPITULATION
202200461
1. Real estate (Schedule A)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B)
.................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) ....................... . 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. 7 6 9 7 8 3
...... .
6. Jointly Owned Property (Schedule F) D Separate Billing Requested . . . . . . . 6. 3 5 3 4 6 9 5
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D Separate Billing Requested . . . . . . . 7.
9. Funeral Expenses & Administrative Costs (Schedule H)
................ 9.
4304478
154500
8. Total Gross Assets (total Lines 1-7)
........................... 8.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
. . . . . . . . . . . . 10.
2 9 8 6
11. Total Deductions (total Lines 9 & 10)
. . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
157486
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13.
4146992
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . 14. 4 1 4 6 9 9 2
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2)X.O _ 0 0 0 15. 0 0 0
16. Amount of Line 14 taxable
at lineal rate X .O~ 4 1 4 6 9 9 2 16. 1 8 6 6 1 5
17. Amount of Line 14 taxable 0 0 0
at sibling rate X .12 17. 0 0 0
18. Amount of Line 14 taxable 0 0 0 0 0 0
at collateral rate X .15 18.
19. Tax Due ........... . ... . . ... ................. ... ..... ...19. 1 8 6 6 1 5
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
o
Side 2
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15056042126
15056042126
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REV-1500 EX Page 3
Decec;lent's ~omplete Address:
DECEDENT'S NAME
LENA M. BENDER
STREET ADDRESS
5287 E Trindle Rd
File Number
Ham den Townshi
CITY
Mechanicsburg
I STATE
PA
ZIP
17050
Tax Payments and Credits:
1. Tax Due (Page 2 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
1,866.15
93.31
Total Credits (A + B + C) (2)
93.31
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
0.00
0.00
1,772.84
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
A. Enter the interest on the tax due.
1,772.84
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 00
b. retain the right to designate who shall use the property transferred or its income; ............................... 0 00
c. retain a reversionary interest; or ................................................................................................ 0 00
d. receive the promise for life of either payments. benefits or care? ....................................................... 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... 0 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. 0 00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 three (3) percent [72 P.S. ~9116 (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 zero (0) percent
[72 P.S. ~9116 (a) (1.1) (iill. 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 retum 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 parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. S9116{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 four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 P.S. ~9116{a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116{a){1.3)]. 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.
RE'J-1508 EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHED'ULE "E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
LENA M. BENDER
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Citizens Bank; Account 620647-205-5
VALUE AT DATE
OF DEATH
5,641.08
2
Country Meadows Associates; resident refund (Lena Bender)
Check payable to Susan Gribble
2,056.75
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
7697.83
REV-1509 EX + (6-98)
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SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LENA M. BENDER
FILE NUMBER
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. Susan K Gribble
5287 E Trindle Rd
Mechanicsburg PA 17050
daughter
B
c
JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL EST ATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 3/15/04 Prudential Financial Mutual Funds; Account 02808377190 33,211.44 50. 16,605.72
Dryden High Yield Fd CI A (PBHAX); 5826.568 shs @ $5.70/sh
2 A 2004 Citizens Bank; Checking Account 610070-124-7 1,380.07 50. 690.04
3 A 2004 Citizens Bank; Money Market Account 620326-702-7 15,514.02 50. 7,757.01
4 A 2004 Citizens Bank; CD 6247-351505 20,588.36 50. 10,294.18
TOTAL (Also enter on line 6, Recapitulation) $ 35346.95
..
(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
ESTATE OF
LENA M. BENDER
SCHEDULE'H
FUNERAL EXPENSES &
ADMINISTRA rIVE COSTS
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) ,
Social Security Number(s}JEIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attomey Fees Jan L Brown & Associates 1.500.00
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountanfs Fees
6, Tax Retum Prepare(s Fees
7. Register of Wills, Cumberland County. filing fee Inheritance Tax Return 15.00
8 Register of Wills, Cumberland County, filing fee Petition Small Estate 30.00
TOTAL (Also enter on line 9, Recapitulation) $ 1,545.00
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-O3}
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LENA M. BENDER
FilE NUMBER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Mobile X-Ray Imaging
29.86
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
29.86
ReV."" ": '.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LENA M. BENDER
SCHEDULE'J
BENEFICIARIES
FILE NUMBER
NUMBER
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS Dnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)J
Susan K Gribble, daughter
5287 E Trindle Rd, Mechanicsburg, PA 17055
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
1.
Lineal
Sch E and Sch F
2
Charles L Bender Jr, son
1414 Zimmerman Rd, Carlisle, PA 17013
Lineal
Sch E
3
Patricia A Fickett, daughter
1416 Kuhn Dr, Boiling Springs, PA 17007
Lineal
Sch E
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 n - 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
DEPAF\TMENT OF REVENUE
BUREAU OF INDIv"IDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 006955
BROWN JAN L
845 SIR THOMAS CT SUITE 12
HARRISBURG, PA 17109
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold ---------- --------
101 I $1,772.84
ESTATE INFORMATION: SSN: 202-20-0461 I
FILE NUMBER: 2106-0618 I
DECEDENT NAME: BENDER LENA M I
DA TE OF PAYMENT: 07/11/2006 I
POSTMARK DATE: 07/10/2006 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 05/11/2006 I
I
TOTAL AMOUNT PAID: $1,772.84
REMARKS:
CHECK# 319
INITIALS: AJW
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER