HomeMy WebLinkAbout06-30-06
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128.0601
REV.1162 EX(11'96)
RECEIVED FROM:
PENNSYLV ANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WALLET DEBRA 1<
24 N 32ND ST
CAMP HILL, PA 17011
_____n_ fold
ESTATE INFORMATION: SSN: 404A2.3141
FILE NUMBER: 2106-0581
DECEDENT NAME: OSBORNE MARIE
DA TE OF PAYMENT: 06/30/2006
POSTMARK DATE: 06/30/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 04/03/2006
NO. CD 006908
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,000.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$3,000.00
REMARKS:
CHECK# 1255
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
(). I--() If ('S~ I
PHONE: (717) 737-1300
1:aw cDffiC!Ej. of
DEBRA K. WALLET
24 N. 32nd STREET
CAMP HILL, PA 17011-2917
Email: Walletdeb@aol.com
FAX: (717) 761-5319
June 30, 2006
(Hand Delivered)
Glenda F. Strasbaugh, Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
,
.--....
Re: Estate of Marie Osborne
75 Oliver Road, Enola, Pa.
Dear Ms. Strasbaugh:
C)
- )
G)
I have enclosed a check in the amount of $3,000.00 made payable to "Register of
Wills, Agent" representing an inheritance tax payment for Marie Osborne who died April 3,
2006. A copy of the death certificate is also enclosed. There will be no need to open an
Estate, but a tax return will be filed.
Should you need any additional information, please contact me.
Sincerely yours,
Jl~ ~.~
Debra K. Wallet
DKW/mml
Ene.
cc: Lucille Jones
,,;;'::: \\.I~\ ,h
This is '0 ccruty th;.!t the inform;.!tion here given is cOITectly copied from ;.!n origin;.!1 certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the St;.!te Vital Records Office for permatlCnt "filing,
WARNING: It is illegal to duplicate this copy by photostat or photograph.
"
,'"'
~
: c~ ' ,
, ......
11Ill~'~({\rotpl;;--____
111.~.l.." _ "4'--
III~' . "'_. ~""-
l<::::i ..... ",-, '. ~.",
~~l_~' , \?~
~c:::a c-- ~"' ~~
~w\ ,Yi1-' l~~
\~. ,.~., >1;/
""- ~"-: -- '. /~'" "
~ ':9',.()~~v "
"".,.---~IMENT \\'=< ~~'IIIIII
""....""'N;UIIIIJ/~l/tl
Fee for this certificate, S6,OO
- ~ I
Ci.' r-~
1(, ).C0(-
,
:"-ilL
Date
-/
'~---
it ,o~ l~J Rev 01,1)6
TYPElPAINTIN
PERP.lANENT
BLACK INK
1 Name 01 Q;;l?dtmllFlrst mI(jOI..!;;~lI
J]l_Pi R. \ E
~ A<je \lJ,,1 n,rthOdV!
'-+51<;
Ilb CuuntyolDealh
~Uf(\i?)E RL
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH STATE FILE NUMBER
o ReSiOence 0 OIher. Soec,r
10 Race Amencan Indl<ln, 8ldc~, \'Vh~e, elC
. (SpeCl!j1
o Yes liD. No
Decedenl's
Actual Aesldence 1701 Slate
SNOLf\
18 Fathel5NamaiFlr5l.madula, last)
W\ LU E
P Pt \ -=tOLS
e:o~E
17d 0
No. Dl!CedenllNed wflhlfl
AclualllffVls 01
C"",,'50ro
20a ~lormanl's Name IT IPlliponl)
N
Lu C\ L
~O~cS
a
w
V)
:::>
V)
<(
::;
<(
1~18118ms.2la_C ontt wtnancamlyno
.. pily~a;lan IS 001 available alllm8 01 dealh 10
.cenlfycause oldealh
. lIems 24.26 musl b8 convle1ed by person
_ who pl'ooounces ;]ealh
2~ Time alDealh
7.3,5
26 Was Cast! Rolalled 10 a MedlCa/ExalTWlef/Coro/1ar?
DYes f)Ato
'-
Ilem'l.7 Part I EnllH lhe ~ - dISeases. inlUrltlS, or corrVhcdll()ns -Ihaldil'aclly caus.xllha addlh DONOT enlel (ermlnal eVl!nlS such ilscard"lC arresl
tesp..-alory allasl. or 'tenlrculal ft,n!lallon wllhout ShoWf\\llhe ellOlogy DO NO T abbra...tate Enlel oMy ona cause on a me
n_ f t-!J?n--<'r-' ~
: ApprO~lfJ1ale Inlerval Pall II EnlerOlhel slOmficanlCondlllOns contflDullnato aealh,
: onsel 10 dealtl but not 18suNIfl\llfllha uooa'IyIf'lQ cause \lIVen III Pan I
30a 'HasanAul~sy
Per1olfTled?
32tl Desert/a how InlUry CccU/lad
2B Old Tobacco Use UlnlfltlulelO DeaU17
o Yes 0 Pfobaoly
)!J' Na 0 UnkOOwn
29 l!,?male
~ Nolpl~illllwql1l1lp.astYedl
o Pregnanl alllffi8 01 dealh
o Nol preonanl. bul pre~nl WI1hlfl 42 days
oldealh
o Nolplll\jllanl.butple\jtlilrU4JaayslO IYddr
belora dealh
o Unlnown ~ p'eQn.anl w~lIlIIlhe p.hl 'Iear
32c.P\aceallIlfUfYHomlI.Falm.$lIeelFaclory.OfIlca
BoIJM\), elc (Speaf)1
IMMEDIATE CAUSE (FIf\.lI dL5t1d58 or
corKllllOnresuh10lfldedlh) -? ..I
DUdlil (01 as a conSlI\luenco QI)
Sequenh.ally lISl coml~lOflS, ~ any,
le.adloQlo1h&causo~l8dollllflaa
.. Enllli ltle UNDERLYING CAUSE
(dlSea.s.tl or Ifllul)' ltIal ~l"'aled tha
e'ten15 lesulmlJ III de,tlh) LAST
Dua 10 (Of o1S a consaqu..nce all
Due 10 \lJf as a COflStIQuence ofl
o '(as rNO
d
JOb Were Aulopsy FindlOQS
AvaliaCle Priollo Wlfl)kihon
01 CdUSri01 DtMltl?
o 'l'es , ~jo
31 Manner a/Death
, Nalural 0 HOf/llCl1a
o AccJdent 0 PenUlnglnve.slllJdllan
o SUIl.:Jde 0 Co.lul(\ NoiSe Delermnad
J2a Dale 01 Inlury (Monlh, d<ly.yeal)
321 II TransporlallOn 11I1II1'f (Spect!j1
o OrNllflOperalOl 0 Passen\jel
o Padtslllan 0 Qller - Speoty
Db. SiljllaluraalldTilleolCartllMII
32l1loc.allOfl(Slleel.c.y,1Q""',5(,}lal
.J
'--.1
I
I
~I
i'E
5:]
~
a
o
,.u
:2
<(
z
32d. Time 01 Injury
JJ.1 Ceniher (CF\t!(~ onlyona)
Cer1ltyinc;l pnysici.ln lPtlv~r..:j.Jn ClllhfyK19 cause 01 dd..lln ...nen anolll!:l \]hYSlCtan IlJS j)IQlIOUr.ced dddlll dnd CiJfTVII;!It:'llllem ~3)
To lilt b;!sl 01 fJl'I' lr..tlQwledQe, "tOlIIl Q(curred due to the caus~sf.1nd ITl.U11lef .15 staled___mh____.
Pronouncing Olfll:l Cl!rtlt)lln'ij physlCl.1n lPh~sJCl.Jn Will prullOunClng d<ldlh all" C<lI1.tylf''J III cause ola<lalhl
To trM! best al mv knowledQe. de<llh occuned <lIthe tune. d<lle. <lnd pl.1ce. <lnd due to the c.1use(s) aoa Ill.lInner <IS sl~ted
MNIC.1le~..ffill\i!llColoroer
On lhe tuSIS of eumuullOn ../lIJ/or iqYl.'SIl'iJ<l.tl()ll, In my opinIOn. ae..lh Q(currl:(l allhe 111Tll!, d.;ite...flCl pl..ce...nd due 10 lhe c..use(sl..nd manner..s SLillcQ
,"~, S<,,,'",, ","0."<1 N""".~
~~<H"' l!,.-C1 )
'-
:/:r--
~ yL <;. 0::>
o
OS ooS-<r -)'J' C
)Jd Dale ::iq-lIxIIMoillh. aay yt:<lli
1~4-0c
JJc lJI.:en~NulTtJal
4~'. l c) 1 IhLLLuLJ
I J (See instructions and examples on reverse)
)4 NanlOl and Aldr&S.'> LlI PerS<J11 Who CGnopkilOO CallS\t ul Death (ll~m 27) IYPlllPT~lfIl
(;. ~ H G-- /-f-tL..~/ ?) "- ~
& '" '" ~~ ,< "'_____ ~-' ,'l.J
C-~f' t4.lL""-- """'" 1""")..)(,
J5