HomeMy WebLinkAbout12-27-06
....J
15056041147
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes ~
PO BOX.280601 ~
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
Year
File Number
" \ S \
County Code
INHERITANCE TAX RETURN 21
RESIDENT DECEDENT
t;~
Date of Birth
07051911
10072006
Decedent's Last Name
Suffix
Decedent's First Name
ATHA
DAYTON
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return
,---
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4. Limited Estate 4a. Future Interest Compromise
(date of death after 12-12-82)
X 6. Decedent Died Testate 7. Decedent Maintained a Living Trust
(Attach Copy of Will) (Attach Copy of Trust)
9 litigation Proceeds Received 10 Spousal Poverty Credit (date of dealh
. between 12-31-91 and 1-1-95)
o
B. Total Number of Safe Deposit Boxes
11.Election to tax under Sec. 9113(A)
(Attach Sch. 0)
MI
M
MI
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
HILLARY A. DEAN 7172433341
Firm Name (If Applicable)
MARTSON DEARDORFF WILLIAMS &
OTTO
First line of address
REGISTER OF WILLS USE ONLY
C)
10 EAST HIGH STREET
Second line of address
City or Post Office
CARLISLE
,..-.....,
) -"J
l>A-t~ ?ILED 3.:
:':1 c.)
State
PA
ZIP Code
17013
",-.
c::;:..
f'.",
-.J
f'V
\.D
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
Kenwood P. Dayton II
ADDRESS
53097
DATE
Hillary A. Dean
10 East High Street, Carlisle, PA 17013
Side 1
L
15056041147
15056041147
....J
\
<'2\rv
-.J
15056041147
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes ~
PO BOX.280601 '~
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN 21
RESIDENT DECEDENT
File Number
Date of Birth
10072006
07051911
Decedent's Last Name
Suffix
Decedent's First Name
ATHA
MI
M
DAYTON
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's First Name
MI
Spouse's Sodal Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WillS
FILL IN APPROPRIATE OVALS BELOW
X 1. Original Return
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4. Limitl3d Estate
4a. Future Interest Compromise
(date of death after 12-12-82)
X
6. Decedent Died Testate
(Attach Copy of Will)
7 Decedent Maintained a Living Trust
. (Allach Copy of Trust)
o
8. Total Number of Safe Deposit Boxes
9. Litigation Proceeds Received
10 Spousal Poverty Credit (date of death
. between 12-31-91 and 1-1-95)
11. Election to tax under Sec 9113(A)
(Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
HILLARY A. DEAN 7172433341
Firm Name (If Applicable)
MARTSON DEARDORFF WILLIAMS &
OTTO
First line of address
REGISTER OF WILLS USE ONLY
10 EAST HIGH STREET
Second line of address
City or Post Office
CARLISLE
DATE FILED
State
PA
ZIP Code
17013
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
,t 's true, corre . and com tete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge
SIGNATUR 0 E, PO IBL~R FILING RETURN DATE
Kenwood P. Dayton" ) 2- 2 (- 2.006
9914 W. Huntington Drive, Mequon, WI 53097
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
Hillary A. Dean
ADDRESS
10 East High Street, Carlisle, PA 17013
Side 1
L
15056041147
15056041147
-.J
--.J
15056042148
REV.1500 EX
Decedent's Social Security Number
Decedent's Name:
ATHA MAE
DAYTON
RECAPITULATION
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. Mort9ages & Notes Receivable (Schedule D)........................................................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................ 5.
4,905.80
15,083.91
6. Jointly Owned Property (Schedule F) Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) i Separate Billing Requested............. 7.
19,989.71
12,211.19
4,423.21
16,634.40
3,355.31
8. Total Gross Assets (total Lines 1-7).................................................................. 8.
9. Funeral Expenses & Administrative Costs (Schedule H)...................................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)................................ 10.
11. Total Deductions (total Lines 9 & 10)................................................................. 11.
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.
14. Net Value Subject to Tax (Line 12 minus Line B).............................................. 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
3 , 355 .31
o .00
15. o .00
16. 150.99
17. 0.00
18. o .00
19. 150.99
3,355.31
o .00
0.00
19. Tax Due........................................................... ....................................................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
D
Side 2
L
15056042148
15056042148
--.J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Atha Mae DAYTON
-- - --------------------------------..----
STREET ADDRESS
4837 East Trindle Road
File Number 21 --
CITY
STATE
ZIP
Mechanicsburg
PA
17050
Tax Payments and Credits:
1. Tax Due (Pag,e 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
150.99
7.55
3. Interest/Penally if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
7.55
Total Interest/Penalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE
(3)
(4)
(5) 143.44
(5A)
(5B) 143.44
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;............................................................................. x
b. retain the right to designate who shall use the property transferred or its income;................................ x
c. retain a reversionary interest; or..............................._............................n............................n................ X
d. receive the promise for life of either payments, benefits or care?........................................................... x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?... .................. ....... ............................... n.......................... ..n..................... x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?............................ .n............................ n............................._.................... x
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. 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 zero
(0) percent [72 P.S. 99116 (a) (1.1) (iill. The statutedoes not exemota 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 parent, an adoptive parent, or a stepparent of the child is zero (0) percent [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 four and one-half (4.5) percent,
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 twelve (12) percent [72 P .S. 99116 (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.
Rev-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DAYTON, Atha Mae
FILE NUMBER
21--
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1 F&M Trust, CD 015-2955812
2.005.80
2 Country Meadows, reimbursement of nursing home fees paid
2.900.00
TOTAL (Also enter on Line 5, Recapitulation)
4.905.80
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rev-1509 EX+ (6-98) ..
COMMONWEALTH OF PENNSYLVANIA
INHER.lTANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
E5TATE OF
IFILE NUMBER
DAYTON, Atha Mae .. 21--
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
A. Lethi L. Dayton-Rivers
ADDRESS
RELATIONSHIP TO DECEDENT
47 Tuscany Court
Camp Hill, PA 17011
Daughter-in-Law
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DESCRIPTION OF PROPERTY %OF DATE OF DEATH
DATE
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 03/2005 Member's 1 st checking 511-266555 23.483.24 50.000% 11.741.62
2 A 03/2005 Member's 1 st savings, 500-266555 763.49 50.000% 381.75
3 A 03/2005 Member's 1 st Money Management, 5.921.07 50.000% 2.960.54
505-266555
TOTAL (Also enter on Line 6, Recapitulation) 15.083.91
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
REV-1151 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DAYTON, Atha Mae
FILE NUMBER
21--
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 10,996.19
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Martson Deardorff Williams & Otto 1,200.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 15.00
TOTAL (Also enter on line 9, Recapitulation) 12,211.19
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev.1502 EX+ (6.98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DAYTON, Atha Mae
FILE NUMBER
21--
ESTATE OF
ITEM
NUMBER DESCRIPTION
1 Fogelsanger-Bricker Funeral Home, Shippensburg, PA
AMOUNT
8,139.12
2 Funeral Reception - Lighthouse Restaurant, Chambersburg, PA
285.00
3 Cemetery Fees - Amberson Cemetery, Shippensburg, PA
300.00
4
Funeral expense - Travel Expenses for family from Wisconsin and Arizona to plan
and attend funeral
1,739.74
5
Lethi L. Dayton-Rivers, reimbursement for funeral reception expenses
532.33
Subtotal
10.996.19
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1512 EX+ (6-98)
,~
~
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DAYTON, Atha Mae
FILE NUMBER
21--
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Ambulance and paramedic fees - West Shore EMS
VALUE AT DATE
OF DEATH
988.96
2 Manor Care, account payable
12.00
3 Debt - Verizon, account payable
129.00
4 Outstanding check - Members 1 st checking 511-266555 on date of death
3.293.25
TOTAL (Also enter on Line 10, Recapitulation)
4,423.21
(If more space is needed. additional pages of the same size)
Copyright (c) 200:2 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV.1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
1
DAYTON, Atha Mae
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
Clistributions, and transfers
under Sec. 9116(a)(1.2)]
Lethi L. Dayton-Rivers
47 Tuscany Court
Camp Hill, PA 17011
FILE NUMBER
21--
NUMBER
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
Daughter-in-law
3,355.31
2 See attached explanation
Total 3,355.31
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
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleJ (Rev. 6-98)
F:\FILESIDA TAFILEIEST A TES\12206.I.sch.j
Estate of Dayton, Atha Mae
File No. 21-06-
Schedule J Explanation:
Pursuant to 72 P.S. S9126, the transferee ofthe joint accounts listed on Schedule F herein shall
be allowed deductions to the extent that said transferee has actually paid the deductible items due
to the fact that the estate subject to administration is insufficient to pay the deductible items.
Such transferee of the accounts listed on Schedule F has paid or will pay all deductions in excess
of the asset listed on Schedule E herein.
I
I
II
II
I
q
II
I,
'I
II
I
I-'ENCH A:-.D CRESSLER I
ATTORNEYS AT LAW I
I
I
I
224 MARKET ST.
NEWPORT. PA 17074
TEL: (717) 567-3139
FAX: (7'7) 567-3130
1 . d
~
-~
-- l
~,'\
-..' ~
1L~~,(!; W3fi.1L ~Jlm 'CltQE~W~;Wl<<jl~
;1
~
"\:::,1
I, ATHA M. DAYTON, of Newville Borough, Cumberland
County, Pennsylvania, being of sound mind, memory and
understanding, do hereby make, publish and declare this to
be my Last Will and Testament, hereby revoking any and all
Wills by me heretofore made.
FIRST: I direct payment of the expenses of my
last illness, funeral and burial costs from my residuary
Estate, as an expense of my Estate, as soon after my death
as conveniently may be done. All Federal, State and other
death taxes payable because of my death, with respect to the
property forming my gross Estate for tax purposes, whether
or not passing under this Will, including any interest or
penalty imposed in connection with such tax, shall be
considered a part of the administration of my Estate and
shall be paid from my residuary Estate without apportionment
or right to reimbursement.
SECOND: All the rest, residue and remainder of
my estate, whether real, personal or mixed, of which I shall
die seized and possessed, and to which I may be entitled at
the time of my decease, and wheresoever the same may be
situate, I give, devise and bequeath in three equal shares
unto my three grandchildren, Tressia M. Pankewicz, Lulu G.
Dayton and Kenwood P. Dayton, II. In the event any of my
grandchildren fails to survive me, then the share of that
grandchild who predeceases me shall be distributed to her or
his issue per stirpes.
THIRD: In addition to all powers granted by law,
I give my Executor/rix, hereunder, the following powers,
which may be exercised without leave of court: to sell at
public or private sale, to exchange, or to lease for any
period of time, any real or personal property, or interest
therein, and to give option for sales or leases, and to give
a good deed of conveyance or bill of sale for the transfer
thereof.
FOURTH: I nominate, constitute and appoint
KENWOOD P. DAYTON, II as the Executor of this my Last Will
and Testament and my Estate. In the event he is unable or
unwilling to serve, then I nominate, constitute and appoint,
TRESSIA M. PANKEWICZ, as Executrix of this my Last Will and
Testament and my Estate.
dEt.:F:n !')n 11 ~~n
FIFTH: I direct that no Executor/rix acting under
this Will shall be required to enter bond for the faithful
performance of duties, in any jurisdiction.
IN WITNESS WHEREOF, I, the said ATHA M. DAYTON,
have hereunto set my hand and seal, to this my Last Will and
Testament, this Jtrl&ay of December, 2001.
() ,,- .I {"I :'
AT~'-M. f?AYTO~'7 /C-"
(SEAL)
The writing contained in this and the preceding
sheet was signed and sealed by the above named, ATHA M.
DAYTON, and by her published and declared as and for her the
Last Will and Testament, in the presence of us, who have
hereunto subscribed our names as witnesses at her request,
in~;;;;c0 ~ 2. rJJ
":::::' Address:
I
il
I,
'I
I:
,I
\,
HENCH AND CRESSLER I
A1TOHNEYSAT~AW !I
:1
1\
II
224 MARKET ST.
NEWPORT, PA . i074
TEL: (717) 567-3139
FAX: (717) 567-313C
2.d
gt try, /......,J C~
V P~.~) Cl/1 17tl7P
i 7lcb.k, f'^c'n'\~\. .~~ GJ...
'\. .
~ ......J5)." \')(. 7l 0 C; ;
dE-v:EO 90 11 ~on
HENCH AND CRESSLER
ATTORNEYS AT LAW
224 MARKET ST.
NEWPORT, PA 17074
TEL: (717) 567-3139
FAX: (717) 567-3130
Z"d
/~
~
~
\:~
Commonwealth of Pennsylvania
County of Perry
We, .4tf.&\;L D"'~tv- , U~<?'-_C/r!S'J~ j..r , and
1)"'1"-__ f~ ~I,.tS" , the testator and the witnesses, .
respectively, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the testator
signed and executed the instrument as her last will and that
she had signed willingly, and that she executed it as her
free and voluntary act for the purposes therein expressed,
and that each of the witnesses, in the presence and hearing
of the testator, signed the will as witness and that to the
best of her knowledge the testator was at that time eighteen
years of age or older, of sound mind and under no constraint
or undue influence.
t
{ftf~ '7Y7 " ~ '~?1
Testator .'
~. 'd L/ t:--<
~fg.~s ~
[lJ{l1~:'-. r. _
- Witness
Subscribed, sworn to and acknowledged before me by
Acita h. V/i<..f-Ji"'"'- , . the testator, and su};:lscribed and sworn to
before me by U.dT~ L. C,"r:.S!u.,..I~' and Ultl\~ t;:. (!hu.h
witnesses, this ~~ day of December, 2001.
9 , CLt\ ~\JliL
"-' ~~ar ublic
---,.-..,.,,-.
~~..,,, ~ "'-"'Nn~,;rS:;a~
UNOA .l. HALL NO: AP~D'Y' '.
, I.~RT sCROOGH. ?EP-p.v:: ",
"~"'''-'''''' "i^
i My Comll'1lSiitlll ExpireS \~O~.~:".:: .
dSv:EO 90 11 ~oO
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU CF INDIVIDUAL TAXES
DEPT. 250601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLV ANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DEAN HILL.ARY ANN
TEN E. HIC;H STREET
CARLISLE, PA 17013
___n___ fold
ESTATE INFORMATION: SSN: 000-00-0000
FILE NUMBER: 2106-1151
DECEDENT NAME: DAYTON ATHA M
DATE OF PAYMENT: 12/27/2006
POSTMARK DATE: 12/27/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 10/07/2006
NO. CD 007616
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $143.44
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$143.44
REMARI<S: DAYTON I<RISTIE
CH ECI<# 1477
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS