HomeMy WebLinkAbout10-22-101505610101
REV-1500 °"°'-'°'
OFFICUIL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes ~""~~~"~ Couniy Code Yeah File Number
PO BOX z8o6oi ~ INHERITANCE TAX RETURN ~ ~ C,,~.9 I'
Harrisburg, PA i~iz8-o6oi RESIDENT DECEDENT ~_
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
101-24-4375 12/10/2009 12/02/1919
Decedent's Last Name Suffix Decedent's First Name MI
Fembaugh Anna 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 INAPPROPRIATE OVALS BELOW
O 1. Original Return dD 2. Supplemental Return O 3. Remainder Return (date of death
prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
Paul Daggs, Esquire (717) 975-9446
First line of address
DPLG, LLC
Second line of address
2132 Market Street
City or Post Office
Camp Hill
State ZIP Code
PA 17011
REGISTER OF WILLS USE Owl
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Correspondent's e-mail address: pdaggS~dplglaW.COm
r penalties of perjury, I deGare that I e exa ~ return, inGuding accompanying sand statements, and to the best of my knowledge and belief,
it is e, correct and complete. Decla n parer o an the personal representati i on all information of which preparer has any knowledge.
SI ~PE~.S~ ~SPO IB ~FORFI ~~~~o/^ f y~j~~~i _ ~ D~D~~~~D/D
Ff l9 W. Main Street, Mechaniot;burg, PA 17055
IG OF PREPyB~OTH~THAN REPRESENTATIVE DATE /
- ,/) ~ J 'lL.., ~ Ca~1o/.fig/D
2132 Market Street, Camp Hill, PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610101 1505610101 J
1505610105
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Anna M. Fembaugh 101-24-4375
RECAPITULATION
1. Real Estate (Schedule A) .......................................... ... 1. 0.00
2. Stocks and Bonds (Schedule B) .................................... ... 2. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00
4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 1,187.92
6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 3,445.10
7. Inter-~vos Transfers si Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested..... ... 7. 0.00
8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 4,633.02
9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 11,369.35
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule 1) ........... ... 10. 488.91
11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 11,858.26
12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. -7,225.24
13. Charitable and Governmental Bequests/Sec 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 13) ..................... ... 14. -7,225.24
TAX CALCULATION -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 .0 0 0.00 15. 0.00
16. Amount of Line 14 taxable
at lineal rate X .0 45 0.00 16. 0.00
17. Amount of Line 14 taxable
at sibling rate X .12 0.00 17. 0.00
18. Amount of Line 14 taxable
at collateral rate X .15 0.00 18 0.00
19. TAX DUE ................................................ ....... ..19. 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~
Side 2
1505610105 1505610105
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Anna M. Fembaugh
STREET ADDRESS _ _ _ _ _ - _ _- _ - --
105 E. Green Street
g - -- --- --- - __ -~-- - - _ __ _
CITt' STATE ZIP
Mechanlcsbur PA ' 17055
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the dfference. This is the TAX DUE.
147.28
(1) 0.00
Total Credits (A + B) (2) 147.28
(3)
(4) 147.28
(5)
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 :........................................................................................ .. ^
b. retain the right to designate who shall use the property transferred or its income : .......................................... .. ^ Q
c. retain a reversionary interest; or ........................................................................................................................ .. ^
d. receive the promise for life of either payments, benefits or care? .................................................................... .. ^ ^x
2. If death occurred after Dec. 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................................ .. ^
3. Did decedent own an "in trust for" orpayable-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? ...................................................................................................................... .. ~ ^
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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent [72 P.S. §9116 (a) (1.1) (i)J.
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (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 21 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 0 percent [72 P.S. §9116(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 percent, except as noted in
72 P.S. §9116(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 12 percent [72 P.S. §9116(a)(1.3)]. Asibling 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)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDI~LE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
ANNA M. FERNBAUGH 2109-1183
Indude the proceeds of Iftigatan and the date the proceeds ire received by the estate.
All properly jointly-owned wish right of survivorship must be disclosed on Schedule F.
(If more space is needed, insert additanal sheets of the same size)
REV-~5og IX+ (oi-i0)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEp1~LE F
70INTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
ANNA M. FERNBAUGH 2109-1183
Tf an assist became jointly owned within one year of the deoederit's date ~ deadT, R must tie reported on Schedule G.
SURVMNG JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A• Jeanne Souder
619 W. Main Street
Mechanicsburg, PA 17055
daughter
B.
C.
.70INTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSiITTlTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE.
DATE OF DEATH
VAWE OF ASSET % OF
DECEDENT'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
1. A. 06105103 Members 1st FCU Savings Acct. No. 3950-05 2,988.93 50 1,494.47
2. A. 10109/56 Members 1st FCU SavingsAcd. No. 3950-00 3,901.26 50 1,950.63
TOTAL (Also enter on Line 6, Recapitulation) I $ 3,445.10
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
j ~ Pennsylvania SCHEDULE G
~ DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
ANNA M. FERNBAUGH 2109-1183
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
iTEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RElATI0N5HIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FDR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
pF APPUCneLEi
TAXABLE
VALUE
1• Federal Employees' Group Life Insurance (claim no. 20100103629)
Beneficiary: Jeanne Souder 4,760.35 0 0.0(
2 John Hancock Life Insurance (policy no. M07170750)
Beneficiary: Jeanne Souder 2,371.50 0 0.0(
3 John Hancock Life Insurance (policy no. M05642153)
Beneficiary: Jeanne Souder 1,661.63 0 0.0(
TOTAL (Also enter on Line 7, Recapitulation) ; I 0.00
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
~ pennsyLvania
DEPARTMENT OF REVENUE
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
ANNA M. FERNBAUGH 2109-1183
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Malpeai Funeral Home 8,530.00
Additional Miscellaneous funeral and burial expenses 1,797.85
Gingrich Memorials (engraving) 135.00
B.
1
2.
3.
4.
5.
6.
7.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address _____ _
City - _ __ _ _ -_ . _-- _ -_ State _.
Year(s) Commission Paid:
Attorney Fees:
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address ___ _
City -- --- -_ _- --- -State
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
Estate publication
ZIP
ZIP
TOTAL (Also enter on Line 9, Recapitulation) I $
If more space is needed, use additional sheets of paper of the same size.
0.00
500.00
104.50
179.00
123.00
11, 369.35
REV-1512 EX+ (12-08)
~i1 Pennsylvania SCHEDULE I
~ DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
REStDENT DECEDENT
ESTATE OF FILE NUMBER
ANNA M. FERNBAUGH 2109-1183
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical excenses.
If more space is needed, insert additional sheets of the same size.
REGISTER OF WILLS
CUMBERLAND COUNTY
PENNSYLVANIA
CERTIFICATE OF
GRANT OF LETTERS
No . 2009- 01 183 PA No . 21- 09- 1 183
Estate Of: ANNA MFERNBAUGH
(fits!, Midd/e, Lastl
Late Of : MECHANICSBURG BOROUGH
CUMBERLAND COUNTY
Deceased
Social Security No: 101-24-4375
WHEREAS, on the 22nd day of December 2009 an instrument dated
May 11th 1988 was admitted to probate as the last will of
ANNA M FERNBAUGH
(First, Middle, Lasll
late of MECHAN/CSBURG BOROUGH, CUMBERLAND County,
who died on the 10th day of December 2009 and
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 11 s in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
JEANNE SOLIDER
who has duly qualified as EXECUTOR(R/XJ
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 22nd day of Decem._her 2009.
* *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
I, ANNA M. FERNBAL'GH, of the Borough of Mechanicsburg, County
of Cumberland and State of Pennsylvania, being of sound and disposing
mind, memory and understanding, do make, publish and declare this my Last
Will and Test~nent, hereby revoking and makir~ w id all former Wills by
me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses
as soon after my decease as the same may conveniently be done.
2.
A11 the rest, residue and ranainder of my estate, real, personal
and mixed, of whatsoever nature and wheresoever the same may be situate, I '~
give, devise and bequeath to my four children, JEANf~ SOUDER, THOMAS M.
FERI`iBAUGH, JOSEPH G. F'ERNBAUGH, and LYNN P. FERNBAUGH, in equal shares.
3.
LASTLY, I nominate, const~.tute and appoint my daughter, JEANI~
SOUT'~., Executrix of this, <<y Last Will and Test~:-,ent, a:ad in 11'ie event
she should predecease me, or should she be unable cr unwilling to serve in
such capacity for any reason, then I nominate, constitute and appoint my
son, ~-i0I4AS M. FERNBAUGH, Executor of this, my 'Last Will and Test~nent, in
her place and stead.
IN WITNESS ti~REOF, I have hereunto set my hand and seal this
i%J~ ~Y of May, A. D. 1988.
/~ ~~
c~~l.cJ~ ~ , ~~/L~ic~~t,< '`(SEAL)
Anna M. Fernbaugh
Signed, sealed, published and declared by the above-n~ned ANNA '
L"1. L l',L~1Y1J1iUl~ti, d5 :.tt lu iC1L il~.i Ti.ci3 ~ vvili Ali ii;. T~::.i tciilt(.:'l ll.., iTl ti1C ~i:"C~C::.CC Of
us, who, at her request and in her presence, and in the presence of each
other, have hereunto subscribed our napes as witnesses.
interest Checking Account Statement
PNC Bank
a
For the period 03/20/201 O to 04/20/201 O
01122
ANNA FERNBAUGH
619 W MAIN ST
MECHANICSBURG PA 17055-3246
PNCBANK
Primary account number: 50-8052-0251
Page 1 of 3
Number of enclosures: 0
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Interest Checking Account Summary Anna Fernbaugh
Account number: 50-8052-0251
Overdraft Protection Provided By: Contact PNC to establish dverdrak Protection
Balance Summary
Beginning Deposits and Checks and other Ending
balance other additions deductions balance
1,167.92 20.00 1,187.92 .00
Average monthly Charges
balance and fees
402.09 20.00 -
Interest Summary As of 04!20, a total of $.71 in interest was
Annual Percentage Number of days Average collected Interest Paid paid this year.
Yield Earned (APYE) in interest period balance for APYE this period
n nn i 7 Y~ 7 A 59.73 n~
Activity Detail
Deposits and Other Additions There was 1 Deposit or Other Addition
Date Amount Description totaling $20.00.
03/30 20.00 Service Charge Refund
Other Deductions
Date Amount Description
03/31 .00 Outstanding Item Close
03/31 1,187.92 Debit Memo Reference No 521607655
There were 2 Other Deductions totaling
$1,187.82.
Daily Balance Detail
Date Balance Date Balance Date Balance
03/20 1,167.92 03/30 1,187.92 03/31 .00
''"~~
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St
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MEMBERS 1St
FEDERAL CREDIT UNION
Send Inquires to:
5000 Louise Drive
PO Box 40
Mechanicsburg, PA 17055
www.membersi st.org
Main Switchboard: (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TDD: (717) 697-5312 or (800) 283-2328 ext. 5312
TeleBranch: (800) 237-7288
10541 1 AV 0.335 21081-10541
Ir~~lll~~rlllr~rrl~l~rlrl~~rllrr~l~lrlrrl~llr~rr~lll~l~~l~r~ll
ANNA M FERNBAUGH
C/O JEANNE SOLIDER
619 W MAIN STREET
MECHANICSBURG PA 17055
Statement of Accounts
Dec 25, 2009 thru Mar 24, 2010
Account Number: 3950
Balances at a Glance:
Checking : 0.00
Savings: 0.00
Certificates: 0.00
Loans: 0.00
Money Management : 0.00
Swipe 5 YTD Reward : 0.00
Page : 1 of 2
Your aggregate balance as of March 1st is $6,894.20.
An aggregate balance of $2,500 and having 3 products
will place you in the Silver MLR level.
We have once again partnered with Carlisle Events to provide you with a
2010 VIP Pass! Your free pass is enclosed.
SAVINGS ACCOUNTS
0000 -REGULAR SAVINGS
Date Transaction Description Additions Subtractions Balance
Dec 25 Balance Forward 3,900.92
Joint Owner: JEANNE A SOLIDER
Dec 31 Deposit Dividend 0.350% 1.16 3,902.08
Annua/ Percentage Yie/d Earned 0.35U~ from 12/01/2009 through 12/31/2009
Jan 31 .Deposit Dividend 0.350% 1.16 3,903.24
Annua/ Percentage Yie/d Earned 0.35U~ from 01/01/2010 through 01/31/2010
Feb 01 Deposit 2,990.94 6,894.18
Feb 01 Deposit 0.02 6,894.20
Feb 01 Withdrawal 6,894.20- 0.00
REGULAR SAVINGS Closed
"'This is the bnal statement presenting information on this product'".
"' P/ease retain this final statement for tar reporting purposes;"v:"'
0002 - HULIi~AY CLUB
Date Transaction Description Additions Subtractions Balance
Dec 25 Balance Forward 600.20
Dec 31 Deposit Dividend 0.400% 0.20 600.40
Annua/ Percentage Yie/d Earned 0.390"/o from 12/01/2009' through 12/31/2009
Jan 04 Withdrawal by Check ~u`.- 600.40- 0.00
Jan 31 Deposit Dividend 0.400% 0.02 0.02
Annua/ Percentage Yie/d Earned 0.410 from 01/01/2010 through 01/31%21~~0
Feb 01 Withdrawal - - 0.02- 0.00
HOL/DAY CLUB Closed
"'This is the final statement presenting information on this product"'
"' P/ease retain this final statement for tar reporting purposes "'
--- Continued on following nave ---
St Send Inquires to: Main Switchboard: 800) 283-2328
~~• 5000 Louise Drive (
EZ Call: (717) 697-4372 or (800) 283-4372
Po sox ao Dec 25, 2009 thru Mar 24, 2010
Mechanicsbur PA 17055 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 ziosz-zosaz
MEMBERS 1° g' TeleBranch: (800) 237-7288 Account Number: 3950
"~`°""° "'°" www.membersist.org Page: 2 of 2
0005 -MONEY MANAGEMENT
Date Transaction Description Additions Subtractions Balance
Dec 25 Balance Forward 2 988 ~
Joint Owner: JEANNE A SOLIDER
Dec 31 Deposit Dividend Tiered Rate 1.27 2 989 83
Annua/ Percentage Yie/d Eamed 0.500"/o from 12/01/2009 through 12/31/2009
Jan 31 Deposit Dividend Tiered Rate 1.11 2,gg0.94
Annua/ Percentage Yie/d Eamed 0.440"/o from 01/01/2010 through 01/31/2010
Feb 01 Withdrawal 2,990.94- 0.00
MONEY MANAGEMENT Closed
"'fiis is the final statement presenting information on this product"'
"' P/ease retain this final statement for tax reporting purposes ""
YTD SUMMARIES
TOTAL DIVIDENDS PAID
0000 REGULAR SAVINGS 1.16
0002 HOLIDAY CLUB 0.02
0005 MONEY MANAGEMENT 1.11
Total Year To Date Dividends Paid 2.29
NOTE: Total includes closed shares
Total Year To Date Interest Paid 0.00
NOTE: Total includes closed loans
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OP REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 77728-0601 -
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX~11-961
NO. CD 012280
SOLIDER JEANNE
619WMAINST
MECHANICSBURG, PA 17055-3246
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
------- told
ESTATE INFORMATION: ssrv: iot-24-4375
FILE NUMBER: 2109-1 183
DECEDENT NAME: FERNBAUGH ANNA M
DATE OF PAYMENT: 01 / 26/ 201 0
POSTMARK DATE: 01 /26/201 0
COUNTY: CUMBERLAND
DATE OF DEATH: 1 2/ 1 0/ 2009
10102329 ~ $83.39
10102330 ~ $63.89
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK#3773
INITIALS: CJ
RECEIVED BY:
$147.28
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER