Loading...
HomeMy WebLinkAbout05-07-13 1505610140 REV-1500 EX (01.10) OFFICIAL USE ONLY department of Revenue Bureau of Individual Taxes County Code Year File Number Bu PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 0 0 2 8 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number date of Death MMDOYYYY Date of Binh MMDUYYYY 0 9 0 9 2 0 1 2 0 9 0 8 1 9 2 7 Decedent's Last Name Suffix decedent's First Name MI B A R R I C K T R E V A J (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 Q 1.Original Return ❑ 2.Supplemental Return ❑ 3.Remainder Return(date of death prior to 12-13-82) ❑ 4.Limited Estate ❑ 4a.Future Interest Compromise(date of ❑ 5.Federal Estate Tax Return Required death after 12-12-82) t ❑ 6.Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust — 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ❑ 9.Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(date of death ❑ 11.Election to tax under Sao.9113(A) between 12-31-91 and 1-1-95) (Attach Son.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Nance Daytime Telephone Number M A R C U S A M c K N I G H T I I I 7 1 c 2 4 9 2 5T3 ITT o rM RQGIST OF 1ML9JJSE 027LY=> -1 r� First line of address co --.7 I R W I N 8 M C K N I G H T , P C Second line of address c r CJ ` c> 6 0 W E S T P 0 M F R E T S T R E E T City or Post Office State ZIP Code DATE IL D -art C A R L I S L E P A 1 7 0 1 3 Correspondent's e-mail address: Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is tare,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG ER$ON RCSgON$ZI LE F LING RETURN DATE ADDRESS 1214 CENTER WAD NEWVILLE PA 17241 SIGN REP ,OJHE HAJAAERaFaNTATIVE DATE / V ADD SS 66 WEST POMF STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 Cl"J J 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: T R E V A J . B A R R I C K 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. Mortgages and Notes Receivable(Schedule D) ... . . .. .. . .. .. . . . . . . . . . . .. 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. . . .. . 5. 5 1 0 9 . 9 6 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . .. .. 6. 3 0 8 5 0 . 9 2 - 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . . .. 7. 8. Total Gross Assets(total Lines 1 through 7) . .. . . . .. .. .. . . . . . . . . . . .. .. . 8. 3 5 9 6 0 . 8 8 9. Funeral Expenses and Administrative Costs(Schedule H) .. . .. .. .. .. .. . . . . . 9. 8 4 5 9 . 2 6 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . .. .. .. .. 10. 11. Total Deductions(total Lines 9 and 10) .. . .. .. ... .. . . . .. .. .. .. . . . . .. .. 11. 8 4 5 9 . 2 6 12. Net Value of Estate(Line 8 minus Line 11) . . . . .. .. . . . .. .. . . . . . . . . .. . . . 12. 2 7 5 0 1 . 6 2 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) .. .. .. .. . .. .. .. . . . . .. . 13. 0 . 0 0 14. Net Value Subject to Tax(Line 12 minus Line 13) . . .. .. .. .. . . . . . . .. .. . . 14. 2 7 5 0 1 . 6 2 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (8)(1.2)x.0 _ 0 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate x.045 2 7 5 0 1 . 6 2 16. 1 2 3 7 . 5 7 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17, 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE . .. . . . . . .. .. . . . . . . .. . . . . .. . . . . . . .. . . . . . .. . . .. . . . . .. . . . 19. 1 2 3 7 . 5 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 L 1505610240 1505610240 Continuation of REV-1500 Inheritance Tax Return Resident Decedent TREVA J. BARRICK 21 13 0028 Decedent's Name Page 1 File Number Correspondents Name Daytime Telephone Number M A R C U S A M c K N I G H T I I I 7 1 7 4 4 0 2 7 6 5 First line of address I R W1 N & M c K N I G H T P C Second line of address 6 0 W E S T P O M F R E T S T R E E T City or Post Office State ZIP Code C A R L I S L E P A 1 7 0 1 3 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,coned and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. 7 SIGNATURE FPERSON SPj)Ny$IB INC7RETURN DATIE O�✓1U ADDRESS ////�\// /�rVV77 1298 CENTER ROAD NEMILLE PA 17241 REV-1500 EX Page 3 Fee Number Decedenfs Complete Address: 21 13 0026 DECEDENT'S NAME TREVA J. BARRICK _ STREET ADDRESS -- - - - -- 8 CONIFER ROAD CITY i STATE ZIP NEVVVILLE PA ?724? Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1} 1,237.57 2. Cred ts/Payments A.Prior Payments a.Discount 61.88 3. Interest Total Credits(A+8) (2) 61.88 4. If Lino 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. (3) Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,175.69 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; ........................... ❑ IR c. retain a reversionary interest;or ................................................................... ❑ 0 ........................... d, receive the promise for life of either payments,beriefrts or care? ....................................................... ❑ 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ FX 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?.................................................................................................. 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 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 172 P.S.§9116(a)(11)(1)]. 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)(it)].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 172 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. REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE INHERITANCE TAX RETURN CASH, BANK DEPOSITS & MISC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: TREVA J. BARRICK 21 13 0028 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 N VALUE AT DATE UMBER DESCRIPTION OFDEATH 1. MEMBERS 1ST FEDERAL CREDIT UNION -SAVINGS ACCOUNT#414602-00 65.67 2. MEMBERS 1ST FEDERAL CREDIT UNION 3,902.57 INVESTMENT SAVINGS ACCOUNT#414602-05 3. M&T BANK-CHECKING ACCOUNT#1071416 1,141.72 TOTAL(Also enter on Line 5,Recapitulation) $ 5,109.96 If more space is needed,use additional sheets of paper of the same size. REV-1509 EX+(01.10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: TREVA J. BARRICK 21 13 0028 If an asset was made jointly owned within one year of the decedents date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT($)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A.ALBERT G. BARRICK 1214 CENTER ROAD SON NEWVILLE, PA 17241 B. C. JOINTLY-OWNED PROPERTY: r LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH 1 ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER,ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. HERITAGE INVESTMENT SERVICES FUND 10,283.63 50. 5,141.82 ACCOUNT#1013339 2. A. HERITAGE INVESTMENT SERVICES FUND 51,418.19 % 25,709.10 ACCOUNT#1013340 i TOTAL(Also enter on Line 6,Recapitulation) S D,850.92 9 we space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER TREVA J. BARRICK 21 13 0028 Decedents debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EGGER FUNERAL HOME, INC. 6,195.60 B. ADMINISTRATIVE COSTS: 1, Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Years)Commission Paid: 2. Attorney Fees: IRWIN & MCKNIGHT, P.C. 1,500.00 3. Family Exemption:(If decedents address is not the same as claimants,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 113.50 5 Accountant Fees: 6. Tax Retum Preparer Fees: PATRICIA A. ROSENDALE, CPA 375.00 7. THE SENTINEL- ESTATE NOTICE 200.16 8. CUMBERLAND LAW JOURNAL- ESTATE NOTICE 75.00 TOTAL(Also enter on Line 9,Recapitulation) $ 8,459.26 If more space is needed,use additional sheets of paper of the same size. REV-1513 EX-(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: TREVA J. BARRICK 21 13 0028 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include oubightspousal distributions and transfers under 1. ALBERT G. BARRICK Lineal 27,501.62 1214 CENTER ROAD HERITAGE ACCTS NEWVILLE, PA 17241 1/5TH REMAINDER 2. DAVID BARRICK Lineal 27 WEIST ROAD 1/5TH REMAINDER NEWVILLE, PA 17241 3. STANLEY BARRICK Lineal 12 WEIST ROAD 1/5TH REMAINDER NEWVILLE, PA 17241 4. BRENDA K. MEALS Lineal 1298 CENTER ROAD 1/5TH REMAINDER NEWVILLE, PA 17241 5. JOANNE B. BURKHOLDER Lineal 600 N. MIDDLE ROAD 1/5TH REMAINDER NEWVILLE, PA 17241 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. NEWVILLE ASSEMBLIES OF GOD CHURCH (10% 403 OAK FLAT ROAD NEWVILLE, PA 17241 TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0.00 If more space is needed,use additional sheets of paper of the same size. RECO,R',OEI} rt-F ICE OF LAST WILL AND TES'PAMmll' 9 �I� 2 96 0 �' of CLEIie; Ci= TREVAJ.BARRICKOFtf'nANO"' on.' ; CUMBERLAP 40 CC)., rA I, TREVA J. BARRICK, of Lower Mifflin Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any Will or Codicil previously made by me. ITEM I: I direct that all my just debts(except as maybe barred by a Statute of Limitations) and my funeral expenses (including my gravemarker and expenses of my last illness) shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITEM II: I am presently not married and I have five children: ALBERT G. BARRICK, DAVID BARRICK, STANLEY BARRICK, BRENDA K. MEALS, and JOANNE B. BURKHOLDER. I make this will in this context. ITEM III: I bequeath those articles of my household furniture and furnishings and those articles of my personal effects and personal property as I have or may set forth in a separate . memorandum(which is or will be signed by me,dated and make specific reference to this Will and memorandum,which I shall place with my Will or deposit with my attorney),to the persons therein designated. ITEM IV: I give and bequeath a sum equal to ten(10 1/4)percent of my estate to my church, the Newville Assemblies of God Church, 403 Oak Flat Road, Newville, Pennsylvania, for general church purposes as shall be determined by the governing body of the said Church. ITEM V: I devise and bequeath all the residue of my estate of every nature and wherever situate in equal shares to such of my children, ALBERT G. BARRICK, DAVID BARRICK, STANLEY BARRICK,BRENDA K. MEALS,and JOANNE B.BURKHOLDER,as are living on the thirty-first (31st) day following my death. Provided however that if at the time of my death I have not been repaid by my daughter,JOANNE B.BURKHOLDER,for sums of money that I have given to her or advanced for her or incurred credit card debt for her benefit,the total of such sums shall be treated as an advancement of JOANNE'S share of any residuary estate and deducted from her distributive share thereof. ITEM VI: Should any of my children, ALBERT G. BARRICK, DAVID BARRICK, STANLEY BARRICK, BRENDA K. MEALS, and JOANNE B. BURKHOLDER,predecease me or die on or before the thirtieth day following my death but leaving descendants who so survive me, such descendants shall receive, per stapes, the share that such predeceased child would have received had he or she so survived me. ITEM VII: If any property passes outright(either under this Will or otherwise)to a minor (which shall be defined as anyone under twenty-one(21)years of age)and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, I decline to appoint a guardian but instead authorize my Executor to distribute such property to a Custodian selected by my Executor(and my Executor may act as such Custodian)as Custodian for the minor under the Pennsylvania Uniform Transfers to Minors Act. Provided, however, that this appointment shall not supersede the right of any fiduciary to distribute a share where possible to the minor or to another for the minor's benefit. ITEM VIII: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as 2 , COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND I, TREVA J. BARRICK, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. (SEAL) TREVA J.BMIRICK,TESTATRIX Sworn to or affirmed and acknowledged before me by TREVA J.BARRICK,the Testatrix,this�day of nord 2011. COMMONWEALTH OF PENNSYLVANIA j Not'F al'I" C FL,IMM.SchaeBer,Notary Public 1 u eoro,Cumberland County mbslon Explms May 15,2031 Notary Public - Member,PCnnsVivanla A oaaon or Notaries COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND We, �QJ91/l1 rI.UI/S and b611117C the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. C Sworn to or affirmed and s11 cubed to / before me by 40v%16 A•&V and -i PhS ,witnesses,this 1p�h day of i 2011. COMMONWEALTH OF PENNSYLVANUI Angela aA.. CrAbotblic Notary Public ShlppensbCounty Commr 2011 mbep Pennlvania sdation of Notaries 4 is$ MEMBERS V MEM CRWff UMON r4i"RE 0, FEB 01 20i3 RWINa 114dKINIGH? LAIR'OFFICES REGULAR SAVINGS ACCOUNT: Account Number/Suffix 414602-00 D-ate Account Established 0410112011 Principal Balance at Date of Death $65.67 Accrued Interest to Date of Death $0.00 Total Principal and Accrued Interest $65.67 Name of Joint Owner None INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 414602-05 D-ate Account Established 02/14/2012 Principal Balance at Date of Death $3,902.31 Accrued Interest to Date of Death $.26 Total Principal and Accrued Interest $3,902.57 Name of Joint Owner None VISA ACCOUNT: Account Number/Suffix 4999500000033641* D-ate Account Established 08105/2011 Principal Balance at Date of Death $.00 Name of Joint Owner Cardholder None 'Contractual Pledge of Shares BERS 1 sr FEDERAL CREDIT UNION Danielle A. Kline Lending Insurance Support Specialist January 30,2013 Estate of: TREVA BARRICK Date of Death: 09/09/2012 Social Security Number: 200-22-5004 5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 (800) 283-2328 • www.memberslstorg © M&TBank 499 Mitchell Road,Millsboro,DE 19966 Adjustment Services Phone 888-5024349 F ax (302)934-2955 Law Offices January 22,2013 Irwin & McKnight,P.C. West Pomfret Professional Buildings; 60 West Pomfret Street Carlisle,PA 17013-3222 !AM 25 201J iR[N'IN&I�ic'rtiVIGH s LAIR OFFICES Re: Estate of Treva J. Barrick Social Security: 200-22-5004 Date of Death: September 9, 2012 Dear Sir or Madam: Per your inquiry on January 14,2013,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: 1. Type ofAccount Checking Account Account Number 1071416 Ownership(Names of) Albert G.Barrick(POA) Treva J Barrick Opening Date 0610111990 Balance on Date of Death $1,141.72 Accrued/merest $ .00 Total $1,141.72 For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds, please call the nigh Street Carlisle at 717-2404536. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transfers, Representative Payee,or Trustee under a Written Agreement. Sincerely, Valarie Mercer Adjustment Services �LNrP' ■ 3 Kacey Ct Ste 101 - Mechanicsburg PA17055-9221 (717)796-9784 � i HERITAGE INVESTMENT SERVICES FUND An investment that works Treva J Barrick c/o 1214 Center Road Year To Date End' :Sep 09,2012 Newville PA 17241 "'—`�-- Account Rate Matures Deposits Interest Withdraws Penalties Balance 1013339 4.50% 1/26/2017 $10,000.00 $272.28 $0.00 $0.00 $10,283.63 1013340 4.50% 1/26/2017 $50,000.00 $1,361.46 $0.00 $0.00 $51,418.19 Jt• "I rlC� r1 �S W1 n114 0�, Sobvir4.0-;p INTEREST FOR THIS PERIOD:$1,633.74 Page 1 ENDING BALANCE:(includes unposted interest)$61,701.82 15 Big Spring Avenue NEWALLE, PENNSYLVANIA 17241 F. CHARLES EGGER, Supervisor 717-776-3414 FRANK C. EGGER, Funeral Director October 4, 2012 Funeral Bill for Treva Barrick Date of Service September 14, 2012 Professional Services $4,120.00 Spencer 20 Gauge Casket $1,575.00 Flowers $217.30 Sentinel Obituary $161.30 Valley Times Star $50.00 12 Death Certificates $6.00 a piece $72.00 Total $6,195.60 Payment 11/3/2012 $2,595.60 kemaining Balance $3,600.00 X2o la