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Home My WebLink About05-26-05 , I OF F1CIAL iJSE ONL Y REV.1500 EX + (6-001 REV.1500 INHERITANCE TAX RETURN !FILENUMBER ZI 0') _ RESIDENT DECEDENT_ I_cOUNTY COOE... YEAR -- - --- ---, -- -- -- SOCIAL SECURITY NUMBER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 . I --.l OliO -.lJ9M8ER , DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I Shedlosky, leon S. I DATE OFDEATH (MM-DD-YEAR) --- I-DATE OFBIRTH (MM-DD-YE.AR\ 01-17-2005 04-17-1913 - - ---- --.- -- ....- -- I(\F APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) , Shedlosky, Evelyn B. -1 I xl1 Original Return 163-16-0774 t- Z W o W () W o THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS -'-.-- - \ J SOCIAL SECURITY NUMBER 3. Remainder Return (dale of death prior 10 12-13-82) 2. Supplemental Return w r ::.:::~l/) u~'" W~U zoo u~~ ~" ~ I 5 Federal Estate Tax Return Required ,. 4. Limited Estate 4a. Future Interest Compromise (dale of death after 12-12-82) ! x' 6 Decedent Died Testate (Attach I 7. Deceden1 Main1ained a Living Trust (Atlach copy of Will) copy of Trusl} I. 1 9. Litigation Proceeds Received J 10. Spousal Poverty Credit (date of death between 11.Election to tax under Sec. 9113(A) (Attach Sch 0) . I 12-31-91 and 1-1-95) 1 .1 .- IT"'ls.secTiONI\ITISrBe.COMPtETi!O,Alil!CQRREs"Clt.l\5~i~ii[)~d""JP~~t~I~~A1lIfulilfi1$!i[)jlbp~lii~c~tO?i ffi N. AM. E . I COMPLETE MAIUNG ADDRESS ~ I ~ichael~ Bangs_ It FIRM NAME (If applicable) ~ w ~ ~ o u 8. Total Number of Safe Deposit Boxes 429 South 18th Street Camp Hill, PA 17011 TELEPHONE NUMBER ..l717/730-731 O~~~~~.~_~~.~~.~~_ 1. ReBI EstBte (Schedule A) (1) None 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole~Proprietorship (2) (3) (4) (5) (6) (7) 1,177,158.50 None None None None None 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) \ J Separate Billin9 Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L): I Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) z o ;:: :5 ::> !:: Q. <( () w "" (8) 1,177,158.50 (9) (10) 12,378.38 -- .---.. ..-- 8,242.78 11. Total Deductions (total Lines 9 & 10) (11) 20,621.16 1,156,537.34 0.00 12. Net Value of Estate (Une 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Une 12 minus Line 13) (13) (14) 1,156,537.34 SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, 287,207.34 x .00 (15) or trBnsfers under Sec. 9116(a)(1.2) z 0 (16) ;:: 16.Amount of Line 14 taxable at lineal rate 869,330.00 x .045 ~ ::> Q. 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) :;; 0 u 18. Amount of Line 14 taxable at collateral rate 0.00 .15 118) >< x <( t- 19. Tax Due (19) 0.00 39,119.85 0.00 0.00 39,119.85 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT >> BE SURE TO ANSWER All QUESTION$ ON Rl!VER$e sloe ANO RECHECK MA'TH << Copyright 2002 form software only The Lackner Group. Inc. Form REV-1500 EX (Rev. 6-00: Decedent's Complete Address: STREET ADDRESS 220 Garrett Lane CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 39,119.85 37,163.86 - -.- - 1,955.99 Total Credits (A + B + C) (2) 39,119.85 3, Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEOVERPA YMENT. 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 B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (3) (4) (5) 0.00 (5A) (5B) 0.00 A. Enter the interest on the tax due. Make Check Payable foe 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; ..................... ......... c. retain a reversionary interest; or..... .......................... ............................. ...........................__.. d. receive the promise for life of either payments, benefits or care?.. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ...................................................... ... ..n ...................... ... ...... I i 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. 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. 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. Decl<l~atlon <?f pre parer other t persClnal rep~,:!sentatlve 1$ base~on all, I~ormatlon ci'Nhlch pr~parer has ,,~ny kno'Nledge __ SIGNATURE OF PERSON RESPO R FILING RETURN ADDRESS Jon L. Shedlosky Y-- SIGNATURE OF PERSON R Tod G. Shedlo I I I 912 Melvin Road Annapolis, MD 21403 DATE JdOI- ADDRESS DATE 6346 N. Powderhorn Mechanicsburg, PA 17055 )JjJ/'J~ DAT~ ADDRESS 429 South 18th Street Camp Hill, PA 17011 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 3% [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 0% (72 P.S. ~9116 (a) (1.1) (ii)]. The statutedoes not exemot 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 twenty-one years of age or younger;: !Jue natural parent, an adoptive parent, or a stepparent of the child is 0% [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( P d !i9116 1.2) [72 P.S. !i9116 (a) (1)]. ILPO.OO (P(PO .00 A."p. D 100 .QU ....1~ 5/,;j,I.o/05 The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% {72 P.S. ~ defined under Section 9102, as an individual who has at least one parent in common with the decedent, wheth Rev.1503 EX+(6-98) *' SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Shedlosky, Leon S. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 29,000 shares of Allied Irish Bks P.L.C. 40.466500 1.173.528.50 2 1,000 shares of Rite Aid Corp. 3.63000 3.630.00 TOTAL (Also enter on Line 2, Recapitulation) 1.177.158.50 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleB (Rev. 6-98) Date of Death, Valuat.ion Date, Processing Date: 01/17/2005 01/17/2005 02/04/2005 Shares or Par Securi ty DescrIption 11 29000 ~LLIED IR!SH BKS P L C (019228402) SPON ADR ORD New York Stock Exchange 01/14/2005 01/18/2005 2) 1000 RITE AID CORP (767754104) COM New York Stock Exchange 01/14/2005 01/18/2005 'T'of,al Value: TQr.a~ ?cct"\lal: Total: $1,177,158.50 High/Ask 40.88600 40.50000 3.63000 3.73000 Page 1 Low/Bid 40.5100D H/L 39.97000 H/L 3.55000 H/L 3.61000 H/L .ell~'4\ Dr. Leon S Shedlosky I~~ Account: 61F096012 Report Type: Date of Deatt; Number of Securities: 2 File TD: Shedlosky, Dr Leon S. IMA Mean and/or Div and Int Adjustments Accruals Security Value 40.466500 1,1'13,52\LS0 3.630000 3,630.00 $1,177,158.50 $(}.\}O ThIS report was produced wIth EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 3136300 or www.evpsys.com. (Revision 7.0.4) REV-1151 EX+ (12-99) *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA !NHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Shedlosky, Leon S. Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 5,485.39 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees 6,000.00 See continuation schedule(s) attached 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State lip Relationship of Claimant to Decedent 4. Probate Fees 710.00 See continuation schedule(s) attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 182.99 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 12,378.38 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleH (Rev. 6-98) Rev.1502 EX+ (6-98) *' SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Shedlosky, Leon S. ITEM NUMBER DESCRIPTION AMOUNT 1 Aver Memorial Home and Cremation 1.530.00 2 Gingrich Memorials - Headstone 2.455.00 3 West Shore Country Club - Funeral Luncheon 1.500.39 Subtotal 5.485.39 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleH-A (Rev. 6-98) Rev-1502 EX+ (6-98) *' SCHEDULE H-82 ATTORNEY'S FEES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Shedlosky, Leon S. ITEM NUMBER DESCRIPTION 1 Michael L. Bangs AMOUNT 6.000.00 Subtotal 6.000.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B2 (Rev. 6-98) Rev-1502 EX. (6-98) '* SCHEDULE H.84 PROBATE FEES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shedlosky, Leon S. IFILE NUMBER ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Probate - Register of Wills 710.00 Subtotal 710.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA~1500 Schedule H-B4 (Rev. 6-98) Rev-1502 EX+ (6-98) *' SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shedlosky, Leon S. IFILE NUMBER ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Adverting - Cumberland Law Journal 75.00 2 Advertising - The Sentinel 107.99 Subtotal 182.99 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B? (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 FILE NUMBER Shedlosky, Leon S. Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Alert Pharmacy Services, Inc. - December and January Services VALUE AT DATE OF DEATH 295.83 2 Alert Pharmacy Services, Inc. - Remainder of January Services 117 .87 3 Alicia D. Stine, Treasurer - 2005 County/Municipal Real Estate Taxes 816.71 4 Bethany Skilled Nursing - January Services 4.129.47 5 Expense - Lititz Mutual Insurance Company (personal umbrella policy) 179.00 6 PP&L Electric 64.48 7 Pulmonary and Critical Care Medicine Assoc. 38.16 8 Visiting Angels - Living Assistance Services for January 2.079.00 9 West Shore EMS 522.26 TOTAL (Also enter on Line 10, Recapitulation) 8,242.78 (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 I (Rev. 6-98) REV 1513 EX+ (9 00) *' SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Shedlosky, Leon S. NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee/51 I. TAXABLE DISTRIBUTIONS [include outright sfrousal distributions, and ransfers under Sec. 9116(a)(1.2)J 1 Nicole Mazurek Granddaughter 10,000.00 912 Melvin Road Annapolis, MD 21403 2 Alexa R. Shedlosky Granddaughter 10,000.00 6346 North Powderhorn Road Mechanicsburg, PA 17050 3 Evelyn B. Shedlosky Wife Remainder of 220 Garrett Lane Estate Camp Hill, PA 17011 4 Jennifer Shedlosky Granddaughter 10,000.00 912 Melvin Road Annapolis, MD 21403 5 Jon L. Shedlosky Son (10,000 shares 404,665.00 912 Melvin Road of AIB Stock) Annapolis, MD 21403 See continuation schedule attached Continuation 434,665.00 Total 869,330.00 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleJ (Rev. 6-98) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Leon S. Shedlosky 163-16-0774 01/17/2005 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 Jonathan Shedlosky Grandson 10,000.00 912 Melvin Road Annapolis, MD 21403 7 Maxwell T. Shedlosky Grandson 10,000.00 6346 North Powderhorn Road Mechanicsburg, PA 17050 8 Sara L. Shedlosky Granddaughter 10,000.00 6346 North Powderhorn Road Mechanicsburg, PA 17050 9 Tod G. Shedlosky Son (10,000 shares AIB 404,665.00 6346 North Powderhorn Road Stock) Mechanicsburg, PA 17050 Total 434,665.00 1 - l . (j)ff$ ()/ ~ 9J'. ~~ L LEON S. SHEDLOSKY, of Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, and any and all taxes and assessments imposed by any governmental body as a result of my death, whether on property passing under this will or otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II. I hereby make the following specific bequests: A. Ten Thousand (10,000) Shares of AIB Stock (or any successor company thereto) to my son JON 1. SHEDLOSKY; B. Ten Thousand (10,000) Shares of AIB Stock (or any successor company thereto) to my son TOO G. SHEDLOSKY; C. Ten Thousand ($10,000.00) Dollars to each of my grandchildren who survive my death by thirty (30) days. ITEM III. I give and bequeath all of my household goods, automobiles, jewelry, and all other articles of household and personal use, equipment and ornament, together with all insurance thereon and relating thereto, to my wife, EVELYN B. SHEDLOSKY, provided she survives my death by thirty (30) days. Should my said wife predecease me or be deceased on the thirty-first day after my death, I give and bequeath all such items and insurance thereon to those of my issue, per stirpes, as survive my death by thirty (30) days. ITEM IV. I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate to my wife, EVELYN B. SHEDLOSKY, provided she survives my death by thirty (30) days. Should my said wife predecease me or be deceased on the thirty-first day after my death, I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate to those of my issue, per stirpes, as survive my death by thirty (30) days. ITEM V. All of the interests of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or attachment. ITEM VI. I appoint my sons JON L. SHEDLOSKY and TOD G. SHEDLOSKY Co- Executors of this my last will. ITEM VII. In addition to the other powers and authorities granted to my personal representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby give to my personal representatives the following powers and authorities effective without court approval and until actual distribution of all property: to compromise any claim or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representatives may determine and at valuations finally to be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representatives deem proper, without regard to any principle of risk or diversification; 2 to retain any or all assets of my estate, real or personal, without regard to any principle of risk or diversification; to sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my personal representatives deem proper; and to allocate receipts and expenses to principal or income or partly to each as my persona] representatives deem proper in their sole discretion. ITEM VIII. I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this ~~ qy" day of ,2004. -. .~.. (,,>l1J/~ LEON S. SHEDLOSK 3 The preceding instrument, consisting of this and THREE (3) other typewritten pages, each identified by the signature of the testator was on the date thereof signed, published, and declared by LEON S. SHEDLOSKY, the testator therein named, as and for his last will, in the presence of us, who at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. 4 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ) ( SS: ) The undersigned, being the testator whose name is signed to the attached or foregoing instrument, l1aving been duly qualified according to law, does hereby acknowledge that f signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed, ) ( 55: COUNTY OF CUMBERLAND ) WE,!1,j/c,_/( ~NCj-f and ,,~ (;,. )UE.D holt ,the witnesses whose names are signed to the attached or foregoing Instrument, being duly qualified a cording to law, do depose and say that we were present and saw the testator sign and execute tl1e instrum t as his last will; that he signed it willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that eacl1 of us in the hearing and sight of the testator signed the will as witnesses; and that to the best of our knowledge, the testator was at that time 18 or more years of age, of sound mind, and under no constraint or undue influence. , Sworn \ r affirmed befQn>, y t \ cknowledged day of ,2004. J10 NOT SEfll WENDY S CHESBRO, tlolarl put\\(: Lower Allen TWll.. r..uml:~r.rJ Coonty My Commiscicn Exp.'rGs May 10. 2007 i ,L"-.- ( "-(V'l 1..-- LEON 5. 5HEDL05KY fj ",\ I bx:J 5 Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Leon S. Shedlosky No. 2/-{)"> -01/0 also known as , Deceased Date of Death 01/17/2005 Social Security No. 163-16-0774 Jon L. Shedlosky Tod G. Shedlosky --.--.--...- -- -- The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. l!We verify that the statements made in this Inventory are true and correct. l!We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. 1.0. No.: fIIIi(;hael L. Bangs_ 41263 Signature: Personal Representative Attorney: Signature: Firm: Signature: Address: 429 South 18th Street C~mp Hill, PA 1701_1 Telephone: 717/730-7310 Address: 912 Melvin Road Annapolis, MD 21403 Telephone: 410 ~r!l.\ Dated: Personal Propertv Cash............................................................................................... Miscellaneous Property................................................................ Stocks/Listed... ......... ............ ................................. ........ ................ Stocks/Closely Held...................................................................... Bonds............................................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable............................................... 1,177,151l.5b_ Total Personal Property......................................... 1,177,158.50 Total Real Property................................................ Total Personal and Real Property......................... 1,177,158.50 I Total Out-ot-State Real Property.......................... ~ Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estlte of: Estlte No: 376 5/26/2005 LEON S, SHEDLOSKY 21-2005-0110 MICHAEL L BANGS, ESQ. 429 SOUIB 181BSTREET JA CAMI' HILL, PA 17011 100.00 Totll $100.00 Qty 1 Fee Description Additional Probate Fee Totll: $100.00 o,ecks should be made payable to the Register of Wills. Tenus: Net 30. Please return one copy of this invoice with your payment. Thank you.