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Home My WebLink About12-13-05 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRIS8URG, PA 17128-0601 REV-1162 EXI11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT WINAND STEVEN S 317 STUMPSTOWN ROAD MECHANICSBURG, PA 17055 n______ fold ESTATE INFORMATION: SSN: 166-54-0661 FILE NUMBER: 2105-0643 DECEDENT NAME: SHA Y JANASIA I DATE OF PAYMENT: 12/13/2005 POSTMARK DATE: 12/13/2005 COUNTY: CUMBERLAND DATE OF DEATH: 07/02/2005 NO. CD 006099 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $13,758.76 I I I I I I I I TOTAL AMOUNT PAID: $13,758.76 REMARKS: CHECK#183 SEAL INITIALS: MW RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SHAY JEROMY J 124 N FREDERICK STREET MECHANICSBURG, PA 17055 ______h fold ESTATE INFORMATION: SSN: 166-54-0661 FILE NUMBER: 2105-0643 DECEDENT NAME: SHA Y JANASIA I DATE OF PAYMENT: 12/13/2005 POSTMARK DATE: 12/13/2005 COUNTY: CUMBERLAND DATE OF DEATH: 07/02/2005 NO. CD 006100 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $4,127.63 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#107 SEAL INITIALS: MW RECEIVED BY: REGISTER OF WILLS $4,127.63 GLENDA FARNER STRASBAUGH REGISTER OF WILLS REV.1500 EX. (6-00) . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I- Z W o W U w o SHAY JANASIA DATE OF DEATH {MM.DD-Year} REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 5 o 643 '"'CoUNTYC'OiiE -YEA~ - - NuMaER- - SOCIAL SECURITY NUMBER I. AJKlA JANASIA "JAN" SHAY DATE OF BIRTH (MM.DD-Year) 1 66- 5 4 - 0 661 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 07/0212005 02/07/1960 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) w ~ :lC~(I) ult::lC w nou :1:00 ,,1t:..J ~ nom no <( !Xl 1. Original Return o 4. Limited Estate [Xl 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received SOCIAL SECURITY NUMBER o 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12.12.82) D 7, Decedent Maintained a Living Trust (Attach copyofTrust) D 10. Spousal Poverty Credit (date of death between 12.31.91 and 1.1.95) D 3. Remainder Return (date of death prior to 12.13.82) D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under See, 9113(A) (Attach Sch 0) 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 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) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) ~ z w c z o no (I) w It: It: o U NAME MURREL R. WALTERS III ESQUIRE FIRM NAME (If Applicable) TELEPHONE NUMBER 717-697-4650 z o i= <C ..J => I- it <C U w 0:: COMPLETE MAILING ADDRESS 54 EAST MAIN STREET MECHANICSBURG PA 17055 OFFICIAL USE ONLY 270,000.00 13,931.15 j ,._-....) ".~"'j c'~. 13,742.41 (8) 297,673.56 35,151.00 79,072.47 (11) (12) (13) 114,223.47 183,450.09 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 183,450.09 z o i= <C I- :::J Q. :IE o U ~ .... 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due X _(15) 91,725.05 X ~(16) 4,127.63 X .12 (17) 91,725.04 X .15 (18) 13,758.76 (19) 17,886.39 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o d , C I t Add ece ents ompee ress: STREET ADDRESS 317 STUMPSTOWN ROAD . CITY I STATE -\ ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 6. Prior Payments C. Discount (1 ) 17,886.39 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty T otallnterest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) 6. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 17,886.39 17,886.39 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; ........................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00 c. retain a reversionary interest; or ...................................................................................................... 0 00 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. 0 00 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ADDRESS . PA 17055 OpE (7-. f.o~ PA 17055 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)l. For dates of death on or after January 1, 1995, the tax rate imposed on the net value oftransfers to or for the use of the surviving spouse is 0% [72 P.S. 39116 (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 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 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%, except as noted in 72 P.S. 39116(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 12% [72 P.S. 39116(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-1502 EX + (6-98) '* . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SHAY JANASIA I. A1K1A JANASIA "JAN" SHAY 21 05 0643 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real prooertv which is iointlv-owned with rioht of survivorship must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 270,000.00 317 STUMPSTOWN ROAD MECHANICSBURG, PA 17055 GROSS SALE PRICE TOT At (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 270,000.00 A. Settlement Statement U.S. Department of Housing and Urban Development OMB No. 2502-0265 B. Type of Loan 1. 0 FHA 2.DFmHA 3.IiUConv. Unins. 4.DVA 5. DConv. Ins. 6. File Number 7. Loan Number GR05 -1197REP 650819427 C. This form is furnished as a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked (p.o.c) were paid outside the closing; they are shown for informational purposes and are not included in totals. D. Name and Address 0 Borrower Daniel G. King Jenny A. King 15 Kensi ngton Dri ve Camp Hill. PA 17011 E. Name and Address 0 Seller o .,.. ..J_ Janasia Irene'Shay by 5{.., Lender ABN AMRO Mortgage Group 2600 W Bi g Beaver Rd Troy. HI 48084 G. Property LocatIOn LLC 317 Stumpstown Road Mechanicsburg. Pennsylvania 17055 Honroe Township. Cumberland County I. Settlement Date 2157 Market Street Camp Hill PA 17011 10/28/2005 101. Contract sales price 102. Personal property 103. Settlement charges to borrower(Iine 1400) 104. overnight 105. wi re Adjustments for items paid by seller in advance 106. City/town taxes to 107. County taxes 10/28/20Ofu 12/31/2005 108. Assessments 10/28/200fu 06/30/2006 7.691.23 25.00 25.00 102 . 56 1.540.62 Adjustments for items paid by seller in advance 406. City/town taxes to 407. County taxes 10/28/20000 12/31/2005 408. Assessments 10/28/2001D 06/30/2006 102.56 1.540.62 279.384.41 271. 643 .18 5.000.00 180.000.00 17.656.00 Adjustments for items unpaid by seller 210. City/town taxes to 211. County taxes to 212. Assessments to Adjustments for items unpaid by seller 510. City/town taxes to 51 1. County taxes to 512. Assessments to 513. 514. 515. 516. 517. 518. 519. 17 . 656.00 253.987.18 The information contained in Blocks E. G. H and I and on line 401 or. if line 401 is asterisked. lines 403 and 404 is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return. a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. HUD-l SETTLEMENT STATEMENT I;) Brainstorm Software 1-540-665-0800 WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 & 1010. SETTLEMENT STATEMENT PAGE 2 ~PAIDFROM PAlDFROM 700. TOTAL SALESIBROKER'S COMMISSION based on price $ 270,000.00 @ 5.5 % - $ BORROWER'S SELLER'S Division of commission (line 700) as follows: FUNDS AT FUNDS AT 701. $ 6,775.00 to Exi t Realty Group SETTLEMENT SETTLEMENT 702. $ 8,075.00 to ERA NRT 703. Commission paid at Settlement 14,850.00 704. TRansaction Fee -ERA NRT $125 (b); Exit Realty $75 (5) 125.00 75.00 801. Loan Origination Fee 0.3750 % Hometown Mortgage 675.00 802. Loan Discount % 803. Appraisal Pee to 804. Credit Report to 805. Lender's Inspection Fee 806. Mortgage Insurance Application Fee to 807. Assumption Fee 808. Hometown Mortgage . processi ng 250.00 809. Hometown Mortgage - app 1 i cati on fee 375.00 810. ABH AMRO - 1 ender acJni nstrat 550.00 8!l. d' frd premium PCC $2340 to Hometown by ABIl AMRO 901. Interest from 10/28/2005to 1110112005 @$ 29.380000 /day 117.52 902. Mortgage Insurance Premium for months to 903. Hazard Insurance Premium for 1 years to . USAA (PCC $615.87) 904. 905. 1001. Hazard insurance 3 months @ $ 51.33 per month 153.99 1002. Mortgage insurance months @ $ per month 1003. City property taxes months @ $ per month 1004. County property taxes 10 months @ $ 48 . 88 per month 488 .80 1005. Annual assessments 5 months @ $ 191.80 per month 959.00 1006. months @ $ per month 1007. months @ $ per month 1008. aggregate adjustment --725.83 111. !lOL Settlement or closing fee to search 20.00 20.00 !l02. Abstract or tWe search to GRSS Ionni (PCC $115) !l03. Title examination to GRSS 1104. Title insurance binder to GRSS !l05. Document preparation to GRSS 1106. Notary fees to cash 10.00 5.00 !l07. Attorney's fees to GRSS (includes above items Numbers; ) !l 08. Title insurance to GRSS (Stewart Title Guaranty) 1,708.75 (includes above items Numbers; ) 1109. Lender's coverage $ 180.000.00 ABH AMRO 1110. Owner's coverage $ 270,000.00 King l!lL endorsements 100, 300, 900 150.00 1!l2. closing service letter 35.00 1!l3. Mary Murray - tax cert (adv by GRSS) 6.00 1201. Recording fees: Deed $ 38.50 ;Mortgage $ 60.50 ;Releases $ 99.00 1202. City/county taxlstamps; Deed $ 2,700.00 ;Mortgage $ 2,700.00 1203. State tax/stamps: Deed $ 2.700.00 ;Mortgage $ 2,700.00 1204. 1205. 1301. Survey to 1302. Pest inspection to 1303. 1304. 1305. 7.691.23 17,656.00 c October 28, 2005 Date REV-1503 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF SHAY JANASIA I. AlKlA JANASIA "JAN" SHAY FILE NUMBER 21 05 0643 All property jointly-owned with right of sUNivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 3,676.25 OPPENHEIMER MONEY MARKET 2. PRUDENTIAL FINANCIAL SAVINGS & RETIREMENT 4,143.91 3. OPPENHEIMER MONEY MARKET 2,964.74 4. 99 CENTS ONLY STORE 250 SHARES @ $12.585 3,146.25 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 13,931.15 REV-1508 EX + (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHAY JANASIA FilE NUMBER I. NKlA JANASIA "JAN" SHAY 21 05 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. 0643 ITEM NUMBER 1. DESCRIPTION PA CENTRAL FEDERAL CREDIT UNION SAVINGS 2. PA CENTRAL FEDERAL CREDIT UNION CHECKING 3. PA CENTRAL FEDERAL CREDIT UNION CHRISTMAS 4. PA CENTRAL FEDERAL CREDIT UNION VACATION 5. PA CENTRAL FEDERAL CREDIT UNION CERTIFICATE OF DEPOSIT 6. 1996 GRAND AM NET SALE 7. WASHINGTON MUTUAL REFUND 8. WEST SHORE TAX BUREAU REFUND OF 2004 INCOME TAX 9. REAL ESTATE TAX REIMBURSEMENT AT HOUSE SALE 10. VICTORIA'S SECRET REFUND VALUE AT DATE OF DEATH 658.65 1,911.54 1,054.87 282.05 5,507.35 2,500.00 32.48 118.24 1,643.18 34.05 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 13,742.41 REV-1511 EX + (12-99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FilE NUMBER SHAY JANASIA I. A/KJA JANASIA "JAN" SHAY 21 05 0643 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS FUNERAL HOME 9,280.00 2. MARIE MAGARO . CEMETARY LOT 775.00 3. GATES OF HEAVEN CEMETARY. BRONZE MARKER 1,500.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 2. Name of Personal Representative (s) STEVEN S. WINAND Renounced Social Security Number(s)/EIN Number of Personal Representative(s) 181-50-0178 Street Address 1107 CHARLES STREET City MECHANICSBURG State PA Zip 17055 Year(s) Commission Paid: 2. Attorney Fees MURREL R. WALTERS III, ESQUIRE 5,200.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS, CUMBERLAND COUNTY 440.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. CENTRAL PENN APPRAISALS HOUSE APPRAISAL 300.00 8. CLOSING COSTS SALE OF HOUSE 17,656.00 TOTAL (Also enter on line 9, Recapitulation) $ 35,151.00 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent SHAY JANASIA Decedent's Name I. AJKJA JANASIA "JAN" SHAY Page 3 21 05 0643 File Number Schedule H - Funeral Expenses & Administrative Costs - 81 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 2. Name of Personal Representative (s) JEROMY J. SHAY Renounced Social Security Number(s)/EIN Number of Personal Representative(s) 183-68-0706 StreelAddress 124 N. FREDERICK STREET City MECHANICSBURG State PA Zip 17055 Year(s) Commission Paid: SUBTOTAL SCHEDULE H.B1 REV-1512 EX + (6-98) . SCHEDULE' DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHAY JANASIA I. A1KJA JANASIA "JAN" SHAY Include unreimbursed medical expenses. FILE NUMBER 21 05 0643 ITEM NUMBER DESCRIPTION 1. PA CENTRAL FEDERAL CREDIT UNION LOAN 2. PA CENTRAL FEDERAL CREDIT UNION VISA CREDIT CARD 3. WASHINGTON MUTUAL MORTGAGE PAYOFF 4. KOHL'S CREDIT CARD 5. WALMART CREDIT CARD 6. VICTORIA'S SECRET CREDIT CARD 7. .J.C, PENNEY CREDIT CARD 8. CAREMARK MEDICAL EXPENSES 9. SHILLlTO'S FURNACE CLEANING 10. MARY MURRAY, TAX COLLECTOR REAL ESTATE TAXES 11. CHASE CREDIT CARD 12. VERIZON CREDIT CARD 13. PNC BANK HOME EQUITY LOAN 14. TIM SULLIVAN BEDROOM PAINTING & REPAIR 15. DANNY GYESKIE REPAIR BEDROOM VALUE AT DATE OF DEATH 1,053.64 1,825.96 44,137.89 742.25 590.06 380.48 1,133.03 40.00 145.00 2,311.30 2,065.12 31.70 21,677 .45 85.00 75.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 79,072.47 Continuation of REV-1500 Inheritance Tax Return Resident Decedent SHAY JANASIA Decedent's Name I. AJKlA JANASIA "JAN" SHAY Page 4 21 05 0643 File Number Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. MR. ROOTER 963.59 PLUMBING EXPENSES 17. AMERICAN RADON SOLUTIONS 650.00 HOUSE REPAIR 18. REM CON 500.00 CONCRETE REPAIR 19. YOUNG'S SEPTIC 175.00 SEPTIC SERVICE 20. ASSOCIATED PRODUCTS 490.00 SEPTIC REPAIRS SUBTOTAL SCHEDULE I 2,778.59 GRAND TOTAL SCHEDULE I $ 79,072.47 ""'-"" ",. '. .COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Y SCHEDULE J BENEFICIARIES FILE NUMBER A NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. STEVEN S. WINAND 1107 CHARLES STREET MECHANICSBURG, PA 17055 .JEROMY .J. SHAY 124 N. FREDERICK STREET MECHANICSBURG, PA 17055 COLLATERAL 50% 2. SON 50% 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size)