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HomeMy WebLinkAbout07-21-06 217 OFFICIAL USE ONLY REV-1500 EX (6-00) COMMONWEALTH OF REV-1 500 PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN DEPT. 280601 FILE NUMBER 21-06-0007 HARRISBURG. PA 17128-0601 RESIDENT DECEDENT - COUNTY CODE YEAR NUMBER D~r;EDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Heller, Rav A. 188-12-4552 z DATE OF DEATH (MM-DD-YEAR) IDATE OF BIRTH (MM-DD-YEAR) w THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C W 1/1/2006 REGISTER OF WILLS u w (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C w 0 1. Original Return 0 2. Supplemental Return 03 Remainder Return (date of death prior to 12.13.82) .... 0:( III 0 04a. 05 " ii2 " 4. Limited Estate Future Interest Compromise (date of death after 12-12-82) 0 l>. U Federal Estate Tax Return Required w 0 0 0 :l: a:: oJ 0 0 U l>. Dl 6. Decedent Died Testate (Attach copy of Will) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes l>. - 0:( 0 010. 011. Election to tax under Sec. 9113(A) (Attach Sch 0) g. Litigation Proceeds Received Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) I- Jijj$$g&tiQNMv$:,l'ijgqQMpgi!;t\tpiA@.PQRRi!;$PQNPit.ii.qijAt.ii.PPPNFlP\tftt!liikt.~iNfQRMAtiQij$B9QgpijtQlR~pt~pt9V) z NAME w COMPLETE MAILING ADDRESS c z Robert G. Frev 5 South Hanover Street 0 NAME (If Applicable) D. FIRM Carlisle, PA 17013 f/) w a:: Frev & Tilev a:: TELEPHONE NUMBER 0 U 717-243-5838 OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) 139,900 2. Stocks and Bonds (Schedule B) (2) NONE '0. , 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) NONE - . 4. Mortgages & Notes Receivable (Schedule D) (4) NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 210,213 -- 6. Jointly Owned Property (Schedule F) (6) NONE '- z Dseparate Billing Requested 0 ~ 7. Inter-Vivos Transfer & Miscellaneous Non-Probate Property .' ., ...I NONE :) (Schedule G or L) (7) , . l- e:' D: <I: 8. TOTAL GROSS ASSETS (total Lines 1-7) (8) 350,113 U w a:: 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 16,063 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) (10) 7,660 11. TOTAL DEDUCTIONS (total Lines 9 & 10) (11) 23,723 12. NET VALUE OF ESTATE (Line 8 minus Line 11) (12) 326,390 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 326,390 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate ,or transfers under Sec.9116 (a)(1.2) 326,390 X .0 45 (15) 14,688 Z 0 i= 16. Amount of Line 14 taxable at lineal rate x .0 (16) <I: - I- :) D. .12 ::E 17. Amount of Line 14 taxable at sibling rate x (17) 0 U X x .15 (18) <I: 18. Amount of Line 14 taxable at collateral rate I- 19. Tax Due (19) 14,688 200 li~~I~~iil;~jl~liip.I~~~I~~;p.~$li~;iiIB~;~~I~~:.I~;~nj~Ilflll ..............................................>>>.....**ae$URe.J'Q:AN$WeR:AtI,;QQe$TtQN$QNReYeR$e~{peANPReQHeQKMAm~.~>..............,.. ece en s omple e ress: STREET ADDRESS 598 South 18th Street CITY I STATE IZIP Carno Hill Pennsvlvania 17013 217 Heller, Ray A. o t' C I t Add d Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 15,000 750 Total Credits ( A + B + C ) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty 4. TotallnteresVPenalty ( 0 + E ) 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 (3) 1,062 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (4) (5) (5A) (5B) AGENT 188-12-4552 14,688 15,750 Make Check to: REGISTER OF PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: 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? If death occurred after December 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration? Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? Yes D D D D D D 2. 3. 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. D No ~ ~ ~ ~ ~ ~ DATE DATE ADDRESS (--- 5 South Hanover Street, Carlisle, Pennsylv' 4/20/2006 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 PS Section 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 PS. Section 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 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. Section 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. Section 9116(1.2) [72 P.S. Section 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% [72 PS. Section 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. 217 REV-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Heller, Ray A. 21-06-0007 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 property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 598 South 18th Street, Camp Hill, Pennsylvania (see HUD-1 statement attached) VALUE AT DATE OF DEATH 139,900 TOTAL (Also enter on line 1, Recaoitulation) (If more space is needed, insert additional sheets of the same size) $ 139,900 217 REV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Heller, Ray A. Include the proceeds of litigation and the date the proceeds were received by the estate. All prooertv iointlv-owned with right of survivorshio must be disclosed on Schedule F. FILE NUMBER 21-06-0007 ITEM NUMBER DESCRIPTION 1 PNC Bank Certificate of Deposit number 31500233414 2 Accrued interest on above account 3 PNC Bank Certificate of Deposit number 31600234704 4 Accrued interest on above account 5 PNC Bank Account number 5140027988 6 Accrued interest on above account 7 Miscellaneous personal property (see auctioneer's invoice 8 Refund of taxes and municipal bills from proration at settlement 9 Refund of service contract VALUE AT DATE OF DEATH 10,620 6 118,641 99 73,807 10 6,123 713 194 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 210,213 217 REV-1511 EX+(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Heller, Ray A. FILE NUMBER 21-06-0007 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 750 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 314 5. Accountant's Fees 6. Tax Return Preparer's Fees 140 7. Expenses of sale of real estate from HUD-1 settlement statement 10,955 8. Auctioneer fee (see invoice attached) 1,623 9. Repairs to automobile sold at public sale 287 10. Utility expenses for real estate sold 869 11. Final medical expenses 1,110 12. Inheritance tax return filing fee 15 TOTAL (Also enter on line 9 Recapitulation) $ 16 063 Debts of decedent must be reported on Schedule I. (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) 217 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Heller, Ray A. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-06-0007 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER 1. 2. DESCRIPTION VALUE AT DATE OF DEATH 2005 federal income tax due 2005 Pennsylvania income tax due 7,534 126 TOTAL (Also enter on line 10, Recaoitulation) $ (If more space is needed, insert additional sheets of the same size) 7,660 217 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER R A H II ay e er 21-06-0007 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 outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Terry L. Heller son 25% 2 Richard D. Heller son 25% 3 Barbara A. Wildon daughter 25% 4 Jeffrey L. Heller son 25% 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 (If more space is needed, insert additional sheets of the same size) IA , U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT UMI:S NU. :i:iUL-ULb:i .,r B. TYPE OF LOAN: 3.~CONV. UNINS. 4.DvA 17. LOAN NUMBER: SETTLEMENT STATEMENT 1.DFHA 2.DFmHA 6. FILE NUMBER: !i!i7q STnl T7 r.nnK O? 8. MORTGAGE INS CASE NUMBER: 5. DCONv. INS. C. NOTE: This form is fUTished. to give you a statement of actual settlement costs. Amounts pa!d to and by the settlement agent are shown. Items marked '[POC] were paid outside the closing; they are shown here for Informat/onal purposes and are not included in the totals. '.0 3/98 (5579 STOLTZ COOK .020.PFD/5579 STOLTZ COOK .02121 D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Jeffrey C. Stoltz and Amy J. Cook single individuals 36 Meadowbrook Court ~k'... Cumberland, PA 17070 Terry Heller as Executor for Estate of Ray A. Heller 598 South 18th Street Camp Hill, PA 17011 I G. PROPERTY LOCATION: , 598 South 18th Street Camp Hill, PA 17018 Cumberland County, Pennsylvania H. SETTLEMENT AGENT: Robert G. Radebach, Esquire PLACE OF SETTLEMENT 3425 Market Street Camp Hill, PA 1.7.011 J. SUMMARY OF BORROWER'S TRANSACTION 11 nn r.Rn<:<: 11= 101. Contract Sales Price 139.900.00 i IGZ. Personal Property 103. Settlement Charqes to Borrower (Line 1400) 6,226.37 104. 105. Arlillstment.~ Fnr ItAms I-'a/rf I:3v :ieller In advance 106. Citv/Town Taxes 04/14/06 to 01/01/07 107. School Taxes 04/14/06 to 07/01/06 11 o~. Municipal Charoes 04/14/06 to 07/01/06 I I v ~ ~ 389.68 249.60 73.29 110. 111. 112. 120. GROSS AMOUNT DUE FROM BORROWER 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: i~iJeposit or earnest monev 202. Principal Amount of New Loan(s) 203. Existinq loan(s) taken subiect to 204. 205 :-2..t 146,83894 2,00000 111,92000 207. '208. '209. Sovereign Bank Federal Savings 601 Penn Street Reading, PA 19601 25-1833632 I. SETTLEMENT DATE: April 13, 2006 K. SUMMARY OF SELLER'S TRANSACTION 400. GROSS DUE <:1=1 I R. 401. Contract Sales Price 402. Personal Property 403. 404. 405. 139.900.00 Arfwstments ror Items I-'am 406. Citv/Town Taxes 04/14/06 407. School Taxes 04/14/06 408. Municipal Charges 04/14/06 409. 410. 411. 412. 420. GROSS AMOUNT DUE TO SELLER 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 501. Excess Deposit (See Instructions) 502. Settlement Charqes to Seller (Line 1400) 503. Existinq loan(s) taken subject to 504. Payoff of first Mortgage 505. Payoff of second Mortqaqe 506. 507. (Deposit disb. as proceeds) 508. 509. r In arlvanr.p to 01/01/07 to 07/01/06 to 07/01/06 38968 249.60 7329 140,612.57 10.95537 Adiustments For Items UnDalrf Bv :ieller Ad/ustments ror Items UnDa/d Bv Seller ~Citv/Town Taxes to 510. City/Town Taxes to 211. School Taxes to 511. School Taxes to 212. Municipal Charoes to 512. Municipal Charqes to ~1'~ 513. . - - 214. 514. '"")' 5 515. -_.---- _ ,t 516. 217. 517. .:18 518. ". ..: 10. 519. ~::" TOTAL PAID BY/FOR BORROWER 113.92000 520. TOTAL REDUCTION AMOUNT DUE SELLER :)uo. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 1301 Gross Amount Due From Borrower (Line 120) 146.838 94 601. Gress Amount Due To Seller (Line 420) '::-:J2.'~ess Amount Paid By/For Borrower (Line 220) (113,920.00) 602. Less Reductions Due Seller (Line 520) 303. CASH ( X FROM)( TO) BORROWER 32.91894 603. CASH ( X TO)( FROM) ~LLERi Tre undersigned hereby aCkn~~;;dge receipt of a completed copy of pages 1 &2 of this statement & an~achmentireferJel to !Jey/in.! Borrower .~ (.1$ Seller .r1l1&J X . .-/-t1) JI.h1 j J.eff. r~. StOltz. /1/. 7 / Terry ~,xec\!o j/-/; ?VJ ~i L:-~t" rf<0 /I ~/ l ~Amy J. cor / ." Estate of Ray A. Heller 10,955.37 140.612.57 1 0 95537, 129,657.20 HUD-1 (3.86) RESPA. HB4305.2 L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price '!; 1 fi'i) F; nnnn % A ~aA nn PAID FROM PAID FROM Division of Commissionfline 700) as Follows: BORROWER'S SEllER'S I; , ) 4.22200 to Jack Gaughen ERA FUNDS AT FUNDS AT 702. $ 4,172.00 to Remax Realty Associates SEffiEMENT SEffiEMENT "03 Commission Paid at Settlement 8,394.00 A i'ransaction Fee to ERA-NRT & Remax Realtv Assoc. 125.00 12500 Note: Line 701 Includes Adjustment of -4,172.00 For hote: Line 702 Includes Adjustment of 4,172.00 For 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Oriaination Fee 0,0000 % to 802 L.oan Discount % to . 2~3 Appraisal Fee to Capital Property Appraisers 300.00 804. Processing Fee to Loan Processing Center 430.00 805. Commitment Fee to Sovereign Bank Federal Savings 650.00 31: : '::;redit Report to Havens MortQaQe Services, Inc. 55.00 a07 Origination Fee to Havens Mortgage Services. Inc. 500.00 '8~6 809. 810. 811. YSP Paid to Broker from Lender to Havens Mortgage Services, Inc. POC $1,259.10b 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 04/13/06 to 05/01/06 @ $ 24.09388Wday ( 18 days %) 433.69 902, Mortgage Insurance Premium for months to S03. Hazard Insurance Premium for 1.0 years to State Farm Insurance Companies POC $429.00b dU4 905 ~OQO. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 3.000 months $ 35.75 Der month 107,25 1002. MortaaQe Insurance months $ Der month 1003. City/Town Taxes 3.000 months ) $ 45.24 oer month . 135 72 < G04. School Taxes 11 .000 months I $ 97.33 per month 1,07063 . 'J05. Municipal Charges 0.000 months @ $ per month '1.>)6. months $ per month 1007 months $ ner month 08. Aaareaate Adiustment months $ per month -32392 1100. TITLE CHARGES 1101. Settlement or ClosinQ Fee to Robert G. Radebach. Esauire 100.00 t : 02. Abstract or Title Search to 1103. Title Examination to 1104. Courier Fee to Robert G. Radebach, Esauire 18.00 11CtJ. Document Preoaration to Robert G. Radebach, Esauire 50.00 1106. Notary Fees to Robert G. Radebach, Esauire 40.00 1107. Attorney's Fees to (includes above item numbers: ) 1 . 'J8. Title Insurance to Lawvers Title Insurance Corn. 84700 (includes above item numbers: ) 1109. Lender's Coverage $ 1110. Owner's Coverage $ 1111. Endorsements 100, 300, 8.1 to Lawyers Title Insurance Corp. 150.00 1112. Closing Service Letter to Lawyers Title Insurance Corp. 35.00 1113. J1Q2 GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 39.50; Mortgage $ 64.50 ; Releases $ 104,00 1202 Cltv/Countv Tax/Stamos: Deed . M 0 ifc:iaQe 1.39900 1203. State Tax/Stamps: Revenue Stamos ; Mortaaae 1.39900 ~c~~ 1300. ADDITIONAL SETTLEMENT CHARGES /' - J 1<-. Survev to .L": // 1",~, Pest Inspection to ,~ .' ) ../ -- -:. 2006 CountvfTownship Taxes to Barbara I-:amilton, Tax Collector ,/' 54287 130.1 2nd Quarter Sewer & Trash to Lower Allen Township / / 85.50 / --'--- - to AON Home Warranty Services / // , :;'::. AON Home Warranty , ./ 40900 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) / // /' 6,226.37 10,955.37 3y signing page 1 of this statement, the signatories acknolNledge receipt of a completed cOp~e2'i:if this two page statement. crp; Ce:~ified to be a true copy. Robe~ :;'l~ach, Esquire ( 5579 STOLTZ COOK ,02/5579 STOLTZ COOK .02 /21 ) /F'./ :r'-- / BRICKERS AUCTI9N Complete Auction Servlce /i CLC- 6 It Auction - Wednesday Evenings 766-5785 Chuck Bricker, Auctioneer TOT AL SALE ~ ;Z 3/ 60 / b 23~ DO SDD,DO COMM. CLEAR. 11 III ~~~ ~2l~ ] Dl C/) dj-;; rn ,ou u;. ~ I ~ uz' f"\ zli () ~ <l; """"'"" IO..U rn I' ~ e ~ ~~ " .. ~ I () ~ ~ ~o' &: - I 'I . ____~] I~~~=c'~='~~-r_~~~-~" ,~,,.--=___~ ,CT J DATE-J - .3\ - 0 0 PHONE l-:aS ISSION ; HEREIN CONTAINED, IT IS AGREED BY o the best and highest bidder to the public sale Jerty offered for sale. hat they may make with respect to said made on the part of the Owner. J the sale or discontinue the same during its ,d as necessary to obtain bids. agreement. ~ ickers Auction --- ... $_ Erica L ,... SchlegellConsumer/PGH/PN C 02/14/200610:34 AM Estate of Ray A Heller (Deceased) SS# 188-12-4552 DOD 01-01-2006 To Matthew Stine/Consumer/SCP/PNC@PNC cc bcc Subject Date of death balances ACCOUNT NUMBER * DATE OF DEATH BALANCE + ACCRUED INTEREST CDS #31500233414 CDS #31600234704 DDA #5140027988 $10,619.51 + $6.04 $118,640.80 + $99.46 $73,806.88 + $10.44 If you selected the balances to be sent to the "Branch" they will only be sent to The requestor by Lotus Notes. Have a great Day!!! :-) 1It, ~ ~ eM/i4e<<ee 4114 de fII1I/l{"9"e4~ ~ kits ~. 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: FREY & TILEY 5 SOUffi HANOVER ST CARLISLE, PA 17013 Qty 1 Fee Description Additional Probate InvoiceNo: Invoice Date: Estate of: Estate No: Fee Total $100.00 100.00 Total: $100.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. 964 7/21/2006 HELLER RAY A 21-06-0007 aJw