IN THE OFFICE OF THE CLERK OF JUDICIAL RECORDS

OF LEHIGH COUNTY, PENNSYLVANIA

REGISTER OF WILLS DIVISION

In re: Estate of	File No.
Deceased

PAYMENT ON ACCOUNT*

1.	Date of Payment
2.	Amount of Payment
3.	Postmark date
4.	Date of Death
5.	Attorney
I.D. No.
Address
Telephone
6.	Taxpayer
Address
Telephone
7.	Signature
Attorney or Taxpayer

*If no estate has been raised, a death certificate is required with this form. The Register of Wills will issue a file number upon receipt of payment.

Rev 7/12

IN THE OFFICE OF THE CLERK OF JUDICIAL RECORDS OF LEHIGH COUNTY, PENNSYLVANIA

Rachel A Wotring

2012-08-15

Lehigh County