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Home My WebLink About01-26-07 (2) . . , REV.l5DO EX (6.001 W f- lI::SCIl U"lI:: WQ.U ;rOO U"...J Q.1Il Q. <I: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 .- Z W C W U W C DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) ADAMS F\R..'i J DATE OF DEATH (MM-DD-YEAR) 0<0 -If.o-2-00<.o REV-1500 OFFICIAL USE ONLY INHERITANCE TAX RETURN RESIDENT DECEDENT 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) FILE NUMBER l--1-~~ COUNTY COOE YEAR ~ ~ 5' ~~ NUMBER SOCIAL SECURITY NUMBER 19~ - 1'2.. z-rs'Z- DATE OF BIRTH (MM-DD-YEAR) 0(..;,-1[- leur{- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ 1 Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach ccpy of Will) D 9. Litigation Proceeds Received o 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12.12.82) o 7. Decedent Maintained a Living Trust (Allach copy of Trust) D 10. Spousal Poverty Credit (date ot death between 12.31.91 and 1.1.95) D 3. Remainder Return (dat' 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 Sec. 9113(A) (Attach Sch 0) z o ~ ...J ~ .- ii: <C u w a:: f- Z W o Z o Q. CIl W " " o U NAME r6.5&~ T IYlACK. FIRM NAME (If Applicable). Jl M -eRBERrCH C/. I't :ssoc/A-rE' TELEPHONE NUMBER J 17 - (PS'2- - q <0<12... COMPLETE MAILING ADDRESS PO BOX. foSC(S PC, H:AR.R IS BtJ 1<.6-. PA , 17 {12. 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. JOintly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (1) \"1 3 500.00 (2) 0 (3) 0 (4) 0 (5) <3 5,07 ,.-/--, GO (6) lq Y-9Z,! + (7) 0 (8) (9) -33. +31 w.-, ---::; . I (10) S 0 't s, f.a5 OFFICIAL USE ONLY 1"-) c;,;;- ~':) --..I c_ C~) ~? N C/', ::::'-" w N ~l'251000,lY- 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (11) 38 q~3.02 (12) -;2. 3 9 5 23 ~l, (13) () (14) :2-39 583 ~b z o ~ ~ ~ a.. ~ o u g 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) 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 .0_ (15) ~3c1 5 '6 3. 1-:> l. x.O~ (16) x .12 (17) x .15 (18) (19) 01'3\,-2....<0 10 l 2 \ 2h 20,~ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS '1[3 ALL e;J <T /0. .,' r 0." f~.. t.-s::. CITY N E..uJ C. UM B;:..R.LAJJJ:> I STATE PA- I ZIP /7670 Tax Payments and Credits: 1. Tax Due (PCjge 1 Line 19). 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 13000.00 5 J or ,0 0 Total Credits ( A + B + C ) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( 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) (58) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT ) 0 I 8 I 2..6 3 53.(~.n(:l o 275730 o cJ 2. -157. :6'0 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;................ .................. ................................ .... . 0 b. retain the right to designate who shall use the property transferred or its income; ..................... .. 0 O. retain a reversionary interest; or............................................................................... .................. .................. 0 d. receive the promise for life of either payments, benefits or care? ..................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ......................................................................................................................,. 0 No ~ ~ ~ ~ ~ [3 ~ 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 retum, including accompanying scheduies and statements, and to the best of my knowledge and belief, it is true, correct and compiele. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. \..SI~NATURE OF Pf;R~ON R{P~NSIBLE FOR ,~~ING RETUR ADDRESS S ,,) SIGNATURE OF ADDRESS 1-/1 to: /) /-~1 I -, c.' I f c/'~ A R. R (S BI) t<:(~Pt\ /7 )/;~TEi.' _ 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. 99116 (a) (1.1) (i)J. 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. 99116 (a) (11) (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. 99116(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, 99116(1.2) [72 P.S. 99116(a)(1)J. 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. ~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. '":V'1502 EX. 16.,,* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF MA R'(' T A,NS AbAMS FILE NUMBER 2- I 0 to 00506 All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is delined 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 li,urvlvorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION q I g A I-Lf rJ STitES!, tJioJ CUfi18fRLArJb I PIi n(nO 5E.S J4/IAC1tt.-D Sf3.-T-rL~~C,^J, 5rA1/;'M~I'J'- VALUE AT DATE OF DEATH /7 3.s0 <J. 0 c) TOTAL (Also enter on line 1, Recapitulation) $ / 7 3, SO () I {) tJ (II more space is needed, insert additional sheets 01 the same size) REV.150IlEX. (1-97) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ADAMS FILE NUMBER "2--l 0(0 0 OS-toto COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATEOF MA R Y TANt:. Include the proceeds of Ii~ga~on and the date the proceeds were received by the estate. All property jolntly.owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. z. 3. 4-, 5. ~, 7, C6, C1. 10, \ \. VALUE AT DATE OF DEATH DESCRIPTION (VI i T BAN K (, HECK IN <:, A C.CQ UN! + fJ. ,-cR.utl) \I"TtR~::>1 lACe. OUNI :t:t.:- 10 I Sb 4-l6'6) .5~2 f/-TTAC.,i-f'c.[) <232.<a.2S" (VI $. T BPu.JK:.. (~to.TI F/CATl of D&.eO'S(I-t..AccRUEb ItJT (ACC.OUNT 03100 39lL..}-qlol q II ) 5Ef- !+TTAu'';~D. /'1-2.'13.72 1 f'lTt.-Q:. R (l~ B AN I( ( Ac..CdUN.tt:: "Z-e>\ ooq 2>38) Sf c ATTAC H Sb 10 3"2- 2. , 4-4- IN T c G> RI TY 13 A tV K, ( I\c. COUNl 4::\:: 100 bO L}7) 5:0 I oy. S;:-"2- [. K I E.- / N SUR A tJ c S .... K f.. ~U}.j h IOS",oo Cc?iY\CA.sT ~ et:t)N ~ G'3. It E. e I E.. INS, J R A tJ c e - R E..- F'U N D lC1l.oo iJ G I - 73 A LAj.) E. of AC.COuN T REf=UN'D -z.. t.f ( . q <0 p, s. (M 6 J R.. $ SM. E;J r "r R ~ A L. ~ ":::> "n.\ T S fAX a:. S 04-5.0 I ~ f_ I .'"'\ B v k $ E!to, E,j T' t) += \J T I L.. , T Y I -rP. A. .s. t-\ 2- S:-. S; 9 'PcRS6lJJAL... PRO(;)ckT'y' H-O()SE,...l--~o(,..b Fui<::.,.JITUR.c Soo do TOTAL (Also enter on line 5, Recapitulation) $ <6 s: 0 [4. Co 0 (If more space is needed, insert additional sheets of the same size) REV.1509EX. (1~7) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNS) LV ANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MAR.l.( TANE. A.DAMS FILE NUMBER 7- \ C) Ia 0 0 5""f.:J b If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G, SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A <::"ARo/... A p (6 tV TJ<ow 5 K I go P.E:E:.R rl S L;) c- A-M P H IL(. PA R:D, /70/1 DAU6t+TcR.. B. PA'Ti?IC!A A f-1t..SSLER. CJ 04- P g.A c e DR fV} E; C HAN IC$ E vI?. er- r Pr1 170 S 5" D 11 J6 /iT::: 1< c. JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or simiiar identifying number. Attach DATE OF DEATH DE CD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A. )., -ltf-a5 /J1.Jtr SAt1JK C~AnPIc-ItTi:- 'llF p~p. (Acc..outlr:J:t:. 031003'1I3J3003Z.) SS3Z .07 50% L7c;,Co.oL(- S E f. A -,-r A c. I+e. 0 z. A. 1t.-21-0) rU!-lof'l BANr<. c. f;.P.TIF=fC!+T?; oFD'6P (A-cco U jJ T -Jt- (?"2.-"Z.;:' O/S /209) S-o, /77.3 z. I r...,(,f., 7 ?3103,o .5~~ J4 IrA C I-ft-.D "3 i3 r2..-'ZI-o I PUL TON BAN I( G&RTIt=Jc,4-Tf D(. DcP 50, /77.32- 1t..(,(.7 g 3L:."3 ,o!;; L A <:.<:. en)"'" oott C>'2-2.- 015'/809) SSe A-,...,-A c..H- f..,j) TOTAL, (Also enter on line 6, Recapitulation) $ IgY-~7-,\4- ~ (If more space is needed, insert additional sheets of the same size) REV.1511 EX+ (12.99) . * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF frlAA t( fAfJi- f-)DAM's Debts of decedent must be reported on Schedule J. FILE NUMBER ;;;2..1 - 0 Co - (j 05(" (., ITEM NUMBER A DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: PARTtH:..M oR '2.. FtJtJ.f:-RAI... l-IoMf.. f<<f:..c€.pnoN - pAT/I r-ic.sSL2R. f;-ATt--S Or:; l-fff+Uf..-,J- rtt.-ADSro,Jz... /D7Cfr...00 250 00 q..so .00 B. ADMINISTRATIVE COSTS: 1 . Personal Representative's Commissions Name of Personal Representative(s) Sociai Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2 Attorney Fees BAN 6 S LAw "F F I C. t...- '3 COO. 0 0 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. CVlt1l5El<..lANb LAc..J ToUR.Alr'H.. LADV:E.R..TISlN0) TfH SS-rJTIN e'- LA Pv'(R,T1SI,J6) ~ E G I STt. R. 0 r.:: WI I...l.. S (F, l...uJ 0 F t. t.:;, ) 5 ~. E:. A-->Y 7 fi c. r-! '1::)) 750CJ IlS'.'ZS- ~S-I.o.. 0 0 I'~ ZqS; (2. s, 9, 1.0. TOTAL (Also enter on line 9, Recapitulation) $ 3 3 4- 31. 4-'3 (If more space is needed, insert additional sheets of the same size) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS MARY JANE ADAMS 21 0600566 10. Maintain home for sale: Borough of New Cumberland - refuse Comcast UGr utilities J ames Grossman - maintenance and cleaning P A Water - utilities PP&L - utilities Erie insurance - property insurance Keystone Petroleum - fill underground tank 11. Era-Nrt, Inc. Realtor commission 12. 1 % transfer tax for sale of home 13. Stone Lafaver & Shekletski - tax certificate fee 14. Era-Nrt, Inc. - Transaction fee 15. New Cumberland Borough - refuse 16. Sewer payment at settlement 100.06 143.04 615.00 460.00 108.81 278.01 393.00 2825.00 10410.00 1735.00 5.00 165.00 38.60 18.60 REV.1SI2 EX. (1.971 '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ADANIS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARY IAJJc FILE NUMBER ":2..1-00-.oo5"fof.o Include unreimbursed medical expenses. ITEM NUMBER 1. :2.., '3, 0, ~, 0, 7. DESCRIPTION (RlrJl4 5;+US-r/t-<, lCAk.~'<-:(;.:;"UE.Kj GI4,II./C)q ;,),;T C.L'2IiRf'b JANlf-,S, 0k....O~:>SIVil.\N C(T)AltJT'ii:N{:Ir-.JCE..) c..K /'f-IO NOt ct.-EARE.D f P 8: L ~ r t t.. ( TIE: So.) c K.. / L./-I! AJ 01 e.. LeA R. E D f'p.. ?M~KICAJoJ uJAT~F~(UTILI'IC::') cK (4-1.... J.Jo'- C.L'CA{.I..~D 1P-lrJt+ SH/).sTI~(CARZ:6:\JF:-f~ FINAL) RoBe-RoT GASP,ER E..TTI T-Prx c..OL.LE.-c.rOI2..(sct+OoL DeST.- r~)CG..;:") V~R.l7-c>tJ (TSt...'e.PH-ONS) AMOUNT t Co OQ. 00 j 2- 5. 0 <:'> Q7,'f( Lf-3 .3, / \ '1 00.00 J 2. (pS. 04- , y... 29 TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ SOY-'S,bS R5V-1513 EX+ (9-00. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF M p,R.Y NUMBER I :JAI\IS AvftM..s FILE NUMBER -LI - (:)f.c, - ooS:r:oL RELATIONSHIP TO DECEDENT NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] &"LIZ-A8f..TI+ ;-I, .ADAMS DAU"'rf.T~~ 1. L Gf...ORb~. J A t:> (\ M .:s ~ TCD-I-\r-\ D AbA.MS >-/. t.f- (YIARy ANN -z... ( /VI tV\. ~ (c... /'r1. A JJ 5. PATRtCIA. A H E.. .s..s l ( K 0, C A R...Q L A r~ ION'" J(Ot...u.5 K I .s o/'-J 5or-.1 DAtJbl-tT'E..R. DAJ6UT~k DAd 6I-tTE-.R AMOUNT OR SHARE OF ESTATE ,/ to T)I 0 F R. &.S /l) i,).{\(<..y E.. STA'i-'L 1/1 ~r4o F R ~ S: I 1:> uP" f... ',' 1..0 E. (';:""1:" /-,,," ~:~ \k T'6~ R&$I'DuAR. Y ,E.-:::.TAT ~ X, T ~F Ks..s, DiJ A R.. '-( E .s TA-Tl:.. 50do,00 A..v D l/<.,TI-+OF= I< t.-<;: /DuA R.Y c:s-rA-, ~ s 0 00,00 AND 11<.0 --(J1~)f' A E;;.. I [:, \J P- f:' '1 Es'-r,"::. T C 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) REGISTER OF WILLS CUMBERLAND County, Pennsylvania CERTIFICATE OF GRANT OF LETTERS :., ~"">f' " ~ ~ .;,.. t,' 01>" ..,.... , '. ':"'. "'t. .. ~#I ~. .. . .. " ~' ~ . ~ No. 2006-00566 PA No. 21-06-0566 Es ta te Of: MARY JANE ADAMS . if,~ ,,; . ~ ~~ : "'- "".. ..-... ':- ~. ",.."., ".,.- - ..~- ~"'.1' ., ..... ....-- ;-.."-.,::" /.>-.,..,.... /, - ..~. ":..~ ......-,."':... - ...,{>"..;,!,~ ""f,~~<~~"fIo;~ 4' \, (First, Middle, Last) Late Of: NEW CUMBERLAND BOROUGH CUMfjERLAND COUNTY Deceased Social Security No: 183-12-2752 WHEREAS, on the 23rd day of June 2006 an instrument dated September 12th 1995 was admitted to probate as the last will of MARY JANE ADAMS (Fi,st, Middl.. LutJ la te of NEW CUMBERLAND BOROUGH, CUMBERLAND County, who died on the 16th day of June 2006 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH for CUMBERLAND County, in the Commonwealth of certify that I have this day granted Letters PA TRICIA M HESSLER and CAROL F PIONTKOWSKI who have duly qualified as EXECUTOR(RIX) and have agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VAN/A. Register of Wills Pennsylvania, hereby TESTAMENTARY to: in and IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 23rd day of June 2006. .",Jj(f!juia Laiiy(!J. ~fL<LI?:U.~ ' eglster 0 ills 0 '-.'/ '-./~~e /(1 ~4-d, &~luif- eputy **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) LAST WILL AND TEST AMENT OF MARY JANE ADAMS I, Mary Jane Adams, of the Borough of New Cumberland, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do make, publish and declare this my Last Will and Testament, hereby revoking any Wills by me heretofore made. ITEM 1. I direct that all my legal debts and funeral expenses be paid as soon after my decease as may be found convenient. ITEM II. I give my Executrixes, hereinafter named, the power to dispose of my personal property by giving part or all of it in kind to my children or grandchildren as they in their sole discretion deem appropriate. ITEM III. I give, devise and bequeath unto my daughters, Patricia M. Hessler and Carol F. Piontkowski, each the sum of $5,000.00. ITEM IV. I give, devise and bequeath the rest, residue and remainder of my Estate of whatever nature and wherever situate, in equal shares, among my children, per stirpes. ITEM V. I appoint my daughters, Patricia M. Hessler and Carol F. Piontkowski, Co-executrixes of this my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this / J i/ day of .~n~/ , 1995. /') / /~ l~~-{ {/q' t:k///!.~ ]~~; ADAMS 1/ The preceding instrument, consisting of this and one other typewritten page, was on the date thereof signed, published and declared by the Testatrix therein named, as and for her Last Will, in the presence of us, who at her request in her presence and in the presence of each other, have subscribed our names as witnesses hereto. Residing at ~L Ge-. /7o;)s'- , 56578-1 I I ~ettlement Statement S. ~ofLoan U.S. Department of Housing and Urban Developmenl OMS A rova/ No 2502.0265 (expires 9/30/2006L. se Number r-- 2. OFmHA 3. OConv. Unins. I 6. File Number I 7. Loan Number J 8. Mort9ag~'lnSU~~~;~a 1. OFHA 4. OVA 5. OConv. Ins. 28289PIRNIK ~-, .. ---.0;, 0'"''' u,""noo.~~.~v. you . I a. "~n 0 a.<,ua'.,..".m.~, <a' ,. Amoun 'PlIO. 0 ana oy ". u,"emenl aoen I a,e 'n.own I TilleExpress S c. NOle: Hems mark.d~(p,o,c r were paid oulsid~ 1110 ClOSing; tney are shown here lor IOfOfmahon purposes Bnd aro nOllncluded In Ihe 101"'5 :~~~~nGc~~':n~J~~~: \fn~n:~7~~~~~~~~~e F '::~;::'~I~~~I~u~nli~~s~alc:;~ ~~~I~na~600"~'~d'~~~~~';~'16onaU'o, upon P~,!I~d J.9/}_1/2 o NAME OF BORROWER LOUrS C. PIRNIK, JR. and BARBARA W. PIRNIK _~.Q.~ESS 121 Parkview Road, New Cumberland, PA 17070 ___u_ E NAME OF SELLER: CAROL F. PIONTKOWSKI and PATRICIA M. HESSLER, Co.Executrixes of the Estate of Mary Jane Adams ---.6QORESS: --"--- F. NAME OF LENDER: New Century Mortgage Corporation I-_A.Q.Q~~: 18400 Von Karman, Suite 1000, Irvine, CA 92612 -...-- G. PROPERTY ADDRESS: 918 Allen Street, New Cumberland, PA 17070 New Cumberland 8oroUQh H. SETTLEMENT AGENT: Cedar Cliff Abstract Agency, Inc., Telephone: 717.774.7435 Fax: 717.774.3869 PLACE OF SETTLEMENT 414 Bridge Street, New Cumberland, PA 17070 -.-. "---.-.- I SEITLEMENT DATE 10/31/2006 1-'--.--nUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTI _100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER ~... ..J.Q~nlracL~!!(~s price 173500.00 401 Conlract sales price --- - .. r-!-Q.2. Personal Property 402. Personal ProDerty ---- - - .1.0}.._,S.!l~fT)!lnt charges to borrower (line 1400) 5411.16 403. f-l.04 404. -----. c-l05 405. Adjustments for ilems paid by seller in advance Adiustments for items pai~~~~i~,advan J.9i-.f!!Y./lown taxes 406. CitY/lown taxes '- r'-" 107. County taxes 1 0/31/0610 12131/06 106.26 407. Count v taxes 10/31/06 to 12/31/06 .-- rJ.Q8 Schoo/taxes 10/31/06 to 06/30/07 838.73 408. School taxes 1 0/31/06 to 06/3Q1.Q~ .-..--- - 109. Trash Proration 10/31/061012/31/06 25.59 409. Trash Proration 10/31/06 10 12/31j.QL-. -----.-- 110 410. -- 111. 411. -_'n ,- - . _ll.L___. 412. u___ '_ 120. GROSS AMOUNT DUE FROM BORROWER 179881.76 420. GROSS AMOUNT DUE TO _SELLER ---- - ----.-, ,.--- - --..- _?OL~MQll.~l~ PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO,Sg~~r-"_ 201. DeJ)()sil or earnesl money 2 000.00 501. Excess DeDosil (see instructions I . __ 202 Principal amounl ot new loans 138 800.00 502. Settlement Charges to seller (line 1400) .- '-~_.. "'?'Q3 Existing loan(s) laken subjeclto 503 Existino loan(s) taken sUbject to n____.._. 204. 504. Payoff of First MortgaQe Loan -. t-- 205. 505. ..---.. -.J. 0 6 506. ~----- ~7 507. -'-,--- 208. 508. -- ---. --- 1-109 509. -.--- Adjustments for items unpaid by seller Adjustments for Ite~!J!.l!Paid.Ei' ~ell~r._ 210 CilY/lown taxes 510. Cily/town taxes - f-1.1.1-,-~.!!nty taxes 511. County taxes .----- ~, SChoollaxes 512. School taxes .-- 213 513 ".--.- 214. 514. -.."-- 215. Sewer Prtn 1 0/31/06 10 12/31/06 18.60 515. Sewer Prtn 1 0/31/06 to 12/31/06 --. f-- 1--216 516. '-----. 217 517 '- . -.- r-l18 518 - ---.-- -- - - 219 519. .1,2,0. TOTAL PAID BY/FOR BORROWER 140,818.60 520. TOTAL REDUCTION AMOUNT Q~S.l;.LgB-'-:c-_,_ ~().o. C~,SH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER ~Gross amounl due from borrower (line 120) 179681.76 601 G,,,, ""'00"""".'" "00 4101 - .-1- ..... ~L..L~~s amounts paid by/for borrower {line 2201 140818.60 602. Less reduction amount due seller (line 52~ --=' ," ,-~9}.S_~~JROM BORROWER 39,063.16 603. CASH TO SELLER -- ell/ernenl Sysle Og6.a!..!.J 14. Cl ok--- - 173,500.01 ce 106.2E 6387: 2555 _,174L470.60 __.12,353.60 18.60 ,_ 12)372.20 _.174,470.60 _ .12,37,2.20 SUBS mUTE FORM 1099 SELLER STA TEMENT: The in'<>m1alion conl.ined herein i, impo<1lnl.., ,nlo,m.'ion en<ll, boing furniShed 10 Ihe Inlernel Revonue SelVice It)'Ou..o f'~u'o<ll" 1010 "'''Un, I n'9'igence p.no"y 01 olhe, sanclion w" be impoled on you ,f Ihi, ilem illGqu.od 10 be 'oport.d ond Ihe IRS dOlormlnUlhal.i1 h.. nol beon reponed The ConU.cl SalO' P,ic. uuse,flood .", lIne <40 I obo...tl COI1SlilulU Ihe O'OSS Pfocfeds ot this lr.anuclion. _ 162,098.40 ~~;;,~:~ ':o~u~~~, ~~ r~:b:~~r~;~=i,'~~ ~,~:::,~':::'~~:2,70~~ (i:~,T.a; ~~ I~~. Undo, ponaU". orpo~~:~ ,v:~i;~;~~~' r~.'~~~~~~~~~~'~~n I~~~~~~,d~~~~~~,~: ,~v;.~~;':~I'iI:~;~~:'~;~:',~:~;I'" I.vo m~ ',_.._____1.__.._ -_. .____ SELLER(S)SIGNATURE[S) SELlERISI NF.W MAILING AOORESS' ._'_._._. ______.____.. SEllE"R(SJ PHONE NUMBERS ..IHI____ ,Wj DE E OPME T F'I N b 28289PIRNIK A1DEPARTMENT OF HOUSING AND URBAN V L N Ie um er: ETTLEMENT STATEMENT Title Express Settlemenl Sj'slem Prinled 10/31/20.Q~W?~~4Jl T ;r. SETTLEMENT CHARGES PAID FROM PAID 700 TOTAL SALES/BROKER'S COMMISSION based of1Jlrice $173 500,00 (1i) 6.000 = 10410.00 BORROWER'S SELL f-: ' Division of commission (line 700) as follows: FUNDS AT FUN 701. $ 1~410.00 10 Era.Nrt Inc. SETTLEMENT SETTL 702. $ 10 '-- -- . 703. Commission paid al Seltlemenl __ ____1 r-!Q9. ITEMS PAYABLE IN CONNECTION WITH LOAN ...._- 801. Loan OriQinalion Fee % ---- ,-~02. Loan Discount % --- -. ..,. 803. ~aisal Fee -- -'-.-.-- 804. Credit Report -_._--~- ---'- 805. YSP ....fJ.d...Qt!.DR 10 10 Bentz Mortgage Group $2 776.00 POC by Lender ,- 806. Processino Fee 10 Bentz Mortllalle Group ~95.QQ. r--- r. 807. Underwrlling Fee 10 New Century Mortgage Corporation LR 30_0,Q~ _ _ ~~umenl Prep Fee 10 New Century Mortgage Corporation LR 300J.Q..r- 809. Flood Cert Fee to New Century MortQaQe Corporation LR 11.?Q e-810 Processing Fee to New Century Mortgage Corporation LR 200.Q.9 __ ___ 811. Tax Service Fee 10 New Century Mortllalle Corporallon LR 78.00_____._ 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE ~--- - 901. Inleresl From 10/31/2006 10 11/01/2006 @$ 40.2100 Id~ 1 DClys LR 40.21 -..-- 902. MortQaoe Insurance Premium for to 903. Hazard Insurance Premium for 12 10 514.00 h__.. _.._-~. 904. 905. -- 1000, RESERVES DEPOSITED WITH LENDER FOR mo.@$ _.. --.-- ~azard Insurance 42.83 Imo mo.@$ U_"'__' 1 002. MortQaQe Insurance Imo mo. (1i)$ ..--- '-- 1003. Ci!Y.Property Tax /mo -..-..-- 1004. County Property Tax mo....@. $ 53.00 Imo --. 1---... 1005. School taxes mO.@$ 105.42 Imo ----- ----..- 1009. AOQreQale Analysis Adjustment 0.00 1100. TITLE CHARGES ..-------- -- . ...-.---- 1101. Se"lemenl or clOSing fee -..--....- -U.92. Abslract or lille search --. 1103. Tille examination -"'-- 1104. Tille insurance binder .-_.____n... 1"-11.05. Documenl Preparalion -- 1"-- -_. ~Notary Fees ..--- -_.. "-'---'- 1107. Morn~'s tees ---- -.-- (includes a~_ve items No: ) ~-.- ---- 1108. Tille Insurance 10 Cedar Cliff Abstract Agency, Inc, Lm..!5 -'--'-. -_.- (includes above items No: Basic I 138 800.00 --...... - 1109. Lender's Poli9' . 1110. Owner's Policy 173 500.00 .1228.75 1111. End 100 End 300 End 900 to Cedar Cliff Abstract AllenCy, Inc. 150.00 1----.- 1112. End 710 10 Cedar Cliff Abstract Allen~ Inc. .----.-. 50.00 10 Cedar Cliff Abstract AllenCy, Inc. .... .... ---~ ----.,,-.--. 1113. ClosingSvcLtr 35J_L__ ~200. GOVER_NMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees Deed $ 38.50 . Mortgage $ 80.50 . Release $ 1 :;::t;>, 1202. City/Counly lax/slamps Deed $1 735.00 ' MortaaQe $ 1203. Slale TaxJs~alT1Ps Deed $1 735.00 ; MO[tgage $ 1204. 1205. ...JlQlLADDITIONAL SETTLEMENT CHARGES 1301. Su~ey '-.-- r-D02. PesllnspeClion -- ------- 1303. Transaction Fee 10 Era.Nrt Jnc. 165.00 1304. Tax Cert Fee 10 Stone Lafaver & Shekletski 4..______.... 1305. ETF Fee to Slone Lafaver & Shekllltskl -- 1306. Fed.ex/wire (ee 10 Stone Lafaver & Shekletskl -----~.MQ. '---'--- 40,.0.9 ~Q7. Trash OcI.Dec-06 10 New Cumberland BorOUllh 1----- "_. .-- 1400, TOTAL SETTLEMENT CHARGES .lenter on lines 103 Section J and 502 Section K) 5411,16 ~.--_J?1. ./ lully rev_~", Selllemenl Sla'emenl end 10 'he be.1 of my kno~edge end belief, II II lrue and OCcure'e "e'emen' I all rece,p" end dllbIJrsemen" m.Oe un my ace""", '~'c:ri':F~"-"~"'~""'."_.~'- J. . _.__ ..u.. ,,"~=a. t!~ ./ ry ane am~ PAGE FROM ER'S OS AT EMENT OJ.4to, 01 0,00 . ,-. "J --- -- I 735.00 165.00 _~.OO '.. -. '.---1 ~_.._.- _38.60 353.60 m M&TBank 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888) 502-4349 Fax (302) 934-2955 August 29, 2006 Mack Gerberich & Associates PC Certified Public Accountants & Consultants 1342 North Mountain Road POBox 6595 Harrisburg, Pennsylvania 17112 Re: Esrareuof:1r1t[f'y Jane Adams Social Security: 183-12-2752 Date of Death: June J 6, 2006 Dear Sir or Madam: Per your inquiry dated August 24, 2006, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: I, Type (if Account Checking Account A ccount Number 10.156488 Ownership (Names of) Mary Jane Adams * Opening Date 0.8/28/64 Balance on Date ojDeath $8.325,86 Accrued 1nterest $ 0.39 Total $8,326.25 Type ojA ccuunt Certificate of Deposit Account Number 0.310.0.3913130.0.32 Ownership (Names of) Mary Jane Adams * Carol A Piontkowski * Opening Date 0.2//4/0.5 Closed 0.7/0.3/0.6 Balance on Date of Death $5,30.30.2 Accrued 1nterest $ 2290.5 Total $5,532,0.7 3. Type of Account Certificate of Deposit A ccount Number 03/0039/496797/ Ownership (Names of) Mary Jane A dams * Opening Date 0//30/06 Closed 07/03/06 Balance on Date of Death $ / 4,000.00 Accrued interest $ 243.72 Total $/4,243 72 Please be advised, there was no safe deposit box found for the above decedent. * For further account information, regarding ownership, closures and/or reimbursement of funds, etc" please call the West Shore Plaza Office # 7] 7-255-2271. Sincerely, ~~ Nancy Clagett Records Management . cr IntegrIty BAN K July 12,2006 Chris Chrien P.O. Box 6595 Harrisburg, Pa 17112 Dear Ms. Chrien, Enclosed you will find J2e information you requested in regards to the Estate of Mary 1. Adams. As of June 1~,2006 the balance of account 201009838 was $10,322.44 and account 1006047 was $50,104.92. If you need any further information please feel free to contact me at 717-920-4900. Sincerely, ~~ Eugene Morris Assistant Branch Manager 3345 Market Street, Camp Hill, PA 17011 . Phone: 717-920-4900 . 877-1- HAVEIT . Fax: 717-920-4904 . www.integritybankonline.com . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 06-0566 ACN 06140465 DATE 06-11-2006 lEY-IUS EX IFP U'-OIl PATRICIA A HESSLER 904 PEACE DR MECHANICSBURG PA 17055 TYPE OF ACCOUNT EST. OF MARY J ADAMS 0 SAVINGS S.S. NO. 163-12-2752 o CHECKING DATE OF DEATH 06-16-2006 0 TRUST COUNTY CUMBERLAND !Xl CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WIllS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 FUL TON BANK has provided the Depart..ent wJth the infor..atJon Usbd below which has been used in calCUlating the potential tax due. Their records indicate that at the death of the above decedent, yoU were a joint owner/beneficiary of this account. If you feel this infor.."tion is incorrect, please obtain written correction frail the financial institution, attach a copy to this for.. and return it to the above address. This account is taxabla in accordance with the Inheritance Tax Laws of the Co....onwealth ofP"ennsYl vanill. QuestJons IISl1" be answa.4d .by "cal1U>g_L7~_Zll~_8~. __~___.""____. "d'"" COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 022-0151609 Date 12-21-2001 EstabUshed Account Belanca Percent Texable Amount Subject to Tax Rate Potential Tex Due x 50,177.32 16.667 8,363.05 .045 376.34 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice Bust accollpany your paYBant to tha Register of Wills. Maka check payable to: "Register of Wills, Agent". Tax x NOTE: If tax pay.ents are .ade within three (3) Bonths of the decedent's date of death, YOU ..y deduct a 5% discount of the tax dua. Any inheritance tax due will becoBe delinquent nine (9) Months after the date of deeth. PART m A. [ CHECK ] ONE BLOCK B. ONLY c. c=J The above information and tax due is correct. 1. You .ay choose to r8llit paYBant to tha Register of Wills with two copies of this notice to obtain a discount or avoid interest, or YOU Mey check box "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Departaent of Revenue. ~ The above asset has been or will be reported end tax paid with the PennSYlvania Inharitance Tax return to be filed by the decedent's representative. c=J The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART @J TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable" 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Texable 7. Tax Rate 8. Tax Due PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF I 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID I TOTAL CEnter on Line 5 of Tex Computation) Under penalties of perjury, I declare that the complete to the best of my knowledge and belief. I $ T^VD^VCD C'TC1IATIIDC' facts I have reported above are true, correct and HOME ( ) WORK ( ) Tr:'II:'DUnur- UIIU"r-n -.-- COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 06-0566 ACN 06140486 DATE 08-11-2006 REV-1543 EX AFP m-DDl CAROL A PIONTKOWSKI 80 DEERFIELD RD CAMP HILL PA 17011 TYPE OF ACCOUNT EST. OF MARY J ADAMS 0 SAVINGS S.S. NO. 183-12-2752 o CHECKING DATE OF DEATH 06-16-2006 0 TRUST COUNTY CUMBERLAND [Kj CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 FUL TON BANK has provided the Depart..ent with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, yoU were a joint owner/beneficiary of this account. If yoU feei this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of PennSYlvania,.. lluesUons...ay be ..nswered by calling (-l-l.7r 787-"'t7. COMPLETE PART 1 BELOW I( I( I( SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 022-0151809 Date 12-21-2001 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 50,177.32 16.667 8,363.05 .045 376.34 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your paYllent to the Register of Wills. Hake check payable to: "Register of Wills, Agent". Tax x NOTE: If tax pal/8ents are ..ade within three (3) months of the decedent's date of death, YOU ..ay deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) 1I0nths after the date of death. PART [J A. [ CHECK ] ONE BLOCK B. ONLY c. If yoU indicate a different tax rate, please state your reletionship to decedent: c=J The above information and tax due is correct. 1. You may choose to remit paysent to the Register of Wills with two copies of this notice to obtain a discount or avoid interast, or YOU Dlay chllck box "A" and return this noticlI to tha RlIgtstar of Wills and an official assllssmllnt will bll issUlld by the PA Dllpartment of RevllnulI. ~ Thll abovlI assat has belln or will bll raportad and tax paid with the Pennsylvania Inheritanca Tax raturn to be filed by thll decedant's rllpresentative. c=J The abovlI information is incorrllct and/or dllbts and dllductions wllre paid by you. You must complllte PART ~ and/or PART ~ below. PART ~ TAX RETURN - COMPUTATION liNE -1 :-ti.{. ifstabiished 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART f!l DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID Under panalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of lilY knOWledge and beUef. HOME ( ) WORK ( ) T^VDAVJ:'D t:T~"'^TIIDI:" Tr'"' r-n..n...... ............... ---- -.,.- L --:,' i . ,""."'. .' ~i'~'l ~.' : "', ~~ ... .'.( " ?Iff 1"+ ~-b,' ~~) ~ ;4 ~,4 .3 --.'. ,j ~:: ~.;:.~~ .....; -' ~., -. ~. -. f -' .. .. l -' I .. II .. \' -' .. \' -. .. -' -'7 ~: .. f~,:. : -') .~ .:::.. 0- ~ ctOI~ o .... ollct <C J:oXQ.. O::iO - Nl_ItI(') " ----.- (-=--" ~ -.J rJ) - .J Ql ~ ~ 1-' U) 0:, r~ LL.:.