HomeMy WebLinkAbout02-27-07
REV-1S00 EX + (6-00)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 -06 0 6 2 1
COuNTYCciiiE ---YEA~ - - NUMsER- -
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
BRENNEMAN James N.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
SOCIAL SECURITY NUMBER
2 06- 3 2 - 4 025
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURIT'Y NUMBER
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07/02/2006 10/11/1942
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[Xl 1. Original Return
o 4. Limited Estate
[Xl 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (AttachcopyofTrust)
o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
Q.. 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALLCORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Jill M. Wineka Es uire
FIRM NAME (II Applicable)
Purcell Kru & Haller 1719 North Front Street
TELEPHONE NUMBER
717 234-4178 Harrisbur PA 17102
124,900.00
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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)
OFFICIAL USE ONLY
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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 Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
9,652.75
,
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416.15
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
19. Tax Due
0.00 X _(15)
-16,665.23 X _(16)
0.00 X .12 (17)
0.00 X .15 (18)
(19)
(8)
134,968.90
16. Amount of Line 14 taxable at lineal rate
27,822.46
124,566.74
(11)
(12)
(13)
152,389.20
-17,420.30
17. Amount of Line 14 taxable at sibling rate
(14)
-17,420.30
18. Amount of Line 14 taxable at collateral rate
0.00
0.00
0.00
0.00
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20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSESIDE AND RECHECK MATH <<
ece en s omple e ress:
STREET ADDRESS
1450 Timberbrook Lane
CITY I STATE I ZIP
Mechanicsburg, PA 17050
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I t Add
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits (A + B + C)
(2)
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( 0 + 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)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
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
c. 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
t. b f" d' t'? f)(l
con alns a ene IClary eSlgna Ion. ....................................................................................................... ~
No
00
00
00
00
00
00
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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ADDRESS
M. Wineka, Esq., 1719 North Front Street,
rrisburQ,
PA 17102
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) (ji)].
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. ~9116(1.2) [72 P.S. ~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 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.
REV-1502 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BRENNEMAN. James N. 21 06 0621
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 orooertv which is iointlv-owned with riaht of survivorshio must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
1450 Timberbrook Drive, Mechanicsburg, Cumberland County, PA 17050. Tax Parcel
No.: 10-15-1283-011-U113 (See attached Deed dated 7/20/1999 and recorded 8/5/1999
in Book 205, Pg. 375. Also, see attached HUD-1 Settlement Statement.)
VALUE AT DATE
OF DEATH
124,900.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
124,900.00
REV-1508 EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
BRENNEMAN James N.
FILE NUMBER
21 06
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.
0621
ITEM
NUMBER
1.
DESCRIPTION
Adjustment for taxes and homeowner's association dues on HUD-1 Settlement
Statement
VALUE AT DATE
OF DEATH
829.38
2.
Refund of 2006/2007 School taxes from real estate settlement
1,009.57
3.
Health Savings Account
81.73
4.
2001 Hyundai Elantra GLS; VIN# KMHDN45D31U031318
4,200.00
5.
Commerce Bank Checking Acct. No. 0536720857
45.49
6.
Health Savings Account
62.50
7.
Misc. personal property
300.00
8.
MetLife - disability check
1,187.36
9.
MetLife - disability check
1,246.72
10.
E-Count
690.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
9652.75
REV-1510 EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
ESTATE OF
BRENNEMAN. James N.
FILE NUMBER
21 06
0621
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. 401 (k) Plan - Beneficiary was Decedent's daughter, 416.15 100. 416.15
Jill L. Mellios
TOTAL (Also enter on line 7 Recapitulation) $ 416.15
(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
ESTATE OF
BRENNEMAN James N.
ITEM
NUMBER
A.
1.
2.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21
06
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
Myers Funeral Home, Inc. - funeral services
Gingrich Memorials - gravemarker
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Jill L. Mellios
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 37 Brittany Boulevard
City Marlton State NJ Zip 08053
Year(s) Commission Paid: not yet paid
Attorney Fees Purcell, Krug & Haller
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
Probate Fees Register of Wills
Accountant's Fees
Tax Return Prepare~s Fees
Seller's closing costs - realtor's commission; transfer taxes; etc.
Fax and postage expenses for Executrix
Mileage and tolls for Executrix
Cumberland Law Journal - advertising
The Sentinel - advertising
Register of Wills - Short Certs; JCP fee; automation fee
Freysinger Pontiac - repairs to vehicle for sale
Register of Wills - fee to file Inheritance Tax Return
Register of Wills - fee to file Inventory
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0621
AMOUNT
3,645.60
650.00
4,000.00
6,000.00
260.00
400.00
10,660.57
71.47
364.11
75.00
166.07
62.00
1,437.64
15.00
15.00
27 822.46
REV-1512 EX+ (6-98)
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SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BRENNEMAN. James N.
FILE NUMBER
21 06
0621
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Washington Mutual Home Loans - 1st Mortgage, Acct. No. 5300425229 - payoff
VALUE AT DATE
OF DEATH
68,611.66
2. Beneficial - 2nd Mortgage, Acct. No. 711714-00-552061-0 - payoff
33,770.14
3. PA Department of Revenue - delinquest State Income Taxes for 2004
661 . 17
4. PA American Water
128.84
5. Travelers Indemnity - homeowner's insurance
74.95
6. Comcast
97.71
7. PP&L
373.18
8. PMI - property management fees
243.00
9. Hampden Township - sewer/water
483.56
10. HSBC Bank - credit card debt
2,163.76
11. Holy Spirit Hospital - medical services within last 6 months
402.90
12. Moffitt Heart & Vascular Group - medical services within last 6 months
122.11
13. Shepherdstown Family Practice - medical services within last 6 months
77.71
14. Heritage Medical Group, LLP - medical services within last 6 months
469.57
15. Heritage Medical Group, LLP - medical services within last 6 months
40.66
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
124,566.74
REV-1513 EX + (8-f1n\
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BRENNEMAN .J::lmp.s N.
NUMBER
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
Jill L. Mellios
37 Brittany Boulevard
Marlton, NJ 08053
FILE NUMBER
21 06
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Lineal
0621
AMOUNT OR SHARE
OF ESTATE
100.00
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
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)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
BRENNEMAN, James N.
Decedent's Name
Page 1
21 06 0621
File Number
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. Capital One - credit card debt 1,138.44
17. Northwest Consumer Discount Company - car loan payoff 1,640.23
18. Veritech Financial Services, LLC 4,410.01
19. Freysinger Pontiac - accounts receivable owed to employer 4,739.44
20. Washington Mutual Card Services - credit card debt 4,840.59
21. Cardiovascular Surgical Institute - medical services within last 6 months 77.11
SUBTOTAL SCHEDULE I 16,845.82
GRAND TOTAL SCHEDULE I $ 124,566.74
IN RE:
ESTATE OF JAMES N. BRENNEMAN,
DECEASED
IN THE COURT OF COMMON PLEAS
DAUPHIN COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-06-0621
TABLE OF CONTENTS
1. Last Will and Testament of James N. Brenneman dated July 20, 2001;
2. Deed from Timber Chase Associates to James N. Brenneman dated July 20, 1999 and recorded
August 5, 1999 in Book 205, Page 375;
3. HUD-1 Settlement Statement.
Last Will and Testafilent
of
J atnes N. Brennefilan
I, JAMES N. BRENNEMAN, of Mechanicsburg, Cumberland
County , Pennsylvania, declare 'this to be my Last :"lill and
Testament, and revoke any and all prior Wills and Codicils made
by me.
ITEM I:
I direct that all my just debts and funeral
expenses, including my grave marker and all expenses of my last
illness, 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: All federal, state and other death taxes payable
because of my death with respect to the property forming_JTIY
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gross estate for tax purposes, whether or not passihg under
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this Will, including any interest or penalty imposed .'in c.'
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connection with such tax, shall be considered a part of :fhe
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expense of the administration of my estate and shall bepf3-id
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out of the residue of my estate, without apportionment or right
of reimbursement.
ITEM III:
I give, devise and bequeath the rest, residue
and remainder of my estate of every nature and wheresoever
Sl~uaLe outright to my daughter, JILL L. MELLIOS, on condition
that my daughter survive me by thirty (30) days.
ITEM IV: In the event my daughter, JILL L. MELLIOS,
predeceases me or fails to survive me by thirty (30) days, I
give, devise, and bequeath the rest, residue and remainder of
my estate of every nature and wheresoever situate to my sister,
SALLY L. BILLER.
ITEM V: I appoint my daughter, JILL L. MELLIOS, Executrix
of this my Last will and Testament. Should my daughter, JILL
L. MELLIOS, fail to qualify or cease to act as Executrix, I
appoint my sister, SALLY L. BILLER, Executrix of this my Last
Will and Testament.
ITEM VI: I direct that no Executrix or her successors
serving hereunder be required to post bond or enter security In
any jurisdiction.
ITEM VII: Where appropriate throughout this my Last Will
and Testament, all references herein to the singular or the
feminine shall include the plural or the masculine,
respectively.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this
., . ((^-.
<>- U day of
~(
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, 2001.
L#
v.--v<~~--- (SEAL)
AMES N. BRENNEMAN
2
The preceding instrument, consisting of this and two
other typewritten pages, was, on the date thereof signed,
published and declared by JAMES N, BRENNEMAN, 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 nam~s as witnesses hereto,
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COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
WE, JAMES N. BRENNEMAN,
,-,,<7 if /7
i(2ctr; _ '-J 0 {L-<Joe- and
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, the Testator and the witnesses,
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respectively, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby declare
to the undersigned authority that the Testator signed and
executed the instLument as his Last Will, and that he had
signed willingly and that he executed it as his free and
voluntary act for the purposes therein expressed, and that each
of the witnesses, in the presence and hearing of the Testator,
signed the Will as witnesses and that to the best of their
knowledge the Testator was at that time eighteen years of age
or older, of sound mind and under no constraint or undue
influence.
~4!~~
AMES N. BRENNEMAN
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Witness
Subscribed, sworn to and acknowledged before me by JAMES
N. BRENNE~, t~e. .Tes. ::..Iat,or, and sUbscribe1\.. i aNd sw,orp to before
m~ by 0 b ~L,' ...c......./(, ~ 6 ~n c;;:Q-Yo'\tt.~~~,
wltnesses, thls t9(J a day of Iii.., , 2001.
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Notary Public
4
Notarial Seal
Bonita E. Prussacl<, Notary Public
Harrisburg, Dauphin County I
My Commission Expires Sept. 24, 2001
08/15/2555 07:53
717258elB52
TRI COUNTY ABSTRACT
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Curnbc:rlll1lCl countY 1"1% PSIl:el No.lo-U.I211)-<ll1 U_
MAD...1R! .".,~,...,
BBTWBRN
TIMBER CHASE ^SSQCIA1"ES. a P=lylvlll1la Umlllld parml!l'll\1ip (QrAntor).
AND
JAMES N. BRENNEMAN. ell a/lull individual (GrAllIBe).
WITNBS SBTH
ThaI Ibe GmnrOf, in CUDIlidc:n1tlon lJfElGHTY.TWO TfT.OUSN'l> 'NINE HUJolDRlID
pOLLARll ($82,900.00), paid lry 0... G"",1eO 10 III. GrMtor, 1110 ....lipt w.""",CilI h.....by
",,'mawlodge.l. dC>e$ hlll"Oby snml Olld COII~ liCIlhe OrarlICI1
ALL 1h4\ ecnain Unit, b..ln8 Unit No. 1450 (\lie "Unl."}. of
Tim!>e, ClIuo n. A Towm.ome C""domln\um (the .Condominium"). 1....\c411l
HlIClpdcn r.."",wp. Comberlzad County, POMIYMIlm, whic!lVnit I.
d""lgnsted in the DeolamtlDII of Ccnl10mlnlum 0 rTimbor Ch_ n. ^ Tawnhome
Condominium (lh. 'Dcollll1olian llfCandamUUlIllI") IIld D~1umtion PIIllI UIld
PIM5 reCCf<lod in tlla ome<> orlbo Cumbc'l...d CoIllllY lllllO<ll1laofDccds in
Miaccllancw& ilook 573, Pago3S 1IlI<I~torw~ PIRllBook 11, P.139
respoolivol)', togath~ w\lh any alId all ornandmlllllll thmolo.
TOO2THB1\ with the undivided parceataae Wcmt in IIJo Conunon
15lcmOllI. ~pUr1"lmllt to 1he Unit ~. ('1'1,,", plltlwll\l'l)' 50t ~h In 1". al\:l",.&IC1
D=laratlon of Ccmdominlum. llJ 1~ IIIl'Icnded.
TOGEnreR. ....hh lhe; rtshlto UBe lbe Limited Common aleman..
opplioalllo 10 !h. Unit bclng c:cnvcyod ham", pUftlUMllO \}Io n..,l=t{on of
Condominium und Deel~rnllon PI;I>>' D/ld l'hns. Jl$ lallt llnl~nl1ed.
ONDBll. ANtI StmJECT 10 any and oll eovClWlm, oondtlloaR,
rcltietllltlll, r1gllllw>f.lIIsy. OIl5ClllenlS ond ~Jlll1m:11.1 oCrcoord In \he ;fbresnil1
eD~ 205 fAD~ 375
08/15/2006 07:53
7172580862
TRI COUNTY ABSTRACT
PAGE:.: I::lL
omc~ !he aforcuid DlIClarll1lcD cf Condominium, IIl1d lllatIlll'!I W1110h D I'hy,lcul
~""lloD NllI survey oflht Unit and Commllft 1tIalI\CIIl1lwould "lfOlase.
BBlNG pm of lbc: 5Bme pl'lmi.... w1licb W~llllr L.lCil. IlI'ld 1",,1li~ M.
;KlJll, busbud lIlld wifll, by deed elAted 11l1le II, 15'97 11lI11011arded I. the OlJlal of
Iho Cllmbcrl4nd CGunl)" Il.DC.ordu orDeal. In Ilo<.d BDO~ I J9. PD!I" 7S8. grunled
ami a:ln.~l1l1nlo Tlmbl:l'Cb1lllll Mo01ltOll," PClInGJIlvan!a limited parlncnwp,
Gr.loUlr beroln.
TIlE Clnmlee, lbr and 011 bebalf of I!>J> Clnntee Bl1d the Gnontee'P heirs,
p<n<maI xoptClCDlativl:B, JM:Ce/Isam md _IPI, by I!1e DO""!'tWO ol'thll !leod,
COVI!11"nla IIJ1d BP"" \0 I'll,)' sueb ebcq:a. for llIDln\Gd\QIIoo, r<;llln. rcploomn"".1
RIll! other txpcnsoo in conndoa wid. dv: Cammon 'Slem....l5, lIlld Ibe Limi led
eo""""" BlcmcnlJ IIl'l'UrtllMnt to .,qd UnIt, lIS mil)' be lIlXISed qainlt bim. ber,
theal, it, or ."id Unit, lltnn lime Ull1me by the J!=livc Bolllll Drib, TimlMlr
Chase II COMominiwn A..""jalian jn IccmI8QCll whh lIIe UnI1\lrm
Ccndcminlum Act ofPl'JIIIU)'lvlnin, M4 flll'll1cr OQVtllllllls 1IIc14jl1l:Cl11bal the
Unit eonve:yed by this D=d shIll be IIlbJ oer. In Illelllbr 1IJIII:JIDllDte lllllSPIlllOcd
e':IcapllDlIOr~r as Seatioll 3407(0) of laid TJnllbnn Condominium I'cl may relieve
a aubIClJ1l"'" Uoll Owm;r ofllablllty fb. pl'ior unpaid """"lIlent.. !hi. eOVCnml
.boll ron with and bind tho Unit limb,. OOllveycd B1I4 aU lIUbBequon1 O'Mlcr.
lltcmof.
,\NO the Ornnlor $ball Mil will SPECIALI. Y W A.F.RANr the 1'rvpel'1y 1\...0I>.r oon...."lId.
l:N WT"TNB51S V.'HBREDF. lb. Grantor """ ",",."" Ihi. Doocd II> be ClllI:i:\Il<:lAS (If 0\= day
llDd ycor n...t wrimm obove.
Tn.mER CHASE ASSOCIATES, B PennoylVlUliD
limited panm:rshlp:
By. CAPITOl. mW PbVm.OfMBNT 00..
lNe, O.~<l'lll'bnnl5l'
,~"'--
Namo: n'JIO.,f ~ I 1<. ~.~
Titlt: (Viee)"I'=id",,~
By
. :a -
Boor 205 ')J;( J?6
vv,~~,.vvU Uf.~~
fJ./",;,JOtll'JOL
11-<1 CUUNIY ABSTRACT
PAGE B3
COMMONWEALTH OF Pl!lNNSYLV~
COUNTY 01>
~btA4J
ss.
01> Ihi"lbO~da)'or "";;;<-('1 .1999, bafcreme, cNo~ Publi<:, tile
lUIdlll'lllBllell officer. pel1lmaUy llPl'ean:iI_I7JICfu" / k LCL U- . who
Bc:bowlCld~d 111mBelflo bo tile ('Y.lAl PlOIlcleat ot CAPrrQT, vmw DIWnOPMRNT CO.,
INC., a PCIUI!I)'lvorUc oC>qlOl:lllon (tbe "COIpDrllI\OIl"). Bald COIporlllon beil\B (ho Ollllmll
Ptu1lI'" ofmmER CHAS2 ASSOCL\TBS. a Pmuaylv8llla llmilO1l JlN1D:lSblp (tlle
"Pa<tnorlhlp"),. and thnt h.e AD lJUob officer. being ftutl1<lrized. kl do 80 pu",u.nt to a reaolunon IIf
tb. COTPOl'alion'. board of dircchm datod Aptl16, 1998, . ""I')' orwh\~ Ie =<mkd. in
Cumberlond County Mi,e8IlanlOOu,< ao..1: $76, Pap: 61l, BXl!Clll~ the ~"In& in_ent for
the pnrposo Iherelo ClORlainod by aisninlllho 7\Illl\O oflhe Corpmalion I>y hl'llJolfiU such oRIcer
in tile Cotpomtian'a C1l11.~lty IIJ Oenont PllI1nct \q)d ~. tlllhllrl::c4 by Iho Pcrrtnernhlp.
IN WITNESS WHER.EOF, I bavB boreul:llo lid my hind and offiei.al .oal
+'4ho..'Ji.l1~
Notary Pub liD
(SEAL)
My cOmnlwl"" c:q>i"""
~OD~ 205 rAGE 3'"
'J.{L~Ot::JCC4
TRI COJNTY ABSTRACT
PAGE 134
COMMONWItAtm OF nmtSYLVAMA
cotJNjy OF ctJMBE1UJ\lIID
ss,
RECORDED ltllbe omae ofU,.. ~r ofDoctI~ In and for ""Iii COUllI}' in Peed BI)O"'~
PBgc~
WIl'NI1S11 my Iulnd 11114 om.11ll ~elll thL9 -..L day of f.h,.., , I Y99.
I h"",by ccrtlfy Ihot the rracrl'e IIddrcas of the Gl1lI1lxle heroin is:
14':'0 TimberBtooItDrive
1I4ellhanicsbur& PI'. 17055
...:
"- '""
a::~" ,
k.,fc::a=- ......
,..J U.f:_ <:I
tJ~~ ......
;:'Ja;3 €:
g;;;
:: f~ Q Lon
<>:"":j
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8~~ ""
... ;;r; ""
""5 0;.. ~nlli~I!~~m r
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1 ii ~Pl - ",. l~
~.
:;::
i ~ ~f
!OOX 205 rAIl 376 ~ j] e.
~~e~~;;:~~~. F "" f
..,
l!!!:g 8J9~~S~~ S;
\. u.s. jEP;\RTMENT OF HOUSING AND URBAN DEVELOPMENT
~LEMENT STATEMENT
Affiliated Settlement Services Group, LLC
3912 Market Street
Fonn Approved O.lB No. 2502-0265
B. TYPE OF LOAN
1. 0 FHA 2.0 FMHA 3. OOCONV. UN!NS.
4. 0 VA 5. 0 CONV. INS.
6. ESCROW FILE NUMBER: 7. LOAN NUMBER:
00063220-001 MAZ 0204180319
Camp Hill, PA 17011 8. MORTGAGE INSURANCE CASE NUMBER:
(717) 975-7839
FINAL
:::. NOTE: This form is fumished to give you a statement of adual seWement costs. Amounts paid to and by the settlement agent are shown.
Items marked "(P O. C.)" were paid outside the dosing; they ale shown here for informational purposes and are not included in the totals.
D. NAME OF BORROWER: Truong V. Nguyen
ADDRESS OF BORROWER: 306 Kay Road
Mechanicsburg, PA 17050
E. NAME OF SELLER: Estate of James N. Brenneman
ADDRESS OF SELLER:
ADDRESS OF lENDER:
Members 1 st Federal Credit Union
PO Box 40 5000 Louise Drive
Mechanicsburg, Pa 17055
1450 Timber Brook Drive
Mechanicsburg, PA 17050
Cumberland County 10-15-1283-011.-U113
Parcel #1 0-15-1283-011.-U113
Affiliated Settlement Services Group, LLC
3912 Market Street, Camp Hill, PA 17011
9/29/2006 PRORATION DATE: 9/29/2006
DISBURSEMENT DATE:
9/29/2006
F. NAME OF LENDER:
G. PROPERTY LOCATION:
H. SETTLEMENT AGENT:
PLACE OF SETTLEMENT:
I. SETTLEMENT DATE:
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
1 O().GROSSAMOOtff'DUE(FROMBClRRc:MtER:'" .. .>..... ..,.'c............./> .}. .1
101. Contract Sales Price 124,900.00 401. Contract Sales Price 124,900.00
102. Personal Property 402. Personal Property
103. Settlement charges to Borrower (line 1400) 4,032.37 403.
104. 404.
105. 405.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE.
106. Cityrrown Taxes 406. Citvrrown Taxes I
107. County Taxes 09/29/06 to 12/31/06 68.85 407. County Taxes 09/29/06 to 12/31/06 I 68.85
108. Assessments 408. Assessments
109. School Tax 09/29/06 to 06/30/07 757.87 409. School Tax 09/29/06 to 06/30/07 I 757.87
110. HOA Sept 09/29/06 to 09/30106 2.66 410. HOA Sept 09/29/06 to 09/30/06 I 2.66
111. 411.
112. 412.
113. 413.
114. 414.
115. 415.
120. GROSS AMOUNT DUE FROM BORROWER: 129,761.75 420. GROSS AMOUNT DUE TO SELLER: I 125,729.38
ZOlliC';.6.MOl.JNTS PAlDBYORJ.N~l:liALFOFBQRROWER:" ".",. "'{"500;,.REDl.JC"r19NS.!~'~NIO.UN;tRIJET9is!:LtER:'.. "'> .....'.;'J
"":::'.;\;'"(";.;.,
201. Deposit or earnest money 2,000.00 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) 124,900.00 502. Settlement charges to Seller (line 1400) 10,410.57
203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
204. 504. Payoff of 1 st mtg. loan to Beneficial 33,770.14
205. 505. Payoff of 2nd mtg. loan to Washington Mutual 68,611.66
206. Seller Paid Closing Cost 250.00 506. Seller Paid Closing Cost 250.00
207. 507.
208. 508.
209. 509.
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER"
210. Cityrrown Taxes 510. CitvlTown Taxes
211. County Taxes 511. County Taxes
.,.., ^ --------"-- "..... ^ -------........
ADDRESS OF LENDER:
PO Box 40 5000 Louise Drive
Mechanicsburg, Pa 17055
1450 Timber Brook Drive
Mechanicsburg, PA 17050
Cumberland County 1 0-15-1283-011.-U 113
Parcel #10-15-1283-011.-U113
Affiliated Settlement Services Group, LLC
3912 Market Street, Camp Hill, PA 17011
9/29/2006 PRORATION DATE: 9/29/2006
DISBURSEMENT DATE:
9/29/2006
;. PROPERTY LOCATION:
-I. SETTLEMENT AGENT:
PLACE OF SETTLEMENT:
SETTI.EMENT DATE:
J. SUMMARY OF BORROWER'S TRANSACTION I K. SUMMARY OF SELLER'S TRANSACTION
GROSSAMOUNTDOE:FRClNIBORRONER:'.\' " ;:,... :;~;:. :':';;;:\J~;~3:'k,:~:'::i "'(::');400iGFiQ$$.-A.MOUN1lT;t>t.Ietil'O'$f;Q.;~~;,:+';, .:. .' ...../1
00. ~::.::.,> '. ;~::i:;;;:";:t:j';:
I 01 Contract Sales Price 1 24,900.00 401 Contract Sales Price 1 24,900.00
I 02. Personal Property 402. Personal Property
I 03. Settlement charges to Borrower (line 1400) 4,032.37 403.
I 04. 404.
1 05. 405.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE'
106. CitylTown Taxes 406. CitvlTown Taxes I
107. County Taxes 09/29/06 to 12/31/06 68.85 407. County Taxes 09/29/06 to 12/31/06 68.85
108. Assessments 408. Assessments
109. School Tax 09/29/06 to 06/30/07 757.87 409. School Tax 09/29/06 to 06/30/07 757.87
110. HOA Sept 09/29/06 to 09/30/06 2.66 410. HOA Seot 09/29/06 to 09/30/06 2.66
111. 411.
112. 412.
113. 413. I
114. 414. I
115. 415. I
120. GROSS AMOUNT DUE FROM BORROWER: 129,761.75 420. GROSS AMOUNT DUE TO SELLER: I 125,729.38
~OO.'AMOUNJS PAID' B'(..~INBEHALFbF.BORRO\iVER: 500.REOOC-110N~Jl\I-A.I\IIQUNTQUETO' SELLER: I
201. Deposit or earnest money 2,000.00 501. Excess deposit (see instructions)
202. Principal amount of new loan(s} 124,900.00 502. Settlement charges to Seller (line 1400) 10,410.57
203. Existing loan(s) taken subject to 503. Existing loan(s} taken subject to
204. 504. Payoff of 1 st mtg. loan to Beneficial 33,770.14
205 505. Payoff of 2nd mtg. loan to Washington Mutual 68,611.66
206. Seller Paid Closing Cost 250.00 506. Seller Paid Closing Cost 250.00
207. 507.
208. 508.
209. 509.
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER'
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER-
210. CitylTown Taxes 510. CitylTown Taxes
211. County Taxes 511. County Taxes
212. Assessments 512. Assessments
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER: 127,150.00 520. TOTAL REDUCTIONS IN AMOUNT DUE SELLER: 113,042.37
3,00,;.'.CAS:I:IAT. SEJTl-EI'1I1EN1lTfl~bIlNTOBg@tQNER: 600.CA~H A"fSE:~l\III?t':I:rm:()IFRqvlSI?I1I..ER: ..... .nl
301. Gross amount due from Borrower ( line 120) 129,761.75 601. Gross amount due to Seller (line 420) 125,729.38
302. Less amount paid by/for Borrower ( line 220) 127,150.00 602. Less reduction in amount due Seller (line 520) 113,042.37
303. CASH { IKI FROM) ( 0 TO ) BORROWER: 2,611.75 603. CASH ( 0 FROM) ( [XI TO ) SELLER: 12,687.01
IARGES
j$/BROKER!S.Cblllllllll$$lON:
lASED ON PRICE$ 124.900.00 _ 6,OOO~;= $7,494.00
")F COMMISSION (LINE 700) AS FOllOWS:
3,772.00 to RelMax Realty Professionals
3,722.00 to John Glise. Inc. Realtor
;ommission paid at settlement
Transaction Fee to Glise/Remax
;TI:I\II$:,f?AYAI3l..g IN CONN ECTlONWITH L.OAN: '
Loan Origination Fee
J2. Loan Discount Fee
a03. Appraisal Fee
804. Credit Report
805. Lenders Inspection Fee
806. Mortgage Insurance Application Fee
807. Assumption Fee
808. Application Fee to Members 1st Federal Credit Union
809. Underwriting Fee to Members 1st Federal Credit Union
810. Document Prep Fee to Members 1st Federal Credit Union
811.
;9l).Q;'TIJ'EI,VI~..~Ql.JI~[)B'(~~~I?B-.,.OElE..P.AlpltllADVANCE:
901. Interest From 09/29/06 to 10/01/06 @ $22.9851/day
902. Mortgage Insurance Premium for Month(s) to
903. Hazard Insurance Premium for Years(s) to
904.
905.
PAID
BORROWER'S FUNDS
AT SETTLEMENT
125.00
7,494.00
295.00
350.00
75.00
275.00
1001.
1002.
1003.
1004.
1005.
1006.
1007.
1008. Aggregate Acct. Adj.
,-- '..'....."........,..-.
1100lTITLECHARGES:
1101. Settlement or closing fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Document preparation
1106. Notary fees
1107. Attorney's Fees
(includes above items numbers:
1108. Title Insurance to Affiliated Settlement Services Group.LlP
(includes above items numb!'!fS:
Hazard Insurance
Mortgage Insurance
City Property Taxes
County Property Taxes
Annual Assessments
School Taxes
months@ $ per month
months @ $ per month
months@ $ per month
8 months @ $ 22.07 per month 176.56
months @ $ per month
4 months @ $ 82.45 per month 329.80
months @ $ per month
months@ $ per month
to Purcell Krug & Haller
to SettlemenUNotary/Clerical
100.00
30.00
15.00
:"'::: .;;c.
1109. lenders coverage $ 124,900.00 J!
-~
1110. Owner's coverage $ 124,900.00
1111. End 100, 300, 8.1, Condo to Affiliated Settlement Services Group,LlP 200.00
1112. Insured Closing letter to Southern Title Insurance 35.00
1113. Overniaht Fees to Affiliated Settlement Services GrouD.LLP 30.00 30.00
12OQ.:, .....;i.).:....\,.. '0(, ......::.P( ~. ...c.).:':.~.:'::...'......
"/",:'.1
1201. Recording Fees: Deed $ 38.50 Mortgage $ 70.50 Release $ 109.00
1202. City/County tax/stamps Deed $ 1,249.00 Mortgage $ 1,249.00
1203. State tax/stamps Deed $ 1,249.00 Mortgage $ 1,249.00
1204. Satisfaction to Recorder of Deed 27.00
1205.
136p;':Abt5!JjO~SE.I.I.L.EMENTctiARGEst 0:....., i.' ......... :j.........,.:t;c". ,.." ~
. ......... .....,"'..:'... ... '. ,'.,
1301. Survey
1302. Pest Inspection
1303. 2006 School Tax to Marie Huber 1,009.57
1304. Sewer 10/1 to 12/31 to Hampden Twp. Sewer Authority 124.00
1305. Oct HOA Dues to Timber Chase II Condo Asso 81.00
1306. Resale Cert to Property Management Inc 75.00
1307. **See attached for breakdown 116.00
900 ITEMS FEQUlRED BYilfENDERTO BE PAID IN ADVAN(;E'
.
%
P;O.C.
. .
45.97
.'
. I
901.
902.
903.
904.
905.
1Mn
1001.
1002.
1003.
1004.
1005.
1006.
1007.
1008. Aggregate Acct. Adj.
1100.11"flJ=.PHAR~E?:
1101. Settlement or closing fee
11 02. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Document preparation
1106. Notary fees
1107. Attorney's Fees
(includes above items numbers:
1108. Title Insurance to Affiliated Settlement Services Group,LLP
(indtJces above items numbers:
Interest From 09/29/06 to 10/01/06 @ $22.9851/day
Mortgage Insurance Premium for Month(s) to
Hazard Insurance Premium for Years(s) to
(2 days)
4
...... .:
months@$
months @ $
months @ $
months @ $
months @ $
months @ $
months @ $
months@ $
. .
--~---::-- ---'--. .: ,:~:<".: " ',. .',
per month
per month
per month
22.07 per month
per month
82.45 per month
per month
per month
. , ~-c. '. _' .' '. P.O.C.
, .'. ..' . .-. ...,: ....:. .' . . . .' '" . I
Hazard Insurance
Mortgage Insurance
City Property Taxes
County Property Taxes 8
Annual Assessments
School Taxes
176.56
329.80
-88.34
. '. ':1
to Purcell Krug & Haller
to Settlement/Notary/Clerical
30.00
100.00
15.00
885.38
1109. Lenders coverage $ 124,900.00
1110. Owner's coverage $ 124,900.00
1111. End 1 DO, 300, 8.1, Condo to Affiliated Settlement Services Group,LLP
1112. Insured Closing Letter to Southern Title Insurance
1113. OverniQht Fees to Affiliated Settlement Services Group.LLP
1200, GOVERNMENTRECOROINGANOTAANSFERCHARGES:: "",:T. ...,c ..en....
1201. Recording Fees: Deed $ 38.50 Mortgage $ 70.50 Release $
1202. City/County tax/stamps Deed $ 1,249.00 Mortgage $
1203. State tax/stamps Deed $ 1,249.00 Mortgage $
1204. Satisfaction to Recorder of Deed
1205.
1300): AOOIllONAL SElTL.EMENJCHARGES: ,...i: :ii,' <':i..: ..:.....
1301. Survey
1302. Pestlnspection
1303. 2006 School Tax to Marie Huber
1304. Sewer 10/1 to 12/31 to Hampden Twp. Sewer Authority
1305. Oct HOA Dues to Timber Chase II Condo Asso
1306. Resale Cert to Property Management Inc
1307. **See attached for breakdown
1400. TOTAL SETllEMENT CHARGES (Enter on line 103,Section J - and -line 502, Section K)
200.00
35.00
30.00
.... .:-:-
109.00
30.00
. . .1
1,249.00
1,249.00
27.00
.- . .
. . J
1,009.57
124.00
81.00
4,032.37
75.00
116.00
10,410.57
have carefully reviewed the HUD-1 Setftement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipls and disbursements made on my
cco unt or by me in this transa dion. I fu r1her certify that I ha ve receive d a copy of the HU 0-1 Setfte ment Statement.
~:"lJJt~
~j j rtJ'7f).} hinhfOJ.-+-0i
ta e of ~es N. Brenneman I
.ffiliated Settlement S
Borrowers
red is a true and accurate account of this transadion.
Settlement Agent
Date
'he H U 0-1 Setftement Stateme
;tatement
VARNING: ltis a crime to knowingly make false statemenls to the United States on this orany similarform. Penalties upon conviction can include a fine and imprisonment Fordetails
ee: Title 18 U.S. Code Section 1 001 and Sedion 1010.
00063220-001 MAl
.JET AILED BREAKDOWN OF GOVERNMENT RECORDING AND TRANSFER FEES
Buyer Seller
Amount Amount
I & County Tax/Stamps
.y Tax/Stamps: Deed $1,249.00
Total as shown on HUD page 2 line #1202 1,249.00
Buyer Seller
Amount Amount
1203. State Tax/Stamps
State Tax/Stamps: Deed $1,249.00
Total as shown on HUD page 2 Line #1203
1,249.00
-iUD 1307 DETAILED BREAKDOWN OF ADDITIONAL SETTLEMENT CHARGES
Total as shown on HUD page 2 line #1307
Seller
Amount
30.00
81.00
5.00
116.00
Description
1308. Document Copies to Property Management Inc
1309. September HOA Dues to Timber Chase \I Condo Asso.
1310. Tax Cert Fee to Marie Huber