HomeMy WebLinkAbout94-00500
"
,
,.
,
l>
',..,1(.
"
"
1(..
"
,p'
"
',:r
I" '.:j' ".,):~'i
''', \\:'< ,,;.;;~i:i:\;;!;i
!' 1'1; I' , ' ,,':, \ ";i) I}: "_\;~~)
" ,,' '1',\; :' ;':, ':" ","'!:~"~';"'I'~~~f
" "I, i: "", ".If ' I" l'~ ~~~~~b'
1,' "';", " """ ";':\"'!"""':'I'd'!"'l\l}~\"Rj
,:, I'.' '." ,I,,: ,~, 'i.. ;',.I,,);,l.....':\ ,:::";\,\~l;~~~~~..
.",'1," .....;' ',;',' ,.!~;.",,:',:i";. '~.,l'I,.I,'iI<t:7l~:ij~V
',' "', """", "''''''''''\W~\""",,
. -) , " ",' '1/\1 d II; '( <, < I' I . . >'~'.'I'/'d,)~("!V(~
I, '''.',,',' , "', : ,", '''','.',1,'.' ""tI
" .\ .\', ' " ,\ " 1" ~II,.. ~,' \\,'11" j.;: ~';ij\
:Jl '\ I, t. I 1,\,,-, '"fll:'f,,,
' ,;" , , "" """ ""'\~ "
' "":", \ '," ',,'1" l"I.' ':1)"'"1'" ,"'Il'"
"" ", ",. ',' 'I' ,I' ,'i,'" "
" . rl'I.' I, " "j~' ,j " ,,\'iH :">,\,' 1\,\\ "~;~~'1;
, ",\ I, ".' "'" ".t-;' 1:ll'),'i:~'
' '" 'I ,'---r'J"II' c.,. ..','
"i' ,1<:. ", \'1 1.~\I':"~Sli\tJnl~'
I, , . \11, .'," l,'-\I 'J
' , '\., " ,,,, ,'.I''', ',,", ~ ~\}I ~"
" 1 '; , ,,,: \tl:",':"':;I:.I,,";i'~\'(iWI~iW!Y~~
,. '11 'I. ,',' ,.!.'r(~;;, f?~lt!lt':tj>'t~l' A
' ", 1 " " 'f \1) ." ) l~';' ,..
", ,,\,', ';/; [ ':(t'.,; ','I'''';,'i;'.:,;.,I,IP:: 'f;f;ii~
" . I J I , !' ~I{ft/
I \ ~i' I{ I 'j' "\ ': "" . '., I tlr."~f1:fo t', :r;,'f' . ~
". ~ \('~".' \ 'I ''')\!''i'i\'ll(.'P\'\'''llll'~I' 1"
I, I',,' '," ~'J'" .')'[1;'//1'1"; ,
..,' 1 'or ",I, II ~;';.I}lp ~
\',1' I, , ; , q ,'l,~ 1 A "iJtt. .
' ',(\,1 "I ,'1111 I f..r/j~Ii(WI'~ .d'1 1
(: '1,','Il'\' l."\'"jl\ \""'If,~~;tt/; l~'M'{1 '
q J I I 'fl tJ ~ ,J4:' h ~
" \ " . I; Il~ ,I, /\,~;. t\~"I'J'Y~ I
,1:.. I 1",1:.1. jJ, ,I, , 'I' ," '.\)'1~I;~) \7\" I ~
" ,I , ,'; , j ,\:' , , " I <, .' : l)\',. '~~I (;11 J ,
:: ' ,,,,',',>1. ',I , , "': """>, "'\::['i"'I,q'y",~
"!', I., . ',:, , ," '1'\: ',,' ,'.','\,' ip\"f'd'\; "
I', . I' ," ,f', "~I 'I'~'.~~j I ~/
" " ,'\ . I' , I} l' j I 'lit, II'~..,\
" '\:"", ,"',,' ( ',..~t., ",I" '
,.,} 'i' \ 11, .r,!, ,. 1'" II \~h'
., ''(' " 1 "'II' " , ", II .. d "lil.'
,/ . ,':"" I I J "\,1" J 'I ' I ", l{,'lll,.'IJ~
I rl'IT,l~'r~,' l' j'1tll',;'A :'~~. ..
';': J" 'i'.~;;l:' .' 1'1, +')')""'l'~(\'~\, "\ll~;\I"/'Y/~~"~:\ ..
I., "1'~" , " '1"'~\I' .,~~ ,> ,
' .' I .I'!\ ' , 1'" , '"j,"" {', '\' ,~,
',' I " j '" I ,~., )t " N\ '
,1 II 'I . , , ' ,~" ~', , ,'. j I " ,
,".'., ,,>, ,-., I.' ,'), ',I:, ',,1", "'["" 1;.,\/. ,,:ff'
,f, " ". :\,; , .\"',"" .' ""'\~'~t-l-'r:., ,:t;~:R'Wl
' ;" " '"'' I I". ",\",.." ,,~," "1'\' l~,
,,: , ~ I' ',",'t.)ll"),.',.... ".: .i,. "','0.; :\(l'
.' '~', d... ',f ' , , , "':','12 ''It\ ',' { .
\' ", :::-,):):,',,: ' ".,' ';},,,...:,-;,;~~~\\',';',~1"1-/fH'
" """. "~,', .. '," "'I" ".. ",',' "",,"'~:'Vt
,:e ':." -t 1,1;\ 't'I' ',", ~ld";ll~':' I.V\.(;"'I"-~~;;"
,l',', ',. , , .' .;1:' '''/;~'';':~~:'~ ',')'-"'''/ (llhf~~~r-
' ",,, "'.' ',' :',;,",'" f', " I\J':tf't,II"f/^,>,,' "
I"., i;" \ ,", ":;':'\':'/'::!;:f',i;\:/"'/~'
' "I :h,' , ) I i."~'r'~ ::,'" ii,~t!"\l'-i';;)I.:;:;/;k;
,["~I' .;'" ""..1, ." I 'I''' , ,I;." "h,,," "', ,il!<'I',
'i'" . ,,',. .: . '/.' ,I.. ", ...' "; I " ,l' "JJjli'
,. I ,""., '" "".:',:,(, .' .;, '1,"" ";;'1;)1
, '..~ ": ': ,;, ...} "'1' 1\" ,.....; I',r,ll,. ,:~
' ~. ' I \ ,) lJ,. " if, ",1;,1 ' d"Lil/~:', Illrf'J'1l.
"I, :. 1,\\' , ',', 1.1 ~.11)1\ I, ~ '(~!lV" f.~IJII~n;1fj
" ,1<:, "" i'"" 1\1;\)1 '~~":" ::J(('.' !j(t""~'''t'~ ,H
,I, I, .l. \ , 1, I \" ,( "\,1, I \.. . [j~ '~ "'l, I, II
' ' I: 1 ,j I,~ 1'\\1, ~,,~, ~'i'~f 9{. ~1<-
'd,' ,[ "'."", ", ,. ,,', "'~l, '~, ",,"
., l ., 'j ,,' '/ ' ,II'; I, I \1 ~ II .',' I, .... ,.! f;'I1:I.-\I . '.
I" . 'I" '. ".1.,. ~,I... f..-.', :','.\,'~~i1)J~.J'jl
.:, ,:,';<:.,,,,:, i: ~\.,;/i;l~[i~;i;f'\i
,J~;,: " I,.'..." ,- ,\~. d, t, ~R' ,d{. t ~~II"
.' : '. :::!, ;:J \i' ;! ,,1:-' '~.\ '~;;.,~;,.;.yll '~'~~I '. 'j
'. f' ,,). " ~ ,",'1.1,... ,j,!.< ~II ,,)_,
'j, '::!, ,;.,:"j',,:j\.':.!,t'd,l,tJ!"\~\~\. >'~I"
"".':,'" ""':''''~;:''I,\',~,,'., '\:"',}!~.~~~. _, ~:
" ~., ".' ,1:. ,j .t., I" ), ',;1' :l!,' , t;:"\", ~. '\,:" 'J,
"""~':"';""''''''",:!:;,;J{;, :""'~"~'1 "'ff~'"
:," "', .'I".i)', '\-:,L,,:~;'i!):!,'.':,;:f'f.6;h'~ijj,\
J ,..: \ ,'i, ":/:1'111, ~~::r:";" '; '~i.<~ ,::\ ;';:I~'~~;~'l\A.fi:\\"
d'I.' > \I',i ,,' , '''1.. !,'. 'r': ';; '. ',' !"\'!J;\"\'f
. ~ r ~, Ii" '\.',,' "i I .,' ',,' . ','1, .t.} ~
': ',.,;V I' '1,,'.1 t. :-"'\';"'HJ~.,j;'-.\, "'\"11'11'\1,/1
"p ,', '- , '-1 'I! ') Ilr" I '1\ "~Il"'~~'~
,I'I! .'i' .! ( ~ 'L,',;.." ,t,t,;(,;\},\ .:',,',j'1>;~~:;'Q~
... - . :"\'! ',' \ 1 ',,:: ~,'\\ "\": I) 1'\' ,11.'~"J.1"
I ! 'r, "~(f f 'l" '" I ..
,r,,',,'" """". 1"\:" "}",i'l,jt,\li.I,
'.,' . " \'! \1" " i'" \l \ () "1~:i1l.'
' .. ./ j) ., ",\jl\' '. ~t'''' ,0+ i/f "'j"'.1fr\
(,' " 'I' ":,r", (''''.'' "Jl(o, 1:1.i:>'\~~",
' 'I i / ", "IJ"i"'>I""IJ'f,t~l~"'''' I
' ~'/n I' .l' "'~' "'~ '"
" 1',1:" )1 ";,'jI,, I' 'I' 'J,';,:f't1'1' ,!,~. ,t.!
" I , ~ . ,~') .. ,.
,., ("" 'I> ..,,') I"" '\~I~r~'lnJ":lii~~
' """1'" [[', '" I"l'~"'"
',," \\'" '. 'I'
I "..r, ',~'!I},~~'l(:,'t: r,,,,.., l'
"', ;n: : ... [':\'4;~\:,1 ,1nll':
,{ 1',\1 \1" ~ ~:"~':'l'~S~i[ff'{"&(})r~, \
. .r,J'lt~'~"'fr~~~v.T)i'j.
' , [, , :.' ,1.\ ",.,: "",]"m" ':<),i<.\;C~fvi:";,'
""'" ' "'""".,": """"'\'ijil'~;'
' I" iff' , II" ~\\I",r- !({~ \', .l;','"'i l:f.
,p l'~' /", \I' Al:l: :;):(,l'j.~, ,
I \ I' <'~').1~\!.."1"'\"r. .~rt V~I "
\ ' ~ W leJ " ~,\'--", >' Ii: ,
'1',':' 1:1" "L"ij,I"J';'~V;Ii~'\ ';.,
, i,' C "I, /, }\''1~ ') ~;lr1J' ,,,
- \ ' ~ I 't': ,~}, , '\ '\\{'t,J...~:, 1\ ',t,.!'; t
';',.' ,.,,1.,,;.'::: \~"(~!IW'
"~ ~!' :,:/llr~,'.'~bl,!1~ ,
t~/.:, ~ Il"I..:;I;~q.~*,~}I~~i.;b~~J""
.. 'r ',t , Il.ffl\'!,\,
,\, ',e (II'" ~.. 1jl;11'~'
",I', '..'\'t".'11'\.cll ,t" \-.;
.".(, .," '.i.l. ';tV,,'Il,r.,~
\' "'," I'" .".I!l'I;'1.'I/
" '.. " ' J',' , iL ,.J"'h1li'j'
",' II ~i " II' '\1(", III ""1 ,
", . "1:'1 II J , ." , 'I 't'l~: 11~~i)I,{jJ{l' ~
' , '. I ,~!. "t'I""'1 I\-.'~ ~ .r.l\ 'i '"
" "'I., (I 'l,' 1"1\~Till~,~ ~\I:\" J~JI~"'jtW'rifJ, :/t'
'. 'lj.f1JI<)'~r,~III'.'/~h~ ll~"'ij\\ ~
"::"""'" ' 'i',..,,;''' ,'1',' !:;'fr:\j'\Yl~"'~~1f~'
"d. " '~t'( '.f.t'!klt1l~t\k~
;, " I" ',i.' '," ( .' 't, I'I,'I} ,1111,"; '!,'U dltl.J '!i1 ~~l }'\ .
\,' 'J I 'I' I,' '" "fj' \ 'I'! 111 N" >~:t~ ..
,>', ", ," .,' \';~ ,,' ','",,,,, I, 'lll."J(~II:r' ~f' 'i".
',I. . ,','" II' , '" ' " :;:"j':I, ". ."\': "",W",:..tfJ.'~;
"'/", " ','" """""""'<''''k'':'J'i;'I''''~
I "'" , )', ~I" , 1\"" Jr.lt "
. ", I. ,,' " " ", , , ',,' " ',' '", '-Ii :'Y,':I{~'i"'I" ~
", , ,'t '" ::'/' ,I,. I" "'l"':,t~i!ll\\: /1,,;.
; .,',,,' , ,) , "'~;Il' -"I.\'h'll '" ~
,,', ". ,""I\(-;I"1l II,i~,'I.; ',1'\'. "~{f~'I~:rIb~
'..\"J ". I:, "',~'l')a~tf:'I"
It. I ..i'L' \'. '''ill (, ~ ' .
',,' I, ',l -',' ". i'lll>{illb\":~I.Ji\
' . 'I',' ,I, ,"in""
., ., '''d\'';i'~
~, ,':, tlq\' ""'1 '~r..',t, I J
' , r '~\',; 'J '\\1,: ,f', 1\ 'VJJ~'
.~ '.'11 ' ,. ~ i'~i" II ~ II~'! '~~'/j~
"~I \""''''1'' "', 'I, IY <'~l
I,. j " .,'" l,. i,' \ I '.J ,'" J"" " l '''\ \ ~
~ \ ".,IW"I, "'l'li,\/\\.~t\~~\ "~
' ' .1 ~:yr.!':l~",'tR,l,~; ','1,\ I,.. 'Ii. li
I' "\~:l: 1/li'~h.,i~}1~~l:/t~'l~~)~~:
/1' '/"', .>/",,1 }.trl~,r\ ',"\' \f1I:!ll
' j , " I." ,;t, 1 ~" I , (1..11
'" 'I',' 1f' fl"H ' II~,.
' , I 'J' J\:' .\ ,1 '(,J;Mf!~
" II I " " !',: '-It\',~'.\';'~~('
' , " : .', /. ;r);,::-~;
"
,
,I:""
,
I"
, ~,.
\','
'I,
"
"
\.
:, I, ~
r,' '/1,
.'t 1"11'" \ ".r
""
'>,II",,,'
"
I"~
",
/'1"
,"
"
,:.'
'.
',.
'. "
,,;-':,,'.i',
'I'
, ,II'
"
,"
,I,'
, , ,\. ~
,\;"Id:'
.'
'"
-, '~', 't
.,I,!"
I,
"
'I
','
, .
"
'I"~
'\".
'.
,
",I:;:,;:;:r:;;'/';-
. :/',.,'
'Ie
'"I'
:~' ,r".
"
"'.\': '
,,',;\ I
'.
",
'/' ,',,',
:" ,\.
i',C
, I , \ i': ~',J' I::,; ':' r I
,~,! ":"" V.J)
. ", '!"
\
,'.,,'.,
'i
",'
"'. 1 .,
,\I(p'\' \1\
"1....,,1'"
.
'I"~ ", "
, "
"'I,i"Ii'
)","
,
I
'..
I,,' ,/"
"
.1." ,,',.
i," ."
1': "
" , I',' I' If
,,'1,' ','I ,',
i' ,01,' ". 'j'
"
"
,','
~,' .;:
""
.1'.
,,':1
",
,:,';':,;:
':'
,:;\' "
"'"I'
"':,:1\
, "
,\':"
,'"
"
.",}
,:.'
",'
(,,'
.J'
'"
, ~", . I.
I'.,
r,,-
',"
,
';', ~ ~
",
"'"
'I';
'.
r" \
~, II
',,'L
i,
"I,
,
"
i,1'
,
1'1 r"
t' II!
I )~ .' '.'
,(,,:
~. (, I
:':I\',.-,','~" :;;;'
I ' ~".. ,. i
-'<It I'
I!
,
I: '.\,'
j,.-
(.' I;
: ~ 'f I, \ I
"I
,
),
,\".
.I,
'I.I
.,
"'i
I'.\;
"
i.',I'
:t':'
..',"
" '1;
',I!:,','
,,1'1
. '. \, ".~; "
1',\'
, '. ~.
i
':.'\,
,I:
I,. ,,'
\'.11
,
'I'
"
,
'"I'
"
1/".:
.'
',,' I'
, "',
"
':1
. "
"
, ,
',j.
,',,(
, ,
1'.1.\ ,
'."'! "1,:
r' , ',Ii
"
'/
',",:
, <"".
',;,i.';'
1",:/ "
"I' '
d'
',;
/'",-
1./'
\'.'.\ ..
:"',:.:;:,
","
"
;<(
, "
'"
,
'.,
"
.'
Ii,
,......
" ;,
-..1':,)',1 J',
/"'i
,,'
.
.. I.
,
", ,)",.'
, ,I,'
" "!
,',
\,'''
',~~,:I, /': ,!
,
, ,
'II',
J,j' "
':':';'{','/I.
,..
',:"
"
':.(
" '1', ':~
., ""'1,
"
1'1,
.1" "
,,,
, '.',1,
" .,il'
i.',:";,-
':'j\"/.'.i
"
.',1
:, "
"1',1
.
'"
"
.1,",
"
"
~ ~ '
,;,1.", ',.
"
,I"
\"
"',
,
!"',.\
.".
'.'"
.,!
';,.'.l,I, },"
'" \,
,
,
",
. :'
'.
'J~ '
I,',
[,
'.
,
"
'.
i
"
,:
..
.,,'
,
'lq
"
, ,
'"
"
.....
'0
;J'
','
"
"
;"
",
/,;t
,
!"
)1',,'
1 ~,
-"1'
,
','.',
"\.' '!\.'.
I"
", .\
.'"
q
"
t.'1
"".:!
I', .
",'
"
""':"
" ",
,',
I, ~"
11'.
"I
,11'1
"
,I 'i
' 1,\,,:,
"
1'.'\/
\: ..
I.:.~': ";1, ;', f L,"
,,'
, ~ I : .
".
:-
,I"
,
,
,l: ' '~:'
..
.:"
'",
, I~ ~ I-I .. _::! .
' <OJ ,;l. \Q.? ..;J,
,.. .-
.'
" ,"
, ,
IN THE COURT OF COMMON PLEAS 0fI' CUMBI<:RLANDCOUNl'V, PENNSVLVANIA
In Re: Bstllte of,Clmrles Eo Cush,
Orphun's Court Division
Deceased
No. 21-94-0500
~
AND NOW, this L'~ dllyof ~~~ 1995, the within pet II Ion hnvlng
been presenteel, rend and considered, Ills hereby decreed thllt the personnl property of Chllrles B. .
Cnsh, deeensed, sllilll be distributed to the person entitled thereto liS set forth in the within petition,
und upon completion of sllch distribution, Susun L. ClIsh Is discharged liS adl11lnlstrutrlx of the estnte
of the aforesaid decedent,
,
,
BY THE COURT, '
V:-<<I F-' Jt;----
arold E, Sheely, P,j,
; '.
','
" '
,
"
, "
,',
1'1.
>>,
"
.'
, ,
"
....,
",
, ,',
, ,
"
,1
\,
;
"
,
,
, "
'Ii
'1"
,I
",'
"I',
"
,I'
\\
',1'
"
"
"
"
i"
."
I'
_ij,
I'
,'11
"
Ie
"
"
,I
"
, \ ~
",
",
.1
."
I ~ ' .1
" I,'
..
"
'"
"
"
'\
,
"
,
"
,
I'
':. "
I."
,J"";"'.,.. _*' ....,.....'..
, ,
,"
, ..
.' I.
'i.,.
"," "'.'
'Ii,
I
.'1'
H;
.. .' .~
,
',.,
\:
'"
,
'..
.'
,I
,/
""1-/
;1;
'~
"
,\1
",
"
!
c
"
,-"
"
"
'.'.
"
i " h
"
"
, "
"
"
, 'i
"
,,).
I,
, "
"
"
'\.
\,'
"
'I' l
,"
tI
:\
, ~ Ii
,-
,-'~' .
"
"I,
I d'
',II
'I
pI
.
"
,
:l;"~"1 ~\'
"....~~' ~:, .
, I'll'
~ . l,'" "
, I'
,.
"
L,.IL
(..'
,.
/:i ftc
.1
t' .1
" 'f
"
,'4
., ;
,
,; ".
,,"J
.
"
1'1'
,
,-.~;,'
,.
'!
I
1\.
,. (.
,
.
.
..,_' .1
~ I~ .. -","
...,.." ' 'I
, . ., ,- J I
, '.
,
""
.
.i
"
1/
\
I
I
I
"
i
~., \,
,
,
"
..
I ,;
.'
I
,
I
..
,
i
, .'
,""1..
IN THE COURT OF COMMON PLEAS OF ClJMDI<:RLANJJ COlINTY, PENNSYJ,VANIA
In Re; Estate of Charles E, Cash,
Decellsed
Orphlln's Court Division
No. 21-94-05(KI
Ul1l'I9N FOR SEl'TLEMEI'l'f OF SMALL ESTATE
To the Honornble Harold E. Sheely, President Judge of suld Court:
The petition of Suslln L. Cush, widow, of the estllle of Churles E. l'lIsh, respectfnlly
represents:
I. Your Petitioner Is SuslIn L, Cush, who Is relnted to Churles E. Cush, decellscd, und hus the
following interest In the lIssets that would comprise the est lite of Churles E. Cush,
2. Chllrles E. Cush died Intestllte on December 7, 199~, In HUl1lpden Township, und lit the
time of death the decedent's lllst prlnclpul resldellce wus 17:1 DlIkhlll Drive, CUlllherlulld Counly,
Carlisle, Pennsylvania.
1 The above-muned decedent died Intestute und no letlers of udmlnlslrution huve bel'n
Issued.
4, TIle lotal vulue of the decedelll's personul estllte Is less thun $10,000 lIndcllnslsts of the
following assets which have the following value:
Asset Vallie
Chevrolet OM Truck 0/10 (1969) $200.00
Chevrolet SlIverudo 1/2 ton Truck (1975) $600,00
5. TIle expeuses of the decedent's 11Ist IlIuess und funerul huve been puid, und there are no
IInpald creditors of the decedent.
" ,
REV:'1547 EX AFP (10.93.,
C_AL TH Of PfNHSYLVAHIA
DEPARTHEHT Of REvtHUE
BUREAU Of INDIVIOOAL TAXEI
DEPT. Zl0601
H.IRIlIIIUllD. PA 1711"0601
NOTICE OF INHERITANCE TAM
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSNENT OF TAM
ACN
101
STA FILE NO.
DATI! OF DEATH 12-07-93 COUNTY CUMBERLAND
NOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUSHIT THE UPPER PORTION OF TIllS FOR" WITH YOUR TAM
PAY"ENT TO THE REGISTER OF WILLS, "AJ<E CHECK PAYABLE TD "REOISTER OF WILLS, AGENT"
REMIT PAYMENT TOI
PATRICIA R BROWN
4 E L IBERTV AVE
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
L AMount R..lttod l
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ...
iiifv: iS4"' " ilii'"AFP" n'ii:m- -iliii'-ici" "oji" i"NHEiiif ANti -YA'x-A"PPRXi sEifEili'";-Ai.'i."liiiANca- iili".... - -".. -""" -"-
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CASH CHARLES E FILE NO. 21 94-0500 ACN 101 DATE 10-18-94
TAM RETURN WASI (X) ACCEPTED AS FILED () CHANGED
RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. R..l E.t.t. (Sohedul. Al
2. Stock. end I..nd. (Sch.dull II
S. Clo..l~ Hold Stock/P.rtn.r.hlp Int.r..t (Schedul. CI
4. Hortgog../Not.. R...lvobl. (Schedul. DI
S. C..h/llnk Dopo.lt.I"I.c. P.r.onol Prop.rty (Sch.dul. El
6. Jolntl~ Own.d Prop.rty ISchodul. FI
7. Tr....f.r. (Soh.dul. G)
e. Tot.l A...t.
I1l
121_
151
141
151
161
171
.00
.00
,00
,00
800.00
.00
,00
lU
800.00
APPROVED DEDUCTIONS AND EXEMPTIONS I
,. Funer.l Expon.../Adnlni.tr.tlv. Co.t.1
"I.o.ll....ou. Expon... (Schedul. HI
10, Dobt./Hortg.go Llobllitl../Llon. (Sch.dul. II
11, Tot.l D.duction.
12, Hot V.lu. of T.x R.turn
15, Chorltobl./Qcv........,tol 1Ie_.ta (Schedul. J)
14, Hot U.luo.of ,Iot.t. SUbject to T..
(,)
(10)
5,620.00
59 , 046.43
UlI
(12)
liS)
(14)
64,666.45
63,866.45-
--:00
.00
If .n ........nt w.. i..u.d previaU8ly, linl. 14, 15 .nd/ar 16 .nd 17 will
refl.ot figur.. th.t inolud. the tatel of ALL rlturn. .1....ld ta d.t..
ASSESSHENT OF TAXI ---
15. AIIount of Line 14 tlxobl. .t 6Y. r.tl (15)
16. AlIOUI'It of Line 14 toxobl. .t 15Y. r.to (16)
17. Prlnolpll Tlx Due
TAX CREDITS I
PAY"ENT
DATE
NOTEI
.OOM.O"
.00 M.15'
(17)
.00
.00
.00
RECEIPT
HUHIER
DISCOUNT (+)
INTEREST (.)
AIlOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REUERSE
FOR CALCULATION OF ADDITItNAL INTEREST.
I IF TOTAL DUE IS LESS THAN II, NO PAYNENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU NAY IE DUE
A REFUND, SEE REUERSE SIDE OF THIS FORN FOR INSTRUCTIDNS.I
,
.-5 ;~'/'J., I
\
,VIS
RIV-1547 IX AFP (10-93*
C_AL TH lll' PENNSYLYANIA
DEPARTHENT Of' REi/[HUE
BUREAU Of INDIYIDUAL TAXES
DEPT. 210601
twlRlllUllll, PA 17121-0601
~
NOTICE OF INHERITANCE TAM
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAM
ACN
DATI! 10'.18-94
101
. FILE NO.
DATI! OF DEATH 12-07-93 COUNTY CUMBERLAND
NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAM
PAVHEHT TO THE REGISTER OF WILLS, HAKE CHECK PAVABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TOI
If an .....Im.nt w.. i..uld pr.viou.ly, lin.. 14, 15 .nd/or 16 and 17 will
r.f1lct figure. th.t include the total of ~ rlturn. Ille..ed to d.te.
ASSESSMENT OF TAXI
lB. Aoounl of Lin. 14 I..abl. .1 6% r.I.
16. Aoounl of Lin. 14 t..ablo ot IB% r.t.
17, Prinoipol To. au.
TAX CREDITS I
PAVHENT
DATE
PATRICIA R BROWN
4 E LX BERTY AVE
CARLISLE PA 17013
TAM RETURN WAS I (X) ACCEPTED AS FILEO
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN RASED ON: ORIGINAL RETURN
1. Ro.l E.tot. (Schodul. A)
2. Stock. Ind Bond. (Schodul. Bl
5. Cloooly Hold Stcck/Plrtnor.hip Intorl.t (Sch.dul. Cl
4. ""rtglg../Not.. R...i.lbl. (Sch.dul. 0)
B. Ccoh/Blnk D.po.it./HI.c. Por.on.l Prcp.rty (Sch.dul. El
6. Jointly Own.d ProPlrty (Schldul. Fl
7. Tr.noflr. (Schldul. G)
B. Tolo1 A...to
APPROVID D~DUCTIONS AND EXEMPTXONS:
9. Fun.rll E.pon.I./AdMlnl.Irlll.. Co.tol
HI.o.llonoouo Expon... (Soh.dul. HI
10. Dobt./Hortg.g. Liablliti../Li.n. (Sohodul. I)
11. Totol O.ductlono
12, Hol Volu. of T.. R.turn
15. Chlrlt.bl./Go..rnMlntll B.qu..t. (Sohedul. Jl
14. Hol V.lu. of Eot.I. Subjlot to T..
NOTlI
RECEIPT
HUHBER
OISCOUNT (.1
INTEREST (-I
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
) CHANGED'
III ,00
(21 ,00
m .00
(41 .00
(Bl 800.00
(6) .00
(7) ,DO
(Bl 800.00
(9)
UO)
5,620.00
59,046,43
llll
(2)
US)
(4)
64,666.45
63,866.45-
.00
.00
(1&)
U61
.00 M.06"
.00 M,U"
.00
.00
.00
U7l _
AHOUHT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
.00
.00
.00
.00
IF TOTAL DUE IS LESS THAN fl, NO PAVHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAV BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
.'
RESERVATJONI Elt.t.. of dlcldlnt, dYlne on or blfor. Deo~r 12, 19.2 .. If lOW future Int.r.st In the ..tat. II trln.flrred
In po.....lon or enJoYMnt to eh.. . (ool1.'.r.l) benef.lol.r.u of thl deCllIdent .ftlr the .xplratlon of MY tnlt. for
llf. or for VII", the C~.lth hereby .)Cpr.l.lv r.~.rv.. the right to apprall' Ind ...... 'rlnlf.r Inh.rltlnG. T'M"
It thl l...ful Cl... . (ool1.t,ra1) rtt. on any IUClh future Int.rut.
PtJRllOSE OF
NOTICE I To fulfill the rlqulre.."h of Slatton 2140 of the Inh.rJtIMI and E.tat, TIM Aot, Act 2Z of 1991. 72 P.S.
Stotlon 2140.
PAVtlENTI Dttlch the top portlon of thll Hotlel and tub_It with your PIV\Mnt to till Rlght,r of Willi printed on the r.y.r.. Ila.
"HIIl. oheCk or ....... ordor .....1. 101 REOISTER OF MILLS, AOENT
AU PIVMI\tl r.celVed ,hill fir.' be IPplJld to any Int.ru' which .'Y b, due wUh MY ,"llndtr 'PPl1~ to the tlM.
REFUND (eR)1 A r.fund of . tlM crldlt, which ..a. not r.quetted on the T'K Rlturn, ..y bl requeltld by coeplttlnt an "Applloltlon
for Rlfund of Ptmlylv.,,11 InhtrltlnCl und fltth Till" CREY~UU), AppllCllt10nl Irl av.Uablt .t thl Offloe
of tilt R.alttlr of WUII, any 0' the 2S Rlv.nut Dhtrlot OffiCII, or by clll1na thl IPtOll1 Z4-hour
anlwlrlna ..rvlel nueber. for fer'l ord4rlnal In Pennlylvlnla 1.800-562-2050, outllde Plnn.Ylv.,,11 and
within 10011 Herrhbura .rll (717) 717.8094, TOOl (717) 17Z~2Z52 CHelrlno Ilpllr.d fmlv),
OIJECTlOHSI Any pertv' In Intlrllt not uthflld with the appreh..tnt, IUonnel or dhlUowencl 0' deduction., or ..........t
of tlM (InoludJng dllcount or Interelt) ae ,hown on thlt Hotlc. IU.t obj.ct within .IMty (60) diY' of r.oelpt of
thh HoUel bYI
."wrlttln protl.t to the PA Otpartl,nt of R,v.nut, Baud of ApPIIII, DEPT. 211021, Hlrrhbura, PA 17121.1021, OR
..ellOtlon to heVI the 11ft., dtttr.lntd .t audit 0' thl account of thl p"lonal rlfll,..tntaUvl, OR
--.....1 to the Orphint' Court.
AllltlN
lST~ATIYE
COIIIlfCTlONSI
Faqtual "rort dhoov.red on thh ........nt .hould b, addra...d In wrltlno tal PA Otparttlnt of R.venut,
luntu of IncUvldul1 TIMII, ATTHI POlt A......ent Revl.... Unit, DEPT. 210601, Htrrhburo, PA 17UI.D601
PhonII (717) 711"6505. SM PI" S of the bookl.t "In.truotlon. for Inhtrltance TIK Return for. Ruldtnt
DtcelMnt" (REY-1S01> for an IKplanttlOIl of adlllnhtrlUvlh' oorrletlblt errora,
If tny tt)( dull II p.ld within thrtt (1) oalend" lenthe Ifter the dlcedont', cMlth, . flvl ptrctnt UiO dhcowtt of
the tu Plld h aUowld.
OISCMiTI
INTElltiSTI
In1lrllt It r.herold bqlmlng with flrtt dillY of d.lIrlquenCly, or nlM (9) IIOnth. and ant 0) dlY fra the dl" of
doth, to the dltl o( pIVHnt. TlMU Nhloh bac... dlllnquent blfore JlMUlry 1, 1912 bier In1lrllt It thl rite of
lhe 16~) pare."t plr IMUII ealculttld at I dilly r.t. of ,000164. A\1 tUII which bto... cMlInquent on and Ifter
Jenuery \, 1912 will bear Intere.t It . r.t. which will vary frol cIllnatr yair to etlendtr yelr with thtt rltl
enMOUnold by the PA O.ptrt.lnt of Rev.nuI. The applloabll Inttr.,t r.tel far 1912 through 1994 .rll
'!!!!: Inten.t R.te Dally Intare.t Factor !!!r Interl"t R.tl Oalh Interll' Factor
1111 lOX .00DiU 1986 lOX .ooom
1961 16X .omu 1967 9X .00m7
1964 m .000lDl 19&1-1991 IlX ,IOUOI
1961 m .000SS6 1991 9X .00m7
1991-1994 7X .00m2
--lnterllt I, calculatld el follow'l
INTEREST. SALANCE DF TAX UNPAIO X NUHBER DF DAYS DELINQUENT X DAILY INTEREST FACTOR
"'Any NoUoe I..utd liter thl tile bleo... dtllnquent wll1 refllot an Inbrut ollculltlon to flfteln (11) din
bevond thl date of thl ......unt. If ply..nt I, 'Ide aft" the Interut cOllPUtaUon dlte thown on the
HoUOI, ItddIUontl Interllt ",.t be ctlcultttd.
<lV.llOO lX, 11'''1
.
I!!
~~g
:~...
Ua.ll
a.
~
.%
Ill...
"'c
"'z
8~
v'
"'II~
) 1-1 ~a., 5 .- 3
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
<2.
PILI NUMIIA
(/L/
500
,~I -
~
c
~
'"
c
COMMONWEAlTH Of PENN$VlV..l.NIA
OEPAiUMwr m REVENUE
POST O"IC( BOX 8311
HARR1$8UIW,'A 11105.B321
ON'S NAM llA~l, fIRSI. MiD MIDDlf INiTiAl!
D
COUNTY CODE
DENf'S-COMPLETf ADDRESS
NUMBEI
YEAR
CASH CHARLES E
S COAL ictrtiiii';OMm----n-jDArE OfDeAfH-r.lTOf8iAfH-
232-70-0851 12-7-93 4-20-45
[XI 1. Original RelUfn LJ 2, Supplemenlal Relurn
173 OAK HILL ROAD
CARLISLE, PA 17013
c,,", CUMBERLAND
o 3, Romainde, Relurn
liar dale. 01 dealh prlarla 12.13.82
[J 5, Federal Ellale To,
Rfth:rn Required
_ 8, Talal Number of Safe Depa.1t Bo,e
o 4, lImlled E.lale
rJ 40. Future Inleretl Compromise
lIar dale. 01 deolh aftor 12.12.821
o 6, Docedenl Died Te.lole [] 7, Docedenl Malnlolned a Living Tru'l
IAlloch capy of Will) (Allach copy of T rulll
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD 8E DIRECTED TOl
NAME fOM"PrmMAlllNO ACDRESS
PATRICIA R. BROWN
LIBERTY LOFT
4 E. LIBERTY AVE
CARLISLE, PA 17013
T [(PHONE NUM8ER
L 717
I 243-7922
z
o
-=
:3
E
~
1, Real EllalelSchedule A) ( II.!:Ion~_._______
2, Slack. and Bond. ISchedule 81 ( 21 __ none
3, Clollly Held Slock/Pallne"hip Inlerell (Schedule CJ (31 none
4. Morlgoge. and Nole' Receivabll (Schedulo 01 I 4) _..fi.Qne
5, Co.h, Bonk Dopo.I" & Miteellonlou, Pe/lonal Properly I 5) ~800. 00
(Schedule E)
6. Joinlly Owned P,op.rly ISchedule FI
7, T rontfe/l ISchedule GllSchedule LI
B, T 0101 Grou Aue" (Iolallln.. \.7)
9, funtrol Exponl", Adminillralive COSII, Mhcellan,oul I 91
E 'pense, (Schedule HI
10, Debll. Morlgoge Lloblliliol, Lien. (Schedule II 110)
11. T 0101 Deduct;ons (Ialallln.. 9 & 101
12. Nel Value 01 EIIOIO IlIne 8 mlnu, line II)
13. Chorilable and Governmenlal Bequell. ISchedule JI
14, Nel Value Subject 10 To, llin. 12 mlnulline 13)
15. AIJIOunl of line 14 IUKable 01 6% role
Ilnclude valulI Irom Schedule K or Schedulo M,I
lb. Amounl of line 14 laxable 01 15% roll
Ilnclude value. from Schedule K or Sd,edule M,I
17. Principal la, due IAdd lox "om line 15 and from line 16,1
18. Credi" Prior Paymenll oilCounl
1171 _llQM...
( 61
(71
none
none
567.0.00
(8) $800.00
59,046'4~
111) _ 64,666.45
1121 _(63,866.45)
1131 none
(14) (63,866.45)
none
115)
)( .06 a
116)
)( .15 a
none
z
o
-=
S
~
o
U
g
lnll'II'
- +
19, If line 18 I. greoler Ihan line 17. enler Iho difference on IIn. 19, Thi. i. Ihe OVERPAYMENT.
aD
20, If linl 17 i, greole'lhon llno lB, enle,lhe dlffe,ence on line 20, Thl. i. Ihe TAX DUE.
A. Enter ,he In'eres' on Ihe balance due on I1n. 20A,
B. Enler Ihe 10101 of line 20 and 20A on line 20B. Thi. i. Ihe 8ALANCE DUE.
Mokl ChICk Payabll 101 Rlgl.tor 01 WillI, Agont
Ch~ctt II("e if you (lro roqu{I\ling 0 rolund o' your overpnymflnt.
118)
1191
1201, none
120AI__
120BI
. .OE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH..
Under penchi.. of perjury. I declart Ihall hOllo examined thil rl'urn, including accompanying Ichlldul~1 and Ilotemenll, and to ,h. bill 01 my knowledg, and b.1i~j
il IllruI, corrlC' and comple'.. I d.clar. rhol 011 "0111101' has been ,eported altrue market yolul. Oeclareri"," of preparer Oln" Ihon th. penanal repr,"nloliv. i
bOlld on olllr.formallan of which preporer hOI any knowl,dge.
$IONATUU O~ PUSON RU'ONSIILf fOR 'IUNO II.ETUIl.N ADDRESS bAlf U
~A.UOTHfll. TH....N Il.fPRfSfNTi~
l./).... ' L ',> I')
7'''A-'\..'--C<'''AV I( .- 00-, HI.....)
v
ADDltfSS
'I .:<.i<'d)
mE
!c,-(,,_ 'lY
(4-'-.('H_(-',(
('~d' t '-" II II::!,\..,
I/(JI, '-j
",'lIlllt ~,ll' ~~ ~ SCHEDULE I J
COMMONWlAUHO"'NNIl"ANIA DEBTS OF DECEDENT,
IN~:::~I~,Wtc'I::~~IN ~ORTGA~E_~I~BLI~I_~S A_N~_L1E~S __.______PI.~_'.!..'ln,'_ 01 Tvp.
i~TATI 0' I PILI NUMIIR
CASH, CHARLES E. --L-
ITEM DISCRIPTION AMOUNT
NUMIIR
1. TOYOTA (1987) (10 MOS. AT 250.29) 2502,90
2. BONTON 231.51
3. CHOICE VISA 1966.00
4. HECHINGER 1848.00
5. LOWE'S 2576.00
6. MONTGOMERY WARDS 148.00
7. BOSCOV'S 402.39
8. FINGERHUT 80.94
9. HOUSEHOLD FINANCE 50% of $13,340.82 6670.41
10. MORTGAGE ON HOME 50% of $84,729.84
AT 173 OAK HILL ROAD CARLISLE, PA 17013
(SEE ATTACHED) 42,364.9~
11. PROPERTY TAXES (to 12-7-93 000) 50% of 423.50 212.75
12. MEDICAL (E. PENNSBORO AMBULANCE) 42.63
TOTAL (Allo enlor on line 10, Recapitulallonl
$ 2~,046.45
(/I more Ipace II nlldld, Inllrt adc/iliana' ,hllll 0/ laml ,ill,)
.
. I
.
" ,
~, SmLF.MENT STATEMENT
ra COMMONWEALTH
~ lAND TITLE INSURANCE COMPANY
OMB No. 2502.0265
B. Type 01 loan 1 lOin Humbtf I Mor1ift1lnlllf'lK. CU, H~mbM
1,0 FHA 2,0 FmHA 3,0 Cony, Unlns, e 11111 Humbtl
4,0 VA 5, [] Cony. Ins,
c, Nole: T~ls 101m IlluIillshed 10 give you a slalemenl 01 aclual ..,llemenl cosls Amounls paid 10 and by Ihe selllemenl agenl aIB shown lIems marked "{p,o,c,}"
wile paid oulslde Ihe closing: Ihey aIB shown here 101lnlOfmallonal purpom end are nOlln.luded In Ihe lolals,
o NMw'M 144,", tlIofIOW.' t H'lTlIlndAddllltOIS,lltf f Hamt .nlt AddrlU ~t l.lIde'
Charles E. Cash and Susan L. SuDan J. Hatch GHAC Hortgage Corporation
Cuh
9 PrOC*1w l"'llOIl H Stlllfm4nrAgtnt
. , Fishman & 0' Brien
R.~ 9, Box 251B
~"oISlUItm'n' I Stnlttl'4111o.t,
Carlisle, PA 17013 ! 155 S. Hanover St.
Carlisle, PA 17013 8/10/87
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SElLER'S TRANSACTION
100. GROSS AMOUNT OUE FROM BORROWER: 400, GROSS AMOUNT OUE TO SEllER:
101, Contract $lIes price 88 800.00 401. Contract nles price 88,800,00
1Of. Persollll property 402. Person.' property
103. Settlement chilies to borrower (line 1400) _11,860.....2.f 403. .-
104. --'-- 404.
-
105. 405.
~ustments lor Items paid by seller in advance: . Adjustments lor Items paid by seller in advance,
106. City/town taxes to 406 City ftown taxes to
107. County tms 8/10 ~o 12/31/87 - 95,53 4U/. County t.xes 8/10 to 12/31/87 95.53
108. Assessments to 408. Assessments to
109. M.inlelllnce to 4l1'J, M.lntenance to
11 O. SchooVT ms to 410. Commitment Fee to
111. tei 411. to
. 112. - to
to 41l,
120. CROSS AMOUNT DUE FROM BORROWER: 93 756.45 420. GROSS AMOUNT DUE TO SELlEIl: 88.895.53
200. AMOUNTS PAlO BY OR IN BEHALF OF BORROWER, 'iDO. REDUCTIONS IN AMOUNT DUE TO SELlER,
201. Deposit or earnest money _.1.QOO.OO _ ~Ol. Excess depOSl1 {see instructions!
-202. Principal amourifornewioan(if-'-- ---, B.8. Bo.oLOO. - 502. Settlement charges to seller (fino 1400) O.047.l;n
-ili3. Exlstlnlloan(Sl'iaken sub/eerlo _-, .. --- _~03. uis.tinlloai1(s) taken subJecno-
2otCOmiiiltment .Fee-------- -----.-. 504. Payoff 01 first mortgage loan First Federa 40 994.13
J'Q.5. r."'A"~t In,.. App"'A~aAl fAA -i9~o.o.. 505. Payoff 01 second mortgage loan 1----.-------.
..206 r.,..Arl i to fnl" f"':rArl it t'A .... ? l;n .506-;-------.----.-..------.h - ...
_~!. r....Af'Ht fnl" nntllT'Y fAns. 'LOO 'J(,T:-
208. 508. "- --..-- --.
209, SO[ ,
AdJustmentl for It,ms gnp.ld by seller. Adjustments lor iteml unpaid by leller,
210. Clly /town taxes - ~IO, _ Clly/town ISleS to
to
211. County tixes to ~a: ii~:i~~;~i:------- ._-:~-_. -...,-
212. Assessments -.-. -- ----
to
r-SfCMiiiiifenarn:e --to-'-'--'---' .. ----.-. '.- .
213. School/Tlxes to 8/10 :=~:~: SChoo!~aiis -=- 7/1 _:~._8nQ.~ ----
7/1 73.91 73,91
214. io -.. .....---...
215. to -SI6. '-----10----'---.. -- --- .... _._-_..
216. to - ---. f-- . to-----' . h_.__. .
517.
217. to ~ra:-- "-to---'''-- . ..~. ,.-... --. -
218. to --519, to-.-----. __n.'_' ,.
219. -- to
520. TOTAL REDUCTION AMOUNT OUE SEllER:
220. TOTAL PAID BY IFOR BORROWER, _8Q. Qon 1.1 51.0~5.54
300. CASH AT SEnLEMENT FROM/TO BORROwtR: 600, CASH AT SmlEMENT TO/FROM SEllER,
301. Gross.mount due Irom borrowar (line 1?0) 93.756.45 601. Grols amount due to seller (Imo 420) 88,895.53
302. leu amounts p.,d bY/lor borrower (line 220) 89,900.411 602. lees toM reductions In amount due seller III.. 1101 5i,015.54 )
303. CASH (~ FROM) (0 TO) BORROWER, 3,856.04 603. CASHlCl(J TOI (0 FROM) SEllER 37,879,99
10IIfIJOt2lkev IIMI
HllUII~ 3161
MS'AHI4~'
.
. ,
. . I '"
File Number
.
CIRTIPICATION
I dlreot and authorize the Company to make the distributions Indloated for my aocount on the
attaohed HUD-1 Settlement Statement, approving the tax prorations Indicated theroln, and
understand that prorations were based on figures for the preceding year, or estimates for tho
ourrent year, and In the event of any change for the current year, all necessary adjustments must be
made between Seller and Borrower direct; likewise any DEFICIT In delinquent taxes will be
reimbursed to Title Company by the Seller,
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and
belief, Ills a true and accurate statement of all receipts and disbursements made on my account or
by me in this transaction. I further certify that I have received a copy of Ihe HUD-1 Settlement
S/7n-J c!. aA
....
-t. } ((
,...
... !/ ~%L
(7"
s..'uYh"h
Borrower.
c~ (7r.l~-'
Seller.
To the best of my knowledge, the HUD.1 Settlement Statement which I hllve prepared Is a true and
accuraol aocount of the fund~ whloh were reoelved and have been or will be disbursed by the under.
slgne aa-p~'- ~Seltlement of t~ransactlon. ,! '
- . S5'i /J ~/.s7
Selll,ment Agent
Oate
WARNING: It Is a orlme to knowingly make false statements to the Unlled States on this or any
other similar form. Penalties upon oonvlotlon can inolude a fine and Imprisonment. For details &ee:
Title 18 U.S. Code Section 1001 and Seotlon 1010.
INFORMATION REPORTING ON REAL ESTATE TRANSACTIONS
THIS HUD SETTLEMENT STATEMENT CONTAINS IMPORTANT TAX INFORMATION (BOXES E, G, H, I,
M AND LINE 401) AND IS BEING FURNISHED TO THE INTERNAL REVENUE SERVICE, IF YOU ARE
REQUIRED TO FILE A RETURN, A NEGLIGENCE PENALTY OR OTHER SANCTION WILL BE
IMPOSED ON YOU IF THIS ITEM IS REQUIRED TO BE REPORTED AND THE INTERNAL REVENUE
SERVICE DETERMINES THAT IT HAS NOT BEEN REPORTED.
SollcltlUon of TIN
Seller Is required by law to provide the Company with his/her correct taxpayer Identification number.
II correct taxpayer Identlfloatlon number Is not provided, he/she may be subject to olvll or criminal
penalties Imposed by law,
C.rtUlcltlon of TIN
Under penalties of perjury, I certify that the taxpayer Identification number shown In this statement Is
my correct taxpayer Identlfloatlon number.
_LAU_'~ Q 7/b
SELLER ,U
POllII... -.1IIll
SELLER