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Home My WebLink About04-19-06 (3) .00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ~L COUNlY CODE -.9L 0104 ___ YEAR NUMBER I- Z W C w o w C DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Lerew Ma DATE OF DEATH (MM-DD-YEAR) DAle OF BIRTH (MM-DD-YEAR) 1/20/2006 7/24/1923 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) E SOCIAL SECURITY NUMBER 179-12-5700 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ [X] 1. Original Return ~ ~U) D u O::~ 4. Limited Estate w 0..0 ::I: 00 r:;;-1X U 0::...1 ~ 6. Decedent Died Testate (Attach copy of Will) o..m ~ D 9. Litigation Proceeds Received D 2. Supplemental Return D 3. Remainder Return (date of death prior to 12-13-82) D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) _ 8. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95) D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS I- Z w C Z o D. U) W 0:: 0:: o o Thomas M. Shorb, Es ire FIRM NAME (If Applicable) Stock and Leader TELEPHONE NUMBER 717-846-9800 Susquehanna Commerce Center East 221 W. Philadelphia Street,Ste. 600 York, Pennsylvania 17401-2994 z o i= :5 ::) l- ii: <( o w 0::: 6. Jointly OlMled Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 137,740.25 0.00 0.00 0.00 297,303.63 0.00 OFFICiAL USE ONL ~ 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) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (4) (5) 51,559.42 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) (8) 17,585.81 281.84 486,603.30 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) ( 13) 17,867.65 468,735.65 0.00 11. Total Deductions (total Lines 9 & 10) (11 ) 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) ( 12) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 468,735.65 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax 0.00 x .0 ~ (15) z rate, or transfers under Sec. 9116 (a)(1.2) 0 i= 16. Amount of Line 14 taxable at lineal rate 468,735.65 x .0 45 (16) <( ~ :::) 0.00 0.. 17. Amount of Line 14 taxable at sibling rate x.12 (17) :E 0 0.00 U 18. Amount of Line 14 taxable at collateral rate x .15 (18) >< <( 19. Tax Due ~ (19) 0.00 21,093.10 0.00 0.00 21,093.10 20. [KJ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W4645 1.000 RK Decedent's Complete Address: SlREET ADDRESS 331 Everqreen Street Cumberland County CllY I STA 1E I ZIP New Cumberland PA 17070- Yes D D D D without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IX] D 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 return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representatiw is sed on all infonnation of which preparer has any knowledge. OF R SON RES paN I I NG R 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 0.00 1,054.65 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 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. (SA) 8. Enter the total of Line 5 + 5A. This is the (58) Make Check PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1 . Did decedent make a transfer and: a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income;. . c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? . . . . . . . . . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death E{. ec ~t-er- 21,093.10 1,054.65 0.00 0.00 20,038.45 0.00 20,038.45 No [Jg og ~ [1a ~ ~ Susquehanna Commerce Ctr. SIGNATURE OF PREPARER OTHER THAN REPR Stock and Leader, B : ADDRESS 221 W. Phila. st., York, PA 17401-2994 t./!;'llt!> 6 221 ~ 2..~~ 'L\ \\) ~ \ ~~ ,o~\, ~ ~\\ ~~ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net valUE [72 P.S. 99916 (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 The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for dis 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 younge or a stepparent of the child is 0% [72 P.S.!3 9116{a)(1.2}J. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.t The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P .5. individual who has at least one parent in common with the decedent, whether by blood or adoption. 3W4646 1.000 A. 17401-2994 Jrviving spouse is 3% ~ P.S. 99116 (a) (1.1) (ii)] n are still applicable even if ] parent, an adoptive parent, 6{1.2) [72 P.S. 99116(a)(1)]. I. under Section 9102. as an COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE . REV-1502 EX + (6-98) ESTATE OF FILE NUMBER Mary E. Lerew 21 06 0104 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 knoVtlledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION NUMBER 1. Real Estate known as 331 Evergreen Street, Cumberland County, New Cumberland, PA @ sale price VALUE AT DATE OF DEATH 137,000.00 2 Real Estate Settlement Adjustments: City/Town Taxes $ 450.30 County Taxes 289.52 Trash expenses .43 740.25 3W4695 1.000 TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 137,740.25 . REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Mary E. Lerew FILE NUMBER 21 06 0104 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 2001 Chrysler Sebring LXi @ sale price 6,500.00 2 Capital Blue Cross, claim payment 6.75 3 Capital Blue Cross, refund of unused premium 277.03 4 M&T Bank Checking Account #55237827 Interest accrued to 1/20/2006 19,826.82 0.65 5 63,000 Par M&T Bank Certificate of Deposit #031003915142027 Interest accrued to 1/20/2006 63,000.00 1,393.45 6 12,000 Par M&T Bank Certificate of Deposit #031003914383200 Interest accrued to 1/20/2006 12,000.00 23.74 7 M&T Bank Certificate of Deposit #031003913152333 Interest accrued to 1/20/2006 25,000.00 715.55 8 Ohio Casualty Group, refund of auto insurance premium 266.03 9 Ohio Casualty Group, refund of over payment 215.94 10 Personal Property @ appraised value 2,525.00 11 Personal Property @ sale price 550.00 12 PNC Bank Checking Account #5003550393 Interest accrued to 1/20/2006 2,986.26 0.19 13 60,000 Par PNC Bank Certificate of Deposit #31300266016 60,000.00 Total from continuation schedules . 102,016.22 3W46AD 1.000 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 297,303.63 Estate of: Mary E. Lerew 179-12-5700 Schedule E (Page 2) Item No. Description Value at Date of Death Interest accrued to 1/20/2006 12.92 14 40,000 Par PNC Bank Certificate of Deposit #31500231518 Interest accrued to 1/20/2006 40,000.00 116.28 15 Sovereign Bank Checking Account #0571135714 Interest accrued to 1/20/2006 7,179.09 8.83 16 9,374.64 Par Sovereign Bank Certificate of Deposit #0775342009 Interest accrued to 1/20/2006 9,374.64 34.53 17 10,000 Par Sovereign Bank Certificate of Deposit #0775364144 Interest accrued to 1/20/2006 10,000.00 27.47 18 Sovereign Bank Certificate of Deposit #0775332158 Interest accrued to 1/20/2006 5,000.00 15.40 19 17,259.93 Par Sovereign Bank Certificate of Deposit #0775539810 Interest accrued to 1/20/2006 17,259.93 31.57 20 10,105.16 Par Sovereign Bank Certificiate of Deposit #0775539851 Interest accrued to 1/20/2006 10,105.16 25.16 21 Suscom, refund 32.99 22 United Church of Christ Home, refund of resident Account 2,792.25 Total (Carry forward to main schedule) 102,016.22 . REV-1510EX+(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary E. Lerew SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21 06 0104 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 IIIClLOE TI-E NAME OF TJ-E TRANSFEREE, THEIR RELA TIONSHlP TO DECEDENT Af\D DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER TI-E DATE OF TRA/ISFER. ATTACH A COPl' OF Tf-E DEED FOR REAl EST ATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. Fulton Bank IRA Account #3151942420 Beneficiary: William K. Cowden, Son 8,270.31 100.0000 0.00 8,270.31 Interest accrued to 1/20/2006 172.37 100.0000 172.37 2 Fulton Bank IRA Account #4001982438 Beneficiary: William K. Cowden, Son 5,737.47 100.0000 0.00 5,737.47 Interest accrued to 1/20/2006 161.78 100.0000 161.78 3 Fulton Bank IRA Account #4001482453 Beneficiary: William K. Cowden, Son 7,599.03 100.0000 0.00 7,599.03 Interest accrued to 1/20/2006 18.34 100.0000 18.34 4 Fulton Bank IRA Account #4001982495 Beneficiary: William K. Cowden, Son 10,402.19 100.0000 0.00 10,402.19 Interest accrued to 1/20/2006 164.89 100.0000 164.89 5 Fulton Bank IRA Account #4001932740 Beneficiary: William K. Cowden, Son 4,591.72 100.0000 0.00 4,591.72 Interest accrued to 1/20/2006 37.83 100.0000 37.83 6 Fulton Bank IRA Account #4001981836 Beneficiary: William K. Cowden, Son 13,944.10 100.0000 0.00 13,944.10 Interest accrued to 1/20/2006 459.39 100.0000 459.39 TOTAL (Also enter on line 7, Recapitulation) $ 51.559.42 (If more space is needed, insert additional sheets of the same size) 3W46AF 1.000 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary E. Lerew ITEM NUMBER A. B. FUNERAL EXPENSES: 1. Musselman Funeral Home funeral expense SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule J. DESCRIPTION Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Claimant Street Address City Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Borough of New Cumberland sewer and trash expense 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions State Zip Street Address City Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3W46AG 1.000 2 PA American Water water service State Zip Total from continuation schedules TOTAL (Also enter on line 9. Recapitulation) (If more space is needed, insert additional sheets of the same size) FILE NUMBER 21 06 0104 $ AMOUNT 852.08 13,145.00 64.72 72.80 3,451.21 17,585.81 179-12-5700 Estate of: Mary E. Lerew Schedule H Part 7 (Page 2) 3 PPL Electric electric service 132.87 4 S.w. Barrett Real Estate and Appraisal Service appraisal fee 300.00 5 Settlement Charges for Real Estate Notary Fees $ 5.00 Transfer Tax 1,370.00 County Tax 583.60 Tax Cert. 5.00 Sewer Proration 25.91 1,989.51 6 Stock and Leader Costs: Add!. Fee for Ltr. $ 150.00 File PA Inh. Tax 15.00 File Inventory 15.00 Probate Fee 370.00 Cumberland Law Joural 75.00 Sentinel - witness 25.00 Sentinel - Adv. Exp. 151.55 Postage expense 39.96 Telefax Charges .50 Photocopy Expense 35.00 1,027.01 7 Verizon telephone service 1.82 Total (Carry forward to main schedule) 3,451.21 . REV-1512 EX+(12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary E. Lerew SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABiliTIES, & LIENS FILE NUMBER 21 06 0104 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Capital Blue Cross Medical Insurance Premium 209.46 2 Guistwite Family Practice 72.38 3W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 281.84 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Marv E Lerew 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] William K. Cowden 19 Log Cabin Road Newville, PA 17241 FILE NUMBER 21 06 0104 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER I Entire Estate: 468,735.65 Son 468,735.65 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 3W46A11.000 (If more space IS needed, Insert additional sheets of the same size) LAST WILL AND TESTAMENT OF MARY E. LEREW I, MARY E. LEREW, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will. I revoke all other Wills and Codicils that I may have previously made. Article I My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. Article III I give, devise and bequeath my tangible personal property in accordance with any memorandum which I have either handwritten or signed, located with my Will or with my valuable papers and found within 30 days of the probate of my Will. Gifts may only Page 2 of 4, Last Will and Testament of Mary E. Lerew Article TIl (continued) be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. To the extent no such memorandum is found, or all of my tangible personal property is not disposed of pursuant thereto, my tangible personal property shall be distributed to my son, WILLIAM K. COWDEN. Article IV If at the time of my death I own that real property located at 331 Evergreen Street, New Cumberland, Cumberland County, Pennsylvania, I give, devise and bequeath my interest in that property to my son, WILLIAM K. COWDEN. If WILLIAM K. COWDEN fails to survive my death by thirty (30) days, I give, devise and bequeath my real property to my daughter-in-law, JANE S. COWDEN, of Cumberland County, Pennsylvania. Article V All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath to my son, WILLIAM K. COWDEN, of Cumberland County, Pennsylvania, ifhe survives my death by thirty (30) days. Ifhe fails to so survive my death, I give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate to my daughter- in-law, JANE S. COWDEN, of Cumberland County, Pennsylvania. Page 3 of 4, Last Will and Testament of Mary E. Lerew Article VI I nominate, constitute, and appoint my son, WILLIAM K. COWDEN, Executor Of my Last Will and Testament. If WILLIAM K. COWDEN is unable or unwilling to serve as Executor, I nominate, constitute and appoint my daughter-in-law, JANE S. COWDEN, as successor Executrix. I direct that my Executor and/or my successor Executrix be permitted to serve without bond, and, in addition to those powers granted by law, I grant them power to distribute in cash or in kind, in like or in unlike shares, and to file any qualified disclaimer I could have filed if living. My Executor and/or my successor Executrix shall receive reasonable compensation for services rendered to my estate. Article VII In addition to the powers conferred by law, I authorize my Executor and/or my successor Executrix in his/her absolute discretion: ( a) to retain in the form received and to sell, either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, ( c ) to invest and reinvest in all forms of property without being confmed to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, Page 4 of 4, Last Will and Testament of Mary E. Lerew Article VII (continued) ( e) to compromise claims without court approval and without consent of any beneficiary , (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor or successor Executrix, and to pay from my estate reasonable compensation for all their services, (i) to conduct alone, or with others, any business in which I am engaged in, or have an interest in at the time of my death, and G) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. IN WITNESS WHEREOF, I, MARY E. LEREW, hereby set my hand to this My Last Will and Testament, on January 1, 2006, at Carlisle, Pennsylvania. ~:zf of~ MAR . LEREW In our presence, the above-named MARY E. LEREW signed this and declared this to be her Last Will and now at her request, in her presence, and in the presence of each other, we sign as witnesses. Name Address ~-ia./7r.-c~/v/ 622 S hlyJ.-l~ ~/}-~~ U/7 ;J;;;l3/Cj . v -f!!-Jlaul tU(U1/v1,JU<- lilf~ uJoJ~ui B~~ Pr:!. A1JLIr<;l~) "PiT 1'!5/)' A. B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.0FHA 2.DFmHA 3. ~CONV. UNINS. 4.DVA 5. DCONV. INS. 6. FILE NUMBER: 17. LOAN NUMBER: SETTLEMENT STATEMENT 06-150(2) 8. MORTGAGE INS CASE NUMBER: C NOTE' This form IS furnished to give you a statement of actual settlement costs Amounts paid to and by the settlement agent are shown. Items marked '[POC)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3/98 (LACOCO KA THRYN(21 PFDID6-15D(2J/12\ D NAME AND ADDRESS OF BORROWER: E. t'llAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Kathryn E. Laeoeo William K Cowden Mark C. and Karen M. Lacaca 331 Evergreen Street New Cumberland, PA 17070 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1857112 L SETTLEMENT DATE 331 Evergreen Street Midstate Abstract Company New Cumberland, PA 17070 March 31,2006 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 2331 Market Street Camp Hill, PA 17011 J. SUMMARY OF BORROWER'S TRANSACTION I K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 137,000.00 401. Contract Sales Price 137,000.00 102. Personal Property 402. Personal Property 103. Settlement Charges to Borrower (Line 1400) 3,006.75 403. 104. 404. 105. I 405. Adjustments For Items Paid By Seller in advance Adjustments For Items Paid Bv Seller in advance 106. CityfTown Taxes to I 406. CitylTown Taxes to I 107. County Taxes 03/31/06 to 01/01/07 450.30 407. County Taxes 03/31/06 to 01/01/07 450.30 108 School Taxes 03/31/06 to 07/01106 289.52 408. School Taxes 03/31/06 to 07/01/06 289.52 109. Trash Proration 03/31/06 to 04/01/06 0,43 409. Trash Proration 03/31/06 to 04/01/06 0.43 110 410. 111 411. 112 I 412. 120. GROSS AMOUNT DUE FROM BORROWER I 140,747.00 420. GROSS AMOUNT DUE TO SELLER I 137,740.25 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201 Deposit or earnest money 501. Excess DeDosit (See Instructions) 202. Principal Amount of New Loan(s) I 137,000.00 502. Settlement Charqes to Seller (Line 1400) 1,963.60 203. Existino loan(s) taken subject to I 503. Existinq loan(s) taken subiect to 204. 504. Payoff of first Mortgage 205. 505. Payoff of second Mortoaae 206. 506. 207. 507. 208. 508. 209. 509. Ad;ustments For Items Unpaid Bv Seller Adiustments For Items Unpaid By Seller 210. CityrTown Taxes to 510. CitylTown Taxes to 211. County Taxes to 511. County Taxes to 212. School Taxes to 512. School Taxes to 213. Sewer Proration 01/01/06 to 03/31/06 25.91 513. Sewer Proration 01/01/06 to 03/31/06 25.91 214 514. I 215. 515. I 216. I 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BYIFOR BORROWER 137,025.91 520. TOTAL REDUCTION AMOUNT DUE SELLER I 1,989.51 300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 301. Gross Amount Due From Borrower (Line 120) 140,747.00 601. Gross Amount Due To Seller (Line 420) I 137,740.25 302. Less Amount Paid BylFor Borrower (Line 220) ( 137,025.91 ) 602. Less Reductions Due Seller (Line 520) I( 1,989.51 303. CASH ( X FROM) ( TO) BORROWER 3,721.09 603. CASH ( X TO) ( FROM) SELLER 135,750.74 UM!:) NU. l5Ul-Ulli5 ,r The ",de~~~:e:e'ebY a,',owled,e mce;~;;,~~Y of page' 1&2 oflh" 'tate:~,:~: a~a;:fe~-,o ZL . Wilham K. Cowden L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price S @ % PAID FROM PAID FROM DIvIsion of CommissIon (Ime 700) as Fa/lows' BORROWER'S SELLER'S 701. $ to FUNDS AT FUNDS AT 702 $ to SETTLEMEN: SETTLEMENT 703. CommisSion Paid at Settlement 704. to 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801 Loan Onainatlon Fee % to 802. Loan Discount % to 803 Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806 Mortaaae Ins. ADD Fee to 807. Assumption Fee to 808 809. 810. 811 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 03/31/06 to 04/01/06 @ $ Iday ( 1 days %) 902 Mortoaoe Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 years to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001 Hazard Insurance months $ per month 1002. Mortoape Insurance months $ per month 1003. CitvfTown Taxes months ( $ per month 1004 Countv Taxes months ( $ per month 1005. School Taxes months @ $ per month 1006. months @ $ per month 1007. months @ $ per month 100B. months @ $ oer month 1100. TITLE CHARGES 1101 Settlement or Closinq Fee to 1102. Abstract or Title Search to 1103. Title Examinal10n to 1104. Title Insurance Binder to 1105. Contract Preoaration to Reaqer & Adler, PC 250.00 1106. Note and Mortoaoe Preoaration to Reaoer & Adler, PC 250.00 1107. Attorney's Fees to {includes above item numbers: T 1108. Title Insurance to MIDSTATE ABSTRACT 1 043.75 (includes above item numbers.11 02, 1103 & 1104 ) 1109. Lender's Coverage $ 1110. Owner's Coverage $ 137,000.00 1,043.75 1111. Endorsements 100, 300, B.1 1112. Notary Fee Midstate Abstract Company. 1113. Notary Fee to Midstate Abstract Company 5.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 41.50; Mortgage $ 51.50; Releases $ 93.00 1202. Citv/CourltYTaX/Stamos: Deed 1,370.00: Mortqaqe 1,370.00 1203. State Tax/Stamps: Deed 1,370.00; Mortqaoe 1,370.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survev to 1302. Pest Insoectioo to 1303. 2006 CounlvfTownshiD to Robin Gasperetti, Treasurer 583.60 1304. Tax Information to Cash 5.00 1305. 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section Kl ./" I 3,006.75 1 ,96360 By slgmng page 1 of thiS slalemenl, the slgnalones acknowledge receipt at a completed copy of page 2 of this 1W0 page slalemi" .~ Mids~~tract Company Settle t Agent Certified to be a true copy. (06-150(2) I 06-150(2) 112)