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PETITION FOR PRORATE and GRANT 01<' LETTERS
t:'tafl' ~F~:I;<'71;jy'(, ..tY<il,{~ No. d) 1-9'~ -:'1'31____
also k"';"'II_as=-=.... t}t(w,OaIfLb<y To:
.;_.;u...-~-~-n!'7T:::~5'T:" ,'JI"3''3'f
Social 'securlfY No, ",_.._____.. ______________.____t.l._l::~___<O;,_._
Register of Wil1sb~ '
Countl' ofLL""'___......_.n 111 the
Conlll;onwealth of Pennsylvnnia
The pelltioll of the undersigned respectfully represenls Ihat:
Your pctitlollcr(s), who is/arc I R Y('Hl'S of age or older an the l'XCCULl1[(. . ,,_..-._-- - - . named
In Ihe lasl will of the ahove dlwden\, daled ..__Q..""~c/Jct"...l'l.-...._._____._....n_____~' 19.2':1-,-
and eodlell(.\) daled__tJJlL_____________. _____ _._~..._.__..._____._~_,____._
(<;lllll' n'lrvrttH dl'(llIll'\tllll\'('S, (',g. ft'l\\Ifl1.:iation, dl'alh of c\c<..'lllor, etc,)
De~enlienl Wlls domieiled lit dellth In ..~_a,."./J.HXa""'-_.n_rrFl:f::':",.,.--. CO\lnly, P9~psYllinnia, ~ /.'N! < )
h~__ Inst family or prineipnlresldenee al ____....._.___-'1L"L~..<-'..II.'_j U!"f 'it!l:!'., u,f'J ".0 ~ to'Y.u-. (,of'
(Ii"l "IH'CI,'lllll1ihl..'t alld llium'lrality)
Deeend~' I, Ih,cn_ ?3__ vears of !l,l!e, dl~ _~ J,tl,-"b<'l 30 _~ Mf.)9 7t .
at '.",qH .2L'fJ.""-rL~~~"':'~--/~_._.. ~ZTv>'i/!..; ~.~/'.,.1ffll;rILi5JlJ/
Except S folloll's. deee,\Qnt did nolmarry, was Fi61 \livorced ~ hllve a child Dorn or adopted
after ele,'ullol1 of Ihl' will offered for probale; lI'as nollhe vicllm of a killing and Was never adjUdicated
incompetent: ..___....._q. __ ....... q....__~._...._..__..
Deeendem at death o\l'ned property with estimated values liS follows: _ v
(If domkilcd In Pa.) All personal property $ 'l.~JVo~
(If nol domiciled in Pa.) Personnl property in Pennsylvania $__~__
(IInol domiciled in I'a.) Personal property in County $_.
Vlllue or reld estaloln PennsYlvan~4 cj, ~ V .11 ,IJ It '70: 10C ~
SIIUIH,'d II' lolloll's: ...q____JJL.__..._....!.,'/:q_.....__...&_f"'1J--ll<M..-I_.__
WHEREFORE, pelllioner(s) respeetflllly r,qu'st(s) the probate of Ihe Illst \1'111 and codlell(s)
presenled hqewith and Ihe grant of lellers....__~ _ ..... ..
(ll..'slalllt.'lHiI .': adrnilll'\lfilliOll ,",l.n.: IHln1inlstratlon d,h,Il.C,1.8,),
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEAITII OF I'ENNS\'LV ANIA I "
r b~
COlJNT\' 0..- CtJt.1Blo:l1,LAND
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Swnl1l III (\1 "llillllf.:d
before lllt' Illi~
on.\;ober
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Till' pclilinnl'rts) ~lbl1\t'-Il11111l'd ~\~'l'i1]'h) or affirlll(s) that thL' SlillCllll'llts in the foregoing petition arc
trUe lllld COITL'l't to lIll' 1'H.'Sl III thl' ktHw.lcdgl' Hlld IK'lk.r of pl'tiliolll'r(q Hlld that as personal represen~
lllth'l'l") ur rill' llhll\'L' dl'l.'l'dL'1l1 ]1L'1111011l'r(\) will wl'll ilnd truly adlllinlster the cstutc according to law.
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B..ELEASE
KNOW ALL MEN BY THESE PRESENTS, that I, STEVEN DAVID MAURER,
of Fayetteville, Arkansas, do hereby acknowledge as for divers
and other good causes and valuable considerations, have remised,
released, quitclaimed, and forever discharged, and by these
presents for myself, my heirs, executors and administrators, do
remise, release quitclaim, and forever disC1\arge the said Morris
Goldberg, Executor of the Estate of E1,sie Grace Goldberg, his
heirs, executors and administrators, of and from all, and all
manner of action and actions, cause and causes of action and
actions, suits, debts, dues, duties, sum and sums of money,
accounts, reckonings, bonds, bills, specialties, covenants,
contracts, agreements, promises, variances, damages, judgments,
extents, executi.ons, olaims and demands, whatsoever !.n law or
equi ty , or otherwise howsoever, which equity, or otherwise
howsoever, which against the said Morris Goldberg, Exp.cutor of
the Estate of Elsis Grace Goldberg, I ever had, now have, or
which 1, my heirs, executors, or administrators, hereafter, can,
shall, or may have, for, or by reason of any manner, cause or
thing whatsoever, from the beginnings of the world to the day of
this date of these presents.
IN
WITNESS
:Y~
WHEREOF, I have hereunto set my hand and seal,
aayof .-Iul1e , 1997.
3~V.~'''':7Jdr'''''_
STEVEN DAVID MAURER
a,J::~. ~k~~.
r
this
cnt Remllled
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
Register of Will.
Cumberland Counly Courthou.e
Carll.le, PA '17013
CUT ALONG THIS liNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS <::>
-REV;'i547EXlo6:97j PC- - - - -- -NCli'iCEOP INHERITANCETfix APPRAiSEMENT;- ALLOWANcl(oR- - - - - - -- - -. - -.. -. - -.
DISAllOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
FilE NO. 2196.0639 ACN 101
TAK RETURN WAS: (cg]) ACCEPTED AS FILED (0) CIIANGED
RESERVATION CONCERNING FUTURE INTEREST. SEE. REVERSE
-APPRAISED VALUE OF RETURN BASeD ON: ORIGINAL RETURN
1. Real Estato (Schodulo A)
2, Stocks and 60nds (Schodulo B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Doposlts/ Misc. Porsonal Property (Schedula E)
6. Jointly Owned Property (Schedule F)
7. Tr8n~fers (Schedule G)
8. Tot~l Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expensos/Adm. Costs/Misc. Expensea (Schadule Hl (9) 24,925.22
10. Oebts/Mortgage Liabilities/Liens (Schedule I) (10) 1,61.7.66
1" Total Deductions (11) 26,552.88
12. Net Velue of Tax Return (12) n,697.21
13. Charitable/Goverr<nental Bequests (Schedule J) (13) 0.00
14. Net Value of Estate Subject to Tox (14) 73,897.21
NOTE: If an aueument w.. I..ued p,evlou.ly, line. 14, 15 andlo, 16,17 and 16 will ,alleot IIgu,ee
Ihat Include the total 01 .....U ,elu,n. a....ud 10 date.
I!; I}' y.-!F
BUREAU OF INDIVIDUAL TAKEB
INHERITANCE TAX OIVISION
DEPT 200001
HARRISBURG, PA 1712B.0001
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
c~
NOTICE OF INHERITANCE TAX
APPRAISEMENT, AllOWANCE OR DISAllOWANCE.
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NO,
COUNTY
ACN
10-6.97
E G GOLDBERG
9.30.96
2196'()839
CumbBrland
101
HBRSCHBL LOCK BSQ
3107 N FRONT ST
HARRISBURG PA 17110
ESTATE OF
E G GOLDBERG
(1)
(2)
(3)
(4)
(5)
(6)
(7)
72,000.00
6,430.13
0,00
0.00
22,019,96
0.00
0,00
(6)
ASSESSMENT OF TAX:
1S. An~unt of line 14 at Spousal rate
16. Amount on line 14 taxable at Line~l/Closs A rate
17. Amount of L1ne 14 taxabte at Collateral/Class B rate
18, Principal Tax Due
TAX CREDITS:
PAYMENT
DATE
05.27.97
(15)
(16)
(17)
0.00 X
73,897.21 K
0.00 K
RECEIPT
NUMBER
AA211355
DISCOUNT (+)
INTEREST/PEN PAID (.)
0,00
AMOUNT PAID
4,493.83
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W~
RtV.l&<l1U(OO,t1lF'C
DATE 10.6.97
NOTE: To Inlure proper
credit to your .ccount,
lubmlt the upper portion
l)f thl, form with your
tall payment.
100,450.~__
.00=
.06 =
.15 :I
(18)
0.00
4,433.83
0.00
4,433.83
TOTAL TAX CREDIT 4,493,83
BALANCE OF TAX DUE 60.00CR
INTEREST 0.00
TOTAL DUE 60.00CR
(IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL OUE IS REfLECTED AS A CREDIT (CR), YOU MAT BE DUE
A REFUND. SEE REVERSE SIDL OF THIS FORM FOR INSTRUCTIONS.)
.
IF PAID AFTER DATE INDICATED, SEe REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
f~)
RESERVATION: Estates of deoodents dying on or befo~e December 12, 1982 ... !f any future Intereetln the eslllte Ie tranllferred In p088eoslon or enjoyment 10 Clses B
(collateral) benefleiarles of the dt'lcedent atter the expiration of any estate for life t)r for veprs, lhe ComrT1Qnweatth hereby expre881y reaervesthe right tu
appraise' and aasees transfer Inheritance Tnxas et the lawful 018aa B (oollateral) rate on sny suOh future Interest.
PURPOSE OF
NOTICE: To fulfill the requlroments of Section 2140 of the InherUance And Estl':lte Tax Act. Act 22 of 1991, 72 p.s, 800tlon 2140,
PA''t'MENT: Detaoh thE! top portion of this Notice and 8ubmlt with your payment 10 IIle Reglstor of Willa printed on tho reverse side. Make check or money order paYClbl~
10: REGIS ,ER OF WILLS. AGENT.
REFUND (CR): ^ refund of a tax credit. w~lch was nol requested on the Tax Return, may be roquested by completing an "Application for Refund of Ponnsy!vanla
Inheritance and Eatate Ta)( (REV.1313). Appllcallonsare available at the Offlco of1ho Register of Wills or any of the 23 Revenue District Offices, or by
calling the speolel 24-hour answerlr'l(j service numbers for forms ordering: In Pannaylvanla 1-800-362-2050, outside Pennsylvania and within local
Harrl.burg araa (717) 787.80g4, TOON (717)772.2252 (Haarlng Impaired Only).
OBJECTIONS: Any party In Interest nolsalisfied with the appraisement. allo'l'lflnce (Jr disallowance of deductions, or ass8S8ment of ta)( (Including discount or InterElst) as
thown on this Notice must object wllhln sixty (60) days of receipt of this Nollce by:
.-wrltten protest to the PA Department of Revenue Board of Appel!lls, Depl. 281021, Harri8burg, PA 17128-'021. OR
~&lecUon to have the matler determined at lludlt of the account of the personal represantatlvo OR
-appeal to the Orpharls' Court.
ADMINISTRATIVE
CORRECTIONS: Fectusl errors discovered on this assessment should be addressed In writing to: PA Department of Revenue, aureau of IndiVidual Taxes, AnN: Post
Assessment Review Unit. Depl. 280601 Harrisburg, PA 17128-0601 Phone (717) 767.6505, See page 3 of the booklet ~Inslruetlons for Inheritance Ta)(
Relurn for a Rf'lsident Decedentfl (REV-1501) for an e)(planallon of administratively correctable errors.
DISCOUNT: If any t3)( due Is paid within three (3) calendar months after the decedent's doath a five pl3rcent (5%) discount of the la)( paId Is allowed,
PENAL TV; The 15% tax amnesty non. participation penalty Is computed on the total of the ta)( and Interest assessed,. and not paid before
January 16,1996, the first day afler the end of the tS)( amnesty period, lhls non-participation penalty Is appealable In the lSInG manner and In the same
time period as you would appElalthe tax and Interest that has been assessed 8alncllcated on thIs notice.
INTEREST: Intereat 18 Chtifged beginnIng with ~rst day 01 dellnquenoy, or nlna (9) months and one (1) day from the data 01 death, to the date of payment. Ta)(e8 whIch
became dellnquent before January 1, 1982 bear Inlerest at the rale of six (6%) percent per snnum oalculated al a dally rate of .000164. Alllaxes which
became delinquent on and after January 1, 1982 wlIl bear Interest at a rate whiCh will vary from calendar yaar \0 calendar year with that rate announced by
the PA Department of Revenue. The applicable Interest rates for 1982 throtJgh 1997 are:
VEAR INTEREST RATE DAIL V INTEREST FACTOR VEAR INTEREST RATE OAIL V INTEREST FACTOR
1982 20% .000548 19a7-- e% .000247
1983 16% ,000438 1988.19gj 11% ,000301
1984 11% .000301 1992 9% .000247
jg85 13% ,000358 1993.1gg4 7% .0001g2
1985 10% ,000274 1995.19g7 9% .000247
..Intereslls oaloulated 88 follOWS:
INTEREST. BALANCE OF TAX UNPAIO X NUMBER OF OAVS OELlNQUENT X DAIL V INTEREST FACTOR
-Any Notlc&188ued after the lax becomes delinquent will raneet an Intera9t oaloulaUon 10 fifteen (15) daya beyond the date of the assoeament. If payment
Is made alter the Inters.t computatlon dllle IIhown on the Nollce, IIddlllonallnt6r8st mUllt 00 oaloulate(!.
\
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEAllH Of 'ENNSYlVANIA (TO BE FILED IN DUPLICATE 96
DEPARTMENT OF REVENUE 21
HARRISfJl&,}~o~~:".0601 WITH REGISTER OF WILLS) COUNTY CODE YEAR
DEC~~NL~;~'~I~':' "'~'~A~; ~D5~;'I~~E --0'-- - - ~-. D'i,~,~id f.~;~IZ~Al~~~s'~r i V ~.-..
saCIAlSECURlfYNUMSER -lD3rn1rDEAr~r----"'-lD~E'OF'BiiiTti--~ Camp Hill, PA. 17011
1 71- 0 '1- 5 3 3 ~~ / 27/96 i.:./ 2 9 !!.'~_h C~"t.~-~rt1'?~':_~~ 119..._____________..._
I" "''''''''' '""'''NO ,"ou" , ",.. I'''' "." :':::'::!~:':"__ '~:~'ECURlly_:v_M=_~_{~OlJNI "(fIV", I'" 'NmvCTloN': .~ _._
g 1. Original Return (] 2. Supplemental Return [] 3. Remainder Return
Ifor do'., of d.olh prior 10 12.13.62)
o 4. Limited Estato [J lie!' Future Inlar(;$l Cl.lmpromiut 05, fedi!lrol Eslale Tax Return R~Hjulrfld
lfor dales of dl!l(1l~ after 12.12.821
o 6, Dec&denl DJed Teslate [] 7. Decedent MolnlalMd 0 Living Trust
IAlloc, copy 01 Will) (Alloch copy 01 TrUll)
ALL (ORRlSPONDENCE AND CONfiDENTIAL TAX INfORMATION SHOULD BE DIRECTED TO,
.. >- NAM' . IMPlElE MAILING ADD''''
gj~ Herschel. Lock, Esquire 3107 North Front Street
8lf '''''HON' NV"'" --.--~-------....-.-.._- Harrisburg, PA 17110
__ ...t.212...L_ 238-6~.6~..c '__'.' ,.~=.~~_~~.~==~~~ __... .
I, R.ol E.'oteISch.dule A) {II _..1J.., 00_Q.,j).Q..~__
2. Slack. and 60ndslSchedule 6} (21 6,430.13
3. Closely Held Slock/Portnenhip Interest (Schedule q (3) ___6"__
4. Mortgages and Nolet Receivable (Schedule D) (4) __-.-::~~..._- ___
5. Coshl Bonk Deposlh & Miscellaneous Personal Properly (5) 2 1019.96
ISch.dul. E} ______
6, Joinlly Own.d Property ISc,edule F) (6) ....
7. Tro",I." ISch.dul. G)ISch.dule l) (7) _..
e, Total Gron AlSets (lolalllnes 1.7)
9. Funeral Exponses, Administrative COSh, MlscelloMous I q I _~~25. ~2
Expenses ISchedule HI
1,627.66
10. DeblS, Mortgage liobiliti.., lIe"'ISch.dul. II 110)
11. Tofal Oeciucliont (10101 lines 9 & 10)
REY.1500 EX~, 17.94l
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fOR DATES 0' DEATH AfTER 12/31/91 CHECK HIR
,f A SPOUSAL
P.C?V.~!lT!n~!l~DITI~CI.~.^:II!l-IJ....... .__.__
fiLl NUMBER
0839
NUM!!:
ffi
~
frl
C>
_ e. Total NumblJr of Safo Deposit 60xes
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S
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...
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100,450.09
(6 )
12. N",' VClluo of Estuttt (Uno 8 minus line 11)
13. Charitable and Governmental Bequt\sh (Schedule J)
14.
26,552.88
::~: ~~3;'897-:21-=-:
1131 ------
73,897.21
114)
Nel VnlufiI Subjecllo Tax (line 12 minu~ line 13)
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~5. Spousal Transfers (for dales of death after 6.30.94)
See InMrucllonl for Applkoble Percentage on Reverse
Side, (1lldude values from S(,h~dule K or Schedule M.l
16. Amount of line 14 taxable 01 6% rate
jlndude values from Schedule K or Schedule M.)
17, Amount of line 14 taxable 01 15% role
llnclude values from Schttdule K or Schedule M.l
18, PrintipollOK due (Add lax from limn 15, 16 and 17,)
19. Credils Spousal Poverly Credit 4';04 ~~~e~t~
_._'-~-",'-~'--"'-.'.-_...- + ..--.--.--.--.
(1?)
120)
115)
1161 _
1171 ----
l'C,__
73,897.21
4,433.83
x .06.
)( .15 III
(16)
4,433.83
Di,count
+ ,----_...._-"_.~ -
Interest
4,493.83
.-.--..--.-- -.---
60.00
l;!!
.-
20, If line 19 is grealer Ihan line 18, enter the difference Cln line 20. Thi~ Is the OVERPAYMENT.
DIU
. Check here if YOl,l tHe requesting a !Olund of YOlll o\'!crpnYrt1(!nt
21. If litlti lS is grealor Ihan line 19, enter !htl diffElrente on line 21. This is the TAX DUE, (21) _ _______~-~.:.;,;______....----..-
.A.. Enler the Inl9rest on Ihe balof1tti dlJO on Linl'! 21A. (21A) ______________~____.___..~."...
B. EnhH tho 10101 at Line 21 and 21 A on line 21 B. This it the 9ALANCE DUE, (21 B)
______._~~~!~.~.~!~y~~ tOI R.U~~!!.t._~.! WIIl!.!._Ag.!!!~__u___..______________ ..__ ______. ____..____~ ~--.:: - - - - ---
~._______ ~. ~ __B~..!l!.~~_T.t:l_~~~~ER A~~..l:l_\!E..~T.19N_s..~_N..~.E..~E.~.E._S.I~E..~!'l~!..C?. RECHECK M~,!__~"'; _____.
~~der penalties of perjury, I dftclorfl thot I hOYfI, oKaminl!ld this return, including accompanying \chedulfls und .'ICltflmflnls, Clnd 10 th" bett 01 my kllowledge and bfllilJ
1111 true, correct ond complete, I declortl Ihul 01, rool 6$tOt(l hos bMrl tepmlad- 011100 rnmkel VOlllfl, DeclarCltlon 01 prepotl'H olher than the peflonal represenfativl1
baled on alllnlofmallonof which pf8pCHtlr hat any knowladge.
~~.,V" 6fjii'''N~~Nilil[i,O'-~l''"''it,U33~'l!'\(;i:"een St i:"eet I uTfai'-rIsbur-g,l'l\ 1711'0- D'i''5,/,.;;:j7-U
,,f;~l!t?7r"~'~='''~?s- 3l~~i"~. Fi:"ont Street I Harrisburg, PAl'lll0 ",lf5;2i;i'}-~-
Act .48 of 1994 provld.. for the r.ductlon of the tall rat.. Impo..d on the n.t valu. of trand.,. to or for
the u.. of the .pau... Th. rot.. a. premlb.d by the .tatut. will b.:
. 3% (.03) will b. appllcabl. for ..tat.. of d.c.d.nts dying on or aft.r 7/1/94 and b.for. 1/1196
. 2% (.02) will b. appllcabl. for ..tate. of d.c.d.nts dying on or aft.r 111196 and b.for. 1/1197
. 1% (.01) will b. appllcabl. for ..tat.. of d.c.d.nts dying on or aft., 111/97 and b.for. 1/1/98
. Spou.al trand.n occurring on or aft., 1/1/98 will b. Itll.mpt from Inh.rltance tall.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (....) IN THE APPROPRIATE BLOCKS.
$ NO
1. Old decedent make a transfer and:
x
a. retain the use or Income of the property transferred, .......................................................
b. retClln the right to designate who shall use the property transferred or Its Income, ...............
x
X
c. retain a reversionary Interost; or ...................................................................................
X
d. receive the promise for life of either payments, benefits or care' .......................................
2. If death occurred on or before December 12, 1982, did decedent within two years preceding
death transfer property without receiving adequate consideration' If deat!' occurred after
December 12, 1982, did decedent transfer property within one year of death without receiving
adequate consideration' ............,.........................................................,................... .........
X
X
X
3. Did decedent own on 'in trust fo,' bonk occount ot his or her deathL.................................... -L
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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ESTATE OF
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES Pie".. Prlnl 0' Typ..
.h ..h.h...... .----~===~-="I.F'LE NUMBER
GOLDBERG, ELSIE GRACE 21-96-0839
.~._-~_._~-_._-_.._.'._..- -~- --~~--~
,.~,'.~'9n
n~.\ ., .
...~. A"""
COMMONWEAlTH Of PENNS,VtVANIA
INHERITANCe TA~ RETURN
RESIDeNT DECEOENT
ITEM
NUMBER
A. Funtral Expense'l
2.
B.
4,
C.
1.
2,
3.
4.
5.
6.
7.
8.
DESCRIPTION
1.
Reese Puneral Home
Romberger Memorial - grave marker
Admlnl.tratlve COltsl
1.
Morris Goldberg
Personal Repre.entatlve Commi..ionl .' 218
Social Security Number 01 Personal Representative: _..___.__
l4,- 0805
Year Commluions paid.
2.
Attorney Fee.
Herschel Lock, Esquire
3.
Family Exemption
Claimant
Add..,. of Claimant at decedent'. d.alh
Street Addre..
City .____.._,____...__.Stole __.___ Zip Code
Relatlon.hip
Probate Fees Register of Wills
Register of wills - filing estate papers
MI.cellaneouIExpenle"
Settlement costs for sale of house
Morris Goldberg - reimbursement ot overnight mail
for documents related to house sale
Cumberland Law Journal - advertising
The Sentinel - advertising
Rabbi Shoper - clergyman Honoriam
Temple Beth Shalom - post-funeral meal
~A Dept of Vital Statistics - Death Certificates
~ostage
TOTAL IAlso entor on line 9, Recapitulation)
(If more Ipoce II needed, Inl.,1 oddltlonollhe." of .ame II.e.)
AMOUNT
6,429.08
l,370.00
5,072.50
5,072.50
226.00
9.00
38.00
6,098.77
13.50
60.00
75.07
200.00
250.00
6.00
4.80
S 24,925.22
l\. rilnTI,EMF.N'[' fJ'J'JI'mMEN'['
l1\n ~o 2~02 '0265
qr
U,S. (IU'ARIHfNl o( II!1JSINll
"IoIfl URn"N lHV(lOl'HOll
B. TYPE Of lOAN
i: fT'~~~,__t]~~I:~~~~~~T~~=~,:~~:~'_".I~::_ ~.~~_{_~:~~t~;:~~_ .____ ,_-.~--17~- .l~~~ N~IMl~~_ '_ln~-_~o~'nA~~- I:_CA~~_ N:~~~
C. NOTEtlhll form II furnllhed to 11''10 you. Itlltt'lllllnt of ICIUIII U1tll~llt COtt.. Amout\ltl pnlc1 III end by till! IlItlll!lMnt ngont
Ire _hawn. IIIIM IMrkld II(POCl" were Judd outlldll t~'!c.lo.tnlt' they llr. Ih/Jwn hllrll for Inlorfl\flll<<1f,1 purpo....nd Irll
ntlt IncluMd In the lohtl. ,- 5,0 10.96 (1/BOl2197,HllI/llot2197l
o;-NAHfIilli~AottAEisor-'BOiliiCi.tEM-"-" ...__...-~ E''''ijA"rANii-ADoREi~'l)f' -SEltER" '-, f ,- UAHE'-AN-D-~iiDiiEsgOf--CfNDER----"---
1/
SIlSAN l. BOlASIl !:SIAH GRACE I\OlOUrlHI I NOR\lUf HORlliAOr. INC.
10J 'TANfOAD COORI 1901, CIlATHA" DRIVE 50DS CAUlSlf 1'lkE BUllE 202
MECHAN I C611U1fQ , PA 11055 I,. CAMI' HILL. rA 17011 HECIIANICSAURG, PA 170<,;5
j
15 1(,J91\' , -- - - < II: SfftiEHENT DATE - --..<
I I
P~Ad-~t::r'~::~~r--p'.''','',-Or,',.'--..,_._'- --- - -" ~'-'I febru.ry 28, 1991
H[CHANIC5BURO, .
J, SlH!ARY OF BORRMR'S TRANSACIIOH 1::. SllHMAllY OF SHUll'S TRANSACIlON
100, OROSS AHWNT DUE fJlQol BORIIMII 1,00. 1l1l.0~S ^"l(XJlH DUE 10 SELLER
~- ~~::~~~~'-~~ ~~;~~ ~c~~~~~"=~~~ ..~~~~~
AdJuumentl for It"", pilld by Seller In .dVflnce AdJu~lmanll lor lt~1ltlI paId by Soller In .dlJ.nee
'06, CWNTY/HON TAXES 02.211-97 t~ 01.01.98 ~25]-;-40 ~, COU~1Y/H1JN-~li"tS.~OZ.28'97 to 01.01.98 __
107. Coooty TlItel to 407. County TOJl;u to
~~ CCtiCiOllA)(ES 02.211.91 to 07.01.97"-- --'-----z9j:9f 401l--:-'SCl!ooL-iAii-ES-.--"~Ci2.'28-:9Tt;;-or:iir'9'------29].99
109. SEWEJI oZ.2i~rto'04-'01.97 --.-- ~-----a:sr 409-:if.WEii..of"2ii:97.to-O;.;:O'.:9i-----.---... ~-------r.5f
;10. TRW0f.2s:9f.i-;-04.oF9"7-------.-.--. ---. -----14:93 41(i':lRAs-ii..Ol:?6:yi-looi;:O-'-:9;-'~~'.~"----.' -. .-----....-14~9]
111. -~- -----'--, 4~1-"--.'-'_-'--'_.__-'_:'_.~------:<..'-'~._~'--" -.,-"----~
m;---------.--~_.._-..-.-._._..-.-+ ~1l_:__---m.. ~- .-...--.-....--.-..-----.- __~n____~
120. OIlOSS A/<<lJNf DUE fllOM DOIlltMR "5,466,~O 420. OROSS AHa.'NT OUE TO SEI.LEII 71,570.1l~
MROPiRtY-lOCATio.-t..-~..---.".M"-----'
1904CIlAJHA.I4DIIIVE
CAMP HILL. PA 17011
CUMBERLAND County. PA
il."Sf"iEHEIIT AOENT -..~
lRI<Cfl,/NIYABSfIlACT SEIIVICE
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25].40
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200. AHOOMTS PAID BY OR IN BI:HAl' 0' 80~ROW~,------.__~_ ~~~~~~~I?~~~ A~~~~~~_SELLER __~,
201. O'POllt 01' e.rne.t lIlGrlty ____.~~!. 501. E.I(UII Oepotlt (teO lnttructlon.)
202. Prlnclptl .A/IloIslt of NIIW Lo.n(l) 68,400.00 502, S.ttlomen, Ch'-rg;,-tQ$";lier--Tlne1400 ----r,-090fl
203. hl.tlng lo.n(') T.ken Subject to I -- ____ 503. ElllttlhglOtnn taklln lubhct to _
2OJ.. 504. Payoff of flrlt mortgllge lOin
205. ---.-.-- SOS:Piiyofr~f.-;c;o;vr-mMtQ;gero.n------
206. ._~- ~6:---------'._--'
207. . --~-_.- ~077.i,iopo;~dj.tK;rled---;; prOllelld.)
2011.<< ------ 508. - _n. .
209, -.,.--- '--_ ---W9,- .. .
Adjustmenlt for lttml unpaid by Sctllor__ --====--= =--~~.E~m;"!!'.~~or i t~_ oop.otd by Sol ~!:.- ___
~'O. COOWTY/I4UN T"Xes to ~10. CroWTY/HUN lAKES to
211. CQ\Wlty Tuell to -t-.----- 5;;. Couil-YTii~;.-~'~-- ~
2a. SCHOOL fAIlES to - 5"i'i:-iCiiOOi-1AKr.s- to ---
213, ----.--- 51'3:---------.---. ---
~14, --~ ----.-.- fli;:-.----~--<~-. .-----
i,5. '---.-~."--~-- S15:---~~---
::~: .__.-- -.' ~: Hi:'~-::~:,'
~e. --1---.... 11', n ....
219. 519.
-
220. fOT"l PAlO 8Y/'OR BOItRMR 69.~OO.00 520, IOTAL RCOUCTlON AMOON' DUE SEHER
100. C"VH AT SETTLEMEN1 nOM/TO 801tROW!.R ._ . _. ;;.._ ~o. CASH AT SETTlEMENT TO/fROM SELLER
301. Grolt MIl Dut fr(lllll Onrrowor n In" 120) 75,466.~O 601. Grolt Amount Due to Seller (t lne 420) 72,HO,05
302. L.1t Mlt Peld by/for 80i:rowftr nino l20)" ( -691~00.oij) 602. llllt-AefNctlnni-nue Seller (lIne 520) ( 6,098.n)
30]. CAIH (10 fROM (I 10 DORROtIER 6,066.50 603. C,UH 1111 TO I) fII<>>l SELLER 66.1,72.08
The undersluned hor.by Icknowltdg. rel'iftlpt 0' . tOll{lletld copy ot P'llel 1&2 of thl. It.tement & Iny IttftchMnt. referred to horeln.
I HAVE CAREflllLY REVIEWED IHE Hun.1 SETtlEMENT STATEMENT AND TO tHE IIUT Of MY kllO\lLEOGE ANti DELlEf. IT 1& A !RUE "NO ACCURATE
InATEHENl OF fIll RECEIPT II AND 'OISlUJtI~MSNTS MADF. ON MY ACCOtJNI ~ bY ~( INTHI!,~RAN''''C'I~'.)n_'U~THE,JI) C~RTI:!' lH_A~ I HAVE
""IVEO :O:~o:.:' ~~~~~?),~r'~~1,,~Ll'"m. mLE!;t'i;i~Qh-iiO.'ttii_ci_71~J~/~-
(/ ,'" .,' ""'t. t .../, ({/ \ .
8OR.WER _~__.__..~,,_,-.---__,.. ~tlL[R -_...;,.t->,.....W-~--;r---._.-.- ..n!
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TO Till! BEST Of MY KNOWlEOGE. lHf IlUCI.l SETlLlHENT ITAUHEHf \lIUtIl I HAVE PR["mO IS A TRUE "110 ACCURATE ACCOONI Of THE FUNGI
WllICH WERE"~IVEtI "Nil H"VE B~EN Oft Will liE D\SBp~tI BY 'HE UNU[IISION[O AS "AR' Of '"f SElTLfllENT OF lHIS TRANSACTION,
. _1d./L"u~Jl1.:Jt{ll,~- _c-':-:.-
1111 COONTY "BS1RACT SERVICE "
WAIININGI IT II A CRlltE 10 KNWINOLY HAI::E 'Al!E 'AH:MlHU 10 IHI UNmo tiTAHS ON TillS O~ ANY SIMILAR fORIl, PEHALTln l/flOM
CONViCtiON C"N INClOOE A fiNE AND IMPIlItOHMEH . '011 OEWlI IIU, llflE 1B U,S. C(rOE SEC110N 1001 & SECTION 1010.
stllllHfNT SlATfHnu I'Al1f; ?
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10(I~Dli,I-S.C..jiiroklfi- c~~j'.i 'on~'b.'l'(l '~nrr tco'i-
- -Di;f'lori -of"ciMnil-.l ~;-( II n. 'Rio) --ii,1 on-ow.I--
10~t:"'Z;S4f:oo.to'iEMAi 'REAl-Tv "ii~oiF.$s lOii...i-'"
702.-.-i;495:00.t"O..WAl-kER..RUI.-l'-e-----.--L- - --.
7Qj~iIiTOnpp;rdH...l"-.i;;tttumft;;t------ ...-.-. ."..-
iO'-:--R..--.--n-----.~-.-.---.- . - -'- -.. ...__..m______.. .--,--. -,---..- .-,. -.. ...-- 'H__' .~. _.__"_.._._~_.~'n..
MO. I1EMS fl~Y"8lE 1H CONNECTION WITIi lO~N
8oCTCi.-r;'OrlgitiaHOiiteo'-'.'-.Luiiiio'Y' to NOII~i'S:(H611foAii~ INC,'" 'n__ 6/\1,'.00- .----- ..-.-
8ii2:-'lo.~t---'--"'---- Hi' ."--to'" -,-- w..,__,.' ..-- -- ..-----.-. ...~ .....----.. -.
~(lj_;_^pii;.&iUt..fe8-oo- ---- .,---. --to H14;ij~El'r.6N~~ ",R'~'_ ---- --i,s roc ---.. -- ----- ...- -----.
iW4-:-C';:idit'R~'Por"'-'- ...-..,-- -- -. -~.... -.-... to i,~EOCO"'_-'4_'~--" ----..-.-...---...~.,-..----5D- ._~~___Rm_' - .--...-..---.-..-..
liO;:-Llnde~nlp'ctlo.n-i;;--- ....-.-- t(l ,---"'.-------- .-~-.-... -~~ ...-..~~''" .......-- __m._.._.__..m_n ....-.----., ...--..--
ilO6."HOrilliO-,;;.--:-r~;-f;I----~ --'--'0" -----..~...~--...... .-.... -. .-,,----..--..- _..~__"4'_ _. -.~---
8or:-'~iiimPtTon",iu~-."----'-'~-~to"" - .-...... ...."..----. --.-.... .....-____.__..H..__..'.___ -_..~'-""-- -~--'--
B08~'-AK.SfRVicE FfE----..--.-.-.-...-..-.to- N'ofii1isf'HCMllaAOE' 'INC_;_- .------...---...--. '".-~._-.%Jio' ..-.~---'
~?~OC~EN' p~}rM~i~("FE-"--""=~~=~~'_::_~~~.~~~!i..~~~_~~!~:~iNC. ~.~'_-=~'=.'.=.=~'~--:_~=~ =":'~::=J:-o~oo _ ~==-~----
810. HOOO CElli fEE to NORIlEST MOIITOAllE IHC. 16.00 --.-.
.i1-;---.-.----..----.-..-....-~.-.._---:--.--.--..---...--.--..- .--...-....--.-. -------.-.
~.m"s "EWIRED 8~ lENDER 10 8E fl~ID IN ADV~NCE
9o~ntfrelt fi:o;oj:2S:97taoj:(H:Vfi,i-14:'ijqoooo;d;v(T--dnv.-'--~%)"'--~~-.. ......--... "-~._-'.'-'''14".99- -.-.---.-
902.M~IMUrmCDPremlu,ii~-mootiil-toAMER'i~-'-.--'-'.-.._--'-_.--"--..-..-.- '-'-__0041:"61"" --~--
9OLHii.NiI"iUrii1"Cepromlllll lor--l~o ye"rv "'to-~'-"---._._'---''''--''--'.'-''--~-]l] roc __'H___~_'_'__. -.--.---
~. --....---'io-...-.--..--.----.-..-....-,.-~--.-.,. ..,---. . ",".- _.___m_.'_~ .'----.--.-.--~-
90S. -----..-. __R.__...._ ------ ----
1000. Ill!llUVEt DEPOSllED IJITH LENDER
100f.HlitrdInM;~'- __~.OOO ~thi _.-i...~----z6:08P;rn;onth--.-~=-=.~. =='---'o4:"i( ==..-:==
1002. KortgllOll In.urlnce month' it "1.61 per month . - -
IDOl. COJHlY/MUH lAllES ;\:000 IllOntti.--Q.i--.-25':~ip;r-iOOii\h---._.---_.-..- ----71:.53". ~~----
1004. COl.Jlty 111111 3.000 mon-iii.-;.'-------p;r-nmtii--..----- --...-----~- ---...---..---.-
1005, SCHOOL lAllE5-----,-O:OOO mofitillQ~.-7~.tO po-r-month --- -- 727.00:-
1006, '-~"--mo-nthQ~-i",- par month .~ --..--- ._H__'''___
1007. mntl1~ ". per monih--"-or_- _'_H~_~'__
lOO8.MioiiEriAIE ESe. ~OJUS1. ---.--.--.-.-------~-- -:i;08Jij- ~.__..'
~.llTLECIl~RQEIl _ _.
1101. OllbunlfMflt ft, to
1102. ~bltr.ct or Till. 5111rc"-~~'
110]. TItle EliMination to-I
1104. 'lthl Inlurlne', Binder to
1105. DOClIMnt prllplIrlltlon to HERSCltEl lOCIC ESQUIIIE
1106. Notlry he. ,oC'ASH'---
1107, Attorney'l Fill to
(lncludil tbove It"" rlUfbrrll _._~-
1108. Title Inl..,rlnco to Trl.ColXlty AbitriCtifrvi'ce--
(lncludn OboVI Item numerll EHO, 100, 300 ^NO 8.1
1109. ltndlrt~ CovllrlSI S '-'6i;'4"00:00
1110. Owner'l cO...llr.llgl . 72,OOO~OO
;r;T:'-----
'fi1i:cooiiEi"fEi----.--~.~NTY ~U9TiiACfii~'vICE
fiTf:- -
1200. GOVERNMENI IlECOADIHQ ANII 'R~NSfEII CKAIIGES
1201. llecordlng F""iietd. 25.50 jHort(ji!lgl' 31.50 lRlilli!l""
1202. City/County "II/St~1 Died' no.oo /Mortglgl'
120]. ltett hK/Stl/lVll Deed' n\I.OOI~-'--~----'
~-_.-
1205.
nOD. ADOITIONAl IEl1LEMENT CH~ROE5
1301. Sur....y to ' --
n02. ~..t Inlpoctlon. to PENN PEn .- 25.00
no]. 1991 COJNTY/IllN. T~IIU to HAR"~rRYOR ]0121
111)1,. '" em '" to HARY AN' "",. '''-Fok"
ifu:' 1I~IH8iiRSE oiiiiQKT fEEl to Joor ROSI.YOOEII 9.50
11.00. T01~l SEtTl-tMEN' CHAII41ES (Entor on Llnel 101, hctlOfl J IInd 502, 'lll;tton IC) 2,895,65 6,098.77
fly Itunlno plUe 1 of thIs ItltffMnt tho Ilun.torlel 11C:~nowledgll rer.llpt of . c:~ltt,d copy 01 plOI 2 of thl. 2 pIIl1e .utMent,
!~~~~.;oo-i ',0000".
:1!~~_o:~?__
r~11) 'ROM
801lROVER'$
rUUDS,,"I
SE'1lEM~Nl
PA1DfAOIl
UttERIS
fUIlOIl ~T
UTllEHENf
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6.00
-----
S46.00
--
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120.00
7Z0.00
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TRI.CWNTYABS1RACTSERVICE u
lelttfllltnl Aglnt
(1/BOL2191.HlID/80L2191)
Ctrtlfltd to be . tr.... c:opy
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PAYMENT I
Detach the top partion of thl. "OUOI tlnd Iublllt with your pIYI!.nt IIlld/'! plyutl to the nu. and IIddr'"
prlnt.d on the r.v.r.. .Ide.
If RESIDENT DEtEDENl llIakl chock or 11I0"''1 ordlr payable tal REGISTER OF WILLS ~ AGENT,
If NON-RESIDENT DECI!DENT 11I,,10'1 oheok or 11I01'1''11 order PItYllbll tal COHl10NWEAL TH OF PENNSYl.VANIA,
REFUND (CR)I A refund of a tax credit, whloh waf not r.qulstad on the Tax Return, lIIay bl rlqueltld by oOlllpletlng an
"AppllcaUon for R.fund of PlnnlylvlInla Inhlr1tanc:1 and Eatate lax" (REV-1313l. Application. are aval1abl. It
the Qffioll of the RIIghtlr of Willi, !Inll of thl 21 R'Vlnu.Dhtrlot Offlou Dr frOll the Dlpartnnt'. 24~hour
anlw.rlng ..rvio, nUlIlbar. for for.. ardednQI In P.nnlllh/.n!8 1-800-~6Z.Z050, out.ld. Plnnllllv",l.
and wlthin local Harrhburg l!waB (717) 1a7~8D9~, TOO. (717) 772-l252 Oltarln9 1l!Iralrld ot'l1l/L
REPLY TO: llu..Uun. regllrding Irror. contalnld on this notlcl should be addr....d tal PA nlParhllnt of Rov.nu', Burell\.!
of Individual TI)(.., ATTN! Post An'"I1I"t Rlvlew Ufllt, Dept. 280601, Harri.burg, PA 17128-0601, phone
(717) 717-6505.
DISCOUNT I
If IIny tDx due i", paId within thr.e (3) oalendar Months aft.r th. dlcldlnt'. dlalh, a f1v. porolr'lt (S;:) dhoount
of the tax paId Is allow.d.
PENAlTYl
The 15% taK a~nosty non-pDrtl~lp~tlon ~.naltll Is co.put~d OM thl total of tho taK and Interl.t allal.lld, and not
paid blforl J~nuery 18, 1996, tho first day aftlr the end of th_ t8x a.ne.t'll p.riod.
INTEREST I
Int.r.vt I. chargld b.glnnlr'lQ with flrlt day of dlllnquency, or nine (9) lIonth. and ona (1) day froll the date of
dlath, to tho date of pay~.nt. TaKls ~hlch b.ca.' dlllnqu.nt bafor. January 1, 1982 b.ar Intor..t at the rat. of
six (6X) plrcent per annUM calculated at 8 dally rat. of .000164. All taKaI which becaMe dc-llhquent on end aft.r
January 1, 1982 will bear Intlr.st at a rat. which will varll froll calendar year to Qalendar lI.er with that retl
announcld by the PA D.part.lnt of R,VlnYI. Th. appllca~l. Inter' It rat.. for 1981. through 1991 ar.l
V..r lnterut Rat. Dallll lnterost Faotor Vear lntlrut Rate !laily Inter'lIt Fftctor
--
1911 lOX .OOOS4& 19&1 9X .OOOZ~1
1981 16;: .000438 19&&-1991 Hi( .000101
1981tt 11:1. .000301 1992 9% .0002:41
1965 11;: .0003S6 1993-i9'lt 7Y. .000192
1986 10i( .00021~ 1995"1991 9% .00O?41
k~lntlr..t 11 clllculated .. folloWl1
INTEREST . BALANCE or TAX UNPAID X . NUNBER Dr DA'IS DELINQUENT X DAILY INTEREST rACTDR
uAny HoUcl luu.d aft.r thl tax b.ca... d.llnquent will refl.ct itn Int.r..t ClIlcuhtlon to 'lft.,n (1S) dlY.
beyond thl dltl of the .....N..nt. If p8yn.nt 1_ ..d. 8ft.r the lnter..t co.,utetlon dlt. Ih~ on the
Nollce, l'Iddlt\(mlll Interut IIIlllt b. c~l<:ulahd.