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Home My WebLink About03-15-07 (4) ~ REV-1500 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 ~L COUNlY CODE ~L 0501___ YEAR NUMBER I- Z W o W U W o DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Schaffer Ro er DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 4/18/2006 6/2/1926 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) D SOCIAL SECURITY NUMBER 193-18-5875 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w ~ ~ ~(/) UO:~ wD.U J:OO uO:...J D.al D. c( [i] 1. Original Retum D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82) D 4a. Future Interest Compromise (date of death after 12-12-82) 0 5. Federal Estate Tax Return Required D 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 8. Total Nu mber of Safe Deposit Boxes D 10. Spousal Poverty Credit (date 01 death between 12-31-91 8nd 1-1-95) 0 11. Election to tax under Sec. 9113(A) (A1I8Ch 5ch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS I- Z W o z o D- m w It: It: o o William T. Hast, Esquire FIRM NAME (If Applicable) Stock and Leader TELEPHONE NUMBER 221 W Philadelphia St, Ste 600 f"-.,,,) c::> Susquehanna Commerce Center East 717-846-9800 York, FA 17401-2994 C) 1 Real Estate (Schedule A) (1 ) 62,694.71 0.00 2. Slocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0.00 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Sdledule E) 0.00 2,123.14 0.00 (4) (5) z o ~ ~ ::J I- 0: <( u w ~ 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) (6) 0.00 8. Total Gross Assets (total Lines 1-7) (8) 21,913.72 64,817.85 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 40,359.24 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) (13) U1 V :::!: en 62,272.96 2,544.89 0.00 2,544.89 14. Net Value Subject to Tax (Line 12 minus Line 13) (14 ) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15 Amount of Line 14 taxable al the spousal tax z rate, or tran sfers under Sec. 9116 (a)(1.2) o ~ 16. Amount of Line 14 taxable at lineal rate ~ :J ~ 17. Amount of Line 14 taxable at sibling rate o U 18. Amount of Line 14 taxable at collateral rate >< ~ 1 9. Tax Due 20. [!] 0.00 2,544.89 x .0 ~(15) x .0 ~(16) x .12 ( 17) x .15 ( 18) (19) 0.00 114.52 0.00 0.00 0.00 0.00 114.52 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 \~ '\ c..:> - Q) - N o o -..J ~ ::s ~ ('D ""'l ('D 'JJ ~ _. 'JJ (') ~ - (') $:: - ~ ~ ('D 0.. ~ o ~ ~ ""'l (') ::r N o N o o -.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~f~~~~~g0882~~8~ ~O\ WO~ ~~'ef(~~";t:. 000000 000000 000000 000000 lJ)~WvJI-")N ~I.;.JOVl-..J~ 0000 O\~-..J ?f??f??f? [ ~ ~~~~~~~~oo~O\Vl~Vl-..Joo~ ?f?~~?f??f??f??f??f?~?f??f?~?f??f??f??f?~~ ;:0 ~ ..... ~ 0000 0000 0000 0000 WvJvJvJ 0000 6666666666666666[ gggggggggggggggg~ N NNNN NN N;:O ~~~~~~~~~~~~~~~~~ ~ OOOOOOOOOOOOOOOOOOOOOOOOOW OOOOOOOOOOOOOOOOOOOOOOOOO~ OOOOOOOOOOOOOOOOOOOOOOOOO~ 00000000000000000000000000 00000000000000000000000000 00000000000000000000000000 00000000000000000000000000 00000000000000000000000000 00000000000000000000000000 00000000000000000000000000 00000000000000000000000000 00000000000000000000000000 0000000000000000000000000 0000000000000000000000000 -E19 ........ VI W '- ~ vJ ~ ~ -< "TJ N (\) 000'" -- ...., Nt:: ~ p:l -< ~ vJ ~ g. W;J> 05, vJ ~ ~ '< '- vJ t:: 0:::1 (\) '- W t:: -< ;J> W t:: -q9 ~ C/J (\) "'0 vJ ;:; o :3 0'" (\) .., o (") vJ 0 0'" (\) ...., vJ o uJ -l 0\ 0 2. 0 0 0 ~ '< vJ * uJ ;A:l Vl ~ ~ (\) ~ p:l :3 - 0 - a ... v, Va uJ N trl 'JJ ~ ~ ~ ('D o I-t:l ;::t' o (JQ ('D ""'l z 0 <: (\) :3 0'" ~ 0 (\) (") (\) :3 0'" ~ (\) .., _. - ('D z 0 N - I 0 0\ I 0 VI 0 ........ o C/J (') ::r ~ ~ ('D ""'l ""tJ )> ::l ::J CD ., ;::;.: Q) ::l (') CD -l Q) X ::l ro ., CD en ...... () Q) n c w ...... o' ::l en Decedenfs Com Jete Address: STREET ADDRESS 100 Rid e Road CUmberland Count: CI1Y Bi leranlle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal poverty Credit B.PrlorPayments C. Discount ...- . - STAlE-" _..- PA . "ZIP 17307- (1) 114.52 0..00 0.00 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if appiicable D. Interest E. Penalty 0.00 0.00 Total Interest/Penalty (0 + E) (3) 0.00 4. If Line 2 is greater than Line 1 + line 3, enter the difference. ThIs is the OVERPAYMENT. Check box on Page 1 Une 20 to reqlBit a refund (4) 0.00 5, If Une 1 + Line 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) 114.52 A. Enter the Interest on the tax due. (SA) 1.53 B. Enter the total of line 5 + SA l1is 1& the BALANCE DUE. (58) 116.05 Make Check Payable to: REGIS1PR OFWI.LS, AGENT ~ ,.:. ~~'L:~~.~,~;~-:~~,.-::' .'::.~~.~~~~:.~"~'_~'_: '3L='=:~~~:~.~:: :.~ ~_~:~:./3~~7.r\:-~~7'}- ':" >~:: ::. '. '.:' ~=~=~.:~L.;';;L?E'=~::1:31:fiZ:.~:""~'{~ -~~~I~=::::;:~~~~'_:.~~~~'~'::.~~i;~;':~~~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. DId decedent make a transfer and: Yes No B. retain the use Dr income of the property transferred;. . . . . . . . . . . . . . . . . . . . . .. D ~ b. retain the right tD designate who shaH use the property transferred or its Income;. . . . . . . .. D [i c. retain a reverslon8IY Interest, or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [j d. receive the promise for life of either payments, benefJts or care? . . . . . . . . . . . . . . . .. D [jI 2. If death occurred after December 12, 1982, did decedent transfer property within one yesr of death without receiving adequate consideration? .. . . . . . . . . . . . . . . . . . . . . . . . . .. 0 [j 3. Old decedent own an "In Wit for' or payabfe upon death bank account or security at his or her death? D [JI ~. Old decedent own an Individual Retirement Account, annuity, or other non-proba1e property which contains a beneficiary de8lgnatlon? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [i IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE rr AS PART OF TtE RETURN. Under p....aruu at perjlIry, 1 dec:ln thIIl.,.. ..mlnld IhIJ f81um, ~c:IIdlg ~ ac:M:fules IIIlCf IUHrnenta, nl to the bwt of my knowledge Ilfld belief, It II true, canc:t end campI_. Dcl..oon of prepnr other thllfl the perIDI"llll ~~ II bIIIId on lllllr1fofmlldlln at wt1Id1 prlplll'lr h.. Ill)' JmowIedgIr. ~z:;;;;;::rl~~jJL )~, 3rr/d7 c/O Suaq Camm Ctr E,221 W p~a St:, . Ste 600, York, PA 17401-2994 SlGNl'.ll..H: OF I"tti'ARER cmtER '1l'fAN REPRESENTAllVE ~-n= Stock and Leader, by: AOORESS SUBq Comm Ct:r E,221 W Phil. St, St. 600, York, PA 17401-2994 '.~: ~~.~;: :;'.~~ ..~. ::.~ ~~.:. ...:.. : :...... :.:',... ...: .:. ~.::.~~~_.... ':'. :~','. .: ...~..::~~_.~: .:~ ~::-.~2.:"_; -.~.:':".-_...~: ~ :::_~';.:.:..:~~::..:.,....,.;: ~:~...,~: ...~: ~= ::.:.:..:.";... For dates of dellth on or after July " 1994 and before January 1, 1995, thet..... mpoeed on the net value aftransfens to or for the use of the survMng IpCIUs.1I3% 172 P.S.g 9918 (EI) (1.1) (I)). For d... of death on or 11Ift... Jenuary 1, 1995, the tax rate Imposed an the net waue oftnmsf8:a to or far the u..ofthe aurvMng lpouae IaO~ [72 P.S. 89116 (a) (1.1) (11)) The stBlute do.. not 8JC8mpt a trBInsfer to . surviving spouse fi'om talc, and thellt8lUtay reqvf..."ent. for dlsclollure of au. IlI'ld filing . tax t'IItum .. stlII applcable even If the IIUrvivlng spoun II the only berIeIIciEQ'. For datu of death an or der July 1, 2000: The tax rate ImpOled on the net value of transfers frcm . deceased child twBnty-one ~ of_. or ~nger81 deaIh lDorfDrfheuB8 ofanatural parent, an adoptive perwrt, or. steppanmofthechld II 0% [12 P.S. g 8118(.)(1.2)). The ta ratelmpoaed an the net value of transftnto crfor the use rlthe decedart's IIne8I ben8licllnJs 1a4.5%. 8DCC8pt asnol8d... 72 P.B. Ii 9116(1.2) (72 P.S. 69116(.)(1)). The till rate Impaled on the net VIIIue aftlW'lafers to or fcr the U88 of the decedent. sUngals 12" (72 P.B. S 9118(1)(1.3)]. A sibling /I deffn", undsrSect10n 9102, as an ildlYldU8l who "- 811eut one parent In common will the decedent, wMther bybtood orlldapfion. 3W"e4B 1.000 .. ----..._------ ,"- ... .. ..-.-.......-----:.-----.- -. .-..----.....--.---.. ._.~..._...- . COMMONWEALTH OF PENNSYLVANIA .. INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE REV-1502 EX+ (6-98) ESTATE OF FILE NUMBER Roqer D. Schaffer 21 06 0501 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 knowtedge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION NUMBER 1. Adjustments from Settlement Sheet: School Taxes $ 194.71 VALUE AT DATE OF DEATH 194.71 2 Real Estate known as 100 Ridge Road, Shippensburg, PA 17257, Southampton Township, PA @ sale price 62,500.00 3W4695 1.000 TOTAL (Also enter on line 1, Recapitulation) (If more space is needed. insert additional sheets of the same size) $ 62,694.71 REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Roqer D. Schaffer FILE NUMBER 21 06 0501 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 Adams Electric Cooperative, Inc., patronage capital 9.09 2 Refund check from Travelers 4.00 3 Orrstown Bank, Checking Account No. 362158 151.80 4 Proceeds from sale of personal property 1,458.25 5 Proceeds from sale of truck 500.00 3W46AD 1.000 TOTAL (Also enter on line 5, Recaoitulation) $ (If more space is needed. insert additional sheets of the same size) 2,123.14 R EIJ- 1 51 1 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Roaer D. Schaffer FILE NUMBER 21 06 0501 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 . Workinger-Semmel Funeral Home Funeral Bill 1,041.20 B. ADMINISTRATIVE COSTS: 1 . Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) - - Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 4,563.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Steve Bender trash removal 200.00 Total from continuation schedules 16,109.52 TOT AL (Also enter on line 9, Recapitulation) $ 21,913.72 3W46AG 1.000 (If more space is needed, insert additional sheets of the same size) 193-18-5875 ~state of: Roger D. Schaffer 2 3 4 5 6 7 8 Schedule H Part 7 (Page 2) Adams Electric Cooperative, Inc. Electric Service (Final Bill) 254.02 Cumberland Valley Medical Services Medical Services Rendered Account #DR0000795836 708.00 C.R.E. Apraisal Service Appraial Fee 300.00 Stock and Leader Short Certificate File Inventory File PA Inh.Tax Return File Release Cert. Mail Costs Photocopy Expense $ 4.00 15.00 15.00 5.00 25.00 35.00 99.00 Stock and Leader Costs Advanced: Cumberland Co. Legal Journal The Sentinel Telefax Charge Photocopy Expense $ 75.00 137.03 .50 4.05 216.58 Settlement Costs: $ 4,375.00 165.00 25.00 10.00 625.00 300.00 657.05 5,500.00 Real Estate Commission Transaction Fee Doc. Pre. Fee Notary Fees Transfer Tax Pest Inspection County Tax 1/2 septic Cost 11,657.05 Chrisann Hatfield Reimbursement for costs to clean out house, long distance calls, car and mobile home insurance, electric bill, overnight mail, and partial payment of administrator's bond 2,874.87 Total (Carry forward to main schedule) 16,109.52 REV-1512 EX + (12-03) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Roger D. Schaffer SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 06 0501 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 . Vivian F. Coy, Tax Collector Cumberland County, Southampton Township, 2006 Personal Income Tax 10.75 2 Franklin County Heart Center Medical Services Rendered Account #FC0000120430 150.00 3 Chambersburg Imaging Associates, PC Medical Services Rendered Account H24927501 282.00 4 Embarq Final Bill for Telephone Service 39.00 5 Chambersburg Imaging Associates, PC Medical Services Rendered Account H24927501A 32.00 6 NCO Financial Systems, Inc. LVNV Funding LLC, Acct No. 4031131400617914 (reference no. X75152) 4,184.01 7 Chambersburg Hospital Medical Services Rendered Account #H00024927501 1,561.00 8 Fayetteville Volunteer Fire Department Inc. medical services rendered 1,070.00 9 Sam's Club Account No. 7714110426739173 balance due 51.48 10 PSECU Balance due on VISA Account 1,886.38 11 Stock and Leader Services rendered prior to death 222.76 12 Orrstown Bank Mortgage $ 30,896.74 Less Refund 26.88 30,869.86 3W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 40,359.24 Rh-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES .cOMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Roaer D. Schaffer FILE NUMBER 21 06 0501 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Chrisann M. Hatfield 8035 South Mayfield Lane Mechanicsvil1e, VA 23111 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE NUMBER I 100% of Residue: 2,544.89 Daughter 2,544.89 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 3W46AI 1.000 TOTAL OF PART 11- 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) $ 0.00 Feb. 2. 2001 1:48PM JACK GAUGHcN KcALIOK tKA February 01~ ~OO7 SETT~EMBNT AGENT r'COMP ANY'~: Fnmldin. Real Eltate Servlte5.a~d Ab.~.tting: CronPUy, IDe. The undersigned parties have requested that the Compmy bold in escrow the .sum of$5,S(J(t.OO(tb.e "fundfll!) from the proceeds .mthc sr;ttlemem ofthl' propertr described in the aOO'V'c; order number. These funds are to be retained without intmest by the Company on the following t.etmt and condition!: (N,w Septic System tnstallation 1/2 of the coste Including perm.1ts and n~n8e) The funds ~e to be paid to (Buyer/Seller/Company). upon satisfaction of the above tenng and conditioDS and after receipt by the Company ofwritteo confirmatian from all parties hereto. In the c;:v:m costs or exp.ClJSes, including attomeye feos, are incu:o:ed by Company beoatl!e of litigatiOIl or otherwise. arisiJig out of~ holding of the: funds, the Compmy alWl ~ entitled to reimburse itself out of the funds for any such costs and ~cnsc8, inchmn<e of atto~ fees. If the Company is TU.labte for any reason to.l'eimburse itself out of the fimds. the undersigned partieS do hercbyjointly and sevcr.illyagrce to indemnify the Companyforariy and all costs and expenses, including attomeys feeS. that the Company:may $\1S~ arising out of my acts taken by 1h~ Company in good faith: pmsu.nt to this Agromncnt It is understood and agreed that. in the ~C7I1t cf a dispute:> the Cpmpany, may in \t$ .ab$olute discretiO%l. pay 1h~ funds into Court and aUO'9I' the- Court to detennin~ the ~ disposition of the,.funds or continue to hold the iUnds pesnding receipt by Company of mrifonn written direction from lill parties hereto. The CompanYt acting- escrow &gl!lllt, shall not be liable fur lSilycn;or ~fjJ1d;gmcntor foranyaettaken nromitwd to bE taken ~ good faith or in relianc.e on 8D.ywrittennoti~e, certificate or other documents beJicv~ byitin good faith to be genuine aud to 'be signed or submitted by an &W.thorized signatory. Bu}'8l' and Seller both lD'CC that the Companywillnot:relcu~ the fUndI from escrow except upon !he happcninl of either oftbe fonowing events: (1) Both B~ and Seller give the Company'Writt<<l authorization to !elase fun6s, or (2) i judamcnt is entered by a Court of Competent Jurisdiction in favor of the Buyer or Seller for the tllIlount held in esa'OW. A charie of $50.QO for the :first six months ihall be made for funds held in escrow by the Company; and .a. minimum charge ofS50.00 abal1 be made for evmyyear beyond the initia1siX month peri~ in which the funds. are held. In oonsideration of the! completion of st;ttlcmcm.tl 11m undersigned do oonsen.t and agree to the terms and conditiOD$ . hereof: SBI.l.ER BUYEIt .Tame. D. .G~fi. ADDRESS: &Gt. J PJt)l.(~5fc,l.c.J~ J.f/I t sta'~(4cw~ _."~ 17 J.5Sb3 TELEPHONE: '1--/1.- 3 B" 5 - .3 50 I ACCEPTEl> ON l.IEHALF OF THE COMPANY BY: . a A. Settlement Statement " u.s. Department of Housing and Urban Development OMS No. 2502-0265 REV. HUD-1 (3/B6) FRANKLIN REAL ESTATE SERV1CES AND ABSTRACTING COMPANY, lNC. 8. TYPE OF LOAN 1035 WAYNE ^VENue. CHNABERSBURG, P'" 17201 1. DFHA 2. OFmHA 3. OConv. Unlns. TEL 717-264-3290 4. [lVA 5. nConv. Ins. FAX: 717-26+1985 6. FILE NUMBER 17. LOAN NUMBER CT A0775 8. MORTGAGE INSURANCE CASE NUMBER orm urNlneo' 0 DIV. you a5lalemenl lll,ilC\Ulllsen"",,"m COI... Jlmounl$ palO'" alltl' y lIle Ml1lemln\ alllnurl IllOWi\. 111ltleExpress Settlement System C. Note: :'~~~~:.du'{p.o.C.I" were IJlIdDUIIldi II1e clo.ll)g; they arnhoWn here 'for InlormaUonpurppa.. aflll .,.. ncX Incl!Jlllld In IlM lalall. =~~~o,; ~~~ J~I:::fl~",:~,~~~~a~~f.~~= :~I~~I~du~~.~'or.r:ctfo:160~~;d -.e~~nm'rnalllRupon Printed 01/29/2007 at 14:47 RAD D. NAME OF BORROWER: ' James D. Griffith ADDRESS: 691 Brownstown Hili Stovstown. PA 15563 E. NAME OF SELLER: Estate of Roger ,D. Sohaffer ADDRESS: 8035 South Mayfield Lane Mechanicsvllle VA 23111 F. NAME OF LENDER: CASH ADDRESS: G. PROPERTY ADDRESS: 100 Ridge Road, Shippensburg. PA 17257 Southamoton township H. SETILEMENT AGENT: Franklin RE Services and Abstracting CO'r Telephone: 717-26+3290 Fax: 717-264.1985 PLACE OF SEITLEMENT: 1035 WlIvne Avenue. Chambersb.ura. PA 17201 I. SETnEMENT DATE: 02101/2007 J. SUMMARY OF BORROWERIS TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER lDt Contract sales nrlce 62 5DO.OO 401. Contract sales orice 62.500.00 102. Personal Prooertv 402. Personal ProDsrIv 103. Senlement chames to borrower fline 1400) 1 098.50 403. 104. 404. 1D5. 405. Adiustments for IteJnJS oald bv seller in advance Adlustments for Items paid by seller In advance 108. School Taxes 02I011Ojr to 06130107 194.71 408. School Taxes 021011071006/30/07 194.71 109. 409. 110. 410. 111. 41t 11t 412. 120. GROSS AMOUNT DUE FRON! BORROWER 63.793.21 A20.GROSS AMOUNT DUE TO SELLER 62.694.71 200. AMOUNTS PAID BY OR ON ElEHALF OF BORROWER 500. REO.UCTlONS IN AMOUNT DUE TO.SEUER 201. Deoosil or eamest monev 1.000.00 50t Excess Denoslt/see instruclions\ 202. Princioal amount of new loans 502. SeUlement charoes to seller lline 140m 6.149.02 203. Elislino loan/s) laken sublect to 503. Exlslino loan/s) taken subiect to 204. 504. Pavolf: 130032846 30,896.74 Orrstown Bank 205. 505. 206. 506. New Sentic SYStem Escrow 5.500.00 Franklin Real Estate ServlC$S 207. 507. 20B. 508. 209. 509. Adjustments foritems.unoald bv seller Adlustments for items unpaid bv seller 211. Countv taxes 01101/.07 to D2JD1J07 8.03 51t CounlV taxes 01/01/071002/01107 8.03 213. 513. 214. 514. 215. 515. 216. 516. 217. , 517. 218. 618. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 1.008.03 520. TOTAL REDUCTION AMOUNT DUE SELLER 42.553.79 3QO. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASHATSETTl.EMENTTO OR FROM SELLER 30t Gross amount due from borrower IUne 120\ 63793.21 601. Gross amount due to seller IlIne 4201 62.694.71 302, Less amounts oaidbvllorborrower lline 220\ 1 Oa8.03 602. Less reduction amount due seller !line 520) 42 553.79 303. CASH FROM BORROWER 62785.18 603. CASH TO SELLER 20140.92, 5UBsm. . UTE FORM 1099 SELL. ER STATEMENT: The Infol'Tllllllon contained hareln 101m,. portan! lax InfO,rma.1I0n andJ. being furnished 10 \helnlemal Rlv.nu. Service. If you .re required 10 fll. . return a nogllg.nee p.nally Dr olher.sanctl,on will be,lmpo.ed on yoU If this Item Is required 10 be reported and lhelRS dllermlne,,'!hallt hill 1101 bltln repllf\8l1. ih. Contract Sal.. PrJ.ce descrlbld on . line ~U1 abavl conatllu\..theGrQ.. Proc.ed. oIl111s InansacUon. 19 f -.5;2 -;J 75 7 , You Ire requlr.d by law to provldo lI1e $8tt1emQnt agent (Fed. Tn 10 No: I wllhyour cor/act taxpayer Idenllrlcallon numb.r. If you do not provide ur COlTact taxpayer ldentJllcallon ~;~: b. aUb~ect 10 civil or ;=~I\Ja. I~D"d by law. Under penaltl..1lf perjury. I co lhallh. OUml>er .huw'7f::.... t. antis ~r. payer I nU tlo~ number. SEUERIS) NEW IMIUNG ADDRESS: SELLERIS) PHONE NUMBERS: I fO L/- u '-/7-(P I 9 !o U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Fila Number. CTA0775 PAGE 2 4 RAD SETTLEMENT ST A TENIENT REV. HUD.1 (3/86\ 1llleExnress Settlemenl Svslem Printe 01/29/2007 al14: 7 L SEITLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on price s62,500.00@ 7.000 = 4.375.00 BORROWER'S SELLER'S Division of commission (line 700\ as follows: FUNDS AT FUNDS AT 701. $ 2,500.00 10 ERA-NRT Inc. SETTLEMENT SETTLEMENT 702. $ 1.875.00 10 Prudential Franklin Associates Realtors 703. Commission [laid at Settlement 4 375.00 704. Transaction Fee 10 ERA.NRT Inc. 165.00 BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Orioination Fee OJ /0 802. Loan Discount OJ /e 803. Annralsal Fee 804. Credit Reoort 805. Lender's Insoeclion Fee 806. Mortnaoe Aoolication Fee 807. Assumotion Fee 808. 809. 810. 811. 900.-ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 10 @$ Idav 902. Marloaae Insurance Premium for 10 903. Hazard Insurance Premium Jor 10 904. 905. 1000. RESERVES DEPOSITED WTTHLENDER FOR 1001. Hazard Insurance mo. @$ Ime 1002. Morlnane Insurance mo. @$ Imo 1003. Cllv ProoertvTax mO.@$ Imo 1004. County Prooerlv Tax mo. @$ lme 1005. School Taxes mo. @$ Imo 1009. Annu!Oate Analvsis Adjustment 0.00 0.00 1100.T1TLE CHARGES 111)1. Settlement or closinn fee to Franklin Real Estate Services 150.00 1102. Abstract or thle search to Franklin Real Estate Services 150;00 1103. Titleexamlnalion 1-104.1llIe Insurance binder 1105. Documenl PreD-Escrow AoreerrniDl Franklin Real Estate Services 25.00 25.00 1106. NolaN Fees 10 Bonita M. Crawford 10.00 10.00 1107. Attomev's fees 10 Stock and Leader Law Offices {includes above ilems No: Deed Precartlon , . 1108. Title Insurance to NO TITLE INSURANCE (includes above items No: ) 1109. Lender's Coveraoe S 1110. Owner's CoveraneS 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordinn Fees Deed $38.50 . Mortoane.!t : Release $ 38.50 1202. Citv/Counlv tax/stamos Deed $625.00 . MorloaoeS . 625.00 1203. Slale T axIslamos Deed $625.00 : Mortnane.s 625.00 1204. 1205. 1300. ADDITIONALSEITLEMENT CHARGES 1301. Survev 1302. Pestlnsoeclion to D. E. W. & Sons 300.00 1303. Transaction Fee 10 Prudential Franklin Associates Realtors 100.00 1304. 2006 Cnlv/SchI39-16.0224-QSO to Cumberland County Tax Claim 649.02 1305. 1306. 1307. 130B. 1400. TOTAL SETTLEMENT CHARGES (enler on lines 103. Section J and 502 SecUon K\ 1.09B.50 6149.02 HUD CERTIFICATION .01' llUYER AND SELLER \n~~~ c;:~~u:,~~~~~~~~.g;~~~;"~~n,'.~~~~~; : J:': ~~.f' ~~~~n~~".r, It '- a tnIe and acanlll.ta~l1llIIlt utall recelpls and dllbu'..me~ mao. on my lCCOIInl a, by , .Jill'DA6 u. urnJlln ~ _ 1/:30/07 WARNING: IT IS A CRIME TO KNOWlNGL Y MAKE FALSE STA MENTS TO THE UNITED STATES ON THIS OR ANY. SIMILAR FOl1M. PENAl Tl UPON COHVlCTION CAN INCLUDE A FINE AND IMpRISONMENT. FOR DETAILS SEE11TLE 18: U.S. CODE SE.CTION 1001 AND 'sECTION 1010. The HUD.1 SaWlmlllt Statemlnt which I have g:;"par.td I. I I,u. and accurale a..aunl of.lhla tr.a.nucUan. I have c:auud or will cauaelhe funds.tQ be dlS ''lid In le.ordanee with thllllala~!\~,:./':::'.."