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Home My WebLink About05-03-07 -.J 15056051058 REV-1500 EX (06-05) PA Department of Revenue '*' Bureau of Individual Taxes . PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Number Date of Death OFFICIAL USE ONLY County Code Year INHERITANCE TAX RETURN 2' I D7 RESIDENT DECEDENT File Number DOOLj7! Date of Birth 174-05-3935 01/07/2007 07/13/1918 Decedent's Last Name Suffix Decedent's First Name MI Keck Louise K (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C.'\ 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate '.J 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy ofTrust) 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes William C. Kallas (717) 731-1 --<(": Firm Name (If Applicable) Kallas and Kennedy First line of address '-'-' 1104 Fernwood Avenue 1') Second line of address p..~) City or Post Office State ZIP Code DATE FILED -' Camp Hill PA 17011 Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this retum, 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 representative is based on all information of which preparer has any knowledge. IBLE FOR FILING RETURN 7TE J 5 J 07 ADDRESS . iLflO LO(\~\S baf) 1Loc~ I (il.(~Lt..-, fA 1701~ SIGNATURE OF PRE ARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM OiNLY Side 1 L 15056051058 15056051058 --I /' -~ .....J 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: Louise K Keck 174-05-3935 RECAPITULATION 1. Real estate (Schedule A). ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 45,150.00 2,456.00 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 134,339.28 2,000.00 6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested. . . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 183,945.28 24,717.48 2,896.60 27,614.08 156,331.20 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10)................................ ... 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. 156,331.20 TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 77,166.00 17. 9,260.00 11,875.00 21,135.00 79,166.00 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 15056052059 -.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME Louise K Keck STREET ADDRESS 1024 N. West Street DECEDENTS SOCIAL SECURITY NUMBER 174-05-3935 CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 21,135.00 19,000.00 950.00 Total Credits (A + 8 + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 19,950.00 Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in avalon Page 2, 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. 1,185.00 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) A. Enter the interest on the tax due. 1,185.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... D [iJ b. retain the right to designate who shall use the property transferred or its income; ............................................ D [iJ c. retain a reversionary interest; or.......................................................................................................................... D [KJ d. receive the promise for life of either payments, benefits or care? ...................................................................... D [iJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D [iJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D [iJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D [iJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6-9. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Louise K. Keck FILE NUMBER 00048 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 1024 N. West Street, Carlisle, PA 17013 1/2 Interest 45,150.00 Sold April 11 ,2007 HUD Attached TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 45,150.00 REV-1503 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Louise K. Keck FILE NUMBER 00048 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 2. DESCRIPTION Series EE US Savings Bond R6095506EE Series EE US Savings Bond R6095507E Series EE US Savings Bond R6095508EE VALUE AT DATE OF DEATH ITEM NUMBER 1. 200.00 200.00 3. 200.00 4. Series EE US Savings Bond R6095505E 200.00 5. Series E US Savings Bond C2057050434E Series E US Savings Bond L 11 07144256E 100.00 6. 50.00 7. Interest on above Bonds 1,506.00 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,456.00 REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Louise K. Keck FILE NUMBER 00048 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. Cash 2. M&T Bank 3. M&T Bank 4. Social Security & Interest Checks 5. Defense Activities FCU 3MO-55007 -KE-42-3 6. Defense Activities FCU 3MO-55007 -KE-4-43 7. 2003 Honda Civic LX 8. Met Life Shares 9. Retirement 10. Interest 11. IRS 2006 - Reimbursement (anticipated) 12. Membe~s 1 st - Savings Account 13. Member's 1st - Money Management VALUE AT DATE OF DEATH 2,200.00 19,718.33 44,556.12 1,252.15 21,015.29 19,112.63 8,250.00 1,789.54 608.70 396.52 440.00 4,406.38 10,593.62 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 134,339.28 REV-15D9 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Louise K. Keck FILE NUMBER 00048 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Bonita L. Hamman 1470 Long's Gap Road Carlisle, PA 17013 Niece B. C. JOINTLY.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR OATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER, ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1, A. 01/01/86 Series HH US Savings Bond D142546HH 500.00 100 500.00 2. A. 07/01179 Series H US Savings Bond D12414213H 500,00 100 500.00 3, A. 07/01179 Series H US Savings Bond D12414212H 500.00 100 500,00 4. A. 07/01179 Series H US Savings Bond D12414214H 500.00 100 500.00 TOTAL (Also enter on line 6, Recapitulation) $ 2,000,00 (If mDre space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Louise K. Keck FILE NUMBER 00048 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Ewing Brothers Funeral Home, Inc. George's Flowers 8,528.70 153.70 678.88 765.00 2. 3. Arlene F. Miller (Repast) 4. Westminister Cemetery B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Bonita L. Hamman Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 1470 Long's Gap Road City Carlisle 8,250.00 .State PA Zip 17013 Year(s) Commission Paid: 2. Attomey Fees 5,600.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Miscellaneous a. Pennsylvania Department of Revenue 2006 Taxes b. Carlisle Borough Tax Account 2007 Taxes State . Zip 642.30 94.00 4.90 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 24,717.48 REV-1512 EX+ (12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Louise K. Keck FILE NUMBER 00048 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 2. Kough's Oil Service 682.50 PPL Electric Utilities 190.68 Com cast 17.97 Embarq 78.17 Borough of Carlisle 75.44 Nationwide Mutual Fire Ins. Co. 38.00 Bon-Ton Credit Card 29.00 Boscov's Credit Card 29.00 FIA Credit Card 111.14 Visa Credit Card 74.11 SW. Barrett Appraisals 300.00 Subway Auto Body 500.00 Commonwealth of Pennsylvania 58.50 AM 20.00 Cumberland County of Aging 5.88 Deluxe Checks 66.41 Michael Hamman, Snow Removal 60.00 Hoy's Greenhouse 37.10 Staples 110.99 Smith's Applicances 102.71 Bonita L. Hamman 300.00 Vital Records 9.00 3. 4. 5. 6. 7. 8. 9. 2,896.60 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1513 EX> (9-00) '* COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Louise K. Keck FILE NUMBER 00048 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Arlene F. Miller Sister 50% 2. Bonita L. Hamman Niece 12.5% 3. Robert C. Miller Nephew 12.5% 4. Jennifer L. Hamman Grandniece 12.5% 5. Joshua M. Hamman Grandnephew 12.5% 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 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) One Percent Withheld Arlene F. Miller Bonita L. Hamman Robert C. Miller Jennifer L. Hamman Joshua M. Hamman $659.00 $135.00 $135.00 $ 65.00 $115.00 EXHIBIT" A" IRS 2006 Reimbursement (Anticipated) Arlene F. Miller Bonita L. Hamman Robert C. Miller Jennifer L. Hamman Joshua M. Hamman $220.00 $ 55.00 $ 55.00 $ 55.00 $ 55.00 HENRY L. STUART, P.C. ATTORNEY AT LAW ',-3 S. '8A~OVER STREET CARUSLE, PA. 17013 LAST WILL AND TESTAMENT I, LOUISE K. KECK, of Carlisle, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my last will and testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I henby direct my personal representative hereinafter named to pay all my just debts and funeral expenses as soon after my decease as may be found convenient to do so. SECOND. I give and bequeath certain items of tangible personal property to the people and parties listed on a separate memo. THIRD. I order and direct that all the rest, residue and remainder of my estate, real, personal and mixed, be sold at either public or private sale and converted into cash and after the same has been converted into cash and all my just debts, funeral expenses, etc. have been paid as above I then give and bequeath the balance as follows: (a) One-half (1/2) thereof to my sister, Arlene F. Miller, or her issue. (b) One-eighth (1/8) thereof to my niece, Bonita L. Hamman. (c) One-eighth (l/S) thereof to my nephew, RobertC. Miller. (d) One-eighth (l/S) thereof to my grandniece, Jennifer L. Hamman. (e) One-eighth (l/S) thereof to my grandnephew, Joshua M. Hamman. LASTLY, I nominate, constitute and appoint my sister, Arlene F. Miller, Executrix, of this my last will and testament, without the necessity of filing bond or surety in this or any other jurisdiction. IN{T:SS ?4 .1--l WHEREOF, I have hereunto set my hand and seal this t2 day of , A.D., 19S5. ~4<- r /ft~-L/(SEAL) Signed, sealed, published and declared, by the abov.e named Testatrix, Louise K. Keck, as and for her last will and tes.tament,in the presence of us, who, at her request and in her presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto. ,,' " ;I " ,'.' "/r#t~~ / . . 1~~f"l. \ ~/j}"jltr# COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT KOLLAS WILLIAM C 1104 FERNWOOD AVENUE CAMP HILL, PA 17011 -------- (old ESTATE INFORMATION: SSN: 174-05-3935 FILE NUMBER: 2107-0048 DECEDENT NAME: KECK LOUISE K DATE OF PAYMENT: 03/29/2007 POSTMARK DATE: 03/28/2007 COUNTY: CUMBERLAND DATE OF DEATH: 01/07/2007 NO. CD 007953 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $19,000.00 I I I I I I I I TOTAL AMOUNT PAID: $19,000.00 REMARKS: CHECK# 1022 SEAL INITIALS: JA RECEIVED BY: TAXPAYER GLENDA FARNER STRASBAUGH REGISTER OF WILLS Andrews & Johnson A. SETTLEMENT SHEET 78 W. Pomfret St., Carlisle, Pa. 17013 HUD-1 RESPA HB 4305-2 B. Type of Loan - FHA - FmHA - Conv. Unins. FileNo. ILoan No. Mortgage Ins. Case No. VA Conv. Ins. C. This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown. Items marked "(p.o.c.)" were paid outside the closing: They are shown for informational purposes and are not included in the totals. D. Name and Address of Borrower E.Name and Address of Seller F. Name and Address of Lender Francis V. Salomone and Bonita L. Hamman, Executrix for the Estate of Countrywide Bank FSB Catherine M. Salomone Louise K. Keck and Arlene F. Miller G. Property Location H.Settlement Agent 1024 North West Street Ronald E. Johnson, Esquire Carlisle, PA 17013 Place of Settlement I. Settlement Date 78 West Pomfret Street I April 11, 2007 Carlisle PA 17013 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100, GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract sales price $95,000.00 401. Contract sales price $95,000.00 102. Personal Property 402. Personal property 103. Settlement charges to borrower{line1400) $2,182.25 403. 104. 404. 105. 405. Adjustments for items paid by seller in advance: Adjustments for items paid by seller in advance: 106. City/town taxes to $0.00 406. City/town taxes to $0.00 107. County taxes 04/11/2007 to 12/31/2007 $316.81 407. County taxes 04/11/2007 to 12/31/2007 $316.81 108. Assessments to 408. Assessments to 109. Maintenance to 409. Maintenance to 110. School taxes 04/11/2007 to 06/30/2007 $228.97 410. School taxes 04/11/2007 to 06/30/2007 $228.97 111. to 411. Commitment fee to 112. to 412. to 120. GROSS AMOUNT DUE FROM BORROWER: $97,728.03 420. GROSS AMOUNT DUE TO SELLER: $95,545.78 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money $1,000.00 501. Excess deposit (see instructions) 202. Principal amount of new loan{s) $76,000.00 502. Settlement charges to seller (line 1400) $5,245.73 203. Existing loan{s) taken subject to 503. Existing loan{s) taken subject to 204. Commitment Fee 504. Payoff of first mortgage 205. 505. 206. 506. Payoff of second mortgage loan 207. 507. 208. 508. 209. 509. Adjustments for items unpaid by seller: Adjustments for items unpaid by seller: 210. City/town taxes to $0.00 510. City/town taxes to $0.00 211. County taxes to $0.00 511. County taxes to $0.00 212. Assessments to 512. Assessments to 213. School taxes to $0.00 513. Maintenance to 214. to 514. School/taxes to $0.00 215. to 515. to 216. to 516. to 217. to 517. to 218. to 518. to 219. to 519. to 220. TOTAL PAID BY/FOR BORROWER $77,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER: $5,245.73 300. CASH AT SETTLEMENT FROMITO BORROWER 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross amount due from borrower (line 120): $97,728.03 601. Gross amount due to seller (line 420) $95,545.78 302. Less amounts paid by/for borrower (line 220) $77,000.00 602. Less total reductions in amount due seller $5,245.73 303.CASH ([ X ] FROM) ([ ] TO) BORROWER: $20,728.03 603. CASH ([X] TO) ([ ] FROM) SELLER: $90,300.05 L. SETTLEMENT CHARGES Paid From Borrower's Paid From Seller's 700. TOTAL SALES/BROKER'S COMMISSION Based on price $95,000.00 @ 4.0% funds at Settlement funds at Settlement Division of commission (line 700) as follows: $3,800.00 701. to 702. $3,800.00 to Spencer & Spencer 703. Commission paid at settlement $3,800.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN. 801. Loan origination fee to 802. Loan discount to 803. Appraisal Report to LandSafe Appraisal Services, Inc. ($500.00) POC 804. Credit Report to LandSafe Credit, Inc ($35.00) POC 805. Final inspection fee to 806. Application fee to 807. Flood Check Fee to LandSafe Flood Dertermination, Inc. $26.00 808. Commitment Fee to 809. FNMA Processing Fee to 810. 811. 812. 813. 900. ITEMS REQUIRED TO BE PAID IN ADVANCE. 901. Interestfrom to @ per day 902. Mortgage insurance premium for mo. to 903. Hazard insurance premium for yrs. to 904. Flood insurance yrs. to 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard insurance mo.@ per mo. $0.00 1002. Mortgage insurance mo.@ per mo. $0.00 . 1003. City property taxes mo.@ per mo. $0.00 1004. County property taxes mo.@ per mo. $0.00 1005. Annual assessments (Maint.) mo.@ per mo. $0.00 1006. School Property Taxes mo.@ per mo. $0.00 1007. Water Dist. Prop. Tax mo.@ per mo. $0.00 1008. Aggragate Escrow Adjustment 1009. 1100. TITLE CHARGES: 1101. Settlement or closing fee to 1102. Abstract or title search to 1103. Title examination to 1104. Title insurance binder to 1105. Document preparation to to 11 06. Notary fees to cash $30.00 $20.00 1107. Attorney fees to Attorney fees to 1108. Title insurance to Ronald E. Johnson, Agent $828.75 (includes above items No.: 1109. Lender's coverage $76,000.00 1110. Owner's coverage $95,000.00 1111. Title Insurance Endorsements $200.00 1112. Restrictions 111 3. Messenger service to Andrews & Johnson $15.50 1114. Wire fee to Andrews & Johnson 1115.Closing Protection Letter fee to Commonwealth Land Title $35.00 1200 GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording fees: Deed $38.50 Mortgage $58.50 Satis Piec $97.00 1202. City/county tax stamps: Deed $950.00 Mortgage $950.00 1203. State tax/stamps: Deed $950.00 Mortgage $950.00 1204. Tax Certificates 1205. 1300 ADDITIONAL SETTLEMENT CHARGES 1301. Survey 1302. Pest inspection 1303. Carlisle Borough Tax Dept - 2007 county/township taxes $438.01 1304. Carlisle Borough - water/sewer - aect no: 00168 $37.72 1305. 1400. TOTAL SETTLEMENT CHARGES (entered on lines 103, Section J and 502, Section K) $2,182.25 $5,245.73 File Number CERTIFICATION I direct and authorize the Company to make the distributions indicated for my account on the attached HUD-1 Settlement Statement, approving the tax prorations indicated therein, and understand that prorations were based on figures for the preceding year, or estimates for the current year, and in the event of any change for the current year, all necessary adjustments must be made between Seller and Borrower direct; likewise and 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 it is 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 the HUD-1 Settlement Statement. Francis V. Salomone Bonita L. Hamman, Executrix for Estate of Louise K. Keck Borrowers Catherine M. Salomone Sellers Arlene F. Miller To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is a true and accurate account of the funds which were received and have been or will be disbursed by the undersigned as part of the settlement of this transaction. Settlement Agent Ronald E. Johnson Date RECEIPTS: Downpayment: Mortgage Financing: From Purchasers: $1.000.00 $75.974.00 $20.728.03 TOTAL RECEIPTS $97 702 03 DISBURSEMENTS: Check # Payee Mortaaae Pavoff to: Proceeds to Sellers: Realtor's Commission to: Spencer &Spencer Realtor's Commission to: Realtor's transaction fee to: Realtor's transaction fee to: Bank fees to: Notarv fees to cash Notarv fees to cash Attornev's fee to Ronald E. Johnson. Aaent Attornev's fee to: Overniaht mail service to Andrews & Johnson Recorder of Deeds Recorder of Deeds Pest Inspection to: Water/Sewer to: Taxes to: Carlisle Borough Wire fee to Andrews & Johnson Closina Protection letter fee to Andrews & Johnson TOTAL DISBURSEMENTS $9770203 Amount $90,300.05 $3,800.00 $30.00 $20.00 $1,028.75 $15.50 $950.00 $1,047.00 $37.72 $438.01 $35.00 $ $