HomeMy WebLinkAbout05-15-07
-.J
15D5bD41147
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 Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 7
File Number
0222
Date of Birth
170242072
02222007
12311919
GARDNER
NELLIE
MI
M
Decedent's Last Name
Suffix
Decedent's First Name
(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
[!] 1. Original Return
2. Supplemental Return
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
9. Litigation Proceeds Received
o
o
o
o
4a. Future Interest Compromise
(data of death after 12-12-82)
o
00
o
4. Limited Estate
6. Dacedent Died Testate
(Allach Copy of Will)
7 Decedant Meintained a Living Trust
. (Allach Copy of Trust)
8. Total Number of Safe Deposit Boxes
10 Spousel Poverty Credit (date of death
. betwMn 12-31-91 and 1-1-95)
o
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
~ORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
ame Daytime Telephone Number
JERRY A. WEIGLE ESQUIRE 7175327388
Firm Name (If Applicable)
WEIGLE & ASSOCIATES. P.C.
REGISTER OF WILLS USE ONLY
First line of address
City or Post Office
SHIPPENSBURG
State
PA
ZIP Code
17257
(")
So
.~ ;;:Q
'-:i:h
':,> -:}~) .......
, ~~r-:.FILED
t:='::::':,
f":;:::"
126 EAST KING STREET
-,
Second line of address
i I
~.",
f'..,.)
(....)
c
Correspondent's e-mail address:
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 prepa[ other than the personal representative is based on all information of which preparer has any knoWledge.
SIGNATURE OF P SON RESPONSIBLE FOR FILING R RN DATE
om as Larry Gardner
Jerry A. Weigle Esquire
126 East King Street, Shippensbur
Side 1
L
15(]Sb(]41147
15DSb(]41147
-.J
~
15056042148
REV-1500 EX
Decedenl'sName: Nellie M. Gardner
Decedent's Social Security Number
170242072
RECAPITULATION
1. Real Estate (Schedule A).......................................................................................... 1.
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.
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested............. 7.
8. Total Gross Assets (total Lines 1-7)....................................................................... 8.
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 Governmental 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.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 1"'4iiiXiible
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
58,915 53
16.
o 00
o 00
19. Tax Due.......................................................................................... ......... .................. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15056042148
35,500 00
3,559 48
29,195.91
68,255 39
5,78800
3,551 86
9,339 86
58,915 53
58,915.53
o 00
17.
2,651 20
o 00
o 00
2,65120
18.
D
15056042148
~
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-07-0222
DECEDENT'S NAME
Nellie M. Gardner
STREET ADDRESS
22 Maple Avenue
CITY I STATE IZIP
Walnut Bottom PA 17266
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
2,651.20
2,518.64
132.56
3. Interesl/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
2,651.20
TotallnterestlPenalty (D + E)
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5) 0.00
(5A)
(58) 0.00
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 D
b. retain the right to designate who shall use the property transferred or its income;.................................... D D
c. retain a reversionary interest; or.................................................................................................................. D D
d. receive the promise for life of either payments, benefits or care?............................................................. D D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................. .............................................................. ...................... D D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... D D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?....................... .............................................................................................. D 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.
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. ~9116 (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. ~9116 (a) (1.1) (ii)]. The statute does not exemDt 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. ~9116 (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. ~9116 1.2) [72 P.S. ~9116 (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. ~9116 (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+ (6-98)
*'
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Gardner, Nellie M.
FILE NUMBER
21-07-0222
ESTATE OF
All real property owned solely or as a tenant In common must be reported et felr market value. Fair market velue is dafined as tha price at which property would be
axchanged betwean a willing buyar and a willing sallar, neither being compelled 10 buy or sell, both having reasonable knowledga 01 tha relavant facia.
Real property which Is JolnUy-owned with right of survivorship muet be disclosed on schedule F.
1
DESCRIPTION
22 Maple Avenue - Walnut Bottom, South Newton Township, Cumberland County,
PA, gross proceeds of sale 03-15-2007
VALUE AT DATE
OF DEATH
ITEM
NUMBER
35.500.00
TOTAL (Also enter on Line 1, Recapitulation)
35.500.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule A (Rev. 6-98)
Rev.1503 EX+ (5-98)
.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Gardner, Nellie M.
FILE NUMBER
21-07 -0222
ESTATE OF
All property JolnUy-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 Prudential Financial - proceeds of sale of 39 shares of 3.559.48
stock on 04-17-2007
TOTAL (Also enter on Line 2. Recapitulation) 3.559.48
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
. Rev-1508 EX+ (6.98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Gardner, Nellie M.
FILE NUMBER
21-07 -0222
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned wtth the right of survivorship muel be dlectoeed on ec:hedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 County tax proration at real estate settlement 166.25
2 Penn National Insurance - refund 13.00
3 School tax proration at real estate settlement 259.53
4 Everett Cash Mutual Insurance Company - homeowner's refund 169.00
5 M & T Bank Savings Account #015004214183200 17.138.71
Accrued interest on Item 5 through date of death 42.43
6 M & T Bank Savings Account #021000001218115 5.613.24
Accrued interest on Item 6 through date of death 2.09
7 M & T Checking Account #97250082 1.307.93
8 PA 2006 Property Tax Rebate (to be received after 07-01-2007) 250.00
9 Presbyterian Homes - refund 1.233.73
10 Personal Property - proceeds of sale with real estate 03-15-2007 3.000.00
TOTAL (Also enter on Line 5, Recapitulation)
29.195.91
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
. REV.1151'EX+ (12.99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Gardner, Nellie M.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-07 -0222
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Weigle & Associates, P .C. 4,584.00
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 Register of Wills, Cumberland County 173.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 1,031.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 5,788.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 SChedule H (Rev. 6-98)
. Rev.1502 EX+ (5-98)
.
SCHEDULE H.B7
OTHER
ADMINISTRATIVE COSTS
continued
C0M\10NWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gardner, Nellie M.
FILE NUMBER
21-07 -0222
ITEM
NUMBER
AMOUNT
DESCRIPTION
1
Carlisle Sentinel - advertising Letters Testamentary
158.81
2
Cumberland Law Journal - advertising Letters Testamentary
75.00
3
Linda K. Klein - notary fee
20.00
4
M & T Bank - charge for estate checks
9.37
5
Real Estate settlement costs - including document preparation ($85.00); realty
transfer tax ($355.00); and 2007 county taxes ($207.82)
647.82
6
Register of Wills, Cumberland County - filing PA Inheritance Tax Return
15.00
7
Register of Wills, Cumberland County - 1 Short Certificate
4.00
8
Register of Wills, Cumberland County - filing Family Settlement Agreement
75.00
9
Register of Wills, Cumberland County - 1 Short Certificate
4.00
10
Weigle & Associates, P.C. - reimbursement for postage, xerox copies, and long
distance telephone calls
22.00
Subtotal
1.031.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6.98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COt.'MONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gardner, Nellie M.
FILE NUMBER
21-07 -0222
Include unrelmbursed medIcal expenae..
ITEM
NUMBER DESCRIPTION
1 Carlisle Regional Medical Center
VALUE AT DATE
OF DEATH
282.00
2 Continuing Care Rx
707.47
3 Graham Medical Clinic
32.83
4 Internal Revenue Service - 2006 federal income tax
944.00
5 Lanc HMA Phys Mgmt Cent Pen
16.08
6 Lanc HMA Phys Mgmt Cent Pen
11.55
7 M & T Checking Account #97250082 - checks clearing after date of death
633.81
8 PA Department of Revenue - 2006 state income tax
745.00
9 PPL Electric Utilities
30.86
10 PPL Electric Utilities
22.46
11 West Shore EMS - Carlisle
125.80
TOTAL (Also enter on Line 10, Recapitulation)
3,551.86
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV.1513 EX+ (9-00)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
1
Gardner, Nellie M.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
Clistributions, and transfers
under Sec. 9116(a)(1.2)]
Thomas Larry Gardner
10937 Morgan Drive
Shippensburg, PA 17257
RELATIONSHIP TO
DECEDENT
Do Not Wet Trustse(e)
FILE NUMBER
21-07 -0222
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
NUMBER
I.
Son
100%
58,915.53
Total 58,915.53
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropnate, 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
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
LAST WILL AND .'l'.E'..STAMENT
I, NF.T.T.TF. M. GARttmR, of Walnut Bottan, South Newton Township, CUmber-
lanl COmty ,Pennsylvania, being of sound llliIxl, maoory am understanding, do
make am publish this my Iast W;i.ll and Testament, hereby revoking and making
void any and all fenner wills am codicils by ne at any tine heretofore made.
FIRST. I direct my hereinafter rianed ExeCutor, or Executors as the case
may be# to pay all my just debts am funeral expenses as soon as conveniently
may be after my 'decease; I further direct that all taxes that may be assessed
in cxmsequence of my death, of whatever nature and by Whatever jurisdiction.
imposed, shall be paid as part of the expense of the administration. of my
Estate.
SEX:XJID. I give, devise and bequeath all my property, real, personal and.
mixed, whatsoever am wheresoever situate, to my beloved husband, CLARENCE A.
GOO:NER, absolutely.
'lHIRD. I ~ naninate, constitute am appoint my said husband,
CLARENCE A. ~, the sole Executor of this my Iast Will and Testament,
FOURTH. Provided.,.hOweV'er, that in the event my said husbarrl, CLARENCE
A. GAROOER, shalld predecease me, or if we should die in a ccmoon disaster,
in either of said events, I give, devise and bequeath all my property, real,
personal am mixed, lftlatsoever and Wheresoever situate, to my son, 'l'HCM\S
IARRY <:ARJ:NER, absolutely; provided. further, that in the event my said scn,
~ LARRY GARtNER, should predecease ne, then in that event, I give, devise
and bequeath all my property, real, personal and mixed, whatsoever and where-
soever situate, in three (3) equal shares, share and share alike, one (1)
equal share to my granddaughter, L. CHRISTINE BIIGER, one (1) equal share to
my grar:d:lallghter, C, SUSANNE GARrNER, am one (1) equal share to my graIrlson,
THCMAS L. GARrNER, JR., absolutely; piovided further, that in the event any
of my aforenanai three grandchildren should predecease ne, then in that event,
I give, devise and bequeath the share of the said deceased grandchild to the
child or children, in equal shares, share am share alike, of my said deceased
11~ >n I
~(SEAL)
.
grandchild, then living at the time of my decease; provided, hCMeVer, that in
the event my said deceased gramchi.1d leaves no child or children livin;J at
the time of my decease, then in that event, I give, devise and bequeath the
share of my said grandchild to the surviving graranild or gramch:i.ldren, to
wit, either L. CHRISTINE BILGER, C. StJSARm ~, or, TIDmS L. GARIEER, JR.
in equal shares, share arxlshare alike, then living at the time of my decease.
FIFm. Provided further, that in the,.event any of my aforanentianed
Iega.t.ees are not at least eighteen (18) years of age at the tine of my decease,
then in that event, I hereby naninate, constitute.and appoint DAUPHIN DEPOOIT
Bl\NK AND TROST CXNPANY, Harrisbln'g, Pennsylvania, as the Guardian of the
estate of the said minor child or children, and the said Guardian to take and
receive the share of the said minor child or children and invest and re-
invest the same in legal or nen-legal investIoonts, \'lbi.chever in its discretion
it deems proper, and. the said Guardian to have full ~and authority, in
its descretial, to IBY such azoounts of iname am principal as are necessary
for the suworL, maintenance and educatien of the said mimr child or. children,
and upcn the said nu.nor. chi.ld or children reach.in,:1 the age of eighteen (18)
years, to pay the said share to the said child.
SIXTH. Provided further, that in the event my said husbarrl, CIARENCE A.
GMIDNER, sOOuld predecease IE, or if we slDuld die .in a carmon disaster, then
in either of said events, I hereby naninate, constitute and appoint my said
sen, TIQW) IARRY GARrNER, the sole Executor of this my last Will and Testa....
ment; provided further r that in the event my said son, ~ LARRY GARtNER,
should predecease me, then in that event, I hereby naninate, constitute and
appoint my said. granddaughter, L.CHRISTINE BIIGER, my said granddaughter,
c. SUSANNE GARIHER, and my said gr~, 'lHCMAS L. GARI:NER, JR., or the
survivor or survivors of them, to witn, either L, CHRISTINE BIIGER, C. SUSANNE
GARI:NER, or, ~ L. ~, JR., then living at the tine of my decease,
as Executors of this my 14st Will and Testament,my said Executor, or Executors
as the case may be, to have full power and authority to do any and all things
/1~ ml)!f~ (SFAL)
-2-
necessary far the CXI11plete administrati.cn of my estate, including the power
to sell aIr:! ard all real and personal property of which I may die seized, at
public ar private sale, in his, or their, discretion, without any Order of any
CaJrt; am I further direct that my sai,d Executor, or Executors as the case
may be, not be required to file any BotXl in oonnecti.an with the settlanent
of my said Estate.
IN Wl'1NESS WHEREOF, I, NF.T:r.TF. M. ~, have hereto set my bani and
seal to this my Last Will and Test:a:rent, written on four (4) sheets of paper ,
this. 4th day of September, 1984.
11~.. m,~~ (SFAL) .
Signed, sealed, published and
declared by NELLIE M, GARlEER,
the Testatrix,asand for her
Iast Will and Test.amen.t,written
an four (4). sheets of paper, in
the presence of us wb:> bav~, at
her request,signed our names as
wi'blesses ba:reto in the: presence
of the said Testatrix ani of each
other .
-3-
~ OF PENNSYLVANIA
ss
OOtNrY OF CUMBE:RIAND
I, NELLIE. M. GARI:m:R, Testatrix, whose naneis signed to. the attached
or foregoing instrunent, having been duly qualifiErlaccarciiD3" to law, do
hereby ackn.owledge that I sigried and executed the . instrunent as my Last Will
and Test.alJent; that I signed it willingly; am that I signed it as my free
and voluntary act for the p.IrpOSeS therein expressed.
~ h11~
NellieM. Gamner
SWOrn or affiJ:med to and acknowledged before me by NF.T.T.TF. M. GARI:m:R,
the Testatrix, this 4th day of september, 1984.
~ OF PENNSYLVANIA
SS .
c .
EUMIllIl 8. FEmI, IOTAIY C
WErt HNlllIOIO 1W~., CUlIE COUlrt
MY COII.,saIOll EIPIRES SEPT. It 1917
....r. ,..,....... AIIociatioa of MotadIi
axJNTY OF CllMBERIAND
We, ImERT J. YOCtM and. .TERESA J. BURKHOIDER, the. witnesses ~ names
are signed to theatta.cn:ad or foregoing i.nst:runent, being duly qualified
aa::arding to l.aw,.do depose and.Bay that we were present and saw the Testa-
trix sign and execute the instrument as her. Iast .Will. and. Testament; that
the Testatrix signed willingly; and that the Testatrix executed it as her
free and voluntary act for the p.IrpOSeS . therein expressed; that each of us
in the hearing and sight of the Testatrix, signed the Will as witnesses;
and that to the best of our knowledge, the Testatrix was at that time 18 or
:rcore years Of age, of sound mind,arxi under no cxmstraint or undue influence,
PA
-:r~.~~~~
Newburg, PA
Sw::>rn or affiDned to and subscribed before Ire this 4th day of September,
1984.
ElIJAKTK e. Fftl, M6f11V ~ "'"
WlST P(N..SSOROlWP., CUMBERLAND COUN"
MY CCIM"'h101 EXPIRES SEPT. 12, 1917 J
"..r, .......,.,..11. AsIIClatllllt ef lI.tarl"
-4-
tJrevwous eamons are ODSOtetl!l
"'"" HUD-1 (3IllIl) ref Handbook 4306.2
- A.' ::settlement Statement
U.S. Department of Housing and Urban Development
B. Type of Loan OMB Aooroval No. 2502-0265 (exolres 9/3012006)
1. DFHA 2. DFmHA 3. DCony. Un ins. I 6. File Number 7. Loan Number I 8. Mortgage Insurance Case Number
4. OVA 5. DConY.lns. 071830SHETTER
C. Note: HilS orm IS you as. "'!~~~~~1O ana DY "" Ie"",,,,",nt agent are snown. I TitleExpress Settlement System
Items INIrked "(p.o.c.r __ peld outside the doslsl:t., they are shcMn here for InformaUOn purposes end ere notlnduded In the totals.
WARNING: It Is a crime to knowl~~ f8lse IlII\ts to the United States on this or 8I1~lher almll. fonn. Penalties upon Printed 03/1512007 at 14:50 RLH
convlCllon cen Indudee fine and I sonmenl FordelaHs_:TIIIe 18 U. S. Code SeCIIon 1 1 and SecIfon 1010.
D. NAME OF BORROWER: Terry L. Shetter and Tlfflny A. Shetter
ADDRESS: 365 Musser Road. Shiooensbura. PA 17257
E. NAME OF SELLER: Estate of Nellie M. Gardner
ADDRESS: 22 Maole Avenue. Walnut Bottom. PA 17266
-
F. NAME OF LENDER:
ADDRESS:
G. PROPERTY ADDRESS: 22 Maple Avenue, Walnut Bottom, PA 17266
South Newton Townshio
H. SETTLEMENT AGENT: South Central Home Settlements, Inc., Telephone: 717.532.7387 Fax: 717.532.6552
PLACE OF SETTLEMENT: 126 East Kina Street Shlooensbura. PA 17257
I. SETTLEMENT DATE: 03/1512007
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 orice 35.500.00 401. Contract sales orice 35 500.00
102. Personal Prooertv 3.000.00 402. Personal ProllArtv 3 000.00
103. Settlement chames to borrower lIine 140m 769.50 403.
104. 404.
105. 405.
Adlustments for Items oald bv seller In advance Adiustments for Items oald bv seller In advance
107. County taxes 03/15107 to 12131/07 166.25 407. Counlv taxes 03/15107 to 12131/07 166.25
108. School Taxes 03/15107 to 06130107 259.53 408. School Taxes 03/15107 to 06130/07 259.53
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 39 695.28 420. GROSS AMOUNT DUE TO SELLER 38925.78
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deoosit or earnest money 501. Excess Deoosit (see instructions)
202. Princoal amount of new loans 502. Settlement chames to seller lline 140m 647.82
203. Existina Ioanlsl taken subiect to 503. Existina loanlsl taken subiect to
204. 504. Payoff of First Martaaae Loan
205. 505.
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for Items unoald bv seller Adjustments for Items unoald bv seller
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 520. TOTAL REDUCTION AMOUNT DUE SELLER 647.82
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower IIine 120) 39 695.28 601. Gross amount due to seller lline 420) 38 925.78
302. Less amounts Mid by/for borrower lline 220) 602. Less reduction amount due seller lIine 520\ 647.82
303. CASH FROM BORROWER 39 695.28 603. CASH TO SELLER 38277.96
SUBSTITUTE FORM 1099 SELLER STATEMENT: The InformeUOn contained her:eln Is ImpoI1anl tax InforINIUOn and Is being fumlshed III the Internal ~e Service. If you are required to fila a retum,
al18llAlI8IlC8 penally or other S8I1CIIon wtll be Il\1lOMd on you If this 118m Is required III be reported and the IRS determines that II has not been reported. The Contract Sales PrIce described on
line 40' ab<MI constitutes the Gross Proceeds 01 this lIanlecUOn.
You are required by law III proWlethe settlement -aent t;'~ 10 No: I wfth your CDIT'8CI taxpa}'8l" ldenUflc8UOn number. If you do not provide your correct taxpa~r IdentlllceUon
number, you INIY be subject to civil or crtmIn8I penliltIes by law. uncs. penaIUes 01 perjuIy, I certify IhaIthe number shcMn on this statement Is my CDIT'8CI taxpa}'8l" IdenUflc8tion number.
TIN:_ _ '_ _ SElLER(S)SIGNATURE(S): ,
SElLER(S) NEW MAILING ADDRESS:
SELLER(S) PHONE NUMBERS:
(H)
(W)
iare OllSOIete
form HUD-1 (3/811) ref H8ndboOk 4:305.2
File Number: 071830SHETTER PAGE 2
Se S P' ed 03/15/2007 t 14 50 RLH
p. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
&ETTLEMENT STATEMENT
TiUeExoress tt1ement ~vstem nnt a
. ,SETtLEMENT CHARGES PAID FROM PAID FROM
/00. TOTAL SALESIBROKER'S COMMISSION based on Drice $35 500.00 e 0.000 = BORROWER'S SELLER'S
Division of commission (fine 700\ as follows: FUNDS AT FUNDS AT
701. ~ to SETTLEMENT SETTLEMENT
702. $ to
703. Commission naid at Settlement
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Orinination Fee %
802. Loan Discount %
803. Aooraisal Fee -
804. Credit Reoort
805. Lende~s InsnAdion Fee
806. Mortaaae Aoalication Fee
807. Assumntion Fee
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to tal$ /dav
902. Mortaaae Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo.(ij)$ /mo
1002. Mortaaae Insurance mo. tal $ /mo
1003. City pronertv Tax mo.(ij)~ /mo
1004. Countv Pronertv Tax mo.(ij)S 17.32 /mo
1005. School Taxes mo. (ij) $ 73.10 /mo
1009. Aaareaate Analvsis Adlustment
1100. TITLE CHARGES
1101. Settlement or c10sinn fee to South Central Home Settlements. Inc. 375.00
1102. Abstract or tiUe search
1103. TiUe examination
1104. Trtle Insurance binder
1105. Document Prenaration to Welale & Associates 85.00
1106. Notarv Fees
1107. Attomev's fees
(includes above Items No: )
1108. TiUe Insurance
(includes above items No: )
1109. Lender's Coveraae $
1110. Owne~s Coveraae$ 35.500.00 .
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordina Fees Deed $39.50 . Mortaaae $ . Release S 39.50
1202. CitY/County tax/stamos Deed S355.00 . Mortaaae S 355.00
1203. State T ax/stamDS Deed S355.00 . Mortaaae $ 355.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey
1302. Pest Insnedlon
1303. 2007 CountvlTownshio to BeverlY Rosenberrv. Tax Collector 207.82
1304.
1305.
1306.
1307.
1308.
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Section J and 502. Section K) 769.50 647.82
HUD CERTIFICATION OF BUYER AND SELLER
revIeMd the HUD-1 SatUemenl Statement and 10 the bast of my knawtadge and belief, II ~ true and accurata statemenl of an receipts and disbursements made on my account or by me
.... I w · ...""...-- ~ Q.. Sh~ >
Estate of Nellie M. Gardner
~J,.~
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION
CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18:
U.S. CODE SECTION 1001 AND SECTION 1010.
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Prudential ~ Financial
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Computershare Shareholder Services. Inc
PO Box 43033
Providence Rhode Island 02940-3033
Telephone: BOO 305 9404
WW'W .computershare.com
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I'MPORTANT TAX RETURN DOCUMENT ENCLOSED I
THOMAS LARRY GARDNER EX EST NELLIE ME GARDNER
C/O WEIGLE & ASSOCIATES PC
126 EAST KING STREET
SHIPPENSBURG PA 17257
1'11111'111111.1.1.1.1'11111.11..11'111.1.11'11.1.1.11111..1.1
Holder Account Number
C 0029913731
FID
IIIIIIIIIIUI
SSNmN Certified
Symbol
Yes
PRU
OOlCS0093.DOMBQSBLUEBG.CJS.S3348....220/000126IOOO126li
Form 1099-8
Summary
(Keep for your records)
Trade Date ,
Transaction Description I ShareslUnits I Price Per I Gross Amount I
Sold Share/Unit ($) of Sales ($)
Deduction I
Amount ($)
Deduction I
Type
Net Amount
of Sale ($)
12 Apr 2007
3.559.48
Sale
39.00??oo
91.630778
3,573.60
14.12 Transaction Fee
Computershare Trust Company, N.A.,as agent. upon written request, wiH provide lfJe name of the executing broker dealer associated with the transaction(s), and within a reasonable amount of
time wi" disclose the source and amount of compensation received from third parties in connection with the transaction(s}, if any.
.
71UTX
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001CD70008 OOHX2E
PRU
Prudential. Financial
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PlEASE CASHIllEPOSIT lliS CHECK PROMPTlY.
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711-1558
719
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Harris Central N.A.
Roselle, Illinois
11.00000 50 ~O ~II. 1:0 'i' ~ ~ ~ 5 5801: 0 1.11. ~ ~ 511'80 511I ~II.
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m M&fBank
499 Mitchell Road, MiIIsboro, DE 19966 Mail Code DE-MB-12
MAR 1 D 2007
Phone (888) 502-4349
Fax (302) 934-2955
March 15,2007
Weigle & Associates PC
Attorneys At Law
126 East King Street
Shippensburg, Pennsylvania 17257-1397
Re: Estate of: Nellie M Gardner
Social Security: 170-24-2072
Date of Death: February 22. 2007
Dear Sir or Madam:
Per your inquiry dated March 13, 2007, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1.
1}pe of Account
Checking Account
Account Number
97250082
Ownership (Names of)
Clarence A Gardner *
Nellie M Gardner *
Opening Date
01/28/80 Oosed 03/14/07
Total
$1,307.93
$ 0.00
-$1:J1j7:9T--..-----.-..-----..-------..-..-----..-------------------------------
Balance qn Date of Death
Accrued Interest
2.
1}1pe of Account
Savings Account
Account Number
015004214183200
Ownership (Names of)
Nellie M Gardner *
Opening Date
10/05/06 Oosed 03/14/07
Balance on Date of Death
Total
$17,138.71
$ 42.43
- 'ii 7, TaTTr------------------------------------------m--------------
Accrued Interest
3.
Type of Account
Savings Account
Account Number
021000001218115
Ownership (Names of)
Clarence A Gardner *
Nellie M Gardner *
Opening Date
01/02/70 Closed 03/14/07
Balance on Date of Death
$5,613.24
$ 2.09
Accrued Interest
Total
$5,615.33
Please be advised, there was no safe deposit box found for the above decedent
* For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please call
the Walnut Bottom Office #717-532-2414.
Sincerely,
f:%._____
1(a#. :--y ..
~ancy ~tt
Records Management
PRESBYTERIAN HOMES
3/16/2007
INVOICE.OAtE. ReF.IO
3/16/2007 REFUND WIlli INI'EREST
DESCRIPTION
EST A TE OF NELLIE GARDNER No. 497648
TOT~AM9I.JNr D1SCQUNI AMOI.INT.APf:ll.ISO
1233.73 0.00 1233.73
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