HomeMy WebLinkAbout05-17-07
REV-1500EX + 16-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT_ 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
NICHOLSON, COLLEEN M.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
08/05/2005' 07/27/1957
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[Xl 1. Original Return
D 4. Lirnited Estate
[Xl 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12.12-82)
D 7. Decedent Maintained a Living Trust (Attach copy 01 Trust)
D 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 5 0 0 7 29
COuN"TYCciiiE ----vE~ - - NUMBER- -
SOCIAL SECURITY NUMBER
3 74- 7 0 - 3 598
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date 01 death prklrto 12,13.821
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (AUach Soh 01
.'THIS'SEcTl()N'MUsi';i ,- ECoMFH0ETE[i;'AliUiC()RRESPONOt:NCE.;'MD;cONFiDENTiAEllftJOOINF()RMATI()N'SH()lJL.DBEOIRECTED' TO:
NAME COMPLETE MAILING ADDRESS
JANE E. ADAMS, ESQUIRE 64 SOUTH PITT STREET
FIRM NAME (If Applicable)
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TELEPHONE NUMBER
717-245-8508
CARLISLE, PA 17013
70,000.00
OFFICIAL USE ONLY
0.00 X _(15) 0.00
0.00 X .045 (16) 0.00
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 0.00
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
(1)
(2)
(3)
(4)
(5)
7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
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)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value SUbject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxa/Jle at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Arnount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. 0
CHECK ~IERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
'> >" BE'SURETO ANSWER'tALL.i1tllJeSTlbNstbt-fREVERSE:SIDEAND RECHECK MATH < <
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0.00
10,000.00
'.-J
(8)
80,000.00
5,015.00
87,917.99
(11)
(12)
(13)
92,932.99
-12,932.99
(14)
-12,932.99
Decedent's Complete Address:
STREET ADDRESS
91 SMITH ROAD
CITY I STATE TZ'P
YORK SPRINGS PA 17372
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
0.00
Total Credits (A + B + C)
(2)
0.00
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
PLEASE
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; ........................................................................... 0 0
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 0
c. retain a reversionary interest; or ...................................................................................................... 0 0
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 0
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................... 0 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beMficiary designation? ....................................................................................................... 0 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
PA 17013
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 3%
[72 P.S. 99116 (a) (1.1) (i)).
For dates of death on or alter January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [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 0% [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 4.5%, 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 12% [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.
RE,v-1502 EX.+ (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
NICHOLSON. COLLEEN fy1. 21 05 00729
All real property owned solely or all 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.
!Ileal propertv which Is lolntly-owned with rlaht of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
91 SMITH ROAD: SOLD AT SHORT SALE 12-22-06 FBO PNC BANK (letter attached)
YORK SPRINGS, PA 17372
2 Parcels sold together see HUD, Exhibit "0": 40-15-0201-036; 40-15-0201-015A
VALUE AT DATE
OF DEATH
70,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
70,000.00
REiV-1508 EX.+ (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
NICHOLSON COLLEEN M.
FILE NUMBER
21 05
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.
00729
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
2,000.00
TRUCK
2.
HORSE TRAILER
800.00
3.
FORD TEMPO
1,500.00
4.
MERCURY TRACER
1,500.00
5.
HORSES
3,200.00
6.
DOGS
0.00
7.
HOUSEHOLD GOODS
1,000.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
10,000.00
REV-1511 EX + (12-99)
.
COMMONWEALTH OF PENNS~LVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
NICHOLSON. COLLEEN M.
FILE NUMBER
21
05
00729
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
1.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) AMANDA JANE NICHOLSON
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 154-B WEST PENN STREET
City CARLISLE State PA
Zip 17013
B.
Year(s) Commission Paid:
2.
3.
Attorney Fees JANE ADAMS, ESQ.
Family Exemption: (If decedent's address is not the same as c1aimanfs, attach explanation)
Claimant
4,750.00
Street Address
City
Rlillationship of Claimant to Decedent
State
Zip
4.
Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS
265.00
5.
Accountanfs Fees
6.
Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
5,015.00
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NICHOLSON. COLLEEN M.
REV-1512 EX + (6-98)
*'
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
21
05
00729
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
17,048.69
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
USAA FEDERAL SAVINGS BANK
Mastercard Account 5491 237033953814
Exhibit "B"
PNC Bank 12-22-06 Settlement (see HUD and letter attached)
Mortgage account 40-1-8110130381
91 Smith Road York Springs, PA 17372 Exhibit "C"
Jane Adams, Esq.
House Sale, Estate Attorney
HUD Exhibit "0"
Cumberland County Transfer Fee
House Sale, Seller Cost
HUD Exhibit "0"
House Sale Transaction Fees
Tax Certification and Overnight Payoff
HUD Exhibit "0"
Cumberland County Tax Claim Bureau
HUD Exhibit "0"
61,234.29
1,056.00
700.00
30.00
2,417.90
2006 County and Township Taxes
Cumberland County
HUD Exhibit "0"
2006-2007 School Taxes
Cumberland County
HUD Exhibit "0"
Bell Real Estate
House Sale commission
HUD Exhibit "0"
Help-U-Sell
House Sale Commission
HUD Exhibit "0"
413.56
1,817.55
1,600.00
1,600.00
TOTAL (Also enter on line 10, Recapitulation) $
87,917.99
(If more space is needed, insert additional sheets of the same size)
I, COLLEEN NICHOLSON of South Middleton Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory, and understanding, hereby declare
this instrument to be my Last Will and Testament, revoking any and all Wills by me heretofore
made.
ITEM ONE: I direct my hereinafter named Executors to pay all my just debts, funeral
expenses and administration expenses, including inheritance taxes, as soon as may be conveient
after my decease.
ITEM TWO: I give my truck and horse trailer to JAMES C. NICHOLSON, of South
Middleton Township, Cumberland County, Pennsylvania.
ITEM THREE: I give my Ford Tempo or other car to AMANDA J. NICHOLSON, of
South Middleton Township, Cumberland County, Pennsylvania. I give my Mercury Tracer to
JESSICA M. NICHOLSON of Cumberland County Pennsylvania.
ITEM FOUR: I hereby give my House, to my Executors upon the following trust:
a. JAMES C. NICHOLSON shall have personal use and occupation of my house
as a place of residence, and the use thereof during his lifetime. My daughters may
also live in the house, however, they must contribute to the household bills.
b. The monthly rent payable by JAMES C. NICHOLSON during his lifetime
shall not exceed the prorated cost of taxes and insurance on the house. JAMES C.
NICHOLSON shall be responsible for the costs of utilities.
c. JAMES C. NICHOLSON shall be responsible for necessary and reasonable
upkeep and maintenance of the house as well as care and upkeep of the horses and
dogs.
d. My Executor shall be responsible to ensure that the grounds of the property are
maintained as nearly as possible as they were at my death.
e. I authorize my Executor, during the lifetime and with the consent of, JAMES
C. NICHOLSON to lease the premises on such reasonable terms as my Executor
may determine such that the rents received are paid to JAMES C. NICHOLSON.
f. Upon the death of JAMES C. NICHOLSON, the house shall pass to these two
of my children, AMANDA 1. NICHOLSON of South Middleton Township,
Pennsylvania, and JESSICA M. NICHOLSON, of South Middleton Township, or
their issue per stirpes, for their use absolutely.
ITEM FIVE: Should JESSICA M. NICHOLSON be a minor at the time of my death,
desire that AMANDA J. NICHOLSON shall act as her legal guardian.
ITEM SIX: I give all the rest, residue and remainder of my Estate, real, personal, or
mixed, of whatsoever nature and wheresoever situate, in three equal shares, unto JAMES C.
NICHOLSON, and my daughters, AMANDA J. NICHOLSON, and JESSICA M. NICHOLSON,
or my daughters issue per stirpes.
ITEM SEVEN: I hereby nominate, constitute and appoint JAMES C. NICHOLSON and
AMANDA J. NICHOLSON as Co-Executors of this, my Last Will and Testament.
ITEM EIGHT: I direct that my Executor or Co-Executrices, shall not be required to give
bond for the faithful performance of their duties in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this this, my Last Will and
Test~tmen~ consisting of ~ typewritten page(s), bearing my signature,
this d"dfJtjay of M~~ A.D. 2002.
~~r1\ \ ~~
Colleen Nic olson, Testator
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
BOROUGH OF CARLISLE
I, COLLEEN NICHOLSON, the Testator, whose name is signed to the atta(:hed or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes therein expressed.
C~~o.ov-- V\~{\~~/
COLLEEN NICHOLSON, Testator
On this, the J d r~ay of /Ut~ , 2002, before me, a Notary Public, the
undersigned officer, personally appeared COLLEEN NICHOLSON, Testator, known or proven
to me to be the person whose name is subscribed to the within Last Will and Testament, and
acknowledged that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set m hand and official seal.
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(SEA :~y C(jmmi~i~s &J/1~. 6, 2004
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
BOROUGH OF CARLISLE
The foregoing will, consisting of~ typewritten page(s), was,
on thQCAM/ day of hlv-C-{, , 20~signed, sealed, published and declared by the
said testator as and for his/her LastWill and Testament, and it is hereby acknowledged that said
testatrix appeared to be of lawful age and sound mind and memory and there was no evidence of
undue intluence. We, at her request and in her presence, have hereunto subscribed our names as
attesting witnesses:
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Witness
of
~uJ~ J f'A-/70!3
/
Address
On this, the day of , 200~efore me, a Notary Public, the undersigned
officer, personally appeared ft. ()I'e A c:e g I't C6-VI r-L..- , known or proven to me to be the
person whose name is subscribed to the within Last Will and Testament, and acknowledged that
she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set
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Witness'
On this, the ~}lj) day of fvto.~ , 200~before me, a Notary Public, the undersigned
officer, personally appeared NtLV\ tAt ' known or proven to me to be the
person whose name is subscribed to the ithin Last Will and Testament, and acknowledged that
she executed the same for the purposes therein contained.
of
IN WITNESS WHEREOF, I hereunto s
. ,~El6-"U!!"'E"",,,....-=a'
i~~.tY~~c,rr~.!~\.~ ~E.,f\.J..
J\Nr- E:f;,DA~ifl~lititi'Y Public
., , . Boro, Cum!:,~jhmd County .
My Commission 8iplres Sept. 6, 2004
1569690
IN THE MATTER OF THE EST ATE
OF
Colleen M Nicholson, Deceased.
CLAIM
1. Claimant, USAA FEDERAL SAVINGS BANK MasterCard Account Number
5491237033953814, has a claim for $17,048.69 against this Estate, which is just and unpaid
after allowing all just credits, deductions and set-offs.
2. The nature of the claim is debt owed.
Herlvnda Garza, Estate Recovery Specialist, on Oath states that the allegations in this claim
are true.
~~
I - rly"da Gtfza ~
Estate Recovery Specialist
.-
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Signed and sworn to before me on September 12,2005.
a- o(~
u.dL .~
Notary Public
ANITA SANCHEZ
Notal)' Public
STATE OF TEXAS
'" My COIlTIl. Exp. 02-24-2007
Order
Allowed for $
Class
,2005
Judge Presiding
POC 95
12-12-.06 11:42 FHOM-
T-129 P001/001 F-112
TUCKERIAREfi~~fl~~
BrettA. Solomon 412-594-3913
bsolomon@tucker~w.com
December 12, 2006
Via Facsimile (717) 243.9200
Jane Adams, Esquire
64 South Pitt Street
Carlisle. PA 17013
Re; Colleen Nicholson
Property Address; 91 Smith Road, York Springs, PA 17372
PNC Account No. 40-1-8110130381
Dear Ms. Adams:
I am in receipt ofthe proposed HOD-I Settlement Statement provided to me from Attorney John C. Zepp,
III. PNC Bank would be willing to release its mortgage On the above-referenced property in exchange for
a minimum payment from the closing of$61,234.29. This closing must occur on or before January 11,
2007 and is subject to tbe following conditions: ~
1. Neither the Buyer nor the Seller will receive any funds back at the closing;
2. The total realtors' commission will not exceed $4,200.00;
3. Any additional proceeds payable to the Seller will be distributed to PNC Bank in addition
to the $61.234.29;
4. Taxes to be pro rated on a yearly basis; and
5. A copy of the fully executed HUD-l Settlement Statement is delivered to my attention
along with the proceeds check.
Therefore, if all of the above-referenced conditions are met, PNC Bank will release its mortgage upon
receipt of the 000-1 Settlement Statement llnd the proceeds in excess of $61 ,234.29, If you have any
questions or need further information, please feel free to contact me.
Very truly yours, .
cc; lohn C. Zepp- Via Facsimile (717) 528-7381
James Varner
BANK_FIN:2119602-1 000011-130555
Tucker Arensberg, P,C. 1500 One PPG Place Pillsburgh, PA 15222 p. 412.566.1212 1,412.594.5619 wwW.tuckerlaw.com
111 N. Front Street P.O. Box 889 Harrisburg. PA 17108 p.717.234.4121 f.717.232.6802
BELL REAL ESTATE
FAX:7!7 528 738!
DEC-20-06 WED 03:42 PM
A. Settlement Statement
U.S. Department of Housing
and Urban Devolopment
PAGE
~
,r
OMS Approval No. 2502.0265
:.~~~~~~C.~ "...1....._.. . ___I' ,~~- l---~-
C. Note: This farm Is furnished 10 give YOu" statement of actual sattlemont costs. Amaunls paid 10 .n,j'j;ylhe ;elti~;"e~l- ~genlii;;-
shoWl\. Items marked "(p.a.c.)' were paid oLltside closin9: they are shown here for informational purposes and not
included. In the tala Is.
D:-N;;-p-;;dMd;;~; ~"a~~;~ ....- --... -. .
E,tate of Colleen M. Nichol5on
. 'IE. Name .n~Aaar8" 01 Seller
i :\l~,,\nlkr W. Berg.mann
F.N;;;;7~dA;;;;~----'_._'.
.... ._ __2!!cO~(!,()Q 401 c.f~!'_'!!~~!!~E!!,e
. . ... ..4~~..-"!!rsan.a1 p'2p'e!1)'. __. ...__.._..._.
... .m!.} 1.5.00 ~.~L..__.____.__..____._,......_._.._...
.... ... .. .. .. '!.~~,......... ..... ....... ._- ........----..-..
405
_. .... n.," _. .._. ...' __ ..... ......_._....'~m_..... .... .. .-,,".. ..., ........... 'M'
_......~~J'!.~_~_~.~~~"f~~.~~~~..P.~.~~,.~y.~!!!C!~J!!.!~~~~_,N. __. .,~.. . "ON" ""N' ..... _~~J~!!!"ents !~.!~Dms paid Dy soUDr in 'd"anel
)!!~,_91l""!".~J~~~nt~'-Q~~.~'1...l~/1.!!9!!_.-.--.... ... ....... ... 1.24 40e. _CI~'!.~.I""e~ l2l22/06 10 12/31/06.
l~L.~~'!.'l'Y.I:!!!~...J~~~'-Q~~].?r.:ELO!1..--....-....... __ ..__.._._.........8.03 ~07 C~~I\.~!!~~-!~/2Zl06 10 ]2/3 ]/06
10e.. A.~~!'GIlIQnIS ..._ . .......!<1.......____ .m...__' ..... ,...... ........ 4oeJ'~~~.5.~~~.~~..._....._..__'_~._..._
~~=i~1l~_~1.=_~=__lY~?!~...!~~'.~Q!~~7 .__._.__ __I ... ..... 860.11 4~~:.~chool" 12(22/O,? 1~.6/30'-~~..__ __ _._...
"0 10 I" 410 ...-........ ...-..-----~-
H~=.::~.:==.=-.::..~.~~~..:_~::. ..:- -----. -' :.~~.:'-- .--.-;;~:..--
l1J. ... ...... ... ". 10.____..... ...... .....___ilL...... ......._.___.___IS'__.__
H~... ..... , .... ... . ,..-\~....-. -- ....--.. .. '!.~~~-.. ...'- .--. ......--....'~......--
~_._,_...."..._.___..__.!'!___......__.__._._. .. ....... ....... ... 4~~....... ..._.... ........\0.. ........--f-------.......
120. GroSs Amaun~lluo F,o", BarroWor 72,184.38 420. Gro.a Amaunl OUt To Sener 70,869.38
2~~:~"'?u".b;~~!~.8y..9nn~al1..~!I.~.!'~~~.!r....__ .................. . .... 500:.~.!~~~~a".I~~~~~~~'Ou. .!!!~.~.IL~r
~ll.LP.!l'.'!~t"r.!~.~~!'!'.~~~_..._.._..__....._...__. . . ...... .1.,000.0.0 S.O.LExce'l!ld~p.oslqs..ln~lr~C1Jons)
f.ll.2.c!.!!~~p.~I_ ~'!'~~~i..o.I.!'~"IO_"~!.l... .. . . ..~cg,~~!~~L!:!)~!~~.n.r (lin. 14~!!L.
~~:_~.~I~li~9!~t~L~~!!'_!~~~_...__._ 503. E>l..lng 19an(5) \alce.n SLlbj~ tQ.
?04,..._.......... .._ 504. p.~y~!.~J~.t mortQ~~ loan PNC
205. 595 Payen ofs,!con~ "'~rtQ.g...~o..n.
~. ~-~=---~~~=-:;=~-.I ~...__
AdjU9\JJlenlS for ~.m.. unpa'~ by .ener . .... . .__...~J~m.n... for !!!'!!.S-'!!1~~:t. ..nor
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220. Tct.al Paid BylFarBal1tlWe' I 1,000.00 5%0, TClallleducllon Amoul1l CU, S.U.r
G. Property LottaliOl\
91 Smith Rd.
H. 50.1811\0,11 A9"nl J!Jhn C. Z~pp, JII
Attorney At Law
p~c:~'c( ~~lIlamr::lnt .
8438 Carlisle Pike
Y!)rk Spring>
York Springs
PA 17372
PA 17372
LQl:
Dlgek,:
. ,K. ~u~nnlary oJ SOtl~s T~I~.~C~~"
ADO. Grosl Amount DU8 To S.II....
~.:_~.~~~~~_.~!.~_~.~~~~.~~!..:!~~~~~.~w _..
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10~.
] 2/22/06
12122/06
F..
70,OOOOQ
1.24
8.03
860.il
9.635..l!.1.
6] .234.37
70,869.38
JOO. Cash AI S.llIemen! FromITo Borrower
::~':=~~L~.
600. !=i~~ ~~.~l!tfl~~~'!!.To~~~~_~~~~.~__._.______ ___..___
7i.l 84}~' ~OJ.,. Gro.~ ~'1'o.~n1 qu~ .ta ~~~.r (~lnQ.4~0~ _..n__._._.....____..?.!l1~~218
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00 To
o from SllIor
o.uo
71.181.38 .03. casn
SIJSSTITIJT!; FORM 1099 SELLER STATEMENT
ThQ information cOl:1lalned in BIQcka.E, G. H. and I il:nd on linl! 0401 (or,line ,003 anCl40") Is important tax i!'\form8ijon aM. is being fUrnished to thE: Internal RAvClnuI
SeI'Vtce. It )lOLl are rEquired to 'iiI. oil retuM.a oclllliSJliftc:8 p.nll11y or ott1er sanction will be Impo:Slild on you if thil it.m is r&quirea 10 De rfiporteCJ 80/3 me IRS determines
I~.t it has.nat b..n repolled. II Ihis r.al ..lel. ,. your pm;c1pOl resiOEn"". fIIQ Forrn Z1' 9, SaI. or Exchango al Prlno;ipol Residence. for any gain. wllh your incoma ~
r.turn: lor oth.r tranaeC1Jon.. camplele tne aDplicaDle por's or Form 4797. Fo,m 6232 .ndlar Soh.dule D, F,,"" 1040). You ara requl'e<llo providelh9 S.H1omanl Aganl
(named above) With Y.Dur correct tatptyeridentlfJcation I1Umbor. If. YOIJ dD tlot providv the S&t1IRtnEnt Agent with )'OUr l;Qrr8~ Ulxpayer iaentillcatlon numbli:r, yolA may be
sub)acl \0 civil or mm!nai p"".IUes.lmpaseo I>y law. Unde, pa"aU,c4 uf p.rjUlY. I cQrtlfY Cs)t~~C~;\C~1al~rtr ~. ,!',~.~r \\~~.~.numbor
( ener":S SIgnature) ~
:SC-20-06 WED 03:43 PM
BELL REAL ESTATE
FAX:717 528 7381
PAGE 7
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; R.I..... $
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1304. Tax Certiflcatioll .. ..M" ....n" -- ... .. .'"_..__.__._______u 10.00
~~~~: c~;:;;bi~~,5~~!ii~S!~i~_~~~~:.~::~_ ... ...__u .... -. ...-----..--.. ..-.-.--.--- I 870.80
!3.0!:._~~!'Iberl~!Id CountUax q~~~~~~~_... .... ... .. .- .-...............-.. ....-- -.. 547.1 0
)~~,. ZOO.6 .c:,?l.'!llr_~~I~;..!~~~~._ -...."..--.... .. .. "... ... "'M"_" M~~'__"_' 413.56
nDI. 2206-2007 School Taxes I 817.55
..lio. Total $~em.nl Charg.,; (.nte. on lines '03. Sedlon J .nd 102, Section K) 1315.00 !I 635.01
CERTIFICATION \.
~~::~~;~~~~.:h~r~~::~~~:r&t~~~~~~~I..!}T(6.ll.~~~:k:nl9
AlelCtinder Vi: B~,:g~~~~ Estate l)f CO\let:l1~ J Nicnobon .s...J.l~
..__...___._._. Seller
_M__ BOffDWQr
T e be,t of my ~nowl d e the HUO..' Settlement Statement whicl'1l heve prep81"f!d is 8 tnJe a"d IIccurste aecoun' of lr,e funds whlcn were received and he'ie Deen or Will
b(ll ~rsed by Ihe. ~f the stttll!lmp.ot of this transactlDn.
:,.--'" . .' ._.__.................... ...._ ............. . SOUI.m.mAg.nl ..... .. . __._...___ [l.t.
~Jllhn ZEPP. III AttorM)' At Law
WAR"UN : n. i~ a erlmq \0 Itr\,owt.ngly l'f\;3M T;;Ilil;\ IIolamm;ntt; 10 th~ IJnftnd Sll1tn on this or any C1lhl!f Illmtt.r form. F'~na1tI'!!l"" lIpcn ctInvlctlon can In.;ludq , One and
lllnri!ll'm ""I For'~r.I;)il~ ~e(l~ TilIe-'S U.S. C~de 5(leliOt'1.1001 alld 5nclioll 1010