HomeMy WebLinkAbout06-04-0715056041125
REV-1500 E>< (~5) a t r~c~ (o~U
PA DepaAment of Revenue
Bureau ~ Indnridual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 6 8 - 2 6- 2 8 0 7 2 1 2 0 0 6 0 4 1 4 1 9 3 3
Decedent's Last Name
C L E V E R
Suffix Decedent's First Name
GAR N E T
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
FILL INAPPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
R
MI
^X 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
^X 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
beiween 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTbN MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
S U S A N J H A R T M A N 7 1 7 2:._~ 9 7` ~. 8 0
Firm Name (If Applicable)
D U N C A N & H A R T M A N P C.
First line of address
1 I R V I N E R 0 W
Second line of address
City or Post Office
C A R L I S L E
State ZIP Code
REGISTER OF 1Atll,1.$ USE OWLY
! .. ... _.
-a -
_`; ::'
E.;
DATE FILED
P A 1 7 0 1 3
Correspondent's e-mail address: SUSANHARTMAN@PLANETCABLE.NET
Under penalties of perjury, I declare that I have examined this return, including accompanying sdiedules and statements, and to the best of my knowledge and belief,
it is try, coned and complete. Declaration of preparer other than the personal representative s based on aB information of which preparer has any knowledge.
W. MAIN STREET WALNUT BOTTOM
JB~E OF PREPARER OTHER THABI REPRESENTATNE
PLEASE USE ORIGINAL FORM ONLY
Side 1
PA 17266
DATE
15056041125 15056041125 ~ ~m
15056042126
REV-1500 EX Decedent's Social Security Number
Decedent's Name: GARNET R. CLEVER 1 6 8 - 2 6- 2 8
RECAPITULATION
1. Real estate (Schedule A) ........................................ 1. 9 4 0 0 0. 0 0
2. Stocks and Bonds (Schedule B) .................................. 2•
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages 8~ Notes Receivable (Schedule D) ................. ... .... 4.
5. Cash, Bank Deposits ~ Miscellaneous Personal Property (Schedule E) ... .... 5. 2 2 3 2 9 • 0 8
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. 1 1 6 3 2 9• 0 8
9. Funeral Expenses & Administrative Costs (Schedule H) ......... ... .... 9. 1 3 8 1 5 • 7 5
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ..... ... .... 10. 9 5 1 3 8 • 7 9
11. Total Deductions (total Lines 9& 10) .................... ... .... 11. 1 0 8 9 5 4. 5 4
12. Net Value of Estate (Line 8 minus Line 11) .................. ... .... 12. 7 3 7 4 • 5 4
13. Charitable and Governmental Bequests/Sec 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. ~ 3 7 4 • 5 4
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
0 0
(a)(1.2)X.0 0 15. O. O O
16. Amount of Line 14 taxable 7 3 7 4 5 4 3 3 1 8 5
at lineal rate X .045 16. .
17. Amount of Line 14 taxable
0 O
O
1
0
O
O
at sibling rate X .12 7. .
18. Amount of Line 14 taxable
O O
O
0
0
0
at collateral rate X .15 18 .
19. Tax Due ................................................ 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
15056042126
3 3 1. 8 5
15056042126 J
KEV-1500 E7( Page 3
Decedent's Complete Address:
File Number
0 0
DECEDENTS NAME
GARNET R. CLEVER
STREET ADDRESS
111 WEST MAIN STREET
CITY
WALNUT BOTTOM STATE
PA ZIP
17266
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 331.85
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + g + C) (2) 0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 331.85
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 331.85
Make Check Payable fo: 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 : ...................................................................... ^
b. retain the right to designate who shall use the property transferred or its income; ............................... ^
c. retain a reversionary interest; or ................................................................................................ ^
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ ^X
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^ ^X
3. Did decedent own an "intrust for' or payable upon death bank account or security at his or her death? ......... ^ ^X
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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 sparse
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 ~ the surviving spouse is zero (0) percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot 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 beneficlary.
Fa dates of death on or after July 1,2000:
The tax rate imposed on the net value of transfers from a deceased childtwenty-one years of age or younger at death to or for the use ~ a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent p2 P.S. §9116(a)(1.2)].
The tax rate imposed on tt>e net value of transfers to or for the use of the decedent's lineal beneficlaries is four and one-half {4.5) percent, excel as noted in
72 P.S. §9116(1.2) ]72 P.S. §9116(aK1)].
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)). Asibling 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
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERCTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
GARNET R. CLEVER 0 0
All real property owned so1Ny or as a tenarn 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 wifiirg buyer and a willing seller, neither being compelled to buy or sell, both hating reasonable knowledge of the relevant facts.
Ral property which is ioirrtly-owned with right of survivorship must be disclosed on Schedule F_
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 11 WEST MAIN STREET, WALNUT BOTTOM, PA 17266 94,000.00
Sold May 11, 2007. A copy of the HUD-1 settlement statement is attached
TOTAL (Also enter on line 1
!If mnro enaro is neerierl ineert a~irlifinnal eheolc of 4he came ci~e1
'REV-1508~EX + (6-98)
SCHEDULE E
CONMAONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC.
INHERRANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GARNET R. CLEVER 0 0
Include the proceeds of litigation and the date the proceeds were received by the estate.
All properlyjoiMly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PATRIOT BANK PRIME SHARE ACCOUNT # 1472070 108.46
2. PATRIOT BANK CHRISTMAS CLUB ACCOUNT # 1472070 1,251.15
3. PATRIOT BANK DRAFT ACCOUNT # 1472070
4. SALE OF PERSONAL PROPERTY
5. CITIZEN'S BANK SAVINGS ACCOUNT # 6140-235251
6. CITIZEN'S BRNK CHECKING ACCOUNT #610079-815-1
7. CASHER'S INC. -RETIREMENT
8. CASHER'S INC. -PAY CHECK
9. FRANKLIN SHOPPER -REFUND
10. TAX PRO-RATIONS -CLOSING
11. 1990 Toyata Camery 4 -door
12. 2000 Ford S-10 LS model Truck
TOTAL (Also enter on line 5, Recapitulation) I S
/lf more snag ~ needed. in.5erf additional sheets of the lama. si~el
• REV-1511' EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF FILE NUMBER
GARNET R. CLEVER 0 0
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be n3ported on Schedule I.
ITEM
NUMBER
DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
1. BRICKER FUNERAL HOME
2. GRAVE OPENING
3. TRINITY UMC CHURCH SOCIAL HALL
4. MAXINE JOHNSTON FOOD SERVICE
B. ADMINISTRATIVE COSTS:
~. Personal Representative'sCommissions
2• Name of Personal Representative (s) SUSAN E. CLEVER
Soaal Security Number(sNEIN Number of Personal Representative(s)
6,832.50
325.00
50.00
197.00
0.00
Street Address
City State Zip
Year(s) Commission Paid:
2, AttomeyFees DUNCAN & HARTMAN, P.C. 2,500.00
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) 3, 500.00
Claimant SUSAN E. CLEVER
street address 11 WEST MAIN STREET
city WALNUT BOTTOM State PA zip 17266
Relationship of Claimant to Decedent DAUGHTER
4• Probate Fees REGISTER OF WILLS CUMBERLAND COUNTY 260.00
5 Acxountant's Fees
6. Tax Retum Preparer's Fees
7. CUMBERLAND LAW JOURNAL LEGAL AD 75.00
8. NEWS CHRONICLE LEGAL AD 76.25
TOTAL (Also enter on line 9, Recapitulation) ~ 3
13.81
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERrfANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, ~ LIENS
ESTATE OF FILE NUMBER
GARNET R. CLEVER 0 0
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. CITIZENS BANK -MORTGAGE -TWO PAYMENTS 1,500.00
2. I LANDFILL
3. IKUHN CABLE
4. BEV ROSENBERRY REAL ESTATE TAXES
5. FRANKLIN SHOPPER -ADS
6. PPL -ELECTRIC BILL
7. CITIZENS BANK MORTGAGE
8. WASTE SERVICES -TRASH BILL
9. STATE FARM INSURANCE -TRUCK INSURANCE
10. CITIZENS BANK -MORTGAGE PAYMENT
11. PPL -ELECTRIC BILL
12. PPL -ELECTRIC BILL
13. EMBARQ PHONE BILL
14. PPL ELECTRIC BILL
15. PUBLIC OPINION PPD TEL PYMT
TOTAL (Also enter on line 10, Recapitulation) I S
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GARNET R. CLEVER
Decedent's Name Page 1 File Number
Schedule 1-Debts of Decedent, Mortgage Liabilities, ~ Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. CITIZENS MORTGAGE 750.00
17. KOUGH'S OIL 92.16
18. ADS, GAS, POSTAGE 51.00
19. PPL ELECTRIC BILL 79.86
20. CERTIFIED LETTER STAMP 12.44
21. WEST SHORE EMS/AMBULANCE 647.34
22. PCFU TRUCK PAYMENT 312.00
23. J. HERSHEY TRACTOR REPAIR 30.00
24. N.E. WASTE SERVICES 65.84
25. PPL ELECTRIC BILL 99.50
26. CITIZENS BANK MORTGAGE 750.00
27. PATRIOT AD 33.60
28. SHIPPENSBURG EMS 87,69
29. KOUGH'S OIL 553.52
30. CITIZENS BANK MORTGAGE 750.00
SUBTOTAL SCHEDULE I I 4,314.95
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GARNET R. CLEVER
Decedent's Name Page 2 File Number
Schedule I -Debts of Decedent, Mortgage Liabilities, ~ Liens
ITEM
NUMBER DESCRIPTION AMOUNT
31. PPL ELECTRIC BILL 122.00
32. TRUCK ADS, GAS 8~ ETC. 41.00
33. CITIZENZS BANK MORTGAGE 750.00
34. AUTO LOCATOR TRUCK AD 34.00
35. KOUGH'S OIL 583.28
36. LAKE'S BURNER SERVICE 146.05
37. PPL ELECTRIC BILL 148.05
38. STATE FARM -TRUCK INSURANCE 243.73
39. KOUGH'S OIL 232.53
40. PPL 129.00
41. COON'S GARAGE -TRUCK INSPECTION 296.86
42. PENN DOT -TRUCK REGISTRATION 58.50
43. CITIZEN'S BANK -MORTGAGE 750.00
44. PA. DEPT. OF REVENUE -INDIVIDUAL TAXES 4.00
45. NEWS -TRASH 65.84
SUBTOTALSCHEDULEI ~ 3,604.84
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GARNET R. CLEVER
Decedent's Name Page 3 File Number
Schedule I -Debts of Decedent, Mortgage Liabilities, 8 Liens
ITEM
NUMBER DESCRIPTION AMOUNT
46. PATRIOT FEDERAL CREDIT UNION -FEES 45.00
47. BEVERLY ROSENBERRY -REAL ESTATE TAXES 280.36
48. KOUGH'S OIL 242.75
49. PPL 114.79
50. CITIZEN'S BANK 750.00
51. PATRIOT FEDERAL CREDIT UNION 152.32
52. NOTARY -CLOSING .10.00
53. DUNCAN &HARTMAN -CLOSING 250.00
54. DUNCAN 8~ HARTMAN -REIMBURSE CLOSING EXPENSES 60.00
55. CITIZEN'S BANK -MORTGAGE PAYOFF 55,748.71
56. BANK OF AMERICA -PAYOFF CREDIT CARD DEBT 7,691.21
57. CITIBANK -PAYOFF CREDIT CARD DEBT 1,699.97
58. PATRIOT FEDERAL CREDIT UNION -CAR LOAN 14,981.00
SUBTOTAL SCHEDULE I 82,026.11
GRAND TOTAL SCHEDULE I 5 95,138.79
kEV-1513 RJ(+ (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERRANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GARNET R_ CLEVER n n
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. SUSAN E. CLEVER Lineal 0.25
111 WEST MAIN STREET
WALNUT BOTTON, PA 17266
2. BRIAN G. CLEVER Lineal 0.25
15179 16 1/2 MILE ROAD
MARSHALL, MI 49068
3. ERIC L. CLEVER Lineal 0.25
3215 31ST AVENUE, S.E.
PUYALLUP, WA 98374
4. TYLER L. CLEVER C/O HELEN THAKER Lineal 0.25
126 SERGEANT ST, 2ND FLR.
JOHNSON CITY, NY 13790
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II, NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -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)
LAST WILL AND TESTAMENT
I, Garnet R. Clever, of Walnut Bottom, C'~rnberland County, Pennsylvania,
declare this to be my Last Will and revoke any will previously made by me.
I. The expenses of my last illness and funeral shall be paid by my
estate.
II. I give all of my estate of_ every nature and wherever situate to my
spouse, Louise E. Clever.
TII. In the event my spouse does not survive me, I direct that my
children shall divide the residue of my tangible household. personal property
among'~themselves as they shall agree; or in the alternative, should they be
unable to agree on such division, T direct that any item desired by two or
more of my children shall_be chosen by my children by lottery conducted by my
Executor. (Matching sets of property shall be deemed a single item.) The
appraised value of each child's share of personal property taken in kind
shall not be set off against that child's residuary inheritance. For
purposes of this clause, "household personal property" includes automobiles.
If my spouse does not survive n~ and my daughter Susan thereby becomes my
Exec.~ztrix, the lottery provided for in this paragraph shall be conducted by a
person of my childrens' choosing if my daughter is involved in a dispute as
to disposition of personal property. My daughter Susan shall conduct any
lottery as herein provided if she is not one of my children who seeks
ownersYLi.p of the particular property involved. If my children are unable to
resolve any dispute as to personal property pursuant to this paragraph, such
personal property shall be disposed of at public sale as quickly as is
practical. If public sale is required pursuant to this clause, my children
~Ylal?. C~.1V7..C3.e the proceeds thereof equally.
N. In the event my spouse does not survive me, I direct that either
F~rian G. Clever, my son, Eric L. Clever, my son, gusan Clever Rathgeber, my
daughter, or Tyler L. Clever, my son, shall have the option to purchase my
real estate at the appraised value for Pennsylvania Inheritance Tax purposes
The option must be exercised in writing within sixty (60) days after my
Executor has obtained a written appraisal of the real estate from a local
auctioneer or real, estate braker_ of my Executor°s choice. In the event that
two or more optionees wish to purchase my real estate, I direct that my
Executor hold a private auction by sealed bid among them and that my Executor
sell and convey my real estate to the highest bidder among them. The sealed
bids must be as mach or greater than the appraised value of my real estate
for Pennsylvania Inheritance Tax purposes. If none of my optionees purchase
my real estate as set forth in this item, I direct that my real estate be
sold at public or private sale, as my Executor may deem best, as soon after
my death as is convenient. In thE: event tl~~t public ar private sale pursuant
to this paragraph is necessary, the proceeds thereof shall be divided equally
among my surviving children.
V. In the event ~' spouse does not survive me, I direct that any
Executor, Administrator or Trustee hereinafter named shall have the legal
right to bid upon and obtain title to any real property sold through public
or private sale pursuant to the previous paragraph, without the necessity of
having first obtained Court approval to do so.
VI. All administrative costs, including inheritance taxes, estate taxes
and transfer taxes imposed upon my estate passing under ny will or otherwise
shall be paid out of the principal of nay residuary estate.
VII. I appoint as Executrix of this my Last Will Louise E, Clever. In
the event an alternate or successor Executrix be required, I ap~x~int as such
my daughter, Susan Clever Rathgeber. I direct that no t~--ustee, executor,
guardian or other fiduciary named, ncani.nated, or appointed in this Will shall
be required to post any bond or give any security of any type for any pur-
poses whatever.
IN WITNESS WHEREOF, I, Garnet R. Clever, the above named Testator, have
to this, my Last p;i 11 am Tesi:.ament, set IttV hand and seal this '~ day of
Garnet R. Clever
SIGNED, SF~.T~D, PUBLISHED AND DECI~IRED by the above named Testator, as
and for his will, in the presence of us, who at his request, i.n his presence,
and izi the presence of each other, have hereunto subscribed our names as
witnesses in attestation thereof.
~ _ ~:.
~. ~ Address ~ ~3,Z.. e~ . ~ ~ 7 %6
1 ,- ~ ~" ~?~?~_ AddressQe~. ~~,G /.~' ~ ~1~.~~f ~ l v-~ ~ i7~~
Cp~ON~nn'F~ALTH OF P~1NSyLUANIA
, JJ
CONY OF CUMBERLA-ND '
cue, Garnet R. Clever, ~tn~~`o~771 C . ~ ~ ~-~ , and
the Testator and the witnesses respectively,
~~,~'`3 ~' ~~~~ ed to the foregoing instrument, bea_ng first duly sworn, do
whose names are sign
hereby declare to the undersigned authority that the Testator signed an exe-
cuted the instnu~nt as his Last Will ande etrein expressed,~and tha teach of
his free and voluntary act for the purpo of the Testator, signed the Will as
.fie wit-.nesses, ~.n the presence and hearing
witnesses and that to the best oo ft~~a o.`'~~ ~d ~,~re~oaconstraint oraundue
eighteen years of age or older,
influence.
Garnet R. Clever
Witness
Witness
the Testator and
SUbsCYlbed, sworn to and acknowledged before me by
subscribed and sworn to before rr~ by ,~~,~4 I°''` ~,, d ~ ~ f . ~," f~~t~i ~.5~ t~ l ~ ~
witnesses, this Y
1 rte. ~ /? ~ ~~~
Notary ~li~,. y. r....:,..
~',~}-, s ~. ;,plc=~.;?! Iit~_'I"Ai=~~t ~[1~i ;~.
qq~~~s'j~Gs'riN.~.a'~'+i,fa tL;i, ~r ~y1~+.f~~~I~~Y~I~?-+ ~ }'::::.
N+j~l.+rdi'~ell'l~l .":~.7StJ(~.( C~.i-"f~}~r'. i 1 ~~..
..,.•~........w.....=w..-,.._.,....e.___e .).:i,k' ;j, 193
HUD-1
A. SETTLEMENT STATEMENT U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT OMB No. 2502-0265
B. T e of Loan
1. ^FHA 2. ^FmHA 3. ^Conv. Unins. 6. File Number: 7. Loan Number: I' 8. Mortgage Insurance Case Number:
4. ^ VA 5. ®Conv. Ins. RE07-50 12181384 I~
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items
marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes land are not included in the totals.
D. Name and Address of Borrower(s): E. Name and Address of Seller(s):
Susan E. Clever Estate of Garnet R. Clever j
F. Name and Address of Lender:
M&T Bank
1 M&T Plaza, Buffalo, NY 14203
Place of Settlement:
1 Irvine Row, Carlisle, PA 17013
G. Property Location:
111 W. Main Street, Walnut Bottom, PA 17266
South Newton Township, Cumberland County
41-32-2292-034
H. Name of Settlement Agent: ~
Duncan & Hartman, P.C.
I. Settlement Date: Funding Date:
5-11-2007 5-11-2007
109. School taxes 5-11-2007 to 6 30-2007 ~ 168 94I 409 School taxes 5-11-2007 to 6-30-2007 I 168.94
112. `"`~
120. Gross Amount Due From Borrower 99 468.95 420. Gross Amount Due To Seller Q4 348.68
. w :~ ~~
_. .esq.,--~ ~..,T;~x,r;;~', •,;;,K C, G-'+'~ y,i>p +•Y^a,~.x t'~; r v •ca~~ - ' g aai ,..
_... - _-~- -- - ..~'.~',~~~..;.3.~ tr 1'trvn cnbSallpri~~sk `.~;; d, .~.. .
204. Grant from Redevlopment Authority 3,000.00 504. Payoff of first mortgage loan 55,748.71
Citizens Bank #6057198542
205. Mortgage Coupon 100.00 505. Payoff of second mortgage loan
,,.,,. ~ ~ 506. Bank of America ~ I 7,691.21
21
F:.
303. Cash ®- _From ^ To Borrower I 2 368 95 L 603 Cash 1251 To u From sever i ~o,o~~. ~
slBroker's-Commiss
...,,.e e n ui
Paid From Paid From
Borrowers Seller's
Funds at Funds at
Settlement Settlement
704 ~a ~ ~.. ~~ka~'~-'~ wY;~"
Rnn {tPms Pavabfe rn Connection with Loan °"~~` '"~"~" ~'~
T
4.
905
zd By Lender To Be Paid In Adv~
5-11-2007 to 6-1-2007
{rance premium for i
ince premium for 1
_ ~s
1
Ti}Ic
1
osing fee to
1107. Attorney's fees to
Duncan & Hartman, P.C.
~y
250.00
includes above item numbers:
Agent for United General Title
Duncan
~ William A 740.48
1108. Title insurance to ,
.
- Premium $ ~> ,„_ ~, ~,"'~ ~ ~~~" .,.
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1109. Lender's covera e $ 94 000.00 ,~ ~
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1110. Owner's covera a 94 000.00 Premium 740.48 ''
1112. Closin Protection Letter United General Title 35.00
1113. -
- ,, 1 ~~~ ~ ~:
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1201. Recordin fees: Deed 44.50 Mort a e 64.50 Release 0.00 109.00
1202. Cit /count tax/stam s:
1203. State tax/stam s:
4
1205.
i
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1'300,. Additional Settlement Char es
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1302. 2007 Count !fw . R.E. Taxes Beverl Rosenber Tax Collector 286.0E
1303.
1305.
~__.:,... ~ .,..,~ cn~ ce~rc.,~ K~
_ 5 120.27
606.07
1400. Tota{ sememeni t,nar rs G~~«~ ~~~ ~~ ," ~~- ----•_.. _ _.._ _ _-
CERTIFICATION : 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 dist~,ursements made on my account or by me in this transaction. I further certify that I received a copy
of the HUD-1 Settlement Statement.
C~y~ ~ r
f
Signature of Borrower ',Signature of Borrower Signature of Seller Signature of Seller
e HUD-1 Settlement Statement which I have prepared is a true and accurate account of the funds disbursed or to be disbursed by the
undersigned s part of the settlement of th' transaction.
~5' /! D 7
Signatu Settl ent Agent Date
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction
can include a fine and imprisionment. For'",details see: Title 18 U.S. Code Section 1001 and Section 1010.