HomeMy WebLinkAbout07-17-07
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue .'
Bureau of Individual Taxes ,
PO BOX 280601
Harrisbur , PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
Decedent's Last Name Suffix
Decedent's First Name
MI
~
(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
<:::)
3. Remainder Retum (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4. Limited Estate
<:::)
<:::)
<:::) 4a. Future Interest Compromise (date of
death after 12-12-82)
<:::) 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
<:::) 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 Da ime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
XL
8. Total Number of Safe Deposit Boxes
-
<:::)
Correspondent's e-mail address:
ADDRESS 178bCj sc. B7 ill. BoLt R/lJE , /tvE.
SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE '
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 preparer other than the onal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
2--7-07
LA/) Y LlfI<E., rL.. ~Z/ b2-
./ DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
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15056051047
15056051047
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15056052048
REV-1500 EX
Decedent's Name:
;J
Swn T1l
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) c::::> Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c::::> 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, 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
19. TAX DUE. . .. . . ... . .. . . ... .. .. . . . . .. . .. .. ., .. .... .. ... .. . ... .. . . .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OFAN OVERPAYMENT
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L--. 15056052048
Side 2
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Decedent's Social Security Number
15.
16.
17.
18.
c::>
15056052048
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REV-1600 EX Page 3
File Number
Decedent's Complete Address:
DECEDENT'S NAME
STREET ADDRESS
m~y ANt0 9Mlflf
q ErJeK VJRJu~
~/LJrJ SPRI1J
STATE
CITY
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
o
Total Credits ( A + B + C ) (2)
()
3. Interest/Penalty if applicable
D. Interest
E. Penalty
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
o
o
o
o
o
--~~----~- 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 oval on 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. (5)
A. Enter the interest on the tax due.
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;.......................................................................................... 0 ~
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 Ie.
c. retain a reversionary interest; or.......................................................................................................................... 0 ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 18
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 S
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)l.
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)J. 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 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. ~9116(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.
LAST WILL AND TESTAMENT
OF
MARY ANN SMITH
KNOW ALL MEN BY THESE PRESENTS, that I, Mary Ann Smith, 9 Enck Drive,
Boiling Springs, Cumberland County, Pennsylvania, being in good health and of sound
and disposing memory, do hereby make, declare, and publish this as my Last Will and
Testament, hereby revoking all former Wills and Codicils heretofore made by me.
FIRST: I direct that all my just debts and expenses of my last illness and funeral
expenses shall be paid by my Executor, hereinafter named, from my estate as soon after
my decease as shall be found convenient.
SECOND:
(a) I give personal gifts of the item named and to the individual listed on the
Listing of Personal Gifts attached to this Will.
(b) I give, devise, and bequeath all the rest, residue, and remainder of my estate,
whether real, personal or mixed, of any nature whatsoever and wherever situated,
including any lapsed or void legacy, to my husband, Eugene A. Smith, Jr. if he survives
me by ninety (90) days.
(c) If my husband, Eugene A. Smith, Jr., predeceases me or is not living on the
ninety-6rst day after my death, then I give the rest, residue, and remainder of my
property whether real, personal, or mixed, to my two children, Mark Travis Smith, 233
Conway Drive, Lititz, Pennsylvania 17543 and Tricia Bethany Smith, 9 Enck Drive, Boiling
Springs, Pennsylvania; each of the two individuals to receive one-half (1f2) share.
If either of the two devisees listed in paragraph (c) predeceases me, the percentage
share that would otherwise be distributed to that predeceased devisee shall lapse, and the
share that devisee would have taken shall go to the other devisee who survives me.
THIRD: I hereby nominate, constitute, and appoint my husband, Eugene A. Smith,
Jr., as Executor of this my Last Will and Testament. If my Executor fails to serve, or for
any reason fails to continue to serve, I then appoint Mark T. Smith and Tricia B. Smith
to serve as Co-Executors.
FOURTH: I direct that my Executor, or his successor, shall not be required to
furnish any bond or other security for the faithful performance of his duties,
notwithstanding any provisions of law to the contrary.
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FIFTH: My Executor shall have, in addition to the powers and authority conferred
upon him by law, the following additional powers and authority:
I. To gift, sell at public or private sale, exchange, lease, mortgage, or pledge any
property, real or personal, constituting a portion of this estate, at any time, and upon such
terms and conditions as he shall deem wise.
2. To invest any money at any time in such bonds, stocks, notes, real estate,
mortgages, life insurance, annuities, or other securities, or such property, real or personal,
as he shall deem wise, without being limited by any statute or rule of law regarding
investments by the Executor.
3. To retain, without incurring any liability, as investments, any property owned
by me at the time of my death, as long as he deems it wise, and even though such property
is not the kind of property he would purchase as an investment, and even though to retain
such property might violate sound diversification principles.
4. To cause any security or other property which may at any time constitute a
portion of my estate to be issued, held, or registered in his own name, or in the name of
a nominee, or in such form that title will pass by delivery.
s. To consent to the reorganization, consolidation, readjustment of the financial
structure, or sale of the assets of any corporation or other organization, the securities of
which constitute a portion of my estate, and to take any action with reference to such
securities which, in the opinion of my Executor, is necessary to obtain the benefit of any
such reorganization, consolidation, readjustment or sale; to exercise any conversion
privilege or subscription right given to him as the owner of any securities constituting a
portion of my estate; to accept and hold as a portion of my estate securities resulting
from any reorganization, consolidation, readjustment, sale, conversion, or subscription.
6. To pay all costs, taxes, charges and expenses in connection with the
administration of my estate.
7. To determine what is "Income" and what is "Principal" hereunder, and his
decision thereon shall be final; and to purchase securities at a premium or discotmt, and
to apply or charge said premium or discount against income or principal as he may
determine.
8. To gift, transfer, sell, exchange, partition, lease, mortgage, pledge, give options
upon, or otherwise dispose of any property at any time held by him, at public or private
sale, or otherwise.
9. To borrow money from any person, firm or corporation, for the purpose of
protecting and preserving or improving my estate or to execute promissory notes or other
obligations for amounts so borrowed.
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10. To employ legal counsel, accountants, brokers, investment advisors, custodians,
managers, and other agents and employees and to pay them reasonable compensation out
of my estate or out of any fund held hereunder to which said compensation is
attributable.
11. To do all other acts in his judgment necessary or desirable for the proper and
advantageous management, investment, and distribution of my estate.
SIXTH: I direct that all transfer and inheritance taxes, state or federal, assessed
because of my death, whether the funds, property, or insurance proceeds to which such
taxes are attributable pass under this Will or not, shall be paid out of my residuary estate
just as if they were my debts and none of those taxes shall be charged against any
beneficiary; that my Executor pay, or provide for payment of all such taxes at such time
or times, and in such manner as my Executor deems best.
SEVENTH: All questions as to the validity of this, my Last Will, or the
administration of the Will shall be governed by the laws of the Commonwealth of
Pennsylvania.
EIGHTH: If my husband and I shall die simultaneously or under circumstances
which make it difficult to determine which of us died first, I direct that I, Mary Ann
Smith, shall be determined to have predeceased my husband, Eugene A. Smith, Jr., and I
direct further that the provisions of this Will shall be construed upon that assumption
irrespective of any provisions of law establishing a contrary presumption or requiring
survivorship for a fixed period as a condition of taking property by inheritance.
NINTH: Should my husband Eugene A. Smith, Jr., my children Mark T. Smith and
Tricia B. Smith, and the issue of my children all fail to survive me, then I give, devise, and
bequeath all the rest, residue, and remainder of my estate of whatsoever nature and
wheresoever situate to Alberta M. Stockard, 206 Pinewood Drive, Butler, Pennsylvania
16001.
TENTH: Except as otherwise provided in this Will, I have intentionally failed to
provide for any other relatives or other persons, whether claiming to be an heir of mine
or not. Insofar as I have failed to provide in this Will for any of my issue now living or
later born or adopted, such failure is intentional and not occasioned by accident or
mistake.
3
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IN WITNESS WHEREOF, I, Mary Ann Smith, the Testatrix to this, my Last Will and
Testament, typewritten on four (4) sheets of paper which I have identified in the margin
of each page by my signature, hereunto set my hand and seal this 13th day of March,
2002. ~~,~
Mary An mith
The preceding instrument consisting of four (4) typewritten pages, each identified
by the signature of the Testatrix, Mary Ann Smith, was on this day and date signed,
published, and declared by her, the Testatrix therein named, as and for her Last Will, in
the presence of us, who at her request, in her presence, and in the presence of each other
have subscribed our names as witnesses.
7~~~xb
7?~f1..-L L
COMMONWEALTH OF PENNSYLVANIA
)
) SS:
)
COUNTY OF CUMBERLAND
I, Mary Ann Smith, Testatrix, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my Last Will on the 13th day of March, 2002; that
I signed it willingly; and that I signed it as my free and voluntary act for the purposes
therein expressed.
M~~Lft
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or
Sworn or affirmed to and acknowledged before me, by Mary Ann Smith, the Testatrix, this
13th day of March, 2002.
"
1J~,-~: J
Notary Public
.\
COMMONWEALTH OF PENNSYLVANIA )
) SS:
COUNTY OF CUMBERLAND )
Notarial Seal
NIven J. Baird, Notary PublIc
CartI8Ie Boto, Cumberl8nd ColJ'Ity
My CommIsslcin Expires New. 2, 2Ob2
Member. P8nnsy1val1ia ,~ssoeIatIon 01 NotarIe8
We, the witnesses whose names are signed to the attached or foregoing instrument,
being duly qualified according to law, do depose and say that we were present and saw
Mary Ann Smith sign and execute the instrument as a codicil to her Last Will; that she
signed willingly and that she executed it as her free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of Mary Ann Smith signed the
codicil as witnesses; and that, to the best of our knowledge, Mary Ann Smith was at the
time eighteen (18) or more years of age, of sound mind, and under no constraint or undue
influence.
. ~.. ~~C2~ ~ck-
{/ ,
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Sworn or affirmed to and subscribed to before me by the
above-named witnesses, this 13th day of March, 2001.
. ,
(\i-vo~ ~.A
Notary Public
5
. L1tarial Seal
Niven J. Baird, Notary PublIc
CarlIle Boro. Cumberllnd CoIftY
My CommIssion " ""Jlres New. 2, 2OlJ2
Men1ber, Pennsylva: .. :...:!<"tton 01 NotIrIe8
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
rnA~Y fttJ rJ
Sm 1111
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
VALUE AT DATE
DESCRIPTION OF DEATH
KONINKLJ~J{c /tflolJ) tJV. 23,/207 s!IAa5 .II:23B, &:>/
a l!;O,3Z f~ ~I-Iff~&.
2.
PlAlWfJo.l77I/l, FINA?Jc4I9L ;T"/IJ c,. 29 SIII//t.&>
@jl$'~q/ {rt;;/2. ~1f/1~.
f/:Z#11'~'1
TOTAL (Also enteron line 2, Recapitulation) ~2.7 30.()o
I -1
(If more space is needed, insert additional sheets of the same size)
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Prudential ~ Financial
~
(pmputershare
+
-
-
-
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-
IiIiiiI
-
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Computershare Shareholder Services Inc
PO Box 43033
Providence Rhode Island 02940-3033
Telephone: 8003059404
www.computershare.com/prudential
Holder Account Number
C 0001185021
INO
11111111111111111011
27 Noy zOC!l:>
0000097117
Yes
({ecord Date
heck Number
SSNfTIN Certified
00 1 CSO 107 .DOMLNOEOS.PRU.204525 20/0067121OO6712/i
Prudential Financial, Inc. · Combine~yment I~"~
o Corrected (If checked)
Form 1099. DIV. DIVIdends and Distributions 2006
Copy B. For Recipient
Account Number Cooo1185021 i
Relplenr. 10 No. 205-36-6653 :
Pay.I'. FedetallD ,No. 22-31037991
OMS No. " ,.', " ,1545-0110 i
ilepmenc Of flt tllllilly. inllmll ReoIIIg snte,
T1IIIIIImpD1tant IMInfannIlIalIIIIIi II bllng fUIWIIled III .. WImII RWIIIlIt ServIct. . JOIIIIt /llqIIlrlId to m. allIUm, a negllQlllct
""'.., or DlIIer IIIlClfGft lllIf iii.... 011 you If IiII iftCOII1t "...... iIId lhe IRS dillllnIlIlIeI tIiat Ill.. nlll'" replllW.
RecIpItilt. MARY ANN SMITH .
9ENCKDR .
BOILING SPRGS PA:17007.9729
Payer's Details I
:
PRUDENTIAl. FlNANCIAL INC
Cia COMPUTERSHARE
P.O. BOX 43010
PROVIDENCE Rl 02940-3010
Payment Date I
21 Dee 2006
Class Descript
Div dend I Gross I
Rate Dividend ($)
27.55
27.55
Deduction I'
Amount ($) ,
0.00
0.00
Deduction I
Type.
N/A
Net
Dividend ($)
27.55
27.55
Form 1099-DIV
Dividend Confirmation
.
46UTX
PRU
+
02C570004
OOMOMA(1 )
PLEASE CASfi'llEPOSIT THIS CHECK PROMPTtY.
. .
TRANSACTION ACKNOWLEDGEMENT
THE BANK OF NEW YORK AS AGENT FOR
KONINKLIJKE AHOLD N.V.
Company No.
Account No.
Transaction Date:
3499
0000049478
03/02/2007
MARY ANN SMITH
9 ENCK DR
BOILING SPRINGS PA 17007-9729
We confirm completion of your requested transaction as indicated
below.
Transaction Description
REINVESTMENT TRANSFER, DEBIT
Ending Share Balance Held By
The Bank of New York If an
~I... AhoIcI NV (NYSE: AHO)
~~~ ,. 0.22 2.18%
Open: 10.28 High:
,)>~(] r\,(v1 ET .~/15! 2007
Change Symbol
AHO
~
10.31
Low:
10.28
Volume:
21,900
7.58 to 11.02
PIE RatiO:
nla
Yield:
nla S2 \Neck Range:
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3'14.101
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I L. M ',0
98 99 00 01 02 03 04 0!5 Cl6
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4z3~.b!
Frequency
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Compare to Index
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<None> 60
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I.... cMrt I
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COMMONWEALTH OF PENNS) "VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
/J1/tR. y
I+N
~h1ITJ-1
FILE NUMBER
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. ~GiE1JE A-, 9mITI./ J12. 1791:1/ 5E B71l-/ BovRrJiZ. /lvE.) l//()Y /AKt$.) SPOvSE..j IIfII78ltNiJ
fw~/(}1j ~21bZ,
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY ~ %OF DATE OF DEATH
ITEM FOR JOINT MADE ~e name of financial institution and bank account number or similar identifying number. ttach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT for joinUy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 7-3-9b f'I<IWlRfty HomE. Cf EAXK PRIVI) 8o'tl"!Jlf/'f;:~ ~Z5,7b9.()p so 11~90.()
.. w,~ p~
2-. 11~22~0I, SEel>NI)lVAtltTit>>J) Hom# 17M ~E 17l}{ 23B,0<<)1 ()p 60 J I Q,(y)fh1X)
8ovllNE. AvE. IAlJY!A-J{Ej FL. 3,Z/j,Z,
:a . A. ..- 2b~9
/2-J/.fJ!J mEmBUJ Pi (lST CR5/)JrUNJDJ Ji/o7(){,7{CJfj ~ 637.6" tJo.
4. It. b -11-811 CO!l.r>JWTlJwt f/P;6IlIlVflhoJ 'iI ZgZ3Z ~;t1 38.171) f)O J 9.bl>
b". ft 'Z-3/~95 mGm85/ZS rillS, C~iTII"'/(),.J it J070f6 ~/W. 2bJ,'/Z g; J'~tJ.l.J
fo, A. ; /-22-0'/ CJTI ~ FI/Z$T 8IrAlK -1I1()"'{1)If)19o(~/,J8> J,bb 7,40 bO B "3'3-
PHotJE. 3~-7~-~;;- 5:b~l)i) ~() z,g 4L/.
1, ft b-Z~-15 " CD~~ 7/),JE e~()J,f)N ,.,1 JI. z828 ~""""1~ 1 "1
~J p,. "-1.t;~ 7~ ~ Co(J.tJ~Il~TlJ,JE. Ca6IJlrll/IJIf),JIJ.2B~ CYEti(/'5 ) Z?- L/~,(1) 50 'i 2'-1.
TOTALJAlso enter on line 6, Recapitulation) $ 237..)00 ;Z
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70
00
2'
7
(If more space IS needed, msert additional sheets of the same size)
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eUlberland County Recorder of Deeds
Miscellaneous Income
ReceiF.ttt 664167
Instr& 2007-999999 6/18/2007 13:21=48
Relarks: GENE SKITH JR
DEED COpy
Checkl 3438
Total Received.......
$2.00
$2.00
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NO. ela
tEbts ietll
Mael. .1.. 3~ clay of ~I
.... cb"'Mn4 Din. !.unclrel..ud -~18hty-aix (1986)
ill Ihe year
ISerw....
ROBERT W. TART, JR. and DOROTHY E. TART. his wife.
CRANTORS
-AND-
EUCENE A. SMITH. JR. and HARY ANN SMITH. his wHe.
GRANTEES
WiflluICm._rhar in cOlllid.racion of NINETY-SEVEN THOUSAND AND NO/IOO--------
_______________________________________________($97.000.00) ~l~
1ft hanel paid, -th. rec.ipt whereof- i. hneb)' adeaowladaed, the .aid Grantor 5' do
Iwftb)' arant ncl. con..)' to rI" .IId Grlnt.. 5, thclr Heirs ilnd Assi!:ns:
ALL .TIIAT CERTAIN Iract of 1.lnu wllh Ihc ImproVem\'nls thereon crencd.
sllullt-t' in S,,"lh Middleton Township. Cumb~rlllnd County. l'cnnsylvilni.., bounded
ilnd dcscribed as fo11.01ols1
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BEGINNING .It u point on the westcrn side of Enck Drive on the dividing line
bel10leen LoiS Nos. 27 and 28 on the hereinafter mentioned Pl"n of Lots; thence
.by suld dividing line. South 59 degrees 8 minutes 30 seconds West 139.88 feet to
a point; thence North 30 degrees 44 -minUles 50 seconds West 120 [eel to 11
-point ~ thence by -the dividing line between Lots Nos. 26 IInd 27 on said Plan
of Lot". North 5-9 degrees 8 minutes 30 seconds East 139.65 feet to a point on
Ihl! western IIhle of Enek Drive.; thence by the weSlern side of Enck Drive.
South 30 tk!grees 51 minutes 30 soconds East 120 feel to the Plac.e of nEGINNING.
BEING Lot No. 27 of Secli~n tiE" on the PI.m of Lots known as Countryside
Acros, ,)5 recorded in the Office of t.he Recorder of Deeds for Cumberland
County in Plan Book 23-. Page 44.
,
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BEING fmproved with a spltt level dJolelling house with uttdched garage.
Being I<.no1oln .Ind numbored as 9-Enck Drive. Bolling Springs, Pennsylvania-.
UNDER AND SUBJECT nevertheless to easelnents. restrictio~s. reservations,
conditions and rights of way of ~ecor~.
BEING the same premises which R. L. Sheibley and Edith H. Sheibley, his wife.
by Deed dated June 29. 1977 and recorded in Ihe Cumberland County Recorder of
Deeds in Book G 27, Page 632. granted and conveyed unto Robert W. Tart, Jr. and
Dorotby E. Tart. hill wife the Grantors herein.
COMMONWEAlTH Of I'1:NNS'fWANII, :;
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AND the ..id Grantor S Wiu Wanant ..._U, the pllOpert, hereby conveyed.
IN WITNESS WHEREOF, the laic! GrullolS ha ve h--. set their baac! S
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A Notary Public
sppear.d Robert W. Tart, Jr.
A. D. I' 8', ~r. m.
... uacIeniped ..., perlOllal1y
a- eo 1ft.. Coclalilfactoril,
pt'lIv.nl to b. the peraon s _hoN....... s are auIoecriI>ed II> ... within IDa_en., and
aclcno..-Ied,ed that t he y e.ecuted the _. for ehe plIfpClCa dlueia _.iIIed. .... I H t ".
IN WITNESS WHEREOF, I hereunto ....~~_r;;;:.?i~.~:~~..;:.J~:;.~...~\
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COMMONWEALnI OP PENNSYLVANIA l 551
COUNTY OF Cum her Iwtct \
Recordedoathil 3 day.f July ....D.I'~iathe
Recorder'a Olrk. of the .aid County In Deed Book Z Vol..... 3J 'Pa,. Cf5t
. Gi_ under my hond and the ...1 of the ..icI Offic., the d.te....... wr~\~..l: J.;'...,~ .
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McLin & Burnsed
Professional Association
December 30, 2004
fr'
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,>>t:-
G. Michael Mahoney
John D. Metcalf
Fred A. Morrison
Richard P. Newman
Steven M. Roy
Jeffrey P. Skates
Phillip S. Smith
Stephanie J. Willcutt
Matthew D. Black
Mark A. Brionez
R. Dewey Burnsed
Gary Fuchs
Brian Hudson
Stephen W. Johnson
Craig W. Little
Walter S. Mclin, III
ATTORNEYS AT LAW
Mr. and Mrs. Eugene A. Smith, Jr.
9 Enck Drive
Boiling Springs, P A 17007
Re: Bryan Sale to Smith
Our File No. 042110
Dear Mr. and Mrs. Smith:
Enclosed herewith please find the following documents with regard to the above referenced closing:
x Original Recorded Warranty Deed
x Original Owners Policy of Title Insurance
Copy of Closing Statement
Appraisal Report
Copy of Completion Certificate
Survey
Commitment
Copy of Termite Report
Copy of Settlement Statement
Copy of Certificate of Occupancy
Amortization Schedule
These documents should be kept in a place of safekeeping, as they evidence ownership of your home and will
be needed in the future should you choose to sell your home. It has been a pleasure working with you on this
transaction and we hope you enjoy your new home.
If you have any questions please do not hesitate to contact us.
Yours truly, )
~;(.IJ-t
Sandra K. Ward
Post Closing Department
skw/Enclosure
REPLY TO THE VILLAGES:1028 Lake Sumter Landing (32162), Post OffIce Box 1299,The Villages, Florida 32158-1299. 352n53-4690 FAX: 352n51-4993
LEESBURG OFFICE: 1000 West Main Street (34748), P.O. Box 491357, Leesburg, Florida 34749-1357 . 352/787-1241 FAX: 352/326-2608
C0
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Prepared by and return to:
Gary Fuchs/sd
Attorney at Law
McLin & Burnsed PA
1028 Lake Sumter Landing
The Villages, FL 32162
File No.: 042110
DAVID R. ElLSPERMANN. CLERK OF COURT MARION C~
DATE: 1113012OO4 10:44:47 AM
FILE #: 2004173186 OR BK 03881 PG 0406
.
RECOR('Il~ ~ r,:; '"'0
DEED DOC TAX 1 ,666,00 f?
[Space Above This Line For Recording Data]
Warranty Deed
This Warranty Deed made this 22nd day of November, 2004 between Judson H. Bryan, Jr. and Ellen T. Bryan,
husband and wife, whose post office address is 852 Castleberry Circle, The Villages, FL 32162, grantor, and
Eugene A. Smith, Jr. and Mary Ann Smith, husband and wife, whose post office address is 9 Enck Drive,
Boiling Springs, PA 17007 grantee:
(Whenever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives, and
assigns of individuals, and the successors and assigns of corporations, trusts and trustees)
WITNESSETH, that said grantor, for and in consideration of the sum of TEN AND NO/100 DOLLARS ($10.00)
and other good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is
hereby acknowledged, has granted, bargained, and sold to the said grantee, and grantee's heirs and assigns
forever, the following described land, situate, lying and being in Marion County Florida to-wit:
PARCEL 10 #: R6744-331-000
Lot 331, Villages of Marion Unit No. 44, according to the plat thereof recorded in Plat
Book 6, Page 108 through 110, Public Records of Marion County, Florida.
TOGETHER with all the tenements, hereditaments and appurtenances thereto belonging or in anywise
appertaining.
TO HAVE AND TO HOLD, the same in fee simple forever.
AND the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple;
that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully
warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and
that said land is free of all encumbrances, except easements, restrictions and reservations of record, if any, and
taxes accruing subsequent to December 31, 2003.
IN WITNESS WHEREOF, grantor has hereunto set grantor's hand and seal the day and year first above written.
Signed, sealed and delivered in our presence:
r
Attorneys' Title Insurance Fund, Inc.
OWNER'S POLICY
Schedule A
Policy No.:
OPM-2650176
Effective Date:
November 30, 2004 @ 10:44 AM
Agent's File Reference:
042110
Amount ofInsurance: $238,000.00
1. Name ofInsured: Eugene A. Smith, Jr. and Mary Ann Smith
2. The estate or interest in the land described herein and which is covered by this policy is a fee simple (if other, specify
same) and is at the effective date hereof vested in the named insured as shown by instrument recorded in Official
Records Book 3881, Page 406, of the Public Records of Marion County, Florida.
3. The land referred to in this policy is described as follows:
Lot 331, Villages of Marion Unit No. 44, according to the plat thereofrecorded in Plat Book 6, Page 108
through 110, Public Records of Marion County, Florida.
Agent No.: 2647
Issuing Agent:
A nt's Si~ature
ary Fuchs/sd
ttorney at Law
McLin & Burnsed P A
1028 Lake Sumter Landing
The Villages, FL 32162
Form OPM-SCH. A
(rev. //98)
DoubleTime@
..
Attorneys' Title Insurance Fund, Inc.
OWNER'S POLICY
Schedule B
Policy No.:
OPM-2650176
Agent's File Reference:
042110
This policy does not insure against loss or damage by reason of the following exceptions:
1. Taxes for the year of the effective date of this policy and taxes or special assessments which are not shown as existing
liens by the public records.
2. Easements and other matters appearing on the plat of the Villages of Marion Unit No. 44, as recorded in Plat Book 6,
Pages 108 and 110, Public Records of Marion County, Florida.
3. Restrictions, covenants, easements and assessments contained in instrument recorded in Official Records Book 3093,
Page 1882, Public Records of Marion County, Florida.
4. Declaration of Consent to Jurisdiction of Community Development District No. 4 and to Imposition of Special
Assessments, recorded in O. R. Book 2805, Page 659 and O.R. Book 3095, Page 1216, Public Records of Marion
County, Florida and Special Assessments for Permanent Debt Service and Maintenance levied by the Village
Community Development District No.4, which are not yet due and payable.
5. Declaration of Private Roads as recorded in Official Records Book 3093, Page 1878, Public Records of Marion
County, Florida.
6. Drainage Release as recorded in Official Records Book 3093, Page 1880, Public Records of Marion County, Florida.
7. Covenant as recorded in Official Records Book 3093, Page 1876, Public Records of Marion County, Florida.
8. Assignment of Easements recorded in O. R. Book 3614, Page 1219, Public Records of Marion County, Florida.
9. Mortgage in the sum of $190,400.00 from Eugene A. Smith, Jr. and Mary Ann Smith, husband and wife to Citizens
First Wholesale Mortgage Company dated 11/22/2004 and recorded 11/30/2004 in Official Records Book 3881, Page
407, of the Public Records of Marion County, Florida.
Form OPM-SCH. B
(rev. 5/94)
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EXCLUSIONS FROM COVERAGE
The foliowing matters are expressly excluded from the coverage of this policy and The Fund will not pay loss or damage, costs, attorneys'
..fees or expenses which arise by reason of:
1. (a) .Any law, ordinance or governmental regulation (including but not limited to building and zoning laws, ordinances, or regulatio~ls)
restricting, regulating, prohibiting or relating to (i) the occupancy, use, or enjoyment of the land; (ii) the character, dimensions or location
of any improvement now or hereafter erected on the land; (Hi) a separation in ownership or a change in the dimensions or area of the land
or any parcel of which the land is or was a part; or (iv) environmental protection, or the effect of any violation of these laws, ordinance~ or
governmental regulations, except to the extent that a notice of the enforcement thereof or a notice of a defect, lien or encumbrance resulting
from a violation or alleged violation affecting the land has been recorded in the public records at Date of Policy. .
(b) Any governmental police power not excluded by (a) above, except to the extent that a notice of the exercise thereof or a notice ofa
defect, lien or encumbrance resulting from a violation or alleged violation affecting the land has been recorded in the public records at Date
of Policy.
2. Rights of eminent domain unless notice of the exercise thereof has been recorded in the public records at Date of Policy, but not excl~lding
from coverage any taking which has occurred prior to Date of Policy which would be binding on the rights of a purchaser for value Without
knowledge.
3. Defects, liens, encumbrances, adverse claims or other matters:
(a) created, suffered, assumed or agreed to by the insured claimant; . .
(b) not known to The Fund, not recorded in the public records at Date of Policy. but known to the insured claimant and not disclosed m
writing to The Fund by the insured claimant prior to the date the insured claimant became an insured under this policy;
(c) resulting in no loss or damage to the insured claimant;
(d) attaching or created subsequent to Date of Policy; or
(e) resulting in loss or damage which would not have been sustained if the insured claimant had paid value for the estate or interest insured
by this policy.
4. Any claim, which arises out of the transaction vesting in the insured the estate or interest insured by this policy, by reason of the operation
offederal bankruptcy, state insolvency, or similar creditors' rights laws, that is based on:
(a) the transaction creating the estate or interest insured by this policy being deemed a fraudulent conveyance or fraudulent transfer; or
(b) the transaction creating the estate or interest insured by this policy being deemed a preferential transfer except where the preferential
transfer results from the failure:
(i) to timely record the instrument of transfer; or
(ii) of such recordation to impart notice to a purchaser for value or ajudgrnent or lien creditor.
CONDmONS AND STIPULATIONS
1. Defmition of Tenns
The following terms when used in this policy mean:
(a) "insured": the insured named in Schedule A, and, subject to any
rights or defenses The Fund would have had against the named insured,
those who succeed to the interest of the named insured by operation of
law as distinguished from purchase including, but not limited to, heirs,
distributees, devisees, survivors, personal representatives, next of kin,
or corporate or fiduciary successors
(b) "insured claimant": an insured claiming loss or damage.
(c) "knowledge" or "knoWn": actual knowledge, not constructive
knowledge or notice which may be imputed to an insured by reason of
the public records as defined in this policy or any other records which
impart constructive notice of matters affecting the land.
(d) "land": the land described or referred to in Schedule A, and
improvements affixed thereto which by law constitute real property
The term "land" does not include any property beyond the lines of the
area described or referred to in Schedule A, or any right, title, interest,
estate or: easement in abutting streets, roads, avenues, alleys, lanes, ways
or watel'Wa~ but nothing herein shall modifY or limit the extent to
.to~rl"OQ,1, ~~."i~ by this policy.
from the insured of either (i) all estate or interest in the land, or (ii) all
indebtedness secured by a purchase money mortgage given to the
insured.
3. Notice of Claim To Be Gmm by InsurecI Claimant
The insured shall notify The Fund promptly in writing (i) in case of any
litigation as set forth in Section 4(a) below, (ii) in case knowledge shall
corne to an insured hereunder of any claim of title or interest which is
adverse to the title to the estate or interest, as insured, and which might
cause loss or damage for which The Fund may be liable by virtue of this
policy, or (iii) if title to the estate or interest, as insured, is rejected as
unmarketable. If prompt notice shall not be given to The Fund, then as
to the insured all liability of The Fund shall terminate with regard to the
matter or matters for which prompt notice is required; provided,
however, that failure to notify The Fund shall in no case prejudice the
rights of any insured under this policy unless The Fund shall be
prejudiced by the failure and then only to the extent of the prejudice.
4. Defense and Prosecution of Actions; Duty of Insured Claimant
To Cooperate
(a) Upon written request by the insured and subject to the options
co~ltained in Section 6 of these Conditions and Stipulations, The Fund,
at I" ~. cOlItancl without J.lIlreasonable delay, shall provide for the
oE.~..~. i.n Uti i.nwbidl any. thi~ party asserts a
,,~
........... ......"".........-0..... -- --- c ~ -,
in favor o~ an insu~ed on;:.' so Jong ?5 "J~e ?D51J.red, ret?Jns il,p esr-Ate or
inter~st in the land. or holds ,en indebtedness stxur,~d by ,t purchase
lTI00ey mortgage given by a purchaser from the insured, or only so long
as the insUl'ed shall have liability by reason of covenants of warranty
ma(!.e 'by the insured in any tra~sfer or conveyance of the estate 0;'
interest. This policy shall not continue in force in favor of am'purchaser
Fund may pursue any litigation to final determination by a court of
competent jurisdiction and expressly reserves the right, in its sole
discretion, to appeal from any adverse judgment or order.
(d) In all cases where this policy permits or requires The Fund to
prosecute or provide for the defense of any action or proceeding. the
insured shall secure to The Fund the right to so prosecute or provide
defense in the action or proceeding, and all appeals therein. and
permit The Fund to use, at its option, the name of the insured for this
purpose. Whenever requested by The Fund, the insured, at The Fund's
expense, shall give The Fund all reasonable aid (i) in any action or
proceeding, securing evidence, obtaining witnesses, prosecuting or
defending the action or proceeding, or effecting settlement, and (ii)
in any other lawful act which in the opinion of The Fund may be
necessary or desirable to establish the title to the estate or interest as
insured. If The Fund is prejudiced by the failure of the insured to
furnish the required cooperation, The Fund's obligations to the
insured under the policy shall terminate, including any liability or
obligation to defend. prosecute, or continue any litigation, with regard
to the matter or matters requiring such cooperation.
5. Proof of Loss or Damage
In addition to and after the notices required under Section 3 of these
Conditions and Stipulations have been provided The Fund, a proof of
loss or damage signed and sworn to by the insured claimant shall be
furnished to The Fund within 90 days after the insured claimant shall
ascertain the facts giving rise to the loss or damage. The proof of loss
or damage shall describe the defect in, or lien or encumbrance on the
title, or other matter insured against by this policy which constitutes the
basis ofloss or damage and shall state, to the extent possible, the basis
of calculating the amount of the loss or damage. If The Fund is
prejudiced by the failure of the insured claimant to provide the
required proof of loss or damage, The Fund's obligations to the
insured under the policy shall terminate, including any liability or
obligation to defend. prosecute, or continue any litigation, with regard
to the matter or matters requiring such proof of loss or damage.
In addition, the insured claimant may reasonably be required to submit
to examination under oath by any authorized representative of The
Fund and shall produce for examination, inspection and copying, at
such reasonable times and places as may be designated by any autho-
rized representative of The Fund, all records, books, ledgers, checks,
correspondence and memoranda, whether bearing a date before or
after Date of policy, which reasonably pertain to the loss or damage.
Further, ifrequested by any authorized representative of The Fund, the
insured claimant shall grant its permission, in writing, for any autho-
rized representative of The Fund to examine, inspect and copy all
records, books, ledgers, checks, correspondence and memoranda in
the custody or control of a third party, which reasonably pertain to the
loss or damage. All information designated as confidential by the
insured claimant provided to The Fund pursuant to this Section shall
not be disclosed to others unless, in the reasonable judgment of The
Fund, it is necessary in the administration of the claim. Failure of the
insured claimant to submit for examination under oath, produce other
reasonably requested information or grant permission to secure rea-
sonably necessary information from third parties as required in this
paragraph shall terminate any liability of The Fund under this policy as
to that claim.
6. Options To Payor Otherwise Settle Claims; Tennination of
Liability
In case of a claim under this policy, The Fund shall have the
following additional options:
(a) To Payor Tender Payment of the Amount of Insurance.
To payor tender payment of the amount of insurance under this policy
together with any costs, attorneys' fees and expenses incurred by the
insured claimant. which were authorized by The Fund, up to the time
of payment or tender of payment and which The Fund is obligated to
pay.
Upon the exercise by The Fund of this option, all liability and obliga.
tions to the insured under this policy, other than to make the payment
required, shall terminate, including any liability or obligation to
" - __~.1,:4-:....~":~""" ...~~ "h~ n,.."flrv lii.h~t1 hp
t~);.s wh,:~.h~~ 0~ Dot i.t shalJ be liable hereunaer. ana s au no
thereby concede liability or waive any provision of this policy. If The
Fund shall exercise its rights under this paragraph, it shall do so
diligently.
(c) Whenever The Fund shall have brought an action or interposed
a defense as required or permitted by the provisions of this policy, The
by the insured claimant which were authorized by The Fund up to the
time of payment and which T~e Fund is obligated to pay; or
(Ii) to payor otherwise settle with the insured claimant the loss
or damage provided for under this policy, together with any costs,
attorneys' fees and expenses incurred by the insured claimant which
were authorized by The Fund up to the time of pay men I and which The
Fund is obligated to pay.
Upon the exercise by The Fund of either of the options provided for in
paragraphs (b) (i) or (ii), The Fund's obligations to the insured under
this policy for the claimed loss or damage, other than the payments
required to be made. shall terminate, including any liability or obliga-
tion to defend, prosecute or continue any litigation.
7. Detennination, Extent of Liability and Coinsurance
This policy is a contract of indemnity against actual monetary loss or
damage sustained or incurred by the insured claimant who has suffered
loss or damage by reason of matters insured against by this policy and
only to the extent herein described.
(a) The liability of The Fund under this policy shall not exceed the
least of:
(i) the Amount ofInsurance stated in Schedule A; or,
(ii) the difference between the value of the insured estate or
interest as insured and the value ofthe insured estate or interest subject
to the defect, lien or encumbrance insured against by this policy.
(6) (Thisparagraph dealingwith Coinsurance was nmwvedfromRmida
policies.)
(c) The Fund will pay only those costs, attorneys' fees and expenses
incurred in accordance with Section 4 of these Conditions and Stipu-
lations
8. Apportionment
If the land described in Schedule A consists of two or more parcels
which are not used as a single site, and a loss is established affecting one
or more of the parcels but not all, the loss shall be com puted and settled
on a pro rata basis as if the amount of insurance under this policy was
divided pro rata as to the value on Date of Policy of each separate parcel
to the whole, exclusive of any improvements made subsequent to Date
of Policy, unless a liability or value has otherwise been agreed upon as
to each parcel by The Fund and the insured at the time of the issuance
of this policy and shown by an express statement or by an endorsement
attached to this policy.
9. Limitation of Liability
(a) If The Fund establishes the title, or removes the alleged defect,
lien or encumbrance, or cures the lack of a right of access to or from the
land, or cures the claim of unmarketability of title, all as insured, in a
reasonably diligent manner by any method, including litigation and
the completion of any appeals therefrom, it shall have fully performed
its obligations with respect to that matter and shall not be liable for any
loss or damage caused thereby.
(b) In the event of any litigation, including litigation by The Fund
or with The Fund's consent, The Fund shall have no liability for loss or
damage until there has been a final determination by a court of
competent jurisdiction, and disposition of all appeals therefrom, ad-
verse to the title as insured.
(c) The Fund shall not be liable for loss or damage to any insured
for liability voluntarily assumed by the insured in settling any claim or
suit without the prior written consent of The Fund.
10. Reduction of Insurance; Reduction or Tennination of Liability
All payments under this policy, except payments made for costs,
attorneys' fees and expenses, shall reduce the amount of the insurance
pro tanto.
11. Liability Noncumulative
It is expressly understood that the amount of insurance under this
policy shall be reduced by any amount The Fund may pay under any
policy insuring a mortgage to which exception is taken in Schedule B
or to which the insured has agreed, assumed, or taken subject, or which
is hereafter executed by an insured and which is a charge or lien on the
estate or interest described or referred to in Schedule A. and the
~mount so paid shall be deemed a payment under this policy to tht'
Insured owner.
12. Pavment of Loss
..
(American Land Title Association Owner's Policy - 10-17-92) (With Florida Modifications)
OWNER'S TITLE INSURANCE POLICY
Attorneys' Title Insurance Fund, Inc.
ORLANDO, FLORIDA
SUBJECT TO THE EXCLUSIONS FROM COVERAGE, THE EXCEPTIONS FROM
COVERAGE CONTAINED IN SCHEDULE BAND THE CONDITIONS AND STIPU-
lATIONS, ATTORNEYS' TITLE INSURANCE FUND, INC., a Florida corporation,
herein called The Fund, insures, as of Date of Policy shown in Schedule A, against loss
or damage, not exceeding the Amount oflnsurance stated in Schedule A, sustained
or incurred by the insured by reason of:
1. Tide to the estate or interest described in Schedule A being vested other
than as stated therein;
2. Any defect in or lien or encumbrance on the tide;
3. U nmarketability of the tide;
4. Lack of a right of access to and from the land.
The Fund will also pay the costs, attorneys' fees and expenses incurred in defense of
the tide, as insured, but only to the extent provided in the Conditions and Stipula-
tions.
In Witness Whereof, ATTORNEYS' TITLE INSURANCE FUND, INC. has caused this
policy to be signed and sealed as of Date of Policy shown in Schedule A, the policy to
become valid when countersigned by an authorized signatory.
e~......~
~"""':...a.. ..... \
/ or- --.~.... .\
i {, SE"'AL .~i
~... ....,11
"'~~7
Attorneys' TItle Insurance Fund, Inc.
By
~~
Charles J. Kovaleski
President
SERIAL
OPM-
2650176
FUND FORM OPM (rev. 3/98)
Statement of Accounts
Send Inquires to:
5000 Louise Drive
PO Box 40
Mechanlcsburg, PA 17055
www.memberslst.org
:f. Sep 25, 2006 thru Oct 24 J 2006
Main Switchboard: (717) 697-1161 or (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TOO: (717) 697-5312 or (800) 283-2328 eX!. 5312
TeleBranch: (717) 795-6049 or (800) 237 -7288
Account Number:
107065
MEMBERS 1st
FEDERAL CREDIT UNION
1022 1 AV 0.293 2043-1022
111.111'111111"11...1...11.1,,1,,.1111.11,11111"11,1,,1.1..1
MARY ANN SMITH
c/o EUGENE A SMITH JR
9 ENCK DR
BOILING SPRINGS PA 17007-9729
Account Balances at a Glance:
Checking: 1,469.74
Savings: 260.92
Certificates: 0 . 00
Loans: 0.00
Money Management: 0 . 00
..
-
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----
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=====
......iiiiiiiiiiii
=
0-
.. !!B!!!!!!!!!
Page: 1 of 2
Your current Member Loyalty Reward level is Silver
Did you know that you can receive BONUS certificate rates and REDUCED consumer
loan rates through our Member Loyalty Rewards program? Read the enclosed
insert for more details.
CHECKING ACCOUNTS
11 - CHECKING
Date
~:
Sep 27
Sep 27
Sep 28
Sep 29
Sep 30
Sep 30
Sep 30
Oct 01
Oct 03
Oct 09
Oct 11
Oct 13
Oct 13
Oct 16
c 18
Oct 18
Oct 20
Transaction DescriDtion Additions
J::~~GENE~ SMITH JR ~
{.;nec~racer ~1424
Withdrawal Debit Card
09/26 674732711200041 GIANT FOOD STORES #112 CAR
Withdrawal Debit Card
09/26 674732711200007 GIANT FOOD STORES #112 CAR
Withdrawal POS #668545
POS KARNS QUALITY 413 FORGE RD. BOILING SPRIN PA
Withdrawal POS #510619
POS ANDREWS AND PA 4518 UNION DEPOSIT HARRISBURG PA
Withdrawal POS #025806
POS GI.ANT FOOD STO 255 S SPRING GARDE CARLISLE PA
Withdrawal POS #078365
POS WAL-MART ff2574 60 NOBLE BLVD CARLISLE PA
Deposit Swipe 5 Rebate 0.45
Withdrawal Debit Card
09/30 674732711200041 GIANT FOOD STORES #112 CAR
Withdrawal POS #669314
pas LOWE' S 850 EAST HIGH STRE CARLlSE PA
Withdrawal pas #415740
POS KARNS QUALITY 413 FORGE RD. BOILING SPRIN PA
Withdrawal
Withdrawal POS ff270385
POS GIANT FOOD STO 130 OLD YORK RD NEW CUMBERLA PA
Withdrawal pas #173845
POS KARNS QUALITY 413 FORGE RD. BOILING SPRIN PA
rawal Debit Card
10/16 749499000067819 TWX*AOL SERVICE 1006 800-8
Depos' rans er From are 1,065.00
Withdrawal pas #222234
POS RUITER'S FARM 899 N US RT 15 DILLSBURG PA
Withdrawal pas #880787
- - - Continued on following page - - -
Subtractions Balance
1 , 145.88
331.57 - 814.31
5.00- 809.31
8.72- BOO.59
34.72- 765.87
20.00- 745.87
10.09- 735.78
38.26- 697.52
697.97
21.13- 676.84
18.89- 657 . 95
20.29- 637.66
100.00- 537.66 -
16.67- 520.99
30.98- 490.01
17.95- 472.06
1.537.06
17.91- 1,519.15
9.41- 1.509.74
.
'I\t l~t
~~~~~I~J:
Date
Oct 23
Oct 24
..
-
-
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---
-
N iiiiliiiiii
-
0\ "==
=
'"':iiiiiiiiiiiii
=
0-
~
..-
-
Send'lnquires IQ:
5000 Louise Drive
PO Box 40
Mechanlcsburg, PA 17055
www.members1st.org
Main Switchboard: (717) 697-1161 or (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TOO: (717) 697-5312 or (800) 283-232B ex\. 5312
TeleBranch: (717) 795-6049 or (800) 237-7288
2044-1022
Transaction Description Additions
pas SAMSCLUB #8175 6781 GRAYSON RD HARRISBURG PA
Check 003712 Tracer 1023020909
Ending Balance
Cour/esv Pav and NSF Fee Summary
Courtesy Pay Fees Year-to-Date
CHECK SUMMARY
Check # Amount Date
003710 331.57 Sep 25
.. Asterisk next 10 number indicates skip in number sequence
2 Checks Cleared for 371.57
Check #
003712*
Sep 25, 2006 thru Oct 24. 2006
Account Number: 107065
Page: 2 of 2
Subtractions
40.00-
~~.
Amount
40.00
Balance
1,469.74
1,469.74
Date
Oct 23
SAVINGS ACCOUNTS
00 - REGULAR SAVINGS
Date
Sep 25
Oct 02
Oct 18
Oct 18
Oct 24
Transaction Description
Additions
oint Owner: EUGENE A SMITH JR
pOSit A N BANK NA.
TYPE: PENS PMTS ID: 1251904625
Deposit ACH sac SEC
10: 3031036030
Withdrawal Transfer To Share 11
Ending Balance
235.92
1,065.00
Subtractions
1,065.00-
Balance
6-~\O
1,325.92
260.92
260.92
YTD SUMMARIES
TOTAL DIVIDENDS PAID
00 REGULAR SAVINGS
11 CHECKING
0.00
0.00
Total Year To Date Dividends Paid
NOTE: Total includes closed shares
0.00
Don't forget about our new Member Loyalty Rewards Program.
The more products you have with us, the more benefits you'lr receive.
Ask an associate for details or visit our website at www.members1st.org for details.
~ ~5?~~~~9~~
~ MfJmber founMd- SBnnce based.
..,. P.O. BOX 1181
CARUSLE, PA 17015
717-249-1661
STATEMENT OF ACCOUNT
NOTICE
SEE ENCLOSED FORM FOR IMPORTANT
INFORMATION REGARDING YOUR RIGHTS TO
DISPUTE BILLING ERRORS.
NOTICE
SEE ENCLOSED FORM FOR IMPORTANT
INFORMATiON IN CASE OF ERRORS OR
QUESTIONS ABOUT YOUR ELECTRONIC
TRANSFERS IDENTIFIED WITH LETTERS "EFT"
oJR
PA 17007
MEMBER
NUMBER
STATEMENT
DATE
28232
10 01 2006 - 12 31 2006
OWNERSHIP OF SHARE. DEPOSIT AND CERTIFICATE ACCOUNTS SHOWN ON THIS STATEMENT is NOT TRANSFERABLE EXCEPT ON THE BOOKS OF THE CREDIT UNION.
Transaction Date
Transaction Description
Transaction
Amount
Principal Payments
New Loans
and Credits
FINANCE
CHARGE
BALANCE
10-01
09-30e
SHARE Ol..REGULAR SHARE ACCOUNT
Previous Balance .
DIVIDEND
Annual Percentage Yield earned from
on an average daily balance of $
EN
CCO
CLOSE 28232-01 TRANSFER TO 2828-01
New e ..___.n..-.-.....---
Year-to-Date Dividends this account
.10
07/01/2006 -
38.11 was
.02
-38.23
09/30/2006
1.05\
38.11
38.21
12 31
38.23
.00
.00
.40
Total Dividends Earned This Year $ .40
Total Finance Charges Paid This Year $ .00
Choose the Overdraft Protection method that is right for you:
1. Redi-Cash Line-of-Credit
2. Share Accounts: savings, special savings, Christmas, and Money Market account
Overdraft Protection is a FREE service offered by your credit union. This
service provides for the automatic transfer of funds from other depOSit accounts
or from a pre-approved line-of-credit. It's purpose is to cover checks and pre-
authorized debits that are presented against an insufficient account balance.
Federal regulations limit the number of times you can take advantage of this
service unless you use the Redi-Cash line-of-credit option.
Get pre-approved today for your line-of-credit and have the funds available if
and when you need them. It can help make your life stress free!
Give us a call today to receive your pre-approval. Loan Policy guidelines apply.
CITIZENS
< FIRST BANK
903 Avenida Central
The Villages, FL 32159
(352) 753-9515
111.111...111...11"1"1111.'..1"1"",",'"",,,',',,','..,
EUGENE A SMITH OR
MARY ANN SMITH
9 ENCK DR
BOILING SPRINGS PA 17007-9729
')
STATEMENT DAT
09/13/06
11
1040010280
ACCOUNT NO.
t"\.i
.I.
CYCLE - 0 13
CITIZENS FIRST BANK TOLL FREE TELEPHONE NUMBER
1 800 707 1893
*** CP-ECKING *** FIRST EXPRESS CKING
ACCOUNT tnJMBER 1040010280
r'J<t;'./.l00~. S'irll'ElviEliiT BliLi'.liiCE AS uF 08/13/,ici .......................
PLUS 0 DEPOSITS AND OTHER CREDITS.....................
LESS 3 CHECKS AND OTHER DEBITS........................
CURRENT STATEMENT BALANCE AS OF 09/13/06 ........................
WUMBER OF DAYS IN THIS STATEMENT PERIOD 31
.. ",........ ...,"
.. I..J-'. Ju
.00
127.96
1. 667 . 40
-------------------------------------------------------.----------------------------
*** CHECK TRANSACTIONS ***
SERIAL DATE AMOUNT
3027* 08/14 45.00
SERIAL
DATE
AMOUNT
-----.------------------------------------------------------------------------------
(
*** CHECKING ACCOUNT TRANSACTIONS ***
DATE DESCRIPTION
08/16 THE LEGACY COUNTRY C THE VILLA
GES FL 08/14/06 20:22:25
08/21 17400 SE 86TH BELLE THE VILLAG
ES FL 08/19/06 08:52:57
DEBITS
22.96
CREDITS
60.00
-----.-------------------------------------------------------------------------------
*** BALANCE BY DATE ***
08/13 1.795.36 08/14
1.750.36 08/16
1.727.40 08/21
1.667.40
THIS STATEMENT OVERDRAFT CHARGES.. . .. .. .
THIS STATEMENT RETURNED ITEM CHARGES....
YEAR TO DATE OVERDRAFT CHARGES.. . . . . . . . .
YEAR TO DATE RETURNED ITEM CHPRGES......
.00
.00
.00
.00
EFFECTIVE NOVEMBER 1. 2006. ALL INTERNJI.TIONAL DEBIT
(,ARD TRANSACTIONS WIT"L EF SUBJPCT TO .... CH1l.PGE OF
UP TO A ONE PERCENT FEE.
NOTE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION
I
I
-'
~,"_.'"'' -"
. -_.,,~--
CORNERSTONE FEDERAL ~-~
-_.-'~-_..~._---..~ ~
OX 1181
CARLISLE PA 17015
(.717) 249-1661
.._-~
IZ-Member Inquiry
~-::--'--~.__._--_.,._.._._,._. ---.
Uiember: 2828 - EUGENE A SMITH J!S/)
SSN: 202-34-7626
Date Range: 09/18/2006 - 10/18/2006
Share Record: 07 - SHARE DRAFT ACCOUNT =C;AI~/~~
Date Printed:
Transaction History
Tran Post Transaction Chk Post Trace Ending
No. Date Description No. Srce Amount Number Fee Balance
112 09/20/06 DRAFT CLEARED 3229 v 20 -45.00 0013034659 .00 2471.47
113 09/21/06 DRAFT CLEARED 3232 ( 20 -100.00 0011054196 .00 2371.47
114 09/22/06 DEPOSIT 80 1571.42 .00 3942.89
EMBARQ-REG SALARY
115 09/22/06 TRANSFER OUT 81 -594.19 .00 3348.70
116 09/22/06 DRAFT CLEARED 3231, 20 -1541. 99 0011058194 .00 1806.71
117 09/29/06 DRAFT CLEARED 3233,- 20 -305.30 0011032170 .00 1501.41
118 10/01/06 DIVIDEND 30 2.92 .00 1504.33
Eff 09/30/06 /
119 10/02/06 WITHDRAWAL 82 -128.00/ .00 1376.33
FIRSTENERGY OPCO-ACH
120 10/06/06 DEPOSIT 80 1571. 42 .00 2947.75
EMBARQ-REG SALARY
121 TRANSFER OUT 81 -594.19 .00 2353.56
122 DRAFT CLEARED 323 6"""'-' 2 0 -45.00 0013032214 .00 2308.56
123 ATM WITHDRAWAL 70 -60.00/ .00 (?248. 56 j
Eff 5 EAST GATE DRIVE CARLISIJE PA --
124 DRAFT CLEARED 3235/20 -45.00 0013016085 .00 2203.56
125 DRAFT CLEARED 3234/20 -300.00 0013046197 .00 1903.56
126 DRAFT CLEARED 323711"" 20 -159.00 0013008664 .00 1744.56
127 DRAFT CLEARED 3238v 20 -560.00 0011103251 .00 1184.56
End
REV-1511 EX+ (12-99) .
, . '*'
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
mfJrav
ftN~
FILE NUMBER
ITEM
NUMBER
A,
5 ;'J'JlII-/
Debts of decedent must be reported on Schedule I.
DESCRIPTION
1,
FUNERAL EXPENSES:
GI/JJl\Jj Bf!tJTJlUS Ft);J~ J./omE CARU~tC. flf.
Ftow~/l5
RfJT mlPlPrl'PtE- (leaPT/oJ ~DryJ ((oaf) J f/~sflJllU.. ()B"(~
]"
3"
B, ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
2. Attorney Fees
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
6,
5, Accountant's Fees
7,
Tax Return Preparer's Fees
H~R. BlI>t-t( ~iJC .
AMOUNT
5699. Of)
)
ISq" OG>
633,22
L./ 1"3.0"
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
6~qo9"o()
./
REV-1512 EX+ (12-03)
4>0
ESTATE OF
.. .
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(fJIIR-Y trtJJ ~mlTII
FILE NUMBER
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.
CfPJTAL ONE }11Asn~CN.IJ /JCCi: S2q/ L/q23 96/b9()L/3
III oZB.OO
J
26.,ot)
IB5, zf37,a?
2...
(Xl... HIt~TUitL IZ-fli ,"0, CAIlU'tE,flJ. /7013
3,
CITIZ6I\JS Flltf" I)JI4/JUiGlI't/E. mp~TAffe
5190 'F16U) Cl<li-~T O/<It.J!Z ;Hi- IIlt/A9Ii:S/::'/...32162
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1 q 5', 3L.Jo .00
"
~ <<;"ap.ra'Une>>
..
..
mltflY /tIJ rJ ~wllll1 AUG 28 . SEP 27. 2l)iJ6
PiI.I{C I of 2
PLATINUM MASTERCARD ACCOUNT
529H923-tl8169043
..
..
'"
; .\CCOlll1t SlIlllmary
..
'"
...
Paymcnts, Credits lIml Adjustmcnts
1 28 AlIG PAYMENT RECEIVED THANK YOll
2 20 SEP PAThIENT RECEIVED - THANK YOU
Prcvious B,danre
~ Pa}'lnents. Credits an(f l\dJustnu'nts
\S Transac:tions
Finance Charges
510,625.01
5665.00
524.95
143.49
$]15.00
.150.0\)-
Tmnsaction!l
31 AUG PPL'BEACHBODY ACTIVIT 800-207-0425 CA
3
$21.95
NOTICE: Look for a new statement design for your Capital One credit card beginning Iwxt Inonlh.
A summary of the key changes will be provided with yotlr new statement.
.II
flt/LJ gOO, t) i/
:: Total Credit Line
: Total A~'3i1able Credit
Credit Line for Cash
~ Available Credit for Cash
..
..
..
N
~
co
..
512,400
52,371.55
56,200
S2,371.55
t'k -- ~.?{,I / m 'y
J91S:"iljftt$3 C()/b)~RGJtWIi /k,-r;
If) ~2I-Ot.->
At your service
To ,..U Cu,tomer Rdotions 01 to report. 1.),t or ,tolen <'lit.!,
1-800-955-7070
..
~
III
..
'"
...
....
Send pnymenb to:
.\ttn: R".mittrm.:-e rl"'ro~;nh .
C.I~I"I One B.nk
P.O. Box 70884
Ch.r1otte, NC 282720884
Selld inquiries to:
C "pita! 011.
P.O. Box 3028S
SLe, UT 84130-0285
Important Account Information
Beginning October 1st, 2006, based on your account activity
}'Ou may be assessed more than two late, ovcrlimit, or returned
(heck fecs that occur doong an}' billing period.
Finance Charges
Plttast' f,'" ""lIttrs~ sid,'jor ;/If/",rt""t i"fi;rm,'f;1"
:E
"I
as
~
r.Nt~"8li:
$1\.019
$.00
B"IJlna"i rHtt PtTi"'ic
"'Pt'i,; to M/t
$10,2103.39 .OlJbi'%
$.00 .05425"
C_t1"mJinC
.fPR
4.W~
19.8lY'f,
PURCHASES
CASH
ANNUAL PERCENTAGE RATE nplJlied tlri~ period
4.1)1)%
. ?L'~_,\~E P.ETURN r'f)RTION BELn\V "VITH Pi', fj\..l~NT .
CITIZENS FIRST WHOLESALE MTG CO
#-
SEI! BACK FOR
IMPORTANT
MESSAGE
CONCERNING IRS
REPORTING
560 FIELDCREST DRIVE
THE VILLAGES FL 32162-9989
352-259-8089 800-477-1086
FEDERAL 10. NO. 11-3654971
TAX YEAR 2006
MORTGAGE INTEREST ST A TEMENT
(FORM 1098 SUBSTITUTE)
OMB NO. 1545-0901
as of 12-31-06
LOAN INFORMA rrON
litH: 1M'~ A
17866 SE 87TH BOURNE AVENUE
THE VILLAGES FL 32162
ACCOUNT NO.
~ MORTGAGE INTEREST
PAID - BOX
~ REAL ESTATE TAX PAID
TAX IDENTIFICATION NO.
TAX IDENTIFICATION NO.
1068014175
10.156.84
3,948.04
202-34-7626
205-36-6653
Ut>ME ....
t^f}O a,,-r ~ tz,
PAYMENT HISTORY
PAlO TRANSACT ION PRINCIPAL PRINCIPAL MTG. INTEREST ESCROW ESCROW LATE LIFEI TOTAL
CATE TO REC'D. FROM DISB.
APPLI EO DATE DESCRIPTION APPLI ED BALANCE BORROWER .APPLIED BALANCE CHARGE INSUR AMOUNT
BEG NNING ALANCES 1 8 7 , 68 1 . 46 733.15
1- 23 02-06 PAYMENT 211.82 187, 4B9. B4' J- 899.31 430.86 1,164.01 1,541.99
2-27 03-06 PAYMENT 212.84 187,2511.80 /' 898.29 430.86 1 , 594 . 87 1,541.99
3-27 04-06 PAYMENT 213.86 187,042.94 ,/ 897.27 430.86 2,025.73 1,541.99
4-05 05-011 PAYMENT 214.88 186,828.06 ../ 8911.25 430.116 2,456.59 1,541.99
5-23 01l-06 PAYMENT 215.91 186,612.15 895.22 430.86 2,887.45 1,541.99
06-30 07-011 PAYMENT 216.95 186,395.20 894.18 430.86 3,3111.31 1,541.99
07-13 08-06 PAYMENT 217.99 186, 1 77 . 2 1 893.14 430.86 3,749.17 1,541.99
08-28 09-06 PAYMENT 219.03 185,958. 18 892.10 430.86 4, 180.03 1,541.99
~:~21 10-06 PAYMENT 220.08 I..". 185,738.10 891.05 430.86 4,610.89 1,541.99
1 .13 11-06 HAl INSUR 185 138.10 1,642.00- 2,968.89 1,642.00
IV-"'" I-V'" 221.1a ::~:~:~:;~ 690.00 430.86 3,399.75 1,541.99
11- 13 11-06 COUNTY TAX 3,948.04- 548.29- 3,948.04 '
11 -21 12-06 PAYMENT 222.19 185,294.78 888.94 430.86 117.43- 1,541.99
12- 12 12-06 PAYOFF 185,294.78 321.09 117.43 185,733.30
ADDITIONAL COPIES $5.00 EACH
REV-1513 EX+ (9-00)
" *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
I
SCHEDULE J
BENEFICIARIES
MftR Y 1f1J
5'm IT/I
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not L1stTrustee(s)
sPovSE
sPouse
AMOUNT OR SHARE
OF ESTATE
~ 23$','1
J24CJ/_39
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
1,
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
KoNTtJ KL.I.rK'E AHotIJ WV,
~
23,/207 GI#1/l$S (j; /o,"3Z Ptt<.9IIJ/lIi
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET .
2,
fRt)O~,~"'1I1tt n;JfpJCflft ItJc* 2qSllME>
@ Igb".q/ PtI< ~
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
<-------
(If more space is needed, insert additional sheets of the same size)
v