HomeMy WebLinkAbout07-25-07
AEV-l500 EX + (6-00) .
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST, FIRST. AND MIDDLE INITIAL)
DROMGOLD
DATE OF DEATH (MM-DD-Year)
DOROTHY
DATE OF BIRTH (MM-DD-Year)
L.
OFFICIAL USE ONLY
FILE NUMBER
2 -07 0 5 2 4
""'COuNTYCOOE -VEAA- - - 'NUMBER- -
SOCIAL SECURITY NUMBER
2 1 0 - 2 6 - 6 6 4 9
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum (date 01 death priorto 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAl.. TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
MARCUS A. McKNIGHT III 60 WEST POMFRET STREET
FIRM NAME (If Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717 249-2353 CARLISLE PA 17013
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0.00 X _(15) 0.00
127,260.41 X .045 (16) 5,726.72
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 5,726.72
OS/23/2007 05/08/1931
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
[X] 1. Original Return
o 4. Limited Estate
[X] 6. Decedent Died Testate (Attach copy 01 Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12.12-82)
o 7. Decedent Maintained a Living Trust (Attach copy 01 Trust)
o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
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)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(6)
(7)
(8)
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
(10)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subjectto Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount 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 HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER Alt. QUESTIONS ON REVERSE SIDE AND RECHECK MATH <
(11)
(12)
(13)
(14)
195,000.00 I
!
OFFICIAL USE ONLY
1"",'
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1 ,859.7(1:\2 CJ
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Co) 216,070.88
25,894.~~
62,915.98
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88,810.47
127,260.41
127,260.41
REV-1502 EX +'(6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DROMGOLD DOROTHY L. 21 07 0524
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is iointly-owned with riaht of survivarship must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
16 RIDGEWAY DRIVE, SOUTH MIDDLETON TOWNSHIP, CARLISLE, PA
SOLD - SETTLEMENT SHEET ATTACHED
VALUE AT DATE
OF DEATH
195,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
195 000.00
REV-1508 EX +'(6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
DROMGOLD
FILE NUMBER
DOROTHY L. 21 07
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.
0524
ITEM
NUMBER
1.
DESCRIPTION
ORRSTOWN BANK - CHECKING ACCOUNT #106210067
VALUE AT DATE
OF DEATH
19,211.18
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
19211.18
REV-1509 EX;' (6-98)
.
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DROMGOLD
FILE NUMBER
DOROTHY
L.
21
07
0524
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. JOANNA DEE HORTON
622 BARMORE AVENUE
GROVE CITY PA 16127
DAUGHTER
B
c
JOINTLy-oWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 11/1997 ORRSTOWN BANK - CHECKING ACCOUNT #411329 3,719.39 50. 1,859.70
TOTAL (Also enter on line 6, Recapitulation) $ 1 859.70
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX +'(12-99)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
DROMGOLD
FILE NUMBER
DOROTHY
L
21
07
0524
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. AUER MEMORIAL HOME AND CREMATION SERVICES, INC. 73,55
2. PASTOR DESTEPHANO 100.00
3. LETORT CEMETARY ASSOCIATION 300.00
4. CARLISLE MEMORIAL SERVICE 170.00
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 IRWIN & McKNIGHT 10,250.00
3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS 240.00
5. Accountant's Fees
6. Tax Return Prepare~s Fees PATRICIA A. ROSENDALE, CPA 350.00
7. REGISTER OF WILLS, FILING FEE 30.00
8. NOTARY FEES 10.00
9. CUMBERLAND LAW JOURNAL, ESTATE NOTICE 75.00
10. THE SENTINEL, ESTATE NOTICE 135.44
11. CLOSING COSTS ON SALE OF REAL ESTATE 14,160.50
TOTAL (Also enter on line 9, Recapitulation) $ 25 894.49
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DROMGOLD
FILE NUMBER
DOROTHY
L.
21
07
0524
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. HOLY SPIRIT HOSPITAL, MEDICAL
VALUE AT DATE
OF DEATH
739.00
2. ORRSTOWN BANK, PAYOFF OF 1ST MORTGAGE
55,693.80
3. STITZELS, ELECTRIC WORK
139.20
4. UGI, FUEUPROPANE
50.29
5. MCI, TELEPHONE
69.55
6. COM CAST CABLE, UTILITY
50.87
7. MET-ED, ELECTRIC
33.45
8. EMBARQ, TELEPHONE
27.87
9. CUMBERLAND-GOODWILL, AMBULANCE
150.00
1 O. WALNUT BOTTOM RADIOLOGY, LLC, MEDICAL
34.92
11. MilLENNIUM PHARMACY SYS, INC., MEDICAL
58.90
12. CARLISLE HMA PHYSICIAN MGMT, MEDICAL
1,434.00
13. UROLOGY OF CENTRAL PA, MEDICAL
2,160.00
14. UNITED CHURCH OF GOD, SARAH A. TODD MEMORIAL HOME, NURSING
2,056.13
15. MEREDITH'S LAWN SERVICE, LAWN CARE
218.00
TOTAL (Also enter on line 10, Recapitulation) $
62915.98
(If more space is needed, insert additional sheets of the same size)
"',.":"",.'.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
1.
n
L
FILE NUMBER
21 07
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Lineal
()~?4
AMOUNT OR SHARE
OF ESTATE
127,260.41
REMAINDER
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
lr H..U 11 HY
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
JOANNA DEE HORTON
622 BARMORE AVENUE
GROVE CITY PA 16127
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
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)
L5\STrvILL :ANV TTST.J12v1TNT
I DOROTHY L. DROIVIGOLD, of South Middleton Township, Cumberland
County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly
revoking all Wills and Codicils heretofore made by me.
ONE: I direct my Executor to pay all of my debts, funeral and administrative expenses as
soon as may be done conveniently after my decease.
TWO: I give, devise, and bequeath all of my estate of every nature and wherever situate
to my husband, EMERSON M. DROMGOLD, provided he survives me by thirty (30) days or
more.
THREE: If my husband, EMERSON IVI. DROMGOLD, has predeceased me or
failed to survive me by thirty (30) days or more, then I give, devise, and bequeath all of my estate
of every nature and wherever situate to my daughter, JOANNA DEE HORTON. If she has
predeceased me, then I give, devise, and bequeath all of my estate of every nature and wherever
situate to the living issue of JOANNA DEE HORTON in equal shares.
FOUR: I appoint my husband, EMERSON M. DROI\IGOLD, to serve as Executor of
this my Last Will. If he is unable to serve or ceases to serve as Executor, I appoint my daughter,
JOANNA DEE HORTON, to serve as Executrix of this my Last Will.
FIVE: My Executor may, at his discretion, compromise claims, borrow money, retain
property for such length of time as he may deem proper; lease and sell property for such prices,
on such terms, at public or private sales, as he may deem proper; and invest estate property and
income without restriction to legal investments.
SIX: No Executor or Executrix acting hereunder shall be required to post bond or enter
security in this or any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal thi~~ay of April,
1995.
'~&:01~ (~~ot;- (SEAL)
Signed, sealed, published and declared by DOROTHY L. DROMGOLD, the above
named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her
request and in her presence and in the presence of each other have subscribed our names as
witnesses hereto.
~4~m4
r'o/ (/yY ~/
2
ACK1VOWLEDGjl;/ENT AND AFFIDA VIT
WE, DOROTHY L. DR01\'IGOLD, TERESA 1\'1. HENRY and CHERYL L.
CLELAND, the testatrix and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and
that she executed it as her free and voluntary act for the purpose herein expressed, and that each
of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that
to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of
sound mind and under no constraint or undue influence.
Lt7~ /? ~QMG{~
DOROTHYL.DRO OLD
COMMONWEALTH OF PENNSYL VANIA
SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by , the testatrix herein and subscribed
and sworn to before me by DOlOTHY L. DROMGOLD, TERESA 1\'1. HENRY and
CHERYL L. CLELAND, thi~ day of April, 1995.
~ !':cta:ia! Seel
80t:i .\. Ivlcl.riSC.f1 ,NotaPj Pub"c
C.1;:.s1€ Boo. ClCmber1and Counhl
rv1y Ccmmission Expims Dec. 15, 1996
Member, Pennsylvania As..."COation of Notaries
. A Settlement Statement
B Type of Loan
1. flFHA 2 []FmHA 3. OConv Unins 6. File Number
4 OVA 5. OConv. Ins MT2007.179JDF
IS orm IS urnlS e 0 give )IOU a s a amen 0 ac ua se omen cos s mounts palCllO anCl by e S8 amen agen are 5 own
C. Note Items marked "(P 0 c )" were paId oulslde the c1osmg, lhey are shown here for Informallon purposes and are nollncluded In the lolals
W.A.RNtNG Jt is a crime 10 knoWingly make false statements 10 the United Stales on thiS or any other Similar lorm Penalties upon
C01WlclIQI1 can Include a fine and Imprisonment For deta.ls see Title 18 U S Code Section 1001 and Section 1010
Marion L. Foreman
D NAME OF BORROWER
_ADDRESS ___..
E NAME OF SELLER
ADDRESS
F. NAME OF LENDER
ADDRESS
G. PROPERTY ADDRESS
Estate 01 Dorothy Dromgold
Cash
16 Ridgeway Drive, Carlisle, PA 17015
South Middleton Township I
H SETTLEMENT AGENT Abstract Company 01 Central PA, Inc., Telephone: 717.243.6222 Fax: 717.243.6486 . ------ --.- .
PLACE OF SETTLEM~NT 26 West High Street, Carlisle, PA 17013_____________1
~TTLEJ~~JM~ARY..Qf.BO~BQ.W~~S LR~ll~ACTIQ~__~SUMM~B_y OF SELLE~'S TR.P-NMCTIQN:_--j
1.1 QQ&~QSS AMQ.lJNL[)UE FROM BORROWER. ..JQIL Q..RQ~~ AMOUNT DUE TQ!)EbLER --- ------s.;
c.JQL~ontr!lf.ti.iJl85Rnce 195,000.00 401. Conlract sales price 19~QOO..QO......_..'
_lQL.J'~rsonal Property 402. Personal Property f-----.--.~ .
.lQl__~e.llie.m-,,-nt charqes to borrower (line 14~ 3,19~~ ~___. _
_.19.1.._____ _ _ 404.
lilli__.__. 405.
---- Adjustments for items paid by seller in advance Adjustments for items oaid bv seller in advance
JQL Coun!Y~)(8_s. .____07/05/07 to 12/31107 223.85 407. Counlv taxes 07/05/07 to 12/31/07
1illl..__._....__.______ --.199
....1.LL___._ -_.___ 410
_llL___.._ 411
112 412.
.J1!L GR.QSS AM_QLLNI DUE FROM BORROWER 198417.73 420. GROSS AMOUNT DUE TO SELLER 195,223.8~
10Q.AMQ~~T!>.PAI[)I~Y_QB.Qt!BEH~~bf_OF BORRQWER _____ .JQLRED~TIONS IN AMOUNT DUE TO SELLER~___
_2QL.J)e.pOSII (lfEJ.ameSllllone'L 5,000.00 501. Excess Demsi! (see instructionsl
.1CJf....frUl9Jlal amZ~;;r;;.f new loans _. 502 Settlement charoes to seller lime 14001 14,160.50
203. Exi;illilgloan~l.laken sublect to 503. Existing loan(s) taken subiect to
.1Q!. -----.---. 504. Pavoff of.First Mortqage Loan
Orrstown Bank
223.85
205. 505
20~_______.___.. 506
207 507
_~Q!L_.B~ Credit. __on ------.1,600.00~. Repair Credit _.__1,~Qll.:QO_
~_.- 509 ._
___~__.__.._.MILJ&'!1ents lor items unpaid !Jy~~___ _. ___A.ctlLJstments l!lr items unpaid b sl!I~____.
_~1l. School Taxes -- 07/01/07 to 07/05/07 _lQ,~ 2!L_~fhool Taxe.L___ 07/Q1/Q7JQ0710~QI__ _._____fO.60
~-. -- ..i1L......_________..__._ _____..
.11!..___._ ._________ 514. __._______..._.
.11~._._____ 515 .___._________ _____
~1ji .-....------..--- --_._ _______.Q16 .____._.__.._.___ ..__.__.._
217________.__ 517
l1JL_____ 518
~-m.'---__ 519
[ffLIQIAL PAID BY/FOR BORROWER 6,620.60 520. TOTAL REDUCTION AMOUNT DUE SELLER ___...l1,174.90
WOO. CASH AT SETTLEMENT FROM OR TO BORR9-WER 600. CASH AT SETTLEMENT TO OR FROM SELLER
I 301. Gross amoljl1t due from bQl'fower (Iine.Jl~_I------~A17.73 601. Gross amount due to seller (line 420\
f:~ ;::;':: :::~:"~""OO2"'L 19: :::;.: ~:~:::L::"' .", ~.. '""" ""
__5~693.~Q.
1------- .
195113.85
71 Al4jlO
12lJ48.95
SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein IS importanllax information aod i,s being fumished 10 the Internal Revenue Service, If you are required 10 file a return
a m:gllgence penalty or other S81lcllon will be Imposed on you If Ihls Item IS reqUired 10 be reported and the IRS determines thai It has nol been reported The Contract Sales Price Oescllbed on
line 401 above constlh,les Ihe Gross Proceeds of nus transaction
SELLER INSTRUCTIONS If lhlS real estate was your prinCipal residence, file Form 2119, Sate or EXcI'1ange of Principal ReSidence, fOl an~ gain, with your Income lax return; for other transactions
complete Ita:: appltcatll", pails of Form 4797 Form 6252 andlo. Schedule D (Form 1040)
~ou are lequlred by law to prO\ilde tile selllement agent (Fed Tax 10 No. . l With your correcl taxpayer Idenhflcalion n~mber If you do not proVide your correctlaxpayer Identification
Ilumbel. yuu may be subjeCltD ::;1'111 or crlmmal penalties Imposed by law Under penalties of perlury, I certIfy Ihallhe ntlmLer shown on lhls slatement IS my correcltaxpayer identification number
TIN
SELLER(S) SIGNATURE(S)
_._I~____-
SELLER\S) NEW MAILING ADDRESS
US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: MT2007-179 FINAL F'AGE 2
~ETTLEMENT ST A TEMEtiT TitleEx ress Settlement S stem Pnnted 07/03/2007 <jt Q~:Q.~__
L. SETTLEMENT CHARGES PAID FROM fAro FROM
700 TOTAL SALES/BROKER'S COMMISSION based on price $195,000.00 @6.000= 11100.00 BORROWER'S SELLER'S
Division of commission (line 700) as follows: FUNDS AT FUNDS A 1
_ ;~_~_==~==-~700.00 :~ Ebener & Associates __~___ SETTLEM...E. ~~___ SE~~. ~:. .~. N.T.
703 Commission paid at Settlement _ _ __11JOO,00
~OJlJIEMS PAY ABLE IN CONNECTION WITH LOAN _ ____
eQL1oQ~~.QrigLnatiQ.~E~.'!....__. %
802 Loan Discount %
_~ Appraisal Fee
804. Credit Report
_Jill~_l,ender's Inspection Fee
806. Mortgage Application Fee
80L..A.2sumpJlon Fee.
e08 . __ n____
809____._ ____
_1l1~_~
811
jlOO. ITEMS REQUIB~P BY LENDER TO BE PAID IN ADVANCE
_ ~OJ._lnteresl F!Qf!l.__~_~___~~__.1<J.q\'_~_
_9(jL.tv1ortgage Insurance Premium for to
._ 903_Hazard Insurance Premium for to
I
I
~____n __ _I
-- ---- J
I~ t--
_904~
_..J!QL_ _______
.1QQQ..RES~~VES Q.~pOSITED WITH LENDER FOR
_JOOLJjazard In~IJf~~'___ mo. @. $
1002 Mortgage Insurance mo. @. $
1003. C"y Pl~E~__~_ mo. @. $
_1.fJ.Q4.c;olJfli'tl'rCl@l!y Tax mo. @. $
_J005~hool Taxes mo @.$
1009. A re ale Anal slsAdlustment
1100. TITLE CHARGES
, 1101 Settlement or clOSing fee
!~1()2 Abstract or title search
I 1103 Tille examination
_1104 TitlemsuranceJ!rnder _____
1105. Document Pr~UQll_ _ __ _
LUOG NQt~r\, Fees_____JQ. SFLllrwin &1VI.f.Knight __~_______'____
I.JJQLi\tIQrn~ysJS'~L___----.JQJ.rwin & McKnight POC SELLER __~__
'___.__lcncludes aboyS'.lIems No. _ ---_____----.1.____
1108,lill"-'~~IJf'!.n~_____..JQ. Abstr~t Company o! Central PAL~___ ___
___'inciudes above !tems No: ) _
.1109 JJ:nclS'!'S Policy__ ___
_ll1()_Q\Vnei'~ PQU(;L____~5,000.00 - 1 ,200.3~~
llJl_________n__~___~
_.1J1L___________
1113
_J~QQV~_RNMENT RECORDING AND TRANSFER CHARGES
_JfQ.1J~S'.cor<fu:ifLfe€s Deed $ 38.50 Mortqage $ ; Release $
_..111JL.9ty/Coun!l'J.ax/stamps Deed $1,950.00 . Mortqage $
...JZQ;) Stale Tax/stal!l~_~eed $1,950.00 ; Mortqaqe $
1204____________
1205________.
.J~QL~DDITIONAL SETTLEMENT CHARGES
_1;)pJ,.l:~waler/se\N_"_'~ to South Middleton Township Mun~'!LAuth,-___
1302_lfIIarranty ______ __ to First American Home --
.J;)Q;)..B9.donlTermlle/HQme Inspect_ to B&T InJipectio~________ __~~==_ip-:-o.c.) 420.00 Buyer
_J1Q4 _ ____
~__n_ _____~_____
_J.1Q~___
1307 ___
1308.
[_J~QQJ.QT AL SETIbEMENT CHARGES
Imo
Imo
Imo
37.83/mo____n
-!ill9 /mo ~_~___
_____~.OO
7.00
___---1JQQ]~
J~_l=_~ lJ@OO
lQ.4,~Q
____)99.0ll.
- -- ~--~- --~--~-
(enter on lines 103, Section J and 502, Section K) _
___1.1~~~~
__14~11JQ,-50
HUD CERTIFICATION OF BUYER AND SELLER
:nhth~: l~:~~~~~~~V:~:ri~~:l~e~t~~t-~a~fg:~~~~~II:~~r~~~pa;~f l~:~l~~~\ OJ;:IY8~::/~~21~r~lf~~tbehef it is a true and accurate slatement 01 aU receipts and disbursements n;ad~ on my aCcOlmt or bv me
j~'1f?'cJ /( h ""51 't"fJII . ~
traflon oreman , ;.
T~~~~U~~1S;~~I~~i~~'a~~~~heefi:n~~j~~ ~~~j:ttu~~~~r~d~~~~~~~l~~~~~~~I~:t:t:I~~~~~ of this lrafl~dcllon
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ORRSTOWN
BANK
A Tradition of Excellence
June 7, 2007
77 East King Street
P.O. Box 250
Shippensburg, PA 17257
TO: Marcus A McKnight, III
Law offices of Irwin & McKnight
60 W Pomfret St
Carlisle, PA 17013
FROM: Andrew G OU
Customer Service Officer
22 S Hanover St
Carlisle, PA 17013
~~~IUWfi~
JUN - 9 '2007
RE:
Estate of Dorothy L Dromgold
. t\! r L'
.. A 1~_4 {t ..;
DATE OF DEATH: May 23,2007
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE
FOLLOWING ACCOUNTS WITH ORRSTOWN BANK:
CHECKING ACCOUNTS
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST
411329
Dorothy Dromqold
Joanna Dee Horton
11/20/1997
3,719.38 + .01 = 3,719.39
106210067
Dorothy Dromqold
11/20/1997
19.21041 +.77 = 19,21118
SAVINGS ACCOUNTS
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST
CERTIFICATES OF DEPOSIT
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST
CITY
ZIP
/7tJ
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
5,726.72
286.34
Total Credits (A + B + C)
(2)
286.34
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + 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 AGENT
0.00
0.00
5,440.38
5,440.38
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 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred alter December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................... 0 00
3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS
DATE
7-cJ j-{) 7
R RESENTATIVE
PA 16127
DATE 1/;).3--07
ADDRESS
T STREET
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. ~9116 (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 orlor the use of the surviving spouse is 0% [72 P .8. ~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 eve~ ~
the surviving spouse is the only beneficiary. ~\ oD ,DO j\ r\ V N:t~ jj1
For dates of death on or alter July 1, 2000: ()W'"" '\ (U 1 L
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 pare~t, vJl ~
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)].iA\JO!U I SJ;"?
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. ~9116(1.2) [72 P .S. ~9116(a)(1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who ha~ at least one parent in common with the decedent, whether by blood or adoption.