HomeMy WebLinkAbout08-29-07
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15056051058
REV-1500 EX (06-05)
PA Department of Revenue '*'
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN
RESIDENT DECEDENT
File Number
21
06
0752
Date of Birth
194-28-8403
03/09/1933
Decedent's Last Name
Suffix
Decedent's First Name
MI
GOENS
EVALlNE
K
(If Applicable) Enter Surviving Spouse's Information Below
Last Name Suffix
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
(8J 1. Original Return
t:::::::)
2. Supplemental Retum
t:::::::)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
t:::::::)
4. Limited Estate
c::::::::>
C8)
c::::::::> 4a. Future Interest Compromise (date of
death after 12-12-82)
t:::::::) 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
t:::::::) 10. Spousal Poverty Credit (date of death t:::::::) 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 Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
t:::::::)
THOMAS E. FLOWER
,.,-.-,,)
Firm Name (If Applicable)
SAlOIS, FLOWER, LINDSAY
First line of address
2109 MARKET STREET
or Post Office
State
ZIP Code
':J
--I
DATE e:Ii:ED
,-
.,
~
Second line of address
CAMP HILL
PA
17011
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
_~~~ILINGRETURN
/Ji. DRESS
EUNICE OLIVER, 427 N. WEST STREET, CARLISLE, PA 17013
SmRE OF PREP~. A REPRESENTATIVE
(th..-tA
A R '
SAlOIS, FLOWER & LINDSAY
DATE
-~~Z------
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051058
15056051058
--.J
-.J
15056052059
REV-1500 EX
Decedent's Name:
EVALlNE
K GOENS
RECAPITULATION
1. Real estate (Schedule A). ............................................ 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . .
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . .
6. Jointly Owned Property (Schedule F) (t) Separate Billing Requested . . . . . . .
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c::J Separate Billing Requested.. . . . . . .
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . . .
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 45 48,671.21
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 OF AN OVERPAYMENT
L
15056052059
Side 2
Decedent's Social
Number
194-28-8403
67,500.00
2.
3.
4.
5.
6.
7.
8. 67,500.00
9.
48,671.21
48,671.21
15.
16.
2,190.20
17.
18.
c::J
15056052059
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REV-HiDO EX Page 3
Decedent's Complete Address:
DECEDENTS NAME
EVALlNE K GOENS
STREET ADDRESS
127 LINCOLN STREET
DECEDENTS SOCIAL SECURITY NUMBER
194-28-8403
CITY
CARLISLE
STATE---l ZIP
PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) 2,190.20
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C ) (2)
385.17
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.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(5)
(SA)
(5B)
2,190.20
385.17
2,575.37
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 [KJ
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [KJ
c. retain a reversionary interest; or.......................................................................................................................... 0 [i]
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [iJ
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 [iJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [KJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 [KJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not 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. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
R.EV-1502 EX+ (6-9*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
EVELINE K GOENS
FILE NUMBER
21-06-0752
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 jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
DWELLING HOUSE, 127 LINCOLN ST, CARLISLE, PA (GROSS SALE PRICE)
2. 1/2 INTEREST IN COMMON, DWELLING HOUSE, 140 N. WEST ST., CARLISLE, PA
VALUE AT DATE
OF DEATH
50,000.00
APPRAISAL VALUE $35,000 X 1/2 =
17,500.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
67,500.00
A. Sett]elnent Statement
U.S. Depa.. ~nt of Housing and Urban Development
S. Type of Loan OMS Approval No. 2502-0265 (expires 11/30/2009) FINAL
1 OFHA 2. OFmHA 3. OCony. Un ins. I 6. File Number I 7. Loan Number /8. Mortgage Insurance Case Number
4. OVA 5. OCony. Ins. MT2007.165JDF
C Note I r IS arm IS furniShed to give you a s a ement of ac ual settlement costs. Amounts pa'd. to and by the settlemen agent are shown I TitleExpress Settlement System
Items marked "(pac)"' were paid oulside the closing; they are shown here for Information purposes and are not included in the totals.
WARNING. II is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon Printed 07/05/2007 at 09:27 KLL
conviction can include a fine and imprisonment For details see: Title 18 U. S. Code Section 1001 and Section 1010
D. NAME OF BORROWER: David C. Sheibley
ADDRESS:
E. NAME OF SELLER: Estate of Evaline K. Goens
ADDRESS:
F. NAME OF LENDER: Cash
ADDRESS: -
G. PROPERTY ADDRESS 127 Lincoln Street, Carlisle, PA 17013
Carlisle Borouah
H. SETTLEMENT AGENT Abstract Company of Central PA, Inc., Telephone: 717.243.6222 Fax: 717.243.6486
PLACE OF SETTLEMENT: 26 West High Street Carlisle PA 17013 .--
I. SETTLEMENT DATE 07/05/2007
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
-.1Q.Q. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales mice 50,000.00 401. Contract sales Drice 50,000.00
102. Personal Property 402. Personal Property
103. Settlement charaes to borrower IIine 1400) 1 409.75 40J
104. 404.
105. 405.
Adiustments for items paid by seller in advance Adjustments for items paid by seller in advance
107. County taxes 07/05/07 to 12/31/07 154.15 407. County taxes 07/05/07 to 12/31/07 154.15
109. 409.
110. 410.
111. 411.
112 412.
120. GROSS AMOUNT DUE FROM BORROWER 51 563.90 420. GROSS AMOUNT DUE TO SELLER 50154.15
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deposit or earnest money 2.000.00 501. Excess Deposit (see instructions)
202. Princioal amount of new loans 502. Settlement charaes to seller (line 1400) 7.191.94
203. Existino loan(s) taken subiect to 503. Existino loan(s) taken subiect to
204. 504. Payoff of First Mortoaoe Loan
205. 505. --
206. 506. ---
207. Seller Financino 2.816.85 507. Seller Financino 2,816.8~_
208. 508. --
209. 509. .---
Adiustments for items unpaid bv seller Adiustments for items unpaid by seller
212. Schoo/Taxes 07/01/07 to 07105/07 8.96 512. School Taxes 07101/07 to 07105/07 8.96
213. 513.
214. 514.
.._--~--
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 4,825.81 520. TOTAL REDUCTION AMOUNT DUE SELLER 10,017.75
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower (line 120) 51.563.90 601. Gross amount due to seller (line 420\ 50,154.15
302. Less amounts paid by/for borrower (line 220\ 4,825.81 602. Less reduction amount due seller (line 520) 10.017.75
303. CASH FROM BORROWER 46 738.09 603. CASH TO SELLER 40 136.40
SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is important tax information and is being fumished to the Internal Revenue Service. If you are required 10 file a return,
a negligence penalty or other sanction Will be Imposed on you .f thiS .tem IS reqUired to be reported and Ihe IRS determines that It has not been reported. The Contract Sales Price described on
line 401 above constitutes the Gross Proceeds of this transaction
SELLER INSTRUCTIONS: If this real estate was your principal residence. file Form 2119, Sale or Exchange of Principal Residence. for any gain. with your Income tax relurn; for other transactions.
complete Ihe applicable parts of Form 4797. Form 6252 and/or Schedule D (Form 1040).
You are required by law to provide. the seltl~ment agent (Fed. Tax ID No: . )with your correct taxpayer identification number. If you do not provide your correct taxpayer identification
number. you may be subject to CIVil or Criminal penalties Imposed by iaw. Under penalties of perJury. I certify that the number shown on this statement IS my correct taxpayer Identification number
TIN:
SELLER(S) SIGNATURE(S):
SELLER(S) NEW MAILING ADDRESS:
It e xoress e,,,_, nent jvstem nnted 5 7 at 9:2 KLL
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on price $50 000.00 @ 0.000 = BORROWER'S SELLER'S
Division of commission (line 700) as follows: FUNDS AT FUNDS AT
701. $ to SETTLEMENT SETTLEMENT
702. $ to
703. Commission oaid at Settlement
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Oriqination Fee %
802. Loan Discount %
803. Appraisal Fee -'-
804. Credit Report
805. Lender's Inspection Fee
806. Mortqaqe Application Fee -..-
807. Assumotion Fee -----.
808. ----
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to @$ /dav
902. Mortqaqe Insurance Premium for to
903. Hazard Insurance Premium for to
~-
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo.@$ /mo
1002. Mortqaqe Insurance mo.@$ /mo
1003. CitvPropertyTax mO.@$ /mo
1004. County Property Tax mO.@$ 26.05 /mo
1005. School Taxes mO.@$ 68.34 /mo
1009. Aaoreaate Analvsis Adiustment
1100. TITLE CHARGES
1101. Settlement or closina fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Doc Prep (Mtq/Note - Deed) to Saidis, Flower & Lindsay 250.00 100.00
1106. Notarv Fees to Said is, Flower & Lindsay 10.00 5.00
1107. Attorney's fees
(includes above items No: )
1108. Title Insurance to Abstract Company of Central PA, Inc. 558.75
(includes above iterns No: )
1109. Lender's Policy
1110. Owner's Policv 50,000.00 .558.75
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES --
1201. Recordina Fees Deed $ 38.50 . Mortqaqe $ 42.50 . Release $ 81.00
1202. CitY/County tax/stamos Deed $500.00 . Mortaaqe $ 500.00
1203. State Tax/stamos Deed $500.00 . Mortqaqe $ 500.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1.301. Water/Sewer to Carlisle BoroUQh 2 273.50
1302. 2007 Ctv/Two Tax to Carlisle BorouQh Tax Account 343.85
1303. Judqrnent Payoff to Old Town Homes 1,500.00
1304. Reimb for Tax/Misc Est Exp to Eunice Oliver 1,940.41
1305. Curb/Sidewalk Judqment to BorouQh of Carlisle 529.18
1306. Reirn for Judq Cert to Said is Flower & Lindsay 10.00
1307.
1308.
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Section J and 502 Section Kl 1,409.75 7191.94
U.S. DEPARTMENT OF HOUSING AND UW" 'I DEVELOPMENT
SETTLEMENT STATEMENT
File Number: p.t--"07.165
1'1 E S S
P'
FINAL
07/0 /200 0 6
PAGE 2
HUD CERTIFICATION OF BUYER AND SELLER
- Settlement to the best of my knowledge and belief. it is a trua and accurate statement of all receipts and disbursements made on my account or by me
received a copy of the HUD-1 Settlement Statement.
-~~~
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENAL TIES UPON CONVICTION
CAN INCLUDE A FINE AND IMPRISONMENT FOR DETAILS SEE TITLE 18
US CODE SECTION 1001 AND SECTION 1010.
The HUD-1 Settlement Slatement which I have prepared is a true and accurate account of this transaction
I have caused or will cause the funds to be disbursed in accordance with this statement
~4\) Oh~ ~-S--07
, . DATE
I ;
l
1
,~
S. W. Barrett Real Estate & Appraisal Services
SUMMARY REPORT
Fie No. 07-0095
APPRAISAL OF
LOCATED AT:
140 West North Street
Carlisle, PA 17013
FOR:
Redevelopment Authority Cumb Cty
114 North Hanover Street
Carlisle, PA 17013
BORROWER:
Redevelopment Authority Of CumbCty
AS OF:
March 2, 2007
BY:
Cassandra J. Crockett
Certified Residential Appraiser
.
S. W. Barrett Real Estate & Appraisal Services
SUMMARY REPORT
File No. 07-0095
03/06/2007
Redevelopment Authority Cumb Cty
114 North Hanover Street
Carlisle, PA 17013
File Number: 07-0095
In accordance with your request, I have appraised the real property at:
140 West North Street
Carlisle, PA 17013
The purpose of this appraisal is to develop an opinion of the market value of the subject property, as improved.
The property rights appraised are the fee simple interest in the site and improvements.
In my opinion, the market value of the property as of March 2,2007
is:
$35,000
Thirty-Five Thousand Dollars
The attached report contains the description, analysis and supportive data for the conclusions,
final opinion of value, descriptive photographs, limiting conditions and appropriate certifications.
Respectfully submitted,
~.~~
Certified Residential Appraiser
REV-1508 EX+ (6-98) *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
EVALlNE K. GOENS
FILE NUMBER
21-06-0752
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.
ITEM
NUMBER
DESCRIPTION
DECEDENT'S FURNITURE, FURNISHINGS AND PERSONAL EFFECTS WERE SOLD WITH THE
HOUSE AT 127 LINCOLN STREET, AS REPORTED ON SCHEDULE A
VALUE AT DATE
OF DEATH
DECEDENT DID NOT OWN AN AUTOMOBILE OR BANK ACCOUNT AT THE TIME OF HER DEATH
RING AND SILVER SERVICE REFERENCED IN DECEDENT'S WILL WERE NOT FOUND AND WERE
PRESUMABLY SOLD OR GIVEN AWAY DURING DECEDENT'S LIFETIME
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1509 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTlY-OWNED PROPERTY
ESTATE OF
EVALlNE K. GOENS
FILE NUMBER
21-06-0752
SURVIVING JOINT TENANT(S) NAME
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
ADDRESS
RELATIONSHIP TO DECEDENT
A. LATANYA GREEN
B.
c.
140 W. NORTH STREET
CARLISLE, PA 17013
DAUGHTER
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 DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. EXECUTRIX DOES NOT KNOW WHETHER JOINT C/D AT
PRUDENTIAL, AS MENTIONED AT SECTION IV, CLAUSE SEVEN OF
DECEDENTS Will EXISTED AT THE TIME OF HER DEATH
TOTAL (Also enter on line 6, Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
EVALlNE K. GOENS
FILE NUMBER
21-06-0752
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
AMOUNT
B.
1.
10.
11.
12.
DESCRIPTION
1.
FUNERAL EXPENSES:
EWING BROTHERS FUNERAL HOME, PROFESSIONAL SERVICES
FACILITIES AND SERVICES
AUTOMOTIVE EQUIPMENT
CARDS, REGISTER BOOK, MEMORIAL FOLDER, DEATH CERTIFICATES
FUNERAL FLOWERS
1,725.00
,020.00
945.00
190.00
165.00
2.
3.
4.
5.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) EUNICE OLIVER
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 427 N. WEST STREET
City CARLISLE ,State PA Zip 17013
Year(s) Commission Paid: 2007
3,375.00
2.
Attorney Fees
3,375.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
,Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
REAL ESTATE TAXES, 127 LINCOLN STREET
AMOUNT PAID TO SETTLE CIVIL LAWSUIT, CUMBERLAND DOCKET NO. 06-5558
MISCELLANEOUS SETTLEMENT CHARGES ON SALE 127 LINCOLN STREET
SIDEWALK REPAIRS
R1E TRANSFER TAX
CONTINUATION SHEET TOTAL
1,940.41
1,500.00
105.00
529.18
500.00
2,472.16
8.
9.
17,841.75
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
SCHEDULE H
CONTINUATION SHEET
ESTATE OF EV ALlNE K GOENS 21-06-0752
13. BORO. OF CARLISLE, WATER/SEWER ARREARS $ 2,273.50
14. R/E TAXES PAID AT SETTLEMENT, NET 198.66
TOTAL THIS SHEET: $ 2,472.16
REV-1512 EX+ (12-03)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
EVALlNE K. GOENS
FILE NUMBER
21-06-0752
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.
REAL ESTATE TAXES, 127 LINCOLN STREET
987.04
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
987.04
REV-1513 EX+ (9-00)
*
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
EVALlNE K. GOENS
FILE NUMBER
21-06-0752
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 LETITIA SMALLWOOD, NO. 004912, PO BOX 180, MUNCY, PA 17756 DAUGHTER .33
2 LINETTE ALEXANDER, 7474 GREENWAY DR, #820, GREENBELT, MD DAUGHTER .33
3 LATANYA GREEN, 140 N. WEST ST, CARLISLE, PA 17013 DAUGHTER .33
4 SHABRE CUMBERBATCH, 140 N. WEST ST., CARLISLE, PA 17013 GRANDCHILD 8,750
5 ALEX NELMS, 140 N. WEST ST., CARLISLE, PA 17013 GRANDCHILD 8,750
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- 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)
~
Ewing Brothers Funeral Home, Inc.
630 South Hanover Street
Carlisle, P A 17013-
(717)243-2421
September 14, 2006
Latonia R. Nelms
127 West Lincoln St.
Carlisle, PA 17013
The Funeral Service for Evaline K. Goens
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff .
Embalming. . . . . . . .
Dressing& Casketing Etc. . . .
2. FACILITIES AND SERVICES
Viewing (Visitation/Wake). . .
Funeral Ceremony. . . . . .
Other, Wast Disposal Church Equipment.
3. AUTOMOTIVE EQUIPMENT
Vehicle to transfer remains to Funeral Home.
Hearse (Casket Coach) . . .
Limousine. . . . . . .
Flower car or floral disposition.
Lead car/Clergy . . . . .
Errand Car for Death Certificate filing & Retrieval .
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
Acknowledgement cards.
Register Book(s). . . . .
Memorial folders. . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THA T YOU HAVE SELECTED . . . . . . . . . . . . .
$1100.00
$450.00
$175.00
$425.00
$425.00
$170.00
$195.00
$295.00
$170.00
$95.00
$135.00
$55.00
$3690.00
$35.00
$60.00
$75.00
$3860.00
Cash Advances
Certified Copies of the Death Certificate. . . . . . . . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES .
$20.00
$20.00
Total
Total Cost.
. . . . . . . . . . . . . . . . . . . . . . . . .
$3880.00
~ ,- Dlo- Dl S~
LAST WiLL IN TESTAMENT OF
EV ALINE GOENS
Julv 29. 2003
I, EV ALINE GOENS, of 127 Lincoln Street, City of Carlisle, County of
Cumberland, Commonwealth of Pennsy lvania, being of sound mind, memory and
understanding, declare this to be my Last Will in Testament, hereby revoking any Will
previously made by me.
SECTION I:
LIFE INSURANCE POLICY
Clause One: I direct the Executrix of my estate to distribute monies from my
insurance policy, as soon as practicable after my death, in the following manner: After all
funeral and burial expenses have been satisfied, all funds remaining from this policy are
to be equally divided between my three siblings/daughters: Letitia Smallwood, Linette
Smallwood Alexander and Latanya Green.
SECTION IT:
PENSIONIRETIREMENT FUNDS
Clause One: I bequeath any and all money remaining from this fund, to my two
minor grandchildren: Shabre L. Cumberbatch and Alex Nelms. Should these
grandchildren be minors at the time of my death, I select as guardian over their affairs,
(their mother) Latanya Green. Should Latanya Green cease to serve in this capacity,
guardianship will be designated to Kevin Smallwood.
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TESTATOR EVALINE GOENS
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PAGE 1 OF (pJ
LAST wILL IN TESTAMENT OF
EV ALINE GOENS
Julv 29. 2003
SECTION ill:
REAL ESTATE
Clause One: I bequeath my real property, with all policies of insurance thereon,
(three story home) located at 140 West North Street, Carlisle, Pennsylvania, County of
Cumberland, in which I have a fifty percent interest, to my two minor grandchildren,
Shabre Cumberbatch and Alex Nelms. Should these children be minors at the time of my
death, I select as guardian over their affairs, (their mother) Latanya Green. Should
Latanya Green cease to serve in this capacity, guardianship will be designated to Kevin
Smallwood.
Clause Two: I bequeath my real property, with all policies of insurance thereon
and all furnishings included, (one-half double house), located at 127 Lincoln Street,
Carlisle, Pennsylvania, County of Cumberland, to my three daughters: Letitia
Smallwood, Linette Smallwood Alexander and Latanya Green.
SECTION IV:
TANGIBLE PERSONAL PROPERTY
Clause One: I bequeath my tangible and personal property located at 127 Lincoln Street,'
Carlisle, Pennsylvania, County of Cumberland, with all policies of insurance thereon, to
my three daughters: Letitia Smallwood, Linette Smallwood Alexander and Latanya
Green.
TESTATOR EVALINE GOENS
PAGE20F6
LAST WILL IN TESTAMENT OF
EV ALINE GOENS
Julv 29, 2003
Clause Two: I bequeath my diamond ring to my minor granddaughter, Shabre
Cumberbatch. Should this child be a minor at the time of my death, I select as guardian
(her mother) Latanya Green. Should Latanya Green cease to serve in this capacity,
guardianship will be designated to Kevin Smallwood.
Clause Three: I bequeath my silver service set located at 127 Lincoln Street,
Carlisle, Pennsylvania, Cumberland County, to my daughter, Linette Smallwood
Alexander.
Clause Four: I bequeath my mother's ring, located at 127 Lincoln Street,
Carlisle, Pennsylvania, Cumberland County, to my daughter, Letitia Smallwood.
Clause Five: I bequeath any automobile that I own at the time of my death or at
the time that I become incapacitated (currently a 1988 Cadillac), to my minor grandson
Alex Nelms. I further stipulate that if Alex is not of leg a! age to own the car at the time
of my death or incapacitation, that the car be sold and the proceeds be placed into a bank
account for his education, or until age 21, ifhe does not use the funds for educational
purposes between age 18 and 21.
Clause Six: I bequeath all money in the account at Harris Savings and Loan, in
Carlisle, Pennsylvania, to my daughter Letitia Smallwood, imprisoned at the State
TESTATOR EVALINE GOENS
PAGE 3 OF6
LAST WILL IN TESTAMENT OF
EV ALINE GOENS
Julv 29. 2003
Correctional Institution at Muncy, Pennsylvania, Lycoming County. If Letitia meets her
demise prior to her release, the funds are to be designated for her funeral and burial
expenses. I appoint my Executrix, Eunice Oliver to handle the designation of this money
in case of the death of Letitia Smallwood.
Clause Seven: I bequeath my fifty percent joint tenure CD of$15,000, Goint with
Latanya Green), held by Prudential Insurance Company, to my two minor grandchildren,
Shabre Cumberbatch and Alex Nelms, to be placed in an educational fund, to be used to
enhance their education.
SECTION V:
FUNERAL ARRANGEMENTS
Clause One: It is my desire to have all funeral and burial arrangements made by
my Executrix, through Ewings Funeral Home, Carlisle, Pennsylvania. All expenses for
funeral and burial will be paid from my insurance policy.
SECTION VI:
APPOINTMENT OF EXECUTRIX/EXECUTOR
Clause One: I appoint Letitia Smallwood who resides at the State Correctional
Institution at Muncy, P.O. Box 180, Muncy, PA 17756 and Eunice Oliver who resides at,
427 North West Street, Carlisle, PA, 17013, as Executrixes of this, my Last Will In
Testament. Should Letitia Smallwood and/or Eunice Oliver fail to qualifY or cease to act
as Executrix, I appoint Kevin Smallwood, who resides at 3326 Willoughby Beech Road,
Edgewood, Maryland, 21040, Harford County, as my Executor.
TESTATOR EVALINE GOENS
PAGE40F6
LAST WILL IN TESTAMENT OF
EV ALINE GOENS
Julv 29. 2003
SPECIAL NOTE
This Last Will In Testament will also serve as Power of Attorney over all my affairs, if
at any time prior to death, I become incapacitated and/or not able to handle my affairs
on a daily basis. The Executrix and/or Executor, appointed for my will is also
appointed as my Power of Attorney.
IN WITNESS WHEREON, I have hereunto set my hand this \ \
N.lgUSt- , 2003.
day of
TESTATOR-Evaline Goens
The preceding instrument, consisting of~typewritten pages, each identified by the
signature of the Testator, was on the date thereof, signed, published and declared by
Evaline Goens, the Testator therein named, as and for her last will, in the presence of us,
who at her request, in the presence of each other, have subscribed our names as witnesses
hereto.
WITNESSES
Name:
Address:
Eunice Oliver
427 N. West St., Carlisle, PA
.~~~r;R~ill.
, SIGNATURE
Name:
Address:
Samuel Oliver
427 N. West St., Carlisle, PA
,dU-e-M~~Y: 103
SIGNA /
Name:
Address:
Kevin Smallwood
3326 Willoughby Beech, Rd.
Edgewood, Mary land
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SIGNATURE
TESTATOR EVALINE GOENS
PAGE 5 OF6
LAST WILL IN TESTAMENT OF
EV ALINE GOENS
July 29. 2003
SIGNATURE OF TESTATOR IN FRONT OF NOTARY
)7h4z~ _~
EvalineGoens
Subscribed before me this' \ +n day of P\ll9L\5t .2003
~l-QRiG 0.. \'ikQ1L
NOTARY
Mv Commission Expires:
NoI:ariaI Seal
K1mbe11y A. Bitner, Notary Public
Carlisle Borough, Cumberland County
My CommIssIon Expires Nov. 12.2000
Member. Pennsylvania Assodumrl Of Nr.l!.\'Irifm
TESTATOR EVALINE GOENS
PAGE 6 OF 6
Settlelnent Statement
A.
U.S. Depa.. ~nt of Housing and Urban Development
B. Type of Loan OMB Approval No. 2502-0265 (expires 11/30/2009)
1. DFH.4. 2. DFmHA J DConv. Un ins. I 6. File Number I 7. Loan Number \ 8. Mortgage Insurance Case Number
4. OVA 5. DConv. Ins. MT2007-165JDF
I nlS rorm IS umlsneo 10 give you a stafememm aClUBrsellfememcosts. Amounts palO. to anO oy me siillfememagent are shOwn. I TitleExpress Settlement System
C. Note: Items marked "(p.oc.)" were paid outside the closing; they are shown here for Information purposes and are not Included In the totals.
WARNING: It is a crime to knowingly r:nake false stateme.nts to th~ United States on this ,?r any other slmlla~ form. Penallles upon Printed 07/05/2007 at 09:27 KLL
conviction can include a fine and Imprisonment. For details see: Title 18 U. S. Code Section 1001 and Section 1010.
D. NAME OF BORROWER: David C. Sheibley
ADDRESS:
E. NAME OF SELLER: Estate of Evaline K. Goens
ADDRESS:
F. NAME OF LENDER: Cash
ADDRESS:
G. PROPERTY ADDRESS: 127 Lincoln Street, Carlisle, PA 17013
Carlisle Borouah
H. SETTLEMENT AGENT: Abstract Company of Central PA, Inc., Telephone: 717-243.6222 Fax: 717-243-6486
PLACE OF SETTLEMENT: 26 West Hiah Street. Carlisle PA 17013 ..-
I. SETTLEMENT DATE: 07/05/2007
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: -
~O. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales orice 50000.00 401. Contract sales mice 50 000.00
102. Personal Property 402. Personal ProDertv
10J Settlement charaes to borrower (line 1400\ 1 409.75 40J
104. 404.
105. 405.
Adiustments for items paid bv seller in advance Adjustments for items paid by seller in advance
107. County taxes 07/05/07 to 12/31107 154.15 407. County taxes 07/05/07 to 12/31107 154.15
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 51 563.90 420. GROSS AMOUNT DUE TO SELLER 50154.15
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. DeDosit or earnest money 2 000.00 501. Excess DeDosit (see instructions)
202. Princinal amount of new loans 502. Settlement charaes to seller !line 1400\ 7191.94
20J Existina loanis) taken subiect to 50J Existina loan(s) taken subiect to
204. 504. Payoff of First Mortaaae Loan
205. 505. 2'81685~
206, 506,
207. Seller Financina 2816.85 507. Seller Financina
208. 508.
209. 509,
Adiustments for items unoaid bv seller Adiustments for items unpaid bv seller
212. School Taxes 07101107 to 07105/07 8.96 512, School Taxes 07101/07 to 07105107 8.96
"-----.
213. 51J
214. 514. .......-.-
215, 515.
.-
216, 516.
217, 517.
218. 518.
219, 519.
220. TOTAL PAID BY/FOR BORROWER 4.825.81 520. TOTAL REDUCTION AMOUNT DUE SELLER 10017.75
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301, Gross amount due from borrower (line 120\ 51 563.90 601. Gross amount due to seller lIine 420\ 50154.15
302, Less amounts paid by/for borrower (line 220\ 4 825.81 602. Less reduction amount due seller iline 520\ 10017.75
303. CASH FROM BORROWER 46 738.09 603. CASH TO SELLER 40136.40
FINAL
SUBSTITUTE FORM 1099 SELLER STATEMENT: The infonmationcontained herein is important tax infonmation and is being furnished to the Internal Revenue Service. If you are required to file a return,
a negligence penally or other sanction Will be Imposed on you If thiS Item IS reqUired to be reported and the IRS determines that It has not been reported. The Contract Sales Price described on
line 401 above constitutes the Gross Proceeds of this transaction.
SELLER INSTRUCTIONS. If this real estate was your principal residence, file Form 2119. ' Sale or Exchange of Principal Residence. for any gain, with your Income tax return; for other transactions,
complete the applicable parts of Form 4797, Form 6252 andlor Schedule D (Form 1040)
You are required by law to provide. the settlement agent (Fed. Tax ID No: .) with your correct taxpayer identification number. If you do not provide your correct taxpayer identification
number, you may be subject to CIVil or Criminal penalties Imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number
TIN;
SELLER(S) SIGNATURE(S):
SELLER(S) NEW MAILING ADDRESS:
U.s DEPARTMENT OF HOUSING AND UW"'I DEVELOPMENT
TATEMENT
File Number: tI.'~-"07.165
S
FINAL PAGE 2
P . d 07/05/2007 t 09 26 KLL
SETTLEMENT S TitleExpress Se..._,nent jvstem nnte a
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on price $50 000.00 @ 0.000 = BORROWER'S SELLER'S
Division of commission (line 700) as follows: FUNDS AT FUNDS AT
701. $ to SETTLEMENT SETTLEMENT
702. $ to
703. Commission paid at Settlement
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan OriQination Fee %
802. Loan Discount %
803. AOPraisal Fee --
804. Credit Report
805. Lender's Inspection Fee -.
806. MortQaQe Application Fee _..~
807. Assumption Fee -----
808. ----..
809. ..-
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to @$ /day
902. MorlQaQe Insurance Premium for to
903. Hazard Insurance Premium for to
~,
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. @. $ /010
1002. MortQaQe Insurance mO.@$ /010
1003. City Property Tax mo.@$ /010
1004. Countv Property Tax mo. @. $ 26.05 /010
1005. School Taxes mO.@$ 68.34 /010
1009. AQQreQate Analysis Adjustment
1100. TITLE CHARGES
1101. Settlement or closina fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Doc Prep (Mta/Note. Deed) to Said is Flower & Lindsav 250.00 100.00
1106. Notary Fees to Said is Flower & Lindsav 10.00 5.00
1107. Attorney's fees
(includes above iterns No: )
1108. Title Insurance to Abstract Company of Central PA. Inc. 558.75
(includes above items No: I
.-
1109. Lender's Policy
1110. Owner's Policv 50000.00 .558.75
1111. --
1112.
1113.
--
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. RecordinQ Fees Deed $ 38.50 . MortQaQe $ 42.50 . Release $ --
81.00
1202. City/County tax/stamps Deed $500.00 . Mortaaae $ 500.00
1203. State Tax/stamps Deed $500.00 . Mortaaae $ 500.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Water/Sewer to Carlisle Borough 2 273.50
1302. 2007 CtvlTwp Tax to Carlisle Borough Tax Account 343.85
1303. Judament Payoff to Old Town Homes 1 500.00
1304. Reimb for Tax/Mise Est Exo to Eunice Oliver 1 940.41
1305. Curb/Sidewalk Judament to Borough of Carlisle 529.18
1306. Reim for JudQ Cerl to Saidis Flower & Lindsav 10.00
1307.
1308.
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Section J and 502, Section K) 1 409.75 7,191.94
HUO CERTIFICATION OF BUYER AND SELLER
Settlement to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me
e received a copy of the HUO.1 Settlement Statement
~dI~
WARNING IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION
CAN INCLUDE A FINE AND IMPRISONMENT FOR DETAILS SEE TITLE 18:
US CODE SECTION 1001 AND SECTION 1010.
The HUD.1 Settlement Statement which I have prepared IS a true and accurate account of this transaction
I have caused or will cause the funds to be disbursed in accordance with this statement
~.. AM..q \) ~~ tJ-z-)'":o7
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S. W. Barrett Real Estate & Appraisal Services
SUMMARY REPORT
File No. 07..0095
APPRAISAL OF
LOCATED AT:
140 West North Street
Carlisle, PA 17013
FOR:
Redevelopment Authority Cumb Cty
114 North Hanover Street
Carlisle, PA 17013
BORROWER:
Redevelopment Authority Of CumbCty
AS OF:
March 2, 2007
BY:
Cassandra J. Crockett
Certified Residential Appraiser
S. W. Barrett Real Estate & Appraisal Services
SUMMARY REPORl
File No. 07-0095
03/06/2007
Redevelopment Authority Cum b Cty
114 North Hanover Street
Carlisle, PA 17013
File Number: 07-0095
In accordance with your request, I have appraised the real property at:
140 West North Street
Carlisle, PA 17013
The purpose of this appraisal is to develop an opinion of the market value of the subject property, as improved.
The property rights appraised are the fee simple interest in the site and improvements.
In my opinion, the market value of the property as of March 2, 2007
is:
$35,000
Thirty-Five Thousand Dollars
The attached report contains the description, analysis and supportive data for the conclusions,
final opinion of value, descriptive photographs, limiting conditions and appropriate certifications.
Respectfully submitted,
~.fLAf
Certified Residential Appraiser
R.EV-1508 EX+ (6-98).
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
-
ESTATE OF
EVALlNE K. GOENS
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ITEM
NUMBER
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.
FILE NUMBER
21-06-0752
DESCRIPTION
DECEDENT'S FURNITURE, FURNISHINGS AND PERSONAL EFFECTS WERE SOLD WITH THE
HOUSE AT 127 LINCOLN STREET, AS REPORTED ON SCHEDULE A
DECEDENT DID NOT OWN AN AUTOMOBILE OR BANK ACCOUNT AT THE TIME OF HER DEATH
RING AND SILVER SERVICE REFERENCED IN DECEDENT'S WILL WERE NOT FOUND AND WERE
PRESUMABLY SOLD OR GIVEN AWAY DURING DECEDENT'S LIFETIME
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
R.EV-1509 EX+ (6-9B*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
EVALlNE K. GOENS
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
21-06-0752
SURVIVING JOINT TENANT(S) NAME
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
RELATIONSHIP TO DECEDENT
A. LATANYA GREEN
B.
c.
JOINTLY-OWNED PROPERTY:
ADDRESS
140 W. NORTH STREET
CARLISLE, PA 17013
DAUGHTER
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 OEED FOR JOINTLY.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. EXECUTRIX DOES NOT KNOW WHETHER JOINT C/D AT
PRUDENTIAL, AS MENTIONED AT SECTION IV, CLAUSE SEVEN OF
DECEDENTS Will EXISTED AT THE TIME OF HER DEATH
TOTAL (Also enter on line 6, Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
~EV-1511 EX+ (12-99>.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
EVALlNE K. GOENS
FILE NUMBER
21-06-0752
Debts 01 decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
1.
10.
11.
12.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
EWING BROTHERS FUNERAL HOME, PROFESSIONAL SERVICES
FACILITIES AND SERVICES
AUTOMOTIVE EQUIPMENT
CARDS, REGISTER BOOK, MEMORIAL FOLDER, DEATH CERTIFICATES
FUNERAL FLOWERS
1,725.00
1,020.00
945.00
190.00
165.00
2.
3.
4.
5.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) EUNICE OLIVER
Social Security Number(s)/EIN Number of Personal Representative(s) /79 ~ Jt? - <<38'd
Street Address 427 N. WEST STREET
City CARLISLE
3,375.00
State PA Zip 17013
Year(s) Commission Paid: 2007
2.
Attorney Fees
3,375.00
3. Family Exemption: (II decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
.Zip
Relationship 01 Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
REAL ESTATE TAXES, 127 LINCOLN STREET
AMOUNT PAID TO SETTLE CIVIL LAWSUIT, CUMBERLAND DOCKET NO. 06-5558
MISCELLANEOUS SETTLEMENT CHARGES ON SALE 127 LINCOLN STREET
SIDEWALK REPAIRS
R/E TRANSFER TAX
CONTINUATION SHEET TOTAL
1,940.41
1,500.00
105.00
529.18
500.00
2,472.16
8.
9.
17,841.75
TOTAL (Also enter on line 9, Recapitulatior) $
(If more space is needed, insert additional sheets of the same size)
SCHEDULE H
CONTINUATION SHEET
ESTATE OF EVALlNE K GOENS 21-06-0752
13. BORO. OF CARLISLE, WATER/SEWER ARREARS $ 2,273.50
14. R/E TAXES PAID AT SETTLEMENT, NET 198.66
TOTAL THIS SHEET: $ 2,472.16
REV-1512 EX+ (12-03)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
EVALlNE K. GOENS
FILE NUMBER
21-06-0752
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.
REAL ESTATE TAXES, 127 LINCOLN STREET
987.04
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
987.04
REV-1513 EX+ (9-00)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-06-0752
ESTATE OF
EVALlNE K. GOENS
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 LETITIA SMALLWOOD, NO. 004912, PO BOX 180, MUNCY, PA 17756 DAUGHTER .33
2 LINETTE ALEXANDER, 7474 GREENWAY DR, #820, GREENBELT, MD DAUGHTER .33
3 LATANYA GREEN, 140 N. WEST ST, CARLISLE, PA 17013 DAUGHTER .33
I
4 SHABRE CUMBERBATCH, 140 N. WEST ST., CARLISLE, PA 17013 GRANDCHILD 8,750
5 ALEX NELMS, 140 N. WEST ST., CARLISLE, PA 17013 GRANDCHILD 8,750
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- 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)
"'.
Ewing Brothers Funeral Home, Inc.
630 South Hanover Street
Carlisle, P A 17013-
(717)243-2421
September 14, 2006
Latonia R. Nelms
127 West Lincoln St.
Carlisle, P A 17013
The Funeral Service for Evaline K. Goens
We sincerely appreciate the confidence you have placed in us and will continue to assist you in bvery way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff .
Embalming. . . . . . . .
Dressing& Casketing Etc. . . .
2. FACILITIES AND SERVICES
Viewing (Visitation/Wake). . .
Funeral Ceremony. . . . . .
Other, Wast Disposal Church Equipment.
3. AUTOMOTIVE EQUIPMENT
Vehicle to transfer remains to Funeral Home.
Hearse (Casket Coach) . . .
Limousine. . . . . . .
Flower car or floral disposition.
Lead car/Clergy . . . . .
Errand Car for Death Certificate filing & Retrieval .
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
Acknowledgement cards.
Register Book(s). . . . .
Memorial folders. . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THA T YOU HAVE SELECTED . . . . . . . . . . . . .
$1100.00
$450.00
$175.00
$425.00
$425.00
$170.00
$195.00
$295.00
$170.00
$95.00
$135.00
$55.00
$3690.00
$35.00
$60.00
$75.00
$3860.00
Cash Advances
Certified Copies of the Death Certificate. . . . . . . . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES .
$20.00
$20.00
Total
Total Cost .
$3880.00
~ \- bLo-DI S~
LAST wILL IN TESTAMENT OF
EV ALINE GOENS
July 29, 2003
I, EV ALINE GOENS, of 127 Lincoln Street, City of Carlisle, County of
Cumberland, Commonwealth of Pennsylvania, being of sound mind, memory and
understanding, declare this to be my Last Will in Testament, hereby revokinig any Will
previously made by me.
SECTION I:
LIFE INSURANCE POLICY
Clause One: I direct the Executrix of my estate to distribute monies from my
insurance policy, as soon as practicable after my death, in the following manner: After all
funeral and burial expenses have been satisfied, all funds remaining from this policy are
,
to be equally divided between my three siblings/daughters: Letitia Smallwood, Linette
Smallwood Alexander and Latanya Green.
SECTION IT:
PEN~ON~TnrnMENTFUNDS
Clause One: I bequeath any and all money remaining from this fund, to my two
minor grandchildren: Shabre L. Cumberbatch and Alex Nelms. Should these
grandchildren be minors at the time of my death, I select as guardian over thelir affairs,
(their mother) Latanya Green. Should Latanya Green cease to serve in this ca.pacity,
guardianship will be designated to Kevin Smallwood.
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TESTATOR EVALINE GOENS
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PAGE lOF (FJ
LAST wILL IN TESTAMENT OF
EV ALINE GOENS
July 29. 2003
SECTION ill:
REAL ESTATE
Clause One: I bequeath my real property, with all policies ofinsurap.ce thereon,
(three story home) located at 140 West North Street, Carlisle, Pennsylvania, County of
Cumberland, in which I have a :fifty percent interest, to my two minor gra1Jldchildren,
Shabre Cumberbatch and Alex Nelms. Should these children be minors at tJhe time of my
death, I select as guardian over their affairs, (their mother) Latanya Green. Should
Latanya Green cease to serve in this capacity, guardianship will be designated to Kevin
Smallwood.
Clause Two: I bequeath my real property, with all policies of insuralnce thereon
and all furnishings included, (one-half double house), located at 127 Lincoln Street,
Carlisle, Pennsylvania, County of Cumberland, to my three daughters: Letitia
Smallwood, Linette Smallwood Alexander and Latanya Green.
SECTION IV:
TANGmLE PERSONAL PROPERTYi
Clause One: I bequeath my tangible and personal property located at 127 Lincoln Street,.
Carlisle, Pennsylvania, County of Cumberland, with all policies of insurance thereon, to
my three daughters: Letitia Smallwood, Linette Smallwood Alexander and Latanya
Green.
TESTATOR EVALINE GOENS
PAGEZOF6
LAST WILL IN TESTAMENT OF
EV ALINE GOENS
July 29, 2003
Clause Two: I bequeath my diamond ring to my minor granddaughter, Shabre
Cumberbatch. Should this child be a minor at the time of my death, I select as guardian
(her mother) Latanya Green. Should Latanya Green cease to serve in this capacity,
guardianship will be designated to Kevin Smallwood.
Clause Three: I bequeath my silver service set located at 127 Lincoln Street,
Carlisle, Pennsylvania, Cumberland County, to my daughter, Linette Smallwood
Alexander.
Clause Four: I bequeath my mother's ring, located at 127 Lincoln Street,
Carlisle, Pennsylvania, Cumberland County, to my daughter, Letitia Smallwood.
Clause Five: I bequeath any automobile that I own at the time of my death or at
the time that I become incapacitated (currently a 1988 Cadillac), to my minor grandson
Alex Nelms. I further stipulate that if Alex is not of legal age to own the cat at the time
of my death or incapacitation, that the car be sold and the proceeds be placed into a bank
account for his education, or until age 21, ifhe does not use the funds for educational
purposes between age 18 and 21.
Clause Six: I bequeath all money in the account at Harris Savings aJIld Loan, in
Carlisle, Pennsylvania, to my daughter Letitia Smallwood, imprisoned at the State
PAGE 3 OF 6
TESTATOR EVALINE GOENS
LAST WILL IN TESTAMENT OF
EV ALINE GOENS
July 29, 2003
Correctional Institution at Muncy, Pennsylvania, Lycoming County. If Letitia meets her
demise prior to her release, the funds are to be designated for her funeral and burial
expenses. I appoint my Executrix, Eunice Oliver to handle the designation dfthis money
in case of the death of Letitia Smallwood.
Clause Seven: I bequeath my fifty percent joint tenure CD of$15,OQO, Goint with
Latanya Green), held by Prudential Insurance Company, to my two minor gtiandchildren,
Shabre Cumberbatch and Alex Nelms, to be placed in an educational fund, t~ be used to
enhance their education.
SECTION V:
FUNERAL ARRANGEMENTS
Clause One: It is my desire to have all funeral and burial arrangemerlts made by
my Executrix, through Ewings Funeral Home, Carlisle, Pennsylvania. All e~penses for
funeral and burial will be paid from my insurance policy.
SECTION VI:
APPOINTMENT OF EXECUTRIXJEXEC*~
Clause One: I appoint Letitia Smallwood who resides at the State Qorrectional
Institution at Muncy, P.O. Box 180, Muncy, PA 17756 and Eunice Oliver who resides at,
427 North West Street, Carlisle, PA, 17013, as Executrixes of this, my Last Will In
Testament. Should Letitia Smallwood and/or Eunice Oliver fail to qualify or cease to act
as Executrix, I appoint Kevin Smallwood, who resides at 3326 Willoughby $eech Road,
Edgewood, Maryland, 21040, Harford County, as my Executor.
PAGEI4 OF 6
TESTATOR EVALINE GOENS
LAST WILL IN TESTAMENT OF
EV ALINE GOENS
Julv 29. 2003
SPECIAL NOTE
This Last Will In Testament will also serve as Power of Attorney over all my affairs, if
at any time prior to death, I become incapacitated and/or not able to handle my affairs
on a daily basis. The Executrix and/or Executor, appointed for my will is' also
appointed as my Power of Attorney.
IN WITNESS WHEREON, I have hereunto set my hand this \ \
h~9U5+- , 2003.
day of
TESTATOR - Evaline Goens
The preceding instrument, consisting of~typewritten pages, each identified by the
signature of the Testator, was on the date thereof, signed, published and declared by
Evaline Goens, the Testator therein named, as and for her last will, in the presence of us,
who at her request, in the presence of each other, have subscribed our names as witnesses
hereto.
WITNESSES
Name:
Address:
Eunice Oliver
427 N. West St., Carlisle, PA
.~'L~~ill
, SIGNATURE
Name:
Address:
Samuel Oliver
427 N. West St., Carlisle, PA
/dt/U4A 1;;;) ~ !o:3
SIGNA /
Name:
Address:
Kevin Smallwood
3326 Willoughby Beech, Rd.
Edgewood, Maryland
~v':'" \t\.t ~j,l
SIGNATURE
TESTATOR EVALINE GOENS
PAGE 5 OF 6
LAST WJ1,L IN TEST AMENT OF
EV ALlNE GOENS
Julv 29. 2003
SIGNATURE OF TESTATOR IN FRONT OF NOTARY
.~hL<<-,- "~
EvalineGoens
Subscribed before me this \ \ +n day of ~USl\5-t ,2003
~M\j.Q~ (1. ~f\\~jL
NOTARY
Mv Commission Expires:
Notarial Seal
K1mbe11y A. Bitner, Notary Public
Carlisle Borough, Cumberland County
My CommIssIOn Expires Nov. 12,2000
Member. Pennsylvania A8so::1ati~n Of .t.J~riflfl
TESTATOR EVALINE GOENS
P AGB 6 OF 6