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Home My WebLink About09-12-07 ~~~ tZ?Zd ~~3Z&~#~~~ Sandra C. Snyder 1?mister of i1M[S and C[erftof Orpfians' Court (j)aupfiin County Court Jfouse 1?90m 1 03 'Front alld:Marl&t Streets (PO. (jJ0)(1295 Jfarris6urg, (P;t17108-1295 rye[ 717-780-6500 'Fa." 717-780-6474 %omas P. qackj, P.squire So[ieitor September 6, 1007 ( ) :.. .) (: -; r. - Dear Glenda F. Strasbaugh, - --I . ~ As per the Department of Revenue's attached letter, you will find the :=: original Inheritance Tax Return documents and Receipt of Payment for the file of Nancy M. Gutshall. We are keeping a copy of the file for our records. If you have any questions in reference to this matter, please do not hesitate to call me at the above given number. fi~(l am~ Gloria J. C~iola Register of Wills Office Re: Dauphin County File # 2207-0636 Cumberland County File # 2107-011 CC""MONWEAl TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 . PENNSYLVANIA . INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. DA007055 Received From: BRUCE D. FOREMAN, ESQUIRE 112 MARKET STREET 6TH FLOOR HARRISBURG, PA 17101 ------Fold Here ACN ASSESSMENT CONTROL NUMBER AMOUNT 8,650.51 101 ~TE INFORMATION: I FILE NUMBER I NAME OF DECEDENT (LAST) I I DATE OF PAYMENT I I POSTMARK DATE I I COUNTY I SSN: 200-24-0430 2207 -0636 (FIRST) (MI) GUTSHALL NANCY 07/13/2007 07/13/2007 I I DATE OF DEATH I ~ DAUPHIN 12/06/2006 8,650.51 REMARKS TOTAL AMOUNT PAID RECEIVED BY SANDRA C. SNYDER Register of Wills SEAL REGISTER OF WILLS Al) /fW!Ak . . .-J 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 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number ~ ot 0030 Date of Birth 200-24-0430 12/06/2006 01/02/1933 Decedent's Last Name Suffix Decedent's First Name MI GUTSHALL NANCY (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 Return (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 Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes BRUCE D. FOREMAN, ESQ (717) 236-9391 Firm Name (If Applicable) FOREMAN & FOREMAN, P.C. REGISTER OF WILLS USE ONLY., ___ 112 MARKET STREET First line of address Second line of address 6TH FLOOR City or Post Office State ZIP Code DATE FILED HARRISBURG PA 17101 Correspondent's e-mail address:bruce@foreman-foreman.COm 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. FILING RETURN J DATE A DRESS BARBARA A. VOGLER, 154 PARKWAY DRIVE, CARLISLE, PA 17015 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS BRUCE D. FOREMAN, 112 MARKET STREET, 6TH FLOOR, HARRISBURG, PA 17101 PLEASE USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 -.J REV-1500 EX Page 3 . . File Number Decedent's Complete Address: DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER NANCY GUTSHALL 200-24-0430 STREET ADDRESS 13 GUTSHALL AVENUE CITY I STATE I ZIP ENOLA i PA i 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 8,650.51 Total Credits ( A + B + C ) (2) 0.00 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. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8,650.51 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 8,650.51 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 [iJ c. retain a reversionary interest; or.......................................................................................................................... 0 [K] 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 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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. S9116 (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. S9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P,S. s9116(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. S9116(1.2) [72 PS. s9116(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. s9116(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. . . ---.I 15056052059 REV-1500 EX Decedent's Name: NANCY GUTSHALL 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) Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . 6. 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) XO_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 72,087.58 18. Amount of Line 14 taxable at collateral rate X. 15 15. 16. 17. 18. 19. TAX DUE ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 200-24-0430 Decedent's Social Security Number 15056052059 97,598.46 0.00 0.00 0.00 10,724.00 0.00 0.00 108,322.46 15,800.55 2,412.44 18,212.99 90,109.47 18,021.89 72,087.58 8,650.51 8,650.51 --.J REV-1502 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF NANCY M. GUTSHALL FILE NUMBER 2007-00011 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market vaiue 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 DESCRIPTION VALUE AT DATE OF DEATH 1. Residence located at 13 Gutshall Avenue, Enola, PA 17025 East Pennsboro Township, Cumberland County, PA (3.70 acres, more or less) 97,59846 By deed recorded in the Cumberland County Recorder of Deeds in Book J-24, Page 105. Proceeds from Settlement 5/21/07 per attached HUD1 TOTAL (Also enter on line 1, Recapitulation) $ 97.598.46 (If more space IS needed. insert additional sheets of the same size) -REV-1508 EX+ (6-98) . . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISe. PERSONAL PROPERTY ESTATE OF NANCY M. GUTSHALL FILE NUMBER 2007 -00011 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 VALUE AT DATE OF DEATH 1. Certificate No. 46176 Belco Community Credit Union 1/2 interest of $6307.84 3,165.81 2. Savings Account No. 091060 Belco Community Credit Union 1/2 interest of $948.33 469.17 3. Christmas Club Acct No. 091060 Belco Community Credit Union 1/2 interest of $150.79 75.10 4. Misc Acct No. 091060 Belco Community Credit Union 1/2 interest of $149.52 74.79 5. Checking Acct No. 091060 Belco Community Credit Union 1/2 interest of $4633.76 2,092.79 6. 1989 Oldsmobile Ciera Sedan 40 Kelley Blue Book Value 450.00 7. Appraised personal property - see attached list 1,510.00 1.00 8. USPS - Safe Deposit Box key refund 9. Social Security payment 946.60 10. House deposit 200.00 11. Deposit refunds (gas and heating) 334.58 12. US Savings Bond 382.80 13. Refund of car insurance 28.00 14. Refund of sewer payment from real estate 68.50 15. Refund from Lane Bryant 47.46 16. Savings Account #766022 - Belco Credit Union 877.40 TOTAL (Also enter on line 5, Recapitulation) $ 10,724.00 (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 NANCY M. GUTSHALL FILE NUMBER 2007-00011 Debts of decedent must be reported on Schedule L ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: Myers-Harner Funeral Horne, Inc. 2. St. Paul's Lutheran Church (Open Grave) 1. 9,51800 725.00 200.00 125.00 3. Cross Gates Community Church (Funeral Luncheon) 4. James R. Gingrich Memorials B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Barbara Vogler Social Security Number(s)/EiN Number of Personal Representative(s) 51-6586200 Street Address 154 Parkway Drive 1,25000 City Carlisle Year(s) Commission Paid: 2007 State PA Zip 17015 2. Attorney Fees 3,500.00 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. Cumberland Law Journal - Estate Advertising 8. The Sentinel - Estate Advertising 256.00 75.00 151.55 TOTAL (Also enter on line 9, Recapitulation) $ 15.800.55 (If more space ]s needed, insert additionai sheets of the same size) . REV-1512 EX+ (12-03) '* . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF NANCY M. GUTSHALL FILE NUMBER 2007-00011 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 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 1. Visa @ Belco Community Credit Union Acct No. 091060 34.62 2. Leffler Energy (2 months @ 63.00 - budget amount) 126.00 3. PPL Electric Utilities (December) 60.18 4. PPL Electric Utilities (January) 26.43 5. PPL Electric Utilities (Feb-Mar) 141 .34 6. PPL Electric Utilities (Final bill) 9.74 7. Verizon (Final Bill) 4.94 8. East Pennsboro Township - Sewer and water - February 75.35 9. East Pennsboro Township - Sewer and water - April 68.50 Camp Hill Animal Hospital (for Nancy's dog, Casey) 145.00 Camp Hill Animal Hospital (for Casey) 45.00 Stonehill, Ltd (Grooming of Casey - 3 times) 75.00 Terminex 318.00 Donegal Mutual Insurance Company (Homeowner's Insurance) 190.50 2007 County Real Estate Taxes 374.69 Bankers Life Insurance 233.15 H & R Block - Nancy's Tax Return 79.00 R J Fried Appraisal (to sell house) 345.00 Chuck Bricker Auctioneer (for personal property appraisal) 60.00 TOTAL (Also enter on line 10. Recapitulation) $ 2.412.44 (If more space is needed. insert additional sheets of the same size) 'REV-1513 EX+ (9-00) '* . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF NANCY M, GUTSHALL FILE NUMBER 2007-00011 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. Jean P. Motter, 6612 Carlisle Pike, Mechanicsburg, PA 17050 Sister 54065.68 (specific bequest plus 60% of rest, residue and remainder of estate) 2. Faye E, Baumgardner, 36 S, Enola Drive, Enola, PA 17025 Sister 18021.89 (specific bequest plus 20% of rest, residue and remainder of estate) 3. Barbara Vogler, 154 Parkway Drive, Carlisle, PA 17015 Niece Specific Bequest 4. David L. Motter, 96 Beagle Club Road, Carlisle, PA 17013 Nephew Specific Bequest 5. Michael J. Bruckhart, 6612 Carlisle Pike, Mechanicsburg, PA 17055 Great Nephew Specific Bequest 6. Mark E. Motter, 6612 Carlisle Pike, Mechanicsburg, PA 17055 Nephew Specific Bequest 7. Mary Kay Burnside, 119 Market Street, New Cumberland, PA 17070 Niece Specific Bequest 8. Andrew W. Motter, 104 E. Simpson Street, Mechanicsburg, PA 17055 Nephew Specific Bequest 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 1. Cross Gates Community Church (20% of rest, residue and remainder of estate) 18021.89 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 18021.89 (If more space is needed, insert additional sheets of the same size) . . SCHEDULE J BENEFICIARIES (Continued) ESTATE OF FILE NUMBER NANCY M. GUTSHALL 2007-00011 NO. NAME RELATIONSHIP AMOUNT 9. Laura J. Vogler Great Niece Specific Bequest 19100 Ford Avenue (Personal Property) Desert Hot Springs, CA 92241 10. Tracy L. Baumgardner Niece Specific Bequest 53 Gilbert Road (Personal Property) Shippensburg, PA 17257 Previous p.dltions are obsolete lement St::~:~:;"fH,ndbOOk43052 A. I' U.S. Department of Housing and Urban Development SM I GEL.. AND E R SON OMS No. 2502-0265 ex ires 9/30/2006 I . S. TYPE OF LOAN I & SA C KS 1 DFHA 2. DFmHA 3. !\lConv Un ins L~.: LU' 4. OVA 5 OConv Ins. .-\T'1'CIRNEYS AT LAW 6. FILE NUMBER 7. LOAN NUMBER 9359-1.9AJAB 77780093BRUCKHA 8. MORTGAGE INSURANCE CASE NUMBER Is-form IS urnlS e 0 give you a semen 0 ac a 58 emen cos 5. aun 5 pa 0 an y e se ernen agen are 5 own. C. Note: lIems marked "(P.o.c.)" were paid out$ide !ht closing; they are shown hore for information purposes and are not Included in the totals. WARNING: It is a crime 10 knowingly make false statements to the United States on this or any other similar form. Ponalties upon convictIon can Include a fine and 1m rlsonmcnt. For details see: TlIle 18 U.S. Code Section 1001 and Section 1010. I D NAME OF BORROWER: Michael R. Bruckhart ADDRESS 6612 Carlisle Pike Mechanicsbur PA 17050 E. NAME OF SELLER Estate Nancy Mae Gutshall ADDRESS: 13 Gutshall Avenue Enola PA 17025 F. NAME OF LENDER COMMERCE BANKlHARRISBURG N.A. ADDRESS 3801 Paxton Street Harrisbur PA 17111 G. PROPERTY ADDRESS 13 Gutshall Avenue, Enola, PA 17025 East Pennsboro T ownshi TitleExpress Settlement System I Printed OS/21/2007 at 1021 CNM H. SETTLEMENT AGENT: Smigel, Anderson & Sacks, LLP, Telephone: 717.234.2401 Fax: 717.234-3611 ~PLACE OF SETTLEMENT 4431 North Front Street, Harrisburg, PA 17110 ,_I SETTLEMENT DATE 05/21/2007 i J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101 Conlract sales nrice 100000.00 401. Contract sales orice 100 000.00 -- 102 Personal Prooenv 402. Personal Pronenv 103 Settlement charqes to borrower (line 1400) 4 274.89 403. 104 404. 105 405. Adiustments for items paid bv seller In advance Ad'ustments for items naid bv seller in advance 109 409. - 110 Refuse 05/21/07 to 06/30/07 13.96 410. Refuse OS/21/07 to 06/30/07 13.96 111 - 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 104 288.85 420. GROSS AMOUNT DUE TO SELLER 100 013.96 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER j 201. DenOSlt or earnest monev 306.00 501. Excess Denositlsee instruction~l- 306.00 i 202. Princioal amount of new loans 97 000.00 502. Settlement charnes to seller ttlne 14001 2 109.50 ..J.Q3. EXlstlnn loanlsl taken sub'ect to 503. Existinn loanlsl laken sub'ect to 204 504. Payoff of First Mortoaoe Loan ~irslDoor Prooram Grant 5 000.00 505. i COMMERCE BANKlHBG. NA 206. 506. I 207 507. 208. 508. 209. 509. Adiustments for items un[Jaid bv seller Adiustments for items un[Jaid bv seller i 213. ...- 513. 214 514. 215 - 515. 216 516. r-117 517. 218 518. i I 219 519. 220. TOTAL PAID BYIFOR BORROWER 102 306.00 520. TOTAL REDUCTION AMOUNT DUE SELLER I 2415.50 l300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER _ J01. Gross amo~ot due from borrower {line 1201 104 288.85 601. Gross amount due 10 seller lIine 4201 r 100 013.96 ~Less am~.t~paid by/for borrower {line 2201 102 306.00 602. Less reduction amount due seile;nine 5201 i 2415.50 I 303. CASH FROM BORROWER 1 982.85 603. CASH TO SELLER 97 598.46 SUBSTITUTE FORM 1099 SELLER STATEMENT: The Information contained here~n Is Important tax Information and ls being furnlshed to the Internal RSlfenuQ Servlco. If you are required to filo a return. a negligence penalty or other sanctlon will be lmpoud on you if this item 15 reqUired to be reported and the IRS determines lhat It has not been reported. The Contract Sales Price described on line 401 above constitutes the Gross Proceeds of this transaction. You are required by Law to provldethl} sl}ttleml}nt agl}nt (Fed. Ta~ 10 No: 1 with your correct lall.paY9f Identlficadon number. If you do not provide your correct taxpayer identification number. you may be subject to cIvil or criminal penalties Imposed by law. Under ponaltl9& of perjury, I certtty that ti1e number shown on this statement is my correctlall.payer Identification number. TIN: .._- _-__1_"_"_ SELLER(S}SIGNATURE[S): SELLER(Sl NEW MAJUNG ADDRESS: SELLER/51 PHONE NUMBERS: (H) (WI PrBvious edillons are obsolete . US DEPARTMENT OF HO NO URBAN DEVELOPMENT SETTLEMENT STAT T File Number: 935. form HUO.1 {3/86) ref Handbook 4305.2 PAGE 2 TitleExDress Settle stem Printed OS/21/2007 at 1021 CNM I L. SETTLEMENT CHARGES PAID FROM PAID FROM LI-oo TOTAL SALESIBROKER'S COMMISSION based on once $100 000.00 = BORROWER'S SELLER'S I Division of commission (line 7001 as follows: FUNDS AT FUNDS AT i 701 $ to SETTLEMENT SETTLEMENT I 702 $ . to i L-lQL..(ommlsslon paid al Settlement ~o. ITEMS PAYABLE IN CONNECTION WITH LOAN ! 801. Loan OrlOlnatlon Fee % 802. Loan Discount 1.000 %COMMERCE BANKlHBG. NA 970.00 ! p:t Appraisal Fee to .8J Fried & Associates 50.00 ..- 804 Credit Rooorl to Credit Reporting Agency $11.68 POC bv Lender ~dmrnlstra\lon Fee to COMMERCE BANKlHBG. NA 325.00 806. Overnlaht Malt Fee to COMMERCE BANKlHBG. NA $30.00 POC bv Lender ~7 flood Certification Fee Fee to US Determination Service, Inc. $6.00 POC bv Lender 808. Mortqaqe Asslqnment to COMMERCE BANKlHBG. NA $3.00 POC bv Lender 809 Bond Prooram Fee to COMMERCE BANKlHBG. NA 300.00 810. 811 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From OS/21/2007 to 06/01/2007 (0)$ 14.9486 Idav 11 Davs 164.43 902. Mortqaqe Insurance Premium for to 903 Hazard Insurance Premium for 1 vr to State Auto PrODertv Insurance (P.O.C.\ 336.00 Buver I 904 I , 905 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance 4 mo. @. $ 28.00 /mo 112.00 1002. Morl aoe Insurance mo. (0)$ Imo 1003. Cltv Property Tax mo @. $ Imo ~County Property Tax 4 mo. @. $ 28.38 Imo ... 113.52 ..1 Q05. SchoolT axes 13 mo. (a) $ 105.58 Imo 1 372.54 1009. Aqareaate Analysis Adjustment to COMMERCE BANKlHBG. NA -169.16 0.00 1100. TlTLECHARGES . 1101 Settlement or c10sinq fee -- i 1102. Abstra~t or title search 1103. Title examination 1104 Title Insurance bi~der 1105. Document Preparation . 1106. Nolary Fees to Cash 10.00 10.00 1107 Altornev's fees (includes above Items No' t 1108. Title Insurance to Smiael AndersDn & Sacks 644.06 _~. [rncludes above items No 75% of basic rate. PHFA I 1109 lender's Policv 97000.00 1110. Owner:s Policv 100000.00 - 644.06 1111 100 No Viol 300 SUr/ev. 900 E to Smiael. Anderson & Sacks 150.00 1112. 1113 CloslnoSvcLtr 10 Smiael. Anderson & Sacks 35.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES '201 Recordln~ Fees Deed $38.50 : Mortqaqe $ 60.50 . Release S 99.00 I 1;>02 City/County taxlstamps Deed $1 ,000.00 : Mortq aqe $ I 1 000.00 1203 Slate T axlstamos Deed S1.000.00 . Mortaaoe $ i 11lQ!hQQ. ~&cord Subordinate Mortqaqe to Recorder of Deeds .. 38.50 I 1205 , I 1300. ADDITIONAL SETTLEMENT CHARGES .J101 Overnight mall lee to Smiael Anderson & Sacks 10.00 _1302 Download fee to Smiael Anderson & Sacks 50.00 ~3 Sewer 4~ 1 ~07 to 6~30-07 to East Pennsboro Townshio Authoritv 68.50 ~Reluse 5~ 1.(j7 to 6~30-D7 to East Pennsboro Townshio Authoritv 31.00 1305 ~ i 1307 I 1308 11400. TOTAL SETTLEMENT CHARGES I I enter on lines 103 Section J and 502 Section KI i 4274.89 2,109.50 I I have carefully revIewed tho HUQ.1 Settlement Statement and Lo the best 01 my knowledge and belief, It Is a true and accurate statement of all r9calptll and disbuncmonts made an my accounl or by mo In thiS transacUon. I further certify that I flavs received a copy of the HUD.1 Settlement Statemenl M"~~~ P.!J.Kl./.P. $+ V<>? A (Cte "- WARNING: IT IS ACRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR ~ORM. PENAL TlES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TlTLE 18: US. CODE SECTlON 1001 AND SECTION 1010. The HUD.1 Settloment Statement which I have pn:.pared Is a true and accurate account 01 this transaction. : have caused or will cause the funOs to be disbursed In accordance wlttllhls statement. By;r C'/~/l 6; DATE . APPRAISAL. Personal Propeny of ,..- ( Appraised by Chuck E. Bricker AU094-L Date ITEM iVALUE I I ! 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