HomeMy WebLinkAbout09-13-07 (2)
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1S0Sb041147
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
REV-1500
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN 2 1 07
RESIDENT DECEDENT
File Number
0267
126260485
03112007
Date of Birth
04261930
Decedent's Last Name Suffix
DUCHARME
Decedent's First Name
DOROTHY
MI
G
(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
X. 1. Original Return
~KJ
7 Decedent Maintained a Living Trust
. (Attach Copy of Trust)
D
D
1
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
9. Litigation Proceeds Received
D
D
D
D
4a. Future Interest Compromise
(date of death after 12-12-82)
2. Supplemental Return
4. Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
8. Total Number of Safe Deposit Boxes
10 Spousal Pov~ Credit (date of death
. between 12-31-91 and 1-1-95)
D
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
r...~."'J
CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORr.fA'~. SHOUL~.. DIRECTEllTO:
Name Daytime Telephb!'l',e Number" : .
IVO V OTTO III 7172433~4-}.. .~ I.
. :'\
Firm Name (If Applicable)
MARTSON LAW OFFICES
~-
REGISTEROF'Wttt.S USE ONL Y-
, ~- -),--) --n -
/) -':'.ii
First line of address
10 EAST HIGH STREET
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_.--i
r.)
r'.,)
Second line of address
DATE FILED
City or Post OffIce
CARLISLE
State
PA
ZIP Code
17013
Correspondent's e-mail address:iotto@martsonlaw.com
Under penalties of p,erjury, 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 personlil representative is based on all information of which preparer has any knowledge.
SIGNATURE OF. PE N NSIBLE FOR FILING RETURN DATE
Michael J. DuCharme
DATE
Ivo V Otto III
10 East High Street, Carlisle, PA 17013
Side 1
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1SDSbD41147
1SDSbD41147
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lSDSbD42146
REV-1500 EX
Decedent'sName: Dorothy G. DuCharme
RECAPITULATION
Decedent's Social Security Number
126260485
1. Real Estate (Schedule A}..................................................................................... 1.
164,900.00
2 .44
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.
16,260.03
5,762.89
6. Jointly Owned Property (Schedule F) D Separate Billing Requested............ 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D Separate Billing Requested............ 7.
8. Total Gross Assets (total Lines 1-7}.................................................................. 8.
186,925.36
53,346.49
693.20
54,039.69
132,885.67
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, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 1"4"iaXable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
132,885.67
o .00
15. o .00
16. 5,979.86
17. o . 00
18. o .00
19. 5,979.86
o .00
132,885.67
o . 00
19. Tax Due............................................................ ...................................................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
D
Side 2
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15056042146
15056042146
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Dorothy G. DuCharme
STREET ADDRESS
140 Old Gap Road
File Number 21 n07 -0267
----
CITY
Carlisle
I STATE
PA
IZIP
17013
--
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
5,979.86
0.00
Total Credits (A + B + C)
(2) 0 . 0 0
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE.
(3)
(4)
(5)
(5A)
(5B)
5,979.86
5,979.86
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:
a. retain the use or income of the property transferred;.............................................................................
b. retain the right to designate who shall use the property transferred or its income;................................
c. retain a reversionary interest: 0[...........................................................................................................
d. receive the promise for life of either payments, benefits or care?...........................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?................................................... ......... ..................................... ................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death:?....... ~~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?............................................................................................................... C L~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Yes No
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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 statutedoes 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.
Rev-1502 EX+ (6-96)
.
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DuCharme, Dorothy G.
FILE NUMBER
21--07 -0267
All real property _ned aolely or aa a tenant In convnon must be reported at fair market valulair market valuels 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 hailing reasonable knowledge of the relevant facts.
Real property which la Jolntly-owned with right of aurvlvorshlp muat be disclosed on achedule F,
ITEM
NUMBER DESCRIPTION
1 Real Estate - Residence situate at 140 Old Gap Road, North Middleton Township,
Cumberland County, PA, known as Tax Parcel No. 29-07-0471-022, being described
in Deed dated June 22,1971, and recorded in Cumberland County, PA, Deed Book
"W", Volume 24, Page 1012, and being conveyed to Joseph G. DuCharme and
Dorothy G. DuCharme. Joseph G. DuCharme died 8/25/1994, leaving title solely
vested in Dorothy G. DuCharme. Actual sale price, see attached Settlement
Statement.
VALUE AT DATE
OF DEATH
164.900.00
TOTAL (Also enter on Line 1, Recapitulation)
164.900.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule A (Rev. 6-98)
Rey-1503 EX+ (6-96)
*'
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DuCharme, Dorothy G.
FILE NUMBER
21--07-0267
All property jolntly-owned with rtght of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 027627108 25 shares of American Motors Corporation, CUSIP 0.00 0.00
027627108 - Last traded 8/5/1987; No value
2 525030102 25 shares of Leigh Valley Industries, Inc. now known .0976 2.44
as First Medical Group Inc.
TOTAL (Also enter on Line 2, Recapitulation) 2.44
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule B (Rev. 6-98)
Rev-1508 EX+ (8-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DuCharme, Dorothy G.
FILE NUMBER
21--07-0267
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jolntly-owned with the right of survivorshIp must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 AARP, refund of insurance 319.00
2 MetUfe Insurance policy 106316770, payable to estate 3.936.77
3 Orrstown Bank checking account # 412186 8.020.28
Accrued interest on Item 3 through date of death 0.72
4 Prudential Life Insurance policy 24627636, payable to the estate 3.024.26
5 US Treasury, refund of 1040 income tax 459.00
6 Personal property and household goods 500.00
TOTAL (Also enter on Line 5, Recapitulation)
16.260.03
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rev-1~09 EX+ (6-98) .
COMMONWEAlTH OF PENNSYLvANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY -OWNED PROPERTY
ESTATE OF
DuCharme, Dorothy G.
FILE NUMBER
21--07-0267
If an anet was made Joint within one year of the decedenrs date of death, It must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Kathryn D. Poling
ADDRESS
7916 Hollington Place
Fairfax Station, VA 22039
RELATIONSHIP TO DECEDENT
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 ~ATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR ALUE OF ASSE INTEREST DECEDENT'S INTEREST
JOINTL V-HELD REAL ESTATE.
1 A 6/13/1997 Orrstown Bank checking account # 11.525.77 50.000% 5.762.89
108202053
TOTAL (Also enter on Line 6, Recapitulation) 5.762.89
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
REV.1151 EX+ (12.99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DuCharme, Dorothy G.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21--07 -0267
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 11,734.55
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Martson Law Offices (estimated) 9,240.00
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 316.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 32,055.94
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 53,346.49
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DuCharme, Dorothy G.
FILE NUMBER
21--07 -0267
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Ewing Brothers Funeral Home, Carlisle, PA
10.354.55
2
Letort View Community Center, funeral reception
700.00
3
Michael DuCharme, reimbursement for funeral dinner
680.00
Subtotal
11.734.55
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
ESTATE OF
*'
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DuCharme, Dorothy G.
FILE NUMBER
21--07 -0267
ITEM
NUMBER
AMOUNT
DESCRIPTION
1
Culligan, water softner repairs and service pending dispostion of real estate
786.69
2
Cumberland County Register of Wills, filing fee, Inheritance Tax Return
15.00
3
H&R Block, tax preparation
66.00
4
Home Depot, house repairs pending dispositon of real estate
49.98
5
JES Waterpooofing, house repairs pending disposition of real estate
3.972.00
6
Kathryn Poling, reimbursement of house repair expenses pending disposition of
real estate, including landscaping, cleaning and various home repair items
4.045.05
7
Lowes, house repairs pending disposition of real estate
279.07
8
Maughns Painting, house repairs pending disposition of real estate
3.900.00
9
Postage, certified mailing to Department of Public Welfare
4.64
10
PPL Electric Utilities, electric service pending dispostion of real estate
155.17
11
Settlement charges net of tax proration
17.389.50
12
The Hartford Insurance, homeowner's insurance pending dispostion of real estate
319.00
13
Walmart, house repairs pending disposition of real estate
27.74
14
York Waste Disposal, trash hauling
1.046.10
Subtotal
32.055.94
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H-B7 (Rev. 6~98)
Rev-1512 EX+ (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DuCharme, Dorothy G.
FILE NUMBER
21--07 -0267
Include unrelmbureed medical exp.n....
ITEM
NUMBER DESCRIPTION
1 Cingular Wireless, account payable
VALUE AT DATE
OF DEATH
78.98
2 Cumberland County Office of Aging, account payable
13.28
3 Embarq, account payable
42.59
4 Forest Park Health Center, account payable
75.50
5 PP&L Electric Utilites, account payable
102.00
6 Robin Sollenberger, 2007 real estate taxes
380.85
TOTAL (Also enter on Line 10, Recapitulation)
693.20
(If more space is needed. additional pages oflhe same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV.1513 EX+ (9-401
ESTATE OF
NUMBER
I.
1
2
3
4
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DuCharme, Dorothy G.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
Clistributlons and transfers
under Sec. 9116(a)(1.2)]
James W. DuCharme
9 Greystone Drive
Voorheesville, NY 12186
FILE NUMBER
21--07 -0267
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
RELATIONSHIP TO
DECEDENT
Do Not List TN8tee(81
Son
31,780.70
Michael J. DuCharme
6185 Run Cross Lane
Enola, PA 17025
Son
31,780.70
Karen D. Laird
4 Christopher Way
Stafford, VA 22554
Daughter
31,780.70
Kathryn D. Poling
7916 Hollington Place
Fairfax Station, VA 22039
Daughter
Sch. F, Line 1 +
one-quarter of
estate residue
37,543.59
Total 132,885.69
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
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
/\ Settlement Statement
U.S. Department of Housing
and Urban Development
OMB Approval No. 2502.0265
B Type of loan
2 [ ] FmHA 3 [ ] Conv Unlns 16 File Number 17. loan Number: I B. Mortgage Insurance Case Number:
5 [X I Conv Ins 4007012B3-CB 0061639001
NO IE' This form is lurnished to 9ive you a slatement of actual seltlement costs. Amounts paid to and by"lhe settlement agent are shown. Items
marked "(p.o.c.)" were paid outside 01 the closing: they are shown here lor informational purposes and are not included in the totals.
D. Name and Address of Borrower I E. Nama and Address of Seller I F. Nama and Address of lendar
JOI IN M. BENNE ,CH AND RUTH M MICHAEL J. DUCHARME, EXECUTOR OF FIRST HORIZON HOME lOANS, A DIVISION OF FIRST
BENNE'I CII THE ESTATE OF DOROTHY G. TENNESSEE BANK
DUCHARME 300 METRO CENTER BLVD.,
WARWICK, RI 02886
1 [ JFHA
4 ( ] VA
c
491 MUSSELMAN ROAD
rREDERICKSBURG. PA 17026
,PA
G. Property Location
140 OLD GAP ROAD,
CARLISLE, PA 17013.
COUN 1 v: CUMBERLAND
PARCEL ID 29-07-0471.022
IOWNSHIP: tJORTH MIDDLE TON TOWNSHIP
J. SUMMARY OF BORROWER'S TRANSACTIONS
100, Gross Amount Due From Borrower
10 ,. Contract Sales Price I
102. Personal Property I
103. Settlement ChOlges to Borrower I
Adjustments For Items Paid By Seller In Advance
113. Cilytrown laxes
114. Counly laxes 39B B200/yr for 08/01/07 thru 01/0 1/0B
115 School Taxes 1526.5 700/yr for 08/01/07 thru 07101/0B
118. Assessments
119.
H. Settlement Agent
SECURED LAND TRANSFERS - MECHANICS BURG
I Place of Settlemant I, Settlement Date 0B/0112007
1,1068 HARRISBURG PIKE Disbursement Date 08/0112007
CARLISLE, PA
K. SUMMARY OF SEllER'S TRANSACTIONS
400. Gross Amount Due To Seller
$164,900.00 40 ,. Contract Sales Price I
402. Personal Property I
$7,758.96 403. I
Adjuatments For Items Paid By Seller In Advance
413. CityfTown Taxes
$187.1B 414. County Taxes 398.8200/yr for 08101/07 thru 01101/08
$1,397.27415. School Taxes 1526.5700/yr for 08101/07 thru 07101/08
418. Assessments
419.
$164,900.00
$167.18
$1,397.27
120. Gross Amount Due From Borrower
200. Amounts Paid By Or In Behalf 01 Borrower
~O 1. Deposit or Earnest Money
202, rrincipal Loan Amount rrom First Horizon Home
Loans, a division of first 'fennessee Bank
?03. Existing loan(s) laken Subject to
Adjustments For Items Unpaid By Seller
210
I
$174,223.41 420, Gross Amount Due To Seller
500, Reductions In Amount Due To Seller
501. Excess Deposits
502. Settlement Charges to Seller
503. Existing loan(s) Taken Subject 10
Adjustments For Items Unpaid By Seller
510.
511.
512.
I
$166.464.45
$1,000.00
$164,900.00
I
I
$14,006.95
211.
212.
713 City/fawn raxes
214. County laxes
218 Assessments
513. CilyfTown Taxes
514. County Taxes
518. Assessments
519.
521. Seller Paid Closing Costs
219.
221. Seller Paid Closing Costs
220. Buyer's Total Credits
300. Cash AI Settlement FromlTo Borrower
301 Gross AllOUlll Due From Borrower (line 120)
302. less Amounls Paid By/For Borrower (line 220)
$170,847.00
520. Seller's Total Charges
$4,941.00
I $1 B,953. 95
I $166,464.45
I $1 B,953. 95
I $147,510.50
$4,947.00
600. Cash At Settlement To/From Seller
$174,223.41 601. Gross Amount Due To Seller (line 420)
$170,847.00 602. Less Deductions In AmI. Due To Seller (line 520)
303. Cash [X] From [ I "To Borrower
I
$3,376.411603. Cash [X] To [ ] From Seller
d~~jl;L/
400701283 - CB Pdge 2
L. SeUlement Statement
700. Tolal Sale Commission 164900.00@6'1e: 9894.00
Division of Commission (line 700) As Follows: Paid From Borrower's Paid From Seller's
701. $9894.00 10 ERA-NRT, Inc Funds AI Sellleme"t Funds At Solllemenl
702. Commission Selling
703. Commission paid at settlement $9.89400
708. Broker Admin Fee to ERA-NRT, Inc. $165.00
709. Broker Admin Fee to ERA-NRT, tnc. $165.00
800. Items Payable In Connecllon With Loan
801. loan Origination Fee
802. Loan Discount
803 Appraisal Fee to E Troup (pOC 300.00 by Boyer)
804. Credit Report 10 Equity Concepts $1620
805 l.ender Inspection Fee
811 Processing Fee to Equity Concepts $995 00
813 Tax Service 10 T utal Mortgage Solutions $90 00
816 Mortgage Broker Fee to Equity Concepts $1.649.00
817 Administration Fee to First Horizon Home Loans, a division of First Tennessee Bank $545 00
819. Yield Spread Premium to Equity Concepts (PaC $2,061.25 by First Horizon Home loans, a division of Firsl
Tennessee Bank.)
826. Fluod Determinallon to Federal Flood $26.00
900. Items Required By Lender To Be Paid In Advance
901 Interest
902 Mortgage Insurance Premium
903 Hazard Ins. Premium to Farmers'Mutuallns. Co. $469.00
904 . Flood Ins. Premium
1000. Reserves Deposited With Lender
1001. Hazard Ins Reserve 3 mo @ 39.08/ mo First Horizon Home loans, a division of First Tennessee Bank $117 24
1002. Mortgage Ins. Reserve 0 mo @ 17727/ mo First Horizon Home l.oans, a division of First Tennessee Bank
1003. City Property Taxes
1004. County Property Taxes 7 mo @ 33.24/ mo First Horizon Home loans, a division of First Tennessee Bank $232.68
1005. Schoul Taxes 2 mo @ 127.21/ mo First Horizon Home loans, a division of First Tennessee Bank $254.42
1010. Aggregate Accounling Adjustment from First Horizon Home Loans, a division of First Tennessee Bank .$205 25
1100. Title Charges
1101. SelllemenUClosing Fee
1102. Abstract or Title Search
1103. Tille examination
1104 Tille Insurance Binder
1105 Document preparation
1106 Notary fee to Cash $20.00 $10 00
1107 Attorney Fee
1108. Title Ins. Total to Secured land Transfers - Mechanicsburg $1,18375
1109. lender's Coverage $164900.00 ($)
1110. Owner's Coverage $164900.00 ($1183.75)
1111. Endorsements-l00/300/900 ($150.00) to Secured land Transfers - Mechamcsburg 515000
1116. Insured Clusing Protectiun Leller to Censtar Title Insurance Company $35 00
1119. Wire Transfer Fee to Secured land Transfers - Mechanicsburg $35.00
1127 Electronic Delivery & Handling Fee to Secured land Transfers - Mechanicsburg $50 00
1138. Processing!Tax Cert. to Secured land Transfers - Mechanicsburg $10.00
1140. Overnight Mall to Secured land Transfers - Mechanicsburg $25 00
1200. Government Recording And Transfer Charges
1201. Recording Fees for Deed 38.50; Recording Fees for Mortgage 84.50 510300
1202. City/County Tax/Stamps 1649.00 --
$1,64900
1203. State Deed Tax 1649.00 $1,64900
1300. Addlttonel Settlement Charges
1302 Pest inspection to POC-B
1305.200712008 School Taxes to Robin K. Sollenberger, Tax Collector $1.52657
1306. Home Inspection to POC-B
1307. Well Inspection 10 Culligan --
$33.92
1308. Septic Inspection 10 Peck's Septic Service $120.00
1309. Waler Service Repairs to Culligan $77.38
1310. Septice Inspection/Repair to Peck's Septic Service $67500
1400. Total Settlement Charges $7,75896 $14.006.95
I have carefully reviewed the HUO~ 1 Settlement Statement and 10 the best of my knowledge and belief it is true and accurate slatement of all receipts and disbursements
made on my account or by me in this transaction. I further certify thai I have received a copy of the HUD-1 Settlement Statement
BUYE~~ SELLERS
f! - 4;;f
_ '1;2 -'-~' A1 It~f /. _ ------ ~he;:IhXl~u&L0t /./~
~nnetch
- - N.. ~ ______ '-- By: Michael J. DuCharme, Ex culor
Ru Bennelch
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 10 be dlsburst::J in
accordance with lhls statement
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Settlement Agent( / ..'j ./ Date
.. .- - ') -~-'~ /L' (i 08/01/2007
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SECURED LAND TRANSFERS - MECHANICSBURG
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Estate Valuation
Date of Death: 03/11/2007
Valuation Date: 03/11/2007
Processing Date: 06/04/2007
Estate of: Dorothy G. DuCharme
Report Type: Date of Death
Number of Securities: 2
File ID: 4934.1
Shares
or Par
Security
Description
High/ASk
Low/Bid
Mean and/or Div and Int Security
Adjustments Accruals ,alue
...,.
25 AMERICAN MTRS CORP (0276271081
NYSE
08/05/1987
4.62500
4.50000 H/L
Last price available on 08/05/1987
4.562500
N/A
2)
25 FIRST MEDICAL GROUP INC (525030102)
NQB
03/09/2007
03/12/2007
0.07000
0.18000
0.07000 H/L
0.07000 A/B
0.097500
'::'.'1"J
Total Value:
Total Accrual:
Total: $2.44
$:.~.j
so.oo
Page 1
7his report was produced with EstateVal, a product of Estate Valuations & pricing Systems, Inc. If you ha,e questions,
please contact EVP Systems at (818) 313-6300. (Revision 6.4.11
c:5~~ t ~
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JUN 05 2007 10:3SAM HP LASERJET 3200
10.2
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ORRSTOWN
BANK
A Tradition of Excellence
June 5, 2007
77 East King Street
P.O. Box 250
ShJppensburg, PA 17257
To: Vicki
From: Traci ShatTer
Orrstown Bank
Customer Service Center
PO BOX 250
Shippensburg, Pa 17257
Re: Estate of Dorothy DuCharme
Date of death March 11, 2007
IT IS HERERBY CERTIFIED THAT T/IE ABOVE NAMED DECEDENT, ON THE
ABOVE DATE. HAD THE FOLLOWING ACCOuNTS WITH ORRSTOWN BANK
CHECKLVG ACCOUNT Accrued Interest ~ e..
ACcOlUlt # Title of Account Date opened Principle
413186 Dorothy DuCharme 2/] 8/97 8020.28 0.72 c5r}rJ
108202053 Dorothy DuCharme 6/13/97 11521.93 3.84 ~ J
Kathryn D Poling J ~I
SA VINGS ACCOUNT
Account # Title of Account Date oDCned Principle Accrued Tnterest
CERTIFICATE OF DEPOSIT
Account # Title of ACcOlmt
pate Opened Principle
Accrued Interest
\\, \\, w.orr\lCl"" n.( (1111
MetLife' Metropolitan Life Insurance Company
Notice of Claim Payment
500 SCHOOLHOUSE ROAD
JOHNSTOWN, PA. 15915
NAME OF DECEASED
nnRnTHY r. nu r.HARMF
II
DATE OF DEATHI
03/11/")007
MARTSON LAW OFFICES
10 EAST HIGH STREET
D1ST PHONE NUMBER
(914) 631-4848
CARLISLE PA 17013
Please See Important Notice on Reverse Side
Policy Number 106316770
Codes Refer to A
:vtessages Below.
Items Payable
Policy Amount 1287.95
One-Year Term Insurance
Additional Insurance 2648.82
Dividends With Interest
Dividend to Policyholder
Terminal Dividend
Premium in Advance
Interest on Claim
Deductions
Premium in Arrears
Loan
Loan Interest
TOTAL
3936.77
A. OUR CHECK FOR THE BALANCE DUE IS ATTACHED BELOW.
5876 (: -:s~,: F'r:n~, oj.n L.S..\
Detach stub before cashing
MetLife
'vletropolitan Life Insurance Company
Prrscnal LIfe Insurance Death Cl:lIm
Policy:-.iumbrr(s)
Check Number
This claim has been
approved for the total of
the amounts appearing
in the boxes below.
Items determining these
amounts are listed to
the left.
Amount Held for DcfcrI"ed Payment
Chl:ck Issued by Customer SCI'\'ICE: Centt>1'
Check for Balance Due
3936.77
JY45i S.~('HL(11'11~4;
623
50-937/213
002739127
:'-Jot Valid Before
Pay In the Order of:
Get Met. It Pays.
Cent>
./P\lor~311 Chase Bank. ~A
61)40 T.1rl'c11 RO:ld
S) r:lcu,e. ~\ J;j2iJ6
MICHAEL J DUCHARME EXECUTOR OF THE
ESTATE OF DOROTHY G DUCHARME,
DECEASED
$ "ob'c3936"'77
i~ft:
c5~c ~ 2-
III 0 0 2 ? 1 g . 2 ? III I: 0 2 . 109 1 ? g I: 13 2 100 b 2 1111
AUfHORIZED SIGNATURE
(~ Prudential
vO Financial
WSHO
BATCH NO. SN34
000000727
The Prudenliallnsumnce Company of America
Cuslomer Service Office
PO Box 7390
Philadelphia. PA 19176
www.prudential.com
Reason for Check: DEATH CLAIM
Check Number: D 1201243069
Check Amount: $3.205.66
Statement Date: JUL 25 2007
Contract Number: 24627636
InsuredAnnuitant: DOROTHY G DUCHARME
~.
MARTSON DEARDORFF ET ALS
ATTN VICTORIA LOTTO
10 EAST HIGH STREET
CARLISLE PA 17013
YOUR CHECK STATEMENT
Page 1 of 2
We hope we have been of help to you during this difficult time.
This check for $3,205.66 represents the proceeds from the death claim on
contract 24 627 636.
SOURCE OF FUNDS $2,000.00 FACE AMOUNT OF INSURANCE
$1,024.26 ACCUMULATED DIVIDENDS AND INTEREST
62 0 TERMINATION DIVIDEND
0.3 POSTMORTEM DIVIDEND
14.06 PREMIUMS RETURNED
45.00 INTEREST FROM DATE OF DEATH
AMOUNT OF CHECK $3,205.66
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
- If the deceased was named as a beneficiary on any other insurance contracts, we
suggest that a new beneficiary be named as soon as possible.
- Social Security benefits may also be available. For more information, get in
touch with the appropriate government office in your area.
** CONTINUED ON NEXT PAGE **
For insurance service, get in touch with your representative or this office.
LIFE CLAIM DIVISION
PO BOX 7390
PHILADELPHIA PA 19176
TEL 800-778-2255
(FP985SN516)
Delach before cashing Dr depositing check. Please relain this check sla(~Jn~PoHSf.t') reference.
~ Prudential
ve Financial
b 1201243069
The Prudential Insurance Company of America
Customer Service Office
PO Box 7390
Philadelphia. PA 19176
www.prudential.com
Wachovia Bank of Delaware, N A.
Wilmington, DE 19803
62-22
311
. r.ONTRAr.T;)4 R?7 R1R non 11R~47 I
~****************THREE THOUSAND TWO HUNDRED FIVE ;JUL 25 2007 ~*****3205.661
~~ ~*****************************AND 66/100 DOLLARS! : i
VOId afler 180 days
Dollars Cents
To theM I C H A E L J D U C H ARM E ADM I N 1ST RAT 0 R 0 F T * * * *
Order of: H E EST 0 F D 0 ROT H Y G DUe H ARM E * * * * * * * * * * * * *
*****************************************
*****************************************
*****************************************
i3.v- -j,J.d~
TREA'iURER
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III . 20 . 2 L. ~ 0 b ClIII I: 0 ~ . . 0 0 2 2 51: 20 7 Cl Cl 5 00 b 7 ~ L. 2111
f: iti les '.da!afi leiwills\4934, wll
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LAST WILL AND TESTAMENT
I, DOROTHY G. DuCHARME, of North Middleton Township, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and
declare this to be my Last Will and Testament, hereby revoking any and all former Wills or
Codicils by me made.
1.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and
all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any
property) shall be paid from my residuary estate as soon as practicable after my decease and as
part of the administration of my estate. My Executor shall have no duty or obligation to obtain
reimbursement for any such tax so paid, even though on proceeds of insurance or other property
not passing under this Will.
2.
I give, devise and bequeath all of my estate, both real and personal property, in equal
shares, unto my children, KATHRYN L. DuCHARME POLING, JAMES W. DuCHARME,
KAREN S. DuCHARME LIARD and MICHAEL 1. DuCHARME, absolutely.
3.
In the event that any of my said children shall fail to survive me but shall leave issue
surviving, then such deceased child's share shall be held by the surviving parent of such deceased
child's issue, as Trustee, and the net income therefrom shall be used for the support, maintenance
and education of the issue of such deceased child. Said Trustee shall use as much of the
principal as he or she shall deem desirable for said purposes and shall distribute absolutely the
principal of such share of such deceased child to the issue of such deceased child per stirpes as
each shall attain the age oft\venty-five (25) years. In the event that any of my children shall fail
to survive me and not leave issue surviving, then such deceased child's share shall be added, in
. / .
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D.G.D.
Page 1 of 4 Pages
equal shares, to the shares of my other children as if originally a part thereof.
To the extent that the same is permitted by law, none of the beneficiaries hereunder shall
have any power to dispose of or to charge by way of anticipation any interest given to such
beneficiary; and all sums payable to such beneficiaries hereunder shall be free and clear of the
debts, contracts, alienations and anticipations of the beneficiaries, and all liabilities for levies and
attachments and proceedings of whatsoever kind, at law or in equity.
4.
I nominate, constitute and appoint my son, MICHAEL J. DuCHARME, as Executor of
my estate.
5.
I direct that my Executor shall not be required to file a bond to secure the faithful
performance of his duties in any jurisdiction.
6.
I authorize and empower my personal representative and trustees, in their sole and
absolute discretion, to purchase or otherwise acquire and retain any investments of which I die
seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer,
exchange, dispose of or grant options in regard to any or all property of any kind forming a part
of my estate for such terms and such prices as they may deem advisable; to borrow money for
any purposes connected with the protection and preservation of my estate; to mortgage or pledge
any real or personal property forming a part of my estate or to join in or secure the partition of
same; to compromise any claims or demands of my estate against others or of others against my
estate; to make distribution in kind and to cause any share to be composed of cash, property or
undivided fractional shares in property different in kind from any other share; to employ agents,
attorneys and proxies and to delegate to them such power as my personal representative and
trustees consider desirable and to pay reasonable compensation for such services as may be
rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as
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D.G.D.
Page 2 of 4 Pages
may be necessary to carry out any of these powers. In addition, I direct that my personal
representative shall have the power to conduct an inventory of any safe deposit box necessary
to the administration of my estate.
/(
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IN WITNESS WHEREOF I have hereunto set my hand and seal this c:J\ I day of
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Dorothy G. Du€harme
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix,
as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto
subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other.
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Page 3 of 4 Pages
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
I, Dorothy G. DuCharme, Testatrix, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
--", " ('"
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Dorothy G. Du harme
Notarial Seal
Corrina L. Myers, Notary Public
Carlisle 80ro, Cumberland County
My Commission Expires May 27, 1999
Sworn or affirmed to and acknowledged before me by Dorothy G. DuCharme, the Testatrix,
)/51 day of ~/Yta~ , 1'11(1.
I/). \
/ '~/~/),( - I~ ~.()vt{fe(.,:J.J
Notary Public '.
this
COMMONWEAL TH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
- p'"
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We, J 'j(~,~, 1/;1 c/} -I) cd=q-r and' ~IIIS t:~ .\::: (rA "" c- ,
the witnesses who e names are signed to the attached or foreg '. g instrument, being duly qualified
according to law, do depose and say that we were present and saw Dorothy G. DuCharme, the
Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and
that the Testatrix executed it as her free and voluntary act for the purposes therein expressed; that
each of us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best
of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under
no constraint or undue influence.
,
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AddreSs
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Sworn or affirmed to and subscribed before me this ,3, I - day of
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Page 4 of 4 Pages