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Home My WebLink About09-27-07 .-.J 15056041125 REV-1500 EX (06-05) PA Department of Revenue. ~~~~:~~~~~uaITaxes INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFJC;r",L \)$[. ()hi '.' County Code Year 2 1 0 7 File Number o 2 1 2 Date of Birth 178050884 o 302 2 007 1 0 0 5 1 9 1 9 Decedent's Last Name Suffix Decedent's First Name REAGER F RED E R I C K MI W (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 00 1. Original Return o 4. Limited Estate 00 o 2. Supplemental Return o o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 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 0 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 o o o o 8. Total Number of Safe Deposit Boxes S USA N H CONFAIR 7177631383 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY REAGER & A D L E R , P C First line of address 2 3 3 1 MARKET STREET 'J j --_...J C AMP H ILL P A 17011 C) - ., J Second line of address (- .'"~l :-n r,) City or Post Office State ZIP Code Correspondent's e-mail address:SCONFAIR@REAGERADLERPC.COM Y ~ ' I Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration arer than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON SPO BL G RETURN DATE ADDRESS 2314 MARKET r CAMP HILL PA 17011 DATE _Z~~ of- PA 17011 ADDRESS 2331 MARKET STREET CAMP HILL PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 15056041125 .-.J cj -.J 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: FREDERICK W. REAGER RECAPITULATION 178050884 2. Stocks and Bonds (Schedule B) ....... . ........................ .. 2. 126900.00 127336.08 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 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) D Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested . . . . . .. 7. 7 3 9 9 1 9.6 3 8. Total Gross Assets (total Lines 1-7) ...................... . 8. 9 9 4 1 5 5 . 7 1 9. Funeral Expenses & Administrative Costs (Schedule H) 9. 7 3 0 8 . 2 7 ............... . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 4 4 5 5 . 6 5 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 1 7 6 3 . 9 2 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 9 8 2 3 9 1 . 7 9 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. 9 8 2 3 9 1. 7 9 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.O _ o . 0 0 15. O. 0 0 16. Amount of Line 14 taxable 9 8 2 3 at lineal rate X .O~ 9 1 . 7 9 16. 4 4 2 0 7 . 6 3 17. Amount of Line 14 taxable o . 0 0 at sibling rate X. 12 17. O. 0 0 18. Amount of Line 14 taxable o . 0 0 at collateral rate X. 15 18. O. 0 0 19. Tax Due 19. 4 4 2 0 7 . 6 3 ............................................... . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT D Side 2 L 15056042126 15056042126 -.J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 07 0212 DECEDENrs NAME FREDERICK W. REAGER STREET ADDRESS 17 SOUTH 24TH STREET CITY I STATE I ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 44,207.63 34,000.00 1,789.42 Total Credits (A + B + C) (2) 35,789.42 3. InteresVPenalty if applicable D. Interest E. Penalty T otallnteresVPenalty ( 0 + E ) (3) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 0.00 8,418.21 5. If Une 1 + Une 3 is greater than Une 2. enter the difference. This is the TAX DUE. (5) B. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (5A) (5B) A. Enter the interest on the tax due. 8,418.21 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 00 b. retain the right to designate who shall use the property transferred or its income; ............................... 0 00 c. retain a reversionary interest; or ................................................................................................ 0 00 d. receive the promise for life of either payments, benefits or care? ....................................................... 0 00 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 00 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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. 99116 (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 retum 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 + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER FREDERICK W. REAGER 21 07 0212 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 properlY which is iointly-owned with right of survivorship must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION 17 SOUTH 24TH STREET, CAMP HILL, PA 17011 CONTRACT SALES PRICE - SEE ATTACHED SETTLEMENT SHEET VALUE AT DATE OF DEATH 126,900.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 126900.00 REV-1503 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FREDERICK W. REAGER FILE NUMBER 21 07 0212 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION US SAVINGS BONDS, 6 SERIES I BONDS, ISSUE DATE 11/1/2001 VALUE AT DATE OF DEATH 60,000.00 2. US SAVINGS BONDS, 3 SERIES EE BONDS, ISSUE DATE 12/15/92 33,012.00 3. US SAVINGS BONDS, 30 SERIES EE BONDS, ISSUE DATE 10/6/92 33,012.00 4. MET LIFE, INC - CUSIP NUMBER 59156R10 PO BOX 4420 SOUTH HACKENSACK, NJ 07606 1,312.08 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 127336.08 REV-1508 EX + (6-98) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FREDERICK W. REAGER FILE NUMBER 21 07 0212 Indude 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 1. 2. 3. 4. 5. 6. 7. 8. 9. DESCRIPTION METLlFE - ANNUITY CONTRACT 007 059118 MA PO BOX 10342 DES MOINES, IA 50306-0342 PNC BANK - CHECKING ACCOUNT 5140051507 500 FIRST AVENUE PITTSBURGH, PA 15219 COMMERCE BANK - DEPOSIT ACCOUNT 101996 3801 PAXTON STREET HARRISBURG, PA 17111 COMMERCE BANK- DEPOSIT ACCOUNT 101995 3801 PAXTON STREET HARRISBURG, PA 17111 COMMERCE BANK - SAVINGS ACCOUNT 626575617 3801 PAXTON STREET HARRISBURG, PA 17111 PNC BANK -IRA - ACCOUNT 6001003480 PO BOX 3499 PITTSBURGH, PA 15230 REFUND - LIBERTY MUTUAL GROUP - HOMEOWNER'S INSURANCE VALUE AT DATE OF DEATH 19,514.71 11,755.69 49,952.77 78,644.72 539,871.95 24,937.41 784.00 DEPOSIT - CASH 7,997.76 REFUND - ASBURY COMMUNITIES, INC. - BETHANY VILLAGE 6,382.55 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 739 841.56 REV-1511 EX+(12-99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FREDERICK W. REAGER FILE NUMBER 21 07 0212 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS-HARNER FUNERAL HOME, INC. 2,370.00 2. MOUNT CALVARY EPISCOPAL CHURCH - BURIAL 500.00 3. CALVIN VAN HOYT - BURIAL 500.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees REAGER & ADLER, PC 1,800.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 540.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. SHORT CERTIFICATES 40.00 8. ADVERTISEMENT - CUMBERLAND LAW JOURNAL 75.00 9. ADVERTISEMENT- CENTRAL PENN BUSINESS JOURNAL 79.00 10. REALTY TRANSFER TAX & PRORATED 2007 SCHOOL TAXES 1,319.27 11. PRORATED 2007 COUNTY/BOROUGH TAXES 318.47 12. PRORATED SEWER BILL 6.93 TOTAL (Also enter on line 9, Recapitulation) $ 7 548.67 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) '* SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FREDERICK W. REAGER FILE NUMBER 21 07 0212 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1, JANET MILLER, TAX COLLECTOR - 2007 PERSONAL TAXES 1939 WALNUT STREET, CAMP HILL, PA 17011 2. R.B. HOBAUGH & SON, INC. - ELECTRIC REPAIR VALUE AT DATE OF DEATH 4.90 55.00 3. ALBERT PHARMACYSERVICES, INC. - PERSCRIPTION 5225 WILSON LANE, MECHANICSBURG, PA 17055 4. MILLENNIUM PHYC. SYS., INC. - PERSCRIPTIONS 2880 BERGEY ROAD, SUITE A, HATFILED, PA 19440 5. KEYSTONE OIL - HEATING OIL PO BOX 157, CAMP HILL, PA 17011 6. UGI - UTILITIES PO BOX 13009, READING, PA 19612 7. PP & L - UTILITIES 827 HAUSMAN ROAD, ALLENTOWN, PA 18104 8. PAAMERICAN WATER - UTILITIES 494.10 28.36 108.21 76.27 64.97 52.31 9. 2006 FEDERAL TAXES 638.00 10. LIBERTY MUTUAL - HOMEOWNER'S INSURANCE 5000 RITTER ROAD, SUITE 103, MECHANICSBURG, PA 17055 11. HOLY SPIRIT HOSPITAL - HOSPITAL BILL 788.00 367.00 12. FREEMAN REAL ESTATE - APPRAISAL 275.00 13. 2006 INCOME TAX -FREDERICK REAGER 311.00 14. 2006 INCOME TAX - GWENDOLEN REAGER 437.00 15. TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4137.18 ><EV-"" EX". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FREDERICK W. REAGER SCHEDULE J BENEFICIARIES FILE NUMBER 21 07 0212 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 ~nclude outright spousal distributions. and transfers under Sec. 9116 (al (1.2)] 1. DAVID W. REAGER - SON Lineal 982,391.79 2314 MARKET STREET CAMP HILL, PA 17011 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 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) REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 34.000.00 Discount 1.789.42 Interest Table Year Days Delinquent Balance Due Interest this time period this year this period Before 1981 1982 1983 1984 1985 1986 1987 1988 throuah 1991 1992 1993 through 1994 1995 throuah 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount Total Balance Due on January 17,1996: Penalty: . dJ9\wiJ,ls\reager.fw LAST -WILL AND TESTAMENT OF FREDERICK W. REAGER I, FREDERICK W. REAGER, of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby :make, publish and declare this my Last Will and Testament, hereby revoking any and all prior wills and codicils thereto by me at any time heretofore made. FIRST I direct that all my just debts and the expenses of my last illness and funeral shall be paid from the assets of my estate as soon as practicable after my decease. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable, for the purchase, erection and inscription of a suitable marker formy grave. SECOND , I give and bequeath all automobiles, household effects and other tangible personal property, not including cash or securities, -owned by me at my death, together with all policies of insurance thereon, to my wife, GWENDOLYN J. REAGER, providing that she is living on the sixtieth (60th) day after the date of my ~eath. Should my wife, GWENDOL YNJ. REAGER, not be living on the sixtieth (60th) day after the date of my death, 1 bequeath such tangible personalty and insurance thereon to my son, DAVID W. REAGER or his heirs. TIDRD 1 give, devise and bequeath the residue of my estate, of every nature and wherever situate, t~ my wife, GWENDOLYN J. REAGER, providing that she is living on the sixtieth (60th) day after the date of my death. In the event my wife, GWENDOLYN J. REAGER, is not living on the sixtieth (60th) day after the date of my death, then I give, devise and bequeath the residue of my estate, of every nature and wherever situate, to my son, DAVID W. REAGER or his heirs. ~~jl~';'{d S, i\''7~2:j-~6C :c) >;c:~';:J 0' ... lId I :i. <t..... E f1. Q \I' ,.' 1 '11"-] j --c~ >~ LdUL. 1 Y~JH'~ . Frederick . Reager - ! -;' ._'~ .-'....'.- :_; dlb\wills\reager.fw . FOURTH All principaJ and income, until actual distribution to the beneficiaries, shall be free of the debts, contracts, assignments, alienations and anticipations of any beneficiary, and the same shall not be subject to any levy, attachment, execution or sequestration. FIFTH I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expenses of the administration of the estate. . SIXTH My personal representative shall have the following powers in addition to those vested in them by law and by other provisions of this Will: A. To retain any or all assets of my estate, real or personal, without regard to any principle of diversification, risk or productivity. B. To invest in all forms of property as my fiduciary may deem proper, without regard to any principle of diversification, risk or productivity. C. To purchase investments at a premium or discount. D. To exercise all rights of a security holder or shareholder in any corporation; to give proxies; to join in any merger, consolidation, reorganization, voting trust plan, or other concerted action of security holders; and to delegate discretionary duties with respect thereto. E. To sell at public or private sale, to exchange or to lease, for any period of time, any real or personal property, and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as my fiduciary deems proper. F. To allocate receipts and expenses to principal or income, or partly to each, as my personal representative thinks proper. G. To borrow money from my corporate fiduciary or others and to mortgage or ple~ge any real or personal property as security therefore, in my fiduciary's sole discretion. , . ffi~k~~ Frederick W. Rea er 2 dlb\wills\reager.fw H. . To compromise any claim or controversy without order of court or consent of any beneficiary. I. To exercise any option, right or privilege granted in insurance policies or arising from ownership of investments. J. To join with my wife, GWENDOLYN J. REAGER, or her personal representative, in filing a joint income tax return, and to join in any gifts made by my wife for gift tax purposes. Any income or gift taxes due on such returns and any deficiencies, interest, penalties or refunds thereotr shall be allocated between my estate.and my wife or her estate as my Executor and my wife or her personal representative may agree. K. To ~ake any distribution herein provided for in cash, in kind, or partly in each, at valuations fixed by my personal representative at the time of distribution. L. . My fiduciary may, in his or her sole discretion, donate any part or all of my tangible personal property to any charitable organization(s) which would benefit from such donation. My fiduciaryis then instructed to use the value of said donation(s) as an tax deduction for any inheritance tax return which may be required to be filed as a consequence of my death. SEVENTH I appoint my son, DAVID W. REAGER, Executor of this my Last Will and Testament. Should my son, DAVID W. REAGER, predecease me or for any reason fail to qualify as such Executor, or having qualified, fail to serve as such Executor, then I nominate, constitute and appoint my daughter.in.law, JEANNE R. REAGER, of Camp Hill, Pennsylvania, Executrix of this my Last Will and Testament. EIGHTH My Executrix shall not be required to post security in. any jurisdiction. IN WIT~SSWHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of three (3) typewritten pages, the first two (2) of which bear my signature in the margin for the purpose of identi~cation, this J7~ day of December, 2004. ~k~ . . . DERICKW. REAGER, Testator 3 dlb\wil1s\reager.fw Signed, sealed, published and declared by the above-named Testator, FREDERICK W. REAGER, as and for his Last Will and Testament, in the sight and presence of us, who, at his request, in his sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ~ /L!>o?- Addresiff.a1 ~M- .' rY(J . ~ /7U// AddreL 'Z?i?/ UdAJta /y(---- . . tl,(/U,p fj,U. flf- 1f7t9 tl 4 dlb\willsveager.fw COMM:ONWEALTH OF PENNSYLVANIA ). : SS: COUNTY OF CUMBERLAND ) I, FREDERICK W. REAGER, the Testator, whose name is signed to the foregoing instrument, having been duly qualified according to . law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ) : SS: COUNTY OF CUMBERLAND ) we,'Dv~'b ~.' and A AIFhIl j ft(. b .2vtd-.e / , the witnesses whose names are signed to the foregoJ.; ~~~ent, being duly qualified according . to law, depose and say that we were present and saw the aforesaid Testator sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each ofus in the. hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and acknowledged before me by FREDERICK W. REAGER, the Testator this 1~ day of December, 2004. . · ~JwR.~ . ERICKW. REAGER, Testa or IJM~tJ-~~ l'4otary PublIC- '1Q\;}I!ai Seal DebOmh L Brenneman, Notary Public Camp Hill BorD, Cumberland County My CommISsion Expires June 18,2006 II/lember. Pennsylvania Association Of Notaries --.-- - COMMONWEALTH OF PENNSYLVANIA Sworn or affirmed to and subscribed to before me, this d7 %. day of December, 2004. Witnessl . . ;J;iltttd-/t ~------- p40tary Public :.._~--~ 5 N0:,:;.:!:r-:; ~-~'-;::L; --_.~ D(;borah L. 8rfir;~',,7;ar; Nota,,! ;:>ql:;l;,., I " C~p Hill. 80m ..~urr:i}~rtan<:l 'CfJl;nt/ fIr! Cornms~;lon i:..~(pf;e~JJria 18. 2006 iViember. Penri3YJV~;~iiJ ~~SSCdaton Of Nutarit1S - - OMB NO. 2502-0265 .,,.. A. B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.0FHA 2.DFmHA 3. OCONV. UN INS. 4.DVA 5. DCONV. INS. 6. F~~~~~~~~R: I 7. LOAN NUMBER: SETTLEMENT STATEMENT W l~fI.l 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3/98 (WENTZ.JOELLEN.PFOIWENTZ.JOELLEN/6) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: JO ELLEN WENTZ and ESTATE OF FREDERICK W. REAGER MONICA D. RHODES 1706 LINCOLN DRIVE CAMP HILL, PA 17011 'G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1857112 I. SETTLEMENT DATE: 17 SOUTH 24TH STREET Midstate Abstract Company CAMP HILL, PA 17011 July 16, 2007 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 2331 Market Street Camp Hill, PA 17011 J. SUMMARY OF BORROWER's TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION Inn nllF FROM 400. r.~nss DUE TO St=1 t=~. 101. Contract Sales Price 126,900.00 401. Contract Sales Price 126,900.00 102. Personal Property 402. Personal Property 103. Settlement Charqes to Borrower (Line 1400) 1,310.50 403. 104. 404. 105. 405. lrliudment... For ""'m." PRjrl Rv Se""'r In Rrlvanc'" Amw:tmRnrs ror /rRms I-'a/o t;W seller In "Irlvan"'" .106. CitvfTown Taxes to 406. CityfTown Taxes to :107. CountvTaxes 07/16/07 to 01/01/08 274.59 407. County Taxes 07/16/07 to 01/01/08 274.59 108. School Taxes to 408. School Taxes to 109. Sewer Proration 07/16/07 to 01/01/08 78.07 409. Sewer Proration 07/16/07 to 01/01/08 78.07 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 128,563.16 420. GROSS AMOUNT DUE TO SELLER 127,252.66 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money 501. Excess Deposit (See Instructions) 202. Princioal Amount of New Loan(s) 502. Settlement Charges to Seller (Line 1400) 1,354.00 203. Existinq loan(s) taken subject to 503. Existing loan(s) taken subject to 204. 504. Payoff of first Mortgage 205. 505. Payoff of second Mortgage 206. 506. 207. 507. 208. 508. 209. 509. Arliustments For Items UnDa/d tW seller Adiustments ror Items unpaJa tN ::>e/ler 210. Citv/Town Taxes to 510. CityfTown Taxes to 211. County Taxes to 511. County Taxes to 212. School Taxes 07/01/07 to 07/16/07 50.27 512. School Taxes 07/01/07 to 07/16/07 50.27 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PA/D BY/FOR BORROWER 50.27 520. TOTAL REDUCTION AMOUNT DUE SELLER 1,404.27 300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower (Line 120) 128,563.16 601. Gross Amount Due To Seller (Line 420) 127,252.66 302. Less Amount Paid By/For Borrower (Line 220) ( 50.27) 602. Less Reductions Due Seller j,I.lfjle 520) ( 1,404.27 303. CASH ( X FROM) ( TO) BORROWER 128,512.89 603. CASH ( X TO) ( FROW, S,ELLER 125,848.39 The undersigned her~Ck~'edge receipt of a completed copy of pages 1 &2 of this statement & any ta:M ~t(red to herein. Borrower IJ~, t<J~ Seller OK:> ELLEN III/I=< ~7 IJ ESTATE OF FREDEKIl;K W. Kr:AGER :PL- HUO-1 (3-86) RESPA. HB4305.2 c..,""'_ L. SETTLEMENT CHARGES 700. TOTAl COMMISSION Based on Price ~ @ Of,. PAID FROM PAID FROM Division of Commission f1ine 700) as Follows: BORROWER'S SELLER'S 701. $ to FUNDS AT FUNDS AT 702. $ to SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 704. to 800.ITEM~ PAY4RLJ: IN CONNJ:CTION WITH LOAN 801. Loan Oriaination Fee % to 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806. Mortgage Ins. ADD. Fee to 807. Assumption Fee to :808. 809. 810. 811. 900. ITEMS REOIIIRJ:D BY LJ:NDER TO BE PAID IN ADVANCE 901. Interest From to @ $ /day ( days %) 902. MIP Totlns. for LifeOfLoan for months to 903. Hazard Insurance Premium for 1.0 years to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months $ per month 1002. Mortoaoe Insurance months $ per month 1003. CitvlTown Taxes months $ per month 1004. County Taxes months $ oer month 1005. School Taxes months @ $ per month '1006. months ~ $ oer month 1007. months @ $ per month 1008. months (iJ) $ oer month 1100. TITLE CHARGES 1101. Settlement or Closino Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Electronic Document Prep. to 1106. Closino Service Letter to 1107. Attorney's Fees to (includes above item numbers: -J 1108. Title Insurance to MIDSTATE ABSTRACT (includes above item numbers.11 02, 1103 & 1104 ) 1109. Lender's Coverage $ .1110. Owner's Coverage $ 1111. Endorsements 100, 300, 8.1 1112. Notary Fee Midstate Abstract Company. 1113. Notary Fee Midstate Abstract Company 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 41.50; Mortgage $ Releases $ 41.50 1202. City/County Tax/Stamos: Deed 1,269.00' Mortoaae 1,269.00 1203. State Tax/Stamps: Deed 1,269.00; Mortoaoe 1,269.00 1204. 1205. 1 ~nn. ADDITIONAL ~ETTLEMENT CHARf.:ES 1301. Survey to 1302. Pest Insoection to 1303. Sewer Bill- July-December to Camp Hill Borouoh #2264 85.00 1304. .1305. 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) A /I 1,310.50 1,354.00 By '~"'"g p'ge 1 of ~I, '''tern,", ~e "g",ton.. "knowledge "'''''ptot, oomp~1ed '1y ?:;t;;:;z::ge '''te7" ~. Certified to be a true copy. Midstate Abstract comPfY ./ /~ Settlement Agent ( WENTZ.JOELLEN / WENTZ.JOELLEN /6 )