HomeMy WebLinkAbout10-01-07 (3)
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15056041147
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
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
21 07
0422
Date of Birth
211226692
03172007
12301915
Decedent's Last Name
Suffix
Decedent's First Name
MI
MATTHEWS
ANN
(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
[!J 1. Original Return
o
4. Limited Estate
o
o
o
o
4a. Future Interest Compromise
(date of death after 12-12-82)
2. Supplemental Return
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
[KJ
6. Decedent Died Testate
(Attach Copy of Will)
7 Decedent Maintained a Living Trust
. (Attach Copy oITrust)
8. Total Number of Safe Deposit Boxes
o
9. Litigation Proceeds Received
10 Spousal Poverty Credit (date of death
. between 12-31-91 and "1-1-95)
o
11.Election to tax under Sec. 9113(A)
(Attach Sch. 0)
~ORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
ame Daytime Telephone Number
MICHAEL L. BANGS 7177307310 ~,
C)
429 SOUTH 18TH STREET
~.'~
Firm Name (If Applicable)
First line of address
-", - ,
REGISTEROFI/\It~S USE6NL Y
. ".-.: --'-1 r
I
Second line of address
CAMP HILL
State
PA
ZIP Code
17011
DATE FILED
c::>
I.D
City or Post Office
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.
SIG n~}f'ERS. ON RES SIBLE FOR FIL G RETURN DATE
~(~ Richard P. Matthews
ADDRESS
DATE
Michael L. Bangs
429 South 18th Street,
p Hill, PA 17011
L
Side 1
15056041147
15056041147
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cY-
ESTATE OF
Matthews, Ann
PA Inheritance Tax Return
Signature of Additional Fiduciaries
FILE NUMBER
21-07 -0422
Under penalties of pe~ury, 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.
Signature #2
Name
Address1
Address2
City, State, Zip
Date
Signature #3
Name
Address1
Address2
City, State, Zip
Date
" ",;t.
J
Enola, PA 17025
Cf/oltltJ7
~~~'7vJc~
MaryAnn McKee
812 Chester Road
Enola, PA 17025
?/ett,/o7
, I
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15056042148
REV-1500 EX
Decedenf.Name: Ann Matthews
Decedent's Social Security Number
211226692
RECAPITULATION
1. Real Estate (Schedule A)...........................................................................................
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) 0 Separate Billing Requested.............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested.............. 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/Sec 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 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X . 15
0.00
15.
103,812.71
16.
0.00
17.
0.00
18.
19. Tax Due............................ ....................................................... ............... ................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
L
Side 2
15056042148
1.
112,920.84
8,860.91
121,781.75
16,109.78
1,859.26
17,969.04
103,812.71
103,812.71
0.00
4,671.57
0.00
0.00
4,671.57
D
15056042148
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-07-0422
DECEDENT'S NAME
Ann Matthews
STREET ADDRESS
257 Brick Church Road
CITY I STATE illP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
4,671.57
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
0.00
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
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 the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(5B)
4,671.57
4,671.57
Make Check Payable to: REGISTER OF WILLS, AGENT
-.....1.lr- ~I--"r-U_ .. II..- -- ~llDr--...-"""--',- L- --III' --'11 .1 ..___
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;......................................... D 00
c. retain a reversionary interest; or..................................................................................................................... D [Xl
d. receive the promise for life of either payments, benefits or care?.................................................................. D 1&1
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?................................................................................................................. ........ D [&]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?............... 0 I&J
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designatiOn?................................................................................................................. ...... D [Xl
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
..-- -~..,~_---1_-_..III111B11111111___-- __._ ''''l "IIIBIIL.~"",
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 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)
.
SCHEDULE A
REAL ESTATE
COMMONWEALlli OF PENNSYLVANIA
IhHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Matthews, Ann
FILE NUMBER
21-07 -0422
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
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Real Estate - Sale of 257 Brick Church Road, Enola, Pennsylvania (see settlement
sheet attached)
112.920.84
TOTAL (Also enter on Line 1, Recapitulation)
112.920.84
(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)
Rev-150B EX+ (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Matthews, Ann
FILE NUMBER
21-07-0422
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Automobile - Sale of 1984 Oldsmobile Cutlass Supreme (see Bill of Sale attached)
VALUE AT DATE
OF DEATH
250.00
2 Bridges at Bent Creek - Refund
1.038.00
3 Comcast Cable - refund
51.26
4 Donegal Insurance - refund of unearned premium
159.50
5 Refund from H.B. McClure Company
538.30
6 Refund from Verizon
1.00
7 Commerce Bank - Account #536946700
6.822.85
TOTAL (Also enter on Line 5, Recapitulation)
8.860.91
(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-1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Matthews, Ann
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-07 -0422
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 9,955.90
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Michael L. Bangs 4,000.00
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 310.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 1,843.88
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 16,109.78
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
COMMONWEAL l1i OF PENNSYLVANIA
INHERITANCE TAX RE1URN
RESIDENT DECEDENT
Matthews, Ann
FILE NUMBER
21-07 -0422
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Geo's Family Restaurant - funeral luncheon
708.90
2
Gingrich Memorials
125.00
3
Sullivan Funeral Home
9.122.00
Subtotal
9.955.90
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Matthews, Ann
FILE NUMBER
21-07 -0422
ITEM
NUMBER DESCRIPTION AMOUNT
1 AT&T 67.53
2 AT&T 84.69
3 Comcast Cable 117.74
4 Comcast Cable 58.87
5 Comcast Cable 40.33
6 Cumberland Law Journal - estate advertising 75.00
7 East Pennsboro Township - sewer and trash bill 126.50
8 East Pennsboro Township - sewer and trash 115.00
9 H. B. McClure Company 598.00
10 PA American Water Company 57.10
11 PA American Water Company 26.62
12 PP&L Electric 64.80
13 PP&L Electric 34.54
14 PP&L Electric 38.13
15 PP&L Electric - final bill 24.73
16 The Sentinel - estate advertising 123.16
17 Thomas & Thompson - electrical work done at real estate 75.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEAllli OF PENNSYLVANIA
INHERITANCE TAX RETIJRN
RESIDENT DECEDENT
ESTATE OF
Matthews, Ann
FILE NUMBER
21-07 -0422
ITEM
NUMBER DESCRIPTION
AMOUNT
18 UGI
46.21
19 UGI
1.28
20 UGI - final bill
13.58
21
Verizon
55.07
Subtotal
1.843.88
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 PEM'lSYLVANIA
l'*iERITANCE TAX RElURN
RESIDENT DECEDENT
Matthews, Ann
FILE NUMBER
21-07 -0422
ESTATE OF
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Alert Pharmacy Services, Inc.
VALUE AT DATE
OF DEATH
67.86
2 AT&T
32.21
3 Comcast Cable
58.87
4 Commerce Bank - service charge on account
10.00
5 Debbie Lupoid - 2007 CountylTownship taxes
346.50
6 Debbie Lupoid - 2007 personal taxes
5.50
7 Donegal Mutual Insurance - Homeowners insurance
220.50
8 H. B. McClure Company
299.00
9 PA American Water Company
33.22
10 PA American Water Company
13.42
11 PP&L Electric
32.18
12 The Motorist Insurance Group - final premium due on automobile
21.58
13 UGI
46.07
14 Verizon
28.67
15 West Shore EMS-ALS
643.68
TOTAL (Also enter on Line 10, Recapitulation)
1,859.26
(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 I (Rev. 6-98)
REV-1513 EX+ (9-00)
*'
SCHEDULE ..
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Matthews, Ann
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
Richard P. Matthews
19 Blue Spruce Drive
Enola, PA 17025
FILE NUMBER
21-07-0422
I.
RELATIONSHIP TO
DECEDENT
Do Not List Truslee{sJ
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
Son
One-third
MaryAnn McKee
812 Chester Road
Enola, PA 17025
Daughter
One-third
Joan F. Troutman
111 Cumberland Road
Enola, PA 17025
Daughter
One-third
Total
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
Copyright (c) 2002 form software only The Lackner Group, Inc.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Form PA-1500 Schedule J (Rev. 6-98)
Previous editions are obsolete
lorm HUD.1 (3186) ref Handbook 4305_2
A. Settlement Statement
u.s. Department of Housing and Urban Development
B. Tvee ot Loan OMB Approval No. 2502-0265 (expires 11130/2009)
1. K1FHA 2. OFmHA 3 OConv. Unins. I 6. File Number I 7. Loan Number I 8. Mortgage Insurance Case Number
4. OVA 5. OConv. Ins. 07-14931S 0000221986 441-7989700-703
c. Note: Ilt~~s o~~r~ed~(~~~~)~~~~: ;~ ~~::;~~l glo~~~thSe~l~e:;h~~her;r~~~I~::;~~ ~";Pds:~ea~Jl~~~:t ~~~:d~~.::~tals. I Title Express Settlement System
WARNING: II i~ a crime 10 knowlIlgly '!lake false statements to !he United States on this or any other similar form. Penalt1es upon Printed 07/YJ12007 at 12:02 TS
conviction can Include a fine and imorlsonment. For details see: Tille 18 U. S. Code Section 1001 and Section 1010.
D. NAME OF BORROWER: SCOTT A RHOADS and M.GABRIELLE RHOADS
ADDRESS: 17 High Street, Enola, PA 17025
E. NAME OF SELLER: ESTATE OF ANN MATTHEWS and RICHARD P. MATTHEWS, Co-Executor and
JOAN T. TROUTMAN, Co- Executor and MARY ANN McKEE, Co-Executor
ADDRESS:
F NAME OF LENDER: American Home Bank, NA
ADDRESS: American Way Comorate Center 3840 HemoJand Road Mountville PA 17554
G. PROPERTY ADDRESS: 257 BRICK CHURCH ROAD, Enola, PA 17025
East Pennsboro Township
H. SETTLEMENT AGENT: Preferred Closing Services, LLC, American Way Corporate Center
PLACE OF SETTLEMENT: 3840 HemDland Rd. Suite 91 Mountville PA 17554
1. SETTLEMENT DATE: 07/3112007
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. Contract sales nrice 118,500.00 401. Contract sales orice 118500.00
102. Personal Prooerty 402. Personal Prooertv
103. Settlement charnes to borrower (line 1400\ 5,551.10 403.
104. 404.
105. 405.
Ad.ustments lor items oaid bv seller in advance Adjustments lor items paid by seller in advance
106. Cityhown taxes 07/31/07 to 12131/07 44.82 406. Citvltown taxes 07/31/071012131/07 44.82
107. County taxes 07/31/07 to 12/31/07 101.36 407. County taxes 07/31/07 to 12131107 101.36
108. School taxes 071311071006/30108 1.077.03 408. School taxes 07/31107 to 06130/08 1 077.03
109. Preoaid Sewer & Trash 07/31107 to 09/30/07 78.13 409. Preoaid Sewer & Trash 07131107 to 09/30/07 78.13
110. 410.
111. 411.
112 412.
120. GROSS AMOUNT DUE FROM BORROWER 125 352.44 420. GROSS AMOUNT DUE TO SELLER 119801.34
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deoosit or eamest money 501. Excess Deoosit Isee instructions)
202. Princioal amount of new loans 117,537.00 502. Settlement charoes to seller (line 1400l 2 380.50
203. Existina loanls) taken subiect to 503. Existino loanls\ taken sub.ect to
204. 504. Payoff of First Mortaaoe Loan
205. Seller Assist 4 500.00 505. 4 500.00
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for items unoaid bv seller Adiustments for items unDaid by seller
210. Citvltown taxes 510. Citvhown taxes
211. County taxes 511. County taxes
212. School taxes 512. School taxes
213. 513.
214. 514.
215. 515.
216. 516.
217. 517
218. 518.
219 519.
220. TOTAL PAID BYIFOR BORROWER 122037.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 6 880.50
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower (line 120l 125 352.44 601. Gross amount due to seller Iline 420\ 119801.34
302. Less amounts oaid bvlfor borrower Iline 22m 122037.00 602. Less reduction amount due seller (line 520) 6 880.50
303. CASH FROM BORROWER 3 315.44 603. CASH TO SELLER 112,920.841
SOLICiTATION; You are required by law to ~ovlde Preferred Closing Services, LLC A~erican Way Corporate Center with your correct taxpayer
ident~licalion number. tl you do not prOVide Prelerred Closing Services, llC Amertcan Way Corporate Center with 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!lOrrect. taxpayer identification number
/(/ .'/JtI~ ;,' J l.~ \
~. MAl 'H"'" ~O-"',",utoc \'lu::, .'~:M';:~~~~Cu~~)
--....e1A~ /Jv#.J /J?<-'i/fO:-
MAH~ A~~ ~. L.;o.t:.xecutor -
t::::>1 AI I:: VI"" ANN MAIIHt:W~
The.informalion contained in Blocks E, G. H, 1, and on line 401 (or illine 401 has an asterisk, Une 403 and 4(4) is importan~ tax informalion and is being
furnIshed 10 the Internal Revenue Service. lI)'Qu are .required 10 file a return. a negligence penalty or other sanction wIn be Imposed on you II this item is
reqUired to be reported and the IRS detennines that It has nol been reported.
REV HUD-1 (3186)
Previous editions are obsolete
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
File Number: 07.1493
TtIE Sttl S
form HUD.' (3/86) ref Handbook 4305.2
PAGE 2
I et:xpress e ement ,vstem nnt at
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on price $118 500.00 = BORROWER'S SELLER'S
Division of commission !line 700\ as follows: FUNDS AT FUNDS AT
701. $ to SETILEMENT SETILEMENT
702. $ to
703. Commission oaid at Settlement
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Oriaination Fee %
802. Loan Discount %
803. Appraisal Fee to Scott P. Archibald 375.00
804. Credit Report to CREDCO 17.83
805. Commitment Fee to American Home Bank. NA 350.00
806. Wire Fee to American Home Bank NA 25.00
807.
808.
809.
810.
811. Yield Soread Prem Pd bv AHB to American Professional Fin. LLC $1 763.05 POC bv Lender
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901, Interest From 0713112007 to 0810112007 (Q)$ 21.7400 Idav 1 Days 21.74
902. Mortnane Insurance Premium for to DeDt of HSG & Urban Dev (HUD) 1 737.00
903. Hazard Insurance Premium for to Liberty Mutual (P.O.C.1 429.00 Buyer
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance 3 mo. (iil$ 35.75 Imo 107.25
1002. Mortaaae Insurance mo. (Q)$ 144.75 Imo
1003. City Prooertv Tax 6 mo. (Q)$ 8.68 Imo 52.08
1004. County Prooertv Tax 6 mo. I1llt 27.96 Imo 167.76
1005. Schooltaxes 2 mo. (iil$ 97.50 /mo 195.00
1009. Aaareaate Analvsis Adjustment to American Home Bank NA .182.31 0.00
1100. TITLE CHARGES
1101. Settlement or dosina fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Document Prenaration to Preferred Closina Services LLC 200.00
11 OS. Notarv Fees to Notary Public 45.00
. 1107. Attomey's fees to Michael Banas Esa (POCI
[includes above items No: 1
1108. Title Insurance to Preferred Closinll Services LLC 953.75
(includes above items No: Includes 1101.1104 1108 )
1109. Lender's Policy 117 537.00 .
1110. Owner's Policv 118 500.00 . 953.75
1111. End 100 End 300 End 8.1 to Preferred Closinll Services LLC 150.00
1112. Wire Fee to Preferred Closino Services. LLC 25.00
1113. ClosinoSvcLtr to Preferred Closina Services LLC 35.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordino Fees Deed $ 38.50 ' Mortaaae $ 52.50 ' Release $ 91.00
1202. City/County tax/stamos Deed $1185.00 . Mortnane $ 1.185.00
1203. State Tax/stamps Deed $1 185.00 . Mortaaae $ 1185,00
1204.
1205.
1300. ADDiTIONAL SETTLEMENT CHARGES
1302. Pest Insoection
1305. Prepaid Tax Certification to Preferred Clasinll Services. LLC 5.00
130S. 07/08School Taxes09140834-QS!N. Debbie Lupoid Tax Collector 1 170.00
1307. Oveminht and Handlinn Fees to Preferred Closino Services LLC 20.50
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Section J and 502 Section K) 5.551.10 2,380.50
P' ed 07/30/2007 12 02TS
HUD CERTIFICATION OF BUYER AND SELLER
~~g;e ~:~~'i~~ ~~:=~O~.el ~~t~~~ ~:J;~~T~a~tl S~~~:~~i~ ~ ~~~Y~IS:ho~ ~O~~~~~:~ ~~~~::. a true and accurate statement of all receipts and disbursements made on my account
::::I...oU I I A HMVAU::::
M.UAt:JHrt:lll: HHUAl}~
t::;:'IAIt:: Ut" ANN MAl I Mt:YV:;:,
('1&v:1?~~~o~~:m
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J ..JUAN I. I HUU t MAN. l,;O- t:xecutor MAA ;. ( 9'~t:, ro:t:xecutor ,....
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 '8:
U.S. CODE SECTION 1001 AND SECTION 1010.
The HUD.1 Settlement Statement which I ha..e prepared is a true and accurate account ollhis
transaction. I have caused or will cause the funds to be disbursed in accordance with this statement.
SETTI.EMENT AGENT:
DATE:
__l~/;'.JU;~UUI J.'&'.(JU rJt.A. .I.'.I."UUU'*601fJ
"'&.,~.......:a.,:a.~ ........_0.1..........
. ,. ...
ADDENDUM Td"hljf>!i 441- 7989700- 703
SETTLEMENT 8T ATEMENT
NOTICE TO All PARTIES: If information is obtained which indicms that the source of the borrower's financial
contribution is other than from the borrower or other than stated by the lender in its closing instructions, the
settlement agent is to obtein written Instructions from the lender before proceeding with settlement.
CERTIFICATION OF BUYER IN AN FHA-INSURED LOAN TRANSACTION
I certify that I have no knowledge of any loar'ls th!t have been 0( will be made to me {us) or loans that
have been or will be assumed by me Ius) for purposes at financing this transaction, other than those described
in the sales contract dated 00/00/00 lincluding Bddende). I certiiy that I (we) heve not
been paid or reimbursed for any of the cellh downpeyment. I certify thllt I (we) have not and will not receive any
payment or reimbursement for arty of my (our) clOsing costs which have not been previously disclosed in the
sales contract (Including addenda) and/or my application for mortgage insurance submitted to my (our) mongage
lender.
Borrower
Date Borrow...
Dtlt"
B6....ower
Dele BorMw'"
Dme
CERTIFICATION OF SELLER IN AN FHA-INSURED LOAN TRANSACTION
, oertify that I have no knowledge of any loans that have been or will be made to the borrower(s}, or
loana thilt h~Ye bMtn or will bo: e$sumod by th(l borrovv.,ns), for purpO$e$ of fin~c;;ing thi$ tr$nsaetion, other
then those dC3crlbed In the sales contract d8ted 00/00/00 (Including lIddenda). I certify
that t have not and will not pey Or reimbUrse the borrower'!s) for any pen of the cell'" downpeyment. I certify
that' have not and will not payor reimburse the borrower/s) for any part of the borrower's closing costs which
have not been previously dieclosed in the sales contract (including any addenda).
X ~jq;(f/1{~ ~d.3I)01 (]~../~)
Seller f t_ t;j.
rf~( 107
I I Dete 5e1~
If-. 7n riA(fri/lVnJ 'r1 Co 'l "
SeRer
7/3/ /07
/ 'Oet"
Dete
CERTIFICATION OF SETTlEMENT AGENT IN AN FHA-INSURED LOAN
TRANSACTION
To 1he best of mv knowledge, the HUO-l Settl..-nent Stlrtement which I have prepared is a true and
eccurate account of the funds which were m received, or (iiI pSid outside closing, and the funds received have
been or will be disbursed by the under$igned 88 Plitt of the settlement of this trensllCtion. I further certify that'
hove obtained the above certlflcetlons which were executed by the borrowerls) and seller Is) as indicated.
---~.----
~--..- .----.)
( - gefllameol ^ll""t
is/~?
Date
[The certifications contained nerein rnllY be obtained from the respective parties et different times or may be
obtained on separate addenda. I
WARNING: It is B crime to knowingly make false statements to the United States on this or any other similar
form: Penalties UpOn conviction CBn include a fine and imprisonment. For details, see: Title 18 U.S. Code
SectIons 1001 and 1010.
_ -446 /91(131.0'
41>
v'"'" MOl'\TG~E FIlIlIllS 'liOO)$l'-729'
!191
V4.74
II1IIIIIII
LOAN ID; 0000221986
May 21, 2007
Commerce
eBank
Bangs Law Office
429 S 18th St
Camp Hill PA 17011
RE: Estate of: Ann Matthews
Tax Identification Number: 211-22-6692
Date of Death: March 17, 2007
Dear Sirs:
This letter is in reference to decedent account information you requested for the
individual listed above.
We are able to provide the following:
Account Type: Checking
Account Number: 536946700
Date Opened: 02/09/05
Primary Owner: Ann Matthews
Date of Death Balance: $6,822.85
Accrued Interest: $0.20
Principal Balance: $6,822.65
Please feel free to contact me at (717) 412-6134 if I may be of further assistance.
rit:~/*
Mindi~~t
Levy Specialist/Deposit Services
Commerce Bank
Commerce Bank I Harrisburg, N.A.
PO Box 4999
3801 Paxton Street
Harrisburg, PA 17111-0999
commercepc.com
BILL OF SALE
WE, RICHARD P. MATTHEWS, JOAN F. TROUTMAN and MARY ANN McKEE,
Co-Executors of the Estate of Ann Matthews, do hereby sell decedent's 1984 Oldsmobile Cutlass
Supreme to Mary Ann McKee for the sum of Two Hundred Fifty ($250.00) Dollars.
Date: dCJ;1~/.)~())
Y?u~~
RICHARDP.MATTHEWS
9t. -I ..L~t:: hJ
OAN F. TROUTMAN
'r7~~, 'H<~
MARY McKEE
OT.
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J^A.NI'ES.M. BACH"'""?'-~~~"--~'._--"""'''''''~~'""-~"",,
ATTORNEY AND COUNSELOR AT LAW
352 SOUTH SPORTING HILL ROAD
MECHANICSBURG, PA 17055
TELEPHONE (717) 737.2033
~
1fiJJt 'iU ~nIDr ~fJtJmfnt ~1
lnn ~Jff~ffuJ
I, ANN MATTHEWS, of the TOWNSHIP of EAST PENNSBORO,
COUNTY of CUMBERLAND, COMMONWEALTH of PENNSYLVANIA,
being in good bodily health and of sound and disposing mind and memory, and not
acting under duress, menace, fraud, or undue influence of any person whomsoever,
merely calling to mind the frailty of human life, and being desirous of disposing my
worldly goods while I have the strength and capacity so to do, I do make , publish
and declare this my LAST WILL AND TEST AMENT. I hereby revoke, cancel and
annul all my former Wills and Testaments, including codicils thereto, by me at any
time made, and declare this alone to be my LAST WILL AND TESTAMENT.
AS TO SUCH ESTATE AS IT HAS PLEASED GOD TO ENTRUST ME
WITH IN THIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ:
ITEM 1 I direct that my Executors hereinafter named, pay and discharge all of
my just debts, funeral and testamentary expenses.
lIEM.2.
I order and direct that I be buried in a lot which I own situated at the
Holy Cross Cemetery, Rutherford, Pennsylvania.
ITEM 3.
All the rest, residue and remainder of my entire estate, wheresoever
situate, and whatsoever it may consist of, I give, devise, and bequeath, absolutely, and
in fee, to my dearly children, JOAN F. TROUTMAN. MARYANN McKEE and
RICHARD P. MATTHEWS, share and share, alike per stirpes.
ITEM 4 I nominate and appoint JOAN F. TROUTMAN, MARYANN
McKEE and RICHARD P. MATTHEWS as co-Executors of this my LAST WILL
and TESTAMENT
ITEM 5 I hereby direct that all my personal representatives, as well as their
successors, shall not be required to give bond for the faithful performance of their
duties in any jurisdiction.
(/..-1NYl~.~~ et/~
ANN MATTHEWS 7-f~'1
Page 1 of 3
ITEM 6. I direct that all estate, succession, legacy, inheritance or other transfer
taxes, however designated that shall become payable by reason of my death in respect
of all property comprising my gross estate for tax purposes, whether or not such
property passes under this LAST WILL, shall be paid by my Executor out of my
residuary estate.
lIEM..Z. I hereby order and director that my Executors use the services of the law
offices of JAMES M. BACH as lawyers for my Estate.
ITEM 8. I grant to my personal representatives herein named, in addition to,
but not in limitation of those powers vested by law, to be exercised without prior
application to or approval of any court, the power and authority to retain
indefinitely any property, to invest and reinvest any assets or the proceeds derived
from the sale of assets, although said investments may not be of the character
prescribed by law, to sell, convey, assign, transfer and encumber any property, to
pay, settle or compromise all claims, to make distribution or divisions in cash or in
kind, and in general to exercise all powers in the management of any property
hereunder which any individual could exercise in the management of similar
property owned in his own right, and to execute and deliver any and all instruments
and to do all acts which may be deemed necessary and proper.
WITNEss9- f /171
~ ln~J~
ANN MATTHEWS 7- p.. f 7
~C6~1
,..
===========~=~~--~--~-END~---==~=_~=_=~~===
Page 2 of 3
..
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA)
) ss
COUNTY OF CUMBERLAND )
I, ANN MATTHEWS, the 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 purpose
therein expressed.
Sworn to or affirmed and acknowledged before me, by: ANN MATTHEWS, the
TESTATRIX, this 9th day of July ,1997.
~J?;~1A-4J
ANN MATTHEWS 7- f~ 9'7
NOTARIAL. SEAl
ATTORNEY JAMES M. BACH. Notary P_
Cumberland County
My Commission E'xpires May 13,1999
~ fiI-L-
ES M. BACH, ESQUIRE
NOTARY PUBLIC
Mechanicsburg, PA 17055
My Commission Expires: 05/13/99
AFFIDA VIT
COMMONWEALTH OF PENNSYLVANIA)
) ss
COUNTY OF CUMBERLAND )
We, JASON MAZZEI and ESME..GOODSIR" the witnesses whose names are
signed to the attached or foregoing instrument, being duly qualified according to law,
do depose and say that we were present and saw the TESTATRIX sign and execute
the instrument as her LAST WILL; that the TESTATRIX signed willingly and that
she executed it as her free and voluntary act for the purpose therein expressed; that
each witness 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 the time,
18 or more years of age, of sound mind and under no constraint or undue influence.
Sworn to or affirmed and acknowledged before me, by: JASON MAZZEI and
ESME GOODSIR, witnesses, this 9th day of July , 1997.
~.ftA~
rWITN~~~
ESME GOODSIR
~
NOTARIAL SEAl
ATTORNEY JAMES M. BACH, Notary Public J S M. BACH, ESQUIRE
Cumberland County
MyCommissionExpiresMay13.1!i99 NOTARY PUBLIC
-..-.", Mechanicsburg, PA 17055
My Commission Expires: 05/13/99
Page 3 00