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HomeMy WebLinkAbout11-09-07 --.J lS0SbOlfl.l.lf7 REV.1S00 EX (06-05) PA Department of Revenue Bureau of Individual Taxes ~ PO BOX.280601 ~ Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year INHERITANCE TAX RETURN RESIDENT DECEDENT 2 1 0 7 Ale Number 0569 Date of Birth 181014483 08032005 07251916 Decedent's Last Name Suffix Decedent's First Name LUPINACCI IDA MI F (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW [!] 1. Original Retum D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82) D 4. Limited Estate D 4a. Future Interest Compronise D 5. Federal Estate Tax Retum Required (date of death after 12-12-82) [!] 6. Decedent Died Testate D 7. Decedent Maintained a LMng Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) D 9. Litigation Proceeds Received D 10 Spousal Pov~ Credit ~date of death D 11.Election to tax under Sec. 9113(A) . between 12-31- 1 and -1-95) (Attach Sch. 0) ~ORRESPONDENT . THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number ROBERT C. SAIDIS ESQ. 7177373405 Firm Name (If Applicable) SAIDIS, FLOWER & LINDSAY '-J REGISTER::9.f WILLS U~NL Y . -.J First line of address 2109 MARKET STREET I ill Second line of address \:J City or Post Office CAMP HILL State PA ZIP Code 17011 D~TEi:ILED N r'-.> N Correspondent's e-mail address: Under penalties of p!!rjury, I declare that I have examined this retum, including accompanyjng schedules and statements, and to the best of my knowl~ 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. ' 51 RE OF PE N RESP ISLE FOR FIUfiG RETURN DATE Kenneth J. Lupinacci I , DATE 1I-t!1/-07 2109 Market Street, Camp Hill, PA 17011 L Side 1 :LS051:.0lf:L:L47 :L5051:.04:L147 -..J~ -.J lSDSbDlf2llf1l REV-1500 EX Decedenl'sName: Ida F. Lupinacci RECAPITULATION 1. Real Estate (Schedule A).......................................................................................... 1. 2. Stocks and Bonds (Schedule B)............................................................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D).......................................................... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................ 5. 6. Jointly Owned Property (Schedule F) 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. 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 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 0.00 15. 41,891.02 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. Side2 L lSDSbDlf211f1l Decedent's Social Security Number 181014483 112,000.00 1,250.84 113,250.84 25,338.95 46,020.87 71,359.82 41,891.02 41,891.02 0.00 1,885.10 0.00 0.00 1,885.10 D lSDSbDlf2llf1l -.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Ida F. Lupinacci STREET ADDRESS 32 South point Dr. File Number 21-07 -0569 Mechanicsburg I STATE PA IZIP 17055 CITY Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 1,885.10 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 0.00 218.46 TotallnterestlPenalty (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) 218.46 (4) (5) 2,103.56 (5A) (5B) 2,103.56 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;.................................................................................. D b. retain the right to designate who shall use the property transferred or its income;.................................... D c. retain a reversionary interest; or.................................................................................................................. D d. receive the promise for life of either payments, benefits or care?.............................................................. D 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? ......... D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefiCiary designation?..................................................................................................................... D ~ 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 [!] ~ [!] ~ ~ [!] 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. S9116 (a) (1.1) (i1)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. S9116 1.2) [72 P.S. S9116 (a) (1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~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+ (6-88) *' SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNS'VlVANIA ~HERrrANCETAXRETURN RESDENT DECEDENT ESTATE OF Lupinacci, Ida F. FILE NUMBER 21-07-0569 All real property owned solely or as a tenant In convnon 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 Jolntly-owned with right of survivorship IIllIst be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 32 South Point Drive - Residence located in Upper Allen Township, Mechanicsburg, 112,000.00 Cumberland County, Pennsylvania (Parcel #42-25-0030-o33.-U1632-2) TOTAL (Also enter on Line 1, Recapitulation) 112,000.00 (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) Rev.1509 EX+ (6-98) . COMMONWEAl. TH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY -OWNED PROPERTY ESTATE OF FILE NUMBER Lupinacci, Ida F. 21"()7"()569 If an as..t was made Joint wIthIn one year of the dec:edent's date of death, It must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME A. Linda M. Hancock ADDRESS 112 Juniper Drive Mechanicsburg, PA 17050 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 DATE OF DEATr, DECO'S VAlUE OF NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSE INTEREST DECEDENT'S INTEREST JOINTl V-HELD REAL ESTATE. 1 A 1/2/2002 Citizens Bank - Checking Account 2.501.67 50.000% 1.250.84 #610640-601-8 TOTAL (Also enter on Line 6, Recapitulation) 1.250.84 (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 F (Rev. 6-98) REV-1151 EX+ (12-891 *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lupinacci, Ida F. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-07-0569 ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT See continuation schedule(s) attached 6,511.60 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State _ Zip 2. Attorney's Fees Saidis, Flower & Lindsay 5,290.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees 269.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Other Administrative Costs See continuation schedule(s) attached 13,268.35 TOTAL (Also enter on line 9, Recapitulation) 25,338.95 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 COMMClNWEAL TH OF PENNS'i'lVANIA IMiERITANCE TAX RETURN RESIlENT DECEDENT ESTATE OF Lupinacci, Ida F. FILE NUMBER 21-07-0569 ITEM NUMBER DESCRIPTION AMOUNT 1 Linda Hancock. Reinbursement for Memorial Luncheon 700.00 2 Malpezzi Funeral Home. Professional services $3545.00; Casket, register, folders, Ackn $823.00; Open Grave, Cemetery Equipment, Death Certificates, Obitiary Notices, Church charges $1501.60; Less $58.00 Discount 5,811.60 Subtotal 6,511.60 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (1\098) ESTATE OF . 8CHEDULI H.87 OTHER ADMINISTRATIVE COSTS continued COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIlENT DECEDENT Lupinacci, Ida F. FILE NUMBER 21-07-0569 ITEM NUMBER AMOUNT DESCRIPTION 1 32 South Point Drive. Closing Costs Broker's commission 6.160.00 2 32 South Point Drive. Closing Costs AHS Home Warranty 435.00 3 32 South Point Drive. Closing Costs Realty Transfer Taxes 1.120.00 4 32 South Point Drive - Closing Costs Notary, UPS, Express Mail 44.03 5 Marlin A. Yohn, Tax Collector. 2007.2008 School Taxes 1.061.55 6 Marlin A. Yohn, Tax Collector. 2007 CountylTownship Taxes 341.64 7 PPL Electric 86.88 8 PPL Electric 12.73 9 PPL Electric 46.05 10 PPL Electric 22.23 11 Said is, Flower & Lindsay. Reimbursement for advertising expenses regarding the Executor's Notice in the Cumberland Law Journal and The Sentinel 236.34 12 South Point Condo Association 80.00 13 South Point Condo Association 80.00 14 South Point Condo Association 80.00 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 COY.lONWEALTH OF PENNSYLVANIA INHERFTANCE TAX RETURN RESIJENT DECEDENT ESTATE OF Lupinacci, Ida F. FILE NUMBER 21-07 -0569 ITEM NUMBER DESCRIPTION AMOUNT 15 South Point Condo Association 80.00 16 South Point Condo Association 160.00 17 South Point Condo Association - Assessment 250.00 18 South Point Condo Association 240.00 19 South Point Condo Association 80.00 20 South Point Condo Association 160.00 21 South Point Condo Association 160.00 22 South Point Condo Association 160.00 23 South Point Condo Association 80.00 24 State Farm - Insurance 9.33 25 State Farm Insurance 9.33 26 State Farm Insurance 9.33 27 State Farm Insurance 9.33 28 State Farm Insurance 9.33 29 State Farm Insurance 9.33 30 State Farm Insurance 51.25 31 State Farm Insurance 146.27 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1502 EX+ (8-98) . SCHI!DULI! H.87 OTHER ADMINISTRATIVE COSTS continued COMMONWEAl. TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lupinacci, Ida F. FILE NUMBER 21-07 -0569 ITEM DESCRIPTION AMOUNT NUMBER 32 State Farm Insurance 99.24 33 State Farm Insurance 99.24 34 State Farm Insurance 105.00 35 State Farm Insurance 102.00 36 United Water Pen Water Bill 15.41 37 United Water Pen Water Bill 6.76 38 United Water Pen Water Bill 6.76 39 United Water Pen Water Bill 6.76 40 United Water Pen Water Bill 6.76 41 United Water Pen Water Bill 6.76 42 United Water Pen Water Bill 6.76 43 United Water Pen Water Bill 2.70 44 Upper Allen Township - 3rd Quarter Sewer 100.00 45 Upper Allen Township 100.00 46 Upper Allen Township 100.00 47 Upper Allen Township 100.00 48 Upper Allen Township 302.90 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 COMMONWEAl. TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESDENT DECEDENT ESTATE OF Lupinacci, Ida F. FILE NUMBER 21-07-0569 ITEM NUMBER DESCRIPTION AMOUNT 49 Upper Allen Township 100.00 50 Upper Allen Township 100.00 51 Upper Allen Township 100.00 52 Upper Allen Township 100.00 53 Waste Management 46.95 54 Waste Management 46.95 55 Waste Management 46.95 56 York Waste Disposal 43.50 57 York Waste Disposal 43.50 58 York Waste Disposal 43.50 Subtotal 13.268.35 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-981 *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIlENT DECEDENT Lupinacci, Ida F. FILE NUMBER 21-07-0569 ESTATE OF Include unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION 1 AARP Health Care Premium VALUE AT DATE OF DEATH 141.25 2 ACN - Invoice #2044942 24.78 3 Comcast Central PA 42.66 4 Commerce Bank - Mortgage Payments for 2005 on Principal 247.50 5 Commerce Bank - Mortgage Payments for 2006 on Principal 622.89 6 Commerce Bank - Mortgage payoff 42,846.89 7 Marlin A. Yohn, Tax Collector 1.048.08 8 MBNA 4.00 9 PPL Electric 99.88 10 PPL Electric 86.91 11 Presbyterian Medical Center - Medical Expenses 424.59 12 South Point Condo Association - Unit 32 Dues from June-December 2005 360.00 13 State Farm Insurance 56.03 14 United Water Pen Water Bill - Reference 050808 999198261 15.41 TOTAL (Also enter on Line 10, Recapitulation) 46,020.87 (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+ (NO) ESTATE OF NUMBER I. . 8CHI!DULI! .. BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Lupinacci, Ida F. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS pndude outright spousal Clistributions and transfers under Sec. 9116(a)(1.2)] FILE NUMBER 21-07-0569 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) RELATIONSHIP TO DECEDENT Do Not List Trustee(s} 1 Linda M. Hancock 112 Juniper Drive Mechanicsburg, PA 17050 Daughter Twenty percent (20%) of the residue 8,378.21 2 Kenneth J. Lupinacci 8759 School House Lane Coopersburg, PA 18036 Son Twenty percent (200/0) of the residue 8,378.21 3 Richard S. Lupinacci Heritage Plantation Nevis, West Indies Son Twenty percent (20%) of the residue 8,378.20 4 Robin P. Lupinacci 2730 Banks Street Harrisburg, PA 17103 Son Twenty percent (20%) of the residue 8,378.20 5 Samuel F. Lupinacci 164 Woods Island Road Lexington, NC 27292-0108 Son Twenty percent (20%) of the residue 8,378.20 Total 41,891.02 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropnate, 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) - ---",,----- r------ ~ .~.....::.~~~,.~~.......~~~ ~.""'oj'''''''~'''...' ~.,.-- -. '~'''.'<'''''. ,""',-_" .~,.,#<~i,~~;a'.:>l',_ -'k .., \~ LAST WILL AND TESTAMENT I, IDA F. LUPINACCI, of the Township of Milford, County of Bucks, Commonwealth of Pennsylvania, being of sound mind, memory and \1 II II I II understanding, hereby make, publish and declare the following to be my Last Will and Testament, hereby making and declaring void any and all former Wills by me at any time heretofore made. FIRST: I authorize and direct my hereinafter named Executor to pay all of my just debts and funeral expenses as soon as conveniently possible after my decease as costs of the administration of my estate. SECOND: I authorize and direct-that my bodily remains be subjected to the process of cremation. THIRD: I give, -deviseand-bequeath all-ofmy property and estate, be it real, personal or mixed and wheresoever -situate unto my husband, SAMUEL F. LUPINACCI. FOURTH: In the event that my husband, SAMUEL F. LUPINACCI, I should predecease me, die at the same time or as a result of a common I disaster, I direct that all the remainder and residue of my estate shall be distributed to our beloved children and their heirs and assigns as follows: II - -----~-~_.~~ , ---------------..-------------------"$"2-4-9----0-0 ~~~~l R~~p.l~ed......... . , ..R' -y-" A. Twenty Percent (20%) unto my beloved son, RICHARD S. LUPINACCI. B. Twenty Percent (20%) unto my beloved son, KENNETH J. LUPINACCI. C. Twenty. Percent (20%) unto my beloved son, SAMUEL F. LUPINACCI, II. D. Twenty Percent{W%)unto-myheloved daughter, LINDA M. HANCOCK. E. Twenty Percent (2D%) unto my beloved son, ROBIN P. LUPINACCI 9f FIFTH: EXECUTOR'S POWERS: My Executor may at his discretion, A. Retention: Retain property for such length of time as he may deem proper. B. Investment: Invest principal and accumulated income in any property which he may deem suitable, without restriction to legal investments, including any common trust fund operated by a corporate fiduciary hereunder and keep cash uninvested. ? -------------s ?'4-9 -:"oU- ,. ----.'-1- -, C Leases and Sales: Lease and sell property for such prices and on such terms, and at public or private sale, as he may deem proper, grant -."- r options for the purchase or lease of property. D. Disability Clause: Apply principal or income for the maintenance, education, and'support of any beneficiary entitled thereto who may be incapable of disbursing the same. SIXTH: All estate, inheritance, transfer, 'succession and death taxes of any kind whatsoever, imposed or payable by reason of my death, and interest and penalties thereon, with respect to.-all property comprising my gross estate for death tax -purposes, whether or not such property passes under this Will, shall-be paid -out -of the 'principal of my residuary estate, as if such taxes were-administrati-on-expenses, without apportionment or right of reimbursement. I authorize my Executor to pay all such taxes at such time or times 'ashe deems advi-sable. Taxes on future inter~sts may be prepaid. SEVENTH: All principal and inrome shall until actual distribution to tHe beneficiary, be free of the debts, contracts, alienations, and anticipations of any beneficiary, and the same shall not be liable to any levy, Jj/ "::l C::?4Q.OU , attachment, execution, or sequestration while in the hands of my Executor. EIGHTH: FINALLY, I nominate, constitute, and appoint my husband, SAMUEL F. LUPINACCI, as Executor of this my Last Will and Testament, and should my husband, SAMUEL F. LUPINACCI, fail to qualify or cease to aetas my Exeetttor, then I appoint my sons, KENNETH J. LUPINACCI and SAMUEL F. LUPINACCI, IT, to act as my Co-Executors. I direct that my Executor and his-successors shall not be required to give bond or furnish sureties- in any jurisdiction. I I I I 'I IN WITNESS WHEREOF, I have hereunto set my hand and seal this ,? 1 I day of l#~ ' A.D., 1999. ~;t~, IDA F. LUP ,-ACCl . Signed, sealed, published and declared by the said Ida F. Lupinacci, as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have subscribed our names as witnesses thereto. ~ c:: fd7 L~~~ ~/~~~h ~~~';.i~"'.R-.~-~'~I-'e-d.:"--. . . . . . . . $249.00 ,---,-, /' ~ A. Settlement Statement U.S. Department of Housing and Urban Development ~ OMB Approval No. 2502-0265 B. T eofLoan 1. 0 FHA 2.0 FmHA 3.0 Conv. Unlns. ..FlleNu_, 4. D VA 5. 0 Conv. Ins. 7. loan NUrTOer 5, MOI1gage Insurance Case NurrtJer C. Note: This form is furnished to give you a statement of actual selUement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside closing; they are shown here for informational purposes and not Included in the totais. D. Name and Address of Borrower Linda Ersoz E. Name and Addr855 of Setler Estate ofIda F. Lupinacci Ida Lupinacci F. Name and Address of Lender alkJa G. Properly Location 32 Southpoint Drive Mechanicsburg PA 17055 H. SeUlemenl Agent R. Scott Cramer, Es uire Place of 5elUemenl 3915 Market St. Camp Hill PA 17011 I. Settlemenl Date 8/28/07 Disbursement Date 8/28/07 Lot; Block: J. Summary of Borrower's Transaction 101. 102. 103. 104. 105. K. Summary of Seller's Transaction 400. Gross Amount Due To Seller 112,000.00 401. Conlrecl sales rice 402. Personal ro ert 2573.50 403. 404. 405. 112,000.00 106. Ci Itown taxes 8/28/07 10 3/1/08 107. Count taxes 8/28/07 to 3/1/08 108. Assessments 10 109. School Tax 8/28/07 to 7/1/08 110. to 111. South oint to 112. Condo ASBo 8/28/07 to 9/1/07 113. 10 114. Sewer 8/28/07 10 10/1/07 115. to 60.56 406. 111.67 407. to 3/1/08 to 3/1/08 60.56 111.67 Acfustments for Items aid b seller In advance 408. Assessments 889.96 409. School Tax 8/28/07 410. 411. South oint 10.66 412. Condo ABso 8/28/07 to 10 7/1/08 889.96 to to to 9/1/07 10.66 413. 35.87 414. Sewer 415. to 8/28/07 to 10/1/07 35.87 to 120. Gross Amount Due From Borrower 115,682.22 420. Gross Amounl Due To SeUer 113,108.72 200. Amounts Paid Bv Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller 201. Deposit or earnest monev 10,000.00 501. Excess deoosit (see instructions) 202. PMnei al amount of new loanlst 502. Selllement chames to saller lline 1400t 9,220.58 203. Existinc loan{s) laken subiect to 503 Existino loanls' taken subiect to 204. 504. Pavoff of first mortoaoa loan Commerce Bank 42,846.89 205. Seller Contribution 300.00 50S. Pavoff of second mori=ne loan 206. 506. Seller Contribution 300.00 207. 507. 208. 506. 209. 509. Adlustments for Items unmold bv s8Uer Adlustments for Items unDald bv seUer 210. Cltvltown taxes to 510. Citvltown laxes to 211. Countv taxes to 511. Countv taxes to 212. Assessments to 512. Assessments to 213. 10 518. to 214. to 514. 10 215. to 515. to 218. to 516. to 217. to 517. to 218. 10 518. to 219. 10 519. to 220. Total Paid By/For Borrower 10,300.00 520. Total Reduction Amount DUB Seller 52,367.47 801. 115 682.22 10300.00 303. Cash 00 From o To Borrower 105,382.22 803. Cash !Xl To o From SeUer 113 108.72 52367.47) 60,741.25 The undersigned hereby acknowledge the receipt of a com~eted copy of pages 1 &2 of this statement & any attachments referred to herein. I HAVE CAREFULLY REVIEWED THE HUD-1 SETTLEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS A TRUE AND ACCURATE STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY THAT I HAVE RECEIVED A COPY OF THE HUD-1 SETTLEMENT STATEMENT. BORROWER SELLER BORROWER SELLER TO THE BEST OF MY KNOWLEDGE, THE HUD-1 SETTLEMENT STATEMENT WHICH I HAVE PREPARED IS A TRUE AND ACCURATE ACCOUNT OF THE FUNDS WHICH WERE RECEIVED AND HAVE BEEN OR WILL BE DISBURSED BY THE UNDERSIGNED AS A PART OF THE SETTLEMENT OF THIS TRANSACTION. WARNING: ITlS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE: TITLE 18 U.S. CODE SECTION 1001 & SECTION 1010. Previous Edition Is Obsolete HUD.1 (3-B6) RESPA, HB 4305.2 l.~ Settlement Char es 700. Total Sales/Broker's Commission based on rice $ Division of Commission line 700) 85 follows: 701. 2,825.00 ro~ 3~5~ 703. Commission aid at Settlement 6,160.00 704 Brokers Real Consumer Service Fee 112000.00 %= 0.00 Paid From Borrower's Funds At Settlement Paid From Selle~s Funds At Settlement to ERA/NRT, Inc. to Brokers Real 6 160.00 800. Items Pi!. ble In Connection With Loan 801. Loan On inatlon Fee 802. Loan Discounl 803. A raisal Fee 804. 805. 806. 295.00 % % 807. 808. 809. 610. 811. 812 813. 900. Items Re uired B Lender To 8e Paid In Advance 901. Interesl from to 902. Mort a a Insurance Premium for 903. Hazard Insurance Premium for 904. 905. 1000. Reserves De oslted With lender 1001. Hazard insurance 1002. Mort a e insurance 1003. elt ra e taxes 1004. Count ro ert taxes 1,005. Annual assessments 1006. 1007. 1008. A re ate Accountin Ad'ustment 1100. Title Char es 1101. Settlement or clcsin fee to to Jicalian Fee to 435.00 Exclude last da in cales -line 901 Ida months to ears to ars to r month ar month ar month er month 10 1102. Abstract or title search 1103. Title examination 1104 Title insurance binder 1105. Document ra sration 1106. Nola fees 1107. Attoma s fees 10 Conununi Settlement LLC 225.00 1108 to to to to to R. Scott Cramer re-settlement 1101, 1103 1105 to 895.00 1109. 1110. 1111. 1112. 1113. 1200. Government Recordin $ $ Law Offices 300.00 1201. 1202. 1203. 1204. 1205. 1300. Additional SeWement Char 8S SUrve to ; Relea... $ 38.50 1120.00 1 120.00 BORROWER 27.78 1 061.55 16.25 100.00 SELLER BORROWER SELLER TO THE BEST OF MY WHICH WERE RECE Ida Lupinacci H -1 S LEMENT STATEMENT WHICH I HAVE PREPARED IS A TRUE AND ACCURATE ACCOUNT OF THE FUNDS OR WILL BE DISBURSED BY THE UNDERSIGNED AS A PART OF THE SETTLEMENT OF THIS TRANSACTION. er, Esquire WARNING: IT IS A CR E TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE: TITLE 18 U.S. CODE SECTION 1001 & SECTION 1010. U." GOVEflHMEHT PRlNllHG ClfflCf: ,.. ........w II Citizens Bank 1-888-910-4100 Call Citizens' PhoneBank anytime for account information, current rates and answers to your questions. US259 BR292 6 1 IDA F LUPINACCI 32 5 POINT DR MECHANICSBURG PA 17055-4270 Checking Account Statement o OF 1 Beginning July 13, 2005 through August 09, 2005 Checking SUMMARY Balance Calculation Previous Balance Checks Withdrawals Deposits & Additions Current Balance 2,568.34 678.84 - 589.74 - 1,018.00 + 2,317.76 = IDA F LUPINACCI LI NDA M HANCOCK Basic Checking 610640-601-8 Previous Balance 2,568.34 TRANSACTION DETAILS Checks' There is a break in check sequence C'-k iI Amount 624 46.95 625 13.00 626 305 . 94 Withdrawals Other Withdrawals D8te Amount 07/13 266.93 07/13 99.90 08/02 39.00 08/05 141.25 08/08 42.66 Date 07/19 08/03 08/03 Check iI 627 628 629 ne-iption Mbna/lbs Check Pvmt 050712620 Pp Elee Bill 05071'3 8636069020ws Mbna/lbs Check Pvmt 050731 630 MRP Health Care 'Premium 050805 0652274101 ",/ Comeast Central Central PA 080805 23856603 'vI" Deposits & Additions Date Amount Description 08/03 1 ,018 .00 US Treasury 303 Soe See 080305 Daily Balance Date 07/13 07/19 08/01 Balance 2,201.51 2,154.56 2,117.56 Member FDIC @ Equa; """"-;'19 Lender Date 08/02 08/03 Balance 2,008.67 2,501.67 Date 08/05 08/08 Amount 206.06 69.89 37.00 Date 08/03 08/02 08/01 Balance 2,360.42 2,317.76 e Total Checks 678.84 e Total Withdrawals 589.74 Total Deposits & Additions o e 1,018.00 ClaTent Balance 2,317.76