HomeMy WebLinkAbout12-26-07
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15056051058
REV-1500 EX (06-05)
PA Department of Revenue ~
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
184-26-3577
Decedent's Last Name
TOTH
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
21 07
0497
Date of Birth
03/26/2007
11/30/1920
Suffix
MI
Decedent's First Name
FRANK
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
WENTZEL
Spouse's Social Security Number
182-22-5216
FILL IN APPROPRIATE OVALS BELOW
. 1. Original Return
4. Limited Estate
.
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
CHARLENEFEUCHTENBERGER
Firm Name (If Applicable)
ORRSTOWN BANK
First line of address
77 EAST KING STREET
Second line of address
P.O. BOX 250
City or Post Office
SHIPPENSBURG,
Spouse's First Name
MI
EMMA
C
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
o
8. Total Number of Safe Deposit Boxes
(717) 530-2614 n
REGISTER OF
j ~7--~
State
DATE I'lLI'D
ZIP Code
PA
17257
Correspondent's e-mail address:cfeuchtenberger@OrrstoWn.COm
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and behef,
It IS true, correct and comple eclaratlon of preparer other than the per t . II . f rm tlon of which preparer has any knowledge.
.NSIBLE FOR FILING RETURN
L
15056051058
ATIVE
P.O. Box 250
Shippensburg, PA 17257
717-530-2605
;'7~I07
tat;;l?
LEASE USE ORIGINAL FORM ONLY
Side 1
15056051058
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15056052059
REV-1500 EX
Decedent's Name:
FRANK
TOTH
RECAPITULATION
1. Real estate (Schedule A).
2. Stocks and Bonds (Schedule B)
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) .
6. Jointly Owned Property (Schedule F) Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested..
8. Total Gross Assets (total Lines 1-7).
9. Funeral Expenses & Administrative Costs (Schedule H). .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I).
.. .. .. 10.
11. Total Deductions (total Lines 9 & 10).
11.
12. Net Value of Estate (Line 8 minus Line 11) . .. . .... 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
. . . . . . . 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) XO_
16. Amount of Line 14 taxable
at lineal rate X 0
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
16.
258,392.17
17.
18
19. TAX DUE.
. . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L
15056052059
Side 2
184-26-3577
Decedent's Social Security Number
1
2.
5
6.
7.
8.
9.
185,680.76
143,048.60
13,78900
34,75000
377,268.36
64,213.71
4,662.48
68,876.19
308,392.17
50,000.00
258,392.17
31,007.06
.
15056052059
--.J
REV-1500 EX Page 3
Dec:edent's Complete Address:
DECEDENT'S NAME
FRANK TOTH
STREET ADDRESS
1 EAST SURD STREET
File Number
21
07 0497
DECEDENT'S SOCIAL SECURITY NUMBER
184-26-3577
CITY
SHIPPENSSURG,
STATE
PA
ZIP
17257
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
31,007.06
34,637.74
1,550.35
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C ) (2)
36,188.09
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
0.00
5,181.03
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
A. Enter the interest on the tax due.
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 [K]
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [K]
c. retain a reversionary interest; or.......................................................................................................................... 0 [iJ
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [iJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 [iJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.............. 0 [K]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 [K]
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. 39116 (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. 39116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 39116(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. 39116(1.2) [72 P.S. 39116(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. 39116(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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
TOTH,FRANK
FILE NUMBER
21-07-0497
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. 29-291/2 NORTH EARL STREET, SHIPPENSBURG, PA 17257; DEED BOOK L22, PAGE 956
SALE PROCEEDS
106,000.00
2
PRO-RATED REAL ESTATE TAXES PAID BY BUYER
997.60
3 1 EAST BURD STREET, SHIPPENSBURG, PA 17257; DEED BOOK Z19, PAGE 858;
SALE PROCEEDS
76,000.00
4
PRO-RATED REAL ESTATE TAXES PAID BY BUYER
2,683.16
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
185,68076
REV-1503 EX + (6-98) f
..
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
TOTH,FRANK
FILE NUMBER
21-07-0497
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
ORRSTOWN BANK INVESTMENT ACCOUNT # 2057; COMRISED OF MONEY MARKET
FUNDS
38,490.73
2
ACCRUED INCOME ON ITEM #1
148.74
3
600 SHS. CONOCOPHILLlPS COMMON STOCK, CUSIP 20825C104
10 SHS. GENERAL MOTORS COMMON STOCK, CUSIP 370442105
400 SHS. PPL COMMON STOCK, CUSIP 69351T106
15,892.00
122.00
4
41,700.00
319.65
5
6
ACCRUED INCOME ON ITEM #5
7
646.4405 SHS. OCCIDENTAL PETROLEUM COMMON STOCK, CUSIP 674599105
ACCRUED INCOME ON ITEM #7
142.22
31,226.31
8
9 97 SHS. ALCA TEL LUCENT COMMON STOCK, CUSIP 013904305, HELD IN PERSHING
INVESTMENT ACCOUNT #4N2-250732
1,156.24
10 28 SHS. LSI CORP COMMON STOCK, CUSIP 502161102, HELD IN PERSHING INVESTMENT
ACCOUNT # 4N2-250732
11
12
282.10
118.7842 SHS. DAIMLERCHRYSLER AG, CUSIP D1668R123
100 SHS. KLM ROYAL DUTCH AIRLINES COMMON STOCK, CUSIP 482516101
9.593.61
3,975.00
TOTAL (Also enter on line 2, Recapitulation) $
143,048.60
(If more space is needed, insert additional sheets of the same size)
REV-15G8 EX+ (6-98) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
TOTH, FRANK
FILE NUMBER
21-07-0497
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
ORRSTOWN BANK MONEY MARKET CHECKING ACCT # 501840
VALUE AT DATE
OF DEATH
1,835.00
2 PERSONAL PROPERTY SALE PROCEEDS
11,954.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
13,789.00
REV-1509 EX+ (6-98) f.
. '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
TOTH, FRANK
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
21-07-0497
SURVIVING JOINT TENANT(S) NAME
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
RELATIONSHIP TO DECEDENT
A. MRS. GYORGY ISTVANNE BOTH
(MAIDEN NAME JUDIT K TOTH)
B.
c.
JOINTLY-OWNED PROPERTY:
ADDRESS
WLASSICS GYULA U 156
BUDAPEST, 1182
NIECE
LETTER DATE DESCRIPTION OF PROPERTY or DNE or DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DEWS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'E INTEREST
----
1. A. 1000 SHS. CONOCOPHILLlPS COMMON STOCK, CUSIP 20825C104 69,500.00 34,75000
50
TOTAL (Also enter on line 6, Recapitulation) $ 34,750.00
(If more space is needed. insert additional sheets of the same size)
REV-1511 EX+ (12-99) f.
. '*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
TOTH, FRANK
FILE NUMBER
21-07-0497
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
A.
AMOUNT
DESCRIPTION
1.
FUNERAL EXPENSES:
REIMBURSEMENT TO MARGARET STEFANOWICZ FOR FUNERAL EXPENSES
2,01814
B. ADMINISTRATIVE COSTS:
1.
Personal Representative's Commissions
Name of Personal Representative(s) ORRSTOWN BANK
Social Security Number(s)/EIN Number of Personal Representative(s) 23-0934350
Street Address 77 EAST KING STREET
21,092.00
City SHIPPENSBURG,
State PA Zip 17257
Year(s) Commission Paid: 2008
2.
Attorney Fees
14,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
Zip
Relationship of Claimant to Decedent
4.
Probate Fees
430.00
5.
Accountant's Fees
176.17
6. Tax Return Preparer's Fees
7.
REIMBURSEMENT TO MARGARET STEFANOWICZ FOR FUNERAL EXPENSES
TRANSFER AGENT SURETY BOND FEES
CARL E. OCKER, AUCTIONEER FEES FOR REAL ESTATE, PERSONAL PROPERTY
REAL ESTATE SETTLEMENT FEES; NOTARYITRANSFER TAX
MIKE BLACK CONSTRUCTION, REAL ESTATE SALE PREPARATION
BOROUGH OF SHIPPENSBURG, RENTAL APPLICATION FEE FOR REAL ESTATE
52.00
1834.13
2209627
1.825.00
126.00
64.00
8
9
10
11
12
64.213.71
TOTAL (Also enter on line g, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ '(12-031
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
TOTH, FRANK
FILE NUMBER
21-07-0497
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
3
HAWKINS CONSTRUCTION COMPANY, SNOW REMOVAL AT REAL ESTATE PROPERTIES
PENELEC, UTILITIES DUE ON REAL ESTATE PROPERTIES
BOROUGH OF SHIPPENSBURG, WATER/SEWER CHARGES ON REAL ESTATE PROPERTIES
PRO-RATED REAL ESTATE TAXES ON REAL ESTATE PROPERTIES
280.00
2
101.55
1,867.26
4
2,339.66
5
BALHARA INTERNAL MEDICAL ASSOCIATES, BALANCE DUE
FRY & BRANNAC OPTHALMOLOGY ASSOCIATES, BALANCE DUE
6159
6
12.42
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4,662.48
REV-1513 EX+ i9-00)
'*
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
TOTH, FRANK
FILE NUMBER
21-07-0497
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
r TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
SANDOR TOTH, 1184 BUDAPEST, XVIII, LAKATOS U. 32/B 1/4,
HUNGARY BROTHER 100% estate residue
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
SHIPPENSBURG PRESBYTERIAN CHURCH, SHIPPENSBURG, PA 17257 50,000.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 50000.00
(If more space is needed, insert additional sheets of the same size)
JRZ - 5.1 toth.l November 6, 2006
LAST WILL AND TESTAMENT
@(Q)~)p
I, Frank Tothl of One East Burd Street, Shippensburg,
Cumberland County, Pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby declare this to be my will,
hereby revoking any and all former wills and codicils thereto by me
heretofore made.
I.
I direct that all my just debts and funeral expenses,
including all expenses of my last illness, shall be paid from my
estate as soon as practicable after my decease as a part of -the
expense of the administration of my estate.
II.
,
J
I give and bequeath the sum of $50,000.00 cash to the
Shippensburg Presbyterian Church, Shippensburg, Pennsylvania, to be
used for general church purposes.
III.
I give, devise and bequeath the residue of my estate of every
nat"UI'"e and wherever situate to my brother, Toth Sandor, 1184
-----
. ,
Budapest, XVIII, Lakatos U. 32/B I/4, Hungary.
In the event my
said brother predeceases me or dies on or before the thirtieth day
following my death, his share shall be distributed to his issue,
per stirpes, living on the thirty-first day following my death.
IV.
Any fiduciary under this will shall have the following powers
in addition to those vested in them by law and by other provisions
of my will applicable to all property whether principal or income,
including property held for minors, exercisable without Court
approval, and effective until actual distribution of all property:
A. To retain any and all of the assets of my estate, real or
personal,
without
regard
to
principle
any
of
diversification of risk.
B. To invest in all forms of property including stock,
common trust funds and mortgage investment funds without
restriction to investments authorized for Pennsylvania
fiduciaries as they deem proper, without regard to any
principle of diversification of risk.
C. 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 they deem proper.
D. To allocate receipts and expenses to principal or income
~-"-
Page 2
---
or partly to each as they from time to time think proper.
E. To compromise any claim or controversy.
F. To distribute in cash or in kind or partly in each.
G. To hold property in their names without designation of
any fiduciary capacity or in the name of a nominee or
unregistered.
V.
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 expense of
the administration of my estate.
VI.
I appoint the Orrstown Bank, with principal offices in
Shippensburg, Pennsylvania, as executor of this my will.
VII.
No bond shall be required of any fiduciary hereunder in any
jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my
last will and testament, consisting of five typewritten pages, the
Page 3
----
first three of which bear my signature
in
the margin for
-Z.!!:. da y
the
purpose
of
identification
this
of
A10V~~J1^-"
, 2 0 0(, .
~~-
~ - (SEAL)
<J~
Signed, sealed, published and declared by the above-named
testator as and for his last will and testament in our presence,
who in his presence, at his request and in the presence of each
other have hereunto set our
IY We, Frank
Uvo I r. Go.- ~ ,
Toth,
han:s~;~ai~~4.
G1VNt1'ILdW, ~, cf;J;eo6fj fJA
~!-bJ~_
and
the testator and the witnesses respectively,
whose names are signed to the attached or foregoing instrument,
being first duly sworn, do hereby declare to the undersigned
authority that the testator signed and executed the instrument as
his last will and testament and that he executed it as his free and
voluntary act for the purposes therein expressed and that each of
the witnesses, in the presence and hearing of the said testator
signed the will as witnesses and to the best of their knowledge
said signer was at that time eighteen years of age or older, of
Page 4
~ ~
ro.
sound mind and under no constraint or undue influence.
~~.
Subscribed, sworn to and acknowledged
before me by the above-named signer and
subscribed and sworn to before me by the
above-name witnesses this ~_day of
V; ,2~
~otana
Carin L. Walter, Notary Public
a.ntbersburg Boro, Franklin County.
I Commission Ex ires May 13, 2009
Page 5
,/
'"
__J...
A. S~nt Statement
U.S. Department of Housing
and Urban Development
~
,r
B. of Loan
1. 0 FHA 2. 0 FmHA 3.0 Cony. Unins.
4. 0 VA 5. 0 Cony. Ins.
OMB Approyal No. 2502..Q265
6. FileNuntler
7. LC*l Number
e. MortgIlge lnsuranctl Cue Number
R070.2
C. Note: This form is furnished to give you a statement of adual settlement costs. Amounts paid to and by the settlement agent are
shown. Items marked "(p.D.C.)" were paid outside closing; they are shown here for informational purposes and not
included in the totals.
D. NlIITl&andAddreud~ E. NlIfM MCIAdaltt,af Seller F. Nam. and Addreu of lender
Comer Properties LLC
Orrstown Bank, Executor of
Frank Toth Estate
Orrstown Bank
625 Norland Avenue
PA 17257 Shi
nsbur
PA 17257 Chambersbu
H. ....,om~l_ Eileen C. Finucane, Esq.
PA 17201
G. PropertyLocatiOtl
1 East Burd Street
Borough of Shippensburg, Cumberland County
Shippensburg PA
17257
P180lt of' Settlement
273 Lincoln Way East
Chambersburg
PA 17201
[. Settlwnem On
9/12/2007
Di~Dat.
11 7
lot BIod<.:
J. SumlMry of Borrower's TraRSllctlon
100. GI'088 Amount Due From BOfT'OW8r
101 Contrad 58les "ce
102. Personal ro
103 Settlementcha eatoborrower line 1400
''''.
105.
K. Summary 01 SeI'",. Tl'llnaactlon
400. Grosa Amount Due To Sttl....
76 000.00 401. Contract sale,
402 Personal
1 667.00 403.
-
405
76000.00
Ad UIIbne"" for ItemI kf HIler In advance
106. C' !town taxes to
107. Coo ,.,.,. 9/1212001, 1213112007
108. Assessments to
109. school tax 9/1212001, 6/3012006
Ad ustrnenta for bms Id setl.,. In advance
406. C' /town taxes to
403.02 407. COli ,.,.,. 9/12/2001, 12/31/2007
408. Assessments to
2260.14 400. school tax 9/12/2001,6/3012006
403.02
110.
111
112
113.
114.
115.
2260.14
10
10
10
10
10
10
410.
411
412.
413.
10
10
10
10
120. Groe. Amount Due From Borrower
414. to
415. to
60,570.16 420. Gran Amount Duo To Sol....
76,663.16
200. Amounta Paid Bv Or In Behalf Of Borrower 500. Reduc60na In Amount Due To Seller
201. Deposit or eamest morHIV 7600.00 501 Excess dMxI.it (see instructions 7600.00
202. Principal amount of new loan s 502 Settlement chImes to setter line 1400) 5247.53
203. Existing Ioan!s) taken subi&d to 503. Existlna loanfs\ tlkef"l sub'eel to
204. Orrstown Bank 100000.00 so.. p8voff of f1~t mortnaCJl!lloan
205. 505. pavorr of second mortaaoa loan
206. 506.
207. 507.
208. 508.
200 509.
Adjustmenta for ltema unnllid tw .....r Adluatmenb for Items unoa.ld bv Hiler
210. Cityltown taxes to 510. Cityltown taxes to
211. Countvtaxes to 51,. County taxes to
212. Assessments 10 512. Assessments to
213 to 513. to
214. to 514. 10
215. to 515. to
218. to 516 to
217 to 517 to
218. to 516 to
219. to 51. to
220. TobIl Paid By-lFar Borrower 107,600.00 520. TobIl Reduction Amount Due Seller 12,647.53
303. Cuh
o From
00 To B_
800. eaah At Settlement ToIFrom Stoller
80570.16 e01. Gl"OSIamountduelosel1er Iine420
107 600.00 802. less reductions in .mt. due seller line 520
)f; 27,029.64 603. Cooh 00 To 0 From Sell",
76663.16
12647.53)
65,635.63
SUBSTITUTE FORM 1099 SELLER STATEMENT
The information contained in Blocks E, G, H, and I and on line 401 (or, line 403 and 404) is Important tax information and is being furnished to the Internal Revenue
Service. If you are required to file a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS detennlnes
that it has not been reported. If this real estate is your pMdpal residence, file Form 2119, Sale or Exchange of Prindpal Residence, for any gain, witt\ your income tax
return; for other transactions, complete the applicable parts of Fonn 4797, Form 6232 and/or Schedule D, Form 1040). You are required to provide the Settlement Agent
(named above) with your comtel taxpayer identification number. If you do not provide tile Settlement Agent with your correct taxpayer identification number, you may be
subject to civil or criminal penalties imposed by law. Under penalties of peljury, I certify that the number shown on this statement is my correct taxpayer identification number.
%- NOT :tl s: % \.) ~ ~ -A"I:- D ". ;rver. Signa"'..)
Affr:1 L.fTB Lt: \0 l>r<.:AW ~..............
jf)-- ~
.
,
#
:#'
L. Sew"mMf: Chf
700. T:>tal SlluIBrok.,.. Commiulon based on rtce s
Division of Commission line 700 as follows:
0.00
%"
Paid From
Borrower's
Funds At
Settlement
Paid From
Sellers
Funds At
Settlement
701.
702.
703. Commission id at Settlement
704.
800. Item. Pa bht In Connection WIth LOIIn
801. Loan 0 'nation Fee
802. lOin Discount
a03. laal Fee
804.
805. lender's Ins Fee
808. Insurance A lication Fee to
807. Assum . n Fee
808. Orrstown Bank-flood certificate
809.
810
811
812.
813.
900. Items R red Lender To B. Paid In AdVIInce
901. Interestfrom to
to
to
%
%
to Orrstown Bank
to
250.00
30.00
Exclude last d In caa ~ line 901
,.
months to
"to
"to
902. Insurance Premium for
903. Hazard Insurance Premium for
904.
905.
1000. Reserve. Deposited With Lender
1001. Hazard insurance
iOO2. a insurance
, 003. C' taxes
1004. Ceu taxes
1005. Annual auessments
1008.
1007.
100B. ate Accountin Ad" stment
1100. TtUe eM ..
1101. Settlementorclosin fee
1102. Abstract or title search
1103. Title examination
1104 Title insurance binder
1105. Document re 'on
1106. Nota fees
1107. Attorn 8 fees
monl/1
monlI1
r month
month
rrnonth
rmonth
monll1
montn
to Finucane Law Office LLP
to
.. Finucane Law Office LLP
to
to
..
to
375.00
375.00
10.00
5.00
Includes above items numbers:
1108. Title insurance to
Includes above items numbfn:
1109. Lender'scov
1110 OWner's cove
1111
1112.
1113
1200. Government Recordl Ind Tnlnsfer Chi ..
1201. Record'n _: Deed S 38.50 ; Mo. S 48.50 ; R.is.... S
1202. C' lcoun taxlstam : Deed $ 760.00 ; Me . $
1203. stolalaxlslam : Deed S 760.00 ; Mort s
87.00
760.00
760.00
..
287.27
1,337.28
2857.98
5247.53
~orrower
Borrower
To the best of
be disbu
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 Of will
. as part of the setl1ement of this transaction. Q./
SetUementAgent t(LL.2-:'/o 7 Date
Filppn . Fin! 1~::::Inp F<c:n
,
,
,./
a
.
fann HUO.' (3Ia&) '" HandbOok 4305.2
p~~llon,"'ob~
U.S. Department of Housing and Urban Development
B. T~nf1 of Loan OMB ADDroval ND. 2502-ll265 fe""ires11130/2oo9\
1.0FHA 2. OFmHA 3. l!ICDnv. Unlns. -\ 6. File Number \ 7. Loan Number 18. Mortgage Insurance Case Number
4. nVA 5. Ins. 2007-301WISER
C. NolO: .~":"~...~:,,,,..';:."~r.=.""'...::::''"=='''' \ Ti\leExpress Settlement system
_ o.n"""'.........~F..-"-' T!U.18U. S."""" __ ";bO, ...S,,"'" 1010
D. NAME OF BORROWER: Troy L. Wiser and Georga L. BlgI.,III and Kelly L. Bigler
ADDRESS: 7121 Olda Scotland Road Shlft~ra. PA 17257
E. NAME OF SELLER: Estate of FrankTotII, also known as Ferenc Imre Toth by OrTStown Bank, Executor
ADORESS: 77 East KI~~'Sireet. P.O. Box 250 Shlnllllllsbura. PA 17257
F. NAME OF LENDER: Adams County National Bank
ADDRESS: 675 Old Harrlsbura Road GAltv.bura. PA 17325
G. PROPERlY ADORESS: 29 & 291/2 North Earl Street, 31 & 31A North Earl Street, Shlppen.burg, PA 17257
Shlaaensbura Borouah
H. SETTLEMENT AGENT: O'Brian, Baric & Scherer, Tel8llhone: 717-249-6873 Fax: 717.249-5755
PLACE OF SETTLEMENT: 19 West South Street Carlisle PA 17013
\. SETTLEMENT DATE: 10/1612OQ7
J. SUtlMARY OF BORR()WI=R'S TRANSACTION: K. SUMIIARY OF SELLER S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. CDntractsalesnrice 106 000.00 401. Contract sales nrice 106 000.00
102. PersonalPmno"" 402. pelSOl1al P;;'''''
103. Set\lem!lnt chi""'" to _r IIin.,400\ 5 623.05 403.
104. 404.
105. 405.
Adiustments lor items Dak! bv seller In advance Ad'ustments for items naid by seller in advance
106. Cttvnown taxes 406. cltvnown taxas
107. Cnu;tv t.... 10116107m12131/07 121.13 407. Co;-tv taxes 1011 Bl07 to 12/31/07 121.13
108. SchoQI Tax 10/16107 to 06f30/l!!! 876.47 408. School Tax 10/16/07\006/30108 876.47
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 112.620.65 420. GROSS AMOUNT DUE TO SELLER 106997.60
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Da~sit 01 eamest monev 10 600.00 sot Excess Dennsit lsee instructions\ 10 600.00
202. PrtnciDaI amount of new loans 125000.00 S02. Settlement ch.mas to seller llina14oo\ 3907.33
203. Existino Io.;;lsitaken su"'eel tD S03. Existinnloanls\ taken sub'eel to
204. Annlicatlon Faa Credtt 585.00 504. Pavoft of First Mortnaoa Loan
205. ""5.
206. 506.
207. S07.
208. S08.
209. 509.
Adjustments for Items uiiDaldbv sener AdI~nts lor Items unnsld bv sellar
210. C;tvnDWn taxes 510. C;tvnown taxes
211. Co~ntv taxes 511. coontv taxes
212. SchQg! Tax 512. School Tax
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 136 185.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 14507.33
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount dua from borrower/line 120\ 112620.65 601. Gross amount due to sell;/Iina 420\ 106997.60
302. Less amounts Mid by/lor borrower1line 220\ 136 185.00 602. Less reduction amount due senerlline 520\ 14507.33
303. CASH TO BORROWER 23 564.35 603. CASH TO SELLER 92 490.27
A Settlement Statement
.
.
'11
~
Pr.\IIOU.Nlion.s....o~
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
File Numbec 2007.301WISER
10"" HUO.'\3I8&1 ref HanObook 4305.2
PAGE 2
TitleExoress Settlement S"stem
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALESlBROKER'S COMMISSION based on orice $106.000.00 = BORROWER'S SELLER'S
Division of oommission lline 7001 as fonows: FUNOS AT FUNDS AT
701. S 10 SETTLEMENT SETTLEMENT
702.$ 10
703. Commission Mid at Settlemenl
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Orioinatian Fee %
802. Loan Discounl 0.500 %Adams Coun tv National Bank 625.00
803. A.....isai Fee 10 Adams Coun tv National Bank 1100.00
804. Credil Rennrt 10 Adams Coun v National Bank 26.86
805. Ooalment PreMration Fee to Adams Coun v National Bank 85.00
806. Flood CllI1ificatfon Fee to Adams Cou National Bank 18.00
807. Underwritlnn Fee to Adams Cou National Bank 245.00
808. Exnress Man 10 Adams Cou National Bank 13.34
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Inlerest From 1011612007 to 11101/2007 ""t 25.1700 Ida" 16 0.;;;, 402.72
902. ~nsurance Premium for 10
903. Hazard Insurance Premium for to CBIA 780.25
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazanllnsurance mo.I!llS 65.02 lmo
1002. Mori~';;e Insurance mo.""" lmo
1003. Cm. Pro...."" Tax mo."'. lmo
1004. Cou;'; Pro~ Tax mo.I!llS 48.48 Imo
1005. School Tax mo. Oil t 103.61 Imo
1009. Aoo_ate Anal"'s Mustment 0.00 0.00
1100. TITLE CHARGES
1101. Ssttlement or clasinn fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Document Pnmllfation
1106. NolaN Fees to Cash 15.00
1107. Attomov's fees to Joel R. Zulllnaer. EMulre POC
linciudes above items No: ;-
1108. Title Insurance to O'Brien Baric & Scherer 885.38
linciudes above ilems No: \
1109. Lendef. Policv 125000.00 -
1110. Ownefs Po/icv 106000.00 - 885.38
1111. End 100 End 300 End 900 to O'Brien Baric & Scherer 150.00
1112. ClosinnSvcLtr to O'Brien Baric & Scherer 35.00
1113. OverninhlFee to O'Brien Baric & Scherer 10.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordinn Fee. Deed 538.50 . Mortn""". 66.50 . Release 5 105.00
1202. Cm./Countv-taxistam.. DeedSl 060.00 . MortoaoeS 1 060.00
1203. State Tax/.t~ Deed "1 060.00 'Mortoaoe" 1 060.00
1204. Mortn~ -31 & 31A N. Eart 51. 10 Cumberland Countv Recorder of Deeds 66.50
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. 07 C;;;-rr"", Taxes 129 & 29-112 to Annela Facehinel Tax Collector 581.79
1302.07 School Taxes 10 AMela Facelnel Tax Collector 1 243.37
1303. Final WaterlSewer.29 & 29.112 to Borouah of Shl"""nsbura 1 022.17
1400. TOTAL SETTLEMENT CHARGES lenter on lines 103 Section J and 502 Section Kl 5 623.05 3907.33
HUD CERTIFICATION OF BUYER AND SELLER
I h.lv.- ~Il' ~ 1M HUD-1 S~ S~.ncllD 1M bHtofm ~ end~, 1111' trw and RalrMe ~menl ofalr rKlIIlptlllOd dlaburwments made on my Iccount
:J.bl' Inthilnn..nCllftlfylhetlhaftrK8lwdloopyoftMH SdIim."tSwllmM'lt. ~
~ <).A-9.-...- ,:;J tt:.. ~ Do f.,. 6.1!,"<',
~,-(j , M~O 0
L~V ~N'~~
~
WARNING: IT IS A CRME TO KNQWlNGl Y WoKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR AMY SIMIlAR FORM. PENAl TIES UPON CONVICTION
CAN INCLUDE A FtNE AND IMPRISONMENT FOR DETAIlS SEE TIne 18"
u.s. CODE SEeTlON 1001 AND SEcnON 1010.
TM HUD.' s.tuem.nt St.wmemwhieh I nave prep.tIWd i.. true ,rid acan. EmUnt otlhil
_. 1__~~Iunda~".""""In"",",,"~_""__
. ~ 11 f~'f(" Q 1
SETTlEMENT AGENT: DATE:
,- -
-
FINAL SETTLEMENT
.
r
tre,,,)<
- -:-- ,..i
. ,." 'I ~'"
. "'.. \ ..
Date
I
i'
I /' .' ~
i/ ~.. ~1
/,/
Address
w {-S+ IS (''c./( r.i
<'."+
...; .
<.-/. ,'".: f)7i
.J\lp?-/;'.':''''i r/
I . \1
Sa e location
Date of Sale
""\
Auctioneell ~ I
\...-
; ! ' r "'"I
<' ((~ . .
J . .
r, .
. )(.11"''' t ~:'
'1 , /":,'
I,
~..,>
Clerk ~. :
.. .~ .#.. ;"'.
Cashier :.~ f /
I . . -'
. I~ ,r-
Other
PROCEEDS OF SALE:
Cash.. --...-......_... ......m... .h._.h..._._.. $
'j ~ ,-Jr ~'". .:- (
-r-- .....} C '.~.l I~.' :..'
Ch ecks _. _.. __.. ._h....m._.... _"'"'' ....._..
1.) _f ,L/c,> ~\ t"',
/ I . / f
Other.._......__... .---.... --...... ""'" ...... ....n...--........____...___........__..h.__....._.
.~-.-_. ..~ ..._~._.._.... -. - -.. ..-. .~..-._--..._~--.. ~_...-.~~---_._-_.-.._~...." ._-_...._~..........-._..
--.......... -.. -. --~..... - --...... . ~....-. -. _.._._-.._-..-.....-.._....~_...-......._-....._~... .-...__.._----._--~
Miscellaneous (see attached list) ......__..h.._......._.___.......__
TOTAL PROCEEDS OF SAlE.__._m_.._m.__..___.__._._$
( 5 -:;i '/ .....
'.:?.... ~ It ~()
LESS SElLER'S SALE EXPENSE:
Auctioneer's Fee ..---....../,L~.~.~::~..-......h-....h.----.--. $
1'...., ..... ~___I... ~ c. ,.~r..",,)
; j f.:Y . _ _
Other Seller's Expenses
Advanced by AUCTioneer:
.....;..7 l~ ....~),... .,.'.
'~;;:;'.~ ( ~ - " ' ,
"1:.. I ..-;-:. '__ -.~, , .8,!t>,~D
!\~:)..frfi~II1"l, ).~~; ./j,.,,:....-
. ,t'
("~~.' i,,,_' ~ .,.., !".... ""f('~~ r:, ;.'~ If.:. _ ,:~',.. .
...,;,'Pd1f.\."., [l;J'f,.." ",,...-' ."..",
,
~J () t;; t' () ~'~)
\ ~..,) ;:.~,' ,,<<i;
":, ,r ~ . ;,\ ~ ~
Lf7 / f S ()
Miscellaneous (see attached list) ...n.h..n_____.__._..
TOTAL NET PROCEEDS TO SELLER....,...$
;{379.d:i{)
Lfl5"~/)t:l
DEDUCT TOTAL SElLER'S SALE EXPENSE_..nm$
I, (or we), the seller of goods, merchandise, and/or property sold at public auction on above date and
location, acknowledge and accept this settlement of proceeds of sale. I (or we) agree to accept all re-
sponsibility for providing merchantable title to ail goods, merchandise, and/or property sold, and for
delivery of title to the purchaser.
~g1
(Date) (Seller's Signature)
fv.,"p 1;0:. .(i
'- . 'v ...' l......... ..' - (" '.......~.JI
Auctioneer or Casnier's Signature (Seller's Signature)
FINAL SETTLE!-IlENT-Form "lo. FS-89. $2.00 per pad, 10 paels at 51.50 each, 20 or more at $1.25 eaen.
Reoroer'rom: ',1ISS0URI AUC,ION SCHOOL. 1600 Genessee . Kansas Clly, MO 64102 . Phone 8i6-~21-71i7
t.
.fl
Jl
.
.
..
fINAL SETTLEMENT
OWNE~
Address
r;.,~ Y1 k
~tL
Date
/ /-1/ '1'
/,Int
f t
~
I
i. ' ,Q "L <r;
".-1 t. .~ l .~;; jst .C
<(' ...
...,)(
Other
_ClerL
f2t.
1-( /: '(I~ AM (:,i;p:t,
Cashier
~
Date of Sa I;..
\
, i ,;i ,,"J
,
Auctioneer ~ !j., i
.. ~ oj. , ,,'
./ \ .. \
PROCEEDS OF SALE
Cash,..... .......... ...n.____.... __.._.__........ $
Other.......n.............. ...... "'" "'''''' ........--... .--....----........----. ..--....-----...
Check s. "" ......_...... '''''''' _........______.
-..~. ~_. ... -. ....--..... --.... . - -. -.... ..... .--...-.-.-... ..........-..--..--...- -.. --'-. -...................-.
...-...------.....--. --........--........ ......--....---........-.--.-.......-----..---.....--.......................
Miscellaneous (see attached list) ......__. ....................._.....
/
LESS SELLER'S SALE EXPENSE:
Auctioneer's Fee ..n__..........__...........__.._~.~....
TOTAL PROCEEDS OF SALE........__...____...____.n...$
e, I, f
..J "if / <..o~
5,:)
$
I C':~'.c- -
.6,;,';,77
'"
\
\
)
Other Seller's Expenses
Advanced by AUCTioneer:
Miscellaneous (see attached list) --.--..-h...____..h.._
DEDUCT TOTAL SEllER'S SALE EXPENSE........$
,...,
TOTAL NET PROCEEDS TO SELLER__......$
/'>2(,;l" ..,.,
o/V'I/
~ ."". '/ / "7 oJ
........; <<<...'Ii ....;.
I, (0' we), the ,elle, of good" me"oh.ndl'e, 'od/o, p,o_ty 'old .f pub!;e .uctlon on .bove dOle .nd
loe.t/on, .eknowledge .nd 'ecept thi, 'efflemenf of proceed, of "Ie. I (0' we) '9'00 to ''''''pf .11 ....
sponsibility for providing merchantable title to all goods, merchandise, and/or property sold, and for
delivery of title to the purchaser.
1!IJf/OI ~
I b "-'"
"~ (ate) I ! \ i
L r j/',/", ~.' !.'..
.t"r..." it, ./ <:"'1" ,',. I. ."
Auctionter ;; Cashier's Signature
(Seller's Signature)
SHEET #
FINAL SETTLE:,'I1ENT -F'Jrm No. FS-69. S2.00 per pad, 10 pads at $1,50 each, 20 or more at $1,25 eaC:1.
Reoroer'rom. '.1JSSCUAI AUC,ION SCHOOL. 1600 Genessee . Kansas City, MO 64102 . Phone 816-421-7117
(Seller's Signature)
'"f"Y.)
f
,
'.
I
,/
.....11 1L,..L.' 1'-' " ".....