The URL can be used to link to this page

Home My WebLink About01-22-08 ---I 15056041125 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes " INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 5 File Number o 1 025 Date of Birth 396380537 10182 005 02021919 Decedent's Last Name Suffix Decedent's First Name ALLARD W E S LEY MI J (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 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return o 4. Limited Estate ~ o 2. Supplemental Return o o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o o o o 8. Total Number of Safe Deposit Boxes Hl1BERT x . GILROY, E SQ. 7 1 7 2 4 3 ~~3 4 1 = () <= REGIST ,~ILLS US~ ONLY : :;~;:=:? z <;. en N "'U N -.". ":;:>': Firm Name (If Applicable) MARTSON LAW 0 F F ICE S First line of address 1 0 E A S T H I G H S T R E E T Second line of address :r,., ......-"" - o City or Post Office State ZIP Code C. DATE FILED CO CARLISLE P A 17013 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. SIGNATURE OF PERSO ESP SIBLE FOR FILING RETURN DATE , <; :. Ii.. . A.. l: /<..~ C ~ ADDRESS I 411 WALNUT! #2654 GREEN COVE SPRINGS EROTHER THAN REPRESENTATIVE j PA 17013 ADDRESS 10 EAST HIGH STREET CARLISLE PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 15056041125 -.J ~ --.J 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: WESLEY J. ALLARD RECAPITULATION 396380537 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 320000.00 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. 1 3 0 8 2 3 . 9 4 ...... . 6. Jointly Owned Property (Schedule F) D Separate Billing Requested . . . . . . . 6. 1 2 3 6 6 9 . 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 5 7 4 4 9 2. 9 4 7 5 4 7 6. 3 5 2 6 0 9. 4 7 7 8 0 8 5.8 2 4 9 6 4 0 7 . 1 2 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. 4 9 6 4 0 7 . 1 2 TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.O _ o . 0 0 15. O. 0 0 16. Amount of Line 14 taxable 4 9 6 4 0 7 . 1 2 at lineal rate X .012- 16. 2 2 3 3 8 . 3 2 17. Amount of Line 14 taxable o . 0 0 at sibling rate X .12 17. o . 0 0 18. Amount of Line 14 taxable o . 0 0 at collateral rate X .15 18. O. 0 0 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 2 2 3 3 8 . 3 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 00 Side 2 L 15056042126 15056042126 -.J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 05 01025 DECEDENT'S NAME WESLEY 1. ALLARD STREET ADDRESS 258 RICH V ALLEY ROAD CITY STATE ZIP MECHAt"\[ICSBURG PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Une 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 22,338.32 25,000.00 1,116.92 Total Credits (A + 8 + C) (2) 3. Interest'Penalty jf applicable D. Interest E. Penalty 26,116.92 TotallnteresUPenalty (D + E) (3) 4. If Line 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) A. Enter the interest on the tax due. 0.00 3,778.60 0.00 5. If Line 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8. Enter the total of line 5 + SA. This is the BALANCE DUE. (SA) (58) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ...................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ............................... 0 00 c. retain a reversionary interest; or ................................................................................................ 0 00 d. receive the promise for life of either payments, benefits or care? ....................................................... 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 00 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ..... .......... ....................................... ............................... ............. 0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse s three (3) percent [72 PS. 99116 (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 sur,wing spouse is zero (0) percent :72 PS. S9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax. and the statutory requ;rerr,ents for diSClosure of assets and '",ng 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. s9116(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 PS. S9116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's sibiings is twelve (12) percent [72 P.S. S9116(a)( 1.3)]. A sibl:ng 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 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WESLEY J. ALLARD 21 05 01025 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 DroDerty which is lolntlv-owned with rlQht of survlvorshlD must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Residence at 258 Rich Valley Road, Mechanicsburg, Silver Spring Township, Parcel No. 38-06-0013-054. Actual sale price (see Settlement Statement attached) VALUE AT DATE OF DEATH 320,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 320,000.00 REV-150B EX + (6-9B) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WESLEY J. ALLARD SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 05 01025 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 1. DESCRIPTION VALUE AT DATE OF DEATH 3. 4. 5. 6. 7. 8. 9. 10. II. 12. 13. I.-L 15. 16. Jar of coins 80.00 2. Travelers checks 920.00 M&T Checking #1283472 6,824.96 Citizens Bank, C.D. #6140-835844 (principal + accrued interest) 5,676.93 Citizens Bank, C.D. #6243-925167 (principal + accrued interest) 5,303.23 USAA, vehicle insurance premium refund 41.12 USAA, homeowner's insurance premium refund 158.28 Verizon, refund 25.96 Audiologic Consultants, refund 10.00 U.S. Treasury, 2005 income tax refund 1,655.00 2006-2007 Real estate tax proration received at settlement 272.06 TransAmerica Annuity #26146891; Beneficiary: Estate (principal + accrued interest) 99,338.40 Chuck Bricker Auction. proceeds 13800 2000 Honda Accord. appraised value iI. -no.un Canoe. appraised value 10500 Cub Cadet lavm mo\ver, sale price 900.00 TOTAL (Also enter on line 5, RecapitUlation) $ (If more space is needed, insert additional sheets of the same size) 130.823.94 Continuation of REV-1500 Inheritance Tax Return Resident Decedent WESLEY J. ALLARD Decedent's Name Page 1 21 05 01025 File Number Schedule E - Cash, Bank Deposits, & Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17. Honda lawn mower, appraised value 400.00 18. Kayak, appraised value 75.00 19. Sport boat and trailer (no motor), appraised value 100.00 SUBTOTAL SCHEDULE E 675.00 GRAND TOTAL SCHEDULE E $ 130,823.94 REV-1509 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WESLEY 1. ALLARD SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21 05 01025 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. LffiER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. A IT ACH DEED FOR JOINTL V-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENrSINTERES ",,,,. ,"0 1. A. 03/21/03 Citizens Bank, Checking #610070-063-1 (prin + acc int) 139,150.67 50. 69,575.34 2. A ~;;I;!;j Members 1st, Savings #8732-00 (") 26.48 50. 13.24 ","Of' ~ 3. A ~4/0 1/03 Members 1st, Investment Savings #8732-05 (") 80,236.58 50. 40,118.29 ~I't' ..... 4. A 04/01/03 Members 1st, C.D. #8732-40 (") 14,026.45 50. 7,013.23 e",r +0 Members 1st, C.D. #8732-41 (") 5. A 04/01/03 13,897.79 50. 6,948.90 TOTAL (Also enter on line 6, Recapitulation) $ 123.669.00 SURVIVING JOINT TENANT(S) NAME A. Joseph M. Allard B c JOINTL Y.OWNED PROPERTY: ADDRESS RELATIONSHIP TO DECEDENT 411 Walnu! Street #2654 Green Cove Springs, FL 32043 Son T (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(12-99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WESLEY J. ALLARD FILE NUMBER 21 05 01025 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Auer Memorial Home & Cremation Society, balance due 91.00 2. Rev. Ronald Hoffman, memorial service 400.00 3. Memorial service reception/interment 558.15 4. The Patriot, obituary 18.80 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City Slate Zip Year(s) Commission Paid: '2. Attorney Fees Broujos & Gilroy/Martson Law Offices (estimate) 21,600.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills of Cumberland County 560.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 2005 income tax returns 185.00 7. Diversified Appraisal Services, real estate appraisal 275.00 S. Conun. ofPA, registration of Honda pending disposition ~8.00 9. Conun. ofPA, registration of boat pending disposition ~6.00 10. Vehicle gas. insurance, maintenance used in estate administration 1,135.19 11. Homeo'WTIer's insurance pending disposition ~4.30 12. 2006-2007 real estate taxes pending disposition of property 2,441.1 1 13. LU'WTI mowing pending disposition of property 121.42 14. Removal of nonsaleable household goods and cleaning of property 1,528.33 15. Electric service pending disposition of property 3,216.86 16. Trash service pending disposition of property 294.94 17. Settlement charges for sale of real estate (see Settlement Statement attached) 25,257.00 18. Citizens Bank, estate checking account fees 205.00 TOTAL (Also enter on line 9, Recapitulation) $ 75,476.35 Debts of decedent must be reported on Schedule J. (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent WESLEY J. ALLARD Decedent's Name Page 2 21 05 01025 File Number Schedule H - Funeral Expenses & Administrative Costs _ 87. ITEM NUMBER DESCRIPTION AMOUNT 19. 20. Phone, fax, copies Joseph M. Allard, reimbursement for living expenses pending sale of property in lieu of Executor's commission Register ofWiJls, filing fee, inheritance tax return Reserved for additional filing fees 599.63 21. 22. 16,775.62 15.00 100.00 SUBTOTAL SCHEDULE H.B7 17,490.25 REV-1512 EX + (12-03) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYl VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WESLEY J. ALLARD FILE NUMBER 21 05 01025 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1,628.54 1. Joseph M. Allard, reimbursement for decedent's expenses paid prior to death 2. Cumberland County Office of Aging, home health care, account payable 672.00 3. Linda Patterson, account payable for medical expense 100.00 4. PPL, account payable 144.70 5. Verizon, account payable 19.42 6. Comcast, account payable 44.81 TOTAL (A!so enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2.609.47 '''.'''''''.'. COMMONWEALTH OF PENNSYL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WESLEY J ALLARD SCHEDULE J BENEFICIARIES RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS [include outri~ht spousal distributions, and transfers under Sec. 91t6(a (1.2)) 1. Joseph M. Allard Lineal 247,915.04 411 Walnut Street #2654 Green Cove Springs, FL 32043 2. Mary C. Spiker Lineal 124,246.04 2904 25th Street Parkersburg WV 26104-2733 3. Patrick W. Allard Lineal 124,246.04 2232 Orchard Road Camp Hill, PA 17011 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET II. NON.TAXABLE DISTRIBUTIONS; A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ FILE NUMBER 21 05 01025 (If more space is needed, insert additional sheets of the same size) _O.6(27/2007~5 HI 7177311799 KEYSTOXE L~XD TRA~SFER K ~002 MB NO 2-02 5 ...~ 0 .250 6 ,r A. e. TYPE; OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMlilllT 10FHA 2.QFIT'HA 3. ~CONV. UNINS. 4. OVA 5.CCCNV iNS. 6. FILE NI.,MBER: 17. LOAN NUMBER: SETTLEMENT STATEMENT 07045 0061281154 5. MCRTGAGE iNS CASE NLMBER: C. Non,: This form ,$ fuml:hed 10 gIVe YOIl a ststemMI of actual sell/ement ecsl.. Amounts ps/cllO and by the 8e/llemenl agent are shown. ;rems mark'd "[POC)" wen> paid outSide the clcsingi they are shewn /;era for Informational purposes and an> not included In /lie total.. 1.0 ~ (t7~5J0704S,4"1 C. NAME AND ADDRESS OF BCRRCWER; E. NAME AND ADDRESS OF SEL~ER: ! F NAME AND ADDRESS OF LENDER: Vichi1e/ K. Y;nkle . and I Jc 5ep~\A Allard. Executor I First Horizon Home Loans. Inc. :lcnna R. C. Hin~'e I of the Wesley J. Man:! Estal. 14000 Hcnzon Way 140 S~efWood Dliv. ; INlng. TX 75063 C3r!;sle, Pa i7015 I I G. PROPERTY LO';:ATiON: I H. SETTLEMENT AGENT; 25.1878915 I. SETTLEMENT DATE: :25B RIch Valley Road I Key.tone Land T,.n.fer, Ltd. Mechan"'.burg. PA 170S0 June 26. 2007 C;umbenand County. Pennsylvania I PLACE OF SETTLEMENT I 3421 Mancel Street I Camp Hill. PA 17011 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. CiROSS AMOUNT DUE TO SEUER: 101. Contrad Sales Price 320.000.00 401. Contract Salea Pnce I 320,000.00 102. Personal Propetly 402, Peraonal Property 103. Settlement CharGes to Borrower Une 14QO) ~.46-4.20 403. 104. 404. 105. 405. Adiustmenl& For Items Paid Bv Se/ler in advance Ad'uslmenls I'or Items Psld By Seller in advance 106. CityfTowt'l Taxes 10 I 400. CilVrrown Taxe. to 107, CounlVTaxes 06126107 to 01/01108 25152 407. Counlv Tax.. 06126107 to 01/01/08 251,62 10B. School Tax 06128/07 to 07101/07 I 20.44 408. School Tax 06/26/07 10 07/01107 20.44 109. Private Trash 7/1.9/30 i 41.85 409. P,ivate Trash (7/1-9/30) 41.55 110, 410. 111. I 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER I 329,778.11 420. GROSS AMOUNT DUE TO SELLER 320,313.91 200. AMOUNTS PAID BY OR IN Bf;HALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SEUER; 201. Deposit or earnesl mOney 5,000.00 501. eXt;QllS Deposit (Se. Instructions 202. Principsl Amount of New Loen s\ 232,000.00 502. Settlement Charges to SeU., Une 1400) 25257.00 203. Existing loants) taken 'ub ect to I 503. EJdstlna laanisllak.n subject to 204. Funds from 2nd Mta I 28.50177 s04. Payoff of firs. Mortgage 205. 505. PaYOff of ..cond MortgaQe 205. I 505. ~O7. 507. (Deposit disb. as eroceeds) 208. I s08. 209. 509. AdJustments Far Items UnDtJid By Se/ler AdJuslmenlli For Il8ms UnlJaid flv S./I" 210. Cilyrrown Tax.. to 510. CIty[Town Taxes to I 211. County Tax.. to 511. Couflly Taxas 10 [ 212. School Tax to 512. School Tax to I 213. I 51.. 214 514. I 215. ~ 515. 215. 516. 217. I 517. 216. 510. 219. I S19. 220. TOTAL PAiD BY/FOR BORROWER J 265.601.77 520. TOTAL REOUCTlON AMOUNT DUE SELLER L 25.257.00 300. CASH AT SETTLEMEllIT FROMITO aORROWER: 600. CASH AT SETTLEMENT TO/FROM SELleR: 301 Gross Amounl DLe From Borrower Line 12D 329.778 ~ 1 601. Gross Amo~nl Due To Selle' (L:ne 420) .20313.91 302 Le.. Amount Paid BylF'a, Borrower Li~e 220) ,( 265,601. ;() 502. Le.. Ra<luctJons Due Seller (Une 520) ( 25.257.0OJ 303 CASH! X FROM) ( TO; BORROWER 64,176.34 603. CASH( X TO)( FROM) SELLER I 295.05691 ;-"'sllef 5tH. A <::::",/1 L1 :L~h-1.. -,...L, ..... a (, Ie...) 06/27/200i 09:26 FAX iliiJl1799 KErSTO~E LAXD TRA~SFER K ~OOJ L SETTLEMENT CHARGES 700. TOTAL COMMtaSION Ba"d on Prlc. S 320,000.00 ilJI 6.0000 % 19,200.00 PNO FROIl ~bJD ~~'* Division of Commission (line 700) aa Follows: 8MRQVVtft'S SELLER'S 701. $ 19.200,00 10 RelMa. Really Associales, Inc. FUNDS 4T FVND5 AT 702. S 10 s ETltEMI:NT iiTTt,.EW(NT 103. CommiSiion PaiO al SeW. men I 19,200,00 704. Transaction Fe" to RelM.. RealI\! Associales. Inc, 295.00 295.00 BOO. ITEMS PAYABLe IN CONNECTION WITH LOAN 601. Loan OriqinaUon Fee 0.2500 '.. to F;~t Hortzon Home Loans, Inc. 580.00 802. Loan Dls""unl % to B03. Appraisal Fe. to 8004. Credit Report 10 805. Courter Fee to Flrsl Hortzon Heme Leans, Ine. aoo 8C6. Unde/WfiUnq Fee 10 First ,"orizen Horn. Loans Inc 300 00 807. Tax SeNica Fe. 10 Tclal Mtg. SOluflona 90.00 808. 809. 8'0, S11. 812. Applciation Fee to Firsl Honzon Hom. Loana. ,ne. 400.00 813. Aood DetenninaUon 10 Federal Flood :26,00 8104. 815. 818. 817. 81a. 819. 820. 900. ITEMS REQUIRED BY LENDER TO 8E PAlD IN ADVANCE 901. Int.r.., From 06/26/07 to 07101/07 @ S 39.472000/day ( 5 days %) 197.38 902. PoAort"aae Insurance Fremium{or months to 903. HII2lIn1lnsurance Premium for 1.0 ye.... 10 Aeon1 POC:S801.0a 90-4. 905. 1000. RESERVES DEPOSITED WITH LeNDER 1001. Hazard Insurance 3000 month, S 5006 Der mon1l'l 150.24 1002. Mor1aaae Insuntnce month. S oar month 1003. CitvrrOWl1 Ta"". month. $ lla. month 1004. Cauntv TaDB 6000 month. S 40.49 Der monlh 242.94 1005. Sdlool TlIX 13.000 months @ S 124.35 per month 1,616.55 1006. months tilf S Der month 1007. montha till S De month 1008. Aaareaate A,fu'lmanl months till $ OO!r monlh -302.64 1100. TITLE CHARGES 1101. Seltlemenl or Cloaing Fee to 1102, Ab&lract or TlU. Search 10 1103. Tide Ewamlnation to 1104. Radon Mlllgation to B & T Inspectfons B15.00 1105. Doeumant Preparation to Hubert X. Gilroy POC 1106. NolaN Fees 10 CASH 25.00 1107. Altom,,>,. Fa.. to line/ude. above it.m numb.,&., ) 1108. Tille Insurano;e to Kevslone Land Tranafer Ltd. 1 958.75 (i"eludes above ;llIm nlJmbars: ) 1109. Lendefs Coyerag. $ 232.000.00 PAL#l06211173 1110. Owne", Coverage S no.o~oo PA0lII108:159028 1111 Endorsements 100,300.8.1 to Key$lona Land Transfer, Lid. 150.00 1112. Closing Protection ~etter to KeVClone Land Tronsfer. Ltd. 35.00 1113. Tax Certifications 10 KaYStone LonG Trans'.'. Ltd. 5.00 11'4. Overnight 10 Keystone Land Transfer, LId. 20.00 26.00 1115. Rein... E Mall Ooeumenls to Keystone Land rransfer, Ltd. 25.00 1118. Ra-Imburae Lawn Care to SleW! Hawbeeker 175,00 1117. Wlr. Proceeds to Key$lone Land Transfer, Ltd. 15.00 1118. SepUe Repairs to WaIte.. ServiCl!.ll 590,00 1200. GOVERNMENT RfCOllDING AND TRANSFER CHARGES 1201. Reconling 1'.81' Deed S 38.50; Mortgage S 66.50; rleleases S 105.00 ~ 202 Chy/CounlY TelCiSlamllS' S 3 :200.00' ',fonaaae 3.20000 1203, Slate ralliStamps: Reyen"e Stamps 320000; Mort"."e 3.20000 1204. 1205. 1300. ADDITIONAL SI!TTLEMENT CHARGES 1301. Survey ~o i ~~ In'PDCllon 10 1303. Re-Irnbu," Sapoe Inspect'"n to SIeve H:lwbecker 325 CO J-JS4 Re-I,.,burs. Sept.c I'!!!pectlcns 10 :Cleve l-'awtJechr Q}i:!1Q 1305. ;nspec.Woler.Radon.Wooo to l1"pectiun Cant.r POCB55C.OO 1400. TOTAL SETTLeMENT CHARGES (Ent.r on Lines 103. Section J and 502, Section K) ;14"",20 25,~570C "_2 'y ,,"',-. F." , ,,'h. ,',,""', no '.rok'~. """"'''<'~'''''''' ""'~,...c ',"y,f,,,,,, "~"!oN< ',:O'7k.4 w~ ~IOr1e Una -ranst..., lid. Selt'f'me:lt Age:,t '::ertlfed IQ be a true copy. ).J.. {3 /7 " (zlz) r i;~'::.l$J a';'e.::5 I 44: ~ ~. .... . i.TM1i~~m~A Annuity Products and Services ATTN: Customer Care Group 4333 Edgewcod Road NE Cedar Rapids, fA 52499 Secure Path Annuity July 10,2005 - October 10, 2005 A~~~'l lof"{" ., @ ......-f";. WESLEY J ALLARD 258 RICH VALLEY RD MECHANICSBURG PA 17055 Annuitant: WESLEY J ALllIRD Owner: WESLEY J ALllIRD Issue Date: January 10, 2001 Type: Non-Qualified Contract Number: 26146891 alue Summary L'lal dlSbur>cments Include annual ,aYlce charge, and nd",. '._ charge" If applicable This Period S97.868.64 0.00. 0.00 1,353.4 1 S99,222.05 ~ Since Ince lion SO.OO 75,000.00 0.00 24,222.05 C S99,222.~ Beginning Value Total Premium Payments Total Withdrawals Total Interest Earned End""g Value.. of 10/10/1005 Cash Surrender Value Galuel .. of 10/10/1~ $99,222.05 Fixed Interest Rate Interest Rate % 5.350 Total Value Dollar Value $99,222.05 $99.111.05 . Efrective Date 7/3 1/2005 3/3 ] /2005 9/30/2005 ransaction llistory Transaction Addltlona/lnterest Credited Additional Interest Credited Additional Interest Credited 7 Amount $19.76 $19.86 $19.30 ;': :-(~:>:, ; T"..ns..meric.. UI~ InMlrance and \nnllily Company Memher of the \Ll,;ON (;"0111' i'J~L j ", .... 6 CoH. E )x.k.uc /,2.. LAST HILL AND TESTAllENT OF HESLEY J. ALLARD 1, HESLE'Y J. ATJLAnD, oi' the 'fovTnshtp of Silver Spring, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and lmderstanding, do make, publish and declare this my Last Hill and '1'estanlent, hereby revoking and making void any and all prior Hills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. I give, devise and bequeath all the rest, residue and rernainder of my estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my wife, ALTA H. ALLARD, absolutely and unconditionally. 3. In the event that my vdfe, ALTA H. ALIJARD, should predecease me, or should s he die \-,i thin thirty (30) days from the date of my death, then in either or such events, I give and bequeath my enth'e estate, of Hhatsoever nature and Hheresoever the same may be situate, to my son, JOSEPH H. ALLARD, my son, PNfRICK \'1. ALLARD ., .. and to rlY stepdaughter, IlARY C. SPIKEn, share and share alike, per stirpes. Should my l-dfe, :\LTA II. :\LLAR.D, so predecease me, or should she die within thirty (30) days from the date of my death, then in such event, I authorize and empower my Executor, hereinafter named, or any substitute personal representative of my estate, to sell any and all real estate which I r:1ay OHn e.t the time of my decease, as well as my personal property, at either public or private sale or sales. LASTLY, I nominate, constitute HDd appoint my son, JOSEPH E. ALLARD, J~xecutor of this my Last \Jill and '1.'estament, and in the event that my said son should predecease me, or should he be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my stepdaughter, KI\RY C. SPIKT.m, Executrix of this my Last \'Till and Testament, in his place and stead, and in all instances, I direct that my said personal representatives be excused from posting bond or other security for the faithful performance of their duties in any jurisdiction. IN 1IfrrNESS v!EETIEOF, I have hereunto set my hand and seal / this -.lLAZ~ day of February, A. D., 1999. A - 4 f u'/ (, 1 /"j ,.~" ' _.- . ~if1''' / ,,/; ,4::'/ . ,.fd (,. ,~. // {l~S le~y J. Allard (SEAL -2- Signed, sealed, published and declared by the above named, \1ESLEY J. ALLARD, as and i'or his Last \Vill and Testament, in the presence of us, who have subscribed our names hereto as witnesses, at the request of said testator, in his presence and in the presence or each other. // , I .---" ..xl., ./-=-r-.i- -3- COH.HONWEALTII OF PENNSYLVANIA ) SS. COUNTY OF CUHI3ERLAND ) I, HESLEY J. ALLARD , the testat or 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 and Testament; that I signed it willingly; and that I signed it as my free and volun- tary act and deed, for the purposes therein contained. before me/b~ ,this _L \'lESLEY day of SS. Notarial Seal Marilyn E. Williams, Notary Public Mechanicsburg Boro, Cumberland County My Commission E):pires Nov. 6, 2001 MemlMlr, Poftnsylvania Association 01 Notaries CONHONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) We, the undersigned, J. ROBERT STAUFFER and SUSAN A. l'lcCOY , the witnesses whose names are signed to tile attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testat or , HESLEY J. ALLARD , sign and exe- cute the instrument as his,/.ltMx Last Wili and Testament; that the said testator , \,mSLEY J. ALLARD , executed it as his/Jualc free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testatOr ,signed the Wili as witnesses; and that to the best of our knowledge, the testat or was, at the time, eighteen (18) or more years of age, of sound mind, and under no constraillt, duress or undue influence. .1 '1~ II Cr,1/(=-1 1/ ~" C. / ' / '// / , '- / /t._/Lc. - '- Sworn and subsc~d to before me this j / day of February , 1999. _1,-