HomeMy WebLinkAbout02-28-08 (2)
. REV.l500 EX (~)
COMMONWEALTH OF
PENNSYlVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCiAl SECURITY NUMBER
212-34-1318
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITiAl)
OBERHOLTZER III SAMUEL MARTIN
FILE NUMBER
21 07
COUNTY CODE YEAR
SOCiAl SECURITY NUMBER
0685
NUMBER
D 3. Remainder Return (dale of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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DATE OF DEATH (MM-DD-YEAR)
07105/07
DATE OF BIRTH (MM-DD-YEAR)
01/30/33
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
[i] 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Allach copy of WiI)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Allach COPyofTrusl)
D 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95)
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NAME
KARL M. LEDEBOHM, ESQUIRE
FIRM NAME (If Applicable)
COMPLETE MAILING ADDRESS
P.O. BOX 173
NEW CUMBERLAND, PA 17070-0173
TELEPHONE NUMBER
(717) 938-6929
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
127,000.00
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
x .0 _ (15)
x .0 _ (16)
x .12 (17)
153,194.74 x .15 (18)
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
57,427.58
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30,486.50
746.34
(11)
(12)
(13)
(14)
(19)
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184,427.58
31,232.84
153,194.74
153,194.74
22.979.21
751.25
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Decedent's Complete Address:
STREET ADDRESS
2075 ENFIELD STREET
CITY CAMP HILL I STATEpA I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
22,979.21
21,079.00
1,148.96
Total Credits ( A + 8 + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
22,227.96
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
A. Enter the interest on the tax due.
(SA)
751.25
0.00
751.25
8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
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;.......................................................................................... D iii
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 IiJ
c. retain a reversionary interest; or.......................................................................................................................... 0 Iil
d. receive the promise for life of either payments, benefits or care? ...................................................................... D lil
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D (i]
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.
~ schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
lion of which preparer has any knowledge.
DATE
,- 2F-1J ?f
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ADDRESS
P.O. B 173, N WCUMBERLAND, PA 17070-0173
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
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 3%
[72 P.S. ~9116 (a) (1.1) (i)l.
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 0% [72 P.S. 99116 (a) (1.1) (ii)).
The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(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 4.5%, except as noted in 72 P.S. ~9116(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 decedenfs siblings is 12% (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:l502 ex- (6-.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE Of
SAMUEL MARTIN OBERHOLTZER, III
FILE NUMBER
21-07-0685
All rul property owned 10I1Iy or .1 I tenant in common muat be reported at fair marbt value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a wiling seier, neither being compelled to buy or sell, both having reasonable koowIedge d the relevant facts.
Real property which is joIntIy-owned with right of survivorship must be dilcloled on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
REAL ESTATE KNOWN AS 2075 ENFIELD STREET, CAMP HILL, PA 17011,
CUMBERLAND COUNTY. ( A COpy OF HUD-1 SETTLEMENT STATEMENT
IS ATTACHED HERETO AS EXHIBIT "A" AND MADE PART HEREOF.)
VALUE AT DATE
OF DEATH
127,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
127,000.00
REV-'.08 EX+ (6-98) .-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
SAMUEL MARTIN OBERHOLTZER, III
Include the proceeds of litigation and the date the proceeds were received by the estate.
AI property jolntly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21-07-0685
ITEM
NUMBER DESCRIPTION
1. MISCELLANEOUS PERSONAL PROPERTY SOLD AT AUCTION B
2. CHERRY DRESSER, OAK DESK, FRAMED PRINT & GLASS VASE
3. M & T BANK CHECKING ACCOUNT # 9843066011 (DATE OF DEATH ACCOUNT
BALANCE IS ATTACHED HERETO AS EXHIBIT "B" AND MADE PART HEREOF)
4. M & T BANK SAVINGS ACCOUNT # 15004214960799 (DATE OF DEATH ACCOUNT
BALANCE IS ATTACHED HERETO AS EXHIBIT "B" AND MADE PART HEREOF)
5. M & T BANK CERTIFICATE OF DEPOSIT # 31003918447911 (DATE OF DEATH
ACCOUNT BALANCE IS ATTACHED HERETO AS EXHIBIT "B" AND MADE PART
HEREOF)
6. SERIES EE BOND
7. PUTNAM INVESTMENT
8. PHYSICIANS MUTUAL INSURANCE
9. PUTNAM INVESTEMENT
10. TAX REFUND
11. CREDIT FOR 2007 REAL ESTATE TAXES SALE OF 2075 ENFIELD STREET
12. CREDIT FOR SEWER CHARGES SALE OF 2075 ENFIELD STREET
13. Alesis OS8.2 Keyboard
14. IRS federal income tax refund for 2007
15. Jelly cupboard
VALUE AT DATE
OF DEATH
3150.00
740.00
12,153.50
12,046.86
12,512.39
57.24
10,884.15
1,730.74
111.81
313.89
1837.00
20.00
470.00
1200.00
200.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
57,427.58
.
REV-1511 EX+ (12-99)
.
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21-07-0685
ESTATE OF
SAMUEL MARTIN OBERHOLTZER, III
DeIIU of decedent must be reported on Schedule L
ITEM
NUMBER
A. FUNERAL EXPENSES:
1. PARTHEMORE FUNERAL HOME
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)JEIN Number of Personal Representatlve(s)
Street Address
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
DESCRIPTION
AMOUNT
2,020.00
City
State _Zip
Year(s) Commission Paid:
2.
Ad F Karl M. Ledebohm, Esq.
omey ees
P.O. Box 173, New Cumberland, PA 17070
Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant
11,000.00
3.
Street Addfess
City
Relationship of Claimant to Decedent
State _Zip
4.
Probate Fees CUMBERLAND REGISTER OF WILLS
318.00
5. Accountanfs Fees
6.
Tax Return Preparer's Fees to John Cox, CPA
325.00
Rowe's Auction services- Sale of personal property
ReJMax Reaty Associates, Inc. - Sale of 2075 Enfield Street
Cumber1and County Recorder of Deeds - Transfer Tax sale of 2075 Enfield Street
Borough of Camp Hill- Sewer for 2075 Enfield Street
Janet L. Miller, Tax Collector 2007 Real Estate Taxes 2075 Enfield Street
Closing cost credit to Scott E. Robinson - Sale of 2075 Enfield Street
PP & L Elecbic
UGI
COMCAST CABLE
Balance from continuation statement attached
1102.50
4607.00
1270.00
85.00
2748.49
4973.10
112.53
73.04
213.39
1638.45
30,486.50
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
SCHEDULE H CONTINUED
ESTATE OF SAMUEL MARTIN OBERHOLTZER, ill
21-07-0685
17. M&K Underwriting - Homeowner Insurance
18. Karl Stine - clean house at 2075 Enfield Street
19. Janet L. Miller, Tax Collector- Per capita & personal tax
20. Check order fee to M&T Bank
21. Alvin Hiester - Lawn care for 2075 Enfield St.
22. Verizon
23. Advertise Estate to The Cumberland Law Journal
24. Advertise Estate to the Patriot News
25. First and Final Account filing fee to Register of Wills
26. Commission to Wray Music House, Inc. sale of keyboard
TOTAL
$604.42
225.00
20.20
17.00
90.00
69.39
75.00
239.94
180.00
117.50
$1,638.45
REV-1512 EX+ (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABlunES, & UENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SAMUEL MARTIN OBERHOLTZER, III
FILE NUMBER
21-07-0685
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. PENNSYLVANIA DEPARTMENT OF REVENUE - UNDERPAYMENT 2006 INCOME
TAX
VALUE AT DATE
OF DEATH
16.29
2. HealthSouth - Television bill
20.00
3. Camp Hill Emergency Physician Ambulance
324.60
250.00
4. Holy Spirit Hospital
5. Internists of Central PA
93.68
6. Quantum Imaging Therapeutic Associates
41.77
TOTAL (Also enter on line 10. Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
746.34
REV-1513 EX+ (9-00)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTIi OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SAMUEL MARTIN OBERHOLTZER, III
FILE NUMBER
21-07-0685
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not list TrustM(I) OF ESTATE
I TAXABLE DISTRIBUTIONS [InClude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2))
1. Wendy Smith, 320 Prowell Drive, Camp Hill, PA 17011 None-specific bequest 5,000.00
2. Samuel D. Reiter, P.O. Box 450, Ellsworth, ME 04605 Nephew 50%
3. Brandt Reiter, 337 W. 14th St., Apt. 21, New York, NY Nephew 50%
10014
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
n 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-i500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
-----
A Settlement Statement
U.S. Department of Housing
And Urban Development
HUD-1 (3/86) OMS No. 2502-0265
B T e of Loan
1. 0 FHA 2. 0 FmHA 3. 0 CONV. UNINS. 6. File Number: 7. Loan Number: 8. Mortgage Ins. Case No.:
4. 0 VA 5. 0 CONV. INS. 71021 3859211
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. Name and Address SCOTT E. ROBINSON
of Borrowers:
F. Name and Address of Lender:
WACHOVIA MORTGAGE CORPORATION
CAMPHlLL PA 17001
E. Name and Address EST ATE OF SAMUEL M.
of Sellers:
BY: KARL M. LEDEBOHM,
1525 WEST W.T. HARRIS BLVD.
CHARLOTTE NC 28288
H. Settlement Agent:
Susquehanna Title AgeJlcy, Inc.
P.O. BOX 659
C/O KARL M. LEDEBOHM, ESQUIRE
P.O. BOX 173
CUMBERLAND, PA 17070-0173
112 Market Street
Harrisburg, PA 17101
G. Property Location:
2075 ENFIELD STREET
I. Settlement Date: Place of Settlement:
08128/2007 SUSQUEHANNA TITLE AGENCY, INC.
Disbursement Date: 112 MARKET STREET, 4TH FLOOR HARRISBURG, PA 17101
08/28/2007
CAMP HILL PA 17011
J. Summary of Borrower's Transaction
K. Summary of Seller's Transaction
100. Gross Amount Due From Borrower 400. Gross Amount Due To Seller
101. Contract sales orice 127 000.00 401. Contract sales Drice 127.000.00
102. Personal property 402. Personal property
103. Settlement charges to borrower (line 1400) 5,298.05 403.
104. 404.
105. 405.
Adjustments for Items paid by seller in advance
Adjustments for Items paid by seller In advance
106. City/town taxes to 406. CMtown taxes to
107. County taxes 08/28/2007 to 12/3112007 297.11 407. County taxes 08/28/2007 to 12/31/2007 297.11
108. Assessments to 408. Assessments to
109. School taxes 08/28/2007 to 06/30/2008 1,539.89 409. School taxes 08/28/2007 to 06/30/2008 1,539.89
110. 2nd Half Sewer Charges 20.00 410. 2nd Half Sewer Charges 20.00
111. 411.
112. 412.
120. Gross Amount Due From Borrower $134,155.05 420. Gross Amount Due To Seller $128,857.00
200. Amounts Paid By Or In Behalf Of Borrower
500. Reductions In Amount Due To Seller
201. Deposit or earnest money ., nnn nn 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) 101,600.00 502. Settlement charges to seller (line 1400) 8,710.49
203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
204. 504. Payoff 1
205. 505. Payoff 2
206. CREDIT TOWARDS CLOSING COSTS 4000.00 506. CREDIT TOWARDS CLOSING COSTS 4,000.00
207. CREDIT TOWARDS CLOSING COSTS 973.10 507. CREDIT TOWARDS CLOSING COSTS 973.10
208. 508.
209. 509.
~iustments for Items unpaid bY seller Adlustments for Items unDald bv seller
210. City/town taxes to 510. Citv/town taxes to
211. County taxes to 511. County taxes to
212. Assessments to . 512. Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid By/For Borrower $108.573.10 520. Total Reductions Amount Due Seller $13 683.59
300. Cash At Settlement FromlTo Borrower
600. Cash At Settlement To/From Seller
301. Gross amount due from borrower Wne 120\ $134 155.05 601. Gross amount due to seller (line 420\ $128857.00
302. Less amount Daid bv/for borrower (line 220\ (SI08573.10) 602. Less reductions in amount due seller (line 520\ (SI3.683.59)
303. CASH 121 FROM OTO BORROWER: $25,581.95 603. CASH 0TO OFROM SELLER: S115,173.41
Buyer'S Initials ~ _
Seller's Initials
ty-
1030
EXHIBIT" A"
slent Charges
Settlement Statement Page 2
Ital SalesfBroker's Commission based on price $ 127,000.00 @ % = 4,350.00 Paid From Paid From
.on of Commission (line 700) as follows: Borrower's Seller's Funds
Funds at at Settlement
,1. 4,350.00 to RElMAX REALTY ASSOCIATES, INC. Settlement
f02. to
703. Commission paid at Settlement 4,350.00
704. TRANSACTION FEE 250.00 250.00
800. Items Payable In Connection With Loan
801. Loan Origination Fee 0.750 % WACHOVIA MORTGAGE CORPORATION 762.00
802. Loan Discount %
803. Aooraisal Fee
804. Credit Report to INFORMATION RESEARCH (PAID BY BUYER) POC 15.00
805. PROCESSING FEE to W ACHOVIA MORTG,-\GE CORPORATION 475.00
806. Mortoaoe Insuranc.. Annlicatlon Fee
807. TAX SERVICE FEE to FIRST AMERICAN REAL ESTATE TAX SERVICE 78.00
808. Flood Certification to GREEN LINK, LLC 15.00
809. APPLICATION FEE to WACHOVIA MORTGAGE CORPORATION (PAID BY BUYER) POC 95.00
810. COLLATERAL V ALUA TION FEE to HANSEN QUALITY (PAID BY BUYER) POC 240.00
811. DOC TRANSMISSION to WACHOVlA MORT.GAGE CORPORATION 25.00
812. MERS FEE to MERS AS NOMINEE FOR LENDER 3.95 .
813.
1rl4:
815.
900. Items Required By lender To Be Paid In Advance
901. Interest from 08/28/2007 to 08/3112007 @ 18.09 / day 54.:Z7
902. Mortgage Insurance Premium for mo. to
903. Hazard Insurance Premium for vrs. to POC 446.00
904. yrs. to
1000. Reserves Deposited With Lender
1001. Hazard Insurance 3 months @ 37.17 per month 111.51
1002. Mortgage Insurance months lBl per month
1003. City property taxes months @ per month
1004. County taxes 7 months @ 72.30 per month 506.10
1005. School taxes 3 months @ 152.57 per month 457.71
1006. months lBl Der month
1007. months @ per month
1008. Aftregate Adjustment (289.24)
1100. Title Charges
1101. Settlement or closing fee to 200.00
1102. Abstract or title search to
1103. Title examination to
1104. Title insurance blnderto
1105. Document preparation to .
1106. Notary fees to
1107. Attomey's fees to
(includes above item Numbers: )
1108. TiUe insurance to Susauehanna Title Allencv. Inc. 993.75
(includes above item Numbers: )
1109. Lender's coverage 101,600.00
1110. Owner's coverage 127,000.00
1111. Policy Endorsements 150.00
1112. Closing Services Letter 35.00
1113. .
1200. Government Recording and Transfer Charges
1201. Recording fees: Deed 45.00 ; Mortgage 80.00 ; Releases 125.00
1202. City/county tax stamps: Deed 1,270.00 ; Mortgage 635.00 635.00
1203. State tax/stamps: Deed : Mortaaae 1,270.00 635.00 635.00
1204. 2ND HALF SEWER CHARGES to BOROUGH OF CAMP HILL 85.00
1300. Additional Settlement Charae.
1301. TAX CERTIFICATE FEE to RElMAX REALTY ASSOCIATES, INC. 7.00
1302. Pest Inspection to to INTERSTATE TERMITE & PEST CONTROL
1303. COURIER FEES 75.00
1304. 2007 COUNTY & BOROUGH TAXES to JANET L. MILLER, TAX COLLECTOR 954.30
1305. 2007 SCHOOL TAXES to JANET L. MILLER, TAX COLLECTOR 1,794.19
1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) 1f5.298.05 S8.1Ul.4S
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my ,=",' by - """ ...,....~. I ,...., ~.~ 'h,11 ,,"w ,~... , "" " "'" HUO.' S""""'''' S",,",,"' ,,"'. , 'M 2). ffl. I
Borrowers , Sellers , ' . ~hj1J
J{j;......u./(,/ .(~,~~ J..... "u"'-'-i:I !:.,/.,~ ' ; c, y ", ; J. r.f.p
SCOTT E. ROBlNSO~ ESTATE OF SAMUEL M. r~=M.ltEDEBOJl~ ,
OBERHOLTZER, III (DECEASED XEC OR
"JC/n~
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with
::;:;:;~gent . /~'-J ~ Date 08128/2007
~,,~
WARNING: It is a crim~:lo knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and Imprisonment.
For details see: Tille 18 U.S. Code Section 1001 and Section 1010.
103
p:! M&fBank
499 Mitchen Road, Millsboro, DE 19966 Mail Code DE-MB-12
Karl Ledebohm, Esq.
P.O. Box 173
New Cumberland, PA 17070
Fax: (302) 934-2955
Phone (888) 502-4349
July 26, 2007
Re: Estate of: Samue' Oberholtzer "'
Account Nutnber. 9843066011. 31003918447911. 15004214960799
Date of Death: Julv 5. 2007
Dear Sir or Madam:
Per a memo from April Linn at M&T Bank, dated July 24, 2007, please be advised that at the time of death, the
balance on the above referenced account was:
1.
Type of Account
Checking Account
Account Number
9843066011
Ownership (Names of)
Samuel Oberholtzer III
Opening Date
01/03/07 (account closed 07/25/07)
Balance on Date of Death
$12,153.47
Accrued Interest
$ 0.03
Total
$12,153.50
2.
Type of Account
Savings Account
Account Number
15004214960799
Ownership (Names of)
Samuel Oberholtzer III
Opening Date
11/24/06 (account closed 07/25/07)
Balance on Date of Death
$12,046.01
Accrued Interest
$ 0.85
Total
$12,046.86
EXHIBIT "B"
. Page 2
3.
Type of Account
Account Number
Ownership (Names of)
Opening Date
Balance on Date of Death
Accrued Interest
Total
July 26, 2007
Certificate of Deposit
31003918447911
Samuel Oberholtzer III
02/20/07
$12,291.20
$ 221.19
$12,512.39
For further account information, regarding ownership, closures and/or reimbursement of funds, etc.,
please call the West Shore Plaza branch # 717-255-2271.
Sincerely,
Cha~ zJ~
Records Management
. Parthemore Funeral Home & Cremation Services, Inc.
P.O. Box 431
1303 Bridge Street
New Cumberland, P A 17070-0431
(717) 774-7721
The Estate of Samuel M. Oberholtzer, III
c/o Mr. Karl M. Ledebohm
P.O. Box 173
New Cumberland, P A 17070
Statement
DATE
8/3/2007
AMOUNT DUE AMOUNT ENC.
50.00
DATE TRANSACTION AMOUNT BALANCE
05/31/2007 Balance forward 0.00
07/06/2007 INV #1236. Due 08/05/2007. 2,020.00 2,020.00
07/30/2007 PMT #96. -2,020.00 0.00
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CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAYS PAST OVER 90 DAYS AMOUNT DUE
DUE DUE DUE PAST DUE
0.00 0.00 0.00 0.00 0.00 50.00
Please don't hesitate to <<:
dstance. Thank you.
EXHIBIT "C"
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LAST WILL AND TEST AMENT
OF
SAMUEL MARTIN OBERHOLTZER, III
I, Samuel Martin Oberholtzer, III, of Camp Hill, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby
make, publish and declare this as and for my Last Will and Testament, hereby revoking
all other Wills and Codicils heretofore made by me.
FIRST
I direct the payment of my just debts and expenses of my last illness and funeral
from my estate as soon after my death as conveniently may be done. I direct that my body
be cremated and my ashes be disposed of in accordance with written instructions which I
may from time to time provide to my Executor under this will.
SECOND
I give, devise and bequeath those items of personal property which I have
designated on a written list from time to time, bearing my signature and maintained with
this will to the persons set forth on said list.
THIRD
I give, devise and bequeath the sum of Five Thousand Dollars ($5,000.00) and my
wood jelly cupboard to Wendy Smith of 320 Prowell Drive, Camp Hill, P A 17011.
FOURTH
I give, devise and bequeath all the rest, residue and remainder of my estate to my
nephews, Samuel Dana Reiter and Brandt Beryl Reiter, in equal shares, with the share of
any predeceased beneficiary to go to the survivor of my said beneficiaries.
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FIFTH
I direct that any and all inheritance, estate, and transfer taxes imposed upon my
estate passing under this Will or otherwise shall be paid out of the principal of my
residuary estate.
SIXTH
In addition to the powers conferred by law, I authorize any personal
representative acting under this instrument, in his absolute discretion:
a) To retain in the form received, or to sell either at public or private sale any
real or personal property;
b ) To exercise any options to subscribe for stocks, bonds, or other investments;
c) To join in any plan of lease, mortgage, consolidation, exchange,
reorganization or foreclosure of any corporation in which my estate or any
trust may hold stocks, bonds or other securities;
d) To sell, transfer, convey, mortgage, pledge, lease or exchange any property,
real or personal, which at any time may form part of my estate, for the
payment of debts or taxes, or for any purpose of administration or distribution,
for such prices and upon such terms as my personal representative, in his sole
discretion, may deem wise, and to execute and deliver deeds of conveyance or
transfer thereof;
e) To make settlements and compromises on such terms as my personal
representative in his sole discretion may deem wise without the necessity of
obtaining any court approval thereof;
t) To make distribution hereunder either in cash or kind, as my personal
representative in his discretion may deem wise.
SEVENTH
I do hereby nominate, constitute and appoint Karl M. Ledebohm, Esquire to
act as Executor of this my Last Will and Testament. In the event Karl M. Ledebohm,
Esq., is unable to act as my Executor for any reasons, then I hereby nominate and appoint
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my nephew, Samuel Dana Reiter, to act as the Executor of this my Last Will and
Testament.
EIGHTH
I direct that no personal representative, guardian, trustee or other fiduciary
appointed under this instrument shall be required to give bond for the faithful
performance of their duties in any jurisdiction.
IN WITNESS WlIEREOF, I, Samuel Martin Oberholtzer, III, have hereunto set
my hand and seal to this my Last Will and Testament, consisting of four (4) typewritten
pages, the first two ( of which bear my signature in the margin for identification, this
:!fJ- day of , 2006.
~&A0iL
amuel In ber 0 tzer, III "~.
Signed, sealed, published and declared by the above-named Samuel Martin
Oberholtzer, III, Testator, as and for his Last Will and Testament in the presence of us,
who have hereunto subscribed our names at his request as witnesses thereto, in the
pence of said Testator and of each other.
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COMMONWEALTH OF PENNSYL VANIA
COUNTY OF Cum bet"./ (~d
We, Samuel Martin Oberholtzer, III, Karl M. Ledebohm,
Rn..,l.--J P m\ ~ '~\-t:, 'U..'J. ' the Testator and witnesses, respectively whose names are
signed to the foregoing or attached Instrument, being first dilly 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 signed willingly and that such execution constitutes
his free and voluntary act and that he executed it for the purposes therein expressed, and
that each of the witnesses, in the presence and hearing of the Testator signed the Will as
witnesses and that to the best of their knowledge the Testator was at the time eighteen
(18) or more years of age, of sound mind and under no constraint 0 ue influence.
w. . fL.
itness L 1V1
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/Witness
Subscribed, sworn to and acknowlt~ged before me by Samuel Martin
Oberholtzer, III, the Testator, and subscribed to and sworn or affirmed to before me by
Karl M. Ledebohm and Rr<:.J~ ? l"\,~\,~\l'-J , witnesses, this 2q~ day of
7 p\R.--..\r)Q..~ , 2006. '
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Notary PublIc -.'\....._.__ ~
NOTARIAL SEAL
DEBRA l SWIGERT NOTARY PUBLIC
SOUTH MIDDLETON TWP CUMiJ CO PA
MY COMMISSION EXPIRES JUNE 26.2010
4
KARL M. LEDEBOHM
ATIORNEY-ATLAW
P.O. BOX 173
New Cumberland, P A 17070-0173
Phone: 717-938-6929
Fax: 717-932-0317
February 25, 2008
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Samuel M. Oberholtzer, III
No. 2007-00685
Dear Register:
I have enclosed an original and two (2) copies of an Inheritance Tax Return for
filing in the above estate along with a check in the amount of$15.00 to cover the filing
fee. Please file the original and provide a clock stamped copy to my office in the
envelope provided.
Thank you for your assistance in this matter. Please contact me with any
questions.
Very truly yours
AJ/MAII~'^
Karl M. Ledebohm
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Enclosures
Cc: Dana Reiter
Brandt Reiter
. arl M Ledebohm, It .' :. ..,..:;."......fPtf.....i'wf'..f~ltjpt.jfdU4ffffl~.fjffl.1f,I..< ~.\ .....:.:.<..;::,x.i;~l;j.~:;
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Jew Cumberland, PA 17070-0173
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Register of Wills
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