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Home My WebLink About04-15-08""'~ REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 15056051047 INHERITANCE TAX RETURN RESIDENT DECEDENT tN r EFL DECEDENT INFORMATION BELOW Social Security Number Date of Death . ~ ._ ,~ ~ . - ~:~~ Decec'ent~s Last Nance Suffix ., _ . _,- . _ . ., /~ 0 °rV C' 1 iS'O I a - . , ., _. ~ _ ~ .. , ~. ` . (If Applicable) Enter Surviving Spouse's Information Below Spot.ses Last Name Suffix a~~oi.~ , Soa31 Secnriry Number ~, OFFICIAL USE ONLY County Code Year File Number ~ ; :..~~~_z_-~ Date of Birth O,,L~. 2 t.~ ~ ,~..' ~ ~: Decedents First h3me MI Spouse's First Name MI i ~ i _ ' 'a' THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~_ : ~ ~ , , ~,. _.. E .y ' ~ i~. `'~ ~ ~ REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW O 1. Original Retum +®} 2. Supplemental Retum O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name „......~,. ~ aytime Tele -~ phone Number ~ i ~*-'' ~` /~ C Igo E~ 1°~ T ~ ~/' ~ , - ~ ~ ~ ~ ~ , F ~~ ~ y. ~. ,. . Firmfla~rerlfApplicablel ~ ~' '~~-~' ~ ~ ~~~~ ~ ~ First lirn; ref -id~7rNss _1 } _ + ~~. J `: ,T _ , ~7 `,_.r - n ._: ,. _.~ ~; `.-~ .rl .5"N' ~ 2d,~r~. ~,'N 5, T°O wytil~ 'p ~ t 71la'I_~~ Correspondent's a-mail address: ~- C B oZO~ ~/V ,M ~ ~ ~~ c e , ~~M 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, cordt and complete. Declaration of ~eparer other than the personal representative is based on all information of which preparer has any knowledge. SI NAT r~F PPGenni orcon __ _ ADDRESS ~ ~ / ass ~. ~Iti s~ , s~,~.~~atis s~.>,,N ~P~ c~ Q ~ ~ SIGNATURE OF PREPARER OTHER THAN REPRES rv ini ivt DATE ADDRESS z- , - o~ PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 J v1; J REV-1500 EX 15056052048 Decedent's Name: ~ ~ d ~ ~ 1J C ~ 5 . Decedent's Social Security Number ~ , „.,, s+ . ,-, • . ~ RECAPITULATION ~ ~ ~ w I ~ 6 ~, ~ ~ ~ O ~ S ~ 1. Real estate (Schedule A) ................ , .. , , ,., ...., ... . ................ ......... .... 1. , 2. Stocks and Bonds (Schedule B) ........ ~ ~ `' ~ ~ ' ........................... .... 2.'~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ~ I 3 , r ` . 4. Mortgages & Notes Receivable (Schedule D) ........................ µ .. . ; ~ , ~; '1 ~ - ~ , .. 4 5. Cash, Bank Deposits & Miscellaneous Personal Pro a P rty (Schedule E} .. . ~. ~ ~~ ,. - .... ... 5. ; 6. Jointly Owned Property (Schedule F) G~ Separate Billing Requested 7 I ' , . .... nter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) .. 6, E' S ~' G { a' C ., ' ~ ~~ ~ ~ ~ . - r ~ O Separate Billing Requested Y , - ~ s ti ~' ; 4 ~ ' ..... 8. Total Gross Assets (total Lines 1-7).......... , ........... .. 7 ~ ~ ' ........... 9. Funeral Expenses & Administrative Costs (Schedule H) .. 8 O ~ ;. c, O ~ .......... ........ 10. Debts of Decedent, Mort a e Liabilities, ~ Liens (Schedule I) 9 9 i 'n S~ ~.O ~ v. 6~. .. g ~ ,.' a_ ............. 11. Total Deductions (total Lines 9 & 10) ~ ~ ~~~ ... 10 ~ ~ r ~~ ~ `'"` ~' ....... , ........................ 12. Net Value of Estate (Line 8 i ... 11. - '~ 3.ao ~ ~ ~ '"' m nus Line 11 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not be 12 E' .oZ ~ p O ~' ~. G Li ~ ' en made (Schedule J) ..... '' ~,~ I ., ................. 14. Net Value Subject to Tax (Line 12 minus Line 13 } ... .. 13. ~ tic ~ ~ ~~ ~ ................... TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable .. 14. 6 ~~ ~ ~ ~U ~' ,g O at the spousal tax rate or , transfers under Sec. 9116 ~ . p, s. _ . . s'. ., ..i 16. Amount of Line 14 taxable ~ - ~ ~ ~ 15. ' I ~ T ~' at lineal rate X .0 _ ~ ~ "' '~'~` 17. Amount of Line 14 taxable ~ ~ 16. ' at sibling rate X .12 ~ 18. Amount of Line 14 taxable ~ .~ ~ I ~ ~ 17. °t at collateral rate X .15 ' - ~ _. ,.,~ ;. ~' 18. 19. TAX DUE ............ .... , ........................................ . 19. `~ ~ '~ ~~ .' ~ ~a 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF A N OVERPAY MENT O Side 2 15056052048 15056052048 J REV-1500 EX Page 3 Decedent's Complete Address: File Number DECE~NTS NAME STREETADDRESS -~z ~S 5 E X ~ .AC( CITY tf C~^^ l~l.~~ STATE n ZIP Tax Payments and Credits: r ~ 11 ~ { I 1. Tax Due (Page 2 Line 19) 2• Credits/Payments (1) a ~ ~ ~ y ~ ~ A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable Total Credits (A + g + C) (2) D. Interest 3 ~ " ~ ~ E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal InterestlPenalty (D + E) (3) Fill in oval on Page 2, Line 20 to request a refund. 3 ( `+ Q 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) A. Enter the interest on the tax due. (5) ~ ~ «~ d ~ ~ B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) 3 , ' ~ ~ c5B) a ~ s a . ~ ., Make Check Payable to REGISTER OF WILLS, AGENT ?A-+r{'~-!"f.`r~ ~ 12~:~.;, yr rr :wry ,~~. K~ n (~~y r G ~a : its it r~s~"a:d1#`<' 1 ~ }~i ~ . ,,~"P ~'r~ _E~i,~ ., ~,~+` ~'V.r *t ~ ,.,7, F r , s r PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE ~BLO ~s ~ ~ ' 1. Did decedent make a transfer and: CKS Yes a. retain the use or income of the property transferred :.................................. No b. retain the right to designate who shall use the ro ~~~~~~~~~~~~~~~~~""""""" (]' c. retain a reversionary interest; or ..................... p ~~ transferred or its income;................... ^ ......................... d. receive the promise for life of either payments, benefits or care. ~~~~~~~~~~~~~~~~~~~~~~~"~~'~"""'"""""' ^ ..................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death ^ without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT ~ ,~+'~ ti~~, vr,~,: ~~` ~~'~'~ ~~` r4 ~' '° ~`-~~' ~:: ~ AS PART OF THE RETURN. is three 3 ~ -~ ,~ ~ .:,~ r; ~, (,~ ,~ t~ ,: ~ , f--., ~_ , For dates of death on or after July 1 1994 and before January 1, 1995, the.tax rate limposed~,on the net value of. ()percent [72 P S. §9116 (a) (1.1) (i)). transfers to or for the use of the surviving spouse For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or far the use of th [72 P.S. §9116 (a) (1.1) (ii)j. The statute do not x m t a transfer to a surviving spouse from tax, and the statutory requirements for dis filing a tax return are still applicable even if the surviving spouse is the only beneficiary, a surviving spouse is zero (0) percent For dates of death on or after July 1, 2000: closure of assets and 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 adaptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and o use of a natural parent, an 72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)], ne-half {4.5) percent, except as noted in The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent (72 P.S. §9116 a 1. Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ( )( 3)j. A sibling is defined, under REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF ~-l-O fZ~.~vcc S. !~6~v T ~J6 If an asset was made Joint within one year of the decedent's date of death, it must be SURVIVING JOINT TENANT(S) NAME ADDRESS A. FILE NUMBER on Schedule G. RELATIONSHIP TO DECEDENT L I N D A C. Q+~p~7' ~1 2 r a j W, /l/~ Al N S T• ~ A~ U ~ "C't (' B. ~. JOINTLY-OWNED PROPERTY: LETTER DATE ITEM FOR JOINT MADE NUMBER TENANT JOINT 1. A. R"~O°99 INCLUDE NAME OF FINANCOIA SNSTPTUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL EST DATE OF DEATH % OF DECD'5 DATE OF DEATH VALUE OF - ATE. 2QA~ ¢ ST A"t'~ /~ T vt ~(- ASS ~ ~( RGI. VALUE OF ASSET . ~ I '3p~ oats INTEREST S6 DECEDENTS INTEREST ~ a oa . ~G 6 s ~ c,q,...~ t~< <t ~ PA , --I o t , , TOTAL (Also enter on line 6 Recapitulation) I$ 6 5 oQ a a a (If more space Is needed, Insert addlGonal sheets of the same size) ~ ts. t T t't QF LOAN - - - - ...... ••' •"•,~~ ue V e W t'M ENT ---•-• • e comouen, mc. t-aoa~zae4ez 1 • ^ FHA 2. ~ FmHA 3. 6. Fiie Number: SETTLEMENT STATEMENT ~] Conv. Unins. 1o44s/M 7. Loan Number 4. 0 VA 5. Conv.lns. C. NOTE: This form is furnished to give you a statement are shown. Items marked '(p.o.c.)' were paid outside the included in tha tnt~i~ Florence S. Montijo and Linda` C. Seaty 44 Essex Road Camp Hill PA 17011 44 Essex Road ~~~ Camp Hill PA 17011 13-23-0555-004 89,999. Robert L. Nause and,Roae„Annr JGLLCK; F, J. Nause 44 Essex Road Camp 8i 11 PA -17011 192-30-3361 H. SETTLEMENT AGENT: -NAME, ADDRESS AN[ Donn L. Snyder Agent for FNTIC Z North 2nd 3t., 7th Floor Harrisburg PA 17101 PLACE OF SETTLEMENT: 2 North Second St., 7th Floor Harrisburg PA 17101 ontijo 8. Mortgage'Insurance Case Number: ictual settlement costs. Amounts paid to and by the settlement agen ping; they are shown here for informational purposes and are not Taxoayer's Identifirat~n~ ni,~..,4.,.. ,734. 09 9 99 ~• ~~~ nuwn iaX@S $74.06 407. County taxes 09109 00 $489.61 dna n~..,..._~_--. - - ,296.9 ,SOO.oo ,500.00 (717)257-755 23-1416352 I. SETTLEMENT DATE: Disbursement Date: 09%l0%99 589,999.0 iadvance 3199 ~ 0~ 3000 $489.6! ~ $90,562.70 (SELLER 10 $7,381.84 $10,051.84 - „ a, ~~~~~~~ uue from norrower line 120 °1~'• t~HSti AT SETTLEMENT TO/FROM SELLER $17, 433.68 X02. Less amounts aid b /for borrower 1220 $92.296' 91 601. Gross amount duet seller line 420 ~03. CASH ( ~ ROM) 51,soo.a 602. Less reduction in amount due seller 1520. $9o,s62.7o ( ".: T0) BORROWER $90,796.91 603. CASH ( ~", i0) 517,433.68' ( ROM) SELLER $73,129.02 :information contained in Blocks E,G,H andtl and ton Line OR~(o U9 L ne 40E s asteriskedELine 403 and 404 ~rmation and is being furnished to the Internal Revenue Service. If you are required to file a return a negligence penalty or ~r sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not)beenpeported.x its real estate is your principal residence, file Form 2119, Sale or Exchange of Principal Residence for any Mme tax return: for other transactions, complete the applicable parts of Form 4797, Form 6252 and /or Schedule D (Form 1040 . You required to provide the Settlement Agent (named above) with your correct taxpayer identification number. f you do not provide Settlement Agent with your correct taxpayer ident~cation number, you may be subject to civil or criminal penalties imposed _aw Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number. Seller HUD-1 (3-86) OMB No. 2502-0265 Pa e 2 of 2 L SETTLEMENT CHARGES 700.TOTAL SALES/BROKER'S commission based on rice Ss9, 999.0 o /o= S5, 400.00 PAID FROM uea2arxie Computers ln. PAID FROM Division of commission (line 700) as follows: BORROWER'S SELLER'S 701. $2,725.00 tO Jack Gaughen Realtor FUNDS AT FUNDS A 702. 52.675.00 to ~A Anderson SETTLEMENT T SETTLEMENT 703. Commission aid at Settlement Ss,4oo.0o Ss 4oo 00 704. _ , . 800.1TEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee 802. Loan Discount a/, i 803. A sisal Fee to 804. Credit Re ort to 805. Lender's Ins ection Fee 806. Mort a e Ins. A lica ion Fee to 807. Assum tion fee to 808. 808. 810. 811. 900. ITEMS REQUIRED B LENDER TO BE PAI IN ADVANCE 901. Interest from 09/IO/99 to / /da 902. Mort a e Insurance Premium for mo. to 903. Hazard Insurance Premiums for r . #o 904, rs. to ~ 905. 1000. RESERVES DEPOSITED WITH LE DER FOR 1001. Hazard insurance mo. /mo~ 1002. Mort a e insurance mo: /mo . 1003. Ci roe taxes mo. /mo 1004. Coun roe taxes mo. /mo . 1005. Annual assessments mo. /mo . 1006. mo. /mo . 1007. mo. /mo . 1008. 1100. TITLE CHARGES 1101. Settlement or Closin Fee S7s. oo to Jack Gaughan Realtor $75 00 1102. Abstract or title search to . 1103. Title examination to 1104. Title in urance binder to 1105. Document Pre oration to 1106. Nota fees $2o.0oto Maronetta F. Miller ' 510.00 $10 00 11x7. Attorne s fees to . includes above item number 1108. Titlelnsurance $768.75tO Donn L. Snyder, Agent for FNTIC $768 75 includes above item number . 1 109. Lender's coven e 1 1 t0. Owner's coves e 589, 999 . o0 1 111. 1 112. 1 113. 1 200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1 201. Recordin fees: Deed 525.50 •Mort a e •Release S2s 5o ~ 1 r 202. Cit /coun tax/stam s: Deed $899.99 'MOrt a e . 1 203. State tax/ stam s: Deed 5899.99 'MOrt a e $899 99 $899.99 .1 204. . 1 205. 1 300. ADDITIONAL SETTLEMENT CHARGES 1 301. Surve to 1 302. Pest ins ection to 1 303. Fax, Copies 1 304. Jack Gaughen Realtor - Home Owners Warranty $30.00 1 305,1999-0o School Taxes $365.00 1 306. Federal Express $607.85 1 307. Penn National Insurance ($232 POC) $24.00 1 400. TOTAL SETTLEMENT CHARGES enter on lines 103 and 502 Sections J and K S1 734 24 h ave carefully rPViawarl tha H~ in _ d co+no.,,e.,+ c+~+e...,..,« ....a .,..~._ ~_~ _~ ~:. ,_ , . $7, 3s1. a4 __. __., . _ _._..__ _.......~ . ,,,,,,,,,,,,,,,,, ~.a,~,,,~,,, o„~ ~~ ,,,c uts~ ~t my Knowieage ana oeuer, rc is a true and accurate statement of al( receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD - 1 Settlement Statement. Seller Borrower Robert L. Nause Florence S. Montijo Seller Borrower Rose Ann J. Nause Linda C. Beaty To the best of my knowledge the HUD- 1 Settlement Statement which I have prepared is a true and accurate account of the funds which were received and have been or will be disbursed by the undersigned as part of the settlement of this transaction. Settlement Agent Date 09/10/99 Donn L. Snyder, Agent WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 101.0. A. OMB NO. 2502-0265 6. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1• FHA 2.QFmHA 3. X CONV. UNINS. 4.QVA 5. CONY. INS. 6. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT - 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is famished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked (POCJ" were. yard outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3/98 (5088-14777 KNEPP SCOTr.PFD/508&14777 KNEPP SCO/9 D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Scott Knepp Linda C. Beaty 2409 New York Avenue Credit Union Mortgage Camp Hill, PA 17011 205 W. Maln Street 9693-A Main Street Shiremanstown, PA 17011. Fairfax, VA 22031 G. PROPERTYtOCATION:. H. SETTLEMENT AGENT: 25-1756308 44 Essex Road I. SETTLEMENT DATE: Camp Hill, PA 17011 American Heritage Abstract Cumberland County, Pennsylvania PLACE OFSETTLEME~~T December 13, 2007 508 North Second Street Harrisburg, PA 17101 . S MMARY F B RR WER' TRANSACTION K. SUMMARY OF ELLER' TRAN ACTION 101. Contract Sales Price 130,000.00 401.. Contract Sales Price 102. Personal Pro a 402. Personal Pro e 1 103. Settlement Char es to Borrower Line 1400 5,769.89 403. 104. 109. 110. 111. 112. 120. 200. 201. ~~~ ..,r~ uvnnvWCfY ~ 136 BY OR IN BEHALF OF BORROWER: t money 2 of New Loan(s) 130 Yvi . ~.ounry i axes 12/13/07 to 408. Assessments 12/13/07 to 409. Sewer 12/13/07 to 01/01/08 410. 411. 412. 420. GROSS AMOUNT DUE TO SELLER 500. REDUCTIONS IN AMOUNT DUE TO SI 501. Excess Deposit (See Instructions) 502. Settlement Charges to Seller (Line ~an~ 504. Payoff of first awn i axes to Taxes .12/13/07 to ;ments 12/13/07 to 12/13/07 to 01/01mR 210. Ci /Town Tar 211. Coun Taxes 212. Assessments 213. 214. 215. 216. 217. 218. 219. 220. TOTAL PAID 300: CASH AT SET 301. Gross Amount 302. Less Amount f 303. CASH (X FR The undersigned h Borrower to n~ usrmenrs ror rtems Un aid el er 510. Ci /Town Taxes to to to 511. Coun Taxes to 512. Assessments to 513. 514. 515... 516. 517. 518. BO R VT F 135,000.00 519. 520. TOTAL REDUCTION AMOUNT DUE SEL ROM/TO BORROWER: LER m Borrower Line 120 600. CASH AT SETTLEMENT TO/FROM SELLER: or Borrower (Line 220) ( 136,340.74 601. Gross Amount Due To Seller Line 420 1 TO) BORROWER 135,000.00) 602. Less Reductions Due Seller Line 520) ( kpowledge eipt of a com feted co P p 1 340.74 603. CASH of (~ TO) ( ROM) SELLER 1 y pages 1 &2 of this stat JJ eme -8~ a achments ref to rein---- Seller P Linda C. Beatv 1 2 3.88 0.56 6.61 ~ ~ 802. Loan Discount at to N WITH LOAN to Credit `Y° to to Gredit to Credit to Credit to Credit to Credit 901. Interest From 12/13/07 to .01/01/08 ~ $ 21 902. Mort a e Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 ears to 904. 905. 1001. Hazard Insurance 3.000 months 4 1002. Mort a e Insurance 19d 1003. Ci /Town Taxes - months ~ ~ 86.67 er month 1004. Coun Taxes months ~ $ er month 1005. Assessments 12.000 months ~ $ 37.90 er month inns 6.000 months ~ $ 82.03 per month 1101. Settlement or Closin Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Document Pre aration to 1106. Nota Fees to Cash 1107. Attorney's Fees ~ includes above item numbers: 1108. Title Insurance to American Herita a Abstl inGudes above item numbers1101-1104, End. 100, 300 900 , 1109. Lender's Coverage $ 130,000.00 1110. Owners Coverage $ 130,000.00 1111. Closing Protection Letter to Lawyers Title Insurance 1112. Retrival of Emailed Documents to Wix Wenger & Weidner 1113. 0. V N C G AN RANS ER HAR E 1201. Recording Fees: Deed $ 38.50; Mortgage $ 64.50; 1202. Ci !Coun Tax/Stam s: Deed 1,300.00• Mort 1203. State Tax/Stam s: Revenue Stam s 1,300.00; Mort 1204. 1205. 1301. Surve to 1302. Pest Ins ection to 1303. UPS Ovemi ht Mail Fee to Wix, Wen er & Weidner 1304. Wire Fee to Wix, Wen er ~ Weidner 1305. See addiYl dish. exhibit to 1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103, Section J any By signing page 1 of this statement, the signatories acknowledge receipt of a Certified to be a true copy. /! ,. 1 PAID FROM PAID FROM BORROWER'S SELLER'S FUNDS AT FUNDS AT SETTLEMENT SETTLEMENT 1 4 492.18 Releases $ 103.00 15.54 25.00 10.80 o~f9p of this two page statement. (5088-14777 KNEPP SCO /508&14777 KNEPP SCO / 9 ) ADDITIONAL DISBURSEMENTS EXHIBIT Borrower: Scott Knepp Seller: Linda C. Beaty Lender: Credit. Union Mortgage Settlement Agent: American Heritage Abstract (717)234-4182 Place of Settlement: 508 North Second Street Settlement Date: Harrisburg, PA 171.01 December 13, 2007 Property Location: 44 Essex Road Camp Hilf, PA 17011 Cumberland County, Pennsylvania 'Lower Allen Township Trash Collection EF #1061710 Total Additional-Disbursements shown on Line 1305 10.80 ~ 10.80 5ELLER $ 0.00 (5088-14777 KNEPP SCOTT.PFD/5088-14777 KNEPP SCO/9 ~ DISBURSEMENTS SUMMARY- / BALANCE SHEET Borrower: Scott Knepp Seller: Linda C. Beaty Lender: Credit Union Mortgage Settlement Agent: American Heritage Abstract (717)234-41.82 Place of Settlement: 508 North Second Street Harrisburg, PA 17101 Settlement Date: December 13, 2007 Property Location: 44 Essex Road Camp Hill, PA 17011 Cumberland County, Pennsylvania INCOMING FUNDS Credit Union Mortgage Loan Funding Amount ~ 126,842.33 Scott Knepp 1,340.74 Total Incoming Funds 128,183.07 DISBURSEMENTS Cash American Heritage Abstract Lawyers Title Insurance Corporation Recorder of Deeds Recorder of Deeds Recorder of Deeds Lower Allen Township Linda C. Beaty Credit Union Mortgage Loan Origination Fee Document Review Underwriting Fee Tax Service Fee Application Fee Document Delivery Fee Interim Interest Escrow: Hazard Insurance Escrow: County Taxes Escrow: Assessments Aggregate Adjustment Wix Wenger & Weidner Retrival of Emailed Documents UPS Overnight Mail Fee Wire Fee Number of checks - 9 Notary Fees Title Insurance 21.00 Closing Protection L etter 1,057.88 Recording Fees 35.00 City/County Tax/Sta mps 103.00 State Tax/Stamps 1,300.00 Trash Collection 1,300.00 Closing Proceeds 10.80 Loan Closing 124,264.85 1,300.00 Deducted 0.00 175.00 Deducted 175.00 Deducted 110.00 Deducted 400.00 Deducted 35.00 Deducted 414.58 Deducted 85.74 Deducted 454.80 Deducted 492.18 Deducted -484.63 Deducted 1112, 1303, 1304 50.00 90.54 15.54 25.00 Total Disbursements 128,183.07 (5088-14777 KNEPP SCOTT.PFD/5088-14777 KNEPP SCO/9 IUMBER ESTATE OF ~-•G rZC lJGL S M6N Tt~ FILE NUMBER 0 Debts of decedent must be reported on Schedule L ITEM REV-1511 EX+ (10-06) SCNEDtifLE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT DESCRIPTION A• FUNERAL EXPENSES: 1. '~~-vses Na i c~v~f ec~ bc~ ~r'e - P~~ ~ f~NZ(,~c ~~i.~~ B• ADMINISTRATIVE COSTS: 1 • Personal Representative's Commissions Name of Personal Representative(s) SVeetAddress _ City Year(s) Commission Paid: State Zp ~- 2• Attorney Fees 3• Family Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant Streef Address city State _ Relationship of Claimant to Decedent 4• Probate Fees 5• Accountant's Fees 6• Tax Return Preparer's Fees 7. Zp TOTAL (Also enter on line 9 Recapitulation) I $ (If more space Is needed, insert additional sheets of the same size) IS ~ o. o0 REV-1512 EX+ (12.03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS wiAlt ur _ L v ~C /V CC 5 . f./~ 6/V ~ '.~ O FILE NUMBER Report debts Incurred bV the decedent nrin. ~„ ae~~ti ,..~.~_- ____:__, .. _ R Z~IaB MFR I S ~,~°~ i l~~ l ~, r; t ~ ~, L: _. \ ~~ C ~' i ~ r. ,~' -+ 6 ~u/~ ' , 1` L-- f ~+ 1 r~ i i ' } ~ ! L R `/ Q 1 C C N L~ ~ ~' ~ti `~~ ~; ~ ,~ ~__ ~ ~. ~;~°~ ~~