HomeMy WebLinkAbout05-21-08 (2)
--.J
15056041147
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
OFFICIAL USE ONLY
.
County Code Year
INHERITANCE TAX RETURN 21 06
RESIDENT DECEDENT
File Number
0829
Date of Birth
019141436
09082006
08191920
Decedent's Last Name
Suffix
Decedent's First Name
ANN
MI
L
HAMMOND
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
181 1. Original Return 0 2. Supplemental Return
0 4. Limited Estate 0 4a. Future Interest Compromise
(date of death after 12-12-82)
0 6. Decedent Died Testate ., 0 7. Decedent Maintained a Living Trust
(Attach Copy of Will) (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10 Spousal Poverty Credtt (date of death
. between 12-31-91 and 1-1-95)
o
o
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
o
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
ROBERT G RADEBACH 7178962666
Firm Name (If Applicable)
LAW OFFICE OF ROBERT
G.
REGISTER CWWILLS USEfbNL Y
(,....() C"c;:,
.~ ~~ ?;
~ .....,..
5[: -.:
r,..)
City or Post Office
HALIFAX
State
PA
~~! (::J
>_J --"
-7=;
f,)~WFILED
:t:---
-
~
First line of address
11
912 NORTH RIVER ROAD
Second line of address
ZIP Code
17032
'f?
w
\D
, ;
.' jcparalegal@aol.com
Correspondent's e-mail address:
Under penaltie:Of pe~ury 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, corre and t r;>eclaration of he personal representative is based on all information of which preparer has any knowledge. '
SlGNATUR7 F PE ONSIBLE f: FILlN ETURN DATE
"
James P. Hammond
- '2 t) , '2.2~B
Robert G Radebach
DATE
912 North River Road, Halifax, PA 17032
Side 1
L
15056041147
15056041147
--.J
~
--.J
15056042148
REV-1500 EX
Decedent's Name:
HAMMOND, ANN L
150,000.00
RECAPITULATION
1. Real Estate (Schedule A).......................................................................................... 1.
2. Stocks and Bonds (Schedule B)............................................................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D).......................................................... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................ 5.
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested............. 7.
8. Total Gross Assets (total Lines 1-7)....................................................................... 8.
9. Funeral Expenses & Administrative Costs (Schedule H)......................................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)................................ 10.
11. Total Deductions (total Lines 9 & 10)...................................................................... 11.
12. Net Value of Estate,(Line 8 minus Line 11 )............................................................. 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J)................................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)................................................. 14.
Decedent's Social Security Number
019141436
233,691.04
7,078.84
390,769.88
14,058.48
18,621.68
32,680.16
358 , 089 .72
358,089.72
TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
358,089.72
16.
17.
18.
19. Tax Due............................................................................................................. ........ 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15056042148
16,114.04
16,114.04
D
15056042148
--.J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 06 - 0829
DECEDENT'S NAME
Hammond, An n L
STREET ADDRESS
5440 Oxford Drive
CITY I STATE IZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
Total Credits (A + B + C)
(2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
1,172.49
16,114.04
0.00
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
!
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) 1,172.49
(4)
(5) 17,286.53
(5A)
(5B) 17,286.53
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes
o
o
o
o
o
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0
t
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a;beneficiary designation?.. .......... ........ ............ ................................. ........................ ................... ......... 0 ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
1. Did decedent make a transfer and:
a. retaiii the use or income of the property transferred;..................................................................................
b. retain the right to designate who shall use the property transferred or its income;....................................
c. retain a reversionary interest; or..................................................................................................................
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?.... ......... ..................................................... ................... ..... ...... ......................
No
~
~
~
~
~
~
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero
(0) percent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after. July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive p,jirent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116 (a) (1.2)].
The tax rate imposed on the rilet 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. ~,9116 1.2) [72 P .S. ~9116 (a) (1 )].
The tax rate imposed on the Det value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
*'
SCHEDULE A
REAL ESTATE
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Hammond, Ann L
FILE NUMBER
21 - 06 - 0829
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 wimng 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 DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 5440 Oxford Drive 150,000.00
Mechanicsburg, PA 17055
(I
,!
. ~'
:
,
TOTAL (Also enter on Line 1, Recapitulation) 150,000.00
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Hammond, Ann L
FILE NUMBER
21 - 06 - 0829
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Member's 1 st Federal Credit Union 4,372.97
Savings Account No. 22550-00
2 Members 1st Federal Credit Union 12,660.14
Checking Account No. 22550-11
3 Members 1 st Federal Credit Union 149,426.96
Money Management Account No. 2550-05
00
I
4 2006 Federal Income Tax Refund 251.00
5 Insurance Policy G;ancelation Refund 3.28
I
6 Auction proceeds of personal property 1,045.00
7 Private sales of personal property 595.00
8 Flea Market sale of personal property 72.00
"
9 Sale of Car 4,000.00
"
10 IRA Liquidation 52,909.70
11 Life Insurance Proceeds 8,354.99
I
-
.
TOTAL (Also enter on Line 5, Recapitulation) 233,691.04
.
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hammond, Ann L
I FILE NUMBER
21 - 06 - 0829
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
James P. Hammond .. 1471 Valley Road Son ..
A Marysville, PA 17053
Anita R. Peoples 1496 Union Street Daughter
B Coalport, PA 16627
JOINTLY OWNED PROPERTY:
LETTER DATE ~~SCRIPIIO~ ~F PROJlERn DATE OF DEATH %OF DATE OF DEATH
ITEM Include name 0 Inanclallns ItU Ion an Dan account number
FOR JOINT MADE or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET DECD'S VALUE OF
NUMBER DECEDENT'S INTEREST
TENANT JOINT estate. INTEREST
1 A,S 1 0/22/2004 Members 1st Federal Credit Union 5,365.74 33% 1,770.69
Certificate of Deposit No. 22550-44
2 A,S 12/27/2007 Members 1 st Federal Credit Union 5,314.52 33% 1,753.79
Certificate of Deposit No. 22550-45
3 A,S 01/13/2005 Members 1 st Federal Credit Union 10,770.78 33% 3,554.36
Certificate of Deposit No. 22550-46
I
- .
I
I
I
,
TOTAL (Also enter on line 6, Recapitulation) 7,078.84
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Hammond, Ann L
FILE NUMBER
21 - 06 - 0829
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES:
A. Neill Funeral Home Inc
DESCRIPTION
AMOUNT
10,618.93
2 Gates of Heaven - Vase and Marker
775.00
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
,
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City
State
Zip
2.
Year{s) Commission paid
Attorney's Fees Hobert G. Radebach, Attorney at Law
2,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
Register of Wills - Cumberland County
Sentinel - Advertising
Cumberland Law Journal - Advertising
438.00
151.55
75.00
5. Accountant's Fees
6, Tax Return Preparer's Fees
7. Other Administrative Costs
1
TOTAL (Also enter on line 9, Recapitulation)
14,058.48
~ !
.
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Hammond, Ann L
FILE NUMBER
21 - 06 - 0829
Include unreimbursed medical expenses.
ITEM DESCRIPTION
NUMBER AMOUNT
1 2006 Pennsylvania Income Tax 16.00
2 Cumberland County - Transfer Tax on Sale of Property 1.500.00
3 Notary Fees - Sale of Property 4.00
4 Resale Certificate - Sale of Property 50.00
5 John Goodwin - Repairs to property 200.00
6 Tax Certification 10.00
7 2007 School Taxes 1.245.11
8 Home Warranty purchased for Property 435.00
9 2007 County/Township Taxes 541.65
10 Real Estate Commission on Sale 9.000.00
I
11 Transaction fee on sale of Real Estate 165.00
12 Initiation Fees/Homeowner's Association to Sterling Property Management - Village of Moreland 938.61
13 Property Clean Out 525.50
14 Bank Statement Fees - Members 1 st FCU 28.00
15 Canopy Re Chang,e 92.50
16 Sewer and Trash from 10/06 to sale date - Lower Allen Township 437.50
TOTAL (Also enter on Line 10, Recapitulation) 18,621.68
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
continued
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Hammond, Ann L
Include unreimbursed medical expenses.
FILE NUMBER
21 - 06 - 0829
ITEM
NUMBER
17
DESCRIPTION
Insurance from 10106 - Libery Mutual
18
Gas Bills from 10106 - UGI
AMOUNT
883.23
925.58
158.54
285.51
20.00
9.95
600.00
100.00
250.00
175.00
25.00
19
Water Bills from 10106 PA American Water
20
Electric Bills from 1 0106 - PPL
21
American Red Crdss lifeline
22
Check Charges
23
Discover Gold Card
24
,.... _ _ _I ""L _ _._ _
25
Penn State
26
Volunteers of America Donation
27
Moreland Home Owners Association - Fee advanced at settlement
Page 2 of Schedule I
REV-1513 EX+ (9-00)
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
NAME AND ADDRESS OF PERSON(S)
RECEIVING PROPERTY
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
I FILE NUMBER
21 - 06 - 0829
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
Hammond, Ann L
I.
DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 James P. Hammond
1471 Valley Street
Marysville, PA 17053
Son
Half
2 Anita R. Peoples
1496 Union Street
Coal port, PA 16627
Daughter
Half
Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, on Rev 1500 cover sheet
II.
J
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS
NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
A Settlement Statement
U.S. Department of Housing and Urban Development
B. Tvee of Loan OMS Anoroval No. 2502-0265 (expires 9/3012006\ FINAL
1. DFHA 2. DFmHA 3. 81Conv Unins. 1 6. File Number 17. Loan Number 18. Mortgage Insurance Case Number
4. OVA 5 DConv Ins. 4812 0045926052
c. Note: lte~so~~ed~~~~~a)~o:~: :j~ ~:=~:f~os'f:~~-m:::~~s~~r~~~~i~ ~rp~s:::a:':~~l ~J~~:~~n\~l~s I TltleExpress Setllement Systen
~:~:~G~~I~n~~~ ~n~~~~:~~~ FS~=~~~~~~t~~k~~~at~~ ~~~a;'~t:~s=o',,~.1~enalljeS upon Printed 10/30/2007 at 12:26 EJE
Timothy R. Diehl
540113 Oxford Drive MechanicsburQ, PA 17055
Ann L. Hammond Estate
5440 Oxford Drive Mechanicsbura, PA 17055
ERA Home Loans
3000 Leadenhall Road Mount Laurel NJ 08054
5440 Oxford Drive, Mechanicsburg, PA 17055
Lower Allen TownshiD
H. SETTLEMENT AGENT: Land Settlement Services, Telephone: 717-273-2858 Fax: 717-273-7819
PLACE OF SETTLEMENT: 107 South 4th Street Lebanon PA 17042
I. SETTLEMENT DATE: 10/31/2007
J. SUMMARY OF BORROWER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER
101. Contract sales price
102. Personal ProOOrN
103. Settlement charoes to borrower (Jine 140m
104.
105.
D. NAME OF BORROWER:
ADDRESS:
E NAME OF SELLER:
ADDRESS
F. NAME OF LENDER:
ADDRESS:
G. PROPERTY ADDRESS
150 000.00
5653.77
Adiustments for items oaid bv seller in advance
106. Citvltown taxes 10/31/07 to 12/31/07
107. Countvtaxes 10/31/07 to 12/31/07
108. School Taxes 10/31/07 to 06/30108
109. SwrfTrash $87.50 40 10/31/07 to 12/31/07
110. Condo Dues $50lmo 10131/071010/31/07
111
112.
120. GROSS AMOUNT DUE FROM BORROWER
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER
201. Deoosit or eamest money
202. Princioal amount 01 new loans
203 Existino loan(s) taken subiect to
204
205.
206.
207.
208.
209.
156 636.98
2 000.00
120000.00
Adiustments for items unDaid bv seller
210. Citv!town taxes
211. County taxes
212. School Taxes
213
214.
215.
216
217.
218.
219
220. TOTAL PAID BY/FOR BORROWER
300. CASH AT SEffiEMENT FROM OR TO BORROWER
301. Gross amount due Irom borrower Iline 120\
302. Less amounts naid bvllor borrower (line 220\
122 000.00
156636.98
122000.00
303. CASH FROM BORROWER
34 636.98
K. SUMMARY OF SELLER'S TRANSACTION:
400. GROSS AMOUNT DUE TO SELLER
401. Contract sales orice
402. Personal Prooertv
403.
404.
405.
150 OOO.Ot
41.46
51.11
830.07
58.96
1.61
Adjustments for items paid by seller in advance
406. City/town taxes 10/31/07 to 12/31/07
407. Countv taxes 10/31/07 to 12/31/07
408. SchoolTaxes 10/31/07 to 06130/08
409. Swr/Trash $8750 40 10/31/07 to 12/31/07
410. Condo Dues $50/mo 10/31/07 to 10/31/07
411.
412.
420. GROSS AMOUNT DUE TO SELLER
500. REDUCTIONS IN AMOUNT DUE TO SELLER
501. Excess Deoosit (see instructions'
502. Settlement chames to seller /line 1400)
503. Existino loan(s\ taken suhiect to
504. Pavoll of First Mortn""e Loan
505.
506.
507
508.
509.
11 779.0!
41.41
51.1'
830.0',
58.91
1.6'
150 983.2'
Adiustments for items unpaid bv seller
510. City/town taxes
511. Countv taxes
512. School Taxes
513.
514.
515.
516.
517.
518.
519.
520. TOTAL REDUCTION AMOUNT DUE SELLER
600. CASH AT SETTLEMENT TO OR FROM SELLER
601. Gross amount due to seller (fine 4201
602. Less reduction amount due seller (line 520)
11,779.0!
150983.2'
11 779.0:
603. CASH TO SELLER
139204.11
SUBSTITUTE. FORM 1099 SELLER STATEMENT: The lnfotmalionconlained herein is important tax infonTlalion and i.5 being fumished to tM Internal Revenue SeNice. If YOU,are reqUited 10 file a return
a negligence penalty Of oU1er sandion wilt be imposed on you if this 11em is required 10 be reported and the IRS determines that It has no! been reported, The Contract Sales Pnce described on
line 401 above conslilutes the Gross Proceeds of thIS trans8dion
TIN:_-_^_'_'_-_ SEllER(S)SIGNATURE(S)
SELLER(S) NEW MAILING ADDRESS'
SELLER(S) PHONE NUMBERS'
YOu are required by law to provide_the s,:,ttlement agent (Fed. Tax ID No: . ).with )'Our.correct taxpayer identification n~mber. If you do not provide your~.taxpayer identification
number, you may be subject to d",1 or cnminal penalties Imposed by law. Under penalhes of pef)ury, t certIfy thai the number shown on thIS statement IS my correct taxpayer Identification number
I
(H)
fWl
U.". ue:r-"" "v,e:" I ur nUU::'IN\;> ANU UKt:lAN UtVtLUf->MtN I
SETTLEMENT STATEMENT
File Number: 4812
FINAL
PAGE
L. SETTLEMENT CHARGES
700. TOTAL SALES/BROKER'S COMMISSION based on price $150.000.00 lID 6.000 = 9 000.00
Division of commission lline 700\ as follows:
701. $ 9000.00 10 NRT Inc.
702. $ 10
703. Commission oaid al Settlement
704. Transaction Fee 12\ 10 NRT Inc.
800.ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Oriainalion Fee 1.000 %ERA Home Loans
802. Loan Discount %
803. Aooraisal Fee
804. Credit Reoort
805. Lender's Insoeclion Fee
806. Martoaoe Aoolicalion Fee
807. Assumotion Fee
808 Flood Certification Fee
809. Document Prenaralion Fee
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Inlerest From 10/31/200710 11/01/2007 I!i)$
902. Martoaoe Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo.1!i) $
1002. Martaaae Insurance mo. rm $
1003. City ProoertvTax 10 mo. rm ~
1004. County Prooertv Tax 10 mo. rm $
1005. School Taxes 6 mo~@-$
1009. Aoareoale Analvsis Adiuslment to ERA Home Loans
1100. TITLE CHARGES
1101. Settlement or closino fee
1102. Abslract or tille search
1103. Title examination
1104. Tille insurance binder
1105. Documenl Preoaration
1106. Notarv Fees
1107. Attomey's fees
(includes above items No:
1108. Title Insurance
!includes above items No:
1109. Lender's Policv 120000.00
1110. Owner's Policv 150,000.00 -1J98.75
1111. End 810 Loan End 900 ALTA SlID Land Settlement Services
1112 Overninhl Mail to Land Settlement Services
1113. ClosinnSvcLtr to Land Settlement Services
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordino Fees Deed ~ 38.50 . Martn""e $ 72.50 . Release $
1202. Citv/Countvtax/stamns Deed $1500.00 . Martaaae$
1203. State Tax/stamos Deed $1.500.00 . Martoaoe $
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Initiation Fee to Sterlinn PronArtv Manaaement Inc.
1302. Resale Certificate 10 Sterlinn PronArtv Manaaement Inc.
1303. Wire Fee to Land Settlement Services
1304. Email Fee to Land Settlement Services
1305. Reoairs to John Goodwin
1306. Tax Certification to Bonnie K Miller Treasurer
1307. 2007 School Tax to Bonnie K. Miller Treasurer
1308. Warranty 10 American Home Shield
TitleExoress Settlement Sv<tem Prinled 10130/2007 at 1226 EJB
PAID FROM PAID FROM
BORROINER'S SELLER'S
FUNDS AT FUNDS AT
SETTLEMENT SETTLEMENT
165.00
9 000.0
165.0
1 200.00
to FNMA CBC
IP.O.C.l19.95 Buver
to ERA Home Loans
IP.O.C.l 500.00 Buver
to STARS
to ERA Home Loans
fP.O.C.l19.50 Buver
IP.o.685.00 Buver
20.5700 /d;rv
1 Davs
20.57
lmo
lmo
20.34 lmo
25.08 /mo
103.76 lmo
203.40
250.80
622.56
-181.68
0.(
to Eric Bentz
\
to Land Settlement Services
\
I
I
I
-111.oll1----
1,500.00
_ _ n_+_ _ ,1,500.1
I
- ----I -
.
312.87
-2ll:()O+~Q..
~__5O.0QL~_-=--
- n r- 200.
10.
415.
435.
1400. TOTAL SETTLEMENT CHARGES
(enter on lines 103 Section J and 502 Section K\
5,653.77
-.11279.
w. ING: IT IS A CRIME TO KNOWNGLV MAKE FALSE STATEMENTS TO THE
UNI EO STATES ON THIS OR ANY SIMIlAR FORM. PENALTIES UPON COf'.MCTION
C INCLUDE A FINE AND IMPRISONMENT, FOR DETAILS SEE TITLE 18
US CODE SECTION 1001 AND SECTION 1010
~ p. a~ed ~and . ccurate account of lhis transaction
I rsed in dance th this slalemenl
A rJ7
By