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HomeMy WebLinkAbout07-03-08 (2)REV-1500 EX + (61p) COMMONWEALTH OF REV-15 0 0 OFFICIAL USE ONLY PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 1- 0 8 0 0 1 2 COUNTY CODE YEAR NUMBER DECE'.DENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER H Z BAILEY JEAN W. 1 6 8- 2 6- 3 6 7 1 I 0 DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE V 12/25/2007 01/05/1933 REGISTER OF WILLS LJ.I (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~~,. ©1.Original Return ~ 2. Supplemental Retum ~ 3 Remainder Return (date of death ri r t 12 13 82 . p o o - - ) ~ a Y ~ 4. Limited Estate ~ 4a. Future Interest Compromise (date of dean aver tz-tz-82) ~ 5. Federal Estate Tax Return Required ~ a ~ X^ 6. Decedent Died Testate (Anach copyofwill) ~ 7. Decedent Maintained a Living Trust tAaacn copy ofrrust> _ 8. Total Number of Safe Deposit Boxes a ~ 9. Litigation Proceeds Received ~ 1 O. SpOt1S81 POVerty Credlt (date of death between 12-31-91 and 1-t-95) ~ 11. Election to tax under Sec. 9113(A) (AUacn sch o) ~, -THIS SECTION MUSTBE COMPLETED. ALL'CORRESPONDENCE AN D'GONFIIDENTtALfiAX iNFORMATiON SHOULD BE DIRECTED TO: Z W NAME COMPLETE MAILING ADDRESS o DOUGLAS G. MILLER ESQUIRE 60 WEST POMFRE T STREET y FIRM NAME (If Applicable) ~ IRWIN & McKNIGHT p TELEPHONE NUMBER ~ 717 249-2353 CARLISLE PA 17013 1. Fteal Estate (Schedule A) (1) 130,000.00 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 44.46 r~-,s ~::_~ 3.Olosely Held Corporation, Partnership or Sole-Proprietorship (3) ,, Q ~~ --;~ 4. Mortgages & Notes Receivable (Schedule D) (4) ~ '~ ~~ ~~` 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 2,866.27 ~' rn 1 ~ ."1 ' ~ ~ ~ Z (;schedule E) ~ _ cry ~ `::1 i _ j ~ 6. Jointly Owned Property (Schedule F) (6) `_ _? t~ --n ~ -"`r ~ ; (~ Separate Billing Requested _ -C~-t ~ r ``-f I 3 ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 36,134.5 ~ ~ ~:,~ , -~ H a Q V W (: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, 8 Liens (Schedule I) 11. lfotal Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) ~~ (g) 169, 045.29 (g) 24,441.74 (10) 1,817.40 (11) 26, 259.14 (12) 142, 786.15 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) _ 142, 786.15 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z ~_ H Q 1-- a V F- 15. Amount of Line 14 taxable at the spousal tax Date, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Ftmount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19.1'ax Due 0.00 x (t5) 0.00 142,786.15 X .045 (t6) 6,425.38 0.00 x .12 (17) 0.00 0.00 x .15 (18) 0.00 (19) 6,425.38 Decedent's Complete Address: STREET ADDRESS 1908 DOUGLAS DRIVE CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1• Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior (Payments 3.000.00 C. Discount (1) 6,425.38 Total Credits (A + B + C) (2) 3, 000.00 3. Interest/IPenalty if applicable D. Interest E. Penalty 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 10 to request a refund (4) 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. 0.00 0.00 (5) 3,425.38 (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 3,425.38 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 : ........................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ........................................ ^ c. retain a reversionary interest; or ...................................................................................................... ^ ^X d. receive the promise for life of either payments, benefits or care? ............................................................. ^ 0 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 "intrust for" or payable upon death bank account or security at his or her death? ................. ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... X^ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declaze 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 PERSON RESPONSIBLE FOR FILING RETURN DATE 1811 CENTERVILLE ROAD PA 17241 For dates of Beath 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. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate iimposed 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. §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 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)j. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. For dates of cieath 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)]. REV-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INIHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER BAILEY JEAN W. 21 08 0012 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 ~sxchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real orooertv which is jointly-owned with rioht of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1908 DOUGLAS DRIVE, NORTH MIDDLETON TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA -SOLD -APPRAISAL ATTACHED TOTAL (Also enter on line 1 VALUE AT DATE OF DEATH 130, 000.00 (If more space is needed, insert additional sheets of the same size) REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER BAILEY JEAN W. 21 08 0012 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SERIES EE SAVINGS BONDS -INVENTORY ATTACHED 44.46 TOTAL (Also enter on line 2, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1508 E>C + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER BAILEY JEAN W. 21 08 0012 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PERSONAL PROPERTY -SETTLEMENT SHEET ATTACHED 1,763.25 2. M&T BANK -CHECKING ACCOUNT #3740580042 139.43 3. M&T BANK -SAVINGS ACCOUNT #15004198314707 963.59 TOTAL (Also enter on line 5, Recapitulation) I $ 2,866.27 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER _BAILEY JEAN W. 21 08 0012 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIPTO DECEDENT AND THE DATE OF TRANSFER ATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (tFAPPLICABLE~ TAXABLE VALUE 1. ALLSTATE LIFE INSURANCE COMPANY 29,953.40 100. 29,953.40 ANNUITY -CONTRACT #GA0752179 BENEFICIARIES: CHILDREN OF JEAN W. BAILEY 2. TRANSAMERICA LIFE INSUANCE COMPANY 6,181.16 100. 6,181.16 ANNUITY -CONTRACT #27304521 BENEFICIARY: GARY L. BAILEY TOTAL (Also enter on line 7 Recapitulation) I $ 36,134.56 (If more space is needed, insert additional sheets of the same size) REV-1511 E;K + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER BAILEY JEAN W. 21 08 0012 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EWING BROTHERS FUNERAL HOME 7,340.56 2. CUMBERLAND VALLEY MEMORIAL GARDENS -GRAVE OPENING 1,210.00 B. ADMINISTRATIVE COSTS: 1, Personal Representative's Commissions Name of Personal Representative (s) JOANNE CONRAD Social Security Number(s)IEIN Number of Personal Representative(s) Street Address 1811 CENTERVILLE ROAD City NEWVILLE State PA Zip 17241 Year(s) Commission Paid: 2, Attorney Fees IRWIN & McKNIGHT 3, Family Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent 4• ~ Probate Fees REGISTER OF WILLS 6,000.00 7, 500.00 244.00 5 Accountant's Fees 6. Tax Return Preparers Fees PATRICIA A. ROSENDALE, CPA 350.00 7. REGISTER OF WILLS, FILING FEE 30.00 8. NOTARY FEES 50.00 9. CUMBERLAND LAW JOURNAL, ESTATE NOTICE 75.00 10. THE SENTINEL, ESTATE NOTICE 158.62 11. ROY D. GOTTSHALL, APPRAISAL ON PERSONAL PROPERTY 60.00 12. STEVEN W. BARRETT, APPRAISAL ON REAL ESTATE 325.00 13. REGISTER OF WILLS, SHORT CERTIFICATES 16.00 14. CLOSING COSTS ON SALE OF REAL ESTATE 465.42 15. DAN HERSHEY AUCTION SERVICE, LLC -AUCTIONEER COMMISSION 617.14 TOTAL (Also enter on line 9, Recapitulation) $ 24.441.74 Zip (If more space is needed, insert additional sheets of the same size) REV-1512 E:X + (6-98) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER BAILEY JEAN W. 21 08 0012 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PPL -ELECTRIC 355.04 2. ~ EMBARQ -TELEPHONE ~ 120.40 3. COMCAST -CABLE 4. SUBURBAN PROPANE -UTILITY 5. NORTH MIDDLETON TOWNSHIP - WATER/SEWER 30.95 923.36 239.70 6. (CARLISLE HMA PHYSICIANS -MEDICAL ~ 52.78 7. (KINETIC IMAGING -MEDICAL ~ 4.79 8. (YORK WASTE DISPOSAL -TRASH ~ 90.38 TOTAL (Also enter on line 10, Recapitulation) I $ 1,817.40 (If more space is needed, insert additional sheets of the same size) REV-1513 EX i (P-~~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER RAII FY .IFAN W ~~ nsz nn~ ~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 1. JOANNE CONRAD Lineal 1811 CENTERVILLE ROAD 1/6TH REMAINDER NEWVILLE, PA 17241 2. GARY L. BAILEY Lineal 153 W. LOUTHER STREET 1/6TH REMAINDER CARLISLE, PA 17013 3. JUDY HEFFLEFINGER Lineal 1557 LONGS GAP ROAD 1/6TH REMAINDER CARLISLE, PA 17013 4. LINDA GUTSHALL ~ Lineal 165 OAKHILL ROAD 1/6TH REMAINDER CARLISLE, PA 17015 . 5. KAREN SHUGHART Lineal 330 PONDEROSA ROAD 1/6TH REMAINDER CARLISLE, PA 17015 6. SHARON GOODLING Lineal 67 CONRAD ROAD 1/6TH REMAINDER CARLISLE, PA 17015 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTA1t~ENT I, JEAN W. BAILEY, of North Middleton Township, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ONE. I direct my Executor or Executrix, as the case may be, to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Executor or Executrix of my estate. TWO. My Executor or Executrix .may, at his or her discretion, compromise claims, borrow money, retain property for such length of time as he or she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as he or she may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. I authorize and empower my Executor or Executrix to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My Executor or Executrix is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executor or Executrix. Initia~ THREE. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my spouse, JOSEPH W. BAILEY. FOUR. If my spouse, JOSEPH W. BAILEY, does not survive me by a period of at least sixty (60) days, then I give, devise and bequeath all of my estate of whatever nature and wherever situate in equal shares to my c ildren, JOANNE CONRAD, GARY L. BAILEY, JUDY HEFFLEFINGER, LINDA GUSHALL, KAREN SHUGHART and SHARON GOODLING, per stirpes, which provides that the child or children of any deceased beneficiary shall take the share their parent would have taken if living. FIVE. If, under any of the provisions of this Will, any principal becomes vested in a minor, my Executor or Executrix, as the case maybe, including any administrator c.t.a., shall have the discretion either to pay over such principal or any part thereof to any parent of such minor, any guardian of the person or estate of such minor, or any person with whom such minor resides, or to retain the same as trustee of a power in trust for the benefit of such minor during his or her minority. Any of the principal thus retained, and any of the income therefrom, including the whole thereof, may be paid to or applied for the benefit of such minor from time to time in the discretion of the trustee of such power. When such minor reaches majority, the funds so held shall be paid over to such person, or, if he or she shall sooner die, to his or her legal representatives. In so holding any principal or income for any minor, the trustee of such power shall have all the rights, powers, duties and discretions conferred or imposed upon my fiduciaries acting under this Will. I further direct that no bond shall be required from any person receiving a payment hereunder and receipt from such person shall be a full discharge to the trustee of such power who shall not be bound to see to the application or use of such payment. The trustee of such power shall be entitled to commissions at the rates and in the manner payable to a testamentary trustee. Initial 2 SIX. I nominate and appoint my spouse, JOSEPH W. BAILEY, to be the Executor of this my Last Will and Testament. In the event he has predeceased me, failed to qualify or is not able or does not serve for whatever reason, I then appoint my daughter, JOANNE CONRAD, to be the Substitute Executrix of this my Last Will and Testament. In the event she has predeceased me, failed to qualify, or is not able or does not serve for whatever reason, I then appoint my son, GARY L. BAILEY, to serve as Substitute Executor of this my Last Will and Testament, whereby the said substitute personal representatives shall have the same powers as are given to the original Executor hereunder. SEVEN. No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty (6Q) days. EIGHT. No Executrix or Executor acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. NINE. No beneficiary may assign, anticipate or pledge his or her interest in any income or principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or otherwise reach any such interest. TEN. If any person or institution entitled to share in any distribution under the terms of this my Last Will and Testament becomes an adverse party in any proceeding to contest the probate of this Last Will and Testament, such person or institution shall forfeit his, her or its entire interest inherited hereunder and all provisions in favor of such person or institution shall be declared void and of no effect. The share of such person or institution so forfeited shall be distributed as part of the residue pursuant to Paragraph Four hereof except that if such person or institution is entitled to share in the said residue, that interest shall be distributed proportionately to the other residuary distributees. InitialZ~~~ 3 IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of Mazch, 2002. ~ (SEAL) AN W. BAILEY Signed, sealed, published and declared by the above-named person as and for a Last Will and Testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. ,~ ~, , ~r~ck~rl 4 ACKNOWLEDGMENT AND AFFIDAVIT WE, JEAN W. BAILEY, DOUGLAS G. MILLER and TRACI D. SMITH, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND TRACI D. S Subscribed, sworn to and acknowledged before me by JEAN W. BAILEY, the testatrix herein, and subscribed and~orn to before me by DOUGLAS G. MILLER a TRACI D. SMITH, witnesses, this ~~day of March, X002. n ~ '\ Public Notarial Seal Jacqueline L. Dra~,vbaugh, Notary Public Carlisle l3orc, Cumberland County My Commission Expires Aug. 14, 2C03 A4en~ber, Pennsylvan;a As~oraticn or ~iot~;;es LAw OFFICES ~~ ~ ~ ~~~~~~~~ A. Settlement Statement U.S. Department of Housing and Urban Development OMB No. 2502-0265 ex ices 11!30!2009 y r 1 ~ ~r B. TYPE OF LOAN WESTPOMFRETPROFESSIOIVAL BUILDING 1. ^FHA 2. (]FmHA 3. ^Conv. Unins. 4. OVA 5. OConv. Ins. 60 WEST POMFRET STREET CARLISLE, PEN111SYLVAIVIA 97093-3222 6. F{LE NUMBER DURAKOVlCH5-08 7. LOAN NUMBER 000003316244 (T9TJ 249-2353 s om+ um s e o g w you a s smen o a a se smen cos mown s pa o an C. Note: trams marked "(p.o.c.y"were paid outside the dosing; they are shown here for irdonnation purp WARNING: It la a crime to knowr+~gb make false atatemsnis to the United Stales on this or an o convictbn can include a flna and i rlsonmsM. For detatis see: Title 18 U. s. Coda ssdion 1~o 8. MORTGAGE INSURANCE CASE NUMBER y e se amen agen area own. oses and era not indudee in the totals. TitleExpreSS Settlement System ther slmllar forth. Penaitles upon f and seal.n ~o~o. Printed 06/06/2008 at 13:01 JMR D. NAME OF (BORROWER: HAZiM DURAKOVIC and MAGBULA SALCINOVIC ADDRESS: 1671 CIUAIL DRIVE- CARLISLE PA 17013 E. NAME OF SELLER: JEAN W BAILEY ESTATE ADDRESS: 1908 DOUGLAS DRIVE CARLISLE PA 17013 F. NAME OF (.ENDER: WACHOVIA MORTGAGE, FSB ADDRESS: 1 JEFFERSON SQUARE WATERBURY CT 08706 G. PROPERT't' ADDRESS: 1908 DOUGLAS DRIVE, Carlisle, PA 17013 LOTS 6 8~ 7D NOLL MANOR North Middleton Townshi H. SETTLEMENT AGENT: 18~M REAL ESTATE SERVICES, LLC, Telephone: 717.249.2353 Fax: 717.249.6354 PLACE OF SETTLEMENT: West Pomfret Professional Bld 60 West Pomfret Street Carlisle PA 17013 I. SETTLEMENT DATE: 06/0612008 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 rice 130 000.00 401. Contract sales rice 130 000.00 102. Personal Pro a 402. Personal Pro art 103. Settlement char es to borrower line 1400 6 884.52 403. 104. 404. 105. 405. Ad'ustments for items aid b seller i n advance Ad'ustments for items aid b seller i n advance 107. Coun taxes 0610610$ to 12131108 228.95 407, Count taxes 06(06108 to 12131108 228.95 108. School Tax 06106108 to 06130108 106.96 408. School lax 06106108 to 06130108 106.96 109. 409. 110. 410. 111. 411. 112, 412. 120. GROSS AMOUNT DUE FROM BORROWER 137 220.43 420. GROSS AMOUNT DUE TO SELLER 130 335.91 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. De osit or earnest mone 1 000.00 501. Excess De osit see instructions 1000.00 202. Princi al amount of new loans 123 500.00 502. Settlement char es to seller line 1400 465.42 203. Existin loan s taken sub'ect to 503. Existin loan s taken sub'ect to 204. 504. Pa off of First Mort a e Loan 205. 505. 206. 5~• 207. 507. 208. 508. 209. 509. Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller 213. 513. 214, 514. 215, 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BYIFOR BORROWER 124 500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 1465.42 300. CASH AT SETTLEMENT FROM OR TO BORR OWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower line 120 137 220.43 601. Gross amount due to seller line 420 130 335.91 302. Less amounts aid b ffor borrower line 220 124 500.00 602• Less reduction amount due seller line 520 1 465.42 303. CASH FROM BORROWER 12 720.43 603. CASH TO SELLER 128 870.49 U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT File Number: DURAKOYICH5-08 PAGE 2 TitleFxnress Settlement Svstem Printed OFi/06/2008 at 1301 .1MR L. SETTLEMENT CHARGES PAID FROM PAlD FROM 700. TOTAL: SALES/BROKER'S COMMISSION based on rice $130 000.00 = 80RROVVER'S SELLER'S Division of commission line 700 as follows: FUNDS AT FUNDS AT 701, t0 SETTLEMENT SETTLEMENT 702. to 703. Commission aid at Settlement 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Od ination Fee %WACHOVIA MORTGAGE FSB 1 235.00 POC b Lender 802. Loan Discount 803. A raisal Fee to WACHOVIA MORTGAGE FSB P.O.C. 350.00 B er LR 804. Credit Re ort to WACHOVIA MORTGAGE FSB P.O.C. 190.00 Bu er LR -171.00 805. Tax Sewice Fee to FIRST AMERICAN REAL ESTATE TAX SERVICE LR 78.00 806. Flood C:ert Fee to WACHOVIA SETTLEMENT SERVICES LLC LR 15.00 807. Proses:;in Fee to WACHOVIA MORTGAGE FSB LR 350.00 808. Doc Transmission Fee to WACHOVIA MORTGAGE FSB LR 25.00 809. A lication Fee to WACHOVIA MORTGAGE FSB P.O.C. 60.00 Bu er LR 810. MFRS to MERS to WACHOVIA MORTGAGE FSB LR 3.95 811. Administrative Fee to WACHOVIA MORTGAGE FSB LR 250.00 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 0610612008 to 07101/2008 23.2600 Ida 25 Da s LR 581.50 902. Mort a e Insurance Premium for to 903. Hazard Insurance Premium for to 904. Loan Counselin Fee to WACHOVIA MORTGAGE FSB $500.00 POC b Lender 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance 3 mo. 30.17 /mo LR 90.51 1002. Mort a e Insurance mo. Imo 1003. Cit Pro pert Tax 6 mo. 41.17 Imo LR 247.02 1004. Count P'ro rt Tax mo. 33.41 Imo 1005. School Tax 12 mo. 130.42 Imo LR 1 565.04 1009. A re ate Anaf sis Ad'ustment to WACHOVIA MORTGAGE FSB LR -135.75 0.00 1100. TITLE CHARGES 1101. Settlement or closin fee 1102. Abstract or title search 1103. Title examination 1104. Title insurance binder 1105, Document Pre oration 1106. Note Fees 30.00 1107. Attome 's fees includes above items No: 1108. Title Insurance to STGC118MREAL ESTATE 1 008.75 includes above items No: 1109. Lender's Polic 123 500.00 - 1110. Owner's Polic 130 000.00 -1 008.75 1111. End 100 End 300 End 900 to STGCII&MREAL ESTATE 150.00 1112. 1113. Closin Svcltr to STGCII&MREAL ESTATE 35.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin Fees Deed 38.50 • Mort a e 64.50 • Release 103.00 1202. Cit (Count taxistam s Deed 1300.00 • Mort a e 1 300.00 1203. State Taxlstam s Deed 1300.00 • Mort a e 1 300.00 12oa. 1205. 1300. ADDITIOMAL SETTLEMENT CHARGES 1301. Surve 1302. Pest Ins ection 1303. wire fee to ORRSTOWN BANK 10.00 1304. 2008 COIT~vP TAXES to ROBIN SOLLENBERGER TAX COLLECTOR 400.94 1305. ovemi ht and a mail to IS<M REAL ESTATE SERVICES LLC 48.50 1306. final WtrlSwr #01000077 to NORTH MIDDLETON AUTHOIRTY 64.48 1307. 1308. 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 6 884.52 465.42 NUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 Settlement Statement an b the boa of y knowledge and beifat: k is a true and accurate statement of all rocaipta and disbursements made on my accoum or b in this transactlon, l fuRher certify that 1 have roceived a cop the HUD-1~tdement Statement , 7 JEAN W BAILEY ESTATE WARNING: rc IS A CRIME TO KNOWINGLY MAKE FALSE STATEMEN'~ Tt~rllrl~ Tha HUD•1 Settlement Statement which i have ppropared is a true and accurate accoum of this transactlo UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION I have caused or will cause the funds to be disbursed in accordance with this statement CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE T1TlE 18: U.S. CODE SECTION 1001 AND SECTK)N 1010. ~- By: (D ~ ~ ~ ~ x ~ o a, a. °- O O Q d tlf ttN CEN ~ ~ 41 N {J7 C1> q N ~ ~ ~ N N N ~ a° ° a ~ mm~. °~ ~cc. ~ d yiNjsN~ ~ ~a~~w ~~~mN ooo~-~, N ~ ~ ~ ~ y C~~D ~ • d S C.~ ?', Z 7 O ~ ~ ~ ~ ~ ..~. 6 • 6~ ~~ a 7'C ~ fIN N O ~. z 4 N,j7~ ~ ~ 4 f~.'G !L CC1 G~,~ Q1 N Q ~•~ U~ [U ~ N o ~' 4y CD ~ a x ~ ,~ a ~ CD -r ~"c -~. 0 --tea ~° m coo y o=^~,?„~ .. c ~, _ oa,p ~ cSeo~2~ ~~~6a N ~ ; ~ Q 'asp N nyt~ O .'] r' t~¢ p,N " Ct- C) Yr N Q- ~ V 7 O 1]) N ~ ~ ~ G (D G1- g. ..,0 N (C] (9 1 O W~ am c. ~, o 0 N DAN HERSHEY AUCTION SERVICES LLC 790 West High Street Carlisle, PA 17013 (717) 532-4647 Steve Ege 717-385-5438 Cell Chris Bream 717-226-1920 Cell SELLERS NAME ~ f~ , "~ ~`~ ~' ~~ ~~~~ 9 '~~ DATE ~' ~ ~'' .p ~'~` ~ '~ ~ ~ if"~t`~~~~~~ ~,~'?'~~~ ~~ ,~~f ~~„~,,.~ ~..1 / ~~ ~~ "PHONE r ,.- ' ~".~.~ ADDRESS ~' ~ `~'~"~' ~"~ ~.= OTHER '~ ~':'`~ r.~, 1 AUCTIONEER % ~ r~' AUCTION DATE/LOCATION CLERK % DESCRIPTION OF MERCHANDISE ~- f° 4~- ~ ~.. ~ ` t r~ t.~t. ~'r- t ' r ~ :l F. 1~ t §:'. F~~ ~~~~ X k fits ~ (~ t ,/ ~~qq ~YF ° lc, r~ r~ ~ 9 4 *1. ~~ ,.h ~, ~, , ~- M ~ ~ . .. .. t ; `.;. a ,_ ~,~. ~. ; ,~,- _ ` a.r ~/ V '!- 1~ /p r V ~~L. ~ ~i~ ¢ ., t ~ a 9 ~ g ' `F r C' ,~ ,fir g r ; ~ ` 1 ;- '~ ~y} f" ~ ° r~?~ ~ f-d_'~ -- {', ` ~l ~ j"' ~ 7~ y :--.,~ (f`j ~) ~,• ~ K V i, t ~ ~ i ~ a ~ i l 4,. "` ~ ~~` 'y °i' t .;J.' .E ~ ~ ' ! id j :+''i ,~y IN f ' ~ ~ ~ ~ '~ ~, ~ ~~ j ~ x #~' ~ 'i ,j ~ ~ fir;/` ~, '~ ~ f ~~ '. K. l J. L L r 7 7 .f ! ., _ t t 7 f _ U ~ ~ "7 1 a ; " d ~ ~ t .. ~~~ r [v~.-J ~ -Y7- ~ ~~ f 1 ~..~.:~r L . ; f'~"r,~` ~~. t f~''',3~ ~ i e' rte, p' +~' ~ '~.. •+ e i"'1~' ' r^+ (.~ i ~ w, ~, + ~~~ S ,fl air ~.A.,~ ~ ~ ~ \ 11.E r-, S ~ ~y~/~. i.~ f j ~ i.' t~!*1 ~a ~: f~ ~ ~~` ~ ~ ~ ' I ; ~~1 ~. ~ ~.. ~ ~-~ F ~ t '~ 1 ;.4~'~'~ ~ ~~ I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen- tative of the merchandise, goods and or property and have good title and the right to sell and that they are free from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in "'this agreement. AUCTION SIGNATUI~ Total Sales (Clerking Tickets Attached) $ ~„~ `. _, ( ~:.';~ ~~~~ ~ _~ _ SELLERS SIGNATURE ~, ~> s: Less~~Sale Expense: % Commission Auctioneer $ % Commission Clerks $ .~ OTHER: ~ ~ ~'~ ~ !1 ~-':'t ' ? f; 4 ~,~~~° r..; ~.-.,, ~; TOTAL SALE EXPENSE DEDUCTED $ s..,q i~., t. ..~ SELLERS NET $ ~` `~-' ~ ~ ~s f~j A CTION SIGNA RE SELLERS SIGNATURE Q MBTF~~nk 499 Mitchell Street, Millsboro, DE 19966 January 7, 2008 Law Offices RECEIVED Irwin 8v McKnight West Pomfret Professional Building JAN 0 9 1008 60 West Pomfret Street Carlisle, PA 17013 IRWAV & Mcl(NIGHT LAW OFFICES RE: Estate of Jean Bailey Date of Death: December 25, 2007 Social Security Number: 168-26-3671 Dear Mr. Miller: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type ........................... Checking Account Account Number ....................... 3740580042 Ownership (Names off .............. Jean Bailey Opening Date ...........................03/29/99 (account closed 01/04/08) Balance on Date of Death..........$139.42 Accrued Interest $ 0.01 Total .......................................$139.43 2. Account Type ........................... Savings Account Account~Number ....................... 15004198314707 Ownership (Names off .............. Jean Bailey Opening Date ...........................08/12/02 (account closed 01/04/08) Balance on Date of Death .........$963.21 Accrued Interest $ 0.38 Total ....................................... $963.59 • Page 2 January 7, 2008 The above named decedent did not have a safe deposit box. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or the name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please contact our North Middletown Branch at 1958 Spring Road, Carlisle, PA 17013, or # 717-240- 4521. Sincerely, ~~ , l~ Charlene Warrington, Records Management 1-888-502-4349 Jan ~ 1 1 ~ 2008 1 0 ~ 40RM 1/S1i2006 8 :35:08 AM PAGE 13/013 FNo ~ 5626rvEP Allstate Life l;rtsurance Company P.O. Box 94212 ~ ~ ~ ~~~ ~~ ,h Palatine, Yl. 60094-4212 ~~ Telephone: (877) 499-6418 You're in good hands. Facsimile: (866) 635-4523 January 11, 2008 Douglas Cr. Miller, Esquire 'OV'est Pomfret Professional Building 60 'QV'est Pomfret Street Carlisle, PA 17013-3222 Re: lean Bailey Contract No: CrA0752179 Dear Mr. Miller, Esquire: This letter is in response to your letter of December 31, 2007 sent to Debra E. Flyte at MBzT Bank. The following information is provided as requested: Owner of Annuity: Jean'W. Bailey Contract Issue Date: August 14, 2002 bate of Death: December 25, 2007 Annuity'V'slue as of Date of Death: $29.953.40 Accrued Interest from 1/1/07-12/25/07: $47.78 There were no changes made [o this annuity within one year of Jean bailey's date of death and there were no other annui[ypolicies that were closed within one year of Ms. Bailey's date of death. Vie trust this information answers your questions. if you have any questions, please contact me at 1-877- 499-6418 Ext. 86491. Sincerely, Donna)(tivera Claim Representative ~TR.ANSAMERICA ® LIFE INSURANCE COMPANY ~~~~~~~ Transamerica Life Insurance Company 4333 Edgewood Road NE PO Box 3183 Cedar Rapids, Iowa 52406-3183 February 19, 2008 ~a~ ~~' Gary Lee Bailey c/o Douglas Miller Atty 60~ W Pomfret St - W Pomfret Bldg Carlisle PA 17013-3222 ~~~ -- .. ,'+- RE: Annuity Number(s) 27304521 Dear Gary Lee Bailey: WEB have received notification, Jean W Bailey, annuitant of the above listed qualified tax deferred annuity is deceased. .Our office wishes to extend sincere condolences for your loss. TYIe following is the current information on this annuity: Ar.Irlui tant :- Owner: Primary Beneficiary(ies): Ar.Inuity Policy Date: Full Value as of 02/15/2008: Taxable Portion: Full Value as of 12/25/2007: Jean W Bailey Jean W Bailey Gary Lee Bailey 100 March 01, 2000 $6,207.24 $6,207.24 $6,181.16 The attached document outlines the options available to the bE~neficiary listed above. Tree full value as of the date of death is for tax purposes only and is not a guaranteed death benefit amount. OX>erations performed on an automatic basis when applicable have been terminated, such as; Systematic Payouts or Automatic Billing. Trle attached document contains general tax information based on Tz-ansamerica Life Insurance Company's interpretation and should not be rE~lied upon for your personal tax planning. If you have questions concerning the direct tax consequences when selecting an option, you may wish to consult a tax advisor. Member of the `EGON. Group r<1NNIifT~ l'1NAN4`tAL EN TERM ~'Q IfbRV SERVIC E~ FkLYA RD ~ POST ~SA66 ". $ERVIC E~`,AWARD 20Q6 20f3.6'`. Any additional questions regarding this annuity can be directed to the Annuity Service Center at 1-800-553-5957. A Transamerica Life Insurance Company representative will gladly assist you with any c~:iestion you may have regarding this annuity and help you meet your financial goals. Sincerely, ,~)~ ~ ~ Diane L Cowell Transamerica Life Insurance Company C]_aims Enclosure(s): Annuity Claimants Statement Death Option Packet Postage Paid Return Envelope Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 ;' January 2, ?J08 Gary I,. Bailey 153 W'. Louther St. Carlisle, PA 17013 The Funeral Service for Jean W. Bailey We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff , $3795.00 FUNERAL HOME SERVICE CHARGES $3795.00 SELECTED MERCHANDISE: 18G Coral Mist Gasketed Casket $1895.00 #5 Regular OBC $1025.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $6715.00 Cash Advances Clergy/Mass Offering $85.00 Certified Copies of the Death Certificate , $90.00 Flowers. $159.00 Sentine;lObitwithphoto, $131.56 Dress tic Underclothing $125.00 Sentinel 2nd run (Discounted) $35.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES . $625.56 Total Total Cost , $7340.56 SUB-TOTAL $7340.56 TNITIAI, PAYMENT / D[SCOIJNT /CREDITS 0.00 TOTAL AMOUNT DUE $7340.56 The unpaid balance over 30 days is subjected to a 1.50 % service charge per month - 18.0000 % per annum. `/, ~~--~ Cur7iberland Valley Memorial Gardens Invaic® Na. 3889 A, DIVTSI01~ OF STONE1VZORPaRTNEYLS, L.P. 1921 Ritner Highway - Carlisle, PA 17013 Phone (717) 243-3541 Fax (717) 243 4495 /N~O,^c ~- Customer Narne IRWIN -Doug Miller Address City State PA ZIP 17013 Phone Fax:717-249-6354 Des 1 Grave Opening/Closing Fee for Jean W. Bailey Westminster Cemetery -Friday 12/28/2007 ZIZ~'~~ Q~~ti~~w Date 12/27/2007 Order No. Ref # FOB Unit Price TOTAL. $1,210.00 ~ $1,21D.00 SubTotal 1 $1,210.00 - Payment uetaiis O Cash O Check Q Money Order Name Taxes State TOTAL I $1,210.00 Please make check payable to: Westminster Cemetery Osiris Holdin8 of Pennsylvania, Inc. 7 ~~ Ff101'ON ~ IAIaIN d~I~HA ~IMfI'1 IN~IFC~ i inns ~ i~~~an