HomeMy WebLinkAbout07-17-08q
~ 15056041147
REV-~ 500
EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue county code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO 60X.280601
Harrisburg, PA 17128-o6ot
RESIDENT DECEDENT 21 0 7 0 0 9 6 5
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
201189174 10142007 12111918
Decedent's Last Name Suffix Decedent's First Name MI
HILER DOROTHY E
(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
® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
® g Decedent Died Testate ^
(Attach Copy of Will) ~ Decedent Maintained a Living Trust Q $. Total Number of Safe DepOSit BOXeS
(Attach Copy of Trust)
^ 9. Litigation Proceeds Received ^ 10, Spousal Poverty Credit (date of death ^ 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 TO:
nlame Daytime Telephone Number
DEBRA K. WALLET 7177371300 f,~,
Firm Name (If Applicable)
LAW OFFICES OF DEBRA K. WALLET
First line of address
24 NORTH 32ND STREET
Second line of address
City or Post Office
CAMP HILL
State ZIP Code
PA 17011
REGISTER OF.S USE mAILY
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DATE FILED
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Correspondent's e~rtail address: wa I l e t d e b @a o 1. c o 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, correct and complete. Declaratia~h of preparer other than the personal representative rs based on all information of which preparer has any knowledge.
16 Lexington Drive, Milford, DE 19963
Charles J. Hiler, Jr. "~ I I
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
+~),~.~ ~~r Debra K. Wallet 31,1.1„ 9 2vOS!
ADDRESS
24 North 32nd Street, Camp Hill, PA 17011
Side 1
15056041147 15056041147 J
J
15056042148
REV-1500 EX
Decedent's Social Security Number
oecede~rsName: HILER, DOROTHY E. 2 0118 917 4
RECAPITULATION
1. Real Estate (Schedule A) ........................................................................................ ... 1. 1 8 7, 1 3 1 0 0
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. 5 6 , 5 8 1 . 3 6
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............ .. 6. rJ 0 , 1 1 4 8 4
7. Inter-Uvos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ............ .. 7,
8. Total Gross Assets (total Lines 1-7) ..................................................................... ... 8, 2 9 3, 8 2 7. 2 0
9. Funeral Expenses & Administrative Costs (Schedule H) ................................. ........... 9. 2 7 , 3 9 9 . 3 4
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........................ ........... 10. 2 , 4 2 9 9 2
11. Total Deductions (total Lines 9 & 10) ............................................................ ........... 11. 2 9 , 8 2 9 . 2 6
12. Net Value of Estate (Line 8 minus Line 11) ................................................... ........... 12, 2 6 3 , 9 9 7 . 9 4
13. Charitable and Governmental BequestslSec 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, 2 6 3 , 9 9 7 . 9 4
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 15.
16. Amount of Line 14 taxable
at lineal rate x .045 2 6 3, 9 9 7. 9 4 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. Tax Due .................................................................................................................... . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
15056042148
11,879.91
11,879.91
15056042148 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 07 - 00965
DECEDENT'S NAME
Hiler, Dorothy E.
STREET ADDRESS
45 Golfview Road
CITY
Camp Hill STATE
PA ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19}
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresUPenalty if applicable
p. Interest
E. Penalty
10,000.00
526.32
Total Credits (A + B + C)
Total InteresUPenalty (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
s. 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.
g. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(1) 11,879.91
(2) 10,526.32
(3) 0.00
(4)
(s) 1,353.59
(sA)
(5B) 1,353.59
Make Check Payable to: REGISTER OF WILLS, AGENT
.. E•rctX. ` ::.?r.. .. ,..4?,xk3/rr.~:.•.f..r..... t..?~t.'!P%'~1.~.5 5....... .,,. ....'r:':~~.+:sLf~I.4~~!.:. :.i~t// Y
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 fts income :......................................... ^ ^x
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? .......................................................................................................................... ^ ^x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............... ^ x^
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.
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 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 imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §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 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 net 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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
_~_ _ . _ -.--r- - -_ __
FILE NUMBER
ESTATE OF Hiler, Dorothy E. 21 - 07 - 00965
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 wilting 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 _ -- -------
NUMBER DESCRIPTION
1 45 Golfview Road, Camp Hill, PA 17011
(based on proceeds from actual sale -HUD 1 attached)
TOTAL (Also enter on Line 1, Recapitulation)
VALUE AT DATE OF
DEATH
__ .
187,131.00
187,131.00
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
°OMMONWEAI.TH°FPENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Hiler, Dorothy E.
~I FILE NUMBER
21 - 07 - 00965
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
NUMBER
1 Sovereign Bank Money Market Acct. #2331047812
2 1994 Buick Regal (based on Kelly Blue Book value)
3 Household contents
VALUE AT DATE OF
DEATH
52,761.36
2,275.00
1,545.00
TOTAL (Also enter on Line 5, Recapitulation) 56,581.36
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hiler, Dorothy E. 21 - 07 - 00965
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
Charles J. Hiler, Jr. 45 Golfview Road Son
A Camp Hill, PA 17011
JOINTLY OWNED PROPERTY:
LETTER ~ DATE
ITEM
' [~F~SCRJPTIOI~ ~F PR~gERkTY
Include name o nanclal Instl u wn an an account number % OF
DATE OF DEATH !
' DATE OF DEATH
FOR JOINT
S MADE
NUMBER TENANT JOINT
or similar identifying number. Attach deed forjointly-held real DECD
S
VALUE OF ASSET ;INTEREST VALUE OF
DECEDENTS INTEREST
estate.
1 A 'before 2000 Wachovia Bank Acct. #1000293247941 18,075.60 50% 9,037.80
2 ~ A ~ before 2000 Wachovia Bank Acct. #1010084090371 24,657.75 , 50% 12,328.88
3 i A 11/25/1992 736 shares PNC Financal Corp. at $70.12/share 51,608.32 50% 25,804.16
;
4 A i 02/28/1994
160 shares The Southern Company at ;
5,888.00 50%
2,944.00
$36.80/share
TOTAL (Also enter on line 6, Recapitulations 50,114.84
'~ SCHEDU_E H '~,
FUNERAL E~E7VSES ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETl1RN ~r~~eTl~ /C ^M'7ti~
RESIDENT DECEDENT I'7.Atw,~V „v1~~YGVW~A7 i
FILE NUMBER
ESTATE OF Hiler, Dorothy E. 21 - 07 - 00965
Debts of decedent must be reported on Schedule I.
- - - _ -
-- ---
---
_--- - __
ITEM ____ _. _ __
NUMBER FUNERAL EXPENSES: DESCRIPTION II AMOUNT
__ _ -_
A. 1 Myers-Harner Funeral Home, Inc. ~ 8,041.00
2 Honoraria for 2 priests 450.00
i
3 Royer's Flowers 300.00
',
4 ~, Gingrich Memorials 1,000.00
B.
1
i ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
~ Year(s) Commission paid
2. Attorney's Fees Debra K. Wallet, Esq.
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) '
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. ', Probate Fees
5. ', Accountant's Fees
6. Tax Return Preparer's Fees Steven W. Fahnestock, CPA (income tax) '
7. Other Administrative Costs
1 New Life Moving & Storage (removal of household goods from home)
4, 000.00
404.00
230.00
2,240.00
TOTAL (Also enter on line 9, Recapitulation) 27,399.34
Sch
eduleH
C
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
~~ C~~~~
RESIDENT DECEDENT
ESTATE OF Hiler, Dorothy E. FILE NUMBER
21 - 07 - 00965
2 TPerformance Appraisal (home appraisal) 300.00
3 I Isoppi Painting (basement painting)
i
~ ~, 500.00
~
4 ,
~ Fred's Lawncare (lawncare and snow removal)
' 520.00
5
General Floor (carpet replacement)
i i
600.00
6 '~, Kitchen and bathroom wallpaper stripping & painting ', 1,500.00
7 i
i, Leggett (kitchen and bathroom faucet repairs)
', 314.00
8 ~I C.W. Fritz (heating and air conditioning repairs) 1,285.00
9 House painting 2,000.00
10 ~ Hershey Carpet Cleaning Co. 500.00
I
11 Nature Guard (roof cleaning) ! 560.00
I
12 Bartlett Tree Experts (tree removal because of ice damage) '~, 450.00
13 Cathy's Cleaning (final house cleaning before settlement) 600.00
14 PP&L 278.79
15
Pennsylvania American Water Co.
UGI
Trash removal
' Verizon
Comcast Cable
Postage, photocopies, mileage, etc.
133.00
16
17
18
19
20
702.58
120.00
66.12
212.35
35.00
Page 2 of Schedule H
Sd~ed~.ie H
Fu~~er~ E~er~ses &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN ~'n~',~ ~~'
RESIDENT DECEDENT 1-_ _~__ _
ESTATE OF Hiler, Dorothy E. ~ FILE NUMBER
21 - 07 - 00965
__-
21 ', Checkbook order charge 24.50
22 ~ Overnight mail charges I 35.00
Page 3 of Schedule H
SCHEDULEI ~
DEBTS OF DECEDENppT, MORTGAGE
COMMONWEALTH CF PENNSYLVANIA ~' LIABILITIES O[ LIENS
INHERITANCE TAX RETURN '~.
RESIDENT DECEDENT
- _ _____. __ -_-___ ___I_ ~~
--- ---.
~-
FILE NUMBER
ESTATE OF Hiler, DOrOthy E. ~, 21 - 07 - 00965
__ _ _ _ _ __ - - _ -- _ ___ _ I
Include unreimbursed medical expenses.
ITEM DESCRIPTION
NUMBER
1 American Home Medical Equipment (wheelchair rental)
2 Debbie Lupold, Tax Collector (2007/08 school taxes)
3 PP&L
4 Pennsylvania American Water
5 UGI
6 Trash Removal
7 Verizon
8 Comcast Cable
9 Quarterly sewer
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
255.68
1,665.10
70.00
47.01
164.00
40.00
20.12
53.01
115.00
2,429.92
REV-1573 EX+ (9-00)
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hiler, Dorothy E. 21 - 07 - 00965
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I~ TAXABLE DISTRIBUTIONS[include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)J
1 Charles J. Hiler, Jr. Son 100% of residuary
16 Lexington Drive Estate
Milford, DE 19963
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Re v 1500 cover sheet
II. 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
LAST Y~ILL AND T~ST~I~~NT
~~
D®~~1T~IY ~. ~IIL~~
I, DOROTHY E. HILER, of Camp Hill, Cumberland County, Pennsylvania, being of
sound and disposing mind, memory, and understanding, do hereby make, publish, and declare
this to be my Last Will and Testament and hereby revoke all other Wills and Codicils that I
have made, including the Will dated August 1, 1996.
FIRST: I give, devise, and bequeath all of my Estate, of whatever nature and
wherever situate, to my son, CHARLES J. HILER, JR., of Camp Hill, Pennsylvania, so long
as he shall survive me by thirty (30) days
SECOND: Should my son fail to survive me by thirty (30) days, then I give, devise,
and bequeath all of my Estate, of whatever nature and wherever situate, to my niece, MARY
LAWLER ABRUZZESE, of New Cumberland, Pennsylvania.
THIRD: All interests of any beneficiary in the income or principal of this Estate,
while undistributed and in the possession of my Executor, even though vested and
distributable, shall not be subject to attachment, execution or sequestration for any debt,
contract, obligation or liability of any beneficiary and, furthermore, shall not be subject to
pledge, assignment, conveyance, or anticipation.
FOURTH: All inheritance, estate, and succession taxes (including interest and any
penalties thereon) payable by reason of my death shall be paid out of and be charged generally
against the principal of my residuary estate, without apportionment or right of reimbursement
from any person. In the event that a substantial portion, as determined in the sole and absolute
judgment and discretion of my Executor, of the non-probate assets such as an annuity or
mutual funds are directed to be paid to a beneficiary or beneficiaries, so that the taxes referred
to herein would be paid out of the probate residue passing to the beneficiary or beneficiaries of
this will (whether or not the same as the beneficiary or beneficiaries under the non-probate
assets), my Executor, in the Executor's sole and absolute judgment and discretion, shall have
the right to allocate the full or partial payment of the taxes to the beneficiary or beneficiaries of
the non-probate assets.
FIFTH: In addition to all rights and powers conferred by law, I authorize and
empower my Executor and his successors, in his absolute discretion and without necessity of
obtaining court approval:
A. To buy investments at a premium or discount.
B. To hold property unregistered or in the name of a nominee.
C. To give proxies, both ministerial and discretionary.
D. To compromise claims.
E. To join any merger, consolidation, reorganization, voting trust
plan, or any other concerted action of security holders and to delegate discretionary duties with
respect thereto.
F. To lend to, and buy from, my estate.
G. To borrow and to pledge real and personal property as security therefor.
H. To sell at public or private sale for cash or credit or partly for each, to
exchange, or to lease for any period of time, any real or personal property, and to give options
for sales, exchanges, or leases.
To exercise any option permitted by law which he believes to be
advantageous from the viewpoint of overall tax reductions, including, without limitation of the
foregoing, power and authority to claim administration or other expenses either as income tax
deductions or inheritance or estate tax deductions, without regard to whether they were paid
from principal or income and without requiring adjustments between principal and income for
any resulting effect on income or estate taxes, and a deduction of such expenses for income tax
purposes shall be given effect in computing the respective shares of all persons interested in
my estate set forth herein, even though the effect is to increase the share of one beneficiary or
class of beneficiaries hereunder at the expense of another; and to make such adjustments, if
any, between beneficiaries with respect thereto as he shall deem appropriate in view of the
nature of the transaction and the amounts involved.
To distribute in cash or in kind or partly in each.
The powers granted hereunder shall be exercisable with respect to all real and personal
property, including, but not limited to, income and principal held for minors or disabled
beneficiaries at any time, until the actual distribution of all property. All powers, authorities
and discretion granted here shall be in addition to those granted by law and shall be exercisable
without leave of court. However, nothing herein shall be interpreted or construed to
encourage, authorize, empower, or permit the Executor to act or cause anyone to act in a
manner contrary to or inconsistent with accepted standards of portfolio diversification and risk
management.
SIXTH: I nominate, constitute, and appoint my son, CHARLES J. HILER, JR.,
as Executor of this, my Last Will and Testament. In the event of the renunciation, death,
resignation, or inability of my son to act for whatever reason in this capacity, then I nominate,
constitute, and appoint my niece, MARY LAWLER ABRUZZESE, as Executrix of this, my
Last Will and Testament.
I direct that no representative named above shall be required to post security for the
faithful performance of his/her duties in any jurisdiction insofar as I am able by law to relieve
him/her of such obligation. Any of my representatives shall be entitled to reasonable
compensation for the performance of the duties set forth here.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~b~` day of
flQri ~ , 2006, on this, the fourth of four typewritten pages. I have also signed the
left-hand margin of the first three of these pages for purposes of identification only.
'~--' ~'
DOROTHY .HILER
SIGNED, PUBLISHED, and DECLARED by the Testatrix, DOROTHY E. HILER, as
her Last Will and Testament, in the presence of us, who at her request, in her presence, and in
the presence of each other, have hereunto subscribed our names as witnesses.
y~QAMt. IL . ~..~~.~
K~Sb INNG+JV~GJ J~~t-•
/,;
Jhc.c1-n..J~ c.sb •rg . ~A S'P~.CS'
h o/ ~ ~ ~ozf-
ACKNOWLEDGMENT
Commonwealth of Pennsylvania
County of Cumberland
I, DOROTHY E. HILER, Testatrix, whose name is signed to the attached instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as
my free and voluntary act for the purposes therein expressed.
/~_ ~' ~^ ~
DOROTHY E.,~ILER
Sworn or affirmed to and subscribed before me by DOROTHY E. HILER, the
Testatrix, this day of ~ p r ~ ~ , 2006.
Notary Publi
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Mary M. Loper, Notary Public
Camp Hifl Boro, Cumberland County
My Canmission Expires Od 27, 2007
Member, Pennsylvan?a .4ssociation Of Notaries
AFFIDAVIT
Commonwealth of Pennsylvania
County of Cumberland
,~ /
We, Debra K. Wallet and (cJ~ ~~~ / ~ !~ e Li~~ y' / ~ the witnesses whose names
are signed to the attached instrument, being duly qualified according to law, depose and say
that we were present and saw the Testatrix, DOROTHY E. HILER, sign and execute the
instrument as her Last Will and Testament; that she executed it as her free and voluntary act
for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix
signed the Will as witnesses; and that, to the best of our knowledge, the Testatrix was at that
time 18 years of age or older, of sound mind, and under no constraint or undue influence.
~Qu~. k.
~,
-~ ;.~
Sworn or affirmed to and subscribed before me by ~ 1~r,n ~ (,t~c~ I ~ C and
Conn Q ~..~- L~rnrt ~ ,witnesses, this ~ day of ~~ri 1 , 2006.
Notary Publi
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Mary M. Loper. Notary Public
Came HiM Born. Cumberland County
MY Commission Expires Od 27, 2007
Member, Pennsylvania Association Of Notaries
~. 3ettlemsM 9taternent
!. Type o1 Losn
t.. oaparaws-N
d ~ t lJroen Dawlapmanl
c t w Na 2eo2.0201 ~1111~
t, ~ FHA 2. ~ FrtIHA 3. Q CDIIV. UnYfa ree numwr wen neaw.~ ....,q.,i sseuranEa Can Nunri+sr
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4. [] VA 5. Q Conv. Ya. I
;. NOTE:Thb form h tamishsd to plw you a atahnlsot of scWal ssNSn+snl sew. Amswma PaN m ant ey pa eetlkrnent ttpanl : n shown,
lama msncsd •0•e•¢" vrsra 9~ oualos of casltl0: rosy aro allawn ears for InfOrttwDattal pulptasa and'sn not InWudac 7 the hale.
..°.
t: NAME AND ADDRESS,OF ~ORRDINER;~IVkhoias•ErDunPGY' ". • %7~:;,:;;::r ~' %'P' ::,~ .. NOrmei J.~OunphY r `: ' ~ ,.
• .• - ~ _ :__ OZp OiJR,lrood Lanti.CamP ~ yA.170i,i' ' ~0?i d Lana: Chun t Hlq PA J7011
:. NAME AND ADDRE66 OF 6ELLER: TAs Eaua s/verlewy lE NHev .
n9 OolAdsse Rood, Camp HNti PA 17011
. iQAME AND AODRE38 OP LENDER: - '.. ~ .~,- ... •. ~ -
• ~~'. .. r
;.PROPeRTY .soeawawRo.a ..
LOCATION: Came MA, PA 17011
1.6ETTLEMENT AGENT: • Fannsnilaebii LAilserJiNJ..:.: c-:Yl ~ ' ~ ~ •~ ' ' • '
PLACE OF SETTLEMENT; Of 1Q East THndla Ad Mpchanlei4w~.•PA i7DSO~ ~, _ .;-
TIN; ?31600810 '. '.~ • ~ ~
. SETTLEMENT DATE: OtMdz00Y ... RESCISSION DATE:
I. SUMMARY OF BORROYVER'S TRANSACTION SUMMARY OF SELLER'S TH ~ WSACTION
i00. GROSS ANOUNT DUE FRDM 90RROVVER: • ' 400. GROSS MIOUNT DUE;TO SELLER: •
.. ~~~
fn.Conveot.S.leeP~fu •
0L Psnonal PsaOeM rCennaeelnMles•'••"
Pastaawl
a3. SeeNmaae 1;rIe18ee 1D eprtaNaf. _, . ~ , .. ~ ..
fUeM Ibe 1400) .' ,. ..:.. ~ .'.. •:....: ~ .. ~,
':' •99.:095..90 4D7.••' •: ~ ~.. •.... . .
~ ; :. .
W. n4• ,
••
ADJUSTIeENTB fOR ITEM6 PAID 0Y 6ELLER M ADVANCE:
toe. enWmwn sane : a ADJUSTMFJ4T8 FOR ITEMS PAID AY SELLeN
n1e..014~'~ TPm ,. ~b _ .. ,
107. County Tevee 0a/10/2OOa m 01/01/100! i0. a9 a07. County Tntl OI/10/JM01 b OS/o)
toan.eenre.tin o4/lo/soot, m. ' a7/ei/aooe..
toe. Barer blllinp Of/10/08 - Di/90/08
tt0. TraeA Dilltsp 0!/10/08,~ 06/90/08 . .:~.,:.•99as;is
aa1. >'a
., 937.95 IOB:Aetleervensa.:-. of/io/2ooa :m'.:.os/D,
400. SOwY Dilllstp Oa/i0/08 - 06/5
.1/D:`TrasL billinp~OS/t0/OB~~ 0~/3
11 t. 111.
112 412. '
20. GROSS AMOVNT DUE FROM BORROWER: sz0=, 9oa • T1
~0. AMOUNTS PAID eY.OR w CEkALF OF BORROWER, -. i20. GROSS AMOUNT DUE TO SLIER
60D. REDUCTIONS IN AMOUN7'DUE TO SELLF
DL Oapeul er eemtlt msaay
'
92.PMEIOM sebum Mnew leellle) -..~. ~~ ~.....~_- 11, 000.00
.:i;:•
.;:'.,,, '~: 801, laatl eeooee ltstl Imtnxuaml
i02leNlelhtltihepeeb tilbl"AMe te00) - -•':' .', ~.
..
07. FJlltlna benlel sren wOpet b eel. ~ a IWM m •
94, a0~"I>.yoRafAnrn,orloKrte.n
fle• soe. f+.yort m tromlo lnenD.O. roan
soe. . toe: s
a7. 507.
~: fae.
;a,
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
210. dgib.m ma b aaD.
AOJU97MENT3 FOR ITEMS UNPAID BY SEI.
no. asst b .
2t t.000nNIaw ~ b'. _ BtT:000mylma-°.'~= ~':'•m~;.
2121~w.nrmt b et2.Nwtnseme b
217. ~• ~' .• :. ' .. ~ . ...:. ~'it~..'. :., :. ~ ..
_,~, 614.
215. ~ •ete.
2u, i+e.
217. - :, :' •. si7:.
2te. e,e.
278. ;.• . .::~: ,..~e '. '.. ~•:'.. .~ ~.~'. . :
t
,.eta:':.:" ~:i:
2D. TOTAL PAID liY/FO(i
BORROWER:
100. CASH AT SETTLEMENT FROM/TO BORROWER:.•
101. Glow amount eua from eortowsr fen. 1201
02. Lan amwm palduynM ssnoevtr pat 22D) !e, 000. vo
9ssz !!a. >•s
:. 9~, ooq', 00 ~0, TOTAL REDUCTIONB
IN AMOUNT DUE TO BELLEF!
60D,. CASE) ^T'SETT~,EMENT ~QiFROM 9ELLEl
801, Grow amount das to wep (Ana 420)
002, La» iedudluna M,prnt:dua sopor pe,s`uo) .
03. cASli (®~) ~ O TO) DORROWER: 319e, 9s0.7z eol. CASM (Q ~~) ~ ®TO) SE
- 199 oeo.oo
•4 ADVANCE:
.:!009 9960. a5
:,ooa azu.u
i,'e1 Sa1.72
:,SOB 927.99
t ..
sis0,a~s.zz
.. alz,so4.tt
..ER: J1a7,191,0e
HUD-1 (3-86) - R.ESPA, HB 4; ~ ~ i.2
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