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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 ~: -t ~ r-' .> r~ - -'= ~ -d f_~~~n ~ __ ~ ~ _~ ~ f j -a :. DATE FILED ~~ . C`? c7 ~~ CJ i 1 I p 3~T`l -~ 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 1921 te6 I caax I~ .. 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 PAGE 1 ~ 919l,e3'J.Z2 " das.so ii,990.00 d1,!!l.00 . !,OD7.50~ d3~,701.Z2 ~ ana ara,nan+ana mo0a tlla hYD-i Sedannsnl SuwnarR wnkn I hba palaraa h s Yw ant amunla aa0ount M ntY Vmwatlaf. 1 eNn m wtl klpa b : i dUbuHld lr+l000~/aflm rNn nY WINN.L o.~.: AaoMm.nU-p ~ .._ oala: J n R. Fenatarmachar 11YARNING: h a a erma b RnoM1MN manta Iwa wbmanu a Na Y~alna 6bw on bl. w rnr enw Hunt brm. P.MIYa rpan mn.ktbn hn ~ : na.. Mr ena MiPruon. mam For /atNb w: TIIM ~! us. Coos iacuon tam on1 daeYOn fora 6onora~ ...- .....- - // el~ ~. f ~ s.lara Zj c..:'~ Dw: -io- ~ Deb: ~laM Nlc Ida E Dunphy j Tha Esate of Do thy F. i1 eemewr Norma J. Dunphy ~3Jb1SOd S~lj i I ~ ~ ~~ r ~ ~~ v r u ~ ~ o ~ io $ ~l315t~H .~ ,' .., 1 ~ ~{ ~ t.a_ " !~ L...' 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