Loading...
HomeMy WebLinkAbout09-15-08r 15056041 147 REV-1500 EX 06 05 ( - ) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes county coda Year File Number INHERITANCE T PO 60X.280601 X RETURN Harrisburg, PA 17128-0601 RESIDENT D 21 0 8 0 2 7 1 CEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death ate of Birth 521 42 1763 02 12 2008 1 14 1929 Decedent's Last Name Suffix ecedent's First Name MI SMITH CHARLOTTE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix pouse's First Name MI Spouse's Social Security Number THIS RETURN M ST BE FILED IN DUPLICATE WITH THE R GISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Retum Required (date of death after 12-12-t32) g Decedent Died Testate ~ ~ Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) Q B. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 1 D, Spousal Poverty Credit (date of death between 12-31-91 and t-1-95) ~ 11. Election to tax under Sec. 9113(A) (gttaCh SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE ND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDMUND G. MYERS (717) 761 450 ,. n ,:_~ _-,~ Firm Name (If Applicable) r_- `='' -' '-~ REGISTERiOF~IyILLS USt~'DNLl4 • JOHNSON D U E F I E First line of address ,- = : ~ ~} -_ _ • c_;: j 301 MARKET STREET '~~ {~ . -, ` ~~ ~~~ -;-~ - - Second line of address ~~- PO BOX 10 9 ~-~ ~~ `' ` r-~' a- -~ r City or Post Office State DATE FILED ~ IP Code LEMOYNE PA 7043 Correspondent's e-mail address: Under penalties of pery'ury, I deGare that I have examined this return, including accompanying s it is true, Correct and com9lete. DeGaration of preparer other than the personal representative Is edules and statements, and to the best of my knowledge and belief, based on all information of which preparer has any knowledge. SIGNA OF PERSO ES ISLE FOR ETURN DATE Charlotte S Goo it ~ (~ DDRE S 219 North 2nd Street, Wormleysburg, PA 17043 SI TURE OF PREP HER THAN REPRESENTATIVE DATE ~~ EDMUND G. MY RS ADDRESS 301 MARKET STREET, Lemoyne, PA 17043 Side 1 15056041147 15056041147 1- ~ J REV-1500 EX oecedenre Name: Charlotte S M I T H Decedent's Social Security Number 521 42 1763 RECAPITULATION 1. Real Estate (Schedule A) ......................................................................................... 1. 2. Stocks and Bonds (Schedule B) .............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C .......... 3. 4. Mortgages 8~ Notes Receivable (Schedule D) ..................................................:...... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .........:..... 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested............ 7, 8. Total Gross Assets (total Lines 1-7) ...................................................................... g, 297,758.40 19,990.33 2,500.00 320,248.73 9. Funeral Expenses 8 Administrative Costs (Schedule H) ............................. ........... 9. 1 5, 8 8 1. 5 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .................... ........... 10. 1 8 , 1 1 5 . 6 6 11. Total Deductions (total Lines 9& 10) ........................................................ .............11. 3 3, 9 9 7. 2 5 12• Net Value of Estate (Line 8 minus Line 11) ................................................ ............12. 2 8 6 , 2 5 1 . 4 8 13. Charitable and Governmental Bequests/Sec 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 8 6 , 2 5 1 . 4 8 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X .00 0 . 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 2 8 6 , 2 51.4 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 18. 19. Tax Due ................................................ ....................................................... ............19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN 150560421148 YMENT. 0.00 12,881.32 0.00 0.00 12,881.32 Side 2 15056042148 15056042148 REV-1500 EX Page 3 rlarorlan+'s Cmm~lpte AddreSS' File umber 21-08-0271 DECEDENTS NAME Charlotte SMITH STREET ADDRESS 70 Diane Circle CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A, Spousal Poverty Credit g. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty (1) 12,881.32 0.00 Total Credits (A + B + C) Total Int rest/Penalty (D + E) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYI Check box on Page 2 Line 20 to request a refund 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACI WILLS, AGENT (2) 0.00 {3) (4) (5) 12,881.32 (5A) (56) 12,881.32 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 transferr d or its income :....................................~ c. retain a reversionary interest; or ................................................................................................................ x d. receive the promise for life of either payments, benefits or care ..............................................................~ x 2. If death occurred after December 12, 1982, did decedent transfer pr erty within one year of death without receiving adequate consideration? ....................................................................................................................^ 0 3. Did decedent own an "in trust for" or payable upon death bank accou t 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? .................................................... ... ... ..................................~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COM LETE 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 imp 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 (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exema>3 transfer to a sun for disclosure of assets and filing a tax return are still applicable even if the surviving sp 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 ye natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P. The tax rate imposed on the net value of transfers to or for the use of the decedent's tin 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 sit sibling is defined under Section 9102, as an individual who has at least one parent in cc on the net value of transfers to or for the use of the fers to or for the use of the surviving spouse is zero spouse from tax, and the statutory requirements is the only beneficiary. of age or younger at death to or for the use of a §9116 (a) (1.2)]. I beneficiaries is four and one-half (4.5) percent, is twelve (12) percent [72 P.S. §9116 (a) {1.3)]. A i with the decedent, whether by blood or adoption. Rev-15o2 EX+ f6-981 SCHEDULE A REAL ESTAT COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SMITH, Charlotte 21-08-0271 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 behveen a willing twyer and a willing seller, neither being compelled to buy ors II, both having reasonable knowledge of the relevant fads. Real property which Is joinflyowned with right of survivorship ust Ge disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Real Estate - 2124 Derry Street -Contracted Sales Pric for sale on August 15, 2008. 102.900.00 A copy of the settlement sheet is attached to this Retu rn 2 Real Estate _ 70 Diane Circle, Camp Hill, PA - Assesse value x 1.22 Common Level 194,858.40 Ratio TOTAL (Also ente on Line 1, Recapitulation) 297,758.40 tlr more space Is needed, additional pages of the sam size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) Rev-7508 EX+ I6-981 SCHEDULE E CASH, BANK DEPOSIT , ~ MISC. PERSONAL PROP RTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SMITH, Charlotte 21-08-0271 Include the proceeds of litiga8on and the date the prose ds were received by the estate. All property jointly-owned with the right of survivorship ust be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Blue Cross Blue Shield Refund 90.37 2 Chase Credit Card Refund 67.97 3 Citizen's Bank 60 Month CD Account No. 6140-840260 10,114.95 4 Citizen's Bank Circle Checking Account No. 610063-57 -9 53.52 5 Members First Regular Savings Account 25.00 6 PNC Bank Checking Account No. 5140059832 470.89 7 Refund Received From Donegal Insurance 230.00 8 Reimbursement - of real estate taxes taxes prorated a time of Settlement. A copy 1,262.63 of the settlement sheet is attached to this Return 9 2000 Mecury Grand Marquis LS Sedan 4 Door -Valued using Kelly Blue Book 4,905.00 10 Personal Property -Appraised by Chuck Bricker, Auct oneer 1,620.00 11 Proceeds from Sale of Sterling Silver Set 250.00 12 Proceeds from the Sale of Decedent's Clothes, Shoes, urses, and 3 Coats 900.00 TOTAL (Also ante on Line 5, Recapitulation) 19,990.33 t„ more space Is neeaea, aaoroonal pages of the sam size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) rtev-w w v.T w-vo~ SCHEDULE G ENTER-VIVOS TRAN FERS & MISC. NON-PROBATE ROPERTY COMMONVYEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SMITH, Charlotte 21-08-0271 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the rev r se side of the REV-1500 COVER SHEET is yes. ITEM I DAT OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VAL E OF ASSET INTEREST (IF APPLICABLE) VALUE 1 John Hancock Annuity -Renee Miller, 2,500.00 2.500.00 Beneficiary, Granddaughter TOTAL (Also enter on Line 7, Recapitulation) 2,500.00 (If more space is needed, additional pages of the sa size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) RFV-1141 FYS /19AY\ SCHEDULE H FUNERAL EXPEN ES ~ COMMONWEALTH OF PENNSYLVANIA IN RES DENTE ECEDENTRN ADMINISTRATIVE OSTS ESTATE OF FILE NUMBER SMITH, Charlotte 21-08-0271 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached 2,045.82 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zi Year(s) Commission paid 2. Attorney's Fees JOHNSON DUFFIE 10,000.00 3. Family Exemption: (If decedent's address is not the same as claimant' ,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 364.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 3,471.77 See continuation schedule(s) attached TOTAL (Also enter on I ne 9, Recapitulation) 15,881.59 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-7502 E)(+ 16-981 SCHEDULE -A FUNERAL EXPE SES continued COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SMITH, Charlotte 21-08-0271 ITEM NUMBER DESCRIPTION AMOUNT 1 Parthemore Funeral Home 1,895.82 2 Parthemore Funeral Home -Expenses for Obituary, D ath Certificates & Coroner's 150.00 Office Subtotal 2,045.82 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EXa 16-981 SCHEDULE H B7 OTHER ADMINISTRATIVE OSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER SMITH, Charlotte 21-08-0271 ITEM NUMBER DESCRIPTION AMOUNT 1 2000 Mecury Grand Marquis LS Sedan 4 Door - Expen a to repair automobile to 1.885.81 drivable condition 2 Chuck Bricker, Auctioneer 120.00 3 Cropf Bros., Inc. -Examination of original hot water he ter for Diane Circle property 119.00 4 Cumberland County Recorder of Deeds Office -Filing ees for transfer of 45.00 Decedent's Diane Circle Property 5 Cumberland County Register of Wills -Filing Fees for I heritance Tax Return and 30.00 Inventory 6 Dauphin County Recorder of Deeds Office -Filing Fee for transfer of Decedent's 40.00 Derry Street Property 7 Hildum Electric -Upgrade of Electric in Derry Street Pr perty 50.00 8 Lowe's -Repair expense for Diane Circle Property 31.96 9 Montour Oil -Oil for Derry Street Property 399.90 10 Register of Wills Fee for Witness Signatures 20.00 11 Repair/Replacement of Sliding Door at Diane Circle Pr perty 500.00 12 The Cumberland Law Journal -Notice of Estate Admini tration 75.00 13 The Patriot News Co. -Notice of Estate Administration 155.10 Subtotal 3,471.77 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1572 EX+ (6-96) SCHEDULE 1 DEBTS OF DECE ENT, MORTGAGE LIABILITIE , & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SMITH, Charlotte 21-08-0271 Include unreimbursed medlcel exps sea. ITEM NUMBER bESCRIPTION VALUE AT DATE OF DEATH 1 AAA -Fees for Transfer of Automobile Plates 77.50 2 Adjustment to Estate Account 221.58 3 Boro of Wormleysburg - SewerlTrash for Diane Circle roperty 121.00 4 Check Clearing After Date of Death 40.00 5 City of Harrisburg - Trash ~ Water for 2124 Derry Stre t Property 86.33 6 City of Harrisburg -Trash & Water for 2124 Derry Stre t Property 76.57 7 City of Harrisburg Real Estate Taxes for 2124 Derry St eet Property 299.55 8 City of Harrisburg -Utility Expenses for 2124 Derry Str et Property 76.57 9 Commonwealth of PA -Fees for Automobile Transfer 58.50 10 Lowe's -Expenses for repairs to Properties 42.27 11 Members First Used Automobile Loans -Final paymen on Auto Loan with Mr. Miller 144.26 12 Milton S. Hershey Medical Center 60.53 13 Milton S. Hershey Medical Center 1,024.00 14 MSHMC Physicians Group 24.96 15 PA American Water 12.68 16 PA American Water 18.81 17 PA American Water 16.09 Total of Continua ion Schedule See attached page TOTAL (Also en r on Line 10, Recapitulation) 18,115.66 (tt more space is needed, additional pages of the sa a size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) Rev-1512 EX+ 16-881 SCHEDULE 1 DEBTS OF DECE ENT, MORTGAGE LIABILITIE , & LIENS COMMONNiEALTH of PENNSYLVANIA INHERRANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER SMITH, Charlotte 21-08-0271 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 18 PA American Water 12.74 19 PA American Water 38.04 20 PP8~L 270.89 21 PPStiL 162.87 22 PP&L 71.95 23 Renee Miller -Reimbursement for Repairs to Automob le 100.00 24 Settlement Charges -for sale of 2124 Derry Street Pro erty. A copy of the 13.731.28 settlement sheet is attached to this Return 25 State Auto Insurance Co. - 2124 Derry Street Property Home Insurance 429.00 26 Verizon 19.54 27 Verizon -Payment on Account 73.13 28 William O'Donnell -Real Estate Taxes for 70 Diane Cir le Property 805.02 TOTAL (Also ente on Line 10, Recapitulation) 18,115.66 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 FJC+ 19.001 SCHEDUL J COMINHENRIT~ANTCEDT~RETURNAN~ BENEFICIAR ES RESIDENT DECEDENT ESTATE OF FILE NUMBER SMITH, Charlotte 21-08-0271 NUMBER NAME AND ADDRESS OF RELATI DE NSHIP TO DENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY (Words) ($$$) Do Not st Trusts s I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Charlotte S Good Daugh er Entire Estate 286,251.48 219 North 2nd Street Wormleysburg, PA 17043 Total 286,251.48 Enter dollar amounts for distributions shown above on lines 5 through 8, as appropri ate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH N ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON INE 13 OF REV-1500 COVER SHEE 0.00 ~.~Nynyn~ 1~7 cwc wrrn svrcware onry 1 ne ~acKner group, mc• Form PA-1500 Schedule J (Rev. 6-98) ESTATE OF CHARLO~'TE SMITH EXHIBIT A EXHIBIT B EXHIBIT C EXHIBIT D EXHIBIT E EXHIBIT F EXHIBIT G EXHIBIT H Last Will & Testament for harlotte Smith signed and dated September 28`h, 1971 Cumberland County Assessme t Page showing Assessed Value of Property located at 70 Diane 'rcle, Camp Hill, PA Settlement Sheet for Sale of Property Located at 2124 Derry Street, Harrisburg, PA on Au t 1 S`h, 2008. Date of Death Letter From Citizen's Bank Date of Death Letter From Men~iber's First Federal Credit Union Date of Death Letter From PN Bank Kelly Blue Book Valuation of 2 00 Mercury Marquis Personal Property Appraisal b Chuck Bricker, Auctioneer 344122 ~~" ~'`__-- =mot ~~___;~_` ~ ~ _ ~ " - "~.- - -=~~- - -- - - - - - ~ f F , LAST WILL AND TES OF CHARLOTTE SMITH I3E I:T REMEMBERED, that I, CH.ARLC)TTF. SMI H, of the Township of East renns Borc, County of Cumberland, Commonwealth of Pennsylvania, being of sound and dis~oosing mind, memory and understanding, do ake, publish and declare this as and f:or my Last Will and Testament, hereb revoking and making null and void any and all Wills and Testaments, Codici s or Writings in the nature thereof by me at any time heretofore made: I. I direct that my Executrix, hereina ter named., shall pay my funeral expenses as shortly after my death as may be convenient. 2. A1.1 the rest, residue and remainder of my property and estate, of whatsoever nature and kind, whether real, pers na1 or mixed, and wheresoever t'_ie sane may be situate, of which I shall die sei ed or possessed or of which I shall be e_ititled to dispose at the time of my Bath, I give, devise and bequeath unto my daughter Charlotte M. Ackert, ab olutely. 3. I do hereby nominate, constitute an appoint the said Charlotte M. Ackert to be the Executrix of this, my Last Wi 1 and Testament and direct that, any statute, Rule of Court or Decision of C urt to the contrary notwith- standing, she shall n.ot be required to post bond n any jurisdiction in which it may be necessary that she act. -1- IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament this o2 ~ ~ day of September, 1971. ~~~~ CHARLOTTE~SMITH SIGNED, SEALED, PUBLISHED AND DEC ED by the above named Testatrix, as and for her Last Will and Testament, in th presence of us, who, at her request and in the presence of each other, ha e hereunto set our hands and seals as subscribing witnesses. (SEAL (SEAL) -2- ;:Result Details ,ailed Results for Parce147-18-1302-158. i e 2004 T ~ ssessment Database listrictNo 47 Parcel ID 47-18-1302-158: MapSuffix IlouseNo 70 Direction Street DIANE CIRCLE Ownerl SMITH, CHARLOTTE C/O PropType R PropDesc LivArea 1791 CurLandVal 35000 CurImpVal 124720 CurTotVal 159720 CurPrefVal Acreage .39 C1GrnStat TaxEx 1 SaleAmt 5aleMo SaleDa SaleCe SaleYr DeedBkPage 0021N-00602 YearBlt 1960 HF File Date 11/08/2004 HF_Approval_Status A Page 1 of 1 http://taxdb.ccpa.net/details.asp?id=47-18-1302-158.&dbselect=l ~ 03/05/08 AUG-14-2009 09:13 CAPITAL AREA ABSTRACTORS 717 909 3045 P. 02 OMB Nt]_ 2502.(1265 T A. B. TYPE OF L u.s. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.QFHA Z.^FmHA 3,^X CONV, UNI 5, a.OvA S.QCONV. INS. SETTLEMENT STATEMENT 6. FILE NUMBER: 2DOtt00116 7. LOAN NUMBER: 8. MORTGAGE INS CASE NUMBER: C. NOTE: This loan is furnished to give you a statement of actrral senlement costs. Amounts paid to and byVre se Items marked 7POC]' were paid outside the dosing; they are shown here for iMormafonal purposes and +.o yea ement agent ale shown. are no! inGuded 1n the totals. asaFOrcooeoorrensr D. NAME AND ADDRESS OF BORROWER: Aric Mercado ~12aDerryStreet Harcisburg, PA 17104 E. NAME AND ADDRESS OF SELLER: Chartotffi Smitlr Good F. NAM Taylot, •: Mortpa 1417 N Ocata,F ANO ADDRESS OF LENDER: can & Whitaker Cap, Magnolia Avenue 34475-9078 G. PROPERTY LOCATION: 2124 perry Street Harrisburg, PA 17104 H. SETTLEMENT AGENT: 20.2039731 Capital Area Absttadas, LLP I. SETTLEMEtJT DATE: AO ust 15 2008 Dauphin County, Pennsytvanla PLACE OF SETTLEMENT 4999 Jonestown Road,. Suite 202 Harrisburg, PA 17108 g , J, SUMMARY OF BORROWER'S TRANSACTION K SUMMARY O SELLER'S TRANSACTION 700. GROSS AMOUNT DUE FROM 80RROWER: 400. GROSS AMOUNT DuE 70 FJ.t.ER: 101. Contract Sales Price 102 9D0.00 401. fontract Sales Price 102,900.00 102. Personal Pro 402. Personal 103. Settlcment Cho es to Borrower Line 1400 3,993.25 403. 10't• 404. 105. Ad usfinenLs For ttems Paid Seller in advance 106. Ci Taxes 08/16/08 t0 Ot/01A8 22 405. Ad'usbnerrts For hems Poi 406. C' Taxes B Seller in advance BI08 m 01!01/09 2gg,2p 107. Coun Taxes 08J16/OB tp 01101/09 112.95 407. Coun Taxes 6108 to 01/01ro9 112.95 108. School Taxes 06/16/08 to 07/01/09 86D.46 408. School Taxes o 6108 to 07/01/09 860.46 109. 409. 110. 410. 111- 411. 112 412. 120. GROSS AMOUNT DUE FROM 80RROWER 108,155.66 4Z0. GROSS AMOUNT DUE TO LLER 104,162.63 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT UE TO SELLER: 201, De h of earnest m 1000.00 501. Excess Dg stt See InstnJdi s 202, Princi I Amount of New Loan S 203. ExlsUn loans taken sub act to 82 320.00 SD2 Battlement Cho as to Sailor 503. F_xLs loans taken sub' a 14D0 to 8 731.28 204. 5D4. Payoff of first MoApage 205- 505. a of second Mo e 206. 506. 2D7. 507. De t dish. as roceeds 208, 209. Seller ASSISI ustmgnts Forlloms Un aid 8 Seller 5 ODO.DO 508, 509. Sellerllssls[ 'usfinents For Items n id 8 Seller ~ 000,00 210. Ci Taxes to 510. CI Taxea to 211. Coun Taxes t0 511. CO Taxes t0 212. SchoG Taxes to 512. Scholl Taxes to 213. 513. 214. 514. 215. 515. 216. 518. 217. 517. 21 B. 518. 219• 519. 220. TOTAL PAID BY/FOR BORROWER 68,320.00 300. CASH AT SETTLEMENT FROM/T0 BORROWER: 301. Gross Amount Due From Borrower 120 103 55.6 302. Less Amount Pald By1Frx Borrower (Line 220) ( 86, D) 520. TOTAL REDUC77p1J AMOU 6DD. CASH AT SETTLEMENT 601. Gross Amount Dug To Seller 602. Less Reductlons Du¢ Seller DUE SELLER ROM SELLER: Lk1g 420 Ina 520) 13,731.28 104,162.63 ( 19,791.2 303. CASH (X FROM) ( TO) BORROWER 19 . 8 603. CASH (X70) ( FROM) ELLER 90,431.35 The undersigned hereby acknowledge receipt of a complotad copy of pages 1 &2 of 1hIS statement & ; Borrower Ballet Aric Mercado A,UG-14-2006 09:14 CAPITAL AREA ABSTRACTORS '~17 909 3045 P.03 L. 5ETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ 102,900.00 6.0000 % 6,174.00 Pao FROM rao Frso-1 DMslon of Commission tine 700 es f=ollows: eonROwors set.l.trrs 701. $ 3,112.00 to traub&ASSOCiates Ft>HOSnr FuHOSnr 702. $ 3, 2.0 to xd Realty apical Area S~tE~+ENr SETT~F~,Errr 703. ommrss n a at ett emenl 6,174.00 704, Realty Transa on ee to Straub & Associates 95.00 800. REMS PAYABLE IN CONNECTION 1M7N LOAN 801. Loan Ori inadon Fee 96 to 802. Loan Discount 56 to 803. Appraisal Fee to 804. Credit Report to 805. Lenders tnspedion Fee to 806. Mo Ins. .Fee tp B07. Assumption Fee to 808. 809. 810. 611. 90D. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 08175/08 to 09/01/08 (~ $ !day ( 17 days 96) 902. Merl a Insurance Premium or months to 903. Hazard Insurance Premium for 1.0 an b 9D4. 905. 7000. RESERVES DEP0511ED WITH LENDER 1001. Hazard Insurance months $ er month 1002, insurance monU16 $ r month 7003. Ci Texas months $ r month 1004. Coun Taxes months $ r month 1 D05. School Taxes - months ~ S pef month 006, months $ r month 1007. momhs @ $ per month 1008. months $ r mondr 1100. TITLE CHARGES 1101. Settlement or Closin Fea to 1102. Deed Pre araUon fD Straub 8 Associates 125.00 7103, T"iik lxaminadon to 1104. Titlelnsurance Binder to 1105. E-Document Pre aration to Ca Ital Area Abstractors LLP t00,p0 1106. No Fees to Dorotl7~ R. Butkus 30.OD 10.00 1107. Attprn9ys Fees to lnGudes above item numbers: 1108. Title Insurance to Ca Itat Area Allstractors Land Am9rlca La Tide 873.75 includes ebove item numbers; 1109. Lenders Goverage $ 82,320.00 1110.Owner•s Coverage $ 102,900,OD 873.75 1111. 700, 300 &900 Enders o Capital Ante Abstradors, I.LP 150.00 1112. Goring Service Letter to Land AmerlCe Lawyers TAIe 35.00 1113, 1200. GOVERNMENT RECORDING AND TRANSFER CHARGL-'~^ 1201. Rer~ng Fees: Deed $ 42,00; Mor~age $ 88.50; Releases S 130 50 1202. Ci fCoun Tax/5tam s: Deed 7,029.00• Mo a e 1203. Srafe TaudSta Revenue Slams 1,026.00; Mori a e 1204. . 1,028.00 1,029.00 7205. 1300. ADDt710NAL SETTLEMENT CHARGES 7301. Surv to 1302. Pestlns bon to 1303. Pa Judgment b Peart En rises, Inc, 1304. 20D8/09 Scholl Taxes b Ci Treasurer 1305. See addict disb. exhibit to 1,450,00 195.1>D 984.54 113.74 1400. TOTAL SETTLEMENT CHARGES Enter on Linos 103, Section J and 502, Section e,rsmynmm~nl.rr~~.,.d,,.,..,,,,,.,.,,,...............v.,~-.__._._,.._. ~--J--• •_.------- -~~ 3,993.25 8,731.28 Certlfled [o be a true copy. 16!200000110! 1~1 AUG-14-2008 09:14 CAPITAL AREA ABSTRACTORS 717 909 3045 P.04 ~ ADDITIONAL DISBURSEMENTS EXNrB1T 1 Borrower: Aric Mercado Seller: Charlotte Smith Good Lender: Taylor, Bean & Whitaker Mortgage Corp. Settlement Agent: Capital Area Abstractors, LLP (717)920-9179 Place of 5ettlem®nt: 4999 Jonestown Road„ Suite 202 Harrisburg, PA 17109 Settlement Dat®: August 15, 2008 Property Location: 2124 Derry Street Harrisburg, pA 1710~F Dauphin County, Pennsylvania PA' City Treasurer Water Termination Fee Capita( Area Abstractors, LLP Wire Transfer fees Capital Area Abstractors, LLP Express Maif -Loan Package Exit Realty Capital Area Realty Transaction Fee Capital Area Abstractors, LLP Express Mail -Judgment City Treasurer City Utilities ToEal Additional Disbursements shown on 25.00 20.00 25.00 125.00 25.00 88.74 1305 $ 195.00 $ 113.74 (200800116.PFD/200800116/13) Total P.04 G'~ti~~ns ~3an~C Account Number 6140840260 Account Title CH OTTE SMITH Date O ened 10/9/2001 Account Tye Time De osits Principal Balance as of DOD $10085.05 Interest from Last Postin to DOD $29.90 Account Balance as of DOD $10114.95 YTD Interest to DOD $35.79 Citizens dank Account Number 6100635759 Account Title C OTTE SMITH Date O ened 7/8/1999 Account Type Checkin Principal Balance as of DOD $53.52 Interest from Last Postin to DOD Account Balance as of DOD $53.52 YTD Interest to DOD ~ i MEMBERS 1St FEDERAL CREDIT UNION SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner LOAN ACCOUNTS: 274270-00 11 /02/2005 $25.00 $.00 $25.00 None Account Number/Suffix 274270-01` Date Loan Established 11/02/2008 Principal Balance at Date of Death $142.45 Loan Type Used Vehicle Interest Rate 7.14% Collateral Held as Security 2003 Chevron Name of Co-Borrower None *Loan does not have credit life insura Insur April Estate of: CHARLOTTE SMITH Date of Death: 02/12/2008 Social Security Number`521-42-1763 Malibu/Contractual Pledge of Shares 3ERS 1ST FEDER CR D T UNION ~~~ le A. K(me nce Services Specialist 1, 2008 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 1055 (800} 283-2328 wwwmemberslst.org Apr. ?. 2009 3:17PM PNC BANK 412-705-2747 B PNCBAIVC TheThlnking Behind The Money Apri13, 2008 Law Offices of .Tohnson, lluff e Dana L Wieseman 301 Marlce~t St P O Box 109 Lemoyne, PA 17043 ItE: Charlotte S:aiitlx (Deceased) SSN: 521-42-1763 DOA: 02-12-2008 Dear Ms. Wieseman: in response to your request for Date of Death records show the following: Checking Account Account # 5140059832 CHARLOTTE SIB DOD balance: $470.88 + 0.01 accrued interest Please note that this office only provides date of deE (IR.A.s, CDs, Checking and Savings accounts). We transactions or provide ststemenfa. If you need a please call 1-888-PNC-BANK (1-888-762-2265) or office. Sincere , Colleen Crowder 1-800.762-1775 F7-PFSC-04-F 500 First Ave Pittsburgh, PA 15219 No.2U99 F. 1 for the customer noted above, our Established 09-01-1974 balances far deposit accounts not process any financial stance with any of these items, sp by your local PNC Bank branch Member FDIC Page 1 of 1 Kelley Blue Book -Private Party Pricing Report -Mercury, rand Marquis -Official Kel... Page 1 of 2 c . > > N~ ~~ 7Fif 1'8lJ5Tict! RESt'n.ti~ Send to Printer ~~rr€~ ~~ 11~v i~~ ' ` ' Enter a i~IN to_~et startetf: avuv , ~ ., 2000 Mercury Grand Marquis LS Sedan 4D BLt1E BQOK~ PRIVATE PARTY YAI.UE Condition Valu Excellent $5,33 ~` Good $4,905 (Selected) ..................................................................... Fair $4,375 Average Consumer Rating (126 Reviews) _;? Read Reviews ................................................................................................................................ 4.7 out of 5 Review This Vehicle Vehicle Highlights Mileage: 37,956 Engine: V8 4.6 Liter Transmission: Automatic Drivetrain: RWD ..~.. .,., I ,.~.. Selected Equipment Standard Air Conditioning Tilt Wheei Dual Front Air Bags Power Steering Cruise Control Power Seat Power Windows AM/FM Stereo Power Door Locks Cassette Blue Book Private Party Value Private Party Value is what a buyer can expect to pay when buying a used ca from a private party. The Private Party Value assumes the vehicle is sold "As Is" an carries no warranty (other than the continuing factory warranty). The final sale pric may vary depending on the vehicle's actual condition and local market conditions. This value may also be used to derive Fair Market Value for insurance and vehicle donation purposes. Vehicle Condition Ratings Excellent advertisement http://www.kbb. com/KB B/UsedCars/PricingReport. aspx?Yea~rld=2000&Mileage=3 795 8&... 05/06/08 ~- Close Window Kelley Blue Book -Private Party Pricing Report -Mercury, . .. • Looks new, is in excellent mechanical condition and needs no reconditioning. • Never had any paint or body work and is free of rust. • Clean title history and will pass a smog and safety inspection. • Engine compartment is clean, with no fluid leaks and is free of or visible defects. • Complete and verifiable service records. Less than 5% of all used vehicles fall into this category. *~ Good (Selected) ~'', • Free of any major defects. • Clean title history, the paints, body, and interior have only mir any) blemishes, and there are no major mechanical problems. • Little or no rust on this vehicle. • Tires match and have substantial tread wear left. • A "good" vehicle will need some reconditioning to be sold at re Most consumer owned vehicles fall into this category. Fair Y' `° $ • Some mechanical or cosmetic defects and needs servicing but is reasonable running condition. • Clean title history, the paint, body and/or interior need work per by a professional. • Tires may need to be replaced. • There may be some repairable rust damage. Poor ,330 wear (if 375 II in N/A • Severe mechanical and/or cosmetic defects and is in poor runnin condition. • May have problems that cannot be readily fixed such as a dama ed frame or crusted-through body. • Branded title (salvage, flood, etc.) or unsubstantiated mileage. Kelley Blue Book does not attempt to report a value on a "poor" vehicle ecause the value of these vehicles varies greatly. A vehicle in poor condition ma require an independent appraisal to determine its value. * Pennsylvania 5/6/2008 Marquis - Official Kel... Page 2 of 2 http ://www.kbb. com/KBB/UsedCars/PricingReport. aspx?Ye~rld=2000&Mileage=3 795 8 & ... 05/06/08 31~~i16 N~SNHOf ~ ~~~ ,~ ,N~~~ -.+ r~ 8002 0 Z ~1dW ~~ cz_ _. ? 4'~~ ,, ~ ~ 1 fI (1 Q .,LAS ~ 7 / ~ 1 J! ~~~. ? 1~S1~az!~r ~ N~ ~ ~~ ~~ . ~/ ,~ nP' ~ -y~~~~-P ~~S~~S ,~ o°p~' ~o~ r ;~~ t Q,p-~,-~ ~~~ j~~i ~I~Ia~C~ ~~' ~ ~~ Q ~~?7 ~ld~' b ~ ' 9 ./ n. l--t n a C ~ ~, ~ S Z: ~ ~' T ~- ~'/ V "~~ ~ Yy7 P q 4 `~ ~ ~ ~~~? ~ l ~~ c~~'tt t ~~h Q `~- ~ ~f t1 n • ~ ~' --~~115 ~'n? ~-~-~ ©~~~ ~~, 1~P~ ~, ~ ~~ ~ ~-l7lc. ~q I! ~~~ '~~ ~ ' ~ '~~ ~ tom' d ~~ gyn . Q ~ 2( ~ ~n ~rt.~ ~~-f .~?S ,~: ' ~ ._,_ sir ~~ ~ r ~s ~~ ?~ 5..~~~ / ~~! S~~i`7~ o ~ ~'( 71~ ~ ~ )~ ~^'~ ~ ~,~ ~ ~ p ~!~ ~ s} zl~l ~ t ~ . ~ f r~ ~ ©~ l~s x.11 ~ ~ 1 Cf ~~ ~ d ~~ ~ ~ ~ ~ ~ ~~ ~d ~ ~ ~ ~ ,. f r va ~'~ W311 ~ Q f~, ~ as-eadc 3fl~tln aa~tolas .3 ~onu3 ~4 P t' ? ~ W311 -1-tr60nd ~~ ~ ~o ~~ado.rd teuosa 3n-~dn ?~cQ~_' ~ ale(] ltlSltlaau~ ~i , I l Rtil '~~ ~ J?~.1.6 ,I; i) A', I!' l1 !)I ! I tl jt~;~ t; 11 [~ f'r; ~V I ~ ~ ~ I; h I Ilf~ I~V`,I`. I ~;,;;;~~G~I ~t,ur~it~ 11~;it~iii.~r 11 U(6 ( ~ ti i il~ ~~,ii~ ~~ ~,~~„i,1 111 1 i V! '~ I ( 1~~11'1 I \ 1t li 1 F I t f i u ~1 ~ \ ~~ UFFI September 12, 2008 Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of hariotte Smith Date of ath: February 12, 2008 Your File o.. 21-2008-0271 Our File N .2856-7 Dear Register: Enclosed for filing please find the following documents for the 1. 2 Original PA Inheritance Tax Returns. There is tax is attached to the Return. 2. Two copies of Pages 1 & 2 of the Pa Inheritance tax return to us in the enclosed envelope. 3. Inventory 4. Two copies of Page 1 of the Inventory, which we ask enclosed envelope. 5. Check No. 4009 attached to this correspondence in 1 fee for the Inheritance Tax Return and Inventory. Should you have any questions, please do not hesitate to Enc. c: Charlotte Smith Good, Executrix :saaaso Very truly yours, NSON, ~ a Wir Estate Administr referenced decedent: ~: , ri ; ~ + ,~ i~, . li~ ~t.l ~~ ~ 1( 'tt• 1f_I~I i it ;!~~ ~~ 1I1~..~i i ~.'. , R; ~ . . OF COUNSEL Il~il(~c!;1 (~~IL~.~n\ i iii ~, ~~t~~: _ ~~,~,, ' ~ 0 ~ ...i .A~j ~? ~ ~ V AJ J ~J ~7 r -,~ t} r`~ . "~~ , _ c __; ti.. "J - • . ~ rte { i ~ ": C7 ... C.`% ' 7 ~ ~ -~ -' ~ -- `~~ --~ .v .. D ~ ; ...., cn ` in the amount of $12,881.32. Check No. 4008 which we ask that you time-stamp and you time-stamp and return to us in the amount of $30.00 representing the filing our office. Thank you for you STEWART &WEIDNER Paralegal i~il ~L1itl~(~.Tyflill'I {'(i l~i)\ I(it? L111ii1'~~I~. PIV~;tiy111\111~U}~lillltl 11\t1\~U~11'CU\1 ~1F_~nL~li~U 1~,1.~ Ali ~h ~;Uf \1.111.~~~ll5lii~i11 JOHNSON, DUFFIE, STEWART & WEIDNER, P.C. ~~ ~ <:r „ v c= rv {- ~~a ~,~, ~ ~~~ ~~ ~ ~~ tlQ ~ M ~ ~ ~ ~ Q b ~ N ~ ~ - O l7 ~ - N N V ^~ t ~'• 1 `? w ~~ f~ Zvi `''~-= '- - u.:r ~ ~ .-. E1- ;rte O Q 2 ~~~ G~3 d, !~ ~'~"_ =l: i ~~: F- W W C E- VJ W C G. p~ X ~i ° 6 ~ ~ o ~ a o ~^ C w ° ° a .~ ~--d. ~_, w ~` ~~ /w ~~ w ~' ~~ F--~1 C/ ~"'~ E~ W O 2 I-- U O ~ ti U ~ O ~ ~ J CA O ~°o~ pZ~a w O cn m U ~ W ~ Z Q ~ U O U INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland Charlotte S Good File Number 21-08-0271 Personal Representative(s) of the Estate of Charlotte SMITH deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets situate and ail of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed o~ item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no re outside of the Commonwealth of Pennsylvania except that which appears in memorandum at th~errd- is invent I verify that the statements made in this Inven- ~`~ ~ - =" tory are true and correct. I understand that false state- '~`~ _ -- ments herein are made subject to the penalties of Charlotte S Good 18 Pa.C.S. § 4904 relating to unsworn falsification to ~ r', ~ authorities. ~~~'..--y ^~ :;~ ~ ~ '' _3~ ---1 Attorney - (Name) (Firm) (Address) (Telephone) EDMUND G. MYERS JOHNSON DUFFIE 301 MARKET STREET, Lemoyne, PA 17043 (717) 761-4540 (Supreme Court I.D. No.) DATE OF DEATH LAST RESIDENCE 70 Diane Circle DECEDENTS SOC. SEC. NO. 02/12/2008 Camp Hill, PA 17011 521-42-1763 FIGURES MUST BE TOTALED Personal Property Cash ............................................................................................... Personal Property ......................................................................... Stocks/Listed ................................................................................. StockslClosely Held ...................................................................... Bonds .......................................................................:..................... Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable ............................................... All Other Property ......................................................................... Total Personal Property ......................................... Total Real Property ................................................ Total Personal and Real Property ......................... ~~f~~'J\i~~ u - 12,316.91 7,675.00 osite each l,~state _ _ ~ __ ;: ~: =~ ~~ . . -rs c. ' - 's ~ 4:~s.~3 ~ -_-, ~-~ , ..... _ . `-, .+f^" 20558 19,991.91 297,758.40 317, 750.31 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative inGude the value of each ftem, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b}) Form RtN-l19 Rev. 10.13-2006