HomeMy WebLinkAbout09-16-08 (2)REV-7501) EX ~ (e-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
I-
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 1- 0 8 0 7 4 1
COUNTY CODE YEAR NUMBER
Z MONISMITH LYDA * J.
IL DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year)
U 06/'12/2008 12/04/1924
LJ.1 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
0
l
A
h
d
S (1) .135,000.00
)
e
u
e
1. Real Estate (
c
2 Stocks and Bonds (Schedule B) (2) 1 '273.92
n.~
rietorship
orSole-Pro
Partnershi
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H
ld C (3) `~' -
p
p
orpora
on,
3. Closely
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hedule D)
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R
N
(4)
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C?
c
va
e (
ece
otes
4. Mortgages & ~
5. Cash, Bank Deposits & Miscellaneous Personal Property
(5) 60,463.51 ~=
_ r,^ _J
~
(Schedule E)
, ,ti ~
6. Jointly Crooned Property (Schedule F) (6) - ~ `~
;~ --r-,
_ ~ -
_ ;~:
.~
^ Separate Billing Requested ` -? ~=~ ~. y ~ .t
Inter-Vivos Transfers & Miscellaneous Non-Probate Property
7
(7) 12,974.35 ' -~ ~ ~ -~
------- -
.
(Schedule G or L) ~'~
I -
w
F ~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Retum (date of death prior to 12-13-82)
a
~ a ~
^ 4. Limited Estate
^ 4a. Future Interest Compromise (date of death aher 12-tz•ez) ^ 5. Federal Estate Tax Return Required
~ a m ~ 6. Decedent Died Testate (Attach copy orwlll) ^ 7. Decedent Maintained a Living Trust (Attach copy orTrust) _ 8. Total Number of Safe Deposit Boxes
a
a
^ 9. Litigation Proceeds Received
^ 1 O. SpoUS21 POVerty Credit (date of death behveen 12-31-91 and 1-1-95) ^ 11. Election to tax under Sec. 9113(A) (Attach scn of
THIS SECTION MUST'EiE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BEbIRECTED TO:'
w NAME COMPLETE MAILING ADDRESS
Z ROGER B. IRWIN ESQUIRE 60 WEST POMFRET STREET
FIRM NAME (If Applicable)
~ IRWIN & McKNIGHT
p TELEPHONE NUMBER
717' 249-2353 CARLISLE PA 17013
OFFICIAL USE ONLY
Z
O
H
a
Q
U
W
8. Total Gross Assets (total Lines 1-7) (8) 209, 711.78
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 21,043.29
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) (10) 366.13
11. Total Deductions (total Lines 9 810) (11) 21,409.42
12. Net Value of Estate (Line 8 minus Line 11) (12) 188, 302.36
13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SOCIAL SECURITY NUMBER
2 0 1- 1 6- 4 6 8 7
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(14) 188, 302.36
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z
O
F-
H
a
O
UX
Q
t-
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
> > -$E SURE TO ANSWER ALL'QUESTIONS ON REVEiRSESII
0.00 x (15) 0.00
188,302.36 x .045 (16) 8,473.61
0.00 x 12 (17) 0.00
.
0.00 x .15 (18) 0.00
(19) 8,473.61
Decedent's Complete Address:
sTREET ADDRESS 1535 LONGS GAP ROAD
CITY STATE PA ZIP 17013
CARLLISLE
Tax Payments and Credits:
~• Tax Due (Page 1 Line 19)
2. CreditslF'ayments
A. Spousal Poverty Credit
B. Prior Payments 8.049.93
C. Discount 423.68
3. Interestll'enalty if applicable
D. Interest
E. Penalty
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 1 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.
(1) 8,473.61
(2) 8,473.61
(3) 0.00
(4) 0.00
(5)
0.00
(5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) 0.00
Make Check Payable fo: REGISTER OF WILLS, AGENT
!PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred : ........................................................................... ^
b. retain the right to designate who shall use the property transferred or its income : ........................................ ^
c. retain a reversionary interest; or ...................................................................................................... ^ ^
d. receive the promise for life of either payments, benefits or care? ............................................................. ^ 0
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................... ^ ^X
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. ^
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 COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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.
Declaration of pre;parer other than the personal representative is based on all information of which preparer has any knowledge.
Slsi(JAT E F P,~j$ON RESP SI OR F NG RETURN ~ DATE
CC s~ ~ 9-~So
ADDRESS 273 NORTH MI TON ROAD
CARLISLE PA 17013
SIGNATURE OF PREP~gER~OTHER THAN REPRES~,NTATIVE DATE
60 WEST,R~OIV~RET STREET
PA 17013
For dates of death on or afte J ly 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)J.
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 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute sloes 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 stepparf;nt of the child is 0% (72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) p2 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 12% (72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX + (6-98)
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
MONISMITH LYDA J. 21 08 0741
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 willing 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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 1535 LONGS GAP ROAD, CARLISLE, PENNSYLVANIA 135,000.00
SOLD -SETTLEMENT SHEET ATTACHED
TOTAL (Also enter on line 1,
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INhIERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
MONISMI~rH LYDA J 21 08 0741
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
96 SHARES FOOT LOCKER, INC.
96 X $13.27 = $1,273.92
DESCRIPTION
VALUE AT DATE
OF DEATN
- - - 1,273.92
TOTAL (Also enter on line 2, Recapitulation) I $ 1,27;
(If more space is needed, insert additional sheets of the same size)
REV-w508 E~: + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
M N I M ITH LYDA J 21 08 0741
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1. PUBLIC SALE -SETTLEMENT SHEET ATTACHED 5,520.75
2. M8~T BANK -CHECKING ACCOUNT #9835255671 11,986.89
3. M&T BANK -SAVINGS ACCOUNT #015004204879447 4,201.63
4. M&T BANK -CERTIFICATE OF DEPOSIT #031003912752879 38,716.18
5. CASH ~ 38.06
TOTAL (Also enter on line 5, Rec~'itul~ti~n) S
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INI-IERITANCE TAX RETURN
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS 8~
MISC. NON-PROBATE PROPERTY
FILE NUMBER
MONISMI'TH LYDA J. 21 08 0741
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIRRELATIONSHIPTODECEDENTAND
THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE.
DATE OF DEATH
VALUE OF ASSET
%OFDECD'S
INTEREST
EXCLUSION
IIfAPPLICABLE)
TAXABLE
VALUE
1. M£~T BANK -IRA 8,221.33 100. 8,221.33
#035004110097464
2. ME4T BANK -IRA 4,753.02 100. 4,753.02
#035004200348313
TOTAL (Also enter on line 7 Recapitulation) I $ 12 974.35
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX. + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
_MONISMITH LYDA J. 21 08 0741
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOFFMAN-ROTH FUNERAL HOME 578.74
B.
2.
3.
4.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attorney Fees IRWIN & McKNIGHT
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees REGISTER OF WILLS
5. I Accountant's Fees
6. ~ Tax Return Preparers Fees PATRICIA A. ROSENDALE, CPA
298.00
350.00
7. REGISTER OF WILLS -FILING FEE 30.00
8. NOTARY FEES 25.00
9. KEVIN M. WICKARD, AUCTIONEER- PUBLIC SALE 1,603.51
10. THE SENTINEL -ESTATE NOTICE 174.58
11. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00
12. D.E.W. & SONS -SEPTIC 75.00
13. INTERSTATE WASTE SERVICES -TRASH REMOVAL 36.61
14. N.L. MINICH & SONS, INC. 212.00
15. STEVEN W. BARRETT -APPRAISAL ON REAL ESTATE 325.00
16. CLOSING COSTS ON SALE OF REAL ESTATE 7,509.85
TOTAL (Also enter on line 9, Recapitulation) $ 21.043.29
Zip
9, 750.00
Zip
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
SCHEDULE I
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MONISMI-fH LYDA J. 21 08 0741
Include unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PP&L -ELECTRIC 184.23
2. ~EMBARQ-TELEPHONE ~ 95.29
3. COMCAST -CABLE 86.61
4.
TOTAL (Also enter on line 10, Recapitulation) $ 366.13
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (osm
COMMOIVWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
MnNISMITH I YfIA I ne ...,
RELATIONSHIP TO DECEDENT i~f
AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2))
1. RICHARD L. MONISMITH Lineal
273 NORTH MIDDLETON ROAD 1/3 REMAINDER
CARLISLE, PA 17013
2. LYNDA K. COLLEGE Lineal
35 SHARON DRIVE 1/3 REMAINDER
SHERMANS DALE, PA 17090
3. THOMAS E. MONISMITH Lineal
2210 LONGS GAP ROAD 1/3 REMAINDER
CARLISLE, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(It more space is needed, insert additional sheets of the same size)
~ IAwoFFlces
~
IQVIGHT
IR WIN ~ M A. Settlement Statement
U.S. Department of Housing and Urban Development
OMB No. 2502-0265 ex irea 11/702009
c
~ B. TYPE OF LpAN
WEST POMFRET PROFESSIONAL BU/LD1NG 1• EIFHA 2. ~FmHA1 3. ^Conv. Unins.
4. VA 5. Conv. ns.
60 WEST POMFRET STREET
CARLISLE, PENNSYLVANIA 1 70 13-32 22 6. FILE NUMBER
MCKILLIPL9-08 7. LOAN NUMBER
1000615272
(717) 249-2333
j
C. Note: n.m. ,nan.a -(pn.e.l- «.,. Data ewla. uw eo.i,y: m.y ~..eo.n n«. rw int•,m.uen vum
WMNING'. It V • GMn• to MeeW M,nM• /a4• •uUm•nb tl nN Unl`0 et•r• m eN• w
we~ncuo. c.,~ Incwa.. n....a nsoem.m. por a.nir ...: Tw. is u. a. coa• swbe i'~ai g, MORTGAGE INSURANCE CASE NUMEIER
441.8542895.703
e.•• ^• •^ net rNwaw ti m. nub. TitleExpress Settlement System
Nw •Im1Yr rtnn. M1,ultl•• upon
.•e s.abe +oto. Printed 0910912008 at 11:00 JMR
r
D. NAME OF BORP.OwER: LONNIE L. MCKILLIP, SR. and ANNETTE M. MCKILLIP
ADDRESS: 13 HIDDEN NOLL ROAD CARLISLE PA 17013
j E. NAME OF SELLER: LYDA J. MONISMITH ESTATE
ADDRESS:
F. NAME OF LENDER: FRANKLIN AMERICAN MORTGAGE COMPANY
ADDRESS: 501 CORPORATE CENTRE DRNE SU FRANKLIN TN 37067
G. PROPERTY ADDRESS: 1535 LONGS GAP ROAD, Carlisle, PA 17013
i North Middleton Townshi
H.H. SE~EMENT ARGENT: 18M REAL ESTATE SERVICES, LLC, Telephone: 717.249-2353 Fax: 717.249.6354
PLACE OF SETTLEMENT: West Pomfret Professional Bld 60 West Pomfret Street Carlisle PA 17013
~ I. SETTLEMENT GATE: 0910912008
J. SUMMARY OF BORROWER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER
tOt. Contrail sales 135 000.00
K. SUMMARY OF SELLER'S TRANSACTION:
400. GROSS AMOUNT DUE TO SELLER
401. Cant/ sales ice 135 000.00
102. Personal Pro 402. Personal Pro
103. Settlement cha es to borrower line 1400 3 735.08 403.
104. 4~•
105. 405.
Ad'ustments for items aid b seller i n advance Ad'ustmenu for items aid b seller i n advance
107. Count lazes 09109108to12131108
108. SchodTax 09109108 to 06130109 116.06
1155.61 407. Coun fazes 09109108to12131108
408. School Tax 09109108to06f30109 116.06
1155.61
109. 4~•
110. 410.
t t t. 411.
112.
120. GROSS AMOUNT DUE FROM BORROWER
200. AMOUNTS PAID BY OR ON BEHALF OF BOR
140 008.75
ROWER 412.
420. GROSS AMOUNT DUE TO SELLER 136 271.67
500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. De sit or earnest mono 501. Excess De sit see instructions
202. Princt al amount of new bans 133 611.00 502. Settlement char es to seller line 1400 7 509.85
203. Existin loan s taken sub'eil to 503. Fxistin to s taken sub'eil to
204. Pa off of First Mon a Loan
205. 505.
206. `•~.
207. 507.
208. 5oe.
2os. scs•
Ad'ustments for Items un aid b seller Ad ustments for Itema un aid b seller
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219.
220. TOTAL PAND BYIFOR BORROWER
133 6t1.00 519.
520. TOTAL REDUCTION AMOUNT DUE SELLER
7509.85
J00. CASH AT SETTLEMENT FROM OR TO BORR OWER 600. CASH AT SETTLEMENT TO OR FROM SELL ER
301. Gross amount due Erom bortower line 120 140 006.75 601. Gross amount due to seller line 420 136 271.67
302. Less amounts aid b flor bortower line 220 133 611.00 602. Less reduction amount due seller line 520 7 509.85
303. CASH FROM BORROWER 6 395.75 603. CASH TO SELLER 128 761.82
U.S. DEPARTMENT OP HOUSING AND URBAN DEVELOPMENT Flle Number. MCKILLIPL9.08 PAGE 2
SETTLEMENT STATEMENT TielnFvnrwc¢ SAHIRmant Sv¢1Rm Printwl I19R191?()nA at 11 •n0 JMR
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROtCER'S COMMISSION based on rice 3135 000.00 ° BORROWER'S SELLER'S
Division of commission (fine 700) as follows: FUNDS AT FUNDS AT
701. to SETTLEMENT SETTLEMENT
702. to
( 703. Commission aid at Settlement
800B00,1~_
TENS PAYABLE IN CONNECTION WITH LOAN
-
r-801.-loan~Ori ination Fee %
h
802. Loan Discount X
803. Appraisal Fee to S.W. BARRETT REAL ESTATE 3 APPRAISAL i 50.00
8C4. Credit Rec>ort to AMERICAN ADVANTAGE MORTGAGE SERVICES 17.16
BCS. Broker Fee to AMERICAN ADVANTAGE MORTGAGE SERVICES 1 336.11
1806. Mortaape Administration Fee to FRANKLIN AMERICAN MORTGAGE COMPANY - LR 595.00
807. Processinr Fee to AMERICAN ADVANTAGE MORTGAGE SERVICES 650.00
808. Flood Cert. Fee to FRANKLIN AMERICAN MORTGAGE COMPANY LR 5.00
SC9. Wire Fee to FRANKLIN AMERICAN MORTGAGE COMPANY LR 10.00
810. Yield S read Premium to AMERICAN ADVANTAGE MORTGAGE SERVIC 619.19 POC b Lender
811.
i 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901r Interest Fmm 09/0912008 to 10/0112006 23.7900 Ida 22 Da s 523.38
902. Mort a Insurance Premium for to FRANKLIN AMERICAN MORTGAGE COMPANY LR 1 649.53
903. Hazard In>urance Premium for to
904.
905.
1000. RESERVES DEPOSITED WRH LENDER FOR
1001. Hazard Insurance 3 mo. 33.00 Imo LR 99.00
1002. Mort a Insurance mo. 137.46 Imo
1003. C Pro Tax rtro. Imo
1004. Count Pro rt Tax 8 nro. 31.051mo LR 248.40
1005. School Tax 4 nw. 119.15 /mo LR 476.60
1009. A r ate Anal sis Ad'ustment to FRANKLIN AMERICAN MORTGAGE COMPANY LR -274.33 0.00
1100. TRLE CHARGES
1101. Settlement or closin fee
1102. Abstract or title search
1103. Title examination
1104. Title insunance binder
1105. Document Preparation
1106. Nola Fees 30.00 10.00
1107. Attome 's fees
includes /above items No:
_
1108. Title Insurance to STGC118MREAL ESTATE
427.00
606.75
indudes above items No'
1109. Lender's Pdi 133 811.00 -
t i 10. Owner's P'oli 135 000.00 •1033.75
111 t. End 100 End 300 End 900 to STGCfl3MREAl ESTATE 150.00
1112.
1113. Closin Svcltr to STGC116MREAL ESTATE 35.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. RecOrdln Fees Deed 38.50 • MoA a 46.50 • Release 67.00
1202. Ci /Coun tax/stam s Deed 1350:00 • Mort e 1 350.00
1203. State Taw'stam Deed 1 350.00 • Mort e 1 350.00
1204.
1205. Inheritance Tax a ment to Estate of L da Monlsmith 225.00
1300. ADDRIUNAL SETTLEMENT CHARGES
1301. Surve
1302. Pest Ins action
1303.
1304. 2008-09 school taxes to ROBIN SOLLENBERGE TAX COLLECTOR 1 429.83
1305.
1306. WIRE FEE to ORRSTOWN BANK 10.00
1307. Ovemi ht and E Mail to 18M REAL ESTATE SERVICES LLC 48.50
1308.
1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 3 735.08 7 509.85
HUD CERTIFICATION Of BUYER AND S[LLER
1 Mv¢ cYMuNa~ nvNw~tl Ih~ HUD•t S~M¢IMM 9bt¢m~nl end b M~ b~H of my knowlWp~ a~M b¢II¢(N N • true and wcunb ~talxn~nt of ali nc¢Ipb and d66un~m¢mt made on my account or b
In IhN ~r.nucd~on. I Nrth¢r nrtpy fMt I hM nc~iv~d • coq of M¢ HUD•1 8tlttl~mrtrR Snbm~M.
~~---
LYDA J. MOMSMr1H ESTATE
'~ ~ ~ c~,_
t~D~
WARMNG: R IS A CRIME ~f119110YNNCLI/ MAKE FA15E STATEMENTS TO 7HE Tlu HUD-t e~ttl¢m~nt ldhm~M whkb i Mv¢ yVnp~nd is ~ W¢ ~M ~carm ueouM of fhb tr~ns~ctlo
UNITED STATES DN THIS ANY SIMILAR FORM. pENALTIE4 UPON CONVICTpN I hm cAw¢d er will cAUU btl funM to b~ dbbun¢d In AccoNma with fhb nabm~nL
CAN INCLUDE A FINE AND IMPRISONMEIR. FOR DETAIW SEE TRLE t0:
U.S. CODE SEC110N 1007 AND SECTK)N 1010. /f /
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12-Jun-08 13.31 14.11 13.24 13.44 1,690,700 13.27
Close price adjusted for dividends and splits.
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afake the security of yvi~r personal dam very serlo~sty.
`father than iderlti€ying you by your social Security Number, we assigned you a unique
~~-digitinvestcr [D.' To activate your Investor iD go to vwwv.b>!tyrnellon.camishar~awt~er/'tsd
yvhere ISD guides you through the two-step' authentication process.
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---------------------------------------------------- ------------------------------------------------------------------------
RETAIN FOR YOUR RECORDS
~- IMPORTAN'C TAX IA-EOf3MATIOM E~ 1'RA#VSAGTIbN UE7'AIL
SHAREHOLDER OF TRANSACTION DESCRIPTION
FOOT LOCKER, fNC _ ___ __ _ DIVIDEND _
INVESTOR ID CUSIP ACCOUNT KEY ISSUEICLASS OF STOCK RECORD DATE PAYABLE DATE
126010414410 ~ 001 450 34484910 MONISMITHLYDAJO100 COMMON STOCK ___ _ _ 04/1812008 05/02/2008
RATE PER SHARE '~ CERTIFICATED SHARES BOOK-ENTRY SHARES GROSS AMOUNT TAX WITHHELD CURRENT DIVIDEND
50.1500000 96 0.0000 ~ $14.40 $0.00 $14.40
DIVIDEND PAID YEAR TO DATE TAX WITHHELD YEAR TO DATE TAX IDENTIFICATION NUMBER please detach and retain this form for your records
$26.40
$0.00
ON FILE .
ADVERTISEMENT
CtIC1I 11~ OU~PBN~
PLEASE DETACH BELOW CHECK NUMBER: 76017401
^M NASH, PO BOX 48 MIFFLINBURG, PA 178!! • PHONE (800) 728.781
."T~ -~ Q „~ S Q (~. ~ s, s a o , ~r 5 FINAL
SETTLEMENT
SELLER NAME E~ ~d ~-e ,~ ~ R o ~~ ~ ~ ~~ d u m o~ I S M I~ h
ADDRESS. r ~~ ~ L o n Q S ?Q /~ ~ (.+ .
_ ~Q1~~1~5~e, / /~1 ~
DATE OF SALE ~! ~P_ o~ DL
PHONE J ___
ZIP
LOCATION OF SALE 5 G~ YYl e Q ~ Q D tL C~__ _____
AUCTIONEER _ _I~ e Vt t ~ i y 1 • (~ ~ c k a r~ rt r~ ~/
PHONE ~ / ' of "T ~~~
~~',' SELLER'S EXPENSES RECEIPTS
~y
.~~^
~~~ UCTIONEER $ U ~ O~
~~
.ERK f 5~1~ $
'n 4SHIER $
~,y
~ ` OTHER EXPENSES
~ t's~ n $ 575 3~
CASH $ 0 / S, Oo
CHECKS $ ~ w ~ S ~ /
OTHER RECEIPTS
$
4:a ~o ~~ - ~ Sale $ a~o.o~
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¢' $
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TOTAL EXPENSES $ ~ ~f/ Q J - ~~
$
$
$
$
$
$
$
$ 5 5~ 6,'7S
$ ~ 03,51
NET PROCEEDS PAYABLE TO SELLER $ ~ 1 ~ !, oS
I (or we), the seller, accept this settlement and acknowledge receipt of the above specified net proceeds
From the auction of my goods and propery sold on the above date. I accept all responsibiliy for providing
merchantable title to all goods, and prgperty sold, and For delivery of title to the purchaser.
` ~~~~"_ Date ~ ~~ ~
'xC.U~ /1'yt . ~ a.~'
Auctioneer or Cashiers Signature (Seller's Signature)
TOTAL RECEIPTS
LESS TOTAL EXPENSES
a~~
499 Mitchell Road. Millsboro. DE 19966 Mail Code DE-ME3-12 Phone (888) 502-4349
Fax (302) 934-2955
June 30, 2008
Law Offices of
Irwin & McKnight ~~~~~+~~a
West Pomfret Professional Building
60 West Pomfret Street _
Carlisle, Pennsylvania 17013-3222 ~°~~~' ~ '~ 2~~~
1FtWIN & D,9ci~.~IGH i
LAV4' QFF~ICE`~
Re: Estate of Leda J Motzismith
Social Security: 201-16-4687
Date o~Death: June 12, 2008
Dear Sir or Madam:
Per your inquiry dated June 23, ?008, please be advised that at the time of death, the above-named decedent had on deposit
with this bank the following:
1. Type ojAccount Checking Account
Account Number 983.1 2.i~671
Ownership (.7Vames o~ Lvda J Monismith
Opening Date 13/31/03
Balance on Date of Death 811, 986.68
Accrued Interest 8 0.21
Total 8J 1,986.89
2. Type of Account Savings Account
Account Number 01.500~1204879;t;17
Ownership (,'Names o~ Lyda J Monismith
Opening Date 12/31/03
Balance on Date of Death 8~, 201.40
Accrued Interest 8 0.23
Total 84, 201.63
3. Type of Account Certificate of Deposit
Account Number 03100391275287 9
Ownership (Names of LydaJMonismith
Opening Date 06/28/04
Balance on Date of Death $38, 672.42
Accrued Interest $ 43.76
Total $38, 716.18
4. ' Type of Account IRA
Account Number 035004110097464
Ownership (Names o~ Lyda J Monismith
Richard L Monismith, Beneficiary
Lynda K College, Beneficiary
Thomas E A~lonismith, Beneficiary
Opening Date 02/08/06
Balance on Date of Death $8, 0~ 4.78
Accrued Interest $ 166..1.5
Total $8, 221.33
5. Type ofAccoirnt IRA
Account Number 035004200398313
Ownership (Names o~ Lyda J Monismith
Richard L Monismith, Beneficiary
Lynda K College, Beneficiary
Thomas E A~lonismith, Beneficiary
Opening Date 04/05/99
Balance on Date of Death $4, 74-1.07
Accrued Interest $ 8.9.1
Total $4, 753.02
Ptease be advised, there was no safe deposit box found for the above decedent.
This letter does not include any accounts in which the deceased may have been listed as Custodian of Uniform
Transfers, Power of Attorney, Representative Payee, or Trustee under a Written Agreement.
* If upon reviewing the information above, you believe there are additional accounts not referenced, please
provide us with an account number and/or name of any possible joint account holder. For any additional
information on the above accounts, including ownership and any changes, closures and/or reimbursement of
funds, etc., please contact our North Middleton Branch at 1958 Spring Road, Carlisle, PA 17013, or # 717-
240-4521.
Sincerely,
-~
~~ y
Nancy Clagett
Records Management
Hoffman-Roth Funeral Home & Crematory, Inc.
219 North Hanover Street
Carlisle, PA 17013
(717)243-4511
July 1, 2008
Lynda Colledge
35 Sharon Drive
She~:mans Dale, PA 17090
The Funeral Service for Lyda J. Monismith
15355-139
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE; FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
OUR SERVICE:
Trac'litional Funeral Service Package _ $4150.00
FUNERAL HOME SERVICE CHARGES $4150.00
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED $4150.00
Cash Advances
Newspaper Obituary Notice- Sentinel , $153.20
Newspaper Obituary Notice -Patriot News $329.32
Clergy Offering $75.00
Certified Copies of Death Certificates , $72.00
Flowers. $159.00
Additional flowers,'10 roses, _ _ _ _ _ _ _ _ _ _ _ $39.22
TOTAL CASH ADVANCES AND SPECIAL CHARGES . $827.74
Total
Total Cost , _ $4977.74
History
06/:30/2008 Allianz $-3439.44
06/30/2008 Allianz $-704.48
06/30/2008 Discount Contract vs PreArrangement , $-255.08
TOTAL AMOUNT DUE $$75.74
This statement is net and payable in full within 30 days of receipt.
Please return this portion with your Remittance
$ Amount Enclosed Service ID # 15355-139
Lyda J. Monismith