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HomeMy WebLinkAbout10-06-0815056041125 REV-1500 EX (x-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number Po aox 28oso1 2 1 0 8 0 6 1 7 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 8 6 3 0 6 9 2 1 0 2 2 9 2 0 0 8 1 1 1 5 1 9 3 7 Decedent's Last Name Suffix Decedent's First Name MI H O O V E R R U T H E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW O 1. Original Return 4. Limited Estate 0 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL WRRESPONDENGE AKD GONFIDtNiWI IAx INFUKMA I IUN SFit)ULU lit UlKtG I tU 1 V. Name Daytime Telephone Number W I L L I A M A D U N CAN 7 1 7 2 4 9 7 7 8 0 Firm Name (If Applicable) D U N C A N & H A R T M A N, First line of address 1 I R V I N E R O W Second line of address City or Post Office REGISTE~F WILLS US~ LY P C ~ ,__ ~ i -~ ; ~ •' ~. r:~ -- I -. ~;" ~„ 131~TE~'FILED State ZIP Code ---~------ _- -~t C A R L I S L E P A 1 7 0 1 3 Correspondent's a-mail address: bIIIdUnCan(c~pa.nr?t Under penalties of perjury, I declare that 1 have examined this return, indudirg acorxnpanying sdledules and statements, and to the best of my knowledge and belief, it is true, oorred and complex. Dedaralion of preparer other than the personal represerrtahve s based on aA information of which preparer has arty lurorrledge. SIG!~URE PE R~~S~ONSIBLE OR FILING RETURN DATE 147 N. EAST STREET CARLISLE PA 17013 E OF PREPAR R OTHER THAN REPRESENTATNE DAT nnnocec 147 N. EAST STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041125 15056041125 J 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: RUTH E. HOOVER 1 8 6 3 0 6 9 2 1 RECAPITULATION 1. Real estate (Schedule A) 6 0 0 0 0 0 0 ........................................ 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 Bitling Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 9. Funeral Expenses ~ Administrative Costs (Schedule H) ................ 9• 10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ............ 10. 11. Total Deductions (total Lines 9 & 10) ........................... 11. 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12• 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. 0. 0 0 9 3 6. 1 7 6 0 9 3 6. 1 7 1 4 2 1 5, 8 3 3 8 4 1 1. 8 0 5 2 6 2 7. 6 3 8 3 0 8. 5 4 8 3 0 8. 5 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable 8 3 0 8 5 4 at lineal rate x .045 . 1s 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 17~ 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 18 19. Tax Due ................................................19- 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0. 0 0 3 7 3. 8 8 0. 0 0 0. 0 0 3 7 3. 8 8 Side 2 L 15056042126 15056042126 J REV-1500 EX Page 3 Decedent's Comalete Address: DECEDENTS NAME RUTH E. HOOVER STREETADDRESS 149 N. EAST ST. CITY i STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: Tax Due (Page 2 Line 19) CreditslPayments A. Spousal Poverty Credit B. Prior Payments C, Discount 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval 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. (1) 373.88 Total Credits (A + B + C) (2) 0.00 File Number 21 08 0617 (5B) Make Check Payable to: REGISTER OF WILLS, AGENT (4) 0.00 (5) 373.88 (5A) 373.88 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 : ................................................................. i ..... ~ O X ncome; .......................... b. retain the right to designate who shall use the property transferred or its ..... ^ 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? ................................................................................. h? " ' ...... ^ ... or payable upon death bank account or security at his or her deat in trust for 3. Did decedent own an ...... 4. Did decedent own an Individual Retirement Aaount, annuity, or other non~robate 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. 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 'rf 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 iwenty~e 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)]. 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 RUTH E. HOOVER 21 08 0617 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, ne'dher being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real nrooerty which is aiMiv-0wrled with ri11M of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 149 N. EAST STREET 60,000.00 CARLISLE, PA 17013 [SEE ATTACHED HUD SHEET] TOTAL (Also enter on line 1, Recapitulation) ~ ; 60,000.00 (If more space is needed. insert additional sheets of the same sizel REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY ESTATE OF r~~c n~mocR RUTH E. HOOVER 21 08 0617 Indude the proceeds of litigation and the date the proceeds were received by the estate. All properly joinly~owned vr~h right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CREDIT CITY/TOWN TAXES 160.38 [SEE ATTACHED HUD SHEET] 2. CREDIT SCHOOL TAXES [SEE ATTACHED HUD SHEET] 775.79 TOTAL (Also enter on line 5, Recapitulation) I S 936.17 Qf more space is needed, insert additional sheets of the same size) EV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER RUTH E. HOOVER 21 08 0617 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EWING BROTHERS FUNERAL HOME INC. 3,932.57 B. ADMINISTRATIVE COSTS: ~. Personal Representative's Commissions Name of Personal Representative (s) RALPH T. HOOVER III & DEBORAH HOOVER Soda) Security Number(s)IEIN Number of Personal Representative(s) Street Address 147 N. EAST STREET Cary CARLISLE S~~ PA Z;p 17013 Year(s) Commission Paid: 2008 2. Attorney Fees DUNCAN & HARTMAN, PC 3. Family Exemption: (If decedent's address is not the same as daimanYs, attach explanation) Claimant RALPH T. HOOVER III Street Address 147 N. EAST STREET Cary CARLISLE Stdfe PA Zip 17013 Relationship of Claimant to Decedent SON 4• Probate Fees REGISTER OF WILLS 5. I AcoountanYs Fees 6. ~ Tax Return Preparer's Fees 7. CUMBERLAND LAW JOURNAL 8. SENTINEL LEGAL NOTICE 9. HELD IN RESERVE 3, 046.81 3, 046.81 3, 500.00 264.00 75.00 150.64 200.00 TOTAL (Also enter on line 9, Recapitulation) I S ~ d (If more space is needed, insert addifional sheets of the same size) REV-1512 EX + (12-03} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS ESTATE OF FILE NUMBER RUTH E. HOOVER 21 08 0617 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PA DEPT OF WELFARE LIEN 19,225.03 [SEE ATTACHED LETTER] 2. DUNCAN & HARTMAN PC REAL ESTATE CLOSING LEGAL FEES 750.00 [SEE ATTACHED HUD SHEET] 3. STATE TAX REAL ESTATE CLOSING 600.00 [SEE ATTACHED HUD SHEET] 4. 2008 SCHOOL TAXES 845.27 [SEE ATTACHED HUD SHEET] 5. 2008 COUNTY TAXES 419.30 [SEE ATTACHED HUD SHEET] 6. CITIFINANCIAL 16,572.20 [SEE ATTACHED HUD SHEEl'7 TOTAL (Also enter on line 10, Recapitulation) I E 38,411. (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (g-0O) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RUTH E. HOOVER 21 08 0617 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [indude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. RALPH T. HOOVER, III Lineal 147 N. EAST STREET 50 % SHARE CARLISLE, PA 17013 2. NAN-ELIZABETH HAMILTON MORRISON Lineal 17 HICKORYTOWN ROAD 50 % SHARE 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 ; tlr more space Is neeoea, Insen atltlltlonal sheets of the same size) LAST WILL TESTAMENT OF I, RUTH E. HOOVER, of 149 North East Street, Carlisle, Cumberland County, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be cremated and disposed of in accord with my expressed wishes. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give, devise and bequeath any and all real estate owned by me at the time of my death, unto NAN-ELIZABETH HAMILTON MORRISON and RALPH T. HOOVER, III, in equal shares. FIFTH. I give, devise and bequeath any and all tangible personal property owned by me at the time of my death unto NAN-ELIZABETH HAMILTON MORRISON and RALPH T. HOOVER, III, in equal shares. SIXTH. I give, devise and bequeath all the rest, residue and remainder of my estate unto NAN-ELIZABETH HAMILTON MORRISON and RALPH T. HOOVER, III, in equal shares. SEVENTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. EIGHTH. I hereby nominate, constitute and appoint my son, RALPH T. HOOVER, III and his wife, DEBORAH A. HOOVER, as Co-Executors of this my Last Will and Testament. I hereby relieve my Co-Executors from the necessity of posting security in connection with their duties, as such, in any jurisdiction in which they may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Co-Executors, in their absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. NINTH. I have made, or may from time to time make, a written memorandum expressing my desire to give certain items of personal property to specific persons. I urge my Co-Executors and beneficiaries to respect these wishes. Such a memorandum, if made, shall be stored in conjunction with this Will. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my, Last Will and Testament, consisting of two typewritten pages this %„~ day of ,~~-~i~.°~ , 2005. RUTH E. HOOVER Signed, sealed, published and declared by the above named Testatrix RUTH E. HOOVER as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ~ ~~, ~ ~~~ 4~~-D G~da,-- COMMONWEALTH OF PENNSYL VANIA CO LINTY OF CUMBERLAND . SS. I, RUTH E. HOOVER ,Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. UTH E. HOOVER Sworn or affirmed to and acknowledged before me, by RUTH E. HOOVER this <~-+ day ^, of ~ Notary P~ub~ic 200. NOTARIAL SEAL Kathy L. Mummert, Notary Public Borough of Carlisle, Cumberland Co., PA My Commission Expires Aug. 11, 2007 COMMONWEALTH OF PENNSYL VANIA COUNTY OF CUMBERLAND SS. _ ~7~LtiYIJ We, ~~ ° ~ ~ ~ ~~ i'`'f1 ~-~ i~v~=~~~A` and ~) c7C1~. ~ ~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw RUTH E. HOOVER sign and execute the instrument as her Last Will; that she signed willingly and that she executed 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 eighteen (I8) or more years of age, of sound mind and under no constraint or undue influence. ~ , ~ C' ~-~C/1.~.... ,p Sworn or affirmed to and subscribed before me by ;~!~; /Jcr;t-~ 4 1 )~,-,:c<ri1 and + -= ~. <n- ~~> t t~m~:~~•~._ ,witnesses, this ~? -`"+ day of ;!~? ~ ; z' , 2005. Notary Puh~,i NOTARAAI. SEAL Kathy L. Mummert, Notary Public Borough of Carlisle, Cumberland Co., PA My Commission Expires Aug. 11, 2007 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 August 7, 2008 DUNCAN & HARTMAN P C WILLIAM A DUNCAN ESQ ONE IRVINE ROW CARLISLE PA 17013 Re: RUTH HOOVER CIS #: 720150290 SSN: 186-30-6921 Date of Death: 02/29/2008 Dear Attorney Duncan: This is to acknowledge receipt of payment in the amount of $19,225.03 regarding the above-referenced estate. The Estate Recovery Program's claim is satisfied. Your cooperation in resolving this matter is appreciated. Sincerely, ~ r ~~. ~~ Barbara E. Witmer Claims Investigation Agent 717-772-6611 717-772-6553 FAX Heavy Duty Tires Ft Tread, Inc. Orrstown Bank 13303 1140 Claremont Road 60-1503/313 Carlisle, PA 17013 Check date: 10/2/2008 Pay to the order of: Ralph T Hoover III 261.48 **Zero And 00/100 Dollars******************************************** Ralph T Hoover III 149 N. East Street Carlisle, PA 17013 NOTICE OF DIRECT DEPOSIT (This is not a check) M Heavy Duty Tires >;t Tread, InC. Regular rate: 13.2500 Period beg.: 9/21 /2008 Check #: 13303 Ralph T Hoover III Period end: 9/27/2 008 Check date: 10/2/2008 F2egular Overtime Double Time Total Wa es Hours Amount Hours Amount Amount" Hours. Amount Deductions Amount Vacation 32.00 424.00 32.00 424.00 Federal W/H 16.36 FICA-SS 25.17 FICA-Med 5.89 State W/H 12.46 PA SUI W/H 0.25 Local 6.70 LST 1.00 401(k) Percentage 21.20 401(k) Loan 1 11.18 Health Ins Pre-Tax 18.09 Universal Life Ins 10.74 ST Disability Ins 8.48 Other Deduction Withholc 286.48 Totals 3200 424.00 32.00; 424:00 424.00 Beg. Bolonce Hours Accrued Hours used YTD Hours used this pay Available ba lance Net Pay 261.48 Vacation 160.00 0.00 160.00 32.00 0.00 Sick 24.00 0.00 24.00 0.00 0.00 Personal 8.00 0.00 8.00 0.00 0.00 Year to Date Regular Overtime Double Time Tota! Wanes }lours Amount Hours Amount Hours Amount ' Hours Amount D d actions Amount Vacation 160.00 2,120.00 160.00 2,120.00 Federal W/H 1,057.73 Hourly 1326.38 17,574.57 34.78 691.26 1361.16 18,265.83 FICA-SS 1,265.43 Sick 24.00 318.00 24.00 318.00 FICA-Med 295.95 Personal 8.00 106.00 8.00 106.00 State W/H 626.61 Holiday 40.00 530.00 40.00 530.00 PA SUI W/H 13.00 Bereavement 24.00 318.00 24.00 318.00 Local 336.77 LST 40.00 401(k) Percentage 1,082.85 401(k) Loan 1 447.20 Health Ins Pre-Tax 1,247.69 Universal Life Ins 429.60 ST Disability Ins 347.68 Other Deduction Withholc 14 467.32 Totals 1582.38 20,966.57 34:78 .691. 26 1617.16 21,657.83 21657.83 Net Pay 13,056.80 Settlement Statement U.S. Department of Housing and Urban Development OMB Approval No. 2502-0491 Name & Address of Borrower RUTH HOOVER DEBORAH HOOVER 149 N EAST ST CARLISLE PA 17013 Name & Address of Lender: CITIF.INANCIAL SERVICES, INC. 950 WALNUT BOTTOM ROAD STE 16 CARLISLE PA 17015 _ Property Location: (if different from above) 149 N EAST ST Settlement Agent: CITIFINANCIAL SERVICES, INC. CARLISLE PA 17013 Place of Settlement: 950 WALNUT BOTTOM ROAD STE 16 CARLISLE PA 17015 Loan Number: 205260 Settlement Date: 02/21/2008 L. Settlement Charges M. Disbursement to Others 800. Items Payable In Connection with Loan: 801. Loan origination fee 3.0000 °o to 471.64 802. Loan discount °% to 1501. TAX CLAIM BOROUGH 1, 491.53 803. Appraisal fee to FINITI, LLC 80.00 1502. WELLS FARGO INS 507.00 * Fee for full appraisal, Automated Valuation Model 1503. (AVM), Broker Price Opinion IBPO), or Comparative Market Analysis (CMAI. 1504. 804. Credit report to TRANS UNION 0.90 1505. 805. Inspection fee to 900. Items Required by Lender to be Paid in Advance: 1 506. 903. Hazard insurance premium for yearlsl to 1507. 905. Credit Life Insurance Premium to 1 508. 906. Disability Insurance Premium to 1509. 907. Involuntary Unemployment Insurance Premium to 1510. 908. 1511. 909. 1512. 910. 1513. 1000. Reserves Deposited with Lender 1 514. 1100. Title Charges: 1 101 , Settlement or closing fee to 1 51 5. 1 102. Abstract or title search to 1516. 1103. Title examination to . 00 1517. 1 104. Title Insurance binder to 1518. 1105. Docurrlent preparation to CITIFINANCIAL 125.00 1519. 1 106. Notary fees to 1520. 1 107. Attorney's fees to (includes above item numbers ) 1521. 1 108. Title insurance toFINITI SE'PTLEMENT, LLC (includes above item numbers 1 420.00 1522. 1 109. Lender's coverage $ N/A 1 1 10. Owner's coverage $. N A 1523. 1111 . Texas Title Guaranty Fee ~ 1524. 1 1 12. Tax Related Service Fee to FIRST AMERICAN TAX SVCE 50.00 1525.CitiFinancial 6,590.1 1200. Government Recording and Transfer Charges: 1526.TOTAL DISBURSEDIenter on line 1603) 588 72 8 1 201. Recordinq fee 44 50 , - 1202. Citylcounty tax/stamps . N. Net Settlement 1203. State tax/stamps 1204. to $__ 0.00 1600. Loan Amount $ 16, 192.78 1205. Release Fee 1300. Additional Settlement Charges: 1601. Plus Cash/Check from Borrower $ 1301 Survey to . _ 1302. Pest inspection to 1602. Minus Total Settlement Charges $ 1 192 04 1 303. Overnight Delivery Fee to (line 1400) , . 0.00 1603. Minus Total Disbursements to Others 1304. Flood Certification Fee to (line 1526) $ 8 588 72 0.00 1 305. to 1604. Equals Disbursements to Borrower (after expiration of any applicable 1400. Total Settlement Charges (enter on line 1602) 1 192.04 rescission period required by law) $ 6 , 412.02 Borrowerlsl Signaturelsl: r-~' g ~. s ti X ~'G;, +-' 4~ ~.., L`..: ' ~~'l`~.'^11+n.~1,..'\....s ~/' °^"Gf".'CO' ~ '°.- 1..~~ l~^L~oS''~.^4..~5../'o.s 21231-4 6/2004 RUTH HOOVER DEBORAH HOOVER form HuD-tA (2/941 ref. RESPA Original (Branch) Copy (Customer) RUTH HOOVER DEBORAH HOOVER GOOD FAITH ESTIMATE -RESPA ESTIMATED LENDER: CitiFinancial LOAN AMOUNT: $ 15.000.00 950 WALNUT BOTTOM RD STE 16 02/21/2008 CARLISLE PA 17015 The information provided below reflects estimates of the charges which you are likely to incur at the settlement of your loan. The fees listed are estimates -actual charges may be more or less. Your transaction may not involve a fee for every item listed. The numbers listed beside the estimates generally correspond to the numbered lines contained in the HUD-1 or HUD-1 A settlement statement which you will be receiving at settlement. The HUD-1 or HUD-1 A settlement statement will show you the actual cost for items paid at settlement. NUMBERS FROM HUD-1 FORM DESCRIPTION OF CHARGES ESTIMATED AMOUNT OR RANGE 801. LOAN ORIGINATION FEE* 3 .0000 % $ 531.61 802. LOAN DISCOUNT FEE % $ 803. APPRAISAL FEE" * $ 80.00 804, CREDIT REPORT $ o . 90 805. INSPECTION FEE $ 1101. SETTLEMENT OR CLOSING FEE $ 1 102. ABSTRACT OR TITLE SEARCH FEE $ . o0 110. TITLE EXAMINATION 1104. TITLE INSURANCE BINDER $ 1105. DOCUMENT PREPARATION FEE*** $ 125.00 1106. NOTARY FEES $ 1107. ATTORNEYS' FEES $ 1108. TITLE INSURANCE $ 420.00 1111. $ 1112, TAX SERVICE FEE (FIRST MORTGAGE LOAN ONLY)**** $ 50.00 1113. $ 1201. RECORDING FEE $ 44.50 1202. CITY/COUNTY TAX/STAMPS $ 1203. STATE TAX/STAMPS $ 1204. $ 0.00 1205. RELEASE FEE $ o.oo 1301. SURVEY $ 1302. PEST INSPECTIONS $ 1303. $ 1304. FLOOD CERTIFICATION FEE $ o . 00 * This fee is a cost of the credit extension and does not provide a benefit to the borrower.' * * Fee for full appraisal, Automated Valuation Model lAVM1, Broker Price Opinion (BPO), or Comparative Market Analysis {CMA). * * * Arizona-only for loa~~s over 510,000. Illinois-fee is 525 if loan less than 525,000. * ~ * * Applicable to California loans over 51 0,000; Kentucky loans over 51 5,000. * * * * * In Kentucky this provider of service is available for loans over 51 5,000, only. * * * * * * In Wisconsin this provider of service is not available for second mortgage loans of 525,000 or less. These estimates are provided pursuant to the Real Estate Settlement Procedures Act of 1 974, as amended (RESPA). THIS SECTION TO BE COMPLETED BY LENDER ONLY IF A PARTICULAR PROVIDER OF SERVICE IS REQUIRED Listed below are providers of service which we require you use. The charges or range indicated in the Good Faith Estimate above are based upon the corresponding charge of the below designated providers. ITEM #_ SERVICE PROVIDED PROVIDER'S NAME AND ADDRESS TELEPHONE # RELATIONSHIP * ~ * , +~ Finiti, LLC * * , * * 7090 Samuel Morse Dr. 803 APPRAISAL Columbia, Maryland 21046 (800) 422-7771 ©YES ^NO 804 Credit Report TRANS UNION 800 888-4213 P.O. BOX 1000 Chester, PA -19022 ®YES ^NO First American Real Estate Tax Service 8435 N Stemmons Freeway 1112 TAX SERVICE Dallas, Texas 75247 (214) 879-5000 X^YES ^NO Unless a service provider is identified above, Lender will require a particular provider from slender-controlled list and the range of costs for the required provider(s) are shown above. Any relationship which exists betvve.en lender and provider of service is based solely on the repeated use of that provider during the last twelve months, except in the case of Finiti, LLC who is an associate of Lender. Finiti's service may not be available in all states. You may inquire of Lender regarding its services in your state. The tax service provider identifed above will provide the service only when such service is required by Lender. RIGHT TO RECEIVE A COPY OF AN APPRAISAL: If an appraisal report is obtained in connection with your application for credit, you are entitled to a copy of the appraisal provided you have paid. or are willing to pay for the appraisal. A request for a copy of the appraisal must be submitted in writing to the lender, at the address shown above, within 90 days of the date on which you are notified about the action taken on your credit application or, if you withdraw your application, within 90 days of the withdrawal. You should be aware that the ovc;rall cost of refinancing an existing loan balance may be greater than the cost of keeping the existing loan and obtaining a second loan for any additional funds you wish to borrow. The undersigned acknowledges receipt of this Good Faith Estimate of Charges, that there may be other lenders and affiliates offering s~ervpices similar to Lender's, and that Lender has encouraged Applicant to compare Lender's loan services and pricing with others. i-'~A,^~U;O~)~..~ t ~~{ ~~~`"y ~ r1 ~(.~ ~'' Applicant Applicant 212302-3 9!2006 Original (Branch) Copy (Customer) Disclosure Statement, Note and Securi Borrower(s) (Name and mailing addressl Lender (Name, address, city and state) ent Account No. RUTH HOOVER CITIFINANCIAL SERVICES, 205260 DEBORAH HOOVER INC . Date of Loan 149 N EAST ST 950 WALNUT BOTTOM ROAD STE 16 CARLISLE PA 17013 CARLISLE PA 17015 02/21/2008 ~~ ANNUAL PERCENTAGE RATE FTN.ANCE CHARGE Amount Financed Total of Payments The cost of Borrower's credit as The dollar amount the credit will The amount of credit provided to The amount Borrower will have a yearly rate. eost Borrower. Borrower or on Borrower's behalf paid after Borrower has made all payments as scheduled. 12.67 °Io $ 19,564.08 $ 15,671.14 $ 35,235.22 Payment Schedule: Number of Amount of Payments Payments When Pa~yyments Are llue 1 $ 221.62 04/01/2008 180 $ 194.52 MONTHLY BEGINNING 05/01/2008 See the cuutract documents for any additional information about nonpayment, default, any required repayment in full before the scheduled date, and prepayment refunds and penalties. Security; If checked, Borrower is giving a security interest in: ^X Real Property Mobile Home or Manufactured Home Late Charge: If a payment is more than 15 days late, Borrower will be charged a late charge of the greater of $ 2 0 . 0 0 or 10.0 % of the payment amount. Prepayment: If Borrower pays off early, Borrower: will not ~ may have to pay a penalty, and will not be entitled to a refund of part of the finance charge. Does not include any insurance premium. Additional Information: 'fatal amount of first month's papmeM including insurance premiums, it any. PRINCIPAL POI N'rS DATE CHARGES BEGIN b221.62 $ 16,192.78 $ 471.64 02/26/2008 Required Insurance llisclosure: If Borrower grants Lender a security interest as indicated in this document, insurance to protect the Lender's interest in the collateral may be required. If this loan is secured by re«I property, or mobile/manufactured home, then fire, extended coverage, collision and/or comprehensive casualh~ insurance is required naming Lender as loss payee, until the loan is fully paid. The amount of such insurance must be sufficient to satisty the unpaid balance of [lie lean, ut he equal to the value of the collateral, whichever is less. Such insurance may be provided through an existing policy or a policy ohtained independently and purchased by Borrower. Borrower may obtain such insurance from any insurer that is reasonably acceptable to Lender. Optional Insurance llisclosure: Borrower is not required to purchase optional insurance products, such as: Credit Life, Credit Disability, Involuntary Unemployment Insurance or any other optional insurance products. Lender's decision to grant credit will not be affected by Borrower's decision to purchase or decline to purchase optional insurance. Coverage will not be provided unless Burrower signs and agrees to pay the applicable monthly premium in addition to the monthly loan payment disclosed above. Borrower should refer to the terms contained in the applicable certificate or policy of insurance issued for the exact description of benefits, exclusions and premium rates. If Borrower purchases insurance, Borrower's monthly payment will include both the monthl loan payment disclosed above and the applicable monthly premiums. ~ ~,~g~ ik }~ c` , --~- ~ }~'f , ~ ~, e~~ •7_r' t/We request the following insurance: ~~,~ Premium Due with the First Month's Loan Payment NONE NONE NONE First Year's Insurance ~~s ~ ~~~~.....~._.- .~ ~ ~" ~ Premiurn * 'type: First Borrower's ignature Date Second Borrower's Signature Date (* First year's premiums are calculated on the assumption that monthly loan payments are timely made). Accrued but unpaid premium, if not paid earlier, will be due and payable at the tune of the final payment on the loan. However, failure to pay premiums may result in termination of insurance as described below. Termuration of Insurance: Borrower may cancel any of the optio~~al insurance products offered at any time. The optional insurance will terminate upon the earliest of the following occurrences: l I) the Lender's receipt of Borrower's written request for termination; (2) on the date when the Burn of past due premiums equal or exceed four tones the tirst month premium; r3) termination pursuant to the: provisions of the insurance certificate; ~4) payment in full of Borrower's Loan; t5) death of Borrower. 7'EKMS: In this Disclosure Statement, Notc and Security Agreement, the word "Borrower" refers to the persons signing below as Borrower, whether one or more. If more than one Borrower signs, each will be responsible, individually and together, for all promises made and for repaying the loan in hdl. The word "Lender" refers to the Lender, whose name and address are shown above. PROMISE "f0 PAY: In return for a loan that Borrower has received, Borrower promises to pay to the order of Lender the Principal amount shown above, plus interest on the unpaid Principal balance from the Date Charges Begin shown above until fully paid at the following Rate of Interest: KA"fE OF INTEREST: 12.05% per annum ou the entire unpaid Principal balance. Lender will compute interest on the unpaid Principal balance on a daily basis from the date charges begin until Borrower repays the loan. If Borrower does not make sufficient or timely payments according to the payment schedule above, Borrower will incur greater interest charges on the loan. Airy amount shown above as Point, has been paid by Borrower as points and any amount shown below as a Buydown Fee has been paid by a party other than Borrower as a buydown fee. These amounts are considered prepaid charges and are in addition to the above Rate of Interest. Any Points or Buydown Fee are earned prior to any other interest on the loan balance, and in the event of prepayment of the loan, will not be refundable to Borrower. ~ NONE has been paid by a parry other. than Borrower as a Buydown Fee. Principal and interest shall be payable i^ ttte substantia]ly equal monthly installments shown above, except that any appropriate adjustments will be made to the first and final payments, begimting on the first payment date shown above and continuing on the same day in each following month until paid in full. Upun the final payment dare ur the acceleratio^ thereof, the entire outstanding balance of Principal and interest evidenced by this Disclosure Statement, Note and Security Agreement shall be due and payable.. Any payment(s) which Lender accepts after the fina . ~~~~ or the acceleration thereof do not constitute a renewal or extension of this loan unless Lender so determines. t~~. Borrower's Initials: 4 lr Over $50,000 - I st Mortgage PA 25422-14 8/2005 Original (Branch) Copy (Customer) .Page 1 of 3 RUTH HOOVER DEBORAH HOOVER 205260 02/21/2008 Each payment shall be applied as follows: (1) monthly loan payments due (first Co interest, then principal), (2) insurance premiums due, (3) unpaid interest to the date of payment. if any, then (4) principal. Lender may collect interest from and after maturity and after a judgement is entered upon the unpaid Principal balance at either the maximum rate permitted by the then applicable law or the rate of interest prevailing under this Disclosure Statement, Note and Security Agreement. LATE CHARGE: If any installment is paid more than 15 days after the scheduled payment date, Borrower agrees to pay a late charge of the greater of $ 20.00 or 10.0% of the installment amount. Lender may, at its option, waive any late charge or portion thereof without waiving its right to require a late charge with regard to any other late payment. PREPAYMENT: Bon•ower may make a fiill or partial prepayment of the unpaid Principal balance at any time (check applicable box): If this box is checked, Borrower ma} prepay this loan in whole or in part at any time without penalty. However, upon partial prepayment, interest will continue to accrue on any remaining Principal balance. Partial prepayment will not affect the amount or due date of subsequent scheduled payments on the loan, but may reduce the number of such payments. If this box is checked and Burrower prepays the entire outstanding Principal amount of this loan during the first three (3) years from the date of the loan, Lender may charge Borrower <: prepayment penalty equal to a percentage of the amount prepaid as follows: for prepayment in full within one year of the date of the loan, 3 m~: within two years, 2%; and within three years, 1 %. Upon partial prepayment, interest will continue to accrue on any remaining Principal balance. Partin( prepayment will not affect the amount or due date of subsequent payments on the loan, but may reduce the number of such payments. Borrower understands if the terms of this paragraph provide for a prepayment penalty, such terms do not apply to a renewal or refinancing of this loan by Lender, nor to the prepayment of this loan from the proceeds of any loan made in the future by Lender to Borrower. No prepayment charge will be collected ii' the loan is accelerated due to Borrower's default or Lender's exercise of any due on sale clause in the Deed of Trust securing this obligation. SECURITY: This loan is secured by a lieu against the real property located at 149 N EAST ST CARLISLE PA 17013 See Mortgage or Deed of Trust for terms applicable to Lender's interest in Borrower's real property ("Property") INSURANCE: If Borrower purchases «uy insurance at Lender's office, Borrower understands and acknowledges that (1) the insurance company may be affiliated with Lender, (2) Lender's employee(s) may be an agent for the insurance company, (3) such employee(s) is not acting as the agent, broker or fiduciary for Borrower on this loan, but may be the agent of the insurance company, and (4) Lender or the insurance company may realize some benefit from the sale of that insurance. If Borrower fails to obtain or maintain any required insurance or fails to designate an agent through whom the insurance is to he obtained, Lender may purchase such required insurance for Borrower through an agent of Lender's choice, and the amounts paid by Lender will he added to the unpaid balance of the loan. KETURNED C}IECK FEES: Lender may charge a tee, not [o exceed $ 20.00 , if a check, negotiable order of withdrawal or share draft is returned for insufficient funds or insufficient credit. LOAN CHARGES: If a -aw that applies to this loan and that sets maximum loan charges, is finally interpreted so that the interest or other loan charges collected or to he collected in connection with this loan exceed the permitted limits, then (i) any such loan charge will be reduced by the amount necessary to reduce the charge to the permitted limit, and (ii) any sums already collected from Borrower that exceeded permitted limits will be refunded to Borrower. Lender may choose to make this refund by reducing the principal owed under this loan or by making a direct payment to Borrower. If a refund reduces principal. the reduction will be treated as a partial prepayment without any prepayment charge. DEFAULT: Borrower will be in defaul! if he does not make any scheduled payment on time or fails to comply with the provisions of any mortgage on the real property which secures this loan. LP Borrower defaults, Lender may require Borrower to repay the entire unpaid Principal balance and any accrued interest at once. Lender's failure to exercise or delay in exercising any of its rights when default occurs does not constitute a waiver of those or any other rights under this agreement. As permitted by Pennsylvania Law, Borrower agrees to pay actual and reasonable attorney's fees, court costs, and other actual and reasonable cost, incurred in foreclosing on the real property securing this loan. Borrower will receive written notice at least 30 days prior to foreclosure. I.AW THAT APPLIES: Pennsylvania law and federal law, as applicable, govern this Disclosure Statement, Note and Security Agreement. If any part is unenforceable, this will not make any otl~ter part unenforceable. In no event will Borrower be required to pay interest or charges in excess of those permitted by law. Borrower, endorsers, sureties and guarantors, to the extent permitted by law, severally waive their right to require Lender to demand payment of amounts due, to give notice of amoums that have not been paid, to receive notice of any extensions of time to pay which Lender allows to any Borrower and to require Lender to show particular diligence in bringing suit against anyone responsible for repayment of this loan, and additionally, waive benefit of homestead and exemption laws now in force or later enacted, including stay of execution and condemnation, on any property securing this loan and waive the benefit of valuation and appraisemen[. 'Phis Disclosure Statement, Note and Seruriiy Agreement shall be the joint and several obligation of all makers, sureties, guarantors and endorsers and shall be binding upon them, their heirs, successors, legal representatives and assigns. if any part of the Disclosure Statement, Note and Security Agreement and, if applicable, the Mortgage or Deed of Trust and accompanying Itemization oEAmount Financed is unenforceable, this will not make any other part unenforceable. REFINANCING: The overall cost of refinancing an existing loan balance may be greater than the cost of keeping the existing loan and obtaining a second loan for any additional funds Borrower wishes to borrow. (Intentionally left blank) Over $50,000 - l st Mortgage Borrower's Initials PA 25422-14 S/2005 Original (Branch) Copy (Customer) ~~(~ ~~i~ Page 2 of 3 RUTH HOOVER DEBORAH HOOVER 205260 02/21/2008 _AUTHORIZATION TO USE CRF,_DIT RF,PORT: By signing below, Borrower authorizes Lender to obtain, review and use information contained in the Borrower's credit report in order to determine whether the Borrower may qualify for products and services offered by Lender. This authorization terminates when Borrower's outstanding balance due under this Disclosure Statement, Note and Security Agreement is paid in full. Borrowermay cancel such authorization at any time by writing the following: Transaction Processing, 300 St. Paul Place, BSP13A, Baltimore, MD 21202. In order to process Borrower's request, Lender must he provided Borrower's full name, address, social security number and account number. The following notice applies only if this box is checked. ^ NOTICE ANY HOLDER OF THIS CONSUMER CREDIT CONTRACT IS SUBJECT TO ALL CLAIMS AND DEFENSES WHICH THE DEBTOR COULD ASSERT' AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED WITH THE PROCEEDS HEREOF. RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY THE DEBTOR HEREUNDER. By signing below, Borrower agrees to the terms contained herein, acknowledges receipt of a copy of this Disclosure Statement, Note and Security Agreement and, if applicable, the Mortgage ur Deed of "Trust and of the. accompanying Itemization of AmounC Financed, and authorizes the disbursements stated therein. WI"I'NESSES: ~~ -- -- SIGNED: ~J~"'`~f r'I ~' ,~~r`" ~ ~ ~~~-~ R TH (H_O,OVE ~ -Borrower ~Y~-LJ) ~~ ~c~4lllZt°tY~"t--cam--^ (Seal) DEBORAH HOOVER -Borrower (Seal) -Borrower CITIFINANCIAL SERVICES INC. ~~ 1 i. l(Nam an i ) 2/21/2008 15:16:26 SECURITY INTEREST OF NONOBLiGOK: Burrower only is personally liable for payment of the loan. Nonobligor is liable and bound by all other terms, conditions, covenants, and agreements contained in this Disclosure Statement. Note and Security Agreement, including but not limited to the right and power of Lender to repossess and sell the Property securing this loan, in the event of default by Borrower in payment of this loan. (Seal) (Seal) Date Signature Date Signature Over $50,000 - 1st Mortgage VA 25422-14 R/2005 Original (Branch) Copy (Customer) Page 3 of 3