HomeMy WebLinkAbout11-06-08
15056041125
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 0 2 9 9
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
2 0 4 1 6 6 5 4 1 0 2 1 0 2 0 0 8 1 1 2 6 1 9 2 6
Decedent's Last Name Suffix Decedent's First Name MI
M I L L E R D E A N W
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
4. Limited Estate
~
4a. Future Interest Compromise (date of prior to 12-13-82)
~ 5. Federal Estate Tax Return Required
Q 6. Decedent Died Testate
(Attach Copy of Will)
~ death after 12-12-82)
7. Decedent Maintained a Living Trust
A
0 8. Total Number of Safe Deposit Boxes
9
Liti
ation Proceed
R
i
d (
ttach Copy of Trust)
.
g
s
ece
ve ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COM PLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
D A V I D H S T O N E E S Q U I R E 7 1 7 7 7 4 ,z, 4 3 5
Firm Name (If Applicable) n~, o
r~
S T O N E L A F A V E R~ S H E K L E T SKI
First line of address
4 1 4 B R I D G E
Second line of address
S T R E E T
City or Post Office
State ZIP Code
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DATE FILED >]~,~
N E W C U M B E RL A N D P A 1 7 0 7 0
Correspondent's a-mail address: DSTONE(a~STONELAW.NET
unaer penaiaes or per)ury, i aeclare 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 preparer other than the personal representative is based on all information of which preparer has any knowledge.
,SJGNATURE PE SON SPONSIBLE FOR FILIN RETURN DATE
ADDRESS
15 SOUTH STON R E. SHIREMANSTOWN PA 17011
SIGNAT P HER THAN REPRESENTATIVE
DATE
. _-- - - _ flrl .?i_ .n ~
414 BRIDGE STREI=T NEW CUMBERLAND PA 17070
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041125 15056041125
J 15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: DEAN W. MILLER 2 0 4 1 6 6 5 4 1.
RECAPITULATION
1. Real estate (Schedule A) ........................................ 1. 6 5 0 0 0 0 0
2. Stocks and Bonds (Schedule B) .................................. 2. 2 4 6 4 7 , 1 4
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages i3< Notes Receivable (Schedule D) ...... . . . . .. . .. . .... . 4
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) .... ... 5. 5 9 4 7 6 3 4
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. 1 0 2 0 3 , 3 4
7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property
(Schedule G) ~ Separate Billing Requested .... ... 7. ,
8. Total Gross Assets (total Lines 1-7) ........................ ... 8. 1 5 9 3 2 6 8 2
9. Funeral Expenses 8 Administrative Costs (Schedule H) .............. .. 9. 2 4 8 9 5 5 6
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .......... .. 10. 8 . 4 0
11. Total Deductions (total Lines 9& 10) ......................... .. 11. 2 4 9 0 3 9 6
12. Net Value of Estate (Line 8 minus Line 11) ....................... .. 12. 1 3 4 4 2 2 8 6
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, 1 3 4 4 2 2 8 6
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 _ 0 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 1 3 4 4 2 2. 8 6 16. 6 0 4 9. 0 3
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 1 g 0. 0 0
19. Tax Due ................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056042126
side 2
6 0 4 9. 0 3
15056042126 J
REV-1500 EX Page 3
,Decedent's Complete Address:
File Number
21 08 0299
Tax Payments and Credits:
~~ Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments 5 500.00
C. Discount 289.47
3. InteresUPenalty if applicable
D. Interest
E. Penalty
(3)
(1) 6,049.03
Total Credits (A + g + C) (2) 5,789.47
Total InterestlPenalty (D + E )
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.
0.00
(4) 0.00
(5) 259.56
(5A)
(5B) 259.56
Make Check Payable to: REGISTER OF W1LLS, 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; ............................... ^
^ Q
X^
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? ....................................................................................... ^
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ ^X
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. 0 ^
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)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 zero (0) percent
(72 P.S. §9116 (a) (1.1) (ii)j. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent (72 P.S. §9116(a}(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent (72 P.S. §9116(a)(1.3)j. 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
t51Alt OF
FILE NUMBER
DEAN W. MILLER 21 OS 0299
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 ro which is 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Property located at 28 North Enola Dr. Enola, East Pennsboro Twp., 65,000.00
Cumberland County, PA sold to Thomas Hostetler on June 30, 2008
TOTAL (Also enter on line 1,
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DEAN W. MILLER 21 08 0299
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
1 $1000 EE US Savings Bonds-(8)-dtd 5-1992 9,340.80
See attached list
2 $50 EE US Savings Bonds (60) see attached list 7,611.36
3 $50 EE US Savings Bonds (84) see attached list 7,126.26
4 $50 US Savings Bonds (5) see attached list 568.72
TOTAL (Also enter on line 2 Recapitulation} I S 24 647 14
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
I" RESI DAENTED EoENTR" PERSONAL PROPERTY
ESTATE OF FILE NUMBER
DEAN W. MILLER 21 08 0299
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 VALUE AT DATE
DESCRIPTION OF DEATH
1. 2002 Harley Davidson 1200 Custom Classic Motorcyle 6,000.00
sold to Michael Miller
2 2005 Dodge Caravan Minivan sold to Joe Betalik 9,300.00
3 Allstate Insurance Co.-refund on car insurance
74.50
4 Comcast-refund on service
22 29
5 Commerce Bank-Premier Savings Acct #410164746
Princ. $41,910.16, Int. $11.39 (Bernadine D. Miller, spouse, has 41910.16
predeceased the decedent)
6 Commerce Bank-Premier Savings Acct #410164746 -Accrued Interest 11.39
7 Donegal Insurance-refund on homeowners insurance
207.00
8 Unclaimed personal property-check received
1,326.00
9 US Treasury-refund on final 1040 income tax return
625.00
TOTAL (Also enter on line 5, Recapitulation) I ; 59 4
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (6-98)
' SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DEAN W. MILLER 21 08 0299
H an asset was made joint within one year of the decedents date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Wesley E Miller 15 South Stoner Avenue Son
Shiremanstown, PA 17011-
13
c
JOINTLY•OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY ova OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1 A 06/29/9 Sovereign Bank-Checking Acct #0921708254 20,406.68 50. 10,203.34
Joint with Wesley E. Miller as of 6-29-1995
TOTAL (Also enter on line 6, Recapitulation) I S 10
(If more space is needed, insert additwnal sheets of the same size)
REV-1511 EX + (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
DEAN W. MILLER 21 08 0299
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
1. K & KFlowers-flowers for funeral 183.45
2 McCracken Funeral Chapel Inc.-funeral expenses 9,424.81
3 Reserve for grave marker 200.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City State Zip
Year(s) Commission Paid:
2, Attorney Fees David H. Stone, Esquire
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4• Probate Fees Register of Wills, Cumberland County
5 Accountant's Fees
6. Tax Return Preparet's Fees
7,456.00
306.00
7. Bankers Life-insurance premium 138
19
2 Bankers Life Ins-premium due .
138
19
3 East Pennsboro-payment for curbing at property .
'1
209
00
4 John Johnson-hauling at property ,
.
300
00
5 Register of Wills-short cent .
16
00
6 Cumberland Law Journal-advertising grant of letters .
75
00
7 The Patriot News Co.-advertising grant of letters .
141
24
8 Register of Wills-filing Inheritance Tax Return and Inventory .
30
00
9 Settlement charges on sale of property ($5,205) less reimb on taxes ($127.32} .
5
077
68
10 Reserve for closing expenses ,
.
200.00
TOTAL (Also enter on line 9, Recapitulation) ~ S
(If more space is needed, insert additional sheets of the same size)
895.56
REV-1512 EX + (12.03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, ~ LIENS
ESTATE OF FILE NUMBER
DEAN W. MILLER 21 08 0299
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION VAOF DEATHTE
1 Quantim Imaging-services rendered
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
a
8
8.40
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
DEAN W. MILLER 21 08 0299
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY
~) Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)J
1. Wesley E Miller Lineal
15 South Stoner Avenue
Shiremanstown PA 17011-
2 Kevin DMiller-Ihli Lineal
2316 Halls Grove Road
Gambrills MD 21054-
3 Michael W. Miller Lineal
Box 149 -207 Washington Street
Robinson, PA 15949
AMOUNT OR SHARE
OF ESTATE
44,807.62
44,807.62
44,807.62
~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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 ~ $
(If more space is needed, insert additional sheets of the same size)
Last Will and Testament
of
Dean W. Miller
I, DEAN W. MILLER, of 28 North Enola Drive,
Enola, Pennsylvania, being of sound mind, memory and under-
standing, do hereby make, publish and declare this as and
for my Last Will and Testament, hereby revoking and making
null and void any and all Wills, or Writings in the nature thereof,
by me at any time heretofor made.
FIRST: I direct that my just debts, funeral expenses
and the expenses of the administration of my estate, be in the
first place fully paid and satisfied by my hereinafter named
Executrix as soon as may be after my decease.
SECOND: All the rest, residue and remainder of my
estate, of whatsoever kind or nature and wheresoever situate,
of which I die seized or possessed, I give, devise and bequeath
to my wife, BERNADINE MILLER, if she survives me.
THIRD: In the event my wife, Bernadine Miller, should
predecease me, or die in a common disaster with me, then and
in that event I glue, devise and bequeath all the rest, residue
and remainder of my estate, of whatsoever kind or nature and
wheresoever situate, to my three sons, namely: WESLEY E.
MILLER, KEVIN D. MILLER, and MICHAEL W. MILLER,
in equal sharsa, share and share alike.
FOURTH: In the event any of my said sons should
predecease me, then I will and direct the share of such
deceased son shall be distributed as follows : One-half (1/2 )
of such deceased son's share, plus one-percent of said share
for each year of marriage to my son, shall go to the widow of
of such deceased son, the balance of such deceased son's
share to go to his children, if any, tf no children then said
balance shall become part of my residuary estate and be
distributed to the living brothers.
FIFTH; I nominate, constitute and appoint my wife,
HERNADINE MILLER, to be the Executrix of this my Last
Will and Testament. In the event my said wife should predecease
me or for any reason be unable to serve as such Executrix,
then I nominate and appoint my son WESLEY E. MILLER, to
be Executor of this my Last Will and Testament, to serv±~.
without being required to furnish a Fiduciary Bond. My said
son, Wesley M. Miller, to be re-imbursed for his expenses to
connection with the administration of my estate, or he may
charge whatever Executor's Fee he feels proper, but not to
exceed the usual and customary fee of 5~ of the value of my
estate .
IN WITNESS WHEREOF, I, the said DEAN W.
MILLER, have caused this my Last Wtli and Testament to be
typewritten and to which I have hereunto set my hand and
seal this ~ ~-'~~-- day of~J/une 198~)0/. ~
Dean W. Miller
Signed, Sealed, Published and Declared by the above
named Testator, Dean W. Miller, as and for his Last Will
and Testament in the presence of us, who, at his request and
in his presence and in the presence of each other have hereunto
set our hands as witness of his Last Will a d yT~estament.
WITNESS: *~~3~vv
~c~
~ 7lJ(/ `~
/1
WI TNESS:T~~~~~t,~,v fzpp.2 s'~ ~,/J,.', `~3~, ,rte,
MARY C. SCNANER, Notary Publip
East Pennaboro Township
Cumberland County
~ Commission Expires Oet. 30, 1982
T'
F P~ DOC'S'.RF' DE D' !vI i I ler. Dean-executors deed. w ptl
DEED
THIS INDENTURE made the ~~~day of 5~~~ , in the year 2008, between
WESLEY E. MILLER, as Executor of the Estate of DEAN W. MILLER, late of County of Cumberland
and Commonwealth of Pennsylvania, of the first part, hereinafter called the Grantors,
-AND-
THOMAS HOSTETLER, of the second part, hereinafter called the Grantee;
WHEREAS, the said DEAN W. MILLER became in his lifetime seised, as of fee, of and in to a
certain tract of land, together with the improvements thereon erected, situate in the East Pennsboro
Township, County of Cumberland, and Commonwealth of Pennsylvania, and more particularly
described hereinafter; and being so thereof seised, died on February 10, 2008, having first made his Last
Will and Testament in writing dated June 13, 1980, duly probated and registered in the Office of the
Register of Wills of Cumberland County on March 17, 2008, wherein and whereby he appointed as
Executor, the said WESLEY E. MILLER, to whom Letters Testamentary were duly issued by said
Register of Wills on March 17, 2008 wherein and whereby said premises hereinafter described were not
specifically devised, all as in and by said Will and the records of said Register of Wills more fully
appears;
NOW THIS INDENTURE WITNESSETH, that the said Grantor, for and in consideration of
the sum of SIXTY FIVE THOUSAND AND 00/100----------($65,000.00)---------- Dollars, which has
been paid to him by the said Grantee at or before the sealing and delivery hereof, receipt whereof is
-1-
hereby acknowledged, has granted, bargained, sold, aliened, released and confirmed, and by these
presents does grant, bargain, sell, alien, release and confirm unto the said Grantee,
ALL THAT CERTAIN lot or piece of land situate in East Pennsboro Township, Cumberland
County, Pennsylvania, bounded and described as follows:
BEGINNING at a point in the easterly line of Brick Church Road at the distance of two
hundred fifty-five (255) feet measured southwardly along said easterly line of Brick Church Road from
the southwesterly extremity of the arc or curve connecting the southerly line of Perry Street with the
said easterly line of Brick Church Road and extending thence north 79 degrees 40 minutes east one
hundred fifteen (115) feet to a point; thence south 10 degrees 20 minutes east fifty (50) feet to a point;
thence south 79 degrees 40 minutes west one hundred fifteen (115) feet to a point in the easterly line of
Brick Church Road north 10 degrees 20 minutes west fifty (50) feet to the Place of BEGINNING.
BEING improved with a two and one-half story frame dwelling house.
BEING the same premises which Franklin E. Shumberger, Administrator of the Estate of Grace
Edna Shumberger, late of East Pennsboro Township, Cumberland County, Pennsylvania, deceased, by
their deed dated December 22, 1971 and recorded in Deed Book K24, Page 954, Cumberland County
records, granted and conveyed unto Dean W. Miller and Bernadine D. Miller, his wife. Bernadine D.
Miller died on November 4, 2006, thus by operation of law vesting title in Dean W. Miller, the
decedent.
BEING known and numbered as 28 North Enola Drive, Enola, Pennsylvania.
-2-
TOGETHER with all and singular the buildings, improvements, ways, streets, alleys, passages,
waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever,
thereunto belonging or in any wise appertaining and the reversions and remainders, rents, issues and
profits thereof, and all the estate, right, title, interest, property, claim and demand whatsoever of them,
the said DEAN W. MILLER, at and immediately before the time of his decease, in law, equity, or
otherwise howsoever, of, in, to or out of the same.
TO HAVE AND TO HOLD the said lot or piece of ground above described, with the buildings
and improvements thereon erected, hereditaments and premises hereby granted or mentioned, and
intended so to be, with the appurtenances unto the said Grantee, to and for the only proper use and
behoof of the said Grantee, forever.
And the said Grantor, for himself and his respective heirs, executors and administrators, does
covenant, promise and agree to and with the said Grantee, his heirs and assigns, that they, the said
Grantor, have not heretofore done or committed any act, matter or thing whatsoever whereby the
premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged, or encumbered
in title, charge, estate or otherwise howsoever.
IN WITNESS WHEREOF, the said Grantor has hereunto set her hand and seal the day and
year first above written.
-~1
fitness
L~~~~ ~ • ~~~ (SEAL)
WESLEY .MILLER, as Executor of the
Last Will and Testament of DEAN W. MILLER
-3-
COMMONWEALTH OF PENNSYLVANIA :
SS:
COUNTY OF ~ ~~,,'a ;
On this, the ~~ day of`S~'~" 2008, before me a Notary Public, the undersigned officer,
personally appeared WESLEY E. MILLER, as Executor of the Last Will and Testament of DEAN W.
MILLER, known to me or satisfactorily proven to be the person whose name is subscribed to the within
instrument, and acknowledged that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereto set my hand and notarial seal.
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL Notary Public
CAROL L. TROXELL, Notary Public
New Cumberland Boro. Cumberland Co.
My Commission Expires Dec. 27, 2009
I hereby certify that the precise address of the Grantee is
Attorney for
-4-
Calculated Value of Your Paper Savings Bond(s)
Page 1 of
Calculated Value of Your Paper Savings Bond(s)
Bonds: 1-8 of 8
45673940 EE $1,000 05/1992 05/ OS/~~
45673941 EE $1,000.05/1992 05/2008 05/2022
456793939 EE :$1,000 05/1992 05/2008.05(2022
45673938 EE $1,00005/1992 05/2008 05/2022
45673937 EE $1,000 05/1992.05/2008 05/2022
45673936 EE $1,000 05/1992 05/2008.05/2022
45673935 EE $1,000 05/1992 05/2008 05/2022
45673934 EE
$1,000 05/1992 05/2008 05/2022
Totals for 8 Bonds ~a
NI Not Issued •
NE Not eligible for payment
P5 Includes 3 month interest penalty
MA Matured and not earnin interest
$500.00 $667.60: 4.00% ¢1,167.60
$500.00 $667.60 4.00% $1,167.60
$500.00 $667.60 .4.00% $1,167.60
$500.00 $667.60 4.00% $1,167.60
$500.00 $667.60 4.00% $1,167.60
$500.00 $667.60 4.00% X1,167.60
.$500.00 $667.60 4.00% X1,167.60
$500.00 $667.60. 4.00% $1,167.60
,000.00 $5,340.80 ~9.3arf_~en
http://www.treasurydirect.gov/BC/SBCPrice
327/~~naz
Calculator Results for Redemption Date 03/2008
Calculated Value of Your Paper Savings Bond(s)
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 03/2008
.00 $7,611.36 $6,111.
Bonds: i-60 of 60
.94
Page 1 of
1137861199
1137831671 EE
EE $50 07/1983 07/2008 07/2013
$25.00
_ $71.98 ~
. 3.62% ~
$96.98
1148499191
EE $50 07/1983 07/2008 07/2.013 '
$50 09/1983 09/2008 09(2013 $25.00
$25
00 $71.98
7 3.62% $96.98
1148467578
1144468406
EE
$50 09/1983 09/2008 09/2013 .
$25.00 $
1.98
$71.98 3.62%
3.62%
$96.98 _
$96.98
1152884128 EE
EE $50 09/1983 09/2008 09/2013
$50 11/1983 05/2008 11/2013 $25.00
$25
00 $71.98 3.62% $96.98
1148588623
1148558098 EE
$50 11/1983 05/2008 11/2013 .
$25.00 $67.80
$67.80 . 4.08%
4.08% $92.80
$92
80
1114238569ee
~ EE
EE
~~ $50.10/1983 04/2008 10/2013
$50
12/1982.06/2008 12/2012 $25.00
$25 00 $70.00 4.1,8% .
$95.00
1114207311ee
1835
EE ..
~~ ~ ~ - ~
$50 12/1982 06/2008: 12/2012; .
~ - -... ~. . ~.
$25.00
.,. $89.98
$89.98 o
~ 4.00 /o
4.00%
, _,$114.98
$114
96
20848
1101265248 EE
EE $50 01/1982.07/2008,..01/2012
$50 08/1982 08/2008 08/2012 .
$25.00
25 $100.,38 „4.00% .
$125.38,
1101213662ee
1114123831
EE
$50 07/1982 07/2008 07/2012 $
.00
$25.00 $97.92
$97.92 4.00%
4.00% $122.92
$122
92
ee
1103413797ee EE
EE $50 10/1982 04/2008 10/2012
$50.10/1982 04/2008 10/2012 _ $25.00
$25
00 $95.50
95 4.00% .
$120.50
197631565ee
1114177205
EE
$50.06/1982 06/2008 06/2012 .
$25.00 $
.50
$97.92 4.00%
4.00% $120.50
$122
92
ee
1103263476ee EE
EE $50 11/1982 05/2008 11/2012
$50 08/1982 08/2008 08/2012 $25.00 $89.98 4.00% '
$114.98
1103327451ee
183553145
EE
$50 09/1982 09/2008 09/2012 $25.00
$25.00 $97.92
$97.92 4.00%
4.00% $122.92
$122
92
ee
183607029ee EE
EE $50 01/1982.07/2008 01/2012.
$50 02/1982 08/2008 02/2012 $25.00 $100.38 4.00% .
$125.38
191190237ee
191221389
EE .
$50 03/1982 09/2008 03/2012 $25.00
$25.00 $100.38
$100.38 4.00%
4.00% $125.38
25
$1
38
ee
197577429ee EE
EE $50 03/1982 09/2008 03/2012
$50 05/1982 05/2008 05/2012 $25.00 -
$100.38 _
4.00% .
.
$125.38
1101182709ee
1158662272 EE
$50 06/1982 06/2008 06/2012 $25.00
$25.00 $97.92
$97.92 4.00%
4.00% $122.92
$122
92
ee
177400213ee EE
EE $50 12/1983 06/2008 12/2013.
$50 12/1981 06/2008 12/2011 $25.00 $67.80 4.08% .
$92'80
177276974ee EE
$50 10/1981 04/2008 10/2011 $25.00
$25.00 $100.38
$100
38 4.00%
4
00% $125.38
177309273ee
177341881ee
EE
EE
$50 11/1981 05/2008 11/2011
$25.00 .
$100.38 .
4.00% $125.38
$125.38
162241457ee
EE $50 11/1981 05/2008 11/2011
$50 09/1981 09/2008 09/2011 $25.00
$25
00 $100.38 4.00%
$125.38
162208299ee
177222593 EE
$50 09/1981 09/2008 09/2011 .
$25.00 $102.88
$102.88 4.00%
4.00% $127.88
$127
88
ee
162147939ee EE
EE $50 10/1981 04/2008 10/2011
$50 08/1981 08/2008 08/2011 $25.00 $100.38 4.00% .
$125.38
162115405ee
EE
$50 07/1981 07/2008 07/2011 $25.00
$25.00 $102.88
$102
88 4.00%
4
00% $127.88
162083783ee
157488723ee
EE
EE
$50 07/1981 07/2008 07/2011
$25.00 .
$102.88 .
4.00% $127.88
$127.88
157521557
EE $50 05/1981 05/2008 05/2011
$50 05/1981 05/2008 05/2011 $25.00 $102.88 4.00% $127.88
157556393ee
EE
$50 06/1981 06/2008 06/2011 $25.00
$25.00 $102.88
$102.88 4.00%
4.00% $127.88
$127.88
http: //www. treasuryd i rect. go v/BC/S BC P ri ce
3/26/2008
Calculated Value of Your Paper Savings Bond(s)
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 03/2008
.00 $7,126 26
- $5,026.26
Bonds: 1-84 of 84
.42
Page 1 of
317078248
335633353 EE
EE $50 04/1987 04/2008 04/2017.
$50 07/1987 07/2008 07
2
7
$25.00, • ~ ~
$46.18 4.00% •
$71.18.
335535004 EE /
01
$50 06/1987 06/2008 ,06/2017 $25.00
$25.00 $46.18
$46
18 4.00%
4
0
~ $71.18:
,
327979485
327878682 EE
EE $50 06/1987 06/2008 ~ 06/2017
$50 05
19 $25.00 .
$46.18 .
0%
4.00% $71.18
$71.18
327775393 EE /
87 05/2008 05/2017
...$50.05/1987 05/2008.. 05/2017 $25_._00
$25
00 $46.18 ..4.00% $71.18:
327680323
253253871 EE
EE .
-
$50 04/1987 04/2008 04/2017, .
$25.00 $46.18
$46.18 ,.,. 4.00%
4.00% $71.18:
18
$71
253290369
_.
EE $50 01/1986 07/2008,01/20.16.
$50 01/1986 07/2008.
01/20
16
$25.00
$25
00
$59.00
59
0
4.00%
° .
:
$84.00 __
265215364
316975794
EE
E .
.
$50 02/1986 08/2008. 02/20.16
~ ~
5
~ .
$25.00
~ .
0
$ _
$59.00
" ~~ 4.00 /o
4.00%
_ . .$64,00...
$84
00
.
.3166668231 E
EE $
0.03/1987 092008 03/2017
_.
/
$50 02 1987 08/2008 02/2017
... $25,.00.. ~~~~
. _.. $47.60
~ _
4.00% .
._
$72.60
316867977
EE
$50 03/1987 09/2008f03/2017 25.00
$
$25.00
$47.60
$47
60 o
4.00/0
4
0
$72.60
316770597
287347209 EE
EE < -
$50 02/1987 08/2008 02/2017
.
$25.00 .
$47.60 .
0%
4.00% $72.60
$72
60
314060354 EE $50 01/1987 07/2008 ~ 01/2017
$50 01/1987 07/2008 01/2017 $25.00 $47.60 .
4.00% .
....
$72.60
314024103
EE
~$50 01/1987 07/2008= 01/2017 $25.00
$25.00 $47.60
$47
60 4.00%
4
$72.60.
313988271
265283951 EE
EE $50 12/1986 06/2008 12/2016
$25.00 .
$47.60 .00%
4.00% $72.60
$72
60
265318677
EE $50 02/1986 08/2008 02/2016
$50 03/1986 09/2008 03/2016 $25,.00 $59.00 4.00% .
$84.00
265386689 EE $50 04/1986 04/2008. 04/2016. $25.00
$25.00 $59.00
$57
36 4.00%
4
0 $84.00
265420918
265455956 EE
EE -
$50 04/1986 04/2008 04/2016
~
$25..00 .
$57.36 .
0%
4.00% $82.36
36
$82
.267894187 EE $50 05/1986 05/2008
05/2016
$50 06/1986 06/2008 06/2016 $25.00 $57.36 - -
4.00% .
-
$82.36
.269753178
2 EE $50 06/1986 06/2008 06/2016
-- $25.00
$25.00 $57.36.
$57
36 4.00%
4
0 $82.36
69789648
269825690 EE
EE - -
$50 07/1986 07/2008 07/2016
$25.00 .
$57.36 .
0%
4.00% $82.36
$82
36
.
269863401 EE $50 07/1986 07/2008 07/2016
$50 08/1986 08/2008 08/2016 $25.00 $57.36 4.00% .
$82.36
269902205
2 EE $50 08/1986 08/2008 08/2016 $25.00
$25.00 $57.36
$57
36 4.00%
4
0 $82.36
69940739
269976071 EE
EE $50 08/1986 08/2008 08/2016 .
$25.00 .
$57.36 .
0%
4.00% $82.36
$82
36
270012153 EE $50 09/1986 09/2008 09/2016
$50 09/1986 09/2008 09/2016: $25 00 $57.36 4.00% .
$82.36
279380128 EE $50 10/1986 04/2008 10/2016. $25.00
$25.00: $57.36
$55
74 4.00% $82.36.
279418870
279455270 EE
EE $50 10/1986 04/2008 10/2016 ~
$25.00 .
$55.74 4.00%
4.00% $80.74
$80
74
291162373 EE $50 11/1986 05/2008 11/2016
$50 11/1986 05/2008 11/2016 $25.00 $47.60 4.00% .
$72.60
253150975
2 EE $50 11/1985 05/2008 11/2015 $25.00
$25.00 $47.60
$59
00 4.00%
4 $72.60
91198980
253218139 EE
EE $50 12/1986 06/2008 12/2016
$25.00 .
$47.60 .00%
4.00% $84.00
$72
60
$50 12/1985 06/2008 12/2015 $25.00 $59.00 4.00% .
$84.00
http://www. treasurydi rect.gov/BC/S BCPrice
Calculated Value of Your Paper Savings Bond(s)
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 03/2008
Page 1 of 1
Total PricE~ Total Value Totat Interest YTD Interest
125.00 568.72 443.72 2.24
Bonds: 1-5 of 5
Serial #i '}er-ies L:ertam Issue Next Fina! Issue Interest
Interest Value Nate
Date Accrual Ma#urity Price . Rate
L193689320EE EE $50 12/1984 06/2008 12/2014 $25.00 $62.40 4.00% $87.40
L124897318EE EE $50 02/1983 08/2008 02/2013 $25.00 $89.98 4.00% $114.98
L103382817EE EE $50 10/1982 04/2008 10/2012 $25.00 $95.50 4.00% $120.50
L97546229EE EE $50 04/1982 04/2008 04/2012 $25.00 $97.92 4.00% $122.92
L91278085EE EE $50 04/1982 04/2008 04/2012 $25.00 $97.92 4.00% $122.92
Totals for 5 Bonds $125 00 $443 72 $568 72
Notes
NI Not Issued
NE Not eligible for payment
P5 Includes 3 month interest penalty
MA Matured and not earnin interest
http://www.treasurydirect.gov/BC/SBCPrice 10/8/2008
March 26, 2008
David H. Stone
Stone, LaFaver & Shekletski
414 Bridge St PO Box E
New Cumberland, PA 17070
RE: Estate of: Dean W. Miller
Tax Identification Number: 204-16-6541
Date of Death: February 10, 2008
To Whom It May Concern:
Commerce
Bank
This letter is in reference to decedent account information you requested for the
individual listed above.
We are able to provide the following:
Account Type: Joint Premier Savings (with right of survivorship)
Account Number: 410164746
Date Opened: August 1, 1997
Primary Owner: Dean W. Miller
Secondary Owner: Bernadine D. Miller (deceased)
Date of Death Balance: $41,921.55
Accrued Interest: $11.39
Principal Balance: $41,910.16
Please feel free to contact me at (717) 412-6127 if I may be of further assistance.
Sincerely,
Cindy Shultz
Research Associate/Deposit Services
Commerce Bank
Commerce Bank /Harrisburg, N.A.
PO Box 4999
3801 Paxton Street
Harrisburg, PA 17111-0999
commercepc.com
S~t~ ~ r~ur~'rtct~. ~ pan ~ 1'„~
P.O. Box 841005
Boston, MA 02284
March 28, 2008
Stone LaFaver & Shekletski
Attorneys at Law
P.O. Box E
New Cumberland, PA 17070
RE: Estate of Dean W. Miller
Date of Death: February 10, 2008
Dear Mr. Stone:
Per your request, enclosed please find the account information as of date of death for the
above-named decedent. Please note the balances do not include accrued interest.
If you should have any further questions, please do not hesitate to call.
Very truly yours,
(.,%-C' -
Linda Spavento
Team Leader
Court Order Processing
(617) 533-1789
(617) 533-1931-fax
Sovereign Bank
ESTATE OF Dean W Miller
SOCIAL SECURITY #: 204-16-6541
DATE OF DEATH: February 10, 2008
Account #: 0921708254 Type: Checking Open date: 6/29/1995
In the name of: Dean W Miller or Wesley E Miller
Date of Death Balance: $20,406.68
Int.(YTD) from 1/1/2008 to 2/8/2008 $63.43
Accrued interest to date of death: $0.00
Other Info:
Page 1 of 1
~ -
aa. 'Settlement Statement U.S. Dspartmsnt Of Housing OMB Approval No. 2502-0265
and Urban Deva:lopmertt (axwras 11/30!2009)
Q. of Lan
O. CKS Number: 7. loan Nambar: a. Morbpa Inwrwiw Cos Nurr~bar
1. ~ FHA 2. ~ Fmliq 3. ^ COnv. Unir15. A06-038285-SiYi y/A ~/jt
4. [] VA 5. Conv. Ins, lCasltJ
C. Note: This form is fumkhsd t0 ghre you w itwterrtent of actual sagbrrrent costs. Arrwurrts by the settbmerd
"(p.o.c)' wane paid outside the closing; tMY wro shown hero for informational purposes and ro net Mduded in thethe totalsare shown. Items marked
D. Name 6 Atldross Of nprrnyvar: E Nerns 6 Address of GeNsr-
TAOfnad HosNaUer F. Nsme 6 Address of I.andor:
4d4 171-eaenut Wiy jytola Dr/w /o•
Nawv Cunfbwrlanal, PA 17070 6-o/a, PA 1 fOZS PA
?Q MCN'U+ PrtON AAv!
Erlo/a, PA 17028
Cumbwiarrd County
J. summary of idorro~
100. Oroea Amourrt DI
101. Contrwot sw1~s prk
102. Personal ProoertY
103. 3ettlerrtant charge
104.
1 OS.
Ad]ustrrreribs for Iberns
10C. CkYROwn tgxaa
t177. County taxes o
708. Assessments o
1 O0. )tarado3,lpal s O
110.
111. '
112.
to borroNrer
seller in
to
l01 to
roe to
'ODD -
202. Prime amount of new ben s)
203. Existing loan(s) taken subject to
204.
Zoe. r(GS,oo~. va
207. ~~~
408.
t. sattiement Date:
OfR/3Ar200e
seller
sz3. as 4u~. county taxes oe/so/rocs t,
,4Z. 3Y 408. Aasasamenta 06/~O/YOOB to
12.26 408. ~iotp,rt,i : 06/30/2008 -
410.
411.
412.
jai • D7 420. Oros Amount Dw To Selier
OO
to aeNer (lim
m subject to
166,000.00
ss. as
82..!2
12.16
~sa,=s~.sz
1S,TOb.OO
2oa 107.
. Vi
P~
tog. a.
sac s. o~
Ad)ustmenls for lMma unpaid fl y aalle ~ f• 7
3
21 O. Cllykown taxes to ; .
510
21,. county taK.a
~ .
~ 8
S r~~
212. Assessments
to ,
6,,.
413. 612.
214 b13.
21 S.
216.
217.
218.
219.
220. Total P.ia d,.R......
taxes to
Kai b
mb ~
814.
$18.
b1lg.
617.
518.
579.
0,,000.00 640. Tobl 1laduction Amourrt Qua>,sller Bs,YOS. 00
600• l7aah At satftsmsrtt To/From Sstisr
66, 732.37 801. Groan amount due to sailer (lino 420) •f65 127 32
.R AAA nn 1 cn••
- --- -~ ioouuions in amt. due seller (line S20) ~ ( 15,205.00 t
• w -
"`~°• •+~~ Ip1 From U To Sorrowar ~ 163,732.57' 603 Gash ®To
Q Fro
159
S
ll
Seotlon 6 01 the Raai Estate Settlement ProoWuros Act {{RREBPA)
roquirea the folbwing: HUD moat dawlo
a S
i m
e
er
922 32
Section 4(w) 01 RESPA rrlgnglatel: that MUD ctwslv
r
anc
pac
P
al Infomwtbn
Beokbt to he persons borrowing money to ftnanoa the purMwse of
resldentlal ra~til wstatw t
b p
p
ascnua tats
standard tbnn to tie used at the time of ban settlement to Provide Lull
disryosurc of aN the es ern
d
p
ettor understand ttre nature and oost8 Of
roal estate ssltletfiat-t aeroicas; Each tinder must provide the bo
kNt ose
These ane thiM party disClosuros tha~ arty t dasignwd~ nr provides the
t
o
to ell applioanb from whom N raoelvas or for whom k prepares s
wriKsn aPPlicatbn to borro forrower with pprtinpnk information Burin
g the settbment process in
order to Oe a r shopper
w money to ttnanw the Purchase of
rwsldantirl rani estate• ~ Lenders must propwro wnd dishibute with the
Booklet a flood Fakh E
ti ,
The PubNc Reporting Burden for this aoNeotien of information is
~Mn°~ t
s
mate of the settbmertt costs ttiwt tl-a
borrwvsr b likely to Incur In connodion with the seWwment
Th o swage one hour per reapanae, including the time for
i~svieVWng instructtona
searching existin
d
t
.
.^e
diadosunsa ere mandatory. ,
g
a
a sources, gethertng
and ma ntaining the data needed, and completing wad roviewin
th
g
e
oollsotlon of infomtatlon.
This tlgenoy may not ooibot this infortnatbn, and yyou an not requirod
to complete this form, unless it displays a currentl
wMd O
y
MB eentrol
number.
Ths Inforrnatlon requested does not fond ksalf to conlidsntiaNt
Pr~vioue editions ere obsolete y.
Page 1 of 2 form MUD-1 (3/88)
ref Handbook 4305.2
Law l7fNca of barrel/ C. iDefih/s/s
TTN: ?~17Z7tf31
Place of Settlement:
2132 Mw-Rwt Sheet
Cwmlo NAl, PA !7011
K. summary of sdbr'a TAnsectio
L00_ t3roas Amount Dua Tp 9allor
O_ DO. 00 401. Contract styles prior
402. Parsons! ona.wA..
--~ ~,
4. bettlement Char
es
g
a 00- Toth t3alea/Broker's Commission based on prig: d65
000
00 7 '
,
.
Dlvlslon Of Commission (Mne 700 as fOllews: ~= d4, 550.00 p+ld Frpm Pslq From
701, f dp, 6?5.00 to Z>vQaw Raa2ty Otou~ FurWs Ms FurW~ ~t
702. ; d1,?.45.00 to Cen tuzy YZ wilak `~nk~nt Set11C1r1Cnt
703. Comrttisaion paid at Settlement
704. R5t'an/aation tee tv waiw}/trpltt d4, 560. 00
>l00. toerne able In Coiaiectlon tllflth Loan d1~r0. 00
801. Lean O nation Fa+ y~ p/A
80~. Loan Discount ob A/A
803. sisal Fee to p/A
a04. !rredlt rt t0 l1/A
a0a. Lenders In otlon Fee ~- A
aria. Mortnape Insurgnw Appllastfon 1=M to p/A .
eoa.
aoo.
a1a.
aia.
azo. -
900. Kama Rsquined By Lander To BB Pe1d In Advance
901. Ir-tervst from' os/ao/?ooe ~ o~/oz~~ooe ~g
902. Mortpa6e Insurance Premium /or months
9D3. Hazard Inwrance Premftsn for yeen to
6~' years t0
905.
1000. Reserves Deppeilad 1lilltl~ Lander
months
r710nti1
month
1100. TNte Charges
00
_ _ .. ~ .................s wn we r0 IJNI W7'IG7: Ct7' raaaReLL C. 11w17lZ>CJ'3
9102. Abstract or tkle aeereh !o
1103. Title examination ~
1104. Title insurance binder to
1106. Docixnent ro tlon to
1108
Note fete
.
~
1107. Alto s gees ~
(includes above Items numbers:
1108. Tkls Insuronae
a~
to
eaurify Title/Fart Office o! Darrell c, Dethlef.
(irtcludea above kerns numbers: ease - No Ned. d64B. 75
1106. unoerf COVeroQe i
1110. Owrters Mve ; d65, 000.00 ( 863, 000.00 )
1111.
1112.
1113.
1290. tiiOVenlrnent Raoordlnn anti Tr~..~I . r.~.~._._-
101. Reeordi tees: Deed S d40. s0 - Mo e i Releases S 740.50
1202• /oou tarvat Dead i ds10. OO ; Mc ~ b d6so. Do
1203. state tax/stamp~: Deed i drsso. oo ~ M a •;
1204 d 6.70.OD
7 205_
1300. Additional Settlamen! gtarges '
. asp. au t0 -
t302. Pest otion to
l
3
1
.
30
atr Office of Aarreis C. DetLleta (2'a~c cyrt }ta,impl
1304. Nut .learawbnre Ternahip Auttaori/~r (?rd quarter: Jti],y tA,[a S~ptJ
1306
dtID.00 db. DO
.
130fi.
1307.
1400. Total Settlement Charges (snbr on lines 103, tlfectlon J and 602, Section K) dl, 604. sa ds,?03.00
Provious editions errs otuntete p~ 2 of 2 form HUD-1 (3188)
ref Hsndbodc 4305.2
s
~~
• Certification
(continued from HUD-1)
1 have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,
R is a true end accurate statement of ell receipts enq disbunsementa made on my account or by me in this
~naact~n• I further oertffy that I haw r+eceivect a copy of the HUD-1 gettlement Statement.
Borrov-,er: //' ~ Seller or
Date: ~p ~ --~ ggent: 1/1, ~L Date: OL~~q~D~
oma Date er Weal Miler, ecutor ~~
Estate of Dean W. Milter
The HUD-1 3~sttlament which I have prepared is a true and axunab account of thl
Caused or will cause the funds to be disbun;ed in accordance with this statement- seetion. 1 have /~ r~
Date: Settlement Agent: (.. - ~G- °O
~""-- Date:
e squ re
WARNING: It Is a Crime to knowingly make false statements to the United States on thle or any other
similar fbrm_ Penalties upon canvlctlon can Include a fine and Imprlaonmsnt. For details
cee: Title 18 U. g, Codr Section 1001 and Section 1010.