HomeMy WebLinkAbout11-07-081505607121
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 2sosol 2 1 0 8 0 6 0 6
Hamsburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 8 2 2 2 8 9 8 8 0 4 3 0 2 0 0 8 0 6 3 0 1 9 2 9
Decedents Last Name Suffix Decedent's First Name MI
E N S O 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 Sociai Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Sate Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
J A C Q U E L I N E A K E L L Y 7 1 7 ~4 1 5~ 5 0
Firm Name (If Applicable)
' ~
REGISTEr~t ~3R~ILLS US~iNLY =~~
-.~, - , ~
!-t' C~
J A N L B R O W N & A S S O C
First fine of address ~~ ~ v f
~ -
8 4 5 S I R T H O M A S C O U R T `_~`- ~ f;
Second line of address =-`~ ~ -_ ?=~i
~'
S U I T E 1 2 cn
" `
City or Post Office State ZIP Code DATE FILED
H A R R I S B U R G P A 1 7 1 0 9
Correspondent's a-mail address: JACKIEJLBaVERIZON • NET
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 preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG URE OF P R ON RESPONSIBLE FO FILING R TURN DATE
>l_5-~
ADDRES r
651 GEORGIAN LACE HARRISBURG PA 1711,1
SI ATURE OF P)?EPARE~TFiE T N REPRESENTATIVE DATE
~ ~ }r
AD ES ,
8 5 SIR THOMAS COURT, STE 12 HARRISBURG PA 17109
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607121 1505607121 J
_~
1505607221
REV-1500 EX Decedent's Social Security Number
Decedent's Name. RUTH E• E N S O R 1 8 2 2 2 8 9 8 8
RECAPITULATION
1. Real estate (Schedule A) ....................................... 1. 1 0 2 4 0 0, 0 0
2. Stocks and Bonds (Schedule B) .............................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D) ..................... ... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... ... 5. 3 6 5 3 . 4 8
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. 5 8 7 9 . 9 9
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ....
... 7. 9 5 0 0 , 0 0
8. Total Gross Assets (total Lines 1-7) ........................ ... 8. 1 2 1 4 3 3, 4 7
9. Funeral Expenses & Administrative Costs (Schedule H) .......... 9.
10. Debts of Decedent, Mortgage Liabilities, & 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.
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.
16. Amount of Line 14 taxable
at lineal rate X .045 9 4 8 2 0. 4 7 16.
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
2 5 5 9 1. 3 0
1 0 2 1, 7 0
2 6 6 1 3. 0 0
9 4 8 2 0. 4 7
0, 0 0
9 4 8 2 D, 4 7
0. 0 0
4 2 6 6. 9 2
0, 0 0
0, 0 0
4 2 6 6. 9 2
0
Side 2
L 1505607221 1505607221 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 08 0606
DECEDENT'S NAME
RUTH E. ENSOR
___ -
STREETADDRESS
316 Second Street
CITY _ _ _ _ STATE ZIP
Enola PA 17025
Tax Payments and Credits:
~~ Tax Due (Page 2 Line 19) (1) 4 266.92
2. Credits/Payments
A. Spousal Poverty Credit
B, Prior Payments 3,700.00
C. Discount 194.73
Total Credits (A + B + C) (2) 3, 894.73
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total InterestlPenalty (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. (4) 0.00
5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 372.19
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) 372.19
Make Check Payable to: 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 : ................................................................ ...... ^ X^
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? ................................................. ...... ^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................................................................. ...... ^ Q
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ... ...... ^ Q
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.
For dates of death on or after July 1,1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12} percent [72 P.S. §9116(a)(1.3)]. 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
ATE OF
FILE
RUTH E. ENSOR 21 08 0606
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 jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Real property located at 316 Second Street, Enola, PA 102,400.00
See attached settlement sheet
TOTAL (Also enter on line 1
(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, & M{SC.
IN RES DENTEDECEDENT N PERSONAL PROPERTY
ESTATE OF FILE NUMBER
RUTH E. ENSOR 21 08 0606
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 65-foot trailer 3,000.00
2. ~ Reimbursement for county/twp taxes on real property @ 316 2nd St, Enola, PA ~ 47.52
3. Reimbursement for school taxes on real property @ 316 2nd St, Enola, PA ~ 605.96
TOTAL (Also enter on line 5, Recapitulation)' $ 3,653.4
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
RUTH E. ENSOR 21 08 0606
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Donald W. Ensor
e
C
JOINTLY-OWNED PROPERTY:
651 Georgian Place
Harrisburg, PA 17111
ADDRESS
ELATIONSHIP TO DECEDENT
son
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSE7 °!° OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTERESI
1. A. 08/64 M&T Bank 11,759.97 50. 5,879.99
Checking Account No: 30931878
TOTAL (Also enter on line 6, Recapitulation) $ 5 879 99
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS 8
MISC. NON-PROBATE PROPERTY
FILE NUMBER
RUTH E. ENSOR 21 08 0606
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
INCWDETHENAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAND
THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE.
DATE OF DEATH
VALUE OF ASSET
%OF DECD'S
INTEREST
EXCLUSION
pF APPLICA04E)
TAXABLE
VALUE
1. Transfer from joint checking, M&T Bank Acct #30931878 25,000.00 50. 3,000.00 9,500.00
to joint owner, Donald Wayne Ensor, in January 2008
TOTAL (Also enter on line 7 Recapitulation) I $ 9 500 00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
SCHEDULE H
EXPENSES &
FUNERAL
COMMONWEALTH OF PENNSYLVANIA .
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RUTH E. ENSOR 21 08 0606
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
.
1. Musselman Funeral Home & Cremation Services, Inc. 7,254.00
2. Rice Memorial Works; headstone 125.00
g. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City State Zip
Year(s) Commission Paid:
2 Attorney Fees Jan L. Brown & Associates 4,477.00
3, Family Exemption: (If decedents 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 247.00
5, I Accountant's Fees
6. I Tax Return Preparers Fees
7. Closing costs for real property at 316 Second Street, Enola, PA 12,545.71
8. Register of Wills, filing fees for Inheritance Tax Return and Inventory 30.00
9. Register of Wills, additioinal probate fees 50.00
10. Register of Wills, filing fee for family settlement agreement 20.00
11. Verizon; real property at 316 2nd St, Enola, PA 36.54
12. PA American Water; utilities for real property at 316 2nd St, Enola, PA 210.38
13. PPL; utilities for real property at 316 2nd St, Enola, PA 354.80
14. Comcast; utilities for real property at 316 2nd St, Enola, PA 53.32
15. Alleghy Power; utilities for real property at 316 2nd St, Enola, PA 81.16
16. UGI; utilities for real property at 316 2nd St, Enola, PA 106.39
TOTAL (Also enter on line 9, Recapitulation) $ 25.591.30
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF "" """"""
RUTH E. ENSOR 21 08 0606
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 OE DEATH
1, West Shore EMS 835.80
2. Internists of Central PA 104.90
3. Quantum Imaging & Therapeutic Associates 81.00
TOTAL (Also enter on line 10, Recapitulation) I $ 1
(If more space is needed, insert additional sheets of the same size)
PEV-1513 EX + (9-00)
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
L-
ESTATE OF
RUTH E. ENSOR
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2]]
1. Donald Wayne Ensor
651 Georgian Place
Harrisburg, PA 17111
2. Jacqueline R. Murphy
110 Srooksmill Road
Grantville, PA 17028
3. Dale H. Ensor
435 High Street
Enola, PA 17025
FILE NUMBER
21 08 060E
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
Lineal
Lineal
Lineal
41, 860.15
26,480.16
26,480.16
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.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
(If more space is needed, insert additional sheets of the same size)
OMB NO. 2502-0265 ~~i-
q. 8. TYPE OF LOAN:
DEPARTMENT OF HOUSING 8 URBAN DEVELOPMENT
U
S 1.QFHA 2.QFmHA 3.QCONV. UNINS. 4.QVA 5.QCONV. INS.
.
.
SETTLEMENT STATEMENT 6. FILE NUMBER:
wcrnoa-oo1o1 7. LOAN NUMBER'.
zza-za71s1
8. MORTGAGE INS CASE NUMBER:
10-10-6-0596529
C. NOTE: Thls form Is lumished to give you a statement o/actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "(POCJ" ware paid outside the closing; they are shown here /orin/ormationalyurposes and are not included in tha totals.
t.0 J/9B (VJCMO8~00101 PFDANCM00~00101192)
D. NAME AND ADDRESS OF BORROWER:
Tracy James Creguer
Mandl L Creguer
4128 Spring Valley Road
Harrisburg, PA 17109 E. NAME AND ADDRESS OF SELLER:
Eslale of Ruth E. Ensor
316 2nd Street
Enola, PA 17025 F. NAME AND ADDRESS OF LENDER:
American Mortgage Network, Inc
. dba AmNet Mortgage
P. O. Box 85462
San Diego, CA 92186
G. PROPERTY LOCATION:
316 2nd Street
Enola
PA 17025 H. SETTLEMENT AGENT: 25-1844509
Fidelity Closing Services, LLC I. SETTLEMENT DATE:
October 31
2008
,
Cumberland County. Pennsylvania PLACE OF SETTLEMENT
4206 Linglestown Road
Harrisburg, PA 17112 ,
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 102,400.00 401. Contract Sales Price 102,400.00
102. Personal Pro ert 402. Personal Pro ert
103. Settlement Char es to Borrower Llne 1400 403.
104. 404.
105. 405.
Ad'ustmenfs For Items Paid 8 Seller in advance Ad'ustmenfs For Items Paid B Seller in advance
106. Clt Rown Taxes to 406. Cit !Town Taxes to
107. Count ITw Taxes 10!31/08 to 01/01/09 47.52 407. Count /Tw Taxes 10/31108 to 01/01/09 47.52
108. School 10131/08 l0 07/01/09 605.96 408. School 10/31/08 to 07101109 605.96
1pg, 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 103,053.48 420. GROSS AMOUNT DUE TO SELLER 103,053.48
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. De osit or eamesl mone 500.00 501. Excess De osit See Instructions
202. Princi al Amount of New Loans 102 400.00 502. Settlement Cha es to Seller Line 1400 12,457.10
203. Existin loan s taken sub ecl l0 503. Exislin loans taken sub ect to
204. 504. Pa oti First Mort a e
205. 505. Pe oh Second Mort a e
206. 506.
207. 507. De osil disb. as roceeds
208. 508.
209. 509.
Ad'ustmenfs For Items Un aid 8 Seller Ad~ustments For Items Un aid 8 Seller
'.210. Cil /Town Taxes l0 510. Cit /Town Taxes to
'211. Count /Tw Taxes to 511. Count !fw Taxes to
212. School to 512. School to
213. Tax Proration Credit SA 88.61 513. Tax Proration Credit SA 88.61
214. 514.
215. 515.
216 516.
217 517.
218. 518.
219 519.
220. TOTAL PAID 8Y/FOR BORROWER
300. CASH AT SETTLEMENT FROM/TO BORROWER: 102,988.81 520. TOTAL REDUCTION AMOUNT DUE SELLER
600. CASH AT SETTLEMENT TO/FROM SELLER: 12,545.71
301. Gross Amount Due From Borrower Line 120 103 053.48 601. Gross Amount Due To Seller Line 420 103,053.48
302. Less Amount Paid 8 /For Borrower Line 220 ( 102,988.61) 602. Less Reductions Due Seller Line 520 ( 12,545.71
303. CASH (X FROM) ( TO) BORROWER 84.87 503. CASH (X TO) ( FROM) SELLER 90,507.77
L. SETTLEMENT CHARGES
Fege 2
700. TOTAL COMMISSION Based on Price E ~ % 5,368.00 PAID FROM PAID FROM
CJlVIS70n OI COmInI55fOn (I(ne 7001 8S FOIIOWS: BORROWER'$ SELLER'S
701.E 2,928.00 IO Jack Gau han Era FUNDS AT FUNDS AT
702. 2 44 .0 O W I e R el -Fir hole SETTLEMENT SETTLEMENT
703. Commission Peld at Settlement 5,368.00
704. t0
800. ITEMS PAYABLE fN CONNECTION WITH LOAN
801. Loan On ination Fee % to
802.LOan Discount % to
803. A praisal Fee to Narth Mountain Appraisals SA 450.00
804. Credit Report to Kroll Factual Data SA 78.99
805. Lender's Inspection Fee to
806. Mort a e Ins. A .Fee to
807. Assumption Fee to
808.
809. Underwriting Fee to American Mortgage Network, Inc. dba Am Net Mortga a SA 425.00
810. Processin Fee to Allied Home Mort a e SA 395.00
811. Tax Service Fee to American Mort a e Network, Inc. dba AmNet Mort a e SA 78.00
s12.
813.
814. Courier Fee to Allied Home Mort age SA 50.00
815, Flood Cert Fee to American Mon a e Network, Inc. dba AmNel Mort a e SA 10.00
816. BroKer Premium pd by lender to Allied Home Mongage POC.L3072.00
817.
B18.
819.
820.
t WCMOB-00101 / WCMOB-D0101 / 92
Fidelity Clos+ng Services, LLC, Settlement Agent
HUD-1, Page 3
Borrower (s): Tracy James Creguer Mandl L. Creguer Selierys): Estate of Ruth E. Ensor
4128 Spring Valley Road 316 2nd Street
Harrisburg, PA 17109 Enoia, PA 17025
Lender: American Mortgage Network, lnc . dba AmNet Mortgage
Settlement Agent: Fidelity Closing Services, LLC
(888)289-8092
Place of Settlement: 4206 Linglestown Road
Harrisburg, PA 17112
Settlement Date:October 31, 2008
Property Location: 316 2nd Street
Enola, PA 17025
Cumberland County, Pennsylvania
Additional Prorated Items
Description Amount From/Through Borrower Seller
Final Sewer and Trash
115.00 10/01/08 through 12/31/08
Total Line 1304
115.00
115.00
Additional Disbursements
Payee/Description Note/Ref No. Borrower Seller
East Pennsboro SD Tax Collector 1,001,21
2008-09 School Taxes 45-17-1044-127
Jack Gaughan Era 165.00
Transaction Fee
Total Additional Disbursements shown on Line 1305 $ 0.00 $ 1,166.21
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and
accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify
that I have received a copy of the HUD-1 Settlement Statement.
~~ Estate of Ruth E. Ensor
uer _ )
~.__ BY: ~.~a„~,,e~ ~,~
Donald Wayne Ensor, dministraior of
the Estate of Ruth E. Ensor
WARNING: It Is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can
Include a fine and Imprisonment. For details see: Title 18 U.S. Code Sactlon 1001 and Section 1010.
(W GMOB-00101 .PF DNVCM08-00101792)