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HomeMy WebLinkAbout11-14-08~~ 1 505605 1 0_58 REV-1 ~~~ EX (06-05) OFFICIAL USE ONLY PA Department of Revenue '' • ~ ~~~ E " County Code Year ~' File Number Bureau of Individual Taxes '' ~ ~~ INHERITANCE TAX RETURN PO BOX 280601 Harrisburg. PA 17128-0601 ~ ~' RESIDENT DECEDENT 'Z' ~ ~ ~ ENTER. DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~ C~ ;j - I ~ _. ~o2tl ~ '..August 15, 2007 March 17, 1925 De/c*edent's Last Name Suffix Decedent's First Name MI `j ~:,~~>~ fir. ~-~ a>rr~ ~- (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 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 Safe 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) CORRIESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Andrew C. Sheely, Esquire ,717-697-7050 ~'' r_: -~ . ., ,- ~ --~ cf~ - Firm Nlame (If Applicable) _ ' _ ~ ~ ~~ _ ttEGISTER .V •.. . ' Andrew C. Sheely, Attorney at Law ~` ~-? °~ ~ ' ' ;-, __._ First line of address ~'' ~ " 127 South Market Street '" ~ ~' -v -,--, - `- - Second line of address c7 _.__ ~ ~• c~t } P O IBox 95 -~~ ~- ; ~ . c~ City or Post Office State ZIP Code DAB ~ FIr.. Ft1 Mechanicsburg 'PA 17055 Correspondents e-mail address: andreWC.Sheely@COmCaSt.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 tnie. correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN j/`~~ ~'^Y~- f•nTG ~~~ryl ~~~ i G`r .. , '~ ' - AnnrzF~~ Elizabeth A. Stager, Executrix, 140 Reeser Road, damp Hj,~, J~1 SIGNAL"URE OF PREPARER OTHER THAN REPRESENTATIVE --~ Cam' pnnrlFCc Andrew C. Sheely, Esquire, 127 South Market St., P.O. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY 150.56051058 Side 1 nA f ~/~ (/ (L3 150_56051058 r~ ~~ 15056052059 REV-1500 EX Dec edent's Social Security Num ber L ~ ] j Decedent's Name ~~ ~ { , ~°[ Cw'!'vt G.,, 'Mi t . l y '') Q • ~ ~ `~ ~ ~< ~U ~ ~ . F2ECAPITULATION - ~` 1. Real estate (Schedule A} . ......................................... ... 1. 200,000.00 2. Stocks and Bonds (Schedule B) .................................... 2. , ... 210,760.41 3 Gosely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 5. Cash, Bank De osits & Miscellaneous Personal Pro ert Schedule E P P Y( ) ..... ... 5. 15,320.54 G. Jointly Owned Property (Schedule F) Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (schedule G) Separate Billing Requested..... ... 7. 89,401.21 8. Total Gross Assets (total Lines 1-7} ................................. ... 8. ' 515,482.08 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 16,434.90 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. .. . 10. 25, 926.74 1'I. Total Deductions (total Lines 9 & 10) ................................ .. . 11. , 42,361.64 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ', 473,120.44 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. 473,120.44 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers unc+~r sec. 9116 (a)(t2) X .0_ 15. 16 Amount of Line 14 '°~3ble at lineal rate X .045 473,120.44 16 21,290.42 17. Amount of Line 14 taxable at sibling rate X .12 17_ , 18. Amount of Line 14 taxable at coAateral rate X .15 1 g, 19. TAX DUE .........................................................19.' 20. FELL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 21,290.42 ,. -- w of ""to ~.. ~ 1 5056052059 Side 2 T 15056052059 iZE"~/ 15(70 EX Page 3 Decedent's Complete Address: Ut~.tUtNfI ~J 1VHMt //~~ A (~.1 {n ` i 6TREET ADDR SS 3816 Carriage House Drive File Number 2.i. o~ X87.3 DECEDENT'S SOCIAL SECURITY NUMBER ~ crrv STATE 'ZIP ~_ Camp Hill ~_PA 17011 Tax Payrr~ents and Credits: 1 Tax Due (Page 2 Line 19) (1) 21,290.42 2 CreditslPayments A. Spousal Poverty Credit B Prior Payments L Discounl Total Credits (A + B + C) (2) 22,204.59 3 Interest/Penalty if applicable D. Interest E Penalty Total Interest/Penalty (D + E) (3) 4 If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Filf in oval on Page 2, Line 20 to request a refund. (4) 914.17 'S. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~~' ~~`~' C~ ~ Cats A. Enter thE: interest on the tax due. (5A) ~-7. ~~c3 B. Enter the total of 1_ine 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLIFASE 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 transferretl :.................................................................................... ...... ^ '~ 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? ........................................................................................................ ...... ^ 3. Dld decedent own an "intrust for" or payable upon death bank account or security at his or her death? ........ ...... ^ 4. Ditl decedent own an lndividual Retirement Account, annuity, or other non-probate property which contains a beneficiary tlesignation? .................................................................................................................. ...... ^ 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 7`L P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. l he iax 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 Seciion 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~_ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE INHERITisNCE rax DIVISION DF DEDUCTIONS AND ASSESSMENT OF TAX PO HOX ;?80601 HARRISBIJRG PA 17128-0601 REV-1547 EX AFP (D6-05) DATE 09-15-2008 ESTATE OF GOFF JR HARRY L DATE OF DEATH 08-15-2007 FILE NUMBER 21 07-0873 COUNTY CUMBERLAND ANDREW C SHEELY ESQ ACN 101 127 S MARKET ST APPEAL DATE: 11-14-2008 PO BOX 95 (See reverse side render G-bjectioras) MECHANICSBURG PA 17055 Amount Remitted -~ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------- --------------------------------------------------- REV-1547 EX AFP CO3-0.5) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS--AND-ASSESSMENT OF TAX -- - ESTATE OF GOFF JR HARRY L FILE N0. 21 07-0873 ACN 101 DATE 09-15-2008 TAX RETURN WAS: C X) ACCEPTED A5 FILED C ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) C1) 204,557.4 0 NOTE: To insure proper 2. Stacks and Bonds (Schedule B) (2) _ 210,7b0.41 credit to your account, 3. Closely Held Stoek/Partnership Interest (Schedule C) C3) .QO submit the upper portion of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) .0 0 tax payment. 5. Cash/Bank DepasitslMisc. Personal Property (Schedule E) C5) 15,32 0.54 6. Jointly Owned Property (Schedule F) C6) .00 7. Transfers (Schedule G) (7) 89,401.21 e. Total Assets ($) 520,039.56 APPROVED DEDUCTIONS AND EXEMPTIONS: 16,434.90 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9] 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 10.169.31 11. Total Deductions (11) 26.604. 1 12. Net value of lax Return Ciz) 493,435.35 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (S chedule J) C13) .00 14. Net Value of Estate Subject to Tax C14) 493,435.35 ~;~I~OTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and Y9 will ~~ ~. reflact'~figures flat include the total of ALL ret urns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) .00 X 0 0 _ .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 493,435.35 X 045 = 22,204.59 17. Amount of Line 14 at Sibling rate C17) • 00 X i2 = . 00 18. Amount of Line 14 taxable at Collateral/Class B rate C18) •00 X i5 _ .0 0 19. Principal Tax Due C19)= 22,204.59 TAY f DCTITTC. P 'Y GATE RECE PT NUMBER ISC (+) INTEREST/PEN PAID C-) AMOUNT PAID 11-09-2007 CD008940 1,078.95 20,500.00 05-14-2008 CD009722 .00 625.67 TOTAL TAX CREDIT 22,204.62 BALANCE OF TAX DUE .03CR INTEREST AND PEN. .00 TOTAL DUE .03CR * IF PAID AFTER DATE INDICATED, SEE REVERSE t IF TOTAL DUE IS LESS THAN 61, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDFT" CCR), YOU MAY BE DUE n ucF~iun. CFF REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Telephone: (717) 697-7050 ANDREW C. SHEF~[.~ ~'. --- AT70RI~EY AT LAW ~--._-~r-- 127 South Market Street Fax: (717) 697-7065 P.O. Box 95 andrewc.shecly(ci),verizon.net Mechanicsburg, Pennsylvania 17055 August 5, 2008 Destiny S. R. Brown, Tax Examiner Bureau of Individual Taxes Department 280601 I Iarrisburg, PA 17128-0601 RE: Estate of 1=larry L. Goff, Jr. 21-07-0873 :Dear Department of Revenue Agent Brown: I write to you on behalf of the Estate in response to your letter dated July 18, 2008. As of this date, no agreement of sale has been reached concerning the decedent's real estate. The property remains listed far sale and has been influenced by the recent decline in real estate sales throughout central Pennsylvania. The value set forth on the inheritance tax return was set by using the common level ratio for Cumberland County as multiplied by the assessed value of the property as of the decedent's date of death. We have used this method of valuing real estate in other circumstances and believe such value to be a fair if not a high valuation considering current market conditions. I note that the return also does not take into consideration real estate commissions and related closing casts which would ultimately impact the inheritance tax in this circumstance. Please contact me to discuss this letter and what action is required. Very truly yours, Al`~1DREW C. SHEELY ACS/bmk Enclosure c: Elizabeth A. Stager, Executrix ANllREW C. SHEELY I~l~:~~li~u~c: (717) 697-700 ATTORNEY AT LAW 137 Souih Market Street Ian: (71 7) 697-706 P.O. l3ox 9~ anrlrc~~c.shecl~ ~~i~~riion.n~t Mechanicsburg, Penns;~lvania 17015 November 14, 2008 PA Department of Revenue Bureau of Individual Taxes Dept. 280601 Harrisburg, PA 17128-0601 RE: Estate of Harry L. Goff, Jr. 21-07-03 Application for Refund (Dear Department of Revenue Agent: Enclosed please find an application for a refund of Pennsylvania Inheritance Taxes in the amount of $914.17. Earlier today, a supplemental inheritance tax return was filed with the Cumberland County Register of Wills Office which included modifications to Schedule A and Schedule I on the original return. The modifications were due to the sale of the decedent's residence which occurred on September 29, 2008, after a lengthy period of sale. Due to the inability to sell the decedent's residence within nine (9) months, the assessed value was used on the original return and no real estate settlement commissions and sale expenses were listed on the original schedule I. A copy of the time-stamped Supplemental Inheritance Tax return is enclosed with this letter. Lastly, I am enclosing copies of correspondence received by me from the Crepartment, and copies of my correspondence to the Department in July and August of this year. At the time I received the Notice of acceptance from the Department in September, the Estate was in good faith providing documents to the Department concerning the sale of the real estate, and it was anticipated that internal adjustments would be made by the Department once a settlement sheet was produced at final settlement. The enclosed settlement sheet sets forth the revisions to Schedules A and on the original return. Should you have any questions concerning any matter, please advise. Verb t my ypu "~~~` ~~~r ~ ;; f ~~' ANDREW C. SHE AC'.S/bmk Enclosures c: Elizabeth A. Stager, Executrix July 18, 2008 Andrew C. Sheely Esquire 127 S. Mkt ST. pob 95 Mechanicsburg, PA.17055 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 Telephone 717 783-6067 FAX 717 772-0412 desbrown@state. pa. us Re' Estate of Harry L. Gaff Jr File Number 2107-0873 Dear Mr. Sheely Esq. We are currently reviewing certain items on the lnheritance Tax return filed for the above-referenced estate. fn order to proceed with our examination, we will require additional information concerning the following: Schedule A item 1 Copy of appraisal, settlement sheet, agreements of sale or other documentary evidence of value. This office should receive the above information no later than 08/18/2008. If you cannot comply with this request by the specified date, please contact the undersigned. Sincerely, j ~'t- estlny S.R~B own Tax Examiner lnheritance Tax Division 7-3:00 3 ~ °r' e REVS-1 313 EX i3-04) ~• ?~.;,, APPLICATION FOR REFUND COMMONWEALTH OF PENNSYLVANVA OF PENNSYLVANIA DEPARTMENT of REVENUE INHERITANCE/ESTATE BUREAU OF INDIVfDUAL TAXES DEPT 2ao6o1 TAX HARRISBURG. PA 17128-0601 To: PA Department of Revenue Bureau of Individual Taxes Dept. 280601 Harrisburg, PA 17128-0601 FROM: Official Representative Name Andrew C. Sheely, Attorney Address 127 South Market Street, P.O. Box 95, Mechanicsburg, PA 17055 Decedent Data Name of Decedent Harry l_. Goff, Jr. File Number 21-07-0873 Date of Death 08/15/2007 Social Security Number 195-16-3248 Phone Number 717-697-7050 e-mail Address andrewc.sheely@verizon.net The undersigned requests a refund in the amount of $ referenced decedent's estate. REFUND REQUESTED ON: 914.17 for the above © Original or Supplemental ^ Joint/Trust Assets ^ Remainder Return ^ Estate Tax Probate Return FxPI ANATION OF OVERPAYMENT An amount of $914.17 was overpaid in this Estate due to house selling for less than assessed value as indicated on Schedule A and expenses increased due to sale of home as indicated on revised Schedule 1. The original return was approved while the department was awaiting copy of settlement sheet per attached correspondence. ~ ~ ~ J C~ ,~ J~ C ,~~ V _ ~~ ~ _ ~'~((t~~, ~ ~~ ~C"~ S net re Date t/J ! ~~~~'"J ~- Official Use Only Please allow four to s'sx weeks for the processing of your refund request. w~ ~ SCHEIaULE A (.)f.J~~itOV`~^Jt_i'+_ rl i OF !'F~u ISYI `JANIA fC~A~ ~STATG IPVH(_-+ITANC[ TnX Rc TURN fii- zliDl::fJ~i DEt;E.llF'Vi~ - - ESTATE pF FILE NUMBER Hany L. Goff. Jr. 21-Q7-0873 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 excl'enged between a wiNing buyer and a wi111ng seller, neither being compelled to buy or sell, both having reasonabre knowleage of the relevant facts. Qf more space is needed, insert additional sheets of the same size) REV-?`12 EX+ (12-G3) COMt~10NWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FRTATF nF FII F NIIMRFR Harry L.. Goff, Jr. 21-07-0873 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 ~. Comcast -final TV bill 2 Verizon -final phone bill The following costs/expenses have been incurred to date and are directly associated with sale of residence following death of decedent. 3. PPL -electric power 4. PA American Water 5. Shipley Oil 6. Shipley Oil -cleaning and repairs to furnace 7. Hampden Township sewer and trash 8. School taxes - 2007 - 2008 9. County/Township taxes 10. Veteran's Affairs -final medication bill 11. Bob Kanoff Electric Service 12_. Cox Renovations -repairs to water damage existing as of date of death 13. Misc. lawncare services due date of death pending sale of real estate 14. Erie Homeowner's Insurance 15. Ben Wirth -winter storm clean-up 16. Carpet Mart -repairs to water damage existing at date of death/removal of damaged carpet 17. Lowe's/Home Depot -misc. costs/repairs to water damage existing at date of death 18. Paul Stager -painting to repair water damage existing at date of death 19. Miscellaneous advertising house for sale 20 Real Estate commission 21. Transaction fee 22. Notary fee 23 Tax certification fee 24. Real Estate transfer tax TOTAL (Also enter on line 10, Recapitulation) $ 3 t}~? 40~ '.Eli 20~{ r 1 93~ 72 1 ~)," ;` 1 r~~ t1< >6 8i~ 24Ct ~~~~ ~~iJ! J%1 iii:) C)i 'Ci.~ 5~; ~,~ :;} 12 . Q C Q 235.1^:) 1 t~.0~1 10 u 2 GI~tC> ~;~; (If more space is needed, insert additional sheets of the same size) REV-1512 EX* (12-03) r+ GO~riMONWEALTH OF PENNSYLVANfA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE nF Harry L. Goff, Jr. FII F NIiMRFR 21-07-0873 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) A. Settlement Statement U.S. Department of Housing OMB Approval No. 2502-0265 and Urban Development B. Type of Loan 1. [ J FHA 2 [ ] FmHA 3. [ X ]Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4. [ ] VA 5. [ ]Conv. Ins. 400801261-CL I 0055565899 C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside of the closing: they are shown here for informational purposes and are not included in the totals. D. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of Lender DONALD L. FRY AND BONNY L. FRY ELIZABETH STAGER, EXECUTRIX OF ( ERA HOME LOANS ESTATE OF HARRY L. GOFF, JR. 3000 LEADENHALL ROAD, A!K/A HARRY L. GOFF MOUNT LAUREL, NJ 08054 6140 ROCKER DRIVE HARRISBURG, PA 17111 3816 CARRIAGE HOUSE DRIVE CAMP HILL, PA 17011 G. Property Location 3816 CARRIAGE HOUSE DRIVE, H. Settlement Agent iSECURED LAND TRANSFERS - MFr:HANI('SRt IR(; GAMIP HILL, PA 17011 Place of Settlement COUNTY: CUMBERLAND 101 OLD SCHOOLHOUSE LANE PAR(:EL ID: 10-20-1848-217 MECHANICSBURG, PA TOWNSHIP: HAMPDEN TOWNSHIP 1. Settlement Date 09/29/2008 Disbursement Date 09129!2008 J. SUMMARY OF BORROWER'S TRANSACTIONS K. SUMMARY OF SELLER'S TRANSACTIONS 100. Gross Amount Due From Borrower 400. Gross Amount Due To Seller 101. Contract Sales Price $200,000.00 401. Contract Sales Price $200,000.00 102. Personal Property 402. Personal Property 103. Settlement Charges to Borrower $4,860.03 403. Adjustments For Items Paid By Seller In Advance Adjustments For Items Paid By Seller in Advance 113. City/Town Taxes 413. City/Town Taxes 114. County Taxes 443.49/yr 9/29/2008 to 1/1/2009 $113.90 414. County Taxes 443.49/yr 9/29/2008 to 1/1!2009 $113.90 115. School Taxes 1,566.80/yr 9/29/2008 to 7/1/2009 $1,180.47 415. School Taxes 1,566.80/yr 9/29/2008 to 7/1/2009 $1,180.47 118. Assessments 418. Assessments 119. 419. 121. Sewer 138.65/gtr for 9/29/2008 to 10/1/2008 $3.01 421. Sewer 138.65/gtr for 9/29/2008 to 10/1/2008 $3.01 120. Gross Amount Due From Borrower I $206,157.411420. Gross Amount Due To Seller I $201,297.38 200. Amounts Paid 8v Or In Behalf Of Borrower 500. Reductions In Amount Due Te Seller 201. Deposit or Earnest Money $2,000.00 501. Excess Deposits 202. Principal Loan Amount from ERA Home Loans $150,000.00 502. Settlement Charges to Seller $16,886.80 203. Existing Loan(s) Taken Subject to 503. Existing Loan(s) Taken Subject to Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller 210. 510. 211. 511. 212. 512. 213. CitylTown Taxes 513. City/Town Taxes 214. County Taxes 514. County Taxes 218. Assessments 518. Assessments 219. 519. 222. Credit for Repairs $750.00 522. Credit for Repairs $750.00 220. Buyer's Total Credits $152,750.00 520. Seller's Total Charges $17,636.80 300. Cash At Settlement From/To Borrower 600. Cash At Settlement To/From Seller 301. Gross Amount Due From Borrower (line 120) $206,157.41 601. Gross Amount Due To Seller (line 420) $201,297.38 302. Less Amounts Paid By/For Borrower (line 220) $152,750.00 602. Less Deductions In Amt. Due To Seller (line 520) $17,636.80 303. Cash [ X ]From [ ] To Borrower I $53,407.41 1603. Cash [ X ] To [ ]From Seller I $183,660.58 400801261 - CL 1 e,.wl....,..... e•.. s.......• Page 2 700. Total Sale Commission 200000.00 @ 6 % = 12000.00 Division of Commission (line 700) As Follows: Paid From Borrower's Paid From Seller's 701. $6025.00 to Homestead Group Inc., REALTOR Funds At Settlement Funds At Settlement 702. $5975.00 to ERA-NRT, Inc. 703. Commission paid at settlement $12,000.00 708. Transaction Fee to Homestead Group Inc., REALTOR $100.00 709. Broker Administrative Fee to ERA-NRT, Inc. $165.00 800. Items Payable In Connection With Loan 801 . Loan Origination Fee 802. Loan Discount 803. Appraisal Fee 804. Credit Report to FNMA CBC Innovis, Inc. $27.00 805. Lender {nspection Fee 810. Document Preparation to ERA Home Loans $85.00 812. Flood Cen. Fee to STARS $19.50 815. Application Fee to ERA Home Loans $500.00 enn w~...~ Onn.,ien,~ 4~. 1 on Aar Tn Rn Dnid In Ldvanrw 901 ~ Interest from 9/29!2008 to 10/1/2008 @27.1400/day 2 days $54.28 902 Mortgage Insurance Premium 903 . Hazard Ins. Premium Nationwide (POC 441.00) 904 Flood Ins. Premium ~nnn Decun.cc nenneited With 1 ender 1001. Hazard Ins. Reserve 3 mo @ 36.75 / mo ERA Home Loans $110.25 1002. Mortgage Ins. Reserve 1003. City Property Taxes 8 mo @ 2.52 / mo ERA Home Loans $20.16 1004. County Property Taxes 1005. School Taxes 2 mo @ 133.49 / mo ERA Home Loans $266.98 1010. Aggregate Accounting Adjustment from ERA Home Loans -$243.54 ~~nn TiHn r`6~.nnc 1101. Settlement/Closing Fee 1102 Abstract or Title Search 1103. Title examination 1104. Title Insurance Binder 1105. Document preparation 1106. Notary fee to Connie L. Wertz, Notary Public $20.00 $10.00 1107. Attorney Fee 1108. Title Ins. Total to Secured Land Transfers -Mechanicsburg $1,358.75 1109. Lender's Coverage $150000.D0 ($) 1110. Owner's Coverage $200000.00 ($1358.75) 1111. Endorsements-100/300/900 ($150.00) to Secured Land Transfers -Mechanicsburg $150.00 1119. Wire Transfer Fee to Secured Land Transfers -Mechanicsburg $35.00 1127. Electronic Delivery & Handling Fee to Secured Land Transfers -Mechanicsburg $50.00 1138. Processing/Tax Cen. to Secured Land Transfers -Mechanicsburg $10.00 1200.. Government Recording And Transfer Charges 1201.. Recording Fees for Deed 38.50; Recording Fees for Mortgage 64.50 $103.00 1202. City/County Tax/Stamps 2000.00 $2,000.00 1203. State Deed Tax 2000.00 $2,000.00 1302. Pest inspection to B 8 T Inspections (POC 50.00 by Buyer) 1303. Home Warranty to American Home Shield $435.00 1305. Radon Mitigation to B & T Inspections $765.00 1306. 2008/09 School Taxes to Marie Huber, TC $1,566.80 1307. Sewer 10/11!12 to Hampden Township Sewer Authority $138.65 1308. Home Inspection to B 8 T Inspections (POC 300.00 by Buyer) 1309. Radon Test to B & T Inspections (POC 100.00 by Buyer) 1400. Total Settlement Charges $4,860.03 $16,886.80 I have car ully reviewed th 1 Settlement Statement and to the best of my knowledge antl belief it is true and accurate statement of all receipts ana eisoursements made on, account or by.,me in thi transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. BUYE,I~Sf /~ J~ ~ J SELLERS ,1 ~(J" G <i ~ ~~ ~ Estate of Harry L. GoHarry L. G i L Fry - .-r abeth Stager, ec trix L. Fr UD-1 ttlement State hich I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in lance with this st meet Agent, / ~ Date ~) fl!-~.~ U 09/29/2008 SECURED LAND TRANSFERS - MECHAN