HomeMy WebLinkAbout12-16-0815056041114
A C
REV' 1 JOO EX (06-05)
OFFICIAL USE ONLY
PA Department of Revenue Counly Code Year File Numher
Bureau of Individual Taxes INHERITANCETAX RETURN
PO BOX 280801
~ I ~
Hamsbur PA 17128-0801 RESIDENT DECEDENT ~~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
162-22-3658 01232008
Decedent's Last Name - Suffix Decedent's First Name MI
ADAMS BETTY F
(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 ITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
Ox 1. Original Retum ~ 2. Supplemental Retum 0 3. Remalntler Ret m (date o! death
pdorto 12-13-8
(] 4. Limitetl Estate ~ 4a. Future Interest Compromise (date of 0 5. Federel Estate )
az Retum Required
death after 12-12-82)
~x 8. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust O e. Total Number o Safe Deposit Boxes
(Attach Copy of Wilq (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax u der Sec. B113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHO LD SE DIRECTED T0:
Name Daytime Telephone N mbar
ROBERT G FREY 717-243-563 8
Firm Name (If Applicable) ,~,
`='
REGISTERO _., FUSE ONLp -~-~
FREY & TILEY ° cn "'
~T
First line of address _
'-: ~ ~
~ ~
5 SOUTH HANOVER STREET ~, _
,,
"=`~ rn
Second line of address - -„ ~ .
~-J~n
- '
? =~
c-
- _D
--f ..
City Or POSt Office State ZIP Code DA ILED O
CARLISLE PA 17013
Correspondent'se-mail address: RFREY@FREYTILEY.COM
Under penalties o perjury, I declare that eve examined Nb return, induding accompanying schedules and statements, and to the best o my k wledge and be ie , R a
true, coned and corn late. Oederetion of re arer other than the ersonal re resentadve is based on all information of which re arer has an k owled e.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ATE
ADDRESS
447 OAK FLAT ROAD, NEWVILLE, PA 17241
SIGNATU E PREP RT N ESENTATIVE ATE
12 / ~G / O 8
ADDRESS
5 SOUTH HANOVER STREET RLISLE, PA 17013
PLEASE U5E ORIGINAL FORM ONLY
Side 1
15056041114 1585604111 .~
REV•1600 EX
oecedenrs Name: BETTY F ADAMS
RECAPITULATION
1. Real estate (Schedule A) ........................................... 1
2. Stocks and Bonds (Schedule B) ................................ . . 2 NONE
3. Closely Held Coryoration, Partnership or Sole-Propdetorship (Schedule C) ..... 3: NONE
4. Mortgages & Notes Receivable (Schedule D) ............................ 4. NONE
174000.00
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 118 62 . O 0
6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ...... .. 6. 22237
0 O
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property .
(Schedule G) OSeparate Billing Requested
....... , 7 5 5 3 4 4. O O
6. Total Gross Assets (total Lines 1.7) ................................ .. 8. 2 63 4 4 3 . 0 0
9. Funeral Expenses & Administrative Costs (Schedule H) .................. . 9. 4 B 2 7 8 . 0 O
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. . 10. NONE
11. Total Deductions (total Lines 9 & 10) ................................ . 11. 4 8 2 7 8 . 0 O
12. Net Value of Estate (Line 8 minus Line 11) ............................ . 12. 215165
OO
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which .
an election to tax has not been made (Schedule J) .
.........
............
. 13. 0 . O 0
14. Net Value Sub eat to Tax Line 12 minus Line 13 ...................... . 14. 215165
O 0
TAX COMPUTATION • SEE INSTRUCTIONS FOR APPLICABLE RATES .
16. Amount of Line 14 taxable at
the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2)X.0 0 15. 0
00
16. Amount of Line 14 taxable .
at lineal rateX.o 45 215165.00 16, 9682
00
17. Amount of Line 14 .
taxable at sibling rate X • 12
16.
Amount of Line 14 taxable 17. 0 . 0 0
at collateral rate X , 15 t B. 0. 0 0
19. TAX DUE ..........
............................................. 19. 9682.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAY MENT
O
Side 2
' 15056042115
15056042115
Decedent's Socia Security Number
162-22-3656
1505604211
REV-1500 EX Page 3 162-22-3658
Decedent's Complete Address:
Flle Number
21-Da-m m
DECEDENT'S NAME
DECEDENT'S SOCIAL
BETTY F ADAMS ECURITY NUMBER
STREET ADDRESS 162-22-3658
343 G STREET
CITY
STATE Ip
CARLISLE
PA 1 013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
(1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
10000.00
500.00
Total Credits (A + g + C) (2)
3
InteresUPenalty if a
li
bl 10500.00
.
pp
ca
e
D. Interest
E. Penalty
Total InteresUPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3
enter the differen
Thi
i 0.00
,
ce.
s
s the OVERPAYMENT.
Fill In oval on Page 2, Line 20 to request a refund
. (4) 818.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
A. Enter the interest on the tax due.
(SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE
. (SB) 0.00
Make Check Payable fo REGISTER OF W/LLS, AGENT
~~44
~,,~: °~~} .:~:':i.°px,~y}i ~.. z.= §R6
~
~ ~S.96S~.'~4am`
"~"uVV'is._ Au. RNxu .iR ..- ..
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE AP .:i
PR PRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferted : ................................ . ...... Yes No
b. retain the right to designate who shall use the property transfened 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, 1962, did decedent transfer property within one year of death
without receiving adequate consideration7 ............................................ ..
3. Did decedent own an "in trust for' or payable upon death bank account or secudty at his or her death9 ..
4. Did decadent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ..... .
. .............
X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES
YOU MUST COMPLETE SCHEDUL
,
E G AND FILE
, ~,. ~ " .r ., _ . , ~. IT A 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 tra sfers 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, nd the statutory
requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the onl 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 dea h 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. §91 t 6(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 ne-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 Vansfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §911 (a)(1.3)]. A sibling
is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or a option.
217
REV-1502 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE
SCHEDULE A
REAL ESTATE
FILE
All real roe y p - ~~-Ut3-U1U7
p p rty ownetl eolel or as a tenant in common must be re ortetl at fair market value. Fair market value is definetl as th price at which property
would be exchanged between a willing buyer end a willing seller, neither being compelletl to buy or sell, both having reasonable knowletl a of the relevant facts.
Rest Property which Is lolntly-owned vdtn d~m..n~,.:a....~.,_ _.._.._ _. _
"G" Street, Carlisle, PA. House and lot of ground
174,000
(If more space is needed, insert additional sheets of the same size)
zn
REV-1508 EX+(6-96) SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
iNHeairANCErAxReruaN PERSONAL PROPERTY
RFCIf1FIJT nF!`FncuT
ESTATE
Include the proceeds of litigation and the date the proceeds were received by the estate. V v
nu .....__.~.,_,_.~_ _'____ ... ..
1 Personal property. See auctioneer statement
2 Real Estate Tax proration from HUD-1 settlement statement
3 Highmark refund
4 Comcast refund
5 Embarq refund
6 Federal economic stimulus
7 DWS scooter refund
8 Automobile insurance refund
9 Pa. income tax refund
10 Federal income tax refund
11 Homeowners' insurance refund
TOTAL (Also enter on fine 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
8,333
1,130
685
127
14
300
70
92
7
808
296
11,862
217
REV-0509 EXt (6-99)
SCHEDULEF
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
BETTY F ADAMS
21-08-0107
If an asset was made joint within one year of the decedent's date of death, It must be reported on 5 hedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS
R LATIONS HIP TO DECEDENT
A. Bonnie L. Roush 447 Oak Flat Rd., Newville, PA 17241 Da ghter
B. David M. Adams P. 0. Box 63, Mt. Holly Springs, PA 17065 So
C. Richard A. Adams 250 "F" Street, Carlisle, PA 17013 So
D. Thomas Adams 10 Stone led a Rd. Newville PA 17241 Son
JOINTL Y-OWNED PROPERTY;
LETTER DATE DESCRIPTION OF PROPERTY
ITEM
FOR JOINT
MADE
INLLVOE NAME OF FINANCIAL INSTNTRION AND BANKALCOUNT NUMBER OR SIMILAR
I
DATE OF DEATH
D OF
CD'S DATE OF DEATH
NUMBER TENANT JOINT DENTIFYING NUMBER. ATTACX OEEp FOR JOINTLY-NEID RFAL ESTATE. VALUE OF
1.
A.
Sovereign Bank, Acct. No
3381197134 VALUE OF ASSET INT REST DECEDENTS INTEREST
2.
A .
Sovereign Bank, Acct. No. 9857308218 2,399 50 00% 1,200
3.
A
1/1/95
Members 1st Acct. No
43810-00 4,466 50 00% 2,233
4.
A
10!20/98 .
Members 1st Acct. No. 43810-02 8,797 50 00% 4,399
5.
A
4/16/98
Members 1st Acct. No
43810-41 425 50 00% 213
6.
A
9/20/00 .
Members 1st Acct. No. 197028-00 2,183 50 00% 1,092
7.
A
9/19/01
Members 1st Acct. No. 197028-05 12,884 50. 00% 6,442
8.
A
5/30/02
Members 1st Acct. No. 197028-03 10,638 50. 0%
5,319
9. B 12/29/04 Members 1st Acct. No: 197028-40 974 50. 0% 487
10. C 12/29/Oa Members 1st Acd. No. 197028-44 567 50. 0% 284
11. D 12/29/Da Members 1st Acct. No. 197028-45 567 50. 0% 284
567 50. 0% 284
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL Also enter on line 6 Reca itul
ti
TIC ---- - a
on S 22 237
~~~ 111~lIC ,pace Is neeceD, Insert atlditional sheets of the same size)
zn
REV-0510 EX+(69S) SCHEDULE G
COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS &
INHERITANCE TAX RETURN
RESIDENT DECEDE MISC. NON-PROBATE PROPERTY
NT
ESTATE OF
FILE NUMBER
BETTY F ADAMS
21-08-0107
This schedule must be completetl and fled if the answer to any of questions 1 thr ough 4 on the reverse sid e of the REV-1500 CO ER SHEET i s yes.
DESCRIPTION OF PROPERTY
ITEM
NUMBER INCLUDE THE NAME OF THE TRAN6FEREE. THEIR RELATIONSHIPTO DECEDENT AND THE DATE Or
TMNSFER. ATTADHACDPY OF THE DEED FOR REAL ESTATE DATE OF DEATH %OF DECD'S CLUSION TAXABLE
1. .
State Farm Annuit
y VALUE OF ASSET INTEREST nF AVrucee~
VALUE
2.
IRA: DWS US Gov Securities A, KUSAX
2172
71 sh @ $8
60 36,659
18 100.00% 36,659
,
.
. ,685 100.00% 18,685
0
0
0
0
D
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
D
D
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL Also enter on line 7 Reca itulation $
f 55.344
(I more space Is needed, Insert additional sheets of the same size)
REV-1511 EX+(10-06)
•"#..
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN
RESIDENT DECEDENT ADMINISTRATIVE COSTS
ESTATE OF
[l-ud-U1 V/
ITEM Debts of decedent must be re orted on Schedule I.
NUMBER DESCRIPTION
A FUNERAL EXPENSES: AMOUNT
i. Honorarium to pastor
5D
2. Honorarium to organist
40
3. Wesleyan Church of the Cross: Memorial Service
75
4. Giant: food for memorial service
81
5. Obituaries
543
B• ADMINISTRATIVE COSTS:
1 ~ Personal Representative's Commissions
Name of Pesonal Representative(s) Bonnie L. Roush
Street Address 447 Oak Flat Road
city Newville state PA zip 17241
Year(s) Commission Paid: 2008
9,000
2• Attorney Fees
7,000
3. family Exemption: (If tlaratlenYS address is not the same as claimant's, attach explanation)
Claimant
SVeet Address
Clry
State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5.
Acceuntant's Fees 310
6 Included w/ atty fee
. Tax Return Preparefs Fees
7.
Advertising in Sentinel and C
b
l included w/ atty fee
um
er
and Law Journal
e. Auctioneer expenses
218
9. Expenses in connection with sale of real estate 1,476
10. Coroner and death certificates 29,105
11. Bank fee 37
12. Final medical bills 11
13. Postmaster, stamps 135
r u I AL Aiso enter on line 9, R
(If more space is needed, insert additional sheets of the same size)
z1~
REV-1513 EX+ (9-DO)
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
F LE NUMBER
BETTY F ADAMS
2 -08-0107
REtATIONSHIPTO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do N
t Li
t T AMOUNT OR SHARE
o
s
rustee(s)
I OF ESTATE
. TAXABLE DISTRIBUTIONS [inGude outright spousal distributions, entl transfers under
Sec. 9118 (a) (1.2)1
1. Bonnie Roush Daughter 1 of Remainder
2. Richard Adams Son
1 of Remainder
3. David Adams Son
1/ of Remainder
4. Thomas Adams Son
1/ of Remainder
.ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18
AS APPROPRI
,
ATE, ON R -1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET §
~~~ ~~~~~_ ~r=w ~~ ~~==~~w insect aomnonai sneers of the same size)
LAST WILL AND TESTAMENT OF CLF^~t CF
BETTY ADAMS ORPi-tglV , (' ~;,~ ~
CUI~,:_,_~~~ ,, ,_, , n ~~
I, BETTY ADAMS, of Cazlisle, Cumberland County, Pennsylvania, being o sound and
disposing mind, memory, and understanding, hereby declare this instrument to be Last Will
and Testament, revoking any and all Wills by me heretofore made.
ITEM ONE: I direct my hereinafter named Executors to pay all my just de~ts, funeral
expenses and administration expenses, including inheritance taxes, as soon as may a convenient
after my decease.
ITEM TWO: SPECIFIC BEQUESTS.
A. I give unto my son, RICHARD ADAMS, of Cazlisle, any and all terest I may
have in the property I own at 250 F. Street, Cazlisle, Cumberland Co ty, Pa_.
17013, and direct him to satisfy any liens or encumbrances against th property
within 6 months of my death.
B. I give unto my daughter, BONNIE ROUSH, of Newville, any and all interest
in my savings account with Members First Bank, Account No. 43810 - AD.
C. I desire to be cremated; therefore, I give my cemetary plot, and al rights
appertaining to such plot, to the first family member that may pass a ay after my
demise.
ITEM THREE: I give all the rest, residue and remainder.of my Estate, real, rsonal, or
mixed, of whatsoever nature and wheresoever situate, in equal shazes unto my childr n, BONNIE
ROUSH, of Newville; DAVID ADAMS, of Mt. Holly Springs, THOMAS ADAMS, of
Newville, and RICHARD ADAMS, of Cazlisle, or their issue per stirpes.
ITEM FOUR: I hereby nominate, constitute, and appoint my daughter, BON
ROUSH of Newville, as Executrix of this, my Last Will and Testament. If BONNI
unwilling or unable to serve, then I appoint THOMAS ADAMS, of Newville, as my
this, my Last Will and Testament.
ITEM FIVE: I direct that my Executor or Co-Executrices, shall not be re
bond for the faithful performance of their duties in this or any other jurisdiction.
ROUSH is
r:ecutor of
to give
IN WITNESS WHEREOF, I have hereunto set my hand and seal this this, my Last Will
Testatment, consisting of ~_ typewritten page(s), bearing my signature,
this day of A.D.2001.
BETTY
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND.
BOROUGH OF CARLISLE
I, BETTY ADAMS, the Testatrix, whose name is signed to the attached or fore oing
instrument, having been duly qualified according to law, do hereby aclmowledge that I igned
and executed the instrument as my Last Will and Testament; that I signed it willingly; d that I
signed it as my free and voluntary act for the purposes therein expressed.
BettyAdams, Testatrix
On this, the ~~ day of ~~ , 2001, bef re me, a Notary Publi ,the
undersigned officer, personally appeazed ~ own or roven to
me to be the person whose name is subscribed to, within Last Will and Testament, d
aclaiowledged that she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~.~
PUBLIC
n ~5~. w~ai }ry
~ ~..u 1.;E 1 t~. et1i '4t a(t i
n eL~~ G~'..:':s3~„1..~' s a Sf~~ wv ~~. b:, tJl3''
Expenses in Connection with Real Estate Sold
Expenses from HUD-i settlement statement
PPL 12 907
Hilton's Lock Service 246
Water bill to Borough of Carlisle 184
Embarq 21
PPL 41
Embarq g3
Appraisal fee to S. W. Barrett 25
Water bill to Borough of Carlisle 325
PPL 21
Real estate taxes to Borough of Carlisle 74
Embarq 645
Water bill to Borough of Carlisle 25
Embarq 21
PPL 26
Earl Moyer, trash removal 55
8JR Plumbing 125
Embarq 55
PPL 28
Water bill to Borough of Carlisle 21
PPL 62
PPL 26
School real estate taz 54
PPL 1,544
Erie Insurance 43
Water bill to Borough of Carlisle 326
PPL 62
Home Spec, install radon remedlation system 40
PPL 200
PPL 22
Roush, Mowing and landscaping g
Roush, repairs to house, preparation for public sale 340
,
Additional lawn care 11,433
Total Real Estate Expenses ~-
A- Se}`tl~ment Statement
B. T g,Qf span U.S. Department of HLUSinp and Ulban pevelopment
1. OFHA 2. ~FmHa 3. ~Cpnv. Unins. fi. File Number OMB mval NL. 2502-0265 a irea H/302009
4. VA 5. CLnv. Ins. 7, Lean Number 6. Mortgage Insurance Case f
32106PUR 68230
C. Note: ln:. m.n.e~a.ecr.w wm.uwee u. e'mm; u.v.n.nu.R nen l.rlnameaon
wARaSNG.nI..mR.bmw.nolr pw~m..mb..d.lo un umue swnmw.om~'•~mi.. imm~a:~.mu upanw~' T9eFxpress SeNe
mn.,aon mn mew.. m..nei n n.Fora.wu....alH. re v. s. c.ea s.w,e i~oi me s.e~m ioto.
D. NAME OF BORROWER Leonard J. Lovejoy Jr. and Jacquelyn R. Mllier Pnnretl 101302008
ADDRESS: 158 Filmore Avenue Johnstown pA 1590fi ard 50 1Win iako- ~
E. NAME OF SELLER: Estate of Betty F. Adams ~ ~~
ADDRESS: GO Eketi• & 7i1ey AidTaraa . ~„ s s. F33raa St. fit; c1o rA 1701
F. NAME OF LENDER pSECU
ADDRESS: 1 Credlt Union Place p.O. Box fi7017 Harrisbur pA 17110-2990
3. PROPER1Y ApgRESS; 343 G Street CRdki. Ne nn.n
H.
exeemyre FCPM tOW BFJ1Ep STAlEM9R; TMMmmYyi mda~W enanlalimmve b.mbRnHmne I.pdrp bmwl.eb IM Inwpl R.wnu. 6.Mm. Hyvuen epulM b Ale. faun,
W .~01e~Nn~ YeMee Ne 6cee WII e.IInmeMmpn ll WeMwYnyYlW bbnpmW ale tlu Yt$Wb~nwuINII1NeMynnmNy Tln LyyepSyepe~yaytlm
Romemd W.LMnGa.
6ElLER INSTRLI^:npHS: Hale iul.eWew piry~ pN nyyrm.N. Fam1115. S.4mFatlnnP d MrmF.I Reeilbny, breryeeN. xiN werbmrrou.nWrrGbrmbrperyelme.
miTlW au FFwmbe LUlt of Famiry). Fenney$ eyemeyAeplFVmiWOJ.
ww.n naweeaylwyb prvAy peruemew eprYtiF 6Tn0 W:
IrEn. wm mybamfevbeW avlinyl rynegee lpn.e pywu...wort Ponuu d ab I~eNrIeuNAOlen numyr. Hyw di ndpuWy yyrmntl la¢awrlMntifititim
_.- u o.a.v~~wNrmu nwnunar.memm dneunnrv4rrymn.da.F.wrbemmeua~nunw-.
SSLLER(5I NEW AWLINGpf]ORE55:
ARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number. 3210fi PA 2
i CEMENT STATEMENT TtleEx ress Setdement 5 to Primed 101302008 at 75:45 SD
iLEMENT CHARGES PAID FROM PAID FRO
TOTAL SALESIBROKER'S COMMISSION beaetl an the 5174000.00 6.00010440.00 BORROWER'S SELLER'S
DidvCn of comrdssion Ire 700 as kllLws: FUNDS AT FUNDS AT
:N7. E 5220:00 la CDmmunl Benefits Real Eskte SETTLEMENT 6ETTLEME T
702.E 5220.00 to JackOau hen Realtor ERA
.703. Ccmdssion aid at SeNement 10 .00
600. ITEMS PAYABLE IN CONNECTION WITH LOAN
601. Loan Od nation Fee %
602. than DiscnuM
803. 'sal Fea to Central Penn A ralsals Inc
604. Credtt
606. Lenders I 'on F
80fi. a A icatlrn Fee
607. Icetlon Fee PSECU P.O.C. 300.00 B er
606. Flood CeNficefbn Fee - N PSECU 6•~
609. UnderwMl Fee k PSECU 100.00
810. Ooa Pre Fee k PSECU 150.00
611.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. In Fmm 1013112006 1110112008 29.2A55 b 1 Da 29.21
902 n a e Insurance Premium kr k
903. HaraN Insurance Premium iw k
904.
905,
1000. REBERVES DEPOSfTED WITH LENDER FOR
1001. Harard lmurm¢e 3 mo. 37.00 /ma 111.00
1002. MM a Insurance mo. Imo
100 . CI P Tax mo. S brio
1004. C Pm Tax 9 mD. 54.46 hno 490.14
1005. School Taxes 5 mo. E 131.25 hro 656.25
1009. ale Pn Ad'usbrent m PSECU •567.62 .00
1100. TITLE CHARGES
1101. Settlement Fee k United One Resources Inc
1102. AhsdaIX Fee k Untied One Resources Inc
1103. TNe 'nallon m Unted One Resources Inc.
1104. Title lnsulam 'rder k United One Resources Ina
1105. Document aretlon m Untied One Resources Ina DO
S
1106. No Foes k Note Public 42.00 .
1107. Ado Ekes
Indudes shwa Ikms No:
1226
75
1106. Title Inwrence k United One Resources Inc. .
IncWdea shwa Ikrrs No:
1109. Lenders Pdi 1 000.00
1110. Owrrers Poll 174 000.00 •1228.75
1111. 100 300 900 m Untied One ResourcFS Inc 150.00
1112. Closin SeMce Loner m Unted One Resources Ina 35.00
1113. Tax CeNficetion mUnited One Reaou Irw. 5.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Pecerdl Fees Dced E425D S 8250 ~ Rdease E 125:00
1 2 am s 1740.00 a 1740.00
T s Deetl 1740.00 ~ Mo
1203 17 0.00
.
1204. P.I.N. CeNficedon k Rewrdar of Deeds - 20.00
1205.
131111. ADDLTIONAL SETTLEMENT CHARGES
1301. Sunre
1302 Fast ins ctlon 50
19
1303. Guarenteed Delive to United One Resrxrrces Ina ,
1304. De1NONc Download Fea k United One Resources Inc.
1306, N1re Fea ~ k Unkatl One Resources Inc 85.00
1305. Havre Wamdn Plan k Amadcan Home Shield fi5
00
1307. Trensadi 'Foe fo Jack Gau hen ERA 7 .
9225
1308. Olher Disbursemenk 1520
140Q TOTAL SETTLEMENT CHARGES enter on Imes 103 Secdan J and 502 Section 4 32203 20 7.25
HJDCPATFlGTIW
wwpNNG R 16 p LNME TO KN'JNINGLY MN(E FK6E STAT~MENr6 Rl TE
11NrrEp ${pTE6 pN T116 0R PNY 61rM VR FOPA1. PENLLTE6 UPON CMML110N
U9. CppE 0E6ECTCN tOD1.Vm fiECrICN tOte~DElA058EEmme 10:
~~ea~F~ `yam ~~ EXE
',ARTMEM OF HOUSING AND URBAN DEVELOPMENT File Number, 32106
,fLEMENTSTATEMENT
Title ress Setllemi
FINAL SETTLEMENT
OWNER
Address
Date
Date of Sale Sale Location
Auctioneer Clerk Cashier -
Other
PROCEEDS OF SALE: Cash ___________________________ _._________________ $ ~~
Checks --------------------- --------------- ~~
ll ~
Other _~~Zti]i'!1Q- -- r
- -TSB'C_~?~Qn`f---------------
----------------- ~~7.0~
Miscellaneous (see attached list)
- TOTAL PROCEEDS OF SALE _________
LESS SELLER'S SALE E,X~PyENSE:
Auctioneer's Fee_.770------------------------------------------------. $ l .Qd
Other Seller's Expenses
Advanced by Auctioneer:
Ot~s~IP~,~~k ~%
~nsd,o C~~er~ ~%
~~~Te~
R^,isca!!angcus (sse attached iis;)
~ (a 5
~65,~ x
~- i, 6
DEDUCT TOTAL SELLER'S SALE EXPENSE
TOTAL NET PROCEEDS TO SELLER
I, (or we), the seller of goods, merchandise, and/or property sold a[ public auction on above date and location, ackl
this settlement of proceeds of sale. I (or we) agree to accept all responsibility for providing merchantable title to all
a.nd/or property sold,.and for delivery of title to the purchaser.
„(Date) _ ~ ~ „ (Seller's Signai
Auctioneer or Cashier's Signature (Seller's Signal
i,vx~
~85~-
e and accept
merchandise,
Form No. FS Reortler from: MISSOURI AUCTION SCHOOL PNOrre 1-806835-7955
St
MEMBERS 161
FEDERAL CREDIT l7NICN
REGULAR SAVINGS ACCOUNT:
Account Number/ Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
HOLIDAY CLUB ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
REGULAR SAVINGS ACCOUNT:
Account Number/ Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
MONEY MANAGEMENT ACCOUNT;
Account Number/ Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
43810-AO
05/02/1985
$8,792.20
$5.29
$8,797.49
Bonnie L Roush
01/1995
43810 -02
10/20/1998
$424.46
$.25
$424.71
Bonnie L. Roush
10/20/1998
43810 -41
04/16/1998
$2,178.45
$4.58
$2,183.03
Bonnie L Roush
04/16/1998
197028 -00
09/20/2000
$12,884.40
$12.20
$12,896.60
Bonnie L Roush
09/20/2000
197028 -OS
09/19/2001
$10,625.16
$12.68
$10,637.84
Bonnie L Roush
09/19/2001
5000 Louise Drive P.O. Box 40 Mechanicsburg, pennsylvania 17055
• (800) 283-2328
ct .,~~
VACATION CLUB ACCOUNT:
Account Number/Suffix 197028 -03
Date Account Established 05/30/2002
Principal Balance at Date of Death $973.62
Accrued Interest to Date of Death $.60
Total Principal and Accrued Interest $974.22
Name of Joint Owner Bonnie L. Roush
Date Joint Ownership Established 05/30/2002
CERTIFICATES OF DEPOSIT:
Account Numtier/Suffix 197028 -40
Date Account Established 12/29/2006*
Principal Balance at Date of Death $565.65
Accrued Interest to Date of Death $1.73
Total Principal and Accrued Interest $567.38
Name of Joint Owner David M Adams
Date Joint Ownership Established 12/29/2006
CERTIFICATES OF DEPOSIT:
Account Number/Suffix 197028 -45
Date Account Established 12/29/2006'
Principal Balance at Date of Death $565.65
Accrued Interest to Date of Death $1.73
Total Principal and Accrued Interest $567.38
Name of Joint Owner Richard A Adams
Date Joint Ownership Established 12/29/2006
197028 -44
12/29!2006`
$565.65
$1.73
$567.38
Thomas L Ac
12/29/2006
'Cert~cates purchased by redeemed certificates originally established 12/29/04 listing same joint owners.
M ERS 1sT FEDERAL CREDIT
e isWol/e//~~
Insurance Services Supervisor
February 22, 2008
Estate of: BETTY F. ADAMS
Date of Death: January 23, 2008
Social Security Number: 162-22-3658
GIBB FINANCIAL, SERVICES, a Division of Orrstown Ban6
4~i vulagellrive
Carlisle, PA 17015
May 6, 2008
Sharon DeVos
Frey & Tiley
Attorneys-At-Law
5 South Hanover Street
Carlisle PA 170]3
RE: Estate of Betty F. Adams
Dear Ms. DeVos,
As per your request enclosed is a statement showing the date of death value
for the account of Betty F. Adams.
This account is an IRA w/Betty's four children as the beneficiaries. The
been submitted to DWS Scudder for distribution to the beneficiaries.
We have no other accounts registered under Betty's name.
Sincerely,
~~~
Lisa Rigg]eman
Registered Sales Assistant
Securities and other investment products offered through Financial Network Investment Corporation. A sr
broker dealer. Member SIPC. The Orrstown Bank, Gibb Financial Services, and Financial Nefwork are nnr
(717) 249-3737
FAX (717) 249-8010
has
NOTADEPOSIT NOT FDIC INSURED Nt1RAAlv!`rrnne„~__
~.1I1T raw ~w .. _ _.
FtDldings by Investor
Betty F Adams Mr Marlin Gibb Combined Account F
447 Oak Flat Road Gibb Financial Serives a division of Date: 01/23/2008
Newville, PA 17241 Orrstownbank Created: 05/06/2008
427 Village Drive
Carlisle, PA 17015
717-249-3737
Betty F Adams
Acct Name:DWS TRUST COMPANY CUST FOR THE IRA ROLLOVER OF BETTY F ADAMS 447 OAK FLA RD NEWVILLE
PA 17241-9462
Acct No:00003840055 AcctType:l A Rollover Account
Rep.No:19129
Asset Name Ticker Asset Type Mgt. Name Quantity Price() Value($)
DWS U.S. GOVT SECURITIES A KUSAX FIXED INCOME DWS 2,172.71 8. 0 18,685.29
SCUDDER
INVESTMENTS
Account Total: $18,685.29
InvestorTotal: $18,685.29