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HomeMy WebLinkAbout01-09-09 (2)~ REV- 1500 ~ (Dg.o~) PA Depar>tnent of Revenue Bureau of Individual Taxes Po eox29oeo7 INHERITANCE TAX RETURN Herriab Pa i~1z 901 RESID ENTER DECEDENT INFORMATION BELOW Sodel Security Number Date of Death I47-16-4047 01252008 Decedent's Last Name Suffix MEYERHOFER (If Applicable) Enter Survivlrtg 3pousa~s Information Below Spouse's Last Name Suf31x OFFICIAL USE ONLY ~~~' ~~ Year File Numt~er Date of Birth 08071926 Decedent's First Name Ml JOSEPH Spouse's First Name MI Spouse's Soda! Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS ® 1: Orfginal Return (~ 2. S uppiemental Return ~ 9 R [~ 4. Llmftad Estate . amastder Return (date of death . ~ prior ba 12-7392) 0 ~' ~77Compromise (date of ~] S. Faders! Eata69 Tax Rehm Raquir~ed ~ © 8. Decsdent DledTeatabe (Attach Copy of WNt) ~ 7~ (A~ ~ ~ ~ a W~8 Trtiat ~ 9. Total Number of Safe Deposit Bwa~s (~ 9. Lifiyation Proceeds Received 10. S u~t Q Po Poverty Credit (date of de th a [~ 11. Eledion to tax under Sec, si 13(A) between 12-31-91 and 2-1-95} (Attach Sch. O) CORRESPONDENT-THIS 8ECTION. MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL T Name AX INFORMATION SHOULD BE DIRECTED T0: ROBERT G .. FREY Daytime Telephone Number ~ r~ Firm Name {If Applicable) 717-243-5838~n e'' . FFtEY & TILEY REGISTER OFYYILLSY ~w+}.Y 7=~ ~ "° First line of address - = " ~-~ a ,, 1"~'l 1 5 SOUTH HANOVER STREET , Second Ifne of_address ,,~ , `--' 4 z ~ . ~.~ ~_.. ~ ~ -~ W .. City or Post Office _ f.' W State 21P Code DATE FILEp ~ CARLISLE PA 17013 CorrespondenYse-manaddreas; RFREY@FREYTILEY.CnM ADDRESS ,5 SOUTH HANOVER ST REPRESENTATIVE CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONL Side 1 15Q5604111.4 2505604111,4 25056041114 _~j 1 ~ :-- =~ > -=, . -<J ~ ..'S .- -- '_, ~., `a 15056042115 REV-1500 EX Decedent's Social Security Number oecedent'sName: JOSEPH MEYERHOFER 147-16 -4047 RECAPITULATION 1. Real estate (Schedule A) ......................................... .. 1. 17 0 0 0 0 . 0 0 2. Stocks and Bonds (Schedule B) ................................... ... 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. NONE 4. Mortgages & Notes Receivable (Schedule D) ......................... ... 4. NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 13 9 6 8 . 0 0 6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ...... .. 6. NONE 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ...... .. 7 NONE 8. Total Gross Assets (total Lines 1-7) ................................ .. 8. 18 3 9 6 8 . 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) .................... 9. 3115 8 . 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. .. 10. 2 3 7 . 0 O 11. Total Deductions (total Lines 9 & 10) ............................... .. 11. 313 9 5 . 0 O 12. Net Value of Estate (Line 8 minus Line 11) ........................... .. 12. 15 2 5 7 3 . 0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... . 13. 15 0 0 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) 1a 13 7 5 7 3 0 0 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 O 15. O.O O 16. Amount of Line 14 taxable at lineal rate x .0 4 5 13 7 5 7 3. 0 0 16, 6191.0 0 17. Amount of Line 14 taxable at sibling rate X • 13 18. Amount of Line 14 taxable 17, 0 . 0 0 at collateral rate X , 15 18. O.0 0 19. TAX DUE ...................................................... . 19. 6 1 9 1. 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056042115 Side 2 15056042115 REV-1500 EX Page 3 147-16-4047 Decedent's Complete Address: Ffle Number 2~_na_~~n DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER JOSEPH MEYERHOFER 147-16-4047 STREET ADDRESS 1000 CLAREMNONT ROAD CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 6000.00 C. Discount 300.00 3. Interest/Penalty if applicable D. Interest E. Penalty (1) 6191.00 Total Credits (A + B + C) (2) 6300.00 Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 109.00 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. (5) (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 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 : ....................................... 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. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................... ~ a 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. 217 REV-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER JOSEPH MEYERHOFER 21-OS-170 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 me poi>"~„~ ~MQ ~•• •••-•- -r~w• •~ ~wvvcu, uwcn auuiuunai SfleG'IS OT irlB SaR1@ SIZE) zn REV-1508 EX+ (6-98) SCHEDULE E CASH BANK DEPOSITS & MISC COMMONWEALTH OF PENNSYLVANIA ~ ~ INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER JOSEPH MEYERHOFER 21-08-170 Include the proceeds of litigation and the date the proceeds were received by the errata ~•• •••-•- -~~~~ ~~ ,,..~~~u, niacii auwuvnai SneeTS Oiin@ S8n1@ SIZ@) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER JOSEPH MEYERHOFER 21-08-170 Debts of decedent must be re orted on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Head stone 1,537 2. Ewing cemetery grave openning 325 3. Memorial dinner 500 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Lawrence Meyerhofer Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4. 5. 6. 7. 8. 9. 10. 11. 12. Street Address Clh' State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparel's Fees Expenses in connection with sale of real estate (see settlement statement attached) Storage costs for personal property Pharmerica, final prescription drug expense Moving expenses Travel expenses Copy expense and office supplies TOTAL (Also enter on line 9 Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) 7,200 5, 000 299 12,361 1, 544 555 1,166 303 368 1.158 REV-1512 EX+(~2-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER JOSEPH MEYERHOFER 21-08-170 Report debts Incurred by the decedent prior to death which remained ~~~~~i~ ~e „E tie a,~..,r a__.~ ~__~..~._ _ _ _ 217 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~SEPH MEYERHOFER SCHEDULE) BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [include ouVight spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 1. Josephine Meyerhofer 2. Paul Bailley RELATIONSHIP TO DECEDENT Do Not List Trustee(s) FILE NUMBER 21-08-170 AMOUNT OR SHARE OF ESTATE 1/2 of remainder 1/2 of remainder 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 6. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Brethren in Christ 2. Boulevard Baptist Church 3. Bethel Baptist Church 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) 5,000 5,000 5,000 1 LAST WILL AND TESTAMENT OF JOSEPH MEYERHOFER I, JOSEPH MEYERHOFER, widower, of South Middleton Township, Cumberland County, (mailing address: 54 Greenfield Drive, Carlisle, Pennsylvania 17013) being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament hereby revoking and making void any and all Wills by me at any time heretofore made. 1. I direct my hereinafter named Executor or Executrices [o.pay al] of my just debts and funeral expenses as soon after my death as may be found convenient to do so. I further direct that all inhcritance, transfer, succession, estate and death taxes, including interest and penalties thereon, which may be payable on account of my death shall be payable from the residue of my estate regardless of whether the assets upon which such taxes are based are included in my probate estate. I also direct my hereinafter named Executor or Executrices to make arrangements for the cremation of my body according to the arrangements I have made with the Cremation Society of Pennsylvania. 2. I declaze that I am an unmarried man widower and that I have no living children or other lineal descendents. 3. I give and bequeath the following; a) The sum of $5,000.00 to the Brethren in Christ Church, Carlisle, Pennsylvania b) The sum of $5,000.00 to Boulevard Baptist Churuh, Anderson, South Carolina. c) The sum of $5,000.00 to Bethel Baptist Church, Bradenton, Florida. 4. All the rest, residue, and remainder of my estate real, personal, and mixed and wheresoever the same may be situate I give, devise and bequeath in equal shares to my brother-in- law, Paul Bailley, and my sister-in-law Josephine Meyerhofer. In the event that Paul Bailley should predecease me or fail to survive me by a period of ninety (90) days, the share he would otherwise have received shall pass to his wife, Dora Lee Bailley, but should she also predecease me or fail to survive me by the aforesaid period of ninety (90) days, said share shall pass to her issue, per stirpes. Should Josephine Meyerhofer predecease me or fail to survive me by a period of ninety (90) days, said shaze shall pass to her son, Lawrence Meyerhofer, Jr., but should he also predecease me or fail to survive me by the_aforesaid period of ninety (90) days, said share shall pass to his children per stirpes. It is my purpose in making these bequests to remember my family and the family of my wife and it is my hope that the legatees will shaze these bequests generously with their families. 5. I hereby nominate, constitute and appoint my brother-in-law, Paul Bailley, and my sister- in-law, Josephine Meyerhofer or either of them as Executors of this my Last Will and Testament, but should both of them predecease me or fail to qualify or cease serving as such, then in such event I nominate, constitute and appoint my nephew, Lawrence Meyerhofer, Jr., as Executor, and I further direct that none of them shall be required to post any bond to secure the faithful performance of his or her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. 6. In addition [o the powers conferred by law, my hereinbefore named Trustees and Executors and their respective successors, are empowered: a. To invest any part of the trust corpus in such securities, investments, or other property as may be deemed advisable and proper, irrespective of whether the same are authorized for the investment of trust funds under the laws of any governing jurisdiction. b. With respect to any corporation, the stocks, bonds, or other securities of which may be held, to vote in person or by proxy on any shares of stock; to consent to the merger, consolidation or reorganization of such corporations; to consent to the leasing, mortgaging or sale of the property of any such corporations; to make any surrender, exchange or substitution of such stocks, bonds or other securities as an incident to the merger, consolidation or reorganization of such corporations; to pay all assessments, subscriptions and other sums of money which may be deemed wise and expedient for the protection and maintenance of the proportionate interest of the investment in such corporations; to exercise any option or privilege which may be conferred upon the holders of such stocks, bonds, or other securities of such corporations either for the conversion of the same into other securities or for the purchase of additional securities, and to make any and all necessary payments which may be required in connection therewith; and generally to have and exercise as to all such stocks, bonds and other securities, the powers of an individual owner who is not under trust obligation. c. To hold the trust corpus in one or more consolidated funds in which separate shares shal] have undivided interests. d. To sell at public or private sale for cash or upon credit, or partly for cash and partly on credit, and upon such terms and conditions as shall be deemed proper, any part or parts of the estate, and no purchaser at any such sale shall be bound to inquire into the expediency or propriety of any such sale or to see to the application of the purchase moneys arising therefrom. e• To keep on hand and uninvested such money as may be deemed proper and for such period as may be found expedient. E To compromise, settle or arbitrate any claim or demand in favor of or against the trust estate. g• And authorized in the discharge of fiduciary duties, to employ counsel and to determine and to pay such counsel reasonable compensation which shall be charged against the principal or income of the trust fund, and shall further be entitled to charge against the principal or income such other reasonable expenses and charges as may be necessary and proper to tncur for the proper discharge of fiduciary duties and for the proper management and administration of the trust estate. h. In making any division of property into shares for the purpose of any distribution thereof directed by the provisions of the trust, to make such division or distribution, either in cash or in kind, or partly in cash and partly in kind, as shall be deemed most expedient, and in making any division or distribution in kind may allot any specific securi or ro e ty P P rty or any undivided interest therein to any one or more of such shares, and to that end may appraise any or all of the property so to be allotted and the judgment-as to the propriety of such allotment and as to the relative value for purposes of distribution of the securities or property so allotted shall be final and conclusive upon all persons interested in the trust or in the division or distribution [hereof. i• And authorized to register any shares of stock or other assets of any trust in their own names or in the name of a nominee. j• To retain and invest in shares of stock of my Trustee. k. To retain any investments including mutual funds which I may own at the time of my death and in addition to invest any part of the Trust corpus in such mutual fund or mutual funds as may be deemed advisable or proper, irrespective of whether the same are authorized for the investment of trust funds under the laws of any governing jurisdiction. 1• To determine from time to time whether all or some portion of realized capital gains shall be treated as ordinary income for distribution to a beneficiary or treated as principal to be retained as part of the corpus, and such designation need not be consistent from one year to another. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on one (2) pages, this 20th day of July, 2001. ose eyer fer (SE'AT') Signed, sealed, published, and declared by Joseph Meyerhofer, the Testator above named, as and for his Last Will and Testament, in our presence, who, in his presence, at his request, and in the presence of each other, have hereunto subscribed our n es as attestin -xuit~esses. ,~ ORRSTO ITN s~ A Tradition of Excellence February 22, 2008 TO: Robert G Frey 5 S Hanover St Carlisle, PA 17013 FROM: Andrew Ott BEO P.O. BOX 250 SHIPPENSBURG PA 17257-0250 RE: ESTATE OF JOSEPH MEYERHOFER DATE OF DEATH: January 25, 2008 77 East King Street P.O. Box 250 Shippensburg, PA 17257 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: CHECKING ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST 106001979 Joseph Meverhofer 04/04/2001 $1 112 51 Kathy AAnthony-Gulden Guardian 106214091 Joseph Meyerhofer Kathy AAnthony-Guiden-Guardian $11 581.70 SAVINGS ACCOUNTS , ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTERES"f CERTIFICATES OF DEPOSIT ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST 1. FHA 2. FmHA 3. Conv. Unins. 4. VA 5. Conv. Ins. C. This form is furnished to give you a the closing; they are shown here fo~ D. Name and Address of Borrower: WALTER F. NICKEL, III BARBARA L. NICKEL 384 LAKE MEADE DRIVE EAST BERLIN, PA 17316 F. Name and Address of Lender N/A G. Property Location 54 GREENFIELD DRIVE, CARLISLE, PA 17015 SOUTH MIDDLETON TOWNSHIP CUMBERLAND COUNTY P H. Buyer's settlement Agent: Frey & Tiley Law OffICe AR CEL NO. 40-24-0748-116 5 South Hanover St i G 1 Se Place of Settlement: . TIN 25-1730538 Carlisle PA 17013 February 19, 2008 5 South Hanover Street @ 3:30 .m. Carlisle PA 17013 J. SUMMARY OF BORROWER'S TRANSA ION K. SUMMARY OF SELLE R'S TRANSACTION 100 Gross Amount Due From Borrower - 101 Contract sales price 400 Gross Amount Due To Selle~~ 170,000.00 loz Personal property aol Contract Sales price 170,000.00 l03 Settlement charges from (line 1400) ao2 Personal property 1,738.50 loa ao3 los aoa Adjustments for items paid by seller in advance: aos 106 City/town taxes 2/19/08 to 12/31/08 351 36 Adjustments for items paid by seller in advance: . l07 County taxes ao6 City/town taxes 2/19/08 to 12/31/08 351.36 los Assessments a07 County taxes 109 aoe Assessments 130 School taxes 2/19/08 to 6/30/06 622.08 1 409 a1o School taxes 2/19/08 11 to 6/30/08 622.08 112 411 izo Gross Amount Due From Borrower 172 711 94 412 4 , . _________ ---------_ 20 Gross Amount Due to Seller 170,973.44 zoo Amounts Paid By Or In BahaNbf 8orrpwur =________- - ~ - 201 Deposit or earnest money 500,I1ed4Ctiops In Amount Due To Se41er 2oz Principal amount of new loan(s)*** 2,000.00 501 Excess deposit (see instructions) zo3 Existing loan(s) taken subject to 502 settlement charges to seller (line 1400) zoa 503 Existing loan(s) taken subject to zos Soo Payoff of first mortgage loan 206 505 Payoff of second mortgage loan 207 506 208 507 209 508 Adjustments for items upaid by seller 509 230 City/town taxes 1/1/OB to 2/19/08 Adjustments for items upaid by seller 211 County taxes 510 City/town taxes 1/1/08 to 2/19/08 212 Assessments 511 COUnty[axeS 213 512 Assessments 23a School taxes 7/1/07 to 2/19/08 513 zls 51a Scho0ltaxes 7/1/07 to 2/19/08 216 515 217 516 218 517 219 518 220 Total Paid By/For Borrower 519 2 suu a.asn nt settlement.FromJ'io Borrdwer. 301 Gross amount due from borrower (line 120) 302 Less amounts paid by/for borrower (from line 220) 303 Cash (X) From ( ) To Borrower ,000.00 520 Total Reductions to Amt Due Seller 600 Cash At Settlement To/From Seller: 172,711.94 601 Gross amount to seller from (line 420) 2 000.00 602 Less reductions in amount due seller (from line 520): 170, 711.94 603 Cash ( )From (X) To Seller 12,360.84 12,360.84 170,973.44 12 360.84 158,612.60 6. File Number - - - - ""'" a~~o ~ruan ~eveio ment Form US HUD - 1 7. Loan Number Pa a No. 1 8. Mortgage Insurance RE3005 Case Number ABST#6452 ement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outs ormational purposes and are not included in the totals. E. Name and Address of Seller: PAUL BAILLEY LAWRENCE MEYERHOFER, JR. ESTATE OF JOSEPH MEYERHOFER -- 700 Total Sales/Broker's Comm. based on price: 170,000.00 Division of Commission (line 700) as follows: 701 10 200.00 r to EBENER Sc ASSOCIATES 702 to 703 - ---.._...........~..~ @ 6~h c 10,200.00 Paid From Borrower's Funds at Settlement Pa9e No Paid From Seller's Funds at Settlement . 2 700 701 702 7oa Commission paid at Settlement 703 7os 10,200.00 7 oa aoo Items Payable In Connection With Loan: 7 os (Mortgage Amt: 0.00 Total charges, Lin es 801 through 0.00 8 00 801 Loan Origination Fee .000 % t0 a02 Loan Discount .000 % t0 0'00 8 01 803 Appraisal Fee to x'00 8 02 boa Credit Report to 8 03 805 Lender's Inspection Fee to S Oa Bob Mortgage Insurance Application Fee to 8 05 607 Assumption Fee to 8 06 806 8 07 809 8 08 810 8 09 811 8 10 900 Items Required 13y Lender T B i a ll o _e Pa d In Advance: 901 interest From 19-Feb-08 to 0.0~~ per day = ? ~' 902 Mortgage Insurance Premium for months to 9 01 903 Hazard Insurance Premium for 1 years to 90 2 904 years to 90 3 905 90 4 1000 Reserves Deposited With Lender: 7oal Reserves, Li nes 1 001 tborugh 1006: 0 90 5 1001 Hazard insurance mos @ , - .00 - 10 00 . looz Mortgage insurance mos @ per month 10 01 . 1003 Clty property taxes per month 10 02 mos. @ per month IoOa County property taxes mos. @ per month 10 03 loos Annual assessments mos. @ per month loo a 1006 mos. @ per month 100 5 1007 School taxes mos. @ per month 100 6 loos Aggregate Settlement Adjustment 100 7 uoo Title .Charges: loo s uol Settlement or closing fee t0 _ 110 0 110z Abstract or title search to 110 1 1103 Title examination to 110 2 1104 Title insurance binder to 110 3 1105 Document preparation to 110 a 1106 Notary fees t0 110 5 1107 Attorney's fees to 110 6 (includes above items numbers: P.O.C. 110 7 lloe Title Insurance to FREY &TILEY (COMMONWEALTH LAND TITLE INS. CO.) (includes above items numbers: ~ 1109 Lender's Coverage g 0 Endorsements: 1110 Owners Coverage $ 170,000 1111 CLOSING SERVICE LETTER TO COMMONWEALTH LAND TITLE INSURANCE CO. lllz 1113 OVERNIGHT DELIVERY FEES TO FREY &TILEY __ _. lzoo Government Recording and„Transfer Charges: Deed Papes: 0 Mtg pages.: 1201 Recording fees: Deed $38.50 Mortgage: Releases 12oz City/county/stamp Deed $1,700.00 Mortgage 1203 State tax/stamps: Deed $1,700.00 Mortgage $ lzoa 1205 a3oo Additional Settlement-Charges: 1301 Survey t0 1302 Pest inspection to 1303 Current Taxes due from Borrower/Seller to Bob Cairns, Tax Collector 13oa FINAL WATER AND SEWER CHARGES TO SMTMA -ACCT NO. 016169 1305 1306 1307 laoo Total Settlement Charges (enter onlFnes 103, Section 7 and 502, Section K) P.O.C. 1109 1110 1111 luz 1113 Ilzoo 38.50 I lzol 1,700.00 ~ ~ lzoz 1,700.OU ~ 1203 1204 lzos ~ 1300 1301 1302 405.84 1303 55.00 13oa 1307 1,738.50 12,360.84 laoo