HomeMy WebLinkAbout02-03-0915056041103
REV-1500 EX cos-o5)
PA Department of Revenue OFFICIAL. USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 281)601 INHERITANCE TAX RETURN 2I 08 0518
• Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMAT{ON BELOW
Social Security Number Date of Death Date of Birth
200242411 05042008 08291933
Decedent's Last Name
KELLY
Suffix Decedent's First Name
DOLORES
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
M
MI
FILL IN APPROPRIATE BOXES 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)
^ ^ 10 f d
th
l P
C
dit
d
t
S ^ 11 El
ti
ta
nd
9113
t
S
A
9. Litigation Proceeds Received . ea
pousa
overty
re
(
a
e o .
x u
er
ec.
ec
on
o
(
)
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 TO:
Name Daytime Telephone Number ev
RALPH W- WIRE, JR•, CPA (717)76~'i8
072 :
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A ~ ~ _,
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Firm Name (If Applicable) '
REGISTER Q„nFt I~$ ,1SE ~Y f
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-
R • WM • WIRE ASSOCIATES, P - C - ~
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First line of address
C"1~-~~-~ ~ •_
_
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19 SOUTH 19TH STREET ~~~ ~ `~-~ ~~a
Second line of address
~ ~ r
~'
N
City Or POSt Office State ZIP Code DATE FILED
CAMP HILL PA 17011-5402
Correspondent's e-mail address: B I L L o0 R W W A C P A S- C O M
Under penalties of perjury, I declare at I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and co te. Dec lion of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI TURE OF PER RE LE FOR FILING RETURN DATE/ /
~ ~ KEITH KELLY, EXECUTOR ~ 212 D4
ADDRESS
SIGNATU
RALPH W. WIRE, JR., CPA
DATE
19 SOUTH 19TH STREET, CAMP HILL, PA 17011-5402 (P00642780t23-2031522)
PLEASE USE ORIGINAL FORM ONLY
Side 1
150561741103 ewasa>>.oo0 15056041103
J
- ~ 15056042104
REV-1500 EX
- Decedent's Social Security Number
Decedent's Name: DOLORES M KELLY
200242411
RE CAPITULATION
1. Real estate (Schedule A) ............................ . 1. 18 9 9 0 0.0 D
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. 8 9 7 5 • 8 ~
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6. 8 0 ~ 6 4 , 8 7
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested 7.
8. Total Gross Assets (total Lines 1-7). 8. 2 7 9 6 4 0. 7 4
9. Funeral Expenses & Administrative Costs (Schedule H) . g. 4 814 7 • ~ 7
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). 10. 18 2 - 93
11. Total Deductions (total Lines 9 & 10) . 11. 4 8 3 3 0 - 7 0
12. Net Value of Estate (Line 8 minus Line 11) 12. 2 31310 - O 4
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. 2 3131 D , D 4
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_ 15.
16. Amount of Line 14 taxable
at lineal rateX .045 231310.04
16.
10408.96
17. Amount of Line 14 taxable
at sibling rate X .12 17
18. Amount of Line 14 taxable
at collateral rate X .15 1 g.
19. TAX DUE 19. 1O4D8.96
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
15056042104 awasaei.ooo 15D56042104 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 210 8 0 518
DECEDENTS NAME
DOLORES KELLY
STREET ADDRESS
b17 NORTH 34TH STREET
CITY
CAMP HILL STATE
PA ZIP
17011-2705
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments 12 0 0 0. 0 0
C. Discount 631 • 56 (512, 000 @ .05263)
3. InterestlPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + g + C)
(1) 10408.96
(z> 12631.56
Total InteresVPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box on Page 2, Line 20 to request a refund. (.4) 2 2 2 2 • 6 0
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAx DUE. (5)
A. Enter the interest on the tax due. (5,4)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5E3) 0 • 0 0
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:
a. retain the use or income of the property transferred;
f
i
i ^
erred or
ncome; .
b. retain the right to designate who shall use the property trans
ts
i ^
nterest; or .
c. retain a reversionary
?
f ^ X^
its or care
d. receive the promise for life of either payments, bene
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .
"
"
0
in trust for
or payable upon death bank account or security at his or her death?
3. Did decedent own an
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
^
0
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 use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~116(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.116(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. 559116(a)(1.3)J. Asibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
ewas~t t o00
REV-1502 EX+(6-98) SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
DOLORES KELLY 21-08-0518
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 DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1. RESIDENTIAL REALTY (117 NORTH 34TH STREET, CAMP HILL, PA 17011) 189,900.00
-AS PER SETTLEMENT STATEMENT AT 7/15/2008 (SEE ATTACHMENT)
8 W 4695 1.000
TOTAL (Also enter on line 1, Recapitulation) I $ 189, 900.00
(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, 8c MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF FILE NUMBER
DOLORES KELLY 21-08-0518
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PERSONAL PROPERTY (AS APPRAISED/LINE & LINE JEWELERS) 3,042.20
2. OTHER MISCELLANEOUS PERSONAL PROPERTY 5,000.00
3. U.S. CASH & CURRENCY (SAFETY DEPOSIT BOX) 308.67
4. U.S. SAVINGS BONDS (SAFETY DEPOSIT BOX) 625.00
TOTAL (Also enter on line 5 Recapitulation) $ ~ 8, 975 _ 87
8wa6AD 1.000 (If more space is needed, insert additional sheets of the same size)
REV-1509 EX+ (6-96)
SCHEDULE F
COMMNHER ANC OAx RETURN ANIA JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DOLORES KELLY 21-08-0518
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 ADDRESS RELATIONSHIP TO DECEDENT
A, KEITH KELLY 4019 RIVER RIDGE ROAD SON
CHARLOTTE, NC 28226
B.
C.
JOINTLY-OWNED PROPERTY:
ITEM
NUMBER LErtEJZ
FORJOINr
rEwwr DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDEN4AAEOFFINMICIALtNSTITUfIONANDBANKACCOUNT
~eERORSM~ JOI'NfLV~IFELDREALESTATE.~ACHDEEDFOR
DATE OF DEATH
VALUE OF ASSET %OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
1. A. 1/2/1996 SAVINGS/CHECKING ACCOUNT 161,529.74 50 80,764.87
-MEMBERS 1ST FCU
A/C #222455
TOTAL (Also enter on line 6 Recapitulation) I$ 8 0, 7 6 4. 8 7
BWasAE 1.000 (If more space is needed, insert additional sheets of the same size)
REV-1511 EX+(10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
DOLORES KELLY 21-08-0518
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
~, MUSSELMAN FUNERAL HOME
2. SHERRIE KELLY- FUNERAL HOME SERVICES
3. BRICKER HOUSE- AFTER FUNERAL RECEPTION
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
2
3
City State Zip
Year(s) Commission Paid:
Attorney Fees (JAMES KOLLAS, ATTORNEY)
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
AMOUNT
4,881.37
2,000.00
175.00
7,500.00
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 3 8 0. 0 0
5. Accountant's Fees (R. WM. WIRE ASSOCIATES, P.C.) 1, 875.00
6. Tax Return Preparer's Fees
7. EXECUTOR TRAVEL EXPENSES 487.36
8. APPRAISAL SERVICES (LINE & LINE) 350.00
9. ADVERTISEMENT 297.15
10. REAL ESTATE ADMINISTRATIVE EXPENSES (SEE ATTACHMENT) 10,362.62
11. REAL ESTATE SALE/SETTLEMENT COSTS (SEE ATTACHMENT) 19,617.11
12. SAFE DEPOSIT BOX OPENING FEES 143.10
13. POSTAGE AND EXPRESS 79.06
TOTAL (Also enter on line 9, Recapitulation) $ 4 8 , 14 7 . 7 7
SW46AG 1.000 (If more space is needed, insert additional sheets of the same size)
ESTATE OF DOLORES KELLY
FILE # 21-08-0518
. ADDENDUM TO SCHEDULE H
FUNERAL EXPENSES & ADMINISTRATIVE COSTS
#10. REAL ESTATE ADMINISTRATIVE EXPENSES -
a. Cable television $30.18
b. Carpeting 2,600.00
c,. Electrical repairs 444.90
d. Electricity 333.23
e. House debris removal 4,088.65
f. House painting 2,000.00
g. Insurance (Penn National) 131.00
h. Lawncare/landscaping 573.50
i. Natural gas 43.30
j. Sewer 66.11
k. Trash removal 51.75
TOTAL $10, 362.62
#11. REAL ESTATE SALE/SETTLEMENT COSTS (SEE HUD SETTLEMENT STATEMENT, ATTACHED) -
a. Sales commission $11,394.00
b. Transfer taxes 1,899.00
c. Recording fees 25.00
d. Tax certification 15.00
e. Sewer and trash 21.87
f. Administrative fees 195.00
g. Home warranty 419.00
h. Seller assistance 6,000.00
i. Real estate tax pro-rations (351.76)
TOTAL $19,617.11
01/29/2009 SCHH.WK4
REV-1513 EX+(g-00) SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DOLORES KELLY
~i _ns~_n~~ a
RELATIONSHIP ~f0 DECEDENT v v vAMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
1. KEITH KELLY 1/2 OF
4019 RIVER RIDGE ROAD RESIDUARY
CHARLOTTE, NC 28226 SON ESTATE
2. JAMES KELLY 1/2 OF
2915 GREEN STREET RESIDUARY
HARRISBURG, PA 17110 SON ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, O N REV-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 $
awasni i.ooo tir more space is needetl, insert additional sheets of the same size)
Previous adidons are obsolete Corm HUO~t (3/e6) rat Handbook 4305.2
Settlement Statement U.S. Department o1 Housing and Urban Development
Tvoe of Loan nsbo n...........t
"-•••--,• -..c.,., c~ nca r irowct/~a rrl'IAL
1. ^FHA 2. ^FmHA 3. ^Conv. Unins. 6. File Number 7. Loan Number 8, Mortgage Insurance Case Number
4. VA 5. Conv.lns. IWEP08.1134 1540043843
o m is urn,a o p you s a omen o ac ua s en cos s. moun o an y e s men ape a e s own. --
C. Note: items m ked'(p.o.c.)" were petd outskfe the cbslnp; they are shown here for Information purposes antl are not Included In Iha totals. TItIeEXPreSS Settlement System
WARNING: Il Is a crime to knowlnply make lalae statements to the United Slates on this or an other sknNar lorm. Penallles upon
convkllon can InUuda a fine antl im rlsonmenl. For tletalls see: Title t e U. S. Code Soctlon 1 ~pt and Section t Ot o. Printed 07/15/2008 at 13:43 LMG
D. NAME OF BORROWER: Phunthlp Sungkarat
ADDRESS: 1921 Rutland Street Cam Hill Pa 17011
E. NAME OF SELLER: Estate of Dolores Kelly
ADDRESS:
F. NAME OF LENDER: EverBank
ADDRESS: Its successors and/or assi ns 8100 Nations Wa Jacksonville FL 32258
G. PROPERTY ADDRESS: 117 North 34Th Street, Camp Hill, PA 17011
01-Zi-0273-187., Camp Hill Borough
Princi al Residence Other Real Estate
H. SETTLEMENT AGENT: EDGE ABSTRACT INDEPENDENCE, LLC, Phone: 610-678-7444 Fax: 610-898.9203
PLACE OF SETTLEMENT: 2213 QUARRY DRIVE SUITE 102A WEST LAWN PA 19809
I. SETTLEMENT DATE: 0 711 512 0 0 8
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 rice 189 900.00 401. Contract sales rice 189 900.00
102. Personal Pro a 402, Personal Pro e
103. Settlement char es to borrower line 1400
5 885.99 _
403.
104. 404.
105. 405.
Ad'ustments for items a{d b seller in advance Ad'ustmenls for items paid by seller in advance
106. Ci !town taxes 07/15!08 to 12/31/06 234.88 406. Ci !town taxes 07/15/08 to 12/31/08 234.88
107. Coun taxes 07!15/08 to 12/31/08 138.18 407. Coun taxes 07/15/08 to 12/31/08 138.18
108. School Taxes 07115!08 to 06!30/09 1 672.47 408. School Taxes 07/15/08 to 06/30/09 1 672.47
109. Libra Tax 07115!08 to 12/31/08 10.88 409. Libra Tax 07115!08 to 12/31108 10.88
110. 2nd Qtr Sewer Char es07/15!08 to 09130/08 44.51 410. 2nd Qtr Sewer Char es 07!15/08 to 09/30/08 44.51
111. Trash 07/15/08 to 09/30!08 43.87 411. Trash 07/15/08 to 09/30/08 43.87
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 197 930.54 420. GROSS AMOUNT DUE TO SELLER 192 044.55
200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. De osit or earnest move 5 000.00 501. Excess De osit see instructions
202. Princi al amount of new loans 151 920.00 502. Settlement char es to seller line 1400 15 761.88
203. Existin loans taken sub'ect to 503. Existln loans taken sub'ect to
204. 504. Pa off of First Mort a e loan
205. 505.
206. 506.
207. 507.
208 • 508.
209. _--.-- _- ____ 509.
Ad'ustments for items un aid b seller _
Ad'ustments for Items un aid b seller
213. 513.
214. 514.
215. Seller Assist 6 000.00 515. Seller Assist 6 000.00
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 162 920.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 21 781.66
300. CASH AT SETTLEMENT FROM OR TO BORR OWER 800. CASH AT SETTLEMENT TO OR FROM SELLE R
301. Gross amount due from borrower line 120 197 930.54 601. Gross amount due to seller lane 420 192 044.55
302. Less amounts aid b /for borrower line 220 182 920.00 602. Less reduction amount due seller line 520 21 78'1.68
303. CASH FROM BORROWER 35 010.54 603. CASH TO SELLER 170 282.89
SUBSTITUTE FORM t 099 SELLER STATEMENT: The Inlonn atlon contained herein Is Important tax Information and Is being furnbhsd to the Internal Revenue Servke. If you are required to file a return,
a nagliponce penaay or other sanction will De Imposed on you If this Item is required to De reported end the IRS determMes that it has not been repo rled. The Contract Sales Ptka described on
line 401 aDOVe constitu les the Grose Procaeda of this Iran satllon.
Vou are required by taw Io provide the settlement agent (Fed. Tax ID No: _ )with your correct taxpayer Wenlllti;ation number. a you do not provide your correct uxpayer iden111Malbn
number, you may be suDle c[ to civil or crlm lnel penallles Imposed by law. 1-1nrTe i~penal[les of pe r)ury, I certify that the number shown on thla stale ment Is my correct taxpayer identllication number.
TIN: ~ ~ SEL LER(5) SIGNATURE(S): /
-__.._ . _ t __...._._..-_.
SELLER(S) NEW MAiuNG ADDRESS:
SELLER(S) PHONE NUMBERS
(H)
IW)
Previous edltlons are obsolete form HUD-1 (3/86) rel Handbook 4305.2
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: IWEP08-1134 FINAL PAGE 2
CFTTI G~AGt~IT STATCWFAIT r:.._~..__ --,. .., --_..._ ... .__.._...--- -.- .-----
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on rice $189 900.00 = 11 394.00 BORROWER'S SELLER'S
Division of commission line 700 as follows: FUNDS AT FUNDS AT
701. $ 5 672.00 to Hel U Sell SETTLEMENT SETTLEMENT
702. $ 5 722.00 to Howard Hanna Real Estate Services
703. Commission aid at Settlement 11 394.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Ori ination Fee
802. Loan Discount
803. A raise! Fee to Wise A sisal Servlces P.O.C. 350.00 Bu er
804. Credit Re on to NCO Credit Services P.O.C. 10.50 Bu er
805. Administrative Fee to EverBank 595.00
806. Flood Certification Fee to Elite Lender Services 15.50
807. Re istration Fee to M.E.R.S. 4.95
608. Tax Service Fee to First American Real Estate Tax Service 74.00
809. Broker Processin Fee to 1st A letree Mort a e 395.00
B10. Broker Com ensation to 1st A letree Mort a e Z2 363.88 POC b Lender
811. Courier Fee to Federal Ex ress 20.00
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 07/15/2008 to 08/01!2008 I'~$ 26.5340 /day 17 DaVS _
451.08
902. Mort a e Insurance Premium for to _ _
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance 3 mo. $ 24.17 /mo 72,51
1002. Mort a e Insurance mo. $ !mo
1003. Ci Pro a Tax 8 mo. 42.10 !mo 252.80
1004. Coun Pro a lax 6 mo. S 28.74 !mo 180.44
1005. School Taxes 2 mo. S 145.26 Imo 290.52
1009. A re ate Anal sis Ad'ustment to EverBank •299.54 0.00
1100. TITLE CHARGES
1101. Out of Office Closin Fee to EDGE ABSTRACT INDEPENDENCE LLC 100.00
1102. Wire Fee to EDGE ABSTRACT INDEPENDENCE LLC 20.00
1103. Courier Fee to Federal Ex ress 34.30
1104. Deed Pre oration
1105. Document Pre araUon to EDGE ABSTRACT INDEPENDENCE LLC 40.00
1106. Note Fees to Dou Kehl 35.00
1107. Attome 's fees
includes above items No:
1108. Title Insurance to EDGE ABSTRACT INDEPENDENCE LLC 1 439.63
includes above items No:
1109. Lendefs PDlic 151 920.00
1110. Owner's PDlic 189 900.00 - 1 439.63
__
1111. End 100 End 300 End 900 to EDGE ABSTRACT INDEPENDENCE LLC
150.00 ___
1112.
t 113. Closin SvcLtr to First American Title Insurance Com an 35.00
__
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES ---
1201. Recordin Fees Deed S 40.50 ~ Mort a e $ 60.50 • Release 101.00
1202. Ci ICoun tax/stems Deed 1 899.00 ~ Mort a e $ 1 899.00
1203. State Taxlstam s Deed $1 899.00 Mort a e $ 1 899.00
1204.
1205. Record POA to Ed a Abstract LLP 25.00
1300. ADDITIONAL SETTLEMENT CHARGES __
1301. Count /Tw !School Cert to Janet L. Miller 5.00
1302. Tax Claim Cert to Cumberland Coun Tax Claim Bureau 5.00
1303. 2008-2009 School Tax 2°k to Janet L Miller 1 704.41
1304. 1st 8 2nd Qtr Sewer a/n 1449 to Cam Hili Borou h 110.25
1305.
1306. Tax Cert to Sue Kent 5.00
1307. Administrative Fee to Howard Hanna Real Estate Servlces 195.00
1308. Home Warren to HSA 419.00
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103, Section J and 502 Section K) 5 885.99 15,761.66
HUD CERTIFICATION OF BUYER AND SELLER
I have carelully revbwed the HUD-1 $efib en[ Statement and to the baSl or my Nnpwledge and bell6l, h It a [rue and accurate stalem ant of all reca4>Ia and disbursemenh made on my account or by me
In lMS van section. I Wrlher certMy dla a racelved a p of the HUD-I Settlement Stalemen 1.
in ip ung ra - I I / 11 U Q
? COOI"---~~~VVV (J
W ARNING. IT IS A GRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON CONVICTION
CAN INCLUDE A FINE AND /MPRISONMENT. FOR DETAILS SEE TITI. E 16
V S. CODE SECTION 1001 AND SECTION 1010.
The H - Settleme Sla enl w Ich 1 nave prepared Is a True and 9<Wrale account or this lra nsacllon.
I nave ca ed or w ca s e tun Io be dlsbur sad In accordance w Ih IMS stalem ant
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EDGE ABSTRACT, INDEPENDENCE, LLC
TRUST ACCOUNT COMMERCE BANK
200 SPRING RIDGE DRIVE, SUITE 205 CAMP HILL, PA
WYOMISSING, PA 19610 60-184/313
(610) 378-5520
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TO THE ``--'~~ J'1
ORDER
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Watchmakers Jewelers
21 Dickinson Avenue Carlisle, PA 17013-2903
(717) 249-3928 Fax (717) 243-2623 mndiamondsinc@pa.net
STATEMENT
William C. Kollas, Esquire
Koilas & Kennedy
1104 Fernwood Avenue, Suite 104
Camp Hill, PA 17011
This is a value statement prepared by Line & Line Jewelry as part of the estate of Delores
Kelly, recently deceased:
Services rendered ................................................................................$350.00
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Watchmakers Jewelers
21 Dickinson Avenve Carlisle, PA 17013-2903
(717) 249-3928 Fax (717) 243-2623 mndiamondsinc@pa.net
Appraisal
November 20, 2008
To whom It May Concern;
This is to certify the following described articles of jewelry part of the estate of one, Delores
Kelly, recently deceased, said jewelry having been submitted to our firm for value appraisal by James W.
Kollas, Esq., Kollas & Kennedy, 1104 Fennwood Avenue, Suite 104, Camp Hill, PA 17011, have current
cash values, as herewith listed:
1. Oval-shaped blue topaz pendant, the stone measuring 18mm by 13mm, set in a 14 karat
Yellow gold mounting, value ............................................................................................$ 30.00
2. 14 karat yellow gold heart-shaped pendant, set with 15 brilliant (round) cut diamonds,
each weighing approximately .OS carats, with 18" yellow gold neck chain, value............$250.00
3. 18 karat 24" gold neck chain, weighing S.SSdwt. @$10.00 per dwt., value ........................ $ 55.50
4. Pair of diamond earrings, each earring being set with 7 diamonds, averaging .03 carats,
each earring also being fitted with a sapphire set enhancer, each enhancer set with 10
round cut sapphires, the mountings being of 14 karat yellow gold, value of the pair........$125.00
5. Ruby and diamond pendant set with a round cut center ruby, measuring approximately
3mm diameter, surrounded by 8 small diamonds, each weighing approximately .O1 carats,
they, in turn, being surrounded by 8 round cut rubies, each approximately 2mm in diameter,
the mounting being of 14 karat yellow gold, fitted with a 18" yellow gold neck chain,
value .................................................................................................................................... $ 75.00
6. Rectangular amethyst, measuring 7mm by Smm, set in a 14 karat yellow gold pendant
mounting with 3 small diamonds, each weighing approximately .O1 carats, value...........$ 35.00
7. Pair of earning enhancers, each set with 5 diamonds and 5 rubies, each weighing
Approximately .O1 carats, value .......................................................................................$ 40.00
8. Sapphire and diamond ring, consisting of a center marquee cut dark blue sapphire,
9mm x Smm, surrounded by 12 round full cut diamonds, each .OS carats in weight,
the mounting being of yellow gold probably 14 karat, value ...........................................$125.00
9. 17" strand of 8mm diameter imitation pearls, value ..........................................................$ 1.00
10. Ladies diamond set tennis bracelet, consisting of 39 diamonds, each weighing
approximately .04 carats, set in 14 karat yellow gold bracelet mountug, value .............$250.00
11. Pair of diamond earrings, each diamond weighing approximately .30 carats, set in
14 karat straight post mountings, value .......................... ..
............................................ ...$350.00
12. Pair of diamond and amethyst earrings, each amethyst measuring 8mm x 6mm, each
earring having four small diamonds, each weighing .O1 carats, value ........................ ...$ 75.00
13. Ladies ring set with two rows of imitation diamonds with a row of rubies in betweeq
all stones measuring approximately 2.5 mm in diameter, the mounting being of
I4 karat yellow gold, value ......................................................................................... ..$150.00
14. Ladies amethyst and diamond ring, having a triangular shaped amethyst as its
center stone with two rows of small diamonds on each side, the mounting
being of 14 karat yellow gold, value ............................................................................ ..$ 75.00
15. Ladies heart-shaped pendant of pierced filigree desigq value ...................................... ..$ 30.00
16. Amethyst and diamond pendant set with spear-shaped amethyst measuring
15mm x lOmm, and one small diamond weighing approximately .03 carats, the
mounting being of 14 karat yellow gold, value ........................................................... ..$ 35.00
17. Several entangled gold chains, having a combined weight of 9.85dwt., at $10.00/dwt .
$10.00/dwt, value ......................................................................................................... $ 98.50
18. 32" strand of cultured pealls, averaging 7.75mm in diameter, each of medium
quality, value ............................................................................................................... .$250.00
19. Yellow gold ruby set tennis bracelet, the rubies being very crudely cut, averaging
less than 2mm in diameter, value ............................................................................... $ 30.00
20. 18" 14 karat yellow gold neck chaiq weighing 7.83dwt, @$10.00/dwt, value ............ .$ 78.30
21. 18 karat gold bracelet, weighting 3.75dwt @$14.00/dwt, value .................................... $ 52.50
22. 24" 18 karat yellow gold neck chain, weighing 9.80dwt, @$14.00/dwt, value ............ .$137.20
23. 14 karat yellow gold bracelet, weighing 9.80dwt, @$10.00/dwt, value ........................ .$ 98.00
24. 18 karat yellow gold bangle-style bracelet, weighing 9.75dwt, @$14.00/dwt, value... .$136.50
25. Cuhured pearl bracelet, consisting of 23 cultured pearls of 7mm in diameter,
medium to low quality, value ...................................................................................... $ 25.00
26. Ladies ruby and diamond ring, consisting of a centrally set marquee c;ut ruby,
6mm x 3mm, surrounded by 18 diamonds, weighing approximately .028 carats
each, set in a 14 karat yellow gold mounting, value .................................................... .$ 75.00
27. Ladies sapphire ring, consisting of a centrally set marquee cut sapphire, measuring
7mm x 3.Smm, surrounded by 12 very small diamonds, weighing approximately
.005 carats each, the mounting being of 18 karat yellow gold, value ........................... .$225.00
28. 16" 18 karat yellow gold neck chain, weighing 8.55dwt, @$14.00/dwt, value ..............$119.~0
29. Amethyst and ruby set pendant, designed to imitate a robot with dangling arms and
legs, a triangulaz-shaped amethyst to simulate the head, a small triangulaz cut ruby
as the neck, the mounting being of yellow gold, value ................................................... 15.00
TOTAL 3,042.20
Line & line Jewelers
.fen C e
REGISTER OF WILLS
CUMBERLAND COUNTY
PENNSYLVANIA
No . 2008- 00518 PA No . 21- 08- 0518
Estate Of : DOLORES KELL Y
(first, Midd/e, Lastl
Late Of : CAMP HILL BOROUGH
CUMBERLAND COUNTY
Deceased
Social Security No: 200-24-2411
WHEREAS, on the 9th day of May 2008 an instrume=nt dated
August 10th 2004 was admitted to probate as the last will of
DOLORES KELLY
(First, Middle, L~st1
late of CAMPH/LL BOROUGH, CUMBERLAND County,
who died on the 4th day of May 2008 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
KEITH A KELL Y
who has duly qualified as EXECUTOR(R/XJ
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND (:OUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 9th day of May 2008.
eglster o l s~ '
e uty
* *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
LAST WILL AND TESTAMENT
OF
DECOKES KELLY
I, DECOKES KELLY of I I7 North 34th Street, Camp 13111, Cumberland County,
Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make and
declare this to be my Last Vb'ill and Testament, hereby revoking all prior Wills and Codicils
heretofore made by me.
All references to my children are to my sons, JAMES M. KELLY and KEITH A.
KELLY.
FIRST: I direct that my Executor pay all my debts and funeral expenses as soon after
my death as may be practicable. I further direct that all state, inheritance, transfer, legacy, or
succession taxes which may be assessed to my estate, or any part of my estate, whether passing under
my will, shall be paid out of my residuary estate as an expense of administration and without
apportionment.
SECOND: I give all the rest and residue of my estate in equal shares to my
executor in trust for my grandchildren Carrie Ann Kelly of Willow Grove, Pennsylvania, and Eva
Elizabeth Kelly of Charlotte, North Carolina, to hold the principal of this trust for the benefit of my
grandchildren then living and shall distribute the principal and income in such proportions as trustee
shall detemnine, without being required to maintain equality among them and, after considering all
other resources available to them, for the education of the respective beneficiaries, until there is no
~~_
grandchild of mine living who is under the age oftwenty-six (26) years. Such distributions maybe
made to cover the following associated expenses of primary and secondary schools and college,
university, and vocational or technical institutions: tuition, laboratory fees, books and supplies, and
room and board. If there is no grandchild of mine under twenty-six (2Ei) years of age, the then-
remaining principal and any accumulated and undistributed income shall be distributed equally
among mythen-living grandchildren.
THIRD: I appoint my son, KEITH A. KELLY, of Charlotte, North Carolina, to be
the Executor of my Last Will and Testament.
FOURTH: In addition to having all the powers conferred by statute or by general
rules of law, my Executor and Trustee, with respect to the properties in Amy estate, subject to any
limitations stated elsewhere in this Will, are specifically authorized and empowered:
(a) To invest any funds of my estate in any corporate shares, bonds, notes,
or other securities or property, real or personal, including any common or commingled funds
maintained by my Executor and Trustee hereunder. This is to reflect any intention to give the
broadest investment powers and discretion to my Executor and Trustee;
(b) To sell or otherwise dispose of any property, real or personal, at any
time forming a part of my estate, for cash or upon credit, in such a way and on such terms as my
Executor and Trustee may deem best;
(c) To manage, operate, repair, improve, mortgage, and lease foranyterm
any real estate at any time held;
: !~ ~
... :~i
(d) To make distribution in cash or in kind upon any division of my estate;
and
(e) In general, to exercise all powers in the management of my estate
which any individual could exercise in the management of similar property in his own right, and to
do all acts which my Executor and Trustee deems necessary or proper to c:arty out the purposes of
this will.
FIFTH: No Executor or Trustee acting hereunder shall be required to post
bond or enter surety in this any other jurisdiction.
SIXTH: If any person or institution entitled to share in any distribution under
the terms of this my Last Will and Testament becomes an adverse party in ~uiy proceeding to contest
the probate of this Last Will and Testament, such person or institution shall forfeit his, her or its
entire interest inherited hereunder and all provisions in favor of such person or institution shall be
declared void and of no effect. The share of such person or institution so forfeited shall be
distributed a part of the residue pursuant to Paragraph Two hereof except that if such person or
institution is entitled to share in the said residue, that interest shall be distributed proportionately to
the other residuary distributees.
~~
IN WITNESS WHEREOF, I have hereunto set my hand this G% day of
~1~ , 2004.
~~~~~ , ~.~ (SEAL)
~ DEL S KELLY `
3
SIGNED, SEALED, PUBLISHED and DECLARED by the above, DECOKES KELLY,
as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence,
and in the presence of each other, have hereunto subscribed our names as witnesses:
`-~
WITNESS
WITNESS
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
of J'~ <%~SS~ K F-Ci1
~G
C'~~~ ~.c.CC. ~c. l7a /J
SS:
I, DECOKES KELLY, Testatrix, whose name i;~ signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowlE:dge that I have signed and executed
the instrument of my Last Will and Testament; that I signed it willingly; and that I signed it as my
free and voluntary act for the purposes therein expressed.
Sworn to and acknowledged before me by DEL,ORES KELLY, the Testatrix, this
kh
~ ~ day of ~_ 2004.
_~~~ ~,
`' ~' v'
otary Public
~~ ,
DE ORE KELLY
N A IAL ~•
CAROLE A ROSE
Notary Publ(c
TWSP OF LOWER ALLEN
CUMBERLAND COUNTY
My Corrxnfsslon Ex es Oct 21. 2007
4
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF
rr~ --Y--,
We, (mil S ~ ~ UC,k__ and ~ ~° ~~~ 2 ~ S , f Jc~t,%2 U ~.. the
witnesses whose names are signed to the attached instrument, being duly caualified according to law,
do depose and say that we were present and saw the Testatrix, DECOKES KELLY, sign and
execute the instrument of her Last Will and Testament; that she signed it willingly and that she
executed it as her free and voluntary act for the purposes therein expressed; that each of us in the
hearing and sight of the Testatrix signed the Vb'ill as witnesses; and that to the best of our knowledge
the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or
undue influence.
~, / Sworn to and subscribed to before me by Ll S i4- ~ ,v Gam- and
,~>y~~.ti~,~ ~ ~Jr~~~- v~ i i ~ ,witnesses, this ~ day of ~_ 2004.
'fitness
Notary Public
1
Witness
N AR{AL AL
CAROLE A ROSE
Notary Pub{{c
7WSP OF LOWER ALLEN
CUMBERLAND COUNTY
Corrxnbs{on E ea OC121, 2007