HomeMy WebLinkAbout03-13-09-J REV-1500 1505607120
EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO 80X.280601 21 0 8 0 0 7 3 2
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
032121810 06012008 09071924
Decedent's Last Name Suffix Decedent's First Name MI
GIROUX JULIE
J
(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 qa, Future Interest Compromise
^ ^ (date of death after 12-12-82) ^ 5. Federal Estate Tax Return Required
^ g Decedent Died Testate ^ ~ Decedent Maintained a Living Trust 8. TOtaI Number of Safe De o
(Attach Copy of Will) (Attach Copy of Trust) p Sit Boxes
^ 9. Litigation Proceeds Received ^ 1 p, Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113 A
between 12-31-91 and 1-1-95) ^ ( )
(Attach Sch. O)
-CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
SAMUEL L. ANDES 7177615361
Firm Name (If Applicable)
First line of address
525 NORTH 12TH STREET
Second line of address
City or Post Office State ZIP Code
LEMOYNE PA 17043
REGIST~OF WILLS U ONLY ~ ~~
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-RA"I"L FILED r'~ -, - , -
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Correspondent's a-mail address: I a W a n d eS @a O I. CO m
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 tr>Je, correct and complete. Declaration of,~reparer other than the personal representative is based on all information of which preparer has any knowledge.
Caroline M. Rich
4 Conestoga Lane, Mechanicsburg, PA 17055
1505607120
1505607120
~-~
~~
525 North 12th Street, Lemoyne, PA 17043
Side 1
J
REV-1500 EX
oecede~rs Name: G I R O U X, JULIE J.
RECAPITULATION
1505607220
1. Real Estate (Schedule A) .......................................................................................... 1.
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.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ............. 7.
8. Total Gross Assets (total Lines 1-7) ....................................................................... 8.
9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10.
11. Total Deductions (total Lines 9 & 10) ...................................................................... 11.
12• Net Value of Estate (Line 8 minus Line 11) ............................................................. 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ................................................. 14.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 6 4, 3 6 7. 7 2 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. Tax Due ..................................................................................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Decedent's Social Security Number
032121810
148,500.00
6, 045.82
16,843.26
171,389.08
38,278.13
68,743.23
107,021.36
64,367.72
64,367.72
2,896.55
2,896.55
Side 2
1505607220 1505607220 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 08 - 00732
N
Giroux, Julie J.
STREET ADDRESS
9 Warwick Circle
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
p. Interest
E. Penalty
Total Credits (A + B + C)
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(1)
(2)
(3)
(4)
(5)
(5A)
(5B)
2,896.55
0.00
0.00
2,896.55
2,896.55
Make Check Payable to: REGISTER OF W/LLS, 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? .................................... ^ a
...................................................................................
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 Acwunt, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................................................................................... ~ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
'`; _ ~:
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)J.
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)J. 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)J.
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)J. 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 adoption.
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF GIPOUX, Julie J. 21 - 08 - 00732
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 wilting seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
ITEM I DESCRIPTION I VALUE AT DATE OF
NUMBER DEATH
1 Single-family townhouse unit at 9 Warwick Circle, Mechanicsburg, Silver Spring Township,
Cumberland County, Pennsylvania. Value based upon sale of property which settled on 29
August 2008
148, 500.00
-----~ TOTAL (Also enter on Line 1, Recapitulation) ~ 148,500.00
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSriVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF GIrOUX, Julie J. 21 - 08 - 00732
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 DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Checking account No. 610078-741-9 at Citizens Bank. Balance on date of death (see attached 3,586.30
statement)
2 Miscellaneous items of household furnishings, clothing, and other tangible personal property 1,000.00
3 1996 Chevrolet automobile in poor condition 500.00
4 Allstate Insurance Company (auto insurance refund) 21.70
5 GMAC Mortgage (escrow fund refund) 918.83
6 Penn Waste Company (refund) 18.99
TOTAL (Also enter on Line 5, Recapitulation) ~ 6,045.82
~~ ~CitizensBank
1-888-910-4100
CaU Citizens' PhoneBank anytime for account information,
current 2tes and answers to your questions.
U5259 BR294 10 1
JULIE GIROUX
9 WARWICK CIR
MECHANICSBURG PA 17050-26.43
Checking Account
Statement
of 3
Beginning May 09, 2008
through June 09, 2008
Checking
SUMMARY JULIEGIROUX
Balance Calculation CAROLINE M RICH
Basic Checking
Previous Balance 3,276.03 610078-741-9
Checks 1,128.78 -
Withdrawals 1,919.11 -
Deposits & Additions 2,710.64 +
Current Balance 2,938.78 =
Rewards Point Summary as of 05/31/08:
Earned: 0 Points Expiring 06/30/08 0
Redeemed: 0 Points Expiring 07/31/08 0
Expired: 0 Points Expiring 08/31/08 0
Available: 27 Renewal Month: April
Visit the Rewards online redemption site at:
citizensbank.com/rewards or call 1-888-777-3946 to redeem points.
Previous Balance
TRANSACTION DETAILS 3,216.03
Checks* There is a break in check sequence
Check # Amount Date Check # Amount Date
2250 18.21 05/19 2256 242.90 05/28
2251 120.00 05/22 2257 31.00 05/30
2252 355.67 05/22 2258 11.00 06/03
2253 144.00 06/04 2260* 126.00 06/02
2255* 80.00 05/27
n 7otalChecks
1,128.78
Withdrawals
Other Withdrawals
Date Amount Description
05/12 79.00 Pp Elec Bill 080512 4736071000ws
05/22 54.54 Bookclub Payment 080521
Check # 0000002249
06/02 59.97 Rbs Credit Card Payment 080530 240380001334155
06/05 1,233.00 Debit Memo
06/05 492.60 GMAC Mortgage, L GMAC Mortg 060508 0685450529
n Total Withdrawals
1,919.11
Deposits & Additions
Date Amount Description
05/30 1,091.00 US Treasury 220 VA Benefit 053008 03234524 10 01
05/30 127.34 Mass Mutual Pennon Ck 080530
Member FDIC Q Equal Housing Lender
~~ Ctt~zens L7~~1~ - Checking Account
~~ 1, L7 Statement
1-8$8-910-41QU Q of 3
Call Citizens' phoneBank anytime for account information,
current rates and answers to your questions.
Beginning May 09, 2008
through June 09, 2008 _
Checking continued from previous page
Deposits & Additions (continued) JULIE GIROUX
Date Amount Description
06/02 259.30 Homeland Center Payroll 080601 032121910 CAROLINE M RICH
06/03 1,233.00 US Treasury 303 Soc Sec 060308 Basic Checking
610078-741-9
n Total Deposits & Additions
2,710.64
n - Current Balance
2,938.78
Daily Balance
Date Balance Date Balance Date Balance
05/12 3,197.03 05/28 2,325.71 06/03 4,808..38
05/19 3,178.82 05/30 3,513.05 06/04 (,664.38
05(22 2,648.61 OGj02°~ 3,586:38 06/05 2,938.78
05/27 2,568.61
MEMU
--The point balance listed in the Rewards Point Summary section shows the total points
available as of the Last day of the month prior to your statement being sent. Any points
earned or redeemed after that date will not be reflected until your next statement. For the
most up-to-date point balance, visit citizensbank.com/rewards.
~ NEWS (RUM CITIZENS
--Important Information about Check Cashing
Cashing a check can be a convenient way to get quick access to funds. We permit check
cashing in our branches for customers who have sufficient funds on deposit to cover the
amount of the item.
Occasionally a check that you cash may be returned to us unpaid. When that happens, we debit
your account for the amount of the item. In some areas, we also charge a fee of $10.00.
Beginning August 1, 2008 we will standardize this fee and apply it to all accounts in PA, DE,
RI, CT, and NH. This fee is the same as the current charge for a returned deposited item.
If you have questions about this change, please see a Banker or call us at the number Listed
on your statement.
--Great news! Beginning in May through June 2008, we're enhancing Online Bill Payment to
offer you faster payments. In most cases, you'll be able to pay your bills in as little as
24 hours. And with a new convenient payment calendar, you'll be able to determine the
earliest day your payments will be received. It's just another way Citizens is working to
make banking better for our valued customers.
Member FDIC Q Equal Housing Lender
COMMONWEALTH OF PENNSYLVANIA SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT ~I$C, NON-PROBATE PROPERTY
ESTATE OF Giroux, Julie J.
FILE NUMBER
21 - 08 - 00732
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY
Include the name of the transferee, their relationship to decedent
NUMBER and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH
VALUE OF ASSET ~ OF
DECD'S
INTEREST EXCLUSION
(IF APPLICABLE)
TAXABLE VALVE
1 Non-contributory retirement annuity with Mass Mutual 16,843.26 10000% 16,843.26
Life insurance Company, Policy No. IP924 (Certificate
No. 143). Value at date of death per attached
I statement.
I
TOTAL (Also enter on line 7, Recapitulation) I 16,843.26
MassMutual
FINANCIAL GROUP®
Attorney Samuel L. Andes
P. O. Box 168
Lemoyne, PA 17043-0168
RE: IP 924
Estate of Julie Giroux
Dear Mr. Andes:
October 29, 2008
I am enclosing a T209 form for estate tax purposes, as you requested in your letter dated
October 15, 2008.
Please call me at (413) 226-3066 if you have any questions.
Sincerely,
Sally A. Haapanen
Account Manager
Financial Products
MassMutual Financial Group
Massachusetts Mutual Life Insurance Company and affiliates Springfield, MA 01111-0001 (413) 788-841 I
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY, SPRINGFIELD, MASSACHUSETTS 01111
SPECIAL STATEMENT (Form 712 Not Applicable)
For Estate Tax Purposes Covering Annuities and Installment Accounts
To Be Filed by Executor with Federal Estate Tax Return Form 706
NAME OF DECEDENT DATE OF DEATH
Julie Giroux 1-Jun-08
1A. POLICY NUMBER(S) 1B. DECEASED'S 2. ISSUED ON LIFE OF:
IP 924 PAYEE ACCT. NO. Contract take over as July 01, 1976
Cert# 143
032-12-1810
3. ORIGINALLY A CLAIM PRIOR TO DEATH OF ABOVE DECEDENT: SURRENDER
MATURED ENDOWMENT OR ANNUITY
NO X YES BY REASON OF: DEATH OF INSURED OR ANNUITANT
4. TYPE OF POLICY OR INSTALLMENTS
IMMEDIATE PARTICIPATION GUARANTEE GROUP ANNUITY CONTRACT NONCONTRIBUTORY RETIREMENT ANNUITIES
5. RIGHTS DECEDENT HAD TO WITHDRAW, COMMUTE OR SURRENDER POLICY
NONE X FULL RIGHT OTHER-EXPLAIN:-
6. DEATH BENEFICIARY(IES) AND RELATIONSHIP TO DECEDENT
MARY KIME, WIFE
7. HOW DEATH BENEFIT PAYABLE
ONE SUM INSTALLMENTS AS FOLLOWS: X
MONTHLY PAYMENTS OF $95.51 PAYABLE TO SPOUSE COMMENCING ON JULY 01, 2008 FOR SPOUSE LIFETIME
8. RIGHT OF BENEFICIARY TO WITHDRAW PROCEEDS OR TO COMMUTE INSTALLMENTS
NONE X FULL RIGHT OTHER-EXPLAIN:-
9. VALUE AS OF DATE OF DEATH 10. ADDITIONAL MEMORANDA
$ 16,843.26
THE ABOVE VALUE IS WITHOUT REFERENCE TO
THE PHYSICAL CONDITION OF THE BENEFICIARY
9A. BASIS OF VALUATION OF INSTALLMENT BENEFITS
(MORTALITY TABLE AND/OR INTEREST RATE)
Present Value rate as of July 01, 2008 @ 5.00%
The undersigned officer of the above named Insurance Company hereby certifies that this
statement sets forth correct true information with respect to the contrac
t
indicated herein.
/
~
•
Date ~~ . ~ ~ ~ ~ Signature Titie ~'C--
p ,,
_/
THIS COMPANY BY FURNISHING THE ABOVE INFORMATION EXPRESSES NO OPINION AS TO WHETHER OR NOT ALL
OR ANY PART OF THE PROCEEDS OF THE ABOVE POLICIES ARE INCLUDIBLE IN THE GROSS ESTATE OF DECEDENT
T209 667
SCHEDULE H
FUNERAL EXPENSES &
COMMONWEALTH OF PENNSYLVANIA ~n A
INHERITANCE TAX RETURN ADIYI'N~~F1~'~ ~~
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF .Giroux, Julie J. 21 - 08 - 00732
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 ~ Myers Funeral Home (funeral services) 10,635.00
2 Diocese of Harrisburg (cemetary plot) 1,290.00
3 ~ Scottie's Beef and Reef Restaurant (funeral luncheon) 620.22
B.
1
DMINISTRATIVE GOSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
2.
3.
4
5.
6.
7.
1
City State Zip
Year(s) Commission paid
Attorney's Fees Samuel L. Andes
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) ~
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate t=ees Register of W ills
Accountant's Fees
Tax Retum Preparer's Fees
Other Administrative Costs
Cumberland Law Journal (advertising)
5,000.00
302.00
75.00
TOTAL (Also enter on line 9, Recapitulation) 38,278.13
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Schedule H
Funeral F~nses &
Actnmtstrahve Costs cor~nued
ESTATE OF Giroux, Julie J. FILE NUMBER
21 - 08 - 00732
2 i The Sentinel (advertising)
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
COSTS OF SALE OF RESIDENCE AT 9 WARWICK CIRCLE:
Sales commission paid to the Homestead Group
Attorney's fees (deed preparation}
I
Express Mail fee
~i One percent realty transfer tax (state)
One percent realty transfer tax (county)
I Final sewer bill
I
Home warranty program
Prudential-Thompson Wood transaction fee
D.L. Heiges Electrical Services, Inc. (electrical repairs)
Debra W lest, Tax Collector (2008-2009 school taxes, less proration)
Seller assistance (to repair garage door)
Less credit for municipal and county tax proration
COSTS TO REPAIR AND PREPARE RESIDENCE AT 9 WARWICK CIRCLE FOR
SALE:
Mr. Handyman (reconstruction of rear porch)
Mr. Handyman (exterior painting)
Lowe's (replacement of kitchen appliances and bathroom fixtures)
Bed Bath & Beyond (replacement of window blinds, curtains and draperies)
134.68
8, 910.00
150.00
17.00
742.50
742.50
58.17
455.00
200.00
196.00
169.49
700.00
-116.66
1,026.70
678.20
3,026.26
481.75
Page 2 of Schedule H
Soule H
COMMONWEALTH OF PENNSYLVANIA /A~~~. Y~,,~,~,~M/~++~~,~~,,~,,~, M.u~
INHERITANCE TAX RETURN /~~.Y I III IpY G1Y~fc \.+~.7pi:~ ~111.~R.7
RESIDENT DECEDENT
ESTATE OF Giroux, Julie J. FILE NUMBER
21 - 08 - 00732
19 ~ Sherwin Williams (paint and paint supplies)
20 T.J. Maxx (kitchen furnishings)
21 I Lancaster Mattress Outlet (replacement of bedframe)
22 Caroline M. Rich Design Company (staging of property for sale, including additional
decorating work)
23 ;Elizabeth Reese (painting supplies)
24 ~ Fluwog Renovations (repairs to roof)
25 Cropf Brothers, Inc. (plumbing repairs)
26 Joan Weise (lawn care)
27 Michelle Joynt (cleaning)
167.81
201.25
45.58
1, 500.00
119.94
346.01
163.73
120.00
120.00
Page 3 of Schedule H
ADDENDUM TO AGREEMENT OF SALE
We, the undersigned, acknowledge and agree to the following changes to the
Agreement of Sale dated July 19, 2008, regarding the purchase of the property
located 9 Warwick Circle, Mechanicsburg, PA 17050.
1) Seller assistance shall.be in the amount of $700.00.
All other terms of said Agreement of Sale will remain the same.
Richard W. Close, Jr., Buyer ~ Date
G~~G~~~ ~
of Juli Giro ,Seller Date
Sworn to and subscribed before me this `~:`3. day of ~ s~, ., , 2008.
Notary Public
COMMOtAM1IFAL.TFI OF PENNSYLVANU\
Notarial Seal
Michael E. Wise Notary Public
Mechanicsburg Boro, Cumberland Courtly
M Commission Tres Jan. 23.2010
A. B. TYPE OF LOAN:
U.3. DEPARTMENT OF HOUSING 8 URBAN DEVELOPMENT 1.QFHA 2,QFmtiA 3.nX CONY. UNINS. 4.[~VA 5.QCONV. INS.
8. FILE NUMBER: 7. LOAN NUMBER:
SETTLEMENT STATEMENT MOUOa-Doles oza7a24932
8. MORTGAGE INS CASE NUMBER: '
C. NOTE: This form !s fumishad to gtve you a statement o/adrra! settlement costs. Amounts paid to end by the settlement agent are shown.
Items marked 7POCp wale paid outside the dosing; they are shown here forlnfomratbna!purpDses end are not lnduded in fha totals
.
1.0 3108 (MOU06-0Ot43.PPdMOWa-OOtOant
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Richard W. Cbae Jr. Estate of Julie Giroux Suntrust Mortgage, Inc.
1246 Cross Creek Drimre 9 Wacwlck Circe 1001 Semmes Avenue
Mechanicsburg, PA 17050 Mechanicsburg, PA 17050 Richmond, VA 23224
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1844509 I. SETTLEMENT DATE:
9 Warwick Ckde fldeaty Cbsing SerNces, LLC
Mechanicsburg, PA 17050 A
t 29
Cumberland County, Pennsylvania
PLACE OF SETTLEMENT ugus
, 2008
26 North 8th Street
Lemoyne, PA 17043
J. SUMMARY OF BORROWER'S TRA NSACTION K SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. ConUact Sales Price 148 500.00 461. Contrail Sales Price 148 500.00
102. PersonelPro a 402. Personal Pro
1 3. SelUement Cha ea to Borrower Llne 1400 4 392.29 403.
104. 404.
105. 405.
Ad ustments for Items Paid B Selterln advance Ad ustments For Items Pard B Setter in advance
106. C frown Taxes io 408. CI !Town Taxes to
107. Co/TW Taxes 08/29/08 to 01/01/09 118.68 407. Co/T Tewes 08129!08 to 01!01!09 116.68
108. School Taxes 08129/08 to 07/01/09 743.70 408. School Taxes 08/29/08 to 07!01!08 743.70
109. 409,
110. 410.
111. 411,
112. 412.
120. GROSS AMOUMWE FROM BORROWER 163,762.65 420. GROSS AMOUNT DUE TO SELLER 149,360.36
200. AMOUNTS PAID BY OR IN eEHA1.F OF BORROWER : 800. REDUCTIONS IN AMOUNT DUE TO SELLER
201. De osit or earnest mone 1 500.00 501. Excess De See InslnrcUons
202. P ' al Amkwnt of New Loan a 87,000. W 502. SetUemeM Cha es to Seller Ina 1400 12 378.38
203. ExIsU ban a taken sub act to 603. Exlstln loans taken sub cA to
204. 504. Payoff Fkst M a e to GMAC Mortgage LLC/~06854 57,769.98
205. 505. Pa ff Second Mort e e
208. 506.
207. 507. t)e sUdtsb.as rocaeds
208. b06.
209. Seller Assist 7D0.00 509. Seger Assist 700.00
Ad ustments For Items Un aid B Seller A ustmeMs forltems Un aid 8 Seger
210. /Town Taxes to 510. C /Town Taxes to
211. Co/Tw Taxes to 511. Co/Tw Taxes to
212. School Taxes to 512. School Texas to
213. 513.
214. 514.
215. 515.
218• 518.
217• 517.
218• 518.
218• b19.
220. TOTAL PAID BY/FOR BORROWER 89,200.00 520. TOTAL REDUCTION AMOUNT OUE SELLER 70,848.32
500. CASH AT SETTLEM NT FROMfTO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
901. Grose Amount Due From Bonower 120 159 752.85 801. Grose Amount Due To Seser a 420 149 380.38
302. Less Amount Pakl B !For Borrower Line 220 ( 89 200.00 802, Less Reductlona Due Setter 620 70,848.3
303 CASH (X FROM) ( TO) BORROWER 64,652.85 803. CASH (X TO) ( FROM) SELLER 76,514.04
L. ~lC 1 1 LLIY1tN 1 1+riAKt~tS
700. TOTAL COMMISSION Based on PHCe $ 148,500.00 ® 8,0000 °.6 8,910.00
PAm FROM
PAIp FROM
Ohvfslon of Commission ilne 7 8$ FOOD W3: aORROwER'8 SELLER'S
701. 4 480.00 to Prudential Thom son Wood Real Estate FUNDS Ar FUNDS AT
4
703_ Commission Pald al Settlement SETTLEMENT SETTLEMENT
704
T
ti
F 8 910.00
•
ransa
on
ee to The Homestead Grow
800. ITEMS PAYABLE IN CONNECTION WITH LOAN 100.00
801. Loan Ination Fee % to
802. Loan Dlsoount 96 to
803. Ap Wal Fee to Central Penn Appraisal POC:B350.00
804. CredR Re R to Kro9 Factual Data
805
Lend
r
I
i
F -43.0
8 4
.
e
s
n ect
on
ee to
808• a Ins, A .Fee to
807, Assum Ucn Fee to
808. Tax Service to alutree Real Estate Serv
809
LOL Fl
d C
78 00
.
oo
eR to First Amerk)an food
810. Admintstratfve Fee !o entral PA Mo a e, LLC
811
M
B 8.00
600.00
.
a e
roker Fee to Central PA Mo a e, LLC POC:L1392.00
.
812. J Process Fee d b broker to SunWst Mo a e, Ina POC:M8500
00
.
813.
814.
815.
818.
817.
816.
810.
820.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
fD411. Interest From 08128f08 to 09!01/08 i 15.020000/dey 3 da %
902. Mort a e Insurance Premlumfor 12 months to 45.06
903. Hazard InsurarTCe Premium for t.0 ors to Erie Insurence POC:B399.00
904.
90b.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance 3.000 months 33.25 r month 99.75
1002. Mort a e insurance months S r month
1003. /Town Taxes months $ month
1004. ColTw Taxes 7.000 months $ 28.46 r month
1005. School Taxes 3.000 months ~ $ 73.92 r month
199.22
~1,7g
1~• months $ per month
0 m
1(108. re ateAd tmen! months r month -113.7
1100. TITLE CHARGES
1101. Settlement or Cbsl Fee to Fide Chain Services LLC 175.00
1102. AbslradorTitie Search to
1103, e a o to
1104. TNie Insurance Binder tD
1105. Document Pre aTatbn to
11 Og. No Fees to
1107. Attoma Feea to Samuel L Andes, Es uire 150.00
odes shove Item numbs 105- 107
0 4 Ins n
1 75
dudes above Item numbers:
1109. LerWers Covers S 87,000.00
11 0. a Co e S 146,500.00 1,103.75
1111, END, 100,300,900,b.i to fdel Clos6r rvicea, LLC 200.00
1112. Cbs Protection Letter to TicorTltle insurence Com en 35.00
1113.
1114. Wire Fee to Flde Cto Services, LLC 20.00
1116. Tess Mati Fee to Fide Clo a, LLC 17.00 17.00
1118. Tax Cert to American Tax Rep 40.00
1117.
118,
1200. GOVERNMENT RECORDING AND TRANSFER CHARGt?S
1201. Recordin Fees: Deed S 38.50; Mo a e S 74.60; Releases S 118.00
1202. !Coon Tax/Slam :Dead 1 485,00• Mo e e 742.b0 742.50
1203. State 7 tam s: Deed 1 485.00; Mo a e 742.50 742.50
1204. d nd a rot ed
1205. Cumberland Coun Recorder of Deeds
1300, ADDRIONAL SETTLEMENT CHARGES
1301. Surve to
1902. Pest I to South Central Pa. dome 1 Ion Coma Inc. POC:880.00
1903. Final Sewer to Silver 3 Townshl Auihodt Acct. 1403.1407 b8.17
1904. Home Wanan to AHS 455.00
1305, Sae addiCl dish. exhlbk to
1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103 Section J and 502 Section 4C
4,392.2 1,301.19
12,376.36
Ftdetity Closing Services, LLC, Settlement Agent
(M0008-OffUe / M0000-001d8 f 21)
HUD-1, Page 3
Borrower(s): Richard W. Close Jr.
1248 Cross Creek Drive
Mechanicsburg, PA 17050
Lender. Sunbust Mortgage, inc.
Settlement Agent: Fidelity Closing Services, LLC
(888)289-8092
Place of Settlement: 26 North 9th Street
Lemoyne, PA 17D43
Settlement Date: August 29, 2008
Property Location: 9 Warwick Circle
Mechanicsburg, PA 17050
Cumberland County, Pennsybania
Seller(s): Estate of Julie Giroux
9 Warwick Circle
Mechanicsburg, PA 17050
Additional Disbursements
PayeelDescriptlon Note/Ref No. Borrower Seller
Debra Wiest, lax Collector 905.19
2008!09 School Taxes 38-19-1621-121
South Central Pa. Home Inspection Company Inc. 310.00
Home Inspection POC:B310.00
Prudential Thompson Wood Real Estate 200.00
Transaction Fee
D.L. Heiges Electrical Services, inc. 196.00
Repairs
Total Additional Disbursements shown on Line 1305
Seiler Loan Payoff petalis
Payoff First Mortgage to GMAC Mortgage LLC
Loan Payoff 57,769.96 As of 09/04/08
Total Additional Interest -6 days
Total Loan Payoff 57,769.96
0.00 $ 1,301.19
Re:#0685450529
Per Diem
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a t~~and
accurate statement of all receipts and disbursements made on my account or by me in this transaction. 1 furth ertifi
that i have received a copy of the HtSD-1 Settlement Statement.
/~ A
Richard W. Close Jr. Y
Giroux
M. Rich, Executrix
WAFtNINO: It is a crime to knowingly make false statements to the United States on this or any similar forth. Pena@les upon convlcUon can
Include a tine and Imprieamnent For deta[Is sea: Title 18 U.S. Code Section 1001 and Section 1010.
(M0008-00148.PFOMt0008A0148121 y
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS
INHERITANCE TAX RETURN f
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF GIrOUX, Julie J. 21 - 08 - 00732
Include unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT J
NUMBER
1 GMAC Mortgage, LLC (mortgage on residence paid at sale of residence) 57,769.96
2 Talbot's charge card 158.00
3 ~ Wal-Mart charge card ~ 777.00
4 Citizens Bank credit account 1,446.31
5 Boscov's charge account 770.59
6 Bon-Ton charge account 208.91
7 Capital One Credit Card 2,641.00
8 Sears Gold credit card 1,881.46
9 HSBC Visa Card 196.37
10 Capital One Services (loan account) 1,889.00
11 Homeland Center (final nursing home bill) 259.30
12 PPL (electric utility service) 256.73
13 Penn Waste (trash service) 44.35
14 Verizon (telephone) 20.64
15 PA American Water (water utility) 108.86
16 Camp Hill Emergency Physicians 31.97
TOTAL (Also enter on Line 10, Recapitulation) ~ 68,743.23
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDENT continued
FILE NUMBER
ESTATE OF Giroux, Julie J. 21 - 08 - 00732
Include unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
17 Moffitt Heart Group 58.06
18 ~ NCH Healthcare System f 13.02
19 Silver Spring Township Sewer Authority 85.70
20 ~ United of Omaha (life insurance premium) 126.00
Page 2 of Schedule I
REV-1513 EX+(g.00) ,~
SCHEDULE J
CDMMON
AN4A
TA
Q B E N E FI CIARI E S
ERI
NCE
TAXRETURN
RESIDENT DECEDENT
ESTATE OF I
Giroux, Julie J. FILE NUMBER
21 - 08 - 00732
NUMBER
NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO
DECEDENT SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
i under Sec. 9116 (a) (1.2)]
1 Laura E. Reese Granddaughter Auto valued at $500
721 Melrose Street, Apt. C.
Chicago, {L 60657
I
2 Mary Beth Reese
Granddaughter
1/4 of household
1206 Highgate Court property ~
Libertyville, IL 60048
I
3 Rebecca A. Reese
Granddaughter
1/4 of household
1206 Highgate Court property
Libertyville, IL 60048
Enter dollar amounts for distributions shown above on lines 1 5 through 1$, as appropriate, on Rev 1500 cover sheet
III NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS
~
I
I NOT BEING MADE
I
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ 0.00
REV-1513 EX+ (9.00) ~ ~, ~
SCHEDULE J
COM NOHERITANCEOTAXRETURNANIA BENEFICIARIES continued
RESIDENT DECEDENT
ESTATE OF
Giroux, Julie J. FILE NUMBER
21 - 08 - 00732
NUMBER RELATIONSHIP TO
NAME AND ADDRESS OF PERSON(S) DECEDENT SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
RECEIVING PROPERTY Do Nat ListTrusfee(5)
I, TAXABLE DISTRIBUTIONS (include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
4 Julianne Reese Granddaughter 1/4 of household
6335 Creekbend Drive property
Mechanicsburg, PA 17055
5 Caroline M. Rich Daughter 1/2 of remainder
~ 4 Conestoga Drive
Mechanicsburg, PA 17055
6 Elizabeth A. Reese Daughter 1/2 of remainder
1206 Highgate Court
LibertyviNe, IL 60048
Page 2 of Schedule J