Loading...
HomeMy WebLinkAbout05-12-09REV-1737-AE%(6-081 pennsylvania INHERITANCE TAX RETURN - t~3 DEPARTMENT OF REVENUE PO BOX28D6oi NONRESIDENT DECEDENT FILE NUMBER g g _ pg Q4-~ ~y HARRISBURG, PA 1'J128-0601 _ _ _ COUNTY CODE YEAR NUMBER ~ DECEDENT'S NAME (LAST, FIRSTAND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z PLANTE, GENEVIEVE FRANCES 341-12-3207 W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) W 06/30/2003 03/01/1923 W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRSTAND MIDDLE INITIAL) SOCIAL SECURITY NUMBER F ®1.Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date ordeam P~ro~ to fz-fa-ez) a w a ~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date ordeam after faf2-az) ^ 5. Federal Estate Tax Return Required ~ a m ^ 6. Decedent Died Testate (Attach copy of win) ^ 7. Decedent Maintained a Living Trust (Attach copy of rm6q 0 8. Total Number of Safe Deposit Boxes a ^ 9. Litigation Proceeds Received ^ 10. Sp9USal POVerty (,fedlt (dale of death between 12-31-91 and 1-1-95) ^ 11. Election to tax under Sec. 9113(A) (Anacn son o) ~ TNiS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: w NAME COMPLETE MAILING ADDRESS i 0 JAMES D. HUGHES, ESQUIRE 54 ALEXANDER SPRING ROAD a FIRM NAME (ifAPProanie) SALZMANN HUGHES, P.C. 3 SUITE 1 p TELEPHONE NUMBER CARLISLE, PA 17015 717 249-6333 METHOD REFER TO METHOD OF COMPUTATION IN THE NONRESIDENT DECEDENT INSTRUCTION BOOKLET (REV-1736) Check One: ^ Flat Rate ^ Proportionate (Complete Worksheet on Reverse Side) Z Q J F- a Q U W 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) (;Schedule C) 4. Mortgages 8 Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ^ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) {10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line S minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) ~ Z SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES W ~ 15. Amount of Line 14 taxable at the spousal tax 2 Y ~ rate, or transfers under Sec. 2116 (a)(1.2) 49,458.64 W d 16. Amount of Line 14 taxable at lineal rate V O 17. Amount of Line 14 taxable at sibling rate U V 18. Amount of Line 14 taxable at collateral rate 19. Tax Due • Make check payable to Commonwealth of PA H H (11) 18,604.96 (12) 75,265.77 (13) 25, 807.13 (1 a) 49,458.64 • •: ~• x .0 _ (15) x .0 45 (1s) 2,225.64 x .12 (17) x .15 (18) (1g) 2,225.64 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 93, 870.73 (8) 18,604.96 93,870.73 C~ N L -~ -~ a A~ W a 0 Uw V Q J !1J W 0 r I W W Y H~ U O 0 !1 N QJ ~J 2 V ~ W O ~ d -~ z z w ia-- ~ god ~QW a~`~ ~Qa Z YZa W Z sag ~ LL. z m z v ~' _O W Z F- ~ 2 J UO' W a O W Z ~ ~ W Z ~ W O ~w~z Q ~ O }y. W W ~F-~ d t-paQ W ~ ~ ~. N d a W Z O ~ ~ a p O = N Q. ~"-a~ z®©©^ o a a } ^^^a ^ ^ N a N ~. ~ O L ~; ~ ~ O ? ~ Q • c c ~ N c6 N O y O C N Q L. O O OC ~ ~ ~ ~ C 4S ~ ~ O= L ~ ~ N C V O ~ O _~ `o $ ~ o ~' N ~ C ~ -O C IQ C C ~ O ~ y _ m _ d d L ~, ~ c c ` c m m ~ m O c .L... G ~ Q ~ O a> H E ~ m d O >. ~ ~ _ tD (~. n ~ n b O tTp N O`_ N .C N W O' N a ~~ `'~~ O N O C d ~ ~ O ~ N~ ~ O ~ O' N d C G] U ~ C ° o c E m e ci a~ E V N ~ O O ~ C ° ' '- ~ C N o- ~ ~ d ~ Q y O ~ O E ~ -O N ° m ~ N a E o y m a`~ o- ~ m 3 3 ~' y ~ > y c o i ~L" U . ~ o m C ~ ~ O = y ~ t '0 Gl d 0 N C C C >_ O ~ N N ~ W (V ~tO N y V .O N ° a ~ d~~ `° o a 0 m m ' 0 ~ b L ~ L N ~ ~ O -.i a " W ~ 1- O z Q O Z a W H I.L. et cfl V' co ~f7 tD ti N N yj N ~: N N ~ N v V U m a N v II L U ~ ~ d ~ c U J Q1 a~ m > m ~ Rf b (V C d N d ~ Qom. ~ -p n ~ o ~ O Cn d O R f- U Q m U ~ nl H m a 4 m >, m C ~ 4l .~'. d N ~ d c N C (L ~ ~ W ri w 1J j h N C d ~ ~ ~ ~ N a ~vj N a~ 'v c c ..J J + ~ ~za -~ w m ~ o Q O ~ a a y W v m Q L ua y U NL... y N C N J v ~ c d ~, C J L m ~ ~ ~ O C J N N .N C N J L = f- O !1' .q~ N m Q Z } Z' Z W a 0 J 2W I 0 ~4 Q. V V Ltl V Z a m L ~- J 0 O ai b :° O y W ,c W m d m Q W I W '= v N NYN L!. _ C ~ 0 ~ ~N Q n o~ LLz~ f b -O C m m N G ~ '~ .~ c W o ' ~ a H n ~ ~ _° Q C r Z ~,a L O m c 3 ~ .N, N /y >` N N Q O c O N m W G~I O O O yo on `ro n o rv ~= $ ~. a N t") O m ~ L O O _ N O ~ ~ C ~ ° ~ ` U - Q ~ j N U d ~ ~ ~ o °' 0 3 N N ~.~ L Oi ~ N N t LY d C C U ~ . ,,, ~> N p v .c ~ °- E m E ~ ~ O 4=I = NL.- N C ~ ~ m c > E `o N ~ _ c C N D ~ ~ C N R N~ ~ N ~~ C N Q V C n C N t0 ~ N O. ~ a d ~ C ~ to 0 G N ~ O I N m~ ~° O o c ~ ~ ro N ? ~ - UU ~ ~ N N N .O N m V (>D n C b~ ~ C O C ~ G~ O C~ ~ O O L L O ?C ~ ~ w d O a~ on L V -o t 0 3 ~ ] 10 O C _ a Q7 ~ N a m ~ O L 'O ~~ Q N~ N N N N C o n _ m ,. io ~ ~ ~ ai m ° m m ~. N iV C ~ O N ~ ~ O ~ ~ d ~ .- t ". p O c7 ~ O> C 11 ~u ~ ~ N O ~ ~ N ~~ y ~.o (V Q~j (D N O N N ~ ~- ~ ~ ~ °' ° ~ o~ O rows ~ our Q i ~ ~ c 0> a N O ' CIS O N >.q N ~ O O ~ ~ O N ~ ~, ~ ~~ a ~ ~~ ~ ~` ~ ~, `° ~ ~ ~ °' a' ~ o ` Q m Q ~° a~ cv r N o .: O~ s= .C m c n m O ~ ° C ~-~ c~ O c. o tT o b C ,p ,.., Z O N O V L O ~-- N coy .p a ~ N~ O C a ~ ~ '~. (O ` p~ o. a O ~ Q N O `o ~N a~ O oc n EN ^' ^a~ a~ O N N- Ni cn ~ c a O ~ m ~ ~ ~ is ~~ O cyL ca ` 3 .... O '. ~ > l ' V d O N d ~ O C ~ ~_ ~ ~.L ~ Li N m H 1L0 O N^ L L Q~ V > . r ..., h - io ~-- ~ a C v ~. ~ O N x ~ ~ N C ~~ ~ U ~. 0 o N' v _ M ~~ N N ~ .. c ~ ~ m o m _ r' ~ (O ~ ~ C t>6 d Q ~ X M m .~ N o ~ c N C N N v a~ c ~~ ~ Q C ~ O O ~ a .~ ° E o E o Q -O -O _ N .~ `. pa N a¢ C N m V N ~ y, N a ~° c ca c c ca x _N O O h J W U N a ... ~ N N ~O O m C L y N I to `o ~ ~ ~ ~ ~ °a a"i to tq m cD n V ~~ ~~ ~, X x X X x x `m `b To N '~ ~ c ~ o N U co c=~ m c=i m ~ a C N N N y ~ .c K~ K v O v x F~ O Fro co ~ c _o ~ O j ~ C ~ O ~' O 4 E° E o E o Q d Q 4 Q d ~ Oi 'a> U n 0 .~ a. ~ o U 0 r V r C O1 a 0 m .~. c a 0 co O1 tp N J O H L F- REV•1737-6 EX + (6-08) ~~i pennsyLvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & Use Schedule G, Part 2, ONLY for proportionate method of tax computation. MISC. NON-PROBATE PROPERTY ESTATE OF Genevieve Frances Plante FILE NUMBER 99-09- Part 1 must include all transfers of real estate and tangible personal property located in Pennsylvania. Complete Part 2 ONLY when the proportionate method of tax computation is elected. Include in the description of property the date the transfer was made and the name and relationship of the transferee. This schedule must be completed and filed if the answer to questions 1 through 4 on the reverse side of the REV-1737 cover sheet is yes. DESCRIPTION OF PROPERTY ITEM Include the name of the transferee, the relationship to Decedent and the date of transfer. DATE OF DEATH % OF DECD'S EXCLUSION NUMBER Attach a copy of the deed for real estate. VALUE OF ASSET INTEREST (IF APPLICABLE) TAXABLE VALUE 1 • Real Estate in trust from husbands Estate -situate at 41 E. South St., Borough of Carlisle, Cumberland Co, PA (See HUD-1 attached) 93,500.00 100 93,500.0 2 James W. Wolf, Jr. & Angela C. Wolf, refund of prorated school real estate tax (see HUD-1 attached) 370.73 100 370.7 PART 1 TOTAL $ $ $ 93,870.7: • DESCRIPTION OF PROPERTY ITEM Include the name of the transferee, the relationship to Decedent and the date of transfer. DATE OF DEATH °/o OF DECD'S EXCLUSION NUMBER Attach a copy of the deed for real estate. VALUE OF ASSET INTEREST (IF APPLICABLE) TAXABLE VALUE 1. PART S TOTAL $ $ $ 0.0( TOTAL (Also enter on Line 7, Recapitulation.) $ 93,870.73 (If more space is needed, use additional sheets of paper of the same size) REV-1737-6 EX + (6-08) REVERSE pennsylvania !.~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCHEDULE H F1~NERAL EXPENSES & ADMINISTRATIVE COSTS Use Schedule H ONLY for proportionate method of tax computation. ESTATE OF FILE NUMBER Genevieve Frances Plante 99-09- Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT q. FUNERAL EXPENSES: 1. B, ADMINISTRATIVE COSTS: 1. Personal Representative's Commission(s) Name(s) of Personal Representative(s) (Submit requested information for additional personal representative's on additional sheets) Social Security Number(s) or EIN Number(s) of Personal Representative(s) Street Address(es) City(ies) State(s) ZIP(s) Year(s) Commission Paid z. gttomey Fees Salzmann Hughes , P . C . 5,425.00 3. Probate Fees 14.00 4. I Accountant's Fees 5. Tax Return Preparer's Fees 6. Miscellaneous Expenses Ronald J. Gerts, Trustees fees 4,675.00 Re/Max Sterling Associates, Inc., realtors commission paid to sell real estate 3,297.50 Wolfe and Shearer Realtors, realtors commission paid to sell real estate 3,247.50 Re/Max Sterling Associates, Inc, transacton fee paid to sell real estate 150.00 Recorder of Deeds, 1 % realty transfer tax paid to sell real estate 935.00 TOTAL (Also enter on Line 9, Recapitulation.) $ CONTINUED (If more space is needed, use additional sheets of paper of the same size) REV-1737-6 EX + (6-06) REVERSE ,~~.,;._ SCHEDULE N s ~ ~~:~ pennsylvania FUNERAL EXPENSES & Use Schedule H ONLY for proportionate ,~' -0EPARTM€NTOF REV€NU€ _ method Of fax COmputatfOn. ADNIINfSTRATIVE COSTS INHERITANCE TAX RETURN NONRESIDENT DECEDENT ESTATE OF FILE NUMBER Genevieve Frances Plante 99-09- Debts of decedent must be reported on Schedule t. ITEM NUMBER DESCRIPTION AMOUNT Salzmann. Hughes, P.C., reimbursement for FedEx Mailings 41.00 Carlisle Borough, final utility service 192.50 James W. Wolf, Jr. & Angela C. Wolf, repair credit to sell real estate 350.00 Robin Sollenberger, Tax Collector, County tax proration from 1/1/09 to 2/19/09 54.08 James W. Wolf, Jr. & Angela C. Wolf, rent proration from 2/19/09 to 2/28/09 223.38 TOTAL (Rlso enter on L.i>ti~ 9, Ftt:capiluid4ion.) ~ $ 18 , 604.96 (If more space is needed, use additional sheets of paper of the same size) REV-1737-T EX + (6-08) REVERSE Life estate in Residual Trust under Clause Six of the Will ~ Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN NONRESIDENT DECEDENT ESTATE OF FILE NUMBER Genevieve Frances Plante 99-09- When flat rate method is elected, list the beneficiaries of the Pennsylvania property. When proportionate method is elected, list all beneficiaries. RELATIONSHIP TO ITEM DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE j, TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. 2116 (a)(1.2)) 1. Paul Plante, Carlisle, PA 17013 Son $ 75,265.77 x .65712 ~ ~ 49,458.64 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE SIDE OF REV-1737 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS t ~ New Melleray Monastery, 16632 Monastery Road, Peosta, Iowa 52038 1/2 remainder interest $75,265.77 x .34288 x .50 2 ~ Saint Vincent Archabbey Seminary, 300 Purchase Road, Latrobe, PA 15650-2592 1/2 remainder interest $75,265.77 x .34288 x .50 12,903.57 12,903.56 TOTAL OF PART II (Enter total non-taxable distributions on Line 13 of REV-1737 cover sheet.) $ 25 , 807.13 (If more space is needed, use additional sheets of paper of the same size) ~~~.~ zZZ ~z~.i~ C~.1>~.~~xnFn~ ~~ AReADE J. PLANTS I, Arcade J. Plate, of 1165 Yale Avenue, Bourbonnais, Kankakee County, Illinois, declare this to be my last will :utd testa~aent. Clause One I revoke all previous wills and codicils. Clause Two I am married and my spouse's name is Genevieve F. Plante. All references in this will to my spouse are to her. Clause Three I have one child now living, a son, Paul A. Plante, who resides at 41 East South Street, Carlisle, Pennsylvania. -I have no deceased children. Clause Four I give all of my televisions and computers to my son, Paul A. Plante. I ~ivG all of ,~,y sp::rts and recreational equipment to my sor., Paul A. i~la;itC, exc;;pt for my boats. I give my Hoff violin to Ruth La1~Iontange Schwartz, currently of 1135 South Poplar, Kankakee, Illinois. I give all of my automobiles and other tangible property of a personal nature to my spouse, if she survives me. Clause Five No person named or described in this Will shall be deemed to have survived me unless he or she is living on the thirtieth (30th) day after the day of my death. -I ~ r, v ` /~ CL Ulm ~,LC~L ~~L f . ~. c/ Clause Six I give the residue of my estate to the trustee named in this instrument in tnrst, to be held and administered on the following terms: A. If my spouse survives me the trustee shall pay the net income from the trust to my spouse until her death. B. The trustee shall pay no part of the principal of the trust to my spouse. C. For so Long as my spouse desires to live at 1165 Yale Avenue, Bourbonnais, Illinois, the trustee shall maintain said property from the income of the trust, said payments shall be considered income payments to my spouse and such payments shall include all maintenance on the house, payment of taxes, utilities, and aII other charges attributable to th e house. D. On the death of the survivor of my spouse the Trust shall continue and the Trustee shall pay the income from the Trust to my son, Paul A. Plante, during his life and. upon his death, the remaining corpus and any undistributed income, after payment of all Trustee's fees and other expenses of administration, shall be divided equally between New Melleray Monastery Peosta Iowa and St. Vincent Arch Abbey La Trobe Pennsylvania and the 'Trust shall be terminated. >.: r o0 ~ '0 Clause Seven a~G Except as otherwise provided, the following provisions apply to the trust under this wily: A. When any beneficiary entitled to receive payments in the absolute judgment of the trustee, is mentally or physically incompetent (irrespective of whether legally so adjudicated), the trustee may in the trustee's absolute discretion, expend or apply any payments for the benefit of the beneficiary. B. Income of the trust estate actually collected but not distributed at the date of the termination of the trust will be payable, or credited, as income to the beneficiary entitled to the estate or interest in proportion to his, her, or their respective interest. If, prior to the final distribution of my estate to the trustee, any part of the net income from my estate has been paid by the executor to any person or persons designated in this instrument to receive any part of the trust net income, the death of the person prior to final distribution will not operate to confer any right to the income so paid on any beneficiary entitled to the next estate or interest. C. The proceeds from the sale or transfer (other than a leasing or letting) of any part of the trust property will be for the account of trust principal. Bonds or other obligations bearing no stated interest will constitute income, when sold or redeemed, to the extent of the profit realized by the trustee. ..~- D. Until the trustee receives written notice of any birth, death, mamage, or other event on which the right to receive payments from the trust estate may depend, the trustee will incur no liability for disbursements of principal or income made in good faith to any person whose interest may have been affected by that event. E. In making any division or distribution of the property of this trust, the trustee is authorized in the trustee's absolute discretion, to make any division or distribution among the respective beneficiaries at any valuation as the trustee deems fit and proper, and in the trustee's absolute discretion may distribute the trust property in cash or in kind to the beneficiary or beneficiaries then entitled to receive any part or all of the trust estate. The trustee is further empowered to sell any portion or portions of all of the trust estate and to take other steps as may be necessary or proper in the trustee's absolute discretion to effect any division or distribution. F. On or before each anniversary date of the inception of the trust, the trustee shall account to the remainder beneficiary, i.e., Paul A. Plante, if he is then surviving. The remainder beneficiary may approve all such accountings in substitution for court approval. G. In handling the trust estate, the trustee has the power: AUG ~ ~ L000 1. To manage, invest, and reinvest the trust property without regard to lack. of diversification; to borrow money, including borrowing from the trustee and to mortgage, convey in trust, pledge, or otherwise hypothecate and encumber the trust property; to grant options; to vote stock; and, to do and perform any and all other acts and things deemed by the trustee necessary or advisable in the management of the tr~ist estate that may be done by an absolute owner of property. The trustee's powers will be cumulative and in addition to the powers conferred on the tnrstee by law. The enumeration here of the trustee's powers will not be construed as a limitation, it being my intent that at no time will the trustee be prevented through lack of an express power from taking any action in connection with the .trust estate which the trustee may deem expedient. 2. To acquire, except as prohibited by law, every kind of property, real, personal or mixed, and every kind of investment specifically including, but not by way of limitation, corporate obligations of every kind, and stocks, preferred or common; including investment in common trust funds. 3. To continue to hold any and all property received by the trustee or subsequently added to the estate, or acquired by the trust estate pursuant to proper authority, so long as the trustee exercises the judgment and care under the circumstances then prevailing which persons of ordinary prudence, discretion and intelligence exercise in the management of their own affairs, not in regard to speculation but in regard to the permanent disposition of their funds, considering the probable income from these funds, as well as the probable safety of their capital. ~j ~/ ~; j ,/~ 4. To allocate receipts and disbursements to principal or income as the trustee deems appropriate. In determining allocations between principal and income, a]1 allocations made by the trustee in good faith will be conclusive. 5. As to property held at any time or from time to time as an asset of any tnist under this instrument, the trustee cannot charge any depreciation to income. The cost of improvements cannot be amortized and no part of the improvements can be charged to income. The cost of ordinary repairs will be charged to income and the cost of extraordinary repairs will be charged to principal. Clause Eight If any beneficiary under this will contests it or any of its parts or provisions, any share or interest given to that person will be revoked and augment proportionately the shares of those beneficiaries who have not joined or participated in the contest. Clause Nine I appoint Genevieve F. Plante, my spouse, trustee of the trust created under this will to serve without bond. In the event for any reason my spouse is unwilling or unable to act as trustee, I name Alan F. Smietanski, my attorney, as trustee to serve without bond. Clause Ten I nominate and appoint Genevieve F. Plante, my spouse, executor of this will to serve without bond. In the event my spouse is unwilling or unable to act as executor, I name Paul ,A. Plante executor of this will. Clause Eleven Unless sooner terminated as otherwise provided in this instrument, the trust created Here fully ceases and terminates 21 years after the death of the last survivor of the testator and all children of the testator living on the date of this will. Gn termination, the entire principal of the trust estate, together with any undistributed income, will-vest in ar,d b~ distabated to the -peexsonx entitled to take under the provisions of the trust. ___ ~; ~, _ ,` r-,.~ ~~ . r7 ~G~~ ~ ~~ We certify that in our presence on the date appearing above, Arcade J. Plante signed the foregoing instrument and acknowledged ii to be his ~~'ill, that at his request and in his presence and 4 in the presence of each other we have signed our names below as witnesses, and that we believe him t~f sound mi and m ~ ory. residing at ~~~~ ,z (~ l ~~ ~C ~ _ residing at~-.~~~-~G~-~ , ~`~', AFFIDAVIT OF WTI'NESSES STATE OF IIfLINOIS ) SS: COUNTY OF >E;A.NKAKEE ) W~, the testator and witnesses, respectively, whose names are signed to the attached instn~ment, being first duly sworn, declare to the undersigned authority that the testator, in the :presence of witnesses, declared as his will the instrument of which this affidavit is a U~u-t; that the testator then freely and voluntarily signed such instrument as his will for the purposes therein expressed; that each of the witnesses believed the testator to be of legal age and sound mind and ;memory and under no constraint or undue influence of any kind; and that each of the witnesses then attested the will at the testator's request and in the presence of the testator and of each other. T tator~'~'` c--' i ` ~ -- /~ witness C 2f.~ Witness ~ SUBSCRIBED AND SWORN TO before me this 18th day of June, 1999. "OFFICIAL SEAL" A J. HAMBY-MORROW 'NOTARY PUB! IC, STATE OF ILL{PtOIS ~~~, ~ ~ ~tA~~;S!ON EXPIRES 10/30;`Z001 5 o..-°i~tiellzent ~tatef»ent B. 1-v r_..r Lodn __ ____ r- -- •, L [(FHA 2. ^FmHA 3. iiConv, Unins. ~ 6. File Number { 4. ~ VA 5. GConv ins. ~_29664WOLF U.S. Department of rlousing ana vluml vevcwNnlc~I, _ OMB Ap rp oval No. 2502-0265 ex ires_11I30/20U9j __ 7. Loan Number 18. Mortgage Insurance Case Number C. Note: Items marYetl "(o os 1" were Fad outs,de ttte closing, they are mown here for mlo~malion purposes and are no! Iritlutled In the tolais. WARNING: II is a co me 10 knowingly mak@ 1215e slalemenlS to the United $lal?s On This Or any olner similar form. Penallles upon cpnmcnon Can mUUtle a 9ne and Impnsonmenl. For details see' Title 18 U. 5. Code SecUOn 1001 and Secbor. 1010. _--___-_- .______-__..-. ___... -_----___._ --__-_._- i - _ _ 0 PJAME OF BORROWER: James W. Wolf,Jr. and Angela C..Wolf l HDDR~`SS -__ _ POBox 694,_Carlisle, Pa 17013 ______.__ E NAME OF SELLER: Estate of Arcade J. Plante ADDRtsS ,--------- ~--- ------- -- --------- F NAME OF LENDER. _ ADDRESS°------ - - --------- ----- G~ROPERTY ADDRESS: 41 E. South Street, Carlisle, PA 17013 { Carlisle Borough H SETTLEMENT AGENT: Cedar Cliff Abstract Agency, Inc., Telephone: 717-174-7435 Fax: 717-774.3869 PLACE OF SETTLEMEtJT_ '--- 414 Bridge 5treetLNew Cumberland, PA 17070 _ - -- - ,_ ___ __ __ _ ___ ___ -_ . ~ J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY 01= SELLER'S TRANSACTION: i I-- -------- FROM BORROWER GROSS AMOUNT DUE 100 4~0_GROSS AMOUNT DUE TO SELLER -- ~ _ _ . j 101. Contracts@les_price __^ I _ 93 500.00 401. Contract sales orice ~ 93 500_00 l 102, Perspnaf Pro~erty_._ -__.__-__, _a_ -__ ___ 402. Personal Property i _ 103,_Sentemenl charges (o.borrowerlline 1400 ____ ~_--__ _ _. 1735_50 403. _ __ I 104 i 4D4. , -- ---- - - - --------- I 105 405. _ - --- - _,-AdLs_tments for Ilemspaid by_seller 1~ vance ___J Adjustments for items paid b sellers in advance ~ ~ ~--_- Cify/town taxes 1106 ____- 1 4Ub. Gil flown (axes ~ __ __ _ _.._ ___ ~ 107 .County tax s .___ __ _ _ i ___ _ i !~40~, _County taxes _ _~__ ~ 02/19109 to 06(30109 ~ 108 School taxE s 370.73 408. School taxes 021191091006130(09 I 370.73 _ __._ - ~ 7 09. ---- - i -- ----- --- - - - ~-409_---- _ f 1110. ~ - --- r------- I, - ---- ~ 410_ --- I 411. --- --- I - 112 _ x ~ 412 --- - 120 GR05S AMOUNT DUE FROM BORROWER 95 6 06.23 ' , 420. GROSS AMOUNT DUE TO SELLER ! _ ~ ~----- _ 93,870.73 -- --- - ---- - - .200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER . --- -- __~ --- - -. 500. REDUCTIONS IN AMOUNT DUE TO SELLER _ - r 201. Deposit or earnest money.-____ I 1,000.00 150L__Excess De op_si~see instructions _ ~ 1,000_00 202 Princ~al amount of new loans ___ 1 _ - ~ 502__ Settlement charges to seller (line 1400) I _ 6887.05 I -_~____. 1 ! l 203 Existingioannjs) taken su~ect_to- __ _ ~_-_ ~ 503. Existing loan~s)_takeri subject to _ ____~ 2D4 I _ ~ 504. Pavoff of First Mortga JE t6an 505 I 205 r-- R~air Crud _ _. -.____ 06 2 ~ 350.00 _ - 506-Repair Credit _ _ _ -___.___ - 350 00 , _ _ . _207 Security Deposits. 695.00 507. Security Deposits 695.00 _206 _ -- ---- _ - --- 508. -- ~ -, 1 209. • -_ -------~ - --- 509_-- - -- -.._.__ _ -_ ,_ - --------- _ _ Adjustments for items unpaid by I setter __ ,- _.- Ad•usl tments for items unpaid by seller ~ _2~ 10. City(town laa;es__-- __ _-__ __ _ 510. Gity/town taxes _ -__ ~ I - 01101109to02/19109 11. County taxe.~ 2 -- _ 54.08 - -- 51t. County taxes 01101109 toO2119109 _ _ ____.` _ . - __ 212 Schooltaxes __ 51.2_ School taxes _~ _ I j 213 - --------- _-_ 1 513.__,__ -- - ---- _- ------ _214_Renl Pnions.2/19109-2/26/09 ____ ~ _ ~----- - 223.38 -- ~ 514. Rent Pnions 211 910 9-2!28/09 ~ _ 223.38 L 215-_ -- ------ -- ~ 515. _ ! I ' 216 . -- - 516. _ _ ~ '-- - - ~ I _ 217 { - ---- - ' - 517_ _ ,-? - -- - ~ 218 518. . ------ 219 -- ~ 2 322 46 f ~ 519_ _. ~ AL REDUCTION AMOUNT DUE SELLER 5 T 209 51 9 20 TOTAL PAID BY/FOR BORROWER I-__ , . .- 20. OT - . , ~ 300 CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER _ _ ~3Q1_Gross amount due tromborrower-(line 12DDL_ I 95,606.23 6D1. Gross amount due to seller (line 420) 93,870.73 `302`Less amounts gzid byffor borrower. line 22Dj __s ____ 2.322.46 1 602. Less reduction amount due seller (line 5201 _ __ 9 2D9.51 I ~ 303. CASH FROM BORROWER 93,283.77 ~ 603. CASH TO SELLER _ ~ _ 0211912009 i -. _____..-_ SETTLEMENT D~±TE: I _ 84,661.22 SUBSTITUTE FARM 1099 SELLER STATEMENT. Th=_ Infprmali0.n contained herein is important tax Information and is being furnished to the Internal Revenue Service If you are required to file a return, a negligence penally or olner sanctior, will De ,mposeo on you I! this ,tern is regulretl to be reported and the IRS pelermines that it nas not been reported. The Conlracl Sales Pnce described on Ilse 407 aDOVe LOnstn,ltes the Gross PIOLeade Ot th,s Iransa0110n. You are repaired Dy taw to provltl¢ the settlement agent (Fed. Tax ID No: )with you! correct taxpayer itl¢ntification number. I( you tlo no: provide your Correct taxpayer idantirication number, you may De suDrecl to clvii or criminal penallle5 Imposed by law. Under penallle5 o erryry, I certify That Ine number shown on Ihls statement is my cgnect taxpayer itlentlficatlon number. TIM 1 -, SELLER(S) SIGNATURE(S). t SELLER(S) NEW MAILING ADDRESS . TitleExpress Setllemen( System SELLER(Sj PHONE NUMBERS. (H) $ET'~I EMENT STATEMENT. - -- - - - - ----- i IueCxV;eap ocu o ~~~,~ .,i- :-.,,.. __.. - ._: - --- - L ~r ,:. _t E~~TCHARGES -_--___-- ~ PAID FROM i PAID FROM 700 i_OTAL SALE S/BROKER'S COMMISSION based on price $93,500.00 6.000 = 5,610 00 ___ ____^~ BORROWER'S I SELLER'S -- ___ Division of commission~hne 700J as follows __-_ _ i_____ _____ _ _ _ ___~ FUNDS AT I FUNDS AT 701 $ __ - 2,630 00 _to Re1Max Sterling_Associates InC. _ __~ SETTLEMENT SETTLEMENT - - - 702. $_ _ __ 2,780.00 to Wolfe and Shearer Realtors _ __~ 703 Commission paid ac Settlement _ _ _ _-__ ~ 5 610.0 - - -- -- -- 704. ?ransaciDn F!~e______ __ to RelMax Sterlin~c_Associat_es, Inc,__ ___________ I i 150.0_ 800. ITEMS PAYABLE IN CONNECTION WITH LOAN But Loan OrglnatiDn Fee % j 803 Appraisal Fee-____ .804_ Credi( Report... _-__ 805 Lender's Inspec(lon_Fee__ _809. _ 810. - - - 811. _900. ITEMS REQUIRED BY LE_ND_ER 901. Interest Fro_m_ to 902_Morigage Jnsurance Premium for. 904. 905.- ------ ---- 1000. RESERVES_DEPOSITE_D_WITH LENDER FOR __.____ ____ _1001 _ Hazard Insurance __-_____-._ mo_ @ ~ Imo _iD02_MDrtgage Insurance mo. C~ $ Imo 1003. Cif Property Tax-____ __ mo. @ $ ____-_, Imo 1005. School taxes _ mo (a~ $ _ 86.08 _1009._ Aggregate. Analysis-Adlu slment _____ ___ 1100. TITLE CHARGES 0.00 I 0.00 1101, Set_lement or closing tee _ - 1102. Abstractor title se_arc_h__ __ _ ___ _.____ __ __ ~ ~ 1103 Title examination _ -- _ -- - -- -- - - -- - - I ---- ~ - _~ Tilleinsurancebinder _ ___ 11044 . 1 I __ ___ _ _ 1105 Document Pre~larafion -- -- 11106 Notar Fees ~ i y . ___ - __- __ _. __ ___- ___ l 1107. Attorney's tees -.-,____ to Stone_Lafaver & 5hekletski I _ 750.00 __~includes above items No: __ _ 1 ____ 1108 Title Insurance __ I 'FF I I _ I -_~ndudes abovE_items No___ _ _____._ __._________ _-____L_ I __~ 1109. Lender's Cover~2ge $ __ __ _ _ _ ! 1110. Owner's Coverage ~ 93,500.00_ 1111. ___ 1 12. -_-- - _ I i I~1113. ----- --- ~ ~ 11,200. GOVERNMENT RECOR_DING_A_ND TRANS_FER_ CHARGES I- - 1120 i_Recordina Fees Deed ~ 5l).50 _L_Mortgage $ ;Release $ 202. City/County taxistamDS _ -_. Deed $935_00 ; Morigaye_~ _ ' 1203. State Tax/stamps _ Deed $935.00 ; Mortgage $ I . SO.SOT_ 935.00 ~ -+ I, ~ 935.00 ~ ~ 1204. -_ ---- I 11205 _ i - - 1300_ADDITIONALSETTtEMENT CHARGES I 1301_Surve~______ _ _ _-_ __ I -- __ I ^ I 1301. Pest Inspection __ _ I _ 303._Final Utilities to Carlisle Borough _ _ _1400. TOTAL SETTLEMENT CHARGES tenter on lines 103. Section J and 502 Section Kl I _ 1 735.50 192.D5~ 6 887.05 I HUD CERTIFICATION OF BUYER AND SELLER.--"' '^'""-- I have carefully review d the HUD 1 Selbement Statement antl to the bes! of my knowledge a d b f (If is a INe anif accu at slalemenT (all r~eip s a tlisbursements matle en my account or by me n to s Iransa .lion. I lunher certify that I ave race ved a copy o(Ine HUD-1 Settlement Statement: ~ \\ ame ol~T.t mot' ~ - A-eTa o ~ ~~a ~._____ ~' ~ - --' _ Estate of Arcade J. Pian1 ~ c, u ~.,t.:a,~j, ..(~, By: Ra~d~Execu(o A /"-^~• WARNING: IT IS h CRIME -0 KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD~1 Settlement Slalemeri; which I have prepared is true and accurate account of This UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION transaction. I nave causetl or will cause the fJddsm a dlstrurs tl m accordance wiln tMS statement. CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: ~\ U.G. CODE SECTION 1001 AND SECTION 1010. I - SEl7LEMENTAGENT: I DATE. L ~ ~ ~~~:~1 ~ ~ ~.