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HomeMy WebLinkAbout05-26-09 (2)1505607121 --, REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 RESIDENT DECEDENT 2 1 0 8 0 5 1 6 Harrisbu , PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Date of Birth Social Security Number Date of Death 1 8 0 0 1 9 5 4 9 0 5 0 2 2 0 0 8 0 9 0 7 1 9 1 6 Suffix Decedent's First Name MI Decedent's Last Name ~ B R O W N M A R G A R E T (If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name Spouse's Last Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI FILL INAPPROPRIATE OVALS BELOW tum l R t ^ 3. Remainder Retum (date of death 0 1.Original Retum ^ e a 2. Supplemen pnor to 12-13-82) te t d E ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required ^ a s 4. Limite death after 12-12-82) ~ it Boxes f D © 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust t f T epos e 8. Total Number of Sa (Attach Copy of Will) Received d ^ ) rus (Attach Copy o death t 10. a 1 ^ nder Sec. 9113(A) 11 ~ (A aO ta s ^ 9. Litigation Procee 95) 1 and i befinreen12-3 9 ) h Sch t BE DIRECTED TO: THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIA L ~ l U ep O O CORRESPONDENT - D ber ne Num ho el e T Name R O G E R B I R W I N ~ E S Q U I R E 7 1 7 2 4 9 2 3 5 3 Firm Name (If Applicable) I R W I N & First line of address 6 p W E S T Second line of address City or Post Office C A R L I S L E M c K N I G H T P C P O M F R E T S T R E E T State ZIP Code ~ p A 1 7 0 1 3 REGISTER OF WILLS USE ONLY ., c n __ _ ~ ,, _,. _ ~ - ' --~ - ;' -- - _ ~. .; , ;` -: ~.. -, --DATE FILLI)% F ~ ~. c. , Correspondent's e-mail address: t sdtrueeco Irrect and ample eeCDeclaration of preparer other tha~the pe o~nal mrxpomsentative scbased on aldl nfotrmation~of which p parerfhas any knowledge.belief, Gir,NATdO2E OF PERSON RESPONSIBLE~FIL G BUR ~~ ~ ~~~" ~ ~ L @r~~c D ss ~ JCARLISLE PA 17013 843 LINDSEY ROAD DATE SIGNATUR F P EPARER OT ER THA !REPRESENTATIVE L ~ d ADDRESS CARLISLE PA 17013 6 0 WEST _0 R E T STREET PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 ~hh ~J 1505607221 REV-1500 EX Decedent's Social Security Number 1 8 0 D 1 9 5 4 9 Decedent's Name: MARGARET C • BROW N RECAPITULATION 1. 1 4 7 9 0 0. 0 0 1. Real estate (Schedule A) ••••••••••••••••••••••••"""""•"'•• 2. Stocks and Bonds (Schedule B) ••••••••••••••••••••••~"""""• 2. 3. Closely Heid Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. • 4. Mortgages & Notes Receivable (Schedule D) . • • • • • • • • • • • • • 8 2 2 3. 5 8 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 NQn_-Probate Property • (Schedule G) U Separate Billing Requested ....... 7. s 1 5 6 1 2 3. 5 8 8. Total Gross Assets (total Lines 1-7) • • • • s 3 7 6 5 9. 3 6 Funeral Expenses & Administrative Costs (Schedule H) . • • • • • 9 . . 1 1 7 0 1 1. 9 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...... ..... . 10. 11 1 5 4 6 7 1. 3 3 11. Total Deductions (totalLines9&10) ••••••••••••••••••••• ••'•" 12. 1 4 5 2. 2 5 •,•,•• 12. Net Value of Estate (Line 8 minus Line 11) . • • •..... . 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13. • an election to tax has not been made (Schedule J) 1 4 5 2. 2 5 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 0 0 0 15. D. 0 0 16. Amount of Line 14 taxable 1 4 5 2. 2 5 16• 6 5. 3 5 at lineal rate X .045 17. Amount of Line 14 taxable 0 . D D 17. 0 . 0 0 at sibling rate X .12 18. Amount of Line 14 taxable D D 0 1 g 0• D D at collateral rate X .15 6 5. 3 5 ...... ..19. 19. Tax Due ........................................ 20. FILL tN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505607221 1505607221 J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME MARGARET C. BROWN STREET ADDRESS 803 W. NORTH STREET CITY CARLISLE STATE PA ZIP 17013 File Number 21 08 0516 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A, Spousal Poverty Credit B, Prior Payments C. Discount (1) 65.35 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 16.34 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 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. Total Interest/Penalty (D + E) (3) 16.34 (4) 0.00 (5) 81.69 (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 81.69 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ b. retain the right to designate who shall use the property transferred or its income; ............................... X c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 0 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ 0 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ ^X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. ^ ^X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE 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 exemot 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 childtwenty-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 p2 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent (72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-15Q2 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARGARET C. BROWN 21 08 0516 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 803 W. NORTH STREET, CARLISLE, PENNSYLVANIA 147,900.00 SOLD -SETTLEMENT SHEET ATTACHED TOTAL (Also enter on line 1, Recapitulation) I $ 147.900.00 (If more space is needed, insert additional sheets of the same size) REV-158 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER MARGARET C. BROWN 21 08 0516 Include the proceeds of litigation and the date the proceeds were received by the estate. All property iointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T BANK -CHECKING ACCOUNT #729787 5,138.46 2. IM&T BANK -SAVINGS ACCOUNT #015004200922480 3. (PERSONAL PROPERTY -APPRAISAL ATTACHED 1,693.12 1, 392.00 TOTAL (Also enter on line 5, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1 F11 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MARGARET C. BROWN 21 08 0516 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EWING BROTHERS FUNERAL HOME 1,919.87 2. FUNERAL LUNCHEON 99.82 3. PASTOR 75.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) DIANNA M. JEDLOWSKI Street Address 843 LINDSAY ROAD City CARLISLE State PA Zip 17013 Year(s) Commission Paid: 2. AttomeyFees IRWIN & McKNIGHT 3, Family Exemption: (If decedents address is not the same as claimants, attach explanation) (:laimant Street Address City State _ Relationship of Claimant to Decedent 4. ~ Probate Fees REGISTER OF WILLS 5 Accountants Fees PATRICIA A. ROSENDALE, CPA 6. Tax Retum Preparers Fees PATRICIA A. ROSENDALE, CPA 7. REGISTER OF WILLS -FILING FEE 8. CLOSING COSTS FROM SALE OF REAL ESTATE & SELLER ASSISTANCE 9. ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY 10. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 11. THE SENTINEL -ESTATE NOTICE 12. REPAIRS MADE TO 803 W. NORTH STREET -RECEIPTS ATTACHED 7,300.00 8,200.00 294.00 110.00 350.00 30.00 15,824.51 60.00 75.00 158.62 3,162.54 TOTAL (Also enter on line 9, Recapitulation) I $ 37 Zip (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER MARGARET C. BROWN 21 08 0516 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CHAPEL POINTE -NURSING 13,749.98 2. PP&L -ELECTRIC 841.90 3. WELLS FARGO HOME MORTGAGE -MORTGAGE PAYMENTS 4,382.59 4. MILLENNIUM PHARMACY -MEDICAL 235.36 5. PHILHAVEN -MEDICAL 23.67 6. BOROUGH OF CARLISLE - WATER/SEWER 196.29 7. WELLS FARGO MORTGAGE -PAYOFF OF FIRST MORTGAGE LOAN 97,045.29 8. WELLS FARGO MORTGAGE -OUTSTANDING CHECK WRITTEN PRIOR TO DATE 536.89 OF DEATH -MORTGAGE PAYMENT TOTAL (Also enter on line 10, Recapitulation) I $ 117,0 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARGAR ET C. BROWN 21 08 0516 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. JOYCE A. GLOVER Lineal 1,452.25 232 CHERRY STREET PERSONAL PROPERTY CARLISLE, PA 17013 8~ $5,000.00 2. LORRAINE K. BOLLINGER Collateral 164 FRYTOWN ROAD $500.00 NEWVILLE, PA 17241 3. DIANNA M. JEDLOWSKI Lineal 843 LINDSAY ROAD REMAINDER CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT of Margaret C. Brown I, MARGARET C. BROWN, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. 1. I direct my Executor or Executrix, as the case may be, to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Executor or Executrix from my estate, and that none of the aforesaid taxes shall be prorated among those persons or entities named herein or otherwise beneficiaries hereunder. 2. My Executrix may, at his or her discretion, compromise claims, borrow money, retain property for such length of time as he or she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as he or she may deem proper; and invest estate 1 property and income without restriction to legal investments unless otherwise provided hereunder. I authorize and empower my Executor or Executrix to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My Executor or Executrix is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executor or Executrix. 3. I give, devise and bequeath all of my estate of every nature and wherever situate as follows: (a) My grandmother clock in the living room, my art pictures on the walls and $5,000.00 to Joyce A. Glover; (b) $500.00 to Lorraine K. Bollinger; and (c) all the rest, residue and remainder to Dianna M. Jedlowski, and if she is not living at the time of my death, to her six (6) children, share and share alike. 4. I nominate and appoint DIANNA M. JEDLOWSKI to be the Executrix of this my Last Will and Testament; she is to serve as such without bond. Should she die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I 2 nominate and appoint JAMES J. JEDLOWSKI as substitute executor, also to serve as such without bond, with the same powers as are given herein to my executrix. 5. I hereby suggest that my personal representatives retain the services of Irwin & McKnight as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~6 ~ day of March , 2007 ~~ 7.:~.~.r` ,-zz..c~ a (SEAL) M GARET C. BRO Signed, sealed, published and declared by MARGARET C. BROWN, the Testatrix above-named, 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 subscribed our names as witnesses hereto. /~j .~ ,(~~ ~ ~ -' 3 ACKNOWLEDGMENT AND AFFIDA VIT WE, MARGARET C. BROWN, MARTHA L. NOEL and SHARON L. SCHWALM, the Testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to .the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament, that she had signed willingly, that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~~7 MA ARET C. B f OWN `~''t-' ~; ,~~ G ~ f ~- MAR ; A L. NOEL r ~ SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by MARGARET C. BROWN, the Testatrix herein, and subscribed and sworn to before me by MARTHA L. NOEL and SHARON L. SCHWALM, witnesses, this /6~ day of March, 2007. '',~ . G~G.,, No#arv Public COMIVIHC,VI'E,>n,Ll'H Ofi PENNSYLVANIA Notarial Sea! Roger B. Irwin, Notary Public Carlisle Boro, Cumberland County My Commission Expires Oct. 3, 2008 Member. Pennsvlvani? Association Of Notaries 4 HUD - 1 UNIFORM SETTLEMENT STATEMENT OMB Approval No. 2502-0265 CCTTT CAACI.tT CTATCAACT~fT B. TYPE OF LOAN 6. File Number: 7. Loan Number: I. FHA 2.FmHA 2009-11 0901103324 3. X Conv. Unins. 4. VA 5. Conv. Ins. 8. Mortgage Insurance Case Number C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. NOTE: TIN = Tax a er's Identification Number D. NAME AND ADDRESS OF BORROWER: E. NAME, ADDRESS AND TIN OF SELLER: F. NAME AND ADDRESS OF LENDER: Brenda Lee Kelley Estate of Margaret C. Brown Soverign Bank Dianna M. Jedlowski,Executrix 1130 Berkshire Blvd 9 Front Street 803 W. North Street Wyomissing, PA. 19610 Boiling Springs, PA 17007 Carlisle, PA 17013 G. PROPERTY LOCATION: H. SETTLEMENT AGENT NAME, ADDRESS AND TIN 803 W. North Street Jaqueline M. Verney, Esquire Carlisle, PA 17013 44 South Hanover Street Carlisle PA 17013 PLACE OF SETTLEMENT I. SETTLEMENT DATE 44 South Hanover Street 04/22/2009 Carlisle Pa. 17013 J. SUMMARY OF BORROWER'S TRANSACTION IC. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract sales rice 14 7 9 0 0. 0 0 401. Contract sales rice 14 7 9 0 0. 0 0 102. Personal roe 402. Personal ro e 103. Settlement char es to borrower Line 1400 4 8 7 7 . 7 7 403. 104. 404. 105. 405. Ad'ustments for items aid b seller in advance Ad~ustments for items aid b seller in advance 106. Ci /town taxes 406. Ci /town taxes 107. Coun taxes 04/22/2009-12/31 2009 453.17 407. Coun taxes 04/22/2009-12/31/2009 453.17 108. Assessments 408. Assessments 109. 409. 110, School Tax 04/22/09-06/30/09 276.45 410. School Tax 04/22/09-06/30/09 276.45 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 153 507.39 420. GROSS AMOUNT DUE TO SELLER 14 8 629.62 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De osit or earnest mone 1 0 0 0 . 0 0 501. Excess de osit 202. Princi al amount of new loans 118 3 2 0 . 0 0 502. Settlement char es to seller Line 1400 12 8 2 4.51 203. Existin loans taken subject to 503. Existin loans taken subject to 204. 504. Pa off of first mort a e loan W e 11 s Far o 9 7 0 4 5 .2 9 205. 505. Pa off of second mort a e loan 206. seller Assistance 3 000.00 506. seller assistance 3 000.00 207. refund of lock fee 500.00 507. 208. 508. 209. 509. Ad~ustments for items un aid b seller Ad'ustments for items un aid b seller 210. Ci /town taxes 510. Ci /town taxes 211. Coun taxes 511. Coun taxes 212. Assessments 512. Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217, 517. 218. 518. 219, 519. 220. TOTAL PAID BY/FOR BORROWER 122 82 0.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 112 8 69.8 0 300. CASH AT SETTLEMENT FROM/TO BORROWER 600. CASH AT SETTLEMENT FROM/TO SELLER 301. Gross amount due from borrower Line 120 15 3 5 07.3 9 601. Gross amount due to seller Line 420 19 8 62 9.62 302. Less amount aid b /for borrower Line 220 12 2 8 2 0 . 0 0 602. Less reduction in amount due seller Line 520 112 8 6 9 . 8 0 303. CASH FROM BORROWER 30 687.39 603.CASH TO SELLER 35 759.82 SELLER'S STATEMENT The information contained in Blocks E, G, H, and I and on line 401 (or, if !ine 401 is asterisked, line 403 and 404) is important tax information and is being famished to the Internal Revenue Service (see Seller Certification). [f you are required to file a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. You are required to provide the Settlement Agent with your correct taxpayer identification number. [f you do not provide the Settlement Agent with your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number. (Seller's Signature) Estate of Margaret C. Brown (Seller's Signature) Dianna M. Jedlowski, Executrix ©EASY SOFT, Inc. 2001 Previous editions are obsolete Page 1 form HUD-1 (3/86) ref Handbook 4305.2 L. SETTLEMENT CHARGES 700. TOTAL SALES/BROKER'S COMMISSION based on rice $ 147 900.00 @ 6. 000 o PAID FROM ' PAID FROM LLER'S Division of Commission line 700 as follows: BORROWER S SE 701. $ 4 4 62.00 to Geor e Ebener & Associates FUNDS AT FUNDS AT 702. $ 4 412.00 to B&H A enc 703. Commission aid at Settlement SETTLEMENT SETTLEMENT 8 8 7 4. 0 0 704. Transaction Fee to B&H A enc 125.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee 802. Loan Discount 803.A raisalFeetoCentral Penn A raisals- 350 POC 299 51.00 804. Credit re orttoCBC Com anies 19.00 805. Lender's [ns ection Fee Soverei n Bank 100.00 806. Tax Service Fee to LSI Tax Services 63.00 807. Document Deliver Fee 3.50 808. Flood Cert to FIS Flood Services 7.50 809.MERS Re istration fee to MFRS 6.95 810. 811. 812. 813. 900. ITEMS RE U[RED BY LENDER TO BE PAID IN ADVANCE 901.Interestfrom 04/22/2009-05/01/2009 @ 16.022 er da 144.20 902. Mort a e Insurance Premium for 903. Hazard insurance Premium for 1 ear s to Peerless POC 371 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard insurance 3 month s @ er month 1002. Mort a e insurance 1003. Ci Pro a Taxes 1004. Coun Pro e Taxes 3 month s @ 55.59 er month 166.77 1005. Annual assessments 1006. school taxes 11 month s @ 124.35 er month 1 367.85 1007. 1008. A e ate Accountin Ad'ustment 1100. TITLE CHARGES 1101. Settlement or closin fee to 1102. Abstract or title search to Coon & Com an 125.00 1103. Title Examination to 1104. Title insurance binder to 1105. Document re station to 1106.Nota fees to Valerie F. Gsell 25.00 10.00 1107. Attome 's fees to Irwin & McKni ht PC POC includes line numbers: Deed Pre & Estate Documents 1108. Titlelnsuranceto Penn Attorne s TI JM Verne Es includes line numbers: Ends 100 300 8 . 1 35 CPL 992.00 1109. Lender s covers e$ 118 3 2 0. 0 0 1110. Owner's covers e$ 14 7 9 0 0. 0 0 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin fees: Deed $ 4 8. 5 0 Mort a e$ 7 8. 5 0 Release $ 1202. Ci /cn tax/stam s: Deed $ 1 4 7 9. 0 0 Mort a e$ 1203. State tax/stam s: Deed $ 1 4 7 9. 0 0 Mort a e$ 1204. 12 7. 0 0 1 4 7 9. 0 0 4 7 9. 0 0 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve to 1302. Pest ins ection to 1303. Carlisle Bor/Water Sewer Final Account # 008064 1304. CC Tax Claim Bureau 2008 School taxes 1305.Borou h of Carlisle: 2009 Co/Tw Taxes 1306.e-mail 25•o/n mail 25• wirin 25 to JM Verne Es uire 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K _c _.. ~._,...,~sa,.e .,.,a Le~:oF :r ~~ 5.00 4 877 .77 9 tr~~o ~o~i arrurate ctate 85.72 1 697.00 653.79 25.00 12 824.51 meni of all receints and CERTIFICATION: I have caretuuy rev~ewea me rtuu-i ~eu~e~nem J~uicu,oui a,~u ~~ ~..~ ~~~. ~_ ..v ~--•~-~•-..b_ _.._ .._..__, __ ._ _ disbursements made on my account or by me in this transaction. I further certify that I received a copy of the HUD-1 Settlement Statement. Seller ., Estate qL` arg~ret C. Brown Borrower Brenda Lee Kelley - , S Iler ianna Jedlowski Borrower The HUD-1 Settlement Statement is have prepared is a true and accurate account of the funds disbursed or to be disbursed by the undersigned as rt of the settlement of th's nsaction. /~ U 04/22/2009 leme gent Jacqueline M. Ver y, Esquire Date ARN It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. © EASY SOFT, Inc. 2001 Previous editions are obsolete Page 2 form HUD-1 (3/86) ref Handbook 4305.2 a~~ 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Law Offices Irwin & McKnight West Pomfret Professional Building 60 West Pomfret Street Carlisle, Pennsylvania 17013-3222 ~~~~`~~~ NgtWiN & McKNIGHT LAW QFFICE.~ Re: Estate of Margaret C Brown Social Security: 180-01-9549 Date o~Death: May 02, 2008 Dear Sir or Madam: Per your inquiry dated May 09, 2008, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 729787 Ownership (Names o, f) Opening Date Balance on Date of Death Accrued Interest Total 2. Type of Account Account Number Ownership (Names o~ Opening Date Margaret C Brown 09/01/67 Closed 05/09/08 $5,138.46 $ 0.00 $5,138.46 Savings Account 015004200922480 Margaret C Brown 11/01/79 Closed 05/09/08 Balance on Date of Death $1,693.09 Accrued Interest $ 0.03 Total $1, 693.12 Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our High Street Carlisle Office # 717-240-4536. Sincerely, a ~~ Nancy Clagett Records Management Phone (888)502-4349 Fax (302)934-2955 May 15, 2008 • ~ -.,c ±~ I .~„~j-f~,4=E.~~,~ ~~~i=~:2..oJ--. ~,'~..y/~+'-t`$'~?1. ~z:.°a-l~.G-~< ~~„G~y~~ G' ~~ .- . ~3~~~~~_ ~ ~~~~~~~~ ~~~:~ ~~t ~ ;.: ~~,~ ~ ~~~~ ,3 .~~ ~ ' -a~lL~--'~r~~~ !''"`" '.~.G~ e~%' b`.~...L ,~2.=1 ~'~`~ chi ~~~ ~%~ ~l- j~~ ~ ~ e:~" v~~ r _ L-~j-- -. ~-~ .~., ~~ ~ L~~?'Il~..~~'/r~ Lam: !.w .~~~ ~.• ~ e / .. i..~ i. ~~' ~~//~.~Gr-cd-a~ - /~%%l'"'^.-~ ~~y; - x,;'01 ~• r ~ ~~~~ Gt/Gg~'C-~~l C_.yL~ f> ltd c~~ _...!'.r t:1- 2~i3G/' ~~`~ .. r 7 l ~.~L~L~ • ~i~~l~~. / ~ i ~ ~L ~_ ~ a:~~''~' _°' ' .~, ~~ .fir-2. ~ ,~ ~ ~ ~ ~ ~ ~~ ~... `- ~~ ~f~r~ ~~~~ o•* ~7. 597.00+ ~_~- 528.00 + ~~--267.00 + 1 ~ 392 0• :; ~ '~~ 0• 1~~~ ~ LowE~° LOUE'S NOME CENTERS, INC. 850 EAST HIGH STREET ;117i2~8-1100 i -SALE- SALES #: S1;i06n1 1068861 05-31-08 103332 GL.INT.LT% EGG WH/BSE2 OL 19.98 778S9 3PK 3/8" TEFLON ROLLERS S 8.97 41405 QURRT FAST N FINAL SPACKL 5.27 SUBTOTAL' 34.22 TAX: 2.06 ('~ INVOICE 10200 TOTAL: ~~6.28 BALANCE DUE: 36.28 CASH 50.00 ~' CHANGE 13.72 1710 TEFM.'r'Ri: 10 05/31/08 11:12:48 ~ OF ITE9+1S 1:'i.li,(;t`~ASE13: ~ EXCLUDES fF.ES, SeRU {CLt• ±;U SPECTAi 'i'ii :? L e?'% ~` "r 1~CM5 PURCHASED: EXCLUDES FEES, SERVICES AND SPECIAL ORDEP ~~ ~~a\. LOWED LOWE'S HONE CENTERS, INC. 850 EAST HIGH STREET CARLISLE, PA 17013 (711)258-7700 -SALE- SALES 1<: S1710CM1 707593 04-21-09 78481 AB ENTRY SGL TYLO 25.47 SUBTOTAL: 25.47 TAX: 1.53 INVOICE 02082 TOTAL: 27.00 BALANCE DUE: 27.00 M/C: 27.00 M/C XXXXXXXXXXXX9267 005532 AMOUNT: 27.00 1710 TERMINAL: 02 04/21/09 12:06:12 # OF ITEMS PURCHASEp: 1 EXCLUDES FEES, SERVICES AND SPECIAL ORDER ITENS THRNK YOU FOR SHOPPING LOWE'S RECEIPT REQUIRED FOR CRSH REFUND. CHECK PURCHASE REFUNDS REQUIRE 15 DAY WAIT PERIOD FOR CASH BACK. STORE MGR: RICN TROSS HAVE A COMMENT OR FEEDBACK? LET US KNOW AT: WWW.LOWES.COMJFEEDBI4CK STORE CODE: 17100-42109-02082 1,~ `~ THE RITE COMPANY-CARLISLE 1550 RITNER HIGHWAY, ATTN: RECEIVING HOURS COUNTER INVOICE/PACKING SLIP CARLISLE, PA 17013 -------------------------------------- ~ (717) 258-8200 ~ 3/17/09 7:56:47 ~ PAGE 1 ---------------------------------------------------- ------ ------------------------------------------------- CUS;TOMER NAME: CARLISLE CASH TRADE D17 ~ CUST BILL-TO ADDRESS: CARLISLE CASH TRADE D17 j CUST#: 29509-000 ~ PO SOX 1754 PHONE#: (814) 944-6121 ~ GIVE TO CHRIS TRAHAN JOB NAME: 717-258-5919 ~ ALTOONA, PA 16603-1754 j TAX EXEMPT#: j j CUST PO#: JAMES JEDLOWSKI ----------------------------------------------------------------------------------------------------------------------j SALESPERSON-ID: LUTH17 MODE: SA METHOD OF SHIPMENT: COUNTER SALES ORDER#: 031609-185904] TYPE OF SALE: CASH SALE j ______________________________________________________________________________________________________________________j ]ITEM DESCRIPTION ~ ~ j j P R I C E LINE # ]DETAIL DESCRIPTION VENDOR/ITEM ~ PREV I BOQTY ~ SHIP ~CUS~ UNIT/UM ITEM COMMENT TO CUSTOMER INVENTORY LOCATIONS j SHIP ~AVLQTY ~ QTY ~ UM~ EXTENDED ---------j--------------------------------------------------------------~-------~-------I--------~---~----------------~ 1 ISQD HOM30M150C LD-CNTR BOX&INT 785901/06137 ~ j ~ l ~ j 124.36/E ~150A MB 1-PH 30-CKT LOAD CEN ~ j ~ ( ~ 124.36 j i I ~ I I I I -------------------------------------------------------------------------------------------------------------- - ------I Unshipped Total: .00 Shipped Total: 124.36 j Total Order: 124.36 j Ship / Handle: .00 Ship / Handle: .00 ~ State Tax-PA: .06000 7.46 State Tax-PA: .06000 7.46 County Tax- .00000 .00 j City Tax- .00000 .00 j Total: 131.82 Total: 131.82 Total: 131.82 Previously Paid: 131.82- j RECEIVER SIGNATURE: Current Payment: .00 New Balance: .00 j CUSTOMER -- PLEASE NOTE: ALL CLAIMS FOR SHORTAGE OR DAMAGE MUST BE MADE 4~7ITHIN 5 DAYS AND MUST REFERENCE THE SALES ORDER# IN THE UPPER RIGHT SECTION. NO MATERIAL MAY BE RETURNED WITHOUT PRIOR PERMISSION. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ s _ _ _ _ _ _ f _ - _ _ _ _ _ -^ _ _ - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ rG :, ,,~ .~ ~ ~ ~ ~~ .- f`'1(~'--z ~ r ~~ ~,~--~ ~" ~ ~~ INVOICE DATE f CUSTOMER'S ORDER-NO. SOLD TO: r SHIP TO: ~s .SALESPERSON. SHIPPED VGA TERMS F.O.B. ~' >~ ~ J'L. (~ L~ /~ i / t~ b '~..y~+~'y y~ ' ~ # P Y " ~! ~~ J ~~~~~ ~ry i ' V ~ ' '` ~~ .~~~ ~ ~ ~. NC3812 ~~ :~`V. ~r - ~ ~ • v'tr 1r ~' P ~~~ G~ LOWE'S HOME CENTERS, INC. ,~// 850 EAST NIGH STREET CARLISLE, PA 17013 (717)256-7700 -SALE- SALES #: S171ilDF1 877060 04-02-09 ~_ J 78389 AB ENTRY TYLO 13.47 135343 DURACELL AAA 16PK .87 SUBTOTAL: 22.34 TAX: 1.34 INVOICE 10867 TOTAL: 23.68 BALRNCE DUE: 23.68 M/C: 23.68 M/C XXXXXXXXXXXX9287 045352 AMOUNT: 23.68 ~~ ~ F~ 1710 TERMINAL: 10 04/02/09 11:43:33 ~ OF ITEMS PURCHASED- Z EXCLUDES FEES, SERVICES RND SPECIAL ORDER ITEMS r v=r ~ S(~PPL.1'= PLUM8ING•NVAC•WATERSYSTEMS•NARDWARE•LIGHTING 8323 Pulaski Highway • Baltimore, MD 21237 410-574-001 a • Fax 410-574-3315 www.northeastern.com t5 P 24 HOUR: (877) - NE 24HOUR (1-877-632.44~8~ + Middletown, DE A70~675.6664 Easton?MD 9 301-739-Z47 MD 410- 35 4375k, MD Hanover, PA Chrlstianshu VA 540-382-855~~ V V V 302-378-7880 Battimare Wesl 410-770.4480 Jessup,P110 Salisbury, MD 410.728-1133 ICDC)Edpewoad, MO 301.490-0170 4 219-1188 10-880-3 MO A410-871-y900 4~~ B l Ai t m l 717-637-2238 PA Lancaster Dulles. VA 703-601-0304 ~ ~ r, , e ai lum roD r,.410-569-2600 ~~ PJdg7rab(ir a Leon ratawn,+MD~ f., J411q•25fr9~.j0~J' ,r'10•S4~?1 900 - ~ rtitJ-7y5- 00 30Y~75;28~8 ~~- W€stiiiilistar MD , 117-560-4099 540 342'4060 .~~ ~~~° ~ om' . , ( ~-' .+~J 410=78 -7200 Ocean City, MD 410-848-7044 4 6 1 York, PA 717-854-5534 Winchester, VA 4158 5 2 t 10- 29- 772 410-876-5855 40-66 - '~ i"'1 =• 11 CJ ~ ? s L g ._ E;_ t~ a ~d ~, _}. 1_. d~ ] i , r ~l1lSi}"t"iF-'. ~'-?i:;t~9y8'Pe.G'iV ~~dd9 ._.- r -' '~ } j ~3~~-,. . ~ - r i ~ ~' r '~ ~. s . ;! t 3 1. ~ ,_ F _ ~ fr .i f `' s _ :'s J ??:'{ i.. ~:-, . , i t ~..' ii ~ " €_'• is P 7 _7 --~ L ~ 4~ { ~ i'i 1 i. E ~ ~ rA 317 '~ c i Z } i_ . _ d ~ • '-:." i_ f-' ~ ; 4 7 _ y i f j. 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E? ='1 ~~•:~ 13 a i r-? ~ _. f _ 1 i~l'•t+~ ~ •~ t a;-n~ 111-.. ~ ~- `? ._ _-__ _ _ --- - -- -___.._ . _._... _.__ _ ... -.._ ..Y. _ __ . ._ _ .~,..__._....~ i f . a.:t ~~'~ L1 s 1 ~ ~. fs a..;_ 1 r 1~'<i 4 1(~ i 4-i -~ ~ ~3 t:..- ~_ ~ .. i i"' ~ t_ ti~°. tt .',] {?' i F t 1 7 P ] [ 2 1 ~~, ~ R ~r~r +~ R ~II ~ LOWE'S HOME CENTERS, INC. 850 EAST HIGH STREET CARLISLE, PA 17013 LOWE'S HOI1E CENTf:RS, INC. (717)256-7700 850 EAST HIGF STREET -SALE- CARLISLE, Pf 17013 SALES q: 51710CM1 707593 03-18-09 (717)258-1700 -SALE•• 70860 GROUND ROD COPPER CLAD 5/ 11.47 SALi:S A: 51710RG'I 12321(14• 03-19-09 73201 4 SOLID BARE COPPER 200 L 17.28 16 0 1.08 10848'.1 Ili:-1 ZINC GROUND (:LAMP 1 1.54 70168 4/0-4/0-4/0 ALUMINUM SEU 32.60 10212h 112-1 GF~OUNl1 CLAMF DB 1 6 4.58 10 @ 3.26 108644 1 1/2 KD SEf1l 1 BF Ii 0.97 290762 METAL STPL 9/16" 450 PK(1 4.37 102126 1/2-1 GROUND CLAMP DB 1 B 9.16 SUBTOTAL' 7.09 2 0 4.58 TAr; 0.42 76985 3/0-4/0 iiVO HOLE SEU STRA 1.38 INVOICE 14.667 TOTAL; 7.51 45695 2 NM/SEU CONN 1 BAG 4.17 24280 ANTI-OXIDANT 4 OZ (75339) 5.66 BALANCE DUE: 7.51 75348 2 WT SEU CONN 3 R4/0 9.42 M/(; 7.51 SUBTOTAL: 95.51 TAX: 5.74 INVOICE 02264 TOiAI: 101,25 M/C }:XXXX~',XX%;(XX928i 035742 y AMOUNT: ~'.51 BALANCE DUE: 101.25 ' I5~ Ir~l~ r~~ J ~'~ ~ //Ir~~~r,. M/C: 101.25 1710 TEF~MINRL.: 1~1 03/1!1%09 17:39:23 M/C XXXXXXXXXXXX9287 025052 AMOUNT: 101.25 # OF ITEMS PUR[:HpSED: 3 XCLUDES FEES, SERVICES AN[ SPECIAL O,~DER~EM§ ~ ~ J ~~_~ I~~~~1~6 ~II~I~~ II~ 1710 TERMINAL: 02 03/18/09 09:20:39 ~~I I ~pw .... # OF ITEMS PURCHASED: 10 EXCLU~ES FEES, SERVICES AND SPECIAL ORDER,/~TEMS IN~lNE~II~I~~I~(6~I~I11 II I~ ~ I~~M LowE~' LONE'S HOME CENTERS, INC. 850 EAST HIOH STREET CARLISLE, PA 17013 (717)258-7700 -SALE- SALES #: S1710LF1 705736 03-19-09 12361 1 1/4 SERUICE ENTRANCE LB 72857 1-1/4"PUC MALE TERMINAL A 3 @ 0.66 2760 HOM 2-POLE 50AMP CIR BREA 12812 HOM 1POLE 20AMP GFI CIA B 2 @ 34.96 23540 402 ALL PUR CEMENT30818D 72817 1-1/4"PVC SCH 40 CONDUIT SUBTOTAL: TAX: INVOICE 02654 TOTAL: BALANCE DUE: MlC: M/C XXXXXXXXXXXX9287 025342 AMOUNT: 101.69 1710 TERMINAL: 02 03/i9/09 13:23:22 # OF ITEMS .PURCHASED: 9 EXCLUDES FEES, SERUICE,S~AND SPECIAL ORDE ITEMS . ~ %G1iG .~=K1%i~f'~ ~G%1y'~ i~ i~~~~ LOWE'S NONE CENTERS, INC. 850 EAST NIGH STREET CARLISLE, PA 17013 (717)258-7700 -SALE- SALES #: 51710001 1138143 03-16-09 LOWED 7.66 1.98 9.97 69.92 3.24 3.16 95.93 5.76 101.69 13317 NOM 2POLE 20AMP CIR BRK 2 @ 9.97 2783 HOM 2-POLE 60RMP CIR BRE 2760 NOM 2-POLE 50AMP CIR BREA 13538 HOM 2POLE 30AMP CIR BRK 2 @ 9.97 12811 HOM 1POLE 20AMP CIR BRK 3.57 DISCOUNT EACH 10 @ 3.21 SUBTOTAL: TAX: INVOICE 02861 TOTAL: 19.94 9.97 9.97 19.94 32.10 -0.36 91.92 5.52 97.44 101.69 101.69 # OF ITEMS PURCHASED: 16 EXCLUDES~FEES~SERVICES AND SPECIAL ORDER I,TE~MS~ ~~ ii~~~~i BALANCE DUE: M/C: TOTAL DISCOUNT: 97.44 97.44 3.60 M/C XXXXXXXXXXXX9287 055032 RMOUNT: 97.44 r~ 1710 TERMINAL: 02 03/16/09 16:50:39 ® IPI LOUIE'S HOME CENTERS, INC. 050 cRST HIGH STREET CARLTSLE, PA 17013 i71T)258-7740 -SALE- SALES ~: S171UCM2 747123 03-31-07 74764 iAPCCN 3/16X1-3/4 HUI 2x20 6.90 61836 5/32X5 1;2 DRILLBIT TRPCO 4.97 St16TOTAL : 1 i . B7 TAX 38550 0.72 TNUO_TCE 14296 TOTAL: 12.59 BALANCE DUE: 12.59 CASK 13.00 CHANGE 0.41 1710 TERMINAL: i4 03/31/07 14:39:27 # OF ITEMS PURC:HASEU: 2 EXCLUDES FEES, SERVICES AND SPECIAL ORDER ITEMS !I~~~,~~ll~~~l~l~{~IIII ,I~{{i~~~~ll~~l~ ~*` OUlE R LOVE'S NOME CENTERS, INC. 850 EAST HIGH STREET CARLISLE. PA 17013 (717)258-7700 -SALE- SALES #: S1710LF1 705736 03-27-09 12811 HOM 1POLE 20AMP CIR BRK 3.57 SUBTOTAL: 3.57 TAX: 0.22 INVOICE 02992 TOTAL: 3.79 BALANCE DUE: 3.79 CASH : 20.00 CHANGE : 16.21 171 TERMINAL: 02 03/27/09 13:37:09 # OF ITEMS PURCHASED: 1 EXCLUDES FEES> SERVICES AND SPECIAL ORDER ITEMS __,/~' ~~ ~~', rip N. Sp~~`C~~.~,, Windows • Doo Cabinets} .Kitchen 8 Bath, • And Much More W W W.mCCaCCEt. clrr nCCARREM 5114,PLt ~} y0 N SPRINpa 17013bbbb CRRl.1SlE• bbbOb©bb2345296 Mr' `lj3nC N1.37i9 b lrrm jp~. ;;4bb4Si0.; 6'6 - Business Hour6 P gyn.-7hu-s. 9 ~' Griday 9 Am. - 7 Pm. atuitiay 9 Am. - 3 Pm. unday 10 Am. - 3 Pm. ®t ~i~ KENO. 17~~~ MC Y;XXXXXXXXXXX9281 ' thod', S~iaea °~ Entry Me Batcha'~ N0@11a ~; i ~ t ~~ ApPrua:4nline 5:11:44 0C l 15 ~ ~$ _Tp, PAID OUT X15111 E AMOUNT CHECK apps Code•~ CASH pE Inv a ~ 9@0901 65.12 i~ `~ Qn. ~ ~Iota1'• c~~u, ~ C•'~Luinc~ I SUB TOTAL I THIS INVOICE Tp,)( ?LEASE PAY FROM URN POLICY TOTAL A RE FINAL UNLESSSP IOR RET~ ALL SALES A NAGEMENT. IS AGREED UPON BY ~ ACCREDITED SERVICES, INC ~ ~ ~ . ~'- CONSTRUCTION CODE INSPECTION AGENCY PO BOX 127, WAYNESBORO, PA 17268 ~ PHONE 1-800-778-7474 FAX 717-762-5333 W W W.PaINSPECTIONS:COM SITE ADDRESS ~ '~ CITY/STATE2IP ~ ~a ~~ FIRST and LAST NAME ADDRESS i~ FIRST and LAST NAME ADDRESS APPLICANT IS THE: INSPECTION AP. LIGATION r ~~ ~o PERMIT NUMBER WORK NUMBER .~~--, t°~-~-' n.i $"/ a ~ ~ ~..'~-~ .~''' ~,. 9 r,~ r ~ .< ..;• a: s PHONE ~...~ ~ °.. - ~`., J .. ~ ~ r _ r^ r ~; "~.,- y%~~j' CITY r ~,~ ,.. ~'s ~' , ;~ STATE ,.~,`~~" ZIP r `-~.~..~"-~~~-` ' '' PHONE CITY STATE ZIP '~•,! OWNER ~ENG/ARCH CONTRACTOR AGENT/OTHER NEW CONSTRUCTION ADDITION INSPECTIONS REQUESTED (CHECK ALL THAT APPLY) PROGRESS GROUND WORKS FOOTINGS ~ FRAMING ~FOUNDATIONNUATERPROOF PLUMBING COMME NTS/VI OLATI ONS: S ALTERATION OTHER USE SEPARATE APPLICATION FOR EACH TRIP HVAC ~ DRYWALL `~. ~ ELECTRICAL ACCESSIBILITY ENERGY CONSTRUCTION FINAL As the owner and/or authorized agent of the project for which this application is filed, I agree and certify that: 1. This project has been constructed in accordance with Uniform Construction Code. 2. No error or omission in drawings, specifications or inspections, whether approved or not, shall permit me or relieve me from constructing in any manor other than provided for in the Uniform Construction Code. 3. It is agreed and understood that Accredited Services and/or said employee shall not assume liability nor responsibility for unreported defects or deficiencies. Accredited Services reports and approvals shall not be used as a guarantee or warranty nor, is any expressed or implied. It is agreed and understood, that should Accredited Services and/or said employees be found liable for any loss or damage resulting from failure to perform any of it's obligations "including but not limited" to negligence, breech of contract or otherwise, then that liability shall be limited to the sum equal to the amount of the fee paid Accredited Services by the applicant. 4. If signed by someone other than the construction owner, I have been authorized by the owner to complete this agreemenUapplication on his behalf. Signature Print Date DO NOT WRITE IN THIS AREA INSPECTORS NAME (PRINT): ,,. ~ INSPECTORS PHONE: ~. ~ ~ ~'~~~~ INSPECON DATE: ~ ~,! PASSED STICKER NUMBER: ~~~ ~~ FEE ~; f CASH aCHECK # ~ ^pREPAID ~~~ ~,Q'~~~`G~HITE=CORPORATE OFFI Y ALLOW=INSPECTO PINK=CUSTOMER 70 ~ ~: 3^d~. s ~~ i r~ L~ t{~ r ~ ~ ~~s~ '` - i ~~ 2~~~ ~ ~ 789-2150 1740 Landisburg Road 0 s r[ 436-9226 Landisburg, PA 17040 OLL_~ 248-3348 ~ 243-4452 a m m m m a n a 0 w O O m 3 w z r z a f O U Z F 2 a w a ': .: ~ ~~f 2 5 / U'~ i _ _~ ~-~ ~ ~ ~ ~~~~~ B U 3722 PDA No. 604520 ~ CASH AMOUNT PAID \° ^ CHECK# I ~~` PDA No. 814006 3 PDA No. 805366 PDA No. 605802 BALANCE DUE I SERVICE ORDER /INVOICE HOME DEPOT 4149 1013 S. HANOVER ST, CARLISLE PA 17013 STORE MANAGER MARK ULRICH 249-1771 4149 00001 18208 03/18/09 SALE 62 PM3474 04:51 PM ~~~.;~; ~~~~°a 039953519130 HSK4'3LEDHL <A> 047569517396 GRND BAR <A> 2®6.29 SUBTOTAL SALES TAX TOTAL XXXXXXXX);XXX9287 MASTERCARD AUTH CODE 05510Zi8010956 9.99 12.58 22.57 1.36 $23.93 23.93 TA ~~ts'~~p Ep<Kirzc d~~6111~9~~11~~~`~N~d~OA HOME DEPOT 4149 1013 S. HANOVER ST, CARLISLE PA 17013 STORE MANAGER MARK ULRICH 249-1771 4149 00002 42909 03/18/09 SALE 61 JMR764 10:07 AM ~sw ~'` L ~~- > .41~~,~ ~~~~ ~g 032076801106 DUCT SEAL <A> 1.98 051411961961 CONLCKNUT <A> 1.39 SUBTOTAL 3.37 SALES TAX 0.21 TOTAL $3.58 CASH 5.00 CHANGE DUE 1.42 ~ ~ `~,~~.C~-f /~ ~/~ ~~ C ~ ~ •~ ii...,.... .,..,.IF'n~.l.,., ...,. ,.i..., .,...~.. , ... .. ... 4149 02 42909 03/18/2009 8810 LOWE'S NOME CENTERS, INC. B50 EAST HION STREET CARLISLE, PA 17013 (717)258-7700 -SALE- SALES #: 51110CM1 707593 D8-08-08; ,` 23531 QUIKRETE CONCRETE REPR Cp 2:94 SUBTOTAL: '2.94 iAX: o.1a ~~'~ INUDICE 02123 TOTRL: 3.12 BALANCE DUE: 12 CASH : ~ 20.00 CHANGE : 16.88 1110 jERMINAI: 07 08/08/08 3:,16:02 # OF ITE_PR5 F^U€tCHflSED: 1' EXCLUDE SEES, SERVICES piJD SFECIAI: ORDER ITEMS H(UME L:lEPCiT 4149 1013 S. HANOVER ST, CARI..ISLE PA 17013 STORE MANAGER MARK ULRICH 249-1771 4149 00059 39970 09/03/08 SALE 14 SCOT59 01:34 PM ~~, ~-- '> ,,~~~'', i ~ - -~,~ ~'~~~[ 051652130010 KLZTOTiPRMGA <A> 19 g8 028076559048 RLR FOAM 4" <A> . 7 97 077089400120 METAL TRAY <A> . 2.g7 SUBTOTAL 30.92 SALES TAX 1.g6 TOTAL $32,78 CASH 40.00 CHANGE UUE 7 22 _ ~~~bl~ ` U~~~~~" . ~ I i I I I I ~ f I II II I ~ I I 1 ~~ 4149 59 . 39970 09/03/2008 0359 (FOR RCCOUNTING PURPOSES? Lowe' i.U'rIF'S NONE CENTERS: INC. ~C50 EAST HIGH STREET C~;LISI.E, PA 110':3 i 117; Z5S- I7DD -SALE- _ r,{it ci -. 51'OC--".l 707561 03-L5-08 Y~.:'':I? e:. .A;.SPAR INi SATIN BSE S.GC SUBTOTAL.: f,."uC TRX: 0.30 T,NVDIGE OZ244 TOTAL: x.30 BALANCE DUE: 5.30 CASH : 20.00 C.NANGE 14.70 i i'o ?Fi~h:`':~±. , ... OB/ 5/08 10:44:5 ~~~~ ~~~~ 3: ~Jt~ . E". 5 PE ~F ASEC3: 1 F~r,LiiDES FEES; SERt~IGES RND SPECIAL ORDER ITEMS I,~~~II ~I1 ilill~tl ~~~~~I~I~~I~ii~~I~I~~'~~N ~?!~~ {.t ~~~~I~I~ HOME DEPOT 4144) 1013 S. HANOVER ST, CARLISLE Pk 17013 STORE MANAGER MARK ULRICH 249-1771 4149 00001 58071 08/07/08 SALE 72 DD20DJ 09:57 AM ar .i ~ A -. ~~~~~, ~ ~~ti~~~ ~1~~ 662333050758 16GRIT DISC <A> 19.77 SALES TAX 1.19 TOTAL $20.96 CASH 21.00 CHANGE D E 0.04 r~~ ~d~I~LS v~~Y ~i~R~I~IIIIIYII~'~~I@IIIVII~IItl HOME DEPOT 4149 1013 S. HANOVER ST, CARLISLE PA 17013 STORE MANAGER MARK ULRICH 249-1771 4149 00059 24071 08/13/08 SALE 14 SCOT59 12:18 PM 042369011921 VINYL TILE <A> 4130.60 122 40 081833430400 THNSPRDADHGL <A> . 11.48 SUBTOTAL 133.88 SALES TAX 8.04 $ XXXXXXXXXXXX9287 MASTERCARD 141.92 AUTH CODE 01597Z/5590531 TA ~~'~ %/~~ ~Ii~N~'Il~pi1~~91~NII~~~VAq HOME DEPOT 41.49 1013 S. HANOVER ST, CARLISLE PA 17013 STORE MANAGER MARK ULRIt;H 249-1771 4149 00058 65142 08/14/08 SALE 14 SCOT58 11:28 AM a~~~~ ~~~~ 051527151034 GRAY SEAL <A> 5.74 051115036804 MASKING TAPE <A> 3.11 042369011921 VINYL TILE <A> 30.60 RSN: 4 5% MKDN -1.53 MAX REFUND VALUE $29.07 SUBTOTAL 37.92 SALES TAx 2.28 TOTAL $40.20 XXXXXXXXXXXX9287 MASTERCARD 40.20 AUTH CODE 02597Z/4581706 TA j /~'` ~ / / ~`~r ~i~V~~Yl~l~llll~9'~ilVl9lrlAll~lll~ f-iC}ME [3EP~T 4149 1013 S. HANOVER ST, CARLISLE PA 17013 STGRE MAPIAGER MARK ULRICH 249-1771 LU4iE'S HOi1E CENTERS, INC. 850 EAST HIGH STREET CARLISIE, PA 170i~ (717}258-77C0 _ -SALE- . _ . SALES #; Si710AG3 1199475 08-16-00 105059 OT AGED OAK GEL STAIN NIH tt.°8 suarOTAL : 11, 98 TAR: 0.72 INVOICE 10b59 TOTAL: 12.70 BALANCE ODE: 1^, 70 CASH 'LC.OJ _ CHANGE 7.30 110 TERNiNAL: CB/i /~:$ 03:5.0:40 ~ EpF 7:T1uMS P~LfI2C3-;~SEL~ : '~ EXCLUDES FEES, SERVICES ANO Sp4CTAL ORDER ITEMS r I !' I {i I '"~"~i i I ~I~i I ~ II #II IIIIII I~, i I II• P I it it I i 4 i I ~II.I!lif' ~~1G ~~ Il~~illlt~~!f~s.~~~~~ll'!~I~~~II~~"Si~~l~~i~a~llfl~'I;~~~~~6li;w~il~j~~ SALE 4149 00001 702f•>6 081: C1;"Oc, 72 DD20GJ 11:05 A.M ~~ '~~~ ~~~~~~~ ~~1#~ i~j .081833356953 L-ADHESIV A- 010306497374 PRG TRWL ,p~ 024500611405 ROUND COkNEk -k= 075378801530 RBTSEAMSLBOZ ~A- 591529 CARPET <A= 30.67@4.23 >3.OU . 44 '? 38 -I 9 129.73 SUBTOTAL 177.50 SALES TAX 10.65 TOTAL 1.138.15 XXXXXXX;(XXXX9287 MASTERCARU 18d.1F~ AUTH CODE U0565Zi8014473 TA L'~r2~~? -f-~S~G,G~i i ~ f/L(Zfi/~1Z/~L~ I I I l l l l l l l l l l l l l l l l l l l l l l l l i l l l i l l I l i!~! ~ II~~{~IIIIIIII,~ 4149 01 70266 08/20/2008 8021 nrn .n.. ..-. -_.. .,--. _ 1013FS~HgNOVERDE~~gRLIS E PA . STORE MANAGER MARK ULRICH 249-1i, SALE 4149 00001 66298 08/1`i/Ob 72 DD20DJ 09:50 AM ~ ~~~ ~~. ,~~~ ~.. 048231315678 LMV1630WW ~A> SALES TAX XXXXXXXXXXXX9287 MASTERCARD AUTH CODE 05508Z/3014156 117.60 7.06 $124.66 124.66 TA E~~Piii~is~~di~~~i~l~~~ia!p~~p~N HOME DEPOT 1013 S. HANOVER ST CARL1z`;1`T~ STORE MANAGER MARK ULRICFtE-iAg_17713 SALE 4149 00002 60"425 X7/26/08 CIL~IE R 71 SSP8P2 C,;55 PM ,;1~ _" ` LOk)E'S NOME CENTERS, INC. ~ ,,~~~~~ 850 EAST HIGH STREET I ~~~~~~ CARLISLE, PA 17013 (717)258-7700 '"~ ~ ~j -~RIE- SALES #: 51710LF1 705736 08-09-08 081099000270 qX8 DRYWALL <A~ 10437 FAST SEi CONC 50A QUIKREi 5.64 38.40 76466610 983 11/4FNDWSCI# < suarorAL A 4.37 SALES TAX 42'77 SUBiOTRL' 5.64 TOTAL 2.57 TAX: 0.34 XXXXXXXXXXXX9287 MASTERCARD 45.34 INVOICE 02434 TOTAL: g 98 RUTH CODE 05560Z/3020184 45.34 JJ ,Q TA BALANCE DUE: 5.98 J CASH : 6.00 ~j IIIIII IIIIIIII IIIIIIII _ IIIIII IIIIIIIIIII CNANa 4149 0 IIIIIIIIIII E. p, 268 II 02 425 07/26/2008 7782 1710 TERNINAL: 02 OB/09!08 12:38:47 ~ ~ ~~ ~"~ ^~'~T"~Trt„"~. # OF ITEMS PURCHASED: -1 EXCLUDES FEES, SERVICES RND SPECIAL ORDER ITEMS N h ~ OC '° 0i R1 n N ~ O 1{'f W N C O N ~ O r r~ ^ O N IO H ._ ,~ N O A 1 W \~ W 2 L-- ,-t W T O Q ~ = K ~ V ~ JO -~ n, OC t/1 O Z C ~. m ~ ~ W _ ~ VJ 2 W ~1 v _ ,7C Y O ~ ~ h p> M Q J ft :i O W ~ M W ~ ~ M1 O = O [Z1 ` ` w J ~ V1, ly~j O h Q 4 W 2 ~ y '•~ ~W ~ J O ~ W h m p [Y] 4 W ~ _ N O ~, ~ >< W L~WESB LOWE'S NOME CENTERS, INC. 850 EAST HIGH STREET CRRLISLE, PA 17013 (717)258-7700 -SALE- SALES #; 51710MG1 67970 11-06-08 222375 FILLUALVE,FLAPPER,TANKLUR 13.97 SUBTOTAL: 13,87 iA><: 0.64 INVOICE 04496 TOiAI: 14.81 BALANCE DUE: 14.61 CASH : 20.00 CHANGE : 5.19 1710 tERMINyL• 04 1/0'6/08 13:39:59 # OF ITEMS PURCHASED: y E%CLUOES FEES, SERVICES AND SPECIAL ORDER ITEMS r J~ M1 M1 ~ ~ ~ m Q' M p N ~ O GO M O U _ N ' , -, W C v W c.; ~ r° o o o W y C _ C ti .. .. V= d am Y.I ~ r U Q Q J ~ W 1-- W N J h ~ W O~ O ~. C ~ H r 2 W J V 0 ~-'~ ~ h v V! O Q C F N t0 ~ U N 3 O ^ y E O 0 J W C.i •. ~ ~ O, ,-y O J H O7 I-#OME D~Pt:57 4 1 ~3,-~ 101; ~. HANUVER ST, CARl.ISi_E PA 17ills STORE MF,PJAGER MARK ULRTCH 24:;+-1711 ~.l X19 000102 38324 . i 1:' t'' ~ (i,: SALE 71 KDV181~D u2:~4 PFf ~~~ ~~'~ ~~ ~~ _~~~ iR1J t,~59-3•a 11 1;947 MODL INf ~,q=. 2114.97 _i'i y:1 3UBTUTAL ,,~:q~i SALES TAX -1.g0 XXXXXXXXXXXX9287 MASTERCARD $31.7; Rl1Tl I CODE 045582/6024953 31 ~ TA II~~~IIII~I~~~~,~i ii ~~~~~~~ill~~ 4149 0< 3882.A u7;1:1i2008 0767 RETURN POLICY DEF:[N1T PJNS P01_ICY ID DAYS POLICY E;(F~It'ES iif. A 1 `~~ 1o~1v~o~~~ THE HOME DEPOT RESERVES 1 ~ IE f:IGI Ii ii, LIMIE i DEPIY RETURPIS. PLE-A'L SF_F 1HF " RETURN PULTt;Y SIGN •IN `STORES FOf? DEEAILS. NEEDIi INSTALLED2 X-800-HUMECIEP~~1` '~1VW.HOMEQEPbT.COM!IPJSTALL y• •~.• ~.a..Xxk*X.~;k YC lt'K YC A'A~:t 9: :1.'.; n;~:yYf r ~ L.7 ~ O (gyp O h 4- H r ~ 4 m W m ~ . c y ,,~ t o ~ y O w o; ~ W o y o~ Q J l .. .. O T y i M l . G y O ' ` G N YM... Q Y. V Q Z ~ S O v~ H .J ~ O ~ M Q DO ~ J ~ W rr i h _ ~ , , -, V W ~ W 1--- W O ~ T V W ~ LL ~ U X W ~. August 26, 2008 A.L. Fence Company P.O. Box 541 Biglerville, PA 17307 Re: Payment on fence repair -Invoice 14940 Please find enclosed a partial payment on the fence repair done on the property at: 803 W. North Street, Carlisle, PA 17013 I will forward the remainder of the payment when the job is finished. As we discussed, we are waiting for the proper gate to be installed. Dianna Jedlowski Enclosure: Check for amount $362.50 cc: Irwin & McKnight Attorneys at Law 60 W. Pomfret Street Carlisle, PA 17013