HomeMy WebLinkAbout06-24-091505607120
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 9 0 115
PO BOX.280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
174 16 9202 O1 26 2009 09 26 1918
Decedent's Last Name Suffix Decedent's First Name MI
FERGUSON HAROLD K
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name ~ Suffix Spouse's First Name MI
FERGUSON JANET M
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
jX~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-82)
i ~ 4. Limited Estate ^ qa. Future Interest Compromise ~_~ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
X ~ 6. (Atta ch Copy of Will) to ^ 7' (AttacheCopy of Trust)a Living Trust 8. Total Number of Safe Deposit Boxes
~ I 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death
i ^ 11. Election to tax under Sec. 9113(A)
____ between 12-31-91 and
-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
JERRY A. WEIGLE ESQ UIRE 717 532 7388,x;
Firm Name (If Applicable)
WEIGLE & ASSOCIATES, P.C.
First line of address
126 EAST KING STREET
Second line of address
City or Post Office
SHIPPENSBURG
State ZIP Code
PA 17257
Correspondent's a-mail address:
C?~ ;
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REGISTER ~' L,4S USNLY'~`.
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DATE FILED
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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 true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE _('~
~+ ' Cheryl L. Zygmunt ~ "'-/ ~ `-- ~
ADDRESS 0 - v 1/ U
1104 Heather Drive, Chambers ur P 17201
SIGNATU F PREPARER OTHER THAN R P S NTAT E DATE
~- Jerry A. Weigle Esquire ~ --~
ADDRESS
126 East King Street, Shippensb , PA 17257
Side 1
1505607120 1505607120
J
1505607220
REV-1500 EX
Decedent's Social Security Number
DecedenPs Name: H a r o I d K. Ferguson 17 4 1 6 9 2 0 2
RECAPITULATION
60,000.00
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.
3,893.86
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5.
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 2 7 6 2 6
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ............. 7.
8. Total Gross Assets (total Lines 1-7) .............................................................._...... g. 6 4, 1 7 0 1 2
6,900.24
9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... 9.
6,045.70
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10.
1 2, 9 4 5 9 4
11. Total Deductions (total Lines 9 8~ 10) .............................___. 11
12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12.
51,224.18
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. 5 1 , 2 2 4 1 8
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
0 0 0
(a)(1.2) x .o0 .
16. Amount of Line 14 taxable 5 1
2 2 4. 1 8 1s 2, 3 0 5 0 9
,
at lineal rate X .045 .
17. Amount of Line 14 taxable
0 0 0
17
0 0 0
at sibling rate X .12 .
18. Amount of Line 14 taxable
0 0 0
18
0 0 0
at collateral rate X .15 .
19. Tax Due .............................................................. 19. 2, 3 0 5 0 9
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. a
Side 2
1505607220 1505607220 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-09-0115
DECEDENT'S NAME
Harold K. Ferguson
STREET ADDRESS
30 Scrafford Street
CITY
Shippensburg
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
2,200.00
115.25
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 theOVERPAYMENT.
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 theTAX DUE
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE
Make Check Payable to: REGISTER OF WILLS, AGENT
y,>.~,
(1) 2,305.09
(2) 2 , 315.2 5
(3)
(4) 10.16
(5)
(5A)
(5B)
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 :............................................................................. [ _~ ~_x~
_ ~ iX
b. retain the right to designate who shall use the property transferred or its income :............................_ .. ~ ~ , _ ,
c. retain a reversionary interest; or ..............................__............................_............................................... [_.. ~ ~ x~
d. receive the promise for life of either payments, benefits or care? ........................................................... ~ x ~
i ~ ~ --~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
--
receiving adequate consideration? .........................................................................................._...................... I _ ~ ~_X
3. Did decedent own an "in trust 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.
_ _____. _ _____ _-_ ---_.. ~au~ ~ ¢ ,~~ ..., ........ ...... _ __._- --.._- .g,Y..__.__~._.._.~.~__._._-
~~ ~r
F. .. .. .(. ,C5Y5 ... .. ... .... .. .. .. .. ... .. ..... ,e,.
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 statutedoes not exempt a transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent (72 P.S. §9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent,
except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. 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.
Rev-15+02 EX+ (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ferguson, Harold K. 21-09-0115
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on schedule F.
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98)
(If more space is needed, additional pages of the same size)
Rev-15A8 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ferguson, Harold K. 21-09-0115
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
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Check on hand at date of death - Embarq refund 0.99
2 County tax proration at real estate settlement 136.16
3 Highmark Blue Shield -benefit check 884.73
4 School tax proration at real estate settlement 180.66
5 State Farm Insurance -refund at cancellation of auto insurance 250.00
6 State Farm Insurance -refund at cancellation of homeowner's insurance 11.44
7 U. S. Treasury - 2008 federal income tax refund and stimulus recovery rebate 1,229.88
8 1987 Buick -proceeds of sale 02-24-2009 1.200.00
TOTAL (Also enter on Line 5, Recapitulation) I 3,893.86
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Ferguson, Harold K. 21-09-0115
ITEM
NUMBER
DESCRIPTION
AMOUNT
Funeral Expenses
1 Family Traditions -luncheon 355.37
2 Geisel Funeral Home 210.00
3 Parklawns -grave opening 645.00
4 Parklawns -marker plate 285.00
5 Rev. Robert L. Mentzer -memorial service 100.00
H-A subtotal 1,595.37
Other Administrative Costs
6 Cheryl L. Zygmunt -reimbursement for supplies for cleaning out residence prior to 18.23
sale
7 Cheryl L. Zygmunt -reimbursement for payment of car insurance ($113.77); car 185.75
registration ($63.50); and key for vehicle ($8.48)
8 Cheryl L. Zygmunt -reimbursement for expenses of selling automobile, including 275.14
inspection and repairs, wheel covers and floor mats, advertising, and tag return fee
9 Cumberland Law Journal -advertising Letters Testamentary 75.00
10 Linda K. Klein -notary fee 20.00
11 News Chronicle -advertising Letters Testamentary 104.75
12 Register of Wills, Cumberland County -filing PA Inheritance Tax Return 15.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Ferguson, Harold K. 21-09-0115
ITEM
NUMBER DESCRIPTION AMOUNT
13 Register of Wills, Cumberland County -filing Family Settlement Agreement 75.00
14 Terry L. Shetter -disposal of scrap material from home 385.00
15 Weigle 8~ Associates, P.C. -reimbursement for postage, xerox copies, and long 15.00
distance telephone calls
H-B7 Subtotal 1,168.87
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
REV-1613 EX+ (g-00)
SCHEDULE J
ANIA
COM
RT BENEFICIARIES
ANCETAXRETURN
NHE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ferguson, Harold K. 21-09-0115
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trustee(s)
I
• TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
1 Cheryl L. Zygmunt Daughter 100% 51,224.18
1104 Heather Drive
Chambersburg, PA 17202
Total 51,224.18
Enter dollar amounts for distributions shown above on lines 15 through 18, as approp riate, on Rev 1500 cov er sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule) (Rev. 6-98)
LAST WILL AND TESTAMENT
I, HAROLD K. FERGUSON, presently residing at 30 Scrafford Street, 5hippensburg,
Cumberland County, Pennsylvania 17257, being of sound mind, memory and disposition, do hereby
make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills
by me at any time heretofore made.
FIRST. I order and direct the payment of all my legally enforceable debts and funeral
expenses as soon as may be convenient after my decease.
SECOND. I give, devise and bequeat~b all my estate, real, personal and mixed, whatsoever
and wheresoever situate, to my beloved daughter, CHERYL L. ZYGMUNT, presently residing at 1104
Heather Drive, Chambersburg, Pennsylvania 17201.
THIRD. In the event my said daughter, Cheryl L. Zygmunt, should predecease me or is not
living on the sixtieth (60th) day following my death, I then give, devise and bequeath my said estate to
my granddaughter, MELISSA M. PALOMO, presently residing at 1519 South Rambling Way,
Frederick, Maryland 21701, on per stirpes distribution basis.
FOURTH. I nominate, constitute and appoint my daughter, CHERYL L. ZYGMUNT, to
be the Executrix of this my Last Will and Testament; if she be unable to fulfill the duties of Executrix, I
then nominate, constitute and appoint MELISSA M. PALOMO to be the Executrix of this my Last
Will and Testament.
FIFTH. I direct that my personal representatives shall not be required to give bond for the
faithful performance of their duties in any jurisdiction.
SIXTH. I direct my Executrix to retain the services of Jerry A. Weigle, Esquire, with
offices located at 126 East King Street, Shippensburg, Pennsylvania 17257, with respect to the
settlement of my estate due to his familiarity with my affairs.
IN WITNESS WHEREOF, I, HAROLD K. FERGUSON, have r to set my hand
and seal to this y Last Will and Testament, written on one (1) page, this S ~ day of
,r ~~ ' ~ , 2001.
' j_ ~, ( )5: ~-~.~~ ,,~-~- (SEAL)
V'~/ y
WEIGLE, PERK-NS & ASSOCIATES -ATTORNEYS AT LAW - 1 Z6 EAST K1NG STREET - SHIPPENSBURG, PA 1 7257-1 3 97
This instrument was by the Testator, on the date hereof, signed, published and declared by him to be his
Last Will and Testament, in our presence, who at his request and in the presence of each other, we
believing him to be of sound and disposing mind and memory, have hereunto subscribed our names as
witnesses.
~~
a `~ !
~r
COMMONWEALTH OF PEI~TNSYLVANIA
COUNTY OF CUMBERLAND
SS
I, Haxold K. Ferguson, the person whose name is signed to the foregoing instrument, having been duly
qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last
Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
Sworn or aff rmed to and acknowledged before
me by HAROLD K. FERGUSON the Testator,
this ~ ~ day of ~`~~~~ ~~.~ , 2001.
if
- - ~V]EI LE, P~~:~Kf~ ~ ~ A~~~~l~TES
~i Attorneys at Law
~' 126 East King Street
Shippensburg, PA 17257
(717) X32-7388
NOTARIAL SEAL
- Jerry A. Weigle, Notary Publ'~c
Shippensburg, PA Cumberland County .
M mi i n Ex iris O~ober 07 2002
WEIGLE, PERKINS & ASSOCIATES -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPEN5BURG, PA 1 7257-1 3 9 7
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND ; ~~
We, ~}-~-r~ c ~ -~ ~. • (o ~'t ~ and , ° ~,' y 1 %~~ ` ~ ' , ~ -
'~~' , ,
the witnesses whose names are signed to the foregoing instrument, being duly qualified according. to
law, do depose and say that we were present and saw Harold K. Ferguson, the Testator, sign and execute
the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary
act for the purposes therein expressed; that each of us in the hearing and sight of the Testator, signed the
will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen (18) or
more years of age and of sound mind and under no constraint or undue influence.
LC,cc.~
~.
r ,~ -
/, ~ ~r
1
Sworn or affirmed to and subscribed before me
b f
and ~ ~ ~ > ~
7
v~ritnesses, this ~ ~ day of ~~~~~'1; -2001.
-- ._. WEIGLE, P~~~i~:': ~~ ~j AS~~~~ATES
_ .. , . Attorn ~ sat ~,aw
°_ "~- " ~ - . 126 East 'ng Street
- - _ ~ Shippensburg, PA 17257
~~ ~ - (717) 532-7388
- NOTARIAL SEAL
- Jerry A. Weigle, Notary Public
. Shippensburg, PA Cumberland County
M C mmi~sion E=~: ,.;~,~s nctober 07
2002
WEIGLE, PERKINS & ASSOCIATES -ATTORNEYS AT LAW - 1 Z6 EAST KING STREET - SHIPPENSBURG, PA 1 7257-1 397
r'revlous ~:dlllons are obsolete
't~10111f.'11t St t ~ t
A, - .~ c`l,. ~117C.11 U.S. Department of F-lousiny and Urban Development
B. Type of_Loan__-- _ - --_-_--- _ - _---- OMB Are rp oval No. 2502-0265 _
1, (_lFl-iA 2. I_.1Frrfl-iA 3. ^Conv. Unins. 6. File Number 7. Loan Number fi. Mortgage Insurance Case Number
4. L1VA 5, C1Conv, Ins. 092060PRICE
--- ~`--" - TFiis~formisliimistied-fo`give you a statement ~t actual selUem`enl costs-Amoun s pas -to`an~-Gy fie se emen agen are S owfi-n---
C. Note: Items masked "(p.o.c.i" were paid outside the closiny; They are shown here for information purposes and are not included In the totals.
WARNING: Il Is a c:rirne to knowingly make false statements to the Unlled Slates on this or any other similar torm. Penalties upon
___ __ __. _- T___ conviction can include a ling and imprisonment. For details see: Title 18 U. S. Code Section 1001 and Secllon 1010. __
D. NAME OF BORROWER: Heather E. Price
__ ADDRESS_.______ 10 Gilbert Road, St. Thomas, PA '17252 ___
E. NAME OF SELLER: The Estate of Harold K. Ferguson
______ADDRESS._____ _ 1104 Heather Drive, Chambersburg, PA 17201
f=. NAME OF LENDER: Patriot Federal Credit Union
ADDRESS; _______ P. 0. Box_778 Chambersburg, PA 17201 __
G. PROPERTY ADDRESS: 30 Scrafford Street, Shippensburg, PA 17257
_____ Southampton Township - _ _
I-I. St=-f"fLEMENl~ AGENT: South Central Home Settlements, Irtc., Telephone: 717-532-73$7 Fax: 717••532-6552
__ PLACE OF.SEi-TLEMEN_T_: 126 East Kin Streets Shin~ensburg, PA 17257
I. SE t TLEMENT DA1 E: 0312712009
-- -
_ ___________J. _SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY UF. SELF
_,100. GROS8 A_M_OUNT DUE FROM BORROWER __ __400. GROSS AMOUNT DUE TO SELL
_101.__Conlract sales price ______ 60,000.00 _ 401. Contract sales price
_ 102_ Personal Properly _ _ __ _ 402. Personal Prooerty
103. Setllert~enl char es to borrower (line 1400___
104.
105. ----------- -- -
___ Adjuslrnenls for_ items paid ~_seller in advance
- ---
__1 U7, __C~unty taxes_______ _____ 03127109 to 12131109.______ __
~I 013. __ school Taxes ___ _ _ " 03127109 to 06130109
109. -- - - - - - ---- -- --
_ 110,------~----- -
111. -
112. - -------- ---- - -
__1-20. GROSS AM_OUN_T DUE FROM BORROWER
__.200. AMOUNTS_-PAID BY OR ON BEHALF OF BORROWER_
_,_201.___De~osit or eai_nest mom __ _ -
_. 202. _ Princit~al amount of new loans __ _ ____
_.__203, _ Existing loan(s) _laken subject to ___ -
204 , - -- - -
205. - ----- -------- - --
206.
207.
2013. - ----- - -------------- -
209, ------ - -- ---- -- --
405.
136.16 __40_7.
1$0.66 qp8,
409.
R
form IIUD-1 (3186) ref f-lanclbook 4305.2
I Itlef=xpress Settlement System
Printed 03/2712009 at 09:28 ASF
TRANSACTION:
60,000.00
Adjustments for items paid by seller in advance
County taxes 03127109 to 12131109 _ _
School Taxes 03127109 to 06130109
_ 412. __
63196.14 420. GROSS AMOUNT DUE TO SELLER
500. REDUCTIONS IN AMOUNT DUE TO SELLER
_ 5 000.00 501, Excess Deposit (see instructions) _
413 000.00 502, Settlement charges to seller (line 1400)
_ _ 503. Existing loan(s) taken subject to
_-_-__ 504, Payoff of First Mortgage Loan
_______ _____ __-_Aa~ustments for items.. tanpaid_by seller
ustmer~ts for items un
136.16
'I $0.(16
60„116.1)2
5 000.00
945.70
seller
, C~,,,,,5 C~nu,n s ~+, e c,usvu~ce
l' S. DEPARTMENT OF I-IOUS-NG ANU URBAN DEVELOPMENT
~r-TTI t=MS=NT ~TOTFMFNT
form HUD-1 (3/86) ref 1landboolc 4305.?_
rile Number: 09206oPRICE PAGE= 2
TitiaFxnrass SarllamPnt Svsl~rn P~inlPCt 03/27/2009 al Q9:28 ASf=
~!_
MENT CHARGES
SETI~LE
L. PAID FROM PA{D FROM
_
_
_
SALES/BROKER'S COMMISSION based on price $60,000.00 @ 0.000 =
7Q0. TOTAL BORROWER'S SELLER'S
_
Division of carnmission line 700 as follows- - FUNDS AT FUND5 AT
____701. `~________V t0 SETTLEMENT SETTLEMENT
--702__.____._____ to
,____703. Cornrnissign paid_al Settlement __. _ ~ -
800. ITEMS PAYABLE IN CONNECTION WITH LOAN _ ~ _
__tl0.1._.Loal.i 0riginaGon 1=ee` 1.375_%Patriot Federal Credit Union __ LR 660.00 ~____
802. Loan Discount % _ ___
_ 1303,_ Appraisal Fee ________________to Ausherman Brothers-,- __ ~P.4.C.) 275.00 Buyer
---^-
_ LR
Transunior-
lo
Credit f~epoi(
804 18.23
__ _
__
_______-__--
--
___
805: Lendei_'s Irlsgection Fee _ ____ i _ _.
_ f306. Mortyaye App{ication_ Fee ____ _ _
n07 Tax Service f=ee to Patriot Federal Credit Union LR 85.00
_
a08. Underwrilinq_Fee to_Patriot Federal Credit Union LR
' 360.00
809. Flood Certification Fee to Transunion l_R - 14.00
810__ Procesing Fee to Patriot Federal Credit Union LR 200A0 _
811.
_ ~_~_-
_
_ _ _ _
NDER TO BE PAID IN ADVANCE
E
D_BY
LE
R~QUIR
ITEMS
800
__ _
_
_
_
_
_
__
901. Interest From 0312712009 to 0410112009 Ca.S 9.0411 Iday____ ~ 5 Days LR
45.21_. _
. ____
to
Mortgage 1nsul ance Premium for
902
____
___
_ -
_, (P.O.C.) 4'10.00 Buyer.
Erie Insurance
to
Premiurn for
903
f-Lazard Insurance
__
_
-
__~_____
_
._.
.__
904= ----
--- - ------ ---
--
905. ~~
._---- ------ -- --- ----
--
1000. RESERVES DEPOSITED WITH LENDER FOR
__
_1001. Hazard Insurance mo. ~ $ Imo
10U2._Mortgaye_Insurance mo. $ _~_ Imo !__
1003`City Pr_operty_Tax__ _!_ mo• c~. $ _- __ Imo -
__1004. County_Properly_f'ax _.___ __ mo. ~ $ ~ __ Imo _ _ _____
--- - --
1005. School Taxes __ __ _~ rno. chi _~____ Y Imo ... _
_1009..~1~cyregale Analysis Adiuslment _,_________ __ _ _ _ ____
1100. TITLE CHARGES
1101~Seltlernent or closingfee _ _. ~_ ,__
1102. Abstract or line search
1103. Title exarninalion
1104. Title insurance binder
_
1105. Document PreUaration to South Central Home Settlements, Inc. 85.00
1106. Notar~Fees `
__ 1107. Attorney's_fees _
_
Includes above items No:
'1108. Title Insurance---- to SCHS Agent for Conestoga Tit{e Ins. Co. ~ _ 556.88
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__ ____~i~~cludes above items No: _ _
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RICHARD L. JOHNSON sa-sa4~si3 5 9 8 9
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ELEANOR M. JOHNSON
i 3347 WIl.UAMSON ROAD PH. 717-597-7260 ~' a C"'~
$ GREENCASTLE, PA 17225 DATE
PAY TO THE .Y ~J~. ~' ~ ~ ~ ......, .. .r.. , r_ ........ I
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A Tradition of Excellence
February 6, 2009 ,~n4
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To: Weigle & Associates
126 East King Street
,Shippensburg Pa 17257 -
From: Traci Yohe
Orrstown Bank
Customer Service Center
PO BOX 250
Shippensburg, Pa 17257
Re: Estate of Harold K Ferguson
Date of death January 26, 2009
IT IS HERERBY CERTIFIED THAT THE ABOi~'E NAMED DECEDENT, ON THE
ABO1~ E DATE, HAD THE FOLLOWING ACCOUNTS WITH ORRSTOW'N BANK:
CHECKING ACCOUNT
Account # Title of Account Date opened Principal Accrued Interest
103003330 Harold K Ferguson 03/04/02 552.52 0.00
Cheryl L Zygmunt -joint upon opening
SA ti'INGS A CCO UNT
Account # Title of Account Date opened Principal Accrued Interest
CERTIFICATE OF DEPOSIT
Account # Title of Account Date Opened Principal Accrued Interest
P.O. Box 250 •Shippensburg, PA 17257 • 717.530.3530 • 717.532.4143 fax
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-~hippensburg Health Care Center
121WALNUT BOTTOM ROAD
SHIPPENSBURG, PA 17257
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(717) 530-8300
HAROLD FERGUSON 01475
Cheryl ZYGMUNT (POA)
1104 HEATHER DR
CHAMBERSBURG, PA 17201.,
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04/01/09 Balance Forward
12/29/08 Co-insurance 3 Days ~
01/01/09 Co-insurance 22 Days ~
12/12/08 BEAUTY/BARBER
12/12/08 BEAUTY/BARBER
04/01/09 FEDERAL BC/BS PAYS 10 BA
04/01/09 REVERSE MANUAL ADJUSTMEN
04/01/09 FED BC PAYS 10 BALANCE
04/01/09 REVERSE MANUAL ADJUSTMEN
May 2, 2009
HAROLD FERGUSON
01475
12/29/08-12/31/08
01/01/09-01/22/09
12/12/08 1
12/12/08 1
May 2, 2009
Balance Due: 3,321.00
Payments/
Charges
---------- Credits
----------
0.00 0.00
384.00 .
2,937.00
12.00
12.00
384.00
384.00
2,937.00
2,937.00
Please Remit: 3,321.00
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Please remit payment within 15 days. We accept MC & VISA.
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