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Home My WebLink About07-07-09 (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 2 1 0 9 0 4 0 8 PO BOX 280601 RESIDENT DECEDENT Hamsbu , PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Date of Birth Date of Death Social Security Number 0 4 0 9 2 0 0 9 0 1 1 0 1 9 2 2 0 4 0 5 3 4 2 9 MI Suffix Decedent's First Name Decedent's Last Name R U T H L S T A R R Y MI (If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name Spouse's Last Name Spouse's Social Security Number THIS RET REGISTER OF IWILLS ATE WITH THE FILL IN APPROPRIATE OVALS BELOW ^ lemental Return 2 Supp ^ 3. Remainder Return (date of death prior to 12-13-82) d 1. Original Return t Compromise (date of ^ 5. Federal Estate Tax Return Require ^ 4. Limited Estate ^ 4a. Future Interes death after 12-12-82) Q Total Number of Safe Deposit Boxes g ^ 7. Decedent Maintained a Living Trust -- . 6. Decedent Died Testate (Attach Copy of Will) (Attach Copy of Trust) ousal Poverty Credit (date of death S 10 ^ 11. Election to tax under Sec. 9113(A (Attach Sch. O) ^ 9. Litigation Proceeds Received ^ p . between 12-31-91 and 1-1-95) BE DIRECTED TO: U O ber THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIADL ytimle Telepho ne N m ONDENT - CORRESP 7 2 6 4 6 0 2 9 7 ] Name , J O E L R' Firm Name (If Applicable) Z U L L I N G E R Z U L L I N G E R First line of address D A V I S P C 1 4 N O R T H M A I N Second line of address S U I T E 2 0 0 City or Post Office C H A M B E R S B U R G S T R E E T State ZIP Code REGISTER OF WILLS USE ONLY ~~ c~ a c~' -y- •-~ "TJ Cve ~. c7 ~-- "~ ---; ` ~_ + ~ `t .,~ ~ :.7. ~ tSi `pry fV Correspondent's a-mail address: er enalties of perjury, I declare that I have exami (od this return, including accompanying schedules and statements, and to the best of my knowledge and belie , ther than the personal representative is based on all information of which preparer has a DATowledge. Und p lete. Decla n of prepare it is true, come d comp t SIGNATU P I LE FOR F N RETURN SHIPPENSBURG PA 17257 ADDRESS DA E 130 PUGH DRIVE ~" SIG E OF P ARE~THER~T N REPRESENTATIVE / CHAMBERSBURG PA 17201 ADDR ss UITE 200 14 N O R T H M A I STREET , PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 1505607221 Decedent's Social Security Number REV-1500 EX 2 0 4 0 5 3 4 2 9 Decedent's Name: RUTH L• S T A R R Y RECAPITULATION 1 4 Q ], 4 3• ], 5 1. 1. Real estate (Schedule A) •~~• ••~~•~~•'~"'"'"•~~~~~~ • 2. 2. Stocks and Bonds (Schedule B) ~ • ~ ~ • • • ~ ~ ~ • " ~ ~ ' ~ ~ ' • 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... . 3. • 4. Mortgages & Notes Receivable (Schedule D) • ~ ~ • • • • ~ • ~ ' ~ ~ ' 4. (, 9 1 5 . 2 4 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .. 5. • Jointly Owned Property (Schedule F) ^ Separate Billing Requested ...... 6 6. . . 7. Inter-Vivos Transfers & Miscellaneous No^n-PgeparaterBill ng Requested ...... . 7. (Schedule G) 1 4 7 Q 5 8. 3 9 .... ...................... 8. Total Gross Assets (total Lines 1-7) . 8. 2 3 Q Q 7. 6 7 ............ 9. Funeral Expenses & Administrative Costs (Schedule H) ~ ~ . 9. 4 4 6 ], • 4 5 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ~ ~ 10. ~ 1 2 7 4 6 9 2 . 11. 11. Total Deductions (total Lines 9 & 10) ~ ~ ], 1 9 5 8 9 . 2 7 ........ 12. Net Value of Estate (Line 8 minus Line 11 ~ • • ts/Sec 9113 Trusts for which 12. .. 13. Charitable and Governmental Beques has not been made (Schedule J) 13. an election to tax ], ], 9 5 8 9 , 2 7 .............. 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 Q Q Q transfers under Sec. 9116 Q ~ Q Q 15. (a)(1.2) x.o ._. 16. Amount of Line 14 taxable 1 1 9 5 8 9 2 7 5 3 8 1. 5 2 16. at lineal rate X •045 Q Q Q 17. Amount of Line 14 taxable Q Q Q 17. at sibling rate X .12 Q Q Q 18. Amount of Line 14 taxable Q Q Q 18. at collateral rate X .15 5 ~ tl 1. 5 2 .......... 19. .. 19. Tax Due .................................. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 ' 15Q56Q7221 15O56Q7221 File Number REV-1500 EX Page 3 21 Og 0408 Decedent's Complete Address: DECEDENT'S NAME _ RUTH L. STARRY___--- - STREET ADDRESS __ - _ _. _-_- 115 North Washin ton Street __-_ _--- - -------- - --- ~ STATE ,ZIP CITY ~ PA 17257 Tax Payments and Credits: (1) 5,381.52 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A, Spousal Poverty Credit B. Prior Payments 269.07 C. Discount Total Credits (A + B + C) (2) 269.07 3. Interest/Penalty if applicable D. Interest E. Penalty Total InterestlPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4.~ 0.00 Fill in oval on Page 2, Line 20 to request a refund. (5) 5,112.45 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5A) A. Enter the interest on the tax due. 5,112.45 (56) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BoLOCKS 1. Did decedent make a transfer and: ..................................................................... ^ o 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? 2. If death occurred after December 12,1982, did decedent transfer property within one year of death ^ O without receiving adequate consideration? .....••••••••••••••••••••••••••••••~•~~•"""""""""•••••••~~~~•••••~••••~•• ^X 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ...... • • • ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which X contains a beneficiary designation? .................................................................................................. ^ IF TI-IF AWCWFI? Tr1 ~I~IY (1G TNF PRQ~/F r71IF$TI(1NS IS YES Vf111 MLIST Q(~MPI ETE SrHEDUI_E r ANL] 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 1,199s not exemat aitransfedr to a surviving spouse fromrtax, and the stat tory equireme 9 s Por d sclosure (of)asset nand [72 P.S. §9116 (a) (1.1) (ii)]. The statute do__e __p 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 paren , 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)]. ercent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) p Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-15o2 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN .. ~..,.,~.~T n~rcnGNT SCHEDULE A REAL ESTATE FILE NUMBER ESTATE OF 21 09 0408 RUTH L. STARRY 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 e exchanged between a wil~lin~g'b'y~e~rP find, Whiclh s ioilntly olwned with r~i ht of survivorshielmusthbedlsclosed on (Schedule Fe of the relevant facts. VALUE AT DATE ITEM DESCRIPTION NUMBER 1. Tract of real estate, together with improvements thereon erected, situate at 115 North Washington Street, Shippensburg, PA 17257, sold to William A. Fizer, III and Bethany L. Fizer, his wife 2, Received on proration of real estate taxes at sale of the above real estate TOTAL (Also enter on line 1, .. ._ _~.~_ _....,,...,,e~ OF DEATH 139,900.00 243.15 40.143.15 REV-1508 EX + (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMN ERITANC ~ AX RETURNANIA PERSONAL PROPERTY RESIDENT DECEDENT FILE NUMBER ESTATE OF 21 09 0408 RUTH L. STARRY Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM OF DEATH NUMBER DESCRIPTION 657.02 ~. Checking Account #6100800482, Citizens Bank 225.85 2. Savings Account #6140234409, Citizens Bank 496.00 3. U.S. Treasury, tax refund 5,536.37 4. Dan Hershey Auctioneering Service, net proceeds from sale of personal property TOTAL (Also enter on line 5 Recapitulation) I $ 6,915 ___1 _.,.,,.:,...,i ~tiaor~ of tha same sizel REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF RUTH L. ITEM NUMBER A. 1. 2. 3. SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS FILE NUMBER 21 ~9 X40 Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: Fogelsanger-Bricker Funeral Home Fisher's Florist & Greenhouse, flowers for funeral Reverend Brenda Kiser g. ADMINISTRATIVE COSTS: ~ Personal Representative's Commissions Name of Personal Representative (s) Street Address State ZiP City Year(s) Commission Paid: 2 Attorney Fees Joel R. Zullinger 3 Family Exemption. (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address State ZiP City Relationship of Claimant to Decedent 4, Probate Fees JCP fee 10.00; automation fee 5.00; short certificates 20.00; will 15.00; letters 260.00; filing return 15.00 Accountant's Fees 5. g, Tax Return Preparers Fees 2,500.00 AMOUNT ~. Penelec, utilities g. Re/Max Homefinders, work at residence in preparation for sale g. R&R Roofing and Construction, Inc., repairs at residence in preparation for sale 10. Cumberland Law Journal, advertise letters 11. News-Chronicle, advertise letters 12. Penelec, utilities 13. Borough of Shippensburg, final water/sewer bill prior to sale of residence 14. Seller's Assist paid at sale of residence 15. Re/Max Homefinders, commission on sale of real estate 16. Re/Max Realty Agency, Inc., commission on sale of real estate 17. Re/Max Homefinders, transaction fee paid at sale of real estate 18. Re/Max Homefinders, ceiling repair prior to sale of real estate TOTAL (Also enter on line 9, Recapitulation) $ 2,130.00 53.00 100.00 325.00 23.08 350.00 155.04 75.00 121.25 19.21 150.61 7,032.48 4,197.00 4,197.00 150.00 30.00 23.007.67 nr mnra space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent 21 09 0408 RUTH L. STARRY Page 1 File Number Decedent's Name Schedule H -Funeral Expenses 8~ Administrative Costs - B7. ITEM DESCRIPTION AMOUNT NUMBER 1,399.00 1 g. 1% Realty Transfer Tax on sale of real estate SUBTOTAL SCHEDULE H-B7 1,399.00 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDtrv i FILE NUMBER ESTATE OF 21 09 0408 RUTH L. STARRY Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE ITEM OF DEATH NUMBER DESCRIPTION 1,413.53 1, Citizens Bank, payoff balance of decedent's line of credit account 21.20 2. Penelec, utilities due at death 171.01 3. Pharmacare, prescription costs due at death 2,332.68 4. Shippensburg Health Care Center, patient's responsibility due for health care 523.03 5. UGI Central Penn Gas, Inc., unpaid balance due for gas service TOTAL (Also enter on line 10, Recapitulation) I $ 4,461.45 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN r~ir nor CnF NT ESTATE OF RUTH L. STARRY NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS ~ISeo. 9116t(ajh(1s2j]usaldlstributions, and transfers under 1. Dale W. Starry, Jr. 130 Pugh Drive Shippensburg, PA 17257 2. Kevin J. Starry 575 Hood Street Chambersburg, PA 17201 3. Brian W. Starry 15711 Andover Heights Drive Woodbridge, VA 22193 FILE NUMBER 21 09 0401 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Lineal Lineal Lineal AMOUNT OR SHARE OF ESTATE 39,863.09 39,863.09 39,863.09 I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET Ij. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS 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 I $ (If more space is needed, insert addltlonal sheets of the same size) ~~.~~ ~ ~l~ ~~~ C~ ~~~~~~5~~ ensbuxg. of 115 North Washington St I, Ruth L. Starry, a_rd Cumberland County, Pennsylvania, being of sound and disposing mind, memory hereby revoking any and understanding, do hereby declare this to be my Wi11, all former Wi11s and Codicils thereto by me at any time heretofore made. FIRST: I direct that all my just dents and funeral expenses, Including estate as soon as p?"acticable m last ~ shall be paid from InY the eX-penses of y il_ness estate. after my decease as a pzst cf the ei~pense of the administration of my I'esidue cf my estate of every gFCOND: I ~i'.'e, devise and begaeath the Lo-vid,ina he sha'='- natu"e and N.hexever situate to my husband, tale P5. Starry, Sr., P" sur'~ ive me , ; th irt~~ r 30 1 clays . '~'' me or d.ie on or Stars°_ ~ 5= ~ , predecease Ti1IRD: ~12ould my -u __ ~,~--- a~~,d be`= ~_th +r~e - - se _ tY,xt-- - ~,, .ame ___ _. _ y,_ _ -_ _ ., _ _M_ aP~ ~- a. ~N ~_ ~__ - ~a~_ .. -__ - __. __~ -_,-_ .. --c ___ - - _ ~~_~- -Tic ~.-~ -_- __ - - .,.~ __~~ c__c ~_ '--__ ___ _ __ S- -- _- _ `.~~-. ___ r: ._a pia - J ~ `_ ,> __ ~ n ~ ~1 ~? '-. C. __ ~ ~__ ~_Ft _1et) 1c_ f° v -- ~ -T~ - Gx shark r01" i7'Ci Ot1=e1 ~,_ such then diving issue such share shall be added xo ~t_e share \\.. =:j~ f children. i that anyone entitled to a share of my estate should `--~ FOUP~TH: In the event ~'~ I constitute and appoint The \ "s~ be a minor at the time for distribution to him O1 Pennsylvania, Guardiar_ cf any First laational Bank of Shippensburg, Shippensburg, to maid m; nor. Said property which passes either under this Will or otherwise Bank, as Guardian aforesaid, shall, in its sole discretion and without order of or to sell the same, giving Court, have the power to retain such property in kind and reinvest in stocks, bonds or other good title to any real estate, to invest al for minors' investments, without being limited to investments which would be leg funds, and to use principal as well as income from time to time as may appear to be page One of a Three Page Will necessary for the minor's ~relfare, comfort, medical care, recreation, support and education, without responsibility to the minor or to any person taking care of the minor; ar_d any balance in the hands of said Bark, as Guardian aforesaid, shall be distributed to said minor when he or she attains the age of eighteen (18) years. If such minor dies prior to attaining the age of eighteen (1S) years, said Guardian in its discretion to pay part or cell of his ox her funeral expenses ;s authorized and the remaining balance in the hands of said Bank; as Guardian aforesaid, shall be distributed to his cr =1Gr :=e'-~sonal representative. In the event the funds held by t, Guardian, too small for the Guardia„ for any minor i~ecome; in the op=nron of le Guardian, in its sole discretion, rac n eifiCient adr,i'-,1stration; th= proper a--d deposit such funds in a sGvi,icrs accour_t in tine name ''•f '=1~e m--1O'"". y-- `„he _ol'_owina powers ~-d.ia slice i _ ,zace TH: N~4 ~'-~e"'J-t Jr and c, u_._ YL __ . pr - m:* vdiil - - t'7c _' 0~-1c_ _ ~, _ _em _ - _aw -- w~ c e a'~ ~ - _ _ _ a.ddr~_Gn - _ __ ___ - _ 1~5_ _._.~ __ ., -, _~ __~_ .~ __ _-- - r: - - _~_ _ - aDUi ~__~ _ ... --_ - _-~ __ -`__ _ - - ~-f cCL--c ~~~~ ~_-_ _ ~--r - _.,.d -- -- ~ ~_~ _E _._ _ -' -- -"___ - _ ~ - -v1_"_C-_-- ._, °-i .i ~,~l, i~a -~_~~1= O"r 'n ;r rCrti-Gia~c -~ ~~,ercO::a~ ~ _ ~:~`~ of diversificat-io,, o- ~-isi_. oommon including stock, t-" B. Io incest in all forms of property, '-' m corporate fiduciary ~'~~ trust funds and mortgage investment funds, whether operated by y or others, without restriction to investments authorized for Pennsylvania fiduciaries, as they deem pr°pe'-'` without regard to any principle of diversification or risk. for ~a1c. to exchange er to lease, u%~iic c~ pr,~ate _' C. To soli at P ,-• =or sales; any period of time, any real or personal property, and to give op~rons exchanges or leases, for such prices and upon such terms or conditions as they deem proper. D. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. E. To compromise any claim or controversy. page Two of a Three Page Wi11 E, To distribute in cash or in kind ox partly each. G, To hold property in their names without designation of any stered. fiduciary capacity or in the name of a nominee or unreg SIXTH: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as apart of the expense of the administration of my estate. gr Executor of this, SE"v-E1Q'I'H: I aPPoint my 'r~usbaad , Dale W . Starry , ~ fail to qualify or cease to act m' will , w.~o'ald my husband. , Dale ~~. Starry , Sr . , y ~~ E ecutor of this , my will . as E7_ecutor, I appoi'-'t =~-• son, Dale ~nT. Starry, Sr., ,^ hereunder ,n any :.,,a shall be ,°equired of ani% fiduc_a_Y j uriSd-_.. ~=-ter-. _ _ _ - ~~rea~tc =et m~ hand and seal _c Th1 s~ my __ - _ -__-r,_._.~ ~=_.-=8ti nrT ~_ ~. _~ _ ~_ .,_- _. _. - - - - - "'L,. ..ate, ~„, p_S - - ~~_ G„d declared. by the above !famed Testatrix r Rutii „PCt , pealed" published S-q-- ~ ~ in her as a,~d fer her Last 'vdill and Testament, in our pxesei_ce, w;io, L. Stax_y, resence of each other have hereunto set our presence, at her request and in the p- hands as attesting witnesses• ~' -:.~~ - ~ Address _,~ f 'ir ' n 1 (l n l 1~ ~ .~ 111 u1(! ~ ~'~ ~'-, ~t ~u ( ~ }, ,, (J ~ ^ -~, v r~ Address ..~ Address Page Three of a Three Paqe Will ~,~ 0 ttOx bGtS AillGlta .. ez~sburg, pA 17257 ' G. PROPER'X ,,gpD~tESS: 115 Washimgtom Stxeet Naztk-, S'hiPP Ca ital Abstract Coxpoxatzon, TelepJa°ne: ~~7-261-9143 Pax: '7X7-26J.-9783 K. S~TTL~MBNT A.GENZ: ~ ~r aCF.OF N 999 _._„_,..... -- -~.. r,.r. To i 9 900.00 8,324.33 230.63 06 26 vy ~-~ 26 09 12/31/09 12.52 06/26/09 06 26/09 06 30 09 _ 148,467_4 1.000.0 -.-~- 141 ,734_0 032. ~QROUGH OF SHIPPENSBVRG J 139,900.0 09 23_ 0.63 09 12.52 140,143_1 ~ o3z.4{ 150.6: 7,156_! CASH A 148 467.48 17 156. 149 766.48 z L ..K_, ~,.......,o. nlnn 9901 -1 122 987 . 1 2 9 9.0 0 Iran to my a 303. CASH TO B SUBSTITUTE FORM 1099 SELLER BTAI-EMENT: The lntortnat{on containetl hereto la Important tax lnlormatlon antl W befog tumlahea to the Irtemel Revenue 8oM°e. It you are er aenctlon wlll bo Impoaod on you It thl~ tram is requin:d to be repoAad end the IRS determinee that R has not been repoRetl. Tha Contract 9alae Prlce deecrtbea on a neglipan~e penally or oth Ilne 4111 above constltuttB Lhe GrOea preCeatlB of thla transaction. with youf conaot taxpayor tdentlflcaNon number. If y°t1 do not provide your c°rrect taxp~yar ldent You are requtrea dY law to drovlde the Settlement agent (Fed Tax ID No: ~ r U 1 oertlry that the number shown on t01a statement Is my corroct taxpaYar Iaentl0catl°n numb number, you may be 9uD)ect [o civil or crtminal panaltleS Imp°sed by Ia`n'- SELLER{S) SIGNp,TUR¢ S): ~~~-_ T1N: - SELLI=R{S) N~ MnILINa ADDRESS: ~ ~H) SELLER{3) PHONE NVMBERB: _ tai ~~Q7.I,I1, 'a~ Xd~ Z~'d~1.Sg'd 'I'dZld'd~ Yid Z~ ~ IO I~~/6002/92/ICI prpvloua odltlons are obsolete i CAPITAL ABSTRACT CORPORATION form MUU-1 (1186) rei tiandhook 43f VdOti~l -'9Z'unp-a'~il paniaaa~ ,,- Settlement Statement 5 ns~?n~Ar,t of H~,~zing And Urban Development ~. OP(-~A 2. ~PmI~A 3- ^Con~. U»ins, r-~_.. ~ rlr__., r.,~ 6. ~CLENUMBEIt 7. LOAN NUMBER 8. ,2vIORI'GAGE ~1SU~tA.NCE CASE NUMBER Thla forRl b Tumished to give you a srucen~r~~• ~• ------ -- C.. Note: Items marked "(p-o.c-)" were pall outelde the cloefnq; they ere ettown Here r wARNINO_ It Is a nrlme to knowln IY make tales elatamente to the U^Ited Stelae on lhie or O. NAME OF ~O~t,JZOWER: W7,11xa11x~ A.- P1,Ze7c, ~ aid ~~,a~~t hureePA 1Z E NAME OF SEL~.JdxZ: Ruth T,• Starry Estate Hen! apen! era shown- I Tltl®Ex r6sE Settlement Syste ~ not Included In the totals- F form. Penalties upon printed ag/2g12ptlq a! 1x'35 H F. NAME OP T,BNAER: SovereigXl~ Bank _ _ _ _.. pn Rox 628. Ameli O _ _ • . ~„ ~, ,~ 7 6/26/200910 07/01/2009 t® .50 6 0 39.75 ~- 37.88 77.77 COrP07 on al Abstract Corporatic 141 734.00 - 10.00 139,900._00 - 1,058.7 1,399.00 1,399.00 b 103.35 2,834.68 477.00 L19.25 227.28 011.01 268.94 225.00 00 ?5.00 68.7 150.00 35.00 105.00 1.399.00 20.00 10.00 le.oo 35.00 RJR Roofi~n & ConstrucT;i r - ~ • ~ • - - 30 _ C _ gemax Home£inders St®ve Decker P.O.C. 350.OO.Se11er 8 324.33 9 973•( p 1 n n 14D~. "TOTAL S HUD CeRTIFICATION OF BUYER AND SELLER I have ceroNlly rohaweA th¢ HUD-t Settlement Statement and t0 ins uvai vi iiiy wT~i:.'I:.~.v^ ~~ C C-11°`• Ir Ig ° !!Oa ane accuram vtatnmont of cll rocalpto ahd alaburaemente made on my sccount 1n lhls tranaactton. 1 torther cerllty that 1 have rsc~ivaA a Copy Of Iha HU~-t gottlem¢nt Statement. Bethany L. Fizer Wllllem A. FIZer,111 Ruth L Starry Estate n WARNINOI IT 13 A CRIME TO KNOWINGLY MAKE FALS[? STATEMENTS TO THE The MUD•1 getUament Statement wnlch I have prepared le a true and accurate account of thta Lran~ UNITED STATES ON THIS OR AN'f SIMILAR FORM. PENALTIES UPON CONVICTION 1 nave caused or will cause the Lunde to be dlaburead in accordance with thle 6[atement. USN CODE SECTION 1pO DAND SECTION 10108 ~E-rgILS 9EE TITLE 1A. 871• DATE ,.,,,, ,inn •. ~~~ Fig7J~[I~ 'off Xdd Z~dd1.Sg'd 'IHZId~~ ~Id 00 ~ IO Ind/6002/9Z/I~T Prevtous edltlons are Obeolele U-S- AEpARTNIENT OF HOUSING AND URBAN A£V£I,OPMENT 39.900. F 4,197.00 4,197.00 Sov~ ~ Lsz ~~ era form NUq-1 (3!813) rot Mandoook 43 ~NdOtr~l :('9Z'unr awl! paniaaa~ PAGE PAID FROM PAID FROM 5.000,__= 6 394.00 BORROWER'S SELLER'S FUNDS AT I FUNDS AT SETTLEMENT SETTLEMEN- 8.394.c 150. LR 425.00 LEt 26.00 P.O.C_ 299.00 Bu er LR LR 200.00 LR 63.00 z,~, 3.5 0 LR 7.50 ' T.R 4.95 _ ~ Z 7 .~r.c o,.,.:e~~tinn Fww Fr «h Account Number 6100800482 Account Title RUTH L STARRY Date Opened 4/1/1980 Account Type Checking Principal Balance as of DOD $657.02 Interest from Last Posting to DOD $ .00 Account Balance as of DOD $657.02 YTD Interest to DOD $ .00 ~ 'y n f~~ ~ 'tt ~ C n ~~ Account Number 6140234409 Account Title RUTH L STARRY Date Opened 4/25/2001 Account Type Savings Principal Balance as of DOD $225.85 Interest from Last Posting to DOD $ .00 Account Balance as of DOD $225.85 YTD Interest to DOD $ •07 ,T~. ._ . . _ . _ -..-----~ .~-r ;. __ _ .. , ~ ~ .~ ~ ' ,: ~ ;~ r~ r _k ; ~ F S 1 - . ~ ~ xH~,. ~ }3 ~_ ~J k+ .. 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