HomeMy WebLinkAbout07-20-09-J REV-1500 15U56U7120
F~( (OB-05) OFFICIAL USE ONLY
PA DBpartmeM of Revenue county cone veer Flle Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box.2tloBat 21 0 8 10 91
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Socal Security Number Data of Death Date of Birth
10192008 07291933
Decedent's Last Name Suffix Decedent's First Name MI
SARRICR DORIS J
(If AppllcabN) Enter Surviving Spouss's Infonnatlon Below
Spouse's Last Name Suffix Spouse's First Neme
MI
Spouse's Social Security Numher
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® t. OAginal Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (date W death
pdor tc 12.13-92)
^ 4. Limited Estate ^ qa. Future IMareet CompromW ^ 5. Federal Estate Tax Retum Required
(date o/ Oaelh Mer 14.1242)
^ g, Decedent Distl Testate ^ T. DaceMM MelMairrotl a LNln9 Trust 0 a. Total Number Of Safe DepOeft e0%BS
(Allsch Capy of WI19 (AdeM Copy M Tnut)
^ 9. Lldgagon Proceeds Received ^ 70. Spousal PoveM CredX ldsb or death ^ 7 t. Electlon to fez under Sec. 9113(A)
bahwen 1241- t era 1-t43) (Attach Sch. 0)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUL TAX INFORMATION SHDULD BE DIRECTED TO:
Name Daytime Telephone Number
HAMILTON C DAVI3 7175325713
Firm Name (If Applicable)
ZULLINGER DAVI3, PC
First Ilne of address
20 EAST BVRD STREET, SUITE 6
Seeond Ilrre of address
City or Post Office
3BIPPENSBVRG
Correspondent's e-mail address: H C
State ZIP Code
PA 17257
amlltondavislaw.com
MELODI KOWNACKI
185 CRESTMONT DRIVE, LOCK HAVEN, PA 17745
REGISTER OF WI
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SIGNATURE OF REPARE ER THAN REPRESENTATIVE
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r C'~ ~~ Hamilton C Davis ~ ~ a q
ADDRESS
20 East Burd Street, Suite 5, Shippensburg, PA 17257
Side 1
L 1505607120 1505607120
1 15~56U722U
REV-1500 EX
oxee.nra Name: BARRICK, DORIS JEAN
DecedenPa Social Security Number
RECAPITULATION
t. Real Estate (Schedule A) ......................................................................................... . t. 16 5 , !7 ~ ~ . ~ ~
2. Stocks and Bonds (Schedule B) ............................................................................... 2.
3. Closet' Held Corporation, Partnership orSole-Proprietorship (Schedule C).......... 3.
4. Mortgagee 6 Notes Receivable (Schedule D) .......................................................... 4.
5. Cash, Bank Deposib & Miscellaneous Personal Property (Schedule E) ................ 5. 7 , 2 8 5 . 8 0
5. Jointly Owned Properly (Schedule F) ^ Separate Billing Requested ............. 8.
7. Inter-Vivos Trensfara & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ............. 7.
8. Total Gross Assets (total Lines t-7) ....................................................................... 8. 17 2 , 2 8 5 . 8 0
9. Funeral F~enses & Administrative Costs (Schedule H) ......................................... 9. 6 , 8 4 9 . 4 2
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... . 10. 1 8 , 9 6 8 . 3 2
11. Total Deductions (total Lines 9 & 10) ..................................................................... . t 1, 2 5 , 817.7 4
12. Net Value of Fatale (Line 8 minus Line 11) ............................................................ . 12. 1 4 6 , 4 6 8 . 0 6
t3. CAaraable and GovammeMal BaquestslSec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................................................. 13.
14. Net Value SubJset to Tax (Line t2 minus Line 13) ................................................. 14. 1 4 6 , 4 6 8 . 0 6
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sac. 9116
{aX1.2) X .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 14 6, 4 6 8. 0 6
t3.
6, 5 91.0 6
77. Amount of Line 14 taxable
at sibling rata X .12 17.
18. Amount of Line 14 taxable
at wllateral role X .15 t 3.
19. Tax Due ..................................................................................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT,
6,591.06
aide 2
L 1505607220 1505607220
REV-1500 EX Page 3 Flle Number 21 - 08 - 1091
Decedent's Complete Address:
BARRICK, DORIS JEAN
STREETADDRESS
13 STAMY ROAD
CITY STATE ZIP
NEWVILLE PA 17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 8,591.06
2. Credits/Payments
A. Spousal Poverty Credit
B. Pdor Payments
C. DiacouM
Total Credits (A + B + C) (2) 0.00
3. InteresUPenalty'rf applicable
p, Interest
E. Penalty
Total lntereaVPenelty (D+E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Cheek box on Pape 2 Llne 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8, 591.09
A, Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is th0 BALANCE DUE. (58) 5 , 5 91.0 5
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 trenaferred :.................................................................................. ^x
b. retain the right to designate who shall use the properly transferred or hs income :....................................
c. retain a reversionary interest; or .................................................................................................................. ^ ^x
d. receive the promise for life of either payments, benefits or care? .............................................................. [] U
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideretion7 ....................................................................................................................... ^ CJ
3. Did decedent own an "in trust for ar payable upon death bank aaount or security at his or her death7......... ^
4. Did derbdent own an Individual ReOrement Account, annuity, or other non-probate property which
contains a beneficiary designation7 ...................................................................................................................... ^ ^x
IF THE AN9WER TO ANY OF THE ABOVE 11UE3T10sL413 YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN.
For dates of death on or afler 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) (il)]. The statute does not exemot a transfer to a surviving Spouse from tax, and the statutory requirements
for disGOSUre of assets and filing a tax return are still applicable even H the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rete 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 (O) percent [72 P.S. §9116 (a) (1.2)].
The tax rete 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) p2 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, es an individual who has at least one parent in common with the decedent, whether by blood or adoption.
DOBTIONNEALTN OF PENNBYLVANl4
INNERITNNDE Tq%RETDRN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF BARRICK, DORIS JEAN
FILE NUMBER
21-08-1091
All real property owned aolelY or as a tenant In common must be reported at fair market value. Fair market value is defined as the price
at which properly 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 whlch is Jointly~owned with right of survivorehip muat be dlaclosed on
schedule F.
ITEM DESCRIPTION
NUMBER
1 13 STAMY ROAD, NEWVILLE, PA 17241 (SEE ATTACHED SETTLEMENT SHEET). SOLD
TO AN UNREALTED THIRD PARTY AT ARM'S LENGTH PRICE AND TERMS. SALE
NECESSARY TO SETTLE ESTATE. SEE SCHEDULE I FOR NECESSARY AND ORDINARY
EXPENSES OF SALE
VALUE AT DATE OF
DEATH
165, 000.00
TOTAL (Also enter on Line 1, Recapitulation) ~ 165,000.00
i SCHEDULE E ~
CASH, BANK DEPOSITS, 8r MISC.
CCMAONWFALTN OF PENN6riVRNW ~ PERSONAL PROPERTY
INNERITr1NCE iPX RETURN
RE61DElR OECEOENT
ESTATE OF gARRICK, DORIS JEAN
FILE NUMBER
21-08-1091
Include the proceada of litigation and the date the proceeds were received by the estate. All property Jolntlyowned with the right oT
survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE OF
DESCRIPTION
NUMBER DEATH
1 ADAMS COUNTY NATIONAL BANK CHECKING ACCOUNT NO. 222615 6,729.76
2 ~ ADAMS ELECTRIC COOPERATIVE I 56.04
3 I PERSONAL PROPERTY AND PERSONAL EFFECTS ~ 500.00
TOTAL (Also enter on Line 5, Recapitulation) ~ 7,285.80
SCFErXJLE H
~~
CAMMONWEPLTH OF PENNBYLVMIIA
AE"r~~'17DA~11lG fY1~`I'~
INHERRANCE TRX RETURN
/'Y.II~M~ ~ rV11 /~/G W'~ 1 ~7
~
RE&DENr DECEDENT
FILE NUMBER
ESTATE OF BARRICK, DORIS JEAN 21 - 08 - 1091
Dells of decedent must be reported on Schedule I.
ITEM
NUMBER
FUNERAL EXPENSES: DESCRIPTION
AMOUNT
A. 1 i PRE-PAID --~-
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Pereonal Representative(s):
Street Address
City Slate Zip
Year(s) Commission paid
2. Attorneys Fees HAMILTON C. DAVIS, ESQUIRE 6,200.00
3, Famiy Exemption: (It decedent's address is not the same as daimanYs, attach explanation)
~ Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
a. ~ Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 100.00
5. I Accountant's Fees
6. Tax Retum Preparer's Fees
7. Other Adminislretive Costs
1 LEGAL ADVERTISING -THE NEWS CHRONICLE 113.00
TOTAL (Also enter on Ilne 8, Recapitulation) 6,849A2
C ScFiedWe H
CAMMONWEALTH OF PENNSYLVANIA Futeral Exper~s&
INHERITANCE TAX RETURN ~~~~
ESTATE OF BARRICK, DORIS JEAN FILE NUMBER
X21-08-1091
2 LEGAL ADVERTISING -CUMBERLAND COUNTY LEGAL JOURNAL -
3 I ACCRUED INTEREST ON ADAMS COUNTY NATIONAL BANK MORTGAGE LOAN
NO. 8721149 -THERE WAS NOT SUFFICIENT MONEY IN THE ESTATE ACCOUNT
TO PAYOFF THE MORTGAGE. i
75.00
361.42
Page 2 of Schedule H
SCHEDULEI ~
DEBTS OF DECEDENT, MORTGAGE
COATgNWEALT1 or VeNNen.vnNw LIABILITIES J},
IN REBIDENCT DECED MRN ! ~^ LIENS
-FILE NUMBER
ESTATE OF BARRICK, DORIS JEAN _~21 - 08 -1091
Include unrelmbureed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 ADAMS COUNTY NATIONAL BANK MORTGAGE LOAN NO. 8721149 15,502.89
2 ~ EMBARO ~ 32.11
3 ~ .DISCOVER CARD ~ 41.80
4 ~ GREEN RIDGE VILLAGE f 819.64
5 (PPL ~ 307.07
6 ~ REAL ESTATE SETTLEMENT EXPENSES (SEE ATTACHED HUD-1) ~ 2,264.81
TOTAL (Also enter on Llne 10, Recapltulatlon) ~ 18,968.32
REV•1Nb P%+tb-0o)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE)
BENEFICIARIES
ESTATE OF BARRICK, DORIS JEAN
FILE NUMBER
21-08-1091
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT ~ (Words)
lht TruNSys)
l
I
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on (Rev 1500 cover sheet
T OF ESTATE
(SSS)
146,829.48
II. iNON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS
NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
RECEIVING PROPERTY
I. (TAXABLE DISTRIBUTIONS[include outright sppousal
dlstributons and transfers
under Sec. $118 (a) (1.2)]
1 MELODI KOWNACKI
185 CRESTMONT DRIVE
LOCK HAVEN, PA 17745
DAUGHTER
Do Not
RESIDUE
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
p
~ M ~u~ o ~ zc~s
COUNTY
NATIONAL HANK
June 30, 2009
Hamilton C. Davis, Esquire
20 East Burd Street
P. 0. Box 40
Shippensbutg, PA 17257
RE: Doris Jean Barrick Estate
Dear Mr. ,Davis:
Mxs. Barrick had two accounts with this bank, both of which were
in her name alone. Checking account /1222615 was opened 1/14/1992 and
had a balance as of October 19, 2008 of $6,729.76 plus .27t accrued
interest and Mortgage loan #8721149 opened October B, 2002 with a balance
as of 10/19/08 of $15,502.89 plus $14.85 accrued interest.
Sincerely your~s,/
?, .dV-
Carolyn Kougfi
PO Box 3129, Gll'115NURG, PA l i32S I ruuve 71.7.334.316! rou. rrzev. 88833-7 2262 wuvaacnb.com
esrpue edldona ore pbedl9le
A: Sett,elnent Statement
term NpG-t (Ya61 rel NerNbpok e305-?
U.S. Department of Housing and Urban Deveropmenl
cn~ rnpp
1 ~ FHA 2. ^FmHA 3. ~Canv. Unins. 6, Fife Number 7. Loen Number 8, Mortgage Insurance Case Number
092037MARTIN
4. VA -mj o,m,Gn~mis S. p p w you e e emen k se amen we s, moon pa an y a@ emen agen en's Irowr.
C. Note: name meuea'(p.am.rw*re wmpmmwa Me clmei,yanmy ere anm.n Mror«inrvrmenpn pnrppeee end aro nonncludm to me tabu. TilleExpra55 SBIQerrleRl System
WARNING: II ieac,hne Wknmwingly inske tales alatamenlxMNe lMpetl Slates cn ewm Mes elmllmfmrm. Penalpeeuwn
i r ~ oa rna d I ~ I r xbr w~ Tiu to u s code sedimn~ot end secpon tpto. Printed 03/098009 at 17:10 RLH
D, NAME OF BORROWER: Wilmer S. Martin
ADDRESS 379 Greenspring Road Newville. PA 17241 _ _
E. NAME OF SELLER: The Estate of Boris Jean Barrack
ADD S5: cio Namllton Davls Eegulre PO Box 40 Shippensburg PA 17257 __~__
F. NAME OF LENDER:
ADDRESS
G. PROPERTY ADDRESS: 13 Starry Road, Newville, PA 17241
North Newton Township _~_-~_
_
H. SETTLEMGNT AGENT: Rioherd L. Webber, Jr., Esquire, Telephone:llT-532-7388 Fax: 717.532.5268
PIACE OF SETTLEMENT 128 Earl King Street 5hippensburg PA 17257
I, SETTLE ENT DATE: 03109/2009
J. SUMMARY O BORROWER'S TR NSACTION: K, SUMMARY F SELLER'S TRAN ACTION:
100. GROSS AMOUNT WE FROM BORROWER 400. GR SS AMOUNT DUE TO SELLER
i01 Contraclsales once 165 D00.00 401 Cpnbad sales alca 165.000.00
102. Personal Pr er( 402. Personal Pro erl
103 Selllement chargesto borrower altos 14001 _____ 2778.88 403.
104. ____~ 404.
105, 405. __ _.
Ad ustments for Items IO D seller I n advance _ _ Ad usanenls for Items old D seller i n advance
107. Coun>~taxes ____03199l091o1213i(09 489.70 407. Count lazes 03l09109 10 1 2131l09 469.70
706. School Taxes 03109l0910061301Q9 892.31 qp8. SchoolTazes 03109109(006130109 ~_ 992.31
_ -
109 ---~_- 40B
110 410.
t 411.
112. 412
120. GR033 AMOUNT DUE FROM BORROWER 189 260.89 42D. GROSS AMOUNT DUE TO SELLER 166 482,01
ON BEHALF OF BOR
200. AMOUNTS PAID BY OR ROWER 500. REDUCTIONS IN AMOUN7 DUE TO SELLER
_
201 Deoosi{ or earnest moos 1 000.00 501. sa D osit sea instruction
_
202 Principal amount or new loans 502. Seulemen char s seller tin 14001 2 264.61
_
?A3. Exislin loan s taken sub L to 503. ExisOn loans taken sub'ecl to
204, _ 504. Pa op of First Mad s Loen ,14y493.20
Farmers National Bank of Newvl
205. 505, ,_
ZOfi. 506. _
207 507.
zofi. 6DB.
209, 509.
_
Ad ustments for Items un aid b seller Ad'uatmente for items un aid b seller
13, 513.
_
214. 514. __~
_
215, 511 J.
-~
216. 516. __
217. 17. „"
216. 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 1000.00 520. TOTAL REDUCTVON AMOUNT DUE SELLER 16 758.01
300. CASH AT SETTLEMENT FROM OR TO BORR OWER 600. CASH AT SETTLEMENT~TO OR FROM SELLE R
301. Gross amount due from borrower (line 1201 169 260.69 601. Gross am unt due to seller line 420 166 462,01
302 Less amounts paid bv/lor borrower (line 2201 _
1 000.00 602. Less reduction amounldue seller line 20 i6 758.01
303. CASH FROM BORROWER 166 260.89 603. CASH TO SELLER 149 724.00
SIIaySTITUTE FORM toe9 aELLER eTATEMENi: The lnlWmallmn mpnlelnetl hereto la lmpadpnl lax lnbm~a0mn and.a being(mmiaM1etl fm Ma lnkmal Revenam 4mvlca, irydv wa nquirNl to llbmrmurn,
Me Ea1g eb0 camn1611~IBahIM~Orpe~a Pwim'etde ol~l+'n 4maaeav~hia %em N raqulnd Im be raporleJ and Me IRS dalrminae Ms111 bee not boon reppnetl. The eonlrecteelas Prkm degcrlGed mn
You aronglired bylawb pmNOB lheaMlbmanlewnl lFBd. Tev 10 NO: )wllh yam wnrtllwpmyar idenlillplinn number, XytW tlm npl p,w'kle yvurcartedlerpeymr ldentifcalMn
number. you meyW auhlBaibcMl or crlminel penellin impmed bylaw. nor Pena lbe m/earfo,y.ICetlltyMal Me numbersbownon lhb eblNnenNS my wnecl lanpayaritllnlillcnhmnnVmber.
TNo ___,~,-„ I SB1F_R(5)SIGNATURE(5(: l i „_,, ,
SELLERIaI NCW MAILING POnREaS: __ -__._-_-,_.__-__-____.__.__.._._.-
e£LLER(S)PH6N£N11MpERS: ,_-___(kt) ____ IWI
xwlous etlltlpng ere CbzplGle
U.S DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
Irnm NllD4 tsrosl ret }terNOppM 4303'1
File Number: 092037MARTIN PAGE 2
TtleEx ressSetBemenlSvslem Prlnled03l091200 a111'tORLH
L. SETTLEMENT CHARGES PAID FROM PAID FROM
_
700. TOTAL SALES/BROKER'S COMMISSION based on price $165.OOD.001~ 9.000 = BORROWER'S SELLER'S
_
DIYIaIW OI CpmmIe51001i e700 S51Dows:___. FUNDSAT FUN03 AT
701. $ to
~
-__ SETTLEMENT SETTLEMENT
__
__ - _ _.-.~_...
702. $ to _
703. Commission paid at Settlement __ __ _
800. ITEMS PAYABLE IN CONNECTION WITH LOAN ~~~
801. Login Ori ination Fee % _
802. Loan Discount % ____
+
803 Appraisal Fee
~_^__ i
804. Credit Report _
~ ,_
805. Lender's InsceoBon Fee
_
80_¢,._Mor19_aee Aopf~cation Fee _
807. Assumption Fee _
808.
&19. ~~-
810.
811. --~---
900. ITEMS RE UIRED 8Y LENDER TO BE PAID IN ADVANCE
901. Interest From _ to X10$ /dav _
~2. Monpaoe Insurance Premium for to
903. Hazard Insurance Premium for _ to _
904. _ - --
905. --
_1000. RESERVES DEPOSITED WITH LENDER FOR
i
1001. Hazard Insurance _ mo. (a1$
/mo
1002. MoApaDe Insurance mo (al $ !mo
1003. City Properly Tax mo a(T $ Imo
1004. County Procedv Tax mo hl $ _49.98 Imo
1005. School Taxes mo. 264.78 lmo
1009. Agaragete AnaWsis Ad uslment __
1100. TITLE CHARGES
111]1. Sslllement orcbsinp fee __
1102, Absbact or title search ~ '
1103, Title axam{natfon
1104. Title Insurance binder
1105. Document Preparation
1106. Npt Fees
_1107. Allomev's fees
_
_ lindudes above items Np: }
1108. Title Insurance 1o SCHS AaeM for Conestoga Tftle Ins. Co. 1 065.38
_
(Includes above tiems No: 1
_
11 . Lender's Po1Nv
1110 Owner's Pdicv 165.000.00 • 1.085.38 '
1111.
1112. _
1113, --
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordlne Fees Deed $48,50 ~ Mortoace $ ~ Release $ 46.50
_
7202. CIIVICounlylax/stamps Deed 1650.00 Mort a 1850.00
1203. Slate Taxlstamps Deed $1 BSO.Oi1 ~ Mort e _
1 650.00
1204.
1205.
1300.ADDRIONALSETTLEMENTCHARGES
1301. Burvev _
1302 Pesl lnsceclion _
_
1303. Ovemipht Fee le South Central Home Settlements Inc
130a 2009 Gounlv/Townsip Tax to Darlene Pittman Tax Collector
15.00
15.00
599.81
1306. __
1306. _
_
1307.
1308.
1400. TOTAL SETTLEMENT CHARGES !enter on lines 103 Section J and 502, Section K 2,778.88 2,264.81.
HUO CFRr'IFICATION OF BUYER l,ND SELLER '
Ihn+e carelultr re ewee lna VlUD-I SnOlempnl Sl01en,9nl zntl to lie OestA(1n}'b10Wlfdae Nntl ppuer, it isn lNenM pCCUrele Melemml of sll receipry enC aieeureemnnle liwtlemrny eccaml or ov me