HomeMy WebLinkAbout09-04-09J REV-1500 1505607120
EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO 80X.280601 21 0 8 0 0 2 6 3
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
432209686 03072008 12131926
Decedent's Last Name Suffix Decedent's First Name MI
SHAFFER SHIRLEY B
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
^ 1. Original Return ® 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to t 2-13-62)
^ 4. Limited Estate ^ qa, Future Interest Compromise ^ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
Decedent Died Testate ~ Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
^ 6. (Attach Copy of Will) ^ (Attach Copy of Trust)
9. Liti anon Proceeds Received tp, Spousal Poverty Credit (date of death ^ ~ t,Election to tax under Sec. 9113(A)
^ g ^ between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
RICHARD E. CONNELL ESQ. 7172328731
Firm Name (If Applicable)
BALL, MURREN & CONNELL
First line of address
2303 MARKET STREET
Second line of address
City or Post Office
CAMP HILL
State ZIP Code
PA 17011
LS USE~ILY
REGISTER ~~ _
-~7
fN*1 %,
~ ` -z
~„ T
C/T ~ _ ":r
''
~
r ,
~~
~
DA~ FILED ~ '.'
_ ,,.F
. ,
c~ ~
.~
s._..,~
r`_i l
~7
L7
w... ~
_~
r_~~
Correspondent'se-mail address: Connell@bmC-IaW.net
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.
SIGN~rTURE OF PERSON` RESPONSIBLE FO~R^FILING RETURN DATE
/D.1f ~ .~lC r rrt,~ ~~ /1L10 ~ 1 Teri Lynn Essey ~ ^ Z 3
52 EawlaStreet, Chaj~i~.pA 1
S NATURE OF PREP ROT - N REPVE DATE
t'~ Richard E. Connell Esq. C/-~- ~ ~f
ADDRESS ~--~~
2303 Market Street, Camp Hill, PA 17011
Side 1
1505607120 1505607120 J
1505607220
REV-1500 EX
Decedent's Social Security Number
oeceeenPs Name: SNAPPER , S H l R L E Y B. 4 3 2 2 0 9 6 8 6
RECAPITULATION
1 7 4, 2 9 6. 7 0
1. ........................................................
Real Estate (Schedule A) .................................. 1.
2. Stocks and Bonds (Schedule B) ............................................................................... 2. 1 8 7, 6 8 3. 9 9
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4.
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 8 8 , 3 6 9 9 7
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ............. 7.
g. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 4 5 0, 3 5 0. 6 6
9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 1 8 , 2 9 3 . 6 6
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... . 10.
11. Total Deductions (total Lines 9 8~ 10) ..................................................................... . 11. 1 8 , 2 9 3 . 6 6
12• Net Value of Estate (Line 8 minus Line 11) ............................................................ . 12. 4 3 2 , 0 5 7 0 0
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. 4 3 2 , 0 5 7 . 0 0
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 15.
16. Amount of Line 14 taxable
at linealrateX .045 432, 057.00
16.
19, 442.57
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
18
at collateral rate X .15 .
19. Tax Due .................................................................................................................... . 19. 1 9, 4 4 2. 5 7
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L,~, 1505607220 1505607220
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 08 - 00263
Shaffer, Shirley B.
STREET ADDRESS
514 Colony Road
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 19,442.57
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 19,492.97
C. Discount 894.74
Total Credits (A + B + C) (2) 20,387.71
3. InteresUPenalty if applicable
p. Interest
E. Penalty
Total InteresUPenalty (D + E) (3) 0.00
4, 1f Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 945.14
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 the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Q . Q Q
Make Check Payable to: REGISTER OF WILLS, AGENT
~,,z yy ~,i }1~~F. -
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
b. retain the right to designate who shall use the property transferred or its income :.................................... ^ x
c. retain a reversionary interest; or .................................................................................................................. ^ 0
d. receive the promise for life of either payments, benefits or care? .............................................................. ^
2. If death occurred after December 12, 1962, did decedent transfer property within one year of death without
receiving adequate consideration? ....................................................................................................................... ^
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? ...................................................................................................................... ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS 15 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 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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
FILE NUMBER
ESTATE OF Shaffer, Shirley B. 21 - 08 - 00263
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 wilting 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.
ITEM ` DESCRIPTION ~ VALUE AT DATE OF
NUMBER I DEATH
514 Colony Road
Camp Hi11 (Hampden Township), PA
Parcel Tax ID# 10-20-1848-335 (SEE SETTLEMENT SHEET ATTACHED)
(The house had been reported on the original return as valued at $210,000 on Schedule A. On
Schedule H, a reserve for closing costs was listed as $14,700 which would have produced a net
value of $195,300 which exceeds the actual proceeds by $21,003.30. Therefore, inheritance ta>
was overpaid leading to this supplemental return. The net taxable estate is $432,057.
Therefore, tax was overpaid by $945.14 and a refund is sought.)
174,296.70
TOTAL (Also enter on Line 1, Recapitulation) ~ 174,296.70
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Shaffer, Shirley B.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
--r - __ - - - - -
ITEM ! DESCRIPTION
NUMBER ''
1 'Morgan Stanley -Account Number 53842
2 Wachovia Securities -Account Number 5236-9732
Evergreen Equity TR
Asset Allocation A -Mutual Fund
(3911.388 shares)
FILE NUMBER
21 - 08 - 00263
UNIT VALUE ; VALUE AT DATE OF
+' DEATH
132,494.31
14.11 55,189.68
TOTAL (Also enter on line 2, Recapitulation) ' 187,683.99
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Shaffer, Shirle B. FILE NUMBER
Y 21 - 08 - 00263
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 DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Wachovia Bank NA 65,269.97
1. Certificate of Deposit #8521 $43,769.52
2. Certificate of Deposit #6431 $5,110.81
3. Certificate of Deposit #7968 $5,445.13
4. Certificate of Deposit #7287 $10,944.51
2 Morgan Stanley Cash /Money Market 23,100.00
Account Number 410 053842 047
TOTAL (Also enter on Line 5, Recapitulation) ~ 88,369.97
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL ExPENSES &
ADMINISTRATIVE COSTS
ESTATE OF Shaffer, Shirley B. FILE NUMBER
21 - 08 - 00263
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Neill Funeral Home 6,327.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2. ~ Attorney's Fees Ball, Murren & Connell 2,500.00
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills (Cumberland County) Filing for Letters 79.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Okher Administrative Costs
1 Cumberland Law Journal 75.00
TOTAL (Also enter on line 9, Recapitulation) 18,293.66
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT C ^Schedule H
l•unClQl ""`f"" """'
Aldminisha6ve Costs COI'lbnued {
ESTATE OF Shaffer, Shirley B. FILE NUMBER
21 - 08 - 00263
2 The Sentinel 167.66
3 Sewer & Refuse 277.30
4 Plumbing Repairs 460.40
5 Water 63.68
6 Utilities 2,068.07
7 Real Estate Taxes (County) $1,538.33 1,973.74
Real Estate Taxes (County/Township) $435.41
8 Executrices Expenses 1,371.02
9 Household Maintenance/Repair 1,121.88
10 Lawn Care and Maintenance 680.65
11 StampslMaterials for disposition of personal possessions 117.99
12 Reimbursement to Ball, Murren & Connell for costs advanced 54.04
13 Miscellaneous costs and expenses for continuing utilities and maintenance of Estate 956.23
real estate.
Page 2 of Schedule H
REV-1513 EX+ (9-003 -. '~ _
'
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA
NHERIT
C BENEFICIARIES
I
AN
E TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Shaffer, Shirley B. FILE NUMBER
21 - 08 - 00263
NUMBER ! NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO
DECEDENT i SHARE OF ESTATE
I (Words) AMOUNT OF ESTATE
($$$)
_, RECEIVING PROPERTY Do Not List Trustee(s)
I, 'TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
j
under Sec. 9116 (a) (1.2)] j
1 'Blake Kenneth Shaffer Son ~ one-half
18584 Santa Isadora Street
Fountain Valley, CA
2 ;Teri Lynn Essey Daughter one-half
52 Eagle Street i
'' Charleroi, PA 15022
I
j Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, on Rev 1500 cover sheet
II NON-TAXABLE DISTRIBUTIONS:
. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS
NOT BEING MADE
f B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
~rev,ous eomons ere o~solele
A: Settlement Statement
wrm RUD-t (3fts6) rei RandlxMx 4305.2
U.S. Department of Housing and Urban Development
nsao A.,.....,,~I nh. ~Fm_maF mvnlr<c t vznnnnoy
1. ^FHA ~v 2. ^FrfrHA 3. ~IConv. Unins. 6. File Number 7. Loan Number B• Mortgage Insurance Case Number
4. OVA 5. OConv.lns. 09-450 2175036022
rs orm Is u o prve you a a amen u s en ws a. o a pa a a amen apen are
C. Note: Items marked "(p.o.c r' wore paid outsfda Ma cloaktp•, they are shorn here for M«mafion purposes and are rql included in the totals. TtieEXQre55 $etllemenl $yStem
WARNING: II Is a erne ro krtowlnply make falu shtemsms ro Me lMiled Slalea on W s a xry oMer simNar form. Penalties upon
wnviction can include a fine and kn sonmsnt For datalls sea: Titb i6 U. S. Code Section t t and section toto. Printed 06/2912009 at 16:56 KR
D. NAME OF BORROWER: SIDNEY G. DREESE and KATHY A. DREESE
ADDRESS: 68 Ollver Rd. Enola PA 17025
E. NAME OF SELLER: THE ESTATE OF SHIRLEY B. SNAPPER
ADDRESS:
F. NAME OF LENDER: Northwest Savings Bank
ADDRESS: 100 Libe Street Warren PA 16365
G. PROPERTY ADDRESS: 514 COLONY ROAD, HAMPDEN TOWNSHIP, CAMP HILL, PA 17011
Ham den townshi
H. SETTLEMENT AGENT: Homesale Settlement Services,lnc.
PLACE OF SETTLEMENT: 4309 L1n lestown Road 717.671.9876 Fax 717-671-9676 Harrisbur PA 17112
SETTLEMENT DATE: 06130/2009
I
.
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales rice 190 000.00 401. Contract sates rice 190 000.00
102. Personal Pro art 402. Personal Pro art
103. Settlement char s to borrower line 1400 6 790.22 403.
104. 404.
105. 405.
Ad'ustments for items aid b setter in advance Ad~ushnents for items aid b seller in advance
107. Count taxes 06130109 to 12/31/09 234.89 407. Count taxes 06130109 tD 12131109 234.89
108. SchooiTaxes 06130/091006130109 4.30 408. School Taxes 06130109 to 06/30/09 4.30
t 09. Sewer 06!30109 to 06130109 1.51 409. Sewer 06130!09 to 06130109 1.51
110. 410.
111. 411,
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 197 030.92 420. GROSS AMOUNT DUE TO SELLER 190 240.70
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. De sit or earnest move 7000.00 501. Excess De alit see insiruch'ons
202. Prins al amount of new loans 152 000.00 502. Settlement char s to seller line 1400 14 644.00
203. Existin loan s taken sub'ect to 503. Exisfin loans taken sub'ecl to
204. 504. Pa off of Flrst Mort a Loan
205, 505.
206. ~~
207. Seller Assist 1 300.00 507. Seiler Assist 1 300.00
208. 508.
209. ~9•
Ad'ustments for items tin aid b seller Ad'ustments for items tin aid h seller
213. 513.
2tq, 514.
215. 515.
216. 516.
217. 517.
218, 518.
219, 519,
220. TOTAL PAID BYIFOR BORROWER 160 300.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 15 944.D0
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower line 120 197 030.92 601. Gross amount due to seller line 420 190 240.10
302. Less amounts aid b !for borrower line 220 160 300.00 602. Less reduction amount due seller line 520 15 944.00
303. CASH FROM BORROWER 36 730.92 603. CASH TO SELLER 174 296.70
SUBSTITUTE FORM ID99 SELLER STATEMENT: The mformalion conlafned herein is important lax Inlormalan and is belrtp rurnlstted to lne Internal Revenue Servke. If you are requirM Io file a return,
a n nce penalty or oMttr senctlan wal he Imposed on you Ir lhls Item ~s required to he reponed and Me IRS determines that It has nd been reported. The Gonlract Sales Rice described on
litre d01 above wnsbWres Me Gross Proceeds of MIS Vansacllon.
SELLER INSTRUCTIONS: Ir Ihls real estate was your pnnclpal residence, rile Form 2159, Save a Exchange of Principal Residenu, rot any pain, wiM your Income lax return, Im other transactions,
compete are appirade pans of Form 0797, Form 6252 andor Schedule D (Form 1040),
You are required by law b provide Me settlement apenl ~Fetl. Tex ID No: ) wiM ~r correct laxpeyxr IdeMiOwllon number. k you do not provide you/ correct taxpayer IdenaflUaon
number. yeti maybe subject to nva or cnmmal penallles mposed bylaw. Under Pena 1 e5 o perjury, cerllfy that lna number mown on Mfs statement Ig my carted taxpayer idenorlcadon number.
TIN: / SELLER(S)SIGNATURE(S): ~
SELLER{S) NEW MAILING ADDRESS:
Previous edlliana, era oDSOlele
brm HUD-1 (3/66) ref Handbook 430$,2
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 09.450 PAGE 2
SFTTI FMFNTSTATFMFNT ,..,_~.------,._..,-- -_. ,. .... .--•--•---- .._--..-
L. SETTLEMENT CHARGES ~JICWJ O
PA46 FROM l I U.JV 1\R
PAID FROM
700. TOTAL SALEStBROKER'S COMMISSION based on rice 5190 000.00 =11 400.00 BORROWER'S SELLER'S
Division of commission line 700 as follows: FUNDS AT FUNDS AT
701. $ 5 725.00 to Keller-Williams of Central PA SETTLEMENT SETTLEMENT
702. $ 5 675.00 to Prudential Homesale Services Grou
703. Commission aid at Settlement 11400.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Ori ination Fee %
802. Loan Discount °h
803. A sisal Fee to Clauser Real Estate A sisal P.O.C. 375.00 B er
604. Credit R rt to ACA Mort a e LR 44.80
805. Admin fee to Northwest Savin s Bank LR 425.00
806. Loan Processin fee to ACA Mort a e 495.00
807. Tax Service Fee tD Northwest Savin s Bank LR 80.00
808. Document Pre aration to Northwest Savin s Bank LR 100.00
609. Flood Determination to Northwest Savin s Bank LR 7.50
BtO. Mt .t3roker Com fee b NWSo ACA Mort a e 2178.16 POC b Lender
811.
900. ITEMS REQUIRED BY LENDER 70 BE PAID IN ADVANCE
901. Interest From 0613Df2009 to D7I01l2009 22.6900 Ida 1 Da s LR 22.69
902. Mort a e Insurance Premium for to
903. Hazard Insurance Premium For to Nationwide Ins. P.O.C. 581.00 Bu er
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance 3 mo. 48.42 Imo LR 145.26
1002. Mort a e Insurance mo. $ Imo
1003. Cil Pro rt Taxes mo. $ Imo
1004. Coun Pro n Taxes 5 mo. $ 38.62 Imo LR 193.10
1005. School Taxes 13 mo. $ 130.81 !mo LR 1 700.53
1009. A ate Anal sisAdustment to Northwest Savin s Bank LR -251.32 0.00
1100. TITLE CHARGES
1101. Battlement or closin fee
1102. Abstract w title search
1103. Title examination
1104. Title insurance binder
1105. Document Pre ration
1106. Note Fees to Nota Public 35.00
1107. Attarne 's fees
includes above items No:
1108. Title Insurance to Old Re ubllclHSS 1 295.66
includes above items No: 1101 110211031104 Enhanced Reissue Rate
1109. Lender's Poilc 152 000.00 -
1110. Owner's Poli 190 000.00 -1 295.66
1111. End 100 300 900 to Old Re ubiiclHSS 150.00
1112.
1113. Closin Svcltr to Old Re ublic 35.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recadin Fees Deed 48.50 • Mort a 82.50 Release 131.00
1202. Cif /Count lax/stam Deed 51900.00 Mort e 1 900,00
1203. State Taxlstam Deed $1 900.00 Mort a 1 900.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Surve
1302. Pest Ins ction to & Home tns ec POC b Bu er
1303. Wire Fee to Homesale Settlement Services Inc. 11.00
1304. Infemet Dac Pre to Homesale Settlement Services Inc. 50,00
1305. 6c ss Lenders Pk to Homesale Settlement Services Inc. 25.00
1306. 6c ress Seller Dots to Homesale Settlement Services Inc. 25.00
1307. Tax Cert. to Michael Lan an 5.00
1308. Ofher Disbursements 1520 195.00 1 314.00
1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 6 T90.22 14 644.00
n Vu V tK I tt ILA I I V N VF BUYER AND SELLER
I have carefully revlewetl me HUD-t Selllernenl Sialernenl and 7o Ne best of my knowledge and belleL II la a true and accurate statement d atl receipts antl disbursements made an my account or Dy me
~Nt lhllhla~t1]rya~ln~`e'~cat~l~ipn. I rprlher Certlly Thal l have received a rnpy of Ne HU0.1 Settlement Slslemenl. 7/~/) n
o'IO1vEe'G~REErE ~ n 0~ •t t~RTri~ ~ ~•L/I 011/Jl~
WARNING: IT IS A CRIMETO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-i SeulelMfd Statement which I have preparetl is a We and accurate account of Ihis transaction.
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION I have roused or will cause the Nnds W be disbune0 In accordance whit Ihis statement.
CAN INCLUDEA FINEAND IMPRISONMENT. FOR DETAILS SEE TITLE te:
U.S. GO9E BECTON 1007 AND SECTION 1070.
o..
Previous adilione are abeDlele
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
- ~-ur nrwrr_wwrur
loan HUO-1 (3/B6) rel HenOaook <305.2
File Number: 09-450 PAGE 3
T:a,.e......,,.,, e..ei,...,.,... h,...nm DdMevl l1RIrX]l7fll10 el 1GF1: KR
VL i I LLIfI LIB 1 V ~n• a..v~... ..__~.. .___ __-..__.__.. _ _.__.. ___ _ _
ITEMIZATION OF HUD LINE 1308
1500. SCHEDULE OF DISBURSEMENTS BUYER SELLER
1501. Transaction fee to Prudential Homesale Services ~rou 195.OD
1502. Transaction fee to Keller Williams of Central PA 225,00
1503. Reimbursement for Abstract to Patrick Smtlh 15.00
1504. Termite Treatment to Sudden Death Termke and Pest Control 954.00
1505. Fence REmoval to RA. Naves 120.00
1506.
1507.
1508.
1509.
1510. ~
1511.
1512.
1513.
1514.
1515.
1516.
1517.
1518.
1519.
1520. TOTAL HUD LINE 1308 EXPENSE: 195.00 1314.00
PHILIP J. MURREN
RICHARD E. CONNELL
TERESA R. MCCORMACK
THOMAS A. CAPPER
LAW OFFICES
BALL, MURREN & CONNELL
2303 MARKET STREET
CAMP HILL, PENNSYLVANIA 17011
(717)232-8731
FACSIMILE (717) 232-2142
MAILING ADDRESS:
P.O. BOX 1108
HARRISBURG, PENNSYLVANIA 17108-1108
HAND DELIVERED
September 4, 2009
WILLIAM BENTLEY BALL
(1916-1999)
o _..
,~.
Glenda Farner Strasbaugh, Register of Wills ~ in ~-~'. '- ~~
Cumberland County Courthouse ~ ~ ~ c , ,
c-~•' •',
One Courthouse Square ~ ~ .~ ~A -~
Carlisle, PA 17013 ~~~ ~ c:=; <-,
r~
~~ r + ~•r~
RE: Estate of Shirley B. Shaffer -' - `'
Date of Death: 03-07-08 c ,.; `~r'
Will No. 2008-00263
Our File No. 2768.1
Dear Ms. Farner-Strasbaugh:
Enclosed please find, in duplicate, a Supplemental Inheritance Tax Return for Shirley B.
Shaffer. Please date-stamp the additional copies of the Return for our records.
Also enclosed, please find a check in the amount of $15 for the filing of the Return.
Very t~Il'y yours, ~.`t
Richard E. Connell
REClhmp
Enclosures
cc: Mrs. Teri Lynn Essey (w/out enclosures)