HomeMy WebLinkAbout09-21-091505607121
REV-1500 EX (06-05)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO Box 2sosol INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601
RESIDENT DECEDENT 2 1 0 7 0 3 4 9
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
2 1 0 2 6 8 9 6 9 0 3 0 4 2 0 0 7 0 6 2 8 1 9 0 8
Decedent's Last Name Suffix Decedent's First Name MI
A K E R S K A T H R Y N S
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
1. Original Return
4. Limited Estate
QX 6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust ~
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
C~ T~
R O G E R B I R W I N E S Q U I R E 7 1 7~ ~I 9 ~', 3~ '3--;
Firm Name (If Applicable) ~ -ri I t t ~- ~ ~ ~ ~
~REGIST~it'Af~' LS US NLY ~.~ 1
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I R W I N & M c K N I G H T P C .
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First line of address ,
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Second line of address ~
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City or Post Office
C A R L I S L E
Correspondent's a-mail address:
State ZIP Code
DATE FILED
P A 1 7 0 1 3
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, corcect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATUR F PERSON RE~ONSIBLE,FOR FILING RETURN DATE
rl'flI/~ ~~7Y~'~-Q, ~/~2 i l0 5r
ADDRESSi
27 WA~`RIOR IDLE STREET EVERETT PA 15537
SIGNATURE OF PRE A R~OTHE i~-IA ~~ RESENTATIVE DAT/5
1 Yl~ I'S n ~ It~(1 ~ ~1'
60 WEST POMFRET STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607121 1505607121
1505607221
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REV-1500 EX Decedent's Social Security Number
Decedents Marne: KATHRYN S• A K E R S 2 1 0 2 6 8 9 6 9
RECAPITULATION
1. Real estate (Schedule A)
........................................ 1. 1 8 0 0 0 0 0. 0 0
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.
1 1 2 9 8 4 0 8
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. ,
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6.
7. Inter-~vos Transfers 8~ Miscellaneous N -Probate Property
h
l
Billi
R
S
d
G
~ S
t
t
d
7
epara
ng
.......
(
c
e
u
e
)
e
eques
e .
8. Total Gross Assets (total Lines 1-7) ........................... 8. 1 9 1 2 9 8 4, 0 8
9. Funeral Ex enses & Administrative Costs Schedule H
P ( ) ................ 9. 1 7 5 9 2 6, 8 7
10. Debts of Decedent, Mort a e Liabilities, & Liens Schedule I
9 9 ( ) ............ 10. 3 '9 5 8 , 3 2
11. Total Deductions (total Lines 9 8 10) ........................... 11. 1 7 9 8 8 5, 1 9
12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 1 7 3 3 0 9 8 , 8 9
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. 1 7 3 3 0 9 8 , 8 9
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.o _ 0. 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 1 7 3 3 0 9 8. 8 9 16, 7 7 9 8 9. 4 5
17. Amount of Line 14 taxable 0 0 0 0 0 0
at sibling rate X .12 17. •
18. Amount of Line 14 taxable
0
0 0
0
0
0
.
at collateral rate X .15 1 g, .
19. Tax Due ................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
.~
Side 2
7 7 9 8 9. 4 5
L 1505607221 150560722J~
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 09 0349
DECEDENT'S NAME
KATHRYN S. AKERS
STREETADDRESS
207 WARRIOR RIDGE STREET
CITY
EVERETT STATE
PA ZIP
15537
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments 75,000.00
C. Discount 3,899.47
3. InteresUPenalty if applicable
D. Interest
E. Penalty
(1) 77,989.45
Total Credits (A + B + C) (2) 78,899.47
Total InteresUPenalty (D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(3)
(4)
910.02
(5) 0.00
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00
Make Check Payable fo: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred : ...................................................................... ^
b. retain the right to designate who shall use the property transferred or its income; ............................... ^
c. retain a reversionary interest; or ................................................................................................ ^
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ ^X
2. If death occurred after December 12,1982, 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? ......... ^ ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. ^ ^X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent (72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
(72 P.S. §9116 (a) (1.1) (ii)]. The statute does not 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 childtwenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)j.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
0.00
REV-1502 EX + (6-98)
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
' INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
KATHRYN S. AKERS 21 09 0349
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 self, both having reasonable knowledge of the relevant facts.
Real roe which is 'oint -owned with ri ht of survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 30 A. TRACT S/S OF RITNER HIGHWAY, CARLISLE, PENNSYLVANIA - 1,800,000.00
SOLD -SETTLEMENT SHEET ATTACHED
TOTAL (Also enter on line 1, Recapitulation) ~ $ 1,800,000.00
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
~~ SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
KATHRYN S. AKERS 21 09 0349
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointiyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. CASH 25,824.58
2. (PERSONAL PROPERTY
9,659.50
3. SECURITY DEPOSIT FOR PURCHASE OF PROPERTY LOCATED ON RITNER HWY - 75,000.00
FORFEITED
4. RENT INCOME -DONALD McKEEHAN 2,500.00
TOTAL (Also enter on line 5, Recapitulation) I $ 112,984.08
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
KATHRYN S. AKERS 21 09 0349
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOFFMAN-ROTH FUNERAL HOME 3,367.50
2. DALLA VALLE FUNERAL SERVICE, INC. 6,259.00
3. WESTMINSTER CEMETERY, INC. -OPENING/CLOSING FEE 1,210.00
4. EVERETT FLOWER SHOP 471.70
5. DICKINSON COLLEGE -FUNERAL REFRESHMENTS 115.54
6. REV. RICHARD WILLIAMS 50.00
7. EVERETT UNITED METHODIST CHURCH 150.00
8. REV. DONALD CIAMPA 50.00
9. ALLISON UNITED METHODIST CHURCH 75.00
10. CYNTHIA ROBINETTE -ORGANIST 25.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) JOHN R. AKERS 51,250.00
SveetAddress 207 WARRIOR RIDGE STREET
City EVERETT State PA Zip 15537
Year(s) Commission Paid:
2, Attorney Fees IRWIN & McKNIGHT, P.C. 52,000.00
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 1,095.00
5. I Accountants Fees
6. ~ Tax Retum Preparers Fees PATRICIA A. ROSENDALE, CPA ~ 600.00
7. REGISTER OF WILLS -FILING FEE
8. S.W. BARRETT REAL ESTATE -APPRAISAL ON REAL ESTATE 500.00
9. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00
10. THE SENTINEL -ESTATE NOTICE 144.29
11. ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY 65.00
12. REGISTER OF WILLS -SHORT CERTIFICATE 4.00
13. NOTARY FEES 10.00
14. ROWE'S AUCTION SERVICE -PUBLIC SALE 3,380.82
15. CLOSING COSTS FROM SALE OF REAL ESTATE 55,029.02
TOTAL (Also enter on line 9, Recapitulation) $ 175.926.87
(If more space is needed, insert additional sheets of the same size)
REV-1512.EX + (12-03)
` COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
KATHRYN S. AKERS 21 09 0349
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE -CLAIM 3,376.09
2. (BEDFORD SURGICAL ASSOC., INC. -MEDICAL
3. (PENNSYLVANIA DEPARTMENT OF REVENUE -INCOME TAXES
4. (JOHN B. O'NEILL -REAL ESTATE TAXES
5. (BOROUGH OF CARLISLE -REAL ESTATE TAXES
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
178.24
36.66
270.34
96.99
REV-1513 EX + (g-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
KATHRY N S. AKERS 21 09 0349
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. JOHN R. AKERS Lineal 866,549.45
27 WARRIOR RIDGE STREET 1/2 REMAINDER
EVERETT, PA 15537
CAROL A. CAMPBELL
DISCLAIMED IN WHOLE TO
THOMAS A. CAMPBELL Lineal 866,549.44
14604 DAYBREAK DRIVE 1/2 REMAINDER
LUTZ, FL 33559
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1, A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
~ tYY ~t~ ~~~i~I1~el~t
I, KATHRYN S. AKERS, of Carlisle, Cumberland County, Pennsyl-
vania, do make and publish this my last will and testament, hereby
revoking all former wills heretofore made by me.
1. I direct my Executors, hereinafter named, to pay all my
gust debts, funeral and administrative expenses as soon as conven-
iently may be done after my death.
2. I give, devise and bequeath all of my property to my chil-
dren, share and share alike, absolutely. Should either child die
before my death, leaving a child or children to survive him or her,
I give, devise and bequeath his or her share of my property to his
or her child or children, share and share alike. If any such child
be under the age of twenty-one years at my death, then this one-
half share of my property shall be held in trust by the Farmers
Trust Company, Carlisle, Pennsylvania, for said grandchild or grand-
children. The trustee, as well as my executors, are hereby author-
ized to retain, unconverted, any property, real or personal, that I
may own at my death, and shall be under no duty to convert the same
into legal investments. The trustee shall have the pove r and author-
ity to sell, transfer, convey, invest and reinvest and to pay over
the net income of the trust property, to or for the use and benefit
of any of said children, whether under or over twenty-one years or
to accumulate the same in the sole discretion of the trustee. The
trustee shall be under no duty to distribute or use the income
equally for each of said children, but may distribute or use it un-
equally in its discretion. The trustee is also authorized and em-
powered to pay over to, or for the use and benefit of any of said
,`~
children, whether under or over twenty-one years, such po~t~.on-of,
reaches the age of twenty-one years, then whatever remains of income
or principal of the trust estate shall be distributed equally to
said children, share and share alike; the said child or children of
any deceased child taking the share their parent would have taken
if living, and subject to the same trust provisions if under twenty-
one years of age at that time.
3. I nominate and appoint J. Rodger Akers and J. Carole Akers,
to be the executors of this my last will and testament without the
filing of any bond. Should they die before my death, renounce or
refuse to serve for any reason, or die leaving any of my estate un-
administered, I nominate and appoint Farmers Trust Company, Carlisle,
Pennsylvania, as substitute executor with the same powers as are
given herein to my executors, and also without the filing of any
bond.
4. I direct my executor to retain the services of Irwin, Irwin
& Irwin, as attorneys in the settlement of my estate. '
WITNESS my hand and seal this ZSJ~ day of April, 1963.
/fGLjt ~~ C~ (SEAL)
-~%~~
--~ ers
Si ~ned sealed i
g , , published and declared by the within named
testatrix, as and for her last will and testament, in our presence,
who at her request, and in her presence and in the presence of each
other, have hereunto set-our names as subscribing wit sses.
~.I to y
A. Settlement Statement U.S. Department of Housing and Urban Development
B- Tune nb l non
1, pFHA 2. OFmHA 3. OConv. Unins. 6. File Number .7. Loan Number ' VVa' vV. ~~v~• B. Mortgage Insurance Case Number
4. ^VA 5. pConv.lns. 034483
rs orm le ~s o give you a a a amen ua se xrt m ou poi o an y e e amen open are
C~ Note: Items markatl "(p.o.c.)"were paid outside Ne Gosing; they ere shown here lw information purposes end are not inGutled N the !orals. TltleEXpre55 $eaement System
WARNING: It is a wime to knowingly make (else atatamems lp the Unitatl Stales on Nis ar any other similar form. Penalties upon
wnvitlion can Induda a fine antl im isonmenl. For ealalla see: r6e,e u. s. coda Section loot and Sactlan 1o1D. Printed 0911512009 at 11:11 KJB
D. NAME OF BORROWER: Dickinson College
ADDRESS:
E. NAME OF SELLER: Estate of Kathryn S. Akers
ADDRESS:
F. NAME OF LENDER: NON•APPLICABLE
ADDRESS:
G. PROPERTY ADDRESS: 30 a. tract sIs of Ritner Hgh
Carlisle Borou h Cumberland Court
H. SETTLEMENT AGENT: Community Settlement LLC, Telephone: 717.2342666 Fax: 717.2348198
PLACE OF SETTLEMENT: Irwin & McKni ht P.C. 60 West Pomfret St. Carlisle PA 17013
I. SETTLEMENT DATE: 09H6f2009
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 1 800 000.00 401. Contract sales rice 1 800 000.00
102. Personal Pro a 402. Personal Pro art
103. Settlement char es to borrower line 1400 69 994.25 403.
104. 404.
105. 405.
Ad'ustments for items aid b seller in advance Ad'ustments for items old b seller in advance
107. Count taxes 09l16109to12131109 35.88 407. Count taxes 09H6109to12131109 35.88
108. School Taxes 09116109to06130N0 244.56 408. School Taxes 09116109to06130110 244.56
109. Farm Lease Credit 711-9116 274.12 409.. Farm Lease Credit 711-9116 274.12
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER
200. AMOUNTS PAID BY OR ON BEHALF OF BOR 1 870 546.81
ROWER 420. GROSS AMOUNT DUE TO SELLER 1 800 554.56
500.: REDUCTIONS IN AMOUNT DUE TO SELLER
201. De sit or earnest mone 501.. Excess De osit see instructions
202. Princi al amount of new loans
' 502. Settlement char es to seller line 1400 54 926.30
203. Exislin loan s taken sub
ect to 503. Existin loan s taken sub'ect to
204. 504. Pa off of First Mort a e Loan
NONE
205. 505.
206. 506.-
207. 507.
208. Billboard Lease Cr 9116-12131 102.72 508. Billboard Lease Cr 9116-12131 102.72
209. 509.
Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller
213. 513.
214. 514.
215. 515.
216. 516. '
217. 517.
218• 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 102.72
300. CASH AT SETTLEMENT FROM OR TO BORROWER 520. TOTAL REDUCTION AMOUNT DUE SELLER 55 029.02
600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower line 120 1 870 548.81 601. Gross amount due to seller line 420 1 800 554.56
302. Less amounts aid b Ifor borrower Tine 220 102.72 602. Less reduction amount due seller line 520 55 029.02
303. CASH FROM BORROWER 1 870 446.09 603. CASH TO SELLER 1 745 525.54
SUBSTITUTE FGRM 1099 SELLER STATEMENT: The Information contalnetl herein is Important tax intormolion and Is being fumishetl to the Ir.;emal Revenue
Service. II you are required to file a velum, a negligence penaly or other sanc0on will be imposetl on you It Nis item is requlretl to be reponetl ,
antl Ne IRS determines that it has not been reportetl. The ConlreG Sales Price tlescnbed online 40, above consoWles Ne Gross Proceetls of Nis
transac0on.
SELLER INSTRUCTIONS: If This real estate was your pdncipal residence, file Form 2119, Sale or Exchange or Pdndpal Resltlence, for any gain, wiN your Income
tax velum; for othw transactions, complete Ne applicable parts of Form 4797, Form 6252 antl/w Sehatlule D (Porto 1040).
You are requlretl by law to pmvitle Ne SetOemenl Agent. Tax 10 No: 04.3621036 with your correct taxpayer Idenlifiwtipn
number. If you tlo not previtle your Comet taxpayer idendricaDOn number, you may be sublet to civil or criminal penalliesimposed bylaw.
Under penalties or perjury, I ceraty Nal the number shown on Nis statement is my correct taxpayer itlenlificaaonrtumber.'
TIN: / SELLER(S)SIGNATURE(S):
SELLER(S) NEW MAILING ADDRESS:
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 034483 PAGE 2
SETTLEMENT STATEMENT TitleExoress Settlement system Printed 09115!2009 at 1 tt1 t KJB
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on rice $1 800 000.00 4.500 = 81 000.00 BORROWER'S SELLER'S
Division of commission line 700 as follows: FUNDS AT FUNDS AT
" 701. $ 81 000.00 tD Wolfe 8 Shearer Realtors SETTLEMENT SETTLEMENT
702. to
703. Commission aid at Settlement 45 000.00 36 000.00
600. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Od ination Fee
802. Loan Discount
803. A raisal Fee
804. Credit Re ort
805. Lender's Ins cticn Fee
806. Mort a e A lication Fee
807. Assum tion Fee
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to !da
902. Mort a Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. Imo
1002. Mort a Insurance mo. Imo
1003. Cit Pro rt Tax mo. !mo
1004. Coon Pro a Tax mo. $ /mo
1005. School Taxes mo. Imo
1009. A re ate Anal sis Ad'ustment
1100. TITLE CHARGES
1101. Settlement or closin fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Document Pre aration
1106. Nota Fees
1107. Attorne 's tees to McNees Wallace 8 Nurick POC b Bu er
includes above items No:
1108. Title Insurance to Communi SetHement LLC 6 933.75
includes above items No: Basic Rate
1109. Lender's Polic
1110. Owner's Polic 1 800 000.00 - 6 933.75
1111.
1112.
1113. Attorne 's Fee to Irwin 8 McKni ht P.C. POC b Seller
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordin Fees Deed $ 50.50 • Mort a e $ • Release 50.50
1202. Cit !Count taxlstam s Deed 18 000.00 • Mort a e 18 000.00
1203. State Taxlstam s Deed 18 000.00 • Mort a e 1 S 000.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Surve
1302. Pestlns lion
1303.2006 Delin uent Taxes Due to Cumberland Coun Tax Claim Bureau 461.70
1304. 2009 Count (Borou h taxes due to Carlisle Borou h Tax Account 134.64
1305. 2009 School Taxes due to Carlisle Borou h Tax Account 309.96
1306. Wire-ln Transfer Fee to Sus uehanna Bank 10.00
1307.
1308.
1400. TOTAL SETTLEMENT CHARG enter on lines 103 Section J and 502 Section K 69 994.25 _54,926.30
t have prelully re ~ 0.1 SelllemeM Sl a nl and to the best of my knowledge antl belief, II Is a We and orate statement of all repip
and disbursement ma account In This 1 [lion. er certify that I have receivetl a copy of the HUD-1 e emen ment.
~c mso ege s e ryn
_ ~ 2.Lrn.1{+
The HUD-1 SelUe t 'faleme hl Ve Drepared Is a ttue and accurate account of This IransaClion. I have posed or will cause funds to be disbursed
in atxordance~e p
! ~ ~
e e n ae
WARNING: II Ise o Nn gly make false statements to the UNted Slates an This or any olher~simllar form. Penalties upon
convlcGOn pn InGutle a fine and Imprisonment. For details see: Ttle 18 U. 5. Code Section 1001 end Sectlon 1010.
ROWS' S AUCTION SERVICE
2505 Ritner Highway
Carlisle, PA
717-249-2677 249-1978 697-4794
May 4, 2008
To: Roger B. Irwin, Attorney
60 W. Pomfret St.
Carlisle, PA 17013
From: Rowe's Auction Service
2505 Ritner Highway
Carlisle, PA 17015
Re: Estate of Kathryn S. Akers
Personal Property Auction
Total Sales $9659.50
Less 35% commission 3380.82
Total Due $6278.68
L - - -~
William G. Rowe
Hoffman-Roth Funeral Home & Crematory, Inc.
219 North Hanover Street
Carlisle, PA 17013
(717)243-4511
Apri127, 2007
John Rodger Akers
207 Warrior Ridge Street
Everett, PA 15537
The Funeral Service for Kathryn S. Akers
14982-54
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
FACILITY, STAFF, EQUIPMENT
Funeral Ceremony (Conducted at another facility) $320.00
USE OF STAFF & EQUIPMENT
Miles Transported, _ $100.00
Casket Coach (Hearse) $250.00
Lead /Clergy /Errand Car _ $95.00
OTHER SERVICES
Receiving of Remains from Another Funeral Home, $1080.00
FUNERAL HOME SERVICE CHARGES $1845.00
SELECTED MERCHANDISE:
Monticello Interment Receptacle $1220.00
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED $3065.00
Cash Advances
Newspaper Obituary Notice -Sentinel, $177.50
Newspaper Obituary Notice -Public Opinion _ $125.00
TOTAL CASH ADVANCES AND SPECIAL CHARGES . $302.50
Total
Total Cost . _ $3367.50
TOTAL AMOUNT DUE $3367.SO
This statement is net and payable in full within 30 days of receipt.
------------------------------------------------------------------
Please return this portion with your Remittance
$ Amount Enclosed Service ID # 14982-54
Kathryn S. Akers
Scott O. DallaValle
Funeral Director
^~
22 West Main Street
P.O. Box 179r
Everett, Pennsylvania 15537
DallaValle
_. __........_._._.__.__., Funeral Service, Ina
Mr. John R. Akers
207 Warrior Ridge Street
Everett, PA 15537
Dear John,
Below is the statement of charges from the funeral home. If you have any
questions, or need help in any way, please call.
Statement of Professional Services: Mrs. Kathryn S. Akers
Services, Facilities, and Equipment: Traditional Funeral
York Azalia Casket
Register Book, Memorial Folders, Thank You Notes
Total of Services and Merchandise:
Cash Advances, Items paid on your behalf:
8 Copies of PA Death Certificate @ $6.00 each
Hairdresser -Linda Tewell
Bedford Gazette
Total of Cash Advances:
Total Amount Due: April 8, 2007
August R. DallaValle
Funeral Director
Area Code 814
Tel: 652.2148 • Fax: 652.9345
Toll Free: 800.727.2148
$3,875.00
2,188.00
80.00
$6,143.00
48.00
35.00
33.00
116.00
6 259.00
Remit To: Everett 't}`lower Shop
40 North Spring Street
Evere"tt, PA 15537-
(814)652-2533
John R. Akers
207 Warrior Ridge St.
Everett, PA 15537-
STATEMENT OF ACCOUNT
Page 1
Closing Date: 3/31/07
Payment Due: 4/30/07
Account ID: AKERJO
BALANCE DUE: 471.70
AMOUNT ENCLOSED:
For proper credit, fill in AMOUNT ENCLOSED and return this top section with your payment.
................................................................................................
DatelTicket~Sent To/Ord By~ # Merchandise $ ~D1vey~Srvice~Phone~ Tax ~ Total ~Balance~
Balance Forward ~ I I I 1471.701
Everett Flower Shop (814)652-2533 PLEASE PAY ---> 471.70
Your Account ID: AKERJO
We're still waiting for spring!
It'll be here before you know it.
Thank you so much for your continued
patronage!
~x~tx~~~~x C~~ex~~e~.~x ~ ~~~
~e~ ~~
1159 Newville Road Phone (717) 249-2029
Carlisle, Pennsylvania 17013-1777 FAX (717) 249-9365
March 21, 2007
To Whom It May Concern:
This is to verify that John Akers paid the Open/Closing Fee for the
interment of Kathryn S. Akers, her burial date was March 9, 2007.
if you have any questions; or need further information, please feel free
to contact the office:
Regards;
~~~~JT - ~
Fonda Taylor
Administrator
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upon proper preeematlon. I prombe ro pay such TOTAL (topstKer wllh any other ~J~er~es Oue
(hereon) sublacl ro arW h eoeordence whh the agreement poveminp Ne use of each card
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ID-FOLIO/CFIECK NOJLIC. NO. STATE REGJDEPT. CLERK TIP
MISC.
~$~~~29 • ~ ~ Irv: D~~
CUSTOMER: RETAIN THIS COPY FOR YOUR RECORDS
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DICKINSON COLLEGE
CASHIER'S OFFICE
PO BOX 1773
CARLISLE, PA 17013-2896
717-245-1909
STATEMENT OF ACCOUNT
Bill To:
John Akers
207 Warrior Ridge
Everett, PA 15537
INVOICE NUMBER:
CUSTOMER ID:
INVOICE DATE
PAGE: 1
S0015685
900157197
19-MAR-2007
DUE DATE: 17-APR-2007
PREVIOUS BALANCE: .00
- CURRENT CHARGES/CREDITS -
50015685 3/9 Funeral Refreshments 109.00
50015685 Sales Tax 6.54
* TOTAL INVOICE BALANCE * 115.54
Direct payments andlor inquiries to the Cashier's Office at 717-245-1909.
I.5% finance charge for all past due balances will be assessed monthly.
CUSTOMER NAME: John Akers BALANCE DUE: 115.54
CUSTOMER ID: 900157197 AMOUNT REMITTING:
Please make checks payable to "Dickinson College".
Please include the bottom portion of this statement with your payment.
S. W. Barrett Real Estate & Appraisal Services
********* INVOICE *********
File Number: 06-0030
Irwin & McKnight
60 West Pomfret Street
Carlisle, PA 17013
Borrower
Invoice #
Order Date
Reference/Case #
PO Number
Ritner Highway
Carlisle, PA 17013
AKERS, Estate
06-0030
01 /25/2006
Appraisal Services
Invoice Total
State Sales Tax @
Deposit
Deposit
Amount Due
Terms: Payable Upon Receipt
Please Make Check Payable To:
S. W. Barrett Real Estate & Appraisal Services
126 North Hanover Street
Carlisle, PA 17013
Fed. I.D. #: 236646-804
03/09/2006
$ 500.00
--------------
$ soo.oo
$ o.oo
~$
~~ )
--------------
$ 500.00
;~,- -
;~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
April 4, 2007
IRWIN & MCKNIGHT
ROGER B IRWIN ESQUIRE
WEST POMFRET PROFESSIONAL BUILDING
60 WEST POMFRET STREET
CARLISLE PA 17013
~~G~4b~~
Re: KATHRYN AKERS
CIS #: 070195297
SSN: 210-26-8969
Date of Death: 03/04/2007
Dear Attorney Irwin:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $3,376.09 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $3,376.09, was incurred during
the last six months of the decedent's life; therefore, it is a Class 3 claim
pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20
Pa. C.S.A. 3392(3). The balance of the claim, namely $.00, is to be entered
as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
r
Elaine Wiest
TPL Program Investigator
717-772-6246
717-772-6553 FAX
Enclosure
QUALIFIED DISCLAIMER
In accordance with Internal Revenue Code Section 2518 (b) and pursuant to Section 6201
of the Pennsylvania Probate Estate and Fiduciaries Code, (20 PA.C.S.A. Section 6201), this
Qualified Disclaimer is being executed by the undersigned beneficiary, CAROLE A.
CAMPBELL, in order to disclaim in whole all of her interest in the ESTATE OF KATHRYN
S. AKERS:
The undersigned, as one of the beneficiaries in the above-referenced Estate is hereby
disclaiming her interest in the estate in favor of her son, THOMAS A. CAMPBELL, as
evidenced by the undersigned's execution hereof.
This disclaimer is executed as of this ~~ day of ~ r` ` 2007, the same being
effective as of the date of death of the decedent, Kathryn S. Akers on March 4, 2007.
WITNESS:
~.
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C,~. ~ ~ ~ ~ ~:t~-~--~.~~~~ .. ~_ (SEAL)
CAROLE A. CAMPBELL
STATE OF ~ ~~~ ~(x-J
J SS
COUNTY OF ~7 ~ t ~~~~
,~
On this, the ~ da of rt 2007 before me, the undersi
y geed officer, personally
appeared Carole A. Campbell, known to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument, and acknowledged that she executed the same for the purposes
therein contained.
In witness whereof, I hereunto set my hand and official seal.
~~r aG~ TAMMY A FIELD ~{ l /1
~ (Votary Public. State of Florida ~ --~SE~)
CommisaionYDD289964 Notary blic .
My comm. expires Mar. 13, 2008