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HomeMy WebLinkAbout09-23-09 (2)15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 09 0033 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 192-14-5743 12/16/2008 10/01 /1924 Decedent's Last Name Suffix Decedent's First Name MI Weber Betty (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 ~wr, 3. Remainder Retum (date of death prior to 12-13-82) __... 4. Limited Estate ~: _3 4a. Future Interest Compromise (date of ~:~::~ 5. Federal Estate Tax Retum Required death after 12-12-82) r,:l;? 6. Decedent Died Testate ;::.:~':~ 7. Decedent Maintained a Living Trust __ 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) __ 9. Litigation Proceeds Received t: _ ~ 10. Spousal Poverty Credit (date of death . , 11. Election to tax under Sec. 9113(A) 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 T0: Name Daytime Telephone Number Robin Holman Loy (717) 582-2410 Firm Name (If Applicable) rya - ~ REGISTER ~I I Ift LS USE OtIfPY Holman & Holman ~ f ; _ _ _r~ cn First line of address ra . rT~ , c~ -~ •._ . - - ,: ,; .gin N 16 E Main Street _ _ -a? ~-'' - ~', - - Second line of address.. . , '' ~ -~, T ~ ; , V = P O Box 97 - ` -- ' ' ~ rv ; .-~ City or Post Office State ZIP Code ~ DA'I~FILED ~ ` Q New Bloomfield PA 17068 Correspondent's a-mail address: ~naer penalties of perjury, I declare that I have examined this return, including accompanying schedule and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of pr arer ether than the personal representative is base on all information of which preparer has any knowledge. SIGNA E OF PER N RESPON LE R FILI G RETURN r DATE / --~-~ / ~ 09/14/09 2114 Mayfred`Lane, Camp Hill, PA 17011 SIG ,11RE(OF,Py2EPARER OT THAN REPRESENTATIVE DATE TXX //~ 09/14/09 MVVRC JJ ~ --- P OBox 97, New Bloomfield, PA 17068 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: Betty Weber ', 192-14-5743 . ~.. ~_~. __ ~.. ~... ~ ....,_.____.~ _ _..__~_. ____ . _ _ _~ ~. m _.. _ __ .._ .. ro~ _~. _ _. _ __ .__ . . _._ __-___ --_~... e~~. RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. 334,819.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. Mortgages ~ Notes Receivable (Schedule D) ......................... .... 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 9,713.18 6. Jointly Owned Property (Schedule F) C:.'".:~ Separate Billing Requested .... ... 6. 0.00 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) K:.v~ Separate Billing Requested..... ... 7. 11,029.87 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 355,562.05 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 40,269.10 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ .... 10.. 86,637.72 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 126,906.82 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 228,655.23 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... ... 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 228,655.23 __....__a_.~.a_ __~._ ____~ ~._.._~ __ ___. -_.__.._._. ----_._._ ~._ _.~__ __ __~ ~ _......~ ._. _.~..,..-__.._._.a.~.~~..._.,.. 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 .0_ 15. 16. Amount of Line l4 taxable at lineal rate X .0 45 228,655.23 '', 16. ', 10,289.48 17. Amount of Line l4 taxable at sibling rate X .12 17, 18. Amount of Line 14 taxable at collateral rate X .15 1 g. 19. TAX DUE .........................................................19. 10,289.48 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-7500 EX Page 3 File Number _ __ __ Decedent's Complete Address: 21 09 0033 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Betty Weber 192-14-5743 STREET ADDRESS 2114 Mayfred Lane CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 10,289.48 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 10,289.48 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 10,289.48 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 :..................................................................................... ..... ^ Q 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? ................................................................. ..... ^ 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 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)]. 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. REV-1502 EX+ (11-OS) ~i Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER BETTY WEBER 21-09-0033 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' I Property at 139 North 23rd Street, Camp Hill, PA -Parcel ID #01-21-0271-198 -Sold at private sale (See attached Settlement Statement) ~ 115,000.00 2. ~ Property at 2717 Market Street, Camp Hill, PA -Parcel ID #01-21-0271-544 (See attached tax assessment card) ~ 219,819.00 TOTAL (Also enter on Line 1, Recapitulation.) I $ 334,819.00 If more space is needed, insert additional sheets of the same size. REV-1508 EX+ (6-98) SCHEDULE E p CASH, BANK DEPOSITS & MISC. COMM ONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER BETTY WEBER 21-09-0033 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PNC -Certificate of Deposit No. *******7494 in amount of $5,352.47 plus $80.75 accrued interest 5,433.22 2. PNC -Checking Account No. ******8833 3,383.79 3. Susquehanna Valley Federal Credit Union Account 5.97 4. Real Estate Tax proration (sale of 139 North 23rd Street) (Line 108 of attached HUD-1 settlement stmt) 576.89 5. Sewer proration (sale of 139 North 23rd Street) (Line 109 of attached HUD-1 settlement stmt) 24.31 6. IRS - 2008 Income Tax Refund 48.00 7. Commonwealth of PA - 2008 Income Tax Refund 241.00 TOTAL (Also enter on line 5, Recapitulation) $ I 9,713.18 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER BETTY WEBER 21-09-0033 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFDRREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE ~~ ING Regular IRA Contract 11,029.87 100 11,029.87 TOTAL (Also enter on line 7 Recapitulation) $ I 11,029.87 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER BETTY WEBER 21-09-0033 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ Myers-Harner Funeral Home -Funeral and burial 8,506.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Doug Weber Social Security Number(s)IEIN Number of Personal Representative(s) 197-52-3890 Street Address 2114 Mayfred Lane City Camp Hill .State PA Z;p 17011 Year(s) Commission Paid: 2009 2. Attorney Fees 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Cumberland County Law Journal -Estate Notice $. The Patriot News -Estate Notice s. Re/Max Realty and Exit Realty Capital Area -Realtor's Commission -139 N. 23rd St. ~ o~ Real estate closing fees - 139 N. 23rd St. > > ~ PA Realty Transfer Tax - 139 N. 23rd St. 12. Death Certificates for Spouse 17, 700.00 5,000.00 410.00 75.00 155.10 7,150.00 62.00 1,150.00 61.00 TOTAL (Also enter on line 9, Recapitulation) I $ 40,269.10 (If more space is needed, insert additional sheets of the same size) REV-1512 EX (12-OS) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER BETTY WEBER 21-09-0033 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1513 EX~t (ll-08} Pennsylvania SCHEDULE J DEPARTMENT OF FEVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER BETTY WEBER 2009-00033 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. Cheryl Hoke, 217 S. High St., Mechanicsburg, PA 17055 Daughter 1/3 2. William Weber, 1381 Springwood Dr., Apt. 20, Maysville, KY 41056 Son 1/3 3. Doug Weber, 2114 Mayfred Lane, Camp Hill, PA 17011 Grandson 1/3 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. 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. Farrer4 ~~-- i~ci, P.C. ~ ~_._...~.._.....__.~ 4423 North front Street Harrisburg, PA t 7110 (717)230-9201 LAST' WILL AND TLS'1'AN[ + NT Ol± I3I~T'I'~Y WI~l3ELt I, Betty Weber, oI• Cumbex•land County, Pennsyl.van_ia, being of sound and cli.sposing mind, clo hereby make, publ.isll and eleclax•e this as my Last Will and Testament, hey°eby revoking all other W:i]ls and Codicils hea°etofore oracle by me. 1~ IRS'1! I direct the payment of my debts aild expenses of my last illness and funeral from my Estate as soon after my debt as conveniently may be done. If there is no cemetery lot available for my internm.e:at, owned by me at tl~e 1;i.me or my cle~~.th, I authorize my personal representative to purchase such cemetery lot with a contract; for perl~etLial. care, using funds from my Esi,ate, in such amount as lie shall consider necessary and desirable, and I authorize my personal representative to cause title to such lot so purchased to be vesl,ecl in such peg°son as my personal representative shall designate. I+urther, in this conxxectiorx, I authorize xny personal x•epresentative 1~o expend funds from my Estate in such amount as my personal representative sha11 co~.~si.der necessary and desirable, ,for the purchase, erection and inscription of a su.it~ible nzarl.~er fox• my grave. S.L+~COND I give and bequeath alltangible personalproperty owned by me at the time of my death, as well a.s real property, .to be divided equally between Chex`yl Hoke o Nleclxanicsburg, Pennsylvania, my daughter.•, William Weber. o[• hayetteville, Ohio, zny son, and Doug Webe~° of Camp 'Hill, .Pennsylvania, my grandson. TIIIIZD In the evexlt that any of the i.ndi.viduals named t~ take under i;his Will predecease nxe, the p~°opea°ty will 1>e divided equally by the sw°viviiig leg~rtees. 1' O U R'I'I I T direct that; any and all Ialheritance, Est~.i;e aild ~I'~°ansfer taxes imposed uz.~on my Estate passing under my Will, or otherwise, shall be paid out of the principal o:f my residuary Estate. ~~ lI~'1`II In addition to the powers confer~:•ed by .law, I authorize my EX(',CLltoT', in his absolute discretion: ~. 'L'o retain in the form recei.vecl, and to sell either at public or.• private sale, any real or personal pr:•operty. I3. To manage Real Estai;e. C. 'loo exercise any option o~:• ~•i_ghts arising from ownership of invest;menu. D. 'I`o compromise claims wil;l"lotlt COUrt approval, and wil;hout thc~ consent of any beneficiary. SIXZ'1-T I nominate, constittirtc and appo:i.nt ~n.y Grandson, .Dotiig Weber,Executor of this my Last Will and Testament. I hereby rolicwe my I~xecui;o~° fiom tl e necessity of posting security in connection with his duties as such in any jurisdiction in which lie may be c~lled~ upon to act insofa~° as T azn able Uy law ~to do so. 13eti;y giber CONIMONWTALTII OI{ P]NNSYLVANIA COUN'T'Y O ~ CUN113LR,1~11ND ss We, ~iti'~~~/~ ~IIa1=~C2_, ~c ~~,.,, ~~C~.-~f~l as witnesses, th.e Testator and the Witnesses respect;ively, whos~atnes are signed to the attached instx•ument, being first duly swox•n, clo hereby declare to the undersi.gnecl authority that t;he 7.'estator signed and executed the inst;x•umeni; as her Last Will, and 1;hat she has signed willingly, and that she executed it as her fi°ce ancT voluntary act for the purposes therein expressed, and that each or the witnesses, in the presence an.cl hearing of i;he '.l~estatox•, signed the Wi].1. as witness, and to the best of their know].eclge, the ~I'estatox• wa.s a1; that tithe lf3 years of age ox• older, of sound mi.ncl and antler ia.o constraint ox• undue influence. ~. U c ~.~i-~~l `~.~ '~ Web Daniel J. Gal.laglTei•~~~~±~squire CONIMONW:L{~AL~L'II OI•, PENNSYLVANIA CO UN~I'Y OI! DAUPHIN SS: r ~~_. On the ~ day of ~=e. ~J~~t u ,, t, 2001., Uefore me, a Notary I?ublic, personally appeared Betty Weber, arzd ~n due form oI' Law acknowledged i;he foregoing~Decla~°ation to be hel:• act and deed and desired -that the same might be recorded as such. WITNl+~SS my hand and notarial. seal pp~~''i1 _._--...._ ~/ ,/,+ /l ... ~ .... NOTAIZY;17UI3LIC ~ r My Commission I~xpires: Notarial Seal Kathy A. Toney, Notary Public Susquehanna Twp., Dauphin County My Commission Expires July 2, 2001 ~Memher. Pennsylvania Association of Notaries ., A. B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING 8 URBAN DEVELOPMENT 1.QFHA 2.~FmHA 3.QX CONV. UNINS. 4. QVA 5. ~CONV. INS. 6. FILE NUMB ER: 7. LOAN NUMBER: SETTLEMENT STATEMENT osos3 5700 805710 . 8. MORTGAGE INS CASE NUMBER: C. NOTE: This (orm is /umished to give you a .statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked '7POCJ" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3/90 (09089/0908925( D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER : Mostafa Ramzani and Howard F. Weber! Betty A. Weber Estate Fulton Bank Noufissa Wahid 139 North 23rd Street One Penn Square -Suite 304 456 State Street, Apt. 1 Camp Hill, PA 17011 Lancaster, PA 17602 Enola, Pa. 17025 G. PROPERTY LOCATION: H. SETTLEMENT AGENT : 25-1878915 I SETTLEME NT DATE: 139 North 23rd Street Keystone Land Transfer, L td. . Camp Hill, PA 17011 F Cumberland County, Pennsylvania PLACE OF SETTLEMENT ebruary 25, 2009 3421 Market Street Camp Hill, PA 17011 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 Price 115,000.00 401. Contract Sales Price 115 000 00 102. Personal Pro a 402. Personal Pro ert , . 103. Settlement Char es to Borrower Line 1400 4,660.32 403. 104' 404. 105. 405. AdLStments Forltems Paid B Sellerin advance Ad'ustments Forltems Paid B Seller in advance 106. Cit /Town Taxes to 406. CI /Town Taxes to 107. Coun Taxes to 407. Coun Taxes to 108. School Tax 02/25/09 to 07/01/09 576.89 408. School Tax 02/25/09 to 07/01/09 576 89 109. Sewer 0illin 02/25/09 to 04/01/09 _ 24.31 409. Sewer Billing 02/25/09 to 04/01/09 . 24 31 110. 410. . 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 120,261.52 420. GROSS AMOUNT DUE TO SELLER 115,601.20 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De osit or earnest mone 2,000.00 501. Excess De osit See Instructions 202. Princi al Amount of New Loans ' 75,000.00 502. Settlement Char es to Seller Line 1400 8 342 00 203. ExisOn loans taken sub ect to 503. ExisOn loans taken sub ect to , . 204. 205 504. Payoff of first Mortgage to PNC Bank/tW00100715D00 55,033.43 . 206 505. Pa off of second Mort a e to PNC Bank/#40030000700 29,338.10 . 506. 207' 507. De osit disb as roceeds 208' , 508. 209. 509. Ad'ustments For Items Un aid B Seller Ad'ustments For Items Un aid B Seller 210. Cit /Town Taxes to 510. Ci (Town Taxes to 211. Coun Taxes 01/01/09 to 02/25!09 - 112.38 511. Coun Taxes 01/01!09 to 02/25/09 112 38 212. School Tax to T 512. School Tax to . 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218 518 219. . 519. 220. TOTAL PAID BY/FOR BORROWER 77,112.38 520. TOTAL REDUCTION AMOUNT DUE SELLER 92,825.91 300. CASH AT SETTLEMENT FROMlTO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower Line 120) 120,261.52 601. Gross Amount Due To Seller Line 420 115 601 20 302. Less Amount Paid By/For Borrower (Line 220) ( 77,112.38) 602. Less Reductions Due Seller (Line 520) ( , . 92,825.91 303. CASH (X FROM) (. TO) BORROWER 43,149.14 603. CASH (X TO) ( FROM) SELLER 22,775.28 re unuersigneo nereoy acknowletlge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein. Borrower ,~ Mostafa R Zap' ~~ Nou ssa Wahid Seller Flaward-F-Weber/ Betty A. Web r E/state rage ~ L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ 115 000.00 no 6.0000 % 6 900 00 PAio FROM PAID FROM Division of Commission Iine700 aSFOIIOWS: BORROWER'S SELLER'S 701.$3,475.00 to Re/Max Realty Associates ruNOS AT FVNDS T 702. $ 3,425.00 to Exit Realty Capital Area SETTLEMENT A SETTLEMENT 703. Commission Paid at Settlement 704. Transaction Fee to RelMax Realty Associates Inc. 6,900.00 250 00 Note: Line 701 Includes Adjustment of 25.00 For . 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori inallon Fee 0.0000 % to 602. Loan Discount 1.0000 % to Fulton Bank 750.00 803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806. Mort a e Ins. A .Fee to 807. Assumption Fee to 808. 809. Tax Related Service Fee to Fulton Bank 75 00 810. Processing Fee to Fulton Bank . 200 00 811. . 812. Application Fee to Fulton Bank POC:B395 00 . 813. Document Prep fee to Fulton Bank 250 00 814. Insurance Service Fee to Fulton Bank . 54 00 815. Flood Determination to Fulton Bank . 816. Automated Underwri0ng Fee Fannie Mae $29.00 POC by Lender 11.50 817. Flood Deter/Monrilor Fee First American Flood $11.50 POC by Lender 818. Insurance Service Fee Ameritrac $13.00 POC by Lender 819. Tax Related Servlce Fee First American Real Estate Services, Inc. $75.00 POC by Lender 820. _ 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 02/25/09 l0 03/01/09 @ $ 10,017100/day ( 4 days %) 40 07 902. Mort a e Insurance Premium for months to . 903. Hazard Insurance Premium for 1.0 ears to Erie Insurance POC:B246 00 . 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months $ er month 1002. Mort a e Insurance months Cod $ per month 1003. Ci /Town Taxes months $ er month 1004. Coun Taxes months $ er month 1005. School Tax months @ $ per month 1006. months $ er month 1007. months @ $ per month 1008. A re ate Adjustment months $ er month 1100. TITLE CHARGES _1101. Settlement or Closing Fee to 1102. Abstract or Title Search to 1103. TiBe Examination to 1104. Title Insurance Binder to 1105. Document Pre aration to 1106. Nota Fees to CASH 1107. Attorney's Fees ~ to 25.00 15.00 includes above item numbers: 1108. Title Insurance to Ke stone Land Transfer L[d. 933 75 includes above item numbers: . 1109. Lender's Coverage $ 75,000.00 PAL#106890981 1110. Owner's Coverage $ 115,000.00 PAO#106905627 1111. Endorsements 100,300,8.1 to Keystone Land Transfer, Lld. 150 00 1112. Closing Protection Le[ter to Keystone Land Transfer Ltd . , . 1113. Tax Certifications to Keystone Land Transfer Lld. 35.00 , 1114. Overnight to Keystone Land Transfer Ltd 7 OD , . 1115. Retrieve E Mail Documents to Keystone Land Transfer Ltd 20.00 20.00 , . 1116. Wire Fee to Keystone Land Transfer Ltd 25.00 , . 1117. 15.00 1118. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 49.50; Mortgage $ 76.50; Releases $ 126 00 1202. Cit /Coun Tax/Stam s: Deed 1,150.00 Mort a e . 1 150 00 1203. Stale Tax/Slam s: Deed 1 150.00; Mort a e , . , 1204. 1,150.00 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to 1302. Pest Ins ection to - 1303. 2009 County Tax to Keystone Land Transfer 800 00 1304. . 1305. - 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103 Section J and 502 Section K ) , , By signing nape t or mis statement. tha smnamnw. a~k,,,,..non„e .ewi,a ,.r, ...,.... 4-,660.32 8,342.00 Certified to be a true copy. Ke~tonne Land Trans~r, Lt ~ ~ ~~;_ Settlement Agent ( 09083 / 09083 ! 25 ) l~axlll3 Kesult Details Page 1 of 1 Detailed Results for Parcel 01-21-0271-544. in DistrictNo O1 Pa rcel_FD MapSuftix HouseNo 01-21-0271-544. 2717 Direction Street, MARKET STREET Owned C/O ProPTYPe WEL3ER, (TOWARD F 8c BETTY A RA PropDesc LivArea 2154 CurLandVal 38690 CurLnpVal 135770 CurTotVal 174460 CurPrefVal Acreage ,28 C1GrnStat TaxEx I SaleAnrt 1 SaleMo 07 SaleDa 1 y SaleCe 19 SaleYr 79 DeedQkPage YearBlt 0028N-00943 1910 HF_File Date liF_Approval Status 02/09/2007 D the 2004 Tax Assessment Database ~--', !/ 1 ~~` , `~ f `~ J ~,i ~,~ C, « ~ l ~,~ I_ !\ r,'1~ r~ ,~ ~ -. ,; ,. i r ~, ~~~~. ~``~` ~ \ ~~ lei` ,~ ~ ~~~ ~, '~ - nil -~~ ___ \\\ http://taxdb.ccpa.net/details.asp?id=O 1-21-0271-544.~Ycdh.Cele(~.t=1 ~ 1/7~~~nno Feu. I[• [w7 I~il~wi iiv~,, ~nivn 411-lVJ~Ll9/ -~-'.'r~'.. i.FJiD1Nta THE WAY February i z, 2009 Robin %lolman i.oy, Esq. 16 E Main 5t P Q >3ox 97 iyew Diooinrieid, rr~ i 7v6a Fem.; 13e~y A Weber SSN: 192-14-5743 I7L~L~; 12-16-200$ ~c:ar ~lr7ii~iadanj: !uo. ~JU~ r. ii 1 In response to your request zor Date of Beath (I7t~D) balances for the customer noted above, our records show the following: Certificate of De~ic~sit 1lccount ~# 11t720047494 Established: 01-19-1995 BETTY A WEBER TDDD balance; ~ 5;352.47 ± $0.75 accnruedq~intnerest ~yry~ lntei'CSI pajd t~11-U1'200© `wz"~.t 1L-16-ZOV© .D 191.03 11L Checking Account Account # 51120(78333 I/stablished: 12-10-1992 BE~1 TY A ~iEBER DQD balance: ~ 3,383.`79. non interest bearing Loan Account The decedent maintained Loan Account 4001007150000005 and 4003000700548101. For further information and assistance, please contact 1-$$$-762-2265. Select option.l, then optior- 3 anti then 0 zero). After pressing zero, please remain an the line to speak with a Loan Financial Sezviee Consultant. Safe Bepoait Boa The decedent maintained safe deposit bva # 01154 located at: Came Hill Branch 214$ Market ~? Camp I=Iil1,1~A 17011 (717) 730-1(}70 Page ] of 2 reu, iL. Luu7 i~ irr~w~ ~~~~~ urtivn ~tiL ivy cr~tr iuu. U.)VU ~ • Li L Please note that this office provides date of death balances for deposit accounts IRAs, CDs, Checking and Sauings}. We ~~ too! process-any i3nanelal transactions or provide statemQnts. If you need ~ssistanee with any of these items, ple~.se c~11 I-S~~~p)\IC-~.A.I~ (l,$$~-752-2265) ar stop by your Ioeal .PNC Bank branch, office. Sincerely, National Financial Services Center PFiC Bank, i~i.A. Member FI~I~ l3age 2 of 2 USQUEHANNA ALLEY FEDERAL CREDIT UNIC-N Robin Holman Loy Holman & Holman Attorneys at Law 16 East Main Street P.O. Box 97 New Bloomfield, PA 17068 Re: Betty A. Weber Member # 1039 Dear Ms. Holman Loy: The date of death balance on Betty A. Weber's account at Susquehanna Valley Federal Credit Union was $5.97. There were no joint owners on the account. Please be advised that in order to close this account, we would need a certified copy of the death certificate. Kind regards, J/ ~~ L I i~l Kathy Jo ~Shoaff Member Services Supervisor 3850 HARTZDALE DRIVE • CAMP HILL, PA 1701.1--7809 ~~~ r LOCAL: (717) 737-4152 TOLL FREE: 800 948-1454 F ( ) AY: (71.7) 737 0589 1 r ~. ! .^_ ~ a i:r i r r [~~r~ ~e~~~~~~' ~a t~ ~-EC-~R ~Ei~ .~r°~~if n rn f.y e ~5~. x eery,/~irr~ F'?-g_~e~: ~i serer, ~~f~ieii,~~ir~ I"~#~~±~ ~is1s Asa ~. ~v~~ inf. ~,.e~F'iti r~i f~,v~f1u~, ~uif43 ~ 3 C~t`,1 fi~a~rrix; ~~i~i~~ '~~ ~¢~~x ~~~t t~: 1 t J~ ~ ^) ~~ ` ~ ~ ~ ~--•_, orb. °-/ ~. 83~~?~jt~~.~ ~~~~ '~~~~: r--, ~.. ~. c `~~ ~ ~ ~~i ~, /% ~ (~ ,~__~ ~! i ~~rb~ra ~f~t?i~€~, ~~~t~i:~~~ €tepr~=~nfi~filV~ ~c3z ~. W~n~v~r ~~r~~i; t~tfrli~l~r i~~ i7t3i~ ~fi7.2~~.~~~x ~a=~x 7ii.Z~i~.~~7'i ~, 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 February 25, 2009 HOLMAN AND HOLMAN ROBIN HOLMAN LOY ESQUIRE 16 EAST MAIN STREET P O BOX 97 NEW BLOOMFIELD PA 17068 Re: BETTY WEBER SSN: 192-14-5743 Dear Attorney Loy: Pursuant to your letter dated February 17, 2009, the Department of Public Welfare (DPW), Estate Recovery Program, has reviewecl the information you provided regarding the above-referenced individual. It has been determined that this individual did not receive any type of assistance during the questioned period. Therefore, according to the information you provided, the Department's Estate Recovery Program will not seek any recovery from this estate. If your client applied for Medical Assistance and had an application and/or hearing pending at the time of death, please advise us and provide any additional information that may affect a recovery by our Department. If you have any questions, please feel free to contact. me. Sincerely, .~ ~~ Carole A. Procope Recovery Secti.~n Manager (717)772-6604 H H Holman & Holman ATTORNEYS AT LAW Glenda Farner Strasbaugh Cumberland County Register of Wills One Courthouse Square Room 102 Carlisle, PA 17013 Re Betty Weber Estate Dear Ms. Strasbaugh: September 22, 2009 Robin Holman Loy 16 East Main Street P. O. Box 97 New Bloomfield, PA 17068 (717) 582-2410 Fax 582-8178 Allan W. Holman, Jr. Of Counsel n ~n ~ - z ~ c ~ --- ~ ~ =- ~~ n, w _ --; ,, - ~ -~', ._ ,._ __, ~ _ . J J ~ . , .~ ~- - Enclosed please find two original inheritance tax returns and two original inventories, as well as a copy of each. I would appreciate if you would time-stamp the copies and return them to me in the enclosed self addressed stamped envelope. I also enclose a check made payable to the Register of Wills for $30.00 for the filing of the return and the enclosed Inventory. We apologize for the error in not including the $30.00 when it was first filed on September 16, 2009. Since we are an out of county attorney, we unfortunately did not realize that Cumberland County charged for filing an inheritance tax return. Might I suggest that it would have been more cost effective to place a phone call to my office requesting the $30.00 payment than to forward all these documents back to me at a cost of $2.92. Of course, you may have issues of storage or a shortage of staff which would prevent you from using this expedited procedure. However, I feel compelled to make the suggestion. If you have any questions, please feel free to contact me. Sincerely, HOLMAN & HOLMAN ' 4.~(~ cR. Robin Holman Loy cvh Enclosure z 0 n a 0 o onn ~o ~' ~ C~ ~ Q- o ~ ~ ~ b N ~ ~ ~ ~ ~. :+ ~' O O ~ ~~ w '~ ~C ~ ~ J7 w ~ UQ U~Q ~~ ~ O ~Gh C