HomeMy WebLinkAbout10-13-09' 1505607121
REV-1500 ~ (x-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Po sox 280601 INHERITANCE TAX RETURN 2 1 0 8 0 5 3 0
Hanisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 8 3 1 2 4 4 5 1 0 4 1 7 2 0 0 8 0 1 2 5 1 9 2 0
Decedent's Last Name Suffix Decedent's First Name MI
E N C K A N N A B E L E
(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 Retum ~ 2. Supplemental Return ~ 3. Remainder Retum (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required
death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 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)
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Name Daytime Telephone Number
M U R R E L R W A L T E R S I I I 7 1? 6 9? 4 6 5 0
Firm Name (If Applicable)
First line of address
5 4 E A S T M A I N S T R E E T
Second line of address
Ci±y or Post ~fics State
M E C R A N I C S B U R G P A
Correspondent's a-mail address:
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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, corned and complete. Declaration of preparer other than the personal representative is ba don all i t~f wh~h prep~rer~les any knowledge.
SJGNATURE OF PERSON RESPONSIBLE FOR,FILING RETURN _ _ .DATE r, _
ADDRESS ~ "
BARBARA J• K T TT "AND JOHN I• ENCK JR-
SIGNATURE OF PR A ,l' T EPRESENTATIVE DATE
r'~i- ~r~d4
ADDRESS
MURREL R• WALTERS III 54 E MAIN ST MECHANICSBURG PA 1?055
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607121 1505607121
J
150560?221
REV-1500 EX Decedent's Social Security Number
Decedents Name: A N N A B E L E• E N C K 1 8 3 1 2 4 4 5 1
RECAPITULATION
1. Real estate (Schedule A) ........................................ 1. 6 0 4 . 9 ?
2. Stocks and Bonds (Schedule B) .................................. 2. •
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. •
4. Mortgages 8 Notes Receivable (Schedule D) ........................ 4. •
5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ....... 5. 3 9 0 5 8 . 8 0
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6• •
7. Inter-Vivos Transfers 8~ Miscellaneous N n-Probate Property
arate Billin
~ Se
Re
uested
S
h
d
l
G
7
•
.......
p
g
q
(
c
e
u
e
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8. Total Gross Assets (total Lines 1-7) ........................... 8. 3 9 6 6 3. 7 7
9. Funeral Ex enses 8 Administrative Costs Schedule H
P ( ) .......
......... 9. 1 1 5 2. 0 0
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ... ......... 10. 1 5 1 5. 1 4
11. Total Deductions (total Lines 9 8~ 10) .................. ......... 11. 2 6 6 7. 1 4
12. Net Value of Estate (Line 8 minus Line 11) ................ ......... 12. 3 6 9 9 6 . 6 3
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. 3 6 9 9 6 . 6 3
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 0. 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .0 0 ~ ~ 16. 0• 0 0
17. Amount of Line 14 taxable
0
~ 0
0
0
0
at sibling rate X .12 17. •
18. Amount of Line 14 taxable 3 6 9 9 6 6 3 5 5 4 9 4 9
.
at collateral rate X .15 18. .
19. Tax Due ....................................... ......... 19. 5 5 4 9. 4 9
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
1505607221 1505607221 J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENTS NAME
ANNABEL E. ENCK
STREET ADDRESS
954 W. TRINDLE ROAD
SILVER SPRING TOWNSHIP
CITY STATE ZIP
MECHANICSBURG PA 17055
File Number
21 OS 0530
Tax Payments and Credits:
Tax Due (Page 2 Line 19)
Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) 5,549.49
Total Credits (A + B + C) (2) 0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (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.
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(4) 0.00
(5) 5,549.49
(5A)
(56) 5,549.49
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 transferred : ...................................................................... ^
b. retain the right to designate who shall use the property transferred or its income; ............................... ^
c. retain a reversionary interest; or ................................................................................................ ^ X^
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 "intrust for" or payable upon death bank account or security at his or her death? ......... ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. ^
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 + (6-98)
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANNABEL E. ENCK 21 08 0530
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 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 ro which is ' i -owned with M of survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 954 WEST TRINDLE ROAD, MECHANICSBURG, PA 17055 604.97
-ADDITIONAL FUNDS RECEIVED AT ULTIMATE SETTLEMENT 7/15/09
Original return prepared in anticipation of scheduled January settlement that buyers
were unable to complete. After new buyers were found, the actual net proceeds received
were slightly higher.
TOTAL (Also enter on line 1, Recapitulation) ~ ~ 604.97
(If more space is needed, insert additional sheets of the same size)
Provious editions era obsolete
form HUD-1 (3/86) ref Handbook 4305.2
A. Settlement Statement U.S. Department of Housing and Urban Development
R Tvno of I nan OMB ADaroval No. 2502-0265 (expires 11/30/2009)
1. EIFHA 2. ^FmHA 3. ^Conv. Unins.
4. VA 5. Conv.lns. 6. Fie Number
09-398 7. Loan Number
2009003180 8. Mortgage Insurance Case Number
441-9170252.702
ortn give you e a em u ae an a pa a age^ ~
C. Note: Ilema marked "(p.o.c.)" were pa,d outside the closing; they aro shown hers far IMOrtnetion purposes and are not Included in the totals.
WARNING: It is a crime to knowingly make false atatemanls to the United States on tMs orrry other similar form. Penakiea upon
conviction can include a fine and im ritwnmsnt. For detatis ace: Title 18 u. s. coda Sedbr 1001 and Section 1010.
p y
TitIeEX Tess Settlement S stem
Printed 07/1512009 at 14:55 KR
D, NAME OF BORROWER: BRIAN K. MCMASTER, JR. and LEAH A. MCMASTER
ADDRESS: 7 Moran Drive Dilisbur PA 17019
E. NAME OF SELLER: ESTATE OF ANNABEL E. ENCK
ADDRESS:
F. NAME OF LENDER: AURORA FINANCIAL GROUP, INC.
ADDRESS: 9 EVES DRIVE SUITE 190 MARLTON NJ 08053
G. PROPERTY ADDRESS: 954 WEST TRINDLE ROAD, SILVER SPRING TOWNSHIP, MECHANICSBURG, PA 17055
Silver S rin townshi
H. SETTLEMENT AGENT: Homesale Settlement Services, inc.
PLACE OF SETTLEMENT: 4309 Lin lestown Road 717-671-9876 Fax 717-671-9676 Harrisbur PA 17112
I. SETTLEMENT DATE: 0711512009
J. SUMMARY OF BOR OWE 'S TRANSACTI N: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales rice 150 000.00 401. Contract sales rice 150 000.00
102. Personal Pro a 402. Personal Pro e
103. Settlement char es to borrower line 1400 44 734.69 403.
104. 404.
105. 405.
Ad'ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance
106. Ci /town taxes 07115/09 to 12131109 76.64 406. Cit (town taxes 07115/09 to 12131109 76.64
107. Count taxes 07/15109 to 12/31109 151.45 407. Count taxes 07115/09 to 12131109 151.45
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 194 962.78 420. GROSS AMOUNT DUE TO SELLER 150 228.09
200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. De sit or earnest mone 1 000.00 501. Excess De osit see instructions
202. Princi al amount of new loans 178 356.00 502. Settlement char es to seller line 1400 10 685.00
203. Existin loans taken sub'ect to 503. Existin loan s taken sub'ect to
204. 504. Pa off of Frst Mort a e Loan
205. 505.
206. 506.
207. 507.
208. Seller Assist 9 000.00 508. Seller Assist 9 000.00
209, 509.
Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller
212. School Taxes 07101/09 to 07115109 48.12 512. School Taxes 07101109 to 07115109 48.12
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 188404.12 520. TOTAL REDUCTION AMOUNT DUE SELLER 19 733.12
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower line 120 194 962.78 601. Gross amount due to seller line 420 150 228.09
302. Less amounts aid b/for borrower line 220 188 404.12 602. Less reduction amount due seller line 520 19 733.12
303. CASH FROM BORROWER 6 558.66 603. CASH TO SELLER 130 494.97
SUBSTITUTE FORM 1099 SELLER STATEMENT: The iMortnatbn contained herein is important tax iMortnaKon and is being furnished to the Internal Revenue Service. It you are required to file a return,
a neglpan~e penaKy or other sanction will be imposed on you K this item is required to ba ropoRed and the IRS determines that Il has not been reported. The Contred Selea Price described on
Iirn 401 above consUtutas the Gross Proceeds of lhh Uanssdion.
SELLER INSTRUCTIONS: If this roal estate was your pnncipal residence, Kle Form 2119, Sale or Exchange of Principal Residence, for any pain, with your Income tax return; for other lrensadions,
complete the applicable parts of Form 4797, Form 6252 and/or Schedule D (Form 1040).
You ere required by law to provide fhe aeKlemeM agent (Fed. Tax ID No: 1 wkh ~ corced taxpayer fdeMificatfon number. H you do not provide your correct taxpayer identification
number, you may be subject to civil or criminal penalties imposed by law. r pens lroa o perjury, certify that the number shown on this statement is my corceU taxpayer identification number.
TIN:
SELLER(S) SIGNATURE(S):
SELLER(S) NEW MAILING ADDRESS:
Previous editions are obsolete
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SFTTI FMFNT STOTEMENT
form HUD-1 (3/86) rat Handbook 4305.2
File Number: 09.398 PAGE 2
TitlaFvnracs Saftlampnf Svefam Prinforl n7/15/9f1nQ ~f 1d•55 ICR
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on rice $150 000.00 = 9 000.00 BORROWER'S SELLER'S
Division of commission line 700 aS follows: FUNDS AT FUNDS AT
701. 4 525.00 to ERA- NRT INC. SETTLEMENT SETTLEMENT
702. 4 475.00 to Prudential Homesale Services Grou
703. Commission aid at Settlement 9 000.00
800. REMS PAYABLE IN CONNECTION WRH LOAN
801. Loan Ori ination Fee ~°Homesale Mort a e Services 1 742.89
802. Loan Discount % .5% to Homesale Mort a e Services 891.78
803. A sisal Fee to Martin Ko its A sisals 350.00
804. Credit Re rt to Homesale Mort a e Services 95.32
805. 891.78- less Rehab Disc 299 to AURORA FINANCIAL GROUP INC. 592.78
806. Su lemental Ori ination Fee to AURORA FINANCIAL GROUP INC. 448.00
807. Commitment Fee to AURORA FINANCIAL GROUP INC. 250.00
808. Commitment Fee to Homesale Mort a e Services 200.00
809. Flood Certification to First American Flood 12.00
810. Rehab Discount Fee to AURORA FINANCIAL GROUP INC. 299.00
811. Rehab Escrow to AURORA FINANCIAL GROUP INC. 30 900.00
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 0711512009 to 0810112009 29.3188 Ida 1T Da s 498.42
902. Mort a e Insurance Premium for to AURORA FINANCIAL GROUP INC. 3 050.00
903. Hazard Insurance Premium for 1 ear to Gran a Insurance 404.00
904. U front MIP Cash to AURORA FINANCIAL GROUP INC. .O6
905. Consultant Fee to Atlantic Home Ins action x500.00 POC b Lender
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance 2 mo. 33.67 /mo 67.34
1002. Mort a e Insurance mo. 79.89 Imo
1003. Cit Pro a Taxes mo. 13.71 Imo
1004. Count Pro Taxes 5 mo. 40.81 Imo 204.05
1005. School Taxes 1 mo. 104.55 Imo 104.55
1009. A r ate Anal sis Ad'ustment to AURORA FINANCIAL GROUP INC. -17.88 0.00
1100. TITLE CHARGES
1101. Settlement or closin fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Document Pre aration to POC
1106. Note Fees to Nota Public 25.00 10.00
1107. Attome 's fees
includes above items No:
1108. Title Insurance to Old Re ubliclHSS 1 128.38
includes above items No: 1101 110211031104 Enhanced Reissue Rate
1109. Lender's Polic 178 356.00 -1 128.38
1110. Owner's Polic 150 000.00 -
1111. End 100 300 900 to Old Re ubliclHSS 150.00
1112.
1113. closin SvcLtr to Old Re ublic 35.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordin Fees Deed 51.50 • Mort a e 100.50 • Release 152.00
1202. Cit /Count tax/stam s Deed 1 500.00 • Mort a e 1 500.00
1203. State Tax/stam s Deed 1 500.00 • Mort a e 1 500.00
1204.
1205. Sti to Prothonota 21.00
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Surve
1302. Pest Ins coon
1303. Wire Fee to Homesale Settlement Services Inc. 11.00
1304. Intemet Doc Pre to Homesale Settlement Services Inc. 50.00
1305. Ex resslHandlin Fee to Homesale Settlement Services Inc. 25.00
1306. 2009-10 School Taxes to HSS Escrow Holdin Account 1 350.00
1307,
1308. Other Disbursements 1520 195.00 175.00
1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section 44 734.69 10,685.00
HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HUD-1 Settlement Statement end to the beat of my knowledge and belie/, it is a true and accurate statement of all receipts and disbursements made on my account or by me
in this tranaacion. I further certify that I have received a copy of the HUD-1 Settlement Statement. ~~nn /~
~` N!~
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION
CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18:
U.S. CODE SECTION 1001 AND SECTION 1010.
The HUD-1 Settlemen Statement which I have prepared is a We and accurate account of this transaction.
I have caused or will ae fhe funds to be disbu ed in ac%c~o}rdance with this statement.
eY I V
Prevaus editions ero obsolete
Conn HUD-1 (3186) ref Handbook 4305.2
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 09-398 PAGE 3
c+r-t-T~ CuCti1T QTATCti~CA1T T7lL.C..n.nne. CeHlen,nnf 6.efnm ori„+a.+mt~~t~nno ~+ 1d•~n, l(R
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ITEMIZATION OF HUD LINE 1308
1500. SCHEDULE OF DISBURSEMENTS BUYER SELLER
1501.
1502. Pre aid Tax Cert Fee to Homesale Settlement Services Inc. 10.00
1503. Bu er Transaction Fee to Prudential Homesale Services Grou 195.00
1504. Seller Transaction Fee to ERA- NRT INC. 165.00
1505.
1506.
1507.
1508.
1509.
1510.
1511.
1512.
1513.
1514.
1515.
1516.
1517.
1518.
1519.
1520. TOTAL HUD LINE 1308 EXPENSE: ' 195.00 175.00
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
ANNABEL E. ENCK 21 08 0530
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, U.S. INCOME TAX REFUND 4,269.00
2. ~ PENNSYLVANIA INCOME TAX REFUND
3. PNC FINANCIAL
NET PROCEEDS FROM STOCK REINVESTMENT ACCOUNT
4. HOUSE INSURANCE REFUND
347.00
34,212.80
230.00
TOTAL (Also enter on line 5, Recapitulation) ~ ~
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8~
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANNABEL E. ENCK 21 OS 0530
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. GINGRICH MEMORIAL -TOMBSTONE 737.00
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City
Year(s) Commission Paid:
State Zip
2 Attorney Fees
3, Family Exemption: (If decedents address is not the same as claimant's, attach explanation)
(;laimant
Street Address
Cry State Zip
Relationship of Claimant to Decedent
4. I Probate Fees
5 Accountant's Fees GREENAWALT & COMPANY -FIDUCIARY INCOME TAX RETURNS
6. Tax Return Preparers Fees
7
415.00
TOTAL (Also enter on line 9, Recapitulation) 13
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
R_ ESIDENT DECEDENT _ _
ESTATE OF FILE NUMBER
ANNABEL E. ENCK 21 08 0530
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. HOUSE INSURANCE 396.50
2. (REAL ESTATE TAXES - 2009 COUNTYITOWNSHIP
3. (SUBURBAN PROPANE -HEATING
4. I PPL ELECTRIC
5. (UNITED WATER
6 IWAYNE MARTINS -LAWN CARE
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
TOTAL (Also enter on line 10, Recapitulation) I a
(If more space is needed, insert additional sheets of the same size)
479.95
299.00
147.22
67.47
125.00
1.515.14
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