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HomeMy WebLinkAbout10-14-09r -~ REV-1500 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county code veer File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO Box.2soso~ 21 0 9 0 010 9 Harrisburg, PA 1712&0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 176321413 01212009 05161918 Decedent's Last Name Suffix Decedent's First Name MI POE JAMES 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 Return ^ 2. Supplemental Return ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death aver 12-122) ® g, Decedent Died Testate ^ 7 Decedent Maintained a Living Trust (Attach Copy of 1Mip (Attach Copy of Trust) ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required 0 S. Total Number of Safe Deposit Boxes ^ 9. LlUgebon PrOCeeds Received ^ 10. ~ I P2m 37 Ysi ad i-1d~95) d~ ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) _C,ORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOR TION SHOULD BE DIRECTED TO: ryam@ Daytime Telephpne Number JAMES M ROBINSON 7172459688 rv Firm Name (ff Applicable- TIIRO LAW OFFICES First line of address 28 S. PITT STREET Second line of address City or Post Office CARLISLE State ZIP Code PA 17013 i=7 Q ~IILLS U~ ON~~ 3 ~ -~~ - . r ., ~...? _ 1...1,1 ~ :.... _~ r -r_ ~~~ ~ ~ •i ~a~ ---I DATE FILED '- ~ Comespondent'se-mailaddress: JRobinson~TulroLaW.com Under 'u re examined this return, includinngg acxompanying schedules and statements, and to the best of my knowledge and belief, it is true, coned plate. r other than the personal representative Is based on all information of which preparer has any knowledge. Patricia A. Kough ADDRESS \ 356 Kerrsville Road, Carlisle, ~A 17015 SIGNA~E OF PREPAR~OTH~R~7F1/~l RF SENTATIVE DATE James M Robinson S. Pitt Str'egf, Carlisle, PA 17013 Side 1 1505607120 1505607120 J 1505607220 REV-1500 EX Decedent's Social Security Number oeoeaern•s tee: POE, J A M E S E 17 6 3 21413 RECAPITULATION 12 0, 0 0 0. 0 0 1. Real Estate (Schedule A) ......................................................................................... . 1. 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 $ Miscellaneous Personal Property (Schedule E) ................ 5. 5 , 0 8 6 . 4 9 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 12 5 , 0 8 6 . 4 9 9. Funeral Expenses ~ Administrative Costs (Schedule H) ......................................... 9. 13 , O 1 9.12 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) ................................ 10. 2 0 2 , 5 5 5 . 7 7 11. Total Deductions (total Lines 9 & 10) ..................................................................... .11. 2 15 , 5 7 4 . 8 9 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. - 9 0 , 4 8 8 . 4 0 13. Charitable and Governmental BequestslSec 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. - 9 0 , 4 8 8 . 4 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 lineal rate X .045 - 9 0 4 8 8. 4 0 16. - 4 , 0 7 1 . 9 8 17. Amount of Line 14 taxable at sibling rate X ,12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18• 19. Tax Due ................................................................................................................... 19. - 4, 0 7 1. 9 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505607220 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: Fiie Number 21 - 09 - 00109 Poe, James E STREET ADDRESS 410 Pine Road -- -- CITY - -- Mt. Holly Springs STATE PA ZIP ------ 17065 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty Total Credits (A + B + C) Total Interest/Penalty (D + E) 4. If Line 2 is greater than line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 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. q. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (1) -4,071.98 (2) 0.00 (3) 0.00 (a) 4,071.98 (5) (~) _ (5B) --- 0 . ~ 0 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 :.................................... ~ ~x c. retain a reversionary interest; or ................................................................................................................~ ^x d. receive the promise for life of either payments, benefits or care? .............................................................~ [I 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .....................................................................................................................~ ^x 3. Did decedent own an °in trust fora 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 RETUR ~ ~.,:~ . a ~~. 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 p2 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 disGosure 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)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 (a.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 p2 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. SCHEDULE A ~~TM~~,,,,~~„~, REAL ESTATE INHERRANCE TIVC RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Ppe, James E 21 - 09 - 00109 All real property owned sole or as a tenant in common must be re or~d at fair market value. Fair market value is defined as the price at which property would be ex~anged between a willing buyer and a willing seller, neither being compelled tp 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 VALUE AT DATE OF NUMBER DESCRIPTION DEATH 1 410 Pine Road, So. Middleton Twp., Cumberland Co., Pennsylvania 120,000.00 valued at Sale Price of Property TOTAL (Also enter on Line 1, Recapitulation) ~ 120,000.00 COMMONVYEALTN of PENNSYLVANUI INFIERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF POe, James E SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY FILE NUMBER 21 - 09 - 00109 InGude 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 -Acct. No. 3000038191182 1,657.59 2 Wachovia Bank -Acct. No. 1000324175076 2,037.67 3 1992 Buick 500.00 4 Refunds from Various Sources 248.72 5 Television - at sale price 350.00 6 Refrigerator and Freezer - at sale price 175.00 7 Proceeds from sale of miscellaneous personal property 117.51 TOTAL (Also enter on Line 5, Recapitulation) ~ 5,086.49 COMAONNiEALTN of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 9CF~U.F H wwFI~iAL D~'B~SES ~ !"~J~t~11~ ~+~J'~71 ~7 FILE NUMBER ESTATE OF Poe, James E 21 - 09 - 00109 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION A. 1 ~ Ewing Brothers Funeral Home, Inc. B. 1 2. 3. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Turo Law Offices Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant a. 5. s. 7. 1 Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills Cumberland Law Journal The Sentinel -Legal Accountant's Fees Elwood 8~ Associates Tax Return Preparers Fees Other Administrative Costs AMOUNT 6,190.72 6,000.00 364.00 75.00 219.40 170.00 TOTAL (Also enter on line 9, Recapitulation) 13,019.12 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE `~"""ON"'~"~TMOF~NNS11V""'" LIABILITIES, 8t LIENS INFB2RANCE TAX RETURN RESIDENT DECEDENT ESTATE OF POe, James E FILE NUMBER 21 - 09 - 00109 Include unreimbursed medical expenses. ITEM NUMBER ----- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 TOTAL (Also enter on Line 10, Recapitulation) 202,555.77 DESCRIPTION Wachovia Bank -Acct. No. 08400496740 -Secured by 410 Pine Rd., Mt. Holly Springs Discover Card -Acct. No. xxxx-xxxx-xxxx-9923 Chase Card Services -Acct. No. 5680-3025-7369-6461 Chase Card Services -Acct. No. 5544-5520-3093-2794 Citi Cards -Acct. No. 5424-1805-0867-6407 USAA Card Services -Acct. No. 5491-2371-1097-0780 Sears Credit Cards -Acct. No. 5121-0750-0142-4931 Sears Credit Cards -Acct. No. 5049-9481-3717-8408 Pentagon Federal Credit Union -Acct. No. xxxx-xxxx-xxxx-8253 Pentagon Federal Credit Union -Acct. No. 124534-75-1 Bank of America Credit Card -Acct. Nos. 5329-0315-3465-1391 ~ 4800-1205-0100-1143 American Express -Acct. No. xxxx-xxxxx0-42005 Bank of America -Credit Line -Acct. No. 749-90720-0173-94 Boiling Spring Animal Hospital Embarq Waste Management AMOUNT 86,203.71 5,180.10 2,804.20 3,914.86 5,991.06 18,024.35 3, 781.49 6,473.95 14,905.14 4,387.37 18,103.86 5,358.94 14,717.22 102.25 34.92 98.34 COMMIONYYEALTX OF PEPNrSYLVANIA INMERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS continued ESTATE OF POe, James E Include unn:imbursed medical expenses. ITEM NUMBER - - - DESCRIPTION _-- - AMOUNT 17 Met-Ed 833.90 18 Robert C. Cairns, Tax Collector -Real Estate Taxes 705.38 Net of reimbursement at settlement 19 United States Treasury - 2008 Income Tax 571.00 20 John Hancock Life Insurance -reimbursement 1,125.66 21 So. Middleton Twp. Municipal Authority -sewer service 153.30 22 Krivenko Rrenovations -remove debris from 410 Pine Road 240.77 23 James Jedlowski -pre-settlement repairs to 410 Pine Road 350.00 24 Cumberland County Recorder of Deeds -Deed copy 2.00 25 Closing costs -sale of 410 Pine Road (net of property tax) 8,492.00 FILE NUIWIBER 21 - 09 - 00109 Page 2 of Schedule I r ~ ~ .~_~ ~ =L'1 ~'j E~T1 ~? LAST WILL AND TESTAMENT ~n ~ ~~~. to OF ~QQcn x ~==; T JAMES E . POE -- ~ ~ ~ Q O r_.~ ~ -c7, I, JAMES E. POE, a legal resident of Cumberland Cou~y'mind'~ ~~ Commonwealth of Pennsylvania, being of sound atnd disposing and memory, do hereby make, publish and declare this instrument to be my LAST WILL A NDheretofore.madehereby revoke any and all wills and codicils by me I IDENTIFICATIONS AND DEFINITIONS JAMES E. POE A, I am a widower. I have four (4) children, II, PATRICIA A. POE, MICHAEL J. POE and PATRICK G. POE. References in this Will to "my children" include these children and any other lawful children born to or adopted by me. Except as otherwise provided in this my LAST WILL AND TESTAMENT, I have intentionally omittedtherpclaimingetoibefan heyrrofaminesorrnotr any other person, whe $, The following definitions obtain in any use of the terms in this Will: 1, "Descendants" means the immediate and remote lawful, lineal descendants of the person referred to, and it means those descendants in being at the time they must be ascertained in order to give effect to the reference to them, whether they are born before or after my death or of any other person. The persons who take under this Will as Descendants shall take by right of representation, in accordance with the rule of per stirpes distribution and not in accordance with the rule of per capita distribution. Persons legally adopted when under the age of fourteen years shall not be differentiated from blood descendants for any purpose. 2, "Survive me" is to be construed to mean that the person referred to must survive me by thirty days. If the person referred to dies within thirty days of my death, the reference to him shall be construed as if he had failed to survive me. he, 3, As used in this Will, the words "Executor," " ' "him," "his," and the like shall be taken as generic and applicable to a natural person of either sex or a corporate person of other legal entity. Page 1 of 4 Pages ,. .. C, I have served in the Armed Forces of the United States. Therefore, I direct my Executor to consult the legal assistance office at the nearest military installation to ascertain if there are any benefits to which my dependents are entitled by virtue of my military affiliation at the time of my death. Regardless of my military status at the time of my death, I direct my Executor to consult with the nearest Veterans Administration and Social Security Administration office to ascertain if there are any benefits to which my dependents may be entitled. II PAYMENT OF DEBTS AND TAXES I direct my Executor to pay the following as soon after my death as may be practicable: 1. All of my just debts and~the expenses of my last illness, funeral and of the administration of my estate; but my Executor need not accelerate and pay those unmatured obligations which, in his opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. 2. All inheritance, transfer, estate and similar taxes (including interest and penalties) assessed or payable by reason of my death, on any property or interest in my estate for the purpose of computing taxes. My executor shall not require any benefic- iary under this will to reimburse my estate for taxes paid on property passing under the terms of this Will. III RESIDUARY ESTATE A. I define "my Residuary Estate" as all of my property after the payment of debts and taxes under Article II, including real and personal property, whenever acquired by me, property as to which effective disposition is not otherwise made in this Will, and property as to which I have an option to purchase or a reversionary interest. B. I direct my Executor to divide my Residuary Estate into equal shares and to distribute those shares as follows: Page 2 of 4 Pages 1. one share to each of my Children who survive me; 2, if any of my Children fail to survive me, then his or her share shall be distributed among his or her descendants who survive me; 3. if any of any Children fail tosurvive me and leave no descendants who survive me, then his ar her share shall be divided equally among such of my Children who survive me, or their descendants who survive me, as set forth in subparagraphs 1 and 2 above. IV APPOINTMENT AND POWERS OF EXECUTOR I nominate and appoint my daughter PATRICIA A. POE, as Executor of this my LAST WILL AND TESTAMENT. If my daughter PATRICIA A. POE, is unable or unwilling to serve in this capacity, I appoint my son MICHAEL J. POE of Mt. Holly Springs, Pennsylvania to serve instead. I request that my executor be per- mitted to serve without bond or surety thereon. I authorize my Executor to do any and all things which in his opinion are necessary to complete the administration and settlement of my estate, including full right, power and authority, without the order of any court and upon such terms and under such c!onditions~ as my Executor shall deem best for the proper settlement of my estate; to bargain, sell at public or private sale, convey, transfer, deed, mortgage, lease, exchange, pledge, manage and deal with any and all property belonging to my estate; to compromise, settle, adjust, release and discharge any and all obligations or claims in favor of or against my estate; and to borrow money for the payment of inheritance and estate taxes or for any other pur- pose. Without in any way limiting the scope of the powers enu- merated herein of my executor, I hereby specifically give to him full power to retain any and all securities or property owned by me at the time of my decease whenever, in his absolute and uncontrolled discretion, such a course shall seem to him to be best, without liability for depreciation or loss, and free from investment restrictions incident to executorship, whether imposed by common law or statute. In the execution of his duties and powers as Executor he shall have the power to comply with all legal requirements as to the execution and delivery of deeds and all other writings, documents or formalities without the order of any court; and he shall furnish a statement of receipts and dis- bursements at least annually to each person then entitled to receive income or property from my estate. Page 3 of 4 Pages a. V MEMORANDUM I have made, or may from time to time make, a written memoran- dum expressing my desire to give certain items of personal pro- perty to specific persons. I urge my Executor and beneficiaries to respect these wishes. Such a memorandum, if made, shall be stored in conjunction with this Will. IN WITNESS WHERE, I have at Carlisle Barracks, ~da of 1987, set my hand and Pennsylvania, this /~ y seal to this my LAST WILL AND TESTAMENT consisting of four (4) typewritten pages. (SEAL) J S E. POE T stator Signed, sealed, published and declared by the Testator, JAMES E. POE, as and for his LAST WILL AND TESTAMENT, in the presence of us, who at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. NAME ADDRESS~n La'Yl„ _ _ ~~ , ~.1. ~.y _ ..w~- 7Q5~ (SGT°~-"r.1 ~~ ~L~2h~ ~~ -~ --- Page 4 of 4 Pages ~ e Acknowledgment COIVIMONWEALTH OF PENNSYLVANIA) SS OOUNTY OF CUMBERLAND ) I, JAMES E.. POE, Testator, whose name is signed, to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to a~ ackno POE, the Testator, this ~ day of (SEAL) dge b fore me, by JAMES E. 1987. E. POE estator tary Public RUSA A. RODRIfiUEZ, NDTARY PUBLIC Af f i da v i t CARLISLE BURUUfiil, CUMBER~.44~D COUNTY NIY CUtABlISSlON EXPIRES 0!C'C• ~8, 1989 Member, Pennsy{+rl*niv Aasocielioc~ of Nutarles COIVMONWEALTH OF PENNSYLVANIA) SS C70U NTY OF CUMBERLAND ) W e , l/ Flc? v.~ fC ~ ~5C0.7~7"' and ~-~l a r°2 c ~ ~ C~ /~la ~~/~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will; that JAMES E. POE, signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the the Testator signed the will as witnesses; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue i of 1 ue nee . Sworn or affirmed to and subscribe to before me by 1A)~ ~, TA~oSG nd ~o~C~/! '~, l~~fla 6~/~ witnesses, this /7~A day o -L,~~ 19 a7. (SEAL) RUSA A. RODRIGUEZ, N6TARY PUBLIC CARLISLE DOHOUGil, CUMBERLA;~IJ COUNTY N-Y COMief5510N EXPIRES OI;T. ?3. 1969 Member, Pe~~~-sy{-rania Assucrafioe of Notaries y . LETTER OF I NTE NT TO MY FAMILY, MY PHYSICIAN, MY CLERGYMA N, MY LAWYER-- If the time comes when I can no longer take part in decisions for my own future, let this statement stand as the testament of my wishes: If there is no reasonable expectation of my recovery fram physical or mental disability, I, JAMES E. POE, request that I be allowed to die and not be kept alive by artificial means or heroic measures. Death is as much a reality as birth, maturity and old age - it is the one certainty. I do not fear death as much as I fear the indignity of deterioration, dependence and hopeless pain. I ask that medication be mercifully administered to me for terminal suffering even if it hastens the moment of death. This request is made after careful consideration. Alth©ugh this "~ document is not legally binding, you who care for me will, I hope, feel morally bound to follow its mandate. I recognize that it places a heavy .burden of responsibility upon you, and it is with the intention of sharing this responsibility and of mitigating any feelings of guilt that this statement is made. ~.~~/~~7 DATE JAMES E. FOE ACK NOWLE DGEME Nf CONiV10NWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) Subscribed and sworn to before me this 1 ~ day of ~ 1987. (SEAL) NOTARY PUBL C ROSA A. ROORIGUEZ, NOTARY PUBLtG CARLISLE BOROUGH, COMBERLAA~O COUBTY MY COMt1flSSlON ERPlRES OCT. 28, 289 Mambor, Pennxyivania Association of P!olaries A. Settlement Statement U.S. Department of Housing and Urban Development (1MR Onnrnval Nn 7502-0265 /®xelres 11/30/20091 8. I OT L08n - 1. ^FHA 2. ^FmHA 3. ^Conv. Unins. 6. File Number 7. Loan Number 8. Mortgage Insurance Case Number 4. VA 5. Conv. ins. 2009.611COOK a is i o give you a amen ua m sun pe a y se age C. Note: Uems maAcM "(p.o.a)"Were paid outside Uie clwinp; they are shown here tw inrormation purpose: and are not included in the focal:. TitlBExpreSS Settlement System WARNING: U h a crime to krwwmgly make false statements to the United Stales on ihfs w any other similar form. PeneUies upon conviction can include a fsie and im sanmeM. Fw details aee: Title 18 U. 3. Code Section 1001 and Secllon 1010. D. NAME OF BORROWER: Paul A. Cook ADDRESS: E. NAME OF SELLER: Estate of James E. Poe ADDRESS: F. NAME OF LENDER: Metro Bank ADDRESS: 3801 Paxton Street Harrisbu PA 17111 G. PROPERTY ADDRESS: 410 Pine Road, Mount Holly Springs, PA 17065 South Middleton Townshi H. SETTLEMENT AGENT: O'Brien, Baric & Scherer, Telephone: 717.249.6873 Fax: 717.249-5755 PLACE OF SETTLEMENT: 19 West South Str Carlisle PA 17013 I. SETTLEMENT DATE: 1010512009 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLE 'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 101. Contract sales rice 120 000.00 400. GROSS AMOUNT DUE TO SELLER 401. Contract sales rice 120 000.00 102. Personal Pro rt 103. Settlement char to borrower line 1400 1 ~ 4 962.26 402. Personal Pro rt 403. 404. 105. 405. Ad'ustments for items aid b seller in advance Ad ustments for items aid b seller i n advance 106, Ci !town taxes 406. Cit /town taxes 107. Coun taxes 10105109 to 12131109 94.98 407. Count taxes 10105109 to 12181109 94.98 108. School Tax 10105109 to 06130110 1 109.23 408. School Tax 10105109 to 06180110 1 109.23 1 ~ 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 126166.47 420. GROSS AMOUNT DUE TO SELLER 121204.21 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUET SELLER 201. sit or earnest move 1000.00 501. Excess De it see instructions 202. Puna I amount of new loans 114 000.00 502. Settlement cha es to seller line 1400 10002.71 203. Existin loans taken sub'ect to 503. Existin loan s taken su 'act to 204 504. Pa off:000008400496740 86 203.71 Wachovia Bank 205. Seller Credit 2 500.00 505. Seller Credit 2 ~•~ 206. PHFA Tax Credit 5 000.00 506. 207 507. 208. 508. 209. 5~• Ad ustments for items un aid b seller Ad ustments for items un aid b seller 210. Ci flown taxes 510. C' (town taxes 211. Coun taxes 511. Coun taxes 212. School Tax 512. School Tax 213. 513. 214 514. 215. 515. 216. 516. 217 517. 218. 518. 219. 519. 220. TOTAL PAID BYIFOR BORROWER 300. CASH AT SETTLEMENT FROM OR TO BORR 122 500.00 OWER 520. TOTAL REDUCTION AMOUNT DUE SFILER 600. CASH AT SETTLEMENT TO OR FROM SELL 98 706.42 ER 301. Gross amount due from borrower line 120 126166.47 601. Gross amount due to seller line 420 121 204.21 302. Less amounts aid b ffor borrower line 220 122 500.00 602. Less reduction amount due seller line 520 98 706.42 303. CASH FROM BORROWER.. _ 3 666.47 603. CASH TO SELLER 22 497.79 __ - - i ,,..,..,,..., ,,....., ,,,a,.,.w,~,..w...~ U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 2009.6 PA E ~u~u~ n7-~Tr\af•\IT TIHeCvnrnee CcHlmm~nf Cvefcm ~7G 1 1 LGI~IGI~ ~ v ~ /'~ r a.mr.~ ~ ~ ~--- - - - L. SETTLEMENT CHARGES PAID FROM PAID FROM ' 700. TOTAL SALES/BROKER'S COMMISSION based on rice $120 000.00 = 7 200.00 BORROWER'S SELLER S Division of commission line 700 as follows: FUNDS AT FUNDS AT 701. 3 625.00 to Cantu 21- A Better Wa SETTLEMENT SETTLEMENT 702, 3 575.00 to Hel -U-Sell Detwiler Rea 703. Commission aid at Settlement 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 7 200.00 801. Loan Ori ination Fee 802. Loan Discount 803. A isal Fee to S.W.Barrett Real Estate 8r A sisal Metro P.O.C. 325.00 B er 804. Credit Re rt to E uifax Mort a e Service Metro P.O.C. 13.18 B er 50.00 805. Lender's Ins ion Fee 806. Mort A lication Fee 807. Assum tion Fee 808. Administration Fee to Metro Bank 325.00 809. Ovemi ht Mail Fee to Unishi ers Metro P.O.C. 18.00 Bu er 810. Flood Certification Fee to Wolters Kluwer Financial SvcslPCi Metro P.O.C. 6.00 B er ~ 811. Tax Certificate Fee to Title Com n Metro 40.00 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 1010512009 to 1110112009 17.5885 Ida 27 D s 474.35 902. Mort a Insurance Premium for to 903. Hazard Insurance Premium for 1 ear to Erie Insurance 373.00 904. 2009 Count Taxes to Robert C. Cairns Tax Collector P.O.C. 393.98 B er 905. Flood Insurance Premium to Franklin Homeowners Assurance P.O.C. 944.00 B er 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance 5 mo. 29.59 Imo 147.95 1002. Mort a Insurance mo. Imo 1003. Ci Pro rt Tax mo. Imo 1004. Count Pro rt Tax 9 mo. 32.83 Imo 295.47 1005. School Tax 5 mo. 123.38 Imo 818.90 1006. Flood Insurance Reserves 5 mo. 78.87 Imo 393.35 1009. A ate Anal sis Ad'ustment to Metro Bank -131.32 0.00 1100. TITLE CHARGES 1101. Settlement or cbsin fee 1102. Abstract or title search 1103. Title examination 1104. Title insurance binder 1105. Document Pr aration 1106. Note Fees to Cash 15.00 1107. Attune 's fees includes above items No: 1108. Title Insurance to O'Brien Baric & Scherer 719.08 includes above items No: 1109. Lender's Poli 114 000.00 - 1110. Owner's Polic 120 000.00 -719.08 1111. End 100 End 300 End 900 to O'Brien Baric & Scherer 150.00 1112. 1113. Closin SvcLtr to O'Brien Baric & Scherer 75.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin Fees Deed 48.50 .Mort a 72.50 • Release $ 121.00 1202. Cit (Count taxlstam Deed 1200.00 • Mort a 1200.00 1203. State Taxlstam Deed 1200.00 • Mort a e 1200.00 1204. Add'I Recordin Fee - Assi n to Cumberland Coun Recorder of Deeds 37.00 1205. Add'I Records Fee - 2nd Mt a to Cumberland Coun Recorder of Deeds 50.50 1300. ADDITIONAL SETTLEMENT CHARGES 1301. 2009-10 School Taxes to Robert Cairns Tax Collector 1 510.71 1302. Tax Certification to Robert Cairns Tax Collector 5.00 1303. Final Sewer Readin to South Middleton Townshf Munici al Authors 77.00 1304. Ovemi ht Fees to O'Brien Baric & Scherer 10.00 10.00 ~ ana TnTO~ SETTLEMENT CHARGES (enter on lines 103, Section J and 502, Section 4 962.26 10002.71 HUD CERTIFICATION OF BUYER AND SELLER I have carid sewed the HUD-1 Sattl~gient Stalemem and to the beat of my knowledge and belief, tl is a true end accurate statement of all receipts and diaburaementa made on my account or by me ' ion. I her flf~f/that I Rave received a copy of the HUD-1 Settlement Statement. 7 d+'~/ .. \ C~~l(,~iy ~'1 LsraToTJames E"-Poe WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE Tha HUD-1 Battlement Stet which I pared b a account of This UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION transaction. I have caused canes the fu to be disYU rJ in • dance with this ataleme . CAN INCLUDE A FINE AND MAPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. J O ~~ ~'~~ SETTLEMENF.-A DATE: L