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HomeMy WebLinkAbout10-26-09J 1505607121 REV-1500 EX (06-05) OFFICUIL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280801 INHERITANCE TAX RETURN Harrisbun7, PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 0 7 5 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 0 5 0 9 8 3 2 4 0 7 1 1 2 0 0 8 0 9 1 0 1 9 1 4 Decedent's Last Name Suffix Decedent's First Name MI K E E N E L E O N ~ (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 THIS RETURN MUST BE FILED IN DUPLICATE !NfITH THE REGISTER OF WILLS © 1.Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of prior to 12-13-82) ~ 5. Federal Estate Tax Retum Required ® 6. Decedent Died Testate (Attach Copy of WIII) ~ death after 12-12-82) 7. Decedent Maintained a Living Trust A 8. Total Number of Safe Deposit Boxes 9 Litigation Proceeds R i d ( ttach Copy of Trust) . ece ve ~ 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 R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3 Firm Name (If Applicable) I R W I N & M c K N I G H T P C First line of address 6 0 W E S T Second Iine of address City or Post Office C A R L I S L E State ZIP Code REGISTER OF WILLS USE ONLY n ~:-_ o - ~~ - - q, `t: . - ~~..;? C~7 , , .- , C'7 ~;~y,__~ •--~ ~ `..-rig 'a3 N _ ~..i::. •~ ~ _ _~_~ _-. '. ~' 4~ ~... - ..: DA~ FILED , , "' P A 1 7 0 1 3 ~. Z~J <_~ f`'~ I: `_;1 f~:7 ~~ i,.,~.,~ .:.} ~~ o ~> N ''~ Correspondents e-mail address: Under penaltles of perjury, I dedare that I have examined this return, induding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, coned and complex. Dedaretion of preparer other than the personal representative is based on all infom>ation of which preparer has any knowk3dye. SIGNAT~apE OF RSON RESPONFOR FILING RETURN _1 DATE _ ~~ w ~`" w 681 CRANES GAP ROAD ~ CARLISLE PA 17013 SIGNATU OF PREPARER OTHER T N REPRESENTATIVE ADDRESS ! ~ ~ U ~ 60 WEST 0 FRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505607121 15056071.21 J P O M F R E T S T R E E T ~' 1505607221 REV-1500 EX Decedents Social Security Number I~cedenYs Name: LEON J• K E E N E 2 0 5 0 9 8 3 2 4 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 2 2 5 0 0 0. 0 0 2. Stocks and Bonds (Schedule B) .................................. 2. ~ • 3. Closely Hetd Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages Z3< Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 1 5 2 8 8 2 . 6 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6• 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 3 7 ? 8 8 2. 6 4 19. Tax Due . 1 g, 4 4 6 6 1. 4 9 ............................................... 9. Funeral Ex enses & Administrative Costs Schedule H P ( ) ......... 9. ....... 5 7 3 2 2 . 9 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ..... ..... .. 10. 7 1 4 5 . 7 8 11. Total Deductions (total Lines 9 & 10) .................... ..... .. 11. 6 4 4 6 8 . 6 8 12. Net Value of Estate (Line 8 minus Line 11) .................. .... ... 12. 3 1 3 4 1 3. 9 6 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 1 3 4 1 3. 9 6 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 0 0 0 0 0 0 . at lineal rate X .045 16. . 17. Amount of Line 14 taxable 7 8 3 5 3 4 9 9 4 0 2 4 2 . at sibling rate X .12 1 ~. . 18. Amount of Line 14 taxable 2 3 5 0 6 0 4 7 3 5 2 5 9 0 7 . at collateral rate X .15 18. . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q Side 2 1505607221. 1505607221 REV-1500 EX Page 3 Decedent's Complete Address Flle Number 21 08 0756 DECEDENTS NAME LEON J. KEENE STREET ADDRESS 801 NORTH HANOVER STREET CITY CARLISLE STATE zlp PA 17013 Tax Payments and Credits: ~~ Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments 48,000.00 C. Discount 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty (1) 44,661.49 Total Credits (A + g +C) (2) 48,000.00 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) 3,338.51 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 0.00 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 ................................................................................................ ^ 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? .................................................................................................. ^ 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 exemot 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)]. 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)J. 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 ~~ r A ~ t ~r FILE NUMBER LEON J. KEENE 21 08 0756 All real properly 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 fhe relevant facts. Real which is in owned with ri ht of survhrorehi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 4411 FARGREEN ROAD, HARRISBURG, DAUPHIN COUNTY, PENNSYLVANIA 225,000.00 SETTLEMENT SHEET ATTACHED TOTAL (Also enter on line 1 Recapitulation] ~.5 225.000.00 (If more space is needed, insert additional sheets of fhe same size) REV-1508 EX + (6-98) ' SCHEDULE E 'COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RES DAENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER LEON J. KEENE 21 08 0756 Indude the proceeds of litlgation and the date the proceeds were received by the estate. All property jointly-owned with right of survhrorship must be dhkbsed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. PERSONAL PROPERTY -AUCTIONED OFF IN SPRING OF 2008 -FUNDS WERE DEPOSITED INTO DECEDENT'S BANK ACCOUNT 2. CITIZENS BANK -CERTIFICATE OF DEPOSIT #6140-834589 56,668.84 3. IM~T BANK -CHECKING ACCOUNT #50465937 I 7,790.47 4. IMi3~T BANK -SAVINGS ACCOUNT #15004210580749 I 4,792.56 5. I M&T BANK -CERTIFICATE OF DEPOSIT #31003918609785 I 83,630.77 TOTAL (Also enter on line 5, Recapitulation) I S 1 (If more space ~s needed, insert addfional sheets of the same size) REV-1511 EX + (10-06) 'COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER LEON J. KEENE 21 08 0756 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 7,186.78 2. JOY'S GREENHOUSE -FLOWERS 159.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) JOHN T. EVANS. JR. Street Address 681 CRANES GAP ROAD City CARLISLE S~~ PA Zip 17013 Year(s) Commission Paid: 2, AttomeyFees IRWIN & McKNIGHT, P.C. 3. Family Exemption: (If deoedenCs address Tg not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4• Probate Fees REGISTER OF WILLS 5. I Accountants Fees 14, 500.00 15,000.00 448.00 6. Tax Retum Preparers Fees PATRICIA A. ROSENDALE, CPA 370.00 7. CLOSING COSTS FROM SALE OF REAL ESTATE 15,874.50 8. REGISTER OF WILLS -FILING FEE 30.00 9. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00 10. THE SENTINEL -ESTATE NOTICE 158.62 11. NOTARY FEES 35.00 12. REGISTER OF WILLS -SHORT CERTIFICATE 8.00 13. GERALD RADLE -LAWN CARE 1,350.00 14. STEVE BEACHY -INSTALLATION AND MATERIALS FOR ELECTRIC PANEL 857.00 15. TRAVELERS INDEMNITY AND AFFILIATES -HOMEOWNERS INSURANCE 1,271.00 TOTAL (Also enter on line 9, Recapitulation) E 57 322.90 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) SCHEDULE 1 'coon NoHNEwRirn ce AX RETURNANIA DEBTS OF DECEDENT, RESIDENT DECEDENT MORTGAGE LIABILITIES, ~ LIENS ESTATE OF FILE NUMBER LEON J. KEENE 21 08 0756 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. PP8~L -ELECTRIC 2,092.00 2. SUSQUEHANNA TOWNSHIP - WATER/SEWER 470.45 3. CONTINUING CARE RX -MEDICAL 286.40 4. PHILHAVEN -MEDICAL 51.93 5. ROBERTA F. WALSH -REAL ESTATE TAXES 1,102.13 6. SCHOOL DISTRICT TOWNSHIP TREASURER -REAL ESTATE TAXES 3,033.55 7. VERIZON -TELEPHONE 46.99 8. PENN WASTE, INC. -TRASH 62.33 TOTAL (Also enter on line 10, Recapitulation) I $ 7 145 78 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT OF FILE LEON J. KEENE 21 08 0756 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 [indude ou ~' ht spousal distributions, and transfers under Sec. 9116 la) (1.2)] 1. JOHN T. EVANS, JR. Collateral 235,060.47 681 CRANES GAP ROAD 40% RESIDUAL CARLISLE, PA 17013 2. BETTY PAGANO Sibling 78,353.49 4022 RIDGEMONT DRIVE 20% RESIDUAL GIBSONIA, PA 15044 3. KAREN RUSSELL Collateral 3331 SPRING ROAD 20% RESIDUAL CARLISLE, PA 17013 4. DARRYL EVANS Collateral 2 HILLCREST DRIVE 20% RESIDUAL MECHANICSBURG, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ to more space is neeaea, insert aaamonal sneers or the same size) i rs © C'? _ LAST WILL AND TESTAMENT ~~~ ~ ~~~ _~ D.~ r Z ..... r P ~ ~ cI3 ~ l C: C;? C7 O zm ~ ` ~ -e~i I, LEON J. KEENE, of the Borough of Carlisle, Cumberland County~vP~nnsylv~ a, " ' ' being of sound mind, disposing memory and full legal age, do hereby make, publish and declaze this to be my Last Will and Testaznent, hereby revoking all Wills and Codicils heretofore made by me. 1. I direct my Executor or Executrix, as the case maybe, to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Executor or Executrix of my estate. 2. My Executor or Executrix may, at his or her discretion, compromise claims, borrow money, retain property for such length of time as he or she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as he or she may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. 3. I authorize and empower my Executor or Executrix to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple, as I could do if living. My Executor or Executrix is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executor or Executrix. 4. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my wife, DORATHY N. KEENE, provided that she survives me by thirty (30) days. 5. Should the gift in Pazagraph No. 4 not take effect, then I give, devise and bequeath all of my estate of whatever nature and wherever situate as follows: a. Forty Percent (40%) to JOHN T. EVANS, JR., of Cazlisle; Pennsylvania; b. Twenty Percent (20%) to my sister-in-law, BETTY PAGANO; c. Twenty Percent (20%) to KAREN RUSSELL of Cazlisle, Pennsylvania; and d. Twenty Percent (20%) to DARRYL EVANS of Bowmansdale, Pennsylvania. It is understood and directed that if any of the above four (4) individuals do not survive me, or are not living at the time of distribution, their share reverts back to the Estate and will then be shared by the other named surviving individuals. 6. I nominate and appoint my JOHN T. EVANS, JR. to be the Executor of this my Last Will and Testament. In the event he has predeceased me, failed to qualify or is not able or does not serve for whatever reason, I then appoint KAREN RUSSELL to be the Substitute Executrix of this my Last Will and Testament, whereby the said Substitute Executrix shall have the same powers as aze given to the original Executor hereunder. 2 7. No person(s) shall benefit hereunder unless such beneficiary shall survive me by thirty (30) days. 8. No Executor or Executrix acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. 9. No beneficiary may assign, anticipate or pledge his or her interest in any income or principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or otherwise reach any such interest. 10. I hereby suggest that my personal representative retain the services of Irwin & McKnight as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 26a' day of March, 2007. (SEAL) Signed, sealed, published and declared by LEON J. KEENE, the above-named Testator, as and for his Last Will and Testament, in our presence, who at his request, in his presence and in the presence of each other have hereunto set our names as subscribing asses. ..: /,JJJfn' ~ , ,. ~. lV ~~ X ~~iC~t G 3 C y . ~~s1.~~/~ ~ ~yi' !' ~ 1 4 3 ACKNOWLEDGMENT AND AFFIDAVIT WE, LEON J. KEENE, KAREN S. NOEL and SHARON L. SCHWALM, the Testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as a witness and that to the best of their knowledge the Testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by LEON J. KEENE, the Testator herein, and subscribed and sworn to before me by KAREN S. NOEL and SHARON L. SCHWALM, witnesses, this 26~` day of March, 2007. N ary Public ~, COMMONWEALTH OF PENNSYWANIA ~~ Notarial Seal Roger B. Irwin, Notary Public Carlisle Boro. Cumberland County ~' Commission Expires Oct. 3, 2008 Member, PennsvlYanu± ~scogiation Of Notaries ~ ~ A. VI"IY 1\V. ivV~ VLVV B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1. FHA 2.~FmHA 3.QX CONV. UNINS.. 4.~VA 5.QCONV. INS. SETTLEMENT STATEMENT 6. FILE NUMBER: ~ 7. LOAN NUMBER: 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. !ferns marked [POCJ" were paid outside the closing; they are shown here for informational purposes and are, not included rn the totals. 1.0 3/98 (LOVE.BJL4411.PFD/LOVE.eJL4411r7) D. NAME AND ADDRESS OF BORROWER: Barbara J. Love E. NAME AND ADDRESS OF SELLER: Leon J. Keene F. NAME AND ADDRESS OF LENDER: Mid Penn Bank 349 Union Street Millersburg, PA 17061 G. PROPERTY LOCATION: 4411 Fargreen Road Harrisburg, PA 17110 H. SETTLEMENT AGENT: 20-2974311 Lykens Valley Settlement Services, LLC I. SETTLEMENT DATE: Se tember 29 2009 Dauphin County, Pennsylvania Tax Parcel No. 62-009-100 PLACE OF SETTLEMENT 3703 Peters Mountain Road Halifax, PA 17032 p , MMARY OF B W R' TRANSA I N K. M R F L R' TRA N ACTT N 101. Contract Sales Price 225,000.00 401. Contract Sales Price 225,000.00 102. Personal Pro a 402. Personal Pro e 103. Settlement Char es to Borrower Line 1400 7,551.23 403. 104. 404. 105. 405. 106. Ci /Town Taxes to 406. Ci !Town Taxes . to 107. Coun Taxes 09/30/09 to 01/01/10 387:23 407. Coun .Taxes 09/30/09 to 01/01/10 387.23 108. School Taxes 09/30/09 to 07/01/10 1,940.77 408. School Taxes 09/30/09 to 07/01/10 1,940.77 109. 409. 110. 410. 111. 411. 112. 412. 120. GAOSS;AMOUNT DUE FROM 80AROWER 234,879.23 420. GROSS AMOUNT.DUE.TO SELLER 227,328.00 200. AMOUIaT'S PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE.TO SELLER: 201. De sit or earnest mone 3,000.00 501. Excess De sit See Instructions 202. Princi al Amount of New Loans 150,000.00 502. Settlement Char es to Seller Line 1400 15,874.50 203. Existin loans taken sub'ect to 503. Existin loans taken sub'ect to 204. 504. Payoff of first Mortgage 205. 505. Pa ff of second Mort a e 206. 506. 207. 507. De osit disb. as roceeds 208. 508. 209. 509: ustments or terns n ar a er ustments or terns n ar a er 210. Ci /Town Taxes to 510. Ci !Town Taxes to 211. Coun Taxes to 511. Couri Taxes to 212. School Taxes to 512. School Taxes to 213. 513. 214. 514. 215. 515. 216. 516. 217• 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 153,00.0.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 15,874.50 300. ASH AT SETTLEMENT FR M/TO BORROWER: 600. CASH AT SETTLEME TO/FR M SELLER: 301. Gross Amount Due From Borrower Line 120 234,879.23 601. Gross Amount Due To Seller Line 420 227,328.00 302. Less Amount Paid B /For Borrower Line 220) ( 153,000.00) 602. Less Reductions Due Seller Line. 520) ( 15,874.50 303. CASH (X FROM) ( TO BORR ER TL.n n~le srl L.e L.. ..I...r.. _[ 81 879.23 603. CASH (X .TO ( FROM SELLER 211,453.50 ••r•-•--~ ""rl ~• r~^a°~ ~a„i v. una aacawnunn a ally a In n[5 reTerre TO nereln. Borrower Seller ~T Bar ara J. Lov eon J. Kee e ~ - l D ~ ra e z L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price ~ ° PAID FROM PAID FROM Division of Commission Ilne 70O aS FOIIOWS: BORROWER'S SELLER'S 701. $ 6,775.00 to Re/Max Realty Professionals FUNDS AT FUNDS AT 702. $ 6,725.00 to Century 21 Carl Snyder sETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 13,500.00 704. t0 801. Loan Ori ination Fee 1.0000 % to Mid Penn Bank 1,500.00 802. Loan Discount % to 803. Appraisal Fee to Midstate Appraisers, Inc. $375 (350 poC) 25.00 ' 804. Credit Report to Kroll Factual Data 11.37 805. Underwriting submission fee to FNMA 35.00 806. Documentation Pre Fee to Mid Penn Bank 200.00 807. Lender Fee to Mid Penn Bank 275.00 808. Flood Search to CBC Innovis 11.00 809. FNMA Underwriting Fee to Mid Penn Bank 165.00 810. 811. .ITEM RE I ED Y LE T PAID I AD 901. Interest From 09/29/09 to 10/01/09 ~ $ 20.320000/day ( 2 days 4.8750%) 40.63 902. Mort a e Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 ears to Erie Insurance Exchan a POC:6675.00 904. 2009 r.e. taxes 1.0 ears to Tax Collector POC:B4022.98 905. IT 1001. Hazard: Insurance 3.000 months ~ $ 56.25 er month 168.75 1002. Mort a e Insurance months 6~ $ er month 1003. Ci !Town Taxes months ~ $ er month 1004. Coun ,Taxes 9.000 months ~ $ 124.11 er month 1005. School;Taxes 4.000 months ® $ 211.14 per month 1,116.99 844.56 1006. 2009 r:e. taxes months 4~ $ er month 1007. months ® er month 1008. A re ate Reserve Ad'ustment months ~ $ er month -955.82 1 A ES 1101. Settlement or Closin Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Document Pre aration to 1106. Nota Fees to Kerwin & Kerwin ' 20.00 10.00 1107. Attorney s Fees to includes above item numbers: 1108. Title Insurance to Stewart Title Guaran Com an 1 483.75 includes above item numbers: 110y. Lender's Coverage $ 150,000.00 1110. Owner's Coverage $ 225,000.00 1,483.75 1111. Service Letter Certification to Stewart Title Guaranty Company 75.00 1112. End. 100, 300 & 8.1 to Stewart Title uaranty Company 150.00 1113. 12 0. OVERNME E R IN A D TR ER HAR S 1201. Recording Fees: Deed $ 41.50; Mortgage $ 73.50; Releases $ 115.00 1202. Ci /Coun Tax/Stam s: Deed 2,250.00• Mort a e 1203. State Tax/Stam s: Deed 2,2b0:00; Mort a e 1204. Tax Parcel Certification to Recorder of Desds 2,250.00 20.00 2,250.00 1205. D 1301. Surve to 1302. Pest Ins action to 1303. final sewer to Sus uehanna Townshi Authori 1304. 114.50 1305. 1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103, Section J and 502, Section Rv sinninn rinnc 1 of rF.ic °f°feTnnl H,e ~ ....~...:__ __i.__...i_~__ _ 7,551.23 15,874.50 _ _ .. _ ------------. --~- -.~.._._..__ __...._....,..y„ ,.....,~r...., o vv,,,N,ciou ~~N~'"~'ayn c of in 15 Iwo page Statement. Certified to be a true copy. Agent ( LOVE.BJ L.441I ! LOVE.BJL.4411 17 ) ~+~ ~ ~ ~ 525 William Penn Place Suite 153-2618 ` Pittsburgh, PA 15219 August 22, 2008 ROGER B IRWIN Esq DECEIVED 60 W POMFRET ST CARLISLE PA 17013-3222 A~~ 2 8 2~~8 IRWIN & McKNIGHT LAW OFFICES Estate of LEON J KEENE Date of Death: July 11, 2008 SSN: 205-09-8324 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his date of death. The decedent had 1 active account at the time of his death and he had no Safe Deposit Box. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884 Sincerely, Phillip Lynch Operations Services `lY / q~^~ " J i ° ~~ ~`~. Ci#~zens Bank., Account Number 6140-834589 Account Title Date ened LEON J KEENE or DORATHY I~EENE 9/20/2001 Account T e Time De osits Princi al Balance as of DOD Interest from Last Postin to DOD $56,620.75 $48.09 Account Balance as of DOD YTD Interest to DOD $56,668.84 $1,238.17 1 VJ4 1 VVtr/ VVV a V. V 1 p n~s~x August 13, 2008 Law Offices Irwin & McKnight West Pomfret Professional Building 6p West Pomfret Street Carlisle, PA 17013-3222 499 Mitchell Street, Millsboro, DE 19966 RE: Estate of Leon Keene Date of Death: July 11, 2008 Social Security Number: 205-09-8324 Dear Mr. Irwin: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Ar_count 7'ype ........................... Checking Account Account Ntcmber ....................... 50465937 Ownership (Ncerrtes of?........._.... Dorathy Keene, Leon Keene Opertir~g Date ..........................08/28/64 (account closed 07/21/08) Balance on Date of Death..........~7,920.45 Accrued Interest $ 0 02 Total ....... . .. .............................$7,790.47 2. Account Type ........................... Savings Account Account Number ....................... 150042.10580749 Ownership (Names off .............. Dorathy ltcenc, Leon I<eene Opcrting.Date ...........................03/08/07 (account closed 07/ 18/08) Balance on Date of Deatii..........~4,792.42 Accrued Interest $ U 14 Total ....................................... $4, 792.56 1 ttJJl. l CI YJJ/ YJ YJ~J i .~ ~ u • Page 2 3. Account Type............ ........ Certificate of lleposit Account Number ....................... 3 10039 1 8609785 Ownership (Names off .............. Leon Keene Opening Date ...........................08; :? 7/ 07 Balance on Date of Deat)•t..........$83,329.4~F /-ccrued litterest $ 301 33 Total .......................................$83,630.77 'l'he above namecl decedent clicl not have a safe deposit box. September 29, 2008 * If upon reviewing the information above, you believe there are additional accou~its not referenced, please provide us with an account number and/or the name of any possible joint account holder. ror any additional, information on the above accounts, including ownership and any changes, closures and/or reimbursernent of funds, please contact our Summerdale Plaza branch at 423 North l;nola Road, Enola, P~ 17025 or # 717- 255-2261. Sincerely, ~~ _ / 9 ~ ~.____. _ Cif GG~G'U~i~)'Ik-. (.~/~~~" ~l'~) Charlene Uf/arrington, Rec rds Management 1-888-502-4349 July 23, 2008 John T. Evans 681 Cranes Gap Road Carlisle, PA 17013 __ Hoffman-Roth Funeral Home & Crematory, Inc. 219 North Hanover Street Carlisle, PA 17013 (717)243-4511 The Funeral Service for Leon J. Keene 15372-155 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. OUR SERVICE: Traditional Funeral Service Package , FUNERAL HOME SERVICE CHARGES ~ $4150.00 ' $4150.00 SELECTED MERCHANDISE: Provincial Casket-Hallmark _ THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE ~ $2680.00 THAT YOU HAVE SELECTED . $6830.00 Cash Advances Newspaper Obituary Notice- Sentinel , Newspaper Obituary Notice -Patriot News ~ $123.21 Certified Copies of Death Certificates , ~ $215.57 . . . . . . . $18.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES . $356.78 Total Total Cost , . . . . . . . . . . . . . $7186.78 TOTAL AMOUNT DUE $7186.78 This statement is net and payable in full within 30 days of receipt. ----------------------------- Please return this portion with your Remittance ~ Amount Enclosed Service ID # 15372-155 Leon J. Keene