HomeMy WebLinkAbout11-23-09 (3)1505607121
-' REV-1500 EX (06-05)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601 2 1 0 9 0 3 9 9
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 9 0 2 2 9 7 7 6 0 4 2 0 2 0 0 9 1 1 2 9 1 9 2 8
Decedent's Last Name Suffix Decedent's First Name MI
K I N N E Y B E T T Y L
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
a 1. Original Return
4. Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
Spouse's First Name
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust _
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name ~ Daytime Telephone Number
J A N L B R O W N 7 1 7 5 4 1 5 5 5 0
Firm Name (If Applicable)
J A N L B R O W N & A S S O C
First line of address
8 4 5 S I R T H O M A S C T S T E 1 2
Second line of address
City or Post Office
H A R R I S B U R G
State ZIP Code
MI
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
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REGISTE~F WILLS US~NLY
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Correspondent's a-mail address: BRENDAJLB~VERIZON.NET
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, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU~E OF PERSON REtS~NSIBLE FOR FILING RETURN DATE
.~ ~
ADDRESS
68 LYALL S WEST ROXBURY MA 02132
SIGNATURE OF PR P ER E ~REPRE~SENTATIVE DATE
ADDRESS ``~~
845 SIR THOf1AS CT STE 12 HARRISBURG PA 17109
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607121 1505607121 J
L~
1505607221
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: BETTY L• K I N N E Y 1 9 0 2 2 9 7 7 6
RECAPITULATION
1. Real estate (Schedule A) 1_ 1 6 7 0 0 0, 0 0
2. Stocks and Bonds (Schedule B) .................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D) ........................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5.
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) ....... . . . . . . . . . ... . ...... . g
4 9 8 7 4. 4 6
1 2 6 5 4. 9 5
1 1 2 1 4. 6 9
5 9 4 5. 5 1
2 4 6 6 8 9. 6 1
9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 3 3 8 9 8 , 7 3
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 4 D . 1 2
11. Total Deductions (total Lines 9 & 10) ........................... 11. 3 3 9 3 8 . 8 5
12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 2 1 2 7 5 D , 7 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. 2 1 2 7 5 D . 7 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. O. D 0
16. Amount of Line 14 taxable
at lineal rate X .045 2 1 2 7 5 D 7 6 1 s. 9 5 7 3. 7 8
17. Amount of Line 14 taxable
at sibling rate X .12 D D D 17. 0. D D
18. Amount of Line 14 taxable
at collateral rate X .15 0 D D 18. 0. D D
19. Tax Due ............................ .......... ... ..... ..19. 9 5 7 3. 7 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505607221 1505607221 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 09 0399
DECEDENT'S NAME
BETTY L. KINNEY
__
STREET ADDRESS
115 Yorkshire Drive
Lower Allen Township
- - _ _ _ -_
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
~. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 9,500.00
C. Discount 478.68
Interest/Penalty if applicable
D. Interest
E. Penalty
9,978.68
(3) 0.00
(4) 404.90
(1) 9,573.78
Total Credits (A + B + C) (2)
Total Interest/Penalty (D + E )
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.
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.
(5)
(5A)
(5B)
0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
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 : ...................................................................... ^ ^X
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X^
c. retain a reversionary interest; or ................................................................................................ ^
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ X^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^ ^X
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ ^X
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
s three (3) percent [72 P.S. §9116 (a) (1.1) (i)],
=or 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
fling a tax return are still applicable even if the surviving spouse is the only beneficiary.
=or dates of death on or after July 1, 2000:
1-he 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)].
fhe 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)].
fhe 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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
BETTY L. KINNEY 21 09 0399
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 roe which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 115 Yorkshire Drive, Lower Allen Township, Cumberland County 167,000.00
Tax Parcel 13-24-0793-069
TOTAL (Also enter on line 1, Recapitulation) I $ 167,000.00
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
SCHEDULE Ey ~+
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, $c MASC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
L_
ESTATE OF FILE NUMBER
BETTY L. KINNEY 21 09 0399
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. Janney Montgomery Scott Account 4891-7733; cash balance 2,835.79
2 Sovereign Bank CD 1685546556 5,083.89
3 Geico; insurance refund 9.41
4 PA Deptartment of Revenue rebate 750.00
5 Real estate tax refund per HUD Settlement Sheet dated 10/23/09 1,008.81
6 Sewer refund per HUD Settlement Sheet dated 10/23/09 74.55
7 Ryan R Leach; reimbursement check for radon mitigation 392.50
8 1998 Oldsmobile 88/LS; VIN 1 G3HN52KOW4803022 2,500.00
9 Household goods and personal effects 0.00
(Decedent's tangible property had little or no resale value.)
TOTAL (Also enter on line 5, Recapitulation) $ 12 654.95
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
BETTY L. KINNEY 21 09 0399
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Scott W Kinney 68 Lyall Street son
West Roxbury MA 02132
JOINTLY-OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A. 9/1999 Sovereign Bank Checking Account 1681725371 5,657.13 50. 2,828.57
2 A 4/2007 Sovereign Bank Money Market 1684067308 16,772.24 50. 8,386.12
TOTAL (Also enter on line 6, Recapitulation) I $ 11,214.69
(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
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
BETTY L. KINNEY 21 09 0399
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. ATTACHACOPVOFTHEDEEDFDRREALESTATE
DATE OF DEATH
VALUE OF ASSET
%OFDECD~S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
1, Janney Montgomery Scott IRA Account 8179-5799 5,945.51 100. 5,945.51
Scott W Kinney, son, beneficiary
TOTAL (Also enter on line 7 Recapitulation) $ 5 945.51
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES 8r
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
BETTY L. KINNEY 21 09 0399
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Funeral luncheon 411.42
2 Memorial inscription 175.00
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City
Year(s) Commission Paid:
State Zip
2 Attorney Fees Jan L Brown & Associates
3, Family Exemption: (If decedent's address is not the same as claimants, attach explanation)
Claimant
Street Address
City State _
Relationship of Claimant to Decedent
Zip
4. ~ Probate Fees Cumberland County Register of Wills
5. I Accountants Fees Parks & Company ESTIMATE
6. ~ Tax Return Preparers Fees
7. Cumberland County Law Journal; legal advertising
8 The Patriot-News; legal advertising
9 Citizens Bank; bank charge
10 Executor travel to/from Pennsylvania/Massachusetts
Adm expenses incurred in order to preserve/liquidate real estate:
11 Green Season's; landscape
12 Home Depot; presale materials
13 Jeremy Francis; landscape
14 Lazur Total Lawn Care
15 Lower Allen Township; sewer
16 Moises Zawadski; presale carpet removal
17 Pennsylvania American Water
5,500.00
390.00
500.00
75.00
318.12
21.00
2,070.28
237.84
338.18
200.00
686.88
201.60
500.00
140.81
TOTAL (Also enter on line 9, Recapitulation) I $ 33,898.73
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
BETTY L. KINNEY 21 09 0399
Decedent's Name Page 1 File Number
Schedule H -Funeral Expenses & Administrative Costs - B7.
ITEM
NUMBER DESCRIPTION AMOUNT
18 PPL Electric Utilities 567.05
19 Tom's Home Services; presale painting 2,590.45
20 Verizon 318.52
21 West Shore School District; real estate tax 426.07
22 Westfield Insurance; homeowners insurance 380.00
23 Real estate settlement costs 17,850.51
SUBTOTAL SCHEDULE H-67
22,132.60
REV-1512 EX + (12.03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
BETTY L. KINNEY 21 09 0399
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
Philip's Lifeline
40.12
TOTAL (Also enter on line 10, Recapitulation) I $ 40.1
(If more space is needed, insert additional sheets of the same size)
rcty ~i~cn+~auu~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
BETTY L. KINNEY ~~ na n~aa
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. Scott W Kinney, son Lineal
68 Lyall Street, West Roxbury, MA 02132 100% residue
SchF&G
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
LAW WILL AND TESTAMENT
OF
BETTY L. KINNEY
I, BETTY L. KINNEY, of Cumberland County, Pennsylvania, declare this to be my Last
Will and Testament. I revoke all other Wills and Codicils that I may have previously made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate shall
be paid by my Executor from the principal of my residuary estate as soon as practicable after my
death.
Article II
All inheritance, estate, and succession taxes (including interest and penalties thereon, but not
including any generation skipping tax) payable by reason of my death shall be paid out of and be
charged generally against the principal of my residuary estate without reimbursement from any
person. This provision is not a waiver of any right which my Executor has to claim reimbursement
for any such taxes which become payable as the result of any property over which I have the power
of appointment.
Article III
I give, devise and bequeath in accordance with any memorandum which I have either
handwritten or signed, located with my Will or with my valuable papers and found within 30 days of
the probate of my Will. Gifts may only be to persons who survive me or to organizations which
exist at my death, and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath to my son, SCOTT W. KINNEY, of West Roxbury,
Massachusetts.
If my son predeceases me or fails to survive me by thirty (30) days, I give, devise and
bequeath his share to his issue who survive me, per stirpes, or if he has no issue, the share(s) are to
be added equally to the other shares.
Article V
If a beneficiary under this Will has not attained the age of twenty-three (23) years, the share
of the beneficiary shall be placed in a separate trust, for the benefit of that beneficiary according to
the terms in Article VI.
Article VI
In the event that a Trust is created by or as a result of any part of this Will, the terms and
conditions of the Trust shall be as follows:
A. To expend and apply so much of the net income and so much of the principal of the
Trust as the Trustee shall consider advisable for the support, health, care and education (including
_~
college, trade school, or other similar training or education) of the child until the child attains the age
of twenty-three (23) years.
B. Upon attaining the age oftwenty-three (23), the remaining principal and accumulated
income of the child's share shall be distributed outright to the child.
C. No beneficiary or remainderman of this Trust shall have any right to alienate,
encumber, or hypothecate his or her interest in the principal or income of the Trust in any manner,
nor shall any interest be subject to claims of his or her creditors or liable to attachment, execution, or
other processes of law.
Article VII
I hereby appoint WAYPOINT TRUST AND INVESTMENTS GROUP, or its
successor(s), of 235 North Second Street, P.O. Box 171 1, Harrisburg, Pennsylvania 17105 (717-
909-6197), as Trustee of any Trust(s) created in this Will.
Article VIII
In order to carry out the purposes of the Trust established by this Will, the Trustee, in
addition to all other powers granted by this Will or by law, shall have the following powers over the
Trust estate, subject to any limitations specified elsewhere in this Will:
(a) to retain in the form received and/or to sell either at public or private sale, any real
°state or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
-3-
(c) to invest and reinvest in all forms of property without being confined to lega;
mvestments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(~ to file fiduciary/income tax returns and pay the tax due for any year for which such a
return is required,
(g) to make distributions in cash or in kind, or in both, and to determine the value of anv
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct along with or with others, any business in which I am engaged in or have
an interest in at the time of my death, and
(j) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services are performed.
Article IX
I nominate, constitute, and appoint my son, SCOTT W. KINNEY, Executor of my Last Will
and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever
of my Executor, I nominate, constitute and appoint my daughter-in-law, SUSAN A. KINNEY,
successor Executrix of my Last Will and Testament. I direct that my Executor or successor
Executrix be permitted to serve without bond and in addition to those powers granted by law, I grant
them power to distribute in cash or in kind in like or in unlike shares and to file any qualified
-4-
disclaimer I could have filed if living. My Executor and successor Executrix shall receive reasonable
compensation for services rendered to my estate.
Article X
In addition to the powers conferred by law, I authorize my Executor and successor Executrix.
in his/her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real estate
or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any benefici ary,
(~ to file any federal income tax return for any year for which I have not filed such
return prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services,
-S
(i) to conduct alone or with others, any business in which I am engaged in, or have an
interest in at time of my death, and
(j) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services are performed.
IN WITNESS WHEREOF, I, BETTY L. KINNEY, hereby set my hand to this my Last Will
and Testament, on ~~~~ i h ~ ~~ ~~ ~~ , 2003, at Harrisburg, Pennsylvania.
.~ -~ ~ 4 ~
J~ 72~ri-L
BETT L. KINNEY
In our presence, the above-named BETTY L. KINNEY signed this and declared this to be
her Last Will and Testament, and now at her request, in her presence, and in the presence of each
other, we sign as witnesses.
Name Address
~~~~,~ , ~,~! 111 1,' ,~' /S ~~,~` ~`~<~~ ~~iL. ~~ , ~i t-,~ 7/G'
_~
1, ~3;1~;'I'TY L. KINNEY, Testatrix, who signed the foregoing instrument, having been duly
qualified according to law, acknowledge that I signed and executed this instrument as my Will, and
that I signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
BETTY L. KINNEY, the Testatrix,
on ~ - 15 ,2003.
Public
BETTY L. KINNEY
l NOTARIAL SEAL
J JESSICA A. HOLLAND, NOTARY PUBLIC
-~' CITY OF HARRISBURG, DAUPHIN COUNTY
MY COMMISSION EXPIRES MARCH 4 2006
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute this
instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the
purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me
by ~c~\~~ ~~,~ F~ ''~.c~.~ ~~~h
and /'n_ su /~ ~~ «~ /~_s ~ ~~
witnesses, on ~-~- f ~ , 2003.
W><tness
Witness
Not~i-y Public
\\ ~ NOTARIAL SEAL
'~ ~ JESSICAA. HOLLAND, NOTARY PUBLIC
_ _~ CITY OF HARRISBURG, DAUPHIN COUNTY
MY COMMISSION EXPIRES MARCH 4, 2006
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WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon
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D. NAME OF BORROWER: Ryan R. Leach
ADD 3334 Louisa Lane Mechanicsbur PA 17050
E. NAME OF SELLER: The Esta[e of Betty L. Kinney _ _
D _ 115 Yorkshire Drive. Mechanicsburg PA 17055
F. NAME OF LENDER: M&T Bank
One Fountain Plaza. Buffalo. NY 14203
G. PROPERTY ADDRESS: 115 Yorkshire Drive, Mechanicsburg, PA 17055
Lower Allen Township
H. SETTLEMENT AGENT: PA Real Estate Settlement Services, LLC
I inn r-RIICC AMnI It.IT nl IG GRf1kA Rnl][]n\n/FD I .Inn r'_oncc n~nni inir ni is rn cci i co I
167 000.00 ri 167 000 .00
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5 538.74
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1
n 10 23 09 12 31 09 129.84 10 23 09 12 31 09 129 .84
10 23 09 06 30 10 878.97 10 23 09 06 30 10 878 .97
--_
t1 74.55 74 .55
1 0. A NT RR W 173 622.10 4 R T L 166 083 .36
0 AM T PAI Y RR W R I O
1 000.00
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T T PAI Y R 171 690.00 T M 17 850. 51
ASH T TT T RR N
173 622.10 168 083. 36
171 690.00 17 850. 51
W 1 932.10 H R____ _.__... 150, 232. B5
SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is important tax information and is being fumished to the Internal Revenue Service. If you are required to fie a return,
a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. The Contract Sales Price described on
line 401 above constitutes the Gross Proceeds of Mis transaction.
You are required by law to provide the settlement agent (Fed. Tax ID No: )with your correct taxpayer identifcation number. If you do not provide your wrrect taxpayer identifcation
number, you maybe subject to civil or criminal penalties imposed bylaw. nder penalties o perjury, I certify that the number shown on this statement is my cored taxpayer identification number.
TIN: - - / - SELLER(S) SIGNATURE(S): /
SELLER(S) NEW MAILING ADDRESS:
SELLEft(S)PHONE NUMBERS: _ (H)' (W)
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U$. DQA~1'A(8kI' OF 11Dt-SING AND U&HAN D~7.QPNt~NT Fik Hum6ar:2004-I IiQ PAGE 2
PAID FRAM PAID FRbwl
~ _ _ ~MCe 1167 ,000.00 ! 6. ~ ~ O 420.00 BORRQW~R'$ $~ I GIC$
FLMtO$ nT ~UNOB AT
a 9B .00 $ETTI„~AIQ~{Y $E7'fLEMENT
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U.S. DEPhRTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
File Number: 2009-I I50
Titles Fvnrccc Cottlemanr Cvclam PrintorV
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PAGE 3
ITEMIZATION F HUD LINE 1308
Hetrick Construction 785.00
Denise Ami Realtor 92.38
vl to Denise Ami 115.00
m AHS 514.00
1
1 1
4
1
1520. TOTAL HUD.LWE13 1 456.38