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HomeMy WebLinkAbout12-14-09.~ REV-7SOO 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county code veer File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 9 - 0 19 6 PO 60X.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 194289533 02152009 03091936 Decedent's Last Name Suffix Decedent's First Name MI NEGLEY LYNN W (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 Retum ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ qa. Future Interest Compromise ^ 5. Federal Estate Tax Retum Required (date of death after 12-12-82) 0 ® 6 Decedent Died Teatate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received 1 ~ Spousal Poverty Credit (date of death ^ between 12-31-91 and 1-1-95) ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Numbe(v BRADLEY L GRIFFIE 71724~~551 °~ ~, `° ,-t ,.~ ~, =~' Firm Name (If Applicable) GRIFFIE & ASSOCIATES First line of address 200 NORTH HANOVER STREET Second line of address City or Post Office CARLISLE -~`v- -I ` ~ ~ r~-'i Zt~j~l~S US~bN LYe`~:?. =i? •> c 7 -r1 ~iC ~ r ~~ - ~ .. -~ C'_. r C'E't C.11 State 21P Code PLEASE NOTE: DUI: TO AN ELECTRONIC MA],FUNCTION WITH P A 1 7 0 1 3 TI'~fECLOCK -THE CLOCK DATF. ON 'I'IIIS DOCUMENT IS 12 HOURS I3F.HTND THE ACTUAL TIME. Correspondent'se-mail address: bgriffie~griffielaw.COm --REGISTER OF WILL/CLERK OF ORPI-INNS' Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true~rx)rrect and complete. DeGaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. y ire a ~ Kellie L. Kask l~.l ~f l 0 35 Maplewood Drive, Etters, PA 17319 SIGNARII~R PA HER_ THAN REPRESENTATIVE DATE ~~ - ~~ Bradley L Griffis ~,~ /, , /~ q 200 North Hanover Street, Carlisle, PA 17013 Side 1 1505607120 1505607120 1505607220 REV-1500 EX Decedent's Social Security Number DecedeM'S Name: N E G L E Y, LYNN W. 19 4 2 8 9 5 3 3 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 948.78 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. 138,541.18 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 1 6 4 3 3 8. 2 4 (Schedule G) ^ Separate Billing Requested ............. 7. , 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 303,828.20 37,075.60 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 22,997.17 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11, 6 0 , 0 7 2 . 7 7 12. Net Value of Estate (Line. 8 minus Line 11) ............................................................. 12. 243,755.43 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 4 3 , 7 5 5 . 4 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 .00 15. 16. Amount of Line 14 taxable 2 4 3, 7 5 5. 4 3 16 10 , 9 6 8 9 9 at lineal rate X •045 . 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. 1 0. 9 6 8. 9 9 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: File Number 21 - 09 - -0196 Negley, Lynn W. STREET ADDRESS 23 Crandle Drive CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable p. Interest E. Penalty Total Credits (A + B + C) Total InteresUPenalty (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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1> 10,968.99 (2) 0.00 (3) 0.00 (4) (5) 10,968.99 (5A) (56) 10,968.99 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? ....................................................................................................................... ^ ^x 3. Did decedent own an "in trust 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? ...................................................................................................................... ~ ^ 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 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)]. 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. CddIMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS FILE NUMBER ESTATE OF Negley, Lynn W. 21 - 09 - -0196 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 Prudential (Computershare) 948.78 Account No. C 0012402511 (42 shares at 22.59/share) (see attached letter) TOTAL (Also enter on line 2, Recapitulation) 948.78 SCHEDULE E CASH, BANK DEPOSITS, & MISC. DDMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERRANCE TAX RENRN RESIDENT DECEDENT __ FILE NUMBER ESTATE OF Negley, Lynn W. 21 - 09 - -0196 Include 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 Pennsylvania State Employees Credit Union 9.10 Account No. 8953687137 (Statement attached) 2 F&M Trust 4,580.46 Checking Account No. 33-16130 (Statement Attached) 3 Susquehanna Valley Federal Credit Union 346.05 Savings Account No. 8165 (Statement Attached) 4 Erie Insurance Exchange 153.00 (Refund of uninsured premium -auto) 5 Prudential (Dividends) 26.25 6 2008 Chevrolet Impala 11,750.00 (VIN No. 2G1WT58NX89200733) (See attached auctioneer statement) 7 Personal Property auctioned 6,212.50 (Statement attached minus vehicle) 8 AARP dental insurance (Delta Dental) 180.44 Premuim refund' 9 Progessive Insurance 22.00 Auto insurance premium refund 10 Pennsylvania Fire Police Association 300.00 (contribution to estate) 11 Embarq refund 10.17 TOTAL (Also enter on Line 5, Recapitulation) ~ 138,541.18 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT continued FILE NUMBER ESTATE OF Negley, Lynn W. 21 - 09 - -0196 Include 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 12 1982 Honda CT 110 Trail 110 (fair condition) 450.00 (See N.A.O.A. attachment) 13 Modular Home, 32 Crandle Drive, Carlisle ~ 111,000.00 (See attachment HUD-1 settlement statement) 14 Lowe's charge account refund of credit balance 20.44 15 Discover credit card refund of credit balance 73.75 16 Refund of deposit for vacation 185.00 17 Final pension distribution 1,500.00 18 Credit for Real Estate Tax Pro-rations 1,158.02 (see attched HUD-1 Settlement Sheet) 19 Credit for pro-rated November rent 175.00 (see attached HUD-1 Settlement Sheet) 20 Eric Insurance Homewoner's refund 39.00 21 Security Deposit Refund 350.00 Page 2 of Schedule E cCHEDULE G COMMONWEALTH OF PENNSYLVANIA S INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Negley, Lynn W. FILE NUMBER 21 - 09 - -0196 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY InGude the name of the trensteree, their relationship to decedent and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET ~' OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Orrstown Financial 164,338.24 100% 164,338.24 IRA Account No. 14 00 1560 010 (Statement attached) TOTAL (Also enter on line 7, Recapitulation) 164,338.24 SCI-EI7Ul.E H FUPE~AI_ ~~ES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ~~~T~, ~.. ~~ RESIDENT DEC WENT ESTATE OF Negley, Lynn W. FILE NUMBER 21 - 09 - -0196 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Ronan Funeral Home 9,860.37 2 West Minster Cemetary 1,335.00 3 ~ Loyal Bible Class 300.00 B. 1 2. 3. 4. 5. s. 7. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Kelfie L. Kask Social Security Number(s) / EIN Number of Personal Representative(s): 207-56-6226 Street Address 35 Maplewood Drive city Etters state PA zip 17319 Year(s) Commission paid 2010 Attorney's Fees Griffie and Associates Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees 2009 Personal Tax Return Tax Return Preparer's Fees 2008 Personal Tax Return Other Administrative Costs Estate Advertising to the Sentinel 2,000.00 3,200.00 361.00 150.00 78.95 187.54 TOTAL (Also enter on line 9, Recapitulation) 37,075.60 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Sd~ed~re H /~~,~.,,~,Fuier~IE~q~ert~se+s & /"K~ 1- II.~fI a11VC WOID ESTATE OF Negley, Lynn W. FILE NUMBER 21 - 09 - -0196 2 Estate Advertising to the Cumberland Law Journal 75.00 3 Creekview Community LLC (Lot rent) 350.00 4 D'Jo Flooring (repairs to residence to prepare for sale) 250.00 5 Creekview Community LLC (Lot rent) 350.00 6 Creekview Community LLC (repairs to residence for sale) 395.85 7 I Auto Loan payment to PSECU 336.13 8 'Erie Insurance Group (Auto insurance) 211.00 9 ', Erie Insurance Group (Auto insurance) 107.00 10 Creekview Community LLC (Lot Rent) 350.00 11 Suburban Energy Services 215.42 12 Adams Electric Cooperative 70.00 13 Creekview Community LLC (Lot Rent) 350.00 14 Suburban Energy Services 80.27 15 Eric Insurance Group (Homeowners) 112.00 16 Suburban Energy Services 12.64 17 Adams Electric Cooperative 29.00 18 Creekview Community LLC (Lot Rent) 350.00 19 Adams Electric Cooperative 30.00 20 Suburban Energy Services 12.64 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT G ~Sched~~ie H p ~ ~w « ~'~ C~' ESTATE OF Negley, Lynn W. FILE NUMBER 21 - 09 - -0196 21 Creekview Community LLC (Lot Rent) 350.00 22 Adams Electric Cooperative 31.00 23 Creekview Community LLC (Lot Rent) 350.00 24 Suburban Energy Services 6.44 25 Eric Insurance Group (Homeowners) 112.00 26 Adams Electric Cooperative 34.00 27 Creekview Community LLC (Lot Rent) 350.00 28 Creekview Community LLC (Lot Rent) 350.00 29 Adams Electric Cooperative 32.00 30 Suburban Energy Services 12.64 31 Adams Electric Cooperative 33.00 32 Suburban Energy Services 12.64 33 Auctioneer expense (See attached statement) 3,082.00 34 Settlement fees on sale of modular home (See attached HUD-1 Settlement Sheet) 8,078.07 (A) Realtor's Transaction Fee ($175.00) (B) Realtor's Commission ($5,550.00) (C) 2009 School Real Estate Taxes ($1,970.74) (D) 2009 County/Township Real Estate Taxes ($382.33) 35 Auctioneer costs 3,082.00 Page 3 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS INHERRANCE TA% RETURN 7 RESIDENT DECEDENT FILE NUMBER ESTATE OF Negley, Lynn W. 21 - 09 - -0196 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Auto Loan payment to Pennsylvania State Employees Credit Union (PSECU) 336.13 2 Adams Electric Cooperative 46.00 (Electric bill) 3 Embarq (internet, phone, Dish) 83.42 4 AT&T (Cell phone) 47.22 5 Suburban Energy Services (propane) 240.71 6 Department of Veterans Affairs 55.00 (medical) 7 Shirley J. Arnold, Tax Collector 9.80 (Personal taxes) 8 United States Treasury 2,045.00 (2008 Personal Income Tax due) 9 VISA 99.26 10 Delta Dental Insurance Premium 135.33 (processed post date of death) 11 Auto loan to PSECU at date of death less principle reductions from monthly payments made 19,899.30 post death (See attached statement) TOTAL (Also enter on Line 10, Recapitulation) I 22,997.17 REV-t 513 EX+ (9.00) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Negley, Lynn W. I 21 - 09 - -0196 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not Llst Trustes~s) I TAXABLE DISTRIBUTIONS [include outright spousal ~ distributions, and transfers under Sec. 9116 (a) (1.2)) 1 Kellie L. Kask daughter Fifty percent 35 Maplewood Drive Etters, PA 17319 2 Todd W. Negley son Fifty percent 224 Larue Drive Coraopolis, PA 15108 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, on Rev 1500 cover sheet III NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET O.OO Attachment to Schedule "B" ~omputershare Computershare Investor Services .250 Royail Street Canton Massachusetts 02021 www,computershare,com __. _ _:__ .. ESTAI"E OF LYNN W. NEGLEY _ __. _ __ _ __. _ _ ___._.. . ___ .--. _... _ _ _ .____. .-. _ ___._.__ _ ._ ..___ 35. MAPLEWOOD DR ,' ETTERS PA 17319-9146. October-20 2009 -. ~ ~ . _ ~ . Company:. PRUDENTIAL FINANCIAL INC Registration: LYNN W NEGLEY Holder Account Number: 00012402511. Document I.D.: 09292WF00217271 Our Reference:. PRU/012009i019/3148641/77053. Dear Sir/Madam: ..~.~;~ . ,; ~-1;;;.;r.::,, i i .Thank you. for contacting Computershare,: Prudentiai's transfer..agent. We,appreciate~ahe:.apportur~ity tc3 Abe t : ;:. ~~ ..:. of service to. you.. , .. . . On February 17, 2009,. account number. 00012402511 held 42 shares. On that date,. the closing. price was. $22.59. per. share.. Should you have other. account related. questions,. please. call. us at 1-800-305-9404 between the hours of 8:30. AM and 6:00 PM Eastern. US time,. Monday through Friday.. Please note that any. available representative can assist you.. A telecommunications device for the hearing. impaired. (TTY/TDD) is also. available at 1-800-619-2837.. Sincerely,. Service Representative Enclosure:. None. .. - .. ..... .. .. I _,~.i:.l..i:l.t.u!l:? l:O;SF~'C'IsiJ(.!%~J.':1;(',`.i~~. ..•~~'._,Lfiflrli);:%'J}~;.~.!yl"~Cy,..'_-;rS!)* .fll6,. ~..~~.,_~.i~f.7;~1~:'Y^~'^h.3~~~1 i~1.t;).l..c. .. .. ... . ~ Attachments to Schedule "E" PSEC~ Grime & Associates 200 North Hanover Street Carlisle, PA 17013 Re: Lynn W Negley, Deceased. PSECU Account # 8953687137 Dear Mr. Griffie: April 15, 2009 The account was opened on March 3, 2008. The Share accounts were held solely by Lynn W. Negley. The Auto loan was held solely by Lynn W Negley. The following are the Date of Death Balances for Mr. Negley's account with PSECU: Account Date of Death Balances Savings (S1) $ 9.10 Checking (S4) $ 0.00 Interest -February 1-15 $ 0.00 $ 0.00 Loans: Auto Loan (L 10) $ 20,194.45 If the Estate has sufficient funds to payoff Mr. Negley's Auto loan, please remit a check, made payable to PSECU, in the amount of $19,804.36. If there are not sufficient funds to payoff the loan, you may contact the Credit Union to make the necessary arrangements to turn the vehicle into PSECU. If you have any questions, please contact me at (717) 234-8484 or toll-free at (800) 237- 7328, then press 6, extension 3120. Si cerely, ~-K-~ Ro nn Myers Service Advisor PSECU Pennsylvania State Employees Credit Union Main Address: 1 Credit Union Place, Harrisburg, PA 171 10-2990 • 717.234.8484 • 800.237.7328 Moiling Address: PO. Box 67013, Harrisburg, PA 17106-7013 717.777.2100 (TDD) 800.472.1967 (TDD) {~ _ _ This credit union is federally insured by the Notional Credit Union Administration. Equal Opportunity Lender www.p5@CU.GOm March 6, 2009 Grille & Associates Attorneys and Counselors at Law 200 North Hanover St Carlisle, PA 17013 RE: Lynn W. Negley To Whom It May Concern: In reference to the above customer, our records show the enclosed information to be accurate of today's date. If I may be of any further assistance, please contact me. Sincerely, 0 Tricia Ganoe Deposit Operations Manager 717-261-3624 . 717-264-6ii6 88~-2646116 P.O. Box 6010 Chambersburg, PA 17201-6010. FtNA.N.~tat~SQ41ttlONS... FROM p~EO~~E Y.OU .KNUW. c5 USQUEHANNA ALLEY FEDERAL CREDIT UN10N February 23, 2009 Bradley L. Griffie, Esquire Griffie & Associates 200 North Hanover Street Carlisle, PA 17013 Re: Lynn W. Kegley Member -No. 8155 Dear Mr. Griffie: Mr. Kegley had a savings account (8165) and Visa credit card at Susquehanna Valley FCU. The account and Visa were in his name only. The date of death balance on the savings account was $345.72. The interest on the account is 0.75% APY, which amounts to $0.33 from January 1, 2009 to the date of his death on February 15, 2009. The Visa credit card has a balance of $99.26. The account has been blocked so that no additional charges are added to the account. There have been ~o withdrawals in-excess ~f $3,00 or~hecks in excess of $3;000 since February 15, 2008. Please let me know if you need any additional information. Kind regards, ~~ KathyJo Shoaff Merr~ber Services Supervisor ~'~~ 3850 HARTZDALE DRNE • CAMP HILL, PA 17011-7809 Cif t~ LOCAL: (717) 737-4152 TOLL FREE: (E00) ~4E-1454 FAX: (717) 737-OSS9 FINAL SETTLEMENT ~ ~ `~ ~ Date OWNER ++vS~~~^^~- ~~ ~ ~`-I f1, Y/1 ~ , ~l eG'i (~ ~-l Address QC, 3 l.. rG'i-'Y\.t/+•L~- ~1i I ~~U T' ~ ~~ .5 ~ P ~ ~ ~ 0 ~ v~ Date of Sale ' fl ) Sale Location __ ~ ~ ~l~c~- ~~ . ~C~-~~11~ Auctioneer ~ ~ ~'~~' "`~ 1 Clerk Cashier Other PROCEEDS OF SALE: Cash .__________,_________-_______________ Checks -------------------------------------- Other---~u!_~C~r ~1 ------------------------------------------------ o__r~~~d~~ _-__v ~.h~rl~ ----------------------------- s ~~iy-~ X ll. ~~ ~. ~ f ,~ ~ ,ate ~ C) ~C' Miscellaneous (see attached list) _..~____________~_____~__~__M_. TOTAL PROCEEDS OF SALE ________~__. $ ~~~'~6 ~~ ~. LESS SELLER'S SALE EXPENSE: ~ _6 ~? ~c Auctioneer's Fee____~__________-___________~_-_______~____ $ Other Seller's Expenses Advanced by Auctioneer: ~~~~ ~e~k 3~~. ~~ ~ cp ~l~~P Pali / ~~ 1 cP ~ - c~ _ oo ~ Miscellaneous (see attached list) M________________~_________________. DEDUCT TOTAL SELLER'S SALE EXPENSE ___________________________ $._ 3 S .D TOTAL NET PROCEEDS TO SELLER ___________________ ______ $ I, (or we), the seller of goods, merchandise, and/or property sold at public auction on above date and location, acknowledge and accept this settlement of proceeds of sale. I (or we) agree to accept all responsibility for providing merchantable title to all goods, merchandise, and/or property sold, and for delivery of title to the purchaser. (Date) (Seller's Signature) Auctioneer or Cashier's Signature (Seller's Signature) Form No. FS Reorderirom: MISSOURI AUCTION SCHOOL Phone 1-800-835-1855 =' .Used 1982 HONDA CT110 TRAIL 110 prices, values, specs and options at NADAguides Page 1 of 2 _. ._ - - .-. _. _ ..,~ . V~tide Pricing & Information 1*A.; d Autos Classic Cars Motorcycles Boats Recreation Vehicles Manufactured Homes Buy a Price Guide _ _ Poweispoirts Ira;tuance ~ Free Cred"d Report ~ Bery a Bute I . Sell a Bike.. i New PowersparLs Prices ...Used Mothrcyc[e Values September 30, 2009 vintage Motorcycle ModeL• CT110 TRAIL 110 tnsuraoce tZuote PE2[Ct~~'s r-reeusraarr~•-••~ i ---------- Vgty Good: --•--- 5875 ~~;y ~ ~~~i~ ~.: 5650 Fa~i : 5450 Know your Credit History Poor: NfA Free Ovine Credit Repclr~.~ Notes _. - ~~c Exp~irielrr '~`~. - 1948-1958 DUE TO THE RARITY OF THESE YEARS AND MODELS OF HONDA, PRICING DATA IS STILL BEING COLLECTED ,,.~,.,,,...,,,,., . L~EXT STEPS Free onirte lnsurarx:e Quote Free Ovine Credd Report 8 Score Free Dealer Quote on a New Vehicle Value Explanations Prices shown era retal consumervahres and th be considered as setting prices_ Extellerrt-Avery correct and raiginat (even if @ shows the patina of Osage) or an exoeptianaiywab-restored moto>cyde. This category is reserved for cortcorus or stmw qual0y machines only. in which everytlring on the machine is iuiy hrncional and operates as new. Ai equipment ~ o~igmal, new old slodc (NOS) factory replaoernents or trees of e>melleni quality reprodut~ions parls- 'Ouerrestored machines (a>s<ari- pairxt: over pofsfwrg ortVrrorrrerg) do rrotfrtin lifts Y es those actr+r~ies debads ham the o-igvra6tyoffhe marJrina_ Very Good -A very preserdable, original motorcycle lttat may show signs ~ minimal wear or a fatly ( and rwsme6easly) restored motorcycle that _~ .. J rl r _ I l ~ '. ~EIt~R ~~l~-I fk1E P~AME~ OF FR~£DOM.; y,t- .. ~~~..r tFJL does not meet contours standards, perhaps due to the age of the restoration or overall goaitY_ All systems are fully operational and the mxhine is not in need of ire- 'ibthat norrpr~ssiorta~rrestaad done carreatfy tarorrlU fd in this rategnry. http://www.nadaguides.com/default.aspx?LI=1-23-38-5697-0-0-0&1=1 &v~23&p=38&f=... 9/30/2009 g pr5t is pale ~ email a friend shop for Powerspods vanities See Your Vehide Online Ship Your Vehicle Donate Your Venk~e ~1rl~r!(> Make 1£ Year > N~,~.~ Trim > Qp~ > Va u Report 1982 ETONI3A CT110 TRAEL 11© `~ .Used 1982 HONDA CT110 TRAIL 110 prices, values, specs and options at NADAguides Page 2 of 2 Good -A machine in nice condition for its age that may need some minor medianipl attention acrd cosmetic rejuverration tD be a `good ridef. Bikes in Uus category generapy look used brd are aril usable, whalheP rt is ~r dirt or street use_ Frames should be straight and unaltered. 'The -eplaoemer-t of ~ tubes, brake, drain sprockets, a~ fifers and otlrer rmrar parts should ba andalOafed. Fair-A motorcyde that is worthy core for restoration. This would exclude _ machines with majorirame and engine moditicationsthat would be cost protubitiva to retain to original sPerdications_ All rrredranical and cosmetic aspects of ire . machine wr~l need attention in the restoration process. This is a complete motorcycle vertih mostd not a8 of its body, angers acrd suspension oomponenls idact, albeit in poor oorr~tian. b/otorcyctes vrith missing engines ormajoroomponents am commonly referred to as parts bikes' and am not covered in this category. Poor -Used for Haney-Davidson and Indian motorrydes only. A poor condition momroyde tras bean used and abused and needs major m~iranical and/or sheet metal work ft may ar may nd nm_ At#eralinns are evident b Game or sheet rrretat Mo~rcycte is missing or has inconect parts, ie. fenders, tank, seat, mechanics, installed. To some individuals tins is a'project or parts bike' at best A tRi motonyde is ono best left ib the professional for restoration. °Rrrle of Thumb° 1. Stated prices are mail and a point of reference fior buyer acrd seller 2 t'tiee apples to reg"raam oftlre UrWed Stakes vsitlr average activity. 3. Be sure condition level is accurately matctred as described in the above toondiion 6urdel'ures. 4. Vakres may vary by region and s~son_ Use this book as a guide_ 5. Consider trarr~or>ation costs vin baryQrg non-local marhines. 6_ VYe assume rro responsiuTdy for mrors ~ omrssior~ Back to Toa ~ I I ~ etADA craves '' Reliable pricing tools '; ~ I1 ~ P~ I ~ ~ that fit our turd I 1 ~ i Dross Room ,.~s . Y 9~• ®Copyright 2009 NADAguides.com. All Rights Reserved j~, ~ ~,• BUYA PRICE GUIDE `:• TOFlAY? ---F i http://www.nadaguides. com/default.aspx?LI=1-23-3 8-5697-0-0-0&1=1 &w=23 &p=3 8&f-... 9/3 0/2009 OMB N0.2502-0265 1r B. TYPE OF LOAN: A 1.^FHA 2.QFmHA 3.OCONV. UNINS. 4.~VA 5.QCONV. INS. U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT MENT STATEMENT 6. FILE NUMBER: FUHRMAN 7. LOAN NUMBER: SETTLE 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. Items marked (POCJ" were paid outside the closing; they are shown here for informational purposes and are not included in tine totals. 1.0 3FJ8 (F•UHRMAN.PFD/FUHRMAN/17) D. NAME AND ADDRESS OF BORROWER: Patricia A. Fuhrman 5 Green Meadows Drive Carlisle, PA 17013 E. NAME AND ADDRESS OF SELLER: Estate of Lynn W. Negley 23 Crandle Drive Carlisle, PA 17015 F. NAME AND ADDRESS OF LENDER: G. PROPERTY LOCATION: 23 Crandle Drive PA 17075 Carlisle H. SETTLEMENT AGENT: 25-1624518 Bradley L. Griffie, Esquire I. SETTLEMENT DATE: November 16, 2009 , Cumberland County, Pennsylvania PLACE OF SETTLEMENT 200 North Hanover Street Carlisle, PA 17073 J. SUMMARY OF BORROW ER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: K. SUMMARY OF SELLER'S TRANSACTION 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 111,000.00 401. Contract Sales Price 111,000.00 102. Personal Pro a 402. Personal Pro e 103. Settlement Char es to Borrower Line 1400 587.50 403. 104. 404. 105. 405. Ad'ustments For Items Paid B Seller in advance Ad'ustments For Items Paid B Seller in advance 106. School Taxes 17/18/09 to 06/30/10 1,114.22 406. School Taxes 11/16/09 to 06/30/10 1114.22 107. Coun /Townshi 11/16!09 to 12131109 43.80 407. Coun /Townshi 11/16109 to 12Y31/09 43.60 108. Assessments to 408. Assessmems to 109. Coun lTOwnshi Taxes 409. County/Township Taxes 110. School Taxes 410. School Taxes 111. November Prorated Rent 175.00 471. November Prorated Rent 175.00 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 112,920.52 420. GROSS AMOUNT DUE TO SELLER 112.333.02 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De osk or earnest mone 1,000.00 501. Excess De osit See Instructions 202. Princi al Amount of New Loans 502. Settlemem Char es to Seller Line 1400 8,078.07 203. Existin loans taken sub'ec[ to 503. Existin Icon s taken sub'ect to P04, 504. Payoff of first Mortga e 205, 505. P.a ff of second Mort e P06 506. 207 507. De osit disb. as roceeds 208. 508. 209. 509. Ad'ustments For Items Un id B Seller Ad'ustments For ttems Un id 8 Seller 210. School Taxes to 510. School Taxes to 211. Coun /Townshi to 571. Coun /Townshi to 212. Assessments to 512. Assessments to 213. 513. 214. 514. 215. 515. 216. 516. i 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 1,000.00 300. CASH AT SETTLEMENT FROM/TO BORROWER: 301. Gross Amount Due From Bortower Line 120 112,920.52 302. Less Amount Paid By/For Borrower Line 220 ( 1,000.00) 520. TOTAL REDUCTION AMOUNT DUE SELLER '. 8,078.07 800. CASH AT SETTLEMENT TOIFROM SELLER: 601. Gross Amount Due To Seller Line 420 i 112,333.02 602. -Less Reductions Due Seller (Line 520) ( 8,078.0 303. CASH (X FROM) ( TO) BORROWER ~ 111,920.52 60.?. CASH (X TO) ( FROM) SELLER ~ 104,254.95 The undersigned hereby acknowledge receipt of a completed copy of pages 182 of this statement & any a hments referred to herein. Borrower ~~ ~ Sel r Patricia A. Fuhrman a )e L. k, Exe x for Estate Lynn W. Negley Psge 2 L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ 111,p00.00 5.0000 % 5,550.00 PAID FROM ' PAID FROM ' Dnnsion of Commission hne 700 aS FOIIOWS: eORROWER S SELLER S 701. $ 2,800.00 t0 Century 21 at the Helm 702. $ 2,750.00 t0 ReMAX 1St ADVantage 703. Commission Paid at Settlement FUNDS AT SETTLEMENT FUNDS AT SETTLEMENT 5,550.00 704. Transaction Fee to REIMAX /Century 21 250.00 175.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee % to 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806. Mort a e Ins. .Fee to 807. Assumption Fee to 808. 809. 810. 81L 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to ~@ $ Iday -: (--~ -~ days %) 902. Mort a e Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 ars to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance - months @ $ - er-month 1002. Mort a e Insurance months @ $ er month 1003. School Taxes months @ $ r month 1004. Coun /Townshi months $ er month 1005. Assessments morrths @ $ per month 1006, months @ $ r month 1007. months @ $ per month 1008. months $ er month 1100. TITLE CHARGES 1101. Settlement or Closin Fee to Bradle L Griffie, uire 3~•~ 1102. Abstract or Title Search to 1103. Title Examination 40 1104. TOlelnsurance Binder `to 1105. Document Pre aration tb 1106. Note Fees to 1107. Attorney's Fees =to includes above item numbers: 1108. Title Insurance -to includes above item numbers:' 1109. Lender's Covera e $ 1110. Owner's Covera e $ 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin Fees: Deed $ ;Mortgage $ Releases $ 1202. C' /Cou Tax/Stam s: Deed ' Mort a e 1203. State TaxlStam s: Revenue Stem s ; MoR a e 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve to 1302. Pest Ins ~on -to 1303. TNe Transfer Fees to -AAA 37.5 0 1304. Secu ' De osft to Creek View POC:6350.0 0 1305. See addiCl dish. exhibft to 2,353.07 ,taco- TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K 587.5 0 8,078.07 By signing page 1 of Mis statement, the egnatoriae acknowledge receipt of a comPlete6 copy ~ Pa9e 2 oflhm Mroyag ~ . Griffie, quire ettlement Age Certified to be a true copy (FUHRMAN/FUNRMAN/17) ADDITIONAL DISBURSEMENTS EXHIBIT Borrower: Patricia A. Fuhrman Seller: Estate of Lynn W. Negley Settlement Agent: Bradley L. Griffis, Esquire (717)243-5551 Place of Settlement: 200 North Hanover Street Carlisle, PA 17013 Settlement Date: November 16, 2009 Property Location: 23 Crandte Drive Carlisle, PA 17015 Cumberland County, Pennsylvania PAYEE/DESCRIPTION NOTE/REF NO BORROWER SELLER Shirley J. Armold, Tax Col. 2009 School Taxes Shirley J. Armold, Tax Col. 2009 County/Twp Taxes Creek View Payment for 1st Month's Rent POC:6350.00 Total Additional Disbursements shown on Line 1305 1,970.74 382.33 350.00 $ 0.00 $ 2,353.07 (FUNRMAN. PFD/FUHRMAN/16) Attachments to Schedule "H" FINAL SETTLEMENT ~ ~ C ~ ~ Date OWNER ~STG^~- ~j ~ Ll-~ I~11 y/V~ ~ I~-~, ~G ~ e ~-j Address ~ 3 1. r~'Yl~'~4-- ~~ i ` ~U (- ~ i~ S ~Q._. ~ ~ ~ 0 ~ ~ l (~ Date of Sale ~ ~' ~' ~ ) Sale Location ~ ~ ~N ~-i/~c+~`~- UJ~ . ~Cx-~~~<~ ~, Auctioneer ~~?~ ~ ~'~~ ~~ ( Clerk Cashier Other PROCEEDS OF SALE: Cash .___________,____________________________ $ ~~~X Checks _--------------------------------------- .~ ~~~~ ~~ X ~f ~ Other ---~u--- ~- --I ------------------------------------------------- /~. G ~ ~r -- Miscellaneous (see attached list) ~_______________-_______~__-______. TOTAL PROCEEDS OF SALE ____________W___. $ 1 - ~' LESS SELLER'S SALE EXPENSE: i Auctioneer's Fee_________________~_______~_~_~_~_________ $ ~ ~~~~ Other Seller's Expenses Advanced by Auctioneer: P~ 3~.?.r~o ~ ~~~P ~ ~~~ ~ 3 ~a. o~c7 ~ cp~L~~~~. ~~ J cP ~k I cx~ . oo ~ Miscellaneous (see attached list) _______________________________________. DEDUCT TOTAL SELLER'S SALE EXPENSE _____________________~_____ $ 3 ~ • D TOTAL NET PROCEEDS TO SELLER ____________________________ $ ~ ~ L ~ I, (or we), the seller of goods, merchandise, and/or property sold at public auction on above date and location, acknowledge and accept this settlement of proceeds of sale. I (or we) agree to accept all responsibility for providing merchantable title to all goods, merchandise, and/or property sold, and for delivery of title to the purchaser. (Date) (Seller's Signature) Auctioneer or Cashier's Signature (Seller's Signature) Form No. FS Reordertrom: MISSOURI AUCTION SCHOOL Phone 1-800-835-1955 OMB N0.2502-0265 7r A B. TYPE OF LOAN: DEVEL OPMENT 1.QFHA 2.QFmHA 3.QCONV. UNINS. 4.OVA 5.QCONV. INS. U.S. DEPARTMENT OF HOUSING & URBAN SETTLEMENT STATEMENT 6. FILE NUMBER: FUHRMAN 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. Items marked %POCJ" were paid outside the closing; they are shown here tar informational purposes and are not included in the totals. 1.0 398 )FUHRMAN.PFDlFUHRMAN/I7) D. NAME AND ADDRESS OF BORROWER: Patricia A. Fuhrman 5 Green Meadows Drive Carlisle, PA 17013 E. NAME AND ADDRESS OF SELLER: Estate of Lynn W. Negley 23 Crandle Drive Carlisle, PA 17015 F. NAME AND ADDRESS OF LENDER: G. PROPERTY LOCATION: 23 Crandle Drive Carlisle PA 17015 H. SETTLEMENT AGENT: 25-1624518 Bradley L. Griffie, Esquire I. SETTLEME November 16 NT DATE: 2009 , Cumberland County, Pennsylvania PLACE OF SETTLEMENT 200 North Hanover Street Carlisle, PA 17013 , J. SUMMARY OF BORROW ER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 111,000.00 401. Contract Sales Price ~ 111,000.00 102. Personal Pro a 402. Personal Pro e 103. Settlement Char es to Borrower Line 1400 587.50 403. 1pq_ 404. 105. 405. ~ Ad' stments For Items Paid 8 Seller in advance Ad'ustmen[s For Items Paid B Seller in advance 106. School Taxes 11116/09 to 06/30170 ~ 1.11422 406. School Taxes 11116/09 to O6/30/10 1 114.22 107. Coun (Townshi 11116/09 to 12!31/09 43.80 407. Coun ITownshi 11/16109 to 12/31109 43.80 108. Assessments to 406. Assessments to 109. Coun (Townshi Taxes 409. CountyfTOwnship Taxes 110. School Taxes 410. School Taxes 111. November Prorated Rent 175.00 411. November Prorated Rent 175.00 112. 412. i i 120. GROSS AMOUNT DUE FROM BORROWER 112,920.52 420. GROSS AMOUNT DUE TO SELLER ~ 112.333.02 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De osit or earnest mone 1,000.00 501. Excess De osit See InsWCtions 202. Princi al Amount of New Loans 502. SetOement Char es to Seller Line 1400 8,078.07 203. Existin loan s taken sub'ect to 503. Existin IDan s taken sub ect to i 2Dq, 504. Payoff of first Mortgage 205. 505. P.a of second Mort a e 206. 506. P07. 507. De osit dish. as roceeds ! 208. 508. ' 209. 509. I Ad'ustments For Items Un id B Seller Ad'ustments For Items Un id B Seller 210. School Taxes to 510. School Taxes to I 211. Coun /Toumshi to 511. Coun /Townshi to ! 212. Assessments to 512. Assessments to ! 213. 513. ~ 214. 514. 215. 515. 216. 516. 217. 517. ~ 218. 518. 219 519. 220. TOTAL PAID BY/FOR BORROWER 300. CASH AT SETTLEMENT FAOM/TO BORROWER: 1,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 600. CASH AT SETTLEMENTTO/FROM SELLER: 8,078.07 301. Gross Amount Due From Borrower Line 120 112,920.52 601. Gross Amount Due To Seller Line 420 ' 112,333.02 302. Less Amount Paid By/For Borrower (Line 220) ( 1,000.00) ( 602. -Less Reductions Due Seller (line 520) 8,078.0 303. CASH (X FROM) ( TO) BORROWER ~ 111,920.52 603. CASH (X TO) ( FROM) SELLER ~ 104,254.95 The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any att menu referred to herein. Borrower ~ ~ ~ Sel r - ~, ~ /~ f',r .y,. Patricia A. Fuhrman a )e L. k, Exe x for Estate Lynn W. Negley Paae 2 L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ 111,000.00 5.0000 % 5,550.00 PAID FROM PAID FROM Division of Commission ine 700 85 FDIIOws: BORROWER'S SELLER'S 701. $ 2,800.00 to Century 21 at the Helm FUNDS AT FUNDS AT 702. $ 2,750.00 to ReMAX 1st ADvantage SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 5,550.00 704. Transaction Fee to REIMAX /Century 21 250.00 175.00 900. ITEMS PAYABLE IN CONNECTION WITH LOAN 601. Loan Ori ination Fee % to 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Repoli to 805. Lender's Inspection Fee to 806. Mort a e Ins. .Fee to 807. Assumption Fee to 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to -.@ $ /day .: (--. -. days %) 902. Mort a Insurance Premiumfor months to 903. Hazard Insurance Premium for 1.0 ears to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance - - monhs @ $ ~ er month 1002. Mort a e Insurance months @ $ er month 1003. School Taxes months @ $ r month 1004. Coun /rownshi months @ $ er month 1005. Assessments months @ $ per month 1006, months @ $ er month 1p07, months @ $ per month 1008. months $ er month 1100. TITLE CHARGES 1101. Settlement or Closin Fee to Bradle L. Griffie, E uire 300.00 1102. AbsVact or Title Search to 1103. Title Examination 40 1104. Title Insurance Binder -to 1105. Document Pre aratlon to 1106. Nota Fees to 1107. Attorneys Fees to inGudes above item numbers: 1108. Title Insurance -to inGudes above dem numbers: 1109. Lender's Covers a ~$ 1110. Owner's Coverage $ 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ ;Mortgage $ 'Releases $ 1202. C' /Coun Tax/Stam s: Deed ~ Mort a e 1203. State TaxlStam Revenue Stam s ; Mort a e 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve to 1302. Pest Ins coon ~to 1303. Title Transfer Fees -to .AAA 37.50 1304. Secun De osit -to Creek View POC:8350.00 1305. See addit'I disb. exhibit to 2,353.07 1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103, Section J and 502, Section K) 587.50 8,078.07 BY X9^^9 page 7 of tltu Hetemenl, the etgnetories arJmorASEge+ecep a a twnpw,w wPY ut W9e c m eea ~~ Grifhe, F~ quire ettlement Age t' Certified to be a vue copy (FUHRMAN/FUHRMAN/111 ADDITIONAL DISBURSEMENTS EXHIBIT Borrower: Patricia A. Fuhrman Seller: Estate of Lynn W. Negley Settlement Agent: Bradley L. Griffie, Esquire (717)243-5551 Place of Settlement: 200 North Hanover Street Carlisle, PA 17013 Settlement Date: November 16, 2009 Property Location: 23 Crandle Drive Carlisle, PA 17015 Cumberland County, Pennsylvania PAYEE/DESCRIPTION NOTE/REF NO BORROWER SELLER Shirley J. Armold, Tax Col. 2009 School Taxes Shirley J. Armold, Tax Col. 2009 County/Twp Taxes Creek View Payment for 1st Month's Rent POC:B350.00 Total Additional Disbursements shown on Line 1305 1,970.74 382.33 350.00 $ 0.00 $ 2,353.07 (FUHRMAN.PFDIFUHRMANIt 6) Attachment to Schedule "I" April 15, 2009 Griff e & Associates 200 North Hanover Street Carlisle, PA 17013 Re: Lynn W Negley, Deceased. PSECU Account # 8953687137 Dear Mr. Grime: The account was opened on March 3, 2008. The Share accounts were held solely by Lynn W. Negley. The Auto loan was held solely by Lynn W Negley. The following are the Date of Death Balances for Mr. Negley's account with PSECU: Account Date of Death Balances Savings (S 1) $ 9.10 Checking (S4) $ 0.00 Interest February 1-15 $ 0.00 $ 0.00 Loans: Auto Loan (L10) $ 20,194.45 If the Estate has suff cient funds to payoff Mr. Negley's Auto loan, please remit a check, made payable to PSECU, in the amount of $19,804.36. If there are not sufficient funds to payoff the loan, you may contact the Credit Union to make the necessary arrangements to turn the vehicle in to PSECU. If you have any questions, please contact me at (717) 234-8484 or toll-free at (800} 237- 7328, then press 6, extension 3120. Si cerely, Roxa n Myers (~~ Service Advisor PSECU Pennsylvania State Employees Credit Union Moin Address; 1 Credit Union Place, Harrisburg, PA 171 10-2990 • 717.234.8484 800.237.7328 ~~ Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013 717.777.2100 (TDD) 800.472.1967 (TDD) _ ... .. _ _.__..__ G......i n.,,,,,n,,,,a~ fender www.psecu.com