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HomeMy WebLinkAbout12-28-09 J REV-1500 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.28osot 21 0 9 0 0 4 4 5 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 057127944 10182008 10111918 Decedent's Last Name Suffix Decedent's First Name MI GOONEY CATHERINE E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ® 1. Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (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) ® g. Decedent Died Testate ^ ~, A~eC Mai f Trnuest a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of vuilq ( oPY ) ^ 9. Litigation Proceeds Received ^ 10. ~I~~~P2~~ YeCfed~ (d~ tse5~f death ^ 11, Election to tax under Sec. 9113(A) t (Attach Sch. O) .C,ORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: lnvame Daytime Telephone Number ROBERT P. KLINE 7177702540 Firm Name (If Applicable) KLINE LAW OFFICE First line of address 714 BRIDGE STREET Second line of address P.O. BOX. 461 City or Post Office NEW CUMBERLAND State ZIP Code PA 17070 rv rya NLY REGISTER ~ LLS US ~ /e ~ p~ .~~.~ ~ ,i ~~ r ~'~ m t~3 . ~ ~ CO c: . i ~ ~ ~ :~ i:.j ~t ;_ - -~ N DATE FILED fV ~ " -~~ ~, -..> l (, .7 ~_-~ -r; C"3 ~..~.~ ~` x Correspondent's e-mail address: 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. DeGaretion of preparer other than the personal representative Is based on all information of which preparer has any knowledge. Anne 719 Barbara Street, New Cumberland, PA 17070 iIGNA RE OF PREP ER OTH R T REP)tESENTATNE Robert P. Kline ADDRESS - ~ \ 714 Bridge Street, New Cumberland, PA 17070 Side 1 L 1505607120 1505607120 1505607220 REV-1500 EX oeceaer,re Name: GOONEY , CATHERINE E Decedent's Social Security Number 057127944 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ........................:...................................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & 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 i3< Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 139,900.00 205.71 140,105.71 9. Funeral Expenses & Administrative Costs (Schedule H) ................:........................ 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 8~ 10) ......................................................................11. 12. Net Value of Estate (Line 8 minus Line 11) .............................................................12. 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. 28,365.19 147,383.10 175,748.29 -35,642.58 -35,642.58 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 16. 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 1505607220 0.00 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 09 - 00445 Cooney, Catherine E STREET ADDRESS 102 Manchester Road CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.0 0 3. InteresUPenalty if applicable p. Interest E. Penalty 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. (4) Check box on Page 2 Lins 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.0 0 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Q , Q Q Make Check Payable to: REGISTER OF W1LLS, 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 :............................................................................... ..~ ^x b. retain the right to designate who shall use the property transferred or its income :................................... . ~ ~x c. retain a reversionary interest; or .............................................................................................................. .~ ^x d. receive the promise for life of either payments, benefits or care? ............................................................ . ~ ^x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................................... ..0 ^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 RETUR 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 p2 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. 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. COMMONN~EALTH of rENNSVwANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE FILE NUMBER ESTATE OF COOCIey, Catherine E 21 - 09 - 00445 All real property owned solely or as a tenant in common must be re orted 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 property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM I DESCRIPTION I VALUE AT DATE OF NUMBER DEATH 1 1102 Manchester Road, Camp Hill, PA 17011 (Lower Allen Twp) Cumberland Co. Parcel #13-23-0545-201 139,900.00 TOTAL (Also enter on Line 1, Recapitulation) ~ 139,900.00 SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. COMMONWEALTH aF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Cooney, Catherine E 21 - 09 - 00445 InGude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Refund from National City Mortgage 105.57 2 M8~T Bank #23947616 41.81 3 M&T Bank #15004208613776 58.33 ~ TOTAL (Also enter on Line 5, Recapitulation) ~ 205.71 COMMONNiEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H /F ~ L yI P ~ EAR ~ A~ Lp D~ ~~EE ~W ~S /E ~S ~&~ /~YJIr~IM~71 f~F111YG VW 1 ~7 FILE NUMBER ESTATE OF Cooney, Catherine E 21 - 09 - 00445 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: A. 1 Parthemore Funeral Home & Cremation Services 8,586.89 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Kline Law Office 3, 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 4. Probate Fees Register of Wills Cumberland Law Journal The Sentinel 5. Accountant's Fees 6. ~ Tax Retum Preparer's Fees 7. Other Administrative Costs 1 Settlement Costs -sale of 102 Manchester (adjusted for prorated taxes, etc.) 2,500.00 520.00 75.00 113.20 15,052.26 TOTAL (Also enter on line 9, Recapitulation) 28,365.19 Sched~~ie H Funeral E~~es & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN / w~~~M ^~ ~ 11^ p11AYYQ V{J6~ RESIDENT DECEDENT FILE NUMBER ESTATE OF Cooney, Catherine E 21 - 09 - 00445 2 M&T Bank -Pre-death checks presented post death and bank charges 301.00 3 Focht Johnston Plumbing LLP 60.00 4 State Farm Insurance 109.29 5 Cloverleaf Service Co. 60.00 6 Hepfers Ace Homecenter 525.19 7 The Home Depot 462.36 Page 2 of Schedule H co~wNwFUTN of aENNSVwANw INHERITANCE TAX RETURN RESICENT ~CEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER ESTATE OF Cooney, Catherine E 21 - 09 - 00445 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 National City #0003944450 120,053.33 2 Chase #222*6225 1,891.06 3 Chase #4266841041377381 c/o West Asset Management 1,181.60 4 Chase #5149231820037929 c/o West Asset Management 2,850.83 5 Home Depot (Citibank) #6035320679306058 c/o Philips & Cohen 1,161.69 6 Wells Fargo #23655355 266.00 7 Home Depot (Citibank) #603532060790463 c/o Philips & Cohen 3,399.60 8 World Financial c/o DCM Services 228.63 9 World Financial c/o DCM Services 99*2794 348.47 10 World Financial c/o DCM Services 1010*2853 456.35 11 World Financial c/o DCM Services 1111111111119663 368.29 12 FIA Card Services #5490999018935055 11,086.32 13 FIA Card Services #4264298926160410 1,984.47 14 Boscovs #9249842 c/o Estate Recoveies, Inc. 2,106.46 I TOTAL (Also enter on Line 10, Recapitulation) ( 147,383.10 REV-1513 E7(+ (9-00) a, SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Cooney, Catherine E 21 - 09 - 00445 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I~ TAXABLE DISTRIBUTIONS[include outright spousal f d t ers distributions an rans under Sec. X116 (a) (1.2)] 1 Mary Anne Cooney Daughter ALL 719 Barbara Street New Cumberland, PA 17070 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, o n 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 SHE~T 0.00 ep\wills\COONEY,CATHERINE LAST WILL AND TESTAMENT OF CATHERINE E. GOONEY I, CATHERINE E. GOONEY, of Lower Allen Township, Cumberland County, Pennsylvania, declare-this to be my last will and revoke any will previously made by me. ITEM I: I direct that my Executor hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. ITEM II: I devise and bequeath all the rest, residue and remainder of my estate of every nature and wherever situate to my daughter, MARY ANNE A. GOONEY. ITEM III: I appoint my daughter, MARY ANNE A. GOONEY, Executrix of this my last will. ITEM IV: No fiduciary acting hereunder shall be required to post bond or enter security for the. faithful performance of her duties in any jurisdiction. IN WITNESS WHEREOF, I, CATHERINE E. GOONEY, have hereunto set my hand and seal this ~ ~ day of 2005. ~: ,: CA. ERI E . COO Page 1 of 2 SIGNED, SEALED, PUBLISHED and DECLARED by CATHERINE E. GOONEY, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presence of each other, have subscribed our names as witnesses. ,; Wit ss Address Witness Addre ~ Page 2 of 2 M. C. WALKER REALTY Fax:7176979d80 Nov 19 2009 01:1dpm P002/OOd ~~' ?~Yl+t r• ~~ryry yy~~ 'Ol flUG 14 P~ 2 t~ THIS DEED ~~ Made fiat ~I --~'~'" day of August, 2001, ~3ET'wEEN SCQ~'~` J 11fUN~0 and I;,AITRA I3. McCLA~, now tn-uwn as LAITRA S. M01~0, his wife, herein desig~u~ated as the Grantors, AND C,A,~~ ~. C4UNEX, a siuagle person, herein designated as the Grantee, ~TI'T}~SSETH, that the Grantors, for and in consideration of ONE id[,TNDt,2ED SEVEN TIdOUSAND FIVE IiUNDRED ($107,500.00] DOLLARS lawfi~t money of the Uzuted States of America, to the Grantors is hand. well and truky pazd by the C,ramee; at or befaxe the seating and delivery of these Resents, the receipt whereof is hereby acknowledged and the Gra~oxs being therewith filly satisfied, do by these presents grant bargain, sett and rpr~vey tmto the Grantee forevelC, her heirs sad assigns, ALL T~IAT CERTAAIN tract of load with the improvements thexeon erected situate an the Northeast side of Manchester Road, Lower Aden Township, G~oabezlmad CnuntY, PennsY beioag Lot No. 22, Slock "N" om P1sua of Higblaaad Park, Plan Book 4, Page 98, bo anded amd desenbed in acra;rdance with a Plan of Survey by Gerrit S. Betz Associates, hoc., Engineers and Surveyors, dated May ?,1,979 and bearing drawing rto. 79213, as follows, to wit: BLG~NNI„I~TG at a hub on the Northeast side of Mancb;ester Road (50 foot wide xig~tt-af-v+~ay) ar a comer of Lot No. 21 of the above znentioraed Plan of Lots, nOw or forrrbcrly of Gilbert C. Murray, said point being 1.05.69 feet to the Northwest cor~ncr of Kelton and Mancheste~c 1toads; thence extending from said beg~iuu~,g bn~b and along the Northeast side of Manchester Road an a lint curving to the right having a radius of 397.50 £eet, a length of X5.00 feet to ~ iron pin f~annd at a corner of Lvt No. 23 of the about mentioned Pfau of Lots, now or fvrbaerly of fames T. Phdpott; thence extending slang same North 34 degrees 57 mineztes 40 seconds East, a, distance of 91.04 feet to an iron pin at a corner of Lot Iii o. 20 of the above mooned P1ari, v~' Lots, now or formerly o£ Gxegary C. Ivioll; thence extending slang same South 41 degrees 4? minutes 00 seconds East, a. distance of 54.45 feet to a hub at a comer of Lot AIa. 21 of the above mentioned. Plan of i:,ots, zxow or fvrxnerly of Gilbert C. Murray, aforementioned; thence extcsading aloz~,g same South 25 degrees 55 minutes 00 seconds West, a distance of 75.00 feet to the frst mentioned hub and place of BECril~iNING. ~~~v~ ;~~ ?r~c~~1~ M. C. WALKER REALTY Fax:7176979d80 Nov 19 2009 01:15pm P003/OOd BEING known and ~aumber«i. as 102 ?viamchester ~oaa. 1 -_-._.l BEING t~ same pzemises whitch James Coffman anal Rebecca A. Hoffnoan, hiswt£e, b3' deed dated ~Ivvember 29, ~ 999 amd recorded Aecember 2, I99g ig. the Office of the Rectrx~dex of iaz and for Cumber3a~ Ct»ty in 3~eed Boob 212, Page 532, granted and convoyed unto Scott ~. Moro and Law~a B. McClain, both si~agle ~crsons, as joint tenants wi~tJ~ tb~e xight of survivarsh~p and not as tenants zn common, the Grantors herein. The said T.,aura $. McClain is mow ~aou-n. as Z,aura B. N,[oz~lco. ~~u~ ~~ ~ "~rc~'~~ M. C.WRLKER REALTY Fax:7176979480 Nov 19 2009 01:15pm P004/004 TOGETHER with ail and singulaz the buildings, uoopzoves~szes, ways, woods, wateXS, watercourses, rigbts,~ h'bezties, privileges, hereditaznents arul apps to the same belonging ar iu arxyvcrise Wig; and the reversion and reversiozzs, reznaiixfer and xeznainders, gents, issues and profits thereof, and ofevery part and parcel thereof, AND ~ ali the estate, ~ title, interest, use, possession, property, claim and demand wbatsoever of the Crrantors both in law anal inequity, o~ iz~ aztd to the premises herein described and every pare and parcel thereof witia the appurtenances. '~`() HAVE AND TO HC1LD all and. singr~J,ar the Pn~ herein deson` together vzith ~e heredrtaments and appurtenances waxo the Grantee and to Grantee's proper use amd benefit for~~ez. AND the Grantors covenant that, except as may be herein set forth, they do and wih iFO>I~VEit SP)ECIALLX ~'VA~LRANT AND DEk'END the lands and premises, h,ereditats and sppurtenauc,+cs hereby conveyed, agaiast the Grantors. In ail references herein to any paz~es, persons, e~ities or cotpazaxions, the use of any particular gender oz the plural or singular number' is intended to include the appropria>Ve g$ndez' ox number as the test of the within in~**~^-* may z~equsre, VVhemver in this instn~ment any party shall be designated oz r~rfexxed to by Hams or gezse;al reference, such desi~ation is intended to asad sha31 have the same e~ct as if the word "heirs,'exec3ttors, adwinistzators; personal or legal represezxatives, successor's aa~d assigns" had been. iuasertted after each and every such desig~aaxion. I~r WTl;~ilSS WIr1ERE(?F, the Gra~artors have hereunto set their bands acrd seals, or if a corporation, it bas caused these presents to be signed by its pz©pax corporate affseers and zts corporate seal to be armed hereto, the day and year first above written. SIGNED, SEA,IIED AND DEL>[VERED in the presence of or ,A,TTES~'ED by r, ,, r ; .~ '~ ~1 T ~' 71' t'~izj 4'w= ~: ~ ~ ~ ~ ~~ r :~ c, ~ - _~ _,_, ,r, ~ n rs~-~.~' ~r`~-fix. 4: Y ttis r~ rs. •~ • ~ rr, r1 --~ w.e y Cv ~~". ~- A ^ !'V is `I ~`- c~ r ~. ~r i". ~ ...r 1~F r.± ~ •~•,i, ~ '. a idl a.'] iri M T C ' ` 4 ~Z J 7 , .;:? C SJ . ~ ~.".7 rte' Cam: ~r3 sx SCO~7, o ~; :~ ~ ~~~ a Laura B. ivlGClain r: ~` .../// LatYrH $. ivFOnl~4 ~~., u C .~i-!- r iir C< "'~ 5 .~~ 1.. Iorl11 MV W 7 (J/tnfj mI Mane000x 6;1U].L a Settlement Statement U.S. Department of Housing and Urban Development B. Tvoe of Loan OMB Approval No. 2502-0285 (expires 11!30!2009) 1. EIFHA 2. ~FmHA 3. (]Conv. Unins. 4. VA 5. Conv. ins. 6. File Number 2009110AB 7. Loan Number 217996003 8. Mortgage Insurance Case Number PA4419565081703 C. Note: Items malked'(p.ot)• wen paltl outeWe en alpal~ Mey aro snows n:r. hr inramadon purpou^ and an not indutled In tM totals. ~~ u"o inawa: m..`"OMIw w~ « aesnu is u s cede s."tla«I i~a'Iwa e s `~~ ioio°~rtti~~ °P°n TiUeEXpress Settlement System Printed 11/23/2009 at 15:02 CEC D. NAME OF BORROWER: Matthew B. GOman and Michele L. Carr ADDRESS: E. NAME OF SELLER: Catherlns E Cooney ADDRESS: F. NAME OF LENDER: Bank of Amark:a, NA ADDRESS: 6100 Ddv Plano TX 75024 G. PROPERTY ADDRESS: 102 Mancfieabr Road, Camp Hill, PA 17011 Lower Allan Townahl H. SETTLEMENT AGENT: Abeolub Abstract, LLC, Telephone: 717.432.7102 Fax: 717-432.1535 PLACE OF SETTLEMENT: 125 West Harrlsb Dllisbu PA 17019 I. SETTLEMENT DATE: 1112312009 I S A 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales rice 139 900.00 401. Contract sales 139900.00 102. Personal Pro 402. Personal Pro e 103. Settlement cha es io borrower Gne 1400 7735.30 403. 104. 404. 105. 405. Adjustments for items paid by setter in advance AdJustments for items paid by seller in advance tos. ca sown taxes aos. c• nOwn taxes 107. Coun taxes 11123l09to12131109 64.29 407. Coun taxes 11123/09to12131l09 64.23 108. School taxes 11013ro91o06130110 671.63 408. School taxes 11123109to06130110 671.83 109. sewer- 4th Otr. 11l23109to 12131/09 16.10 409. Sewer -4th Qtr. 110131091012131109 18.10 110. Trash - 4th DU. 11013/09 b 12131109 24.58 410. Trash - 4th Qtr. 11/23109 to 12131!09 24.98 111. 411. 11z. a12. 120. GROSS AMOUNT DUE FROM BORROWER 148 411.84 420. GROSS AMOUNT DUE TO SELLER 140 676.54 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. De tt or earnest moos 1000.00 501. Excess De sit see insfrudbns 202. Prins al anloun of new bans 137 365.00 502. Settlement cha es to seller Poe 1400 10 697.00 203. Exi ' ban s taken su ' to 503. Existi loan a taken sub'ect io 204. 504. P oif:0003944450 120 053.33 PNC Mo a Co ration 205. 505. 206. 508. 207. Seler Assist 4 11.00 507. Seller Assist 4 911.00 208. 508. 209. 509. Ad usbnsnts for items un seller Ad ustmertts for items un aid seller 210. C' sown taxes 510. Ci !town taxes 211. Coun taxes 511. Coun taxes 212. School taxes 512. Schooitaxes 213. 513. 214. 514. 215• 515. Flnai SewerlTrash 220.80 216. 516. 217. 517. 218• 5t8. 219. 220. TOTAL PAID BYIFOR BORROWER 143 276.00 519. 520. TOTAL REDUCTION AMOUNT DUE SELLER 135 882.13 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLE R 301. -Gross amount due from borrower Poe 120 148 411.84 601. Gross amount due to seller line 420 140 676.54 302. Less amounts b !for borrower line 220 143 78.00 602. Less reductbn amount due seller line 520 135882.13 303. CASH FROM BORROWER 5135.84 603. CASH TO SELLER 4 794.41 SUBSTfRJTE FORM tOpp SB1ER STATEYENi: llr informatlan eomaNW Mrsin 4lmpw}ant tax Intormalbn aril is Oenp fumbhed to the Mtemal Revenue SerWU. s you an rnquketl b tNe a rowm, • ru0lfemp penally a otlw aangbn MII he ilrpoeetl on you Ntlpe i4m M rsyWred to t» npoMC antl tM IRS tleterminu Mal it Ms nd been rspwlM. The Conlrad Sala Pnca deuril»d on ane 70i above aorytltuW tM tirwe Repute dMb Vanaaelbn. Yp are req,MeO by law b prevke dIe srtaelpnt aped (Fed Tax q No: 71-0a1101iT) wiM your corral taxpayer Wsntlncatlon number. M yp tlo nd provlG your wrroa Wxpeyar idantMeatlon number, you may M ^I+bled to dNi or ralminal psnaMMa 1mppW bylaw. Under penaltlee o(perJury. I evtiry Mrt tM number shown on Mia Wtsment h my gonad laxpeya iden6NCadon number. TW: / __ SEt1ER(S)SIGNA'iURE(S): SELLER(S) NEW AWLWG ADDRESS: SELLER(S) PHONE NUMBERS: U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT - SETTLEMENT STOTEMENT tefm NUU•1 (~Ititf) fat MMOtg01l A'JUO.L File Number. 2009110AB PAGE 2 TiHaFYnmss Sattlamant Svctam Printed 11123120f19 at 15'02 CEC L SETTLEMENT CHARGES PAID FROM PAiD FROM 700. TOTAL SALESBROKER'S COMMISSION based on prkx 5139 900.00 8.000 = 8 394.00 BORROWER'S SELLER'S Division of commission tine 700 as folbws: FUNDS AT FUNDS AT 701. OO to M.C. Walker SETTLEMENT SETTLEMENT 702. 17200 to REIMAXA•1 Rea Inc. 703. Commisson 'd at Settlement 8 394.00 704. Transaction Fee to REIMA)CA•1 Rea Inc. 195.00 800. REMS PAYABLE IN CONNECTION WRH LOAN 801. Loan 0' inatan Fee %Benk Df Amerla N.A. LR 654.00 802. Loan Discount % 803. A sisal Fee to LandSafe Taal LR 460.00 804. Credit R to LandSale Cred Inc. LR 35.00 805. Lenders Ins Fee 806. Mort A lication Fee 807. Tax Service Fee to BAC Tax Service LR 89.00 808. Fk>od Check Fee to LandSafa Flood LR 26.00 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 11@301009 to 1210112009 18.3500 Ida 8 D LR 146.80 902. Mort a Insurance Premium for to Federal Housl Admin LR 362.55 903. Hazard Insurance Premium for to State Auto 42200 904. 905. 1000. RESERVES DEPOSTtED WRH LENDER FOR 1001. Hazard Insurance 3 mo. 35.17 !mo LR 105.51 1002. Mo a Insurance mo. 196.88 tmo 1003. C' Tax m0. !mo 1004. Coun Pro Tax 10 mo. 50.10 Imo LR 501.00 1005. School taxes 6 Inc. 92861mo LR 557.16 1009. A ate Anal sis Ad' stment LR -517.10 0.00 1100. TRLE CHARGES 1101. Settlement a d fee 1102. Abstract or title search 1103. Title examination 1104. Title insurance binder 1105. Document lion 1106. Nora Fees to Carrie E. Cook 25.00 20.00 1107. Attune s fees includes above items No: 1108. Tide Insurance to Absolute LLC 95288 includes above items Na: 1109. Lenders Pd' 137 365.00 - 1110. owners PDr 139900.00 -952.88 1111.100 No Viol 300 SuTVe 900E to Absolub Abstract LLC 150.00 1112. 1113. Ckui Svcltr to Atuolub LLC 75.00 1200. GOVERNMENT RECORDING AND TRANSFER C1IARGE3 1201: Reoondin Fees Deed 48.50 • M e 68.50 • Release 115.00 1202: C' /Coun tax/stam s Deed 1399.00 • Mort a 1399.00 1203. State Taxlsta Deed 1399.00 • Mort a e 1 399.00 1204. R istration Fee Deed • Mort e • Release 1205. 1300. ADpRIONAL SETTLEMENT CHARGES 1301. Roof Cert to TDHI Services 60.00 1302. Transaction Fee to M.C. Walker 195.00 1303. Wire Transfer Fee to Absotub LLC 20.00 25.00 1304. Ovem' ht Mail to Absolub Abstra LLC 15.50 1305. Doc. Der Fee to Absolute LLC 35.00 1306. Tax Cert. Fee to Absolub LLC 10.00 1307. Tax Cert -Reimburse to Mlle BenrlKt 10.00 1308. Home Warren to Amerkan Home Shield 495,00 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section 7735.30 10 697.00 HUD CERTIFICATION OF BUYER AND SELLER I MN tarsfuay n7w'iawatl tlu HU61 SN1NmaM Statafnant and fo the Mat~lal myknmvtsd9s and Usher, it 4 s true a tamsn tN all nwsipb end dls0uroemsnb made on my account `1 atrY m.in WaC~/~~~ ~~_~`l ~-3 ot~tNn.nt 1- 3-Get tumtelslrle. Tan WARNNG: m 6 A CRIAAE TO IQIOWNGLY MAID FALSE STATEIENTS TO THE Tha HU0.1 Ssttlamsnt Sbt and 1 prspyed is a Ova and aeawu aaou( rl C UNREO STATES ON THB OR ANYSNtlLAR FORIA PENALTFS UPON CONVICTION transectlon. 1 nave aused N nd! to ~ diaburosd in arxordana a 1 snL U ' CAN NCLUDE A FINE AND 1-PRLSONMEIII'. fOR DETNLS SEE TnLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. SETTLEMENT AGENT: DATE