HomeMy WebLinkAbout02-18-1015056051058
-~ RED/-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Po Box 2so6o1 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
201-16-1848 12/28/2008 .07/31 /1926
Decedent's Last Name Suffix Decedent's First Name MI
Klick Sr. Robert C
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~;> 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required
death after 12-12-82)
;~.{. 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0.. 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
.. .. 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
John F. King, Esq. (717) 258-4343
Firm Name (If Applicable)
REGISTER OF WILLS USE ONLY
John F. King Law, P.C.
First line of address
19 S. Hanover Street
Second line of address
Suite 103
City or Post Office State ZIP Code DATE FILED
Carlisle PA 17013
Correspondent's a-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. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF P SON RES ~ NSIBLE FOR FIL~TURN DATE v
~l`.i1 1 Z~ / ? 1 ~
ADDRESS ^ . ~ ~ ~ t . e ~. ~. S (~ ~~ (~. 1ryl- ~ l ~ C~ ~ ~ ~ V V
SI TU OF PREPA R HER THAN REPRE NTATIVE ` DA ~E
~~1.- r 3'l-~'- S ~ ~I' ~1 t1 ~ ~ I /'L 4r ~ S ~ ) mod... ~ / '7 / rC~
USE ORIGINAL FORM ONLY
15056051058
Side 1
15056051058
J
15056052059
REV-1500 EX Decedent's Social Security Number
................................---...:
Robert C Klick ' 201-16-1848
:
Decedent's Name: ... _m:.
RECAPITULATION
1 149,900.00
1. Real estate (Schedule A) . ............................................
2.
Stocks and Bonds (Schedule B) ....................................... 2.
.._ . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages 8~ Notes Receivable (Schedule D) ............................. 4.
5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ........ 5. ' 93,855.27
6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6.
7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property
. (Schedule G) =Separate Billing Requested........ 7.
8. Total Gross Assets (total Lines 1-7) .................................... 8. , 243,755.27
9. .... .
Funeral Expenses & Administrative Costs (Schedule H) .....................
9.
30,114.45
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 4,720.98
11. Total Deductions (total Lines 9 & 10) ................................... 11. 34,835.43 '.
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 208,919.84
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, 208,919 84
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 .0_ 15.
16. Amount of Line 14 taxable
16 9,401.39
at lineal rate X .0 - .
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
9,401.39
19 . TAX DUE ........................................................ .19. _ __
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
<y,
15056052059 Side 2
15056052059
File Number
REV-1500 EX Page 3 - -
Decedent's Complete Address: ~ ..
DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER
Robert C Klick 201-16-1848
STREET ADDRESS
30 North Road
CITY
Mechanicsburg
STATE
PA
ZIP
17050
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 9,401.39
2. Credits/Payments
A. Spousal Poverty Credit 10,132.00
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2) 10,132.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total InterestlPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 730.61
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
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? ................................................................ ......
If death occurred after December 12, 1982, did decedent transfer property within one year of death
2
.
without receiving adequate consideration? ....................................................................................................... ....... ^
^
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ....... .......
Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
4
. X
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 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)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX+ (11-0$)
~ Pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Robert C. Klick 2009-00018
All real property owned solely or as a tenant in common must be reported at fair market value. tair marKec value is aennea as me pn~e a~ muu~ N~uNCi~y
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.
oe~i h~nncrty that iC 1nlntiV-owned wrath right of survivorship must be disclosed on Schedule F.
If more space is needed, insert additional sheets of the same size.
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Robert C. Klick 2009-00018
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.
(If more space is needed, insert additional sheets of the same size)
REV-l.`i 1.1. EX+ (1C}-09}
`~~ pennsylvania
DEPARTMENT OF REVENUE
~~~~~ •wi~~rntTww~!`c T~V OCTI IDPI
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representatives}
Street Address
City __ _ _.__ _ .._. State ........
Year(s) Commission Paid: _________________ _
Attorney Fees:
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
ESTATE OF FILE NUMBER
Robert C. Klick 2009-00018
Decedent's debts must be reported on Schedule I.
ITE M
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Trefz & Bowser Funeral Home, 114 W. Main St., Hummelstown, PA 2,514.89
B.
1
z.
3.
4.
5.
6.
~.
s.
9.
SCHEDULE H
FUNERAL EXPENSES AND
A ~1MTIUTCTD ATT\/~ /`ACTC
5,000.00
Street Address
City _ State
Relationship of Claimant to Decedent ___ ____._..._.___. __.
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
Bank checks
Home repair to prepare house for market
Closing costs for sale of house
ZIP
332.74
11.95
5,055.02°
17,199.85
TOTAL (Also enter on Line 9, Recapitulation) $ 30,114.45
If more space is needed, use additional sheets of paper of the same size.
ZIP
REV-1511 EX+ {1L-08)
pennsylvania SCHEDULE I
~. DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
- -___
ESTATE OF FILE NUMBER
Robert C. Klick 2009-00018
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert additional sheets of the same size.
Pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
--
ESTATE OF FILE NUMBER
Rnhcr+ r Klirk 2009-00018
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).j
1. Russell D. Klick, 302 Pennsylvania Avenue, Camp Hill, PA 17011 Son 50%
2. Robert C. Klick, 437 Virginia Road, Mechanicsburg, PA 17055 Son 50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SHEET, A S APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
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.
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COr1MUNWEALI'N OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
x, FOBLRT C. ~C,ICTi the testat OY'
whose nan[e is signed to the attached or foregoing instrument, having
been duly qualified according to law, do hereby acknowledge that I
sighed and executed the Instrument as my Last Will and Testament;
that I signed it willingly; and that I signed it as my free and volun-
tary act and deed, for the purposes therein contained.
Sworn and affirmed to and acknowledged before me bye yt-~,_
RO B~~T u. T~ICii fire r. estator ,_-this---~..:1_.~,..-/-~~
day of December ~ A• ll• , 1991.x..
_ ~ , ~ _~
~~
h,;~t:r~nf C' _~
r_ •.
COMMONWFALTII OF PENNSYLVANIA ) ~,y~r,,}-~•~e;.;::';:.~s~~Ei^~~7;r~~,}~rv~i'.'r~~;~+=+~i~
• S S ~ A/iy C;~f~z+r~:~;.tt ~a;~rES t~c~v. G,1~+97
COUNTY OF CUMI3EKLANll ) [r~c:.i, ~r'rt'yMnr''a ~ rC 'a~a~ of ~~~+~~ .
We, the undersigned, J. ROBOT STAUF~+'~.
a[id ~RITiA. L. LT:'V~~T'd~iACrEiT , the witnesses whose names are
signed to the attached or foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the
testat or ROBERT C. hT:,YCIi sign and exe-
cute the instrument as his/.~[~ Last Will and `t'estament; that the
said testat axy RCBEiRT C. T~I,TCI~ executed it as
1[is~~ free and voluntary act for the purposes therein expressed;
that each of us, in tl[e hearing and sight of the testat oz' , signed
the Wilt as witnesses; and that to the best oL- our knowledge, the
testat or was, at the time, eighteen (18) or more years of age,
of sound mind, and under no constraint, duress or undue influence.
Sworn attd sub gibed to before
me this ~ I " day of
December ~, . 1991.
' T/
,~
OMB NO. 2502-0265
A. ..
B. TYPE OF LOAN:
U.S. DEPARTMENT OF HOUSING 8~ URBAN DEVELOPMENT 1• X^FHA 2.QFmHA 3. QCONV. UNINS. 4. QVA 5. [~CONV. INS.
SETTLEMENT STATEMENT 6. FILE NUMBER:
09-631 7. LOAN NUMBER:
6100090963
8. MORTGAGE INS CASE NUMBER: OLD MORTGAGE INS CASE NUMBER:
441-9580151 5.25/F/812.76
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 the totals.
1.0 3/98 (KENNEDY.JARED.AMY.PFD/09-631/20)
D. NAME AND ADDRESS OF BORROWER:
Jared M. Kennedy and
Amy M. Kennedy
207 Chestnut Grove Rd.
Dillsburg, PA 17019 E. NAME AND ADDRESS OF SELLER:
Estate of Robert C. Klick F. NAME AND ADDRESS OF LENDER:
Graystone Mortgage, LLC
5115 E. Trindle Road, Suite B
Mechanicsburg, PA 17050
G. PROPERTY LOCATION:
30 North Road
Mechanicsburg, PA 17050 H. SETTLEMENT AGENT: 25-1857112
Midstate Abstract Company I. SETTLEMENT DATE:
November 18
2009
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
2331 Market Street
Camp Hill, PA 17011 ,
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 149,900.00 401. Contract Sales Price 149,900.00
102. Personal Pro ert 402. Personal Pro ert
103. Settlement Char es to Borrower(Line 1400 7,384.50 403.
104. 404.
105. ~ 405.
Adjustments Forltems Paid 8 Se/lerin advance Adjustments Forltems Paid B Sellerin advance
106. Cit !Town Taxes to 406. Cit /Town Taxes to
107. Count Taxes 11/18/09 to 01/01/10 55.11 407. Count Taxes 11/18/09 to 01/01/10 55.11
108. School Taxes 11/18/09 to 07/01/10 737.67 408. School Taxes 11/18/09 to 07/01/10 737.67
109. Sewer4th Qtr. 11/18/09 to 01/01/10 21.21 409. Sewer4th Qtr. 11/18/09 to 01/01/10 21.21
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNTDUE FROM BORROWER 158,098.49 420. GROSS AMOUNT DUE TO SELLER , 150,713.99
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. De osit oreamest mone 1,000.00 501. Excess De osit See Instructions
202. Princi al Amount of New Loans 147,184.00 502. Settlement Char es to Seller Line 1400 10,698.36
203. Existin loan s taken sub'ect to 503. Existin loans taken sub'ed to
204. 504. Payoff of first M ortg age
205. 505. Pa off of second Mo rt a e
206. 506.
207. 507. De osit disb. as roceeds
208. 508.
209. Seller Assist 6,501.49 509. SellerAssist 6,501.49
Adjustments Forltems Un aid B Seller Adjustments For/tems Un aid B Seller
210. Cit /Town Taxes to 510. Cit /Town Taxes to
211. Count Taxes to 511. Count Taxes to
212. School Taxes to 512. School Taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PA/D BY/FOR BORROWER 154,685.49 520. TOTAL REDUCTION AMOUNT DUE SELLER 17,199.85
300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301. Gross Amount Due From Borrower Line 120 158,098.49 601. Gross Amount Due To Seller Line 420 150,713.99
302. Less Amount Paid By/For Borrower (Line 220) ( 154,685.49) 602. Less Reductions Due Seller (Line 520) ( 17,199.85
303. CASH (X FROM) ( TO) BORROWER 3,413.00 603. CASH (X TO) ( FROM) SELLER 133,514.14
The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement 8 any attachments referred to herein.
Borrower Z- ~ Seller Estate f li
J d .Kennedy
BY:
~~" ~j r. a xecutor
Amy M. Kenn dy ~ Ro .Kick,
Russell D. Klick, as Co-Executor
rage z
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price $ 149,900.00 % 8,749.36 PAID FROM PAID FROM
Division of Commission line 700 8S FOIIOWS: BORROWER'S SELLER'S
701. $ 4,547.18 to RE/MAX REALTY ASSOCIATES FUN05 AT FUND5 AT
702. $ 4,202.18 to STRAUB AND ASSOCIATES REAL ESTATE GROUP, INC SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement
704. to 8,749.36
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Ori ination Fee % to
802. Loan Discount % to
803. Appraisal Fee to Graystone Mortgage, LLC POC:6350.00
804. Credit Report to Graystone Mortgage, LLC POC:B19.37
805. Lender's Inspection Fee to
806. Mort a e Ins. A .Fee to
807. Assumption Fee to
808. Processing Fee to Graystone Mortgage, LLC 125.00
809. Graystone Mtg;Admin Fee to Graystone Mtg/Admin Fee 250.00
810. Flood Cert/F.A.F.D.S. to Flood Cert/F.A.F.D.S. 18.50
811. G M/DO C $375 - Ap pra i CR $5.63 to G M/DOC $375 - Ap pra i CR $5.63 369.37
812. Graystone Mtg/MFRS Fee to Graystone Mtg/MFRS Fee 4.95
813.
814.
815.
816.
817.
818.
819.
820.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 11/18/09 to 12/01/09 @ $ 21.170000/day ( 13 days %) 275.21
902. Mortgage Insurance Premium for months to Dept of HSG & Urban Development 2,531.43
903. Hazard Insurance Premium for 1.0 ears to Allstate POC:6464.88
904..
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance 3.000 months $ 38.74 er month 116.22
1002. Mort a e Insurance months $ 65.88 er month
1003. Cit /Town Taxes months $ er month
1004. Count Taxes 11.000 months $ 37.33 er month 410.63
1005. School Taxes 7.000 months @ $ 102.95 per month 720.65
1006. months $ er month
1007.. months er month
1008. A re ate Escrow Ad'ustment months $ er month -638.21
1100. TITLE CHARGES
1101. Settlement or Closin Fee to
1102. Abstract orTitle Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Electronic Document Pre to Midstate Abstract Com an 50.00
1106. Closin Service Letter to Midstate Abstract Com an 75.00
1107. Attorney's Fees to
includes above ifem numbers: J
1108. Title Insurance to MIDSTATE ABSTRACT 1 108.75
includes above item numbers1102, 1103 & 1104
1109. Lender's Coverage $ 147,184.00
1110. Owners Coverage $ 149,900.00 1,108.75
1111. Endorsements 100, 300, 8.1 to Midstate Abstract Company 150.00
1112. Notary Fee to Midstate Abstract Company. 10.00
1113. Notary Fee to Midstate Abstract Company 5.00
1114. Overnight Fees & Handling to Midstate Abstract Company 15.00
1115. Wire Fee to Midstate Abstract Company 10.00
1116.
1117.
1118.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 48.50; Mortgage $ 64.50; Releases $ 113.00
1202. Cit /Count Tax/Stam s: Deed 1,499.00• Mort a e 1,499.00
1203. State Tax/Stam s: Deed 1,499.00; Mort a e 1,499.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Su rve to
1302. Pest Ins ection to
1303. Tax Certification to Debra B. Wiest, Tax Collector 10.00
1304. Home Warrant to First American Home Bu ers Protection Cor 435.00
1305. Administrative Fee to Straub and Associates 170.00
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K
o.. ~ ..s u.:. 7,384.50 10,698.36
-~ - a a r-ate ~• "•^' "•"•"••^'• . .v .any. a....w owa~n....~wyo .va.vya V~ o a.an~~pnoaa~u a.a~~/ VI Na yv L ul U11~ lwV ~l(~ 5[B IBfTI 1
Midstate Abstra o any
Settlement Age
Certified to be a true copy.
( 09-631 / 0&631 / 20 )
St
MEMBERS 1St
FEDERAL CREDIT UNION
SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
3531-00
05/31 /1955
$12,825.90
$9.49
$12,835.39
None
3531-11
09/01 /1993
$7,249.58
$2.03
$7,251.61
None
3531-42 3531-43
04/14/2008 06/02/2008"
$60, 243.49 $11,168.91
$147.06 $25.28
$60,390.55 $11,194.19
None None
"Opened by transfer of funds from 3531-11.
LOAN ACCOUNT:
Account Number/Suffix 3531-03
Date Loan Established 12/21/1979
Principal Balance at Date of Death $.00
Loan Type Personal Service Loan/Contractual Pledge of Shares
Name of Co-Borrower None
VISA ACCOUNT:
Account Number/Suffix 4287590005035312
Date Loan Established 07/19/1996
Principal Balance at Date of Death $507.63
Name of Joint Cardholder None
M BERS 1ST FEDERA CREDIT UNION
~ •'` -
Danielle A. Kline Vl_J~--
Insurance Services Specialist
March 11, 2009
Estate of: ROBERT C. KLICK SR.
Date of Death: 12/28/2008
Social Security Number201-16-1848
5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org
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DEPARTMENT OF TRANSPORTATION
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- CERTIFICATE OF TITLE FOR ,~' S3
A VEHLCLE ~_, . -
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issued in accordance with Section 1105 of the -~ehicle Code, Title 75, Pennsylvania Consolidated Statutes , •~
8828~003300~b457-00 _ ~
ROBERT C KLICK ~,
3 O NORTH R D
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MECHANICSBURG PA 17055 ''_~
A =ANTIQUE VEHICLE .~
- C_= CLASSIC VEHICLE ~
F =OUT OF STATE VEHICLE ~^ j
H =AGRICULTURAL VEHICLE
lw =LOGGING VEHICLE ~~ .
P = FORMERLI' A POL~CI:..,VEHiCLE I •
' R =RECONSTRUCTED VEHICLE
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VEHICLE IDENTIFICATION NUMBER ,.
MAX. GRUSS VEHICLE WEIGHT MAX. GROSS COMB. WEIGHT
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],0/21/88 8/25/88 1120~y~~~ ~~~'`.~~ `F~~~~~tr~~l"IBS
•~5 UNLADEN WEIGHT DATE ISSUED DATE PA TITLED ODOMETER AT PURCHAS tQQDF '
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The vehic% described hereon is subject to the fol/owing liens: - '
FIRST LIEN FAVOR OF:
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AUTHORIZED REPRESENTATIVE '~.=
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warrants the issuance of this certificate naming the applicant as /awthl owner of
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records of the l'crmsylvania Department of Transportation reflect that said a licant.
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