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Home My WebLink About04-14-1015056071120 R~V-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes county code Year File Number Po Box.2soso~ INHERITANCE TAX RETURN 21 09 01075 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 159 24 8376 11 07 2009 05 31 1930 Decedent's Last Name Suffix Decedent's First Name MI MI LLI KEN JAMES 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 Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ qa, Future Interest Compromise ~ 5. Federal Estate Tax Return Required /date of death after 1?-1?-8?l g Decedent Died Testate ~ ~• Attacher~oMaiotained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) ( G py f Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death 11, Election to tax under Sec. 9113(A) between 12-31 ~J1 and T-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 C. ROY WEIDNER JR. (717) 761 4540 i~ Firm Name (If Applicable) JOHNSON DUFFIE First line of address 3 O 1 rtiARKET ST . Second line of address PO BOX 109 City or Post Office LEMOYNE Correspondent's a-mail address: State ZIP Code PA 17043-0109 REGISTER ~ !~lI LS US ONLY c ~ ,, . rY, ~ t_ ~,..~ l:1 ~. , , a, ,.., f !+ f ,. _.~~. ' ~.:::;~ ~. W... ......~. ;: ~... _~ DAT~"FILED .. '~"'~ ,..•~ :~ .~ '`... ~~ ~.;V ~ ;-r-~ t-.~ _.~. ~ 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. ATURE OF PERSON R ONSIBLE FILING RETURN DATE • ~ PATRICIA DONNELLY / ADDRESS 1400 L. A. CARR LANE, DAUPHIN, PA 17018 SIGNATURE OF PREPAf~sit OTHER TF~IN~EPRESENTATIVE ~/~ / ..-1 ROY WEIDNER JR. O ADDRESS "~ !/ " (/ / / '' JOHNSON, DUFFIE, STEWART &WEIDNER, Lemoyne, PA 17043 Side 1 L Lsos6o~112o Lsos6o~1120 REV-1500 EX Decedents Name: JAMES W. MILLIKEN Decedent's Social Security Number 159 24 8376 RECAPITULATION 153,500.00 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 8~ Notes Receivable (Schedule D) ........................................................ 4. 59,487.68 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers 8~ Miscellaneous f~on; Probate Property arate Billin Re uested Se 7 63 , 8 7 7 . 5 6 ............ g q p (Schedule G) ^~ , 8. Total Gross Assets (total Lines 1-7) ..................................................................... g, 2 7 6 , 8 65.2 4 22,997.53 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 5,627.58 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. 10. 28,625.11 11. Total Deductions (total Lines 9 8 10) ................................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 248,240.13 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 248,240.13 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. 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 8 , 2 4 0.13 16 at lineal rate X .045 . 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 . 17. 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 . 18. 19. Tax Due ................................................. ................................................................. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 15056072120 0.00 11,170.81 0.00 0.00 11,170.81 Side 2 L 1505607212U 15056072120 REV-1500 EX Page 3 decedent's Complete Address: File Number 21-09-01075 DECEDENT'S NAME JAMES W. MILLIKEN STREET ADDRESS 1015 VALLEY STREET CITY ENOLA STATE PA ZIP 17025 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty 9,500.00 500.00 Total Credits (A + B + C) (1) 11,170.81 (2) 10,000.00 (3) Total Interest/Penalty (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. g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (4) (5) 1,170.81 (5A) (56> 1,170.81 Make Check Payable to: REGISTER OF W_ ILLS, .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 :............................................................................... ^ 0 b. retain the right to designate who shall use the property transferred or its income :.................................. ^ [~ c. retain a reversionary interest; or ............................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ............................................................ ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... 0 ^ 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 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. Rev-1502 EX+ (11-08) SCHEDULE A . REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MILLIKEN, JAMES W. 21-09-01075 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a wl-Iing 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. Attach a copy of the settlement sheet if the property has been sold Include a copy of the deed showing decedents interest if owned as tenant in common. ITEM ~ VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real Estate - No. 1015 Valley Street, East Pennsboro Township, -Cumberland 153,500.00 County PA. (Deed Book - D, Vol. 28, Page 816) -Sale Price copy o~ Settlement Statement attached. TOTAL (Also enter on Line 1, Recapitulation- I 153.500.00 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) Rev-1508 EXt (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MILLIKEN, JAMES W. 21-09-01075 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cash in decedent's wallet. 34.00 2 Comcast refund 7.69 3 Nationwide Insurance -premium refund -Truck Insurance. 129.08 4 Sale of Scrap Metal -Cash 21.00 5 Susquehanna Bank -Checking Account No. 146004402 -Date of death balance, 37.848.78 plus accrued interest. 6 The Patriot-News -refund 26.15 7 United States Treasury - 2009 Income Tax Refund 1.056.00 8 12 Gauge Pump Shotgun -appraised value. 200.00 9 2004 Bix-Tex Trailer (used for hauling items) appraised value. 400.00 10 Browning 12 Gauge Shotgun -appraised value 300.00 11 Household Goods -appraised value. - ' 4.625.00 12 Remington Mod. 700 - 270 Cal. Rifle -appraised value. 400.00 13 Ruger - 22 Mag. Rifle w/scope. -appraised value 200.00 14 Truck -Ford F-150 -Sale price. 13.000.00 15 Grove Insurance -Refund -homeowner's policy 392.00 I Total of Continuation Schedule See attached page TOTAL (Also enter on Line 5, Recapitulation) 59.487.68 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF (FILE NUMBER MILLIKEN JAMES W. 27-08-01075 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER MILLIKEN, JAME W. 27-09-01075 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF TRANSFERSATTACNTA CO Y OF THE DEIED FOOREREAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Susquehanna Bank -Revocable Totten Trust - 20.530.16 20.530.16 CD #346094015 -Beneficiary: Donna Rohacek, Stepdaughter -date of death balance, plus accrued interest. 2 Susquehanna Bank -Revocable Totten Trust - 43.347.40 43.347.40 CD #403300003932 -Beneficiaries: Patricia Donnelly & Nancy Hoover, Stepdaughters -date of death balance, plus accrued interest. TOTAL (Also enter on Line 7, Recapitulation) I 63.877.56 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (10-06) SCHEDULE H ' COMM~{ ~4gN~EQ~Fp,P~~N RLVANIA FUNERAL EXPENSES & " RIDENTDECED~N~ IJ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MILLIKEN, JAMES W. 21-09-01075 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT R A, FUNERAL EXPENSES: See continuation schedule(s) attached 756.13 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) PATRICIA DONNELLY Street Address 1400 L. A. CARR LANE City DAUPHIN State PA Zio 17018 . Year(sl Commission paid 2010 9,350.00 2. Attorney's Fees JOHNSON, DUFFIE 7,500.00 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 364.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs , ~ 5,027.40 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 22,997.53 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER MILLIKEN, JAMES W. 21-09-01075 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Gravemarker 135.00 2 McCulloch Mills Cemetery -grave opening/closing charges. 300.00 3 Patricia Donnelly -reimbursement for expenses to provide -funeral luncheon. 321.13 H-A 756.13 4 Other Administrative Costs Chuck Bricker -household goods appraisal. 150.00 5 Cumberland Law Journal -advertise Letters 75.00 6 Dillards's Trash Removal - 1015 Valley Street. 160.28 7 East Pennsboro Township -sewer charges -1015 Valley Street 68.50 8 Nationwide Insurance -premium increase -homeowner's policy 91.00 9 Nationwide Insurance -Truck insurance. 93.78 10 PA American Water -1015 Valley Street 69.78 11 Patricia Donnelly -reimbursement for cleaning and painting supplies - -purchased 931.85 at Home Depot. 1015 Valley Street 12 Postmaster -stamps 5.28 13 PPL -electric service -1015 Valley Street 97.37 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER MILLIKEN, JAMES W. I 21-09-01075 ITEM NUMBER DESCRIPTION AMOUNT 14 Recorder of Deeds -1 % transfer tax -1015 Valley St. 1.535.00 15 Register of Wills -file Inventory & Inheritance Tax Return 30.00 16 Service Oil Company -oil delivery -1015 Valley Street 1.153.18 17 Service Oil Company -oil delivery -1015 Valley Street 380.64 18 The Patriot-News -advertise Letters 155.10 19 Verizon -telephone service - 1015 Valley Street 30.64 H-B7 _ 5.027.40 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ 02.08) . SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MILLIKEN, JAMES W. 21-09-01075 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbureed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Associated Cardiologists -balance not covered by insurance. 357.78 2 Central PA Pulmonary Association -balance not covered by insurance. 361.65 3 Comcast -cable service -final charges. 6.60 4 Holy Spirit Hospital -balance not covered by insurance. 2.721.21 5 PA American Water -1015 Valley Street 13.85 6 PA American Water - 1015 Valley Street -Final Bill 7.43 7 PPL -electric service - 1015 Valley Street 22.08 8 PPL -electric service -1015 Valley Street -Final Bill 20.70 9 Quantum Imaging -balance not covered by insurance. 38.20 10 Real Estate - No. 1015 Valley Street, East Pennsboro Township, -Settlement 2.078.08 Charges. A copy of the Settlement Sheet is attached. TOTAL (Also enter on Line 10, Recapitulation) ( 5,627.58 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (11-08) • SCHEDULE J COMI~QQNwEDEN~EDECEDEN~RNANIA BENEFICIARIES ESTATE OF FILE NUMBER MILLIKEN, JAMES W. 21-09-01 075 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 1 Patricia Donnelly Stepchild 1/6 Pers. 1400 L. A. Carr Lane Property; Dauphin, PA 17018 1/6 Residue 2 Nancy Hoover Stepchild 1/6 Pers. 8 Wagner Drive Property; Shippensburg, PA 17257 1/6 Residue 3 Barry M. Milliken Son 1/6 Pers. 4311 Derbyshire Drive Property; Titusville, FL 32780 1/6 Residue 4 Fredrick M. Milliken Son 1/6 Pers. 9853 N. 52nd Street Property; Temple Terrace, FL 33617 1/6 Residue 5 Donna Rohacek Stepchild 1/6 Pers. 231 Fairway Drive Property; Kilmarnock, VA 22482 1/6 Residue See continuation schedule attached Continuation Tota I Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 150 0 cover sheet, as a r o riate. II NON-TAXABLE DISTRIBUTIONS: . A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FO R WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS -__ _- TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: JAMES W. MILLIKEN 11/07/2009 159-24-8376 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) Steven M. Milliken Son 1/6 Pers. Property; 2020 Oakland Run 1/6 Residue Mount Juliet, TN 37122 Tota I ESTATE OF JAMES W. MILLIKEN SCHEDULE OF EXHIBITS EXHIBIT A Signed Copy of the Last Will and Testament of James W. Milliken signed and dated April 27`h, 2006 EXHIBIT B Settlement Sheet for Sale of Property located at 101 S Valley Road, Enola, Pennsylvania EXHIBIT C Susquehanna Bank Date of Death Letter for Checking Account and 2 Totten Trusts EXHIBIT D Appraisal from Chuck Bricker, Auctioneer 398008 of JAMES W. MILLIKEN I, JAMES W. MILLIKEN, of the Township of East Pennsboro, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind; memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills heretofore made by me. ARTICLE I My Executrix shall pay from my estate all- my legal debts, funeral and administration expenses and all taxes which shall become payable by reason of my death. ARTICLE II I bequeath all of my household and personal effects and other tangible personal property of like nature (excluding cash, securities or motor vehicles), together with any existing insurance thereon, to my sons -and stepdaughters, _STEVEN M. MILLIKEN, BARRY M. MILLIKEN, FREDRICK M. MILLIKEN, PATRICIA DONNELLY, NANCY HOOVER and DONNA ROHACEK, to be divided by sail i of i ier~ selecting one item, in rotation, oldest first a~ ~d then proceeding in order of declining seniority to the youngest, until such time as all items which they wish to take in kind have been chosen. Any items not selected by them shall be sold and the net proceeds are to be distributed as part of the residue of my estate without regard to the value of any items taken in kind. Any disputes concerning this method of allocation shall be resolved by my Executrix. ARTICLE III I devise and bequeath all of the residue of my estate in equal shares to my sons and stepdaughters, STEVEN M. MILLIKEN, BARRY M. MILLIKEN, FREDRICK M. MILLIKEN, PATRICIA DONNELLY, NANCY HOOVER and DONNA ROHACEK. Should any of my sons or stepdaughters have predeceased me, such deceased beneficiary's share shall be added proportionally to the shares of the other beneficiaries entitled to share in the residue of my estate. ARTICLE IV I appoint my stepdaughter, PATRICIA DONNELLY, Executrix of this my last Will. In the event of her inability or unwillingness to act or continue to act as Executrix, I appoint my stepdaughter, NANCY HOOVER, Executrix. ARTICLE V I direct that my Executrix, or her successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction in which they may be called upon to act, insofar as I am able by law to do so. ~~ IN WITNESS WHEREOF, I hereunto set my hand and seal this ~~ day of 2006. . ~ o (SEAL) James W. Milliken _. -. k- Signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament in the presence of us, who at his request, in his presence and in the presence of each other have hereunto subscribed our names as witnesses. ~ ~ ._ ,t .~, -~ p ~ "~ j`4 ;. i''. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND I, JAMES _W. MILLIKEN, Testator, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~ d ~' James W. Milliken Sworn or affirmed to and acknowledged before me, by James W. Milliken, the Testator, this ~~~ day of I ~ , 2006. Notary Pu 'c COMMONWEALTH OF PENNSYLVANIA Notarial Seal Elizabeth L Zegler, Notary Public Lemoyne Boro, Cumberland County My Commission Expires Nov. 7, 2009 Member, Pennsylvania Association of Notaries - ~ _ i / ~ „ [ i; . ~.rZ.y^, ....-r...~.. r..... k !'~ AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ._ -~ ~. ', _~ _ ,- i ~~ •.,.~ ~, ~ .J-~ i ~J --.; I1 I f ~ ~,_~ ~1 _~ :! ~~ a ~ ------- ~ ,~, ' z F ' ~ '``- ~ `'^ ~~tt r 1 ss: We, C ~ ~ ~~zc1'~~~ , ~~. and ~ 2\\ t1 ~ \E~ the witnesses whose names are signed to the foregoing instrument, being duly qualified ~ cording to law, do depose and say that we were present and saw the Testator sign and execute the foregoing instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at least 18 years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed to and subscribed to before me by C . ~ e~: ~ ~ , ~ and ~ ~~~~\e. , ~ r ,witnesses, this o~~~day of ' i , 2006. Notary Pu~btlc :273699 COMMONWEALTH OF PENNSYLVANIA Notarial Sea! Elizabeth L Ziegler, Notary Public Lemoyne Boro, Cumberland County My Commission Expires Nov. 7, 20Q9 - Member, Pennsylvania Association of Notaries -, - - - - - _ ~ = ~ ~ J - --- - --- - - ~ -- •"'- ~ - ` ~ / _ ~ ~ a ~ ti. ~ -- ( ~ _ _" n 3 is ~~;- a. Settlement Statement (HUD-1) ~ ~ ~ ~ ~, B. Type of Loan Printed ne: 3/30/?010 7.•59:SSAb! 1 • ^ FHA 2. ~ RHS 3. [] Conv. Unins. 6. File Number. 7. Loan Number. B. Mortgage Insurance Case Number: 4. ~ VA 5. QX Conv. Ins. 68003044888 C. Note: This form is furnished to give you a statement of actual set0ement costs. Amounts paid to and by the settlement agent are shown, hems marked "( .o.c.)"were paid outside the Gosi th n ; are shown here for informational u oses and are not included in the totals. D. Name b Address of Borrower E. Name ~ Address of Seiler DOROTHY M. SWEGER F. Name & Address of Lender ESTATE OF JAMES W. MILLIKEN MEMBERS I ST FDL CREDIT UNION 2326 HOFFER STREET H.9RRISBURG PA 17103 5000 LOUISE DRNE 1400 L.A. CARR LANE MECHANICSBURG, PA 17055 , DAUPHIN, PA 17018 TIN 27-6314374 G. Property Location 1015 VALLEY ROAD H. Settlement Agent 1rNOLA, PA 17025 CHARLES E. PETRIE Place of Settlement i. Settlement Date 301 MARKET STREET' 03/31/10 LEMOYNE, PA 17043 Disburse Date: 3/31/2010 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 153,500.00 401. Contract Sales Price 102. Personal Property 402. Personal Properly 153,500.00 i03. Settlement charges to borro li 1 wer ( ne 400) 4,124.53 403. 104. 404. 105. .__ wa7ustments for hems paid by seller in advance Adjustments for items paid by seller in advance 106- City/town taxes 3!31/2010 to )2/31/2010 410.66 406. City/town taxes 3!31/2010 to I2/312010 107. County taxes 410.66 407. County taxes 108. Assessments 408. Assessments 109. School Taxes 3/3]12010 to 6/30/2010 1'10. 437.32 409. School Taxes 3131/20]0 to 6/30/2010 437.32 4'10. 111 _ 411. 112. 412. 120. Gross Amount Due From Borrower 163 47251 420. Gross Amount Due To Seller 200. Amounts Paid By Or to Behaff Of Borrower 154.347.98 500. Reduction !n Amount Due To Seller 201. Deposit or earnest money 1,000.00 501. Excess deposit (see instructions) 202. Principal amount of new loan(s) 117,500.00 502. Settlement charges to seller (line 1400) 2 078 08 , . 203. E~dsting loan(s) taken subject to 503. Existing loan(s) taken subject to 2~' 504. Payoff of first mortgage kran 2~' 505. Payoff of second mortgage loan 206. 506 207. 507 208. 506. 208. ~. Adjustments for items unpaid by Seller Adjustments for items unpaid by Seller 210. City/town taxes 510. City/town taxes 271. County taxes 511. County taxes 212. Assessments 512. Assessments 213" 513. 214. 514. 215. 515. 216. 516, 217. 517. 218. 518. 219. 519. 220. Total Paid IFor Borrower l l8 .00 520. Total Reduction Amount Due Sellor 2 078 08 . 300. Cash At Settlement fromlto Borrower 800. Cash At Settlement to/from~Seller 301. Gross amount due from borrower (line 120) 163,472.5] 601. Gross amount due to seller (line 420) 154 347 98 . 302. Less amounts paid by/for borrower (line 220) 118,500.00 602. Less reductions in amount due seler (line 520) 2,078.08 303. Cash ~ From ^ (To) Borrower i 44,972.51 803. Cash ~ To ^ (From) Setter $ 152 269.90 , SELLER INSTRUCTIONS: !f this reef estate was your principal residence, file Form 2119. Sete or Exchange of Principal Residence, for any gain, with your Income tax return; for ocher transactions, complete the app6cabla pBRs of Form 4794, Form 6252 andlor Schedule 0 (Form 1040). SU9STITtJT1=1098: The infomrafion cord(n BbrJ[s E G h1,,1 acrd on fine 401 {or if Gn 401 i i , , e s aster sked, tines 403 and 404) is important tax irrfonnatkrn and is being furnished to the Internal Revenue Servtce.ifyou are required~o file a return, a negligence penally or other sanction wii be imposed on you if this Rem is required to be reported and the IRS determines that R has not been repnfted. SoRwere and Added FormaRing ®2010 Alta Star Sofirare, Inc. A6 Rlghts Reservetl. (877)279-8898 www.rtudLtte.com Page 1 of 3 ~. vaaucuwna a.naryes 700. Total Real Estate Broker fees Division of Commission (line 700) as follows: 701. $ to 702. $ to 703. Commission paid ai Settlement 704. to 800. ttetas Payable to Connection With Loan DRAFT Printed on: 3/30/2010 7:59: SSAM _ _ Paid From Paid From Borrower's Seller's Funds at Funds at Settlement Settlement ov ~ . vur ongrnaoon Cnarpe $ 830.00 (from GFE #1) 802. Your creditor charge (points) for the specific interest rata chosen $ 3,G71.88 (from GFE #2) 803. Your adjusted origination charges to MEIvIgERS 1ST FDL CREDIT UNI (from GFE A) 804. Appraisal fee to (from GFE tY3) 4,501.88 805. Credit report to (from GFE #3) 806. Tax service to (from GFE #3) 807. Flood cert'fiication to {from GFE fl3) 808• to 809. to 810. to 811 • to 900 Ire R d ms equtre BY Lender To Be Patd In Advance ytn. ualry rnterest charges from 03/30/10 to 03/31/10 $ 14.08391 da from GFE#10 14.08 902. Mortgage insurance premium for months to (from GFE if3) 903. Homeowners insurance for 1 years to (from GFE#11 B): $ 492.00 9~• to 905. to 1000. Reserves Deposited With Lender 1001. Initial deposit for your escrow atxowt (from GFE t>:9) 1,273.32 1002. HomeawneJ's insurance 3 months (~ $ 41.00 per month $ 123.00 1003. Mortgage insurance months ~ $ per month $ 1004. Ci / Pro Tax 2 months (~ $ 45.26 per month $ 90.52 1005. $ 1006- School Pro tax 10 months ~ $ 144.59 per month $ 1,445.90 1007. Aggregate Adjustment $ -386.10 1100. Title Charges 1101. Title services and lenders title insurance (from GFE #4) 1,348.?5 1102. Settlement or dosing fee to CHARLES E. PETR)E $ 250.00 1103.Owners title insurance to {from GFE tx5) 1104. Lenders title insurance to $ 848 25 1105. Lenders title policy limit $ 1106.Owners title policy limit $ 7107. Agent's portion of total title insurance premium $ 1108. Underwn'ters portion of total title insurance premium $ 1109. Additional title services 1110. Document aration to CHARLES E. PETRIE 20.00 1111. NOTARY FEES to CHARLES E. PETRIE 50.00 1112.2010 CTYrI"WP TAX to DEBBIE LUPOLD 543.08 1200. Government Recording and Transfer Charges 1201. Government recording charges: (from GFE 7) 152.00 1202. Deed $ b2.00 Mortgage $90.00 Releases $ 1203. Transfer taxes (from GFE 8) 1,135.00 1204. City/County taxlstamps Deed $ Mortgage $ 1205. State tax/stamps Deed $ 3,070.00 Mortgage $ 1,535.00 1206. to 1207. to 1300. Additional Settlement Charges t 301. Required services that you can shop for (from GFE #6) 1302. to 1303. to 1304. to 1305. to 1306. to 1307. to 1308. to 1 0. Total Settlement Charges (enter on line 103, Set~ion J and 502, Section K) i v caretu9 reviewed th flue t s 9124.53 2,078 OS y e ettlemerd Statement and to the best of rtry knowAed d baief it is a true and accurate accourrt of a8 receipts and disbursemerrts made on a or by me in this transaction. er certty that I have received a copy of the f Settlement Statement BuyerJBorrowv DOR THY M SWEGER Serer ESTATE OF JAMES W. MII,LIKEN 9uyer/8ortower Seller To the best of my knawicdge, fhe HUD-1 Settlement Statement which I have prepared is a true and accurate account of the funds which were received and have been or will be disbursed qp unde red at: Pe t th~ ernee f~ eGon. 03/31/10 settlement Agent CHARLES E. PETRIE oate WARNING: h i5 a uirtte to knowingly make false statements io the United States on this or any other similar fonrt PenaNies upon conviction indude a fine and imprisonment Software and Added Farmattiny ®2009 Alta Star Software. Ina (87~2i'9-8898 www.HudLle.com Page 2 of 3 Form HUD-i (3/86) Comparison of Good Faith Estimate (GFE) and HUD-1 Charges Cha es that Cannot Increase HUD-1 Line No. Our origination charges # 801 Good Faith Estimate 830 00 HUD-i 830 0 Your credit or charge (points) for the specific interest rate chosen # 802 . 3 71 88 . 0 3 67] 8 Your adjusted origination charges # 803 , . 4 501 88 , . 8 4 501 88 Transfer taxes # 1203 , . 1,535.00 , . 1,535.00 charges that in Total Government recording d # 1201 HUD-1 ] 32.00 - .- . .- s 'E Char es that Can Chan a HUD-1 Line No. G Initial deposit for your escrow account # 1001 Daffy interest Charges # 901 Homeowner's insurance # 903 Title services and lender's title insurance # 1101 Loan Terms ~ .00 or .00 h E stimate HUD-1 1,4 6.64 1,273.32 1 97.1? ] 4.08 5 0.00 492.00 1.348.25 Your initial loan amount is $ 117,500.00 Your loan term is 20 years Yaur initial interest rate is 4.375 °~(, Your intial monthly amount owed for $735.46 includes principal, interest ~ Principal and any mortgage insurance is ~ Interest ^ Mortgage Insurance Can your interest rate rise? ~ No. CI Yes, it can rise to a maximum of °~. The first change will be on and can change again every after . Every change date, your int ~ rest rate can increase or decrease by °~. Over the life of the loan, your interest rate is guaranteed to never be lower than % or higher than %. Even if you make payments on tune, cart your loan balance rise? ~ No. ^ Yes, it can rise to a maximum of $ Even if you make payments on time, ~ No. ^ Yes, the first increase can be orj can your monthly amount owed for prindpal, and the amount owed can rise to $ interest and mortgage insurance rise? The maximum it can ever rise to is $ Does your loan have a prepayment penalty? ~ No. ^ Yes, your ma>amum prepayment penatiy is $ hoes your loan have a balloon payment? ~ No. ^ Yes, you have a balloon paym ~t of $ due in -years on Total monthly amount owed ^ You do not have a monthly escrow account fir items, such as property induding escrow account payments taxes and homeowners insurance. You must pay the Isl a items diredly yourself. J'~T You have an additional monthly escrow payment of $230.85 that results in a total monthly amount owed of $ .This includes princpal, interest, any mortgage insurance and any items checked below: ^ Property taxes ^ Homeowners insurance ^ Flood insurance ^ ^ ^ I i i Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. Software and Added Formatting O20o9 ARa Star Software. Inc. {877)279-8898 www.HudLife.com age O Sus uehanna q Susquehanna Bank 26 North Cedar Street P.O. Box 1000 Lititz, PA 17543-7000 Toll free 800.311.3182 November 23, 2009 JOHNSON AND DUFFIE LAW OFFICES ATTN: CYNTHIA S HUBLER 301 MARKET STREET PO BOX 109 LEMOYNE PA 17043-0109 RE: James W Milliken SS # : 159-24-8376 DOD: November 7, 2009 To Whom It May Concern: In response to your letter of November 19, 2009, here is the above customer account information as of November 7, 2009. Account #1 Account #2 • Account Title: James W Milliken James W Milliken Revocable Totten Trust • Account Type/# Ckg-146004402 CD-346094015 • Date Opened /Maturity 03/03/2004 2/ 19/2004 2/19/2010 • Interest Rate: .20% 3.06% • Account Balance*: 37,848.58 20.497.52 • Accrued Interest: $0.20 $32.64 • YTD Interest: $104.80 $515.10 *Account balance does not include accrued interest. There is no safe deposit box in the name of the decedent. If I can be of further assistance, please feel free to call. Sincerely, c~vu ~?!j Dawn M. Berrier Support Services Lead 1-717-625-6546 DMB/kklo Account #3 James W Milliken Revocable Totten Trust CD-403300003932 8/22/2007 1/22/2011 3.93% $43,272.86 $74.54 $1,391.24 . AIPhI~AISAL ~~ Personal Property of ,~ . ~ ~ L ~ ~IOV ~ ~ ~ 09 r M 1 ~- I ~ ~~r r~ ~ ~ U -~~ ~IvDL Appraised by Chuck E. 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