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Home My WebLink About05-10-10 (2)REV-1500 Ex (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po eox 28os°' 21 09 0920 Harrisburg, PA 17128-0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 172 01 2433 09 25 2009 09 26 1917 Decedent's Last Name Suffix Decedent's Frst Name MI Peiffer Fay A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Frst 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 O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) ~ a. Limited Estate O 4a. Future Interest Compromise (date of D 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate D 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) C! 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 to: Name Daytime Telephone Number Stephanie Kleinfelter, Esq. 717 901 7786 Frm Name (If Applicable) Keefer Wood Allen & Rahal, LLP Frst line of address 635 N. 12th Street, Suite 400 Second line of address City or Post Office State ZIP Code Lemoyne PA 17043 Correspondent's a-mail address: Sklelnfelter@keeferWOOd.COm REGISTEROF WILLS USE ~Y '- n c ~ __ ~ i-~ > - t - za ~ w ~ D,4TE-F~EO f •~3 t~..~ N 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 the preparer other than personal representative is based on all information of which preparer has any knowledge. SIGNATUREOF PERSON RESPONSIBLE FOR FILING RETURN DATE /Llti~vt 4i'~ ~~.CL~~'fF`YS~L'!l sf'~L/-~C A RESS Karen M. Gillardy - 445 Shelle s Lane, Etters, PA 17319 SIGNATU E FPREPAREROTH,~RT ANR PRESENTATIVE DATE ADORES ; Step anie Klein elter, Esq. 635 N. 12th Street, Suite 400, Lemoyne, PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 ^ CI^ ^I I ^^ I ^ ^^ L1 I ^^ J ~~.._. _~ Rev-1500 IX Decedent's Social Security Number Decedent's Name: Fay A. Peiffer 172 01 2433 RECAPITULATION 1. ..................................... Real estate (Schedule A) 1• .... 126,000.00 2. ................................ Stocks and Bonds (Schedule B) .... 2. O.OO 3. Closel Held Corporation, Partnershi or Sole-Proprietorshi Schedule C y P P( ).. .... 3. O.OO 4. Mortgages&NotesReceivable (Schedule D) ~.••••••••••••••••••••• •••• 4• O.OO 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... .... 5. 82,419.65 6. Jointly Owned Property (Schedule F) O Separate Billing Requested • • . • • • 6. 27,052.96 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested • • • • • • 7. 78.01 8. ............................ Total Gross Assets (total Lines 1-7) .... a. 235,550.62 9. Funeral Expenses & Administrative Costs (Schedule H) ... • • .. • • • • • • • • • • • • • 9. 20,613.01 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .... • • • • • • • • • • • 10. 2,078.39 11. Total Deductions (total Lines 9 & 10) .. ~ • • • • • • • • • • • • • ~ • • • • • • • • • • • • • • • 11. 22,691.40 212 859.22 12. 13. 14. Net Value of Estate(LineBminusLinell)......•••••••••••••••• Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .. • • • • • • • • • • • Net Value Subject to Tax (Line l2 minus Line l3) ..•••••••••••••• ••••••• •••••• 12. ,3 1a. ' 0.00 212,859.22 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 OO O O OO (a)(1.2) X .00 . 15. . 16. Amount of Line 14 taxable 212 85 9 22 16 9,578.66 at lineal rate X .045 17. Amount of Line 14 taxable 0 00 0.00 at sibling rate x .12 . 17 1s. Amount of Line 14 taxable 00 0 0.00 at collateral rate X .15 . 1g 9,578.66 19. ............................................. TAX DUE ....... ,s. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q Side 2 Rev-1500 EX Page 3 Decedent's Complete Address: Fle Number 21 09 0920 DECEDENTS NAME Fa A. Peiffer DECEDENTS SOCIAL SECURITY NUMBER 172-01-2433 STREET ADDRESS 558 Walunt Street CITY Lemoyne STATE PA ZIP 17043-1546 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 9,578.66 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments 8,393.00 C. Discount 441.72 Total Credits (A + B + C) (2) 8,834.72 3. Interest/Penalty if applicable D. Interest 0.00 E. Penalty 0.00 Total Interest/Penalty (D + E) (3) 0.00 4. If Llne 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Flll in oval on Page 2, Llne 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) 743.94 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 743.94 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? ................................. ... 3. Did decedent own an "intrust fog" or payable upon death bank account or security at his or her death? Q ^ 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. Sect. 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. Sect. 9116(a)(1.1)(ii)]. The statue 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. Sect. 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. Sect. 9116(1.2) [72 P.S. Sect. 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. Sect. 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+(8-98) SCHEDULE A COM NOHERTANCEOTAXRETURLNANIA REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Fav A. Peiffer 21 09 0920 All real property owned solely or as a tenant in common must be reported atfair marketvalue. Fair marketvalue is defined as the price at which property would be exchanged between a willing buyerand a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. (If more space is needed, insert additional sheets of the same size) REV -1508 EX+ (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAXRETURN PERSONAL PROPERTY RESIDENTDECEDENT ESTATE OF FILE NUMBER Fay A. Peiffer 21 09 0920 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 Scheduel F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Susquehanna Bank 21,365.84 Checking Account No. 10004353685 2 Susquehanna Bank 4,946.93 Statement Saviangs Account No. 10004354030 3 Members 1st 17,390.64 Certificate Of Deposit No. 31973-42 Maturity Date 10/14/09 Principal $17,366.52 Accrued Interest $24.12 4 Members 1st 31,956.88 Certificate Of Deposit No. Maturity Date 04/15/2010 Principal $31,956.88 5 Members 1st 5,861.68 Account No. 31973-42 Savings 6 Cash 13.68 Held In Scottrade Account No. 65853434 7 U.S. Treasury -Refund Of Overpayment Of U.S. Individual Income Tax For 884.00 Year 2009 TOTAL (Also enter on line 5, Recapitulation) I 82,419.65 (If more space is needed, insert additional sheets of the same size) 1 REV-1509 EX+(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN RESIDENTDECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Fay A. Peiffer 21 09 0920 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Karen M. Gillardy 445 Shelleys Lane Daughter Etters, PA 17319 B. Lisa McBride 612 Overlook Drive Granddaughter Etters, PA 17319 c. JOINTLY-OWNED PROPERTY: ITEM NUM. LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY. INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCTNUMBERORSIMILARIDENTIFVING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 AB Cornerstone 26.53 33.333 8.84 Federal Credit Union Member No. 107 2 A 57 Common Shares Peabody Energy Corp. 2,114.70 50.000 1,057.35 Held In Scottrade Account No. 65853434 3 A 4,250Common Shares Sprint Nextel Corporation 16,830.00 50.000 8,415.00 4 A 290 Common Shares Century Tel 9,529.40 50.000 4,764.70 5 A 432 Shares Windstream 4,246.56 50.000 2,123.28 6 B 2,970 Common Shares Sprint Nextel 11,761.20 50.000 5,880.60 Corporation 7 B 202 Common Shares Century Tel 6,637.72 50.000 3,318.86 8 B 302 Shares Windstream 2,968.66 50.000 1,484.33 TOTAL (Also enter on line 6, Recapitulation) I 27,052.96 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+(6-98) COMMONWEALTH OF PENNSYLVANIA INH ERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Fay A. Peiffer 21 09 0920 This schedule must be completed and filed if the answerto any of questions 1 through 4 on the reverse side of the REV-1500 COV E R SH E ET is yes. ITEM NUM DESCRIPTION OF PROPERTY INCLUDE NAMEOFTRANSFEREE,RELATIONSHIPTODECEDENT& DATE OF TRANSFER. ATTACH COPYOF DEED FOR REAL ESTATE DATE OF DEATH VALUE OF ASSET %OFDEC'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1 Cornerstone Federal Credit Union 25.95 100 0.00 25.95 Member No. 7241 2 Cornerstone Federal Credit Union 26.09 100 0.00 26.09 Member No. 7242 3 Cornerstone Federal Credit Union 25.97 100 0.00 25.97 Member No. 7240 TOTAL (Also enter on line 7, Recapitulation) (If more space is needed, insert additional sheets of the same size) 78.01 REV-1511 EX+(10-OB) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETU RN ADMINISTRATIVE COSTS RESIDENTDECEDENT ESTATE OF FILE NUMBER Fay A. Peiffer 21 09 0920 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Myers-Harner Funderal Home, Inc. 2,137.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City _ State Zip Year(s) Commission Paid: 2. Attorney Fees 9,000.00 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 310.00 5. i Accountant's Fees 6. Tax Return Preparel's Fees See schedule attached TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) 9,166.01 20,613.01 Page 2 Estate of: Fay A. Peiffer 21 09 0920 Schedule H, Part B -Administrative Costs Miscellaneous Expenses Item Number Description Amount 7 Cumberland Law Journal -Legal Advertisement 75.00 8 The Sentinel -Legal Advertisement 166.30 9 Cumberland County Register Of Wills 80.00 Miscellaneous Charges: Will $15.00 Short Certificates $20.00 JCP Fee $10.00 Automation Fee $ 5.00 Inheritance Tax Return $15.00 Inventory $15.00 10 Eshenaura Fuels, Inc. -Repair Pipe To Kitchen Sink 112.76 11 Bonsell Lawn Care 598.30 11 /4/09 $169.60 12/12/09 $222.60 04/11/10 $196.10 04/23/10 $ 10.00 12 PP&L 282,07 11/13/09 $48.32 12/14/09 $47.45 01/15/10 $49.99 02/17/10 $41.56 03/15/10 $34.36 04/17/10 $30.39 04/23/10 $30.00 13 Pennsylvania American Water 206.01 11/16/09 $33.92 12/15/09 $35.53 01/15/10 $32.60 02/13/10 $31.81 03/15/10 $29.44 04/15/10 $28.71 04/23/10 $14.00 14 Borough Of Lemoyne -Sewer And Refuse 270.13 10/01 /09-12/31 /09 $120.50 01 /01 /10-03/31 /10 $120.50 04/23/10 $29.13 15 Montour Home Comfort Services -Fuel Oil 952.25 TOTAL. (Carry forward to main schedule) ...... 2,742.82 Estate of: Fay A. Peiffer Schedule H, Part B -Administrative Costs Miscellaneous Expenses Item Number Description 15 11/19/09 $118.17 01/23/10 $257.83 02/01/10 $294.46 02/22/10 $281.79 16 Richard Cassel -Trash Removal 17 Jeff Taylor -Snow Removal 12/20/09 $50.00 18 Special Pest Control Service Agreement -Termites 19 Complete Inspection Agency - Repair Flooring in Livingroom (termite damage) 20 Keefer Wood Allen & Rahal, LLP Miscellaneous Disbursements Paid 12/07/09 Register Mail/Insured Mail $17.13 Postage $ 5.35 Copies $ 7.20 Telecopier $ 8.00 Deed Search $30.00 21 Cordier Antiques & Auctions -Advertisements and Commissions 22 Secured Lanad Transfers -Tax Certification Page 3 21 09 0920 Amount 200.00 50.00 824.68 520.33 67.68 4, 745.50 15.00 TOTAL. (Carry forward to main schedule) ...... 6,423.19 REV-1512 EX+(12-03) COMMONWEALTH OF PENNSYLVANIA iNHERITANCETAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ____ ESTATE OF FILE NUMBER Fay A. Peiffer 21 09 0920 Report debts incurred by decedent prior to death which remained unpaid as of date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Holy Spirit Hospital -Medical Expense 1,068.00 2 ~ Bonsell Lawn Care -Lawn Maintenance ~ 437.78 3 USAA P&C Premium -Check Cleared After Death (Homeowners' Insurance) 260.17 4 PP&L -Electric Service To Residence 72.33 5 Pennsylvania American Water ~ 30.31 6 WSEMS- Chambersburg ALS/BLS -Medical Expense ~ 99.80 7 ~ Keefer Wood Allen & Rahal, LLP -Legal Services ~ 110.00 TOTAL (Also enter on line ~0, Recapitulation) I 2,078.39 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+(9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCETAX RETURN RESID ENTDECEDENT ESTATE OF FILE NUMBER Fay A. Peiffer 21 09 0920 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBE NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY Do Not Llst Trustees OF ESTATE z TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Karen M. Gillardy Daughter 202,097.42 445 Shelleys Lane Etters, PA 17319 Lisa McBride Granddaughter 10,683.79 612 Overlook Drive Etters, PA 17319 Alexandra N. McBride Great-Granddaughter 25.97 612 Overlook Drive Etters, PA 17319 Andrew M. McBride Great-Grandson 26.09 612 Overlook Drive Etters, PA 17319 Ryan C. McBride Great-Grandson 25.95 612 Overlook Drive Etters, PA 17319 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18, AS APPROPRIATE, ON REV-1500 COVER SH EET it NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 (If more space is needed, insert additional sheets of the same size) A Settlement Statement U.S. Department of Housing and Urban Development OMB Approval No 2502-0265 B Type of Loan t ; ,' FHA 2. I RHS 3 ; 1 Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Numoer 4_ [ ] VA 5- ; ~ Gonv. Ins. 401000323-CH C NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlemen; agent are shvwn Items marked "(p.o.c.)" were paid outside of the closing: they are shown here for iniormationat purposes and are no! included ir: me totals D. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of Lender ROMEO LIO KAREN GILLARDY, EXECUTRIX OF ESTATE OF FAY A. PEIFFER 209 N. 36TH STREET CAMP HILL, PA 17011 558 WALNUT STREET LEMOYNE, PA 17043 G. Property Location 558 WALNUT STREET, H. Settlement Agent (SECURED LAND TRANSFERS - MECHANICSR', IRr; ~~iwvTrvr=, rH i ~v4a Place of Settlement COUNTY: CUMBERLAND 485 ST. JOHNS CHURCH ROAD„ PARCEL ID: 12-21-0267-261 SHIREMANSTOWN, PA 17011 TOWNSHIP: LEMOYNE BOROUGH I. Settlement Date 04/23/2010 Disbursement Date 04!23/2010 J. SUMMARY OF BORROWER'S TRANSACTIONS K. SUMMARY OF SELLER'S TRANSACTIONS 100. Gross Amount Due From Borrower 400. Gross Amount Due To Seller 101. Contract Sales Price $126,000.00 401. Contract Sales Price 5126,000.00 102. Personal Property 402. Personal Property 103. Settlement Charges to Borrower $2,211.88 403. Adjustments For Items Paid By Seller In Advance Adjustments For Items Paid By Seller in Advance 113. City/Town Taxes 413. City/Town Taxes 114_ County Taxes 621.781yr 4/23/2010 to 1/1/2011 $430.99 414. County Taxes 621.78/yr 4/23/2010 to 1/1/2011 $430.99 115. School Taxes 1 ,243.63lyr 4/23/2010 to 7!1/2010 $235.10 415. School Taxes 1 ,243.63/yr 4!23/2010 to 7/1/2010 5235. i 0 118. Assessments 418. Assessments 1 19. 419. 122. Sewer and Refuse 120.50igtr for 4/23/2010 to 7/1 /2010 $g1 37 422. Sewer and Refuse 120.50/qtr for 4/23/2010 to 7/1 /2010 $91 37 120. Gross Amount Due From Borrower $128,969.34 420. Gross Amount Due To Seller $1 "t6,757.46 200. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller 201. Deposit or earnest money $10,000.00 501. Excess Deposits 202. Principal 502. Settlement Charges to Seller ~ 6.141 00 203. Existing Loan(s) Taken Subfect to 503. Existing Loan(s) Taken Subject to Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller 210. 510. 211. 511. 212. 512. 213. City/Town Taxes 513. City/Town Taxes 214. County Taxes 514. County Taxes 218 Assessments 518. Assessments 219. 519. 220. Buyer's Total Credits $10,000.00 520. Seller's Total Charges ~ [~,6 141 Oii 300. Cash At Settlement From/To Borrower 600. Cash At Settlement TolFrom Seller 301. Gross Amount Due From Borrower (line 120) $128,969.34 601. Gross Amounl Due To Seller (line 420j $ i 26,757.46 302. Less Amounts Paid By/For Borrower (line 220) $10,000.00 602. Less Deductions In Amt. Due To Seller (line 520) 36,141 -00 303. Cash [ X ] Frorn [ ] To Borrower $118,969.341603. Cash [ X ] To [ ]From Seller 3? 20,t,16 46 40' ii00323 - CH L. Settlement Statement 700. Total Sale Commission 126000.00 @ 3 % = 3780.00 Division of Comm~ssior. (hne 700) As Follows: 701. $378C.00 to Cordier Antiques & Auctions 702. Commission Selling Page 2 Paid From Borrowers Paid From Seller's Funds At Settlement Funds At Settlement 703. Commission paid at settlement $3 780 00 800. Items Payable In Connection With Loan 1001. Hazard Ins. Reserve 1002. Mortgage Ins. Reserve 10x)3 City Property Taxes 1004. County Property Taxes 1010. Aggregate Accounting Adjustment i i vu. ~ ive cnarges 1101. SettlemenUClosing Fee 1102. Abstract or Title Search 1103. Title examination 1104. Title Insurance Binder 1105. Document preparation 1106. Notary fee 1107 Attorney Fee 1108. Title ms Total to Secured Land Transfers -Mechanicsburg $ggg g8 1109- Lender's Coverage $ ($) 111 r~ Owner's Coverage $126000.00 ($889.88)Reissue Rate 1138. Processing;Tax Cert. to Secured Land Transfers -Mechanicsburg $15.00 1200. Government Recording And Transfer Charges 1201 _ Recording Fees for Deed 62.00; Recording Fees for Mortgage $62.00 1202. City/County Tax/Stamps 1260.00 $1,260.00 1203. State Deed Tax 1260.00 $1,260.00 isuu. F+oamonai aemement Gnarges 1 305. Advedising Fees to Cordier Antiques & Auctions $965 50 1306- Sewer and Refuese (AprillMaylJune) to Lemoyne Borough Office $120-50 1400. Total Settlement Charges $2,211 .88 ~ $6,141 .00 I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief it is true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. BUYERS SELLERS ~ i-~ . _~!~!~/"_.-_____ _ _ 'w _ __ __ Estateof F ayA. Peiffer _ Romeo L~~o ,,~ , ~~ -_,~ ~~fC~.lC/ ~~ / ~ By: Karen Gillardy, Executrix The HUD-)/Srttler~ient Stal men accordande ~th hi~ st-t~tnent.~ t which I have epare~s a true and ~ ~ ;' accurate account of this transaction. I have caused or will causr~~ the funds to be disbursed in ~ ~ d;' J/' Settlerrl~ert3'A ~- ' Date 04/23/2010 SFCURFDt_AND7RANSFFRS- MECHANICSBUR~ yuu. items Kequirea ay ~enuer ~ v oe raga m wavance 901 _ In(erest 902 . Mortoaee Insurance Premium 903 . Hazard Ins. Premium 1000. Reserves Deposited With Lender REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA No . 2009- 00920 Estate Of: FAYA PEIFFER CERTIFICATE OF GRANT OF LETTERS PA No . 21- 09- 0920 (First, Middle, Last/ Late Of : LEMOYNE BOROUGH CUMBERLAND COUNTY Deceased Social Security No: 172-07-2433 WHEREAS, on the 1st day of October 2009 an instrument dated February 15th 1995 was admitted to probate as the last will of FA Y A PEIFFER /First, Middle, Last) late of LEMOYNEBOROUGH, CUMBERLAND County, who died on the 25th day of September 2009 an WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: KAREN M GILLARDY who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, all of which ful ~ y appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 1st day of October 2009. ~_~' !~ `_ '' F Register of Wills /j t ~ `' ~, J **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) ~11'tt,~~ ~tll tt~td ~E~ttt~tP~t~ O F F A Y A. P E I F F E R I, FAY A. PEIFFER, being of sound and disposing mind, declare this to be my Last Will and Testament and hereby revoke all prior wills and codicils made by me. -1- M}- Executrix shall pay from the residue of my estate all debts, administrative expenses and all estate, inheritance, succession and transfer taxes imposed by the United States or any state, territory or possession which shall become payable by reason of my death. It shall not be necessary to file any claims therefor, nor to have them aJ.lowed by any court. -2- I give, devis~ a^.d bequeath the rest, .residue and remainder of my estate, real, personal and mixed, of whatever kind and nature, and wherever situated at the time of my death, including any property over which I now have or hereafter acquire a power of appointment to my daughter, RAREN M. GILLARDY, provided she survives me by sixty (60) days. -3- In the event my daughter, RAREN M. GILLARDY, predeceases me or does not survive me by sixty (60) days, the rest residue or remainder of my estate to my granddaughter, LISA R. MC BRIDE, ~ s/9~ -4- Should my granddaughter, LISA R. MC BRIDE, predecease me or fail to survive me by sixty days, I direct that the rest, residue or remainder of my estate be divided between my great grandchildren living at the time of my death. At the time I write this My Last Will and Testament, my great grandchildren are ANDREW MICHAEL MC BRIDE, RYAN CODY MC BRIDE AND ALEXANDRA NICOLE MCBRIDE. -5- I appoint my daughter, KAREN M. GILLARDY, as Executrix of this, My Last Will and Testament. In the event that my daughter, KAREN M. GILLARDY, fails to survive me, fails to qualify, refuses or ceases to act as Executrix, I appoint my granddaughter, LISA R. MC BRIDE, as Executrix of this, My Last Will and Testament. In the event that my grandaughter LISA R. MC BRIDE, fails to survive me, fails to qualify, refuses or ceases to act as Executrix, I appoint my nephew, JAMEB L. COULSON, JR., as Executor and as Trustee for that portion of my estate designated for any great grandchild who is a minor at the time of my death to serve in that capacity until said great grandchild attain their majority. Either LISA R. MCBRIDE or JAMES L. COUL60N JR. are to serve without bond or without being required to account to any Court. IN WITNE68 WHEREOF, I, FAY A. PEIFFER, have set my ~~ hand and seal this /S~`"day of ~ 199 ~~ /_k~ ( SEAL ) Signed sealed, published and declared by the above named Testatrix, FAY A. PEIFFER, as and for her Last Will and Testament, in the presence of us, who have hereunto subscribed our names at his request as witnesses hereto, in the presence of the said FAY A. PEIFFER, and of each other. The preceding document consists of this and ? other consecutively numbered typewritten pages. /1 ~ /}--~- i'~~,, ~ ~ residing at ~~o,~ r ~ (%~~- _~~_ ~~_ ~,_ residing at~'~~- ~-~-~"'-~r- COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND ~FfEO~ ~i~r~,~~a~F l ,~i.~SCti/ and the Testatrix and the witnesses trument1 havinghbeennduly are signed to the foregoing qualified according tc law, do hereby declare to the undersigned authority that we were present and saw the Testatrix sign and execute the instrument as her Last Will and Testament; that she signed it willingly; and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as witness and to the best of their knowledge the Testatrofx sound t mind ande underteno years of age or older, and that I, the said constraint or undue influence; that I signed and Testatrix do hereby acknowledge that I si ned it last will, g executed the instrument as my willingly and that I signed it as my free and voluntary act for the purposes herein expressed. /~ 1~! ll ~ /~ „-,~1~ ~-ti y Sworn and subscribed to before me th i s 1$'t-~--..' day o f ~c~-L~-~--~ 19 [51 n .~ ~ Notary blic t of ~~ ~~ ~r~r f I)J IC Da ~ ~r V I .... 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