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HomeMy WebLinkAbout06-11-10J 1505607120 REV-1500 EX (OS-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Boxzsosol INHERITANCE TAX RETURN Harrisburg, PA 1712s-0601 ~ RESIDENT DECEDENT 2 1 0 9 0 6 6 2 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 202 14 7272 01 01 200$ 12 12 1921 Decedent's Last Name Suffix Decedent's First Name MI MULLIGAN DORGTHY V (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 IX ~ ~ 1. Original Return ~ 2. Supplemental Return L~ 3. Remainder Retum (date of death 4. Limited EstateI~j 4a Future Interest Compromise prior to 12-13-82) l (date of death after 12-12-82) 5. Federal Estate -Tax Retum Required L-J LX~ 6. Decedent Died Testate f ~ (Attach Copy of Will) L ~ Decedent Maintained a living Trust (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ~~ 9. Litigation Proceeds Received ~ S o I P J u 10 be~een 12 31-91 and~tllatge5)f death I~ 11. Election to tax under Sec. 9113(A) ~-~ (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name JAN M SiJ I L E Y Daytime Telephone Number 717 432 9666 Firm Name (If Applicable) THE W I L E Y G R C~ U P, p C REGISTER OF WILLS USE ONLY First line of address t~ ~ <:,~_ 1 3 0 W . CHURCH STREET `=~~~ `~~ .~'t.~' Second line of address , ~ , -i-- ~ ~ ~. :~ ~~ ~ 1 i~ . City or Post Office DATA-~fiL ~ =~~`~ '= ~ D I L L S B U R G State ZIP Code ; f:--.~~ °.-- ..:~~. ~-`~~ ~ P A 1 7 0 1 9 -~ ~.:, ~ ..;-~ R ~ _ yi ~•~~ \~a r~ Correspondent's a-mail address: y Under penalties of perjury, I declare that 1 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 informati SIGNAT f URE OF PERSON RESPONSIBLE FOR FILING RETURN i ~ , on o which preparer has any knowledge. ~ ' t Terry Sierotowicz DATE ADDRESS ~- f~ v 1134 S afras Lane, Mechanicsburg, PA 17055 SIGNATU 1 OF P EPARER OTHER THAN REPRESENTATIVE f/YI Jan M Wiley DATE ADDRESS,~^ ~ O 13 W, hurch Street, Dillsburg, PA 17019 Side 1 1505607120 1505607120 J 1505607220 REV-1500 EX ' Decedent's Social Security Number Decedent s nra~: Dorothy V. M u i i i g a n -- -------- --------- - ---------- - -- ECAPITULATION __ - -- ---------- 2 0 2 1 4 7 2? 2 ---___- 1. Real Estate (Schedule A) ..................................... .............................................. 1. 1 2 0 5 2 3 9 4 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 , 4 1 1 3 5 6. Jointly Owned Property (Schedule F) CJ Separate Billing Requested ............. 6. 3 8 5 6 0 0 5 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property , (Schedule G} ~ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7} ......... .............. ....... g. 1 5 4 9 5 3 4 9. Funeral Expenses & Administrative Costs (Schedule H) ............................. ............ - 9. ----- .3 2 , 5 6 2 1 8 10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) ........................ 4 0 8 2 5 5 11. Total Deductions (total Lines 9 8~ 10) ................. ........................................ 11. ~; 6 6 4 4 7 3 12. Net Value of Estate (Line 8 minus Line 11) ...... . .................................................... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12. 128 850 61 an election to tax has not been made (Schedule J) ....... ......... ................................. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... - ........................... 14. 128 , 850.61 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 0 0 0 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate X .045 1 2 8, 8 5 0. 6 1 17. Amount of Line 14 taxable 16. 5, 7 9 8. 2 8 at sibling rate X .12 0 0 0 17- 0 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18- 0 0 0 19. Tax Due ................................................... .................................................................. 19- 5, 7 9 8. 2 8 20. FILL tN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. L 1505607220 Side 2 1505607220 J REV-1500 EX Page 3 File Number 21-09-0662 Decedent' C s omplete Address: DECEDENT'S NAME Dorothy V. Mulligan STREET ADDRESS - - _ ---------- ---___ -_-__-- ------------- -- - 483 Delancey Court --- _ __ CITY - --- -- ---- ------- _ Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 STATE _ _ _ '-ZIP --- --- ------ - PA 17055 c1) 5,798.28 3. InteresUPenalty if applicable Total Credits (A + g + C) (2) ____ 0.00 D. Interest 0.0 0 E. Penalty _-_-_ ..- Total Interest/Penalty (D + E) (3) _ 0.00 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 (4) ______ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5,798.28 A. Enter the interest on the tax due. ------- --- -- (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. --- -- - (5B) 5, 7 9 8.2 8 Make Check Payable to: REG/STER OF W/LLS, AGENT ,~. ,, PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BL OCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;.................. Yes No ................................................................ a° o b. retain the right to designate who shall use the property transferred or its income :.................................... c. retain a reversionary interest; or ...................... x 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 x receiving adequate consideration?....... ^ ^ ......................... . ......................................................................... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ ^ contains a beneficiary designation? ................ ^ .... ... ......... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)j. 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)J. 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. Rev1502 EX+ (fi-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mulligan, Dorothy V. FILE NUMBER 21-09-0662 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 willing buyer and a willing seller, neither being compelled to buy or self, 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Sale of property situate at 483 Delancey Court, Mechanicsburg, PA: 119,900.00 2 Tax and utility proration due estate from sale of real estate: 623.94 TOTAL (Also enter on Line 1, Recapitulation) 120,523.94 ({f more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) Rev-1508 EX+ (1i-981 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mulligan, Dorothy V. FILE NUMBER 21-09-0662 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Carl Muller (payment owed -mold mitigation): 1,100.00 2 Cash found at decedent's residence: 2,746.38 3 Comcast (refund): 4.41 4 Jack Gaughen Realty Assoc.: 1,000.00 5 PNC Bank Checking Account #5070102355: 1,050.17 6 Tax rebate: 500.00 7 Verizon (refund): 10.39 TOTAL (Also enter on Line 5, Recapitulation) 6,411.35 (If more spare 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) SCHEDULE F JOINTLY-OWNED PROPERTY Rev-1509 EX+ (6-98) ~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mulligan, Dorothy V. ILE NUMBER 21-09-0662 A. Terry L. Sierotowicz B. C. 1134 Sassafras Lane Daughter Mechanicsburg, PA 17055 JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY ITEM NUMBER FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER DATE OF DEATH % OF DECD'S DATE OF DEATH TENANT JOINT OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST JOINTLY-HELD REAL ESTATE. 1 A 12/19/2003 PNC Bank Account Number 33,862.38 0.500% 16,931.19 50-3012-4904: 2 A 12/19/2003 Wachovia Securities Account 43,257.72 0.500% 21 628 86 #6086-7093: , . TOTAL (Also enter on Line 6, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. H 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 38,560.05 Form PA-1500 Schedule F (Rev. 6-98) REV-1151 EX+ (12-99) t COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Mulligan, Dorothy V. Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Terry Sierotowicz Social Security Number(s) / EIN Number of Personal Representatives}: Street Address 1134 Sassafras Lane city Mechanicsburg state PA zip 17055 Year(s) Commission paid 2010 2. Attorney's Fees The Wiley Group, PC 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant FILE NUMBER 21-09-0662 AMOUNT 2,081.27 7,000.00 7,000.00 Street Address Clty State zip Relationship of Claimant to Decedent 4. I Probate Fees Register of Wills: 294.00 5. Accountant's Fees 6. Tax Return Preparer's Fees Boreman ~ Babb: 50.00 7. Other Administrative Costs 16,136.91 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 32,562.18 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 Mulligan, Dorothy V. 21-09-0662 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Hetrick Funeral Home: 1,568.27 2 Memorial Luncheon: 250.00 3 Obituaries: 263.00 H-A Subtotal 2,081.27 Other Administrative Costs 4 Battery for garage door opener: 5.29 5 Carpet Barn (replace carpetj: 811.00 6 Cumberland Law Journal (advertise estate): 75.00 7 Fagers (new kitchen faucet): 63.32 8 Mold Remediators: 2,310.00 9 Pat Rainell (Electrical repairs): 357.10 10 PNC Bank (check printing fee): 16.19 11 Postage: 41.50 12 Real estate settlement charges: 9,125.27 13 Register of Wills (filing fee): 30.00 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 Mulligan, Dorothy V. FILE NUMBER 21-09-0662 ITEM NUMBER DESCRIPTION AMOUNT 14 Seller Assist -sate of real estate: 2,500.00 15 Terry L. Sierotowicz (reimbursement for kitchen disposal and bathroom faucet): 105.00 16 Terry L. Sierotowicz (reimbursement for stove, copies, etc): 488.46 17 The Sentinel (advertise estate): 208.78 H-B7 Subtotal 16,136.91 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERrrANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS tSTATE OF Mulligan, Dorothy V. Include unrelmbursed medical expenses. FILE NUMBER 21-09-0662 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Comcast: 56.17 2 Delancey Court (condo assoc): 920.00 3 Messiah Village: 692.05 4 PP&L: 365.12 5 Real estate taxes: 1,177.95 6 State Farm Insurance: 218.00 7 United Water: 117.22 8 Upper Allen (sewer): 336.00 9 Verizon: 26.04 10 York Waste Disposal: 174.00 TOTAL (Also enter on Line 10, Recapitulation) I 4 082 55 (If more space Is needed, addlUonal pages of the same size) ' Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule i (Rev. 6-98) REV•1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES t51ATE OF Mulligan, Dorothy V. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2}} 1 Patricia N. Loboda 111 South Street Lewisberry, PA 17339 2 Christopher T. Mulligan 77 Sterling Dr. Colonic, NJ 07067 3 Robert M. Mulligan 1 Maple St. Clark, NJ 07066 4 Terry L. Sierotowicz 1134 Sassafras Lane Mechanicsburg, PA 17055 II. FILE NUMBER 21-09-0662 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) ~$$$~ Do Not List Trusteels- ~ Daughter I Son I Son Daughter 32,212.65 32,212.65 32,212.65 I Total 128,850.60 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Copyright (c) 2002 form software only The Lackner Group, Inc. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 32,212.65 Form PA-1500 Schedule J (Rev. 6-98) LAST WILL AND TESTAMENT ot= DOROTHY VIRGINIA MU!LLtGAN I, DOROTHY VIRGINIA MULLIGAN, a resid ent of 483 Delancey Court, Mechanicsburg, Cumberland County, Pennsylvania, do miake, publish and declare this to be my Last Will and Testament, hereby revoking all previous Wills and Codicils made by m e. FIRST IDENTITY OF TESTATRIX'S FAMI LY I declare that I have four children, now living, whose names are CHRISTOPHER T. MULLIGAN of Rahway, New,Jersey, ROBERT M. MULLIGAN, II of Clark, New ,Jersey, and TERRY LYNN SIEROTOWICZ of Mechanicsburg, Pennsylvania and PATRICIA NOREEN LOBODA of Lewisberry, Pennsylvania an d all of whom have reached the age of majority. All references in this Will to "my children" are references to the above named children. SECOND DISPOSITION OF ESTATE I specifically bequeath to my daughter PATE:ICIA NOREEN L_OBODA the automobile which I own at the time of my death. f~U ~~ ~ ~^ d ~-~l I give, devise, and bequeath my entire estate ,whether real, personal or mixed, to my children, to share and share alike. Each bE~quest to a child who does not survive me by thirty (30) days shall be distributed to such child's issue, per PAGE ONE OF FIVE stirpes, who survive me by thirty (30) days. In the event there shall be no person who survives me, I give, devise and bequeath my entire estate to the organization known as Save the Children. THIRD EXECUTOR/EXECUTRIX (1) I appoint my daughter, TERRY LYNN SIEROTOWICZ, as the Executrix of this Will. In the event of her death, resignation, renunciation, or inak>ility to actin that capacity, I direct that my son, ROBERT M. MULLIGAN, II serve as the sole Executor. No Bond Re uired (2) No bond or other security shall be required of any Executor appointed in this Will. Powers (3) My Executor/Executrix shall have, in, extension and not in limitation of the powers given by law or by other provisions of this Will, the following powers with respect to the settlement and administration o~f my estate: Employment of Attorneys, Advisors :and Other Agents (a) To employ any attorney, investment advisor, accountant, broker, tax specialist, or any other agent deemed necessary by my Executor/Executrix; and to pay from my estate reasonable compensation for all services performed by any of them. Conduct Business (b) To conduct alone or with others any business in which I am engaged or in which I have an interest at my dE~ath, with all the powers of any PAGE TWO OF FIVE owner with respect thereto, including the power to delegate discretionary duties to others, to invest other property held hereunder in such business and to organize a partnership or corporation to carry on such business. Distribution of Estate (c) Prior to any distribution of my estate, I direct that all taxes, expenses, costs or fees, if any, be paid from my gross estate in order that all beneficiaries share equally in their burden execept for any beneficiary of a specific bequest herein. (d) When paying legacies or dividing or distributing my estate, to make such payments, division, or distribution wholly or partly in kind by allotting the transferring specific securities or other personal or real properties of undivided interests therein as a part of the whole of any one or more payments or shares at current values in the manner deemed advisable by my Executor/Executrix. Any of the above powers may be exercised, except as otherwise provided by law, from time to time in the discretion of my Executor/Executrix without further court order or license. FOURTH WILL CONTESTS If any beneficiary or remainderman under this Will in any manner, directly or indirectly, contests or attacks this Will or any of its provisions, any share or interest in my estate established by this Will given to that contesting beneficiary or remainderman under this Will is revoked and shall be disposed of in the same manner provided herein as if that contesting beneficiary or remainderman had predeceased me without issue. FIFTH It is my wish that my body be cremated. PAGE THREE OF FIVE SIXTH GENERAL- Effect of Inoperative, Invalid, or Illegal Provision (1) If any of the provisions of this Will or of any Codicils thereto are held to be inoperative, invalid, or illegal, it is my intention that all of the remaining provisionsthereof shall continue to be fully operative and effective so far as is possible and reasonable. Headings (2) The headings above the various provisions of this Will have been included only in order to make it easier to locate the subject covered by each provision and are not to be used in construing this Will or in ascertaining my intentions. IN WITNESS WHEREOF, I, DOROTHY VIRGINIA MULLIGAN, hereby set my hand to this my last Will, consisting of five (5) typewritten pages, on this day of 1994. --(Seal) DOROTHY VIRGINIA MULLIGAN Attestation Clause Signed, sealed, published and declared by DOROTHY VIRGINIA MULLIGAN, the above-named Testatrix, as and for her last Will and Testament, in the presence of us, who, at her request, in her presence, and in the presence of each other, all being present at the same time have subscribed our names as witnesses. residing at residing at PAGE FOUR OF FIVE ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF I, DOROTHY VIRGINIA MULLIGAN, Testatrix, 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. DOROTHY VIF~GINIA MULLIGAN Sworn to or affirmed to and acknowledged before me key DOROTHY VIRGINIA MULLIGAN, the Testatrix, this day of _ ~ 994. Notary Public My Commission Expires: AFFIDAVIT Commonwealth of Pennsylvania County of ss: We, and ,the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as his Last Will and Testament; that DOROTHY VIRGINIA MULLIGAN signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that, to the best of our knowledge, the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Witness and Witness Sworn or affirmed to and subscribed to before mE~ by witnesses, this day of 1994. Notary Public My Commission Expires: PAGE FIVE OF FIVE ,VQT -.. ~J y s OMB Approval No. 2502-0265 - R ~ W A. Settlement Statement (HUD-1) L~BRN oe~E~nP` B. Type of Loan 1. ©FHA 2. ~ RHS 3. ~ Conv Unins 6. File Number: 10 157 7. Loan Number: 8. Mortgage Insurance Case Number: . . 4. ~ VA 5. ~ Conv. Ins. - 0285141917 4460139102 C. Note: This form is famished to give you a statement of actual settlement costs. Amounts paid to and b the tttl " y se ement agent are shown. items merked (p.o.c.)"were paid outside the closing; they are shown here for lniormatio al D. Name and Address of Borrower: n purposes and are not included in the totals. E. Neme and Address of Seller:, F. Name and Address of Lender: Daniel J. Clarke 483 Delancey Court Estate of Dorothy Mulligan SUNTF;UST MORTGAGE INC. Mechanicsburg, PA 17055 90? SEMMES AVENUE RICHMOND, VA 23224 . Property Location: 483 Delancey Court H. Settlement Agent: 68-0510988 I. Settlemen t Date: Community Land Transfer, LLC Mechanicsburg, PA 17055 2331 Market Street Cumberland County, Pennsylvania Camp Hill PA 17011 May 4, 2010 , Ph 1717)909-6949 Place of Settlemenk 2331 Market Street Camp HIII, PA 17011 J. Summary of Borrower's transaction 100. Gross Amount Due from Borrower: K. Summary of Selter'a transaction 101. Contract sales rice 400. Gross Amount Due to Seiler: 102. Personal roe 119,900.00 401. Contract sales rice - I 119.900.00 103. Settlement Char es to Borrower Line 1400 402. Personal ro ert 104. 8,122.90 403. -- 105. 404. Ad ustmerrts for items atd b Selle i d 405. r n a vance 106. Ci /Town Taxes t Ad ustments for items aid b Seller in advance o 107. Coun Taxes 05/04/10 to 01/01/11 256.10 406. Ci /Town Taxes to 407 Count Taxes , 108. School Taxes 05/04/10 to 07/01/10 109. Ma HOA Dues 05/04/10 to 06/01/10 213.36 . 05;04/10 to 01!01!11 408. School Taxes 05/04!10 to 07/01!10 256.10 213.36 110. Sewer 2nd Qtr 05/04/10 to 07/01/1 83.10 409. May HOA Dues 05/04/10 to OEil01/10 _ 83 10 . 0 111. 71.38 410. Sewer 2nd Qtr. 05/04/10 to (17101/10 . 71.38 112. 411. 412. - 120. Gross Amount Due from Borrower 12$,646.84 420. Gross Amount Due to Seller 200. Amounts Paid b or In Behalf of Borrower 120,523.94 201. De osit or earnest move 1 _ 500. Reductions in Amount Due Seile 202. Princl ai amount of new loa ,500.00 501. Excess de osit see instructions ns 203. Existin loans taken sub e t t 117,727.00 502. Settlement char es to Seller (Line 1400) 9 125 27 c o 204. 503. Existin loans taken sub ect to . . 205 504. Payoff First Mortgage . 206. 505. Pa off Second Mort a e I -- 207. 506. - 208. 507. De osit disb. as roceeds 209. Seller Assist 508. Ad'ustments for items un aid b Sell 2,500.00 509. Seller Assist 2 500 00 er 210. Ci /Town Taxes t Ad'ustments for items un aid b Seller o 21 510. Ci (Town Taxes to 1. Coun Taxes to 212. School Taxes to 511. Coun Taxes to 213. 512. School Taxes to 214. 513. 215. 514. 216, 515. 516. ~ 217. 218. 517. Inheritance Tax Escrow to Rea er & Adler PC 15,000.00 219. 518. 519. 220. Total Paid b !for Borrower 300. Cash at Settlement from/to B 121,727.00. 520. Total Reduction Amount Due Setter 26,625.27 orrower 301. Gross amount due from B 600. Cash at settlement tolfrom Seller orrower line 120 302. Less amount paid b /for Borrower Il 220 ( 128,646.84 601. Gross amount due to Seller Ilne 420 120,523.94 ne ) ( 121,727.00} 602. Less reductions due Seller (line: 520} ( 26,625.27 303. Cash ~ From ~ To Borrower 8,919.84 603. Cash ~ To ~ From Seller T .~-~~ 93.898.67 C urruerst5~nea nereoy~s nowledge receip f a completed copy of this statement & any attachments referred to herein Borrower _ ~' Seller Davie - -- Estate of Dorothy Multi an BY:~~ ~ ~6P_t.v~J~ The Public Reporting Burden for lhls collection of Information-IS estimated at 35 minutes per response for collecting, reviewing, and reporting the tlata. This agency may not coney this informatlon, and you are not re0uired to complete this forth, unless Il displays a curtently valid OMB control number. No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transactlon with information during the settlement process. Page 1 of 3 HUD-1 (CLARKE.DANIEL.PFD/10-157(11) ~ L. settlement Charges ~nnr*to ~~. --~ --~~ ~~°~ ~ `c' $ 7,044.00 Division of commission (line 700J as follows: Pa1d From Paid From 701. 3 547.00 t0 ERA-NRT INC. 9omowers sever= 702. 3 497.00 t0 THE HOMESTEAD GROUP INC. _ Funds at FunOS et 703. Commission aid at settlement - semement Settlement 704. Additional Brokers a Commission to ERA-NRT LLC 7.044 705. Buyers Commission to The Homestead Group, Inc. 16E 800. Items Pa able in Connection with Loan 295.00 801. Our on ination.char a Includes Ori ination Point % o r $ 4,373.15 802. Your credit or charge (points) for the specific interest rate chosen $ -3 773 15 from GFE #1 f ---- , . 803. Your adjusted origination charges ( rom GFE #2) 804. A raisal fee to T Eb Real Estate A raisals (from GFE #A) from GFE #3 600 00 805. Credit Re ort to First American CREDCO from GFE #3 - 400.00 806. Tax service to Valutree Real Estate Services (from GFE #3) 10.88 - 807. Flood certification to First American Flood Services (from GFE #3) _ 83.00 808. Finallnspection - 6.00 809 (from GFE #3) - 810. (from GFE #3} _ 811. - (from GFE #3) ____ 900. Items Re ufred b Lender to Be Paid in Advance (from GFE #3) 901. Dai-y interest charges from 05/04/10 to 06/01/10 28 @ $16.130000/day (from GFE #10) 902. Mort a e insurance remium for months to De t. of HUD from GFE #3 451.64 903. Homeowner's insurance for 1.0 ears to GEICO from GFE #11 2,024.80 pOC~B200 00 904. 905. from GFE #11 . __ (from GFE #11} 1000. Reserves De osited with Lender 1001. Initial deposit for your escrow account omeowne s nsurance mon s per mon (from GFE #9) 1.315.83 -- - _ 1003. Mortgage insurance months $ 52 68 per month $ - --" - 1004. Property taxes -- _ County Taxes months @ $ per month $ - Assessments months $ er month - 1005. 1006. County/Township Taxes 4.000 months @ $ 31.54 per month $ $ 126.16 "~ 1007. School Taxes 12.000 months @ $ 109.65 per month $ 1,315.80 1008. 1009. Aggregate Adjusment $ -126 13 ' 1100. Title Char es . 1101. Titie services and lender's title insurance from GFE #4} 1102. Settlement or closin fee - 1,308.75 5. 1103. Owner's title (nsurance to COMMUNITY LAND TRANSFER INSURANCE ACCT $ . 1104. Lender's title insurance to COMMUNITY LAND TRANS from GFE #5 10.00 FER INSURANCE ACCT. 1105. Lender's title oli Ilmit $ $ 948.75 - ~•-` 117,727 00 1106. Owner's title oli limit $ 119,900.00 1107. A ent's onion of the total title insurance remium to Communi Land Transfer, LLC $ 1108 Underwrit ' i 843 70 y ,~F J ,. - . er s ort on of the total title insurance remium. to COMMUNITY LAND TRANSFER INSUR 1109 Tax Cert $ 115 05 ._ . . to Dennis Zerbe, Tax Collector 1110. 10.t 1111. _ 1112. 1113. 1200. Government Recording and Transfer Charges 1201. Government recordin cha es to Recorder of Deeds Office from GFE #7 1202. Deed $ 62.00 Mortgage $ 80.00 Releases $ Other $ _ 142.00 1203. Transfer taxes to Recorder of Deeds Office (from GFE #8) 1 199 00 1204. City/County tax/stamps $ 1,199.00 $ , . 1205. State tax/stam s $ 12os. $ 1,1ss.c 1207. 1300. Additional Settlement Char es 1301. R ufred services that ou can sho for from GFE #6 ._ 1302. 1303. Ca itol Fund HOA to Delance Court Condo. Assoc. 1304. HOA/Ma Dues to Delance Court Condo, Assoc 276.00 . 1305. See addit'l dish. exhibit to 92.C 1400. Total Settlement Char es enter on Imes 103, Section J and 502 Section K) 610. , eY s~9ntng pegs 1 or this statement. the sfonatoAes acXncwwwrir,a rerotm ,.r e .....~M..._. _ 8 122.90 9,125. Communi an ransfer, LLC, Settlement Agent Certified to be a true copy. Page 2 of 3 HUD-1 (CLARKE.DANIEL.PFD/10-157/11) ~ I,ORtDarlSnrl nT (:non ~. ~~ew ~.....`_._ .r.~.-. _._._ _- -~ -' "'~ ' "`"`"-' ""°'y" Charges That Cannot Increase Good Faith Estimate HUD-1 -- HUD-1 Line Number Our origination charge -- Your credit or charge (points) for the specific inte t # 801 __ 4,373.15 -- 4,373.1 res rate chosen Your adjusted origination charges # 802 -3,773.15 -3,773.1 Transfer taxes # 803 600.00 600.0 #1203 1,199.00 1,199.0 Char es That in Total Cannot Increase More than 10% - Government recording charges C~ood Faith Estimate HUD-1 Appraisal fee #1201 175.00 182 0 Credit report # 804 __ _ 450.00 . 400.0• Tax service # 805 25.00 10 8. Flood certification # 806 . 83 0 Final Inspection # 807 6.00 . 6.0 Mortgage Insurance Premium # 808 150.00 Title services and lender's title insurance # 902 ___ 2,024.80 2,Q24 g~ Owner's title insurance to COMMUNITY LAND TRANSFER INSU #1101 2,063.75 1,308. T #1103 500.00 10.Ot Total In(`rPa SP hcahunnn (.GC .,..,i VI in ~ n~____ - 5,394.55 .. -- _ 3,985.4; - -- - i.~v~. ~< yr -Cti 1. Charges That Can Change _ - Good Faith Estimate HUD-1 Initial deposit for your escrow account #1001 ---- 1,650.00 1,315.8: Daily interest charges # 901 $ 16.130000/da y 483.90 451.6 Homeowner's Insurance # 903 ~ 420.00 20CAC Loan Terms - Your initial loan amount is $ 117,727.00 Your loan term is 30 years Your initial interest rate is 5.0000 Your initial monthly amount owed for principal, interest and $ 684.66 includes any mortgage Insurance Is OX Principal 0 Interest QX Mortgage Insurance Can your Interest rate rise? 0 No ~ Yes it can rise to a maximum of , %. The first change will be on and c<rn change again every _ months after Every change date, your interest 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 time, can your loan balance rise? QX No [~ Yes, it can rise to a maximum of $ Even If you make payments on time, can your monthly amount owed for principal Interest and mort a i QX No ~ Yes, the first increase can be on and the monthly , , g ge nsurance rise? amount owed can rise to $ _ The maximum it can ever rise to is .i+ Does your loan have a prepayment penalty [~X No ~ Yes, your maximum prepayment penalty is $ Dces your loan have a balloon payment? ~X No ~ Yes, you have a balloon payment of $ due in -years on Total monthly amount owed Including escrow account payments ~ You do not have a monthly esc:row payment for items such a , s property taxes and homeowner's insurance. You must pay these items directly yourself. XO You have an additional monthly escrow payment of $141 19 that result . s in a total initial monthly amount owed of $825.85. This includes principal, interest, any mortgage insurance and any items checked below: Property taxes ~ Homeowner's insurance Flood insurance Note: If you have any questions about the Settlement'Charges and Loan Terms listed on this form ~iPA~a ~,,,,r~,.~ ,,,,,,. ~,,..a,._ Page 3 of 3 HUD-1 (CLARKE.DAN IEL.PFD/10-157/11 } HUD-1 Addendum Borrower(s): Daniel J. Clarke SelleKs): Estate of Dorothy Mulligan 483 Delancey Court Mechanicsburg, PA 17055 Lender: SUNTRUST MORTGAGE INC. 5ettiement agent: Community Land Transfer, LLC (717)909-6949 Place of Settlement: 2331 Market Street Camp Hill, PA 17011 Settlement Date: May 4, 2010 Property Location: 483 Delancey Court Mechanicsburg, PA 17055 Cumberland County, Pennsylvania Additional Adjustments For Items Paid By Seller In Advance (Borrower Debit) Description Amount From/Through Prorated Amount May HOA Dues 92.00 05/01/10 through 05/31/10 83.10 Total Line 109/409 83.10 Sewer (2nd Qtr.) 112.00 04!01/10 through 06/30/10 71.38 Total Line 110/410 71.38 Additional Disbursements Payee/Description Note/Ref No. The Mitigator Mold Remediation POC:S2310.00 Dennis Zerbe, Tax Collector 2010 County/Township Taxes Upper Alten Township Sewer Jan -June Total Additional Disbursements shown on Line 1305 Adjusted Origination Charge Details Origination Charge Origination to SUNTRUST MORTGAGE INC. Origination Credit/Charge (points) for the specific interest rate chosen Credit/Charge to. SUNTRUST MORTGAGE INC. Borrower Seller 2,310.00 386.27 224.00 $ 0.00 $ 610.27 4,373.15 Totat $ 4,373.15 -3, 773.15 Total $ -3.773.15 Adjusted Origination Charges $ 600.00 Reserves Deposited with Lender County/Township Taxes 4.000 at 31.54 per month School Taxes 12.000 at109.65 per month Aggregate Adjusment month 126,16 1,315.80 -126.13 Tota I 1, 315.83 WARNING: It is a crime to knowingly make false statements to the United States on this or any similar forrn. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. (CLARKE. DANIEL. PFD/10-157/11) HUD-1 Addendum - Continued Title Services and Lender's Title Insurance Details Closing Service Letter Community Land Transfer, LLC Electronic Doc. Preparation Community Land Transfer, LLC Wire Fee Community Land Transfer, LLC Notary Fee Community Land Transfer, LLC Overnight Fees Community Land Transfer, LLC End. 100 300 8.1 820 Community Land Transfer, LLC BORROWER SELLEF 75.00 50.00 10.00 10.00 5.00 15.00 2ao.o0 Total $ 360.00 $ 5.00 Owner's Title Insurance Owner's Policy Premium to COMMUNITY LAND TRANSFER INSURANCE ACCT. Tota I BORROWER SELLER 958.75 $ 10.00 $ Lender's Title insurance BORROWER SELLER Lender's Policy Premium to COMMUNITY LAND TRANSFER INSURANCE ACCT. Total 948.75 $ 948.75 $ WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. 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N ~ o ~ ~ n cnN,c~~m crto~~~m~, ~_ o m ~ o o ~ cn~~m~o _~ ~' ~'~m ~ wcn ~~ ~ ~~ c ~ ~~~p~~. co a ~ ~ cn tQ ~D N N C c~ x 0 '"~ H F~~"yy'+ rL~~ V/ Vl Z D 0 ..i D ~- -~ p ~:=::: C7 z a0 ~:;: O m app `:_ ~ ~ r ..,.: C N ~'~ ~ z m ~: m ap C :=::::: ~ w O r :::: O ~:>:> ~ N . o _~ D :>` rn o 2 :::: O o n ^ ;:> w N v :> rn ~ m v -~ n:=:: ~ -~ ° W Z Qo "D 0 v ~~~~~~~e Flan Ae~°clunt Statement ~~ c : ~>~iil ~ For the period 05/16/2009 to 06/16/2009 DQRQTNY MULLIGAN TERRY SIER070WICZ 483 DELANCEY CT MECHANICSBURG PA 17055-5455 PNCBANK Primary account number: 50-3012-4904 Page1of3 Number of enclosures: 0 For 24-hour banking, and transaction or ~. - interest rate information, sign on to 'S PNC Bank Online Banking at pnc.com. For crlstorrrer service call 1-888-PNC-BANK between ilje hours of 6 AM and Midnight E T- Para servicio en espar3ol, 1-866-FTOLA-PNC Moving't Please contact us at 1-888 -PNC-BANK ~ Write to: Custorrler Service PO Box 609 Pittsburgh PA 15230-9738 ~1-_,~ :~ISIt .:5 i3t ~nC.Cvii~ L =i~ "~" TDD terminal: 1-800-531-1648 I For hearing impaired clients only or1 a e r:~tes :ire hisforicalh~ lo~~-~. Stop by your local branch to meet with a PNC Mort~a~e Home Mc-rt>ya~e Consultant today hofce Plan Dorothy Mulligan lo[tey Market Account Summary Terry Sierotow~icz count number: 50-3012-4904 erdratt Protection Provided By: Contact PNC to establish Overdraft Protection stance Summary Please see the .Activity Detail section for Beginning Deposits and Checks and other Ending additional information. balance other additions deductions balance 33,862-3`3 1,447.50 1,568.27 33,741.61 Average monthly Charges balance and fees 34,198.56 .04 ansaction Summary Checks paid/ Check Card POS Check Card/Bankcard withdrawals signed transactions POS PtN transactions 1 0 0 Tota! ATM PNC Bank Other Bank transactions ATM transactions ATM transactions 0 0 0 terest Summary As of 06/16, a fatal of $50.80 in interest was Annual Percentage Number of days Yield Earned (APYE) i i t Average collected Interest Paid paid this year. n n erest period balance for APYE this period 0.25% 32 34,]98.56 750 :tivity Detail posits and Other Additions There were 2 Deposits and Other Additions Amount Description totaling $1 447 50 03 1,440.00 Direct Deposit - Soc Sec . , . US Treasury 303 XXXXX 7272A 7 sj 7.50 Interest Payment Jan M. Wiley David J. Lenox June 9, 2010 THE WILEY GROUP Attorneys at Law Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 t., ~..~ , ,~; ~: ;::. .~ ~ ~ _x M -1 *_:? .: s ~. a. -~~~~ ~. ~~ ~~ x~ In Re: Estate of Dorothy V. Mulligan, deceased File Number 21-09-0662 Dear Register: e~ CQ -.,. ~7 r~~_~ "~ 1 `.,..~ _~~ '~'~ ~~ ~i cr Enclosed for filing please find an Inventory, the inheritance tax return in duplicate, and the status report with regard to the above captioned estate. Also enclosed is a check in the amount of $5,798.28 representing the tax due, and a check in the amount of $30.00 representing the filing fee. Please return the recording receipts to my attention in the enclosed envelope. Thank you for your cooperation. Sincerely, Dawn Gl~~er/Le al As stant g /dg encl. 130 W. Church Street, Suite 101 Dillsburg, PA 17019 Phone: (717) 432-9666 (800) 682-4250 • Fax: (717) 432-0426