HomeMy WebLinkAbout06-09-10t
1505607120
.J 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 Box.2soso~ 21 10 0 0 3 2 8
Harrisburg, PA 1712&0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
205036410 03242010 04071920
Decedent's Last Name Suffix Decedent's First Name MI
ROBINSON WILLIAM A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
M1
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
Decedent Died Testate 7, Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes
® 6. (Attach Copy of Will) ~ (Attach Copy of Trust) -
^ 9. Litigation Proceeds Received ^ 10. be~tuve~enl2-31 y91 ad 11 98jf death ^ 11,Election to tax under Sec. 9113(A)
(Attach Sch. O)
~ameESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Daytime Telephone Number
JAMES M ROBINSON 7172459688
Firm Name (If Applicable)
TURO LAW OFFICES
First line of address
28 S. PITT STREET
Second line of address
City or Post Office
CARLISLE
REGISTER OF WILLS U~ONLY
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State ZIP Code t._. ~'~
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PA 17013 ~
Correspondent's a-mail address: J R o b i n s o n~ T u r o L a w. c o m
Under penalties of pery'ury, I eolare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and compl te.' Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG TU PER REP SIBLE FOR FILING RETURN ,PATE
~„' ~ ~~~.~- Allen E. Ferguson ~//~j ~! c~
ADDRESS
2590 Spring Road, Carlisle, PA 17013
SIG RE OF PREPARER Q Tligpi'F~ RESENTATNE
S. Pitt Strut, Carlisle, PA 17013
James M Robinson
Side 1
1505607120
tD~~ ~/~
1505607120
J~
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1505607220
REV-1500 EX
DecedentsWame: ROBINSON~. WILLIAM A
Decedent's Social Security Number
205036410
RECAPITULATION
115 , 0 0 0. 0 0
1. ( ) ..........................................................................................
Real Estate Schedule A 1.
2. Stocks and Bonds Schedule B ......, 2_ 3 3 , 12 0 . 4 6
3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4.
5. Cash, Bank Deposits 8 MisceOaneous Personal Property (Schedule E) ................ 5. 61 , 8 9 9 . 5 8
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested .............
7.
4 8 9 , 0 4 4.41
8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 6 9 9, 0 6 4. 4 5
9. Funeral Ex enses ~ Administrative Costs Schedule H
P ( ) ......................................... 9, 3 3 , 917.3 2
10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) ................................ 10. 2 , 5 2 8 . 2 0
11. Total Deductions (total Lines 9 8 10) ..................................................................... .11. 3 6, 4 4 5. 5 2
12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 6 6 2 , 618.9 3
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13} ................................................. 14. 6 6 Z , 618.9 3
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a}(1.2) X .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 6 6 2 , 618.9 3 18.
19. Tax Due .............................................................................................................. .....19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
99,392.84
99,392.84
Side 2
1505607220 1505607220
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 10 - 0 0 3 2 8
Robinson, William A
STREET ADDRESS
3407 Walnut Street _
CITY
Camp Hill STATE
PA ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 9 9 , 3 9 2.8 4
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 4,969.64
Total Credits (A + B + C) (2) 4,969.64
3. Interest/Penalty if applicable
p. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.0 0
4. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2 Line 20 to request arefund -~
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 94,423.20
q, Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 9 4, 42 3.2 0
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 :.................................................................................^ ~x
b. retain the right to designate who shall use the property transferred or its income :..................................... ~ x^
c. retain a reversionary interest; or ...............................................................................................................^
d. receive the promise for life of either payments, benefits or care? ..............................................................~ Ox
2. If death occurred after December 12, 1982, did decedent transfer property within ape year of death without
receiving adequate consideration? .....................................................................................................................^ 0
3. Did decedent awn an "in trust for" or payable upon death bank account or security at his or her death?......... []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................................................................................~ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUR
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zeco
(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.
COMMONVNEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
FILE NUMBER
ESTATE OF Robinson, Wi{{iam A 21 - 10 - 00328
All real properly owned sole)y or as a tenant in common must be re orted at fair market value. Fair market value is defined as the price
at which property would be exchanged beiween a willing buyer and a willing seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 3407 Walnut Street, Borough of Camp Hill, Cumberland County, Pennsylvania 115,000.00
Parcel ID No. 01-21-0273-238 Valued at sale price
TOTAL (Also enter on Line 1, Recapitulation) ~ 115,000.00
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF Robinson, William A FILE NUMBER
21 -10 - 00328
All property jointly-owned with right of survivorship must lie disclosed on Schedule F.
ITEM
NUMBER ~ DESCRIPTION UNIT VALUE VALUE AT DATE OF
DEATH
1 PPL Corporation -Common Stock 28.24 2,824.00
2 PPL Corporation - 4.40% Preferred Stock 79.40 1,588.00
3 PPL Corporation - 4.50°!o Preferred Stock 79.40 317.60
4 Ameriprise Financial Tax Exempt Hi income 4.225405 28,390.86
Mutual Fund Account No. 140'17592
TOTAL (Also enter on line 2, Recapitulation) 33,120.46
r v
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Robinson, William A 21 - 10 - 00328
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.
NUM ER DESCRIPTION VALUEDAETADHTE OF
1 Wachovia Bank Acct. No.000590355921 25,840.97
2 Wachovia Bank 72 Mo. IRA No. 257410050202436 5,809.04
3 Wachovia Bank -High Performance MMI No. 1010058127513 29,124.57
4 1986 Ford Taurus -Valued at Kelley Blue Book 625.00
5 TS-440 Radio Receiver 8s, Astron Power Supply 500.00
I TOTAL (Also enter on Line 5, Recapitulation) I 61,899.58
COMMONWEALTH OF PENNSYLVANIA SCHEDULE G
INHER{TANCE TAX RETURN INTER VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Robinson, William A
FILE NUMBER
21 -10 - 00328
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
Include the name of the transferee, their relationship to decedent
and the date of transfer. Attach a copy of fhe deed for real estate. DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST EXCLUSION
(IF APPLICABLE)
TAXABLE VALUE
1 Ameriprise Financial Fixed Retirement Annuity 78,438.56 78,438.56
Acct. No. 0000 0930 0204 6218 8 004
2 Ameriprise Financial RVS Rate Bonus 1 NQ 186,482.19 186,482.19
Acct. No. 0000 0930 0825 9584 2 004
3 Ameriprise Financial RVS Bonus 1 NQ 109,398.95 109,398.95
Acct. No. 0000 0930 0825 9716 0 004
4 Ameriprise Financial RVS Bonus 1 NQ 114,724.71 114,724.71
Acct. No. 0000 0930 0826 0604 5 004
TOTAL (Also enter on line 7, Recapitulation) I 489,044.41
9CI-®l~E H
EXP®V:SES &
GOMMONWEALTH OF PENNSYLVANIA ~pw
INHERITANCE TAX RETURN ~~7~ ~~
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Robinson, William A 21 -10 - 00328
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Neumyer Funeral Home, Inc. 3,197.27
B. `ADMINISTRATIVE COSTS:
1. I Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
2.
3.
4
5.
s.
7
1
City State Zip
Year(s) Commission paid
Attorney's Fees Turo Law Offices
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
Probate Fees Register of Wills
The Cumberland Law Journal
The Sentinel -Legal
Accountant's Fees
Tax Retum Prepares Fees Gift Associates
Other Administrative Costs
G. Scott Ramsey -clean out 3407 Walnut Street in preparation for sale
20,956.93
408.50
75.00
208.78
320.00
1,200.00
TOTAL (Also enter on line 9, Recapitulation) 33,917.32
S~cheduiE H
_ Funeral E~q~er~es ~
COM NHERITANCE TTAX RETURN~~ ~~ (,pb"~g QQ~,~
RESIDENT DECEDENT
ESTATE OF Robinson, William A FILE NUMBER
21 -10 - 00328
2 Denise Dailey -lawn service, care of house and auto 500.00
3 Deluxe Checks -purchase checks for estate account 23.00
4 I Settlement charges on sale of 3407 Walnut Street, Camp Hill, net of I 7,027.84
reimbursed taxes and sewer rents
Page 2 of Schedule H
COMMONVYEAL?H OF PENNSYLVANIA
INHERRANCE tAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
FILE NUMBER
ESTATE OF Robinson, William A 21 -10 - 00328
include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Cumberland Crossings 1,974.80
2 West Shore EMS -BLS 205.02
3 Cumberland Goodwill EMS 113.90
4 Verizon 4.17
5 PPL Electric Utilities 37.58
6 Pennsylvania American Water Co. 13.11
7 UGI 93.33
8 Comcast 13.79
9 Borough of Camp Hill -sewer service 72.50
~ TOTAL (Also enter on Line 10, Recapitulation) ~ 2,528.20
REV-1513 EX+ (8-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Robinson, William A
21 -10 - 00328
NUMBER
NAME AND ADDRESS OF PERSON(S)
RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s) SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
I~ TAXABLE DISTRIBUTIONS[include outright spousal
f
ers
distributions and trans
under Sec. X116 (a) (1.2}]
1 Allen E. & Betsy J. Ferguson Cousin Fifty Percent
2590 Spring Road
Carlisle, PA 17013
2 Debra Ferguson Cousin's daughter Twenty-five Percent
134 Liberty Avenue
Carlisle, PA 17013
3 Heather Rose Cousin's daughter Twenty-five Percent
131 Westgate Drive
Mt. Holly Springs, PA 17065
Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, o n Rev 1500 cover sheet
III NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS
NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHE~T 0.00
REV-1513 EX+ (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Robinson, William A 21 - 10 - 00328
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s) __
I~ TAXABLE DISTRIBUTIONS[include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)j
4 Robert Carpenter Friend Specific Devise
10 E. Slate Hill Road
Carlisle, PA 17013
Page 2 of Schedule J
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0
LAST WILL AND TESTAMENT ~;
~7
®F .~~~ C,J
WILLIAM Av IZ®~INS®N ~~~'~
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I, WILLIAM A. ROBINSON, of Camp Hill, Cumberland County, Pennsylvania, being
of sound and disposing mind, memory, and understanding, do hereby make, publish, and
declare this to be my Last Will and Testament and hereby revoke all other Wills and Codicils,
if any, that I have made.
• FIRST: I give and bequeath the following items of tangible personal property to
the following individuals, so long as each shall survive me by thirty (30) days:
A. TS440 radio transceiver and Astron power supply; all other electronic
hardware; books; magazines; filing cabinet materials; antenna; and tower hardware to my
,~
friend, ROBERT CARPENTER, of Huntsdale, Pennsylvania;
B. Zenith twenty-seven (27") inch television to my cousin, ALLEN
FERGUSON, of Carlisle, Pennsylvania;
C. All US Savings Bonds to my cousin's daughter, DEBRA FERGUSON,
of Carlisle, Pennsylvania.
SECOND: I direct that any of my clothing be donated to THE SALVATION
ARMY.
THIRD: All the rest, residue, and remainder of my Estate, of whatever nature and
wherever situate, I give, devise, and bequeath, to the following individuals who shall survive
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me by thirty (30) days:
A. Fifty (50%) percent to my cousins, ALLEN and BETSY FERGUSON,
or to whichever one of them shall survive me by thirty (30) days;
B. Twenty-five (25%) percent to my cousin's daughter, DEBRA
-_..
- - F-ER-GIBS - ;
C . Twenty-five (25 %) percent to my cousin's daughter, HEATHER ROSE,
of Carlisle, Pennsylvania.
Should any of the above-named individuals fail to survive me by thirty (30) days, but
be represented by children then living, these children shall take, per stirpes, the share to which
my beneficiary would have been entitled if then living.
FOURTH : All interests of any beneficiary in the income or principal of this Estate,
--~
while undistributed and in the possession of my Executor, even though vested and
distributable, shall not be subject to attachment, execution or sequestration for any debt,
contract, obligation or liability of any beneficiary and, furthermore, shall not be subject to
`"-- pledge, assignment, conveyance, or anticipation.
FIFTH: All inheritance, estate, and succession taxes (including interest and any
_.
c' penalties thereon) payable by reason of my death shall be paid out of and be charged generally
against the principal of my residuary estate, without apportionment or right of reimbursement
from any person. In the event that a substantial portion, as determined in the sole and absolute
judgment and discretion of my Executor, of the non-probate assets such as an annuity or
mutual funds are directed to be paid to a beneficiary or beneficiaries, so that the taxes referred
to herein would be paid out of the probate residue passing to the beneficiary or beneficiaries of
this will (whether or not the same as the beneficiary or beneficiaries under the non-probate
assets), my Executor, in the Executor's sole and absolute judgment and discretion, shall have
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the right to allocate the full or partial payment of the taxes to the beneficiary or beneficiaries of
the non-probate assets.
SIXTH : In addition to all rights and powers conferred by law, I authorize and
er~power~y~xee~tto~and lris~ueeessor-s, in his-absolute-discretion and without recess-ity-o~---- -
obtaining court approval:
A. To buy investments at a premium or discount.
B. To hold property unregistered or in the name of a nominee.
C. To give proxies, both ministerial and discretionary.
`- D . To compromise claims .
E. To join any merger, consolidation, reorganization, voting trust
~~
plan, or any other concerted action of security holders and to delegate discretionary duties with
respect thereto.
F. To lend to, and buy from, my estate.
G. To borrow and to pledge real and personal property as security therefor.
H. To sell at public or private sale for cash or credit or partly for each, to
~-
~- exchange, or to lease for any period of time, any real or personal property, and to give options
for s
ales, exchanges, or leases.
I. To exercise any option permitted by law which he believes to be
advantageous from the viewpoint of overall tax reductions, including, without limitation of the
foregoing, power and authority to claim administration or other expenses either as income tax
deductions or inheritance or estate tax deductions, without regard to whether they were paid
from principal or income and without requiring adjustments between principal and income for
any resulting effect on income or estate taxes, and a deduction of such expenses for income tax
purposes shall be given effect in computing the respective shares of all persons interested in
my estate set forth herein, even though the effect is to increase the share of one beneficiary or
- zus$-af-bene~iu~ies-her-ettnder-at-the-expense-of~nother-and-to-rnake-sueh~dj~ustment~~f -
any, between beneficiaries with respect thereto as he shall deem appropriate in view of the
nature of the transaction and the amounts involved.
J. To distribute in cash or in kind or partly in each.
K. To employ agents, legal counsel, brokers, and assistants, and to pay their
fees and expenses as he may deem necessary or advisable to carry out the provisions of this
Wiil or any Trust.
The powers granted hereunder shall be exercisable with respect to all real and personal
property, including, but not limited to, income and principal held for minors or disabled
beneficiaries at any time, until the actual distribution of all property. All powers, authorities
and discretion granted here shall be in addition to those granted by law and shall be exercisable
without leave of court. However, nothing herein shall be interpreted or construed to
encourage, authorize, empower, or permit the Executor to act or cause anyone to act in a
manner contrary to or inconsistent with accepted standards of portfolio diversification and risk
management.
SEVENTH: I nominate, constitute, and appoint my cousin, ALLEN FERGUSON, as
Executor of this, my Last Will and Testament. In the event of the renunciation, death,
resignation, or inability of my cousin to act for whatever reason in this capacity, then I
nominate, constitute, and appoint my cousin's wife, BETSY FERGUSON, as Executrix of
this, my Last Will and Testament.
s
s
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I direct that no representative named above shall be required to post security for the
faithful performance of his duties in any jurisdiction insofar as I am able by law to relieve him
- -- ~~ ~ueh-ebli~a~ian-~4ny-af-m~ represent-atives~hal-l-be-entitled-to-reasonable-eompensativrrfor-
the performance of the duties set forth here.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~''~M` day of
WILLIA O IrT ~
SIGNED, PUBLISHED, and DECLARED by the Testator, WILLIAM A.
~cbra `ry , 2010, on this, the fifth of five typewritten pages. I have also signed the
left-hand margin of the first four of these pages for purposes of identification only.
ROBINSON, as 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.
y,Sb A ~ ~c~t v~'~ De..
1 Mtct~~'cs 6-~y . ~~- Z ~03~'
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7
ACKNOWLEDGMENT
Commonwealth of Pennsylvania
County of Cumberland
I, WILLIAM A. ROBINSON, Testator, whose name is signed to the attached
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.
1
LIAM A . ROBINSON
Sworn or affirmed to and subscribed before me by WILLIAM A. ROBINSON, the
Testator, this ~'~ day of ~~v cc..ct. , 2010.
~.< ~,~
Notary Public
1'~U`~ARIAL SEAL Public
MARIA L• STRO ~umberia d County
Lower Allen Twp.~
My Commission Expires Nov. 29.2010
~ ~
• ~ 3 ~ ~~
AFFIDAVIT
Commonwealth of Pennsylvania
'~ -- Eount~y-o~C-trr~ber-land --
We, Debra K. Wallet and 5l~~vn ~ • ~~~~ ,the witnesses whose names
are signed to the attached instrument, being duly qualified according to law, depose and say
that we were present and saw the Testator, WILLIAM A. ROBIN5ON, sign and execute the
instrument as his Last Will and Testament; 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 that time 18
years of age or older, of sound mind, and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by ~ h,~a. ~ . G~.OC~! (~-f and
shr~-row l~• ~o-f+ ,witnesses, this ~.~ day of ~~~r~-may , 2010.
~~..-cam
Notary Public
~Ul:~fii~-~~~ ~ir~ I'E,,,,~SYLVAI'~IA
~l~OTARIAL SE
iNARIA L. STROH, Notary Public
Lo Comm ss on Exp es Plovan29, 2010
My
V ~
OMB NO. 2502-0265 ~j~
q, B. TYPE OF LOAN:
DEPARTMENT OF HOUSING ~ URBAN DEVELOPMENT
U
S 1.~FHA 2.QFmHA 3.~]CONV. UNINS. 4.QVA 5. []X CONY. INS.
.
.
SETTLEMENT STATEMENT 6. FILE NUMBER:
10201 7. LOAN NUMBER:
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "(POCJ" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3/98 (10201110201!22)
D. NAME AND ADDRESS OF BORROWER:
Romeo Lio
209 North 36th Street
Camp Hill, Pa. 17011 E. NAME AND ADDRESS OF SELLER:
William A. Robinson Estate F. NAME AND ADDRESS OF LENDER:
CASH
G. PROPERTY LOCATION:
3407 Walnut Street
PA 17011
Camp Hill H. SETTLEMENT AGENT: 25-1878915
Keystone Land Transfer, Ltd. I. SETTLEMENT DATE:
June 4
2010
,
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
3421 Market Street
Camp Hill, PA 17011 ,
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 115 000.00 401. Contract Sales Price 115,000.00
102. Personal Pro a 402. Personal Pro ert
103. Settlement Char es to Borrower Line 1400 2 346.75 403.
104. 404.
105. 405.
Ad'ustments For Items Paid B Seller in advance Ad ustments For Items Paid 8 Seller in advance
106. Ci !Town Taxes to 406. Ci /Town Taxes to
107. Coun Taxes 06/04/10 to 01!01/11 389.62 407. Coun Taxes 06/04/10 to 01/01/11 389.62
108. School Tax 06/04/10 to 07/01/10 106.03 408. School Tax 06/04/10 to 07/01/10 106.03
109. Sewer Billie 06/04/10 to 07/01/10 21.51 409. Sewer Billing 06/04/10 to 07/01 /10 21.51
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 117,863.91 420. GROSS AMOUNT DUE TO SELLER 115,517.16
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
De osit or earnest mone
201 5 000.00 501. Excess De osit See Instructions
.
202. Princi al Amount of New Loans 502. Settlement Char es to Seller Line 1400 7 545.00
203. Existin loans taken sub'ect to 503. Existin loans taken sub'ect to
204. 504. Payoff of first Mortgage
205. 505. Pa off of second Mort a e
206. 506.
207, 507. De osit disb. as roceeds
208. 508.
20g, 509.
Ad'ustments For Items Un aid B Seller Ad ustments For Items Un aid B Seller
210. Cit /Town Taxes to 510. Cit !town Taxes to
211. Coun Taxes to 511. Count Taxes to
212. School Tax to 512. School Tax to
213. 513.
214. 514.
215. 515.
216. 516.
217, 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 5,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 7,545.00
300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301. Gross Amount Due From Borrower Line 120 117 863.91 601. Gross Amount Due To Seller Line 420 115 517.16
302. Less Amount Paid B /For Borrower Line 220 ( 5,000.00) 602. Less Reductions Due Seller (Line 520 ( 7,545.00
303. CASH (X FROM) ( TO) BORROWER 112,863.91 603. CASH (X TO) ( FROM) SELLER 107,972.16
The undersigned hereby acknowledge receipt of a completed copy of pages 182 of this statement & any attachments referred to herein.
Borrower ~ ~ ~~, ~ Seller Willia inson Estat
Ro a Lio , r'~ ~ ~ + ~ - - ^
Page 2
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price $ % 6,375.00 PAID FROM PAID FROM
Division of Commission Ilne 7OO aS FOIIOWS: BQRROWER'S SELLER'S
701. $ 2,950.00 to Help-U-Sell FUNDS AT FUNDS AT
702. $ 3,425.00 t0 Re/Max Realty Associates, InC. SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement 6,375.00
704. Broker Fee to Re/Max Realty Associates, Inc. 195.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Ori ination Fee 0.0000 % to
802. Loan Discount % to
803. Appraisal Fee to
804. Credit Report to
805. Lender's Inspection Fee to
806. Mort a e Ins. A .Fee to
807. Assumption Fee ~ to
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to @ $ /day ( days %)
902. Mort a e Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 ears to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance $ er
1002. Mort a e {nsurance $ er
1003. Cit /Town Taxes $ er
1004. Count Taxes $ er
1005. School Tax @ $ per
1006. $ er
1007. @ $ per
1008. A re ate Ad'ustment $ er
1100. TITLE CHARGES
1101. Settlement or Ctosin Fee to
1102. Abstract or Title Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Document Pre aration to
1106. Nota Fees to
1107. Attorney's Fees to
includes above item numbers:
1108. Title Insurance to Ke stone Land Transfer Ltd. 933.75
includes above item numbers:
1109. Lender's Coverage $
1110. Owner's Coverage $ 115,000.00 933.75PA0#107193575
1111.
1112.
1113.
1114. Deed Prep Turo Law Offices N/C
1115.
1116.
1117. Notary Fee to Cash 5.00 15.00
1118.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 63.00; Mortgage $ Releases $ 63.00
1202. Cit /Coun Tax/Stam s: Deed 1 150.00 Mort a e 1,150.00
1203. State Tax/Stam s: 1 150.00 ; 1,150.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Surve to
1302. Pest Ins ection to
1303. Tax Certs to Hel U Seil 5.00
1304.
1305.
1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103 Section J and 502, Section K 2,346.75 7,545.00
~r a~y~ w ~y Nvyv ~ ~~ .~ ~~~ a~a.e~~~a, ~., env s~gncaivnes acRnowieage receip~ or a compie~ea copy or page t or [nis two p ge acemern.
Keystone Land Transfer, Ltd.
Settlement Agent
Certified to be a true copy.