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06-22-10
S --.~ REV-'~~~0 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO 80X.280601 INHERITANCE TAX RETURN 2 1 1 0 - 0 0 9 5 Harrisburg, PA 17128-0601 - RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 172269478 01092010 04161933 Decedent's Last Name Suffix Decedent's First Name THRONE ROMAINE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name THRONE Spouse's Social Security Number Suffix Spouse's First Name RODNEY THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI V MI E 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) 0 ® 6 Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1 p. Spousal Poverty Credit (date of death ^ ~ 1. 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 BRADLEY L GRIFFIE F' N If I' I 7172435551 irm ame ( App scab e) GRIFFIE & ASSOCIATES First line of address 200 NORTH HANOVER STREET Second line of address City or Post Office CARLISLE Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which oreDarer has anv knowledae. State ZIP Code PA 17013 REGISTER OF WILLS USE ~LY ~..~ ~--~ c~ ~> ~~:~ __ ~7 C.w -~:~ I_ , _ ,--~ ~_ ..__ t_ ~K< , ~' ~.~ r ~-~ ~,:~ Iti ~_:.. .- DATE:~F~ED ~.~. __a .. ~r~ - -- ,; I _.' --~ ..~ .4'." - -~; ~ Correspondent's a-mail address: b g r i f f i e@ g r i f f i e l a w. c o m JI ~ A f UKt UI- F'tFtJVN KtSF'UNSBLE h VR FILING RETURN !DATE !~!_ ~,.,~ f~~ Dennis M. Shaw ~ ~y/2~, ~ ADDRESS 2437 East Bayberry Drive, Harrisburg, PA 17112 SIG REP ER THAN REPRESENTATIVE DATE Bradley L Griffie ~ j ~ ~ ~ ~ ,, '~00 N6rth Haver Street, Carlisle, PA 17013 Side 1 1505607120 1505607120 J 1505607220 REV-1500 EX Decedent's Social Security Number Decedents Nerve: THRONE , R O M A I N E V 17 2 2 6 9 4 7 8 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 17,234,92 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. 41, 828.41 6. Joint) Owned Pro ert Schedule F y p y ( ) ^ Separate Billing Requested ............. 6. 3 7, 5 0 0 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7, 3 7, 4 4 5 2 7 8, Total Gross Assets (total Lines 1-7) ....................................................................... g, 1 3 4, 0 0 8 6 0 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 15,515.73 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 543.54 11 • Total Deductions total Lines 9& 10 ( ) ...................................................................... 11. 1 6, 0 5 9 2 7 12. Net Value of Estate (Line 8 minus Line 11) ............................................................ 12. 1 1 7, 9 4 9 3 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. 1 1 7 , 9 4 9 3 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 1 17 , 9 4 9. 3 3 16. 5 ,, 3 0 7. 7 2 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ..................................................................................................................... 19. 5, 3 0 7 7 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505607220 15056072 20 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 10 - -0095 DECEDENT'S NAM Throne, Romaine V STREET ADDRESS 122 Brighton Drive CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 5 , 3 0 7.7 2 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 5 , 0 0 0.0 0 C. Discount 2 6 3.16 Total Credits (A + B + C) (2) 5, 2 6 3.16 3. Interest/Penalty if applicable p, Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.0 0 4. If 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 a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 44.5 6 A, Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 44.5 6 Make Check Payable to: REGISTER OF WILLS, AGENT .4 ~, 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 "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)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natucal 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) j72 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)J. 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. SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BON DS INHERITANCE 7AX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Throne, Romaine V 21 - 10 - -0095 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 Exxon Mobil Common Stock 69.52 556.16 8 Shares at $69.52/share (See attached statement) 2 Prudential Gilbraltar Fund (SIP Shares) ~ 16,678.76 1,859.3651 shares at $8.97014lshare Contract No. 067209A01 (See attached statement) TOTAL (Also enter on line 2, Recapitulation) 17,234.92 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Throne, Romaine V 21 - 10 - -0095 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Members 1st Federal Credit Union 3,566.37 Savings Account No. 49780-00 (See attached statement) 2 Mernbers 1st Federal Credit Union 4,000.31 Savings Account No. 49780-04 (See attached statement) 3 Members 1st Federal Credit Union 1,949.86 Checking Account No. 49780-11 (See attached statement) 4 Members 1st Federal Credit Union 12,066.20 Certificate of Deposit No. 49780-40 (See attached statement) 5 Members 1st Federal Credit Union 14,051.22 Certificate of Deposit No. 49780-42 (See attached statement) 6 MEmbers 1st Federal Credit Union 1,214.45 Certificateof Deposit No. 49780-43 (See attached statement) 7 1996 Audi A4-V6 Sedan 4,725.00 VIN (See attached NADA value) 8 ~ Social Security Administration Death Benefit ~ 255.00 I TOTAL (Also enter on Line 5, Recapitulation) , 41,828.41 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Throne, Romaine V I FILE NUMBER 21 - 10 - -0095 tf 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 Debra E. Rasp 831 West North Street Daughter q Carlisle, PA 17013 Daniel E. Keeseman 40 Ann Street Son g Christiana, PA 17509 Dennis M. Shaw 2437 East Bayberry Drive Son C Harrisburg, PA 17112 JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT ~F~SCRIPTIO~I C~.F PRO~ERTY Include name o Inanclal Ins Itu Ion an bank account number or similar identifying 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 ABC 11/07/2005 Real Estate 150,000.00 25% 37,500.00 122 Brighton Drive Carlisle, PA Cumberland County Pennsylvania (See attached Deed and HUD-1 Settlement Sheet) TOTAL (Also enter on line 6, Recapitulation) 1 37,500.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Throne, Romaine V SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21 - 10 - -0095 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 InGude the name of the transferee, their relationship to decedent and the dale of transfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET o~ OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Members 1st Federal Credit Union 0.21 100% 0.00 0.21 IRA Certificate No. 49780-10 (See attached statement) 2 Members 1st Federal Credit Union 15,669.31 100% 0.00 15,669.31 IRA Certificate No. 49780-16 (See attached statement) 3 Members 1st Federal Credit Union 3,861.40 100% 0.00 ' 3,861.40 IRA Certificate No. 49780-18 (See attached statement) 4 Members 1st Federal Credit Union 14,588.90 100°l0 0.00 14,588.90 IRA Certificate No. 49780-19 (See attached statement} 5 Members 1st Federal Credit Union 3,325.45 100% 0.00 ~ 3,325.45 IRA Certificate No. 49780-20 (See attached statement) TOTAL (Also enter on line 7, Recapitulation) 1 37,445.27 SCHEDULE H FUNERAL ©CPENSES & COMMONWEALTH OF PENNSYLVANIA ~,'c~w `~'~ INHERITANCE TAX RETURN ADM'I~ I I~1~E C~ I J RESIDENT DECEDENT L- `FILE NUMBER ESTATE OF Throne, Romaine V I 21 - 10 - -0095 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Hoffman-Roth Funeral Home and Crematory, Inc. 8,028.04 2 Minister donation 100.00 3 Cosmetologist 50.00 B. ~ ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 2. 3. 4. 5 6 7 Social Security Numbers} / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Griffie & Associates Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Rodney E. Throne Street Address 122 Brighton Drive city Carlisle state PA zip 17 Relationship of Claimant to Decedent Husband Probate Fees Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs The Sentinel (Advertising) 2,500.00 3,500.00 357.50 105.19 TOTAL (Also enter on line 9, Recapitulation) 15,515.73 . , Schedule H p COMMONWEALTH OF PENNSYLVANIA //~~~~.~ ~~,~;~.,~ ^,.~r«~; ^ .,~,~ INHERITANCE TAX RETURN f11W 11I111.7u AuvG ~ w1 1unt~GL1 RESIDENT DECEDENT ESTATE OF Throne, Romaine V FILE NUMBER 21 - 10 - -0095 Real Estate appraisal fee Cumberland Law Journal (Advertising) Reserves 300.00 75.00 500.00 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS INHERITANCE TAX RETURN 7 RESIDENT DECEDENT FILE NUMBER ESTATE OF Throne, Romaine V 21 - 10 - -0095 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Members 1st Federal Credit Union 473.54 VISA Account No. 46720900000125237 2 ~ Caremark (medical bill) ~ 70.00 ~ TOTAL (Also enter on Line 10, Recapitulation) ~ 543.54 ' REV-1513 EX+ (9.00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Throne, Romaine V FILE NUMBER 21 - 10 - -0095 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 f ers distributions, and trans under Sec. 9116 (a) (1.2)] 1 Dennis M. Shaw Son thirty-three and 2437 East Bayberry Drive one-third percent Harrisburg, PA 17112 2 Daniel E. Keeseman Son thirty-three and 40 Ann Street one-third percent Christiana, PA 17509 3 Debra E. Rasp Daughter thirty-three and 831 West North Street one-third percent Car{is{e, PA 17013 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, on Rev 1504 cover sheet II 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET' 0.00 Attachment to Schedule «B» Did you know? Most shareholders can manage their moldings online with free access to Computershare's Investor Centre r~' website. Use this simple tool to quickly and easily update account information, sign up for• electronic delivery of documents and more. Enroll FREE today at www.computershare.cam/investor. BRADLEY L GRIFFIE GRIFFIE & ASSOCIATES 200 NORTH HANOVER ST CARLISLE PA 17013 March 23, 2010 Company: Registration: Holder Account Number: Document I.D.: Our Reference: Dear Sir/Madam: EXXON MOBIL CORPORATION ROMAINE V THRONE 00007069791 10077WF00161496 XOM/0002872158/21/66140/If (~,omputershare Computershare Investor Services 250 Royall Street Canton Massachusetts 02021 www,computershare.com Thank you for your inquiry regarding the above referenced account. We appreciate the opportunity to be of service to you on behalf of Exxon Mobil Corporation. Please accept this letter as confirmation that the transfer was completed on February 16, 2010. On January 9, 2010, account number 00007069791 held 8 shares of ExxonMobil common stock. The per share market prices for that date are listed in the table below: High Price Low Price ~ Closing Price $69.75 $69.22 ~ $69.52 Should you have any questions, please call us toll free at 1-800-252-1800. Our telephone representatives are available Monday through Friday between the hours of 8:30 AM and 5:00 PM Eastern Time. If you are calling from outside of the US, please call collect at 1-781-575-2058. Please note that any available representative can assist you. If you have Internet access, you may also obtain information about available services by visiting our web site at www.computershare.com/exxonmobil or write to us at ExxonMobil Shareholder Services, c/o Computershare, P.0. Box 43078, Providence, RI 02940-3078. Sincerely, .. ' Service Representative Enclosure: None /.... p Prudential Amwftie8 /~~ ~~"'~~~ A Business otPn:dentiai Financial, Inc. .•!. P.O. Box 7960 PhlNdelpLfn, PA 19176 (888) 778-Sd7! TTY: (800) 65d-7637 W W W.prtr[10011 a~.COQI Bradley GrifCe RE: Romaine V Throne Fax # 717 2435063 Contract ]Number: 067209A01 April 8, 2010 Dear Mr. frrlffie: The information you requested; The contract value as of January 9, 2010 was ~1G,678.7G. The number of shares was 1,8S9.3G51 and price per share 8.97014, If you have any questions, please call the Prudential Annuity Service Center at (888) 778-2888. 'The Service Center is open Monday through Thursday between 8:00 a.m. and 7:00 p.m. and Friday between 8:00 a.m. and 6;00 a.m. Eastern time. If you are using a telecommunications device for the hearing impaired, you may call (800) 6.54-7G37, Monday through Friday between $:DO a.m. and 8;OOp,m. Eastern time. Sincerely, ~I't~l.'i01lS .xQ?~8?' Annuity Claims Variable aanulties ai$ asued by Proco Ilfe lnsuiance Company (in Nsiv+~ York, by Proco i.ifc Insurance Company ufNe~v Jeraoy). Arnl~ wmpanit~ art located in Nowarl;, N!. Variable anouitiec rue disUibnted by pn~dential Anmdiies Distributors, Inc., Slreliou, CT. Fixed wrnuities rrrC issued by The Prodorrlial lnsnmaco Company o! America All rue Prucieatial Finanuirrl t:ompdnias $nd egeh is sulall~ ra5prmsib}e 1'or its a~vn firrwrcitr! condition and rontn-ch~al obligations. TPage ] ~f 1] Attachment to Schedule «E» ~~ MEMBERS 1St FBDBKALCRBDIT I1-VION SAVINGS ACCOUNT: Account Number/Suffix 49780-00 Date Account Established 05/13/1986 Principal Balance at Date of Death $3,566.10 Accrued interest to Date of Death $.27 Total Principal and Accrued Interest $3,566.37 Narne of Joint Owner None LIFE SAVINGS ACCOUNT: Account Number/Suffix 49780-04 Date Account Established 02/02/2001* Principal Balance at Date of Death $4,000.DO Accrued Interest to Date of Death $.31 Total Principal and Accrued Interest $4,000.31 Name of Joint Owner None "Opened by transfer of funds from 49780-00. CHECKING ACCOUNT: Account Number/Suffix 49780-11 Date Account Established 05/13/1986 ,Principal Balance at Date of Death $1,949.86 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest $1,949.86 Name of Joint Owner None IRA SAVINGS ACCOUNT: Account Number/Suffix 49780-10 Date Account Established 10/01/1986 Principal Balance at Date of Death $.21 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest $.21 Name of Beneficiary Dennis Shaw 331/3% Debra Rasp 33 1!3% Daniel Keeseman 33 1/3% IRA CERTIFICATES: Account Number/Suffix 49780-16 Date Account Established 03/10/2009 Principal Balance at Date of Death $15,660.49 Accrued Interest to Date of Death $8.82 Total Principal and Accrued )merest $15,669.31 Name of Beneficiary Dennis Shaw 33 1/3% Debra Rasp 33 1/3% Daniel Keeseman 33 1/3% IRA CERTIFICATES: Account Number/Suffix 49780-18 Date Account Established 10/23/2007 Principal Balance at Date of Death $3,861.40 Accrued interest to Date of Death $2.18 Total Principal and Accrued Interest $3,863.58 Name of Beneficiary Dennis Shaw 33 1/3% Debra Rasp 33 1!3% Daniel Keeseman 33 1/3% SUUU Louise Drive P.O. Box 40 • Mechanicsburg, Penns~~lvania 17055 (S00) 283-2328 u~un~:Inernbersl st.org 1RA CERTIFICATES: Account Number/Suffix 49780-19 Date Account Established 12/01/2008 Principal Balance at Date of Death $14,576.03 Accrued Interest to Date of Death $12.87 Total Principal and Accrued Interest $14,588.90 Narne of Beneficiary Dennis Shaw 33 1/3% Debra Rasp 33 1/3% Daniel Keeseman 33 1/3% IRA CERTIFICATES: Account Number/Suffix 49780-20 Date Account Established ~ 10/28/2009 Principal Balance at Date of Death $3,324.29 Accrued Interest to Date of Death $1.16 Total Principal and Accrued interest $3,325.45 Name of Beneficiary Dennis Shaw 33 1/3% Debra Rasp 33 1/3% Daniel Keeseman 33 1/3% CERTfFiCATES OF DEPOSIT: Account Number/Suffix 49780-40 Date Account Established 01/06/2009* Principal Balance at Date of Death $12,057.21 Accrued Interest to Date of Death $8.99 Total Principal and Accrued Interest $12,066.20 Narne of Joint Owner None *Rollover from certificate 49780-44, originally established 12/30/2004. CERTIFICATES OF DEPOSIT: Account Number/Suffix 49780-42 Date Account Established 12/30/2004 Principal Balance at Date of Death $14,043.62 Accrued Interest to Date of Death $7.60 Total Principal and Accrued Interest $14,051.22 Name of Joint Owner None CERTIFICATES OF DEPOSIT: Account Number/Suffix 49780-43 Date Account Established OS/14/2009* Principal Balance at Date of Death $1,214.03 Accrued Interest to Date of Death $.42 Total Principal and Accrued Interest $1,214.45 Name of Joint Owner None *Rollover from certificate 49780-41, originally established 08/12/2004. VISA ACCOUNT: Account Number Date Account Established Balance on Date of Death Joint Cardholder 4672090000125237 12/06/1989 $473.54 None .\ EM ERS 1sT F ERAL REDI l~JN. ~~ ~~ ~anielle A Kline Lending Insurance Support Specialist February 23, 2010 Estate of: ROMAINE V. THRONE Date of Death: 01/0912010 Soctat Security Number: 172-26-9478 4/7/2010 Used Car Value -Audi A4-V6 Sedan 4D ... ~:. i The Power o~ Yshiale Ininrmation i•fUME AU7'C~5 CLAaS~G C~1F~S MUTt~I~tCYCLES l13UA'rS RV~ MAIUU~ACTU~tEt~ HOit-'ii:~ FSUI' A ~itTClr ~U~CI'31" Aprl 07, 2 1 Vehicle History Report ~~ print email 11 ~ Get a Free VIN Check 996 Aud ' .~~..~, Ilstfngs of this model within +Ress GO or Enter VIN; t PRICING 25 miles of your ZIP code _._..~__._...._.T_._._._ .......,, ~AutoCheck Expand Your Search Roush Average Clean Clean r--•---••---- ADVERTISEMEl~'r find Your Car Trade-In Trade-In Trade-In Retail Audi ~ Base Price $800 $1,450 $2,000 $3,725 ~ ~~~~~ ~ ZIP 17013 I Mileage - 61,450 miles $1,000 $1,000 $1,000 $1,000 /""v`^ A taT}ndari;~' TOTAL PRICE •;1;800 #2,430 #3,000 sa,723* Free Insurance Quote "This Retell price is based on a cl ean vehicle historv•reoort. Don't make a $4,725 mistake. Find out - why At!toCheck is better than Gar fax. 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Articles AppraiairrD Your Car SriNing'frps • 6uying a Used Car Finnncng 101 Home I Media Room I About Us I Help/FAQ I Contact Us I Advertising I Llnk to Us I Huy a Price Guide I Business Users I Change Z1P ~)Copyrighl 2010 NADAguldes.com. All Itlghts Reserved. Copyright I Privacy Pohry ~hanae Make > Chanae Year & Model > Shanae Trlm > Chanoe Mlleaae & Ootlons > Value Report 1996 Audi A4-V6 Sedan 4D 2.8 J w®h'icNe Rr"ccirtg & In~Carnmation NAD~4g~ides.cotn NADAguides.corn Price Report 4/6/2010 Rou h Average ~ Clean Clean Trade-In Trade-In Trade-In Retail Base Price $800 $1,450 $2,000 $3,725 Mileage 51,450 miles $1,000 $1,000 $1,000 $1,000 TOTAL PRICE $1,8D0 $2,450 $3,000 $4,725* Rough Trade-In The Rough Trade-In values on nadaguides.com are meant to reflect a vehicle in rough condition. A vehicle with significant mechanical defects requiring repairs in order to restore reasonable running condition; Paint, body and wheel surfaces have considerable damage to their finish, which may include dull or faded (oxidized) paint, small to medium size dents, frame damage, rust, or obvious signs of previous repairs; Interior reflects above average wear, with inoperable equipment, damaged or missing trim, and heavily soiled /permanent imperfections on the headliner, carpet, and upholstery; May have a branded title and un-true mileage; Vehicle will need substantial reconditioning and repair to be made ready for resale; Some existing Essues may be difficult to restore. Because individual vehicle condition varies greatly, users of nadaguides.com may need to make independent adjustments for actual vehicle condition. Average Trade-In The Average Trade-In values on nadaguides.com are meant to reflect a vehicle in average condition. A vehicle that is mechanically sound but may require some repairs/servicing to pass all necessary inspections; Paint, body and wheel surfaces have moderate imperfections and an average finish and shine which can be improved with restorative repair; Interior reflects some soiling and wear in relation to vehicle age, with all equipment operable or requiring minimal effort to make operable; Clean title history; Vehicle will need a fair degree of reconditioning to be made ready for resale. Because individual vehicle condition varies greatly, users of nadaguides.com may need to make independent adjustments for actual vehicle condition. Clean Trade-In The Clean Trade-In values on nadaguides.com are meant to reflect a vehicle in clean condition. A vehicle with no mechanical defects and passes all necessary inspections with ease; Paint, body and wheels have minor surface scratching with a high gloss finish and shine; Interior reflects minimal soiling and wear, with all equipment in complete working order; Vehicle has a clean title history; Vehicle will need minimal reconditioning to be made ready for resale. Because individual vehicle condition varies greatly, users of nadaguides.com may need to make independent adjustments for actual vehicle condition. Clean Retai) The Clean Retail values on nadaguides.com are meant to reflect a vehicle in clean condition. A vehicle with no mechanical defects and passes all necessary inspections with ease; Paint, body and wheels have minor surface scratching with a high gloss finish and shine; Interior reflects minimal soiling and wear, with all equipment in complete working order; Vehicle has a clean title history. Because individual vehicle condition varies greatly, users of nadaguides.com may need to make independent adjustments for actual vehicle condition. The consumer values on nadaguides.com are based on the Consumer edition of the NADA Official Used Car Guide ~, and should not be utilized for industry purposes. The consumer values may vary from the NADA Official Used Car Guide values presented to you by insurance companies, banks, credit unions, government agencies and car dealers due to vehicle condition, regional market differences and frequency of updates. nnvFn ricGMFnrr pCopyright 2010 NADAguides.com. All Rights Reserved. CGNADASC 2010. All Rights Reserved. ~ttp://www.nadaguides.com/print.aspx... 1/1 Attachment to Schedule «G~~ MEMBERS 1St FBDBItALCRBDIT UN10N SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner LIFE SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 49780-00 05/13/1986 $3,566.10 $.27 $3,566.37 None 49780-04 02/02/2001 $4,000.00 $.31 $4,000.31 None *Opened by transfer of funds from 49780-00. CHECKING ACCOUNT: Account Number/Suffix 49780-11 Date Account Established 05/13/1986 Principal Balance at Date of Death $1,949.86 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest $1,949.86 Name of Joint Owner None IRA SAVINGS ACCOUNT: Account Number/Suffix 49780-10 Date Account Established 10/01/1986 Principal Balance at Date of Death $.21 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest $.21 Name of Beneficiary Dennis Shaw 33 1/3% Debra Rasp 331!3% Daniel Keeseman 33 1/3% IRA CERTIFICATES: Account Number/Suffix 49780-16 Date Account Established 03/10/2009 Principal Balance at Date of Death $15,660.49 Accrued Interest to Date of Death $8.82 Total Principal and Accrued Interest $15,669.31 Name of Beneficiary Dennis Shaw 33 1/3% Debra Rasp 331 /3% Daniel Keeseman 33 1!3% IRA CERTIFICATES: Account Number/Suffix 49780-18 Date Account Established 10/23/2007 Principal Balance at Date of Death $3,861.40 Accrued Interest to Date of Death $2.18 Total Principal and Accrued Interest $3,863.58 Name of Beneficiary Dennis Shaw 33 1/3% Debra Rasp 33 1/3% Daniel Keeseman 33 1/3% 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 v~~Tw rneinbersl st.org IRA CERTIFICATES: Account NurnberlSuffix 49780-19 Date Account Established 12/01/2008 Principal Balance at Date of Death $14,576.03 Accrued Interest to Date of Death $12.87 Total Principal and Accrued Interest $14,588.90 Name of Beneficiary Dennis Shaw 33 1/3% Debra Rasp 331/3% Daniel Keeseman 33 1/3% IRA CERTIFICATES: Account Number/Suffix 49780-20 Date Account Established ~ 10/28/2009 Principal Balance at Date of Death $3,324.29 Accrued Interest to Date of Death $1.16 Total Principal and Accrued Interest $3,325.45 Name of Beneficiary Dennis Shaw 33 1/3% Debra Rasp 33 1/3°~ Daniel Keeseman 33 1/3% CERTIFICATES DF DEPOSIT: Account Number/Suffix 49780-40 Date Account Established 01 /06l2009* Principal Balance at Date of Death $12,057.21 Accrued Interest to Date of Death $8.99 Total Principal and Accrued Interest $12,066.20 Name of Joint Owner None *Rollover from certificate 49780-44, originally established 12/30/2004. CERTIFICATES OF DEPOSIT: Account Number/Suffix 49780-42 Date Account Established 12/30/2004 Principal Balance at Date of Death $14,043.62 Accrued Interest to Date of Death $7.60 Total Principal and Accrued Interest $14,051.22 Name of Joint Owner None CERTIFICATES OF DEPOSIT: Account Number/Suffix 49780-43 Date Account Established 08/14/2009* Principal Balance at Date of Death $1,214.03 Accrued Interest to Date of Death $.42 Total Principal and Accrued Interest $1,214.45 Name of Joint Owner None "Rollover from certificate 49780-41, originally established 08/12/2004. VISA ACCOUNT: Account Number Date Account Established Balance on Date of Death Joint Cardholder 4672090000125237 12/06/1989 $473.54 None EM ERS 15T ~ ERAL REDf 1~JN. ~~ ~ ~ anielle A. Kfine Lending Insurance Support Specialist February 23, 2010 Estate of: ROMAINE V. THRONE Date of Death: 01/09/2010 Social Security Number: 172-26.9478 4/7/2010 Used Car Value -Audi A4-V6 Sedan 4D ... :_ . The Power of Y~hicle Information IiUMI= AtJTO-S Cl.AaSIC' C/1RS MC1TU~tC1rCL>rS E3~AT5 13V~ MAIVU~ACTUREt~ Ht7Ml^S FSU'!' !~ f~KICE ~uzia~ April 07, 2010 Vehicle History Report ~~ r print small 11 ~ Get a Free VIN Check 996 Aud Press GO or Enter VIN ~ PRICING listings of this model within 25 miles of your ZIP code •.-~.., __._ ~Autot:heek 6tpand Your Searoh Rough Average Clean Clean .._._._.__.._____..._.._....._....._RTISEMENT ; Find Your Car . Trade-In Trade-In Trade-In Retell f Audi -~~ Base Price $800 $1,450 $2,000 $3,725 ~ ZIP i 1i17013 lw _------I Mileage - 61,450 miles $1,000 $1,000 $1,000 $1,000 ~ ...r.. Atrto?}vdBZ'l;~?' TOTAL PRICE •$1;800 $2,450 $3,000 sa.~zs* Free Insurance Quote "This Retell price is based on a cle an vehicle history •reoort. Don't make a $4,725 mistake. Find out why AutoCheck is better than Carf ax. Get a Free VIN Check today. Free Online Insurance . Ouote . ~j~© ~:: NEXT STEPS ' Free Auto Loan Quote Free•Loan Poole-Bad Credit OK! Find this Vehicle Start Your Loan Aoolication ~ Free Orttine Credit Score Seh Your Car 2090 CADILLAC CTS xutu,,..ct~~,.,: ~ SOLUrIC~N5 Lower your hsurance Payment Finance 8 hsurance Center A Gar andDrlvariOBost Search CPO hcenlives & Rebates 3- Cara runNn ; Y B• Free Credit Report Note: Vehicleswflh lowntileago that are in exeeplionolly good wndilion and/or include a mnnulaclurer ceAl(icelion can be Free Online Credit Score 11M0~t a signihwnlly higher value Than the Retell puce chovnt ~Q , ~ ~ DisWowre aalemonl Locale 3 Dealer . Request a ~luoie Trusted Partners Lt)CBIe a VB-tiCle find a Dealer Sell Your Car ll ft N S e ow Pw,rM i1 Arttdl3r~tdr~r~ ` ; Free Dealer Price Quote ! Near Car Dealer Quote Auto Resources .. ..... ___ ............... ..... .. . Articles Appraisirtfl Your Car sexing rps riuying a Used Car ' Finnnchg 101 Home ~ Media Room ~ About Us I Nelp/FAQ ~ Contact Us ~ Adverl151rtg ~ Link to Us ~ Iiuy a Price Gu,de i eu5tness Users ~ Change Z1P C)Copyrigltl 2010 NADAguldes.com. All Rlgltts Reserved. Copyright I I>rivaty Pol,cy Chance Make > Chance Year & Model > Chance Trlm > Chance Mlleaae & Ootlons > Value Report 1996 Audi A4-V6 Sedan 4D 2.8 II 1 Weh~icye Frici~,~ & in~rarirnnation NAD14c~uides.com NADAguides.com Price Report 4/6/2010 Rouah ~ Average Clean Clean Trade-In Trade-In Trade-In Retail Base Price $800 $1,450 $2,000 $3,725 Mileage 61,450 miles ~ $1,000 $1,000 $1,000 $1,000 TOTAL PRICE $1,800 $2,450 $3,000 $4,725* Rough Trade-In The Rough Trade-in values on nadaguides.com are meant to reflect a vehicle in rough condition. A vehicle with significant mechanical defects requiring repairs in order to restore reasonable running condition; Paint, body and wheel surfaces have considerable damage to their finish, which may include dull or faded (oxidized) paint, small to medium size dents, frame damage, rust, or obvious signs of previous repairs; Interior reflects above average wear, with inoperable equipment, damaged or missing trim, and ~heavlly lolled /permanent imperfections on the headliner, carpet, and upholstery; May have a branded title and un-true mileage; Vehicle will need substantial reconditioning and repair to be made ready for resale; Some existing issues may be difficult to restore. Because individual vehicle condition varies greatly, users of nadaguides.com may need to make independent adjustments for actual vehicle condition. Average Trade-In The Average Trade-In values on nadaguides.com are meant to reflect a vehicle in average condition. A vehicle that is mechanically sound but may require some repairs/servicing to pass all necessary inspections; Paint, body and wheel surfaces have moderate imperfections and an average finish and shine which can be improved with restorative repair; Interior reflects some soiling and wear in relation to vehicle age, with all equipment operable or requiring minimal effort to make operable; Clean title history; Vehicle will need a fair degree of reconditioning to be made ready for resale. Because individual vehicle condition varies greatly, users of nadaguides.com may need to make independent adjustments for actual vehicle condition. Clean Trade-In The Clean Trade-In values on nadaguides.com are meant to reflect a vehicle in clean condition. A vehicle with no mechanical defects and passes all necessary inspections with ease; Paint, body and wheels have minor surface scratching with a high gloss finish and shine; Interior reflects minimal soiling and wear, with all equipment in complete working order; Vehicle has a clean title history; Vehicle will need minimal reconditioning to be made ready for resale. Because individual vehicle condition varies greatly, users of nadaguides.com may need to make independent adjustments for actual vehicle condition. Clean Retail The Clean Retail values on nadaguides.com are meant to reflect a vehicle in clean condition. A vehicle with no mechanical defects and passes all necessary inspections with ease; Paint, body and wheels have minor surface scratching with a high gloss finish and shine; Interior reflects minimal soiling and wear, with all equipment in complete working order; Vehicle has a clean title history. Because individual vehicle condition varies greatly, users of nadaguides.com may need to make independent adjustments for actual vehicle condition. The consumer values on nadaguides.com .are based on the Consumer edition of the NADA Official Used Car Guide p, and should not be utilized for industry purposes. The consumer values may vary from the NADA Official Used Car Guide values presented to you by insurance companies, banks, credit unions, government agencies and car dealers due to vehicle condition, regional market differences and frequency of updates. I ©Copyright 2010 NADAguides.com. All Rights Reserved. I UNADASC 2010. All Rights Reserved. ~ttp://www.nadaguides.com/print.aspx... 1/1 Attachment to Schedule «F~~ t,~, ` .. _ ,~ ,,,~ Lv _... I, a 1 1 r~^ `( ~~^^ , .. ~ ~ ~ OF Gi~~U"~ `. `~ ~ 1 ~~ f jf~} 1 ~ ~ 3 Tax Parcel No. 40-09-0529-084 ~~~ I,~U . DEED ______ THIS DEED is made the ~ day of n~o ~ gym, ~ _, 2005, BETWEEN OLD FIELD PARTNERSHIP, a Pennsylvania general partnership, as record owner; and MAX D. MARBAIN, an adult individual, as equitable owner (together "Grantor"), AND ROMAINE V. THRONE, DENNiS M. SHAW, DEBRA E. RASP and DANIEL E. KEESEMAN, adult individuals, as joint tenants with rights of survivorship, and not as tenants in common (collectively "Grantee"): WITNESSETH That the Grantor in consideration of One Hundred Forty-Four Thousand DOLLARS ($144,000.00) paid by the Grantee to the Grantor, the receipt whereof is hereby acknowledged, does hereby grant and convey unto the Grantee: LL THAT CERTAIN lot or parcel of ground situate in South Middleton `~ T;~~hip, Cumberland County, Pennsylvania, being identified as Lot No. 65 on the Final Subdivision Plan for Phase 1 - Summerfieid as .prepared by Alpha Consulting Engineers, Inc. and recorded in Cumberland County Plan Book 85, Page 25 (the "Plan"), as more particularly described as follows, to wit: BEGINNING at a point on the northeastern right-ofi way line of Brighton Drive {5D feet wide), said point being on the dividing line between Lot 65 and Lot 66 as shown on the Pfan; thence continuing along the said dividing fine North 34 degrees 36 minutes 10 seconds East a distance of 104.94 feet to a point on line of Future Commercial Development as shown on the Plan, thence continuing along same the following two {2) courses and distances: {1) South 55 degrees 23 minutes v0 seconds East a distance of 43.D1 feet; and (2) South 28 degrees 09 minutes 15 seconds East a distance of 34.35 feet to a point; thence South 54 degrees 01 minute 30 seconds West a distance of 105.07 feet to a point on the northeastern right of way line of Brighton drive aforementioned; thence along same by a curve to the left, having a radius of 225.00 feet and a chord bearing of North 41 degrees 02 minutes 58 seconds Vlfest, an arc door Zvi eAC~4~i3 distance of 39.90 feet to a point on the dividing fine between Lot 65 and Lot 66, said point being the point and place of BEGINNING. BEING Lot 65 and CONTAINING 6,258 square feet, more or less. BEING part of the same premises which Max D. Marbain, by deed dated May 11, 1990 and recorded in Cumberland County Deed Book O, Volume 34, Page 246, granted and conveyed unto Old Field Partnership, record owner. AND the said Old Field Partnership entered into a certain Agreement of Sale with Max D. Marbain dated March 22, 2002, a memorandum of which is recorded in Cumberland County Misc. Book 685, Page 4020. UNDER AND SUBJECT to a certain Declaration of Covenants and Restrictions dated October 7, 2002 and recorded in Cumberland County Miscellaneous Book 690, Page 4333 and a certain Declaration of Consolidation dated September 8, 2004 and recorded in Miscellaneous Book 711, Page 3098; to conditions shown on the Plan: to all other covenants, conditions, restrictions, rights-of--way, easements and agreements of record in the aforesaid Office of the Cumberland County Recorder of Deeds; and to matters which a physical inspection and survey of the Lot would disclose. THE GRANTEE, for and on behalf of the Grantee and the Grantee's heirs, personal representatives, successors and assigns, by the acceptance of this deed, covenants and agrees to pay such charges for maintenance, repair, replacement and other expenses in connection with the Common Facilities, as may be assessed against him, her, them, it, or against the said Lot, from time to time by the Executive Board of the Summerfield Homeowners Association in accordance with the Pennsylvania Uniform Planned Community Act, 68 Pa. C.S. 5101 et seq. (the "Act"), and further covenants and agrees that the Lot conveyed by this deed shall be subject to a lien for all amounts so assessed except insofar as Section 5407(c) of the Act may relieve a subsequent Lot Owner of liability for prior unpaid assessments. This covenant shall run with and bind the Lot hereby conveyed and all subsequent owners thereof. Max D. Marbain has executed this Deed in his individual capacity as equitable owner and as Authorized Partner of~Old Field Partnership pursuant to a Partnership Resolution dated March 22, 2002 and recorded in Cumberland County Miscellaneous Book 685, Page 4026. ~OnK ~~~ PAG.E4~~.~ And the Grantor wil{ warrant SPECIALLY the property hereby conveyed. Ilrl VI-tTNESS WHEREOF, the Grantor has caused this Deed to be duly executed as ofi the day and year first written above. WITNESS: GRANTOR: OLD FIELD PARTNERSHIP, a Pennsylvania general partnership, record owner By Max D, Marbain, Authorized Partner Max D. Marbain, individually, equitable owner i~~mn~r-a.a~ci Gc~~rr~.~ ~:n,:~jr{.tut ct~~ i:~eer3~ '~~t?w'Ct~ld~{E't'ti: ~ :L~.111q F4~:+'~'] ~r~ '"a~3~ ~'C1G ~r-s~_r# ~'4t'i5-~t)irc~.ii:~li ~.if~1~~ ~~~s ~.~ •'4 a ~ s~' 'I'{~{~(If~E I~C~D air<x'r „JCl t:o z~~r~aur:~i~i~'r r~t~ ' , 4~ Ttl::~. ai'IF+~t~i4T !°'-1~1G1 ~ S~Jt) ~'f'tN::~':~' ~}~~~~ ~.J. r ~t~:G . UG r'?. tj'7j r;Q ., Ah(iY x'71 PAGF~~~~ ' COMMONWEALTH OF PENNSYLVANIA ; SS; COUNTY OF CUMBERLAND On this, the day of`~ , 2005, before me, a Notary Public in and for the above-named Commonwealth and County, the undersigned officer, personally appeared MAX D. MARBAIN, individually, as equitable owner, and as Authorized Partner of OLD FIELD PARTNERSHIP, record owner, pursuant to Partnership Authorization dated March 22, 2002 and recorded in Cumberland County Miscellaneous Book 685, Page 402fi, known to me {or satisfactorily proven), to be the individual who executed the foregoing instrument, and duly acknowledged to me that he executed the same on his own behalf as equitable owner, and as Authorised Partner of Old Field Partnership for the purpose contained therein. fN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public My Commission Expires; COMMONWEALTH OF PENNSYLVANIA Notarial Seal • Anna Marie Mader, Nafary Public Hampden Twp., Cumbertand County My Canmiaslpn ExphesAug.1s, 2008 Member, Pgnneylvanl~~ !~»anclntion Of Notaries (SEAL) ; r~.~,~.. ~ ;. ', ~'~-<::•. ~. fir' ,~.'.. ; r~:~ ',A'`~ , y!~..t~j:' F~' t s,k., •ii .r. ., `~ ;~;y ,.FAQ if .'Y:' ~~:~ .~*.4 -. J -r t 9 rR 800K ,Z'7i PAGE46~.s CERTIFICATION OF ADDRESS I hereby certify that the precise residence of the Grantee herein is: 122 Brighton Drive, Carlisle, PA 17013 r e fi or Grantee COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND RECORDED in the Office of the Recorder of Deeds in and for said County in Deed Book ~,,, Page _. WITNESS my hand and official seal this day of , 200. Recorder of Deeds 1 Certify t~1is to be recce rd ~;d In Cumberland Coux1~:y ~' p~ h, 1J`~ • 2 O V ~DOK ~"x~, PAGE~~i,~ Recorder of I)ce~.s OMB N0.2502-0265~r A. B. TYPE OF LOAN: OUSING & URBAN DEVELOPMENT 1•~FHA 2.~FmHA 3.~JCONV. UNINS. 4.~VA 5.[]CONV. INS, V.S. DEPARTMENT OF H SETTLEMENT STATEMENT 6. FILE NUMBER: THRONE2 7. LOAN NUMBER: e. MORTGAGE INS CASE NUMBER: C. NOTE: This form Is famished to glue you a statement o/ actual settlement costs. Amounts pa/d to and by the settlement agent ere shown. ' Items marked '(POCJ' were pa/d outside the closing; they are shown here for Jnlormetlonal purposes end ere not Included In the totals. 1.0 3/BB (THRONE2.PFD/rNRONE4/1) D. NAME AND ADDRESS OF BORROWER: r Rodney E. Throne 122 Brighton Drfve Carlisle, PA 17013 ~ E. NAME AND ADDRESS OF SELLER: Dennis M. Shaw Debra E. Rasp Daniel E. Keeseman F. NAME AND ADDRESS OF LENDER: ' ta. PROPERTY LOCATION:. 122 Brighton Drive PA 17013 ~~ ` • • ~~ Carlisle H. SETTLEMENT AGENT: 2b-1824518 Bradley L, QrlNie, Esgulre ~ ~ « ~ • ~~~ ~ ~~ I. SETTLEMENT DATE: 2010 Apri112 , Cumberland CDUnty, Pennsylvania • y. r.• • 1 .. • •• • ••"~~~ • • PLACE OF SETTLEMENT• ' " •• '; .... 200 NoAh Hanover Slreti~t ~. Carlisle, PA 170'J3~~~ ••• ~.. , J. SUMMARY OF 80RROWER'•S TRAN SACTION • • ••• • • •- K. SUMMARY OF SELLER'S TRANSACTION 100. 4ROSS AMOUNT DUE FROM BORROWER: ~ ~ ~ • ' 400. GROSS AMOUNT DUE TO SELLER: 101. Contrecl Sales Price • ~ "~ ~ • 160,000.00 40'1. • Contract Sales Price 150 000.00 102. Personal Pro ; ' 402. 'Pereonel'Pro art 103. Settlement Char es to Borrower Una 1400 1,984.00 403. 104. 404. 10b. 40b. Ad'ustments For hems Paid 8 SeNei In advance ~ Ad uslments For Items Pald B Seller /n advance i06. School Taxes to ~ ~ 406. School Taxes to 107. Coun lTownshl to 407. Coun liownshi to 108. Assessments to 408. Assessments to 109. Coun liownshl Taxes ' ; ~ ; 409. CountyR'ownship Taxes 1 i 0. School Taxes 410. School Taxes 111. 1 _.. . , ... 411'. .. . . 112. : ' ~ 412. i20. DROSS AMOUNT DUE FROM BORROWER • ~ •.:151,984.00. ~ 420. GROSS AMOUNT DUE TO SELLER 150,000.00 200. AMOUNTS PAID BY OR IN BEHALF•OF BORROWER: ~ 500.. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De Dell or eemest mon • ~ ~ ' 1,000.00: :•501. •Excess De Dail See Instructions 202. Princi ai Amount of New Loans 4~:. , ~ ~ •~ ~ ' •' • .502. ~Setllement Char es to Seller IUne 1400 1,520.00 203. Existin loan s taken sub'ect fo '•• ' ~ ~ "'" ~ 603: 'Existin loan a taken sub act to 204. ` " °' ~ •" :: '• '604:• Payoff'of first Mortgage 205. ' ' ~ "' '• ° " "" =• .• b05.. Pa of second Mort e 206. .. ~ ~ 606.... . 2D7. •- -- • • ~ • • • • ~ -507. De ostt dish. as roceeds 208. .. .... ., . .. ... -508. . 208. ... .. .. 6d9. Ad ustments For Items Un Id 8 Seller •• • -' Ad ustments For Items Un Id B Seller 210. SchoolTexes to••~- '• 510. School Saxes to 211. Coun /Townshi to •-•• - • • •• • • •• • - •511. Count /Townsht to 212. Assessments ' to "' ~ - ~ -• ~ 'S12.'Assessments to 213. ..... ..- • 5'13. •,: •. 214. ,,. .._ ;«h..: 5)4: .. 215. .. ... .. ..... _..._...... : •'51.5-....... _.._. . 216. ._ ..,.. ..,.,. ..... ,>, .516••. .... 217. ~' bi•7. ~ - 218. ........ 518. 218. .. .... .. ;, t _ 618. 220. TOTAL PAID BY/FOR BORROWER- •:~•:.,~' • ~ • • • • . 1,OOD.OO.+ i ~1 X20. TOTAL REDUCTION AMOUNT DUE SELLER 1,520.00 300. CASH AT SETTLEMENT FROM/TD EORROWER: • ..' • •~ •' , BOO..CASH AT SETTLEMENTTO/FROM SELLER: 30i. Gross Amount Due From Borrower Line 120 ib1,984:00• ~ 801. Groas'Amount Due To SeNer Llne 420 150,000.00 302. Leas Amount Pakl B lFor eorrowet'{Una'-220 ~=" ( ~ ~-1,000:00 .; "802'. %tesa Rriduclions Due Seller (Una 620) 1,620.00 303. CASH (X FROM) ( TO) BDRROWt=R:..~ ..: 160,984.OOti ; i :ti'tz,?.:CASH (X TO) ( FROM) SELLER .. 148,480.00 •7he undersigned. here y knowledge recefpl of a om~ eted copy of pages.l ~2~ of ihls atalement & any attachments referred to herein. Borrower Jf :,• .'. .:. :~t•/„~~..'..'• ' :seller yj odney E. n ....: 1 •: .' ' .:. ~' ~°.;=- .... :. De is Shaw r• ... .. , •.. ~" ., .. '; .. ,jt .1:.• _. .' Debra E. Ras ~ . .. ' .t'~..: ~. i1: 1. .... .... : 1: 1.''.. .. ,c _.. .. .... ,l'i ... .. .. ... .. ..,- ~. • .. .... • r.pe 2 • ... L. SETTLEMEN'T•CHARGES 700. TOTAL COMMISSION Based on Price $ ~ @ • .;.I . ' , % Division of Commisslon J/ne 700 as Follows: ~ ` 701. $ t0 ~ t ~ ' 702. $ t0 - ~ :.h ~ • '.1 -. PAID FROM PAID FROM aORROwER'8 BELLER's FUND& AT FUNDS AT BETiLEMENi 6ETTLEMENi 703. Commission Pald at Settlement •• -' •'`~ % '•' • ' 704. to ~:.~ . e00.1TEMS PAYABLE IN CONNECTION WITH LOAN • ~ ~ .-• 801. Loan Ori inetion Fee 96 ' -. •to 802. Loan Discount °,G•,• ~; to ..- ±. • 803. Appraisal Fee to 804. Credit Report to 80b. Lender's Inspection Fee to ~ BDti. Mort a e Ins. A .Fee ..to , . ~ • 807. Assumption Fee to ~ ' , ~ 808. r l : ' 809. .. .~ ...: 810. • . t .. 811. .. _. , .. ...... .. .. 900. ITEMS REQUIRED 8Y LENDER TO,BE.PAIQ,IN.ADVANCE ;'.•.....:'..'::• -:~.;',.:,:. ,..' 801. Interest From to .. '..,,..»@..$ ._..._ .. ... . /dtyl .: (•...-•:da s °.6) 902. Mort a e Insurance Premlumfor •- mondis'to•• ~ - 903, Hazard Insurance Premlumfor 1.0 • ers •to•• ~ s•- •••••• •-••• 904. • • .:: _ ::, - . 805. _ .. 1. ,. •. 5;. •1... .. 1000, RESERVES DEPOSITED WITH LENDER••~- -. •'• •«• •• •• - • •• ••M^•~' ~^• • - • - 1001.Hazard Insurance • • •- -~• • • •• months• $~ = ~ • • ~~ er • month 1002. Mort a e Insurance • ~ •months @ $ • - - • •• • er month 1003. School Taxes • • • • • ~ months @ $ •• er month 1004. Coun /Townshi •- •• -months • @ ~ • • • - '• • • er month 1005. Assessments • • ••~ •months @ $ • •• • -• •••per month ~• 1006. -~ - months @ $ •••' er month 1007. - ~ • •• • •months -@ •$ •• • • - ••; •- •per•• month ' •• 1006. - •• • months @ •.$-- •• - • ~ •~ er••month 1100. TITLE CHARGES ~ - ° ° - '- ' •' « • ' 1101. Settlement or Closin Fee io - •• ~ ~ ~ - ` • 1102. Abstract or Tftle Search ~ - •• - -~to •• • • • • -• •• %~ ~~'~ • 1103. tie Exeminati n •• .•io.°• ~ ....i• ~ - .. ,: r: "- • ,• - .• 1104. Pre station of Mori a e & Note "' •• • to 'Btadld 'L'Gdffie•- Es'•uir'e' ;'%•" ~' • ' 50.00 1105. Document Pre station .=;>••a;b • Bradle L•:~Grlffie ulre °' • •: • -~ 300.00 1106. Note Fees • • •• • = ~ to Cash • • ° •• - • • • • 10.00 20.00 1107. Attorneys Fees ~ ~ • =io ~ - - - ~ • - - • • - Indudesabove Item numbers: • •• - - • • - 1108. Title Insurance to ' indudes above item numbers. "" ' ' ~" ~ • ~ ' ' °-"• - ' 1109. Lender's Cover e • • •• ;$ •-~ •• • ° r: !': ~ • ' 1110.Owner's Coverage •- ~ $ • • ~~ 1111. ••• 1112. .. -- ; : . 1113. _ .. . 1200. GOVERNMENT RECORDING AND IAANSFER CHARGES . • ' - :~''•' ' 1201. Recording Fees: Deed $ 62.00'; ytortgage $ •••~ X62.00;• • • ~ ~~ ~j~Releases.$- 124.00 1202. CI /Coun TaxlStam s: Deed • •• • •. • •-•• ..•_• • •; •..: ...:.Mort a e„;,:...... ... . • ... 1,500.00 1203. State TaxlStam s: Revenue Stam s: .- ... ;.Mort a a.,:. •' 1,500.00 1204. .. ~ . 120b. .. . ~.... . 1300. ADDITIONAL SETTLEMENT CHARGES ;«: •. ~.. .. 1301. Surve ~fo. -•:.. ,•• 1302. Pest Ins cllon .... ~::;- ~ to ..:. ' .........- • `_..:.:....r .; ........ ~_. ' 1303. 2010 Ct R Taxes - •-~••• -r•I•~ •:Robert C~Calms •Tax•Collector••-- -•• 1304. .,... - 1305. w.. .. .. « ..~,. .. .. '1400. TOTAL SETTLEMENT CHARGES:° Efiter•on'Lines 103, Section':I artd 502; Sec ' 1,984.00 1,620.00 ,w.•r.. .. ......... .... _.. ~ ~ ti. -' .. ... ... . ~ :...»:..,..... • . .. - . • - • :': '"/' : Br d(e ,Esquire .. _.._ .. .... ...... _: a.. gent Cetillled to be a Vue copy •y~ ~ • • .• • • ~-~ •• •• :-~; •• . •_ . . . • .. yl.il ,Mlryyi. . ~:, •1±W• _ .. i,... .. _. .. •1. _..~ •t. .... •;rl.. .. ..... ..... «. ... .. « ~ .V. . .. . .. . »w...»h11.. ...... . . .. ... ~ ii2/...ww.... . . N.. : nF,Fd J:'a . .. .. :•1! tl :711: j•ir.:. ..... .. .. ~ , ..... : 1 i • ~'.. .. - ..... .t:. .. .. .. _ . ~' ~ ' :: ; . ,; ~ •_. .... ' . .. .. =-:1 :~u• ,- •... (n+RONea/7HRONE2/7)