Loading...
HomeMy WebLinkAbout07-30-101505610101 REV- ~ 500 EX (oi-io) OFFICIAL USE ONLY PA Department of Revenue Pennsylvania -- - UEPARTMENTOFREVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOx 28o6oi 2 1 0 9 0 1 2 0 5 Harrisburg, PA 1128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 7 2 2 4 8 5 5 8 1 1 0 7 2 0 0 9 0 6 2 1 1 9 1 6 Decedent's Last Name Suffix Decedent's First Name MI B E ARD MA RY E' (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime TelephonE; Number M a r 1 i n R M c C a l e b E s q 7 1 7 6 9 1 7 7 7 0 REGI I_ {R,_~O~F WILLS~E ONLY ~' '' - ~ {:.._ C 7 ` ~._ - fr ,: . . ~, -- , ~` t _~ .. _ T_.t ~. , -~" DA,TIE FILED.-> ._ _~.,_. First line of address 2 1 9 E a`s t M a i n S t r e e t Second line of address P O B a> x 2 3 0 City or Post Office State ZIP Code M e c h a n i c s b u r g P A 1 7 0 5 5 Correspondent's a-mail address: 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 prep.arer has any knowledge. SIGNA RE OF PERSON RE PON I LE FOR FILING RETURN a DATE ~Q,~ Administratrix ~~~~~ ~ d ADDRESS a ric ac po e ~' 64 San Monica nu Car isle, PA 17015 _ SIGNATU P PA R ENTAT,I~/E ~~~~ ~~~~~~-DATE ADDRESS -Marlin R . McCaleb'~"~ - ~""" _ _219 East Main .Street , P , 0. Box 230 , Mechanicsburg , PA 17055 .w ~ PLEASE USE ORIGINAL FORM ONLY ~~~~ Side 1 1505610101 1505610101 1505610105 REV-1500 EX Decedent's Social Security Number Mary E• Beard ' 1 7 2 2 ` 4 8 5 5 8 s Name: Decedent RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 5 0 0 0. 0 0 2. Stocks and Bonds (Schedule B) ....................................... 2. 0 • 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0 *' 0 0 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 0 ~ 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 4 0 4 1 7 • 0 8 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 1 6 4 1 6 • 6 5 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 0 ~ 0 0 8. ( g ) ............................ Total Gross Assets total Lines 1 throw h 7 8. 6 1 8 3 3 7 3 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 1 6 7 9 6 • 9 3 10. 9 9 ( ) .............. Debts of Decedent, Mort a e Liabilities, and Liens Schedule I 10. 1 3 4 • 1 2 11. Total Deductions (total Lines 9 and 10) ................................. 11. 1 6 9 3 1 . 0 5 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 4 4 9 0 2 ' 6 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. • 4 4 9 0 2 6 8 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. • TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 15 0« 0 0 . (a)(1.2) X .0 . 16. Amount of Line 14 taxable at lineal rate X .0 ~,5 4 4 9 0 2 .6 $ 16. 2 0 ~ 0. 6 2 17. Amount of Line 14 taxable 17 0* 0 0 at sibling rate X .12 • . 18. Amount of Line 14 taxable at collateral rate X .15 ~' 18• Q' 0 0 19. TAX DUE ......................................................... 19. 2 0 2 Q. 6 2, 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Slde 2 1505610105 1505610105 REV-1500 EX Page 3 File Number Decedent's Corrrpl~te Address: 21-os-o12o5 NAME _ Mares E . Beard _ STREET ADDRESS 64 Santa Monica Avenue c~TY Carlisle STATE PA z~P 17 015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments __ B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval 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. (1} 2,020.62 Total Credits (A + B) (2) 0.0 0 (3} 0.00 (4} 0.00 (5) 2,020.62 Make check payable to: REGISTER OF WILLS, AGENT. .r.. - ,.. ., ~~ s :.. ..-....;...., ~. ;::. ,. ., .::. -~ ..-... P.. . ~.. ..~ ... .. i' ........ .t s l''' '» - ~,. ^i' ~. a ;.-a'~.,. , ti, :3€.~,. .yl` - -)~. V'^., "t.4' w i fr S ~ T2 .c. .. ~~ y~~~,, S. Ty :~ . S • .may ~.7"...~~ S ~ ~Y ~. 3. « .. 1~~,E f ,'.W+ ~1- F y~. w ~{ x..u:.~" .~,',:s'..:_ 1::>. ~. ~~'s, ~' ~o '~~t'h'..^v ..~"'' ';!i`~ :.w 1 +,q .: ~.~....at `"~`'.rt~ x..~'r^.c~;~:""+~M1"X~.4:`-'w. .';r~i ':i~~: 1~~.'~'",~.~.+:a.~~:.. T~.i~i~' . ~~.'. !rT.~' J i- . i ..~f .fit ~ ~. ~ ~ - s. ' NY.S <: _7!: . ~ .. r .... k ~.1. ~"Yt L ..... a .Y. <.: .. ..... '~ -. :... .. .v. ~:I.::.. ... .S 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 Dec. 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? .............. ^ 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. ,~ eFi^ y~ _ -r- . ~. ,. ..... .- ~:~ ~ .~ ~ ~ .~ ,~. _,-x. -t - .: .~~.t, ,~ '...... .-~w-. .. w. - . g <« ~~ Mir "`~:<~ .t'y' .. 5 ~ . z ,, ~+ . - ~'. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 21 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 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 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 12 percent [72 P.S. §9116(a)(1.3)). Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+~(1-97)_ ~ SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary E. Beard SS~~ 172-24-8558 11/07/2009 21-09-01205 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 sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with ri ht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 1640 Paxton Street, Harrisburg, - undivided one-half interest 5,000.00 (along with Beatrice L. (Beard) Stackpole) in and to the house and lot known and numbered as 1640 Paxton Street, City of Harrisburg, Dauphin County, PA, acquired by deed of CCNB Bank, N.A., dated January 22, 1991, recorded in Record Book Volume 1535, Page 441; value based on sale to Bee Boo 2, Inc., on 06/17/2010. TOTAL (Also enter on line 1, Recapitulation) ~$ 5 , 000 .00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, I nc. Fonrn REV-1502 EX {Rev. 1-97} REV-1508 EX ; {1-97j SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ M~~7C. IN RESIDENTDECEDET TRN PERSONAL PROPERTY ESTATE OF FILE NUMBER Mary E. Beard SS~~ 172-24-8558 11/07/2009 21-09-01205 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Wachovia Bank, - High Performance Money Market Account 16,776.71 ~~1010165115007; principal balance as of D.O.D.: $16,776.53; interest accrued to D.O.D.: $0.18). 2 Wachovia Bank, - Crown Classic Banking Account ~~1010028423247; 17,971.29 principal balance as of D.O.D.: $17,971.20; interest accrued to D.O.D.. $0.09). 3 1994 Oldsmobile Ciera automobile, - V-6, 3.1 liter engine, 965.00 automatic transmission, 100,000 miles, fair condition. 4 AFLAC, - refund of cancer insurance premium. 6.98 5 Public School Employees' Retirement System, - pro-rated 246.04 retirement benefit for November, 2009. 6 Travelers Insurance Co., - refund of auto insurance premium. 126.00 7 U. S. Treasury, - 2009 federal income tax refund. 460.60 8 UGI Utilities, - refund of utility account. 3,864.46 TOTAL (Also enter on line 5, Re (lf more space is needed, insert additional sheets of the same size) Copyright {c) 1998 form software only CPSystems, Inc. ulation) ~$ 40 ,417.08 Form REV-1508 EX {Rev. 1-97} REV-1509 EX t (1-97~ SCHEDULE F COMMONWEALTHOFPENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary E. Beard SS~~ 172-24-8558 11/07/2009 21-09-01205 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.. SURVIVING JOINT TENANT(S) NAME A. Beatrice L. Stackpole ADDRESS 64 Santa Monica Avenue Carlisle, PA 17015 RELATIONSHIP TO DECEDENT B. C JOINTLY-OWNED PROPERTY: Daughter ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and 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 Members First Federal 6,427.58 50.00% 3,213.79 Credit Union, - Savings Account ~~201817-000, in names of Decedent and Beatrice Stackpole (created 02/10/2001); principal balance as of D.O.D.: $6,427.21; interest accrued to D.O.D.. $0.37. 2 Members First Federal 8,001.70 50.00% 4,000.85 Credit Union, - Certificate of Deposit Account ~~201817-40, in names of Decedent and Beatrice Stackpole (created 02/10/2001); principal balance as of D.O.D.: $8,000.00; interest accrued to D.O.D.. $1.70. 3 Members First Federal 12,002.75 50.OOI 6,001.38 Credit Union, - Certificate of Deposit Account ~~201817 -41, in names of Decedent and Beatrice Stackpole (created 05/17/2001); principal balance as of D.O.D.: $12,000.00; interest Tot 1 of Contin ation Schedule(s) 3,200.63 TOTAL (Also enter on line 6, Recapitulation) ~ $ 16 , 416 .65 (If more space is needed insert additional sheets of the same size) Copyright (c} 1996 form software only CPSystems, Inc. Farm REV-1509 EX (Rev. 1-97} Estate of: Mary E. Beard Soc Sec ~~: 172-24-8558 Date of Death: 11/07/2009 Continuation of Schedule F (Jointly Owned Property) Item Ltr for Date Description of property ~~ Jt Ten Joint Total Val Decds Dollar Val of of Asset % Int Decds Interest accrued to D.O.D.: $2.75. 4 Members First Federal Credit Union, - Certificate of Deposit Account ~~201817 -42 , in names of Decedent and Beatrice Stackpole (created 04/18/2005); principal balance as of D.O.D.: $6,400.00; interest accrued to D.O.D.. $1.25. 6,401.25 50.00% 3,200.63 -------------- 3,200.63 REV-1511 EX +/~1-97}' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Mary E. Beard SS~~ 172-24-8558 11/07/2009 21-09-01205 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Bible Baptist Church, - rental of social room for funeral 100.00 luncheon. 2 Giant Food Stores, - food for funeral luncheon. 330.19 3 Ronald C. L. Smith Funeral Home, - payment on account of funeral 5,000.00 expense. Total of Continuation Schedule(s) 3,541.65 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney's Fees Law Offices -Marlin R . McCaleb 3 , 000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 4. 5. 6. 7. 1 2 3 4 5 6 City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Andrew G. Saft, - housing inspection fee. Brett Lecthaler, - fee for appraisal of real estate. City of Harrisburg, - water termination fee. City of Harrisburg, - utility, water/refuse. Cumberland Law Journal, - advertising Letters. Harrisburg city Treasurer, - city utilities for June. 62.50 300.00 12.50 24.56 75.00 12.29 ~Tota1 of Continuation Schedules} 4,338.24 TOTAL (Also enter on line 9, Recapitulation) $ 16 , 796.93 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97; Estate of: Mary E. Beard Soc Sec ~~: 172-24-8558 Date of Death: 11/07f2009 Continuation of Schedule H-A (Funeral Expenses) Item Description Amount ~~ 4 Ronald C. L. Smith Funeral Home, - balance of funeral expense. 3,541.65 3,541.65 Estate of: Mary E. Beard Soc Sec ~~: 172-24-8558 Date of Death: 11/07/2009 Continuation of Schedule H-B7 (Other Administrative Costs) Item Description Amount ~~ 7 Karl Stine, - trash removal, cleaning house, in preparation for 2,701.00 sale. 8 Purcell, Krug & Haller, - tax certification. 10.00 9 Recorder of Deeds, - PIN certification. 5.00 10 Register of Wills, - probate fee. 138.50 11 Register of Wills, - filing Inventory and Appraisement. 30.00 12 Register of Wills, - reserve for final expenses (filing Account, 250.00 Receipts, etc.}. 13 ReMax Realty Associates, - real estate broker's commission. 1,062.50 14 The Patriot-News Co., - advertising Letters. 141.24 -------------- 4,338.24 REV-1512 EX +'(1-97)~ ~ SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INRESIDENTDECEDENTRN MORTGAGE LIABILITIES, AND LIENS ESTATE OF FILE NUMBER Mary E. Beard SS~~ 172-24-8558 11/07/2009 21-09-01205 Include unreimbursed medical expenses. Copyright (c) 199& form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-~14) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Mary E. Beard SS~~ 172-24-8558 11/07/2009 21-09-01205 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE (. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)J 1 Beatrice L. Stackpole Daughter Entire Estate 64 Santa Monica Avenue Carlisle, PA 17015 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON R EV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTIQN 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 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) OMB NO. 2502-a2s5 B. TYPE OF LOAN: A USING & URBAN DEVELOPMENT 1.QFHA 2[]FmHA 3.QCONV. UNINS. 4.~]VA 5.[~CONV. INS. U.S. DEPARTMENT OF HO 6. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT g. 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 ageant are shown. Items marked "(POCj" were paid outside the closing; they are shown here for informational purposes and are not included rn the totals. D. NAME AND ADDRESS OF BORROWER: Bee Boo 2, Inc. 68 Charles Street Highspire, PA 17034 E. NAME AND ADDRESS OF SELLER: The Estate of Mary E. Beard Beatrice L. Stackpole 64 Santa Monica Avenue Carlisle, PA 17015 F. NAME AND ADDRESS OF LENDER: Cash Transaction G. PROPERTY LOCATION: 1640 Paxton Street PA 17104 Harrisburg H. SETTLEMENT AGENT: Leon P. Haller Escrow Agent I. SETTLEMENT DATE: June 17 2010 , Dauphin County, Pennsylvania PLACE OF SETTLEMENT 1719 N. Front Street Harrisburg, PA 17102 , , J. SUMMARY Or BORROWER'S TR!`,NSF,CTION K. SUMMARY OF SELLER'S TRANSACTIO N 101. Contract Sales Price 10,000.00 401. Contract Sates Price 10,000.00 102. Personal Prope 402. Personal Prope 103. Settlement Char es to Borrower (Line 1400) 575.50 403. 104. 404. 105. 405. Ad ~ustments For Items Paid B Seller in advance Ad "ustments For Items Paid 8 Seller in advance 106. Coun /Local Taxes 06/18/10 to 01/01/11 400.78 406. Count /Local Taxes 06/18!10 to 01/01/11 400.78 107. Water/Sewer/Refuse 06/18/10 to 07/01/10 10.65 407. Water/Sewer/Refuse 06/18/10 to 07/01/10 10.65 108. School Taxes 06/18/10 to 07/01/10 24.50 408. School Taxes 06/18/10 to 07/01/10 24.50 109. 409. 110. 410. 111. 411. 112. 412. 120, GROSS AMOUNT DUE FROM BORROWER 11,011.43 420. GROSS AMOUNT DUE TO SELLER 10,435.93 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest move 1,000.00 501. Excess Deposit (See Instructions 202. Princi al Amount of New Loans 502. Settlement Char es to Seller (Line 1400 2,429.57 203. 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 dish. as roceeds 208. 508. 209. 509. Ad ustments For Items Un aid B Seller A ~ustments For Items Un aid 8 Seller 210. Coun /Local Taxes to 510. Count /Local Taxes to 211. Water/Sewer/Refuse to 511. Water/Sewer/Refuse to 212. School Taxes to 512. School Taxes to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BYIFOR BORROWER 1,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 2,429.57 300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT 70/FROM SELLER: 301. Gross Amount Due From Borrower (Line 120 11,011.43 601. Gross Amount Due To Seller (Line 420 10,435.93 302. Less Amount Paid By/For Borrower (Line 220) ( 1,000.00) 602. Less Reductions Due Seller (Line 520) ( 2,429.57 303. CASH (X FROM) ( TD) BORROWER 10,011.43 603. CASH(X TO) ( FROM) SELLER 8,006.36 Schedule A ~ NO.1 HUD-1 (3-86) RESPA, HB4305.2 L. SETTLEMENT CHARGES 2,000.00 '700. TOTAL COMMISSION Based on Price PAID FROM PAlO FROM DivlSlon Of Commission (line 7OO aS FOiIOWS: BORROWER'S SELLEf2'S 701. $ 2,000.OQ ` to •ReMax Realty Associates FUNDS AT FUND5 AT 702, $ tp SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 2,000.00 704. Commission to ReMax Rea1t Associates 125.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee % to 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806. Mort a e Ins. App. Fee to 807. Assumption Fee to 808. 809. 810. 811. 900. ITEMS RE UIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to @ $ /day ( days %) 902. Mortgage Insurance Premium for months to 903. Hazard Insurance Premium for ears to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance $ per 1002. Mort a e Insurance $ per 1003. Coun /Local Taxes $ er 1004. Water/SeweNRefuse $ per 1005. School Taxes @ $ per 1006. $ per 1007. @ $ per 1008. $ er 1100. TITLE CHARGES 1101. Settlement or Closin Fee to 1102. Abstract or Title Search to 1103. Tax Certifications to Purcell, Kru & Haller 20.00 1104. Title Insurance Binder to 1105. Document Pre aration to 1106. Nota Fees to 1107. Attorney's Fees to (includes above ifem numbers: 1108. Title Insurance to First American Title Insurance Co. 420.00 (includes above item numbers: 1109. Lenders Coverage $ 1110. Owner's Coverage $ 10,000.00 420.00 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 55.50 ;Mortgage $ Releases $ 55.50 1202. Ci /Count Tax/Stam s: Deed 100.00• Mort a e 100.00 1203. State Tax/Stam s: Deed ; Mort a e 100.00 100.00 1204. PIN Cert to Dau hin Count Recorder of Deeds 10.00 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve to 1302. Pest Ins ection to 1303. Final Cit Utilities to Harrisbur Cit Treasurer 24.57 1304. Water Termination Fee to Cit of Harrisbur 25.00 1305. Reimburse City Inspect/Sheet to Andrew G. Saft 125.00 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 575.50 2,429.57 By signing page 1 of this statement, the signatories acknowledge receipt of a completed copy of p 2 his two page statement. Le .Haller ow Age Settlement Agent ( / BEE60021640PAXTON(10 / 15 ) Schedule A, No. 1 ~ ACKNOWLEDGMENT OF RECEIPT OF SETTLEMENT STATEMENT 1 ' ~ 'Borrower: Bee Boo 2, Inc. Seller: The Estate of Mary E. Beard and Beatrice L. Stackpole Lender: Cash Transaction Settlement Agent: Leon P. Haller Escrow Agent (717)231-3000 Place of Settlement: 1719 N. Front Street Harrisburg, PA 17102 Settlement Date: .tune 17, 2010 Property Location: 1640 Paxton Street Harrisburg, PA 17104 Dauphin County, Pennsylvania 1 have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. Bee Bo , I ~ ~ ~~ ~_ The Estate of Mary E. Beard res en u,~--- ~. Beatrice L. Stackpole ATTEST: Secretary To the best of my knowledge, the HUD-1 Settlement Statement which I have pr is a true and accurate account of the funds which were received and have been or will be disbursed by t e ~ ned part of the settlement of this transaction. _ . Leon P. Haller Escrow Agent Settlement Agent 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. Schedule A, No.l HUD-1 (3-86) RESPA, H643052 ram ~~x wpt ~, U/ 1 ~J / L V 1 V 11 : G U: J! f1J'1 YdlV G 1/ V V L I' d J`. ~ C. L V C C Wticttcw-a Battle Belatyoc C.nstfirmttvar, Stm~ees F U t3vac 40026 Rwnvkc, VA 240Z". lone ~'~, 2q 10 MAALIN R M,CALE$ ~.AO~Y 0~'FICES i SUEJBL'T: Val 1 C~rt~orr ofAocwlut end BaL~oc I.nfarmation p~cgvidnd tbr: Cv~tMaitrs MARY B, ~~.ARD Date ~ Dtatttr Ne~rcmbcr 71 ZOU9 ~dt Aoooaat Ief A~oouet Acao~aek ode of ~ed5 A~a~e Btlanoc i7aLe ~+~? ladsesi Accrued X'i D iaede ~ ~~Oi" O~eaod tkDe Rem i~taod '.~rtttad Paid Ck~nd Q;RC'~C(NC: a+C~c7'DOCX7oCX.37A7 517a71.2U '~1J/2U03 5fl.09 E7. EiKI l hin07 0 1.F.GAY,TTITd: D~Jl1CY K HN.ART) (x,()St1Nti F3AJ.AT~ICF: ~SS~6t-, i ~ CY1l:CxCi.'rKi ~'~'X3~:.X.5007 $!6,'T7d.S1 8P7lLOQ'7 $0.1>s $3.''_O? I:G12C10 L1~LiAL TCTf F.: MAR Y ~ ~3~AFd) Gl fi~TP7(1 F3AL.eiNC~ ~ ~ 1G?'T9.3l~ P~ 1 vt 2 Schedule E, Nos. 1$2 JI_f~'~~- ail-~0~.~' ~~.~..5~ from: T ffiJ~. ~L"ii ~! C71 '~~i~7~i t+4o 5ase t)apc~s~! timc frnarcl Ibr ci~sROmix, U~o ~s~ brSetrR cVoen eaw ar.J-~ t>zn,od i~a+.~t. ~ZfOHLC ~' ~~tO ~ tf diw ai dc~b ooawn m a ~d ~ ~ hdrLy, Batts oid~ ~alo~too doa~ twticdtadc uy Wauadium tort r~ax «uclc d<ui~ tart ti~ac PC's ~ S~haub Jc~ifsr 5rtr~~lb 'Icrvi~nt~r 11ga~oc7ate .la: Jg EYyttacptit~q clas Yt.'s+n*4t~, rht ncciP~ thrrec:f n~7lrpsarts andsu~[Tarb C- Wrh ff~ t~ ld.A (*4ktet- Fzg"), t}Nt tAe roa~iatt a trtf]~ormad try tlac cuaye~r to rocciwu lrwfuE~ ;har inlonssdiriti The lcc~ienl t~i+aa lhd.it .;; ;.rA ~030~ t#~ia teiLtstatio~ to my tt+Rd wnv, tinlow aompoDed to da so by I~t toed t1~t it +n't1lRwfuiDr tao ihic i~fortietiaa 'Cha ert admowiart~rr ilzut wcu: Fta~o d~ oa ropraaat a.d varrenc But ~ rt~srartian is aaimpino.aa anw-m.. 'ilia ra~n.at f+~tcaar tal~wLtE~e tiasUt: inSdm~tsrzd may tot d~re~+e for e-dsu rr~aieorp~i+ip hvora.~ ttv~nv and Wtttlt Ftl~,q. '~1w ~k-aeatioa s t~tl;+oa[ to wi9>,nu rtotioc m tic oapiart. 'i'be troGtpe.rl urea m ind~!t~r, ..~ bald Niritr Far~p ~slrr ~ sd a~airt~~ try elrim reauhi.~ tnm th. 1~1.'*lttfc ttld Os0 Of tlrt inforrr~no. bt !hC ICRi+,~load o- Gao ~ha lrs+w~ by the 10ctp~11 t~lflY ~ft0~imtt. ~gx~am~ati~4 a ®arart~ rrnfaia~ed baitYt. Wx~avia bank and ~+~u Hu~JccE Drlm+wra ae dnwuottt d Pdtdl~ FtrgsrFsaa~ N.:. ~2aT 2 To:71759177?c P.~~~3 p! J.J/ ~.ViV it LV J ! /`1t'1 YCI~..IL: L/ uve, t un ~.Jtri rvt Schedule E, Nos. 1$2 . ~ ~~ ~ '' Tt1ETRtJSTEt? RES~~JRGE ~ai'1r~i$ld3t'l '~cE~UtEL ~~~~~~~t3t ~~,r~~~ ~~~~ ~.®~~ Fair ~~65 ~/ehicle 1'llghlight5 Mileage: 100,On0 Engine; V6 3.1 Liter Transmission: Automatic Drivetrain: FWD :Selected Equipment :Standard Air Conditioning Potiver Steering Optional Cassette A1~1/FM Stereo ~Eue ~aak Pri~a~e Party ~-'atue i<eilev 61ue 1"5orir, Private Party Value is the amount a buyer can expect to pay when buying a~- use3 car from a private party. The Private Party Value assumes the vehicle is sold "As is" and carries no warranty tother than any remaining factory warranty). The final sale price may vary depending on the vehicle's actual condition and local market conditions. This value may also be used to derive Fair Market Value for insur~ac7cr; and vehicle donation purposes. 1Aehicle Conditi©n ratings • Looks new, is in excellent mechanical condition and needs no reconditioning. • Never had any paint or body work and is free of rust. • Clean title history and will pass a smog and safety inspection. r Engine compartment is clean, with no fluid leaks and is free of any wear or visif,le defects. ~ Complete and verifiable service records. Less than S°>o of all used vehicles fait into this category. ~~€~G~ ~,~~ Schedule~E, No. 3 ' Send to Printer ~ ` . T ~-- ~ ~ t ~;~ [ ~ x ~~ ; Close VVindo~~,~ • Free of any major defects. •~ CIeaJ~ title history, the paints, body, and interior have only minor (if any) blemishes, and there are no major mechanical problems. • Little or no rust on this vehicle. • Tires match and have substantial tread wear left. • A "good" vehicle will need some reconditioning to be sold at retail. Most consumer owned vehicles fall into this category. '~ fall' (Selected) ~:~:~~,~~ $965 ~~ ~.~ ~~ • Some mechanical or cosmetic defects and needs servicing but is still in reasonable running condition. • Clean title history, the paint, body and/or interior need work performed by a professional. • Tires may need to be replaced. • There may be some repairable rust damage. ~€~c~r ,..^ /~ • Severe mechanical and/or cosmetic defects and is in poor running condition. • May have problems that cannot be readily fixed such as a damaged frame or arusted-through body. • Branded title (salvage, flood, etc.) or unsubstantiated mileage. Kelley Blue Book does not attempt to report a vaiue on a "poor" vehicle because the value of these vehicles varies greatly. A vehicle in poor condition may require an independent appraisal to determine its value. * Pennsylvania 12/24J2009 Schedule E, No. 3 . St 0 MEMBERS 15t FEDERAL CREDIT UNION 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 Date Joint Ownership Established CERTIFICATES OF DEPOSIT: 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 Date Joint Ownership Established 201817-00 02/10/2001 $6,427.21 $.37 $6,427.58 Beatrice Stackpole 02/10/2001 201817-40 02/10/2001 $8,000.00 $1.70 $8,001.70 Beatrice Stackpole 02/10/2001 CERTIFICATES OF DEPOSIT: Account Number/Suffix 201817-42 Date Account Established 04/18/2005` Principal Balance at Date of Death $6,400.00 Accrued Interest to Date of Death $1.25 Total Principal and Accrued Interest $6,401.25 Name of Joint Owner Beatrice Stackpole Date Joint Ownership Established 04/18/2005 'Opened by transfer of funds from 201817-00. SAFE DEPOSIT BOX: Yes Date Established 02/10/2001 Name of Joint Owner Beatrice Stackpole Estate of: MARY E. BEARD Date of Death: 11/07/2009 Social Security Number: 172-24-8558 201817-41 05/17/2001 $12, 000.00 $2.75 $12, 002.75 Beatrice Stackpole 05/17/2001 M BERS 1ST FEDE L CR T UNION ~~ Danielle A. line Lending Insurance Support Specialist January 14, 2010 5000 Louise Drive P.O. Box 40 1Vlechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org Schedule F, Nos. 1-4