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HomeMy WebLinkAbout07-29-10 (2)~, _ _ Ex (01-10) 1505610143 ~ REV-1500 ;; PA Department of Revenue pennsyfvanla Bureau of Individual Taxes oErueTwEnrorREVENUE PO 80X.280601 INHERITA Harrisburg, PA 17128-0601 RESIDE ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Cade Year FGe Number TAX RETURN 21 0 9 1121 Date of Birth -- - - 194 Zt3 tf4-/9 lV Ly LuUy ii cy iy.~ r decedent's Last Name Suffix Decedent's First Name MI DOIIDEN ORPHA M ff Applicable) Enter Surviving Spouse's Information Below !, 5pouse's Last Name Suffix Spouse's First Name li MI I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WI~ H THE REGISTER OF WILLS ~~ FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return ate of death pnorto 12-13-82) ^ q. Limited Estate ^ qa. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date a death arter 12.12-s2) ~ ^ g Decedent Died Testate ^ ~, Decedent Maintained a Living Trust 8. Total Number of S f Truaq o f (Attach Copy e Deposit Boxes (Attach Copy ai V1AN) t e rf v ^ 9. Litigatlon Proceeds Received [) 10. ~pO11~ni2~-31~~ er~id ti~a5~d~' ^ 11.Election to tax and r Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATIONS OULD BE DIRECTED TO: Name Daytime Telephone umber RICHARD E CONNELL ESQ 717 232 8 31 REGISTE~OF WIL S U~ ONLY ~ First line of address -(7 C~._ rte, .: - _~ ~ ~--., ,.`,~ _.~~~, rte-- 2303 MARKET STREET <` ~~ t-- e°,., ;- ,~ N _~ _ ~r:. ~ cry x ~ ~ t[~ _~-, ,, ~ Second Itne of address ~ C7 ~ c_" ...~ ~~ ` D FIL w D= `, City or Post Office State ZIP Code ~ cn~ CAMP HILL PA 17011 ' ~ Correspondent's e-mail address: c o n n e l l~ b m c -law . n e t Under penalties of pery'ury, I dedars that 1 have examined this return, inducting aooompanying schedules and statements, and to the best of knowledge and belief, it is true, correct and plate. Dad of preparer er than the personal representative Is based on all information of which preparer h s any knowledge. SIGNATURE OF R RESPONSIBL OR FI ING RE N ~- TE ~'" 2©~ ~ Jeffrey L. Douden ADDRESS 119E Road Mechanicsbu , PA 170 SIGNAT PREP R OTHER AN R RES NT IV D TE Richard E Conned Esq ,z 7-~ d / d ADDRESS 2303 Market Street, Camp Hill, PA 17011 Side 1 L 1505610143 1505610143 I~ II J 1505610243 REV-1500 EX Decedent's Social Security Number o~aa,rsr~„a: DOUDEN, ORPHA MAY 194 2 8 84 7 9 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 12 , 12 2 . 7 5 2. Stocks and Bonds (Schedule B) ............................................................................... 2. x 2 0 4. 2 9 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. , 2 3 2 • 2 7 6. Jointy Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. ~ 0 . 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7, , 3 5 8 . 3 6 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 14 , 91 7 . 6 7 9. Funeral Expenses 8 Administrative Costs (Schedule H) ......................................... 9. , 4 4 9 . 9 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 1 , 9 3 9 . 0 2 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 8 , 3 8 9.01 12. Net Valus of Estate (Line 8 minus Line 11) ............................................................. 12, 1 3 8 , 5 2 8 . 6 6 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. 13 8 , 5 2 8 . 6 6 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 13 8, 5 2 8. 6 6 16. 17. Amount of Line 14 taxable at sibling rate X ,1Y 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ..................................................................................................................... 19. 20. FILL iN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 6,233.79 6,233.79 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 09 - 1121 Douden, Orpha May STREET ADDRESS 1555 Simpson Ferry Road CITY New Cumberland STATE PA ZIP 17070 ~I Tax Payments and Credits: I 1. Tax Due (Page 2, Line 19) , (1) 6,233.79 2. Credits/Payments A. Prior Payments 5, 5 5 7.5 0 i B. Discount 311.69 Total Credits (A + B) (2) 5,869.18 3. Interest ~ (3) 0.00 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. i ~~ I II (5) 3 6 4.6 0 ~I Make Che k P I c ayab a to. REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPRO'~ PRIATE BLOCKS 1. D d Yes No regain the use or income ofthe property transferred :............................................................................ a. J ..... ^ ^x o shall use the property transferred or its income :.............................. wh ~ h ..... x o reersionary anteres c. retain a ...................................................................................... ^ a d. receive the promise for life of either payments, benefits or care? ......................................................... ..... ^ ^x 2. If death occurred after December 12, 1982, did decedent transfer property wkhin one year of death wit out receiving adequate consideration? ..................................................................................................................' r.... ^x ^ 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? .................................................................................................................I ..... ^x ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT ~ 1S PART OF THE RETURN. 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 f r the use of the surviving spouse is 3 percent p2 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 su iing spouse is 0 percent p2 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requi ments for disclosure of assets and filing a tax rectum 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 21ye ars of age or younger at death to or for the se of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent p2 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, ex~ept 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)1. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, ether y blood or adoption. SCHEDULE A REAL ESTATE ca+~a+wEN.ni of r~rx+snv~ww xa~wru+ce r~x netur~ aeswErrt oec~rrr FILE NUMBER ESTATE OF Doudetl, Orpha May 21 - 09 - 1121 All real propeRy owned sole)y or as a tenant in common must be reppoorted at fair market value. Fair market vale at which property would be exchanged between a willing buyer and a willing sailer, neither being compelled to buy or s reasonable knowledge of the relevant facts. Real property which is Jointly-owned with right of survivorship must schedule F. Attach a copy of the settlement sheet if the property has been sold. Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM DESCRiPTiON NUMBER 1 1555 Simpson Ferry Road New Cumberland, PA 17070 (HUD-1 Attached) (Tax Parcel Number: 26-24-0809-013) .the price on VALUE AT DATE OF DEATH 122,122.75 TOTAL (Also enter on Line 1, Recapitulation) ~ 122,122.75 SCHEDULE B STOCKS ~ BONDS coN.THOFPENNSYWAMw RHiERI-ANCE TAX NETURN iE:BDEMT DECEDENT FILE NUMBER ESTATE OF Douderi, Orpha May 21 - 09 - 1121 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH NUMBER 1 Verizon -140 shares C~ $30.04/share 30.4 4,205.60 2 Manulife Financial - 206 shares @ $19.41 19.41 3,998.46 3 Fairpoint Communications - 2 shares $ .115 .115 I II I I I I ICI ~I it ~I 0.23 TOTAL (Also enter on line 2, Recapitulation) 8,204.29 SCHEDULE E .CASH, BANK DEPOSITS, ~ MISC. CgMgNWEALTN OF PENNBnvAN1A PERSONAL PROPERTY lJHEItlTANCE TAX RETURN REBIDENi DECEDENT ', FILE NUMBER ESTATE OF Douden, Ofpha May 21 - 09 - 1121 ' InGude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned survivorship must be disclosed on schedule F. lth the right of ITEM DESCRIPTION ~ VALUE AT DATE OF DEATH NUMBER 1 Belco Savings 49.00 Account No. 836848-S1 2 Belco Checking ~~ 743.21 Account No. 836848-S4 3 Belco Money Market ~, 1, 367.59 Account No. 836848-S6 ~, 4 1996 Oldsmobile Cutlass Supreme !, 1,200.00 VIN #1 G3WH52MOTF359818 Mileage 72,835 5 Personal Property I'~ 922.35 Haar's Auction $672.35 Miscellaneous Household Goods and Personal Effects $250.00 ~i 6 Weis Markets 'i I 11.88 7 Highmark -Freedom Blue Premium Dividend I'~ 3.86 8 The Patriot News -Refund 6.45 9 Verizon -Refund ~ 2.00 10 Reai Estate Tax Reimbursement ', 7.85 11 Credit Refund - HoracelMann insurance ~, 101.00 12 Belco Variable IRA No. 836848-S5 2.00 TOTAL (Also enter on Line 5, Recapltulatlon) 8,232.27 SCHEDULE E CASH, BANK DEPOSITS, & MISC. corw~a~vFxTMOF~E~wsvwu~w. PERSONAL PROPERTY NERRANCE TNf RETURN *~ continued FILE NUMBER ESTATE OF Douden, Oirpha May 21 - 09 -1121 InGude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned survivorship must be disclosed on schedule F. ith the right of ITEM DESCRIPTION +: VALUE AT DATE OF NUMBER DEATH 13 Pennsylvania American Water Company ~ !, 11.41 14 Belco Community Credit Union ~I ~ 3,803.67 ii i ~~l lil i ~~ ~~I ~! ~i I i P~ge 2 of ScheduVe E i I SCHEDULEF COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I FILE NUMBER Douden, Orpha May 21 - 09 - ~ 121 If an asset was made joint within one year of the decedent's date of death, it must tae reported on schedule G.I SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONS IP TO DECEDENT Jeffrey L. Douden 119 Ewe Road Son A Mechanicsburg, PA 17055 I~ ~,I JOINTLY OWNED P ROPERTY: ITEM LETTER DATE I E~ N pp p TY nclude name o~iinancial ins~i u~tlon a pd bank account number DATE OF DEATH ~~ ~ DEC 'S DATE OF pEATH VALUE OF NUMBER FOR JOINT MADE or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTER ST DECEDENTS INTEREST TENANT JOINT @Stat@. 1 Attached are REV 1548EX AFP relating to the 50 /0 0.00 following accounts: Members 1st #217940-49 #217940-48 ~I #217940-47 !, #217940-41 #217940-40 ~ ~ ~ #217940-05 I #217940-11 ~I Such accounts have been reported, tax has ~~~ been paid and the Department has accepted the tax payments as evidenced by the attached I forms. I i ~~ ~I TOTAL (Also enter on line 6, Recapitulation) 0.00 t.,~..~ COMMO SCHEDULE G NWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Douden, Orpha May FILE NUMBER 21 - 09 -1 1121 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page is yes. ITEM NUMBER DESCRIPTION OF PROPERTY l"a"de the name a the tranareree, their relatbnship to decedent DATE OF DEATH VALUE OF' ASSET % OF DECD'S FJ(CLUSION TAXABLE VALUE and the date of transfer. Attach a Dopy of the deed for real estate. INTEREST OF APPLICABLE) 1 Belo IRA No. 34923-IRA 8,358.36 8,358.36 Transferees: Allen Douden -Son Jeffrey Douden -Son James Douden -Son 2 TOTAL (Also enter on line 7, Recapitulation) ~ 8,358.36 cotiwa-evEn~Tf+oF PErwsnvualn. NJIIERITANCE T/V( RETURN RESIDENT DECEDENT SCI~DU.E H FI~E}?AL D~V3ES & ADN~ISTRATNE C06T5 FILE NUMBER ESTATE OF Douden, Orpha May 21 - 09 -J1121 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION A OUNT A. 1 Neill Funeral Home 1,950.01 2 Blooms by Vickery -Funeral Flowers 410.75 3 Italian Oven -Funeral Gathering 489.73 B. ADMINISTRATIVE COSTS: ~. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Ball, Murren 8~ Connell 3. Family Exemption: (lf decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 5. Accountant's Fees 6. Tax Retum Prepan3r's Fees 7. Other Administrative Costs 1 Pennsylvania-American Water Company 0.00 750.00 307.00 129.74 TOTAL (Also enter on line 9, Recapitulation) 6,449.99 Sce H Fulneral E~er~ses & COMMONWEALTH OF PENNSYLVANIA w~~~M ^ , INHERITANCE TAX RETURN !1~ 1 w 11,Y~1YYC Vf~J6Ci RESIDENT DECEDENT ESTATE OF Douden, Orpha May FILE NUMBER 21-09-1121 ''i 2 Sam Brinley Lawn Service 100.00 3 Pennsylvania Power & Light 213.19 4 Cool & Cozy LLC -Air Conditioning Service (Compressor) 60.00 5 Davis Country Living 166.95 6 ABC Fuel Oil Company 793.47 7 Home Depot - Sink/Faucet/Ceiling Tile/Lock/GFI 405.15 8 Mark Snell -Porch Repair/Cleanup 425.00 9 New Cumberland Borough -Sewer/Refuse 101.55 10 Truck Rental 125.99 11 Hepfers Ace Homecenter 21.46 12 Page 2 of Schedule H SCHEDULEI DEBTS OF DECADENT, MORTGAGE co~oNwEAUNOFaENNSrwANU, LIABILITIES, 8~ LIENS pJl#RRANCE TAX RETURN '.. RE8IDENT DECEDENT ~.. FILE NUMBER ESTATE OF Douden, Orpha May 21 - 09 -1121 ', Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimburse~d medical expenses. ITEM NUMBER DESCRIPTION ~, AMOUNT 1 Dialysis Corporation ofAmerica ~ 1,123.36 2 Camp HIII Emergency Physicians 262.46 3 Reader Service ~ 20.46 4 ~ New Cumberland Borough (Sewer & Refuse) ~ 101.55 5 Comcast '~ 9.27 6 i~ PP&L ~,, 42.40 7 Pennsylvania American Water ~, 20.59 8 Verizon I I 25.63 9 Members 1st -VISA Bill II 333.30 TOTAL (Also enter on Line 10, Recapitulation) ~ 1,939.02 Rev-~atsex+Itt.oe) ~ ~! . SCHEDULE) COMMNHER~iTALNCEOTnx RETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF Douden, Orpha May FILE NUMBER 21 - 09 - 1121 NUMBER NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO DECEDENT SHARE OF ESTAT (Words) AMOUNT OF ESTATE ($$$) RECEIVING PROPERTY Do Not Us! TrustN(s) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. X116 (a) (1.2)] 1 Allen L. Douden, Jr. Son One-Third 518 W. Main St. Mechanicsburg, PA 17055 2 Jeffrey L. Douden Son ~I One-Third 119 Ewe Road Mechanicsburg, PA 17055 3 ~ James M. Douden Son One-Third 881 Moonlight Dr. York, PA 17402 ~~ Enter dollar amounts for distributions shown above on lines 1 5 through 18 on Rev 1500 cover sheet, as appropriate. II NON-TAXABLE DISTRIBUTIONS: . A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 BUREAU OF INDIVIDUAL TAXES INF~RITANCE TAX DIVISION PO !0)( 280601 HARRISOUR6 PA 17128-0601 JEFFREY L DOUDEN 119 EWE ROAD MECHANICSBURG PA 17055 REGISTER OF WILLS ~ 1 COURTHOUSE SQUARE CARLISLE PA 17013 'i Pennsylvania ~ NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE APPRAISEMENT, ALLOWANCE. OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP C12-09) JOINTLY HELD OR TRUST ASSETS DATE 03-08-2010 ESTATE OF DOUDEN ORPHA ~M DATE OF DEATH 10-29-2009 FILE NUMBER 21 09-1121 COUNTY CUMBERLAND SSN/DG 194-28-8479 ACN 10003596 APPEAL BY DATE:05=07-20 0 (See reverse side under Objection ) Awount Reaitted MAKE CHECK PAYABLE AND REMI PAYMENT T0: CUT ALON6 THIS LINE '~'> RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP X12-09~----------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 03-OS- ESTATE OF:DOUDEN ORPHA M DATE OF DEATH:10-29-2009 FILE NO.: 21 09-1121 S.S/D.C. NO.: 194-28-8479 ACN TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INS7ZTUTION: MEMBER 1ST FED CREDIT UNION ACCOUNT NO.: 217940- TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST CX)TIME CERTIFICATE DATE ESTABLISHED 06-05-2002 Account Balance Percent Taxable Awount Subject to Tax Debts and Deductions Taxable Awount Tax Rate Tax Due TAX CREDITS: 15,130.36 X 0.500 7,565.18 - .00 7,565.18 r .45 340.43 NOTE: 10003590 TO ENSURE PROPE CREDIT TO YOUR ACCOUNT, S BMIT THE UPPER PORTION 0 THIS NOTICE WITH YOUR TAX P YMENT TO THE REGISTER OF WIL S AT THE ABOVE ADDRESS. NAKE CHECK OR MONEY ORDER AYABLE T0: "REGISTER OF WI LS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT L+) INTEREST/PEN PAID C-) AMOUNT PAID 01-29-2010 CD012296 17.02 323.41 TOTAL TAX PAYMENT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE COUNTY:CUMBERLAND 340.43 .00 .00 .00 +~ IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. +~ ' IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. pennsyLvania ~ BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIYLSION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE REV-1548 EX AFP C12-09) PO BOX 280601 OF DEDUCTIONS. AND ASSESSMENT OF TAX ON HARRISBURG PA 17128-8681 JOINTLY HELD OR TRUST ASSETS DATE 03-08-2010 ESTATE OF DOUDEN ORPHA M DATE OF DEATH 10-29-2009 FILE NUMBER 21 09-1121 COUNTY CUMBERLAND SSN/DC 194-28-8479 JEFFREY DOUDEN ACN 09176093 119 EWE ROAD APPEAL BY DATE:05-07-20 0 MECHANICSBURG PA 17055 (See reverse side underObjeciion) Amount Remitted MAKE CHECK PAYABLE AND REMI PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 ~I CUT ALONG THIS LINE ~"~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP C12-09)---------------------------------------------------- -------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF !i DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 03- 8-2 10 ESTATE OF:DOUDEN ORPHA M DATE OF DEATH:10-29-2009 COUNT :CUMBERLAND FILE NO.: 21 09-1121 S.S/D.C. NO.: 194-28-8479 AC I: 09176093 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED I JOINT OR TRUST ASSET INFORMATION i FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 217940-11 TYPE OF ACCOUNT: ( )SAVINGS (X) CHECKING C )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 06-06-2009 i, Account Balance 761.40 NOTE: TO ENSURE PROP R CREDIT TO Percent Taxable X 1.000 YOUR ACCOUNT, UBMIT THE Amount Subject to Tax 761.40 UPPER PORTION F THIS NOTICE Debts and Deductions - •00 WITH YOUR TAX AYMENT TO THE Taxable Amount 761.40 REGISTER OF WI LS AT THE Tax Rate Y .45 ABOVE ADDRESS. MAKE CHECK Tax Due 34.26 OR MONEY ORDER PAYABLE T0: "REGISTER OF WI LLS, AGENT." TAY CQFiITTR: i PAYMENT DATE RECEIPT NUMBER DISCOUNT t+) INTEREST/PEN PAID C-) AMOUNT PAID 01-29-2010 CD012295 1.71 32.55 TOTAL TAX PAYMENT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 34.2b .00 .00 .00 * IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO 6000 280601 HARRISBURG PA 1]128-0641 JEFFREY DOUDEN 119 EWE ROAD MECHANICSBURG PA 17055 penrnsylvania ~ NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE APPRAISEMENT, ALLOWANCE OR DISALLOWANCE REV-1548 EX AFP c12-o9) REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-08-2010 ESTATE OF DOUDEN ORPHA M DATE OF DEATH 10-29-2009 FILE NUMBER 21 09-1121 COUNTY CUMBERLAND SSN/DC 194-28-8479 ACN 04174455 APPEAL BY DATE:05-07-2010 (See reverse side under Ob,~ection Avount Revitted MAKE CHECK PAYABLE AND REMI PAYMENT T0: CUT ALONG THIS LINE "'~ RETAIN LOWER PORTION FOR YOUR RECORDS <'~' REV-1548 EX AFP C12-097 rt-------- NOTICE DF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF ~~ DEDUCTIONS. AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS '~ DATE: 03-08-21010 ESTATE OF:DOUDEN ORPHA M DATE OF DEATH:10-29-2009 FILE NO.: 21 09-1121 S.S/D.C. NO.: 194-28-8479 09174455 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 217940- TYPE OF ACCOUNT: (X)SAVINGS C ) CHECKING ( )TRUST t )TIME CERTIFICATE DATE ESTABLISHED 06-05-2002 Account Balance Percent Taxable Avount Subject to Tax Debts and Deductions Taxable Avount Tax Rate Tax Due TAX CREDITS: 6,896.43 X 0.500 3,448.22 - .00 3,448.22 Y .45 155.17 NOTE: TO ENSURE PROPE CREDIT TO YOUR ACCOUNT, S BMIT THE UPPER PORTIDN D THIS NOTICE WITH YOUR TAX P YMENT TO THE REGISTER OF WIL S AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER AYABLE T0: "REGISTER OF WI LS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 01-29-2010 CD012295 7.76 147.42 TOTAL TAX PAYMENT BALANCE OF TAX DUE INTEREST AND PEN, TOTAL DUE COUNTI~: CUMBERLAND 155.18 .O1 .00 .O1 * IF PAID AFTER THIS DATEr SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ^ IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 JEFFREY DOUDEN 119 EWE ROAD MECHANICSBURG PA 17055 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS pennsylvania ~ DEPARTMENT OF REVENUE REV-1548 EX AFP Q2-09) DATE 03-08-2010 ESTATE OF DOUDEN ORPHA DATE OF DEATH 10-29-2009 FILE NUMBER 21 09-1121 COUNTY CUMBERLAND SSN/DC 194-28-8479 I~', ACN 09174456 APPEAL BY DATE:05-07-2010 (See reverse side under Objectio ) Aotount Reoitted MAKE CHECK PAYABLE AND REMIfi PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 M CUT ALONG THIS LINE '~'> RETAIN LOWER PORTION FOR YOUR RECORDS ~"~ '~ ---------------------------------------------------------------------------t--------------- REV-1548 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 03-08-2010 ESTATE OF:DOUDEN ORPHA M DATE OF DEATH:10-29-2009 COUNTY~:CUMBERLAND FILE NO.: ;21 09-1121 S.S/D.C. NO.: 194-28-8479 ACN~: 09174456 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED ~~ JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 217940- TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST CX)TIME CERTIFICATE DATE ESTABLISHED 06-05-2002 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Awount Tax Rate Tax Due TAY CRFi1TTQ. 6,194.12 X 0.500 3,097.06 - .00 3,097.06 v .45 139.37 NOTE: TO ENSURE PROPEI YOUR ACCOUNT, S~ UPPER PORTION 01 WITH YOUR TAX P. REGISTER OF WIL .ABOVE ADDRESS. OR MONEY ORDER "REGISTER OF WI PAYMENT DATE RECEIPT NUNBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 01-29-2010 CD012295 6.97 132.41 TOTAL TAX PAYMENT BALANCE OF TAX DU INTEREST AND PEN. TOTAL DUE Z CREDIT TO BMIT THE THIS NOTICE YMENT TO THE S AT THE MAKE CHECK AYABLE T0: LS, AGENT." 139.38 .O1( .OD .O1( ^ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ^ IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. _ - NOTICE OF INHERITANCE TAX ~ pent!lsylvania ~ BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISENENT, ALLOWANCE OR DISALLONANCE REV-1548 EX AFP C12-09) PO sax 2ao6oi of DEDUCTioNS, AND ASSESSMENT OF TAX ON HARRISBURG PA 17128-06x1 JOINTLY HELD OR,TRUST ASSETS DATE 03-OS-2010 ESTATE OF DOUDEN ORPHA M DATE OF DEATH 10-29-2009 FILE NUMBER 21 09-1121 COUNTY CUMBERLAND SSN/DC 194-28-8474 JEFFREY DOUDEN ACN 09174457 119 EWE ROAD APPEAL BY DATE:05-07-2010 MECHANICSBURG PA 17055 (See reverse side underObjectio ) Awount Rewitted MAKE CHECK PAYABLE AND REMI PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 ~, CUT ALONG THIS LINE ""~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST. ASSETS DATE: 03-0 - 0 ESTATE OF:DOUDEN ORPHA M DATE OF DEATH:10-29-2009 COUNT :CUMBERLAND FILE NO.: 21 09-1121 S.S/D.C. NO.: 144-28-8479 ACNI: 09174457 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED ~ JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 217940-4~ TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST CX)TIME CERTIFICATE ~I DATE ESTABLISHED 06-05-2002 Account Balance Percent Taxable Awount Subject to Tax Debts and Deductions Taxable Awount Tax Rate Tax Due 15,186.20 ~( 0.500 7,593.10 - .00 7,593.10 Y _ .45 341.69 NOTE: TO ENSURE PROPEI YOUR ACCOUNT, S~ UPPER PORTION 01 WITH YOUR TAX P. REGISTER OF WIL ABOVE ADDRESS. OR MDNEY ORDER "REGISTER OF WI CREDIT TO 'BMIT THE THIS NOTICE YMENT TO THE S AT THE MAKE CHECK AYABLE T0: LS, AGENT." ~rwv ro~nrsc. PAYMENT DATE RECEIPT ~ NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 01-29-2010 CD012295 17.08 324.61 TOTAL TAX PAYMENT 341.69 BALANCE OF TAX DUE .00 INTEREST AHD PEN. .DO TOTAL DUE ~, .00 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ i IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORM FOR INSTRUCTIONS. -- - - - BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIYISIWI PO 8DX 280601 HARRISHUR6 PA 17128-0601 JEFFREY DOUDEN 119 EWE ROAD MECHANICSBURG PA 17055 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS penmsylvania ~ DEPAPoTMENT OF REVENUE REV-1548 IX AFP C12-09) DATE 03-08-2010 ESTATE OF DOUDEN DATE OF DEATH 10-29-2009 FILE NUMBER 21 09-1121 COUNTY CUMBERLAND SSN/DC 194-28-8479 ACN 09174458 APPEAL BY DATE:05-07-2t (See reverse side under Objechio~ Amount Resitted MAKE CHECK PAYABLE AND REMI REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 ORPHA M 0 PAYMENT T0: CUT ALONG TWIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS F" --------------------------------------------------------------------------- --------------- REV-1548 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 03-08-2010 ESTATE OF:DOUDEN ORPHA M DATE OF DEATH:10-29-2009 FILE NO.: 21 09-1121 S.S/D.C. NO.: 194-28-8479 COUNT :CUMBERLAND A6 09174458 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 217940-4 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST CX)TIME CERTIFICATE DATE ESTABLISHED 06-05-2002 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 14,928.73 X 0.500 7,464.37 - .00 7,464.37 Y .45 335.90 NOTE: TO ENSURE PROPE CREDIT TO YOUR ACCOUNT, S BMIT THE UPPER PORTION 0 THIS NOTICE WITH YOUR TAX P YMENT TO THE REGISTER OF WIL S AT THE ABOVE ADDRESS. MAKE CHEC K OR MONEY ORDER AYABLE T0: "REGISTER OF WI LS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 01-29-2010 CD012295 16.80 319.11 TOTAL TAX PAYMENT 335.91 BALANCE OF TAX DUE .O1CR INTEREST AND PEN. .00 TOTAL DUE .O1CR * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR], YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. pn~hsyLvania ~ BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX ~ ppEP.ApTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE "9.'" ':REV-148 EX AFP C12-09) PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON .-.,- HARRISBURG PA 17128-0601 JoiNTLY HELD OR TRUST ASSETS JEFFREY DOUDEN 119 EWE ROAD MECHANICSBURG PA 17055 DATE 03-08-20.0 ESTATE OF DOUDEN .. ORPHA M DATE OF DEATH 10-29-2009 FILE NUMHER 21 09-1121 COUNTY CUMBERLAND SSN/DC 194-28-S~j79 ACN 09174459•` APPEAL HY DATE:05-~0'7-2010 (See reverse side under Ob,~ectio ) Awount Rewitted ,~ MAKE CHECK PAYABLE AND;[i,EMI PAYMENT T0: :.~ REGISTER OF WILLS 1 COURTHOUSE SQUARE.. • CARLISLE PA 17013 CUT ALONG THIS LINE ""~ RETAIN LOWER PORTION FOR YOUR RECORDS <"~ REV-1548 EX AFP-C12-09)--------------------------------------------------- --------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 03-OS-20 0 ESTATE OF:DOUDEN ORPHA M DATE OF DEATH:10-29-2009 FILE NO.: •21 09-1121 S.S/D.C. NO.: 194-28-8479 :CUMBERLAND . 09174459 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 217940- TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST CXITIME CERTIFICATE DATE ESTABLISHED 06-05-2002 Account Balance - Percent Taxable Awount Subject to Tax Debts and Deductions Taxable Awount Tax Rate Tax Due TAX CREDITS: 15,019.53 K 0.500 7,509.77 - .00 7,509.77 r .45 337.94 NOTE: TO ENSURE PROPE CREDIT TO YOUR ACCOUNT, S EMIT THE UPPER PORTION 0 THIS NOTICE WITH YOUR TAX P YMENT TO THE REGISTER OF WIL S AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER AYABLE T0: "REGISTER OF WI LS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 01-29-2010 CD012295 16.9D 321.05 TOTAL TAX PAYMENT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ~ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. 337.95 .D1CR .00 .O1CR BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PD eox 2eoBO1 HARRISBURG PA 17128-0601 JEFFREY DOUDEN 119 EWE ROAD MECHANICSBURG PA 17055 NOTICE OF INHERITANCE TAX pennsylva n'la ~ DEPARTMENT OF REVENUE APPRAISEMENT, ALLOWANCE OR DISALLOWANCE REY-1548 EX AFP C12-09) OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-08-2010 ESTATE OF DOUDEN DATE OF DEATH 10-24-2009 FILE NUMBER 21 09-1121 COUNTY CUMBERLAND SSN/DC 194-28-8479 ', ACN 09174460 APPEAL BY DATE:05-07-20 0 (See reverse side under Objection Awount Rewitted MAKE CHECK PAYABLE AND REMI REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 ORPHA PAYMENT T0: M CUT ALONG THIS LINE '-~' RETAIN LOWER PORTION FOR YOUR RECORDS ~^ REV-1548 EX AFP C12-09~-----------------------------------------------------i,--------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF ~, DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS ~ DATE: 3-OS-2 0 ESTATE OF:DOUDEN ORPHA M DATE OF DEATH:10-29-2009 COUNTY:CUMBERLAND FILE NO.: 21 09-1121 S.S/D.C. NO.: 194-28-8479 ACN: 09174460 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 217940-4~r TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 06-05-2002 Account Balance 10,013.02 NOTE: TO ENSURE PROPE CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, S BMIT THE Awount Subject to Tax 5,006.51 UPPER PORTION 0 THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX P YMENT TO THE Taxable Awount 5,006.51 REGISTER OF WIL S AT THE Tax Rate Y .45 ABOVE ADDRESS. MAKE CHECK Tax Due 225.29 OR MONEY ORDER AYABLE T0: "REGISTER OF WI LS, AGENT." TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 01-29-2010 CD012295 11.26 214.03 TOTAL TAX PAYMENT BALANCE OF TAX DU INTEREST AND PEN. TOTAL DUE 225.29 .00 .00 .00 * IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. __ _ _ _ _ _ __ __ o~~ b~v . . R e A. Settlement Statement (HUD-1) G ~~h osJE~ y B. Type of Loan 1. Q FHA 2. Q RHS 3. ~ Conv. Unlns. 4. ©VA 5. ~ Conv. Ins. 6, Ftle Number. 7. Loan Number: 1000025441 8. Mortgage I canoe Case Number: 10-10-8-06114 7 C. Nobs: T'h!s lbvrrr la furnished to ,gNe you a statement of atlas/settlement coats, Amounts paid M and by the settlement epent Ifems marked'(p.o.c.)"were paid outside the cioahQ; they are shown here /or hilomratlonalpurposes and are notind shown. /n the totals. D. Name and Address of Borrower: TRAVIS J TAFOYA 517 4TH STREET NEW CUMBERLAND, PA 17070 E. Name and Address of Selbr. THE ESTATE OF ORPHA M DOUDEN F. Name and Address pf WALKER JACKSON MO CORPORATION AND/O OFAFFAiRS, TSAOA,A 1000 URBAN CENTER BIRMINGHAM, AL 35242 Lender: TGAGE SECRETARY IMA RIVE #500 G. Property Location: 1555 SIMPSON FERRY ROAD NEW CUMBERLAND, PA 17070 • H. Settlement Agent: ~ SEASONS SETTLEMENTS INC - WEICHERTREALTORS FIRST CHOICE UNGLESTOWN RD HBG ph, I. SettbmeM Date: ay 10, 2010 Place of SettbmeM: WEICHERTREALTORS FRST CHOICE LINGLESTOWN RD HBG ' J. Summary of Bon~ower s transaction K. Summary of Seller's transaction 100. GrossAmount Due from Borrower: ~ 400, GrossAmouM Due to Seller. 101. Contract sales ce 138 000.00 401. Contract riles ca 138 000.00 102. Personal 402. Personal 103. Ssttbment Cha es to Borrower Line 1400 9092.35 403. 104. 404: 105. 405. ~ ustmsrrts for Items id b Seller in advance A ustmertts for Items td b Seiler In advance 06. CI /Town Taxes 05/11/10 to 01/01/11 379.97 406, CI /Town Taxes 05/11/10 to 01!01/1 379 9 07. Coun Taxes to 407. Coun Taxes to 08. Aaae~ments 05/11/10 to 07/01/10 130.44 408. Assessments 05/11/10 to 07101/1 130.44 09. 409. 10. TRASH 05/10-8/30 21.45 4 0. T H 10- 21,45 11. 411. 12. 412. 20. t3ro~ Amount Due from Borrower 147,824.21 420. (cross Amount Due m Seller 138,531.86 00. Amounts Pald b or in BehaNof Borrower 600. Redudtons in Amount Dus Seller: 01. D sit or earnest move 1000.00 601. Exosss d t sea inatruk*tons 02. Pried I amount of new ban a 140 987.00 Settbment ohs s to SeNsr Une 1400 10 883.56 03. Exb ban s taken sub d to 503. Exist ban s taken su d to 04. 504. Payoff First ge ~ • 50 . a econd e 08. 506. 07• 507. sit dbb. as ds ' ~8. SELLER ASSIST 520.00 508. S1:LLER ASSIST 5 520.00 ]9. SEWER 4/1-OS/10 25.55 509. SEWER 4/1-05/10 25.55 ' ustmerrts for ftmns un aid Seiler A ustmerrits for Items ~ aid Seller 10. CI own Taxes to .510. CI !Town Taxes to 11. Coun Taxes to 511. Coun Taxes to 12. Assessments to 512. Assessments to 13. '513. 14• 514. 15. 515. I6. 516. 17. 517. 18. 518. 'B• 519. :0. Total Paid b /far Borrower 147,512.55 620. Total Reduction Amount Due Seller 16,409.11 ~0. Cash at Settlement fromRo Borrower t100.. Cash at settlement to/from Seller ~1. Gross amount due from Borrower Iine 120 14T 824.21 801. Grams amount due to Selbr Iine 420 138 531.86 ~2. Less amount id /for Borrower Iine 220 ( 147,512.55) 602. Less reduWons due Ibr Ibe 520 ( 16,409.11 3. Cash ~ From ~ To Borrower 111.86 603. Cash XO To ~ From Seller 122,122.75 'he undersigned hereby acknowledge receipt of a completed copy of pages 1, 2 & 3 of this statement & any attachments referred t~,Aer~gi~. L~ Settlement t;:narges T00. Total Real Estate Broker Fees $ 8,143,80 Paid Fran P•IdFran 4f On COwnlrrlJd (ire 00 es OWS: 9onoNera S•Ibra T4 . 9 o W CH R CHOICE Finds a Funds ~ 70 1 4 to PROD N11AL HOME LE SERVICES OUP ~ ~•^~ sea«n•nt T03. Commis id et se omen ' 8143.80 T04. BROID:R FEE to WEICHERT REALTORS FIRST CHOICE 250.00 705. 300. Items able !n Connection with Loan 301.Ourorlghstbn dt ergs Indudes Orlgkra0on Point (.0305% or "^~ 4. '~;.R,: ~~++w -~.r ~, 302. Your credR or charge (points) for the specific interest rate chosen •:. ^'' -3,763.82 (from GFE #2) to p" 303. our uat orlginat on char to JAC from GFE 772,81 304. rebel fee to FREEMAN REAL ESTATE from GFE #3 75.00 305. Credit Re rt to CREDIT PLUS from GFE #3 .84 308. Tax service to ( G 30 . F od certificatbn to ( #3 308. (from FE ) 309. (from #3 310. (from tY3 311. from FE 300. Items R aired Lender to Be Paid in Advance 301. Dai interest cha from 05/10/10 to 08/01/10 $ 20.278080/d from GFE #10) .07 302. e r iumfor hs o CRETAR OF VA 2 .00 303. Homeowner's Insurance for 1.0 an; to ERIE INSURANCE from OFE #11 98.00 304. from GFE #11 )05. (from GFE #11) 1000. Reserves De osiisd with Lender 1001. Initial sit for r escrow account from GFE #9 1002. Homeowner's Insurance 3.000 months $ 33.17 per month S 99.51 1003. Mo a Insurance mont s r mon 1004. P rt tames $ i /Town axes months $ r month Assessments months er mon 1005, months ~ $ r month $ .006. CO TWP TAX 2.000 months $ 49.18 r month $ 98.38 :007. SCHOOL TAX .11.000. months $ 77.79 per month $ 855.69 :008. AG E S $ -280.2 '009. $ '100. Title Char s 101. Tfile services and tinder's tdle Insurance ~ 1,322.38 7 , 102. Settlement or doss fee 103. Owner's title krsurance to STEWARTTITI.E from GFE 104. Lender's a insurance to $ 9 .38 105. Lender's tkie Iic Bmfi 140 987.00 108. Owner's title I Ymk 138 000.00 107. ants Ion of the total title ine~rrancs emlum to SEASONS SETTLEMENTS INC $ End: .00 108. Underwriter's portbn of the total tide insurance premium to STEWARTTITLE $ 143.81 End: $0.00 109. 110. 111. CPL 112. • 113. 114. TAX CER FICATION ' to M INC 10.00 115. 2010 CO TWP TAX to R BIN R C TO 602.21 116. D D to ASO S ME S I 125.00 117. L AR to E N C 10.00 118. 200.Oovernment Recordirr8 and Trensfir Charges 201. Government reoordi dta es to Recorder's Offloo from GFE 225.00 202. Deed $ 65.00 Mort e $ 160.00 Releases $ Other $ 203. Transfertaxes (from GFE #8) 204. CI /Coup tax/atam $ $ 205. State tax/stam s 208. TRANSFER TAX to Recorder's Office 380.00 207. TRANSFER TAX to Recorder's Office 1,380.00 300. Additional Settlement Char s 301. R uked services that u can ah for from 302. SEWER 1/2/3 TRASH 4/5/8 to BOROUGH OF N CUM"BERLAND 97.55 303. 304. HOME WARRANTY to AHS 495.00 305. comparison of good rann t:atlmaw ~c~rt) ana nuu-i unarges voce raan cscunacp nvu= r Cha es ThatCannotlncrease HUD•1 Line Number Ourori ination char a #801 4,536.x'6 4,536.73 Your credo or charge ( n for the spectlic interest rate chosen # 802 3,411.40 -3,763.82 Your ad)uaed origination charges # 803 1,125. 6 772.91 Tra nsfe r taxes #1203 ~ 1,380. 0 1,380.00 Cha ea That in Total Cannot Increaee Moro than 10% ~ Good Faith Estimat HUD-1 Government reoordi cha es #1201 125. 225.00 sisal fee # 804 475. 375.00 Credit report # 805 182. 182.64 Mortga a Insurance Premium # 02 2,987. 2,967.00 Owners tale Insurance to STEWART TITLE #1103 10. Total 3,759. 3,749.64 Increase between GFE and HUD-1 Charges $ -9. or -0.25 Charges That Can Change Good Faith Estimate HUD-1 Initial deposit for your escrow account #1001 924. 773.35 Daffy interest charges ~ # 901 $ 20.276080/day 446.0 446.07 Homeowner's Insurance # 903 480.00 398.00 T#fe services and lender's title insurance #1101 1,423.75 1,322.38 Loan Terms Your Initial loan amount Is $140,987.00 ~! Your loan term is 30 years Your initial Interest rata is 5.2500 °e6 ~, Your initial monthly amount owed for principal, inbaroat and any mortgage tnsurance is • $ 778.42 tndudes 0 Prindpal © Interest ^ Mortgage Insurance :an your interest rata rise? X No Yes, it can rise to a maximum of ^ ^ change will be on and can change again ev . Every orange date, yourinterest rate can I by %. Over the INe of the loan, your Interest to never be lower than % or higher than °k. The first _ months after ease ordecrease to is g uaranteed %. :van If you make paymerrta on time, can your loan balance-rise? ® No ^ Yes, it can rise to a ma~dmum of $ :van If you make psrymerrts on time, qn your mouthy amount owed far principal, inbareet, and mortgage Insurance rise? 0 No ^ Yes, the first Increase can be on ~ amount awed c;sn rise to $ T:he maxknum R can ever dse to is S and the mouthy roes your loan have a prepayment penalty? ~ ^X No ^ Yes, yourmaxgnum prepayment penaky i S ices your loan have a balloon payment? ® No ^ Yes, you have a balloon payment of $~ due In _ years. on ~._ otal monthly amount owed including escrowaccount payments ^• You do not have a mouthy escrow payment for ~e taxes and homeowner's Insurance. You must pay these it yourself. XL7 You have an additbnal monthly escrow payment ot; In a total initial mouthy amount owed of $839.ti6. This ~ princpal, interest, arty mortgage Insurance and any Items ^ Property taxes © Homeowner ^ Fbod Insurance ^ 0 0 , such as properly ms directly 60.14 that resuks rides edted below: 's ~rsuranoe ~~ . de: If you have arty questions about the Settlement Charges and Loan Terms Nsted on this form, please contact your lender. HUD-1, Page 4 ~ ' Borrower (s): TRAVIS J TAFOYA 517 4TH STREET NEW CUMBERLAND PA 17070 seller(s): THE ESTATE OF ORPHA M DOUDEN lender: WALKER JACKSON MORTGAGE CORPORATION AND/OR SECRETARY OF AFFAIRS, TSAO Settlement Agent: SEASONS SETTLEMENTS INC Place of SettNment: WEICHERT R FACTORS FIRST C HOIC E j LINGLESTOWN RD HBG settlement Date: May 10, 2010 Property locatlon:1555 SIMPSON FERRY ROAD NEW CUMBERLAND, PA 17070 Adjusted Origination Charge Details Origination Charge ORIGINATION FEE to WALKER JACKSON MORTGAGE CORPORATION AND/OR SECRETA ORIGINATION FEE to DEAN JACOB MORTGAGE Origination CreditlCharge (points) for tfie spedfic Interest rate chosen Credit/Charg to ,~/'tDl~~ r I~ 42.94 4,493.79 Total 4,536.73 ~i, -3, 763.82 Total Adjusted Origination Charges Title Services and Lender's Title Insurance Details BORROWER END 300100 8.1 SEASONS SETTLEMENTS INC CPL STEWART TITLE DOC DOWNLOD WIRE FEDX COP SEASONS SETTLEMENTS INC NOTARY 150.00 75.00 100.00 40.00 Total .S 365.00 -3,763.82 772.91 SELLER I have carefully revfew~ed 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 Dopy _o,,f~he HUD-1 Settlemend Statement. SEASONS SETTLEMENTS INC Loan Number: 1000025441 Property Address: 1555 Simpson Ferry Road, New Cumberland, PA 17070 Closing Date: 05/10/2010 Addendum to HUD-l~aeuer paid closing coat) Settlement Char es Borrower Seller on Lion a• 9 Credit R ort A sisal Fee 7 ~ v~/ Final coon Fee Process' Fee lication Fee Mo a Broker Fee Courier Fee Admire Fee WJMC Admire Fee Dail Interest ~ 4 Homeowners , d O Floodlwindstorm Settleament/Closin Fee Attorne Fee Title Binder Fee • U Co Fee Doc P Fee Email Fee Misc rename fee 7 7~ 3 Misc rename fee • o D Misc rename fee i3 YO• Gd Misc rename fee a • ~d ~ ~~'a **** This document must be signed by all parties as.the above fees have been excluded from the APR as they being c d by the seller credit.**** Borrower Co-Borrower Z' Closing Agent Closing Agent T GO J`l~li