HomeMy WebLinkAbout09-21-10
15Q5610140
REV-1500 °` ~°'-'°'
PA Depatre~ent of Revenue ~~' 1JSE ~~ 1
t3ursau d individual Taws INHERRANCE TAX RETURN Cour~r Cods Year FNe Number
Po t~ox 2sos°1 2 1 0 ~1 0 8 9?
l~artitbwo, P/117128.0801 RESENT DECEDENT
er~ree err NN~'OIMIATiON eELOw
social security Number Dale of Death f1eMDDYYW Dais of eirtn lYNtDDYYYv
2 0 1 1 6 4 6 2 6 0 9 1 3 2 0 0 9 0 9 1 7 1 9 2 2
Deoederrt's Last Name SuRa DeoederrCs First Name MI
A D A M S M A R I A N ' M
(K AppNcabN) t.rersr 8urvtvirtp 8powe's InMnnatlorr Below
Spouse's Last Name SuPPoc Spouse's First Name MI
Spouss"s SodN Ssourily Number ~!
THIS RE1'Ut~l MUST ~ RLED IN DUPLICATE --' - ~ 1 THE
REGISTER OF WILLS
FILL M /1PPROPRIATE 01/ALS BELOW
® 1.Oripinal Rettun ~] 2. Suppbrtrsrrtal Retum ~ 3. Rerrroirrdsr R~u (date of deaM
prior bo 12-13~)
4. Limited Fatale ~ 4a. Futuro Interest Corr~romise (date of ~ 5. Federal Esta~ T Return Requirod
®
6. Daoedsrrt Disd Testate
[~ death alter 12-12-82)
7. Dsoedsnt Maintained a Lhrinp Tnrat
8. Total Nieanberlaf ~
afe Deposit Bozea
(~- Copy ~ ~ ( SPY of Trust)
9. LibiBalion Proossds Reosived ~ 10. t~overty Credit (dabs of death ~ 11. Ekdion to ts~urr~ br Sea 9113(A)
between 12-31-91 and 1-1-95) (Atbidi Sch. )
- TINE 8EC110N tlw15T BE COf~1.Ef EQ ALL Al0 COItFMH111A1 TAX M~OfIrATtON 8E ONECT®TO:
Name Daytime Teispltone
W IL L I AM A D UN CAN 717 24,9 7780
RECD Y
~ 'a
rr'r ~ G~ ;::~
First line of address ~ ~ ~ "
.,,_. ~-
1 I R V I N E R O W ~ ~-
second line of address Cr"y~~ ~ a ~ `'->
..?Ci Z .~, "~r't
~ r.._. 0~"*"i
City or Post Ofiioe Stale ZIP Code ~' ~ ~
C A R L I S L E P A 1 7 0 1 3
I
Con+agroederrC's e~rail addnae: B I L L D U N C A N R P A• N E T
thrder penrNfee ar per)ul. ~ seders Nat I:hw setwined Nis nNerrti tndbdirrpaoporr~rrtirp achadube and ateMrnerMS, and to N, one my end baler,
it is trw, aareMx end a>tnplMe. osii..tiarr ar peeparer aver Nea Ns pasarel rapeeerMdhie ie tined on aN iribnnetion drroidr p~pr~ wroeeedps.
of wrt ~ r~nxtrt
ar X -- d
A~RESs
26 BELLAIRE AVENUE CARLISLE PA',1 013
SK31MT11RE OF PREP/1RER O~rtiER TFMN R~RE3EMATNE
IIDDRES3 li
PLEA8E USE ORK31NAl. FORM ONLY
Side 1
L 1505630140 1505610141 ~,
1505610240
REV 1500 D(
DsosderrPs Social Seer
Num
ber
DecedsncaNsme: MARIAN M. ADAMS 2 0 1 1; 6' 4 6 2 6
RECAP17111J1TiON
1. ftsal Eetab (Sdredrrb A) ........................................... 1. b 9 ~~, 8 ! 0 9. 5 6
2. Stocks and Bonds (Sdbdule B) ...................................... 2.
3. Cbssy Held Corporation, Partnnership or Sots-ProprietonslNP (Sd~edub C) ..... 3.
4. and Notes Reosivabie (Schedub D) .......................... 4. I'
5. Gash, Bank DeposBs and MsoeNaneorrs Personal Property (Sd~edub E)....... 5. 1 4'~ 0 $ . ? 2
6. JoMly Owrrsd Property (Sclrsdub F) ^ separate BiNirg Requested ....... g. '' 1 9 8 . 4 2
7. Inter-Vivos Transfers ~ Misoelbneous
(Schedub G)
~
g
rate
BiHir
RequesMd ....... 7.
I
•
s. Taal ciroas Aaaels (mW Lirrss t tlMOrrgh 7) ........................... s. 7 l
'~ 4 'I 1 3. 7 0
9. Furbral Expenses and Adminbtrative Costs (Schedub H) .................. 9.
10. Debts of Dsosrbrd, INortgags Liabi~fies, and cans (Schsdub I) ............. 10.
11. Total Dedrrctlons (total Linos 9 and 10) ............................... 11.
12. Nat Value d Ead1e (t.ire 8 micas Lire 11) ............................ 12.
13. Ctnritabb and GowermrerKal Bsqussts/Sec 9113 Trusts for which
~ ebcfion to tax has not been made (Sciredub J) ...................... 13.
14. Nat VaNre Brrb)act b Tax (Line 12 minrs Line 13) ...................... 14.
--r-i-
1 4~',2I4 4. 4 4
2 I1'7 0. 7 7
1 6 I4'1 5. 2 1
5 4',919 8. 4 9
5 4 j9 !9 8. 4 9
TAX CN.CUt.ATION - 8EL tN>3TRt1Ci10NS POR /IPPlJCABLE RATES
15. Amount of Line 14 taxabb
at the spousal tax rate, or
translate under Sec. 9116
(ax1.2) X .0 _ 0 . 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X .045 5 4 9 9 8. 4 9 16,
17. Anrorak of Line 14 taxabb
at soling rate X .12 0 . 0 0 17.
18. Anwurk of Lire 14 taxabb
at oolbteral rate X .15 0 . 0 0 18.
19. TAX DUE ...................................................... 19.
20. t7.L Nr TIME OVAL IF YOU 11RE IiEGUEa111Ui A REFt11tD OF AN OVERPAYMENT
Side 2
L 1505610240
15056102401,
' '
0.
0
0
2 14 '7 4. 9 3
', 0. 0 0
!, ', o . 0 0
2 II4 ~,7 4. 9 3
REV-1500 EX Pays 3
Decedent's Colmple~bs Address:
FIN I~Nxnbar
21 09 D897
oEtxoe~rs t~
MARIAN M• ADAMS
S71tEET ADDRESS
45 E• NORTH STREET
cmr
CARLISLE
PA
17013
Tax Payments and Credits:
t. Tax Due (Page 2, Line 19)
2. CreditslPayrrlents (1) _ h 2 , 4 7 4.93
A. Prior Payments
B. Disaourlt
Total Credits (A + g) (2) ', 0 • D D
3. Irrlerest
4. ff Line 2 is greater than Line 1 + Lase 3, enter the differerroe. This is the ONERPAYl1ENT. (3) ~~
FiN ti ovrat on Pag.2, LNIe m b rsquet+t a refund. (4) ' 0.00
5. ff Line 1 + ~rle 3 is greater than Lme 2, enter the di~nence. This is the TAX DUE. (5) ~_~ 2 , 4 7 4.9 3
Make check payable to: REGISTER OF WILLS, AGENT
II
PLEASE ANSIIMER THE FOLLOYY~IG t~ESTIONS BY PLACING AN "X" IN THE APPROPTE BLOCKS
1. Did decedent make a transfer and: Yes I ' No
a. retain the use or inoonle of the property Uarlsferred : ...................................................................... ^ ~
b. retain tits right b designate who st1aN use the property 1''ansferred Or its irloorrle; ............................... ^
c. retain a reversionary irNeresk or ................................................................................................ ^
d. receive the promise for kFe of either paymerr>s, berlrriits or care? ....................................................... ^ '~
2. ff death oocrxred aNer Deoernber 12,1982, did deoederrt transfer property wittan one year of death
without reoeivirlg adegrlate oorlaideration?
3. Did deoederrt awn an •in trust 1or• ar payablealpon-deatir bank account or secuity ~ his or her death? ......... ^ '', gC
4. Did deoedeM own an individual retirerrlent aooouM, annuity orother rnon-probate properly, which
oontakrs a berre8dary designation? .................................................................................................. ® ^
IF THE ANSIMER TO ANY OF THE ABOVE CUESTION313 YE3, YOU MUST COMPLETE SCHEDULE G AND FEE R PA~tT OF THE RETURN.
For dates of death on or afbr July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net vale of transfers b or for Mhe ~ of the surviving spout,e
3 percent ]72 P.S. §9116 (a) (1.1) (i)].
For dales of death on or aver Jan.1,1995, tits tax rate imposed on tits net value of transfers >b or for the use of the surviving Is 0 percent
(72 P.S. §9118 (a) (1.1) (~]. The statute does trot exempt a transfer b a surviving spouse irorrl tax, and the
~9 a tax rettirrn are s6T applicable even if the su ~ ~ ~ ~I'~~n' disclosure of assets and
rvivmg spouse the only berrefiaary.
For dates of death on or otter July 1, 2000:
• The tax rate imposed on Cie net vakie of trar~fers from a deceased dr8id 21 years of age or younger at death to or for the iwbe ottj a natural parent, an
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(aj(1.2)].
• The tax rate imposed on the net value of transfers b or for the use of the decederrCs ~I beneficiaries is 4.5 perr~ent, exoe~t asI noted in
72 P.S. §9116(1.2) [12 P.S. §9116(a)(1)].
• The ~ tale Ynposed on the net vakle ~ transfers b or for the use of the deoedreiCs sibNrigs is 12 percent p2 P.S. §9116(a~1.3p]. A sibling is defirred, unr>E
Section 9102, as an iridnridual who has at least one parent in corrirrion with the decedent, whetirer by blood or adoption.
REV,SOZ E,cf ro,.,o~
Pennsylvania SCHEDULE A
~~
r~TAxr: REAL ESTATE
raESioE~r oHr
ESTATE OF: FILE tiUTABER:
MARIAN M. ADAMS 21 09
All nTal prop«ir owmd aolNy a as a t~ant In oo~non a nporbd at hir nwrkat vaNw. Farr market vak~e ~ detlned as
would be eoa~hangea between a wirlkig btryer and a wtlling seller, neither being campeMed a buy a sell, eoU- haNrg ieeeonable I~
[bet propeely tlwk k joi~awlNd vdlh rlOht of swrvNvnhip nMwt be derJoted on 8ahedule F.
Attach a copy of the setgement sheet if the pn~perty has been sold.
ITEM ka~de a copy al the deed stro~whig decederrCs interest rf owned as tenant in Darman.
NUMBER
DESCRIPTION
1• 45 E• NORTH STREET
CARLISLE, PA 17013
[SEE ATTACHED HUD SHEET]
al which property
oe of the relevant tads.
VALUE AT DATE
OF DEATH
69, 809.56
TOTAL (Also solar on Line 1, Recapitulation.) II S
69,809.56
REV 1506 p(+ (6-98)
aCNEDt/LE F
~TM CASH
BANK DEPOSRS
~ MlSC.
~ ,,,~„ ,
,
" M T PERSONAL PROPERTY
ESTATE OF FLE NUMBER
MARIAN M• ADAMS 21 09 O~b97
incbde the d N~atlon and the dale the gooeede wets n~oebed bq the eefale.
M wMl- of aNprt be dNdogd on SduduN F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t. CAPITAL BLUE CROSS REFUND 366.51
2• FRATERNAL ORDER OF EAGLES CHECK 200.00
3• SHIPLEY OIL REFUND 672.32
4• CENTURYTEL, INt• REFUND 6.09
5- COMCAST REFUND 36.80
6• DEPOSIT REFUND 20.00
?- PA NATIONAL MUTUAL CASUALTY CO• REFUND 104.00
TOTAL (Also enter on (ine 5, Recapilulaljon) III _
1,405.72
REY-1509 EX+ (01-10)
pennsylvar~ia
~~
INHERRANCE TAX RETURN
RESHIENT DE(~DENT
SCH~~/LE F
JOINTLY-OWNED PROPERTY
ca ~ w~ c vr: - -- ---------
MARIAN M ADAMS 21 09 OI697
N an aeeet wr Wade jolnY~i owned wIULiIL one gear d the decedenCe deie d dee11L, tt nLUet be reported on Slche~ule G.
SURVTIING JOMIT TENANT(S) NAbE(S) ADDRESS RELATIONSHIP TO DECEDENT
a DOUGLAS HALL 26 BELLAIRE AVENUE ON
CARLISLE, PA 17013
JAr/fL.Y.dAl1EDFROPERTY:
Rg,L
NUMBER
Fgt~jpMi
TENANT
M~AD~E
JOMi
INCUJDE NAME DF RNANCIAL~MISTITUTION ~ BI1lN(A000IN~(i NUM6ER OR SII~.AR
Ipp~IT1FYNiG NUNBER. ATTACH GEED FOR JON~ITLKI~ELD REAL ESTATE-
DATE OF DEATH
VALUE OF ASSET % OF
ST DATE OF DEATH
v/1LUE OF
OECEDENrSINiEREST
t. A. 04/83 MST BANK CHECKING ACCT• ~ 33340765 396.83 ', ~',50•
j 198.42
TOTAL (Also enter on Lines, Rec,~apitulafion) I i ' 19 8.4 2
REV 1511 EX+ (10-0a]
pennsyivania SCHEDULE H
°~"~""~'1T0F FUNERAL EXPENSES AND
'""~""~T"~~"'R" ADMINiSTRATNE COSTS
r~ES~e~rt o~Hr
ESTATE OF _ _ _ F~.E NUI~R
MARIAN M • ADAMS 21 09 ~ 0197
DecedwN's de6tt awet ba n~oArd on Setudrle L
fTEM
NUM~R DESCRIPT101V AMOUNT
A. FUI~RAL EXPENSES:
~. HOFFMAN-ROTH FUNERAL HOME 9,776.84
B. ADMINISTRATIVE C06TS:
L Personal Represenfalire Gommi~ions:
Nerne(a) d Personal tiepieeerrleYre(s)
SbeetAdrieee
Cat Sfdre ZIP ~
YeM(s) Comnieefon Paid
y, Aroma~-Feas: DUNCAN S HARTIIAN, Pt
3, Farrier Exemplforc (11 decedents addieas b not rie arrne ae deirrer-Ce, atlach ergder~on.)
Claimant ~'
Sheet Addn~es
~ S'esle ~
RelrrwrehiP d CWrmrrt b l)eoederrt
4. ~ooee,r-ee~ REGISTER OF PILLS
~
5. I
~ '~
'~
6. Tax ReMrrn Plaperar Fees:
7. CUMBERLAND LAY JOURNAL
8• THE SENTINEL - LEGAL AD
9• REGISTER OF PILLS -FILING FEE
10• HELD IN RESERVE
3,570.68
330.00
75.00
376.92
15.00
300.00
TOTAL Also enter on Line 9 I =
~~n) 14,244.44
REV-1512 EX+ (12-06)
penrniylvania SCHEDULE I
°~"'~"r °F DEBTS OF DECEDENT, II
rr~rwcr~ruiar MORTGAGE LIABILITIES, 8~ LIENS
i~s~r oEC~rrr
ESTATE OF FLE MISER
MARIAN M• ADAMS 21 D9 ~OI697
t~port dabb Micurrtd ~ ~ daadant prior to daNh flat rwraNad unpaid at tM daw o(datlh, includNq u n~Cal experna.
REM VALUE AT DATE
NUMBER DESCRIPTION ~ OF DEATH
~. SHIPLEY OIL ' 384.1?
2• BOROUGH OF CARLISLE - WATER/SEWER BILLING ' 96.36
3- PPL - ELECTRIC BILL 76.31
4• UGI -GAS BILL 27.73
5• EMBARa 34.16
6• COMCAST ', 61.23
7• CARLISLE BOROUGH TAX ACCOUNT - 1l3 PAYMENT 303.92
8- CUMBERLAND HEATING 8 A•C• ',
I 94.00
9- DIVERSIFIED APPRAISAL SERVICES - 45 E• NORTH ST• 325.00
10- CENTURY LINK - TELEPHONE BILL
11• COMCAST
12• PPL - ELECTRIC BILL
13• UGI - GAS BILL
14• PAINT S PAINTING OF 45 E- NORTH ST- PROPERTY
15- PENN NATIONAL INSURANCE - HOMEOWNERS INSURANCE
33.02
63.34
36.40
24.93
156.88
151.00
TGTAL (Also solar on Una 10, Rec~pilulaHon)I' i 2 ,17 D • ? 7
~ mole apace sa needed kieert addaaal aheela of rie same sine.
Continuation of REV-1500 Inheritance Tax Return Resic~nt Deceder>+t
MARIAN M. ADAMS 21 09 0897
Dscsderit'a Nams Pegs 1 Fib Nurr~sr
Sch~duk 1- Dsbb of DsCed~tlt, Mortpape LiabttitNs, b LisisK
ITEM
NUMBER DESCRIPTION AMOUNT
16. PPL - ELECTRIC BILL 33•?U
17- IUGI -GAS BILL
1d- ITRASH HAULING - 45 E. NORTH ST. PROPERTY
19 • (MAILING >i< POSTAGE FEES
SUBTOTAL Sg1EDlILE 1
GRAMD TO?AL SCIIEDUIE 1
REV-1513IX+(01-10)
Pennsylvania
oEP~Rn~rr of Ri_vENt~E
INHERITANCE TAX RETURN
RESIDENT DE(~IT
SCHEDULE J
BENEFICIARIES
FLE NUMBER:
MARIAN M• ADAMS 21 09 0897
RELATIONSHIP TO DECEDENT ~ AMOUNT OR SHARE
NUM~R NAME At+~ ADDRESS OF PERSON(S~ RECEIVING PROPERTY Do Not Lbt TnnIN(y ~~ OF ESTATE
I ot
TAXABLE DISTRIBUTIONS (Ntd ~
~ ~
. 1 f6 (a (1.~.]
9
1. DOUGLAS L- HALL Lineal
26 BELLARIE AVENUE 1X3 SHARE
CARLISLE, PA 17013
2• PATRICIA SEIBERT Lineal
418 FIRST STREET 1'15 SHARE
CARLISLE, PA 17D13
3- MICHAEL KECK Lineal
2 MOORLEAND AVENUE 115 SHARE
MT• HOLLY SPRINGS, PA 17D65
4• CINDY BOYERS Lineal
211 BELLAIRE PARK ROAD 1/15 SHARE
CARLISLE, PA 17013
5- ROBERT KECK Lineal
340 WAGNER DRIVE 1/15 SHARE
CARLISLE, PA 17013
6• JOHN A• JAKOMAS Lineal
14184 CHRISTOFF AVE• 1/18 SHARE
MT• UNION, PA 17D66
?• SUE MALCOM Lineal
129 E• NORTH ST- 1/1,18 SHARE
CARLISLE, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTR18lJT101~ SHOWN ABOVE ON LINES 15 THROUGH 18 OF REY-1500 COVER , AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TARN:
1.
Ii
B. CHARRABLE AND GOVERIrH1AENTAL DISTRIBUTIONS: i
L
TOTAL OFPART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REY-1500 COVER SHEET. II i '
ff 1tvYw cnarp is ntVarlAr( ii¢a arirTfinnal RhErNC M n•~ of the RarriR aim '
~I
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
MARIAN M. ADAMS 21 09 0897
Dsoedet~'s Name p~ ~ Fite Number
Schedule J - BeneAciatrNs -1
NUI~ER
NAME AND ADDRESS OF S RECEIVING PROPERTY RELATfONSHIP TO DECEDENT
t9o Not lht T AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS lSec. 91 i6 (a (1.2~. ~buliore ~d >lamfers under
8- CHRISTINE ERICKSON Lineal
2 MOORELAND AVE• 1/18 SHARE
MT- HOLLY SPRINGS, PA 17068
9- DONALD ADAMS Lineal
412 S- COLLEGE ST•, APT- 204 1/!18 SHARE
CARLISLE, PA 17013
10 BELINDA COY Lineal
1012 ROCKLEDGE DRIVE 1/18 SHARE
CARLISLE, PA 17015
11 DEBRA YEAGER Lineal
926 OUTER DRIVE 1/18 SHARE
STATE COLLEGE, PA 16801
li
~.
LAST NULL & TESTAMENT'
OF
I,1vZARIAN M. ADAMS, of 45 East North Street, Carlisle, Cumberland Cpuiity,
Pem~sylvania, being of sound and disposing mind, memory and understanding, do her~by~, make,
publish and declare this as and for my Last Will and Testament, hereby revoking any ~ndl all
other wills and codicils heretofore made by me.
FIRST. I duect that all my just debts and funeral expenses be paid from my'es~ate as
soon after my death as practically and conveniently may be done.
SECOND. I direct that my remains be interred within my family's burial plod located
in Kutz Cemetery in accord with my expressed wishes.
THIItD. I authorize my personal representative to expend funds from my e~tat~, in
such amounts as my personal representative shall consider necessary and desirable for the
purchase, erection and inscription of a suitable marker for my grave.
FOURTH. I give, devise and bequeath any and all tangible personal pro ~ owned
by me at the time of my death as follows: One-third unto my son, Douglas L. Hall~O~e-third
unto my daughter, Charlotte A. Jakomas, per stirpes, and One-third unto my daughter B~rbara
Keck's children, Arthur Keck, Jr., Patricia Seibert, Cynthia Bowers, Robert Keck and ~hael
Keck.
FIFTH. I give, devise and bequeath any and all real estate owned by me at tie dime
of my death as follows: One-third unto my son, Douglas L. Hall, One-third unto my er,
Charlotte A. Jakomas, per stirpes, and One-third utrto my daughter, Barbara Keck's c
Arthur Keck, Jr., Patricia Seibert, Cynthia Bowers, Robert Keck and Michael Keck. ',
SIXTH. I give, devise and bequeath all the rest, residue and remainder of m}t a to
as follows: One-third unto my son, Douglas L. Hall, One-third unto my daughter, C e A.
Jakomas, per stirpes, and One-third unto my daughter, Barbara Keck's children, Arthu~K k,
Jr., Patricia Seibert, Cynthia Bowers, Robert Keck and 11~chael Keck. '
SEVENTH. I direct that any and all Inheritance, Estate and Transfer taxes used
upon my estate passing under my will or otherwise, shall be paid out of the principal o mfr
residuary estate.
EIGHTH. I hereby nominate, constitute and appoint my children, Charlotte ,~.
Jakomas and Douglas L. Hall, as Co-Executors of this my Last Will and Testament. I #,erl~by
relieve my Executors from the necessity of posting security in connection with their du~ie~, as
such, in any jurisdiction in which they may be called upon to act insofar as I am able bye, la~v to
do so. In addition to the powers conferred by law, I authorize my Executors, in their absc#lute
discretion, to retain in the form received, and to sell either at public or private sale any ~ea~ or
personal property owned by me at the time of my death.
__ __ __
_ _ _ _,
''" ..
. NII~TTH. I have made, or may from tune to time make, a written memorandum
expressing my desire to give certain items of personal property to specific persons. I urge my
Executors and beneficiaries to respect these wishes. Such a memorandum, if made, shall' be
stored in conjunction with this Will.
IN WITNESS WHEREOF, I have hereunto set my d and seal to this, ~ Fast
Will and Testament, consistuu of two typewritten rues this day of , 200.
~2
v~ ~~'~
MARIAN M. ADAMS
Signed, sealed, published and declared by the above named Testatrix Marian
Adams as and for her Last Will and Testament, in the presence of us, who, at her requ ' in
her sight and presence and in the sight and presence of each other, have hereunto sub 'lied
our names as witnesses. ',
.\
~~~~,J1,~1~ C. i
~.
COMMONWEALTH OF PENNSYLVANIA
ss.
. COUNTY OF CUMBERLAND
I, Marian M. Adams, Testatrix whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that'll signed
and executed the instrument as my Last Will; that I signed it willingly; and that I signed i~ as
my free and voluntary act for the purposes therein expressed.
~~ ~ ~~
MARIAN M. ADAMS '
Sworn or a$'umed to and
acknowledged before me by
Marian M. Adams this ~ ~ day ~
of-A~eteb~~2000.
NOTARIAL BEAI
KATHY L YItIR1ERT NOTARY PUBLIC
CITY OF CI~ERUlND CO., PA
No IIY COM11188i0N E8 AUQU8T 11, 20f7
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
We, (~.c,~il~wr, 14- ~cciN~ and U~ or I~., a~/l the wit~e~,ses
whose names are signed to the attached or foregoing mshument, being duly qualified ,
according to law, do depose and say that we were present and saw Marian M. Adams igjn and
execute the instrument as her Last Will; that Marian M. Adams signed willingly and t
Marian M. Adams executed as her free and voluntary act for the purposes therein exp es ;
that each of us in the hearing and sight of the Testatrix signed the will as witnesses; an t~ at to
the best of our knowledge, the Testatrix was at that time eighteen (18) or more years f age, of
sound mind and under no constraint or undue influence.
Sworn or a$nmed to and
subscribed befo a me by
(,~1tiX.lxo~ 14 .S ~n c~ and
,~ L . ~~ ,witnesses,
flocs ~~day of ~eEeber• 2000.
vw.-r~r..
Not
NOTARIAL BEAL
KATHY L ~IlIiMERT NOLt~y r._, . ;
EXNRESf AUGUST 11, 2C 7
r
naa un oSn~s~aa T
A
.
NT OF HOUSING b URBAN DEVELOPMENT
1. FHA 2. FmHA 3. X CONV. UNINS. 4. VA 5. CONY. INS.
U.S. DEPARTME 6. FILE NUMBER: 7. LOAN NUMB R:
SETTLEMENT STATEMENT 8. MORT GE INS CASE NUMBER:
C. NOTE: This form is famished to give you a statement of actual settlement costs. Amounts paid to and by the settlement nt are shown.
Items marked lPOCj" were paid outside the closing; they are shown here for infomladonal purposes and are not inc udeld in the totals.
1.0 3f98 (11152.5 HOFF}AAN, CIiR1S/11 52.5' MOFFMAN123)
D. NAME AND ADDRESS OF BORROWER:
Christopher H. Hotiman
111 Schoolfieki Drive
Carlisle, PA 17013 E. NAME AND ADDRESS OF SELLER:
Estate of Marian M. Adams
45 East North Street
Carlisle, PA 17013 F. NAME AND AD RE S OF LENDER:
Orrstown Bank
77 East King Street'.
Shippensburg, PA ~729~7
G. PROPERTY LOCAT{ON:
45 East North Street
Carlisb, PA 17013
Cumberland County, Pennsylvania H. SETTLEMENT AGENT: I. SETTLEMENT DATE:
Manson Deardorff Williams Otto Gilroy b Faller
January 19, 2010
PLACE OF SETTLEMENT
10 East High Street
Carlisle, PA 17013
101. Contrad Sabs Price 75 000.00 401. Contrad Sabs Price 75 000.00
102. Persona! P 402. Personal P
103. Settlement Cha a to Borrower Line 1400 5,014.63 403.
104. 404.
105. 405.
108. Coun R .Taxes to 406. Coun /T .Taxes to
107. School Taxes 01/20/10 to 07/01/10 404.66 407. School Taxes 01/20/10 to 0 101 10 404.66
108. Assessments to 408. Assessments to
109. '~•
110. 4 0.
111. 41 t
112. 412.
120. GROSS AMOUNT OUE FROM BORROWER
00. N AI 1 60,419.29 420. GROSS AMOUNT DUE TO SELLER
IN U L 75,404.66
201. it or earnest more 1,500.00 501. Excess sit See Instrudions
202. Princi a{ Amount of New Loans 60,000.00 502. Settlement Cha ss to Selbr Line 1400 5 572.26
203. Existi loans taken sub'ed to 503. Exist/ loan s taken su 'sd to
204, 504. Payoff of first Mo
205. 505. Pa off o second Mort a e
206. 506.
207, 507. De sft disb. as roceeds
208. 508.
209.
us en ms 509.
u n s r ms n a r
210. Coun R .Taxes 01/01/10 to 01/20/10 22.84 510. Coun R .Taxes 01!01/10 to 01 20/ 0 22.84
211. School Taxes to 511. School Taxes to
212. Assessments to 512. Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 61,522.84
A A F WER: 520. TOTAL REDUCTION AMOUNT DUE SELL R
T 5,595.10
301. Gross Amount Due From Borrower Line 120 80,419.29 601. Gross Amount Due To Selbr Line 420 75,404.66
302. Less Amount Paid 8 /For Borrower (Line 220) ~( 61,522.84 602. Less Redudions Due Selbr (Line 520) ~( 5,595.10
303. CASH (X FROM) TO) BORROWER 18 896.45 603. CASH (X TO FROM) SELLER 69,809.56
HUD•1 (3-88) RESPA. MB~305 2
_~
L. SETTLEMENT CHARGES
7 . T TA A P PAID FROM PAID FROM
Division of Commission line 700 a3 FOIIOWS: BORROWER'S SELLER'S
701. $ 4,500.00 to Hooke, Hooke ti Eckman FUNDS AT FUNDS AT
702. $ t0 SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement 4,500.00
704. to
8 1. Loan n Inabon ee to rrstown an
802. Loan Discount 2.5000 °~ to Orrstown Bank 1,500.00
803. Application Fee to rrstown Bank 88.70
804. Credit Report to rrstown Bank POCL-CBY Systems, Inc. 11.30
805. Appraisal Fee to Orrstown Bank POOL-McCarth Associates 375.00
806. Tax Service Fee to Orrstown Bank 75.00
807. Document Preparation Fee to Orrstown Bank 200.00
808. Underwrttin Fee to Orrstown Bank 195.00
809. Flood Certification Fee to Orrstown Bank POCL-United One Resources 14.50
810. Flood Maintenance Fee to Orrstown Bank ' 15.50
811.
901. Interest From 01/19N0 to 02/01/10 $ 9.375400lday ( 13deys °10) 121.88
902. Mo a e Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 ars to
904.
905.
1001. Hazard Insurance months $ r month
1002. Mort a e Insurance months $ r month
1003. Coun R .Taxes months $ r month
1004. School Taxes months $ r month
1005. Assessments months $ per month
1006. months $ r month
1007. months $ per month
1008. months r month
1101. Settlement or Closi Fee to
1102. Abstract or Tdle Search to
1103. Title Examinaf n to
1104. Title Insurance Binder to
1105. Dsed Pre aration to Duncan 8 Hartman 225.00
1106. Note Fees to
1107. Attome s Fees to
indudas above item numbers:
1108. Tito Insurance to Oki Re ublic Nation I Title Insurance Com an B is 708.75
includes above item numbers:
1109. Lenders Cover $ 80,000.00
1110. Owners Cover a 75,000.00 T08.75
1111. Endorsements 100, 300 8 8.1 to Oki Republic National Title Insurance Company 150.00
1112. Closin Service Letter to Old Republic National Title Insurance Compan 75.00
1113.
1201. Recording Feea: Deed $ 62.00; Mort age $ 72.00; Releases $ ' 134.00
1202. C' !Coun TaxlStam :Deed 750.00• Mort a 196 transfer lax 750.00
1203. State TaxlStam s: Deed 750.00: Mort a e 1 °l° transfer tax 750.00
1204.
1205.
1301. Surve to
1302. Psat Ins ion to
1303. Final Sewer 8 Water to Borou h of Carlisle Acct. 007230 97.26
1304.
1305.
1400. TOTAL SETTLEMENT CHARGES Enter on Llnes 103, Section J and 502, Section K ,014.63 5,572.26
By signing page 1 of this statement, the signatories acknowledge receipt of a completed copy of page 2 of this two page statement.'
Cert~ed to be a true copy. Martson Deardorff Williams Otto Gilroy ti Faller
Settlement Agent
(~ 1152 5 HOFFMAN / 11152 5 HOFFMAN ! 29 )
l ACKNOWLEDGMENT OF RECEIPT OF SETTLEMENT STATEMENT ~
Borrower: Christopher H. Hoffman
Seller: Estate of Marian M. Adams
Lender: Orrstown Bank
Settlement Agent: Martson Deardorff Williams Otto Gilroy & Faller
(717)243-3341
Place of Settlement: 10 East High Street
Carlisle, PA 17013
Settlement Date: January 19, 2010
Property Location: 45 East North Street
Carlisle, PA 17013
Cumberland County, Pennsylvania
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge andb~ lie, it is a true and
accurate statement of all receipts and disbursements made on my account or by me in this transacttionl. I further certify
that I hav eceiv y of the HUD-1 Settlement Statement.
Es of Marian M. Ad ms
C nstopher . Ho an
By:
Douglas .Hall, Executor
To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is a true anc~, acccurate account of
the funds which were received and have been or will be disbursed b e undersigned as part of the settlement of this
transaction. ~ S
Martson Deardorff Williams Otto Gilro 8 Faller
Settlement Agent ',
WARNING: It is a crime to knowingly make false statements to the United States on this or any simlila~form. Penalties
upon conviction can include a 8ne and imprisonment. For details see: Title 18 U.S. Code Section 100 and Section
1010.
' M~UD~1 (3-86) RESPA. HB4305 Z
-- --. I .
~.~i~i ~~
494 Mitchell Road, Millsboro, DE 19966 Mail Cade DE-MB-12
Phone(888~502-4349
Fax (302 9342955
October 2, 2009
Duncan 8c Hartman,'P.C.
Attorneys at Law
One Irvine Row
Carlisle, Pennsylvania 1'1013
II
Re: Estate of ~ Marian M. Adams
Social Security: 201-16-4626
Date o Death: September 14.2009
Dear Sir or Madam:
Per your inquiry dated September 28, 2009, please be advised that at the time of death, the above-namedl, decedent had on
deposit with this bank the following:
1. 7~pe of Account Checking Account
Account Number 33340765
Ownership (Names ofl
Opening Date
Balance on Date of Death
Accrued Interest
Total
Marian MAdams*
Douglas Hal!*
Charlotte A Jakomas*
4/28/83 Closed 9129/09
$ 39tf.83
$ U. DO
$ 396.83
Please be advised, there was no safe deposit box found for the above decedent.
* If upon revkwing the intormatan above, you beNeve there are additional acconnb not r+ekrenoed, provide
us with an account number and/or name of any possible joint account holder. For any addhionai into 'non the
above accounts, includhrg ownership and any changes, closures and/or reimbursement of funds, etc.,' contact
our High Street Carlisle Office # 717-240-4536.
Sincerely,
~.
Tracie Hare
Adjustment Services
i
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