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HomeMy WebLinkAbout10-13-101505607121 REV-1500 EX (06-05) OFFICUIL USE ONLY PA Depertmettt of Revenue County Code Year File Number BureauotlndividualTaxes INHERITANCE TAX RETURN PO BOX 280601 2 1 0 9 0 9 4 7 Hardsburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 9 9 4 0 4 5 2 7 0 9 2 2 2 0 0 9 0 9 2 9 1 9 4 7 Decedent's Last Name Suffix Decedent's First Name MI Z O O K J E R E M I A H S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return 4. Limited Estate ® 6. Decedent Dled Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum 4a. Future Interest Compromise (date of death after 12-12-82) 0 7. Decedent Maintained a Living Trust _ (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) MI 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL Tax INFDRrIwT ION snuuLU nt urrct~ r to ~ u: Name Daytime Telephone Number 7 1 7 5 3 2 3 2 7 0 Firm Name (If Applicable) H ANTHONY ADAMS First line of address 4 9 WEST ORANGE STREET Second line of address S U I T E 3 City or Post Office S H I P P E N S B U R G State ZIP Code P A 1 7 2 5 7 .F' Correspondent's e-mail address: htadamslawt~embargmail.com Under penal8es of perjury, I dedane that I have examined this return, including accompanying schedules and statements, and l0 the best of my knowledge and belief, it is true, coned and complete. Declaration of preperar other than the personal representative a based on all lnfonnatlon of which preparer has any kralrledge. SIGNATURE OF P4RSON~tES ONSIBLE FOR FILING RETURN 'bATEI m .. I , i\ a~ 3 i , ~, 7 z~ i7as~ Side 1 L 1505607121 1505607121 ~ ;\~ ru REGISTER O USE O 0o 0 O n rn n - ~ ~; c:. a - =~~ ~ ~°~ _ -1 7 ~ OD ' ~~ hh OA7E FILED .. ~ ~ REV-1500 '~( Page 3 . Flle Number Decedent's Complete Address: 21 09 0947 DECEDENTS NAME JEREMIAH S. ZOOK _ STREET ADDRESS 80 ZOOK LANE CITY NEWBURG STATE PA ZIP 17240 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 11.253.35 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fiil 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. A. Enter the interest on the tax due. (3) 0.00 (4) 0.00 (5) 11,253.35 (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) 11,253.35 Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................... ^ c, retain a reversionary interest: or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ 3. Did decedent own an 'intrust 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 beneficary designation? .................................................................................................. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before January 1,1995, the tax rate Imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P,S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even ff the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate Imposed on the net value of transfers from a deceased child twenty-0ne years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent (72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [!2 P.S. §911fi(a)(1)]. REV•1502 EX + (8-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF rat numntr< JEREMIAH S. ZOOK 21 09 0947 All real property owned solely or as a tenarrt In common must be reported at hir market value. Fair market value is defined as the price at whkh property would be exchanged between a willirq buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant fads. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 80 ZOOK LANE, NEWBURG, HOPEWELL TOWNSHIP, CUMBERLAND COUNTY, PA 120,000.00 IMPROVED 2 ACRE TRACT #11-07-1495-021 2. (APARTMENT BUILDING 36 WEST KING STREET BOROUGH OF SHIPPENSBURG, CUMBERLAND COUNTY, PA 3. MOUNTAIN LAND HOPEWELL TOWNSHIP, CUMBERLAND COUNTY DEED BOOK "R" 34 PAGE 488 25610 X 1.26 COMMON LEVEL RATION 132,000.00 32,268.60 TOTAL (Also enter on line t, Recapftulatlon) I S 284.268.60 (If more space is needed, insert additional sheets or the same size) REV-1508 EX + (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER JEREMIAH S. ZOOK 21 09 0947 Indude the of litigation and the date the proceeds were received try the estate. All property iMlyowned with rlpht of eurvNorshlp must be d4cbeed on ticheduk F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TEMPLETON GROWTH FUND (IRA) 2,561.67 2. HOUSEHOLD AND PERSONAL PROPERTY 29,911.50 SOLD AT AUCTION 3. ORRSTOWN BANK STOCK 2,514.51 102.46 SHARES (~D 24.54 4. CASH REFUND FROM FLORIDA POWER AND LIGHT 47.24 5. ORRSTOWN BANK CHECKING 8,194.38 ACCOUNT # 631515 6. REFUND ON REAL ESTATE TAX ON SALE OF 36 W. KING STREET, 1,103.68 SHIPPENSBURG, PA TOTAL (Also enter on Tine 5, Recapitulation) ~ ; (If more apace is needed, Nsatt additional sheet ~ the sarrm size) REV-1511 EX+(10-08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER JEREMIAH S. ZOOK 21 09 0947 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. FOGELSANGER-BRICKER FUNERAL HOME 2,771.40 3. 4. B. 1 AMMON FISHER- GRAVE STONE INSCRIPTION BEN KURTZ-CRAFTING OF COFFIN ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City Year(s) Commissbn Paid: State Zip p, AttomeyFees H. ANTHONY ADAMS 3. Fatuity Exemptlon: (If decadence address is not the same as daimanCs, altarir explanation) Claimant IVAN ZOOK Street Address 80 ZOOK LANE City NEWBURG state PA Zip 17240 Relationship of Claimant to Decedent CHILD 4. I Probate Fees 5. I Aocounfancs Fees 6. I Tax Retum Preparers Fees 7. I ORRSTOWN BANK-ESTATE CHECKS 450.00 300.00 3,200.00 3,500.00 371.00 19.75 TOTAL (Also enter on line 9, Recapitulation) I S A ~ C A ~, I?f more space's needed, insert additional sheets of the same size) REV-1512 EX + (12.03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANW DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER JEREMIAH S. ZOOK 21 09 0947 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MORTGAGE LOAN #1520005268 41,267.69 TO ORRSTOWN BANK 2. TRANSFER TAXES ON REAL PROPERTY SALES 2,520.00 3. COUNTY/TOWNSHIP REAL PROPERTY TAX 898.14 4. BOROUGH OF SHIPPENSBURG SEWER/WATER 1,212.80 5. THOMAS D. KILGGE (SECURITY DEPOSIT RETURN) 1,415.00 6. CHAMBERLIN'S PEST CONTROL 1,000.64 7. REESE'S PLUMBING AND HEATING 91.75 8. SAILHAMER REAL ESTATE (COMMISSION) 7,920.00 9. TIMMONS OIL 4,562.20 10. PENELEC (ELECTRIC) 180.24 11. CARL CRAMER (INSURANCE) 469.00 12. CHRISTIAN ZOOOK 1,291.64 (REPAIR TO LANE FOR REAL ESTATE AND PARKING FOR AUCTION) 13. NEWBURG FIRE POLICE (AUCTION) 200.00 14. BOROUGH OF SHIPPENSBURG (UTILITY) 412.46 15. AUSHERMAN BROTHERS (APPRAISAL) 300.00 TOTAL (Also enter on line 10, Recapitulation) I ; (If rtwre space is needed, Insert eddilanal sheets of the same size) ' Continuation of REV-1500 Inheritance Tax Return Resident Decedent JEREMIAH S. ZOOK Decedent's Name Page 1 21 09 0947 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, ~ Liens ITEM NUMBER DESCRIPTION AMOUNT 16. GARY GATES (TRANSPORTATION TO SELL ESTATE PROPERTY) 25.00 17. HARRY KILLIAN (REAL ESTATE TAX) 391.59 18. CAM MUTUAL AID (INSURANCE) 196.56 19. CENTRAL PENN GAS (UTILITY) 186.18 20. REAL ESTATE TAX PRO-RATION ON ZOOK LANE 29.10 21. SETTLEMENT FEE FRO ZOOK LANE 20.00 22. REALTY TRANSFER TAX ON ZOOK LANE 1,200.00 23. EMBARQ 117.79 24. LUTHERAN HOME HOSPICE 2,970.00 25. ELMER FISHER (SALE ITEMS) 50.00 26. CAM MUTUAL AID 196.56 SUBTOTALSCHEDULEI 5,382.78 GRANDTOTALSCHEDULEI S 69,124.34 REV-1513 EX+(4W1 ' SCHE©ULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER .IFRFMIAH S 7nOK 21 09 0947 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Irldude ou ht sppoousal distributions, and transfers under Sec. 9116 (a~ (1.2)J 1. SYLVIA BEILER Lineal 534 CARMARGO 1/8 QUARRYVILLE, PA 17566 2. GIDEON ZOOK Lineal 25 ZOOK LANE 1/8 NEWBURG, PA 17240 3. CHRISTIAN ZOOK Lineal 425 ENOLA ROAD 1/8 NEWBURG, PA 17240 4. MARY SMOKER Lineal 30 LESHER ROAD 1/8 NEWBURG, PA 17240 5. ABNER ZOOK Lineal 99 ZOOK LANE 1/8 NEWBURG, PA 17240 6. RUEBEN ZOOK Lineal 30 ZOOK LANE 1/8 NEWBURG, PA 17240 7. IVAN ZOOK Lineal 85 ZOOK LANE 1/8 NEWBURG, PA 17240 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II, NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ; (Ii more space is needetl, insert atlditional sheets of the same size) ' Continuation of REV-1500 Inheritance Tax Return Resident Decedent JEREMIAH S. ZOOK 21 09 0947 Decedent's Name Page 2 File Number Schedule J -Beneficiaries -1 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. DAVID ZOOK Lineal 5141 PETERS ROAD 1/8 KINZERS, PA 17535 OMB Approval No. 2502-0265 e.,d,~ ~' II~ IIINi'= A. Settlement Statement (HUD-1) ~,....~ 1. ^FHA 2. ^RHS 3. ^/ Caty. Unint. 6. Fla Nudx. 7. lean Number. 8. abrgepe imumu Caw NumDx: 4. ^VA 5. ^Conv. Ins. M526114 2085005938 C. Nola: 7Nabrm b bxnehed b pM you a atebmenl olachd sswnnenl uoa4. Ammmis peb b and by file wxlement spent art clpwn. Items maked YD.o.c )'wart paid ouube tlrt tloeiq: art1' are 911oem Ilala br e1p11Me0nY pxpsseb eM art not allllldetl p tlrt btNC. D. Nate d Addess of awmwer. E NNN d Atldleae of Ssbr F. Nana d Address of tinder. JOSEPH L. KING ESTATE OF JEREMIAH S. ZOOK NORTHWEST SAVINGS BANK 310 STATE ROUTE 897E ~ ZOOK LANE 100 LIBERTY STREET NEVJMANSTOWN, PA 17073 NEWBURG, PA 17240 WARREN, PA 18385 G.PmpMylnatlon: H. SaebmenlMent MADISON SETTLEMENT SERVICES 1.5axNmem Dab ~ D'sburseniem Dale 80 ZDOK LANE B IRVINE ROW, CARLISLE, PA 17013 71812010 / 718/2010 NEWBURG,PA 17240 (CUMBERLAND) (717243-2121 (11-01-0495-021, HOPEWELL TOWNSHIP) Place a6e11bmenC H. ANTHONY ADAMS, ESQUIRE 49 W. ORANGE STREET 100.GrmMaudDw'.Frameonower '.. 400'Cyoes/ViapMDw1'oBalNr __ ~ 10t.Conlradsab6 '. 5120,000. 401:'Cantrectaelea:. ~ 5120,000,00 102. Perstxal P .. OD2-Petsaal 103. Sa1tlemmtC idBorroxer (Bne 1400) 57,848. 403.. ~~.~ _. 104. 404- 105. 405:.., Ad uaNrnh torlWrs aNlx In advance Ad forgmn sdley in advance 106. C axes 406. C'.. ftwve taxes 107. Ctxm t~ces 7188010 to 17/3112010 ~ 5326.B6/Vear 5157.61 407. Coumy taxes71812010 to17/3112010 QS326:B61Ywr 5757.81 108. Arsessnlenb 408. ASeessmxMS , 109. 409• ;.. 110. 410. 111. 41C'.. 112. 4t2... 120.GroaAmoadOwFromBOrrower 5126,005. 4T0•GrossMwuMDuaToSSNx-- 5720,151.61 7DO. Atnlwde Pald Gr In Be1raNO4Bonower 500: Raduedoevln Ampuot Duo To BeINr 201. a Eantest 501. Fxmas seeOtsOtx:tlOtre 202. Prhtdpal em0um d new kxn. 584,000. 502:.Setllement es.tu-SeBx One 140D .. 51.270.50 203. a lakxtw b 503. loans lderts to 204. Fee Credo from NarOremt Sevi Bank 550. 504: q flab load 205. 505.. Paydfdaemld mor~agel0an 208. 506:, 207. 507. 208. 508:. 209. 509. .. Ad forNxnsanpaM ae0x Atl '7orgemuun eNlx '. 210.C Sawn tares 510:, 211. faxes - 511: C0u taxes ~.... 212. Asttesamertb 512. Asseasmama `° 213. ShcOOI Tax 7111201010 7/812010 51,517.5611'ear 529.1 513. Schod Tax7/112010 to 7/8/2010 51,577.SfarYeer 529.10 214 514 215. 515. 216. 516. 217. 517. 218. 518.- 219. 519. , 220. TOW Paid Byffot Botrovwr 584,079.7 520. TOW Radudlon AmountDw SNNr 57,299.80 300..Cash At Bdllamant FroMTo Bomoteer BOO. Cash At BdtlxrrdTolFrom6NMr... 301. Gross Anqum Due From Bortounsr '120 5128,005.87 601. Gross Amount-0ue To Seller IIne420 S72D,157.81 302 Lest Amamts Pall aearawar ne 220 584,079.10 602Less DeotrcOOn:IOAmL DDB TO SNIOP Iona 520) E7,299.60 303.Cuh ^/From ^TO Borrower 513,926.77 fi03.CMh QTo ;; ^From SNlx 5118,858.01 Previous edlOore era tphsdde Page i d 4 O7PoB/2010 10:32 AM HUD-1 . Tottl foal EtfMS BrakM Fus DMsbndCommiasion ne 700 es /allows:. e )~ ~.. ~ =~~.: 791. r kr Fmll~y e4~' ,~..{~ xti. 702. - i ~~ ~~a. ." ,~~°. 703.Commisabn etSeltlarleM 701. 600.IfanN. ,.... ., ., ..1(.YY~{Aen:&a»,; ~+, ..a~'*.. r, ..s +::.r.. .,, ~~u~ 4ts"r„ 7b '.,-'wa. ~. a k f?..a^.7 ,a .~, u.,..k~'it ~, r :~-: w~ y. eot. our Inatlon 61,870.00 (rrom GFE u1) 802. Your tredtl ar brtlre Irltares[rate dreaen SL260 00:' ~. (ham GFE rig 803. Your usled. Bretlorc '' l kan GFE A ~ 53,13D.00 801. Fee m.NOrtlaaeM ~ Servioas han GFE #3... BOS:CreMtRepdrttoCBClmnNS ((ranGFE#3).. 13.50 806. Tax service loLerela Loan Prdecbr :. from GF.E ip f80.D0 807. flooO Certlflatlon m NarBnvest Sad Bank. f?CICB 57.50 from GFE 1K1 900.Ibna i.rNWwTa& PaW ln'llilvan ~ ~~,, ~," ~.., ~. ",x...• . s~', ~.x ~2 . Y.' . " .".hwe'Yc ~ "' ` N~~y ~ 901. Del Inleresi from 71872010b8N2010 70.7 IofJOAhwest SaN. s:Bank 'from GFE ri10 5258.96 902. ImurarxePreMum "from GFE 03 903: Naneawrlera lnsuance.. r tram GFE'#11 1000. Reaarree~ Frrndec6((,".ti,??z,*,~ i '=7~"Wru--+p;.'.. .: ; ~C9~a:_?.`~, !. ~.. ~ ~. ~, ~ ., +. : ,~e. 1001. Initlal for.escrow accaurd - 'tram GFE:89' 51,824.92 1002 Fidrneowrlers lnaunnce, PDCB 5375.00 1003: Inserance. mon0is.. yar~nlonM 1004. faxes6.00;montK SS27:24 rnmtliti63:44' 1005. School lac 14.00 molrtlre 5426.48 manlh~ 1,770M. ustmeM 5108. 100 7. y,, y ~y~ /~ 1d00rTMN V 44 :. lYYi "1{,'r' fN C K4 { h&' yA`TV Yf, .1 e ~L/ t1L1YFL b i ,:+SaK.Y`: ~ . 1101. Title services eM lenders title ir~aurance inxrc GFE q4 5986.66 1102. tialtlement ar doel tee lof4adkonSettlemenl Servkss 5117.00 '. 520.00 1103, Ovniers Welnaurarrcero ~ -':(fnan GFE #5)' 5198.00 1104: Candela title Ireurrae ro 5614.88 1105. Lenders tole Ilntlt ...584,000.00.. . 1108.Owners Btle. Bm8>..512Dp00.00 . 1107. s dBreWdtltlekswsrae'. WrnbMedbarSetllemenlSerdoas X5860:95 1708. Urderwdtera dtlle lafel,tltlelmurNlCe IumtoOdd Regrbtlc.Natlonel TitleInsurance Campmly.S151.93. 1108. CPL to Ob k.Natlonal 7HIe Insurance ~ f75.00 1200.aowmmaot+ -:YIdT ~ I yi:~.tk. ~r ._'~':,v~YZ,.. rairE,taw .C`:atl~~a<.". ~(r; N _~'r'' ~ _»yi.:.; 1201. Ga/emrnrrf 9om GFE .5166.00 ~ ~ 550.50 1202. Deed 562.00 5104.00 Releases; 1203. Tmmfer.ffixes from GFE 11B 51,200.00 51,200.00 1204.C !C taxlslamps ". Deed 51,200.00 $.:. 1205: Stale taxlsfam .Dead 51,200.00,:. e S 1208. Release d b CurMedeM: Cou RemNer d Deeds 550.50 1700.' . ~.., ~ XNy: {~k~xiv 'ii" ~PR,S~'a!'•,k ,, , ,~# r, ~.~ °vF"%°;~ c ...~ 1301. R uin0 aavkes that crl s for hom GFE#8 1302 Su 1303. Pest I 57,84828 51,270,50 Previous edillana are obsolete Page 2 d 4 07A)81201010:32 AM HUD-1 I Iwe u~+lad mkxee me MU61 Settlement SmlemeMmle b tlk neetM my krax>Be~ am neum n k bus ane eocurek etel8menlol a1 nampts ane ennurseinenk mesa on mya®unt a by ire b Ihk trancaceon. I M1atl~eroBltlee iMl I IIeVe receiree 9 Ny' WNB HU67 $BItlB1110n1 Stmelnent. BUYERS S,EfLJy~ER~S/ _,,,~ T kYIGL~' ~" ~p7 ~.~-r~1 ~ tea., 2~m~ JOS PHPN LAG GIDEON ZOOK EXECUTOR CHRISTIAN ZOOK FJ~CIJIOR Tna HUGi SenNnaM StWmenl WYCh sew pmprM k e true Yb eoaew eaouM Mtle imroaceon. I lmre c&aee a I wtl pwe tlM hxie8 b ne enwmee b etlnMBnm Wm bk 8tmement ~j~p~~nt,AgM ~~N, y~(AI` ~~ Prwioua etlidOna are g060181e Page 4 d 4 07/OS/201010:32 AM HUD-1 WQ'PZyENippyp OMB Approval No. 2502-0265 * * = a. Settlement Statement (HUD-1) =O ~WZ `~B~a oEVe`p o ThorpsFmra.com The Public Reporting Burden for this eolleWon of Infortnetlon is estimated at 35 minutes per response for collecting, reviewing, entl reporting the data. This agency may not collet this informaton, and you are not required to complete this forth, unless k displays a curroMly valid OMB control number. No confidentlality Is assured; this distlosure is mandatory. This is designed to provide the parties to a RESPA covered transeGlon wtth information dudng the settlement process. 700. Total Rrral Eslata Broltx Few St 32,000.00 ~ % Divkdon M Commbalon lire 700) as fo0ows: 701. t0 702. to 703. Commission paid at Setllen»M 7.920.00 704. 800. Items Payable In Connsedon whh Loan 801. Our origination dwrge (from GFE # 1) 802. Your uedk or eha (points for the specific interest rate chosen (from OFE # 2) 803. Your ad'usted o ' inatbn charges (from GFE A) 5 0.00 804. Appraisal fee to: from GFE # 3 805. Credk Report to: (from GFE # 3) 806. Tax service to: (from GFE # 3) 807. Food certification to: (from GFE # 3) BOB. 809. 810. 811. 812. 813. 814. 900. Itarrra Wrod Lander t0 Ba Paid in Advance 901. Dairy interest t0 ~ per da (from GFE # 10) 902. Mortg Insurance promium for. months to (from GFE # 3) S 0.00 903. Homeowners Insurance for re to (fran GFE # 71) S 0.00 904. 905. 1t1ta. txsxrvas os Ifsd with LenMr 1001. Inkbl deposk Mr your escrow acwuM (from GFE # 9) S D.00 1002. Homeowners inwrencs months S per month S 0.00 t 003. Mo Insurance months S rmoMh S 0.00 1004. Property taxes months S per month 5 0.00 1005. School taxes mon8ts S per month E 0.00 1006. months ~ S per month S 0.00 1007, ant Ad ustment enter as a five 1008. 77oo. 71w Ctmrgu 1101. Title servkas and bndars tkb insurance to: (from GFE # 4) 11 Oz. SettbmeM or cbsirp fee to: 1103. Owners 8tle insurance (hen GFE # 5) 1104. Lenders tkb insurence to: 1105. Lenders tkle I' Isnk 1108. owners tkb link 1107. Agent's portbn of the total Otle Irisurence premium 1108. Undervrtkers den of the total titb insurance premium 1709. AbstraWdtle search fee to: 1710. Attorneys fee to: H. Anthon Adams, Esquire 1111. 1112. 1200. Gowrranant Raeordi and Transfer Cha 1201. Government recadi cha to: (from GFE # 7) S 62.00 1202. Deed (NO a Rebeses 1203. Transfer taxes to: (from GFE # 8) 57,320.00 51,320.00 1204. CkyfCoun tax/atmnps Deed Mortgage 1205. State taxlstamps Deed Mo a e 1206. 1207. 1208. 7300. Adaroonat SsttlamaM charges 1301. Required asrviou that u un aho for (from GFE # 8 1302. Ed Chambertin 1303. Reeses 1304. 1305. 1306. 1307. 1308. 51,382.00 510,332.39 CERTIFICATION I have carefully reviawecf the HU0.1 Settlement Statement and to the beat of my knoa7edge and belie k is a true and acpurate smtement of all receipts and diaburse~n m~M or by me in this trenseraion. I further oer5y that I have receiv d a copy of the H `U0.1 Settlement Statement ~d~o Seller Borrower -~~ ~" n Zook s II Seller Borrower Chris' n Zook, Eexc Janet F.KI e To the best q my knowledge the HU0.1 SeBbrrent Statement which I have prepared b true and axurete aaount of the funds which were received and have bean of will be a ed M the undereigned as part of the sehbment of this trensedion.( e,. - Settbment Agent ~' l , ~ ~CF I Date hony Adams. Esquire ~" WARNING: It is a crkrce to knowingy make false statements to the United States on this or any other ainller form. Penakies upon conviction pn inGude a fine and inprisonment For details see: Tale 18 U.S. Cotle Section 1001 and Section 1010. m lhwpsFamr.wm LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, JEREMIAH S. ZOOK, of Pennsylvania being of sound .and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament hereby revoking all prior wills and codicils by me at any time heretofore made. FIRST: I direct the payment of all my .legal debts, funeral expenses including my grave marker and all expenses of my last illness, state, federal estate and inheritance taxes and administration costs shall be paid as soon as may be conveniently done following my decease leaving all specific bequests free of tax to the legatee. SECOND: I give, devise and bequeath all my property, be it real, mixed or personal to my children Gideon Zook, Christian Zook, Mary Smoker, Abner Zook, David Zook, Reuben Zook, Ivan Zook and Sylvia Beiler in equal shares, share and share alike, per stirpes. THIRD: I nominate and appoint my sons, Gideon Zook and Christian Zook as the Executors. of this my Last Will and Testament and to serve without the requirement of bond of any nature or knid. IN WITNESS WHEREOF, I, JEREML4H S. ZOO^K, to this my Last Will and Testament set my hand and official seal, this J `" 'day of 2008. -r..cjG EAL) miah S. Zook Sworn to and subscribed, declared and Published by Jeremiah S. Zook, as His Last Will and Testament, and so Done in the presence of we the Witnesses, who sign at his request, And in his presence and in the presence Of each other. COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND I, Jeremiah S. Zook, whose name is signed to the foregoing instrument, having been duly qualified acxording to law, do hereby acknowledge that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. miah S. Zook Swom to and acknowledged, before me; _ _ _ . BY Jeremiah S. Zook, a Testator, This .~~' day of 2008. oot~o o sYtvnx~a, H AnU~o~ry~ Cpl CgnrN~MOn E~1-e~ NMY 31.0 Notary Public ~~ ~ . COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we saw the Testator sign and execute the instrument as his Last. wll and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing. and sight of the Testatrix signed the Will as witnesses, and that to the best of our knowledge and belief the Testator was at the time at least eighteen (113) or more years of age and of sound mind and under no constraint or undue influence. Sworn to and subscribed before me by, Darlene M. Bigler and Sharon Coleman Adams, The witnesses, this S'~" day of V~~- .(~ 2008. cot~oxwa ~rH a xsrcv Noquim s~a~ __My_~ea!!!+~~ ~aY st. 2010 __ _ Notary Public