HomeMy WebLinkAbout10-13-10I 1505610140
REV-1500 EX (01-10)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 0 0 0 4 8
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 8 3 5 4 8 7 3 9 0 1 0 2 2 0 1 0 1 0 0 7 1 9 7 1
Decedent's Last Name Suffix Decedent's Firs t Name MI
K E L L E R C H R I S T I N E A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
^X 1. Original Return
4. Limited Estate
QX 6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WIITH THE
REGISTER OF WILLS
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
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)
State ZIP Code
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone (Number
R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3
First line of address
6 0 W E S T
Second line of address
City or Post Office
C A R L I S L E
Correspondent's a-mail address:
3. Remainder Return (date of death
prior to 12-13-•82)
5. Federal Estate' Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tai: under Sec. 9113(A)
(Attach Sch. O)
REGISTER 01r'WILLS USE O LY ~
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, Corr ct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNAT OF P ON RESPONSIBLE FOR FILI G RETU N D TE /
ADDRESS
393 BOBCAT ROAD NEWVILLE PA. 17241
SIGNATURE. PF~PARER OTH THANC~NTATIVE DATE
nnnR cc Y
60 WEST POMF~ET STREET
CARLISLE
PA. 1,7013
PLEASE USE ORIGINAL FORM ONLY
1505610140
P O M F R E T S T R E E T
Side 1
15056101L10 J
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1505610240
REV-1500 EX
Decedent's Social ;ie curity Num ber
Decedent's Name: CHRISTINE A• KELLER 1 8 3 5 4 8 7 3 9
RECAPITULATION
1. Real Estate (Schedule A
...........................................
1. 2 6 9 8 1 6. 4 0
2. Stocks and Bonds (Schedule B) ...................................... 2. •
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. •
4. Mortgages and Notes Receivable (Schedule D) .. . ....... . . .............. 4. •
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... , . , 5. 3 3 5 1 7 • 3 1
6. Jointly Owned Property (Schedule 1=) ^ Separate Billing Requested ....... 6. •
7. Inter-Vivos Transfers 8 Miscellaneous N n-Probate Property
(Schedule G) ~ Separate Billing Requested ....... 7.
8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 3 0 3 3 3 3 . 7 1
9. Funeral Expenses and Administrative Costs (Schedule H) ......... ....... .. 9. 2 2 1 8 5 . 0 4
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... ....... .. 10. 1 4 7 8 2 3 . 2 0
11. Total Deductions (total Lines 9 and 10) ...................... ....... .. 11. 1 7 0 0 0 8. 2 4
12. Net Value of Estate (Line 8 minus Line 11) ................... ....... .. 12. 1 3 3 ~ 2 5 . 4 7
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............. ....... .. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ............. ....... .. 14. 1 3 3 3 2 5 . 4 7
TAX CALCULATION -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 .0 0 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 1 3 3 3 2 5. 4 7 16. 5 9 9 9. 6 5
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 ~ 0 0 18. 0. 0 0
19. TAX DUE ............................................. ....... .. 19. 5 9 9 9. 6 5
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610240 1505610240
REV-1500 EX Page 3
Dececl'ent's Complete Address:
File Number
21 10 0048
DECEDENT'S NAME
CHRISTINE A. KELLER
STREET ADDRESS - - ---- --- -----
67 N. MOUNTAIN ROAD
CITY
NEVWILLE STATE
PA ZIP
17241
Tax Payments and Credits:
~. Tax Due (Page 2, Line 19) (1) 5,999.65
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits (A + B) (2) 0.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5, 999.65
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPF',IATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred : ...................................................................... ^ Q
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q
c. retain a reversionary interest; or ................................................................................................ ^ 0
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 within one year of death
without receiving adequate consideration? ....................................................................................... ^ Q
3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? ......... ^ Q
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? .................................................................................................. ^ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requiremeints for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, excef-t as noted in
72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, undE
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX+ (01-10)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
CHRISTINE A. KELLER 21 10 0048
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts,
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER
DESCRIPTION OF DEATH
1. 67 N. MOUNTAIN ROAD, NEWVILLE, PENNSYLVANIA 223,700.40
$177,540 X CLR 1.26 = $223,700.40
2. 370 CACTUS HILL ROAD, CARLISLE, PENNSYLVANIA 46,116.00
$36,600 X CLR 1.26 = 46,116.00
TOTAL (Also enter on Line 1, Recapitulation.) u $ 269,816.40
If more space is needed, use additional sheets of paper of the same size.
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CHRISTINE A. KELLER 21 10 0048
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. SOVEREIGN BANK -CHECKING ACCOUNT #1671018052 1,614.82
2. SOVEREIGN BANK -SAVINGS ACCOUNT #1674009897 2,662.49
3 PERSONAL PROPERTY -APPRAISAL ATTACHED 29,240.00
TOTAL (Also enter on line 5, Recapitulation) I $ 33, 517.31
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
Attorney Fees: IRWIN & McKNIGHT, P.C.
Family Exemption: (If decedents address is not the same as claimant's, attach explanation.)
Claimant
ESTATE OF FILE NUMBER
CHRISTINE A. KELLER 21 10 0048
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. EGGER FUNERAL HOME, INC. 7,855.00
B
2.
3.
4
5.
6.
7.
8.
9.
10
11
12
13
14
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
13,000.00
Street Address
City State ZIP
Relationship of Claimant to Decedent
Probate Fees: REGISTER OF WILLS
Accountant Fees:
Tax Return Preparer Fees: PATRICIA A. ROSENDALE
INCOME TAX & FIDUCIARY TAX RETURNS
REGISTER OF WILLS -FILING FEE -INHERITANCE TAX RETURN
REGISTER OF WILLS -SHORT CERTIFICATES
CUMBERLAND LAW JOURNAL -ESTATE NOTICE
SOVEREIGN BANK -DATE OF DEATH VALUATION FEE
NOTARY FEES
REGISTER OF WILLS -FILING FEE -QUALIFIED DISCLAIMER
THE SENTINEL -ESTATE NOTICE
RECORDER OF DEEDS -RECORD DEEDS (2)
315.50
510.00
30.00
36.00
75.00
20.00
25.00
5.00
187.54
126.00
TOTAL (Also enter on Line 9, Recapitulation) $ 22,185.04
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
CHRISTINE A. KELLER 21 10 0048
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. SOVEREIGN BANK -MORTGAGE PAYOFF - 67 NORTH MOUNTAIN RD, NEWVILLE 115,244.02
2. CAPITAL ONE #00568111398388 -CREDIT CARD 546.26
3. WEST SHORE EMS -AMBULANCE 1,140.21
4. CAPITAL ONE FINANCE -OUTSTANDING LOAN #568111398388 6,000.00
5. TOYOTA FINANCIAL SERVICES ACCOUNT #027 6391533 -OUTSTANDING LOAN 24,892.71
TOTAL (Also enter on Line 10, Recapitulation) $
147,823.20
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
CHRISTI NE A. KELLER 21 10 0048
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. KATHRYN KELLER Lineal 133,325.47
393 BOBCAT ROAD REMAINDER
NEWVILLE, PA 17241
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1, A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
It more space is needed, use additional sheets of paper of the same size.
~. t
LAST WILL AND TESTAMENT
I, CHRISTINA A. KELLER, of Upper Frankford Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament, hereby expressly revoking all Wills
and Codicils heretofore made by me.
1. I direct my Executrix to pay all of my debts, funeral and administrative expenses as
soon as maybe done conveniently after my decease.
2. I authorize and empower my Executrix to sell any realty owned by me at my death
and not specifically devised herein at either public or private sale, and to give good a~r~d sufficient
deeds therefor, in fee simple, as I could do if living.
3. I give, devise and bequeath all of my estate of every nature and wherever situate as
follows:
(a) All money and/or checking and savings accounts, etc. to my
mother, KATHRYN M. KELLER, and if she is not living, to TODD
A. KOCH; and
(b) All the rest, residue and remainder including all real
estate to TODD A. KOCH.
1
.~ . ti
.: ~,
4. I nominate and appoint KATHRYN M. KELLER to be the Executrix of this my Last
Will and Testament; she is to serve as such without bond. Should she die before my death,
renounce or refuse to serve for any reason, or die leaving any of my estate unadnunistered, I
nominate and appoint TODD A. KOCH as substitute Executor, also to serve as such without
bond and with the same powers as are given herein to my Executrix.
5. I hereby suggest that my personal representative retain the services of Irwin,
McKnight & Hughes as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this , F~ ~' day of
April, 2003.
/~~
~~~~~!2~~%~ " G /(~ SEAL
~ ~
CHRISTINA A. KELLER
Signed, sealed, published and declared by CHRISTINA A. KELLER, the Testatrix
above-named, as and for her Last Will and Testament, in the presence of us, who, at her request,
in her presence and in the presence of each other have subscribed our names as witnesses hereto.
2
r ~
0
ACKNOWLEDGMENT .AND AFFIDAVIT
WE, CHRISTINA A. KELLER, JACQUELINE L. DRAWBAUGH and SHARON
L. SCHWALM, the Testatrix and witnesses respectively, whose names are signed to the
foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that
the Testatrix signed and executed the instrument as her Last Will and Testament, that she had
signed willingly, that she executed it as her free and voluntary act for the purpose herein
expressed, and that each of the witnesses, in the presence and hearing of the Testatrix;, signed
the Wi11 as a witness and that to the best of their knowledge the Testatrix was, at that time,
eighteen years of age or older, of sound mind and under no constraint or undue influence.
CHRIS INA A. LER
JA UEL L. DRAWBAUG
~!~~~' -/ice ~~'~ `~ f~~~t..~
SHARON L. SCHWALM
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by CHRISTINA A. KELLER, the
Testatrix herein, and subscribed and sworn to before me by JACQUELINE L.
DRAWBAUGH and SHARON L. SCHWALM, witnesses, this ~~ ~ day of April, 2003.
~S . C.-C~,--
N~talr_y Public
'Notarial Seal
Roger B. Irwin, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Oct. 3, 2004
Member, Pennsylvania Association of Notaries
TaxDB Result Details
.rage i ui
DistrictNo 43
Parcel ID 43-04-0387-075.
MapSuffix
HouseNo 67
Direction
Street NORTH MOUNTAIN ROAD
Ownerl KELLER, CHRISTINA A
C/O
PropType R
PropDesc
LivArea 2174
CurLandVal 27150
CurImpVal 150390
CurTotVal 177540
CurPrefVal
Acreage 1.83
C1GrnStat
TaxEx 1
SaleAmt 135000
SaleMo 04
SaleDa 07
SaleCe 20
SaleYr 03
DeedBlcPage 00256-02142
YearBlt 2003
HF File Date 02/28/2005
HF Approval_Status A
Detailed Results for Parcel 43-04-0387-075. in the 2004 Tax Assessment Database
77 ~'~/~ w
3U ~o+~
httn://taxdb.ccpa.net/details.asp?id=43-04-0387-075.&dbselect=l 2/4/2010
TaxDB Result Details
Page 1 of 1
Detailed Results for Parce129-15-1245-016. in the 2004 Tax Assessment Database
DistrictNo 29
Parcel ID 29-15-1245-016.
MapSuffix
HouseNo 370
Direction
Street CACTUS HILL ROAD
Ownerl KELLER, CHRISTINA
C/O
PropType RS
PropDesc
LivArea 576
CurLandVal 15000
CurImpVal 21600
CurTotVal 36600
CurPrefVal
Acreage .27
C1GrnStat
TaxEx 1
SaleAmt 27000
SaleMo 02
SaleDa OS
SaleCe 20
SaleYr 07
DeedBkPage 00278-03439
YearBlt 1933
HF File Date 11/09/2004
HF Approval_Status T
http://taxdb.ccpa.net/details.asp?id=29-15-1245-016.&dbselect=l 9/1/2010
~~ ~~~;- Soverei n
~~ g
MA1 MB3 02-10
Court Ordered Processing/Decedent
P.O. Box 841005
Boston, MA 02284 i ~E~ ~ ~ ~ ~~ E~~
9R~11~ ~ f~cKNiuF~ ~i
~~ CFF~CES
February 1, 2010
Attn: Roger B. Irwin
Law Offices
Irwin & McKnight, P.C.
60 West Pomfret Street
Carlisle, PA 17013-3222
RE: Estate of Christina A. Keller
Date of Death: January 02, 2010
Dear Roger B. Irwin:
Per your request, enclosed please find account information as of the date of deathh for the
above-named decedent. For your information, accrued interest in not included in. the date
of death balance.
Please feel free to contact me if I can be of any further assistance.
Ve truly yours,
---- /;
~ ~-
Nicole Job
COP Specialist III
Decedent Department
(617) 533-1364
Sovereign Bank
ESTATE OF Christina A. Keller
SOCIAL SECURITY #: 183-54-8739
DATE OF DEATH: January 2, 2010
Account #: 1671018052 Type: Checking Open date: _ 4/25/2003
In the name of: Christina A Keller
Date of Death Balance: $1,614.82
Int.(YTD) from 1/1/2010 to 1/2/2010 $0.00
Accrued interest to date of death: $0.00
Other Info: Account closed on O1/15/10 - $2,018.00.
Account #: 1674009897 Type: Savings Open date: _ 5/20/2004
In the name of: Christina A Keller
Date of Death Balance: $2,662.49
Int.(YTD) from 1 / 1 /2010 to 1 /2/2010
Accrued interest to date of death: $0.00
Other Info: Account closed on Ol/15/10 - $2,662.49.
$0.00
Page 1 of 1
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****** Payoff Stafie m e n t*****
Date: February 4, 2070
Loan Number' 0356110432
Primary Borrower's Name: Chrlstlna A Keller Estate
Property Address: 67 NORTH MOUNTAIN ROAD
NEWVILLE, PA 17241
Quote sent to: Irwin and McKnight, P.C.
Fax: 717-24g-6354
's*~"Payoff Calculations'k***
Principal Balance ~ 115'13'1.46
Interest calculated to 01102/10 $ 37.08
Accumulated Late Charge Balance ~ 0
Life/AH [nsur~nce Calculated to $ 0
Escrowllmpound Advance Balance $ 1755.69
Fax Fee and other fees as applicable $ 25.00
Recording Fees $ 50.80
Prepayment Penalty Fee $ 0
Grant PayofF (if applicable) $ 0
Less Unapplied Funds $ 0
TOTAL REQUIRED TO PAYOFF LQAN ~115Z44.02
PM1/FHA to be deducted from escrow balance $0
Payoff quote prepared by: Teller 366
For questions related to this payoff quote please call us at 1-B00-232-5200
Page 1 of 2
****Rayaff Statement pisclosure****
Attached you will find the requested payoff yuvle. Every eifurt has keen made to ensure accuracy ire this c.~iculation. In the
event a calculation error, derirai error, or ai~~i53ivri t;rror has been rnac~e, notice of adjustments will be directed to the
borrnwcr or 3cttlement agent. tf the payatf of tl re ludn does not oct;t,r within 5 days of the requested payoff date a rcviaod
quote will need to be requested. Due tp the requested Dayoff, if taxcas nr insurance premiums ar® duce, Sovereign Bank
maylmay not pay these items.
Interest for the peyroff is due up to the date the furuls are received in this offux. Net Diem intarast must be added a3
apptirable. Please ensure that payments are kept current until the ~-ayoff funds are received In our office to avoid late
charges. Funds received that are not sufficient lu tray the Loan In futi will he returned to the sender and inierost on the
loan will continue 1o accrue. Certified fur~rls ur wired funds area the prefcmed method of payoff. If non certified funds are
u~cd for payoff, the loan will not be cu=~~iclered paid to full rmtil checks present®d are cleared by the ;zssociotmd leading
institution. Checks must be made payable to Sovereign Bank. Checks returned due to inEUfficicrtt fund3 ere subject to a
$30.00 fee in addition to interest due until replacement fortis hAVe been received,
. Failure tnproyide writt n n ic-o reaardino the diseontinu~ancaof automatic aaymanta wi11 resuit.in a
~1 fee if a.paymenl draft needs to b®® rem .
Please enetose a copy of page one of thi3 3tetement, r^efieotinq the pdyv(F calculation, along with the payoff tunds.
Payment shouts! Eye mailed to the fnllvwin9 address.
Mail payments to: Wire payments to:
Sovereign Bank Sovereign Bank
Mail Codc # 10-X21-MPZ Wyomissing. Na
460 Pcnn Street ARA # 231372691
Rcading~ ('A 19Q02 Acct # t)o20-19'E500
Credit: Mortgage Acct #____ Acct Name _
~~'Payott funds must be received by x:00 p,rn. for credit on tine same day.'*""
To contact Mortgage Servicing /Phone # 1.800-232-500 !pax # 1-88833-8779 ! GMaii
"mot'tserv~a soverefignbank.c:om"
This tacsintilr ia~intsnded ier the exclusive use of the above reforenacd recipient, and may oonteir~ legally privileged and
contid6rltid ir~fvrmatlon_ tf .ynu are not the intended recipient of.thi~ facsimile, you are hereby natifieci that any dlssem~ation,
distribution, or copy~c't9 of this facsimile is strictly prohibited. If you receive this facsimile in error; please notify us immediately
by tslephane,
Please provide the borrower's new mailing address io inEUre post-payoff items era sent to the correct acidness;
TO BE IUSED~oNLY IF A CHANGE OF aoDRESS is APPi_t~agi.E: (Pt_~ASE PRINT LEt~IS~.Y~
Scrrowcr Name
Mortgage Loan Number
Bomow+er's New Address
CityfState/Zip
QUALIFIED DISCLAIMER
In accordance with Internal Revenue Code Section 2518 (b) and pursuant to Section 6201
of the Pennsylvania Probate Estate and Fiduciaries Code, (20 PA.C.S.A. Section 6201), this
Qualified Disclaimer is being executed by the undersigned beneficiary, TODD A-. KOCH, in
order to disclaim in whole all of his interest in the ESTATE OF CHRISTINA A. I~LLER:
The undersigned, as one of the beneficiaries in the above-referenced Estate is hereby
disclaiming his interest in the estate in favor of the Decedent's mother, KATHRYN M.
KELLER, as evidenced by the undersigned's execution hereof.
~a~
This disclauner is executed as of this day of February, 2010, the same being
effective as of the date of death of the decedent, Christina A. Keller on January 2, 2010.
WITNESS:
~ ,~j _ G~`---- ~ c SEAL ~
( )~
TODD A. KOCH ~. ~> ~ __r~ _;=?
COMMONWEALTH OF PENNSYLVANIA . ; ~-, . ;~ ~ i:,
COUNTY OFCUMBERLAND
On this, the ~ ~" day of February, 2010, before me, the undersigned officer,
personally appeared Todd A. Koch, known to me (or satisfactorily proven) to ~be the person
whose name is subscribed to the within instrument, and acknowledged that he executed the same
for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
:~
i
' (SEAL)
Not Pu lic
~p~IMONw'EA_L.T!-! Or- ~E1~~1~Yt-VANtA
Karon ~. r!c~'., Pdot~ry Public
Ca~iisle Sorg. ~%'~+~b~'1and County
~ ~; ~ ~ F ~r~s D°c. 8.2011
CUmmi~..l-~. -XP
Member, Pennsylvania ~assac~a:ion °' Notaries
PHILLIPS AND COHEN ASSOCIATES, LTD.
1002 JUSTISON ST
WILMINGTON, DE 19801
PH (800) 477-6441 EXT 2125 OR EXT 2205
Office Hours: M - Th: 8am - 9pm; Fri.: Sam - 6pm; Sat: Sam - 12pm
APRIL, 1, 2010
THE ESTATE OF KELLER, CHRISTINA A
67 N MOUNTAIN RD
NEWVILLE, PA 17241
Our Client: CAPITAL ONE FINANCE
Original Acct.# 568111398388
Our File#: 16981143
Orig:Bal: $7,439.40
Settlement: $6,000.00
To Whom It May Concern:
Pursuant to our telephone conversation on APRIL, 1, 2010 Phillips and Cohen
Associates, Ltd. has been retained to serve as authorized representatives for CAPITAL
ONE FINANCE.
Effective immediately, Phillips and Cohen Associates has been authorized to ;accept
$6,000.00 as payment in full on the above referenced account.
Upon receipt of $6,000.00 The Estate will be released from any further obligation to
CAPITAL ONE FINANCE regarding the above referenced account.
PAYMENT TO. BE CONSUMMATED AS FOLLOWS:
$6,000.00 CHECK BY PHONE OR OVERNIGHT MAIL TO BE RECEIVED l3Y
PHILLIPS AND COHEN ASSOCIATES AT THE ABOVE ADDRESS ON OR.
BEFORE APRIL 8, 2010.UPON COMPLETITION OFrTHE PAYMENT THERE WILL
BE NO FURTHER OBLIGATION REGARDING THE ESTATE OF KELLER,
CHRISTINA A.
Thank you for your prompt attention to this matter.
~.., Sin ly,
l ~ 6 i
B j am n Brown Probate Manager
Phillips & Cohen Associates, L1:d.
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