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HomeMy WebLinkAbout10-11-101505610143 REV-1500 Ex (°'-'°' PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes oEFannerrtoFnEVExuE County Code Year File Number Po Box.zsosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 10 0685 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 206 14 1416 06 24 2010 10 05 1924 Decedent's Last Name Suffix Decedent's First Name DUNK MI COURTLAND E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 0 1. Original Return ^ 2. Supplemental Retum ^ 3. Remainder Return (date of death ^ 4. Limited Estate ^ prior to 12-13-82) qa Future Interest Compromise F ^ 5 . (date of death after 12-12-82) ederal Estate Tax Return Required g, Decedent Died Testate (Attach Copy of Will) ^ ~ Decedeat Maintained a Living Trust 0 (A ttach copy of T n,st) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ C p Y 10• b9lweeriP2 31 9'1 audit (datge5~fdeath ^ 11.Election to tax under Sec. 9113(A) T (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD B N ame 6~DIRECTED TO: Da time Tele Y p~T4ne Number- '`? WM D SCHRACK III ESQ _ 717 432 ,~'33 ~ . ? ~- : - ~~ ~, REGISTER OF 1MLL'-SiUSE ®tVLY First line of address ~ ~~ -t-' -' i 124 W HARRISBURG STREET ._ + ~ , _ :=-+ Second line of address . ~ ? ~~> ~_ ~ -; , c_ City or Post Office State ZIP Code DATE FILED DILLSBURG PA 17019 Correspondent's a-mail address: Schracklaw@comcast.net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIeLF FnR Fu wr. wFn iau ~' ' ~ 1 J~--C.J~ L- Elizabeth D. Kerr Q ~~, ~p~~ ADDRE 136 Millers Ga Road Enola PA 17025 SIGNATURE OF PRE OTHER T N REPRESENTATIVE DATE Wm. D. Schrack Esq. lot ADDRESS 124 W. Harrisburg Street, Dillsburg, PA 17019 Side 1 15D5610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: i~unn, Courtland E. 206 14 1416 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 202 , 750.00 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages i£ Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank De osits & Miscellaneous Personal Pro e p p rty (Schedule E) ............... 5. 5 , 930.11 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous N,on-Probate Property (Schedule G) u Separate Billing Requested............ 7, 8,7 902.95 , 8. Total Gross Assets (total Lines 1-7) ..................................................................... g, 296 , 583.06 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 2 7 , 67 9.12 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 145 , 348.44 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 17 3 , 0 2 7 . 5 6 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 123 , 555.50 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, 123 , 555.50 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. 0.00 16. Amount of Line 14 taxable 123 555.50 at lineal rate X .045 r 1s. 5 560.00 r 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 0 18. 0. 0 0 19. Tax Due .................................................................................................................. 19. 5 , 560.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-10-0685 DECEDENT'S NAME Dunn, Courtland E. STREET ADDRESS 5 Redbud Drive CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 10,000.00 278.00 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 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. Make Check Payable to: REGISTER OF WILLS, AGENT. (3) (4) (5) 5,560.00 10,278.00 4,718.00 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 :............................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................. ^ 0 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? .................................................................................................................... ^ ^x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. (1) Total Credits (A + B) (2) Rev-1502 EX+~11-06) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Dunn, Courtland E. 21-10-0685 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorshipmust be disclosed on schedule F. Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) (If more space is needed, additional pages of the same size) Rev-1508 EX+(6-98) SCHEDULE E CASH, BANK DEPOSITS, 8r, MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dunn, Courtland E. 21-10-0685 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on schedule F ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Members 1st Federal Credit Union -Checking Account #55015-11 305.70 2 Members 1st Federal Credit Union -Savings Account #55015-00 1,145.74 3 Household contents 2,885.00 4 Costs reimbursed to Estate on sale of real estate (see lines 407, 408, 409 of HUD-1 settlemen 1,593.67 sheet) TOTAL (Also enter on Line 5, Recapitulation) I 5,930.11 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+(6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF - (FILE NUMBER Dunn, Courtland E. 21-10-0685 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATENI~ ROANSFERSATTACNTA COPY OF THE DEIED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Prime Capital Services, Inc. -Jackson National Life 87,902.95 87,902.95 Insurance Company Annuity (see attached) TOTAL (Also enter on Line 7, Recapitulation) I 87,902.95 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (10.06) COM INONEEWRREAgqLTjtOFgqP~EN~T~RLVANIA RESIDEN DECED N NN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Dunn, Courtland E. 21-10-0685 ___._ _. _..~............a..~a va..~.Mv.aca. vn v~.ncaau~c ~. ITEM DESCRIPTION N M AMOUNT A, FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Year(sl Commission oaid Zip 4,839.24 2. Attorney's Fees Wm. D. Schrack III, Esquire 5,000.00 3. Family Exemption: (If 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 437.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 17,402.38 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 27,679.12 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Dunn, Courtland E. 21-10-0685 ITEM NUMBER DESCRIPTION AMOUNT Funeral Exoenses 1 Beth Seng -funeral luncheon catering 837.00 2 Father Alling -clergy honorarium 150.00 3 Jesse H. Geigle Funeral Home 3,702.24 4 Robert Lau -organist honorarium 150.00 H-A 4,839.24 5 Other Administrative Costs Bent Creek Homeowners' Association fees -July and August 2010 362.00 6 Charges to Estate on sale of property (see lines 1113, 1114, 1115, 1116, 1118, 1203, 1303, 4,304.95 1304 on HUD-1 settlement sheet) 7 Clerk of Orphans' Court -Fiduciary Release 1•iling fee 20.00 8 Costs to prepare home for sale: A C Rimmer (heating/cooling system repairs) 452.00 9 Costs to prepare home for sale: Cindy Mueller (cleaning property prior to sale) 100.00 10 Costs to prepare home for sale: Courtland E. Dunn Jr. (reimbursement for "For Sale by 31.75 Owner" sign) 11 Costs to prepare home for sale: Culligan (repair water purification system) 153.00 12 Costs to prepare home for sale: Greg Carol, Painting Contractor (repaint home) 5,500.00 13 Costs to prepare home for sale: Home Depot (paint and materials) 50.87 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Dunn, Courtland E. 21-10-0685 ITEM NUMBER DESCRIPTION AMOUNT 14 Costs to prepare home for sale: Penske Truck Leasing (leasing truck to move furnishings 288.98 from home to storage facility) 15 Costs to prepare home for sale: Triangle CW Storage (storage for furniture removed from 288.98 home as a condition to sale of property) 16 Costs to prepare home for sale: The Virtus Group (radon mitigation) 885.00 17 Costs to prepare home for sale: Yale Electric (replacement chandelier) 125.28 18 County of Cumberland -retirement check reimbursement 939.47 19 Cumberland Law Journal -estate advertisement 75.00 20 Debra Bashore Wiest, Tax Collector - County/Township real estate taxes 712.00 21 Innovative Carpets -replacement carpeting at property prior to listing for sale 2,300.00 22 Members 1st Federal Credit Union -payment on line of credit 189.88 23 Miscellaneous expenses during period of administration (phone, postage, copies, etc.) 25.00 24 Orrstown Bank -bank fees 124.75 25 Pennsylvania American Water Company -water service to residence during administration 65.84 26 Register of Wills -additional Short Certificates 24.00 27 Register of Wills -Inheritance Tax Return filing fee 15.00 28 Silver Spring Township -sewer charges 116.08 29 The Patriot News Company -estate advertisement 134.31 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Dunn, Courtland E. _ 21-10-0685 ITEM NUMBER DESCRIPTION AMOUNT 30 Verizon -telephone expenses 118.24 H-B7 17,402.38 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+~12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dunn, Courtland E. 21-10-0685 Repoli debts incurred by the decedent prior to death that romained unpaid at the date of death, including unrolmburoed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Alert Pharmacy -prescriptions costs 337.10 2 Beth Seng -debt of decedent for spouse's funeral luncheon of May 26, 2010 850.00 3 Bishop McNutt -debt of decedent for clergy honorarium at spouse's funeral on May 26, 2010 150.00 4 Church Publishing Company -debt of decedent 38.63 5 CitiMortgage -August mortgage payment 1,272.18 6 CitiMortgage -Mortgage payoff shown on line 504 of HUD-1 settlement sheet 100,651.49 7 Father David -debt of decedent for clergy honorarium at spouse's funeral on May 26, 2010 150.00 8 HealthSouth -uncovered medical expense 16.00 9 Homeinstead Senior Care - in-home care for spouse, Virginia Dunn, who died on May 26, 473.82 2010 10 Hospital telephone charge 32.00 11 Jesse H. Geigle Funeral Home -debt of decedent for spouse's funeral of May 26, 2010 5,021.87 12 Members 1st Federal Credit Union -Loan Account #55015-01 (personal service 2,556.06 loan/contractual pledge of shares) 13 Members 1st Federal Credit Union -Loan Account #55015-05 (home equity line of 28,404.97 credit/contractual pledge of shares/collateral secured by 5 Redbud Drive, Mechanicsburg PA 17050) 14 Members 1st Federal Credit Union -VISA account #4833660000010369 5,129.56 15 Robert Lau -debt of decedent for organist honorarium at spouse's funeral on May 26, 2010 150.00 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 10, Recapitulation) 145,348.44 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-7500 Schedule I (Rev. 12-08) Rev-1512 EX+ (6-98) scHe~u~e ~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF I FILE NUMBER Dunn, Courtland E. 21-10-0685 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (11-08) SCHEDULE J COM IN~~wIE,~AALNT DECEDNN$YRINVANIA BENEFICIARIES ESTATE OF FILE NUMBER Dunn, Courtland E. ~ 21-10-06 85 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal ~ distributions, and transfers under Sec. 9116 a 1.2 Courtland Dunn Jr. Child 595 Coatesville Road West Grove, PA 19390 Steven Dunn Child 821 Fairfield Road Pittsburgh, PA 15237 Elizabeth D. Kerr Child 136 Millers Gap Road Enola, PA 17025 Total Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. 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 5HEE11 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) ~~c~t ~i11 ~rc~ (~1P~t~cYrtQrct OF COURTLAND E, DUNN I, COURTLAND E. DUNN, of Fairview Township, York County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare the following to be my Last Will and Testament, hereby revoking and making void, any and all wills, codicils and testamentary dispositions by me at any time heretofore made. ITEM I~ I direct tYiat all m~ just debts and. _`uneras. c?SZpPngec __ _ _ ~e _ _ .. ____ .._.,..., u~., 1 a ~x ~---~._. ~.._! ~ i'1ti ~.~i~A ~~~ i7~mei~ d;~ ~~G_z u conveniently may be done after my decease. ITEM II: In the event that my wife and I should die as the result of a common disaster so that it is impossible to determine who predeceased the other, it shall be presumed that I predeceased my wife. ITEM III: All the rest, residue and remainder of my estate, real, personal and mixed, I give, devise and bequeath unto my wife, Virginia D. Dunn, if she survives me. ITEM IV: In the event my said wife, Virginia D. Dunn,. shall ~:, not survive me, I give, devise and bequeath my said estate, real, personal and mixed, to my children, Courtland Dunn, Jr., Steven Dunnl and Elizabeth Dunn, to be divided into three equal shares. ITEM V: I hereby nominate, .constitute and appoint my wife, Virginia D. Dunn, Executrix of tl%3s my Last Will and Testament, however, if she shall not survive me as aforesaid, I hereby nominate, constitute and appoint all my children, Courtland Dunn, Jr., Steven Dunn and Elizabeth Dunn, as Executors of this my Last Will and Testament, to serve without bond. IN WITNESS WHEREOF, I, COURTLAND E. DUNN, have hereunto set my hand and seal this $T ~ .day of ~ 1989. ~_ Courtland E. Dunn 5.~gneC~ =2:~ _ .'•.A~i~L~ `}~~r_ ~it~i C~L'~~ t 3i°~ ,1 ~~.- ~t -•V `-' i1.rt11 COURTLAND E. DUNN, asMand for his Last Will and Testament, in the a presence of us, the subscribing witnesses, who at his instance and request and in his presence and in the presence of each other have hereunto set our hands the day and year aforesaid. Address OMB NO. 2502-0265 A. B. TYPE OF LOAN: DEPARTMENT OF HOUSING & URBAN DEVELOPMENT U S 1.QFHA 2.~FmHA 3. QCONV. UNINS. 4. ~VA 5. QCONV. INS. . . SETTLEMENT STATEMENT 6. FILE NUMBER: o2-so3.oo1 7. LOAN NUMBER: 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked (POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3/98 (GOODRICH.SHELDON.PFDl02.603.001/9) D. NAME AND ADDRESS OF BUYER: Sheldon G. Goodrich Living Trust 5 Redbud Drive Mechanicsburg, PA 17050 E. NAME AND ADDRESS OF SELLER: Elizabeth D. Kerr Executrix of the Estate of Courtland E. Dunn J F. NAME AND ADDRESS OF LENDER: G. PROPERTY LOCATION: 5 Redbud Drive Mechanicsburg, PA 17050 H. SETTLEMENT AGENT: 25-1857112 Midstate Abstract Company I. SETTLEMENT DATE: September 23 2010 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 2331 Market Street Camp Hill, PA 17011 , - - J. SUMMARY OF BUYER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BUYER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 202 750.00 _ 401. Contract Sales Price 202,750. 0 0 _ 102. Personal Pro a __ 402. Personal Pro e _ . _ - 103. Settlement Char es to Bu er Line 1400 4,800.88 403. 104. 404. -- 105. 405. - - -_ Ad'ustments For Items Paid 8 Seller in advance _- - - Ad'ustments For Items Paid 8 Seller in advance 106. Cit /Town Taxes to 406. Cit /Town Taxes to _ 107. Coun Taxes 09/23/10 to 01!01/11 177.33 -- - 407. Count Taxes 09/23/10 to 01/01/11 - _- 177.33 108. School Taxes 09/23/10 to 07/01/11 1,368.07 _ _ 408. School Taxes 09/23/10 to 07/01/11 _ __ -- 1, 368.07 109. Se t. Condo Fees 09/23/10 to 10/01/10 48.27 409. Sept. Condo Fees 09/23/10 to 10/01/10 __ 48.27 110. 410: 111. 411. - - 112. ~ 412. ~ 120. GROSS. AMOUNT DUE FROM BUYER 209,144.55 1 420. GROSS AMOUNT DUE TO SELLER 204,343.67 200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: (500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De osit or earnest mone 5,000.00 ~ 501. Excess Deposit (See Instructions) ~ 202. Princi al Amount of New Loans _ _ 502. Settlement Charges to Seller (Line 1400) _ ~ 4,304.95 203. Existin loans taken sub'ect to 503. Existin loans taken sub'ect to 204. 504. Payoff of first Mortgage to CitiMortgage -- 100,651.49 205. 505. Pa off of second Mort a e to Members 1st FCU 28,642.21 - 206. 506. _ _ -__- 207. _ 507. De osit disb. as roceeds _ 208. 508. 209. --- 509. ---- _ Ad'ustments For Items Un aid B Seller Ad'usfinents For Items Un aid 8 Seller 210. Ci /Town Taxes to _ 510. Cit /Town Taxes to - ---- 211. Coun Taxes to _ 511. Coun Taxes to 212. School Taxes to 512. School Taxes to 213. 513. -- - 214. -- 514. - - -- 215. 515. - - -- 216. __ 516. _ 217. 517. - 218. 518. --- _ - 219. 519. __ 220. TOTAL PAID BY/FOR BUYER 5,000.00 - -- - _ 520. TOTAL REDUCTION AMOUNT DUE SELLER - _ _- 133,598.65 300. CASH AT SETTLEMENT FROMITO BUYER: -- - _ - - - 600. CASH AT SETTLEMENT TOIFROM SELLER: 301. Gross Amount Due From Bu er Line 120 209,144.55 _ 601. Gross Amount Due To Seller Line 420 204,343.67 302. Less Amount Paid By/For Buyer (Line 220) ( 5,000.00) 602. Less Reductions Due Seller (Line 520) ( 133,598.65 303. CASH (X FROM) ( TO) BUYER 204,144.55 603. CASH (X TO) ( FROM) SELLER - ------ ~ 70,745.02 The undersigned hereby ackn wled ~e-r-~e(ceipt of a completed copy of pages 182 of this statement 8 any attachments referred to herein. Buyer Seller ~~ ~ ~~ L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ % PAID FROM PAID FROM Division of Commission Tine 7~0 aS FOIIOWS: BUYER'S SELLER'S 701. $ IO FUNDS AT FUNDS AT 702.$ t0 SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 704. to 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee % to 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806. Mort a e Ins. A .Fee to 807. Assumption Fee to 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to @ $ /day ( days %) 902. MIP Totlns. for LifeOfLoan for months to 903. Hazard Insurance Premium for 1.0 ears to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months $ er month 1002. Mort a e Insurance months $ er month 1003. Cit /Town Taxes months $ er month 1004. Coun Taxes months $ er month 1005. School Taxes months @ $ per month 1006. months $ er month 1007. months @ $ per month 1008. months $ er month 1100. TITLE CHARGES 1101. Settlement or Closin Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Electronic Document Pre to 1106. Closin Service Letter to 1107. Attorney's Fees to Reager & Adler, PC 718.00 includes above item numbers: 1108. Title Insurance to MIDSTATE ABSTRACT Reissue 1 236.38 includes above item numbers1102, 1103 & 1104 1109. Lender's Coverage $ 1110. Owner's Coverage $ 202,750.00 1,236.38 1111. 1112. Notary Fee 11 3. Notary Fee 1114. Overnight Fees & Handling 1115. September Condo Fees 1116. Sewer Fee to Sept. 23 to to to to to Midstate Abstract Company. Midstate Abstract Company Midstate Abstract Company BCCHCA Silver Spring Township Authority 5.00 5.00 30.00 181.00 124.42 1117. Capital Improvement Fee 1118. Resale Certificate to to BCCHCA PMI, Inc. 750.00 150.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 64.00; Mortgage $ Releases $ 1202. Ci /Coun Tax/Stam s: Deed 2,027.50 Mort a e 64.00 2,027.50 1203. State Tax/Stam s: Deed 2,027.50; Mort a e 2,027.50 1204.. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve to 1302. Pest Ins ection to 1303. Tax Certification to Debra B. Wiest, Tax Collector 10.00 1304. 2010-11 School taxes to Debra. B. Wiest, Tax Collector 1,777.03 1305. 1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103, Section J and 502, Section K 4,800.88 4,304.95 By signing page 1 of this statement, the signatories acknowletlge receipt ar a wmpletetl copy or page z or mis env puye sieienieni. Midstate Ab ct Company ,~t~~ ~ ,tc.. -~- merit ent ~--'r' Certified to be a true copy. ~LE~. ~ ~/ `` L ~~ St MEMBERS 1St FEDERAL CREDIT UNION PRIMARY OWNER: SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established LOAN ACCOUNT: Account Number/Suffix Date Loan Established Principal Balance at Date of Death Loan Type Interest Rate Name of Co-Borrower Virginia Dunn 55015-00 09/28/1979 $1,145.55 $.19 $1,145.74 Courtland Dunn 09/28/1979 55015-11 09/15/1983 $305.70 ',`=,%'/\ $.00 $305.70 Courtland Dunn 09/15/1983 55015-01* 04/04/1998 $2,556.06 Personal Service Loan/Contractual Pledge of Shares 11.00% Courtland Dunn *Loan does not have life coverage. LOAN ACCOUNT: Account Number/Suffix 55015-05* Date Loan Established 03/26/2008 Principal Balance at Date of Death $28,404.97 Loan Type Home Equity Line of Credit/Contractual Pledge of Shares Collateral Secured 5 Redbud Drive, Mechanicsburg, PA 17050 Interest Rate 4.00% Name of Co-Borrower Courtland Dunn *Loan does not have life coverage. VISA ACCOUNT: Account Number/Suffix 483366000001-0369 Date Account Established 08!30/2005 Principal Balance at Date of Death $5,129.56 Joint Cardholder Courtland Dunn *Contractual Pledge of Shares. M BERS 1~s~T F~~D~ERQAL CREDIT IO'Nn Danielle A. Kline Lending Insurance Support Specialist July 23, 2010 Estate of: COURTLAND DUNN Date of Death: 06/24/2010 Social Security Number: 206-14-1416 M ij ~,y~v~~ 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org HOUSEHOLD INVENTORY COURTLAND E DUNN S REDBUD DRIVE MECHANICSB URG, PA LIVING ROOM 1 Couch :~ 7~D0 1 Loveseat ~6 , d0 2 Chairs J~.00 4 End Tables / ~~. DD 4 Pictures ~• ~~ 2 Table Lamps ~~ • DD 1 Floor Lamp /Jr. ~~ DINING ROOM 1 Dining Room Table 8 Chairs 2 Storage Hutches 1 Corner Desk Misc China HITCHEN 4 Bar Stools Dishes Pots/Pans Utensils ~ Misc Kitchenware z~. ~6d .OD /7.00 9~'~0 /DD.~ ~Q, DO ~~DD ~5'oa 7.~~a ,,, PATIO ROOM ~ 2 Chairs / ~Q , ~ 1 CD PlayerlRadio 7.~pd 1 TV S;DO 1 TV Stand ~ 06 1 Floor Lamp ?S' Q G 1 Storage Chest 700 BEDROOM 1 ~QD ~ 1 Full Size Bed Frame • 1 Full Size MattressBox Spring ~~. 0~ 2 Dressers X60. ~ 1 Mirror 2.5.0 D 1 Desk ~ 7~Od 1 Nightstand .3~ 00 2 Chairs SQ . 00 1 Bookshelf _.3Q, 00 BEDROOM 2 /ZS~.~ 2 Twin Size Bed Frames 2 Twin Size MattressBed Spring /Old • d~ 1 Nightstand • DD 1 Dresser SOD 1 Mirror Z~: (.~0 1 Bookshelf ~~ , p~ INVENTORY TOTAL ~ ~ g' ~j~ OC) o ~ O ~ rnm O N N O v o ~ 0 V A ~b ~~ m b ~ m o ~ .~ ~~ ~~ ~ ~ cn G_ O' O rn w oa 0 ~_ w a ~a % Q A O ~. A a 7 3 n O~ A h n ti b n M~ l J y ao $~ e e ~'mZ~1~a~.i kJ ~, m O C B O A yy/ C ~~f d Q m~ R A ^' Y 'q'1 l J w~~ A m 2~° Q a B y ~ ~ °o c °e e ~ ~ °e A A o~ ~y a_ o_ ~ m 3 m a ~] 1 C 1 .~. m~ A p~ y~j A_ 0 A~ 000 m~ /CO A y e w ~" m ~aA A ~ = o ~ _ ° a ,ems m ~ -m a a f0 ~ n 0 y n t" ~ C ~ ~~ z y &9 EA 10 O O fA t0 O O O 10 O O O v0 O O N ~. 0 n Hs ~~0. o- 5;~ cc o~ ~~ A a. &9 O O N m~~ d 6 p~ n ~ ~ eOme p a~ Lr ~ .y n 3 m~ °e a e e w~~ lll~„ O n n m `< C x w W~ n d `x 6 ~y m ~ b r ~v~ePeaae~eag~t N O A A R O~ A C O d ~ A O 1 N p ~ 9 w~ m~ C ~~ ~ ~°rsm~` ay~~ m9 ~ m o c e o 0 o m a z~ .~ O fe0 ~ A 4~~ ~y n ID C .. - r/~ y o m A Cd ~. ~ ~ eo ~ ~,i ~ a z '~ ~~a z ~~~ ~ ~, ay,~, ~ '~ V] b .t.. ~ ~, . c C ~ r" a ~, ~ *~ a. CAl'7 ~' ~ En ~ `::, ~ N E!iRGSi! ~~ i:; V O p ~, , ;,.! ~~ -• o W ~ Vv ~'` a~. O: ~o °o m °° ~a a m m N N N O N N O CT v+ .-~ En b9 b9 ~ b9 N O O 69 fA FA ~ A O O O O O W ~ O O 00 O O N Ov v d 7 3 ~ m n y ~ ~ ~ o ~ m _ ~ ~ m c~~ m o S °ia d ~v ~ ~ o 3 ~K ~ d ~.N ~ yy F p 0i 0. 7 0 N ~ a j O N~ O d O O ~ O y N C N ~, 0) ~ N °-' ~ z o a = `~y N gj 7 0 ~ (!~ C rr: m• .~. ~ > > ~ W N ~ Yr 3o-ado.N3T a ~ ~ ~ ~ ~ ' n o~ n~ a~ a ~-'~ u7i ~ m m m ~ o~3~~N~o °o o~~~ m c N 3 b 0 O' QC)o ap_ ~ °``„~o v7i30 m ~ ~ m n ~ ~ T n n o Q m ~ d G N n~ 3 ~ ~ a o ~ e o j ~ O on ~~ ~. a a•e b 0 C O do N (O O N (O CO N V Vt O m CO m o b Ad ~n 3m m~ 1 ~ A ~ E. m e~ fJ9 A N N D) 4A N O f0 (O (O ~`rS ~~ ~~~ lJL~ 'C ib FC ~~ a n ~ O tf 3 ~ p me ~ ~ <D ~ . W v~ ~ Zo o zm N ~ o w ~ N ~ V O V O o~ w 0 N O 0 n D -i D m n m St MEMBERS 1St FEDERAL CREDIT UNION PRIMARY OWNER: SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established LOAN ACCOUNT: Account Number/Suffix Date Loan Established Principal Balance at Date of Death Loan Type Interest Rate Name of Co-Borrower Virginia Dunn 55015-00 09/28/1979 $1,145.55 $.19 $1,145.74 Courtland Dunn 09/28/1979 55015-11 09/15/1983 $305.70 $.00 $305.70 Courtland Dunn 09/15/1983 55015-01* 04/04/1998 $2,556.06 Personal Service Loan/Contractual Pledge of Shares 11.00% Courtland Dunn *Loan does not have life coverage. ACCOUNT: Account a ffix 55015-05* Date Loan Established 03/26/2008 Principal Balance at Date of Death 7 Loan Type 't Line of Credit/Contractual Pledge of Shares Collateral Secured 5 Redbud Drive, icsburg, PA 17050 Interest 4.00% e of Co-Borrower Courtland Dunn *Loan does not have life coverage. VISA ACCOUNT: Account Number/Suffix 4833660000010369 Date Account Established 08/30/2005 Principal Balance at Date of Death $5,129.56 Joint Cardholder Courtland Dunn *Contractual Pledge of Shares. OAyD~~ o~' ~~ S'Now~V a~ ~I~E 5D5 ~'~ NUD / S`CN~U~ ~' M BER/S 1sT F DERAL CREDIT ION Danielle A. Kline Lending Insurance Support Specialist July 23, 2010 Estate of: COURTLAND DUNN Date of Death: 06/24/2010 Social Security Number: 206-14-1416 // ~~ ~~~u~ 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org LAW OFFICE OF WM. D. SCHRACK III 124 WEST HARRISBURG STREET POST OFFICE BOX 310 DILLSBURG, PA 17019-0310 Telephone 717-432-9733 October 12, 2010 "1'elefax 717-432-1053 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Courtland E. Dunn D/D: June 24, 2010 File #: 21-2010-00685 Dear Register: ~., c7 °`' - c~ ~ ~ ' ',-- ~ -,; c~ -_ n ~ _ - -i _, --; ::_; ~, , .- - ~:. ~~, _ -~ ~~, T _. _~, , ,-; o ~. c~ You will find enclosed herewith the original and one copy of the REV-1500 form filed on behalf of the Executors of the above-noted estate. This submission is accompanied by a copy ol~ the front page of the Return, as well as my trust account check for the sum of $15.00, covering the cost of processing the Return. Please accept the Return as filed, and return atime-stamped receipt, along with the copy of the. front. page of the Return, to me in the envelope provided. Thank you for your attention to this request. Sincerely, .Sc accIII WDS/jct enc. N W IO m I ; W lid ~~~~ .-~ O N 0 0 o_rn_ O O N ~