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HomeMy WebLinkAbout11-24-10' 1505610140 REV-1500 EX (°'~'°' PA Department of Revenue Bureau of Individual Taxes Coun Code Year ry File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 0 0 3 0 0 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Deat h MMDDYYYY Date of Birth MMDDYYYY 1 8 6 2 4 7 5 5 5 0 2 2 5 2 0 1 0 0 5 1 7 1 9 3 1 Decedent's Last Name Suffix Decedent's Firs t Name MI L O V E G L O R I A J (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 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number D A V I D H S T O N E ~ E S Q U I R E 7 1 7 7 7 4 7 4r-~ 5 - , ~_-~, _ ,_ _~.., ___ REGISTER OF~AIt ~ USE ON~,rY ,: , ~ c.~: s "~ First line of address ~ °'~ ~? ! 4 1 4 B R I D G E S T R E E T ~ '~ ~ .~. ~ -,~„~ , Second line of address ' `~~ : ~`~' :: - City or Post Office State ZIP Code DATE FILED --~.~ ~' ' N E W C U M B E R L A N D P A 1 7 0 7 0 Correspondent's a-mail address: D S T O N E a S T O N E L A W• N E T 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. SIGNAT E OF PE ON RESP NSIBL OR FILING RETURN DATE i ..... . ~., ~~,AD ESS 51,9 ET S E T NEW CUMBERLAND PA 1,7070 SI ATUR F PR AR TH TNAN REPRESENTATIVE ATE /~ ~2~ --r A SS 414 BRIDGE _S_ EET NEW CUMBERLAND PA 1,7070 PLEASE USE ORIGINAL FORM ONLY 1505610140 Side 1 1505610140 J J 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: G L O R I A J• L O V E 1$ 6 2 4 ? 5 5 5 RECAPITULATION 1. Real Estate (Schedule A) ...... . .................................... 1. 4 2 0 0 0 • 0 0 Z. Stocks and Sonds (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. 1 D 0 $ 3 . 3 3 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. • 7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 5 2 0 $ 3 • =~ 3 9. Funeral Expenses and Administrative Costs (Schedule H) ........ ...... .... 9• 2 1 2 4 1 • 4 5 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ... ...... .... 10. 3 3 9 1 . 5 5 11. Total Deductions (total Lines 9 and 10) ..................... ...... .. . . 11. 2 4 6 3 3 . 0 0 12. Net Value of Estate (Line 8 minus Line 11) .................. ...... .... 12. 2 7 4 5 D . 2 3 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. 2 ? 4 5 0 • ~ 3 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 .o D 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at -ineal rate x• 0 4 5 2 7 4 5 0. 3 3 16, 1 2 3 5. 2 6 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. 1 2 3 5. 2 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 150561,0240 1,505610240 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 10 0300 DECEDENT'S NAME GLORIA J. LOVE STREET ADDRESS 714 MARKET STREET C{TY I STATE ', ZIP iNEW CUMBERLAND PA i 17070- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest (1) 1,235.26 Total Credits (A + B) (2) 0.00 (3) 0.00 (4) 0.00 (5) 1,235.26 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. 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 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 sha{{ use the property transferred or its income; ............................... ^ c. retain a reversionary interest; or ................................................................................................ 0 d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 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 "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? .................................................................................................. ^ 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)}, 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 applicab{e 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)J. 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 INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: GLORlA J. LOVE 21 10 0300 Ail 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 jointlyowned 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. VALIJE AT DATE NUMBER OF DEATH DESCRIPTION ~ Property located at 714 Market St New Cumberland Cumberland County, PA sold to I 42,000.00 Randall J. Tasker and Sharon M. Curl on November 18, 2010 TOTAL (Also enter on Line 1, Recapitulation.) I $ 42,000,00 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, Ot MASC. {NHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER GLORIA J. LOVE 21 10 0300 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VAUJE AT DATE NUMBER DESCRIPTION OF DEATH ~, M&T Bank-Checking Acct #1108360 92.72 Samuel Love predeceased wife on November 1, 2009 2 Metro Bank-Checking Acct #513205898 1,635.89 Samuel Love predeceased wife on November 1, 2009 3 Net proceeds of personal property sold at public auction by Chuck Bricker on 2,333.00 November 13, 2010 including the 1989 Crown Victorian Station Wagon 4 PA Dept of Revenue-PA40 State tax refund ~ 3.00 5 Penn Mutual-Uncashed check 56.01 6 Social Security check received 1,138.00 7 Nationwide Life Insurance-policy proceeds to estate 4,824.71 Beneficiary Samuel Love (deceased) and Contingent Benef Marie E. Frank (deceased) TOTAL (Also enter on line 5, Recapitulation) I S 10,083.33 (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 SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER GLORIA J. LOVE 21 10 0300 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: Linda Love-Reimbursement for funeral luncheon 293.00 Stone & Murray Funeral Home-funeral expenses 3,626.00 Mt Olivet Cemetery-services rendered 1,000.00 B. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. Attorney Fees: David H. Stone, Esquire 3, Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address City State ZlP 4 Relationship of Claimant to Decedent Probate Fees: Cumberland County SEE BELOW #2 5 Accountant Fees: 6. Tax Return Preparer Fees: 5,000.00 ~ Karl L. Stine-cleaning out property 145.28 2 Probate fees-reimbursement to Linda Love 262.50 3 Dog food for animals owned by decedent 40.00 4 Dog food for animals of decedent 40.00 5 Camp Hill Animal Hospital-services rend. on dogs 166.89 6 Chapman Oil-services at property 1,885.05 7 Reimb for adv in Sentinel & Cumb Law Journal 262.54 8 Reimb for death, birth and marriage cent 26.00 9 Strawser Towing-inspection of 1989 Crown Vict 427.48 10 Dog food for the animals of decedent 30.00 11 Norm Hess-mowing grass at property 25.00 12 Norm Haas-mowing grass at property 25.00 TOTAL (Also enter on Line 9, Recapitulation) __ _ ~ 21.241.45 If more space is needed, use additional sheets of paper of the same size Continuation of REV-1500 Inheritance Tax Return Resident Decedent GLORIA J. LOVE 21 10 0300 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses ~ Administrative Costs - B7. ITEM NUMBER DESCRIPTION ,4MOUNT 13 Norm Haas-mowing grass at property 40.00 14 Norm Haas-mowing grass at property 40.00 15 Norm Haas-mowing grass at property 25.00 16 Norm Haas-mowing grass at property 20.00 17 Norm Haas-mowing grass and cleanup at property 20.00 18 Norm Haas-mowing grass at property 25.00 19 Norm Haas-mowing grass at property 40.00 20 Selling costs ($6400.33) less reimb. (853.62) 5,546.71 21 PP&L Electric Utilities-services at property 1,000.00 22 PA American Water-services at property 1,000.00 23 Register of Wills-filing 1nh tax return & Inv 30.00 24 Closing expenses 200.00 SUBTOTAL SCHEDULE H-67 ~ 7,986.71 ftEV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER GLORIA J. LOVE _ 21 10 0300 _ Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ New Cumberland Boro-court costs on prop violation 119.75 2 New Cumberland Boro-water & sewer at property ~ 1,281.86 3 {Metro Bank-loan payoff 4 (Golden Living-nursing home services TOTAL (Also enter on Line 10, Recapitulation) I S If more space is needed, insert additional sheets of the same size. 959.14 1, 030.80 3.391.55 REV-1513 EX+ (01-1D) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: GLORIA J. LOVE 21 10 0300 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS {Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).J 1. Lf NDA L LOVE Daughter Linea 1 27,450.33 519 MARKET STREET NEW CUMBERLAND PA 17070- ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 1$ OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART ZI -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, $ If more space is needed, use additional sheets of paper of the same size. II ~' 'l ;~_. .t~%~ 'f ... ._~, >> ~. ..i - ! .; ~"t~3CkF i. .it C~'f.?1 - ~.~. „_I tel: t:f .~v ~; C7 Tax Parcel #: 26-24-0811-410. Address: 714 Market Street New Cumberland, PA 17070 DEED THIS INDENTURE made the 18th day of November, in the year 2010, between LINDA LOVE, Administratiix of the Estate of GLORIA J. LOVE;, late of the Borough of New Cumberland, County of Cumberland and Commonwealth of Pennsylvania, of the first part, hereinafter called the Grantor, - AND - RANDALL J. TASKER AND SHARON M. CURL, joint tenants with rights of survivorship, of the second part, hereinafter cared the Grantees; WHEREAS, the said GLORIA J. LOVE became in her lifetime seised, as of fee, ,~f and in to a certain tract of land, together with the imprr~vements thereon erected, situate in the Borough of New Cumberland, County of Cumberland, and Commonwealth of Pennsylvania., and more particularly described hereinafter; and being so thereof seised, died ors February 25, 2010, intestate; and Letters of Administration upon her estate have been duly issued by said Register of Wills on March 25, 2010 to said LINDA LOVE {File No. 21-2010-300) all as in arld by the records of said Register ~f Wills, recourse thereunto being had, appears: NOW THIS INDENTURE WITNESSETH, that the said Grantor, for and in consideration of the sum of FORTY TTn10 THOUSAND and NO/100 ($42, 000.00} Dollars, which has been paid to her by the said Grantees at or before -1- the sealing and delivery hereof, receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, released and confirmed, and by these presents does grant, bargain, sell, alien, release and confirm unto the said Grantees, ALL THAT CERTAIN piece or parcel of land situate in the Borc-ugh of New Cumberland, County of Cumberland and State of Pennsylvania, more particularly bounded and described as follows, to wit: BEING Lot No. 180 in the Plan known as Elkwood, said Plan being recorded in Cumberland County Recorder's Office in Deed Book "M", Vol. 5, Page 498. BEING bounded on the North by 8rh Street; on the East by Market .~rr_~eet; on the South by Lot lVo. 179, on said Plan and on the West: by a ten (10) feet wide alley, and having a frontage on Market Street of forty (40) feet and extending an even width one hundred (100) feet to said ten (10) feet wide alley. HAVING thereon erected a two (2) story frame single dwelling house, No. 714 Market Street, New Cumberland, Pennsylvania. BEING THE SAME PREMISES WHICH William F. Rittner and F'rancE~s M. Rittner, his wife and Mqrah E. Ro°,ae Rittner, widow, by their Deed elated July 18, 1957 and recorded July 23, 1957 in the Office of the Recorder of Deeds in and for the County of Cumberland, Pennsylvania, in Record Bcok Y-17-165, granted and conveyed unto Samuel Love and Glcria .J. Love, -2- his wife. Samuel Love died on November 1, 2009, thus by operation of law vesting title in Gloria J. Love, deceased. TO HAVE AND TO HOLD the said lot or piece of ground above described, with the buildings and improvements thereon erected, hereditaments and premises hereby granted or mentioned, and intended so to be, with the appurtenances unto the said Grantees, to and for the only proper use and behoof of the said Grantees, forever. And the said Grantor, for herself and her respective heirs, executors and administrators, does covenant, promise and agree t:o and with the said Grantees, their heirs and assigns, that she, the said Grantor, has not heretofore done or committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged, or encumbered in title, charge, estate or otherwise howsoever. IN WITNESS WHEREOF, the said Grantor has hereunto set her hand and seal the day and year first above written. (SEAL ) LINDA LOVE, Administratrix of the Estate of GLORIA J. LOVE - 3 -- COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF CUMBERLAND On this, the 18th day of November, 2010, before me a Notary Public, the undersigned officer, personally appeared LINDA LOVE, Administratrix of the Estate GLORIA J. LOVE, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I gave her to set my hand and notarial seal. COMMONWEALTH OF PENNSYLVANIA , „ , ,, , , . , NOTARfAI SEAL ~ N o t a ~~ y Pub t i c CAROL L. TROXELL, Notary PubNc New Cumberland Boro. Cumberland Co. My Commission Expires Oec. 27, 2013 . ~ . , I here certify that the pre ise address of the Grantee is DATE : ~f • /,~ ; j j . Attor era ` or -4- Q M~TSank 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone($SS)502-4349 Fax (302)934-2955 April 2, 2010 Stone LaFaver & Shekletski 414 Bridge Street PO Box E New Cumberland, PA 17070 Re: Estate of: Gloria J Love Social Security: 186-24-7555 Date of Death: February 25, 2010 Dear Sir or Madam: Per your inquiry, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: l . Type of Account Account Number Ownership (Names of} Opening Date Balance on Date of Death Accrued Interest Total Checking Account 1108360 Gloria J Love, joint-secondary Samuel Love, joint-primary 08/081'91 closed 0325/10 $ 92.72 $ 0.00 _. $ 92.72 Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact otil' Highland Park branch, 344 South 10th Street, Lemoyne, PA 17043 Call #717-737-3322. Sincerely, Norissa Sears, Adjustment Services ~ • ~ ~ 3801 Paxton Street Harrisburg • PA • 17111 mymetrobank.com 888.937.0004 March 31, 2010 Stone, LaFaver & Shetletski Attn: David Stone 414 Bridge St New Cumberland PA 17070 RE: Estate of: Gloria J. Love Tax Identification Number: 186-24-7555 Date of Death: February 25, 2010 To Whom It May Concern: This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Checking Account Number: 513205898 Date Opened: 06j22/2000 Primary Owner: Samuel Love Secondary Owner: Gloria J. Love Date of Death Balance: $1635.89 Please fee{ free to contact me at (717) 412-6127 if I may be of further assistance. Sincerely, •r-- Diana Reynolds Metro Bank Research Associate/Deposit Services loan hIUU•1 (3,H9) rel Handbook 4305.2 A. Settlement Statement B. Type of Loan U.S. Department of Housing and Urban Development OMB Aooroval No. 2502-0265 1. ^FHA ~ 2. []FmHA 3. QConv. Unins. 4. VA 5. Conv.lns. 6. File Number 31109TASKER 7. Loan Number 8. Mortgage Insurance Case Number is Is uma pws you a s en u s n pat a are s C. Note: Hems marked'(p o.c.)' wero paid outside the doeutn~qq they era shown hero for information purpose and are nil irtdudsd In the totals. WARNING: h n a crime to knowingly make lake stafemerm to the United SttNSe on thb or any shat similar form. PsneHla upon convict+on can include a line and ~m sanmeM, For dstarli see: rde to U. S. cod. Ssgbn toot and Section toto. T111eEXpress Settlement SyStern Printed 11/18/2010 at 14:46 CLT D. NAME OF BORROWER: Randall J. Tasker and Sharon M. Curl ADDRESS: 1000A Otto Drive Meehank:sbu Pa 17055 E. NAME OF SELLER: Estate of Gloria J. Love ADDRESS: 714 Market S New Cumberla Pa 17070 F. NAME OF LENDER: ADDRESS: G. PROPERTY ADDRESS: 714 Market Street, New Cumberland, PA 17070 New Cumberland Borou h H. SETTLEMENT AGENT: Cedar CiiH Abstract Agency, Inc., Telephone; 717-774.7435 Fax: 717.7743869 PLACE OF SETTLEMENT: 414 Brad s S New Cumberia PA 17070 I. SETTLEMENT GATE: 11/1812010 J. UMMARY F B RR WER' TRAN A TI N: K. SUMMARY OF ELLER` TRANSA TtON: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER t01. Contract sales rice 42 000.00 401. Contrail sales rice 4000.00 102. Personal Pr 402. Personal Pr 103. Settlement char to borrower line 1400 938.30 403. 104. 404. 105. 405. Ad'ustments for items id b seller in advance Ad ustments for items id b seller In advance 106. Ci /town taxes 406. Ci /town taxes t 07. Coon taxes 11/18110 to 12/31/10 88.94 407. Coun tax 11/18/10 to 12131/10 88.94 108. Scholl taxes 11 /18/10 to 06/30111 746.64 408. School tax 11 /18110 to 06/30111 746.64 109. 409. 110. Trash rtn 4th tr 11/18110 to 12/31110 18.04 410. Trash M 4th 11/18110 to 12!31/10 18.04 i t L 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 43 791.92 420. GROSS AMOUNT DUE TO SELLER 42 853.62 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. D ' a earnest mon 5000.00 501. Excess D it see instructions 202. Pri amount d new loans 502. Settlement char to seller line 1400 16 400.33 203. Existin I s taken sub'eil to 503. Existin loans taken sub'eil to ~• 504. Pa :400213021 959.14 Metro Bank 205. 505. 208. 508. 207. 507. 208. 5p8, 209. 509. Ad ustments for items un id b seller Ad ustmertts for Items un k! b seller 210. Ci /town taxes 510. C' rtown taxes 211. Coun taxes 511. Coun taxes 212. Scholl taxes 512. Scholl taxes 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218• 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 5000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 17359.47 300. CASH AT SETTLEMENT FROM OR TO BORR OWER 600. CASH AT SETTLEMENT TO OR FROM SELLE R 301. Gross amount due from borrower line 120 791.92 601. Gross amount due to sailer line 420 42 853.62 302. Less amounts 'd b !for borrower line 220 5000.00 602. Less reduction amount due seller line 520 17359.47 !303. CASH FROM BORROWER 38 791.92 603. CASH TO SELLER 25 494.15 5~G ~ f I G ~ ~~ Ov ~ - ~ LJ rrsd to qe r and R dstsrmirw thy tt h~ ,tq p~ ~nfsmal Rawnue Serviw. H you are regt,ired to fik a return, epwted The COnlroq Sales Pros daecnbed on tU npng ~ s tS ~ ~{c0. ~3 36r ~s3. a4 /ns ~ P~ ~' 9 s9 , y 3s, ~9~. + S 1 wrth your correct taxpayer identification number. a you do nil provide your correct taxpayW identification penalUM d perjury. i cerofy that the number afwwn on thie stafamern is my cores taxpayer tdentiication numtxr. SELLER(S) SIGNATURE(S): 7 _ (Fi) (Ur UUU, ~~ ~5, ~`1y .1~, Cwt U.S. DEPARTMENT OF I-{OUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT File Number: 31109TASKER PAGE 2 TitlaFvnrasc Swttlamant Svstam Printarf 11/1A/201t) at 14~4fi CLT L. SETTLEMENT CHARGES ~ PAID FROM PAID FROM 700. TGtAL SALESlBROKER'S COMMISSION based on rice $42 000.00 = 80RROWER'S SELLER`S Division of commission line 700 as follows: FUNDS AT FUNDS AT 701. t0 SETTLEMENT SETTLEMENT 702. to 703. Commission aid at Settlement 800. !TENS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori 'nation Fee 802. Loan Discount 803. sisal Fee 804. Credit R 805. Lender's Ins ion Fee 806. Mort ication Fee 807. Assum lion Fee 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to G /da 902. Mort Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo. ® /mo 1002. Mort Insurance mo. ~ /mo t 003. Ci P Tax mo. @ Imo 1004. Coup pr Tax mo. ® 62.92 /mo 1005. Scholl taxes mo. ~ 101.39 Imo 1009. A to sis Ad'ustment 0.00 0.00 1100. TITLE CHARGES 1101. Settlement or dosin fee 1102. Abstrad or title search 1103. Title examination t 104. Title insurance binder t 105. Document Pr anon t t 06. Nola Fees to Cash 10.00 t 107. Attom s fees indudes above items No: t 108. Title insurance to Cedar Cliff Abstract A Inc. 456.30 includes above items No: Re-Issue 1109. Lender's Pdi 1110. Owner's Poli 42 000.00 -456.30 1111. t t 12. Inheritan Tax Escrow to Cedar' CIHf Abstract A Irtc. 10000.00 t 113. Clean out house to Carl Stlne 500.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES t 201. Recordin Fees Deed 62.00 • Mort • Release 62.00 1202. Ci /Coun tax/stam Deed 20.00 • Mort 420.00 1203. State Taxistam Deed 20.00 • Mort 420.00 t 204. t 205. wire fee for off to Stone Lafaver ~ Shekietsld 20.00 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Fifin tee for Civil suit to New Cumberland Boro h 79.75 1302. Trash 4th r to New Cumberland Born h 38.60 1303. Tax Claim to Cumberland Cou Tart Claim Bur~u 788.04 t 304. 2010 Coun Tax-P to Robin Ga etd' 830.50 1305. 2010 Sd1od Tax-Penal to Robin G ' 1338.29 1306. Tax Cart Fee to Stone Lafaver dl Sheidetsld 10.00 1307, sewer t0~1ro9~6r3a10 to New Cumberland Boro h 241.36 1308. Trash t/1/10.9J30i10 co New Cumberland Boro h 125.79 I 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Sedion J and 502 Section 938.30 16400.33 HUO CERT~ICATION OF BUYER AND SELLER I have Carefuly reviewed the HUO.1 Settlement Statement Ind ro the Deet d my knOwlAflp~ end belief, K is a thN and rate slat a by me in this transaction. I further canify Mat 1 have received a caPY d Ute HUD•1 Settlement Stalemartt. receipu andd dsbursements~ on my 8r ( Estate d Gi J. ove `~ ~ ~- ~ ~~ . , _. V WARNItJG; IT IS A CRIME TO KNOWING FALSE STATEMENTS TO THE The HUD•1 Settlement Stet I have pr r is aca,rate aocaurtt d this UNITED STATES ON THIS OR ANY SI FORM. PENALTIES UPON CONVICTKNV transaction. I have wiM caws urtds t ds in aooordartoe with tMs statement. CAN INCLUDE A FINE AND IMPRISO .FOR OETAll3 SEE TITLE t8: 1 U. S. CODE SECTION 1001 AND SEC 1010. / SETTLEMENT AGENT: _ DATE:/. f ~J