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Home My WebLink About12-03-10. ~ 1,50561,0101, REV-1500 Ex~o~_~o, OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes DEiANTMENTOF F'VNuHERITANCE TAX RETURN , ~~~~~~ - ~~- ~ -- PO BOX 28o6oi t Harrisburg, PA i'J128-o601 RESIDENT DECEDENT ~~ ~ I `.~~" ~ 'J~-~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 178-16-5583 08/06/2010 ` 10/14/1923 __ -_ _ _ _ Decedent's Last Name Suffix Decedent's First Name MI GORNIK 'DOROTHY , M (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 Clio 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit {date of death O 11. Election to 1:ax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. rJ) CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ___ _ _ _. - _ COLENE M GORNIK (570) 606-5244 _ _ _ _ ___ _ __ __ _ __ First line of address __ 7 CIRCLE DRIVE __ _ _ __ Second line of address _.. City or Post Office State ZIP Code _..... WYOMING PA 18644 Correspondent's a-mail address: REGISTER C )F WILLS US~NLY ~ ~ "_ ~ `mil C~'t s t ~~ -~ ~ ~ < _ r `~ ~-rt 1 I ~ -3 ,,--~ _ 4 ~ ~ ..~ ~~ ~"~ i. --- rr..'4! -.,ijhl~ -. /~1"EJ'IFILED c_~ --~ .-, ,_.,. ;i _.. . _..i. 1 "~ ~,._ . ~ --;- ~ 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. SIGy~(7URE OF PERSON RESPONSI FOR FILING RETURN DATE A~RESS CJ SIGNATU' E F P P RER OTHER THAN REPRESENT TIVE ,~~ /~ ,/ DATE L' P~ /'yap--~ /C •~ «re~.w, C P~ ~//-/~- /o ADDRE ~ 269 IERCE STREET KINGSTON PA 18704 PLEASE USE ORIGINAL FORM ONLY 1505610101 Side 1 1505610101 J J REV-1500 EX Decedent's Name: DOROTHY M GORNIK Decedent's Social Security Number __. _ _ ___ 178-16-5583 RECAPITULATION _ _ _ _ _._ 1. Real Estate (Schedule A) ............................................. 1. 125,000.00 2. Stocks and Bonds (Schedule B) ......................................,. 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 75,785.20 6. Jointly Owned Property (Schedule F) O Separate Biiling Requested ....... 6. 77,894.53 7. Inter-Vivos Transfers ~ Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. , 278,679.73 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 8 476.50 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 41.68 11. Total Deductions (total Lines 9 and 10) ................................. 11. 8,518.18 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ' 270,161.55 13. Charitable and Governmental BequestslSec 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. ' 270,161.55 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_ 16. Amount of Line 14 taxable at lineal rate X .0 45 ... ~_._,_ . _..,..... _. _ .._ .,_ ...., . w _, ..._ _ 17. Amount of Line 14 taxable at siblin t X 12 15. 1 s. 12,157.26 grae 17.' 18. Amount of Line 14 taxable at collateral rate X .15 18 19. TAX DUE ..... .................................................. 19. 12,157.26 _ _ ._ _ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1,50561,01,05 1,50561,01,05 1,50561,01,05 O J R€V-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME DOROTHY M GORNIK STREET ADDRESS -- 4612 N CLEARVIEW DR C~CAMP HILL STATE ZIP PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 12,157.26 2. Credits/Payments --- A. Prior Payments B. Discount Total Credits (A + B) (2) 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 12,157.26 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: Ye_s No a. retain the use or income of the property transferred :.......................................................... _ ................................ [_~ 0 b. retain the right to designate who shall use the property transferred or its income : ............................................ [ ~ x[] c. retain a reversionary interest; or ...................................................... [ .................................................................... x d. receive the promise for life of either payments, benefits or care? ................. ......................,,,,.....,,, [~' ^x ................... 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 0 3. Did decedent own an "in trust 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 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 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 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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 11f 12/2025 22: (~1 _ ~, ...,. :;,; ~.~, 506962802 REGISTER QE V~ILI~S ~vIVIBE~LAn€a co~u~TY PI=NNSYLVAIU~A HAlE!rPl~E111 ~'O WNShIlF CUMB,~'RL,QIVD COfINTY .De~~a~ed Soc~ al Secu,ri ty Nc~ : 178--'18-5683 AREAS, on the 33th day of August X030 ,an ix~,~t.z-ument dated S~Dtembex' .~9t,h 2oQ2 way admitted to .probate as the last w.~1~~ o~ DOROTHY M G[7RNrK rF/+st. ~wEO,~., ,cssrl ~~ ~e of /-rAMPDFN Tf?WNS/YfP, CUf~'1l~ERLANI~ bounty, who died on the 6 t~2 dam pf .August 2Q~ 0 axed, .~~5, a trtl~ cc~p~ cad the w3I1 a.s ,probated is anne2~ed hereto. ~~F'~ ~, GLENIaA FARl11ER 67RASBAUGH Register of` W:i~.~s in and f~~ C~~,F2La Caunt~, in the Corru~zz~veal th o.f Penns~l vansa, ~.ereby certify that I have dais day gx`anted .£,ette,x's TESTAMENTARY t~: COLENE N1 JA Yl1lE who has a~z1y r~~a1i.€ied ~s E.XECU7"(~R(R1X1 • axid ha.~ ag.~'~ed. to adzr~zx~i s tex the cis to to according to I aw, aI I o.t` w.hi ch V fu11;Y appears of r'eco.xd ixI my o~fi ~e a ~ ~UMB,El3l,.4ND COtlNTY COLIR~` NOUS~, OARLISLE, ~'PNN~YL VANIA. IN ~,5~'',~',tv,(p,~r '.~.REO~', ,I .1~ave heret.~nto ~~t ,m~' hand az~d affixed the seal of ,my office on the T.~~`f~ d'ay of Aug~si 200. jf jS ~ ~^J~11 /~, ~, 1 ~ 1 ~~ ~ J ~~ '1 44-~ 'I" , ~_~ '` iM~i 1/•ML/t .,I...~ n ~_ ~ wal { a .~ 1 t ~~sgsner'or s - ~,~ B PAGE 01 c~RTi~rc~a _ GRAINY ~~ LETTEI~~ .~Vo , 20 r D- 00834 P~ ~1To . 21' -~ yQ- 083 Estate Of : L3ORD THY M G DRNIK ~ *~T~7~'.E* * .A..~L IVAM"E,S A~3OVE • AF.FE~1R (PTR~~, 1-gIDD~,E, ~~8~~ 11/12/2e05 22:01 5706962802 BMET PAGE 02 LAST G1TLL AND TESTA~I~NT D~ DO~,QT~Y M, GQRV~K T, Dorothy ~, ~Gorri,ik of Cumberland County, Pennsylvania, being of sound z~~.nd end mez~ory, do make, publish and declare this my Last Will and Testament, hereby revoking ariy az~d a~.~. wi~,~.s by zee heretofore made. ~ TE~~~ : .~ direct t~iat my =uneral be conducted iz~ a m8nner carrespondi~g with my estate and situatiar~ ixz life, and thGit all my just debts a,nd, ~tzneral expenses be paid and satisfied ~ by my Administrator herei.naftex named, as soon as Conveniently may be after my decease. SEC~~TD: I give, deva,se and bequeath ali of my estate, both real, personal and mixed, ofi whatsoever kind and wheresoevEr situate, to zny husband, Edward ~. Gc~~nx.k, Sr., providing however, that he ~ur~iv~s me fQ,r a period of at least 60 days , Zf Edward N1. Go_~nik, Sr. does not survi~te me for a period of at least ~Q days then I giver devise and bequeath a.~~. of my estate, both real, personal and nl~xed, o~ whatsoever kind and whexesoe~rer situate, in equa,~ shares to my two granddaughtersr Colene ~. Cornik and Chzistian R. Porasky a~r~d their issue per stirpes. T~iIRD: ~ything herein to the contraxy notwithstanding, ~.t any issue of mine has not ~t the date of di.stributidr~ of . my estate, r attained 25 years off' age, ~ direct that the share (s) a„l,~Oeahie ~,o such PAGE l OF 4 pA,~~S _~ ~- D.M.G.w 11/1212005 22:01 5706962802 BMET PAGE 03 tissue be pa~.d ~.n Trust upon the following ter~zs and condition~~ axzd ,for the folzoWYng uses arzd purposes: a) The Trustee shall invest and, xeinuest the Trust assets. b) A separate Trust shall be maintained for each iss~ae~ of mine whose share is paid to said Trustee. c3 The Trustee may in its sole and uncontro~.led discxet~.an pay any amouxzts of income and/or }principal far the health., si~pphrt, educat~.on, we~.fa.re a~zd ma~,ntenazzce of said Beneficiary ts) . d) dill ,paymen.ts by the Trustee relating to a partzcular Beneficiary~s}, or expenses charged or paid al~.ccable to a ga.rt-icular Trust, shall be laid out of and frazb that Trust. ~) The Trusts sh111 be managed and the Trust funds invested in accordance with the provisiox;s of the Pennsylvania "Proba.te, Estates and ~'a.duciaries Code", its suppl.ezr~ents anal amendments, except as otherwise Provided herein_ f ) Upon a Trust Benef~,ciary attaii~ing age 25, that Trust ~~~shall termizxate and the Trustee shall pay to such Benefica,aryr free ans~ clear of the Trust, till remaining assets t~f that Trust. FQURTH: I hereby nQminat~:, c4z~st~,tute and appoint my ]~.usband, Edward ~. Cp,~n.~,k, fix, ~o be the Executor of tha.s z~ty Last ~il~. and Testament, Tt the said Edward M. Cornik, Sr. is unab.~e or un~rilling to ,~.. serve a , such, I then aFP:v~nt Co.ien~ 1~. Gornik to 5o serve as ExeCUtrix_ ~'I~GE 2 OF 4 PAGES i `~ L D.I+'i. ~. 11f12f2005 22: e1 5706962802 BMET PAGE 04 ^.~~T:'_" ~ nG~ii;~..a~£, v.t:~_5x.::..~t:,t~ ~;i~ ~~~'~~,.~;;~. ~.~"iy 3e~~~~~.t0'" ,^.i Colene ~ , Garni k ~.r~r~ C:r ri s tiara ~ . Perasky tQ be the ?ruste~.e c~,~ any trust established pursuant to th.~s fast L+1.~1~. .~z~d Testament. SIXTH: I direct that each tx~usteP may compensate herself out o~ any trust over which they are trustee but that such compensation shall not exceed 1~ of the net asset value of the trust ~-er yeaar. SEVEP~TH: I direct that any f~.duciaxy of mine herein r3amed, be permitted to serves without band in any jurisdiction where a bend c~rould be requ~.xed for the faithful performance of his/her duties, ~n the absence of this provision. I, Dorothy M. Gorx~ik, the ~'estatr~.x whose name is s~gne~c~ to the foregoing instrument, hav'i21g been duly qualified according tQ 1,e,w, do hereby ackxiowledge that I signed and executed the ~netxument as m5T ~.ast Mill: and that Z signed it wi111ng1y axed as T.~y free and vo].uz~t~dx~Y act for the purposes there,~n expressed. ., Sworn to or affix zed axxd acknowledged before e by Dorothy M. Garnik, the Testatrix, this ~~~ d~u c~ ~~, ~ _ f . X002. .~ ~. ~. , `"~~~ - f Seal ) T'esta'Caca.x ~: .~~, •,: { T Y UBI,IG My comm~.seion Expires ~M'*wtiiTn.~1.J11R~~~J1 pp c,1 ,•~ a 1~i•~ P,A.~~ 3 OF 4 P,~G~S ~~?: -•_•:...,.;-;• ...: ~:,:,~~ tom;, ~3.-~~~'~ L' S4 Fh 4'•:hi•`•...'r ••~nn .m ,•rWrYWW'~'iMA.r..wyMw.µu... 1 ' , 1 11/12/2005 22:01 5706962802 BMET PAGE 05 duly qualified according to law, do depose aid say that we were present and saw the Testatrix sign and execute the in.strc~ment as her ~aast dill; that the Testatrix signed ~rilling,ly and executed it as hex free and volunts,ry a.et for t~.e purposes therein expressed; that each subscrib,~ng ~ritness in the heaxir~g and sight of the Tegta~~rix signed the wi1.1 as a wztness; and that to the best o~ our knoraledge the Testatrix was at that tune x8 ox ztic~re years of ages of sound m~.z~d. anc~ v.nder no constraint or undue influence. Sworn to or affirmed, and ~ubsczibed fio beforE: zne by ~~ .~/~ end ~}l/rt /$~. tai~nesses this ~ Y~ _~-. day of ~ 2002. r ~ ;~ ~...-- Witne s . ~- r.: TART U$.T,l'G * - .__..~ __. ,, y~; My COmIri1.SS1.4I1 Expires ;~ 1,.N 1~"~~ (c.~l i'. ~:.i F',-~ 6.'~~Ri .~a.~~rk l.`~•r~•~ ~Fh~'~'4' •d y.. ^.~y Vim:-.t. ~ .rr.ni,~_u •. .w. w.iK..w~gS~?p,Y,~.T.~}1A WAGE 4 aF 4 ~~~ ~~ n tur r_ REV-1502 EX+ (11-08) r ~ `, Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY M GORNIK Ali 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 wilting seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with ri4ht of survivorship must be disclosed nn SchPdi~i'e F Ir more space is needed, insert additional sheets of the same size. 11/9/2010 4;42:58 PM .,~r~varn~ ~~~ ~~ ~ ~~ ~' ~ ~ y ~ ~~I * ~ B. Type of Loan 1.^ FHA 2.^ RHS 4.^ VA 5.^Conv. Ins C. Note: 'D. Name & Address of Borrower: E. Name ~ Address of Seller: F. Name & Address of Lender: G. Property Location: H. Settlement Agent: Place of Settlement: I. Settlement Date; A. Settlement Statement (HUD-1) Disbursement Date: 11/9/2010 - ... $125,000.00 401. Contract sales price 101. Contract sales price 102. Personal property 103. Settlement charges to borrower (line 1400) 104. 105. 106. _.........: _.:~,:: ,.~ ~:: ,;~:, ~;~::;.,....., ; ; ~, c-;. City/town taxes :,<:.:::..:.~:.--::,,::, 107.. County taxes 11/9/2010 to 1/1/2011 108, Assessments 109• School Taxes 11/9/2010 to 7/1!2011 110. 3rd Qtr Sewer/Refuse 11/9/2010 to 12/31/2010 111. 112. 120. Gross Amount Due from Borrower 201. Deposit or earnest money ..,_ ..~~~~Wni~r~~.."~,~ 202• Principal amount of new loan(s) 203. Existing loan(s) taken subject to 204, 205. Lender Over-Tolerance Credit from Freedom Mortga 206. 207. 208. 209. - ~~ 210. City/town taxes :`...~, 211. County taxes 212. Assessments 213. 214. 215. 216. 217. 218. 219. 220. Total Paid by/for Borrower 30:t) CasFi4at Settlement~frorn/t:o Borfower~;, ~,~ 301. Gross amount due from borrower (line 120) 302. Less amounts paid by/for borrower (line 220) 303. Cash ®From O To Borrower 402. Personal property , $6,133,02 403. 404. 405. OMB Approval No. 2502-0~"6~ ~. r ~_ $125, 000.00 ..:..,: „f:: r . rs ~,r~ w t ~ 406. City/town taxes _..;_ _..F r!~ r'~(. "t~~'~ E . $41.51 407 , County taxes 11/9/2010 to 1/1/20 ` 408. 11 Assessments -- $41.51 $681.07 409. School Taxes 11/9/2010 io 7/1/2011 -` $85.48 410. 3rd Qtr Sewer/Refuse 11/9/2010 $681.07 411. to 12/31/2010 - X85.48 412. -_ $131,941.08 420. Gross Amount Du - a Sell w~„,.~ ~ ~ ~, r r ,. er sWt.rN}rr ; 808.06 $125 ~,~4,,~;,1~~~~~.f;f 500W~~e~duct(`o"tls"[nA~" 4;r ,4 k:,:~kJ; ,,~, .~.: ~.,.... ~...., moynt D e3to,,S $1,500,00 501. Excess deposit (see inst I ~ ~ 'ur;1~,~ ~~'~ `~`~ " ,~`;;' $100,000.00 502. ructions) Settlement charges to s ll _ e er (line 1400) 503. Existing loan(s) taken subject to $`0.150.01 504. Payoff of first mortgage loa "-- $32.39 505. n Payoff of second mortgage loan 506, Inheritance Tax to Register of Wills - 507, Overnight Inheritance Tax to Mark Kneerea $5.625.00 508. m to Grea $25.00 509. _ '~ ~!Y' f J , trr)ents,for,ltems unpaid by sell ,,. , ~ ~~~~ { a k A 510. „ ~ ~,~ ~, ef , ;: .. ~: City/town taxes _,.;.~ ryu~. ;.<,~.~,, ,h>~;~ ~ ,;~ { , F.; ~, - :r ..,;~ 511. County taxes 512• Assessments 513. 514. 515. 516. _ 517. 518, 519, - $101,532 39 520 Total Reduction Amount D ue Seller ~ . u~ J mk ~~ :.. v ; 4? m t r -~~`!nr"t:~'l~~tk:!~s1~r4~ 600~t~c'~.C,as~~°at~Set#le~,:~>~ a,,.: :.;~ ~.,« ~~:., r, t ~~. ~ - tTt ~1~ toifrbm~S l ~ $14 800 01 $131,941.08 601. ; e~ er~ 1,~~,-; ~,~I~t~,i>":u , .:~::1~~` ~~`, )v; Gross amount due to sell y 6 ($101,532.39) 602. er (line 420) - Less reductions in amount d $12 5,808.06 $30,408.69 603. ue seller (line 520) Cash ®TopFrom Seller - ($14,800.01) $111,008.05 The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collectin re collect this information, and you are not required to complete this form, unless It displays a currently valid OMB Control . is mandatory, This is designed to provide the parties to a RESPA covered transaction with information Burin the 9e viewing, and reporting the data. This agency may not number. No conFidentlality is assured; this disclosure Previous editions are obsolete ~ ttlement process. Page 1 of 3 HUD-1 3.®Conv. Unins. 6• File Number; 7. Loan Number: 20100508 8. Mortgage Insurance Case Number: ^ Other 0084436021 This form is furnished to give you a statement of actual settlement costs. Amounts paid to and b the y 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. Jamie Stehman, 4206 King George Drive, Apt C, Harrisburg, PA 17109 Scott Snyder ' Estate of Dorothy M. Gornik Freedom Mortgage Corporation, ISAOA, ATIMA, 907 Pleasant Valley Avenue, Suite 3, Mt. Laurel, NJ 080,54, Loan: 0084436021 Property Address 4612 N Clearview Dr, Camp Hill, Pennsylvania 17011 PIN . 10-21-0279-1.39 James A. Miller, Esq,, 1-Great Road Settlement Services, LLC, 765 Poplar Church Road, Camp Hill, PA 1,'011 _ 765 Poplar Church Road, Camp Hill, PA 17011 , (717)731 1040 11/9/2010 Proration Date: 11/9/201n 700, Total Real Estate Broker Fees""based~on price , $7,500,0~f Division of commission (line 700) as follows: 0 701. $3,950.00 tb Homestead Group 702• $3,750,00 to Straub & Associates Real Estate Group, Inc. 703, Commission paid at settlement $7,700.00 704. 705. Broker Fee to Straub & Associates Real Estate Group, Inc. ;, _~ 'I l/y/'LU1U 4:41:58 PM _. .:.~ ;:; ~? #, :;,:,ir i...:it~~"'caYy~.~^~.~ ,r~~~T;!I~~+'der,~~~-~y~vulu~,'$~i~~~~~t~'~r~P~{Iti~lj{: 801, Our origination charge Freedom Mortgage Corporation, ISAOA, ATIMA'$1,690.00 (from GFE #1) 802. Your credit or charge (points) for the specific interest rate chosen 803. Your adjusted origination charges to Freedom Mortgage Corporation, ISAOA, ATlf~fpom GFE A) ) 804. Appraisal fee to Colestock Appraisal Services 805. Credit report to Corelogic Credco (from GFE #3) 806. Tax service (from GFE #3) 807, Flood certification to Madison Credit Managment (from GFE #3) 808 Appraisal Management Fee to Madison Credit Management Services (from GFE #3) 9001? Items°Requi~ed py Lender to Be { ,"~"y"s~'E;~; ., -~ ,:: ;.Paid (r'A~'dv'aijcerr~Y~. ~E r~d'~~~~,~ }'~y,~,;!!l~;'~fgl'*~' y ~'rn771 n iytit i 901 Daily interest charges from 11/9/10 to 12/1/10 ~ I ~~„t `~ Ih° .`~?l~1 ~{~~{b`~ )k,~ y{ fI'„ 902• Mortgage insurance premium for @ $11.8100/day (from GFE #10) 903. Homeowner's insurance for 1 years} to Travelers Insurance (from GFE #3) 904. (from GFE #11) 905. 1001. ~_:: .~_ ~:-:: ~~ ~ , .~.~~ ~'~ ~'~~~i'x~'r ~ ~~ ,r~~, ,, ~~. Initial deposit for your escrow account '4~'~ "~;,~~;1^~j1~.41'tye"5 ,f~'i4~„ ~`,~ 1002. Homeowner's insurance 3 mo. (from GFE #9) 1003, Mortgage insurance @ .$34; 0800 per mo. $102.24 1004. City property taxes 1005. County property~taxes 11 mo. 1006. School Tax 6 mo: @ $80,3300 per2mo.100 per mo. $267.41 1007. $541.98 1008, 1009. Aggregate Adjustment ` ;~ ~~u i iue e.~arges~ ry :- , , ~ , } ~~ -~ ~ r, ,..~w ..:.., ~ ,,- r ~ ($428 24) . ' ~ t ...: . 1 .. ~ i ~~~ ~ ,.;. t '{. N~'11r j,Y§$~1 ~, ~jt -I~~iP{4i~ ~T'K'!a 1:6 1101 Title services and l ,L i { it { lx r,~. ~.~i. ~~ ~" 3 d ' ~ j ~ ~ '~~ ~ °~~ ~ en er s title insurance '' iy 7 a _ y ,. a.t.. L!I, " ,.1 itip r . '" ~ 1102. Settlement or closing fee (from GFE #4) 1103. Owner's title insurance to Great Road Settlement S i 1104. erv ces, LLC Lender's title insurance to Great Road Settlement S i (from GFE #5) 1105, erv ces, LLC Lender's title policy limit $100,000.00 $150.00 1106. Owner's title policy limit $127,000.00 1107. Agent's portion of the total title i 1108. nsurance premium to Great Road Settlement Services, LLC $884 Underwriter's portion of the total title insuranc 69 1109. e premium to Stewart Title Includes~Ends 100, 300, 900 Guarant Com an Y P Y $149.06 1110. Doc Prep fee to Great Road Settlement Services LLC 1111. , Overnight/wire fee to Great Road Settlement Se i $250.00 1112. rv ces, LLC Closing Protection Letter to Stewart Title Guara t $50,00 1113. n y Company Tax Cert to Michael Langan $75.00 1114. Notary Fee to Cash 11.~.5~_ _ $25.00 F1:2o0 Government Recordtn r .:' ~ : _ g "and,TfansfersChar es ! r ~ {~ ' , 1201. Government recording charges ~ ~~ " ~~ -, ~,'~ ~ ~ '~ "+ i~, y j ~1w ~;` u < ,x ~ ~: .1202. Deed $53.50 Mortgage $89.50 Releases (from GFE #7) 1203. Transfer taxes $143.00 1204. City/County tax stamps Deed $1,270.00 (from GFE #8) 1205. State tax/stamps Deed $1;270.00 $1,270.00 1206. UPI Certification Deed $10.00 Mortgage $10.00 1207. $20,00 POCB $295. POCB $100, ;: File Number: 2010,^,Flpg _ _, ~ ,, ` Paid From Pa{d From " Borrower's ~ Seller's Funds at Funds at Settlerr{ent Settlement __ $7,700.00 ;6483.39 :,.. $650.00 $983,75 $5.00 --___._ $10.00 $1 E~3.00 $1,270,00 $1,270.00 ..._.. ...,-• - 1,., ',i.ta. - ~a : ;:i~ , ~`s il.i n~i ulia, p~ J,4 t 1 I~ k _ 301.. Required services that you can sho ,~ ;,,~;- ~~~~~~~~ ~ ~ (~ "' ~ ~~ r ~~'' ~ ~{.I `~~ r~ " i s,~,a , ~ ' it ~ t "~ ~ vy_~,~~fi'~'t. ~,:~U~L~6vt`~~~n ~~,~~r,Yl{ ~a l,~r i; .rs~I', ~N~~ {~,E.'a ~,f,~ _r ~ , 7.E ~{ ...~iE S ~{ :; , ~ : r i (from GFE #6) ~-~:' ~~ ~ ~~~ . '~ 1302. 2010 County/Township Tax on 4/20 2010 to Michael Langan , 1 1303. 2010 School Tax on 8!9/2010 to Michael Langan POCS $285.90 "- 1304. 3rd Qtr Sewer/Refuse to Hampden Township Authority POCS $1,062.36 _ 1305, 1400, Total Settlement Charges (enter on lines 103, Section J and 502, Section K) - $165.01 "Includes Origination Point ($1,690.00). $6,133,02 Items marked "POC" were paid outside the closing by; Borrower (POCB), Lender (POCL), Mortgage Broker POCM $9150.01 ( ), Other (POGO), Real Estate Agent (POOR), or Seller (POCS). Previous editions are obsolete Page 3 of 3 HUD-1 i iiu~~u iu 4:4~:ou rive CERTIFICATION: I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurat File Number: 2010(!-r g disbursements made on my account or by me in this transaction. I further certify that I have received a copy of HUD-1 Settlement Statement. The warrant or represent the accuracy of information provided by any pa a statement of all receipts and ~~ including information concerning POC items and information supplied by the lender in this transaction appearing on this HUD-1 Settlement Statement pertaining to "Comparison of Good Faith Estimate (GFE) and HUD-1 Charges" and "Loan Terms" Settlement Agent does not the Settlement Agent as to any inaccuracies in such matters. and the parties hold harmless ,• Ja rnan ATE OF DOROTHY M. GO K Sco der '~ ~' r7/ C ene M. Gornik `'J/ To the best of my knowledge, th - Settlement Statement which I have prepared is a true and accurate account of the • disbursed b the u ~-~ Y ned as part of he settlement of this transaction. funds which were received and have been or will be J es A. Miller, Esq. ~-c.G.c~ WARNING: It is a c ' to knowingly make false statements to the United States on this or any other si D etreform. Penalties upon conviction ca ris r details see: Title 18: U.S. Code Section 1001 and Section 1010, n include a fine and i iryrtu iu ~.~rc.oo riw SUBSTITUTE FORM 1099 SELLER STATEMENT - The information contained in Blocks E, G, H and I and on line 401 (or, if line 401 ' and 408-412 (applicable part of buyer's real estate tax reportable to the IRS) is important tax information and is being furnished to the Int t-Ile Number: 2010Q~~tt$ required to file a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRSIS asterisked, lines 403 and 404), 406, 40'7 SELLER INSTRUCTION - If this real estate was your principal residence, file form 2119, Sale or Exchange of Principal Reside ernaf Revenue Service. If you are For other transactions, complete the applicable parts of form 4797, Form 6252 andlor Schedule D (Form 1040 , determines that it has not been reported, nce, for any gain, with your income tax return; You are required to provide the Settlement Agent with your correct taxpayer identification number. ) If you do not provide the Settlement Agent with your correct taxpayer identification number, you may be subject to civil or criminal penalties. ESTATE OF DOF~OT M. GO ~~NIK '~ . `' Cfslene M, ornik vL~ecutrix %I REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF COLENE M GORNIK FILE NUMBER 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 disr.Inseri r,~ Scharlnla F ~~~ i nv~ c sNac;e ~s neeaea, insert aoaitionai sheets of the same size) 2000 Dodge Neon -Trade In Value, blue book value -Kelley Blue Book Pa e 1 of 3 g ~~. ~~ ~~ey 8~~ ~~ I.~~ ,~ THI TKUSTED ti:fsClUkCE ~ dW ~ M' SEARCH Home New Cars Certified Pre-Owned Used Cars Research Reviews & News Dealers & Inventory Used Cars For Sale Loans & Insurance Used Car Values ~ Search Used Car Classifieds I Certified Pre-Owned ~ Compare Vehicles ~ Perfect Car Finder ~ Most Researched Vehicles ~ CARFA>C Vehicle History Welcome Back ~ Sign In ~ Create Account ~ My KBB ZIP Code: 18644 Recently Viewed You Might Also Like Free Dealer Price Quote [~ODG E GRAND CARAVAN ~ - - ,:_ _,> . -- Class exclusive Stow n' Go® offers ~~ r.: .. .. flexible seating and storage. , , .-. ^~ , News More Car News 10 Comfiest Cars Under $30,600 Car Repairs That Can Wait AOL Aui:os C'? Save Vehicle Pnnt Email G~ g~My; ~ advertisement advertisement d~~~~ --..._ ~,.~ Search all Cars For Sale near 18644 ' - 75 Miles ` SEARCH Lease a 2010 __.T__. Near ZIP 18644 _ journey SXT for Home > Used Cars > Sedans > Dodae > Neon > 2000 > ES Sedan 4D 2000 Dodge Neon ES Sedan 4D .............._.......... . ............ . Trade-In Value _ _._ . _ _ _ _ _ _ _ Private Party Value BLUE BOOK® TRADE-IN VALUE ','''~''~ Suggested Retail Value _.__. __ _ _ CPO Value ax +}. ~~` „~- ~ "; .,~ , ~' ' Condition t ,, ~,. Value Photo Gallery ~ ~,~~ u, .„ ,.• • . ... , . Cars For Sale New, ~~ ~1x ,~ _.i ; '' Excellent $3,025 Compare Vehicles ~~~, ., - r Good $2,750 Review Fair $2,275 Consumer Ratings Find Your Next Car More Photos Specifications # Price New Cars BUY A USED CAR On Blue Book ClassifiedsTM ` _ Local Listings: ,'' Dodge _ _ ii: Search Dodge Neon Neon $239 a month ~~or 39 months with 52404 'l due at tease signing i=~ ZoiO podge WurneyR/TShown ~M;.-6. Find aDealer - Average Consumer Rating (975 Reviews) Read Reviews Fnd The Right Car Compare Used vs. New ~'t'~'a"", s 4.2 out of 5 Review the 2000 Dodge Neon _...__ Under $5 000 _ To View Ads, Click cS~ Shopping Toots CARFAX Record Check Auto Loan from 3.59% APR Compare Insurance Rates with Progressive Payment Calculator ' ~.._ Find Your Next Car Both New and Used __ - _. Sedan... To View List, Click °-^- . , f ,» ~ ,y ~ c.~;. .. .. . , -: .. '- '.s x . See ect YAn~tla~ Vehicle I 20Ac ord da 20 Camryota I 20 Sonata dal ~ MSRP $21,930 MSRP $20,480 ~ MSRP $19,915 Select Make... Select Nlode;... VIEW DETAILS VIEW DETAILS i VIEW DETAILS Or Search by Category Vehicle Highlights Or Change ZIP Code Mileage: 60,000 Engine: 4-Cyl, 2.0 Liter Transmission: Automatic Drivetrain: FWD __ .._.........._.. . __ __ i Selected Equipment Change Equipment Standard http://www.kbb.com/used-cars/dodge/neon/2000/trade-in-value/pricing-report?condition=... 11/16/201.0 ~ .. ~'~~~ August 19, 2010 Colene M Jayne 7 Circle Dr Wyoming, PA 18644 RE: Dorothy M Gornik SSN: 178-16-5583 DOD: 08-06-2010 Dear Ms. Jayne: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Certificate of Deposit Account # 31800111581 Established: 06-28-2005 DOROTHY M GORNIK CHRISTIAN R PORASKY DOD balance: $ 13,573.56 + 0.78 accrued interest Account # 31200200657 Established: 06-28-2005 DOROTHY M GORNIK DOD balance: $ 12,278.04 + 2.94 accrued STIAN R PORASKY interest Account # 3 1 1 00205058 Established: 06-28-2005 DOROTHY M GORNIK CHRISTIAN R PORASKY DOD balance: $ 13,017.84 + 2.42 accrued interest Checking Account Account # 5140118062 Established: 06-28-2005 DOROTHY M GORNIK: DOD balance: $ 60,784.82 + p.33 accrue~STIAN R PORASKY d interest Savings Account Account # 5004560366 Established: 07-13 -2005 DOD balance: $.71,758.08 + 2.12 accD eOd Ot HY M GORNIK Brest Page 1 of 2 Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checkin and Savings). Vt'e do not process any financial transactions or provide statements. If you need assistance v~~it any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch h office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Page 2 of 2 REV-isog EX+ (oi-io) ~ - Pennsylvania • DEPARTMENT OFREVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: DOROTHY M GORNIK FILE NUMBER: If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• COLENE M GORNIK 7 CIRCLE DRIVE GRANDDAUGHTER WYOMING PA 18644 B' CHRISTIAN R PORASKY 139 BUTTERNUT RD GRANDDAUGHTER SHAVERTOWN PA 18708 C JOINT LY OW NED PROPE RTY: -- LETTER D T ITEM NUMBER 1. FOR JOINT TENANT A A E MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET -- DECEDENT'S INTEREST DAV 0 E ~ TH DECEDENT'S INTEREST • 06/28/05 PSECU REGULAR 71.24 50 35.62 2. A. 06/28/05 -PSECU CHECKING 56,057.10 50 28,028.55 3. B 06/28/05 PNC BANK CERT OF DEPOSIT 31800111581 13,574.34 50 6,787.17 4. B 06/28/05 PNC BANK CERT OF DEPOSIT 31200200657 12,280.98 50 6,140.49 5~ B 06/28/05 PNC BANK CERT OF DEPOSIT 31100205058 13,020.26 50 6,510.13 6. B 06/28/05 PNC BANK CHECKING 5140118062 60,785.15 50 30,392.57 TOTAL (Also enter on Line 6, Recapitulation) $ ' 77,894.53 If more space is needed, use additional sheets of paper of the same size. PSEC August 19, 2010 Account # 0178XXXXXX COLENE M GORNIK 7 CIRCLE DR WYOMING, PA 18644 Dear MS. GORNIK: The following is the status of DOROTHY M. GORNIK's account with PSECU as of the date of death. Joint Owner's Name COLENE M. GORNIK ADDED 06.2$.2005 AS JOINT TENANT W/ROS Date of Death 08.06.2010 Date of Birth 10.14.1923 Share S O1 Description Regular Shares Open date Balance Accrued Dividend S 04 Checking 09.25.1981 $ 71.24 $0.00 09.25.1981 56,057.10 0.00 The dividend earned from January 1, 2010 through the date of death was $33.13. The decedent had no loans with us. We do not have safe deposit boxes for our members. If you have any questions, please ca11234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227. Sincerely, Meade Fairfa ~ r4e*nber Sp; vice R epresen±ative Finance Support Unit Pennsylvania State Employees Credit Union Main Address: 1 Credit Union Place, Harrisburg, PA 1 71 1 0-2990 • 717.234.8484 • 800.237.7328 Mailing Address: P.O. Box 67013, Han•isburg, PA 1 71 06-701 3 • 717.777.2100 (fDD) • 800.472.1967 (TDD) This credit union is federally insured by the National Credit Union Administration. E ual O pS@CU.COm q pportunity Lender ~ r~cV-1J11 [1Ct (lU-U`j) ~~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND a11MTA1TCTDnTrve ~~~-rn ESTATE OF DOROTHY M GORNIK Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1' ROLLING GREEN CEMETERY COMPANY NEILL FUNERAL HOME B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) FILE NUMBER 2. 3. Street Address City State Year(s) Commission Paid: Attorney Fees: 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. 5. 6. 7. Probate Fees: Accountant Fees: Tax Return Preparer Fees: TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. ZIP AMOUNT 3,536.00 4,150.00 415.50 375.00 8,476.50 PREt~EED COUtwSELOR SALES RECEfPT RC~LLif~G GREE1•~I CE~~ETERY CO~iP~,NY ~2~ ~~i~.0~}~~~4~ i 81 ~ CARLISLE RD CAt~~~P H{LL; PA ~ 7011 71 ; -761-4055 DATE _ ~ ~ ~ C~ l ("3 RECEIVED FROM ~ ~,~-,, ^ ~~ p,V, ~ ~~_~ Name of Purchaser THE AMOUNT OF ~ -------_ DOLLA ~ Rs ~ ~ ~ .SSG . Cc~ ~ AS: DOWN PAYMENT ^ REGULAR PAYMENT ^ / CREDIT CARD CHARGE ^ CASH ^ CHECK [~ CARD TYPE ^ FOR THE PURCHASE OF INTERMENT RIGHTS AND/OR MERCHANDISE AND SERVICES FROM THE ABOVE NAMED CEMETERY. RECEIVED BY CEMETERY SALES COUNSELOR DATE BY NAME ` GEN 8002 (6/02) (~ V, 3 r ,.' i i. ,~ a `~~ " No.: ., ,. ,- ;, INTERMI/NT RIGHTS; MERCHANDISE AND SERVICES '"'' ~ ~,,Intel;tnantRights (iuo: ~ _ 1/CF) $ ~~ L +t- 4sa• 1 ~ k _ °Nleinori'alizatign Type `~d ~ ~ ~~ ~ ~ l~ '~ ' ,~ Iaesi n~ ,s t'"`~~'--~ ~,~ Dovut~PaytnentCash .~.,. ...., ., ~.,,~, ($ ~~' ~~h `~' ~)~ .S~~e '~' ~ ~ ~ ~ g ,t _ Credit For ~ ( ) ~" Mei•~orial Base Type j{ ~ ~, `--~' ' ',Size a ~ i ~ ~- Color r i ~ ' i . ~' °~ b Total Dovrn P~ meat : .~, ~ ~ ` } '" 'Me~noti'alInstallation/InspectionEee ' ~f t 1~ ~~ <' - (c) U id B l ' C h F u a °~ a ,s ; w npa ance oi rrce (Amo as nt Fin nced).::.,t , ~ , ~Nterj~orlalM~;i~ntenance~ .. .:~ ,;. , '~ ~`' ~ .,~ _ ~' . . '., " ' ~~ ..,.. . r_.__._._..... ,, , (d) S ervic®,Charge.~(Pinanoe Charge) ~ ~ - `Gasket ~: Des,c>iption ~ ,. ~.,.~,,,~ , ,.~,~, .~: ,:: .`Material` Wood/Metal. ~ . ,,,, ~ (e),;Time Bslanc~ (Total gfPaym~nts) ....... .......: l- ' Gauge Outer Burial Container .Type ~ ~. ~ 'Time Sa e Price T (Total Sale Price),..,: ,,. << '~ ` '~ ~~ ,r~.' 1 Ct? ~ ~ = - , . ,. ~ Interme'ntandRecot'dingl~ee;. ,.... , .,; 1 - ', ' i' ~ ~ ~~ , , , , _ { ~ t~, ~ :Pro~~ssipg Fee >. .~,;,~~ . ..... ~ K r ~~ ~'" " -.~.. , , .., Other ~ _ =" Rerrtarks; -I ~ l -r ;, r_ ,., T, 'Away Fron1•Hoine Protection°' Plan {see below) ~ ~= ' ~ ,. ,. ~ r , `Sates,Tax,, , ,,..;,.,,,, .,.. .~,. ,~,. ,,.. ~ ~ ~~ ~ '' r (a) Total Cas1a Price (Including Sales Tax) „, „ '.„ $ ~ J ~., , ~,~" ~ ;~,`' ,. Tlie Away. Ft~o»i Tonle ~?r•otectiort Plan, being purchased hereunder is a product provided by a third party,,not by the cer~rete identified in this A reement:; The third rt , rY g 1?~ Y :pr6Vlderis tlot~ovvned by,or affiliatedwith the cemetery; and~the cemetery is }~otxesponsiblefor.tlie perfot~ance of die servie~ associate~~withthe A>ti~ayFr•orn.Horatel~~~oteotian Play; T11~Purcttaserwillberegiiredtoenterfijtoasepai~atecontractwiththethirdpr3rtypl{gvi~erpertairiingtoAivny.Fi~orn~Io~tieP.rdtectiortI'lan, That. lanhasbesnr~'fererice ~iii~Chls Agi~eetnetlt and inchdedin the purchase price. above solely fdr the convenience ~of,tha Purehaaerin making paymenfs. ~` p ~ ~~~ ' : d i ,;, , .< .-£: X~')/M1Z`A'TTON~OF~~AMQT:J`I~T ~LNAl~CED•gf $ ' ;~,$ shall b~e gredlted to~youraccount v~tL~h'Se~1er:.~ >>:~ A.t~o~nt~ ai t~ others.on, pur behal~'~; ~~ to ubl c a ficla s ~~ to Assist An;~erica Prearrangement Serv~cgs~,Tnc:~~ - _. '~~` weanay be rotalning a~~portlon of this mount). ~ `~ ~ ~~ ~~ ~ ~, ~~~ C - _ ~ . ANNUAL ~ ' FINANCE ~ ~" Amount Financed ~ ~Total'of Payments ~ • 'T'otal. Sale_Price FLRCEN T_AGE ~ RATE ~ ' ' '' ~ CHARGE: "- ;,~ - - Tlse'd llar o tli ~ ~ G 'The.amount of credit ~ id d~ The amount you will have a The total Gost.of.your ur-!' ' . The cost of yotSx credit ' arn e o un ~ credit will pos~,3~ou.. prov e ~to you,ax , - orl your behalf; .:p id, ai~er you~have ma call payments s'schedule~ ' ._ ~' ~ohase on credit, lncludin 'your dawn paymerXt of ~ : ' ` hte ~~'~.Year~,~~t ~' , r f ~F : A. Yoin• payrneiit schedule will'b'e': " ' ~: _- e - Ntitn1bei~ of Payments ~ ~ Amount of Payments y When Pa ments Axe Due ;A ~ ~ Beginning ~: l~it~pti~n~ent,f If you spay off early, you .will be entitled to a r~b.ate of all or ~~rt of the Binance Charge, c , S~c~u'lty; You are giving a security interest in;the goods and prop~rty.,betrxg purchased. , Late charges: Tf full paytrient is not mad'~`withiii;lS days aftar.it ls dus,'yoti! will: be ehtrrged X5.00 or 5% of'such payment w hichever is less'..:: _ , Ofhirr Provisiops:.$ee thrs'Agt-eement•for any.additional.tnforrimatldrt"bout nonpayment; dafatrlt, any required repayment in ~tll ' , , (exclusive ofuriearne~~nairrre . bharges) before~the'schediiled date, ar~d prepayment rebates:arxd.penaltie : - ~: ' " I'f;~t'ccepted by Seller, the parties heretd agree to the fallowirtg terms ancL~GOnditionei '' ~~ ' ' 1,Agreemenf to Pay; Having first been quoted l~atl~,a Total CaslxPrice.and;d Total_Sale Price for the items described above, and for value received; the u dersi' ned,.~ ''. ~ ,~,:, . Ptlt'Chasef~; jointly and severally; if more than one, promises"to pay tQ the pt'tier of Seller, at its address shown below; th®;amount identif7ed above'as thry T`otai o P . tints' ' ~' aY~! 'in accer'danoe~with the. payment schedule dates-sat out above, ~2', ~'itl~. Seller.wilt retain-atle to said Interment Rigl~CS%and Merchandise until the Total SaleF'rice liAS'beeri.paid by Purchaser to Seller,;' . '.' ~; ', `~' ~"~ i .'j ; ~f .3; Cemetery"Rules ~-nd Regulations. 1'urchasei' agrees that all rights conveyed under this Agz~ement are subject to', and Purchaser agrees to;at all Ei ~es coin ] .~ pY with, tlie.preserlt (and as inay he l}eTeafter ad~pted~;lmended or altered) Rules, Regulations and $~laws of Seller'whiCh are available for examinatioh;in Sel er's office , -'~ ~.~-;;,Prepayment. Upon prepayment`in full, whetlcrvolutltarilyor upati acceleration by reasorx'af,Purchasar's tiefat~lt and a r~entrn full or 'ud' ment b~~` ante ed, ]? Y J ~ tlg r ~~~ -,~- agaYnst Purchaser for the' unpaid balance; Put~c)~aset' shall receive a rebate of any unearned l"i;nance~~harge cdmputed in accordance with the Actuarial method.' If (i ' ' ~. the need fQr interment arises within I.20 days of the date of this Agreement and the Agreement is paid itt full or (i}} thf s Agreement provides only for` the phrc~ase .,` of 1~`<emoi ialiaation an`d its installation and is paid infull within 12Q daysof the d~#e of this Agreement, Purchaserwill be entitledto afull reb~s~te-of ~11Ein~nce. , t~~t .. ij' ;t ;` ~Chiirges'previously paid, ~ 4 ~~ $,~ Itttermcrtt and R'ecording Fee;':unless otherwise_specifically~pzoyidedherein, a charge for.opening and~closing the intermentspace and.a ~licabl~ cerneter '-, pp - ~' dpeutx7ent rocoreling (herein referred to as "Interment and Recording Fee"), is not included` in the Total Cash Price set forth herein, and thexe will $e an added cl.arge . ` ' fot'fhis S~ryice at the tithe of need: If the Tnterrnant attd ReCOrdin~ 1~ee is purchased hereunder,. the price set forkh herein reflects normal work hojar rates.~'There will ' ~.~ ~be~n additionalehargeif the interment servioe.'is prouided an a~iueek'end, holiday; or~afternorinalwork`hours~, ~ ~~ ' ~ ~ }~ ~ ` " ` ~ ' 6~ Issuance, of .Gertificateof Llterment Iii l~ts;'U oC~~ a n~ent~of the TotalSale Price b thePurchaser;~ the Sellex a rees.to conve ~ the above-describedInte~i~ent; ;;, . g p~ ~' Y g y ,'r Rights by issuance of 1 Certificate of Interment Rights tq the,person(s) designated below; ~, . ~, i _ '' ~ ......-.._..~--------' - °' ~ i .ADDRESS ~ :; :~AD)~R~ESS ~ ~~ `` ~' .C ~ , ~ ~ ~, ,,~ t I~'~' ~?~ITY "k` 1 NEXT Q'F KhN ~r - t , ~ 1~ ~Nhme Address ~ ~ ~'' . CIty~State,Zip ~ ~ ~~ Phony ~ `' ~~ ~Iolice to the~.Suye~t~- (1}~Donot sign this Agreerrient befare_you read it or~~lf it,contalils ~nyy~blank spaces.~'(2)~~'ou~~re entitled~~t~o a~ ~omplet~ly tilled-tn copy of th~ls Agreement., (3) Under~the law, you have.the right to pay off in;advance the full umpunt due mind under ~` ae><•tain conditions to obtain a partial refund of the Set~vtce Charge., - ~ ' ' ;,'~ ` NOTI~'E; B~' SIGNING;THIS,A,GREEIVIENT'PURCI~ASER I5 AGREEINC".~ THAT ANY CLAIM PUR~HASER'NTAI' HAVE A`.GAINS~' ~,~'< THE S LLER SHALL B>v RE~OL'YEl? $Y ARB~TRATIQN AND PURCHASER IS GIVING UP HTS/ '''' Ei _, ~ BIER RIGHT Tb A ~'tJURT QR ~UR~ TRIAL AS ~V~LL AS HISlHER RIGI~T QFt APPEAL. ~ .; , , , : ~ .' , ~{ t' .~ .,- .;, . . ,; i..,, ~. ~ ~ Buyer.li~ereby~~hckn~owled~ges ~thatL this A~reementwas completedas to all essential provisions before 1twassigned tiy,Bu~%er aid a'capy° ` ,~ ~~ ~ , thex eof.was, delivered to`Buyer- at th.e time this Agreement was signed, - - Neill Funeral Home, Inc. 3401 Market Street ` Camp Hill, PA 170114428 (717) 737-8726 Supervisor : Kevin J. Shillabeer The following is a detailed bill for the professional services and/or merchandise arranged for Dorothy M. Gomik Date of Service :August 13, 2010 Colene M Jayne Statement Date August 18, 2010 7 Circle Drive Contract Number 741100200184 Wyoming, PA 18644 Arran er Name 9 Daniel C Huff Jr. Initial Selection Final Selection Difference Package Offerings Immediate Burial Basic Professional Service Fee Merchandise REVERE SILVER Cash Advance Certified Copies $2,995.00 $2,995.00 _. Intl Incl Total Package Offerings $2 995.00 $2,995.00 _ Total Merchandise $1,095.00 $1,095.00 $1,095.00 $1,095.00 Total Cash Advance Total Services, Merchandise and Cash Advance Total Charges (Total Services +/_ Allowances + Taxes) Less Cash Received Unpaid Balance Due $60.00 $60.00 $4,150.OG $4,150.00 $60.00 $60.00 $4,150.00 $4,150.00 ($4,150.00) $0.00 SELLER: r. PART ONE OF TWO PARTS ^ ..501 Decry Street ^ 3401 ~Aark~t S*.rt;ai i•(:;rrlaburg, PR 17111 Carttp Hlil, PA 17011 7 i 7-554-2633 7'17-737-$72fi titaPl".C3 S, tit;itdss~t, ti~mt'r6a8€ 1Ce~;t~ Si~tlllrt~>~r, nup>:tttEev7 ~~f~ ~,'" 2QQ~.~4 /STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED/PURCHASERGREEMENT ~• Date of Death ~/ (,::f /-L(,1 >~ DD YY / ~ r ~ r Date of Service Name of Deceased :_. ~'.... •.<. ~ . t,9 ( ~ C.y. '~ 1` ~~ t t'~ t_~•~ .l D/ j/ Y~~C( 7 • r, ' - ace of Birth / ~-' /) L Deceased's Last Address ~at~-~ , t'-. jc7 fj r \ t t () ~ -r- I~~ r - ~ P r ( ~` City ,~ Lam. ~ ~-+~ ~ ! State Zip Code 1Rl~J i Purchaser's Name f .C3 ~P t'} ..~ ~f .1\~ /~J / Phone NrC,( ~~ i,: d( .~ ~- Purchaser's Home Address _~~~ { l ~ r' j •=% ~ ~ ~ / t r 11 City ~. ./V? C }!' ~ ~ f ~r~.-,Lt Co-Purchaser's Name --~-- State !~ ` Zip Code __ /J Co-Purehaser's Home Address - Phone No. ( ___) Ctry -- State ~ Zip Code Affinity Group Member Membership ID -- Code In this Agreement the words you and your refer to the Purchaser and Co-Purchaser if an si i hi , y, gn ng t s Agreement. The words we, us and our refer to the Funera] Provider or Seller whose name and address appeaz above. For good and valuable consideration, which each You authorize u t e g r s o prepaze and caze for the body of the decedent named in this Agreement and to t:ondu c the funeral and services We have the right [o collect th land i h h l ncur t e azges listed in saidd Agreem ea . e total amounts due under this Agreement from any person who signs this Agreement as Purchaser or Co-Purchaser Charges are onl for th i y ose tems that you selected or that are required. we will explain the reasons in writing below. If you selected a funeral that ma . If we are required by law or by a cemetery or crematory to use any items i , y requ re embalming, such as a funeral with viewing, you may have to pay Por embalming. You do not have to pay for embalming you did not approve if you selected arrangements such as direct cremation or i we will explain wh below di y . mm e ate burial. If we charged for embalming, SECTION I -SERVICES AND MERCHANDISE - MERCHANDISE FUNERAL DIItECTOR AND STAFF SERVICES Casket orAltemative Container ....... ................ "^ ~ ^ ~~ ........................ $ ~ ~'7:.:a Basic Professional Service Fee ................................................. $ ---- Manufacturer/Supplier_- _ Model NameMumber _ PACKAGE PLANS _ Material Direct Cremation ...................................................................... $ ~ Species of Wood --- Immediate Burial ......................................... ............ $ ~~ t ti ~YPe of Metal -- ....... .......... Forwarding Remains to Another Funeral Home ...................... $ ~--- - WeighUGauge--- - Receiving Remains from Another Funeral Home .................... $- --- Shell Style __ $_,_.- Interior _-- $ _ r Exterior Color _-- Outer Burial Container ................ ....... „ ,_.,.,,,,,, $ ................ . ARE AND PREPARATION OF REMAINS Manufacturer/Supplier_- ,,..,..., Embalming ............................................................................... $ Model Name/Number- - Refrigeration ............................................:................................ $ ~-- - Material ."_. OtherPrepazation ............................................................. . $ Urn................................. . ....... _ (Describe) Manufacturer/Supplier_- .......... $ USE OF FACILITIES AND STAFF Model Name/Number __ Material Use of Facilities and Staff Services for Visitation (-days) $_,_._.-. __ -_ $ ~~ Use of Facilities and Staff Services for Service in our Chapel $ r $ _ Staff Services for Funeral Service in Other Facility ............... ~$ .r--- -_ _ .. Use of Facilities and Staff Services for Memorial Service __ $ wrthout remains present) at our Chapel .................................. $_' TOTAL SECTION L t ' ~ ` tall Services for Memoria] Service (without remains present) .............. ........... .. ................................... $ ' - ~~.% ' at other Facility ............................ g_ ............................................. E SECTION II -CHARGES TO IlE INCURRED BY US ON YOUR BEHALF quipment and Staff Services for Graveside Service ............... $_- Other Use of Facilities and S[aff (Certain charges may be estimated - "e' means estimated.) We chazge you for our .............................................. $_- (Describe) services in obtaitung those itetrts marked with an "X" ry ........................... O Cemete ................... ..................................... $ ---- TRANSPORTATION O Crematory ............................................ ..................................... $ ------ sferring remains to funeral home ..................... --- ................. $ ^ Flowers ............................. ..................... ^ Obituary notices ......................... ............ $ _.-. Funera] vehicle O° ............ $ --- ............................ ..... O Escorts ................... $ .................. Family vehicle @ ............ $_ F ....................................... ....... O Certified copies ....... r~ ~ rC- ? .................................... $ ` lower vehicle @ $ '--- ............ Service vehicle @ . .. . ...... ^ Outside Funeral D'irector's Expense ..... .................................... $ (, 1 I ..................... •••............ $ ----- ............ $_ Additional Transportation: ^ Clergy/Religious Facility ...................... .................................... $ O Musicians or Singers ............................. ................................ . $ -~---_ $ -""-" ^ Haudressin g ......................................... . .. ........................... $ $ O Permits .................................................. ......... .................................... $ -' OTHERGOODS AND SERVICES ~ -- $ Memorial book .................... ..................... $ ----- -- $ ^-~ ........ Service folder ................ ...................................................... $ . -- $ .--_._ ..... Prayer cards .............. O g -- Acknowledgment cards ............................................................ $ -. _. -- $ ~-^~ Memorial package .................................................................... $ ---- . Flowers ................ TOTAL SECTION II ................. ~ r / .................. ....................... . Shipping container .................................................................... $ ......... ..................... Cemetery ................................. .................................. $ .............. . TOTAL SECTION I CHARGES..... $~ ~ C~ (7 ................................. Crematory ................................................................................. $ ~.~ TOTAL SECTION II CHARGES... .. ............... TOTAL SECTION I AND II CIIARGES ......................... $ ~t / e' ~ rl (Purchaser's Initials & Date Witness' Initials & Date White -Funeral Home Copy Yellow -Receipt for Family Pink - Accountin:G Copy FORM FUN 0084 REV. (01/071 PARTTWO OF TWO PARTS Name of Deceased -;--'T 'c' `- ~` i V.- r (""""v ': s t i M~ v i --1 -- _ Agreement No. ~,$~~ ~ ~ ~r ~~~ STATEMENT bF FUNERAL GOODS AND SERVICES ___ _ ~ SELECTED/PURCIHASE AGREEMENT TOTAL SECTION I AND SECTION II CHARGES ~- ..................................................................... SECTION III • ALLOWANCES $ ;;•,,ff ~ ~; ............................................................. _ g -.. $ ~-- __ $ r. _ $ -..__. -- $ -- ' TOTAL ALLOWANCES .....................:......... g --- -- SECTION IV • TAXES : Taxable Items Suction 1 + or -Section III .................................... f ..................... Less Deductib]es ......................................................... ~..-~ ................... TOTAL TAXES '% .................................... ^-_ TOTAL CHARGES: Section I + II + or -III + IV = ....... ................................................................. Less Cash Received .................................... ............................................ r i ~ .......................... $ _ ~! ;' Less Assignments of .................................................................. : ._-- ............................ . p y. .............................. n at balance due b ...................................................................... $ _ - - _ _ PAYMENT TERMS: You understand that no extensron of credit b us, sub'ect to federa l or state credit disclosure, installment sales, or other consumer credit statutes, is contemplated by this Agreement. You have no rt ht to defer payment of any amount due under this Agt•t:ement. You agree that for payment of the appLcable balance due sh ou y are personally liable own on the Statement of Funeral Goods and Services Selecrted by the date indicated on the Stateme Such payment will be made to us at the address set forth in this A t greement. Where the ful called for by this Agreement, you authorize us [o inquire into o di n . l amount due will not tte paid prior to the performance of the services y ur cre t history. IDENTIFICATION AND DESCRIPTION OF MANDATORY ITEM S AND EXPLANATION legal, cemetery or crematory re uirement hi h OF EMBALMING CHARGE: We have identified d d i q s w c compel the purchase of any items listed You acknowledge and agree .that embalmi d/ an escr bed below any in Part One an~i we have explained wh we cha d f y rge ng an or embalming. or preparation of the remains may be performed at the. facilit another facilit of [he ab that is d l li f y u y censed and equipped to provide such services. y ove-re erenced funeral home or at You confirm that you have examined the service and merchandise items listed in Part One and found them to be correct and according to the arrangements selected and that prior to signing this Statement, you reviewed and approved a completed copy of this Statement. You also confirm that you have been informed of your right to select only such services and merchandise as you desire, and that you have the legal right to arrange the funeral services for the deceased named above. ACKNOWLEDGMENT OF DISCLOSURES/DISCLAIME;R The Federal Trade Commission Trade Regulation Rule on "Funeral Industry Practices" requires certain disclosures and prohibits misrepresentations. The following is a checklist we ask [hose we serve to read and sign to verify that the funeral arrangement conterenre was conducted in compliance with [he Rule. ,You who~made the arrangements for the funeral and final disposition of the above-named decedent do hereby attt:st to the following: l: You were given a General Price List effective on~-~,' ~'~ ' ~ ~ prior [o discussing funeral arrangements or the selection of any funeral goods or services. 2. You were shown a Casket Price List effective on prior to discussing caskets. 3. You were shown an Outer Burial Container Price List effective on prior to discussing burial containers. 4. You were advised that the law does not require embalming except in certain special cases, 5. You were not advised that embalming is required for direct cremations, immediate burial, or a closed casket funeral without viewing or visitation if refrigeration is available, where state or local law does not require embalming in such cases. 6. You were not advised that any law requires a casket for direct cremation or that any container, other than an alternative container, is required for direct cremation. 7. You were advised that state law does not require the purchase of art outer burial container or any of the funeral goods or services you selected except as set forth on your Statement of Funeral Goods and Services Selected/Purchase Agreement. 8. No claims were made to you as to the merchandise or services (embalming, casket, outer burial container) to the effect that embalming or the use of any merchandise available from us would delay the decomposition of the remains for a long term or indefinite time, or that any such merchandise would protect the body from gravesite substances. No representations or warranties were made to you about the protective features of caskets or outer burial containers other than those made by the manufacturer. The only warranties, expressed or implied, granted in connection with goods sold with the funeral service we arranged were the expressed written warranties, if any, extended by the manufacturers of such goods. No other warranties were extended to you. 9. You were advised that the funeral firm's cost for the items listed in Part One, Section II, may be different based on volume or cash discounts or other professional/trade customs where permitted by state or local law. SEE OTHER SIDE FOR TERMS AND CONDITIONS THATTARE PART OF THIS AGREEMENT. DO NOT SIGN THIS AGREEMENT BEFORE YOU READ IT OR IF IT CONTAINS ANY BLANK SPACES. YOU ACKNOWLEDGE RECEIPT OF' AN EXACT COPY OF THIS AGREEMENT. BY SIGNING THIS AGREEMENT, YOU ARE AGREEING THAT ANY CLAIM YOU MAY HAVE AGAINST THE SELLER SHALL BE RESOLVED BY ARBITRATION AND YOU ARE GIVING UP YOUR RIGHT TO A COURT OR JURY TRIAL AS WELL AS YOUR RIGHT OF APPEAL. ACCEPTED FOR SELLER: I - Pdnt Name License No. --i f rr ~ ~ y,.. ~ ~' ~~ I Stgnoture I ~ ' ~_ Executed this ~ -~ _ da}' of ~` --'tip < , 20 t, 1J _ i Purchaser's Name ~ ` ' " !'~` ~ j f"' ~_!__) -C~ ~ f -~~ Purchaser's Signature r=~- ~' ' = ,; C Purchaser's Social Security No. _ Co-Purchaser's Name Co-Putchaser's Signature Co-Purchaser's Social Security No. I attest that I have completed/review/ed this document as required by the Company's SOX Key'Control Checklist: Print Name: ', / , , . ' ' ' I , i ~ r r ~ ; ~ tl Title: ~ ~ /~ Signature: ~ ~• - Date: , RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date: 8/13/2010 Cumberland County - Register Of Wills Receipt Time: 13:33:02 One Courthouse Square Receipt No.: 1062248 Carlisle, PA 17613 GORNIK DOROTHY M Estate File No.: 2010-00834 Paid By Remarks: COLENE M GORNIK DM ------------- -..Receipt Distribution Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST WILL 360.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 15.00 12.00 CUMBERLAND CUMBERLAND COUNTY COUNTY cryENERAL c ENERAL FUN FUN JCS FEE AUTOMATION FEE 23.50 BUREAU OF RECEIPTS .~ & CNTR M.D 5.00 CUMBERLAND COUNTY t3ENERAL FUN Check## 888 415 50 Total Received......... . 415.50 REV-1513 EX+ (O1-10) ~; v , ~ Pennsylvania DEPARTMENT OF REVENUE s INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF: FILE NUMBER: DOROTHY M GORNIK NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE i TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• COLENE M GORNIK GRANDDAUGHTER 50% 7 CIRCLE DR WYOMING PA 18644 2. CHRISTIAN R PORASKY GRANDDAUGHTER 50% 139 BUTTERNUT RD SHAVERTOWN PA 18708 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -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. REV-1512 EX+ (12-Q8) ~._.~ pennsylvania ~ DEPARTMENT OFREVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF DOROTHY M GORNIK FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1' DISCOVER CARD 1916 41.68 TOTAL (Also enter on Line 10, Recapitulation) $ 41.68 If more space is needed, insert additional sheets of the same size. • ~ PO Box 3 0 0 8 ~~ ~' ~~o ~ New Albany, OH 43054-3008 1 August 9, 2010 LDCXRA01 0003250 Dorothy M Gornik 4612 N Clearview Dr Camp Hill PA 17011-4012 I.,~i,ii~„I.~,iil~il~~~„~,I..~lili„~il,ill~,iii~„i~l~liiill~l Account Number Ending In: 1916 Current Balance $41.68 Amoun! Now Due $0.00 Amount Enclosed 000001986458854099~68000000000000000000000 Mail top portion in enciosed envelope Dear Dorothy M Gornik: ~~ -- This letter is to confirm `' 08/09/10 for Your authorization received over the phone on payment to your Discover Card from your bank account, using --- the information listed below: Payment Amount: $41.68 '~~ Bank Account Number Ending In: 8062 ~~' Date Pa ~~,~, Yment Presented to Your Bank: August 9, 2010 ~': ,~,~ Please call us immediately at the number below if there is an regarding this transaction. Thank you for Y Problem ~-- with the Discover Card, your continued participation ~~ ~~ Sincerely, ~~.. ..~ John Craven ~~ DFS Services LLC ~~ 1-800-347-7766 Account Number Ending In: 1916 r C7 X D 0 0 o 0 w N C11 O 1986458854099468 318N ~pD, 33705 / 40 1499 / 40 Qo Pri ~ on ieSydab/e papers This is an attempt to collect a debt and any information obtained may be used for that purpose. Discover.com Discovers, issued by Discover Bank, Member FDIC 100811 Page 1 of 1 02:39:59