HomeMy WebLinkAbout12-14-10
1505610140
REV-1500 ~ (01-10)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box 2sosol INHERITANCE TAX RETURN 2 1 1 0 0 1 5 2
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 4 2 2 4 8 6 9 7 0 7 1 1 2 0 0 9 0 6 3 0 1 9 3 2
Decedent's Last Name Suffix Decedent's First Name MI
P L Y L E Y J R C H A U N C E Y A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
P L Y L E Y B E R N I C E I
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
1 5 1 2 4 1 3 7 1 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)
Q 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 Telephon~e,Number r
R M A R K T H O M A S E S Q U I R E 7 1 7 ~~...-~ 6 2 0 0
C'7- r
REGISTE USE LY r"
C r .~-
.::'' CJ's ~ ~'
First line of address ~~~ ~ ~ c; ,,
1 0 ], S O U T H M A R K E T S T R E E T ~~ _~ 4=
Second line of address ~ ~ ~ ~~--^~-;;
.C' ~ -tea
City or Post Office State ZIP Code ~ DATE FILED
M E C R A N I C S B U R G P A 1 7 0 5 5
Correspondent's a-mail address: rmarkthomasCcD_gmail.com
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.
SIGNATU OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRESS /) / ~
172 DOUGLAS DR V V CARLISLE PA 170],3
SIGNA RER ~ T N REPRESENTATIVE /~ ~~~ f~D~
PLEASE USE ORIGINAL FORM ONLY
1505610140
Side 1
1505610140
e
101 SOUTH MAR_KET_STREET MECHA_NICSBURG PA 17055
1505610240
REV-1500 EX
Decedent's Name: CHAUNCEY A • PLYLEY~ JR •
Decedent's Social Security Number
1 4 2 2 4 8 6 9 7
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1
2. Stocks and Bonds (Schedule B) ...................................... 2. '
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. •
4. Mortgages and Notes Receivable (Schedule D) .......................... 4. •
0 ' ~ ~
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 2 4 1 4 4 6 . 9 5
7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property
arate Billin
Re
uested
~ Se
h
l
G
S
d
7 5 1 1 5 0. 8 0
.......
g
q
p
u
)
(
c
e
e .
8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 2 9 2 5 9 7 . 7 5
9. Funeral Ex enses and Administrative Costs Schedule H
P ( ) .................. 9. 6 2 1 . 5 0
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. •
11. Total Deductions (total Lines 9 and 10) ............................... 11. 6 2 1 . 5 0
12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 2 9 1 9 7 6 . 2 5
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................... 13. 0 . 0 0
14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... 14. 2 9 1 9 ? 6 . 2 5
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 .00 0 0 0 15.
16. Amount of Line 14 taxable
at lineal rate x o0 2 9 1 9 7 6. 2 5 1s.
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 ~ ~ ~ 18.
19. TAX DUE .................. ........................... .. ..... ..19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505610240
Side 2
1505610240
0. 0 0
0. 0 0
0. 0 0
0. 0 0
0. 0 0
J
REK-1500 EX Page 3
Dpr_edent's Cemnlete Address:
File Number
21 10 0152
DECEDENT'S NAME
CHAUNCEY A. PLYLEY, JR.
STREET ADDRESS
47 KITSZELL DRIVE
CITY
CARLISLE STATE
PA ZIP
17015
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
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.
Total Credits (A + B) (2) 0.00
(1) o.oo
(3)
(5)
(4)
0.00
0.00
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 : ................................................................ ...... ^ ^X
b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^
c. retain a reversionary interest; or .......................................................................................... ...... ^
d. receive the promise for life of either payments, benefits or care? ................................................. ...... ^ 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................................................................. ...... ^
3. Did decedent own an "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
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, undf
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
RSV-1509 EX+ (01-10)
' pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
CHAUNCEY A. PLYLEY JR. 21 10 0152
If an asset was made 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 ~tEIATIONSHIP TO DECEDENT
A. Bernice I. Plyley 7 Kitszell Drive
arlisle, PA 17013
C.
JOINTLY-OWNED PROPERTY:
ITEM
CUMBER LETTER
FOR JOINT
TENANT DATE
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 % OF
DECEDENT'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. /23/99 7 Kitszell Drive 265,000.00 50. 132,500.00
arlisle, PA 17013
Z. 8/17/99 achovia Bank, Checking Account #3783 1,939.19 50. 969.60
. O. Box 40028
oanoke, VA 24022
3. 9/05/03 achovia Bank, Checking Account #2220 215,954.69 50. 107,977.35
. O. Box 40028
oanoke, VA 24022
TOTAL (Also enter on Line 6, Recapitulation) $
241 446.95
If more space is needed, use additional sheets of paper of the same size.
RSV-1510 EX+ (08-09)
' pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
FILE NUMBER
CHAUNCEY A. PLYLEY JR. 21 10 0152
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
1. rrstown Bank, IRA Account #3225 7,692.65 100.00 0.00 7,692.65
27 Village Drive
Carlisle, PA 17015
2. Hart Family Fund II, LP (Chauncey had a 2.11% interest in this Fund which 43,458.15 100.00 0.00 43,458.15
passed to his wife, Bernice I. Plyley, pursuant to Chauncey's will which
is attached hereto. This entire amount was included on the Bernice I.
Plyley Estate Inheritance Tax Return filed under case number 21-09-0773.
he attached valuation dated 4/30/10 was used to determine the date of
eath value herein.
TOTAL (Also enter on Line 7, Recapitulation) I $ 51 150 80
If more space is needed, use additional sheets of paper 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
CHAUNCEY A. PLYLEY JR. 21 10 0152
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. (These expenses were included on the Inheritance Tax Return of Bernice I. Plyley, indexed at
File No. 21-09-0773, as debts. Bemice I. Plyley, the wife of Chauncey A. Plyley, Jr., died 31 days
after Chauncey A. Plyley, Jr., and none of these expenses had been paid prior to her death.)
B.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
State ZIP
2, Attorney Fees: R. Mark Thomas, Esquire
3, Family Exemption: (If decedent's address is not the same as claimants, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
500.00
4• Probate Fees: 121.50
5 Acxountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL (Also enter on Line 9, Recapitulation) $ 621.50
If more space is needed, use additional sheets of paper of the same size.
REV-1513 EX+(01-10)
' pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
nuns i~i~cv n of vi cv io
FILE NUMBER:
21 10 0152
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outs' ht spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. Bernice I. Plyley Spousal 100.00
47 Kitszell Drive
Carlisle, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0.00
If more space is needed, use additional sheets of paper of the same size.
LAST WILL ANll TESTAM ~ NT
BE IT REMEMBERED THAT
I, CHAUNCEY A. PLYLEY, JR., a resident of Cumberland County, Pennsylvania, being of
sound and disposing mind, memory and understanding, do make, publish and declare this to be my
LAST WILL.and TESTAMENT, hereby revoking any and all Wills and Codicils previously made
by me.
I
I declare that I am married to BERNICE I. PLYLEY, and that I have four (4) children,
LAURA ILENE HUBSCH, SUSAN LYNN KEMP, CHAUNCEY A. PLYLEY, -III aiid
WILLIAM R: PLYLEY.
11
I direct that all my just debts and funeral expenses shall be paid from my residuary estate as
soon as practicable ai~er my decease.
11I
I direct that all taxes that may be assessed in consequence Qf my death, of whatever nature
. and by whatever jurisdiction imposed, shall be paid from my residuary estate as a pout of the
..expense of the adtniiiistration of my estate:..
IV
I give, devise, and bequeath all my property, whether real. or personal, wherever situate,
including any property over which I may have a power of appointment to my -Wife, BERNICE I.
PLYLEY provided that she survives me by thirty (30) days.
V
If my wife, shall predecease or fail to survive me by thirty (30) days, I hereby make the
following specirc devise or bequest:
A. To my daughter, LAURA ILENE HUBSCH I give the .sum of ten thousand
($10,000:00) dollars. In the event that my daughter, Laura llene Hubsch shall predecease or fail to
survive me by thirty (30) days. then this giP. shall lapse.
VI
All the rest, residue and remainder of my Estate, whether real or personal, .wherever situate,
including ally property over which I may have a power of appointment shall be divided info three
'.
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,~
1
(3) equal shares with one (1) share passing to each of my tlvee (3) remaining children, SUSAN
LYNN KEMP, CHAUNCEY A. PLYLEY, III and WILLIAM R. PLYLEY, per stirpes, pursuant to
the terms of the hereinafter Trust.
V1I
TRUST
If my wife shall fail to survive me by thirty (30) days and I have any grandchildren who
A
inherit property under the terms of this Will who are under the age of twenty-one (:21) years, I
appoint my daughter, SUSAN LYNN KEMP as Trustee of the property that I have given to my
grandchildren. If SUSAN LYNN KEMP is unable or unwilling to act as Trustee, then I appoint my
son, CHAUNCEY A: PLYLEY, III as Trustee. if CHAUNCEY A. PLYLEY, III is unable or
unwilling to act as Trustee, then I appoint my soil, WILLIAM R. PLYLEY as Trustee.
A, .The assets that are transferred to the Trust shall be divided into approximately equal
shares for each of my grandchildren who inherits property under the terms of this Will under the age '
of twenty-one (21) years of age.
B. The Trust estate shall be administered until each grandchild reaches the age of twenty-
one (21) years. Until that time, the Trustee shall apply all net income alid principal of the Trust
estate as follows:
1) So long as my grandchild is under the age of twenty-one (21)
years of age, the net income of the Trust shall be paid to, or
applied for the benefit of my grandchild at such times and in such
amounts as the Trustee shall in his discretion deem necessary for
his support, welfare, maintenance a.nd education. Education-shall
be defined broadly to include not only that available in college,
but. also trade school and other similar training. In the event that
the income shall be insufficient to provide my grandchild with
adequate maintenance, support, welfare or education, the Trustee •
may invade the principal of this Trust for this purpose.
2) The Trustee in exercising his discretionary authority with respect
to the payment of income or principal of the Trust Estate to my ,
beneficiary, shall take into consideration any income or other
resources available to my grandchild from sources outside of this
Trust that may be known to the Trustee. The determination of the
Trustee with respect to the necessity of making payments out of
income or principal to my beneficiary shall be conclusive on all
personshowsoever interested in the Trust.
3) The Trustee shall accumulate and add to principal any net income
of the, Trust not paid out in accordance with the discretion
hereinabove conferred on the Trustee.
2
In the .event my grandchild predeceases me or dies prior to the
termination of this, Trust, the interest of my grandchild in the Trust
shall :'cease, except that, if he is survived by any legitimate
children born of a legal marriage, theli the Trustee shall pay net
income of the Trust to or apply the salve for the benefits of such
children of ~my deceased grandchild, in such amount or amounts
as the Trustee in lvs sole discretion may determine for support,
welfare and maintena<ce.
C. When my grandchild reaches the age of twenty-one (21) years, a calculation of the
property remaining in the Trust shall be made and the total thereof shall be distributed to him or her.;
D. My grandchild, as beneficiary of this Trust, shall not have any right to alienate,
encumber, or hypothecate his interest in the principal or income of the Trust in any manner, nor
shall any interest be subject to claims of his creditors or liable to attachment, execution or other
process of law.
E, In order to carry out the purposes of tlvs Trust established by this Will, the Trustee, in
addition to all other powers granted by this Will, or by law, shall have the following. powers over the
Trust estate, subject to airy limitation specified elsewhere ill this Will:
1) To retain any property received by the Trust estate for as
long as the Trustee considers it advisable.
2) To spend funds for the maintenance alid repair of real
. property.
3) To sell at public or private sale, exchalige or lease for a
period of time, any real or personal property and give
options for sale of the lease.
4) To execute aild deliver any deeds, leases, assignments or
other instrwnents as may be necessary to carry out the
provisions of this Trust.
5) To borrow money aild to mortgage or pledge any real or
personal property. .
6) ~ The Trustee shall maintain accurate records and accounts
and shall render statements to my beneficiary hereunder
showing receipts and disbtu•sements of principal and ~,
income no less frequently than annually. The Trustee shall
serve without bond alid shall receive fair and reasonable
compensation for administration of this Trust, not to exceed
• five (5%) percent of annual income.
7) To distribute property in kind.
8) To do all other acts that are in his judgment necessary or
desirable for the proper management, investment and
distribution of the Trust estate.
3
. ~, ~
~~ ~ •
VIII
If any person or beneficiary under this.Will objects to or contests the probate of this Will, or
any part thereof, or attempts to revoke or avoid the probate thereof, or attempts to set aside, or takes
any proceeding whatever, with the intended effect of voiding this Will or any part thereof, then and
in that event any devise, bequest or benefit given to or conferred upon such person or beneficiary
shall be and the same is revoked and annulled, and in that event such person or beneficiary shall
receive no part or benefit of my Estate.
IX
I nominate,. constitute and appoint my wife, BERNICE I. PLYLEY as Executrix of this
LAST WILL, to serve without bond. If my wife is unable or unwilling to actin that capacity, then I
nominate, constitute and appoint my children, SUSAN LYNN KEMP, CHAUNCEY A. PLYLEY,
III and WILLIAM R. PLYLEY as Co-Executors of this LAST WILL, to serve without bond.
IN WITNESS WHEREOF, I, CHAUNCEY A. PLYLEY, JR., have set my hand to this LAST
``A'
WILL this ~ da of 2001.
~Z y ~ ,
~~ ~ ~~~a
CHAUNCEY LYLEY,~Z~~
Signed, sealed, published and declared by the above-named CHAUNCEY A. PLYLEY, JR.,
as and for his Last Will and Testament, in the presence of us, .who, at his request ~ and in his
presence, and in the presence of each other, have hereunto subscribed our names as witnesses.
4
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ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND :
I, CHAUNCEY A. PLYLEY, JR., Testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act
for the purposes therein expressed.
~~~ ~~~~
CHAUNCE . PLYL , J .
Sworn or affirmed to and acknowledged before me by CHAUNCEY A. PLYLEY, JR., Testator,
this Z Z-day of LI/~~ , 2001.
rf!i , n.
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No Public
Notarial Seal
AnnA Carmody, Notary Public
''~' `~f~: ~ '' ~ ~. `- AFFIDAVIT M~a~nnioebur~ eo% Cumberland County
`` ~~ . ~..'' ~ ~~~ ~ i ~;' ~~ ~~~ My Commise cn Expb~as Mar,11,2002
~.
..'
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
We, ~/' i l~ ~ /t0'~-utS and ~~"E' ~ /^y •~ , ~ ~~~~~
the witnesses whose names are signed to the attached or fo egoing instrument being duly qualified
according to law, do depose and say that we were present and saw Testator sign and execute the
instrument as his LAST WILL; that CHAUNCEY A, PLYLEY, JR. signed willingly and that he
executed it as his free and voluntary act for the purposes therein expressed; that each of us in the
hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge,
the Testator was at the time 18 years of age or more, of sound mind and under no constraint or
undue influence.
Sworn or affirmed to
this Z Z- day of
..,, {
r~ i A,l ~
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'~ ~ ~~~ r r - ''~ Not Public
~' I~ ' r '~ 5 Notarial
seal
~, ,,~ Anne Carmody, Notary PubUc
' ,ter ;~,,,' MQaMAtliosburp Bo% Cumberland County
~ y ' ~ ~ ~. ~ My Gbrnmlee on Expires Mar. 11, 2002
t /~ "~ `~h~~ OMB Approval No. 2502-0265
(,~~=~j~j~*~;±) ~ A. Settlement Statement (HUD-1)
..
,AA1N OC~~t~
~ ~ ~
^ RHS 3. ^X Conv. Unins.
^ FHA 2'
1 6. File Number: 7. Loan Number: 8. Mortgage insurance Case Number:
.
. 10-84 5701114080
4. ^ VA 5. ^Conv. Ins.
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown. Items marked
"(p.o.c)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. Name & Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender:
,lames K. Winters, Carmen Winters, Brigitte M. The Estate of Bernice I. Plyley Fulton Mortgage Company
Burkholder 1 Penn Square, Lancaster, PA 17602
4407 Chandler Drive, Frisco, TX 75034
G. Property Location: H. Settlement Agent: I. Settlement Date: 12/0'V2010
47 Kitszell Drive A&A Abstract & Settlement Services Disbursement Date: 12/01/2010
Carlisle, PA 17015 Telephone: 717-249-0020 Fax: 717-249-0026
South Middleton Township Place of Settlement: TitleExpress
337 Lincoln Street, Carlisle, PA 17013
:.100. Grass'Amoiu~nt Due from Hoirowrer
101. Contract sales price 265,000.00
102. Personal ro ert
103. Settlement charges to borrower (fine 1400) 7,265.64
104.
105.
Ad'ustments for items aid b seller in advance
106. Cityltown taxes to
107. County taxes 12101/2010 to 12/31/2010 47.46
108. Assessments 12/01/2010 to 06/30/2011 1,308.64
109.
110. HOA Annual Assessn 12/0112010 to 12131/2010 7.81
111.
112.
120, Gross Amount Due from Borrower 273,629.55
X200. Amountti..~sl~ Fb at .iri ~eh~lif af',8di~ror
201. Deposit or earnest money 5,000.00
202. Principal amount of new loan(s) 212,000.00
203. Existin loa s taken sub'ect to
204.
205. Monies received by wire 53,000.00
206. Conf# 20101130 B1QGC4C 00370411301029
207.
208.
209.
Ad ustments for items un aid b seller
210. Cityltown taxes to
211. County taxes to
212. Assessments to
213.
214.
215.
216.
217.
218.
219.
220• Total Paid b /for Borrower 270,000.00
J00. Case: ~ Settlement fromlta Borrawer
301. Gross amount due from borrower (line 120) 273,629.55
302. Less amounts paid by/for borrower (line 220) 270,000.00
303. Cash ^X FrBm ^ To Borrower 3,629.55
40b. Grass Amourllt Due to Seller
401. Contract sales price 265,000.00
402. Personal ro ert
403,
404.
405.
Ad'ustments for items aid b seller in advance
406. Cityltown taxes to
407. County taxes 12/01/2010 to 12/31/2010 47.46
408. Assessments 12/0112010 to 0613012011 1,308,64
409.
410. HOA Annual Assessn 12101 /2010 to 12/31 /2010 7.81
411.
412.
420. Gross Amount Due to Seiler 266,363.91
500: . RedUcflons In Amount Df~e to.'Sell+~r
501. Excess deposit (see instructions)
502. Settlement charges to seller (line 1400) 44,155.24
503. Existin loa s taken sub'ect to
504. Payoff of first mortgage loan
505, Payoff of second mortgage loan
506,
507.
508.
509.
Ad'ustments for items un aid b seller
510. Cityltown taxes to
511. County taxes to
512. Assessments to
513.
514.
515.
516.
517.
518.
519. .
520. Total Reduction Amount Due Seller 44,155.24
G00. Cash ~It Battlement talfrom 5efler
601. Gross amount due to seller (line 420) 266,363.91
6Q2, Less reductions in amount due seller (line 520) 44,155.24
603. Cash ^X To ^ From Seller
an repo ing e a a. is agency may no co a is m orma ion an you are no requue
o comp e e 222,208.67
this form, unless It displays a currently valid OMB control number. No confidentiality Is assured; this disclosure Is mandatory. This Is designed io provide the parties to a RESPA covered transaction with information during the
settlement process.
Previous editions are obsolete Page 1 of 4 HUD-1
L. Settlement Charges
'700. ToteFfZeal Esf~ite,Broker Fees " _ Paid Flom Paid From
Division of ~ommissan line 700 as follows: Borrower`s `Seller's
701 • $15,900.00 to C-21 A Setter Way Fu ndS at Funds at
702. $o.oo to Settlement 'Settlement
703. Commission paid at settlement 15,900.00
704. Broker Fee to C-21 A Better Way 175.00
.::800.,,: flame P~ able fn Cannectio~ wititl'Loan .
801. Our origination charge (Includes Origination Point % or $0.00) $695.00 (from GFE #1)
802. Your credit or charge (points) for the specific interest rate chosen $ (from GFE #2)
803. Your adjusted origination charges (from GFE A) 695.00
804. Appraisal fee to Central Penn (from GFE #3) 150.00
805. Credit report to Credstar (from GFE #3) 12.89
806. Tax service to from GFE #3
807. Flood certification to American Flood Services (from GFE #3) 11.50
808. to
900. Items R wired b .Lender:ta be Paid in`Advance `
901. Daily interest charges from from 12/01/2010 to 01/0112011 @ $21.0548Iday (from GFE #10) 652.70
902. Mortgage Ins. Premium for months to (from GFE #3)
903. Homeowner's insurance for 12 months to USAA (from GFE #11) 631.80
904. months to from GFE #11
~AfM. '.I~e~esnere Mnnai4drl ua+h I enrie~
1001. Initial deposit for your escrow account (from GFE #9)
1002. Homeowner's insurance months $ 52.651month $0.00
1003. Mortgage Insurance months $ 0.00/month $0.00
1004. City Property Tax months $ O.OOlmonth $0.00
1005. County Property Tax months $ 48.12Imonth $0.00
1006. Assessments months $ 188.651month $0.00
1007. Aggregate Adjustment $0.00
;11DO. Title ohs es ,
1101. Title services and lender's title insurance (from GFE #4) 1,266.50
1102. Settlement or closing fee to $
1103. Owner's title insurance (from GFE #5) 806.25
1104. Lender's title insurance $275.00
1105. Lender's title policy limit $212,000.00
1106. Owner's title policy limit $265,000.00
1107. Agent's portion of the total title insurance premium $734.34
1108. Underwriter's portion of the total title insurance premium $346.91
1109. Attorney Fees to Abom & Kutulakis $602.50
1110. E-mail Fee to A&A Abstract $50.00
1111. Settlement Fee to A&A Abstract $200.00
1112. Title Search to A&A Abstract $75,00
1113. Wire Fee to A&A Abstract/Orrstown Bank $24.00
1114. Overnight Mail Fee to A&A Abstract/Fed Ex $10.00
1115. Notary Fee to Keliy f3aker __ _ $30.00 10.00
1200.: Government fZe+cairtlin and Transfer Cha ° es
1201. Government recording charges (from GFE #7) 214.00
1202• Deed $64.00 Mort a e $96.00 Release $0.00
1203, Transfer taxes (from GFE #8) 2,650.00
1204. City/County tax/stamps Deed $2,650.00 Mort a e $0.00
1205. State Tax/stamps Deed $2,650.00 Mort a e $0.00 2,650.00
1206. Deed $0.00 Mort a e $0.00
1207. Record 2 Power of Attorneys $ 54.00
1300.=AdditiorfaLSetttement Cba~ es
1301. Required services that you can shop for (from GFE #6)
1302. Survey to $
1303. to
1304. 2010 CountylTwp. taxes to Robert C. Cairns, Tax Collector $577.49 P.O.C. S`
1305. 2010-11 School Taxes to Robert Cairns, Tax Collector $2,263.76 P.O.C. S`
1306. Final Water/Sewer - Acct# 017098 to South Middleton Townshi Authorit 73.78
1307. Home Warranty to American Home Shield 435.00
1308. Repairs to Radon mitigation system to American Radon Solutions 75.00
1309. Inheritance Tax Escrow - Chauncey Ito A&A Abstract 24,971.46
1310. Resale Certificate to Ma a le Villa a Homeowners Assoc. 40.00
. ~ i ~ • ~ ~ 7,265.64 44,155.24
*Paid outside of closing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er.
Previous editions are obsolete Page 2 of 4 HUD-1
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Loan Terms
.-Gaud F~itl ~st~mate ~ ' HUa-i
695.00 695.00
o.oo o.oo
695,00 695,00
2,650.00 2,650.00
Goon 1=~iith Estimate . ~.; HUD-1 ~,
155.00 214.00
450.00 150.00
40.00 12,89
11.50 11,50
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$ -268.11 or -40.8393°1°
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0.00 0.00
126,33 652.70
500.00 631.80
1,226.50 1,266,50
300.00 806.25
~~~~ .i~itf~~ I~ arnobnt is .~ ~ ~ $212,000.00
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$1,528.60 includes
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^ Interest
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^X No
^ Yes
it can rise t
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,
o a max
mum o
%. The first chan e
9
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~ will be on 1 1 and can change again every years after / / .Every change
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4 Q' 4 4~ date our interest rate can increase or decrease b %,
~ Y y Over the life of the loan, your
~
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t : ~ 7 ~ 1
~; interest rate is guaranteed to never be lower than % or higher than %.
~
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^X No. ^ Yes, it can rise to a maximum of $
d ~ a?.9
fa#'~+red for'
p r eP
4 C 1~R 2M1t
X^ No. ^ Yes, the first increase can be on / ! and the monthly
I ~
{ ; a~ ~ a ~ ~ s ~~ ~ ~° ~
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~ he maximum it can ever rise to is $ ,
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es, your max
mum prepayment penalty is $ .
' , ~ ~;~1 '~ ~a,~ c ~ °e~ ti
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0 No. ^ Yes, you have a balloon payment of $ due in
i
,:, ~S~ r s ? r
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ears on
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X^ You do not have a monthly escrow payment for items, such as property taxes
k
1 t
Y
p ~ ~',. {~ ~'` l ~°7 r 1 ~
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9~
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~ and homeowner's insurance. You must pay these items directly yourself.
si
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' ^ You have an additional monthly escrow payment of $
~
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54
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,~~ "~ ~~
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that results in a total initial monthly amount owed of $ ,This includes nnci al interest
P~ P
any mortgage insurance and any items checked below:
~
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3
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,
~•~«. ~~ r~~ ~~a~C ai-y yuesuuns aUeut me aetuement ~narges and roan Terms listed on this form, please contact your lender.
Previous editions are obsolete Page 3 of 3 ~ HUD-1
HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and
disbursements made on my account or by me in this transaction. I further certify that {have received a copy of the HUD-1 Settlement Statement.
~ 4
James K. Winters Carmen Winters
___..
Bri .Burkholder
The Estate of Bernice I. Plyley
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be
disbursed in accordance with this statement.
v
SETTLE ENT A ENT DATE
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND {MPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010.
Previous editions are obsolete Page 4 of 4 HUD-1
1 Name of Borrower:
James K. Winters
Carmen Winters
Brigitte M. Burkholder
Name of Seller:
The Estate of Bernice I. Plyley
~, ~,
"~ ~ ~~ate~ "'f 2!1 /10
The Estate of Bernice I. PI ey
File Number
10-84
TitleExpress
Prepared 12/01/2010 at 11:20 am
James K. Winters
Carmen Winters
1-,~---..'~~.'
r
' tte M. Burkholder
Date 12/1 /10
Date 12/1 /10
Date 1211!10
Note: This a e is furnished to ive ou an itemization of the amounts shown on Lines 1101, »03 and ~'~ - ~ '~ ~'~ ~. "`
P g & Y ~ ,, ~ ~~ ~:,'~
1104 of the Settlement Statement (HUD-l). This page accompanies but is not a part of the
f, ~ r
f';: L .
settlement statement. if a discrepancy exists, the information shown on the Settlement Statement ~ y ~ ~
(HUD-1) applies. f ',; ~~ ~~..,_ .. ~ ~~