HomeMy WebLinkAbout01-03-11150561,0140
1500 EX (01-10)
-' REV
- OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes
INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601 2 1 1 0 0 4 6 5
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Deat h MMDDYYYY Date of Birth MMDDYYYY
1 7 4 3 6 7 0 2 9 0 4 2 7 2 0 1 0 0 2 1 9 1 9 4 5
Decedent's Last Name Suffix Decedent's Firs t Name MI
A T W O O D I L O N A G
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
1. Original Return
4. Limited Estate
^X 6. Decedent Died Testate
(Attach Copy of Will)
9. litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust ~
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
S T R E E T
State ZIP Code
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
R O B A K R U G E S Q U I R E 7 1 7 2 9 2 5 6 1 5
First line of address
P O B O X
Second line of address
5 3 E A S T
City or Post Office
D O V E R
1 5 5
D A N A L
Correspondent's a-mail address:
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
REGISTER OF WILLS USE ONLY
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI PERSC~RESP BLE FOR FILING RETURN p~/~~~`~
ADDRESS ' '
PO BOX 155 DOVER PA 173],5
SIGNATURE OF PREPARER THER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
L 15as61o140
Side 1
1505610140
~~
J
1505610240
REV-1500 EX Decedent's Social Security Number
Decedent's Name: I L O N A G• A T W O O D 1 7 4 3 6 7 0 2 9
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1. 8 1 0 0 0• 0 0
2. Stocks and Bonds (Schedule B) ...................................... 2. •
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. •
4. Mortgages and Notes Receivable (Schedule D) .......................... 4. •
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 1 0 1 2 5 2 . 9 7
6. Jointly Owned Property (Schedule F} ^ Separate Billing Requested ....... 6. •
7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property
(Schedule G} ~ Se
arate Billi
R
t
d
7
p
ng
.......
eques
e .
8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 1 8 2 2 5 2 • 9 7
9. Funeral Expenses and Administrative Costs (Schedule H) ........... ....... 9. 2 0 1 9 7 . 0 2
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ...... ....... 10. 6 8 8 6 8 . 3 6
11. Total Deductions (total Lines 9 and 10) ........................ ....... 11. 8 9 0 6 5 . 3 8
12. Net Value of Estate (Line 8 minus Line 11) ..................... ....... 12. 9 3 1 8 7 . 5 9
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............... ....... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ............... ....... 14. 9 3 1 8 7 . 5 9
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 0 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X .0 0 0 0 16.
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 9 3 1 8 7. 5 9 1 g,
19. TAX DUE .................... ......................... .. ..... ..19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0. 0 0
0. 0 0
0. 0 0
1 3 9 7 8. 1 4
1 3 9 7 8. 1 4
0
Side 2
150561,0240 1505610240
t
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 10 0465
Tax Payments and Credits:
~. Tax Due (Page 2, Line 19) (1) 13,978.14
2. CreditslPayments 13,450.58
A. Prior Payments
B. Discount 707.92
Total Credits (A + B) (2} 14,158.50
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) 180.36
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 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 : ...................................................................... ^ Q
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q
c. retain a reversionary interest; or ................................................................................................ ^ 0
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^ Q
3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ......... ^ Q
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? .................................................................................................. ^ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent [72 P.S. §9116 (a) (1.1) (i)J.
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory 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)j.
• 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.
REV-1502 EX+ (01-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF: FILE NUMBER:
ILONA G. ATWOOD 21 10 0465
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. I Sale of real estate at 101 South Street, Enola PA ~ 81,000.00
See attached HUD-1
TOTAL (Also enter on Line 1, Recapitulation.)' $ 81,000.00
If mare space is needed, use additional sheets of paper of the same size.
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
--
ESTATE OF FILE NUMBER
ILONA G. ATWOOD 21 10 0465
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. First National Bank of Marysville 50,446.59
Cert of Deposit # 795
2. Net proceeds received from public sale of personal property and car 2,873.85
3. Allstate auto insurance refund 108.60
4. Verizon refund 8.35
5. Comcast refund 15.32
6. M & T Bank checking account 45,934.90
7. State income tax refund 95.30
8. Federal Income tax refund 1,035.00
9. Homeowners Insurance refund from Erie Insurance 157.00
10. Flood Insurance refund from Franklin Assurance 578.06
TOTAL (Also enter on line 5, Recapitulation} I $ 101,252.97
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ILONA G. ATWOOD 21 10 0465
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Richardson Funeral Home 1,700.00
2. Costs for disposal of ashes per deceased's wishes 300.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) Rob A. Krug, Esquire 9,000.00
street Address 53 East Canal Street
City Dover State PA Zlp 17315
Year(s) Commission Paid: 2010
2. Attorney Fees: Krug Law Firm 2,000.00
3, Family Exemption: (If decedents address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: Register of Wills of Cumberland County 335.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. Debts and deductions 10.00
8. Reserve for future filings 100.00
9. Release filing fees 10.00
10. Postage 44.00
11. Notary fees 35.00
12. Home Instead Vistiting Nurses--last illness 4,412.52
13. Hardy's Auction Service--Commission and expenses for real estate sale 2,250.00
TOTAL (Also enter on Line 9, Recapitulation) ~ $ 20,197.02
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ILONA G. ATWOOD 21 10 0465
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Settlement charges from HUD-1 855.00
2. Chase Home Finance--payoff of home mortgage from HUD-1 64,551.51
3. 2010/11 School taxes 854.41
4. Attorneys fees due incurred prior to death 1,000.00
5. Monthly mortgage payments to Chase Home Finance up to time of safe 596.17
6. Comcast 59.10
7. PPL 102.72
8. PA American Water 79.82
9. UGI 115.58
10. Capital One Credit Card 410.10
11. Verizon 24.12
12. PSERS reimbursement for unearned pension payment 104.83
13. East Pennsboro Township sewer/trash 115.00
TOTAL (Also enter on Line 10, Recapitulation) I $ 68,868.36
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania ~ SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ILONA G. ATWOOD 21 10 (14F5
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. Heinz Kaminsky Collateral 46,593.80
2. Willi Kaminsky Collateral 46,593.79
ENTER DOLIAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
It mare space is needed, use additional sheets of paper of the same size.
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LAST WILL AND TEST
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I, ILONA G. ATWOOD, of .101 South Street, West Fairview, Cumberland ~~
County, Pennsylvania, being of sound mind, memory and understanding, do make,
publish and declare this as and for my Last Will and Testament, hereby revoking and
making null and void any and all Wills and Testaments and writings in the nature thereof
by me at any time heretofore made.
ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my
demise as may be convenient.
ITEM Z: All the rest, residue and remainder of my estate, of whatsoever nature and
wheresoever situated, whether it be real, personal or mixed, including property over
which I have a power of appointment, I give, devise and bequeath unto my cousins,
Heinz Kaminsky and Willi Kaminsky, in equal shares per capita.
ITEM 3: I direct my Executor to pay all inheritance, estate, succession and legacy taxes
of whatsoever nature and kind, to which my Estate or the transfer of any property passing
hereunder or otherwise passing by reason of my demise, may be subject and to charge
such taxes against my residuary estate, it being my intention that none of the aforesaid
taxes, either federal or state, on any property required to be included in my gross estate,
under the provisions of any state or federal law now in force or hereafter enacted, shall be
prorated among the persons interested in my Estate to whom such property is or may be
transferred or to whom any benefit accrues.
W~ ~74
~~ ~ /~
~LONA G. ATWOOD
ITEM 4: I appoint Rob A. Krug as Executor of this my Last Will- and Testament.
Should Rob A. Krug fail to act as Executor for any reason, I then appoint Vicki L. Bode
as Executor hereunder.
ITEM 5: I direct that my Executor or his successor shall not be required to give bond for
the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~~~`
day of__~~~ ~/~~ / > 2010.
ILONA G. ATWOOD
The preceding instrument, consisting of this and one other typewritten page was on
the day and date thereof signed, sealed, published and declared by ILONA G. ATWOOD
the Testatrix herein named as and for her Last Will and Testament, in the presence of us,
who at her request, in her presence and in the presence of each other, have subscribed our.
names as witnesses hereto.
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF YORK
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Wc, ILONA G. ATWOOf, ,
,the Testatrix and the witnesses respectively,
whose names are signed to the foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testatrix signed and executed the instrument
as her Last Will and Testament, and that she signed willingly, and that she executed as
her free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses, and
that to the best of their knowledge, the Testatrix was at the time eighteen years of age or
older, of sound mind, and under no constraint or undue influence.
W~S
~_ .. ~<~~
ILONA G. ATWOOD
SWORN TO AND SUBSCRIBED
BEFORE ME THIS (o '~ DAY
OF ~ /lt..~ , 2010.
` COMMONWEALTH QF PENNSYLVANIA
' (SEAL) Notadei gam{
NOTARY PUBLIC vtdd ~ ~~ ~+Pue+~c
Dover Bao, Yak County
~ Corrx->~ion ~r+es Oct 23, 2011
Member, Pennsylvania Aasociatlon of Notaries
A. Settlement Statement U.S. Department of Housing and Urban Development
C. Tvns ..~ t .,~.. AMR Annrnval Nn ~~m_n~~s
1. ^FHA 2. ^FmHA 3. OConv. Unins.
4, pVA 5. OConv.lns. 6. File Number
10.43 7. Loan Number 8. Mortgage Insurance Case Number
is i o give you a erne n oun pa an e e en agen ara s awn.
C. Note: Itsms marked "(p.o.c.)" were paid outside the dosirp; they are:sown here for ktformatian purposes and ara rwt Included in the totals.
WARNING: It is a aims to knowingty make tales atetemente to Inc United Stelae on this or an other simller forth. Penalties upon
conviction can Include a fine and im sorxnent. For details acs: Tdk 18 U. S. Code Section 1001 end Section 1010.
TItIeEXpreSS Settlement System
D. NAME OF BORROWER: Mark L. Myers and Jill L. Myers
ADDRESS: P. 0. Box 249 Valle Street Summerdale PA 17093
E. NAME OF SELLER: The Estate of Ilona G. Atwood
ADDRESS: 101 South Street West Fairview PA 17025
F, NAME OF LENDER:
ADDRESS:
G. PROPERTY ADDRESS: 101 South Street, Enola, PA 17025
East Pennsboro Townshi
H. SETTLEMENT AGENT: ABtA Abstract 8 Settlement Services, LLC
PLACE OF SETTLEMENT: 337 Lincoln Street Carlisle PA 17013
I. SETTLEMENT DATE: 0810412010
J. SUMMARY OF B RR R'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales rice 81 000.00 401. Contract sales rice 81 000.00
102. Personal Pro rt 402. Personal Pro art
103. Settlement char es to borrower line 1400 1 648.75 403.
104. 404.
105. 405.
Ad'ustments for items aid b seller in advance Ad'ustments for items aid b seller fn advance
107. Count taxes 08104110 to 12131110 83.18 407. Count taxes 08104110 to 12131/10 83.18
108, School Taxes 08/04110 to 06!30111 628.20 408. School Taxes 08104110 to 06130111 628.20
109. 409.
110. 3rd Qtr. Wtr/SwrlTr Proration 70.00 410. 3rd Qtr. Wtr/SwdTr Proration 70.00
111• 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 83 430.13 420. GROSS AMOUNT DUE TO SELLER 81 781.38
200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. De sit or earnest mone 5 000.00 501. Excess De osit see instructions 5 000.00
202. Princi al amount of new loans 502. Settlement char es to seller line 1400 1 709.41
203. Existin loans taken sub'ect to 503. Existin loans taken sub'ecl to
204. 504. Pa off of First Mort a e Loan 64 551.51
Chase Home Finance LLC
205. 505.
206. 506.
207. 507.
208. 508,
209, 509.
Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller
213• 513.
214. 514.
215. 515.
216. 516.
217. 517.
218• 518.
219• 519.
220. TOTAL PAID BY/FOR BORROWER 5 000.00
300. CASH AT SETTLEMENT FROM OR TO BORROWER 520. TOTAL REDUCTION AMOUNT DUE SELLER 71 260.92
600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower line 120 83 430.13 601. Gross amount due to seller line 420 81 781
38
302. Less amounts aid b !for borrower Tine 220 5 000.00 602. Less reduction amount due seller line 520 .
71 260
92
303. CASH FROM BORROWER 78 430.13 603. CASH TO SELLER .
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SUBSTITUTE FORM 1099 SELLER STATEMENT: Ths IMortnetkxr contained herein fa knportanl tax infortnalbn and Is being furnished to the Internal Revenue Service. If you ara required to file a return,
a negligence penalty tx other aertctlon will t>e Imposed on you if this item Is required to be reported and the IRS determines Nat h has not been reported. The Corriracl Sales Price described on
Ilne 4401 above eonslltules the Gross Proceeds of thb transaction.
SELLER INSTRUCTIONS: If this real estate was your Prindppeel residence, file Form 2119, Sele or Exchange o/ Prlncipel Residence, for any gain, with your Income tax return; for other transactions,
complete the applicable parts of Forth 4797, Form 8252 and/or Sohsduk D (Form 1040).
number, required by law to provxfe Ute seltlemeM ageM'(Fed. Tax ID No: )with your corteG taxpayer kfentfiaition number. If u do not rovide
you may be subject to cNfl or akninal peneftfes Imposed law, nU3er naTtiesT- •u I caN that the number shown on this atatemr~ ism correct t fur correct taxpayer identification
~ ~ Pen ry' ~ Y payer Identification number.
TIN:
SELLER(S) SIGNATURE(S):
SELLER(Sj NEW MAILING ADDRESS:
U.3. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 10.43
nrrT~ cuCt\IT QTATC\ACLIT Tiflu~vnrocc Golflamant SvstPm
PAGE 2
JL 1 1 LL.n~Vn ~ v ~ n ~ r.n~r.. ~ - --
L. SETTLEMENT CHARGES
PAID FROM
PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on rice $81 000.00 = BORROWER'S SELLER'S
Division of commission {ine 700 as follows: FUNDS AT FUNDS AT
701 to SETTLEMENT SETTLEMENT
702, $ to
703. Commission aid at Settlement
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Ori ination Fee
802. Loan Discount
803. A raisal Fee
804. Credit Re rt
805. Lender's Ins ection Fee
806. Mort a e A lication Fee
807. Assum tion Fee
808.
809.
810.
811,
900. ITEMS REQU{RED BY LENDER TO BE PAID 1N ADVANCE
901. lnteresk From to Ida
902. Mort a e Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001, Hazard Insurance mo. /mo
1002. Mort a e Insurance mo. /mo
1003. Cit Pro rt Tax mo. Imo
1004. Count Pro rt Tax mo. Imo
1005. School Taxes mo, Imo
1009. A re ate Anal sis Ad'ustment 0.00 0.00
1100. TITLE CHARGES
1101. Settlement or closin fee to ABr,A Abstract ~ Settlement Services LLC 100.00
1102. Abstract or title search to A81A Abstract & Settlement Services LLC 50.00
1103. Title examination
1104. Titte insurance binder
1105. Document Pre aration
1106. Note Fees to Kell Baker 20.00 15.00
1107. Attorne 's fees to B ron Walker 304.00
includes above items No:
1108. Title Insurance to Stewart TitlelA&A Abstract 290.75
includes above items No:
1109, Lender's Po1ic NONE
1110. Owner's Polic 81 000.00 - 290.75
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordin Fees Deed 82.00 ~ Mort a e $ • Release 62.00
1202. Cit /Count tax/stam s Deed $610.00 • Mort a e 810.00
1203. State Taxlstam s Deed 810.00 • Mort a e 810.00
1204,
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Surve
1302. Pest Ins ection
1303. 2010 Cnt /Tw Tax house/lot to Debbie Lu old Tax Collector P.O.C. 249.85 Seller
1304. 2010-11 School Tax house to Debbie Lu old Tax Collector 692.73
1305. 2010-11 School Tax lot to Debbie Lu old Tax Collector 161.88
1306. Wire Fee to A8A Abstract & Settlement Services LLC 12.00
1307, Cashier's Check Fee to Orrstown Bank 10.OC
1308. Tax Certification to Debbie Lu old Tax Collector 20.Of
1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 1,848.75 1,709.41
I have carefully reviewed the HUD-1 Satllemenl Statement and to Iha best of my knowladpe and belie/, it is a true an accurate statement of a ceipls and disbursements made on my account or by me
in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement.
. ~~`n.~ ~'~tiv ~
M rx ~. Myers ,
yer
t
e s e o one
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction.
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION 1 /faun caused a wilt cause the funds to be disbursed in accordance with this statement.
CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 1B:
U.S. CODE SECTION 1001 AND SECTION 1010. By /e~ ~ ~~r~ f