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Home My WebLink About01-05-11. 1505610101 El4 (oi-io) ~~~-150~ OFFICIAL USE ONLY PA Department. of Revenue Pennsylvania oEP.q,»E»ro, aF.,»~E Coun Co Bureau of Individual Taxes ` ~ ty de Year File Number INHERITANCE TAX RETURN °~- - Po aox zatisoi ~ ng Harri"sburg, PA i'7iz8-o6oi RESIDENT DECEDENT" ENTER DECEDENT INFORMATION BELOW Social Security Number Date of peath MMDDYYYY Date of Birth MMDDYYYY 210-58-2302 11/17/2008 06/09/19~i3 Decedent's Last Name Suffix _ _ _ Decedent's First Name ... . Shelley _ - _ Nancy (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last,Name Suffix Spouse's First Name MI L MI ... . Spouse's Social Security Number ~ ' THIS RETURN "MUST BE FILED IN DUPGCATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Retum 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) O 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 tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AHD CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Diane M. Dils, Esquire (717) 232-9724 First line of address 1400 N. Second Street Second line of address City or Post Office State ZIP Code Harrisburg PA 17102 Correspondent's a-mail address: didllSwerizOn.net REGISTER OF WILLS USE O~L~' t ' ~ C.... _..; C~ ~ '"~ ~> r- t ~- i"~i'i t.li" 3 ~ ~ L~ ".7 ~~ :~:r ~ DA7~Ffi~D ~d, t ~-x C~"? {. ~ 4.~ C ._ } r "7 -~ -~ _: ~ r ~+ ~~ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ~uuttt~s DATE 01 /04/11 1400 N. Second St., Harrisburg, Pa. 17102 PLEASE USE ORIGINAL FORM ONLY _1505610101 Side 1 1505610101 J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: Nancy L. Shelley !' 210-58-2302 RECAPITULATION 1 : Real Estate (Schedule A) .................... ..... , , , , .. ..:. 1' , 125,000.00 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. 22,248.34 6. . Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property ! - (Schedule G) O Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8 147,248.34 9. Funeral Expenses and Administrative Costs (Schedule H) ...... 9 .......... ... . 19,740.42 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule q ........... .. . 10. ; 115,279.70 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 135,020.12 12. Net Value of Estate (Line 8 minus Line 11) .......... 12 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ... 12,228.22 an election to tax has not been made (Schedule J) ..................... ... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 12,228.22 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 - - _ _. _ (a)(L2) X .0_ 15. 16. Amount of Line 14 taxable ~ ` `~' ' '" ` ' `' _ _ _ _ at lineal rate X .0 45 16. 550 27 17. Amount of Line. 14 taxable _ _ .. . _ . at sibling rate X .12 17 18. Amount of Line 14 taxable _ at collateral rate X .15 18 19. TAX DUE ....................................................... ..19. _ 550.27 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 I„~ 1505610105 1505610105 J REV-1500 EX Page 3 Decedent's Complete Address: File Number Nancy Louise Shelley STREET ADDRESS 9 Sale Road cm Enola STATE PA ZIP 17025 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 550.27 Total Credits (A + B) (2) 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) 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) 550.27 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 ......:................:................................:.................. ..........:...........:........................ ^ a d. receive the promise for life of either payments, benefits or care? .............. , ,,,,,,.,,..,......,..,, ^ ......................... . 2. If death occurred after Dec. 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? .......................... n fxl 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, 1.995, 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)]. 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 yaunger 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 heal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 ?.S. §9116(a)(1)J. • 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(x)(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~- (11-08) `~ i~. Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF Nancy Louise Shelley FILE NUMBER 2008-01158 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 iointly-owned with rieht ~f c~~'.,L,,..~ti;., m..~...., ~:__~___. __ .,_~ _ .. _ •~ ~~~~~.. apwc a uccucu, anci~ auuiuvnai SN2BCS OT Lne Same SIZe. REV-i5o8 EX+ (u-io) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCFIEDIJLE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Nancy Louise Shelley - ~ 2008-01158. Include the proceeds of litigation and the dateChe proceeds were received by the estate. Ali property jointly owned with right of survivorship must be disclosed on Schedule F. If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(10-09) 4 Pennsylvania ~ SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS ... RESIDENT DECEDENT ESTATE Of FILE NUMBER Nancy Louise Shelley 2008-01158 Decedent's debts must be reported on Schedule Z. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Sullivan. Funeral Homes 8,171.00 Gingrich Memorials 2,629.00 B. ADMINISTRATIVE COSTS: L Personal Representative Commissions: 7,362.42 . Name(s) of Personal Representative(s) MallOr~Shelley __ __ ___ _ Street Address 216 Basin Hill Road .city. _Duncannon,-- --------- ------ ------- ----.----state __pq zIP 1702D Year(s) Commission Paid: 2010_ _ _ ______ _____________ 1, 500.00 2. Attorney Fees: 3. Family fxemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address _ City ___ State __ ZiP Relationship of Claimant to Decedent _ _________-__-_.-- 4. Probate Fees: 78.00 5, Accountant fees: 6. Tax Return Preparer Fees: 7. TOTAL (Also enter on Line 9, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 19, 740.42 REV-].51 ~X* ~1Z-o8, SCHEDULE I pennsylvania DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT FILE NUMBER ESTATE OF 2008-01158 Nanc Louise Shelle Report debts incurred by the decedent. prior to death that remained unpaid,at the date of death, including unreimbur sed medical expenses. VALUE AT DATE NUMf3ER DESCRIPTION OF DEATH I ~ Costs of Sale of Real Estate 112,348.98 677.76 F.M. Oppel (oil) 40.00 Walgreens Pharmacy 334.78 PP & L 24.00 USPS . 699.74 PAWC PNC -check printing fee 24'99 137.87 PP & L Bureau of Account Management 75.00 Afni collection agency for MCI 271.58 CAC Collection agency for East Pennsboro Ambulance 645.00 TOTAL (Also enter on Line 10, Recapitulation) ~ 115,279.70 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) ~~ r ~, Pennsylvania DEPARTMEN7 OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES FILE NUMBER: ESTATE OF: Nancy Louise Shelley 2008-01158 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. Mallory Shelley, 216 Basin Hill Road, Duncannon, Pa. 17020 Daughter one-third Megan Shelley, 1134 State Road, Apt. C. Duncannon, Pa. 17020 Daughter one-third Robert Shelley, 30 Miller St., Apt. C-1, Lemoyne, Pa. 17043 Son one-third 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: L 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. A, ~etclement Statement U.S. Department of Housing and Urban Development B. T e of Loan OMB A royal No. 2502-0265 ex Tres 11/30/2009 __ 1. ~1FHA 2. ^FmHA 3. ^Conv. Unins. 6. File Number 7. Loan Number B. Mortgage Insurance Case Number 4. JVA 5. ^Conv.lns. 09245 0000760074 441.9435723 is arm is Uri11 o gwe you a s a amen o ac a se en ws s. oun s pal o an y e se amen agen are s own. --- C. Note: Items marked "(p.o.cJ"were paM outside the cbsing; they are shown here for information purposes and are not included in the totals. TlfleEXpreSS Settlement System '. WMNING: Il is a a'une to knowingly make false stalemanta to the Urelad States on this or any other similar form. Penalties upon mnviclion can include a fine and imprisonment. For details see T'lle 18 U S Code Sect on 1001 a d s Cron Iola Printed t 0123/2009 at 1509 KS ~~' D. NAME OF BORROWER: Collette S. Garrett -- ,_ , ADDRESS: 102 Hawk Court, Mechanicsburg PA 17050 - E. NAME OF SELLER: _ - - Estate of Nancy L. Shelley ADDRESS 403 First Street, Summerdale, PA 17093 F. NAME OF LENDER: First National Bank of Chester County thru ADDRESS: AM Home Bank division, 3840 Hempland Road Mountville, Pa 17554 G. PROPERTY ADDRESS: _ 403 First Street, Summerdale, PA 17093 East Pennsboro Township H. SETTLEMENT AGENT: 1st Advantage Settlement Services Inc., Telephone: 717.591-7755 Fax: 717.591-7756 PLACE OF SETTLEMENT: 6375 Mercury Drive Suite 102 Mechanicsburg PA 17050 I. SETTLEMENT DATE: 1012312009 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION• 100. GROSS AMOUNT DUE FROM BORROWER 1 _ 400. GROSS AMOUNT DUE TO SFI I FR -- 101. Contract sales rice 125 000.00 401. ----- Contract sales rice 125 000.00 102. Personal Pro art 402. Personal Pro art 103. Settlement char es to borrower line 1400 7 563.43 403. 104. 404. -- ' 105. 405. Adjustments for items aid b seller in advance Adjustments for items paid by seller in advance 106. Cit /town taxes 406. Cit Itown taxes _ __ 107. Count taxes 10123109to12131109 91.56 407. Count taxes 10123109to12131109 91.56 108. School taxes 10123109 to 06130110 1 123.59 408. School taxes 10123/09 to 06130110 1 123.59 1109. Sewer & Trash 10123109 to 12131/09 87.50 409. Sewer & Trash 10123109 to 12/31109 87.50 ' 110- 410. ~ -- -__ _ 111. ^ __ ~ 411. - - - 112. 412. -i ---- --- _ __ i 120. GROSS AMOUNT DUE FROM BORROWER 133 866.08 420. GROSS AMOUNT DUE TO SELLER I 126 302.65 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. De osit or earnest mane 1 000.00 501. Excess De osit see instructions _ _ i 202. Princi al amount of new loans 122 735.00 502. Settlement char es to seller line 1400 19 921.21 203. Existin loan s taken sub'ect to 503. Existin loan s taken sub'ect to ', 204. PHFA Assistance 3 000.00 504. Pa off of First Mort a e Loan I 89,402.77 First National Bank of Chester Bank of Landisbur i 205. 505. -- i 206. 506. 207. 507. Ovemi ht Delive -Pa off 25.00 1st Advanta a Settlement Servi _ 208. 508. Inheritance Tax Escrow 8 010.00 1st Advanta a Settlement Servi II 209. 509. Adjustments for items un aid b seller Adjustments for items un aid b seller 210. Cit !town taxes 510. Cit /town taxes _ ~ 211. Count taxes 511. Count taxes 1212. School taxes 512. School taxes 213. 513. -- 214. 514. -- _215. Seller Assist 3 000.00 515, Seller Assist - -_- - _ 3 000.00 - - ~---- 216. _ _516. ~ --217. 51 Z -- - - r-- ---- _218. 518. - - ----- - _219. 519. - -- 220. TOTAL PAID BYIFOR BORROWER 129 735.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 120 358.98 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLE R 130t. Gross amount due from borrower line 120 133 866.08 601. Gross amount due to seller line 420 126 302.65 302. Less amounts aid b Ifor borrower line 220 129 735.00 602. Less reduction amount due seller line 520 120 358.98 303. CASH FROM BORROWER 4131.08 603. CASH TO SELLER 5.943.67 ,DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT cTTLEMENT STATEMENT iui i~~ i i~v- i ter ~r i v. i ~u~ iuvwn .~~~... File Number: 09245 PAGE 2 TitleExpress Settlement Svstem Printed 10/2312009 at 15:09 KS SETTLEMENT CHARGES PAID FROM PAID FROM J0. TOTAL SALES/BROKER'S COMMISSION based on rice $125 000.00 = 7 320.00 BORROWER'S SELLER'S Division of commission Tine 700 as follows: FUNDS AT FUNDS AT 701. 3 635.00 to RelMax 1st Advanta a SETTLEMENT SETTLEMENT 702. $ 3 685.00 to La ers Real LLC ~i 703. Commission aid at Settlement 7 320.00 i 704. Transaction Fee to Re/Max 1st Advanta a 250.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee 802. Loan Discount °/a 803. A sisal Fee to P Scott Archibald A sisal LR 375.00 804. Credit Re ort to First American Credco LR 38.70 805. Ins action Fee to First National Bank of Chester Coun thru LR 75.00 806. AUS Fee to First National Bank of Chester Coun thru LR 25.00 807. 1st American Flood Data to First National Bank of Chester Coun thru LR 12.50 808. Wire Fee to First National Bank of Chester Coun thru LR 25.00 809. Lender Admin Fee-Vision Ca Mto First National Bank of Chester Coun thru LR 325.00 810. FHA Mort a e Insurance Prem to De t of HSG & Urban Develo ment LR 2110.94 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE -' 901. Interest From 10/2312009 to 11/0112009 18.9100 /da 9 Da s LR 170.19 902. Mort a e Insurance Premium for to 903. Hazard Insurance Premium for to Libe Mutual Insurance 798.00 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance 3 mo. 66.50 /mo LR 199.50 1002. Mort a e Insurance mo. 54.96 Imo 1003. Cit Pro rt Tax mo. /mo 1004. Count Pro rt Tax 10 mo. 38.99 Imo LR 389.90 1005. School taxes 5 mo. 133.44 /mo LR 667.20 1009. A re ate Anal sis Ad'ustment LR •539.81 0.00 1100. TITLE CHARGES 1101. Settlement or dosin fee 1102. Abstract or title search 1103. Title examination 1104. Title insurance binder t 105. Document Pre ration ' 1108. Note Fees to Kristen D. Shiva 60.00 10.00 1107. Attome 's fees includes above items No: 1108. Titre Insurance to 1st Advanta a Settlement Services Inc. 737.81 indudes above items No: 1101-1104 25°/a PHFA 1109. Lendels Pdi -106700977 PASL 122 735.00 - j 1110. Owner's Poli -107118577 125 000.00 •737.81 t 111. 100 No Viol 300 Surve 900E to 1st Advanta a Settlement Services Inc. 150.00 i 1112. 1113. Closin SvcLtr to 1st Advanta a Settlement Services Inc. 75.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin Fees Deed 48.50 • Mort a 62.50 • Release 111.00 1202. Cit (Count taxlstam s Deed 1 250.00 • Mort a e 1 250.00 1203. State Taxlstam s Deed 1 250.00 • Mort a e 1 250.00 1204. Record 2nd Mort a to Cumberland Coun Recorder of Deeds 50.50 1205. Record Assi nment to Cumberland Cou Recorder of Deeds 37.00 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Sewer & Trash Thru 12131 to East Pennsboro Townshi 2 570.00 1302. 2008 Tax Claim to Cumberland Cou Tax Claim Bureau 2 473.62 1303. Wire In Fee to -1st Advanta a Settlement Services Inc. 10.00 1304. Taff Cert Fee to 1st Advanta a Settlement Services Inc. 10.00 1305. Ovemi ht Delive Fets-Plc to 1st Advanta a Settlement Services Inc. 25.00 1306. Email Pk (Doc C Fee to 1st Advanta a Settlement Services Inc. 35.00 1307. 2009 Coun IT Tax to Debbie Lu old 525.16 1308. Other Disbursements 1520 100.00 5 762.23 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section 7 563.43 19 921.21 HUD CERTIFICATION OF 9UYER AND SELLER I have carefully reviewed the HUD-1 Seltlemerd Statement and W the best of my knowledge and belief, it is a true and accurate statement of all receipts end disbursements made on my account w by main This Vansaction. 1 furdarr that I ve received a copy of the HUD-1 Sedlemenl Statement. //~ 9 /, ^ ,~ _ ~y^ l' Y {I l ~~ Gv L ~1 Lo1r0e 6. ~etr WARNW G: R IS A CRIME TO KNOW WGLY MAKE FALSE STATEMENTS TO THE The HUD-1 SeWement Statement which I have prepared is a true and aaurale account of this UNITED STATES ON THL9 OR ANY SIMRAR FORM. PENALTIES UPON CONVICTION transaclbn. I have causetl ar will cause Ute funtls to De disbursed in accordance with Nis statement CAN INCLUDE A FINE AND MPRISONMENT. FOR DETAILS SEE TITLE 18: . U.S. CODE SECTION 1001 AND SECTION 1010. SETTLEMENT AGENT: ` r DATE: ~ ~~~~'~ .-_~_ .~.._~__. ne~~c PAGE 3