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HomeMy WebLinkAbout01-14-11 1505610143 1500 ~``°'-'°' --~ REV - OFFICIAL USE ONLY PA Department of Revenue Pennsylvania county code veer File Number Bureau of Individual Taxes 0°""T'~"r~' Po Box.2soso~ INHERITANCE TAX RETURN 21 09 1201 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 195 16 3858 11 22 2009 05 24 1924 Decedent's Last Name Suffix Decedent's First Name MI ZEIGLER MARY JANE (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 x 1. Original Retum ^ ^ 2. Supplemental Retum ^ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ^ ^ qa. Fulure Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) g, Decedent Died Testate ^ 7, p~ece~e~t PY ~ntgrn~)a Living Trust ~ 8. Total Number of Safe Deposit Boxes (( (Attach copy of wily ^ 9. Litigation Proceeds Received ^ 10. ~tweeni23i ~1 ~t,~date~of death ^ 11,Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDMUND G MYERS (717) 7 61 4 5 4 0 `' __ ~., REGISTER OF'1i~E>I~SE t~I~Y ~ `~ 7 , -..1 ~._ -= rr-t ---' ~ ~ ~ First line of address 301 MARKET STREET Second line of address PO BOX 109 City or Post Office LEMOYNE ~--• • r J ~--'r _ \. ~~.7 l~ .i i ~1~ ~ , ~ ~--- ~r: DATE FILED State ZIP Code PA 17043 Correspond 'se-mail d ss: ~li~~~LJ~'a~'•~""' Under 'es o ry'ury I that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is d cory~lle aration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. Terry R Sul~aberger Jr. X13 Venice Avenue Carlisle PA 17015 SIG RE OF PREPARER OTHER THAN REPRESENTATNE DATE ~/,~,~„~( ~~_ EDMUND G. MYERS 1113 ~-~01 ADDRESS 301 MARKET STREET, LEMOYNE, PA 17043 Side 1 1505610143 1505610143 ~- t REV-1500 EX 1505610243 Decedents Name: Zeigler, Mary Jane 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 8~ Notes Receivable (Schedule D) ........................................................ 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous coq Probate Property (Schedule G) u Separate Billing Requested............ 7. g. Total Gross Assets (total Lines 1-7) ..................................................................... 8. Decedent's Social Security Number 195 16 3858 119,000.00 4,155.02 10,172.34 133,327.36 9,997.53 9. Funeral Expenses 8 Administrative Costs (Schedule H) ....................................... 9. 12,071.33 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 22,068.86 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 111 , 258.50 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 111 , 258.50 14. ................... Net Value Subject to Tax (Line 12 minus Line 13) ............................ 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15. (a)(1.2> x .oo 16. Amount of Line 14 taxable 111 , 258.50 16. at lineal rate X .045 17. Amount of Line 14 taxable 0 . 0 0 17. at sibling rate X .12 18. Amount of Line 14 taxable 0 . 0 0 18. at collateral rate X .15 19. Tax Due ................................................. ................................................................ . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 5,006.63 0.00 0.00 5,006.63 Side 2 ~, 1505610243 1505610243 REV-1500 EX Page 3 nereAnnt~s C_mm~lete Address: File Number 21-09-1201 ..........~..- . . _. .r---- - ---- - - - - DECEDENTS NAME Zeigler, Mary Jane STREET ADDRESS 3950 Mountain View Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund (1) 5,006.63 Total Credits (A + B) (2) 0.00 (3) 77.89 (4) 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) S,0$4.rJ2 Make Check Pa able to: REGISTER OF WILLS, AGENT. _~~z. 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 :............................................................................... ^ 0 b. retain the right to designate who shall use the property transferred or its income :.................................. c. retain a reversionary interest; or ............................................................................................................... x d. receive the promise for life of either payments, benefits or care? ............................................................ ^ 0 2. If death occurred after Decembe'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?....... ^ ^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 January 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)]. A sibling 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) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSriVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Zeis>Iler. Marv Jane _ 21-09-1201 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 fade. Real property which is jointlyowned with right of survivorship must be disclosed on schedule F. Attach a copy of the sstgement sheet K the propeAy has been sold Include a copy of the deed showing decedenPs Interest K owned as tenant (n common. ITEM VALUE AT DATE NUMBER DESCRIPTION __ OF DEATH Real Estate located at 3950 Mountain View Road, Lot No. 12 -Contracted Sales Price. I 119,000.00 Property Sold on December 13, 2010. A copy of the Settlement Sheet is attached. TOTAL (Also enter on Line 1, Recapitulation) I 119,000.00 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) Rev-1ti08 EX+ (1i-88) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY colwMONwEAUN of aENNSnvANw INHERITANCE TAX RETURN RESI~NT DECEDENT ESTATE OF (FILE NUMBER Zeigler. Marv Jane _ 21-09-1201 InGude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship rtwst be disclosed on schedule F. Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) (K more space is needed, additional pages or the same slze~ Rev1509 rx+ Is-~j COMMONWEALTH OF PENN8YLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF (FILE NUMBER Zeis~ler, Mary Jane 21-09-1201 Kan asset was made joint within one year of the decedents date of death, it must bs reported on schedule G. SURVIVING JOINT TENANT(S) NAME A. Terry Robert Sultzaberger Jr B. C. ADDRESS 413 Venice Avenue Carlisle, PA 17015 RELATIONSHIP TO DECEDENT Grandson JOINTLY ITEM NUMBER OWNED P LETTER FOR JOIN TENANT ROPER 1 r: 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 ALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH DECEDENT'S NTEREST 1 A 2/28/1985 MB~T Bank Checking Account No. 42688787 20,344.67 50.000% 10.172.34 TOTAL (Also enter on Line 6, Recapitulation) 10,172.34 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-96) REV-1151 EX+(10.08) COM~DECE~RN ANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Zei ler, Ma Jane 21-09-1201 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A, FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address Cry State Zio Year(sl Commission oaid 2. Attorney's Fees JOHNSON DUFFIE 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 6,500.00 Street Address City State Zio _ Relationshio of Claimant to Decedent 4. Probate Fees 307.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 3,190.03 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 9,997.53 Copyright (c) 2009 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Zeigler. Marv Jane _ 21-09-1201 NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Chuck Bricker, Auctioneer -Appraisal of Decedent's personal property 100.00 2 Cumberland County Register of Wills Office -Filing Fees for Inheritance Tax Return and 30.00 Inventory 3 Cumberland County Register of Wills Office -Additional Short Certificates 8.00 4 Expenses for Personal Property Sate at Auction on October 23, 2010 - By Chuck Bricker, 2,460.00 Auctioneer 5 Michael Jones -Lawn Care 105.00 6 Reserves: Additional Out of Pocket Expenses 250.00 7 The Cumberland Law Journal -Notice of Estate Administration 75.00 8 The Patriot News -Notice of Estate Administration 162.03 H-B7 3,190.03 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) coMtwoNWEAL7H CF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF (FILE NUMBER Zeigler. Marv Jane 21-09-1201 Report darts Incurred by ttro decedent prior to death that remained unpaid at the date of death, including unreimbursed msdiesl szpsnsss. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 1 CCS Financial Systems -West Shore Emergency Medical Services 907.21 2 Check Clearing After Date of Death -Checks payable To Terry Sultzaberger and Gretchen 1,000.00 Noll written on November 9, 2009 3 Checks Clearing After Date of Death 162.30 4 Comcast Cable Television -Final Invoice 59.22 5 Gary Radabaugh Heating and Air Conditioning -Repairs to Residence to prepare for Auction 139.75 6 Golden Living Nursing Home 4,589.58 7 Hampden Township -Sewer and Trash for Residence 150.00 8 Hampden Township -Sewer and Trash for Residence 165.01 9 Hampden Township -Sewer and Trash for Residence 315.76 10 PA American Water 263.14 11 Penn National Insurance 242.00 12 Penn National Insurance 50.00 13 Pharmerica 39.72 14 PP&L _ Residence located at 3950 Mountain View Drive 205.51 15 Settlement Charges from Sale of Decedent's Residence -located at 3950 Mountain View 3,155.28 Road, Mechanicsburg, PA. Property sold on December 13, 2010. A copy of the Settlement Sheet is attached to this Return. 16 United American Insurance Premium 626.85 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 10, Recapitulation) 12,071.33 (K more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EXf (11-08) SCHEDULE J COMI~A~o~Fwe~~~~~A BENEFICIARIES ESTATE OF €L~ FILE NUMBER Zei ler, Ma Jane 21-09-1201 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 Gretchen Noll Granddaughter 112 of Residue 601 3rd Street West Fairview, PA 17025 2 Terry R Sultzaberger Grandson 112 of Residue 413 Venice Avenue Carlisle, PA 17013 ~ Total ~ Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet as a ro i NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE I I Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) ESTATE OF MAR Y JANE ZEIGLER SCHEDULE OF EXHIBITS EXHIBIT A Last Will and Testament for Mary Jane Zeigler signed and dated March 19`h, 2003.. EXHIBIT B Settlement Sheet (HUD-1) for sale of Decedent's property located at 3950 Mountain View Road, Mechanicsburg, Hampden Township, Cumberland County, PA sold on December 13, 2010. EXHIBIT C Receipt of Sale of Auction of Decedent's Personal Property EXHIBIT D Date of Death Value Correspondence from M&T Bank for Decedent's Joint Account aa~ssa ~.ac~f ~iir a~b ~e~tarnent OF MARY JANE ZEIGLER I, MARY JANE ZEIGLER, of Hampden Tovmship, Cumberland County, Pennsylvania, being of sound and disposing mind,. memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking: and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I DEBTS I direct the payment of all my legal debts and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently maybe done. ARTICLE H SPECIFIC BEQUEST OF JEWELRY I give and bequeath my j ewelry unto my granddaughter, GRETCHEN NOLL, provided she survives me. ARTICLE III REST, RESIDUE AND REMAINDER I give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wherever situate, unto my grandson, TERRY ROBERT SULTZABERGER, JR. and my granddaughter, GRETCHEN MOLL, in equal shares, the issue of either who may predecease me ~to take the share of the deceased parent per stirpes. ARTICLE V UNIFORM TRANSFERS TO MINORS In the event any beneficiary of my Will has not reached the age of twenty-one (21) years at the time for distribution of his or her share, distribution of said share maybe made in the discretion of my Personal Representative after considering the age and needs of the beneficiary, either directly to the beneficiary or to a Custodian under the Pennsylvania Uniform Transfers to Minors Act, 20 Pa. C.S.A § 5301 et seq., or the applicable Uniform Gifts to Minors Act or Uniform Transfers to Minors Act in the state of residence of such beneficiary as the case may be. My Personal Representative may designate as such Custodian any institution or person, including my Personal Representative, qualified to act as a Custodian for such beneficiary under such Act in effect at the. time such distribution is made. A receipt for any payment or distribution so made shall be a full discharge therefore to my Personal Representative, who shall not be responsible to see to; or be liable for, the application of such proceeds thereafter. ARTICLE VI PERSONAL REPRESENTATIVE I name, constitute and appoint my grandson, TERRY ROBERT SULTZABERGER, 'JR., Executor of this my Last ~JVill ar~d Testament. Should my grandson, TERRY ROBERT SULTZABERGER, JR., fail to qualify or cease to so act, I name, constitute and appoint my granddaughter, GRETCHEN NOLL, alternate Executrix of this my Last Will and Testament.. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. 2 ---, - - s IN WITNESS WHEREOF, I have hereunto set my hand and seal, this l~ ~~ day of ~~~'~~ , 2003. c..,., ., :, ~ (SEAL) MARY J ZEIG R SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, 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 hereunto subscribed our names as witnesses. .~ ~. -- C~ ~ ~~ c..Pic~~ 3 .. ,_ a , - _ - ~: _,>,, - - .- ;. {. ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS `MARY JANE ZEIGLER, ~> ~- ~~ ~/ and 2~ ,the Testatrix and the itnesses, respectively, wh se names are signed to the attached or foregoing instrument, being first duly sworn, do 1lereb declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly and that she executed it 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 witness and that. to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. MARY A E ZEI L - Witness Cis Wit ess Subscribed, sworn to and acknowledged .before me by MARY JANE ZEIGLER, Test rix, and e subscribed and sworn to before me by zr~- ~j ~-,, and c. ... l~ ~~~~~~ Nitnesses, this ''-day of 2003. Notary Public ®w _ t ~` J .. '_ ~J O ~~ r m ~ ~ ~ ~ z o ~ z ~ ~~ ,~ !'~ z ~ p ~+ m~ Dl C o =~ ~ z N d -~ i-n ~ --,~ r\ z a „~ .Z~ h7 N r ~ < ~ ~ H ~ ~ ~ A. SETTLEMENT STATEMENT (HUD-1) ~M<,~~ •`k ~f1i1 *~< c, `tv x,ti~4 L ^ FHA 2. ^ RHS 3. ^X CONV. UNINS. 4. ^ VA 5. ^ CONV. [NS. 6. FILE NUMBER: 7. LOAN NUMBER 10-00243-ALT 8000074239 8. MORTGAGE INS. CASE NO.: C. NOTE: This form is famished to give you a statement of actual settlement cnsFS. Amounts paid [o and by the settlement agent are shown. Items marked "(p.o.e.)" were paid outside [he closing; they are shown here for informational purposes and are nofincluded in the totals. D. NAME & ADDRESS Dale R Henry and Margaret G. Henry OF BORROWER: 2383 Lambs Gap Road, Enola, PA 17025 E. NAME & ADDRESS Terry R. Sultzaberger, Jr., Executor of the Will of Mary Jane Zeigler OF SELLER: F. NAME & ADDRESS PNC Mortgage, a division of PNC Bank, Na: OF LENDER: 116 AlleRhany Center Mall, Pittsburgh, PA 15212 G. PROPERTY LOCATION: .3950 Mountain View Road, Mechanicsburg, PA 17050 H. SETTLEMENT AGENT: Assured Land Transfers, Inc. PLACE OF SETTLEMENT: 301 Market Street, Lemoyne, PA 17043 (717) 761-4720 I. SETTLEMENT DATE: 12/13/2010 CLOSING DATE: ]2/13/201( J. Summar of Borrower's Transaction K Summa of Seller's Transaction 100. Gross Amount Due From Borrower: 400. Gross Amount Due To Seller: IOI. Contract sales rice 119 000.00 401. Contract sales rice 119 000.00 102. Personal property 402. Personal property 103. Settlement charges to borrower: (line 1400) 5 053.72 403. 104. 404. 105. 405. Adjustments For Items Paid B Seller In Advan ce: Adjustments For Items Paid B Seller [n Advance: - ! 06. City/town taxes to 406. City/town taxes to 107. County taxes 12/13/]0 to 12/31/10 19.]6 407. County taxes 12/13/10 to 12/31/10 19.16 108, Assessmrnts to 408. Assessments to 109. School Taxes 12/13/2010 to 6/302011 754.77 409. School Taxes 12/132010 to 6/30/2011 754.77 110. Sewer/Refuse (Oct -Dec) 12/13/2010 to 12/312010 24.59 410. Sewer/Refuse (Oct -Dec) 12!132010 to 12/31/2010 ~ 29.59 111. 411. 112. 412. 113. 413. 114. 414. IIS. 415. 116. 416. 120. Gross Amount Due From Borrower: 124,857.24 420. Gross Amount Due To Seller: 119,803.52 200. Am un Paid B Or In Behalf Of Borr er: 500. Reduction In Amoun Due To Seller: 201. De sit or eamcst money 10 000.00 501. Excess deposit (sec inswctions) 202. Principal amount of new loan(s) 75 000.00 502. Settlement charges to seller (line 1400) 9 155.28 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject [o 204. 504. Payoff 1st Mtg. Ln. 205. 505. Payoff2nd Mtg. Ln. 206. 506. 207. 507. 208. 508. 209. SOq. ', Adjustments For Items Unpaid By Seller: 210. City/town taxes to - Adjustments For items Unpaid By Seller: 510. City/[own taxes to 2I 1. County taxes to 511. County [axes to 212. Assessments to S l2. Assessments to 213. 513. 214• 514. 215. 515. 216. 516. 21 Z 51 Z 218• SI8. 219. S l9. 220. Total Paid By1For Borrower: 85,000.00 520. Total Reductions In Amount Due Seller: 9,155.28 300. Ca h At Settlement From/To Borrower: 600. Cash At Settlement From/To Seller: 301. Gross amount due from borrower (line 120) 124 857.24 601. Gross amount due to seller (line 420) 119 803.52 302. Less amount paid by/for borrower (line 220) 85 000.00 602. Less reductions in amount due seller (line 520) 9 155.28 303. Cash (©FR011~ i^TO) Borrower: 39,857.24 603. Cash (l~fl'0) (^FROIVI) Seller: 110,648.24 the Yubne Keponmg Harden for this collection of infomta[ion is estimated a[ 35 minutes per response for collecting, reviewing, and reporting [he data This agency nay no[ collect this informazion, and you arc no[ required to complete this form, unless it displays a currently valid OMB control number. No confidentiality is assured; X s disclosure is mandatory. This is designed to provide the parties to a RESPA covered transacti)o(n with information during [he settlemenX rocess. ?revious editions are obsolete Page 1 of 4 HUD-I SF.TTLF.MF.NT CHARGES Escrow:l0-00243-ALT 700. Total Real Estate Broker Fees Paid From Borrower's Paid From Seller's Divi i f mm' i n in 7 F II w: Funds Funds At At 702. to Settlement Settlement 703. Commission aid at settlement 704. ' 801. Our on ination char e PNC Mort a e a division of PNC Bank Na. 600.00 fr m FE # 1 802. Your credit or char a oints for the s ecific interest rate chosen 656.25 from F #2 803. Your ad'usted on ination char es PN M rt a e a division of PNC Bank Na from GFE A 1 256.25 1804. Appraisal fee to Quantrix Valuations. LLC (from GFE #31 I 54S.OOI I 1805. Credit report to CBC Innovis (from GFE #3I I 11 3SI I 1806. Tax service to First American Real Estate Tax Service (from GFE #3) I 60.001 I 1807. Flood certification LPS National Flood Services (from GFE #31 I S.OOI 808. Document Preparation To: PNC Mort~ge. a division of PNC Bank. Na. I I I r 809. Processine Fee To: PNC Mortgage. a division of PNC Bank. Na. I I I 1810. Underwriting Fee To: PNC Mortgage, a division of PNC Bank. Na. I I I i 81 1. Application Fee To: PNC Mortgage. a division of PNC Bank. Na. I I I 812. Tax Service Fee To: PNC Mort a e a division of PNC Ban a. 813. Flood Certification Fee To: PN Mort a e a divisiod of PNC Bank Na 814. 815. 816. 817. 818. 819. 01. Dail interest chaz es from 12/13/2010 to 1/01/2011 .7300 /da 1 da from GFE #10 165.87 902. Mo a e insurance remium for mo. t fr m GFE #3 903. Homeowner's insurance for 1 rs. to Shiner Insurance A enc from GFE # 11 408.00 904. FI od insurance remium for rs. to 905. 906. 1001. Tnitial de osit for our escrow account from FE #9 1002. Homeowner's in urance 0 months Pa $ O.OO~er mohth - 11003. Mortgage insurance 0 months (~ $ 0 00 per month I I I 11004. City property taxes 0 months (~ $ 0.00 ner month I I I 11005. County property taxes 0 months (7a, $ 32.38 ner month $0 00 I I I 11006. Annual assessments 0 months na $ 0.00 ner month I I I 11007. Flood insurance 0 months (cr7 $ 0.00 per month I I I 1008. School Tax Reserves 0 months (a, $ t 15.36 per month $0.00 I I i 10 A re ate Ad'u tment 0.00 1010. l 101. Title services and lender's title insurance from FE #4 1 0 7.25 l 102. Settlement or closin fee to 1103. wner's title insurance Assured Land Transfers Inc. Basic from GFE #S 245.0 1104. Lender's title insurance Assured Land Transfers Inc. B 'c .8.75 0.00 105. Lender's title lie limi 000.00 1106. Owner's title olic limit l 19 000.00 l 107. Agent's portion of the total title insurance premium $810.69 Assured Land Transfers, Inc. 1108. Underwriter's portion of the total title insurance premium $143.06 First American Title Insurance Company I 1109. Ovemieht Courier/I-Iandlin~ to Assured Land Transfers. Inc $18.50 I I I 11 l0. Wire Fee to Assured Land Transfers. Inc $20 00 I I I 111 L Electronic Document Fee to Assured Land Tran fern Inc. 25.00 1 112. Endorsements 100. 300. 900 to Assured Land Transfers. Inc. $150.00 I l l 13. Closine Service Letter to First American Title Insurance Com~v $75.00 I 1114. Not Fee to Cash 10.00 10.00 I 1201. Government recordin char es from GFE #7 160.00 1202. Deed 62.00 Mort a e 98.00 Release 0.00 1203. Transfer taxes (from GFE #81 I 1190 OO I I 1204. Ci /Coon tax/stam s Deed 0.00 Mort a e 0. 0 1205. State tax/stamns Deed $ 2380.00 Morteaee $ 0 00 t t 9n nn 1206. 1207. 1 O1. Re uired services that ou can sho for from GFE #6 1302. Tax Certification Fee to Michael Lan an 5.00 1303. 2010/2 11 Sch of Taxes to Michael Lan an 1 522.81 1304. 2010 C un /Munici al Taxes to Michael a an 427.47 1305.. Escrow For Inheritance Tax [ As ore L d Transfers Inc. 6 00 . 1306. 1307. Enter on line /03 Section J-and -line 502 ection K S 53.72 _ 9,155.28 'revious editions are obsolete Page 2 of 4 HUD-1 Com orison of Good Faith Estimate GFE and HUD-1 Char es Good Faith Estimat HUD-1 har a at ann t ncre - i bar e Our orieination charge # 801 ~ ~ 600.00 ~ 600.00 Your creditor charge (points) for the s~eci6c interest rate chosen # 802 ~ ~ 656.25 ~ 656.25 Your adjusted orieination char¢es # 803 ~ 1.256.25 ~ ].256 25 Transfer taxes #1203 ~ ~ 2.380.00 ~ _____ 1,190.00 Char es That in Total Cannot increase M re Than 10% Good Faith_E_stimate HUD-i_, Government recordin char a #1201 95.61 160.00 LTitle Services and lender's title insurance # 1101 ~ ~ 1.559.00 ~ 1.007 25 Appraisal # 804 ~ ~ 470.00 ~ 545 00 Credit Reoort # 805 ~ ~ 11.35 ~ 1 l 35 Tax Service # 806 ~ ~ 60.00 ~ 60 00 Flood Certification # 807 ~ ~ 5.00 ~ 5.00 Owner's title insurance #1103 ~ ~ - 0.00 ~ 245 00 # ~ ~ # # ~ ~ Total ~ 2.200.96 ~ 2.033.60 Increase between GFE and HUD-1 CharPea ~$ (167.361 or (7.60401 %~ Char es That Can han Good Faith Estimate HUD-1 Initial de osit for our escrow account #1001 Daily interest char¢es # 901 $ 8.7300 /dam ~ 130.95 ~ 165.R7 ~ Homeowner's insurance # 903 ~ ~ 476.00. 408.00 I # ~ # Loan Terms Your initial loan amount is $ 75,000.00 Your loan term is 15 years Your initial interest rate is 4.250000 Your initial monthly amount owed for principal, interest, and $ 564.21 includes and any mortgage insurance is ^X Principal ^X Interest ^ Mortgage Insurance Can your interest rate rise? ^X No. ^ Yes, it can rise to a maximum of %. The first change will be on and can change again every after . Every change date, your interest rate can increase or decrease by %. Over the life of the loan, your interest rate is guaranteed to never be lower than % or higher than %. Even if you make payments on time, can your loan balance rise? ^X No. ^ Yes, it can rise to a maximum of $ '. Even if you make payments on time, can your monthly ~ No. ^ Yes, the first increase can be on and the monthly amount owed for principal, interest, and mortgage insurance rise? amount owed can rise to $ The maximum it can ever rise to is $ Does your loan have a prepayment penalty? ^X No. ^ Yes, your maximum prepayment penalty is $ Does your loan have a balloon payment? ^X No. ^ Yes, you have a balloon payment of $ due in yeazs on Total monthly amount owed including escrow account payments ^X You do not have a monthly escrow payment for items, such as property taxes and homeowner's insurance. You must pay these items directly yourself. ^ You have an additional monthly escrow payment of $ that results in a total initial monthly amount owed of $ 564.21 This includes principal, interest, any mortgage insurance and any items checked below: ^ Property taxes ^ Homeowner's insurance ^ Flood Insurance ^ ^ ^ Vote: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. K X 'revious editions are obsolete Page 3 of 4 HUD-1 :- - . - ~ ~ .Chuck Bricker, Auctioneer -- - t3try & Sett on Commission - Comp~te#e Sate Service .. .. -~ S3 Texaco Rd., •Ntechanicsburg, PA 'tT055 7fi6~5785 Pers+oinel #~'r+o~pe,rly~ o~ , ~! ~~~ ~ 5 ~4 r~ .aaa~ -sow i~ s>~ - GT- ate/ ~ ~ . Told " aif 'i~d-Necks To~sl Cash ri`itsli 5// 2~5 lQ x~.\ . . - Aue~ion.er & clacks ~~ U, o U Sate Setup or Help ~ ~ , d ~ . Total E:pa~es ~-- (~ d , U ~ ` ~ ~~ r ~ . 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888) 502-4349 Fax (302)934-2955 January 20, 2010 Johnson, Duffle, Stewart & Winder Dana L Wiseman 301 Market.Street PO Box 109 Lemoyne, PA 17043-0109 Re: Estate of• Mary Jane Zeiler Social Security: 195-16-3858 Date of Death: November 22, 2009 Dear Sir or Madam: Per your inquiry, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number Ownership (Names of) Opening Date Balance on Date of Death Accrued Interest Total 42688787 Mary Jane Zeigler, joint primary Terry R Sultzaberger Jr, joint-secondary 0228/85 $ 20343.80 $ 0.87 ------------------------------------------------------------- $ 20344.67 Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our Summerdale branch, 423 North Enola Road, Enola, PA 17025. Office # 717-255-2261. Sincerely, ,.. . N rissa Sears Adjustment Services JERRY R. DUFFLE RICHARD W. STEWART C. ROY WEIDNER, JR. EDMUND G. MYERS DAVID W. DELUGE JOHN A. STATLER JEFFERSON J. SHIPMAN JEFFREY B. RETTIG KEVIN E. OSBORNE MARK C. DUFFLE JOHN R. NINOSKY MICHAEL J. CASSIDY J p °E ,MELISSA PEEL GREEVY WADE D. MANLEY ELIZABETH D. SNOVER ANDREW P. DOLLMAN SARAH E. HOFFMAN ANDREW ]. PETSU, ~R. CAROLYN B. MCCLAIN OF COUNSEL HORACF. A. JOHNSON F. LEE SHIPMAN (1965-2006) January 13, 2011 Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Dear Register: ~: ~ ~, - - ,--, ~ m , _ ~ RE: Estate of Mary Jane Zeigler , -~, Date of Death: November 22, 2009 ~ >~ ~' _ =~ Your File No. 21-2009-1201 - ~ ;- ~-_. m Our File No. 4006-5 b ..>= - `'' c' cu Enclosed for filing please find the following documents for the above referenced decedent: 1. 2 Original PA Inheritance Tax Returns, There is tax due in the amount of $5,084.52. 2. Inventory 3. 2 copies of Page 1 of the Pa Inheritance tax return, which we ask that you time-stamp and return to us in the enclosed envelope. 4. 1 copy of the Inventory , which we ask that you time-stamp and return to us. 5. Check enclosed in the amount of $30.00 representing the $15.00 filing fee for the Inheritance Tax Return and the $10.00 filing fee for the Inventory. Should you have any questions, please do not hesitate to contact our office. Thank you for you assistance in this matter. Enc. c: Terry Sultzaberger, Executor :427890 Very truly yours, SON, D F,F4~, ST~E,W'ART~ER a Wie an Estate Administration Paralegal 301 MARKET STREET P.O. BOX 109 LEMOYNE, PENNSYLVANIA 17043-0109 WWW.JDSW.COM 717.761.4540 FAX: 717.761.3015 MAILC~JDSW.COM JOHNSON, DUFFIE, STEWART &WEIDNER, P.C. - 6~4 `' ~ ~K^ v' ~ +.~ N cn ri., "- r '~r, ~Cr~~ N a ~~. 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