HomeMy WebLinkAbout02-11-111505610143
REV-1500 Ex(°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
Po Box.2aosol INHERITANCE TAX RETURN ~1 ~ ~ ~ ~ C~ ~ 0
Harrisburg, PA 17128-OS01 RESIDENT DECEDENT ~'
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
184 20 6519 05 11 2010 O'~ - I'~l - l 9Z ~'
Decedent's Last Name
HERB
Suffix Decedent's First Name
LOIS
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
Spouse's First Name
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
1. Original Return ~ 2. Supplemental Return
!~ ~ 4. Limited Estate ~ 4a. Future Interest Compromise
(date of death after 12-12-82)
u
~ n i 8 Decedent Died Testate
(Attach Copy of Wil') ~ ~ (AttaoheCoMaintained aLiving Trust
py of Trust)
9. Litigation Proceeds Received ~ 1°. Spousal Povert Credit date of death
between 12-31 X31 and 1<-1-95)
3 Remainder Return (date of death
prior to 12-13-82)
5 Federal Estate Tax Return Required
MI
M
MI
8. Total Number of Safe Deposit Boxes
1 t ,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
J RONALDO LEGASPI 71.7 234 4161
REGISTER OF WILLS USE ONLY
First line of address
320 MARKET ST
Second line of address
~~
n ~_~
0
~
~
- :~
.
~
~ CX7 t
;~ - ,
.x
,
~
~~, ~ -
x ~
,
7.
_' r .
r
DAB f
City or Post Office State ZIP Code ~''~" ~' '~t~i
HARRISBURG PA 17101 ~~~ 't,ts ;'=.= ~J
.~~ ~~ O
c.:~ -r,
Correspondent's a-mail address: jfl@gOldbergkatzman.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.
~~_
ADDRESS
o~ - ~ - / I
620 Southridge Dr. Mechanicsburg, PA 17055
SIGNA 0 P ER OTHER THAN REPRESENTATIVE DATE
J. Ronaldo Legaspi 2 - ~' _ / ~
ADD SS
320 Market St., Harrisburg, PA 17101
Side 1
1505610143 1!i05610143
J 1505610243
REV-1500 EX
Decedent's Name Herb, LOIS M.
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 & Notes Receivable (Schedule D) ...................................................... .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............. .. 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested........... . 6.
7. Inter-Vivos Transfers & Miscellaneous Inn,-Probate Property
(Schedule G) ~J Separate Billing Requested........... . 7,
8. Total Gross Assets (total Lines 1-7) ................................................................... .. 8,
9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... . 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. . 10.
11. Total Deductions (total Lines 9 & 10) .................................................................. . 11.
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.
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
(a)(1.2) X .00 15.
16. Amount of Line 14 taxable 110 17 6
0 8 16
.
at lineal rate X .045 ~ .
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 0.00 18.
19. Tax Due ................................................................................................................. . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Decedent's Social Security Number
184 20 6519
2,949.27
115,000.00
117,949.27
4,393.42
3,379.77
7,773.19
110,176.08
110,176.08
0.00
4,957.92
0.00
0.00
4,957.92
Side 2
1505610243 1505610243 J
REV-1500 EX Page 3
n.~.. e.~nn+~~ ~`mm~ln+o Arirlrocs•
File Number
DECEDENT'S NAME
__ _-
Herb, Lois M.
_ _
STREET ADDRESS
CITY STATE ZIP
PA
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 4,957.92
2. Credits/Payments
A Prior Payments -4,944.42_
B. Discount 247.89
Total Credits (A + B) (2) 5,192.31
3. Interest (3) ---
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 234.39
Check box on Page 2 Line 20 to request a refund
g. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
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 :.............................................................................. [~
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? .......................................... _............. _ _xJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without I _ _
receiving adequate consideration? .......................................................... ~ x' J~
3. Did decedent own an "in trust for" or a able upon death bank account or security at his or her death?....... ~'
P Y -
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................................. x
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
sitting is defined under Section 9102, as an individual who has at least one parent in common with the decadent, whether by blood or adoption.
Rev-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF (FILE NUMBER
Herb, Lois M.
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
(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 E (Rev. 6-98)
Rev-1510 EX+ (6-98)
i
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Herb, Lois M.
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
THE DATE OF TRANSFERSATTACH A COP OF TIE DEIED ~OR REAEESTATE DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1 Condominium at 595-1 Geneva Dr., Mechanicsburg, 115,000.00 115,000.00
PA -Owned solely by the Decedent. DOD value is
based on selling price. See attached copy of
settlement sheet.
TOTAL (Also enter on Line 7, Recapitulation)
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
115, 000.00
Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+(10-06)
SCHEDULE H
COMMONWRREALTCCHH OF PEryENSUYLVANIA FUNERAL EXPENSES $c
INH ESIDENTED CE EDENTRN ADMINISTRATIVE COSTS
ESTATE OF R FILE NUMBER
Herb, Lois M.
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N M ER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
2, 810.00
Street Address
City State Zio
Year(sl Commission raid
2 Attorney's Fees Goldberg Katzman, P.C. 1,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio
Relationshio of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 83.42
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 4,393.42
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE (;OSTS
continued
ESTATE OF FILE NUMBER
Herb, Lois M.
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex ea nses
1 Auer Cremation Services 1,495.00
2 Gingrich Memorials -Death Tab (inscription) 40.00
3 Rolling Green Cemetery -Grave Marker 945.00
4 Urn for Decedent's ashes 330.00
H-A 2,810.00
Other Administrative Costs
5 Death certificates 18.00
6 Harrisburg Patriot Obituary 65.42
H-67 83.42
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-7512 EX+112-OS)
COMMON WEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Herb, Lois M.
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
(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 I (Rev. 12-OS)
REV-1513 EX+ (11-08)
~, ~ . N
COMMNHERITANCE~ AX RETURNANIA
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Herb. Lois M-
NUMBER NAME AND ADDRESS OF RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S) RECEIVING PROPERTY (Words) ($$$)
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 a 1.2
PA
Stephen Herb Son
403 Spring House Rd.
Camp Hill, PA 17011
Paula Young Daughter
620 Southridge Dr.
Mechanicsburg, PA 17055
Total
Enter dollar amounts for distributions shown above on lines 1 5 throw h 18 on Rev 150 0 cover sheet, as a r o riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAJC IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA•1500 Schedule J (Rev. 11-08)
LOIS HERB
SSN: 184-20-6519
INDEX
PENNSYLVANIA INHERITANCE TAX RETURN
EXHIBIT SCHEDULE OF RETURN DESCRIPTION
A Death Certificate (copy) DOD:
5/11/10
B Last Will and Testament 7/18/88
C Copy of valuation of accounts from
Metro Bank
D Settlement Statement (HUD-1) for
property located at: 595-1 Geneva
Drive Mechanicsburg, PA 17055
zo2sss.l
E~~-IIBIT A
HI05.905 REV.(3I09) -
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with
the Vital Statistics Law of 1953, as amended.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
5593821
No.
Linda A. Caniglia
State Registrar
,SUN 01, ZO10
Date
HiDSi43 REV 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS
TYPE /PRINT IN
PEau"ac"""IN°ifN CERTIFICATE OF DEATH
(See InstrueTions and e3yamolea nn revnrerel
~~
1. NNre d Oeptlem (Foal, middy, bs4 sIMM) 2. Bea 3. Social Sepudy Numtea V 4. Deb d DepN (MOnm, my, year)
Lois Mae Herb Female 184 - 20 - 6519 Mav 11, 2010
5. Aq (tap BBlbby) Uritler 1 Unmr I m 6. Dale d BMh 7. Bt an eM slate «lor ' BL PYw d Deem l:hec6 od one
Mddb Wye Hama tawbs Fbepitsl:
O
1Mr'.
I
~
81 Yrs. Jul 14 , 1928 Williams or t , PA ^ lipel6N ^ ER / Ch~albnl ^ Doa yy Nurpng Hare ^ aepaellp ^ qyr . Spady
W. County d Deam &. Cby, Bam, Twp. d Deam BtL Fatlnty Name In not mpmabn, pbe clreel antl nurMer) 9. Wu DecedrH d HieprBC OdphT ®No ^ Yee 10. Rep: American Intlbn, Bbck Whha, ak.
York Dillsburg Elmcroft of Dillsburg (Mezlren Pi MRiwo,eb) jsPeom White
Il. Dsoetlnh Maud Ooc ion KaM dw«B done du' natdwo Na. W clot paten' 12. Waa D,ptleM evm b me 13. D•Wad's Edupaon (Spedly ony NpMel pratle cortpkled) 14. MariW SleWx Married, Newr Mertieq 15. Suniviq Spouse Ie wie, gNS nlaitlen name)
KiW d WaM KiMdBupnesa/lrxlp U.S. Armed Pomee7 WimwaQ Divdpd /Spz/y/
Elemenbry / sepndary (o-IZ) calege (Id «s,)
Hairdresser Self-Em to ed ^ Yea ®Na
Widowed
• 18.DB=edeMe Ma9iq Addreee lSbeet.dryltown, state.,W pmt Dacedea's Ditl Decadent -
153 Logan Road AdpI R•aamlp 1Te. sbl. PennF9ylvania i
n=,^vee, Decema Livedb Tao
w
e
u
Dillsbur PA 17019
B a
wn
r
n?
ne.coanly York nd.G-Ne,Deceaeret;•edwnnb
Dill
b
, ~/~
s
ure
Adaelumiba
1B. Fehr: Hartle IFrt mldtll8, lap. suBMl 19. nbMre Name (Frt nddds, mebm alanarra)
Ral h 0. Wa ner Effie Moyer
20e. Iaomwnfs Name (iyq / Pria) 20b. ml«manl's McYrp Atltrna (Shay, =nv / ka41, ebb, np cetls)
Mrs. Paula J. Youn 620 Southrid a Drt.ve, Mechanicsbur PA 17055
z/a. Lb61m a Dbpcenbn ®cramelbn ^ Oonatlon
• zm. Dm a 13i,pawbn IMOnm. my, years z1=. Plat. a Dkpaplron IName a prnst.ry, cremabrr «aher
plepl
21d LopBOn IDnY/bwn, yak, ,b cotle)
^ o^m. ~ml ^ w~phans.b ~ wM.mIE"",n«k.°anc~«rM"„AI""°d°d®Y.e^ w
~ May 13, 2010 Cremation Society of PA Harrisburg, PA 17109
23. SgMbn tiSr•vip tiprbae ee each)
~~a 220. licaibe NuMer 22c NSme and Adtlroasd FadBy Auer Cremation Services of Pennsylvania, Inc.
- ~• FD-010694-L
4100 Jonestown Road Harrisbur PA 17109
eortckb ilanm z3e<wy when remlying 23e. To tro heel cry , tleMh «prred al the nme, tlab and Db=a wtad. j5ignalure a~w IMe) z3b. licame MBlber z3c. Data ' IM
my
ywr)
pny,kbn ~ rw .weeds e1 tare ar dean ro
pdaypwdd.em.
~ '~~
l . ~~ ~ .
,
3- ~~ ~o
nerve z4~zs map M rd 4. r a D.em zs. Dab Pr«wrre.a Dead pm
conpb by grson ( my, year)
26. Waz Cw Reb b Medal Examiner I Cororel
b a Reason Debt iMn Crarnan=n or Danelan?
wM pmnlnpa meth. ~ r Sac M. ,s ~ i , o ^ Yes No
CAUSE OF DEATH (Ssa Inatrlsetbna and exempla) I Appodmale Inlervp:
Man 27. Pad I: Enlr hb Mob d eveas - tlbeases, bjurias, « pmplkeBms -mat dve=B) ceased the mem. DO NDT anbr lermirel events such as cxtliec mp, Qls•I m DxM
i
i Pert IL Eder afar yapyB d rmdl a°'. 1 I~w.,.1 m th
but rmI nbuning'n Nb udstlyinp puce given m Pen I. 2B. Otl Tdbcp Use Contrbule to Deam?
^ Y
ea
^ PmMby
reslr
mbry uresl, «wna
adar Fbriaeam wilhoN showhg tlb eadogy. LbI ody one cause an aaM ire
YAEDIATE CAUSE Fe
l6 2
.
CI no ^ Unkgwri
u
svev or / /
and6« resdlig h ~ph) a ~ ( y3 ~1/ J ~ ~ ~ t
-~ _Ar,. ~ eiv / / ~, c/„-Ll /r, . A /~ f-y' //~ /~ ,A ~
/ y 11 / / 1 / V /
29. IIf~~l~~mela:
plepnen
C~ na IwiMin
est
ear
Oue b/~ar ~/p~a~,e prB/ f //~~-
SgwrMny fpmNiY=ne.parry, b. l~sl'2 /l Yt lre Y~JC~.i/<r !l/~OQSG
b the aUee fpBd on IBb a a~'
~•yl IY11 ~n W
y
^PngW plNre dmam
^ N
b
EKer IMDERLYIND DAUSE ~ k 1«
- (above «eljary Mal eniabd IM e ~~
a
eww radhq n meml LAST. ~ ~ ~A ~y-Cn d Wepnanl,
ut peplant wlldn 42 mys
d de.n
^
Due b I« as a enro en: Nd preganl, but prpnam 43 mys b 1 year
d. Mlore mem
^ uNmown n pagml w;min m. qp yob
30e. Wes en Aubpsy
Pvmrmetl7 30b Were Aulcgy FiMnq
vpbbb Prior b Completion 31. Manner of Daam 32a Dale d Inury QAmal, tlry, year) 32b. Dn«bs How Injuy Opumtl 32c. Plop d Injury: Hama, Fann, SIreeI, Factory,
o
I Guee of Deem?
~ Natural ^ Homicltle Olf a Buldnq, ek. /SAeciy/
gyp.
^ Yes Iq No ^ Yet ^ No ^ Acdmnl ^ Pendnq Inrestpatkn 32d Time of Inlu7 32e Injury aI WoM? 321 n Transporlefion Inµry ($px!/y) 32g. Loptbn d iryury (Street, dry /sown, pabj
^ Sukpa ^ CouN Nd M Wbmnnetl ^ Ves ^ No ^ Driver/Opvral« ^ Pessangr ^ Pemadan
M ^ Omer - Syxily
33a. Grtlfier (chegi oay ore) 33b Signature and TMb d Gainer
• CeaBybp lshyakbn (Physkbn pnilyrcrcig coup d Beam when anadl« phypden Ms pr«aaxretl m end corrplNetl hem 23)
-
To IM Mp amy MnoMMga, mom opurmd dw to Bra ceaee(e)ark manner as alWd__ _____________________________~ ~/V
• Prorourcing mtl panylrlg pNyekbn (Pnyakbn bdh dNm ertl ce
D rlRyLq ton d mom) 3&. Licerbe NumMr
33d. Data Siprotl (Manor. my, yer)
To iM beeldmy bmwletlpa deNhop«IM aItM flora, nd pbp, and tltlebtM asle)antl mblreree pmM__________________ ^ OS /l
• Medcp ExemhleylG««Mr a
(/
~
G
On the Mob neUOn end I or Imemlgibn, In a nlon, maul opurretl • e tlm., date, one pace, end clue 1o pa quu(el eM menrer ee elated ^ 3d. Name aM AtltlnY d %non'Mb cdlWgyd a De (1 27) Typ
1
e
36. Regbtrere tae Di ' N F ( a , r) e
Jt0 0
J• j3~
r
Y
~ ~~ 4/ I .S
i
~s I
Dbpasnbn P«mn Na. _ 0513052
EXHIBIT B
r ~ ~
LAST WILL AND TESTAMENT
OF
LOIS M. HERB
I, LOIS M. HERB, of 105 Hawk Court, Mechanicsburg,
Cumberland County, Commonwealth of Pennsylvania, 17055, declare
this to be my Last Will and revoke any Will previously made by
me.
ITEM I: I direct that all of my just debts and
funeral expenses, including the cost of a suitable gravemarker
and perpetual care for my burial plot, shall be paid from the
assets of my estate as soon as practicable after my decease.
ITEM II: I give, devise and bequeath my entire
estate, consisting of all my real, personal and mixed property
wheresoever situated, to my two (2) children, ~'~TEPHEN R. HERB of
4 Slate Hill Road, Borough of Camp Hill, Cumberland County,
Commonwealth of Pennsylvania, 17011, and PAULA JOAN YOUNG of
1548 McCormick Drive, Mechanicsburg, Cumberland. County,
Commonwealth of Pennsylvania, 17055, equally, share and share
alike, their heirs and assigns forever.
ITEM III: No interest in income or principal shall be
assignable by, or available to anyone having a claim against a
beneficiary before actual payment to the beneficiary.
Page One (1) of Six (6) Pages
ITEM IV: All federal, state, and other death taxes
payable on the property forming my gross estate for tax pur-
poses, whether or not it passed under this Will, shall be paid
out of the principal of my residuary estate just as if they were
my debts, and none of those taxes shall be charged against any
beneficiary.
ITEM V: I authorize my Executor:
(a) to retain and to invest in all forms of
real and personal property, regardless of (i) any limitations
imposed by law on investments by executors or trustees, (ii) any
principle or law concerning delegation of investment respon-
sibility by executors or trustees, or (iii) any principle of law
concerning investment diversification;
(b) to compromise claims a.nd to abandon any
property which, in my Executor's opinion, is of little or no
value; to borrow from, and to sell property to others, and to
pledge property as security for repayment of an.y funds borrowed;
(c) to sell at public or F~rivate sale, to
exchange or to lease for any period of time any real or personal
property, and to give the options for sales or leases;
(d) to join in any merger, reorganization,
voting-trust plan or other concerted action of security holders,
and to delegate discretionary duties with respect thereto;
Page Two (2) of Six (6) Pages
(e) to use administrative ~or other expenses
of my estate as income tax or estate tax deductions and to value
my estate for tax purposes by any optional method permitted by
the law in force when I die, without requiring adjustments bet-
ween income and principal for any resulting effect on income or
estate taxes; and
(f) to distribute in kind and to allocate
specific assets among the beneficiaries in such. proportions as
my Executor may think best, so long as the total market value of
any beneficiary's share is not effected by sucY:~ allocation.
These authorities shall extend to all real
and personal property at any time held by my Executor and shall
continue in full force until the actual distribution of all such
property.
All powers, authorities, and discretion
granted by this WiII shall be in addition to those granted by
Iaw and shall be exercisable without leave of court.
ITEM VI: I appoint Stephen R. Herb <~nd Paula Joan
Young, Co-Executors under this Will. I direct that any fidu-
ciary acting hereunder shall not be required to enter bond or
other security in any Court or jurisdiction in which said fidu-
ciary may be called upon to act.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal and caused this my Last Will and Testament, consisting of
Page Three (3) of Six (6) Pages
typewritten pages, including this attestation clause, and the
following Acknowledgment and Affidavit, to be executed, declared
and published this ~~.~ day of ~-~,c~Gp , 1988, at
Harrisburg, Pennsylvania.
r,
LOl M. HERB
Page Four (4) of Six (6) Pages
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF DAUPHIN
I, LOIS M. HERB, the Testatrix, whose name is signed to
the attached or foregoing instrument, having been duly qualified
according to law, do hereby acknow"ledge that I signed and exe-
cuted the instrument as my Last Wiil; that I signed it willingly
and that I signed it as my free and voluntary act for the pur-
poses therein expressed.
L I M. HE B
Sworn or affirmed to and acknowledged before me by LOIS
,~~.~
M. HERB, the Testatrix this ~~ ~ day of ~,~,;.-C~;;< 1988.
(.
-~
,~
'Notary Public ~`*T,
(SEAL)
My Commission Expires:
_v ~~. .
X111 i n Y4~if3C _ ,. , ,
Page Five (5) of Six (6) Pages
EXHIBIT C
'METRO
BANK
3801 Paxton Street
Harrisburg • PA • 17111
mymetrobank.com
888.937.0004
January 30, 2011
Goldberg Katzman
320 Market St
PC Bcx 1258
Harrisburg PA 17108
RE: Estate of: Lois M. Herb
Tax Identification Number: 184-20-6519
Date of Death: May 11, 2010
To Whom It May Concern:
This letter is in reference to decedent account information you requested for the individual fisted above.
We are able to provide the following:
Account Type: Checking
Account Number: 82007394
Date Opened: 10/27/1998
Date Closed: 07/27/2010
Primary Owner: Lois M. Herb
Date of Death Balance: $304.27
Please feel free to contact me at (717) 412-6127 if I may be of further assistance.
Sincerely,
^~
Diana Reynolds
Metro Bank
Research Associate/Deposit Services
EXHIBIT D
A\N.EN7p~,.a.
=~G dlq~ ,= A. Settlement Statement (HUD-1)
QB~rN ozJE~n~
B. Tvae of Loan
OMB Approval No. 2502-0265
1. ^ FHA 2. Q RHS 3. [X Conv. Unins.
4. Q VA 5. Q Conv. Ins. 6. File Number:
10-121 7. Loan Number:
13689294 8. Mortgage Insurance Case Number:
446-0105558-734
C. Note: This form is furnished to give you a statement of actual settlement cosfs. Amounts paid to and by the settlement agent era 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 and Address of Borrower:
Robert A. Lora and
Susan G. Lora
4611 B Florence Avenue
Mechanicsburg, PA 17055 E. Name and Address of Seller:
Paula Young
595-1 Geneva Drive
Mechanicsburg, PA 17055 F. Name and Address of Lender:
M87 Bank
One Fountain Plaza
Buffalo, NY 14203
G. Property Location:
595-1 Geneva Drive
Mechanicsburg, PA 17055
Cumberland County, Pennsylvania H. Settlement Agent: 68-0510988
Community Land Transfer, LLC
2331 Market Street
Camp Hill, PA 17011 Ph. (717)909-6949 I. Settlement Date:
May 26, 2010
Place of Settlement:
2331 Market Street
Camp Hilt, PA 17011
J. Summary of Borrower's transaction K. Summary of Seller's transaction
100. Gross Amount Due from Borrower: 400. Gross Amount Due to Seller:
101. Contract sales rice 115,000.00 401. Contract sales rice 115,000.00
102. Personal roe 402. Personal ro art
103. Settlement Char es to Borrower Line 1400 7,023.94 403.
104. 404.
105. 405.
Ad ustments for items aid b Seller in advance Ad'ustments for items aid b Seller in advance
106. Ci !Town Taxes to 406. Cit /Town Taxes to
107. Coun Taxes 05/26/10 to 01/01/11 214.49 407. Count Taxes 05/26/10 to 01/01/11 214.49
108. School Taxes 05/26/10 to 07/01/10 105.60 408. School Taxes 05/26!10 to 07/01/10 105.60
109. Ma HOA Dues 05/26/10 to 06/01/10 28.06 409. May HOA Dues 05/26/10 to 06/01/10 28.06
110. Sewer 2nd Qtr. 05/26/10 to 07/01/10 44.31 410. Sewer 2nd Qtr. 05/26/101.0 07/01/10 44.31
i11. 411.
112. 412.
120. Gross Amount Due from Borrower 122,416.40 420. Gross Amount Due to SeYler 115,392.46
200. Amounts Paid b or in Behalf of Borrower 500. Reductions in Amount Due Seller:
201. De osit or earnest mone 1,000.00 501. Excess de osit see instructions
202. Princi al amounf of new loans 105,311.00 502. Settlement char es to Seller Line 1400 7,922.86
203. Existin loans taken sub'ect to 503. Existin loans taken sub'ect to
204. MST Cou on Credit 500.00 504. Payoff First Mortgage
205. 505. Pa off Second Mort a e
206. 506.
207. 507. De osit disb. as roceeds
208. 508.
209. 509.
Ad'ustments for items un aid b Seller Ad'ustments for items un aid b Seller
210. Ci /Town Taxes to 510. Cit /Town Taxes to
211. Coun Taxes to 511. Count Taxes to
212. School Taxes to 512. School Taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. _
518.
219. 519.
220. Total Paid b /for Borrower 106,811.00 520. Total Reduction Amount Due Seiler 7,922.86
300. Cash at Settlement from/to Borrower 600. Cash at settlement tolfrom Seller
301. Gross amount due from Borrower line 120 122,416.40 601. Gross amount due to Seller line 420 115,392.46
302. Less amount paid by/for Borrower (line 220) ( 106,811.00) 602. Less reductions due Seller (line 520) ( 7,922.86
303. Cash ~ From ~ To Borrower 15,605.40 603. Cash ^X To C~ From Seller 107,469.60
The undersigned hereby acknowled a recei f ompleted copy of this statement & any attachments referred to herein
Borrower / Seller ~~,,~ ~ (;~,~_
it
e ''A. Lora ~/, = j Paula Young ~ '
Susan G. Lora
The Public Reporting Burden for this collection o1 informallon is estimatetl at 35 minutes per response for collecting, reviewing, and reporting the data. This agency may not collect this information, and you are not required to
complete this form, unless it displays a curtently valid OMB control number. No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information
during the settlement process.
Page 1 of 3 HUD-1
(LARA.ROBERT.PFD/10-121 /11)
L. Settlement Charges
700. Total Real Estate Broker Fees $ 5,750.00 Paid From Paid From
Division of commission (line 700) as follows: eorrowers severs
701. 2 900.00 to Cantu 21 At the Helm Funds at Funds at
702. 2 850.00 to THE HOMESTEAD GROUP INC. settlement settlement
703. Commission aid at settlement 5 750.00
704. Transaction Fee to Cantu 21 At the Helm 175.00
705. Buyers Commission to The Homestead Group, Inc. 200.00
800. Items Pa able in Connection with Loan
801. Our on ination char a Includes Ori ination Point 0.700% or $ 725.00 $ 725.00 from GFE #1
802. Your credit or charge (points) for the specific interest rate chosen $ 90.57 (from GFE #2) '- ~~
803. Your adjusted origination charges from GFE #A 815.5 ~ '
804. A raise! fee to Kirchme er & Assoc. from GFE #3 POC:B380.00
805. Credit Re ort to from GFE #3
806. Tax service to (from GFE #3)
807. Flood certification to First American FDS (from GFE #3) 8.00
808. (from GFE #3) x;;l
809. (from GFE #3)
810. (from GFE #3)
811. (from GFE #3)
900. Items Re uired b Lender to Be Paid in Advance
901. Daily interest charges from 05/26/10 to 06!01/10 6 @ $13.704860lday (from GFE #10) 82.23
902. Mort a e insurance remium for months to HUD from GFE #3 1,811.25 '
903. Homeowner's insurance for ears to from GFE #11
904. from GFE #11
905. (from GFE #11)
1000. Reserves De osited with Lender
1001. Initial deposit for your escrow account (from GFE #9) 1,187.14
omeowne s tnsurance mont s per mont ;
1003. Mort a e insurance months $ 42.82 er month $ ~ ~,, ~,
1004. Property taxes $ :: ~, ,
County Taxes months @ $ per month '- t
Assessments months $ er month
1005. $
1006. County taxes 4.000 months @ $ 29.06 per month $ 116.24
1007. School Taxes 12.000 months @ $ 98.93 per month $ 1,187.16
1008. $ '~t~t . ,
1009. Aggregate Adjustment $ -116.26
1100. Title Char es
1101. Title services and lender's title insurance (from GFE #4) 1,194.75 5.00
1102. Settlement or ciosin fee $
1103. Owner's title insurance to COMMUNITY LAND TRANSFER INSURANCE ACCT. from GFE #5 99.00
1104. Lender's title insurance to COMMUNITY LAND TRANSFER INSURANCE ACCT. $ 834.75
1105. Lender's title olic limit $ 105,311.00 K'~" ~:~~:` .
1106. Owner's title olic limit $ 115,000.00
1107. A ant's onion of the total title insurance remium to Communit Land Transfer, LLC $ 821.70 x,~ „~ ~aFh.~. ,~ `
1108. Underwriter's ortion of the total title insurance remium to COMMUNITY IAND TRANSFER INSUR. $ 112.0 ~ '~` ~`"
1109. Deed Prep. to Reager & Adler, PC 125.00
1110. Community Land Transfer, LLC
1111.
1112.
1113.
1200. Government Recording and Transfer Charges
1201. Government recordin cha es to Recorder of Deeds Office from GFE #7 146.00 `;
1202. Deed $ 62.00 Mortgage $ 84.00 Releases $ Other $
1203. Transfer taxes to Recorder of Deeds Office (from GFE #8) 1,150 00
1204. City/Countytaxlstamps $ 1,150.00 $ , ,_` ~ ~ ;
1205. State tax/stam s $ $ r `,: - 1,150.00
1206.
1207.
1300. Additional Settlement Char es
1301. Re uired services that ou can sho for from GFE #6
1302. Home Ins action to !ns action Center b Mike Biechler POC:B310.00
1303. Home Warrant to 1st American Home Bu ers Protection Cc 185.00 250.OD
1304. 2010 Count lTownshi Taxes to Dennis Zerbe, Tax Collector 355.86
1305. See addit'I disb. exhibit to
145.00
112.00
1400. Total Settlement Char es enter on lines 103, Section J and 502, Section K 7 023.94 7 922.86
~~ ~~y~„~y,,oyo ~ .,, ~„~ o~e.a~,~o , u~o „y„aw~~n~ ncnnuwrouyn ~ace~pi rn a wmpietea copy or page [ or tnis two page state L ~' f
i 1'I ~'
Community La n r, LLC, tlement Agent
Certified to be a true copy.
Page 2 of 3 HUD-1
(LARA.ROBERT.PFD/10-121/11)
Comparison 4f Gnod Faith Estimate (GFE) and HUD-1 Charges Good Faith Estimate HUD-1
Charges That Cannot Increase HUD-1 Ltne Number
Our origination charge # 801 725.00 725.00
Your credit or charge (points) for the specific interest rate chosen # 802 48.44 90.57
Your adjusted origination charges # 803 773.44 815.57
Transfer taxes #1203 2,300.00 1,150.00
Charges That in Total Cannot Increase More than 10% Good Faith Estimate HUD-1
Government recording charges #1201 200.00 146.00
Appraisal fee # 804 380.00 380.00
Tax service # 806 68.50
Flood certification # 807 8.00 8.00
Mortgage Insurance Premium # 902 1,811.25 1,811.25
Total 2,467.75 2,345.25
Increase between GFE and HUD-1 Charges $ -122.50 or -4.96°/
Charges That Can Change Good Faith Estimate HUD-1
Initial deposit for your escrow account #1001 1,441.96 1,187.14
Daily interest charges # 901 $ 13.704860/day 205.57 82.23
Homeowner's insurance # 903 240.00
Title services and lender's title insurance #'1101 1,345.75 1,194.75
Owner's title insurance to COMMUNITY LAND TRANSFER INSU #1103 933.75 99.00
Loan Terms
Your initial loan amount is $ 105,311.00
Your loan term is 30 years
Your initial interest rate is 4.7500
Your initial monthly amount awed for principal, interest and $ 592.17 includes
any mortgage insurance is Q Principal
Interest
a 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-months after
. Every change date, your interest rate can increase or decrease
by %. Over the life of rihe 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 ^X 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 i:s $
Does your loan have a prepayment penalty? ^X No ^ Yes, your maximum prepayment penalty is $
Does your loan have a balloon payment? Q No ^ Yes, you have a balloon payment of $
due in _ years on
Total monthly amount owed including escrow account payments ^ You do not have a monthly escrow payment for items, such as property
taxes and homeowner's insurances. You must pay these items directly
yourself.
^X You have an additional monthly escrow payment of $127.99 that results
in a total initial monthly amount owed of $720.16. This includes
principal, interest, any mortgage insurance and any items checked below:
^X Property taxes ^ Homeowner's insurance
^ Flood insurance ^
^ ^
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender.
Page 3 of 3 HUD-1
(IARA. ROBERT. PFD/10-121 /11)
HUD-1 Addendum
Borrower(s): Robert A. Lara and Susan G. Lara Seller(s): Paula Young
4611 B Florence Avenue 595-1 Geneva Drive
Mechanicsburg, PA 17055 Mechanicsburg, PA 17055
Lender: M&T Bank
settlement Agent: Community Land Transfer, LLC
(717)909-6949
Place of Settlement: 2331 Market Street
Camp Mill, PA 17011
Settlement Date: May 26, 2010
Property Location: 595-1 Geneva Drive
Mechanicsburg, PA 17055
Cumberland County, Pennsylvania
Additional Adjustments For Items Paid By Seller In Advance (Borrower Debit)
Description Amount FromlThrough Prorated Amount
May HOA Dues 145.00 05/01/10 through 05/31/10 28.06
Total Line 1091409 28.06
Sewer (2nd Qtr.) 112.00 04/01/10 through 06/30/10 44.31
Total Line 110!410 44.31
Additional Disbursements
PayeelDescription NotelRef No. Borrower Seller
Horst Property Management 145.00
June HOA Dues
Upper Allen Township 112.00
2nd Qtr. Sewer
Total Additional Disbursements shown on Line 1305 $ 145.00 $ 112.00
Adjusted Origination Charge Details
Origination Charge
Origination 725.00
to M&T Bank
Total $ 725.00
Origination Credit/Charge (points) for the specific interest rate chosen
Credit/Charge 90.57
to M&T Bank
Total $ 90.57
Adjusted Origination Charges $ 815.57
Reserves Deposited with Lender
County taxes 116.24
4.000 at 29.06 per month
School Taxes 1,187.16
12.000 at 98.93 per month
Aggregate Adjustment -116.26
month
Total 1,187.14
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 imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010.
(IARA.ROBERT.PFD/10-121/11)
HUD-1 Addendum - Continued
Title Services and Lender's Title Insurance Details BORROWER SELLER
Closing Service Letter 75.00
Community Land Transfer, LLC
Electronic Doc. Preparation 50.00
Community Land Transfer, LLC
Wire Fee 10.00
Community Land Transfer, LLC
Notary Fee 10.00 5.00
Community Land Transfer, LLC
Overnight Fees 15.00
Community Land Transfer, LLC
End. 100 300 8.1 & 810 200.00
Community Land Transfer, LLC
Total $ 360.00 $ 5.00
Owner's Title Insurance BORROWER SELLER
Owner's Policy Premium 933.75
to COMMUNITY LAND TRANSFER INSURANCE ACCT.
Total $ 99.00 $
Lender's Title Insurance BORROWER SELLER
Lender's Policy Premium
to COMMUNITY LAND TRANSFER INSURANCE ACCT.
Totai
834.75
$ 834.75 $
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 imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010.
(LARA.ROBERT.PFD/10-121/11)