HomeMy WebLinkAbout03-24-11' 1505610140
REV-1500 EX (01-10) OFFICIAL USE ONLY _
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 2 1 1 0 0 9 0 8
Harrisbur PA 17128-0601 RESIDENT DECEDENT -
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
2 0 8 4 2 5 1 4 1 0 8 0 8 2 0 ], 0 0 7 0 6 1 9 6 2
Suffix Decedent's First Name MI
Decedent's Last Name
D A V I D S O N D AL E L
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
FILL IN APPROPRIATE OVALS BELOW
rn
t
l R
i
i
~
2. Supplemental Return ^
3. Remainder Return (date of death
u
e
na
g
0 1. Or prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate 'Tax Return Required
death after 12-12-82)
Q 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will)
9. Litigation Proceeds Received
~ (Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
~
haxOj nder Sec. 9113(A)
11 ~ A
h S
between 12-31-91 and 1-1-95) c
ttac
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Daytime Telephone Nlumber
Name
M A R C U S A M c K N I G H T, I I I 7 1 7 2 4 `~ 2 3 5 3
First line of address
6 0 W E S T
Second line of address
City or Post Office
C A R L I S L E
State
P A
ZIP Code
__ r._~r
REGISTER L9fj VVILLS USE bNLY
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Correspondent's a-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best cif rriy knowledge and belief,
it is true, correct and complete. Declaration of pr r other than the person sentative is based on all information of which prepare~r has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE OR FIL RE URN DA~~ ~/
ADDRESS
1,41 SHIPPENSB RG ROAD SHIPPENSBURG
SIGNATU F I~PAR jHER T~IAN REPRESENTATIVE
60 WEST POMFR~T S~'1~EET
15056],0140
P O M F R E T S T R E E T
CARLISLE
PLEASE USE ORIGINAL FORM ONLY
Side 1
PA 17257
DA
~~
PEA 17013
1505610140 J
J
1505610240
REV-1500 EX
Decedent's Social ;iec urity Num ber
Decedents Name: DALE L• D A V I D S O N 2 0 8 4 2 5 1 4 1
RECAPITl7LATION .
1. Real Estate (Schedule A) ........................................... 1. 1 5 0 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 4 4 6 . 5 2
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. •
7. Inter-Vivos Transfers & Miscellaneous N -Probate Property
(Schedule G) ~ Se
arat
Billi
R
t
d
7
p
e
ng
eques
.......
e .
8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 1 6 0 4 4 6 . 5 2
9. Funeral Expenses and Administrative Costs (Schedule H) ............... ... 9• 1 9 3 3 2 . 3 2
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... ... 10. 1 8 1 4 6 . 2 4
11. Total Deductions (total Lines 9 and 10) ............................ ... 11. 3 7 4 7 8 . 5 6
12. Net Value of Estate (Line 8 minus Line 11) ......................... ... 12. 1 2 2 ~ 6 7 . 9 6
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. 1 2 2 9 6 7 . 9 6
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 .045 1 2 2 9 6 7. 9 6 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 0. 0 0 1 g.
19. TAX DUE .................. ........................... .. ..... ..19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
0. 0 0
5 5 3 3. 5 6
0. 0 0
0. 0 0
5 5 3 3. 5 6
r ~ 1505610240 1505610240
J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
DALE L. DAVIDSON
STREET ADDRESS
809 REDWOOD DRIVE
CITY
CARLISLE
Tax Payments and Credits:
~ ~ Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
File Number
21 10 0908
STATE Zlp
PA 17013
5, 533.56
Total Credits (A + B) (2) 0.00
(3)
(4) 0.00
(5) ~ 5,533.56
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
5. tf Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
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 : ...................................................................... ^ a
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ 0
c. retain a reversionary interest; or ........................................................... .
. . .................................. ^ a
d. receive the promise for life of either payments, benefits or care? ....................................................... ^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
. .
without receiving adequate consideration? .................................................................................... ^
3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? ......... ^ 0
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 A5 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 survivin souse
3 percent [72 P.S. §9116 (a) (1.1) (i)]. g P
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 requiremE:nts for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)).
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in
72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, undE
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
ca ~ H ~ t ur:
FILE NUMBER:
DALE L. DAVIDSON 21 10 0908
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
DESCRIPTION OF DEATH
1. 809 REDWOOD DRIVE, CARLISLE, PA 17013 -SOLD 150,000.00
SETTLEMENT STATEMENT ATTACHED
TOTAL (Also enter on Line 1, Recapitulation) I $ 150,000.00
If more space is needed, use additional sheets of paper of the same size.
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
IN RESI DENT DECEDENTRN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
DALE L. DAVIDSON 21 10 0908 _
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F. _
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PERSONAL PROPERTY 2,604.00
2. MEMBERS 1ST FEDERAL CREDIT UNION -SAVINGS ACCOUNT #101893-00 ~ 5.00
3. MEMBERS 1ST FEDERAL CREDIT UNION -CHECKING ACCOUNT #101893-11 I 1,337.52
4. VEHICLE - 2002 PONTIAC GRAND PRIX -SOLD ~ 6,500.00
TOTAL (Also enter on line 5, Recapitulation) $ 10,446.52
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (10-09)
' pennsylvania
• DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
DALE L. DAVIDSON 21 10 0908
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. FOGELSANGER-BRICKER FUNERAL HOME, INC. 5,223.59
B.
1.
2.
3.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
Attorney Fees: IRWIN & McKNIGHT, P.C.
Family Exemption: (If decedents address is not the same as claimants, attach explanation.)
Claimant
8,000.00
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: REGISTER OF WILLS 307.50
5 Accountant Fees:
6. Tax Retum PreparerFees: PATRICIA A. ROSENDALE, CPA 350.00
7. CLOSING COSTS FROM SALE OF REAL ESTATE 4,736.69
8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00
9. THE SENTINEL -ESTATE NOTICE 187.54
10. ROY D. GOTTSHALL -APPRAISAL ON REAL ESTATE 65.00
11. DIVERSIFIED APPRAISAL SERVICES -APPRAISAL ON REAL ESTATE 350.00
12. NOTARY FEES 25.00
13. REGISTER OF WILLS -SHORT CERTIFICATES 12.00
TOTAL (Also enter on Line 9, Recapitulation) ~ $
If more space is needed, use additional sheets of paper of the same size.
19.332.32
REV-1512 EX+ (12-08)
' pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
DALE L. DAVIDSON _. _ 21 10 0908
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. AT&T -TELEPHONE 39.38
2. BOROUGH OF CARLISLE -WATER/SEWER 219.32
3. COMCAST -UTILITY 1,191.68
4. DONEGAL INSURANCE GROUP -INSURANCE 549.00
5. HOLY SPIRIT HOSPITAL -MEDICAL 24.00
6. MASLAND ASSOCIATES, INC. -MEDICAL 38.00
7. PP&L -ELECTRIC 609.00
8. UGI -UTILITY 475.86
9. DONALD H. AND VESTA M. DAVIDSON -OUTSTANDING DEBT 15,000.00
TOTAL (Also enter on Line 10, Recapitulation) l $ 18,146.24
If more space is needed, insert additional sheets of the same size.
ntV-i~ i3 tX+ (U1-101
' pennsylvania SCHEDULE J
D
EPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF:
DALE L. DAVIDSON FILE NUMBER:
21 10 0908
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under OF ESTATE
Sec. 9116 (a) (1.2).)
1. LAUREN MARIE CAMPER Lineal
1169 MEADOW LARK WAY 61,483.98
BETHLEHEM, PA 18015 112 REMAINDER
2. JACLYN RENEE DAVIDSON Lineal
809 REDWOOD DRIVE 61,483.98
CARLISLE, PA 17013 112 REMAINDER
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:
1.
TOTAL OF PART I1-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
If more space Is needed, use addltlonal sheets of paper of the same size.
L.~S~1NIll .~.TrD 2'~S~.~l~'N'~
I, DALE L. DAVIDSON, of the Borough of Carlisle, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly
revoking all Wills and Codicils heretofore made by me.
ONE: I direct my Executor to pay all of my debts, funeral and administrative; expenses as
soon as maybe done conveniently after my decease.
TWO: I give, devise, and bequeath all of my estate of every nature and whe;rever situate
to my children, LAUREN MARIE DAVIDSON and JACLYN RENEE DA'VIDSON, in
equal shares, per stirpes, provided they have each attained the age of Twenty-Two 1;22) years of
age.
If one of my children has predeceased me, then the share of said predeceased child will be
equally distributed to the living issue of said child. If one of my children has predeceased me
without living issue, then said share will be distributed to my child who survives me.
THREE: If my children have not yet attained the age of Twenty-Two (22) ;years of age,
then I give, devise, and bequeath my estate of every nature and wherever situate in TRUST to
DONALD HAROLD DAVIDSON and VESTA MARIE DAVIDSON, as CO-'TRUSTEES
for the benefit of my children, subject to the following provisions.
a. This Trust will be for the sole benefit of my children, LAUREN MARIE
DAVIDSON and JACLYN RENEE DAVIDSON, as provided herein.
b. The net income of the TRUST shall be applied at the sole and absolute
discretion of the Trustees to the support, maintenance, education and general Urelfare of my
children, in such manner as the Trustees deem proper, without regard to any other funds which
may be available for the Trust purposes, or may be accumulated in Trust. Upon the creation of
the TRUST, I direct the Trustees to establish separate Trust shares for each child. Thereafter
income and principal can only be distributed from each child's own share for the benefit of said
child.
c. I further authorize the Trustees, to apply not only the income, but also so much
of the principal as the Trustees deem necessary, in, for, or toward the maintenance, support,
education and general welfare of my said children, in such manner as they shall deem proper. I
specifically request that Trust funds be used for transportation and living expenses fc,r my children
in order for them to visit their living relatives.
d. When my each of my children attains the age of Twenty-Two (22) years, the
Trustees will distribute the balance of the Trust principal and accumulated income to each child.
If one of my children has died, then said share of the Trust principal and accumulated income
should be distributed in equal shares to the living issue of said child. If said child has died without
2
living issue, then said share will be distributed equally to my children who survive me.
e. The Trustees shall have the following powers, in addition to those vested in
them by law, for my property held for the benefit of my beneficiary, whether income or principal,
exercisable without court approval and effective until the distribution of all property under the
terms of this Trust; the Trustees, at their discretion, may compromise claims, borrow money, or
retain property for such length of time as they may deem proper, sell, lease, pledge, mortgage,
transfer, exchange, convert or otherwise dispose of or grant options of all or an.y portion of
TRUST property for such prices, on such terms in public or private transactions as they may
deem proper; and invest Trust property and income without restriction to legal investments.
FOUR: I name DONALD HAROLD DAVIDSON and VEST'A MARIE
DAVIDSON, to serve as Guardians of the Person and Guardians of the Property of my children,
LAUREN MARIE DAVIDSON and JACLYN RENEE DAVIDSON, if they are minors at my
death.
FIVE: I appoint DONALD HAROLD DAVIDSON, to serve as Executor of this my
Last Will. If he is unable to serve, or if he ceases to serve as Executor, I name VESTA MARIE
DAVIDSON, to serve as Executrix in his place.
SIX: My Executor may, at his discretion, compromise claims, borrow money, :retain
3
property for such length of time as he may deem proper; lease and sell property for such prices,
on such terms, at public or private sales, as he may deem proper; and invest estate property and
income without restriction to legal investments.
SEVEN: No Executor, Executrix, Guardian or Trustee acting hereunder shall be
required to post bond or enter security in this or any jurisdiction.
(,~ 11.=~
IN WITNESS WHEREOF, I have hereunto set my hand and seal this , -- clay of April,
1996.
~~
DALE L. DAVIDSON
Signed, sealed, published and declared by DALE L. DAVIDSON, the above named
Testator, as and for his Last Will and Testament, in the presence of us, who, at his request and in
his presence and in the presence of each other have subscribed our names as witnesses hereto.
.~/' l~
,~~
a
/J~~~~O'- (SEAL)
4
ACKNOWLEDGMENT AND AFFIDA VIT
WE, DALE L. DAVIDSON, TERESA M. HENRY and CHERYL L. CLELAND,
the testator and witnesses respectively, whose names are signed to the foregoing; instrument,
being first duly sworn, do hereby declare to the undersigned authority that the testator signed and
executed the instrument as his Last Will and that he had signed willingly, and that he executed it
as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in
the presence and hearing of the testator, signed the Will as a witness and that to the: best of their
knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under
no constraint or undue influence.
~~ ~ ~~~
I1XLE L. DAVIDSOIY~
.r i ~ r•
TERESA M.
• ...
YL L.
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND :
Subscribed, sworn to and acknowledged before me by DALE L. DAVIDSON, the
testator herein, and subscribed a d~sworn to before me by TERESA M. HENRY and CHERYL
L. CLELAND, witnesses, this ~~~tlay of April, 1996.
/ ~ I ~~~ ~ ~ -1 ~1t
!ice -- ( j ,('~j~~
Notary Public
n~,`.afaf ~1
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Ca-i'.5ie 6oro, Cun?~~ra~~d Counh
~ r~ny ia+~~aacn ~u es Di~c.15,1 ~9b
Mern~er, enr~s;+fvaniaF~ssoaabon Not~uies
~' ~~ w"~°'~ OMB Approval No. 2502 0265
" •F A. Settlement Statement (HUD-1)
^ RHS 3
^ FHA 2
^Conv
Unins
1 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
.
.
.
.
. DAVI DSONJ2-11 6800402122
4. ^ VA 5. ^Conv. Ins.
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown. Items marked
"(p.o.c)"were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. Name & Address of Borrower: E. Name 8 Address of Seller: F. Name 8 Address of Lender:
JACLYN DAVIDSON DALE L DAVIDSON MEMBERS 1ST FEDERAL CREDIT UNION
809 REDWOOD DRIVE, CARLISLE, PA 17013 809 REDWOOD DRIVE, CARLISLE, PA 17013 5000 LOUISE DRIVE, MECHANICSBURG,
PA 17055
G. Property Location: H. Settlement Agent: I. Settlement Date: 03/07011
809 REDWOOD DRIVE 18~M REAL ESTATE SERVICES, LLC Disbursement Date: 03/07/2011
Carlisle, PA 17013 Telephone: 717-249-2353 Fax: 717-249354
Carlisle Borou
h
g Place of Settlement: Title
Express
West Pomfret Professional Bldg, 60 West Pomfret SVeet, Printed 03/07/2011 at 11:35 am
Carps PA 17013 by JMR
101. Contract gales price 1
102. Personal
103. Settlement charges to borrower (tine 1400) 3,679.37
104.
105.
Ad for iberrrs seller in advance
106. Cityltown taxes to
107. County taxes 03/07/2011 to 12I31I2011 658.07
108. School Taxes 03/07/2011 to 06!30@011 533.49
109.
110.
111.
112.
120. Gross Amount Due from Borrower 154870.93
201. Deposit or earnest money
202. Prinapal amount of new loan(s) 65,000.00
203. Extsstin I s taken su 'ect to
204. LENDER CREDIT 375.00
205.
206. gift of equity 75,000.00
207.
208.
209.
ustmanb for ittems u seller
210. City/town taxes to
211. County taxes to
212. School Taxes to
213.
214.
215.
216.
217.
218.
219.
220. Trial Paid eomower 140,375.00
301, Gross amount due from bonower (line 120) 154,870.93
302, Less amounts paid byffor borrower (line 220) 140,375.00
303. Cash ^X From ^ To Borrower 14,495.93
uas romt un«~ a mapwp ^ anenuy vane ~r.o oomra nurrmar. rvo ooamomwny o asmraq ups aoaowre o mamnory.
setllemem process
Previous editions are obsolete Page 1 of 4 HUD-1
'Paid outside of closing by (B~rrower, (S~Iler, (L)ender, (I)nvestor, Bro(I~er.
Previous editions are obsolete Page 2 of 4 HUD-1
3679.37 w 4736.69
830.00 830.00
0.00 _
0.00
830.00 830.00
1,500.00 0.00
238.00 186.00
0.00 _
0.00
0.00 _ 0.00
0.00 - 0.00
238.00 166.00
$ -72.00 o r -30.2521%
0.00 1,150.45
34.73 217.04
525.00 522.00
1,608.75 ~ 901.88
~
0.00 414.00
0.00 0.00
0.00 _
0.00
0.00 0.00
1 nsn Tnr~nc
~17J1000.00
30. years
4.8750%
$343.99 includes
^X Prindpal
Q Interest
^ Mortgage Insurance
^X No. ^ Yes, it can rise to a maximum of %. The first change
will be on ! I and can change again every years after I I . 1=very change
date, your interest rate can increase or decrease by %. Over the I'rfe of the loan, your
interest rate is guaranteed to never be lower than ~° or higher than °~.
^X No. ^ Yes, it can rise to a maximum of $
^X No. ^ Yes, the first increase can be on 1 I and the monthly
amount owed can rise to $
The maximum it can ever rise to is $
^X No. ^ Yes, your maximum prepayment penalty is $
^X No. ^ Yes, you have a balloon payment of $ due in
years on ! /
^ You do not have a monthly escrow payment for items, such as property faces
and homeowners insurance. You must pay these items directly yourself.
^X You have an additional monthly escrow payment of $247.31
that results in a total initial monthly amount owed of $591.30. This includes priincipal, interest, any
mortgage insurance and any items checked below:
^X Property taxes 0 Homeowners insurance
^ Flood insurance ^
a ^
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender.
Previous editions are obsolete Page 3 of 4 HUD-1
HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, k is a true and accurate statement of all receipts and
disbursements made on my account or by me in this transaction 1 further certify that I have received a copy of the HUD-1 Setttl~ement Sfateme~nt
~!!~
JA N DA SON
DALE L.~bAVIDS(
Agent: DONALD F
Title: EXECUTOR
DAVIDSON
The HUD-1 Settlement Statement which I have prepared is a true and axurate account of this transaction I have caused or will cause the funds to be
J.~L..~_~._ _____~
W ~ 1f
DATE
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010.
Previous editions are obsolete Page 4 of 4
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MEMBERS 1St
FEDERAL CREDIT LIlVION
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REGULAR SAVINGS ACCOUNT:
Account Number/ Suffix 101893-00
Date Account Established 05/10/1988
Principal Balance at Date of Death $5.00
Accrued Interest to Date of Death $0.00
Total Principal and Accrued Interest $5.00
Name of Joint Owner None
CHECKING ACCOUNT:
Account Number/Suffix 101893-11
Date Account Established 10/08/1994
Principal Balance at Date of Death $1,337.52
Accrued Interest to Date of Death $0.00
Total Principal and Accrued Interest $1,337.52
Name of Joint Owner None
VISA CREDIT CARD ACCOUNT:
Account Number 4672090000329433
Date Account Established 05/10/2005
Balance at Date of Death $0.00
Name of Joint Cardholder None
E~EIVE~
CEP ~. ~ 200
~RWIN ~ McKNiGH~
LA~I 01=FICE~
MEMBERS 1ST FEDERAL CREDIT UNION
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Leigh- ne Stallings
Lending Insurance Support Specialist
September 15, 2010
Estate of: Dale L. Davidson
Date of Death: 08/08/2010
Social Security Number: 208-42-5141
5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 vwvw:memberslst.org
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September 5, 2010
RE: Debt owed to Vesta M. and Donald H. Davidson (parents) by Dale L. Davidson (son),
deceased
To Whom it May Concern:
Over the past few years, Vesta M. Davidson and Donald H. Davidson, our grandparents have
helped to financially support their son and our father, Dale L. Davidson through financially
rough times. Unfortunately, Dale L. Davidson passed away on August 8, 2010 before ]Ze was
able to repay this debt to his parents. Although the exact amount of money Dale had c~~lculated
to be repaid exceeds $15,000, Vesta M. Davidson and Donald H. Davidson have decidE;d to
allow only $15,000 to be repaid. Other monies Dale intended to be repaid are to be considered
gifts from parents to son out of love. The signatures below indicate agreement by all parties that
$15,000 will be repaid to Donald H. and Vesta M. Davidson upon the sale of Dale L. Davidson's
estate.
Sincerely,
Lauren M. Lamper
Jaclyn R. Davidson
Lauren M. Lamper (daughter & beneficiary)
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Donald H. Davidson (father & executor of estate)
Jaclyn R. Davidson (daughter & beneficiary)
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Vesta M. Davidson (mother)