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HomeMy WebLinkAbout04-18-11 (2)1505610140 REV-1500 EX ~°'-'°' PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number Po Box 2sosol 2 1 1 0 1 0 4 3 Harrisburo, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 8 1 3 2 5 6 3 9 0 7 1 8 2 0 1 0 0 9 2 8 1 9 4 1 Decedent's Last Name Suffix Decedent's First Name MI F R I T Z R O Y W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI L Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 0 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of prior to 12-13-82) ~ 5. Federal Estate Tax Return Required QX 6. Decedent Died Testate ~ death after 12-12-82) 7. Decedent Maintained a Living Trust ~ S. Totat Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number D A V I D H S T O N E E S Q U I R E ? 1 7 7 7 4 7 4 3 5 First line of address 4 1 4 B R I D G E S T R E E T Second line of address City or Post Office N E W C U M B E RL A N D State ZIP Code REGISTER OF~ILLS USE ONLY `~ ~ s ~ :.~ E7 j - . 'Ye r t ~?` l ~F~ a _ ~ti ~.~....3 -- :-r' C ,, _, _. a @/~~ILED ~J~ - ~-- --, ;_-?'~ ~, ~.~.~ ~1 ,: P A 1 7 0 7 0 Correspondent's a-mail address: D S T O N E a7 S T O N E L A W• N E T 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. Sly E OF PERSON RESPONSIB'I~E FOR ETURN DATE 745 A DEN ~~ LEWISBERRY PA 17339 SIGNA E OF E R 0 R THAN REPRESENTATIVE DATE ------ - V -c~i-~I 414 BRIDGE S'1'~EET NEW CUMBERLAND PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 1505610240 REV-1500 EX Decedent's Social Security Number oecedent's Name: R O Y W• F R I T Z 1 8 1 3 2 5 6 3 9 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 1 6 5 0 0 0. 0 D 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. 2 8 2 2 . 8 5 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .. ..... 6. 7. Inter-Vivos Transfers 8 Miscellaneous N Probate Property (Schedule G) ~ Se ar Billi t R t d p a e ng eques e .. ..... 7. 8. Total Gross Assets (total Lines 1 through 7) ....................... .... 8. 1 6 7 8 2 2 . 8 5 9. Funeral Expenses and Administrative Costs (Schedule H) .............. .... 9. 2 5 0 9 8 . 7 4 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ......... .... 10. 4 8 3 . 9 3 11. Total Deductions (total Lines 9 and 10) ........................... .... 11. 2 5 5 8 2 . 6 7 12. Net Value of Estate (Line 8 minus Line 11) ........................ .... 12. 1 4 2 2 4 0 . 1 8 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 4 2 2 4 0 . 1 8 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X• 0 0. 0 0 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate x .12 1 4 2 2 4 0. 1 8 17. 1 7 0 6 8. 8 2 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. 0. O D 19. TAX DUE .................................................. ....19. 1 7 0 6 8• 8 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240. 1505610240 J REV-7500 EX Page 3 File Number Decedent's Complete Address: 21 10 1043 DECEDENT'S NAME ROY W• FRITZ STREET ADDRESS ------------------- - -------- __ _----------------- 1104 MARKET_STREET CITY ~ STATE -- ZIP- - NEW CUMBERLAND PA j17070- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments 15 , 5 0 0. 0 0 A. Prior Payments B. Discount 815.7 9 3. Interest 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 10 to request a refund. (1) 17, 068.82 Total Credits (A + g) (2) 16 , 315 • ? 9 (3) 0.00 (4) 0.0 0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (5) 7 5 3 • 0 3 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 : ...................................................................... ^ ^X b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ 3. Did decedent own an "intrust for' orpayable-upon-death bank account or security at his or her death? ......... ^ Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse 3 percent [72 P.S. §9116 (a) (1.1) (i)], For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or 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)J. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)J. 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+ (Ot-10) Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: NUMBER: ROY W• FRITZ 21 10 1043 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 jointlyowned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1 Property at 1104 Market St New Cumberland 165,D00.00 Cumberland County, PA sold to Mark C• Mateer on March 4, 2011 TOTAL (Also enter on Line 1, Recapitulation.) 165,000.00 If more space is needed, use additional sheets of paper of the same size. REV-1508 EX + (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER ROY W• FRITZ 21 10 1043 Include the proceeds of IitigaGon 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• Fulton Bank-Checking Acct #3620-22978 2,814.85 2 (Miscellaneous deposit ~ 8.00 TOTAL (Also enter on line 5, Recapitulation) I S 2, 8 2 2. 8 5 (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 ROY W• FRITZ 21 10 1043 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Stone & Murray Funeral Home-funeral expenses 5,731.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. AttomeyFees: DaVld H• Stone Esquire 7,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4• Probate Fees: See # 2 b e l O W 5 , Accountant Fees: 6 • Tax Retum Preparer Fees: 7• Stone LaFaver & Shekletski-Reimb on advertising 230.67 2 Register of Wills-probate costs 319.60 3 Verizon Wireless-services rendered 48.11 4 Check written by decedent but not cleared 25.00 5 Verizon wireless-services rendered 3.61 6 UGI-service contract on maintenance 47.55 7 Settlement costs ($9.343.91) less reimb ($1115.64) 8,228.27 8 PPL-service at property 189.17 9 UGI-gas service at property 55.18 10 PPL-service at property 107.81 11 PA American Water-service at property 23.03 12 UGI-gas service at propert 43.83 TOTAL (Also enter on Line 9, Recapitulation) S 2 5 , 0 9 8 •7 4 If more space is needed, use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent ROY W. FRITZ 21 10 1043 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses & Administrative Costs - B7. ITEM NUMBER DESCRIPTION AMOUNT 13 New Cumberland Borough-sewer & trash at prop 139.13 14 PPL-service at property 45.05 15 PA American Water-service at property 42.25 16 UGI-gas service at property 171.68 17 UGI-gas service at property 214.22 18 PPL-service at property 31.29 19 PA American Water-service at property 50.75 20 PA American Water-service at property 15.18 21 UGI-service at property 155.92 22 UGI-gas service at property 64.22 23 PA American Water-service at property 179.93 24 UGI-service at property 172.27 25 PA American Water-service at property 30.14 26 PPL-service at property 33.20 27 PPL-service at property 23.77 28 UGI-gas service at property 173.84 29 New Cumberland Borough-sewer & trash at prop 97.55 30 PA American Water-service at property 31.16 31 UGI-gas service at property 61.49 32 PPL-service at property 309.87 33 New Cumberland Boro-sewer 8 trash at property 223.00 34 Register of Wills-filing Inh Tax Return & Inv 30.00 35 Reserve for closing expenses 250.00 SUBTOTAL SCHEDULE H-B7 2,545.91 REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8 LIENS ESTATE OF FILE NUMBER ROY W- FRITZ 21 10 1043 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 PharMerica-medications 364.33 2 Rutter's Store-debt of decedent 64.61 3 Capital One-VISA card charges 19.99 4 Sears-Mastercard services 35.00 TOTAL (Also enter on Line 10, Recapitulation) I S 4 8 3. 9 3 If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: ROY W• FRITZ 21 10 1043 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outs' ht spousal distributions and transfers under Sec. 9116 (a) (t.2).J 1 DANNY L FRITZ 745 GLEN ARDEN DRIVE LEWISBERRY PA 17339- Sibling 142,240.18 I 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• I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1• TOTAL OF PART tI -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I E If more space is needed, use additional sheets of paper of the same size. FiADOCS~EF7WILLS\Eritz.Roy.wpd LAST WILL AND TESTAMENT OF ROY W. FRITZ I, ROY W. FRITZ, of the Borough of New Cumberland, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I devise and bequeath all of my estate of every nature and wherever situate to my brother, DANNY L. FRITZ, if he survives me. ITEM II: I appoint my brother, DANNY L. FRITZ, Executor of this my last will. ITEM III: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his or her duties in any jurisdiction. IN WITNESS WHEREOF, I, ROY W. FRITZ, have hereunto set my hand and seal this ~.~ day of ~ ~-~ ,` 2009. ROY W./FRITZ Page 1 of 3 SIGNED, SEALED, PUBLISHED and DECLARED by ROY W. FRITZ, the Testator above named, as and for his Last Will and Testament, and in the presence of us, who at his request, in his presence and in the presence of each other hav subscribed our names as witnesses. 414 Bridge St., New Cumberland PA Wi Address ne 414 Bridge St., New Cumberland PA Address COMMONWEALTH OF PENNSYLVANIA: . SS: COUNTY OF CUMBERLAND . I, ROY W. FRITZ, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. ROY W FRITZ Sworn to or affirmed to and acknowledged before me by ROY W. FRITZ, the Testator, this ~~ day of ~ ir~t~-I- 2009. COMMON'NEAI.i H 0~ PEyNSYLVANIA ~ ~r-: N '~ Notary Publi BROOKE E, ~-Ei. PpA, Notary Public New Cumber}and Boro. Cumberland Co. ~+miss;on 'res June 5 2012 Page 2 o f 3 ,,. COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND We , LaV:~I ~ S~'nr~~1 and inn ~ ~ ~' ~ - (~f1-a~~ , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testator sign and execute the instrument as his last will; that Testator signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Swnorn to or affirmed to and acknowledged beforne me by !,I UV ~ CSI ~ • ~'d(~,~.. and SQ,nr: ~ R ~ ~~k~-Q ,~` witnesses, this,C~7~`L~_ day of / ,~ /~"~.~ ~~ 2009. CO~IPAONWE~Li H OF PENNSYLVANIA ~~-~- NfjTARIAL S Notary Publi BRC+U}CE E. rE'L`PPA, Notary Public New Cumberland Bono. Cumberland Co. M Commissbn Ex Tres June 5, 2012 Page 3 of 3 y ~ ~ ~s~ ~~ Pregared By: Appalachiaa Settlement Agemcp, LLC. Retusa To: Appalachian Settlement Agency, LLC. 113 Linglestown Road Harrisburg, PA 17110 Purcell No . 26-23-0541-2'70 iii~ii~iiuii This Indenture ode the ~ ~ ~ day of /~~Q rG ~ in the year of our Lord two thousand and eleven (2011) Between DANNY L. FRITZ, EXECUTOR OF THE ESTATE OF ROY W. FRITZ, deceased (hereina~er called the Grantor(sJJ, of the one part, and MARK C. MATEER (hereina,~er caned the Grantee(sJJ, of other Pa~~ Witnesseth That the said Grantor(s) for and in consideration of the sum of ONE HUNDRED SIXTY-FIVE THOUSAND AND 00/ 100 DOLLARS ($165,000.00) lawful money of the United States of America, unto them well and truly paid by the said Grantee(s) at or before the sealing and delivery hereof, the receipt whereof is hereby acknowledged, have granted, bargained and sold, released and confirmed, and by these presents do grant, bargain and sell, release and confirm unto the said Grantee(s), their heirs and assigns, ALL THAT CERTAIN piece or parcel of land situate in the Borough of New Cumberland, County of Cumberland, Commonwealth of Pennsylvania, bounded and described as follows: BEGINNING AT A POINT and a monument on the West side of Market Street at the other lands now or formerly of Saint David's Court Trust, said point being one hundred sixty-four and forty-six hundredths (164.46) feet measured northwardly from Eleventh Street; thence South 61 degrees, 29 minutes 07 seconds West, along other lands now or formerly of Saint David's Court Trust, a distance of ninety-five and forty-two hundredths (95.42) feet to a monument; thence North 35 degrees 27 minutes 53 seconds West, a distance of sixty-four and seventy-three hundredths (64.73) feet to a monument; thence along an unopened fifteen foot alley North 54 degrees 52 minutes 48 seconds East, a distance of one hundred three and ninety three hundredths (103.93) feet to an iron pin on the West side of Market Street; thence along the Westside of Market Street South 28 degrees 30 minutes 53 Seconds East, a distance of seventy-six and twenty-one hundredths (76.21) feet to a monument, and the point and THE PLACE OF BEGINNING. CONTAINING 7,000 square feet as surveyed Alpha Consulting Engineers, Inc. P.L.S.P.E. and known as Drawing Number C:199144 and dated January 30, 2001. THIS DESCRIPTION is based on the approved final subdivision plan recorded in Plan Book 84 and Page 43 in the Office of Recorder of Deeds for Cumberland County on October 30, 2001. HAVING thereon erected a single one-story brick dwelling and an attached one-car garage known as 1104 Market Street, New Cumberland, Pennsylvania 17070 BEING THE SAME PREMISES which Roy W. Fritz and Danny L. Fritz, individually and as Co-Executors of the Last Will and Testament of James N. Fritz, deceased and Richard Fritz, by Deed dated March 23, 2009 and recorded April 1, 2009 in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Instrument No. 200909985, granted and conveyed unto Roy W. Fritz. And The Said Roy W. Fritz, being therefore so seized, having departed this life on July 18, 2010, leaving a Last Will and Testament, dated March 26, 2009, in which he/she named Danny L. Flritz, Executor. Whereas, Letters of Testamentary were granted on October 20, 2010 by the Register of Wills of Cumberland County to the above named executor/executrix the within Grantor(s). Whereas, the said Danny L. Fritz, Executor of the Estate of Roy W. Fritz conveys the within described tract of land in accordance with and by virtue of the Last Will and Testament of the said Roy W. Fritz. Together with all and singular the buildings and improvements, ways, streets, alleys, driveways, passages, waters, water-courses, rights liberties, privileges, hereditaments and appurtenances, whatsoever unto the hereby granted premises belonging, or in any wise appertaining, and the reversions and remainders, rents, issues, and profits therefore; and all the estate, right, title, interest property, claim and demand whatsoever of them, the said Grantor(s), as well at law as in equity, of, in, and to the same. TO have and to hold the said lot or peke of ground with the buildings and improvements thereon erected and premises hereby granted, or mentioned, and intended so to be, with the appurtenances, unto the said Grantee(s), their heirs and assigns, to and for the only proper use and behoof of the said Grantee(s), their heirs and assigns forever. UNDER AND SUBJECT as aforesaid. And the said Grantor(s), do/does hereby covenant and agree to and with the said Grantee(s) that the Grantor(s), their successors and assigns, shall and will SPECIALLY WARRANT AND FOREVER DEFEND the hereinabove described premises, with the hereditaments and appurtenances, unto the Grantee(s), Grantee's successors and assigns, against the Grantor(s) and against every other person lawfully claiming or who shall hereafter claim the same of any part thereof, by, from or under it, him, her, them or any of them, shall and will, subject as afaresaid, SPECIALLY W~?IRRANT AND FOREDER DEFEND. SUBJECT as aforesaid, 1n Witness Whereof, the said Danny L. Fritz, Executor of the Estate of Roy W. Fritz, party(s) of the frst part have hereunto set their hand(s) and seal(s). Dated the day and year first above written. _. _ _._ ..._ ~'\ Sealed and ~__._ ... ... Delivered Danny , ecutor iN THE PRESENCE OF: Of the Estate o Roy W. -'~J'--7~'7 - Friltz Witness Commonwealth ojPennsylva la County of ~' n,~G+'(`"~ SS On this, the ~ day of ~Qf ~'~' , 2011, before me, the undersigned Officer, personally appeared Danny L. Fritz, Executor/Executrix known to me (satisfactorily proven) to be the person whose name(s) is (are) subscribed to the within instrument, and acknowledged that he executed the same for the purpose therein contained. In Witness Whereof, I hereunto set my hand and official seal. COMMONWEALTH OF PENNSYLVANIA NOTORIAL SEAL DOUGLAS C. RAUCHUT, Notary Public Susquehanna Twp., Dauphin County My Commission Ex fires Oct. 27, 2011 ~~~~ Notary blic My Commission Expires: 1 hereby certify that the precise~alddress of the Grantee ' )0 Settlemen ROBERT P. ZIEGLER RECORDER OF DEEDS CUMBERLAND COUNTY 1 COURTHOUSE SQUARE CARLISLE, PA 17013 717-240-6370 Instrument Number - 201107657 Recorded On 3/8/2011 At 11:23:27 AM * Total Pages - 5 * Instrument Type -DEED Invoice Number -83381 User ID - MSW * Grantor - FRITZ, ROY W * Grantee - MATEER, MARK C * Customer -APPALACHIAN SETTLEMENT AGENCY LLC * FEES STATE TRANSFER TAX STATE WRIT TAR STATE JCS/ACCESS TO JUSTICE RECORDING FEES RECORDER OF DEEDS PARCEL CERTIFICATION FEES AFFORDABLE xOUSING COUNTY ARCHIVES FEE ROD ARCHIVES FEE WEST SxORE SCHOOL DISTRICT $1,650.00 $0.50 $23.50 $12.50 $lo.oo $11.50 $2.00 $3.00 $825.00 NEW CU1dBERLAND BOROUGH $825.00 TOTAL PAID $3,363.00 Certif cation Page DO NOT DETACH This page is now part of this legal document. I Certify this to be recorded in Cumberland County PA is RECORDER O D DS • -Information denoted by an asterisk may change during the veriticaNon process and may not be reflected on this page. IlVllll~d!Iil~ ~ilto~iBarik LISTENING IS JUST THE BEGINNING.s" November 18, 2010 Stone LaFaver & Shekletski Attorneys at Law 414 Bridge Street P.O. Box E New Cumberland, PA 17070 Dear Mr. Stone, RE: Roy Fritz, deceased July 18, 2010 In response to your recent inquiry concerning the accounts maintained in the name of the decedent, please be advised that the following account was open at the date of death: Checking #3620-22978 Date of death balance $2,814.85, opened 1/7/99, titled in his name alone with Danny Lee Fritz as Power of Attorney If you have any other questions, please feel free to contact me at (717) 291-2436. Sincerely, ~~ Joshua A. Groff Credit Confirmation Processor This irform8i~rt is turnishr~i ~s a matt~ar of bus;r~ess courtesy in ansr~>?r tc `r i-?q±~isy, arni is ftx yGUr xx?f'w~?t:st use aniy. The bank tuniishing this irtormati4n does not rspr~~nt cr g;;arartae the ~cc;uracY, cvf~npi~t~aness or r~!iability of the i;~tom~ation prod. No respsx'fsit;+j~~ is r~ssurr~t# by the hank cr arry ai tts c~e~rs, $mplc~s s~ s~nts• Rm~ opinion horein sxprsased is sut;ject to cnnnge witho4~t notice 1.800.FULTON.4 • fultonbank.com Fulton Bank, N.A. Member FDIC. Member of the Fulton Financial Family. ~MEw~ty, ~ • ~ •`~L ~` ~~~ ~ A. Settlement Statement (HUD-1) 9kM oN~~~ B. Type of Loan OMB Approval No. 2502.0265 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: t. ©FHA 2. ~ RHS 3. QConv. Unins. ASA-110029 6100110013 446-0640010-703 4. Q VA 5. Q Conv. Ins. C. Note: this form is lumished to give you a statement o/actual settement costs. Amounts paid to and by the settlement agent are sirown. Items marked (p.o.e.)" wero paid outside the closing; they ero shown hero kx in/ormatrone/purposes end ero not included in the totals. D. Name and Address of Borrower: E. Name and Address of Seler: F. Name and Address of Lender: Mark C. Mateer Danny L. Fritz Graystone Mortgage LLC 1104 Market Street Estate of Roy W. Fritz 5115 East Trindb Road, Suite B New Cumberland, PA 17070 Mechanicsburg, PA 17050 G. Property Location: H. Sekbment Agent: 02-0840071 I. Settlement Date: 1104 Market Street Appalachian Settlement Agency, LLC. New Cumberland, PA 17070 115 Lingbatown Road March 4, 20 11 Cumberland County, Pennsylvania Harrisburg, PA 17110 Ph. (717)901-3600 Place of Sekbment: 1104 Market Street New Cumberland, PA 17070 J. Summary o/ Borrovwr's trensactlon K. Summary of Ssllsr's transaction 100. Gross Amount Due from Borcower: 400. Gross Amount Due to Seller. 101. ControG sobs rice I 165 000.00 401. DOntreU saba rice 165 000.00 102. Pesonal r I 402. Personal ro , 103. Sekbment Cha es to Borrower Line 1400 I 7 634.27 403. 104. 404. t 105. I 405. Ad ustments for kems id Seler In advance ' Ad ustments for kems id Seller In advance 106. C !Town Taxes to I 408. Ci /Town Taxes to 107. Coun Taxes 03/04/11 to 01/01/12 644.06 407. Coun Taxes 03/04/11 to 01/01/12 Og gg4 108. School Taxes 03/04/11 to 07/01/11 444.99 408. School Taxes 03/04/11 to 07/01/11 , 444 89 109. Trash Proration 01/01/11 to 03/04/11 I 26.59 409. Trash Proration 01!01/11 to 03/04/11 . 26 59 110. 41 . I . 111. i 411. 112. I 412. 120. Gross Amount Dw from Borrowwr I 173,749.91 420. Gross Amount Due to Seller j 168,115.64 200. Amounts Paid or In BehaH of Borrower 500. Reductions in Amount Due Seller: 201. De sit or eamesl mon 1,000.00 501. Excess de sit see instructions 202. Princi al amount of new loans ' 160,817.00 502. Settlement cha es to Seler Line 1400 23 786 00 203. Exists loans taken su act to 503. Existin bans taken sub'ed to . 204. Lender Cou n Credit 150.00 504. payoff Firot Mo age 205. A sisal fee Credit 450.00 ~ 50 . a eco orl a e 206. 207 506. De d rotained seller i 1 000.00 . 507. i 208. 508. ~ 209. Seller Assist 5 488.38 509. Seler Assist 5 486 38 Ad ustmsnts for kems un Id b Seller Ad ustmenb for kems un id Seller . 210. Ci Rown Taxes to i 510. C /Town Taxes to I 211. Coun Taxes to 511. Coun Taxes to 212. School Taxes tc I 512. School Taxes to I 213. Water/Sewer Proration 01/01!11 l0 03/04/11 ! 71.53 513. Water/Sewer Proration 01/01/11 to 03/04/11 ~ 71 53 214. 514. . 215. f 515. 216. I 518. 217. 517. 218. 518. 219. i 519. ~ 220. Total Paid Hor Borrower ~ 167,974.91 520. Total Reduction Amount Dw Seller 30 343 91 300. Cash at SatUsment homRo Borrower 800. Cash at settlement toHrom Seller , . 301. Gross amount due from Borcower line 120 173 749.91 601. Gross amount due to Selbr line 420 I 166 115 84 302. Less amount aid b Mor Borrower line 220 I( 167,974.91 602. Less rodudions due Seller line 520 ( . 30 343 91 303. Cash a From ~ To Borrower i 5,775.00 803. Cash O To ~ From Seller , . 135 771 73 , . ne unoersgned hereby acknowledge receipt of a completed copy of this statement & any attachments refereed to herein Borrower Mark C. Mat Se I r-~_ (-~ -- M/1 eQf Danny for the E ate of Roy ' ,,r'i1r Zr,lt. +rty f Urr~USkS trn(ty F'urtha ~c PrtcF. y l(e 0 SUup.~~ ~~'S-(s 3 786 . c v 5486.311 S3 13y3 91 TI u ` 4' 1 ~X (f s ~ r 15. 6`I r~c ~,~~~ ~ °~ ~(& ~ 7 ~ Per relpones for caASCenq, nviewvq, aW reponaq trte Eeta. TMl WAY may not tdbd Vxs hrormaUOn, arM you ere rot requirso to n6sYty if sewrw. ttrq dltAwurs N menaatory. TMl it tleepnW to provge rte PeNel b e RESPA coverotl tranlettion w{pt Mormetion Page 1 of 3 HUD-1 (ASA-110029.PFD/ASA•110029l28) ~. aememenl: cnarges 700. Total Rsal Estdta Broker Fees PwC From Paq From Division o commission (line 700) as llows: ~r~f s~,f 701. t FurWUI FWf tl 702. t 703. Commission aid at seltlemen Settlfmfrn SatlNnyrn 704. 705. 800. Items Pa able In Connection with Loan 801. Our on ination cha a Includes O ' ination Point S 860.95 S 860.95 from GFE #1 , 802. Your credit or charge (points) for the specific interost rate chosen S (from GFE #2) 803. Your ad'usted o ' ination charges from GFE #A 860 9 5 804. A raisal lee to A raisal L istia from GFE #3 . 370 0 0 805. Credit Re rt to First American Credco from GFE #3 . 17 3 7 ,: 806. Tax service to (from FE #3) . 7. lood cart' iwtion to from #3) 08. from #3) 809. ( rom # ) 1 (om #3) 11 . from F #3 900. Items Re utred b Lsndsr to tae Paid In Advance 901. Daly interest cha es from 03/04/11 to 04/01H 1 28 520.930000/da (from GFE #10) 586 04 ' - 902. MoR a e insurance remium for months to De artment of HUD from GFE #3 . 1 592 25 90 . omeownefs insurance or 1.0 era to fate enn from #11 P :593.0 ~ . 0 ' from GFE #11 905. (from GFE #11) 1000. Reserves De sited with Lender 1001. Initial deposit for your escrow account (from GFE #9) ' omeowne s msurance mon s per mon 909 28 , ,, 1003. Mort a einsurance 0.000 months S 118.58 er month S 1004. Property taxes S 193.95 ouny ax 3.000 months 64.65 per month ouny Taxes months ~ E per month Assessments months per month 1005. s loos. months ~ S per month S ~ 1007. School Tax 11.000 months ~ S 113.74 per month S 1,251.14 1008. S - 1009. A ggregate Adjustment i -684.07 1100. TIUe Cha es 1101. Tdb services and tinders title Insurance rom ) 1102. Settbment or Gosi tee to aiachian Settbment A en LLC. S 150 00 1,492.38 125.00 . 1103. ers tkb insurance to Old Republic National Titb Insurance ompan from GFE #5 1104. Lender's tilb insurance to OW Republic National Titb Insurance Com an 18.00 p S 1,197.38 1105. Lenders tkle I limit S 160 817.00 1106. Owner's tRb li limit S 185 000.00 1107. A cot's onion of the total titb insurance remium to A alaehian Settbment A en LLC S 1 0 , . , 57.38 1108. Underwritefs ortion of the total title insurance remium to Ohf Re ublic National Titb Insuranc C e a S 158.00 1109. Cloning Service Letter to Old Re bli N ti pu c a onal Tkle Insurance Comp y 75.00 1110. 1111. 1112. 1113. 1200. Government ReeoMing and Transfer Charges 1201. Government recordin cha es to Cumberland Coun Recorder of Deeds from GFE #7 1202. Deed S 84.00 MoR a e S 74.00 Rebases S 138.00 ' Other S 1203. Transfer taxes to Cumberland Count Record f D ., y er o eeds (from GFE #8) 1204 Ci 1 650 00 . /Coun tax/stampa Deed S 1,650.00 Mort age S . 1205. State taxlstam s Deed S 1 650.00 MoR a e S 1 650.00 1207. 1300. Additional Settbment Char ss 1301. R wired services that ou can aho for from GFE #6 1302. 1303. 1304. 1305. See addit'I dish. exhibit to 1400. Total Settlement Char es enter on Imes 103, Sactlon J and 502, Section K 22.011.00 7 834.27 23 786.00 m w~ro PfYf , «ovf ftarfrrwN, aw fiprwmne..dvnWrw. nceq of • comp.ra copy of ww Z 6 9 d a,~i first pfpf w x Av""valac ~rA~i Settlehft~nt Agenq, LLC., Settlement Agent Page 2 0/ 3 HUD-1 (A SA-110029. P F D/AS A-110029/2 8 ) Comparison of Good Faith Estimate (GFE) and HUD-1 Charges Good Faith Estimate HUD-1 Chat es That Cannot Increase HUD-1 Line Number Our origination charge # 801 860.95 860.95 Your uedR or char a (points) for the specific interest rate chosen # 802 Your adjusted on ination charges # 803 860.95 860.95 Trans/ertaxes #1203 1,650.00 1,650.00 Cha es That in Total Cannot Increase Moro than 10% Good Faith Estimate HUD-1 Government rewrdin charges #1201 160.00 138.00 Appraisal fee # 804 370.00 370.00 Credit report # 805 17.37 17.37 Mort age Insurance Premium #902 1,592.25 1,592.25 Title services and lenders tflb insurance #1101 Owners title insurance to Old Republic National Title Insurance C #1103 1,500.75 1,492.38 1800 Total 3,640.37 3,628.00 Increase between GFE and HUD-1 Charges S -12.37 or -0.34 Charges That Can Change Good Faith Estimate HUD-1 Initial deposit for your escrow account #1001 2 592 24 909 28 Daily interest charges #901 S 20.930000/day 318.28 586.04 Homeowners insurance #903 577.44 593.00 Loan Teens Your Initial loan amount Is S 160,817.00 Your loan term Is 30 years Your Initial Interest rate Is 4.7500 °~ Your initial monthly amount owed for principal, interest and E 957.48 inGudea any mortgage Insuancs Is Q principal Q Interest QX Mortgage Insurance Can your Interest rate rise? QX Na ~ Yes, ft can rise to a maximum of %. The first change will be on and can change again every _ months aRer . Every change date, your interest rate can inueaae or decease 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? QX No ~ Yes, It can rise to a maximum of S Even If you make payments on time, can your monthly QX No ~ Yes, the first increase can be on and the monthly amount owed for principal, interest, and mortgage Insurance rfsa4 amount owed can rise to S The maximum it can ever rise to is E Does your loan have a prepayment penalty? ~X No ~ Yes, your maximum prepayment penalty is E Does your loan have a balloon payment? QX No ~ Yes, you have a balbon payment of S due in _ years on Total monthly amount owed Including escrow account payments ~ Yau do not have a monthry esuow payment for items, such as property taxes and homeowner's insurance. You must pay these items directly youreen. XO You have an additional monthly escrow payment of 5346.39 that results in a total initial monthly amount owed of 51,185.29. This includes pnncipal, interest, any mortgage insurance and any items checked below: QX PropeRy taxes Q Homeowners insurance Flood insurance .~~e. ~~ yvu nave any quasuons aoout the Settlement Charges and Laan Terms listed on this form, please wntact your lender. Page 3 of 3 HUD-1 (ASA-110029.PFD/ASA-110029/28) HUD-1 Attachment Borrower(s): Mark C. Mateer 1104 Market Street New Cumberland, PA 17070 Lender: Graystone Mortgage LLC settlement Agent: Appalachian Settlement Agency, LLC. (717)901-3600 Place of Settlement: 1104 Market Street New.Cumberland, PA 17070 Settlement Date: March 4, 2011 Property Location: 1104 Market Street New Cumberland, PA 17070 Cumberland County, Pennsylvania Seller(s): Danny L. Fritz, Executor for the Estate of Roy W. Fritz(deceased) Additional Adjustments For Items Paid By Seller In Advance (Borrower Debit) Description Amount From/Through Prorated Amount Trash Proration 38.60 01/01/11 through 03/31/11 26.59 Total Line 109/409 26.59 Adjustments For Items Unpaid By Seller (Seller Debit) Description Amount From/Through Prorated Amount Water/Sewer Proration 103.83 01/01/11 through 03/31/11 71.53 Total Line 213/513 71.53 Additional Disbursements Payee/Description NotelRef No. Borrower Seller Robin Gasperetti 2,011.00 2011 County/Township Taxes Appalachian Settlement 20,000.00 Inheritance Tax Escrow held in escrow Total Additional Disbursements shown on Line 1305 S 0.00 S 22,011.00 Adjusted Origination Charge Details Origination Charge Origination Charge to Graystone Mortgage LLC Origination CrediUCharge (points) for the specific Interest rate chosen 860.95 Total S 860.95 Total ; Adjusted Origination Charges S 880.95 WARNING: it b a crime to knowingty make false statements to tha 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. (ASA-110029.PF0/ASA•110029/28) HUD-1 Attachment - Continued Reserves Deposited with Lender Homeowner's Insurance 3.000 at 49.42 per month County Tax 3.000 at 64.65 per month School Tax 11.000 at113.74 per month Aggregate Adjustment month 148.26 193.95 1,251.14 -684.07 Total E 909.28 Title Services and Lender's Title Insurance Details BORROWER SELLER Courier Fee 40.00 to Appalachian Settlement Agency, LLC. Tax Certification Fee 20.00 to Appalachian Settlement Agency, LLC. Wire Fee 10.00 to Appalachian Settlement Agency, LLC. Deed Prep 125.00 to Appalachian Settlement Agency, LLC. Settlement Fee 150.00 to Appalachian Settlement Agency, LLC. Lender's title insurance 1,197.38 to Old Republic National Title Insurance Company Closing Service Letter 75.00 to Old Republic National Title Insurance Company Total S 1,492.38 S 125.00 Owner's Title Insurance BORROWER SELLER Owner's Policy Premium to Old Republic National Title Insurance Company 18.00 Total i 18.00 S 0.00 Lender's Title Insurance BORROWER SELLER 'fees also shown above In TIUe Services and Lender's Title Insurance Details Lender's Policy Premium 1,047.38 to Oid Republic National Title Insurance Company Lender's Endorsement Charges 150.00 Endorsement Endorsement Charge ALTA Endorsement Form 8.1 (Environmental Protection Lien) 50.00 PA Endorsement 100 50.00 PA Endorsement 300 50.00 Total S 1,197.38 S 0.00 WARNING: It Is a crime to knowingly make false statements to the United States on this or any almilar form. Penalties upon conviction can Include a fine end imprisonment. For details see: TIUe 18 U.S. Code Section 1001 and Section 1010. (ASA-110029. PFD/ASA-110029/28) STONE LAFAVEI3. &SHEKLETSKI ATTORNEYS AT LAW 414 BRIDGE STREET DAVID H. STONE POST OFFICE BOX E GERALD J. SHEKLETSKI NEW CUMBERLAND. PA 17070 www.stonelaw.net April 15, 2011 Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3887 RE: Estate of Roy W. Fritz No. 21-10-1043 Greetings: Enclosed please find an original and one copy of the Inheritance Tax Return and Inventory for the above mentioned estate. Please clock in the copy of the Inventory and send it back to my office along with any receipts in the enclosed stamp addressed envelope. Also, enclosed is check #1 in the amount of $753.03 for payment of the inheritance tax and check #2 in the amount of $30.00 for filing the return and inventory. Please note the new procedure on the Fulton Bank checks. Should you have any questions, please do not hesitate to contact my office. DHS/tmb Enclosures OF COUNSEL CHARLES H. STONE JON R LwFAVER TELEPHONE (717) 774-7435 FACSIMILE (717) 774-3869 Very truly yours, STONE L FAVER & SHEKLETSKI J,M.,,_ id H. S ne n ~-: .zc~ . i -~~ r-- --'ern -7 ~-'~ ~ . `_. i .'J ~~i _~ --I a ~~ :{-, ~ , ~ -`C7 '' l ::J CU -,-, __ ; ~_. i `; ~ c,. O ~ ~ `~ o v .~ ~ W ~ ~ ~ • ~ W W ~ w ~ M Oa ~ W o o C ~ OU NM F- m D N W W U Z S-I .--1 U1 ° ow tr',~ ~ ~ - > c ~ 3 ~u ,aN~ d U N~ a v a v , 4"i m W O W w ~ O Z Z ~ N 0 ~ ~ r -I r -1 N ~ ~ ~ N to N ~ •,i •~ A O •-~ ~ ~ U ~ P4U~U