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HomeMy WebLinkAbout05-06-111505610105 REV-1500 Ex (02-~~, (F~, PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes °`°"A."-"T°`RE~'"°` County Code Year File Number Po Box zso6oi INHERITANCE TAX RETURN ~` Harrisburg, PA 1y128-0601 RESIDENT DECEDENT ~~ 1 ~ V ~~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 174-20-1745 07/22/2010 04/30/1925 Decedent's Last Name Suffix Decedent's First Name MI WERT LORRETTA M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE; REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tai: Return Required death after 12-12-82) CID 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust D 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) (:UKKESPUNDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE (DIRECTED T0: Name Daytime Telephone Number DONNA M. MULLIN, CPA (717) 761-7210 First Line of Address BOYER &RITTER CPAS Second Line of Address 211 HOUSE AVENUE City or Post Office CAMP HILL State ZIP Code PA 17013 REGISTER OF WILLS USE ONLY- n r". • . - ;--~ -- -~ -~~:-, -~ . _ `---? _, l _ i 1 DA7E-1`~~ D _ •Y ~ ---- - 1 t l ~~ , ~~ ~.. ~ ~~ .i Correspondent's a-mail address: dmUllln@Cpabr.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 hats anv knowledge. ~i~rvHi t ~r rtKSUN KESPONSIBLE FOR FILING RETURN DATE= rruur~o 29 HICKORYTOWN ROAD, CARLISLE, PA 17015 Sic~Nwi u--ct OF PREPARER OTHER TH REPRESENTATIVE DATE= ADDRESS BOYER &RITTER CPAS, 211 HOUSE AVENUE, CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY ~,~, 1505610105 Side 1 150561105 <~-a 1505610205 REV-1500 EX (FI) Decedent's Name: LORETTA M WERT Decedent's Social Security Number 174-20-1745 RECAPITULATION 1. Real Estate (Schedule A) ......................................... .... 1. 125,500.00 2. Stocks and Bonds (Schedule B) ................................... .... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .... 3. 0.00 4. Mortgages and Notes Receivable {Schedule D) ....................... .... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... .... 5. 42,626.09 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ... .... 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.... .... 7. 8. Total Gross Assets {total Lines 1 through 7) ......................... .... 8. 168,126.09 9. Funeral Expenses and Administrative Costs (Schedule H) ............... .... 9. 28,475.06 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... .... 10. 1,428.34 11. Total Deductions (total Lines 9 and 10) ............................. .... 11. 29,903.40 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. 138,222.69 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................... .... 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13} .................... .... 14. 138,222.69 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 45 138,222.69 16. 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 1 g 19. TAX DUE ....................................................... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1,505610205 6,220.02 6,220.02 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: DECEDENT'S NAME LORRETTA M. WERT _ - - -- - -- STREET ADDRESS 262 MCKNIGHT STREET File Number - - __ - __ _ - - - _ CITY -- -- _ __ - - STATE _ - - _ _ I ZIP - -_ --...------- CARLISLE I PA 17013 Tax Pa ments and Credi y ts. 1. Tax Due (Page 2, Line 19} (1) 6,220.02 2. Credits/Payments -- A. Prior Payments _ _ 6,000.00 -- ---- B. Discount 311.00 Total Credits (A + B) (2) 6,311.00 3. Interest --- (3) 0.00 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. (4) 90.98 5. 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 .............................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ................................................................................... 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 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(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a}('1.3)). A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~ pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER LORRETTA M. WERT 21-10-0758 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as they 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 ~„~~~+ hp diar~nao~l ,,., c,.tiea..~e i~ ~~~~~~ ~Na~c ~~ neeuea, mser< aaaiuonai sneers or the same size. REV-15o8 EX+ (ii-io) Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: LORRETTA M. WERT 21-10-0758 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 ~n c~tip~~~io ~ •~ ~~~~~~ ~Na« ~~ iiceueu, use aaaitionai sneers or paper of the same size. ftF1l-I..`iI I E~X+ , t0-~lzi) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER. LORRETTA M. WERT 21-10-0758 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1' HOLLINGER FUNERAL HOME 5,832.65 2. BOUGHMAN MEMORIAL 1,331.00 B. ADMINISTRATIVE COSTS: 1, Personal Representative Commissions: Name(s) of Personal Representative(s) JONI K. BRICKNER Street Address 29 HICKORYTOWN ROAD City CARLISLE _ _ _ _ _ _ _ __ State PA ZIP 17015 Year(s) Commission Paid: 2011 z• Attorney Fees: 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: 5• Accountant Fees: 6• Tax Return Preparer Fees: ~• USPS -Postage B Estimated Closing Fees 9 Utility costs for residence while on Market (See attached listing) 1 o Fix-up Costs for sale of residence (See attached listing) 11 Closing Costs -Sale of Real Estate (See attached listing and HUD-1) TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. 5,800.00 321.50 800.00 8.80 100.00 1,166.90 3,462.73 9,651.48 28,475.06 ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER LORRETTA M. WERT 21-10-0758 Report debts incurred by the decedent prior to death that remained unuaid at the date of death ~M~~~~a~~., ~~~..e:...~........,a __~:__~ _..______ ~~ nwic aNa~e is neeaea, inser[ aaamonai sheets of the same size, REV-151.3 EX+ (01-10) ~ pennsylvania SCHEDULE ~ DEPARTMENT Of REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: LORRETTA M. WERT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1~ JONI K. BRICKNER, 29 Hickorytown Road, Carlisle, PA 17015 2. LOIS E. GLEIM, 101 McClures Gap Road, Carlisle, PA 17013 3. LESTER L. GOUFFER, JR., 100 Wedgewood Circle, Etters, PA 17319 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) DAUGHTER DAUGHTER SON 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. FILE NUMBER: 21-10-0758 AMOUNT OR SHARE OF ESTATE 1 /3 1 /3 1/3 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I$ If more space is needed, use additional sheets of paper of the same size. ~ ~ ~ - ~ c~ _ LAST WILL AND TESTAMENT ~= rn-- r ~-~ '~`~' rn tv ~___ - OF , ,~ ~T ~ ~ _~,F • LORRETTA M . WERT ~ ~ w • __" '-r=; _,~ ,. I, LORRETTA M. WERT, of Carlisle, Cumberland C~unty,~~ Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and expenses of my 3 last illness and funeral from my estate as soon after my death as conveniently may be done. I direct my personal representatives to arrange for my interment at my father's plot in Churchtown. Further, I authorize my personal representatives to expend funds from my estate, in such amount as my personal representatives shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. SECOND SAIDIS, CHUFF & MASLAND ATTORNEYS•AT•LAW Z6 W. HIgh Street Carlisle, PA I give, devise and bequeath all the rest, residue and remainder of my estate to my beloved children, JONI K. BRICKNER, LOIS E. GLEIM and LESTER L. GOUFFER, JR., share and share alike, the children of any deceased beneficiary taking the ~~hare their parent would have had if living. :~-- i 4. 3 SAIDIS, >HUFF & MASLAND ATT01tNEYS•AT•LAW 26 W. High Street Carlisle, PA THIRD I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. FOURTH In addition to the powers conferred by law, I authorize any personal representatives acting under this instruments in their absolute discretion: A. To retain in the form received, or to sell either at public or private sale any real or personal property; B. To exercise any options to subscribe far stocks, bonds, or other investments; C. To join in any plan of lease, mortgage, ,consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any tru:~t may hold stocks, bonds or other securities; D. To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as my personal representatives, in their sole discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; E. To make settlements and compromises on such terms as my personal representatives in their sole discretion may 2 deem wise without the necessity of obtaining any court approval thereof; 'F. To make distribution hereunder either in cash or kind, as my personal representatives in their discretion may deem wise. ~~ FIFTH I do hereby nominate, constitute and appoint my children, JONI K . BRICKNER, LOIS E . GLEIM and LESTER L . GOUFFER, JR . to act as Executors of this my Last Will and Testament. SIXTH I direct that no personal representative, guardian, trustee dr other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, LORRETTA M. WERT, have hE=reunto set my hand and seal to this my Last Will and Testament, ~~onsistin g of f ive ( 5 ) typewritten pages, the first two (2 ) of which bear my signature in the margin for identification, this ~~~ day of ~ 1998. ~..~. LORRETTA M. WERT SAIDIS, HUFF & MASLAND ATro1WEYS•AT•[.AW Z6 W. High Street Carlisle, PA Signed, sealed, published and declared by the above-named LORRETTA M . WERT _ Tait- ~ ~,~; .. _ _ _ __ ~ _ Testament in the presence of us, who have hereunto subscribed our 3 names at her request as witnesses thereto, in the re p sence of ~~ ~3 ~O SA IDI S, >HUFF & MASLAND ATTORNEYS•AT•LAW 26 W. High Street Carlisle, PA said Testatrix and of each other. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND J ADDRE S S ~'7 [..CJ ~/iC~ ~ " ~ I ~~ L / ~~(~~~ ff ~~~ ~ ~DDRE S S 2 ~ W • ~ • ss We , LORRETTA M . WERT , . f' /~ QL and ~ ~~ 1i " ~ ~ the Testatrix and witnesses, respectively whose names are si ne g d to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will arld Testament and that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses and that to the best of their knowledge the Testatrix was at the time eightE~en (18) or more years of age, of sound mind and under no constraint or undue influence. 4 w'~ Witness ___ .._ Subscribed, sworn to and acknowledged before me by LORRETT A M. WERT, the Testatrix, and subscribed to and sworn or affirmed to before ~me by and Q' /''/~ i~~/ ~'~' -~?~~ , witnesses, this ~ day of 1_Q98. :~ r ~},~,~~,~ ~~::~:t o a ry P •~ ~ _ ~~ ~Si 1'{~`.~f:i.: ~e ~: t.. 'c:,s:~y~ifC:j ~Z,j'.7'r r~i~ ~ '~M~~~'~_ SA IDI S, >HUFF & MASLAND ATTORNEYS•AT•LAW 26 W. High Street Carlisle, PA c 5 Lorretta M. Wert Estate -Form Rev-1511 -Supplemental Detail for totals on Schedule H File No. 21-10-0758 Utilities for Residence While on Market: PPL (Electric) 09/03/10 $85.48 Borough of Carlisle (water/Sewer) 09/20/10 $87.60 PPL (Electric) 09/24/10 $39.96 PPL (Electric) 10/30/10 $24.56 PPL (Electric) 11/29/10 $24.68 Borough of Carlisle (water/Sewer) 12/18/10 $65.94 PPL (Electric) 01/02/11 $16.20 Heating Oil 01/12/11 $295.01 PPL (Electric) 01/30/11 $20,88 PPL (Electric) 03/05/11 $25.69 Heating Oil 03/07/11 $370.00 Borough of Carlisle (water/Sewer) 03/15/11 $65.94 PPL (Electric) 03/30/11 $25.18 PPL (Electric) 04/26/11 $19,78 Total to Sch H $1,166.90 Fix-up Costs for Sale of Residence: Jose Ramos (paint house) 08/25/10 $1,000.00 Lester Gouffer (repairs) 08/25/10 $9,97 Carpet America 08/26/10 $620.00 JD Flooring 08/26/10 $300.00 JD Flooring 09/09/10 $446.92 Lowes (repair supplies) 09/03/10 $272.02 Lester Gouffer (repairs) 09/20/10 $58,29 Citicard (repair supplies) 10/08/10 $635.53 Don Winterdale (repairs) 11/13/10 $120.00 Total to Sch H $3,462.73 Closing Costs from HUD-1 Re Sale of Real Estate Realtor Commission 05/02/11 $7,725.00 Notary Fees 05/02/11 $10.00 Transfer Taxes 05/02/11 $1,255.00 RE Taxes (net expand reimb) 05/02/11 $16.26 Home Warranty 05/02/11 $495.00 Deed Prep 05/02/11 $100.00 Carlisle Borough Water/Sewer 05/02/11 $50.22 Total to Sch H $9,651.48 'av~ovs eGt~ons a~a Ob~O~ete A. Settlement Statement o t.... ~.~...... U.S. Department of Housing and Urban Development f+MR Onnrnv~l Nn 7~iM_MR5 SINAI i. []FHA 2. OFmHA 3. OConv. Unins. a. vA 5. Conv.lns. 6. Flle Number 11.235 7. Loan Number 8, Mortgage Insurance Case Number i m ~ u ~ tv y Y Y ~ n t i y • n wn. C. Note: Hems manteo'rp o c )' were D•t0 aut>NOS m• cwung, tMy •rs mown n.r• for m+orm•tion purpo~oe ona are not mduCet) m the tOtelf TilleExpress Settlement System WARNING: It t>ti a U1m• to knowingly m+-@ fell0 •t•lem•nq to p1• Urut•0 51.1•! nn (ftis W anv otnsr fimdN (Omr P•n81b~s upon wnacUCn un usctuae a nee aid nn tsonmurn i0r oetells w•: Tttw 16 u S Cone Section 1 1 ono s•WOn ,a+a Printed 04128/2411 a115:52 BM p. NAME OF BORROWER: SAIL L. I~rLLEh ADDRESS- 925 Mount Mock Rd., CarllshPA 17015 E. NAME OF SELLER: THE ESTATE OF LORRETTA M. WERT ADDRESS: 262 McKnfaht St.. Carlisle, PA 17013 _ F. NAME OF LENDER: ADDRESS G. PROPERTY ADDRESS: 262 MCKNIGHT STREET, BOROUGH OF CARLISLE, CARLISLE, PA 17013 Carlisle Bcr~ugh H. SETTLEMENT AGENT. .c-r,:LS^t~ "^t•I~^:ent Services PLACE OF SETTLEMENT: 4309 Linglestown Road, 717.671-9876 Fax 717.671.9676, Harrisburg, PA 17112 I. SETTLEMENT DATE: 05!02!2011 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER t01. Contract sates rice 125 SOb.00 401. Coutr t sales rice 125500.00 102. Personal Pro ert 402. Personal Pro rt 103. Settlement char es to borrower line 1400 2 530.86 403. 104. 404. _ _. - -_ 105. 405. Ad'ustments for items aid b seller in advance Ad~ustments for items aid b seller in advance 107. Count taxes 05102N 1 to 12131!11 413.79 407. Count taxes 05!02!11 to 12131111 413.79 108. School Taxes 05JOZ111 to 06130111 188.95 408. School Taxes 05!02111 to06130111 188.95 109. 409. 110. 410. 111. 411, 112. 412. 120. GROSS AMOUNT DUE IRON EtUIZROYJER 128 633.60 420, GROSS AMOUNT DUE TO SELLER 126102.74 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. De osit or earnest move 1 000.00 501. Excess De osit see instructions 202. Princi al amount of new loans 502. Settlement char es to seller line 1400 11 754.22 203. Existin loan s taken sub'ect to 503. Existin loans taken sub'ed to 204. 504. Pa off of First Mort a e Loan 205. 505. 206. 506. -. -- _-- _ zo7. so7. _ 208. 508. 209. 5~- Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller 213. 513. 214. 514. 215. 515. 216. 516. _ _ . 2t7. 517. X218. -- - - ~ --- 518. 219. 519. i 220. TOTAL PAID BYIFOR BORROWER 1 000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 11754.22 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower line 120 128 633.60 601. Gross amount due to seller line 420 126102.74 302. Less amounts aid b /for borrower line 220 1 000.00 602. Less reduction amount due seller tin 520 11,754.22 303. CASH FROM BORROWER __- 127 633.60 603. CASH TO SELLER _ 114,348.52 Pfer.o~{ Otl~40n3 aro ObiOIWe U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT _ File Number: 11.235 FINAL PAGE 2 TdI2t=YnrPSS Safllamanl Cuclem Ddf.end nA ncnn~, _..me•I n.. L. SETTLEMENT CHARGES PAID FR 700. TOTAL SALES/BROKEr: S I:UPr'•~1L'SS~Or: Dased on rice S125 500.00 = 7 530.40 OM BORROWER'S PAID FROM SELLER'S Division of commission line 700 as follow : FUNDS AT FUNDS AT 701. 3 765.00 to Prudential Homesale Services Grou SETTLEMENT SETTLEMENT 702. S 3 765.00 to ERA• NRT INC. 703. Commission aid at Settlement 7 530.00 704. Broker teas to Prudential Homesale/Jack Gau hen 225.00 195.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee % i _ _ _ _ 802. Loan Discount ___ °/ _ 803. A raisal Fee 8 .Credit Re n 805. Lender' Ins ection Fee 806. Mort a e A lication Fee 807. Tax Service Fee 808. Document Pre aration 809. Flood Certification 810. __~_~.-- 811. 900. ITEMS REQUIRED SY LENDER TO BE PAID 1N ADVANCE 901. Interest From to Jda 902. Mort a e Insurance Premium for to 903. Hazard Insurance Premium for Io 904. 905. 1000. RESERVES DEPOSITED_ WITH LENDER FOR 1001. Hazard lnsurance rno. Imo 1002. Mort a e Insurance ma. Imo 1003. Cif Pro ert Taxes mo. Imo 1004. Count Pro ert Taxes mo. 51.58 !mo 1005. School Taxes mo. 95.79 !mo 1049. A re ate Anal sis Ad'uslment 0.00 _ 0.00 1100. TITLE CHARGES 1101. Settlement or closin fee _ _ - _ _ 1102. Abstract or title search _ 1103. Title examination 1104. Title insurance binder 1105. Document Pre aration 1106. Nola Fees to Nota Public 10.00 10.00 1107. Altome 's tees includes above items No: 1108. Title lnsurance to First American Title Insurance Com an 978.86 includes above items No _ 110 x,110211031104 Rate 1109. t.ender's Polic 1110. Owner's Po1ic 125 500.00 •978.86 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Reoordin Fees Deed S 62.00 ~ Mort a e S • Release 62.00 1202. Cit (Count taxlstam s ~. Decd 1 255.00 • Mort a e 1 255.00 1203. State Tax/slam s ~;;~,; ~1 255.00 • hlort a e 1 255.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve 1302. Pest Ins ection to HOMESPEC POC BY BUYER 1303. Home Ins ection to HOMESPEC POC BY BUYER 1344.2 11 Co. & Tw .tax to Carlisle Borou h Tax Account 619.00 1305. Home Warrant _ ._._. Io, American Home Shield 495.00 1306. Deed Pre . to ERA• NRT INC. 100.00 1307. Final water! ewer Aattt046921 to Carlisle Borou h Office 50.22 1308. Escrow Inheritance Tax to CPSS Escrow Holdin Account 1,500.00 i 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 2 530.86 _ 11,754.22 MUO CERTIFICATION OF BUVER AND SELLER navs urofuuy rwlewetl IM HUD-1 Setosmsnl Slplemsnl bntl fo tho boil of my knowlodpo antl Osuof. II n p Irve sntl pCGwoto ttslomoM of ptl rocolpb antl tlltburtsmontt mptle on my ptCOUn1 or by mo tMt t/ISpC/I//O'n. I fuMOLr cenlfy that 1 he rt rMt:arry n Cbpy 011he MVO.1 Stttltment SIp10mOnt ~-l1. ~ /U~il_~ Erg- WARNING IT IS A CRIME TO KNOWINGL" MAKF. ~ / L ~E STATEMENTS TO THE Tho MUO.1 SeltltNnOm Sgtomont Wt11d1 I hOVO propMttl It A VuY antl ptxurWS aaount Of INt IrOntactgn UNITED STATES ON THIS OR ANV Cf. •~~ Aft F URM PEN~• l TIES UPON CONVICTION I (IOW tAUtbtl tl/ wIU CAUt1 IrIY fYntlt f 00 WtbUftitl IA i0t:pftlanC6 wiN Ihlt ttitOmtnl CAN INCWDE A FINE ANO IMI'I~.:a~. P' • I ' ~~. ,~ ~ TITLE IB' ~+• U S CODE SECTION toot AND SECTION ipfu ~ /(/ ey ~~ .M.&1 Lianl~ ACCOUNT N0. ACCOUNT TYPE 950322177 RELATIONSHIP CHECKING WITH INTEREST 00 0 06128M NM I17 12217 LORizETTA M WERT 262 MCKNIGNT ST CARLISLE PA 17013-2020 INTEREST PAID YEAR TO DATE 4.30 STATEMENT PERIOD PAGE JUN.25-JUL.23,2010 1 OF 2 CARLISLE WEST ACCOUNT SUMMARY BEGINNING DEPOSITS K OTHER BALANCE OTHER ADDITIONS CHECKS PAID SUBTRACTI CURRENT ONS INTEREST PD ENDING N0. AMOUNT N0. AMOUNT N0. AMOUNT BALANCE 42,465.19 1 2,078.72 4 1,704.61 4 794.89 0.33 42,044.74 ACCOUNT ACTIVITY POSTING DATE DEPOSITS,INTEREST TRANSACTION DESCRIPTION 8 OTHER A T CHECKS 8 OTHER DAILY DDI IONS SUBTRACTIONS BALANCE 06-25-10 BEGINNING BALANCEE 06-28-10 CHECK NUMBER 1336 542,465.19 06-28-10 CHECK NUMBER 1337 118.86 06-28-10 BANKERS LIFE 357 INS PREM 85.75 07-02-10 CHECK NUMBER 133' 26.41 42,234.17 07-06-10 UNITED AMERICAN :[NS. PREM 1,000.00 41,234.17 07-12-10 DEPOSIT 304.95 40,929.22 07-19-10 2,078.72 CHECK NUMBER 134;>_ 43,007.94 07-20-10 ERIE INSURANCE 1256038677 000000000001341 500.00 42,507.94 07-23-10 INTEREST PAYMENT 433.00 42,074.94 0.33 07-23-10 CenturyLink BILL PYMT 000000000001343 30.53 42,044.74 ENDING BALANCE 542,044.74 CHECKS PAID SUMMARY 1336 1342* 06-28-10 118.86 1337 06-28-10 85.75 07-19-10 500.00 1339* 07-02-10 1,000.00 ANNUAL PERCENTAGE YIELD EARNED = 0.00 L008A (8/07) ~.~s d':1#1~'; ~"i§~=~1~ ,'%+`€ ~+ti~lgtitl€~, ,31 i~~ g z ~61~~t,I~~iFtji~. April 20, 20`i1 PA C~epartrrtertt of Revenue E3ureau cif Individual Taxes Inheritance Tax Division -- ~xt PQ Box 284fCJ~, Harrisburg, PA 17128-Q~Cl1 Re: Estate of Lorretta M. Vltert Curr~berlar~d County File Number 21-1U-t}758 C1ate of Death: July 22, 2Q11. social Security N~~mber of Decedent: 1.7~-2t~-17~~~ ~entlen~er7: tin behalf of tl~e Executrix, Joni K. Brickner, we request an extensir~n of tune to file the Pennsylvania Inheritance Tax return for tfie above referenced estate. The executrix has previously prepaid ~s,OtJt7 toward the inhe ritar~re tax receipt attached} ar~d we anticipate that this paymer7t will fully satisfy the balance due. vve rer~uest an extension of tine of ~C~ days to allow the estate to finalize settlement. on the sale of the decedent's residence, scheduled to occur early next month, sv that the MU1~-1 and actual sales pri~:e grid expenses 4f sale may be incorporated in the return. The estate has been actively marketing thr~ rr~si~~enc:~~~ since the date of death ar~d rec:er~tly contracted for its sale. V11e believe the department of revenue and the estate would be hest served ley filing a ret~~rn }with the actual ~,~ales proceeds and casts. Sincerely, l:~ortna M. Nlullirr,. JD, CPA Senior Tax Manager Boytxr , Ritter, CPIs cc: J©nr K. E~rrckr~er, kxec~rtrix enc~iasure .................. ........................... .............. ~;ef= , "~~;~€, t""Fd~t j ;;at l~S~~~. -~.~. ..: i. v.}E?'°rl i1~:'L;~~ ~~ ,,. ;3+f:~~~' ~.... t~}=1 f:.'.f.;~£~', F'~4 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARR158URG, PA 1 7 1 2 6-0601 RECEIVED FROM: BRICKNER JONI K 29 HICKORYTOWN RD CARLISLE, PA 17015 "'"""' f.IIJ ESTATE INFORMATION: SSN: 174-20-1745 FILE NUMBER: 2110-0758 DECEDENT NAME: WERT LORRETTA M DATE OF PAYMENT: 10/ 18/ 2010 POSTMARK DATE: 1 011 8/201 0 COUNTY: CUMBERLAND DATE OF DEATH : O7/ 22/ 2010 REMARKS: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DUPLICATE REV'•1162 EX(11-96) NO. CD 013502 AMOUNT ACN ASSESSMENT CONTROL NUMBER 101 ~ ss,oo0.00 I TOTAL AMOUNT PAID: $ fi, 000.00 CHECK# 212 INITIALS: SAP SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER