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Home My WebLink About05-09-11 1505610140 REV-1500 EX (01-10> PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 0 0 4 6 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Deat h MMDDYYYY Date of Birth MMDDYYYY 2 0 3 1 0 4 0 0 2 0 4 0 3 2 0 1 0 0 1 3 0 1 9 2 0 Decedent's Last Name Suffix Decedent's First Name MI L O Y G E R A L D I N E B (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 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 OX 6 Decedent Died Testate ~ death after 12-12-82) 7 D d . . ece ent Maintained a Living Trust 8. Total 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 R O G E R B I R W I N 7 1 7 2 4 9 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 1 7 0 1 3 Correspondent's a-mail address: :~.-~ __ ; -, ~~ ..-.~ ..4 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN T r~vur~~~~ ` ~ r 200 W•RIDGE STREET CARLISLE PA ],70],3 SIGNATURE OF P PA~RrE~R/OTHER THAN REP SENTATIVE _ A E S Fj l ADDRESS ., 60 WEST POMFR~ STREET CARLISLE PA L7^13 PLEASE USE ORIGINAL FORM ONLY P O M F R E T S T R E E T Side 1 1,505610140 1505610140 J r Oh2029505'[ on2a29sos2 Z aP!S 1N3WAVda3n0 Nd ~O dNf1~3a d JNIlS3flb321321b f10J1 ~I lt/AO 3Hl NI lll~ 'OZ 2 9 '6 S E +~ •6~ ...................................................... 3f1a X~dl '66 0 0' 0 .8 ~ 0 0. 0 5 6' X a;e~ le~a~ei~oo ;e • g ~ a~gexe; ~6 aui~ }o }unowy 0 0' 0 'L 6 0 0. 0 Z ~' X a~e~ 6ui~gis ;e ' algexe; ~~ awl }o }unowy L ~ 2 9' 6 S ~ h .g ~ 9 6' 9 h S Z 6 5~0' x a;e~ leaui~ ;e ~ a~gexe; ~~ aui~ }o ~unowy g~ 0 0' 0 'S ~ 0 0. 0 0' x (z' ~)(e) g ~ 66 •oaS ~apun spa}sues} ~o 'a}e~ xe} lesnods aye }e a~gexe} ~~ aui~ }o lunowy .5 ~ S31V~1 3l9bOlldd`d 210 SNOI1~f1211SN1 335 - NOilt/-lfl~ld~ XHl -- 9 6 '9 h S Z 6 ~~'~ ~~•~~~•~~~•~••~•~••''' (£6aui~snuiwZ~aui~)xelo;;oafgnSanlen;aN 'til •£~ • • • • • • ~ • • • • • • • • • • • • • • • (p alnpayoS) apew uaaq;ou sey xe; o~ uoi~oa~a ue yoiynn ~o} s}sn~l £ L l6 oaS/s}sanba8 ~e~uawu~ano0 pue a~qe}uey~ ~£ ~ 9 6 ' 9 h S ~ 6 •z ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ' ' ~ ' (6 6 aui~ snuiw g aui~) a;e;s3 }o amen;aN 'Z ~ 2 E' S E Q 0 2 ' L L ............................... (0 6 Pue g saui~ le;o3) suol;onpaa le;ol ' 6 6 9 E ' h 9 S E •0 ~ ~ • • • • ~ ~ ~ ' ' ' ' ' (I alnpayoS) suai~ pue 'sai}i~igei~ a6e6~ow `~uapaoaQ }o s;qaa '0 ~ 9 6 'E Z 6 9 '[ .6 • • • • • • • • • • • • • • • • • • (F.l alnpayoS) s~so~ and}e~}siuiwpy pue sasuadx3 le~aun~ .6 Q 2 ' S Q E Q 2 'I .8 .- .......................... (L y6no~y} ~ saul~ le~ol) s;assd sso~0 Idol '8 . .L • • • • • .. pa~sanba~l 6uliilg a}e~edaS (O alnpayoS) ~ ~(}~adad a~egad-u N snoauellaoslVN'8 spa}sued sonin-aa}ul L •g • • • ~ ~ ~ ~ pa~sanba~ 6ulpl8 a;e~edaS ~ (~ alnpayoS) ~(}~adad paunnp ~l}uiop 'g .5 ~ ~ ~ ~ ' ~ '(3 alnpayoS) ~(~adad leuos~ad snoauellaoslW pue s}isodaa ~lue8 `yse~ 'q ~ 2 ' S Q E E '[ .~ .......................... (d alnpayoS) algenlaoaa sa~oN pue sa6e6}~olN ~~, . '£ ' ' ' ' ' (~ alnpayoS) dlys~o}al~dad-aloS ~o dlys~au~ed `uol~e~od~o~ plaH ~(lasol0 '£ 'Z ...................................... (9 alnpayoS) spuo8 pue s~loo~S 'Z ' . ~ ........................................... (b alnpayoS) a}e}s3 leaa ~ ~ 0 0 0 0 0 5 0 2 NOIlVlfllldd0321 2 0 0 h 0 '[ E 0 2 Jl 01 ' 8 3 N I Q 1 d ZI 3 `~ :aweN s,~uapa~aQ ~agwnN ~(~unoag lelooS s,~uapaoaa X3 005 6-n3 i`I on2o29sos2 _ 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 GERALDINE B. LOY 21 10 0466 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. CENTURYLINK -TELEPHONE 45.65 2. IEVERETT CASH MUTUAL INSURANCE CO. -HOMEOWNERS INSURANCE I 347.00 3. IKOUGH'S OIL SERVICE -FUEL OIL I 1,174.00 4. NORTH MIDDLETON AUTHORITY -WATER/SEWER 493.80 5. PP&L -ELECTRIC 433.96 6. ROBIN K. SOLLENBERGER -REAL ESTATE TAXES 1,115.95 7. THORNWALD HOME -NURSING 254.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 3, 864.36 If more space is needed, insert additional sheets of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent GERALDINE B. LOY 21 10 0466 Correspondents Name Daytime Telephone Number R O G E R B I R W I N 7 1 7 2 4 9 2 3 5 3 First line of address 6 0 W E S T P O M F R E T S T R E E T Second line of address City or Post Office C A R L I S L E Correspondent's a-mail address: State ZIP Code P A 1 7 0 1 3 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. SIGNAT E OF PERSON RES SIBLE FOR FILING RETURN D TE ~ ~~ DRESS 1106 KAREN DRIVE CARLISLE PA 17013 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 10 0466 DECEDENT'S NAME GERALDINE B. LOY STREET ADDRESS 1112 NEVWILLE ROAD CITY STATE Zip CARLISLE PA 17013 Tax Payments and Credits: ~ • Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 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 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 4,389.61 0.00 (3) (4) 0.00 (5) 4, 389.61 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 ................................................................................................ ^ 0 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? ....................................................................................... ^ ^X 3. Did decedent own an "in trust for" or payable-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? .................................................................................................. ^ X^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 'I , 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. 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. Total Credits (A + B) (2) REV-1502 EX+ (01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE • INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT w ~ r+~ ~ vr. FILE NUMBER: GERALDINE B. LOY 21 10 0466 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 DAl-E NUMBER OF DEATH DESCRIPTION 1. 1112 NEWVILLE ROAD, CARLISLE, PENNSYLVANIA 105,000.00 TOTAL (Also enter on Line 1, Recapitulation.) I $ 105,000 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. INHERITANCE TAX RETURN ~~~.. _ . _ . . _ _ _ - ESTATE OF FILE NUMBER GERALDINE B. LOY 21 10 0466 Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T BANK -CHECKING ACCOUNT #3740130764 936.03 2. M&T BANK -SAVINGS ACCOUNT #15004201521778 4,543.77 3. M&T BANK -CERTIFICATE OF DEPOSIT #31003910433611 6,158.48 3. 1973 CHEVROLET IMPALA 1,000.00 4. PERSONAL PROPERTY 747.00 APPRAISAL ATTACHED (LESS THE 1973 CHEVROLET IMPALA) TOTAL (Also enter on line 5, Recapitulation) I $ 13, 385 28 (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 GERALDINE B. LOY _ 21 10 0466 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME B. 1. City State ZIP Year(s) Commission Paid: ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address 2, Attorney Fees: IRWIN & McKNIGHT, P.C. 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant 4. 5. 6. 7. 8. 9. 10 11 12 13 Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees: REGISTER OF WILLS Accountant Fees: Tax Return Preparer Fees: PATRICIA A. ROSENDALE, CPA REGISTER OF WILLS -FILING FEE CUMBERLAND LAW JOURNAL -ESTATE NOTICE THE SENTINEL -ESTATE NOTICE ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY B-H AGENCY APPRAISAL SERVICES -APPRAISAL ON REAL ESTATE R.T. CAREY TRUCKING, LLC -TRASH REMOVAL CLOSING COSTS FROM SALE OF REAL ESTATE AMOUNT 174.48 6,500.00 261.50 375.00 30.00 75.00 198.16 65.00 350.00 367.52 8,577.30 TOTAL (Also enter on Line 9, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 16.973.96 _ REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE. INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER GERALDINE B. LOY __ 21 10 0466 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. CENTURYLINK -TELEPHONE 45.65 2. EVERETT CASH MUTUAL INSURANCE CO. -HOMEOWNERS INSURANCE 347.00 3. KOUGH'S OIL SERVICE -FUEL OIL 1,174.00 4. NORTH MIDDLETON AUTHORITY -WATER/SEWER 493.80 5. PP&L -ELECTRIC 433.96 6. ROBIN K. SOLLENBERGER -REAL ESTATE TAXES 1,115.95 7. THORNWALD HOME -NURSING 254.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 3, 864.36 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE Nl1M6ER~ GERALD INE B. LOY 21 10 0466 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 outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. MAXINE E. METZGER Lineal 42,773.48 200 W. RIDGE STREET 1/2 REMAINDER CARLISLE, PA 17013 2. DIANE C. GOOD Lineal 42,773.48 1106 KAREN DRIVE 1/2 REMAINDER CARLISLE, PA 17013 3. SCOTT METZGER Lineal 2,000.00 10 IAN DRIVE MT. HOLLY SPRINGS, PA 17065 4. DOUG METZGER Lineal 2 000.00 28 W. HUNTER DRIVE , CARLISLE, PA 17015 5. BRIAN METZGER Lineal 2,000.00 419 PINE ROAD MT. HOLLY SPRINGS, PA 17065 6. JUSTINE GOOD Lineal 2,000.00 1106 KAREN DRIVE CARLISLE, PA 17013 7. NATHALIE SINGER Lineal 2,000.00 1106 KAREN DRIVE CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ ~~ nw~G Jflal.G W IICCUCU, UJC cuunwnai ~neeis ~r paper or the same size. . Continuation of REV-1500 Inheritance Tax Return Resident Decedent GERALDINE B. LOY 21 10 0466 • Decedent's Name Page 1 File Number Schedule J -Beneficiaries -1 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright s ousal distributions and transfers under Sec. 9116 (a~(1.2).] 8. REBECCA GOOD Lineal 2,000.00 1106 KAREN DRIVE CARLISLE, PA 17013 r + LAST WILL AND TESTAMENT I, GER.ALDINE B. LOY, of North Middleton Township, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my executrices to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my executrices to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good. and sufficient deeds therefor, in fee simple, as I could do if living. 3. I devise and bequeath all of my estate of every nature and wherever situate as follows: (a) The sum of $2,000.00 to each of my six grandchildren, and (bl All the rest, residue and remainder to my two daughters, Maxine E. Metzger and Diane C. Good, share and share alike, the child or children of any deceased daughter taking the share their parent would have taken if living. ACKNOWLEDGMENT AND AFFIDAVIT WE, GERALDINE B. LOY, CHERYL L. CLELAND and MARTHA L. NOEL, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will, and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. GERAI.DINE B. LOY CHER ~.CLELAND t._ , THA .NO L COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by, GERALDINE B. LOY, the testatrix herein and subscribed and sworn to before me by CHERYL L. CLELAND and MARTHA L. NOEL, witnesses, this 29TH day of July, 1999. ~•~ Public `"Notarial Seal Roger B. Irwin, Notary Public Carlisle Boro, Cumberland County My Commission Expires Oct. 3, 2000 Member, Pennsylvania Association of Notaries 1-,CVIVYi OU,4U„i ei4 UYiUlOlO A. Settlement Statement o r....., ..s i ,..,.. IYII„,IVV-~ ~W V~,Y, ,,u..VYVVn ivvv... U.S. Department of Housing and Urban Development L. ^ FHA 2. ~~FmHA 3. ^Conv. Utrins. 4 ^ V ~~ 6. File Number 7. Loan Number 8. Mortgage Insurance Case Number This form is famished td give you a statement of seals/ settlement wsls. Amounts paid to and by the settlement agent are shown. C. Note: Items marked'(p.o.e.Y were paid outside the closirg; they aro sham here for informatlon purposes and are not inducted in the totals. WARNING: it is a crime to knowingly make hlse afatamanb to the United States on Ws or an other sindir form. Penalties upon TirleExpress Settlement System Printed 04/2012011 at 08:14 KSC D. NAME OF BORROWER: Jamie L. Kushel E. NAME OF SELLER The Estate of GeraldlIIe B. Loy F. NAME OF LENDER The Bank of Landisburg G. PROPERTY ADDRESS: 1112 Newville Road, Carlisle, PA 17013 Middlesex Township H. SETTLEMENT AGENT: PA Real Estate Settlement Services LLC, Telephone: 717-249-6333 Fax: 717-249-7334 4 arli e 1 0 4 J. SUMMARY OF B RROWER'S TRANSACTION: K. U M RY F S L R'S TRANSACTION: M 105 000.00 105 000.00 3 748.00 04 20 11 12 31 11 240.04 04 20 11 12 31 11 240.04 04 20 11 06 30 11 249.10 04 20 11 06 30 11 249.10 109 237.14 105 489.14 Y 2 000.00 100 000.00 6 577.30 2 000.00 ~ 2,000.00 5 000.00 r P I F 109 000.00 8 577.30 T 109 237.14 105 489.14 109 000.00 8 577.30 237.14 96,911.84 SUBSTITUTE FORM 1099 SELLER STATEMENT: The iMormaUOn contained herein Is important tax Informatlon and is being tumished to the Internal Revenue Service. If you are required to file a realm, a negllgenee penalty or other sanction will be Imposed on you N this item is required to be reported and the IRS determines that It has not been reported. The Contract Sales Price described on line 401 above consUWles the Gross Proceeds ~ thls Uansacbon. You are required bylaw to provide the seWemenl agent (Fed. Tax ID No: ) with ~ur wrreU taxpayer Identification number. tl you do not provide your wrrect taxpayer Idenfficatlon number, you may ba subJect to civil or crlminal penalties Imposed bylaw. n er pen es perjury, certify that the number shown on this statement is my correct taxpayer IdentNleatlon number. TIN: - __ - / SELLER(S) SIGNATURE(S): / SELLER(S) NEW MAiI.ING ADDRESS: SELLER(S) PHONE NIJMBERS: (H) (yy) {2o Oc ~~ S coo b. D~ -___---. (' I Qo S. 8( rrevtous eamons are oosolete ronn nuu-i 1'sirstil rer nanatwolc asuo.[ U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 2011-058 FINAL PAGE 2 QCTTI C~ACAIT CTATCI-ACAIT ~-.._~______ ~_..,____. ~_._.__ ..1_._~ ............... _....._........ PAID FROM PAID FROM ' 105 000.00 5.000 = 5 250.00 BORROWER'S SELLER'S FUNDS AT FUNDS AT 2 625.00 Prudential Homesale Services Grou SETTLEMENT SETTLEMENT 2 625.00 Re Max Delta Grou 5 250.00 Prudential Homesale Services Grou 195.00 195.00 The Bank of Landisbur 600.00 The Bask of Landisbur 600.00 Morrison La~lr Office 150.00 0 mont 0 moat 1 0.00 .0.00 Salzmann Hu hes P.C. 300.00 Sal~~=*+^ Hu hes P.C. 675.00 M NT R SF 62.00 62.00 124.00 1 050.00 1 050.00 1 050.00 1 050.00 Cumberland Collin Redevlo nt Authorit 27.00 North Middleton Authori 62.30 Recorder of Deeds 27.00 1400.TOTAL SETTL 3 748.00 6 577.30 HUD CERTIFICATION OF BUYER AND SELLER I have carefullyy reviewed the HUD-1 Settlement Statem a best of my knowledge and belle(, it Is a We end acwrate statement of all receipts and disbursements made on my account or by me In this lransacllan. I fu er certify that 1 have received of the D-1 Settlement Statement ~• e . Kushel The fete of Geraldine B. WARNING: R IS A CRIME TO KNOWINGLY MAKE FALSE STATEMEMS TO THE The 1 Stn which 1 have propared is a bun and accurate account of this transactlon UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION I e qus a anus funds to be dlsbu in accordance with this statement. CAN INCLUDE A FINE AND IMPRISOI~pNENT. FOR DETAILS SEE TfTLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. B. ~~- M~TBank 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 F ax (302) 934-2955 July 7, 2010 Irwin & McKnight, P.C. Attorneys At Law 60 West Pomfret Street W Pomfret Prof Bldg Carlisle, PA 17013-3222 Re: Estate of Geraldine B Loy Social Security: 203-10-4002 Date of Death: A~ri13, 2010 Dear Sir or Madam: Per your inquiry on May 4, 2010, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names o, fl Opening Date Balance on Date of Death Accrued Interest Total 2. Type of Account Account 1Vumber Ownership (Names o~ Opening Late Balance on Date of Death Accrued Interest Total Checking Account 3740130764 Geraldine B Loy 12/18/'98 $936.03 ~ > $ 0.00 $936.03 Savings Account 15004201521778 Geraldine B Loy 0922%99 $4,543.63 $ .14 $4,543.77 3. Type of Account Account Number Ownership. (Names o, fl Opening Date Balance on Date of Death Accrued Interest Total Certificate of Deposit 31003910433611 Geraldine B Loy 0922/99 $6,157.64 $ .84 $6,158.48 For further account information, closures and/or reimbursement of funds please call the High Street Carlisle Office at #717-240-4536 We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not indude any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement Sincerely, Suzanne M Kimble Adjustment Services Bill of Sale Date: ~.~~ ~~ , ~~~~ Seller's Information: Marne: 1~ I MIL ~. (_ . ~ ~~ ~ ~f2W L i ~1~ I -z~ ~b~ y Address: Telephone # Signature: Purchaser's Information: Name: ~ l ~..b-N-t~~.... L~ ~ ~-dL~~.~1 Address: '~~J~ lvt C C~~J t-~'~~~~ t,,(_Il.~ l Telephone #: Signature: Vehicle Information: Year: ~ ~ Make: C~~ ~~~Model: ~~~Ll~ VIN : ~ ~-- 5 ! t~ J I ~ ~'l.¢ v~-I Z~ Purchase Price: $ ~ ~(~(~`! ~j I Sworn & Subscribed to before me this ~ ~ ~ day of ~ ~~ ~~ ~ NOTARIA! 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