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Home My WebLink About05-11-11~ REV- 7Jr~~Ex (01-1°' 1505610143 I'~ OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 80X.280601 INHERITANCE TAX RETURN 2 1 1 1 I,)~ ~ =~ Harrisburg, F'A 17128-0601 RESIDENT DECEDENT ``` -------- - --- ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 175 34 8294 O1 31 2011 08 20 1943 Decedent's Last Name Suffix Decedent's First Name BROOKS THEODORE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name BROOKS CHERYL Soouse's Social Security Nurriber THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 4. Limited Estate ^ 4a. Future Interest Corr~promise (date of death after 12-12-82) ® g Decedent Died Testate (Attach Copy of Will) ^ ~. Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) MI S MI E ^ 3, Remainder Return {date of death prior to 12-13-82J ^ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes ^ 11.Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number GREGORY M KERWIN 717 362 3215 First line of address 4245 STATE ROUTE 209 Second line of address City or Post Office ELIZABETHVILLE State ZIP Code PA 17023 Correspondent's a-mail address: g m k e r W l n@ h o t m a I I. C 0 m Under penalties of penury, 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 pr r other than the personal representative is based on all information of which preparer has any knowledge. SI URE O ERSON RESPONSIBLE F ING RETURN DATE ~'GCG C~ Patricia A. Barder ~ - ~.-,'~ O /~~ 128 est Main S eet, Lykens, PA 17048 r. .~- 0 I SIGNA U OF E A ER HER THAN REPRESENTATIVE DA1-E ~ Gregory M Kerwin ADDR tate Route 209, Elizabethville, PA 17023 Side 1 ...:.n ;~ : _ t! !^J =; } 1505610143 1505610143 J J REV-1500 E:X 1505610243 Decedent's Name BROOKS, THEODORE S RECAPITULATION 1. Real Estate (Schedule: A) ....................................................................................... 1. 2. Stocks and Bonds (Sc;hedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ...................................................... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested............ 7. g. Total Gross Assets (tota- Lines 1-7) ..................................................................... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) ........................................................... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .........................•.............,......, 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate', or transfers under Sec. 9116 6, 2 5 3 3 8 15 (a>(1.2) x .o0 . 16. Amount of Line 14 taxable 1, 0 0 0 0 0 16 at lineal rate X .045 . 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X 15 18. 19. Tax Due ................ .......... ........................................................................................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 175 34 8294 83,900.00 1,000.00 84,900.00 12,055.50 65,591.12 77,646.62 7,253.38 7,253.38 0.00 45.00 45.00 Side 2 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21 - 1 1 Decedent's Complete Address: Brooks, Theodore S STREET ADDRESS 4440 Valley Road 'CITY STATE ZIP Enola PA 17025 Tax Payments and Credits: 1. 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. Check box 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. Make Check Payable to: REGISTER OF WILLS, AGENT. (4) (5) 45.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :...................................................................... ........ b. retain the right to designate who shall use the property transferred or its income :................................. c. retain a reversionary interest; or ............................................................................................................. 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" 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return ane 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. X9116 (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 bloo~ or adoption. (1> 45.00 Total Credits (A + B) (2) 0.00 (3i 0.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE FILE NUMBER ESTATE OF Brooks, Theodore S 21 - 11 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 which 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. Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 Unimproved lot situate in Hampden Township, Cumberland County, PA, tax parcel 83,900.00 #10-13-0995-012A, assessed at $83,900.00 see attachment printed 3-16-2011 attached hereto TOTAL (Also enter on Line 1, Recapitulation) I 83,900.00 SCHEDULE E " ~ CASH, BANK DEPOSITS, & MISC. °MM°"WEAN"°F PE"NSV~VA"'A PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ___ FILE NUMBER ESTATE OF Brooks, Theodore S 21 - 11 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Value of personal property given to Brian Brooks VALUE AT DATE OF DEATH 1,000.00 TOTAL (Also enter on Line 5, Recapitulation) I 1,000.00 ;'~ SCHF~IJLE H FUNEJ~L DCPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN /~r~A~~~~/~TI~ /C ^~'-T'C RESIDENT DECEDENT r1V1~~N \h7 ~ ~ Y'\ ~ ~~/~ \,I<J~7 ~ ~7 FILE NUMBER ESTATE OF Brooks, Theodore S 21 - 11 Debts of decedent must be reported on Schedule I. ITEM __ NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Sullivan Funeral Home, 51 N. Enola Drive, Enola, PA 17025 5,300.00 B. ADMINISTRATIVE COSTS: ~ . Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Kerwin & Kerwin 2,608.59 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Cheryl E. Brooks 3,500.00 Street Address 4440 Valley Road City Enola State PA Zip 17025 Relationship of Claimant to Decedent SpoUSe 4. Probate Fees 262.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Gosts 1 Notary Fee on Oatri of Subscribing Witness 5.00 TOTAL (Also enter on line 9, Recapitulation) 12,055.50 COMMONWEALTH OF PENNSYLVAPJIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Brooks, Theodore S Scr~eclule H Funeral F~enses & A~runis~-a~ve Costs oontir~ed 2 Patriot News -estate advertisement 3 Cumberland Law Journal -estate advertisement FILE NUMBER 21 - 11 304.41 75.00 Page 2 of Schedule H SCHEDULEI m ' DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT __ FILE NUMBER ESTATE OF Brooks, Theodore S 21 - 11 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Select Specialty Hospital -account payable 165.00 2 Holy Spirit HospitaN -account payable 272.83 3 Pinnacle Health Hospital -account payable 132.64 4 Dr. Clem Ciceareille, M.D, -account payable 58.16 5 Dr. Howard Cohen., M.D. -account payable 1,338.00 6 Hampden Physicians -account payable 156.86 7 Dr. Bryan House, M.D. -account payable 250.00 8 Nephrology Central PA, Inc. -account payable 160.95 9 Spirit Physicians -account payable 57.83 10 HBCC Holy Spirit Hospital -account payable 2,275.00 11 Dr. Moffett, Pease ~ Limm Cardiology -account payable 41.26 12 Loeffer Oil Company, account payable 13 Household Finance Company -account payable 6,058.15 14 Capital One Credit Card -account payable 15 Mortgage loan to Ciitizen's Bank 54,624.44 TOTAL (Also enter on Line 10, Recapitulation) I 65,591.12 REV-1513 EX+ (11-08) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Brooks, Theodore S NUMBER NAME AND AGDRESS OF PERSON(S) RECEI\/ING PROPERTY I TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Bryan Brooks c/o Tracey Miller 503 North Reeser Drive York Haven, PA 17370 2 Cheryl Elaine Brooks 4440 Valley Road, Enola, PA 17025 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) FILE NUMBER 21 - 11 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) son 3 deer rifles; gun cabinet; race cars #10C & #60 -both junked wife Residue of estate Enter dollar amounts for distributions shown above on lines 15 through 18 on 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 n r .; ._~ ~I - LLT 1~, ~- _ ) I r '~u _a~'~ - ... .- I t. ~ ~ ~--7 LAST WILL AND TESTAMENT =~~'-" ~_ OF ~-~ ~' THEODORE S. BROOKS GREGORY M. KERWIN TERRENCE J. KERWIN JOSEPH D. KERWIN ILLY MCCLURE KERWIN ATTORNEYS AT LAW I, THEODORE S. BROOKS, of 4440 Valley Road, Enola, Pennsylvania, being of sound mind, memory and understanding, do make and publish this, my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. FIRST: I direct my hereinafter named Co-Executrixes to pay all my legally enforceable debts, funeral expenses, administration expenses, and inheritance, estate, succession or excise taxes, which I owe or may become due on account of my death, as soon as-may be convenient after my decease. I request that my mortal remains be interred with either my son, WILLIAM BRADFOKD BROOKS, or my uncle, i~ViLLIAiVI A. FstcvuriS, in Si. john Cemetery in Shiremanstown, Pennsylvania. SECOND: I give and bequeath my guns, gun cabinet, four wheeler, the toys in the :attic that were Bryan Brooks, and race cars #lOc, 60 and 4A, to my son, BRYAN BROOKS. THIRD: All the rest, residue and remainder of my estate, be it real, personal and mixed, whatsoever or wheresoever the same may be situate at the time of my death to my wife, CHERYL ELAINE BROOKS. My wife, at her sole and absolute discretion, may give to my daughter, JANE BRCIOKS, any item or items as a remembrance of me. Pa e 1 of 2 Pa es ~~~ ~" ~ ~~~~f ~~ _(SEAI,) g g THEODORE S. BROOKS THIRD: I nominate, constitute and appoint PATRICIA A. BARDER and MARGIE MITCHF;LL, as Co-Executrixes of this, my Last Will and Testament, authorizing aiid empowering them to sell and convey any and all real estate of which I own at the time of my death. GREGORY M. KERWIN TERRENCE J. KERWIN ,.IOSEPH D. KERWIN OLLY MCC LURE KERWIN ATTORNEYS AT LAW I further direct that my Co-Executrixes or personal representative shall not be required to post bond to act in said capacity. IN WITNESS WHEREOF, I, THEODORE S. BROOKS, have hereunto set my hand and seal, to this my Last Will and Testament, this 7 fi~ , day of April, 2010. SIGNED, SEALED, PUBLISHED and DECLARED by the above- named Testator, THEODORE S. BROOKS, as and for his Last Will and Testament, in the presence of us, who at his requ:.st aid ir. the r-Psence of each other, have iereunto set our names as witnesses: /° ~-. ~ces~~ng;ar.~ f .~ , r ,. ; Pa 2 of 2 Pages d \m \will\Brooks.Theodore S. . ~ ~ (SEAL) THEODORE S. BROOKS Page 1 of 1 Detailed Results fo:r Parcel 10-13-0995-012A in the 2010 Tax Assessment Database DistrictNo 10 Parcel_ID 10-13-0995-012A MapSuffix HouseNo Direction Street VALLEY ROAD Ownerl F3ROOKS, THEODORE S C/O PropType k0 PropDesc LivArea CurLandVal 63800 CurImpVal 20100 CurTotVal 83900 CurPrefVal Acreage .~~7 CIGrnStat TaxEx 1 SaleAmt 1 SaleMo 0$ SaleDa l a SaleCe 19 SaleYr gg DeedBkPage 0034C-00487 YearBlt HF_File_Date 1 G/26/2004 HF Approval_Status D 03/16/2011 No. 542 ~~ ,~lll ~t~r~o~T~ C~In ~I~uzn '~~~P~~ ~rE~en#~ ~~tt1I (~o~te, PATRICIA A. BARDER ~' '' o f Dauphin County, Pennsylvania, Executor rix of the last Will nrrd TeStallrellt of Theresa E . Brooks laic of Cumberland County, send Greetings: ~~herr~ts, The said Theresa E . Brooks byher last 11%ill acrd Te.ctanrent, dryly proved and recorded in the Register's Office of Cumberland I'' Cotcnty, Perrrrsylvarna , provided inter alia ~', "EIGHTH: I nominate, constitute and appoint • .;. ~~ my niece, PATRICIA A. BARDER, as Executrix of this my Last Will and Testament, authorizing and empowering ~' her to sell and convey any and all real estate of which I may die seized and possessed." f i;~ ; co <~ ~ ,_- ; _~ <.> -, -- ::> '~; _, '~ .} ~ _J 1 ~~ -.. - -~ ~ .1 D rn ~17~ ~ttu~u ~e, That by virtrce of the pozucr and authority aforesaid, in said mill I'n ~ contained, and in consideration of the sum of--------___ONE ($1.00)----------- ----------------~--------Dollars, to be paid by Theodore S . Brooks of the Township of Hampden in the County of Cumberland and State of ~~ the receipt whereo f is hereby acknowledged, ,trarrted, so.1d, bargained acrd conveyed, and does hereby grant, sell, bargain and convey to the said Theodore S . Brooks ' Heirs and Assigns forever. All that certain ~iiece or Marcel of land situate in the Township of Hampden !i County of Cumberland and Statc of Pennsylvania, bounded and described as {nllorr~c, to rurit: I~ ~I ~~~~C 34 FACE 48'7 BEGINNIrfG at an iron pin located' on the northern side of the right-of'-way of a road designated as Legislative Route 31051 (also knows e,~ Summerdale Road S.R. 1004); said iron pin located at the southwest;corner of lands now or formerly of Theodore S. Brooks; thence :north thirty-three degrees .twenty minutes forty-four seconds West (N 33° 20' 44" W) to an iron pin; thence along lands now or formerly of J.R. Hake north :seventy-five degrees zero minutes zero seconds East (N 75° 00' 00" E) four hundred (400) feet to an iron pin; thence along the east side of lot number one on the hereinafter mentioned subdivision plan; south thirty-three degrees twenty minutes forty-four seconds East (S 33° 20' 44" E) four hundred forty-eight and forty hundredths (448.40) feet to an iron pin; thence along the northern side of the right-of-way of a road designated as Legislative Route 21051 north sixty-nine degrees one minute forty-one seconds East (N 69° Ol' 41" E) sixty and eleven hundredths feet (60.11) to an iron pin the point and place of beginning. BEING Lot No. 2a on a subdivision. plan prepared by Ronald S. Raffensberger, Professional Engineer, dated .December 12, 1986 and recorded in the Recorder of Deeds Office of Dauphin County on May 29, 1987. Containing .569 acres of ground. THIS conveyance is subject to the conditions and restrictions set. forth in the aforesaid plan. BEING part of the same premises which William B. Unger, widower, by Deed dated March 13, 1953, and recorded in the Recorder of Deeds Office of Cumberland County in Deed Book 15-F, Page 406, granted and conveyed unto William A. Brooks and Theresa E. Brooks, his wife. The said William A'. Brooks died on January 20, 1969 thereby vesting fee simple title in Theresa E. Brooks. The said Theresa E. Brooks died testate on September 18, 1987. eook;~,34 Q,~cE 488 LnilPthrr rvilh all a»d singzrlczr t/~e rights, liberties, privileges, hereditarnents and appzcr- tc»ances luhntsocver therezcrzto bolongrng, or in any wise appertaizzing and the reversions a»d rrmairrders, rezzts, issues azzrl profits thereof, and all the estates, right, title, interest, /~r-nperty, r•lnint and dclzza,rd whatsoever of the said Theresa E . Brooks at and izn~zraediately before the tune of decease, in law or c~q»it~~, or othcrlvisc howsoever, of, izz, to or out of the same. Un a-I~n~I: illll~ tU ~~Iull the said grated prerrziscs to the said Theodore S . Brooks Hairs a»cl Assig,rs forever. Azzd the said Patricia A. Barder for herself, her Heirs, T.~cr~»tors and fld»zi»ish-ators, c-ovczrant with the said Theodore S. Brooks Heirs and Assigns as aforesaid, that the said Grantor, has not heretofore done or committed anv act, matter or thing whatsoever whereby the premises hereby granted, or any part. thereof, is, are, shall or may be impeached, charged or encumbered in title, charge, estate and otherwise howsoever. or Jn ~itIt!'55 ~Clhrrrnf, I I~avc hereunto set my hand and seal ,the 26th day of July in the year of our Lord n»e thorrsmrd nine htcrrdred and eighty- nine (19 89) . ~i131IPt~, 5P~1P1~ and 3rltuPrPl~ ~ G s z in the ~IXPSenLP of PATRICIA A. BARDER ~~ _ --. __ ---------------------------- SEAL b / Fsecrctnax o the last Will and Testament o{ Theresa E. Brooks - - - - --- Deceasec ~nntlilnnluPaltll rrf ~IPIIn5I11Uttritu SS. C~nIInt11 of cr`~t_p ~ ~~l Pcrsorzally appeared before me a Notary Public i,c nrzd for said County and State, Patricia` A: Barder Exectet~>ix o f the last Will and Te.ctamrrzt of Theresa E . Brooks deceased, and acknowledged the f oregoi»g Dced or co»veya»ce, to be her act and deed, and desired the same shozrld be recorded ns such. i11ItItPSS; „cy hnncl a»d seal this 26th day of July A. D. 19 8 ~' NOTARIAL SEAL _ __ _ _ _ ~ ___ _ _ _ ~ __ __ )19ICHELLE M. PRUCNAL, Notary Public ~~ ~/ ~ ~ •~ ~ ~~`~~~~ ~ - Harrisburg, Dauphin County My Commission Expires June 4, 1990 Member, Pennsylvania Assoc. oC Notaries ,...wae~u~,Nf ~~, ~ ~~•o . ,~.., . c ld, : C= ~.~ a~ :~, .~ ' .~, ,`~. t ~.' ~~;. ~.~ ~.rja Y ~M.•• Y ~~; .~ ~~MliMIMtY~~`: aooK ~4 PAGE 489 -I~•r~bu ~ertif~=, t/pat fhc t~recise residence of the Grantee is 4440 Valley Road Enola ~ PA 1702. Terrence."J. Y.erwin~ Es~uire_ Attorirc~~ for _Grantee for Recording Only._ w• a~ .... ~ v_. ~ HCJ~ E G U c W~ ~ ~i °- ~ v rn x ~ ~ -;-~ o ~a- ~ H ~ ~ co ~ ~ ~ ~~ ~ ~~ ~ 2 N ~ )Tt W ~ Q ~ ~ h cn .~ x O ~ '-! q~ 2S ~H.~ ~-~I yC U +~t ^ ~ ; ~ o ~. x ~ o - Q ~ wo ~ ' ~ ~ ~+ ~ P~ ~ ~ N -"I = ~ ~ ~ xo a H r~ ~~ H r ~ G FC ~ W ~ ~ ;~10 ;~ r ~ ~~ H ~ U o (ti ~ f~ O G ~- .~ ~, c ~ ~ CkYI , Z ~ ~i ~ ~-I O '= ~ ~ ° ~ ~ ~~ S-i ~ E-i u v W .,', i ~ ~ ~ ~ ~ k R'r~-I ~-I ~ ~ x .~ x ~ ~ o o, t~ o, ~ ~ W ~ r~ a ~: N , N ._. U ~ o ~ ~ ~ Nix C.~,~~i~t~~ of _,_i~ri~~~r!~,.n~, . ,;:COi"Lii/CI iii l?+" ~ '!~' S. \ I ii l 1 fll~ _.__ _ _ ~ J t 4;1 rS~l~ ~ ~ ..~V 1 _T'j~ ~J ._~ ~ yr 1 .: ~ ; ~ i s~ .r_ .r ~u:.~; • - ~ ,. ooox C,34 PACF 490 Fax Server 4/20/2011 11:25:1.3 AM PAGE 1/001 Fax Server ~R Citizens Bank Loan Account No: 6050262614 Date: 4!20!2011 Requestor Name: Customer - VRU Attention To: Fax: 7173624459 Customer Name: THEODORE S BROOKS Collateral Description: 4440 VALLEY ROAD ENOLA PA You are receiving this notification as a result of your recent request for a fax payoff confirmation. To pay your account in full, you need to remit the balance owed of $54,624.44. The amount reflected above is your outstanding loan balance of $54,599.44 inclusive of a recording fee of $50.50 and/or an early termination fee of $0.00. This amount also includes the Fax Fee of $25.00 which was disclosed to you at the time of the fax confirmation request. The payoff is valid through: 412012011. The Per-diem is $8.17 per day if payment is received after the valid- through date. Payment can be made at any Citizens Bank branch or mailed to: Consumer Finance Attn:Payoff-RJW230 443 Jefferson Blvd. Warwick, RI 02886 PLEASE READ THE DISCLAIMER BELOW Any outstanding checks or charges that are not included in the above payoff amount are the responsibility of the customer. The customer is also responsible for the entire balance on the account regardless of the quoted payoff amount. ff this account is secured by a mortgage, the mortgage will not be released until the above conditions are met. The customer information contained in this fax is only for the use as requested or authorized by the customer whose name is listed above. This Information may not be reused for any purpose or re-disclosed to any afflllated or nonafflliated third party unless authorized by the customer or by Citizens Bank of Pennsylvania. ff this fax has been received in error, please destroy this document immediately.