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Home My WebLink About05-24-11 (2)1505610140 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO Box 28oso1 INHERITANCE TAX RETURN 2 1 1 0 1 0 8 4 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 1 8 6 2 8 3 2 2 5 0 9 2 9 2 0 1 0 0 2 1 6 1 9 3 7 Decedent's Last Name Suffix Decedent's First Name MI K U N T Z S R L A R R Y E (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 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate 0 7. Decedent 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 L I N U S E F E N I C L E 7 1 7 7 6 3 1 3 8 3 First line of address 2 3 3 ], M A R K E T Second line of address City or Post Office C A M P H I L L REGISTER OF WILLS USE ONLY ...... T .~ rv LCU '~ L - N 3~ t1"t State P A C~ ~-~--. ~~ ~.. i ,,.;1..~ Correspondent's a-mail address: LFENICLEa~REAGERADLERPC • COM Under penalties of perjury, 1 declare that I have examined this return, including accompanyin sc edules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representati is ased on all information of which preparer has any knowledge. SIGNATU OF RSON RF,£~ON$IBl~69R FILING~RETURN ~? ~ ndTG / ADDRESS 712 ERFO D ROAD CAMP HILL PA 17011 SIGNATURE SPARER O E N REPR NTATIVE ATE ADDRESS 2331 MARKET STREET _ CAMP HILL PA 17011, PLEASE USE ORIGINAL FORM ONLY } Side 1 S T R E E ZIP Code 1 7 0 1 1 1505610140 1505610140 J 150561U240 REV-1500 EX Decedent's Name: LARRY E• K U N T Z, S R Decedent's Social Security Number 1 8 6 2 8 3 2 2 5 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1 • 0 0 0 2. Stocks and Bonds (Schedule B) ...................................... 2. • 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6 1 0 0 • 0 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 0 • 0 0 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. 1 1 6 7 8 3. 3 2 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 1 2 2 8 8 3 . 3 2 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 9 5 2 2 . 8 2 10. Debts of Decedent, Mort a e Liabilities, and Liens Schedule I 9 9 ( ) ............. 10. 5 7 ~ 3 • 1 0 11. Total Deductions (total Lines 9 and 10) ............................... 11. 1 5 2 9 5. 9 2 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 1 0 7 5 8 7 . 4 0 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 0 7 5 8 7 . 4 0 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 0 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 1 0 ? 5 8 7. 4 0 1s. 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 1 g. 19. TAX DUE .................. .......................... ... ....... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 0. 0 0 4 8 4 1. 4 3 0. 0 0 0. 0 0 4 8 4 1. 4 3 1505610240 REV-1500 E.X Page 3 Decedent's Complete Address: File Number 21 10 1084 DECEDENTS NAME LARRY E• KUNTZ, SR STREET ADDRESS 710 ERFORD ROAD CITY CAMP HILL STATE PA ZIP 17011 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. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4 , 8 41.4 3 Make check payable to: REGISTER OF WILLS, AGENT _. _~ _. .~ ~ro 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 : ...................................................................... ^ Q 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? .................................................. ..... ^ ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................. ..... Q ^ 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? ............................................................................................. ..... ^ 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 i 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)]. • 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. (1) 4,841.43 Total Credits (A + B) (2) 0.0 0 (3) REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER LARRY E• KUNTZ, SR 21 10 1084 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2007 FORD FOCUS 5,600.00 2• PERSONAL PROPERTY ~ 500.00 TOTAL (Also enter on line 5, Recapitulation) 13 6 ,10 0.0 0 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER LARRY E• KUNTZ, SR 21 10 1084 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEtR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET °!° OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1, LARRY E• KUNTZ, JR- - TRANSFER OF REAL ESTATE 115,900.00 50.00 3,000.00 54,950.00 WITHIN ONE YEAR OF DEATH -710 ERFORD ROAD, CAMP HILL, PA - SETTLEMENT SHEET ATTACHED 2• JASON R• KUNTZ - TRANSFER OF REAL ESTATE 115,900.00 5D•00 3,000.00 54,950.00 WITHIN ONE YEAR OF DEATH - ?10 ERFORD ROAD, CAMP HILL, PA - SETTLEMENT SHEET ATTACHED 3• LARRY E• KUNTZ, JR• - JOINT ACCOUNT WITH 4,333.06 50.00 2,166.53 PA CENTRAL FEDERAL CREDIT UNION WITHIN ONE YEAR OF DEATH-CHECKING #61028-070 4• JASON R• KUNTZ- JOINT ACCOUNT WITH PA 4,333.06 5D•00 2,166.53 CENTRAL CREDIT FEDERAL CREDIT UNION WIHTIN ONE YEAR OF DEATH-CHECKING #61028-070 5• LARRY E• KUNTZ, JR• - JOINT ACOCUNT WITH 2,55D•25 50.00 1,275.13 PA CENTRAL FEDERAL CREDIT UNION WITHIN ONE YEAR OF DEATH -SAVINGS #61028-010 6• JASON R• KUNTZ-JOINT ACCOUNT WITH PA 2,550.25 5D•DO 1,275.13 CENTRAL FEDERAL CREDIT UNION WITHIN ONE YEAR OF DEATH -SAVINGS #61028-010 TOTAL (Also enter on Line 7, Recapitulation) I $ 116 , 7 8 3 3 2 If more space is needed, use additional sheets of paper 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 LARRY E• KUNTZ, SR 21 10 1D84 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. FUNERAL EXPENSE - FACKLER-WIEDEMAN FUNERAL HOME 6,697.32 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2, AttomeyFees: REAGER & ADLER, PC 2,500.00 3, Family Exemption: (If decedents address is not the same as claimant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4• Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 89.50 5 Accountant Fees: 6. Tax Retum Preparer Fees: 7. FILE INHERITANCE TAX RETURN AND INVENTORY 30.00 8- LEGAL ADVERTISEMENT - CUMBERLAND LAW JOURNAL 75.00 9• LEGAL ADVERTISEMENT - JOURNAL PUBLICATIONS 131.00 TOTAL (Also enter on Line 9, Recapitulation) I $ 9 , 5 2 2 8 2 If more space is needed, use additional sheets of paper of the same size. '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 LARRY E- KUNTZ, SR 21 10 1084 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. CAR LOAN - FORD MOTOR CREDIT 5,6~0.OD 2• AMBULANCE - WEST SHORE EMS 13.54 3• PA• MUNICIPAL RETIREMENT SYSTEM (ONE DAY OF PENSION RETURNED) 69.56 TOTAL (Also enter on Line 10, Recapitulation) I $ 5 , 7 7 3.10 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 NUMBER: LARRY E• KUNTZ, SR 21 10 10 84 .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. JASON R• KUNTZ Lineal 53,793.70 712 ERFORD ROAD CAMP HILL, PA 17011 2• LARRY E• KUNTZ, JR• Lineal 53,793.70 1676 BEECH LANE HANOVER, PA 17331 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ li more space Is neeaea, use aaaltional sneers of paper Dt the same size. L•UV[OC1hiI1NTL-LE.WII.:9/12/94 :i LAST WILL AND TESTAMENT ii '' OF .f ii 'i LARRY EUGENE KUNTZ, SR. ,~ ~~ f ~! I, LARRY EUGENE KUNTZ, SR., of Cumberland County, Pennsylvania, 'E ~ I declare this to be my Last Will, and hereby revoke all prior Wills and Codicils made ~~ i ~ by me. ~~ I I. I nominate, constitute and appoint my wife, PATRICIA LEE KUNTZ, as the II I~ ~ ~ Executrix of this my Will, (herein after referred to as "Executor"). Should she be 4 ~f (~ unwilling or unable to serve for any reason, then I nominate, constitute and appoint J ~~ ~ my son, JASON R. KUNTZ, and my son, LARRY EUGENE KUNTZ, JR., or the survivor of them, as Executors of this my Will. ' II. j~ j I direct that all my just debts and funeral expenses be paid out of my estate as ~~ soon as practicable after my death. 1 .; 1 7 ~ L\MOCIF~C 9N"IZ-LEWII,:9l12/94 ,.. III. ~~ ~~ All of my automobiles, household and personal effects, together with insurance thereon, I give and bequeath to my wife, PATRICIA LEE KUNTZ, if she shall survive me by a period of thirty (30) days; but if my said wife does not so survive me, then I give and bequeath such property equally to such of my children as so survive me to be divided among them as they may determine, or, should they be unable to agree, as my Executor may decide. I direct that those items not selected shall be liquidated and the proceeds, together with all the rest, residue and remainder of my estate, be distributed in accordance with the provisions for distribution set forth below. IV. If my said wife shall survive me for a period of thirty (30) days, all the rest, residue and remainder of my estate, of whatever nature and wherever situate, including any property over which I have any power of appointment, I give, devise and bequeath to my said wife, PATRICIA LEE KUNTZ. V. Should my said wife predecease me, or should she survive me by a period of less than thirty (30) days, or should she not be my wife at the time of my death, or should she die simultaneously with me, or in a common disaster, then I give, devise, and bequeath my entire estate of whatsoever nature and wherever situate to my son, LARRY EUGENE KUNTZ, JR., and my son, JASON R. KUNTZ, in equal shares, share and share alike. 2 i{ . L•\MOCIKLJN'TL-LEWII.:9/12!94 (' VI. i ~: '' All gifts of any kind herein made shall be delivered directly to the beneficiaries ;, free from their control, debts, contracts and engagements, and such gifts shall not be subject to the assignment or anticipation or pledge by them, or to execution, attachment, or any other process for the enforcement of judgments or claims of any sort against them. VII. All inheritance, estate, succession or transfer taxes, whether State, Federal or i i otherwise, or any other tax in the nature thereof, which may be payable by reason of my death, shall not be apportioned but shall be paid, together with any interest or penalties, out of the principal of my residuary estate as if such taxes were administration expenses. I further authorize my Executor to prepay taxes on future I and remainder interests if deemed advisable. i VIII. I confer on my Executor and successor Executors, in addition to those powers :; ' ` granted by law, the following powers to be exercised in a prudent manner and appli- ;; cable to all property constituting a part of my Estate: A. Power to Invest: To retain, and to invest in, all forms of real and personal property, regardless of any limitations imposed by law on investments by ~' fiduciaries, to exercise all the rights ordinarily belonging to the owner of or investor in such property, to register investments in the name of a nominee and to keep such property in such good order and repair as they deem expedient. B. Power to Sell, Lease, Mort~La~e__ ,etc. To sell at public or private sale, to exchange, to mortgage, to lease or to extinguish any mortgage, lease or loan for 3 VilIl:9/ 12194 any period or periods of time, to repair, alter and improve any real or personal property upon such terms as to cash, credit or options as he in his sole discretion may deem appropriate and to do all things necessary or ordinary in achieving these ends, without liability on the part of any third party to see to the application of the funds given therefor. C. Power to Borrow, Pledge and Compromise. To borrow money from any source or sources, to pledge any assets as security therefor and to compromise claims. D. Power re a~ rdin~Administrative Expenses. To treat administrative expenses either as income tax or as estate tax deductions, without regard to whether the expenses were paid from principal or income, and without requiring reimbursement. E. Power to Distribute, Allocate and Value. To make distributions in cash or in kind or partly in each, to allocate property to persons entitled thereto and to fix the value of property. F. Power to Make Loans. To make loans, secured or unsecured, in such amounts, upon such terms, at such rates of interest, to such persons, firms or corporations as Trustee shall think fit. G. Power regarding Employee Benefit Plans. To use his discretion to elect the most propitious settlement option with regard to any qualified employee benefit plans available to me at my death so long as such election shall be in accordance with the Plan's Administrative Committee or Administrator as the case may be. IX. Any Executor, their successors, or any other fiduciary named, constituted or appointed in this my Will or during the administration of my estate, shall be excused from posting bond in all jurisdictions regardless of any law or rule of court to the contrary. 4 (' L•\MOCIKLIN7Z-LE.WII~9/12/94 i, i ;i f i I~ ~ X. } r It is my desire, and I so direct, that ROBERT D. CHAMBERLAIN, JR., :; ~~ Esquire, of Harrisburg, Pennsylvania, be retained as the attorney for my Estate to 'I i. handle the settlement of my Estate, he being acquainted with my affairs. ~i ~~ (i :~ R IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of September, 1994, to this My Last Will and Testament typewritten on eight (8) sheets of paper (including witness' signatures). LARR} E GENE K Z, SR. 5 i j L•\MOC\Rt{N'IZ-LEWII:9/12/94 II ~~ ~~ ~~ ti On the l~ day of , 1994, LARRY EUGENE KUNTZ, SR. declared unto us, the undersigned, that the foregoing instrument was his Last Will and Testament, and he requested us to act as witnesses to the same and to his signature thereon. He thereupon signed this Will in our presence, we all being present at the same time, and we now, on the same date, at his request and in his presence and in the presence of each other, hereunto subscribe our names as witnesses. And each of us declares that he believes this Testator to be of sound mind and memory. j~.. ~ ~. :, ,. ;' ,' L ,., ~: ;.,:.rte. ~ C~~'~ .. ;,~~ y ^~I 1 Address Address `~ D ~, . C~~~ ~.~ /t ddress 6 ( ' ' L•\MOCII~~T'IZ-LE.WII:9/12!94 i -1 ~', COMMONWEALTH OF PENNSYLVANIA I COUNTY OF DAUPHIN ss. I, LARRY EUGENE KUNTZ, SR., Testator, whose name is signed to the r ~~ foregoing instrument, having been duly qualified according to law, do hereby fi 3 c acknowledge that I signed and executed the instrument as my Last Will and ~: ~; Testament; that I signed it willingly; and that I signed it as my free and voluntary act ,. for the purposes therein expressed. j Sworn or affirmed to and acknowledged ~' LAR Y E GENE K Z, S R. before me, by LARRY EUGENE KUNTZ, SR., the Testator, (~ this ~ .~ ` `' day of September, 1994. - ~' j' l~Totary public ~~ - si ~, i My Commission Expires: war~rttA~ s~ o a. +tooMS, Norwt~r PuBtrc HARRISBURG DAUPHIN CO. PA. MY iAMMtSSION EXPIRES MARC~14,1g95 ~; ',~ 7 >i e+ L•1MOr 1h1~ITL-LE.WII,:9/12/94 COMMONWEALTH OF PENNSYLVANIA COCINTY OF DAUPHIN ...- .-- f- 1-. iJ.tr/ f ~ / i ~: l ss. /~`Iu ~~~c~ ~~i~~~ and /I'~ ~~t~;F~~,_ . ~ _ ;t~ -~~.~~~ ,the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will and Testament; that he 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; and that to the best of our knowledge the Testator was at that time eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed to and subscribed -"~ .~-' 1~ ~_ .~ .. to before me by ~. t ~~, s ~ ~~e~>~/e , ~, ~ ~ ~F~ a u ~~~ and ~`r ~ . ~~,; . r~^ ~`' ~` ~~ , this ~~'.~~` t6`~ day of September, 1994. ~ ;;, ,., ~ !i i, Notary Public (SEAZ) j My Commission Expires: ~~ !s ` ~~AL SE~ DEBORAH K. KOOKS, NaTARY PUBLIC HARRtSBflRG DAUPHIN CO. PA. MY COMMtSStON EXPIRES MARCH! 4,1995 g e .e e 100. Gross Amount Due from Borrower 400: Gross Amount Due to Seller 101. Contract sales price 115,900.00 401. Contract sales price _ ~ 15900 00 '102. Personal ro ert 402. Personal ro rt 103. Settlement charges to borrower (line 1400) 5,391.61 403. :1:04. -- 404. .1.06;>: - 405. 11d'u'stments for items aid b seller in advance Ad ustments for items aid b setter in advance 106. City/town faxes to 406, City/town taxes to 107: County taxes to 407. County taxes to ;1;08 , Assessments l0 408. Assessments to aq9; School Tax 01/1912011, to 06/30/2011 416.33 409. School Tax 01!19/2011 l0 06/30!2011 416.33 ~t10: SewerlTrash 01/19/2011 to 03131/2011 1.10.40 410. SewedTrash 01/1912011 to 03/31/2011 110.40 111•' 411. 112. _. 412. _120• Gross Amount Due from Borrower 121,818.34 420. Gross Amount Due to Seller 116,426.73 X200. Amounts Paid b or in Behalf of Borrower ~ .500. Reductions In Amount Due to Seller 201. Depositor earnest money 1,000.00 501. Excess deposit (see instructions) _202. Principal amount of new loan(s) 108,070.00 502. Settlement charges to seller (line 1400) 14966.27 203. Existin loa s taken sub'ecl to 503. Exislin loa s taken sub'ect to ?~' 504. Pa off of first mort a e loan .205. 505. Payoff of second mortgage loan 20fi.: 506. X07:: Seller Assistance 5,000.00 507, Seiler Assistance 5 ~ ~ ~~~~` ~ 508. 2b~:. 509. Aii'ustments for items un aid b seller~~ Ad ustments for items un aid b seller 2:t -:: City/town taxes : to 510. Cityllown taxes to 29'j. County taxes 01101/2011.to 01119/2011 14.95 511. County taxes 01!01/2011 to 01/1912011 14.95 . X212 `. Assessments `_ to 512. Assessments to 213. 513. 214. 514. w215. 515. 216. 516. 217. __ 517. ._.218. 518. ' -219. 519. .220: Total Paid bylfor Borrower >114 084:95 530. r Total Reductioh:Amount Due Seller 19,981.22 300.E Cash at Settlement fromlto Borrower 600: Cash at Settlement toffrom Seller ~i)t; ~ Gross amount due from borrower (line-120) .121,818.34 601. Gross amount due to seller (line 420) 116,426.73 ~q~:.;' Less amounts paid byflor borrower (line 220) 114,084.95 602. Less reductions in amount due seller (line 520) 19 981.22 °303: Cash [X ] From ~ To Borrower 7,733.39 603. Cash ~X To ~ From Seller 96,445.51 u C spo inp u en or is eo 0 i . ~ mi ii ~ unless p 0ispiays a eunentry vNid OMB control num ~NO eonlWenUO1M k .ssur U,IS Eisdowro k m.ntlalory. This Is d ~ y e ~flf gocess. ,~r~' ~ Y .~ eslprod to provide IM p,elu 10 • ResnA oownd Usns.Gion wit Infoimelbn iM t.:~' ~ ;: E .: i~ .. Previous editions are obsolete Page 1 of 4 F .. HUD-1 rn ~r ~ OMB Approval No. 2502-0265 -: - ~~ A. Settlement Statement (HUD-1) ~:.. ,.: . FINAL ia•nur i.~ar~ 700. TOtai Real Fstato R.ntrn. ce,... ~ .. ,.... ,._ ... -. ~Tf'?~id outside of closing by (B)orrower, (S)gller, (L)ender, (I)nvestor, Bro{K)er. ~~as~•61 ~ 14,966.27 ~ ;;.: Y: ~,. _F , . ~.`: , 1: ~..: <; ;. ~`° ::,' _. :~'r•a:: _., `; =~ iPi;~V.ious editions are obsolete ~-~'~' Page 2 of 4 HUD-1 r.; :rte ; :l=. ~~ ~; :~~~f:, 5;~: ,., ~:Com arlson of Good FalthkEs~imate G~E irid Ftlj[~1 t~h ` es ~~~~' ~ , u~y `~ `~ ~ "" ~,r,, ;.r"' ='~~ try,~;t? .~'~ s.::Gtl th~Es~m ta" ~r ~i'~ t ~ s r , , , :; '-•~har es That Cannot Increase .. ~ _ }i 5 t~~t~-a u r SF ~~f •_ _ .+re _ee:^ ..A.rr..:. `~,;~odgiriaUon cha'` ' ~ ,. a I~umbe ' ~~'. 495.00 495.00 .. M{~,1!, 5 ill f ~ /y~ Your credit or charge:(p~~~ing~ieafic.inlere3t Faf$ d`i¢sen #""~ ~, ~ ~,~ ~ ~~, i, ':Your adjusted ongmafion ch~es< "., ~' „ ~' ~ w~ t ~~ ,. ,,, ,, 0.00 Transfer'lazes ~ Y;. T ~'~~`~' ' ' v 495.00 495.00 .; 1,159.00 1,159.00 t ,-i~;,. ~._ , t t fir. c._;GoodFa"IT~i".Ea made ~ y.i J f.1 r ''11,,11 _ ' j s 6 i,~..rJyt] 1 1 .yr . 1s7.oo lasso 455.00 q~.00 14.84 14.84 0.00 0.00 1,070.00 1,070.00 1,288.75 280.00 0.00 704.06 19.00 19.00 3,014.59 2,729.40 5-285.19 or -9.460396 .p;Gaod Faith'EstimYa~es `; o '',,,:....~'.: ~'HM'U~1 ~ ` 1,881.30 663.91 205.35 144.30 500.00 479.00 Previous editions are obsolete Page 3 of 4 MUD-1 Gliarges That Can Chan a E, ,~ ~ ~ F~ ,~ , .., ~,, ;, ., Ini4al deposit for your escrow a `~ ' Daity.interesl charge ~= ~' `'~ :~ , ~ ~ `9~i,' 4, ; rv ~ ~Lj`a day Homeoxmec's insurance ~ ,,.,r Y # 903 ~ r z . ~ a ,. „. ---- ~. • - - - - ] -,-~~..~,... ~..~..~ ,.,~ ~awo,narn ~narges ana roan I arms listed on this form, please contact your lender. ~' HUD CERTIFICATION OF BUYER AND SELLER ~ have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and ~:. isbursements made on my account or by me in this transaction. I furthe[ certify that I have received a co of the HUD-1 Settlement Statement. _, , _ .:. PY Abdeslam Tourat .~, ~'• i...>Y.. .._. j.:. ~, _'., ~~~ a::,'?. ~:? ~.:: ~ :.;~ ~{ ~J ?u.C,' ~_ `.'•.~ ~. ~ - ,d ~esorrR"K~I~ and Larry . nunrz, dr. Jason .Kuntz ,Th~.~lUD-1 Settlement Statement which I have"prepared is a true and accurate account of this 'disbursed in accordanc4 with this statement. ., r: ~~~ r:r:;. . .:TLEMENTAGENT ', :>=.. _ . ~'~.~ _`r~`r , r=n!: x.~:: _;~,V `?i,;.7 I have caused or wlll cause the funds to ~ 1 ~1 II DATE ...;:;~. { ~,~ :.. ; °, VVaRNING: IT IS a CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. Previous editions are obsolete Page 4 of 4 HUD-1