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HomeMy WebLinkAbout06-23-11J 1505610101 REV-1500 ~ {01-1°~ PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes DF-M~NFMTauVfNVf PO BOx Z8osoi INHE County Code Year RITANCE TAX RETURN !~ File Number Harrisbur , PA 1']128-0601 RESIDENT DECEDENT '7` ` ~1~ f~ ~ I ENTER DECEDENT INFORMATION BELOW J Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 405-26-9701 12/28/2009 04/04/1924 Decedent's Last Name Suffix Decedent's First Name MI Johnson Audrey W (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 O 1. Original Return ~ 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 Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate (Attach Co f Will O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes py o ) (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 Sch, O) GOKFiESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number David M. Hollar, PLLC (610) 729-2900 First line of address __ 8 Tower Bridge #400 Second line of address 161 Washington Street City or Post Office State ZIP Code Conshohocken PA 19428 Correspondent's a-mail address: dhollar c~Dvillarilaw.com REGISTER OF WiLL~SE ONLY ~: •--- C~ Q ~ .. _~ ;,r i-T~f ~,, r .~ "C~ ~ a ~~-.1t C-.' ~~ ..~-~.r -, ~:~ ~. .. DATE FII;ED ~ ~._e r ~ f .r ~~,~ ., _. ~7 -; x ~ _`1 t - ; "- ~ - :'"r't ~~7 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 RE OF PER ON RESPONSIBLE FOR FILING RETURN DATE ADDRESS ., ~~ ~-r ~ ~k~ C~ ~.n•~~.- ~ ~ Z"~~ ~ 1 J ~.i'- sir" ~ g©~ c~ ~.~, ~ i'3 ~ l ~~ SIGNATURE •F ~RE~ARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15D5610101 150561010], J ~,. J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: Audrey W. Johnson 405-26-9701 RECAPITULATION 1. Real Estate (Schedule A) ............................................ . 1. 348,700.00 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. 11,214.54 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. 0.00 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 359,914.54 9. Funeral Expenses and Administrative Costs (Schedule H) ............ ....... 9. 66,150.90 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... ....... 10. 169,050.78 11. Total Deductions (total Lines 9 and 10) .......................... ....... 11. 235,201.68 12. Net Value of Estate (Line 8 minus Line 11) ....................... ....... 12. '124,712.86 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................. ....... 13. 2,920.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ................. ....... 14. 121,792.86 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 45 121,792.86 16 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 Side 2 ~, 1505610105 1505610105 5,480.68 5,480.68 O J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME Audrey W. Johnson -------------------- - STREET ADDRESS 17 Honeysuckle Drive File Number _-- -_ _-_ ~ - STATE ZIP Mechanicburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 5,480.68 2. Credits/Payments A. Prior Payments B. Discount - --___- - - _ _ _ - 0.00 Total Credits (A + B) (2) 3. Interest (3) 131.56 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. (q) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5,612.24 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; or .......................................................................................................................... ^ 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" orpayable-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(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, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1.502. EX+ tiI1°(?8) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE c~iA~t ur FILE NUMBER Audrey W. Johnson, Deceased 21-09-1212 An 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 iointiv-owned with right of survivorship muct hP die~Inend ~~ c~tio.~~~ie G it more space is neetled, insert additional sheets of the same size. OMB Approval No. 2502-0265 ~,\ ~,,,;. A. Settlement Statement (HUD-1) 1. Q FHA 2. Q RHS 3. Q Conv. Unins . 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4. Q VA 5. ®Conv. Ins. 31324SPECK 629061 C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown Items marked " " . (p.o.c) were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. Name 8 Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender: Jonathan D. Speck, Grace M. Speck Estate of Audrey W. Johnson GSF Mortgage Corporation 647 Heritage Court, Mechanicsburg, Pa 17050 1 Beach Drive SE #1805, St. Petersburg, FL 33701 15430 W. Capitol Drive, Suite 100, Brookfield, WI 53005 G. Property Location: H. Settlement Agent: I. Settlement Oate: 06/07/2011 8 E. Woodland Drive Keystone Land Transfer, LTD Disbursement Oate: 06/07/2011 Mechanicsburg, PA 17055 Telephone 77-774-7435 Fax 717-774-3869 Mechanicsburg Borough Place of Settlement: TitleExpress 3421 Market Street, Camp Hill, Pa 17011 Printed 06/07/2011 at 11:03 am by CLT 100. Gross Amount Due from Borrower 400 Gross Amount Due to Seller 101. Contract sales price 170,500.00 . 401. Contract sales price 170 500 00 102. Personal 402. Personal r , . 103. Settlement charges to borrower (line 1400) 8,652.90 403. 104. 404. 105. 405. Ad ustments for Items id b seller in advance Ad ustments for llama aid b seller to adva 106. CiryRown taxes to nce 406. Cityltown taxes to 107. County taxes 06ro7/2011 to 12/31/2011 560.00 407. County taxes 06/07/2011 to 1 213 1 120 1 1 ~O pO 108. Assessments 06/07/2011 to 06/30!2011 138.19 408. Assessments 06/07/2011 to 06!30/2011 , 138 18 109. 409. , 110. 2nd qtr sewer/trash P~ 06107/2011 to 06/3012011 29.91 410. 2nd qtr sewer/trash pi 06/07/2011 to 06/30/2011 29 9 111. 411. . 1 112. 412. 120• Gross Amount Oue from Borrower 179,881.00 420. Gross Amourtt Oue to Seller 171 228 10 200. Amounts Paid b or In Behalf of Borrower 500. Reductions In Amount Due to S ll , . 201 • Deposd or earnest money 5,000.00 e er 501. Excess deposit (see instructions) 202. Prinapal amount of new loan(s) 153,450.00 502. Settlement charges to seller (line 1400) 13 677 4 203. Existin b s taken su ~ to 503. Existi ba s taken su 'act to , . 4 ~' 504. Pa off of first mort loan 205 ' 505. Payoff of second mortgage loan ~' 506. Payoff loan 5 853 207. , .53 507. 208. 508. 2~' 509. Inheritance Tax Escrow 12 200 0 Ad ustments for Items un aid b seller Ad ustments for items un id b ll 0 10. City/town taxes to se er 510. City/town taxes to 211. County taxes to 511. County taxes to 212. Assessments to 512. Assessments to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. u0• Total Pald b !for Borrower 158,450.00 520. Total Reduction Amount Due Seiler 31 730 300. Cash at Settlement trorttRo Borrower f 00. Cash at Settlement tolfrom SeNer , .97 301, Gross amount due from borrower (line 120) 179,881.00 601. Gross amount due to seller (line 420) 171 2 302, Less amounts paid by/For borrower (line 220) 158,450.00 602. Less reductions in amount due seller (line 520) , 28.10 303. Cash QX From ~ To Borrower 21,431.00 1;03. Cash ~X To ~ From Setter 31,730.97 139,497.13 . 4YIMNIy rYd 0118 coMtq MAIEeI. No mnrW,Nlrly b eaeure R Wt GbvW We b n1Yd.lory. Th b b Ma1puO b u provi0e tln pwlW W . RESPA Cov.nOlnnsrllon w1111 InfemrUon durNq t l,e See attached addendum for additional information Previous editions are obsolete Page 1 of 4 HUD-1 W. ~ ~ Rear taus exvRer reel a w,°tsu.uu Division of commission line 700 as follows: Paid From Borr ' Paid From ' 701• ;10,580.00 to Re/MaxRealtyAssociates ower s Fund t Seller s 702. $0,00 to 703. Commission paid at settlement s a Settlement Funds at Settlement 704. Broker Fee to Re/Max Realty Assoclates 350.00 10,580.00 800. kerns Pa able in Connection with Loan 801. Our origination charge (Includes Origination Pant 96 or $0.00) $2,045.00 (from GFE #1) 802. Your aedit or charge (points) for the specific interest rate chosen $67.77 (from GFE #2) 803. Your adjusted origination charges (from GFE A) ~~ ~~~ fee 1,477.23 to Bentz Mort Grou (from GFE #3) 805. Credit report to {from GFE #3) 450.00 806. Tax service to from GFE #3 807. Flood certification to from GFE #3 ~• to 900. !tams R wired b Lender to be Paid in Advance 901. Daily interest charges from from 06/07/2011 to 07/01/2011 @ $19.1813/day (from GFE #10) 460 35 902. Mortgage Ins. Premium for months to (from GFE #3) . 903. Homeowners insurance for months to (from GFE #11) ~~ months to from GFE #11 1000. R rvea sited with Lender 1001. Initial deposit for your escrow account (from GFE #9) 2 496 57 1002. Homeowners insurance 3 mor>ihs ; 40.08/month 120.24 , . 1003. Mortgage Insurance months S 62.66/month •00 1 .City Property Tax months ; 0.00/month 0•~ 1005. County Property Tax 5 months ; 80.64/month 03.20 1006. Assessments 13 months ; 182.76/month $2,375.88 1007. Aggregate Adjustment ;-002.75 1100. Title Cha es 1101. ille services and lenders title insurance from GFE #4) 1,478.75 1102. Settlement a dosing fee to $ 1103. Owners title insurance (from GFE #5) 85.00 1104. Lender's title insurance $1,353.75 1105. Lender's UUe po~cy limit $153,450.00 Lender's Poicy 1106. Owners GUe policy limit;170,500.00 Owner's Policy 1107. Agent's portion of the total title insurance premium $1,172,82 1108. Underwriters portion of the total title insurance premium $265.93 1109. 1200. Government Reconlin and Transfer Cha es 1201. Government recording charges (from GFE #7) 150.00 1202' p~ $$2.00 Mort $88.00 Release;0.00 1203. Transfer taxes (from GFE #8) 1 705 00 1204. City/County taxlstamps Deed;1,705.00 Mort a ;0.00 , . 1205. State Tax/stamps peed $1,705.00 Mo $0.00 1206. peed $0.00 Mort ;0,00 1,705.00 1207. 1300. Additional Settlement Char es 1301. Required services that you can shop for (from GFE #6) 1302. Survey to 1303. to 1304. 2010 School Tax- (Tau Claim) to B L. Nedcard' $2 668 64 P O C S' , . . . . 1305. 2011 County Tax to Ba L. Hedcard' 1306, Tax Cert Fee to Ke stone Land Transfer, LTD 1307. Doc prep Fee S 987. 5 to tone Lafaver & Shekletski 1308. Notary Fee to Cash 1309. wre fee for town prooeedsJpayoff to Ke stone Land Transfer, LTD 1310. 2nd qtr sewerltrash to Mechan'~cstw Bor h $118.32 P.O.C. S' 1311. Inheritance tax escrow fee S L 225 10 40. to tone afaver ~ St~ekletski 125 .... ,, , ~ , « - «: . .:.: r ~ 8,6S2.9b 13,677.44 'Paid outside of dosing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. See attached addendum for additional information Previous editions are obsolete Page 2 of 4 HUD-1 ~. K+, n, ~~ ` A'. Settlement Statement HUD-1 OMB Approval No. 2502-0265 •wm.;: - L ~~~'`, ~ ~ F1NA 1. ^ FHA 2. ^ RHS 3. ^Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 10-247 1001190411 4. ^ VA 5. ^X Conv. Ins. C. Note: This forth is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown Items marked "(p.o.c)" were paid outside the closing; they are shown here for informational purposes and are not included In the totals. D. Name & Address of Borrower: E. Name & Address of Seller: F. Name ~ Address of tender: JACOB THOMAS WHITELEY, EMILIA M. THE ESTATE OF AUDREY W, JOHNSON USAA Federal Savings Bank WHITELEY 1 Beach Drive SE, #1805, St. Petersburg, FL 33701 10750 McDermott Freeway, San Antonio, TX 11142 Voyager Lane NW, Apt. BB101, Silverdale, WA 78288-0558 98383 G. Property Location: H. Settlement Agent: I. Settlement Date: 06/02/2010 17 HONEYSUCKLE DRIVE, SILVER SPRING Homesale Settlement Services Disbursement Date: 06/02/2010 TOWNSHIP MECHANICSBURG, PA 17050 Place of Settlement: TitleFacpress Silver Spring Township 4309 Unglestown Road, 717-071-9876 Fax 717-671-9676, Printed 06/02/2010 at 11:02 am Harrisbu , PA 17112 by KR ~ :. • 100. Gross Amount Due from torrower 400.. Gross Amount Due;fo ;Seller 101. Contract sales price 175,000.00 401. Contract sales price 175,000.00 102. Personal r 402. Personal o rt 103. Settlement charges to borrower (line 1400) 8,788.08 403. 104. 404, 105• 405. Ad'ustments for items ald b seller in advance Ad'ustments for Items ald b seller in advance 106. City/town taxes to 406. City/town taxes to 107. County taxes 06/02/2010 to 12/31/2010 256.80 407. County taxes 06102/2010 to 12/31/2010 256.80 108. Assessments 06/02/2010 to 06/30/2010 93.30 408. Assessments 06/02/2010 to 06/30/2010 93.30 109. 409. 110. 410. 111. 411. 112. 412. 110. Gross Amount Due from Borrower 184,138.18 420. Gross Amount Due to Seller 175,350.10 200. Amounts Paid b or'ln Behalf of Borrower . `: 500:: Reductfahs lt(~4mounf Due fo Seller;: -' 201. Deposit or earnest money 5,000.00 501. Excess deposit (see instructions) 202. Prinapal amount of new loan(s) 146,750.00 502. Settlement charges to seller (line 1400) 13,827.21 203. Existin loa s taken sub'ect to 503. Existin loa s taken sub'ect to 204, Origination Charge Credit 350.00 504. Payoff of first mortgage loan 125,385.57 205. 505. Payoff of second mortgage loan 32,137,32 206. 506. 207. Seller Assist 4,000.00 507. Seller Assist 4,000 00 208. 508. 209. 509. Ad'ustments for Items un aid b seller Ad'ustments for items un aid b seller 210. City/town taxes to 510. Cityltown taxes to 211. County taxes to 511. County taxes to 212. Assessments to 512. Assessments to 213. 513. 214• 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 120• Total Pald b /for Borrower 158,100.00 520. Total Reduction Amount Due Setter 175,350.10 300, Citsh:at$ettlement;:fromlto Borrower 600; Cash if~eWemenl; offromSelfer 301, Gross amount due from borrower (line 120) . 184,138.18 601, Gross amount due to seller (line 420) 175,350.10 302, Less amounts paid byl(or borrower (line 220) 158,100,00 602, Less reductions in amount due seller (line 520) 175,350.10 303. Cash ^X From ^ To Borrower 26,038.18 603. Cash X^ To ^ From Setter 0.00 Nls Wrtn uMati R tlisppys ~ W~nnly v.fd BOMB CoMr01 numt»r. No oonfi0em1.N1Y auwW; Ills dlcWsun M mrd.lory. ~7Tit k WalpnM 10 pOVld~ 1M pMMf b . RESPA COV.IM tlani.GlOn wMA InformMlon wf(q IM ~ s~tlrrroM por..u. Previous editions are obsolete Page 1 of 4 HUD-1 700. Total Real Estate Broker Fees $ 10,850:00 Pald From Paid From Dvjsion of commission fine 700 : as follows: 8orrovirer'S Seller's 70a. $5,225.00 tp Prudential Homesale Services Group Funds at Funds at 702. $5,625.00 to ReMax Realty Assoc. 703. Commission paid at settlement . Settlement Settlement 10,850.00 704. Broker Fee to Prudential Homesale Services Group / 195.0 0 800. ttems Pa ble: n Conneiaion v~ftte.Loan 801. Our origination charge (Includes Origination Point °~6 or $0.00) $600.00 (from GFE #1) 802. Your credit or charge {points) for the speafic interest rate chosen $185.94 (from GFE #2) 803. Your adjusted origination charges (from GFE A) 785.9 4 804. Appraisal fee to Servicelink (from GFE #3) / 290.00 805. Credit report to CSC (from GFE #3) % 14.00 806. Tax service to First American Tax Service (from GFE #3) l 80.00 807. Flood certification to First American Flood Data Service (from GFE #3) 5.25 808. to 900. Items Re uiredrb .Lender to be~P:iiid ina~dvance 901. Daily interest charges from from 06/02/2010 to 07/01/2010 @ $20.6597/day (from GFE #10) `599.13 902. Mortgage Ins. Premium for months to (from GFE #3) 903. Homeowner's insurance for 12 months to USAA (from GFE #11) 526.08 904. months to from GFE #11 1000..Reserves De ostted with bender ,_ 1001. Initial deposit for your escrow acx;ount (from GFE #9) 618.27 1002. Homeowner's insurance 3 months $ 43.84/month $131.52 1003. Mortgage Insurance months $ 16.11/month $0.00 1004. City Property Taxes months $ 0.00/month $0• 1005. County Property Taxes 5 months $ 162.25/month 811.25 1006. Assessments months $ O.OOlmonth 0.00 1007. Aggregate Adjustment $-324.50 1100. Title Char es 1101. Title services and lender's title insurance (from GFE #4) 1,456.75 1102. Settlement or closing fee to $ 1103. Owner's title insurance {from GFE #5) 117.66 1104. Lender's title insurance $1,103.75 1105, Lender's title policy limit $148,750.00 1106, Owner's title policy limit $175,000.00 1107. Agent's portion of the total title insurance premium $1,087.06 1108. Underwriter's portion of the total title insurance premium $134.35 1109. 1200. Govemment`Recordin and Tran.Sfer Cha . es -: 1201. Government recording charges (from GFE #7) 150.00 1202• Deed $62.00 Mort a $88.00 Release $0.00 1203. Transfer taxes (from GFE #8) 1,750.00 1204. CitylCounty tax/stamps Deed $1,750.00 Mort a e $0.00 1205. State Tax/stamps peed $1,750,00 Mort a $0.00 1 ~' Deed $0.00 Mori a e $0.00 1,750.00 1207. :1300.- AdditionafSettlement Ck~a.; es ,, . _. 13 1. Required services that you can shop for (from GFE #6} 1302, Survey to 1303. 2010 School tax escrow to CPSS Esaow Holdin Account 1304. Prepaid Tax Cert Fee to Homesale Settlement Services, Inc. 1305. Twp/County Tax#38-0289-137 to Debra Baseshore-Wiest, Tax Collector 1306. Home Warranty to American Home Shield 1307. Sewer Bill to Silver S tin s Townshi Authori 1308. Fed Ex to Sharon Goddin 1309. Deed Prep Fee to ReMax Realt Assoc. 2,200.00 10 440.0 543.12 69 ~ 40.00 125 • . ~ ~ . ~ ~ ~ 8,788.08 13,827.21 'Paid outside of closing by (B~rrower, (S~Iler, (L)ender, (I)nvestor, Bro(K)er. °4~ Previous editions are obsolete Page 2 of 4 HUD-7 ~oo~ ~~~: P~c~ ~~~ THIS DEED, made this 24thday of August l9 79~ by and between MASSANUTTEN VILLAGE, INC., a Virginia Corporation, party of the first part; and David R. Johnson and Audrey W. Johnson, Husband and Wif e parties of the second part; Ti? I T N E S S E T H THAT for ~ and in consideration of the sum of Ten Dollars ($10.00) , cash in hand paid by the parties of the second part to the party of the first part, and of other good and valuable consideration given, all of which is hereby acknowledged by the party of the first part before the execution and delivery hereof, the said party of the first part does hereby grant and convey with General Warranty and .English Covenants of title unto the said David R. Johnson and Audrey W. Johnson, Husband and Wife as tenants by the entireties with the right of survivorship as at couuuon - law parties of the second par. t, an undivided one fifty--second { 1 /52} co--tenancy interest in that certain piece or parcel of land, with improvements thereon, situate in Stonewall District, Rockingham County, Virginia, shown and designated as UNIT NO. Forty-three upon a certain plat entitled "MOUNTAINSIDE VILLAS, SECTION ONE, PHASE Nine , MASSANUTTEN VILLAGE," which said plat is duly of record in the Clerk's Office of the Circuit Court of Rockingham County, Virginia, in Deed Book No . 559 , Page 454 . TOGETHER with the rights to occupy the said unit during TI1~IE PERIOD (s ) Iv G . (s ) 43 as defined iii "Statement of Mutual Ownership Agreements, Protective Covenants and Restrictions' {STATEMENT), made by .Massanutten Village, znc., dated July l5, 1978, and duly of record in the aforesaid Clerk's Off ice in Deed Book No. 527., Page 442, and subject to the covenants, restrictions, and easements as set forth in said STATEMENT. aooK ~~~ ~~cF~ ~~.~ TOGETHER with the right to use private roadways and pathways situate on the lands of the party of the first part of which the above described premises were formerly a part, for the purposes of ingress and egress to the above described premises to and from the public road in common with the party of the first part and other persons. The real estate herein conveyed is a portion of the property acquired by the Grantor herein by deed dated April 26, 197?, from Massanutten Development Company, duly of record in the aforesaid Clerk's Office in Deed Book No. 495, at Page 448. IN WITNESS WHEREOF, the party of the first part has caused this writing to be executed in its corporate name by a duly authorized Officer: MASSANUTTEN VIi,LAGE, INC. HY S F. SHENK Vice-President STATE OF VIRGINIA, COUNTY OF ROCItiINGHAM, to-wit: The foregoing instrument was acknowledged before me this 24th day o f August , 19 7 9 , by HYLUS F . SHENK ~ Vice-President of MASSANUTTEN VILLAGE, INC., a Virginia Corporation, on behalf of said Corporation. My commission expires /'~ ~ 2 - ~~ ,.. Notary Public ~ AFTER RECORDING FORWARD T0: Mr. and Mrs. David R. Johnson 8503 Evesham Road .Richmond, VA 23229 vl~:.. ', r~. .. .~t: .7... -~_ •--. .~.;Si~l~rl~ ~lTll.r'l;.:, ciai.~ .ea r~~1t:, b.tioir ~.~, .;i. --~ .~..~.!I.`~• I LIr',t,:,y Lff~l [~Xe° + t id ~; e etc:.:.:::-,r~ - ., .• .4-_t z.~--C-~L.7 Sir, :~~,-~Y.3 `. ` .~~_ ^ ~~'-`~ -~~_Cti;~ ---------------- lr:Jlt: - L ~'l~Y~E ~ARPEfi Da2c1 Soon No.~,.~,~,1--_Page____ ACTt~dG CLfi4K /~.~. REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Audrey W. Johnson, Deceased 21-09-1212 All property jointly-owned with right of survivorship must hp dlsc~n¢ar~ ~~ c~tie,~~~~o c ~~~ iiwiC aNa~e w neeoea, mser[ aaamonal sheets of the same size) REV-1504 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Audrey W. Johnson, Deceased SCHEDULE C CLOSELY HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP FILE NUMBER 21-09-1212 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted fnr cnlP_nrnnr;atnrch;nc ~~~ nw~e space is neeaea, insert agg;uonal sheets of the same size) REV-1507 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE is SATE of FILE NUMBER Audrey W. Johnson, Deceased 21-09-1212 All property jointly-owned with right of survivorship must be disclosed nn Srhadu~a t` ~~~ iiwiC Space is neeaea, insert aaaitional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY w~r~~~ yr Audrey W. Johnson, Deceased FILE NUMBER 21-09-1212 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survlvorshin must be disclnsad nn Scherlulo ~ ~~~ nwiC sNace is neeaea, insen aaainonal sheets of the same size) REV-i5og EX+ (oi-io) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: Audrey W. Johnson, Deceased FILE NUMBER: 21-09-1212 If an asset became jointiv owned within one veer of the de~e~p..t~~ ~~to ~f ~e~tM :.......~ ~... _..__.~_., __ ~_~_~__._ .. Evan ~ ~Y uWIVtD PKOPERTY: _~ ~ ~ ~~~ ~ aNat,c ~5 neeaea, use aaoitionai sheets of paper of the same size. RFV-1.51 C1 CwX+ Lt?8.03 ~` Pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PRnpFRTV ~~ i w i t ur FILE NUMBER Audrey W. Johnson, Deceased 21-09-1121 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 DESCRIPTION OF PROPERTY NUMBER INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1• New Market Cert. No. 003061, 3 sh., Audrey W. Johnson as Custodian for Matthew Gill (grandson) per PA Uniform Transfers to Minors Act 352.86 0 0.00 2 Albemarle Corp. No. 23201, No. 25369, 9 sh., Audrey W. Johnson as Custodian for Matthew Gill (grandson) per PA Uniform Transfers to Minors Ac 670.56 0 0.00 3 Tredegar Corp. No. TC 2320, 2 sh., Audrey W. Johnson as Custodian for Matthew Gill (grandson) per PA Uniform Transfers to Minors Act 31.50 0 0.00 4 IRA, Mutual Bank, Account No. xxxx11702 to Kathy M. Davey (daughter) as beneficiary 8,336.61 100 0.00 TOTAL (Also enter on Line 7, Recapitulation) $ I 0.00 If more space is needed, use additional sheets of paper of the same size. REV-3.SI.1 Ex+ ;10-L19) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Audrey W. Johnson, Deceased 21-09-1212 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES; 1' Auer Funeral Home 1,544.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Kathy M. Dave l~ _ Street Address 1 Beach Dr. SE #1805 --- - _ _ city St_Petersburg___ state FL zIP 33701 Year(s) Commission Paid: 2• Attorney Fees: 3,500.00 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 0.00 Claimant Street Address City _ _ _ _ State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 428.50 5• Accountant Fees: 1,000.00 6. Tax Return Preparer Fees: ~~ Tax, Insurance, Utility and Maintenance costs (17 Honeysuckle Dr.) 2,194.98 s Closing costs ,pro-rations and seller assist (sale of 17 Honeysuckle Dr.) 18,177.31 s Tax, Insurance, Utility, Maintenance and Repair costs (8 E. Woodland Dr.) 24 150.86 1o Closing Costs and pro-rations (8 E. Woodland Dr.) 14,405.54 11 HOA Assessment (Timeshare, Massanutten Villas) 400.00 12 Misc. administrative costs and fees 349.71 TOTAL (Also enter on Line 9, Recapitulation) $ 66,150.90 If more space is needed, use additional sheets of paper of the same size. REV-1.517 EX+ ;17-Cl~i) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Audrey W. Johnson, Deceased 21 09 1212 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1' Reverse Mortgage, 17 Honeysuckle Dr., Bank of America No. xxxx9599 (see Settlement Statement) 125,385.57 2 Term Loan, M&T Bank, Account No. xxxx350001 (See Settlement Statement, 17 Honeysuckle Dr.) 32,137.32 3 Credit Card, HSBC Account No. xxxx4090 878.00 4 Term Loan, M&T Bank, Account No. xxxx350001 (See Settlement Statement, 8 E. Woodland Dr.) 5,853.53 5 Credit Card, AT&T Account No. xxxx4253 153.69 6 Medical (various providers) 1,545.74 7 Term Loan, M&T Bank, Account No. xxxx350001 (Carrying cost June 2010-June 2011) 3,096.93 TOTAL (Also enter on Line 10, Recapitulation) I $ 169,050.78 If more space is needed, insert additional sheets of the same size. REV-151.3 EX+ (01-10) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: Audrey W. Johnson, Deceased 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• Julie Ann Gill, 8 E. Woodland Dr., Mechanicsburg, PA 17055 2 Kathy M. Davey, 1 Beach Dr. SE #1805, St. Peterburg, FL 33701 II RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Daughter ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1 50% 50% B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. Donation of Decedent's Personal Possessions 2,920.00 FILE NUMBER: 21-09-1212 AMOUNT OR SHARE OF ESTATE TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ 2,920.00 If more space is needed, use additional sheets of paper of the same size. ~w 4/ I,,~-~T •ILL ~111D TEBTYsIl~811T ~E I'~ 1ZEt4EIdBER~aD THAT I, AUDREY iQ. JOHNSON, a resident Of Oumberlatad coetnty, Pennsylvania, being of sound and disposing mind, me~dory and uhderatanding, do make, publish and declare this to be iqy LAST WILL and TS$TAIrIEN'1', hereby revoking any al~'~d all ~Vi11~ and Codicils previoun].y mt~de by me. I I dealers that I am married to DAVIp IZ. JOHNSON, and that I have tW.4 (~) daughters, XATSY M. FRY aid JULiE A. GILL. II I direct that all 1uy just debts at1Q funeral expenses shall be paid from ld~y residuary eStAta as aoUit as prdGticable aftex my deoaaee. III I ~ixect that alX taxes th~-t mcty be assessed 3,n aor-eeguenaa of my death, of whatever.nature'and key whatever jurisdictiv~- imposed, aha,1Z. be paid from my r$siduary estate as a part o~ 'th® expense of the administrat~:on of my estate. IV I give, dev~,se and bequQath all my property, whether reel yr personal, Wherever s3.tuate, ihaZuding any property over which I may have a power of agpair~tment to my husband, DAVIp, provided that he survives me bx thirty (30} days. V If 1~ry husband, DAVID, shall predeoeass or zai,I to survive me by thiz`ty (30} t9ays, Y give, devise and begLt~ath till of my property, whether, Y'et~l pr personal, wherever situate, including any property over which. I nay gave a power of appointment, to my daughters, KATHY and JULIE, in $quell shares, per stirpes. na . ~~ ~ ~, : , ca ~ T-r•s ~-> 32 ~ ~ {;ti 'z ca ` ~z. `~- tj~j ~ w C: ~ j ~~ L7 ~~ ~ ~~~ ~ c~'. {~ ~ 1 ^ _ _ _ ' ~.- w .. . i' .y ACEDityWLBbOR![gliT CpI~'lC?NidE,ALTH OP L~ENNSY~,VANIA ss. GOCJNTX OR CUMBERLAND I, AUI]RE'Y W. JOHNSON, Testatrix, whose name is signed to the attaGried ox fo~Cegoing instrument, having been duly qumlified according tv law, do hereby aeknowledgg that Y signed and executed the instrument as my LAST WILL; t1~at I signed it as p-y Erse and voluntary act for the pux'Qoses therein expressed. !.r/ A[TDREY W JOHN Sworn or affirmed to tend aeknowYedged before ms by AUP~t,~Y W. JONiaiSON, ~'sstatrix, this a~/~.Q! day of ~ 1993. ` Nat y b is gal ' ilr~tou No~r~rPt~lo .1ne A, t7 lDtpIDAPIT CQN~'iONWEALTH QF PBNNSYLVANZA ss. covN~rx o~ cvDMa~LAxD ,We, /\ • /~'.~c2r'~ ~jdlylc'~S and ~iQ N-4. /~ - ~~ ~ ~ , the witnesses whose names are signed to the attached qr foregoing instrument being dilly quaZifi.ed according tp ~.aw, do depose and say that we w$ra present and saw Testatrix Sign artd execute the it~st,rument as hex LAST WILD,; that AUDREY W, JOHNSON signed will~.ngly and thbt she executed ~t as her free and voluntary act for the purposes therein expressed; that each of us ~n the hearing end sight of the Testatrix signea the Will as witnesses; and that to the best of our kn~awledge, the Testatrix W4s $t the time 18 years of age ox more, of sound rind and under no constrmint ox undue ir,! luence _ F ~d ~-~ ~ ~ I sworn or affirmed to ~tnd acknaw,ledged before me this ~.321~ day Q$ , 1493. .... ii '~ Nck c !ar ~r ~lVu~ir Arc ~^ .~ VI 1 nominate, Constitute and appoi3lt my husbatid, b1s,VID, as executor of this LAST WT~,Z,, to serve without band. if ~1x huBb~nd ., is unable ar unwilling to aat in that capacity, then I nomi~r~ate, Constitute and appoint my daughter, KATIiX, as Eaceoutrix of this LAST WILL, t4 Serve w~.thoUt bond. IN {FITNESS WHEREOF', T, AUAR~Y W. ,TPHNSON, have sgt my ,hand to this T.,~A~T WILL this ~~' ~ day of , 19~~ - h ~V~ Au~r~z~Y w. xNSo signed, sealed, ptiblisbed and declared by the ax,ove~n~.med AUD'HEY W. aOHNSON, as and for hes Lt~Bt Will and Tssltsxderit, ~.n the presence Cf us, who, at hex request and in her presence, and in the presana¢ of e,aeh othex, have here~tnta sttbsaribed our ttame6 as witnesses. 2