Loading...
HomeMy WebLinkAbout06-30-111 E. 1,50561,01,05 Ri~~ i ~ V ~ EX (o2-ii) (FI) J ~•~j OFFICIAL USE ONLY PA Department of Revenue pennsylvania - Bureau of Individual Taxes ~EFANiHEHTOF3EYENUE COUnty COde Year File Number PO BOX ~8o6oi INHERITANCE TAX RETURN Harrisburg, PA 1y128-o601 RESIDENT DECEDENT Z / /~ ,~ ~`/ ~- ENTER DECEDENT INFORMATION BELOW - Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 186-28-4938 03/12/2011 03/20/1936 Decedent's Last Name Suffix Decedent's First Name MI Fulton Virginia L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C~ 1, Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate C7 4a. Future Interest Compromise (date of O 5. Federal Estate Tax FZeturn Required death after 12-12-82) CIdD 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE: DIRECTED T0: Name Daytime Telephone Numbr~r Ronald E. Johnson, Esq (717) 243-0123 First Line of Address 78 West Pomfret Street Second Line of Address City or Post Office State ZIP Code Carlisle PA 17013 Correspondent's a-mail address: rejohnSOn@pa.net REGISTER OF WILLS USE ONLY ~~ r° .~ ) C ~ _-..-~ {.- + .. -, wE~ ~, -:.1 I.r r.....- ,. >~ J _ r,~~ ~- -; t:~D {... ~ ~-a ~~~ %-- ' , f - DATE~FI _~ "' ~~ - . ~~ ~t-i ; !1 E"i-1 r ~ ,~ .-, ~ t...~ ,~ ~ti t: ~, _°: __ ~, -, ~ ~ ~ -: ti ~ ~ J ~.~..) ~ 1 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, corre and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has ;any knowledge. SIGNATU OF P SO _ IBLE F R FILING RETURN DATE AD RESS / c/o 78 West Pomfret Street arlisle, PA 17013 S RE F P ARER AN REPRESENTATIVE DATE s A D ES /0 78 West Po et Street, Carlisle, PA 17013 ' PLEASE USE ORIGINAL FORM ONLY Side 1 1,50561,01,05 1,50561,01,05 J 1,5D561,0205 REV-1500 EX (FI) Decedent's Social ;Sec;urity Number Decedents Name: Virginia L. Fulton 186-28-4938 RECAPITULATION 1. Real Estate (Schedule A) ............ . .......... . ................... .. 1. 120,000.00 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. 2,533.05 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. 122,533.05 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 30,710.49 10. Debts of Decedent,Mortgage ~Liabiiities arrd Liens:(Schedule I) .... . ... . .... .. 10. 36,482.91 11. Total Deductions (total Lines 9 and 10) ..... . ......................... .. 11. 67,193.40 12. Net Value of Estate (Line 8 minus Line 11) ............................ . . 12. 55,339.65 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .......... . ........... .. 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........ . .............. . 14. 55,339.65 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_ 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 55,339.65 16. 2,490.28 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. 2,490.28 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAY MENT O Side 2 ],50561,D205 150561,D205 REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number Total Credits (A + B) (2) 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2,105.26 - 0.00 0.00 385.02 Make check payable to: REGISTER OF QUILLS, AGENT. PLEASE ANSWER THE FOLLOWING (~U`ESTIONS BY PLACING AN "X" IN THE APPROPRC4TE` BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred .......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income ............................................ ^ c, retain a reversionary interest ........................................................................... d. receive the promise for life of either payments, benefits or care? .............................:.. ^ ...................................... 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ^ ...................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLE T E SCHEDULE G AND FILE IT AS 13ART 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 taor for the. lase. of th? 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 sun,~ivir~g 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 fer 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(x)(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(x)(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(x)(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. Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 2,490.28 2. CreditslPayments - A. Prior Payments _ 2, 000.00 B. Discount 105.26 LAST WILL AND TESTAMENT OF VIRGINIA L. FULTON I, VIRGINIA L. FULTON, of North Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hf:re;by make, publish,and declare this as and for my Last Will and Testament, .hereby revoking alI other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and fianeral expenses, inciudin~; my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease°. ~' SECOND: I give and bequeath certain of my miscellaneous household goods, jewelry, furniture and personal effects to the persons designated in accordance with rr~y last dated ' memorandum .executed by. me prior to my death. ~, . THIRD: I give and bequeath the sum of $10,000.00 to RONALD J~. BUSSER, ~,,,'_ b y. _ p if he is living at the tune of m death. I further direct my Executor -however to av this sum over to -'~ his son, MICHAEL BUSSER with the further direction that MICHAEL BUSSEF: will make ~ payments to or for°the benefit of his father from this bequest as MICHAEL BUS-SEF may deem ~ ~ ( appropriate in his sole discretion. FOURTH: I give and bequeath the sum of $1,000 to .each-of my grandchildren ~} who are living at the time of my death. FIFTH: I give and bequeath the sum of $500 to each of my great-grandchildren who may be living at the time of my death and I further direct that should any o:f my great- grandchildren be under the age of 21 years at the time of my death said sum shall be paid to their 1 1 ~I Jf"a(•rSt~i--tin ~r+-a ~~ F-1 -~ ~ ~ ~- '--_ 1~ - ~ -'1 L, 1 .' t ~itLlC:lll whV i,_; ~1_Y b~u~luviiLi~.: ullu 11~1U i1i Qll lA1L~1l.Jl i~~alll~ ai,~VLl11~ Liillll ..,ll(:il i.11T1C d.J .~d.lli bl ~L grandchild attains the age of 21 years at which time said sum shall be paid over directly 'to the great- grandchild. SIXTH: I give, devise and bequeath the residue of my estate, of e.vE;ry nature and wherever situate, to my children, equally, namely, DEBORAH LEREW, VICKI F~ULTON, EDWARD FULTON, provided that the share of any child who predeceases me shall be: distributed to his or her issue, per stirpes, living at the my death, and in default of such then living issue, such share shall be added to the share or shares for my other children. SEVENTH: I direct that all taxes that may be assessed in consequence of'my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. EIGHTH: I nominate, constitute and appoint my daughter, VICKI: F'ULTON, Executrix of this my Last Will and Testament. Should my daughter, VICKI FULTON, i:ail to qualify or cease to act as Executrix, I appoint my daughter, DEBORAH LEREW, Exec;ul:rix of this my Last Will and Testament. FIFTH: I direct my Executrix and her successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Lase: Willd Testament, consisting off two (2) typewritten pages, each identified.l~y my signature, this ` ~'~ °~ day of ._~.~,~#~~~%r~ ~~~ , 2002. -''~ i f ) r' „ J J 4~~ ~ f i ~•~~..~.~~-~ -~~,.!~r°~..~,~~~ ~ (SEAL) Virgix~a L. Fulton Signed, sealed, published and declared by the above-named Testatrix, VIRGINIA L. FULTON, as and for her Last Will and Testament in the presence of us who at her red u~st in her ' ~ ~ l.r- ,-.~. sight and presence, and in the sight and presence of each other, have here~rito.subscrib'e'd our names as w1itnesses. ~° ~ ~.' o lI ~ , ~,r-~J ~ i e~ '~l ~ ~'/ ~ "~ /~~ ,'~„y~~,~' ~ f i~ i ~ +~~_`'' Jar ~i -,~ r ~ ~ / j i i f ~~ _ / f f i COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) I, VIRGINIA L. FULTON, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that .[ 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. Sworn. or affirmed to and acknowledged before me by VIRGINIA L. FUIJTON, the ,- ~. ~, Testatrix, this ~~ day of a~f;~~~~;-,~~~ , 20Q2. ~~ ; NOTAr3lAL SEAL ~ SHELLY SEkTOiV, ~~OT(i6'( PU6LIC CAPLISLc 60k0; C1. ~iwE~~.A~~rJ OOUf'-1TY f~lY COP~~i',^I`~SiOi~! IWi:!';~`~`~ ~',-~~ i! ::I, 5Q0;~ i~~a L. Fu~t~,n, Te~s~a`~r`i i~T~ ~/ r' t` !.~ f: ,i ~- '~.._..- __(S EAL) ublic A L~L'TTl A ~ 7TT COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND ) .~-_.. , We, RONALD E. JOHNSON and ~ % ~~~, ~; ~.~ ,,. ,<~i-~~~~''~w..~ ; , th.e witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instn ~rrient as her Last Will and Testament; that Virginia L. Fulton signed willingly and that she executed it as her free and voluntary act for the purpose therein expressed; that each of us in the hearing anal sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. jvv-l?Tlt ~~I~ aliiriilCu tip a?"!ll Stibsc_ilbed tG be~:~i'~ rre b,' I?.~?NAT ,Tl F' , J(l~.Sn1~T and ~,,- ~~~%- ~ ~`;-,:-,,~. ~~=~~: ~ ~ witnesses, this ~~~ day of ,- ~ ' / 2002. EAL) SHELLY 5~~-;iIV, Pd(J;~raSY GU6LIC CARLISLE EJr~~?, C.;i'~~Z,L;L;;ND COU~!IY I~~IY CUi~•rl~~ii'~+i..i~i ~~j~,j-j r,P:ill '~S 7iJ03 EAL) REV-1502 EX~ (01-10) r Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: FILE NUMBER: Virginia L. Fulton 21-11-0388 ail 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 exchang.ed.between,a,willing.bu,yer,and a ~til!ingseUer..neither.being compelled to,buy orsell,,~,bnth,haui~Ig 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 DATE NUMBER OF DEATH DESCRIPTION ~• ALL THOSE TWO CERTAIN TRACTS of land situate in North Middleton Township, Cumberland County, Pennsylvania, improved with a dwelling known and numbered as 184 Darr Avenue, Carlisle, PA 17013. Being the same premises which George H, and Grace Schlusser by deed dated 2/20/1959 and recorded in Deed Book Y, Volume 18, Page 115 granted and conveyed until Edward E Fulton and Virginia L. Fulton. Edward E. Fulton died 6/19/1971, thus vesting full fee simple title in Virginia L. Fulton. Property sold (see settlement statement attached) I 120,000.00 TOTAL (Also enter on Line 1, Recapitulation.) I $ 120,000.00 If more space is needed, use additional sheets of paper of the same size. ~ a~~AE~~O~ ~ a c OMB Approval No. 2502-0265 : 7 eR ~~f~~II y. L G~~QN oeJE~.~2~ B. Type of Loan 1 ~ FHA 2 ~ RHS 3 C 6. File Number: 7. Loan Number: i,8. iVlortgage Insurance Case Number: . . ~ onv. Unins. LEPLEY.D 77788174 I 4 ^ VA 5. ~X Conv. Ins. C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid fo and by the settlement agent 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 and Address of Borrower: E. Name and Address of Seller: F. Name and Address of Lender: David A...Lepley and METRO EIANK Elizabeth R. Lepley VICKI L. FULTON, Executrix 3801 PA~;TON STREET 4 Emerald Circle of the Estate of Virginia L. Fulton HARRISBURG PA 17111 Carlisle, PA 17015 184 Darr Avenue , Carlisle, PA 17013 G. Property Location: H. Settlement Agent: 23-2402316 I Settlement Date: 184 Darr Avenue PURITY ABSTRACT COMPANY . Carlisle, PA 17013 3329 MARKET STREET No. Middleton Twp, Cumberland County CAMP HILL PA 17011 Ph. (710737-8359 June 3, 2011 Place of Settlement: - CENTURY 21 A BETTER WAY 398 E. HIGH ST, CARLISLE, PA J S ' . ummary of Borrower s transaction K. Summary of Seller's transaction 100. Gross Amount Due from Borrower: 400. Gross Amount Due to Seller: 101. Contract sales rice ~ 120,000.00 _ 401. Contract sales rice 120 102. Personal rope _ 402. Personal roe ,000.00 103. Settlement Char es to Borrower Line 1400 6,654.50 403. 104. 404. 105. 405. Ad'ustments for items aid b Seller in advance Ad'ustments for items aid b Sell i d 106. COUNTYROWNSHIP 06/03/11 to 01/01!12 176.90 er n a vance 406. COUNTY/TOWNSHIP 06/03/11 t 01/01/12 107. CITY TAX to o 407. CITY TAX t 176.90 108. ,SCHOOL TAX 06/03/'11.: to .0?101/11 ~ 103.87 o 408. SCHOOL TAX 06/03111 t 07/01/11 109. o 409 103.87 1 10. . 410. - 111. 411. ~ 112. 412. ' 120. Gross Amount Due from Borrower 126,935.27 420. Gross Amount Due to Seller 120 2 200. Amounts Paid b or in Behalf of Borrower _ 500 Reductions in Amo t D S ll , 80.77 201. Deposit or earnest mone 1,000.00 . un ue e er: 501. Excess deposit see instructions) '202, Principal amount of new loans 105,000.00 502. Settlement char es to Seller Lin 1400 203. Existin loans taken sub~ect to e ) 503 Existin loans taken sub'ect to 16 700.00 204. . __ 504 Payoff First Mort a e 205. . g g 505 Payoff Second Mort a e 206. . _ 506 207. . 507 (Deposit disb as roceeds 208. . . p 508 -- 209. SELLER ASSIST ~ 500.00 . 509. SELLER ASSIST ~- Ad~ustments for items un aid b Seller _ Ad'ustments for items id b S l 500.00 210. COUNTY/TOWNSHIP to un a e ler 510 COUNTY/TOWNSHIP t 211. CITY TAX to . o 511. CITY TAX ~ to 212. SCHOOL TAX to 213. _ __ 512. SCHOOL TAX to 513 214. . 514 215. . 515 216. . 516 217. . 517 2011 CO/TVVP TAX to ROBIN K: SO 218. . . LLENBERGER, Ta 518 FINAL WATER/SEWER t NOF;TH 304.57 219. . o MIDDLETON TOWN - 519. 69.87 220. Total Paid by/for Borrower 106,500.00 _ 520. Total Reduction Amount Due S ll 300. Cash at Settlement from/to Borrower e er 600 Cash at settleme t t lf S 17,574.44 301. Gross amount due from Borrower line 120 ~ 126,935.27 . n o rom eller 601. Gross amount due to Seller li 420 302. Less amount paid by/for Borrower (line 220) ~( 106,500.00) nt; 120,280.77 602. Less reductions due Seller (line 520) ( 303. Cash X^ From ~ To Borrower 20,435.27 17,574.44) 603 Cash ~ To ~ F :S . rom eller 102,706.33 The undersigned hereby a~~nDwledge receipt of a completed copy of this statement & any attachments referred to herein Borrower ry~~~.: av-r Seller ;-~ =:i .; Davt e e ~ ~ ,~'~, , ~/ ~~~ "/ ~ ~~ ~-~~~"'- VICKI L FUL-TON. Executrix Elizabeth R". Le fey '/ ~ ` Tne Public Reporting Burden for this coXeation o/ irrformation is eslima:ed:a! 35minutes~parre,gonse~fot•tG~c;ict~; ieview:ng,.~f rePo.Mngtrac~;ra°~~,is sgencymayriblc:oNeCtttas irdoimation, andyouae not required to complete this form, unless it displays a currently valid OMB control number. No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with infonnalion during the seltlemenl process. Page 1 of 3 HUD-1 (LEPLEY. D.PFD/LEPLEY. D/14) L. Settlement Charges 700. Total Real Estate Broker Fees $ 7,200.00 Paid From Paid =ram Oi.visinn of co.~mission.t'line 700)~as follows: Bomcraers sellers .701. $ 3,895.00 to REMAX REALTY ASSOCIATES ~ Funds at Funds at Note: Line 701 Includes Adjustment of 295.00 For setaement settlement ___ i 702. $ 3,600.00 to CENTURY 21 A BETTER WAY ___ 703. Commission paid at settlement _ 7 495.00 704. BROKERAGE FEE to CENTURY 21 A BETTER WAY 175.00 705. 800. Items Payable in Connection with Loan 801. Our on ination char e $ 895.00 from GFE #1 ~ _ 802. Your creditor charge (points) for the specific interest rate chosen $ (from GFE #2) 803. Your adjusted origination charges from GFE #A ~ 895.00 _ 804. Appraisal fee to DIVERSIFIED APPRAISAL SERVICES from GFE #3 $360 POC/B 605: Credit Report ''to' EOUIFAX 1viORTGAGE SOLUTIONS from GFE #3 21.66 - _ 806. Tax service to (from GFE #3) _ 807. Flood certification to WOLTERS KLUWER FINANCIAL SERVICE (from GFE #3) 6.00 _. _ 808. (from GFE #3) ~ _ 809. (from GFE #3) 810. (from GFE #3) 811. (from GFE #3) _ 900. Items Required by Lender to Be Paid in Advance 901. Daily interest charges from 06/03!11 to 07/01 /11 28 @ $13.854200/day (from GFE #10) 387.92 __ 902. Mort a e insurance remium for months to from GFE #3 __ X03. Homeo~nmcrs insurance-?os "Y.u^ ears to ' ~Rl3GRE5SIVE i=iO1v1E'ADVANTAGE from GFE'#11) 528.00 904. from GFE #11 905. (from GFE #11) 1000. Reserves Deposited with Lender 1001. Initial deposit for your escrow account (from GFE #9) 1,536.17 1002. omeowner's rnsurance 3.000 months @ $ 44.00 per month $ 132.00 _ ;. - 1003. Mort a e insurance 0.000 months $ 42.88 er month $ 1004. Property taxes $ COUNTY TAX months @ $ per month _ CITY TAX months @ $ per month SCHOOL TAX months @ $ per month 1005. $ ~ - - _ City/Town Taxes months @ $ per month - Assessments months @ $ .per month 1006. COUNTYffWP TAX S.OOD months @ $ 25.38 per month $ 126.90 1007. SCHOOL TAX 13.000 months @ $ 112.83 per month $ 1,466.79 1008. $ 1009. AGGREGATE ADJUSTMENT $ -189.52 1100. Title Charges 1101. Title services and lender's title insurance (from GFE #4) P;11-091 1,200.75 1102. Settlement or closin fee $ ~ 1n4 r~WrlPr'c titles incur~nrc to GIR CT t1 ~ACD1(`MI TITI ~ inic ~n ,. ..~_ .. _. - - _._ _-~-~ ~ i ..,.,. - .._. _ ...._ ....._......,., .., .., ,.. , , .,.,~~ .~..r,~. ~ ~ ~ ~~ ~~..,. ~~. ~ 1104. Lender's title insurance to FIRST AMERICAN TITLE INS. CO. $ 1,033.75 _. -.. OU I - 1105. Lender's title olic limit $ 105,000.00 5011342-0026314e - - 1106. Owner's title olic limit $ 120,000.00 5011442-0018666e . 1107. A ent's ortion of the total title insurance premium to PURITY ABSTRACT COMPANY $ 942.44 _ 1108. Underwriter's portion of the total title insurance premium to FIRST AMERICAN TITLE INS. CO. $ 166.31 .--.~ . ~~ iv iv~~aiy ~.~c~n __ 10.00 11 10. Tax Cert fee to PURITY ABSTRACT COMPANY _ 5.00 1111. Deed Prep to ATTORNEY RON JOHNSON _ 150.00 1112. Attorney's Fee to ATTORNEY RON JOHNSON _ 640.00 1113. INHERITANCE TAX to PURITY ABSTRACT CO ESCRO'JV (E) 7,200.00 1200. Government Recording and Transfer Charges 1201. Government recording charges to RECORDER OF DEEDS (from GFE #7) _ 144.00 =:::: 1202. Deed $ 62.00 Mortgage $ 82.00 Releases $ Other $ 1203. Transfer taxes to RECORDER OF DEEDS (from GFE #8) _ 1,200.00 1204. City/Countytaxlstamps $ 1,200.00 $ _ 1,200.00 1205. State tax/stamps $ 1 200 00 $ - 1206. -- 1207. - 1300. Additional Settlement Charges 1301. Required services that you can shop for (from GFE #6) _ _ 1302. HOME & RADON INSPS to CHAMBERLIN INSPECTIONS 400.00 1303. 1304. PEST INSP to GILBERT'S 85.00 1305. -- 1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) _ 6,654.50 16,700.00 ~ % -_-_ By signing page 1 of this statement, the signatories acknowledge receipt of a completed copy of page 2 8 3 of this three pagB statement. i PURITY AB$.T;RACT COMPANY, Settlement Agent Certified to be a true copy. ~"~ Page 2 of 3 HUD-1 (LE PLEY. D. PFDILEPLEY. 0/14) Comparison of Good Faith Estimate (GFE) and HUD-1 Charges Good Faith Estimate HUD-1 Charges That Cannot Increase HUD-1 Line Number Our origination charge #801 89h.00 895.00 Your credit or charge (points) for the specific interest rate chosen # 802 _ Your adjusted origination charges # 803 895.00 895.00 Transfer taxes #1203 ___ 1,200.00 1,200.00 Charges That in Total Cannot Increase More than 10% Good Faith Estimate HUD-1 Government recording charges #1201 225.00 144.00 Appraisal fee # 804 __ 360.00 360.00 Credit report # 805 ___ 21.66 21.66 Flood certification # 807 ___ 6.00 6.00 Title services and lender's title insurance #1101 _ 1,363.75 1,200.75 Owner's title insurance to FIRST AMERICAN TITLE INS. CO. #1103 _ 30.00 75.00 Total ~ 2,006.41 I 1,807.41 Increase between GFE and HUD-1 Charges $ -199.00 or -9.92°/ Charges That Can Change Good Faith Estimate HUD-1 Initial deposit for your escrow account #1001 2,610.00 1,536.17 Daily interest charges # 901 $ 13.854200Iday 346.36 387.92 Homeowners insurance # 903 360.00 528.00 Loan Terms Your initial loan amount is $ 105,000.00 Your loan term is 30 years Your initial interest rate is 4.7500 °,~° Your initial monthly amount owed for principal, interest and $ 590.61 includes any mortgage insurance is ;( Principal ® Interest QX Mortgage Insurance Can your interest rate rise? QX No ~ Yes, it can rise to a maximum of %. The first change will be on and can change again every _ months after . Every change date, your interest rate can increase or decrease by %. Over the life of the loan, your interest rate is guaranteed to never be lower than % or higher than %. Even if you make payments on time, can your loan balance rise? O No ~ Yes, it can rise to a maximum of $ Even if you make payments on time, can your monthly 0 No ~ Yes, the first increase can be on _ and the monthly amount owed for principal, interest, and mortgage insurance rise? amount owed can rise to $ The maximum it can ever rise to is $ ~ Does your loan have a prepaymentpenalty?; ~X No ~ Yes,. your maximum prepayment penalty is $ Does your loan have a balloon payment? ^X No ~ Yes, you have a balloon payment of $ due in _ years on 'I Total monthly amount owed including escrow account payments ~ You do not have a monthly escrow payment for items, such as property taxes and homeowner's insurance. You must pay these items directly yourself. X You have an additional monthly escro~ro payment of $182.21 that results in a total initial monthly amount owed of $7?2.82. This includes i principal, interest, any mortgage insurance and any items checked below: XO Property taxes ~~ Homeowner's insurance ~ ~ ~ Flood insurance ~~ I Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. Page 3 of 3 HUD-1 (LEPLEY.D.PFD/LEPLEY.D/14) REV-i5o8 EX+ (il-io) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERS®NAl. PR®PERTY ESTATE OF: FILE NUMBER: Virginia L. Fulton 21-11-0388 Include the proceeds of litigation and the date the proceeds were received by the estate. AIl.,propeety.joindy owned with right of surviVOrship must be disclosed on Schedule F. If more space is needed, use additional sheets of paper of the same size. - ' - r April 7, 2011 Andrew-s & Johnson Attorneys At :Law 78 West Pomfret Street Carlisle PA i 7013 Estate of VIRGINIA L FULTON Date of Death: Mar 12, 2011 SSN: 186-28-4938 Dear Sir/Madam: One Citizens Drive :ESOP 112 Riverside, F:I 02915 h~ accordance with your request, the attached information sheet has been provided in the above decedent's name as of hisiher date of death. For Ilzstallment Loans or Line of. Credit accounts, contact our Loan Department at 1-800-708-~568C1. For all other inquiries, please call 1-877-579-2667 Sincerely, ~-~-~ ~~~ ,.~ ~-~ lL Kristen L. Petl-ucci Decedent Account Processing IZEF~t: 4 8 91 ~ 9 ,- ,~ _, ~. i .~.Y Account Number 6224343210 Account Title ___ VIRGINIA L FULTON Date Opened ___ 6/29/2009 Account Type_ ___ Checking Principal Balance as of DOD __ $ .55 Interest from Last Posting to DOD __ $ .00 Account Balance as of DOD __ $ .55 YTD Interest to DOD ____ $ .00 Account Number 6100731146 Account Title ___ VIRGINIA L FULTON Date Opened __ 6/6/1966 Account Type __ Cl~eclcilzg Principal Balance as of DOD _ ___ __ $469.65 Interest from Last Posting to DOD _ $ .00 Account Balance as of DOD __ $469.65 YTD Interest to DOD _ $ .00 RF`J-11.1 ~X~ i~~`U{'i i pennsylvania UEPARTMEN'T OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Virginia L. Fulton 21-11-0388 Decedent's debts must be reported on Schedule I. ITEM -- NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1' Hoffman-Roth Funeral Home 9, 872.90 2. Carlisle Memorials -engraving 359.00 8. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative{s) Vicki L. Fulton Street Address 139 Porter Avenue city Carlisle Year{s) Commission Paid; 2011 State PA ZIP 17013 Z• Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant 4, 5. 6. ~. s. 9. 10. 11. 12. Street Address City State Relationship of Claimant to Decedent ZIP Probate Fees: Accountant Fees: TaX Return Preparer Fees: North Middleton Authority -water/sewer PP&L -electric Four Seasons Lawn Care -maintenance PP&L -electric Register of Wills -short certificates David A. and Elizabeth R. Lepley -sellers assistance for purchase of real estate TOTAL (Also enter on Line 9, Recapitulation) I $ If more spate is needed, use' additional sheets of paper of the same size. 6,126.65 4,000.00 311.50 30.00 82.30 32.85 105.00 20.25 20.00 500.00 Continuation of Schedule H 13. 2011 County/township real estate taxes $304.57 14. North Middleton Twp Authority -final water/sewer $ 69.87 15. ReMax Realty Associates -partial real estate commission $3,895.OG 16. Century 21- A Better Way -partial real estate commission $3,600.00 17. Cash -notary fee $10.00 18. Purity Abstract -reimbursement for tax certification $5.60 19. Ronald E. Johnson, Esquire -preparation of deed $150.00- 20. Recorder of Deeds - 1% real estate transfer tax $1,200.00 21. Register ofWills -filing fee $15.00 Total $30;710.49 RE',1-112 EX~- ;,;r.-OSj pennsylvan~~ SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN N9®RTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Virginia L. Fulton 21-11-0388 Report debts incurred by the decedent prior to death that remained unpaid at the date ofi death, including unreimbursed medical expenses, If more space is needed, insert additional sheets of the same size. ." COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 April 14, 2011 ANDREWS & JOHNSON RONALD E JOHNSON ESQUIRE 78 WEST POMFRET STREET CARLISLE PA 17013-3216 Re: Virginia Fulton CIS #: 240240642 SSN: ###-##-4938 Date of Death: 03/12/2011 Dear Attorney Johnson: Please be advised that the Department of Public Welfare maintains a claim in the amount of $34,697.02 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $29,367.71, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 2.0 Pa. C,S.A. 3392(3). The balance of the. claim, namely $.5.,.,3.29..31, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether thE; Commonwealth's claim is admitted and when payment may be expected. .f the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax asses:>ment, and a current appraisal, if available. Sincerely, t Karen P. Georgoulis Claims Investigation Agent 717-214-1283 717-772-6553 FAX Enclosure '. r~=- ~~X ;~_k~.~~v~~iiL 1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS TPL SECTION -CASUALTY UNIT PO BOX 8486 HARRISBURG PA 17105-8486 April 8, 2011 STATEMENT OF CLAIM SUMMARY NAME Estate of FULTON, VIRGINIA ID 240 240 642 MEDICAL CLASS 3 CLASS 5.1 TOTAL INPATIENT .00 .00 .00 OUTPATIENT .00 .00 .00 LONG TERM CARE 29,357.01 5,329.31 34,686.32 DRUG 10.70 .00 10.70 REIMBURSEMENT TO DPW 29,367.71 5,329.31 34,697.02 COMMONWEALTH OF PENNSYtVANkA DEPARTMENT OF PUBLIC WELFARE EIN - 23-6003113 ~ REV-1513 EX~ (O1-lU) per~nsylvania DEPARI'~~1ENT DF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: Virginia L. Fulton 21-11-0388 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY.. Dp Nat. List Tr.ustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec, 9116 (a) (1.2).) 1• Vicki L. Fulton, 139 Porter Ave, Carlisle, PA 17013 daughter 1/3 of residue 2 Deborah Lerew, 311 Fairview St, Carlisle, PA 17015 daughter 1/3 of residue 3 Edward Fulton, 420`Bridgeport Rd, Landisburg, PA 17040 son 1/3 of residue 4 Jennifer Junkins, 906 W North St, Carlisle, PA 17013 granddaughter 1,000.00 5 Kenneth Starner, 957 Willow Ridge Rd, York, PA 17404 grandson 1,000.00 6 Edward Fulton, III, 420 Bridgeport Rd, Landisburg, PA 17040 grandson 1,000.00 7 Emily Fulton, 420 Bridgeport Road, Landisburg, PA 17040 granddaughter 1,000.00 8 Rodrick Keck, c/o Deborah Lerew, 311 Fairview St, Carlisle, PA 17015 grandson 1,000.00 9 Jared Keck, 230 A York Road, Carlisle, PA 17013 grandson 1,000.00 10 Kerri Keck, c/o Deborah Lerew, 311 Fairview St, Carlisle, PA 17015 great granddaughter 500.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APFROI'RIATE, 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. I $ If more space is needed, use additional sheets of paper of the same size. ~ REV-1513 EX~ (01-10) ® p~nnsylvanla DEPARTMEN'i OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES ESTATE OF: FILE NUMBER: Virginia L. Fulton 21-11-0388 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF P1=R.SON(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 11 Kassidi Junkins, c/o Jennifer Junkins, 906 W North St, Carlisle, PA 17013 great granddaughter 500.00 12 Karson Junkins, clo Jennifer Juhkins, 906 W North St, Carlisle, PA 17013 great grandson 500.00 13 Sierra Starner, 957 Willow Ridge Road, York, PA 17404 great granddaughter 500.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113. FOR WHLCH 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. I $ If more space is needed, use additional sheets of paper of the same size.