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Home My WebLink About07-05-11 I 1505610140 REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 0 0 4 9 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 7 6 1 2 4 4 7 1 0 5 0 2 2 0 1 0 1 1 3 0 1 `~ 2 1 Decedent's Last Name Suffix Decedent's First Name MI S A B E L L A D 0 ~1 I N I C K C (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 a 1. Original Return ~ 2. Supplemental Return ~ :.. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) ^X 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 Ec. 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 TO: Name Daytime Telephone Number B E N J A ~1 I N J B U T L E R 7 1 7 2~ 6 1 4 :~ 5 ...~. REGISTER OI USE ON ~~ First line of address ~ Crime u-t r"~,~ o ~'r=~ 5 0 0 N T H I R D S T R E E T `~-~ ~~ `~'' ` ~~= ~ =~ Second line of address .~,~ ~ ~ _ '• P O B O X 1 0 0 4 -°- ,. ~~ City or Post Office State ZIP Code DATE FILED H A R R I S B U R G P A 171 0 8 Correspondent's a-mail address: LAWYERS(a~BUTLERLAWFIRM.COM Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statement:;, and to the best of my knowledge and belief, it is tru o ct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. PERSO SIBLE FOR FILING RETURN DATE ~-,~ ~ - ~/ ADDR 1047 CU D IVE HARRISBURG PA 17110 SIGNATURE PR E E AN REPRESENTATIVE DATE _~_~~ ADDRESS 500 N THIRD STREET, PO BOX 1004 HARRISBURG PA 17101 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 ~ A DI I rF- ~iM" J 1,50561024D REV-1500 EX Decedent's Social Security Number Decedents Name: D OMINICK C• SABELLA 0 7 6 1, 2 4 4 7 1 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 1 2 0 0 0 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. 2 9 0 4 2 . 6 6 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. L 4 9 0 4 2 . 6 6 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9• 2 8 1 L 6 . L 4 10. Debts of Decedent, Mort a e Liabilities, and Liens Schedule I 9 9 ( ) ............. 10. 6 8 2 . 0 2 11. Total Deductions (total Lines 9 and 10) ............................... 11. 2 8 7 9 8 . 1 6 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 1 2 0 2 4 4 . 5 D 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 2 0 2 4 4 . 5 D 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 2 0 2 4 4 5 0 16. 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 18. 19. TAX DUE .................. .......................... ... ....... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 155610240 0. 0 0 5 4 L 1. 0 0 0. 0 0 0. 0 0 5 4 1 1,• 0 0 0 Lsos61o24a REV-1500 ~X Page 3 Decedent's Complete Address: File Number 21 10 0496 DECEDENT'S NAME DOMINICK C. SABELLA STREET ADDRESS 5219 Sriiart Drive CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: ~. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 6,348.81 B. Discount 263.15 (1) 5,411.00 Total Credits (A + B) (2) 6,611.96 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) (4) 1,200.96 (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ X^ b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ 0 d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death%' ......... ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ^ 0 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-1502,EX+ (01-10) ' pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: DOMINICK C. SABELLA 21 10 0496 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. (Property at 5219 Stuart Drive, MechanicsbL>rg, Lower Allen Township, Cumberland County, PA - I 120,000.00 value based on sale dated June 14, 2011 -See attached HUD-1 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. REV-150$ EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN REST DAENTEDECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER DOMINICK C. SABELLA 21 l.0 0496 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. Sovereign Bank -Checking Account No. 0371082617 23,620.91 *net of checks written before death but clearing after death* 2. OPM -Final Payment 3,004.75 3. Veteran Copay -Refund 24.00 4. VA Insurance -Dividend 189.00 5. 2002 Chevrolet Cavalier 2,000.00 value based on sale dated June 14, 2011 6. 2010 1040 - Refiind 204.00 TOTAL (Also enter on line 5, Recapitulation} I $ 29,042.66 (If more space is needed, insert additional sheets of the same size) REV-1511.EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER DOMINICK C. SABELLA 21 10 0496 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Malpezzi Funeral Home 369.71 2. Funeral Reception 385.70 B. 1 2 3 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Linda E. Zisman Street Address 1047 Custan Drive City Harrisburg State PA Year(s) Commission Paid: 2011 Attorney Fees: Butler Law Firm Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant 8,235.34 ZIP 17110 8,916.91 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 1S. 16. 17. 18. Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: 2009 1040X; 2010 1040 and PA-40 Cumberland Law Journal -Estate Advertising The Sentinel -Estate Advertising Sovereign Bank -Bank Charge Notary Fee Postage Butler Law Firm -Litigation Fees Butler Law Firm -Supplemental Fees Butler Law Firm -Litigation Expenses Cumberland County Register of Wills -Filing Fees Sovereign Bank -Check Fee Mark Heckman Real Estate Appraisers -Appraisal of 5219 Stuart Drive PNC Bank -Bank Charge 338.50 400.00 75.00 219.40 20.00 5.00 34.17 6,S07.S0 329.80 200.SS 30.00 41.23 360.00 25.00 TOTAL (Also enter on Line 9, Recapitulation} I $ 28,116.14 If more space is needed, use additional sheets of paper of the same size. • Continuation of REV-1500 Inheritance Tax Return Resident Decedent DOMINICK C. SABELLA 21 10 0496 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses & Administrative Costs - B7. ITEM NUMBER DESCRIPTION AMOUNT 19. Executrix Reimbursements 121.83 20. Sale of 5219 Stuart Drive -Closing Costs -See Attached HUD-1 (property reported at sale value) 1,500.50 SUBTOTAL SCHEDULE H-67 ~ 1,622.33 REV-151 EX+ (12-08) ' pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER DOMINICK C. SABELLA 21 10 0496 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, Verizon 56.02 2. Pennsylvania American Water 29.82 3. Leffler Energy 119.00 4. PPL Electric Utilities 79.18 5. Visiting Angels 228.00 6. 2009 1040X -Tax Due 120.00 7. Sovereign Bank -Line of Credit Account No. 4539111396 50.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 682.02 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 RE5IDENT DECEDENT ESTATE OF: FILE NUMBER: DOMINICK C. SABELLA 21 10 0496 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE j TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).) 1. Estate of Michael Sabella Lineal 120,244.50 5219 Stuart Drive Mechanicsburg, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. jj. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size. REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 5,000.00 Discount: 263.15 Interest Table Year Days Delinquent this time period Balance Due this year Interest this period Before 1981 1982 1983 1984 1985 1986 1987 1988 throw h 1991 1992 1993 throw h 1994 1995 throw h 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 2010- 00496 PA No . 21- 10- 0496 Estate Of : DOMIN/CK C SABELLA (First, Midd/e, Lasil Late Of : LOWER. ALLEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Securi ty No : 076-12-44:71 WHEREAS, on the 13th day of May 2010 instruments dated: March 12th 2003 April 18th 2005 were admitted to probate as the 1 as t wi 11 and codi ci 1 of DOMINICK C SABELLA (first, Midd/e, Last) late of LOWER ALLEN TOWNSHIP, CUMBERLAND County, who died on the 2nd day of May 2010 and, WHEREAS, a true copy of the wi 11 &codi ci 1 as probated i s annexed hereto THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsy.I vani a, hereby certify that I have this day granted Letters TESTAMENTARY to: LINDA E ZISMAN who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to 1 aw, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, GARLiSLt, PEIVI~r'S YL Aid%A. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the ~3th day of May 200. * *NOTE * * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST ) LAST WILL AND TESTAtVlENT OF DOIYIInTICK C. SABELLA I, DONIINICK C. SABELLA of Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament hereby revoking all prior Wills and Codicils. ITEM I. I direct that the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. ITEM II. All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of.my death shall not be paid from my residuary estate, but rather shall, be ~1located to the recipient of bequests under the terms of this Will such that each beneficiary will be responsible for payment of allinhentance, estate and succession taxes due on assets distributed to that beneficiary. ITEM III. I give, devise and bequeath in acGOrdance with any memorandum which I have either handwritten Qr signed, located with my Will or with~my valuable papers and found within 30 days of the probate of my Will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. To the extent no such memorandum is found, or all of my tangible personal property is not disposed of pursuant thereto, I direct that my tangible personal property be sold and the proceeds added to my residuary estate and pass under Article N hereof. ITEM N. All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath according to the following: 1 A. My refit properly located at 5219 Stuart Drive, Mechanicsburg, Pennsylvania, subject to all outstanding taxes, mortgages, utilities and debts, and any vehicle owned by me at the time of my deathto my son, MICHAEL SABELLA. MICHAEL SABELLA shall be responsible for timely payment of all inheritance taxes due on these items. This tax must be paid before distribution to him of these assets. Failure to pay the inheritance tax within nine months ~of the date of my death will result in a lapse of this bequest. M~ real property and vehicle will then be sold by my Executor and the proceeds equally divided and distributed one-half to NIICHAEL SABELLA, outright and one-half to be held in a Special Supplemental Care Trust for my daughter, MADELINE BARBARA SABELLA, to be held, managed and administered according to Item V. Further, in the event NIICHAEL SABELLA is incarcerated at the time of my death or within nine (9) mon aver a date of my death, or if he is convicted of a crime for which incarceration is a possible sentence at my death or within nine (9) months therea~er, this bequest shall lapse. I then direct that my real r property and vehicle be sold and the proceeds equally divided and distributed one-half to MICHAEL SABELLA, outright, and one half to be held in a Special Supplemental Care Trust for my daughter, MADELINE BARBA1tA SABELLA, to be held, managed and administered according to Item V. In the event that MICHAEL SABELLA predeceases me or fails to survive me by thirty (30) days, I give, devise and bequeath his share to be held in a Special Supplemental Care Trust for my daughter, MADELINE BARBARA SABELLA, to be held, managed and administered according to Item V. 2 In the event that MADELINE BARBARA SABELLA predeceases me or fails to survive me by thirty (30) days, then her share shall be distributed to PINNACLE HOSPITAL HOSPICE OF CENTRAL PENNSYLVANIA., Harrisburg, Pennsylvania. B. The balance of my residuary estate shall be held in a Special Supplemental Care Trust, for my daughter MADELINE BARBARA- SABELLA, to be held, managed, and administered according to TI'EM V. In the event MADELINE BARBARA SABF .T.A predeceases me or fails to survive me by thirty (30) days, then her share shall be distributed to PINNACLE ~OSP~TAL HOSPICE OF CEri'TRAL PENNSYLVANIA, Harrisburg, I~ennsylvania. ITEM V. S»ec__ ia1 Supplemental Care Trust for MADELINE BARBARA SABELLA, a disabled adult. I hereby nominate and appoint my niece, LINDA E. ZISMAN as Trustee of the Special Supplemental Care Trust under this my Last Will and Testament. If LINDA E. ~ISMAN is unable or unwilling to serve, I appoint THE FAMILY TRUST, or its successors, of 711 Bingham Street, Pittsburgh, Pennsylvania,15203, as successor Trustee. The share ofmy estate that is set aside for MADELINE BARBARA SA$ELLA shall be held by my Tnistee, LINDAE. ZISMA,N other successor(s), in trust for MADELIl~E BARBARA- SABELLA's benefit in a Special Supplemental Care Trust in accordance with the following provis~pns: A. IlVTENT It is my intention by this trust to create a purely discretionary supplemental care fund for the benefit of MADELINE BARBARA SABELLA and not to displace financial assistance that may otherwise be available to her. Illustrative of the kinds of supplemental, non-support disbursements that would be appropriate for my Trustee to make from this trust for MADELINE BARBARA 3 SABELLA include: sophisticated medical or dental or diagnostic work or treatment for which there are not funds otherwise available, including plastic surgery or other non necessary medical procedures; private rehabilitative training; dental care; recreation.and transportation; differentials iti cost between housing and shelter for shared and private rooms in institutional settings; supplemental nursing care and similar care that assistance programs may not otherwise provide; telephone and television service, companions for travel, reading, driving and cultural experiences and payments to bring her siblings or others for visitation in the event my Trustee deems that appropriate and reasonable. B. It is important that MADELINE BARBARA SABELLA maintain a high level of human dignity andthat her care be humane. If this trust were to be eroded by creditors, subjected to liens or encumbrances, or cailse assistance benefits to be unavailable or terminated, it is likely that the trust corpus would be deleted prior to her death, especially if the cost of care for her would be high. ~ In such event there would be no coverage for emergencies or supplementation to basic needs. The trust provisions contained in this instrument should be inte~:pretedby my Trustee in light ofthese concen~s and this intent. C. My Trustee shall pay or apply for the benefit of my daughter for her lifetime such amounts from the principal or income, orboth, of this trust up to the whole thereof; as the Trustee, in the Trustee's sole and absolute discretion, may from time to time deem necessary or advisable for the satisfaction of MADELINE BARBARA SABELLA's special non support needs, if any. Any income not distributed shall be added annually to principal. As used in this instrument, "special non support needs" refers to the requisites for maintaining my daughter's good health, safety and welfare when, in the discretion of the Trustee, such requisites are not being provided by any public agency, 4 office or department of the state where she lives or of the United States, or are not otherwise being provided by other sources of income available to heir. Special non-support needs shall include but shall not be limited to the list of suggested non support items set out in this article. D. In•the event that she is unable to maintain and support herself independently, the Trustee may, in the exercise of the Trustee's best judgment and fiduciary duty, seek support and maintenance for her from all available public and private sources. Tl~e Trustee shall take into consideration the applicable resources and limitations of any public assistance program forwhich she is eligible. In cazrying out the provisions of this trust, my Trustee shall be mindful of the probable future needs of my daughter, but not of the trust remainder beneficiaries. E. No part of the corpus of the trust Created by this article shall be used to supplant or replace public assistance benefits of any county, state, federal or other governmental agency that has a legal responsibility to serve persons with disabilities that are the same or similaz to those which MADELINE BARBARA SABELLA may be experiencing. For purposes of determining my daughter's public assistance eligibility, no part of the principal or undistributed income of the trust shall. be considered available to her. In the event that the Trustee is required to release principal or income of the trust to or on behalf of MADELINE BARBARA SABELLA to pay for benefits or services which such public assistance is otherwise authorized to provide were it not forthe existence of this trust, or in the event the Trustee is requested to petition the court or ant other administrative agency for the release of trust principal or income for this purpose, the Trustee is authorized to deny such request. My Trustee is authorized, in the Trustee's discretion, to take whatever administrative or judicial steps may be necessary to continue the public assistance program eligibility of MADELINE BARBARA SABELLA, including obtaining uistructions from a court of competent 5 jurisdiction ruling that the trust corpus is not available to the beneficiary for such eligibilitypurposes. Further, my Trustee should cooperate with the beneficiary's conservator, guardian, or legal representative to seek support and maintenance for the beneficiary from all available resources, including but not limited~to, the Supplemental Social Security Income Program (SSI); the Medicaid Program; and any additional, similar or successor programs; and from any private support sources. Any expense of the Trustee, including reasonable attorney fees, shall be a proper charge to the trust. F. SPENDTHRIFT PROVISIONS No interest in the principal or income of this trust shall be anticipated, assigned or encumbered or shall be subject to any creditor or to any legal pxocess prior to the actual receipt by the beneficiary. Furthermore, because this trust is to be conserved and maintained for the special non support needs of MADELINE BARBARA SABFT.r.A throughout her life, no part of the corpus hereof, neither principal nor undistributed income, shall be construed as part ofMA~DELIlVE BARBARA SABELLA'S estate or be subj ect to the claims of voluntary or involuntary creditors for the provision of care and services, including residential care by any public entity, office, department, or agency of any state orthe United States or any governmental agency. Underno circumstances can the beneficiary compel a distribution. G. TRUSTEE; AUTIiORTTY TO TERMINATE TRUST Notwithstandinganything tothe contrary contained inthis trust, inthe eventthatthe trust has the effect of rendering MADELINE BARBARA SABELLA ineligible for any program of public benefit, the Trustee is authorized, but not required, to terminate this trust. In determining whether the existence of the trust has the effect of rendering iVIA.DELINE BARBARA SABELLA ineligible for any program of public benefit, my Trustee is granted full and complete discretion to initiate either b administrative or judicial proceedings, or both, for the purpose of determining eligibility. All costs relating thereto, including reasonable attorney fees, shall be a proper charge to the trust. In the event of voluntary termination, the undistributed balance of the trust shall be distributed to LINDA E. ZISMAN, Per Stirpes. H. VOLUNTARY CARE It is my wish that subsequent to the termination of the trust for the benefit of MADELINE BARBARA SABELLA, if my contingent beneficiaries are living and distribution has been made outright to them, if MADEi.INE BARBARA SABELLA is still living because th~te has been a voluntary termination of the trust in accordance with the provisions pf this article, that such contingent beneficiaries will conserve, manage and distribute the proceeds of the former trust for the benefit of 1VIADELINE BARBARA SABELLA to insure that shE receives sufficient funds for her basic living and supplemental needs when public assistance benefits are unavailable or insuffiicient. This request pertaining to the use and management of the trust proceeds after the termination of the trust is not mandaxory, but is an expression of my wishes only. I. BENEFICIARIES OF TRUST RESIDUE UPON DEATH OF DISABLED BENEFICIARY Unless sooner t , »ated, t11e trust created for MADELINE BARBARA SABELLA shall r terminate upon her death. At that time all remaining trust assets shall be distributed to PINNACLE HOSPITAL HOSPICE OF CENTRAL PENNSYLVANIA, Harrisburg, Pennsylvania, or its successors, to be used at their discretion. 7~ J. TRUSTEE'S POWERS S~xbjectto the requirement that my Trustee be prudent, my Trustee shall have full power and authority to manage and control the trust estate and to sell, exchange, lease, rent, assign, transfer and otherwise dispose of any or part thereof upon such terms and conditions as my Trustee may, in my Trustee's discretion, deem proper. My Trustee may invest or reinvest all or any part of the trust estate in such common or preferred stocks, bonds, debentures, mortgages, deeds, deeds of trust, notes and other securities, investments of property, including common trust funds, which my Trustee, in my Trustee's absolute discretion, may select or Vie. It is my express intentionthatthe Trustee shall have full power to invest and reinvest the trust fiends as I might do if living, without being restricted to forms of investments which Trustees may be otherwise permitted by law to make, and without any requirements as to diversification of investments. My Trustee may continue to hold in ~. the form in which received, any securities or any property which I might own atthe time ofmy death or whichmy Trustee may at anytune acquire hereunder, and may invest amy:part of the trust fiords in property located wit~iin or outside of the Oommonwealth of Pennsylvania. My Trustee is further authorized to invest in life, annuity, accident, sickness, including disability, and medical insurance on behalf of and for the benefit of the trust beneficiaries. My Trustee shall not be obligated to undertake litigation for collection of any benefits or assets payable by reason of my death including, but not limitedto, such benefits under life insurance policies, employee benefit plans or other contracts, plans or arrangements providing for payment or transfer at death which are payable to my Trustee unless my Trustee is indemnified to my Trustee's satisfaction against any liability and the expense of such litigation. Payment to my Trustee and the s receipt of or release by my Trustee shall fully discharge anq payor, and no payor need inquire into or take notice of my Will to see to the application of such payment. My Trustee shall, in addition to the powers granted above, have all powers otherwise granted under the Pennsylvania Fiduciaries' Powers Act as amended after the date of my Will and after my death. My Trustee shall specifically have the powers to invest innon-income producing assets. K. UNSUPERVISED ADMIlVISTRATIOI~T The trust created bythis Will maybe administered by my Trustee free from the control of any court that may otherwise }gave jurisdiction over my estate. ITEM VI. I nominate and appoint my niece, LINDA E. ZISMAN as Executrix of my Will. If LINDA E. ~TSMAN is unable or unwilling to act as Executrix, I appoint my attorney, 1~~IAR~LLE F. HAZ~N, as Executrix of my will. I direct that my Executrix or Successor Executrix be permitted to serve without bond and in addition to those powers granted by law, I grant them power to sell-both real and personal properly, at private or public sale, to invest cash without being limited to statutory investments, to distribute iu cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if living. Dated ~~ ~~~~~'~ ~ 2 2003 ~~ ~ ~~ 9 In our presence, the above-named DOMIlVICK C. SABET .T. A signed this and declared this to be his Last Will and now at his request, in his presence, and in the presence of each other, we sign as witnesses. Name Address ~ L~~S1..a~~-~ ~c X43, ~ ~~-/~//o D %~ rr pl- ~ ~~ ~?~~ 1Q I, DOMINICK C. SABELLA, Testator, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by . DOA~CK C. SABELLA, the Testator, tlus~dayof~ , 2003. No Public Notarial seal MarieUe F. Hau:s, N Public C;i of Harrisburg, Damn County ~I t'ownission Fa~pirra Pt. 23. ?A06 4 f w ^ /t ~~~ vy ~. ~ y-- DONIINICK C. SABELLA ,• ` ;~. :~ r. •~ , .; ~.. •, ` ~ . ;. • '', ~ • .i .., . ,~ ,' ,. !., r ~ ' ~ ,~ . ~, r~ i . t ~~~; :~i, '1. ..i71it' We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testator sign and execute this instrument as his Will; that he signed and executed it willingly as his free and voluntary act for the Purposes therein expressed; that each of us in his sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that he was at that time eighteen (18) years or more bf age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and sub 'bed before me b ~~ ~ c~. L..Zt ~ ~-e.~ y and witnesses, this day of ~~c~.l~ , 2003. Notary Public Notarial Seal Marielk F. Hazen, N Pnblic Ci -tl of ,xffirsburs., D~~n Gusty My Coamm~ B~cpires Pt. 2006 11 FIRST CODICIL TO THE WILL OF DONIINICK C. SABELLA I, DOMINICK C. SABELLA, of Mechanicsburg, Cumberland County, Pennsylvania, declare this to be a first codicil to my Will dated March 12, 2003. FIRST: I revoke ITEM IV of my Will in its entirety and substitute therefore the following new ITEM IV: ITEM IV. All the rest, ~ residue and remainder of my, estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath according to the following: A. My real property located at 5219 Stuart Drive, Mechanicsburg, Pennsylvania, subject to all outstanding taxes, mortgages, utilities and debts, and any vehicle owned by me at the time of my death to my son, MICHAEL SABELLA, provided the following: (1.) he is not incarcerated at the tune of my death or within nine (9) months of a date of my death, (2.) he has not been convicted of a crime for which incarceration is a possible sentence as of my_ death or within nine (9) months thereafter; and (3.) MICHAEL SABELLA shall be responsible for payment within nine (9) months from the date of my death of all inheritance taxes due on these items. This tax must be paid before distribution to him of these assets. Failure to meet any of the above terms shall cause this bequest to lapse. My real property and vehicle will then be sold by my Executor and the net proceeds, after payment of all outstanding taxes, mortgages, utilities, debts, and inheritance taxes due on this bequest, shall be distributed to MICHAEL SABELLA, outright. In the event that MICHAEL SABELLA predeceases me or fails to survive me by thirty (30) days, I give, devise and bequeath his share to be held in a Special Supplemental Care Trust for my daughter, MADELINE BARBARA SABELLA, to be held, managed and administered according to Item V. In the event that MADELINE BARBARA SABELLA predeceases me or fails to survive me by thirty (30) days, then her share shall be distributed to PINNACLE HOSPITAL HOSPICE OF CEN'T'RAL PENNSYLVANIA, Harrisburg, Pennsylvania. B. The balance of my residuary estate shall be held in a Special Supplemental Care Trust for my daughter, MADELINE BARBARA SABELLA, to be held, managed, and administered according to ITEM V. In the event MADELINE BARBARA SABELLA predeceases me or fails to survive me by thirty (30) days, then her share shall be distributed to PINNACLE HOSPITAL HOSPICE OF CENTRAL PENNSYLVANIA, Harrisburg, Pennsylvania. SECOND: In all other respects, I confirm and republish my Will dated March 12, 2003. I signed this first codicil to my Will on ~ ^ ~. ~ , 2005. DOMINICK C. SABELLA On the date last above written, we saw DOMINICK C. SABELLA, in our presence, sign the foregoing instrument at its end. He then declared it to be a first codicil to his Will and requested us to act as witnesses to it. We then, in his presence and in the presence of each other, signed our names as attesting witnesses, believing him at all times herein mentioned to be of sound mind and memory and not acting under constraint of any kind. Name Address ~ 2000 Lin~lestown Rd., Suite 202, Harrisburg, PA 17110 t ~ 2000 Linglestown Rd., Suite 202, Harrisburg, PA 17110 -2- I, DOMII~TICK C. SABELLA, Testator, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my First Codicil to my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by DONIINICK C. SABELLA, the Testator, on - 2005. otary Pu 1 ~~.~~ c ~ DOMINICK C. SABELLA COMM NWEALTH OF PENNSYLVANIA Notarial Seal Marielle F. Haan, Notary Public Susquehanna 7~., Dauphin County My Commission Exxpires Sept. 23, 2006 We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testator sign and execute this instrument as his First Codicil to his Will; that he signed and executed it willingly as his free and voluntary act for the purposes therein expressed; that each of us in his sight and hearing signed his First Codicil to his Will as witnesses, and that to the best of our knowledge, that he was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by ~ ~. c'~b and witnesses, o - 2005. o~ wme rtness COMMONWEALTH OF PENNSYLVANIA Notarial Seal Marielle F. Hazen. Notar~r Public " Susquehanna Twp.. hm County My Commission Exp>t~es Sept. 23, 2006 E X GRANTED TEMPLATE Page 1 of 1 Benjamin J. Butler From: RV, Inheritance Tax Extension [RA-InheritanceTaxExt@state.pa.us] Sent: Tuesday, January 25, 2011 12:21 PM To: Benjamin J. Butler Cc: 'gfarner@ccpa.net' Subject: DOMINICK C. SABELLA, EST. r ~°~ ~' ~. Ga E F+~A R ~ i~1 E N T' 0 I` F1 E'~ E I'J Lt E The following message is being sent from an unmonitored account. Please do not reply. Re: Estate of DOMINICK C. SABELLA File Number 2110-0496 Dear Sir or Madam: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 08/02/11. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the rnaximum time permitted. We now offer you the option to request your extension request via a-mail. Please use the following a-mail address: RA-InheritanceTaxExt@state.pa.us. Please contact me with any questions or concerns at 717-787-8327. Sincerely, Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division Please do not reply to this email. This mailbox is not monitored and you will not receive a response. For assistance., visit us on the web at www.revenue.state.pa.us or call us at 717-787-8327 The information transmitted is intended only for the person or entity to whom it is addressed and may contain confidential and/or privileged material. Any use of this information other than by the intended recipient is prohibited. If you receive this message in error, please send areply a-mail to the sender and delete the material from any and all computers. 6/28/2011 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE • BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: ZISMAN LINDA E 1047 CUSTAN DRIVE HARRISBURG, PA 17110 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 076-12-4471 FILE NUMBER: 2110-0496 DECEDENT NAME: SABELLA DOMINICK C DATE OF PAYMENT: 07/22/2010 POSTMARK DATE: 07/22/2010 COUNTY: CUMBERLAND DATE OF DEATH: 05/02/2010 REV-1162 EX(11-96) NO. CD 013083 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $ 5, 000.00 TOTAL AMOUNT PAID: REMARKS: $5,000.00 CHECK# 1 15 INITIALS: DM SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ' BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: ZISMAN LINDA E 1047 CUSTAN DRIVE HARRISBURG, PA 17110 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 013974 ACN ASSESSMENT AMOUNT CONTROL NUMBER Told ESTATE INFORMATION: SsN: 076-12-4471 FILE NUMBER: 2110-0496 DECEDENT NAME: SABELLA DOMINICK C DATE OF PAYMENT: 02/02/201 1 POSTMARK DATE: 02/01 /201 1 COUNTY: CUMBERLAND DATE OF DEATH: 05/02/2010 101 ~ $1, 348.81 TOTAL AMOUNT PAID: REMARKS: RECEIPT TO ATTY SEAL CHECK#150 INITIALS: DB RECEIVED BY: $1,348.81 GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER a Settlement Statement u.s. Department of Housing OMB Approval No. 2502-0265 and Urban Development (expires 11/30/2009) 8. T e of Loan ' B. File Number. 7. Loan Number. 8. Mortgage Insurance Case Number. 1. ^ FHA 2. ^ FmHA 3. ^ Conv. Unins. 4. ^ VA 5. ^ Conv. Ins. C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside dosing; they are shown here for informational purposes and not included in the totals. D. Name and Address of Borrower. E. Name and Address of Seller. F. Name and Address of Lender. John T. Norman Estate of Dominick C. Sabella Unda E. Zisman, Executrix G. Properly Location: H. Settlement Agent Ronald D. Butler, Esquire 5219 Stuart Drive Place of Settlement: I. Settlement Date: 500 N. Third Street, 12th Floor 6/14/11 Mechanicsburg PA 17055 Harrisburg PA 17101 Disbursement Date: Lot: Block: J. Summary of Borrower's Transaction K. Summary of Seller's Transaction inn r:rnc~ emn~~n4 ni~o Rrnm Rnrrnwcr dnn r~rnee emn~~nf n~~e Tn Cnllur 101. Contract sales ce 120 000.00 401. Contract sales rice 120 000.00 102. Personal rb 2 000.00 402. Personal ro 2 000.00 103. Settlement cha es to borrower line 1400 1562.00 403. 104. 404. 105. 405. Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance 108. Ci !town taxes 8/14/11 to 12/31/11 382.03 408. C /town taxes 6/14/11 to 12/31/11 382.03 107. Coun taxes to 407. Coun taxes to 108. Assessments to 408. Assessments to 109. School taxes 6/14/11 to 6/30/11 53.44 409. School taxes 6/14/11 to 6/30/11 53.44 110. Sewer & trash 6/14/11 to 6/30/11 18.28 410. Sewer & trash 6/14/11 to 6/30/11 18.28 111. to 411. to 112. to 412. to 113. to 413. to 114. 10 414. -o 115. to 415. to 120. Gross Amount Due From Borrower 124,015.75 420. Gross Amount Due To Seller 122,453.75 inn emn~~nfe P~irl Rv Ar in Rohnlf M Rnrrnwor Fnn Rarl~ir_finns In emn~~nt nt~a Tn Caliwr 201. De sit or earnest move 501. F~tcess de sit sea Instructions 202. Princi I amount of new loans 502. Settlement cha to seller Tine 1400 1 210.00 203. Existin loans taken sub ed to 503. Exlsti loans taken sub'ed to 204. 504. Pa ff of first mo loan • 290.50 205. 505. Pa of second mo a e loan Zoe. 505. Escrow 2 000.00 207. 507. 208. 508. 209. 509. Ad ustments for items un aid b seller Ad ustments for items un aid b seller 210. CI /town taxes to 510. C nown taxes ~ 211. Coun taxes l0 511. Coun taxes to 212. Assessments to 512. Assessments to 213. ~ 513. to 214. to 514. to 215. to 515, to 218. ~ 518. ~ 217. to 517. to 218. ~ 518. to 219. to 519. to 220. Total Paid By/For Borrower 520. Total Reduction Amount Due Seller 3,500.50 Seller 301. Gross Amount due from borrower (Ilne 1201 I 124.015.75 1801. Gross amount due to seller (line 420) ~ 122,453.75 302. Less amounts id b /tor borrower the 220 802. Less redudlons in amt. due seller ine 520 3 500.50 ) 303. Cash ®From ^ To Borrower 124 015.75 603. Cash ®To ^ From Seller 118 953.25 Section 5 of the Reai Estate Settlement Procedures Act (RESPA) requires Section 4(a) of RESPA mandates that HUD develop and prescribe this the following: • HUD must develop a Spedal Information Booklet to help standard form to be used at the time of loan settlement to provide full persons borrowing money to finance the purchase of residential real estate disdosure of all charges Imposed upon the borrower and seller. These are to better understand the nature and costs of real estate settlement services; third party disdosures that are designed to provide the borrower with • Each lender must provide the booklet to all applicants from whom it pertlnent Information during the settlement process in order to be a better receives or for whom it prepares a written application to borrow money to shopper. finance the purchase of residential real estate; • Lenders must prepare and The Public Reportlng Burden for this collecton of infomtatlon is estimated distribute with the Booklet a Good Faith Estlmate of the settlement costs to average one hour per response, induding the time for reviewing instruc- that the borrower is likely to Incur in connectlon with the settlement These lions, searching existing data sources, gathering and maintaining the data disclosures are mandatory. needed, and completing and reviewing the collection of informatlon. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. The information requested does not lend itself to confidentiality. Prev(ous editions are obsolete Page 1 of 2 form HUD-1 (3/86) ref Handbook 4305.2 700. •Totai`Sales/Broker's Commission based on price S 120,000.00 (j?? '~: = 0.00 Paid From Paid From Divisbn of Commission (line 700) as follows: Borrowers Sellers 701. i to Funds At Funds At Settlement Settlement 702. S to 703. Commission paid at Settlement 704. Rnn 14nrn~ D~~roF.ln In r`nnnnnfinn Wifi. 1 non 801. Loan Originatlon Fee % 802. Loan Discount % 803. Appraisal Fee to 804. Credit Report t0 805. Lenders Inspection Fee 806. Mortgage Insurance Application Fee to 807. Assumption Fee 808. 809. 810. 811. 812. 813. onn i*e...~ Den~~i.ea n.. 1 enae. Tn ne D~sa in ea..~.,s c..,.t..wa i.,.~ a.,.. t.....,t..~ us en, 901. Interest From to ~S /day 902. Mortgage Insurance Premium for months to 903. Hazard Insurance Premium for years t0 904. years to 905. innn De~e...e~ fln..~.cbed Wili. 1 e...ie. 1001. Hazard insurence 1 months®S per month 1002. Mortgage insurance 1 months= per month 1003. City property taxes 1 months®S par month 1004. Counly property taxes 1 months®i per month 1005. Annual assessments 1 monthsEjr~S per month 1008. 1 montht,~S per month 1007. 1 months®i per month 1008. Aggregate Acxountlng Adjustment ~ ~ nn Tike r•i,~...e~ 1101. Settlement or closing fee to 1102. Abstract or title search to 1103. Title examinatbn to Butler Law Fit1n 300.00 1104. Tide insurance binder to 1105. Document preparation to 1108. Notary fees to Cash 10.00 1107. Attorney's fees to (Includes above items numbers: 1108. Title Insurance t0 (Includes above items numbers: 1109. Lenders coverage S 1110. Owners coverage S 1111. 1112. 1113. ~nnn r,...e......e.,! ne,.....at.... ~...! T.~..~ss. rti~...e~ 1201. Recording fees: Deed S 62.00 ;Mortgage i ;Releases i 62.00 1202. C(ty/county tax/stamps: Deed S 1,200.00 ;Mortgage Z 1 200.00 1203. State tax/stamps: Deed S 1,200.00 ;Mortgage S 1 200.00 1204. 1205. 1301. Survey to 1302. Pest inspectlon to 1303. 1304. 1305. 1308. 1307. 1308. 1400. Total Settlement Charges (enter on Tines 103, Section J and 502, Section K) 1 562.00 1 210.00 ctr•c I IruwA I lulu I 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 disbursements on my account or by me in this transaction. I further certlfy that I have received a copy of the HUDr1 Settl ant S me t Seller Borrower to of mini belle J n . Nomlan seller Bonower i da . Zisman, Ex tr To the est of m e e HU 1 Settlement Statement which I have prepared is a true and accurate account of the funds which were received and have been or will be' disbursed by nde n a rt o ement of this trensadion. ~~i~/~`/ Settlement Agent Date Ronald D. utler, Esquire WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar Tone. Penaltles upon convictlon can 1nGude a fine and imprisonment For details see: Title 18 U.S. Code Section 1001 and Sectlon 1010. Previous editions are obsolete Page 2 of 2 form HUD-1 (3/86) ref Handbook 4305.2 Sovereign Bank ESTATE OF Dominick C Sabella SOCIAL SECURITY #: 076-12-4471 DATE OF DEATH: May 2, 2010 Account #: 0371082617 Type: Checking Open date: 6/25/2005 In the name of: Dominick C Sabella (Linda E Zisman POA) Date of Death Balance: $23,975.21 Int.(YTD) from 1 /1 /2010 to 5/2/2010 : _ $0.00 Accrued interest to date of death: $0.00 Other Info: Account #: 4539111396 Type: In the name of: Dominick C Sabella Date of Death Balance: $0.00 Line of Credit Open date: 12/26/2008 Page 1 of 1