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HomeMy WebLinkAbout07-29-11REV-179'~A EX (6.08) ~ ~ ~ pennsylvania ,, P INHERITANCE TAX RETURN - DE ARTMENT OF REVENUE NONRESIDENT DECEDENT FILE NUMBER PO BOXz8o6oi 2 1_ 1 1 0 0- 4 7 2 HARRISBURG, PA 1128-0601 COUNTY CODE YEAF' NUMBER DECEDENT'S NAME (LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z W Burlison, Jean Eleanor 159 - 24 - 9873 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) U 03/08/2011 02/23/1927 W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER F ®1. Original Retum ^ 2. Supplemental Return ^ 3. Remainder Retum (dale of deam poor to 12-i3-az) a w a ~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise (dale ofdealnaaer 1z-12-sz) ^ 5. Federal Est;Bte'Tax Return Required ~ a m ®6. Decedent Died Testate (Atact copy or wiu) ^ 7. Decedent Maintained a Living Trust (Atlacn copy of trust) 8. Total Number of Safe Deposit Boxes - a a ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date ordeam between iz-3l-si and i-i-ss) ^ 11. Election to tax under Sec. 9113(A) (Atlacn scn o) ~ THIS SECTION'MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: o NAME COMPLETE MAILING ADDRESS o Marlin R. McCaleb E FIRM NAME 219 East Main Street y pf App~icab~e) W _ P.O. Box 230 p TELEPHONE NUMBER Mechanicsburg, PA 17055 717/691-7770 METHOD REFER TO METHOD OF COMPUTATION IN THE NONRESIDENT DECEDENT INSTRUCTION BOOKLET (REV-1736) Check One: ^ Flat Rate ^ Proportionate (Complete Worksheet on Reverse Side) 1. Real Estate (Schedule A) (1) ~.1`S,000.UU " ~ a C7 2. Stocks and Bonds (Schedule B) (2) None ,~ - ~-- -7-; ;=~ r 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None r m=~ , ~ r ~ -, ~ C7 t -` r Schedule C ~ ~ ~,~' r - ` 4. Mortgages & Notes Receivable (Schedule D) (4) NOne '-/% ~~ ~"`' 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5) 1,706.26 "'' ~-> -T~ ~:: - 0 (Schedule E) ; -~ ~~z7 ~ - _ Q 6. Jointly Owned Property (Schedule F) (6) None F _.~ `~ =;r ~ . ~. ^ Separate Billing Requested C .; J ~ ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None d (Schedule G or L) V 8. Total Gross Assets (total Lines 1-7) (8) 116,706.26 _ ~ 9. Funeral Expenses ~ Administrative Costs (Schedule H) (9) 14s987.09 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) (10) 685.14 11. Total Deductions (total Lines 9 8 10) (11) 15,672.23 12. Net Value of Estate (Line 8 minus Line 11) (12) 101,034.03 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14 101,034.03 W ~ Z W Q _ ~ Y~ U = wa _~ U~ = U V Q a~ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax x .0 Q (15) 0.00 rate, or transfers under Sec. 2116 (a)(1.2) - - 16. Amount of Line 14 taxable at lineal rate 101,034.03 x 0 45 (16) 4,546.53 17. Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate x .15 19. Tax Due -Make check payable to Commonwealth of PA zo. ^ . .. > > BE SURE TO ANSWER ALL QUESTIONS ON R (17) - 0.00 (18) 0.00 (1s) _ 4,546.53 SIDE AND RECHECK MATH < < N w~ W L ^~ W _~ Q 0 U ^~ L V M M M N H w ryy~ 1M~1 W v ~n w w Q ~ Z Z ~--1~I,1~/ W H F- Q O ~ 0 d W } ~^ ^~ J ~' Q' m a~ ' ~ : a Q (/~ ~O t = Z Z ~ ~ `a H a~ J o T ~ c V' ~ Z N N ~ .y c ~ 2 u Q Y = s ~ Z U ~ `o Z 3 c U ti Z d N ~ ~ a m O i a N~/ m 4. ~ ~O ~ ` ~. 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C N J L w ~ V d t d aci C `m d mw Vl ~ M 0 m C J F + L ~ N C N J L ~~ h d a x :~ N v c 0 N d C .~ a`~ w d Te Or S~ ~~ c ~ vi C °~~' € 3 ~i ~a ~ m A N` o` m 3 d p ~ N ~~ A ~ ~`s _Q Z. ~. J f!J Z _ a J L r (LJ W ~ W c T i .N.~ ~ ~ Y X x x Z I/VV /A„` ~ ~ O Y L m y ( ~c^ G ' ~/ li m .- ~ ~ ~ o m o O ~ N N 'ct C_ ~ O) n J uj p' Q d ~ ~> t` ) 0 ~ ~_ ~ °) -°)o c~ y ~° =° m a N ~ c ~ ~ m ~ ~ m m m W m' N E ~ ~ m m [ ` x R~ c G m ~ ~c ~ C m ~ N j ~ ~~ x ~ x a) _ _ ~ ~- O) ~ d a ~ C N y ~ Ol d J B O O m - o _ a _ W > d y ~ -> ~ Q c y N~ a) ~ ~- a. `J x' N GJ a c d N a c N N a E V ~ S. m o ~ t° c :-° c c,°e~ m x~ Xd K~ Q c o a) 0 0 m U ') ~ O ~ o ~ o X a a y rn o v ~~ ~' ~~ °~ umi ca o O .m. On .m.. O ~ p) x Lj O U o' n O o o. O o n O .-- N c7 C' ~ (D ~ W Oj w w U 2 Q m N H Q Ln N N C `o m 0 m d w m • V Z J N Z O a W Z W O W Q ~ t O N ~ N N ~ ~ ~ ~ U U d o N = °~ "' °' ~ 3 O ~ y O N N c N.' L rn Z m 'o U y c o v E m c~ a) L n d E ~] N U U ~ n 0 `o ° 'Z ~ a a) v ~ ~, `o w w- m ~ h c ? > y O j O` C `) .R m m n C w~ N N ~ w m U 1` C ~ N ~ .m.. N ~_ .J C N y N O CO +~' .n ` mom N L y y ~ o m m " n ` ° „ `o `o ~ ~ ~ ~v m E X _ ' __ m e ~ W U m N N E ~ a> N `m m m > n ~ y ~ m y r a) R c o O C E y ~ m C> v U r_,. o L X ~ N ~ ~ a m - p 3 .f° o w v O m L_ N= m O C ' O N~ ~ ~ p .,m.. ~ D N N~ d .-. C EL o E m m .J fir- `= ~ ~ ~ ~ o~ a)~ m^ ~ io x m o `ov O `o rn o vi ~ ~ LO ~ ,C~ m d N .--. ~ p ~ C ~ ~ . . N= ~ O ~ ~ ~ , c` U ~~ m C rnm o rn "- .- o ~ O ~~ N V °i `O ~ ~ U ~ Qf b N O ~ fn N O ~ c o n ~ .y ~ v ~ C ~.g ~ L C ~ N v C R u w d m d `u ~ N U "~ O p a m O ~ C~ C N O O O)~ O O) C C C n d CC O O > C N O C(V O •-- "O ~ C L N A T O > L Z , m L y y ~<J ~ O~ X41 N N .O O y m N m y m m ` na E ~ m B o n a o io ~ E N ,_, y O "" N y _ O O)~ ~ C m ~ 3 N ~,~ ° ` m °) v~ m c c o v .? v m ai m v w a x °) ~° o ~ m m ~ v N ~ )( L'~ m N O C O U 1~ N REV-1502 EX + (1-97) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN ESTATE OF FILE NUMBER Jean Eleanor Burlison SS~~ 159-24-9873 03/08/2011 21-11-0472 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with ri ht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 House and lot, - known as 408 East Coover Street, Borough of 115,000.00 Mechanicsburg, Cumberland County, PA, acquired by Decedent and husband, John B. Burlison, by deed dated 09/24/1952, recorded in Deed Book 15, Volume C, Page 327 (John B. Burlison died 09/23/1993); value based on sale to Assault Vehicle, LLC, per contract dated 05/03/2011. TOTAL (Also enter on line 1, R (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. $ 115,000.00 Form REV-1502 EX (Rev. 1-97) REV -1508 EX + (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8c M~$C. nOriRESIDENTDECEDEN RN PERSONAL PROPERTY ESTATE OF FILE NUMBER Jean Eleanor Burlison SS~~ 159-24-9873 03/08/2011 21-11-0472 _ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ~~~ ~~~~~~ ~No~~ ~~ ncnueu, mserr aaa¢lonai sneers of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-tSOH EX (Rev. 1-97) REV-1511 EX+(1_g7) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES $ INHERITANCE TAX RETURN ADMINISTRATIVE COSTS nO11RESIDENT DECEDENT ESTATE OF FILE NUMBER Jean Eleanor Burlison SS~~ 159-24-9873 03/08/2011 21-11-0472 Debts of decedent must be reported on Schedule I. ITEM T~ NUMBER DESCRIPTION I A. FUNERAL EXPENSES: B. 1 2. 3. 4. 5. 6. 7. 1 2 3 4 5 6 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney's Fees Law Offices-Marlin R. McCaleb Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant AMOUNT 6,950.00 Street Address Clty State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills 320.50 Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Cumberland Law Journal, - advertising Letters. 75.00 Exit Platinum Plus Realty, - real estate broker's commission on 5,750.00 sale of house. Recorder of Deeds, - Realty Transfer tax on sale of house. 1 150.0() Register of Wills, - filing Inventory and Appraisement. 30.0() Register of Will, - reserve for filing Account, Releases, etc. 400.00 The Patriot-News, - advertising Letters. 137.24 Total of Continuation Schedule(s) ~~~ ~~ TOTAL (Also enter on line 9 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1496 form software only CPSystems, Inc. lation) $ 14,987.09 Forni REV-1511 EX (Rev. 1-s7) Estate of: Jean Eleanor Burlison Soc Sec ~~: 159-24-9873 Date of Death: 03/08/2011 Continuation of Schedule H-B7 (Other Administrative Costs) Item Description Amount ~~ 7 UPS, - express mail delivery to attorney in Tennessee. 24.35 8 Wayne's Hauling, - hauling and disposal of junk from house,in 150.00 preparation for sale. 174..35 REV-1512 EX+(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN riOriRESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS ESTATE OF FILE NUMBER Jean Eleanor Burlison SS~~ 159-24-9873 03/08/2011 21-11-0472 Include unreimbursed medical expenses. ~~~ more space Is neetlea, Insert atltlltional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN nORRESIDENT DECEDENT SCHEDULE) BENEFICIARIES FILE NUMBER .lean ~aeanor liurlison 55~p 159-24-9873 03/08/201 1 21-11-0472 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousaldistributlons,and transfers under Sec. 9116(ax1.2)] 1 Jack R. Burlison Son :50,517.01 805 Old Silver Spring Road Mechanicsburg, PA 17055 2 Marjorie A. Seiler Daughter '50,517.02 6407 Knightsbridge Road Hixson, TN 37343 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON R EV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. Forrn REV-1513 EX (Rev. 9-00) i ~ ~.9 ' SST WILL AND TESTAMENT I, JEAN ELEANOR BURLISON, of the Borough of Mechanicsburg, County of Cumberland and Commonwealth of Pennsylvania,, being of sound and disposing mind, memory and understanding, do make, publish and d®clare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils `~, by me at any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Co-Executors, hereinafter named, as soon as conveniently may be done after my decease. ~• SECOND. I give, devise and bequeath my automobiles and personal effects and such household goods, furniture and furnishings as may be my individual property and not: the property of my husband or owned jointly by me with him, and ~~ .. . other tangible personalty of like nature {not including cash or securities), together with any existing insurance thereon, unto my children, namely: MARJORIE A. SEILER, MARK B. BURLISON and JACK R. BURLISON (or to the survivor of them if any are not then living), the same to be divided between them by my Co- Executors, hereinafter named, with due regard for their personal preferences and in as nearly equal shares as possible. THIRD. I give, devise and bequeath all the rest., residue and remainder of my estate, real, personal and mixed, whatsoever and .wheresoever situate, in equal shares unto my children, namely: MARJORIE A. SEILER, MARK B. BURLISON and LAW OFFICES JACK R. BURLISON, share and share alike, absolutely and in fee RLIN R. McCALEB simple. .~ If any of my said children shall predecease me leaving lawful issue to survive ma, then I order and direct that the share which such deceased child would have received had he or she survived me shall be paid over and distributed unto his or her said lawful issue, said issue to take the ancestor's share by representation and not per capita. gOIIRTH. I nominate, constitute and appoint my san, MARK B. ~~ C.__ _: r. 1 BURLISON, Guardian of any property which passes either under this Will or otherwise to a minor and with respect to which T am authorized to appoint a Guardian and have not otherwise specifically done so. Such Guardian shall serve without bond and shall have the power to use principal as well as income from time to time for the minor's education, support and welfare without regard to the ability of said minor's parents 'to provide for such education, support or welfare; or to make payments for these purposes without further responsibility to the minor, the minor's parents, or to any person taking care of the minor; or, in the event the funds held by the Guardian for any minor shall become, in the opinion of the Guardian, too small for proper and efficient administration, to deposit such funds in an interest-bearing account on behalf of the minor. LASTLY. I nominate, constitute and appoint my children, LAW OFFICES ~RLIN R. McCALEB namely: MARJORIE A. SEILER, MARK B. BURLISON and JACK R. BURLISON, Co-Executors of this, my Last Will and Testament, but if for any reason any of them shall fail to qualify as such Co- -2- ~: Executor or cease so to serve, it shall not be necessary to appoint a substitute Co-Executor in his or her place, but in such event the surviving or remaining Co-Executors, as the case may be, shall serve with full power and authority under this, my Last Will and Testament. All shall serve without bond in this or any other jurisdiction. IN WITNESS WHEREOF, I, JEAN ELEANOR BURLISON, have hereunto set my hand and seal to this, my Last Will and Testament which consists of three (3) typewritten pages for each of which I have other typewritten pages, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by JEAN ELEANOR BURLISON, the. Testatrix therein named, as and for her Last Will and Testament,, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. . affixed my signature this ~~ day of ~,_.Glir~-~~ , A.D., One Thousand Nine Hundred Ninety (1990). ~• .~ ' ~ ~? ~ ~ (SEAL) l~ v The preceding instrument, consisting of this and two (2) ~@ LAW OFFICES LIN R. McCALEB -3- n ~e+ .r+ei ASB 73-r armS~~D,~,o..e ~R~E rrsi~ m uFioOR.~i^u^mbEa. ~`~~+a~ ~M,o~daLtlaa ~ ATO~RSm (PAR~• ~,_~ vu is~aKc j, o,,,. -- - - - BUYER'S ~,p~GADDR)3SSt l;$LL11:R'8 MAII.INGADAR$~s PROPERTY ~DDRE55 4 t: es TdP Z 5 MP.C IC RG , iq tlta tnunielpality of BOi In the 5ogool Dlsrrlot of ~ i~l~nrlfie^c[ou (e.6. Tsx ID - $UYEA'3 [] No Swltien Relatloz,shlp ()Buyer b not t3rolca(Cvmparty)_ IT IJ1R'INtrD[ pi,V9 R)cALTY WITfi PA l,ieeaaaa(o) (Naote)3suT3su Tl~iy- R 8 Company Address 66 as Ra c~at+ piLS+ rn 1033 CoatpanyPhoae 717)610-3460 __...-.- CoutpeteyFaX 717 737-503 Eroker ta: Q Httyer Agsat (Broke tnpraeats Buyer oaly) Q Deal Agent (gee Dual md/or Dedgaaud Agent box below) DiraotPhotu(s) j~17) 611-,460 Cell Phone(s) 1717) 350-0 36 -- - - Fax Email matt=Striamroo .coat Lioonate(a) is: Q Bvycr Agent with Designrted Agency Q Bayer Agmc trithout DasignRted Agency Dual Agent (Sea Duel end/a Designated Agttu box below) ~ Trinasotlon Lioeaaee (Broker end lieeitsa(e) provide real eerau aecvioe^ but do not represent Buyer) Q Na Badness Reltttlonsbip (Ballet !s aot represented tty g protcary aroker (Coropwy) =7~1' g2.7lTSN1At pLUB A>e71L'1'7C Lioanace(s) (Narno)>~71'~T[~'N R BOC.~~Y _~_ DireatPhone(s) j717) 61 -1440 ~,~,^ ,~_ CompmyAddraa Asa asss<ra'vno nD c~wp x:ta„ t•>, r.. 7e Cell Phone(s) .~~,~50-013 ~~_~ CotnpaayPhotsa ?17 610-1460 Fax CampanyPax S 7 737- 030 Etnail taatLBteeatreo.cont Brolter ~: Llooaaaa(a) is: Q 9aIlv Agent (Broke tcpreaeota senor only) ^ SaUer Agent with Deaignaud Agency Q Dud Agont (gee Dual antllor Deaigttered Agent boX baloF~ ^ Dual Ag~ 8ae DualDsnd/or tDealgnetcd Agent Uox beknv) (] 'hanaacrion Lioeoaes (9rokar end Lloetuso(a) provide tal nattte oarvlaea but do not reptWeat SeUv) riUA)L AN13/OR DE5It~NAT~D AQt1NCY A Broltot K e Duet Agent when a 8rolux repreteati both Httyer Wd Seiler In the seine ttanaaotion. A Licensee i^ a Dun! Agent when a Lteensw represents Buyer sad Bailer In tlzc acme transaction. Ail o[BtokerY licrosew era also Dntd Agattts UNLESB dton era seperato Deslgntred Agents !br Buyer and Sella. if the carne Lleensea is designated [or Buyer and Seller, rho Lioensce !s a Lfosl Agent. By algnlae th1^ Agreement, Buyer and Seller each RoknowladCe having been prevlonsly ia[vrmed o[, and t:an^eabd te, dunl agency, if applioahla. ASR P^ee 1 of 11 Seger t^ldala~ 6uyerinttlat^: ]Zeditdt110 eoTYAtaHTPsrPtdalR.vuYlwAalOClw'rtnltoMRP.ACTORBmtolo I paratsylvanleAaaodetlon of REALTORS' tno rla w 1701 ~ rY,^,t 717-~-ilOD -a~ r17R3a~faM ~uFdi WLkb, 4i.C. rxir rWw^ r~.s aa+tn ra~o axq.Yw~ aaa ~ 6 r PmEUa^d rMh zpPa^~ Dr rlpt.^oa i1er0 Pllem aH^ Ao^4 fns. aa^as~m ~l1 ~ a-~+r =¢ ltav~wr Heckler , County of C~~-tar inilte Cattcmonwcaltb of Penasylvanlw ZZO/t+001~ NOI10(181SN00 A3NHd3)I IESLlB9El8 Xdj LZ~~ftl iIOZ/ZO1~0 Schedule A.1 1 1. 2 3 4 5 6 7 8 9 10 ii 12 13 14 15 16 17 18 19 20 21 22 z3 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 sl SZ 53 54 55 56 57 58 59 60 61 62 63 Z. 3. 4. S. 6. By this Agreement, dated 2+D-Y s, 2011 Seller hereby ap~ees to sell ttad convey to Buyer, r-ho a~eea to pnrchtue, the fdeattQed Property. PURCHASE PRICE AND DEPOSITS (1-1~ (A) PunchasoPrioeS 115.000.00 (One Hundred Fifteen Thousand _- _-- _-- -- U . DoDars~ to pm Buyer u lows: 1. Deposit at signing of this Agtzcmmt _.. ___ ------.__- .. 1.000.00 2 Deposit wiQrin days of the Execution Date of Wis Agnoeatent: S 3. 3 4. Remaining once will be paid at settlement. (B) A1! feeds paid by Bayer, ht+dadlat deposits, wW be pabd by dterlc, casttirr't checlr or lA6sd rands. All Easels paW b7 Bayer wlihfn 30 DAYS erf st#lement, indadit~ fonds paid at sdtlaswt, wW be by exs6ltr': rJyedc o: aired funds, bat not by per- sons] check. (C) Deposits, rrgsrdiess of the form of paynxat and the person designated as pays, will be paid in U.S. Dollars to Broker for Seller (unless otherwise stated ha ~ ), who will tedrin deposits in sa escrow account in ty we all app cab a awe etrons un ' cansammahon a ta- ntination of thin Agroenxnt Only reel estate brokers are rexltrirod to hold deposits is aooadence with the rules and regaallations of the State Real Estate Cornmiaaion. Checb tendered ss deposit monies may be held unexahed pending the exeaxrti~ of thin ~°- ' SELLER ASSIST (U Appllubk) (1-10) Sella will pay S or °rf, of Putarase Price (0 if not apaafiod) toward Buyer's coats, as permitted by the mortgye leader, if any. Seller is Daly obligated ro pay up to the amount a paceatage which is approved by mortgage leader. SETTLEMENT AND POSSESSION (1-10) (A) Settkanot Date is Jul` 8 2011 , or before if Buys end Seller agree. (B) Settlement will oocarr m e coemty w ere ra err m ao lacxn! county, ' g normal bosineaa kiwis, antes Buys sad Sella agree e><herwise. (C) At time of aettlemeat, the following wrU be pno-rated oa a dar7y basis between Buys and Sella, reimbensiag whexe applicable: enrceat taus (see Notice Rega:+ding Real Estate Taxes); rents; intert~t on mortgage assumptions; corrdorninium fbd and homo- owner aseooctiatinn foes; wale and/or sews fee, together with any other lieaable munieapal service fees. All ehatgea wr71 be pro- rated for the period(s) covered. Seller will pay up bo and inchrding the date of eettlemmt end Buyer wBl pay for all days follow- in$ satlemeat, ualeas otherwise stated here: (D) veyanot from Sella will fee smrpk deed of apxtal wertarrty esa stated hoe+a . (E) Payment of tranafa taxes will be divided ogoelly between Buyer and Sellamless oWe:wise stated hat ~ Possession is to delivered by eonstiog keys and physical poesasion to a vacant Prerperty free of debris, with all strucdrres brvom~cloan, et day and time of sett]emeat, unless Sella, before aigaing this Agroeorent, has idcatifiod in writing that the Property is subject bo a lease. (G~ Ff Sella has identified in writing that the Prupesty is arrbjexx to a leasq pasaees;on is to be ddiver+ed by deed, existing keys and assignment of eaciating ]oases for the Property, together with secaariity dapoarts and inteuat, if say, at day and time tst' settlement Sella will not tuber into say new leases, nor extend existing lessee, far the Property without the witteu oonemt of Buyer. Buyer will edmowledge extitiag keao(a) by initialing the lease(s) at the e~toeartion of thin Agr+eerneat, unless otherwise atebod in this Agreement ^ Tenut-0eeapkd Properly Addeardam (PAR Form TOP) is s+tdtched. DATP.SlTIIMIE IS OF THE ESSENCE (I-10) (A) Written eooeptanex of all parties will be on or bdore:101Y 3 2 011 (B) The Sedtlemart Date and all other dates and tunes r eel fur any o ens o Agroanart are of the eaaeace and are binding. (C) The Exextrtiaa Dabo of this Agr+eenrart is the date when Buyer and Sella have indicated full soceptanoo of this Agnanent by sign- ing and/or initialing it Far prnpoxs of this Agroemerrt, the numbs of days will be counted fi»m the Ererartien Dste, excluding then day this Agreernerrt was executed and inchtding the last day of the time period. All clangs to tbls Agreement sTtoaW be W- tiaiod asd dated. (D) The Sdtlemeat Date is not extended by any other provision of this Agreaneot and rosy only be certtadecl by mutual written agrco- ment of the parties (>:~ Certain terms and tune periods are pro-printed in this Agreaneat as a oonvenienex >p the Buys sad Seller. All pro-prinbod terura end time periods are negotiable sad may bo drangod by atrr7ang out the pro~xiated teat and inverting diflaent terms aooeptable to all parties. ZONING (1-10) Failure of this Agreement to contain rho inning clessificatioa (except in cease where the property {and each parcel drereoi, if aubdi- vidable} is zoned solely or primarily to permit singlo-family dwellings) vhll render this Agr+eemart voidable et voided, any deposits tendered by the Buys will be returrrod to the Buys without any roquirenrerrt t?or court setian. Huye~a ~~ ~' Zonlreg Chnstflcatbn: 64 t3e+yer laitlats: ~ t " ASR Pose 2 of 11 Seller Routed L10 t~odree wdih avFa,na by spteyx learn Raven i~- peed F...er, ~~ rases mien Aasauk Vehicle, Schedule A.l 593 (8) AddldonBl Terms: 394 J97 i% s97 59B J99 600 401 602 603 604 605 606 607 60d 609 610 6!1 611 617 614 613 Buyer and Seller aclmowlt:dge receipt of a ropy of thie Aeree[oent at the ttes of dpiine 616 This Agreement may be executed !n one or more couaterperts, IAdt of which shag be deemed tp be Aa vrlgtud and wbich Wun- 617 terparts ugstber shsU constitute ons and the ume Agreewesd of the Pe[ri04, 61s NOTICE To PARTIES: ~N SIGNED, Tffia A.GRELM6NT IS A BIIiD~tQ troNTRACT. parties to this tramevtton are di 9 advipd to coaeule a Pennsylranla nal u[ate attorney before slping it' [hey dedre legal advla, 620 Return of this AEreemont, and any addenda and emerdcne[ik, including retprn by electrottk tranamltston, hung the signatpres 621 of eII pertlet, tonrdtutes acoeptaace by the par[les. ~ _/__ Buyer has received the ConeWaer Nottte et adopted by the Bdtte Red Estak Commission er 49 Pe. Code 613 (36.338. 624 _ / -~ Boyer hAS recdved n ste[ement of BuyW'e estlmeted tlodno Colts before signlag this Agrsem6ttt, 625 ~- /_ Buyer hes read aad uadertunds the aotitel and explanatoq blformation in this AgreeaunL 626 -_ /^ 627 61e _,~` 629 630 ,_~ / ~~ 43l 631 WITNESS 633 WITNESS Boyer hen received a Seller's property Disclvsutro Statement before signing this Agrument, it required by taw (see IAformadon Regarding the Red F.4tete BeLer DisMasure Lowy Haysr MAC rscslved the beposit Money Nothx (for cooperatlre sales when Srokar for Seller !s holdlaq deposit money) belltre eigalag this AgreetgenQ Buyer has reeelred the Lead-Based Paint Hoards Ixsrloeure, whieh !< Atptched to the Agreemeak of 8ele, and the pamphlet protect Yopr FE mliy from Lead 1a Your Hoals (for propertlee bnllt prior to 1p7~ BuY$a DATE ~~~~ 74881WI~' Viii , BUYER DATE 634 WITNYiS14 BUYER DATE `~~`~ 633 BeIIer has reee[ved the Comnmer Notke us adopted by the Stale Real Estate Commlulon dt d!1 Pe. Cod! @ 31.338. 636 Seller hoe reeelved a ststtement of Seller's a:tlmated clodag cosh bltore sledag this Agtetunen , 637 Seller has read and understands the Avdces and explanatory taforwtioa la this Agreethent. 63B WITNIl:SS AELL$ DATE ~ ~.2.T~ t: or =p 63Y WITNESS SE;LLEBI D~ITE 64o WI'IIYESS SELLBIi DAT$ ASR -asc 11 or 1 L Produpr Mm LpFom,te Dy slpleph 11070 flMAn MIi Ro.Udi Fa~u. MMHoen 4e90 ye~ar.[laL,oWr.o.,, A:An,lt Yehfcl., ZZO/4LOQi NOIl~tidlSNO~ A3NaV3~1 lEriLl88E18 XV~ 6E~pl IIOZ/ZO/~0 Schedule A.1 APPRAISAL Personal Property of T~~ ti ,r~ it ~~ f. i ~; v ,~,~ ,~ ~ ~= , c ~ U y c-~ ,2 ~ ~ ~l ~ r ~ ~ _~, ~i~ , i~J u.~ Appraised by Chuck E. Bricker AU094-L Date ITEM VALUE ITEM VALUE l7" 1 CI L~ !~. 7; C" hC L ~,. ~ _ ; c~ ~ ~ N G' /~` U L/-1 ~ ., {. o N~ s~-~ Z~ 2 s ~ J~a,oo ~ c I~(N~' rr~ se ~!-c,~, PCo c ~ A _ ~/~ tL F ~z.~fZ ~0 G ~ t~ ~~ U o _ L.~~NMt;t~~~• ~G,G R E' c L ; ~ 70 00 ~ ~ L_UM, oZ G ' ~- A d d ~ RS :2 i„, ~'~ 4- G ~ o /y/ HG ,4- << , L "`~ F3[. L~' d X I'i~~ 55 ~ A a .'N'' ~ - `f ~ ~ U. 0 S v T ~~ ~ ~ ssr, ?" ~t-s G ~, ~ ~~tc, c~2 ,v v - _ ~v/u ~i ,; c: L /fit L vU V t( t~ - L C~`c/ C ~ d UU N.l h - ~G _ 0 f ~, s ~Y'T L UU l I-~l , ~ c! p, o U ~ - /TC" t 0,00 r T nod o,~;e ~~ T /D,Ga - `` 5 Pic s J©,Uo - o~ i N i ~~ U,ao - .~ _c~~~ r ~~~ ~~ I f. - _~' ~lv,ilV (~ ~,~~/ / L QU ~ E,U~t d~-c~S U,O~ - N d '~k. 0, 0 d _ i ~ ~ Gt! l/E ~ ~ , G G? - - 5~ F'c_ K•s 1U,~o 55 (. ~CCC,-2c15 j~ G~ ;sT, f~tSi~+t~s l~cr - ~s ~ Ca - Schedule E.1 c • U. S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT OMB No.. 2502-0265 SETTLEMENT STATEMENT TITLEPF20 "' LIBERTY LAND TRANSFER, INC. B. TYPE OF LOAN 4660 Trindle Road, Suite 201 ~ 1. FHA 2. RHS ~ 3. CONV.UNINS. Camp Hill, PA 17011 a. vA s. coNV. INS.. 6. FILE NUMBER: 7. LOAN NUMBER; Phone: 717-975-9915 FAX: 717-763-7460 ssD75 MORT. INS. CASE NO.: C. NOTE: This form is furnished to give you a statement of actual sdflernent costs. Amounts paid to and by the settlement agent are shown. Items marked'(p.o.c.)' were paid outside the dosing;they are shown here for infortnagon purposes and are not inducted in the totals. D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDF_R Assault Vehide, LLC Jean Budisan Estate G. PROPERTY LOCATION: 406 E. Coover Street Medtanicsburg, PA 17055 Mecharraburg Borongfr Cumberland County, PA J. SUMMARY OF BORROWER'S 00. Gross Amount Due From Burro O7. Contract sales price 02. Personal Property 03. Settlement Charges (line 1400) H. SETTLEMENT AGENT: Liberty Land Camp Hill, PA 17011 K. SUMMARY OF SELLER'S TRANSACTION 400. Gross Amount Due to Seller 115,000.00 401. Contract sales price 402. Personal Property 2,062.38 403. 404. 405. ETTLf_MENT DATE: 12 20'11 11 Adjustments for kerns paid in advance by setler(5) Adjustments for items paid in advance by seller(s) 106. City/Town tax to 406. City/Tawn tax to 107. County/City tax 7/12/2011 to 12131!2011 324.74 407. County/City tax 7/12/2011 to 12/31/2011 324.7 108. Assessments to 408. Assessments to 109. Scholl Tax 7162011 to 6x302012 409. School Tax 7/82011 to 6!3012012 110. to 410. to 111. to 411, to 112. to 412 to 120. Gross Amount Due from Borrower 117,387.12 420. Gross Amount Due to Sallar 115,324.7 00. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller 1. Deposit Or earnest money 1,000.00 501. Excess deposN (see insWCtions) 2 Prindpei Amount of new loan(s) 502. Settlement charges to seller (line 1400) 6,900.0 3. Existing loan(s) taken subject l0 503. Existing loan(s) taken subject to _ 04. 504. Payoff of Fast Mortgage loan 05. 505. Payoff of Second Mortgage Loan 206. 506. Escrow -Inheritance Tax 5,250.0 207. 507, 208. 508. Adjustrnents for ffems unpaid by seller Adjustments for items unpaid by seller 210. Cky/Town tax l0 510. City/Town tax to 211. County/City tax to 511. County/City tax to 212. Assessments to 512. Assessments to 213. School Tax 7!12011 to 7/122011 44.42 513. School Tax 7/1/2011 to 7/1212011 q4,4 214. Trash 7/1201.1 to 7/122011 5.18 514. Trash 7/1/2011 to 7/122011 5.1 215. Sewer 7112011 to 7!122011 6.97 51.5. Sewer 7/12011 l0 7/12/2011 _ 8.9 216. to 516. to _ 217. 517. 218. 518. >t 9. 519. ?20. Total Paid by/for Borrower 1,058.57 520. Total Reduction in Amount Due Seller 12,ypg, 500. CASH AT SETTLEMENT From/To BORROWER 600. CASH AT SETTLEMENT To/From SELLER 501. Gross amount due from borrower (line 120) 117,387.12 601. Gross Amount due Seller (line 420) 115,324.7 ID2. Less amounts paid by/for borrower (line 220) 1,058.57 602. Less reduction in amt. due Seiler (line 520) 12,208.5 103. Cash ®FROM ~ TO Borrower 116,328.55 603. Cash ®TO ~ FROM Seller 103,116.1 Jean Biu3ison Es/t~ate ~ /, Buyer or Borrowers Signature Seller's SignaWre _ l Sched>ile H. B . 7 Hu°-1 L. SETTLEMENT CHARGES Case # 95075 700. Total Real Estate Broker Fees S 3,750.00 Paid From Paid From Division of commission (line 700) as fellows: Borrowers SelleYs 701. 5,750.00 to F~cit Platinum Plus Realty Funds At Funds At 702. to Settlement Settlement 703. Commission paid at Settlement 5,750.00 704. to 800. Items Payable in Connection With Loan 801. Our origination dtarge (from (GFE #1) 802. Your credit or charge (pelvis) for the interest rele chosen $ (from (GFE #2) 803. Your adjusted origination charges to (from (GFE A) 0.00 0.0 804. Appraisal Fee to (from (GFE #3) 805. Credit Report to (from (GFE #3) 806. Tax Service to (from (GFE #3) 807. Flood ceRfication to - (from (GFE #3) 808. to 809. to 810. to 811. to 812. to 813. to 814. to 900. Items Required by Lender to Be Paid in Advance 902. Mortgage insurance premitrrl for 0 months to (from (GFE #3) 903. Homeowner's insurance premium for 0 years to (from (GFE #11) 904. to 1000. Reserves Deposked with Lender 7001. Initial deposit for your estaow account (from (GFE #9) 0.00 0.0 1002. Homeowners insurance 0 Months @ $ /Month 1003. Mortgage Insurance 0 Months @ $ /Month 1004. Property taxes 0 Months @ $ Month 1005. 0 Months @ $ /Month 1006. 0 Months @ $ /Month 1007. Aggregate Adjustment - 1100. Title Charges 1101. Title services and lentlefs title instrance (from (GFE #4) 10.00 0.0 1102. Setllemenl or dosing fee to Liberty Land Transfer 1103. Owners title insurance to Liberty Land Transfer (from (GFE #5) 840.38 1104. Lenders UUe insurance 1105. Lenders title policy limit $ 1106. Owners title policy limit $ 115,000.00 1107. AgenCs portion of the total title insurance premium 714.32 1108. Underwriters portion of the total title insurance premium 126.06 1109. to 1110. to 1111. to 1200. Government Recording and Transfer Charges 1201. Govemment recording idtarges (from (GFE #7) 62.00 C 1202. Deed $ 62.00 Mtxtgage $ fA~eb~yf Deeds 1203. Transfer taxes (from (GFE #8) 1,150.00 1204. City/Counry lax/stamps Deed $1,150.00 Mortgage S Recorder of Deeds 1205. State tardstamps Deed $1,150.00 Mortgage $ Recorder of Deeds 1,150.00 1206• to Recorder of Deeds - 1300. Additional Settlement Charges - 1301. Required services that you tan shop tor (from (GFE #6) 0.00 - 1302. to - 1303. to - 1304. to - 1305. to ' - 1306. to - 1307. to ' - 1400. Total Settlement Charges (enter on lines 103, Sections J and 502, Sections K) 2,062.38 6,900.0 Parties agree that no kabalty l5 assumed by Settlement Agent for the accurary of information (umishetl by others es shown on the HUD-i Settlement Statement. HUD CERTIFICATION OF BUYERS AND SELLERS 1 have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, fl Ls a true and atxurate statement of all receipts and disbursements made on my account by me in this transaction. I further certify that I have received a copy of the HU0.1 Settlement Statement. Jean B~lison Estate Buyar or Borrowers Sgnature Severs SknatuEE Buyers Address 8 Phone: Sellers New Addmss 8 Phone: The HUD-t Settlement Statement which I have prepared is a we and accurate account of this lransacbon. I nave causetl or will cause the (ands b be disbtxsetl in accomance with this statement. Battlement Agent Dale --'-' WARNING: It is a come to krwwingly make false statements to the Urutetl States on this or any similar form. Penalties upon mnvicaon can inUude a fine and impnsonmenl. For details see Ttlle 18: U.S- Code Section 1001 and Section 1010. Schedule H.B.7 .~ .~. u o uerAti IMt:N I yr rtouetNa and URBAN DEVELOPMENT OMB No. 2a02.OZes SETTLEMENT BTATlMWT TITLEPRt7 TM LIBERTY LAND TRANSFER, INS, 8. TYPE QF LOAN 4680 7rindle Road,uUlte 201 t. FHA 2, RHS 3. f:ONV.UNM18 Camp HIII PA 17011 , 4 yA a coNV. tNB 8 FILE NUMBER, 7. LOAN NUMBER: Phone: 7t7-B76-9815 FAX; 717-783-7460 eao7e MORT INS. CASE NO.. C. NOTE: Thlra icon u futnlahed to ttiw you a nnement of ^dunlwtth~mern ooeta Ameurne peld a enC UY the »Nnnanl agent ere ehom, lame mukw'(p,aG}' wen Pald 0ulalde the cloelnp; they an lhWrn Man for IrNortnmbn purpoea~ utd an nol Included M the ten$, D. wNO ADDRESS OF BORROWtR: E, NAME ANO ADDRE66 0 R: F, NAME AND A 6 OF LENDER Aaeeult yaNcle, LLC Jean Burllron ~tne G PROPERTYLOCATION• FL SETTLEMENT AGENT; LbenyLend7r^n^ter t.BETflEMGNTDATE 400 E, Coovrar event dal 12 zDt'I M•Gh•rdceburp, PA 17066 7ueadey Mechnfubup Btxvupn PLACE OF RETTLEMENT: dge0 Tnndk Rwd, Cumb^rl^rtC Counly, PA Cemp kiM, PA 57011 J. SUMMARY OP llQRROWER't- NSACTIO !(, eUMMARY OP $EI,I,.ER•8 TRANSACTION 00 Oroee Amount Pue From Borrower 400, Groh Amount oue to Eelter 101. CorWeaeerotrprim tt6,00000 a01, Conyaaealeepnp tts,oo0, oz, Perwrwl Property 402, Penortal Properly t03, BeeMemern Ch^ryse ulna 1400) 2,Oe2,39 403. 709, apq 706, X00. Ad~lroenle for Mama paAltl In adwnce q' eat~r(c) A~uevnenm for Ilam^ Dab N ^dv^nq by pli^ri^) t 08 GMtrl7'own to (0 40a. CldlTttwn lex t0 107. CounylGlrytex 7H 212011 to tala1r2011 324,74 407. CourxyrCnyua 711212ott to 12l3t120tt 324 74 toe. a,esematt: to , 4os, Mouemenra to t08. Sd+oolTax 71BR011 to tt+d012012 406. 3rhoolTea 7/6!2011 W 9f30f2p1Z t 1a to 410. ~ 117. 10 411, to I1z ro a12. ,o HUb-t Schedule H.B.7 finnlinnFr3~ ~tnTi~nutounr, A~uuu~~ tcr.iioocto vu~ n~ ni iin~~~i Iin ~-~- Buyer or Bortowe('6 8lgneluro SII•P6 8 9n6tUfb -~ - - ---~--- -~ -••-•~•-••• nv^m mrm^ ^Oaunry 6t nrolmetltln ftiml.h.q eY tlN^n ^. e0own On the HUD•1 S^Ilbmenl Bt^grnml. I have cerefuAy revlswetl Vw HU0.1 Seabmem 8lelem m end to Ih be~e1 o ON p owl~dG~ ~~ yal ~ELfLERB e mebup~mertu metlo on my ecoourn by me ~ 1hw ireneef;+aOn, l f~Or ~ ertd occufem elelemem p( ^fl recelple end ~kY 41 ~ Mv~ tseeived a copy of the HUO.1 BeHlemetil Slelsmenc Buyer of BOrto1HI pnefuro Beller^ pnelun BWefe Atldr^^^ a Phonr. -~ S^INh NewAddrue 8 Phone; thl^ peum.nL h^ MU0./ S^dleRNAI f nl^m^nl vfilcn I have pnPemtl le a INe ^na ^pWr11e eoaovnt O} 1hi^ Nn^i000a have Gu^^d ar MO Nuu IM tund~ m tlUbun^a In etc^r~in~w M11h 9^IB^m^nl Apenl WARNING. n N e alm^ fo knawlnpiy make fd^^ IUteT^rw m Ne UNI^d ealee an Ihl^ or enytl^Imll^rferm. P^neltln upon ovnvaion pn hdud^ ^ Me ena hnDmm~menl For deWll ^^^'1'fIM 10' U 9 Cotle f^otlOn 1001 ena B^04on 1010 Schedule H.B.7 400/7001 Nf1TI:1fIHISNf1:1 A~NHb'a5l LSGILRAF.LR XN~ 07.:dL LL07/7L/JO