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HomeMy WebLinkAbout04-0778 PETITION FOR PROBATE and GRANT OF LETT.~RS Estate of_~ Rol-ty .1_ Mntzabaugh also known as To: · Register of Wills for the _ _IliA Deceased. County of Cumberland in the Social Security No. 193-12-5722' Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executor named , 19 80 in the last wilt of the above decedent, dated · ...... y ? and codicil(s) dated N/A Melvin M. Mutzabaugh predeceased Betty J. Mntzabaugh on Jnauary 2: 2002. (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in _ Cumberland County', Pennsylvania, with h_er last family or principal residence at 424-A Brandy Lane, ttamnden Toranghip; _ Cumberland County~ Pennsylvania (list street, number and muncipality) Decendent, then 3'9 years of age, died__ Augu.qt 10, xtO~L0116~, at_Holy _Spirit ltospital: v.a~r ponnghnrn Tnum~hlp ' Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of th~/~l offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: unknown (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ $ unknown Value of real estate in P~gs_y/[vaBnriaandy Lane, Mechancisburg, PA situated as follows: WHEREF~[RE, petitioner(s) respectfully' req:aest{s) the Crobate of the last will and codicil(s) ~.esramentary presented her~vith and the grant of letters (testamentary; administration c.t.a.; administration d.b.n.c.t.a,) theron. 0'4 7~' ~ . M~chael M. Mutzabaugh ~ ' ~.~< 2165 valley Road ==:~. Marysville, PA 17053 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF P~ENNSYLVANIA } ss COUNTY OF C~}~6 g-T~btk~ The petitioner(s) abo,~e-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to t~e best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s)will w~/nd t7 ad~ the estate according to law. Sworn to or affirmed -and subscribed C c~' before me this ,.~(~ day of / Mit-h~ol M ,, August ~ , l~X 20041 Estate Of Betty J. Mutzabaugh , Deceased DECREE OF PROBATE AND GRANT OF LETTERS A the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated. January 7, 1980 described therein be admitted to probate and filed of record as the last will of. Betty J. Mutzabaugh and Letters Testamentary Michael M. Mutzabaugh are hereby granted to Regisier of Wills FEES Probate, Letters, Etc .......... sho~t Ceai:¢~t~( ) .......... s '~: ( ~ith o. ~n~ Renunciation ............... $ 66 ~. ~in Street, ~echancisburg, PA 17055 (717) 697-8528 Filed ................................... CERTIFICATE OF DEATH Betty J Mutzabaugh z Female a 193-12-5722 ~ August 1i}~"2004 hc~e Zora Weidenha~meI REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw the testat ., sign the same and that signed as a witness at the request of testat__ in h.__ presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of (Name) 19 (Address) Register o (Name) (Address) I~GIS~R OF WILLS OF ctr~V.R~a~D COUNTY OATH OF NON-SUBSCRIBING WITNESS Michael lq. lqutzabaugh (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that he ia familiar with the signature of aotry .l M,,l'~ahn,,gh , testatrix of (one of the subscribing witnesses to) the will presented herewith and codicil that he believes the signature on the will is in the handwriting of Betty J. mutzabaugh to the best of his . knowledge and belief. Sworn to or affirmed and svbscribed before ~ Oa ~ me this 20th day of lqichae! M. MutzaOda{t'~°l~ t t August 1~ 200h 2165 Valloy I~narl Maryswillo, ~a 17053 ' ~,- 4- ~ ~ ~ (Name) (Addressj REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw the testat_ ., sign the same and that signed as a witness at the request of testat__ in h~__ presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of (Name) 19 ~' (Address) c? Register (Name) (Address) REGISTER OF WILLS OF cut. mgmo~D COUNTY OATH OF NON-SUBSCRIBING WITNESS Keith O. Brenneman (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that he is familiar with the signature of n,~vvy · M,,v~h=,.gh , testat rix of (one of the subscribing witnesses to) the will presented herewith and codicil that he believes the signature on the will is in the handwriting of Betty J. Mutzabaugh to the best of his knowledge and belief. Sworn to or affirmed and subscribed before I me this 20th day of Keith O. Brenne~,mel~squire August ,1:~ 2004 /,/, ,a u. hain Ct., ~.__t.__~: ~,>; .: t ~ , ,, .,_ , ~, ~ ............... ~, ~A 17055 ~ k~. / '-~ ~ / :~ ' Register , - ~r-4~ -~ (Name) ' -J (Address) LAST ?TILL AND TESTAmeNT I, BETTY J. ~TZABAUGH, of the To~mship of Hampden, County of Cumberland and State of Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this to be my last Will and Testament, hereby revoking and making void all former wills, codicils and other testamentary dispositions by me at any time heretofore made. !. i direct my executor, hereinafter named, to pay as soon as prac- ticable after my decease all my just debts and the expenses of my last illness and burial. 2. I give, devise and bequeath all of my estate real, personal and mixed - unto my husband, ~elvin M. Mutzabaugh, absolutely. 3. Should my said husband predecease me, then and in that event I give, devise and bequeath all of my said estate unto my son, Michael Id. i{utza- baugh. 4. I hereby nominate, constitute and appoint my husband, Melvin M. Mutzabaugh, executor of this my last Will and Testament. Should my said husband fail to qualify or cease to act as executor, I appoint my son, Michael M. Mutzabaugh, executor of this my last Will. IN WITNESS W~HEREOF, I, BETTY J. ~!UTZABAUGH, the testatrix, have hereunto set my hand and seal to this my last Will and Testan~ent this day of January, 1980. '-, :' (S~AL) Signed, sealed, published and declared by the above named Betty d. >~utzabaugh as and for her last Will and Testament in the presence of us, who, at her request and in her presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Betty J. Mutzabaugh Date of Death: August 10, 2004 No. 21-04-0778 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiary of the above-captioned Estate on August 20, 2004. Name Address Michael M. Mutzabaugh 2165 Valley Road Marysville, PA 17053 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None. Date: August 20, 2004 F Keith O. Brenneman, Esquire Snelbaker, Brenneman & S][~Ae~ p. C. 44 W. Main Street Mechanicsburg, PA 17055~ i ~,:~: :~, (717) 697 8528 ' :~ ' Counsel for Personal Repre~'~mativevo LAW OFFIC[$ SNELBAKER BRENNEMAN PENNSYLVANIA RECEIVED FFIOM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004567 MUTZABAUGH MI HAEL M 2165 VALLEY RO~D MARYSVILLE, PA 7053 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 $16,140.26 ESTATE INFORMATION: SSN: 193125722 FILE NUMBER: 2104-0778 DECEDENT NAME: MUTZABAUGH BETTY J DATE OF PAYMENT: 1/01/2004 POSTMARK DATE: 1/01/2004 COUNTY: CUMBERLAND DATE OF DEATH: 08/10/2004 TOTAL AMOUNT PAID: $16,140.26 REMARKS: MICHAE M MUTZABAUGH CHECK# 100: INITIALS: VZ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PEI~ ~ISYLVANIA COUNTY OF CUMBERLAND j ss: Michael M. Mutz ,augh being duly sworn __ according fo law, deposes and says fhaf he is the Ex~ ~utor of fhe Esfafe of Betty J. Mutzabaugh [ale of Hampden Tor, rn~!hJ__p__ _, Cumberland Counfy, Pa., deceased and fha+ fha Michael M. Mutzabaugh ., {'he said Executor w;fhin {s an Jnven{'ory made ~y of {'he enHre esl.ale of sa~d cecedenf, consis{.ing of all fhe personal property and real esfa{'e, excepf real esl'ate oufside fhe Commonwealfh of Pennsflvania, and {'hal {'he figures opposi{'e each |fern of {'he Inven~'ory represenf if's fair vaIue as of ~'he da{'e of deceden{'': deafh. Sworn to .and subscribed before me, ~ ~ ~ Execufor - Admin;sfrafor ~-~/~'//~'f,~- ~'~'~ ~ 2004 Michael M. Mutzabaugh .<< zn z--~-~ . ~ Marysvzl/e, PA 17063 COMMONWEAl'TH Notar BI Seal Addr.~ Susan b Ma~ ~J, Notary Public MeCilanicsburg Bor( Cumberland County My Commissio~ E: ~res Nov. 24, 2007 Member. Pennsylvania ~l.s~ociation Of Notaries August 2004 Dale of Dea{'h ~ay Monfh Year INSTRUCTIONS I. An Jnvenfory mus{' be ;ed wifh~n {'brae monfhs affer appo;nfmenf of personal represenfafive. 2. A supplemenf inven{'or musf be filed wifh~n fhlr{'y days of d[scoveryof addltionalassefs. 3. Additional sheers may aH'ached as fo personaJ{.y or really 4. See Article IV, Fiduciarh Acf of 1949. Inventory of the real and personal estate of Betty J. Mutzabaugh deceased i. REAL PROPERTY. All that certain ~and improved with a residential dwelling located partly in Hampden Township and partly in the Borough of Mechan~csburg, Cumberland County, Pennsylvania as more fully des,:ribed in Cumberland County Deed Book "W", Volume 16, Page 4.. Sales Price (October 1, 2004) $89,900.00 TOTAL APPRAISED VALUE, REAL ESTATE: $89,90( )0 II. PERSONALTY. Wachovia Bank, N.,b., Certificate of Deposit No. 2474120718714i5 $71,304.29 Miscellaneous per:~onal property and furnishings 935.00 Waypoint Bank a. Certificate of Deposit No. 1800004967 51,586.23 b. Certificate of Deposit No. 9600016406 72,556.64 Citizens Bank a. Checking Ac~ount No. 6100700348 1,562.12 b. Time Deposi Account No. 6140-773768 39,609.59 The Patriot News' subscription refund 82.80 Comcast - cable s, rvice refund on account 1.98 TOTAL APPRAISED VALUE, PERSONALTY: ~237,638 66 TOTAL APPRAISED VALUE, ALL PROPERTY: $327,538.66 ooM o, ,E^.T. oF REV-1500 , PENN: ;YLVANIA ._ DEPARTMEI~ TOF REVENUE ~DEPq 28060 INHERITANCE TAX RETURN FILENUMBER 2 1__0 4 0 O 778 fi" HARRISBUR( PA1712843601 RESIDENT DECEDENT DECEDENT'S NAME (LAS~ RSr. AND MIDDLE INITIAL) i SOC[ALSECURITYNUMBER ~.~ zabaugh Betty J. 193 12 5722 9ATE OF DEATH (MM-DD-YE ~R) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE DATE OF BIRTH (MM-DD-YEAR) 08-10-2004 09-30-1924 I REGISTER OF WILLS FAPPLICABLE) SURVIVING POUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) ~ SOCIALSECURITYNUMBER [~ 4 Limited ECa~e E~ 4a Future Interest Compromise .:ca e o'c~[h ~ ~ 12~2) [~] 5 Federal Estate Tax Relum Required [] 6 Decedent Died Testat. (AL'~gh Copt of Will) [] 7 Decedent Maintained a Living Trust !A-~ch cop~ o' Tn.s[} I 8 Total Number of Safe Deposi[ Boxes [] 9 Litigation Proceeds R, ceived [] 10. SpousalPove~C ed I ..... ~be e. 2-; ' a ,195, [] 11 ElectiontotaxunderSec 9113(A):A:~S ~0) THI~ ~1~ ON;MUST; E ~OMpLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX !NFORMATION SHOULD BE DIRECTED TO: ~AME COMPLETE MAILING ADDRESS Keith O. B:;enneman, E_squire 44 W. Main Street Mechanicsburg, PA 17055 Snelbaker, Erenneman & Spare, P. C. 697-s: 2s 1 Real Estate (Schedule A (1) 89,900. OO 34,242.42 29,225.26 391,006.34 12,828.53 made (Schedule J) 3 7 7,5 3 9.1 2 16,989.26 ! > t, BE suRE TO ANSWERA~ QUESTIONS ON R~ERSE S DE AND RECHECK MATH ~ < Decedent's Complete I~ddress: ISTREET ADDRESS 424-A rand), Lane CIT'~ Mechan:~csburg ] STATE PA ] ZiP 17055 Tax Payments and Crt lits: 1. Tax Due (Page 1 Line 19) (1) 16,989.26 2. Credits/Paymeets A, Spousal Poverty CredR B, Pdor Payments _ ] 6 ~ 140.26 C Discount 849.00 Total Credits (A + B + C ) (2) 16,989.26 3 interest/Penalty if applicable D Interest E Penalty Total interest/Penalty ( B + E ) (3) 4. if Line 2 is greater than Line 1 4. ne 3, enter the difference. This is the OVERPAYMENT. Check box on I age 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater thac Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax ~ ue. (5A) B Enter the total of Line 5 + 5A This is the BALANCE DUE. (5B) -o- Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWE THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent I~ake a transfer and: Yes No a, retain the tJse or income of the property transferred; [] [] b. retain the ~9ht ta designate who shall use the property transferred or its income: [] [] c. retain a reversionary in e es; o [] [] d. receive the promise for life of either payments, benefits or care? ................................................................ [] [] 2. If death occur ed after Becember 12, 1982, did decedent transfer property within one year of death without receiv g adequate consideration? .......................................................................................................... [] [] 3. Did decedent ~vn an "in trust for" or payable upon death bank account or security at his or her death? ............ [] [] 4. Old decedent wn an Individual Retirement Account, annuity, or other non-probate property which contains a be !flciary designation? [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. SIGNAT~IRE 0 IDLE FOR FILING RETURN DATE , E,,ec, tor ABORESS 2165 Valle, Marysville, PA 17053 SIGNATURE( REPRESENTAT[VE ADDRESS 44 W. Main St eet~ Mechanicsburg, PA 17055 For dates of death on or after Jul 1994 and before Januar7 1 1995. the tsx rate imposed on the net value of transfers ~o or for the use of the survivtsg spouse is3% 172PS §9116(a) 11)i)] For dates of death on or aftsr Janu ry 1 1995 the tax rate imposed on the net value of transfers to or for the use of the surviving spouse ~s 0% [72 PS §9116 (a} (1 1) (ii)l the surv~wng spouse is the only ben( ~ciary For dates of death en or after July 1,2000; The tax rate imposed on the net va ~e of transfers from a deceased child twenty-one 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% [7; P.S §9118(a)(1.2)1 The tax rate impoeed on the net vail The tax rate imposed on the net vi lue of transfers to or for the use of the decedent's siblings ~s 12% I72 PS. §9118(a}(1 3)1 A sibling is defined under Section 9~02 as an individual who has at least one pare ~t in common with the decedent, whether by blood or adoption SCHEDULE A OOMMONWEALTH OF PEI SYLVAN,A REAL ESTATE INHERITANCE TAX R ~ESIOENT DECEE ESTATE OF FILE NUMBER Betty J. 21-04-00778 All real property a tenant in common must be reported at fair market value. Fair market value is defined as the prce at which properly would be buyer and a willing selleg neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t that certain land improved with a residential ling located partly in Hampden Township and partly Borough of Mechanicsburg, Cumberland County, 'lvania as more fully described in Cumberland ~ty Deed Book "W", Volume 16, Page 41. :s Price (October 1, 2004): $89,900.00 TOTAL (Also enter on line 1, Recapitulation) $ 89,900. O0 (Lf more space is needed inser~ additional sheets of the same size) REV 1508 EX+ (6-98) I ,,~ SCHEDULE E COMMONWEALTH OF F NNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX ~ETURN PERSONAL PROPERTY R~SlDENT DEC )ENT ESTATE OF FILE NUMBER Betty J. Mt :zabaugh 21-04-00778 Include the proceeds of litigation and the date the proceeds were received by the estate All property jointly-owned with fight of survivorship must be disclosed on Schedule F ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Wachovi. Bank, N.A., Certificate of Deposit No. 2474120 ~871455 71,304.29 2. Miscell ~eous personal property and furnishings 935.00 3. Waypoin Bank a. Certificate of Deposit No. 1800004967 51,586.23 b. Certificate of Deposit No. 9600016406 72,556.64 4. citizen Bank a. Checking Account No. 6100700348 1,562.12 b. Time Deposit Account No. 6140-773768 39,609.59 5. The Pat lot News - subscription refund 82.80 6. Comcast - cable service refund on account 1.98 TOTAL (Also enter on line 5, Recapitulation) $ 237 ~ 638.66 (If more space is needed, insert additional sheets of the same sizej REV 1509 EX"' (6~98) _ ,¢~' SCHEDULE F COMMONWEALTH OF PE 4NSYLVANIA JOINTLY-OWNED PROPERTY iNHERITANCE TAX F ETURN RESIDENT BECEl lENT ESTATE OF FILE NUMBER Betty fl. Mut: ~baugh 21-04-00778 [fan ~set was made joint within one year of the decedent's date of death, [f must be reported on Schedule G. SURVIVING JOINT TE ~,NT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Michael M. Mul zabaugh 2165 Valley Road Marysville, PA 17053 son B JOINTLY-OWNED PROPER' Y: DESCRIPTION OF PROPERTY BATE OF DEATH ITEM INOLUOE NAME OF FINANCIAL INSTITUTIQN AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH VALUE OF NUMBER IDENTIFYING NUMBER ATIACH DEED FOR JOINTLy. HELD REAL ESTATE VALUE OF ASSET DECEDENTS INTEREST ~ Commerce Bank Savings Account $68,484.84 $34,242.42 No. 616300926 TOTAL (Also enter on line 6, Recapitulation) 34,242.42 (if more space is needed, insert additional sheets of the same size) EX* (6-9e SCHEDULE G COMMONWEALTH OF PEI 4SYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX R TURN MISC. NON-PROBATE PROPERTY RESIDENT DECEE ENT ESTATE OF FILE NUMBER Betty J. M ~tzabaugh 21-04-00778 This schedule must ~e completed a~ filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM ~NCLUD£~ NA~O¢'~ETRANSFEREEPCEIRRELATIONSHIpTODECEBENT.M~D IATE OF DEATH %OFDECD'S EXCLUSION TAXABLE NUMBEH mEo~ 'EOF TRAhSFER ATTACH ACOPyOF mEDEED FORREALESTATE VALUE OF ASSET INTEREST (iF APPL,CAI~LE) VALUE 1 MetLife Aniuity. Date of Transfer: August 10,906.2~ 100% 10,906.28 10, 2004 (,late of death). Transferee: Michael M. Mutzabaugh (Decedent's son). Contract N). A2044492 2. Iefferson ~ilot IRA. Date of Transfer: 18,318.9~ 100% 18,318.98 August 10, 2004 (date of death). transferee Michael M. Mutzabaugh (Decedent ' son). TOTAL (Also enter on line 7 Recapitulation) $ 29,225.26 (if more space is needed, insert additional sheets of the same size) FUNERAL EXPENSES & COMMONWEALTH OF PI 4NSYLVANIA NHERITANCE TAX :~,ETURN ADMINISTRATIVE COSTS RESIDENT DEC~ DENT ESTATE OF FILE NUMBER ;eLtO' J. Ml~tzabaugh 21-04-00718 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EX[ ENSES: Malpezz FuneraI Home $3,198.72 B ADMLNISTRA'1 VE COSTS: 1. Personal Re resentative's CommissLons Nane )fPersonaIRepresentative(s) Michael M. Mutzabaugh waived Sccial Security Number(s)/EIN Number of Personal Representative(s) Street ~ddress City State __ Zip Year(: I Commission Paid: 2. A~t0rneyFe( to Snelbaker, Brenneman & Spare, P. C. 2,500.00 3 Family Exen tior~: (if decedent's address is not the same as claimant's, attach explanation) 4. ProbateFe, Initial: $69.00; Additional fee: $255.00 324.00 5. Acc0untanr~Fees to Greenawalt & Company, P. C. 250.00 Reserxe for filing fees, notary fees and miscellaneous 7. expen.~ es 200.00 8. Adver!ising costs - grant of letters: a. the Patriot News $211.81 b. Cumberland Law Journal 75.00 286.81 9. Chuck 5ricker, Auctioneer - appraisal fee (personalty) 75.00 10. State local transfer tax upon sale of realty 899.00 lt. Dugan Realty Group/Homes of Central PA - sales com~ission, real estate 4,495.00 TOTAL (Also enter on line 9, Recapitulation) $12,828.53 ,,~ SCHEDULE I COMMONWEALTH OF qNSYLVANIA DEBTS OF DECEDENT, INHERITANCETA RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DE( EDENT ESTATE OF FILE NUMBER Betty J. M1 ttzabaugh 21-0/4-00778 Report debts incul Id by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 United Water - payment on account 11.08 2. Westsh(re EMS - payment on account of medical service 587.87 3. PP&L - payment on account 27.92 4. Verizo[ - payment on account 11.82 TOTAL (Also enter on line 10, Recapitulation) $ 638.69 (If more space is needed, insert additional sheets of the same size) SCHEDULE J COMMONW~TH OF PE ~NSYLVANIA BENEFICIARIES ESTATE OF FILE NUMBER BeLLy J. Hu Lzabaugh 21-04-00778 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE Sec. 9116 (a) (1.2)] Michael M. Mutzabaugh son 100% 2165 VaLley Valley Road MarysviLIe, PA 17053 ENTER DOLLAR t MOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET Il NON-TAXABLE DI ~TRIBUTIONS: A SPOUSAL Ol.~ I'RIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX iS NOT BEING MADE B. CHARITABLE, ,ND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PAR' - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional shee[s of/he same size) OMB NO, 2502-0265 lr A. B. TYPE OF LOAN: U.S. DEPARTMENTOF HOUSING URBAN DEVELOPMENT 1.[~FHA 2.F]FmHA 3. E~CONV. UNINS. 4.[~VA 5. ~]CONV. INS, 6, FiLE NUMBER: I 7 LOAN NUMBER: PH04268 SMRI 2359~44 SETTLEMENT ;TATEMENT 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished t ~ give you a statement of actual settlement costs. Amounts paid to and by the settlement a¢ent are shown. /terns marked "[POC]" ~ ~ere paid outside the closing; they are shown here for informational purposes and are not included in the totals. I 0 3/98 (PH04268_SMR PFD/PHO4268_SMPJ13) D NAME AND ADDRESS OF BO8 ROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: WILLIAM L SHIPMAN. JR. and ESTATE OF BE~q'Y J, MUTZABAUGH CONSUMER MORTGAGE SERVICES INC DEBORAH S, SHIPMAN 999 WEST CHESTER PIKE, STE 200 WEST CHESTER, PA 19382 G. PROPERTY LOCATION: H, SETTLEMENT AGENT: 25-1648139 i. SE~q'LEMENT DATE: 424A BRANDY LANE PENN HERITAGE TRANSFER COMPANY MECHANICSBURO. PA 17055 October 25, 2004 CUMBERLAND County, Pennsylva~ ~a PLACE OF SE%I'LEMENT 3464 TRINDLE ROAD CAMP HILL, PA 17011 J SUMMARY OF BOI ~ROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FRON BORROWER: 400. GROSS AMOUNT DUE TO SELLER: ~01. Contract Sales Price 89.900.00 401. Contract Sales Price 89,900,00 102. Personal Properh/ 402. Personal Property 103. Settlement Charges to Borrow( r (Line 1400) ~ 3,900.48 403. 104, i 404. 105. j 405. Adjustments For Items Paid, tv Seller in advance Adjustments For Items Paid Bv Seller in advance 106. Cib//Borough Taxes to ! 406. CiL~/Borough Taxes to 107. Count~/TwpTaxes 10/2[r04 to 12/31/04 ~ 4036 407. County/TwpTaxes 10/25/04 to 12/31/04 : 40.36 108. School Taxes 10/2[ r04 to 06/30/05 59276 408. School Taxes 10/25/04 to 06/30/05 i 592,76 109. Sewer/Refuse 10/25/04 to 01/6 1/05 85.00 409. Sewer/Refuse 10/25/04 to 01/01/05 I 85,00 120. GROSSAMOUNTDUEFRON BORROWER 94,518.60 420. GROSSAMOUNTDUETOSELLERI 90,618.12 200. AMOUNTS PAID BY OR IN BI ~ALF OF BORROWER: 500, REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money 1,000.00 501. Excess Deposit (See Instructions) 202. Pdncipa~ Amount of New Loan, s) 85,40500 502. Settlement Charges to Seller (Line 1400) 5,400.00 203. Existing loan(s) taken subject t 503. Existing loan(s) taken subject to 204. 504. Payoff of first Modgage 205. ~ 505. Payoff of second Mortgage 206. 506. 207 507. (Deposit disb. as proceeds) 208 508. 209. Closing Costs Paid By Seller 509. Closing Costs Paid By Seller Adjustments For Items Ut laid By Seller Adjustments For Items Unpaid By Seller 2t0. Cit~/Borough Taxes to 510. City/Borough Taxes to 211. Count*//Twp Taxes to i 511. Count)'/Twp Taxes to 212 School Taxes to I 512, School Taxes to 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220 TOTAL PAID BY/FOR BORRC '¢ER 86,40500 520. TOTAL REDUCTION AMOUNT DUE SELLER 5,400.00 300. CASH AT SETTLEMENT FRO VI/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borr( wer (Line 120) 94,51860 601 Gross Amount Due To Seller (Line 420) i 90,618 12 302. Less Amount Paid By/For Borr ~wer (Line 220) ( 86,40500) 602. bess Reductions Due Seller (Line 520) ( 5,400.06 303. CASH( X FROM)( TO)B(~RROWER ~. 8,11360 603, CASH( X TO)( FROM) SELLER I 85,218.12 The undersigned hereby achnowie t~e recefet bf a comseted copy of pages 1&2 of this statement &anv attachments referred to herein ~VILLIAM L, H~PMAN~JR;~/'__ .~ ~' ESTATE OF BETTY J. MUTZABAUGH DEBORAH S SHIPMAN L. SETI'LEMENT CHARGES 700. TOTAL COMMISSION Based ,n Price $ ~,, % 4,49~,QQ PAID FROM PAiD FROM Division of Commission (line '00) as Follows: BORROWER'S SELLER'S 701. $ 1,798.00 tO DUGAN REALTY GROUP ~UNOSAT FUNDSAT 702. $ 2,69700 to HOMES OF CENTRAL PA, INC SE%ILEMENT SE~LEMENT 703. Commission Paid at Settlemer 4,495.00 704 to 800. ITEMS PAYABLE IN CONNE( :TION WITH LOAN 801 Loan Originatiqn Fee % to 802. Loan Discount % to 803 Administrative Fee to CONSUMER MORTGAGE SERVICES, INC 600.00 804. Processing Fee to CONSUMER MORTGAGE SERVICES, INC 375.00 805 Application Fee to CONSUMER MORTGAGE SERVICES, INC. 350.00 806 Mortgage Ins. App. Fee to 807 Assumption Fee to 808 809 810 811. 900. ITEMS REQUIRED BY LENDE R TO BE PAID IN ADVANCE 901. Interest From 10/25/04 to 11/01/04 @ $ 13.454200/day ( 7 days %) 94.18 902 Mortgage Insurance Premium or months to 903. Hazard Insurance Premium for 1.0 years to 904. 905. 1000. RESERVES [~[~POSITED WI 'H LENDER 1001.Hazard Insurance 3.000 months ~ $ 25.00 per month 75.00 1002. Mortgage Insurance months ~ $ per month 1003. CilT/BoroughTaxes months ~ $ per month 1004. Count~/TwpTaxes 10.000 months ~ $ 17.75 per month 177.50 1005. School Taxes 5.000 months ~ $ 70.97 per month 35485 1006. months ~ $ per month 1007. months ~,, $ per month 1008. Ag~reCateAdjustment months ¢ $ per month -266.30 1100. TITLE CHARGE$ 1101. ClosingSencice Letter to FIRST AMERICAN TiTLE INSURANCE COMPANY 35.00 1102. Courier Fee to PENN HERITAGE TRANSFER COMPANY 15.50 1103. Wire Transfer Fee to PENN HERITAGE TRANSFER COMPANY 1000 1104. Title Insurance Binder to 1105. Document Preparation to 1106. Notary Fees to STEPHANIE RIDER 12.06 6.00 1107. Attorney's Fees to (includes above item num ~ers: ) 1108. Title Insurance to PENN HERITAGE TRANSFER COMPANY 798.7~ (includes above item nurn ~er$: ) 1109. Lender's Coverage $ 85,405.00 103061103PAL 1 t 10. Owner's Coverage $ 89,900.00 102133418PAO 1111. Endorsements 100,300,8 1.,/F~M to PENN HERITAGE TRANSFER COMPANY 200.0C 1112. 1113. 1200. qOVERNMI~NT REI~ORDIN( i AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 40.50; Mortgage $ 62.50; Releases $ 103.0 1202. City/Counl~ Tax/Stamps: Dee 899.00; Mortgage 899.00 1203. State Tax/Stamps: Rev ~nue Stamps 899.00; Mortgage 899.0 1204. Assignment of Mortgage to RECORDER OF DEEDS 27.0C 1205. 1300. ADDITIONAL SE'rDLEMENT BHARGES 1301. Survey to 1302. Pest thspection to PENN PEST INC. 400C 1303. 1304. 1305. 1400. TOTAL SETTLEMENT CHAP GES (Enter on Lines 103, Section J and 502, Section K) 3,90048 5,40000 By signing page 1 of this statemen , the signatories acknowledge receipt of a completed .c~?~y ~f page 2 of this two page statement. SHELLY J. KUJNKEL, ESQUIRE Certified to be a true copy. SeSlement Agent ~A~T.WILL AND TESTAmeNT I BETTY J. MUTZABAUGH, of the Township of Hampden, County of Cumber and and State of P~nnsylvania, being of sound mind, memory and unders:anding, do make, publish and declare this to be my last Will and Testament, hereby revoking and making void all former wills, codicils and ot~er testamentary dispositions by me at any time heretofore made. 1. I direct my executor, hereinafter named, to pay as soon as prac- ticabl after my decease all my just debts and the expenses of my last illnes and burial. 2. I give, devise and bequeath all of my estate - real, personal and mixed unto my husband, Melvin M. Mutzabaugh, absolutely. 3. Si~ould my said husband predecease me, then and in that event I give, devise and bequeath all of my said estate unto my son, Michael M. Mutza- baugh. 4. I hereby nominate, constitute and appoint my husband, Melvin M. Mutzab, tugh, executor of this my last Will and Testament. Should my said husban, fail to qualify or cease to act as executor, I appoint my son, Michael M. Mutzabaugh, executor of this my last Will. I1 WITNESS WHEREOF, I, BETTY J. MUTZABAUGH, the testatrix, have hereun~ ~ set my hand and seal to this my last Will and Testament this ~ ~ay of January, 1980. ~uL ~ ~Z%L~j~-~- (SEAL) SJ gned, sealed, published and declared by the above named Betty J. Mutzab~ugh as and for her last Will and Testament in the presence of us, who, at her request and in her presence~nd in the presence of each other, have h~reunto subscribed our names as witnesses thereto. OO MONWE^LT. OE REV'1500 ~ PENNSYLVANIA ,,,~b,m. DEPARTMENT OF REVENUE ~1,¢~.,~ DEPT. 280601 INHERITANCE TAX RETURN .,LE..M... 2 1 0 4 0 0778 HARRISBURG, PA17128 )601 RESIDENT DECEDENT DECEDENTS NAME (LAST. FIRS~ AND MIDDLE INITIAL) SOCIAL SECURI I~ NUMBER ~j. t~baugh, Betty J. . 193 12 5722 DATE OF DEATH (MM-DO-YEAR) I DATE OF BIRTH (MM-Db-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 08-10-2004 [ 09-30-1924 REGISTER OF WILLS IF APPLICABLE) SURVIVING SPOUSE'S NAME (LASL FIRST. AND M{DDLE INITIAL) SOCIAL SECURITY NUMBER [] 1 Original Return [] 2. Supplemental Return [] 3 Remainder Return (~a~o' o ,o ~o2 3~2, [] 6 Decedent Died TestatelA~t~op/o~Wm) [] 7 DecedentMaintainedaLivingTrustfA~h~pya T..~t) 1 8 TofalNumberofSafe Deposit Boxes [] 9 Litigation Proceeds Received [] 10. Spousal Poverty Credit (cate of :earn be-weer ,2-31 91 ate I, §5) [] 11. Election to tax under Sec 9113(A)(A :,,d. ach o. THiS SECTIONMUST BE COMPLETED. ALL. CORRESPONDENCE AND CONFIDENTIAL TAX INFORMAT ON SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Keith O. Bren_nemcn, Esquire 44 W. Main Street Mechanicsburg, PA 17055 Snelbaker, Brenneman & Spare, P. C. TEL~ O~SNUMBER I 697-8528 1 Real Eslate (Schedule A) (1) 89 ~ 900. O0 2. Stocks ar~ So,ds (Schedule B) (2) 3. Closely Held Corpomtiofl. Partnership or Sole-Propdetemhip (3) 4 Mortgages & Notes Receivable (Scpedule D) (4) 5 Cash. Bank Deposits & Miscellaneous Personal Property (5) 237,638.66 (Schedule E) 6 Joindy Owned Property (Schedule F) (6) * ' 34 242 42 29,225.26 Separate Requested 7 inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 391,006.34 8 Total Gross Assets (total Lines 1-7) (8) 12,828.53 9 Funeral Expenses & Ad ministrative Costs (Schedule H) (9) 638.69 10. Debts of Decepenl, Mortgage Liabilities, & Liens (Schedule I)(10) 11 Total Deductioas (toLa[ Lines 9 & 10) (11) 13,467.22 12 Net Value of Estate (Line 8 minus Line tl) (12) 377,574.12 13 Chabtable and Governmental Bequests/Sec 9113 TrusLs 1or which an election to t~ has no~ deen 113) made (Sched ute J) 3 7 7,5 3 9.12 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9116 (a)(12) x 0 (15) 16 Amount of Line 14 taxable at lineal rate 377,539.12 x.o ~5 (16) 16~,989.26 17 Amount of Line 14 taxable at sibling rate x 12 (1 ?) 18 Amount of Line 14 taxable at collateral rate x 15 (18) 19 TaxDue (19) 16,989.26 > > BE SURE TO ~swER A~ QUESTIONS ON REVERSE SIDE AND RECHECK MATH< < Decedent's Complete Address: STREETADDRESS 424-A Braady Lane CITY Mechanicsburg [STATE PA I ZIP 17055 Tax Payments and Credits: 1. Tax Due (Pa§e 1 Line 19) (1) ]6,989.26 2. Credds/Payments A. Spousal Poverty Credit B, Pdor Payments 16,140.26 C Discount 849. OO Tofal Credits (A + B + C ) (2) 16,989.26 3. Interest/Penalty if applicable B. Interest E Penalty Total Intarest~Penalty ( B + E ) (3) 4 If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT. Check box on Page 1 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) A. Enter the interest on the tax due, (5A) B Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) -o- Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1 Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; [] [] b. retain the nght to designate who shat[ use the property t~ansferred or its income: .................................... [] [] c. retain a reversionary interest; or [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2, If death occurred after Becember 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. Bid decedent own an Individual Retirement Account. annuity, or other non probate properi7 which contains a beneficiar7 designattan? [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury I declare that I ha~e examined this return, indudtag accz~mpanying s~edules and statements, and to the best of my ~nowled~ and belief, it is true, cc"red and complete ADDRESS 2165 Valley Road, Marysville, PA 17053 SLGNATURE OF PRC~P"/~ER OTHER THAN REPRESENTATIVE B TE ABDRESS 44 W. Main Street, Mechanicsburg, PA 17055 For dates of death on or after July 1, 1994 and bebre January I 1995, the tax rate imposed on the net value of transfers to or for ~he use of the surviving spouse is 3% [72 PS §9116 (a)(1 1) For dates of death on or after January !, 1995, the tax rate imposed on the net value of transfers to or for Ihe use of [he surv~wng spouse is 0% [72 PS §9116 (a) (1 1) (ii)) The statute does not exemot 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 For dates of death on or after July 1 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent or a steppareof of the child is 0% [72 RS §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 45% except as noted in 72 PS §9116(1 2) [72 PS §91 The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12% [72 PS, §9116(a)(1 3}] A sibling is defined, under Section 9102 as an individual who has at least one parent in common with the decedent whether by bteod or adoption REV-1502 EX+ (6 98). ~, . SCHEDULE A OOMMONWEALPH OF PENNSYLV^N,^ REAL ESTATE INHERITANCE TAX RETURN S OENT OECEOENT ESTATE OF FILE NUMBER Betty J. Mntzabaugh 2]-04-00778 All real property owned solely or as a tenant in common must be reported at fair market Yalue. 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 right of survi¥orshi@ must be disclosed on Schedule F ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 All Lhat certain land improved with a residentia! dwelling located partly in Elampden Township and parEly in the Borough of Mechanicsburg, Cumbertand County, Pennsylvania as more fully described in Cumberland County Deed Book "W", Volume 16, Page 41. Sales Price (October 1, 2004): $89,900.00 TOTAL (Aisc enter on line 1, Recapitulation) 89,900. O0 (If more space is needed, insed additional sheets of the same size) REV 1508 EX+ (8-98) ,,~ SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Betty J. Mutzabaugh 21-04-00778 Include the proceeds of litigation and the date the proceeds were received by the estate All property jointly-owned with dght of survivorship must be disclosed on Schedule F ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH l. Wachovia Bank, N.A., Certificate of Deposit No. 247412071871455 71,304.29 2. Miscellaneous personal property and furnishings 935.00 3. Waypoint Bank a. Certificate of Deposit No. 1800004967 51,586.23 b. Certificate of Deposit No. 9600016406 72,556.64 4. Citizens Bank a. Checking Account No. 6100700348 1,562.12 b. Time Deposit Account No. 6140-773768 39,609.59 5. The Patriot News - subscription refund 82.80 6. Comcast - cable service refund on account 1.98 TOTAL (Also enter on line 5, Recapitulation) $ 23 7,638.66 (If more space is needed, insert additional sheets of the same size) REV 1509 EX+ (698)~ ~ . SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Betty J. Mutzabaugh 21-04-00778 If an asset was made joint wIfh[n one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Michael M. Mutzabaugh 2165 Valley Road Marysville, PA 17053 son JOINTLY-OWNED PROPERTY: LETfER DATE DESCRIPTION OF PROPERTY % OF 9ATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAM~ OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMB ER OR SIMILAR DATE OF DEATH DECDS VALUE OF '4UMBER T~NANT JOINT IDENTiFYiNG NUMBER A~ACH DEED FOR JOiN Iq-Y HELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENT S INTEREST 1 A 1/3/02 Commerce Bank Savings Account $68,484.84 50% $34,242.42 No. 616300926 TOTAL (Als0 enter on line 6, Recap~u~ati0n) $ 34,242.42 (If more space is needed, insed additional sheets of the same size) REV Ex+/6-98 SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Betty J. Mutzabaugh 21-04-00778 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SE EET is yes DESCRIPTION OF PROPERTY ITEM iNCL~}EmE NAMEOFTHE~ANSFERFE THEiR R~LA-iONSNiPT0 BEC£DENTANO DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER ~,r~E DATE 0 F TR,,~NS F ER A~,M;H A COPY OF ~r4E DEED FOR REA~ ESTATE VALUE OF ASSET INTEREST <IF AP~L,CABLE) VALUE 1 MetLife Annuity. Date of Transfer: August 10,906.2; 100% 10,906.28 10, 2004 (date of death). Transferee: Michael M. Mutzabaugh (Decedent's son). Contract No. A2044492 2. Jefferson Pilot IRA. Date of Transfer: 18,318.98 100% [8,318.98 August 10, 2004 (date of death). Transferee: Michael M. Mutzabaugh (Decedent's son). TOTAL (Also enter on line 7 Recapitulation) $ 29,225.26 (If more space is needed, insedL additional sheets of the same sLze) REV 1511 EX+ (12-99)~ I SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & iNHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Betty J. Mutzabau~h 21-04-00778 Debts of decedent must be reported on Schedule I, ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: Malpezzi Funeral Home $3,798.72 B ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representatwe(s) Michael M. Mutzabaugh waived Social Securib/Number(s)/EIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: 2 Att0meyFees to Snelbaker, Brenneman & Spare, P. C. 2,500.00 3 Family Exemption: (If decedent's address is not the same as claimant's, a~tach explanation) Claimant Street Address City State __ Zip Relationship of Claimant to Becedent 4. Pr0bateFees Initial: $69.00; Additional fee: $255.00 324.00 5. Acc0untanrsFees to Greenawalt & Company, P. C. 250.00 6 Tax Return Prepdrer's Fees Reserve for filing fees, notary fees and miscellaneous 7. expenses 200. O0 8. Advertising costs - grant of letters: a. The Patriot News $211.81 b. Cumberland Law Journal 75.00 286.81 9. Chuck Bricker, Auctioneer - appraisal fee (personalty) 75.00 10. State/local transfer tax upon sale of realty 899.00 11. Dugan Realty Group/Homes of Central PA - sales co~m~ission, real estate 4,495.00 TOTAL (Also enter on line 9, Recapitulation) $12,828.53 (If more space is needed, insed additional sheets of the same size) ,,~ SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, 'NHERITANCETAXRETLJ.N MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Betty J. Mutzabau~h 21-04-00778 ITEM Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 United Water - payment on account 11.08 2. Westshore EMS - payment on account of medical service 587.87 3. PP&L - payment on account 27.92 4. Verizon - payment on account 11.82 TOTAL (Also enter on line 10. Recapitulation) $ 6-']8.69 (If more space is needed, insed addi[ional sheets of [he same sizeI REV 1513 EX+ (940) SCHEDULE J COMMONWF~LTN OF ~'EHNSYLVARIA BENEFICIARIES INHERITANCE TA~ RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Bett4y .l. Mu~abau~h 2~-0~-00778 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TA~BLE DISTRIBUTIONS [include ou[righ~ spousal dfstribu[~ons, add ~ransfers under Sec. g116 (a) (1.2)] 2165 Va~e7 Val~e7 Road Ma~ysvJ~le, ~A ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET Il NON-TAXABLE DISTRIBUTIONS; A SPOUSAL DISTRIBUTIONS UNDER SECTION 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 (If more space is needed, insert additional sheets of the same size) OMB NO. 2502-0265 A B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.[~FHA 2.[]FmHA 3. r~CONV. UNINS, 4 r~VA 5. ~]CONV. INS. 6. FILE NUMBER: I 7. LOAN NUMBER: PH04268 SMRI 2359144 SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUMBER: C, NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement ag~ent are shown. Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1 0 3/98 (PH04268_SMR PFD/PH04268 SMPJ13/ D NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: WILLIAM L. SHIPMAN, JR. and ESTATE OF BE~q-Y J. MUTZABAUGH CONSUMER MORTGAGE SERVICES DEBORAH S. SHIPMAN 999 WEST CHESTER PIKE, STE 200 WEST CHESTER, PA 19382 G PROPERTY LOCATION: H. SE%T-LEMENT AGENT: 25-1648139 I. SE~q'LEMENT DATE: 424A BRANDY LANE PENN HERITAGE TRANSFER COMPANY MECHANICSBURG, PA 17055 October 25. 2004 CUMBERLAND Counb¢, Pennsylvania PLACE OF SE"rq'LEMENT 3464 TRINDLE ROAD CAMP HILL, PA 17011 J SUMMARY 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 Price 89,900.00 401. Contract Sales Price 89,90000 102 Personal Properb/ 402. Personal Property 103. Settlement Charges to Borrower (Line 1400) 3,90048 403. 104. 404. 105 405. Adjustments For Items Paid By Seller in advance Adiustments For Items Paid By Seller in advance 106. City/Borough Taxes to 406. City/Borough Taxes to 107 CountyFFwpTaxes 10/25/04 to 12/31/04 4036 407. CountyFFwpTaxes 10/25/04 to 12/31/94 i 4036 108. School Taxes 10/25/04 to 06/30/05 59276 408. School Taxes 10/25/04 to 06/30/05 ! 592.76 109. Sewer/Refuse 10/25/04 to 01/01/05 i 8500 409. Sewer/Refuse 10/25/04 to 01/01/05 I 8500 111. ! 411. I 120. GROSSAMOUNTDUEFROMBORROWER I 94,518.60 420. GROSSAMOUNTDUETOSELLER I 90,618.12 200, AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money I 1,000.00 501. Excess Deposit (See Instructions) 202. Principal Amount of New Loan(s) I 85,405.00 502. Settlement Charges to Seller (Line 1400) i 5,40000 203. Existing loan(s) taken subject to I 503. Existin~ loan(s) taken subject to 204. 504. Payoff of first Mortgage 205 i 505. Payoff of second Mortgage 206 ~ 506. 207. 507. (Deposit disb. as proceeds) 208. 508. 209. Closing Costs Paid By Seller 509. Closing Costs Paid By Seller Ad/ustments For Items Unpaid By Seller Adjustments For Items Unpaid BF Seller 210. Cit~/Borough Taxes to 510. City/Borough Taxes to 211. CountyFFwp Taxes to 511. County/Twp Taxes to 212. School Taxes to 512. School Taxes to 213. 513. 214. 514. 215. 615. 216. 516. 217. 517, 218. 518. 219. 519. 220 TOTAL PAID BY/FOR BORROWER 86,40500 520 TOTALREDUCTIONAMOUNTDUESELLER 5,400.00 300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower (Line 120) 94,51860 601. Gross Amount Due To Seller (Line 420) ~ 90,618.12 302. Less Amount Paid By/For Borrower (Line 220) ( 86,40500) 602. Less Reductions Due Seller (Line 520) i( 5.40006 303. CASH( X FROM)( TO)BORROWER ~. 8,113.60 603. CASH( X TO)( FROM)SELLER I 85,21812 The undersigned hereby acknowl~d'bie rec~Bt r~f a completed cody of Daaes 1&2 of this statement & any attachments referred to herein WILLIAM b SHIPMAixT~ JR;.~' J ESTATE OF BE~-i'Y J. MUTZABAUGH HUD 1 (3 86) RESPA. H84305 2 Pa~e 2 g SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ ~, % 4,490.00 PAiD FROM PAID FROM Division of Commission (line 700) as Follows: 8ORROWER'S SELLER'S 701. $ 1,798.00 to DUGAN REALTY GROUP FUNDS AT FUNDS AT 702 $ 2r697,00 to HOMES OF CENTRAL PA, INC SETTLEMENT SE~'LEMENT 703 Commission Paid at Settlement 4,495.00 704 to 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801 Loan Origination Fee % to 802. Loan Discount % to 803. Administrative Fee to CONSUMER MORTGAGE SERVICES, INC 600.06 804. Processing Fee to CONSUMER MORTGAGE SERVICES, INC 375,06 805 Application Fee to CONSUMER MORTGAGE SERVICES, iNC. 350,06 806 Montgage Ins, App. Fee to 807. Assumption Fee to 808. 809 810 811. 900, ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 10/25/04 to 11/01/04 @ $ 13.454200/day ( 7 days %) 94.18 902 Modgage Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 years to 904. 905, 1000. RESERVES DEPOSITED WITH LENBER 1001.Hazard Insurance 3.000 months ~ $ 25.00 per month 7500 ;1002. Mortgage Insurance months ~ $ per month 1003. Cii~/BoroughTaxes months ~ $ per month 1004. Coun~FrwpTaxes 10.000 months ~ $ 17.75 per month 177.50 1005. School Taxes 5.000 months ~ $ 70.97 per month 354.85 1006 months ~ $ per month 1007. months ¢, $ per month 1008. A~gre~ateAdiustment months ¢ $ per month -26630 1100. TITLE CHARGES 1101. Closing Service Letter to FIRST AMERICAN TITLE INSURANCE COMPANY 35.00 1102. Courier Fee to PENN HERITAGE TRANSFER COMPANY 15.50 1103. Wire Transfer Fee to PENN HERITAGE TRANSFER COMPANY 10,00 1104. Title Insurance Binder to 1105, Document Preparation to 1106. Notar~ Fees to STEPHANIE RIDER 12.00 6.00 1107. Attorney's Fees to (Includes above item numbers: 1108. Title Insurance to PENN HERITAGE TRANSFER COMPANY 798.75 (includes above item numbers: 1109. Lender's Coverage $ 85,405,00 103061103PAL 1110 Owner's Coverage $ 89,900.00 102133418PA© 1111, Endorsements 100,300,8 1.,ARM to PENN HERITAGE TRANSFER COMPANY 200.00 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 40.50; Mortgage $ 62.50; Releases $ 103.00 1202. City/Count), Tax/Stamps: Deed 89900: Modga~e 89900 1203. State Tax/Stamps: Revenue Stamps 899.00; Mortgage 899.00 1204, Assignment of Mortgage to RECORDER OF DEEDS 2700 1205, 1300. ADDITIONAL SETrLEMENT CHARGES 1301. Survey to 1302. Pest thspection to PENN PEST INC. 40.00 1303. 1304. 1305. 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 602, Section K) 3,900.481 5,400.00 By signing page 1 of this statement, the signatories acknowledge receipt of a completed c~¢,y ~f page 2 of this two page statement. Certified to be a true copy. SHELLY J. KU_NKEL, ESQUIRE ( PH04268 SMR / PH04268_SMR ,r 13 ) ~A~T.~.JILL AND TESTAmeNT I, BETTY J. MUTZABAUGH, of the Township of Hampden, County of Cumberland and State of Pgnnsylvania, being of sound mind, memory and understanding, do make, publish and declare this to be my last Will and Testament, hereby revoking and making void all former wills, codicils and other testamentary dispositions by me at any time heretofore made. 1. I direct my executor, hereinafter named, to pay as soon as prac- ticable after my decease all my just debts and the expenses of my last illness and burial. 2. I give, devise and bequeath all of my estate - real, personal and mixed - unto my husband, ~,~elvin M. ~4utzabaugh, absolutely. 3. Should my said husband predecease me, then and in that event I give, devise and bequeath all of my said estate unto my son, ~Iichael M. 14utza- baugh. 4. I hereby nominate, constitute and appoint my husband, Melvin M. ~[utzabaugh, executor of this my last Will and Testament. Should my said husband fail to qualify or cease to act as executor, I appoint my son, ~[ichael ~. Mutzabaugh, executor of this my last Will. IN WITNESS WHEREOF, I, BETTY J. ~TZABAUGH, the testatrix, have hereunto set my hand and seal to this my last Will and Testament this ~ day of January, 1980. Signed, sealed, published and declared by the above named Betty J. Mutzabaugh as and for her last ~ill and Testament in the presence of us, who, at her request and in her presence~~nd in the presence of each other, have hereunto subscribed our names as witnesses thereto. l.1_ Co I.L.1 ( ~'\ [j.: - L'.._ C:"" STATUS REPORT UNDER RULE 6.12 Name of Decedent: Bettv J. Mutzabau(lh Date of Death: August 10, 2004 Will No.: 21-04-0178 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: l. State whether administration of the estate is complete: Yes El No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No ~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes [E: No 0 c. Copies of receipts, releases, joinders and approval offormal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this reBort. Date: January 19, 2005 'It~ Signature Keith o. Brenneman Name 44 W. Main street Mechanicsburg, PA 17055 '.0 Address ~~ ::J':: a... o C'J ,-,"- (:5 (717)697-8528 Telephone No. :-;<~(I - , ;--,' L_.!~.''-,' __..J<. C) :~~ ! L,- c:- _ o~, o Capacity: 0 Personal Representative IiJ Counsel for personal representative -,.- ........ <.I'~-r: _'h_) Lr.o C? L= "'" j COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL WE~':-\'_T :\::\C~ Of INHERITANCE TAX DIVISION rt.:D.,j:-,:".:._"j '-'~.' ',,:- NOTICE OF INHERITANCE TAX PO BOX 2B0601 :-' \'" \ ,\PPRAISEMENT, ALLOWANCE OR DISALLOWANCE HARRISBURG~ PA 17128-0601 I 'u <, I, ,,-,_....' OF DEDUCTIONS AND ASSESSMENT OF TAX 2005 JAN \ 0 M\ 9: l; 1 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-03-2005 MUTZABAUGH 08-10-2004 21 04-0778 CUMBERLAND 101 CLER\\ OF ORPHAN'S COU.~T _ KEITH 0 BRE~ff'eSt) C.! - r;\ SNELBAKER ETAL 44 W MAIN ST MECHANICS BURG PA 17055 *' REV-1S41EXAFPCD9-04l BETTY J Amount Ralli 'Had MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~ iii-\i=m-j-Eif-AFP--fiiFli3rNOi"icE--OF-'rNHEififAi"-CE-YAX-A-pjiRA-ZSEi"-€NT~--Ar.rOWAi"-CE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MUTZABAUGH BETTY J FILE NO. 21 04-0778 ACN 101 DATE 01-03-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED NOTE: I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate (15) 16. Allount of line 14 taxable at Lineal/Class A rat. (16J 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due .00 X 00 = .00 377,539.12 X 045 = 16,989.26 .00 X 12 = .00 .00 X 15 = .00 (19)= 16,989.26 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule 0) 5. Cash/Bank Deposits/Misc. Personal Property {Schedule EJ 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets ll) (2) (3) (4) (5) (6) (7) 89.900.00 .00 .00 .00 237.638.66 34.242.42 29,225.26 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) IlO) 12,828.53 638.69 llll (12) (13) (14) NOTE: To insure proper credit to your account 1 submit the upper portion of this form with your tax payment. 391,006.34 ] ~ . 467 ?? 377 ,539 .12 .00 377,539.12 TAX CREDIT!!. rMmen .e~ur , (+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-01-2004 CD004567 849.46 16,140.26 TOTAL TAX CREDIT 16,989.72 BALANCE OF TAX DUE .46CR INTEREST AND PEN. .00 TOTAL DUE .46CR "< . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE _ / A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) .<)/\