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Home My WebLink About08-30-11 (2)REV-1500 ~`(°'-'°' 1505610143. PA Department of Revenue Bureau of Individual Taxes Pennsylvania OFFICIAL USE ONLY DEPARTME PO 80X.280601 NT OF REVENUE County Code Year File Number Harrisburg, PA 17128-0601 INHERITANCE TAX RETURN 2 1 ENTER DECEDENT INFORMATION BE 11 RESIDENT DECEDENT 0 0 2 01 LOW Social Security Number Date of Death 513 5 2 2 g O g O Date of Birth 1 28 2011 Decedent's Last Name 03 29 1947 K L U Z Suffix Decedent's First Name MI GAYLE H (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 FILL IN APPROPRIATE OVALS BEL REGISTER. OF WILLS OW ® 1. Original Retum ^ 2. Supplemental Return ^ 4 Li ^ 3. Remainder Return (date of death i . mited Estate ^ pr or to 12-13-82) 4a. Future Interest Compromise ® g, Decedent Died Testate (date of death after 12-12-82) ^ 5. Federal Estate Tax Return Required (Attach Copy of Will) ^ 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe Deposit Bo ^ 9. Litigation Proceeds Received ^ xes 1 p Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ 11. Election to tax under Sec. 9113(A) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CO ('attach Sch. O) Name NFID ENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: MICHELLE L S O MME R Daytime Telephone Number 717 249 0900 r -.... , ~~-'~ REGISTER ELLS US~filNLY r' ~ - First line of address ~ ~ ^ ~ ° - ~ ~, ~. f ~.t .J f 1~..' A~ 2 WEST HIGH STREET '~~ ~~ R ,. : Second line of address ..., _ _. - ~ ~ ' ~~~' --~ ~3 ~ f City or Post Office -~ . ;~~ ~- ~ ~ CARLISLE DATE FILED State ZIP Code PA 17013 Correspondent's a-mail address: m I S@ a b O m Ic u t lu l a k I S. C O m Under penalties of perjury, I declare that I have examined this return including accompanying schedules and statements, and to the best of it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which pre arer ha SIGNATURE OF P ON RESPONSIBLE FOR FILING RETU N my knowledge and belief, P s any knowledge. Y DATE ADDRESS Christopher Speece a /~ ~ 847 Lindsey Road, ,arlisle, PA 17015 ' I A1~URE OF REP R R OTH THAN REP ~ ~ ~ ~ / '' - ~ ~ , ~ NATIVE 1 / ~ DATE Michelle L Sommer ADDRESS 2 West High Street, Carlisle, PA 17013 Side 1 1505610143 1505610143 J ' ~~% s J REV-1500 EX 1505610243 Decedent's Name: K L U Z, G A YL E H i~ecedent's Social Security Number RECAPITULATION 5 1 3 5 2 2 8 0 9 1. Real Estate (Schedule A) ....................... .......................... ......................................... 1. 2. Stocks and Bonds (Sch d 170, 000.00 e ule B) .............. ................................................. 2. 3. Closely Held Corporati 7 17 4 ~ • 2 1 on, Partnership or Sole-Proprietorship (Schedule C ) .......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......... ................................................ 4 • Cash, Bank Deposits & Mi 73,159.19 scellaneous Personal Property (Schedule E) ...,,,,•..•,.. 5 6. Jointly Owned Pro e P rty (Schedule F) ^ Separate Billin 7 R I t 7 ~ 915.31 g . n equested ............. er-Vivos Transfers & Miscellaneous Non-Probate Property 6. (Schedule G) 2.12 3 . $ 9 ^ Separate Billing Requested ............. 7~ 8. Total Gross Assets (total Li 180, 116.34 nes 1-7).. ................... ............................................ 8. 9. Funeral Expenses & Administrative Costs (Sch d 440, 488.94 e ule H) ............... .......................... 9. 10. Debts of Decedent Mort 52, 572 .76 , gage Liabilities, & Liens (Schedule I) ....... ......................... 10. 11. Total Deductions (total Lines 9 & 10) .............................. 8, 433.95 ............................. ........... 11. 12. Net Value of Estate (Line 8 minus Line 11) 61, 0 0 6.71 .................. ......................................... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Sched l 3 7 9 4 8 2 . 2 3 u e J) ................................................. 13. 14. Net Value Subject to T 300.00 ax (Line 1 2 minus Line 13) ........ .... . TAX COMPUTATION -SEE INSTRUCTIONS FAR ArrLICAeLE RATES 14 15. Amount of Line 14 taxabl 3 7 9 1 8 2 ' • 2 3 e at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 16. Amount of Line 14 taxable 15. at lineal rate X .045 3 7 9 ' 1 8 2 2 3 16. 17. Amount of Line 14 taxabl e at sibling rate X 12 17, 063 .20 18. Amount of Line 14 taxable 17. at collateral rate X .15 18. 19. Tax Due ................................ ................................................................................... 19. 17, 063 .20 20. FILL IN THE OVAL tF YOU ARE REQUESTING A REFUND OF AN OVERPAYMEN T. L 1505610243 Side 2 1505610243 J ' REV-1500 EX Page 3 Decedent's Complete Address: Kluz, Gayle H STREET ADDRESS 71 Partridge Circle File Number 21 _ 11 _ 0 0 2 01 CITY -- Carlisle STATE ZIP PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments (1) 17,063.20 A. Prior Payments B. Discount 3. Interest Total Credits (A + B) (2) 0.00 (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 17,063.20 Make Check Payable to: REGISTER OF WILLS q GENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN T'HE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred :...................... Yes No ........... , ............................ x b. retain the right to designate who shall use the property transferred or its income :.............. ^ c. retain a reversionary interest; or ............................................ ^ ^ ...................... d. receive the promise for life of either a ~~~~~~~~~~~~~'~"""" ^ P Yments, benefits or care?........ ............................................. ^ ................. Q 0 2. If death occurred after December 12, 1982, did decedent transfer roe x ............... receiving adequate consideration? .................................. P P rty within one year of death without ........... . ....................... x Did decedent own an "in trust for" or payable upon death bank account or security at his or ^ ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate roe her death?......... ^ ^ contains a beneficiary designation? ............... x ............................ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST p p rn' which . ...................... x 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 r spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. ate imposed on the net value of transfers to or for the For dates of death on or after January 1, 1995, the tax rate imposed on then use of the surviving [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from assets and filing a tax return are still applicable even if the surviving spouse is thelonly bteneficirs to or for the use of the surviving spouse is 0 percent tax, and the statutory requirements for disclosure of For dates of death on or after July 1, 2000: ary • The tax rate imposed on the net value of transfers from a deceased child 21 years of a e or o adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)]. 9 y unger at death to or for the use of a natural parent, an • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal be 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. neficiaries is 4.5 percent, except as noted in • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblin s i sibling is defined under Section 9102, as an individual who has at least one parent in common w' )~ g s 1rthphe decedent whethe6 by fjlood~o adoption. >~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF K~UZ, Gayle H ~ All real property owned solely or as a tenant in com FILE NUMBER at which property would be exchanged between a willing bu er 121 - 11 ' 00201 mon must be re orted at fair market value. Fair market value is defin reasonable knowledge of the relevant facts. Real property which is 'o' schedule F. Y and a willing seller, neither bein 1 intly-owned with right of su~ryilvoashibuy or sell, both feavl~gthe price Attach a copy of the settlement sheet if the roe P must be disclosed on ITEM Include a copy of the deed showing decedent's interest if owned as tenan ~d. NUMBER t m common. _ DESCRIPTION 71 Partridge C cri le Carlisle, PA 17013 Sold on 5/26/11 TOTAL (Also enter on Line 1, Recapitulation) VALUE AT DATE OF DEATH 170, 000.00 170, 000.00 A SETTLEP,~ENT STATE".1ENT ~lai_ip_,.I - ,,-~,,;. :.,. . ` B ,~ l Select Platinum Settlement Services, LLP TYPE pF II~~~~1 +'~c; 1. ^ FHA LOAN ----- ~~I1~II~ ~ 3912 Market Street z ^ RHs t = ~ ^ VA 5 ^ CONV. INS. 3 ~CONV UNINS `s+-.; ., ~~~ e. ESCROW Fh_E NUMBER Camp Hill, PA 17011 001j 12241-OQ1 CER ~. LOAN NUMBER: (717) 737-0884 I-_____ Ff NAL i8. MORTGAGE INSURANCE CASE NUMBER 000004389 C NOTE: This form rs famished to ive 9 you a statement of actual settlement costs. Amounts paid to and b th Items marked '(P p. C~„ were paid outside the closin D NAh1E OF BORROWER: 9; ~eY ere shown here for infomlational u y e settlement agent are shown. Vincent C. Books and Janna M. Books p rposes and are not included in the totals. ADDRESS OF BORROWER: 2215 North 2nd Street E. NAME OF SELLER I-IarrlSbUf Pq 17110 Estate of Gayle H. Kluz ADDRESS OF SELLER: F NAME OF LENDER: Orrstown Bank • ADDRESS OF LENDER: 2695 Phlladelphla AVenUe Chambersburg, pA 17201 G PROPERTY LOCATION: 71 Partridge Circle Carlisle, PA 17013 Cumberland County 29-15-1252-087 H. SETTLEMENT AGENT: Parcel #29-15-1252-087 Select Platinum Settlement Services, LLP PLACE OF SETTLEMENT: Jac{( Gaughen Realtof ERA, 1068 Harrisbur I SETTLEMENT DATE: (717) 737-0884 5/26/2011 PRORATION DATE. 9 Plke, Carlisle, PA 1-7013 J' SUMMARY OF BORROWER'S TRANSACTION 5/26/201 1 DISBURSEMENT DATE: ~ 5/26/201 1 101. Contract Sales Price K. SUMMARY OF SELLER'S TRANSACTION 102. Personal Property 400; GROSS'AMOUNT DUE TO SELLER; 170,000.00 401. Contract Sale 103. Settlement charges to Borrower (line 1400) s Price 402. Personal Property 170,000.00 104. 7,475.84 403. 105. 404. ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: 405. 106. City/Town Taxes 107 ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: Count Taxes 05/26/11 406. Cit !Town Taxes 108. Assessments t0 .12/31/11 287.42 407. Count Taxes 109. School Tax 05/26/11 to 12/31/11 05/26/11 to 06/30/11 408. Assessments 287.42 _ 110. Assn. Dues 20829 409. --._______05/26/11_to 05/31/11 School Tax _ 111. 9.04 410. 05/26/11 to 06/30/11 Assn. Dues 208.29 112. ----___ 05/26/11 to 05/31/11 41 i. 113. 9.04 - 412. 114. 413. 115. 414. 120. GROSS AMOUNT DUE FROM BORROWER: 415. 200. AMOIAVTSPAID BY OR:IN BEHALF OF BORROWER; 177' 980.59 420. GROSS AMOUNT DUE TO SELLER: 201. Deposit or earnest money 202. p 500• REDUCTIONS IN;4MOUNT D 170,504.75 _ Princi al amount of new loan(s) 2,000.00 501. Excess deposit (;tee instru~ctionOsSELLER: 203. Existing loans} taken subject to 130,500.00 204. 502• Settlement charges to Seller (line 1400) 205. 503. Existing loan(s) taken subject to 13,407.91 206. 504. Payoff of 1st mtg, loan to CitiMortgage 207 505. Payoff of second mortgage loan 73.159.19 208. 506. 209. 507. 508. ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: 509. 210. City/Town Taxes ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: 211. County Taxes 510. Cit /Town Taxes 212_ Assessments 51 t 213 County Taxes 512. Assessments 214. 513. 215. 514. 216. 515. 217. 516. --_ 218. 517. 219. 518. 220. TOTAL PAID BY/FOR BORROWER: 519. 300: CASH AT SETTLEMENT FROM/TO BORROWER: 132,500.00 520 TOTAL REDUCTIONS IIV AMOUNT DUE SELLER: 301. Gross amount due from Borrower (line 120) -' 600. CASH AT S 86,567.10 302. Less amount paid by/for Borrower (line 220) 177'980.59 ETTLEMENT T0/FROM`SELLER; 601. Gross amount due to Sel a 420) 303. CASH (®FROM 132.500.00 602. Less reduction in amcunt due eS Iler !line 5201 170,504.75 _ ) ( ~ TO) BORROWER: --~-__ 45,480.59 603. CASH (~ FROM ) 86,567.10 The Public Reporting Burden for this collection of information is estimated at 35 minutes per res ores I (~~ TO SELLER: agenq~ may not collect this information, and you are not required to complete this form, unless it displ 83,937,65 confidentiality is assured; this disclosure is mandato p e for collectin settlement process. g, reviewing, and reporting the data. This rY This is designed to provide the parties to a RESPA covey ed transa OonBwith reformat on duroin the 9 • t It l AL KtAL tJ 1 A l t tKUKER FE ES: ^~~/~SIC,N CF COMMISSION i (LINE 7( 0 , ) AS FOLLOWS, 701 `r1Q~Op On fo ERA NRT Inc P.O.C. 702 S `o 703. Commiss,on paid at settlement __ PAID FROM I PAID FROM BORROWER'S FUNDS __ 704. k3roker Admin F ee to ER,q-NRT Inc I AT SETTLEMENT SELLER'S i FUNDS AT . 705. Deed Prep Fee to ERA NRT Inc SETTLEMENT 800. ITEMS PAYABLE IN C ONNECTION WITH LOAN: 801. Our origination ch ~ 10,200.00 195.00 arge 802. Your credit or charge (points) for the s 803 Yo t P.O.C, ' $1 327.50 (from G 195.00 100.00 . rate Chosen ur adjusted origination charges to Oprstown Bank 804. A ppra~sal Fee to C FE #7) $0.00 (from GFE #2) entral Penn Appraisals 805. Credit report to CBC I (from GFE .q) nnovis Inc. 806. Tax service (from GFE X23) (375.00)6 1.327.50 807. Flood certification to CBC Innovis Inc (ffOm GFE x:3) , . 808. A ppratsal Fee Due to Central Penn A (from GFE #3) 33.80 ppraisers 809, (from GFE #3) 810. 10.00 900. fTEMS REQUIRED BY 25.00 LENDER TO BE PAID IN ApVg 901 Dail i . y NCE: nterest charges _______ from 5/26/2011 to 6/1/2011 @ $18.5800 /day % (6 da s 902. Mortgage insura y ) P•O.C. (ffOm GFE #ut) nce premium for 0 month(s) 903. Homeowner's insu 111.48 904, rance for 1 year(s) to Erie Insurance Exchange (from GFE #3) 905. (from GFE #7 t (225.00)8 1000._RESERVES pEpOSIT - ED VIA 1001. Initial deposit for TH LENDER: your escrow account 1002, Homeowner's insu rance . 1003. Mortgage insurance 4 months @ $ 21 25 Per month (from GFE #9) months @ $ 1004. Ciry property taxes $85.00 2,172.18 months @ g Per month 1005. County props r1Y taxes per month 5 months @ $ 1006. Annual assessments 39.92 per month 1007. School Taxes months @ $ $199.60 12 months g Per month 1008 @ 181.02 per month 1009. A months @ $ ggregate Acct Adj $2,172.24 . . Per month months @ $ 1100., TITLE (~-1gRGES per month ; 1 101. Title services and l ' -$284.66 ender s title insurance 1102. Settlement or closi P,p.C: ng fee 1103. Owner's title insuran (from GFE #q) ce to Select Platinum Settlement Services 1 104. Lender's title insur LLP 1 312.38 , ance • to Select Platinum Settlement Services 1105. Lender's title policy limit LLP (from GFE #5) , $912.38 1 106. Owner's title policy limit $130,500.00 175.50 - 1107. Agent's portion of the total title insurance $170,000.00 premium 1108. Underwriter's portion of the total title ins $1.094.70 to Se l urance premium ect Platinum Settlement S~:rvices, LLP 1109. Ends. 100, 300, 8.1, pud • to Select Pl 68 18 to Old R i at num Settlement Services, LLP 1110. Insured Closing Letter • to Old Re $200 00 b epublic National Title In;;. Co . pu lic National Title Ins. Co. 1111. Notary Fees • to Settlement Office $75.00 r $45.00 1 112. "See attached for breakdow n p $so.oo 1200. GOVERNMENT RE O ~ teG AND TRANSFER"CHARGES: 1201. Government recordin 10 00 rg g c 1202. Deed $62.00 Mortgage $96.00 Releas $p P•O.C.` . 20.00 e .Op 1203. Transfer taxes prom GFE #7> 1204. Ciry/County tax/stam s 70 f 158.00 $0.00 1205. State tax/stamps Deed $1e700 00 o D ( rom GFE ~f8) . Mortg 9e $ O 1206. 1, 700, 00 1207. 1, 700.00 1300.,' ADDIT~pNAL SETTLEMENT GHgRGES 1 : 301. Required services th t a you can shop for 1302 2011 Counry/Twp Taxes to Robin K. P.O,C, 1303. Home Warranty to American Home Sollenberger (from GFE #6) 1304. Assn Dues April/May/June to Middleton' Estates Comm. Assn. 1305. H/O Initiation Fee to Middleton Estates Comm. Assn. 479.03 1306. Final Sewer Thru 5/26/1 1 to North Middleton Authority 534.00 1400. TOTAL SETTLEMENT CHARGES (Enter on Tine 103,Section J -and -line 502, Section K) 55.00 115.00 200.00 I have carefully revieved the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true account or by me in this transaction. I further certify that I have received a co 7,475.84 54.88 ' ~ PY of the HUD-1 and accurate seettement of all receipts and disbursements made on m407.91 i ~ ~., Settlement Statement. Vincent C. Books ~r~' ' ~"-' ~ 7 c.' i' /~ ,.L , -~ 1 Estate of Gayle . Kluz --G-= ~ ' ~ ~~~ ; Jl Jan M. Books T HUD-1 SettlementStatem Borrowers s-fgment. g t ich I have preparQd is a t ;,..~ ,. {; '. / ,a accurate account of this transaction. I have F~ ~ ~ ~ caused orwill ca~~se the funds to be disbursed in accordan Sellers Select latinum Settlem ~ ~ ~ '~ ~ with this ent Services, LLP Settlement Agent WARNING: It is a crime to knowin I Date Title 78 U S. Code Section 1007 a d Sectkionfal0e0 tatements to the United States on this or an y similar form. Penalties upon conviction can include a fine and imprisonment. For details see: ' C mo parisori of Go od Faith-Estimate .Char (GFE) and HUD-1 Charges ges That C annot Increase I Our origination charge HUD-1 Line N ~ I Good Faith Estimate umber ~ Your credit or ch ' -~ HUD.1 arge ( poinfs) for the specific interest rate chosen #802 ~ Yeur adjusted ori i I '-+I 1 327 50 g nation charges 1 Transfer taxes #803 ---t I ~ , . 0.00 1, 327.50 #1203 ' ---~ i I 1,327.50 I 0.00 Charges That in Total Cannot Increas M l ~ -___ 1 ~ 700.00 1,327.50 1 7 e ore Than 10% Go~r~ment recording fee , 00.00 s Appraisal fee #1201 --- Good Faith Estimate Credit report #804 , ~ 185.00 i HUD-1 Flood certification #805 ~~ i i 375 00 158.00 Appraisal Fee Due #807 6270 375.00 II #808 10.00 33.80 # 0.00 10.00 25.00 Increase between GFE and HUD-1 Charges) 632.70 Charges:That Cane:Change $ -30.90 or 601.80 Initial deposit f -4.8838% or your escrow account Daily interest charges Homeowner's insurance Title services and lender's title insurance Owner's title insurance Loan Terms Your initial loan amount is Your loan term is Your initial interest rate is Your initial monthly amount owed for mortgage insurance is Principal, interest, and any Can your interest rate rise? Even if you make your payments on time, can your loan balance rise? Even if you make your payments on time, can owed for principal, interest, and mortgage insu aonce nset? ly amount Does your loan have a prepayment penalty? Does your loan have a balloon payment? Total monthly amount owed including escrow account payments Good Faith Estimate #1001 HUD-1 #901 $ 18.5800 /day 3,089.94 2,172.18 #903 278.70 111.48 #1101 500.00 225.00 # 1103 1, 658.00 1,312.38 # 225.00 175.50 $ 130,500.00 30 years 5.1250% $ 710.56 includes Principal Interest Mortgage Insurance No. ~ Yes, it can rise `o a m on and can chan e a aximum of 0.0000%. can increase or decrease by 0.0000%, p ve The first change will be ry change date, your interest rate is guaranteed to near be lower than 0.0000°ohorlh gherhthan 00000%. your interest rate No. ~ Yes, it can rise to a maximum of $ 0.00. No. ~ Yes, the first increase can be on and the monthly amount ow rise to $ 0.00. ed can The maximum it can ever rise to is $ 0.00. No. ~ Yes, your maximum preps X yment penalty is $ 0.00. No. ~ Yes, you have a balloon y Pa ment of $ 0.00 due in 0 years on . You do not have a monthly escrow payment for items, such as pro ert and homeowner's insurance. Ycu must pay these items direct) P y taxes Y Yourself. 0 You have an additional monthly escrow total initial monthly amount owes! of payment of $ 242.19 that results in a any mortgage insurance and any item schecked bejnoWUdes principal, interest, Property taxes tr-- l.X~ Homeowner's insurance ~1 Flood insurance ~-7 Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form n please contact your lender. ~~~HKDOWN OF PAYOFF ON HUD LINE 504 C,itiNlortgage Description Loan # Principal Balance 1120067541 Interest Amount 72,369.77 Statement Fees 713.92 Recording Fee Total Payoff 25.00 Total as shown on HUD fine 504. 50.50 73,159.19 73,159.19 HUI, 1112 DETAILED BREAKDOWN OF ADDITIONq L TITLE CH,4RGES Description 1113. Doc Trans/Wire Fees • + DE~tail 1114. Overnight Fees • '0 Select Platinum Settlement Services, LLlS510.00 Seller to Select Platinum Settlement Services, LLP Amount 1115. Tax Cert Fee to Select Platinum Settlement Services, LLP $30.00 Total as shown on HUD 15.00 Page 2 Line #1112 5.00 HUD 1200 DETAILED BREAKpOWN OF GOVERNM 20.00 ENT RECORDING AND TRANSFER FEES City 8 County Tax/Stamps Buyer Seller City Tax/Stamps: Deed $1,700.00 Amount Amount Total as shown on HUD page 2 Line #1204 1,700.00 State Tax/Stamps Buyer Seller State Tax/Stamps: Deed $1,700.00 Amount Amount Total as shown on HUD page 2 Line #1205 1,700.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF K~UZ, Gayle H All property jointly-owned with right of survivorship must be disclos ed on Schedule F. ITEM NUMBER DESCRIPTION Prime Fund-Capital Reserves Class Prudential Financial, Inc. American Short Term Bond Fund CL A SCHEDULE B STOCKS & BONDS FILE NUMBER 21 - 11 - 00201 UNIT VALUE i VALUE AT DATE OF DEATH 1.00 222.61 61.11 2, 521.40 10.08 4,430.20 TOTAL (Also enter on line 2, Recapitulation) 7,174.21 i I SCHEDULE D COM NOERITANCEOTAX RETURN ANIA I ,•1 ORTVq~jES RESIDENT DECEDENT & NOTES RECEIVABLE ESTATE OF ~ Kluz, Gayle H ~ ~ FILE NUMBER All propert y 9 21 - 11 - 00201 y joint) -owned with the ri ht of survivorshi ---- p must be disclosed on Schedule F. ITEM ------ NUMBER 1 CITIMORTG GA E DESCRIPTION TOTAL (glso enter on Line 4, Recapitulation) VALUE AT DATE OF DEATH 73,159.19 73,159.19 ~. ~~ ~-~'~~~ SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS R 'N RESIDENT DE EDENTRN ~ `^ MIS C, PERSONAL PROPERTY ESTATE OF KIUZ, Gayle H FILE NUMBER Include the proceeds of litigation and the date the ro 21 - 11 - 00201 survivorship must be disclosed on schedule F,p Ceeds were received b y the estate. All propeirty jointly-owned with the ri ht o 9 f ITEM NUMBER DESCRIPTION Century Link -refund Comcast- refund IRS Tax Refund/Verizon Refund County Tax Refund Homeowners Insurance Refund Escrow Refund Miscellaneous towels, sheets, blankets, clothin 9 Refund from Auto Insurance Policy TOTAL (Also enter on Line 5 Recapitulation) VALUE AT DATE OF DEATH 9.69 91.32 2, 709.80 479.03 45.00 4, 375.31 100.00 105.16 7,915.31 '~, COMMONWEALTH OF PENNSYLVANIA SCHED INHERITANCE TAX RETURN ULE F RESIDENT DECEDENT ~~~NTLY-OVI/NED PRpp ESTATE OF ERTY Kluz, Gayle H If an asset was made joint within one FILE NUMBER year of the decedent's date of deat ' 21 - 11 - 00201 _ h, ~t must be reportEad on schedule G. SURVIVING JOINT TENANTS) NAME Christopher J. Speece ADDRESs 1 847 Lindsey Road RELATIONSHIP TO DECEDENT Carlisle, PA 17015 son Jodi Lyn Speece 2 847 Lindsey Road Carlisle, PA 17015 daughter-in-law JOINTLY OWNED PROPERTY: ITEM LETTER NUMBER FOR JOINT TENANT ~ ~ DATE I MADE aR P Include name o~~nancialT~OsN Oo PR O for simil a &2 JOINT 01/01/2010 b d k ccount n ar identifying number. Attach defied for jointly-held r umbe DATE OF DEATH estate. eal VALUE OF A % OF ~ DEC ' ATE OF DEATH I SSET M&T Bank - Checking Account D S INTEREST VALUE OF DECEDENT'S INTERE I 2 i 10/09/08 I 2,322.04 M&T Bank -Savings Account 33% ST 931.27 ~ I I ~ I I I I 2,c~85.24 50% 1,192.62 i i~ I ~ ~ i i ---_ I I ! i TAL (glso enter on line 6 Re I , capitulation) 2,123.89 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-Sul-434y Abom and Kutulakis Fax (30?)y34-?955 Attorneys At Law 'u'y 6•'~l I 2 West High Street Carlisle, PA 1'7013 Re: Estate of Ga le Harlin Kluz Social Securit : 513.5L_2809 Date of Death: Janua 28 2011 Dear Sir or Madam: Per your inquiry on June 21, 2011, please ~ ad ' deposit with this bank vised that at the time of death, the above-na the following: med decedent had on 1' T'y'pe ofAccount Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Checking Account 10440844 Gayle Harlin Kluz Christoplier J Speece Jodi Lyn Speece 07/30/93 $2, 822.04 $ .00 $2,822.04. ____ .._..._ ..__._.._..._.._________...__.___ _...._.._.._ 2' 7yPe ol`Account Savings Account ' Account Number 15004219432206 Ownership (Names of) Gayle Harlin Kluti Jodi Lyn Speece Opening Date 10/09/08 Balance on Date of Death $2,385.24 Accrued Interest Total ~ .10 $', 385.34 __ _ . >' IM . ~~ ~ I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G ~ RESIDENT DECEDENT I ~' NTER-\ ~IVOS T C. NONY-PROBATE pRERS & ESTATE OF OPERTY Kluz, Gayle H This schedule must b I FILE NUMBER e completed and filed if the answer to an 21 - 11 - 00201 ITEM I Y of uestions 1 throu ROPERTY 9 on page 2 is NUMBER I Include the name ofshe t ansOfereOeFt eir relationship to decedent q h 4 and the date of transfer. yeS. Attach a copy of the deed for real estate. DATE OF DEATH % OF 1 American Ca VALUE OF ASSET DECD'S EXCLUSION P World Growth & Income INTEREST (IFAPPLICABLE) j TABLE VALUE 17, 733.44 2 Oppenheimer Main Street 17, 733.44 3 Alcatel Lucent Spon qpR 9 294 28 9, 294.28 4 23.17 American Capital Income Builder 23.17 22, 605.05 5 Oppenheimer Global Strategiv Income 22,605.05 6 American Income Fund of A 6880.47 merica 6,880.47 7 9,872.43 American Intermediate Bond of America 9,872.43 8 Prime Fund Capital Reserve 1x'975.45 s Class 16,975.45 9 I MassMutual Transitio 134.36 ns -Non-Qualified 134.36 10 6,322.33 Mass Mutual Odyssey Plus -IRA 6, 322.33 11 27,313.92 MassMutual Transitions Select - IRq 27,313.92 62, 961.44 62, 961.44 TOTAL ~ (Also enter on line 7, Recapitulation) 180 ,11 x.34 yam. _ .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kluz, Gayle H SCHEDULE H FUNERAL DCPEN~S & ADMINISTRq~ COSYTS ITEM ! Debts of decedent must be reported on Schedule I. NUMBER i FUNERAL EXPENSES: DESCRIPTION A• 1 i Hoffman-Roth Funeral Home & Cremato ,Inc. 219 North Hanover Street, Carlisle, PA 1 013 i B. 4 5. 6. ~. 33, 750.00 390.50 75.00 166.30 285.00 1 2. 3. FILE NUMBER 21 - 11 - 00201 AMOUNT 3,287.08 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Christopher Speece Street Address 847 Lindsey Road I city Carlisle State PA Zip 17015 Year(s) Commission paid WAIVED Attorney's Fees Michelle Sommer, Esquire, Abom & Kutulakis Family Exemption: (If decedent's address is not the same as claimant's, attach LLP Claimant explanation) Street Address City Relationship of Claimant to Decedent State Zip ~_ Probate Fees Register of Wills -Court Filing Fee Estate Notice Publication -Cumberland Law Journal Estate Notice Publication -The Sentinel Accountant's Fees Tax Return Preparer's Fees Kevin B. Benton, CPA 401 E. Lowther Street, Suite 220, Carlisle, PA 17013 Other Administrative Costs Real Estate Settlement Costs-Home Warrant y 534.00 TOTAL (Also enter on line 9, Recapitulation) GA ~~w vL, J / G. / 0 M. '«~ .~ I '`' ` ~ Schedule H COMMONWEALTH OF PENNSYLVANIA C INHERITANCE TAX RETURN Furl ~-~~'~S~S -__ RESIDENT DECEDENT ~n~n~~{*,,,~ ESTATE OF Kluz, Gayle H ''~~~V~ ~.~nu~ ----_-- Realt Estate Settlement-Assn. Dues (April-J une) Real Estate Settlement-Final Sewer ' bill-N. Middleton Authority ~ Real Estate Settlement-Transf er Tax j Real Estate Commission ~ Broker Adm in Fee Deed Prep to ERA_NRT I Transfer Tax Tax Certification Fee Overnight fees FILE NU R 21 - 11 - 00201 i'I I i Page 2 of Schedule H 115.00 54.88 1, 700.00 10,200.00 195.00 100.00 1, 700.00 5.00 15.00 $/share as of NFS Brokerage Accpunt ,. NaM_ # of Shares 1/2g/11 Qualified Market Value pPJ-3.75277 Prime Fund -Capital Reserves Class Prudential Financial lnc 222.63. $1.00 ~lrnerican Shart_Term Bond Fund CL A 41"~~ $~ZZ 61 $61.11 $Z,S23,.40 439.504 $10.0$ $4, NFS Brokerage ,A;ccoun~t -18,q gpa 430.20 aPJ-581046 American Cap World GrQwtl~ & Income Oppenheimer Main Street 49Z.3~2 $36.02 Alcatel Lucent Spon ADR 185.056 $17,733.44 $32.49 $9.294.28 American Capital Income Builder 7 $3.33 Oppenheimer Global Strategic Income 453,Q07 $3.17 American Income Fun 1.603.84 $49.90 $~?2,505.05 d ofiAmerica ~ $4.29 $G,880.47 American intermediate Bond bfAmerica X89 399 1262.1x5 $16.75 $9,872.43 Prime Fund -Capital Reserves Class $13.45 134.36 ~ 1'6, 975.45 $1.00. $134.36 Value as of 1/28/x3. MassMutual Transitions ., Non-Quall;Fped TRC~t4757104 $6,322.33 Mass-V-utual Odyssey Plus - r,Rp 4yDP4801,14,59 $27,313.92 Massivlu#ua[ Transitions Select - IF~A 7~RN448499~6 $6Z,96~..44 Payout value of MasslVlutuai 7~nsitians and Transitions Select election, to be determined upon receipt of proof of dea~~h and Payment ~;~:~ ... ! SCHEDULE DEBTS OF DECEDENT M COMMONWEALTH OFPENNSYLVANIA , ORTGAGE IN RESIDENT DE EDENTRN LIABILITIES & L TENS -___ EsrgrE of Kluz Gayle H FILE NUMBER Report debts incurred by the decedent prior to Beat 121 - 11 - 00201 -_ h that remained unpaid at the date of death, includ' Ong unreimbursed medical expenses. ITEM NUMBER DESCRIPTION ~- Middleton Estates Homeowner's Association Fee AMOUNT s MedStaffers 160.00 19 Brookwood Avenue, Suite 103 Carlisle, Pq 17013 1,800.00 CitiMortgage -Mortgage payments for March, A ri p I and May UGI Gas Service 3, 922.32 PPL Electric Utilities 318 37 Verizon Wireless 174 81 CenturyLink 134.32 Comcast 43 54 Bon-Ton Credit Card 137.84 North Middleton Authority 240 Clearwater D i 129.79 r ve Carlisle, Pq 170'13 82.30 Robin Sollenberger, Tax Collector-Real Estate Ta 5 Hill Drive xes Carlisle, PA 17013 469.96 Robin Sollenberger, Tax Collector, Personal 5 Hill Drive Taxes Carlisle, PA 17013 9.80 TOTAL (quo enter on Line 10 Recapituta~tion) 8,433.95 i i I ~_ ~. SCHEDULE '~~ ~ ~ DEBTS OF DECEDENT COMNOERITANCEOTAXRETURNANIA e(~ 7 MORTGAGE RESIDENT DECEDENT LIABILITIES, & LIENS continued ESTATE OF KIuZ, Gayle H FILE NUMBER 21 - 11 - 00201 Report debts incurred by the decedent prior to death that rema' fined unpaid at the date of death, including unreimbursed medical ex ense p s. ITEM NUMBER DESCRIPTION ~ State Employees' Retirement System 30 North Third Street, Room 319 Harrisburg, PA 17101 Carlisle Electronics -purchase refrigerator to s ell house Jerald -junkman -remove bulk trash from ho use AMOUNT 139.02 686.88 225.00 Page 2 of Schedule I ~ REV-1513 EX+ (11-08) . ~ I COMMONWEALTH OF PENNSYLVANIA S~+HEDULE J INHERITANCE TAX RETURN RESIDENT DECEDE BENEFI NT ~ CIARIES ESTATE OF Kluz, Gayle H NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 ~ Christopher Speece r 847 Lindsey Road Carlisle PA 17015 I 2 i Jodi Lynn Speece 847 Lindsey Road Carlisle PA 17015 RELATIONSHIP TO DECEDENT Do Not list Trustee(s) ---- Son Daughter-in-Law i FILE NUMBER j 21 - 11 - 00201 SHARE OF ESTATE ~ AMOUNT OF ESTATE (Words) ($~$) i 99.9978 0021141 I Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 15 I II. NON-TAXABLE DISTRIBUTIONS: ._ 00 cover sheet, as appropriate. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION T O TAX IS NOT TAKEN IB. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I Salvation Army -dropped ofF clothing and small household item s at Carlisle PA sfter hours ~ ~ I i T/1 T . ~" ~ `''~ yr h'f'-F~T ~I -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHFF-r 440,488.94 440, 488.94 300.00 300.00