HomeMy WebLinkAbout09-10-11 (2)REji-1500 EX Page 3
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File Number
21 11 0699
L/~iVVMV~.~ V vv...r.--- - --------
DECEDENT'SNAME
RAYMOND S. BLACN:
_
STREET ADDRESS
139 E. SOUTH STREET
C~~, STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments 11,790.33
A, Prior Payments
B. Discount 620.54
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
(1) 12,410.87
Total Credits (A + B) (2) 12,410.87
(3)
(4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN'°X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred : ......................................................................
b. retain the right to designate who shall use the property transferred or its income; ............................... X
c. retain a reversionary interest; or ................................................................................................ ^
d. receive the promise for life of either payments, benefits or care? ....................................................... ^
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^
3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ......... ^
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? .................................................................................................. ~ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE: G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, undE
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REi~r-1502 EX+ (01-10)
pennsylvania SCHEDULE A
~ DEPARTMENT Of REVENUE
REAL ESTATE
INHERITANCE TA7( RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RAYMOND S. BLACK: 2"I 11 0699
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosecl on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. 139 E. SOUTH STREET, CARLISLE, PENNSYLVANIA 95,000.00
APPRAISAL ATTACHED
TOTAL (Also enter on Line 1, Recapitulation.) I $ 95
If more space is needed, use additional sheets of paper of the same size.
RE,~(-1506 EX + (6-98)
SCHEDULE E
' CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RAYMOND S. BLACK: 21 11 0699
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointty-ovmed wdh right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PERSONAL PROPERTY -APPRAISAL ATTACHED 5,619.00
2. M&T BANK -CHECKING ACCOUNT #1044508 10,495.14
3. SOVEREIGN BANK -CHECKING ACCOUNT #1691027677 11,059.84
4. SOVEREIGN BANK -MONEY MARKET ACCOUNT #2894076681 10,400.15
5. SOVEREIGN BANK -CERTIFICATE OF DEPOSIT #2895539704 86,260.75
6. SOVEREIGN BANK -CERTIFICATE OF DEPOSIT #2895553135 25,250.94
TOTAL (Also enter ors line 5, Recapitulation) I $ 149,085
(If more space is needed, insert additional sheets of the same size)
REi/-1509 EX+ (01-10)
Pennsylvania
• DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF: FIILE NUMBER:
RAYMOND S. BLACK. 21 11 0699
If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. FAE L. HORNER 139 E. SOUTI-I STREET FRIEND
CARLISLE, PA 17013
B
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. M&T BANK -CHECKING ACCOUNT #9846061985 2,626.62 50. 1,313.31
TOTAL (Also enter on LinE: 6, Recapitulation) I $ 1,313.31
If more space is needed, use additional sheets of paper of the same size.
REaV-1510 EX+ (OS-09)
pennsyNvania
~ DEPARTMENT OF REVENUE
INHERITANCE TAk'. RETURN
RESIDENT DECEDENT
SDHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
RAYMOND S. BLACK 21 11 0699
This schedule must be completed and filed if the znswer to any of questions 1 through 4 on page thre:e of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THETRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH ACOPY OFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST prAraucneLEl VALUE
1. WESTERN NATIONAL LIFE INSURANCE COMPANY 55,561.23 100.00 55,561.23
ANNUITY CONTRACT #W217016
BENEFICIARIES: WENDY K. PRIZE AND TRACY A. RAY
TOTAL (Also enter on Line: 7, Recapitulation) ~ $ 55,561.23
If more space is needed, use additional sheets of paper of the same size.
R ~V-1511 EX+ (10-09)
pennsylvania
DEPARTMENT OF~ REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF ri~~ nvmor..n
RAYMOND S. BLACK 21 11 0699
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)ofPersonalRepresentative(s) ROGER B. IRWIN 10,320.00
Street Address 60 WEST POMFRET STREET
City CARLISLE State PA ZIP 17013
Year(s) Commission Paid:
2. AttomeyFees: IRWIN & McKNIGHT, P.C. 11,670.00
3, Family Exemption: (If decedents address is not the same as claimants, attach explanation.)
Claimant
Street Address
City State ZIP .
Relationship of Claimant to Decedent
4. Probate Fees: REGISTER OF WILLS 146.50
5 Accountant Fees:
6. TaxRetumPreparerFees: PATRICIAA. ROSENDALE, CPA 375.00
7. REGISTER OF WILLS -FILING FEE 30.00
8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00
9. THE SENTINEL -ESTATE NOTICE 178.92
10. NOTARY FEES 25.00
11. SOVEREIGN BANK -DATE OF DEATH VALUATION 20.00
12. TRAVEL EXPENSES - TRACEY BLACK / WENDY PRIZE 2,677.61
13. S.W. BARRETT REAL ESTATE -APPRAISAL ON REAL ESTATE 350.00
14. ROY D. GOTTSHALL - APPRAISAL ON PERSONAL PROPERTY 15.00
TOTAL (Also enter on Line 9, Recapitulation) $ 25.883.03
If more space is needed, use additional sheets of paper of the same size
RED/-1512 EX+ (12-08) I
pennsylvania SDHEDULE
DEPARTMENT OF REVENUE DELTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, ~ LIENS
RESIDENT DECEDENT
ESTATE OF FIILE NUMBER
RAYMOND S. BLACK 2'1 11 0699
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, inclwding unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. CUMBERLAND GOODWILL FIRE RESCUE EMS -AMBULANCE 1,370.65
2. DEPARTMENT OF VETERANS AFFAIRS -REIMBURSEMENT OF BENEFIT ~ 974.00
TOTAL (Also enter on Line 10, Recapitulation) I $
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
~ DEPARTMENT OF REVENUE BENEFICIARIES
iniuc olTnnl!`C TAY OCTI IOAI
ESTATE OF:
RAYMOND S. BLACK;
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
~ TAXABLE DISTRIBUTIONS [Include outright spousal distributiuns and transfers under
Sec. 9116 (a) (1.2).]
1. FAE L. HORNER
2.
3.
II.
1.
139 E. SOUTH STREET
CARLISLE, PA 17013
WENDY K. (HORNER) PRIZE
21 SOUTH ZINNIA WAY
LAKEWOOD CO 80228
TRACEY A. (RAY) BLACK
905 REYNOLDS FARM LANE
LONGMONT, CO 80503
FILE NUMBER:
21 11 069!
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Collateral
Lineal
Lineal
AMOUNT OR SHARE
OF ESTATE
1,313.31
JT ACCOUNT
135,709.68
1/2 REMAINDER
135,709.69
1/2 REMAINDER
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL. DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $
If more space is needed, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
I, RAYMOND S. BLACK, of the Borough of Carlisle, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly
revoking all Wills and Codicils heretofore made by me.
1. I direct my executors to pay all of my debts, funeral and administrative expenses
as soon as may be done conveniently after my decease.
2. I authorize and empower my executors to sell any realty owned by me at my
death, and not specifically devised herein, at either public or private sale, and to give good and
sufficient deeds therefor, in fee simple, as I could do if living.
3. I devise and bequeath all of my estate of every nature and wherever situate to
Wendy Kay Horner and Tracey Ann Ray, share and share alike;, or the survivor thereof.
However, as long as Fae L. Horner desires to do so and actually does so, I direct that she shall be
able to live in my house at _139 E. South Street, Carlisle, and use the; contents therein, provided
she pays the taxes, utilities, insurance and upkeep.
4. Should the gift in Paragraph No. 4 not take effect, I devise and bequeath all the
rest, residue and remainder of my estate of every nature and wherever situate to the children of
Wendy Kay Horner and Tracey Ann Ray, share and share alike, per stir~pes.
5. I nominate and appoint Roger B. Irwin and James D. Hughes to be the executors
of this my Last Will and Testament; they are to serve as such without bond. Should they die
before my death, renounce or refuse to serve for any reason, or die leaving my estate
unadministered, Inominate and appoint Marcus A. McKnight, III, as substitute executor with the
same powers as are given herein to my executors, and also without the filing of any bond.
6., I hereby suggest that my personal representative retain the services of Irwin,
McKnight & Hughes, as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 27TH day of July,
2001.
'~~ S /U AL)
RA OND 5. BLACK
Signed, sealed, published and declared by RAYMOND S. BI:,ACK, the Testator above
named, as and for his Last Will and Testament, in the presence of us, who at his request, in his
presence and in the presence of each other have subscribed our names as witnesses hereto.
2
ACKNOWLEDGMENT AND AFFIDAVIT
WE, RAYMOND S. BLACK, CHERYL L. CLELAND and MARTHA L.
NOEL, the testator and witnesses respectively, whose names are :>igned to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
testator signed and executed the instrument as his Last Will, and that he had signed
willingly, and that he executed it as his free and voluntary act for the purpose herein
expressed, and that each of the witnesses, in the presence and ]hearing of the testator,
signed the Will as a witness and that to the best of their knowlecige the testator was, at
that time, eighteen years of age or older, of sound mind and under no constraint or undue
influence.
RA~OND S.
CLELAND
COMMONWEALTH OF PENNSYLVANIA
. SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by, RAYMOND S. BLACK,
the testator herein and subscribed and sworn to before me by CHERYL L. CLELAND
and MARTHA L. NOEL, witnesses, this 27TH day of July, 2001.
Notary
3. c~_
Roger B. Irwin, Notary Public
Carlisle Horo, Cumberland County
My Commission Expires Oct. 3, 2004
Member, Pen nsylvania Association of Notaries
S. W. BARRETT REAL ESTATE AND APPRAISAL SERVICES
APPRAISAL OF
LOCATED AT:
139 East South Street
Carlisle, PA 17013-3429
CLIENT:
Irwin S McKnight
60 West Pomfret Street
Carlisle, PA 17013
AS OF:
June 10, 2011
BY:
Stan A. Skowronek
PA Certified Residential Real Estate Appraiser
• S. W. BARRETT REAL ESTATE AND APPRAISAL SERVICES
07!0112011
Irwin JL McKnight
60 West Pomfret Street
Carlisle, PA 17013
File Number: 11-0140
In accordance with your request, I have appraised the real property at:
139 East South Street
Carlisle, PA 17013
The purpose of this appraisal is to develop an opinion of the defined value of the subject property, as improved.
The property rights appraised are the fee simple interest in the site and improvements.
In my opinion, the defined value of the property as of .June 10, 2011 is:
$95,000
Ninety-Five Thousand Dollars
The attached report contains the description, analysis and supportive data for the conclusions,
final opinion of value, descriptive photographs, assignment conditions and appropriate certifications.
Respectfully submitted
Q.~~~
Stan A. Skowronek
PA Certified Residential Real Estate Appraiser
Summary
Residential Annraisal Rr+nnrt .,_ ,~ ,,..,,
The purpose of thls appraisal report is [o provide the client with a credible opinion of the defined value of the subject propery, given the intended use Gf the appraisal.
ClientNamellntended User Irwin 8 McKnight Email NIA
Client Address 60 West Pomfret Street city Carlisle state PA zi 17013
Addivonal Intended users The Intended User of this a sisal re ort is the Client. No additional intended Users are ermitted without
the rmission of the a raisers .
Intended use The Intended Use is to evaluate the ro ert that is the sub'ect of this a sisal to provide the Client with an
accurate and ad uatel su ooed o infon of value.
Pro .Address 139 East South Street ci Carlisle state PA zi 17013-3429
Owner of Puhlic Record 818ck, Raymond S. Caun Cumberland
Le al De~rlpbon Deed Book 33X, page 1152
' Assessor's Parcel # 03-21-0320-106R Tax Year 10111 R.E. Taxes s 1 926.00
'
Ne
hborhood Name Borou h Of Carlisle Ma Reference 21-0320 Census Tract 0122.00
Pro a Ri hts A raised X Fee Sim le Leasehold Other describe
M research did X did no[ reveal an dor sales or trartsfers of the subject ro for the three ars rier to the a#ecdve date of this sisal.
PrbrSale/Transter: Date 01/09/1989 Price S1 Sources Deed
Anatysis of prior sale or transar history of the subject property (and comparable sales, if applicable) No prior transfers of the Sub'ect within the ast 36
months, nor were there an prior transfers of the comparables within 12 months of their sale date.
0#erings, opfions and contracts as of the a#ecdve date of the appraisal None known
- NelphborhooA;Chvacleristlcs'
- ..- -
~_. .-.. Onelnit Houslnp Trends .,_
::.one•Unit Housing; -.
PfeslntL'and Usl9(i-
Catalan Urban X Suburban Rural Pro a Values Increasin X Stable Dedinin PRICE AGE One-Unit 72 %
BuiR-U Over 75% X 25-75% UMer 25% DemandlSu Shona e X In Balance Over Su Og0 rs 2-4 Unit 8 %
Growth Ra id X Stable Stow Markedn 7me Under 3 mths X 3.6 mths Over 6 mths FIO Low 25 Multi-Fami 0 %
Neighborhood Boundaries The sub ect is bounded on the north b Pitt St on the east b 1;i0 Hi h 100 Commercial 5 %
Juni er St on the south b Rid St and on the west b West St. 1110 Pred. 75 other Schl 15 %
Neighborhood Descripdon The subiect is located amongst sinOle family detached attached and semi •detached homes of va 'n size
'• st a and quality. It Is wtthfn close proximity to ammenities such as schools shopping and em to ent.
Market (:ondibons (including support ar dle above conclusions) See Attached Addendum
Dimensions 42.79x126.83x42.84x128.70 Area .13 Acre m/I Sha a Rectan ular view SchoollResidential
s ecific zonin classification R4 zonin Descri lion Town Center Residential
Zonin Com Hance X L al L al Nonconarmin Grandfathered Use No Zonin Ille al describe
Is the highest and best use of the subject property as improved (or as proposed per plans and specficadons) the present use? X Yes No If No, describe.
Utilities Public Other describe Public Other describe Off-sltE~lm rovements-7 a Public Privaze
Elecvici X water X Sveet Macadam X
Gas I 1 I I SankaN CPWP (~ Alley None
site comments There are no apparent adverse easements encroachments or other adverse condiition. The im rovements are in
a FEMA special flood hazard area per Map #42041C0233E/dated 03h8l2009lZone AE
..:GENERAL DESCRIPTION ': FOl1NDATION '
Units X One Onew/ACC.unil X ConcreteSlab Crawls ace
# of Stories 2 Full Basement Partial Basement D(TERIOR DESCRIPTION :maFednls:
FoundatbnWalls ConCSlab/Aw
Exterior Walls BriCk1T-1111Av ,INTERIOR. ~maOedaLs .
Floors Cr tMn I/Av
Walls D all/Av
T e Det AtL X 5-DetJEntl Uni[ Basement Area N/A s . g. Roof Surface COm OSh le!IAv TriMFinish WOOd/Av
X Easdn Pro osetl Under Const Basement Finish NIA % Guvers & Downs uts Aluminum/AV Balh Floor 'fin IAv
Desi n S e 2 Sto outside En /Exit Sum Pum window T e Wood FramelAv cam Wainscot D all/Av
Vear Built 1981 Storm SasNlnsulated Thermal/Av Car Sara a None
E#ective a rs 20 Screens Y2SIAV Drivewa # of Cars
Atdc None Heatrn X FWA HW Radiant Amenities WootlSave :; # Drivewa Surface 2 S aces/Mac
X Dro Stair Stairs Other Fuel Elect Fire laces # Fence Gara e n of Cars
Floor ScuWe Coolin X Central Air Condibonin X PabolDeck X Porch Car on # of Cars
Fini~ed Heated Intlhridual Other Pool Other Aa. Det Built•in
A liances X Retr eraar X Ran a/Oven X Dishwasher X Dis sal Microwave Washerro r Other describe
~ Finished area above grade contains: 5 Rooms 3 Bedrooms 1 5 BaN(s) 1 240 5 uare Feet of Gross Livin Area Above Gratle
AdtliUOnal FeaNres Front porch. Rear patio.
Commenu> on the Improvements Improvements are in average condition with no physical or functional iinade uacies noted.
r ' ~ Page lala .-...-_______..__..__._...,,...,.,., ~.,„w.,z.nxpia xesenea.
tgPAiln)General Propose Appraisd Report t7/pp5
,_ gci,cral purnoa~: ~ppra~smrcpo.i GPARI001_OS 0513a110
ADDENDUM
•
Client Irvvin 8 McKnight File No.: 11-0140
Property Address 139 East South Street Case No.:
City: Carlisle State: PA Zip: 17013
Neighborhood Market Conditions
List/Sale ratio approximately 98%. I have considered relevant competitive listings and/or contract offerings in the
performance of this appreisal and in the trending information reported in this section. If a trend is indicated, I have
attached an addendum providing relevant competitive IisUnglcontrect offering data. Locail multi-list data indicates
stable market in the past calendar year with no appreciation in the subjects market area, wiUi an average marketing
time of 90-180 days. Economic trends and lending rates have remained favorable. Sales concessions are occuring
more frequently; however, there is no known prevelance of unusual seller financing concessions or buydowns.
There are new homes under construction in surrounding developements, as well as resales available in the
neighborhood.
Aaaenaum rage -i or -,
Summary
Residential Appraisal Report File No. 11-0140
• -
FEATURE SUBJECT COMPARABLE SALEN0.1 COMPARABLE SALEN0.2 COMPARABLE SALEN0.3
139 East South Street
Address Carlisle PA 17013 328 Juniper Street
Carlisle PA 17013 324 Juniper Street
Carlisle PA 17013 1313 N. Pitt Street
Carlisle PA 17013
Proldmi to sub' t 0.23 miles SE 0.23 miles SE 1.32 miles N
Sale Pdce 8 $ 127 000 $ 110 000 $ 109 900
Sale PricelGross Lnr. Area 8 0.00 . n. 8 98.60 s . fL 8 98.21 . n. _ 8 80.81 . ft
Data sources ins on.: CPMLS 10195067 CPMLS 10197270 CPMLS 10201060
verification Sources Courthouse Courthouse Courthouse Courthouse
VALUE ADJUSTMENTS DESCRIPTION DESCRIPTION ~(•15Adjuslmenl DESCRIPTION ~(~)SAduslnenl DESCRIPTION •a)s
sale or Financing '
Concessions NIA;'
` 56,000 CI. Csts
FHA DOM 65 None, Cash
DOM 220 None, Other
DOM 116
pate of salelTime NIA; 0912412010 02/2412011 02108/2011
Caption Suburban Suburban Suburban Suburban
LeaseholdlFeesim le Fee Sim le Fee Sim le Fee Sim le Fee Sim le
site .13 Acre m11 .08 Acre mll .11 Acre mll .07 Acre mll
view Schl/Residential Residential Residential Residential
Iasi n S
ual' of Construction 2 Sto SemD
Avera a 2 Sto SemD
Avera a 2 Sto SemD
Avera a 2 Sto SemD
Avera e
~ AcWal A e 30 Years 35 Years 34 Years 41 Years
. condition Avera a Good - 10% -12 700 Good - 10% -11 000 Good - 10% -10 990
_ Above Gratle Tad ed,mt eau° Taal adms adns Taal edrma eaNs Tad tioms eagn
Room Count 5 3 1.5 6 3 1.5 5 3 1.5 6 3 1.5
' Gross Area30.00 1 248 . n. 1 288 . Ic 0 1 120 . tL 3 840 1 360 . n. -3 360
'
• Basement&Finished
Rooms Below Grade
wncdonal tldli
Head ICoolin
Ener Efficiemltems Slab
Avera a
FWA/CA
T ical Full Bsmt
Famil Room
Avera a
EBB1None
T ical -5,000
-3000
4 000 Full Bsmt
Unfinished
Avera a
EBBJNone
T ical -5,000
4 000 Full Bsmt
Game Room
Avera e
FWAICA
T ical -5,000
-3000
Gar erCar on Off Street Off Street Off Street Off Street
ParchlPadolDeck PorchlPatio Patio/Fence ScInP/Patio -5.000 Patio/Fence
None 1 Fire lace -3 000 None 1 Fire lace -3 000
Net Ad' stment Total + X - $ 19 700 + X - $ 1:i 160 + X - $ 25 350
Adjusted Sale Price
otCom ambles Ne[Adj. -15.5%
GrassM'. 21.8%
8 107 300 Net Adj. -12.0%
Gross Ad. 26.2%
8 9fi 840
' Ne[Adj. -23.1%
Grt>SSAd'. 23.1%
8 84 550
Summ of sales Com o ustment for com arable #1
rison A roach O inion of value ran a is 585 000 to $107 000. No closin cost ad
since it sold below list rice. The condition ad'ustments result from a review of the com airables interiors via the "virtual
tour" feature of the Central Penn Multi-List System These are the best sales comparables iknown to be available.
7COSTARP.ROACHTOVALUE~~ - :_ -
site value Comments A two ear review of land sales did not locate an sales within the sub acts market therefore the o inion of
value for the site is based u on the 2010 tax assessment of 526 500 which is a sub active value. O inion of value for the
sub'ect site - 526 000.
ESTIMATED REPRODUCTION OR REPLACEMENT COST NEW OPINION OF SITE VALUE ....................................... = 8 26 000
Source of cost data Dwellin S . FL 0 8 .... = 8 0
•
ali rafin nom cost service Enecdve date of cost data S . FL ~ 8 = 8
Comments on Cos[ A roach toss I' ' area cakulaUOns, de reciatron, etc.
Cost A roach deemed a oor indicator of value. The
• Estimated Remainin Economic Life- 40 arS. Gar efCar n 0 S . FL C~ $ _ $ 0
TotalFsdmateofCost-New = 8 0
Less Ph sisal Functional EMernal
De reciation = S 0
De reciatedCostoflm rovements ................................ = 8 0
'AS•is" Value 01 site Im rovements ............................... = 8
INDICATED VALUE BY COST APPROACH ...................... =8 NIA
':INCOaEAtaRROACHTOVALUE. - - ~ ~ -
Estimatetl Month Markel Renl$ N/A X Grass Rent MuIU tier NIA = 8 NIA Indicated Value b Income A rcach
• Summary of Income Approach (including support for market remand GRM) NIA
Indicated Value Sales COm arisonA roachs95 OOO CostA roach Ifdevelo ed $ NIA IncomeA roach if develo ed $ NIA
The Market Data Anal is su orts m o inion of value for the sub act. The Cost roach was not deemed an a ro riate
indicator of value and therefore was not included herein. The Income roach was also steamed ina r riate for this
anal sis. -
•
This appraisal is matle X "as is," subject to completion per plans and specifications on the basis of a hypothetical condition shat the improvements have been completed,
subject to the following repairs or alterations on the basis of a hypothetical wndidon that the repairs or aderadons have been completed ^ subject to me following:
The prope-`y ~°° ~°°^ '^^ °°~ lr. caarr°nt condition. This is for the clients use only.
• Based on the scope of work, assumptions, limiting conditions and appraiser's certification, my (our) opinion otthe defined value of the real properly
that is the subject of this report is$ 95.000 _ as of 0 611 0120 1 1 ,which is the effective date of this appraisal.
`~ ProauUO USng Aq mlMme.aW.Zaa.alai vxw.eore0.cam TNS Iaim COpy~IgN 02005~a010 ~q GiASian NI50 Calms SaMCes.Inc.N Rlra°ResenN.
Page 2 °I d (gPAR°) Gened Pmp°se Appdsel Repon 1712005
~TM GPARIWa 05051aM10
ge~~~„P~„o, PP~,,,,,,.~Pa,, S.W. Barrett Real Estate 8 Appraisal Services
FIe No. 11.0140
Scope of Work, Assumptions and Limiting Conditions
Scope of work is defined in the Uniform Standards of Professional Appraisal Practice as" the type and extentof research and analyses in an
assignment" In short scope of work is simpy whazthe appraiser did and did not do during the course of the assignment It inNudes, but is not
limited to: the extenttowhich the properly is identified and inspected, the type and extent of data researched, the type and extentaf anatyses applied
az arrive azopinions a conclusions.
The scope of this appraisal and ensuing discussion in this reportare specific tothe needs of the lien; other identified intended users and tothe
intended use of the report. This reportwas prepared fa the sok and exclusive use of the elierrtand other identified Intended users for the identified
intended use and its use by any otlaer parties is prohibited. The appraiser is not responsl6lefa unauthorized use of the report
The appraiser's certification appearing in this appraisal report is subjecttothe following conditions and to such other specific conditions as are
setforlh bythe appraisar in the report. All extraordinary assumptions and hypothetical conditions are stazed in the reportand might have affected the
assignment results.
i. Thee appraiser assumes no responsibility for matters of a legal nawre affecting the property appraised or title thereto, nor does the appraiser render any opinion as to the title, which is
assumed ro be goad and marketable. The property is appraised as though under responsible ownership.
2. Any sketch in this report may show approximate dimensions and is included only ro assist the reader in visualaing the property. The appraiser has made no survey of the property.
3. The appraiser is not required to give testimony or appear in court because of having made the appraisal witlt reference ro the property in question, unless arrangements have been
previousty made thereto.
4. Neither afl, nor arty pan of the content of this report, copy or other media thereof (including cendusions as ro the property value, the identity of the appraiser, professional designations,
or the firm with which the appraiser is cronnected), shall he used tar arty purposes by arryone but the agent and other intended users as identified in this report, nor shafl it be wmeyed by
anyone ro the public through advertising, public rela~ns, news, sales, or other media, witlrout the written consent of the appraiser.
5. The appraiser will not disclose the contents of tlas appraisal report unless required by applicable law or as spedfied in the Uniform Standards of Professional Appraisal Practice.
6. Inrormadon, estimates, and opinions furnished ro the appraiser, and contained in the report, were ahtained hom sources considered reliable and believed ro he mre and coned.
However, no responsbility for accuracy of such items furnished ro the appraiser is assumed by the appraiser.
7. The appraiser assumes that tftere are no hidden or unapparent conditions of the property, subsoil, or structures, whkh would render l more or less valuable. The appraiser assumes
no responsibility ror such conditions, or for engineedng or resting, which might be required ro discover such factors. This appraisal is not an environmental assessment of the property and
should not be considered as such.
8. The appraiser specializes in the valuation of real property and is not a home inspector, building contracror, structural engineer, or simflar expert, unless otherwise noted. The appraiser
did not rrondud the intensive type of field observations of the land intended ro seek and discover property deeds. The viewing of the property and any improvemems is for purposes of
deveroping an opinion of the defined value of the property, given the intended use of this assignment Statements regarding condition are based on surface observations onry. The
appraiser claims no spatial expertise regarding issues including, but not limited ro: roundation settlement, basement moisture problems, wood deshoying (or other) insects, pest infestation,
radon gas, lead based paint, mold or environmental iswes. Unless otherwise indirared, mechanical systems were not activated or tested.
This appraisal report should not be used ro disclose the condition of the property as i[ relates ro the presence/absence of detects. The diem is invited and encouraged to employ qualified
experts to inspen and address areas of concern. If negative conditions are discovered, the opinion of value may be affected.
Unless otlterwise noted, the appraiser assumes the components thazconstilutie the subject property improvemem(s) are iundamentalty sound and in
working ceder.
Any viewing of the property by the appraiser was limited ro readity observable areas. Unless otherwise noted, attics and crawl space areas were not aceessed. The appraiser did not move
furniWre, floor coverings or other items that may restrict the viewing of the property.
9. Appraisals involving hypothetical conditions related ro completion of new construction, repairs or alterafion are based on the assumption that such completion, alteration ar repairs will
be competently performed.
10. Unless the intended use of tltis appraisal spedficaly includes issues of property insurance coverage, this appraisal should not be used for such purposes. Reproduction or
Replacement cost figures used in the cost approach are tar valuation purposes any, given the imended use of the assignment The Definition of Value used in this assignment is unlikery
to be consistent with the definition of Insurable Value for property insurance coverageluse.
]i The ACI General Purpose Appraisal Report (GPARTM) is not intended fa use in transactions that require a Fannie Mae 10rMIFreddie Mac 7g form,
also known as the Uniform Residential Appraisal Report(URAf2).
Additional Comments ReWted To Scope Ot Work, Assumptions and Limiting Crxtdltions
None
^
pennrol gopo^+c aPPracnl roPOrt
File No. 11-0140
Appraiser's Certification
The appraiser(s) certifies that, to the best of the appraiser's knowledge and belief:
1. The statements of lac[ contained in this report are vue and correct
2. The reported anatyses, opinions, and conclusions are limited only by the reported assumptions and IimNng conditions and are the appraiseYS personal, impartial, and unbiased
prote:ssional anatyses, opinions, and conclusons.
3. Unless otherwise statetl, the appraiser has no present or prospective interest in the property that is the subject of this report and has no personal interes[wim respect to me parties
invahretl.
4. The appraiser has no hiss with respect to the property that is the subject of this report or to the parties irnolved with this assignment
5. The appraiser's engagement in this assignmentwas no[ contingent upon devebping or reporting predetermined results.
6. The appraiser's compensation for completing mis assignment is not contingent upon the development or reporting of a predetermined va61e or direction in value that favors the cause of
the client, the amount of me value opinion, the attainment of a stipulated result, ar the occurrence of a subsequent event directly related to me intended use of this appraisal.
7. The appraiseYS anatyses, opinions, antl wnclu~ons were developed, and This report has been prepared, inconformity with the Uniform Standards of Professional Appraisal Practice.
B. Unless otherwise noted, the appraiser has made a personal inspection of the property mat is the subject of this report
9. Unless noted below, no one provided signficant real property appraisal assistance to the appraiser sgning mis ceNfication. Significant real property appraisal assistance provided by:
Additional Certifications:
None
Definition of Value: X^fNarketValue ^OtherValue:
5ourceotDefinition: USPAP
The most probable price in terms of money which a property should bring in competitive and open market under all
conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price is not
affected by undue stimulus.
ADDRESS OF THE PROPERTY APPRAISED:
139 East South Street
Carlisle PA 17013-3429
EIFFECTNE DATE OF THE APPRAISAL: 06/1012011
APPRAISED VALUE OF THE SUBJECT PROPERTY $ 95 000
APPRAISER SUPERVISORY APPRAISER
~. ~ ~ ~~~~
Signaure: K .~. ~+ ~~ x Signature:
Name: Stan A. Skowronek Name: Steven W. Barrett, SRPA SRA ASA
;state Certification a RL001572L State Cedification u GA000298L
or License u or License tr R6028921A
or Omer (describe): State N: State: PA
crate: PA Expiration Date of Certification or License: June 30, 2013
i:xpiration Date of Certification or License: June 30. 2013 Date of Signature: 0710112011
Date of Sgnawre and Repore 07101!2011 Date of Property Viewing:
Date of Property Viewing: 06/1012011 Degree of property viewing:
Degree of property viewing: ^ Interior antl Exterior ^ f3tterior Only XO Ditl not personalty view
~~ Interior and Exterior ^Exterior Only ^ Did not personally view
Praev<eaawg na Ada eoo.:ae.nn w.w.a~e.wm m,m~,caoMgmomos~mlo na oaxoa onso u~aa sa„xrs. mn. wuu rayno Resa,rca.
Pape Z of 2 IvPAR"') Central Purpose Apgesal Report 7712pG5
GPMtJ p5 pellmpa
'~ pc~c~aiP~moS~nP~~~s:e~~POn S.W. Barrett Real Estate 8 Appraisal Services
FLOORPLAN
Client Irwin & McKnight _ File Nio.: 11-0740
Propem~ Address 139 East South Street Case No.:
Ci Carlisle State: PA Zi :17013-3429
:-.c4ae~c'P:~ta:~ ~sm~~~
a
r`e
Kitchen
a
O`c`c
Bedroom
m
.s am
Living Bedroom
Bedroom
. ~eot~prDr~'
SksIN ey npa M~6iu"'
Comments:
ARIJC CALCULATIONS SUMMARY LIVING AREA BREAKD OWN
Cade DeacFiptlon Net-Size NeCTotals Breakdown Subtotals
GLA1 Firet Floor 624.0 624.0 Firet Floor
QI.A2 Second Ploor 624.0 624.0 24.0 x 26.0 624.0
P/P Porch 60.0 Second Flaor
Covered Patio 130.0 190.0 24.0 x 26.0 624.0
OTH Storage 110.0 110.0
i
Net LIVABLE Area
(rounded)
1248
2 Items (rounded)
1248
surs~tt; t rttOrEHI Y PHOTO ADDENDUM
FROINT VIEW OF
SUBJECT PROPERTY
Appraised Date: June 10, 2011
Appraised Value: $ 95,000
RE/4R VIEW OF
SUEIJECT PROPERTY
STREET SCENE
Client: Irwin 8 McKnight File No.: 11-0140
Property Address' 139 East South Street Case No.:
City' Carlisle State: PA Zip: 17013-3429
RoEUCM uanq PCI wMgll, Bp0.7l/.B7t7 WNN.GCAPD.[an VHI31U1l1010
..vmrwrwrs~t rKUrtlt I Y NHUTO ADDENDUM
Client: Irwin 8 McKnight _ File NO.: 11-0140
Pro a Address:139 East South Street Case NO.:
City' Carlisle State: PA Zlp: 17013-3429
COMPARABLE SALE #1
328 Juniper Street
Carlisle, PA 17013
Sale Date: 09/24/2010
Sale Price: $127,000
COMPARABLE SALE #2
324.luniper Street
Carlisle, PA 17013
Sale Date: 0212412011
Stile Price: $110,000
COMPARABLE SALE #3
1313 N. Pitt Street
Carlisle, PA 17013
Sale Date: 02108!2011
Sale Price: $109,900
LOCATION MAP
ClienC Irwin JIB McKnight File No.: 11-0140
Promo erty Address 139 East South Street Case No.:
Ci Carlisle State: PA Zi :17013-3429
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c-~. `~' °~ Flood Information
FloodMap Legend Community: 425382-CARLISLE, BOROUGH OF
Property is in a FEMA sperysll flood hazard area.
FEOOd Zones Property is Within 250 feet o~i a FEMA special Rood hazard area.
Measmto[aa[etlDy50~yearnooamg Map Number 4204100233E Map date: 03f1612009
grass aatrase of see too antl soo-yeu ltaaapus[s Panel 0233E FIPS 42041
__,', Aroaa rntwetlatotl oY tooyear nootltng Zone: AE
`t?='^'~:^,F,I Areas i7np[tlatetl eY leOyear nootling vrill[ voEaCHy hYZartl
rvedher iran~.~manea Flood Hazard certulC+GOn (TFHCI nor acl make any
® aroes
FAY rzpresenta[lons a warrannes many party concemtng Ne content accuracy or
5,=wsk"~a PlooQrmy aroes vr~h voloWy hazarE compla[anesa of this Flo°d report, ind°ding any warranty of merchanta6llity Gr
fllnr_gs for a parka L'fr pu rpose. Neither TFHC nor ACI ~wr the seller Of [hik
Areas Of untlalOrrolnetl Oad posStD[o ROOtl haSaroi Hood report shell have any IlaDlll[y to any thud party for any use or misuse of
,~ys ~ myp~tl pn ~. pya6shetl FIRM ['nis flood re Dort
********* QUALIFICATIONS *****"**~`
~ ~ ii
The following checked items are SPECIFIC SPECIAL CONDITIONS that were identified by this appraiser during the
inspection of the subject property, the comparables sales, and their neighborhoods and locations. Unless otherwise
noted, the conditions that apply to the subject property or the comparable sales used DO NOT AFFECT THE MARKET
VALUE OR THE FUTURE MARKETABILITY OF THE SUBJECT PROPERTY BEING APPRAIISED. This is not a home
inspection service. This is an appraisal to estimate market value.
__1. The subject is located in a rural area and is less than 25% built-up.
x_2. Commercialllndustrial uses are located within the subject's neighborhood. These uses are typical of similar
neighborhoods.
_3. Vacant and undeveloped land uses are located within the subject's neighborhood. These uses are typical for
the area.
4. The predominant value in the neighborhood is less than that of the market value of the subject property. This
is due to the very wide range of value of properties in the area and superior quality of the subject property.
,_5. The subject property is located in a F.E.M.A. Identified Flood Zone. Flood insurmce coverage is required and
suggested.
_6. Dampness is noted in the basement of the subject. Standing or running water Nras not present on basement
floor. This condition is considered typical in dwellings of this style.
_7. The subject property is serviced by private well andlor septic systems which is common for the area.
_x_8. The subject is older than five(5) years. All mechanical systems including the heating, electrical and plumbing
systems appear upon a visual exterior inspection to be in working order. No warranties: are implied in this statement.
_9. Repair items were noted in the comments section of the report. These commenits on repair items are for
descriptive purposes only and are not required repairs. The items listed are cosmetic in nature.
_10. The basement floor is a dirt floor. This condition is common and typical for the area. and does not pose a
health or safety hazard.
_11. The subject property does contain functional obsolescence as noted in the report. This condition is
considered typical and common for the area and this style dwelling.
_12. The land value exceeds 30% of total value due to the high demand for vacant land in this neighborhood. This
condition is considered common and typical for the neighborhood.
_73. The land value exceeds 30% of total value. This is due to the large size of the site. This condition is
considered to be typical and common.
_14. Individual adjustments were required that exceed 15°~. These adjustments were required due to lack of more
similar comparables on that individual rating. All comparables used are the best available.
_15. Total adjustmerMs exceed 25%. This is due to the lack of comparable sales that were more similar in the
subject's market area. All comparables used are the best available.
_x_16. One or more comparable sales are older than six(6) months. Although there are comparable properties in the
subject's area, none have sold recently; therefore, sales in excess of six(6) months have to be used. All comparables
used are the best available.
_17. One or more comparables used were in excess of one (1) mile from the subject: property. Although there are
comparable properties in the immediate area, none have sold recently. Therefore, it was necessary to use comparable
sales outside of the immediate area. All comparables used are located in similar neighborhoods and within the same
marketing area. All comparables used are the best available.
18. The electrical system was not connected during inspection.
19. The water service was not connected during inspection.
_20. The heating system was shut down during inspection.
_21. Roofing_Plumbing_Electrical_Heating_certification(s) islare sugl~ested.
_22. Inground swimming pool .out buildings are included .not includled_according to lender's
guidelines.
_23. According to lender's guidelines a maximum of_acres were considered for this valuation. Remaining
acreage was given no value.
i
• f ~ *"******* QUALIFICATIONS ****"**"'"
__24. The subject property is located on a private road.
25. Wood infestation inspection is suggested.
x 26. Last recorded deed transfer: Date 01109/1989_ Consideration: S_7.00__,
_27. Proposed construction/renovation in accordance to plans and specifications to be completed in a workman-like
manner.
_28. Seller is paying part or all of closing costs.
_x 29. All comparable sales are verified closed sales.
_x_30. There are no special conditions or other requirements that would affect market value or future marketability in
the Appraisal Report.
31. AMC fee was required in order to accept this appraisal request.
me
"'"'"*'"**"`'"` QUALIFICATIONS *'"*~*"***
Confidentiality and Security Policy
We consider privacy to be fundamental to our relationship with clients. We are committed to maintaining the
confidentiality, integrity and security of clients' personal information. Internal policies have been developed to protect
this confidentiality, while allowing client needs to be served.
We restrict access to personal information to authorized individuals who need to know thus information to comply with
federal standards to protect your nonpublic personal information. We do not disclose this information about you or
any former consumers or customers to anyone, except as permitted by law. The law permits us to share this
information with our affiliates. The law also permits us to share this information with companies that perform
marketing.
When we share nonpublic information referred to above, the information is made availabk: for limited purposes and
under controlled circumstances. We require third parties to comply with our standards for security and confientiality.
We do not permit use of consumer/customer information for any other purpose nor do we permit third parties to rent,
sell, trade or otherwise release or disclose information to any other party.
Education
As of the date of this report, land/or Steven W. Barrett, SRPA, SRA, ASA have completed the requirements under the
continuing education program of the Appraisal Institute and the American Society of Appraisers.
. ~ l`~3 ~~~d~~~~~'~
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•
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499 Mitchell Road, Millsboro, DE ] 9966 Adjustment Services
Irwin and McKnight PC
60 West Pomfret Street
Carlisle, PA 17013-3222
Phone 888-502-4349
F ax (302) 934-2955
June 28, 2011
Re: Estate of Raymond S Black
Social Security 168-26-5072
Date of Death: June 10 2011
Dear Sir or Madam:
Per your inquiry on June 20, 2011, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1 • Type of Account Checking Account
Account Number 1044508
Ownership (Names oj~ Raymond S Black
Opening Date 08/01/89
_ _ Balance on Date of Death $10,495.13
Accrued Interest $ 01
Total -- -----------------------------
$10,495.14
2. Type of Account Checking Account
Accorcrtt Number 9846061985
Ownership (Names ofl Raymond S Black
Fae L Horner
Opening Date 07/17/08
Balance on Date of Death $2,626.60
Accrued Interest $ 02
Total - ------------------- -
- - -- ----
$2, 626.62
~ _ - _ --
ECE~~E~
~~ ~ _,
~~~T~~E~~~ '~ ~ I~UL 0 5 2011
a
n ~ lu~~
- ~awo~c~
Court Ordered Processing \ Decedents - MA1-MB3-02-10 - P. O. Box 841005 -Boston, MA 02284
June 28, 2011
Law Offices
Irwin & McKnight, P.C.
60 W. Pomfret St.
Carlisle, PA 17013-3222
RE: Estate of Raymond S. Black
Date of Death: June 10, 2011
Dear Mr. Irwin:
Per your request, enclosed please find the account information as of the date of death
for the above-named decedent. For your information, accrued interest is not included in
the date of death balance.
Please feel free to contact me if I can be of any further assistance.
V~r~r truly yours,
f ~
Linda Spavento
Team Leader
617-514-•5189
•
I
Sovereign Bank
ESTATE OF Raymond S Black
SOCIAL SECURITY #: 168-26-5072
DATE OF DEATH: June 10, 2011
Account #: 1691027677 Type: Checkin
In the name of: Raymond S Black g Open date: 11/7/1988
Date of Death Balance:
Int.(YTD) from 1/1/2011
Accrued interest to date of death:
Other Info:
to
$11,059.81
5/31 /2011
$0.03
• $0.38
Account #: 2894076681 Type: Money Market Open date• 5/8/2007
In the name of: Raymond S Black ---.
Date of Death Balance: $10,399.30
Int.(YTD) from 1/1/2011 to 5/31/2011
Accrued interest to date of death: _ $10.76
$0.85
Other Info:
Account #: 2895539704 Type: CD
In the name of„ Raymond S Black OPf'n date: 3/20/2006
Date of Death Balance: $86,199.94
Int.(YTD) from 1 / 1 /2011 to 5/31 /2011
Accrued interest to date of death: ._ $703.18
$60.81
Other Info:
Account #: _ 2895553135 Type:
In the name of: Raymond S Black
Date of Death Balance:
Int.(YTD) from 1/1/2011
Accrued interest to date of death:
Other Info:
CD Open date: 8/23/2010
$25,239.79
5/31 /2011
$11.15
to
$129.14
Page 1 of 1
'' WEST_J NATIONAL
Life Insurcince Company
Western National Life ;Insurance Company
P. O. Box 871
Amarillo, Texas 79105
Telephone: 800.424.4990
July 6, 2011
ROGER B IRWIN
60 W POMFRET ST
CARLISLE PA 17013-3222
Re: Name of Deceased: Raymond Black
Contract Number: VV217016
Beneficiary: Wendy K Prize, Tracy A Ray
Dear Sir or Madam:
b~l~
iJ~-L ~ 4 2011
c~n~l ~ ~~K~icH Q
f'.AW OFFICES
We have received notification of the death of Raymond Black, the owner/amiuitant of the referenced
contract. On behalf of Western National Life Insurance Company, we wish to express our sincerest
condolences for your loss.
The following items are enclosed:
1) Claims Checklist - A list of items required to initiate a claim for this contract.
2) Beneficiary options page - A list of claim options available to the referenced beneficiary.
3) Applicable documents for completion.
The value of policy on the date of death was $55,561.23.
We appreciate your prompt attention to this matter. Should you have any questions or require further
assistance, please contact our Client Care Center by using our toll free number of 1-800-424-4990.
Sincerely,
`~ . ~~
B.M. Graves
Annuity Claims Manager
Enclosures
WNL Cvr Ltr DOD