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HomeMy WebLinkAbout10-26-11 (2) 1505610105 REV-1500 I=_x tO2_' 3' «' PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes E.a*~F~ oFaE~E~~E County Code Year Flle Number ~ INHERITANCE TAX RETURN PO BOX z8o6o>. Harrisburg, PA 1~1z8-otioi RESIDENT DECEDENT 21 11 !, ? 0139 ENTER DECEDENT INFORMATION BELOW Social Security Number Date _._ of Death MMDDYYYY Date of Birth MMDDYYYY _. 204-03-6243 E ! 01/28/2011 04/11/1922 Decedent's Last Name ~__..,__ __,,._._,,,_~ _.~... _.._.._....._ . . Suffix Decedent's First Name MI _. .__. ...mm_ .._....... _..._.. Wolf ; Helen J ._._~ _ _~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ___ ........... ____ ... Spouse's Social Security Number ~ 7 i i t ! _ _. ~_.. ...._ ..... _. . _.. ._ [.... .t THIS RETURN MUST BE FILED IN DUPLICATE WITH THE __ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW QD 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust U 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O , 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number __ _ _... _ Keith O. Brenneman, Esq. (717) 697-85~?-8 First Line of Address 44 W. Main Street Second Line of Address City or Post Office _. ;Mechanicsburg Correspondent's e,~gtail address: State ZIP Code ? PA 17055 R.;y 'ILLS USEtONLY 'CJ ' ~ C'~ .. ~~ ` __ '~> - _t ;:~ inn ~.~ ;~ rv, ~ ; = _ _.~_ . ' __ ~~ .. . , , :~, .. ,~ DATE FILED ~"`- _.-~, ^r~ .; ;- ,.:~, C Under penalties of pti:r' ry, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct ah omplete. Declaration o re arer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE O RS~N~ R/~S ORJS F LING RETURN DATE >< c it<I-Cali( ~~ F.xariitnr /b~2G~// 11 Brenely Land, Mount Holly Springs, PA 17065 SIGNATU P PARER OTHER THAN REPRESENTATIVE DATE ADDRESS 44 W. Main Street, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J~ J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number __ _ , Decedents Name: Helen Jane Wolf 204-03-6243 i RECAPITULATION 1. Real Estate (Schedule A) ............................................. L ' 165,000.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ( 539,199.74 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. , 278,948.16 _w_...... . .... _. __ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7.: 192,915.81 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 1,176,063.71 13,547.74 10,816.53 24,364.27 1,151,699.44 '~ 1,151,699.44 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable _ ~ ....._. at lineal rate X .0 45 1,141,699.44 ______ .~......_... ..mm.~_ __~.....~ .. 17 A t fL' 14t bl 3 _ _ __. 15. 1 s. , 51, 376.47 moun o me axa e at sibling rate X .12 j 17. 18. Amount of Line 14 taxable ~ ~ ~ ~ ~ at collateral rate X .15 10,000.00. 18 ; __ 19. TAX DUE .........................................................19.`'`! 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 1,500.00 52,876.47 REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number 21-11-0139 DECEDENT'S NAME Helen Jane Wolf STREET ADDRESS 17 Ridgeway Drive CITY Carlisle STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 60,000.00 B. Discount 2,643.82 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 876.47 Total Credits (A + B) (2) 62,643.82 (3) (4) (5) 9,767.35 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 ............................................ ^ c. retain a reversionary interest .............................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ ~ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (O1-10) . ~ Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Helen Jane Wolf 21-11-0139 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1• All that certain parcel of land improved with asingle-family residential dwelling located at 17 Ridgeway Drive, Carlisle, South Middleton Township, Cumberland County, Pennsyvlania, tax parcel No. 40-24-0748-055. Fair market value (based upon May 31,2011 agreement of sale; settlement statement attached): 165,000.00 TOTAL (Also enter on Line 1, Recapitulation.) $' 165,000.00 If more space is needed, use additional sheets of paper of the same size. REV-i5o8 EX+ (il-io) •°. . -. pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ____ ESTATE OF: FILE NUMBER: Helen Jane Wolf 21-11-0139 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 'Wedding ring and Christmas tree ornaments 1,125.00 2.' Miscellaneous personal property and furnishings 1,238.50 3.' ;2008 Honda Accord 16,200.00 4. Fidelity Investment Account No. Z44-270652 366,663.90 5,' USAA Federal Savings Bank Account No. 6189 6,655.06 6, Invest Financial Corporation, Account No. 5ZV-030464 140,990.21 7. 12010 Federal income tax refund 3,885.00 g,` '2010 State income tax refund 588.00 g, PA Life and Health Insurance refund 115.34 10. Marsh Global Consumer refund 218.73 11. Outer Banks Beach Club, Beach Club 2, week 44 time share 1,500.00 12. Fleet Control, Norfolk refund 20.00 C']/1 AAA 7A If more space is needed, use additional sheets of paper of the same size. REV-i5o9 EX+ (oi-io) ~ ~ >, pennsylvania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: Helen Jane Wolf FILE NUMBER: 21-11-0139 If an asset became 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• George W. Ely, Jr. 11 Brenely Lane, Mount Holly Springs, PA 17065 Son B. C. JOINTLY OWNED PROPERTY: REM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR]OINTLV HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. .:08/14109 Members 1st F.C.U., Savings Account No. 14833-00 382.79 50% 191.40 2. A. 08/14109 Members 1st F.C.U., Checking Account No, 14833-11 6,872.00 50%- 3,436.00 3. A. `08/14/09 '.Members 1st F.C.U., Money Management Account No, 14833-05 20,690.97 50% 10,345.49 4. A. 08/14/09 Members 1st F.C.U., Certificate of Deposit Account No. 14833-56* 159,121.03 50% 79,560.52 5. A. 08114/09 Members 1st F.C.U., Certificate of Deposit Account No. 14833-57* 100,349.20 50% 50,174.60 6. A. -08/14109 Members 1st F.C.U., Certificate of Deposit Account No. 14833-58* 270,480.30 50% 135,240.15 * Joint Account established with funds from a joint account established '8114/09 TOTAL (Also enter on Line 6, Recapitulation) I $ 278,948.16 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (08-09) . ~= pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen Jane Wolf 21-11-0139 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INQUDE THE NAME OF THE TRANSFEREE, THEIR REIATIDNSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A CDPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE I• Transamerica Life Insurance Company, non-qualified tax deferred annuity , 113,524.16 100 113,524.1( Policy No. 02CBT138290, beneficiary George W. Ely, Jr. (son of Decedent) 2 FEGLI Life Insurance payable at death to Estate of Helen Jane Wolf ' 7,768.58 7,768.58 0.0( 3 , USAA Investment Account No. 821 44 04, transferred 7128110 from Decedent 82,391,65:. 100 3,000,00 79,391.6; to Decedent's son, George W. Ely, Jr. as JTWROS TOTAL (Also enter on Line 7, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 192,915.81 REV-1511 EX+ (10-09) Pennsylvania . DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Helen Jane Wolf 21-11-0139 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1' .Hollinger Funeral Home, funeral luncheon and honorarium 4,521.37 e. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Waived Name(s) of Personal Representative(s) Street Address City State Year(s) Commission Paid: ZIP 4, 500.00 z. Attorney Fees: to Snelbaker & Brenneman, P.C. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation,) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: to Register of Wills ($258.50; Additional fee $275.00) 533.50 5• Accountant Fees: Smith Elliott Kearns & Company, LLC 265.00 6. Tax ReturnPreparerFees: final accounting fees, reserve and misc. costs 1,000.00 ~~ Larry Foote, real estate appraisal fee 325.00 B. :Advertise grant of letters: Cumberland Law Journal, $75.00, The Sentinel, $219.40 294.40 s. Transfer tax payable upon settlement of real estate 1,650.00 ~ a Rowe's Auction -expense to auction personalty 458.47 TOTAL (Also enter on Line 9, Recapitulation) $ 13,547.74 If more space is needed, use additional sheets of oaner of the same size. REV-1512 EX+ (12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen Jane Wolf 21-11-0139 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• '.Members 1st FCU VISA credit card account 109.85 2. Betra Home Care 3,075.00 3. :Cumberland County Goodwill EMS 91.75 4. Quantum Imaging 20.60 5. Spirit Physicians Services 7.78 6. `West Shore EMS ($1,007.06; $362.50) 1,359.56 7. AT&T 57.50 8. Century Link 61.71 9. IWS of Central PA 39.87 10. UGl gas 76.00 11. Met Ed 189.41 12. Comcast 127.50 13. Depalma Construction -roof repair for sale of real estate 5,600.00 TOTAL (Also enter on Line 10, Recapitulation) $ , 10,816.53 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (O1-10) ~ Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Helen Jane Wolf 21-11-0139 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Linda M. Ely, 11 Brenely Lane, Mount Holly Springs, PA 17065 Daughter-in-law 1,125.00 2. Tammy Halverson, 752 Shippensburg Road, Newville, PA 17241 Granddaughter 40,000.00 3. David B. Ely, 420 Bumt House Road, Carlisle, PA 17013 Grandson 40,000.00 4. ':Linda Kelly,1519 ShirleyAvenue, Carlisle, PA 17013 .None 10,000.00 5. George W. Ely, Jr.,11 Brenely Lane, Mount Holly Springs, PA 17065 Son ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS; L TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size. LAST WILL AND TESTAMENT OF HELEN JANE WOLF SNELBAKER e BRENNEMAN I, HELEN JANE WOLF, of South Middleton Township, Cumberland County, Pennsylvania, being of somtd and disposing mind, memory and understanding, do hereby make, publish and declaze this as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. 1. I direct that all my debts and funeral expenses be paid as soon as practical after my death by my Executor hereinafter nazned. I direct that all taxes that maybe assessed as a consequence of my death shall be paid from my residuary estate as part of the expenses of the administration of my estate. Z. I give my antique Christmas tree collection and my wedding ring (gold band with ten small diamonds) to LINDA M. ELY. 3. I give to TAMMY HALVERSON the sum of Forty Thousand Dollars ($40,000.00). 4. I give to DAVID B. ELY the sum of Forty Thousand Dollazs ($40,000.00). 5. I give to LINDA KELLY the sum of Ten Thousand Dollars ($10,000.00). 6. All the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise acid bequeath to my son, GEORGE W. ELY, JR. 7. Tn the event any of the beneficiaries named in Paragraphs 2, 4, 5 and 6 of this my Last Will and Testament should predecease me, I direct that the share that such deceased beneficiary would have received hereunder be given to iris or her issue surviving me per stiipes. 1n the even TAMMY HALVERSON should predecease me, I direct that the shaze that she would have received hereunder be given to GEORGE W. ELY, JR. 8. I hereby nominate, constitute and appoint my son, GEORGE W. ELY, JR., as Executor of this my bast Will and Testament. I further direct that my Executor shall not be required to post any bond to secure the faithful performance of his duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on Two (2) pages this 27a' day of April, 2006. (SEAL) Helen Ja Wolf Signed, sealed, published and declared by HELEN JANE WOLF, the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~/ ~~~-- ~-~- ~~ .~a-vt-cti (SEAL) LAW OFFICES II SNELBAKER & _2_ BRENNEMAN COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND ) We, HELEN JANE WOLF, KEITH O. BRENNEMAN, ESQUIlZE and JANE J. GOONEY, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Wi11 and Testanient and that she had signed willingly, and that she executed it as her &ee and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his or her knowledge the Testatrix was at drat time eighteen years of age or older, of sound mind and under no constraint or undue influence. _~~~ fit/ Testatrix ~~ Witness ~n IAW OFFICES SNELBAKER BRENNEMAN Subscribed, sworn to and acknowledged before me by HELEN JANE WOLF, Testatrix, and subscribed and sworn to before me by KEITH O. BRENNEMAN, ESQUIRE and JANE J. GOONEY, witnesses, this 27a' day of June, 2006. ~ ~ ., Notary ublic COMMONWEALTH OF PENNSYLVANIF. Notarial Seal Susan L Matrazi, Natary Public Mechanicsbur9l3oro, Cumberland County My Conrmiesion Expires Nov.24, 2007 Member. Pennsylvania Association O(Notades A. Settlement Statement THUD-11 ( ) 1. FHA • Settlement Statement - U. S. De artment of Housin antl Urban Devato ment Form US HUD - 1 Pa a No. 1 ( ) 2. FmHA 8. File Number 7. Loan Number 8. Mortgage Insurance X 3. Conv. Unins. Case Number ( ) a. vA RE3393 11-000102 ( ) 5. Conv. Ins. ABST#6668 C. This form is furnished to give you a statement of aMual settlement costs. Amounts paitl to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside of the closing; they are shown here for informational purposes and are not included in fhe totals. D. Name and Address of Borrower: E. Name and Atltlress of Selier. F. Name and Address of Lender. ROBERT C. STOUGHT ESTATE OF HELEN JANE WOLF FARMERS AND MERCHANTS TST CO. DEBORAH K. STOUGHT ISAOA ATIMA 1 WATERLOO ROAD 20 SOUTH MAIN STREET CARLISLE, PA 17015 PO BOX 6010 CHAMBERSBURG, PA 17201 G. Property Location H. Settlement Agent: Settlement Date: 17 RIDGEWAY DRIVE, CARLISLE, PA 17015 Fre & Tile Law Offices Jul 18, 2011 SOUTH MIDDLETON TOWNSHIP Place of settlement: 3pm CUMBERLAND COUNTY 5 South Hanover Street PARCEL NO. 40-24-0746-055 Carlisle, PA 17013 100 Gross Amount Due From Borrower 1 400 Gross Amount Due To Seller 101 ContraM sales price i 165,000.00 . 401 Contract Sales price 165,000.00 .102 Personalproperty I 402 Personal property 103 Settlement charges from (line 1400) 4,757.02 403 104 404 105 Settlementcharges from Addendum 0.00 4os :.Adjustments (oritems paid by seller in advance: Ad/ustments for items paid by seller in advance: tOBCityAowntaxes7/18/11 to12/31/11.. 202.97 406CItyltowntaxes7/18111 to 12/31/11 202.97 t0Y County taxes 407 County taxes 108ASSessments 408 Assessments 109 409 110School taxes 7/18/11 to 8/30/12 1,559.02 410 School taxes 7!16111 to 6130112 1,559.02 111.. 41 i. 112 .412 120 Gross Amount Due From Bortower 171,519.01 420 Gross Amount Due to Seller 166,761.99 200 Amounts Paid.ByOr In Behalf Of Bortower S00 Reduct)ons In Amount Dua To Seller 201 Deposit or earnest money 3,000.00 501 Excess deposit (see instructions) ~~ 202 Prinupal amount of newioan(s)"' 132,000.00 502 Settlement charges to seller (line 1400) 3,461.76 203 Exisgng loan(s) taken subject to SD3 Existing loan(s) taken subject to 204AppralsaLFeeRefund - 50.00 304 Payoffotfirstmortgageloan 205 Applicatfonn fee Refund 423.72 505 Payoff of second mortgage loan 208 506. 207 507 208 - 508 - zos i I sos Settlemertt charges from Addendum 0.00 AdJusimentsforltemsupeldbyseller. AdJustmentslorttemaupaldbyseller .210 City/town taxes 1/1111 to 7/18!11 510 City/town taxes 1/1/11 to 7/18/11 211 County taxes 511 County taxes 212 Assessments 512 Assessments 213 513 214 School taxes 7/1/11 to 7/16!11 514 School taxes.7l1/11 to 7N8/11. 215 315 218. 51s 217 517 218 518 219 519 220 Total Paid BylFor Borrower 135,473.72 .520 Total Reductions to Amt Due Seller 3,461.76 300 Cash At Settlement From/ro Borrower. 800 CastrAt SetNemeM TolFrom Seller. 301:Gross amount due from borrower (Iine120) 171,519.01 1301 Gross amount to seller from (hne 420) 166,761.99 302 Less amounts paid by/for tarrower.(from line 220) 135,473.72 802 Less reductions in amount due seller (from line 520): 3,461.76 303 Cash (X) From O To Borrower 36,045.29 803 Cash(.) From (X) To.Seller 163,300.23 Initials ~ Page 1 of 4 initials 700 Total SaleslBrokers Comm. based orr price: 165,000.00 0.00 Division o/ Commission pine 700) as Pollows: NIA 701 to 702 to 703 Commission paid at Settlement 704 eoo Items Payable In Connection With Loan: ~ (Mortgage Amt: 132,000.00) Total charges, Lines 601 through 806: 1,242.05 601 Our origination fee $ 600.00 (from GFE #1) 602 Your credit or charge (points) for the specific interest rate chosen $ 330.00 (from GFE #2) 603 Your adjusted arigina8on charges (from GFE A) 604 Appraisal fee to $350.00 (from GFE #3) 605 Credit report to FACTUAL DATA CORP - $26.28 (from GFE#3) 808 Tax service to (from GFE #3) eo7 Flood certlficalion to FACTUAL DATA CORP. (from GFE #3) eo6 Lender Fees from Additional Lender's Fees Addendum soo Items Required By Lender To Be Pald In Advance: 901 oanymteresteneroes 18-Jul-11 to 30Ju1-11 @16.73000 (from GFE#to) 902 Mortgage Insurence Premium for months to (from GFE #3) 903 Hazard Insurance 1 years to Kemper Auto 8 Home (from GFE #11)... '~~ soa $398 1000 Reserves Deposited With Lender: WAIVED 1001 Initial deposit for your escrow account (from GFE #9) ~ 1002 Homeowners insurance - , mos. ~ per month '. 1003 Mortgage insurance mos. ~ per month 1004 Property taxes mos. @ permonth 1005 School taxes mos. ~ $er month 1006 mos. ~ per month 1007 Aggregate Adjustment 1100 Title Charges: 1101. Title Services and lenders title insurance .BASIC RATE (from GFE #4) 1102 Settlement or closing fee 'PREY & TILEY $ - t 103 Owners title insurance $ 165.00 (from GFE #5) 1104 Lenders title insurance $ 1,168.75 1105 LendersOtllepollcylimit $ 132,000.00 1108 Owners title policy limit S 185,000.00 1107 Agent's portion of total title insurance premium $1,133.69 1106 Underwriters portion of total titleinsurance premium $200.06 ) 1200 Government Recording and Transfer Gharges: 1201 Government Recording Charges 1202 Deed $62.00 .Mortgage $86.00 Releases ' 1203 Transfer Taxes 1204 City/county tax Deed $1,650.00 Mortgage: $ 1205 Statetax/stamps: Deed $1,650.00 Mortgage: $ 1206 ~aoo Additional Settlement Charges: 1301 Required Services that you can shop for (from GFE #6) 1302 Pest inspection ' ' to 1303 Current Taxes due from BonowerlSeller to Robert C. Calms, Tax Collector 1304 13os FINAL WATER AND SEWER CHARGES TO SMTMA -ACCT N0.016112 1,650.00 1205 .120E '' 130C 1301 1302 1,681.86 1303 1304 129.90 13x5 ,,, ~ - .- - . ~ . . ~ . 4,757.02 3,461.76 1400 I direct and authorize Frey & Tiley to make distributions indicated for my account on the attached HUD-1 Settlement Statement, approving the tax prorations indicated therein, and understand that prorations were based on figures for the preceding year, or estimates for the current year,,.~nd in the event of any change for the current year, all necessary adjustments must be made between Seller and Borrower direct; likewise any DEFICIT in delinquent taxes will be reimbursed to Frey & Tiley by Seller. have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a tru 'and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy o tie HUD-1 Settlement Stat mefif RO RT C. STOUGHT - E OF LEN JANE W F ~"` DEBORAH K. STOUG T ,~" To the best of my knowledge, the HUD-1 Setti'e ant Statement which I have prepared is a true and accurate account of the funds which were received and have been or will be dis ursed b he and rsignet~ pa the settlement of this transaction. ~ July 18, 2011 Fre &Tiley,SettlementAgent - Page2ora Date %~~ Paid. From Borrowers Funds at aid From 700 severs ~unds at 701 ettlement 702 703 704 1,130.00 POC POC 10.60 101.45 234.22 POC 801 802 803 eoa 805 806 807 aoe 901 soz 903 soa 0.00 1001 11oc 1,317.75 1101 1102 165.00 1103 1104 } 1200 1201 148.00 1zo2 1203 1,650.00 1zo4 ~ HUD-1 Additional Settlement Charges to Borrower INCOMING WIRE FEE TO ORRSTOWN BANK $12 SEE LINE 1101 CPL FEE TO CLTIC $75 SEE LINE 1101 ELECTRONIC DELIVERY FEE TO FREY &TILEY $50 SEE LINE 1101 OVERNIGHT DELIVERY FEE TO FREY 8 TILEY $12 SEE LINE 1101 Total to line 105 to Borrower: 1 ' ADDENDUM TTY FEES TO SNELLBAKER 8 BRENNENAM, P 0 Total to Line 509 ADDITIONAL LENDER FEES ADDENDUM Wire fee to FBrM Trust Company Overnight postal fee to US Postal Service Tax Transcripts to F8M Trust Company MERS fee 20.00 60.00 14.50 6.95 Total to line 808 101.45 0.00 0 TAX PRO-RATION ADDENDUM Date of Pro-Ration: SCHOOL REAL ESTATE TAX July 18, 2011 from July 1, 2011 to June 30, 2012 School Real Estate Tax- Face School Real Estate Tax- Per Day ASSESSMENT: COUNTY & MUNICIPAL TAX from January 1, 2011 to December 31, 2011 Co. &Munic. Real Estate Tax- Face Co. &Munic. Real Estate Tax- Per Day See Settlement Sheet Lines Yes 106 8406, 110 8 410, School taxes P.O.C. or charged to Seller : x 210 & 510, 214 8 514, School taxes P.O.C. or charged to Borrower and 1303 for Co. 8 Munic. P.O.C. or chargetl to Seller : x Results of this Addendum. Co. &Munic. P.O.C. or charged to Borrower 5.40 1.25 1,681.68 P.O.C. Owes: $1,688.55 $4.57137 n,.,e~ Page 3 of 4 St MEMBERS 1st FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account NumberlSuffix 14833-00 j Date Account Established 06/21/1973 V Principal Balance at Date of Death $382.66 Accrued Interest to Date of Death $.13 Total Principal and Accrued Interest $382.79 Name of Joint Owner George W. Ely Date Joint Ownership Established 08/14/2009 CHECKING ACCOUNT: Account Number/Suffix 14833-11 Date Account Established 06/08/1977 Principal Balance at Date of Death $6,871.42 /~ Accrued Interest to Date of Death $.58 Total Principal and Accrued Interest $6,872.00 Name of Joint Owner George W. Ely Date Joint Ownership Established 08/14/2009 MONEY MANAGEMENT ACCOUNT: Account Number/Suffix 14833-OS ~~ Date Account Established 10/01/1985 ~ Principal Balance at Date of Death $20,684.74 ~ Accrued Interest to Date of Death $6.23 Total Principal and Accrued Interest $20,690.97 Name of Joint Owner George W. Ely Date Joint Ownership Established 08/14/2009 v'~ CERTIFICATES OF DEPOSIT: Account Number/Suffix 14833-56 Date Account Established 09/20/2010* Principal Balance at Date of Death $158,963.46 Accrued Interest to Date of Death $157.57 j Total Principal and Accrued Interest $159,121.03 ll Name of Joint Owner George W. Ely Date Joint Ownership Established 09/20/2010 ~- ~ ~^ V~ 1 y *Rollover from Certificate of Deposit 14833-47 Originally Established 2/19/10. CD 14833-47 opened by transfer of funds from 14833-05 Money Management Account. CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 14833-57 10/25/2010* $100,249.83 $99.37 / $100,349.20 George W. Ely 10/25/2010 ~ *Opened by transfer of funds from 14833-05 Money Management Account. ~ 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.or~ CERTIFICATES OF DEPOSIT: Account Number/Suffix 14833-58 Date Account Established 11/30/2010* Principal Balance at Date of Death $270,260.39 Accrued Interest to Date of Death $219.91 Total Principal and Accrued Interest $270,480.30 Name of Joint Owner George W. Ely Date Joint Ownership Established 11/30/2010 *Opened by transfer of funds from 14833-05 Money Management Account. VISA CREDIT CARD ACCOUNT: Account Number 4672090000231886* Date Account Established 06/01/2005 Balance at Date of Death $109.85 Name of Joint Cardholder None "Contractual Pledge of Shares MEMBERS 1sT FEDERAL CRf EDIT~U~NjIO~Ny, LeighL~~~ta ings yG~~~^~c''~ ~ Lending Insurance Support Specialist v February 17, 2011 Estate of: Helen J. Wolf Date of Death: 01/28!2011 Social Security Number: 204-03-6243