HomeMy WebLinkAbout11-07-11 15 0 5 61014 3
~ REV-~I 5~~ ~" (0 1-10)
OFFICIAL USE ONLY
PA Departmen of Revenue pennsylvanla County Code Year File Number
Bureau of Indi idual Taxes DEPARTMENT OP REVENUE
Po Box.28os ~ INHERITANCE TAX RETURN 21 11 016 6
Harrisburg, PPr' 17128-OSO1 RESIDENT DECEDENT
ENTER DECEDENT INFORMA ION BELOW
Social Security Number Date of Death Date of Birth
210 26 5034 ~ ~ 02 02 2011 10 27 1935
Decedent's Last Name Suffix Decedent's First Name MI
HOLLINGSWORT~ ANTOINETTE
(If Applicable) Enter SurvivingSpouse'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
REGISTER OF WILLS
FILL IN APPROPRIATE OVAL BELOW
® 1. Original Return ^ 2. Supplemental Retum ^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Retum Required
(date of death after 12-12-82)
Decedent Died Testate
® 6.
^ ~, Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
(Attach Copy of Will)
^ 9. Litigation Proceeds Recewed ^ 1D. between l2-391 na ddldat9e5of death ^ 1 t,.Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT - THIS SECTI N MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
FRANCIS A ZU~,LI 71.7 232 1488
First line of address ',
109 LOCUST STREET
Second line of address
City or Post Office
HARRISBURG
State ZIP Code
PA 17101
REGISTER OF WILLS USE OILY
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Correspondent'se-mail add ess: WZS~n'IlndSpring.COlfl
Under penalties of perjury, I deGar that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. D laration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SI TURE O PERSON RESPO LE F FILING RETURN DATE
Barbara Casler 3
ADDRESS
5776 ake Dri e, Harrisburg A 17111
SIGNATU E REPARER OTHER REP ESENT TI • TE
Francis A Zulli /
ADDRE
109 st Street, Ha i b rg, PA 17101
Side 1
150561 p143 1505610143
J 1505610243
REV-1500 E~
Decedent's Social Security Number
DecedenPsName: HOLLINGSWORTH, ANTOINETTE 210 26 5034
RECAPITULATION
1. Real Estate (Schedule ,,,,,,,,,,,,,,, 1. 6 2, 0 0 0. 0 0
~4) ...........................................................................
2. Stocks and Bonds (Schedule B) ............................................................................... 2. 7, 7 3 6. 3 2
3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C).......... 3.
4. Mortgages 8~ Notes Receivable (Schedule D) .......................................................... 4.
5• Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ................ 5. 1 0 7 , 3 5 5 . 0 6
6. Jointly Owned Property` (Schedule F) ^ Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ............. 7.
8. Total Gross Assets (t~tal Lines 1-7) ....................................................................... 8. 1 7 7, 0 9 1. 3 8
9. Funeral Expenses & A~Iministrative Costs (Schedule H) ......................................... 9. 12 , 3 7 4 . 3 8
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 1 0 , 0 6 9 . 9 5
11. Total Deductions (tot~l Lines 9 & 10) ...................................................................... 11, 2 2 , 4 4 4 . 3 3
12• Net Value of Estate ( ine 8 minus Line 11) ............................................................. 12. 1 5 4 , 6 4 7 . 0 5
13. Charitable and Governmental BequestslSec 9113 Trusts for which
an election to tax has of been made (Schedule J) ................................................. 13.
14. Net Value Subject to I ax (Line 12 minus Line 13) ................................................. 14. 1 5 4 , 6 4 7 . 0 5
TAX COMPUTATION - SE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 tax ble
at the spousal tax rate or
transfers under Sec. 9116
(a)(1.2) X .00 ~~ 15.
16. Amount of Line 14 tax ble
at lineal rate x .0 5 15 4, 6 4 7. 0 5 16. 6, 9 5 9.12
17. Amount of Line 14 tax ble
at sibling rate X .1 17.
18. Amount of Line 14 tax ble
at collateral rate X .1 18.
19. Tax Due ......................1'.............................................................................................. 19. 6 , 9 5 9.12
20. FILL IN THE OVAL IFYOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
sill
Side 2
1505611243 1505610243 J
~~
~ -
REV-1500 EX Page 3
nproripnt'c Cmm~lete Address:
File Number 21 - 1 1 - 0166
E E N ' E
Hollingsworth Antoinette
STREET ADDRESS
5432 Oxford Dlrive
CITY STATE ZIP
Mechanicsbur PA 17055
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 6,959.12
2. Credits/Payments
A. Prior Payments ' 8,500.00
B. Discount 347.96
Total Credits (A + B) (2) 8,847.96
3. Interest (3) 0.0 0
4. If Line 2 is greater than Lind 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 1, 888.84
'~, Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greaten, than Line 2, enter the difference. This is the TAX DUE. (5)
', Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE
1. Did decedE
a. retail
b. retail
c. retail
d. recei
2. If death oc
receiving z
3. Did deced~
4. Did deced~
contains a
IF THE ANSWER TO ANY I
THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
t make a transfer and:
f
d Yes
^ No
^x
:..................................................................................
erre
the use or income of the property trans
income
it
f
d
rt
t ^ 0
:....................................
erre
or
s
rans
y
the right to designate who shall use the prope
a reversionary interest; or ..................................................................................................................
?
b
f
t ^
^ 0
.............................................................
s or care
ene
i
e the promise for life of either payments,
urred after December 12, 1982, did decedent transfer property within one year of death without
equate consideration? ....................................................................................................................... ^ 0
nt own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ ^x
nt own an Individual Retirement Account, annuity, or other non-probate property which
^
eneficiary designation? ......................................................................................................................
F THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART O F THE RETURN.
For dates of death on or after ulv 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. §91 6 (a) (1.1) (i)].
For dates of death on or after~anuary 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
p2 P.S. §9116 (a) (1.1) n)]. he 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 re 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 steppe ent 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) . A
sibling is defined under See ion 9102, as an individual who has at least one parent in common with the decedent, wðer by bloo~ or adoption.
COMN40NWEALTH OF PENNSYLVANIA '.
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
FILE NUMBER
ESTATE OF Hollingsworth, Antoinette 21 -11 - 0166
All real property owned solelyy or s a tenant In common must be reported at fair market value. Fair market value is detined as the price
at which property would.be exchan ed between a willing buyer and a wilting seller, neither being compelled to buy or sell, both having
reasonable knowledge of the releva t facts. Real property which 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.
Incl de a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER ', DEATH
1 5432 Oxford Drive, echanicsburg, Lower Allen Township, Cumberland County, Pennsylvania. 62,000.00
For title see Cumbe land County Recorder of Deeds Office, Instrument No. 200810790, deed
dated April 07, 200. Decedent owned 1/2 interest in the real estate as tenants in common with
her daughter Barba a Casler. Real Estate sold to Mary P. Howard on 10/18/2011 for
$124,000.00. See a~tached settlement sheet.
TOTAL (Also enter on Llne 1, Recapitulation) ~ 62,000.00
COMMONWEALTH OF PENNSYLVANIA '
INHERITANCE TAX RETURN '~
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF Hollingsworth, ~,ntoinette
All property jointly-owned with right ~ survivorship must be disclosed on Schedule F.
ITEM ', DESCRIPTION
NUMBER
1 U S Savings Bonds ,Series EE
FILE NUMBER
21 - 11 - 0166
UNIT VALUE VALUE AT DATE OF
DEATH
7,736.32
TOTAL (Also enter on line 2, Recapitulation) I 7,736.32
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA ~ PERSONAL PROPERTY
INHERRANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Hollingsworth, Antoinette 21 - 11 - 0166
Include the proceeds of litigation acid the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed ~n schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 2004 Saturn Ion 3,000.00
2 M&T Bank Checkinjg Account no. 480392 17,870.27
3 M&T Bank Checking Account No. 98294040 81,956.81
4 Credit of proration Ilof taxes, Assoc. dues, etc. at settlement - 1/2 interest 583.50
5 Penn. Treaty - Medi~Cal reimbursement 3,000.00
6 Refunds from utilities, and health refunds 944.48
I TOTAL (Also enter on Line 5, Recapitulation) I 107,355.06
I _ - _ _ - __
SCf~DULE H
FUf~RAL D(POVSES &
COMMONWEALTH OF PENNSYLVANIA '. ~~
INHERRANCETAX RETURN ~~,
RESIDENT DECEDENT
ESTATE OF Hollingsworth, An Inette FILE NUMBER
~~ 21-11-0166
pebts of decedent must be reported on Schedule I.
ITEM I AMOUNT
NUMBER FUNERAL EXPENSE : DESCRIPTION
A. 1 Neill Funeral Homel -Flowers 380.71
2 City Line Diner - Luhcheon after funeral 609.50
B. ADMINISTRATIVE C~STS:
~, Personal Representati~re's Commissions
Name of Personal Representative(s)
Street Address
City '~ State Zip
Year(s) Commissio~n~ "paid
2. Attorneys Fees Lion, Zulli and Seibert -- Francis A Zulli
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City ' State Zip
Relationship of C aimant to Decedent
4. Probate Fees Re~ister of Wills
Filirhg fee
5. Accountant's Fees
6. Tax Return Preparer'slFees
7, Other Administrative Costs
1 Cumberland Coun~y Law Journal -Advertising
1,400.00
323.50
30.00
75.00
TOTAL (Also enter on line 9, Recapitulation) 12,374.38
Schedule H
Funeral E~enses &
COMM HER ANCETAXERETURNANI~ w~M^~~
RESIDENT DECEDENT I /~M.Y 1 ^, IL7YAYYG ~(JO~
ESTATE OF
Hollingsworth, Antoinette FILE NUMBEK
21 - 11 - 0166
2 The Sentinel - Advertising 230.02
3 PPL Electric - Febll,-Oct -1/2 interest 147.53
4 UGI -Feb -Oct - 1Y2 interest 206.25
5 Moreland Codomir~ium Assoc Fee - 1/2 interest 679.14
6 Homeowners Insurance - 1/2 interest 92.00
7 Lower Allen Twp - Sewage/Trash -1/2 interest
Z 51.98
8 eal Estate Tax -1/2 interest
Lower Allen Twp 899.25
9 George Rodkey - ~ tepairs on House - 1/2 interest 255.00
10 Mold removal -1/2! interest 39.75
11 Real Estate Broke Commission - 1/2 interest
I 3,720.00
12 Seller Assist - 1/2 interest 1,860.00
13 Notary - 1/2 intere st 5.00
14 1% Real Estate Tr ~nsfer Tax -1/2 interest 620.00
15 Re-sale Certificated - 1/2 interest 25.00
16 Lower Allen Sewed (final) 1/2 interest 23.03
17 Moreland Condo I$uture Assessment - 1/2 interest 701.72
Page 2 of Schedule H
conanoNwEUrrl of PENNSV~vaNw
INHERRANCETAX RETURN ~I
RESIDENT DECEDENT ~.
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
FILE NUMBER
ESTATE OF Hollingsworth, ,4ntOlnette _ 21 - 11 - 0166
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Hospice of Central Pennsylvania 9,580.36
2 2010 Income Tax ' 318.00
3 Betty Seidel - Preparation of 2010 Income Tax 150.00
4 Verizon 21.59
TOTAL (Also enter on Line 10, Recapitulation) 10,069.95
it
- -
REV•1513 EX+ (71-08)
COMMONWEALTH OF PENNSYL~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF Hollingsworth, Antoinette I FILE NUMBER
21 -11 - 0166
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND AD RESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVI G PROPERTY Do Not List Trustee(s)
I~ TAXABLE DISTRIBUTIO S [nclude outright spousal
distributions and transfers
', under Sec. X116 (a) (1.2)]
1 Robert A. Hollingsworth, Jr. Son 2/3rds of Bank
3815 Over Drive ' Accounts
Harrisburg, PA 171109 1/2 of Residue
2 Barbara Casler Daughter 1/3rd of Bank
5776 Hidden Lake rive Accounts
Harrisburg, PA 171,11 1/2 of Residue
Enter dollar amounts for istributions shown above on lines 1 5 through 18 on Rev 1500 cover sheet, as appropriate.
II NON-TAXABLE DISTRI UTIONS:
. A. SPOUSAL DISTRIBU IONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
I
TOTAL OF PART II - E TER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
`_~
LAST WILD. AND TESTAMENT
OF
A~OINETTE HOLLINGSWORTH
a.k.a. ANN HOLLINGSWORTH
KNOW ALL MEN BY THESE PRESENTS, That I, ANTOINETTE
HOLLINGSWOR~TH, a.k.a. ANN HOLLINGSWORTH, of the Township of Lower Allen,
County of Cumb Ilrland, and Commonwealth of Pennsylvania, do make, publish, and
declare this instn~hment to be my Last Will and Testament, hereby revoking and making
void any and all f~rmer Wills by me at any time heretofore made.
FIRST: ~ direct the Executrix hereof to pay all my just debts, funeral expenses
and costs of administra#ion as soon as conveniently may be done after my death. I
further direct the (Executrix hereof to pay all inheritance, estate, transfer and succession
taxes which maybe levied or assessed upon any property which is included as part of
my gross estate ~or the purpose of any such tax.
SECOND I give and bequeath to my son, ROBERT A. HOLLINGSWORTH,
JR., and to my d~ughter, BARBARA CASLER, per stirpes, any bank account that.l
might own at the
a.) Robert
b.) Barbai
THIRD:
my Last Will and
discretion and a~
lease pledge, ex
Y~ ° .
~`
date of my death in the following proportions:
A. Hollingsworth, Jr. -two thirds;
Caster -one third.
I appoint my Daughter, BARBARA CASLER, to be Executrix of this
Testament. I do hereby give to the Executrix hereof full power,
ithority at any time or times to sell, at private or public sale, mortgage,
;hanae or otherwise deal with or dispose of the property comprising my
-1-
estate as deemejd best, to settle and compound any and all claims in favor of or against
my estate as deemed best and, for any of the foregoing purposes, to make, execute
and deliver any ~nd all deeds, mortgages, contracts, leases, bills of sale or other
instruments necessary or desirable therefor.
LASTLY:'~,I direct that no fiduciary appointed by this, my Last Will and Testament,
shall be required) to give bond and that if, notwithstanding this direction, any bond is
required by any law, statute or rule of court, no surety shall be required thereon.
IN WITN~SS WHEREOF, I have set my hand and seal to this, my Last Will and
Testament, consisting of two (2) typewritten pages on the margin of which (except this
page) I have affi~Ced my initials this 17th day of June, A.D. 2005.
ANTOINETTE HOLLING ~.ORTH
a.k.a. ANN.HOLLINGSWORTH
Signed, s aled, published and declared by, the above-named Testatrix, as and
for her Last Will ~nd Testament, in the presence of us and each of us, who at her
request, and in ~er presence, and in the presence of each other, have hereunto
subscribed our ames as attesting witnesses. ,
---~~
-2-
w
~r
ACKNOWLEDGMENT AND AF
We, ANT~INETTE HOLLINGSWORTH, a.k.a. ANN HOLLINGSWORTH, the
testatrix, and th~ undersigned witnesses to the Will, the attached or foregoing
instrument, having been qualified according to law do depose and say:
: ss.
Commonwealthbf Pennsylvania . .
~' FIDAVIT
County of Cumberland =
(a)that I, t~e testatrix, do hereby acknowledge that I signed the instrument as my
Will, that I signed it willingly and as my free and voluntary act for the
purposes therein expressed; and
(b)that w~, the witnesses, were present and saw the testatrix sign the instrument
as her fast Will, that she signed it willingly and as her free and voluntary
ac for purposes therein expressed; that each of us in the hearing and
sig t of the testatrix signed the Will as a witness and that to the best of
ou knowledge the testatrix was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
Y
J~~
Sworn to br affirmed before me by ANTOINETTE HOLLINGSWORTH, a.k.a.
ANN HOLLING$WORTH, testatrix, and Amy Knauer and Beth Myers, witnesses, this
17th da of Junk 2005
.';
-~
~.r~~
ATTORNEY i.D No.21582
ANTOINETTE HOLLINGSW TH
a.k.a. ANN HOLLINGSWORTH
(Witness)
( fitness)
-3-
V
ACKNOWLEDGMENT
On this,l
personally appe
HOLLINGSWO
name subscribe
same for the pu
IN WITN
My commission ~
17th day of June, 2005, before me the undersigned officer,
~ed ANTOINETTE HOLLINGSWORTH, a.k.a. ANN
fH, known to me, (or satisfactorily proven) to be the person whose
to the within instrument and acknowledged that she executed the
ose herein contained. .
iS WHEREOF, I hereunto set my hand and official seal.
xplres:
rtow:w. seat
nn+n IarnuEa
Notary Public
ig0a0UGl{Q1V~D0~
~fon Expires Jan 25, 2009
-4-
~I~
I
A. SETTLEMENT STATEMENT' (HUD-1)
.•dVE'n ry~yy~
c1~~
+ .~
~0 . ..d'•
OMB No. 2502-0265
B. TYPE OF LOAN
L ^ FHA 2. ^ RHS 3. ^ CONV. UNINS.
4. ^ VA 5. ® CONV.INS.
6. FILE NUMBER: T. LOAN NUMBER
I1-00126-ALT 1012236
8. MORTGAGE INS. CASE NO.: 27523284
NOTE: This form is famished to give you a statement o
C }actual settlement costs. Amounts paid to and by the settlement agent aro shown. Items
.
marked (P o c) were paid outride the closin • th ere shown here for informational purposes and are not included in the totals.
NAME & ADDRESS Mary P. Howard
D
.
OF BORROWER: 5328 Oxford Circle A t #24 Mechanicsb PA 17055
E. NAME & ADDRESS Estate of Antoin H. Hollingsworth
OF SELLER: 5776 Hidden Lake rive, Harrisbur PA 17111
F. NAME & ADDRESS GMH Mortgage Se ices, LLC
OF LENDER: 10 Cam us Blvd. ewtown S u PA 19073
G. PROPERTY LOCATION: 5432 Oxford Drive Mechanicsbur PA 17055
SETTLEMENT AGENT: Assured Land Tran
H fern, Inc. 301 Market Street, Lemoyne, PA 17043 (717) 761-4720
.
PLACE OF SETTLEMENT: La era Real LL 307 Market Stre Lemo PA, 17043 717 761-4720
tnn>znnrt rrns NC:T)ATF.~10/18/2011
J, JL •u SummaV of Borrower's Transac ion IC. Summa of Seller's Transaction
100. Gross Amount Due From Borrower: 400. Gross Amount Due To Seller:
101. Contract sales rice 124 000.00 401. Contract sales rice 124 000.00
102. Personal ro arty 402. Personal ro
103. Settlement char es to borrower: line 1400) 3 392.92 403.
1 ~ 404.
105. 405.
Adjustments For Items Paid B Seller In dvanc e: Adjustments For Items Paid B Seller In Advance:
106. Ci !town taxes to 406. City/[own taxes to
107. Coun taxes 10/18/11 to 12/31/11 118.52 407. Coun taxes 10/18/11 to 12131!11 118.52
108. Assessments to I 408. Assessments to
109. Association Dues 10/182011 to 10/31/2011
110. S ecial Assessment 1 011 82 0 1 1 to 12/312011
I 11. School Taxes 10!182011 to 6/302012 46.44
132.19
869.84 409. School Taxis 10/182011 to 6/30/2012
410. Association Dues 10/182011 to 10/31201 l
411. S ecial Assessment 10/18201 I to 12/312011 869.84
46.44
132.19
112. 412.
113 413.
114. 414.
115. 415.
116. 416.
120. Gross Amount Due From Borrower: 128,559.91 420. Gross Amount Due To Seller: 125,166.99
2 B hal f B r w Red cti I e 1 er:
201. osit or earnest money 1000.00 501. Excess de osit see instructions
202. Princi al amount of new loans 117 800.00 502. Settlement charges to seller line 1400) 10 189.48
203. Existin loan(s) taken sub'ect to 503. Existing loan(s) taken sub'ect to
204. Seller Assistance 3 720.00 504. Pa ff 1st Mt . Ln.
205. 505. Pa off 2nd Mtg. Ln.
206. 506. Seller Assistance 3 720.00
207. 50T.
208. 508.
209. 509.
Adjustments For Items Unpaid By Sellers
210. City/town taxes to ' Adjustments For Items Unpaid By Seller:
510. Ci hown taxes to
211. County taxes to 511. County taxes to
212. Assessments to 512. Assessments to
213. 513.
214. 514.
215 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid By/For
Borrower• 122,520.00 520. Total ReduMlons
In Amount Due Seller: 13,909.48
e
301. Gross amount due from borrower Tine 120
302. less amount aid b /for borrower (line 220)
303. Cash (FROM) ~^I'O) Borrower:
128 559.91
12 520.00
6,039.91
601. Gross amount due to seller ine 420)
602. Less reductions in amount due seller line 520)
603. Cash (~O) (^FROM) Seller:
125 166.99
13 909.48
I1 ],257.51
Tho Public Rep m en for this collection of info~etion is estimated at 35 minutes per response ror cmwcray5, ,~.,~.,,,,6, d... •°r°•••••e -- --- • •~- -_---~
s of cone js i scion, and you not tequi d to P mplete this fomt, unless it displays a currently valid OMB control number. No confidentiality is assured;
deli X to rovid the ernes to a }lESPA covered transaction w, raform~tio u 'erg the„settl~~rocess.
Page 1 of 4 HUD-1
Previous editions are obsolete
I
L. Escrow: l 1-00126-ALT
SETTLEMENT CHARGES
70(1. Total Real Estate Broker Fees Paid From Paid From
Borrower's Seller's
~ 0 Ila Funds ;Funds
At At
~tft ~ 3 Settlement Settlement
2 3 72 t La ers Real L '
i n id a e e e
7 440. 0
704.
1 ur ' ' ati char is LC 5.0 fr #1
2 u ch a 'n r e ec' c' teres rate ch -2 0 E #2
ur a 'u i c e ervice L E 1
4 i ee t e i FE #3
5. d' e H tt a ices C #
is t 4
FI d 'fi a' n E#
ica' e L
e ee rt e
d erti tali Fee o: ~ce C
1 D cu Pre aratio T ices
2. P ce To• rt a erv'
erwritin Fee To: o a e ervice
14.
1.
I
l
I.
'f in char a fro 1 /18/2011 11' 2 1 14.5 da 4 da # 2
2. rt ranee f #
0 e er' in u for I . t (state m #1 2 2.0
4. d i u ce rem' i for o
6.
i' d r wa u # 4
10 2. me wner's i u c 3 oaths 2 er 3 '
1 03. ort a e in ante 0 months ("al $ 65 77 oer month $0 00
4 i taxe 0 n
5. u ro e t 1 er 2
06. Ann al en 0 nths e n
~ ~.~+~ ~~~~ ~sce 0 months d'a1$ 0 00 oer month
100 c of Re erves 5 mo th 10 2 e o th 5 .4 '
e ate d'us e t 47 72
] 010.
1 'lei u c 4 2
1 02 the eat r c i ee o
110 Owe e i ur e d e c Rei e o # 2.
11 4. L det' tit e' u d T e I c Re' e 8
105. ende' t t e olic 1' it 1 0
110 . O er' title olic ' 't 1 4 000.
1107. Agent's portion of the total title insurance premium $748.75
Assured Land Transfers, Inc.
1108. Underwriter's portion ofthe total title insurance premium $132.13
First American Title [nsurance Company
Previous editions are obsolete Page 2 of 4 HUD-I
h Good Faith Estimate HUD-1
ar es
a ' n o G d Faith Estimate GFE and H D-1 C
annotIn ea e ~
# 801
9 5.00
995.00
u o i' ati n chaz e
dit ~ char a oint for the s ecific interes rate chosen # 802 0.00 2 000.00
cre
# 3 995.00 1005.00
ur ad' ed on ination char es 2 480
0 0
1 24
#]203 . .
Good Fai h ~ timate Hl -1
i tal a n I crease More Th n %
15 0 1
v mme e r 'n char a 400.00 4 0.
# 805 50.00 36.3
' e o
Tntal _. 4.3
Increase between G - ~ (13 611 or (2.23851 %I
ha a han e
I 't' it r e c w a un
ail in char es
i ~ #1 0
# 0 4.52 da
# 0
wne in u ce
T' i an lender' 'tl in u ce # 3
# 1
In'C n Fce #13 2
o d ~a' E~ imate UD-
2 2 0 I 5.4
21 .8 20
20.0 2•
.75 27.00
363.0 l 2 2.73
21 .0 217 32
Loan"Perms
Your initial loan amount is $ 117,800.00
Your loan term is 30 years
Your initial interest rate is 4.500000
Your initial monthly amount owed for principal, interest, and $ 662.65 includes
and any mortgage insurance is ^X Principal
^X Interest
^X Mortgage Insurance
Can your interest rate rise? ®No. ^ Yes, it can rise to a maximum of %. The first changr,
will be on and can change again every after
. Every change date, your interest rate can increase or
decrease by %. Over the life of the loan, your interest rate is
guaranteed to never be lower than % or higher than %.
Even if you make payments on time, can your loan balance rise? ^X No. ^ Yes, it can rise to a maximum of $
Even if you make payments on time, can your monthly ^X Na. ^ Yes, the first increase can be on and the monthly
amount owed for principal, interest, and mortgage insurance rise? amount owed can rise to $
The maximum it can ever rise to is $
Does your loan have a prepayment penalty? ~ No. ^ Yes, your maximum prepayment penalty is $
Does your loan have a balloon payment? ^X No. ^ Yes, you have a balloon payment of $ due in
years on
Total monthly amount owed including escrow account payments ^ You do not have a monthly escrow payment for items, such es property
taxes and homeowner's insurance. You must pay these items directly ;/ourself.
^X You have an additional monthly escrow payment of $ 173.51
that results in a total initial monthly amount owed of $ 836.16 . This
includes principal, interest, any mortgage insurance and any items chcckcd below:
^X Property taxes ^X Homeowner's insurance
^ Flood Insurance ^X School Taxes
^ ^
Note: If you have any questions about the Settlefient Charges and Loan Terms listed on this farm, please contact your ienoer.
Page 3 of 4 HUD-1
Previous editions aro obsolete