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HomeMy WebLinkAbout11-09-11 (2)J 15056©I~43 REV-1500 E"'°'~'°) OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPUeTUENT OF PEVENUE Po Box.28oso1 INHERITANCE TAX RETURN 21 ~.~. 00728 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 179 10 3913 04 23 2011 01 12 1914 Decedent's Last Name Suffix Decedent's First Nan'le MI MYERS RUTH N (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ^ 2. Supplemental Retum ^ 3, Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after,2-12-82) ^ 5. Federal Estate Tax Retum Required g Decedent Died Testate ~ Decedent Maint fined a Living Trust 0 (Attach Copy or Will) ^ (Attach Copy ofeirust) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1p. Spousal P4ve~Credit~date of death 1-~, Election to tax under Sec. 9113 A between 12-3,- ,and -1-95) ^ (Attach SCh. O) ( ) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JOHN JAS MOONEY III 717 632 4656 First line of address 230 YORK STREET Second line of address City or Post Office HANOVER State ZIP Code PA 27331 REGISTER OF V~IG9USE ONLaG rJ, TJ ~-. r° ~-' C`1 C7 ^-~ c,;~-„ _ . G.~j --t `. DATE Fi~D f`••% -~-r ~~:.~ ~-~ t_ - ,, ~i ,- ~~~ Correspondents e-mail address: Under penalties of perjury, 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 and complete. Declaration of preparer other than the persona representative is based on all information of which preparer has any knowledge. SIGN{yTU F PERSON~ES9QNSI¢LE FOR FILING RETURN ..._~ Jeffrey L. Cisn /o-ay- ~ 9287 Mud un Orrstown P 17244 SIGNATURE OF P RER ER THA REPRESENTATIVE DATE John James Mooney 111 ADDRESS 230 Yor St eet ano r, / ~/3 (~ 1/ Side 1 L 15 S61 3 15CIS610143 PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Myers, Ruth N. 21-11-00728 Under penalties of perjury, 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 and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. Signature #2 Name Address1 Address2 City, State, Zip Date 9407 Muddy Run Road Orrstown, PA 17244 ~~-~~-ll REV-1500 EX Decedent's Name: Mye~S, Ruth N. Decedent's Social Security Number 179 10 3913 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 119,x00.00 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 37 9, 774 . ~ 5 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous MoD; Probate Property Se arate Billin (Schedul Re u G t d p g ) u q e es e ............ 7, 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. ,,~ 98 , 7 7 4 . 3 5 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 2 ~ , 315.3 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. ~ 0 , ~ 5 9.74 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 3 ~ , 77 5.13 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. Q 51, 998.23 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. tj ~ (~ 0 ©. ~ (~ 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. ,~ 5 5 , 9 98.2 ~ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (x)(1.2) X .00 15. ~ . 00 16. Amount of Line 14 taxable 0 , ~ 0 at lineal rate X .045 16. 0 . 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17. 0 , 00 18. Amount of Line 14 taxable at collateral rate X .15 45 5 , 998.23 18. 68 , 54 9.73 19. Tax Due .................................................................................................................. 19. 58 , 54 9.73 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 15x561a243 Side 2 150561x243 1513561x243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-00728 DECEDENT'S NAME Myers, Ruth N. STREET ADDRESS 121 Willow Drive CITY Shippensburg STATE PA ZIP 17257 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 68,000.00 3,427.49 q, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) Total Credits (A + B) (2) (3) (4) (5) 68,548.73 7'[,427.49 2,877.76 Make Check Pa able to: REGISTER OF WILLS, AGENT. .~ .. .. . _.. ..~. , ~ _ . F . .. , 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 :.................................. ^ 0 c. retain a reversionary interest; or ............................................................................................................... ^ 0 d. receive the promise for life of either payments, benefits. or care? ............................................................. ^ ^x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ^ ^ receiving adequate consideration? .................................................................................................................... x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ^ ^x 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 January 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) (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)]. A sibling 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 tJt+ (11-0B) SCHEDULE A REAL ESTATE COMMONWEALTHOF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Ruth N. ESTATE OF FILE NUMBER 21-11-00728 All real property owned solely or as a tenant in common must be rspoRed at fair market value. Fair market value is defined as the price at which properly would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jolntlyowned with right of survivorship must be disclosed on schedule F. Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) tlr more space Is neeaed, additional pages of the same size) Rev-1508 EX+ (6-98) ~CMEDUi.E E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Myers, Ruth N. 21-11-00728 Indude the proceeds of litigation and the date the proceeds were received by the estatfs. All property jolntlyowned with the rlgM of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 All State -Car insurance refund 8.30 2 Allstate -Homeowner's insurance refund 79.79 3 Allstate -Car insurance refund 129.10 4 Century Link -Refund 30.31 5 Citizens Bank -Checking Account #6219100674, Principal $50,345.35, Accrued interest $.55 50,345.90 (See attached statement) 6 Citizens Bank -Checking Account #6100667448, Principal $23,574.01, Accrued interest $.13 23,574.14 (See attached statement) 7 Countylfown taxes -Reimbursed at real estate settlement (See HUD attached) 143.45 8 The Sentinel -Subscription refund 3 82 9 Wells Fargo -Account #5897-5992 (See statement attached) 300,836.10 10 1984 Ford 8 Personal Property -Sold at Public Sale (See Final Settlement attached) 4,623.45 TOTAL (Also enter on Line 5, Recapitulation) I 379,774.36 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+(10-06) COM IN~INT DECEpEN~R~ANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Myers, Ruth N. _ 21-11-00728 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT q, FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State ZiD _ Yearls) Commission paid 2. Attorney's Fees John James Mooney III 24,928.28 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State ZiD Relationship of Claimant to Decedent 4. Probate Fees 145.50 5. Accountant's Fees 425.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs 817.61 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 26,316.39 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Myers, Ruth N. I 21-11-00728 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Gosts 1 Cumberland Law Journal -Estate notice 75.00 2 Mooney 8< Associates -Photocopying and postage fees 150.00 3 Register of Wills -Filing fee S additional probate fees 350.00 4 The Sentinel -Estate Notice 242.61 H-B7 817.61 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 Ex+ (12-081 SCHE©ULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Myers, Ruth N. 21-11-00728 Repoli debts Incurred by the decedent prior to death that remained unpaid at the date of death, Including unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Allstate -Car insurance 193.70 2 Barry Negley -Lawn care 4/27 thru 6/21111 $230.00; 7113 to 7/14/11 $75.00 305.00 3 Baxter Wellmon, DO -Medical bill 100.60 4 Borough of Shippensburg -Water bill 96.40 5 C.F.J.M.A. -June sewer bill $93.00; August $33.00, September $31.50 157.50 6 Carl Ocker Real Estate -Deposit on advertising fees for public auction 1,000.00 7 Centurylink -Utility - 5/4/11 $30.31, 7/4/11 $8.68 38.99 8 Citizens Bank -Check fee 8 paper statement fee 16.88 9 Comcast -Utility -June $71.94, July $29.28 101.22 10 CORE Auctions, LLC -Auctioneer fees paid at real estate settlement (See HUD attached) 5,178.23 11 Lauver's Lawn Care -yard work 742.00 12 Notary Fees -Paid at real estate settlement (see HUD attached) 20.00 13 Penelec -Electric bill - 7/7/11 $189.69; 8/5/11 $109.26; 9/13/11 $113.48 412.43 14 Recorder of Deeds -Transfer tax paid at settlement (See HUD attached) 1,190.00 15 Rodney Smith - Repair to water heater 665.00 16 School tax -Tax for 7/1/11 to 9/1/11, paid at real estate settlement (See HUD attached) 241.79 TOTAL (Also enter on Line 10, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. 10,459.74 Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+I71-OS) scHEau~E a COM ~N~FjtOF~D~~$)'LVANIA BENEFICIARIES ESTATE OF Myers, Ruth N. FILE NUMBER ~~.~ ~ _nrn~n NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 Andrew C. Breneman Nephew 5,000.00 1304 Doubling Gap Road Newville, PA 17241 2 Charles R. Cisney Nephew 1/2 Residue 9207 Muddy Run Road Orrstown, PA 17244 3 Jeffrey L. Cisney Nephew 1/2 Residue 9287 Muddy Run Road Orrstown, PA 17244 4 Summr Ruth Myers Friend 1,000.00 1523 Hoffman Road Olmstedville, NY 12857 Total 6,000.00 Enter dollar amounts for distributions shown above on lines 1 5 throu h 18 on Rev 150 0 cover sheet, as a r o riate. II NON-TAXABLE DISTRIBUTIONS: . A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TA:K IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ~ Orrstown United Brethren Church 5,000.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE 5,000 00 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) t13 C ~~ LAST ~~~ WILL AND TESTAMENT c~ ~~ O ~, ' I, RUTH N. MYERS, a '.7 ©T) ~~ resident of Southampton T~wrish ~~ ~ ~ i~ ~ ~1~ ip;~Frac~ County, Pennsylvania, being of sound mind and and declare this my last will a memory, do m nd testament, hereb re ki ake,? ublisr by me heretofore made. y vo ng any and all wills ITEM I. I direct my executor or executors, hereinafter named, to pay my funeral expenses as soon after my decease as nnay be found convenient, and also to pay all estate, inheritance, succession and other death transfer taxes, of whatever nature and by whatever jurisdiction imposed and interest and penalties in respect thereto, assessed against my estate or payable by reason of my death, with respect to any and all property, life insurance and other interests comprising my estate for death tax purposes, whether or not such property or interests pass under this will or any codicil thereto, without reimbursement as if such taxes were administration e~l;penses. ITEM II. I give, devise and bequeath all my e:;tate, real, personal and mixed, of whatever nature and wheresoever situate, which I may own or have the right to dispose of at the time of my decease, to my husband, W. BRUCE MYERS, absolutely, if he is living at the time of my decease. ITEM III. In the event my husband, W. Bruce Myers, is not living at the time of my decease, I dispose of my estate as follows : - (A) I give and bequeath the sum of Five Thousand Dollars ($5, 000.00 ) to ORRSTOWN UNITED BRETHREN CHURCH. (B) I give and bequeath the sum of Five Thousand Dollars ($5,000.00) to my nephew, ANDREW C. BRENEMAN, if he is living at the time of my Law Offices GLEN & GLEN 5 Chambenbur¢ Trust Bld¢. ;hambersbur¢~ PA 172D1 decease, but in the event the said Andrew C. Breneman has predeceased me, then this bequest to him shall lapse and form part clf my residuary estate. Law Offices GLEN & GLEN Chambersburg Trust Bldy. :hambersburc, PA 17201 (C) I give and bequeath the sum of One Thousand Dollars ($1, 000.00) to my friend, SUMMR RUTH MYERS, if she is living a.t the time of my decease, but in the event the said Summr Ruth Myers has predeceased me, then this bequeath to her shall lapse and form part of my residuary estate. (D) All the rest, residue and remainder of my estate, real, personal and mixed, of whatever nature and wheresoever situate, which I may own or have the right to dispose of at the time of m y decease, I give, devise and be- queath in equal shares to my nephews, CHARLES R. CISNEY and JEFFREY L. CISNEY, if both are living at the time of my decease:, but in the event either of said nephews have predeceased me, then the eni:ire said residue and re- mainder of my estate to the survivor of said two neplzews . ITEM IV. I nominate and appoint CHAMBERSBUI3G TRUST COMPANY, of Chambersburg , Pennsylvania, guardian of the estate of any person under the age of 18 years and with respect to which I am authorized to appoint a guardian and have not otherwise done so, to serve until such persons attain the age of 18 years, and no bond shall be required of said guardian; said guardian shall have the power to use principal as well as income from time to time for the maintenance, education and medical care of such beneficiaries under the age of 18 years. ITEM V. I hereby nominate and appoint my husband, W. BRUCE MYERS, executor of this my last will and testament, but in the event the said W. Bruce Myers is not living at the time of my decease, or fails to qualify, I nominate and appoint my nephews, CHARLES R. CISNEY and JEFFREY L. CISNEY, executors of this my last will and testament, and direct that no bond shall be required of said executor or executors . IN WITNESS WHEREOF, I have hereunto set my hand and seal to this last will and testament, this ~~~ da of Ma Y y, A . D „ 1986 . SIGNED, SEALED, PUBLISHED AND DECLARED by the said Ruth N. Myers to be her last will and testament in our presence, who at her request and in her presence and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. Law Offices GLEN & GLEN )6 Chambersburg Trust Bldg. Chambersburg PA 17201 3 . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 014735 CISNEY CHARLES R 9407 MUDDY RUN ROAD ORRSTOWN, PA 17244 fog ESTATE INFORMATION: SSN: t~9-~o-3913 FILE NUMBER: 21 1 1 -0728 DECEDENT NAME: MYERS RUTH N DATE OF PAYMENT: 07/19/201 1 POSTMARK DATE: 07/19/201 1 couNTY: CUMBERLAND DATE OF DEATH: 04/23/201 1 REMARKS: RECEIPT TO ATTY CHECK#1002 SEAL ACN ASSESSMENT CONTROL NUMBER REV-1162 EX(11-96) AMOUNT 101 ~ 568,000.00 TOTAL AMOUNT PAID: INITIALS: WZ RECEIVED BY: REGISTER OF WILLS 5 68, 000.00 GLENDA EARNER STRASBAUGH TAXPAYER ~p~MEef~~ ~! ~~~ * ~ ~'^~- `,V.' OMB Approval No. 2502-0265 kG ~tiu~q ~= A. Settlement Statement HUD-1 94<M pT1E~~ B. Type of Loan 6. Flle Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 1.O FHA 2. Q RHS 3. ^Conv. Unins. 210347 4. Q VA 5. Q Conv.lns. C. Note: TJus formis famished to glue you a statement of actual settlement costs. Amounts paid to and by the seWement agent are shown. !tams marked (p.o.c.)' were paid outside fhe c/osing,• they era shown here forlnformatlonal u p rposes and are trot included !n the tote/s. D. Name and Address of Borrower: E Name and Address of Seller. F. Name and,Address of Lender. Janet L Zeger ~ Estate of Ruth N. Myers 11591 Lincolrnvay West N/A--Cash Pw•chase Fort Loudon, PA 17224 230 York Street Hanover, PA 17331 G. Property t.ocatlon: H. Setiement AgenL• 23-2886664 121 Willow Street Mooney $ Associates, Hanover, PA I. Settlement Date: Shippenslwrg, PA 17257 230 York Street Cumberland County, Pennsylvania Hanover, PA 17331 September 1, 2011 Ph. (717)632-4656 Place of Settlement: 230 York Street Hanover, PA 17331 I:o 120. Gross Amount Due from Borrower 200. Amounts Paid b orin Behalf of Borrow 121,602.48 420. Gross Amount Due to Seller 119 1 er 201. De osit or earnest moos , 500. Reductions in Amount Due Seller 202. Pfincl al amount of new loans . 5000.00 501. Excess de oast sae Instruc0ons 203. Exists Icons taken sub act to 502. Settlement char es to Seller Line 140 6 3 204. , 503. Exlstl loans taken sub act to 205. 504. P Flrst Mort age 206. ~ 505. Pa ff Second Mort a e 207. 506. 208. 507. De oast disb. as roceeds to Estate of Ruth N. M 5 0( 209, , 508. Ad ustments for items un aid b Seller ~9' 210. Coun /sown Taxes f0 Ad ustments for items un aid b Seller 211. Coun Taxes to 510. Coun /Town Taxes to 212, School Tax to 511. Coun Taxes to 213. 512. School TaX 07/01/11 to 09/01%11 24 214. 513. 215. 514. 216. 515. 217. 516. 220. Total Paid b Nor Borrower 5,000.00 520. Total Reduction Amount Due Seller 300. Cash at Settlement from/to Borrower 11,630.0< 301, Gross amount due from Borrower line 120 600, Cash at settlement to/from Seller 121 602.48 601. Gross amount due to Seller IIne420 302. Less amcunt paid Nor Borrower Ilse 220) ( 5,000.00) 602. Less reductions due Seller line 520 119 143.4: 303. Cash XD From ~ To Borrower ^ ( 11,630.Oe 116,602.48 603. Cash X To ~ From Seller 107,513.43 The undersigned hereby ackn edge receipt of a completed copy of this statement & any attachments referred to hereto Borrower Seller J et L. Zeger ~~ Es2 Ruth bgi _ _ ,. J/ Y,Co- r . Char . Clsney, Co- .uto The Publle Reportlnp Bataan br tlda mtlactlon of Inbrmetlon b astlmaled x136 minute^ par response for mllsctlnp, nNarin nolrequlrod b romplaM Nis brm, unlau It displays • errantly valid OMe control number. No wnEdentlelly Is aawred; Iola dlsdawre Is mnandabry.'rhlslls dedpned m proNde rie perUea boas RESPA mwred banaamon vdtl~ Mrormetlon durlnq Yle saltlamenl prouas. oe..e ~ ,. L. Settlement Charges i, vi-- 700. Total Real Estate Broker Fees Peia From Pald From OfvlsionOfCOmmissl0n (l/ne 700) as follows: Borrowers Sellers 701. t0 Funds el Funds el 702. to Semsmenl Sememenl 703. Commission aid at settlement 704. 800. kerns P able In Connection with Loan 801. Our on ination cha a Includes Orf ina8on Point % ar $ from GFE#1 802. Your credit or charge (points) for the specific Interest rate chosen $ (from GFE #2) 803. Your adjusted origination charges from GFE #A 804. sisal fee to from GFE #3 605. Credit Re ort to from GFE #3 806. Tex service to (from GFE #3) 807. Flood certification to (from GFE #3) 8~• from GFE #3) 809. (from GFE #3) 810• (from GFE #3 811• (from GFE #3 90D. Items Re wired b Lender to Be Paid in Advance 901. Daily interest char es from to Q $Poa (from GFE #10] 902. MIP Tot Ins. for Lite of Loan months to from GFE #3 903. Homeowner's insurance for ors to from GFE #11 ~• ~ from GFE #11 905. (from GFE #11) 1000. Reserves De osited with Lender 1001. Initial deposit for your escrow account (from GFE #9) 1002. omeowne s nsurance months $ per moot $ 1()03.Mort einsurance months $ er month $ 1004. Property taxes $ Cityffown Taxes months Q $ per month Assessments months $ er month 1005. $ 1006. months (a~ $ per month $ 1~7• months @ $ per month $ 1008. $ 1009. $ 1100. TItIe Cha es 1101. Title services and lender's title insurance (from GFE #4) 1102. Settlement or closin fee $ 1103. Owner's title Insurance to from GFE 1104. Lender's title Insurance to $ 1105. Lender's title oil limit $ 1106. Owner's title ollc limit $ 1107. ant's rtlon of the total title Insurance remium $ 1108. Underwritefs ortion of the total tf0e (nsurance remium $ 1109. 1110. Notary Fees to Mooney & Associates, Hanover, PA 20 ~ 1111. Incomi Wire Fee to Mooney 8 Associates, Hanover, PA 10 00 1112. . 1113. 1200. Govemment Recording and Transfer Charges 1201. Govemment recordin char es to Recorder of Deeds from GFE # 63.50 1202. Deed $ 63.50 Mortgage $ Releases $ Other $ 1203. Transfer taxes to Recorder of Deeds (from GFE #8) 1,190.00 1204.Ci /Countytax/stamps $ 1,190.00 $ 1205. State tax/slem s S 1 190.00 $ 595.00 1206. 595.00 1207. 1300. Additional Settlement Cha es 1301. Re wired services that u can sho for from GFE #6 1302. Tax Certification to Bar L Ne le ,Tax Collector 1000 1303. Auctioneer Fees to CORE Auctions LLC 5 178 23 1304. . 1305. 1400. Total Settlement Cha es enter on lines 103 Section J and 502, Section K ar slonlno eweetnrMla sMlwmwnf Ms dnnaH.w.as.a......n.w........,..,..r..~__~_._. __.. _.____.. _..~~_._.___ 1 273.50 6 388.23 Joh M e ,III, Esq ire S tlementAgent Certified to be a true copy. Page 2 of 3 HU0.1 Homeowners policy refund Allsfofe Insurance Company 10815 David Taylor Dr Charlotte. NC 2E 262-1046 ""I'IIIIII'I"IIIIIIIII~ItI'III"I~'ll~l'IIIIIIIIIIII"I'IIIIII Information as of October 12, 2011 ESTATE OF RUTH N MYERS Policyholder C/ O 1 E FF C I S N E Y Estate of Ruth N Myers 9287 NiUDDY RUN RD C/O Jeff Cisney ORRSTOWN PA 17244-9676 Polic number 098 422 325 Property 121 WILLOW DR SHIPPENSBURG PA 17257 Your Allstate agency is What yo~l should know Gannon Associates As you requested, we have tcrirrinated your policy effective September 66 E King Street Shippensburg, PA 17257 1, 2011. Attache~j is your refund check. We thank you for the (717) 532-4181 opportunity to serve you and hope we can provide your insurance protection in thE~ future. If you have any questions, please contact your agent or producer of record. Page 1 of 1 Payment history 10/11/10 Previous-balance $483.23 __ _ 10/20/10 Payment received __ - 483.23 _ 9/15/11 Renewal premium ~ 503.79 __ 10/11/11 Policy cancellation adjustment - 79.79 __ _ 10/11/11 Revise renewal ~ - 503,79 10/12/11 Refund issued 79.79 Balance $0.00 :t;~~+~ r'~ ~'iF Allstate Insurance Company Check number: 0071057010 6b-156 10815 David Taylor Drive Charlotte NC 28262 s3f Date of issue: 10/12/2011 Policy Number: 098 422 325 Pay: Seventy-nine and 79/100 dollars To the order of: ESTATE OF RUTH N MYERS C/O JEFF CISNEY Amount: 9287 MUDDY RUN RD $79.79 ORRSTOWN PA 17244-9676 Premium Refund Account Wachovia Bank, a division of Wells Fargo Bank Chapel Hill, NC 27514 , N.A, p ti.r</~ ~, l C.~,~ Void if not presented within 180 days ofthe date of issue Authorized Signatures u"007105?0 LOn^ t;053 L0156 li: 20?9900 L L8 L t5ii' Auto policy refund Allstate Inwronce Company 10815 David Taylor Dr Charlotte, NC 28262-7046 'I"II~~I'II'I1111~'~III~II'~III~'llll~I1~111"1~111~~1~11~1~111~ ESTATE OF RUTH N MYERS C/O JEFF CISNEY 9287 MUDDY RUN RD ORRSTOWN PA 17244-9676 What you should know As you requested, we have terminated your policy effective September 1, 2011. Attached is your refund check. We thank you for the opportunity to serve you and hope we can provide your insurance protection in the future. If you have any questions, please contact your agent or producer of record. Payment history 10/11/11 Policy cancellation adjustment -129.10 10/11/11 Refund issued 129.10 Balance $0.00 ~~ Allstate® You're in good hands. Information as of October 11, 2011 Policyholder Page 1 of 1 Estate of Ruth N Myers C/O Jeff Cisney Polic number 008 635 274 Vehicle 1984 Ltd Yottr Allstate agency is Gannon Associates 66 E King Street Shippensburg, PA 17257 (717) 532-4181 -2071 M W ...................................................... Allstate Insurance Company -`"heek'number: 0.070958696 6~-ise °10315 David Taylor Drive Charlotf~ ..; 28262 .ate of issue: 8/15/2011 ssi Policy Number.:. 008 635 274.;. ' ' Payc "'~ Eight and 30/100 dollars ~~ ,q l Istate v To the order of: RUTH N MYERS ~ You're in good hands. 121 WILLOW DR SHlPPENSBURG PA 17257-9441 Amount: $8.30 --~, Premium Refund Account Wachovia Bank, a division of Wells Fargo Bank, N.A. ~ t Chapel Hill, NC 27514 ~.l` ~, P~ ~ ~„,,,~ Void if not presented within 180 days of the date of iswe } o.ws ~ °"" Authorized Signatures ii'00 709 58696ii' ~:0 5 3 LO l 56 i~: 20 79900 i ~8 1 1 5ii' CENTURYTEL, INC. Document /Date ATTN: Controllers Group 2000784369 / 09/16/2011 ~~~~ P.O. BOX 4065 ~i,~ MONROE, LA 71211 Your vendor number CenturyLink° 1-877-386-7151 500000 Document Invoice Date Gross Amount Deductions Net Amount . Text Payment is made on behalf of EQ United Tel-PA, T856. 1900038554 3135884950 09/15/2011 30.31 0.00 30.31 Refund Questions? Call 1 888 723 8010 Sum total 30.31 0.00 30.31 Citizens Bank- Account Number 6219100674 Account Title RUTH N MYERS Date erred 1/28/2008 Account T e Checkin Princi al Balance as of DOD $50345.35 Interest from Last Postin to DOD $ .55 Account Balance as of DOD $50345.90 YTD Interest to DOD $14.10 Citizens Bank' Account Number 6100667448 Account Title RUTH N MYERS Date ened 12/7/2001 Account T e Checkin Principal Balance as of DOD $23574.01 Interest from Last Posting to DOD $ .13 Account Balance as of DOD $23574.14 YTD Interest to DOD $5.12 ~~ .. Por inquiries call (563j 383-2128. Detach and retain this statement before depositing check. REMOVE DOCUMENT ALONG TWIS PERFORATION ~~""E:y~'ez~ra'g"1~e~-D_~'~~f~t:r'.'.~StL6'°,~S.~~a~~~°~°:R'~~o a e 4`Y~t~~i~„'S - ~ a '. Procttr~`riie~t ~So1~Y;~'io'~s Eq ~~~'I~C. ~ ~ E S$NTWEI; '"" _ ~ - (C,I-1~C'K 110 ,2695190 ~r r ~. •cw.~ ~~t~ 79-1160. Wausaq Wisconsin ~.. - ~ ~~ '~. ~ Three and ~82/100~ Dollars ''~ r`i ****,~,t**,t*~*~r**,t*~*,k***,tr*w*,*~**~** - , :~ Void after 90 days THE RUTH MXERS~******,t*******.******~*.. :, ;;, DER 121 WILLOW DR . ` /~ SHIPPENSBURG . PA 1'257 - 9441 ax ~-emu`" ,~.,; .: ,1f,. ~ ,, ll'2695L9011' ~:0759~~603~: L82380LB458611' Wells Fargo Advisors, LLC 1145 Professional Court Post Office Box 1289 Hagerstown, MD 21740 Tel: 301733-2353 Fax: 3 017 91-0 8 4 0 Toll Free: 800-388-1248 Ruth N Myers Acct# 5897-5992 Estate of Ruth N Myers Date of Death Evaluation Sunday, April 24, 2011 uanti Descriation Mean Value 25,000 Connellsv 4.5% 2027 101.709 $ 25,427.25 40,000 Erie PA. 4.35% 2024 100.51 $ 40,204.00 50,000 Kiski 4.25% 2040 85.27 $ 42,635.00 50,000 Lancaster 4.5% 2028 97.05 $ 48,525.00 20,000 Lehigh 5% 2035 93.477 $ 18,695.40 15,000 PA. St. 5% 2040 92.047 $ 13,807.05 40,000 Phila. 5% 2026 99.886 $ 39,954.40 50,000 Phila 5.25% 2030 103.103 $ 51,551.50 10,000 Phila Ath. 5.125% 2028 99.148 $ 9,914.80 10,000 Radnor 4.4% 2025 101.217 $ 10,121.70 Grand Total $ 300,836.10 This date of death valuation was completed by obtaining the high and low prices on F riday, April 22, 2011 and the high and low pries on Monday, April 25, 2011 and using the mean of those days to arrive at a mean price for the date of death. This pricing information is a courtesy to all Wells Fargo Advisors, LLC account holders and Wells Fargo Advisors, LLC assumes no liability on the part of Wells Fargo Advisors, LLC or any of it's employees. Member FINRA/SIPC Date of Other ~(/ U ~ - -- ~ - - ~ - - , PROCES?5 OF SALE Casio--r-_.._._.._... _.~.._.r ~ ~ ~l g S, ;1; 5 . . cried ~ Lf ~ D t ~ D Other._ ~ Q ~'~t4~ a irt. S5$. 50 NUscaltaneovs (see attached list)_~ TOTAL PRDCS-~7S OF SA1 F ~~_(p 7 ~} b'y aS~ ~' 155 SBbER'S SALE EXPB'ISF~ = Audlonetsr ~ Faa .l ~..C_° S ~0 7 `f, g D Other Seller's Expenses Advankxd by Auctioneer: ~ _ .. ~ ~a~n~- ~ a~~~~ ~ ~ 3~~,~~ f ".'~ . -~ ~~4~~~GY1riNtM. ~ ! ~5~ ~O . ,~~~ckr,~,~.,1 v~it~~r,~..~ ~ 1~ D,ab ~ • Po ~-fiA. ~©t' ' Miscellaneous (see • attached list):, 7m fa 1 ra s zI ° 6$• O t? > ~ ~ ~3~ r s ~~t +~ 5~. s ~ l ~ ~, p DEDUCT ToTAt Sa ~ ~•s so-r~ nrnQvs~ s a ` a ~ ! ~ D ~ (~ ~ ~ $ _ TOTAL NEI' PROC~DS TO SSI.FR,._,r5._ ~o o~ ~ r ~{- 1, (ar we), the salter of goads, merchandise, location, acknowledge and adept this se#tie and/ar property sold at public auction on an d mertt f ' a~~ ~ spansibility for providing merk:.'~antable title delivery of Nils to Jhe purchaser. te o pi ~ acsads of sale_ i (ar we) agree fo to alt goods; mercf~andise, and/or property sold,' and i`+or (Date) ' (5e!!er's Signature) Auctioneer or Cashier's Signature . _ (seller'snature) AL aE7 i LETvIF~IT-Fa ~7 -- rm No. F3-69. 32.tl0 per oad, 10 pads at 37.5a each 20 ar more at 37.25 each. i