HomeMy WebLinkAbout11-14-11 (3)15D561D143
REV-1500 Ex(°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania county code Year File Number
Bureau of Individual Taxes oEP~M~~w~uE
Po Box.2soso~ INHERITANCE TAX RETURN 21 11 0382
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
210 24 8676 03 15 2011 12 19 1933
Decedent's Last Name Suffix Decedent's First Name MI
MCCLELLAN PHYLLIS M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
Cam Hill PA 1
N REPRESENTATIVE
MI
FILL IN APPROPRIATE OVALS 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
(date of
death aft
e
r 12-12-82) ~ 5. Federal Estate Tax Retum Required
6 Decedent Died Teatate
(Attach Copy of Will) ~ pr
~
n
7. ~gtta~Giecopy Hof T ~)a Living Trust g, Total Number of Safe Deposit Boxes
g, Litigation Proceeds Received ~ 1 p. b~ou~~Pg~v3efrt~~e~~t,~datge54f death ~ 11 Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECfiION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL'TAXlNFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
MICHAEL L BANGS 717 730 7310
First line of address
429 SOUTH 18TH STREET
Second line of address
City or Post Office
CAMP HILL
15D561D143
Correspondent's a-mail address:
Under penalties of perjury, I declare that I have examined this return, inGuding 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.
ADDRESS
OF
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
State ZIP Code
PA
Kimbra Jo Kurtz
Michael L. Bangs
ADDRESS
429 South 18th Stre .Camp Hill. PA
Side 1
REGISTE~F WILLS U~6'ONLY
.-_ ---
~_ n -- -r, r~
.
;_ t , --,
-~ P
~~I ~
f
y
,.
'
_ r"
.
`-
r-
T7 - _
- 7
,
~; -d.. ._A.._
~; _ .
C
C
`
{.t w~
~
~ + I
r
O :-- ~ W -
FILED - _ _ ,
D C~ r ~,
~~ -,
~~ ~~ ~~
150561D143
J~
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF
McClellan, Phyllis Marlene
FILE NUMBER
21-11-0382
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 beliell, 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 ~~ft.~./r~yf~c/y"'
Name Mark Edward McClellan
Address1 102 Norman Road
Address2
Clty, State, Zlp Cama Hill, PA 17011
~~~~/~r
date
15D561D243
REV-1500 EX
Decedent's Social Security Number
oeceaern~sName: McClellan, Phyllis Marlene 210 24 8676
RECAPITULATION
121,359.92
1. Real Estate (Schedule A) ....................................................................................... 1.
2. Stocks and Bonds (Schedule B) ............................................................................. 2.
3.
4.
5.
6.
7.
8. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).........
Mortgages & Notes Receivable (Schedule D) ........................................................
Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...............
Jointly Owned Property (Schedule F) ^ Separate Billing Requested............
Inter-Vivos Transfers ~ Miscellaneous N,oq Probate Property
(Schedule G) u Separate Billing Requested............
Total Gross Assets (total Lines 1-7) ..................................................................... 3.
4.
5.
6.
7.
8,
7,554.20
13,126.83
$ 3 , 2 4 6.94
225 , 287.89
13,137.18
9. Funeral Expenses 8~ Administrative Costs (Schedule H) ....................................... 9.
1 , 8 7 0 . 4 9
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. 10.
11.
Total Deductions (total Lines 9 & 10) ...................................................................
11. 15,007.67
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 210 , 2 80.22
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.
210,280.22
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 15 ~ • ~ ~
(a)(1.2) X .00
16. Amount of Line 14 taxable 210 , 2 80.22 1s. 9 , 4 62.61
at lineal rate X .045
17. Amount of Line 14 taxable
0
~ 0
17
0. 0 0
.
at sibling rate X .12 .
18. Amount of Line 14 taxable
~
~ ~
18
0. 0 0
•
at collateral rate X .15 •
1 s. Tax Due .................................................................................................................. 19. 9 , 4 62.61
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
Side 2
L 15D561D243 15D561D243 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-11-0382
DECEDENT'S NAME
McClellan, Phyllis Marlene
STREET ADDRESS
339 Stonehedge Lane
CITY
Mechanicsburg STATE
PA ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
8,600.00
452.63
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
g. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(1) 9,462.61
Total Credits (A + g) (2) 9,052.63
(3)
(4)
(5) 409.98
Mlake Check Pa able 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 ............................................................................................................... ^ ^x
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?....... ^
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 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
[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 nit 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 Welt 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 l:X+ (11-08)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
McClellan, Phyllis Marlene 21-11-0382
All roal properly owned solely or as a tenant In common must bs reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a Nulling buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real propoAy which is Jointly-owned with right of survivorohip must be disclosed on schedule F.
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-OS)
Rev-150g 13X+ (g-gg)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
McClellan, Phyllis Marlene 21-11-0382
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right o} survivorship must be disclosed on acheduls F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Automobile - 2005 Chevrolet Cobalt (see Kelly Blue Book attached; private party value used) 6,679.00
2 Refund - 2010 IRS income tax 102.00
3 Refund - Comcast Cable 95.20
4 Refund from PA Department of Revenue 250.00
5 Refund of homeowners insurance premium 428.00
TOTAL (Also enter on Line 5, Recapitulation) I 7,554.20
(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-1509 FJ(+ Is-~1
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
McClellan, Phyllis Marlene 21-11-0382
Kan asset was made joint within one year of the decedent's date of death, it must be reported on achedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Mark Edward McClellan 102 Norman Road Son
Camp Hill, PA 17011
B.
C.
JOINTLY OWNED PROPERTY:
ITEM
NUMBER
FOR JOIN
TENANT
MADE
JOINT DESCRIPTION OF PROPERTY
(NUMBER OR EMILARNDENTIFY NG INUMBERAATTACH D EDOFOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
ALOE OF ASSE % OF
DECD'S
INTEREST DATE OF DEATH
DECEDENTUS NTEREST
1 A 08/09/1999 PA State Employees Credit Union -Regular 6,947.65 50.000% 3,473.83
Share account
2 A 8/9/1999 PA State Employees Credit Union -Checking 2,475.18 50.000% 1,237.59
account
3 A 8/9/1999 PA State Employees Credit Union 5,695.95 50.000°/a 2,847.98
4 A 8/9/1999 PA State Employees Credit Union - 36 Month 5,920.48 50.000°/a 2,960.24
CD
5 A 8/9/1999 PA State Employees Credit Union - 24 Month 3,127.24 50.000% 1,563.62
CD
6 A 03/03/12003 PNC Bank -Savings Account 5003650415 2,087.14 50.000% 1,043.57
TOTAL (Also enter on Line 6, Recapitulation) I 13,126.83
(B more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98)
Rev-1570 EX+ (8-A8)
SCHEDULE G
INTER-VIVOS TRANSFERS ~
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
McClellan, Phyllis Marlene 21-11-0382
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-15017 COVER SHEET is yes.
ITEM
NUMBER ~~ADNNESCRIPTION OF PROPERTY
THE DA ENOF TRDANSF~R.SATTACIi A COPY OF THE DEED OR REAL EST TE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1 Vanguard -STAR Fund 0056-09884802467 70,083.44 70,083.44
2 Vanguard -Windsor II Fund Inv 13,163.50 13,163.50
TOTAL (Also $nter on Line 7, Recapitulation) I 83,246.94
(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 G (Rev. 6-98)
REV-1151 EX+(10-06)
COM~Q~~~~ANIA
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
McClellan Phyllis Marlene 21-11-0382
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
A, FUNERAL EXPENSES:
See continuation schedule(s) attached
6,029.00
B.
1. ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
Ciry State Zio
Year(sl Commission paid
2. Attomev's Fees Michael L. Bangs 6,500.00
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio
Relationship of Claimant to Decedent
4. Probate Fees 377.50
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs 230.68
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 13,137.18
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
McClellan, Phyllis Marlene 21-11-0382
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex ses
1 Gingrich Memorials 160.00
2 Myers Funeral Home, Inc. 5,869.00
H-A 6,029.00
Other Administrative Costs
3 Cumberland Law Journal -estate advertising 75.00
4 The Sentinel -estate advertisement 155.68
H-B7 230.68
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1812 EX+ (72-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8~ LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
McClellan, Phyllis Marlene _ ___ 21-11-0382
Repoli debts incurrod by the decedent prior to death that romalned unpaid M the date of death, including unreimburesd medical sxpsnssa.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Heritage One Insurance -homeowners insurance 615.00
2 Hospital Telephone and Telcom, LLC 8.00
3 Pinnacle Health Medicine 51.33
4 PP&L 109.83
5 PPSL - 3128/11 to 4128/11 50.75
6 PP&L - 4128/11 to 5126/11 21.28
7 PP&L - 5126111 to 6/27/11 20.81
8 PP&L - 6127111 to 7/27111 24.52
9 PPS<L - 7127/11 to 8/25/11 20.87
10 Premier Eye Care Group 68.87
11 Property Management, Inc. -April 2011 payment 99.00
12 Property Management, Inc. -May 2011 payment 99.00
13 Property Management, Inc. -June 2011 payment 99.00
14 Property Management -July 2011 payment 99.00
15 Property Management -August 2011 payment 99.00
16 United Water 32.69
17 United Water 10.49
Total of Continuation Schedule See attached page
TOTAL (Also enter on Line 10, Recapitulation) 1,870.49
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule I (Rev. 12-08)
_~
Rev1512 EXt(5-98)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
continued
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
McClellan, Phyllis Marlene 21-11-0382
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
18 United Water 10.49
19 United Water 10.49
20 United Water 10.51
21 United Water 15.41
22 Upper Allen Township -sewer/refuse 112.00
23 Upper Allen Township -sewer and refuse 112.00
24 Verizon 19.53
25 Verizon 9.69
26 Youngs Medical Equipment 40.93
TOTAL (Also enter on Line 10, Recapitulation) I 1,870.49
Copyright (c) 2002 form software only The Lackner Group, Inc. Forth PA-1500 Schedule I (Rev. 6-98)
REV-1517 EX+ (11-05)
SCHEDULE J
COMMN)I~DECED~ANIA BENEFICIARIES
ESTATE OF
FILE NUMBER
McClellan, I'h Ilis Marlene 21-11-03 82
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
~ distributions, and transfers
under Sec. 9116 a 1.2
Kimbra Jo Kurtz Daughter 105,153.54
4073 Seneca Avenue
Camp Hill, PA 17011
Mark Edward McClellan Son 105,153.54
102 Norman Road
Camp Hill, PA 17011
Total 210,307.08
Enter dollar am unts for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet as a r o riate.
NON-TAXABLE'DISTRI BUTTONS:
II. 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 SHEETI
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
__
WQ'ptMEM ~ CstiO
*~~ ~-. Settlement Statement (HUD-1)
O ~~ OEVk~~~
OMB Approval No. 2502-0265
~
1. ~ FHA 2. ~ RHS 3. L'J Conv. Unins.
4. ~ VA 5. ~ Caw. Ina. _ B. File Number. 7. Loan Number: - _- .
0225368653 -8. Mortgage Insurance Cave Number:
_
C. Note: This form is furnished to give you a statement of aGual settbmeM costa. AmouMS paid to and by the settbment spent are shown. Items marked
'(p.o.c.)` were paid outside the desi~tg; Dray are shown here fa informational purposes and aro not induded In the toteb.
- ~-
D. Name 8 Address of Borrower:
COLIN 0 DAY
1339 ASPtR DRIVE
BOILING SPRINGS PA 17007
_ E. Name 8 Addross of Selbr:
ESTATE OF
PHYLLIS MARLENE MCCLEWIN F. Name 6 Address of Lender:
MEMBERS 1ST FEDERAL CREDTf UNION
5000 LOUffiE DRIVE
MECHANICSBURG __PA 17055
_
G. Property Locatbn
PARCEL ar42 30 11545 064 u7339 H. Settlement Agent:
MEMBERS 1ST SETTLEMENT SVC 717-795-5170
5000 LOUISE DRIVE
MECHANICSBURG PA 17055 I. Settbment Date:
9/1/2011
339 STONEHEDCiE LANE
MECHANICSBl1RG PA 17055
_ _._ Pace of Settlement:
5000 LOUISE DRIVE
MECFUWICStlURG PA 17055
OISBURSEMEWT DATE
912011
lop. arose Arrwratt Dw hortt eor-orrer I IOO.Orow Arrlsratt Dw to Salter
1of. Corttrati sabs prig
130 000.00
401. CorNtact sobs prbe _
130 000.00
102. Parsortd propeAy 402. taarsorq! raps -
103.9sWerltelttcharges to bonowsr (srte 1 ) 4 676.31 X03.
104. Oat: •
105. a, 405. a.
to lams paid by sells In 1'or kMna paid-by sNNr In advarta
fOti. C fates to 408. (ilyAown tatas to
107. woes 9 1 al 20. 151.53 407• taw 9 1 2011 tot 31 11 151.53
f08. As~wsntatta to 408. Assasrtads to
t08. SCHOOL TAX 9 1 201 1255.09 ~• SCHOOL TAX 1 2011 to6 30 2012 1255.09
tio• 9 1 011 tog. 1 35.30 410. SEWER 9 1 2011 fog 30 2011 __ 35.30
111. to 411. to _
112. s. 412.x.
tIO.. Dw 136118.23 119 to Isr 131441.92
200. Amotnls Paid or~ln of 600. Nr Dw to SsNa-
POt; Bafweit a earrteat 2000.00 '8D7. Eaoeeus abporiit (ssi Ytstructiorts)
202. RdadpW ataouttt of rNw loart(a) 85 000.00 ~. Setllnrtartt a seller (lime 1400) 9110.00
203. E~0 bnt(a) tslan subject a i 503. gan(N Wan subjsd a
204. t~Or amount ~ PA.C. 375.00 504. W Iht loan
205. 008. of-secortd loon _
206. 508. TAX , TO NIS ZERBE 10.00
207. 507. TO PMI 150.00
208. 506. SOLUTIONS 700.00
209. a. ;i09ai.. 7 1 112.00
for lams utpW by aMar Adjawpdanls lsrflsmrtmpald by ssMsr ,
210. uses W 510. CNyAoMat taucas to
21 L favrw to ! 511. CoutXy ttraes to
-212. Awsasntsrla to 542. Agawpalgs to
213. to 513. to
214. to 514. to
215. to 515. to _
216. 518.
217. 517.
218. 518.
219. e. 5i9. s.
220. TeW Paid /for eoROawr 87 375.00 ':620. ToW Radtwlisn Amotutt DrN l3ellsr 10 082.00
300. Cash at aMWmant 800. Cash ~ pstllsrusnt to/from Sailer
901. Gross amourtt dw from bortowx (gtte 20) 136 118.23 801. arws arrtourtt due to se8er (Cate 420 131441.92
302. taw arttourtts paid borrosrx (li 220} ( 87 375.00) ~. Lew mductlorts a srrwunt dw ssssr {one 520} ( 10 082.00)
303. Cash ^X From ~ To
48 743.23 805. Cash ~ To ~ From SNNr
121359.92
The Public Reporting Bwrden for this
reporting the data. This t$gerxy may
curtently valid OMB control number.
a RESPA covered trans8dion with k
of information is estimated at 35 minutes per response for collecting, reviewing, and
this information, and you are not required to canplete this form, unless it displays a
trttia8ty is assured; this disclosure is mandatory. This is designed to provide the parties to
durirtg the settlement process.
Previous editions are obsolete
Page 1 of 3
HUD-1
700.. Total Real Estate t3rolter Fees -- - --- -----
Division of commission (line 700) 04 fol'ows:
PMO From
Paid Fran
lot. S 3900.00 to
LnwYERS REALrr Borrower's
Furrds at Setlefs
Pantie at
702.; 3,900.00 to C21 WALAK Semsrnent SettlsrasPtt
703. Corrxnission id of settisrrrsnt
~~. sra~6f Fee ~ C21 walak(B) 150 00 -- 7 soo.oo
150.00
-
800. tome in Cermstxlorr ~: Loan
801.Our origination charge
i
802. Your creditor charge {points) for the speck inter
t
t 830.00 f~ GFE #1)
es
ro
e chosen i
803. Your adjusted orgination charges (from GFE #2)
804. Appraisal fee to (horn GFE A)
830.00
805
-- -- _
Crodd
rt t (from GFE #3)
.
repo
o
-
806
Tax se
i
t (from GFE #3)
.
rv
ce
o ----
--- --
607
Flo
d
rtif
i (from GFE #3)
.
o
ce
icat
on -
808. a. (from GFE #3)
000: Marrs RequMed by -.errder to Be PaM.r rn Adwnee X Exclude Isst day in oaks' Wrs-801
tr01. Yilsrest charges tram g 11 _- to1D/i/Z®11 m -10
42 kfs y (itpn GFE #t0) 327
6
,
902. irrsuronce ptanNan for npntlq to
909. -fonasorsrrsrs irrsuranp fcr
a
o
(from GFE ACi) .
0
-
-
ye
re t
904.e. (from GFE #i t)
1000. Tiaeervse DstrosMsd vMth l~rrdtir
t 00L lydtlal . for your sacrow account '
n (from GFE #$) 741
71
t0~. Homeort#
r's insurance 4 months ~ i 21.00 Per morkA 3 84
00 .
1003. tiAortpage insurorws months ~ i Per rtrtxrtlt i .
p p0
1004. Proputy nixes g morr0rs ®i 38.09 Per month i 304
72 - ---
1005. SC} f00L TAX 4 montlu S 126.34 Per month i .
505
3
1008. a. montAS +~ i per rnarth S .
000
1007. Adjustment .i
-152 37 _
1100, TNN
1 N11. 'Title >lsnfoss and lendsds title frrwrance
1102
seltlsmsntor ee (from GFE *4) 1 051.75
.
__ s
t t03.Owater!stitle iruurance (from GFE #b) 91
25
t 104. Lsrrder's tlge insurarbe PA. ENDORSEMENT5100 300 81:t~1 i 263 75 .
1105. Lerrdefs-title policy tlmp i _ r~s00R00 PEIVIV AT'fORNFYS Ot1~ Brt1R T1TLE _
ttoe.OwrrsrsfMb tlmit3 1 00
1707.. pglbn of the tsf4 t11I~ bsrrrarros prgnMyrq ~ i
4f08. UnderwrMsRs oftlrstoW 1116 rano~ 3 5.00
108. a. Metttbers 1st Seltletfhxtt Sa'vlor~' ityttlOrt 0f t#te b]~ title hts~.a~+e • ~•,4•~, 3788 OD
,Zoo. oovsnrnrerrt acrd Tr4urrfsr!C
1201. Govsrmtsrd __ (from GFE *7) 164.00
1202. o~ed; 62.00 i 102.00 Referees S _
1203. Transfer taxes tfr0rn GFE #8) 1 2M M t inn nn
4 676.31 9110.00
CERTIFICATION
I have carefully reviewed the MUD-1 Seltkimerrt $tatement and to the beat of my knowbdge and belief, d is a true and accurate statement of ao receipts and
disburaemeMa~ o` y account a by me in this tronsadion. I further osAify that I have repiv7ed~aACOpy,,of the FIUD•i Ss Statement.
Borrower: v _ Date: 9 1 2011 Se11er~!" / ~/ffO~j ,,•C~" Date: ~~i ~~~
COLIN 0 DAY ESTATE ~
Borrower: Data:
Sslbr: D~s:9/1/2011
PHYLLIS E
To the best of my knowbdgs the HUD-1 Settlement Statement which 1 have prepared is a true and accuro u Af which were received
and haw been or will be disbursed by the ur9ersgned as peA of the settlement of this transaction.
Settlement
- fie' Agent: Date:9l1/2011
. a MEMBERS 1ST SETTLEMENT SVC
WARNING: h is a crime to krrowirrgy make fape statements to the Unksd States on this or any other similar form. Penalties upon conviction can include a Ikre
and imprisonnrsrd. For detaik see: Title 18 l'.S. code Sedion 1001 and Section 1010.
Previous editions are obsolete Page 2 of 3 - -_ - HU0.1
I lap. S1ste taxmamps Deed i i ~ 1---J
~ 1208. a.
_ - - _ _. _.
~ Coarpaffson of Liood Fakh F.plmata (titFE) and N1JQ,4 ChprgM .
~~tS Tha1 Cafnat ktweue - Qood Faith EsUrnal~ fW0.4
Our __ INJD-7 L,Mte Nttgtpa-
dwge- -._ -._ - -
_ -
- - -_ 1! ~ _ --tt30 00 --- - - _. 830_00
Yov kaedihor -._- ---
__~ (pdritr) for ihec ~^tereet fate. -- * ~'
•Yculr edµmded on~i~ation oFgrpes ~ ~ _ _ __ _ 0.00
- - __. 830.00 - 830.00
I.~fFna[erl4xoa IWI~}3- _.-_~ -- 1,300.00 - ...1,300.00
-_ -
_... --- _
4'hi-pas Thal in ToW Canrwt MmaMM Mas TMn 10%
--- --
C
T . -,
_~_.. _. ,
ood Fakh fcstimate
-- -- -
`
1
_
+rr`verrroarMraoordirgGgf~-------- --~-- --
APProISW Fea -- - -- ------ -- N12W
_ 238.00
- - -- - --- 164.00
_ --- ---
eport
_T
- --
~. - -. .----
--
-
__ - -
---
Ta><SerkACa
-- ------ -- A . -~, _-~T- --- - ---r--
alb ~8_
..
__ --- --
----
_ ___ _ -
T
----
--
^"- - ---- --- a fIOQ
_. --- _-
~---_ - -- --- ----
_
d - - ---
_ _.
_-
__-_
TipeaerMoeeaadknder's_ItIN~_ ~--'--'~-
_-_~_ ------
_
_-_ ~1p7;.
- X508.75
-
1051.75
~
Oana"e tWe MNUrancs
-- _
__-.~ ~Htpti ..
, ~_._.----Y--
-- --._.-_ .- __
91.25
-__.,._T __...--- _.-_
- -
___.-_
T--
- ~ _ - -. - - - _ -
~__ _ ___ 1,746.751 __ _1,30700.
I a - 501.75 a - . 28.72477 %
t:Itayas fifat Can Clwtge
-- _ _ _. _
-- _,- - --_---
° Loud Falfh EslYrala -
FN14+1
(r~aF d~pp-sk fetter °scrvw avo9uu - ^ --
_- ~1(lq~ ~ __ _
- _ 495.52 ~ -__ ` ~ 741.71
-~-- -- ~-~.-~ _ * ~ lOeTT. _
-
--
183.10
- ---
____ _ --
327.60
s'
-
~
.
~ .
-- - -
500.00
-
-
- - - _
_.. - . - _ _
-- ~
., --
-- - - ~ _ _
Loan Tams _
-- --
- - -
~YrarrirtNNittl:ban~ountls
w i . -- --SS,000:0f# --- - ----- --- --- -
;
,.
.^.-~~----- - ---_ -- -
~~^ ~ 30:. years
Yarir,Milrl irMsr!rwettafs iF ., ,' +~ : ' %
"rar~+ual rf-oagtr arfwurd.+tt~~-ftdnaw' `^a ' . s ,
_ _ --~i at12 indudes
:'rtl' " k
- ~ f'rirrcipal
- .
, L~ IS lrWerest
. Mortgage Irrokrarroe
Gan yalrittt~roat tale risaT ~
- [~f No. ~~ Yes. k can rise b a maximkxn of %. The fast drarge wlN be
~ `.." :, ' ... 3r and Can dwrtge ~r ~Y - .. " alter
. `:, ' < .., .: • Every crerrge date, your Ntterest rab can kraeaee or dsoeaas
by . `.~ %. Over dre Yfe of the ban, your irrleresl tats is guerarrleed b newer be
-. ~ .. `: lower ~ :~~'}; % or NgINr lfkan %.
~vutil y9tr weak. peymeftl6 or- unre, can ywir blbl)0S +h42' : ~ No. [ ] Yes, k can rise to a maximum ~ i
E~rMrifyoy e~IwpaymerMS qt lima, CM6
`z -- - - --
~X~ No. ~] Yes, the first inaeese can ba on and IM marghly arnaaY
ap!pf?M tara8aor prirrcipal; krlpraat, arrd y+eursrioe ~ ' owed can rise b:
!
r-.
:-.---. ;;-
The maximun k can ever rise a is S
.. _
-
-
t?eM YPtX 1uprtlMMa a pnpeyplant parWty4
____
(~ No. CI Yes, ywrr maximum prepayment paraky is t -- -
4ces yourMparrtrakre a baNoon PiyrJ-ealT .~ ~] tVo. ( ~ Yes. You Crave a traYoon payment tk i due in
..gyp .. Yes ~ ...
iotal r!ronMtryf.amourd owed kridudYp eeaow _.
.ppyrYantf
- --- -_
- -- ---
--- -_ _--
^ You do not have a mondtfy escrow Payment for Items, such as property
. taxes and tromeowrrer'a irtatxance. You must pay Giese items dirocJly youreelf.
- °. ~] You have an additional monthly escrow payment W i ~;~
that roarlb in a total initial monttrly amount owed of i 6I2.~3. Ttria irrcNrdes
, interest, any mortpa9e M~xarrce an0 arty kerns checked Oelow:
P
-
. r
~"1
~] Progeny taxes ~f Manoowrrers insurance
- ~
- ^ Fbod inskxarrce ~.
) ~ ,. ~ - .
-7
Note: If you have any questions about the Charges and Loan Terms listed on this form,
please conbd your lender.
Previous aditiorrs are obsolete Page 3 of 3 tiUD-1
_ _ _
- _ _ -
4VV/ \,itaV •1Vlvt \iVV41t VV\itill LV 111VVJ YY ltll VFl t1 V11J 1\V Jt41 tJ
jib > I~~~Q elf > ~hgyrrLlQt > Cobalt > 2005 Cobalt Sedan > Ps_i_~Q~_wi_kh__QpSgnS >
Prices with Options Results
Save I Email I Share 1 ~ I Newsletter
f wnaison,an rYOnoweoorer~r lw+oorwaetr sirrterw awrfc¢mtiywAi)siit~rtARD! '!
_~ ___~
~ ~ ^~h9anirto far a toed Gr? .. ..... _. _. _ .. .. ............_._ -
1 ~ Check the CARFAX ~ ~~ y°~ V°~° C~ Predict which cars consumers lik•
1
Report for ever')' Rite a rNlew P4Y the Edmunds
C vlhkl! you.rt Vvhide Retlnq i
i oortsidermq. Y~ tar Game. ~
li ~ ~~ ~~
2005 Chevrolet Cobalt Sedan -Prices with Options Results
_ _.
lnlo _ ~~~
Prang ra _..
Herrbbrg, PA
Trade-in
Private Pally Sale
Dealer Retail
Pricing Details for a Chevrolet Cobalt sedan !-s
2.2L 4-ql. 5-speed Manual
Customized True Market Value° Prigs
Trw Marken Vaiwe
55,384
x,679
x,049
Trade-In Private Party Dealer Retalf
Natlonal Base Price
f ;4,299 f5,569 ;6,890
Optkntal Equipment ;174 ;202 f256
f AM/FM/CD/MP3 Audb System X75 y{3 ;52
4-Speed Autanatk Transmissbn ;139 f161 ;204
Color AdjustmenK - Gray ;-3 S-4 ;-6
Regbnal Adjustment - for Zip Code 17110 S-8 S-SO ;-13
Mibage Adjustment- 19,500 miles ;922 ;922 ;922
Conditlon Adjustment - Clean SO sp ;0
Total ;5,384 ;6,679 ;8,049
Buying a CtPrtNied Used Vehicle
i Dgler Retail
Certified Used Prke Vehkkt not Nigitile for certifltation.
' NSw Car IfwerrtOry j
r----_ _ -_ _.
I
Find the right new car in Harrisburg, PA f'
Select a make and model to see whkh dealers have the right car at !
' the right prke.
E
_..._- _
Select Make Select Model
I,
i Zro code
__
Search 2005 Chevrolet Cobalt Listings Near
1 fl~t, 1 Vl L
http://www.edmunds.com/chevrolefi/cobalt/2005/trnv-appraise-results.html 7/6/2011
welcome, Gist I Sian tnl 1.`aSelzQOis Sipa.inl Asr~lintl r141?ilE I tleln I inside ~~ne
Vanguard'
April 18, 2011
P.O. Box 2600
Valley Forge, PA 19482-2600
wvvw.vanguard.com
KIMBRA JO lKURTZ
4073 SENECA AVE
CAMP HILL PA 17011-6748
Re: Estate of P. Marlene McClellan
Dear Ms. Kurtz:
We are responding to the letter we received requesting a valuation of P. Marlene
McClellan's Vanguard account as of March 15, 2011. The information requested
is included on the enclosed account value report.
If you have any questions, please call Vanguard Voyager Services® at
800-284-7245. You can reach us on business days from 8 a.m. io 10 p.m. and on
Saturdays from 9 a.m. to 4 p.m., Eastern time.
Sincerely,
Retail Investor Group ,
Vanguard
juv
Enclosun:(s): ** P. Marlene McClellan -Traditional IRA Account Value Report
51747143
~~~ ~lset,~~
U7Cp
~~~~ Page ' 1 of 1
V~11hl~tid~ a
P. Marlene McClellan
4073 Seneca Ave Voyager Services: 800-284-7245
Camp Hill, PA 17011-6748
Total report vslu!e: --- $83,246.94
_. ---...
ofal report value fndudes any acanred dividends.)
Name Fund 8. Acooni-4 DaOe `- Price Per Accrued
Number Opened Shares i Share Value` Dividends
STAR Fund 0056-09884802487 02/10/1993 3,638.808 ; $19.28 $70,083.44
Windsor II Fund Inv 0073-09884$~146T 1D/0411996 . 4fl7.T11 I $26.48 $19.163.50
--_ .~ ITotals '-'~~_____ - ;83,246.94 60.00
' Doesn't k~dude accrued dividelnds. ~__ -_-- -
0207035228 04!182011 13:42:52
i
r'Ip ~. IJ• LVI !IJpnm Inv vnl~~• TIL 7V/ L/TI
~~
tr~w~sr~a~Y
April 15, 2011
Michael L Bangs
Attorney at Law
429 South 1$~' St
Camp Hill, PA 17011
12.E: P Maxlene Mc~lellan
SSN: 210-24-8676
DQD: 03-15-2011
Dear Mr. Bangs:
i n v. J/ V V i I/ i
Ir- response to Your resluest for Date of Deat12 {DUD) balances for the customer noted above, our
rocords show the follawing:
9av6ega ,A-cta-aat
Aocrnmt # 50036504 ] 5 Established: 03-03-2003
P MARLENE MCC'LIfiLLAN
MARK E MCCLELLAN
DUD balance: $2,087.14 + 0.07 accrued intescst
1nGetest paid Ol -Ol 2011 thnt 03-15-2011 S 0.17 YTZI
Please node ti~at tbis offioo provides duo o:F doeth behaoes for doposit Acoouae~ (IitA,s, CDs, Choa~ng and
Savings}. We eb sot P~ ~7 ~~ tis~s or Pnwide . If you nerd since svifh
any of ih~e iteams, please cell 1-S88-PNC-BANK (1-Sa8-76Z~265) a stop b'Y Y'~ Iocal PNC Bank btameh
office.
Sincerely,
National Finaacisl Seevices Center
PNC Hack, N.A..
Membtr FDIC
This massage is i~tsr~ded for the t~ of t1x imdfi+ or to which ft 3s addressed and may
coretatn irlfovma~iort that is prtvileg~ co~ftdentfal aid arempt from discloserre under t~plicaablt la-v.
If the reauakr of thfs message is root the iraerded reTCipie~u or the ergalayee or agera respwRSible for
delivering this message to flee iRte~d recipie~ yrue are herby notified that any disserrriratio>n,
a!isrribtaion or c~pybrg of this coAerena:ications'is stricttyprohib#tad Ify~e havr neeived this
comenaiicatfon irr ePmr, please notffy mB faeaeedfa~ely by retply or by telephaate at 84Q-762-1775 and
imn~tdy desb'oy'thfs fared dodeeatnt
Page 1 of 1
PSE(~k
April 14, 2011
Account # 8206XXXXXX
MICHAEL L BANGS
429 SOUTH 18TH ST
CAMP HILL, PA 17011
Dear MR BANGS:
The following is the status of P MARLENE MCCLELLAN's account with PSECU as of the date of death.
Joint Owner's Name MARK E MCCLELLAN )DINT TENANT W/ROS ADDEI) 0$.09.1999
Date of Death 03.15.201 ]
Date of Birth 12.19.1933
Share Description Open date Balance Accrued Dividend
S O 1 Regular Shares 08.02.1982 $6,947.65 $1.07
S 03 Christmas Shares 0.00 0.00
S 04 Checking 08.02.1982 2,475.18 0.10
C 50 36 Month Certificate 07.12.2007 5,695.95 4.33
C 51 36 Month Certificate 07.12.2007 5,920.48 4.50
C 52 24 Month Certificate 03.12.2009 3,127.24 2.09
Loan Description Open Date Balance Accrued Interest
L O1 PSL Loan 05.06.1985 $ 0.00 $0.00
L 09 VISA 11.06.1986 ~ 0.00 0.00
The dividend earned from January 1, 2011 through the date of death was $62.61. The decedent had no loans with us.
We do not have safe deposit boxes for ow members.
If you have any questions, please ca11234-8484 in Harrisbwg or ow toll-free number, (800) 237-7328. At the menu
prompt, enter 6 and then extension 2227.
Sincerely,
Meacie Fair ax
Member Service Representative
Finance Support Unit
Pennsyh-ania State Emplq-ees Credit Union
Main Address: 1 Credit Union Place, Horrisburr., PA 171 10-2990 • 717.234.8484 • 800.237.7328
Mailing Address: P.O. Box 67013, Harrisburg, PA 17106- %Ol 3 • 717.777.2100 (fDD) • 800.472:1967 (TDD)
psecu.eom
This credit union is federally insured by the National Credit Union Administration. Equal Opportunity Lender
LAST WILL AND TESTAME~Tr
R. lCOTT CRAMCR
ATTO RN [Y AT LA W
C[NT[R lQUAR[
r.O. ORAW[R t!9
DUNCANNON. PA.
i~oao
t~»)!a•-s~o!
I, PHYId,IS MAF2LII~ M~~, of the Borough of Mechanicsburg,
Ctim~berland County, Pennsylvania, being of sound and disposing mind,
~O~' and understand. do make, publish and declare this writing as
and for my Last Will and Testament, hereby expressly revoking all
writings in nature testamentary by me at any time heretofore made.
FIRST: I direct that all my just debts, to ~~ there are no
defenses in law or equity, and the expenses of my last illness and
funeral be paid out of my estate as soon after my death as is convenient
and expeditious in the judgmt~t of my Co-E~oecutors, hereinafter named.
SD00[~ID: I give, devise and bequeath all my property, be it real,
personal or aauaoed, of whatsoever nature and whPT,A~r,~ w situate, to my
two children, Kinbra Jo Kurtz and Mark Ddward McClellan, or their
ttzen-living children, in equal shares, share and sure alike.
THIRD: Should any Person less than 18 years of age be entitled to
distribution from my estate, I nominate, constitute and appoint my
then-living child as ~.iardian of the estate of such person and I autho-
rize and direct said Ckiardian to invest the wane and to pay the inoocaie
arising therefrom together with so much of the principal thereof as in
the opinion of said Ckiardi.an is necessary or desirable to be expended
for the proper maintenance, support and education of such person, to the
Person having custody of such person, and upon such person attaining 18
Years of ache to pay to him or her the then remaining principal together
with any undistributed incase.
FtiUR7.3~: I direct that all taxes that may be assessed i.n oazse-
quence of my death, or whatever nature and by whatever jurisdiction
i~osed, shall be paid from my residuary estate as a part of the expense
of the administration of my estate.
FIFTEI: I hereby nominate, oosistitute and appoint my two children,
Kimbra Jo Kurtz and Mark Edward McClellan, or the surviwr of the two,
Oo-Erectors of this my Last Will and Testament. I further direct that
my personal representatives shall not be required to post any band to
secure the faithful performance of their dutiesfin the Goywealth of
Pennsylvania or in any other jurisdiction.
IN WITI~SS , I have heretmto set my hand and seal to .this my
Last Will and Testament, which consists of two (2) sheets of paper,
dated this / ~ t day of Nove~er, 1983 .
~ ,`~ , n .. .. .
~i~'is~lene-~ccie~ian
The wrifiing contained on this and the one preceding page was signed and
sealed by Phyllis Marlene McClellan and by her published and declared as
her Last Will and Testament, in the presence of us, who have heretmto
subscri]aed our names as witnesses at her request, in her presence, and
in the presence of each other.
R. SCOTT C RAM ER
ATTORNEY AT LAW
CENTER ^QUARE
P.D. DRAWER 159
DU NCAN NON. PA.
17050
(717) 094-3700
. ;: ,
''~:
OQM~Nfn, ~ ALTfi OF PII~NSYI,VANIA )
)~
00[7NI'Y bF PERRY
I,. Phyllis Marlene McClellan, whose name i~ signed to she attached
or foregoing i nc't9Ct8nf?Ilt, having been duly qual~..~`:ed according to law, do
hereby ~clmawledge that I sign and executed ~~~:~s in~strurnnt as my Last
Will; that I signed it willingly; and that I swyned it as my free and
wluntaxy act for the puzposes therein expresss,,~.
~~ ~r~~t~~~/~ ~
SWORN or affianed to and aclaiowledg+ed
before tine by ~yllis Mi3rlene McClellan,
testatrix, this /7~'~day of November, 1983.
i
RUTH ELE^,D;O'R GUNTFUM, Notary Public ''
Duntannon, Perry Co., Pa.
My Commissimn Expires May 18, 1985
R. 8COTT CRAMER
ATTO R N [T AT LA W
C[NT[R ^gUAR[
•.O. DRAWER 139
DUNCANNON, PA.
17Dao
(717) 894-5700
::,j
~;'. .
-,~
R. SCOTT CRAMER
ATTORNCY AT lAW
0CNT[R lgllARC
P. D. DRAWCR 139
Dl1NCANNON. PA.
17010
(717) 0'{-3700
~ALTH Of' ~SYLVANIA )
)SS
COUNrY OF Pn~RY ~
~;' !'[". .Sc ~. t f" Cfz Rr-~t~. 2 azrl the t~
the wii~nesses~w ise names are sided to a
in~strt, being duly qualified according to
that were present and saw testatrix sign ark
as her 'Last Will; that Phyllis Marlene MoC1e1LE
that sHe eaaecuted it as her free and wlimtary
therein expressed; that each of us in the hear
testatrix signed will as witnesses; and ''
~~lec~ge the tes trix was at the time 18 or ~
mirxl and un no constraint or undue ink:
~1
~i or affirnled to and subscribed ! i
to before me by h~ ~c e'ft~ C2A~e2 ~
~ 1.1.. /C e~l~~r , wltneBSeS~
this l q~i73ay o~Nrov~-~983.
!~
~_ !
-~' -~
~ ~. ~-~
Duncannon, Porry Co., Pa.
My Commissi~,n Expires May 18, 1985
f
L.. LQH~
or roregoing
r. ~ depose and say
~oecute the int
signed willingly and
t for the purposes
and sight of the
to the best of our
e years of age, of