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Home My WebLink About11-21-11 (3)1505610105 REV-1500 ~ (U2 11) (FI) PA Department of Revenue pennsylvartia Bureau of Individual Taxes ""'"~" '~""` PO BOX 28o6ai INHERITANCE TAX RETURN Harrisburg, PA 17128-0601. RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW OFFICIAL USE ONLY County Code Year FNe Number Socal Securty Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _ ___ ': 175-34-4890 08/28/2011 ' 06/02/1944 Decedent's Last Name Suffix Decedent's First Name MI _. _._. _ . McCoy ' Ms 'Charlotte , R _. (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 FlLED IN DUPLICATE WITH THE _ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Retum (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will} (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS 5ECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number __ 'Gregory Katshir, Esquire '; (717) 763-8133 __. _. __ __ First Line of Address 900 Market Street Second Line of Address City or Post Office Lemoyne _ _.. State ZIP Code REGISTER QFyVILLS USE OI 0 ~ ~ ice- '~ ~,~ ~ ~ ~_r - .~cn~ ~-- ~~« '_a ~ J C ~-~-'' ~ L'~fiLED ~ .. ... ~n PA ! 17043 i*v Correspondent's e-mail address: KatShlrt~aOl.COm Under penalties of per)ury, 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 ~mplete. Declaration of preparer other than the personal representative is based on ail information of which preparer has any knowledge. ~SIG~VyTURE OF PERSON R~SPONSIDLE FOR FILING RETURN DATE `7't a OF DREPAREBIXHER THAN ~. fW' I'7~~1~ 1505610105 NAL FORM ONLY Side 1 DATE 15D5610105 :7 'T7 _,l r'i ~,~ T, C~ -,-, J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedents Name: Charlotte R McCoy ' 175-34-4890 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. '; 122,000.00 2. Stocks and Bonds (Schedule B} ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. '. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. '. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 45,174.06 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. !. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property i 52 166 94 lling Requested........ (Schedule G) O Separate B 7. , . 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. '' 219,341.99 9. Funeral Expenses and Administrative Costs (Schedule H) ............... .... 9. ' 9,167.52 10. Debts of Decedent, Mortgage Liabilities and liens (Schedule I) ........... .... 10. ; 30,569.81 11. Total Deductions (total Lines 9 and 10) ............................. ...: 11. ' 39,737.33 12. Net Value of Estate (Line 8 minus Line 11) .......................... ... . 12. ! 179,604.66 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. ' 179,604.68 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 _ (a)(1.2) X .0. 15. 16. Amount of Line 14 taxable _ , " at lineal rate x .0 45 179,604.66 ! 16. 8;082.21 17. Amount of Line 14 taxable at sibling rate X .12 17. ', 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ..................................................... ....19.' 8,082.21 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 1505610205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 8,082.21 2. Credits/Payments A. Prior Payments __._._._..._ B. Discount -404.1.1... Total Credits (A + B) (2) 404.11 3. Interest (3) 4. If line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 7,678.10 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain. the use or income of the property transferred .......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income ............................................ ^ c. retain a reversionary interest .............................................................................................................................. ^ ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent (72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent (72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent p2 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 172 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent (72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. uev-I.saz ex+ fit.-asI pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN 0.ESIDEN7 DECEDENT ESTATE OF FILE NUMBER Charlotte R McCoy 21-11-0975 Atl real property owned solely or as a tenant in common must be reported at fair market value. Fair market value Is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right oP survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant In common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1• 1010 Allen Street New Cumbe~iand Pennsylvania 122,000.00 see attached copy of settlement sheet TOTAL (Also enter on Line 1, Recapitulation.) I $ 122,000.00 If more space is needed, insert additional sheets of the same size. REV-15ogEX+(11-10) 4`~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDI~LE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ----- ESTATE OF: FILE NUMBER: Charlotte R McCoy 21-11-0975 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1.' Primerica -Individual account 33,033.05 2. M&T Bank savings account 5,399.00 3, M&T Bank checking account 3,740.00 4, Belco Credit Union savings account 1,406.00 5,' Belco Credit Union money market account 596.00 g, ` miscellaneous personalty 1, 000.00 TOTAL (Also enter on Line 5, Recapitulation) ; 45,174.06 If more space is needed, use additional sheets of paper of the same size. ~ REV-1514 EX+ (OS-09) r Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Charlotte R McCoy 21-11-0975 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR REUITIONSHID TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET °k OF DECD'S INTEREST EXCLUSION IF APPLICABLE) TAXABLE VALUE 1• Primerica Traditional IRA 30,043.07 100 30,043.07 2 PrudentiallRA 22,123.87 100 22,123.87 :Transferee of both accounts is Karen Bretr, daughter of deceased TOTAL (Also enter on line 7, Recapitulation) ~ ( 52,166.94 If more space is needed, use additional sheets of paper of the same size, acv-_sa.I. Ex+ tIO-a9) ~~ pennsytvania ~~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Charlotte R McCoy 21-11-0975 Decedent's debts must be reported on Schedele I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES; i' .Stone & Murray Funeral Home 5,656.00 B. ADMINISTRATIVE COSTS: i. Personal Representative Commissions: Name(s) of Persona! Representative(s) _ _ _ _.... Street Address City __ _ _ _. State _. _ _ ZIP __ _ _ __..... Year(s) Commission Paid: __..._. ............. .. . __ _ _. _ _ . ................_.-.....__......_... Z• Attorney Fees: 3,000.00 3. Family Exemption: (If decedent's address is not the same as cla+mant`s, attach explanation.) Claimant ........ _ .... _.... __..___, _ _ _ ..._ Street Address - ..................... -.... _ __ _ _ ........_ ................_. ___ _ City .._._ ___ ___ _ _.__..- _--.__ _ _ _ _._- _. -- ___ __. _. State ___ _ __ ZIP ._.___ _____ __._ Relationship of Claimant to Decedent 4. Probate Fees: 511.52 S• Accountant Fees: 6. Tax Return Preparer Fees: 7. IOTA! (Also enter on line 9, Recapitulation) i; 9,167.52 If more space is needed, use addit~onai sheets of paper of the same size. ~ REV-1512 EX+ (12-08) ~i Pennsylvania SCHEDULE I DEPARTMENT Of REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Charlotte R McCoy 21-11-0975 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION Of DEATH i• 'Belco Loan 252.00 2. 'Everhome Mortgage 27,092.77 3. UGI 23.14 4. Verizon 108.19 5. ' Belco VISA 1,542.00 6. PA American Water 95.28 7.: 'Michael Neff (lawn) 70.00 8." ' pp&L 120.03 9. Griswold 114.00 10. State Farm VISA 1,152.40 --- TOTAL (Also enter on Line 10, Recapitulation) $ ' 30,569.81 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT Of REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES ESTATE OF: FILE N!lMBER: Charlotte R McCoy 21-11-0975 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).J 1. Karen L Bretz 2034 Stanton Street York PA 17404 daughter 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: L B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS; L TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. i ~ 0.00 If more space is needed, use additional sheets of paper of the same size. ;' i' .~ .. .. LAST WILL AND TESTAMENT : ; i ~ _ OF CHARLOTTE R MCCOY ~ „- ;r G.-,F-j,-,;~, .. I, CHARLOTTE R McCOY, of New Cumberla~~, Cumberland County, Pennsylvania, being of sound mind and memory, do make publish and declare this my last will and testament, hereby revoking and declaring null and void any and all wills and codicils made by me at any time heretofore made. FIRST: I direct my Executor hereinafter named to pay my legal debts, the expenses of my last illness, my funeral expenses and the administration expenses of my estate. SECOND: I direct that any Estate, inheritance and other death taxes, including generation skipping taxes, and including any interest and penalties, thereon, which may be due and payable by reason of my death with respect to any of my property passing under this Will or otherwise, shall be paid out of the principal of the residuary estate. THIRD: I give, devise and bequeath all of my property, 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 death, to my daughter, KAREN L BRETZ of York, Pennsylvania. In the event that KAREN L BRETZ should predecease me or fail to survive me for a period of sixty (60 days, I give, devise and bequeath my entire estate in equal shares, per capita, to my sister, PATRICIA OSTROWSKI, of York, Pennsylvania, my brother, ALBERT A KUENTZLER, JR, of Felton, Pennsylvania and my friend, CHRISTINE NEFF of Mechanicsburg, Pennsylvania. FOURTH: I name, constitute and appoint my daughter, KAREN L BRETZ, as the Executor of my estate. In the event that my Daughter, KAREN L BRETZ, is unwilling or unable to serve as my Executor, I then name my sister, PATRICIA OSTROWSKI, as the Executor of my estate. None of the individuals named in this paragraph shall be required to furnish a bond for the faithful performance of his duties as Executor. FIFTH: In addition to all of the powers conferred by law upon my Executor and not in limitation thereof, I hereby authorize my Executor to sell any stocks, bonds, or other personal property and any and all real estate which I may own at the time of my death, without the order of authority of any Court being required, at public or private sale, upon such terms as may in the discretion of my said Executor seems to be in the best interest of my estate. In pursuance of her power, my Executor shall execute and deliver all documents of conveyance, including deeds or bills of sale or any other instruments which may effectively transfer title. I further authorize my Executor to settle and compromise any and all claims in connection with the administration of my estate herein and to do any and all things in her discretion that shall be conducive to the best interest of my estate. SIXTH: Any individual who has not been included as receiving a distribution from my estate has been intentionally excluded and is not to receive any of the proceeds of my estate. SEVENTH: All pronouns referring to an Executor and the term "executor" shall be construed to mean any person acting as my Executor as the case may be. IN WITNESS WHEREOF, I have set my hand and seal at Cumberland County, Pennsylvania this ~.,~"~""- day of ~' ~~°-,,;_,i+.~:,~...- 2010. r ,.__,~ , 7~~' Charlotte R McCoy .~ u SIGNED, sealed, published and declared by the above named Testatrix, Charlotte R McCoy, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscri}a~d our names as witnesses. ~... ~ ,. \~1 ~__,,..,. ~ ~ ~r ~~•~ Name Name C__.", Address Address ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND ) i, Charlotte R McCoy, the Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. arlotte R McCoy SWORN or affirmed to and acknowledged before me by Charlotte R McCoy, the Testatrix, this L.,`..a r~ da y o f ~~ ~ 4'y'~~)~'- ~._ 2 010 . .P ~~~ _} i. ~....•...n..~- otary blic COMMONWEALTH OF PENNSYLVANIA ---..~ NOTARIAL SEAL TRAC'~ K. KATSNIR, p C~88oro., . ?lSG AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: We, p~u.~c DrrYr~a- and ~rirt~-~~. p~)SC~-c.~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will, that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses and that to the best of our knowledge, the Testatrix was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. -~. i ter ~ ~~ .__. Address : Tub N~.T .Yt- ~. C.- fir-~~... C.. _. Address: Ctuc, rrrer~.r sr SWORN or affirmed to and subscribed to before me by •-- _._ , ~~'~_~`' ~~.y.~,,~:_~ ~ and ~:"`~ >Y.~-. \ ~:~~.~~<_. witnesses, this ~- •~ day of ~ti~v~~ ud°~.,~ ~ 2010. ,, ~ ,~r,1 ota~ry.~'Public CObIMgMMrW.TN WNr1A I+K)TARIAL ~l TRACY K. KATSHIR, PubNc len'ioy~'io 8c~x!o., . Comm~aior- ~~ ~ ptwtNfq ~„ .~~ OMB Approval No. 2602.0265 ';9*~s~,.~ A. Settlement Statement (HUD-1) trv ot~t B. T pe of Loan L ~ FHA 2. Q RHS 3. QX Conv. Unins. 4. Q VA 5. Q Conv. Ins: 6. File Number. 2011090077 7. Loan Number: 14223681 8. Mortgage Insurance Case Number: C. Note; This font) Is lumished [o give you a statement of actual setflemenf costs. Amounts paid to end by the settlement agent era shown. Items marked "(p.o.a)"were paid outside the dos/ng; they era shown heB Ior lnfomraflonal purposes and ere not Included In the totals. D. Name and Address of Borrower: Faith Sullo 1010 Allen Street New Cumberland, PA 17070 E. Name and Address of Seller: Estate aF Charlotte R. McCoy F. Name and Address of Lender: M&T Bank 1 Fountain Plan Buffalo, NY 14203 G. Property Location: 1010 Allen Street New Cumberland, PA 17070 Cumbedand County, Pennsylvania H. Settlement Agent: Core Settlement Servkes, Inc. 3800 Market Street Camp H81, PA 17011 Ph. (717)731-9700 I. Settlement Date: October 14, 2011 Parcel rf26-24-0809-167 Place of Settlement: 1200 Market Street, Unit 23 Lem e, PA 17043 J. Summa of Borrower's transaction K. Summery of Seller's transaction 100. Gross Amount Due from Borrower. 400. Gross Amount Due to Seiler. 101. Contr sales rice 122 000.00 401. Contract asks rke 122 000.00 102. Personal ro 402. Personal ro 103. Settlement Cha ea to Borrower L1ne 1400 4 903.03 403. 104.. 404. 105. 405. Ad uatments for items ftl b Seller in advance Ad ustments for Items aid Seller in advance 106. LoeaUCoun Taxes 10/15/11 to 01/01/12 131.21 408. LocaVCoun Taxes 10/15/11 to 01101H2 31 1 107. School Taxes 10/15/11 to 07!01112 738.29 407. School Taxes 10/15/11 to 07!01/12 738.29 108, Assessments to 408. Assessments to 109. 409. 110. 410. 111. 411. 112. 412. 120. Gross Amount Due from Borrower 127,772.53 420. Gross Amount Due to Seller 122,889.50 200. Amounts Paid or in Behalf of Borrower 201. De rR or sameat moos 5000.00 202. Prin 1 amount of new loans 97 600.00 203. bens taken su act to 204. ination Fee POC 250.00 500. Reductions in Amount Due Seller: 501, Execs de it see insWetiona 502. Settlement cha es to Seller Line 1400 1 370.51 503. ExisNn loans taken s d to 504. Pa A Flrsl Mo a e to Everhome Mort a e/0000170 27,092.77 205. 505. Pa Saco ort a to k0 sderel Credit Uni 500.00 206. 506. De sit retained D seller 5000.00 207. 507, 2~• 508. 209. A ustmertts for Items u aid Sailer 210. LocsVCount Texas to 211. School Taxes to 212. Assessrtlents to 509. . A intmenta for itstna un nid b Seiler 510. LoeaUCoun Taxes to 511. School Taxes to 512. Asseasntents to 213. 513. 214. 514. 215. 515. 216, b16. 217. 817. 218. 518. 219. 519. 220. Total Paid b !for Borrower 102,850.00 300. Cash at etdement frorn/to Borrower 301. Gross arrauht due from Borrower line 120 127 772.53 302. Less amount paid b Nor Bonower tine 220 { 102,850.00 620.. Total Reduction Amount Dw Selisr 33 963.28 600. Cash at • ttiemsnttl>lfrom Salter 601. Gross amount due to Seller line 420 122 869.50 602. Leas reductions due Seller (8ne 520 33 963.28 303. Cash X^ From To Borrower 24,922.53 803. Caah a To ~ From Seller 88,906.22 The undersigned hereby acknowledge receipt of a mpleted copy of this statement 8 any attachments referted to herein ~` ° - Borrower ~ =°' n Seller Estate of Cheriotle R.~i alts, ullo t,,.I X ~C TO THE BEST OF MY KNOWLEDGE, THE HUD-1 SETTLEMENT STATEMENT WHICH I HAVE PREPAREDBS A TR AND A AC OU "THE FUNDS WHICH WERE. RECEIVED AND HAVE SEEN OR VJlll BE DISBURSED BY THE UNOERSIONEO AS PART OF THE SETTLEMENT OF THIS TRAN CTION. Core Settlement Services, Inc., Setreltxnt Agent WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAM INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE: TITLE 18 U.S. CODE SECTION 100/ 8 SECTION 1010. iM f>uoic Rpolline auMM for Wi edbttion of Ygontugat if ewnsad N.te Mnibr tsar inponfe for eoNc4q, rwlswNp, W npafinp No oeW. 71ftt spmoy may na eaNen tNS INOmulYon, rb you v. not npirv0 a aimpob UW lam, uMOss t QeW W o wrtentY vtlW ONB oaNrol nrnear. No eenA4rWoty b nwr~ Wt ditcbrun b manNlay. TMr b dHllneo to provge tho pYliq b ~ RESPA covoroe Inntaetlon won NYaoaron tlwYq (M talWmMl OroCOft Page 1 of 3 HU0.1 (2011090077.PF02011090077/12) L. Settlement Charges .700. Total Real Estab Broker Feas P^W From -^n From noteammissbn Hna 00 as lows: Borrowers sarr^ 7 Fwn^e a Fungi, u 1 seswau swuar^ 7oa. 705. 800. Item Pa k In Connection with Loan 801.Our o inadon cha S 985.00 fran OFE #1 802. Your rsedk or charge (points) for the spedfic interest rate chosen S -386.00 (from GFE 2) . Your atl usted br ination char es from GFE #A 819.00 804. sal fee to Kirchme r & Assodates from GFE #3 POC 155.00 805. CredN rt to from GFE #3 OB. Tax service to oreLO is rom E #3 8 oe ' tbn to CoreL is rom GF 8. 8 B. 3 809. m GFE #3) 810. (from GFE tf3 1 t from #3 900. Items R uirad b Lender to Be Paid in Advertca 907. Da irrtarest ch K from 10H4f11 . to 11ro1l11 18 E11.38438a1da from GFE #10) 201.56 902. a insurance remium for months ro from GFE #3 90 . omeowne s nauranoe or 1, era to ~ rom 00242 93 11 9 2 .8 904, hom OFE #11 905. (from GFE #11) 1000. Reserves Oe ited with Lender 1001. Im'tial deposit for your escrow account (from GFE #9) 544.13 omeowne a naurance mon s 4 . per 1 e urtince months t month 1004, Property taxes E Ci oMm axes mondra E r month n axes months r month 1005. E. 1006. City Taxes 9.000 months ~ S 51.17 per month E 460.53 1007. School Taxes 5.000 months ~ S 80.81 per month E 433.05 1008. E 1009. Aggregate Adjustment E -480.37 1100.TIde CM ea 1101. Tide services and lender's title Insurenoe (from 1,347.08 65.00 1102. Seldamant or chain fee to hidR Notes Service 250.00 1103. Owner's dde inaurence to wart le uaranty C an from GFE #5 E109. 1 '80 11 .Londe s tide insurance to Stewart Title Guaran Compan E 912.08 else 1105. Lender's f Iknit E 97 800.00 1782. ttpB:Ownsr'atltlt Ilmit E 722000.00 8.1/1 t 107. errs rlion of Me total dde i rence mium to ore Settlement Services inc. 934.8 1108. Undsrwrtter'a rtion of the total title insurance ramium to Stewart Tdla Guars an E 87.19 1109. C Protection letter to Stewart TBIe Guaran Co an 15.00 1 10. 111. E itt . 1113. 1200. Govomment Recording and Transfer Charges 1201. GovemmeM recotdi cha ea to Recorder of Deeds from GFE #7 187.00 1202• Deed i 83.00 Mo e e E 104.00 Rebasea E Other S 1203. Transfer ttixaa to Recorder of Deeds from GFE #8) t 1204. Ci n tax/stamps E 1,220.00 S 610.00 1205. Stall taxis 1 22D.00 610.00 1207. 1800. Addltbnal Settlement Cha ea 1301. utred serotoea that u con oho for from GFE #8 1302. 1303. Final Water 1017 •12x31 to New Cumberland Boro 1010 Aden S 5.87 1504. Final Sourer Prorated to New Cumberlantl Bore 1010 Albn S 58.60 10.62 1305. Finest Sewer 7/1 -9/30 to New Cumberland Boro 1010 Atbn S 89.12 1400. Totsi Settlement Char s srrter on lines 103 Section J and 802 Section 490 .03 1 370.51 er wan+~a vro. + aw^ ua.mww, uv aanaaw «wrnwr^ap^Haas. mmMu.d sear a o~. x a a a siu ur.. Pap. uaam«a Core Sedlement Services, Inc., Sedlement Agent Certified to be a true Copy. Page 2 of 3 HUD-t (2011090077. P FD/2011090077/12)