Loading...
HomeMy WebLinkAbout12-13-11 (2)_ 1505610140 REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 1 1 0 3 8 6 Po sox 28oso1 RESIDENT DECEDENT Harrisbur PA 17128-0601 ENTER DECEDENT INFORMATION BELODate of Death MMDDYYYY Date of Birth MMODYYW Social Security Number 0 2 1 4 2 0 1 1 0 5 3 1 1 `~ 1 2 0 4 0 1 6 1 3 4 MI Suffix Decedent's First Name Decedent's Last Name R O B E R T M M E A L S Ouse's Information Below MI (If Applicable) Enter Surviving Sp Suffix Spouse's First Name Spouse's Last Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS IN APPROPRIATE OVALS BELOW ^ 3. Remainder Return (date of death FILL ^ lemental Return 2. Supp prior to 12-13-82) © 1. Original Return f t ^ 5. Federal Estate Tax Return Required ^ e o 4a. Future Interest Compromise (da ^ 4. Limited Estate death after 12-12-82) Total Number of Safe Deposit Boxes Q g ^ 7. Decedent Maintained a Living Trust , © 6. Decedent Died Testate f Will) (Attach Copy of Trust) th f d nder Sec. 9113(A) ^ 11 • a (Attach Copy o 9. Litigation Proceeds Received ^ ea ^ 10. Spousal Poverty Credit (date o between 12-31-91 and 1-1-95) O) EAttach Sch RECTED T0: BE DI L RRESPONDENCE AND CONFIDENTIA o U ep le o CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CO D ~ ber e Num ho el Name 7 1 7 2 4 3 3 3 4 1 S E T H T M O S E B E Y REGISTER OF WILLS USE ONLY ~_ ...".T ~~ First line of address " '~ ' "' " -;--, i A R T S O N L A W O F F I C E S .~~ ~ ~_' _ M Second line of address y :~E %"~ E H I G H S T oAr~o -' 1 0 State ZIP Code r~ City or Post Office " -+ - r"~ _. ~' C A R L I S L E --- W S M O S E B E Y a M A R T$ O N L O d belief a , ^ s Correspondent's a-mail address: dines and statements, and to the best of my knowledge an arer has any knowledge. examined this return, including accomp Y 9 , n all information of which prep d o Under penalties of perjury, I declare that I have ct and complete. Declaration of preparer other than the personal representative is base DATE ~ it is true, corre SI ATURE OF PE}ZSO ESPONSIBL G RETURN J / ~I ~ L / D ESS I BOILING SPRINGS PA 17007 1 CRISWELL DRIVE DAQTE ~ ~) _._..~...,~ ..c ovcoARFR (1THER TF~e4lV REPRESENTATIVE ~ Z / / A RESS r -~ 10 E HIGH STREE CARLISL PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 PA 17013 1505610140 .....,~ 1505610240 Decedent's Social Security Number REV-1500 EX 2 0 4 0 1 6 1 3 4 ~ecedenYs Name: ROBERT M - MEAL S RECAPITULATION 1 4 0 0 0 0. 0 0 1. ................... 1. Real Estate (Schedule A) .. • • • • • • • • • • • • ' ' ' ' ' • ' Q • 0 0 2. 2. Stocks and Bonds (Schedule B) ..•••••••••••••"""""'•~~~~• • 3. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . • • • . ................. 4. 9 4. Mortgages and Notes Receivable (Schedule D) . • • • • • • • ~ 8 8 8 3 . 6 Schedule E)....... 5• 5. Cash, Bank Deposits and Miscellaneous Personal Property ( 0 • Q 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 0 • 0 0 7. Inter-Vivos Transfers & Miscellaneous N~II;PS ParaterBi fng Requested ....... 7• (schedule G) U 1 4 8 8 8 3. 6 9 . s. __aesr~ilrytalLines1through7) .•••••••••••••''''''''''~~ -, -~ $. 1 OLaI vlvaa rwo...~ ~--_-. _ 9. 2 r 5 ~ -1 • C ~ 9. Funeral Expenses and Administrative Costs (Schedule H) .... • • • • • • • • • • • • • • 5 7 2 9 2. 7 9 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........ ..... 10. 8 4 8 8 2. 0 6 ........... 11. Total Deductions (total Lines 9 and 10) . • • • • • • • • • • • • ,.,..11. 6 4 0 0 1 • 6 3 .............. 12. Net Value of Estate (Line 8 minus Line 11) .... • • • • • ts/Sec 9113 Trusts for which 12. ..... 0 • 0 Q 13. Charitable and Governmental Beques an election to tax has not been made (Schedule J) . 13. 6 3 p 0 1 14. 6 4 . ....... ..... 14. Net Value Subject to Tax (Line 12 minus Line 13) ...... TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or 0 ~ 0 0 transfers under Sec. 9116 0 ~ Q 0 15. (a)(1.2) x.o _ 2 8 8 0. 0 7 16. Amount of Line 14 taxable 6 4 0 0 ], 6 3 16. at lineal rate X .045 0 • 0 0 17. Amount of Line 14 taxable 0 ~ Q 0 17. at sibling rate X .12 0 • 0 0 18. Amount of Line 14 taxable Q 0 0 18. at couateral rate X .15 2 8 8 0. 0 ? ....... 19. ..... 19. TAX DUE ........................................ FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20. Side 2 1505610240 -1505610240 REV-1500 EX Page 3 Decedent's Complete Address: nGrFnFNTS NAME File Number 21 11 0386 ROBERT M. MEALS STREET ADDRESS 1636 LEIDIGH DR1VE CITY 30ILING SPRINGS Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greatF'll in ovial on Page 2, Liner20 toirequest a refund.e OVERPAYMENT. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. STATE ZIP PA 17007 (1) 2 880.07 Total Credits (A + 8) (2) 0.00 (3) 5.90 (4) 0.00 (5) 2 885.97 Make check payable to: REGISTER OF WILLS, AGENT WING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS PLEASE ANSWER THE FOLLO Yes No 1. Did decedent make a transfer and: ••.•..•.•,•.•..••••.•••..•.•.•.•..•,••••••..•..,. ^ transferred; ..••••••••••••••••••• a. retain the use or income of the property ,,.•.•.,...... ^ b. retain the right to designate who shall use the property transferred or its income; • • • • • ~ • ~ • • • • • • •- c. retain a reversionary interest; or ..... . ........................... d. receive the promise for life of either payments, benefits or care 2. If death occurred after December 12,1982, did decedent transfer property within one year of death ^ ^ without receiving ddequate consideration? ..................................... ^ 3. Did decedent own an "in trust for" orpayable-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 .................. "' RT OF THE RETURN. Y OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PA IF THE ANSWER TO AN .. , , -.... ~ :; ~, ;: ' , th 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 I For dates of dea 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate impose sferthe net value of transfers to or for the use of the surviving spouse is percen to a surviving spouse from tax, and the statutory requirements for disclosure of assets and [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a tran 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: • e tax rate imposed on the net value of transfers from a deceased1 6 a21 •~ears of age or younger at death to or for the use of a natural paren , an Th adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9 ()( • 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)]. g p A siblin is defined, and • The tax rate imposed on the net value of transfers to or for in common~wi h the decedentnwhether byrblood o~ adoption16(a)(1.3)]. 9 Section 9102, as an individual who has at least one parent REV-1502 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE SCHEDULE A REAL ESTATE INHERITANCE TAX RETURN I _ - RESIDENT DECEDENT ram ,~~, ESTATE OF: 21 11. 0386 ROBERT M. MEALS All real property owned solely or as a tenant in common mu selblerrne ther be ng compelled to buyForl sell, both hav ng rleasor able knowledge of the pee a t facts. would be exchanged between a willing buyer and a well g Real proplsrh- that is jointly-owned with right of survivorship must be disclosed on Schedule . Attach a copy of the settlement sheet if the property has been sold. VALUE AT DATE of the deed showing decedent's interest if owned as tenant in common. OF DEATH ITEM Include a copy NUMBER DESCRIPTION 140,000.00 pA; known as 1. Real estate located at 1636 Leidigh Drive, So. Middleton Twp., Cumberland Co., Tax Parcel No. 40-11-0284-19A~ being described in Deed dateconve/ ed t Robert MaMeals & Cumberland Co. Derrd Book B ,Vol. 26, Page 703, & being Y Iva B. Meals, his wi~'e. Iva Bulls actuals al/e 8alue7 See attached Settlement Statement rt M Meals, Decedent herein. Va TOTAL (Also enter on Line 1 Recapitulation) I $ 140,000.00 If more space is needed, use additional sheets of paper of the same size. EV 1508 EX + (6-98) R SCHEDULE E SH BANK DEPOSITS, & MISC. CA , COMMNHERITANCE TTAX RETURNANIA PERSONAL PROPERTY RESIDENT DECEDENT FILE NUMBER ESTATE OF 21 11 038 ROBERT M. MEALS Include the p ncee~s~ed with right of survi or phip meust be disclos d on Schedule F. All property jo Uy ITEM DESCRIPTION NUMBER ~ F&M Trust checking, 33-17641 See attached 2. 2010 1040 personal income tax refund 3 2003 Chrysler Sebring vehicle See attached 4 County Tax proration 5. School Tax proration 6 Personal property and household goods VALUE AT DATE OF DEATH 1,564.69 900.00 5,100.00 37.41 781.59 500.00 TOTAL (Also enter on line 5 Recapitulation) $ 8,883.6` (If mon: space is needed, insert additional sheets of the same size) REV-1511 EX+(10-09) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT FILE NUMBER ESTATE OF 21 11 0386 ROBERT M. MEALS Decedent's debts must be reported on Schedule I. AMOUNT ITEM DESCRIPTION '----- NUMBER ' 2,880.04 A FUNERAL EXPENSES: 439.73 ~, Hollinger Funeral Home, Mt. Holly Springs, PA 2. Ministerial donatiom, organist donation and funeral flowers 405.57 3. Family funeral reception 1,917.50 4, Travel expenses foi* daughter, Lois Diehl, to plan and attend funeral B ADMINISTRATIVE CASTS: 1 Personal Represent;~tive Commissions: 7,444.00 . Name(s) of personal Representative(s) Jennie M. Stra er --------- StreetAddr~ss 361 Criswell Drive State PA ZIP 17007 Ciry Boil' S rin s Year(s) Cormmission Paid: 2012 7,705.00 Attorney Fees: Mattson Law Offices 2 Family Exemption: (IN decedent's address is not the same as claimants, attach explanation.) 3 Claimant Street Addrtess State ZIP _ City Relationship of Claimant to Decedent 327.50 Probate Fees: Oberland County Register of Wills 4, 5. Aa;ountant Fees: g. Tax Return Preparer Fees: 15.00 Filing Fee, Inheritance Tax Return 200.16 ~, g The Sentinel,'advertising Letters Testamentary 75.00 . q Cumberland )~,aw Journal, advertising Letters Testamentary 1,400.00 . 10 1% Realty Transfer Tax 5.00 . 11. Community settlement LLC, Tax Certification fuel oil pending disposition of real estate Oil Service h' 1,606.23 154.71 12. 13 , s Koug Met Ed, electric service pending disposition of real estate 55.82 . 14. IWS/PA, trash service pending dispostion of real estate ending disposition of real estate l 1,644.53 50 4 15. taxes p South Middleton Township, county/schoo house insurance pending disposition of real estate urance I . 93 40.00 16. , ns Peerless Hazardous nhaterials kits, house clean up pending disposition of real estate i 338.98 17. rs an Farm Equipment, lawn tractor (included with sale of house), repa P 1 g. eterm TOTAL (Also enter on Line 9, Recapitulation) 5 27 589.27 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-OS) __. - Pennsylvania - DEPARTMENT OF REVENUE INHERITANCE TAX RETURN SCHEDULE I - DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT _ FILE NUMBER ESTATE OF 21 ] 1 0386 ROBERT M. MEALS ,_...- bts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medicalVA UE AT DATE Report de OF DEATH ITEM DESCRIPTION 1,415.00 NUMBER 33-17641, on date of death ~ Outstanding check, F!&M checking 2 3 4 55,839.56 Commonwealth of Pennsylvania, Department of Public Welfare claim 117800659 11.57 Sarah Todd Home, account payable 26.66 Carlisle Neuro Care, account payable TOTAL (Also enter on Line 10 Recapitulation) I S 57,292.7` If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN SCHEDULE J BENEFICIARIES KCJw~n i v.-...-.-• ESTATE OF: FILE NUMBER: 21 11 0386 RELATIONSHIP TO DECEDENT t List Trustee(s) AMOUNT OR SHARE OF ESTATE ON(S) RECEIVING PROPERTY NAME AND ADDRESS OF PERS Do No NUMBER 91~16 (a) (1 zjlldistributionssnd transfers under g TAXABLE DISTRIBUTIONS limos Sec 30,875.81 1 . Lineal ~ Jennie M. Strayer , 361 Criswell Drive 30,875.82 Boiling Springs, PA 17007 Lineal 2 Lois Diehl 109 Pinion Circle 500.00 Layfette, LA 70508 Lineal 3 , Robert Ashley Strayer 409 Criswell Drive 250.00 Boiling Springs, PA 17(107 Lineal 4. Allison Strayer c/o409 Criswell Drive 500.00 Boiling Springs, PA 17b07 Lineal 5, Brian Gregory Diehl 1496 W. l 16th St. Apt, 26 500.00 Westminister, Co. 80234 Lineal 6, Lauren E. Diehl 1102 w. Avalon Dr. 250.00 Kill Devil Hills, NC 2'948 Lineal 7, Carrie L. Diehl 241 Conway St. Greenfield, MA 01301! VE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. LLAR AMOUN ENTER DO S FOR DISTRIBUTIONS SHOWN ABO II NON-TAXABLE DISTRIB TI TIONS: ONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKE 1. A. SPOUSAL DISTRIBU B. CHARITABLE AND GjOVERNMENTAL DISTRIBUTIONS: 1 O.OC ..~ ~t ~r.irGQ TnTAI_HON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET. b IVIHLyrrnn~==i -••~- If more space is needed, use additional sheets o paper V-1500 Inheritance Tax Return Resident Decedent Continuation of RE 21 11 0386 _ File Number Rc)BERT M. MEALS Page 1 Decedent's Name Schedule J -Beneficiaries -1 AMOUNT OR SHARE RELATIONSHIP TO DECEDENT OF ESTATE Do Not List Trustee(s) NUMBER NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY 1 TAXABLE DISTRIBUTIONS nclus~ 9196t(a~1,211 istributions and transfers under 250.00 Lineal g. Christopher R. Diehl 1970 Palmer St. Lot # 3 Christiansburg, VA 240"J3 LAST WILL AND TESTAMENT ~ -~ o OF `'° -~-~~'-- c~ =i7~~^ i, ` ~ tlt'1 ROBERT M. MEALS ~ ' ~' -~~ L=~ ;~~~~> ^~ ~~-; -~,~: ~. ~~ I ROBERT M. MEALS, a resident of Boiling Springs, Cumberland County, Pennsylvania being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last Will,and Testament, hereby revoking all Wills and Codicils heretofare made by me. ITEM 1: I direct that all my just debts, the expenses of my last. illness and funeral expenses be paid as soon after my decease as the same can conveniently be done. ITEM 2: I direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the government of the United States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such governments, whether the property passes under this Will or otherwise, excluding, however, any property over which 1 have a taxable power of appointment, provided, however, that no residuary beneficiary shall by reason of this provision be denied the benefit of any deduction, credit, favorable rate of tax or other benefit. which by law t .~. _, .:.. -~= .T ` -.; ~,• ~~3 d ~; enures to such beneficiary. 1T_ I give, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and nature, and wheresoever situate ROBERT M. MEALS 1 LAST WILL AND TESTAMENT OF ROBERT M. MEALS at the time of my death, unto my wife, iVA B. MELAS, provided, however, that she survives me and ins living sixty (60) days after the date of my death. ITEM 4: If and in the event that my wife, NAB. MEALS, does not survive me and is not living sixty (60) days after the date of my death, then and in such event, to the individuals listed below, I bequeath the following: a. To my grandson, ROBERT ASHLEY STRAYER, if he shall survive me, the sum of Five Hundred Dollars ($500.00). b. To my grandson, BRIAN GREGORY DIEHL, if he shall survive me, the sum of Five Hundred Dollars ($500.00). c. To my granddaughter, LAUREN ELIZABETH DIEHL, if she shall survive me, the sum of Five Hundred Dollars ($500.00;1. d. To my great granddaughter, CABBIE LYDIA DIEHL, if she shall survive me, the sum of Two Hundred Fifty Dollars ($250.00). e. To my Great Grandson, CHRISTOPHER ROBERT DEEHL, if he shall survive me, the sum of Two Hundred Fifty Dollars ($250.00). f. To my great granddaughter, ALLISON MACKENZIE STRAYER, if she shall survive me, the sum of Two Hundred Fifty. Dollars ($250.00). ROBERT M. MEALS 2 LAST WILL AND TESTAMENT OF ROBERT M. MEALS ITEM 5: If and in the event that my wife, IVA B. MEALS, does not survive me and is not living sixty (60) days after the date of my death, then and in such event, I give, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and nature, and wheresoever situate at the time of my death, in equal shares, unto my children, LOIS MARIE DIEHL, and JENNIE R. STRAYER, provided however, that they survive me and are living sixty (60) days after the date of my death. ITEM 6: If and in the event that a child of mine does not survive me and is not living sixty (60) days after the date of my death, then and in such event, I give, devise and bequeath the interest in my estate, which such deceased child would have received, if living, to the issue of said deceased child, per stirpes. ITEM 7: I hereby nominate, constitute and appoint my wife, NA B. MEALS, Executrix of this my Last Will and Testament, with full power to do any and all things necessary for the complete administration of my estate, and direct that no bond or other surety is required of her in this or any other jurisdiction for her performance el`this office. If and in the event that my wife, NA B. MEALS, does not survive me and is not living sixty (60) days after the date of my death, or does not complete her duties as ~~ b~ti'L~, r..:.r., ROBE T M. MF,ALS 3 LAST WILL AND TESTAMENT OF ROBERT M. MEALS Executrix, then and in such event, I hereby nominate, constitute and appoint my daughter, JENNIE R. STRAYER, Executrix of this my Last Will and Testament, with full power to do any and all things necessary for the complete administration of my estate, and direct that no bond or other surety is required of her in this or any other jurisdiction for her performance of tlhis office. If and in b'be event that my daughter, JENNIE R. STRAYER, does not survive me and is not living Sixty (60) days after the date of my death, or does not complete her duties as Executmx, then and in such event, I hereby nominate, constitute and appoint my grandson, ROBERRT ASHLEY STRAYER, Executor of this my Last Will and Testament, with full power to do any and all things necessary for the complete administration of my estate, and direct that no bond or other surety is required of him in this or any other jurisdiction for his performance of this office. ITEM 8: If any provision of this Will or of any Codicil hereto is held to be inoperative, invallid or illegal, it is my intention that all the remaining provisions thereof shall continue to be fully operative and effective, so far as is possible and reasonable. IN WITNESS WHEREOF, I, ROBERT M. MEALS, the Testator, have to this my Last Will and Testament, typewritten on five (5) consecutively numbered pages, subscribed my name and affixed my seal this day of ~-~-'~~ ~ , 2004. ~~~' ~• ~ _ %' ~ ~ L, ,,: (SEAL) ROBERT M. MEALS 4 LAST WILL AND TESTAMENT OF ROBERT M. MEALS Signed, sealed, putblished and declared by the above named ROBERT M. MEALS, as and for his Last VlJill and Testament, in the presence of us, who have hereunto subscribed our names at his request, as witnesses hereto, in the presence of the said Testator, and of each other. `_ ~~. residing at /mot/ ~" ..~' ~' r(.~ B"' ~~ C7 O~ ~,3_~~~~ 4i~~~ ~, ~ ~ t~~~siding at ~~ ~ c ,vy Gtr ~ 7~ ~ 5 eorNamPnt Ctatement _.. - - _ _ _ _ Iulm nuu-I lrWl Iw nwluw+n r.wo.c U.S. Department of Housing and Urban Development form HU0.1 (3186) rel Handbook 430S.Z Previous edmona are obaolate _ _ ,- ,~„ ~ ~ ,~rvri nrn¢Air Fila NumheC Qif7.947 PAGE 2 tTa HU0.1 Settl I p b a tote and acaNeb aaount W Ws Usnaaetbn. l haw wuaad a will ware lands to be dbbutsaO In accaidance b ~~/ WARN+NG: It a rtN knvM make bIN sbtemenb to the United Slaba on tldf a eny Olhar almlbr fdm. Panaluea upon conviction an ads a tlns and Inprlaonmant. Far tlebila sae: Tdb 16 U. S. Code SeC110n 1001 and SecUOn 1010. 1 retully rewawed tlro HU0.1 Settle SbbrtMlll ana ...s ~~~^~ __._. _ d yOi~}~tyl~,rssmanb mWapf~~n~_my aaanl i` Uanaxtlon• 1 car8ty 8iat 1 hew rocNwd a mpy M Ihs HU0.1 SsWanaM SlaWltsn File No. 037-947 CERTIFICATION I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. BORROWEgR,,,S: yy~~ /2,,~1.~ Terrence M. McDonough Mari orette cDonough SELLERS: Estate of Robert M. eals Jennie S ye ntrix To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is a true and accurate account of the funds which were received and have been or will be disbursed by the undersigned as part of the settlement of this transaction. COMMUNITY SETTLEMENT LLC By. ~~ a.~ /i Settl t ge ate WARNING: It is a crime to knowingly make false statement to the United States on this or any other similaz form. Penalties upon conviction can include a fine and improvement. For details see: Title 18 U.S. Code Section 1001 and Section 1010. HUD.FRM COMMUNITY OFFICES IN STATE=MENT OF ACCOUNT FRANKLIN, 33-17641 CUMBERLAND, FULTON AND HUNTINGDON ;;TATEMENT PERIOD COUNTIES - TRUST www.imtrustonline.com FROM THROUGH 02-14-11 03-13-11 -~ *********'*****AUTO**3-DIGIT 170 PAGE 1 of 2 -"'-' 1655 0.7150 AT 0.357 9 1 19 11~~11~~'IIIIIIII"III~IIII~I~lll~l~l'~~~~I(u~~l~lll~~~ll~l~ll~~ 1110 ~~ 1~2OBERT M MEALS VVA B MEALS ,JENNIE M STRAYER POA ENCLOSURES 1 '1636 LEIDIGH DR BOILING SPRGS PA 17007-9603 5 GO CLUB REGULARICHECKING ACCOUNT: 33-17641 BEGINNING DEPOSITS/ CHECKS/ SERVICE .ENDING BALANCE NUMBER CREDITSS NUMBER 485.30 FEEOSO BA 149 39 1, 564.69 0 ACTIVITY CREDITS DEBIT-5 BALANCE DATE DESCRIPTION 1,564.69 02-14 BEGINNING BALANCE - 1,415.30 02-28 FORCE PAY CHECK 90073800008 149.39 1562 149.39 03-13 ENDING BALANICE CHECKS * -denotes missing check number in sequence R -denotes returned check CHECK NO AMOUNT CHECK NO AMOUNT CHECK NO AMOUNT 1562 1,415.30 TOTAL NUMBER OF CHECKS 1 TOTAL AMOUNT OF CHECKS 1,415.30 SERVICE FEE BALANC~ INFORMATION FROM 2-14-11 THROU AVERAGE COLLECTED BALANCE 705.40 AVERAGE LEDGER BALANCE 705.40 MINIMUM COLLECTED BALANCE 149.39 MINIMUM LEDGER BALANCE 149.39 DIRECT F&M TRUST -BOILING SPRINGS OFFICE INQUIRIES TO: 3 E 1ST ST BOILING SPRINGS, PA 17007-0400 TELEPHONE: 717-241-4130 OR 717-241-4131 CHAMBERSBURG BOILING SPRINGS MARION MONT ALTO NEWVILLE SHIPPENSBURG ~ ~ WAYNESBORO ~-~-- T~ ` CARLISLE gpEExrM.M8At5 s~~e a 1562 µi{ippcHOluv6 BOGJNG917{Wf3.lA TA01 ~~ _ ~ .. ~ f a ~. , _ ,~ ~( . f ~• ~ e~ L ~ !~ i:0 3 1304 306~C 3~17641r 2 Y__ ACCOUNT: PAGE: 3317641 2 of 2 2003 Chrysler Sebring LX Sedan 4D Trade In Values -Kelley Blue Book Page 1 of 1 rind car value or faaUares home ~ car values ~ cars foi- sale ~ car Yeviews ~ kbb top picks ( research tools - .__ ., 'Popular at KBB.com ~I 10 Coolest Cars Under :. $15,000 ~ ' ._ Chrysler ,~}! Sebnng _ i 2003_ @ go See Used Car Prices 2003 Chrysler Sebring LX Sedan 4D $1,254 bnOF1 TOT )IOllf I7C]CL Golf Nii~c a new jai ;. advertisement _.. __ __ I ~~ Very Good $5,954 --... __... __, I advertisement Good $5,829 Verif)r Condition ;Fair $5,154 How to Get Instant Trade-In Offer get the offer 3 09 lid Own it? Love it? review this car ~; Most for Your Car Know Your Car's Sel Like a Pro: List Your Car see What Other Specs 10 Expert Tips Online Cars Are Worth 3 Easy Ways Ito Sell Your Car Fast why ads? why ads? II New Cars You Might Like ~ I want to list my car for sale ~ List it on Autotrader.com place your ad i Place an ad on AutoTradeccom ~I Reach over 14 million shoppers. -- - _. _ _ _ . _ i What if my credit's not perfect? I Apply with a specialist now ~ http://www.kbb.com/cl~ysler/sebring/2003-Chrysler-Sebring/lx-sedan-4d/?vehicleid=2082... 11 /3/2011 Nome > Car Values > Chrysler > Sebring > 2003 > Category > Style > Options > LX Sedan 4D Trade-In/Sell Values Show Used Car Prices