HomeMy WebLinkAbout11-02-11 (2)-~ REV-1500 1505611180
EX (02-11) (FI)
PA Department of Revenue pennsylvdnid OFFICIAL USE ONLY
Bureau of Individual Taxes OEPARTAIENTOPREVENUE County Code lre~ File Number
Po Box zaosol INHERITANCE TAX RETURN l` ~" ~
Harrisbur , PA 17128-0601 RESIDENT DECEDENT ~ _ ~~`~ (~ D~,
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth
MMDDYYYY
177-42-4751 12282010 05191951
Decedent's Last Name
Suffix Decedent's First Name
KENNEDY MI
(If Applicable) Enter Surviving Spouse's Information Below CRAIG S
Spouse's Last Name Suffix
Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
FILL IN APPROPRIATE BOXES BELOW REGISTER OF WILLS
Q 1. Original Return Q 2. Supplemental Return
Q 3
R
.
emainder Return (Date of Death
Q 4. Limited Estate ~ Prior to 12-13-82)
4a. Future Interest Compromise (date of
5
F
d
0 6. Decedent Died Testate
Q .
e
eral Estate Tax Return Required
death after 12-12-82)
7
D
d
(Attach Copy of Will) .
ece
ent Maintained a Living Trust ]~
(Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes
Q 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (Date of D
th
ea
Q 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95)
(Attach Schedule O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFO
N
ame RMATION SHOULD BE DIRECTED T0:
Daytime Telephone Number
Robert G. Frey
7172435838
First Line of Address
5 South Hanover Stree
Second Line of Address
City or Post Office
Carlisle
rct(itSTER~OF WILLS USA ONLY
`- _~~ ~_
`~ -_
_ _~
~,
_,.
-.. / i'1
- ., _ _
State ZIP Code DATEf FILED ` '
,--.
P A 17 013 ` ~=i=~
Correspondent's a-mail address: R F R E Y a~ F R E Y T I L E Y. C O M
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 corn Iete. Declaration of re arer other than the ersonal re resentative is based on all information of which re arer has an knowledge.
SIGNATURE OF PF~ON RESPONSIBLE FOR FILING RETURN
274___5,:~~v Street, Harrisbur
ADDRESS
5 South Hanover Street
PA 17103
arlisle, PA 17013
)ATE
Z Z
DATE
Z2
Side 1
L 1505611180
1505611180 J
i
J
REV-1500 EX (FI)
1505611280
Decedent's Social Security Number
oecedent'sName: CRAIG S KENNEDY 177-42-4751
RECAPITULATION
1. Real Estate (Schedule A) ......................................... 1. 14 9 9 0 0. 0 0
2. Stocks and Bonds (Schedule B) .................................... 2. N 0 N E
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. . 3. N 0 N E
4. Mortgages and Notes Receivable (Schedule D) ....................... . 4. N 0 N E
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ... . 5. 1 O 4 8 . O O
6. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. 6. N 0 N E
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) OSeparate Billing Requested ..... .. 7. NON E
_ 8. Total Gross Assets (total Lines 1 through 7) . 8 15 0 9 4 8 O 0
9. Funeral Expenses and Administrative Costs (Schedule H) ............... . 9. 2 O O 6 8 . O 0
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... . 10. 1 O O 19 2 . O 0
11. Total Deductions (total Lines 9 and 10) ............................ . 11. 12 O 2 6 O . 0 0
12. Net Value of Estate (Line 8 minus Line 11) .......................... . 12. 3 O 6 8 8 , O O
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ..................... . 13. 0 , O Q
14. Net Value Subject to Tax (Line 12 minus Line 13) ......... 14 3 0 6 8 8 0 0
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 0 15. 0.0 0
16. Amount of Line 14 taxable
at lineal rate X .0 4 5 16. 0. 0 0
17. Amount of Line 14
taxable at sibling rate X . 12 17. 0 , O 0
18. Amount of Line 14 taxable
at couateral rate x .15 3 0 6 8 8.0 0 ts. 4 6 0 3. 2 0
19. TAX DUE ...................................................... . 19. 4 6 0 3.2 O
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0
Side 2
L 1505611280 1505611280 J
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
21-11-0008
File Number
DECEDENT'S NAME
CRAIG S KENNEDY
STREET ADDRESS
116 West Bi S rin Avenue
CITY
NEWVILLE STATE
PA ZIP
17241
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
(1)
177-42-4751
4603.20
Total Credits (A + B) (2)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in 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.
0.00
(3) 193.82
(4) 0.00
(5)
4797.02
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.
_~r~. ~~~ .x' .4:.Yew ~~ tea" ate:. :ii ~ _ W ~•...y . _ ~., :'..
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 [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(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.
REV-1502 EX+ (01-10)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Craig S Kennedy 21-11-0008
All 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.
If more space is needed, use additional sheets of paper of the same size.
REV-1508 EX+(11-10) SCHEDULE E
Pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Craig S Kennedy 21-11-0008
Include the proceeds of litigation and the date the proceeds were received by the estate.
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX + (10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
ESTATE OF FILE NUMBER
Craig S Kennedy 21-11-0008
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Memorial Reception. Expenses not claimed on prior return
B.
1
City
Year(s) Commission Paid:
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
4.
5.
6.
7.
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
State ZIP
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
Postage
8. Expenses of sale of real estate -suspended pending sale
ZI P
263
1, 000
32
18,773
TOTAL (Also enter on Line 9, Recapitulation) ~ $ 20
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
Craig S Kennedy 21-11-0008
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
Pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Crain S Kennedy ~~_~~_nnnR
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
Tara Houser
1
2745 Canby Street, Harrisburg, PA 17103 Niece 100% of residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SHE ET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
Expenses of Real Estate Sale
Expenses from HUD-1 settlement statement 10,894
Water and Sewer to Newville Borough 418
Interstate Waste 19
Lawn Care to Dale heberlig 789
Onyx Landscape 361
Real Estate taxes 1,963
PPL 659
Kough's Oil Service 2,931
Advertising in the Sentinel 224
Lowes Materials 252
Cleaning & Miscellaneous Supplies 80
Cleaning and Moving 23
Erie Insurance 160
Total Real Estate Expenses 18.773
Practitioner Portal
Penalty and Interest Calculations
CALCULATION DATES-
9/28/11 TO 12/27/2011
TAX DEFICIENCY $ 26 263 80
CALCULATED INTEREST
BALANCE AS OF 12/27/2011
,}-- .
Start Over
--~,.~...._~.....r-~
$ 193.82
$ 26,457.62
12/23/11 10:19 AM
https://www.doreservices.state.pa.us/pitservices/Default.aspx Page 1 of 2
OMB Approval No. 2502-0265
'!!?~~~ A. Settlement Statement (HUD-1)
FINAL
.- . ..
1. Q FHA 2. ~ RHS 3. ~ Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
2011-61/BADDA 0332856483
4. Q VA 5. X^ Conv. Ins.
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown. Items marked
"
(p.o.c)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. Name & Address of Borrower: E. Name 8 Address of Seller: F. Name & Address of Lender:
Heidi E. Badda Estate of Craig S. Kennedy HomeSale Lending LLC
407 Steelstown Road, Newville, PA 17241 13675 Technology Drive, Eden Prairie, MN
55344-0000
G. Property Location: H. Settlement Agent: I. Settlement Dafe: 12/22/2011
116 West Big Spring Avenue Baric Scherer LLC Disbursement Date: 12/22/2011
Newville, PA 17241 19 West South Street, Cadisle, PA 17013
Newville Borough
Telephone: 717-249-6873 Fax: 717-249-5755
Place of Settlement: TitleExpress
19 West South Street, Carlisle, PA 17013 Printed 1 2/2 212 0 1 1 at 12:48 pm
by ALF
100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller
101. Contrail sales price 149,900.00 401. Contract sales price 149,900.00
102. Personal ro rt 402. Personal ro rt
103. Settlement charges to borrower (line 1400) 6,003.79 403.
104. 404.
105. 405.
Ad'ustments for hems aid b seller in advance Ad ustments for hems aid b seller in advance
106. City/town taxes to 406. Cityftown taxes to
107. County taxes 12122/2011 to 12131/2011 18.02 407. County taxes 12/22/2011 to 12/31/2011 18.02
108. Assessments to 408. Assessments to
109. School Taxes 12/22/2011 to O6I30/2012 1,029.74 409. School Taxes 12122/2011 to 06/30/2012 1,029.74
110• 410.
111. 411.
112. 412.
120• Gross Amount Due from Borrower 156,951.55 420. Gross Amount Due to Seller 150,947.76
200. Amounts Paid b or in Behalf of Borrower 500. Reductions In Amount Due to Seller
201. Deposit or earnest money 2,000.00 501. Excess deposit (see inshuilions)
202. Principal amount of new loan(s) 134,910.00 502. Settlement charges to seller (line 1400) 60,292.90
203. Existin loa s taken sub'eil to 503. Existin loa s taken sub'ect to
2D4. 504. Payoff of first mortgage loan to F&M Trust 85,074.75
205. 505. Pa off of second mort a e loan
2~• 506.
207. Seller Help 900.00 507. Seller Help 900.00
2D8. 508.
209. 509.
Ad'ustments for hems un aid b seller Ad'ustments for items un aid b seller
210. Cityftown taxes to 510. Cityflown taxes (o
211. County taxes to 511. County taxes to
212. Assessments l0 512. Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220• Total Paid 6 Ifor Borrower 137,810.00 520. Total Reduction Amount Due Seller 146,267.65
300. Cash at Settlement fromfto Borrower 600. Cash at Settlement toffrom Seller
301. Gross amount due from borrower (line 120) 156,951.55 601. Gross amount due to seller (line 420) 150,947.76
302. Less amounts paid byHor borrower (line 220) 137,810.00 602. Less reductions in amount due seller (tine 520) 146,267.65
303. Cash QX From ~ To Borrower
. ~ ,~ . ,~ w . o ,n ,m m, u v., 19,141.55
P~ 603. Cash X^ To ~ From Seller 4,680.11
r.......p u.,~rv,,,,,,,,o... no ~o„n..n,,.wyu nw,.a m~amuaw,~~. m.m.,e,y. rr,a oe.roon.umaonm me ._-•---._._..-._.._._.
xnlemant poPeu p.niee to • NESPA wve,e048na.dpn MV, IPMm,Mlan UW,q n,e
Previous editions are obsolete Page 1 of 4 HUD-1
700. Total Real Estate Broker Fees $ 8,994.00 Paid From Paid From
Division of commission Iine700 as follows: Borrower's Seller's
701. $4,497.00 to Prudential Homesale Services Group Funds at Funds at
702. $4,497.00 to RelMax A-1 Realty, Inc. Settlement Settlement
703. Commission paid at settlement 8,994.00
704. Broker Fee to Prudential Homsale Services Group 225.00
705. Broker Fee to Re/Max A-1 Realty, Inc. 195.00
800. hems Pa able in Connection with Loan
801. Our origination charge (Includes Odgination Poin10.000 h or $0.00) $595.00 (from GFE #1)
802. Your credit or charge (points) for the spedfic interest rate chosen $ (from GFE #2)
803. Your adjusted odgination charges (from GFE A) 595.00
804. Appraisal fee to RELS Valuation $380.D0 P.O.C. B' (from GFE #3)
805. Credit report to RELS Credit $11.66 P.O.C. B' (from GFE #3)
806. Tax service to from GFE #3
807. Flood certification to from GFE #3
808. to
900. kerns Re aired b Lender to be Paid in Advance
901. Daily interest charges from from 12/22Y2011 to 01/01/2012 @ $15.7100/day (from GFE #10) 157.10
902. Mort a e insurance remium months to from GFE #3
903. Homeowner's insurance for 1 ears to Safeco Insurance (from GFE #11) 542.00
904. months to from GFE #11
1000. Reserves De osited wtth Lender
1001. Initial deposit for your escrow account (from GFE #9) 1,326.31
1002. Homeowner's insurance 3 months $ 45.17Imonth $135.51
1003. Mort a e insurance months $ /month
1004. Property taxes County 11 months $ 54.821month $603.02
1005. School Taxes 7 months $ 166.921monih $1,168.44
1006. Assessments months $ 0.00/month $
1007. Aggregate Adjustment $-580.66
1100. Title Cha es
1101. Title services and lenders title insurance from GFE #4 255.00
1102. Settlement or closing fee to $
1103. Owner's title insurance from GFE #5 997.88
1104. Lender's title insurance $225.00
1105. Lenders title policy limit $134,910.00 Lender's Policy
1106. Owner's title policy limit $149,900.00 Owner's Policy
1107. Agent's portion of the total title insurance premium $975.70
1106. Underwdter's portion of the total title insurance premium $247.78
1109.
1200. Government Recordin and Transfer Cha es
1201. Government recording charges $ (from GFE #7) 202.50
1202. Deed $62.00 Mort a e $90.00 Release $
1203. Transfer taxes $ (from GFE ft8) 1,499.00
1204. CitylCounty tax/stamps Deed $1,499.00 Mort a e $
1205. State Taxlstamps Deed $1,499.00 Mort a e $ 1,499.00
1206. Deed $ Mort a e $
1207. Assignment Recording Fee $50.50
1300. Additional Settlement Cha es
1301. Required services that you can shop for (from GFE #6) 119.00
1302. Tax Certification to Deborah Pi r 5.00
1303. Termite Inspection to Gilbert's Professional Pest Control, Inc. 85.00
1304. Final Water/Sewer to Baou h of Newville 121.48
1305. Furnace Repair to HV Mechanical 80.00
1306. Flood Lrfe of Loan Fee to WF Flood Services $19.00
1307. Tax Service Fee to WF RE Est Tax Services $100.00
1308. Inhedtance Tax Escrow to Badc Scherer LLC 49,398.42
1309. Pest Inspection to $
'rr r ~ r 6,003.79 60,292.90
'Paid outside of closing by (B)onower, (S)eller, (L)ender, (I)nvestor, Bro(I~er. "Credit by lender shown on page 1. "`Credit by seller shown on page 1.
Previous editions are obsolete Page 2 of 4 HUD-1
Com arison of Good Faith Estimate GF and HUD-t Char es
Char es That Cannot Increase HUD-1 Line Number
Our origination charge # 801
Your credit or charge (points) for the specific interest rate chosen g 802
Your adjusted origination charges # 803
Transfer taxes # 1203
Char es That in Total Cannot Increase More Than 10°/
Government recording charges g 1201
Appraisal fee # 804
Credit report # 805
Title services and lender's title insurance # 1101
Owner's title insurance # 1103
r
Char es That Can Chan e
Initial deposit for your esaow account # 1001
Daily interest charges from # 901 $15.71001da
Homeowners insurance ~ 903
Flood Life of Loan Fee # 1306
Tax Service Fee g 1307
Pest Inspection # 1309
Loan Terms
Good Faith Estimate HUa1
595.00 595.00
0.00 0.00
595.00 595.00
2,998.00 1,499.00
Good Faith Estimate HUU-1
230.50 202.50
480.00 380.00
11.66 11.66
2,161.70 2ss.oo
1,219.15 997.88
4,103.01 1,847.04
$ -2,255.97 or -54.9633
Good Faith Estimate HUD~1
3,758.32 1,326.31
141.39 157.10
550.00 542.00
19.00 19.00
100.00 100.00
105.00 0.00
Your initial loan amount is $134,910.00
Your loan tens is 30. years
Your initial interest rate is 4.2500°
Your initial monthly amount owed for principal, interest, and any mortgage $733.38 includes
insurance is Q Principal
0 Interest
^X Mortgage Insurance
Can your interest rate rise? Q No. ^ Yes, it can rise to a maximum of %. The first change
will be on I / and can change again every years after I I .Every change
date, your interest rate can increase or decrease by %. Over the life of the loan, your
interest rate is guaranteed to never be lower than % or higher than % .
Even if you make payments on time, can your loan balance rise? ^X No. ^ Yes, it can rise to a maximum of $
Even 'rf you make payments on time, can your monthly amount owed for ^X No. ^ Yes, the first increase can be on I I and the monthly
principal, interest, and mortgage insurance dse? amount owed can rise to $
The maximum it can ever dse to is $
Does your loan have a prepayment penalty? ^X No. ^ Yes, your maximum prepayment penalty is $
Does your loan have a balloon payment? ^X No. ^ Yes, you have a balloon payment of $ due in
years on I 1
Total monthly amount owed including escrow account payments ^ You do not have a monthly escrow payment for items, such as property taxes
and homeowners insurance. You must pay these items directly yourself.
^X You have an additional monthly escrow payment of $266.90
that results in a total initial monthly amount owed of $1,000.28. This includes principal, interest, ar
mortgage insurance and any items checked below:
0 Property taxes ^X Homeowner's insurance
^ Flood insurance ^
^ ^
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender.
Previous editions are obsolete Page 3 of 4 HUD-1
HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HU0.1 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 trensaction. I further certify that I have received a copy of the HU0.1 Settlement Statement.
Heidi E. Badda
Estate of Cralg S. Kennedy
The HU0.1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be
disbursed in accordance with this statement
SETTLEMENT E J7
~ti ~ L`'.' ~ L l
DATE
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010.
Previous editions are obsolete Page 4 of 4 HUD-1
. .
Name of Bonower:
Heidi E. Badda Name of Seller:
Estate of Craig S. Kennedy File Number:
2011.51/BADDA
Prepared 12/22/2011 at 12:49 pm
Note: This page displays an itemization of the adjusted origination charges shown in section 800 of the HUD-1 Settlement Statemen
This page accompanies but is not a part of the HU0.1 Settlement Statement. If a discrepancy exists, the information on the HUD-1
Settlement Statement applies.
Your Loan Origination Charges Borrower Seller
801. Our origination charge (Includes Origination Point 0.000 % or $0.00)
Origination Charge to $ 595.00
802. Your credit or charge (points) for the spedfic interest rate chosen
to $ 0.00
803. Your adjusted origination chazges 595.00 0.00
r
Name of Borrower:
Heidi E. Badda Name of Seller:
Estate of Craig S. Kennedy File Number:
2011-81BADDA
Prepared 12/22/2011 at 12:49 pm
Note: This page displays an itemization of the charges shown on line 1101 of the HUD-1 Settlement Statement This page
accompanies but is not a part of the HU0.1 Settlement Statement. If a discrepancy exists, the information on the HU0.1 Settlement
Statement applies.
1100. Title Charges Borower Seller
1101. Title services and lender's title insurance to 255.00 0.00
Notary Fees to Cash $ 10.00 Bonower
Overnight Fees to Baric Scherer LLC $ 20.00 Bonower
Subtotal $ 30.00
1102. Settlement or dosing fee to $ 0.00
1104. Lender's title insurance to Baric Scherer LLC $ 225.00 Bonower
SellerlLender credits shown on a e 1 POC =Paid Outside Closin
Previous editions are obsolete Page 1 of 1 HUD-1