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Home My WebLink About12-05-111505611185 REV-1500 EX (02-11)(FI) PA Department of Revenue Bureau of Individual Taxes Po Box 2aosol INHERITANCE TAX RETURN Harrisburg, PA 1 7 1 28-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date Of Death MMDDYYYY 210-26-9840 03052011 Decedent's Last Name Suffix HOUSE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number OFFICIAL USE ONLY County Code Year File Number 21 11 0339 Date of Birth MMDDYYYY 12291933 Decedent's First Name M I ROSELLA JEAN Spouse's First Name M I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (Date of Death Prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (Date of Death ^ 1 1. 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 INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number RICHARD C- SNELBAKER 717-697-8528 _ First Line of Address Second Line of Address 44 WEST f1AIN STREET City or Post Office State ZIP Code f1ECHANICSBURG PA 17055 Correspondent's a-mail address: REGISTEFZQF~LLS USE ONLY - -~ ~_ - _; :_ .,, -. __. _;J ` ~ ._._Y ... ...~ ., . 1'~- - -"', ~ ~ I ,~,~~g7 - _ ' .~ ~~ C~ ~.-i -: :~ DATE FILED ~,~. 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, co ect and complete. lion of preparer other than the personal representative is based on all information of which preparer has any knowledge. S~GNA P HERS ,, ,. RETURN 12 / 2 / 2011 ROBERT LEE STRAYER-, EXECUTOR 1003 PARK PLACE, f1ECHANICSBURG, PA „« SIG RE QFPfjZEPARER OTHER THAN REPRESENTATIVE uHl t 1 / VJJ (~~ 12/2/2011 ADDRESS RICHARD C• SNELBAKER, ESQUIRE 44 WEST ~1AIN STREET, MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA 17055 Side 1 1505611185 1505611185 OM4647 3.000 ^\ ~. 1505611285 REV-1500 EX (FI) Decedent's Social Security Number 210-26-9840 Decedent's Norris: H O U S E R O S I I A J A N RECAPITULATION 1. Real Estate (Schedule A) 1. ~, 2 $ , 0 6 2 • 7 3 2. Stocks and Bonds (Schedule B) . 2 D • D 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , , ... 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ................ 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5 2 3 , 8 4 9 • 3 5 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6 0 • 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 2 2 , 5 21 • ], 4 8. Total Gross Assets (total Lines 1 through 7) . 8. 17 4 , 4 3 3. 2 2 9. Funeral Expenses and Administrative Costs (Schedule H). g . 4 2 , 2 D 5 • 6 9 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) _ 10 4 7 , 3 7 D • 5 5 1 1. Total Deductions (total Lines 9 and 10) , 11. 89,576.24 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 8 4 , 8 5 6 • 9 8 an election to tax has not been made (Schedule J) , 13 . . a•Do 14. Net Value Subject to Tax (Line 12 minus Line 13) • • 1a. 84,856.98 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 (a)(1.2)x.o- O.OD 15 0 • 00 16. Amount of Line 14 t xable o 4~ at linealratex 17. . 84,586.98 Amount of Line 14 taxable 16. 3,806.41, at sibling rate X .12 18 0 • 0 0 17. 21, • 6 D 18. Amount of Line 14 taxable at collateral rate x .15 9 0. 0 0 18. 13 • 5 0 19. TAX DUE 19. 3 , 8 41 • 51 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 OM4648 3.000 REV-1500 EX (FI) Page 3 File Number 3. Interest 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. ~•~~ (3) ~ • ~ ~ (4) o.oo 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3 , 8 41 • 51 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 [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. OM4671 2.000 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 3 , 8 41.51 2. Credits/Payments A. Prior Payments ~ • ~ ~ B. Discount 0 • 0 a REV-1502 EX + (p1-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE t5 I A I E OF: FILE NUMBER: Rosella Jean House 21 11 0339 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. Real property that isjointly-owned with right of 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. NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. Real Estate 128,062.73 located at 815 West Keller Street, Monroe Township, Mechanicsburg, PA 17055, sale value (see attached settelment sheet) TOTAL (Also enter on Line 1 Recapitulation) I $ 128, 062 73 swasss z.ooo If more space is needed, use additional sheets of paper of the same size. REV-1508 EX+ (t',-10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS ~+ INHERITANCE TAX RETURN f ~ MIS ~+. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Rosella Jean House 21 11 0339 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 1999 Buick automobile sale value 3,750.00 2 Central Penn AAA refund due the decedent 31.36 3 Geico refund on auto insurance policy 78'42 4 Household goods sale value 1,305.00 5 Household goods retained by residual beneficiaries. 640.00 6 Household goods bequest of dark ine d p~ ry sink to Margaret Marie Erickson 90.00 per Article IV, item number 2. 7 Household goods bequest of small oak writing desk to Ray Richard Strayer 180.00 per Article IV, number 3. 8 Various jewelery, bequest of all jewelry to Karen LaDawn House per Article 1,240.00 IV, Item 1. (see attached appraisal) 9 Member's lst Federal Credit Union savings account #26968-00 563.22 10 Member's 1st Federal Credit Union checking account #26968-11 15,086.25 11 Member's 1st Federal Credit Union checking account #26968-05 274.61 12 Patriot News refund due the decedent 178.37 13 Penn Waste refund due the decedent 33.12 14 Riding mower sale value 350.00 Total from continuation schedules 49.00 TOTAL (Also enter on line 5, Recapitulation) $ 23, 849.35 owa6AD 2.000 If more space is needed, use additional sheets of paper of the same size. Estate of: Rosella Jean House Schedule E (Page 2) 21 11 0339 Item No. Description Value at Date of Death 15 Tax refund on 2010 income tax return 49.00 Total (Carry forward to main schedule) 49.00 REV-1510 EX + (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY tJIAfEOF Rosella Jean House 21 11 0339 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 DESCRIPTION OF PROPERTY NUMBS II~CLIAETFENAMEOFTFETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAND TFEDATEOFTRPIJS~ER ATTACHACOPV OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET' %OFDECD'S EXCLUSION TAXABLE 1 INTEREST IF APPLICABLE VALUE . Member's 1st Federal Credit Union 22,521.14 100.0000 0.00 22 521 14 IRA account #269688-15 , . Beneficiaries are Karen Vasiliadis a/k/a Karen LaDawn House and Robert Strayer in equal shares TOTAL (Also enter on line 7, Recapitulation) $ 22 521.14 If more space is needed, use additional sheets of paper of the same size. 9W46AF 2.000 REV-isil Ex+(iaosl Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS tSIATE OF FILE NUMBER Rosella Jean House 21 11 0339 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. Gingrich Memorials headstone engraving 160.00 'Total from continuation schedules B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s)Robert Lee Strayer Street Address 1003 Park Place City _Mechanicsburg State PA ZIP 17055 Year(s) Commission Paid: 2 3 4. 5. 6. Attorney Fees: Snelbaker & Brenneman, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Robert Lee Straver Street Address 1003 Park Place City Mechanicsburg State PA ZIP 17055 Relationship of Claimant to Decedent SON Real Estate was sold 10 31 2 C aimant rest e in e Probate Fees: same household as the decedent at the time of her death. Accountant Fees: Tax Return Preparer Fees 10,750.30 7,500.00 3,468.75 3,500.00 323.50 7. 1 Chuck Bricker appraisal fee for household goods 100.00 2 Cumberland Law Journal advertise Executor's Notice 75.00 Total from continuation schedules 16,328.14 TOTAL (Also enter on Line 9, Recapitulation) $ 42 , 205.69 swasAC z o0o If more space is needed, use additional sheets of paper of the same size. Estate of: Rosella Jean House Schedule H Part 1 (Page 2) Item No. Description 2 Myers Funeral Home funeral services 3 Karen House reimbursement for funeral luncheon Total (Carry forward to main schedule) 21 11 0339 Amount 10,413.00 337.30 10,750.30 Estate of: Rosella Jean House 21 11 0339 Schedule H Part 7 (Page 2) 3 Mary Murray, Tax Collector real estate taxes 1,678.05 4 MetEd Electric electric service 106.29 5 Monroe Tonwnship Sewer Authority sewer services 220.00 6 Penn Waste trash service 47.85 7 Register of Wills short certificate 4.00 8 RSR Appraisers & Analysts real estate appraisal fee 350.00 9 Settlement charges associated with the real estate sale a. Broker's commission $7,815.00 b. Notary fees $10.00 c. Transfer taxes $1,270.00 d. Tax certification $5.00 e. Sewer charges $220.00 f. Home warranty $514.00 g. Seller assist $2,621.00 12,455.00 10 The Sentinel advertise Executor's Notice 219.40 11 United Water water service 47.55 12 Reserve for filing fees, accounting fees and other costs associated with the administration of the estate 1,200.00 Total (Carry forward to main schedule) 16,328.14 REV-1512 EX + (12-0a) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Rosella Jean House FILE NUMBER 2~ i 1 n~- Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Comcast cable tv, phone and Internet services 308.38 2 Home Instead Senior Care in home nursing care 2,678.58 3 Member's 1st Federal Credit Union Home equity loan #26968-02 44,138.40 4 MetEd Electric electric service 189.80 5 United Water water service 55.39 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS TOTAL (Also enter on Line 10, Recapitulation) $ 47 370.55 awasAH z o0o If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania DEPORTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: Rosella .Taan u~„moo SCHEDULE J BENEFICIARIES IMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY [ TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] t''Karen LaDawn House 15 Palmer Drive jCamp Hill, PA 17011 Various jewelery, Inventory Value: 1,240.00 1 One Half of Residue: 41,673.49 2 Robert Lee Strayer 1003 Park Place Mechanicsburg, PA 17055 One Half of Residue: 41,673.49 FILE NUMBER: 21 11 0339 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Daughter Son 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: 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 42,913.49 41,673.49 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0 0 0 swasAi z.ooo If more space Is needed, use additional sheets of paper of the same size. Estate of: Rosella Jean House Item No. Description 3 Margaret Marie Erickson 123 Church Street Taylor, PA 18517 Household goods Inventory Value: 90.00 4 Ray Richard Strayer 889 King Street Lewisberry, PA 17339 Schedule J Part 1 (Page 2) Relation Niece 21 11 0339 Amount 90.00 Household goods Inventory Value: 180.00 Brother 180.00 Previous editions are obsolete A. Settlement Statement B. Tvoe of Loan farm HUD-t (3lfifi) ref Handhook 4305.2 U.S. Department pf Housing and Urban Development Imo r royal rv0. Z5U2-UY65 1. ^FHA 2. ^FmHA 3. ^Conv. Unins. 6. File Number 7. Loan Number I, 8. Mortgage Insurance Case Number I 4. OVA 5. ~Conv.lns. 11153 ~ I Is orm Is is o give you a s men n pal o an y e se a agen ar C. Note: Items marketl'(p.o.c.)' were paid outside Ne closingaMey are shown here for information purposes and are not inclutled in the totals. TItteEXpreSS Settlement $yStem WARNING: It is a crime to knowingly make false statements to the Unitetl States on this or any other similar form. Penalties upon I conviction can include a fine and im nsonment. For details sae, nna tau. s. code section ,001 and section tot0. Printed 10/3112011 at 12:22 KS D. NAME OF BORROWER: Eugene Keith and Martha Keith ADDRESS: 1250 Brandt Road Mechanicsbur Pa 17055 E. NAME OF SELLER: Estate of Roselle J. House ADDRESS: F. NAME OF LENDER: ADDRESS: I G. PROPERTY ADDRESS: 815 West Keller Street, Mechanicsburg, PA 17055 Monroe Townshi H. SETTLEMENT AGENT: Keystone Land Transfer, Ltd, Telephone: 717-731.4200 Fax: 717.731-17991 PLACE OF SETTLEMENT: 3421 Market Street Cam Hill PA 17011 I. SETTLEMENT DATE: 1 0131 /2 01 1 J. SUMMARY OF BORROWER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER K. SUMMARY OF SELLER'S TRANSACTION: 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales rice 127 000.00 401. Contract sales rice 127 000.00 102. Personal roe 402. Personal ro ert 103. Settlement char es to borrower line 1400 2 625.75 403. 104. 404. 105. 405. Ad'ustments for items aid b seller in advance Ad'ustments for items aid b se ller in advance 106. Cit !town taxes _ 406. Cit !town taxes 107. Count taxes 10131N 1 to 12/31/11 63.66 407. Count taxes 10/31/11 to 12131111 63.66 108. School Taxes 10/31111 to 06/30/12 850.81 408. School Taxes 10131/11 to 06/30/12 850.81 109. Sewer 10/31N 1 to 12131111 148.26 409. Sewer 10/31111 to 12/31111 148.26 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 130 688.48 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 420. GROSS AMOUNT DUE TO SELLER 128 062.73 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. De osit or earnest mone 2 000.00 501. Excess De osit see instructions 202. Princi al amount of new loans 502. Settlement char es to seller line 1400 9 834.00 203. Existin loan s taken sub'ect to 503. Existin loan s taken suti'ect to 204. 504. Pa off of First Mort a e Loan 44138.40 Members 1st Federal'Credit Uni 205. 505. Pa off of second mort a e loan 206. 506. 207. 507. Inheritance Tax Escrow 4 288.15 Ke stone Land Transfer Ltd 208. 508. 209. 509. Ad'ustments for items un aid b seller Ad'ustmemts for items un aid b seller 210. Cit (town taxes 510. Ci /town taxes 211. Coun taxes 511. Count taxes 212. School Taxes 512. School Taxes 213. 513. 214. 514. 215. Seller Assist 2 621.00 515. Seller Assist 2 621.00 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BYIFOR BORROWER 4 621.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 60 881.55 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLE R 301. Gross amount due from borrower line 120 302. Less amounts aid b /for bonower line 220 130 688.48 4 621.00 601. Gross amount due to serer line 420 602. Less reduction amount due seller line 520 128 062.73 60 881.55 303. CASH FROM BORROWER 126 067.48 603. CASH TO SELLER ~~ 67181.18 SUBSTITUTE FORM 1099 SELLER STATEMENT: The infortnatimn contained herein is important taz information and is being furnished to the Internal Revenue Service. N you are requiretl to file a return, a negligence penalty or other sangion will be imposed on you it this item is required to be repoAetl and the IRS determines that it has not been repdrted. The Contract Sales Price described on line 401 above constitutes the Gross Proceeds of this trensaction. I you are required by law to provide the settlement agent (Fed. Tax f0 No: 1 with your correct taxpayer idenbficason number, lt you tlo not provide your cored taxpayer identification number, you maybe subject to civil or criminal penalties Imposed bylaw. Under penalties of perjury. I cerfify that the number shown on this statement is my cored LvWayer identification number. TIN: / SELLER(S) NEW MAILING ADDRESS: _ SELLER(S) PHONE NUMBERS: SELLER(S)SIGNATURE(S): Previous editions are obsolete U S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT ST4TFMFNT File Number: 11153 ' form HUD-1 (3/86) ref Handbook 4305.2 PAGE 2 -- I metx ress Settlement S stem L. SETTLEMENT CHARGES Printed 10/31/2011 a PAID t 12:22 KS 700. TOTAL SALES/BROKER'S COMMISSION based on rice $127 000.00 = 7 815.00 FROM BORROWER'S PAID FROM ' Division of commission line 700 as follows: ' FUNDS SELLER S 701. $ 3 810.00 to Re/Max Real Associates Inc. AT SETTLE FUNDS AT 702. $ 4005.00 to ERA-NRT Inc. MENT SETTLEMENT 703. Commission aid at Settlement 7 815.00 704. Broker Fee to RelMax Real Associates Inc. 295.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee °/a 802. Loan Discount °/p 803. A raisal Fee I I 804. Credit Re orf 805. 806. 807. 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to $ /da 902. Mort a elnsurance Premium for to 903. Hazard Insurance Premium for to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo. $ Imo 1002. Mort a e Insurance mo. $ /mo 1003. Cit Pro erf Tax mo. $ !mo 1004. Count Pro rf Tax mo. $ 31.23 /mo 1005. School Taxes mo. $ 106.35 Imo 1009. A re ate Anal sis Ad'ustment 0.00 0.00 1100. TITLE CHARGES 1101. Settlement or Closin Fee 1102. Abstract or Title Search 1103. Title Examination 1104. Title Insurance Binder 1105. Document Pre aration 1106. Nola Fees to Kristen D. Shive 5.00 10.00 1107. Attorney's fees includes above items No: 1108. Title Insurance to First American Title Insurance Com an ' 993.75 includes above items No: 1109. Lenders Polic 1110. Ownel's Polic -5011442-21364 127 000.00 - 993.75 I 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin Fees Deed 62.00 Mort a e $ Release $ 62.00 1202. Cit /Count tax/stam s Deed 1 270.00 • Mort a e $ 1 270.00 1203. State Tax/slams Deed 1 270.00 Mort a e ~' 1 270.00 1204. Deed $ Mort a e $ 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1302. Tax Certification Fee to Ke stone Land Transfer Ltd 5.00 1303. Sewer 10/1-12/31 to Monroe Townshi i 220.00 1304. Home Warran to American Home Shield 514.00 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K ' 2 625.75 9 834.00 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-t Settlement Statement and to the best o y 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 receivetl copy of UD-1 Settlement Statement. /~ ~ ~ ~ ~ ~i r to e a e o a ou ~~~~ ~~ I WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Settlement Statement which I h~ UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION transaction. I have causetl orwill cause the CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 78: U.S. CODE SECTION 1001 AND SECTION 1010. ( ~ t SETTLEMENT 'pared is a We and accurate account of this to be disbursed in accordance with Nis statement. DnrE: ~ '~' ~~ ~ NOV-S1-il 12:35 PM Joseph James 7177957257 P.@1 f _ ~ 1 ~ F ~ I i / ~ ~) r J'osEp~ DAMES .IEWELERS I; ~1'U W!!OM I"1 Mt1Y CC1N(,({kN; 7hix is lu eartily thm wc. alt rngaged in ihC jc~.elry baxinrss, apprnixing Diamonds wau:hcx, ewch and retinas ~r m ((~ aKaninrd tM: 1'o11,)w;,tA IixtrJ and descrlb.,~l N~ IIl'rl f, the pmpcn) nr 1 Y P x l Cb V!'ali d~xu iiN tans We herCwllh GCIZiry fi1Bl tvl' (7avt' lln7 lltl) G1fCr11riy NAME: Cslnte of Itns~Ila I louse af)OItLSS: c/n Kann Ifuu5c li I'.tfrrtcr 1>riv~, Camp liill, PA UUI 1 WC CRt101(rt1' 1qC ~'araP NY rl5led C)! IM1RaIAIIC{~ VI VIhCf pUrp0AC5 hf II11' GlUlllll ITI S71 YdIVI', G'ICIJii;ng Fadri nl n~~d alhcl ta~cy. in making This Appraisal we UO NfY'f 4greq~t0 p~uclfAeC O' fcvlhcr tllf Articles. ~)IrS(.'ltI!''I'IO~ The followttl~ items are evaluated for estate purposes: Assorted ster[ing silver items including, but nut limited to, chants, bt'acelets, earrings, watch: individt{A,IIy, these items have little value. As a unit, Uresc items have an appruxirnatc weight of ,39,5 grants, Value: $;i8U.UU a i A$sot'tecl sterling silver rings with mar'casi(e, cc, and various imitation and /or genuine stones: lndivid}salty, these itcti~s have little value. As a unit those items have an approximate weight oC 3.8 grams: VAluc: ~33~,00 One 14K white ~;uld % ct dianti~nd cngagcrzunt ring; Value: $150.04 One pair of 1~7K whitc,<_;old ear'r'ings, 3.Rgrams: 7 Value: ~98.OU v t Two 14K white gold anniversary rings with cubic zirconia: , Vaiuc: $7(1.00 each k Two 14K white gold wt:dding ring enhanccrr with cultic ZlfcOlliil: Value: ?0.00 each ~ ~BUg.Jd hu (oz eguing AppraiRal is Ihade with the under;ul~l~fir~~ Ihat the Appniwr nax:m~ex na Iiabili:V with respect tq nny Actiwl that mxS be !aken nn the haciR of rAk Arry1. R;gal ' C 3011 East Main Str•CE)t: ~ Mncl~lanicsbur•g. P/a 17055 [717) 755-9224 LAST WILL AND TESTAMENT OF ROSF.LLA JEAN HOUSE I, Rosella Jean House, a resident of Mechanicsburg, Pennsylvania declare this to be my Last Will and revoke all former Wills and Codicils. ARTICLE I Identification of Family At the present time I am unmarried. In making this Will I have in mind my children, Robert Lee Strayer, born 1951, and Karen LaDawn House, born 1961, but does not include any children hereafter born to or adopted by me. Any reference to a "child of mine" or "my children" shall include the persons named or referred to in this Article. ARTICLE II Disposition of Remains I direct that my remains be buried in Mechanicsburg Cemetery in existing burial plot and tombstone. I authorize my Executor to carry out these directions and wishes, particularly those for the disposition of my remains. ARTICLE III Appointment of Fiduciaries A. Appointment of Personal Representative. I appoint my son, Robert Lee Strayer, as Executor of my estate. If Robert Lee Strayer is or becomes unable or unwilling to serve, I appoint my daughter, Karen LaDawn House as alternate Executor. B. Bond; Court Supervision. My Executor shall have the right to serve without bond and to administer and settle my estate without the intervention or supervision of any court, except to the extent required by law. Nothing herein shall prevent my Executor from seeking the assistance of the court in any situation where my Executor deems it appropriate. ARTICLE IV Specific Gifts A. Gifts of Specified Items of Property. I give all my interest in certain items of tangible personal property to the beneficiaries designated in this section as follows: 1. Specific Gift One. I give all jewelry including a white gold 14K Will of Rosella Jean House Page 1 of 6 Initials: ~ ~~~~ Date: rf" ~' ! ~ half-carat diamond ring to my daughter, Karen LaDawn House if she survives me. If Karen LaDawn House does not survive me, I give this gift to my granddaughter, Sabrina Rose Vasiliadis. 2. Specific Gift Two. I give my dark pine dry sink (belonged to Grandma Gettys) to my niece, Margaret Marie Erickson if she survives me. If Margaret Marie Erickson does not survive me, I give this gift to my brother, Ray Richard Strayer. 3. Specific Gift Three. I give my small oak writing desk (belonged to my mother) to my brother, Ray Richard Strayer if he survives me. If Ray Richard Strayer does not survive me, I give this gift to my nephew, Richard Keith Strayer. 4. Specific Gift Four. I give a crocheted heart shaped pin cushion (green and yellow) made and given to me by Grandma Gettys* as a gift *Sabrina's great great grandmother to my granddaughter, Sabrina Rose Vasiliadis if she survives me. If Sabrina Rose Vasiliadis does not survive me, I give this gift to my daughter, Karen LaDawn House. B. Insurance. I give to each recipient of an item of tangible personal property my interest in any insurance covering the item. My purpose in making this gift is to give each recipient the benefit of insurance coverage for which I have already paid. It is not my intention to give any recipient the proceeds of an insurance claim that exists but is unpaid at my death. ARTICLE V Disposition of Residue A. Provision for Descendants. I give all of the rest and residue of my estate, wherever located (hereafter referred to in this Article as "residue"), to my descendants if they survive me per stirpes. 1. Provision for Others. If I am not survived by any of my descendants, I give the entire residue to my heirs. ARTICLE VI Alternative Methods of Distribution A. Purpose of Article. Recognizing that under certain circumstances the terms of this Will may direct that property be distributed outright to a person who is under age twenty-one (21) or under a legal disability; I make the following provisions to facilitate the distribution of property to such persons. B. Alternative Methods. Whenever the terms of this Will direct my personal representative (referred to in this Article as the "fiduciary") to distribute property outright to a person who is then under age twenty-one (21) or under a legal disability, the fiduciary may retain pursuant to Paragraph C. of this Article or distribute all or any portion of that property in any one Will of Rosella Jean House Page 2 of 6 Initials: ~L~J -~-pate: /- c~ ~ (( or more of the following ways: 1. Delivery directly to the beneficiary; 2. Delivery to the parent or stepparent of the beneficiary; 3. Delivery to the guardian of the beneficiary's person or property; 4. Delivery to any Custodian for the beneficiary under the Uniform Gifts to Minors Act; 5. Delivery to any then existing trust created for the beneficiary; 6. Deposit in a financial institution in an account established in the name of the beneficiary alone pursuant to the laws of the State of Pennsylvania; 7. Storage of any tangible personal property in safekeeping with the costs of storage to be borne by the beneficiary; or 8. Sale of any tangible personal property and delivery of the proceeds in any manner permitted by this Article. Provided the fiduciary acts in good faith, upon delivery of any property in accordance with the provisions of this Article, the fiduciary shall be discharged from all responsibilities in connection with the property. C. Discretionary Trust. Any property not distributed as provided in Paragraph H. of this Article shall be retained by the fiduciary in trust for the beneficiary on the following terms and conditions: During any period in which the beneficiary is under a legal disability or under twenty-one (21) years of age, the fiduciary shall pay to or apply for the benefit of the beneficiary so much of the income and principal of the trust as the fiduciary, in its sole and absolute discretion, determines is advisable for the beneficiary's health, support, education and general welfare. At such time as the beneficiary is neither under a legal disability nor under age twenty-one (21), the fiduciary shall distribute any remaining trust assets to the beneficiary. If the beneficiary dies before all of the trust assets have been distributed, the fiduciary shall distribute any remaining trust assets to the beneficiary's estate. ARTICLE VII Administrative Provisions A. Powers and Duties of Personal Representative. My personal representative shall have all of the powers and duties granted to or imposed upon personal representatives serving with non-intervention powers pursuant to the laws of the State of Pennsylvania. B. Debts and Expenses. All expenses of administration chargeable to principal, the Will of Rosella Jean House Page 3 of 6 Initials: `;~~~~~ Date: ~ - ;.~... t ~ expenses of the disposition of my remains, and all my legitimate debts, if and when paid, shall be paid from the principal of my residuary estate. No debt need be paid prior to its maturity in due course and except as otherwise provided in this Will no interest in any property passing under this Will need be exonerated. C. Taxes. All estate, inheritance or other similar death taxes, together with any interest or penalties thereon, arising by reason of my death with respect to any property includable in my taxable estate, and any adjusted taxable gifts, whether passing under or outside of this Will, shall be paid from the principal of my residuary estate without reimbursement from the recipients or beneficiaries of such property, provided, however, that in the event any proceeds of insurance upon my life or any property over which I held a power of appointment are included in my estate for purposes of determining the federal estate tax liability of my estate, then the residue of my estate shall be entitled to receive from the recipients of any such proceeds or property the portion of such federal estate tax liability attributable to such proceeds or property determined in accordance with IRC §§ 2206 and 2207. ARTICLE VIII Miscellaneous A. Number and Gender. Unless the context indicates a contrary intent, the plural and singular forms of words shall each include the other, and every noun and pronoun shall have a meaning that includes the masculine, feminine and neuter genders. B. Survival. To "survive" me, as that term is used in this Will, a person must continue to live for thirty (30) days after my death. C. Descendants. The "descendants" of an individual include only the following: 1. All such individual's biological descendants, except any person not born in lawful wedlock and his descendants, unless the biological parent who would otherwise cause him or her to be a descendant has acknowledged paternity or maternity in legitimation proceedings, or in an unambiguous signed writing identifying such person by name, or by raising such person in the same household; and 2. Persons adopted by such individual or one of his or her descendants, and their descendants. If the parent, who would cause a person to be a descendant as defined above, is replaced in an adoption proceeding, such person shall remain a descendant unless such parent voluntarily consents to the relinquishment of his or her status as parent in connection with such adoption proceedings. D. Heirs. The term "heirs" shall mean those persons entitled to inherit under the then-applicable laws of the State of Pennsylvania governing the descent of an intestate's separate Will of Rosella Jean House Page 4 of 6 Initials: ~ Date: (- `- f j estate. They shall inherit in their statutory proportions. E. Exclusion of Pretermitted Heirs. Other than as set forth in this Will, I make no provision for any child of mine or descendant of a deceased child of mine. I specifically make no provision for any person (whether now living or hereafter born), other than a child named or referred to in Article I or a descendant of mine as defined in this Will, who may be entitled to claim an interest in my estate under the laws of the State of Pennsylvania. F. Legal Disability. A person is under a legal disability if my personal representative determines, in good faith, that the person is incapable of managing her property or of caring for herself, or both, or is in need of protection or assistance by reason of physical injury or illness, mental illness, developmental disability, senility, alcoholism, excessive use of drugs, or other physical or mental incapacity. G. Title to Real Property. Upon my death, title to any real property passing under this Will shall vest in my personal representative in his fiduciary capacity and shall remain so vested until my personal representative distributes or sells that property, at which time title shall vest in the distributee or purchaser. H. Disclaimer. Except as may be otherwise specifically provided in this Will, in the event that any beneficiary disclaims an interest arising out of this Will or any trust created herein it is my intention that the interest disclaimed shall be distributed in the same manner and at the same time as if the disclaiming beneficiary had died immediately preceding the event pursuant to the laws of the State of Pennsylvania. I. Governing Law. The provisions of this Will shall be interpreted in accordance with and in light of the laws of the State of Pennsylvania. J. Corporate Successors. Whenever a corporation or other business entity is referred to herein, the reference shall include any successor organization. K. References to Statutes. In this Will, the abbreviation "IRC" shall refer to the Internal Revenue Code of 1986 as amended. Will of Rosella Jean House Page 5 of 6 Initials~~~~ Date: ~ _ w - ~~ I have initialed and dated for identification purposes all pages of this, my Last Will, and have executed the entire instrument by signing this page on the ~,i~'~ day of ~~_ ~t,ccc~_, 2p ~ ~ , at ~l~C ~t~i ~ ~ u~~ ,Pennsylvania. %J Rosella can House Attestation and Statement of Witnesses Each of us declares under penalty of perjury under the laws of Pennsylvania that Rosella Jean House, the Testator, signed this instrument as her Last Will in our presence, all of us being present at the same time, and we now, at the Testator's request, in the Testator's presence, and in the presence of each, other, sign below as the witnesses, declaring that the Testator appears to be of sound m~d:id unde' .no duress, fraud, or undue influence. ` I ~ 4 ---- [Witness Signature] [Witness Signature] ~- -mot ~_~~`~~ I ~... _ ~_ ~ la's [Print Name] [Print Name) Residin at Residin~ at Will of Rosella Jean House Page 6 of 6 Initials: ~`< Date: ~~ "c~- / / -- f~ SELF-PROVING AFFIDAVIT STATE OF PENNSYLVANIA } COUNTY OF } ss. u~I~.nd } I, the undersigned, an officer authorized to administer oaths, certify that Rosella Jean House, the Testator, and ~l~rrrt~~ SGt-^sSo~r,r. c'~ r~ NUIIU (~Idis ,and the witnesses, whose names are signed to the attached or foregoing instrument and whose signatures appear below, having appeared together before me and having been first duly sworn, each then declared to me that: 1) the attached or foregoing instrument is the last will of the Testator; 2) the Testator willingly and voluntarily declared, signed and executed the will in the presence of the witnesses; 3) the witnesses signed the will upon request by the Testator, in the presence and hearing of the Testator, anal in the presence of each other; 4) to the best knowledge of each witness the Testator was, at that time of the signing, of the age of majority (or otherwise legally competent to make a will), of sound mind and memory, and under no constraint or undue influence; and 5) each witness was and is competent and of the proper age to witness a will. ,- ~" ~ e~ ~ ~~ [Witness Signature] ~~ [Print Name] ,~ ~ / Rosella Jean House C.1`c.C ~` ~ ._.__._ , _ [W tness Signature] ~ 1~ L. /-~l~i [Print Name] Residing at ~ i~'Mrl~-rF~~n7~1 ~ ,~ f~ - Residing. X _ ;~- Section for Notary Public: Subscribed. sworn and acknowledged before me by the said Rosella Jean House, Testator, and by the said i~~r~~ t...S c~_s~~~_me.~~n and _ I~-~ c~ 11 ~ ~ l~, ~? ~c~ t`~ witnesses, this t~;} day of _~~- 20 (I ' ~~ ~~~ ~~ Signature of otary] U-e I< ~Y1 ~ r,_0. n [Print or stamp name o otary] t±OMfltKJNWEALTH OF PENNSYLVANIA TMorpan Nofaty F+ubMp wp., Curt~badapd Co1r1ly ~'~~~ 7,2013 ~~.4~mher, Pe!rsnscyh~ania A of Notaries