The URL can be used to link to this page

Home My WebLink About01-20-12 (2)J 1505611185 EX (02-11) (FI) REV-1500 f PA Department of Revenue Bureau of Individual Taxes Po Box zlsosol INHERITANCE TAX RETURN HarrisburgF PA 17128-1)601 RESIDENT DECEDENT ENTER DECEDENT INF RMATION BELOW S OFFICIAL USE ONLY County Code Year File Number 21 10 D855 octal Security Number Date of Death MMDDYYYY Date of Birth 177-24-5470 MMDDYYYY Decedent's Last Name 0 812 2 010 101319 2 9 Suffix Decedent's First Name BRETZ, JR. MI (If Applicabte) Enter Surviving Spouse's Information Below H A R V I E Spouse's Last Name A Suffix Spouse's First Name MI Spouse's Social Security Numbrer _ _ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN APPROPRIATE BOXE$ BELOW REGISTER OF WILLS 1. Original Return ^ 2. Supplemental Return ^ ^ 3. Remainder Return (Date of Death 4. Limited Estate ^ Prior to 12-13-82) 4a. Future Interest Compromise (date of ^ ^^ death after 12-12-82) 5. Federal Estate Tax Return Required X 6. Decedent Died Testate (Attach Copy of Will) ~ Decedent Maintained a Living Trust ~ ^ ^^ (Attach Copy of Trust.) 8• Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) ~ 11 Election to Tax under Sec. 9113(A) Name CORRESPONDENT - THIS SECTI~pN MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOtRMATION SHOUOLD B RICHARD C . Daytime Telephone Number E DIRECTED TO: SNELBAKER, ESQ First Line of Address 44 WEST MAIN STREET Second Line of Address P•O• BOX 318 City or Post OfficE~ MECHANICSBURG Correspondent's a-mail address: Under penalties of perjury, I declare th~t I it is true, correct and complete. Declar 'tio SIGNATURE OF PERSON SPON I L ADDRESS R• M CHAEL BRETZ,!,E SIG E (~~pgRER OTHER H 717-697-8528 REGISTER OF WILLS USE ONLY --~ ..,-- --~ _-~ ,_ :, .~ ;., ,, State ZIP Code DATE FILED PA 17055 _.., .: - n of preparer other than the personal rep esema'tivesshbased onnallsnfoemation of wh chhpreparerfhas any knowledge. E R FILING RETURN y knowledge and belief, DATE XECUTOR ~ °~~~- AN REPRESENTATIVE 1318 OLD WILLOW MILL ROAD,MECHANICSBURG DATE A 1705 RICHARD C • SNELBAK R ~' ~~ ~a 44 WEST MAIN STREET, MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA 17055 L Side 1 ~~, ~. , f _. 150561118 ~ OM46473.000 15056],1185 rl ...J 1505611285 REV-15p0 EX (FI) Decedent's Name: RECAPITULATION Decedent's Social Security Number 17 7- 2 4- 5 4 7 p 1 • Real Estate (Schedule A) , 2. Stocks 1. and Bonds SSchedule B) . , , , , 1, 7 7 , 4 Q 7 , 0 4 2 3. Closely Held Corpgration, Partnership or Sole-Proprietorshi 2 8 ' S 0 2 •80 p (Schedule C) , 3 4• Mortgages and Notts Receivable (Schedule D) 0.00 5. Cash, Bank Depositls and Miscellaneous Personal Propert 4 y (Schedule E) p ' p Q 6. Jointly Owned Pro ~ ~ ~ ~ 5' p$rty (Schedule F) ~ Separate Billing Requested 7. Inter-Vivos Transfer$ & Miscellaneous N s 3 , 6 8 5.9 8 . on-Probate Property (schedule G) ... Se a 11, 4 0 7 • 8 2 p rate Billing Requested 8 7 . Total Gross Assets Qtotal Lines 1 through 7) ---- .... 27,169.23 9. Funeral Expenses anjd Administrative Costs (Schedule H). $ 2 4 8 ,172.87 10. Debts of Decedent, t~portgage Liabilities, and Liens (Schedule I) 9 14,698.59 11. Total Deductions (tot(~I Lines 9 and 10) . 10 3 , 6 8 0 12. Net Walue of Estate ~ ~ ~ ~ 11. (Line 8 minus Line 11) 13 18 , 3 7 8 7 4 . Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 an election to tax has not been made (Sch d . 229 794 e ule J) . , .13 1_=Value Subject to'~ax (Line 12 minus Line 13) ~ ~ ~ ~ 13. 0.00 TAX CALCULATION - SSE INSTRUCTIONS FOR ~ 14. 15 A . APPLICABLE RATES mount of Line 14 taxable 2 2 9 , 7 9 4 . ], 3 at the spousal tax rate, pr transfers un~(er Sec. 91 p6 (a)(1.2) X .0 L~ 16. Amount of Line 14 t xable 0 • 00 0 4 ~ 15. at lineal rate X . 17. Amount of Line 14 taxakple 2 2 9 , 7 9 4 •13 0.00 at sibling rate X .12 16. 1, 0, 3 4 0. 7 4 18. Amount of Line 14 taxat~le 0 • Q Q at collateral rate X 15 1 ~' . 0_ Q Q Q•OQ 18. 19. TAX DUE Q . 0 Q .1s. 1,0,340.74 20. FILL IN THE BOX IF YOU ARE REQUESTING A REF UND OF AN OVERPAYMENT 1..... Side 2 15D561128~ 1505611285 J OM4648 3.000 I REV-1500 EX (FI) Page 3 I~e..,..~__.._ 4 If Line 2 is greater than Line 1 + 4ine 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (3) D • 0 0 5. If Line 1 + Line 3 is greater than Llne 2, enter the difference. This is the TAX DUE. (4) 0 • 0 0 (5) 2, 990.74 'Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE ~OLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRI 1. Did decedent make a transfer and: ATE BLOCKS a. retain the use or income of the property transferred . Yes No b. retain the right to desijgnate who shall use the property transferred or its income ^ O c. retain a reversionary interest d. receive the promise foir life of either payments, benefits or care? 2. If death occurred after D$c. 12, 1982, did decedent transfer property within one year of death ^ without receiving adequate consideration? . . 3. Did decedent own an "in tlrust for" or payable-upon-death bank account or security at his or her death? ~ ^ 4. Did decedent own an individual retirement account, annuity, or other non-probate property, which ^ contains a beneficiary designation? . IF THE ANSWER TO ANY OF THE ABbVE ~ ^ QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT Ag pgRT OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfer is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 19p5, the tax rate imposed on the net value of tran s to or for the use of the surviving spouse [72 P.S. §9116 (a) (1.1) (ii)]. The statute do$s not exempt a transfer to a surviving spouse from tax, and the statuto re ' filing a tax return are still applicable even if tMe surviving spouse is the only beneficiary, sfers to or for the use of the surviving spouse is 0 rY qulrements for disclosure of assets and 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 f adoptive parent or a stepparent of the child is 0 percent 72 P. • The tax rate imposed orl the net value of transfers to or[for the §se osthe( decedent's lineal beneficiari or the use of a natural parent, an • The tax rate imposed on the net value oftransfers to or for the use of the decedent's siblings is 12 percent [72 P.S g under Section 9102, as an individual who fhas at least one parent in common with the decedent, whethes is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)]. § 116(a)(1.3)]. A sibling is defined, by blood or adoption. 3. Interest Total Credits (A + g) (21 7,350.00 OM4671 2.000 -~ ~4Q ~rdye' c, une 19) 2. Credits/Payments A. Prior Payments (~) 10 , 3 4 0 . 7 I{ g. Discount 7 , 0 0 0.0 0 350. REV-1502 EX+(01-70) Pennsylvania DEPARTMENiOF REVENUE INHERITANCE TAX RETURN RESIDE NT DECEDENT ESTATE OF: SCHEDULE A REAL ESTATE narvie A. FILE NUMBER: -~- Bretz Jr. would be exchanged betwee 21 10 0855 All real property owned sol¢ly or as a tenant in common must be reported at fair market value. Fair market value is defined as the ' 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 w(th ri ht of survivorshi Pnce at which property g p must be disclosed on Schedule F. ITEM Attach a copy of the settlement sheet if the property has been sold. NUMBER Include ~ copy of the deed showin d g ecedent's interest if owned as tenant in common. 1. Pro ert known ,and n DESCRIPTION VALUE AT DATE p y umbered as OF DEATH 5415 Wertzville'~,Road, Hampden Townshi County, Enola, pp, 17025 p' Cumberland 177,407.04 settlement sheet) ' sale value (see attached i swasss z o0o TOTAL (Also enter on Line 1, Recapitulation.] If more space is needed, use additional sheets of paper of the same size. $ 177 , 407.04 REV-1503 EX + (g.ggl COMMONWEALTH OF PENNSYLVANIA SCHEDULE B INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT FILE Alu property jointly-owned with right of survivorship must be disclosed on Schedule F. 1 10 0855 ITEM NUMBER 1. 23 "E~ ~~ DESCRIPTION Savings onds VALUE AT DATE (see attached listing) OF DEATH 28,502. 3wasse i.ooo TOTAL (Also enter on line 2, Recapitulation) g (If more space is needed, insert additional sheets of the same size) 28,502.80 I REV-1508 EX+(11-701 ~ - - pennsylvania DEPARTMENiOF REVENUE SCHEDULE E INHERITANCE TAX RETURN RESIDENT DECEDENT CASH, BANK DEPOSITS, ~ MISC esrarE of , PERSONAL PROPERTY Harvie A. Bretz Jr. Include the proceeds of litigation and the date the roc FILE NUMBER: .All property 'ointl owned with ri ht of ITEM 1 10 0855 mu NUMBER survivorshi st be dlsclo ed oneSchedu le F ~ • 1947 Willys Je$ DESCRIPTION VALUE AT DATE OF p DEATH aPPraised values -----_ 2 1977 Trailer 475.00 aPPraised value. 3 1980 Ford pickup truck 500.00 sale value 4 1996 Ford Ran e 9 ~' Truck 500.00 sale value 5 American Sentine'1 1,450.00 Insurance refund, due the decedent Co. 6 Cental Reserve L #~fe Co. 3.63 refund due the d ~cedent 7 Comcast Financia] Agency 192.89 refund due the decedent 8 Nationwide Mutual. Insuranc 60.74 e refund due the decedent Co. 9 West Shore Patholp ~' Ass 61.90 oc., refund due the decedent Inc. 10 Williams Grove Hi storical 57.02 Ste refund due the decedent am Engine Assoc. 384.80 -__ owasAD z.ooo TOTAL (Also enter on line 5, Ii more space is needed, use additional sheets of paper of the same sCZe. $~ 3,685.98 I - Pennsylvania - °EPgRTM':NTOFREVENL,E SCHEDULE F INHERIT,4NCE TAX RETURN ~T DECEDENT JOINTLY OWNED PROPERTY ESTATE OF: c " `'r • FILE NUM BER-~- If anasset bErcame'oin -~- f ~~ oW~d wrthin one year of the decedent's date of death, rt m 21 10 0 855 SURVIVING JOINT TENANT(S) NAA~(S) ust be reported on Schedule G. ADDRESS A Bretz RQATbNSHIPTODECEpQ,lr ~R• Michael 1318 Old Willow Mill Road, Mechanicsburg, pA 17050 Son JOINTLY OWNED PROPERTY: ffEM LETTER pA-~ FpR JOINT MODE NUMBER TENANT JOIM DESCRIPTION OF PRppg~-Iy INCLUD~NAh£GFFINgNCIALINSiITUTIgyqN DBANKqCCWNTNUM3ERCRSIMUR IDENTIFYING NUM3ER. ATTACH DEED FCR JgNTLY HELD REAL ESTATE. DATE OFDEAT}I V ~u DF S DATE OFDFI4TH 1 A Inceptio ~~ ~~ 11 E Savin s B ALUE OFASg~ ~~~ T VALUE OF D~®~TSINrERESr g onds (fee attached listing) 1,837.08 50.0000 2 A 2/23/2009 918.54 Americhoice Federal Credit Union I certificate of de Posit 10 370.88 50.0000 #44640-61 5,185.44 3 ~'~ 2/23/2009 Am~richoic I e Federal Credit Union I savings account #44640-01 5.60 50.0000 4 ~A 1/22/2009 Citii 2.80 ~ zens Bank I checking account 10,602.08 50.0000 ~ ~ ~ #62123987459 5,301.04 ~ ~ 9W46AE 2.000 If mire space is needed, use additioOnalAsheets of paper of the samecapitulation) $ 11,407.82 size. REV-1510 EX + (pq_09 8 W 46gF 2.000 pennsylvainia SCHEDULE G DEPARTMENT OFREVEMUE INTER-VIVOS TRANSFERS AND INH_RITANCE TAX RETURN RESIDENT DECEDENT MISC. NON-PROBgj'E PROPERTY :STATE OF narv1e A• Bretz This schedule must: be completed and fil FILE NUMBER 21 10 0855 ed if the ITEM DESCRIPTION F PROPERTY INCLLOE TFf PWME OF 7FE TRANSFEREE, THEIR RELATIONSHIP T JMBE T1`E DATE answer to an of uestions 1 throw h 4 on y q 9 Page three of the REV-1500 is e O DECEDEM AND OF iR,q~~ER gngDHA~~, OF THE DEED FOR REAL ESTATE. 1' Citizens Bank DATE OF DEATH VALUE OF ASSET o ~°OFDECD'S y s. EXCLUSION certificate of dleposit 5, 568.50 INTEREST 100 0000 IFgPPLICgBLE TAXABLE VALUE #6247568415. Account is as Harvie titled A . 0.00 5,568.50 . Bret=z , Jr . Trustee for Robert Michael Bretz. 2 Western Catholi c 'Union annuity } #140-1195 payable to R 21,600.73 100.0000 • Michael Bretz 0'00 21,600.73 TOTAL (Also enter on line 7, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 7,169.23 REV-1511 EX+(10.09) - _ Pennsylvania DEP,nRTMENTCFREVENUE SCHEDULE I-I INHERITANCE TAX RETURN FUNERAL. EXPENSES AND RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Decedent's debts must be reported on Schedule t. 21 10 0855 ITEM NUMBER A• FUNERAL DESCRIPTION EXPENSES: t Malpezzi F'unk~ral Home AMOUNT funeral services (paid by R. Michael Bretz) 7,803.08 B. ADMINISTRATIVE COSTS: t • Personal Representati(re Commissions: Name(s) of Personal Representative(s) Street Address ~_ City Year(s) Commission Paid: State ___ ZIP 2 Attorney Fees: Smelbaker & Brenneman, s. P. C. 4,467.75 Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City Relationship of Claimant to Decedent State ~_ ZIP ~--~_ 4. Probate Fees: 5 Accountant Fees: 315.50 6. j Tax Return Preparer Fees: 7 I 1 Cumberland Law Jqurnal i advertise Executor Notice 75.00 Total from contin,~ation schedules 2,037.26 swas,ac z.ooo If more space is needed, use additioOna sheets of Hoer on Line 9, Recapitulation) $ P pe of the same size. 14 698.59 Estate of: Harvie A. Bretz, Jr. Schedule H Part 7 (page 2) 2 Hampden Towniship sewer service (paid by R. Michael Bretz) 3 Leffler Ener~, heating fuel'(paid by R. Michael Bretz) 4 Martin J. Fl~~eY,y 201.0 income tax preparation 5 PPL Electric electric service (paid by R. Michael Bretz) 6 Register of Walls filing fee foxy Inheritance Tax Return 7 The Sentinel advertise Exec~itor Notice 8 Verizon phone service paid by R. Michael Bretz) 9 Reserve filirxg fees, abcountant fees costs associated with and other miscellaneous Decedent's the administration of the es tajte 21 10 OB55 150.00 333.00 150.00 117.88 15.00 219.40 51.98 1,000.00 Total (Carry forward to main schedule) 2,037.26 I REV-7572 EX+ (12-06) Pennsylvania DERART4IENTOF REVENUE INHERITANCE TAX RETURN -~ SIDENT DECEDENT ESTATE OF ~arvie A. Bretz Report debts incurred by M ----~-~- SCHEDULEI MORTGAGE LOIABIL TEES & LIENS FILE NUMBER decedent prior to d ITEM eath that remained unpaid at the date of d e 8 NUMBER eath, incluq ng unr i b rsed medical expense t Church of DESCRIPTION God Hbme s. VALUE AT DATE nursing home caire (paid b Y R OF DEATH . Michael Bretz) 2 Comcast cable tv service (paid by R 964.00 . Michael Bretz) 3 Continuin g Care ',RX perscri ption exp,~nses (paid by R 62.76 . Michael Bretz) 4 Harrisbur Ph ' g arm cy perscr.iption exp~nSe (paid by R 7 95 . Michael Bre tz) 5 Kath ryn Dock in home nursing dare (paid by R 16.64 . Michael Bretz) 6 Leffler Energy heatin g fuel (paid by R 160.00 Michael Bretz) 7 Lifeline in home monitoring system (paid by R 111.00 . Michael Bretz) 8 Live-In Care of p fin home ~ nursing calre (paid by R 26.12 . Michael Bretz) 9 Medco Health perscri ption expense (paid by R 595.00 . Michael Bretz) 10 Michael L angan, Tai Collector real estate tax 111.06 es (,paid by R. Michael Bretz) 11 Pennsylvania De ar p t ent m of Revenue tax due on 2010 Find 1+172.73 Individual Income Tax Return 12 ~PPL Electric electric service (paid by R 6.00 Michael Bretz) 13 Verizon phone service (paid Eby R 103.90 , Michael Bretz) 14 Verizon Wireless cell phone service (laid b R 25.95 y . Michael Bretz) III 115.34 ~~ Total from continual ion schedules • ~W46AH 2.000 IIf more space is e A l e 201 • 70 e ca itulationl $ needed, insert addi t onal sheets of th s 3 6 e same i 80.15 Estate of: Harvie A. Bretz, Jr. Schedule I 21 10 0855 (Page 2j Item No. Description Amount 15 West Shore Pathplogy medical expenses (paid by R. Michel Bretz) 16 West Shroe EMS 57.02 ambulance service (paid by R. Michael Bretz) 144.68 Total (Carry forward to mein schedule) 201.70 I I REV-1513 EX+(p1.10) pennsylvania DEPgRTMENiOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT :STATE OF SCHEDULE .1 BENEFICIARIES nwCtR NAME AND /#DDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUfiIONS [InGude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] ~ R• Michael Bretz 1318 Old Willow Mill Road Mechanicsburg, pA 17050 A1:1 of Residtjie: 229, 794 • 13 FILE NUMBER 21 10 0855 RELATIO IPNSH TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE ~-- OF ESTATE Son _`R DOLLAR gMOUNTS FC~R DISTRIBU170NS SHOWN ABOVE ON LINES 15 THROUGH 1~8 OF REV-1500 COVER SHEET, AS APp II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS WNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: ROPRIATE. 1. I B. CHARITAE3LE AND GOVERNM(~NTAL DISTRIBUTIONS: L TOTAL OF PART II .ENTER OTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 swnsrl 2.00o If .ore space is needed, use additional sheets of paper of the same size. OVER 229,794.13 0.00 ,y Il~fll~f„~~ A. Settlement Statement (HUD-1) B• TYPe of Loan OMB Approval No. 2502-0265 1. ®FHA 2. ~ RHS 3. ~ Conv. UninS, 4' ^ VA 5~ ~ Conv Ins 6. File Number. 7. Loan Number: 2011-0072-Fidelity 6. Mortgage Insu . . 58012.99610 rance Case Number: 446-1004643-703 C. Note: This farm is furnished to give you a statement of actual settlement costs. Amounts paid to and by th "(p.o.c)" were paid outside the closing; they are shown h f D. Name & Address of Borrower ere or informational purposes and ar E e settlement agent are shown. Items marked e not included in the total Jason 8. Eckman . Name & Address of Seller: s. 200 Camelof Arms York, PA >7406 Estate of Harvie A, Bretz, Jr., R. Michael Bretz, Executor F Name 8 Address of Lender: Fulton Bank N A 5415 WerizviUe Road Enola, PA 17025 , . ., One Penn Square, Suite 304 Lancaster, PA 17602 ~. r+roperty Location: 54115 Wertzville Road EnQla, PA 17025 Cumberland County J. SUmmarv nr a..._,....__._ --•-• ~ a~~sacuon 100. (gross Amount Due From Borrower 101. ontract sales price 102. Rersonal property ~- 103. Slettlement charges to borrower (line 1 104. ~. aecuement Agent: -~- DETHLEFS-PYKOSH LAW GRDUP, LLC, Darrel! C. Dethlefs, Esquire Phone Number: (717) 875.9446 2132 Market Street Camp Hill, PA 170>'1 Place of~ est. 2132 Market Street, Camp Hill, Pq 17011 K. Summary of Seller'c rra.,~,,..:__ I. Settlement Date: 12/09/2011 Disbursement Date:i2/pg/2p11 7U5. Adjust ents for Items paid b_y seller in _.r 106. City/town taxes 107. Ct~unty taxes 12/09/2021 to 12/31/2017 108 AsSeSSments 12/09/2012 to 06/30/2012 109 Mil-~zczpal i2/9/202~ to 12/32/2021 110. 111. 112. 120. Gr ss Amount Due From Borrower 200. Am unts Paid By Or In Behalf Of Borrower 201. Deposit or earnest money 202. Principal amount of new loan(s) 203 Existing oan(s) taken sublect to 204. i 205. ~--- 206. Seller Assistance w /Closing Costs 207, 208. I ~n~, I Adjustment's for items unpaid by seller 210. Citylto ' n taxes to 211. Counfy''..taxes to 212. Assess ents to 213. 214. 215. 216. ~'- 217. 218. 219. 4D0. Gross Amount Due To Seller 176, 500. 00 401. Contract sales price 402. P____ er~onal property S7, 961.57 403. 404, 405. Adjustments for items paid by seller in advance 406. City/town taxes 525.3a 407. Count taxes to Y 12/09/2017 to 12/31/2011 $894.20 405. Assessments 12/09/2012 to 537.50 409.Muni ci a.i: 06/30/2012 P 12/9/2OII to 12/31/201 410. 411. 412. 5285,368. 611 420. Gross Amount Due To Seller 500. Reductions In Amount Due To Seller S5, 000.00 501. Excess deposit (see instructions) 5172, 025. 00 502. Settlement charges to seller (line 1400) 503. Existing loan(s) taken subject to 504. Payoff of first mortgage loan 505. Payoff of second mortgage loan S7,I65.39 506. Seller Assistance w/Closin 4 Costs 507. 508. 509. Najus[ments for items unpai_ d- by se~ie~ 510. City/town taxes 511. County taxes ~- ~_ 512. Assessments 513. ..__'."-.--~° 514. ----~-_ 515. "_'-'---~- 516. ~---------- 517, ----~ 518. --------- $176,500.00 525.39 5849.20 $37.50 SI77, 407. 04 51,785.00 $7,165.39 519. 220. Total Pai BylFor Borrower 300. Cash At ettlement From/To Borrower 5289, 280' 39 301. Gross am unt due from borrower (line 120} 520. Total Reduction Amount Due Seller 6D0. Cash At Battlement TolFrom Seller S8, 950.39 302. Less amo nts paid by/for borrower (line 220) 5185, 368. 61 601. Gross amount due to seller (line 420) ( 5284,190.39 602. Less reductions in amt. due seller (line 520) S2 77, 907.09 303. Cash From S8, 950.39 ^ To Borrower 52,278 22 603. Cash ®To ^ From Sailer 5268,956. 65 The public R porting Burden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and reporting the data. This agency may not collect this information, and you are not required to complete this form, unless, it displa s a currently valid) OMB control number. No Confidentiality Is assured; this disclosure is mandatory. This is designed to provide the parties rn a RESPA covered transaction with information during the settlement process, y - ~ Page 1 of 3 HUD-1 L. Settlement Charges 700. Total Real Estate Broker Fees Division of Commission (line 700) as follows : 701. $ to Paid From 702 $ ~- Borrower's 703. Commission paid at Settlement to Funds at Sertlement 704. 800. Items Payable In Connection With Loan l P.o.c. by i 801. Our origination charge Ful too sank, 802. Your credit or charge (points) for the spec fc iinterest rate chosen 803. Your adjusted ori i $ 695. 00 $ (from GFE #1) g nation charges 804. appraisal fee t ar (from GFE #2) o ark xecls,an n PPrs I 805. Credit report to Creds ta P.o.c. by (from GFE A) 5695.00 r ( 806. Tax service to P.O.C. by 1 (from GFE #3) $425.00 807. Flood certification Corelogic Flood Sv ( I P O.C. by I (from GFE #3) 1 (from GFE #3) S6 97 808. 809. P.O.C. by ~ (from GFE #3 ) $71.50 810. 611. -_ 812. --~-.-_ _~ 900. Items Required By Lender To Be Paid In Advanc e 901. Daily interest charges from 12/09/20ZZ to 01/01/2012 902. Mortgage Insuran P @$ Z9 4422 ce remium for months. to FuZ ton Bank Lif /day (from GFE #10) ~ Sa47 IS e of Loan 903. Homeowner's ins (from GFE #3) Si , 703.22 urance for Ip Erie Insurance Z.00 Years, 904 5354-p0® $354. DO ~-'- (fro_ m GFE #11) --- to years. ----_ 905. -~_ iOGn w ---~-~_ eposited With Lender 1001. Initial deposit for your escrow account 1002. Homeowner's insurance (fro g) 1003. Mortgage insurance 3.00 months @$29.50 per month $ &a, gp 1004. Property taxes months @$161.95 per month 1005. S$iiool Taxes Il ~ 00 months @$34. Z9 1006. 7. 00 months @$I28. Z 6 per mpnfl $376. Og per month $ 897, ,2 1007. A gregate Adjustment months @$ per month-- i i00 TtCle Charges $ 3~"- 1101.Title services and lender's title insurance 1102. Settlement or closing fee ~-' (from GFE #4) 1103. Owne?s title insurance $~- 1104. Lender's title insurance (from- GFE #5j 1705. Lender's title policy limit S 172, 025. 00 1106. Owner's title policy limit $ 176, 500. 00 -- 110?. Aganfs portion of the total title insurance premium De thlefs-pykosh yaw Group $ 1 1 1108. Underwriter's portion of the total title insurance premium Fidelity Nat'I Title 1109. (Basic -End. 100, 300, 8, 1~ $20g. 06 i 1110, £i delity National Title (CPL Feel --~ 1?11. Darrell C. Dethlefs (Notary ="ee $75.00 I ?112. Dethl efs-Pykos.*. Law ) 1113. Group, LLC (Tax Cert Reimbursemen C; $25.00 1114. 1115. 1200. Government Recording and Transfer Charges ~_ 1201. Cumberland County Recorder 1202. Deed $ 64.00 Government recording charges: ;from GFE #7) 1203. Transfer taxes Cumberland Co~tMorigage $ 136.00 _~_ ;Releases $ ~ 1204. City/County tax/stamps: 1' Recorder Deed $ 1, 765.00 (from G- F- E #8) I 1205. State tax stamps: Mortgage $~- 1206. Deed $ 1, 765.00 Mongage $~~`- 1207. S 1208. 1209. $ 1300. Additignal Settlement Char es $ 1301. Required services that you can shop for 1302. (from GFE #6) 1303. 1304. 1305. 1306. ~ 1307. 1308. 1309. 1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) Previous editions are obsolete Page 2 of 3 $988.98 S2 , 698.75 -~_. $20.00 $200.00 S2 , 7 Paid From Seders Funds at Settlement $Z0. 00 $I0. 00 $1, 765. 00 S7, 962.57 I ' $2, 785. 00 r.L~~_1 I Comparison of Good Faith Esti mate (GFE) and HUD-1 Charges That Cannotln Charges crease Our origination charge HUD-1 Line Ni Your credit or char e p # 801 g (points) for the s ecific interest rate Your adjusted origination char chosen # 802 ges Transfer taxes # 803 # 1203 Charges That in Total Cannot Increase More Than 10% Government recording charges Appraisal Fee #1201 Credit Report Fee # 804 Flood Deter/Monitor #B05 Mortgage Insurance Premium # 807 Title Services/Lender's Si t1e Insurance #902 Ormer's Ti t1e Insurance #1101 # 1103 Increase between GFE and HL Charges That Can Chan ge Initial deposit for your escrow account Daily interest charges #1001 Homeowner's insurance # 901 $ IB. acz2 # 903 # Loan Terms 'Your initial roan I ~ s I72, o2s. 00 Your loan term is 30 years Kour initial interest rate is 4.12s % Your initial monthly amount owed for principal, interest and , and any mortgage insurance is $ 995. 67 includes ~~ Lf Principal ® Interest Mortgage Insurance C6n your interest rate rise? I ®No. ^ Yes, it can rise to a m i ax mum of %. The first change will be on and can change aoain every ~ 1=very change date, your interest rate can increase or Qr decrease by %. Over the life of the loan, your interest rate is guaranteed to never be lower than ° Evpn if you make payments on time, can your loan balance rise? gy~pp;; ~ or higher than e~J No. ^ Yes, it can rise to a i Ev$n if you make payments on time, can your monthly amount owed for principal interest and max mum of $ ~ No ^ Yes th f , , mortgage insurance rise? . , e irst increase can be on and the monthly amount owed can rise to $ Dogs your loan have a pre a The maximum it can ever rise to is S p yment penalty? ®No. ~ Yes your maxim Doet; your loan have a balloo , um prepayment penalty is $ n payment? ® No. ^ Yes, ycu have a ballo on payment of $ years on due in Total monthly amount owed including escrow account payments ^ Yo d u o not have a monthly escrow payment for items, such as property taxes and homeowner's insur ance. You must pay these items directly yourself. ® You have an additional monthl ~, y escrow payment of $ 191.85 that results in a total initial monthly amount owed of $ 2 167 52 , . . This includes principal, interest, any mortgage insurance and any items checked below: ® Propert tax y es ~ Homeowner's insurance Flood insu rance Note: ~f you have any questions about the Settl ® School Taxes ement Charges and Loan Terms listed on this form, please contact your lender. °•_•,~~~~a vav+t~nc a~A nhenieto Goo sti $695.00 So. o0 $695.00 $1,765.00 Good Faith Estimate 5200.00 $450.00 540.00 $SI.50 $I, 703.22 $1, 702.75 530.00 50.00 S0. DO $0.00 50.00 Total $4,237, 47 irges $ -72.03 or Good Faith Estimate S2, Z 08.33 fay -~- $330.50 $600.00 50.00 $0.00 50.00 50.00 $0. 00 50.00 So.ao Pace 3 of 3 HUD-1 Certification (continued from HUD-1) 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. Borrower: Seller or Jason ~ .Eckman Date: ~~~~i~ Agent: ~, ' ~v--- Date: ~02 ~ R. Michael Bretz, E cutor 200 Camelot Arms Estate of Harvie A. Bretr, Jr. York., PA 17406 5415 Wentzville Road Enola, PA 17025 `f'he HUD-1 Settlement which I have prepared is a true and accurate account of this tra saction. I have paused or will cause the funds to be disbursed in accordance with this statement. Date: Settlement Agent: Date: ~ ~ -~1- ii Darr ethlefs, Esquire --"~- WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. ADDENDUM TO Ht~D-1 SL'1"1'LEMENI' S't'A'1'LMEN1' NOTICE TD ALL PARTIES: If infgrrnalion is obtained which indicates that the source: of the borrower's financial contribution is other than from the borrower or other than stated by the lender in rts closing instructions, the se[tlernenl agent is to obtain written instructions from the lender before proceetling with se>ttlerncn(. CERTIFICATION OF BUYER IN AN FHA-INSURED LOAN TRANSACTION I certify that I have no knowledge of any loans that have been or will be; made to me (us) or lawns Utal have been or will be assumetl by ma (us) far purposes of financing this transaction, other Ihan thosa described in the sales contract dated October 19, 2011 (including addenda). I certify that I (w e) have not been paid or reimbursetl for any of the cash downpayment. I certify tha~: I (weJ have not and will not receive any payment or reimbursement for any of my (our) closing costs which have not been previously disclosed in the sales contract (including adde da) and/or my application for mortgage irsurance submitted to my (our) mortgage lender. .-~ /~ Boer r JAS E MAN le Borrower Date 9orrower Gale Borrower ~ - - Date CERTIFICATION OF SELLER IN AN FHA-INSURED LOAN TRANSACTION I certify Thal I have no knowledge of any loans that have bean or will be made to the borrow er(s), or loans that have been or will be assumed by the borrower(s), for purposes of financing This transaction. other than those described in the sales contract dated October 19, 2011 that I have not and will not (including addendaj. I certify pay or reimburse the borrower(s) for any part of the rash dow npayment. i certify that I have not and will not pay or reimburse [he borrower(s) for any par: of the borrower's closing tests which ~h,.a/v)e not been pre/fviously disclosed in the sales contract (includinn any addenda). ~~xe.~e sever ' Date Seller Owlc a'eller Dale Selier Jale CERTIFICATION OF SETTLEMENT AGENT IN AN FHA-INSURED LOAN TRANSACTION To the best of my knowledge, the I-IUD1 Set±lement Statement which I have prepared is a true and accurate account of the funds which were (i) received, or (ii) paid outs' e c sing, and the funds received have been or will be disbursed by the undersigned as part of the settlemen of fhi transaction. I further certify that I have obtained the above certifications which wore executed by the b crow er(s and seller(s) as indiraied. sememer~l ng ! DET eFS PYKOSIi LAW GROUP, pate [The certifications con?wined herein may be obtained from the respective parties at different limes or may be obtained on separate addc;nda.l WARNING: It is a crime to knowingly make false. s(atern cnts to R,e United Stetes on [his or any other similar form. Penalties upon conviction can include a fine and imprisonment. Far details; see: Title 1G U. S. Code Sections 1001 and 1070. -oao~o~toeoizava,o. Calculated Value of Your Paper Savings Bond(s) ,e Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 08/2010 900.00 ! $28,502 80 $2.0,602.80 Bonds: 1-Z3 of 23~ -~'~~ 915.68 Page 1 of ~.. C125770647EE EE „__. 0:03/1987 09/2010' 03/2017 ,_ X50.00 X107._16 __4...00% _ $157.16 C125770646EE EE. _ $100;03/1987 092010 03/2017,,,,,,,,,,,,,,$50..00;_, _ $.107.16 4.00%. C125717490EE. EE $100;,10/1986..10/2010; 10/2016: -° $.157.16 $50.00 $128.28 4.00% C118874640EE EE _„$100:10/1986 10/2010; 10/Z016178.28 C118874639EE EE _ . $50.00 $128.28 4.00% 17$.28 ,.. ' $100; 10/1986 10/2010 10/2016 $50.00 $128.28 4.00% _. .._$178.28 C112153279RR EE $100 10/1986 10/2010 10/2016 C112153280EE. EE - - $50.•00. .....$128.28 4.00%.__ $178.28 $100 10/1986 10/2010:10/2016 $50,00! $128.28 4.00% C1121532`iORR EE $100 09/1986 09/2010'. 09/2016 $178'28 C112153251EE EE $100 09/1986 09/2010 09/2016 $50.00 $128.28 4.00% $178.28 C1113386;73EE EE $100 05/1986 11/2010 05/2016 $50.D0 $128.28 4.00% $1.3'8,28 M14463278EE EE $1,000 .03/1986.09/2010.03/2016 $50.00 $131,88 4.00% $181,88 M208924S33EE EE $500.00 $1,318,80 4,00% $1,818,gp ..$1,000.03/1987 09/2010 03/2017 $500.00 ~+ o~ M20892494EE EE $1,000..03/1987 09/2010 03/2017 $500.00 X1,071,60 4.OOoo $1571.60 .1,071.60 4.00 /o $1~571.fs0 C1188746:38EE EE $100:10/1986 10/2010 10/2016 c118874637ee EE - _ $50.00 _ _.,.$128.28 4.00% $178.28 $100 1D/1986 10/2010; ,10/2016 C118874636EE EE - - $50.00 __ .,$128.28 4,00% $178.28 __ $100 10/1986 10/2010 10/2016. $50.00 $128,28 '4.00% 0112153278 EE . EE $100 10/1986 10/2010 10/2016: ~ 178.28 C112153277EE EE $50,00 $128.28 4.00% $178.28 C11215325'3EE EE $100.10/1986 10/2010 10/201.6 $50.00 $128.28 4,00% $178.2fi $100 09/1986 09/2010,! 09/2016 $50.00. $128.28 4.00% C112153252EE EE $100.09/1986.09/2010 09/2016: $~-7'28 C111338674EE EE $100 05/1986 11/2010 05/2016 $5D,00 $128.28 4.00% $1.78.28 M14453279EE EE _ _ ._. $50.00 .._..$131.88 4.00% $181.88 $1,D00 03/1986 G9/2D10 03/2016 $500.00 $1,318.80 4.00% $1,818.80 X490058 EE EE $.10,000:01/1986 01/2011 01/2016 $5,000.00 $1.3,548.00 4.00% 3ota~s for 23 ~csr~~s $7,9C~Q.QO $~ _ $x.8',548.00 _f~,cr(~2.8Ek ~28,502.5'Ek • - -- ~. - h~I Nct Issued l~tE Not eligible for payment P5 Includes 3 month interest penalty NiA Matured and not e~rninq interest Calculated ti'alue of Your Paper Savings Bond(s) .____...ea, Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 08/2010 •®'" I $318,75 ~ $1837.08 - - _ ~ 1 518.33 0.00 -- L __c:___ Bonds: 1°11 of 11' "t { f Page 1 of l 6317636200E Q63O0413898E E E $25'05/1979 ~ $25 04/1979: 05/2009 ; 18.75 ~ -$ ' $90.58: 1 09.33 $ MA 17636098E .~. ~ _. ... E ~- -$25 .03f 1979 ;: 04/2009 ~ 03/2009 ; $18.75 : - $18 75 89.53. _ ~ - _ , . .. -- - - _._ _ ~IO8.28 . MA Q6300413888E Q63176360i'OE E E „$25 . .... 03/1979.:. _ 03/2009 . $18.75 ......... $89.53 $89 53 $,108.28 _. MA Q6300413882E E $25 ~ $25 03/1979 - 02/1979 03/2009 $18.75 . _$89.53 $108:.28 ' $108.28 MA MA Q63004138E~7E ._ E $25 01/1979 02/2009 - :01/2009 $18.75 18 $ 75 $89.53 $108.28 MA Q6300446877E C2032160571E E E $25 12/1978 - 12/2008, . .. . $18.75 $89.53 $89 52- $.1.08.28 MA K202724930E E $100 $75 11/1978 11/1978' 11/2008 $75.00' . $356.92 $108.27 $431.92: MA MA L2106446637E E $50 - 10/1978 1.1/2008 10/2008 $56.25 $37 50 $267.69 $323.94 MA Totals for 11 Bonds . $318,75 $176.44 $1 518 33 X213.94 MA , . $1,837.08 NI Not Issued NE Not eligible for payrment P5 Includes 3 month interest penalty MA Matured and not earning interest ,.a ~~ , ti r~ `~,.~ -.,. ~ ~..-e ~s`w r .~~ } ~ ~~ ~,.~ ' ~'' ~ ,., .. ~ _ ~ u.~.~ !°~ http://www.treasurydirect. gov/BC/SBCPrice 9i1i?UIO LAST WILL AND TEST_ AIvtENT LAW OFF4CE5 SNELBA~CER & I BRENNEI~AAN I, HARVIE A. BRETZ, JR., of the Township of Hampden, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declaze this as and for my Last Will and Testament, hereby revoking and malting void all former wills and codicils by me at anytime heretofore made. FIRST. I order acid dv-ect that all my just debts acid funeral expenses be paid by my Executrix or Executor, as the case may be, hereinafter ;named, as soon as conveniently may be done after my decease. SECOND. I give, devise and bequeath atl the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, unto my wife, MABEL E. BRETZ, absolute-ly and in fee simple if sh.e survives me by as many as sixty (60) days. THIRD. If my said wife, MABEL F,. BRETZ, does not survive me by as many as sixty (60) days, then and in that event, I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and nuxed, whatsoever and wheresoever situated, unto my son, lamely, R. MICHAEL BRETZ, absolutely and in fee sir-nple, if he survives me. If my said son, Z. MICHAEL $RETZ, does not strrvive me, then and in such event, I give, devise and bequeath ny said residti~ry estate in equal shares unto my two (2) grandsons, namely, TODD M. BRETZ nd JASON L. BRETZ, share and share alike, absolutely and in fee simple. LASTLY. I nominate, constitute and appoint my wife, namely, MABEL E. BRETZ, to the Executrix of this, my Last Will and Testament, but if for any reason she should fail to .talify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and point my son, uaniely, R. MICHAEL BRETZ, to be the Executor hereof, each and both to b q al without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, HARVIE A. BRETZ, JR., have hereunto set my hand and seal to this my Last Will and Testament, which consists two (2) typewritten pages to each of which I have axed my signature this day 19~' of January, A.D., Two Thousand Pive (2005). ~~~'2"Lf C ~ ~ ll ~ , .r (SEAL) HARVIE A. BRETZ, JR. The preceding uistrument, consisting of this and one (1) other typewritten page, each i identified by the signature of the Testator, was on the date thereof signed, seated, published anal declared by HARVIE A. BRETZ, JR., the Testator therein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other; have subscribed our naznes as witnesses hereto. ,~~~ / a..~-c._.- ,z .~; ._ !~ COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OP CUMBERLAND ) We, HARVIE A. BRETZ, JR., RICHARD C. SNELBAhER and JANE J. GOONEY, the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declarf; to the tu~rJersi:gned authority that the Testator signed and executed the instnuent as his Last Will and Testament and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence quid hearing of the Testator, signed the Will as a witness and that to the best of his or her knowledge, the Testator was at that time ei~,hteen years of age or older, of sound mind and under no constraint ar undue influence. ~~-~ vie A. Bretz, Jr. ~~` fitness r (- J - `N-r~ness u4w ocFlCFs S rJEL8.4KER 6!{:ENNEMAN Subscribed, sworn to and acictiowledged before .-ne by I-I~,R ~'IE A. BP.ETZ, JR., the 'estator, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J. ;OONEY, the witnesses, this 19`" day of January, 2005. (~~ ~.. 1 ~ Notanal Seal Sandra K Shovers, Notary public -2- Mechanicsburg Brno, Cumbedand County MY Corrvrtission Wires Nov. 22, 2007 Member, PE~nsylvani2 Association OfNotariF