HomeMy WebLinkAbout03-0781COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
CO~JNTY
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Lauver Sr., Walter L. 206-10-9070
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
05/29/03 07/28/22 ~ THIS RETURNREGiSTERMUST BE FILEDoFIN DUPLICATEwiLLS wrrH THE
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
N/A
[] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (da~ o~death p~or to 12-13~)
[] 4. Limited Estate [] 4a. Future Interest Compromise (da~ or death rata' 1242-82) [] 5. Federal Estate Tax Return Required
]6. Decedent Died Testate (Attach copy of Wdl) [] 7. Decedent Maintained a Living Trust (Attach c~y of Trust) 8. Total Number o~ Safe Deposit Boxes
[] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (~a~ o, death b~ 12-31-91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A) (A.~ach S~ O)
NAME [ COMPLETE MAILING ADDRESS
Janet M. Spangler -~ 604 S. Portland
FIRM NAME (ff~cau.) ! Mesa, Adzona 85206
TELEPHONE NUMBER
(480) 664-4640
I. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. JoinUy Owned Prope~ (Schedule F) (6)
U Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9~ Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)(10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
106,959.00
0.00. -:,
0.00
0.00
25,163.00 '~.
0.00
0.00
(6)
5,936.00
12,629.00
(11)
(12)
(13)
(14)
132,122.00
18,565.00
113,557.00
0.00
113,557.00
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES
15. Amount of Line 14 taxable at ~e spousal tax
rate, or ffansfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
x .0 (15)
x .o 4_..~_. (15)
...... x .12 (17)
............................ x .15 (18)
(19)
5,110.00
5,110.00
Decedent's Complete Address:
STRL"E,T ADDRESS
26 Palmer Dr.
crrYcamp Hill
IS[ATE Pa
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B, Prior Payments
C. Discount
(1)
Total Credits (A + B + C )
3. IntemsfJPenalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D * E )
4. If Line 2 is gmatar than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I Line 20 to request a retired
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(2)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(3)
(4)
(5)
(5A)
(5B)
I~P17011
5,110.00
0.00
0.00
0.00
5,110.00
5,110.00
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 usa 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; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2, ff death occurred after December 12, 1982, did decadent 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 secudty at his or her death? .............. [] []
4. Did decadent own an Individual Retirement Account, annuity, or other non-probate property which
contains a benefidary 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.
Under penalties of perjury, I de,J=,~ that I have examined this retum, induaing ac~,a~nying schedules and statements, and to the best of my knowledge and belief, it is true, ca~rec~ and complete.
,DedaraUon oflpreparer olhe- lha~ the,per~n~ al representative is based on all infom~ation of which prepare- has any knowledge.
81GNATU~ OF P~SON RESP~SIBLE FOR FILING RETURN DA~T.E/ j
6~'_: p?rUand, Mesa, Arizona 85206
DATE
For dates of death on or after July I, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for lhe use of the surviving spouse is 3%
[72 RS. {}9116 (a) (1.1) (i)].
For dates of death on or after January 1, t995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 RS. §9116 (a) (1.1) (ii)].
The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return am 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 lmnsfers from a deceased child twenty-one 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% [72 RS. {}9116(a)(1.2)].
The tax rote imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. {}9116(1.2) [72 RS. §9116(a)(1)].
The tax rote imposed on the net value of transfers to or for the use of the decedenrs siblings is 12% [72 P.S. {}9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE A
REAL ESTATE
FILE NUMBER
Real properly which is joinlly-owMd with rigM of survivomhip must be di~le~d o~ Sch_~,!e F.
ITEM
NUMBER DE$CRIFrlON
1. Residence 26 Palmer Dr., Camp Hill, Pa 17011
Land situate in the Township of Lower Allen, County of Cumberland and the
state of Pennsylvania. Describe as follows:
Being Lot No. 26 Block M on Plan of Country and Town Homes, Inc. recorded
in Deed Book 7, Page 41, Cumberland County records.
TOTAL (Also enter o~ line 1, Recapitulation) $
VALUE AT DATE
OF DEATH
106,959.00
106,959.00
'REV-1508 EX+ (6-98)
"
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESYATE OF FILE NUMBER
Indude the proceeds of ltlig~ and the date the proceeds were received by the estate,
ITEM
VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
2.
3.
4.
5.
6.
7.
8.
9.
10
11
12
Allfimt Bank, 3045 Market St., Casmp Hill, Pa Account - 54520975, checking-The
end of June they changed their name to M & T at the same location and account
number.
Bank One, P.O. Box 92102, Bedford Texas 76095 - account 649375391
5/29/03
6/09/03
6/16/03
7/02/03
7/17/03
7/21/03
7/31/03
7/24/03
7/21/03
7/31/03
8/19/03
8/20103
Balance at death - checking account
Cordias Antique - sell of all household furniture
Sell of car - 1996 Buick Park Ave - from ad put in paper
Cordias Antique - picked up the furniture and paid balance
Interest on checking account
Interest on checking account
Interest on checking account
Railroad Retirement death benifit
Refund check
Comcast refund check (cable)
Credit card refund
Interest on checking
TOTN. (AJso enter on line 5, Recapim~,~) $
(If more space is needed, insert additional sheets of lhe same size)
14520.19
1575.00
6000.00
1500. 00
364.38
.93
.60
.07
1138.60
6.98
27.75
25.96
2.49
25,162.95
'RE¥-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
ITEM
NUMBER
A.
1.
5.
6.
7.
Debts of decedent must be repmted on Schedule L
DESCRIPTION
FUNERAL EXPENSES:
Musseirnen Funeral Home
Basic Services,Body Prepatalion, Funeral Ceremony,Transfer of remains to fumeml home,
Casket
Liner
Rowers
2O copies of death Certificate
Grave Open and dose
Credit from the VA
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Pemonal Representalive(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
City State
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not lhe same as claimant's, attach explanation)
C, la~t
Zip
Sffeet Address
city
Relationship of Claimant to Decedent
Probate Fees
A~ountant's Fees
Tax Return Preparer's Fees
Sta~~p
TOTAL (Also enter on line 9, Recapitulation)
(ff i~,G,-e space is needed, ineed additional sheets of lhe same size)
AMOUNT
3,495.00
1,025.00
500.00
106.00
40.00
870.00
<100.00>
$ 5,936.00
'REV-1512 EX+ (6-98)
"
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABIUTIES, & UENS
FILE NUMBER
Indmle ~ medical e~emms.
ITEM
NUMBER DESCRIPTION
2.
3.
4.
5.
6.
7.
8.
9.
10
11
12
13
14
15
16
17
18
19
2O
21
22
23
24
25
5/29~03
6/05/03
6/05/03
6/05/03
6/05/03
6/09/03
6/10/03
6/13/03
6/13/03
6/24/03
6/28/03
7/09/03
7/09/03
7/17/03
7/17/03
7/17/03
7/17/03
8/04/03
Waitem care giver Delores Kocher
PP&L electric bill
UGI gas bill
AT&T telephone bill
Comcast cable biJl
Free Flow Drain Cleaner, sewer blockage
Vedzon telephone bill
PAWC water bill
PP&L electric bill
Famham Insurance Co, House insurance
Janet Spangler trustee, airfare round trip for fumal
AT&T telephone bill
UGI gas bill
Famhan Incurance Co, House Insurance
Lower Allen Township, sewer and trash bill
PP&L electric bill
PAWC water bill
UGI gas bill
8/22/03 Richard Yacapa - tax consultation
8//22/03 Sale of House - document enclosed with break down
8/24/03 PP&L electric bill
8/24/03 PAWC water bill
9/10/03 UGI gas bill
9/10/03 PP&L electric bill
9/10/03 PAWC water bill
TOTAL (ALso enter on line 10, Recapitulation) $
(If more space is needed, insert add~ sheets of the same size)
VALUE AT DATE
OF DEATH
2000.00
52.91
16.92
7.56
39.64
121.50
28.28
40.82
51.58
25.00
1047.00
53.59
25.65
28.00
73.35
28.46
21.60
17.49
125.00
8764.03
7.25
17.91
16.25
9.43
9.86
12,629.08
NOTARIZED SUMMARY OF TRUST
THE WALTER L. LAUVER, SR.
REVOCABLE LIVING TRUST AGREEMENT
The undersigned hereby certifies that I created a Revocable Living Trust. T,l~st is know~ as
THE WALTER L. LAUVER, SR. REVOCABLE LIVING TRUST, dated the ~/O day
/'?O ~ , ~ WALTER L. LAUVER, SR., Settlor and Trustee, resides ~t 26 Palmer Driv
t t,- ' ' e, Camp
Hill, County of Cumberland, Commonwealth of Pennsylvania.
IT IS AGREED BETWEEN THE PARTIES HERETO AS FOLLOWS:
Description of Trust
The party hereto desires to confirm the establishment of a Revocable Trust on this date for the benefit of the
Settlor and containing herein the following provisions:
o
The Settlor is designated as the Trustee to serve until his death, resignation, or incompetence.
Upon the end of the terms of the original Trustee, JANET M. SPANGLER is designated as First
Successor Trustee and WALTER L. LAUVER, JR. is designated as Second Successor Trustee.
Any Trustee/Settlor has the power and authority to manage and control, buy, sell, and transfer the
Trust property in such manner as the Trustee may deem advisable, and shall have, enjoy and exercise
all powers and rights over the concerning said property and the proceeds thereof as fully and amply
as though said Trustee were the absolute and qualified owner of same, including the power to grant,
bargain, sell and convey, encumber and hypothecate, real and personal property, and the power to
invest in corporate obligations of every kind, stocks, preferred or common, and to buy stocks, bonds
and similar investments on margin or other leveraged accounts, except to the extent that such
management would cause includability of an irrevocable trust in the Estate of a Trustee.
Following the death of Trustee, the Trust will continue or be distributed in whole or in part for the
benefit of other named Beneficiaries according to the terms of the Trust.
While Settlor is living and competent, except when there shall be a Corporate Trustee, Trustee may
add money to or withdraw money from any bank or savings and loan or checking account owned by
the Trust.
Unless otherwise indicated to a prospective transferee, the Trustee has full power to transfer assets
held in the name of the Trust. Subsequent transferees are entitled to rely upon such transfers
provided that the chain of title is not otherwise deficient.
The Trust Agreement also states that any bank, corporation, brokerage firm, or other entity or
individual, may conclusively presume that the Trustee has full power and authority over the Trust
Assets and such person or institution shall be held harmless and shall incur no liability by reason of
so presuming.
8. The situs of the Trust is the COMMONWEALTH OF PENNSYLVANIA.
TRUST SUMMARY
Page 1
o
The use of this Summary of Trust is for convenience only and the Trust solely controls as to
provisions and interpretations. Any conflict between this abstract and the Trust shall be decided in
Favor of the Trust.
IN WITNESS WHEREOF, the party has hereto executed this Summary of Trust this date.
SETTLOR/TRUSTEE
WALTER L. LAUVER, SR.
STATE OF PENNSYLVANIA}
COUNTY OF C~ERLAND} ss.
On this, the /~) day of ~2,tJ~ , ~'~before me, a Notary Public, personally appeared
WALTER L. LAUVER, SRO, ~'~rsonally known to me t--~ be the person whose name is subscribed on this
instrument, and acknowledged that he executed it for the purposes herein expressed.
ommonwealth of Pex~vania
Not~ri~l Seal
I John N. Wight, Notary Public
I U~..pe~r__Me '.r~n .1-Wl~._' Montgomery Courtly
I '~ ~nmission Expires Sept. 1,2003
M~,¥,~., Pennsylvania Association o! Notaries
TRUST SUMMARY
Page 2
zoo
o ,'", ~-
CRMN
L--~ ' '
~,1~1~D (STATEMENT OF FUNEHAL GOODS AND ~EHVICV. S til:Lt:CIl:u)
(Charges are only for those items that you selected or that arc required. If we are required by law
or by a cemetery or crematory to uae any itema, we will explain the rcesons in writing below.)
Section 13.204 of the Rules ar~d Regulations of the Pennsylvania State Board of Funeral Directors requires this
contract to be signed by the person or persons arranging for the funeral service and by the funeral director.
(A) OUR SERVICE:
BASIC SERVICES OF FUNERAL DIRECTOR & STAFF... $
EMBALMING ...................................... $
If you selected a funeral that may require embalming
such es a funeral with viewing, you may have to pay for
embalming. You do n~t have to pay for embalming you
did not approve if you selected arrangements such as
a direct cremation or Immediate burial. If we charged
for embalming, we will explainlw, hy below. ·
REASON FOR EMBALMING:
OTHER PREPARATION OF THE BODY ................
USE OF FACILITIES, STAFF & EQUIPMENT:
Funeral C.e~y (Co~u~ed e, F .... I Home ) .............. $
Visitation / v,t~jpg (Co,,d~ed at Funeral Home }
Memorial Service ( conduct~ at Funeral Home ) ............. $
USEOFSTAFFAND EQUIPMENT:
F..uneral Ceremony ( cDr,dueled at another faciliry) .............. $
Visitation / Viewing ( Conducted at another faci~y ) ............. $
M e moria!..S.e wice ( Conducted at another facility ) .............. $
Graveside Service ................................ $
TRANSFER OF REMAINS TO FUNERAL HOME ............. :$
.. _ ( -, -- · Miles Tr~nsportad)
AUTOMOTIVE EQUIPMENT:
Casket Coach (Hearse) ............................. $
Funeral Sedan .................................... $.
Limousine
FlowerCar ................. ,,,L_ .................... $
aery ce f4--,~,)C ergy Car...~.....~..t/t~)..: ....... $
MISCELLANEOUS MERCHANDISE:
Acknowledgment / Thank You Cards .................. $
Visitors' Register Book ............................. $
Memorial Folders / Prayer Cards ..................... $ L,,
Crucifix .........................................
~ CASKET '~ ~ ~ ........... --
~ OUTER BURIAL CONTAINER (As Selected) $
Receptacle (other than casket)
We~dng Apparel
FORWARDING OF REMAINS TO ANOTHER FUNERAL HOME ......................
RECEIVING OF REMAINS FROM ANOTHER FUNERAL HOME .....................
DIRECT CREMATION (As Selected) ............................................
S-7 PA
IMMEDIATE BURIAL (As Selected) ...... $
· Total (A) $
e & CREMATION SERVICES, INC.
Established 1895 NO.
BRIAN C. MUSSELMAN, Supervisor WILLIAM G. PEGAN
'- .' 324 Hu01mel Avenue LEMOYNE,PA 17043 /
· 1 Phone (717) 763-7440/ Date -v~/,.~,~
Full name of de. ceased ~ / "~ ~' I"- ,~. ~:~ U 0 ("' ['"'r ~'/?' Age
....-..,......
Date of Death ~ ~'~ . Deceased is /*'<~ ~'"/~ P* ~ of person arranging services.
(Give Relationship)
(B) CASH ADVANCE ITEML.' . Total (A) Forward $ ~'~ ~ o~(~, ~
F~we~ ..,~....~.'..:. ~ ...................... $ /~,~,.
Telephone Calls and Telegrams .........................
Transportation Cost ............... ..~ ..................
Certified Copy of Death Certificate..,.~...¢~...~4'.... $ ~). ~
Out-of-City and / or State Funeral .Directors Oharges ........ $
Newspaper Death Not ces....'~./...~.. .................... $ ----
Tent and Grave Servicing Charge ........................ $
Cremation Authorization Fee ............................ $
(C) OTH TEMS: ~ ~, ~: ''~
e. $ £'7 , _ To,,,(A)
.-- .(_ .. $
d ..~ I~1~ ,~ "~,~ . t' '~1'~-- . ,.~=:t~:~. Total Amou n,,~
LISTED ABOVE:
The undersigned purchaser(s) hereby attest to the following: (1) I/We did ( [~} did not ( ) authorize embalming
of the above named deceased. (2) I/We were shown a Casket Price Llet and an Outer Burial Containe~ Price List before the
showing of caskets ami outer burl,,I conteinere. (3) I/We were glven/offercd for retention a General Price List upon the
beginning of a dlacuesion of funeral arrangements and/or eslectlon of so, vices and merchandise.
TERMS: Net due 30 days. A charge of 1.5% per month (18% per annum) for UNANTICIPATED LATE PAYMENT will be charged
on any amount unpaid after due date.
I, or we, having read the above, accept and approve same, and jointly and severaflypromise to make full payment therefor. Each purchaser
understands that this promise to jointly and severally make full payment means the Funeral Home has the right to collect the entire amount
from anyone or more of the purchasers without resort to any 'clmm against any other purchasers. This right exists regardless of whether
or not one or more of the purchasers have agreed among themselves how much each will contribute to make full payment. Receipt of a
copy of thi,~ contract is ackpowledged,
/ Signature of Purchaser(s) Street Address
S.STNo.
City State Zip Code
Signature of Purchaser(s) Street Address City and State Zip Code
Signature of Purchaser(s)
We agree to provide the service & merchandise indicated above.
Musselman Funeral Home
& Cremation Services, Inc.
Address ~. City and State Zip Code .
'4/ Purchase
Consignment
~-'~CO~I ER
~ANTI,~. ES
fine art
Owller~
Property Description:
Estate Liquidation Services Agreement
Tel:
Purchase Price: .3; ~ ~ ~. ~' Commission:
Services/Fees: (Sorting, Packing, Dumping, Trash Removal)
Owner Responsibilities:
Terms:
mer's Signature / / Da~
Cordier Antiques & Fine Art
2201 Market Street
Camp Hill, PA 17011
Phone: (717) 731-1740
Fax: (717) 731-9830
Website: www.cordierantiq ues. com
e-mail: dcordier~cordierantiques.com
A. Sett'lement Statement
B. Type of Loan U.S. Oeparlmonl of }'lousing
/ 1. &i:it^ ---;" 'q, ~l A ] r-~ .......... I . .. x, · -~ ............. ~ban Devel0Pm~n~ OMB No. 2502-0265
/4 FJV.~ ~ ~N'onv Ins J 03 426
I ADDI(fiSS: 3 SCARSDALE DRIVE, CAMP HILL, PA 1701 t
,xl)l)Rt~fi: 604 SOUTH POR'TLAND, MESA. AZ 85206
F. NAME al,' LENDI~R: Citizens Mortgage Coq~. &%/a CMC Funding
· .,~DI)RL~,S.S: 10 Tripps l, ane, Riverside, RI 02915
G. ?KOPEI",'f¥ ,,XDDiq.~SS: 26 PALMER DRI~, LOWER ALLEN q'()~~'P-i~A 17011
OF SI~'I"I"I~t!Mt~N':I': 4309 Linglestown Road, l:larrishm.g, PA 17112 ' -
1. SE'I"i'I EM ENT DA'f E; 08/22/2003
,I. SUMMARY OF BORROWER'S TRANSACTION
100 GROSS AMOUN[ OUE FROM BORROWER
.._!m _~Corm_.ac_! s_..~2?~.Ltxice [ l. OS, 900.00
K. SUMMARY OF SE!LLER'S TRANSACTION:
400. GROSS AMOUNT DUE TO SL:LLER:
_4..~0~ Contrac/._.sal~es fmce __ ! 10~; , 900.00
-" ~ .......... -- 402 Pet':anal
t02. PersonaIPQc,.p_erly I 2 576 73
104.
405
Adjuslmenls for ilems aid b ' ' .......
.................... p ~.seller) 7 advan~
~oL County loxes 08/22/031o 12/31/03 ~ ..... lt~. 86 ~'' 3~tmenls for ilem$ paid by seller in advance
111 410.
112
120. GROSSAMOUNTD~-~';~'~'~'~ ~ ~'T~ 4,2
' 420. G}ZOSS AMOUNT DUE TO SELLER:
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500 REDUCTIONS IN AMOUNT DUE TO SELLER.,
..................... ¥ 1,000 . 00
202. ~ri~aI a ~ ounl of new uans
Z00,600. o0
203. Ex~slinc~A~.~a~e~u_pject o
204.
205 ............................................
266 .......................
20 Z. -- .....................
208
209
AOjustments/or itea.!s~un,.,aid
.................. ~ byseller
21 3. r-' '1'
215
216.
2'17
216.
2~9.
220. TOTAL PAID BY/FOR BORROWER 101,600. O0
I' 300. CASH AT SE'FTLEMENF FROM OR TO BORROWER
}_3ol Gross ar r,ou,,i due fi'o,n L~orrower (_.Ji,.i~e .120) __~J 109,535.97
J3021 Le$:$amoums aidbllOrbon.ower Ite220 ' 101,600.00
.--~-~ ......... I .._-'o_L ........ ! ...........
[ 303. CASH FROM BORROWER J. 7,935 . 97
501. Excess..Deposit (see inslructiom0
502 Setllemen{ char~_s. Lo~_e.~,.,~.4.0~0) .
503. Extstinfj Ioal s{~Jaken sub/ect to
504: ~?.¥offqt~FiE~t.t_Mortgacje Loan
505.
506.
507
509.
8,764.03
513.
514.
5'15.
A0justmenls for items unp. aid b seller
516.
51?
5'18
519.
520.
000.
001.
· 6o2
6O3
TOTAL REDUCTION AMOUNT DUE SELLE___~_~
CASH AT SETTLEMENT TO OR FROM SELLER
Less teduclJon a~r~unt due 5olJ,~r
CASH TO SELLER
8,764 .03
98,195.21
$UBSTI1UiEI:ORM ID59~qI~LI~.'I~$'IAl'EME',/T rheJnlolma anco la edheo; 5 I r-i~ ' ' ' ·
c~m~ele lhe ~plll~bio fro{ts 0 FOrm 4197, Fo;,'n 6202 ar ~ Schedule D {Form 10,10)
$ELLE RI5) NEW MAILING
RIiV II(.q)- I
DI~PAI(T~I£::NT OF IIOU$1NG AND L.II~t,~N I)EVtJI~JI"~IEN'I'
SETTLEMENT STATEMENT
basedon rice$105,90O.00 = 6,354.00
$ In
$ 6,3~4.00 {0 C~ Hol~esale Services Group, Inc..
?03 Corer s~ u.~aid al
800 ITEMS PAYABLE IB~B~.~.T/g~WlTH LOAN
in~lio~ b~e %
Fee lo National R.E. Info Svces
~o The Credit Network
Film Numhc~: 03-426
PAGE ?
BORROWER'S / SELLER'S
SETTLEMENT ~ SET'rLE~ENT
(P.O.C.) 15.00 Buyer ....... '
liatJ:u,/ee to CITIZENS MORTGAGE CORPORATION LR'~! ............ ~'~-~"["6'~ ..............................
ires lo CITIzENs MORTGAGE CORPORATION L:R i 300 00 ~ --
D9 TaxService 1¢) First ~eriCan Tax Servlce '
ia CITIZeNs MORTGAGE .............. L:R ~ 61 0~-'~ .......
ta Citizens Mortgage Corp. d/b/a CMC Funding L[R
PAID IN '
From 08/22/~003 m 09/01/2003 ~S 1~.~253 N9Z 10 Days
905.
1000. RESE qVES DEPOS 'fED WITH LENDER FOR
r Taxes ~. ~ bna
~~](~,~tJ, ]'axes 7 mu ~ $ 3 ] . 38 /moL),~233 . 66
100 TITLE CHARGES LR 278. ~5-
~ 0,00
1101. Seltle ~le t or
1105. DooumeFl! Pre aralk,' CPSS
............................. ~ ~o
_110__.~ ._No._,.12~ Fees !0 Cash
"s tees
95.00
110~. Tills h%s,tNance
11'12.
1113
$
Closing Se '
to Central ~enn Agents for Chicago Title Insu
1101,1102,1103,110~
100,600. 3 )
1.05 900.00
m Central Penn Agents for Chicago Title Znsu
1200. GOVERNMENT R__E_CO___R_DI_..N_G AND TRANSFER CHARGES
Fees D~ed $ %3.50 Mod - 69.50
.........................
Deem
- ' J' -20'~'J~ -'S t~a !-e- -'~ a x---.-//s-~:a ~-~:~.E-s--. - _ Deed
1204. -- ..................................
1205.
1300 ADDI"I'IONAL -%ETTLEMENT CHARGES
1 Su¢vev
-'l-~(22~-~.e-s,L..~pect'u" IO Accuspect poc
~ CP$S
1304. Wire
I'-; .......... ,o c~ss
305 Ho, re ~/.~ecMon AccuSpect poc
.... -- Io
_~06 Transaci0rltee 1o CB Homesale Services Group,
J ..]~.0_7.: ~2_.O_Oi}~c[,,aolta;~ ~o Bonnie K. Miller, Treasur~%
L 1400. TOTAL SETTLEMENT
185.00-
' ]
(omer on lines 103, Section J an,,] 502. Seclion K) 2,57 6.73 8,
HUD CERTU:ICAI'ION OF BUYER AND SELLER
' "O~[rFJ'~ t.r" "-~ .....................
WAI~NING: rr IS A (;RI/'~E IO KNt.)WIN(,~[ y MAKE FALSE STAT~_MEN
U.S. CODE SECTION I~1 AND SFC'FION
9/21/2003
Account Transactions
MandTBanking
Page i
Num
Date Payee
Opening Balance
Month Ending 5/31/2003
1092 5/29/2003 Delores Kocker
1093 5/30/2003 Musselman Funeral
Total Month Ending 5/31/2003
Month Ending 6/30/2003
1094 6/5/2003 PP&L
1095 6/5/2003 UGI
1096 6/5/2003 A-I%T LongDistance
1097 6/5/2003 Comcast
6/9/2003 Cordias Antique
1098 6/9/2003 Free Flow Drain Clean
1099 6/10/2003 Verizon
1100 6/13/2003 PAWC
1101 6/13/2003 PP&L
6/16/2003 Depost from Sale of Car
6/20/2003 Balance check book per statement
1102 6/24/2003 Famhan Insurance
1103 6/28/2003 ]anet Spangler - Alffare
Total Month Ending 6/30/2003
Month Ending 7/31/2003
7/2/2003 Cordias Antique
1104 7/9/2003 AT~T LongDistance
1105 7/9/2003 UG!
7/17/2003 interest
1106 7/17/2003 Walter Lauver Trust In Phoenix B
7/31/2003 interest
1107 7/31/2003 Walter Lauver Uving Trust close
Total Month Ending 7/31/2003
Grand Total
, Category
Gifts
Miscellaneous
Bills
Bills
Bills: Telephone
Bills
Other Income: Furniture
Bills
Bills
Bills
Bills
Automobile: Maintenance
Other Income
insurance
Other Income: Furniture
Bills
Amount Running Balance
14,520.19
(2,000.00) 12,520.19
(5,936.00) 6,584.19
(7,936.00)
(52.91)
(16.92)
(7.56)
(39.64)
1,575.00
(121,50)
(28.28)
(40.82)
(51.58)
6,000.00
364.38
(2S.00)
(1,047.00)
6,508.17
6,531.28
6,514.36
6,506.80
6.467.16
8 042.16
7 920.66
7 892.38
7 851.56
7 799.98
13 799.98
14 164.36
14 139.36
13,092.36
1,500.00
(53.59)
(25.65)
0.93
(i4,000.00)
0.60
(514.65)
(13,092.36)
14,592.36
14,538.77
14,513.12
14,514.05
514.05
514.65
0.00
(14,520.19)
0.00
9/21/2003
Account Transactions
Bank One Checking #2
Page 1
Num
Date Payee
Category
Amount Runninq Balance
Opening Balance
0,00
Month Ending 7/31/2003
7/16/2oo3
9990 7/17/2003
9991 7/17/2003
9992 7/17/2003
9993 7/17/2003
7/21/2003
7/24/2003
7/31/2003
Total Month Ending
start
Erie Insurance For Home
Lower Allen Township Sewer/Trash
PPSd.
PAWC water
INTEREST EARNED
RR Retirement 1138.60 & 6.98 mis
comcast 27.75 M&T close 514.65
7/31/2003
Insurance
Bills
Bills: Water & Sewer
Healthcare
14,ooo.oo 14,ooo.oo
(28.00) 13,972.00
(73.35) 13,898.65
(28.46) 13,870.19
(21.60) 13,848.59
0.07 13,848.66
1,145.58 14,994.24
542.40 15,536.64
15,536.64
Month Ending 8/31/2003
9994 8/4/2003
8/19/2003
8/20/2003
9995 8/21/2003
8/25/2003
8/25/2003
8/28/2003
UGI
Credit card refund
INTEREST EARNED
3anet only one more check to wr
sale of house
030825002828 INCOMIN
ATM LST 5 DEP CRG
Total Month Ending 8/31/2003
Bills
(17,49) 15,519.15
25.96 15,545.11
2.49 15,547.60
(4,000.00) 11,547.60
98,195.21 109,742.81
(12.00) 109,730.81
(1.00) 109,729.81
94,193.17
Month Ending 9/30/2003
9/11/2003 walter lauver jr his cut w/20.
9/12/2003 030912006000 WIRE TR
Total Month Ending 9/30/2003
(34,374.00) 75,355.81
(20.00) 75,335.81
(34,394.00)
Grand Total
75,335.81 75,335.81
21-2003-781
RETURN RECEIPT
REQUESTED
7003 1680 0002 6783 2195
RETURN RECEIPT
REQUESTED
RETURN RECEIPT
REQUESTED
IIETURN RECEIPT
REQUESTED
R ~. RETURN RECEIPT
REQUESTED
D O C U M E N T M A I L E R
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003062
SPANGLER JANET M
604 S PORTLAND
MESA, AX 85206
........ fold
ESTATE INFORMATION: SSN: 206-10-9070
FILE NUMBER: 2103-0781
DECEDENT NAME: LAUVER WALTER L SR
DATE OF PAYMENT: 09/26/2003
POSTMARK DATE: 09/26/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 05/29/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $5,110.00
REMARKS:
TOTAL AMOUNT PAID'
$5,110.00
SEAL
CHECK# 9996
INITIALS' SK
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
IHHERITANCE TAX D/VISION
DEPT. ZB0601
HARRISBURG, PA 17128-0601
JANET H SPANGLER
60~ S PORTLAND
HESA
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLOHANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
AZ 85206
DATE 12-01-2005
ESTATE OF LAUVER SR
DATE OF DEATH 05-19-200:5
FXLE NUHBER 21 0:5-0781
COUNTY CUHBERLAND
ACN 101
Amount Remitted
REV-1;47 EX AFP (OI-gS)
WALTER L
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 1701:5
CUT ALONG THIS LINE ~ RETATN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP {01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTZONS AND ASSESSHENT OF TAX
ESTATE OF LAUVER SR WALTER L FZLE NO. 21 0:5-0781 ACN 101 DATE 12-01-200:5
TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATION CONCERN:ZNG FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2 Stocks end Bonds (Schedule B)
$ Closely Held Stock/Partnership Interest (Schedule C)
Nortgegas/Notes Receivable (Schedule D)
5 Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6 Jointly Owned Property (Schedule F)
7 Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funeral Expenses/Ada. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
(1) 106/959.00
(2) .00
($) .00
(4) .00
(5) 25/165.00
(6) .00
(7) .00
(B)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
132,122.00
(9)
(10)
5,956.00
1Za629.00
(11)
(12)
11:5,557.00
13.
14.
NOTE:
ASSESSHENT OF TAX.'
15. Amount of Line 1~ et Spousal rate
16. Amount of Line 14 taxable et Lineal/Class A rate
17. Amount of Line 14 et Sibling rate
16. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECEIP I DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-)
09-26-200:5 CDO0:506Z . O0
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15)
Net Value of Estate Subject to Tax
:Zf an assessment ~as issued prevlously, lines 14, 15 and/or 16, 17,
.00
11:5,557.00
18 and 19 will
reflect figures that lnclude the total of ALL returns assessed to date.
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(15) .00 x O0 = .00
(16) 11:5,557.00 x Oq5 = 5,110.00
(17) .00 x 12 = . O0
(18) .00 x 15 = .00
(19)= 5,110.00
AHOUNT PAID
5,110.00
TOTAL TAX CREDIT I
I
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
5,110.00
.00
.00
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REOUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December IZ, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the rlght to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF NILES) AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications are available at the Office
of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special Z4-hour
one#sting service for forms ordering: 1-800-362-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3010 (TT only).
Any party in interest not satisfied with the appraisement, alloeance, or disalloaance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--eritten protest to the PA Department of Revenue, Board of Appeals, Dept. ZSiOZ1, Harrisburg, PA 17118-1011, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Year
1981 201
1983 161
1984 111
1985 13Z
1986 107.
--Interest is celculated as follows:
ZNTEREST= BALANCE OF TAX UNPAZD
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administrativeZy correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (51) discount of
the tax paid is allowed.
The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (61) percent per annum calculatad at a daily rata of .0D0164. All taxes which became deZinquent on and after
January 1, 1982 will bear interest at a rate which will vary fram calendar year to calendar year with that r~te
announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z003 are:
Interest Daily Interest Daily Zntmrest Daily
Rata Factor Yea.~r Rate Factor Year Rate Factor
.000548 1987 91 .000247 1999 71 .O00Igz
.000438 1988-1991 1ZZ .000301 2000 81 .000219
· 000301 1991 91 .000147 2001 91 .000147
· 000356 1993-1994 71 .000191 ZOO2 61 .000164
.000274 1995-1998 9Z .000247 2003 SZ .000137
X NUHBBR OF DAYS DELINQUENT
X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.