HomeMy WebLinkAbout01-30-12COMMONWEALTH OF PENNSYLVANIA -
APARTMENT OF REVENUE Pennsylvania ~ :~
' `-'~" ~~l ~~" r, _' DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES NOTICE~;p~,~;, ~5171~~~INHERITANCE
INHERITANCE TAX DIVISION TAX A R.1A~M'EN~!- ' ~~-LOWANCE OR REV-537 EX AFP (12-11)
PD cox zao6ol DISALLOW NCB ~F. DUCTIONS,
HARRISBURG PA 171za-o6o1 A D ASSESSMENT OF TAX
'~~~~' ~.~~~~30 ,~~l~tl'fOT~E,. 01-30-2012
EST/C#E OF BURLISON JEAN E
(,'CERK (1 DATE OF DEATH 03-08-2011 _ ` , Dy}a
I~~+y~~~~~~ G,oU~FILE NUMBER 99 11-0668 ~ 1
vtlM~il=~~1{~j.~ r,~~ ~ONNTY 101-RESIDENT 7-I~l ~-
MARLIN R MCCALEB ff1~~
219 E MAIN ST APPEAL DATE: 03-30-2012
P O BOX 2 3 0 (See reverse side under Objections )
MECHANICSBURG PA 17055 Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
PA DEPARTMENT OF REVENUE
P.O. BOX 280601
HARRISBURG, PA 17128-0601
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS !--
------------------------------------------------------------------------------------------
REV-537 EX AFP C12-11) NOTICE OF NONRESIDENT INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BURLISON JEAN E FILE N0. 99 11-0668 ACN 101 DATE 01-30-2012
TAX COMPUTATION METHOD ELECTED: C ) FLAT RATE C X) PROPORTIONATE
TAX RETURN WAS: ( ) ACCEPTED AS FILED C ~ CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL AND SUPPLEMENTAL RETURN N0. O1
11fi, 000.00 NOTE: 7o insure proper
1. Real Estate (Schedule A) (1)
.00 credit to your account,
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) C3) .00 submit the upper portion
4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this form with your
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) liD,026.26 tax payment.
6. Jointly Owned Property (Schedule F) ((,) .00
7. Transfers (Schedule G) C7) 8,561.27
8. Total Assets c8) 133,587.53
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 2 3,61 3.67
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 685.14
11. Total Deductions C11) 24,298.81
12. Net Value of Tax Return C12) 109,288.72
13. Charitable/Governmental Bequests (Schedule J) C13) .00
14. Net Value of Estate Subject to Tax C14) 109,288.72
NOTE: If an assessment was issued previously, lines 14, 15 and/or 1 6, 17, 18 and 19 will
reflect figures that include the total of ALL returns assesse d to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) .0 0 X 0 0 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate C16) 95,474.63 X 045 = 4,296.36
17. Amount of Line 14 at Sibling rate C17) .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B ra te (18) .00 X 1 5 = .00
19. Principal Tax Due C19) 4,296.36
rwv rocnrrc.
AYM N+~
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID C-) AMOUNT PAID
07-29-2011 CD014777 .00 4,546.53
10-07-2011 NR014729 .00 56.22
TOTAL TAX CREDIT 4,602.75
BALANCE OF TAX DUE 306.39CR
INTEREST AND PEN. .00
TOTAL DUE 306.39CR
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TDTAL DUE IS REFLECTED A'S A "CREDIT" (CR), YOU MAY BE DUE ~""~"
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- If any future interest in the estate is
transferred in possession or enioyment 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 right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S.
NOTICE: Section 9140).
OBJECTIONS: Any party in interest not satisfied with the appraisenent, allowance or disallowance of deductions or assessnent of tax
(including discount or interest) as shown on this Notice nay object within 60 days of the date of receipt of this notice
by filing one of the following:
A) Protest to the PA Department of Revenue, Board of Appeals. You nay object by filing a protest online at
www.boardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for
an a ec tonic pro es o e valid, you must receive a confirmation number and processed date from the
Board of Appeals website. You way also send a written protest to: PA Department of Revenue, Board of Appeals,
P.O. Bax 281021, Harrisburg, PA 17128-1021. Petitions nay not be faxed.
B) Election to have the ^atter determined at the audit of the account of the personal representative.
C) Appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessnent should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg,PA 17128-0601
Phone (717) 787-6505. See page 4 of the booklet "Instructions for Inheritance Tax Return for a Nonresident
Decedent" (REV-1736) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (3) months after the decedent's death, a discount of five percent C5Y.) of
the tax paid is allowed.
REFUND CCR): A refund of a tax credit, which was not requested on the Tax Return, ^ay be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available
online at www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's
24-hour answering service for forms orders: 1-600-362-2050; services for taxpayers with special hearing and/or
speaking needs: 1-800-447-3020 CTT only).
PENALTY: The 15Y. 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 sane tine period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency or nine (9) months and one C1) 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 Chi) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1962 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. Rates for years 1982 through 1999 can be found in the Pennsylvania
Resident Instruction Booklet, (REV-1501), the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the
Pennsylvania Dept. of Revenue web site www.revenue.state.pa.us. The applicable interest rates for years 2000 through
2012 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
2000 8% .000219 2001 9% .000247 2002 6x .000164
2003 5% .000137 2004 4i .000110 2005 5% .000137
2006 7% .000192 2007 87. .000219 2008 7Y. .000192
2009 5i .000137 2010 4i .000110 2011 3i .000082
2012 3i .000082
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER 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.
TO REMIT
PAYMENT: Detach the top portion of this Notice and submit with your payment to PA Department of Revenue, at the address
shown on the reverse side.
-Make check or money order payable to: PA DEPARTMENT OF REVENUE
Failure to pay the tax, interest, and penalty due nay result in the filing of a lien of record in the appropriate
county, or the issuance of an Orphan's Court citation.
COMMONWEALTH OF PENNSYLVANIA PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE AND ESTATE TAX
~;
DEPT. 280601
HARRISBURG, PA 17128-0601 OFFICIAL RECEIPT
No. NR014729
RECEIVED FROM:
Marjorie A Seiler
219 East Main Street
Mechanicsburg, Pa 17055
ESTATE INFORMATION
FILE NUMBER
99 11-0668
NAME OF DECEDENT (LAST) (FIRST) (MI)
Burlison Jean E
DATE OF PAYMENT
10/20/2011
POSTMARK DATE
10/7/2011
COUNTY
Non-Resident
DATE OF DEATH
3/8/2011
REMARKS
ACN
ASSESSMENT
COIVTROL AMOUNT
NUMBER
101 56.22
TOTAL AMOUNT PAID $56.22
RECEI\/ED BY
John M. Riedman
SEAL
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
Register
REV•1d70 EX (01-10)
r pennsylvania
DEPARTMENT OF REVENUE
BUREAU OFINDIViDUALTAXES
PO Box 280601
INHERITANCE TAX
EXPLANATION
OF CHANGES
BURLISON JEAN ELEANOR
Elizabeth Bloom
ILE NUMBER
9911-0668
101
ITEM
SCHEDULE Np, EXPLANATION OF CHANGES
The value of the estate has been adjusted as the result of the correction of an error in
arithmetic.
Row Page 1
REV-1502 EX a (1-97)
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Jean Eleanor Burlison 55~~ 159-24-9873 03/08/2011 21-11-0472
All real property owned solely or as a tenant in common must be reported aYfair 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 which is jointly-owned with ri ht of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 House and lot, -known as 408 East Coover Street, Borough of 115,000.00
Mechanicsburg, Cumberland County, PA, acquired by Decedent and
husband, John B. Burlison, by deed dated 09/24/1952, recorded in
Deed Book 15, Volume C, Page 327 (John B. Burlison died
09/23/1993); value based on sale to Assault Vehicle, LLC, per
contract dated 05/03/2011.
TOTAL (Also enter on line 1, Recapitulation) ~S 115 , 000.00
(If mote space is needed, insert additional sheets of the same size) '
Copyright (c) 1996 form software only CPSystems, Inc. Form REY-1502 EX (Rev. 1-97)
ASB
~~ ~AGR~EMENT~FO~A~~~~ ~„ti~~,~ R~~
~ aK,bacmtt•~d
Hi15C&R(B?t -
6~LLBR'8 MAILINGADARESS~
BiJYER'e MA~CiADDRBB4t
pgglrgRgy~pR8S5 4 ~ ss Z8 x.7^,5'+ - '
- - ~ IIAG ~ c`aanty of et7l
ht the meaielpaHty of ~' f+oE ~ In:the.~oouxealib of Peaniylttinlw
!a the 8obool D1seltx CBSDAG
Ideadfieatlon (o~er,'rax ID R; Pamald; Let, Block; Deed Boot, Path, Raoarding Dam),
]E;UY&'1><'8 RTLATIOM6EUr w
^ No Bttableaa IWatloiahlp (Duyar 1a not repraenad by a bco
groka (CompsaY) iT Br,'08 iukT,T7t
Cott+paoy Ad~ess ~~ oe :ra Ramer ~ ra
it
Co~pac4iFhamO 7 ' i - 460
~ptygcc s71717l9-303
Br~l[et Ia:
Q ~ ~ (Hroket ~~ Bttyer only)
ja Deal Agm= (See Dual aada t>wfignated Ages box belo~
BROK>!<A
L,;eaaste(s) (Naow)
DjteotPhonc(f) SZl3L~~.{
Co11 PhooaKe) i''~ ~t a50-0~ ~6
Fa
Tsneilteat 4~smxee.eon
Liooaaoe(s) i:;
^ Buyer ~ wills ~ Agmay
Q Bayer Agetrc peaignand AgeneY A pu box helot)
p Deal Agent (sea Beal md/a Dastg~tatod g
rmide real errata aervioes but 4o aot rep-oeeat Buyer)
p T~petion Ll~ee (Broker and l3catsoe(s) p
No Bn:lius! Seltttionsblp (B~er L~
Broker (Company)~'f B~ ~~~
Cotnpa~' Addrgs ~so as44sa=oilo aD SLL ~a
~a
CoagxnyPhate 7i7 610-1460
Comtu4yPaa ~yiot7tt7.9030
erolter ~:
p 9aIIer Agcnt (Stotou ~taean SeNor Daly)
,L] Dual Agent (9ro Dial aadlor DedgMrod Agem box baloNj
Uonnsee(a) (Natsto)1o-~3°rl~ll 'R t3P
DtreotFhoae(r) j7z7) 61 -3 60 -
Cefl P6onda) (717 s50-013, - -
Fax
Email awttgtssdzstio.e~n
Liooaaaa(r) ir.
^ 5aua Agent whh Daaigaaud Ageucy
^ seller Agoat vrlthwn Designated Ae~ay
p Dual A[Saat (Bee Deal and~et Desigaaud Agate hex bclaw)
rokcr a+M Iaoenuo(a) provide tai estate tesviosa but.do ttos repteamt Se-ei'j
[] Tianaaedoa Llooasaa (9
DUAY~ ANDIDR DE6I(~P1AT&u w~ta~rtt: z
A Broken is a peal A~ when a Broker repraeots both Hnyer and Buller In the setae ttanaaodon. A Liceasce is a Dual APear when a Lloensoo
~~ >~ ~ Seller In tfte creme rrsasact~ea. All ofBznker's I Via, ~o ~~ ~ a ~ ~L98 theme an sbpatate Designlued Ageuute
ibrHtryar and Salla.If tbo `sme Ureasea la doslgaattd ttr 8ltynr and
~, sl~etnq fbls Agreement, Buyer and Seger each aokaotrladCa bat+lag baai prevlaaely iaTortned eC, aed consented la, dual agMey, tf
aPpBoabla aeperiafdFL~
ASA Pqe 1 of ll
B~ Ialdats: ~ Rebell 1110 COTNtIGflT pLl~tl~taYtvMt11- Aaa0t:4tttOH ol` aGALT0a1i Td1e
tno
~, paa,da Asaoclatlon of rtEALZ'ORS' 'm m,~b ,w-.hvrwa u.c.
sad c.4 xa, r~ tvon :-..r nr~~
ti ~ ta~0' WO arq~Yr~{ PiodueNl r~ghL¢ra~sOYtb~px 110ro l~n lY~ Rd4 Pte. MMaMY~ ~lOl1 r~
ZZO/b00 ~ NOI19f181SN09 A3NHY3A lES1.188E1.6 Xtld LZ~tiI li0b/ZO/90
Schedule A.1
1 i. By 13~is Agr'eemen~ died liar 3, - 2011
2 Seller hereby t~ to reel! ttad convey to Bgyta', ~-to ttrrtea to psrchaae, t~lehkatli9<ed Property
3 Z. PITRCHASB t'RIt3 APID Dii~OS1TS.~ 1~
4 (A~j Ptce~aePrioeS 1].S,000.DO
S (One Htmdrad lYltrsan Thousand
6 _ U to ~Ya'+a town:
7 1. De~oaitatsi~ofthisAgcoensmt: --•- --. ---__._ ~ 1.000.00
8 2 Deposit widen days of the Execavon Dabs of this Agcewtmt: S
~ 3. 3
1D 4. will bepeid at aettlm>ntt .
i i ($) Ail llncds paM h7 $~. >adasitiinz ~ ~ P~ bIr ~, eaattx'e ctecit or wised fsmdz. AS fnoda part by Boyer
IZ w~tia 30 DAYS of ts~lematt, fasals pall at tattlasraat; wW 6e b7 .artier': eieek err wlrOd ~, bat sat by per-
13 aosal chedr.
14 (C) Depoatta, eeBardlhs of the focm of payment sad the pertton deoignated m payeq will be peaid in U.S. Dollars !n Broker for Sdta
15 (unless dhawiae atatad hest` ~
16 who will retain de~poaib is an escrow saeouat in all caosamotstton a ta-
17 mi~on of thin Asnom~eat t)aty mat estate brakaa are caluirsd is hold depostli io aooordanoe with 8ie roles end ~alatione of
18 fha State Real- Balate Commitaioa. Cboctm tmderod m deposit monist auty be tart aaeashad peadog the acecutian of this
19 Ajseeosa-L
20 3. 51~.LbR ASSIST (If Applkabk) (1-19)
21 Seller w01 pay S a X of Pause Prioe (0 if not spad5ed} towset3
22 Buyers eooatr, ere pamided try the awrtgq®e. leader, if any. Sella is only obligated bo Pay oP to tha amount a pacattage which is
~ ~laod~
za a. SEITLEWitiNr AND rossgss~oN n io)
2s (A) Setiiwomt Date is Ju]:" 8 2011 , or tofu`s if Buyer and Shca agooe.
25 (B) Setdmneot w,~ Doan` m ootmty u or m ~ oeraahr, aexmal beesietna horns, tmlas
27 Bayer and Shca ~ otherwise.
28 (~ At time of amt; the following .vrc11 be pm-tsbsd as a dt~7y basis betvtem Bnyrr and Srltey tdmboamg where appIicabla
29 eoxrmt tenses (roe Notioe Regacd'mg Real Eab6s Taxesk `eats; iabae~t oat mortgage boas; coodomimecm teas and honto-
30 Du`ne` assoraatian fees; water and/or seava fen, tage8ta witie soy oma ~e 'mil sorviee floes„ Al] chteges w71 be pm-
31 rated for the period(s) cnves<nd. Sella well pay np b and iachuiigg the date of aatlemmt sad Htryer wBi pay 5or all days follow-
32 iRg aettiemaoit, mien otherwise stated has
33
34 (D) fivm Seller wt71 fee simple decd of spaaal waaaoly absted tent .
35
36 (E) Payment of hslsde taxes wc71 be dividod ogosllybetwoea Boys sad Seilamlas othawiae stetod her+~
37 '
38 (F) Posaesuoa is to ddiva~od by eanstivg loeys sad phyaial poaaaion b s vaaiat Pcope~ty fire of debris, with all strue.~dtce~s
39 broom-clang st day and time of settlomeot, tailess Seller, before signing this Ag~coemmt, has idarttfied is wcitiog that the Property
40 is attl~ect to a lase:
41 (tip If 5dler has ideatitied in writing that the Pmpaty is a>bjxt to a learn, poaaeiaa is b be ddivetnd by deed, existing ycey= and
42 ;went of acietiag learn fa the Property, togeWa ~ aeco<ity deposits and ia-aak if aqy, at day sad lime of sGtiemcat Seller
43 wlll not mbQ into nay near lases, ncr admd esouting learn, for the Pmpecty without then written ooaseat of Bays. Bayer will
~ ~ ~6 Ieesd~) by imdialiag the leads) at dte e;xeattion of thin Agtomtat, aakaa dhawies statexl in this Agcament
45 ^ Tmaot-Oeapied tiroperty Addsdm (tAR Form TOP'j b attaeLed.
~ 5. DATP~ l:R OF TI$ F.4SSitiCL (1 lo)
47 (A) Wcitben aooepdma at: all.pertin wBl be on err bdsra I!DIY 3 2011
48 (B) The Seftlesaeat Date and aFl othc dates and rims for pa6omnaoe soy Ageaacteot ace of the
49 essence sad are bindatg.
50 (G~ The Exeauioa Dots of this Agceemcat is the date when l3uyar sad Sella have indicated fall sxxxptonw of this Agnaaatt by sign-
51 ing and/or ittitieling it For pnrpwa of this ABeematt, the manta of day: wiU be oambed Srom rim Exaeutim Debq exclndwg
SZ the day thin Ag[eaamt was exowtnd sad i<tciodmg the brat day of the tint: period. AH ctsages Es ~, si~oald ~ ~-
53 tinted sod dated. 4
54 (D) The Sottiaoat Date is not exbmdod by ~ other pcoviaim of this Agceeateot end may exdy be a[tmded by acataal written egrea-
ss aunt of the pastes.
56 (~ Certain teams and time periods ace pro-printed is this Agroemmt as s oonvmimx 1a fhe Buys. sad Seller Ali pro-}uintod teems
57 end time periods ace »egotiab~ sad mry bo edtangeod by dre7oag art the pro-prigbod tart noel imatiog dily'atatt tetnu aooeptable
58 to all pactia.
s9 ti. ZONING (110)
60 Fae7ean of this Aglaement m exxttain rho zoautg elsasificstioa (accept in caeca where the property (and each psced thexoal, if aubdi-
61 vidable} is zoned solely or primarily to permit singlo-family dwellings) wtu reader thin !-gc+eaneat voidable e< Buya'a option, sad, if
62 raided, nay deposits beached by the Buyer will be retumod bo the Buys vri8tout nay regooc+cenest for court aeon,
63 Zoniueg Classification:
64 Bayer Ioitlak:- ~~ ASB Pate 2 of Il gar
R.a.aa vla
~ap.e wan aPr~ny>~to~ tao~o an..a so. tlo.a. R..s, -w+s•~ sense ~ Am.ult V~icsa,
Schedule A.1
593 (>Q) Addidoarl Terms:
J94
797
396
s97
S9r
399
600
601
602
603
604
605 .
606
607
6or
609
61p
611
611
613
614
615 Suytr and lbllter aclrnowlodge receipt nta copy rf thit Agreeatmt at tMe ttuo of riEnltQ.
6t6 ThY Agreement orq' bs esoentsd m ~e ar more coatterptrn, eArh of wbi9h aha11 be deemed eo be to orlgina[ and rrhlcU oonn-
617 tay.rt, zoaather ebaU eonrlttata ous and the came AQr^mgeat ottbe Ptrda.
61a NIOiICE TD PI4RTIL5: WHEN 8IGN8D, Tffi8 AG1tE151VffigT I6 A BII1'DIIYIi CONTMCT. Pattioc tp tLle tramrction tr•
619 advlt•d to eonenle a P•nnrylnNa real arnto tttoraey before cigthig Cdt7 dedn l~gid tdvloe,
620 Itstnrn of ibis Agreemont, and my uidand: aad unerda-rartc~ 4cludLte rcq-r„ by eleatroplc trttualh•dou, hel~tiag 1)re +lgaatMrac
62! oI aIl putlot, eon+ctUatec tcp•ptanw by tiro pvriet,
~ _/__ Breyer bu raobived the Coerumer 1VoHce u adopted by !h^ tietto Rt~l_F.etate_~ommlreitn at .{y pa, Code
6T3 fS6.18&
624 _/,._, Hnyer has rtedred a rnsemeat o[Buypr'4 edbnated dorlnQ OOtkr betaa~e elQtdq thirAgraemdttt.
62S ~, /_ Bnyvr'hac read and andercundc me aetiret imd esplanatoq itformation in thb Agreement
676 `/_ Breyer iru received ^ Seller's prapaty Dbieloran Stattmeat before sjp~hig ibis Agrument, U regntred by law
6Z7 {cec>:bformatiaa ReQttdlgg the'Itaal F4tate BeAer Dladatur6 Lr.rj,
~ ^ / ` Hny^r kac raaoived the Deporit Macy Nattoe (tar oooporatire raloo whet Brakar for Seller 4 llpbilag depmlt
62D motley) beibrp ci~ning thir AerarlneriA .
690 ,~!` 8~ bu tviceived the Lead-Bored Paint Htvardr luirvlprare, w>tieh is plashed In th4 Agreement 0t 8tle, and
b7l the pamphlet Protect YpuC Fr<mlly from Lead In Yotr Bbt11, (for propmrtlee bnlit prior to 1p7~
632 vYiT1YEBS ~ HUYRR . ~ DATE ~~i~
67a w17CAiF88 nse ,
BUYE7I DATE
63~ WITN$$g
Bl7YER
DATE
WS BeOer ha rae[ved tht Conenmer Hpe[ot a~ tdvpted by for Stitt Real Eltllte Commlwlon tit dD Pa. Code f 9J.336,
676 Seprr ~ reeeivcd t tatrment of6el[er'c ratlmated elodaa o9rtr before rlealat;.thlr Agreement,
677 Seller be read and nnderrtande the tloHct• tad aipLnatory hdormatba la thlr AQrNgrrnt.
63e WIT1Ylsis 6E ~ ~ DATE ~.Z.f~
>c to
u9 W1TNL~gB 6I$1d.1~I ~ _ DATE
640 egg BFId,BIi DAT$
AtR Tire lI a[ 11
PmdvaetlMm Foment R..bed1110
rep lento flMw lie ke.a. Fwta.MMFfea~ ~ene• areesbl,ape~^er Auwl[ YehfcuS
ZZO/VLOQJ NOIl~DB15NQ9 h3N8Y3~ lESZl69El8 XY~ bE~~! LlOZ/ZO/~0
. Schedule A.1
U. S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT OMB No. 2502-0265
~ • ~ SETTI.EMENTSTATFJdENT TfREPRO"'
LIBERTY LAND TRANSFER, .INC.
B. TYPE OF LOAN
4660 Trindie Road, Suite 2D1
Camp Hill, PA 17011 1. FHA z RHS 3. Cf)rN.UNINS.
a. va 5. CDNV. INS..
Phone:717-975-9915 FAX:717-763-7460 6. FlLE NUMBER
s5o75 7: LAAN NUMBER:
MORT. INS. CASE NO.:
C. NOTE: This form rs famished to give you a statement of arOrral aeOlmreud costs. Amourrs plod b and by the satiemeM agent ere shown.
Memo marked'(p.otJ' were paid cutdde Ore.dosing•'ttbyareBhown here forinforma0an purposes and are not Inch~ded In Ore totals.
D. NAME AND ADDRESS OF BORROW ER:
Assault Yehkie, LLC E. NAME AND ADDRESS OF SELLER:
Jean &albm Estate F. NAME AND ADDRESS OF LENDER
G. PROPERTY LOCATION:
408 E Ccouv Strad
MacheNcsburg,PA 17D55 H. SETTLEI~NT AGENT: Liberty Land Trar>sfer
_ ' I. SETTLEMENT DATE:
Jul 12 2D11
uesda
Y
W Af`F (1F CFTT F•IFAR•
Crmherletd County, PA 486D
Camp Hit, PA 17011
J. SUMMARY OF BORROWERS TRANSACTIO N K SUMMARY OF SELLERS TRANSACTION
00. Groh Amount Due From Borrower 400. Groac Amount Due to SaO~ '
01. Contract sobs prbe 115,000.00 401. ContraG sales prise 115,000.
02 Persond Properly 402 Persorrel Property
03. SeObnrent (ins 1400) 2.062.38 '403.
p4, 404.
Q5. 405.
Adjrtabmenls for isms paid h advance by seier(s) Adjustments far Gems paid b advarx:e by seie(s)
O6. Clly/Town tax to 406. CilylTown bx bo
07. Cotaaylt7lytax 7(122011 b 12/342011 324.74 '407. Caunly/COytax 7M22011 bo 12/312011 324.7
OB. Assesamerds b 408. Assessments bo
09. Scholl Tax 7182011 m 6130/2012 409. Setxwi Tax 7/82011 b~ .61302012
10. b 410. b
11. to 411. bo
tz b at2 b~
zo. Giosa Amevnt cave from Borrower 1tt,367.12 a2D. cross Amount Due to sager 115,324.7
. Amourac Pald By Or M Behalf Of Borrower 6l>0. RidueOonc In Amount Due To SaNler
1_ Deposi a eemeat matey 1,DODJ><I 501. Excess deposal (see instructions)
Prirdpal Amasd of new ban(s) 502 SeOlemant charges W aelbr (Tore 14[10) 6.900
.. Ex~Ong loan(s) taken subject b 503. Existmp ban(s) taken subject b
5D4. PayoO of F6st Mortgage Loan
505. Payoff of Second 1Aatgege Loan
5D6. Escrow - Inheribnee Taz 5,25D
7. 507.
B. 508.
509.
Adjustrnords for items unpaid 4Y Geier Adjuslmerds for Items unpab by seller
10. glyfTown tax b 510. Clty/Town tax kr
11. l.orady/Clty fmc b 511. CouNy/COy tax b
12 Assessments to 512 Assessments b
13. 9rJwd Tax 7/12011 to '711212011 44.42 513. School Tax 7M2011 to 7/122011 44.4
14. Trech 711201.1 b 71122011 5.18 514. Trash 7/12011 to 7!722011 5.1
15. Sewer 7/12011 to 7/122011 8.97 515. Sewer 7(12011 to 7/122011 8.9
16. b 51fi. k~
17. '517. _
18. 518.
19. 519.
0. Total Pafd bylfar8orrowar 1,058.57. 52D. Total Reduction in Amount Due Seiler 12,208
. CASH AT SETTLEMENT FrorNTo BORROWER 600, CASH AT SETTLEMENT 7olFrom SELLER
1. Gloss amount dos frorn borrower~(ine 120) 117,367.12 t. Gross'Amount due Seller (ins 420) 115,324.7
2 Less amourtls pakl bylfor borrower (ins 220) 1,058b7 602. Less reducOon In amt due Beier (ins 520) 12,208.5
3. Cash®FROM ~TD Borrower 11fi,328.55 603. Gash®TO FROM Seiler 103,116.1
sayer or Bartiwer~ signature
Jean B1~slison Estate
~~ ~~ ~~L ~
seibrs sigifalare
Sched>sle H.B.7 HUD-1
L SETTLEMENT CHARGES Case # 95075 _ , ~
700. ToW Ral EsMe Broker Fsa i 3,750A0
oivtsion d eamndesbn (qne 700) as fdbws: Paid From Paid From
rot
5,750A0 b 6dt Platksan Rue Rally Borrowers sellers
702
b Funds At Funds At
703.
Commisebn paid e<SetlkmeK Settlement Settlement
704. tc 5,751
800. Items Payable In Correction 1f111tlf Loan
801. Ourarigirra8on drarge
.802
Your cred8 ar charge (pokds) fartha krbrest rata dfosen S (from (C,FE #'1)
803.
Your sdptsted adgirndfan drerges b (from (GFE f12)
804. Appraisal Fa
b (from (GFE A) 0.00 0
8115. .
Credt Report b (from (GFE #3)
806.
Tax Selvlce b (from (GFE #3)
807.
Food czrtYCation b (~ (~ ~)
808 (tram (GFE IIC4)
. _ b
808. b
810: b
811. b
812 ~
813. b
814. b
900- Items Required by Lanldar to Be Paid in Advance
avc. aaorspage nelrartce prarum for 0 morphs b - (from (GFE#3) -
903. Homeowner's ir~sutance premim for 0 years b
904. b (Uom (GFE #11)
1000. Reserve Daposihd with Lender
1[(01. InOial deposO far your eaaow account
1002 Homeowners insurance 0 MonOls ~ S /a4antlt (~ (~~) 0.
1003. Mortgage ktsrsance 0 Montlrs ~ S fMonOl
1004. Ftaperty takes 0 Mmlhs ~ S ./Morltlt
.1005. 0 Months ~ S /tdaWl
1006. 0 Months @ S /Manih
1007. Aggregate Adjusbnenl _
1100. Title Charge
1101: Title cervices and lerfders Otle ktslaarrce
1102. SaOlarreM or dosing fee b Uberty Lard Transfer (from (GFE #4) f O.t
1103. Owaters tlik irfstsarlce b Uberty Land Transfer (from (GFE #5) 840:3
1104. Lenders Olk frrslaartae
1105. Larders Olle policy IknB S
1106. Owrlars Wle policy fdNt .S 115,000.00
1107. AgertPs potion d Ore trial title trrsurence pr®nium 714.32
1108. Undervrdters portion of the trial Otte insurance premium 126.06
1109. b
1110. b
1111. b
1200. Goverrrrent Recording and Transfer Charge
1201. Govenrrtenl reconGrrg drerges
1202 [lead S 6200 Mortgage S Rlde~Slf [~ (from (GFE #7) 6200
12D3. Trensferfalces
1204. ~~Y ~ Deed S 1,150.OD Mortgage S Retbrder d Deeds (from(GFE.#8) 1,150J>0
1205. State tatdstamps Deed S 1.150.00 Mtr~age S Recorder d Deeds
1300. AddiBonal SettbmantChargas
1301. Required services that you can shop for (from (GFE #6) 0.00
1302 to
1303. b
13oa. b
1305. b
13os. b
13D7. b
1400. Total Settlement Charges (order on lines 1 D3, Baritone J std 502, Sections K) 2,062.36 6,900. ~
Partles spree that ro Babaly n assumed try Selibment Agent br lire aaauary of Mlbrmation fumished by others ea shown on the HUD-t Settlement SfetanerrL
HUD CERTIFlCATION OF BUYERS AN[J SELLERS
I have ceretutly reviewed the HU0.1 Settlement Statement end b the best d my knowledge and bepd, 8 is a true and atslrrate statement d all receipts and
disbursernen4s made on my atxounl by me in Ous transaction. I further codify Ihat I have raceHad a copy d the HU0.1 SeOlement Statement.
Jea,1n B~Iison Estate
Buyer or BormweYS Signature ~~I - ~ Li s ~ p . ~.~~~
seOets S6nmf66
Buyer's Address a Ptnne: Setlers New Andress a Phone: .
The Hl1D-1 SedbmeM Statement which I have papered Is a true and amaae account of tNs aanseetlon. I have caused or wip oatse the funds to be dlabursed In aaordance wOh
this statement
i
Settlement Agora Dale ~~
WARNING: It fs a trine ro laarvingly make (else statements b pre UNted SIaMS on OHS orarry simper form. PenelOes upon mnvktion can Include a fine eM imPdsonmerlL For ~~
datebs see Title t e: V.S. Code Seetlon 1001 and Sectlon 1010.
Schedule H.B.7
i