HomeMy WebLinkAbout02-22-12'-"', REV-1500 EX (02-11) (FI)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
1505611185
OFFICIAL USE ONLY
County Code Year File Number
INHERITANCE TAX RETURN 21 10 1 ~ 4 5
RESIDENT DECEDENT
162-36-9772 09172010
Decedent's Last Name
AGRAFIOTIS
MMDDYYYY Date of Birth MMDDYYYY
01241,945
Suffix Decedent's First Name
MARCIA
(If Applicable) Enter Surviving Spouse's Information Belo Suffix Spouse's First Name
Spouse's Last Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
C
MI
FILL IN APPROPRIATE BOXES BELOW
^
Supplemental Return
2 ^
3. Remainder Return (Date of Death
1. Original Return . Prior to 12-13-82)
^ ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required
4. Limited Estate
te
t
T
^ death after 12-12-82)
7. Decedent Maintained a Living Trust
~
8. Total Number of Safe Deposit Boxes
a
es
6. Decedent Died
(Attach Copy of Will) (Attach Copy of Trust.)
^
9113(A)
r Sec
^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (Date of Death
Between 12-31-91 and 1-1-95) .
1 1 ~ Attach Schedule O)
(
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIALDaAXnNe Teleph O2 NuOmber BE DIRECTED TO:
Name
-_
RICHARD C• SNELBAKER 717-697-8528
REGIST - _ FOWILLS USFfONLY `~'!
~' -. -
First Line of Address ~ -"'T ~~ r ~ ~ ~' '
~J J ~` _.
44 WEST MAIN STREET ''«~~ --~
Second Line of Address '~` '~~'
p.0. BOX 318 `'~'
DATE FILED '"'
City or Post Office State ZIP Code --
MECHANICSBURG PA 17055
Correspondent's a-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer hDATE knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN i Z _ ~ r - I -Z-
7~ltxl~ 1.
MARIAA~EVER, CO-EXECUTOR
~~.~..~~ .o nc R OTHER THAN REPRESENTATIVE
PETER A•`YELK, CO-(EXECUTOR
~- ~a~ i
ADD ss 44 WEST MAIN STREET, MECHANICSBURG
RICHARD C• SNELBAKER
PLEASE USE ORIGINAL FORM ONLY PA 17055
Side 1
1505611185 1505611185
OM4647 3.000
J `" s
~~
1505611285
REV-1500 EX (FI)
Decedent's Social Security Number
162-36-9772
Decedents Name AGRAFIOTTS MARCIA C-
RECAPITULATION
1. Real Estate (Schedule A) 1 ~ 17 5 , 8 8 0 • 8 0
2. Stocks and Bonds (Schedule B) .
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ,
4. Mortgages and Notes Receivable (Schedule D)
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested
8. Total Gross Assets (total Lines 1 through 7) 2.
3.
4.
5.
g.
7.
g. 9 S , 5 31.6 0
0 • 0 U
0 • 0 0
13 , 9 6 6 •91
~ ' ~ ~
Q • O M
2 8 5 , 3 7 9 • 3 ],
9. Funeral Expenses and Administrative Costs (Schedule H). 9. 3 9 , 8 71.0 4
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 9 , 6 67 •8 0
11. Total Deductions (total Lines 9 and 10) , 11. 4 9 , 5 3 8.8 4
12. Net Value of Estate (Line 8 minus Line 11) . 12. 2 3 5 , 8 4 0.4 7
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
0 • 0 ~
an election to tax has not been made (Schedule J) , . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . 14. 2 3 5 , 8 4 0. 4 7
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers un~er Sec. 9116 0 • 0 0
16. Amount of Line 14 t xable
at linealratex.o4~ 235,840.47
16. ], 0 , 612 •8 2
17. Amount of Line 14 taxable
0 0
12 0
17 0 • ~ 0
•
at sibling rate X . .
18. Amount of Line 14 taxable
at collateral rate X .15 0 • 0 0
18. ~ • ~ ~
10,612.82
19. TAX DUE....... .
19
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505611285 1505611285
OM4648 3.000
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments 9, 5 0 0. 0 0
B. Discount 4 7 5. 0 0
Total Credits (A + B) (2)
(1) 10,612.82
9,975.00
3. Interest
(3) 1 3.0 7
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 0 • 0 0
Fill in box on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 6 5 0 •8 9
Make check payable to: REGISTER OF WILLS, AGENT.
LLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
PLEASE ANSWER THE FO
1. Did decedent make a transfer and: Yes No
X
a. retain the use or income of the property transferred
b. retain the right to designate who shall use the property transferred or its income ^
c. retain a reversionary interest ^
d. receive the promise for life of either payments, benefits or care?
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death ~ ^
without receiving adequate consideration? .
? ^
3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death
4. Did decedent own an individual retirement account, annuity, or other non-probate property, which ^
contains a beneficiary designation?
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
0 M4671 2.000
File Number
REV-1500 EX (FI) Page 3
REV-1502 EX+ (01,10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
o~cinGniT nF('F WENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER:
21 10 1045
Marcia C. A rafiotis
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointlyowned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common.
NUMBER DESCRIPTION
~. Property known and numbered as
1339 Concord Road, Hampden Township, Mechanicsburg, PA
17050, sale value (see attached settlement sheet)
TOTAL (Also enter on Line 1, Recapitulation.) I $
swasss z o0o If more space is needed, use additional sheets of paper of the same size.
VALUE AT DATE
OF DEATH
175,880.
175,880.80
REV-1503 EX ~ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ATE
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
Marcia C. A rafiotis 21 10 1045
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER
1.U.S. Savings Bonds 95,531.60
18 series "E" savings bonds with $1,000.00 face value
(see attached listing)
TOTAL (Also enter on line 2, Recapitulation) I $ 95 , 531.60
3wasss i o00 (If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (11-10)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
FILE NUMBER:
ESTATE OF:
Marcia C. A rafiotis 21 10 1045
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with ri ht of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
OF DEATH
NUMBER DESCRIPTION
7,625.00
1. 2 007 Saturn Ion 3
Kelly Blue Book value (see attached appraisal)
53.63
2 Member's 1st Federal Credit Union
savings account #72745-00
527.52
3 Member's 1st Federal Credit Union
checking account #72745-11
25.16
4 Member's 1st Federal Credit Union
savings account #219324-00
2,314.10
5 Member's 1st Federal Credit Union
checking account #219324-05
112.47
6 Highmark
refund due the decedent
3,291.03
7 Household goods
proceeds from sale of household goods
18.00
8 The Hartford
refund due the decedent
TOTAL (Also enter on line 5 Recapitulation) $ I 13 , 966.91
owasAO 2.000 If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
Pennsylvania
DEPPRTMENT OF REVENUE
INHERITANCE TAX RETURN
oCCInFnR nFf1F fIF NT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILt Numt3thc
Marcia C. A rafiotis 21 10 1045
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
~ Peter A. Yelk
reimburse for funeral and burial expenses
B.
1
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
2. Attorney Fees: Snelbaker & Brenneman, P.C.
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
I.. n4
4.
5.
6.
7.
1
2
9 W46AG 2.000
Street Address
City State ZIP
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
Cumberland Law Journal
advertising Executor's notice
Hampden Township
sewer expenses
Total from continuation schedules
State ZIP
TOTAL (Also enter on Line 9, Recapitulation) ~ $
If more space is needed, use additional sheets of paper of the same size.
AMOUNT
10,782.20
4,280.00
323.50
895.00
75.00
165.01
23,350.33
39,871.04
Estate of: Marcia C. Agrafiotis 21 10 1045
Schedule H Part 7 (Page 2)
3 PNC Bank
33.20
check printing fee
4 PP&L
872.68
electric service
5 Real Estate Settlement charges as follows:
a. Realtor's Commission: $10,455.00
b. Notary fee: $10.00
c. Tax certification: $10.00
d. Deed preparation: $150.00
e. Transfer taxes: $1,750.00
f. Home warranty: $495.00
g. Home inspection: $1,670.00
h. Sewer charges: $155.05
i. Cumberland County Tax Claim Bureau: $473.80
j. Sellers assistance: $4,000.00
k. County taxes: $5.70 19,174.55
6 Register of Wills
00
15
filing fee for Inheritance Tax Return .
7 Repairs to real estate
035.50
2
needed to prepare house for market ,
8 The Sentinel
219.40
advertising Executor's Notice
9 Reserve
for filing fees, accountant fees and other
miscellaneous costs associated with the
administration of the Decedent's estate 1,000.00
23,350.33
Total (Carry forward to main schedule)
REV-1512 EX+(~2-OB) SCHEDULE
pennsylvania
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT _
FILE NUMBER
ESTATE OF
Marcia C. A rafiotis 21 10 1045
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER
1. Ally Bank
payoff on automobile loan 4,525.84
2 Heritage Medical Group
13.11
medical services
3 Holy Spirit Hospital
28'07
medical services
4 Kohl's
121.58
payoff credit card
5 M&T Bank
699.21
2
visa account #4672090000174755 ,
6 Michael Langan, Tax Collector
11.00
2010 personal tax
7 Michael Langan, Tax Collector
2,238.03
real estate taxes
8 Tru Green
30.96
lawn care services
TOTAL (Also enter on Line 10 Recapitulation) ~$ 9, 667.80
awasAH z o0o If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania
DEPPRTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
Marcia C. Agrafoti~
SCHEDULE J
BENEFICIARIES
IMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1, Maria Dever
1715 Walnut Street
Camp Hill, PA 17011
One Half of Residue: 117,920.24
2 Peter A. Yelk
1073 Kuhn Road
Boiling Springs, PA 17007
One Half of Residue: 117,920.24
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
Son
117,920.24
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1
TOTAL OF PART II ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ 0.00
If more space is needed, use additional sheets of paper of the same size.
FILE NUMBER:
AMOUNT OR SHARE
OF ESTATE
117,920.24
9 W 46AI 2.000
OMB Approval No. 2502-0265
:. - -
Gross Amount Due to Seller
400
100. Gross Amount Due from Borrower
000.00
175 •
401. Contract sales price 175,000.00
,
101. Contract sales price
402. Personal pro e
102. Personal pro ert
103. Settlement charges to borrower (line 1400) 8,090.60 403.
404.
104. 405.
105. Ad'ustments for items aid b seller in advance
Ad'ustments for items aid b seller in advance to
wn taxes to
lt
Cit 406. Cityltown taxes
o
y
106. 407. County taxes to
to
107. County taxes
01106/2012 to 06!3012012
l T
h
785.38
01106/2012 to 06130/2012
T 785.38 ax
oo
408. Sc
ax
108. School
0110612012 to 0310112012 95.42 409. Sewer 0110612012 to 0310112012 95.42
109. Sewer 410.
110. 411.
111. 412.
80
880
175
112.
183,971.40 .
,
420. Gross Amount Due to Seller
120. Gross Amount Due from Borrower
Reductions I~ Amount Due to Seller
500
200. Amounts Paid b or in Behalf of Borcower
2,000.00
.
501. Excess deposit (see instructions)
201. Deposit or earnest money 563.00
170 502. Settlement charges to seller (line 1400) 15,168.85
202. Principal amount of new loan(s)
,
503. Existin loa s taken sub ect to
203. Existin loarys) taken sub ect to 504. Pa off of first mort a e loan
204.
505. Pa off of second mort a eloan
205.
506.
206. 7,059.00
507. Inheritance Tax Escrow
207.
508.
208 509.
209 Ad'ustments for items unpaid b seller
Ad'ustments for items unpaid b seller 510, Cityltown taxes to
210. Cityltown taxes to
0110612012 5.70
1!0112012 t
511. County taxes 0110112012 to 01!0612012 5 ~0
o
211. County taxes 0 to
t 512. School Tax
o
212. School Tax
513.
213.
514.
214 4,000.00 515. Sellers Assist 4,000.00
215. Sellers Assst
516.
216. 517.
217.
518.
218. 519.
219 176,568.70 520. Total Reduction Amount Due Seller 26,233.55
220. Total Paid b Ifor Borcower
600. Cash at Settlement tolFrom Seller
300. Cash at Settlement fromfto Borcower
40
971
183 Gross amount due to seller (line 420) 175,880.80
601
.
,
301. Gross amount due from borrower (line 120)
70
568
176
20
.
Less reductions in amount due seller (line 520)
602
.
,
)
Less amounts paid byHor borrower (line 2
302 .
.
m ^ To Borcower 7,402.70
^X F 149,647.25
603. Cash ^X To ^ From Seller
ro
303. Cash
mmu es cer n;sponse g, rev,ew,n
_______.__,..._,..., ,... ,..,, ,_ rwe,n 9~_ repo ing 5. rs agency may rw w e rs in orma n a you are n regmr o comp e e
~_.._ ...... oceoe,.,....,n,r,eaaninn vrilh mlortnelion CUnng the seNemem
lne ruonc Rep,,,,,,yo.,.,a,,.M ,,..~.._..__.._. __.__.. yls aswr ,,,.,,,
inls corm, unless tl tlkplays a curtenlly valiE OMB comrol numhef. No conhaenliela ,s i o i
process.
See attached addendum for additional information HUD-1
Previous editions are obsolete Page 1 of 4
/.E,~..~
~l
A. Settlement Statement (HUD-1)
-, ~
700. Total Real Estate Broker Fees $ 10,455.00 Pdld From
' Paid From
'
ll
S
Division of commission Iine700 as follows: S
BOrrOWer er
S
e
Re/Max Realty Associates, Inc. Funds at Funds at
701. $5.130.00 to t
l
00 to ERA-NRT, Inc.
702
3 Settlement emen
Sett
. 85,
25. 10,455.00
703. Commission paid at settlement
704. Broker Fee to Re/Max Realty Associates, Inc. 295.00
800. hems Pa able in Connection with Loan
801. Our origination charge (Includes Origination Point 2.887% or $4,874.69) $5,769.69 (fmm GFE #1)
Your credit or charge (points) for the specific interest rate chosen $-4,874.69 (from GFE #Z)
802
.
803. Your adjusted origination charges (from GFE A) 895.00
804. Appraisal fee to Class A raisal $475.00 P.O.C. B' (from GFE #3)
805. Credit re oR to from GFE #3
806. Tax service to from GFE #3
807. Flood certification to LandSafe Flood Determination, Inc. (from GFE #3)
14.00
808. to
900. items R wired b Lender to bePaid in Advance from GFE #10 485.99
901. Daily interest charges from from 01!06/2012 to 02101!2012 @ $18.6918Iday ( )
902. Mortgage insurance premium for months to De t of HUD (from GFE #3) 0.75
903. Homeowner's insurance for ears to State Farm $738.00 P.O.C. B' (from GFE #11)
00
1
688
3
,
.
)
904. UFMIP for months to De t of HUD (from GFE #
1000. Reserves De osited with Lender (from GFE #9) 1,114.73
1001. Initial deposit for your escrow account
1002. Homeowner's insurance 3 months $ 61.50/month $184.50
1003. Mortgage insurance months $ 160.54Imonth $
1004. Property taxes months $ O.OOlmonth $
1005. County taxes 13 months $ 34.76/month $451,88
1006. School Tax 8 months $ 135.331monlh $1,082.64
1007. Aggregate Adjustment $-604.29
1100. Title Char es 1,687.13
from GFE #4
'
s title insurance
1101. Title services and lender
1102. Settlement or closing fee to $
20
00
1103. Owner's title insurance -First American Title Insurance Company from GFE #5 .
1104. Lender's title insurance -First American Title Insurance Company $1,562.13
1105. Lender's title policy limit $170,563.00 Lender's Policy
1106, Owners title policy limit $175,000.00 Owner's Policy
1107. Agent's portion of the total title insurance premium $1,281.06
to Ke stone Land Transfer, Ltd
1108. Underwriter's portion of the total title insurance premium $301.07
to First American Title Insurance Com an
1109. 10.00
1110. Notary Fee to Kristen D. Shive
10.00
1111. Tax Certification Fee to Ke stone Land Transfer, Ltc 150.00
1112. Deed Preparation to Ke stone Land Transfer, Ltc
1200. Government Recordin and Transfer Char es
(from GFE #7) 140.00
1201, Govemmenl recording charges $
1202. Deed $62.00 MoR a e $78.00 Release $
(from GFE#8)
750.00
1
1203. Transfertaxes $ ,
1204. CitylCounty taxlstamps Deed $1.750.00 MoR a e $
1.750.00
1205. State Tax.rstamps Deed $1.750.00 Mort a e $
1206. Deed $ MoR a e $
1300. Additional Settlement Charges (from GFE #6)
1301. Required services that you can shop for
to
1302
.
1303. to
1304. to
1305. t0 495.00
1306. Home Warranty to American Home Shield 1,67C.00
1307. Radon Mitigation to Mike Sheel Home Ins ection 155.05
1308. Sewer t/1-3130 to Nam den Townshi 473.8
1309. 2011 Co1Twp Taxes to Cumberland Count Tax Claim Bureau
c ~co oc
11 1 ~ I u,va~.vv
. •-
'Paid outside of closing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. "Credit by lender shown on page 1. "'Credit by seller shown on page 1.
See attached addendum for additional information
Previous editions are obsolete Page 2 of 4 HUD-1
Good Fa'dh Estimate HUD-1
Comparison of Good Faith Estimate (GF and HUD-1 Char es
Cha es That Cannot Increase HUD-1 Line Number
349.00
6
5,769.69
Our origination charge
h # 801
# 802 ,
-4,874.69 -4,874.69
osen
Your credit or charge (points) for the specfic interest rate c 31
474
1 895.00
Your adjusted origination charges # 803 .
,
750.00
1
1,750.00
Transfer taxes
# 1203
,
Cha es That in Total Cannotlncrease More Than10%
Government recording charges # 1201
Appraisal fee # 804
# 807
Flood certification
#902
Mortgage insurance premium # 904
UFMIP
Title services and lenders title insurance # 1101
Owner's title insurance -First American Title lnsurance Company # 1103
Loan Terms
Your initial loan amount is $170,563.00
Your loan term is 30. years
Your initial interest rate is 4.0000%
Your initial monthly amount owed for principal, interest, and any mortgage $974.84 includes
insurance is QX Principal
^X Interest
^X Mortgage Insurance
Good Faith Estimate HUD•1
175.00 140.OD
475.00 475.00
14.00 14,00
0.75 0.75
1,688.00 1,688.00
1,233.00 1,687.13
125.00 20.00
3,710.75 4,024.88
$ 314.13 or 8.4654%
Good Faith-Estimate HUD-1
2,444.00 1,114.73
504.68 485.99
480.00 738.00
Can your interest rate rise? Q No. ^ Yes, it can rise to a maximum of °/ . The first change
will be on ! 1 and can change again every years after I 1 .Every change
date, your Interest rate can increase or decrease by %. Over the life of the loan, your
interest rate is guaranteed to never be lower than % or higher than %
Even if you make payments on time, can your loan balance rise? Q No. ^ Yes, it can rise to a maximum of $
Even if you make payments on time, can your monthly amount owed for Q No. ^ Yes, the first increase can be on I I and the monthly
~ principal, interest, and mortgage insurance rise? amount owed can rise to $
The maximum it can ever rise to is $
Does your loan have a prepayment penalty? QX No. ^ Yes, your maximum prepayment penalty is $
^X No. ^ Yes, you have a balloon payment of $ due in
Does your loan have a balloon payment?
years on 1 1
Total monthly amount owed including escrow account payments ^ You do not have a monthly escrow payment for items, such as property taxes
and homeowner's insurance. You must pay these items directly yourself.
X^ You have an additional monthly escrow payment of $231.59
that results in a total initial monthly amount owed of $1,206.43. This includes principal, interest.
mortgage insurance and any items checked below:
^X Property taxes ~ Homeowner's insurance
Flood insurance ^
^ ^
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender
See attached addendum for additional information Page 3 of 4 HUD-1
Previous editions are obsolete
HUD CERTIFICATION OF BUYER AND SELLER
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.
Estate of Marcia C. Agrafiotls
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaUion. I have caused or will cause the funds to be
disbursed in accordance with this statement.
t,~
SETTLE NT
DATE
CONVICTION CANCINCLUDEOA FWE AND MPR SONMENT. FOR DETAILS SEE T THE 8DUSACODO SECTION 1001 ANDISECT ON OtONALTIES UPON
See attached addendum for additional information Page a of a HUD-1
Previous editions are obsolete
Name of Seller: File Number:
Name of Borrower: 11192
Chad R. Palmer Estate of Marcia C. Agrafiotis
Christina L. Palmer
Prepared 01 10 612 0 1 2 at 11:00 am
Note: This page displays an itemization of the adjusted origination charges shown in section 800 of the HUD-1 Settlement Statemen
This page accompanies but is not a part of the HUD-1 Settlement Statement. If a discrepancy exists, the information on the HUD-1
settlement Statement applies.
Loan Origination Charges
Our origination charge (Includes Origination Point 2.887% or $4,874.6 89500
Origination Fee to United Wholesale Mortgage ~
to Bentr Mort a e g 4,874 69
Broker Fee
Your credit or charge (points) for the specific interest rate chosen A ore ao
803. Your adjusted origination charges
Borrower ~ Seller
0.00
r
Name of Seller: File Number:
Name of Borcower: 11192
Chad R. Palmer Estate of Marcia C. Agrafiotis
Christina L. Palmer
Prepared 01/0612012 at 11:00 am
Note: This page displays an itemization of the charges shown on line 1101 of the HUD-1 Settlement Statement. This page
accompanies but is not a part of the HUD-1 Settlement Statement. If a discrepancy exists, the information on the HUD-1 Settlement
Statement applies.
100. Title Charges
1101. Title services
to
to
Email\Doc Copy Fee to Keystoi
Wire In Fee to Keysto
Notary Fee to Kristen
1102. Settlement or closing fee to
1104. Lender's title insurance -First American Titio First A
credits shown on
Total
Land Transfer, Ltd $
Land Transfer, Ltd $
Land Transfer, Ltd $
Shive $
rican Title Insurance Cc$
Totals: $
anr•. =Paid Outside
Borrower ~ Seller
35.00 35.00
10.00 10.00
55.00 55.OC
0.00
1,562.13 1,562.1;
CR=
See attached addendum for additional information Page 1 of 1 HUD-1
Previous editions are obsolete
Calculated Value of Your Paper Savings Bond(s)
...®..
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 09/2010
Page 1 of 1
Total ri Total ~aE~t Total Int~-st Ir~t~rst
$13,500.00 $95,531.60 $82,031.60 $0.00
Bonds: 1-18 of 18
r~s ~~~~o~ Is t E~nl
t~ ,real ~tur~ iss~~ 'r~:,~e ~:~_ `~ r ~~~~-test _
~~~
~~
~~~~>~
M213693616E E ' $1,000 11/1976 ~'" 11/2006 $750.00 $4,756.00 $5,506.00 MA
M213693614E E $1,000 09/1976 ~f 09/2006 $750.00 $4,702.80 $5,452.80 MA
M213693615E E ' $1,000 10/1976 .~~°" :10/2006 $750.00 $4,702.80 $5,452.80 MA
M213693613E E $1,000 01/1976 ~°~" 01/2006 $750.00 $4,640.40 $5,390.40 MA
M213693612E E $1,000 12/1975 .~'" 12/2005 $750.00 $4,640.00 $5,390.00 MA
M213693610E E $1,000 06/1975 ~~'" 06/2005. $750.00 $4,576.00 $5,326.00 MA
M213693609E E $1,000 04/1975. w"°~' 04/2005 $750.00 $4,512.80 $5,262.80 MA
M213693617E E $1,000. 02/1977 ~ta,,~ 02/2007. $750.00 $4,771.60 $5,521.60 MA
M213693618E E $1,000 03/1977 >,~ 03/2007 $750.00 $4,771.60 $5,521.60 MA
M213693619E E $1,000 05/1977 -<""" 05/2007 $750.00 $4,826.00 $5,576.00 MA
M213693620E E $1,000 05/1977 •°" 05/2007 $750,00 $4,826.00 $5,576.00 MA
M213693621E E $1,000 07/1977 ~~°' 07/2007 $750.00 $4,836.80 $5,586.80 MA
M213693622E E $1,000 09/1977 ~ ``m 09/2007 $750.00 $4,836.80 $5,586.80 MA
M213693623E E $1,000. 10/1977 ~'"` 10/2007 $750.00 $4,836.80 $5,586.80 MA
M213693624E E $1,000 11/1977 ~--~° 11/2007 $750.00 $4,373.60 $5,123.60 MA
M213693625E E $1,000 12/1977 ~`'~ 12/2007 $750.00 $4,388.00 $5,138.00 MA
M213693626E E $1,000 05/1978 ~'`" 05/2008 $750.00 $3,516.80 $4,266.80 MA
M213693627E E $1,000 05/1978 ~~" 05/2008 $750.00 $3,516.80 $4,266.80 MA
Totals for 18 Bonds $13,500.00 $82,031.60 $95,531.60
NI Not Issued
NE Not eligible for payment
P5 Includes 3 month interest penalty
MA Matured and not earning interest
http://www.treasurydirect. gov/BClSBCPrice 10/ 18/2010
2Q.IIZ~aturn Ion -Trade In Value, blue book value -Kelley Blue Book Page 1 of 3
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LAST WILL AND TESTAMENT
I, MARCIA C. AGRAFIOTIS, 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 declare this as and for my Last Will and Testament, hereby
revoking and making void all former wills and codicils by me at anytime heretofore made.
FIRST. I order and direct that all my just debts and funeral expenses be paid by my
Executors, Executor or Executrix, as the case maybe, hereinafter named, as soon as conveniently
maybe done after my decease.
SECOND. I order and direct that all the rest, residue and remainder of my Estate, real,
personal and mixed, whatsoever and wheresoever situated, shall be divided into two (2) equal
parts, which I give, devise and bequeath to the persons as follows:
A. One such equal part of my residuary estate unto my daughter, namely,
MARIA DEVER, absolutely and in fee simple, if she survives me.
B. One such equal part of my residuary estate unto my son, namely, PETER
A. YELK, absolutely and in fee simple, if he survives me.
If either of my children shall not survive mc, I order and direct that the share attributable to such
deceased child shall be distributed unto her or his issue by stirpes by representation and not per
capita, but subject to the protective trust provisions in Item "Third hereinbelow with respect to
any beneficiary who has not attained the age oftwenty-five (25) years at the time for
distribution. If either of said children should not survive me and leave no issue to survive me,
then in such event, I order and direct that the share attributable to such deceased child shall be
distributed to my surviving child or the living issue of such child equally if none of my children
should survive me.
In the ev nt that both of my cldren and I should die as the result of a common cause or
LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
disaster, I order and direct that I shall be deemed to have survived my children for the purpose of
making distribution hereunder.
TH1RD. If any beneficiary under Item Second hereinabove has not attained the age of
twenty-five (25) years at the time of distribution, I order and direct that the distributive share of
such person shall be paid over and delivered unto my testamentary Trustee, hereinafter named,
IN TRUST, NEVERTHELESS, to hold, manage, invest, accumulate income and reinvest in a
separate trust for each beneficiary until said beneficiary attains the age of twenty-five (25) years,
at which latter time, said trust shall be terminated and the net proceeds thereof shall be paid over
to the beneficiary absolutely.
I authorize and empower my said Trustee to invest the assets of said trust in any
reasonable manner and not be limited or restricted to so-called "legal" or statutory investments
for fiduciaries.
I designate any trust hereunder to be aspend-thrift trust. The beneficiary shall have no
right to im~ade, pledge, assign, or otherwise dispose of the assets of said Trust (including
income) nor shall any creditor of a beneficiary have any right to seize, levy or execute upon said
assets by reason of any pledge, assigtunent or other transfer, voluntarily or involuntarily, made
by said beneficiary.
I further authorize and empower my said Trustee to use, consume, expend and apply from
LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
time to time such amounts of principal and income of and from said trust which in the exercise of
its sole discretion shall be determined to be reasonable and necessary for the beneficiary's
education. The terns "education" shall be construed and interpreted to mean college or other post-
high school training which is intended to improve the beneficiary's productivity as an adult or
enhance the quality of his or her life. In considering what is reasonable and necessary, my said
Trustee shall take into consideration the primary responsibility of the beneficiary's surviving
parent to provide such education. It is my will and intention that the
foregoing discretionary provision for education be supplementary to the parent's primary
~-esponsibiliry.
LASTLY. I nominate, constitute and appoint my children, namely, MARIA DEVER and
?ETER A. YELK, to be the Executors of this, my Last Will and Testament and the Trustees for
-2-
any trust created hereunder, but if either should fail to qualify as such fiduciary or cease so to
serve (executor, executrix or trustee), then and in that event, I order and direct that the child so
qualifying or remaining shall be the sole executor, executrix or trustee, as the case maybe.
If both of my said children should fail to qualify as such fiduciaries or cease so to serve,
then in that event, I nominate, constitute and appoint my daughter-in-law, namely, ANNA
YELK, to be the sole fiduciary hereunder
If all of the above-named persons should fail to qualify as such fiduciaries, then and in
that ultimate event, I nominate, constitute and appoint my son-in-law, namely, THOMAS
DEVER, to be the sole executor and trustee hereunder.
I order and direct that none of the above-named persons shall be required to post bond or
other security as a condition of qualification hereunder.
IN WITNF,SS WHEREOF, I, MARCIA C. AGRAFTOTIS, have hereunto set my hand
and seal to this my Last Will and Testament, which consists of three (3) typewritten pages to
each of which I have affixed my signature this 23rd day of June, A.D. Two Thousand Three
(2003).
~~~4~.F ~ ~ (SEAL)
MARCIA RAFIOTIS
The preceding instrument, consisting of this and 1tiv0 (2) other typewritten pages, each
identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and
declared by MARCIA C. AGRAFIOTIS, the Testatrix therein named, as and. for her Last Will
and Testament, in the presence of us, who, at her request, in her presence and in the presence of
each other, have subscribed our names as witnesses h>~fe a.
j ~-_'~
i
,`~ ~~
r; ~}
its '`~ ~~/v'-~-ati:..<
`~~ - -t~---~
LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
-3-
COMMONWEALTH OF PENNSYLVANIA)
SS.
COUNTY OF CUMBERLAND ~
We, MARCIA C. AGRAFIOTIS, RICHARD C. SNELBAKER and JANE J. GOONEY,
the Testatrix and the witnesses, respectively, whose names aze signed to the attached or
foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that
the Testatrix signed and executed the instrument as her Last Will and Testament and that she had
signed willingly, and that she executed it as her free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the
Will as a witness and that to the best of his or her knowledge, the Testatrix was at that time
eighteen years of age or older, of sound mind and under no constraint or undue influence.
1,
trix
.~
Hess
'' ~~
Witndss
Subscribed, sworn to and acknowledged before me by MARCIA C. AGRAFIOTIS, the
Testatrix, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J.
GOONEY, the witnesses, this 23rd day of June, 2003.
otary Publrc
LAW OFFICES
~NELBAKER.
3RENNEMAN
& SPARE