HomeMy WebLinkAbout02-23-12,`
1505610143
REV-1500 Ex `°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes OEPoIRTMENT OF REVENUE
Po Box.2aosol INHERITANCE TAX RETURN 21 11 00953
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
186 34 0025 05 21 2011 06 19 1921
Decedent's Last Name
CALAMAN
(lf Applicable) Enter Surviving Spouse's Information Below
Suffix Decedent's First Name
MARIAN
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ^ 2. Supplemental Return
^ 4. Limited Estate ^ 4a. Future Interest Compromise
(date of death after 12-12-82)
g Decedent Died Testate 7 Decedent Maintained a Living Trust
(Attach Copy of Will) ^ (Attach Copy of Trust)
^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death
between 121 91 and t-1-95)
^ 3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
~
8. Total Number of Safe Deposit Boxes
^ 11.Election to tax under Sec. 9113(A)
(Attach Sch. O)
MI
J
MI
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
MARK A MATEYA 717 241 6500
First line of address
55 W CHURCH AVENUE
Second line of address
City or Post Office State ZIP Code
CARLISLE pp,
Correspondents a-mail address: mam@mateyalaw.com
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REGISTER Q~~IfVILLS USE~ILY
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, co ct and complete. Decl lion of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNA ~U PERSON ESP NSI E OR ING RETURN DATE
I David A Calaman
ADDRE S
600 Rid Road Shi ensbur PA 17257
SIGNATURE OF REPARER OTHER T N REPRE E DATE
_ Mark A. Mateya
ADDRESS
55 W. Church Avenue, Carlisle, PA
Side 1
1505610143 1505610143 J
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF FILE NUMBER
Calaman, Marian J 21-11-00953
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 has any knowledge.
/ _~_-
G .'
Signature #2 ~--~ ~,~.~~~~ "" ~'~-~'~~
Name Kenneth Calaman
Address1 104 N. Locust Lane
Address2
City, State, Zip Mechanicsburg, PA 17050
Date
15D561D243
REV-1500 EX
Decedent's Social Security Number
Decedeni'sName~. Ciaiaman, Marian J 186 34 0025
RECAPITULATION
1. Real Estate (Schedule A) ....................................................................................... 1. 65 , 000.00
2. Stocks and Bonds (Schedule B) ............................................................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3.
4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 16 , 18 0 . 3 9
6. Jointly Owned Property (Schedule F) jJ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers & Miscellaneous NQn-Probate Property
(Schedule G) ~ Separate Billing Requested............ 7.
8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. $1 ,18 0 .3 9
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 13 , 4 97 .7 6
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 1 , $ 7 8.51
11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 15 , 3 7 6 . 2 7
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 65 , 804.12
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............................................... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) .............................................. . 14. 65 , 804.12
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
15
0.00
(a)(1.2) X .00 .
16. Amount of Line 14 taxable 65 , 804.12 16. 2 , 961.19
at lineal rate X .045
17. Amount of Line 14 taxable
0
00
17
0.00
.
at sibling rate X .12 .
18. Amount of Line 14 taxable
0
00
18
0.00
.
at collateral rate X .15 .
19. Tax Due ................................................................................................................. . 19. 2 , 9 61.19
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
~, 15D561D243 1505610243
REV-1500 EX Page 3 File Number 21-11-00953
Decedent's Complete Address:
DECEDENT'S NAME
Calaman, Marian J
STREETADDRESS
CITY STATE 'ZIP
PA
Tax Payments and Credits:
1. Tax Due jPage 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
0.00
(1) 2,961.19
Total Credits (A + B) (2)
3. Interest
(3)
0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2 Line 20 to request a refund y
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2 961.19
y
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
~-, ~-
a. retain the use or income of the property transferred :............................................................................... I _] j~
b. retain the right to designate who shall use the property transferred or its income :.................................. L] LX.1
c. retain a reversionary interest; or .............................................................................................................. ]] Lx
d. receive the promise for life of either payments, benefits or care? .........................................................._ ~__; z I
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without _
receiving adequate consideration? .................................................................................................................... __ i
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ] [x]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which __
contains a beneficiary designation? ................_................................................................................................ ~ J L~
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 January 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 1.2) (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)]. 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.
Rev-1502 EX+t11-OS)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Calaman, Marian J 21-11-00953
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 which is jointly-owned with right of survivorship must be disclosed on schedule F.
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08)
Rev-1508 EX+t6-98)
SCHEDULE E
CASH, BANK DEPOSITS, 8~ MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Calaman, Marian J 21-11-00953
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+(10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Calaman, Marian J 21-11-00953
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
2,250.00
Street Address
City State Zio
Year(sl Commission oaid
2. Attorney's Fees 5,300.00
See continuation schedule(s) attached
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 5,947.76
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 13,497.76
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Calaman, Marian J 21-11-00953
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex e~ nses
1 Cremation Society of PA -Funeral/cremation expense 1,340.00
2 Westminester Cemetery -Burial Plot 910.00
H-A 2,250.00
Attorney Fees
3 Mateya Law Firm -Legal Fees 2,000.00
4 Mateya Law Firm -Final Legal Fees for Estate Administration 3,300.00
H-B2 5,300.00
Qther Administrative Costs
5 Commonwealth of PA -State tax/stamps relating to real estate sale
6 Cumberland County Recorder of Deeds -Purchase of copy of Deed
7 Cumberland County Register of Wilis -Probate Fee
8 Cumberland Law Journal -Legal Advertisement of Estate
9 Mateya Law Firm -Charge for Deed prep
10 Office of Vital Statistics -Purchase of Death Certificates
11 Prudential Homesale Services Group -Real estate broker's commission
12 Prudential Homesale Services Group -Broker Fee
Copyright (c) 2002 form software only The Lackner Group, Inc.
650.00
1.00
327.50
75.00
200.00
36.00
3, 900.00
295.00
Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Calaman, Marian J 21-11-00953
ITEM
NUMBER DESCRIPTION AMOUNT
13 Sarah D. Dieckman -Notary Fees for real estate transaction 10.00
14 Sump Pump -Charge for new sump pump deducted from settlement proceeds from sale of 200.00
real estate
15 The Sentinel -Legal Advertisement for Estate 253.26
H-B7 5,947.76
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
• 1
Rev-1512 EX+{12-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Calaman, Marian J 21-11-00953
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Carlisle Propane -Heating oil for residence 57.72
2 Carolyn McQuillen -Taxes 199.59
3 Carolyn McQuillen -Real Estate Taxes 972.14
4 Cumberland Goodwill EMS -Ambulance Service 90.33
5 Elizabethtown Insurance -Insurance on residence 285.00
6 Interstate Waste -Trash service at residence 42.60
7 Met Ed -Electric service at residence 60.02
8 Met Ed -July electric service at residence 8.07
9 Met-Ed -Electric service for month of August 2011 at residence 50.05
10 Met-Ed -Electric service at residence for November 2011 32.99
11 Yellow Breeches EMS -Ambulance Service 80.00
TOTAL (Also enter on Line 10, Recapitulation) I 1,878.51
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software on{y The Lackner Group, fnc. Form PA-1500 Schedule I (Rev. 12-08)
REV-1513 EX+111-OS)
SCHEDULE J
COM IN~ ERITANC~E~ AX RETURNANIA BENEFICIARIES
RESIDEN DECEDENT
ESTATE OF
FfLE NUMBER
Calaman, Marian J ~ 21-11-00 953
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$)
o No ist T uste
I TAXABLE DISTRIBUTIONS [include outright spousal
~ distributions, and transfers
under Sec. 9116 a 1.2
David A Calaman Child 32,902.06
600 Ridge Road
Shippensburg, PA 17257
Kenneth G Calaman Child 32,902.06
104 N. Locust Lane
Mechanicsburg, PA 17050
Total 65,804.12
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 15 00 cover sheet, as a r o riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
LAST WILL AND TESTAMENT
OF
MARIAN J. CALAMAN
I, MARIAN J. CALAMAN, widow, of Dickinson Township (mailing address: 332
North Dickinson School Road, Carlisle, Pennsylvania 17013), Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make,
publish and declaze this as and for my Last Will and Testament, hereby revoking and making void
any and all Wills by me at any time heretofore made.
1. I direct my hereinafter named Executors to pay all of my just debts and funeral
expenses as soon after my death as may be found convenient to do so. I direct that my body be
cremated in accordance with the arrangements which I have made with the Cremation Society of
Pennsylvania and that my ashes be interred on my burial ?.ot in Westminster Cemetery near the
Borough of Carlisle, Pennsylvania beside the place of interment of the body of my husband,
George W. Calaman. I further direct that all inheritance, transfer and succession taxes which may
be payable on account of my death shall be paid from the residue of my estate regardless of
whether the assets upon which such taxes aze based are included in my probate estate.
2. All of the rest, residue and remainder of my estate, real, personal and mixed, and
wheresoever the same may be situate, I give, devise and bequeath in equal shares to my three (3)
sons, their heirs and assigns, provided each of them shall survive me by a period of ninety (90)
days, but should any of my said three (3) sons fail to so survive me then the share which he would
have received shall lapse and be added to the share or shazes of my other sons who shall survive
me by a period of ninety (90} days. My three (3) sons aze: Kenneth G. Calaman, David A.
Calaman, and Phillip L. Calaman.
3. I hereby nominate, constitute and appoint my said three (3) sons, Kenneth G.
Calaman, David A. Calaman, and Phillip L. Calaman, as co-Executors of this my Last Will and
Testament and I further direct that none of them shall be required to post any bond to secure the
faithful performance of his duties in the Commonwealth of Pennsylvania or in any other
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will
and Testament, written on one (1) page, this 5th day of October , 1994.
~'' ~ ~ ~ ~ " SEAL
Marian J. Calam dx~ ( ~ )
Signed, sealed, published and declazed by MARIAN J. CALAMAN, the Testatrix above-
named, asand for her Last Wi11 and Testament, in our presence, who, in her presence, at her
request, and in the presence of each other, have hereunto subscribed our names as attesting
witnesses.
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Previous edidona are obsolete
A. Settlement Statement
A T....n ..i 1 ..
form HUD-1 (3/66) ref Handbook 4305.2
U.S. Department of Housing and Urban Development
1. ^FHA 2. ^FmHA 3. ^Conv. Unins. 6. File Number 7. Loan Number V w~ 8. Mortgage Insurance Case Numtler
4. VA 5. CDnv.lns. 11-118
a9arl are wn.
C. Nate: Ibug ~dred'(p.o.a)' ware pa'd nubtde Me dornnpp~~ May are efwwn hers fa Inbrnetbrr purposes and are na bcMrded In Me totab. TitleExpresS Settlement System
WARNING: s iv s dime m lerowirlpty make tabs stebmsnta to the Unbsd Stapes on Mb orsr~f~ oMsr dmxsr form. Peneldee upon
mnvictlon can include a me arrd Im nmenp For deWb sea: Trod to a S. coda Saedott t00t and Ssepion tot o. Printed 1 1 12312 0 1 1 at 14:51 SDC
D. NAME OF BORROWER: Paul Bear, Jr. and Lois Bear
ADDRESS: 40 Church Lane Carlisle PA 17015
E. NAME OF SELLER: Estate of Marian J. Calaman
ADDRESS:
F. NAME OF LENDER:
ADDRESS:
G. PROPERTY ADDRESS: 332 North Dickinson School Rd, Carlisle, PA 17015
Dickinson Townshi
H. SETTLEMENT AGENT: The Law Office of Andrew H. Shaw, PC, Telephone: 717.243.7135
PLACE OF SETTLEMENT: 200 S. S rin Garden Stree Suite 11 Carlisle PA 17013
I. SETTLEMENT DATE: 1112912011
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales rrcz fi5 000.00 401. Contract sales rice 65 000.00
102. Personal ro 402. Personal ro
103. Settlement cha to borrower line 1400 1770.75 403.
104. 404.
105. 405.
Ad'ustments for items aid seller in advance Ad'ustments for items id b seller in advance
106. Ci /town taxes 406. Ci flown taxes
107. Court taxes 11129111 to 12131111 17.59 407. Court taxes 11129111to12131111 17,59
106. School taxes 11129N1 to06130112 571.06 408. School taxes 11129!11 to06130112 571.06
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 67 359.40 420. GROSS AMOUNT DUE TO SELLER 65 588.65
200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. De sit or earnest more 1000.00 501. Excess De sit see instructions
202. Princi al amount of new loans 502. Settlement cha s to seller line 1400 5 255.00
203. Existi ban s taken sub'ect to 503. ExisOn ban s taken sub act to
2~• 504. Pa off of First Mort Loan
205. 505.
206. Seller Credit for Se tic 1000.00 506. Seller CredA for Se tic 1 000.00
~7• 507.
206. 508.
~9• 509.
Ad'ustments for items un id b seller Ad'ustments for items un aid b seller
210. Ci /town taxes 510. Ci rtown taxes
211. Court taxes 511. Court taxes
212. School taxes 512. School taxes
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
216• 516.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 2 000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 655.00
300, CASH AT SETTLEMENT FROM OR TO BORRO WER 600. CASH AT SETTLEMENT TO OR FROM SELLE R
301. Gross amount due from borrower line 120 67 359.40 601. Gross amount due to seller line 420 65 588.65
302. Less amounts aid b Ifor borrower line 220 2 000.00 602. Less reduction amount due seller line 520 ti 255.00
303. CASH FROM BORROWER 65 359.40 603. CASH TO SELLER 59 333.65
SUBSTIME FORM 1(x19 SELLER STATEMENT: The kdormatbn conbinud herein is important tax infonnagon and b bekp fumbhed [o Me Imemal Revenue Servloe. M you ere requked [o file a return,
e n nce penalty or oMer wnctlon wtll be imposed on you 6 Mia Item is required to be reported and the IRS depvrrrXrlps Met 1 has not been rerwrted. The Conbact Sales Pace deacdbed on
line above cormEtu[ee Me Grow Proceeds of tMv trenvartion.
Vou are required by law b provide MB sattlemem sappaen[ (Fed. Tax ID No: 267544555) wRh your correct t r ideMSicatlon number. M pu do net provide your correct Iazpayar identxicatlon
number, you maY t>e vubject to civY or criminal pensl0es unpaved try law. Under panaroea of perjury, l ce~rtXy that Me rwrtiher algwn on Mh statement fe my coned taxpayer identification number.
TIN: _- / SELLER(S)SgNATURE(S): ~
SELLER(S) NEW MAILING ADDRESS:
SELLER(S) PHONE NUMBERS: rN, ,,,,,
~ Previous editlons are obsolete form HUD-1 (3/88) ref Handbook 4305.2
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number.l1.118 PAGE 2
SFTTI FIIIFhITSTATFYFWT r:.,_~---- --,. ...... .... ... .......__.__.. ...-- _--
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALESBROKER'S COMMISSION based on rice 5 000.00 6.000 = 3 900.00 BORROWER'S SELLER'S
DIYISIOn of COmmISS10n line 700 a5 folhnvs: FUNDS AT FUNDS AT
701. $ 1950.00 to Prudential Homesale Services Grou SETTLEMENT SETTLEMENT
702. 1950.00 to Prudential Homesale Services Grou
703. Commission aid at Settlement 3 900.00
704. Broker Fee to Prudential Homesale Services Grou 295.00 295.00
B00. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Od inairon Fee %
802. Loan Discount 96
803. raisal Fee
804. Credit Re ort
805.
806.
807.
808.
809.
810.
811.
900. ITEMS RE UNRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to !da
902. Mo a Insurance Premium for months to
903. Hazard Insurance Premium for ears to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance 2 mo. Imo
1002. Mo a Insurance 2 mo. Imo
1003. C' Pro Tax 2 mo. $ Imo
1004. Coon Pm Tax 2 mo. !mo
1005. School taxes 2 mo. Imo
1009. r ate Ana sis Ad'ustment 0.00 0.00
1100. TRLE CHARGES
1101. Settlement or Cbsin Fee
1102. Abstractor Title Search
1103. Title Examinatbn
1104. Title Insurance Binder
ttt15. Document Pre oration to The Law Office of Andrew H. Shaw PC 100.00
1106. Note Fees to Sarah D. Dieckman 15.00 10.00
1107. At~rne s fees to Mate a Law Firm 200.00
includes above items No:
1108. Title Insurance to Law Office of A. H. ShawISTGCOB 648.75
includes stave items No:
1109. Lender's PDlic
1110. Ownel's Polic 65 000.00 - 648.75
1111.
1112.
1113.
1201). GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordi Fees Deed $ 62.00 ~ Mo Release $ 62.00
1202. Ci lCoun tax/stam Deed 5650.00 ;Mort $ 650.00
1203. State Taxlsta s Deed 650.00 ~ Mort 650.00
1204. UPI Fee Deed Mort
1205. Deed Mo e • Release
13011. ADDRIONAL SETTLEMENT CHARGES
1301. Surve
1302. Se tic Pum 200.00
1400. TOTAL SETTLEMENT CHARGES enter on tines 103 Secton J and 502 Section K 1770.75 5 255.00
nuu ccm irnwu IOn ar eUYER AND SELLER
I have wrelully reviewed the HUD-1 SealemeM Statement and tc the beat of krgwledpe and ballet, p 4 e true and eaurate statement of ell recaipb and dlabureameme made on my acwuM
or fry ma h thla aanmctbn. I NMer wrtily thffi I have received a Dopy of Ne HUD-1 Stadement Statement.
WARNING: IT IS A CRIME TO 1P10WINOLY MAKE FALSE STATEMENTS TO THE The Hla-1 Settlement Statement which I have prepared b e true end axureta account of Mis
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIFB UPON CONVICTK)N trermctbn. I have wusetl or wiN woes the footle to be dieburaad in accordance adM this statement.
CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18:
U.S. CODE SECTION 1001 AND SECTION 1010.
SETTLEMENT AOENi:
DATE: