HomeMy WebLinkAbout03-16-12 (2)1505610143
REV-1500 Ex(°'-'°'
PA De artment of Revenue OFFICIAL USE ONLY
P Pennsylvania County Code Year File Number
Bureau of Individual Taxes oerNerwENT OF REVENUE
Po Box.2aosol INHERITANCE TAX RETURN 21 11 0947
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
167 40 2098 08 24 2011 12 04 1948
Decedent's Last Name
FISHER
Suffix Decedent's First Name
DAVID
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
MI
V
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Retum ^ 2. Supplemental Return ^ 3, Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise 5. Federal Estate Tax Return Re
(date of death after 12-12-a2) ^ quired
a B Decedent Died Testate
(Attach Copy of Will)
^ ~ pecede t Maintained a Living Trust
(AttachGopy of Trust) 8. Total Number of Safe Deposit Boxes
^ 9. Litigation Proceeds Received ^ 1 D. s usal Povert Credit (date ~f death ^ 11. Election to tax under Sec. 9113(A)
between 12-31 X31 and T-1-95
(gttaCh SCh. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JAN M WILEY 717 432 9666
First line of address
3 N BALTIMORE ST
Second line of address
City or Post Office
DILLSBURG
Correspondent's e-mail address:
State 21P Code
PA 17019
REGISTER OF YOQ.LS USE ONti1'
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Under penalties of pery'ury, I deGare that 1 have examined this return, tncludtng 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.
SIGNATURE OF PERSON RESPONS~IByLE FOR FILING RETURN DATE
~~J~~vt~. V..la,~ )!ta ~ ~i~ ~ Donna Rae Fisher 3 --C~~~?
SIG TURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
- - (~I ' Jan M Wiley ~ ~f - ~
~.8 N. Baltimore St., Dillsburg, PA
Side 1
1505610143 1505610143 J
REV-1500 EX
Decedent's Name: Fisher, David Victor
1505610243
Decedent's Social Security Number
167 40 2098
RECAPITULATION
1. Real Estate (Schedule A) ...................................................................................... . 1. 13 5 , 8 4 3.3 8
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. 21 , 93 9. 7 4
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers & Miscellaneous N ,c~ Probate Property
(Schedule G) u Separate Billing Requested............ 7. $ , 356.40
8. Total Gross Assets (total Lines 1-7) .................................................................... . 8. 166, 139.52
9. Funeral Expenses & Administrative Costs (Schedule H) ............................... ........ 9. 81 , 65 7 . 0 7
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...................... ........ 10. 6 , 67 6 . 0 0
11. Total Deductions (total Lines 9 & 10) ........................................................... ........ 11. 88 , 333.07
12. Net Value of Estate (Line 8 minus Line 11) .................................................. ........ 12. 7 7 , 8 0 6.45
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, 7 7 , 80 6 . 4 5
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 0 . 0 0 16.
17. Amount of Line 14 taxable
at sibling rate X .12 7 7, 8 0 6. 4 5 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 . 0 0 18.
19. Tax Due ............................................................... .................................................. . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
1505610243
0.00
0.00
9,336.77
0.00
9,336.77
Side 2
1505610243
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-11-0947
DECEDENT'S NAME
Fisher, David Victor
STREET ADDRESS
313 Keith Road
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
0.00
4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
(1) 9,336.77
Total Credits (A + B) (2)
(3)
0.00
(4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 9,336.77
Make Check Pa able to: REGISTER OF WILLS, AGENT.
4 - .-~:.
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 :............................................................................... ^
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? ............................................................ ^ ^x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ^ ^
receiving adequate consideration? .................................................................................................................... x
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? .................................................................................................................. 0 ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
r--
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-1b02 EX+(tt-08)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Fisher, David Victor 21-11-0947
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 jolntlyowned with right of survivorehip 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-1808 EX+tB-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Fisher, David Victor 21-11-0947
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property JoinUyowned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Members 1st FCU Checking 15736-11 4,454.15
2 Members 1st FCU Money Market 15736-05 2.91
3 Members 1st FCU Savings Account 15736-00: 6,101.98
4 Refund -AAA: 75.00
5 Refund - Comcast: 9.40
6 Refund -Holy Spirit Hospital: 61.14
7 Refund -Progressive Insurance: 154.36
8 Refund - Verizon: 30.80
9 Sale of guns: 5,050.00
10 Sale of truck: 6,000.00
TOTAL (Also enter on Line 5, Recapitulation) I 21,939.74
(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-1510 EX+(6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Fisher, David Victor 21-11-0947
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S
NUMBER THE DATE OF TROAFNSFER.SATTACFi ACOPY of TIHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST ( APPLICABNE) TAXABLE
I VALUE
1 Members 1st FCU IRA #15736-10 (Decedent's three 8,356.40 8,356.40
sisters, Donna Rae Fisher, Kimberly L. Fisher, 8 Kath
J. Weber are the equal beneficiaries)
TOTAL (Also enter on Line 7, Recapitulation) I 8,356.40
(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 G (Rev. 6-98)
REV-1151 EX+~10-06)
COMM~~rxD~F,ry~$yLVAN IA
SCHEDULE H
FUNERAL EXPENSES 8~
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Fisher, David Victor 21-11-0947
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
2,430.37
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zia
Year(sl Commission oaid
2. Attorney's Fees The Wiley GrOUp, PC 8,200.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 319.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 70,707.20
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 81,657.07
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
Fisher, David Victor 21-11-0947
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex enses
1 Eggar Funeral Home: 2,430.37
H-A 2,430.37
Other Administrative Costs
2 Basement repair:
3 Closing costs -sale of real estate:
4 Cumberland Law Journal (advertise estate):
5 Members 1st FCU (estate account checks):
6 Members 1st FCU (Payoff mortgage):
7 Register of Wills (filing fee):
8 Seller Assist -sale of real estate:
9 The Sentinel (advertise estate):
H-B7
2,000.00
10,970.31
75.00
14.75
53,836.36
30.00
3, 570.00
210.78
70,707.20
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Fisher, David Victor 21-11-0947
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Hampden Twp (sewer 8 water): 305.05
2 Heritage Medical Group: 4.13
3 Members 1st FCU (Mortgage payments) 3,840.00
4 Pa American Water: 494.07
5 Pinnacle Health Medical Services: 164.36
6 PP&L: 263.10
7 Progressive Insurance: 503.49
8 Travelers Property Insurance: 589.00
9 UGI: 316.57
10 Verizon: 43.63
11 Visiting Nurse Assoc.: 152.60
TOTAL (Also enter on Line 10, Recapitulation) I 6,676.00
(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 I (Rev. 12-08)
REV-1513 EX+ (11-08)
C OMM_ Q~~~OF~ENN$yRLVAN IA
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Fisher. David Victor ~,. A A Aff I~l
NUMBER
NAMEAND ADDRESS OF
PERSON(Sl RECEIVING PROPERTY
RELATIONSHIP TO
DECEDENT - -
SHARE OF ESTATE
AMOUNT OF ESTATE
(Words) ($$$)
I
' TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 a 1.2
1 Donna Rae Fisher Sister 27
217.81
535 Shed Road ,
Newville, PA 17241
2 Kimberly L. Fisher Sister 27
217.56
113 Touchstone Drive ,
Carlisle, PA 17015
3 Kathy J. Weber Sister 27,217.56
377 Limestone Road
Carlisle, PA 17015
Total 81,652.93
Enter dollar amounts for distributions shown above on lines 1 5 throw h 18 on Rev 150 0 cover sheet as a r o riate.
II NON-TAXABLE DISTRIBUTIONS:
. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTA L OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 OVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
ir~sk 3~i11 ttnd Urstttrarnt
OF
DAVID VICTOR FISHER
BE IT REMEMBERED, that I, DAVID VICTOR FISHER, of 313 Keith Road.
iVlechanicsburg, Cumberland County, Pennsylvania. being of sound mind. memory and
understanding, do make, publish and declare this as and for my Last Will and 'I estament;
hereby revoking and making null and void any and all ~liills and Testaments and writings
in the nature thereof by me at any time heretofore made.
ITEM I: I direct that all myjust debts and funeral expenses be paid as soon after
my demise as may be convenient.
ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and
wheresoever situate; whether it be real, personal or rnixed. including propcrtti ~;ver which
I have a power of appointment, I give, devise and bequeath unto my three sisters, DONNA
RAE FISHER, KATHY JO WEBER, aind HIMBERLY LEE FISHER, in equal shares;
per capita.
ITEM 3: I direct my hereinafter .named Executrix to pay all inheritance. estate.
succession and legacy taxes of whatsoever nature and kind, to which my estate or the
transfer of any property passing hereunder or otherwise passing by reason of my demise,
may be subject and to charge such taxes against my residuary estate, it being my intention
that none of the aforesaid taxes, either federal or state, on any property required to be
included in my gross estate, under the provisions of any state or federal law now in force
or hereafter enacted, shall be prorated among the I~ersons interested in my estate to whom
such property is or may be transferred or to whom t.~ny benefit accrues.
~#I'TNESS:
~v ~sEAL~
DAVID VI~^TO FISHER
ITEM 4: 1 appoint my sister, DONNA RAE FISHF,K, as Executrix of this my
bast Will and Testament. Should DONNA RAE FISIIER, predecease me, fail to quali fy.
cease to act or renounce probate, I then appoint my sister, KATHY JO WEBER, as
alternate Executrix ofthis my i.ast'vVill and Testament.
ITEM 5: I direct that my Executrix, cr her successor shat] not be required to give
bond for the faithful performance o (their duties in any jurisdiction.
IN WITNESS WHERF,OF, I have hereunto set my hand and seal this 18'~ da.~ of
,luly, 2007.
WITNESS:
,; ~ ~, .
~ ~~ ~ ~~~
_(SEAL)
DAVID VICT FISHER
-L-
COMMONWEALTH OF PENNSYLVANI,4 ,
SS
COUNTY OF YORK
We. DAVID VICTOR FISHER, JAN M. WILF.Y, ESQUIRF, and MARCY K.
RENSHAW, the Testator and the witnesses respectively; whose names are signed to the
attached or foregoing instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testator signed and executed the instrument as his bast ~'il I
and Testament and that he had signed willingly (or willingly directed another to sign for
him), and that he executed it as his free and voluntary act Cor the purposes therein
expressed, and that each of the witnesses, in the presence and hearing of the Testator.
signed this Last Will and Testament as witness and that to the best ofiheir knowledge the
Testator was at the time eighteen (I 8) years of age or older. of sound mind and under no
constraint or undue influence.
~! v_' _
yID VICT R F1SHT;R
~/ 1
SS
Sworn to and subscribed
before me this ] 8`" day of
July, 2007.
>~~s~-°`
NOTARY PUBLIC
MY COMMISSION F,XPIRES:
COtJ~LOi::'.''!:~ t.+:1 CF PENNSYLVANIA
r:;Dlic
` My C;ommiss'ion F:;cpiros May 17, 2009
Memb or, Pennsylvania Association of Notarles
COlv7; o;:.~/;~:~t_;51:~F?E~NSYLVFlPiItI
Notarial Seal
S. Dawn Gladfeiter, Notary Public
Dillsburg i3oro, York County
My Commissbn F~cpires May 17, 2009
M ombor, Pennsylvania Association of Notaries
-3-
I~~) l+``=, OMB Approval No. 2502-0265
,-i~pl~~, _; A. Settlement Statement (HUD-1)
,- . •.
1. X FHA 2. RHS
^ ^ 3. ^ Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
4. ^ VA 5. ^Conv. Ins. 12 136 104305060 446-1083427-703
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown. Items marked
"
(p.o,c)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. Name & Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender:
RYAN M. MESURE, KELLI E. GASKILL ESTATE OF DAVID V. FISHER AIK/A DAVID PRIMARY RESIDENTIAL MORTGAGE
514 Breezewood Court, Mechanicsburg, PA 17050
VICTOR FISHER ,
INC.
313 Keith Road, Mechanicsburg, PA 17050 4'50'N. WILEY POST WAY, SUITE 200,
SALT;,~KE CITY, UTAH 84118
G. Property Location: H. Settlement Agent: I. Settlement Date: 02/17/2012
313 KEITH ROAD, HAMPDEN TOWNSHIP Homesale Settlement Services Disbursement Date: 02117!2012
MECHANICSBURG, PA 17050 4309 Linglestown Road
717-671-9876 Fax 717-671.9676
,Hampden Township ,
,
Harrisburg, PA 17112
Place of Settlement: TitleExpress
4309 Linglestown Road, 717.671.9876 Fax 717-671-9676, Printed 02/15/2012 at 2:52 pm
Harrisbur , PA 17112 by KAC
. :.
100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller
101. Contract sales price 135,000.00 401. Contract sales price 135
000
00
102. Personal ro ert 402. Personal ro ert ,
.
103. Settlement charges to borrower (line 1400) 6,766.53 403.
104. 404.
105. 405.
Ad ustments for Items old b seller in advance Ad'ustments for items aid b seller in advance
106. City/town taxes to 406. Cityltown taxes to
107. County taxes 02l1712012to 12!3112012 298,49 407. County (axes 02/171201210 12131/2012 49
298
108. Assessments 02/17/2012 to 06!30/2012 469.92 408. Assessments 02117I2012Io 06130/2012 ,
469
92
109. Sewer Bill Proration 02!1712012 to 03/3112012 74.97 409. Sewer Bill Proration 02/17/2012 to 03131!2012 .
74
97
110. 410. ,
111.
411.
112 412.
120• Gross Amount Due From Borrower 142,609.91 420. Gross Amount Due to Seller 135
643
38
200. Amounts Pa(d b dr in Behalf ofBorrower
201. Deposit or earnest money 2,500.00 ,
.
500: Reductions Ih Amount Due to Seller
501. Excess deposit (see instruc(ions)
202. Principal amount of new loan(s) 131,577.00 502. Settlement charges to seller (I'me 1400) 10,970.30
203. Exlstin loo s taken sub'ect to
204. 503. Exisfin loans taken sub'ect tc
504. Payoff of firs/ mortgage loan #15736-07 to
MEMBERS 1ST FEDERAL CREDIT UNION
53,836.36
205. 505. Payoff of second mortgage loan
206. 506.
207. Seller Assist 3,570.00 507. Seller Assist 3
570
00
208' 508 ,
.
209. .
509
Ad'ustments for Items un aid b seller .
Ad'ustments for item
id b
ll
210
Cit
/town taxes s unpa
se
er
.
y
l0 510. Cityltown taxes to
211. County taxes to 511. County taxes ;~
212. Assessments to 512. Assessments f~
213. 513
214. .
514
215. .
515
216. .
516
217 .
. 517
218 .
. 51 B
219 .
.
519
220• Total Paid b Ifor Borrower
137,647.00 .
520. Total Reduction Amount D
e S
ll
7
66
300
Cash at S
ttle
t er
u
e ,3
6,66
.
e
men
fromlto Borrower 600
Cash atSettlement t
lf
ll
S
Gross amount due from bor
301
li
1 .
o
rom
er
e
.
rower (
ne
20} 142,609.91 B01
Gross amount due to seller (line 420)
Less amounts paid b
302
/for b
r
li , 135843.38
.
y
o
rower (
ne 220) 137,647.00 602. Less reductions in amount due seller (line 520)
303. Cash ^X From ^ To Borrower
a u w •no ,oo u ,: w •c ,•. . m,ou ea o.r
ms mrm um•a a a~enmr:'. eorr.amiv vans oMe ~~mmi ~°m".."
4,962.91
ro •oosa or co • ,oo, mvi•w~op, •„
603. Cash ^X To ^ From Seller
po
r• i.a .... „•o..c. m.,,,,,, .,, .. ,- _._..__ ._ ..__ __ -- 68,376.66
67,466.72
~•• •~~~~.~~• ~...~.~o.,o,r. , ms a aeaioo.a w nrwm• mu Dames io-• aesan cove.oa ire~~acii~~-.un inrormnno~ o~nnp me
Previous editions are obsolete Page 1 of 4
HUD-7
L. Settlement Charges -
700. Tot91 ReaLEstate BrokenFees $ 8,380:80 Paid From Paid From
Divisiondfcommission Iine700 as follows: Borrower's Seller's
701• $4,437.90 t7 ReMaxlstAdvantage Funds at Funds at
702, $3,942.90 to Prudential Homesale Services Group
703. Commission paid at settlement Settlement Settlement
8
380
80
704. Broker Fee to Prudential Homesale Services Group 225.00 ,
.
800. Items Pa able in Connection with Loan
BO1. Our origination charge (Includes Origination Point 0.000% or $0.00) $995.OG (from GFE #1'i
802. Your credit or charge (points) for the specific interest rate chosen $ (from GFE #21
803. Your adjusted origination charges (from GFE A) 995,00
804, Appraisal fee fo AMC Links (from GFE #3) 450.00
805. Credit report to (from GFE #3)
806. Tax service (o from GFE #3'
807. Flood certification to from GFE #3
808. Appraisal re-inspection to (from GFE #3)
900. Items Re ulred b Lenderto be Paid in Advance
901. Daily interest charges from from 02117!2012 (0 0310112012 @ $14.4194Iday (from GFE #101 187,45
902. Mortgage insurance premium for months to HUD (from GFE #3) 1
302.75
903. Homeowner's insurance for 1 ears to Erie Insurance $492.00 P.O.C. B` (from GFE #11) ,
904, months to from GFE #11'
1000. Reserves De osited with Lender
1001. Initial deposit for your escrow account (from GFE #9) 748.58
1002. Homeowner's insurance 2 months $ 41.OOlmonth $8200
1003. Mortgage insurance months $ 123.85/month $
10174, Pro ert (axes months $ (month
1005. County faxes 2 months $ 27.971monlh $55.94
1006. School Taxes 8months $ 1d6,171monlh $849.36
1007. Aggregate Adjustment $-238.72
1100: TItIe Char es
1101. Title services and lender's title insurance from GFE #4 1,371.75
1102. Settlement or closing fee to $
1103. Owner's title insurance from GFE #5
1104. Lender's title insurance $1,018.75
1105. Lender's title policy limit $131,577.00 Lender's Policy
1106. Owner's title policy limit $135,000.00 Owner's Policy
1107. Agent's portion of the total title insurance premium $906.69
1108. Underwriter's portion of the total title Insurance premium $112.06
1109.
1200. GovernmentRecdrdln and Transfer Char es
1201. Government recording charges $ (from GFE #7) 136.00
1202. Deed $62.00 Mort a e $74.00 Release $
1203. Transfer taxes $ (from GFE #8) 1,350.00
1204, CitylCounty taxlstamps Deed $1,35D.00 Mort a e $
1205. State Tax/stamps Deed $1,350.00 Mort a e $ 1,350.00
1206. Deed $ Mort a e $
207. $
1300. Additional :Settlement Char es
1301. Required services that you can shop for (from GFE #6)
1302. to
1303. Escrow for Twp/county 2012 Taxes to CPSS Escrow acct 450
00
1304. Notary Fee to Nota Public .
20
00
1305. Prepaid Tax Cert Fee to Homesale Settlement Services, Inc. .
1000
1306. Overnight tee for Payoff to Homesale Settlement Services, Inc. 17
50
1307. Termite Treatment to KNOW SWETT
~ ~ ~nwR .
742,00
- - 0,!00.73 lU,'J(U.SU
`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.
Previous editions are obsolete Page 2 of 4 HUD-1
Com arisonbtGodtl,Faith Estimate GF ;'andHUD•YChar es '
'Char' es3fiatCannotlndrease HUD-1 Line Number
Ourorigipahon,pgarge ~ 801
Yourcredit or charge (ports) foi thaspedific interest rate chosen # 802
Your aiijusted origination charges # ..803
Transfer taxes" # :1203.
-.Char es-ThatCanCftan e -
Irntial depgsit foryoui isdrow accbunt- # 1001'
Daily Interest charges from p 901 $14.4194Iday
Homeowher's insurance . - # 903
Title services arid'IendersTitletnsurance # 1101
Owner'stitle insurance # 11.03
# "
Loan Terms
Good'Faith Estimate HUD•1
995.00 995.00
0.00 0.00
995.00 995.00
1,350.00 1,350.00
Good Faith Estimate HUD•1
175.00 136.00
45C 00 450.00
0.00 ~ 0 00
'.302.75 1,302.75
1,927,75 1,888.75
$ -39.00 or 2.0231°
Good Faithfstimate HUD-1
2,370.04 748.58
190.06 187.45
420.00 a92.00
1,371.75 1, 371.75
0.00 0.00
Your iriilial loan amours; is $131,577.00
Your loan term is 30. years
You• Initial interest rate is 4,0000%
Your initialmenthly amcent owed for pnnclpal interest, and;any mortgage. $752.02 includes
insurance is
^X Principal
^X Interest
^X Mortgagelnsurance
Can your ihteresYrate rise? ^X No. ^ Yes, it can rise to a maximum of %. The f rat change
will be on / / and can change again every years after / / Every
change date, your interest rate can increase or decrease by °/ . Over fhe life of
the loan, your interest rate is guaranteed fo never be lower than % or higher
(han %.
Even if you make payments on time, can your loan balance nse? ^X No. ^ Yes, it can rise to a maximum of $
Even it you make payrnentson lime; can your monthly.amount owedfor ^X No. ^ Yes, fhe first increase can be on I 1 and the monthly
pnncipal,. 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? ' ^X No, ^ Yes, your maximum prepayment penalty is $
Does your loan have a balloon payment? ^X No ^ Yes, you have a balloon payment of $ due in
years on I
Total monthly amountowed including escrow acbount payments ', ^You do not have a monthly escrow payment for items, such as property faxes
and homeowners insurance. You must pay These items directly yourself.
0 You have an addi(ional monthly escrow payment of $17514
tha( results in a total initial monthly amount owed of $927.16. This includes principal, interest, any
mortgage insurance and any items checked below:
0 Property taxes X^ Homeowner's insurance
^ Flood insurance ^X School Taxes
^ ^
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact vcur lender.
Previous editions are obsolete Page 3 of 4 HUD-1
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-I Settlement Statement.
RYAN M. MESURE KELLI E. GASKILL
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be
disbursed in accordance with this statement.
2J1~~1~
SETTLEMENT AGENT DATE
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010.
Previous editions are obsolete Page 4 of a
HUD-]
rr •~
Name of Borrower: Name of Seller File Number:
Prepared 0 211 512 0 1 2 at 2:52 pm
Note: This page displays an itemization of the credits shown in section 200 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.
Credits
Credit
.. •
Name of Borrower: Name of Seller; File Number:
RYAN M. MESURE ESTATE OF DAVID V. FISHER AIK/A DAVID 12.136
KELLI E. GASKILL VICTOR FISHER
Prepared G2I1512012 of 2;52 pm
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.
Your Loan Origination Charges
801. Our odginatlon charge (Includes Origination Point 0.000% or $0.00) Borrower Seller
Administration Fee to PRIMARY RESIDENTIAL MORT$ 245.00
Underwriting Fee to PRIMARY RESIDENTIAL MORT$ 400.00
Processing Fee to PRIMARY RESIDENTIAL MORT$ 350.00
802. Your credit or charge (points) for the specifc interest rate chosen
to $ 0.00
803. Your adjusted origination charges
995.00 0,00
• 1
Name of Bonower Name of Seller. File Number.
RYAN M. MESURE ESTATE OF DAVID V FISHER AIK/A DAVID 12-136
KELLI E. GASKILL VICTOR FISHER
Prepared 02!15/2012 of 2:52 pm
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 Settl
t
Statement applies. ,
emen
1100. Title Charges
1101
Title services and lender's title insurance Total Charge Borrower Seller
.
Doc Download Fee to
to Homesale Settlement Services, I$ 50.00
50
00
Overnight Fee to Homesale Settlement Services, I$ 18.00 .
18
00
Wire Fee to Homesale Settlement Services, I$ 15.00 .
15
00
NOtary Fee to Nota Public $ 45.00 .
45
00
End 1 0 011 00 00 to Old Re ubiic Title $ 50.00 .
50
00
300130000 to Old Re ubiic Title $ 50.00 .
50
00
900181000 to Old Re ubiic Title $ 50.00 .
50
00
ClosingSvcLtrICSL fo Old Re ubiic Title $ 75,00 .
75
00
1102. Settlement or closing fee .
to $ 0,00
1104, Lender's title insurance to Old Re ubiic Title $ 1,018.75 1,018.75
SellerlLender credits sliovm on pace 1 Totals: $ 1^371.75
nnc - o~~a n,.•~ia_ ,.~__:_ .. 0.00
... 1,371.75 0.00
Previous editions are obsolete Page 1 of 1
HUD-7
MEMBERS 1St
FEDERAL CREDIT UNION
SAVINGS ACCOUNT:
Account Number/Suffix 15736-00
Date Account Established 02/01!1974
Principal Balance at Date of Death $6,101.02
Accrued Interest to Date of Death $.gg
Total Principal and Accrued Interest $6,101.98
Name of Joint Owner None
CHECKING ACCOUNT:
Account Number/Suffix 15736-11
Date Account Established 04/06/1999
Principal Balance at Date of Death $4,453.84
Accrued Interest to Date of Death $.31
Total Principal and Accrued Interest $4,454.15
Name of Joint Owner None
MONEY MANAGEMENT ACCOUNT:
Account Number/Suffix. 15736-05
Date Account Established 01 /03/2011
Principal Balance at Date of Death $2.g1
Accrued Interest to Date of Death $.00
Total Principal and Accrued Interest $2.91
Name of Joint Owner None
IRA SAVINGS ACCOUNT:
Account Number/Suffix 15736-10
Date Account Established 10/26/2006
Principal Balance at Date of Death $8,354.56
Accrued Interest to Date of Death $1,gq
Total Principal and Accrued Interest $8,356.40
Name of Beneficiary Donna Rae Fisher 33%
Kathy Jo Weber 33%
Kimberly Lee Fisher 34%
VISA ACCOUNT:
Account Number/Suffix 4672090000232066
Date Account Established 04/30/1997
Principal Balance at Date of Death $.00
Joint Cardholder None
5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org
LOAN ACCOUNT:
Account Number/Suffix
Date Loan Established
Principal Balance at Date of Death
Loan Type
Collateral Secured
Interest Rate
Name of Co-Borrower
*Loan does not have life coverage.
LOAN ACCOUNT:
Account Number/Suffix
Date Loan Established
Principal Balance at Date of Death
Loan Type
Collateral Secured
Interest Rate
Name of Co-Borrower
*Loan does have life coverage.
15736-07*
10/31 /2006
$55,241.40
Home Equity/Contractual Pledge of Shares
313 Keith Road, Mechanicsburg, PA
7.14%
None
15736-08*
06/21/2008
$2, 387.68
Home Equity/Contractual Pledge of Shares
313 Keith Road, Mechanicsburg, PA
5.39%
None
B~ER(S~1sT FEDE L CRED T NION
Danielle A. Kline
Lending Insurance Support Specialist
September 27, 2011
Estate of: DAVID V. FISHER
Date of Death: 08/24/2011
Social Security Number: 167-40-2098