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Home My WebLink About03-30-12 (2)1505E~41125 REV-15 0 ~ ~) DFFICw. ust= Dr~nY PA Deperbnent of R eurasrl of krdhrklual T INHERITANCE TAX RETURN Coin ~ Year ~ Number r~ow,eo1~X,w2t~1 2 1 1 1 0 1 6 8 iierttsbr~, PA 1712e-o~ao1 ~~ RESIDENT w~w~ww~~~ ENTER DECEDENT INFORttilAT10N BELOW Social Security Number Data of Death 1 7 4 2 0 7 9 5 9 0 2 0 2 2 0 1 1 Docedent's Last Name Suffix GAR N E R (If Applicablo) Enter Surviving Spojws's IMotrnatlon Below Spouse's Last Mame Su`fbr Spouse's Social Security Number Data of Birth 1 0 2 3 1 ,9 2 6 Decedent's First Name ROB E R T A Spcuse's First Name MI R MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRUTIE OVALS BELOW ® 1.Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Rstum (date of death prior to 12-13-82) - ^ 4. Limited Estate ^ 4a. Futuro interest Compromise (date of ^ 5. Federal Estate Tax Retum. Required death after i2-12-82) ® 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Nfilh (Attach Copy of Trust) ^ 9. Litigation Prooesds Reoeivbd ^ 10. Spousal Poverty Credit (date of death ^ 11. Ebdion to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (~-ttach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTLAL TAX MIFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number n,~ H A R D L D S I R W I N I I I E S Q ? 1 T 2 4~ip6 0~ 0 ~~ Firm Namo (If Applicable) -: " ~ -, `'~' REGISTER OF ONLXts ~ ~-r ~~' " I R W I N L A W g F F I C E ~_~ ~~~ ; 7=~ r, ' `~ - . Fist line of address <' 6 4 S O U T H P I T T S T R E E T `-'~ `~ ' _ r-"~- Second line of addnjss ~- r~ _.., , , ~ ~ .: City or Post Office State ZIP Code Dnr F'LEa C A R L I S L E P A 1 7 0 1.3 ComespondsM's e-mail address: Under plnaNbs of perwry, I dedre llret I sxemkred this Tatum, kldudYp eooonlperryryklg sclredldes end sfeterrrerlls, end 1o fle beet of my knowledge and beNef, k ie true, coned end oxrrplete. of paperer other the the personal roprosentatlvs rs tweed on eN which prsperor hae ergr knowledge. NATURE F~PE SPONS LE FOR FILING N DATE 2 LS !L- AoDRESS . 1162 CENTERVILLE OAD NEWVILLE PA 17241 E OF R ER OTHER REPRESENTATfVE DATE Z ! 'i7~ 64 SOUTH P T TR ET ~~ CARLISLE PA 17013 b PLEASE USE ORIGINAL FORM ONLY . s(ae ~ L 1S056041~25 ~ ~ ~ ~ 15056041125 ~ J 15D56042126 REV-1500 EX Deoedenfs Social Security Number DeosdsrrCsNems: ROBERTA R. GARNER 1 7 4 2 0 7 9 5 9 RECAPITULA710N 1. Real estate (schedule a) ........................................ 1. 4 7 8 0 0 0 0 2. stocks and Bonds. (scnedub ~> .......... .... ........ 2. 0 0 0 3..Closeh,~ Held Corporation, Pardnership or Sob-Proprietorship (Schedub C) ,..... 3. 0 0 0 4. Mortgages s£ Notes Reoeivebib (Schedub D) ........... ............ 4. 0 0 0 5. Cash, Bank. Deposits S Misoe+ianeous Personal Property (Schedule E) ... .: 5. 1 5 .3 8 2 8 2 6. Jointly Owned Property ( ub F) ^ Separate Billing Requested ....... B. ~ 0 0 0 7. Inter-Vows Transfers 8 MIansous Probate Property 0 0 0 (Schsdub G) ~ Separate BilNng Requested ....... 7. a. Total pros: Assets (rota Line 1-7) ........................... 8. 6 3 1 8 2 8 2 9. Funeral Expenses b Administrative Costs (Schedub ~ ................ 9. 1 8 3 4 6 7 5 10. Debts of DeoedeM, Mortgagd LiabiNNes, r~ Lbns (Schedub I) ............ 10. _ 3 4 2 ~ 3 6 9 11. Todd Deductions (total Lineal 9~ 10) ........................... 11. 2 1 7 7 0 4 4 12. Net Value of Estab (Line 8 mjinus Line 11) ......... ....... 12. 4 1 4 1 2 3 8 .......... 13. Cheritabb and Govemmentar Bequests/Ssc 9113 Trusts for which 0 0 0 an ebdion to tax has not been made (Schsdub J) .................. t3. 4 1 4 1 2 3 8. 14. Net Value Subject to Tax 12 minus Line 13) ........ `.......... 14. TAX COMPUTATION -SEE INS UCTIONS FOR APPLICABLE RATES 15. Amount of Lins 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)x.o4g 4 1 4 1 2 3 8 1s. 1 8 6 3 5 6 18. Amount of Line 14 taxabb at Iineal rate x .0;_,,, 0 0 0 18 0 0 0 17. Amount of Line 14 taxabb at sibling rate x .12 0 0 0 17. ~ 0 0 0 18. Amount of Line 14 taxabb at collateral rate x .15 0 0 0 1S. 0 0 0 19. Tax Dw ......:........................ ............x.19. 1 8 6 3 5 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 _ - 150560421126 15056042126 J V-1500 IX ~ ~ ecedent's Comulste Address: File kumher apse ECEl~NTS NAME 01lRTA R. GARNER TREET ADDRESS . 37 PINE GROVE ROAD ' RY AItDNlR3 STATE PA ZIP.. 17324 iU( Payments and Credits:- Tax Due (Page 2 Line 19) Cre~ifslPayrrlents , A. Spousal Poverty Credit.- B. Prior Payments C. Discount InteresUPenafty if applicable (1) 1,at33s3s Trial Credfts (A + B + C) (2) 0.00 D. Interest E. Penalty F - - Total interest/Penafty (D + E ) ff Line 2 is greater Phan Line 1 + line 3, enter dNferersoe. This !s the OVERPAYMENT. FNI in oval on tie 2, Line ~0 b ngwat a r!Mund. (3) 0.00 (4) o.oo ff Line 1 + Line 3 is greater, than Une 2, enter the difference. This is the TAX DUE. (5) 1,sa3•~ A. Enter the interest on the tax due. (5A) B. Enter ttse total d Line 5 + 5A. This is the BALANCE DUE. (5B) 1,t3t33.s36 Maki Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE F~ILLOWING QUESTIONS BY PLACINGAN "X" IN THE.APPROPRIATE BLOCKS t Dkt decedent mire a transfer and; Yes No a. retain the use or iracarrse~ d the property transferred : ........:............................................................ '~ b. retain the right b desigr~abe who shall use the property tr7r>sferred ar its income; ........:..:................... c. retain a reversionary • a .........................:.................................. ............................... ^ d. receive the promise for Ike cf either payrnerda, benefits a care? ........................................................ ^ 2. If death oocumed steer 12,1982, did decedent transfer prdperty with(n one year d death without rerseiving adequ eonskleration? ............ 3. Did decedent oMan an 'in for' or payable upon death bank account or security at his or her death? ,........ 4. Did decedent own an lr>div~dual Retirement Account, annuity, a other non-probate proper~r which contains a berseflciary des~grsatlors? .................................................................................................. ^ ^ iF THE ANSYVER TO AIRY OF THE ABOV~ QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE 0 AND FILER AS PART OF THE RETURN. x dates of dea~.on or abbey July.1,1994 and January 1;1995, the tic rate imposed on the net value d transfers to or for the use d the surviving spouse three (3) percent (72 P.S. §9116 (a) (1.1) (i)J. ', x dabea d death on or aRer January 1,1995, ~ tsar rate imposed on the net value d transfers to orfof the use d the surviving spouse is hero (0}percent 2 P.S. §9116 (a) (1,1) (ii)]. The status a transfer to a surviving spouse from tax, and the statutory rerprirerrlents for disclosure d assets and .rig a tart nstum are still appik~ble even iF the n9 spouse >s the ony benefidary. x lobes d death on or after July 1,2000: ,e test rate knposed on the net vdue d trap from a deceased d>Hd twenty~orse years d age or younger at death to a for the use d a natural parent, an ioptiva parent, or a stepparent d'the child is (0) percent (72 P.S. §9116(aX1.2)). ie tart rate imposed on the net value d trap to or for the use d the decedent's lineal bendfaaries is four and onefialf (4.5) percent except as nded in 1 P.S. §9116(1.2) (72 P.S. §9116(a)(1)j. hs test rate imposed on the r>et valued to or for the use d the decedent's siblings is twelve (12) percent (/2 P.S. §9116(a)(1.3)). A aiblirlg isdefined, under ectlors 911)2, as an irxflviduab whohas at~ parent in cortwnon with the decedent, wtsether by Mood or adoption. V 1502 EX + (8-~L}I SCHEDULE A - c0Ul1ut0NWEALTH of PENNSYLVANIA ~ REAL ESTATE INHERRANCE TAX RETURN RESIDENT DECEDENT iTATE OF FILE NUMBER 1-EERTA R. GARNER 0164 _ AN real propery- orared soNty or as a board in mwt be nporbd at fatr market vaNu. Fair nrerlaet value is defined e, tl~e price at which properly would be s~od~erged betreen a w~fnp buyer and a aeNx, rreNlrer bekp aompeNed b buy or aeN; both having roasorwbb knowledge of the rebvant fada. Real k willh M of survkorsh mlat be dhrcbaed on 9chaduN F. ITEM VALUE AT DATE CUMBER DESCWPTION OF DEATH _ 1. NOUiE AND LOT AT 'INE OROV! ROAD, OARDNERS, IrA 17324 47,600.00 Valve fbaswd on AEewn~nt of salmi 8N affidavit Of ttNNf a~mcn~a u ExhNeit "d" ' TOTAL, Also enter on line 1, latiorl = 47 td00.00 (Il more space k needed, kreert addNional aheefs of the acme size) N-1503 EX + (e-o8) • SCHEDULE B - CONNAONWEALTH OF PENNSYLVANIA STOCKS ~ BONDS INHERffANCE TAX RETtiRN RESIDENT DECEDENT STATE OF _ FILE NUMBER OslRTA R. OiARNlR 01 ~ AN propMty jointly-0wmd wNh ~IpM of sunNonhip nuat M ditclot~d on &huduN F. BEM VALUE AT DATE CUMBER DESCRIPTION OF DEATH 1. NON! 0.00 _. Y,50.EX+ce-se' ~ SCHEDULE C CLOSELY-HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN SOLE-PROPRIETORSHIP RESIDENT DECEDENT iTATE OF FILE NUM~R OiERTA R. GARNER 0104 _ Schedule C-1 or C-2 (N~cludkg aM Mlonnetlon) must be attacl-ed ioreach closely-held aorpaaUonlpaMentihip inbreat of lha decadent, oU~er than a . See inslnx:tlorla ioP the ~pporUnp Infomiadon to be sut>rtlNled for aol~pioprfebrahipe. ITEM VALUE AT DATE CUMBER DESCRIPTION OF DEATH 1. NONE 0.00 .- TOTAL Also enter on line 3, letion S ~ 0.00 (If more apace b needed, k~sert addftlonel sheets of the same alas) - - - -- /-1507 EX + (8.68j ' SCHEDULE D ~Nt„~,«T,.I ~ p~,,l,~y~ygpl~ MORTGAGgE~S~ 8i NOTES INHERITANCE TAX RETURN REL-E11f /1oLE RESIDENT DECEDENT TATS OF ~ FILE NUMBER -- HEItTA R. QARNEit - 01dd AN propMryl joN~tly-owned wkh tM ~ipM of survtvonhip mwt a dkcioad on SdnduN F. ITEM VALUE AT DATE JMBER DESCRIPTION OF DEATH L NONE 0.00 . •• . u TOTAL Also enter on line 4, IaUorr i 0.00 (lf more apses is needed, insert additional sheets of tha name size) :v ~soe Ex+ cs-ee) • SCHEDULE E - CASHr BANK DEPOSITS; $ MISC. CO~NiAONWEALTH OF PENNSYLVANW '""EaITANCeTRX RETURN PERSONAL PROPERTY RESIDENT DECEDENT iTATE OF ~ FILE NUMBER DBERTA R. GARNER 01 ~ ' Irrduge fhe of Ntlpetlon end the date the were reoeh!ed ty the estab. AN wish of survivors must bs discbted on 8cheduN F. . ITEM ~ ~ VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PNC BANK 6,630.76 _. Chaekh~g Aacowrt Na ~1~015.44?2 Vdw bawd On statamsnt attached as Exhibk ..C.. 2. PNC BANK ~ 6,966.36 savings Account No. 6',r~031-6343 Vaiw bead on t ertllrclad as ~ibk "C. - ~ 3. MISCELLANsOUS NOU ENOLD Qi00DS AND ~ERSOMIIL ITEMS 1,000.00 4. 1~6 CHEVROLET LUMINA 2,000.00 144,000 MNa / falr Cojndklon VMw bond on KNty ~iw Book Avaraga Valws 6. LIBERT1r MUTUAL ~•~ _ RNund d UnNmod Prlamlum 6. COMCAST' 17.02 RNund d Unsarnad Monthly Charges 7. CENTURY LINK ~•~ Rdund of Un~wn»d Monthly Charges 8. CASH ON NAND 4x4.26 9. BLUE CROSS 403.50 • Rdund d Unaarnad P~wnium 10. MOFFITT MEDICAL 1.21 _ Msdigd Rdund . 11. WASTE MANAOEMlNfi 31.26 Rdund TOTAL (Also entx on Ih>e 5, Rec~ilulatlon) i 16 2.62 (ff more apeoe b needed, insert additlonel sf reeb of U1e same size) ,l/-1!909 EX + (8-88) SCHEDULE F _ coMMONWFALTH of PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT TATS OF FILE NU~ER DeERTA R. GARNER ~ oldd - Il an asst vaa mido Jofnt tidtllM~ ono yar of the dsudsnCs dab of dsdh, k must ba rspoAsd on t3cMduM G. SURVMNG JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT I~ITl.1(-04YMED PROPERT1l: M ABER LETTER FOR JOMfT TENANT ~ QATE WIDE JOMIi DESCRIPTION OF PROPERTY MlCLUDE NAME FINANCIAL INSTITUTION AND BAlHf ACCOUNT NUMBER OR SIMILAR NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. ~ DATE OF DEATH VALUE OF ASSET x OF DECDS MREREST. DATE OF DEATH VALUE OF DECEDENTS INTEREST A. 1NONE aoo . o.oo TOTAL (Also ~teT on NTIe 6,Recapitulation) I S 000 ' (If mae apaos b needed, k~sert additior~el aheeb of the creme aixe) __ - _ - ~__ -~ s~ o Ex • (e-ee) . , SCHEDULE G INTER VIVOS TRANSFERS ~ COA9AAONWFALTH OF PENNSYLVANIA INHERITANCE TAx RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT TATE OF FILE FAlMBER _ ~ERTA R. GARNER ~ ~ 01dA ' . ThB xhedule mrmt be aonrpleted Ord flbd N the answer b any of queatlorra 1lhrouph 4 on the reverse sfde of the REV-1500 COVER SHEET is yea. (EM VEER DESCRIPTIOFI OF PROPERTY Maucenreww¢oFnE nrertraunowanooac®ertwo nEahaFm ~nea~ aFnEO®wrtrrr~ivv.Err~~ DATE OF DEATH VALUE OFASSET % OF DECD'S INTEREST EXCLUSION pFwn~aq TAXABLE VALUE NONE 0.00 0.00 TOTAL (Also enter on Une 7 Recxlpitulation) I S 0.00 (If more apeos b needed, kwert addNfonal aheela ~ the same alas) - Y-1511 EX + (12-9a) COMMONWEALTH OF PENNSYLVANIP INHERRANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES 8 ADMiNISTRATNE COSTS TATE OF ' ' FILE NUMBER nERTA R. OWtNER 01~ Debts of decedent moat be nportad on Schedule L ITEM ` CUMBER DESCRIPTION AMOUNT FUNERAL EXPENSES: 1. MOLLINOER FUNERALi NOME ti,507.00 -- ADMINISTRATIVECOSTS: - Petgonal Representative's iCommlasions MmnedPe~aonslR~eproeeMatlre{a) SocW Securer Num~er(syEtN Number d Peraortet Representatlve(s) Street Atldroea i CKy State Zip Yeer{s) Commlaaiorl Pafd: AtOomey~ Fees IRNIIN L~IIr OFFICE Famly,Exemptlon: (If deoedekrPa address to not the same as deMrrenPa, attach exptanatlon) Cla~ant S1reetAddrsaa Cihr__ _~ _ _ __ State Zip. Reletlorahip d grant b Decederd Probate Fees CUMBERLAND COUNTY REGISTER Of WILLS AccoutNrrt's Fees •~ Tex Rehan Preperer'a Fees CUMBERLAND NTY REGISTER Of wlLls -Film Imnnttory and Appralsamaet CAROLYN McgUl TAX COLLECTOR -2011 CouMy/Townshlp rrtal Eshb Taucs~s- LIBERTY MUTUAL GROUP - NonNOwnaKS Inswnnq IRtNIN LAMI O~ - Fsaati for Rs~al Estaib Matttars TRAt:M COLLECTI N FOR PROPERTY CLEANUP PROJECTED FER TAXES ON SALE OF REAL ESTATE - 5,500.00 - 30.00 1,277.06 566.00 500.00 476.00 - TOTAL (Also enter on dne 9; Recapitulation) ' f ~a_~~a (H more apace b nestled, kaert addiUorra! aMeb d the name afae) . .V 1512 EX + (12-03) ,, SCHEDULE i - ' coNl~oNwEA~T" of PEN"snvnraw DEBTS OF DECEDENT, '"HERITANCETAXRETURN ' MORTGAGE LIABILITIES 8c LIENS RESIDENT DECEDENT ~ STATE OF - FILE NUMBER - O~ERTA R. GARNER 0168 Report debt incurned by the decedent) prbr to death twhkh ranalned unpaid e: of the dab of dedh, indudhp unntalmbursed medkkal acpeneee. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH _ 1. CNURCN OF fiOD MOMlr,1NC. Z,Z51.64 NorslnE NonN lxpsns~s Z. 1'ANTINUINO CARE RX'' 65.65 Medicwi ONI 3. METED 253.50 •. NtilNty SIII 4. ~ LIFELINE Z8.1Z Equlpmset Rental SIII 5. lZNIPLlT ENERGY 710.E • PuN OII efil 6. CENTURY LINK 33.18 T~Isphons Bill •~ 7. MOPPI7T HEART i VASCULAR GROUP 1.21 Medical BNI • 8. IIN>t OF PA 42.60 . Trash Coil~ctlon >i. UNPAID P!R>sONAL T~8 5:50 ., ° . TOTAL (Also enter on line 10, Rec~pi4ilNion) ; ~.~ (H moro speoe is needed, kaett eddilonal shaeta o(the creme airs) _ i _ __ '-1513 EX + (9-00) . SCHEDULE J col~oNwEA~Tr'i of PENNSV~vANa BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT tTATE OF FILE NUMBER KERTA R. OARNlR + ~ 0155 ' IMBER ' NAME AND ADDRESS OF RSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Tnusbs(s~ AMOUNT OR SHARE OF ESTATE L TAXABLE DISTRIBUTIONS ~~ ~~ ~ ~~ u~ ( ' 1 ] 16 (a 1. MARLIN R. GARNER Linpl 1102 Canbrvllla Road SOX RESIDUE M~wvill~ PA 17241 2. sUSAN L sTARTZEL Lind 5150.Lakocnst Dr Apt i05 SOX Rlti1DUE OrrNnbN! MD 20755 ENTER DOLLAR AMOUNTS FOR 1STRIBUTI0NS SWOWN ABOVE ON LINES 15 THROUGW 18, AS APPROPRIATE, ON REV-1500 COVER SHEET Q. NON-TAXABLE DISTRIBUTIONS:. A. SPOUSAL DISTRIBUTIONS UDDER SECTION 9113 FOR WWICW AN ELECTION TO TAX IS NOT BEING MADE 1. NON! - 0.00 B. CWARITABLE AND GOVERNMENTAL DISTRIBUTIONS " 1. NONE. 0.00 Y ~ , TQTAL OF PART II -ENTER 1fOTALNGN-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ s .. ~ (If more space Is needed, Insert additional sheets of the same size) 0.00 I, ROBERTgI R. GARNER, of Gardners, Cumberland County, Pennsylvania, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expe~ses as soon as convenient after my decease. I direct that all inheritance taxes infiposed or payable by reason of my death.. and interest and penalties thereon with respect to all property, whether or not such property passes under this Will, shall be paid b~ my personal representative out of my estate. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or ~rivate sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple, as I could do if living. My representative is authorized and embowered to engage in any business in which I may be engaged at my death, for such 'period of time after my death as seems expedient to said representative. 3. I gives devise and bequeath all of my estate of whatever nature and wherever situate tol, my spouse, Marlin E. Gamer. 4. If my spouse does not survive me by a period of at least sixty (60) days, then I give, devise end bequeath all of my estate of whatever nature and wherever situate to my childr n, share and share alike, the child or children of any deceased child taking the share th it parent would have taken if living. , !I 5, I nominate and appoint my spouse to be the personal representative of my estate, to serve lwithout bond. If my spouse cannot or does not serve, then I appoint Marlin F~. Gamer and Susan L. Startzel to be the substitute personal representatives, also without bond. 6. I sugg'lest that my personal representative retain the services of Harold S. Irwin, III, Carlisle, Plennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of August, 2001. (SEAL) _ OBERTA R. GARNER Signed, sealled, published and declared by the above-named person as and for a last will and testamdnt, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. WE, ROBEF~TA R. GARNER, RHONDA S. IRWIN and HEATHER A. ,BARBOUR, the tes~atrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly swom, do hereby declare to the undersigned authority that the te~tatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein 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 their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue) influence. ROBERTA R. GARNER RHONDA S. IRWIN HEATHER A. BARBOU COMMONWEALT~i OF PENNSYLVANIA as: COUNTY OF CU111~BERLAND . Subscribed,] swom to and acknowledged before me by ROBERTA R. GARNER the testatrix herein, and subscribed and swom to before me by RHONDA S. IRWIN and HEATHER A. BAF~BOUR, witnesses, this day of August, 2001. Notary Public otarial Seal Harold S. I 'n III, Notary Pi:UGc Carlisle Borp, Cumberland Ceurty My Commissi n Expires Sep).: a, 2Q:1'2 ~! ,n,pgr a~n^G~d~.,ania P•ssoctation o? Nntanes PHFA Form 3 - AFFIDAVIT OF SELLER To be colleted by seller() at or before' closing unleu (1) the borrower is purchasing property under as eligible' installment sales agreemenk, or (~ the seller is.HUD; Fatmie Mae or Freddie Mac. This affidavit is made for the'purpose of satisfying the requirements' set forth is the Internal Revenue Code of 1986, as amended, (tile "Code's and the rules and regulations promulgated p, ant thereto by the U.S. Department of the Treasury. Read and co~lete it carefully to be sure that the information is~e and correct ~r S~~Rr-~'G .rtke~~~da~ UWe, the undersigned sell~1(s): MJQ l~ ~ 1 ~ ~ G~iAi2M~d. ~ ~C! ~.IJ/ L' depose and~tate tbe following: 1. Uwe have etrterod into an agreement of sak th the falloAVing person(s): 2. The Residence to be with the proceeds of the Mortgage Loan from the Peansylvania.Housing Finance Agency is located in the Coun _ of ~r'LiAw ~ GN~~,i w~ ,Pennsylvania, at the following address: 'L37~~ ~'~.vE G~a~t= G,p~.~- G.~x~iAlc.~ P,/- 17324 3. The acquisition cost o~ the land sad residence to lie acquired by the Buyer froth the Seller is computed as follows: (a) Amount paid, in ash or is kind, by the Borrower or.any other person to or for the benefit of the Seller (or a related party) for the land and Residence (excluding any personal _ .property which ]sl not. a fixture) ............................................................................... S (b) Amount paid for (if not included in (a) above) .......................................... S (c) TOTAL ACQUI~TCION COST ............................................................................. S 4. The Residence does t contain any unfinished areas that an suitable for completion and normally fished in homes similar to the Reside .Please describe any exceptions to the foregoing statement. - ~ 5. No put of the Mort ge Loan proceeds will be used directly or indirectly to repay an existing loan made by me or anyone acting on my f to the Buyer or anyone acting on Buyer's behalf in connection with the Residence, except construction loans, b dge loans or similar tea~orary initial financing with a term of 24 months or less. 6. Neither Uwe nor anyone acting on my/our behalf has entered into any contract, arrangement or understanding to make any other than the read estate broker or agent fees disclosed on the HUD 1 Settlement sheet. ' Uwe understand that, if U have made any material misstatements in the representations contained is said document, or omitted to state any of the information requested, the following may occur. (1) Uwe could be imprisoned for up to 30 years pursuant to Section 101 of Title 18 of ~ the United States Code; (2) The Office of the Attorney General' of the Commonwealth may be cc}ntacted for investigation regarding perjury, misrepresentation and false swearing. lure of Seller Date- Si of Sell to Jnly 2011 Page S of 7 ~- - - FJCHIBIT "C" f~ F.r ~ ~~ ~~rnsne~e a et~ssrie~~ 001768 RODERTA OWRNER 237 PINE ROVE RD OARDNERS IPA 17324-6946 ` . Q P`NCBAIVK Flrtmary aooourd number. 51-4018.4422 Pape 1 of 4 Numberof enclosures: 0 . For 24-hour bsnkkq; and transactbn or , interest rate Informetbn, sign on to PNC BankOntins BaMdnp at prrcoam. 'a' For oustontsr ssrvia qll t-888-PNC-BANK Monday - Frklay:.7 AM -10 PM ET S,etur±day dr Sunday: 8 AM - 5 PM.Ef Pars esrvkdo sn eapaflol,1-866-HQLA-PNC . MoMnBt Pbase.oontact usat 1-688-PNC-BANK ® Writs to: Custoinsr Servios . PO Box 609. . ' Pktaburph PA 15230-9736 , V fsk us at pnooorrt ~ __ . ®TDDtetmina1:1~800=531-1648 . Far hasin6 tmpatrat elierw anip ~[. AOOO~glti Desplptlon Account Number Deposk.Bahna .Free (tiecEiug 51-4018~44~2 _ 5,530.y8 Savings 5I-3031-8343 b,968:38 _ Total _ 11,499.18 STN t'r Roberta Gamer - Aooountnumber. 51-4018-4422 Overdraft.Probction Provkled By: C~rtlMt l~MC a a+eealrlMM owrirart frtaMSWa I eahuoe ~N1rpMM1y Qpinntrp j Deposita end Checb and.other Endirg - bebnce other eddkbns deduattons bdena 4,899.35 1,155.00 5Y3.57 5,530.78 Avange. monthly t-herpes balance . . and fits . i 5,553.55 1:.00 .. Tt~wsae~tien . ,. ch.ea a+~ j Check taro Pos ch.ck aroreenixero . withdrawals. ' slprad transactions POti PIN transeettans 3; 0 0 - • Tofal_ATM Pf1C Bank Other Bank tnsnsectlons ATM trenaaotlons ATM tranaadions 0~ 0 ~ 0 A~IMI~ Q~tall •. ,. _ DttpOfai!'s awd Otl~ Awt111 tlNt Am~ y l~ 01/03 1,155.00 Dire US; Deposit - Sot Scc ~srny 303 Xa~XX'7959A Thera was 1 Dspadt or Other Addition tGtallrlQ s~1.1RAe. PNDMLT01~.10613652-140-NNNNNN-002-004731