HomeMy WebLinkAbout04-20-121505610105
REV-1500 EX (oz-u) (FI) 1 ~1
enns lvania OFFICIAL USE ONLY
PA Department of Revenue P Y County Code Year File Number
Bureau of Individual Taxes Ev~pT~E~'~FpINHERITANCE TAX RETURN
PO BOX 280601 ~
Harrisburg, PA iyi28-o6oi RESIDENT DECEDENT ~ ~ ( (/~ ~ ~. )~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
04/05/2011 07/16/1931
Decedent's Last Name Suffix Decedent's First Name MI
Hawkins DAISY R
(If Applicable) Enter Surviving Spouse's Information Below
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
QD 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death
' Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
William L. Grubb, Esq.
First Line of Address
3803 Gettysburg Road
Second Line of Address
City or Post Office
Camp Hill
State ' ZIP Code
PA 17011
REGISTER OF~ILLS USE ONL'Y'
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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 has any knowledge.
SIGN U E OF PER ON R P NSIBL FOR FILING RETURN DATE
~,cu.~.~. ~a,~~~ ApR /~. 20/2
ADDRESS
5219 6LiD `0/~,ct.4n/ ~ihA.D ScfF~ Q Sa~v C~ Ti, ' /~10 (aS109 ~ ~/~ /T
SIGNAT.URQOE.PREPARER pTHER A EPRESENTATIVE DATE
ADDRESS
3 So
1505610105
PLEASE USE ORIGINAL ORM ONLY
Side 1 ,
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1505610105
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1505610205
REV-1500 EX (FI) Decedent's Social Security Number
Decedent's Name:
RECAPITULATION
1. Real Estate (Schedule A) ............................................. 1.
2. Stocks and Bonds (Schedule B) ....................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 9,747.56
6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 193,560.95
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
147
00
000
(Schedule G) O Separate Billing Requested..... ... 7. ,
.
8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 350,308.51
9. Funeral Expenses and Administrative Casts (Schedule H) ................ ... 9. 5,549.94
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I).....? ...... ... 10. 24,066.94
11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 29,616.88
12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 320,691.63
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. 320,691.63
TAX CALCULATION -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 .0_ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 45 16. 14,431.12
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE ..........................................:........... ... 19. 14,431.12
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~
Side 2
1505610205 1505610205 J
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
File Number
DECEDENT'S NAME
DAISY R. HAWKINS __
STREET ADDRESS
939 Herman Dr.
CITY
Mechanicsburg STATE
PA ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 14,431.12
2. CreditslPayments
A. Prior Payments
B. Discount
Total Credits (A+ g) (2) 0.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval 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) 14,431.12
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 .................................................................................... ...... ^
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 "intrust 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.
REV-iso8 EX+ (u-io)
r Pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DAISY R. HAWKINS 21-11-0457
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
If more space is needed, use additional sheets of paper of the same size.
REV-1509 EX+ (oa,-io)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
70INTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
DAISY R. HAWKINS 21-11-0457
If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A• Kevin G. Hawkins 5219 Old Lohman Rd., Jefferson City, MO 65109 son
B.
C.
JOINTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR]OINTLY HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % OF
DECEDENT'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A. 01101103 Ameriprise Financial, Acct. 0000 0930 0709 5480 3004 215,121.90 50% 107,560.95
2 A 01/24107 939 Herman Dr., Mechaniscburg, PA 17055 172,000.00 50% 86,000.00
TOTAL (Also enter on Line 6, Recapitulation) $ 193,560.95
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
Pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERRANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DAISY R. HAWKINS 21-11-0457
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBER -
DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
I• Cheryl D. Hawkins, daughter, deed filed March 29, 2011, 33 Gettysburg Pike
, 150,000.00 100 3,000.00 147,000,01
Mechanicsburg, PA 17055, Tax Assessment x CLR
TOTAL (Also enter on Line 7, Recapitulation) $ ~ 147,000.00
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09}
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
DAISY R. HAWKINS 21-11-0457
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A, FUNERAL EXPENSES:
1.
B,
1.
z.
3.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City _ State ZIP
Year(s) Commission Paid:
Attorney Fees:
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:
5. Accountant Fees:
6. Tax Return Preparer Fees:
~• Publication fees
TOTAL (Also enter on Line 9, Recapitulation) I $
If more space is needed, use additional sheets of paper of the same size.
5, 000.00
338.50
211.44
5, 549.94
REV-1512 EX+ (12-OS)
i pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
~~wwww~~ss INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DAISY R. HAWKINS 21-11-0457
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
~i Pennsylvania SCHEDULE ~
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DAISY R. HAWKINS 21-11-0457
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1• Kevin G. Hawkins, 5219 Old Lohman Rd., Jefferson City, MO 65109 son 1/3
2 Carolyn D. Phillips, 1027 Tuckawanna Dr. S.W., Atlanta, GA 30311 daughter 1/3
3 Cheryl D. Hawkins, 33 Gettysburg Pike, Mechanicsburg, PA 17055 daughter 1/3
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 $
If more space is needed, use additional sheets of paper of the same size.
`~ ~5~ ~.
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PARCEL N0.42-27-1888-07I
This Deed,
MADE THIS - :` ~~ day of ~G 1 ~t~ ,Two Thousand Eleven (2011),
BETWEEN DAISY R. HAWKINS, single person, of Mechanicsburg, Cumberland
County, Pennsylvania, hereinafter called Grantor,
AND CHERYL D. HAWKINS, single person, of Mechanicsburg, Cumberland County,
Pennsylvania, hereinafter called Grantee,
WITNESSETH, that in consideration of the sum of One and no/i 00 ($1.00) Dollar, and
other valuable consideration, in hand paid, the receipt whereof is hereby acknowledged,
the GRANTOR does hereby grant and convey to the GRANTEE, her heirs or successors
and assigns,
ALL THAT CERTAIN tract of land situate in Upper Allen Township, Cumberland
County, Pennsylvania, bounded and described, as follows, to wit:
BEGINNING at a point in the center of the Harrisburg-Gettysburg State Highway at line
of property now or late of James Neff, known as Lot No. 2; thence along the same, South
fifty-three (53) degrees thirty (30) minutes East, three hundred sixty-one and five tenths
(361.5) feet to a point at the line of property of the Mechanicsburg Gas and Water
Company; thence along said last mentioned lands, South thirty-nine (39) degrees West,
one hundred (100) feet to a point at lands now or late of Norman L. Berkebile, Jr. and
June M. Berkebile, his wife, known as Lot No. 4; thence along said last mentioned lands,
North fifty-three (53) degrees thirty (30) minutes West, three hundred sixty (360) feet to
a point in the center of said state highway; thence along and through said state highway,
North thirty-six (36) degrees thirty (30) minutes East, one hundred (100) feet to a point
and place of BEGINNING.
BEING known as Lot No. 3 of a certain plan of lots as laid out for Norman L. Berkebile,
Jr, and June M. Berkebile, his wife, on March 18, 1949 by W.G. RecheI, Registered
Surveyor.
HAVING THEREON ERECTED a dwelling house known as No. 33 Gettysburg Pike,
Mechanicsburg, Pennsylvania.
SEINC the same premises which Constance E: Dolley by her Attorney-in-Pact Thomas
P. Dooley, by deed dated January 3, 2001, and recorded January 12, 2001, in the Office
of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Deed Book
237, Page 825, granted and conveyed unto Daisy R. Hawkins, the Grantor herein.
THI5 CONVEYANCE IS BETWEEN A PARENT AND CHILD, AND THEREFORE
IS EXEMPT FROM REALTY TRANSFER TAX.
AND the said Grantor does hereby covenant and agree that she will warrant specially the
property hereby conveyed.
IN WITNESS WHEREOF, said Grantor has hereunto set her hand and seal the day and
year first written above.
SIGNED, SEALED, AND DELIVERED
IN THE PRESENCE OF:
~ ~~
~~• ~ ,
~~ ~ ~~
Daisy R. Hawkins
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
On this, the ~'G. '~ day of ~~ ~, , 20 i 1, before me the undersigned
officer appeared Daisy R. Hawkins, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument, and acknowledged that she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
No u c
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I hereby certify that the Rss;c:
and, Post Offl ~t~tin Grant::<.
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7) j..L ~ i 7 arm or p*;~~~.... .
ROBERT P. ZIEGLER
RECORDER OF DEEDS
CUMBERLAND COUNTY
1 COURTHOUSE SQUARE
CARLISLE, PA 17013
717-240-6370
Instrument Number - 201109554
Recorded On 3!29/2011 At 8:54c37' AM
* Iustrument Type -DEED
Invoice Number -84446 User ID - MSW
* Grantor - AAWKINS, DAISY R
* Grantee - HAWKINS, CAERYL D
* Customer - DAISY HAWKINS
* FEES
STATE WRIT TAX $0.50
STATE JCS/ACCESS TO $23.50
JUSTICE
RECORDING r:EES - $li.5o
RECORDER OF DEEDS
PARCEL CERTIFICATION $10.00
FEES
AFFORDABLE HOUSING $11.50
COUNTY ARCHIVES FEE $2.00
ROD ARCHIVES FEE $3.00
MECHANICSBURG SCHOOL $0.00
DISTRICT
UP°~'R ALLEN TOWNSHIP $0.00
TOTAL PAID $62.00
I Certify this to be recorded
in Cumberland County PA
* Total Pages - 3
Certification Page
DO NUT DETACH
This page is now part
of this legal document.
RECORDER O D DS
* - Information denoted by an asterisk may change during
the verification process and may not be reQeMed on this page.
iiad~uwi~ia
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`~~' ~:`i ~ S (~i1 1 G y 5
MADE THE ~, ~ ~ ~ day of in the year
of our Lord two thousand seven
BETWEEN Daisy R. Hawkins, widow, of Upper Allen Township, Cumberland
County, Pennsylvania,
Grantor,
And Daisy R. Hawkins, widow and Kevin G. Hawkins, son, as joint
tenants with the right of survivorship and with Daisy R. Hawkins
retaining a life estate in the premises.
Grantees,
WITNESSETH, that in consideration of
One ($1.00)---------------------------------
--------- p ------------------------
------------ ------------------- ---------Dollar,
in hand aid, the receipt whereof is hereby acknowledged, the said Grantor does
hereby grant and convey to the said Grantees,
ALL THAT CERTAIN tract or parcel of land situate in Upper Allen Township,
Cumberland County, Pennsylvania, being more particularly bounded and
described on Exhibit "A".
BEING the same premises which George Hawkins and Daisy R. Hawkins, his
wife, granted and conveyed to Daisy R. Hawkins, by their Deed dated December
8, 1995 and recorded in Deed Book 132, Page 447 in the Office of the Recorder
of Deeds in and for Cumberland County Pennsylvania granted and conveyed
unto Daisy R. Hawkins, Grantor herein.
THIS TRANSFER /S BETWEEN A PARENT AND CHILD AND IS THEREFORE
EXEMPT FROM REALTY TRANSFER TAXES.
UNDER AND SUBJECT to all restrictions, easements, covenants, conditions and
agreements of record.
TOGETHER with all and singular the buildings and improvements, ways, streets,
alleys, passages, waters; watercourses, rights, liberties, privileges,
hereditaments and appurtenances, whatsoever unto the hereby granted
premises belonging, or in any wise appertaining, and the reversions and
remainders, rents, issues and profits thereof; and all the estate, right, title
interest, property, claim and demand whatsoever of them, the said Grantor, as
well at law as in equity, of, in and to the same.
TO HAVE AND TO HOLD the said lot or piece of ground above described, with
the messuage or tenement thereon erected, hereditaments and premises hereby
granted, or mentioned and intended so to be, with the appurtenances, unto the
said Grantees, their heirs, personal representatives assigns, to and for the only
proper use and behoof of the said Grantees, their heirs, personal representatives
and assigns, forever.
AND the said Grantor, for herself, her heirs, personal representatives and
assigns, do covenant, promise and agree, to and with the said Grantees, their
heirs, personal representatives and assigns, by these presents, that she, the said
Grantor, her heirs, personal representatives and assigns, all and singular the
hereditaments and premises hereby granted or mentioned and intended to be,
with the appurtenances, unto the said Grantees, their heirs, personal
representatives and assigns, against her, the said Grantor, her heirs, personal
representatives and assigns, and against all and every person and persons
whomsoever lawfully claiming or to claim the same or any part thereof, by, from
or under him, her, them or any of them, shall and will, Subject as aforesaid,
WARRANT and forever DEFEND.
'~ ATTACHMENT A
ALL THAT CERTAIN House and Lot of Ground situate in the Township of Upper
Allen, County of Cumberland and State of Pennsylvania, bounded and described
as follows, to wit:
BEGINNING at a point on the Western line of Herman Drive at the Northern line
of Lot No. 50 on the hereinafter mentioned Plan of Lots; thence by the division
line between Lots Nos. 50 and 51 on said Plan, South 48 degrees 44 minutes
West, one hundred fifty-four and fifty-five one-hundredths (154.44) feet to a point;
thence North 48 degrees 40 minutes 42 seconds West, ninety-eight and eight-
tenths (98.8) feet to a tree; thence North 15 degrees 43 minutes 37 seconds
West, twenty-six and eighty-nine one-hundredths (26.89) feet to a point; thence
by the dividing line between Lots Nos. 51 and 52 on said Plan, North 56 degrees
35 minutes 54 seconds East, one hundred fifty-eight and thirty-seven one-
hundredths (158.37) feet to a point on the Western line of Herman Drive; thence
by the Western line of Herman Drive, in a Southeasterly direction by an arc or
curve to the left with the radius of two hundred five and eight-tenths (205.8) feet,
an arc distance of twenty-eight and twenty-five one-hundredths (28.25) feet to a
point; thence by the same, South 41 degrees 16 minutes East, seventy-one and
seventy-five one-hundredths (71.75) feet to a point, the place of BEGINNING.
BEING Lot No. 51 in the Plan of Lots of Center Square Manor, Section 3, which
Plan is of record in the Cumberland County Recorder's Office in Plan Book 20, at
Page 45.
HAVING thereon erected a single family dwelling known and numbered 939
Herman Drive, Mechanicsburg, Pennsylvania.
., .-
IN WITNESS WHEREOF, said Grantor has hereunto set her hand and
seal the day and year first above written.
~igiteD, ~+ealeD anD ~elibereD
in tfje ~regcncc of .
Sfafe of Pennsylvania
f~, (~1~t1 ~ .~~`z SEAL
Daisy R/. Hawkins
SEAL
SEAL
ss.
County of Cumber/a d ~~``
On this, the ~`t' day of , 2007, before
me, the undersigned offrcer, personally ap red Daisy .Hawkins known to me
(or satisfactorily proven) to be the person whose nam is subscribed to the within
instrument, and acknowledged that she executed the same for the purposes
therein contained.
IN WITNESS WHEREOF, 1 hereunto set my and and officia! seal.
~~
.rr„er, ~. i,ooq ~+vrwn wax:
~r Gw'°u ~°~°. a~wsvr""° °°..'" SEAL
~~ W'ti1E! ~EtTlMI~OI s, tcp
-.,+..~.r~c
• I do hereby certify That the precise residence and complete
post offrce address of the within named Grantees is 939 Herman Drive,
Mechanicsburg, PA 97055.
' c~, ,~ ry this t;; be i-ccu;~~c_Ied
Irl Cumberland County PA
i
Reco~~~~r of De~.;1~
.~
Attorney for C~ -~"
OMB Approval No. 2502-0265
~~,W..,.
~.I~~~IIi.}1 A. Settlement Statement (HUD-1)
1. ~/ FHA 2. ~RHS 3. ~Conv. Unins. X446-0605049703
4. ~VA 5. ^Conv. Ins. MS35576 RODDIN
_
C. Note: Tnk bml k Nmhhed b give you a statement d ache! felaemem coat. MwuMf pab b end M the fstlbmenl yeM n seown. aerro marhed'tp.o.c.)' were peW Quake dro cbfnq; diet ere
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D. Nero 8 Ad6an d 6aeoeer. E. Name 6 Adtrau d Saaer. F. Nrro d Adtresf d Lender:
EUGENE W. RODDIN KEVIN G. HAWKINS MEMBERS 1ST FEDERAL CREDIT UNION
335 LIBERTY COURT 5219 OLDINHAM ROAD 5000 LOUISE DRIVE
MECHANICSBURG, PA 17050 JEFFERSON CITY, MO 65109 MECHANICSBURG, PA 17055
G. Property Lacadon: H. Setlbnwnl Agent MADISON SETTLEMENT SERVICES I. Saskment Dale r D'ndafaront DaN
939 HERMAN DRIVE 8 IRVINE ROW, CARLISLE, PA 17013 gry12011 ! 9/1!2011
MECHANICSBURG, PA 17055 (CUMBERLAND) (717)243.2121
(42.30-2108.124, UPPER ALLEN TOWNSHIP) Place a SsalxronC EXIT REALTY GROUP
57 E. MAIN STREET
Previous edilioln are obsolete Pape 1 0l 4 OBlJ112011 10:06 AM HUD•1
Previous editions are obsolete Page 2 of 4 08!31/2011 10:08 AM HUD-1
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Underwdting Fee to Members 1st Federal Credit Union he'+u r
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YSpj~, St;,.~ t
Loan Terms
5288.50 5190.50
51,659.80 51,659.80
jaoo.oo uoo.oo
520.00 520.00
512.50 512.50
5150.00
__ _
52,358.80 52,432.80
574.00 or 3.14 %
51,029.07 31,372.08
5325.96 5611.18
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31,718.75 51,395.88
520.00 520.00
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'~ ~,r S, ? } ~ a ,~ /^ No. ^ Yes R can rtes to a mexhnum of '' % The first change will be
`'r' , j .,, on ~ ~ ~ ~ ~a?1,fi, and can charge again every ~~ ~~a{~~;~~ a8er
'' fVa ~ ~,r Every charge tlete, your Interest rete can Increase or decrease by
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f ` %. Over the life of the loan, your interest rate is guaranteed to never be lower than
~r.. ^~~}~ tti~3, ! '
~ ,.%orhlgherlhan y;°'~st%.
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/^No. ^Yes, R cen rise to a maximum of Sj , ~,X ,~
4 ~ ^/ No. ^ Yea, OM fret kwrease cen be on ~ ' l~~and the montlVy anauM
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m k - owed can doe to S ~+ ;
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' The maximum R can ever doe to b j
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" . ^/ No. ^Yes, Your maxknum prepayment penally b S ~ r'Y"~fr~1i ~ '
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{ / No. Yea u have a balloon a nt of S
^ ^ 1ro P Y~ ~ i€P"~;~rkd +1}i $.~~ due In
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7~e1 mbn elhMrM.orgd ~Cfud!!~Ole9crow ~CCO ~ ~ ^You do not have a monthly escrow payment to llama, such as property
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taxes and homeownefs Insurance. You must pay these Remy directly to yourself.
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^/ You have an addRional monlMy escrow payment of j ~ ~
that roaulb in a total inkiel monthly amount owed of S ~~,. This includes
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~' ~. . ~ ,~ Principal, interest, any mortgage Insurance and am/ Hems checked below:
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Q Property taxes ^/ Homeownefs Insurance
41 y
' ^ r '1' ^ Flood Insurance ~'; rj ~; , ~~i+~
Note: If you have any questbns about the Battlement Charges end Loan Terms listed on this form, please contact your bndar.
Prevbus edRbns ere obsolete Page 3 of 4 05131/2011 10:08 AM HUD-1
Supplemental Page
HUD-1 Settlement Statement
Addendurtu for Page 1 Amounl
Addendum 506
a. Earnest money rotained by Exil
1 have praluay revbvved Ne HUD-1 Satlkmenl Slarament end m Ne oecl of mY krq~Nedpe and balbl a it aue end aecurale alabmenl al a6 receipra end distnaaemenb made on my a[[ouM a W me in Nis transaction.
1 hlrtlrer gniy MI I here received a caPV of ale HUP1 Sedkrnont Statement
BUYERS
EUGENE W. RODDIN KEVIN G. HAWKMS
The tND-1 SsekmeM Slalemanl whicA 1 have papered b a true end accvak aecdlM of dris transaction. l here eared a i rda cause dre ILnda b he d'ebused in accordance wiN Nu ebtement
Settlement Agent
Dots
9l120N
Provious edllions are obsolete Page 4 0( 4 08/31/2011 10:08 AM HUD•1