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HomeMy WebLinkAbout05-23-12 (2) 1505611185 FI ) 1500 EX (02-11)( REV - OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau oflndividualTaxes INHERITANCE TAX RETURN 21 11 0760 PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date Of Blrth MMDDYYYY 186-34-0720 07012011, 06051945 Decedent's Last Name Suffix Decedent's First Name MI PIFER DORIS E (If Applicable) Enter Surviving Spouse's Informati on Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (Date of Death Prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ^ 9. Litigation Proceeds Received ^ 1 ~ Spousal Poverty Credit (Date of Death ^ 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 RICHARD C• SNELBAKER 717-697-8528 ...., First Line of Address SNELBAKER & BRENNEMAN ~ P•~• Second Line of Address 44 WEST MAIN STREET City or Post Office State zIP Code MECHANICSBURG PA 17055 Correspondent's a-mail address: -;=~- REGISTER~ bfILLS USE tY C~ _ z 'r ~ ~ ' ~ =~':. 1> _<_ ~ ~ ~ C,; t~ ~~ C ~__ ~,.. ~ - ; .. r .~ c DATE FILED L-^, _ 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. SIGNpaTlJ~2 PEQSOf~E$F~N~ LE FOR~ILI~NG RETURN S D// ~ ~2~'l1 HUUYCCJJ VICKI PARKS, EXECUTRIX 118 MARTEL CIRCLE, DILLSBURG, PA SIGNAT OF PREPARER OTHER THAN REPRESENTATIVE .~- PAT ` 17019 FIV URLJJ RICHARD C• SNELBAKER, ESQUIRE 44 WEST MAIN STREET, MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA 17055 Side 1 1505611185 1505611185 OM4647 3.000 1505611285 REV-1500 EX (FI) Decedent's Social Security Number 186-34-0720 Decedent's Name P I F E R D O R I S E RECAPITULATION 1. Real Estate (Schedule A) 1. ], 4 8 , 9 0 5. 5 2 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. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 8. Total Gross Assets (total Lines 1 through 7) g. 4,222.00 ~•~~ o•oo 44,926.80 o.oo 180,651.55 378,705.87 9. Funeral Expenses and Administrative Costs (Schedule H). 9. 3 8 , 719 •3 4 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 1 p. 19 8 • 4 7 11. Total Deductions (total Lines 9 and 10) , , , , , , , , , , , , , , , , , , , , , 11. 3 8 , 917.8], 12. Net Value of Estate (Line 8 minus Line 11) 12, 339 , 788 • 06 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , . 13. 5 , 0 0 0 • 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) . 14. 3 3 4 , 7 8 8 •0 6 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 16. Amount of Line 14 t xable 4 ~ at lineal rate X .0 0 . 0 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 318 , 9 9 7 - 6 6 17. 18. Amount of Line 14 taxable at collateral rate x .15 15 , 7 9 0 • 4 0 18. 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 OM4648 3.000 0.00 0.00 38,279.72 2,368.56 40,648.28 REV-1500 EX (FI) Page 3 . A_W._I_a_ AJJ..~~~. File Number al. 1.1. r17Lf1 V riV~iM~i 11~J v •~~.I•~. ~~ -- DECEDENT'S NAME PIFER DORIS E STREET ADDRESS TOWNSHIP CUMBERLAND COUNTY CITY STATE ZIP MECHANICSBURG PA 1,7055- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 1, 5, 0 0 0. 0 0 e. Discount 7 5 0. 0 0 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) (1) 40,648 • 28 15,750.00 (3) 0 •0 0 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2 4 , 8 9 8 • 2 8 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 "in trust for" or payable-upon-death bank account or security at his or her death? 4. Did decedent own an individual retirement account, annuity, or other non-probate property, which ® ^ contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are stilt 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. Total Credits (A + B) (2) OM4671 2.000 REV-1502 EX ~ (01-10) pennsylvania DEPARTMEM OF REVENUE INHERITANCE TAX RETURN SCHEDULE A REAL ESTATE ESTATE OF: FILE NUMBER: Doris E. Pifer 21 11 0760 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointlyowned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH Real Estate 148,905.52 known and numbered as 1110 Granada Lane, Upper Allen Township, Mechanicsburg, PA 17055, sale value (see attached settlement sheet) TOTAL (Also enter on Line 1, Recapitulation.) I S 148 , 905.52 swasss z.ooo If more space is needed, use additional sheets of paper of the same size. REV-1503 EX + (fr98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Doris E. Pifer 21 11 0760 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1.U.S. Savings Bonds 4,222.00 5 EE savings bonds with face value of $1,000.00 each (see attached listing) TOTAL (Also enter on line 2, Recapitulation) ~ $ 4.222.00 3wasss i.ooo (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (11-10) pennsylvania DEPARTMEN70F REVENUE INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. r~r~n~u w ~ n[]~1~]C~T/ ESTATE OF: FILE NUMBER: Doris E. Pifer 21 11 0760 Include the proceeds of litigation and the date the proceeds were received by the estate. All propert jointly owned with ri ht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. 2005 Ford Freestar 7,000.00 Kelly Blue Book value 2 AAA 23.52 refund due the decedent 3 Amerigas 10.79 refund due the decedent 4 Member's 1st Federal Credit Union 24,529.53 savings account #101074-00 5 Member's 1st Federal Credit Union 504.96 checking account #101074-11 6 Member's 1st Federal Credit Union 10,569.30 investment savings account #101074-05 7 Member's 1st Federal Credit Union 320.36 holiday club account #101074-02 8 Proceeds from sale of household goods 539.16 9 U.S. Treasury 1,429.18 refund due the decedent on 2011 Final Individual Income Tax Return TOTAL (Also enter on line 5 Recapitulation) $ ~ 44 , 926.80 owasAD 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX + (OB-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Doris E. Pifer 21 110760 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 NUMBS DESCRIPTION OF PROPERTY INCLIAETFE WNAEOF TFE TRANSFEREE, TFEiR RELATIONSHIP TO DECEDEM Alm TFE DATE OF TRM6FER. ATTACHACOPV OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET o /o OF DECD~S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE 1~ Ameriprise Financial 52,965.35 100.0000 0.00 52,965.35 SPS advantage account #00029241494 3 021. Transfer on death to Jean Steffen, Vicki Parks, John Fearnbaugh, Earl Fearnbaujgh and Paul Fearnbaugh in equal shares. 2 Ameriprise Financial 111,895.80 100.0000 0.00 111,895.80 annuity account #93103330109 0 004. Beneficiaries are Jean Steffen, John Fearnbaugh, Earl Fernabaugh, Paul Fernbaugh and Vici Parks, in equal shares 3 U.S. Savings Bonds 15,790.40 100.0000 0.00 15,790.40 19 EE savings bonds payable on death. See attached listing of bonds and the designated beneficiaries. TOTAL (Also enter on line 7, Recapitulation) $ 1.55 If more space is needed, use additional sheets of paper of the same size. 9W46AF 2.000 REV-1511 EX+(10.09) SCHEDULE H Pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Doris E. Pifer 21 11 0760 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Church of the Brethren funeral luncheon 250.00 Total from continuation schedules 12,674.32 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: Snelbaker & Brenneman, P.C. 4,440.00 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: 377.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 Cumberland Law Journal advertising Executrix Notice 75.00 2 Dennis Zerbe, Tax Collector real estate taxes 1,858.29 Total from continuation schedules 19,044.23 TOTAL (Also enter on Line 9, Recapitulation) $ 38 719.34 swasac z.ooo If more space is needed, use additional sheets of paper of the same size Estate of: Doris E. Pifer Schedule H Part 1 (Page 2) Item No. Description 2 Gingrich Memorials grave marker 3 Jean Steffen reimburse for grave opening 4 Malpezzi Funeral Home funeral services 5 Vicki Parks reimburse for grave opening Total (Carry forward to main schedule) 21 11 0760 Amount 2,204.00 300.00 9,870.32 300.00 12,674.32 Estate of: Doris E. Pifer 21 11 0760 Schedule H Part 7 (Page 2) 3 Eichelberger Inc water softner service from 7/28/11 to 3/30/12 92.22 4 Member's 1st Federal Credit Union check printing fee 13.95 5 Nationwide Credit / Terminix terminix service from 7/2011 to 3/30/12 162.18 6 Nationwide Insurance homeowners insurance 267.00 7 PPL Electric electric service from 7/2011 to 3/30/12 638.62 8 Real Estate settlement charges a. Realtors Commission $8,580.00 b. Broker Fee $195.00 c. Transfer taxes $1,480.00 d. Deed preparation fee $115.00 e. Tax certification $10.00 f. County taxes $569.31 g. Notary fee $15.00 h. Sewer adjustment $112.00 i. Sellers assistance $5,000.00 16,076.31 9 Register of Wills filing fee for Inheritance Tax Return 15.00 10 RSR Appraisers & Analysts real estate appraisal fee 350.00 11 The Sentinel advertising Executrix Notice 221.40 12 United Water of Pennsylvania water service from 7/2011 to 3/30/12 50.73 13 Upper Allen Township sewer services from 7/28/11 to 3/30/12 112.00 14 York Waste trash services from 9/26/11 to 3/30/12 44.82 Total (Carry forward to main schedule) 18,044.23 Estate of: Doris E. Pifer Schedule H Part 7 (Page 3) 15 Reserve for filing fees, accountant fees and other miscellaneous costs associated with the administration of the Decedent's estate 21 11 0760 1,000.00 Total (Carry forward to main schedule) 1,000.00 REV-1512 EX+(12-08) SCHEDULE pennsylvania DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8 LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Doris E. Pifer 21 11 0760 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. swasAH z.ooo If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) SCHEDULE J pennsylvania DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Doris E. Pifer 21 it 0760 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [InGude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Jean M. Steffen 1138 Pinetown Road Lewisberry, PA 17339 One Fifth of Residue: 63,799.53 Sister 63,799.53 2 John M. Fearnbaugh 3600 W. Orange Grove Road Lot 224 Tucson, AZ 85741 One Fifth of Residue: 63,799.53 Brother 63,799.53 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. 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 See Attached 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ $ 5 , 000.00 swasAl z.ooo If more space is needed, use additional sheets of paper of the same size. Estate of: Doris E. Pifer Schedule J Part 1 (Page 2) Item No. Description 3 Earl R. Fearnbaugh 1808 S. York Street Mechanicsburg, PA 17055 One Fifth of Residue: 63,799.53 4 Paul R. Fearnbaugh P.O. Box 334 Mechanicsburg, PA 17055 One Fifth of Residue: 63,799.53 5 Vicki L. Parks 118 Martel Circle Dillsburg, PA 17019 Relation Brother Brother 21 11 0760 Amount 63,799.53 63,799.53 One Fifth of Residue: 63,799.53 Sister 63,799.53 Estate of: Doris E. Pifer Schedule J Part 2B (Page 1) Item No. Description 1 Mechanicsburg Church of the Brethren 301 Gale Street Mechanicsburg, PA 17055 21 11 0760 Amount Bequest per Item Second of Will 5,000.00 5,000.00 OMB Approval No. 2502-0265 >'``iii;ii`'~, A. Settlement Statement HUD-1 1. ^ FHA 2 ^Conv. Unins. ^ RHS 3 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: . . 12-213 104305070 446-1146428-703 4. ^ VA 5. ^Conv. Ins. 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: DEREK C. BUTT, KAREN S. BUTT ESTATE OF DOR!S E. PIFER PRIMARY RESIDENTIAL MORTGAGE, 1050 Highfield Court, Mechanicsburg, PA 17055 1110 Granada Lane, Mechanicsburg, PA 17055 INC. 4750 W. WILEY POST WAY, SUITE 200, SALT LAKE CITY, UTAH 84118 G. Property Location: H. Settlement Agent: I. Settlement Date: 03/30/2012 1110 GRANADA LANE, UPPER ALLEN Homesale Settlement Services Disbursement Date: 03/30/2012 TOWNSHIP 4309 Linglestown Road, 717-671-9876 Fax 717-671-9676, MECHANICSBURG, PA 17055 Harrisburg, PA 17112 Upper Allen Township Place of Settlement: TitleExpress 4309 Linglestown Road, 717-671-9876 Fax 717-671-9676, Printed 03/29/2012 at 2:28 pm Harrisbur , PA 17112 by KAC 100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller 101. Contract sales price 148,000.00 401. Contract sales price 148,000.00 102. Personal ropert 402. Personal propert 103. Settlement charges to borrower (line 1400) 7,524.07 403. 104. 404. 105. 405. Adjustments for items aid b seller in advance Adjustments for items aid b seller in advance 106. Cityltown taxes to 406. City/town taxes to 107. County taxes 03/3012012 to 12/31/2012 430.87 407. County taxes 03/3012012 to 12/3112012 430.87 108. Assessments 03/30/2012 to 06/3012012 472.19 408. Assessments 03/3012012 to 06/30/2012 472.19 109. Sewer Proration 03130/2012 to 0313112012 2.46 409. Sewer Proration 03/3012012 to 03/3112012 2.46 110. 410. 111. 411. 112. 412. 120• Gross Amount Due from Borrower 156,429.59 420. Gross Amount Due to Seller 148,905.52 200. Amounts Paid b or in BehalF of Borrower 500. Reductions In Amount Due to Seller 201. Deposit or earnest money 2,000.00 501. Excess deposit (see instructions) 202. Principal amount of new loan(s) 128,270.00 502. Settlement charges to seller (line 1400) 11,076.31 203. Existin loo s taken sub'ect to 503. Existin loans taken sub'ect to 204 504. Pa off of frst mort a e loan . 205. 505. Payoff of second mortgage loan 206. 506. 207. Seller Assist 5,000.00 507. Seller Assist 5,000.00 208 508. . 209 509. . Adjustments for items unpaid by seller Adjustments for items un aid b seller 210. Cityltown taxes to 510. City/town taxes to 211. County taxes to 511. County taxes to 212. Assessments to 512. Assessments to 213 513. . 214 514. . 215 515. . 216 . 516 . 217 -~_--._..._~~ 517. . 218. 518, 219. 519. 220• Total Paid b Ifor Borrower 135,270.00 520. Total Reduction Amount Due Seller 16,076.31 Cash at Settlement fromlto Borrower 300 600. Cash at Settlement tolfrom Seller . Gross amount due from borrower (line 120) 301 156,429 59 601. Gross amount due to seller (line 420) 148,905.52 . Less amounts paid bylfor borrower (line 220) 302 135,270.OC 602. Less reductions in amount due seller (line 520) 16,076.31 . 303. Cash ^X From ^ To Borrower _ __ 21,159.59 603. Cash ^X To ^ From Seller . ,~e~.° m,~ ~~ ,~ a~ ,~,^ n,ma,nn an vpp are np reealre 132,829.21 p ppmp e e I he 1'uDl,c Iteppning tlumen for In,s coi'~ealon o, ln,c^naaon ,s es,,,ne~vv e, a~ ~,~~~u,ca ~c~ ~=.,v~~.+=,~• -~~~~~•••u. •~••-.....n. -..-.-.-...... ...- --. _. - -°- Inis form, unless II tlispldys a curzenlly valid OMB control number. 4o confdenlial'ily Is a55~~re0', !M1is aisGOSUre Is mannalory T}I'IS is neslB^etl to provitla IM1e ponies to a RESPA eoveren transacllpn wilt informellon during IM1e seniemem process. Previous editions are obsolete Page 1 of 4 HUD-] 700. Total Real Estate Broker Fees $ 8,580.00 Paid From Paid From Division of commission Iine700 as follows: Borrower's Seller's 701. $4,290.00 to Prudential Homesale Services Group Funds at Funds at 702. $4,290.00 to Keller Williams Keystone Realty Settlement Settlement 703. Commission paid at settlement 8,580.00 704. Broker Fee to Prudential Homesale Services Group 225.00 705. Broker Fee to Keller Williams Keystone Realty 195.00 800. Items Pa able in Connection with Loan 801. Our origination charge (Includes Origination Point 0.000% or $0.00) $995.00 (from GFE #1) 802. Your credit or charge (points) for the specific interest rate chosen $ (from GFE #2) 803. Your adjusted origination charges (from GFE A) 995.00 804. Appraisal fee to AMC (from GFE #3) 450.00 805. Credit re ort to from GFE #3 806. Appraisal Re-Inspection Fee to (from GFE #3) 807. to 808. to 900. Items Re wired b Lendecto be Paid in Advance 901. Daily interest charges from from 0 313 012 0 1 2 to 0 410 112 01 2 @ $13.6177/day (from GFE #10) 27.24 902. Mortgage insurance premium for months to HUD (from GFE #3) 1,270.00 903. Homeowner's insurance for 1 ears to Gunn Mowe Insurance $410.00 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) 1,388.07 1002. Homeowner's insurance 2 months $ 34.171month $68.34 1003. Mortgage insurance months $ 115.461month $ t00a. Pro ert taxes months $ (month 1005. County taxes 2 months $ 46.071month $9214 1006. Schoof Taxes 8 months $ 154.861month $1,238.88 1007. Aggregate Adjustment $-1?.29 1100. Title Char es 1101. Title services and lender's title insurance from GFE #4 1,356.75 1102. Settlement or closing fee to $ 1103. Owners Title insurance from GFE #5 84.01 1104. Lenders title insurance $1,003.75 1105. Lender's title policy limit $128,270.00 Lender's Policy 1106. Owner's title policy limit $148,000.00 Owner's Policy 1107. Agent's portion of the total title insurance premium $968.11 1108. Underwriters portion of the total title insurance premium $119.65 1109. 120D. Government Recordin and Transfer Char es 1201. Government recording charges $ (from GFE #7) 136.00 1202. Deed $62.00 Mori a e $74.00 Release $ 1203. Transfer taxes $ (from GFE #8) 1,480.00 1204. CitylCounty tax/stamps Deed $1,480.00 Mort a e $ 1205. State Taxlstamps Deed $1,480.00 Mort a e $ 1,480.00 1206. Deed $ Mort a e $ 1207. $ 1300. Additional Settlement Char es 1301. Rea,uired services that you can shop for (from GFE #6) 1302. to 1303. Deed Prep Fee to Homesale Settlement Services, Inc. 115.00 1304. Prepaid Tax Cert Fee to Homesale Settlement Services, Inc. 10.00 1305. 2012 TwplCounty Tax to Dennis E. Zerbe, Treasurer 569.31 1306. Notary Fee to Nota Public 15.00 1307. Sewer Bill 1/1-3131/12 Acct#630021 to Uo er Allen Sewer Authorit 1300. SewerBui4i1-0iJG/?2ACCt*fOJ~.~iLl tow er,AifenSewerP.uihent 112.00 112.00 ,rr r r 7,524,07 11,076.31 `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-] Com orison of Good Faith Estimate GFE and HUD•1 Char es Char es That Cannot Increase HUD-1 Line Number Our origination charge # 801 Your credit or charge (points) for the specific interest rate chosen # 802 Your adjusted origination charges # 803 Transfer taxes # 1203 Charges That Can Change Initial deposit for your escrow account # 1001 Daily interest charges from # 901 $13.6177/da Homeowners insurance # 903 Title services and lender's title insurance # 1101 Ownef's title insurance # 1103 Loan Terms Good Faith Estimate HUD-1 995.00 995.00 0.00 0.00 995.00 995.00 1,480.00 1,480.00 Good Faith Estimate HUD-1 2,480.00 1,388.07 27.62 27.24 480.00 410.00 1,391.75 1,356.75 60.00 84.01 Your initial loan amount is $128,270.00 Your loan term is 30. years Your initial interest rate is 3.8750% Your initial monthly amount owed for principal, interest, and any mortgage $718.63 includes insurance is QX Principal QX Interest QX Mortgagelnsurance Can your interest rate rise? QX No. ^ Yes, it can rise to a maximum of %. The first change will be on I I and can change again every years after I I .Every change date, your interest rate can increase or decrease by %. Over the life of the loan, your interest rate is guaranteed to never be lower than % or higher than %. Even if you make payments on time, can your loan balance rise? QX No. ^ Yes, it can rise to a maximum of $ Even if you make payments on time, can your monthly amount owed for QX No. ^ Yes, the first increase can be on I I and the monthly principal, interest, and mortgage insurance rise? amount owed can rise to $ The maximum it can ever rise to is $ Does your loan have a prepayment penalty? QX No. ^ Yes, your maximum prepayment penally is $ Does your loan have a balloon payment? QX No. ^ Yes, you have a balloon payment of $ due in years on I Total monthly amount owed including escrow account payments ^ You do not have a monthly escrow payment for items, such as property taxes and homeowners insurance. You must pay these items directly yourself. ^X You have an additional monthly escrow payment of $235.10 that results in a total initial monthly amount owed of $953.73. This includes principal, interest, any mortgage insurance and any items checked below: QX Property taxes Q Homeowner's insurance n Flood insurance n School Taxes Note: If you have any questions about the Settlement Charges and Loan Terms fisted on this form, please contact your ienaer. Previous editions are obsolete Page 3 of 4 HUD-] HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. DEREK C. BUTT e R N .BUTT F ,,c/ L x f!4 "/,k. ESTATE OF ORIS E. PIFE 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. 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 4 HUD-] 11 Name of P.orrower. Name of Seller: File Number: ~ Prepared 03/2912012 at 2:28 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: DEREK C. BUTT KAREN S. BUTT Name of Seller: ESTATE OF DORIS E. PIFER File Number: 12-213 Prepared 03/2912012 at 2:28 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 Borrower Seller 801. Our origination charge (Includes Origination Point 0.000% or $0.00) Administration Fee to PRIMARY RESIDENTIAL MORT$ 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 specific interest rate chosen to $ 0.00 803. Your adjusted origination charges 995.00 0.00 1 Name of Borrower: DEREK C. BUTT KAREN S. BUTT Name of Seller: ESTATE OF DORIS E. PIFER File Number: 12-213 Prepared 0312912012 at 2:28 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 Settlement Statement applies. 1100. Title Charges Total Charge Borrower Seller 1101. Title services and lender's title insurance to Notary Fee to Nota Public $ 45.00 45.00 Doc Download Fee to Homesale Settlement Services, I$ 50.00 50.00 Wire Fee to Homesale Settlement Services, I$ 15.00 15.00 Overnight Fee to Homesale Settlement Services, I$ 18.00 18.00 End 100110000 to Old Re ublic Title $ 50.00 50.00 300130000 to Old Re ublic Title $ 50.00 50.00 9 0 0181 0 0 0 to Old Re ublic Title $ 50.00 50.00 ClosingSvcLtrlCSL to Old Re ublic Title $ 75.00 75.00 1102. Settlement or clcsin ' e g re to $ 0.00 t 104. Lender's title insurance to Old Re ublic Title $ 1,003.75 1,003.75 Totals: $ 1,356.75 0.00 1,356.75 0.00 SellerlLender credits shown on a e 1 POC =Paid Outside Closin CR =Lender Credit Previous editions are obsolete Page 1 of 1 HUD-1 Calculated Value of Your Paper Savings Bond(s) Page ( o ^~~ f -.. , .~:. a (~r,. Calculated Value of Your Paper Savings Bond(s) ~~ ~~s.~, ~ t.. ,~/ ~-_ ~ 1 Calculator Results for Redemption Date 07/2011 ~.~~, ~/jr ~?~"~~';/ Totem! F~s-~~;~ "cat ~~4~ ~"~sl .~ "~ .. ~'~~ Tr~~te~-c;~t $2,500.00 $4,222.00 __ $1,722.00 $30.00 Bonds: 1-5 of 5 M67264740EE/EE $1,000 05/1996 11/2011 05/2026 $500.00 $344.40 1.67% $844.40 M67264738EE/EE $1,000 05/1996 11/2011 05/2026 $500,00 $344.40 1.67% $844.40 M67264739EE/EE $1,000 05/1996 11/2011 05/2026 $500.00 $344.40 1.67% $844.40 M67264742EE~ EE $1,000 05/1996 11/2011 05/2026 $500.00 $344.40 1.67% $844.40 M67264741EE+'' EE $1,000 05/1996 11/2011 05/2026 $500.00 $344.40 1.67% $844.40 Totals for 5 Bonds $2,500.00 $1,722.00 $4,222.00 fie,- ~ -: NI Not Issued NE Not eligible for payment P5 Includes 3 month interest penalty MA Matured and not earnin interest http://www.treasurydirect.~ov/BC/SBCPrice . _...~. _..~ __.~~.~..~..~.,..~,.,.....,~ a 7/ 12/20 ~.../'~ + ~~ ~.1 lated Value of Your Paper Saving Bond{s) k~f ~ ,~ -~~~ ~''~ ,.~. ~,~i Calculator Results for Redemption Date 07/2011 c~a ~~-~ae _~s~Y: "as°~4t~~.4 "€~c~f.,~i '';,-~r-~v ~ Y i £7 ~nt~~-e~t X9,500.00 ___$15,_790.40 $6,290.40 $2ll.2~ Bonds: 1-19 of 19 PAYABLE ON DEATH BONDS S~riai #:~ 5 ~ri~a ~- --- ~~~~.- ~i E€r~# atu~~~it~ ~s ~-~~ nt~:i~st In£reat ~~~e ~t~~~~ ~t `M57409643EE EE $1,000 07/1996 01/2012 07/2026 $500.00 $344.40 1. 67% $844.40 '~567409653EE EE $1,000 07/1996 01/2012 07/2026 $500.00 $344.40 1. 67% $844.40 A~467409652EE EE $1,000 07/1996 01/2012 07/2026 $500.00 $344.40 1. 67% $844.40 <'•t67409650EE EE $1,000 07/1996 01/2012 07/2026 $500.00 $344.40 1. 67% $844.40 '167409648EE EE $1,000 07/1996 01/2012 07/2026 $500.00 $344.40 1. 67% $844.40 'M73272704EE EE $1,000 08/1999 08/2011 08/2029 $500.00 $260.00 1. 50% $760.00 M73272703EE EE $1,000 08/1999 08/2011 08/2029 $500.00 $260.00 1. 50% $760.00 i~973272702EE EE $1,000 08/1999 08/2011 08/2029 $500.00 $260.00 1. 50% $760.00 `i`167409649EE EE $1,000 07/1996 01/2012 07/2026 $500,00 $344.40 1. 67% $844.40 ~167409651EE EE $1,000 07/1996 01/2012 07/2026 $500.00 $344.40 1. 67% $844.40 ~167409644EE EE $1,000 07/1996 01/2012 07/2026 $500.00 $344.40 1. 67% $844.40 M67409647EE EE $1,000 07/1996 01/2012 07/2026 $500.00 $344.40 1. 67% $844.40 'M67409645EE EE $1,000 07/1996 01/2012 07/2026 $500.00 $344.40 1. 67% $844.40 M67409646EE EE $1,000 07/1996 01/2012 07/2026 $500.00 $344.40 1. 67% $844.40 M67264746EE EE $1,000 05/1996 11/2011 05/2026 $500.00 $344.40 1. 67% $844.40 j M67264745EE EE $1,000 05/1996 11/2011 05/2026 $500.00 $344.40 1. 67% $844.40 M67264744EE EE $1,000 05/1996 11/2011 05/2026 $500.00 $344.40 1. 67% $844.40 M67264747EE EE $1,000 05/1996 11/2011 05/2026 $500.00 $344.40 1. 67% $844.40 M67264743EE EE $1,000 05/1996 11/2011 05/2026 $500.00 $344.40 1. 67% $844.40 Totals for 19 Bonds $9,500.00 $6,290.40 $15,790.40 Nis NI Not Issued NE Not eligible for payment P5 Includes 3 month interest penalty MA Matured and not earning interest t (~'~} / ~/ / p4 f d y t J t 1 a~:. ~/ ChA/c..t~ C' Y~17f~.~ ~'ri f' f ,~~' r r~s ~ 1 ll t ,~' ~J ~~~~ ~~ (`( ~,, ;fir` ; f ~' ~ *? ~ . ~- I ,.,.. i } ~ ,{ w } p~ ) ~i t f nttp://~~~~w.treasurydirect.govBL/SBCPrice 'i ~ i ~~7~ s..,,. ti __ , _... - - - ~_~_ _._..- _._ r _- _.- _ - ~` / r ~~ ~ J~, 11 i + f f ~ r ~f _, -~~ ~~~ ~ ~ ~ ~ ~' 7/12/201 LIS"I' OF SAVINGS BOND RL.CII'IEN"CS ISTATI~. OF llORIS E. PTFI.R (Payable on Death Bonds) Charles Albright 131 Bosler Avenue Lemoyne, PA 1704> Michael Albright (South Korea) Cindy Fearnbaugh 1808 S. York Street Mechanicsburg, PA 17055 Kathy Fearnbaugh 1726 State Street, Apt 2 Harrisburg, PA 17103 Matthew Fearnbaugh 6108 N. Hermitage, 2h Chicago, 1L 60660 Ted Fearnbaugh 1215 Gross Drive Mechanicsburg, PA 17050 Ted Koob 15 Skippack Creek Road Souderton, PA 18964 Jason Parks 301 Running Bond Drive Middletown, I'A 17057 Beth Rice 27 N. 17'x' Street Camp Hill, PA 17011 Barbara Shetrom 1421 Valley Road Marysville, PA 17053 Michael Steffen 1427 ~3"r Street. I\iW Washington, DC 20007 Richard Steffen 1825 S. 296°i Street Federal Way, W A 96003 Robert Steffen 12600 Moray Firth Way Br1stOW, VA 20136 Tina Welker ?8 Pheasant Ridge Road Dillsburs;, i'A 17019 Patti Wheeler 18 Willow Way I=.nola, I'A 17025 All beneficiaries are a Collateral Tax Rate of 15~. With the exception of Ted Koob (no relationship), all other beneficiaries are nieces and nephews. LAST WILL AND TES7~AMENT I, DOR1S E. PIFER, of the Township of iJpper Allen, County of Cumberland, and th of Pennsylvania, being of sound and disposing mind, memory and erstanding, cto make, publish and declare this as and for my Last Will and "Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. PTRST. I order and direct that all my just debts and ftuleral expenses be paid by my Executrix, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give and bequeath the sum of Five Thousand ($5,000.00) Dollars unto w ,~ ~31 '.~ MECI IANICSBURG CHURCII OF THE BRl?.THRFN, absolutely. 1'I IIRD. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated in equal shares unto fhe following named persons, provided that each survives me, namely: my sister, JEAN M. STCFI~ LN, my brother, JOI-IN M. FEARN[3AUGII, my brother, EARL R. hEAI2NT3AUGH, my brother, PAUL, R. FEARNBAUGH, and my sister, VICKI L. PARKS, share and share atil:e. LASTLY. I nominate, constitlrte and appoint my sister, namely, VICKI L. PARKS, to be the C~ecutrix of this, my Last Will and Testament, but if Tor any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, [nominate, constitute and appoint rLly Sister, riaIDely, JEAN M. S'TFTFF,N, to be the Exxecutrix hereof, each a~~d both to serve without bond or other security as a condition of qualification hereunder. Iht ~tJI7'h'L'SS WHEREOF, I, DORIS E. PIFTR, have hereunto set my hand and seal to LAW a~~~Es SNELB AKER 8c HRENNEMAN. P.C. this my Last Will and "Cestaulent, which consists of two (2) typewritten pages to each of which I ve aPfxed my signature this ~ day of Novet~ber, A.D., Two Thousand Se~~en (?007). -(SEAL,) DORIS E. YIIER The preceding instrument, consisting of this and one other typewritten page, each ~~identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by I)ORIS E. P[FER, the Testatrix therein named, as and for her Last Will and "['estament, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as wihlesses hereto. ;~ 'i ~~ ~~ I ~r2 ~~-'~ - -- i _..~ W OFFICES ELB AKER ~c NEMAN, P. C. TH OP PENNSYLVANIA) SS. UN'1'Y OP CUMBERLAND We, DORIS E. PIPER, RICHARD C. SNELBAKI;R and JANE J. GOONEY, the TestaUrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly swoni, do hereby declare to the undersigned authority that die Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of his or her lniowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no eonst~-aint or undue influence. .'J i ~~i<~..<_.- 'fit ~ ~~,C~'Z'-;,~L`-r -- - ~`~ Witless LJ 1 .~ ~ Notary Pub is CGMMONYVEAL 1 H GF PENNSYLVANIA Notarial Seal Susan L Mafra~, Notary Public Macttanicsbury Soro, Cumbe MY Commia,icn nand County Expires Nov. 24, 2Cp7 Member, Pennsylvania Association of Notaries ~4W OFFICES NELBAKER & :NNF_MAN, P. C. Subscribed, sworn to and acknowledged before me by DORIS E. PiFER, the Testatrix, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J. GOONEY, the witnesses, this ~r~, day of November, ?007