HomeMy WebLinkAbout06-07-12 (2)J Lsos61o1os
REV-1500 Ext°~-"'tF"
PA Department of Revenue pennsylvanfa OFFICIAL USE ONLY
°"^"^°^'°'^'°°°°
Bureau of Individual Taxes
INHERITANCE TAX RETURN Coun Code Year
h Flle Number
---
PO BOXa8o6ot
Harrisburg,PAt71z8-o6ot RESIDENT DECEDENT C~ ) ~~ ~7'"
~~ J~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth NIMDDYYYY
09/07/2011 03/05/1943
Decedent's Last Name Suffx ~ Decedent's First Name
MI
,Watson Jr. James g
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number - -- ~ -^
THIS RETURN MUST BE FILED IN DUPLNCATE WITH THE
__ REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 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 6. 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 12-31-97 and 1-1-96) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name _. Daytimie Telephone Number
Adam R Deluca, Esq. (717) 249-1177 ~
I- r•:~
I REGISTER OF t~313
First Line of Address }s L ~ ~ I
. V s ~!
61 West Lowther Street ~
'7
__
Second Lme of Address
~~ ~~~~~~ ~
.,
Q~ A
~
_,_
_ ~~ C7
CIty Or POSt Office State ZIP Code DATE FILED Cb
Carlisle PA 17013
Correspondent's a-mall address: ardeluca85@aol.com
Under penalties of perjury, I tleclare that I have examined this return, including accompanying schedules and statements, and to th e best of my knowledge and belief
it is true, correM and complete. DeGaration of praparer other than the personal representative is based on all information of whic ,
h preparer has any knowledge.
TURE OF PERSON SPON IBLE OR FILING RE~yygqRN DATE
61 West Louther Street, Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 15D5610105 J
>{{~''''))
6~,~-,
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1505610205
REV-1500 EX (FI)
Decedents Name: James B. Watson, Jr.
Decedent's Social Security Number
RECAPITULATION
1. Real Estate (Schedule A) ........... ........ ....... . 1
. . 56 600.79 ',
.......
2. Stocks and Bands (Schedule B) .... ......... ............ ..... .. 2. ........ ....... 2 236.6$ '..
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. . 3 0.00 '.
4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. 0.00 ''..
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. ' 18,092.44 '..
6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... . 6 0.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Pro
erty " ~~~~~~~~' ' `~~~~~~- -°-~ - -~----..--
p
(Schedule G) O Separate Billing Requested......
.. 7. ', .
0.00 '.
8. Total Gross Assets (total Lines 1 through 7) ...... ........ . 8 78,929.91
9. Funeral Expenses and Administrative Costs (Schedule H)..... _ .......... .. 9. ',. 19,644.75 ',
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I)... ........ . 10 51 700.51
11. Total Deductions (total Lines 9 and 10) ......... ........ . 11 71 345.26
_...
12. Net Value of Estate (Line 8 minus Line 11) ....... ........ . 12. 5,584.65
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.
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
trensfers under Sec 9116 ---
5,584.85
_ __
16. Amount of Line 14 taxable _ """"" """' '°" """ °-°~" • • °°~- ~ _-~--~-
at lineal rate X .0 45 251.31 i6 251.31 ''
17. Amount of Line 14 taxable ~~ ~ ~•~~~~~_" ~~
...-F .... .._..-,.. ...,-_ ..., ....
"""'-""` '°° """"`" °' ` ° ` ~ ••°°
at sibling rate X .12 ', 1 ~
18. Amount of Line 14 taxable ~~-°-__. ~ . _._.._... ... ._..... _,._
......... ....,....._ .
at collateral rate X .15 '. 18
19. TAX DUE .. ......... _ ..
......... 19 251.$1 '..
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205 J
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
Flle Number ,~ b l 1- O I D S'-~
DECEDENT'S NAME
James B. Watson, Jr.
STREETADDRESS
740 Forge Road
CITY
Carlisle STATE Zip
PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments 0.00
B. Discount 0.00
3. Interest
(1)
251.31
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Total Credits (A+ B) (2) 0.00
(3)
0.00
(4) 0.00
(5)
0.00
Make check payable to: REGISTER OF WILLS, AGENT.
;* k i ~ nen ik,~~ iUrua~i °~?!~ : i, a,,. ~ w~..~~,'.E,dih; ~k`rv'~!'tit'~ i .`~t~~.'.,, llu ~ ° ~ I!"v ..'~~{" nr v ~ n, t i ~ i1 ai k r -~ v1 ~' a~ ~E ~
. ..~.,. x~.;.+N ~~._k`~!:a ltd:~t.+~, t"<~.ixi+.wr+~'`tl:l?.ti~,:a.Sf.kt~{ Il:liC.~T:l~.I9...Etli.~rfix~i'~?~;?:;~t1:~.~1~aiE~..st`if+tn~:~i r~:
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, benefts 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 SCH_ EDULE G AND FILE IT AS PART OF THE RETURN
Si.' !, .~,m. a n. ;`t~,.~ .u 3:.M ~ t~:,_,..1~'Y'::`~u,~~a~~iy'.{k~~rl,n~~v;It~Ti~~i 4E~~ryi ~i%~~!~~~~r5 ,~i~fat~i~€,?~i!S:,tY~iH'x! h~~~~;; ~{~iisst~'iN ~4ti, lfil4k ~::i~l',I ll~~~.}N~ H,4~kH'~l~i,a~i.,`~,..~k 6j~1~~.i7.1'~Lic
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 Uansfers 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-1502 EX+ (11-OB)
~ Pennsylvania
DEPARTMENT OF REVENDf
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
eolAte of FILE NUMBER
James B. Watson, Jr. 2011-01054
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 jointly-owned 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 OF DEATH
DESCRIPTION
1' 740 Forge Road, Carlisle, PA 17013 -settlement sheet attachment A
56 600.79
TOTAL (Also enter on Line 1, Recapitulation.) $ 56,600.79
If more space is needed, insert additional sheets of the same size.
REV-r5o3 EX+(~-n)
~ Pennsylvania SCHEDULE B
OEYAFTMENT OF PEVENOE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDEM DECEDENT
ESTATE OF
FILE NUMBER
James B. Watson, Jr. 2011-01054
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
I, OF DEATH
73 shares of Foot Locker, Inc Common Stock at $30.8764681/share CUSIP 00145034484910 2,236.68
TOTAL (Also enter on Line 2, Recapitulation) $ 2,236.68
]f more space is needed, insert additional sheets of the same size
REV-r5o8 E%+ (u-io)
~ Pennsylvania
DEPARTMENT OF REVENUE
INNERRANCE TA%RETDRN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS & MISC.
PERSONAL PROPERTY
ESTATE OF:
FILE NUMBER:
James B. Watson, Jr. 2011-01054
Include the proceeds of litigation and the date the proceeds were received by the estate.
T' All property jointly owned with right of survivorship must be disclosed on schedule F.
R DESCRIPTION VALUE AT DATE
OF DEATH
1. M&T Bank Business checking Account # 2676047133 -1002 N. 7th St., Hamsburg
PA 17102
, 2,160.67
2, Memberslst CheckinglSavings Account # 75921 - 5000 Loise Drive PO Box 40 Mechanicsburg
PA 17055
, 369.33
3, All personal property sold at estate auction, net value -see attachment B
11,652.75
4. All locksmith tools sold to a licensed locksmith -see attachment C
2,750.00
5. Loose Change (coins) u
1,159.69
TOTAL (Also enter on Line 5, Recapitulation) ; 18,092.44
if more space is needed, use additional sheets of paper of the same size.
REV-1737-6 EX t (6-06)
REVERSE
2~ Attorney Fees
~ enns lvania SCNEDYLE N
p y FUNERAL EXPENSES & Llse Schedule H ONLY for proportionate
DEPARTMENT OF REVENUE ADMINISTRATIVE COSTS method of tax computation.
INHERRANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF
FILE NUMBER
James B. Watson, Jr. 2011-01054
Debts of decedent must be reported on Schedule I.
ITEM NUMBER DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
~ Cocklin Funeral Home, Military Service at Fort Indiantown Gap ` "
6,223.46 '
B. ADMINISTRATIVE COSTS:
t. Personal Representative's Commission(s) 4,615.79
Name(s) of Personal Representafive(s) PaUI and Sandra WatSOn
(Submit requested information for additional personal representative's on additional sheets)
Social Security Number(s) or EIN Number(s) of Personal Representatlve(s)..92'34-6704 164-40-67$2
sheet Address(es) 48 Nailor Road
Ciry(ies) Dillsburg State(s)PA` ZIP(s).17019
Year(s) Commission Paid'2012
3. ~ Probate Fees
4. ~ Accountant's Fees
5~ I Tax Return Preparer's Fees
4,615.79
_ _ - 0.00 '
0 00
0.00..'..
6. Miscellaneous Expenses
Advertising for estate, Extensive cleanup of home/dumpster rental/hauling fee,
recycle multiple computers, charge to sell stocks- see itemized attachment D
3,791.46
Home owner's insurance
398.25 '
TOTAL (Also enter on Line 9, Recapitulation.) $ 19,644.75
(If more space is needed, use additional sheets of paper of the same size)
REV-1737-7 EX + (fi-O81
~ pennsylvania SCHEDULE 1
DEPARTMENT OF REVENUE DEBTS OF DECEDENT, Use Schedule I, Part 2, ONLY for
MORTGAGE LIABILITIES, & LIENS proportionate method of taz computation.
INHERITANCE TAX gETURN
NONRESIDENT DECEDENT
ESTATE OF FILE NUMBER
James B. Watson, Jr. 2011-01054
Part 1 must include mortgage liabilities, liens and taxes against the PennsylvaniEi realty that were due and
owed as of the date of decedent's death.
Cmm~le~e O..w o nw v ...~__ .
••••-•• •••~ r•~r~~ ••~••=•e niuuwa vT sax compu[auon Is electe d.
•i • •
ITEM
NUMBER DESCRIPTION AMOUNT
t. Settlement Charge
2,057 17 .;
2. Payoff of Mortgage to Memberslst FCU -shown on settlement sheet
7,484.69
TOTAL PART 1 $ 9,541.86
• ~
ITEM
NUMBER DESCRIPTION
AMOUNT
t Medical- Masland Associates
114.00
2. Medical- Carlisle Surgical Institute (Paid to Apex Asset Management)
8,217.00
3. Medical- Blue Mt. Anastesia
3,870.00 -
4. Medical- Pinnacle Cardiovascular Institute (Moffitt Heart and Lung)
590.00
5. Medical- Mount Rock Inpatient
2,514.00
6. Medical-Alexander Springs Emergency Physicians
1,037.00
7. Medical- Carlisle HMA Physician Management
2,138.50
8. Medical- Quantum Imaging and Therapeutic Associates
2 960 00
TOTAL PARTS $ 21,440.50^
TOTAL (Also enter on Line 10, Recapitulation.) $ 30,982.36-
Colr}"q
~+'d
(If more space is needed, use additional sheets of paper of the same size)
~ P~
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS CONTINUED
9. Medical -Carlisle Medical Pathology, P.C.
10. Medical- Healing Arts Surgical Associates $650.00
11. Medical- Carlisle Regional Medical Center (Paid to American Info Source) $ 132.00
12. Medical- Lung, Asthma, and Sleep Associates
$1227.00
13. Lowes Credit Card Balance
14. Capital One Credit Card Balance
15. Citizen's Bank Credit Card Balance
16. DEX One Account Balance
17. Direct TV Account Balance
18. California Contractors Supplies Account Balance
19. Zipf Lock Company Account Balance
20. Century Link Account Balance
21. Verizon Wireless Account Balance
22. MS<T Bank Credit Line Balance
TOTAL OF PART 1: $9,541.86
TOTAL OF PART 2: $42,158.65
$218.81
$8101.38
$6502.48
$531.64
$23.21
$125.30
$123.49
$144.80
$14.93
$1731.11
Schedule I Total: $51,700.51
REV-0737-7 EX ~ (6-06)
REVERSE
~ pennsylvania SCNEp11LE J
DEPARTMENT OF REVENUE BENEFICIARIE
INHERRANCE TAX RETURN
NONRESIDENT DECEDEM
ESTATE OF FILE: NUMBER
James B. Watson, Jr. 2011-01054
When flat rate method is elected, list the benefciaries of the Pennsylvania property.
When proportionate method is elected, list all benefciaries,
RELATIONSHIP TO
ITEM DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Nnt Llat Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS linclude outright spousal Oistribufions and transfers under Sec. 2116 (aj(1.2)]
t.
David Ray Watson 3251 Ridge Drive, Beale AFB, CA 95903 Son 5,333.34
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE SIDE
OF REV-1737 COVER SHEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
t
TOTAL OF PART II $5,333.34
IC.Ne. Inlnl nn... Lav.~61e d~.d.:6~ A...... .... ~ :.... 1O ..! oCV 1909 .....,..~.. w...J ~
(If more space is needed, use additional sheets of paper of the same size)
A.
OMB NO. 2502-0265 ~~~
B. TYPE: OF LOAN:
U. S. DEPARTMENT OF HOUSING 8 URBAN DEVE LOPMENT 1.^FHA 2.QFmHA 3.~CON`/. UNINS. 4. ~VA 5.~CONV. INS.
6. FILE NUMBER:
SETTLEMENT STATEMENT week-1z 7. LOAN NUMBER:
8. MORTGAGE IN S CASE NUMBER:
C. NOTE: This /orm is furnished to give you astatement o/actual settlement costs.
"
" Amounts paid to and by the settlement agent are shown
Items marked
(POC]
were paid outside .
the closing; they are shown het for in/ormationa/purposes rind are not included in the totals.
D.
NAME AND ADDRESS OF BUYER: 1.0 3188 (WEB1412.PFDNJEBI&1218)
E. NAME AND ADDRESS OF SELLER
: F, NAME AND ADDRESS OF LENDER:
TIMOTHY F. WEBER ESTATE OF JAMES B. WATS ON CASH
82 NORTH OLD STONEHOUSE ROAD 740 FORGE ROAD
CARLISLE, PA 17015 CARLISLE, PA 17013
G. PROPERTY LOCATION: H. SETTLEMENT AGENT:
740 FORGE ROAD I. SETTLEMENT DATE:
CARLISLE, PA 17013 ANDREW C. SHEELY, ESQ.
Cu mberland County, Pennsylvania
PLACE OF SETTLEMENT February 17, 2012
61 WEST LOUTHER STREET
CARLISLE, PA 17013
J. SUMMARY OF BUYER'S TRANSACTION K. SUMMAf2Y OF SELLER'S TRANSACTION
100 . GROSS AMOUNT DUE FROM BUYER: 400 . GROSS AMOUNT DUE TO SELLER:
101.
102. Contract Sales Price
Personal Pro art 56,000.00 401 . Contract Sales Price 56,000.00
103.
104
Settlement Char es to Bu er Line 1400
1,391.50 402
403 . Personal Pro art
.
. 404 .
105. 405 .
106 Ad"ustments For Items Paid B Seller in advance
Ci /Town T Ad'ustments For Items Paid 8 Seller in advance
.
107 axes 02/17/12 to 01/01/13
Count Taxes 219.27 406. Cit lfown Taxes 02/17/12 to 01/01/13 219
27
.
108. to
SCHOOL TAX 02/17/12 to D7/01/12
381.52 407.
408. .
Count Taxes to
SCHOOL TAX 02/17112 to 07/01/12
109. 381.52
110 409.
.
111.
410.
112 411.
. 412.
120. GROSS AMOUNT DUE FROM BUYER 57
992.29 420 GROSS AMOUNT DUE TO S
, . ELLER 56,600.79
200. AMOUNTS PAID BY OR IN BEHALF OF BUYER : 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201.
De osit or earnest mone
5,6DO.D0
501. :
Excess De osit See Instructions
202.
203 Princi al Amount of New Loans
E
~ 502. Settlement Char es to Seller (Line 1400) 2
057
17
. xistin loans taken sub
ecl to 503 Exislin loans taken sub'
t t ,
.
204. . ec
o
205 504. Payoft o(frst Mortgage to MEMBERS 1ST FEDERAL CI 7,484.69
.
206. 505. Pa off of second Mort a~ e
207' 506.
208. 507. De osit disb. as roceeiis
209. 508.
Ad"ustments For Items Un aid 8 Seller 509.
Ad'ustments For Items Un aid B Seller
210. Cit /Town Taxes to 510. Cit /Town Taxes to
211. Count Taxes to 511. Count Taxes to
212. SCHOOL TAX
t0
512.
SCHOOL TAX to
213. 513.
214.
215. 514.
216. 515.
217. 516.
218. 517.
219' 518.
519.
220. TOTAL PAID BY/FOR BUYER 5,600.00 520. TOTAL REDUCTION AMOUNT DUE SELLER
300.
CASH AT SETTLEMENT FROM/TO BUYER: 9,541.86
301.
Gross Amount Due From Bu er Line 120 600. CASH AT SETTLEMENT TOIFROM SELLER:
302.
Less Amount Paid B /For Bu er Line 220
y ( )
( 57,992.29
5
60 601. Gross Amount Due To Seller Line 420
56,600.79
,
0.00) 602. Less Reductions Due Seller (Line 520) ( 9,541.86
303. CASH (X FROM) ( TO) BUYER 52,392.29 603. CASH (X TO) ( FROAd) SELLER
47,058.93
~~~ ~~~~~, ~,y„~~ ncicuy ecxnowieege receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein.
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 TRANON. I FURTHER CERTIFY
THAT I HAVE RECEIVED A.COPY, eOF THE HUD-1 SETTLEMENT STATEMENT. _ 'ry 7
Buyer C,.:...Irp ~• /L/o ~/,Lc~-C_ ('~ /y Zf_ r~.
1f ,l - Seller ESTATE pF JANfE B. WATSON
TIMOTHY F.,VJIEBER By~-l\ ' -
TO THE BEST OF MY KNO DGE, T T7 MENT STATEMENT WHICH I HAVE PREP-ARED IS A TRUE ND ACCURATE ACCOUNT OF THE
FUNDS WHICH WERE R IVE WILL BE DISBURSED BY THE UNDERSIGNED AS FART OF THE SETTLEMENT OF THIS
TRANSACTION.
S T CEMENT OF
Set ement Agent
WARNING: IT IS A CRIME TO KNOWINGL E 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 & SECTION 1010.
>~~ t-~Lc~,w~,¢~,~- /A,
Page 2
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price $ o
PAID FROM PAID FROM
Division o/Commission line 700 as Follows:
7Q1_ $ t0 BUYER'S SELLER'S
702,$ tD FUNDS AT FUNDS AT
703. Commission Paid at Settlement SETTLEMENT SETTLEMENT. -'
704. TRANSACTION FEE to
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Ori ination Fee / to
8
02. Loan Discount % to
803. Appraisal Fee to
804. Credit Report to
805. Lender's Inspection Fee to
806. Mon a e Ins. A .Fee to
807. Assumption Fee to
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to @ $ /day ( days ^/,)
902. MIP Totlns. for LifeOfLoan for months to
903. Hazard Insurance Premium for 1.0 ears to
904.
905
.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance months $ er month
1002. Mort a e Insurance months $ er month
1003
Ci !Town Tax
.
es months $ er month
1004. Count Taxes months $ er month
1005. SCHOOL TAX months @ $ per month
1006. months $ er month
1007
. months
@ $ per month
1008. AGGREGATE ESCROW ADJUSTME months $ er month
1100. TITLE CHARGES
1101. Settlement or Closin Fee to
1102. CLOSING PROTECTION LETTER to FIRST AMERICAN TITLE INSURANCE COMPANY
1103. TITLE SEARCH & HUD PREP to TRI-COUNTY ABSTRACT SERVICE
1104. RE-IMBURSEMENT FOR TAX CERT to TRI-COUNTY ABSTRACT SERVICE 200.00
1105. OVERNIGHT MAIL FEE to TRI-COUNTY ABSTRACT SERVICE 5.00
1106. Note Fees to CASH 14.50
1107. Atlomey's Fees to ANDREW C. SHEELY
ESQ 10.00 5.00
,
.
includes above item numbers: 350.00
1108. Title Insurance to TRI-COUNTY ABSTRACT SERVICE/AGENT FOR 1ST AMEfiICA
includes above item numbers: 209.50
1109. Lender's Coverage $
'
1110. Owner
s Coverage $ 56,000.00 209
50
.
1111. ENDORSEMENTS
5011442-0034216E
1112
.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 62.00; Mortgage $ Releases $
1202. Ci /Count Tax/Slam s: Deed 560.00' Mon a e 62.00
1203. State Tax/Stam s: Revenue Stam s 560.00; Mort a e 560.00
1204. 560.00
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301
Surve
.
to
1302. Pest Ins action to
1303. 2011 DELINQUENT TAXES to CUMBERLAND COUNTY TAX CLAIM BUREAU 40-09-0533-002A
1304. FINAL BILL WATER/SEWER to SMTMA 1,16205
1305. 2012 COUNTYROWNSHIP TAXES to ROBERT C. CAIRNS, TAX COLLECTOR ID#40-09-0533-002A 59.04
1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103, Section J and 602
Section K 251.58
,
By signing page t of Mls statement, tfta signatories acknowlatlge receipt of a comoletetl coov of nnnn ~ nr mm w ,.~.. 1,391.50 2,057.17
Certified to be a true copy.
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SET MENT OFFICER ~.
Settlement Agent /
( WEB19-121 WEBt B-1219 )
Rick Foreman Auctioneer Au1163L
386 Springfield Rd.
Shippensburg Pa 17257
(717)776-4602
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'ad door & coricrete ramp;
be certified organic in June
rnuary 7th & 14th from
:e due within 45 days. Cash
iecks must be approved by
Bidder number. Owner and
ts. All announcements sale
lures ®www auction io
John & Mary
RAISALS
s~u~.
.R
1P LISTS ON WEBSITE
'E YOU CAN JOIN US !!!!
eecnet
Cash, PA Check, Visa, NC
No Buyer's Premium
Absentee Bids Accepted
Food Availgbk
P.M.
F--~
VINTAGE CLOTHING
GAN SILVER DOLLARS
i-FURNITURE
ALLIED ATTORNEYS
OF CENTRAL PENNSYLVANIA, L.L.C.
Main Office Branch Office
61 West Louther Street 100 N. Main Street
Carlisle, Pennsylvania 17013 Mifflintown, PA 17059
(717)249-1177 (717)436-0220
(717) 249-4514 Fax (877) 882-8904 Toll Free
Stephanie E. Chertok, R. N., Esquire -Managing Attorney Adam R. Deluca, Esquire
Andrew J. Bender, Esquire Shawn M. Stottlemyer, Esquire
January 18, 2012
Paul and Sandra Watson
43 Nailor Road
Dillsburg, PA 17019
Re: Foreman Auction Proceeds Check
Dear Paul and Sandy,
Enclosed please find a check from the proceeds of the Auction held on J;amtary 14, 2012, that was
received at our office from Rick Foreman.
Please deposit this check in the Estate Account.
Sincerely,
Alice Zimmerman
Enclosed
RICHARD D FOREMAN JR
AUCTIONEER ESCROW ACCOUNT
386 SPRINGFIELD ROAD PH.717-776-4602
SHIPPENSBURG, PA 17257
Pay to
Order
~ ACNB BANK
6ETIYSBUAG, PENNSYLVANIA
For~~o, ~' /S~ /Z.
x:03 i309945-:
840
60-990/313
' % ~` ~/~ BPM'GH 83
Date
$~1~~7,25
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2 15111 27 i•" ill• 0840
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11/9/11 Rent dLUnpster $483.60
11/22/11 Advertise estate in Cumberland Law Journal $75.00
11/22/11 Advertise estate in Patriot News $208.44
12/9/11 Dispose of computers $27.00
12/li/11 Purchase "No Trespass" signs $3.07
12/17/11 Medical records of Carlisle Regional Medical Center $349.25
1/9/12 Advertise Estate Auction Sale in Sentinel $573.55
1/11/12 Mailed inverter to locksmith who purchased equipment $15.65
Nov-Dec-
Jan Adam Deluca and Shawn Stottlemyer:
Clean out trash from house, prepaze for sale of contents, photograph
items for ad, meet prospective locksmith equipment and house buyers to
show equipment/house; move/locksmith equipment when purchased.
(110.75 hours @ $15.00 per hour) $1,661.25
Total amount
1/31/12 Dave Anderson cleaned the house and the yard after the auction.
He spent 4.5 hours, had two (2) men and hauled one (1) dump truck
load, one (1) pickup load and one (1) trailer load to the dump.
Total amount
3/21/12 Paid to Idaho Historical Society for a copy of James & Sylvia Watson's
Idaho divorce file
Total amount
$3,396.81
$250.00
$250.00
$43.50
$43.50