Loading...
HomeMy WebLinkAbout05-03-12 1505610105 EX (oz-u REV- ~ 5OO ) (FI) ' ~ ~ PA Department of Revenue OFFICIAL USE ONLY Pennsylvania oEOA ,MEN, o~ E~E~~E County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN r~ '' PO BOX z8o6oi ) Harrisburg, PA 112$-0601 RESIDENT DECEDENT /~.- / f ~(~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDWYY Date of Birth MMDDYYYY 192-20-7818 ' 08/12/2011 ' 02/12/1926 Decedent's Last Name Suffix Decedent's First Name MI Shistle ! Lewis ' L (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 DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Op 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) Op 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 James A Miller, Esquire ' (717) 737-6400 First Line of Address 4 South 17th Street Second Line of Address City or Post Office State ZIP Code Camp Hill PA 17011 c7 __ REGISTER~F~LS USE 0~11k.Y 1 ~ ~I "C7 ~" ?CIS -~ ~ . C.,3 - ~ --~ ~. ~ DATE FILED `tl , ~r -~ ;=~ i Correspondent's a-mail address: jameS paatlaw.com 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 com lete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. S;C~1~'URE OF PEER SI~BLE~OR FII,J,NG RETURN ~ DRT~ Z ~~0 jL 25 Pine Ridge Circle Enola PA 17025-2056 SIGNATURE OF PREPAjt~ey~ i},_ER TI-~N REPRESENTATIVE Camp Hill PA 17011 4805 ~~' Z~ ~ Z PLEASE USE ORIGINAL FORM ONLY 1505610105 Side 1 1505610105 {~m~ -l 1505610205 REV-1500 EX (FI) Decedent's Social Security Number oecedenYs Name: Lewis L Shistle 192-20-7818 RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. 70,000.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. Mort a es and Notes Receivable Schedule D 9 9 ( ) ......................... 4. .. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 770.00 ', 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 35,486.00 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 106,256.00 ', 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 27,485.71 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10, 15,856.09 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 43,341.80 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 62,914.20 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. 62,914.20 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(L2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 62,914.20 ' 1g. 2,831.00 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. 2,831.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX (FI) Paye 3 Decedent's Complete Address: File Number DECEDENT'S NAME Lewis L Shistle STREET ADDRESS 58 Oliver Roacl CITY Enola STATE PA ZIP 17057 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 2,831.00 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) 2,831.00 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 awn 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. LAST WILL AND TESTAMENT OF LEWIS L. SHISTLE I, LEWIS L. SHISTLE, now of Enola, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and hereby revoke all prior Wills and Codicils made by me. ITEM I. I direct that all of my j ust debts and faneral expenses, including the cost of my gravemarker, if any, shall be paid for from my residuary estate as soon as practical after my decease as an administrative expense of my estate. ITEM II. I give and devise all of my estate of every nature and wherever situate in equal shares, share and share alike, to my children, MARY LOU FREUNDEL, LEWIS A. SHISTLE and KIMBERLEY WAGNER, or their respective issue, per stirpes. Should a child predecease me and die without issue, I give such child's share to my surviving children, or their respective issue, per stirpes. ITEM III. If any income or principal shall be payable to any person who shall be under the age of twenty-one (21) or who shall be incapacitated for any reason, my personal representative. as trustee, shall hold such income and principal for such beneficiary until the age of twenty-one (21) or during incapacity and shall be entitled to apply such income and principal to the health, maintenance, support and education of such person without the appointment of any guardian or committee or any authority of court, and shall be entitled to make direct application hereunder or to make application by payment thereof to the parent or other person in charge of such person, or to his or her guardian Lewis L. Shistle -/ or to a custodian under the Uniform Transfers to Minors Act. Any remaining income and principal to which such person shall be entitled shall be paid and distributed to such person upon attaining the age of twenty-one (21) or upon the termination of incapacity. ITEM IV. I appoint my children, MARY LOU FREUNDEL, LEWIS A. SHISTLE and KIMBERLEY WAGNER, Co-Executors of this my Last Will and Testament. No bond shall be required by my personal representatives in any jurisdiction. ITEM V. In addition to the powers given by law to my personal representative(s) and trustee(s) [hereinafter fiduciaries] in the administration of my estate and of any trust(s) created herein, they shall have the following discretionary powers applicable to all real and personal property held by them, including property held for minors, effective without court order until actual distribution. A. To retain any property owned by me at my death and to invest any funds held by them in any stocks, bonds, notes or other securities or property, real or personal, including common trust funds, mutual funds and money market deposit accounts operated or offered by my corporate trustee, if any, or any affiliate of it. B. To sell or otherwise dispose of any properly, real or personal, at any time forming apart of my estate or the trust estate, for cash or upon credit, in such manner and on such terms as they see fit, and no one dealing with the fiduciaries shall be bound to see to the application of any monies paid. C. To manage, operate, repair, improve, mortgage or lease for any term [even if beyond the duration of the trust(s)] any real estate at any time held or owned by them as fiduciaries. D. To hold investments in the name of a nomineeand exercise and dispose of warrants. ~ ~ ~+ Q Lewis L. Shistle 2 E. To engage in litigation and compromise, arbitrate or abandon claims and property. F. To conduct any business in which I am engaged or in which I have an interest at the time of my death for such period as the fiduciaries deem advisable, with the power to borrow money and to pledge the assets of the business and to do all other acts which I, in my lifetime, could have done, or to delegate such powers to a partner, manager or employee without liability for any loss occurring therein. G. To allocate items of receipt or disbursement between principal and income as the fiduciaries deem equitable regardless of the character given such items by law; to distribute in cash or kind or partly in each at valuations fixed by the fiduciaries. H. To borrow money, including the right to borrow from any corporate trustee, if any, and to mortgage or pledge as security or to hold its own stock if a corporate trustee. I. To join in any merger, reorganization, voting trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto. J. Should the principal of any trust herein provided for be or become too small in trustee's opinion. so as to make establishment or continuance of the trust inadvisable, my trustee(s) may make immediate distribution of the then remaining principal and any accumulated or undistributed income outright to the person or persons and in the proportion they are then entitled to income. Upon such ternlination, the rights of all beneficiary(ies) who might otherwise have an interest as succeeding income beneficiary(ies) or in remainder shall cease. ~, ~.. ~r~~ Lewis L. Shistle K. In general, to exercise all powers in the management of the assets of my estate or the trust estate which any individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as the fiduciaries may deem best, and to execute and deliver all instruments and to do all acts which the fiduciaries may deem necessary or proper to carry out the purposes of this will or any trust(s) created herein. L. To apply income or principal to which any beneficiary is entitled, directly for his or her comfort, maintenance and support, should the fiduciaries deem such beneficiary incapable of receiving the same by reason of age, illness, infirnuty or incapacity, or to pay the same to such person or persons as the fiduciaries select to disburse it, whose receipt shall be a complete acquittance therefore without the intervention of any guardian. M. To assume continuance of the status of any beneficiary with reference to death, marriage, divorce, illness, incapacity or other change in the absence of information deemed reliable without liability for disbursements made on such assumptions. N. All principal and income shall, until actual distribution to any beneficiary, be free of the debts, contracts, alienations and anticipations of any beneficiary, and the same may not be liable for any levy, attachment, execution or sequestration while in the hands of any beneficiary, and the same may not be liable for any levy, attachment, execution or sequestration while in the hands of any fiduciaries. ~~ IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of ~ , 1998. Lewis L. Shistle 4 The preceding instrument, consisting of this and four other typewritten pages, identified by the signature of the testator, as on the day and date thereof signed, published and declared by Lewis L. Shistle, the testator therein named, as and for his last Will, in the presence of us, who, at his request, in his presence and in the. pfesenge, o eac other, subscribed our names as witnesses hereto. -%~ / _~` _ - - - ~ ~ ~ ~ ~/ 5 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA . SS. COUNTY OF DAUPHIN I, LEWIS L. SHISTLE, testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will, that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. Lewis L. Shistle Sworn or , ffirmed to and acknowledged before me, by Lewis L. Shistle, testator, this ~~ U ~~ day of ri 1 _ , 1998. No Public My Commission Expires: AFFIDAVIT NOTARIAL SEAL LINDA L. GUSTIN, Notary Public Harrisburg, Dauphin County COMMONWEALTH OF PENNSYLVANIA : My Commission Expires May 24,1999 . SS. COUNTY OF DAUPHIN We,~t~~C. hCLtd ~.•~ ~C~:; C? •nCf ~"ti1~~.~. 1C,~C~ _ ~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testator sign and execute the instrument as his last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testator signed the Will as witnesses; and that to the best of our knowle ge the testator was at that time 18 or more years of age, of sound mind and under no con ~ run e influen e~- Sworn to and subscribed before me this 3 U~ day of n , 1998. Not Public M Commission Ex i es: NOTARIAL SEAL Y P LINDA L. GUSTIN, Notary Publfo Harrisburg, Dauphin County My Commission Expires May 24,1999 REV-1502 EX+ (11-08) ~..U pennsylvania SCHEDULE A ~..~= DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Lewis L Shistle 2012-00290 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' 58 Oliver Road, Enola, East Pennsboro Township, Cumberland County, Pennsylvania 17057 70,000.00 Parcel number 09-13-1002-012 TOTAL (Also enter on Line 1, Recapitulation.) $ 70,000.00 If more space is needed, insert additional sheets of the same size. 3!29!2012 10:20:58 AM A• SOtt~@fTtetltcitatl3ftlent U.S. Department of Housing OMB Approval No. 2502-0265 and Urban Development B. Type of Loan 1.^ FHA 2.^ FmHA 3.®Conv. Unins. 4.^V'A 5.^Conv. Ins. ^ Other 6. File Number: 20120230 7. Loan Number: 8. Mortgage Insurance Case Number: C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(POC)" were paid outside Me closing; they are shown here for informational purposes and are not included In the totals. D. Name & Address White Hill Housing, LLC, 2602 Market Street, Camp Hill, PA 17011 of Borrower: E. Name 8: Address Estate of Lewis L. Shistle, 58 Oliver Road, Enola, PA 17025 of Seller: F. Name & Address Integrity Bank, 3345 Market Street, Camp Hill, PA 17011 of Lender: G. Property Locatio Property Address 58 Oliver Rd. Enola, Pennsylvania 17025 PIN 09-13-1002-012 H. Settlement Agent: Great Road Settlement Services, LLC, 6 S. 17th Street, Camp Hill, PA 17011, (717)731-1040 Place of Settlement: 6 S. 17th Street, Camp Hill, PA 17011 1. Settlement Date: 3!29/2012 Proration Date; 3/29!2012 Disbursement Date: 3/29/2012 J, Stiguaary of 6orrourer's,TransactfoR K Summary_otSetlar's Frahsactlon 100. -GrossArgouetQuefram6orrower - 400. ~-Groe&AmcunfDUatoSejter 101. Contrail sales price $70,000.00 401. Contract sales price $70,000.00 102. Personal property 402- Personal property 103. Settlement charges to borrower (line 1400) $3,215.75 403. 104. qOq. 105. 405. Ad stments for items paid by salter Fn advance Adjuatments for (terns p4id by eeper In advance' 106. City/town taxes 406. Cityltown taxes 107. County taxes 3/2912012 to 1 2131120 7 2 $247.59 407. County taxes 3/29/2012 to 1 213 112 0 1 2 $247.59 108. Assessments 408. Assessments 109. School Tax 3129/2012 to 6l30I2012 $285.46 409. School Tax 3!29/2012 to 6/30!2012 $285.46 110. 1st Qtr Sewer 312912012 to 3/3112012 $3.02 410. 1st Oir Sewer 3!29!2012 l0 3/3112012 $3.02 111. 411. 112. 412. 120. Grose Amount Due Trom Borrower $73,751.82 420. Gross Amount Due to Seller ;70,536.07 300. Amounts Pald by or In Bati'alf of Borrower- - ~ 500. Rednctlorra'in Arno nEDueto Seger. 201. Deposit or earnest money $1,000.00 501. Excess deposit (see instructions) 202. Principal amount of new loan(s) $81,000 $63,000.00 502. Settlement charges to seller (line 1400) $5,569.64 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to 204. Closing Costs (90%) from Integrity Bank 52,894.17 504. Payoff of first mortgage loan 205. 505. Payoff of second mortgage loan 206. 506. 207. 507. 208. 508. 209. 509. AdjUSttneilts focltems anpald ny seller AdJustmants fo/hemsun pa)d by seller 210. City/town taxes 510. Cityltown taxes 211. County taxes 511. County taxes 212. Assessments 512. Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total Pald bylfor Borrower $66,894.17 520. Total Reduction Amount Due Seller $5,569,64 30A Cash at Se . ~rttent froa((tp-Borrower "' 600. Ca`s °at$ettlament tolfiom Ssirer"` 301. Gross amount due from borrower (line 120) $73,751.82 601. Gross amount due to seller (line 420) $70,536.07 302. Less amounts paid bylfor borrower (line 220) ($66,894.17) 602. Less reductions in amount due seller (line 520) ($5 569.64 303. Cash ®From OTo Borrower $6,857.65 603. Cash ®TOOFrom Seller =64,966.43 7' PROPERTY SOLD -SETTLEMENT SHEET 3/29/2012 10:20:58 AM File Number: 20120230 L Settlement Charges 700. Total Sales/Broker's Commission based on price $70,000.00 = $4,400.00 Paid From Paid From Division of commission (line 700) as follows: Borrower's Sellers 701. $2,100.00 + $200.00 to C8 Homestead Group Funds at Funds at 702. $2,100.00 to Straub & Associates Real Estate Group, Inc. Settlement Settlement 703. Commission paid at settlement $4,40(1.00 $4,400.00 704. 705. Broker Fee to Straub & Associates Real Estate Group, Inc. $295.00 800. tteme Payable In ConpocUon whp Loan fiD1. Loan origination fee to Integrity Bank $110.00 602. Loan discount 603. Appraisal Tee 604. Credit report 605. Lender's inspection fee 806. Mortgage insurance application fee 807. Assumption fee 808. Doc Prep to Integrity Bank $350.00 809. Flood Cert to Integrity Bank $15.00 810. 811. 812. 813. 900. Items Ragttlfetl by lender to Be Paid in Advdnce - 901. Interest from 902 Mortgage insurance premium for 903. Hazard insurance premium for 904. 905. tOp0: Reserves Deposited with Lender- 1001. Hazard insurance 1002. Mortgage insurance 1003. City property taxes 1004. County property taxes 1005. Annual assessments 1006. 10[17, tooe. 10[19. ft00. Title Charges 1101. Settlement or closing fee 1102. Abstract or title search 1103. Title examination 1104. Title insurance binder 1105. Document preparation 11(76. Notary fees to Cash $25.00 $10.00 11 [I7. Attorney s tees to Includes above item numbers: 1108. Title Insurance to Greet Road Settlement Services, LLC $694.75 Includes above Item numbers: 11[19. Lenders coverage $81,000.00 $894.75 1110. Owners coverage $70,000.00 11'11. Estate Attorney Fees POCS to Miller Lipsitt 17'12. Closing Protection Letter to Stewart Title Guaranty Company $75.D0 1113. 1200. Government Recording end TranSfer:Charges 1201. Recording fees: Deed $53.50; Mortgage $89.50 $143.00 1202. City/county taxlstamps: Deed $700.00 $700.00 1263. State taxlstamps: Deed $700.00 $700.00 1204. UPI Certification to Recorder of Deeds $20.00 1205. Erecording to Recorder of Deeds $50.00 1206. 1300. Addltlonal Settlement Chargea 1301. Survey 1302. Pest inspection 1303. 2012 County/TownshipTaxes to Debbie Lupold, Tax Collector $327.14 13114. 2011-12 School Tax on 11!30/2012 to Debbie Lupold, Tax Collector POCB $1,260.99 1305. Wood Infestation Treatment to Archer Pesl control $132.50 1306. White Hall Housing LLC filing and documents to Miller Lipsitt $200.00 1307. White Hill Housing -LLC filing and documents to Miller Lipsitt $200.00 7308. 2nd Qtr Sewer to East Pennsboro Township Municipal Authority $138.00 1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) $3,215.75 $5,569.64 Items marked POC were paid outside the closing by: Borrower (POCK), Lender (POCL), Mortgage Broker (POCM), Other (POGO), Real Estate Agent (POCR), or Seller ). srz~rotz fo:2o:~a AU r~~e luumber; ~nf~oro CERTIfICAT10N: I nave are(UIP/ reviewed me HUO-1 Setflemant Si»tement and to me t)e5t o` my gcaHlPtlq? and belief t' » 7iie iio)In -_,.,ent o` I, _. --'- -- . mstxrtsements made on my account or try me in this t!ansacttor.. I further certify tha± I have received a wpy of HUD-7 Se[ement S:atament. The Settlement Apent tloas not w»rr»nt nr represent the zo-unary M information oro-.~ded try zry party, incWding infwmatlon concom ing f'OC !lams ur~.C intarmfltion supplied by the lender in ;his .ran:u,~..,r~n 4p~ ^.°.•'^C o^ ,fLS t',ViJ-1 SPtiIE'fnEnt 5i8t9'11P-nf pP.(iPi~:nt~ to "(,~Om C2rsrn nt "-niv,? F~flh EStim ]'C (C~ Ft-1 a < =1.)j)~' ~";h _fn95` 3n,~ "t.0~ ^.'I't~• 3 _ ...]rt'r.^ h IA 1+.- _. the S4HIRm=nt AnPn` a° tc 9 V „a-ra. ra ~~'n ~.Kh mntter5 R(~n ~~~'~ 't7 j" C1 ~ ~ ~ !~ ~~~ ~ " ~ v'HfT!-Hll.! HftuBl'Jr I_ (' '-__. ~ =.C lX !?,-a~. lil) ~ ~._. ( v _~",~1. . )~V~:1J Trmotrty F. Str F - i~ TO the 6PSt of n-V knoUNednp r~ HI10-' gAUI»In»rt ~.7_meM if" Ch t h0'~~ DfC~ r _ ,:... ~~~ s '.ciira n'm~nt of hr ~ lr ~unl I c - , I=pr;rcn.i bti the rcderekzn., .t..:'.mRn'>`~~ sett'eroen c`th`s trenx^:fioa James A. MllleF, Esq. r rate - - WARMING I ~sa ~.rrr~+ I tti ,I=.. f „ram nr,~n~+.~~^r,r i .,. - ~ ~ ~ "' ' ` impds ment. For dwt»,Is saes Title t8- U.S. Code Section 1007 and Section 1010. ~ _ ...... ~ ~ ~ - ___ 4 , , ` - - "' " ~ t r ~ ~ _i REV-> 508 EX+ (ii->.o) '-~., . SCHEDULE E ~ pennsylvania ~` DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Lewis L Shistle 2012-0290 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-1510 EX+ (OS-09) pennsylvania SCHEDULE G ~~ DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Lewis L Shistles 2012-0290 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. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE TAXABLE VALUE i• Mary Lou Leonard, daughter, 9130111 17,743.00 100 17,743.00 2 Lewis A Shistle, son, 9/30/11 17,743.00 100 17,743.00 TOTAL (Also enter on Line 7, Recapitulation) $ 35,486.00 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 Lewis L Shistle 2012-0290 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I' Richardson Funeral Home 5,646.47 Services, facilities, automotive $3875.00; Merchandise, cards, books, folders $1215.00; newspaper $206.47; clergy $100.00; flowers $250.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: 5,312.80 z. Attorney Fees: Miller Lip~itt LLC 3. f=amily 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 a. Probate Fees: Cumberland County Register of wills 273.50 5. Accountant Fees; 50.00 6. "fax Return Preparer Fees: ~• Cumberland County Law Journal -advertising 75.00 s The Sentinel -advertising 189.54 9 Executor Administration fee -Mary Lou Leonard - 25 Pine Ridge Circle Enola PA 17025 5,312.80 1 o Executor Administration fee - Levis A Shistle - 429 Losh Road, PO BOX 22, Shermansdale PA 17090 5,312.80 11 Executor Administration fee - Kimberly A Wagner - 517 Park Avenue, New Cumberland PA 17070 5,312.80 TAT111 ini..,. ,...~,.. ,... 1 ;..,, n o,...~..~~~~i-,~~,..,~ ~ 27.485.71 State ZIP If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) .~; SCHEDULE I ~ , F pennsylvania ~~ DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHEfiITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT - ___ ESTATE OF FILE NUMBER Lewis L Shistle 2012-0290 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• Closing Costs pursuant to the sale of real estate (see attached HUD-1 settlement statement) 5,569.64 2 House Repairs -Allen Carmichael/Neat Wagner 8,700.00 3 Carrucoli & Associates -attorney, advanced by Mary Lou Leonard 25.00 4 UGI -gas advanced by Mary Lou Leonard 162.45 5 East Pennsboro Twp -sewer/sanitation advanced by Mary Lou Leonard 138.00 6 201'1-2012 School Real Estate Taxes advanced by Mary Lou Leonard 1,261.00 TOTAL (Also enter on Line 10, Recapitulation) $ 15,856.09 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (O1-LO) Pennsylvania SCHEDULE J DEPP,RTMENT OE REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Lester L Shistle 2012-00290 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. Mary Lou Leonard 25 Pine Ridge Circle Enola PA 17025 daughter 33.333% 2 Lewis L Shistle 429 Losh Road PO BOX 22 Shermansdale PA 17090 son 33.333% 3 Kimberly A Wagner 517 Park Avenue New Cumberland PA 17070 daughter 33.333% 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. (:HARITABLE 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. EXHIBIT "B" STATEMENT OF ACCOUNT ESTATE OF LEWIS L BRISTLE - 2012-0290 A Real Estate: 58 Oliver Road, Enola, PA 17025 $ 70,000.00 B Personal Property: $ 36,256.00 1 PNC Bank Account Number 51-4030-3006 $770.00 2 Morgan Stanley Smith Barney LLC #410035609021 $35,486.00 TOTAL ASSETS $ 106,256.00 DEBTSlDISBURSEMENTS: 1 PA Dept of Rev $ (2,831.00) 2 Register of Wills, Cumberland County -Probate Fees $ (273.50) 3 Legal Advertising -Cumberland Law Journal $ (75.00) 4 Legal Advertising -The Sentinel $ (189.54) 5 Co-Executor Fees -Marylou Leonard, Lewis A Shistle, Kimberly A Wagner $ (15,938.40) 6 Attorney Fees, Estate -Miller Lipsitt LLC $ (5,312.80) 7 Closing costs for sale of home, IA above $ (5,569.64) 9 Legal Services - Carrucoli and Associates (Marylou Leonard) $ (25.00) 10 2011-2012 school real estate taxes (Marylou Leonard) $ (1,261.00) 11 Accountant Fee - (Marylou Leonard) $ (50.00) 12 UGI - (Marylou Leonard) $ (162.45) 13 East Pennsboro Twp public utilities - (Marylou Leonard) $ (138.00) TOTAL DEBTSIDISBURSEMENTS $ (31,826.33) III DISTRIBUTION: A Centric Bank Estate Account Number 1522465 Balance: $ 64,966.43 B Payments: 1 PA Dept of Rev $ (2,831.00) 2 Legal Advertising $ (264.54) 3 Marylou Leonard reimbursement - II 9, 10, 11, 12, 13 above $ (1,909.95) 4 Co-Executor Fees -Marylou Leonard, Lewis A Shistle, Kimberly A Wagner $ (15,938.40) 5 Attorney Fees -Miller Lipsitt LLC (5% of gross assets) $ (5,312.80) TOTAL PAYMENTS: $ (26,256.69) D Net Proceeds to Beneficiaries: $ 64,966.43 $ (26,256.69) $ 38,709.74 $ 38,709.74 1 Marylou Leonard $ 12,903.25 2 Lewis A Shistle $ 12,903.25 3 Kimberly L Wagner $ 12,903.25 Total Beneficiary Distribution $ 38,709.74 Account Balance $ - Receipts/Disbursements - Pa No 21-12-0290 3/29/2012 10:20:58 AM A• $@tt~@ffl@Ilt $tat@fi'1@nt U.S. Department of Housing OMB Approval No. 2502-0265 and Urban Development B. Type of Loan 1.^ FHA 2.^ FmHA 3.®Conv. Unins. 4. [] VA 5.^Conv. Ins. ^ Other 6. File Number: 20120230 7. Loan Number: B. Mortgage Insurance Case Number: C. Note: This form is furnished to glue you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(POC)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. Name & Address White Hill Housing, LLC, 2602 of Borrower: Market Street, Camp Hill, PA 17011 E. Name & Address Estate of Lewis L. Shlstle, 58 Oliver Road, Enola, PA 77025 of Seller: F. Name & Address Integrity Bank, 3345 Market Street, Camp Hill, PA 17011 of Lender: G. Property Location: Property Address 58 Oliver Rd. Enola, Pennsylvania 17025 PIN 09-13-1002-012 H. Settlement Agent: Grea[ Road Settlement Services, LLC, 6 S. 17th Streef, Camp Hill, PA 17071, (717)731-1040 Place of Settlement: 6 S. 17th Street, Camp Hill, PA 17011 I. Settlement Date: 3129/2012 Proration Date: 3/29/2012 Disbursement Date: 3!29/2012 J.'Suminary of'Cibrrpwer's TrahsactTon - K; Swtltrlary o} SeMar'~ Transactbn 100: GrossAmountpuefroin6orrowar~`. '. 400..GrOesAawuri4DuetoS~fter 101. Contract sales price $70,000.00 401. Contract sales price $70,000.00 102. Personal property 402. Personal property 103. Settlement charges to borrower (line 7400) $3,215.75 403. 104. 404. 105. 405. Ad]uetments forft9mg paid by seller In advance !td stmebts for items p+Id b aoHer In ad4anca 106. Cityltown taxes 406. Cityttown taxes 107. County taxes 3!29/2012 to 12/37!2012 $247.59 407. County taxes 3/29/2012 to 12/31/2012 $247.59 108. Assessments 408. Assessments 109. School Tax 3!29/2012 to 6/3012012 $265.46 409. School Tax 3!29!2012 to 6/30/2012 $285.46 110, 1st Qtr Sewer 3/2912012 to 3!3112012 $3.02 410. 1st Qtr Sewer 3!29/201210 3!31!2072 $3.02 111. 411. 112. 412. 120. Gross Amount Due from Borrower 573,751.82 420. Gross Amount Dua to Seller 570,536.07 Z 0, dmaunfs Paid by or fn Behalf 6f Boirovver 500. ReductlonB Hr Amount Dua to Seller 201. Deposit or earnest money $1,000.00 501. Excess deposit (see instructions) 202. Pdncipal amount of new loan(s) $81,000 $63,000.00 502. Settlement charges to seller (line 1400) $5,569.64 209. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to 204. Closing Costs (90 %) from Integrity Bank $2,894.17 504. Payoff of irsl mortgage loan 20:1. 505. Payoff of sewnd mortgage loan 206. 506. 207. 507. 20ft. 506. 2041. 509. ,.-, 111f1justlTrerttstor Items unpaid byseller -~ A ustmerits for.ftamsunpaid by sstler -. . 21(1. Ciryttown taxes 510. Cityltown taxes 21'd. County taxes 511. County taxes 272. Assessments 512. Assessments 21:i. 513. 214. 5'14. 215. 515. 218. 516. 217. 517. 218. 518. 219. 519. 220. Total Pald by/for Borrower 566,894.17 520- Total Reduction Amount Dua Seller 55,569.64 0: Lash at S9tttafr7e11tfMrnjt6 Bonower 6b0. Cash atS ` ,' ` `t f01~fe}15 Se]ler-. ~ - 301. Gross amount due from borrower (line 720) $73,751.82 601. Gross amount due to seller (line 420) 570,536.07 302.. Less amounts paid by/for borrower (line 220) ($88,894.17) 602. Less reductions in amount due seller (line 520) ($5,569.64) 303. Cash ®From ^To Borrower $6,857.65 603. Cash ®7oOFrom Seller 564,966.43 3129/2012 10:20:58 AM File Number: 20120230 L, Settlement Charges 700. Total SaleslBrokers Commission based on price $70,000.00 = $4,400.00 Paid From Paid From Division of commission (line 700) as follows: Borrower's Sellers 701. $2,100.00 + 5200.00 to CB Homestead Group Funds at Funds ai 702. $2,100.00 to Straub & Associates Real Estate Group, Inc. Settlement Settlement 703. Commission paid at settlement 54,400.00 $4,400.00 704. 705. Broker Fee to Straub & Associates Real Estate Group, Inc. $295.00 800. Items A9yable Iri Conrre6UOn wtlh loan 801. Loan origination fee to Integrity Bank $110.00 802. Loan discount 803. Appraisal fee 804. Credit report BOS. Lender's inspection fee 806. Mortgage insurance application fee 807. Assumption fee 808. Doc Prep to Integrity Bank $350.00 809. Flood Cert to Integrity Bank $15.00 810. 811. 812. 813. 800... Itemms'Ragnpedby t-ender to 0e Paid In Advance 901. Interest from 902'.. Mortgage Insurance premium for 903. Hazard insurance premium for 904. 905. 1000.ReaervesbeposBedwlthLender 1001, Hazard insurance 1002. Mortgage insurance 1003. City property faxes 1064. County property taxes 1065. Annual assessments 1006. 10L4. 1068. 1009. 1100. 'title Cher es 1101. Settlement or closing fee / 1G2. Abstract or title search 7103. Title examination 1104. Title insurance binder 1105. Document preparation 1108. Notary fees to Cash $25.00 $10.00 1 tG7. Attornaysfees to Includes above item numbers: 11C8. Title Insurance to Greet Road Settlement Services, LLC $ggq,75 Includes above item numbers: 1109. Lenders coverage $81,000.00 $894.75 1110. Owners coverage $70,000.00 1111. Estate Attorney Fees POCS to Miller Lipsitt 7112. Closing Protection Letter to Stewart Title Guaranty Company $75.00 1113. 12(10.GovernmenERacardingarrdTransfe~IIherges 12(11. Recording fees: Deed $53.50; Mortgage $89.50 $143.00 1202. City/county tax/slamps: Deed $700.00 $700.00 1203. State laxlstamps: Deed $700.00 $700.00 1204. UPI Certification to Recorder of Deeds $20.00 1205. Erecording to Recorder of Deeds 550.00 1206. 7300; A,idltlonaTSettlemeMCfidrpes 1301. Survey 1302. Pest inspection 1303. 2012 CountylTownshipTexes to Debbie Lupold, Tax Collector $327.14 1304. 2011-12 School Tax on 11!3012012 to Debbie Lupold, Tax Collector POCB $1,260.99 1305. Wood Infestation Treatment to Archer Pest control $132.50 1306. Whit® Hall Housing LLC filing and documents to Miller Lipsitt $200.00 7307. While Hill Housing -LLC filing and documents to Miller Lipsitt $200.00 7308. 2nd Qtr Sewer to East Pennsboro Township Municipal Authority $1311.00 1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) $3,215.75 ;5,569.64 Items marked POC were paid outside the closing by Borrower (POCB), Lender (POCL), Mortgage Broker (POCM), Other (POGO), Real Estate Agent (POCK), or Seller (FOGS). 3129!2012 10:20:58 AM File Number: 2012023D CERTIFICATION: I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge end belief, it is a true and accurate statement of all receipts and dist~ursements made on my account or by me in this transaction. I further certify that I have received a copy of HU0.1 Sat0ament Statement. The Settlement Agent does not warrantor represent the accuracy of information provided by any party, including information concerning POC items and information supplied by the !antler in this transaction appearing on this HUD-1 Settlement Statement pertaining to'Comparison of Good Faith Estimate (GFE) end HUD-1 Charges' and °Loan Terms", and the parties hold harmless the Settlement Agent as to any inaccuracies in such matters. WHITE HILL~I,~C-~~? _____,_ ~~A\W?\\/~T~l~~~ ~!`~ ~(=~~~~~ ~ n//~ -1~, Estate of Lewis L. ShisUe ---~f~r Timothy F. Straub ~J To the best of my knowledg the HUD-1 Settlement Statement which 1 have prepared is a true antl accurate account of the funtls which were received and have been or will be disbursed by the under3ig~~aT.oUjpe dement of this transaction. ,~,~.wt,y, a p ye ~ Z Dale 31y make false statements to the United States on this or any other similar form. Penalties upon convibtion can include a gne and 18: U.S. Code Section 1001 and Section 1010.