HomeMy WebLinkAbout07-13-12 (3) 1505610140
1500 EX (01-10)
REV
- OFFICIAL USE ONLY
PA Department of Revenue
County Code Year
File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO Box 28D6D1 2 1 1 2 0 5 5 3
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Deat h MMDDYYYY Date of Birth MMDDYYYY
1 8 0 2 6 0 7 6 7 0 4 1 3 2 0 1 2 0 2 2 8 1 9 3 5
Decedent's Last Name Suffix Decedent's First Name MI
J O H N S O N J O Y C E G
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
a 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)
0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
R O G E R B I R W I N E S Q U I R E 7 1 7 2~ 9 2 ~~5 3
First line of address
I R W I N &
Second line of address
6 0 W E S T
City or Post Office
C A R L I S L E
M c K N I G H T P C
P O M F R E T
S T R E E T
State ZIP Code
P A 1 7 0 1 3
Correspondent's a-mail address:
REGISTER IA~LS US E DOILY ,~ '"7
m ` ; ~ % C,~
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DATE FILED
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.
SIGNATURE OF PERSON REj~PONSIBLE FOR FILING RETURN D TE
ADDRESS
399 PINEDALE ROAD CARLISLE PA 17015
SIGNAT~.U~R-E^~OF PREPARER'7OTHER jHAN REPRESENTATIVE DAVE
' y'~. tii ~'1 C ~ ~ j~13 `//L
'-----
60 WEST ~O,IhFRET STREET
1505610140
CARLIS
PLEASE USE ORIGINAL FORM ONLY
Side 1
PA 17013
1505610140 J ~`~,
~ ~ e;(,~
REV-1500 EX
Decedent's Name: JOYCE G - JOHNS O
RECAPITULATION
1505610240
1. Real Estate (Schedule A) ...... .
.................................... 1.
2. Stocks and Bonds (Schedule B) ............................
.......... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages and Notes Receivable (Schedule D) .......................... 4,
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5.
6. Jointly Owned Property (Schedule F
7. Inter-Vivos Transfers & Miscellaneous NaProbate Property Requested ....... 6.
(Schedule G) ~ Separate Billing Requested ....... 7.
Decedent's Social Security Number
1 8 0 2 6 0 7 6 7
1 5 6 0 0 0. D 0
3 7 9 3 8.0 0
1 9 1 2 3. 7 5
8 . Total Gross Assets (total Lines 1 through 7)
.........
..........
........ 8.
2 1 3 0 6
1. 7
5
9. Funeral Expenses and Administrative Costs (Schedule H)
.... .
~••••
•~•~•••• 9.
2 2 2 7
9. 7
6
10 . Debts of Decedent, Mortgage Liabilities, and Liens (Schedule 1)
..... ........ 10.
8 9
2. 1
2
11. Total Deductions (total Lines 9 and 10)
................... • ,
• 11.
2 3 1 7
1. 8
8
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 1 8 9 8 8 9. 8 7
an election to tax has not been made (Schedule J)
14. ............ .
.
Net Value Subject to Tax (Line 12 minus Line 13)
........ 13.
0. D
0
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 14 1 8 9 8 8 9. 8 7
15. Amount of Line 14 taxable
at the spousal tax rate
or
,
transfers under Sec. 9116
16. (a)(1.2) X .0 D . D
Amount of Line 14 taxable 0 15.
0 . D
D
at lineal rate X .0 D . D D
17.
Amount of Line 14 taxable 16
D . 0
0
at sibling rate X .12 D . 0 0
17
18. Amount of Line 14 taxable ~ D • D D
at collateral rate X .15 1 8 9 8 8 9. 8 7
18
2 8 4 8
3. 4
8
19. TAX DUE ........................................
.............. 19. 2 8 4 8 3. 4 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0
Side 2
L 1505610240
1505610240
REV-1500 EX~ Page 3
nor-prlpnt'c Cmm~lete Address:
File Number
21 12 0553
.......~ ._- -----r---- - ----
DECEDENT'S NAME
JOYCE G. JOHNSON _
STREET ADDRESS
3495 ENOLA ROAD
_. _ _ - -
CITY STATE ZIP
CARLISLE PA 17015
Tax Payments and Credits:
~ • Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments
B. Discount 1,424.17
3. Interest
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.
(1) 28,483.48
Total Credits (A + B) (2) 1,424.17
(3)
(4)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 27,059.31
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 : ................................................................. ..... ^
X
b. retain the right to designate who shall use the property transferred or its income; .......................... .....
^
c. retain a reversionary interest; or ........................................................................................... .....
^ 0
d, receive the promise for life of either payments, benefits or care? ................................................. ......
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
^
0
without receiving adequate consideration? .................................................................................
h?
d
" ......
^ 0
...
eat
orpayable-upon-death bank account or security at his or her
3. Did decedent own an "intrust for ......
Did decedent own an individual retirement account, annuity or other non-probate property, which
4
.
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(1.2) [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~+ (01-10)
. pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
JOYCE G. JOHNSON 21 12 0553
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
3495 ENOLA ROAD, CARLISLE, PENNSYLVANIA I 156,000.00
SOLD -SETTLEMENT SHEET ATTACHED
SCHEDULE A
REAL ESTATE
TOTAL (Also enter on Line 1, Recapitulation.) I $ 156,000.00
If more space is needed, use additional sheets of paper of the same size.
REV-1503 EX•+ (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOYCE G. JOHNSON 21 12 0553
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. SERIES I & EE SAVINGS BONDS -INVENTORY ATTACHED 37,938.00
TOTAL (Also enter on line 2, Recapitulation) ~ $ 37,938.
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (11-10)
. pennsylvania SCHEDULE E
• DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, 8~ MISC.
INHERITANCE TAX RETURN pERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JOYCE G. JOHNSON 21 12 0553
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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PERSONAL PROPERTY -APPRAISAL ATTACHED 5,327.00
2. M&T BANK -CHECKING ACCOUNT #49471058 3,586.50
3. ORRSTOWN BANK -MONEY MARKET ACCOUNT #143001125 7,092.70
4. ORRSTOWN BANK -STATEMENT SAVINGS ACCOUNT #706001093 1,817.71
5. CASH 1,299.84
TOTAL (Also enter on Line 5, Recapitulation) I $ 19,123.75
If more space is needed, insert additional sheets of paper of the same size
REV-1511 E,t+ (10-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
JOYCE G. JOHNSON 21 12 0553
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOFFMAN-ROTH FUNERAL HOME 4,176.06
B.
1
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
2 Attorney Fees: IRWIN & McKNIGHT, P.C.
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
ri~~M~~f
10,100.00
4.
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees: REGISTER OF WILLS
5 Accountant Fees:
6. Tax Return Preparer Fees:
7.
8.
9.
10.
11.
12.
13.
REGISTER OF WILLS -FILING FEE
REGISTER OF WILLS -SHORT CERTIFICATE
CUMBERLAND LAW JOURNAL -ESTATE NOTICE
THE SENTINEL -ESTATE NOTICE
ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY
S.W. BARRETT REAL ESTATE -APPRAISAL ON REAL ESTATE
CLOSING COSTS ON SALE OF REAL ESTATE
361.50
30.00
12.00
75.00
189.54
60.00
350.00
6,925.66
TOTAL (Also enter on Line 9, Recapitulation) I $ 22,279.76
State ZIP
ZIP
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
. pennsylvania
' DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8~ LIENS
ESTATE OF FILE NUMBER
JOYCE G. JOHNSON 21 12 0553
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. CARLISLE REGIONAL MEDICAL CENTER -MEDICAL 285.00
2. EXXONMOBILE -CREDIT CARD 44.85
3. ADAMS ELECTRIC COOPERATIVE -ELECTRIC 394.94
4. CENTRUYLINK -TELEPHONE 47.89
5. AT&T -TELEPHONE 17.32
6. WASTE MANAGEMENT -TRASH I 102.12
TOTAL (Also enter on Line 10, Recapitulation) I $ 882.12
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+101-10)
. pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF: FILE NUMBER:
JOYCE G. JOHNSON 21 12 0553
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfer; under
I Sec. 9116 (a) (1.2).]
1. GERALD GUSTAVE SCHWANKE Collateral 2,500.00
PO BOX 614
OJAI, CA 93024
2. ELIZABETH ANN SCHWANKE Collateral 2,500.00
135 TRENTON ROAD
FAIRLESS HILLS, PA 19030
3. JAMES THOMAS MARSHALL Collateral 2,500.00
1232 NORTH LASALLE APT 231
CHICAGO, IL 60610
4. IRIS MARIA GALIMBERTI LIBERATORE Collateral 2,500.00
436 PINE VALLEY
BRIDGEVILLE, PA 15017
5. BETTY LAY LEBO Collateral 1,000.00
45 KENWOOD AVENUE
CARLISLE, PA 17013
6. ROSIE BAER Collateral 1,000.00
416 FAIRVIEW AVENUE
WAYNESBORO, PA 17268
7. DONNA LEE HARPSTER Collateral 1,000.00
347 E. GARFIELD STREET
SHIPPENSBURG, PA 17257
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
.
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ 0.00
If more space is needed, use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
JOYCE G. JOHNSON 21 12 0553
Decedent's Name Page 1 File Number
Schedule J -Beneficiaries - 1
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF ESTATE
TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
I Sec. 9116 (a) (1.2).]
8. MARTHA RITTENHOUSE TREICHLER Collateral 1,000.00
7988 VAN AMBURG ROAD
HAMMONDSPORT NY 14840-9772
9. JOANNE SIEMON CASTEEL Collateral 1,000.00
185 WILDWOOD DRIVE
GREENSBURG, PA 15601-3919
10. ANDREW J. GUBICZA, JR. Collateral 1,000.00
3509 HAWTHORNE DRIVE
CAMP HILL, PA 17011-2721
11. MARK E. HEISHMAN Collateral 173,889.87
399 PINEDALE ROAD REMAINDER
CARLISLE, PA 17015
n
~.7 ,-, :_
LAST WILL AND TESTAMENT 1 _ , .~-- ~. ° ;:
~,_ _ _ _.
:. ~ ` ` <~,
I, JOYCE G. JOHNSON, of Lower Frankford Township, Cumberland C . ``~ `-~
city, -~,
Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make,
publish and declare this to be my Last Will and Testament, hereby revoking all Wills and
Codicils heretofore made by me.
1. I direct my Executor or Substitute Executor, as the case maybe, to pay all of my debts,
funeral and administrative expenses as soon as convenient after my decease. Furthermore, I
direct that all state, inheritance, succession and other death taxes imposed or payable by reason of
my death and interest and penalties thereon with respect to all property composing of my gross
estate for death tax purposes, whether or not such property passes under this Will, shall be paid
by the Executor or Substitute Executor of my estate.
2. My Executor or Substitute Executor may, at his discretion, compromise claims,
borrow money, retain properly for such length of time as he may deem proper; lease and sell
property for such prices, on such terms, at public or private sales, as he may deem proper; and
invest estate property and income without restriction to legal investments unless otherwise
provided hereunder.
3. I authorize and empower my Executor or Substitute Executor to sell any realty and/or
personalty owned by me at my death and not specifically devised or bequeathed herein, at public
or private sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee
simple, as I could do if living. My Executor or Substitute Executor is authorized and
empowered to engage in any business in which I may be engaged at my death, for such period of
time after my death as seems expedient to said Executor or Substitute Executor.
4. I give, devise and bequeath all of my estate of every nature and wherever situate as
follows:
a. The sum of $2,500.00 to each of the following four (4) persons:
GERALD GUSTAVE SCHWANKE, ELIZABETH ANN SCHWANKE,
JAMES THOMAS MARSHALL and IRIS MARIA GALIMBERTI
LIBERATORE, providing they are living at the time of my death. If any
of these persons are deceased at the time of my death, their gift shall lapse;
b. The sum of 1,000.00 to each of the following six (6) persons: BETTY
LAY LEBO, ROSIE BAER, DONNA LEE HARPSTER, MARTHA
RITTENHOUSE TREICHLER, JOANNE SIEMON CASTEEL, and
ANDREW (DREW) J. GUBICZA, JR., providing they are living at the
time of my death. If any of these persons are deceased at the time of my
death, their gift shall lapse; and
c. All the rest, residue and remainder to my neighbor, MARK E.
HEISHMAN, provided that he gives $20,000.00, within One Hundred
Twenty (120) days of my death, to each of the following four (4)
churches: FIRST CHURCH OF THE BRETHREN in Carlisle, PA;
HANOVER CHURCH OF THE BRETHREN in Hanover, PA;
MECHANICSBURG CHURCH OF THE BRETHREN in
Mechanicsburg, PA; and RIDGE CHURCH OF THE BRETHREN
in Shippensburg, PA.
2
6. I nominate and appoint MARK E. HEISHMAN to be the Executor of this my Last
Will and Testament. In the event he has predeceased me, failed to qualify or is not able or does
not serve for whatever reason, I then appoint STEVEN E. HEISHMAN to be the Substitute
Executor of this my Last Will and Testament, whereby the said Substitute Executor shall have
the same powers as are given to the original Executor hereunder.
7. No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty
(60) days.
8. No Executor or Substitute Executor acting hereunder shall be required to post bond or
enter security in this or any other jurisdiction.
9. No beneficiary may assign, anticipate or pledge his, her or its interest in any income or
principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or
otherwise reach any such interest.
10. I hereby suggest that my personal representative retain the services of Irwin &
McKnight, P.C. as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 9th day of January
2009.
~ (SEAL)
YC G. HNSON
3
Signed, sealed, published and declared by the above-named Testatrix as and for her Last
Will and Testament, in our presence, who, at her request, in her presence and in the presence of
each other have hereunto set our names as subscribing witnesses.
/' ' %l
iJ '
~~ \ /~/ /n
4
ACKNOWLEDGMENT AND AFFIDAVIT
WE, JOYCE G. JOHNSON, KAREN S. NOEL and SHARON L. SCHWALM, the
Testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and
executed the instrument as her Last Will and that she had signed willingly, and that she executed
it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in
the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of their
knowledge the Testatrix was, at that time, eighteen years of age or older, of sound mind and
under no constraint or undue influence.
OYCE OHNSON
~~ ,.
REN .NOEL
SHARON L. SCHWALM
COMMONWEALTH OF PENNSYLVANIA
. SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by JOYCE G. JOHNSON, the
Testatrix herein, and subscribed and sworn to before me by KAREN S. NOEL and SHARON
L. SCHWALM, witnesses, this 9`I' day of January 2009.
v .~..~j .
Public
Notarial Seal
Roger B. Irwin, Notary Public
Carlisle Boro, Cumberland County
ly Commissbn Expires pot. 3, 2012
5
OMB Approval No. 2502-0265
~;ii~~ii~~ ` A. Settlement Statement (HUD-1)
.- . ._
^Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
^ RHS 3
FHA 2
1
^
.
.
.
HEISHMANT6-12
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:
TIMOTHY R. HEISHMAN ESTATE OF JOYCE JOHNSON, MARK MEMBERS 1ST FCU
399 PINEDALE ROAD, CARLISLE, PA 17013 HEISHMAN 5000 LOUISE DRIVE, MECHANICSBURG,
3495 ENOLA ROAD, CARLISLE, PA 17015 PA 17055
G. Property Location: H. Settlement Agent: I. Settlement Date: 07/13/2012
3495 ENOLA ROAD I&M REAL ESTATE SERVICES, LLC Disbursement Date: 07/13/2012
Carlisle, PA 17015 West Pomfret Professional Bldg, 60 West Pomfret Street,
Lower Frankford Township Carlisle, PA 17013
Telephone:717-249-2353 Fax:717-249-6354
Place of Settlement: TitleExpress
West Pomfret Professional Bldg, 60 West Pomfret Street, Printed 07/12/2012 at 2:09 pm
Carlisle, PA 17013 by JMR
:. a
100. GrossAmount'DuefromBorroxler 400. `lirossAmountDue ii'Seiler
101. Contract sales price 156,000.00 401. Contract sales price 156,000.00
102. Personal ro ert 402. Personal ro ert
103. Settlement charges to borrower (line 1400) 3,202.15 403.
104. 404.
105. 405.
Ad'ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance
106. City/town taxes to 406. Cityltown taxes to
107. County taxes 07/13/2012 to 1213112012 185.55 407. County taxes 07/13/2012 to 12131/2012 185.55
108. School Taxes 0711312012 to 06/3012013 2,055.78 408. School Taxes 0 711 312 0 1 2 to 0613012013 2,055.76
109. 409.
110. 410.
111. 411.
112. 412.
120. Gross Amount Due from Borrower 161,443.48 420. Gross Amount Due to Seller 158,241.33
200. Amounts Paid b or in'Behalf of Borrower 500. Reductlonssln AmourttDue to'SeINv
201. Deposit or earnest money 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) 124,800.00 502. Settlement charges to seller (line 1400) 2,125.66
203. Existin loa s taken sub'ect to 503. Existin loa s taken sub'ect to
204. 504. Pa off of first mort a e loan
205. 505. Pa off of second mort a e loan
206. LENDER CREDIT 375.00 506.
207. GIFT OF EQUITY 31,200.00 507.
208. SELLER ASSIST 4,800.00 508. SELLER ASSIST 4,800.00
209 509.
Ad'ustments for items unpaid b seller Ad'ustments for items unpaid b seller
210. City/town taxes to 510. City/town taxes to
211. County taxes to 511. County taxes to
212. School Taxes to 512. School Taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217 517.
218. 518.
219 519.
220. Total Paid b Ifor Borrower 161,175.00 520. Total Reduction Amount Due Seller 6,925.66
300.
301. Cash at Settlementfromlto Borrower
Gross amount due from borrower (line 120)
161,443.48 600.
g01. Cash aYSettlemeMtoNrom Seller:.
Gross amount due to seller (line 420)
158,241.33
302. Less amounts paid by/for borrower (line 220) 161,175.00 602. Less reductions in amount due seller (line 520) 6,925.66
303. Cash ^X From ^ To Borrower
__ __ __ ___ _ .___ .-...~..........a ....~ a ~.i~i~oe ro 268.46
rrecmnse nr fn a ,np. rev,evnpp.
an 603. Cash ^X To ^ From Seller
,np e a a. 1s agency may no w e ,s ,n ortna ipn, an you are no raga,
repo 151,315.67
o comp e e
..._. __.._.._~-...... __.__..._. _.. 1a15,s pas pmv,ae,ne pa,,,o ,~e..~~r.. w.=.a.~a...,.
lais loan, unless II Eisplays a w,renpy valiE OMB coMml number No canppeMialpy is assuretl: ll,is 015 osure ,s man a ory
selllem¢M process.
Previous editions are obsolete Page 1 of 4 HUD-1
700: Total Real Estate Broker#ees Paid.From Paid`from
Division of commission Tine 700 as follows: Borrower's Seller's
701. $o.oo to Funds at Funds at
702. $o.oo to Settlement Settlement
703. Commission paid at settlement
800. Rems P ble in Connection with Loan
801. Our origination charge (Includes Origination Point 0.000°/. or $0.00) $830.00 (from GFE #1)
802. Your creditor charge (points) for the specific interest rate chosen $ (from GFE #2)
803. Your adjusted origination charges (from GFE A) 830.00
804. A sisal fee to from GFE #3
805. Credit re ort to from GFE #3
806. Tax service to from GFE #3
807. Flood certification to from GFE #3
808. to
900. Items R aired b Lender to be Pald in Advance
901. Daily interest charges from from 07113/2012 to 0 8 /0 112 01 2 @ $11.9671/day (from GFE #10) 227.38
902. Mort a e insurance remium months to from GFE #3
903. Homeowner's insurance for 1 ears to STATE FARM INSURANCE $509.00 P.O.C. B" (from GFE #11)
904. months to from GFE #11
1000. Reserves ited with Lender
1001. Initial deposit for your escrow account (from GFE #9) 527.02
1002. Homeowner's insurance 3 months $ 42.42/month $12726 to MEMBERS 1ST FCU
1003. Mort a e insurance months $ (month
1004. County Property taxes 6 months $ 33.57/month $201.42 to MEMBERS 1ST FCU
1005. months $ 0.00/month $ to MEMBERS 1ST FCU
1006. School Taxes 2 months $ 187.52/month $375.04 to MEMBERS 1ST FCU
1007. Aggregate Adjustment $-176.70 to MEMBERS 1ST FCU
1100. Td1e Cha es
1101. Title services and lender's title insurance from GFE #4 1,303.75
1102. Settlement or closing fee to $
t 103. Owner's title insurance from GFE #5 155.00
1104. Lender's title insurance $1,208.75
1105. Lender's title policy limit $124,800.00 Lender's Policy
1106. Owner's title policy limit $156,000.00 Owner's Policy
1107. Agent's portion of the total title insurance premium $1,095.44
1108. Underwriter's portion of the total title insurance premium $268.31
1109.
1200. Government Recordin and TransferCha es
1201. Government recording charges $ (from GFE #7) 159.00
1202_ Deed $63.00 Mort a e $96.00 Release $ to Recorder of Deeds
1203. Transfer taxes $ (from GFE #8)
1204. City/County tax/stamps Deed $ Mort a e $ to Recorder of Deeds
1205. State Tax/stamps Deed $ Mort a e $ to Recorder of Deeds
1206. Deed $ Mort a e $ to
1300. AddibonatSetflementCha es
1301. Required services that you can shop for (from GFE #6)
1302. to
1303. to
1304. 2012-13 SCHOOL TAXES to PAMELA BURKHOLDER, TAX C $ 2,125.66
1305. to
• r r , , r r 3,202.15 2,125.66
'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-1
Com rison:GfGoaf~F8itltl:sUmate G aniF"fifiD-1-Clio Good'Faitl~°Esdmafe HUD-1
Ch ' ee'ThetCannot'dncreaae HUD-1 LlneNumber
Ouroriginationcharge # 801 830.00 830.00
Yourcreditorcharge:(po(nts)forthespedficintetest[atechosen # 802 0.00 0.00
Youradjustedoriginationcharges #803 830.00 630.00
Transfer taxes - # 1203 1,560.00 0.00
,~;ovemmenrrecoramgcnarges # tzut
';#
Ch e~ThatCar-~Chan
ItidiatdepositYoryoftr<esc[ow:accamt -~ •11Nn
Daily,interestcharges:fnxrr #901•- 11:9674{d
Homeoyvne~sansptance -~ 903' ,,.
TiUeservioasand`lendets titleinsurmce # 71131
OwnelsUUeynsurance: # 1103 ,
2012-13 SCHOOLTAXES # 1304
Loan Terms
GoodFi~IthEatlmate HU~'1'
0.00 527.02
203.44 227.38
450.00 509.00
1,638.75 1,303.75
156.00 155.00
0.00 0.00
YourinitiaFloanambuntis $124,600.00
YourloanYerrti~is 30. years
Yourinitialurterestrate is 3.5000%
Yourinl6almonthly;amountowetl•forprincipal;titterest,3ntl'anymortgage $560.41 includes
insurance is ^X Principal
^X Interest
^ Mortgage Insurance
Can.youriritefestrate rises ^X No. ^ Yes, it can rise to a maximum of %. The f rst change
will be on I 1 and can change again every years after 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''rfyoii.makepaym~nts:on Ume,<~n;yourloah balance rise? X^ No. ^ Yes, it can rise to a maximum of $
Even ifyoumake-payments on tinx=, coo yourmoothly amoun: owed•for ^X No. ^ Yes, the first increase can be on I / and the monthly
pdncipaf~lnterest„and rnorigage insurance nse~ amount owed can rise to $
The maximum it can ever rise to is $
Does youraoan^have a prepayment penalty? . ^X No. ^ Yes, your maximum prepayment penalty is $
Does youcloarrhave aballoonpayment?• X^ No. ^ Yes, you have a balloon payment of $ due in
years on / !
Totatmonthlyanrountowed induding,esaowaccountpaymerts ^ You do not have a monthly escrow payment for items, such as property taxes
and homeowner's insurance. You must pay these items directly yourself.
^X You have an additional monthly escrow payment of $263.51
that results in a total initial monthly amount owed of $823.92. This includes principal, interest, any
mortgage insurance and any items checked below:
^X Property taxes ^X Homeowner's insurance
< ^ Flood insurance ^
^ ^
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender.
Previous editions are obsolete Page 3 of 4 HUD-1
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.
TIMOTHY R. HEISHMAN
ESTATE OF JOYCE JOHNSON MARK HEISHMAN
MARK HEISHMAN, EXECUTOR
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-1
..
Name of Borrower: Name of Seller: File Number:
Prepared 0 711 2 /2 01 2 at 2:09 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:
TIMOTHY R. HEISHMAN Name of Seller:
ESTATE OF JOYCE JOHNSON
MARK HEISHMAN File Number:
HEISHMANT6-12
Prepared 07/12/2012 at 2:09 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)
ORIGINATION FEE to MEMBERS 1ST FCU $ 830.00
802. Your credit or charge (points) for the specific interest rate chosen
to $ 0.00
803. Your adjusted origination charges 830.00 0.00
r
Name of Borrower:
TIMOTHY R. HEISHMAN
Name of Seller:
ESTATE OF JOYCE JOHNSON
MARK HEISHMAN
File Number:
HEISHMANT6-12
Prepared 07/12/2012 at 2:09 pm
Note: This page displays an itemization of the charges shown online 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
WIRE FEE to SOVEREIGN BANK, FSB $ 15.00 15.00
OVERNIGHT AND E MAIL to I&M REAL ESTATE SERVICES $ 50.00 50.00
NOTARY to $ 30.00 30.00
1102. Settlement or closing fee to $ 0.00
1104. Lender's title insurance to STGC/18MREAL ESTATE $ 1,208.75 1,208.75
Totals: $ 1,303.75 0.00 1,303.75 0.00
cane.n sae. ~.~a. ahmun ~~ raven 1 POC =Paid Outside Closing CR =Lender Credit
Previous editions are obsolete Page 1 of 1 HUD-1
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- Q MBTBank
499 Mitchell Road, Millsboro, DE 19966 Adjustment Services
Irwin & McKnight, P.C.
West Pomfret Professional Building
60 West Pomfret Street
Carlisle, PA 17013-3222
Re: Estate of Joyce G. Johnson
Social Security: 180-26-0767
Date of Death: April 13, 2012
Phone 888-502-4349
F ax (302) 934-2955
May 30, 2012
~A ~~,
~{tWIiV ~ ivlcKi~iUii
1_A~V OFFICE ;
Dear Sir or Madam:
Per your inquiry on May 15, 2011, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1. Type of Account Checking Account
Account Number 49471058
Ownership (Names oj~
Opening Date
Balance on Date of Death
Accrued Interest
Total
Joyce G. Johnson
Karen Marie Heishman(POA)
Edgar J. Johnson _Ot'C-~Cz~c~
0128/1968
$3, 586.50
$ .00
$3, 586.50
For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds,
please call the High Street Carlisle at 717-24011536.
We were unable to locate any safe deposit box for the above-mentioned decedent.
This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers,
Representative Payee, or Trustee under a Written Agreement.
Sincerely,
Valarie Mercer
Adjustment Services
V1tK~'1'UW N
BANK
A Tradition of Excellence
May 17, 2012
Law Offices of Irwin & McKnight, P.C.
Roger B_ Irwin
West Pomfret Professional Building
60 West Pomfret Street
Carlisle, PA 172013
Fax: 249-6354
Re: Estate of Joyce G. Johnson
Social Security Number 1 SO-26-0767
Date of Death 4/13/2012
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE
FOLLOWING ACCOUNTS WITH ORRSTOWN BANK:
CHECKING ACCOUNT
Account No.- 143001125
Account Type- Money Market
Date Opened- 12/11/2008
Joint Account (name/date)- No
Balance- $7,092.70
Accrued Interest- $0.03
Interest Earned 1/1/2012 -DOD- $1.46
2695 Philadelphia Avenue
Chambersburg, PA 17201
1.888.ORRSTOWN
SAVINGS ACCOUNT
Account No.-
Account Type-
Date Opened-
Joint Account (name/date)-
Balance-
Accrued Interest-
Interest Earned 1 / 1 /2012 - DOD-
706001093
Statement Savings
4/6/2000
Edgar J. Johnson, Primary (Date of Death 5/6/2006)
$1,817.71
$0.09
$0.69
Best Regards,
~'
Ji R. Worthington
Deposit Processing Clerk
219 North Hanover Street
Carlisle, Pennsylvania 17013
717.243.451 1
toll free 1.866.451.451 1
fax 717.243.3723
www.hoffmanroth.com
info@hoffmanroth.com
Mark Heishman
399 Pinedale Road
Carlisle, PA 17015
May 25, 2012
Statement of Funeral Expenses for: Joyce G. Johnson
Date of Death: April 13, 2012 Account Id: 16528-095
PACKAGE:
Immediate Cremation
OPTION 5 -Cremation $ 1,890.00
Sub Total: $ 1,890.00
MERCHANDISE:
Urn: Centurian (without Lip) Roman $ 180.00
Sub Total: $ 180.00
TOTAL FUNERAL HOME CHARGES: $ 2,070.00
CASH ADVANCES:
Rolling Green Cemetery $ 995.00
12 Certified Death Certificates at $ 6.00 each $ 72.00
Newspaper Notice -Sentinel $ 150.72
Newspaper Notice -Patriot $ 283.82
Clergy $ 75.00
Newspaper Notice -Greensburg & Connellsville $ 156.00
Newspaper Notice -Burk Cty Trib $ 25.00
Coroner's Fee $ 25.00
Newspaper Notice -Evening Sun, Hanover $ 93.00
Newspaper Notice -Public Opinion $ 162.40
Newspaper Notice -Record Herald $ 68.12
Sub Total: $ 2,106.06
Total Funeral Expense: $ 4,176.06
Please return this portion with your Remittance.
$ Amount Enclosed
Joyce G. Johnson
Service ID#: 16528-095
Balance: $ 4176.06
SERVING OUR COMMUNITY SINCE 1 9~7
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