HomeMy WebLinkAbout07-30-121505610140
1500 EX (01-10)
REV- OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes .INHERITANCE TAX RETURN
2 3
PO BOX 280601 2 1 1 1 0 8
Harrisbur , PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date Of Birth MMDDYYYY
2 0 8 2 4 4 6 8 4 0 7 1 9 2 0 1 1 0 9 2 5 1 9 3 3
Decedent's Last Name Suffix Decedent's Fi rst Name MI
R A K O C Y J O H N J
(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
1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 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
J A M E S H TURNER E S Q U I R E 7 1 7 2 3 2 4 5 5 1
First line of address
4 7 0 1 N O R T H
Second line of address
City or Post Office
H A R R I S B U R G
F R O N T S T R E E T
State ZIP Code
P A 1 7 1 1 0
REGISTER OF WILLS USE ONLY
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Correspondent's a-mail address: jht@tUrnerandOCOnnell Corn _
Under penalties o -perjury, I declare that I have e fined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, corre a complete. Declaration of arer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU PERS ES~SI R ING RETURN ~'"'~ DAT /h/
3VGRANT STREET °~ ENOLA PA 17025
SIGNATUF3)=.-AFPjt,EA I~ER O~e~ °y REPRESENTATIVE ~ pATE\/~
ADDRFi~'S '
4701 NORTH FRONT STREET HARRISBURG PA 17110
PLEASE USE ORIGINAL FORM ONLY
1505610140
Side 1
1505610140
1505610240
REV-1500 EX Decedent's Social Security Number
2 0 8 2 4 4 6 8 4
Decedents Name: JOHN J. RAKOCY
RECAPITULATION
1 6 2 9 3.1 6
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. •
2 5 0 0. 0 0
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6.
7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property
. (Schedule G) ^ Separate Billing Requested .... ... 7.
1 8 7 9 3 1 6
8. Total Gross Assets (total Lines 1 through 7) ........................ ... g.
9.
... .
Funeral Expenses and Administrative Costs (Schedule H 9. 1 7 3 3 4. 4 5
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........ ..... 10. 9 6 1 7 . 4 1
11. Total Deductions (total Lines 9 and 10) ......................... ...... 11. 2 6 9 5 1 8 6
12. Net Value of Estate (Line 8 minus Line 11) 12. - 8 1 5 8 . 7 0
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. - 8 1 5 8. 7 0
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.0 _ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 _ 16.
17. Amount of Line 14 taxable
17
at sibling rate X .12 .
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE .............................. .....19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505610240
Side 2
1505610240
J
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 11 os23
DECEDENT'S NAME
JOHN J. RAKOCY
STREET ADDRESS
539 MAGARO ROAD
CITY STATE ZIP
ENOLA PA 17025
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1)
2. Credits/Payments
A. Prior Payments
B. Discount Total Credits (A + B) (2)
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)
00.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0 0 0 0
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
^X
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; .......................... ..... X
c. retain a reversionary interest; or ^
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? .................................................................................
? ......
^
...
3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death ......
Did decedent own an individual retirement account, annuity or other non-probate property, which
4
. ^ 0
contains a beneficiary tlesignation? ............................................................................................ ......
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 SCHEDULE A
DEPARTMENT OF REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JOHN J. RAKOCY 21 11 0823
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 Net proceeds from sale of 539 Magaro Road, East Pennsboro Township, Cumberland 16,293.16
County, Pennsylvania
TOTAL (Also enter on Line 1, Recapitulation.) I $ 16,293.16
If more space is needed, use additional sheets of paper of the same size.
REV-1508 EX+ (11-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
JOHN J. RAKOCY 21 11 0823
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. 1993 Ford Tempo 600.00
2. 1997 Chevy Van 1,500.00
3. (Coins I 400.00
TOTAL (Also enter on Line 5, Recapitulation) I $ 2,500.00
If more space is needed, insert 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
JOHN J. RAKOCY 21 11 0823
Decedent's debts must be reported on Schedule t.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Richardson Funeral Home 3,650.00
B
2.
3.
4.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attorney Fees: Turner and O'Connell
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees: Register of Wills
5 Accountant Fees:
6. Tax Return PreparerFees:
ZIP
ZIP
7. David Rakocy-reimbursement of mortgage payments made to Metro Bank
8. Costs incurred to ready the real estate for sale
TOTAL (Also enter on Line 9, Recapitulation) I $
If more space is needed, use additional sheets of paper of the same size.
900.00
343.50
2, 763.95
9,677.00
17.334.45
REV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
JOHN J. RAKOCY 21 11 0823
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. OneMain Personal Loan 3,489.58
2. H.B. McClure Company 113.82
3. AT&T 59.67
4. Capital One/Kohl's Departament Store 2,168.07
5. HSBC Retail Services/Bon-Ton 104.82
6. PPL Electric Utilities 1,027.97
7. Comcast Cable 16.28
8. Bank of America 1,089.19
9. Citizens Bank 180.53
10. Verizon 210.51
11. Citi MasterCard 445.08
12. Capital One 711.89
TOTAL (Also enter on Line 10, Recapitulation) I $ 9,617.41
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania ~ SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER:
JOHN J. RAKOCY 21 11 0823
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. Thomas Rakocy Lineal 0.00
c/o David Rakocy
3 Grant Street, Enola, PA 17025
2. David Rakocy Lineal 0.00
3 Grant Street, Enola, PA 17025
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, 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. $
If more space is needed, use additional sheets of paper of the same size.
:~)~~~p~a A. Settlement Statement (HUD-1)
I(iaVi ;
OMB Approval No. 2502-0265
FINAL
1. ^X FHA 2. ^ RHS 3. ^Conv. Unins 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
12-0599GC 27004713 446-1286247-703
4. ^ VA 5. ^Conv. Ins.
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown. Items marked
"(p.o.c)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. Name & Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender:
Raymond M. DeRoy, Meghan D. DeRoy, Robert E. The Estate of John J. Rakocy, David A. Rakocy, GMH Mortgage Services, LLC
McCann, Janis A McCann Executor 10 Campus Blvd, Newtown Square, PA 19073
48 Glendwood Avenue, Dover, NH 03820 539 Magaro Road, Enola, PA 1702.5
G. Property Location: H. Settlement Agent. I. Settlement Date: 0612 9/2 01 2
539 Magaro Road Guardian Transfer Corporation Disbursement Date: 06(29/2012
Enola, PA 17025 4075 Markel St, Camp Hill, PA 17011
East Pennsboro Township
717-909-0700
Place of Settlement: TitleExpress
4775 Linglestown Road, Ha« isburg, PA 17112 Printed 06/29/2012 at 1:48 pm
by SLC
100: -Goss Amount Due from Borrower .:. 400. Gross AmounfDue to Seller
101. Contrail sales price 111;000.00 401. Contract sales price 111,000.00
102. Personal ro eR 402 Personal ro ert
193. Settlemen! charges to borrower (line 1400) 8,711.43 403.
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. Cilyftown faxes to
107. County lazes 06!29/2012 to 12131/2012 264,54 40?. County taxes 0612912012 fo 12131!2012 264.54
108. Schooi taxes 0 612 9/2 0 1 2 to 06/30/2012 9,09 408. School taxes 06!2912012 to 06130/2012 9.09
109. Sewer AIMIJ 06129!2012 to 06/30/2012 3.03 409. Sewer A/MIJ 0612912012 l0 06130/2012 3.03
110. 410.
111. 411.
112. 412.
120• Gross Amount Due from Borrower 119,988.09 420. Gross Amount Due to Seller 111,276.66
20D. ^ :Amounts Paid b"or irrBebalf of Borrower r, 500. Reductions In Amount Due o-Seller
201. Deposit or earnest money 3,OC0.00 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) 101,648.00 502. Setllemenl charges 1o seller (line 1400) 9,666.75
203. Existing loan s taken sub'ect to 503. Existin loans taken sub'ect to
204. 504. Payoff of first mortgage loan #33332582 to Metro
Bank 85,316.55
205. 505. Payoff of second mortgage loan
206. 506.
207. 5U7.
208. 508.
209. 509.
Ad'ustments for items unpaid b seller Ad'ustments for Items unpaid b seller
210. Cityltown taxes to 510. Cilyltown taxes to
211, County taxes l0 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 /for Borrower 104,648.00 520. Total Reduction Amount Due Seller 94,983.30
300. Cash at SettlementfromltoBorrower' 600. Cash at Settleinenttolfrorri'Seller
301. Gross amoun( due from borrower (line 120) 119,988.09 601, Grass amount due to seller (line 420) 111,276.66
302. Less amounts paid by/for borrower (line 220) 104,648.00 602. Less reductions in amount due seller (line 520) 94,983.30
303. Cash ^X From ^ To Borrower
........ _. ....... .~... .,.......,.,,,, ..,., .... ~m, o ~ m.~.~ .. ,,. 15,340.09
....~,.,.~. ,,. ~.~ .. ~e~ re~~r,.,,ee
ae 603. Cash ^X To ^ From Seller
,eee ,~e a a a. ~s aeeec~ may e c ec s m ama ae. an ree are no rene,re 16,293.36
o wmP a a
mis roan urxess it a~spiays eeer~enuy eaia orna cor,vni nemom. no wenoenramyis asswea, mra aimmsere is menoarery. rnu ~zeee,Aeeo ~o rro~me,re pane:,oaRee...w.a,e„e.,,~e~a~,,..~,~, ~~~~..,,.,,,~~..,.,.~.,.„,._
seUkmenl pnrcess.
Previous editions are obsolete Page 1 of 4 HUD-1
700. TotalReaLEstate,BrokerFees $'7;200.00 Paid From Paid From
Division ofcominission Ijne;UJ ascllows: Borrower's 'Seller's
701. $3 620.00 to Keller Williams of Central PA Funds aC Funds at
702. $3,580.00 to Coldwell Banker Select Professionals Sett1Enlent Settletnent
703. Commission paid at settlement 250.00 6,950.00
-800.; :Items Pa able'in,Connection.with Loan
801. Our origination charge (Includes Origination Point 0.000°/ or $0.00) $995.00 (From GFE #1)
802. Your credit or charge (points) for the specific interest rate chosen $ (from GFE #2}
803. Your adjusted origination charges (from GFE A) 995.D0
804. Appraisal fee to Br n Mawr A sisal (from GFE #3) 575.00
805. Credit report to Credit Plus (from GFE #3) 159.25
806. Tax service to from GFE #3
807, Flood certification to from GFE #3
808. to
800..Items Re uired;b Lender.. to be'Paid inrAdvance
901. Daily interest charges from from 0612 9/20 1 2 to 07101!2012 @ $10.7914/day (from GFE #10) 21.58
902. Mortgage insurance premium for months to HUD (from GFE #3) 1,748.25
903. Homeowner's insurance for 1 ears to Erie Insurance (from GFE #11) 676.D0
904. months to from GFE #11
1000:,Reserves De osited vvith:Lender
1001. Initial deposit for your escrow account (from GFE #9) 1,901.97
1002. Homeowner's insurance 3 months $ 56.341mon(h $169.02
1003. Mortgage insurance months $ 99.081month $
1004. Property taxes months $ O.OOlmonlh $
1005. County taxes 5 months $ 43.38Imonih $216.90
1006. School taxes 13 months $ 138.64(month $1,802.32
1007. Aggregate Adjustment $.286.27
11DO. Title,Char es
1101. Title services and lender's title insurance from GFE #4 ~ 1,093.88 25.00
1102. Settlement or closing fee to $
1103. Owner's title insurance -Title Resources Guaranty Company from GFE #5 40.50
1104. Lender's title insurance -Title Resources Guaranty Company $1,006.88
1105. Lender's title policy limit $101,648.00 Lender's Policy
1106. Owner's title policy limit $111,000.00 Owner's Policy
1107. Agent's portion of the total title insurance premium $849.02
to Guardian Transfer Cor ration
1108. Underwriter's portion of the total title insurance premium $198.36
to Title Resources Guarani Com an
1109.
1200.. Government Recordin and:Transfer Cliar es '
1201 Government recording charges $ (from GFE #7) 140.00
1202. Deed $62.00 Mort a e $78.00 Release $
1203. Transfer (axes $ (from GFE #B) 1,110.00
1204. CitylCounty tax/stamps Deed $1,110.D0 Mort a e $
1205. Stale Tax/stamps Deed $1,110.00 Mort a e $ 1,110.00
1206. Deed $ Mort a e $
1207. $
1300.'Addiftonal Settlement~Char es
1301. Required services That you can shop for (from GFE #6)
1302. Survey to $
1303. to
1304. 2012 Cc/Twp Taxes to Debbie Lu Id 572.60
1305. Sewer Cue to Eas[ Pennsboro Conswner Office 1,009.15
t r r ~ r 8,711.43 9,666.75
"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 Paye 2 of 4 HUD-1
Cbm arisonof Good Faith Estirnafe GFE and HUD-1 Char es Good Faith Estimate HUD-1
Char es ThaFCahnot Increase HUD~1 Line Number
Our origlria!lor charge >E P,'il ~ 995.00 995.00
Your crEd'~t ~~ cha~ne (mints}for,the'sped5c interest rate chael t, 5~~2 0.00 0.00
leur~jusledoriglnaCionchar~as~ ~ °03 995.00 995.00
Trans,`eclax~s rr 1[03.. 2,220.00 1,110.00
1 Char es That ih Total Cannot Ihcrease More Than 10% ' , ' Good Faith Estimate HUD•1
~Governmen! r~~rd;ngGherges # 1201 ' 150.60 I4G.00
r pprai=aldee ~ C i4 450.00 575.00
red'd~epod ,; ~ ';~; , ~ ~ 75.00 159.25
Uortgaecinscrarce prem im ;y r, i7 1,748.25 1,748.25
rS ---_., -- ---
,.,,
at
2,423.25 2,622.50
~ $ 199.25 or 8.2224%
ChSr esThaf Can Chan e Good Faith Estimate HUD-1
InlfialdepositGryourescroWaccount ~;~ '~01 1,926.00 1,901.97
-0ai y nterest~ rarges morn t ~+GT $10'9',day 161.87 21.58
Hprreo;arer's ~srranres f. P,3 360.00 676.00
`die services 3i d lender's ld e nsurance fc 1101 1,714.61 1,093.88
r},anersGllein;rranre-TdleResoursesGuarahtyCornpany t, 11.02 90.90 40.50
Loan Terms
Y~ui niUal,loan omo~nGis ~ $101,648.00
Y,ur loan'errn s 30. years
Yriunni'ialin'r s~ late Is 3,8750%
Ycu'Ini;lalaii~i ;hly ar7ouM o,vetl f~rprncipal i=merest grid am it ripa;~~ $577.07 includes
insurance Is', X^ Principal
^X Interest
X^ Morioage Insurance
Car your la,erest rate nse ~ ^X No. ^ Yes, it can rise to a maximum of %. The first change
will be on I I and can change again every years after ! ! .Every
change date, your interest rate can increase or decrease by % . Over the life of
s, the loan, your interest rate is guaranteed to never be lower than % or higher
than `,o,
Ever iFyo'u m rke pa/menL cn time,:car yo,u loran bald ice nse^ X^ No. ^ Yes, it can rise to a maximum of $
EJen i yoa,ma,~a payments on time,`;c ~~r yrui monl_h~y amnnrit o;,ed fcr , ^X No. ^ Yes, ihefirst Increase can be on I 1 and the monthly
prmc pal, merest and mortgage insurance tine?~~ ~ ; amount awed can rise to $
The maximum it can ever rise to is $
DIES your.^n F~~e a prepaymen: penalty? i ^X No, ^ Yes, your maximum prepayment penally is $
Dons yourlonn ha~~ a~ba Imri payments X^ No. ^ Yes, you have a balloon payment of $ due In
years on ! I
Total me,OCrily an o.~ur oviud inel~d,rio-escroN acCDunt pa~r7ienU ^ 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 $238.36
that results in a total initial monthly amount owed of $815.43. This includes principal, interest, any
s mortgage insurance and any items checked below:
Property taxes 0 Homeowner's insurance
^ Flood insurance 0 School taxes
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
r
Name of Borrower:
Raymond M DeRoy
Meghan D DeRoy
Robert E. McCann
Janis A. Mr,Cann Name of Seller:
The Estate of John J. Rakocy, David A. Rakocy,
Executor File Number:
12-0599GC
Prepared 0 6129 /2 01 2 at 1:48 pm
Note: This page displays an itemization of the charges shown on line 1101 of the HUD-1 Settlement Statement. This page
accompanies but is not a part of the HUD-1 Settlement Statement. If a discrepancy exists, the information on the HUD-1 Settlement
Statement applies.
1400. Title Charges TotaFChargc Borrower Seller
1101, Title services and lender's title insurance to
Wire In to Guardian Transfer Cor oration $ 12.00 12.00
Notary Fee- Purchasers to Guardian Transfer Cor oration $ 25.00 25.00
Courier Fee-Purchase to Guardian Transfer Co oration $ 15.00 15.00
Electronic Document Fee to Guardian Transfer Cor oration $ 35.00 35.00
Courier Fee- Sellers to Guardian Transfer Cor oration $ 15.00 15.00
Tax CErt Reimbursement Fee to Guardian Transfer Cor ration $ 10.00 t0.D0
1102. Settlement or closing fee to $ 0.00
1104. Lender's title insurance -Title Resources Gto Tile Resources Guarant Com ~$ 1,006.88 1,006.88
Totals: 5 1,118.88 0.00 1,093.88 25.00
SelledLender credits shown on:page 1 POC =Paid Outside Closing CR =. Lentler Credit
Previous editions are obsolete Page 1 of 1 HUD-1
HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HU0.1 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 HU0.1 Settlement Statement.
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Raymo De oy
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Robert E. McCann
~~~~i~~~
Meghan D.geRdy J J
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nis .McCann
EXECUTOR
The HU0.1 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.
ETTLEM T 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 1007 AND SECTION 1070.
Previous editions are obsolete Paye 4 of 4 HUD-1
Final Bill for the Estate of John Rakocy
Costs Incurred:
Drvwall:
Living Room/Above Fireplace Area (Boxed In)
8 Sheets Drywall ($14 per sheet) $112.00
12 Tubes Caulking ($6 per tube) $72.00
2 Buckets Mud ($12 each) $28.00
4 Gallons Primer ($120 gallon) $480.00
5 Gallons Finish Paint ($140 gallon) $700.00
1 Laborer (John) $150.00
Hardwood Floors:
Sanded, Stained, Polyurethane
Rental of Sander (3 days - $59 per day) $177.00
Sandpaper $72.00
Stain $56.00
Polyurethane $155.00
1 Laborer (Jay) $200.00
Bathrooms:
Two Toilets ($175 each) $350.00
Vinyl Floor (Main Bath) $430.00
Vinyl Floor (Second Bath) $285.00
Paint for Bathroom. Trim & Kitchen:
($26.00 X 12 Gallons) $312.00
Painting of Interior:
1 Laborer (Mark) $1 500.00
Paintin Outside
Wall (Required by Inspector for Buyer's FHA Loan)
Painted and Scraped chipped paint
Paint $108.00
Supplies $196.00
Electrical:
Replaced Faulty Wiring in Living Room & Panel Box
(up to code)
Electrican (Alan) $900.00
Flooding of Basement Cleanup:
September 2011 (Major Storms/Flooding)
y
Pump Failure due to Power Failure
30 hours x $28.00 (mold )
Temporary Repair to Basement Wall (also painting wall) $840.00
Miscellaneous:
New Kitchen Faucet $72.00
New Door Knobs (14 X $18 each) $252.00
Locksmith (Security Locks) $185.00
Removal/Loading of Contents of Home:
1 Laborer (Steve) $200.00
Storage Fees•
Amount Paid to date $345.00
Well:
Dug up and shocked
Required Backhoe and operator (Shane) $600.00
Paid Laborers:
Tom Smith $300.00
Tom Sawyer (Use of Trailer) $400.00
Jeff Wittle $200.00
Total Amount for Work Completed : $9,677.UU
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