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HomeMy WebLinkAbout08-09-12J 1505610140 REV-1500 ~` (°'-'°) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisbur PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 0 2 2 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 7 2 2 4 9 6 6 4 1 0 2 6 2 0 1 0 0 6 1 6 1 9 3 1 Decedent's Last Name Suffix Decedent's First Name R E A M MI M A R G A R E T D (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name R E A M MI N O R M A N Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW 0 1. Original Return ~ 2. Supplemental Return 3. Remainder Return (date of death 4. Limited Estate ~ prior to 12-13-82) 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) QX 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 T0: Name Daytime Telephone Number R O G E R M M O R G E N T H A L E S Q 7 1 7 2 3 4 2 4 0 1 First line of address 4 4 3 1 N F R O N T Second line of address 3 R D F L O O R City or Post Office H A R R I S B U R G REGISTER OF WILLS USE ONLY ~a .. ~' '~',"' S T r -'I' i "~ ~-- _ ``~ 1 ~.~ rg- .vim r7 .. L: '-- • r -~ ~ r , ,! C?~~ i ~i State ZIP Code FILED -'^ - ~ ~? , P A 1 7 1 1 0 a~ ~- n ~ . 3 tv Correspondent's a-mail address: RMORGENTHAL(a~SASLLP COM Under penalties of perjury, I declare that f have exam' ed this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct a plete. D aration of rep r other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU P ~O ONSI LI RETURN /J~ ~ E ADDRESS O~ 157 LAKESIDE DRIVE LAUREL DE 19956 S//~FjPF~P T~ THAN RE RESENTATNE ` 10 V ~, DATE ADDR SS 4431 N• FRONT ST•, 3RD FLOOR HARRISBURG PA 17110 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 1505610140 J(` i ~.~ 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: MARGARET D• REAM 1 7 2 2 4 9 6 6 4 RECAPITULATION 1. Real Estate (Schedule A) ...................................... ..... 1. 6 4 9 5 0, 0 0 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. 0 . 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).. ..... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .. ..... 6. 0 . 0 0 7. Inter-Vivos Transfers & Miscellaneous N Probate Property ~ (Schedule G) Separate Billing Requested .. ..... 7. 8. Total Gross Assets (total Lines 1 through 7) ....................... .... 8. 6 4 9 5 0 , 0 0 9. Funeral Expenses and Administrative Costs (Schedule H) .............. .... 9. 2 5 8 9 4 . 0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ......... .... 10. 5 5 9 8 9 . 5 7 11. Total Deductions (total Lines 9 and 10) ........................... .... 11. 8 1 8 8 3 . 5 7 12. Net Value of Estate (Line 8 minus Line 11) ........................ .... 12. - 1 6 9 3 3. 5 7 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. - 1 6 9 3 3. 5 ? 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.o _, - 1 6 9 3 3. 5 7 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 _ 0. 0 0 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 0. 0 0 19. TAX DUE .................................................. ....19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505610240 1505610240 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 12 0221 DECEDENT'S NAME MARGARET D. REAM STREET ADDRESS 128 CAMBRIDGE DR CITY MECHANICSBURG STATE PA ZIP 17055 Tax Payments and Credits: ~• Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 0.00 B. Discount 3. Interest 0.00 Total Credits (A + B) (2) 0.00 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. (3) (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 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 : ...................................................................... ^ ^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? ....................................................... ^ ^X 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ ^X 3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? ......... ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ^ 0 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 j (i)J. 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 MARGARET D. REAM 21 12 0221 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 128 CAMBRIDGE DRIVE, MECHANICSBURG, PA -UNDIVIDED 1/2 INTEREST AS TENANT IN COMMON WITH SON, RIKKI A. ROCKETT; SALE PRICE $129,900.00 SEE ATTACHED HUD-1 TOTAL (Also enter on Line 1, Recapitulation.) ~ $ 64,950.00 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 MARGARET D. REAM 21 12 0221 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. WATSON FUNERAL HOME, MILLSBORO, DE 8,000.00 B, ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) VICKI L. WOMER Street Address 157 LAKESIDE DRIVE City LAUREL State DE Zlp 19956 Year(s) Commission Paid: N/A Z, Attorney Fees: SMIGEL, ANDERSON & SACKS, LLP 3, Family Exemption: (If decedent's address is not the same as claimanCs, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. ~ Probate Fees: CUMBERLAND COUNTY 5. I Accountant Fees: 6, ~ Tax Return Preparer Fees: 7. PATRIOT NEWS -LEGAL AD 8. CUMBERLAND LAW JOURNAL -LEGAL AD 9. SELLING COSTS OF REAL PROPERTY - 128 CAMBRIDGE DR. (1/2 share) SEE ATTACHED HUD-1 0.00 3,500.00 230.50 175.00 90.00 13,898.50 TOTAL (Also enter on Line 9, Recapitulation) I S 25 00 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, & LIENS w ~ n ~ ~ yr FILE NUMBER MARGARET D. REAM 21 12 0221 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, BANK OF AMERICA -HOME EQUITY LOAN 4 108.86 JUDGMENT NO. 08-4008 CUMBERLAND COUNTY, PA 2. CAPITAL ONE BANK CARD -ACCT. #XXXX1866 3,350.70 3. DELAWARE DEPARTMENT OF WELFARE MEDICARE LIEN 4,686.78 4. CAPITAL ONE BANK CARD -ACCT. #XXXX6522 1,525.00 5. CAPITAL ONE BANK CARD -ACCT #XXXX109696 2,550.52 6. BANK OF AMERICA -MORTGAGE ACCT. #1 1 1 73 8092 (1/2 share) 39,767.71 TOTAL (Also enter on Line 10, Recapitulation) ( $ 55 If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE I BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MARGAR ET D. REAM 21 12 0221 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 outr~' ht spousal distributions and transfers under Sec. 91 f6 (a) (1.2).] 1. NORMAN REAM Spousal -16,933.57 231 S. WASHINGTON ST. MILLSBORO DE 19966 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: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. E If more space is needed, use additional sheets of paper of the same size. ~ ~ 902-856-1931 01:1 p,m. 01-13-2012 2110 ~x~k ~i1i C~TP~Yrzntent OF MARGARET D. RBAM - •. I, MARGARET D. REAM,. of the Township of Lower Allen, Cumberland County., Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will :and Testament, hereby revolting and making void any and all wills or codicils at any time heretofore made by me. ARTICLE I I direct the payment of all my just debts, and the expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. I authorize my Executor to expend funds from my estate for the purchase, erection, and inscription of a suitable grave marker. All of the foregoing shall be considered expenses of the '~ administration of my estate and paid from my residuary estate. ARTICLE II I give, devise and bequeath all the rest, residue .and remainder of my estate of whatever nature and wherever situate, unto my husband, NORMAN A. REAM, provided he survives me by a period of thirty (30} days. ARTICLE III Should my husband, NORMAN A. REAM, predecease me or die on or before the thirtieth (30th) day fallowing my death, I give, devise and bequeath all the rest, residue and remainder of my estate, in equal shares, to my children, RICHARD A. REAM, Mechanicsburg, Pennsylvania. and VICKI L. WOMER, Dagsboro, Delaware, provided however that should either child predecease me, I direct that such child~s share. shall pass to his or her issue, per stirpes, or if there be no such issue, then such child's share shall pass to my surviving child. Q 302-656-1931 ..~ Oi:1~ p.m. 01-13-2012 3110 ARTICLE IV I appoint CCNB Bank, N.A., guardian of .any property which passes undef this will or otherwise to a minor with respect to which I am authorized to appoints guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not. supersede the .right of any fiduciary, in its discretion, to distribute a share where possible to a minor, or to another for the. minor's support and `education (including trade school and college education, both graduate and undergraduate) without regard to hie or her p$rent~s ability to provide for said support and education, or to make payment for these purposes, withoufi further responsibility, to the minor, or to the .minor!s parent or any person taking care of the minor. ARTICLE Y I nominate, constitute and appoint my husband, NORMAN A. REAM, Executor of this my Last WiII. Should my husband, NORMAN A. REAM, fail to qualify or cease to act as Executor, I nominate and appoint CCNB Bank, N. A., Camp Hill, Pennsylvania, Executor of this my Last Will. IN WITNESS WHEREOF, I have hereunto set my hand and seal this rG ~`~ day of ~.n.~,-u,~-v4..~,~- 1984. ~ //MARGARET D. REAM Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~! l ~ ~ ~' -2- 302-856-1931 01:1_ p.m. 01-T3-2012 4110 ACgN©'WLEDGMENT COMMONWEALTH OF PENNSYLVANIA , ~; ... COUNTY OF CUMBERLAND ~ ' I, MARGARET R. REAM, whose name is signed to the foregoing instrument, ha been duly guaIified according to law, do hereby acknowledge Chet I si ned the instrument as my Last Will and Testament; that I si ned it w~llin 1 g and excel it 85 my free and voluntary act for the purposes therein eXFressed.g Y, and that I sig Sworn to or affirmed and acknowledged before me, by MARGARET I). REAM this r~~~ day of t~-~k~,.~....,.~.. 1984. ___. Nata ublia~ :d>r ~; 302-856-1931 I COtY!lVIONWEALTH OF PENNSYLVANIA COUNTY OF CU~VIBERL.4ND 01:1, p.m. 01-13-2012 5110 I i AFFIDAVIT ss: ~~ ~. We, E ct m .~ ~ ~ ~ . M y e R S and rn ~ ~ y !. - m `1 S ,the witnesses whose names are signed to the foregoing instrument, being duly qualified according to taw, do depose and say that we were present and saw the Testator sign and execute the foregoing instrument as his Last Will and. Testament; 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 knowledge, the Testator was at that time IB or more years of age., of sound, mind and under no constraint or undue influence. >;51 E~ mv~,d y-. m`~ etc ~ ~ s ~ rn ,a. sz y ~. . Sworn to or affirmed and subscribed to before me by C-cam v ~ c~ Cs... iv-y~ r'~ S and M b ~. y i, , rn y S ,witnesses, this ~ '~-~~day of 1'=~~.~ , 1989. .. ,1 - - - ~ Notary Public oCTa,MarroFrO~ =G. YI * = OMB Approval No. 2502-0265 ~. ~' A. Settlement Statement (HUD-1) N840eJE O~ B. Type of Loan 128 7• Loan Number: 8. Mortgage Insurance Case Number: 1.^X FHA 2.Q RHS 3. ^Conv. Unins. DAUIGHENBAUGH 4. Q VA S. Q Conv. Ins. . 6800532906 446-1235029-703 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 "(p.o.c.)"were paid out id th s e e closing; they are shown here forinlormational purposes and are not included in the D. Name and Address of Borrower: . totals. E. Name and Address of Seller: F. Name and Address of Lender : Shawn Adam Daughenbaugh and Vicki L. Women Administratrix Lauren Eileen Daughenbaugh , MEMBERS 1ST FCU Rikki A. Rockett 773 Lee Lane 5000 LOUISE DRIVE Enola, PA 17025 MECH,4NICSBURG, PA 17055 G. Property Location: 128 Cambridge Drive H. Settlement Agent: 23-2402316 PURITY ABSTRACT COMPANY I. Settlement Date: Mechanicsburg, PA 17D55 3329 MARKET STREET lower Allen Twp, Cumberland County CAMP HILL PA 17011 May 23 , 2012 Ph. (717)737-8359 Place of Settlement: Century 21 Realty Services 3315 Market St, Camp mill, PA J. Summary of Borrower's transaction 100. Gross Amount Due from Borrower: K. Summary of Seller's transaction t O1. Contract sales rice 400. Gross Amount Due to Seller: 102. Personal roe 129,900.00 401. Contract sales rice 129 900 00 103. Settlement Char es to Borrower Line 1400 402. Personal roe 8 423 27 403 , . 104. , . . 404 105. . 405 Ad'ustments for items aid b Seil i d . er n a vance 106. COUNTY/TOWNSHIP 05/23/12 Ad'ustments for items aid b Seller in advance to 01/01/13 107. CITY TAX to 393.03 406. COUNTY/TOWNSHIP 05/23/12 to 01/01/13 407 393.03 108. SCHOOL TAX 05/23/12 to 07/01/12 741 93 . CITY TAX to 109. 2ND QTR SEWER $55 05/23/12 to 07/01!12 . 23 57 408. SCHOOL TAX 05/23/12 to 07/01/12 409 141 93 110. 2ND QTR REFUSE $53 95 05/23/12 to 07/01/12 . . 2ND QTR SEWER $55 0523/12 to 07/01/12 23.57 . 111. 23.12 410. 2ND QTR REFUSE $53:95 05/23/12 to 07/01/12 411 23.12 112. . 412. 120. Gross Amount Due from Borrower 138,904.92 420. Gross Amount Due to Seller 200. Amounts Paid b or in Behalf of Borrower 500. Reductions in Amount Due Seller: 130,481,65 201. De osit or earnest mone 202. Princi al amount of new loans 1,000.00 501. Excess de osit see instructions 203. Existin loans taken sub'ect to 127,546.00 502. Settlement char es to Seller Line 1400 15,358.40 204. 503. Existin loans taken sub'ect to 205. 504. Payoff First Mortgage to BANK OF AMERICA 79 535 41 206. 505. Pa off Second Mort a e , . 207. 506. 208. 507. De osit disb. as roceeds 508 209. SELLER ASSIST 6,811.92 . 509 SELLER ASSIST Ad'ustments for items un aid b Seller . Ad'ustments for items un -aid b Sell 6,811.92 210. COUNTYlfOWNSHIP to er 510 CO 211 CITY . UNTYlfOWNSHIP to . TAX to 511. CITY TAX to 212. SCHOOL TAX to 512. SCHOOL TAX to 213. 513. 214. 514. 215. 515. 216. 516. 217' 218 517. JUDGMENT PAYOFFS to CAPITAL ONE 7,212 83 ' 219 518. JUDGMENT PAYOFF to' IDT 5,182.76 . 519. 220. Total Paid b /far Borrower 135,357.92 520. Total Reduction Amount Due Seller 114 101 32 300. Cash at Settlement fromlto Borrower 800. Cash at settfement tolfrom Seller , . 301. Gross amount due from Borrower line 120 302. Less amount paid by/for Borrower line 220) ( 138,904.92 135 357 92) 601. Gross amount due to Seller line 420 6 130,481.65 , . 02. Less reductions due Seller (line 520) ( 114 101 37) 303. Cash ~X From ~ To Borrower 3,547.00 603. Cash ~ To ~ F S ll , . rom e er 16,380.33 The undersigned hereby acknowl~eceipt of a completed copy of this statement 8 any attachments referred to herein Borrower Seller ~~ G¢ n Adam D Vicki L. Wo ~, A~trix 1111CT----~ ' uren Eileen Dough b gh Rlkkt A. Rockett / - rT~ The Public Reporting Bunten for this colleUion of infortnalion is estimated at 35 m'wartes per rosponse for collecting, ravievnng, and reporting the data. This agenry may not mlleG this information, antl you are not reguaetl to complete Ihis norm, unless it displays a wrtenlly valid OMB control number. Nc wnfidenlialiy is assured; IMs tlisrbsure is mandatory. This is tlasigned to pmvida the parties to a RESPA coveretl transaction vnth information during the setllement process. Page 1 of 3 HUD-1 (DAUGHENBAUGH.128.PFb/DAUGHENBAUGH.128/28) 802. Your credit or charge (points) for the specific interest rate chosen $ 505.00 from GFE #1 $ 803. Your adjusted origination charges (from GFE #2) 804. A sisal fee to from GFE #A 505.00 805. Credit Re ort to from GFE #3 400.00 , 806. Tax service to from GFE #3 13.50 807. Flood certification to (from GFE.#3) 808. (from GFE #3) 12.50 809. (from GFE #3) 810. (from GFE #3) 811 (from GFE:#3) 900. Items Required by Lender to Be Paid in Arivance (from GFE #3) _- 901. Daily interest charges from 05/23/12 to 06/01/12 9 @ $13.290000/day (from GFE #10) 119 57 902. Mort a e insurance remium for months to MEMBERS 1ST FCU 903. Homeowner's insurance for 1 0 t E -from GFE #3 UPFRONT MIP . 2,193.68 . ears o 904. RIE INSURANCE from GFE #11 438.00 905. from GFE #11 (from GFE #11) 1000. Reserves Deposited with Lender 1001. Initial deposit for your escrow account (from GFE #9) 1 002. omeowners Insurance .0 0 mon hs 6.50 per month ,305.36 1003. Mort a e insurance 0.000 months $ 129.48 er month $ 1004. Property taxes 1005. $ Assessments months @ $ Per month City/Town Taxes months @ $ per month 1006. COlrWP TAX 4.000 months @ $ 52.75 per month $ 211.00 1007. SCHOOL TAX 12.000 months @ $ 108.78 per month $ 1,305.36 1008. $ 1009. AGGREGATE ADJUSTMENT $ -320.50 1100. Title Charges 1101. Title services and lender's title insurance (from GFE #4) , p,12-141 1 220 88 1102. Settlement or closing fee $ , . 1103. Owner's htle insurance to FIRST AMERICAN TITLE INS Cn ..___ ~~~.... ~......_.__.._ _ _ _ _ t t o/. A ent's ortion of the total title insurance remium to PURITY ABSTRACT COMPANY $ 976.36 1108. Underwriters portion of the total title insurance remium to FIRST AMERICAN T1TLE INS CO $ 172 30 1109. _ _ PURITY ABSTRACT COMPANY 1200. Govemment Recording and Transfer Charges 1201, Govemment recordin char es [o RECORDER OF DEEDS from GFE #7 140.50 . 1202. Deed $ 62.50 Mortgage $ 78.00 Releases $ Other ,$ 1203. Transfer taxes to RECORDER OF DEEDS (from GFE #8) 1.299.00 1204. City/Countytax/stamps $ 1,299.00 $ _ 1.299.00 1300. Additional Settlement Charge 1301. Required services that you ran 1305. LEGAL FEES to SMIGEL, ANDERSON & SACKS 5,025.00 1400. Total Settlement Char es (enter on lines 103, Section J and 502, Section K) 8 423.27 15 358.40 ey signing page t M this statement, the signatories acknovAedpe receipt or a completed copyof page 2 8 3 d this Three page staleme PURITY AB ettlementAgent Certified to be a true copy. Page 2 of 3 HUD-1 (DAUGH ENBAUGH.128. PFD/DAUGHENBAUGH.128/23) ~omparlson of [iootl Faith Estimate (GFE) and HUD-1 Charges Good Faith Estimate HUD•1 Gharges That Cannot Increase HUD•1 Line Number Our origination charge # 801 505.00 505 00 Your credit or charge (points) for the speck inter t t h . es ra e c osen # 802 Your adjusted origination charges # 80 3 505.00 505 00 Transfer taxes . #1203 1,299.00 1,299.00 Charges That in Total Cannot Increase More than 10 % Good Faith Estimate HUD-~ Government rewrding charges #1201 - Appraisal fee # 804 266.50 140.50 Credit report 400.00 400.00 # 805 Flood certification 13.50 13.50 # 807 Mortgage Insurance Premium 12.50 12.50 # 902. Title services and lender's title insurance 2,193.68 2,193.68 #1101 Owner's title insurance to FIRST AMERICAN TITLE INS. CO. #1103 1,508.75 1,220.88 99 78 Total 4,394.93 4,080.84 Increase between GFE and HUD-1 Charges $ -314.09 or .7 15'~ Charges That Can Change Initial deposit for your escrow account Good Faith Estimate HUD-1 #1001 1,305.36 1 305.36 Daily interest charges # 901 $ 13.290000/day 118.69 , 119 57 Homeowner's insurance # 903 . 438.00 438.00 Loan IermS Your initial loan amount is $ 127,546.00 Your loan term is 30 years Your initial interest rate is 3.7500 Your initial monthly amount owed for principal, interest and $ 720.17 includes any mortgage insurance is a Principal a Interest ~X Mortgage Insurance Can your interest rate riseP QX No ~ Yes, it can rise to a maximum of %. The first change will be on and can change again every _ months after Every change date, your interest rate can increase or decrease by °/. Over the life of the loan, your interest rate is guaranteed to never be lower than % or higher than %, Even if you make payments on time, can your loan balance rise? ~X No ~ Yes, it can rise to a maximum of $ Even if you make payments on time, can your monthly ~X No ~ Yes, the first increase can be on and the monthly amount owed for principal, interest, and mortgage insurance rise? amount owed can rise to $ The maximum it can ever rise to is $ Does your loan have a prepayment penalty? QX No ~ Yes, your maximum prepayment penalty is $ Does your loan have a balloon payment? QX No ~ Yes, you have a balloon payment of $ due in _ years on Total monthly amount owed including escrow account payments ~ 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. QX You have an additional monthly escrow payment of $198.03 that results in a total initial monthly amount owed of $918.20. This includes principal, interest, any mortgage insurance and any items checked below: QX Property taxes QX 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. Page 3 of 3 HUD-1 (DAUGHENBAUGH.128.PFb/DAUGHENBAUGH.128/23) i ~i~ DELAWARE HEALTH AND SOCIAL SERVICES ~IVISIDN OF MEDICAID $c MEDICAL ASSISTANCE March 21, 2012 Smigel, Anderson & Sacks, LLP 4431 North Front Street 3`d Floor Harrisburg, PA 17110-1778 Attn.: Roger M. Morgenthal, Esquire Dear Mr. Morgenthal: TELEPHONE: (302)255-9500 RE: Mazgazet D. Ream Medicaid # 0002214074 I am writing to you on behalf of the Delaware Division of Medicaid and Medical Assistance in response to your letter dated March 1, 2012 regarding Medicaid's claim against the estate of Mazgaret D. Ream. Delaware Health and Social Services provided long-term care services for Mazgazet D. Ream from September 1, 2010 through October 26, 2010. A detailed summary of the services paid by Medicaid is attached. This is a request for payment from the estate of Margaret D. Ream in the amount of $4,677.38. We received a payment of $1.00 on March 23, 2011; therefore, the balance due is $4,676.38. Please note that this claim is to be paid using only the resources in Margaret D. Ream's estate (bank accounts, insurance policies, stocks, bonds, real estate, or any other resources). If you would like to discuss this claim, you can contact me at (302) 255-9656. To pay this claim, a check payable to Treasurer, State of Delaware, can be mailed in the enclosed envelope. You may also send a written response instead of calling. Please include a phone number where you can be reached during the day in case I need to contact you. Your assistance in this matter is appreciated. Enclosure Sincerely, r-:1 ~ ~~~~~i C~rr~ Medicaid Third Party Liability Analyst P.O. 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BY: FREDERIC I. WEINBERG, ESQUIRE Identification No.: 41360 JOEL M. FLINK, ESQUIRE Identification No.: 41200 1001 E. Hector Street, Ste 220 Conshohocken, PA 19428 484j351-0500 IDT CARMEL INC As Assignee of Citibank--Cordons vs. MARGARET D REAM Pursuant to Pa.R.Civ.P. you are hereby notified you in the above procee~ u COURT OF COMMON PLEAS CTJMBERLAND COUNTY DOCKET NO. 08-4008 NOTICE 236 of the Supreme Caurt of Pennsylvania, that a judgment has been entered against ling as indicated below. Judgment by Default $4,108.86 Money Judgment $ Judgment on Award of Arbitratora$ Judgment on Verdf.ct$ IF YOU HAVE ANY ¢UESTIONS CONCERNING THIS NOTICE, PLEASE CALL ATTORNEYS: FREDERIC I. WEINBERG OR JOEL M. FLINK, ESQUIRES AT THIS TELEPHONE NUM$ER: 484j351-0500 PROTH ARY 01/10/2012 xUE 913 FAx 856 75 020 ~aaiioai A A P4T~IAKER & SSnCIATE~S, P.C. ATTORNEYS AT LAW 1atnlary lU, ZU12 REMAX REALTY ASSUC(A'I'LS,1NC:. AT7N:.1T.JT)Y FAX#717-~F41-.5(iU6 3425 MARKL"1' S'1' t'AMP T-TTT,T,, PA l7U'I 1 RF.: CAPTTAT, C)NF BnNK VS. MR1Zt;AK1r"I~ RL-;t1M T)UC:I{.CT NQ.: U7-1347 UUR FILE NU: I U9E-96 The p~yctt'C figure liir the ahiroe account is $3,315.90. This payoff is good until January 2U, 2012. Tlie per diem is x.29 per d(~y. Ylease send our settlement check tc> the New .Iertiey irt'liee. APnTHAKER & ASSUC:IA'I'LS, Y.L. /TCY 'Phis firm is a debt collector, We nre Attenaptiiib to cvliect a debt and uny inlitrnn~[ii»t i~btaincd will Uc iiscd li)r the purpc~sc ol'cuffccting the debt. ~ ~~ a(~~~P~° fo ~ ~ ~~, ~~`~ ~ ~~ .;~~ ~~~ ~~ ~~,~ ~~~? ~~ J ~~ J ~ ~ ~~ ~ S2U I'elluwsltip Road, C:1U6, Motu)( L~ttl'zl, NJ 4BUSd RSC, 7RU.lUt)U 8S6 7RU,lU2Ul' 2I 5 631.8920 215 634.842 i f 800 472.02 F5 8UU 757.4~)28f iuforr~n nnnth ak a r.c~m 01/14/2012 TUE 9+15 Fax 855 ) 1020 `~°, ®441/001 A POTHAKEK cat ~ CIATES P.C. SSQ , ATTORNEYS A'1' LAW larut<<ry ! U, 2U 12 RLMAX RliAL'1'Y ASS(.}C'IATF.S,1(N("_ ATTN:.n T1~Y FAXll7 ! ?-441-5605 3425 MAKI~T STRRF.T CAMP HILL, YA 17U11 RE: C;AYi'1'AL UNL BANK VS. MARGARET REAM T)OCKF,T NO.. U7-4347 UU12 1'TZ.,T: Nn: 1 Q563U ORIGINAL lYCC:'1' N(.): ending ....1522 llliA1Z 1UllY PALM: The ptlyoff fibure !ur the ~hcwe account is X2,529.52. This payvfl'is goe~cl until January 20, 2U1Z. The pcr diem is x;.21 pcr day. T'lea~~e send tsar settlement ehcck to the New Jersey office. AYU'1'HAICLIt 8z ASSC}C:TAT'F:S, P.C. /KY 'Phis firm is a debt collector. We are attempting to collect a debt and my infur)natiun ahtait,ed will b~ used litr the purpc)u; of collecting the debt. 520 F~Ilnwsliip Road, C3Ub, Mount Latu~el, NJ U8Uti4 BS6 780.1000 856 78O.1O2U1' 215 634.8`I'LU 'L I S (1:)4.8421 f 800 672.0215 8Ot) 757.4N28f in fo~~)auatlm I<er.c nni D1/10/2012 TjJE x:10 FAX 85 0 1020 1(3THAI~~ ~ SS~CIATES, P.C. lmD01/001 Al"i'UltiYLYS A'!' LAW .Ic~tluary 10, 2Ql2 RF.MAX REAT.TY ASSOC'IATI;S, INC. ATTN: ,11.IT)Y I'AX#7I7-4a1-S(iUG 3425 MAKKE"I' S'1'KEL"1' CAMP T-TTT,T,, PA 17011 RR: CAPTTAT, QNF F3ANK VS. MAR(TART~.T REAM 1>UC:KL'!' NU.: 07-4347 nUit FILE NQ: l OGUOU UTZ.ICiTNAT. AC'GT NO: ending ....1 RGG DE/1R J[JDY PALM: '1'hc payoff figure for the nbovc account is $1,512.00. 't'his payoff is good until January 2U, 2012. 'l71c per diem is $_ 13 per tlay. Please send uur settletinenl check lu the NCw .)erxey ~~fTice. AYU'1'HAICLiK 1{c AS~UC:111'1'L-'S, Y.C. /iCY This firm is a debt c~>Ileclur. We are ~ttten~ptirtg to collect a dehl ~md <<ny iitli~rmaliotii c~hiai»ed will be ased .for tl~e purpose of cullectinb the debt. _- _.._-. __ ____ _ -_- ____- -52OF~tluwtifti iil <:3UG;"Nluiuill:aur~f-N.1-O8tt.5~1- ----- _ _- _ ._ _ 85G 780,140 56180. I OI.Of 34,85 15 G34.R421 f ROA G72.(S2 I5 ROO 757.4428f info~~t~oothaker.co~t~ IAARC R. CORDON FREOERIC 1. WEINBERG• JOEL M, PL)NK' CHRIS70PHER S. FR08A• 'Ak0 member N,J Bar ~~~~-.•~11' T A t t 0 r n e s Y a t l a w Jan 10 2012 Od:12pm P002/U02 tDOS E. HECTOR STREET SUITE 220 CONSNOHOCKEN,PA 19a2g ~ 260 LAUREL OAK R040 SUITE 104 VOORHEES, NJ OBOaJ 7'anuary 10, 2012 PHpNE: (484) 355.0500 FACSIMILE: (4841 ;SS•0501 MARGARET D READ 128 CAMBRIDGE DR MECHANICSBURG I',A, 17055-3560 Sent via facsimile only 7~T ~ 44~ 56D6 RE; C><editor Accouxat No. Docket lvo. Our File No, Ms. Ream: IDT CARiV~L INC _ 6035253007925903 . os-aaos 2048385 (Reply [o PA of/icP1 My client will accept $5,090.00 as satisfaction of ttae judgmetzt that has been entered against yvu. Payment is due no later than Jaztuary 25, 2012 and tztust be in the fotzzz of a cashier's or title company check Upozt.receipt and clearatzce of these funds, we will prepare the n~ecessazy docutnents to satisfy the judgzztent that, has been entered against you in the Court of Coz;nmon PIeas of Cumberland County having docket number 08-4008. You should make your payment payable to Gordon & Weiztberg, P.C. a><ad sexed it to this office located at 1001 E. Hector Street, Suite 220, Conshohocken, PA 1942$. Z£you have any questions, you Fray contact me at 484-35I-0500 eat 119. Velry ttlt~y yo , N &WEINBERG, P.C. L D, ROBE,R50N, ~tII, LEGAL SPECIALIST 'WZ?R/KH Gordon ~ Weinberg, ,P C. is a debt collector. This letter arzd any futrtre Zetters from our,fv m are an attempt to collect a debt and any iaforrnation obtained will be used for that pur,Pose. GOROON&iUE I NBERG Fax TOIL FREE: (8661 46S-8oB7 µ'~'h'. $ordonwei nber g. co m SMIGEL, ANDERSON AMY L.HAINES,ESQUIRE & SACKS LLP PHONE: (717) 234-2401 ATTORNEYS AT LAW TOLL FREE: 1-800-822-97b7 FACSIMILE (717) 234-3611 EMAIL: ahaines@sasllp.com www.sasllp.com File No. 11424-1-SA August 7, 2012 ~~ ~~ -~, -=. U~n'r~ ~, ~ ,~ - m ~ ~~~~ ~~ Register of Wills Office ~~ , ~ ~ -r` Cumberland County Courthouse ~ ~ , 1 Courthouse Square n~'' -~^ O C =_ Carlisle, PA 17013 :.p-:` ~ ~- n _ ~~ RE: Estate of Margaret D. Ream a1k/a Margaret Day Ream ~~ No.: 2012-00221 Dear Sir or Madam: Enclosed please find for filing: 1. An original and two (2) copies of the Inheritance Tax Return; 2. An original and two (2) copies of the Inventory; 3. Our check in the amount of $30.00 for filing both documents; 4. Aself-addressed, stamped envelope for your convenience in returning the datestamped copies to our office. Thank you for your attention to this matter. Very truly yours, Lr Amy L. Haines /alh Enclosures cc: Vicki L. Womer, Administratrix 4431 North Front Street 3rd Flr., Harrisburg, Pennsylvania 17110-1778 A PENNSYLVANIA LIMITED LIABILITY PARTNERSHIP ~o ~o O /~/~ I C M N <- W ~-• ~ W ~O~,O d Q ~ V r~ < a ~'` ~ N N 0 ~ ~~i u~ O LL fir` ` a v W ~p,~ ~ J ""' 00~ ~ ,~ ,~ ,, _-iJ'r'-i7 ~ ~ ~~ ~ it :~ :'~ '~: ?:~,i l ° \t~ 3 W ._ N N V .s' '~~i' .t;r~ _9 ~~ ~~ 4 r r,:. .~ •' _ ~ (~ (n O Y '~ '- U ~-rm ~ ~ ~a~ o' ~ ZQ~Q~ ~ oQZ~-~ o `~ ~ ~- Q~O~° w ° oa J Q z ~ ~ W m~ N ~ ~~~ H H ~ 8~ cn = h