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HomeMy WebLinkAbout08-08-121505610140 REV-1500 Ex t°'-'°' OFFICIAL USE ONLY PA Depart~rent of Revenue Bureau of~lndividuai Taxes INHERITANCE TAX RETURN County Code Year File Numt~er Po sox 28oso1 2 1 1 0 1 0 4 3 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 8 1 3 2 5 6 3 9 0 7 1 8 2 0 1 0 0 9 2 8 1 9 4 1 Decedent's Last Name Suffix Decedent's First Name MI F R I T Z R O Y W (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 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) OX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 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. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number D A V I D H S T O N E E S Q U I R E First line of address 4 1 4 B R I D G E S T R E E T Second line of address City or Post Office N E W C U M B E RL A N D State ZIP Code REGISTti~OF WILLS UNLY c ru - ~ ~: ~ 7 C , .~' C.ri ~: cv ._ D ~r ,, ©:"' 7 r. 'T7 Q ' ~ ATE FILED tV ~' r, ~ P A 1 7 0 7 0 C? '77 :~ C~1 -~" Correspondent's a-mail address: D S T O N E a1 S T O N E L A W• N E T 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. DeGaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ~~A1RE OF PERSON RE~PON (LING RETUR~ DATE ADDRESS - ~'' 745 N D LEWISBERRY PA 17339 SIGNA R R TNAN REPRESENTATIVE DATE ~ ~ 7r`.t'7 414 BRIDGE S~fREET NEW CUMBERLAND PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 150561024D REV-1500 EX Decedent's Social Security Number Decedent's Name: R O Y W• F R I T Z 1 8 1 3 2 5 6 3 9 RECAPITULATION 1. Real Estate (Schedule A) ...................................... ..... 1. 2. Stocks and Bonds (Schedule B) ................................. ..... 2. 3 2 7 4 1 • 0 0 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) ^ Separate Billing Requested .. ..... 6. • 7. Inter-Vivos Transfers 8 Miscellaneous N n-Probate Property (Schedule G) ~ Separate Billing Requested .. ..... 7. • 8. Total Gross Assets (total Lines 1 through 7) ...................... ..... 8. 3 2 7 4 1 . 0 0 9. Funeral Expenses and Administrative Costs (Schedule H) ............. ..... 9. 3 1 3 0 . D D 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........ ..... 10. • 11. Total Deductions (total Lines 9 and 10) .......................... ..... 11. 3 1 3 0 . 0 0 12. Net Value of Estate (Line 8 minus Line 11) ....................... ..... 12. 2 9 6 ], 1 . 0 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. 2 9 6 1 1 . 0 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 .o _ 0. 0 0 15. D. 0 D 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 2 9 6 1 1. 0 0 17. 3 5 5 3. 3 2 18. Amount of Line 14 taxable at collateral rate X .15 D. 0 D 18, D. D D 19. TAX DUE ...................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 3 5 5 3. 3 2 Side 2 1505610240 1505610240 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 1D 1043 DECEDENT'S NAME ROY W• FRITZ __ STREET ADDRESS ---- ------ - 1104 MARKET STREET ---- - --- - CITY STATE ---- ZIP -- 1 NEW CUMBERLAND PA 1 7070 Tax Payments and Credits: ~~ Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 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) 3, 553.32 Total Credits (A + B) (2) 0 • 0 0 (3) (4) 0.0 0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3 , 5 5 3 • 3 2 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ b. retain the right to designate who shall use the property transferred or its income; ............................... ^ 0 c. retain a reversionary interest; or ................................................................................................ d. receive the promise for life of either payments, benefits or care7 ....................................................... ^ ^ Q 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death 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? ......... ^ ^ Q X^ 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 3 percent (72 P.S. §9116 (a) (1.1) (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)j. Asibling is defined, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ROY W• FRITZ 21 10 1043 Atl property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Fractional share in Burnt Cabins Camp, Inc• stock 32,741.00 consisting of Real estate only located at 1676 Sheepskin Hollow Road, Fort Littleton, Dublin Twp•, Fulton County, PA• Said property was sold to Randall L• Shearer and Lori S• Shearer, husband and wife on January 5, 2012• $237,500 sales price TOTAL (Also enter on line 2, Recapitulation) ~ 3 3 2 , 7 4 (If more space is needed, insert additional sheets 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 ROY W• FRITZ 21 10 1043 Decedent's debts must be reported on Schedule [. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) SVeet Address City State ZIP Year(s) Commission Paid: 2, AttomeyFees: David H Stone, Esquire 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. I Probate Fees: 5 Accountant Fees: 6. Tax Retum Preparer Fees: ~. I Register of Wills-Filing Suppl Inh Tax Ret & Inv 2• Closing expenses TOTAL (Also enter on Line 9, Recapitulation) I S If more space is needed, use additional sheets of paper of the same size. 3, 000.00 30.00 100.00 3,130.00 REV-1513 EX+ (Ot-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ROY W• FRITZ 21 10 1043 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. DANNY L• FRITZ Sibling 29,611.00 745 GLEN ARDEN DRIVE LEWISBERRY, PA 17339 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS 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 I S If more space Is needed, use addltlonal sheets of paper of the same size. i 'ri\DOCS~EFr\WILLS\Fcitz.Roy.wpd LAST WILL AND TESTAMENT OF ROY W. FRITZ I, ROY W. FRITZ, of the Borough of New Cumberland, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I devise and bequeath all of my estate of every nature and wherever situate to my brother, DANNY L. FRITZ, if he survives me. ITEM II: I appoint my brother, DANNY L. FRITZ, Executor of this my last will. ITEM III: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his or her duties in any jurisdiction. IN WITNESS WHEREOF, I, ROY W. FRITZ, have hereunto set my hand and seal this ~~ day of _ ~ ~.~,L 2009. ROY W./FRITZ Page 1 of 3 SIGNED, SEALED, PUBLISHED and DECLARED by ROY W. FRITZ, the Testator above named, as and for his Last Will and Testament, and in the presence of us, who at his request, in his presence and in the presence of each other hav subscribed our names as witnesses. 414 Bridge St., New Cumberland, PA Wi Address " v v 414 Bridcte St., New Cumberland PA nes Address COMMONWEALTH OF PENNSYLVANIA: . SS: COUNTY OF CUMBERLAND I, ROY W. FRITZ, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. ROY W FRITZ Sworn to or affirmed to and acknowledged before me by ROY W. FRITZ, the Testator, this~~~ day of ~ ~C~ 2009. COMMONWEAt,~i H OF PENNSYLVANIA BROOKEE ~ Notary Publi FEL..PPA, Notary Public New Cumberland Bo% t~xnberiand Co. ~xnissla~ res June 6 X12 page 2 o f 3 i ~.. COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND We, _ ~JaV:c~l S~n,.Q and _ S-ern;~er- A. r~~L~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testator sign and execute the instrument as his last will; that Testator 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; that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed to and acknowledged before me by UV ~ ~ ~' ~"~- and ~~r~: ~ a, ~(1-~~~ 0 ~,~ .--_, witnesses, this,~,~~,,~- day of ~~~ -~ 2009. COMMONWEALi H OF PENNSYLVANIA ~Q JTARIAL Notary Publi BROOKE E. FEL~PPq, Notary Public N Commisyion fires JOu uric 5~2p12 Page 3 of 3 a m n z 1 ~S~ ~. S ~s~ ~~~ €~ ~, ~, +~i` I~~ z bd n 0 v 0 m oy Z 0 a~ ~ ~~ ~' m ~• a a. 0 1~1 om $o a ~~,, Z ` 1 x ~ i o ~v m z z F..~ y z > ~ Z:\BUS\RES\Burnt Cabins Camp, Inc. - resolution (POA to sell real estate).wpd CORPORATE RESOLUTION OF BURNT CABINS CAMP, INCORPORATED The undersigned, being all of the Directors and Shareholders of Burnt Cabins Camp, Incorporated, (hereinafter the "Corporation"), a Pennsylvania corporation, INTENDING TO BE LEGALLY BOUND, hereby adopt the following resolutions. WHEREAS, the directors of the Corporation have authorized DANIEL FRITZ, to do and perform every act and thing which the said attorney-in-fact may deem necessary or proper, in his sole discretion, to sell and dispose of the real estate located at 1676 Sheepskin Hollow Road, Fort Littleton, Fulton County, Pennsylvania, including but not limited to the execution, acknowledgment, and delivery of sales contracts, affidavits, settlement sheets, and any and all documents of any kind which may be required by any party to a transaction in order to sell and dispose of the aforesaid property. NOW, THEREFORE, BE IT RESOLVED, that DANIEL FRITZ is hereby authorized and directed to take any actions and sign any and all documents which he deems appropriate, in his sole discretion, to finalize the transaction hereinabove authorized. The above resolutions are adopted by consent of the undersigned, being all of the Directors and Shareholders of the Corporation, this _,~ day of ~~N 2012. LL SHEAFFE irector and Shareholder J C BARNES, Director and Shareholder J EPH A. CSDORAS, Director and Shareholder DANIEL FRITZ, Dir c rand Shareholder -1- \x/T'iTTR Q C F:\DOCSIBUSIRES\Burnt Cabins Camp, lnc. - resolution.wpd CORPORATE RESOLUTION OF BURNT CABINS CAMP, INCORPORATED The undersigned, being all of the Directors and Shareholders of Burnt Cabins Camp, Incorporated, (hereinafter the "Corporation"), a Pennsylvania corporation, INTENDING TO BE LEGALLY BOUND, hereby adopt the following resolutions. WHEREAS, the directors of the Corporation has authorized the sale of land herein described on Exhibit "A" attached hereto, to be sold to Randall L. Shearer and Lori S. Shearer, husband and wife for the purchase price of TWO HUNDRED THIRTY-SEVEN THOUSAND FIVE HUNDRED and NO/100 ($237,500.00) Dollars; and WHEREAS, the directors of the Corporation have authorized and hereby do authorize, JOSEPH A. CSDORAS, President of the Corporation, to take such actions and to execute such documents, in the President's sole discretion, as are required to complete the above stated transaction. NOW, THEREFORE, BE IT RESOLVED, that President is hereby authorized and directed to take any and all actions and sign any and all documents including the deed of conveyance which he deems appropriate to finalize the transaction hereinabove authorized. The above resolutions are adopted by consent of the undersigned, being all of the Directors and Shareholders of the Corporation, this ~ day of- ,~~~~„ 2012. SHEAFFER~I~irector and Shareholder BARNES, Director and Shareholder JOS . CSDORAS, Director and Shareholder DANIEL F i e for and S o er WITNESS: Exhibit "A" ALL THAT CERTAIN tract of ground, situate in Dublin Township, Fulton County, Pennsylvania, more particularly bounded and described as follows: BEGINNING at an existing %s" rebar, a corner common to lands of Donald Brant and Donna Brant, and lands of Robert W. Lamberson; thence along lands of Robert Lamberson, North 26° 43' 43"East 601.68 feet to an existing 5/8" rebar; thence South 50° 11' 17" East 910.02 feet to a point; thence South 46° 11' 17" East 2,007.70 feet to a point; thence South 53° 18' 43" West 572.11 feet to a point; thence North 61 ° 41' 17" West 277.20 feet to a point; thence North 58° 41' 17" West 2,393.12 feet to a point; thence along lands of Donald Brant and Donna Brant, North 39° 18' 12" East 519.29 feet to an existing %" rebar, the place of BEGINNING. CONTAINING 54.03 acres and more particularly shown on a draft of subdivision prepared by Thomas E. Shelly, Professional Land Surveyor, on May 16, 2000. Said draft of subdivision was approved by the Dublin Township Supervisors on June 6, 2000, and recorded in Fulton County Plat Book 9, Page 19, Plat Title #184-C. BEING KNOWN AND NUMBERED as 1676 Sheepskin Hollow Road, Fort Littleton, Pennsylvania. TOGETHER with a 50 foot wideright-of--way through lands of Robert W. Lamberson, for ingress, egress, and regress to and from the property herein conveyed and Township Route 406, as more particularly described as follows: BEGINNING at a p.k. nail in Township Route 406; thence following four (4) courses and distances; South 68° 27' 17" East 61.104 feet to a point; South 04° 45' O1"East 225.624 feet to a point; South 35° 00' 03"East 172.837 feet to a point; South 26° 00' 40" East 123.292 feet to a 5/8" rebar with cap (set) on line of lands herein; thence along the Tract herein conveyed, South 26° 43' 43" West 62.823 feet to a 5/8" rebar with cap (set) on line of lands herein conveyed; thence the following four (4) courses and distances: North 26° 00' 40" West 157.396 feet to a point; North 35° 00' 03" West 182.421 feet to a point; North 04° 45' O1" West 208.075 feet to a point; North 68° 27' 17" West 30.039 feet to a p.k. nail in Township Route 406; thence along Township Route 406, North 21 ° 32' 43" East 50.000 feet to a p.k. nail, the place of BEGINNING. BEING the same premises which Rosenberry Family Limited Partnership, a Pennsylvania Limited partnership having as general partner, G.C. Logs, Inc., by deed dated May 18, 2000, and recorded June 8, 2000, in the Office of the Recorder of Deeds of Fulton County, Pennsylvania, in Deed Book 298, Page 22, granted and conveyed unto Burnt Cabins Camp, Incorporated, Grantor herein. -2- f f Z:\BUS\AGM\Burnt Cabins Camp, Inc. - Dissolution Agreement.wpd AGREEMENT REGARDING DISSOLUTION OF BURNT CABINS CAMP INCORPORATED THIS AGREEMENT, made this 4th day of January, 2012, among the shareholders and heirs of shareholders of Burnt Cabins Camp, Incorporated; W I T N E S S E T H: WHEREAS, the parties hereto are the sole shareholder and executors of the estates of the deceased shareholders of Burnt Cabins Camp, Incorporated; and WHEREAS, the sole assets of the incorporation is a hunting cabin known as 1676 Sheepskin Hollow Road, Fort Littleton, Pennsylvania and a checking account; and WHEREAS, the parties anticipate selling the cabin on January 5, 2012, to Randall L. Shearer and Lori S. Shearer for the purchase price of Two Hundred Thirty-Seven Thousand Five Hundred and no/100 ($237,500.00) Dollars and WHEREAS, the parties desire to dissolve the corporation and divide the monies received in the sale of the cabin. -1- NOW, THEREFORE, intending to be legally bound, the parties hereby agrees as follows: 1. The parties agree to execute the documents necessary in order to sell and convey the cabin to Randall L. Shearer and Lori S. Shearer for the purchase price of Two Hundred Thirty-Seven Thousand Five Hundred and no/100 ($237,500.00) Dollars. 2. The parties agree to deposit the proceeds of the sale into the corporate checking account. 3. Upon the determination of the estimated tax liability and estimated accounting and attorneys fees in connection with the dissolu- tion of the corporation, the parties agree to distribute the remaining monies in the checking account. 4. The distribution of the checking account shall be made first to the reimbursement to the parties in accordance contributions by the shareholders as set forth in the attached exhibit. Any balance will be distributed equally. In the event that there is insufficient funds to reimburse the parties in full, the distribution shall be made in the following percentage basis: Jill Sheaffer o22, Joyce Barnes o24, Joseph A. Csdoras b37, and Daniel Fritz %17. 5. The parties agree to continue cooperate and sign whatever documents necessary to dissolve the corporation. (Signatures on following page) -2- J IN WITNESS WHEREOF the party has set their hand and seal at the day and year above written. ('- LL SHEAFFE E DANIEL Director and Shareholder ES, Director and Shareholder ctor ~d~ Shareholder -3- ~v~,rn rj. ~.,~uvtc[-,5, Director and Shareholder r"-~ l y. , _ X~IRE L°K'NU.I)~nny : ac eo-uwnctl,yv bvnn~i aL:os CaiLp. i c.~c~ ..~ _. .: ~ l (_ . ~'_ ~ -. 1 ~ ~ _ r l ~ t ~~- it 1.: ,, 1 ,, i ~ ~;~ 'CHIS DEED TAX PARCk:L NO.: ~~ _ ~~ -D~ o~ AAI)RESS: t67G Sheepskin Hollow Road Fori Littleton, PA 17223 MADE THE ~ day of in the year of our Lord two thousand twelve (2012). BETWEEN BURNT CABINS CAMP, INCORPORATED Grantor, and RANDALL L. SHEARER and LORI S. SHEARER, husband and wife Grantees, '"` WITNESSETH, that in consideration of TWO HUNDRED THIRTY-SEVEN THOUSAND •IVE HUNDRED and NO/100 -------{$237,500.00 )-----------Dollars, in hand paid, the receipt whereof is hereby acknowledged, the said Grantor does hereby grant and convey to the said Grantees, their heirs and assigns, ALL THAT CERTAIN tract of ground, situate in Dublin Township, Fulton County, Pennsylvania, more particularly bounded and described as follows: BEGINNING at an existing %z" rebar, a corner common to lands of Donald Brant and Donna Brant, and lands of Robert W. I.amberson; thence along lands of Robert Lamberson, North 26° 43' 43" East 601.68 feet to an existing 5/8" rebar; thence South 50° 11' 17" East 910.02 feet to a point; thence South 46° 11' 17" East 2,007.70 feet to a point; thence South 53° 18' 43" West 572.11 feet to a point; thence North 61 ° 41' 17" West 277.20 feet to a point; thence North 58° 41' 17" West 2,393.12 feet to a point; thence along lands of Donald Brant and Donna Brant, North 39° 18' 12" East 519.29 feet to an existing %z" rebar, the place of BEGINNING. CONTAINING 54.03 acres and more particularly shown on a draft of subdivision prepared by Thomas E. Shelly, Professional Land Surveyor, on May 16, 2000. Said draft ofsubdivision was approved bythe Dublin Township Supervisors on June 6, 2000, and recorded in Fulton County Plat Book 9, Page I9, Plat Title #184-C. BEING KNOWN AND NUMBERED as 1676 Sheepskin Hollow Road, Fort Littleton, Pennsylvania. TOGETHER with a 50 foot wide right-of--way through ]ands of Robert W. Lamberson, for ingress, egress, and regress to and from the property herein conveyed and Township Route 406, as more particularly described as follows; BEGINNING at a p.k. nail in Township Route 406; thence following four (4) courses and distances; South 68° 27' 17" East 61.104 feet to a point; South 04° 45' O1 "East 225.624 feet to a point; South 35° 00' 03"East 172.837 feet to a point; South 26° 00' 40" East 123.292 feet to a 5/8" rebar with cap (set) on line of lands herein; thence along the Tract herein conveyed, South 26° 43' 43" West 62.823 feet to a 5/8"rebar with cap -1- (set) on line of lands herein conveyed; thence the following four (4} courses and distances: North 26° 00' 40" West 157.396 feet to a point; North 35° 00' 03" West 182.421 feet to a point; North 04° 45' O1" West 208.075 feet to a point; North 68° 27' 17" West 30.039 feet to a p.k. nail in Township Route 406; thence along "Township Route 406, North 21° 32' 43" East 50.000 feet to a p.k. nail, the place of BEGINNING. BEING the same premises which Rosenberry Family Limited Partnership, a Pennsylvania Limited partnership having as general partner, G.C. Logs, Inc., by deed dated May 18, 2000, and recorded June 8, 2000, in the Office of the Recorder of Deeds of Fulton County, Pennsylvania, in Deed Book 298, Page 22, granted and conveyed unto Burnt Cabins Camp, Incorporated, Grantor herein. AND the said Grantor hereby covenants and agrees that it will warrant specially the property hereby conveyed. IN WITNESS WHEREOF, said Grantor has caused this deed to be executed by its authorized President who has hereunto set his hand and seal the day and year first above written. ATTEST BURNT CABINS CAMP, INCORPORATED :By: (SEAL) . EPH A. CSORDAS, President COMMONWEALTH OF PENNSYLVANIA: (, ~ : SS: COUNTY OF r '"" On this, the 5~' day of 2012, before me the undersigned officer, a Notary Public, personally appeared, JO PH A. CS AS, President of BURNT CABINS CAMP, INCORPORATED, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same for the purposes therein contained, IN WITNESS WHEREOF, I have hereu to et my hand and official seal the day and year first above written. ~ fl ~ NotarbPublic OMMONVVEAN Sea NSYLVN't~ pamb 4. W~ Nary PubIK fiamD~ ~, ~bg76nd BGour~ MY ~m~sflon sgpn p(NotaM1es µe~, pennsytvanla -2- Grantees DATED: -3- nP .,ti -~.?J ?~~: . ~r ^`* ~~~~~~~ *''..`~ A. Settlement Statement (HUD-1) -~~ -Il~~ll~ ~# .~ . ~~, OMB Approval No. 2502-0265 HUD-1 Page 1 of 3 B. Type of Loan 1. ~ FHA 2. ^ RHS 3. Q Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4. ^ VA 5. ^ Conv. Ins. 401102054-CL 919-300 NOTE: This form is furnished to give you a 5taiement of actual settlement casts. Amounts paid to and by the settlement agent are shown. . Items marked "(p.o.c.)" were paid outside the cbsing; they are shown here for informational purposes and are not included In the totals. O. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of Lender RANDALL L. SHEARER AND LORI S. BURNT CABINS CAMP, INCORPORATED CORNING FEDERAL CREDIT UNION SHEARER ONE CREDIT UNION PLAZA, 1664 WILKSON LANE PA CORNING, NY 14830 CHAMBERSBURG,PA 17202 G. Property Locatlon H. Settlement Agent SECURED LAND TRANSFERS, LLC 1676 SHEEPSKIN HOLLOW ROAD, 485 ST. JOHNS CHURCH ROAD , FORT LITTLETON, PA 17223 SHIREMANSTOWN , PA 17011 Phone : (717) 901-8342 COUNTY; FULTON Place of Settlement i. Settlement Date 01/05/2012 PARCEL ID:OS-06-0108 TOWNSHIP: DUBLSN TOWNSHIP 464 GATEWAY AVENUE Disbursement Date OS/OS/Z012 CHAMBERSBURG,PA 17201 mer of Borrower's Transaction ) S K. Summa of Seller's Transaction . um Gross Amount Due from Borrower 100 400. Gross Amount Due to Seller . l P i S 237 500.00 401. Contrail Sales Price 237 500.00 r ce a es 101. Contract l P 402. Personal Pro ro 102. Persona ower line 1x00 b t 7 172.21 403. orr o 103. Settlement cha es 404. 104. 405. 105. id b seller in advance i Ad'ustment for items aid b seller in advance tems a Ad ustment for T 406. Ci own Taxes axes 106. Ci /Town 407. Coun Taxes 107. Coun Taxes 408. Assessments 108. Assessments 68/ r 1 5/2012 to 7/1 2012 2 276 1 107.24 409. School Taxes 2 276.68 r 1/5/2012 to 7!1/2012 1 107.24 . 109. School Taxes 410. 110. all. 111. alz. llz. Gross Amount Duo from Borrower 120 245 779.45 420. Gross Amount Due to Seller 238 607.24 . Amounts Paid by or In Behalf of Borrower 2D0 500. Reductions In Amount Due to Seller . e 1 000.00 501. Excess De sits 201. De sit or earnest mon Federal Credit om Comin nt f A 502. Settlement Cha es to Seller 49 375.00 g mou r 202 Principal Loan i U 8190,000.00 503. Existin loans taken sub'ect to n on loans taken sub ed to ti i E 504• n x s 203. 4 505. . 20 506. 205. 507. 206. 508. 207. 08 509. . 2 Ad ustments for items un aid b seller Z09. stmants for items un aid b seller Ad 510. Ci /Town Taxes 649.70/ r 1 1 2012 to 1 5 2012 7.10 u 70 r 1 1 2012 Co 1 5 2012 n Taxes 649 T Ci 7.10 511. Count Taxes . ow / 210. xes t T C 512. Assessments oun a 211. ments A 513. Credit for Extension Fee 285.00 ssess 212. dit for Extension Fee C 3 8285.00 514. re 21 . 515. 214. 516. 215. 6 517. . 21 7 518. . 21 218. 519. 219 520. Total Reduction Amount Due Seller 49 667.10 220. Total Paid for Borrower 191 292.10 Cash st Settlement Prom/to Borrower 300 600. Cash at Settlement to/from Seller . m borrower line 120 f d 245 779.45 601. Gross amount due to seller line 420 238 607.24 ue ro 301. Gross amount r borrower line 220 id b f 191 292.10 602. Less reductions in amount due seller line 520 9 667.10 o 302. Less amounts a 303. Cash X From To Borrower ;54,467.35 603. Cash X 7o From Setler 168,940.14 The PubUC RepoAinp Burden for tDis collection of informabon a estimated at sb mmuces per respanse,a cw,ew,w, ,e.Ar„ry. a,~ .°w~ ••••r °•~ ---~ ~ ~•~ -.°•-, called this information, aril you are not required to complete tNS form, unless it displays a arrently valid OMB control number. No confidentiality fa assured; this u is mandatory. This re designed to provide the parties to a RESPA covered Uansadion with information during Uie settlement process. Initials 401102054-CL unn-t ~oy~ ~~ L. Settlement Char es 700. Total Real Estate Broker Fees;14445.00 Division of Commission line 700 as follows: Paid From paid From 701. 7125.00 to ReMax Count Real Borrower's Funds Seller's Funds 702. 7320.00 to ERA-NRT LLC/ERA-NRT LLC 7 125.00 + 195.00 At Settlement At Settlement 703. Commission aid at settlement 704. 195.00 $14 250.00 800. Items Payable in Connection with Loan 801. Our on (nation char a S2 010.00 from GFE #1 802. Your credit or cha a lots for the s ecific interest rate chosen from GFE #2 803. Your ad'usted on Inatlon cha es from GFE A 2 010.00 804. A raisal Fee to Ausherman POC 325.00 from GFE #3 805. Credit re rt from GFE #3 805. Life of Loan Fe to Comin Federal Credit Union from GFE #3 1.50 807. Flood Cert. Fee to Comin Federal Credit Union from GFE #3 12.50 808. 900. Items Required by Lender to Be Paid in Advance 901 Daily Interest charges from 01/05/12 bo 02/01/12 ~ 22.1233/day Corning Federal Credit Union (from GFE #10) $597.33 902. Mort a e Insurance Premium from GFE #3 903. Homeowner's Insurance All Risks Limited POC 1 550.24 from GFE #11 904. 1000.Reserves Deposited with Lender 1001. initial de osit for our escrow account from GFE #9 1002. 1003. 1004. 1005. 1006. 1007. 1100.Title Charges 1101.Title services and lender's title insurance to Secured Land Transfers LLC from GFE #4 1647.88 1102. Settlement or closin fee to Secured Land Transfers LLC 225.00 1103.Owners title inwrance to Secured Land Transfers LLC from GFE #5 216.00 1104. Lender's title insurance to Secured Land Transfers LLC 1 327,88 1105. Lender's title oli limit 190 000.00 1106.Owner's title li limit 237,500.00 1107. Agent's portion of the total title insurance premium to Secured Land Transfers LLC $1,312.30 1108. Underwriter's portion of the total title Insurance premium to First American 231.58 - PA 1109. Nola fee to Connie L. Wertz Nota Public 20.00 1110.Insured Closing Protection Letter to First American Title Insurance ;75,00 Com an 1200.Government Recording and Transfer Chsrges 1201. Government recordin cha es from GFE #7 117.00 1202. Deed 42.50 Mo a e 20 Pa es 74.50 Releases 1203. Transfer taxes from GFE #8 2 375.00 1204. Cit Coun taz slam s Deed 2375.00 Mort a e 1205. State tax/slam s Deed 2375.00 Mort a e 1206. $2 375.00 1300.Additional Settlement Charges 1301. R wired servces that ou can sho for from GFE #6 1302. Nola Fee to Connie L. Wertz Nola Public 1303. Tax Cert Processin Fee to Secured Land Transfers - Mechaniabu 10.00 10.00 1304. Pest Treatment to Pest Pros 1305. Percolation Test to )WP Environmental Inc. 583.00 305.00 1306. Se tic Ins ion to Ramse 's Se tic Service 1307. Escrow Hold for Resurve to Shell and Witter 1308. Escrow Hold for Se tic S stem to Ramse 's Se tic Services 1309. Di Probe Holes and Perk Holes to Ramse 's Se tic Service 1310. Attome Fee to Stone Lafaver & Shekletski 500.00 3,000.00 18 620.00 360.00 750,00 1311. Escrow Hold for 2011 School Taxes to Secured Land Transfers - Methanksbur ;2,600.00 1312. Lien Cert. Fee to Secured Land Transfers - Mechaniabu 12.00 1313. Escrwo Hold for 2011 Coun Taxes to Secured Land Transfers LLC 1314. Escoow Hold For Co .Lien Cert. t0 Secured tend Transfers LLC 1 000.00 5 000.00 1400.TOtal Settlement Charges (enter on lines 103, Section 7 and 502, Section K) 57,172.21 649,375.00 If you have arty questions about the settlement Charges and ban terms fisted on this form, please cooled your lerxler. Settlement agent is not responsible for content o} lenders assessments on HUD. The sellers end borrowers signatures hereon acknowledge their approval and signify their understanding that tax and Insurance proretions and reserves are based on figures for the preceding year or supplied by others or estimated for the current year, and in the avert of any charge for the current year, alt necessary adjustrnenta will be made between borrower arq eefier direttty. Any defict definqueM taxes or mortgage payoffs will be promptry reimbursed to the selttemeM agent by the seller. I have Carefully reviewed the HUD-t SettlameM SfatemeM and to the best of my knowledge and belief, it is true and acwrate statement of all rekxipts and disbursements made on my account a Dy me in ibis trensaction. I fiather certify that I have received a copy d the HUD-1 Settlement Statement. BUYE R L. -'- S. hears - SELLERS mt Cabins Camp, I ra ~~ By: aniel ri The 1 Satllemenl 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 ac rda CB with this slate nt /' ,~~ i 5 f ~a c /V/~If`/)ff 401102054-CL HUD-i o~..e ~ ..r ~ Com arison of Good Faith Estimate GFE and HUD-1 Char es HUD-1 Una Good Fa1th Charges That Cannot Increase HUO-1 Number Estimate our o ' inatlon cha e # 801 2 010.00 2 010.00 Your credit or char a ints for the s cific interest rate chosen # 802 Your ad'usted on inatlon char es # 803 2 010.00 2 010.00 Transfer taxes # 1203 2 375.00 2 375.00 HUD-1 Una Good Faith Charges That in Total Cannot Increase More Than 10% Number Estimate HUD-1 Government recordin cha es # 1207 129.00 117.00 Attorne fee # 650.00 A sisal Fee # 804 325.00 325.00 Life of Loan Flood # 806 81.50 1.50 Flood Certification # 807 12.50 12.50 Title Services -Lender's Insurance # 1101 1 873.75 1647.88 Owner's Title Insurance # 1103 100.00 216.00 Total 3 091.75 2 319.88 Increase between GFE and HUD-1 Char es 771.87 or -24.97% Charges That Can Change Good Falth HUD-1 Estlmate Initial de osit for our escrow accaunt # 1001 3841.04 Dail Interest cha es # 901 22.12 da 353.97 597.33 Homeowner's Insurance' # 903 600.00 1 550.24 Loan Terms Loan Number: 919-300 Your initial loan amount is $190,000.00 Your loan teen is 30 years Vour initial interest rate is 4.25 % _.. .._ .. $934.69 includes Your initial monthly amount owed for principal, Interest X Principal and any mortgage insurance Is X Interest Mortgage Insurance No. ^ Yes, it can rise to a maximum of o/,. The first . _. _ change will be on and can change again Can your Interest rate rise? _ every after .Every change date, your interest rate can increase or decrease by %. Over _- - -._.. the life of the loan, your interest rate is guaranteed [o never be lower than % or higher than alo. Even if you make payments on time, wn your loan balance 0 No. ^ Yes it can rise to a maximum of $ rise? , ~ Yes the first Increase Q No n b Even if you make payments on time, can your monthly . , p e on and the amount owed monthly amount owed can rise to $ .The maximum it can for prindpal, interest and mortgage insurance rise? '" ever rise to is S l l ~ No. ^ Yes, your maximum prepayment penalty is $ Does your oan have a prepayment pena ty? , _.__ _ __ X^ No. ^ Yes, you have a balloon payment of $ due in Ooes your loan have a balloon payment? _ .... .. years on a 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. You have an additional monthly escrow payment of; _ _ _ _... that results in a total initial monthly amount owed of $ Total monthly amount owed inducting escrow account _ This includes principal, interest, any mortgage insurance and any items payments checked below: Property taxes ~ Homeowner's insurance Flood insurance Huse: a you nave any questions aoouc cne aearemenc c.narges ana roan Terms ustea on tms corm, please contact your lender. `~_ Initiats` HUD-1 Addendum file Number: 401102054-CL Settlement Agent/Place of Settlement: Property Address: 1676 SHEEPSKIN HOLLOW ROAD, Secured Land Trsna/ers LLC FORT LITTLETON, PA 17223 , 485 ST. JOHNS CHURCH ROAD , COUNTY: FULTON SHIREMANSTOWN , PA 17011 PARCEL ID: OS-06-0108 Phone : {717) 901-8342 TOWNSHIP: DUBLIN TOWNSHIP Seller(s): BURNT CABINS CAMP, INCORPORATED euyer(c): RANDALL L. SHEARER AND LORI S. SHEARER Settlement Date: 1/5/2012 1:30:00 PM Disbursement Date: 1/5/2012 Loan Number: 919-300 Lender: Coming Federal Credit Union Mortgage Broker: Buyer Charges New Loan fees: Processing Fee to Corning Federal Credit Union Courier Fee to Coming Federal Credit Union ;300.00 Rate Extension Fees ;1,425.00 ;285.00 Line 803 Total: 12,030.00 Appraisal Fee to Ausherman POC;325.00 Flood Cert. Fee to Coming Federal Credit Union Life of Loan Fe to Coming Federal Credit Union ;12.50 ;1.50 Title and Escrow Charges: Settlement/Closing Fee Buyer to Secured Land Trensfers, LLC Notary tee to Connie L. Wertz, Notary Public ;225.00 Lender's Coverage to Secured Land Transfers, LLC ;20.00 100/300/900 to Secured Land Transfers, LLC ;1,177.88 $150.00 Insured Closing Protection Letter to First American Title Insurance Company ;75.00 Line 1101 Total: ;1,647.86 RI to Secured Land Trensfers, LLC ;216.00 Una 1103 Total: 5216.00