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HomeMy WebLinkAbout09-05-121505610105 REV-1500 EX (o2-ii) (FI) '~ PA Department of Revenue Pennsylvania OFFICIAL USE ONLY ~t~.A~~,Mt~, of ~,E~t~~E County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX X80601 h Harrisbur , PA 1'7128-o6oi RESIDENT DECEDENT ~I vl' ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 195-28-0030 ' 01/23/2012 :10/01/1936 Decedent's Last Name Suffix Decedent's First Name MI Hoffman Donna F (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 FILE D IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) p 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O} CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number _. David A. Baric, Esquire 249-68~ (717) ~ ~ -~-, Q .. ~-~- _ x::~ ~ t - - REGISTER ~LS USE 0~1~'If r r ~ ~:; `..~ .- ~_.-' ~~ ~~_ ; I ~_., . First Line of Address ~ ~%~ ~ } r,- ~ .. ~ Baric Scherer LLC ~ ;~-~ ~ . ~ ° r ~.. ~~ - Second Line of Address o ~.- ~_', C"ra " ~_ _~ - -; `•- ''~~"? I;~ ' 19 West South Street O ~' ~ ~~ c.^ Cit or Post Office State ZIP Code DATE FILED y Carlisle PA 17013 Correspondent's a-mail address: dbarlC@barlCSCherer.COm Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG TUR OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS 40 ssroad S ool Road, arlisle, PA 17015 SIG OF PF~E A R ER PRESENTATIVE DATE oR D4 1 a ,~ ~ 19 West South Street., Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J ,, ~~~v J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number decedent's Name: Donna F. Hoffman 195-28-0030 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 135,618.57 2. Stocks and Bonds (Schedule B) ....................................... 2.' 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ....................... .... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... .... 5. ' 74,071.64 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ... .... 6. 103,886.50 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule v) ©Separate Billing Requested.... .... 7. 8. Total Gross Assets (total Lines 1 through 7) ......................... .... 8. 313,576.71 9. Funeral Expenses and Administrative Costs (Schedule H} ............... .... 9. ' 37,728.41 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... .... 10. 0.00 11. Total Deductions (total Lines 9 and 10) ............................. .... 11. 37,728.41 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. 275,848.30 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................... .... 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .... 14. 275,848.30 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 _ _ 16. Amount of Line 14 taxable at lineal rate X .0 ~'_5 275,848.30 ' 1g. 12,413.17 17. Amount of Line 14 taxable at sibling rate X .12 ' 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ....................................................... .. 19. ' 12,413.17 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 1505610205 1505610205 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Donna Hoffman STREET ADDRESS 1404 Walnut Bottom Road CITY Carlisle ~ STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments __ B. Discount 3. Interest 16, 825.93 620.65 4. If Li..e 2 is greater than I.~ine 1 + Line 3, inter the difference. This is the 01/ERPAYP.R~NT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) {3) (4) (5) 12,413.17 17,446.58 0.00 5,033.41 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred .......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income ............................................ ^ c. retain a reversionary interest .............................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable-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? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption, RFV-1.511. EX~ (10-Q9) ` ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Donna F. Hoffman 21-12-0179 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. 1 2 3 4. 5, 6. 7. s. 9. 10. 11, ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Catherine Gree street Address _402 Crossroad School Road __ city Carlisle Year(s) Commission Paid: 2012 state PA ZIP 17015 13,900.00 Attorney Fees; Family Exemption: (If decedent's address is not the same as claimant's, attach explanation,) Claimant None Street Address City State ZIP 13, 900.00 __________ _ _.___.___ Relationship of Claimant to Decedent Probate Fees: Accountant r"ees: Tax Return Preparer Fees: The Sentinel (legal advertising) 168.30 Cumberland Law Journal (legal advertising) 75.00 Heritage Lawn Landscape 1,380.00 PPL 176.92 Comfort Construction 175.00 *CONTINUED ON ATTACHED SHEET* TOTAL (Also enter on Line 9, Recapitulation) I $ 37,728.41 If more space is needed, use additional sheets of paper of the same size, ESTATE OF DONNA F. HOFFMAN Estate # 21-12-0179 SCHEDULE H CONTINUED: 12. Green Ridge Village $ 6,467.42 13. Robert Cairns tax collector $ 303.03 14. Robert Cairns tax collector $ 4.90 15. Sharon Eakin $ 100.00 16. IRS $ 559.00 17. Department of Revenue $ 286.00 18. Dr. Guistwite $ 12.84 19. Smith Elliot Kearns & Co. $ 220.00 REV-isog EX+ (oi-io) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Donna F. Hoffman 21-12-0179 SCNED~lLE F JOINTLY-OWNED PROPERTY If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A, Catherine Greeley 402 Crossroad School Road Carlisle, PA 17015 daugther B. C JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST i. A. 12106112 Susquehanna Bank; Acct. # 1000940213 207,773.00 50 103,886.50 TOTAL (Also enter on Line 6, Recapitulation) I $ 103,886.50 If more space is needed, use additional sheets of paper of the same size, REV-iso8 EX+ (li-io} 4 i ~~ pennsylvania SCHEDt~LE E DEPARTMENTUFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Donna F. Hoffman 21-12-0179 Include the proceeds of litigation and the date the proceeds were received by the estate. Ali property jointly owned with right of survivorship must be disclosed on Schedule F. If more space is needed, use additional sheets of paper of the same size. DO1~IlITA F . HOFFMAN - I, DONNA F_ HOFFMAN, of 285 South Side Drive -Newvlle, -Penn Township, Cumberland County, Pennsylvania, being of sound and dzspo5ng -::mi:n.d; memory and understanding do make, publish and declare this to be my Last Will an3-Testament.' I hereby revoke all .previous Wills and Codicils at any time heretofore made by me. - - - ~_ :_ _ ,. .. ~ - ,, _ - - --=iii I--_-_--. _. __ - order and= direct my Executor , hereinafter named, to pay my `debts funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. ITEM II I direct that my body shall be cremated according to my plan with the Cremation Society of Pennsylvania and the ashes scattered on my property in Newville_ I also direct that there be no viewing or public memorial services. ITEM III I give, devise and bequeath all of the remainder of my property, of - - every kind and description (including lapsed legacies and devises wherever situate and whether acquired before or after the execution of this Will , to my husband, FART, E _ HOFFMAN, if he survives me , or if he predeceases me, to my children, CYNTHIA MANGUM, SHARON ANN E.AKIN and CATHERINE GREELEY, per stirpes. Page 1 of 4 ~• ~~~~ C~ LAST WILL AIJD T$STAMENT - OF ~_ of this, my last Will and Testament. ITEM VI I hereby direct that no Executor or other Fiduciary named or .'appointed by this Will shall be required to post any bond or give any security of any type for .any purpose whatsoever, nor be liable for - failure to file any report, accounting or inventory, in any jurisdiction `in which he or she may be called upon to act, insofar as I am able by iaw to do. IT$M VII _,: --_ -- I authorize my Executor in his discretion, to sell, with or without `:notice, at either public or private sale, and to lease any property _~ belonging to my estate , subject only to such confirmation of Court as .may be required by law, for such prices and on such terms and conditions as he deems best, and to make distribution hereunder either in cash or kind, as he may deem wise. Page 2 of 4 _ ~ _ - _ _ y ~a --`; ,}^ ~= F` ,~ ~~_ ~_ ~- ~' :; ,- i fi=!~ . - ~ residing at :~._~~ ~ ~ V "r~ fan 'S L, residing at ,~ ~ tress ~~~'~-~-~ tic, %~7~--=-~-~ residing at ~---~,~~-~._z- ~,~ _ _ _ _ F~~itness COMMONWEALTH OF PENNSYL`TANIA `--CE~~3Ir1TY OF Ct]MBBI~.LAI~TD We , DONNA F . HOFFMAN , JAMES J . KAYER , SS. DEBRA D . NELSON and PATRSCIA R. BROWN, Testatrix and the witnesses, respectively, whose names are .signed to the attached or foregoing instrument, being first duly sworn, ;do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament, and she had signed willingly and that she executed it as her free and voluntary act ~;, for .the.- purposes therein;- expressed., :.and. _ that each: _.of the -~ritnesses , in - ; the presence and hearing of the Testatrix, signed the Will as witness ,' and that to the best of his/her knowledge, the Testatrix was at that or older, of sound mind, and under no DONNA F. HOF - EST X Page 3 of 4 OMB Approval No 2502-0265 ~~'~'~~_~`'~ ,A. Settlement Statement (HUD-1) illulii ; 1. ^ FHA 2. ^ RHS 3. ^Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 12-31 4. ^ VA 5. ^Conv. Ins. C. Note: This forrn 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 8r Address of Seller: F. Name & Address of Lender: Holly Lyn Shoemaker Estate of Donna F Hoffman USDA Rural Development 22 Clifton Terrace, Carlisle, PA 17015 1404 Walnut Bottom Road, Carlisle: PA 17015 401 East Lowther Str, Ste 304, Carlisle, PA 17013 G. Property Location: H. Settlement Agent: I. Settlement Date: 06/22/2012 1404 Walnut Bottom Road A One Settlement Services, LLC Disbursement Date: 06/22/2012 Carlisle, PA 17015 337 Lincoln Street, Carlisle,-PA 17013 South Middleton Township Place of Settlement: TitleExpress 337 Lincoln Street, Carlisle, PA, 17013 100.. ::Gross Arnaunt Due rom.Borrower 101. Contract sales price 146,000.00 102. Personal ro ert 103. Settlement charges to borrower (line 1400) 4,892.69 104. Payment Toward Principal payable to USDA Rural H 221.65 105. Ad'ustments for items aid b seller in advance 106. Cityltown taxes to 107. County taxes 06122/2012 to 12/31 /2012 158.97 108. Assessments 06122/2012 to 06130/2012 26.69 109. 110. 111. 112. 120. Gross Amount Due from Borrower 151,300.00 200. `AmountsE~aid b or<im~Behalf of Borirower. 201. Deposit or earnest money 1,000.00 202. Principal amount of new loan(s) 151,300.00 203. Existin loo s taken sub'ect to 204. 205. 206. 207, 208. 209. Ad'ustments for items unpaid b seller 210. City/town taixes to 211. County taxes to 212. Assessments to 213. 214. 215. 216. 217. 218. 219. 220• Total Paid b Ifor Borrower 152,300.00 300. Cash at Settlemenfftomfto`Borrower 301. Gross amount due from borrower (line 120) 151,300,00 302. Less amounts paid by/for borrower (line 220) 152,300.00 303. Cash ^ From ^X To Borrower 1,000.00 ..._ . __.._.._,,.,.....~ .._ ....... .......................... ... ......~„~o,~.,,~ ,....,.~,~,a.~.. o...~ ~~~~~~,..~~ r~~ ~~~r,.~~o~ ~..~ ~~~~ou~~~y, ~e.~~..~~~y. a~~ P B ~ B Y Y is i ortna ion. en you ere no requue o comp e e this form, unless II tlisplays a currently valltl OMB control number. No conftlentiality Is assured; tMS disclosure Is mantlatory. Thls is tlesignetl to provide the parties to a RESPA covered transaction witn information during the settlement process 40t) GrossAmountiDueto Seller 401. Contract sales price 146,000.00 402. Personal ro ert 403. 404. 405. Ad'ustments for items aid b seller in advance 406. Cityltown taxes to 407. County taxes 06/22/2012 to 12!31/2012 158.97 408. Assessments 06/22/2012 to 06/30/2012 26.69 409. 410. 411. 412. 420. Gross Amount Due to Seller 146,185.66 500 , Red~ictions In>Amount'Due to Seller 501. Excess deposit (see instructions) 502. Settlement charges to seller (line 1400) 10,567.09 503. Existin loans taken sub'ect to 504. Pa off of first mort a e loan 505. Pa off of second mort a e loan 506. 507. 508. 509. Ad'ustments for items unpaid b seller 510. Cityltown taxes to 511. County taxes to 512. Assessments to 513. 514. 515. 516. 517. 518. 519. 520. Total Reduction Amount Due Seller 10,567.09 600: Cacti at~Settlementtolfrom Seller 601. Gross amount due to seller (tine 420) 146,185.66 602. Less reductions in amount due seller (line 520) 10,567.09 803. re o m Cash X^ To ^ From Seller e a a is a enc ma no co e n 135,818.57 Previous editions are obsolete Page 1 of 4 HUD-1 ~.~~ • ' 700. Total Real Estate Broker Fees - $8,985.00 Paid From Paid from Division ~of commission lihe 700 as follows: Borrower's Seller's 701. $4,605.00 to Prudential Home Sale Services Funds at Funds at 702. $4,380.00 to Re/Max Delta Group Settlement Settlement 703. Commission paid at settlement 8,985.00 704. Broker Fee to RelMax Delta Group 195.00 '800: Items-Pa able in Connectionw,nth Loan 801. Our origination charge (Includes Origination Point 0.000% or $0.00) $ (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) 804. Appraisal fE:e to Rural Develo ment (from GFE #3) 425.00 805. Credit report to (from GFE #3) 806. Tax service to Rural Develo ment (from GFE #3} 96.00 807. Flood certification to from GFE #3 808. to 900. Items R iiiired b L-ender to be Paid in Advance 901. Daily interest charges from from 06122/2012 to 07/01/2012 @ $0.00/day (from GFE #10) 902. Mort a e insurance remium months to from GFE #3 903. Homeowner's insurance -for 1 ears to Erie Insurance Exchan e $562.00 P.O.C. B' (from GFE #11) 904. months to from GFE #11 1000: Reserves lk osifed:with Lender 1001. Initial deposit for your escrow account (from GFE #9) 1,220.94 1002. Homeowner's insurance months $ 46.83/month $ 1003. Mort a e insurance months $ Imonth 1004. Pro ert taxes months $ Imonth 1005. months $ /month 1006. Assessments months $ O.OOlmonth $ 1007. Escrow for taxes and insurance $1,220.94 1100. Title"Chan es 1101. Title servia:s and lender's title insurance from GFE #4 1,365.75 1102. Settlement or closing fee to $ 1103. Owner's title insurance from GFE #5 1104. Lender's title insurance $1,313.75 1105. Lender's title policy limit $151,300,00 Lender's Policy 1106. Owner's title policy limit $146,000.00 Owner's Policy 1107. Agent's portion of the total title insurance premium $1,028.16 1108. Underwriter's portion of the total title insurance premium $285.59 1109. Notary Fee to Kell Baker $30.00 20.00 1110. Wire Transfer Fee to A One SettlementslOrrstowi $12.00 1111. Overnight Mail Fee to A One Settlements/Fed Ex $10.00 .1200. ;Government Recordin and TransferCha es 1201. Government recording charges $ (from GFE #7) 130.00 1202. Deed $62.(10 Mort a e $68.00 Release $ 1203. Transfer taxes $ (from GFE #8) 1,460.00 1204. CitylCounty tax/stamps Deed $1,460.00 Mort a e $ 1205. State Tax/stamps Deed $1,460.00 Mort a e $ 1,460.00 1206. Deed $ Mort a e $ 1300. Additional Settlement Cha es 1301. Required services that you can shop for (from GFE #6) 1302. to 1303. Pest Inspection to All American Pest Control $45.00 P.O.C. B' 1304. 2012 County/Twp. taxes to Robert Cairns, Tax Collector $303.03 P.O.C, S' 1305. 2011-2012 School Taxes to Robert Cairns, Tax Collector $1,220.94 P.O.C. S" 1306. Final Water/Sewer-Acct#022208 to S.M.T.M.A. 102.09 1307. Deed Prep to Baric & Scherer POC 1308. Home Inspections to MidPenn Home Ins ections $280.00 P.O.C. B' ' ~ ~ • ' ~ ~ 4,892.69 10,567.09 '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 editior~s are obsolete Page 2 of 4 HUD-i ;: Com `~ison~~ofl~yood~Fa1th.Esffriate" GF. and HUD-1 Cha es ::. 1Cha es 7hat`Ga~rtifaf Irifnease~'.:; ' .; . WUD-1..~ir-e! Number ~'-Our'ori~in;~tion~ar e.~~ '.`#.~$01> . <Your;aedit~r~ckia' ' , ' ""ts for'ftie:s ifiGanterest(atechosen; #,:802. Youradjustedotittination°char~es ;: . , # °8D3 Tratasfertazes ~~ ::, ~ # ° 1'203 .:, " Mrttal.d~ppa,,+fior~"w t'G4uaccount #,,1001,., rDa,lyi~ter~sto~.~.. #ratn' - ~ - ~: # ~~',~~: ~ ~ $~ lda ~Homeovimer's:~nsrurance .~~ # .~ #~ # - Loan Terms Good Faitf9:Estimate " HUD-1 0.00 0.00 0.00 0.00 0.00 0.00 1,460.00 1,460.OC Good Faitfi~Estimate` HUD-1 150.00 130.00 425.00 425.00 32.00 0.00 96.00 96.00 1,448.75 1,365.75 0.00 0.00 2,151.75 2,016.75 $ -135.00 or -6.2740% Gina Fa~ffi"";Estimate>~ = HUB~1_ 1,263.79 1,220.94 0.00 0.00 540.00 562.00 'Youran~tial Ioan;aGnonntis ~° $151,300.00 Yourloar!~ferm is; r 33. years Your initial mferest~ rate is 3.2500% Your~nttial monthly amount-owed for prjr~apal,' lntete~t, and any,mortgago $623.37 includes :insurance;is. ; - ~ ~ ~ ,. r ^X Principal ^X Interest ^ Mortgage Insurance 'Can yaun,nterest-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 the loan, your interest rate is guaranteed to never be lower than % or higher than %. Even.if~youmake p8yr~ertts`'on time; can yburtoah balahcense?' ~~- ^X No. ^ Yes, it can rise to a maximum of $ __,, -~uen rf yqu make payments on.fime;.can yodrtnonthly;amouritowed for X^ No. ^ Yes, the first increase can be on I 1 and the monthly principal,<interest; attd mortgage insurance rise? _ amount owed can rise to $ _, , „ The maximum it can ever rise to is $ Dods you> Iban h~a~e~~repaymant penalty? :~; ~'. 0 No. ^ Yes, your maximum prepayment penalty is $ Does your loan hsve a balloon payment? X^ No ^ Yes, you have a balloon payment of $ due in _ years on I 1 ?otal morithly amoiJnt owed~including`escrow account payments; - ^ You de 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 $173,83 that results in a total initial monthly amount owed of $797.20. This includes principal, interest, any mortgage insurance and any items checked below: ;, X^ Property taxes Q Homeowner's insurance ^ Flood insurance ^ ^ ^ Note: It you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. Previous editions are obsolete Page 3 of 4 HUD-1 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. 1 Holly Lyn Shoema er ~ j` `~ ~~ Estate of Donna F. Hoffman ti .~. The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this statement. SETTLEM NT AGI-T1T DATE ` WARNING: IT IS .4 CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. Previous editiorus are obsolete Page 4 of 4 HUD-1 • • 1 1 • /~ Name of Borrower: i Name of Seller: File Number Holly Lyn Shoemaker ~ Estate of Donna F. Hoffman 12-31 TitleExpress Prepared 06/21/2012 at 3:42 pm Note: This page is furnished to give you an itemization of the amounts shown on Lines 1101, 1103 and ,~;~ 1104 of the Settlement Statement (HUD-1). This page accompanies but is not a part of the ~ ~ ..e - ~ti°', settlement statement. if a discrepancy exists, the information shown on the Settlement Statement ~± (HUD-t) applies. ~ - ~` .~.~.; .',_ ~"~'1 L a~~'-r"'~1arg lt~"'~ ~~kirrll~ : i _ ~ _ ...... _.. .......... ......-.-....: .T.~,.s_....r~ms,_..~an.<. ~~..,. :rn .. r.^t 54..~t!".;..~ ,~....w.. P'~"T... 'r --~ ?f VV.T.:Rr. 1101. Title services and lender's title insurance ~ .. _ 1,365.75 - _.... _ _ a. b. c. 1102. Settlement or closing fee 1103. Owner's title insurance 1104: Lender's title insurance (policy) 1,088.75 $ 1,313.75 a. Endorsement 900 EPL-Residential 50.00 b. Endorsement 100 (No Violation) 50.00 c. Endorsement 300 Survey 50.00 d. Closing Service Letter 75.00 (Total 1103 + 1104) ry y. :3I~ f L :i~~Fl.4"MH ' .:"R- Y4 .1 t.J,.y CC "i Z . ~ ,. ~. - .. :. ~... ~.... S .~. y r`~~ ~~ ~, 'd 'aS~ n vXy, 1109. Notary Fee $ 30.00 ! 1110. Wire Transfer Fee $ 12.00 1111. Overnight Mail Fee $ 10.00 1112. _9 - . ... _. _ ...._ .. ....r _ .. _.. .. 1101. Title services and lender's title insurance $ ._ 1104. Lender's title insurance to First Americas Title/A One Settlement Serv 1,313.75 1,313.75 1109. Notary Fee to Kelly Baker 50.00 30.00 20.00 1110: Wire Transfer Fee to A One SettlementslOrrstown Bank 12.00 12.00 1111. Overnight Mail Fee to A One Settlements/Fed Ex 10.00 10.00 ._ .. -r'yi' snf,. .. ~r ~. -.. `.. .r :-~. n. -s. ~ ~. ...r .p . . 4. .,:. 1. -...;.. «.w:~ S", ~~i .-'::: ~. .,. ~a ~~v ~ y~w~T~ a~ r-~:j' / r ~:, ~l-~`-`--`-~- S • ~-= LL~-~- ' - l , EC-- Date 6/22/12 ~ ~t~ ~I ~~5~~- J ~~ o(~ve--~~ Date 6/22/12 Estate of Donna F. Hoffman ~ ~ Holly,L~ Stidemaker