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10-9-12 (3)
15D5610143 REV-1500 Ex(°'-'°' " OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE Po gox.2sosol INHERITANCE TAX RETURN 21 12 0181 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW _ - Social Security Number Date of Death Date of Birth 011 24 9417 O1 10 2012 10 04 1929 Decedent's Last Name Suffix Decedent's First Name MI CONNORS PHYLLIS S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 0 1. Original Return ^ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Comppromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) ^ g. Decedent Died Testate ~ ecederp~t Mainta'ned a Living Trust ~ 8. Total Number of Safe De osit Boxes (Attach Copy of Will) ^ Attach Gopy of 1lrusl) p 9. Llti ation Proceeds Received 1 °. Spousal Povert Cred't ((date f death g ^ between 12-31 ~1 an~ T-1-95~ ^ 11.Election to tax under Sec. 9113(A) ;~^~ (Attach Sch. O) `-"- ~ -~ c~ ~ ;-*~ CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION _ _ D BE DIR~'ED T~~d.T- Name Daytime Telephone `~ er _..a .~ ~ . RONALD M KATZMAN ESQ 717 234 4 ~r ~~~ __ - :,.~, REGISTER OF WIL~$ CAE ONLY -.. T ' _ ~C~ _ - ;-~ t ~ First line of address -~~`4~' ~ - ~.~ ~ 4250 CRUMS MILL ROAD Second line of address PO BOX 6991 DATE FILED City or Post Office State ZIP Code HARRISBURG PA 17112 Correspondent's a-mail address: rmkt~goldbergkatzman.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. SIGNATURE OF P RSON ESPONSIBLE FOR FILING RETURN DATE ~q~A~~ ~ ~ ` ~ .,~ `-, 'r}"',2~-,"~y~,'~-'t-~"`""- M i ch ae I S. Connors ~) ~~ ° I/ ADDR SS t 4569 Saddlewood Drive, Minnetonka, MN 55345 SIGNATURE OF PREPARER OTHER T N REPRESENTATIVE DATE ~~ ~ Ronald M Katzman Esq/ ~~~;~~+~•~' Goldberg Katzman, P.C., 4250 Crums Mill Road, Harrisburg, PA 17112 Side 1 L 155610143 1505610143 ~,~ J REV-1500 EX Decedent's Name: COnnOrS, Phyllis S. Decedent's Social Security Number 011 24 9417 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2 0 6, 0 0 0. 0 0 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 311 , 5 3 0 . 9 4 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 160 , 525.80 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous f~on; Probate Property ^~ Se arate Billin (Sch Re d l G t d p g ques e u e ) e ............ 7. 63 4 92.2 3 i 8. Total Gross Assets (total Lines 1-7) ..................................................................... g. 7 41 , 5 4 8 . 9 7 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 5 5 , 7 3 9. 5 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 641.24 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 5 6 , 3 8 0.81 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 685 , 168.16 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. 685 , 168.16 TAX COMPUTATION -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 .00 15. 16. Amount of Line 14 taxable 6 8 5 16 8 16 16 at lineal rate X .045 . ~ . 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 ~ . 0 0 18. 19. Tax Due ...................................................................... ............................... . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 30,832.57 0.00 0.00 30,832.57 Side 2 1505610243 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-12-0181 DECEDENT'S NAME Connors, Phyllis S. STREET ADDRESS 502 Allison Avenue CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 26,000.00 1,368.42 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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. (1) Total Credits (A + B) (2) (3) (4) (5) 30,832.57 27,368.42 3,464.15 Make Check Payable to REGISTER OF WILLS, AGENT .. ~iii:.f ~sLL-Kil'ra . '_a.~'~<'w..~. -(d~.~s '....~.. ~ ..._ :S.- .:. _ a ..:.r . ~. ~:,,:~ .~.. ~....... ... , ... _ __, ... .. _. r .. _ ~ . ~ a ~bx~:r_ .. l ... .. _.r.. w_...a..~,...;s!,._,,....~ .... _,,..;:.:.,;: .~..,........ . 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 ............................................................................................................... ^ 0 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? .................................................................................................................... ^ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^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. L y- .~, ~, r. :,.. - ii £w~ '. .._,.,. ....._ .._,. x.. ......_ _.... _ _.. _.. .. .-..... .. .. _.... .. ..._ _.. .. .. _. _, ~ ... ,........ 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 January 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)J. 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)J. . 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. Rev-1502 EX+ (11-08) SCHEDULE A ;; REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Connors, Phyllis S. FILE NUMBER 21-12-0181 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 which is jointly-owned with right of survivorship must be disclosed on schedule F. Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) (If more space is needed, additional pages of the same size) Rev-1503 EX+ (6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Connors, Phyllis S. 21-12-0181 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 545 shares of BNY Mellon Vodaphone stock -com 25.666844 13,988.43 2 62886E108 77.668 shares of NCR Corp New -Com 16.7500129 1,300.94 3 193 shares of Pershing Guardian Account -Alcatel Lucent - 1.62 312.66 com 4 29.76 shares of Pershing Guardian Account - AT&T -Com 3432 102,136.32 5 923.964 shares of Pershing Guardian Account -Delaware HY 3.9500024 3,649.66 Opportunities -Mutual Fund 6 17,587.254 shares of Pershing Guardian Account -Delaware 8.15 143,336.12 PA Tax-Free -Mutual Fund 7 259 shares of Pershing Guardian Account -Frontier 5.05 1,307.95 Communications -com 8 1,082 shares of Pershing Guardian Account - Verizon 38.57 41,732.74 Communications -com 9 77.668 shares of TeraData -Com 48.489983 3,766.12 TOTAL (Also enter on Line 2, Recapitulation) 311,530.94 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1508 EX+ (8-98) SCHEDULE E s CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Connors, Phyllis S. 21-12-0181 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Belco Certificate of Deposit -Certificate number 46606 12,165.78 2 Belco Checking Account No. 152680 3,926.81 Accrued interest on Item 2 through date of death 4.60 Accrued interest on Item 2 through date of death 5.13 Accrued interest on Item 2 through date of death 4.99 Accrued interest on Item 2 through date of death 2.52 Accrued interest on Item 2 through date of death 2.45 3 Belco Savings Account No. 152680 12,765.94 4 Members First Credit Union -Account no. 334918 594.54 5 Pershing Guardian Account -Money Market Account -Account # 33W200515 125,960.72 6 Household items -Appraisal of personal property - 2/13/12 2,220.00 7 BNY Mellon Vodaphone -replacement dividend check from lost check received in 2006. 628.82 8 PA Department of Revenue - 2011 State income tax refund. 64.00 9 US Treasury - 2011 Federal income tax refund. 707.00 10 Verizon medical premium -refund of prepaid amount 472.50 11 Miscellaneous personal property 1,000.00 TOTAL (Also enter on Line 5, Recapitulation) I 160,525.80 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. N N-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I FILE NUMBER Connors, Phyllis S. 21-12-0181 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF TRANSFER SATTACiiTA COPYEOF TIOHE DEED ~OR REAEESTATDE. DATE OF DEATH VALUE OF ASSET °i° OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Pershing Guardian IRA Rollover - Metlife Bank Money 50,231.84 100.000% 50,231.84 Market Account no. 5WL528226. All children named beneficiaries, in equal shares. 2 Phoenix TIP -Annuity account No. 13025714. Son, 13,260.39 100.000% 13,260.39 Michael Connors sole beneficiary. TOTAL (Also enter on Line 7, Recapitulation) I 63,492.23 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (10-06) . ,, COM IN~HEgETA CE~ ~ RET~RN ANIA RE,,IDENT DECEDEN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Connors, Phyllis S. 21-12-0181 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(sl Commission raid 12,272.07 2. Attorney's Fees Goldberg Katzman, P.C. 11,000.00 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. Probate Fees 595.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 31,872.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 55,739.57 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Connors, Phyllis S. 21-12-0181 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex enses 1 Diocese of Harrisburg -Burial Expense 1,025.00 2 L'Costa Villa -Food/refreshment expense at Funeral. 600.35 3 Malpezzi Funeral Home 10,646.72 H-A 12,272.07 4 Other Administrative Costs ADT Security -payment for 502 Alison Avenue, Mechanicsburg, PA 17055. 24.06 5 American Home Shield -Home Owner's Warranty fee as shown on page 2, line 1303 of HUD 540.00 -1. 6 Barry Hechard, Tax Collector -Town/County taxes. Estate paid total amount of $987.18 on 727.76 512/12. Estate received 259.42 as adjustment from buyer of 502 Alison Avenue, Mechanicsburg, PA, as depicted on page 1, line 407 of HUD-1. 7 Barry Hechard, Tax Collector -School taxes. Estate paid total amount of $2,504.32. Estate 578.99 received 1,925.33 as adjustment from buyer of 502 Alison Avenue, Mechanicsburg, PA, as depicted on page 1, line 409 of HUD-1. 8 Belco -Bill pay fee. 5.00 9 Belco -Bill pay fee. 5.00 10 Borough of Mechanicsburg -For billing period of 03/30/12 to 06-30-12 128.32 11 Borough of Mechanicsburg -trash/sewer for 502 Alison Avenue, Mechanicsburg, PA 17055. 152.32 12 Borough of Mechanicsburg -For billing period of 7/1/12-9/30/12 128.32 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Connors, Phyllis S. 21-12-0181 ITEM NUMBER DESCRIPTION AMOUNT 13 Carlisle Sentinel -Publication fees. 235.00 14 Chuck Bricker -Appraisal of household items. 100.00 15 Comcast -Final amount owed for cable for 502 Alison Avenue, Mechanicsburg, PA 17055, 6.85 paid March 13, 2012. 16 Commonwealth of Pennsylvania -Auto title search 5.00 17 Culaman's -February 2012 Snow Removal at 502 Alison Avenue, Mechanicsburg, PA 17055. 47.93 18 Cumberland Law Journal -Publication fees. 90.00 19 Deluxe Checks -Checks for Estate checking account. 15.25 20 Don Lenk Tree Service -Tree removal at 502 Alison Avenue, Mechanicsburg, PA. 400.00 21 Erie Insurance Group -Home Owner's Insurance for 502 Alison Avenue, Mechanicsburg, PA 355.00 17055. 22 Goldberg Katzman, P.C. -Attorney's fee for real estate transfer as shown on page 2, line 1,500.00 1304 of HUD-1. 23 Jack Gaughen Realty -Broker's commission on sale of real estate as shown on page 2, lines 12,315.00 703 and 704 of HUD-1. 24 Johnson, Duffie, Strewart & Weidner -Reimbursement of Tax Certification as shown on page 10.00 2, line 1302 of HUD-1. 25 Kevin Connors -Lawn Maintenance 388.21 26 Masland & Barrick Advisory, Inc. -Preparation of federal and state income taxes for 2011 - 150.00 3/15/12 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Connors, Phyllis S. 21-12-0181 ITEM NUMBER DESCRIPTION AMOUNT 27 Masland & Garrick Advisory, Inc. -Brokerage Account matters 881.25 28 Maureen Ross -House cleaning, May 2012. 100.00 29 Maureen Ross -House cleaning, September 2012. 90.00 30 PPL -March 2012 electric Service to 502 Alison Ave, Mechanicsburg, PA 17055. 259.01 31 PPL -April 2012 electric Service to 502 Alison Ave, Mechanicsburg, PA 17055. 355.98 32 PPL -May 2012 electric Service to 502 Alison Ave, Mechanicsburg, PA 17055. 234.00 33 PPL -June 2012 electric Service to 502 Alison Ave, Mechanicsburg, PA 17055. 233.99 34 PPL -July 2012 electric Service to 502 Alison Ave, Mechanicsburg, PA 17055. 208.98 35 PPL -August 2012 electric service to 502 Alison Ave, Mechanicsburg, PA 17055. 208.97 36 Quality Construction -Painting at 502 Alison Avenue, Mechanicsburg, PA 17055. 2,400.00 37 Quality Construction -Painting at 502 Alison Avenue, Mechanicsburg, PA 17055. 2,800.00 38 Realty Transfer Tax - As shown on page 2, line 1205 of HUD-1. 2,060.00 39 Register of Wills, Cumberland County -Fee to file final Guardianship report. 15.00 40 Robert M.M. Van Rensselaer, Esquire -Fee for obtaining Last Will and Testament of 50.00 Decedent -1/25/12 41 Seller's Assistance to Buyer of real estate - As depicted on page 1, line 506 of HUD-1. 4,000.00 42 United Water -May 2012 water bill for 502 Alison Avenue, Mechanicsburg, PA 17055. 28.04 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Connors, Phyllis S. 21-12-0181 ITEM NUMBER DESCRIPTION AMOUNT 43 United Water -July 2012 water bill for 502 Alison Avenue, Mechanicsburg, PA 17055. 22.18 44 United Water -August 2012 water bill for 502 Alison Avenue, Mechanicsburg, PA 17055. 11.45 45 Verizon -Home telephone for 502 Alison Avenue, Mechanicsburg, PA 17055. 5.14 H-B7 31,872.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) SCHEDULE 1 s DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Connors, Ph Ilis S. 21-12-0181 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) (If more space is needed, additional pages of the same size) REV-1513 EX+ (11-08) ~" SCHEDULE J COMMNHERITANCET//.~~FRET RNANIA BENEFICIARIES RESIDENT DECEDEN~ ESTATE OF FILE NUMBER c:onnors, rn Iles 5. ~ 21-12-0 181 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) o Not is s I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 James Connors Son One-fifth 137,033.63 1775 Winterhaven Drive interest. Mechanicsburg, PA 17055 Kevin Connors Son One-fifth 137,033.63 2185 Canterbury Drive interest. Mechanicsburg, PA 17055 Michael S. Connors Son One-fifth 137,033.63 4569 Saddlewood Drive interest. Minnetonka, MN 55345 William M. Connors Son One-fifth 137,033.63 345 Cochran Road interest. Lexington, KY 40502 Catherine Ferguson Daughter One-fifth 137,033.63 5509 Wells Curtice Road interest. Canandaigua, NY 14424 Total 685,168.15 Enter dollar amounts for distributions shown above on lines 1 5 throu h 18 on Rev 150 0 cover sheet, as a r o riate. NON-TAXABLE DISTRIBUTIONS: II• A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FO R WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) _ ~~ _ ,e _, __ .~,, r _ I, PHYLLIS S. CONNORS, residing at 502 Alison Avenue, Mechanicsburg, Pennsylvania, do make, publish and declare the following to be my last will and testament, intending hereby to dispose of all the property, real and personal, of which I may be entitled to dispose at the time of my death, hereby revoking all prior wills and codicils by me at any time heretofore made. f FIRST: I direct that all my just debts, funeral, and last illness expenses be paid as promptly as possible after my death. SECOND: I give and devise all my clothing, jewelry, personal effects, furniture, household furnishings and effects, automobiles and accessories, and other tangible personal property which I may own at the time of my death_to my husband, WILLIAM J. CONNORS, if he survives me. If my said husband should predecease me, or if we should both die at the same time or under circumstances in which it is impossible to determine which of us died first, I give and devise the same to my issue me surviving, per stirpes. If any of my issue to whom a devise under this paragraph is made is a minor at the time ~?f ~:i str:a_b~tio.r., thereof ; I authorize and empower my executor to make delivery of.his or her devise to a parent of such minor, or to an adult person with whom such minor resides, without requiring guardianship to be obtained, and the receipt by the person to whom delivery is so made shall be a complete acquittance to my executor. THIRD: All the rest, residue and remainder of my estate, real anti personal, wheresoever situate, of which I may die seized or possessed, or of which I may be entitled to dispose by this my will, hereinafter designated my residuary estate, I give and devise as follows: A. If my said husband, WILLIAM J. CONNORS, shall survive me, and we do not both die at the same time or under circumstances in which it is impossible to determine which of us died first, I give and devise my said residuary estate to him absolutely. B. If my said husband shall predecease me, or if we should both die at the same time or under circumstances in which it is impossible to determine which of us died first, I give and devise my said residuary estate to my issue me surviving, per stirpes, and in default thereof to such persons and in such amounts and proportions as would be entitled thereto if I had died at the same time as such issue, intestate, the absolute owner thereof, a resident of the Commonwealth of Pennsylvania, and owning personal property only. FOURTH: If, pursuant to the provisions of this my will, any property shall become payable to or vest in a minor, I authorize and empower my executor, in his sole discretion, to do any or all of the following: A. In the case of income, to accumulate and add to principal such part or all of such income as my said executor may deem not to be reasonably required for the support, maintenance, _ 2 health, education or comfort of such minor. B. To pay over or deliver such property, whether income or principal, in whole, or from time to time in part, to a parent or duly appointed guardian of such minor or to any person with whom such minor may reside, for the use and benefit of such minor, and the receipt of such parent, guardian or other person shall be a complete discharge to my executor. C. In Lhe case of principal., t~? permit may executor to receive or retain such property and to hold the same in the capacity of a donee of a power in trust on behalf of such minor during his or her minority and to deliver and pay over the same to such minor upon his or her attaining majority. While said property may be held by such donee, he may exercise with respect thereto all the powers which a court-appointed guardian would have and also all the powers which are conferred upon my executor hereunder, specifically including the power to sell, lease or mortgage real property, and he is hereby further empowered to pay out for the benefit of such minor .such part or all of the income and principal of such property as to him shall seem proper for the support, maintenance, health, education or comfort of such minor. No bond or other security shall be required of the donee acting hereunder and no such donee shall be required to render periodic accounts to any court. Said donee shall be entitled to receive and may retain without judicial authorization as full compensation for his services the same commissions to which he would have been entitled 3 had he held such property as a testamentary trustee. FIFTH: I direct that all estate, inheritance, transfer, legacy or succession taxes or dutiesr that may be assessed, levied or imposed in or ~y any jurisdiction by reason of my death, whether they be assessed, levied or imposed upon or with respect to property passing under my will or otherwise, be paid out of my residuary estate. SIXTH: In addition to such po~r~rs a~s he ~rnay have by lava, I fully authorize and empower my executor with respect to any and all property which may constitute a part of my estate, whether real or personal, as principal or income, and until final distribution thereof, in his sole discretion, and without applying to any court for permission so to do, or for instructions in regard thereto, as follows: (a) To retain any such property, whether or not authorized by law for the investment of estate funds. (b) To invest and reinvest in any stocks, bonds, common trust funds, or other securities, including securities of regulated investment companies, or in any real or personal property whatsoever and wheresoever situated, whether or not authorized by law for the investment of estate funds and regardless of any rule regarding diversity of estate investments. (c) To sell at public or private sale, grant options on, exchange or otherwise dispose of all or any part of such property 4 __ __ _ _~" or any interest therein at such times and upon such terms and conditions, including credit, as shall seem proper and to give good and sufficient instruments of transfer thereof and to receive the I proceeds of any such disposition. I direct that the power of sale herein granted to my said executor, which includes the power to sell real property, may be exercised for any purpose whatsoever, including the distribution of my estate, and that no purchaser need look to the application made of the proceeds of sale of such real estate. (d) To treat stock dividends as from time to time provided under the laws of the Commonwealth of Pennsylvania. To treat as income any and all cash dividends, whether ordinary or extraordinary, except liquidating dividends, and to treat as principal any and all stock splits, warrants, rights or similar incidents of stock ownership; provided that my executor may, in his discretion, treat as income any such distributions received by him which are taxable as income under Federal or state laws or tions and may treat as principal any such distributions regula , received by him which are not so taxable. e To purchase or sell securities at a premium or ~ } ' 'thout making any deductions from or additions to income, discount wi by reason thereof. ' 'n im rove and insure any real (f} To manage, maintai p ;;~ 1 F eriods, irrespective °f property and to lease the same for such p ~.~. ~ ~~ :r~.. -~ ht otherwise be applicable, and ~on~', any statutory period which mig ~: =r ~:_'~ ..,'} 5 ~' k gg 9. N"i~ ,.~ ' such terms, limitations and conditions, including provisions for renewals or options, as shall seem advantageous, and, if advisable, to pay for the value of any improvements made by a tenant under any such lease. All such leases shall be in all respects binding upon all persons interested in my estate. (g) To exercise or sell rights, options, powers and privileges pertaining to, and to vote in person or by proxy upon, l any stocks, bonds or other securities, all as fully as might be done by persons owning similar property in their own right. (h) To assent to, to oppose and to participate in any reorganization, recapitalization, merger, consolidation or similar proceeding affecting any corporation or association, the securities of which are held hereunder, and in connection with any such proceeding, to deposit securities, delegate discretionary powers, pay assessments or other expenses and exchange property, all as fully as might be done by persons owning similar property in their own right. (i) To borrow money from any person or corporation, as may be necessary to pay taxes or to facilitate any purchase, sale, divisi.~on, partition, or other di sposition~ of an~r :pr©pe~ty 1~21d hereunder, or in aid of the execution of any other power herein conferred, and to give notes or bonds for the sums so borrowed and pledge or mortgage any property as security therefor. (j) To extend or modify any note or bond and mortgage 6 held hereunder, to foreclose any mortgage or take title to the property secured thereby in lieu of foreclosure, and to protect any such property against forfeiture. (k) To settle or compromise all claims or controversies. (1) To hold such property in the name of a nominee, or in such form that title thereto may pass by delivery. (m) To exercise any options owned by me at the time of my death and to retain as part of my estate the securities or other property purchased through the exercise of such options for such period of time as my executor shall determine. (n) To make a just and equitable division or partition of any such property, to allocate particular assets or portions thereof or undivided interests therein to the several beneficiaries as hereinabove provided, and to make distribution in cash or in kind, and, to the extent permitted by law, to make binding valuations of such property. (o) To make any election which may be available to my executor, including, but not by way of limitation, those to determine whether to claim deductions_.available tome or to~ my estate on estate tax or on income tax returns, and to determine the date upon which to value my estate for estate tax purposes, all in such manner as may seem most advisable and without thereafter making any adjustment between income and principal on account of any such determination. 7 (p} To join in or consent to income and gift tax returns filed with or by my surviving husband and to pay any part or all of the income or gift tax due upon such returns. (q) To carry out any direction or authorization to pay over income or principal to any beneficiary by applying the same for the benefit of such beneficiary. (r) To pay all necessary or proper expenses and charges from income or principal, or partly from each, in such manner as j may seem equitable. (s) To employ counsel, accountants and other agents and II to determine and pay to them reasonable compensation. j (t) To make payment from time to time on account of commissions and legal fees, without requiring the payment of interest thereon or obtaining security for repayment. (u} To do all such acts and exercise all such rights and privileges, although not specifically mentioned hereunder, with relation to any such property as if the absolute owner thereof, and to make, execute and deliver any and all instruments or agreements binding my estate. No person dealing with my executor shall be required to inquire into the necessity or propriety of any transaction or into the application of any money or property paid or delivered to him. SEVENTH: I hereby nominate, constitute and appoint my 8 - said husband, WILLIAM J. CONNORS, as executor of this my will, and I direct that no bond be required of him as such executor in any jurisdiction. In the event my said husband shall predecease me or for any reason fail to qualify or cease to act as such executor, I nominate, constitute and appoint my son, MICHAEL S. CONNORS, presently residing at 311 Benham Court, Newark, Delaware, as executor in the place and stead of my said husband with all powers as though originally named as executor hereof, and I direct that no bond be required of him as such executor in any jurisdiction. In the event said MICHAEL S. CO~NORS shall predecease me or for any reason fail to qualify or cease to act as such executor, I nominate, constitute and appoint my son, JAMES M. CONNORS, presently residing in Mechanicsburg, Pennsylvania, as executor in II the place and stead of said MICHAEL S. CONNORS with all powers as though originally named as executor hereof, and I direct that no bond be required of him as such executor in any jurisdiction. EIGHTH: As used in this instrument, the gender used shall be deemed to include the masculine or feminine wherever necessary or appropriate, the singular shall include the plural, and the plural shall be deemed to refer to the singular wherever necessary or appropriate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ day of ~~~~--~_- ~~--~ ~~ 1990. .~ The foregoing will was signed, sealed, published and declared by PHYLLIS S. CONNORS, the testatrix above named as and for her Last Will and Testament, in the presence of us, who, all being present at the same time, at her request, in her presence, and in the presence of each other, have hereunto set our-n zees as subscribing witnesses, this ~ . ~~; day of ~~ ~ ~ ~~~ , 1990 . { ~..,.. --~A ti' ~ ~ 4 -~ Residing at ~, ~. ~ /~ ~ ~~Pr~ '~r- ~;~ ~ ~~'~`'' / ~ ~% "~ ~ ~~ Residing at / / ~' ~a ,/~l~Yr.~ /t'f ! ~ ~~~~~ ~-~ - ~ ---- Residing at ~=~ ~~~~s~.;~.~-~`.~.~~~s-~ ~~,_~'<:?_.~~~ ~~~~~~~_f!}.~~a~..,~'. a~- ~'- ~ ~~~~ ~u_~ ~. 10 . ,~...Q..a.~---- ..~'~.-s~~a ti.~~..., rv~c;~:~3SC.~~`/4nnrn~A~3-~~..~C~~ .. -> .'r~: >~ ~.. .ter ati ~. ~.;::+_.. '~ .. I, PHYLLIS S. CONNORS, the testatrix, sign my name to n this instrument this ~~~ day of ~'.-;~~~~-~~r-~-' , 1990, and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this instrument as my Last Will and that I sign it willingly, that I execute it as my free and voluntary act for the purposes therein expressed, and that I am 18 years of age or older, of sound mind, and under no constraint or undue influence. ~/ ~~ .'~ t'«~ - 1 .~.T.. _r ~[r~~~.:.3~ <~~.'"~ 'i_....'"6 "~o''~%'..fr1'~~+-'~f,, ~r~ L . S • f /~ . der u~or~ o6ert .~'J. Ua ~'~Ss~a~r' '~~r'~t 0~//~~' , the witnesses, being first duly sworn, do each hereby declare to the undersigned authority that the testatrix signs and executes this instrument as her Last Will and that she signs it willingly, and that each of us states that in the presence and hearing of the testatrix, each of us hereby signs this Will as witness to the testatrix's signing, and that to the best of each of our knowledge the testatrix is 18 years of age or older, of sound mind, and under no constraint or undue influence. .~ ~ ~ .. ,/~` ~,,'~,~~,.~,,; e•~ ~,~. is .~,~'` ,. ~ f» a~ . ~~ ~~. y STATE OF NEW JERSEY COUNTY OF SOMERSET SS • Subscribed, sworn to and acknowledged before me by PHYLLIS S. CONNORS, the testatrix, and s}}~~bscr'bed and sworn to before e by C~/~°iI1~ • ~.''/" !/SOr~ , rt ~ t'j9 U ~ y' ; and ~" ° ~Y witnesses, this day of ~G pdC',Y' 1990. Al~iv~~~~/,yv~ • ~ ~~ ~l07AR1P ~JB;Y~fll~ ~lE~! ~PERS4~°~~jgq ~~ ~i'~~ D~-s w~fC/d+~ ~ ~~p. f ~Q14~ A 11 OMB No. 2502-0265 B. TYPE OF LOAN A. SETTLEMENT STATEMENT (HUD-1) 1. ~ FHA 2. ^ RHS 3. ^ CONV. UNINS. "<r.u',,~~" 4. ^ VA 5. ^ CONV.INS. ~~ ~. ~; * ~ li (*, ~ 6 2 00228-ALT 3310 591MBER ~' s° 9eq,r iy`y E'9F 8. MORTGAGE INS. CASE NO.: C. NOTE: This form is famished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.e.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. NAME & ADDRESS Matthew Witters and Jenni Witters OF BORROWER: E. NAME & ADDRESS The Estate of Phyllis S. Connors also known as Phyllis G. Connors OF SELLER: F. NAME & ADDRESS Quicken Loans, Inc. OF LENDER: 1050 Woodward Avenue, Detroit, MI 48226-1906 G. PROPERTY LOCATION: 502 Alison Avenue, Mechanicsburg, PA 17055 FI. SETTLEMENT AGENT: Assured Land Transfers, Inc. 301 Market Street, Lemoyne, PA 17043 (717) 761-4720 PLACE OF SETTLEMENT: Jack Gaughen Realtor ERA 27 W. Chocolate Avenue, Suite 109, Hershey, PA, 17033 (717) 761-4720 I. SETTLEMENT DATE: 9/28/2012 CLOSING DATE: 9/28/2012 DISBURSEMENT DATE: 9/28/2012 t C...., .,,.. .,F R..rr...,.e..r~ T......~..,.a:..., v n .. 100. Gross Amount Due From Borrower: 400. Gross Amount Due To Seller: 101. Contract sales price 206 000.00 401. Contract sales price 206 000.00 102. Personal property 402. Personal property 103. Settlement charges to borrower: (line 1400) 6 495.84 403. 104. 404. I O5. 405. Adjustments For Items Paid B Seller In Advan ce: Adjustments For Items Paid B Seller In Advance: 106. City/town taxes to 406. City/town taxes to 107. County taxes 09/28/12 to 12/31/12 259.42 407. County taxes 09/28/12 to 12/31/12 259.42 108. Assessments to 408. Assessments to 109. School Taxes 9/28/2012 to 6/30/2013 1 925.33 409. School Taxes 9/28/2012 to 6/30/2013 1 925.33 110. Trash Charge 9/28/2012 to 9/30/2012 0.95 410. Trash Charge 9/28!2012 to 9/30/2012 0.95 11 1. Sewer Charge 9/28/2012 to 9/30/2012 1.g6 411. Sewer Charge 9/28/2012 to 9/30/2012 1.86 112. 412. 1 13. 413. 114. 414. 1 15. 415. 16. 416. 120. Gross Amount Due From Borrower: 214,683.40 420. Gross Amount Due To Seller: 208,187.56 200. Amounts Paid B Or In Behalf Of Borrower: 500. Reductions In Amount Due To Seller: 201. Deposit or earnest money 5 000.00 501. Excess deposit (see instructions) 202. Principal amount of new loan(s) 202 268.00 502. Settlement charges to seller (line 1400) 16 425.00 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to 204. 504. Payoff 1st Mtg. Ln. 205. 505. Payoff 2nd Mtg. Ln. 206. Seller To Buyer Assistance 4 000.00 506. Seller To Buyer Assistance 4 000.00 207. 507. Escrow For Inheritance Taxes 1 668.17 208. 508. 209. 509. Adjustments For Items Unpaid By Seller: 210. City/town taxes to Adjustments For Items Unpaid By Seller: 510. City/town taxes to 21 I .County taxes to 511. County taxes to 212. Assessments to 512. Assessments to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total Paid By/For Borrower: 211,268.00 520. Total Reductions In Amount Due Seller: 22,093.17 300. Cash At Settlement From/To Borrower: 600. Cash At Settlement From/To Seller: 301. Gross amount due from borrower (line 120) 214 683.40 601. Gross amount due to seller (line 420) 208 187.56 302. Less amount paid by/for borrower (line 220) 21 1 268.00 602. Less reductions in amount due seller (line 520) 22 093.17 303. Cash (FROM) ~^TO) Borrower: 3,415.40 603. Cash ^'O) (^FROM) Seller: 186,094.39 7 he Public Keportmg burden for this eouecuon or mtormauon ~s esnmarea ar» mmures per response rur cuuccuug, rcvrcwurg, auu rcpunurg arc uaia. i uia agcucy may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. X X X X Previous editions are obsolete Page 1 of 4 HUD-I 1 CF.TTi.r.MF.NT C'FTAidf.P'.6 Fsrrnw~ 1?-(1(1228-AT.T 700. Total Real Estate Broker Fees Paid From Borrower's Paid From Seller`s Division of Commission line 700 As Follows: Funds Funds _ At At 702. to Settlement Settlement 703. Commission aid at settlement 12 120.00 704. Exhibit "A" Attached Hereto 195.00 195.00 801. Our on ination char e uicken Loans Inc. 4 183.83 from GFE #l 802. Your credit or char e oints for the s ecific interest rate chosen -8 090.72 from GFE #2 803. Your ad'usted on ination char es uicken Loans Inc. from GFE A 3 906.89 804. A raisal fee to uicken Loans Inc. from GFE #3 480.00 805. Credit re ort to Credco from GFE #3 20.88 806. Tax service to from GFE #3 807. Flood certification to from GFE #3 808. Flood Determination Fee To: CoreLo is Flood Services 10.50 809. Tax Certification Fee To: Title Source Inc. 18.00 810. Mort a e Insurance Paid In Cash To: uicken Loans lnc. 0.83 811. Tax Service Fee To: uicken Loans Inc. 812. Flood Certification Fee To: CoreLo is Flood Services 5.00 813. 814. 815. 816. 817. Broker Admin Fee To: Inte i Bank POCB 3 478.83 818. Credit Re ort To: Inte ri Bank POCB 20.88 819. A raisal Reimbursement To: Inte i Bank POCB 480.00 901. Dail interest char es from 9/28/2012 to 10/01/2012 20.7800 /da 3 da s from GFE # 10 62.34 902. Mort a e insurance remium for mo. to from GFE #3 903. Homeowner's insurance for l rs. to Erie Insurance from GFE #11 1 046.00 904. Flood insurance remium for rs. to 905. Mort a e Insurance Premium to uicken Loans Inc. 3 478.00 906. 1001. Initial de osit for our escrow account from GFE #9 1 134.33 1002. Homeowner's insurance 3 months 87.17 er month 261.5 ] 1003. Mortgage insurance 1 months (cry, $ 205.34 per month $205.34 1004 City property taxes 0 months (a7 $ 0.00 per month L 1005 Countyproperty taxes 9 months (~ $ 82 25 per month $740 25 1006 Annual assessments 0 months (a7 $ 0 00 per month 1007 Flood insurance 0 months ~a $ 0 00 per month 1008 School Tax Reserves 5 months c~$ 208 69 per month $1043 45 1009. A re ate Ad'ustment 1 116.22 1010. 1101. Title services and lender's title insurance from GFE #4 1718.85 ] 102. Settlement or closin fee to 1103. Owner's title insurance .Assured Land Transfers Inc. Sale Rate from GFE #5 15.00 1104. Lender's title insurance .Assured Land Transfers Inc. Sale Rate 1415.00 0.00 1105. Lender's title olic limit 202 268.00 1106. Owner's title olic limit 206 000.00 1107. Agent's portion of the total title insurance premium $1215.50 .Assured Land Transfers, Inc. 1 108. Underwriter's portion of the total title insurance premium $214.50 First American Title Insurance Company 1109. Overni ht Courier/Handlin to .Assured Land Transfers Inc. 18.85 1110. Wire Fee to .Assured Land Transfers Inc. 25.00 11 11. Electronic Document Fee to .Assured Land Transfers Inc. 25.00 1112. Endorsements ]00 300 900 to .Assured Land Transfers Inc. 150.00 1 1 13. Closin Service Letter to First American Title Insurance Com an 75.00 1114. Nota Fee to Cash 10.00 1201. Government recordin char es from GFE #7 158.00 1202. Deed 0.00 Mort a e 0.00 Releases 0.00 1203. Transfer taxes from GFE #8 2 060.00 1204. Ci /Coun tax/stam s Deed 0.00 Mort a e 0.00 1205. State tax/stam s Deed 4120.00 Mort a e 0.00 2 060.00 1206. Recordin Fees to Cumberland Count Recorder of Deeds 158.00 1207. 1301. Re uired services that ou can sho for from GFE #6 1302. Reimbursement Of Tax Certification to Johnson Dine Stewart & Weidner 10.00 1303. Home Owner's Warran to American Home Shield 540.00 1304. Attorne Fee to Goldber Katzman P.C. 1500.00 ] 305. 1306. 1307. .~„ .,._._~ ~_..~.._...... ~~.....,.,. ~~~~o. „h ~~ho 1~3 .Cocttnn.l -and -line 502. Section K) ___ 6 495.84 16 425.00 Previous editions are obsolete Page 2 of4 HUD-t Com arison of Good Faith Estimate GFE and HUD-1 Char es Goad Faith Estimate IIUD-1 har es That Cannot Increase HUD-1 Line Number Our on ination char e # 801 4 183.83 4 183.83 Your credit or char e oints for the s ecific interest rate chosen # 802 8,090.72 8 090.72 Your ad'usted on ination char es # 803 3 906.89 3 906.89 Transfer taxes #1203 2 060.00 2 060.00 Char es That in Total Cannot Increase More Than 10% Good Faith Estimate HUD-1 Governmentrecordin char es #1201 227.00 158.00 A raisal # 804 465.00 480.00 Credit Re ort # 805 25.00 20.88 Owner's title insurance # 1103 0.00 15.00 Title Services and lender's title insurance #1101 1 835.00 1 718.85 Flood Determination Fee # 808 10.50 10.50 Tax Certification Fee # 809 18.00 18.00 Mort a e Insurance Paid In Cash # 810 0.83 0.83 Flood Certification Fee # 812 5.00 5.00 Mort a e Insurance # 905 3 478.00 3 478.00 Total 6 064.33 5 905.06 Increase between GFE and HUD-1 Char es ] 59.27 or 2.6263 Char es That Can Chan a Good Faith Estimate HUD-1 Initial de osit for our escrow account # 1001 1 024.60 1 134.33 Dail interest char es # 901 20.7800 /da 311.72 62.34 Homeowner's insurance # 903 600.00 1 046.00 RE Broker Fee # 700 0.00 195.00 Loan Terms Your initial loan amount is $ 202,268.00 Your loan term is 30 years Your initial interest rate is 3.750000 Your initial monthly amount owed for principal, interest, and $ 1,142.08 includes and any mortgage insurance is ^X Principal ^X Interest ^X Mortgage Insurance Can your interest rate rise? ^X No. ^ Yes, it can rise to a maximum of %. The first change will be on and can change again every 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? ^X No. ^ Yes, your maximum prepayment penalty is $ Does your loan have a balloon payment? ^X 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. ^X You have an additional monthly escrow payment of $ 378.11 that results in a total initial monthly amount owed of $ 1,520.19 This includes principal, interest, any mortgage insurance and any items checked below: ^X Property taxes ^X Homeowner's insurance ^ Flood Insurance ^ ^ ^ Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. Previous editions are obsolete Page 3 of4 HUD-1 SELLEI2'5 AND/OR B~RROWEIt'S STATEMENT Escrow: 12-00228-ALT t have caref,~lly 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. Borrowers/Purc asers '/~~' Sellers ~' "' The Estate of Phyllis S. Connors also Matthew Witters known as Phyllis G. Connors r en fitters Mic ae S. onnors, Executor The HUD-1 Settleme State ent which av rep ed is a e nd accurate account of this transaction. I have caused or will cause the funds to be disbursed in accord ce with his s at Settlement Agen : Date: ~ v~ _ ~_ Tie fficer, Assu ed Land nsfers, Inc. WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine or imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. Page 4 of 4 ATTACHMENT TO HUD 1 Settlement Date: 9/28/2012 EXHIBIT A: (HUD Section 700 ) Division of Commission (Line 700) As Follows: Additional Brokerage Commission To: ERA-NRT, INC. RE Broker Fee To: ERA-NRT, INC. Total: Escrow No.: 12-00228-ALT Title No.: 12-00228-ALT Page: 1 Buyer Amount Seller Amount 195.00 195.00 195.00 195.00 _. _. ~..__ _..__. _- _~~w. o ~ ~ Vii ~~ J I ~ "~^' C ` .--. 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C~<~'UV V ' ~1~~1~N~ T1Q-~~N~ ~ o ~ C7<O< ~ n '77W 7l <D ~ ~o ~cflc o .cm oo 'er m CD wm ~•° cD m ~2 cnwNr n OQV 0 C7° ~ wN no - ~o3 o3 o ~~ o ~ ~`~ ~ O ~ N X•D~~ ~ 00 Q rnx n D~ a n w°~ N -P 3 ~ ° ~ ~ ~ o ~D~ ~ ~ n i ~ i rn o < ~ ~ ~ ~ o ~ ~ ~ ti 1 ~ o o ~ o Z O ~ ~ ~ S o ~ w x D u, ca o• o~ ~ ~ n O v ~ ~ - ~ , m ~ ~ '~'~ ~ w o --' O O V Ui Oo CD N _a O OD N Q (n ' C -„ Ut V W N (O ~ C7 ~ O (17 O O O ~ ~ ~ ~ ~ O O ~ ~ O O O O O O # ~ O .1 1 _i ~ W O O O O = _ N 0 > N 0 N 0 N 0 N ~ 0' ~~ D r'f` ~ - N ~ N .~ N ~ N -~ ,~ p N <D ~ n O ~ •~ b9 .~-~ ~ b4 ~ FR Oo EA W W OO fA ~ Cn ~ fn 3. N rn -~ cn cn V cn co. O N ~ ~ ~ ~ ~ 0 p ~ ~p, f~} 69 ~ ~ ~A, ~ ~ ~ ~ ~ O O o -~ W w ~' w oo w W ~ ~~ N ~ rr CD N N N O W N O O W ~ W W W W -p V W rt W O' C , , ~' 07 O O ~ OD O O CD N 'v 01 O iw I ~ ~ O W W Co Co W CD O ~ ~ v -~ N W m V .p O= ~ p -~ ~ V ry. O O O ~ N ~ O N N N ~! O CO O OD O' p ~ O 1 ~ D ~ p V V ~j N OD V -A V O W d1 N V : ~ ~+ Q} g ° o 0 0 o a o 0 0 0 0 'o" . ~~ ~ mo -n-~p ' --~o mo mo o ~ ~o X vo ~vo ~o ~o D •~ m Q- m m 3 0- c~ m `` y `` a r+ .~ ~ ~ ~~ ~ ~ ~ ~ cn ~ cn ~" cn ~~ cn ~?, ~~ .~ ~ m 0 3 ~ ~, n ro ~ 3~ ~ _ ~ ~ ~ to ~ Q N ~ ~ n P1 O r m -~~ QJ2 ~ <~ n~ ~ ~ .~ cQ j c ~ ~~ s ~ cn ~ Q ~ ~ c ~ N a' ~ ''~: ~ m . ~ a, Q ~ cu m C7 . N A N to ~ ~_ ~ v y rn ~ ~ ~ ~ ~ ~° a ~ s ~~ n 0 ~ ~ N ~ N 0 W = ~ Q 01 ~ a -a ~ ~ ~ ~ ~ o ~ ~ .. o ~ ~ o v ~ ~ ~ a~ c~ m n' m `~ - ~ ~~ ~ G1 ~ ~ ~ to ' ~ ~ .-. 0 v -n -v -n 3 ~- m c~ ~• o ~ u, ~ 3 ~ ra r ~ ~ cn cQ N o ~ m o ~ p _ O _ ~ O ~ N C7 Q o p N .._. ~ ~ ~. O O ~ a ~ ~ w ~ w D ~- ~'" D W ~ N .~ , Z O ~ ~ -~ C ~ ~ rn cn ~ ~-~: ~ ~ ~ ~ ~ ~ -~ ;' '" ~ n O cn ~ ~ ~ ~ ~ m ~ r"f` (D ° _ ~ ~ .~ 0 O - SU ~ ~ ~1 ~G CSt - -, <__ "T7 ~ ~~ D (Q ~ N ~ ~G~ < ~ ~ ~ W ~ G O n~ ~ v O - cQ . O c o D __ ~ o r--p ~ ~ ~ ~~'O ~~ ~ ° ~ :N~ ~ ~ ~ D `~ < o ~ cn ~• ~ N N ! d ~ G e~ ~~ ~, '-.C~n ~ ~~jo ~ n ~ o ~: o `~ ~ ~ cn ~ v ~ ~ ~ ~ -i "' N N G) ~ o ~ v ~ ~ N n O , O. O ~,i„ • ~ O O O N O . ~ cD - - . i. ~ ~ _ . N ~ ~ ~ e~i~ O n N ~ ' O ~ 0! N .__. D ~ fD f!3 .p 8R EA ffr .A. fR ~ fA ~A. - Vl a7 ~_ ~ QQ ~ 3 -~-~ Q1 ~ (II y ~ ~ Ph -~ W W 00 O OD:~p ~ ~ N ~' O c0 N N o N O Ca ~ N ~. ~ rn C o h C '* m ~ ~ (p ~ N e-+ ' ' P O W tC W CD o ~ 00 -~ C ~ ~ ~D O ~ ~ ~ ~ ~ ~ ' ~ rF ~ ~ ~ ~ ~ .~ ~ n ai ~ ~ -~ °o. N' N ~ o rn o a ''~ ~ o O y CTt ~ Ut is Gfl ~ oo , o• N W ~ ~ ~. ~ o o a o ~ c~ n ~ 0 N O cD CD '~ ~ ~ ~ ~ 0 0 0 3 o co N ~ o .. _ ~ -D o ~ ~ ~ n m o con ~ ~ -, = v ~ ~ ~ o c o o ~ ~ ~ ~ cD ~ ~ ~ ~ ~ . m Q co ~ 00 m • - • ~ ~ m ~ cD ~ ~ ~ ~ ~ con no a ~ - o• ~ ' ~ ° v ° ~ o ,.,. o ~ ~ ~ c 0 m -~, . ~ ~, Q o ~' ~ ~ o° v Q < < ~ ic D c'cn mc ~ o3 ~ ~ o ~ O ~ 3 ~ w ~': o ~ o m `~ ~~ • ~ m ~- ~~ i o ~ o o n m ~ ~ ~ ~ O ~ • ~ ~~ o n _~ ° o o~ ~"~ •c ~ ~ cD ~ o °A~~ ~~•~ c f,O ~~oov3~?~vcn ~ ~ •~ Q~~ ~' ~~o v o ~ u' ~ ~, ~'~ p° ~ ~ ~ • O ~ cQ r n • C ~3 oo~ -~cQ ~ ° m ~D 0 cnv~ o~m .~ ~vcn ocn .-•~ ~ o~i~o~~'o~om`<~N~ C7 ~ O moo-, o -oQC~~•-~w~-•,~~NO cn ~, ~• ~ ~ ~ o ~ ~. .~.• ~ ~ o- v o ~ n Q cP ~ ~ 3 ~ co • ~ cn ~ ° ~ ~ ~ ~ ` O o~~ N ~~~~o ~~~ ~~ N voce . ~"u,sno ~mc~<3Q ~ N <~ _-. < ~Q~~°o~.~~~~~~ ~ D o • ~ ~ ~ ~~ v N ~ (D D Oo ( (D ~ Q O ~ ~ '•'• ~ S ~ -, ~ ~ C7 C m ~ ~ ~ ~ ~ ~ ~ • ~ • O (D O v .o ~ ~ ~~ ~ ~ o o~ `~ v -~ ~ to ~ ~ .N~ ~-~~~:~ • ~, ~~ ~,~0o3~~~no ~.~~, - S11 ~cn ~ ~<~~~"'~~o v°~ v m n - v 3 V! n ~ N ~, ~, ~Q~~~~,o~c~ ~~ ~ C7 (D ~ o ~ fD O ~ v n ~ (Q ~ `< < -~ (D ~- m O ~ ~ _ v ~ ~ ~• cD 3 0 ~•~ ~ ~ ~ N ~ O ~ ~o • X v~ °' `~ ~ o o ~• `D c i o u i Y a ~ Q~~ ' c ~ ..~ Q ~ ~ ~- ~~ v c~ .-,. ~ ~ ~. o ~ ~ ~ Q co ~ n ~ ~~ =,.QO o c ~ ~~ Qo ~ v m ~ m m Q co O '~ v ~ ~ _~~.~ o ~, ~ ~ ~ -~ CA ~ no-i • ° m c-p Q ~. < con ~ v -o ~ ~ ~ o m - - ~, ~ • ~ ~ ~ c~ -~, ~ v ~-. N O a »-'~ • cn tD o =w~m~~uoi~ ~~~ ~ C7 o .~ m cn ~ ~ o ~ < ~~ ~ v•m v o•Q~ o v ~ o cn -~ ~ O = z ~ ~ ° ~ ° fl? ~ ~ ~ m ~ ~ o N ' [n' Cn C7 c ° ° O c D ~ ~ ' N ~ fn _ ~ ~ v' c ~ `~' cp ~ o • ~• ~ ~ v a' ~ ~ , e t~ O O C C _ cn ~ X 3 ~ ~ ~ ~' ~ ~' 6 S O ~ O N C ' v ~ v D ~ i ~ ~ ~- ~ c n CD to • CD O ~ cD ~ N Q. , `< ~ o CD = ~ ~ 3 ~ O ~ IV ~ D ~ (D (D ~ ~ v '-'. O ~ O ~ ~ ~ C7 Q fn fn ~ h flJ r ~ O ~ ~' O • .,- CD ~ O ~ ~" ~ ~ ~, O (U ~ Q cQ ~ • ~ n ~ ~ - - n ~ o rF ~ O ~ ~ p ~~ ~ -o V1 ~ O ~ O v `C Q ~ ~ ~ ~ (D cD _ ,< -, - ~ cn Q lD ~ ~ ~ ~ N' C7 ~ ~ O n = N ~ ~; N ~ ~ ~ °~ ` ~ ~ o • n e ~'- RX NU, i s i , ", - - 06-12 FRI 0132 PM BELCO CU Na~yt,.;(S~ in which tho a,countwas held: z. llccaunt »umber~_._..--~-- 1 3. [~nl~~,uo gas of date of death: 01110 _ Qalr~nce 1526gd ~ $1 G ~6,____-- Accrued Dividends $2.29 YTD Dividends $5.84 c S1 $1~~ 4~_~. ~~ ilr+r Savin~~ ~~~- $8.57 itch S3Y~ ~ 0.14_ Wh;•~ttwer Club ._--_.- ~~_ $ ~/lan :y S4 $3.926.81 -- .~-- (,hErkin~; - -- ~-- ~.-_`.._..----~ Gertficate Number Accrued Dividends X606 Balance ~~? 23 ~_,, _~----w Gc.rl'.ficates: ... ~-----~'- ~_ ~- M _ ~ ~,, pcjt, ;the account was initiated: _ ~ ~_ r , i s ire which Sc-+f+: Dopasit Box was held: _.,_,,.,~......- _r----- _ ...M,...--- G. Dal ~ the bax was initi:~lly rcrgte ocatetl: 7, (-ira~~clti address at which the bax is t ~~r~ -~..~~ Balance _.~,,.. - a i o:~n Ir~tormal-on. A t.lnsecurcd LoanSCard 1,14 Classic Visa ~ Secured Loans. D ~Ilortga9e 1,•oans: 0. Mi:.cellaneous: ~......--~ 7ATE INFORMATION(On Date of Death) p~CEDENS 1=5 P kdYl.Ll~ D NNORS .~,,..~- .,...~- .~--~- __---~" _.r..-. ~_ S `_ Accrued Interest ppencd 912611985 3110119II7 Y1'p Dividends $21.50 f :~ -" ~..~ ~ ~, $ ..~"-- Per Diem tnt /' w ~~-~- ~ .~ $ .~..», ~.,~„~,~u&r. ~ •„~.a~ ,c~»~ e,: Red A .I+.. (...' . u.. ..S.lnt .I~lFC1I~ i i ~ ... •.. .... wa....1 w,,,.w ....11.M~ i