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HomeMy WebLinkAbout10-11-12 (2) 1505611180 REV-1500 Ex,d2-,,,IFI) Pennsylvania OFFICIAL USE ONLY PA Department of Revenue oerexmrxrorncvexee County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 28°601 Hamisburo, PA 17128-0801 RESIDENT DECEDENT 2t-t2-DSt2 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 183-09-6865 05182012 08211918 Decedent's Last Name Suffix Decedent's First Name MI HERTZLER CLARA K (If Applkable) 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 BOXES BELOW ® 1. Original Rehm Q 2. Supplemental Retum Q 3. Remainder Retum (Date of Death Prior to 12-13-82) Q 4. Umited Estate 0 4a. FuNro Interest Compromise (date of Q 5. Federal Estate Tax Retum Required death aner 12aaez) © e. Decedent Died Testate 0 7. DecetleM Maintained a Living Trust (] 8. Total Number of Safe Deposit Boxes (Attach Copy of Wilp (Attach Copy of Trust) Q 9. LitlgaBOn Proceetls Received 0 10. Spousal Poverty Credlt (Date of Death Q 11. Election to Taz under Sec. 9113(A) Between 12-31-91 and 1•t-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number STEPHEN D. TILEY 717-243-5838 First Line of Address 5 SOUTH HANOVER STREE Second Line of Address Clty Or POSt ~fflCe CARLISLE State ZIP Code PA 17013 12EGISTER QPjWILLS USE ON2Y C~ a 'T] n.o 7 QQ7 f1'1~ l7 C7 t } ~ 1 ~J U `` 7 o , ~-; -, ~` _~ st - ti ~y ~ - _ FILED ~ fV Correspondent's a-mail address: Under penelses of perjury, I tledaro that I have examined this return, induding accomparrying schedules antl statements, and to the best of my knowledge antl belief, it is true, correct and comolete. Dedarotion of orecerer other than the cereonel reoroaentative Is based on all information of which orecerer has env knowledge SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ~ ] - °n cti NE I. SHUGHART, 22 VALLEY STREET_ CA DATE ~~~/~ . 1 `_] ~-, G ~j c, -n C Tl ,, STEPHEN D. TILEY 5 SOUTH HANOVER STREET CARLISLE PA 17013 PL E USE ORIGINAL FORM ONLY Side 1 L 1505611180 1505611180 J /,~ REV-1500 EX (FI) 150561128[] Decedent's Social Security Number oecedent's Name: CLARA K HERTZLER -L83-09-6865 RECAPITULATION 1. Real Estate (Schedule A) ....................................... .. 1. 12 5 CI ~ ~ . D O 2. Stocks and Bonds (Schedule B) .................................. .. 2. N 0 N E: 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. . 3. N 0 N E. 4. Mortgages and Notes Receivable (Schedule D) ....................... . 4. N 0 N f. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ... . 5. 2 2 3 3 . 0 C1 6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ..... .. 6. 1118 31.4 8 7. Inter-Vivos Transfers & Miscellaneous Nan-Probate Property (Schedule G) OSeparate Billing Requested ..... .. 7, N O N f. 8. Total Grosa Assets (total Lines 1 throuch 71 8 239064.48 9. Funeral Expenses and Administrative Costs (Schedule H) ............... . 9. 16635 . C) CI 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... . 10. 1918 . D (1 11. Total Deductions(total Lines9and 10) ............................ . 11. 18553.00 12. Net Value of Estate (Line 8 minus Line 11) .......................... . 12. 22 (1511.4 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... . 13. 0 . E) D 14. Net Value Subieet to Tax (Line 12 minus Line 131 14 22 (1511.4 8 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(t.2)x.o 0 t5. 0.0[1 16. Amount of Line 14 taxable at linealratex.o 45 220511.48 1s. 9923.[]2 17. Amount of Line 14 taxable at sibling rate X # # # , 7. o . a a 18. Amount of Line 14 taxable at collateral rate X # # # 18. 0 . 0 CI 19. TAX DUE ...................................................... . 19. 9923. []2 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 ' 1505611280 1!i []5611280 REV-1500 EX (FI) Page 3 Decedent's Complete Address: 21-12-0612 File Number 183-09-6865 DECEDENTS NAME CLARA K HERTZLER STREETADDRESS 24 VALLEY STREET cITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 9126.00 B. Discount 480.25 Total Credits (A + B ) 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill In box on Page 2, Line 20 to request a refund. (1) 9923.02 (2) 9606.25 (3) (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 316.77 Make check payable to: REGISTER OF WILLS, AGENT _~as ~~ PLEASE ANSWER THE FOLLOWING. QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred .............................. . 0 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 occurced 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 cleath? ...... ...... ^ 4. Did decedent own an individual retirement account, annudy or other non-probate property, which contains a beneficiary designation? .............................................................................................................. ...... ^ IF THE ANSVIER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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 deelth 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)j. • 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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (01-10) pennsylvania DEPARTMENT OP REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: NUMBER: Clara K Hertzler 21.12 0612 All real property owned solaty or as a tenant In common must be reportetl at fair market value. Fair market value is defined as the pdce at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that Ia jolntlyowned whh right of survlvorehlp must be dlselosed on Schedule F. ITEM Attach a copy of the settlement sheet if the property has bean sold. NUMBER Include a copy of the deed showing decedent's interest 'If owned as. tenant in common. VALUE AT DATE nccroicnnni OF DEATH 1. Personal Residence 24 Valley Street, Carlisle, PA 17013 South Middleton Township, Cumberland County, PA Tax Parcel No.: 40.22-0489-100 Year 2010 Assessment 142,800 ! CLR of 100.6% _ $141,948 Sold June 29, 2012 to unrelated parry -See Settlement Sheet attached as Exhibit "A" See copy of deed attached as 6thibit "B" TOTAL (Also enter on Line 1, Recapitula If more space is needed, use additional sheets of paper of the same size. 125,000 REV-1508 EX+ (17-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TA% RETURN EST SCHEDULE E CASH, BANK DEPOSITS, 8r MISC. PERSONAL PROPERTY FILE N Clara K Hertzler 21-12-0612 Include the proceeds of litigation and the date the proceeds were received by the estate. N more space Is needed, use atltlitional sheets of paper of the same si::e. REV-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Clara K Hertzler 21-12-0612 If an asset became jointly owned within one year of the decedent's date o} death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Geraldine I. Shughart 22 Valley Street, Carlisle, PA 17013 Daughter B. C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FDR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FORJOINI'LY HELD REAL ESTATE. DATE OF DEATN VALUE OF ASSET ~ of DECEDENT INTEREST DATE OF DEATH VALUE OF OECEDENPS INTEREST 1 Susquehanna Bank CD# 3000196022 (Roll over from prior A 9/13/11 joint funds) See Exhibit "C" 20,032.99 50.00% 10,016.50 2 A 11/18/11 Susquehanna Bank CD#3000199389 (Roll overfrom prior joint funds) See Exhibit "C" 15,001.95 50.00% 7,500.98 3 Orrstown Bank CD# 4000031668 See Exhibit "D" . A 3/9/09 20,128.50 50.00% 10,064.25 4 A Orrstown Bank CD# 4000031670 See Exhibit "D" . 3/9/09 20,128.50 50.00% 10,064.25 5 A Orrstown Bank CD# 4000032630 See Exhibit "D" . a/16/09 20,058.74 50.00% 10,029.37 6 Orrstown Bank CD# 4000032966 See Exhibit "D" . A 5/6/09 20,024.94 50.00% 10,012.47 7 Orrstown Bank CD# 4000033282 See Exhibit "D" . A 6/9/09 20,116.99 50.00% 10,058.50 8 A Orrstown Bank CD# 4000033283 See Exhibit "D" . g/g/Dg 20,116.99 50.00% 10,058.50 9 Orrstown Bank CD# 4000033284 See Exhibit "D" . A 6/9/09 20,116.99 50.00% 10,058.50 10 A 6/1 Orrstown Bank CD# 4000033363 See Exhibit "D" . 8/09 20,105.29 50.00% 10,052.65 11 A 10/21/0 Orrstown Bank CD# 4000035398 See Exhibit "D" . 9 20,024.94 50.00% 10,012.47 12 A 9 M&T Bank Checking Account # 420964 See Exhibit "E" . /1/67 7,806.08 50.00% 3,903.04 0.00 0.00 0.00 0.00 TOTAL (Also enter on Line 6, Recapitulation) I S 111 831 48 If more space is needed, use additional sheets of paper of the same :size. REV-1511 EX+(10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ~~ ~ FILE NUMBER Clara K Hertzler 21-12-0612 Decedent's debts must be reported on Schedule I. ITEM A. FUNERAL EXPENSES: 1. Ronan Funeral Home 8,006 2. Bethany Evangelical Church Memorial Service 1,000 3. Ronan Funeral Home -Refund 18 4. The Sentinel -Thank you advertisement 69 5. Evans Cemetery Memorials 75 B. 1. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) o! Personal Representative(s) Street Address city Vear(s) Commission Paid: State ZIP 2. 3. Attorney Fees: Frey & Tiley Fatuity Exemption: (I! decedenTS address is not the same as Gaimant's, attach explanation.) Claimant 5,000 Street Atltlress City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 406 5. Accountant Fees: Frey & Tiley Included 6. Tax Return Preparer Fees: Frey & Tiley Included 7. Roy D. Gottshall, Auctioneer, persoanl property appraisal 60 8. Advertising (The Sentinel $189.54; Cumberland Law Journal $75 00) . 265 9. Register of Wills (Short Certificates $12.00; Filing fee for Inheritance Tax Return 9115.00) 27 10. Costs of Sale of Reaf Estate (Transfer Tax $1,250.00; Final Water & Sewer $112.32) 1,362 11. Costs of Sale of Real Estate (Cty & Twp tax pro-ration -$157.53; Sch tax pro-ration -$6.19) _164 12. Costs to Prepare and Maintain House for Sale -See Exhibit "G" 525 TOTAL (Also enter on Line 9 RE If more space is needed, use additional sheets of paper of the same size. REV-1512 ER+(12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE INHERITANCE TAX RETURN DEBTS OF DECEDENT RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Clara K Hertzler __ 21 12 0612 REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES ca lwle ter: FILE NUMBER: Clara K Hertzler 21-12-0612 _ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [InUUtle outright spousal distributions antl trensrers under Sec. 9118 (a) (1.2).j Geraldine I. Shughart, 22 Valley Street, Carlisle, PA 17013 Daughter See Schedule "J-1"for List of Grandchildren and Great-Grandchildren 100% Residuary ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. 11 NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKER: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHI_ET. 0 00 tt more space is needetl, use adtlkional sheets of paper of the same size. Estate of: Clara K. Hertzler SCHEDULE "J-1" File No.: 21-12-0612 1 Terri Shreve 216 Shughart Avenue, Boiling Springs, PA 17007 Granddaughter 1,000.00 Specific Bequesfof $1,000.00 Pursuant to paragraph 2 of Will 2 Vicki Demastus 2020 Water Street, lebanon, PA 17046 Grnnddaughter 1,000.00 Specific Bequest of $1,000.00 Pursuant to pamgrnph 2 of Wlll 3 DavidShughart P.O. Box 124, New Kingstown, PA 17072 Granddaughter 1,000.00 Specific Bequest of $1,000.00 Pursuant to pamgrnph 2 of Will 4 Timothy L. Shughart 3 Flagstone Drive, Cazlisle, PA 17015 Granddaughter 1,000.00 Specific Bequest of $1,000.00 Pursuant to parngrnph 2 of Will 5 Seth Shreve 52 Brian Drive, Cazlisle, PA 17015 Great-Granddaughter 1,000.00 Specific Bequest of $1,000.00 Pursuant to paragraph 3 of Will 6 Leah Shreve 29 Bethel Street, Columbia, PA 17512 Great-Granddaughter 1,000.00 Specific Bequest of $1,000.00 Pursuant to parngrnph 3 of Will 7 Ashlee Demastus 2571 H. MountainCircle Lodge, Birmingham, AL 35216 Great-Granddaughter 1,000.00 Specific Bequest of $1,000.00 Pursuant to parngrnph 3 of Will 8 HeatherSteese 115 Sierra Lane, Miffiinburg, PA 17844 Great-Granddaughter 1,000.00 Specific Bequest of $1,000.00 Pursuant to paragraph 3 of Will 9 Timothy J. Shughart 1113 Nanroe Drive, Mechanicsburg, PA 17055 Great-Granddaughter 1,000.00 Specific Bequest of $1,000.00 Pursuant to parngrnph 3 of Will LAST WILL AND TESTAMENT OF CLARA K. HERTZLER I, CLARA K. HERTZLER, widow, of South Middleton Township (mailing address: 24 Valley Street, Cazlisle, PA 17013), Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and malting void any and all Wills by me at any time heretofore made. 1. I dtrec[ my hereinafrer named Executrix to pay all of my just debts and funeral expenses as soon after my death as maybe found convenient to do so. 2. I give and bequeath the sum of $1,000.00 to each grandchild of mine who shall survive me by a period of ninety (90) days, but should any grandchild fail to so survive me [hen the same shall lapse and be added [o the residue of my estate. At the present time I have four grandchildren. 3. I give and bequeath the sum of $1,000.00 to each great grandchild of mine who shall survive me by a period of ninety (90) days, but should any great grandchild fail to so survive me then the same shall lapse and be added to the residue of my estate. At the present time I have five great gandchildren. 4. All of the rest, residue and remainder of my estate, real, personal and mined, and wheresoever the same may be situate, I give, devise and bequeath to my daughter, GERALDINE L. SHIIGHART, her heirs and assigns, of 22 Valley Street in South Middleton Township, Cumberland County, Pennsylvania. 5. I hereby nominate, constitute and appoint my daughter GERALDIIQE L. SHUGHART as Executrix of this my Las[ Will and Testament, and direct that she shall not be required to post any bond to secure the faithful performance of her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. RQ WITN&SS WFIEREOF, I have hereunto set my hand and seal to this my Last Wit] and Testament written on one (1) page, [his ~,~,CT,flay of September, 2002. CLARA K. HERTZLER Signed, sealed, published, and declared by CLARA K. IIERTZLER, the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, a[ her request, and in the presence of each other, have hereunto subscribed our [tames as attesting witnesses. OMB Approval No. 25F~NAL A. Settlement Statement (HUD-1) 1. ^ FHA 2. ^ RHS 3. ^Conv. Unins. fi. File Number: 7. Loan Number: S. Mortgage Insurance Case Number: 2012/POTTEIGER q. ^ VA 5. ^Conv. Ins. C. Note: This form is furniahatl to give you a atalement of adual settlement coats. Amounb paid to end by the settement agents are shown. Items marked "(p.o.cj" wero paid outaitle the doming; they are shown here for informational puryoaes and aro nd Indutled in ma totals. D. Name 8 Atldress of Borrower: E. Name 8 Address of Seller: F. Name 8 Address of Lender: Roger K. Potteiga Clara K Hedzler 2045 West Tnntlle Road, Apt. Rear, Carlisle, PA 17073 do Gereloine I. Shughan, Exe, 22 Valley Street, Carlisle, PA 17013 G. Property Locatiorc H. Sa8lement Agent: I. Settlement Date: 06/282012 24 Valley Street Sale Scheer LLC Disbursement Data: 08/292012 Carlisle, PA 17013 19 Wes[ SouN Sheet, Carlisle, PA 17013 South Middleton Township Telephane:717-249E873 Fax: 717-249-5755 Place of Settlement: TNeExpress 19 West South Sheet, Carlisle, PA 17013 Pdntetl 08@82012 at 1:45 prn by ALF 101. ` Conaaot sales Price 125,000.00 401. I Conhad salsa Drbe ~ 125,000.00 102. Personal 402. Personal 103. Setllelrenl chalgBS to bonoaa (line 1400) 2,525.30 103. 104. 404, 105. qg5, Ad uahmn6 for Ibms k aNler M advance M utOnenke for 8ema b aa0er In advma 106. CiryBavn taxes to 406. Ciry/Wwn faces 10 107. County taxes Ofi29f2012 to 77/312012 157.53 407. County taxes 0629/1012 to 12/31/2012 157.53 108. 109. Assessments to Scholl taxes 061298012 b Ofi13012012 6.19 406 409. Assessments b Scholl faces 0612912012 ro 061362012 6.19 110. 410. 711. 411. 112. 120. Gran AmounlOw koin BOrrovwr 127,BW.10 412. 420. Grow AnrouM OwbBNlar 125,183.72 201. 202. Depos0 a eamast matey Prlndpd amount d new ban(s) 2, 125,000.00 i. 502. Excess tlePOSlI (see instnc0ons) Settlement charges to sells (line 1400) 6,987.32 203. ExisB I s taken su ' ro 503. Exis' loa s taken au 'ect to 204. 504. Pa offirst ban 205. 905. Pa dldsecgM mort eban 206. gp5, 207. gp7, 208. gp8, 209. Ad 6 for Yeme un M sdla 509. Ad uahnaMa fa Iletna un ald eNhr 210. CiryBOwn lazes b 510. ity/loan taxes to 211. County taxes to 511. Couny taxes b 212. Assessments b 512. Assessments to 213. 513. 214. 514. 215. 515. 21fi. 516. 217. 517. 218. 518. 218. ~O- ToW qtl Borrowwr 127,500.00 519. SRO. Tohl Re0udbn Attroum Due Seller 8,987.32 301. 302. Gross amount tlue fmm bonoa+er (Grre 120) Less amounts paid by11a bonaaer pine 220) 127,fi89.10 127,500.00 801, 602 Gross amount due b sells (line 420) Less reductions in amount tlue seller (line 520) 125,183.72 6,987.32 301. ww,,,, Cpn ^E From ^ To Borrower w...we,.n. en.+v.aeaw.um,.,,m„ ra m. w 188.10 -__.. _._,______ -.. 603. ... Cash ^X To ^ From Setler 118,178.b .,w,,.o,aow •„ m r..~ Previous editions are obsolete • Page 1 0 4 HUD-1 fj` ,. x n .1~Y1 ~` 3:5 ~~y~~ '; ~~ 5i'~. w~~ n:#i Y ~~. n.,Y.r~: - - /Y t • ' O Y O W ~p ~ 1~TM; «' ~ v 1 # .. '}'.' ~y ,1 f L J ~~ ~ .~ f. ~ ~L ~ LY~ .~ . . ' ~..r, y,,: ~ <'.gNnaiV~Naa~,•,rP11, ae ldlOwi=x"'$.;:_ , ,l. 80.00 to 102 80.00 to 703. Commission paid at sedh:ment . _ --iEIIi~idlbl%ii[FCenlis~, ~. •..~', 801. Our origination charge pndudes Origination Poin10.000%or 80.00) $ (from GFE#1) 802. Yar credit or charge (points) for the specific merest ate chosen $ (from GFE #2) 803, Your adjusted origination charges (from GFE A) 804. raisalfee to from GFE#3 805. Credit re n to from GFE #3 806. Tax service to from GFE#3 807. Flood cedi8catiw to from GFE #3 808. to 901. Daily interest charges from from 06/29/201 to 07101/ 12 ~ $O.OOlday Qrom GFE #10) 902. Mon a insurance mium monNS to (tart GFE #3 903. Homeowner's insurance monhs to from GFE #11 904. months m from GFE #11 1001. InPoal deposit fa your escrow acmunt (iron GFE #9) 1002. Homeowner's insurance months $ Imonth 1003. Mon a einsuance months $ /month 1004. Pm taxes months $ Imanlh 1005. months $ /month 1006. Assessments months $ D.IlOlmonth E 1007. Aggregate Adjustment $ 1101. TNIe services and lendefs tie insurance from GFE #4 885.38 1102. SeWement or dosing fee tc Banc Scherer LLC 5885.38 1103. Ownefs title insuance from GFE #5 1104. lantleh ti8e insurance $ 1105. LeMefs title policy limit 5125,000.00 1106. Ownefs title policy limit $125,000.00 1107. Agent's poNOn of the total OOe insurance premium $ 1108. UntlenvrNefs portion of the teal Bile insurance premium $ 1109. Document PreParatlon Fee fo Manson ~,y DRcyy 2l~0.00 1201. Govemmenl recoMing chares E (from GFE #7) 110.00 1202. peed $62.00 Mo 578.00 Release $ 1203. Transfer taxes E (from GFE #8) 1,250.00 1204. Ciry/County tarJstamps erred 51,250.00 Mon e 8 1205. State Tax/stamps peed $1,250.00 Mon 8 1,250.00 12~. Deed E E 1301. Required services Nat you can shop fa (from GFE p6) 1302. final Water/Sewer to Routh MiOtllelan Townshi Munid al Author 112, 1303. Inheritance Tax Payment to R ister d Wllis 5,625. 1304. to 1305. to rr ' ~ r 2,525.38 6,987.32 aid oulsltle d dosing by (B)ortvwer, (S)eller, (L;entler, (I)nvests, Bra(K)er. °CredN M' lender shown on page i. "'Crerlil by seller shown on page t. Previous editions are obsolete • Page 2 0 4 HUD-1 e+/y ~? 'nae+°lsR°+v~~ Ptima?R'9° ~.~ ~~TS f•..q~•,~ ~-,~,1 - -SarvF~F...~ 3-.w } :yy.` 1` • YM^ ..1 !° 1 11 1 11 a .'~ 'f' e^ 1 11 1 11 ': 'J L~ 111 111 a ~ ;:a cltt ac ~.. dr"~4ux iL._.~c~r.'A&H.n~t'~4 J+ 111 1 11 Loan Tanna 0.00 0.00 0.00 0.00 0.00 0.00 $ years $ inclutles ^ Pdncpat ^ Interest ^ Mongage Insurance ^X No. ^ Yes, it wn dse N a maximum of %. The fire) change will he on 1 I and can change again every years aher / ! .Every charge date, your interest rate can increase a decease by %. Over tlxl life of the loan, your interest rate rs guaranteed to never Ire lower Nan % or higher than %, LxJ No. U Yes, it can rise to a maximum of E ^X No. ^ Yes, the first increase can Ire m / I and the monhly amount owed can rise to $ The maximum it can ever dse to is E ^X No. ^ Yea your maximum prepayment penalty is E ^X No. ^ Yes, you have a halloon payment of S due in years on / / ^X You Oo not have a monthly escrow payment fa itenre, such as propedy taxes and haneownels Insurance. You must pay these Items directly yourself. ^ You have an additional monhly escrow payment of $ Nal results in a total initial monhly armunt axed M $ .This Inclutles pdncipa{ any mongage insurance antl any Hems checked belay ^ Progeny loxes ^ Homeowner's insurance n Flood insurance n ne1e. „ yuu nave any yuesuuns' aoom me xmemem cnarges and roan I erns sstetl on Nis form, please wnfad your lender. Previous editions are obsolete • Page 3 0 4 HUD-1 c'r,y~,Y, 98h,'~yi~~1 r'u~": HUD CERTIFICATION OF BUYER AND SELLER carefully reviewetl the HU61 Settlement Statement and to the best of my knowletlge antl belief, it is a true and awurafe statement of all reizipts antl .orsements made on my account or dy me in this transaction. I tuRher ceniy that I have recaivetl a copy of the HUP7 Settlemenl5talement. i w i Roger K Potteiger Clar K. Heiler r: v\ Tha HUPt Settbmem Statement which I nave pmparetl b a trve and acwrrte aaount of mia VansaQbn I have oauaetl or wAl cause me funds to ba tlisbursetl in earordanw wim min ntatemanL M~~~.- G -LPL f ~~- SETTLEME A DATE WARNING: R IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1070. Previous editions are obsolete Page 4 of 4 HUD-1 .-.;r1~ sd~~ ,a'« Tax Parcel No.: 40-22-0489-100 THIS INDENTURE MADE THE v13'-'day o in the year of our Lord twa thousand twelve (2012) BETWEEN GERALDINE /. SHUGHART, Executrix of the Last Will and Testament of CLAR.4 K. HERTZLER, Deceased, late of South Middleton Township, Cumhertand County, Pennsylvania, patty of the first part, GRANTOR, AND ROGER K. POTTEICER, single man, of 2045 West Trindle Road, Apartment Rear, Carlisle, Cumherland County, Pennsylvania, parry of the second part, GRANTEE, WHEREAS, Clam K. Hertzler died May 18, 2012, seized in fee oC the hereinaf[er- described real estate; WHEREAS, by her Last Will and Testament dazed September 18, 2002, she provided in part as Collows: "5. I hereby nominate, constitute and appoint my daughter GERALDINE L SHUGHART as Executrix of this my Last Will and Testament, and direct that she shall no[ be required [o post any bond [o secure the faithful performance of her duties in the Commonwealth of Pennsylvania or in any other jurisdiction." WHEREAS, the middle initial of Geraldine I. Shughart was incorrectly stated as "L" on the said Will. WHEREAS, Letters Testamentary in the Estate of Clara K. Hertzler, Deceased, were issued by the Cumberland County Register of Wills to Geraldine L Shughart on May 31, 2012, without the requirement that any bond be posted by her, which Letters Testamentary remain in full force and effect, WHEREAS, Sections 3351 oC [he Probate Estate and Fiduciaries Code (20 P.A.C.S.A. 3351) gives a personal representative the power to sell at public or private sale any real property not specifically devised and WHEREAS, the hereinafter described real property was no[ specifically devised, Page 1 of 4 b~" x: > _ nod (~.`' NOW THIS INDENTURE WITNESSETH, that the said Grantor for and in consideration of the sum of One Hundred Twenty-Five Thotuand and no/httndredtha--- ($125,000.00)--- Dol/nrs lawful money of the United States, to her in hand paid by the said Grantee at and before the sealing and deliver hereof, the receipt wleereof is hereby acA:now[edged has granted, bargained, sold, aliened, released and confirmed, rind by these presents, do grant, bnrgain sell, alien, release and confirm unto tite said Grantee, his heirs and assigns, ALL THAT CERTAIN Vact of land situate in South Middleton Township, Cumberland County, Pennsylvania, bounded and described as follows: LOT No. 19 of Block M of the Plan of Lots known as Carlisle Manor Extension, which Plan is recorded in the Office of [he Recorder of Deeds for Cumberland County in Original Plan Book No. 3, Page 99 (Photo Plan Book No. 3, Page 40), said lot being triangular in shape, and having a frontage oC Ninety-four and Forty-six hundredths (94.46) fee[ on Valley Street, a depth of One Hundred Seventy-seven and Thirty-six hundredths (177.36) feet on the North along Bayley Street, and a depth of One Hundred Fifty-one and Twenty-two hundredths (151.22) feet on the South along Lot No. 20, Block M, of said Plan of Lots. HAVING thereon erected a brick dwelling house known as and numbered 24 Valley Street, Carlisle, Pennsylvania 17013. SUBJECT, NEVERTHELESS, to the Building and Use Restrictions as recorded in [he prior deed: 1. No building or any part thereof shall be erected or maintained closer than 40 feet to the curb lines of the streets as shown on said Plan, street lines as shown being from curb line [o curb line. 2. No single house shall be erected on any lot costing less than $5,000.00, and no double house costing less than $9,000.00. 3. Omitted 4. No business property, of any kind, shall be erected or maintained on any lot, excepting however, Lots Nos. 1, 2, 3, 4, 5, 6, 28, 29, 30 and 31 of Block "M", and Lots Nos. 19, 20, 21, 22, 23, 24, 25, 26, 27, 2S, 29 of Block "D", on which lou buildings my be erected for retail commercial use, provided [hat such buildings shall not cos[ less than $5,000.00 to erect. 5. The existing building or its replacement, on Lots Nos. 10, 11, 26 and 27 of Block "K" may be used for commercial purposes. 6. No stable, pig pen, slaughterhouse, cattle yazd or any other objectionable or obnoxious strucmre shall be erected or maintained on any lot. 7. No structure may be used or occupied as living quarters, temporarily or otherwise, unless such swcmre wmples with restriction 2 above. 8. All lots must be kept cleared of weeds, high grass or other objectionable growths; if such be no[ removed by [he owner of any lot after 10 days written notice to do so by any other lot owner, said other lo[ Page 2 of 4 ';fie-NN CCId,B LL` owner may remove such and charge the lot owner with twice the cos[ of removal thereof. BEING [he same premises which Robert J. Wire, Jr., Executor of the last Will and Testament of Samuel H. Wingert by deed dated April 26, 1963, and recorded May 9, 1963, in the Office of the Recorder of Deeds in and for Cumberland County at Cazlisle, Pennsylvania, in Deed Book "V;' Volume 20, Page 518 granted and conveyed to Clara I. Keck. THE SA[D Clara I Keck [hereafter in[ennazried with James Wayne Hertzler in Ft-ederick County, Maryland. See copy of Cectifica[e of Manage attached hereto as Fathibit "A." THE SAID James Wayne Hertzler died on January 20, 1998. See Cumberland County, Pennsylvania, Estate File Number 98-00089. TOGETHER with all and singular ways, waters, water-courses, righu, Uberties, privileges, hereditaments and appurtenances whatsoever thereunto belonging, or in anywise appertaining, and the reversions and remainders, rems, issues and profits thereof,• and also all the estate, right, title, interest, use, trust, property, possession, claim and demand whatsoever of the said Clara K. Hertzler at and immediately before the time of her death, in late, equity or otherwise howsoever, of, in, to or out of the same: TO HAVE AND TO HOLD, [he said buildings, heredi[amems and premises hereby granted and released, or mentioned and intended so to be, with the appurtenances, unto the said, Grantee, his heirs and assigns, to arsd for [he only proper use and behoaf of the said Grantee, his heirs and assigns, forever. AND the said Grantor does covenant, promise and agree, to and with the said Grantee, his heirs and assigns, by these presents, that she the said Grantor, has not done, committed, or knowingly or willirsgly suffered to be done or committed, arty act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered, in title, charge, estate, or otherwise howsoever Page 3 of 4 WITNESS the due execution hereof the day month and year first above written. Vi'ITNESS: ~I,Li ~f (_iZJ . 9 _ ~ , 1, .. l (SEAL) G LDINE I. SHUGHART, utrix of the Esta[e of Clara K Hertzler Commonwealth of Pennsylvania Counry of Cumberland }ss. On this, the day of , 2012, before me, the undersigned officer, personally appeared GERALDINE I. SHUGHART,. Executrix of the Inst WiU and Testament of CLARA K. HERTZLER, late of South Middleton Township, Cumberland County, Pennsylvania, Deceased, known to me (or satisfactorily proven) to be the person whose name is subscribed to the withirs instrument, and ackrsowledged that she executed the same in the capacities therein stated and for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and ofJcia[ seal. ! do hereby certify that the precise residence and complete post office address of the within named Grantee is Michael A. Scherer, Esquire Attorney for Gramee Page 4 of 4 N u~~ June 21, 2012 FREY & TILEY 5 SOUTH HANOVER STREET CARLISLE, PA 17013 Susquehanna Susquehanna Bancshares, Inc. 26 North Cedar Street P.O. Box 1000 Litdz, PA 17543-7000 Tel 1.800.311.3182 Fax 717.625.4478 RE: Clara K Hertzler DOD: 05/18/2012 SS#: XXX-XX-6865 Tracking # 279316 "to Whom It May Concern: In response to your letter of June 15, 2012, here is the above customer account information as of May 18, 2012. Account # 1 Account #2 Account #3 • Account Title: Claza K Hertzler Clara K Hertzler Geraldine I Shughart Geraldine I Shugttart • Account Type/# CD/ CD/ 3000196022 3000199389 • Date Opened /Maturity 09/13/2011-09/13/2016 11/18/2011-11/18/2016 • Interest Rate: 1.588400% 1.588400% • Account Balance*: $20,000.00 $15,000.00 • Accrued Interest: $32.99 $1.95 • YTD Interest: $159.14 $99.08 *Account balance does not include accrued interest. ® There is no safe deposit box in the name of the decedent. ^ There is a safe deposit box # in the name of the decedent located a1: the If I can be of further assistance, please feel free to call. Sincerely, ~~~Lm. / Dawn M Berner Deposit Reseazch -Reporting Department Lead 1-717-625-6546 DMB/cmw ~l~e~+r~~h a~ vxxsrrowly sarrx A Tiadilion of Excellence June 19, 20]2 Frey & Tiley Attorneys At Law Stephen D. Tiley 5 South Hanover Street Carlisle, PA 17013 Fax: 243-6441 Re: Estate of Claza K. Hertzler Social Security Number 183-09-6865 Date of Death 5/18/2012 IT IS HEREBY CEI:TIFIED THAT THE ABOVE NAMED DECEDENT HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: CERTIFICATE OF bEPOSTT Account No.- Account Type- Date Opened- Joint Account (name/date)- Balance- Accrued Interest- Account No.- Account Type- Date Opened- Joint Account (name/date)- Balance- Accrued Interest- Account No.- Account Type- Date Opened- Joint Account (name/date)- Balance- Accrued Interest- 4000031668 60-119 Month Income CD 3/9/2009 Geraldine I. Shughart, 3/9/2009 $20,000.00 $128.50 4000031670 60-119 Month Income CD 3/9/2009 Geraldine I. Shughazt, 3/9/2009 $20,000.00 $128.50 4000032630 60-119 Month Income CD 4/16/2009 Geraldine I. 5hughart, 4/16/2009 $20,000.00 $58.74 2695 Philadelphia Avenue Chambersburg, PA 17201 1.BBB.ORRSTOWN ~ ,:~rK. wrWZn;.orrs~saW ra.coraa Account No.- Account T}pe- Date Opened- Joint Account (name/date)- Balance- Acerued Interest- Account No.- Account Type- Date Opened- Joint Account (name/date)- Balance- Accrued Interest- Account No: Account Type- Date Opened- Joint Account (name/date)- Balance- Accrued Interest- Account No: Account Type- Date Opened- Joint Account (name/date} Baiance- Accrued Interest- Account No: Account Type- Date Opened- Joint Account (name/date)- Balance- Accrued Interest- Account No.- Account Type- Date Opened- Joint Account (name/date)- Balance- Accrued Interest- 4000032966 60-I ] 9 Month Income CD 6/6/2D09 Geraldine I. Shughart, 5/6/2009 $20,000.00 $24.94 4000033282 60-119 Month Income CD 6/9/2009 Geraldine I. Shughart, 6/9/2009 $20,000.00 $116.99 4000033283 60-119 Month Income CD 6/9/2009 Geraldine I. Shughart, 6/9/2009 $20,000.00 $116.99 4000033284 60-I 19 Month Income CD 6/9/2009 Geraldine I. Shughart, 6/9/2009 $20,000.00 $116.99 4000033363 60-119 Month Income CD 6/18/2009 Geraldine I. Shughart, 6/18/2009 $20,000.00 $105.29 4000035398 60-119 Month Income CD 10/21/2009 Geraldine I. Shughart, 10/21/2009 $20,000.00 $24.94 Best Regards, Jill R. Worthington Deposit Processing Clerk ~~ E°;s ~~~~ © M&T~11k 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Frey & Tiley Attorneys at Law 5 South Hanover Street Carlisle, PA 17013 Re: Estate of C-aza K. Hertzler Social Security: 183-09-6865 Date of Death: May 18.2012 Phone 888-502-4349 P ax (302) 934-2955 June 29, 2012 Dear Sir or Madam: Per your inquiry on June 15, 2012, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names ofl Opening Date Balance on Date of Death Accmed Interest Total Checking Account 4209154 Clam K. Hertzler Geraldine L Shughaa 09Po1/1967 $7, 806.06 $ .02 - -------------------------------------------- $7.806.08 --- - --- For any additional information on the above accounts, inducting ownership and any changes, dosures and/or reimbursement of foods, please ®ll the High Shull Carlisle at 717-1A0453ti. We were unable to locate any safe deposit box for the above-mentioned decedent This letter does not indude any amounts in which the deceased may have bem listed as power of Attorney, C~.stodian ~' Uniform Treaders, Reprecentative Payee, or Trustee under a Written Agreement Sincerely, Valarie Mercer Adjustment Services ~~ ,~~.~ iI .: _ ~ » 1- ~~~ ~r~ ' ~- I ~+ ,.-. _ 1 ~ /~py(q ~ v/.fig/q //~J ~(^ ,/ _ ~~~`~ ~~ _ I. r - , -- a2 ~~~- -~~- ~1,~.~%'~ yam' .~ a . . ~_.__ -_ __._ -_- __... e° { `, r f p. _ ?~ ~/~.~~C.2'-.;K'-£+I ~/i„'sss :~>,,,,6~/i•~"~=rte ~ ). /Q L/'i _. ~..,~ ~-- -~ _ ___ __ .._ ~~ ~ .,.. ~_.. rte.. __. _._. _ _ _ _.._. _..-___ __. ~ ~ ~ ~ / ~.. j, ,~;, ,~;. ~ ~ ~~ __ . ~ f ///'' ~- ~/ - --ter u L r -~'~~ ! -G -~;' ~ _> _._ ~~ -- -- r ~-~ ~ ~ ~/, ~J .: tJ Il I q / % n^ i ~ ; I ~ ~ II .-7 !H ,.~ ,J.~ a , .~_. Y _ ~ f: f i ~ ~=- ~ > .n - ~, .,~ . ~, /~ L /.~ d. f l_r ~~ ~~ /K ", ~.ti 4.. ~.. .....e. /' '/ ~ 1 3 ~ /'' __ ~ ~- .-_._ ---- - ~ - ~ -..- _.... __.~_ -- ..... r~ yy - __ _ ' r s -- ~'`- ~. i ~ ,, r ~ ~ .. (~, /.. _~ .° _ __~ /~,y /'r ~~ ~ l~ r / _ 1 ..~_.. r .~ -g^~7/J, / /~ i _~ ~s~ ~_i ,~ .: _ / / /J//~~~ •^ ,n -- / ~.~.~^TJ" f ///~ y1 ~.~ej ~ / _. ~ ~ G A~ r...' ~a-..+ i~' ~r ~ 4'Uo-'~t ~~ ~~ ~ rA`.: «Y~~ ~ "~ n~~ GL/ r j/ , L -, ( Z ..___-% _ - ._ bt --- -- _ ._. _ ~ ...___ _ _ ____ --- _ _-- ._- _..-. . __ .~,~J..~-.. ,. .. ... ----. ~ r ~ .,~ Y ._----._ .__._. _._. _... -- - _. ~ n ~ r. .,~, ~ 1. i ... s - I ~ i _ ~~ ~ ..._ ii ~! s _ __ ~ ~ ~ _._..... . _.:.. f -. I . ((~~~~~T~.~µ(`"F dp~.kt .. ~ ~_ , , Estate of: Clara K. Hertzler EXHIBIT "G" Payment to Maintain House and Prepare it for Sale: 4/12/12 Barry's Lawn Service 4/18/1212andolph's Paving to seal driveway 4/23/12 Barry's Lawn Service 5/1/12 Barry's Lawn Service 5/103/12 Barry's Lawn Service 5/17/12 Barry's Lawn Service 5/23/12 Barry's Lawn Service 5/23/12 David Shughart -Clean out house 5/30/12 Barry's Lawn Service 5/31/12 David Shughart -Clean out house 6/4/12 Tip for paper carrier 6/4/12 David Shughart -Clean out house 6/4/12 Barry's Lawn Service 6/9/12 Teri Shreve -Clean out house 6/13/12 Barry's Lawn Service File No.: 21-12-0612 30.00 75.00 30.00 30.00 30.00 30.00 30.00 50.00 30.00 50.00 10.00 20.00 30.00 50.00 30.00 525.00