The URL can be used to link to this page

Home My WebLink About10-15-12 1505610140 REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 1 1 1 1 6 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Decedent's Last Name Suffix Decedent's First Name MI S t o n e r G r a c e E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N / A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~.. , Scot t W. Mor r i son, Esq 717 ~~2 2:,0 0:.x, r@YILLS USE LY REGISTEF~ ' ` _' .~-; l * ~ .J ~ ~ ! I First line of address ~~-~ ~- -~ ~ ~ ~ 6 Wes t Mai n S t r e e t ~ c= '; Second line of address ~ ~ 'R'1 '` ~ _ ' ~' ~' C~ P O Box 2 3 2 `~' -`-' City or Post Office State ZIP Code DATE FILED New B I o o m f i e l d P A 1 7 0 6 8 Correspondent's a-mail address: smorrisonlawi~centurylink.net Under penalties of perjury, 1 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. S.~IGNATURE OF PERSON RESPONSIBLE FOR FILLNG R TURN ._ ,.~ DATE t ,~ ,~ 1337 Shermans Vallev Road Elliottsbura PA 17024 SIGNATUR ER OTHE THAN REPRES ,4T+~E- ~ O J J ADD 6 Main .$treet New Bloomfield PA 1 068 PLEASE USE ORIGINAL FORM ONLY Side 1 i 1505610140 1505610140 ~~ J REV-1500 EX Decedent's Name: Grace E. Stoner Decedent's Social Security Number RECAPITULATION 8 9 5 0 0 0 0 1. ........................................... Real Estate (Schedule A) 1 . 2. Stocks and Bonds (Schedule B) ...................................... 2• 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. ' 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. • 1 0 3 8 8 2 ' 9 7 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 7 8 2 1 7 2 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 2 3 7 7 3 4 5 9 (Schedule G) ^X Separate Billing Requested ....... 7. • 4 3 8 9 3 9 2 8 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. . 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9• 1 1 5 8 1 6 3 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. 1 4 5 4 4. 0 4 11. Total Deductions (total Lines 9 and 10) ............................... 11. 2 6 1 2 5. 6 7 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12• 4 1 2 $ 1 3 . 6 1 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. 4 1 2 8 1 3 • 6 1 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X •0 0 0 0 15. 16. Amount of Line 14 taxable 1 7 5 0 7 9 0 2 at lineal rate X .045 16. 17. Amount of Line 14 taxable 0 ~ ~ 1 at sibling rate X .12 7. 18. Amount of Line 14 taxable Q Q 0 at collateral rate X .15 18. 19. TAX DUE .................. ............................. ..... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610240 0. 0 0 7 8 7 8. 5 6 0. 0 0 0. 0 0 7 8 7 8. 5 6 Side 2 1505610240 1505610240 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 11 1116 DECEDENT'S NAME Grace E. Stoner STREET ADDRESS 1104 Laurel Avenue CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: ~. Tax Due (Page 2, Line 19) 2, Credits/Payments A. Prior Payments 10, 000.00 B, Discount 393.93 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (1) 7,878.56 Total Credits (A + B) (2) 10, 393.93 (3) (5) (4) 2,515.37 0.00 Make check payable to: REGISTER OF WILLS, AGENT ~. ,, . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ................................................................. ..... ^ 0 b. retain. the right to designate who shall use the property transferred or its income; .......................... ..... ^ c. retain a reversionary interest; or ........................................................................................... ..... ^ d. receive the promise for life of either payments, benefits or care? .................................................. ..... ^ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................. ..... ^ 3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ... ...... ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ............................................................................................ ...... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent (72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (01-10) pennsylvania ~ SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Grace E. Stoner 21 11 1116 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts, Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. Lots Nos. 134 and 135 of Cumberland County Plan Book 2, Page 42, situate in Lower 89,500.00 Allen Township, Cumberland County, Pennsylvania, having thereon a dwelling known as 1104 Laurel Avenue, Camp Hill, Pennsylvania. See Cumberland County Deed Book "G", Volume 32, Page 163. Sold to Harry F. Reilly, Jr. on July 6, 2012 TOTAL (Also enter on Line 1, Recapitulation.) I $ 89,500.00 If more space is needed, use additional sheets of paper of the same size. REV-1508 EX + (6-98) SCHEDULE. E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Grace E. Stoner 21 11 1116 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Real Estate tax & sewer/trash refund -see attached settlement statement 1,411.22 2. Personal property appraised by Mark K. Keller 20,465.00 3. PNC Bank Certificate of Deposit #11020028744 6,159.26 4. PNC Bank Checking Account #5112076352 50.27 5. Integrity Bank Certificate of Deposit #1037663 67,296.04 6. Disability premium refund, etc. 391.12 7. Accident insurance refund 70.00 8. Beauty shop products 65.00 9. Jewelry sold to Brian McPherson 1,000.00 10. Honda insurance refund 317.08 11. State income tax refund 117.00 12. Local Income tax refund 35.09 13. Sale of Mustang 5,000.00 14. Mustang insurance refund 41.00 15. Federal income tax refund 1,416.14 16. Homeowners insurance refund 30.50 TOTAL (Also enter on line 5, Recapitulation) I $ 103,882.97 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent Grace E. Stoner 21 11 1116 Decedent's Name Page 1 File Number Schedule E -Cash, Bank Deposits, & Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17. Verizon refund 18.25 SUBTOTAL SCHEDULE E ( 18.25 GRAND TOTAL SCHEDULE E ~ $ 103,882.97 REV-1509 EX+ (01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Grace E. Stoner 21 11 1116 If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Dale B. Smith 1337 Shermans Valley Road father Elliottsburg, PA 17024 B C JOINTLY•OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE, DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. The Bank of Landisburg certificate #700016597 15,643.43 50. 7,821.72 TOTAL (Also enter on Line 6, Recapitulation) I $ 7 821 72 If mere snare is needed. use additional sheets of paper of the same size. REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN f~C[~111CAIT f1C (`C fIC AIT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Cirar.P F Stnner 21 11 1116 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1, Woodmen of the World -See attached letter -Beneficiaries 237,734.59 100.00 237,734.59 are sister Barbara Smith of X109 ~(~``Sfi ~ l~ew Cube ~tq~ ~ and stepdaughters, Nichole Rines of 9218 W. Oak River~~o70 Road, Petersburg, VA 23803 and Stephanie Barr of 12031 Southern Ridge Drive, Chesterfield, VA 23838 TOTAL (Also enter on Line 7, Recapitulation) ~ $ 237,734.59 ~f mnrP s^ace 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 wir+i~vr Grace E. Stoner 21 11 1116 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: ~ 3,581.24 2. Pastor 200.00 B. 2 3 4 5 6 7. 8. City State ZIP ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: Attorney Fees: Scott W. Morrison Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address Relationship of Claimant to Decedent Probate Fees: Glenda Farner Strasbaugh Accountant Fees: Tax Return Preparer Fees: Cumberland Law Journal -estate advertising The Sentinel -estate advertising 7,000.00 370.50 75.00 354.89 TOTAL (Also enter on Line 9, Recapitulation) I $ 11 581.63 If more space is needed, use additional sheets of paper of the same size, REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Grace E. Stoner 21 11 1116 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, Costs of sale of real estate -see attached settlement statement 2,739.12 2. Brian McPherson -auctioneer costs 4,975.00 3. Mark Keller -personal property appraisal fee 200.00 4. Sovereign Bank -death balance fee 20.00 5. Sewer/trash 327.78 6. electric bills 431.98 7. Verizon -telephone 484.87 8. Water 319.94 9. Oakwood 40.00 10. HSBC -account 69.42 11. Chase -account 386.94 12. Schoeneman -beauty supplies account 94.34 13. Hartford -home insurance 566.58 14. Roof repair 1,800.00 15. Mustang insurance 87.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 14,544.04 If more space is needed, insert additional sheets of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent Grace E. Stoner 21 11 1116 Decedent's Name Page 2 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, 8~ Liens ITEM NUMBER DESCRIPTION AMOUNT 16. Bob Jones -tax prep 100.00 17. ~ County/Township real estate taxes 18. furnace repair and pic board at funeral reimbursement 19. I Headstone 534.01 240.06 1,127.00 SUBTOTAL SCHEDULE I 2,001.07 GRAND TOTAL SCHEDULE I ~ 14,544.04 REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT L_ ESTATE OF: FILE NUMBER: Grace E. Stoner 21 11 1116 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).) 1. Dale B. Smith Lineal 1337 Shermans Valley Road One-half Elliottsburg, PA 17024 2. Helen R. Smith Lineal 1337 Shermans Valley Road One-half Elliottsburg, PA 17024 I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: 1. B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size. previous editions are obsolete A. Settlement Statement rv,,,, r.~v i ,.. ~~ i i i.u.~vvv.... ~.......- U.S. Department of Housing and Urban Development nnxe Ann.n,rol Nn 7Fn7_n7F5 _ __ ts. I e ur Loan 1. OFHA 2. (]FmHA 3. ~Conv. Unins. 6. File Number 7. Loan Number 8. Mortgage Insurance Case Number 4. ^VA 5. ^Conv.lns. 12206 moun s poi o an y e se emen agen are s own. T emen cos s Settlement System E l . x ress ~s orm is urnis e o give you a s a emen o ac ua se it e C. Note: Items marked'(p.o.c.)' were paid outside the closing; they are shown here for information purposes and are not included in the totals. p WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon Printed 0710612012 at 09:56 KS conviction can include a fine and im risonmenl. For details see: Title 18 U. S. Code Section 1001 and Section 1010. D. NAME OF BORROWER: Harry F. Reilly, Jr. ADDRESS: E. NAME OF SELLER: Estate of Grace E. Stoner ADDRESS: 1104 Laurel Avenue Cam Hill PA 17011 F. NAME OF LENDER: ADDRESS: G. PROPERTY ADDRESS: 1104 Laurel Avenue, Camp Hill, PA 17011 Lower Allen Townshi H. SETTLEMENT AGENT: Keystone land Transfer, Ltd, Telephone: 717-731.4200 Fax: 717-731-1799 PLACE OF SETTLEMENT: 3421 Market Street Cam Hill PA 17011 I. SETTLEMENT DATE: 0710612012 SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: J . 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 89 500.00 89 500.00 401. Contract sales rice 101. Contract sales rice 102. Personal ro ert 402. Personal ro ert 103. Settlement char es to borrower line 1400 1 802.00 403. 404 104. . 405 105. . Ad ustments for items aid b seller in advance Ad~ustments for items aid b seller in advance Cit /town taxes 406 106. Cit (town taxes 07106112 to 12131112 240.82 . 407. Count taxes 07106112 to 12131112 240.82 107. Count taxes 07106112 to 06130113 1 067.38 408. School Taxes 07!06112 to 06!30113 1 067.38 108. School Taxes 07106112 to 09130112 52.01 409. Sewer 07106112 to 09130112 52.01 109. Sewer 09130112 2 51.01 410. Trash 07106112 io 09!30!12 51.01 to 110. Trash 07106N 411. 111. 112. GROSS AMOUNT DUE FROM BORROWER 120 92 713.22 412. 90 911.22 420. GROSS AMOUNT DUE TO SELLER . . 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TD SELLER 10 000.00 10 000.00 501. Excess De osit see instructions 201. De osit or earnest move 2 739.12 Settlement char es to seller line 1400 502 202. Princi al amount of new loans . Existin loans taken sub'ect to 503 203. Existin loan s taken sub ect to . 504. Pa off of First Mort a e Loan 204. 505. Pa off of second mort a e loan 205. 506. 206. 507. 207' 508. 208. 509. 209. Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller Cit !town taxes 210 510. Cit (town taxes . 511. Count taxes 211. Count taxes School Taxes 512 212. School Taxes . 513. 213. 514. 214. 515. 215. 516. 216. 517. 217. 518. 218. 519. 219. ON AMOUNT DUE SELLER 12 739.12 TOTAL PAID BYIFOR BORROWER 220 10 000.00 520. TOTAL REDUCTI . CASH AT SETTLEMENT FROM OR TO BORR 300 OWER 600. CASH AT SETTLEMENT TO OR FROM SELLER . Gross amount due from borrower line 120 301 92 713.22 90 g11 22 601. Gross amount due to seller line 420 12 12 739 . r line 220 /f b 10 000.00 . 602. Less reduction amount due seller line 520 orrowe or 302. Less amounts aid b 3n3 cases FROM BORROWER 82 713.22 603. CASH TO SELLER 78172.10 SUBSTITUTE FORM 1099 SELLER STATEMENT: The intortnation contained herein is important tax information and is being furnished to the Internal Revenue Service. N you are required to file a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. The Contract Sales Price described on line 401 above constitutes the Gross Proceeds of this transaction. You are required by law to provide the settlement agent (Fed. Tax ID No: )with your correct taxpayer identification number. If you tlo not provide your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by taw. Under penalties o~rjury• I certify that the number shown on this statement is my correct taxpayer identification number. ~ SELLER(S) SIGNATURE(S) J TIN: - StLLtK(JJ IVC~"r M/1iL~rvV nuvr~c~~. -- -- SELLER(S) PHONE NUMBERS: (H) (W) form HUD-1 (3/86) ref Handbook 4305.2 Previous editions are obsolete PAGE 2 V.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 12206 t P fed 0710612012 at 0956 KS SE ~ TLEMENT STATEMENT TItIeEx ress Settlement S s em rin PAID FROM PAID FROM ~. SETTLEMENT CHARGES BORROWER'S SELLER'S TOTAL SALES/BROKER'S COMMISSION based on rice $89 500.00 = 700 AT . FUNDS AT FUNDS Division of commission line 700 as follows: SETTLEMENT SETTLEMENT 701. $ to 702. $ to 703. Commission aid at Settlement 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee 802. Loan Discount 803. A raisal Fee 804. Credit Re ort 805. 806. 807. 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to $ fda 902. Mort a e Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo. $ Imo 1002. Mort a e Insurance mo. $ Imo 1003. Cit Pro ert Tax mo. $ Imo 1004. Count Pro ert Tax mo $ Imo 1005. School Taxes mo. $ Imo 0.00 0.00 1009. A re ate Anal sis Ad ustment 1100. TITLE CHARGES 1101. Settlement or Closin Fee 1102. Abstractor Title Search 1103. Title Examination 1104. Title Insurance Binder 1105. Document Pre aration 1106. Nota Fees 1107. Altorne 's fees includes above items No: First American Title Insurance Com an t 845.00 o 1108, Title Insurance includes above items No: 1109. Lenders Polic 1110. Owner's Polic 89 500.00 - 845.00 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 62.00 1201. Recordin Fees Deed $ 62.00 Mort a e $ Release $ 895.00 1202. Cit !Count taxlstam s Deed 895.00 • Mort a e 895.00 1203. State Taxlstam s Deed 895.00 ~ Mort a e Deed Mort a e 1204 50.50 . 1205. Record Satisfaction Piece to Cumberland Coun Recorder of Deeds 1300. ADDITIONAL SETTLEMENT CHARGES 55.00 1301. Sewer 711-9130 to Lower Allen Townshi 53.95 1302. Trash 711-9130 to Lower Allen Townshi 1 082 21 1303. 2012-13 School Taxes to Bonnie Miller 602.46 1304. 2012 Co1Tw Taxes to Bonnie Miller .rte nr r • esn~e r_...,....., h.,..c 1M Cortinn f anri 5(1~ SPCtiOn Kl 1 802.00 2 739.12 14UU. I U I AL Jt I I LCIYICI`I I \+r1r1r~VLV ci ncr vi i ~ - - - - -- - HUD CERTIFICATION OF BUYER AND SELLER 1 have carefWly reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a Vue and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certif have received a copy of the HUD-1 Settlement Statement. 4`~ l 0~1j - arty ei y. r. - , ~ ~¢~ ~ s a e o race ~t\o^/n`er ~pny,~yYt.t WARNV~ A CRIME TO KNOWI MAKE FALSE STATEMENTS TO THE The HUD-1 Settlement Statement which I have Prepared is a true and accurate account of this ~ - - UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION transaction. I have caused or cause the funds to be disbursed in accordance with this stat mehl. CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: ,'1) U.S. CODE SECTION 1001 AND SECTION 1010. ~-i/7,// SETTLEMENT GENT: DATE P-201-AT-11-Worranry Decd, Short Form. Act of 1909-Arranged for Photo-Recording Henry Hall, Inc Indiac)a, PA : ~ ~ ~ 1 ,~ -. w 3~ •~' ,`' ~ ;r F --~__ ~ Y_.l rY ^°-- .._... ,~_ a .. ~~. is~~ :Ay ax ~ `% ,_ " "` e ~j<,s MADE THE ~ """ day of in the year of our Lord one thousand nine hundred eighty-six (1986) . BETWEEN VIRGINIA J. WEVODAU, single person, of Camp Hill, Permsylvania , Granter , and GRACE E. STONER, single person, of Camp Hill, Permsylvania, Grantee WITNESSETH, that in consideration of Sixty-Seven Thousand and No/100 -------------- --------------------------------------------($67,000.00) ----- Dollars, in hand paid, the receipt whereof is hereby acknowledged, the said grantor do es hereby grant and convey to the said grantee her heirs and assigns ; ALL THAT CERTAIN tract of land situate in I,awer Allen Township, Cumberland Crnmty, Pernzsylvania, being more particularly bounded and described as follows, to wit: BEGINNING at a point on the western line of Laurel Avenue on the dividing line be- tween Lots ~1os. 133 and 134 on the hereinafter mentioned Plan of Lots; thence in a westerly direction along the said dividing line one h~mdred sixty-six and seventy-five h~mdredths (166.75) feet to Lot No. 57 on said plan; thence in a northerly direction along the eastern lines of Lot No. 57 and Lot No. 56 one h~,mdred thirty (130) feet to Lot No. 136 on said plan; thence in an easterly directiari along the southern line of said Lot No. 136 one hundred sixty-six and seventy-five l~amdredths (166.75) feet to Laurel Avenue; thence in a southerly direction along the western line of Laurel Avenue one hundred thirty (130) feet to the point or place of BEGINNING. BEING Lots Nos. 134 and 135 on Plan of Rana Villa Spring Terrace, said plan being recorded in the C~nberland County Recorder's Offi-e in Plan Book 2, Page 42. ....... HAVING IlZECTID T~~ZEON a dwelling house being Down and numbered as 1104 Laurel Avenue, Camp Hill, Pennsylvania. BEING the same premises which Annie L. Frank, widow, by deed dated October 13, 1951 and recorded in the C~nberland County Recorder of Deeds Of_ f ice in Deed Book "V", Volt~ne 14, Page 113, granted and conveyed unto Lee W. Wevodau and Virginia J. Wevodau, his wife. The said Lee W. Wevodau died May 7, 1986 where- upon full and canplete title became vested in Virginia J. Wevodau, the surviving spouse and joint tenant . Schao} D;st. Cumb. Co., Pe. L~7e Reef Estate Transfer Iax _~'~ .c c- Date ~ .U.::~: C. Amt. .~~..'.:~. . ` - r'~~ '~*mb. Co. Dist. Cal. Ate. I ~sv~.b.ip n~ ......, ..~ ~-.... Cumb. Co., Aa. ,!._9'o Rsal Estate Transfer Tex ` C~,b. Co. bast. Col. Agt. ; .~~ ~o~~ ~ 32 PACE i~4 Mark I~. Keller 6441 Waggo~e:s Gap Road Las~disbsssg, PA i?040 Plsosse T i?-Z89-3616 Fax ? i?-Z89-9619 AUCTIONEER ~ REAL ESTATE CONSULTANT On December 29, 2011 I, Mark K. Keller, personally appraised the following personal property for the Grace Stoner Estate. 2010 Honda Fit (7300 mi) .........................................................................................$11,500.00 1967 Ford Mustang convertible (restored) ....................................................................8000.00 Dry sink ..............................................................................................................................45.00 Kenmore microwave .........................................................................................................20.00 Usual pots, pans, and dishes ..............................................................................................75.00 Dinning room table/6 chairs ...............................................................................................85.00 Hutch ..................................................................................................................................95.00 Plant stands ........................................................................................................................20.00 Roll top server ....................................................................................................................30.00 Couch and love seat ...........................................................................................................75.00 Chair and ottoman ..............................................................................................................25.00 Entertainment center .........................................................................................................45.00 Coffee table .......................................................................................................................10.00 Press back rocker ...............................................................................................................50.00 Cabinet Sewing machine .............................................................................20.00 Stereo System .........................................................................................30.00 G.E. TV ................................................................................................15.00 End tables .............................................................................................20.00 Shelves and cabinet ..................................................................................20.00 Computer desk .........................................................................................5.00 Small table .............................................................................................35.00 Cedar chest ............................................................................................50.00 White treadle sewing machine ......................................................................45.00 Jewelry case ..................................... . ................................................25.00 Barber chair ............................................................................................20.00 Small desk and chair ..................................................................................15.00 Four drawer file cabinet ..............................................................................15.00 Air compressor ........................................................................................25.00 Patio furniture ..........................................................................................20.00 Hand tools ...............................................................................................30.00 Total Appraised Value ........................................................................ $20,465.00 December 6, 2011 Integrity B A N K Scott W. Morrison Center Square, PO Box 232 New Bloomfield, PA 17068 Re: Estate of: Grace E. Stoner Social Security #: 177-42-4734 Date of Death: 09/30/2011 Dear Mr. Morrison, The following reflects upon the relationship Grace E. Stoner had with Integrity Bank as of 09/30/2011: 1037663 (Certificate of Deposit) $67,230.61 Last interest payment before death was made 9/ 19/ 11. The interest accrued from 9/ 19/ 11 to 9/30/11 is $65.43. The account was titled Grace E. Stoner. If I can assist you further, please feel free to contact me at (717)920-4900 ext. 231 or dpainter@integritybankonline. com Sincerely, Debbie Painter Integrity Bank -Camp Hill Customer Service Representative 33451~1arket Street, Camp Hill, PA 17011 • Phone: 71? 920-4900.877-I-HAVEIT • Fax: 717-920-4904 • www. integritybankonline.com Dec. 6. 2011 11.07AM PNC BANK No. 1905 P. 2 This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby noted that arty dissemination, distribution or copying of this communications is strictly,prohibited. If you have received this communication in error, please note me immediately by reply or by telephone at 500-762-1775 and immediately destroy this faxed document, Pale 2 of 2 Bank records indicate the following account balances on 9/30/11 for Stoner, Grace E SS # 177-42-4734 1337 Shermans Valley Rd (addressor file) Obituary says deceased lived in Camp Hill r:lliottsburg PA 17024 Lale B Smith - Father - SS;~193-12~-9113 1337 Shermans Valley Rd Elliottsburg PA 17024 Balance Acct Sole Jt Acct Account Prior to Interest Accrued Opened Ownership With Number Type Interest Bearing Interest 05/05/06 Titled Dale B Smith or Grace E Stoner 700016597 CD 15,633.40 Yes 10.03 BY `~ r From:CORE OPS WOODMEN JJl °f t~Wo~.D 800-225-3 108 woodmen.org 1700 Farnam Street, Omaha, NE 68 102 Woodmen of the World Life Insui ante Society and/or Omaha Woodmen Life Insurance Society December 6, 2011 SCOTT W. MORRISON, ESQUIRE PO BOX 232 NEW BLOOMFIELD PA 17068 Dear Mr. Morrison: Grace E Stoner Certificate 63 67941 Deferred Annuity 6375246 Deferred Annuity 9736581 Annuity IRA 9740146 Deferred Annuity 9769169 Deferred Annuity 3933962 Monthly Disability Policy We have received your letter dated November 21, 2011 regarding the estate of Grace E Stoner. The values of. these certificates as of the date of death of September 30, 2011 are as follows: Certificate Value 6367941 $82,690.62 ~ 6375246 $24,617.71 9736581 $18,4568.81 9740146 $10,581.04 ,~ 9769169 $101,388.41 / 3933962 $0.00 If we may be of further service, please let us lalow. Sincerely, Lisa Hardy Life Claims 402 661 6281 12/05J2011 14:36 #265 P.002/002 /lh enc. ,~~ pennsytvania DEPARTMENT OF PUBLIC WELFARE November 29, 2011 SCOTT W MORRISON ESQUIRE 6 W MAIN ST PO BOX 232 NEW BLOOMFIELD PA 17068 Re: Grace Stoner SSN: ###-##-4734 Dear Attorney Morrison: Pursuant to your letter dated November 21, 2011, the Department of Public Welfare (DPW), Estate Recovery Program, has reviewed the information you provided regarding the above-referenced individual. It has been determined that this individual did not receive any type of assistance during the questioned period. Therefore, according to the information you provided, the Department's Estate Recovery Program will not seek any recovery from this estate. If your client applied for Medical Assistance and had an application and/or hearing pending at the time of death, please advise us and provide any additional information that may affect a recovery by our Department. If you have any questions, please feel free to contact me. Sincerely ~--r~'~ ~~ ~ ~d' Vince A. Porter Recovery Section Manager (717)772-6604 Bureau of Program Integrity ~ Division of Third Party Liability ~ Recovery Section PO Box 8486 ~ h~arrisburg, Pennsylvania 17105-8486 '~ ~l 1 1 t c c n ~~ 3 ,~ c ~~ ~ ~ c ~ ~ ~ r ~° Q -~ ,. n ~~; C' c ., ~. ._. N a r~ r d J O 00 ~, ~-~ c~ ifi~ _.._ -~ =~.w~ r° ~ ~~ ~~ oz D 'i ~ O o mN O b O C y n N m 0 W Z m o ao c o~ ~-~i o in 0 o 3 ,....0-~, Oo~1:3~ ~ C(OO~ri~-+-~ v~ n~~ ~+ Z• O~•-~00 J .MT C~ S <+i n ~ ~: ~13g3i1~j , -~: 'su' :i `„~[y. y ... ..w ~~ ..~.~ ~,~ ..~.. ire.,. W ... ~~ ~ ... ~~ R O -~'~~~// `_~ ~ W p ~ ..~.. ~ ~ ~ t' ~Zcn~M ~ ~ o ~ ~ ~ ~~-- ~.~' W ~ O e-1 _.s •• i tti.i .~ Z ~ O E-' p.., ._' O W ~ p" W ;: ~'' pq ~ U ~ f _ 5 C~ ~ ~ -~, ~ U C~ O U ~ . ._t_ ~..~ U ;••~ c:.~ ;~:' cs,s ' W U o0 N ~ W I- ~ w °w O ~ m ~ (n N O N Z X W m >W ~ ~ >m W ~-- Z U