Loading...
HomeMy WebLinkAbout11-01-12 (3)J 1505610105 REV-1500 ~"°'-'" I"'~ PA Department of Revenue Pennsylvania Bureau of Individual Taxes ~~~,~~m~~INHERITANCE TAX RETURN PO BOX 280601 Harrisburo. PA 17128-0601 RESIDENT DECEDENT Social Secudy Number.-. 196-14-2910 Decedent's Last Name Johnston Dale of Death MMDDYYYY 111/07/2011 -~ .____.__~ Suffix (If Applicable) Enter Surviving Spouse's Information Below OFFICIAL USE ONLY Coun Cale Year File Number II ~ I ZS~ ~ Date of Birth MMDOYYYY 11/09/1925 i~ _Decedent's First Name James Spouse's Last Name Suffx Spouse's First Name _...___1 _.._ __. __.. ..._ __l Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - ----- -------- REGISTER OF WILLS MI MI FILL INAPPROPRIATE OVALS BELOW m 1. Original Return O 2. Supplemental Return O 3. Ranlainder Return (Data of Death O 4. Limited Estate O 4a. Future Interest Compromise (data of Prior to 1243-32) O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O (Attach Co of Will 7. Decedent Maintained a Living Trust 0 8, Total Number of Safa Deposit Boxes py ) (Attach Copy of Trust.) O 9. litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax untler Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name _ _ Daytlme Telephone Number David A. Baric, Esquire _- __ _ - i ' (717) 248-6873 ~ -~ First Line of Atltlress Baric Scherer LLC Second Line of Address 19 West South Street City or Post Once _ Carlisle Correspondent's a-mall address: Under penalties of periury, I deGere Ihet I it is true, correct and complete. Declaretia RETURN REGISTER OF WILLS USE ONLY s ~~, :,` m z~ (r 1 GATE F --' -' r - _-- ~ -- - ~~ -ti :fletlules and statements,; is basso on all Information ~O and belie( 291 I~iJ}~o~d, Styppensburg~ennsylvania 17257 19 West South Street, Carlisle, Pennsylvania 17013 f f PLEASE USE ORIGINAL PORM ONLY Side 1 L 1505610105 1505610105 J State ZIP Code PA ! 17013 _ 1~ --n Fr :~D f_,7 C~ C.• ^ i+ l_) ~ ~ ~7 r' ; a ':i=n ~~ T ~_ m cn T REV-1500 EX (FI) 1505610205 Decedents Nama: James E. Johnston RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1 2. Stocks and Bonds (Schedule B) ....................................... 2. Der;edent's Social Security Number 196-14-2910 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Depos~•s and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ---- - - _- (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines i through 7) ............................. 8. 62,750.00 9. Funeral Expenses and Atlministrative Costs (Schedule H) ................... 9. 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ......... ...... 10. ___ ___-- 11. Total Deductions (total Lines 9 and 10) .. ........ ........ . ...... 11. 12. Net Value of Estate (Line B minus Line 11) ........ ......... .. ---_ ...... 12. 13. Charitable and Go•~~emmental Bequests/Sec 9113 Trusts for which an election to tax Y'as not been made (Schedule J) .................. ...... 13. -- 14. Net Value Subject to Tax (Line 12 minus Line 13) .................. ...... 14. 15,240.18 0.00 -_ 15,240.18 47.759.82 0.00 47,759.82 7AX GALGULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 i6. Amount of Line l4 taxable - - --_-~~-" --""- -"~~_"-~. _ .._ ---- at lineal rate X .0 _ i6 17. Amount of Line 14 taxable at sibling rate X 12 ~ 17 18. Amount of Lne 14 taxable ~ at collateral rate X.15 _.. _.. _. 47,759.82 18 ~.--_..___, __ _,--___,. __"_ 19. TAX DUE ......:................................................. ., .. 19. ~~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610205 1505610205 7,163.97 7,163.97 O REV-1500 EX (FI) Page 3 Flie Number U6GegeflCS James E. Johnston STREET ADDRESS 152 Neil Road clTv Shippensburg ___T PA _ __ __-- STATE _ - _ _ ~ ZIP 17257 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments _ __ __ B. Discount 3. Interest 4. If Line 2 is greater than Line 1 +.Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 fo request a refund. (i) 7,163.97 Total Credits (A+ g) (2) 0.00 (3) (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 7,163.97 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred ................................................................................... ....... ^ b. retain the ri~.fhl to designate who shall use the property transferred or its income ..................................... ....... ^ c retain a rev„~sionary interest ....................................................................................................................... ....... ^ d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^ ~ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "intrust for" orpayable-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 trans6~rs 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 Ja:f. 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 sty lute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and f ling a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 'i, 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 percEant, 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 172 P.S. §9116(a)(1.3)]. Asibling is defned, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. AC10reSS: 0.EV-1502 EX+ (O1-10) ~pennsylvania SCHEDULE A DEPAPTMENT OF gEVENNE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUM9ER: James E. Johnston 21.11 1266 All real properly owned solely or as a !anent in wmmon moat ba reported at lair 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 Nght of survfvorehip moat be dlaclosed on Srhedule F. Attach a mpy 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 DESCRIPTION OF DEATH 1 152 Neil Road, Shippensburg, Pennsylvania 17257 mobile home on real property (HUD-1 from sale attached) TOTAL (Also enter on Line 1, Recapitulatfon.) ; If more space is needed, use additional sheets of paper of the same size. 62,750.00 62,750.00 REV45o8 EX+ (o8-IZj Pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH BANK DEPOSITS & MISC. Irvneavarvce Tnx REruRN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: James E. Johnston 21-11-1286 _~ ~~~~~_ ~Ra~o ~~ nmueu, use aaD¢mnai sneers or paper of [ne same size. REV-1511 E%+ (10-09) ~ pennsylvania SCHEDULE H OEPAPTMENT OF REVENUE FUNERAL EXPENSES AND '""ERn""cETax"EruR" ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER James E. Johnston 21-11-1286 Decedent's debts must be reported on Schetlule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' permit soo.oo marker 450.00 burial service 7,005.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address - City __ State ZIP _ Year(s) Commission Paid: z. attomeyFees: garic Scherer LLC 3. Family Exemptio:c (If decedent's address is not the same as claimant's, attach explanation.) Claimant None Street Address City State 2IP ___ Relationship of Claimant to Decedent 4. Probate Fees: 5~ Accountant Fees: 6. Taz Return Preparer Fees: z Adam's Electric. a. CFJMA s. water bill to. homeowner's insurance >> The Sentinel (legal advertising) 12. Cumberland Law Journal 13. Real estate taxes TOTAL (Also enter on Line 9, Recapitulation) ~ 15 , 240.18 5,500.00 186.50 321.00 291.00 114.00 341.00 157.68 75.00 199.00 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (O1-10) Pennsylvania SCHEDULE ] iEv DEPARTMENT OF REVENUE INHERITANCE TpX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: James E. Johnston 21-11-1286 RELATIONSHIP TO DE(EDENT AMOUNT OR SHARE NUMBER NAME Ah'D ADDRESS OF PERSON(S) RECEIVING PROPERTY DD Not List Trustee(s) OF ESTATE I 7AXABLE 0[STRIBUTIONS [Include outright spousal distributlDns and transfers under Sec. 9116 (a) (11).] i. Jean E. Bartley none 100% 201 Neil Road Shippensburg, Pennsylvania 17257 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 18 OF REV-1500 COVER :THEFT, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTi0N5 ON LINE 13 OF REV-1500 COVER SfiEET. § If more space is needed, use additional sheets of paper of the same size. LAST WILL AND TESTAMENT OF JAMES E. JOHNSTON I, JAMES E. JOHNSTON, currently of 152 Neil Road, Shippensburg, Cumberland County, Pennsylvania, revoke any prior Wills and Codicils and declare this to be my Will. ITEM 1. I give my fumiture, household and personal effects, and other tangible personalty of like nature, other than cash or securities, together with any existing insurance thereon, to my neighbor, :LEAN BARTLEY, if she survives me by thirty days. If JEAN BARTLEY is not living on the thirty first day following my death, then this gift shall lapse and I give my furniture, household and personal effects, and other tangible personalty of like nature, other than cash or securities, together with any existing insurance thereon, to my neighbor, LARRY McLAUGHLIN, if he survives me by thirty days. ITEM 2. I give the rest, residue and remainder of my estate to my neighbor, JEAN BARLTEY, if she survives me by thirty days. If JEAN BARTLEY is not living on the thirty first day following my death, then this gift shall lapse and I give the rest, residue and remainder of my estate, to my neighbor, LARRY McLAUGHLIN, if he survives me by thirty days. ITEM 3. If neither JEAN BARTLEY nor LARRY McLAUGHLIN are living on the thirty-first day following my death, then all gifts to either of them shall lapse and I give my entire estate to my heirs at law in such proportions as is provided for under the Pennsylvania Probate, Estates and Fiduciary Code or its successive legislation as is in force at the time of my death. Uocumett[ #3 /?313. Page 1 of5~~ ITEM 4. I direct that all my just debts and the expenses of my last illness and disposition of my remains shall be paid from my residuary estate as soon as practicable after my death and as part of the expense of the administration of my estate. ITEM 5. In addition to the powers conferred by the common law, by statute, or by any other provisions hereby, my Personal Representatives are hereby empowered as follows: (a) Subject to the gifts made in Item 1 of this Will, to sell at public or private sale, to exchange, to lease, to pledge, to mortgage, to transfer, to convert, or otherwise dispose of, or grant options with respect to, any and all property, real, personal, or mixed, at any time forming a part of my probate or trust estates, in such manner, at such time or times, for such purposes, for such price or prices, and upon such terms, credits, and conditions as shall be deemed advisable or necessary under the circumstances. (b) To assent to, join in, and vote in favor of any merger, reorganization, voting trust, plan, lease, mortgage, consolidation, exchange, foreclosure of any corporation or other investment in which the probate estate or trusts may hold stock, bonds, investments, or an mterest; (c) To vote in person or by general or limited proxy with respect to any share of stock or other investment held by the probate estate or trusts; (d) To make distribution in division of the probate estate in cash, in kind, or partly in both; (e) To distribute articles to a minor or to her or his guardian or to any person taking caze of the minor to hold for the minor within the limits authorized by statute or rule of law; (~ To compromise any claim or controversy; Document #3/2313. / Page 2 oFT~~ (g) To apportion between principal and income any receipts and disbursements and to ascertain income and principal in accordance with the statutes and rules of law of the Commonwealth of Pennsylvania; (h) To keep property in the name of a nominee with or without disclosure of any fiduciary relationship; (i) To employ attorneys, auditors, depositories and proxies with or without discretionary power. (j) To make, execute, acknowledge, and deliver any and all instruments which may be deemed advisable or necessary to carry out any of the; powers herein granted or provided by law; (k) To invest and reinvest the principal of the trusts, together with any accumulated income thereon whenever such accumulation has been permitted by the terms hereof, in all forms of property, real, personal, or mixed, including but not limited to stocks, bonds, common trust funds, mortgage, investment funds, insurance policies, and annuities, without being limited by any statute or rule of law concerning investments by fiduciaries; (1) To join with my spouse, if I am married at the time of my death, in filing any federal income tax returns for any year in which suchjoincier is permitted by law and to pay all or such ratable share of any taxes due thereon as my fiduciaries shall deem proper, and to join or consent to any gifts made by my spouse during my lifetime as having been made one-half by me for the purpose of any federal gift tax law; (m) To carry out the terms of any agreement I may have entered into to sell all or any part of any property or any interest I may own in any business at the time of my death; Documert! tf3ll3 /3/ ~~~_......~~~... Page 3 of ?~~ (n) To exercise any law-given option to treat administrative expenses either as income tax or as estate tax deductions, without regard to whether the expenses were paid from principal or income; (o) To disclaim inheritances and interests in property. (p) To apportion tax basis among bequests in accordance with the Internal Revenue Code, applicable regulations and other state or federal laws. ITEM 6. No bond shall be required of my Personal Representatives or Trustees but if bond is nevertheless required, it shall be without surety. ITEM Z I appoint my neighbor, JEAN BARTLEY, Executrix. If JEAN BARTLEY fails to qualify or ceases to act, I appoint my neighbor, LARRY McLAUGHLIN, Executor. ITEM 8. I note to my Executors that I have retained the services of David H. Martineau, Esquire, and the firm of Metzger, Wickersham, Knauss & Erb,1?.C., in connection with the writing of this Will. Executed on L~~a- ~ ~~,-~ ~ 2004. ,i ames E. Johnst In our presence, JAMES E. JOHNSTON signed this Will and decla~:ed it to be his Will, and now at his request, in his presence, and in the presence of each other, we sign as witnesses: Residence l~~ ~ ~~ Residence Document N3 [23I3J Page 4 of ~~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF i.~a~t?H~-tt% SS We, JAMES E. JOHNSTON, and 1~~4~,' d I~. VY1ar~n~... ,and m,. i=~ ~~ ,~• ,the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declaze to the undersigned authority that the Testator signed and executed the instrument as his last Will and that he had signed willingly (or willingly directed another to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed, and that each o f the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of our knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. .~ l estator ',~,~f r~d~C//C'---~ SWORN to or affirmed and acknowledged before me by the above named Testator and witnesses this cY day of ~~~_t,;~,.- , 2004. ~, n Notary Pu itit c My Commission Expires: (SEAL) Notarial Seal Angela M. Miller, Notary Public City of Harrisburg, Dauphin County My Commission Expires Oct. I5, 2006 Documemt X3[2313.[ Page 5 of 5 .,e.,o~. •a,w.•1.e m.oi.,e O m~~uL--~IVSSI.•1 H.,,eeoox aeosz A. S0t11P,TIl CTIt St3teTIl CTIt U.S. Depanment of Housing and Urban Development B. Type of Loan umtl A royal No. 2602-0265 L CPHA 2. ^FRIHA 3. i]Conv. Unins. fi. File Number 7 loan Numbe . r FI. Mongage Insurance Case Number IVA 5 pConv Ins 2012.351MILLHOU ~F§T ~ C N t o1 it `6» le~lla-R.Rir-T~i aTa ~i 6- 1ASA,1 all lu p amuwe m. wpNOa.m•y.re.no.nlw mnmemaxm pY,pwe•e,w.re nm iwYawm me mws TiteExpress Settlement System WARNING: 61•PC mxM•nnyly T•MIeINIIMen.nl•mme UNM461eb•p~tlx•ba,ry oN•!•i,nXi/blln.PM•Ities YpCn mnY Iron un mgYE• a fw mE IT ,IVprvnent Fpr eeWl• rea Tm 18 U $ Lo0.8egbn 1001 . . . me beNOn t010. i D. NAME OF BORROWER: Angela Millhouse and Faye Millhouse ADDRESS: E. NAME OF SELLER: James E. Johnston ADDRESS: do Jean E Bartley Executrix F. NAME OF LENDER. ADDRESS' G. PROPERTY ADDRESS: 752 Neil Raatl, Shippensburg, PA 17257 Southam on Tovmahl H. SETTLEMENT AGENT: Badc Seheror LLC, Telephone: 777449.8873 Fax: 717.249.5755 PLACE OF SETTLEMENT: 79 Went Soldh Street Carlisle PA 17073 I. SETTLEMENT DATE: 0 917 412 012 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 701. Contract sales rice 63 000.00 401. Controcl sales nce 63 000 00 102. Personal ro n . 402, Personal ro 103. Setdement char es to bonower line 1400 1 398.50 403. 104. 404. 105. 405. Adushnants (or items aid b seller 106 C in advance Ad'ustmants for items eitl seler in advance . it down taxes 406, Cil /town taxes 107. Count taxes 091f4142to 12131112 39.68 407. Count taxes 0917M72to'12137111 39 66 106. School Tax 0911Q12to061301f3 108.62 408. School Tax 09114112 to98130173 . 488 82 109. 409, , 110. a1D. 111. 411. 772. 412, 720. GROSS AMOUNT DUE FROM BORROWER 64846,80 420. GROSS AMOUNT DUE TO SELLER 63448 30 200. AMOUNTS PAID RY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER . 201. De osit or earnest mono 501. Excess Da 't see inssuctions 202. Princi al amount of new loans 502. Settlement cha es ro seller line 140D 24597 35 203. Existin loans taken suti act to 503. Exisdn loans taken sub'ect to . 2~' 504. Pa off of First Mon a Laan 205. 505. Pa H of second mon a e loan 2~' 506, 207. 507. 206. 506. 209. 509. Ad'ustmeMS for Items un aid b seller 2 Ad'uatments for Rertls un aid b seller 10. Ci Mwn taxes 510. Cg flown taxes 211. Coun taxes 511. Coun taxes 272. School Tax 512 School Tax 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 516. 219' 519. 220. TOTAL PAID BYIFOR 80RROWER 520. TOTAL REDUCTION AMOUNT DUE SELLER 24 597 35 300. CASH AT SETTLEMENT FROM OR TO BORRO WER 600. CASH AT SETTLEMENT TO OR FROM SELLE . R 301. Gross amount due from bonower line 120 64848.80 601. Gmss amount due to seller Tine 420 63448 30 302. Less artwunts aid b Ror borrower line 220 602 Less reduction amount due seller line 520 . 24 597.35 303. CASH FROM BORROWER 84 8/8,80 603. CASH TO SELLER 38 850.95 .~...„.,,J ~~'•'JEPARTMENT Oe'I i 'o^^row lamai rel Xe^ae^oraaosz OJSING AND URBAN DEVELOPMENT File Number 2012.351MILLHOU PAGE2 ' ~ SETTLEMENT STATFMPNT - - - I metxo ss Settlement SVStem L. SETTLEMENT CHARGES PAID FROM I PAID FROM 700. ^IOTAL SALES/BROKER'S COMMISSION basetl on rice $63 000.00 = 1 BORROWER'S SELLER'S Division of commission (line 7001 as follows it FUNDS AT FUNDS AT 701. $ to SETTLEMENT SETTLEMENT 702.5 to 703. Commission aid at Settlement 800. ITEMS PAYABLE IN CONNECTION WRH LOAN 801. LWn Ori ination Fee % 802. LDan Discount % 803. ADDraisal Fee __ 804. Credit Re od 805. _ 806. _ 807 808. 609. 810. 811. 900. REMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 907. Interest From tc /da 902. Mort a e Insurance Premium far t0 903. Hazard Insurance Premium for to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. HazaN Insurance mo. /mo 1002. Mort a Insurance mD, Imo 1003. Cit Pro ert Tax mo. /mo 1004. Count Pro rt Tax mo. /mo 1005. School Tax mo. Imo 1009. A re ate Anal sis Adustmenl 1100 TITLE CHARGES 000 000 . 1101. Settlement or Cbsin Fee 1102. Abslraq or Tine Search 1103. Title Examination 1104. Title Insurance Binder 1705. Document Pre oration 1106. Note Fees to Caah 1107. Attome 's fees 10.00 10.00 includes above items No: 1108. Title Insurance to Beric $eherer LLC includes above items No: 896 50 1109. Lendefs Polic 1110. Owner's Polic 63 000.00 •896.50 111 t. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recerdin Fees Deetl 62.00 ~ Mo a ~ Release 1202. Ci ICounl tax/stam s Deed 630.00 Mort a e 1203. State Taxlstam s Deed 630.00 ~ Mart a e 1204. Dead Mort a e 62.00 830.00 630.00 1205. 1300. ADDRIONAL SETTLEMENT CHARGES 1301, Final Water/Sewer to Borou h of Shi eesbu 1302. Motor Vehkle T01e Escrow to Beric Seherar LLC 57.35 23 900.00 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J antl 502 Section K 1 398.50 24 597.35 i MVeuremlly nm..na me euD-rsmMmem sLMmem nwmlM emn yxrowleese era Mller, Il lv core am.cwnu sMlemml olmlreMlps erw emew..mam. measw my ecmum oey 1^mll nl^/n~l mn/nJx~wmp mnleee.reulsa.c^Prmme riuD-r semememsleum.m. A er. Mlpl6s A e "-.+(GY~^G ~ ~s0 r% .ve (l y n . / J eonnalon y e ^ n ^s WARNING IT IS ACflIME TO NNOWINGLV MAKE FALSE STATEMENTS TO TXE TM MUO4 SeMemFnt wM[!~I VNITFOSUTES ON THIS OR ANV SIMILAR FORM >ENALTIES UPON CONVICTION Inns¢OOn. lpewq lun0~. reel e e ew ^I ^I tlee CAN INCLUDE A FINE ANO IMPRISONMENT. FOR pETAILb SEE TITLE IB'. orynm wiM 11i1e e4lemenl. V 6. CODE SECTION 1 W1 ANO SECTION 10 W. 1 SETTLEMENT AG i DATE'.