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HomeMy WebLinkAbout10-31-12 (2)1505610143 REV-'1500 ~``°'-'°' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania county code veer File Number Bureau of Individual Taxes °E'""T''~"*~R~~ Po Box.2soso~ INHERITANCE TAX RETURN 21 11 1021 Harrisburg, PA 1712s-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 09 15 2011 12 06 1931 Decedent's Last Name Suffix Decedent's First Name MI HINER MARY J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL INAPPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1. Original Return ~ 2. Supplemental Return 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) 8 Decedent Oied Testate (Attach Copy of Will) ~ ~~ (Att~acdher~ oMeintained a Living Trust (: py of T ru st) 9. Litigation Proceeds Received ~ C r 1 D. between 1231 ~J1 a^d~t (datge5~f death 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required MI B. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number DAVID J LENOX 717 432 9666 First line of address 3 N BALTIMORE ST Second line of address City or Post Office DILLSBURG State ZIP Code PA 17019 REGISTER OF~ILLS USE ONlY n ~ ~ - > rn -- - - --,I ~~~ ~, . ~ c,.a ;_, , c-~ c ~_,~. E, ©~ ~ ~.~ '_ DAT ICFD '"` ' ~- ~ . n 4rJ c~.~~ -z~ c-~ ~:~ c'" T Tl C~ --r~ Correspondent's a-mail address: davelenox@comcast.net nder Wallies of perjury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, rrect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ~ ~ <--~~ Jan M. Wile Es U Z9 AD ESS 3 N. Baltimore St. Dillsbur PA 17019 SIG OF P OTH THAN REPRES TATIVE DATE David J. Lenox ~ d ~~ 9~ Z ADDRESS -' U / 3 Baltimore Street, Dillsburg, PA Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: i"ilne~, Mary Jane RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 119 , 8 0 9 . 2 7 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 16 , 7 3 6. 3 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 4 3 , 0 91.4 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous lyoq Probate Property (Schedule G) u Separate Billing Requested............ 7, 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 17 9 , 63 6.97 9. Funeral Expenses & Administrative Costs (Schedule H) ................................ ....... 9. 90 , 422.12 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........................ ...... 10. 290.28 11. Total Deductions (total Lines 9 & 10) ............................................................ ....... 11. 90 , 712.40 12. Net Value of Estate (Line 8 minus Line 11) .................................................... ...... 12, $$ , 924 .57 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ......................................... ...... 13. 55 , 127.21 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................................ ....... 14. 33 , 7 97.3 6 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable 0 , 0 0 at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 33 , 7 9 7 . 3 6 18. 19. Tax Due ................................................................................................................. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 0.00 0.00 0.00 5,069.60 5,069.60 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Hiner, Mary Jane STREET ADDRESS 204 West Main St. CITY Shiremanstown STATE PA ZIP 17011 File Number 21-11-1021 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 (1) Total Credits (A + B) (2) 5,069.60 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) rJ.069.s~ Make Check Pa able 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: a. retain the use or income of the property transferred :............................................................................... b. retain the right to designate who shall use the property transferred or its income :.................................. c. retain a reversionary interest; or ............................................................................................................... d. receive the promise for life of either payments, benefits or care? ............................................................ 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 "in trust for" or payable upon death bank account or security at his or her death?....... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ^ ^x 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 Y spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. 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)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Yes No ^ ^x ^ ^x ^ 0 Rev-1502 F.X+ (~ ~ -08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Hiner, Mary Jane 21-11-1021 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is Jointly-owned with right of aurvivorehip must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) Rev-1503 EX+ (6.98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hiner, Mary Jane 21-11-1021 All propeRy jointly-owned with right of survivorship must be disclosed on Schedule F ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 323 shares of ATBT Inc. 28.54 9,218.42 2 153 shares of Comcast Corp: 22.61 3,459.33 3 22 shares of Frontier Communications Corp. 7.03 154.66 4 4 shares of LSI Corporation 6.71 26.84 5 95 shares of Verizon 36.19 3,438.05 6 US Savings Bonds redemption: 439.00 TOTAL (Also enter on Line 2, Recapitulation) 16,736.30 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1508 EX+ (8.98) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Hiner, Mary Jane 21-11-1021 Include the proceeds of litigation and the date the proceeds were received by the estate. All property JolnHy-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Hardy's Acution (personal property): 9,674.00 2 Joseph James Jewelers (sale of ring) 390.00 3 Kilmore Eye Associates (refund): 25.00 4 M&T Bank Checking Account Number 1191306: 928.07 5 Metro Bank Checking Account Number 513224964: 479.99 6 Metro Bank Savings Account Number 616165346: 323.29 7 Sale of 1994 Buick: 500.00 8 Sale of collectibles, and other personal property on E-Bay: 30,771.05 TOTAL (Also enter on Line 5, Recapitulation) I 43,091.40 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+(10.08) C 0 Mlyl_ QEAO F~E~yLVAN IA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Hiner, Mary Jane 21-11-1021 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached 3,234.00 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Jan M. Wiley Esq. Street Address 3 N. Baltimore St. City Dillsburg State PA Zio 17019 Yearls) Commission paid 15,000.00 2. Attorney's Fees The Wiley Group, PC 15,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationshio of Claimant to Decedent 4. Probate Fees 503.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 56,684.62 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 90,422.12 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Hiner, Mary Jane FILE NUMBER 21 11 1021 ITEM NUMBER DESCRIPTION AMOUNT 1 Funeral Expenses Zimmerman Auer Funeral Home: 3,234.00 Oth Ad i i H-A 3,234.00 2 er m n strative Costs Computershare (lost certificates): 159.58 3 Cumberland Law Journal (advertise): 75.00 4 David Geesey (home repairs): 2,577.39 5 Donnie Davis (sale help): 130.00 6 Hardy's Auction (Fee 8: costs for sale of personal property): 1,826.46 7 Jennifer Boyle (sale help): 80.00 8 Jennifer Myers (work on house): 36,058.18 9 Metro Bank: 59.17 10 Real estate closing costs from sale of home: 15,266.02 11 Recorder of Deeds (satisfaction of mortgage): 50.50 12 Register of Wills (add'I short certs) 20.00 13 The Sentinel (advertise estate): 210.78 14 Waste, trash removal: 149.04 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Hiner, Mary Jane 21 11 1021 ITEM NUMBER DESCRIPTION AMOUNT 15 Wm. H. Wessels (obtain car title): 22.50 H-67 56,884.62 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV•1513 EX+t11-08) COMM~OF~F$ RLVANIA SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER ..11161, Itlgl Jg11C 21-11-1 021 NUMBER NAME AND ADDRESS OF PERSON(Sl RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 Juanita Bomgardner First Cousin 5 074.33 80 Stephania Drive , Middletown, PA 17057 2 Wolford Lee Hoke Second Cousin 500 00 403 Park Street . Harrisburg, PA 17109 3 Linda Hoke Second Cousin 500 00 614 Frances Drive . Harrisburg, PA 77109 4 Mildred Lescanec Friend 500 00 701 Monroe St. . Harrisburg, PA 17113 5 Mary K. Ofak Friend 5 000.00 650 Chambers St. , Harrisburg, PA 17113 See continuation schedule attached Continuation 22,222.97 Total 33,797.30 Enter dollar amounts for distributions shown above on lines 1 5 throw h 18 on Rev 150 0 cover sheet as a r o riate. II NON-TAXABLE DISTRIBUTIONS: . A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Shiremanstown Police Department 1s,375.7a 2 Shiremanstown Fire Department 18,375.73 3 Shiremanstown United Methodist Church 113,375.74 TOTA L OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 C(~vFR SHFFT .~i5 197 91 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Mary Jane Hiner 09/15/2011 193-24-1204 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) v rranK rremer First Cousin 4,074.33 3424 Old Saint Augustine Rd. Tallahassee, FL 32311 7 Jerome Wehler First Cousin 9,074.32 215 W. Simpson St. Mechanicsburg, PA 17055 8 William Wehler First Cousin 9,074.32 27 W. Keller St. Mechanicsburg, PA 17055 Total 22.222.97 1 ~~~.t i.Il ~n~ ~'.~~.t~tm:.ertt OF MARY JANE HINER BE IT REMEMBERED, that I, MARY .JANE HINER, of 2~4 W. Main Street, Shiremanstown, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof made by me at any time heretofore. ITEM I: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: I give the sum of Five Thousand Dollars ($5,000.00) to Jerome Wehler, provided he survives me. ITEM 3: I give the sum of Five Thousand Dollars ($5,000.00) to William Wehler, provided he survives me. ITEM 4: I give the sum of One Thousand Dollars ($1,000.00) to Juanita Bomgardner, provided she survives me. ITEM 5: I give the sum of Five Hundred Dollars ($500.00) to I..inda Hoke, provided she survives me. ITEM 6: I give the sum of Five Hundred Dollars ($500.00) to Wolford Lee Hoke, provided he survives me. ITEM 7: I give the sum of Five Thousand Dollars ($5,000.00) to Mary Kay Ofak, provided she survives me. ITEM 8: I give the sum of Five Hundred Dollars ($500) to Mildred I_escanec, provided she survives me. ITEM 9: I direct my Executor herein named to sell all of my shares of stock and spit the proceeds equally between JEROME WEHLER, WILLIAM WEHLER, FRANK WEHLER and JUANITA BOMGARDNER, in equal shares, per capita. Page 1 of 4 ITEM 10: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate. whether it be real, personal or mixed, including property over which 1 have a power of appointment, I give, devise and bequeath unto the following charities, all located in Shiremanstown, Pennsylvania, in equal shares: THE SHIREMANSTOWN POLICE DEPARTMENT, THE SIIIREMANSTOWN FIRE DEPARTMENT and THE SHIREMANSTOWN L7NITED METHODIST CHURCN, absolutely. ITEM 11: I direct my hereinafter named Executor to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 12: I appoint JAN M. WILEY, ESQUIRE, as Executor of~this my bast Will and Testament. Should he predecease me, fail to qualify, cease to act or renounce probate, I then appoint the law office of THE WILEY GROUP, P.C., as alternate Executor of this my Last Will and Testament. ITEM 13: I direct that my Executor or his successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM 14: My Personal Representatives shall have the following powers in addition to those vested in them by Law and by other provisions of this, my Last Will and Testament, exercisable without court approval, and effective until distribution of al] property: 1 • To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Pennsylvania fiduciaries, as they from time to time may deem proper, without regard to any principal of diversification or risk. Z• To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries, as they from time to time may deem proper, without regard to any principal of diversification or risk. Page 2 of 4 3. To sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they from time to time may deem proper. 4. To allocate receipts and expenses to principal or income or partly to each as they from time to time may deem proper. 5. To borrow money from persons or institutions, themselves included, and to mortgage or pledge any or all real or persona] property as they in their sole discretion shall choose, without regard to the dispositive provisions of this instrument. 6. To compromise any claim or controversy asserted by or against my estate or trust estate. 7. To make distribution in cash or in kind or partly in cash and partly in kind, and in such manner as they may determine, and at valuations finally to be fixed by them. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 7`" day of December, 20 ] 0. WI ES / -~~.~ /~s,. (SEAL) /f ~ /~ MARY JAN ~ 3INER Page 3 of~4 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF YORK We, MARY JANE HINER, DAVID J. LENOX, ESQUIRE and M. SUSAN McMICHAEL, the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed this Last Will and Testament as witness and that to the best oftheir knowledge the Testatrix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. ~~~~ MARY E HINER ES Sworn to and subscribed before me this 7`~ day of December, 2010. NOTARY PUBLIC MY COMMISSION EXPIRES: COMMONWEALTH OF PENN3YLVAN Nofarlsl Ssal S. Dawn GladtelEar, Ndary Publk; Dlllaburg Born, York County MY Commlaslon E><pfrea May 17, 2013 Member, PenruyNenla Aseodatlon of Notarlea Page 4 of 4 ~,... ~o ~WRl11114.`~~ z~ I~~II~b ~ ,4. Settlement Statement (HUD-1) a R.v oxve9Q~ B_ Tvnw of l non OMB Approval No. 2502-0265 1,^X FHA 2.0 RHS 3 ~Conv Unins 6 File Number HESS 7 Loan Number 8 Mortgage Insurance Case Number. . 1202009055 446-1219793.703 4. ^ VA 5 ^ Conv Ins. C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts peb' to and by the settlement agent are shown " " . Items marked (p.o.c.J were paid outside the closing; they are shown here for inlormetiona/ purposes and ere not included in the totals. D, Name and Address of Borrower. E Name and Address of Seller F. Name and Address of Lentler: KYLE P HESS ESTATE OF MARY JANE HINER VISION MORTGAGE CAPITAL 204 W MAIN STREET SHIREMANSTOWN PA 17011 620 WESTGERMANTOWN PIKE SUITE 350 , PLYMOUTH MEETING PA 19462 G Property Location H Settlement Agent 204 W MAIN STREET SEASONS SETTLEMENTS INC I, Settlement Date SHIREMANSTOWN, PA 17011 CUMBERLAND County, Pennsylvania May 4, 2012 Ph. Place of Settlement. J Summa of Bo ' . ry rrower s transacton K. Summary of Seller's transaction 1D0. Gross Amount Due from Borrower: 400. Gross Amount Due to Seller 101. Contract sales nce 102 Personal ro a t 119,000.00 401. Contract sales rice 119,000.00 . r 402. Personal ro art 103. Settlement Char es to Borrower Line 1400 7,395.24 403. ~ 104. 404. 105. ' 405, Ad'ustments for items Id b Seller in advance Ad'ustmen[s for items id b Seller in advance 106. Cit /Town Taxes OS/OS/12 l0 01/01/13 470.82 107 Count Taxes 406. Cit /Town Taxes 05/05/12 to 01/01/13 470.82 . to 407. Count Taxes to 108. schooltax 05/05/12 to 07/01! 12 301.85 408. schooltax 05/05/12 to 07/01/12 301 85 109. SEWER 514-6/30 36.60 _ . 409. SEWER 5!4.6/30 ! 36 60 110. . 410, 111. 411. 112. 412. 120. Gross Amount Due from Borrower 127,204.51 420. Gross Amount Due to Seller 119 809.27 200. Amounts Paid b or in Beha If of Borrower , 500. Reductions in Amount Due Seller: 201. De ositoreamestmone 2,500.00 501. Excess de osit see instructions 202. Princi al amount of new loans 115,983.00 502. Settlement cha es to Seller Line 1400 9 316 02 203, Existin loans taken subect to , . 503. Existin loans taken sub'ed to 204. i 504, Payoff First Mortgage 205. 505. Pa off Second Mort a e 206. 506. 207. 507. De osit disb as roceeds 208. SELLERASSIST 209 5,950,00 508. SELLERASSIST 5,950.00 . 509. Ad'ustments for items unpaid by Seller Ad'ustments for Items un aid b Seller 210. Cit !Town Taxes to 510. Cit /Town Taxes to 211. Count Taxes to 511. Count Taxes to I 212, schooltax to 512. schooltax to I 213 513. 214, 514. 215. 515. "-- 216. 516. ~-- 217. 517, -- 218. 518. 219. 519. 220. Total Pald b /for Borrower 124,433.00 520. Total Reduction Amount Due Seller 15 266 02 300. Cash at Settlement from/to Borrower , . 600. Cash at settlement to/from Seller 301 Gross amount due from Borrower line 120 302 L 127,204.51 601. Gross amount due to Seller line 420 119 809 27 . ess amount paid by/for Borrower (line 220) ( 124,433.00) , . 602. Less reductions due Seller (line 520) ( 15 266 02 303. Cash ^X From ~ To Borrower 2,771.51 , . 603. Cash O To ~ From Seller 104.543 25 ~_ ~~~~=ioiyiieu nereoy acxnowieege receipt or a completed copy of this statement 8 any attachrilents fened to herein Bonower _. ~%. ~ Seller ~ ~ _c rte-, , ~~~ _ ,Z,~a C SKY E~ -?I E Ai~~OF MARY JANE HINE i co Pg 121 R oaung Bumal lorla5 colectOn of IrAanaem i9 estimated at 35 mnUf eS pet respan se to calecang, remeM+ng, antl repo ring trw tlala Ths agency may na calaci tms nbimalpn. aa1 ym a'e rnl reyuRtl to mp tit urYessi(tlisplay5acurrenAy valid OMB callml rw'nber NO Calrtlenlialiry6 eea~retl: lne OisCbeWaerrprl0 story lnts is tlesign eb to prwltlelhe paNesla aRESn.~coverey Vansenlian wlr „>f rxirulkr~ sung Ina sal llemenl process Page 1 of 3 HUD~'I tHE5 ; PFpi~1ESSl141 I I C..!ll.........! n~_____ ._. ~..., 700. Total Real Estate Broker Fees $ 7 335 00 P la F , . DIVi51000/0007~;,SSiO:'7'(10e ]DD) aS /ONO WS: a rom 0orrovers pam From r S 701 S 3.57C 00 A`/ALRY REALTY ° eig s 702 S 3 765_00 ~ EnA-NRT INC unas ei Fvnas e~ 703 Commission a d at sett~ement Settlement Sememeni 704. EROKER FEE to CAVALRY REALTY 7 335.00 705. 3D0.00 800. Items Pa able in Connection with Loan 801. Ourori ination char a Includes Or' ination Point ($ 750.00 $ 750.00 (from GFE #1 802. Your credit or charge (po n!s) for the specific interest rate chosen $ -289.96 (from GFE #2) 803 Your adjusted ong nation charges from GFE #A 804. A raisal fee _ to CENTRAL PENN APPRAISALS INC (from GFE #3 POC435 0 460.04 0 . BOS Gedu Rey ort_ __ to KROLL FACTUAL 15.00 POC from GFE #3 '1 96 8G6 Tax serwce tc (from GFE #3) . 807, 1=1ood certl`ica(ion to KROLL FACTUAL DATA (from GFE #3) 8 00 808. ELLIE MAE CLGSING F to VISION MORTGAGE CAPITAL (from GFE #3) . 100 . 809. .00 (from GFE #3) 810 811 (from GFE #3) (from GFE #3) 900. Items Required h Lender to Be Paid in Advance 901 ,Daily interest charges from 05/04/12 to 06!01/12 28 @ $12.313300/day (from GFE #10) 3qq 77 902. Mort a e insurance remium for 12 months to VISION MORTGAGE CAPITAL from GFE #3 ' 1 148 35 903. Homeowner s insurance for 1.0 ears to AMERICAN STRATEGIC INC CORP from GFE #11 , . 427 00 904. from GFE #11 . 905. (from GFE #11) 1000. Reserves De osifed with Lender 1001. Initial deposit for your escrow account (from GFE #9) 10 2. omeowners insurance mont s per mont 1,938.24 1003. Mort a e insurance months $ 109.15 er month $ 1004. Property taxes $ City/Town Taxes months @ $ per month Assessments months $ er month 1005. 1006. CO TWP TAX 4.000 months @ $ 59.59 per month $ 238.36 1007. SCHOOL TAX 12.000 months @ $ 161.52 per month $ 1,938.24 1008. AGGREGATE ADJUSTMENT $ •345.13 - 1009. S 1100. Title Char es 1101. TRIe services and lender's title insurance (from GFE #4) 1102. Settlement or closin fee $ 1,273.36 1103. Owners title insurance to from GFE #5 1104. Lender's title insurance to $ _ 1105. Lender's title olic limit $ 115,983.00 1106. Owners title olic limit $ 119,000.00 1107. A ent's onion of the total title insurance remium $ 1108. Underwriter's onion of the total title insurance remium $ 1109. 1110. 1111, 1112. 1113 1114. TAX CERT to SEASONS 5 TTLEMENTS INC 1115. 2012 CO TWP TAX to JUDY PROWELL TAX COLLECTOR 10.00 , 1116. 715.02 1117. 1118. 1200. Government Recording and Transfer Charges 1201. Government n;cordin cha es to Recorder's Office from GFE #7 193 50 1202. Deed $ 73.50 Mortgage $ 120.00 Releases $ Other $ . 1203. Transfer taxes (from GFE #8) 1204. City/Countytax/stamps S $ 0 1205. State tax/stam s $ $ 1,190.0 1206. to Recorder's Office 1207 1 190.00 , 1300. Addltlonal Settlement Char s 1301. Re wired services that ou can sho for from GFE #6 1302. SEWER 4/5!6 to LOWER ALLEN TWP SEWER 1303, 66.00 1304. 1305. r 1400. Total Settlement Char s enter on lines 103, Section J and 502 Section K , 7 395.24 9 316,02 signing pa 9e 1 of In6 sl aiene nl the sigreiwies uc~~w.N e[i 9a :oreai Ula comPglea copy al pegs 2 8 ~ of Ih¢ irvea page sta~er~ SEASONS SETTLEM TS INC, Sek ment Agent Page 2 of 3 HUD•1 (HESS.PFD/HESS/14) ; VUrn [Arlcnn nr t.:nrw ~..,.w c..v.__._ ,.. ~.-, ...._ _ - - _.. _ - _ ________ ~;;aryes Charger s ThetCannotlncrease Good Faith Estimate HUD-1 _ -_-_ _ HUD-1 Llne Number ~ _ ___ Our origination charge _ _ __ #801 Your credit or charge (points) for th 750.00 750.00 e specific interest rate chosen # 802 Your adjusted Origination char es '289.96 -289.96 g __-______ # 803 Transt`ertaxes 460.04 460.04 #1203 ------ 1 190 00 , . 1,190.00 Charges That in Total Cann t I o ncrease More than 10 ------ Government 2cord;ng char es Good Faith Estimate HUD-1 g __ #1201 Appra~salfee -----~ 200.00 193 50 _ ____ # 804 Credif report i -- 450.00 . 435 00 _ # 805 Flood certification ~ --- # 807 50.00 . 26.96 ELLIE MAE CLOSING FEE # 808 8.00 8.00 Mortgage Insurance Premium # 902 100.00 100.00 1,148.35 1,148.35 Total 1,956.35 1 911 81 Increase between GFE and HUD-1 Charges , $ -44.54 or ~2 2g% , Charges That Can Change Initial deposit for your escrow account Good Faith Estimate HUD-1 __ #1001 Daily interest charges 2,964.00 1,938.24 # 901 $ 12,313300/day Homeowner's insurance 344.68 344.77 # 903 Title services and lender's title insurance 600.00 427.00 #1101 1,143.38 1,273,38 Your initial loan amount is $ 115,983.00 Your loan term is 30 years Your initial interest rate is 3.8750 Your inital monthly amount owed for principal, interest and $ 654,55 includes any mortgage Insurance is ~X Principal Q Interest QX Mortgage Insurance Can your interest rate rise9 ~ No ~ Yes, it can nse to a maximum of _ % . The first change will be on __ and can change again every _ months after __. Every change date, your interest rate can increase or decrease by _ % Over the life of the loan, your interest rate is guaranteed to never be lower than _ % or higher than _ %,, Even if you make payments on tlme, can your loan balance rise? QX No ~ Yes, it can rise to a maximum of $_ Even if you make payments on time, can your monthly QX No ~ Yes the first increase can be on amount owed for principal, interest, and mortgage insurance rise? , __ and the monthly amount owed can rise to $_ _ The maximum it can ever nse to is $ Does your loan have a prepayment penalty? ~ No ~ Yes, your maximum prepayment penalty is $_ _ Does your loan have a balloon payment? UX No ~ Yes, you have a balloon payment of $ _ _ due in _ years on __ Total monthly amount owed Including escrow account payments ~ You do not have a monthly escrow payment for items s ch I , u as property taxes and homeowners insurance You must pay these items directly you rseli QX You have an additional monthly escrow payment of $256.70 that results in a total initial monthy amount owed of $911.25. This includes principal, interest, any mortgage insurance and any items checked below: QX Property taxes QX Homeowner's insurance Flood insurance Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. Page 3 of 3 HUD-1 (HESS.PFD/HESS/14) HUD-1 Attachment Borrower(s): KYLE P HESS Seller(s): ESTATE OF MARY JANE HINER 204 W MAIN STREET SHIREMANSTOWN, PA 17011 Lender: VISION MORTGAGE CAPITAL Settlement Agent: SEASONS SETTLEMENTS INC Place of Settlement: Settlement Date: May 4, 2012 Property Location: 204 W MAIN STREET SHIREMANSTOWN, PA 17011 CUMBERLAND County, Pennsylvania Adjusted Origination Charge Details Origination Charge ORIGINATION FEE to VISION MORTGAGE CAPITAL 750.00 Total $ 750.00 Origination Credit/Charge (points) for the specific interest rate chosen Credit/Charge to VISION MORTGAGE CAPITAL -289.96 Total $ -289.96 Adjusted Origination Charges $ 460.04 Reserves Deposited with Lender Homeowner's Insurance 3.000 at 35.59 per month CO TWP TAX 4.000 at 59.59 per month SCHOOL TAX AGGREGATE AD~USTMENT2 per month at per month 106, 77 238.36 1,938.24 -345.13 Total $ 1,938.24 Title Services and Lender's Title Insurance Details UNDERWRITER PORTION TITLE to STEWART TITLE GUARANTEE AGENT PORTION TITLE to SEASONS SETTLEMENTS INC END 300 100 8.1 to SEASONS SETTLEMENTS INC DOC DOWNLOAD COPIES WIRE FE DX to SEASONS SETTLEMENTS INC NOTARY to SEASONS SETTLEMENTS INC CPL to STEWART TITLE GUARANTEE BORROWER SELLER 128.76 729.62 150.00 150.00 40.00 75.00 Total $ 1,273.38 $ 0.00 WARNING: It is a crime to knowingly make fa Ise statements to the United States on this or any similar form. Penalties upon conviction can include a fine and imprisonment For details see: Title 16 U.S. Code Section 1001 and Section 1010. (HESSPF~/HESS/14j o M~~ 499 tilirehell Road. Millsboa~, DE 19966 Adjustment Sen-ices The Wiley Group Attorneys at I,aw 3 N Baltimore Street I)iDsburg, PA 17019 Re: Estate of Marv Jane Hiner Social Security 193-24-1204 Date of Death~September 15, 201 I Phone Si3R-502-4349 F a~ (302) 934-2955 No~~emhrr Z 301 1 Dear Sir or Madam: Per your inquiry on October 28, 201 ], please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: I . Type ofAccnunt Checking Accowv Account Number 1 ]91306 Ownership (Names ofl Mary Jane Hiner Opening Date OS/10/J4 Balance on Date of Death $928, p~ Accrued Interest $ .00 Total - -- - $928.07 _ _ -- - - - - For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please call the Trindle Road t~cP at #717-737-2308. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as power of Attorney, Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement Since//re}y, i) ~~JC~rrUr rt 'J Tammy Spencer Adjustment Services ETR B /~ ~ ~ .3801 Pax?on S(reet 83B_937.0004 /y Harrisburg, F'A 171 11 m~ymetrobank corn May 9, 2012 The Wiley Group Attention: Jan M Wiley 3 Baltimore St Dillsburg Pa 17019 RE. Estate of: Mary Jane Hiner Tax Identification Number: 193-24-1204 Date of Death: September 15, 2011 To Whom It May Concern: This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Checking Account Number: 513224964 Date Gpened: October 17, 2000 Primary Owner: Mary Jane Hiner Date of Death Balance: $479.99 Account Type:Savings Account Number: 616165347 Date Opened: October 17, 2000 Primary Owner: Mary Jane Hiner Date of Death Balance: $323.29 Please feel free to contact me at (717) 412-6126 if I may be of further assistance. j Si n ~, \. Pamela Lig y Savings/CIF Associate Metro Bank FINAL SETTLEMENT ELLER NAME ~~4<<y ~Cir~ t~-ir~ ~5~~ DATE OF SALE ~ ~ l~ DDRESS ate`-'( W . t ' I q,,, S CATION OF SALE ~~~ (_' PHONE ZIP_ .-, ~ ~' S ~, ,, V'~ UCTIONEER _ 1 )c~l,tS1 ~ ~ <<j> C,c (~"3~_ 3 ~ ,~ . PHONE ,.. ^.. ,.- x~ ;;Ct€R'S EXPENSES ', ~ ~ ~ ' RECEIPTS;` ~_~ ~- ; PROFESSIONAL FEES AUCTIONEER~a`~p $ ~ I (p~} . ~ ~ ~; CASH $ ~ ~ 7~ , ~J i :~=1 CLERK $ i CHECKS $ ~ ~~ . ~ 5 CASHIER $ OTHER RECEIPTS OTHER EXPENSES s $ ~~7 _1~I IP ~~r~ 4 (~_U~ t~ W F $ ~: c~2 ~ , ~c7 $ x ~r _ $ $ $ $ $ $ $ $ $ $ TOTAL RECEIPTS $ ~~D~`1 • GHQ ,' $ LESS TOTAL EXPENSES ~ ~ ~ • `~ JOTAL'EXPENSES $ 1- . y~ NET PROCEEDS PAYABLE TO' SELLER $ ~ ,~ ~ ~• I (or we), the seller, accept this settlement and acknowledge receipt of the above specified net proceeds from the auction of my goods and property sold on the above date. t accept all responsibility for providing merchantable title to a!I goods, and property sold, and for delivery of title to the purchaser. Auct oneer or Cashier's Si nature Date g (Seller's Signature] ~ Date Date (Seller's Signature Imcast Corp Quote Page (CMCSA) http://www.dai lyfinance.corrv'quote/nasdaq/comcast-core/cmcsa/histor. Start Date (YYVY-MM-DD) -..<011-09-15 End Date (YVYY-MM-DD) 2611-69-15 ~~ t _ Get Prices ~~ Date Open High Low Close Volume Change % Historical Rating /'' 09/15!2077 22.27 22.66 22.14 22.61 73,408,417 * +2 5T, J ' (~~~ I ~r ~ 5 ~~ t~ e s C ~a ~ - ~ I ~-- s~hQ.r~ r f3 _ 5/4/2012 9:02 AN ~i4t yC: E,! iti :~. f)r'ir7 i~'~ F~;, ~ ., o._, E ~ ~1 f - c71.~.~~ .V ~_i~ Ct''~.f'i~~u.~F L~~ 1 i ~._,~ __. n~~ ii;~! E. _I'c~ t ~(_ _i( t~:1_ ~t ?ii tC' i,l{C`r.fl~ ZR:i c3511', i~il :rj~~,, ~ i ~= ~ f` ~ c, _~i-1"~l t r1C~<b ~ , 3 ._ ..~ ~ .lili Ic t~ i,.„ . _ EP ( ti~ 1, _. i~'1~11 n_`1L_ dflt~ rTiilr" tr3~Jll rkiCE btu ,1- ~ ~ t„^.A-v_Cantt~ut:~~ ,I::.<.__;lTl; (1w~5tLr JAN M WILEY ESQ THE WILEY GROUP 3 N BALTIMORE STREET DILLSBURG PA 17019 March 16, 2012 Company: Registration: Holder Account Number Document I.D.: Our Reference: AT&T INC. MARY JANE HINER 00006283896 12068WF00292002 ATT/0002835244/9/RS/66032 Dear Sir/Madam: Thank you for your inquiry. We appreciate the opportunity to be of service to you. (omputershare Computershare Investor Services 250 Royall Street Canton Massachusetts 02021 www.computershare.com Below is the account balance information that you requested for Mary Jane Hiner as of September 15, 2011. Company Name: AT&T Inc. Account Number: 00006283896 Shares Held by Agent: 233 Shares Held in Certificate Form by Holder: 90 ~ ~. ~ ~, Total Shares: 323 ~. Closing Price Per Share: $28.54 Company Name: Frontier Communications Corporation Account Number: 00005820782 Shares Held by Agent: 22 Shares Held in Certificate Form by Holder: 0 ~ ~ 5 cR ~ ~ I" Total Shares: 22 Closing Price Per Share: $7.03 Company Name: LSI Corporation Account Number: 03001748385 Shares Held by Agent: 4 Shares Held in Certificate Form by Holder: 0 ~ ~ ~ ~'t-/ Total Shares: 4 Closing Price Per Share: $6.71 Company Name: Verizon Communications Inc. Account Number: 00009280154 Shares Held by Agent: 0 ~; Shares Held in Certificate Form by Holder: 95 Total Shares: 0 Closing Price Per Share: $36.19 In order to sell shares of Common Stock registered in the name of a deceased party, a transfer of ownership must first be completed. Our records indicate that all outstanding certificates are currently registered in the deceased shareholder's name. If you are unable to locate these certificated shares, please contact us so that we may begin the replacement process. Please provide us with a completed Transfer of Ownership Form, available at our website, signed by the court appointed estate representative (Personal Representative /Executor /Administrator). The signature must be Medallion Signature Guaranteed. Medallion Guarantees are provided by eligible institutions, such as a commercial bank, trust company, national bank, credit union, or brokerage firm that is participating in a Medallion Guarantee Program such as STAMP (Securities Transfer Agents Medallion Program), SEMP (Stock Exchange Medallion Program), or MSP (Medallion Signature Program). The Medallion guarantee is not a notarization. The financial institution providing the Medallion Signature Guarantee will require additional documentation regarding the death of the shareholder, and the authority of the court appointed representative. Please contact the Medallion Signature Guarantee institution directly for specific information regarding what documents they may require. The Computershare stock transfer wizard will walk you through the transfer process and assist you in completing the necessary documentation to complete the transfer. Please see our website at www.transfermystock com. We also require ONE of the following: • An Inheritance Tax Waiver Stamp, next to the signature on the stock power form certifying that no inheritance tax waiver is required. The stamp may be obtained from the same financial institution providing the Medallion Signature Guarantee. OR • An Inheritance Tax Waiver form: Depending on the decedent's state of legal residence, an Inheritance Tax Waiver Form may be required. You can obtain this form, and instructions on how to complete the form, from the state tax agency of the decedent's last state of residence. OR • A notarised Affidavit of Domicile (available from the state), attesting to the state of residency of the decedent. In some cases, an Inheritance Tax Waiver form may be also be required in addition to the Affidavit of Domicile. Please ask the state office where you obtain the Affidavit of Domicile to advise if they require the Inheritance Tax Waiver form for security transfers. Please send all certificates, as well as the appropriate documents, with a letter of instruction. Please also provide your daytime telephone number, in the event we need to contact you.