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HomeMy WebLinkAbout11-21-12J 1505610143 REV-1500 Ex(°'-'°' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes UEPNNTNENT OF flEVENUE PO 80X.280601 INHERITANCE TAX RETURN 21 11 1285 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 164 30 3295 11 20 2011 06 24 1937 Decedent's Last Name LINDSAY (If Applicable) Enter Surviving Spouse's Information Below Spouse's last Name Suffix Decedent's First Name MI RUBY M Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW U 1.Original Return a 2. Supplemental Return 4. Limited Estate ~ qa. Future Interest Compromise (date of tleath after 12-12-82) g Decedent Died Testate (Attach Copy of Will) ~ ~ Decedent Maintained a Living Trust (Attach Co py of T rust) 9. Litigation Proceeds Received ~ C p g 1D. 6eN/eenP231 ~f ^d~t fCatgeSof death 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARK A MATEYA 717 241 6500 First line of address 55 W CHURCH AVENUE Second line of address City or Post Office State ZIP Code CARLISLE PA ~~ ~- ~^; na REGISTER ~ ~IIILLS U SE~@NLY ; , iTt-..~- ~J r'; - =r N - - c~ c ` ' , ~ ~, < h. _,.-{ N D PV DATE FILED Correspondent's a-mail address: mam@mateyalaW.COm Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ~ a~.donald L Lindsay /~ - J~- ADDRESS 2955 Bodder Road Rieaelsville PA 18077 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE Mark A. Mateya ADDRESS 55 W. Church Avenue, Carlisle, PA Side 1 1505610143 1505610143 J PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Lindsay, Ruby Mae 21-11-1285 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on afl information of which preparer has any knowledge. Signature #2 ' Name _ Cynthia K Hotchkiss Address1 488 Fivefoot Pronp Lane Address2 C1ty, State, Zip Camden Wyoming, DE 19934 Date /~~~lo ~ ~a- 1505610243 REV-1500 EX Decedents Names Lindsay, Ruby Mae RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. Decedent's Social Security Number 164 30 3295 69,900.00 2,984.08 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. 98 , 50 9.34 6. Jointly Owned Property (Schedule F) L] Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous h( aq Probate Property (Schedule G) u Separate Billing Requested............ 7. 278, 395.61 8. Total Gross Assets (total Lines 1-7) .................................................................... . 8. 449 , 78 9.03 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 31 , 915 .43 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 3 , 2 94 • 65 11. Total Deductions (total Lines 9 8 10) ..........................................__.................... . 11. 35 , 210.08 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 414 , 5 7 8.95 13, Charitable and Governmental BequestslSec 9113 Trusts far which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .............................................. . 14. 414 , 578.95 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 O . OO (a)(1.2) X .00 16. Amount of Line 14 taxable 0.00 16. 0.00 at lineal rate X .045 17. Amount of Line 14 taxable 18 4. 5 0 3 6 9 17. 4 4, 3 02 .14 , at sibling rate x .12 18. Amount of Line 14 taxable 3 94.45 4 5 18. 6 , 80 9.17 , at collateral rate x .15 19. Tax Due ................................................................................................................. . 1s. 51,111.31 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-1285 DECEDENT'S NAME _ Lindsay, Ruby Mae STREET ADDRESS 802 E Lowther Street CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 60,222.15 1,285.79 (1) Total Credits (A + B) (2) 51,111.31 61,507.94 3. Interest q, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) (q) 10,396.63 (5) 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: Yes No a. retain the use or income of the property transferred :............................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................... ^ ^x d. receive the promise for life of either payments, benefits or care? ............................................................ ^ ^x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ ^x 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 ^ x ^ 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 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)j. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 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. Rev-1502 EXr (11-08) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETDRN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lindsay, Rubv Mae 21-11-1285 All real properly 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 propedy 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 dght of survivorship 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-1151 Ex+(10-O6) COM INHERITANCE TFAX RF~T~IRN ANIA RESIDENTT DECED N SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Lindsay, Ruby Mae 21-17-7285 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N ER q. FUNERAL EXPENSES: See continuation schedule(s) attached 3,566.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Mark A. Mateya 18,867.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 185.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs 9,296.93 See continuation schedule(s) attached TOTAL (Also enter on tine 9, Recapitulation) 31,915.43 Copyright (c) 2009 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Lindsay, Ruby Mae 21-11-1285 ITEM NUMBER DESCRIPTION AMOUNT 1 Funeral Ex e~ nses Hoffman Roth -Funeral Bill 3,566.50 H-A 3,566.50 Other Administrative Costs 2 All American Termite 8 Pest Control -Treatment for sale of real estate 1,134.20 3 Andrew Shaw -Title Services for sale of real estate 10.00 4 Bouder's Trash Removal -Expense for 5 truck loads of trash removed from residence 625.00 5 Countryway Insurance Company -Homeowners Insurance on residence 585.00 6 Cumberland County Register of Wills -Probate Fee 473.50 7 Cumberland County Register of Wills -Fee for filing of Inheritance Tax Return 8 Inventory 30.00 8 Cumberland County Register of Wills -filing fee for REV-1500 8< Inventory 30.00 9 Cumberland Law Journal -Legal Advertisement of Estate Admin 75.00 10 Delp's HVAC -Electrical repairs for sale of real estate 2D0.00 11 Government recording and transfer tax 699.00 12 Liliane Wonders -Cleaning Service for real estate in preparation of sale 250.00 13 Mateya Law Firm -Deed prep 150.00 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 Lindsay, Ruby Mae _ 21-11-1285 ITEM NUMBER DESCRIPTION AMOUNT 14 Prudential Homesale Services Group -Real estate commission for sale of real estate. See 4,194.00 attached settlement sheet 15 Prudential Homesale Services Group -Real estate broker fee for sale of real estate. See 295.00 attached settlement sheet 16 Rowe's Auction Service -Auctioneer's commission on sale of personal/household property 182.35 17 The Sentinel -Legal Advertisement for Estate 263.88 18 Walsh's Lawn & Landscaping Service -Snow removal from residence on 10/29/11 & 1/21/12 100.00 H-B7 9.296.93 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lindsay, Ruby Mae _ 21-11-1285 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 Borough of Carlisle -Water/Sewer fees for period of 10/3/11 to 1/3/12 72.90 2 Borough of Carlisle -Water/Sewer fees for period of 1/3/12 - 4/2112 72.90 3 Borough of Carlisle -Final Water/Sewer bill 146.89 4 Brian Walsh -Lawn Care for 11/4/11 55.00 5 Brian Walsh -Lawn Care for 4/5112 - 4/27/12 93.00 6 Brian Walsh -Lawn Care for 5/10/12 8 5125/12 62.00 7 Brian Walsh -Lawn Care for 6/7112; 6119/12; 6/29112 8:7/19112 124.00 8 Brian Walsh -Lawn Care for 8/3H2 through 8/23/12 93.00 9 Brian Walsh -Lawn Care for 8/29112 through 9/27112 93.00 10 Leffler Energy -Heating Oil for residence located at 802 E. Louther Street, Carlisle, PA 111.68 11 Leffler Energy -Heating Oil for residence located at 802 E. Louther Street, Carlisle, PA 116.57 12 Millennium Pharmacy Systems -Prescription medicine 397.98 13 Millennium Pharmacy Systems -Prescription medications 1,076.85 14 Millennium Pharmacy Systems -Prescription medications 678.87 15 PP&L Electric -Electric service at residence 20.26 16 PPBL Electric -Electric Service at residence 0.19 17 PPBL Electric -Electric service at residence 9.25 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 10, Recapitulation) 3,294.65 (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 I (Rev. 12-08) Rev-1512 EX+ (6-96) COMMON WEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS continued ESTATE OF FILE NUMBER Lindsay Ruby Mae 21-11-1285 ITEM NUMBER DESCRIPTION 18 PPBL Electric -Electric service at residence 19 PPS:L Electric Utilities -Acct No. 95401-2800 on real estate at 802 E. Louther St. 20 PPBL Electric Utilities -Acct No. 95401-2800 on real estate at 802 E. Louther St. 21 PP&L Electric Utilities -Acct No. 95401-2800 on real estate at 802 E. Louther St. 22 PP&L Electric Utilities -Acct No. 95401-28019 on real estate at 802 E. Louther St. 23 PP&L Electric Utilities -Acct No. 95401-28019 on real estate at 802 E. Louther St. 24 PP&L Electric Utilities -Acct No. 95401-2600 on real estate at 802 E. Louther St. 25 PP&L Electric Utilities -Acct No. 95401-26019 on real estate at 802 E. Louther St. VALUE AT DATE OF DEATH 10.68 9.20 10.95 2.84 5.86 9.25 11.28 10.45 TOTAL (Also enter on Line 10, Recapitulation) I 3,294.85 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) -~~~ i4. Settlement Statement (HUD-1) DMBApproval No. 2502-0265 1. Q FHA 2. ~ RHS 3. ©Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 12-119 0419625348 4. Q VA 5. ^Conv. Ins. C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents ere shown. Items marked "(p.o.c)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. Name 8 Address of Borrower: E. Name & Address of Seller: F. Name 8 Address of Lender: Nelson E. Holley Estate of Ruby M. Lindsay Wells Fargo Bank, N.A. 15 East South Street, Carlisle, PA 17013 2701 Wells Fargo Way, Minneapolis, MN 55467-0001 G. Property Location: H. Settlement Agent: I. Settlement Date: 1 t/07/2012 802 East Louther Street The Law Office of Andrew H. Shaw, PC Disbursement Date: 1'V07/2012 Carlisle, PA 17013 200 S. Spring Garden Slreel, Suite 11, Carlisle, PA 17013 Carlisle Borough Telephone: 717-243-7135 Place of Settlement: TitleExpress 200 S. Spring Garden Street, Suite 11, Carlisle, PA 17013 Printed 1 V07/2O12 at 9:59 am bySDC e. e tOD. Gross Amount Due from Borrower 400. Gross Amount Due to Seller 101. Contract sales price 69,900.00 401. Contract sales price 69,900.00 102. Personal ro art 402. Personal ro art 103. SeDlement charges to borcower (line 1400) 3,919.60 403. 104. 404. 105. 405. Ad ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance 106. Citykown taxes to 406. City/town taxes to 107. County taxes 11/07/2012 to 12131/2012 104.84 407. County taxes 11/0712012 to 12/31/2012 104.84 108. School Taxes 11/07!2012 to 06130/2013 1,115.80 408. School Taxes 11/07/2012 to 06/3012013 1,115.80 109. 409. 110. 410. 111. 411. 112. 412. 120. Gross Amount Due from Borrower 75,040.24 420. Gross Amount Due to Seller 71,720.64 200. Amounts Paid b or in Behalf of Borrower 500. Reductions In Amount Due to Seller 201. Deposit or earnest money 1,000.00 501. Excess deposit (see instructions) 202, Principal amount of new loan(s) 66,405.00 502. Settlement charges to seller (line 1400) 8,727.36 203. Existin loa s taken su 'act to 503. Existin loans taken sub'ect to 204. 504. Pa off of first mort a e loan 205. 505. Payoff of second mortgage loan 206. Credit by Seller 2,097.00 5D6. Credit by Seller 2~pg7,00 207. 5D7. 208• 508. 209. 509. Ad'ustments for items un aid b seller Ad ustments for items un ald h seller 210. City/town taxes to 510. City/town taxes to 211. County taxes to 511. County taxes fo 212. School Taxes to 512. School Taxes to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 21 B. 518. 219. 519. 220. Total Paid b /for Borrower 69,502.00 520. Total Reduction Amount Due Seller 10,824.36 300. Cash at Settlement fromko Borrower 600. Cash at Settlement tolfrom Seller 301. Grass amount due from borrower (line 12D) 75,040,24 601, Gross amount due to seller (line 420) 71,120.64 302. Less amounts paid bylfor borrower (line 220) 69,502.00 602. Less reductions in amount due seller (line 520) 10,824.36 303. Cash XQ From ~ To Borrower a u m apo u en r ,e a .ono orme en,e• me nu es oe 5,536.24 neecenae orm a ne. rene o,,.. e 603. Cash QX To ~ From Seller m,., ~,., .. .....,..,... ...- ._ __ -_ 60,286.28 seXlamenf Oroeess. ~ en ena ,e enure: ,e eeewreo men tay. ,sis Eaepned to prwMe rM1e peNae to aRE6PA Covered tremarfion with inloemellon tlun,q iM1e 700. Total Real Estate 8rokerFees $ 4,194.00 Paid From Paid From Division of commission Iine700 as follows: Borrower's Seller'S 701• $2,097.00 to PrudenlialHomesaleServicesGroup Funds at Funds at 702. $2,097.00 to PrudenlialHomesaleServicesGroup Settlement Settlement 703. Commission paid at settlement 4,194.00 704. Broker Fee to Prudential Homesale Services Group 295.00 295.00 800. Items Pa able in Connection with Loan 801. Our origination charge (Includes Origination Point 0.000°k or $0.00) $665.00 (from GFE #1) 802. Your credit or charge (points) for the specific interest rate chosen $-249.02 (from GFE #2) 803. Your adjusted origination charges (from GFE A) 415.98 804. Appraisal fee to RELS Valuation $380.66 P.O.C. B' (from GFE #3) -0.66 805. Credit report to RELS Credit $11.00 P.O.C. B" (from GFE #3) 806. Tax service to from GFE #3 807. Flood certification to from GFE #3 808. to 900. kerns Re aired b Lender to be Paid in Advance 901. Daily interest charges from from 11/0712012 to 12101/2012 @ $6.6000/day (from GFE #10) 158.40 902. Mortgage insurance premium for months io (from GFE #3) 903. Homeowner's insurance for ears to Millville Mutual (from GFE #11) 306,00 904. months to from GFE #11 1000. Reserves De osited with Lender 1001. Initial deposit for your escrow account (from GFE #9) 751.88 1002. Homeowner's insurance 3 months $ 25.501month $76.50 1003. Mortgage insurance months $ O.OOlmonth $ 1004. Property taxes months $ O.OOlmonth $ 1005. County taxes 10 months $ 47.131month $471.30 1006 School Taxes 6 months $ 103.67/month $622.02 1007. Aggregate Adjustment $-417.94 1100. Title Char es 1101, Title services and lender's title insurance to The Law Office of Andrew F from GFE #4 998.50 10.00 1102. Settlement or closing fee to $ 1103. Owner's title insurance from GFE #5 16.50 1104. Lender's title insurance $618.50 1105. Lender's title policy limit $66,405.00 Lender's Policy 11 D6. Owner's title policy limit $69,900.00 Owner's Policy 1107. Agent's portion of the total title insurance premium $508.00 1108, Underwriter's portion of the total title insurance premium $127.00 1109. Deed Prep. to Mate a Law Firm 150.00 1200. Government Recordin and Transfer Char es 1201. Government recording charges $ (from GFE #7) 160.00 1202. Deed $62.00 Mon a e $98.00 Release $ 1203. Transfer taxes $ (from GFE #8) 699.00 1204. City/County tax/stamps Deed $699.00 Mort a e $ 1205. State Tax/stamps Deed $699.00 Mort a e $ 699.00 1206. UPI Fee Deed $ Mort a e $ 1207. $ 1300. Additional Settlement Char es 1301. Required services that you can shop for (from GFE #6) 119.00 1302. Survey to $ 1303. to 1304. 2012/13 School Taxes to Borou h of Carlisle 1,898.27 1305. HVAC Service to Del 's HVAC 200.00 1306. Termite Treatment to All American Termite 8 Pest Control 1,134.20 1307. Tax Service Fee to Wells Far o Real Estate Tau $100.00 1308. Flood Life of Loan Fee to Wells Far o Flood Services 19.00 1309. Final Water/Sewer Account #009305 to Borou h of Carlisle 146.89 ' t r ~ ~ ~- ~ t ~ ~ r ~ 3,919.60 8,727.36 i 1 raio outsitle of closing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. "Credit by lender shown on page 1. ""Credit by seller shown on page 1. Com arieoh of Good Fakh Estimate GF and HUD-1 Char es Cha es That Cannot Increase HUD•1 Llne Number Our origination charge g g01 Your aedit or charge (points) forthe specific interest rate chosen # 802 Your adjusted origination charges # 603 Transfer taxes g 1203 Cha es That In Total Cannot Increase More Than 10% Government recording charges g 1201 Appraisal fee g 804 Credit report # 805 Title services and lender's title insurance p 1101 Owners tide insurance ~ 1103 Tax Service Fee # 1307 Flood Life of Loan Fee # 1308 ~. ~• ~ ~ Cha es That Can Chan e Initial deposit foryour escrow account # 1001 Daily interest charges from #901. $6.6000/da Homeowner's insurance #903 Loan Terms Good Fakh Estimate HUD•1 665.00 665.00 -249.02 -249.02 415.98 415.98 650.00 699.00 GoodFaith Estimate HUD•1 180.D0 160.00 380.00 380.00 11.66 11.00 1,447.7 998.50 10.00 16.5D 100.00 100.00 19.00 19.00 2,148.63 1,685.00 $ 463.63 or -21.5779°k I .Good Fakh Estimate ( HUD•1 I Your initial loan amount is $66,405.00 Your loan term is 30. years Your initial interest rate is 3.6250% Your initial monthly amount owed for principal, interest, and any mortgage $339.93 includes insurance is ^X Principal ^X Interest ^X Mortgage Insurance Can your interest rate rise? ^X No. ^ Yes, it can rise to a maximum of °~, The first change will be on ! / and can change again every years after I ! .Every change date, your interest rate can increase or decrease by %. Over the life of the loan, your interest rate is guaranteed to never be lower than % or higher than %. Even if you make payments on time, can your loan balance rise? ^X No. ^ Yes, it can rise to a maximum of $ Even if you make payments on time, can your monthly amount owed for ^X No. ^ Yes, the first increase can be on / I and the monthly principal, interest, and mortgage insurance rise? amount owed can rise to $ The maximum it can ever rise to is $ Does your loan have a prepayment penalty? ^X No. ^ Yes, your maximum prepayment penalty is $ Does your loan have a balloon payment? ^X No. ^ Yes, you have a balloon payment of $ due in years on ! / Total monthly amount owed including escrow account payments ^ You do not have a monthly escrow payment for items, such as property taxes and homeowner's insurance. You must pay these items directly yourself. ^X You have an additional monthly escrow payment of $176.30 that results in a total initial monthly amount owed of $516.23. This includes principal, interest, any mortgage insurance and any items checked below: Q Property taxes ^X Homeowner's insurance ^ Flood insurance ^ ^ ^ rv~[e: n you nave any quesnons aoout the Settlement Charges and Loan Terms listed on this form, please contact your lender. HUD CERTIFICATION OF BUYER ANO SELLER I have carefully reviewed the HU0.1 Settlement Statement and to the hest of my knowledge and belief, it is a true antl accurate statement of all receipts and disbursements made on my account or by me in this transaction I further certify that I have received a copy of the HUD~1 Settlement Statement. ~>~~ 7 Nelson E. Noll TATE OF RUBY M. LINDSAY ~TT The HUO-1 Settlement SSttement whicfi I have {pared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this statemefitl / 1 AGENT DATE