HomeMy WebLinkAbout12-12-12
1505610105
REV-1500 EX(ii_iz)tFt,
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
PM1MENi0FPEV UE County Code Year File Number
PO Bureau BOX 28o6o1 Individual. Taxes INHERITANCE TAX RETURN
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
124-22-6345 02042012 07191931
Decedent's Last Name Suffix Decedent's First Name MI
Lassi Janet D
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
(31ID 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death
Prior to 12-13-82)
O 4. Agriculture Exemption O 5. Future Interest Compromise (date of O 6. Federal Estate Tax Return Required
(date of death after 7-1-2012) death after 12-12-82)
C@D 7. Decedent Died Testate O 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
O 10. Litigation Proceeds Received O 11. No Taxable Asset Return O 12. Election to Tax under Sec. 9113(A)
(Attach Schedule O.)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Peter Lassi (717) 439-3797
REGISTER OF WILLS USE ONLY
c. :Z7
n N M
First Line of Address C> ~ 6D C> M C->
200 Fineview Road M C C--)
~ C7
y. r- I--` rn {YI
Second Line of Address r- M r\3
U> p ''a
City or Post Office State ZIP Code -ATE FIB
Camp Hill PA 17011 C-)
i
T, t
Correspondent's email address: plassi comcast.net
Under penalties of perjury, I declare 1 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.
SIGNATURE OF PERS9WRf SPONSIBLE R FILING RETURN DATE
.F`-V 11 - 12/11/2012
A
ADDRESS
200 Fineview Road, Camp Hill, PA 17011
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105
1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name: Janet D. LaSSi 124-22-6345
RECAPITULATION
1. Real Estate (Schedule A) 1. 142,000.00
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.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6,059.46
6. Jointly Owned Property (Schedule F) O Separate Billing Requested 6. 2,597.30
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets total Lines 1 through 7 8. 150,656.76
9. Funeral Expenses and Administrative Costs (Schedule H) 9. 39,835.36
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule 1) 10. 15,027.30
11. Total Deductions (total Lines 9 and 10) 11. 54,862.66
12. Net Value of Estate (Line 8 minus Line 11) 12. 95,794.10
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. 95,794.10
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- 15.
16. Amount of Line 14 taxable
at lineal rate X .0 45 95,794.10 16. 4,310.73
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE 19. 4,310.73
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610205 1505610205
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Janet D. Lassi
STREET ADDRESS
200 Fineview Road
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 4,310.73
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits (A + B) (2)
3. Interest
(3) 13.07
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. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4,323.80
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 ❑ 0
c. retain a reversionary interest ❑ 0
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? ❑ E
3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ❑ N
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(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 EX+ (01-10)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Janet D. Lassi 21-12-0190
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
1 306 April Drive, Camp Hill, PA 17011, Camp Hill Borough. Sold for $142,000.00 on November 142,000.00
28, 2012.
TOTAL (Also enter on Line 1, Recapitulation.) $ 142,000.00
If more space is needed, use additional sheets of paper of the same size.
REV-15o8 EX+ (o8-12)
i pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Janet D. Lassi 21-12-0190
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. 1994 Ford Crown Victoria Sedan sold by Executor 1,900.00
2. Erie Insurance--Reimbursement of auto insurance premium 440.00
3. U.S. Treasury--Federal Income Tax refund for 2011 245.00
4. Furniture sold by Executor 425.00
5. Dryer sold by Executor 200.00
6. Verizon refund 7.99
7. Cash 25.00
8. Pa. Treasury, Dept. of Revenue-Property Tax refund for 2011 250.00
9. Erie Insurance-Reimbursement of homeowners' insurance premium 61.50
10. Washing Machine 225.00
11. Television 100.00
12. 1/3 CT. Diamond Solitaire Engagement Ring, 14 K Gold 649.00
13. 14 K Gold 2 mm Wedding Band 149.00
14. Credit on Settlement Sheet for County real estate taxes 79.36
15. Credit on Settlement Sheet for School real estate taxes 1,241.63
16. Credit on Settlement Sheet for Sewer bill 60.98
TOTAL (Also enter on Line 5, Recapitulation) $ 6,059.46
If more space is needed, use additional sheets of paper of the same size.
REV-i5o9 EX+ (oi-io)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN 30INTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Janet D. Lassi 21-12-0190
If an asset became 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. Peter Lassi 200 Fineview Road, Camp Hill, PA 17011 son
B. Amy E. Lassi 2701 Calvert Street, Apt. 523, Washington, DC 20008 daughter
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 07/12/10 PSECU Acct. No. 8002850967-S1 2,823.19
J6. dG) 470.54
B. 07/12/10 PSECU Acct. No. 8002850967-S1 2,823.19 / E , 6L '7 470.54
2. A. 07/12/10 PSECU Acct. No. 8002850967-S3 135.15 16 C4 22.53
B. 07/12/10 PSECU Acct. No. 8002850967-S3 135.15 66 22.53
3. A. 07/12/10 PSECU Acct. No. 8002850967-S4 3,287.22 547.88
B. 07/12/10 PSECU Acct. No. 8002850967-S4 3,287.22 547.88
4. A. 07/12110 PSECU Acct. No. 8002850967-CD50 1,546.19 6G 17 257.70
B. 07/12/10 PSECU Acct. No. 8002850967-CD50 1,546.19 2 257.70
TOTAL (Also enter on Line 6, Recapitulation) $ 2,597.30
If more space is needed, use additional sheets of paper of the same size.
REV-1511, EX+ (10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Janet D. Lassi 21-12-0190
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers-Hamer Funeral Home 12,013.00
2. Royers Flowers (funeral arrangements) 386.90
3. Gate of Heaven Cemetary (grave opening) 1,315.00
4. The Church of the Good Shepherd (funeral luncheon) 250.00
5. Romberger Memorials (grave marker) 350.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City _ State ZIP
Year(s) Commission Paid:
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 323.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. Cumberland Law Journal (legal advertising) 75.00
8. Carlisle Sentinel (legal advertising) 147.06
9. Patriot News (sale advertising) 30.20
10. Register of Wills (short certificates) 20.00
11. PSECU (home equity payoff fee) 50.50
12. Other Administrative Costs (see continuation sheet) 24,874.20
TOTAL (Also enter on Line 9, Recapitulation) 39,835.36
If more space is needed, use additional sheets of paper of the same size.
SCHEDULE H-B.12. Other Administrative Costs (continued)
1. UGI (utilities) 682.98
2. Penn Waste (utilities) 137.25
3. PPL (utilities) 547.87
4. Pennsylvania American. Water (utilities) 168.85
5. Verizon (utilities) 71.79
6. Janet L. Miller (County Real Estate Taxes) 837.22
7. Borough of Camp Hill Sewer (utilities) 480.00
8. Erie Insurance Group (homeowners insurance) 383.50
9. Home Paramount (termite warranty) 133.56
10. Home Depot (carpet replacement) 1319.61
11. Janet L. Miller (School Real Estate Taxes) 2065.72
12. Harland Clarke (Estate Check Order) 23.85
13. Anderson Mechanical (furnace repair) 150.00
14. Zimmerman Plumbing and Heating (plumbing
and electrical repair) 868.00
15. Real Estate Closing Costs:
Seller's Assistance 6554.00
Real Estate Broker Fees 8325.00
Reimbursement of tax cert. fee 10.00
Notary Fee 20.00
Transfer tax 1420.00
Deed preparation fee 115.00
Home Warranty 460.00
Tax Service Fee 100.00
TOTAL 24,874.20
REV-1512 EX+ (12-08)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Janet D. Lassi 21-12-0190
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• PSECU-Home Equity Loan, Acct. No. 8002850967-1-50 14,354.07
2. UGI 133.00
3. Borough of Camp Hill Sewer 150.00
4. Verizon 67.72
5. PPL 104.00
6. Discover 86.91
7. Pennsylvania American Water 44.69
8. Discover 86.91
TOTAL (Also enter on Line 10, Recapitulation) $ 15,027.30
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
It DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Janet D. Lassi 21-12-0190
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. Amy E. Lassi daughter one-quarter
2701 Calvert Street, Apt. 523, Washington, DC 20008
2. Cindy L. Butz daughter one-quarter
846 Parkside Lane, Lancaster, PA 17601
3. Mary Pat Lylo daughter one-quarter
1930 Princeton Avenue, Camp Hill, PA 17011
4. Peter Lassi son one-quarter
200 Fineview Road, Camp Hill, PA 17011
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 TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
Will & Testament
Of
Janet D. Lassi
I, Janet D. Lassi, of 306 April Drive, Camp Bill Borough, Cumberland
County, Pennsylvania, declare this to be my last will and revoke any will previously made by
me.
ITEM L I direct that all my just debts and funeral ems, including my gravemarker
and all expenses of my last illness, and any and all taxes and assessments imposed by any
o governmental body as a result of my death, whether on property passing under this will or
otherwise, shall be paid fi-om my residuary estate as soon as practicable after my decease as a
rj-
part of the expense of the administration of my estate.
ITEM H. I give and bequeath all of my household goods, automobiles, jewehy, and all
other articles of household and personal use, equipment and ornament, together with all
insurance thereon and relating thereto, to those of my issue, per stirpes, as survive my death by
thirty (30) days.
ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my
possessions and estate of every nature and wherever situate to those of my issue, per stirpes, as
survive my death by thirty (30) days.
ITEM N. Should any of my issue entitled to a share of my estate not have alined the
age of twenty-five (25) years at the time for distribution to him or her, I wise and bequeath the
share of such issue to my hereinafter named trustee, IN SEPARATE TRUSTS, to hold, manage,
invest, and re-invest, the shares so received, and 'tire acccanulaxion of income thereon, and to use
1
and apply from time to time such portion of income and principal thereof as my trustee thinks
proper for the comfortable support, maintienance, health, welfare, and education of the issue or to
make payment for such purposes, without further responsibility, directly to such issue, or dbudy
to any person taking care of such issue. Any principal or income not so applied shall be
distributed to such issue when he or she attains the age of twenty--five (25) years, or if he or she
dies prior thereto, to his or her personal representative.
ITEM V. I appoint my son, PETER LASSI, trustee of the trust or trusts created by
this my last will. Should Peter Lassi predecease me or otherwise fail to qualify or cease to serve
0
as Trustee of this my last will, I appoint my daughter, AMELIA LASSI, trustee of the trust
or busts created by this my last will. In addition to the other powers and authorities granted to
my trustee by Pennsylvania law and by the preceding paragraph ofthis my last will, I hereby
give my trustee the following special powers and authorities:
A. To retain any or all of the assets of my estate, real or personal
(ncluding any stock or securities of any corporate fiduciaries), without any regard
to any principle of diversification, risk, or productivity;
B. To invest and re-invest in all forms of property without restriction to
investments authorized for Pennsylvania Fiduciaries, as my trustee deems proper,
without regard to any principle of diversification, risk or productivity;
C. To sell at public or private sale, to exchange or to lease, for any period
of time, any reek or personal property and to give options for sales, exchanges, or
2
leases, for such prices and upon such terms or conditions as my trustee deems
proper and in the best interest of the beneficiary or beneficiaries of said trusts;
D. To allocate receipts and expenses to principal or income or partly to
each as my trustee fi+om time to time deems proper in its sole discretion;
E. To compromise any claim or con uvaW,
F. To exercise any option, right, or privilege granted in insurance policies
or in any other investments-,
G. My trustee may accumulate the income firm this trust during the term
thereof but may, from time to time, distnIx to from current income or from
accumulated income or from principal such amounts as my trustee, in its sole
discretion, deems advisable for the education, welfare, and comfort of the trust:
beneficiary
.
g~ ITEM VL All of the interests of the beneficiaries hereunder d" not be subject to
anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or
attachment.
ITEM VII. I appoint my son PETER LASSI executor of this my last will.
Should Peter Lavd predecease me or otherwise fail to qualify-or cease to serve as executor of this
my last will, I appoint my daughter, AMELIA LASSI, executor of this my last will.
ITEM VIiL In addition to the other powers and authorities granted to my personal
repr, by Pennsylvania law and by the other terns and provisions of this will, I hereby
give to my personal representatives the following powers and authorities effective without court
3
approval and until actual distribution of all property: to compromise any claim or controversy;
to make disln'bution in cash or in kind, or partly in cash and partly in kind, and in such manner as
my personal represeztatives may determine and at valuations finally to be fixed by than; to
invest in all forms of property, including any shock or other securities in any corporate fiduciary
or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my
0
personal represen atives deem proper, without regard to any principle of risk or diversification;
to retain any or all assets of my estate, real or personal, without regard to any principle of risk or
diversification; 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 my personal representatives deem proper; and to allocate
receipts and expenses to principal or income or partly to each as my pawnal representatives
deem proper in their sole discretion
ITEM I% I direct that my personal representatives and fiduciaries shall not be required
to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNFM WHEREOF, I have hereunto set my hand this : day of
AeEn~-, 010.
JANET D LASSI
4
The preceding instrument, consisting of this and FOUR (4) odw typewritten pages, each
identified by the signature of the testator was on the date thereof signed, published, and declared by
JANET A LASSL the teswor therein named, as and for her last will, in the presence of us, who at
her request, in her presence, and in the presence of each other, have subscribed our names as
witnesses hereto.
LAI
17
5
COMMONWEALTH OF PENNSYLVANIA )
(SS:
COUNTY OF CUMBERLAND )
The undersigned, being the testator whose name is signed t0 the attached or foregoing instrument, having
been duly qualified according to law, does hereby acknowledge that I signed and exee uted the finegonog instromenct
as my last will, that I signed it will nAr, and 60 I *wd it as my five and voluntary act for the purposes therein
evressed-
oCY
JANET D. LASSI
Swots or armed to and acknowledged
before by the testator named above i _
this "day of "M%W-Q-2010. 4 ~ y
WEAL TN PEWSYLVANIA '
NOTARIAL SEAL
CFWiEES A. MOM, Notary PMc
COV HM Sm, Cwnbwbmd County
Conxois*n Expirm Dec. 30, 2010
COMMONWEALTH OF PENNSYLVANIA )
(SS:
COUNTY OF CUhffJERLAND
~J
WE, LQ z and the
witnesses whose names are signed to the attached or foregoing instrument; being duty gaali5ed according to law, do
depose and say that we were present and saw the tcstatw sign and execute the instrument as her last will-, that she
signed it willingly and that she executed it as her free and voluntary act for the purposes tier aim expressed; that each
of us in the herring and si& of the testator. signed the will as witnesses; and that to the best of our knowledge, the
testator was at that time 18 or more years of age, of sound and udder no constraint or
$idue
influence.
Sworn at affirmed to and acknowledged
before me by the testator named above
th~day of SA)i'- 2010.
1-
L SAL 6
ZMALES TARIA
BOL
I1Al?, ~ Aablic
oro, Cumberla d Cm*
n Exks Dec. 30. 2010
A►• Settlement Statement (HUD-1) OMB Approval No. 2502-0265
•~,..<~E FINAL
!B. Type of 1. ❑ FHA 2. ❑ RHS 3. X❑ Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
12-1641 GC xxxxxx4857 446-1522402-703
4. ❑ 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 are 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 & Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender:
Kelly M. Tomlinson, Katie M. Tomlinson The Estate of Janet Lassi, by Peter Lass!, Executor Wells Fargo Bank, N.A.
56 Church St„ Pittston, PA 18640 306 April Drive, Camp Hill, PA 17011 Pa Box 5708, Springfield, OH 45501-5708
G. Property Location: H. Settlement Agent: I. Settlement Date: 1 V2812012
306 April Drive Guardian Transfer Corporation Disbursement Date: I V2812012
Camp Hill, PA 17011 4075 Market St., Camp Hill, PA 17011
Camp Hill Borough
717-9094700
Place of Settlement: TitleExpress
4075 Market Street, Camp Hill, PA 17011 Printed 11/28/2012 at 2:05 pm
by JMG
J. Summary of Borrower's Transaction K. Summary of Seller's Transaction
100. Gross Amount,Due from Borrower
400. `Gro'ss Amounf Due taSeller
101. Contract sales price 142,000.00 401. Contract sales price 142,000.00
102. Personal property 402. Personal property
103. Settlement charges to borrower (line 1400) 7,570.36 403.
104. 404.
105. 405.
Adjustments for Items aid b seller in advance Adjustments for items aid b seller in advance
106. City/town taxes to 406. City/town taxes to
107. County taxes 11/2812012 to 12/31/2012 79.36 407. County taxes 11/28/2012 to 12/31/2012 79.36
108. School taxes 11/28/2012 to 06/30/2013 1,241.63 408. School taxes 11/2812012 to 06/30/2013 1,241.63
109. Sewer 11/28/2012 to 12/31/2012 60.98 409. Sewer 11/28/2012 to 12/31/2012 60.98
110. 410.
111. 411.
112' 412.
Due from
120. Gross or in Borrower 150,952.33 420. ,381.97
Gross Amount Due to Seller 143
hilf ot:Borrgwer 500.'', Reductions In _ ounfbue:fo seller
201. Deposit earnest
posfl t money 1,00u00 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) 139,428.00 502. Settlement charges to seller (line 1400) 18,450.00
203. Existing loa s taken subject to 503. Existing loa s taken subject to
204. 504. Payoff of first mort a e loan
205. 505. Payoff of second mortgage loan
206. 506.
207. 507.
208. Sellers Assistance 6,554.00 508. Sellers Assistance 6,554.00
209. 509.
Ad ustments for items unpaid b seller Adjustments for items unpaid b seller
210. C!ty/town taxes to 510. City/town taxes to
211. County taxes to 511. County taxes to
212. School taxes to 512. School taxes to
213' 513.
214' 514.
215. 515.
216. 516.
217' 517.
218' 518.
219. 519.
220 Total Paid 6,982.00 520 Total Reduction Amount Due Seller 25,004.00
300 1,Cash`at Settlement homlto'Bo~rower 14 600. ' Casti''at Settlementtolfrom Seller
) 150,952.33 601. Gross amount due to seller line 420
301. Gross amount pai from borrower (life 120 146,982.00 602. Less reductions in amount due seller 143,381.97
302. Less amounts aid b/for borrower line 220) (line 520) 25,004.00
303. Cash ro ❑ From E] To Borrower 3,970.33 603. Cash ❑X To ❑ From Seller 118,377.97
Ihi: roum~1niUIt a~.pl:y:I ou-":llao%~e~m I;~W ~~NO CO
~nlY."0 n W-ao requ ren a
nne.ml :niulsss ~ma°nl:ats°cmu~ 'e la nB4nis l: a :i nn°eam •B'n`y co, sm.rm.Tn n
settlement p,vusa Y ~'p pmvltle Ne paNes to a RESPA uv"rotl Irensadlon vAlh Inlo,matlon tlu,in° the m
See attached addendum for additional information
Previous editions are obsolete Page 1 of 4 HUD-1
700. T601`tial Estate Broker Fees $ 8;720.00 Paid From Paid From
Divisio0ofcommissi6n'line700 as follows Borrower's Seller's
701• $4,275.00 to Prudential Homesale Services Group Funds at Funds at
702. $4,445.00 to Coldwell Banker Homestead Group Settlement Settlement
703. Commission paid at settlement 395.00 8,325.00
800 ,,Rems,.Pa able'in,Connection with Loan
801. Our origination charge (Includes Origination Point 0.000% or $0.00) $665.00 (from GFE #1)
802. Your credit or charge (points) for the specific interest rate chosen $-697.14 (from GFE #2)
803. Your adjusted origination charges (from GFE A) -32.14
804. Appraisal fee to RELS Valuation $455.00 P.O.C. B' (from GFE #3)
805. Credit report to RELS Credit $23.36 P.O.C. B* (from GFE #3) 20.64
806. Tax service to from GFE #3
807. Flood certification to from GFE #3
808. to
.906.4!, :Rerni-Re 'ulredai` L ender' o!be Paid in.Advance
901. Daily interest charges from from 11/2612012 to 12/0112012 @ $12.41001day (from GFE #10) 37.23
902. Mortgage insurance premium for months to HUD (from GFE #3) 2,398.03
903. Homeowner's insurance for 1 ears to ASI (from GFE #11) 499.00
904• months to from GFE #11
1 OOj.R serve'.De 'Ited-, thL'ender
1001. Initial deposit for your escrow account (from GFE #9) 1,231.60
1002. Homeowner's insurance 3 months $ 41.58/month $124.74
1003. Mortgage insurance months $ 0.00/month $
1004. Property taxes months $ 0.00/month $
1005. County taxes 10 months $ 71.19/month $711.90
1006. School taxes 6 months $ 175.661month $1,053.96
1007. Aggregate Adjustment $-659.00
IN., Tltle Char es
1101. Title services and lenders title insurance from GFE #4 1,412.05-
1102. Settlement or closing fee to $
1103. Owners title insurance - Title Resources Guaranty Company from GFE #5 10.00
1104. Lenders title insurance - Title Resources Guaranty Company $1,325.00
1105. Lenders title policy limit $139,428.00 Lenders Policy
1106. Owners the policy limit $142,000.00 Owners Policy
1107. Agent's portion of the total the insurance premium $1,093.50
to Guardian Transfer Corporation
1108. Underwriters portion of the total title insurance premium $241.50
to Title Resources Guaranty Company
1109. Reimbursement of tax cart fee to Guardian Transfer Co orat 10.00
1110. Notary Fee to Guardian Transfer Corporal 20.00
1202. Deed recording cha charges .'Transfer Charges
1201. Government ment $ (from GFE #7) 160.
00
Mort a e $98.00 Release $
1203. Transfer taxes $ from GFE #8) 1,420.00
1204. City/County tax/stamps Deed $1,420.00 Morta e $
1205. State Tax/stamps Deed $1,420.00 Mort a e $ 1,420.00
1206. Deed $ Mortgage $
1207. $
1300: Additional Settlenik'Char es - „
1301. Required services that you can shop for (from GFE #6) 19.00
1302. Deed preparation fee to Homesale Settlement Services 115.00
1303. Home Warranty to American Home Shield 460.00
1304. Inheritance tax escrow to Guardian Transfer Co 8,000.00
1305. Tax Service Fee to Wells Faro Real Estate Tax $ 100.00
1306. Flood (Life of Loan) to Wells Far o Flood Services $19.00
KM X= i - 7,570.36 18,450.00
*Paid outside of closing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(Iger. "Credit by lender shown on page 1. -Credit by seller shown on page 1.
See attached addendum for additional information
Previous editions are obsolete Page 2 of 4 HUD-1
Corp asoa of Good' Faithr~stimate GF arid HUD 1'Char es Oood Faith,E;timate„w HUD 1. .
Cha? es,Tliat C~hnot.lt crease tij,~j,
r HUD 1 Lme Number ~
N;Oui orig[fgh9Y ! S F p _o ~,~f~ 80ai h'u 665.00 665.00
?,YoQr credffoghatge?(po~Y ts) for the pecif i7teesiw„hd~sepa,~f;~r# BOs _i 697.14 69774
Y oU[ulUs4~~~°tSiCllarges4w` va~ctt ...BC 32.14 32.14
1,420.00 1,420.00
µ(jhar es4That,id,PTo611dirlnot"incr@'asgMoreThanl04 ^"s
t Good Fa_'itfilEstimate r -1
GQber(i~pjebo7dg D
Pf4,prgej3"j h 4 # 1201, _ ' # 164.00 160.00
801 455.00 455.00
4rg~ltr€poS stkya~} ~~F,+'-;ti;# 80~ 23.32 44.00
dxNlo{tgdge Ofznce pieffi2
m~ a A"
2,398.03 2,398.03
itlee3jbegand~ender,s~frtleaPaulam e :{'k#1',1Ci„_ 1,886.55 1,412.00
~r,Qw0e sttltle=ina ~0 Tdl pfpr~ v Company; t ~4,1103'},r; 10.00 10.00
vlc~ese 100.00 0.00
yjFlgbdSLofoarYj¢N 11 #'13( 19.00 19.00
5,055.90 4,498.03
Increase between GFE and HUM Cha es $ -557.87 -11.0340%
~Cha e'sThdt~Can~hatf e r~s}"~'
[ ~Goptl',~aith Eslimate H.l'1D-1 '
aI Po~ij~fb~'~rot(reso(owacadU~h
4jnitl 1,749.96 1,231.60
rrDaihfeeStyc p~~esfro ]~i a" ' , , r, 901 $12.41 Q070a 372.30 37.23
v hJomeceCS3~l~O a~~ a tMr'#u` 90: 1112Ar IT, '1
IiG 500.00 499.00
Loan Terms
4q~!tll~~a ova o xs ,.ri4v~ $139,428.00
out ej jst 30. years
i9`t'~14am$ awet°1)ytl wi w yt 3.2500%
u gt
na$ n t~ q u t q h ajlFi iier,'est Oft. • Oadnne, $748.24 includes
4tr „ r'. ❑X Principal
1 gF ❑X Interest
t h Fy hr1' , , €v ❑X Mortgage Insurance
e k : ❑X No. ❑ Yes, it can rise to a maximum of The first change
a will be on and can change again every years after Every
t a., change date, your interest rate can increase or decrease by Over the life of
f ' the loan, your interest rate is guaranteed to never be lower than % or higher
than
a e pa G nee can , u lorj! afar ¢ r~ t~;• Q No. ❑ Yes, it can rise to amaximum of $
en~~{ F INr t * to
s1 e€ ts~On time ceyybljjpa ou~~ot QX No. ❑ Yes, the first increase can be on / I and the monthly
IP[(" a s a 0rt9agesura c~riseq ii 17 amount owed can rise to $
r f The maximum it can ever rise to is $
0e aJ ° e e e a
Q• .aHm~1 rf: r ❑X No. ❑ Yes, your maximum prepayment penalty is $
r L { a 0 No. ❑ Yes, you have a balloon payment of $ due in
years on I /
TBta'I'K~ a " ° i '!t ° fb w t ~
~t X eg a ~aoc ml I nie m ❑ 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.
F kk s €
❑ You have an additional monthly escrow payment of $288.43
F? a w„ that results in a total initial monthly amount owed of $1,036.67. This includes principal, interest, ai
a ..f~ mortgage insurance and any items checked below:
re a n, r s r,r ❑X Property taxes X
Homeowners insurance
r'
Flood insurance X❑ School taxes
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender.
See attached addendum for additional information
Previous editions are obsolete Page 3 of 4
HUD-1
Sig nature Page HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and 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
e
Kelly 'M. Tomlinson Katie M. Tomlinson
THE ESTATE OF JANET LASSI, BY PETER LASSI, EXECUTOR
Settlement Agent
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction I have caused or will cause the funds to be
disbursed in accordance with this statement.
T\ 0
SETTLEM NT GENT DATE
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010.
See attached addendum for additional information
Previous editions are obsolete Page 4 of 4 HUD-1
ItemiZation of Line 1101
Name of Borrower. Name of Seller: File Number:
Kelly M Tomlinson The Estate of Janet Lassi, by Peter Lassi, Executor 12-1641 GC
Katie M. Tomlinson
Prepared 11/28/2012 at 2:05 pm
Note: This page displays an itemization of the charges shown on line 1101 of the HUD-1 Settlement Statement. This page
accompanies but is not a part of the HUD-1 Settlement Statement. If a discrepancy exists, the information on the HUD-1 Settlement
Statement applies.
1100. TItle.Charges Total Charge Borrower Seller
1101. Title services and lender's title insurance to
Wire In to Guardian Transfer Corporation $ 12.00 12.00
Notary Fee- Purchasers to Guardian Transfer Corporation $ 25.00 25.00
Courier Fee-Purchase to Guardian Transfer Corporation $ 15.00 15.00
Electronic Document Fee to Guardian Transfer Corporation $ 35.00 35.00
1102. Settlement or closing fee to $ 0.00
1104. Lender's title insurance -Title Resources Gto Title Resources Guaranty Com r$ 1,325.00 1,325.00
Totals: $ 1,412.00 0.00 1,412.00 0.00
-Seller/Lender credits ;shoWn.on'"a 'e 1 Poc = Paid Outside Closi"n` CR i Lender Credit
See attached addendum for additional information
Previous editions are obsolete Page 1 of 1 HUD-1
PSEC4k. 03/09/2012
Peter Lassi
200 Fineview Rd.
Camp Hill, PA 17011
Re: JANET D LASSI,-Deceased:-
PSECU Reference # 6936369479114
Dear Mr. Lassi:
The above referenced person has an account with PSECU which was opened on
October 7, 1980. The Share accounts were jointly held by JANET D LASSI, PETER LASSI
and AMELIA LASSI. The joint owners were added to this account on July 12, 2010. The
Home Equity Line of Credit is individually held.
The following are the Date of Death Balances for JANET D LASSI's account with PSECU:
Account Date of Death Balances Interest - February 1-4
Shares:
(S1) - Savings $2,823.19 $0.08
(S3) - Christmas $135.15 $0.00
(S4) - Checking $3,287.22 $0.03
(S50) - Certificate $1,546.19 $0.08
Loans:
(L50) - Home Equity LOC $14,354.07
The joint owner needs to close the decedent's account with PSECU at the earliest
convenience.
The Home Equity Line of Credit balance must be satisfied by the Estate.
If you have any questions, please contact me at (717) 234-8484 or toll-free at (800) 237-
7328, press 6, extension 3120.
Sincerely,
- V CC.
Sandy Fa ley
Member Service Representative
PSECU
Pennsylvania State Employees Credit Union
P.O. Box 67013, Harrisburg, PA 17106-7013 • 717.234.8484 • 800.237.7328 • psecu.com
THIS CREDIT UNION IS FEDERALLY INSURED BY THE NATIONAL CREDIT UNION ADMINISTRATION. EQUAL OPPORTUNITY LENDER.
Personal Income Tax e-Services Center Page 1 of 1
Penalty and Interest Calculations
CALCULATION DATES-
11/04/2012 TO 12/11/2012
TAX DEFICIENCY $ 4,310.73
CALCULATED INTEREST $ 13.07
BALANCE AS OF 12/11/2012 $ 4,323.80
Start Over
https://www.doreservices.state.pa.us/pitservices/Default.aspx 12/10/2012
December 11, 2012
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
Room 102
One Courthouse Square
Carlisle, PA 17013
RE: Estate of Janet D. Lassi
File No. 21-12-0190
Dear Ms. Strasbaugh:
Enclosed is an original and one (1) copy of the Inheritance Tax Return
that I am filing on behalf of the above-referenced estate, as well as
an Inventory and a Status Report. Also enclosed is a check for $30 to
cover the filing fees, and a check for $4323.80 representing the
inheritance tax due.
Please note that by letter dated October 26, 2012, I requested that
the Department of Revenue grant a six month extension of time to file
the inheritance tax return, and it is my understanding that the
extension was granted.
Sincerely, =
C:_
n m
X G>
W ca Gn►
tsi ~ C*~~ ~
Peter Lassi r- r r- M
200 Fineview Road Cnn tea a
Camp Hill, PA 17011
(717) 761-0778
C3
C k'_ nii
Enclosure cx~
O N'
~D/■~o o '
N
■
a0U°
H} a
cN
If) G
e N U.
~i LO °
o
~CD W
~S No a
~31Mn o o i
a
co cn
o
40
U- U- C' I= V ~ y
caw N Wa'J U
`yea ,
w
t N d
LA
7
/J
LA