HomeMy WebLinkAbout01-04-13r r4 • ,
Ex cot-+DI 1505610143
~ REV-1500 ,,,
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania county toes veer Fae rvumbar
Bureau of Individual Taxes °E°^a.ME"T°'aE°ENOE
Po Box.zaosof INHERITANCE TAX RETURN 21 1 l 0115 3
Harrisburg, PA 17126-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
192 30 0706 10 OS 2011 07 08 1926
Decedent's Last Name Suffix Decedent's First Name MI
RUNK CLAIR V
(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
^ 1. Original Return
l~
2. Supplemental Return
^
3. Remainder Retum (date of death
prior to 124 3-ffi)
^ 4. Limited Estate ^ qa. Future Interest Compromise
(tlate of death after 1242-82) ^ 5. Federal Estate Tax Re[urn Required
Dacetlent Dietl Testate
® 8. (Attach Copy of Wilh
^ 7 Dacetlent Maintainetl a Living Tmst
(Attach Capy of TivsQ g. Total Number of Safe Deposit Boxes
^ 9. Litigation Proceeds Received
^ 10. spousal Poverty credit ((eeta or death
between 12-31-91 antl 1-1-95) ^ t t, Election to tax under Sec. 9113(A)
(Adach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD eE DIRECTED TO:
Name Daytime Telephone Number
SCOTT B HOROWITZ 412 391 1014
First line of address
428 FORBES AVENUE;
Second line of address
SUITE 1240
City or Post Office
PITTSBURGH
State ZIP Code
PA 15219
Correspondent's a-mail address: ShOrOWItZ~W95E1C.COm
REGIST~R ~ WILLS 8S~ O~
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Under penalties of peryury, I declare tha(I have examined [his return, including acwmpanying schedules and statements, and to the best of my knowledge and belief,
it is true, coned and complete. DeclaraUOn of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
ATURE gF PtE ON RESPONSIBLE FJ~ FILING RETURN DATE
x ~A ~ ~ ,(! l~ Michael S. Runk 12/LI ~fL
225 Orchard Road, North,Cumberland, PA 17070
SIGNATUR REPARER HERT A REPRESENTATIVE DATE
Scott B Horowitz ~ Z Z ~~
ADDRESS
428 Forbes Avenue;, Pi rgh, PA 15219
Side 1
L 1505610143 1505610143
T ~
.J 1505610243
REV-1500 EX
oeceaem~s uame. RUNK, CLAIR VICTOR Decedent's Social Security Number
192 30 0706
RECAPITULATION
242.58
1. Real Estate (Schedule A) ........................................................................................ .. 1.
2. Stocks and Bonds (Schedule B) .............................................................................. . 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)........ .. 3.
4. Mortgages & Notes Receivable (Schedule D) ........................................................ .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .............. .. 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ........... .. 6.
7 Inter-Vivos Transfers R Miscellaneous Non-Probate Property
. (Schedule G) ^ Separate Billing Requested ........... .. 7.
g, Total Gross Assets (total Lines 1-7) ..................................................................... .. 8. 2 4 2 . 5 8
9 2 3 , 7 0 8 . 7 3
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... .
..
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10.
11. Total Deductions (total Lines 9 & 10) ................................................................... ... 11. 2 3 , 7 0 8 . 7 3
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... ... 12. - 2 3 , 4 6 6.15
13. Charitable and Governmental BequestslSec 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. - 2 3 , 4 6 6.15
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATE5
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
1 5
4 6 6
- 2 3 16
.
,
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
18
at collateral rate X .15 .
19. Tax Due ................................................................................................................... .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
-1,055.98
-1,055.98
Side 2
1505610243 1505610243
REV-1500 EX Page 3
ncrnrlcnf's Cmm~lete Address:
File Number 21 - 11 - 01153
AM •
Runk, Clair Victor
STREET ADDRESS
110 Maple Drive
CITY ~ ~ STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
a, 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.
(1) -1,055.98
Total Credits (A + B) (2) 0.00
(3) 0.00
(a> 1,055.98
(5)
Make Check Payable to: REGISTER OF WILLS, AGENT.
f
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 inwme :.................................... ^nx
c. retain a reversionary interest; or .................................................................................................................. x
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? ....................................................................................................................... x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ 0
..~ ~___~__. _..._ __ i_~:..:a....i oer:.e...e.d e......,,n~ ~nnuirv nr niher nnn-nrnhale rxooerty which
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 wmmon with the decedent, wsether by bloo or adoption.
SCHEDULE A ~
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TA%RETURN
RESIDENT DECEDENT
- FILE NUMBER
ESTATE OF RUnk, CI81f VICtOr '21 - 11 - 01153
All real property owned sole)y 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 wilting 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 survrvorshlp must be disclosed on
schedule F.
Attach a copy of the settlement sheet if the property has been sold.
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 51 Red Hill Road, Newport, PA Perry County (Assessed value x common level ratio factor) 40,500.00
2 Reduction in value of 108 and 110 Maple Drive based upon sale (see settlement statement -40,257.42
attached)
TOTAL (Also enter on Line 1, Recapitulation) I 242.58
SCFFDULE H
~~FLr~Uyr~Np~Er~\RA~~Q~L~ ]D~~ (~~Pr~E/~~N/SE~S`~&'~
COMMONWEALTH OF PENNSYLVFNW ~r~IRlIM11YG ~1W IJ
INHERITNNLE TA% REtURN
RESIDENT DECEDENT
"- - ';FILE NUMBER
ESTATE OF Runk, Clair Victor 21 - 11 - 01153 _
Debts of decedent must be reported on Schedule I.
NUMBER DESCRIPTION ~ AMOUNT
FUNERAL EXPENSES: ~-
A.
B.
1.
2.
3.
4.
5.
6.
7.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
Attorney's Fees
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
Probate Fees
Acwuntant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Repairs for real estate prior to sale (see attached reciepts)
23,708.73
TOTAL (Also enter on line 9, Recapitulation) 23,708.73
V 7
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a
~l. Settlement Statement (HUD-1)
VMb v.pp~oval Ivo. ~ouz-umo
File Number: 7. Loan Number: 8. Mortgage Insurance Case Number.
6
.
1. X^ FHA 2. ^ RHS 3. ^ Conv. Unins. 12 Ot-2-25956 201246485 446-1516074-703
4. ^ VA 5. ^ Conv. Ins.
Note: Thls form is fumishetl to give you a statement of etlual saHlemenl costs. Amounts paid to and by the settlement a9enls are shown. Items marked
C
.
"(p o c)" were paid outside the closing, they are shown here for informational purposes and are not indudetl in the totals.
Name & Address of Borrower:
D E. Name & Address of Seller F. Name & Address of Lender:
. Estate of Clair V. Runk alk/a Clair Vlclor Runk Howard Hanna Mongage Services
Rudy E. Widjaja
238 Somh 74th S1ree1, Harrisburg, PA 17104 110 Maple Ddve, Mechanicsburg, PA 17050 119 Gamma Orive, Pittsburgh, PA 15238
Property Location:
G H. Settlement Agent: I. Settlement Dale: i V3012012
.
110 Maple Drive Barristers Land Abslrad Company Dishursement Date: iV3W2012
Mechanicsburg, PA 17050 3310 Markel Slreel, Camp Hill, PA 17011
717-761-6190
Place of Settlement: TitleExpress
3310 Market Street, Camp Hill, PA 17011 Printed 1 V2912012 at 5:26 pm
by LM
100. Grose Amount Due from Borrower 400. Gross Amount DUe to Seller
000
00
125
101. Contract sales Drice .
,
125,000.00 401. Ccntracl sales price
102. Personal ro etl 402. Personal ro rt
103, Se0lement charges to borrower (line 1400) 7,322.65 403.
104 404.
105. 405.
Ad'ualments for Items paid h seller in advance Ad'uslments for Items aid b seller in advance
106, Cilyllown taxes l0
1113012012 to 1213112012 33,63 406. Cityltavn saxes to
407. County taxes 1113012012101213112012 33,83
107. County saxes
School Taxes 11130I20121o Ofi13012013 65663
108 408. School Taxes 1113012012100613012013 fi5663
.
109. Trash 1113012012 to 12/3112012 1329 409. Trash 1113012012 to 12131/2012 1329
110. 410.
111. 411.
112.
120. Grass Amount Due from Borrower 133,026.40 412.
420. Gross Amount Due to Geller 125,703.75
Amounts Paid b or In Behalf of Borrower
200 500. Reductions In Amount Due to Seller
.
201, Deposit or earnest money 1,50000 501. Exiess deposit (see instructions)
202. Pdncipal amount of new loan(s) 122,800.00 602. Settlement charges to seller (line 1400) 8,311.01
203. Exislin loo s taken suh'ecl l0 503. Existin loan 5 taken sub'ecl to
204 504. Pa off offirst mon a eloan
Pa off of second mod a e loan
505
205. ,
5~'
206,
207. Seller ASSisI 5,917.16 507. Seller Assist 5,917.16
208. 508'
209. Good Faith Deposit 37500 509.
Ad'ustments for items un aid h seller Ad uslments for items un aid b seller
210. Cityllown taxes to 510. Cityltown 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.
220. Total Paid blfor Borrower 130,392.16 519,
520. Total RetluMion Amount Oue Seller 14,220.17
Cash at Settlement fromko Borrower
300 600. Cash at Battlement tolfrom Seller
.
Gross amount duefrom bonawer pine 120) 133,026.40
301 601, Gross amount due to seller(line 420) 125,703.75
.
302. Less amounts paid bylfor bonower (line 220) 130,392.16 602. Less retlucllons in amount due seller (line 520) 14,228.17
303. Cash ^X From ^ To Borfower 2,fi34.24 603. Caeh ^Q To ^ From Seller 111,475.58
..,,,,~, m,..,e..~ ~.,.,~,,..,.....,.,.._ ................,.. w: elk%Wni: m.m.iorv: inn,. e.,yfiem o,.me. e. o.m..m. aasanw..ne,,.,,...„a..,,,, ~.,.~.~~.....w„~.
~m q.,:. w,am,r..ue omawrvA, o~me.. rw w.m.,,u.ev ~: w~~a,
Previous editions are obsolete Page 1 of 3 HUD-1
14
374
~~ a~ $6 Pald From Paid From
.
,
700. Total Real Estate Broker Fees Borrower's Sellers
Dimsion of commission Tine 700 as follows: Funds at Funds at
701. $3,17207 tc ERA-NRT, LLC
1o HOWARD HANNA REAL ESTATE
Settlement
Settlement
702. 53,202.07 225.00 6,149.14
703. Commission paitl a1 seP.lemenl
800. Items Pa able in Connection with Loan
801. Ourorlginalien charge (Includes Origination Point 0.000%or $0.00) $69000 (from GFE#1)
your credit or charge (points) for the spedfic'mteres(ate chosen $ (from GFE#2)
802
,
(from GFE A) 690.00
803. Your adjusted od97natlon charges
(from GFE #3) 375,00
604. Appraisal fee to A aisals b E.J. Ko enhaver
(from GFE #3) 29,44
805. Credit repan to CBC Innovls, Ina
to from GFE #3
806. Tax service
(from GFE #3) 13.00
607. Flood ceniGCatlon to FDSI
(from GFE#3) 100.00
BO6. Fnal lnspeclion toA aisalsb E.J. KO enhaver
900. Items Re aired b Lender to be Paitl in Advance
901. Daily interest charges from from 1 113 012 01 2 to 7210112012 @ $10.92001day (from GFE #10)
10.92
502. Mortgage insurance premium for months to De t. of HU0 (from GFE #3) 2,109.24
396
00
903. Homeowners insurance for 72 ears to Howard Hanna Insurance Services (from GFE #11) .
904. months to from GFE #11
1000. Reserves De asited with Lender from GFE #9 541.96
( )
1001. Initial deposit for your escrow account
1002. Homeowners insurance 4 months $ 33.171month $132,66
1003. Mortgage insurance months $ 124.371monN $
1004. Pro en taxes months $ Imonlh
1005. Ccunty saxes 12 months $ 31.601month $379.20
1006. School Taxes 7 months $ 91.691monfh 8643.23
ID07. Aggregate Adlustmenl $-613.15
1100. Title Char es 1,333.59
1101. Title services and lenders title insurance from GFE i74
1102. Settlement orclosing fee to $
1103. Owner's title insurance -First American Title Insurance Co - Hbg from GFE #5 112.50
1104. Lender's title Insurance-First American Title lsuance GO-Hbg $1,240.00
1105 Lenbers lisle policy limit$722,600.00 Lender's Policy
1106. Owner's title policy limit $125,000.00 Owners Policy
1107. Agent's potllon of the local Mlle insurance premium $1.14576
1708. Underwriter's podion of the total title insurance premium $202.75
1109,
1200. Government Recortlin and Transfer Char es
134
00
.
1201. Government recording charges $ (hom GFE #7)
00 Mod a e$72.00 Release$
1202. Deed $62
.
$ (from GFE #6) 1,260.00
1203. Tansfer taxes
1204. ClrylCounty taxlslamps Deed 81,250.00 Mod a e$
1
250.00
1205- State TarJstamps Deed $1,250,00 Mod a e $ ,
1206. Deed $ Mod a e$
1300. Additional Settlement Char es
(from GFE #6)
1301. Requiretl services Ihat you can shop for
460.00
1302. Home Warranty to American Home Shield
1303. Pest Inspection to Ins ed A Hame $ $45,00 P,O.C. B'
20.00
1304. Tax Cen Reimbursement to Barristers Lantl Abstract General - Hb 15.00
1305. Notary Fee to Jo ce Ehrich
1306. Home lnspeclion to Ins ed A Home $245.00 P.O.C. B'
416'67
1307. Final Gewer to Silvers rin Townshi Aulhorll
rrrr art'r[1~9'11~T~+!'TTTrT"1TTlT7R T I ~ azz ss a 31161
`Paid outside of dos`,ng by (B)onower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. °Cadlt by lender shown on page 1,'"'Credll by seller shown on page L
Previous editions are obsolete Page 2 of 3 HUD-1
'Good Faith Eallmate - HU0~1
'. Com ison of Gob Faith Estimate GFE end HUD-1 Char ei .
'Char es That Cannot Increase ~ HUDA Line Number
90
00
690
00
Our origination charge .. ~ /< 801 6
.
00
0 .
0
00
Your cretlit or charge(points)focthespedfc interest rate chosen' p 802 +- .
0
00 .
00
690
Your adjusted ongination charges ~ tl 803 .
69
1
250
00 .
1
250
00
Transfer lazes 1203: ,
. ,
.
Cha es That In TOtafCadnot lnireaee More Than l0% '.GOOd.FaBh Eatlmate' 'HUD1
134
00
es $ iZ01 '.
cordin
char
t r
G 210.00 .
g
g
overnmen
e 37500 375.00
ADWaisal fee R 804 !
p 805 50 W 29.44
Cretlit report
Nficallon # 807
Fl
o 13.00 13.00
oo
ce
p 808 75.00 100.00
Final lnspecllon 109
24
2 2,109.24
premlum $902 ,
MOrfgagelnsumnce .
,
,
Ti0e services and lendefs Otle insurance p 1101 > 1,337.00 1,333.59
Ownefs tlllelnsurance:-First AmericanTllle Insurance Co-Hbg 81103 r~ 20.00 112.50
45
00
ecUOn - g 1303=
st lns
P 0.00 .
p
-
a 4,189.24 4,25177
$ 62.53 o r 1.4926%
Cha es That Can'.Chan a Gootl: Faith EStlmete':. HUG-1'
541
96
ourescrav account
osit for
iti
l de
I $ 1001 - ~.~ 2,082.68 .
Y
p
n
a
Daily interest charges from..
Homeowner's insurance q 901 ::
q 903 - $10.92001da. 10.92
398,00 10.92
398.00
iR
Lean lefine
Your initial loan amount Is -.. -. $122,600.00
Your loan term is 30, years
Your initial Interest rate is = 3.2500%
Your initial monthly amouhtawed for principal;interest and any mortgage 8657.931ncludes
insurancels - ^X Principal
'. ^X Interest
^X Modgage Insurance
Can your Interest rate nse? : ^Q No, ^Yes, it can rise Io a maximum of %. The first change
will be on I I and can change again every years after I I ,Every
change dale, your interest rate can increase or decrease by %. Over the life of
the loan, your inte2sl rate is guaranteed to never be lower Than % or higher
than %.
Euen d you make payments m time can your loan balance nse?'. ` ~ No. ^Yes, It can rise to a maximum o($
Even lfyou make Dayments on time can youemonthly amountawed for ~.. ^X No ^Ves, the first increase can be on I I and the monthly
pdnrJDal, interest and mortgage insurance nse? -. amount owed can rise to $
The maximum it can ever rise to is $
Dees your loan have a prepayment penaltyc -' ^X No. ^Yes, your maximum prepayment penalty is $
Goesybur loan have a Galloon payment? ^X No. ^Yes, you have a balloon payment of $ due in
years on I I
Total monthly amount owed including escrod account payments' ^ You do not have a monthly escrow payment for items, such as property taxes
' - r and homeowners insurance, You must pay these items directly yourself.
' Q You have an addltlonal monthly escrow payment of $156.66
that results in a total initial monthly amount owed of $814.59. This includes Ddncipal, interest, any
': modgage insurance and any items checked below:
' . ^X Property taxes ^Q Homeowner's insurance I
^ Flood insurance ^
^ ^
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this farm, please contact your lender.
Previous editions are obsolete Page 3 of 4 HUD-1
HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed Ida HUD-1 Settlement Statement antl to the best of my knowledge and belie( it is a Irue antl accurate statement of all receips antl
disbursements matle on my account or by me in this transaction. I torther certify that I have received a copy of the HU41 Setllemenl Statement.
C~
~' iI U
E. Wldjaja
ESTATE OF CLAIR V, RUNK AIWA CLAIR VICTOR RUNK
~`~G~/l ~~tA ~~ i~ct~y~~
Micha I Sloven Runk, Executor,
The HU0.1 Settlement Statement which I have prepared Is a true and eccurete account of this transaction. I have caused or will cause the funtls to be
disbursed in accordance with this statement
SETTLEMH AG NT
11~3.A~/,~-
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.
Previous etliflons are obsolete Page 4 0 4 HUD-1
1 1 1•
Name of Borrower:
Rudy E Widjaja
Name of Seller. File Number
Estate of Clair V. Runk a/k/a Clair Victor Runk 12-01-2-25956
TitleExpress
Preparetl NI29/2012 at 5:27 pm
Nate: This page is furnished to give you an Itemization of the amounts shown on Patd from
Lines 1101, 1103 and 1104 of the Settlement Statement (HUD•f ). This page Borrower's
accompanies but Is not a part of the settlement statement. If a discrepancy 'Funds at
exists, the information shown on the Settlement Statement (HUD-~) applies. Settlement Patd From
Seller'S
Fundsat
Settlement
Amounts Included
1100. Title Charges I In LIne7101
1101. Title services and lender's title insurance 1,773.59
a. Electronic Document Fee $ 4500
b. Ovemi ht Fee 13.59
c. Wire Fee 5.00
d, Notary Fee 30.00
$ 93.59
1102. Settlement or closing fee
1103. Owner's title Insurance (policy) $ 112.50 112.50
1104. Lender's title insurance policy) 1,015.00 $ 1,240.00
a. Endorsement 900 EPL-Residential 50,00
b. Closin Service Letter 75.00
c. ALTA Short Form Loan 100.00
(Total 1103+1104)
1105. Lentlefslllle policy limi($122,600.00
1106. Owners title policy Ilmit §125,000.00
1107. Agent's potlion of the total title insurance premium $ 1,149.75'
1100. Untlerwdtef§ poiticn of (he total title Insurance prem. - 20275'
(TOtaf1107+1108)
1109.
111 a.
t 111
.
1112.
1
• r
1100. Title Char es with Pa ee ~ ~ .~ 7dtat~
~~ char a :Bdtrower
-POC.or Credit > Borrower
-- line 1101 - Seller`
Paid
Title services and lender's title insurance
7101 $
.
a. Electronic Document Fee to Banisters Land Ahslracl General -Hbg 45.00 45,00
b. Overnight Fee to Banisters Land Abstract Postage-Hbg
c. Wire Fee to Barristers Land Ahslracl Wire -Hbg 13.59
5.00 13.59
5,00
d. Notary Fee to Joyce Ehrich
1104. Lender's line insurance to Barristers Land Abstract Company 30,00
1,240.00 30.00
1,240.00
§ 9,33359 - 133359 ~ -
SY C ~ Date 11/30/12
Rudy E. Widjaja
A. Settlement Statement (HUD-1)
OMe Approval No. 2502-0265
File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
6
.
1. ^ FHA 2. ^ RHS 3. ^Conv. Unins: 12-01-2-259565
q. ^ VA 5. ^Conv. Ins.
Note: This torte is hmished to give you a statement of actual settlement costs. Amounts paitl to antl by the settlement agents are shown Items marked
C
.
"(p.o. c)" were paid outsitla the closing; they are shown here for infortnetionel purposes end era not inclutle0 in the totals.
D. Name S Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender:
Rudy E. Widjaja Estate of Clair Vclor Runk
238 5. 14th Street, Hartisburg, PA 17104
G. Property Location: H. Settlement Agent: I. Settlement Date: 1 V30/2012
108 Maple Drive Bartlslers Land Abstract Company Disbursement Date: 1 V30/2012
Mechanicsburg, PA 17050 119 Gamma Odve, Pittsburgh, PA 15236
Silver Spring Township
Place of Settlement: TRIeExpress
119 Gamma Ddve, Pittsburgh, PA 15236 Printed 1 V29/2012 at 8:26 am
by JE
100. Gross Amount Due from Borower 400.. Grose Amount Due to Seller
101. Contract sales price 4 1. DWtraCt sales price
102. Personal ro ed 402. Personal ro e
703. Settlement charges to borrower (Ilea 1400) 421.00 403.
104. 404.
105. 405.
Ad'uatments for llama aidh seller in advance Ad usMents for items aidb seller in atlvance
106. Citytlown taxes to 40fi. Cityftavn taxes to
107. Counry taxes 1113012012 to 1213112012 8.94 407. County taxes 1113012012 to 1213112012 8.94
108. School7axes 11I30120121o O6I3012013 182.58 406. Schod Taxes 111301201210 06/3012013 182b8
109. 409.
110 410.
111. 411.
712 412.
.
120. Gross Amount DUe from BOrteWer 672.52 420..Groes Amount Due to Sallar 191.52
200. Amounts Paldh or lrtBehsR of Borrower - 500. ~RedueBohs lh'Amdunl Due toSeller
ZOt. Deposit or earnest money 501. Excess deposit see instmctions)
202. Principal amount of new loans) 502. Settlement charges to seller (line 1400) 359.00
203. Existln loo s taken subecl to 503. Existin Ica s taken su 'act tp
204 504. Pa off of Aral mod eloan
p~ 505. Pa ofl of sewed mart a e loan
206. 506.
207. 507.
200. 5~.
209. `~
Ad'ustmenta for items un aidb seller Ad'uatments for items un aidb seller
210. Cityllown (axes to 510. Cityltown taxes to
211. Counry lazes to 511. County taxes 10
212. School Taxes to 512. School Taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
278. 518,
219. 519.
220. Total Pald b Ifor Borrower 0.00 520. Total ReducBon Amount Due Seller 759.00
300. Cash at Settlementfromlto.Borrosven - 600:: -0aaM1al SelBhment lolfrom Seller
301. Gross amount due tram borrower Qine 120) 612.52 801 Gross amount due to seller (line 420) 191.52
302. Less amounts paid byHor borower (line 220) O.DO 602. Less reductions in amount due seller (line 520) 359.00
]03. Cash ^X From ^ To Borrower 812.52 803. Cash ^ To ^X From Seller 167.48
._.._--...._~_„. amFnr •.~e ous~:,m,~,,,,m.,. xo~,na.n,wnn.o~..eanuauue...am.,m,on. ma. e..en.e wr.o.a. e. w•..~o..w
,m,.,mh,~oayn:~
Previous etlitions are obsolete Page 1 0 4 HUD-1
I.SRlttementChalaaa
--'--~~
Paid From
Paid rr"ram
700. Total Real Estate Broker Fees Borrower's Seller's
Division of commission (line 700 as follows: Funds at Funds at
701. $0 DO t0
Settlement
Settlement
702. $0.00 to
703. Commission paid at settlement
800. kema Pa able in Connection with Loan from GFE #7
000
$ ( )
)
901, Our origination charge (Includes Origination Point 0.000%or $
Your credit or charge (points)for the specific interest rate chosen $ (tram GFE#2)
902
.
803. Your adluslad origination charges (from GFE A)
804. A sisal fee tc from GFE#3
to from GFE #3
805. Credit re rt
from GFE #3
BO6. Tax service to
from GFE#3
807. Flcod certification to
808. to
900. kerns Re ulred h Lender to he Pald in Advance
(from GFE #10)
OOld
O
ay
.
901. Daily Interest charges from from 11/30/2012 to 12101!2012 @ $
902 Mod a e insurance remium months to from GFE #3
903. Homeowners insurance months to from GFE #11
904. months to from GFE #11
1000. Reserves De osltetl with Lender (from GFE #9)
1001. Initial deposit for your escrow account
1002. Homeowners insurance months $ Imonfh
1003. Mon a e insurance months $ Imonfh
1004. Pro en taxes months $ Imonfh
1005. County taxes months $ 6.521monlh $
1006. Assessments months 8 2fi.07/month $
1007. Aggregate Adjustment $
1100. Title Char es
1101 Title servlcas and lender's title insurance from GFE#4
1102. Beltlemenl or closing fee to $
1103. Owner's Title insurance from GFE #5
1104, Lentlers line insurance $
1105. Lenders title policy limit $0.00
1106. Owners title policy limit $0.00
1107. Agent's portion of the total title insumnce premium $
1108. Underwdler's portion of the total Wle Insurance Dremlum $
1109.
1200.GovernmentftecoNin and Transfer Cher ea
62
00
.
(from GFE#7)
1207. Government recording charges $
1202. Deed $62.00 Mort a e $ Release $
(from GFE #9)
359.00
1203. Transfer taxes $
1204. CirylCounty taxlstamps Deetl $359.W Mon a e8
359.00
1205. Slate Taxlslamps Deed $359.00 Mod a e$
1206. Deed $ Mort e $
1300. Additional Settlement Cha ea '
(from GFE #6)
1301. Required services that you can shop for
1302 to
1303. to
1304. to
1305. to
r t , 421.00 359.00
r
'Paid outside of closing by (B)ortower, (S)eller, (L)ender, (I)nvestor, Bro(K)eC"Credit by lender shown on page i. "'C2diI by seller shown on page 1.
Previous editions are obsolete Page 2 of 4 HUD-1
~ MUD CERTIFICATION OF BUYER AND SELLER
have carefully reviewetl the HUD-1 Settlement Statement and to [he best of my knpwletlge antl belief, it is a True antl accurate statement of all receipts anb
iisbursements made on my account or by me in this transaction. I fudher certify that I have received a copy of the HU61 Settlement Statement.
~ /
t~~ l
Rudy
Esiat of Clair Victor Runk
Agent'. Michael Steven Runk, Executor
Tha HU61 Settlement Statement which I have prepared Is a true antl
tlisbursed in accordance with this statement.
SETTLEMEN T
caused or will cause the funds tp be
~~~~ ~i.~
GATE
CONV IGTION ICAN MCLUDEOA F NEIAND~MPRKSONMENT, FOR OETAS S SEE TITLE ieOUSACOOE SECTIONR1001 ANDISECT OR 1010NALTIES UPON
Page 4 0 4 HUD-1
Previous editions are obsolete
e
LOU! E:'~ LOI ILA IE~~
H~i~V'I NG "~~I~~NI I+IG
L04lE'S HOME CENTERS, INC. LOWE'$ HOME CliNiliR:S, INC.
5500 CARLISLE PIKE 55110 LAAL:[SLI! PIKE
MECHNN ICSBURG. FA 1]050 (717) 610-9230 MECHAN ICSBURG PN 11050 (71D 610-9230
- SRILE -~ - :iRl_E -
SALES4: 52223pT1 1035913 TRANSY: 9367749 07-15-12 SALESN: 52223NC2 6770[1 iRAlISX: 10212413 07-13-12
34724 QT.PREM.E%T.SNT.6SD3 7310 11.41 356808 GL OLY 011E 1.Ni IEGG E:ML BS 25.97
'L78715 6" BROAD KNIFE - PC2 7.98 356801 GL OLY 011E 1.Ni EGG ENL iR 25.97
11937 SHURLN PHEM IUM '~:OHNER ?AD 4.91 356801 GL OLY 011E 1NT I[GG EML TA 25.97
174993 3" PLpST IC REFINISHING TO 2.98 356801 GL OLY 011E ].Ni f:G6 EML iR 25.97
124174 BN 12" PLAST Ii I1U0 PAN 3.46 144257 WNI22 GAIFINEi & DOIIF'~ KIT 6.97
7184 3 LB V"' ''C'ARU 1DINi G)MP 5.48 2138 IAWIN 6" BL'METIIL IIOOA IN 20.GB
61391 PB ENTRY TVLO 9.97
SUBTOTAL: 36.34 234557 WOOSiEA ;!PK 9-314" FIOLLEA 7.97
TA%: 2.19 69922 3M GLUE APE. APPLII:AiOA 7.97
INVOICE 09173 TOiRL: 38.53 158763 3G WHITE MIDSZE SW'.aCH PL 1.76
VISA: 38.53 158755 2G WHITE MIDSZE SW::1'CH PL 2.48
2 Y 1.24
'J ISR:%X%%%%%XX%%%7088 AM'JUNT:38.53 AUTHCO:015524 74091 1G MIOSI'E f'LRTE TI'1WCC20 2.30
SWIPED AEF ID:3677802223C9 07/15(12 71:56:20 5 0 6.46
' j1 fn (~ ~ 158834 1G WHITE MIUSItIi OIITLET P 4.40
/~i-y ~f i^_.'~_~~-I~ f( 9 .-- 10 0 6.44
STOREI 2223 TERMINAL: C9 Ol/15% 2 11:56:35
it OF IT 6P!S PUiFiC HFISEO: 6 SUBTOI"AL 168.58
1A% 10.13
EXCLUDES FEES, SERVICES AND SPE;IAL DRDEA ITEMS
INVOICE 10!171 101"pL 178.71
I i pl~~ i Jt I~'n ICI ~ I i l rI~`~~~ A l~ i 1 i ~ 1
CHAIIGE 21.29
~~I~III~"INS'IIM^IIO~~IIi~II~gIIII~~~~`~I~IBI~I~IIIII~IIIII~~~llll1lld~~l~lll CA;iH 200.00
THANK YOU FOR S'dOPP ING LCWE'S. STORE: 2223 TEIIMIIIAL: 10 07/13112 16:41:09
SEE REVERSE SIDE FOR RETU'.AN PULICY. ii OF I T EMS• PURCHASE 0 : 27
$TOHE HANAGEH: _IIM DUNI(ELBERGER EXCuLIOOES~yFE~E~yS, SEIIVICES IIND S~P'ECIAL DRDEA ITEMS
IVE HRUE THE LUWESi ?ItICES, GUAFANTEED! ~pj~I~~pprlIlI~II~I~Illll~~
IF YOU FIND A LCWER PRICE, IVE 11I'_L BERT IT BY 10$. I~A 11 °IIIAIIi~ ICI
SEE 5i0AE F3R DETAILS. THANK Y011 FOR SIIOPI'1'.NG LOWf!'S.
SEE REVERSE SIDE FOR IIE'.iUAN P[ILICY.
:x###'it*#Y3#*?^lA.::ta####*##KV##'[4#t###x###i #:F###MXt#zv#
STORE MANOGEf'.: ,IIM ['~UNKELBE:RGEA
# YCUF OPINIONS COU:r'T! #
REGISTER TC YIM A F5,000 LOYIE'S GIFT CARD! +
WE HAVE THE LOWEST PRII:E.S, GUAFlANTEED!
* PRECIS?RESE FARA DAKAR UNA TAAJE?d DE AEGALO LOVIE'S! * IF YOU FIND A LOWEN PF'ICE, WI: WILL GE:Ai IT BY 10$.
# #
SEE STOf:E F(IR HETR ILS.
REGISiEE SY CCMFLETING A GJESi Si?T ISFACTIGN SURVEY
* IiTTHEN DNE WEEK AT: ,;u;m.low=s.comi suroer #
= Y 0 U R I D p 09173 2223 197 # YOUN OPINIONS COUNT! +
# # * REGISTER TO YIII A 55,1100 !.DYE'S IEIFT CARL.
# NO PURCHASE NECECSR~dY TO EATER OR WIN. * # iAEOISTAESE PRAA GAIIAA UNA iAIIJETA DE AEGALO LOWE'S!
* VOID =;THERE IRON IB ITED. MUST BE 18 GR OLCEF i0 ENTEF. +
DFFIC IAL RULES 8 VINNEAS AT: eiaoi.l muss. ceni so ruev # # REGISTER BY COMPLE~~INU p OUErI SAi IBFACT ION SURVEY =
WIiTIN ONE WEIiN ti: uww lowes.snm/surweY
STORE: 2223 TERM INP.L: 09 07!15/12 11:56:35 # Y D U A I C Y 10!171 2223 195 >
#
* NO PUACHAGE IIECESSAIIY -G ENTER OA WIN.
* VOID WHERE PROHER 111'0. MIIS' AI' to nP fll nFR Tn FNiLA
~. ~ _ .
Lowe'
LOWE'S HOME CENTERS, INC.
5500 CARLISLE PIKE
MErHP.NICSBURG, PA 17050 (717i 610-9230
- SRLE -
SALESa: S2223HC2 671703 TAANSA: 20000510 Ob 03-12
4269 40' BLACK PLASI ti FOG RAG 18.98
92125 0.5 CU FT RIVER AUCA 2.U'
92125 G.5 CU FT kIVER ROCK 2.05
52125 0.5 CU Fi °TUEA ADCK 16.40
A 4.10
rilBTr~-; AI : 35.4b
TA%. 2.36
IN"- SCE ?0698 TOTAL: 41.84
VISA: 41.84
VISA:%KK%%K%K%KKK70A8 AMOUNT:41.B4 AUTHCD:092747
SWIPED REF ID:000525222320 08!03/12 09:28:45
i
STBRE:U2`223 TERMIN L: 20 08703/12 09.28'S~ ~
it OF ITEMS PURCHRS~I
E%CLUDES FEES, SERVICES AND SPEf-'~ 'FF: ETEN'
THANK YOU FOA SHOPPING !t"F'S.
SEE REVERSE SIDE FOA RETURN POLICY.
STORE MANAGER: JIM OUNn~."`RGe^
WE HAVE THE LOWEST PF.ICES, GUARHNI~ !
IF YOU FIND A LOWER PAIGE. WE HILL BEAT IT bV 10$.
SEE Si ORE BOA DETAILS.
####ifi#:x###############Y######fi####:A##X#: #######X#XAX#
# YOUR DP TNIDNi COURT! #
* REfiISTER TO YIN A i5.F JO LOYF-S fiIF' ` :!%'
* iREGISTRESE PARR GANV" UNA TARJC - .' kEGGL^ "IF'S' *
fi REGISTER BY COMPLETIIIG ' GUEST "•;aT" ~ 9i SUPU'
II ITNI'N ONE WF'h AT: www ,<os .r-ir
Y O U R I! 4 20fiUP 222' - '
i.
#
Nu PURGNA~r A E SARA`' E i.~N
# VOID UHERE °FON'"ITIJ MU°T DF - - ~'~ EATER.
OFFIG IHL kJLE' 8' INAF S pT: u, ~ ,,; vev
STORE: 222 ':ERMINE 20 -'28:55
Louu~~
"1`~~~iv~~M~
LOWESS' NOME G?ETEFS, INC.
5500 r,ARLISLE PIKE
MECH'ANICSBUAG. PA 17J50 Q17? 610-9230
,nLE -
BAIESa: s?23E'U1 664.12 iHJ9~,x_ ?994023 Od-03-12
93125 0.5 CiJ r. RIVER ROCK 73. b0
td '0 4.10
94463 2?.' BLAGN PLAST [C EDGT'AG 9.98
SUBTOTAL' 83.78
TA%: 5.03
TN'd:'.:Ct ~<ab ,'•o~ : 88.81
VISA: 48.81
VISA:%%%%tiXK%d%%A7088 AMOUNT :08.81 AUTNC0:073942
S14IFED RfFID:99404022¢2/309 08!'73/12 07:40:4DJ
f~r~ I.Y.'*'Jf ! ~~~'~~'r Ir -_~~A...
cg. ~
STORE[ 2223 TEFMI)IAL: 09 0'~B/031 12 07:40:51
7F OE I9': hiS °URCii fISE~= 9
EXC UDES °cES, ~ '.N5 C r'. IA .ROE" _ E"$
iHANri ~ ~I' ,,,,, °'GPPINE L041E'S.
SEE REVz6'•_ aTDE PJR ni'UAN POLICY-
STUkf. NHNAGER: J:n DN R
!lE HAVE THE LOWEST pR'. s, GLiARANTEE
IF YOU FINC A !^vJ1ER PRICE, i1L WI..i 6EAi IT BY 10$.
SEE STORE F'JF RETAILS.
##~xn*##x ,a..*4ai=%xa#n*#..x:q nP x ~~, .###n**#x*fi rn *.*k
* vauR oPlnmNS abWUrs
+ fl€GISTER TO MIN A E5,500 LOY!E'S GIFT 'AAD'.
* iFEGT.S'RESE PARR GANAR UNE iAR.iETA DE REGP D LOUE"O!
#
* fiEBISTER GY OOMPLEi ING tT 3'~~FST &+T i$FNf--ZION SURVEY #
` IVITH iii OYrE WEEK AT: .. .1 Ci~l i'.e011ii 54 NEY
* e 5 9 R i C a -;588 2t 2t6
# *
* Ii0 F'JF':HASE HECESSA ~~ - - ~• .1IN. #
fi UpID OHERE RRCN IBITEG. 14US~ '~ ,~ ~CER i0 ENTER. '
OFFICIAL RULES d WINNERS ~ .nip.. ,r:ec.c N/su rue+~
STORE: 2223 EnM INAi ]303/7"_ 07:40:
~~~Fn ~~nn~q r
r ry t-~~~i0i INC'
LOWESS HOME CENTERS, INC.
5500 CARLISLE PIME
NECHANICSBURG~ PA 17050 (117) 610-9230
- SAILE -"
SALE SN: 527 lT2 1211520 iRANSN: 9504939 OR-20-12
21955 CRPi TRIM fLUTEU 1.375X36 5.59
219651 SCREW NAILS 1-174 12 CL 1.59
60935 4 OZ CA SCENTS L'ITRUS/ORA 3.98
SUBiOTRI: 11.16
fRK: 0.68
INVOICE 09043 iOTRL: 11.04
U ISA: 11. G4
VISA:XXXKKKXXXXXX7088 NMOUNT:11.84 AUTHCD:092135
S4IIPED REFID:504954222309 08/20/12 19:22:34
STORE: 2223 TERMINAL' G9 O'~B/20/12 19:22:36
iP OF ITEMS PIJIRCHFlSEf]. 3
EXCLUDES FEES, SERVICES AND SPEC IAL ORDER ITEMS
IIIiI ~ ~ ~ ~~iN ~~ ~'~~~~N~ ~~ ~ N~~~'~~I ~I~~~lil~'~~Ul~'i~'~~~!
iHANM VOU FOR SHOPPING LOWESS.
SEE REVERSE SIDE FOR RETURN POLICY.
Si ORE MANAGER: JIM DUNNELBERGER
NE HAVE THE LOWEST PRICES, Go,,^AANTEED!
IF YOU FIND A LOVIEA PRICE. WE WILL BEAT Ii BY 108.
SEE STORE FOR OEiA IL3
XX**%#kF%k*#av%#kYYkFW%r%%a *A. ni ., ::1y*xs4X kRR+.:eMiXM4}s}
+ YOVfi OPIA I'iM$ CO!liT! +
* AESI5I EA TO YIN A S!i. 700 LOYIE'S 6TFT CARD! *
x iREG ISTAESE PARR SANAA UMA TARJETA OE REGALO LOWE'S! +
# *
REGISTER BY CDpIPLETiNG A 6UESi S~iTISFACT IDN SURVEY ~
* ;!IiHIR ORE 1EEK qT: ~nue.loues.comisuruev +
# Y O U R I D u 09043 '2223 233 +
%
NO PURCHASE RECESSANY i0 ENTER fiP l7IN. *
% UDID iJHEAE PROHIB IiED. MIISf BE 18 DH OLD'cR TD ENTER. +
* OffICIAL RL'lES & WINNERS Ai: .;:ru.loues.con/suruev x
:*%%##X**%xxx%X*##%xzx%zwxM #,. x}ruf kx%+X#mx.x.'*#Mil%**#z
STORE: 2229 TEAM INAL: v3 D3/20/12 19:22:36
r ~
Stoner Flooring
331 S. Enola Dr.
Enola, PA 17025
,' 717.648.5044
Bill To:
IMike Runk
225 Orchard Rd
'New Cumerland, PA 17070
i
j_. ---
PO Number
Invoice
Number: 1001
Date: August 02, 2012
Ship To:
Mike Runk
225 Orchard Rd
~I New Cumerland, PA 17070
I
_-- . _ __ __._____ - J
L -- -.
Terms ~ Protect ~
_ _ __ _ ___
110 Maple Dt
Amount Paid: 225.00
31 60 days 61 - 90 days ~ > 90 days II Total
t $0.00 $0.00 I_ _ $0.00 - L $0.00
- _ _. _.
~ _- _. __
r
onv~o w. scfrwErrzE.R
15 NATURES CROSSING
ENOI.A, PA 17025
'.OLD TO
--
(Y1ik~ (~ur~x
2,~5 01~GNA,eO Ra
/y~/ c~im~Qc~nN~ 17070
Invoice No. /236
8~ f~f z
SHIP TO
Din S /JO:~SE
/; 0 /~~cki~ ~R~U~.
/y1~'eN~J~i<sgU1,P~ f~A 1050
•
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LOIIE'i H('ME CENTERS. INC.
!ii00 CAA,ISLE PINE
MECHANICSBUB~1, PA 17050 (71 ]) 610-9230
- SRLE -
SALESA: F2223PE1 1115592 iRANS4: 6D61D42 O6-G4-12
37615 3PK 15A 12`-~V IVORV GFCI 29.98
70614 CWD 1-fi STD ULANK PLATE I 0.47
72567 1G MIDS'IZE TPIICC100 1.38
3 @ 0.46
44402 1G MID:iIZE BLRNK IVORY 1.70
2 @ 0.85
769:6 4" SU UJ%, L 5" DEEP, 1/2 2.04
'<' @ 1.02
547V0 1/2 Ofl^EI ILIP?lE 1 8AG 2.03
2468`.3 2509/61iCW FLASTIC LAMPHOL 1.26
246603 15A 1294' IVY SAITCN 663IG 2.78
@ 1.39
75443 1/2 STEIEL L.OCKNUT 2 Bp6 0.39
701 E5 ROUND I?VEF', 3 1/2". KO 0.90
273f7 4" EXPOSED IIORR COVER. 1 5.00
i 3 T.50
70998 1 GANG ZO CI PVC NEN WORK 2.34
E B 0.39
1564DU JELLY .1„R WALE LIGHT WNI 4.97
WBTDTAL• 55.32 /, s,s/
TAX: 3.32 /~+ ~ (j
INVOICE U'S46D TOTAL: 58.64 ~ -X
LpR: 58.64
LAA:XXyXX%%%%%%I(149f~ AM3UNi:58.64 AUTHC0:000425
KEVED IiiiFID: 06/04/12 09:31:52
FCCOUNi Np?E: SCHJE ITZEA CONSTRUCTION
RUTH tlUVER: SCHWE ITZEA DAU 10
ACCOUNT FILL 6E BC~.LE6 OP3N MERGHAND ISE TRANSACTION
DATE FOA STOCK MEAD: HANIDISE AND NO LATER iHRN 90 DAYS
FROM if.ANSACi IOH DAZE FOR SOS OR DIRECT DEI IVERY
MERCHANDISE.
V ~-~
STORE: 2223 2AMlNAL: O6 00/04/12 0959
4t OF ITEkIIS PURCHRSED: 24
EXCLUDES FEES, :i':RU]CES AND SPECIAL ORDER ITEMS
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` ~ , Comz`7~ercal Subterranean~Termite .Gontrol;P.rogram Agreement
+ Home Pazaznount Pest Control.. 888.888,HOME. www.homepazamount.com
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PO Box 850, Forest Hill, NID 21050 License/Phases: ~iJ Z5, ?R Date: 3i~1'' (.
{ONIMERCIk~,SERYICES~ ..- .,. :: - ~ ,.+a `'
RETREJ-T~ENTGUARANTEE ctz+asrr=~ is ~~»
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This Agreement provides for the retreatment of a structure"but does not provide for the. repair of damage caused by Subterranean Termites '~
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Agreement. Customer is the owner/authorized agent of the property acid has e~ected Home Paramount Pest Control`s Residentta`f{SUbte~ anean Termite Contrdl
Program. This Agreement constitutes the entire understanding between the parties. No other terms are binding unless made m wrinng and sgned by a Home "~
g P - p {her oral or written.
Paramount Officer. This A reement su ersedes any and all rior re resentanons, discussions or agreements between artes w et
Servlc h sAgreement provides subterranean termite control5erwces tuf does NOT cover Formosan/Dampwood/Drywood Termites Carpenter Ants or any other
pe Home Paramount will promde an initial subterranean termite service and following treatment, make subsequent mspecnons~as necessary and/or as requested ,
n N,Ft II. ~ '
during a one (1) year term. Hdme Paramount will retreat infested area(s) previously treated by Home. Paramount as~necessary Ip Home Paramount s professional
opinion at no additional cost to the Customer during the term of this Agreement. Home~Paramount, in Its solediscrenon, will determine materials acid methods used
for treatment. Customer must nonfy Home, Paramount audits representa4ves of anyprawl spaces, concealed pipes or cables, water sources of any other co ndinon +$, ,.,;
that may result~in property damage or injury to the~envlronment prior to treatment _ .~'.: ,.^~+t' =
Customer Infprmadon (Owner/Authorized A ant) Billing Information . Service Information
~ ^
,
~
Name (First, Last) ' ' Company Name i
;
Contact Name (First, Last)
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~Addr Address ~ 6~.-• ~` I. ~. Address - t' -'
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Telephone `+" "' ` Telephone'
~ aytime Telephohe;
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~ Tax Exempt_p, (vehin, Seryie Co 'ttma_. ` phone..
E-mail
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Structure(s)~`Cbfhed/Scdpe of Service! ~ '' `"`-~
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o.,.....e..e m~ each acranted. Please make check/money order payable to Home Paramount rest ~ontroi wmpaniee, ~~~~.
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Program fee ~,.. ~ _ Plus Taz,., _. Agreement TOtal. ,,.- „1..,.~ }3t.; . iC?~
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Amount ;;y ~. ^ Money Order q ^ Check g ~ '~ Finance Yi
,,,... ;
Acct tt Cardholder Name Exp. Date
f+ "' i
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^MC '~:DisC ^'Visa'. ^ AmEx -
Renewal ($120 Minimum ^Agreement Pncexig% ~ -. Not Renewable ,;po-}I :..
-.Customer shall harre`the option to extend this Agreement on or befpre the er,piratiop date for an additional term. of one (1) year, if agreeable tp both partest. upon ,+...
payment In full of the Renewal Fee. Home.Paramount ispot obligated to notify Customer of the renewal date. The Renewal Fee is not subject to change fora penpd;
of three (3~ years from the date of this Agreement Thereafter, Home Paramount reserves the right [o adjust the Renewal Fee...,
Customer Acknowledgement. Customer has read and accepts this Agreement including the Terms and Conditions on the reverse. Customer acknowledges receipt of.., ..-:
the Customer lnformaN6h Handout ~ '
Customer Signature Home Paramount Signature Print Name ID#r °.
This Agreement is cpntingent on managgmeptapproval. ,
Home Paramount reserves the right to revoke this
Agreement if not accepted within thirty (30) days.
Top Copy- Branch/Middle Copy-Service Department/
Bottom Copy-Customer
L10601.10 ®2010 Home Paramount Pest
Control Companies, Inc.
I in NCJ ,I
OVER
:*n
YEARS OF SERVICE
f y
225 orchard road
New Cumberland , Pa
$0.00 $0.00 I $0.00 I $0.00. I $0.00
Y
225 orchard road
New Cumberland , Pa
$4,020.00 $O.DO I $0.00 I $0.00 $4,020.00
r
~~~~
33 Queen Ave.
Enola, Pa 17025
Phone# 717-798-4667
topchoiceconstruction(a~verizon.net
PA License # 37005
CONSTRUCTION CONTRACT
(dome improvement)
This Consbvetion CoMrad (°Contract") is erhared into by and between Too Choice Cortstructloar
("Contractor ") and Mike Runk ("Owner"), whose residence address ~ 225 orchard Road New
Cumberand. Pa, whose contact phone number ~ 717.3645282. and whose project address
("Project") is 225 orchard road New Cumberland. Pa.
The Owner and the Contractor agree as set forltr below:
7.OESCRIPTION OF THE PROJECT AND DESCRIPTION OF THE SIGN~ICANT MATERIALS TO BE
USED AND EQUIPMENT TO BE INSTALLED:
Contractor will furnish ail labor, materials, equipment, supervision, and contract administration to complete in
a good and workmanlike manner the following alterations to the Project
See attached bid and deck plans for ali work to be completed and materials
(~ These atterabons are described as needed mare fully in Attachment A, °Description of Work and
Materials', and 'rf applicable, in attached drawings and specifications prepared by
.Sheets 1-, dated ey this
reference, those drawings are incorporated in and made a part of this Contract
' « Y
2. EXCEPTIONS: Contractor's scope of work under this Contrail does not include any of the following items:
F~rdusions irrduded in bid
3. CONTRACT PRICE: Owner shall pay Contractor the foced sum of OZO.00 (the "Contract Price) for the
work to be performed under this Contrail, subject M addrlrons and deductions pursuant to drange orders
agreed upon in writing by the parties, and subject to °allowances' as provkted in this Paragraph 3.
The contract amount must include tha entire cost of the contract inducting profit, labor and materials, but
excluding finance charges.
The Contact Price may include ailawanoes for cerhain materials, finishes, fixtures and/or other items. which
have not yet been selected or decided by Owner. Alowances are specific dollar amounts, which Contractor
has albcated for the purchase of the materials, finishes, fixtures and/or orrer items to be selected. These
allowances include all overhead and profit, plus all applicable sales taxes. if the final cost of any item covered
by an allowance 's greater m less than the specified allowance, the Contrail Price will be increased or
decreased accordingly by a written change order to be issued by Contractor. The allowances for the Project
agreed Tfl by Owner and Contractor are specified under "Albwances' on Attachment B to this Contrail.
4. FINANCE CHARGE: If applicable, Owner shall pay Contractor a finance charge of N/A
(The finance charge must be included in dollars and cents.)
5. DOWN PAYMENT: ff applicable, the sum of thirty (0%) 50.00 shall be rendered to the Contractor prior to
start of work.
6. SCHEDULE OF PROGRESS PAYMENTS: If applicable, the Contact Price shall be paid in progress
payments, which do not include finance dtarg~ of any kind and do not include the Down Payment, according
io the following schedule:
Amount Due on Completion Work or Service Perfonned
4020.00
Completion of all work
Y
7. APPROXOIATE START DATE: The work to be performed under this Contract shall canmertce on
approximatety this date:June 26th, 2012 , as kxrg as any required building pennds are received and any
agreed upon funds are paid to Contractor.
Substantial commencement of the work shall be deemed to occur when Contractor first supplies workers to
the Project who actualty commence construction operations. Failure of Contractor without lawful excuse to
substantialty commence work within twenty (20) days from the approximate date specfied in this Contract is a
violation of this contract.
$. APPROXIMATE COMPLETION DATE: The Contractor shall use hislher best efforts to complete said work
of improvement on approximately this date:July 13th, 2012, subject to permissible delays as defined in this
Contract-
9. LIST OF DOCUMENTS TO BE INCORPORATED INTO THIS CONTRACT:
Attachment A, Description of Work and Materials
_ Professional drawings and specifications from
X Other. Bid #12-19
- -~~
10. NOTE ABOUT F_XTRA WORK AND CHANGE ORDERS: Extra Work and Change Orders become part of
the contract once the order is prepared in writing and signed by the parties prior to the commencement of any
work covered by the new change order- The order must describe the scope of the extra work or change, the
cost [o be added ib or subtracted from the contract, and the effect the order will have on fhe schedule of
Progress payments.
17. F~(TRA WOR3C AND CHANGE ORDERS: If Owner or his agents or any public body or inspector directs
any modfication or addition to the work covered by th~ Contract, the Contract Pace and time of performance
shall be adjusted accordingly. Payments for extra work shall be made as the work progresses, concumentty
with progress payments. Work or expenses necessitated as a result of Contrat3or encountering mnditiorts at
the Project site which (a) are subsurface or otherwise concealed corWitions which differ materially from those
indicated in the plans and specifications, or (b) are unusual and differ matedatty from those ordinarily
encountered on construction activities of the kind described in the plans and specifications, shall be deemed
extra work and shall be paid for by Owner in arxordance with this Paragraph t i .
Contractor shall not be required to perform any extra or change-order work without prior written author¢ation
of Owner in a signed change order form before any new work is started. Signed change orders shall be
incorporated into and become a part of this Contract Ttrere shall be a $0~ administrative fee for each
change order.
The Owner is rrot liable for the costs of extra work or change orders unless the signed change order includes
all of the folbwing in writing prior to the commencemenrt of any work covered by the new change order.
(A) The scope of work encompassed by the order-
(B) The amount, in dollars and cents, to be added b or subtracted from the contract.
{C) The effect the order will make in the progress payments or the completion date.
M
(D} A statement informing the buyedOwner that the contractor's failure to oompty with the requirements of
this paragr~h does not preclude the recovery of compensation for work performed based upon legal
or equitable remedies designed ffl prevent unjust enrichment
If Owner or his agents or any public body or inspector directs any modfiption or addition to the work covered
by this Contract, the Contract Price shall be increased by the amount of Time and Materials expended
therefore by Contractor plus 20 percent (%} for overhead and profit As used in this paragraph, °Time and
Materials' means the sum of (a) Contractor's labor computed at a robe of $45_110 per man-hour and (b) the
actual wsi to Contractor of mater~ls, equipment and subcontractors. Payments for extra work shall be made
as the work progresses, concurrenity with payments made under the payment schedule set forth in Paragraph
6 above.
12 PERMfTS AND TESTS: Unless otherwise agreed to in writing by both parties, the Contractor shall
procure the necessary permits for the work Owner shall pay the governmental fees and Contracts charges
for sad permits. !f any tests w inspections are required by the plans and specifications w by ttte orders of any
public authority having jurisdiction, Owner agrees to procure said tests and inspections and to pay ail costs
and fees associated with them.
93. SUBCONTRACTS: All portions of the work chat Contractor's empbyees pnnot perform directly shall be
performed under subpnfracts. Unless Owner has agreed in advance in writing, all subcontracts sha0 txx on a
faed price basis. The Contractor shall secure the Owner's written consent before entering into any
subcontracts.
94. COMMERCIAL GENERAL UABiLiTY INSURANCE (CGL):
^ This contractor does not tarty commercial general liability insurance.
^ This contractor is self-insured.
^ This contractor pities commercial general liability insurance written by this insurance company:
Erie tnsurance Comoanv_ You may ptl them of this phone number
to check the contractor's insurance coverage: 717-766-9200.
95.OVYNER INDEMNIFICATION: The Contractor hereby agrees to hold the Owner harmless and to
indemnify the Ovmer against any and all claims that may arise dudng the course of the work as a
consequence of the neglk~ent ads w deliberate omissions of the Contractor, its agents or empbyees.
96. CONTRACTOR INDEMNIFICATION: The Owner hereby agrees tc hold the Contractor harmless and to
indemnify the Contractor against any and all claims chat may arise during the course of the work as a
consequence of the negligent ads or deliberate omissions of the Owner, its agents or empbyees.
17. ATTORNEY'S FEES: In the event any arbitration or any action at law or in equity shall be brought on
account of any breach of this Contract, or to enforce or interpret any of the provisions of this Contract, the
prevailing party shall be entitled to recover from the other party its reasonable attorney's fees, which shall be
fixed by the tribunal or court and be made a part of any award or judgment rendered.
..
18. COHiiRACTORS REQUIRED TO BE LICENSED: Contractors are naauked by law to be licensed and
regulated by the Contractors' State License Board which has jurisdiction to invesfigate cornplaints against
nny questions carceming a contractor may be referred to the Registrar, Contrailors' Sla6e License Board,
using the contact intomration in paragraph 18.
19. ACKNOVYLEDGMENT: Owner is entitled to a completiety fitted in copy of this agreement, signed by
both the Owner and the Contractor, before any work may be started. Owner admowledges receipt il a
complete, signed and legible copy of this Contract L~
20. COMALEfE ACaREEMENT: This Contrail constitutes the entire agreement between the parties. There
are no other agreements, oral or written, pertaining to the work to be performed under this Contract This
Contraot can be modified only by an agreement in writing signed by the partite.
~~ ~~~~5
Owner'a Signature
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URC'rR iil;idhEH DEPARTMENT ALESPE .SON WHEN SHIP TERMS HOW SHIP I DATE
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Philadelphia Area
215-855-4020
Philadelphia pub.
610.277-3445
Trenton Area
609-341-0010
NJilmington Area
302652-62?7
~~~~~~~~
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~~~ America's Basemen! Specralists~^ __/~~
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1/alu~Dry
Basement Walerpraoling 8 Remodebng
154 Hansen Access Road
King of Prussia, PA 19406
''/~O{JP~`OSfAL'V.IUBMI'fTE )l0
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rtASEMENT IS: ^ FINISHED ~I
r?r)' Arccpmd Syatron F.-olio
KI°en Flow Triple Wal PVC.
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Tear ouf Slueding A Drywall @ 3 feo
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Suntp Well ~`~ ~ 4
V1 HP ERluam Pump
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LENGTH OF TIME FOR INSTALL.
~' ^ 1-3 DAYS ^ t-5 DAYS -t
=INISHE ^CRAWLSPACE (Please check one)
ku.mmtendcd Scn~ice5 metier Pressure Relief System
ull Perimeter System ^ Battery Backup on all pumps
Japor Barrier ^ Other (~.., c,.„,rl
Toll Free:
1-866-328-2583
www.valuedry.com
Approximate S.arting Date _
Approximate Ending Date ---
INSPECTION DArE
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DAYS ^ POSSIBLY LONGER
^ FINANCE
Kleen Wall
dditional Feahn'es
of Foundation WPII'
^ Poured Concrotc
^ Slono
Other
System to tlraln into:
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^ Existing S mp
Othe ip~"~_~
Type of Wall Fnish_
^ Plain
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snide
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Olher
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l'ype of Floor Finish
Obslarl s logo around
[7 Pilaster
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tN ll tslr F l l ,,r. ~ Y) ra folly ercplalnad I le merits of the hasem,nt walerprnofing syelem, and ! mderstand that Valr a Dry is only responsible Inr picu l n r'he ~,rer.e::zry I .oar ro
tkn ".e r '^~ to ~ dinnmal ervlces or Syslen r~aturaa may be supi 'ctl it lapuesleq subject loan agreed upon envision in tho scope of ,ervi~s and.l .horbQd lee. A'aF(u Dn~ may
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