HomeMy WebLinkAbout01-22-1315D561D143
EX (01-10) OFFICIAL USE ONLY
REV-1500
County Code Year File Number
PA Department of Revenue pennsylvania
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO 60X.280601 $_0601 INHRESI IDENTEDECEDENTRN 21 12 019 6
Harrisburg, I'A 1712
ENTER DECEDENT INFORMATION BELOW Date of Birth
Social Security Number Date of Death
- 02 01 2012 .10 27 .1920
Suffix Decedent's First Name ~ MI
Decedent's Last Name J
MARY
TREGO
(If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name MI
Spouse's Last Name
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW ^ lemental Return ^ 3. Remainder Return (date of death
a 1. Original Return 2. Supp prior to 12-13-82)
^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
4. Limited Estate ^ (date of death after 12-12-82)
6 Decedent Died Testate ^ 7• (Attach Copy~of T ust)a Living Trust 1 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will)
9. Litigation Proceeds Received ^ 1 D• beiween12 31 ~~anditl(dat~e5~f death ^ 11 • Attach SchaO) nder Sec. 9113(A)
CORRESPONDENT -THIS SECTION MUST SE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIALDTy~trme Telephone Numbe BE DIRECTED TO:
Name 7.17 .243 5551
BgADLEY L GRIFFIE
REGISTf01`."WILLS USE ONt~Y
~ 4~ ~., .__ a, t t
rt~ ... .... i ..
First line of address `~~~ f ~~ R~
- I C1:,
2 0 0 NORTH Hp>STOVER STREE ~ ~; ~~ .,
_T.~
.. . ,
;. ._._..... J ..
Second line of address ~ - ~ •'
DATE FILED
State ZIP Code `~',~ ~~~" `'°`b
City or Post Office --.~ '_~ t
CARLISLE PA 17013
b riffle riffielaw.com
Correspondent's a-mail address: 9 @g
Under penalties of perjury, I declarclahation ofe a timer othe than the personalaep~esentative is based on aldl irifomt ton of wti'ICh prepares haS any knowledge.belief;
it is true, correct and complete. ~e M ~ SATE
S~;F~O~PERSON RESP IBLE~ILI~ETURN ` /Q ~ _ , ~ ~~ /~
~~~ ~~1 , ~ JoAnn E. Kelly ~~
r
16 Mountain View Drive Carlisle PA 17013 DATE
SIGNATURE ARER OTHER THAN REPRESENTATIVE ~
Bradley L Griffie
- 200
1505610143
~ ,,~-
Nan~ver-Street, Carlisle-PA _ _ - _ _ _ _ _ -
Side 1
15D561D143
J
`7~
PA Inheritance Tax Return
Signature of Additional Fiduciaries
FILE NUMBER
ESTATE OF 21-12-0196
Trego, Mary J.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the.best of
Howled a and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all
my k g
information of which preparer has any knowledge.
Signature #2
Name Ter A. Glass
Address1 2 Hillto Drive
Address2
Clty, State, ZIP Mount Holl S rin s PA 17065
Date ~r ~`~ ~ ~ ,`~
J
1505610243
REV-1500 EX
Trego, Mary J.
RECAPITULATION $ rj , 0 0 0. O O
..............
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.
98,281.66
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...............
5
~,
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested............
6. 50 056.25
~
7. Inter-Vivos Transfers & Miscellaneous Nnn-Probate Property
!~ Separate Billing Requested............
7.
(Schedule G)
.
$
233,337.91
g. Total Gross Assets (total Lines 1-7) .................................................................... .
33,834.60
. ........................
9. Funeral Expenses & Administrative Costs (Schedule H) ............... 9.
1,124.78
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I} ..............................
10.
34 , 959.38
11. Total Deductions (total Lines 9 & 10) ...................................................................
11.
12 198 , 378.53
..........................
12. Net Value of Estate (Line 8 minus Line 11) ............................... . .
Charitable and Governmental Bequests/Sec 9113 Trusts for which
13 13
.
an election to tax has not been made (Schedule J) ....................... . .
.
14 198 378.53
~
......................
14. Net Value Subject to Tax (Line 12 minus Line 13) .........................
.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or Q . Q Q
transfers under Sec. 9116 15.
(a)(1.2) X .00
9 2 7 . 0 3
8
16. Amount of Line 14 taxable 19 $ , 3 7 8 . 5 3 16. ,
at lineal rate X .045
~ ' 0 0
17. Amount of Line 14 taxable 0 _ Q Q 17.
at sibling rate X .12
0 ~ 0 0
18. Amount of Line 14 taxable 0 , Q Q 18.
at collateral rate X .15
H , 927.03
....
19.
.
19. Tax Due .............................................................................................................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
1505610243
Side 2
1505610243
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Trego, Mary J.
STREET ADDRESS
828 Hamilton Street
CITY
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
13,000.00
650.00
STATE ZIP
pq 17013
(1) 8,927.03
Total Credits (A + B) (2)
(3)
4• 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.
Make Check Payable to: REGISTER OF WILLS, AGENT.
(4)
(5)
13,650.00
4,722.97
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes No
1. Did decedent make a transfer and: x
.. ... ......................................... ^ 0
a. retain the use or income of the property transferred :.............................:...
b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^
c. retain a reversionary interest; or ...............................................................................................................
benefits or care? ........................................................... ^
d. receive the promise for life of either payments,
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ^ ^
receiving adequate consideration? .................................................................................................................. .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ ^
contains a beneficiary designation? .................................................................................................................. x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ath 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
For dates of de
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 se from tax, and the statut ryh equi elmentsf or disclosuee of t
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a survroing spou
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 decease 911 ~d a 1 1 2jjs 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 § ()
. 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 owho has at least one patle t n clolmmon w ht he decedent whether by blood] o adoption.
sibling is defined under Section 9102, as an individua
File Number 21-12-0196
Rev-1502 EX+ (11-08)
.„
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
oGCinFn1T nFCEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF (FILE NUMBER
21-12-0196
Tre o, Ma J.
All real Pexohanged betweeln a will ng buyeaand a willingosel e~rSneither be ng compelledato buy oluselF, both having reasonable knowledgelof thevrelevant fact y would be
Real property which 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
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM DESCRIPTION
NUMBER
1 828 Hamilton Street, Carlisle -
Cumberland County, PA
(See attached HUD-1)
TOTAL (Also enter on Line 1, Recapitulation)
d~f I a es of the same size)
VALUE AT DATE
OF DEATH
85,000.00
85,000.00
(If more space Is needed, ad I Iona p g
Form PA-1500 Schedule A (Rev. 11-08)
Copyright (c) 2009 form software only The Lackner Group, Inc.
Rev-1508 EX+ (6-98)
t
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
oceinFNT nFC`FnENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
(FILE NUMBER
T_...r„ nn~n, ~ 21-12-0196
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER 405.92
1 Blue Cross Premium Refund
762.78
2 Refund from Shipley Energy for credit balance
3 Checking Account No. XXXXXX2037 -Citizen's Bank
17,688.71
(See attached statement)
4 Certificate of Deposit No. XX)O(XX1364 -Citizen's Bank
39,139.97
(See attached statement)
5
Checking Account No. XXXXX0096 - Orrstown Bank 730.57
(See attached statement)
6 Certificate of Deposit No. XX)CXXX8011 - Orrstown Bank
14,493.24
(See attached statement)
7 Certificate of Deposit No. XXXXXX8732 - Orrstown Bank
11,319.51
(See attached statement)
8 Savings Account No. XXX525-00 -Members 1st Federal Credit Union
489.63
(See attached statement)
g Personal property auctioned - (See attached statement)
12,291.50
61.78
10 Comcast Refund
753.05
11 Tax proration credited at settlement
145.00
12 Ohio Casualty homeowner's insurance refund
TOTAL (Also enter on Line 5, Recapitulation) I 98,281.66
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rev-1509 EX+ (6-98)
„
COMMONWEALTH OFPENNSYLVANIA
INHERITANCE TAX RETURN
oc ClnFnIT f1F('.FI~F NT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
(FILE NUMBER
-..,.,.,, nn~~.~ _~ 21-12-0196
If an asset was made joint within one year of the decedent's date of death, it must be reporte on sc e
ADDRESS RELATIONSHIP TO DECEDENT
SURVIVING JOINT TENANT(S) NAME
16 Mountain View Drive Daughter
A. JoAnn E. Kelly
Carlisle, PA 17013
2 Hilltop Drive Daughter
g, Terry A. Glass
Mount Holly Springs, PA 17065
C.
JOINTLY OWNED PROPERTY:
OF DEATH
DESCRIPTION OF PROPERTY % OF DATE
VALUE OF
ITEM LETTER DATE I
MADE NCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
ER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR DATE OF DEATH DECD'S
VALUE OF ASSE DECEDENT'S INTEREST
INTEREST
NUMBER FOR JOINT
TENANT JOINT NUMB
JOINTLY-HELD REAL ESTATE.
000% 8,008.44
87 50
016
16
07/31/2003 Certificate of Deposit No. XXX525-40 -
.
.
,
1 g Members 1st Federal Credit Union
(See attached statement}
B 02116/2010 Certificate of Deposit No. XXX525-41 -
14,560.80 50.000% 7,280.40
2 Members 1st Federal Credit Union
(See attached statement)
A B 07/31 /2003 Certificate of Deposit No. XXX525-48 -
90,460.01 33.333% 30,153.34
3 Members 1st Federal Credit Union
(See attached statement)
A B 02116/2010 Certificate of Deposit No. XXX525-49 -
13,842.22 33.333% 4,614.07
4 Members 1st Federal Credit Union
(See attached statement)
TOTAL (Also enter on Line 6, Recapitulation)
50,056.25
(If more space is needed, additional pages of the same size) Form PA-1500 Schedule F (Rev. 6-98)
Copyright (c) 2002 form software only The Lackner Group, Inc.
REV-1151 EX+ (10-06)
. ,
COMMNHERITANCEOTAXERETURN ANIA
RFCinFNT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
T
ITEM
NUMBS
A.
J.
FILE NUMBER
21-12-0196
FUNERAL EXPENSES:
Debts of decedent must be reported on Schedule I.
DESCRIPTION
See continuation schedule(s) attached
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
State Zip
City
Yearlsl Commission paid
2. Attorney's Fees Griffie & Associates, P.C.
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
State Zip
City
Relationship of Claimant to Decedent
4. ~ Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
AMOUNT
12,832.48
7,000.00
568.50
225.00
13,208.62
7. Other Administrative Costs
See continuation schedule(s) attached
33,834.60
TOTAL (Also enter on line 9, Recapitulation)
Form PA-1500 Schedule H (Rev. 10-06)
Copyright (c) 2009 form software only The Lackner Group, Inc.
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
(FILE NUMBER
ESTATE OF 21-12-0196
Tre o, Ma J.
ITEM DESCRIPTION AMOUNT
NUMBER
Funeral Fxuenses
9,791.48
1 Hoffman Roth Funeral Home
175.00
2 Otterbein United Methodist Church
2,866.00
3 Osiris Holding of Pennsylvania, Inc. (Interment)
H-A 12,832.48
Other Administrative Costs
4 Advertising to the Sentinel
5 Advertising to Cumberland Law Journal
6 Bank fees
7 Homeowner's Insurance
g Borough of Carlisle (Water and Sewer)
g Auctioneer (personal property) fees
10 Lawn Service to Don Heishman Lawn Services
11 Home repairs to Quigley Mechanical
12 PPL Electric Utilities
13 Bouder Trash Removal
14 Real estate taxes to Borough of Carlisle (School)
Copyright (c) 2002 form software only The Lackner Group, Inc.
200.16
75.00
25.00
553.00
145.80
4,902.02
750.00
138.00
428.61
275.00
1,395.64
Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
(FILE NUMBER
ESTATE OF 21-12-0196
Tre o, Ma J.
ITEM DESCRIPTION AMOUNT
NUMBER
692.12
15 Real estate taxes to Borough of Carlisle (County/Borough)
2,628.27
16 Real estate sale costs and fees
17 Reserves
1,000.00
H-B7 13,208.62
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+ (12-08)
,, ,
;.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
.~,~c~n~niT ncr.FnFNT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
T
FILE NUMBER
21-12-0196
~ V ~/,
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER 4.90
1 Personal Per Capita Tax
72.90
2 Water/Sewer Bill
1,008.00
3 Claremont Nursing and Rehabilitation Center
38.98
4 PPL
I 1,124.78
TOTAL (Also enter on Line 10, Recapitulation)
I es of the same size)
(If more space Is needed, addltlona pag
Form PA-1500 Schedule I (Rev. 12-08)
Copyright (c) 2009 form software only The Lackner Group, Inc.
REV-1513 EX+ (11-08)
,
COMMNHERITANCEOTAX RETURN ANIA
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Trego, Mary J.
NAME AND ADDRESS OF
NUMBER PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 a 1.2
PA
Terrry A. Glass
2 Hilltop Drive
Mount Holly Springs, PA 17065
JoAnn E. Kelly
16 Mountain View Drive
Carlisle, PA 17013
FILE NUMBER
21-12-0196
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
DECEDENT (Words) ($$$)
Daughter fifty percent of 99,189.27
net distributable
estate
Daughter Fifty percent of 99,189.27
net distributable
estate
I I Total ~ 198,378.54
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet, as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 ~ OIVEP 1500 Schedule J (Rev. 11-08)
Copyright (c) 2009 form software only The Lackner Group, Inc.
LAST WILL AND TESTAMENT
I, MARY JANE TREGO, of the Borough of Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish
and declare this to be my Last Will and Testament, hereby revoking any and all former
Wills or Codicils by me made.
1.
LAW OFFICES '~
(ILLIAM F. MARTSON. P. C.
I give, devise and bequeath all of my estate, both real and personal property, to
my husband, KENNETH E. TREGO, absolutely.
2.
In the event my said husband shall predecease or fail to survive me, then I give,
devise and bequeath all of my estate, both real and personal property, in equal shares,
unto m daughters, JOANN ELIZABETH KELLY and TERRY ANN GLASS absolutely.
Y
3.
I nominate, constitute and appoint my husband, KENNETH E. TREGO, as
m estate. In the event he shall be unwilling or unable to serve in such
Executor of y
ca acit , I nominate JOANN ELIZABETH KELLY and TERRY ANN GLASS as
P y
Executrices of my estate.
4.
I direct that neither my Executor nor my Executrices shall be required to file a
bond to secure the faithful performance of their duties in any jurisdiction.
5.
I authorize and empower my personal representatives in their sole and absolute
ion to urchase or otherwise acquire and retain any investments of which~I die
discret , p
;, ~,
_ .._... f- ~_-
,l ~.
Mary Ja, Tr o
i
Page 1
seized or any real or personal property of any nature; to sell, lease, pledge, mortgage,
transfer, exchange, dispose of or grant options in regard to any or all property of any
kind forming a part of my estate for such terms and such prices as they may deem
advisable; to borrow money for any purposes connected with the protection and
preservation of my estate; to. mortgage or pledge any real or personal property
forming a part of my estate or to join in or secure the partition of same; to
compromise any claims or demands of my estate against others or of others against my
estate; to make distribution in kind and to cause any share to be composed of cash,
roperty or undivided fractional shares in property different in kind from any other
P
share; and to execute and deliver such instruments as may be necessary to carry out
any of these powers.
WHEREOF I have hereunto set my hand and seal this I Q ~'' day of
IN WITNESS
1~eV ~'Mi3~2 , 1981.
(SEAL)
ary J Tr
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix,
as and for her Last Will and Testament, in the presence of us, who at her request, have
hereunto subscribed our names as witnesses thereto, in the presence of said Testatrix
and of each other.
LAW OFFICES ~~
ILLIAM F. MARTSON. P. C.
Page 2
COMMON1iNEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND
I, MARY JANE TREGO, Testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that I signed it
willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
Swop°n or affirmed to and acknowledged bef " e me by MARY JANE TREGO, the
Testatrix, this / ~ ~' day of lv~v~'n~t3E R , 1981•
~~
Notary Public WILLIAM L. EARP, Naatary Public
Carlisle., Cumberland Co., PA
1V1y Commission Expires Aug. 13, 1984
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND J
We, ~~ t~Rl ~€ L .
the witnesses whose names are signed to the attached or foregoingesentuand sawethe
duly qualiified according to law, do ument as heryLast Will; that the Testatrix signed
Testatrix sign and execute the instr
willingly and that the Testatrix executed it as her free and volu~ of the Testatrixe
purposes therein expressed; that each of us, in the hearing and sigh
signed the Will as witnesses; and that to the best of our knowledg constra ntaoriundue
at that tame 18 or more years of age, of sound mind and under no
influence.
Address
Addr s ~
affirmed to and subscribed before me this ~ C~~~' day of
Sworn or
NovEivl~3~~.. , 1981.
LAW OFFICES
VILLIAM F. MARTSON. P. C.
~~ ~ ~. ~ a
~~
Notary Public
WILLIAM L. EA~tF, Nb~tary Rubllc
Carlisle, Cumberland ' Co., PA
My Commission Expires Aug. 13, 198
Page 3
4850DD41,D46
REV-485 EX (05-04)
SAFE DEPOSIT
BOX INVENTORY PLEASE USE ORIGINAL FORM ONLY
PA Department of Revenue
County Code Year Flle
Number
_.. _ ....
Social Securit or Death Certificate Number Date of Deat
_ __..._ _
__
............
.__ __
_.._
__ . _
__ ..
..........
__. _
_ . __ Suffix
__
__ _.
_ .
First Name
_
I
Decedent's Last Name _
_
'
r
~
~
/a
J G ~- ~
~ e ~ O
__ _ _ __
ZIP CODE:
_ _.
_. _... .. _...
ADDRESS OF DECEDENT STREET:/~
~ S r
7-
~~ CITY:
~ , / ~ ~ f ~
J STATE:
~ G~
~~ j
U
~m~
8Z~
NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX
NAME:
CITY:
STATE:
ZIP CODE:
STREET ADDRESS:
RESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON{S) PRESENT AT THE BOX OPENING
NAME, ADD RELATIONSHIP:
a. NAME:
CITY: STATE: ZIP CODE
STREET ADDRESS:
RELATIONSHIP:
b. NAME:
CITY: STATE: ZIP CODE:
STREET ADDRESS:
RELATIONSHIP:
c. NAME:
CITY: STATE: ZIP CODE:
STREET ADDRESS:
AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
NAME
NAME: ~ / ~ 1S ~C/r1 lL
1
ZIP CODE:
CITY: STATE:
S REST ADDRESS: ~ l- s ~
~
~ T C ~ ~- f~~ f ~- ~ "~ --~
-'
` DATE AND TIME OF LAST ENTRY
NAME OF PERS N MAKING LA~ST,_ENTRY _ _ ~ ~ ~ ;
e ~-e
1 TITLE UNDER WHICH BOX tS
D
REQUES
: DATE O CONTRACT TO RENT BOX NUMBER OF BOX ~ /
/ ~
!7
/_~ _
NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX
b. NAME:
a. NAME:
STREET ADDRESS:
STREET ADDRESS: '
STATE: ZIP CODE CITY:
STATE:
ZIP CODE:
CITY:
NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY
WAS A WILL IN THE BOX? ^ YES ~ NO If yes, a. Date of wilt:
b. Name and address of personal representative, if named in the will
NAME:
CITY: STATE: ZIP CODE:
' STREET ADDRESS:
c. Name and address of attorney, if any
NAME:
CITY: STATE: ZIP CODE:
STREET ADDRESS:
4850D041,D46 ,~,!
485DD041,046
.-. r-. i ~ n r r V
INST'RUCTi IONS
(1) Cash: Report total only.
(2) Stocks: List in detail every common or preferred certificate, warm
Warne of company, certificate number, date of certificate, name in wl
(3) Obligations of U.S. Government: Number of items, date of issue
i.e., jointly held, payable on death, etc.
(4) Bonds: Designate by name, amount, serial number, or other desi
(5) Bank and Savings and Loan Passbooks: State name of depos
and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe a~
(7) Deeds, Mortgages, Current Insurance Policies or other evidel
(8) All other contents.
(9) Return completed form to: DEPARTMENT OF F
INHERITANCE TAX
DEPT. 2806!
HARRISBURG, PA 1
ITEM ITEM DESCRIP
NO. f/
e 7e ~ j / ~
~5
Ti~~i~a ~~ Or ~`
Page ~ of 1
~t or other rights found in box. Stocks are to be designated by
rich stock is registered, and number of shares and class of stock.
,face value, names in which registered and type of ownership,
Ination. (Bearer Bonds)
:or, number of book, last date appearing in book, name of bank
fully as possible.
ices of indebtedness: List and describe as fully as passible.
EVENUE
]IVlSION
1
'128-0601
PION
~ ~/~ ~ S'
ar
_ ~
'"TJ / ~ /
S~,~E ®EPOSIT BOX IN~ENTC3Rl(
I CERTIFY UNDER PENALTYTOOFTHE BEST OF MY KNOWLOEDGE AND BELIEF. SAFE DEPOSIEIBOX INOVEN ORY:
CORRECT AND COMPLETE ~ SIGNATURE
PRINT NAME AND CHECK APPROPRIATE BOX BELOW:
P ME ~, , /~ ~ / e
D /~/~ /,()~ mil` n h .~
DATE CHECK APPROPRIATE BOX:
PRINT TITLE
`/~}~ /~ ~Executor(trix) ^ Administrator(trix)
~X e ~ 7 ^ Estate Representative ^ Joinl owner of safe deposit box
NOTE: Attach additional 8'12" x 11" sheet(s) if necessary or use duplicates of this page of form.
The Department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require dis of the e t Se.cThe Commonwealth may also uise hehinfommafoenii gexhange of tax of Dmafion agreements
Social Security number to identify the decedent and personal representative
with Federal and local toxin authorities. The state law prohibits the Commonwealth's personnel from disclosin confidential tax information except for official purposes.
OMB Approval No. 2502-0265
~`pEnrt OFy
aT >~ ~ o °
"*) ~ (*~~ A. Settlement Statement (HtJD-1 }
~~ I III I
e~
G96~N s~~E~O
B. Type of Loan
'~ 1. ~ FHA 2. Q RHS 3. QX Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
ESHENOUR 100720
4. Q VA 5. Q Conv. ins.
form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
-Thi
l
C
N
t
t
e:
s
a
s.
.
o
J"were paid outside the closing; they are shown here for informational purposes and are not incl uded in the to
o
c
s marked "(p
It
.
.
.
em
E. Name and Address of Seller: F. Name and Address of Lender:
D. Name andAddress of Borrower:
Estate of Mary J. Trego Farmers tx Merchants Trust Co.
Bryan IC. Eshenour
828 Hamllton Street 20 South Main Street
Dawn M. Eshenour
PA 17013 Chambersburg, PA 17201
Carlisle
,
620 West Old York Roed
Carlisle, PA 17015
H. SetllementAgent: 1. Settlement Date:
G. Property Location:
828 Hamllton Street ~ Bradley L. Grlffie, Esquire
2012
December 20
,
Carlisle, PA 17013 200 North Hanover Street
(717)243-5551
Ph
.
Penns Ivania Carlisle, PA 17013
Cumberland County, Y
Place of Settlement:
200 North Hanover Street
Carlisle, PA 17013
K. Summary of Seller's transaction
Summary of Borrowers transaction
J
.
400. Gross Amount Due to Seller:
100. Gross Amount Due from Borrower:
00 401.. Contract sales rice 85,000.00
000
85
101. Contract sales rice .
, 402. Personal ro e
102. Personal ro e
103. Settlement Char es to Borrower Line 1400
3,198.33
403.
404
1 ~' .
05
105. .
4
r items aid b Seller in advance
f
t
'
Ad'ustments for items aid b Seller in advance 91
18 s
o
ustmen
Ad
ffw Taxes 12/20/12 to 12!31!12
C
06 18.91
106. Coun /Tw Taxes 12/20/12 to 12/31/12
12/20/12 to 06/30/13 .
734.14. oun
.
4
407. School Taxes 12/20!12 to 06!30/13 734.14
107. SchoofTaxes 408. Assessments to
108. Assessments to
109. 409.
110. 410.
411.
111. 412.
112.
951.38
88
420. Gross Amount Due to Seller 85,753.05
,
120, Gross Amount Due from Borrower
500. Reductions in Amount.Due Seller.
200. Amounts Paid b o~.in Behalf of Borrower
500.00
8
501. Excess de osit see instructions
,
201. De osit orearnest mone
000.00
68 2 628 27
502. Settlement char es to Seller Line 1400
,
202. Princi al amount of new loans
' 503. Existin loans taken sub'ect to
ect to
203. Existin loans taken sub 504. Payoff First Mortgage
204. 505. Pa off Second Mort a e
205. 506
206. .
as roceeds
De Dell disb
507
207. .
.
508
f
208. .
509. 1
209.
Ad'ustments for items un aid b Seller
Ad'ustments for items un aid b Seller Coun !fw Taxes ~ to
510
to
210..Coun ffw Taxes .
School Taxes t0
511
211. School Taxes to .
to
Assessments
512
212. Assessments to .
513
213 .
514.
214. 515.
215. _ 516.
216. 517.
217. 518.
218. 519.
219.
76,500.00 620. Total Reduction Amount Due Seller
2,628.27
220. Total Paid b /for Borrower t settlement tolfrom Seller
h
C
300. Cash at Settlement from/to Borrower
120
li
68,951.38
a
as
600.
601. Grass amount due to Seller line 420
85,753.05
2,628 2~
ne
301. Gross amount due from Borrower 00)
500
( 76 602. Less reductions due Seller (line 520) (
502. Less amount paid by/for Borrower (line 220) .
, 78
124
83
38
451
12 To ~ From Seller
603. Cash X~. .
,
-
303. Cash ~ From n To Borrower .
,
' Pald oulslde of dosing by borrowar(81. selleriS).lentler(L), orthird-parly(T) .
The undersigned hereb acknowledge receipt of a completed copy of this statement & any attachments .referred to herein
Borrower ~ Seller Estate of M J. Trego
~,,y l l~
Dawn M. Eshenour _,~,..~..-
C~ec
nolrequired to complal rlfiis form, unlelss Ild splays a werentlyvalld OMB conbollnumbereNo confidentlality is as u ed; tlifsdisdosuee s mnandalory. Trris'is des goad fo p ovidle the partieos oae RESPAwvered
transaction wllhinlormation during the settlement process. HUD-1
Page 1 of 3
(ESHENOUR.PFD/ESHENOURl11)
~• - - ~~ ~-
Settlement Cher es
L
_
.
a e2 8J~50 Paid From Paid From
0 f e rn
Division of commission (line 700) as follows: 6orrovvers
Funds at severs
Funds at
$ 1,669.50 to Rowe'sAuction Service
701 Battlement Settlement
.
702. $ to 1 669.50
703. Commission aid at settlement
704.
705.
BO a otc~f n ~ o
$ 800.00 from GFE #1
401. Our orl ination char e
5 from GFE #2
Your credit or char a oints for the s eclftc interest rate chosen
302 00
00
.
from GFE #A .
8
303. Your ad usted on ination char es
from GFE #3 00.00 POCb
-50.00
304. A sisal fee to Diversified A sisal Svcs.
from GFE #3 $52.00 POCb
°1.84
Credit Re ort to Kroll Factual Data
305
.
from GFE #3
to
306. Tax service
from GFE #3 10,60
to Kroll Factual Data
307. Flood certlficalion
from GFE #3 30.00
to Farmers & Merc ants Trust Co.
rase Mall
308 00
20
.
from GFE #3
Wire Fee to Farmers & Merchants Trust Co.
309 .
90
35
.
Verification of Em to e to The Work Number from GFE #3
310 .
.
00
14
.
from GF.E #3
Tax Transcri t Fee to Farmers & Merchants Trust Co.
t11 .
95
6
.
312.MERS Registration Fee to Farmers & Merchants Trust Co. (from GFE# 3) . _
I~ em Re re e a
Dail interest char es from 12/20/12 io 01/01/13 12 $7.6t34930/da from GFE#10
)01
92:22
.
to (from GFE #3)
th
s
)02. Mortgage insurance premium for mon
$345.00(B)'
C
O
GFE:#11 P
f
)
.
.
.
rom
er's insurance for 1.0 years to J. Rodney Fickel Ins. Agency (
)03. Homeown
(from GFE#11)
104.
(from GFE#11) _
105. -
~_ __e~,esxpeposl. e- ,__ en --e., {from GFE #9)
t -
•
accoun
001. Initial deposit for your escrow
er's insurance months @ S -.per month $ •
002. Homeown
003. Mort a e insurance months 5 er month $
$ -
004. Property taxes ~
005.
months @ $ per -month $
006.
months @ $ per month $
007.
$ .
008. $
009.
o
(from GFE #4)
Ott-~*-- ~^~m
' 1,122:25
s title insurance
101. Title services and lender
$
102. Settlement•or closin lee
from GFE #5)
{ 55.25
Owners title insurance to Tri-CountyAbstract/Agent for First American
103
.
.3gg.50
104..Lender's title insurance to Tri-County Abstract/Agentfnr First American $
limit $ 68,000.00
li
l
i
'
cy
e po
s. t
t
105. Lender
limit $ 85,000.00
li
i
l
'
cy
e po
s t
t
106. Owner
$
m
i
u
107. Agent's portion of the total title insurance prem
erican $ 248.50
tA
Fi
m
rs
Underwriter's portion of the total title insurance premium to Tri-County Abstract/Agent fo$
108
.
109. $
110.
$.
111. $
112.
- ~
'
r
.
- -- -
113 v 4
.
L0, _~ v~er:[rmen , eco . ~~9. n__ nsfer'~.._a.59eS -
to Cumberland Count Recorder's Office from GFE#7 158.00
201. Government~recordin char es
Other ~
00 Mort aqe $ 96.00 Releases $
202. Deed $ fi2.
to Cumberland County Recorder's Office (from GFE #8) 850.00
203. Transfer taxes
$ $
Ci /Coun taxistam s
204
.
00 $
$ 850
.
205. State taxlstam s
to Cumberland County Recorder's Office 850.00
206.
207. . .i ., ~ ~..~.: - ,: • -
.
~3~,,,~UO'(€to aj(S" ef{jeme td a es (from GFE#6) _
301. Required services.that•you can shop for ~ 30.00 14.00
302. Notary Fee to Robin J. Bassett
$ 25.00
Overnight Express Mail to Grlffie &Associates
303 94.77
$
.
304. Final Water & Sewer to Borough of Carlisle
$-
305. Pest inspection ~~~~^~~s~~ „~ri#5'02i'fS~Eion .° ~~~~r'' ' ~ ~ ~ ~X ~~' 96 3 ~ a~"2' j5~8??~7
Pald ouWtle of dosing by borrower(a), seller(s), lender(L), or Ihlyd-pary(T) -
3y signing page t of this statement, the signatories ecWrowledge rerslplof a completed copy of page of tlrt _
B die quire, Settlement Agent
HUD-1
Page 2 of 3
(ESHENOUR.PFD/ESHENOUR/11)
Good Faith Estimate HUD-1
Comparison of Good~faith Estimate (GFE) and HUD-1 Charges
Charges That Cannot Increase HUD-1 Line Number
00 800.00
800
.
# 801
Our origination charge
00 800.00
800
.
# 803
Your adjusted origination charges 850.00
Transfer taxes #1203
es That in Total Cannot Increase More than 10% Good Faith Estimate HUD-1
Char
00
168
g
.
#1201 211.00
Government recording charges 500.00 350.00
Appraisal tee # 804
00
52
16
# 805 .
Credit report 00
96 0.00
# 806 .
Tax service
# 807 10.60 10.60
Flood certification 00
30 30.00
# 808 .
Express Mail
# 809 20.00 20.00
Wire Fee
# 810 75.00 35.90
Verification of Employment Fee
: # 811 30:00 14.00
Tax Transcript Fee 95
6 6.95
# 812 .
MERS Registration Fee
00
100
0.00
# 813 .
.
Appraiser Insp/Completion 55.25
Owner's title insurance to Tri-CountyAbstract/Agent for FirstAm~ #1103
Total 1;131.55 278.86
.increase between.GFE-and HUD=1 Charges $ -852.69 or -75.36°
Good Faith Estimate HUD-1
Charges That CanChange
- # 901 $ 7.684930/day 115.27 92•~
Daily interest charges 720:00: 345.00.
# 903
Homeowner's insurance
75
576
1
1,122.25
# 1101
' .
,
s title insurance
Title services and lender 00.
80 0.00
#1305 .
Pestlnspection 00
300 0.00
- #1306 .
.
Architectural/Engineering Fee
00
300
0.00
#1307 .
Realtor Transaction Fee
• .
Loan TetTns
initial loan amount is ;
Y $ 68,000.00
our
is
term
l 30.00 years
.
oan
Your
itial interest rate is
i
Y 4.1250
n
our
Your initial monthly.amount owed for principal,~interesYand $ 329.57 includes
any mortgage insurance is ~ Principal
^ interest
^ Mortgage insurance
°
i°. The first
^X No ~ Yes, it can rise to a maximum of
Can your interest rate rise? change will be on. and can change again every- months after
. Every change date, your interest rate can increase or decrease
by %.. Over the life of the loan, your interest rate is guaranteed
to never be lowerahan °io 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 $
ou make payments on time, can your monthly
Even if X No Yes, the first increase can be on and the monthly
^ ^
y
amount owed for principal, interest, and mortgage insurance rise?. amount owed.can rise to $
The maximum it can ever rise to is $
? X No Yes, your maximum prepayment penalty is $
^
Does your loan have a prepayment penalty
Yes, you have a balloon payment of $
^X No ^
Does your loan have a balloon payment? n
due in _ years o
Total monthly amount-owed including escrow account payments Q You do not have a monthiyescrow payment for items, such as property
You must paythese items directly
ce
'
.
s insuran
taxes anti homeowner
yourself.
^ .You have an addifioni3l monthly escrow payment of $N/Athat results
in a total initial monthlyamount owed of $N/A. This includes
principal, interest, anymortgage insurance-and any items checked below:
[~ Property taxes ~] •Homeowner's insurance
^ Flood insurance ^
Note: If you -have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender.
HUD-1
Page 3 of 3
(ESHENO UR.PFD/ESHENOUR/5)
HUD-1 Attachment
Borrower(s): Bryan K. Eshenour and Dawn M. Sellef(s): Estate of Mary J. Trego
Eshenour
620 West Old York Road 828 Hamilton Street
Carlisle, PA 17015 Carlisle, PA 17013
Lender: Farmers & Merchants Trust Co.
Settlement Agent: Bradley L. Griffie, Esquire ~
(717)243-5551 ~
Place of Settlement: 200 North Hanover Street ~
Carlisle, PA 17013
Settlement Date: December 20, 2012
Property Location: 828 Hamilton Street . ~
Carlisle, PA 17013
Cumberland County, Pennsylvania
Adjusted Origination Charge Details
Origination Charge .
800.00
Origination Fee. , -
~to Farmers & Merchants Trust Co.
Total $ 800.00
Origination Credit/Charge (points) for the specifiic interest rate chosen
Total $
. Adjusted Orig ination Charges $ 800.00
Title Services and Lender's Title-Insurance Details BORROWER SELLER
135.00
Title Search
to Tri-County Abstract/Agent for First American
~ 75.00
Closing Protection Letter
to Tri-County Abstract/Agent for First American
513.75
Approved Atty, Title ins.
to Bradley L. Griffie, Esquire
. .. 398:50
Lender's title insurance
to Tri-County Abstract/Agent for-First American
Total
Owner's Titleansurance
Ovvner's Policy Premium
to Tri-County Abstract/Agent for First American
Total
BORROWER SELLER
one -~~
VIIARNING: It is a crime to knowingly make. false statements to the Unlted States on this or any simlfar form. Penalties upon conviction can
include a fine.and imprisonment. For details see: Tltie 18 U.S. Code Section 1001 and Section 1010.
(ESH EN O U R. PF D/ESH EN O U R/9)
i~ ~
HUD-1 Attachment - Continued
Lender's Title insurance BORROWER SELLER
*fees.also.shown above in Tltie Services and Lenders Tltle insurance Details
Lender's Policy Premium 248:50
to Tri-County Abstract/Agent for First•American
Lender's Endorsement .Charges 150.00
Endorsement Endorsement Charge
ALTA Endorsement Form 8,1 .(Environmental Protection 50.00
Lien)
ALTA Endorsement Form 9 (Restrictions, 50.00
Encroachments, Min.)
300 Mortgage Survey Exception 50.00 -
Total $ 398.50 $ 0.00
WARNING: It is a crime to.knowingly make false statements to the United States on this or any similarform. Penalties upon conviction can
include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010.
(ESHENO UR.PFD/ESHENO UR/9)
~~ C@tiaens E3ar~6c.
March 19, 2012
GRIFFIE & ASSOCIATES, P.C.
ATTORNEYS AND COUNCELORS AT LAW
200 N HANOVER STREET
CARLISLE PA 17013
Estate of MARY JANE TREGO
Date of Death: Feb Ol, 2012
SSN: 177-16-0188
Dear Sir/Madam:
One Citizens Drive
a ROP 112
Riverside, RI 02915
In accordance with your request, the attached information sheet has been provided in the above decedent's
name as of his/her date of death.
As per your request, the decedent's accounts did not have a withdrawal over $3000.00 occurring within
12 months from date of death. Also, the decedent did not have a safe deposit box with our institution.
For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For
all other inquiries, please call 1-877-579-2667
Decedent Accc
REF#: 533169
~~ Citizens Bank"
Account Number 6100732037
Account Title Kenneth ETrego /Mary Jane Trego
Date Opened 6/6/1966
Account Type Checking
Principal Balance as of DOD $17688.54
Interest from Last Posting to DOD $ .17
Account Balance as of DOD $17688.71
YTD Interest to DOD $ .81
A~ C~caer~s Barak
Account Number 6140731364
Account Title Kenneth ETrego /Mary Jane Trego
Date Opened
Account Type
Principal Balance as of DOD
Interest from Last Posting to DOD 8/1/1998
Time Deposits
$39139.33
$ .64
Account Balance as of DOD $39139.97
YTD Interest to DOD $39.81
~.~ J. zr s.v - .~ _.
B~~
A Tradi>"imi of Excellence
February 22, 2012
Griffie & Associates, P.C.
Bradley L. Gxiffie, Esquire
200 North Hanover St.
Carlisle, PA 17013
Fax: 243-5063
Re:. Estate of Mary Sane Trego
Social Security Number 177-16-0188
.Date of Death 2/1/2012
IT IS HEREBY CERTIFIED THAT THE ABOVE NAIvIED DECEDENT HAD THE
FOLLOWING ACCOUNTS WITH ORRSTOWN BANK:
CHECKING ACCOUNT
Account No.-
Account Type-
Date Opened-
3oint Account (name/date)-
Balance-
Acerued Interest-
106000096
RMA Checking
11/13/1997
Kenneth E. Trego -Primary (deceased 7115/2(}03 ),
Mary Sane Trego -Joint
$730.57
$0.01
CER?'IFICATE OF DEPOSIT
Account No.-
Account Type-
Date Opened-
Joint Account (name/date}-
Balance-
Accrued Interest-
5060068011
30-35 Month Growth CD
9/14/2001
Kenneth E. Trego -Primary (deceased 7/15!2003 ),
Mary Jane Trego -Joint
$14,493.24
$13.51
2695 Philadelphia Avenue
Chamber burg, PA 17201
q.86B.oRRSTOWN
~rV~~~~ S~~V ~rM~N~P
Account No.-
Account Type-
Date Qpened-
JointAccount (name/date)-
Balance-
Accrued Interest-
5060068732
48-59 Month Growth CD
12/I/2001
Kenneth E. Trego -Primary (deceased 7/I SI2003),
Mary cane `Trego -Joint
$11,319.51
$26.1 S
Mary Jane Trego (deceased) did not maintain a safe deposit box with Orrstown Bank.
Best Regards,
~-
3iII R. Worthington
Deposit Processing Clerk
MEMBERS 1St
PEDERAL CREDIT iJNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
D-ate Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
233525-00
07/31 /2003
$489.63
$.00
$489.63
None
CERTIFICATES OF DEPOSIT: 233525-40 233525-41
Account Number/Suffix 02/16/2010" 02/16/2010*"
D-ate Account Established 87
$16
016 $14,560.80
Principal Balance at Date of Death .
,
$ 00 $.00
Accrued Interest to Date of Death - $16
016.87 $14,560.80
Total Principal and Accrued Interest ,
Terry Glass Ter Glass
Name of Joint Owner
Date Joint Ownership Established
02/16/2010 p2/ 6/2010
*Rollover from certificate 233525-44, originally established 07/31/2003.
"`*Rollover from certificate 233525-43, originally established 02/16/2010.
CERTIFICATES OF DEPOSIT: 233525-48 233525-49
Account Number/Suffix 11/12/2011* 11/12/2011*"
D-ate Account Established
al Balance at Date of Death
Princi
$90,460.01 13,842.22
$
00
p
Accrued Interest to Date of Death $.00
460.01
$90 $.
$13,842.22
Total Principal and Accrued Interest ,
Terry Glass Terry Glass
Name of Joint Owner Joann Kelly Joann Kelly
Date Joint Ownership Established
11 /12/2011
11 /12/2011
*Rollover from certificate 233525-45, originally established 07/31/2003.
*"Rollover from certificate 233525-46, originally established 02/16/2010.
.EM ERS 1ST FEDERAL EDIT
D ie e A. Kline
Lending Insurance Support Specialist
February 17, 2012
Estate of: MARY J. TREGO
Date of Death: 02/01/2012
Social Security Number: 177-16-0188
5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org
~ ~V~~~ CRH 79L) .
~~~~~~~
2505 Ritner Highway Carlisle, PA 17015 Dave Rowe (AU 2295L)
Bilk Rowe (AU 1538L) 24g_1978 215-1044 574-1008 .
Auction Is .Action Call `,owe" .For Satisfaction
SELLERS NAME r~S ~ ~ '~ ~. !~" ODATE ~.~oA~6 ~ ~LL-
DRESS G~o ,t3 r'Q.~ ~ t--c ~.~~.~„_., PHONE ~lc+d--~t~~S~
AD
OTHER
AUCTION DATE/LOCATION
AUCTIONEER ~% ~~'.
CLERK % ~~
DESCRIPT~4N OF MERCHANDISE
,~ •-- ~ r ~
S
s ~
S `~ ~~7 _ .S `a S--~ --
t -
~ ~
',~ JP D F{- C.,,~,~....e n ~ '~ ,~,Lc~ t 51.E ~-- Z ~ ~n.•, S f ~~.d ~ ~ C-~-^'S~t~ y
i
~ti~ ~ ~ ~ .~
~.
~'0 1 ~ ?~ C/L. ~+. ~ .,L1.~t fl ,~ (o ~ • f ~ ~ Z~`~%1, t~~~G'_" `-~:~T-~j11~-r/'~-' ~ E1 C.
G.
~---
I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise
to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen-
tative of the merchandise, goods and or property and have good title and the right to sell and-that. they are free
from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of
title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in
this agreement. .
AUCTION SIGNATURE
S LERS SIGNATURE
s'''
Total Sales (Clerking Tickets Attached) ~ ~ 1- ~-- P -'~
Less Sale .Expense:
c~ '~-
3.5~% Commission Auctioneer ~ ~ 3 ~ '1, l
% Commission Clerks ~
~~
t1 ~tc1LT c s ~ r.~-- ~ ~
OTHER: ~~,~~L ~~~~- ~
v -~-
TOTAL SALE EXPENSE DEDUCTED ~ ~ °1 ° z" ~
'.~ ~ S c~ ~,~'
SELLERS NET ~
MEMBERS 1St
PEDERAL CREDIT iJN10N
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
D-ate Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
233525-00
07/31 /2003
$489.63
$.00
$489.63
None
CERTIFICATES OF DEPOSIT: 233525-40 233525-41
Account Number/Suffix 02/16/2010* 02/16!2010**
D-ate Account Established
Principal Balance at Date of Death
$16,016.87
$14,560.80
Accrued Interest to Date of Death _ $.00
87
016
$16 $.00
$14,560.80
Total Principal and Accrued Interest .
,
Terry Glass Ter Glass
Name of Joint Owner
Date Joint Ownership Established
02/16/2010 02/ 6/2010
*Rollover from certificate 233525-44, originally established 07/31/2003.
**Rollover from certificate 233525-43, originally established 02/16/2010.
CERTIFICATES OF DEPOSIT: 233525-48 233525-49
Account Number/Suffix 11 /12/2011 * 11 /12/2011 **
D-ate Account Established
01
460
$90
$13,842.22
Principal Balance at Date of Death .
,
00
$ $.00
Accrued Interest to Date of Death .
01
460
$90 $13,842.22
Total Principal and Accrued Interest .
,
Terry Glass Terry Glass
Name of Joint Owner
Joann Kell
Y Joann Kell
Date Joint Ownership Established
11 /12/2011
11 /12/2011
*Rollover from certificate 233525-45, originally established 07/31/2003.
**Rollover from certificate 233525-46, originally established 02/16/2010.
.EM ERS 1ST FEDERAL EDIT
V~
D ie a A. Kline
Lending Insurance Support Specialist
February 17, 2012
Estate of: MARY J. TREGO
Date of Death: 02/01/2012
Social Security Number: 177-16-0188
5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org
OMB Approval No. 2502-0265
P`~1`-NipF
a~ ~ yo e
y ~*, ~ I'' ` A: Settlement Statement (HUD-1 }
I III I
4
e
96'AN p~J~~n
B. Type of Loan
1. ~ FHA 2. Q RHS 3. 0 Conv. Unins.
6. Flle Number: 7. Loan Number:
0
8. Mortgage Insurance Case Number:
ESHENOUR 10072
4. Q VA 5. Q Conv. Ins.
Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
urposes and are not included in the totals.
C
afionaf
f
i
.
p
orm
n
Items marked "(p.o.c.)"were paid outside fhe closing; they are shown here for
Name and Address of Seller:
E F. Name and Address of Lender:
D. 'Name and Address of Borrower:
.
Estate of Mary J. Trego Farmers & Merchants Trust Co.
Bryan K Eshenour
828 Hamllton Street 20 South Main Street
Dawn M. Eshenour PA 17013
Carlisle Chambersburg, PA 17201
620 West Old York Road
,
Carlisle, PA 17015
I. Settlement Date:
G. Property Location:
H. Settlement Agent:
Bradley L. Grlffie, Esquire
828 Hamllton Street 200 Norih Hanover Street December 20, 2012
Carlisle, PA 17013
PA 17013
Carlisle Ph. (717)243-5551
Cumberland County, Pennsylvania ,
Place of Settlement:
200 North Hanover Street
Carlisle, PA 17013
K. Summary of Sellers transaction
J. Summary of Borrowers transaction 400. Gross Amount Due to Seller:
100. Gross Amount Due from Borrower: 85,000.00
101. Contract sales rice 85,000.00 401.. Contract sales rice
402. Personal ro e
102. Personal roe 3,198.33 403.
103. Settlement Char es to Borrower Line 1400 404
1 ~ • 405.
105. Ad'ustments for items aid b Seller in advance
Ad'ustments for Items aid b Seller in advance 18.91 406. Coun Ifw Taxes 12/20/12 to 12!31/12 18.91
106. Coun ITw Taxes 12/20/12 to 12/31/12 734.14
107. School Taxes 12!20/12 to 06(30113 734.14. 407. School Taxes 12/20!12 to 06!30/13
408. Assessments t0
108. Assessments to
409.
108• 410.
110. 411.
111. 412.
112. 85,753.05
120. Gross Amount Due from Borrower 88,951.38 420. Gross Amount Due to Seller
500. Reductions in Amount.Due Seller.
200. Amounts Paid b or:.in Behalf of Borrower
201. De osit orearnest mone 8,500.00 501. Excess de osit see instructions 2 628 27
202. Princi ai amount of new loans 68,000.00 502. Settlement charges t6 Seller Line 1400
203. Exisiin loans taken sub'ect to 503. Existin loans taken sub act to
504. Payoff First Mortgage
204. 505. Pa off Second Mort a e
205. 506.
206. 507. De osit disb. as roceetJs
207. 508. f '
208. 509. ~
209• Ad'ustments for items un aid b Seller
Ad'ustmentsforitemsun aid b Seller 510. Coun /Tw Taxes.- t0
210..Coun !fw Taxes t0 to
to 511. School Taxes
211. School Taxes 512. Assessments to
212. Assessments t0
513.
213. 514.
214. 515. .
215. _ 516.
216. 517.
217. 518. •
218. 519.
219.
2,628.27
220. Total Paid b !for Borrower 76,500.00 520. Total Reduction Amount Due Seller
600. Cash at settlement tolfrom Seller 85,753.05
300. Cash at Settlement fromlto Borrower
301. Gross amount due from Borrower line 120 88,951.38 601. Gross amount due to Seller line 42 ( 2 628 2
302. Less amount paid by/for Borrower (line 220) ( 76,500.00) 602. Less reductions due Seller (line 520)
^ To ~ From Seller 83,124.78
12,451.38 603. Cash X
303. Cash ~ From ~ To Borrower ' '
Pald ouUlde of dosing by borrowar(B), seller(S).lentlef(l.), orlhird-perfy(T) -
The undersigned hereb acknowledge receipt of a completed copy of this statement & any attachments referred to herein
Seller Estate of M J. Trego
Borrower ~J ,~v
~,` ~ `
Dawn M. Eshenour • ,.._-~•-- / ~ xQ C.~
The Public Reporting Burden for this collection of information Is estimated at35 minutes per response for collecting, reviewing, end reporbnp fhe dela.This agency may not w1leUthis information. and you ere
nolrequired b complete ffris Corm, unless Il displays a prrrently valid OMB Control number. No confidentiality is assured: thisdisdosure is mandatory. This is desipnad to provide the parties to a RF.SH4 HUD-1
transectionwllh~information during fhe setllemanlprocess. - Page 1 Of 3
(ESHENOUR.PFD/ESHENOUR/11)
310.Veriflcatlon or tm Iv rtn ~~ ~ ~~~ -•~~•~ • •-~••--
t11.Tax Transcri t Fee to Farmers & Merchants
t12. MFRS Registration Fee to Farmers & Merchants
`
(q(~ aim Re u re'~t~i 1erl ~„_.A` .,Ya e
~~eJ~16~ir
101. Dail interest char es from 12120!12 to 01/0111:
102. Mortgage insurance premium for months to
103. Homeowner's insurance for 1.0 years to J. Rodney
104.
105.
;p _ervg- ~ eposi. e. _,.__ _.en ..e,
001. Initial deposit for your escrow~account .
002. Homeowner's insurance months
003. Mort a e insurance months
004. Property taxes
005. months
006.
007.
months
006.
~.,~.
102 Setllement~or closing fee
103. Owners title insurance to T
. n. ~ .~..,aer~ titlA insurance to T
107. Agent's portion of the total iitle insura
...., ~ ~_a.......uer•~ nnrtinn of the total tlfle
GUJ. 1~1 OI1.~••+.
204. City/Countyta
205. State tax/stam
10 (;urrlDerlanu
g 96.00
to Cumberland
~~ -
301. Required services that you can shop for
302. Notary Fee to Robin J. Bassett
303. Overnight Express Mafl to Grlffie g,pssociates
304. Final Water & Sewer to Borough of Carlisle
305. Pest Inspection
40~0'i'o~l~~ ement~O .amps n"~er~or`i~lines~1~03 Mac to"~"n "~n~;,5
-`Paid ouWda of dosing by borrower(B), seller(s), !antler(!), or Otird-perry(T)
3y signing page 1 o1CUS sfalemanL the signatories edmowledga recelplof a eompleled wpy olpage
quire, Settlement Agent
HUD-1
Page 2 of 3
(ESHENOUR.PFDlESHENOUR/11)
Comparison of Good~Paith Estimate (GEE) and HUD-1 Charges
Charges That Cannot increase HUD-1 Line Number
Our origination charge # 801
Your adjusted origination charges # 803
#1203
Transfer taxes
That in Total Cannot Increase More than 10%
Charges #1201
Government recording charges-
Appraisal fee # 804
# 805
Credit report # SD6
Tax service # 807
Flood certification # 808
F..xpress Mail # 809
Wire Fee # 810
Verification of Employment Fee
Tax Transcript Fee #. 811
.# 812 '
MFRS Registration Fee
Appraiser Insp/Completion # 813
Owner's title insurance toTri-County AbstracUAgentfnr FirstAmi #1103
Good Faith Estimate HUD-1
800.00 800.00
800.00 800.00
„.,,,,, ,.,. 850.00
Good Faith Estimate
211.00
500.00
52.00
96.00
10.60
30.00
20.00
75.00
30.00
6.95
100.00 .
Total
Increase between GFE and HUD-1 Charges I $
1,'131.55
-852.69 or
Good Faith Estimate
Charges That Can•Change # 901 $ 7.684930/day •115.27
Daily interest charges - 720:00
Homeowner's insurance # 903
1,576.75
Title services and lender's title insurance #1101
80.00
Pest inspection #1305
300.00.
.
Architectural/Engineering Fee - #1306
300.00
Realtor Transaction Fee #1307
Loan Terms
HUD-1
158.00
0.00
10.60
30.00
20.00
35.90
14.00
6.95
o.oo
55.25
278.86
-75.36`
HUD-1
92.22
345.00.
1,122.25
0.00
0.00
0.00
• ;$ 68,000.00
Your initial loan amount is
30.00 years
Ydur loan temt. fs
4.1250
Your initial interest rate is
•
Your initial monthly .amount owed for principai,•interest and $ 329.57 includes
any mortgage insurance is ^ Principal
^ Interest
Mortgage Insurance
QX No ^ Yes, it can rise to a maximum of %. The first
Can your interest rate rise? change will be on, and can change again every- months after
Every change date, your interest race can increase~or decrease
.
by %._ Over the life of the loan, your interest rate is guaranteed
to never be lower-than % or higher than %~
can your•loan balance rise?
ents on time
^X No ^ .Yes., it can rise to a maximum of $
,
Even If you make. paym X No ~ Yes, the first increase can be on .and the monthly
^
Even if you make payments on time, can your moe Insurance rise?.
and mortgag
est
t
i mount.owed-can rise to $
a
,
er
n
amount owed for principal, The maximum it can ever rise to is $
X No ^ ~ Yes, your maximum prepayment penalty is $
^
Does your loan have a prepayment penalty?
^X No ^ Yes, you have a balloon payment of $
Does your loan have a balloon payment? due in _ years on
~X You do not have a monthiyescrow payment for items, such as property
Total monthly amount owed including escrow account payments taxes and homeowner's insurance. You must pay these items directly
yourself.
,You have an additional-monthly escrow payment of $NlAthat results
in a total initial monthlyamount owed of $N/A. This includes
anymortgage insurance-and any items checked below:
interest
l
i
i
,
,
pa
nc
pr
Property saxes ~ -Homeowner's insurance
^ Flood insurance ^
^ ^
tions about the Settlement Charges and Loan Terms listed on This form, please contact your lender.
-
ques
Note: If you -have any
HUD-1
Page 3 of 3
(ESHENO UR.PFD/ESHENOURlS)
HUD-1 Attachment
Borrower(s): Bryan K. Eshenour and Dawn M. Seller(s): Estate of Mary J. Trego
Eshenour
620 West Old York Road
828 Hamilton Street
PA 17015
Carlisle Carlisle, PA 17013 ~
,
Lender: Farmers & Merchants Trust Co.
Settlement Agent: Bradley L. Griffie, Esquire ~
(717)2x3-5551 I
Place of Settlement: 200 North Hanover Street j
Carlisle, PA 17013 I
Settlement Date: December 20, 2012
~
Property Location: 828 Hamilton Street.
Carlisle, PA 17013
Cumberland County, Pennsylvania
Adjusted Origination Charge Details
Origination Gharge ~ 800.00
Origination Fee.
~to Farmers & Merchants Trust Co. '
Total $ 800.00
Origination CreditlCharge {points) for the specific interest rate chosen
Total $
Adjusted Origination Charges $ 800.00
Title Services and Lender's Title Insurance Details
BORROWER
SELLER
135.00
Title Search
to Tri-County Abstract/Agent for FirstAmerican
75,00
Closing Protection Letter
Tri-County Abstract/Agent for First American
to .
. 513 75
Approved Atty., Title ins.
to Bradley L. Griffie, Esquire
.. 398:50
Lender's itle insurance
to Tri-County AbstractlAgent for.First American
Total $ .1,122.25 $ 0..00
BORROWER SELLER
Owner's Titleansurance
303.75
Ovvner's Policy Premium
to Tri-County Abstract/Agent for First American
Total $ 55.25 $ 0.00
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 sae: Title 18 U.S. Code Section 1001 and Section 1010.
(ESHENO UR.PFDIESHENOURl9)
r
~l
HUD-1 Attachment - Continued
Lender's Title insurance BORROWER SELLER
"fees. also. shown above in Title Services and Lender's Title Insurance Details
248:50
Lender's Policy Premium
to Tri-County Abstract/Agent for First•American
150.00
Lender's Endorsement Charges Endorsement Charge
Endorsement
ALTA Endorsement Form 8,1 .(Environmental Protection 50.00
Lien) 50.00
ALTA Endorsement Form 9 (Restrictions,
Encroachments, Min.) 50.00 -
300 Mortgage Survey Exception
Total $ 398.50 $ 0.00
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.
(ES H E N O U R. P F D/ES H E N O U R/9)
~ .: V ~ (RH 79L) .
~~
2505 Ritner Highway Carlisle, PA 17016 Dave Rowe (AU 2295L)
Bill Rowe (AU 1538L) 249-1978 215-1044 574-X008
Auction Is Action Call `Rowe" For Satisfaction
SEI.,LER,S NAME
G~O ,~ r-'G~ C~ ~ r--~ ~.~~--, PHONE ~ ~ ~ ~-~t ~ ~ S
ADDRESS
AUCTIONEER ~% ~~'
OTHER
AUCTION DATE/LOCATION
DESCRIPTION OF MER,CHANDI~E
CLERK % ••~-~
~~~ ~ r ~~
S --
' ~ ~ c.,,
~ ~ ~~
i
..~ ~ r •~_~~.
.., S ~ L~ ~~ ~-Uz
,~ "--
ion the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise
I Commiss
to be sold as is & grouped as necessary to obtain bids. I certify. thaana the rie ht,to sell and that they are free
tative of the merchandise, goods and or property and have good title g
from all encumbrances. I agree to accept all responsibility for providing mercl ams of thelnature ~e erred o n
title to the purchaser. I agree to hold harmless the Auctioneers aga.~nst any c a
this agreement.
AL7CTION SIGNATURE S LERS SIGNATURE
sue'
._~
Total Sales (Clerking Tickets Attached) $ ~ L- I
Less Sale Expense:
~~
3 ~% Commission Auctioneer $ y 3 ~ ~"'
% Commission Clerks $
-- ~~
~ ~u1L? - S~ ~- ~ ~ ~-
OTHER: -~ mot- '~~~'~ ~
~ ~-
TOTAL SALE EXPENSE DEDUCTED $ ~ ~- ° -z. o
SELLERS NET $