HomeMy WebLinkAbout01-14-13 (2)
1505610105
OFFICIAL USE ONN.Y
REV-1500 ° (OZ41)(FI)a
PA Department of Revenue p°n`~^'1V 11 Couirtty code Yeer HIS Number
Bureau oPIndividual Taxes
INHERITANCE TAX RETURN =
BOX 280601
Ha
rrlsburgrg, PA 1 ,i7uB-aF0l RESIDENT DECEDENT
ENTE7t DECEDENT INFORMATION BELOW
Social Security Number Data of Death MMDDYYYY Date of Birth MRODYYYY
15245-1162 05/12/2012 0611511954
Decedents Lent Name - Suffix ` Decedent's First Name Mt
Seibold l± ~ John -f L".
(if Applicable) Eriter Surviving Spouse's Informatlon Below
Spousaa Last Name I Suffix irSpouse's First Name- MI j
j Tile- - - - _ _ I i ~_t L---- -
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE 1M7H THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
G>b I- Original Return G=oo 2_ Supplemental Return O 3. Remainder Retum (Date of Death
Prior to 1243°82)
Q 4- Urnhad Estate O 4a. Future Interest compromise (data of t= 5. Federal Estate Tax Return Required
death after 12-12-82)
p 8. Decedent Died Testate O 7. Decedent Maintained a Living Trust S. Total Number of Safe Deposit Boxes
(Attach Copy of WAN) (Attach Copy ofTnist.)
CM 9. Litigation Probe RocAved O 10. Spool Poverty Credit (Date of Death O 11 Election to Tax under Sec 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONADEMTIAL TAX YIFMIIATION SHOULD BE DIRECTED TO:
Name Daytime Talephor>e 1jumber
- s
;Adam R. Deluca, Esq. i(~17849-1177`' r~r C
~mgM t>~;Iw: ItS S SLY
p- r ti r r t f) l
First Una of Address Cn
61 West Louther St 9 _71
- _J
Second Una ofAddresa ___r----- C
.r p S •y"i
City or Post Office state ZIP Code
Carlisle - PA 17013 _ j
Correspondent's e-mail address: 8rdeluca852aolzanl
Under panardes of Wpay, I declare that I have wamrned this return, Inducting accorrpenyft sdwdulse and statements, and to the best of my knc*Wge and belief,
It h true, cWsd and cunhpleta- Declaration of praparerather than the personal representative Is based an at Womretlon of which preparer h~asiany]knaaMedge.
SIGNAT PERSONRfrSPON9( LE~ R ILI RERIRN ID/ 6lII
ADDRESS
104 Derby Court, King, NC 27021
SIGNAT PREPAIa=R O E T7VE D
ADDRESS
61 West Louther St., Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 3505610105 J
1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name: John J. Selbold, Jr. 152-46-1162
RECAPITULATION
1. Real Estate (Schedule A) 1. 133,750.00
2. Stocks and Bonds (Schedule B) 2. 8,331.25
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3.
4. Mortgages and Notes Receivable (Schedule D) 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 22,090.13
6. Jointly Owned Property (Schedule F) O Separate Billing Requested 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7. j
8. Total Gross Assets (total Lines 1 through 7) 8. 164,171.38
9. Funeral Expenses and Administrative Costs (Schedule H) 9. 13,222.61
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) 10. 102,693.98
11. Total Deductions (total Lines 9 and 10) 11. 115,916.59
12. Net Value of Estate (Line 8 minus Line 11) 12. 48,254.79
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) 14. 48,254.79
TAX CALCULATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0- 15.
16. Amount of Line 14 taxable
at lineal rate X .0 _ 16.
17. Amount of Line 14 taxable
at sibling rate X .12 48,254.79 17. 5,790.57
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE .........................................................19. 5,790.57
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205 J
REV-1500 EX (FI) Page 3 File Number ] r ~~~Q
Decedent's Complete Address:
DECEDENT'S NAME
John J. Seibold, Jr.
STREETADDRESS
52 Quarry Hill Road
CITY STATE [ZIP
Newville PA 17241
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 5,790.57
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits (A+ B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5,790.57
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred ❑ 0
b. retain the right to designate who shall use the property transferred or its income ❑ 0
c. retain a reversionary interest ❑ 0
d. receive the promise for life of either payments, benefits or care? ❑ E
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ❑ 0
3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ❑ N
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? ❑ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX+ (12-12)
{ Z' pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
John J. Seibold, Jr. 21-12-0565
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1 52 Quarry Hill Road, Newville, PA 17241, Penn Township (see attachment A) 133,750.00
TOTAL (Also enter on Line 1, Recapitulation.) $ 133,750.00
If more space is needed, use additional sheets of paper of the same size.
REV-1503 EX+ (8-12)
pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
John J. Seibold, Jr. 21-12-0565
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. SunAmerica Mutual Funds, Harborside Financial Ctr 3200 Plaza 5, Jersey City, NJ acct#9441316 2,505.97
2 384 shares of Pitney Bowes, Inc. common stock @$15.17/share 5,825.28
TOTAL (Also enter on Line 2, Recapitulation) $ 8,331.25
If more space is needed, insert additional sheets of the same size
REV-15o8 EX+ (o8-12)
i ; pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
John J. Seibold, Jr. 21-12-0565
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T Bank Checking, Acct# 1113690, 1 West High St. Front, Carlisle, PA 17013 2,063.98
2. M&T Bank Savings, Acct# 015004212310053, 1 West High St. Front, Carlisle, PA 17013 1,612.83
3. PA Dept of Revenue Tax/Rent rebate check 750.00
4. State Farm Auto Insurance Acct# 0405014113 rebate check 265.77
5. Wells Fargo Mortgage loan # 0314156951 Escrow overage rebate check 1,661.97
6. PPL Electric overpayment refund check 16.93
7. All Personal Property Sold at Estate Auction (see attachment B) 11,202.50
8. Remington Model 76 Sportsman 30.06 rifle with case sold 400.00
9. Ithaca Model 5712 gauge shotgun with case sold 400.00
10. China dishware service sets sold 1,000.00
11. County and School Tax refund from home sale (see attachment A) 1,077.02
12. ` Wells Fargo Mortgage loan # 0314156951 Escrow final rebate check 1,423.27
13. AIIState Homeowner's Insurance premium refund check 215.86
TOTAL (Also enter on Line 5, Recapitulation) $ 22,090.13
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
P pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
John J. Seibold, Jr. 21-12-0565
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Egger Funeral Home, Inc. 2,265.00
2. R.H. Kelly & Son Select Barre Granite (inscribed grave marker) 810.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative (s)
Street Address
City State ZIP
Year(s) Commission Paid:
7,910.00
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 351.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. Cumberland Law Journal advertisement 75.00
8. Patriot News Company advertisement 99.66
9. M&T Estate checks 25.20
10. Obtain medical records, Robert A. Rovner, P.C. 1,632.25
11. Order additional death certificates, Egger Funeral Home, Inc. 54.00
TOTAL (Also enter on Line 9, Recapitulation) $ 13,222.61
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-12)
; SCHEDULE I
9 l.4' pennsylvania
tis DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
John J. Seibold, Jr. 21-12-0565
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1• Wells Fargo, PO Box 10368 Des Moines, IA 50306 loan# 0314156951 payments from May-Nov'12 4,284.63
2. Phillips and Cohen Medical Associates 4,579.50
3. Cumberland Goodwill fire/rescue EMS 166.98
4. Account closing fee for Century Link 19.95
5. Presbyterian Homes Inc., Green Ridge Village Nursing Home 1,258.00
6. West Shore EMS Ambulance Chambersburg Division 82.45
7. Community Life Team EMS Ambulance 92.13
8. Millenium Pharmacy Systems 778.50
9. ` Mable Stitt, Tax Collector (real estate) 1,867.58
10. West Shore EMS Ambulance 359.94
11. MSHMC Physicians Group 195.03
12. Obtain Vehicle title from PA Dept of Transportation 22.50
13. Paul Merritt A/C repair for home 40.00
14. Gary Foster trash removal 85.00
15. Orthopedic Associates of Chambersburg, PA 19.36
16. Stephanie E. Chertok reimburse for home cleaning supplies 30.09
17. John R. Tritt A/C repair for home 127.75
18. PPL Electric bill from October-December 2012 (prior months were pre-paid) 198.93
19. Spring Creek Health and Rehab Center, Harrisburg, PA 4,080.00
20. Gary Foster extensive cleanup of home and preparation for on-site auction 773.51
21. Randy Dyarman extensive cleanup of home and weekly lawn cutting/yard maintenance, auction prep 1,590.00
22. UPS overnight mail charge for home sale paperwork (signature required) 18.95
23. Wells Fargo Mortgage Payoff loan # 0214156951 (see attachment A) 73,695.70
24. Settlement charges for sale of home (see attachment A) 8,327.50
TOTAL (Also enter on Line 10, Recapitulation) $ 102,693.98
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsytvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
John J. Seibold, Jr. 21-12-0565
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
I. Gregory 0. Seibold, 104 Derby Court, King, NC 27021 Brother 100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
L
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
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A
I, JOHN J. SEIBOLD, JR., of the Borough of Spotswood,
County of Middlesex, State of New Jersey, do make, publish and
declare this to be my last Will and Testament, hereby revoking all
prior wills and codicils made by me.
FIRST: I direct that all my lawful debts, funeral and
testamentary expenses be paid as soon as practicable after my
death.
SECOND: All the rest, residue and remainder of my estate,
whether real, personal or mixed, of whatsoever it may consist and
wheresoever it may be located, including any property over which I
may have the power of appointment or other disposition, I give,
devise and bequeath to my brother, Gregory 0. Seibold.
THIRD: My Executor is hereby granted all powers conferred upon
executors and trustees under the laws of the State of New Jersey.
In addition, my Executor and Trustee are empowered to make dis-
tributions in cash or in kind, or partly in cash and partly in
kind.
FOURTH: The decision of my Executor with respect to the
exercise and nonexercise by them of any discretionary power under
this my Last Will and Testament, or the time or manner of the
exercise thereof, made in good faith, shall fully protect them and
shall be conclusive and binding upon all persons interested in my
estate. All of the rights, privileges and powers granted to my
Executor shall apply to all property at any time held by them
under this my Last Will and Testament, and until the actual dis-
tribution thereof.
FIFTH: Any beneficiary under this my Last Will and Testament
shall be conclusively presumed to have predeceased me if he or she
shall die within (30) days after my death.
SIXTH: I order and direct my Executor to pay from my
residuary estate any and all inheritance, succession, transfer and
estate taxes, including any interest or penalties assessed in
connection therewith, imposed against my estate or the legacies,
bequests and devises given, devised and bequeathed or trusts
created in and by this my Last Will and Testament and any codicils
thereto, or imposed by reason of the inclusion in my estate for
tax purposes of any life insurance proceeds, gifts, inter vivos or
other property.
SEVENTH: I nominate, constitute and appoint my brother,
Gregory O. Sdibold to be the Executor of this my Last Will and
Testaments to serve without bond. to be the Executor of this my
Last Will and Testament to serve without bond.
-2-
LASTLY: Wherever used herein, the words "Executor",
"Trustee" and "Guardian" shall be deemed to include the feminine
wherever the context so requires.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this day of P-P r,' /
, 1990. ~j
h,~,j
JOHN J. SEIBOLD, R.
The foregoing will consisting of three (3) typewritten
pages, including this page was signed, sealed published and
declared by the said JOHN J. SEIBOLD, JR. as and for his Last Will
and Testament, in the presence of us, all being present at the
same time, and who, at the Testator request, in his presence, and
enc eaher, have hereunto subscribed our names
4hi'
in the pres
a4d addr sses as attewitness ~l
-3-
In the Matter of the Will
-of-
JOHN J. SEIBOLD, JR.
I, JOHN J. SEIBOLD, JR., the Testator, sign my name to
this instrument this /S day of P P 6 f' ) , 1990, and
being first duly sworn, do hereby declare to the undersigned
authority that I sign and execute this instrument as my Last Will
and that I sign it willingly, that I execute it as my free and
voluntary act for the purposes therein expressed, and that I am
eighteen years of age or older, sound mind, and under no con-
straint or undue influence.
JOHN J. SEIBOLD, JR., Testator
We, and Drik ~bfjw( J rahl)o
witnesses, being first duly sworn, do each hereby declare to the
undersigned authority that the Testator signs and executes this
instrument as his Last Will and that he signs it willingly and
that each of us, in the presence and hearing of the Testator,
hereby signs this Will as witness to the Testator's signing, and
that to the best of our knowledge the Testator is eighteen years
of age or older, of sound mind, and under no constraint or u due
influence. SSY
State of New Jersey:
County of Midiles2)( :
Subscribed, sworn to and acknowledged before me by JOHN J.
SEIBBOLD, JR., the iTe~stator and subscribed and sworn to before me
by ! S tvDb, ~ ~ Wane and Ch1 L)k oher Como wit-
nesses, this day of , 1990.
ARLENE I MALINCHAK
Natary Public of New Jersey
My Corp-,mission Expires April 2h, 1993
A. Settlement Statement U.S. Department of Housing and Urban Development
B. Type of Loan OMB Approval No. 2502-0265
1. EIFHA 2. 0FmHA 3. NConv. Unins. 6. File Number 7. Loan Number 8. Mortgage Insurance Case Number
4. [IVA 5. ❑Conv.Ins. 12-135
MS OM is mis e to give you a s a amen J; ua se amen cos s. moun s paid to an by Ine settlement agent are shown.
C. Note: Items marked "(p.o.c.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals. TltleExpress Settlement System
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon
conviction can include a fine and imprisonment. For details see: Title 16 U. S. Code Section 1001 and Section 1010. Printed 12/07/2012 at 10:42 SDC
D. NAME OF BORROWER: David Hess
ADDRESS: 49 Smith Road Gardners PA 17324
E. NAME OF SELLER: Estate of John J. Seibold, Jr.
ADDRESS: 52 Quarry Hill Road Newville PA 17241
F. NAME OF LENDER:
ADDRESS:
G. PROPERTY ADDRESS: 52 Quarry Hill Road, Newville, PA 17241
Penn Township
H. SETTLEMENT AGENT: The Law Office of Andrew H. Shaw, PC, Telephone: 717-243.7135
PLACE OF SETTLEMENT: 200 S. Spring Garden Street Suite 11, Carlisle PA 17013
1. SETTLEMENT DATE: 1210712012
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101: Contract sales rice 133 750.00 401. Contract sales rice 133 750.00
102. Personal property 402. Personal property
103. Settlement charges to borrower line 1400 3,444.50 403.
104. 404.
105. 405.
Adjustments for items aid b seller in advance Adjustments for items aid b seller in advance
106. City/town taxes 406. Cit /town taxes
107. Count taxes 12107112 to 12131112 23.00 407. County taxes 12107111202/N12 23.00
108. School taxes 12107112 to 06130113 1,054.02 408. School taxes 12107112 to 06130113 1,054.02
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 138 271.52 420. GROSS AMOUNT DUE TO SELLER 134 827.02
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. De osit or earnest money 1,000-00 501. Excess Deposit see instructions
202. Principal amount of new loans 502. Settlement charges to seller line 1400 8,265.00
203. Existing loans taken subject to 503. Existing loans taken subject to
204. 504. Pa off:0314156951 73 695.70
Wells Faro Home Mortgage, Inc
205. 505.
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for items unpaid b seller Adjustments for items unpaid b seller
210. City/town taxes 510. Cit /town taxes
211. Count taxes 511. Count taxes
212. School taxes 512. School taxes
213. 513.
214. 514.
215. 515.
216• 516.
217• 517.
218. 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 1,000-00 520. TOTAL REDUCTION AMOUNT DUE SELLER 81 960.70
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower line 120 138 271.52 601. Gross amount due to seller line 420 134 827.02
302. Less amounts aid by/for borrower line 220 1,000.00 602. Less reduction amount due seller line 520 81 960.70
303. CASH FROM BORROWER 137 271.52 603. CASH TO SELLER 52 866.32
SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return,
a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. The Contract Sales Price described on
line 401 above constitutes the Gross Proceeds of this transaction.
You are required by law to provide the settlement agent (Fed. Tax ID No: 261544555) with your correct taxpayer identification number. If you do not provide your correct taxpayer identification
number, you may be subject to civil or criminal penalties imposed by law. Under penalties of perjury, I certify that then tuber sho on this statement is my correct taxpayer identification number.
TIN: 1 ` SELLER(S) SIGNATURE(S): f.r'~C~~~~t//!R 1
SELLER(S) NEW MAILING ADDRESS: ~tSp 1 -76 13
SELLER(S) PHONE NUMBERS: (H) t '7 .241- 1 17-7 (tM
ExLt~& A
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 12.135 PAGE 2
SETTLEMENT STATEMENT TitleEx ress Settlement System Printed 12/07/2012 at 10:42 SDC
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on rice $133,750.00 5.000 = 6,687.50 BORROWER'S SELLER'S
Division of commission line 700 as follows: FUNDS AT FUNDS AT
701. 3,343.75 to Spencer & Spencer Realtors SETTLEMENT SETTLEMENT
702. 3,343.75 to Prudential Homesale Services Group
703. Commission aid at Settlement 6,687.50
704. Broker Fee to Prudential Homesale Services Group 295.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee %
802. Loan Discount %
803. Appraisal Fee
804. Credit Report
805.
806.
807.
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to /day
902. Mortgage Insurance Premium for months to
903, Hazard Insurance Premium for ears to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance 2 mo. /mo
1002. Mortgage Insurance 2 In o. /mo
1003. City Property 2 mo. /mo
1004. Count Property mo. /mo
1005. School taxes 6 mo. $ 155.63 /mo
1009. Aggregate Analysis Adiustment 0.00 0.00
1100. TITLE CHARGES
1101. Settlement or Closing Fee
1102. Abstract or Title Search
1103. Title Examination
1104. Title Insurance Binder
1105, Document Pre aration to The Law Office of Andrew H. Shaw PC 100.00
1106. Notary Fees to Sarah D. Dieckman 25.00 10.00
1107. Attorney's fees
includes above items No:
1108. Title Insurance to Law Office of A. H. Shaw/STGCOB 1,100.00
includes above items No:
1109. Lender's Policy
1110. Owner's Policy 133 750.00 -1 100.00
1111. Courier to The Law Office of Andrew H. Shaw PC 30.00
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordin Fees Deed 62.00 Mortgage Release 62.00
1202. City/County tax/stamps Deed $1,337.50 Mortgage 1337.50
1203. State Tax/stamps Deed 1 337.50 ;.Mortgage 1337.50
1204. UPI Fee Deed $ Mortgage 1205. Deed . Mort a e Release $
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Surve
1302. Home Ins ection to Ins ector PI Home Ins ections 375.00
1303. Se tic Ins ppg ection/Pum in to Sunda Septic Service 150.00 200.00
1400. TOTAL SETTLEMENT CHARGES enter on lines 103, Section J and 502, Section K 3 444.50 8 265.00
HUD CERTIFICATION OF BUYER AND SELLER
I. have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account
or by me in this tr ) saction. I further I have received a copy of the HUD-1 Settlement Statement.
aw ess 14
Estate of John J. Seibold, Jr.
Y. regory ei o , xecu or
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION The HUD-1 Settlement Statement IV I have prep ed is a e d accurate account of this
CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: transaction. I have caused or will u th ds t disb se in accordance with this statement.
U.S. CODE SECTION 1001 AND SECTION 1010.
SETTLEMENT AGENT:
/o`~... ~ - , G,h
DATE:
A. Settlement Statement U.S. Department of Housing and Urban Development
B. Type of Loan OMB Approval No. 2502-0265
1. OFHA 2. OFmHA 3. &Conv. Unins. 6. File Number 7. Loan Number 8. Mortgage Insurance Case Number
4. OVA 5. OConv.Ins. 12-135
s orm is furnished to give you a state men o a ua se amen cos s. noun s pai o an y tine settlement agent are shown.
C. Note: Items marked "(p.o.c.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals. TltleExpress Settlement System
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon
conviction can include a fine and imprisonment. For details see: Title 18 U. S. Code Section 1001 and Section 1010. Printed 12/07/2012 at 10:42 SDC
D. NAME OF BORROWER: David Hess
ADDRESS: 49 Smith Road Gardners PA 17324
E. NAME OF SELLER: Estate of John J. Seibold, Jr.
ADDRESS: 52 Quarry Hill Road Newville PA 17241
F. NAME OF LENDER:
ADDRESS:
G. PROPERTY ADDRESS: 52 Quarry Hill Road, Newville, PA 17241
Penn Township
H. SETTLEMENT AGENT: The Law Office of Andrew H. Shaw, PC, Telephone: 717.243.7135
PLACE OF SETTLEMENT: 200 S. Spring Garden Street Suite 11, Carlisle PA 17013
1. SETTLEMENT DATE: 1210712012
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101: Contract sales rice 133 750.00 401. Contract sales rice 133 750.00
102. Personal property Personal property
Settlement charges to borrower line 1400 3,444.50 403.
104. 404.
105. 405.
Adjustments for items aid b seller in advance Adjustments for items aid b seller in advance
106. City/town taxes 406. Cit /town taxes
107. Count taxes 12/07112 to 12131112 23.00 407. Count taxes 12107112 to 12131112 23.00
108. School taxes 12107112 to 06130113 1,054.02 408. School taxes 12107112 to 06130113 1,054.02
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 138 271.52 420. GROSS AMOUNT DUE TO SELLER 134 827.02
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deposit or earnest money 1,000-00 501. Excess Deposit see instructions
202. Principal amount of new loans 502. Settlement charges to seller line 1400 8,265.00
203. Existin loans taken subject to 503. Existing loans taken subject to
204. 504. Pa off:0314156951 73 695.70
Wells Faro Home Mortgage, Inc
205. 505.
206. 506.
207• 507.
208. 508.
209• 509.
Adjustments for items un aid b seller Adjustments for items unpaid b seller
210. City/town taxes 510. City/town taxes
211. Count taxes 511. Count taxes
212. School taxes 512. School taxes
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 1,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 81 960.70
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower line 120 138 271.52 601. Gross amount due to seller line 420 134 827.02
302. Less amounts aid by/for borrower line 220 1 000.00 602. Less reduction amount due seller line 520 81 960.70
303. CASH FROM BORROWER 137 271.52 603. CASH TO SELLER 52 866.32
SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return,
a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. The Contract Sales Price described on
line 401 above constitutes the Gross Proceeds of this transaction.
You are required by law to provide the settlement agent (Fed. Tax ID No: 261544555) with your correct taxpayer identification number. If you do not provide your correct taxpayer identification
number, you may be subject to civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the n tuber sho on thi statement is my correct taxpayer identification number.
TIN: 1 SELLER(S) SIGNATURE(S):
SELLER(S) NEW MAILING ADDRESS: 1 1 CJL"' (n3L~` ~ ('fU ~t tf/ ! •'S I-76!3
SELLER(S) PHONE NUMBERS: (H) -7, -7 ° 2'-t`r - 117 7 (W)
C-K ~ t~ A
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 12.135 PAGE 2
SETTLEMENT STATEMENT TitleEx ress Settlement S stem Printed 12/07/2012 at 10:42 SDC
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on rice $133,750.00 5.000 = 6,687.50 BORROWER'S SELLER'S
Division of commission line 700 as follows: FUNDS AT FUNDS AT
701. 3,343.75 to Spencer & Spencer Realtors SETTLEMENT SETTLEMENT
702. 3,343.75 to Prudential Homesale Services Group
703. Commission aid at Settlement 6,687.50
704. Broker Fee to Prudential Homesale Services Group 295.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee %
802. Loan Discount
803. Appraisal Fee
804. Credit Report
805.
806.
807.
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to /day
902. Mortgage Insurance Premium for months to
903. Hazard Insurance Premium for ears to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance 2 mo. /mo
1002. Mort a e Insurance 2 mo. /mo
1003. Cit Pro ertTax 2 mo. /mo
1004. Count Property mo. /mo
1005. School taxes 6 mo. 155.63 /mo
1009. Aggregate Analysis Ad'ustment 0.00 0.00
1100. TITLE CHARGES
1101. Settlement or Closing Fee
1102. Abstract or Title Search
1103. Title Examination
1104. Title Insurance Binder
1105. Document Preparation to The Law Office of Andrew H. Shaw PC 100.00
1106. Notary Fees to Sarah D. Dieckman 25.00 10.00
1107. Attorney's fees
includes above items No:
1108. Title Insurance to Law Office of A. H. Shaw/STGCOB 1 100.00
includes above items No:
1109. Lender's Policy
1110. Owner's Policy 133 750.00 -1 100.00
1111. Courier to The Law Office of Andrew H. Shaw PC 30.00
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees Deed 62.00 Mortgage Release $ 62.00
1202. City/County tax/stam s Deed $1,337.50 Mortgage 11337.50
1203. State Tax/stamps Deed $1,337.50 Mortgage 1,337.50
1204. UPI Fee Deed Mortgage
1205. Deed • Mort a e Release
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey
1302. Home Ins ection to Inspector PI Home Inspections 375.00
1303. Septic Inspection/Pumping to Sunda Septic Service 150.00 200.00
1400. TOTAL SETTLEMENT CHARGES enter on lines 103, Section J and 502 Section K 3 444 .50 8 265.00
HUD CERTIFICATION OF BUYER AND SELLER
I. have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account
or by me in this transaction. I Afurtr certify that I have received a copy of the HUD-1 Settlement Statement.
X
avi mess
Estate of John J. Seibold, Jr.
y regory ei o zeta or
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Settlement Statement w I have prep 6d is a e accurate account of this
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION transaction. I have caused or will u th ds t disb in accordance with this statement.
CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18:
U.S. CODE SECTION 1001 AND SECTION 1010.
SETTLEMENT AGENT: l DATE:,v, -C;-_-
.
A
Rick Foreman Auctioneer Au1163L
386 Springfield Rd.
Shippensburg Pa 17257
(717)776-4602
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PUBLIC AUCTION
Saturday, September 08, 2012 at 9:00 A.M.
Located at 52 Quarry Hill Rd., Newville, PA 17241
From Shippensburg follow Rt 11 North Approximately 5 miles to Quarry Hill Rd.
and turn Right, travel to house on Right.
From Carlisle, follow Rt 11 South, pass the Drive in Theatre, and turn left on Quarry Hill Rd.,
travel to house on Right.
Guns: Colt.357 blued, 7 inch barrel; Ruger GP 100,357 Stainless 7" barrel with case; BRAND NEW Ruger SP 101.38
Special 2 3/4" stainless; Ruger Super Six.22; Remington model 76 sportsman 30.06 pump with redfield 3x9 scope;
Remington model 76 sportsman 30.06 pump with fixed 4 power leupold; Ithaca model 5712 gauge BBL modified and
BBL improved cylinder; Left Handed Renegade Thompson Center Arms Company Cap Lock Muzzle Loading Rifle; Plus
reloading equip and ammo; Compound Bow & Arrows; Fishing and Hunting gear (reels, rods, full tackle boxes);
Collectibles: Cumberland County crocks; collector pins; ammo pins; Texaco 53 Chevy Pickup; Large collection of Zippo
lighters (many brand new); Jeff Gordon Pepsi racing, 1999 Lmtd; 7 piece train set, other Lionel trains from early to mid
1900's, 3 train transformers (Lionel), 2 commemorative HO Scale model train sets, other accessories; NASCAR Beannie
Racers; Valvoline; Kodak; Tide 1960 MB 61 Mac Tractor & Trailor; Hess Trucks; Case knife and other knives; Cub Scout
ring plus Antique Cub and Boyscout items; Penn Joy metal trucks; Winross Cars and Trucks; Numerous additional metal
trucks in original boxes; pistol crossbow; Jim Beam 200th Anniversary tractor trailer; lots of wildlife/fish and game
patches; field note patches; other patches; game commission fishing pictures and posters; beautifully framed wildlife
stamps with certificate and prints; Texaco signs; Beer signs; 58 Impala remote control car; Low Rider magazine cruiser;
Limoges dishware C47 Lyric 1 KS-384 22 carat gold leaf; Odd pieces of Crystal plus Blue Onion and Bone China; Vases;
John Deere pillows; Budweiser/Olympic/other collector Steins; Baseball hats; Top hats; Penn State Santa, Mrs. Claus,
Snowman, and Sleigh (4 piece set); Beanie Babies; Lots of books and VHS tapes; large colleciton of belt buckles; Large
amount of very clean collectible items;
Furniture & Antiques: 3 pc Bedroom suite; double bed; chest of drawers; night stand; cherry wood furniture; secretary
desk with swivel captain chair; fold out couch; breakfast set; blankets and bedspreads; wood desk; china cabinet; side
board with mirror; Antique lamps; fax machines; wall mirror; stuffed pheasant; macaroni thermo; power chair (needs
battery); Century 5570 safe; antique and modern photograph equipment, including cameras (Exakta and Minolta),
enlargers, light meters, negatives, and other items; antique Christmas ornaments and decorations (still in packages);
Antique Russell and Stoll New York Post Lamp; Speedaway Antique Sled; WWII memorabilia (Army uniform, WAV
uniform, patches, newspapers, magazines, pamphlets, pins including American and German); 1930's New York World's
Fair items; Antique and modern toys and board games, Antique toy chest; Antique Steif Bear with tag; Antique hat
boxes (Disney and Wallach); Fine handcrafted items (crochet, needlepoint, cross stitch); 1950 silverware set; lots of
household items (small appliances, kitchenware, silverware, dishes, pots/pans);
Lawn Mowers & Shop Equipment: John Deere XL 255 Lawn Mower (like new); New John Deere push mower; Yard King
snow blower; Stihi weedeater; Lincoln 225 Amp welder and helmets; Small air compressors; ladders; Dayton heavy duty
fleet battery charger; Craftsman tool chest; bag cart; air tools; metal work bench; lots of wrenches; chords; hand tools;
extensive tool collection; nuts and bolts; shop vac; Electric shop grinder; Homelite Chainsaw; deer spotlights; Mil.
Sawzall. Roto zip; Lots of good clean tools/power tools in good condition;
1996 Chevy Lumina Van: Seats 7, teal green color, good condition;
Set of 12 VHS tapes of the movies "Centennial", early west story complete set;
Estate of John Seibold, Jr. 52 Quarry Hill Road, Newville, PA 17241
Stephanie Chertok Attorney
Food available during sale.
Rick Foreman Auctioneer AU11163L 717-776-4602
TERMS - Cash or Good Check on day of sale. ID Required for Bidder Number.
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