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HomeMy WebLinkAbout01-30-13 REV-1500 EX (oz-ii) (FI) ^ !~ enns lvania OFFICIAL USE ONLY PA Department of Revenue p~P.a.rE Y County Code Year File Number Bureau of Individual Taxes ~ ,aEVEw~E PO BOX 28o6oi INHERITANCE TAX RETURN ~ ~ I ~ ~' Harrisburg, PA i'71z8-o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 04/30/2012 11 /13/1922 Decedent's Last Name Suffix Decedent's First Name MI Jacobs Louise H 1505610105 (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILE D IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW m 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) OD 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Nurhgdr n i. ,_; ;~ David A. Baric, Esquire (717)549-6873 f~1 First Line of Address Baric Scherer LLC Second Line of Address 19 West South Street City or Post Office Carlisle State ZIP Code PA 17013 .. N IjE61S. RCS WILitS US E'd L~!`.T - r..,.. r ,~ • ,. L;.i r~~ ~ I I C.J _, ,~ . .,:.:'t ~:: i ..r ,..w DATE FIL-E~ -y ~ Correspondents a-mail address: dbaric@baricscherer.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI ~IAT RE F PF~SON ESPONSIBLE FOR FILING RETURN DATE ~~ ~..JO ~~ 300 Road, ill , Pe ylvania 17241 SIGN P E O T N PRESENTATIVE DATE ~ d~ 30 ~3 ADDRESS ( ~ 19 West South Street, Carlisle, Pennsylvania 17013 PLEASE USE ORIGINAL FORM ONLY 1505610105 Side 1 1505610105 J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's nieme: Louise H. Jacobs RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. ....-... _..... 77,301.00 2. Stocks and Bonds (Schedule B) .................................... ... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 6,274.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1 through 7) ......... . ................ ... 8. ', 83,575.00 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 30,331.80 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 53,216.70 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. .. 83,548.50 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 26.50 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. 26.50 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 A_ 15. ~i 16. Amount of Line 14 taxable .~"~ ."~""- _._-..._.__..____._.---.._.______., ~..__.._---_____._._.__...__._._.__...__._ _.,__ _.__._...._._._.. at lineal rate X .0 45 26.50 ~ 16.. 1.19 17. Amount of Line 14 taxable ~~~- at sibling rate X .12 17. 18. Amount of Line 14 taxable - - -- - - I at collateral rate X .15 ; ____ _ 18. ! 1.00 19. TAX DUE ........................................................ .19.' 1.19 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 1505610205 REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Louise H. Jacobs STREET ADDRESS 253 Walnut Street CITY Carlisle STATE ZIP PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _ B. Discount 3. Interest 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) (3) (4) (5) 1.19 0.00 1.19 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 ................................................................................... ....... ^ b. retain the right to designate who shall use the property transferred or its income ..................................... ....... c. retain a reversionary interest ....................................................................................................................... ....... ^ d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 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? .................................................................................................................. ...... ^ 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)]. Far 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)]. Asibling 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~ J1-1Jl Pennsylvania SCHEDULE A DEPARTMENT'OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Louise H. Jacobs 21-12-0581 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. ITEM NUMBER 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. DESCRIPTION VALUE AT DATE OF DEATH 1• 253 Walnut Street 77,301.00 Carlisle, Pennsylvania 17013 (HUD-1 attached) ~._.._._,~ ~__,~.___,.~..-~~ .. TOTAL (Also enter on Line 1, Recapitulation.) 77,301.00 ~.m® It more space is needed, use additional sheets of paper of the same size. REV-1508 EX+ (u-io) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: Louise H. Jacobs SCNEDI~LE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY FILE NUMBER: 21-12-0581 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must 6e disclncnd ~~ c~tio.~~~io F a~ iiwic oNac,e is neeoea, use aaamonai snee[s of paper of the same size. Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Louise H. Jacobs 21-12-0581 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES; _ I• Hoffman Roth Funeral Home __ 2. Memorial Check B. I ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Kirk E. Jacobs and Brian L. Jacobs st-eet Address 300 Creek Road .._ 6,510.00 u.. r, City Carlisle state F'A ZIP 17013 Year(s) Commission Paid: 2013 Z• Attorney Fees: ~ 6,510.00 J w Sri ...s~.~ 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant NOne Street Address City State ZIP Relationship of Claimant to Decedent k;: 4• Probate Fees: 323.50 ) ~~ S• Accountant Fees: ~..~ ~.b•~,,. Tax Return Preparer Fees: i m~ ~• ...x...........****"'""*"""*""""'***"SEE ATTACHED SHEET.,~f+...~*..,:.,~,....~.t#,..,' ....:........~.,~. ~~..°.®'°~ ~.~~, ~~ ~,~. ~ ~_ ~.~ a~~= .__ ,~ m ~.z~ ~ _.r~.;J TOTAL (Also enter on Line 9, Recapitulation) $!~ 30,331.80~Y~ If more space is needed, use additional sheets of paper of the same size. __ _ _ ~; ~ ~ . __ _ - REV-1512 EX+ (12-~2) pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & L.YENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Louise H. Jacobs 21-12-0581 Report debts incurred by the decedent prior to death that remained unsaid at the date of death. indudina unreimbursed mrdi~al eYnnnces IT more space is needed, insert additional sheets of the same size. ,~' Pennsylvania ~„ti7 OEPAfi'MENi pF R=`/ENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE 0 Louise h NUMBER I 1. 2. 1. 1. SCHEDULE BENEFICIARIES F: i. Jacobs NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] Kirk E. Jacobs 300 Creek Road Newville, Pennsylvania 17241 Brian L. Jacobs 253 Walnut Street Carlisle, Pennsylvania 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX RELATIONSHIP TO DECEDENT Do Not List Trustee(s) FILE NUMBER: 21-12-0581 AMOUNT OR SHARE OF ESTATE son r 50% >. . .n ~~.~ ,... son 50%~ ,~.u r ,~,. ..~ 1 ~ ~...... r~..~r.~i j ~:,.~:~;,~,..~_~:, ~_... Sus ...~.. ~- i P .i. E.. /¢ .... i- `- .. -..ji~ (11 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. IS NOT TAKEN: i .~~~ x-._.,.:~_ ) ] r~_ ..:_ 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: '"'""` .. ~; --_ - , _= a ~._ ~ ._ _. x s ..,. ; TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. 1• If more space is needed, use additional sheets of paper of the same size. LAST j~'ILL AND TFSTAA2Z?TdT OF LOUISE H . JACOBS I, LOTJISE H. JACOBS, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last gill and Testament, in manner and f_oz^m following: 1. I hereby expressly revoke all ~~Ti]_ls and Codicils hereto- fore made by me. 2. I hereby direct my Executor to pay all my just debts, funeral and administrative ex..penses out of my estate, as soon as practicable after my death. 3. Should my husband, Kenneth F. Jacobs, survive me for a period of thirty daysf..ollowing my death, I devise and bequeath f ~ the remainder of my estate t.o Z'enn.eth F. Jacobs. I 4. Should my husband, Kenneth r. Jacobs, predecease me or die on. or before the thirtieth day following my death, I devise and bed~ieath the remainder of my estate tc my issue li..ving on the thirty-first day follo~,~ing my death, per stirpes. 5. I nominate and appoint G'ommonwealth National Bank, Carlisle, Pennsylvania, Trustee of the share of any beneficiary who may be under the age of twenty-one years. The income and/or principal of said trust may be accumulated or expended for the maintenance, education and support of such. beneficiary as my Trustee in its sole discretion may determine; and my Trustee, in the expenditure of income and/or principal for such purposes, ma.y, at its discretion, apply the same directly without the intervention of a guardian or nay the same to any person having the care or control of s=_iid benef iciary or with whom the bene- ficiary resides, without duty on the part of the Trustee to supervise or inquire into the application of the .funds by any person to whom any payment is so made. The hal_ance of such income and/or principal shall be paid. to such beneficiary upon - 1 - reaching the age of twenty-one years or to s~~ch beneficiary's estate in the event of death prior thernto. i 6. I nominate and appoint my husband, Kenneth E. Jacobs, ~ as Executor of this my Last ?di11 and Testament; and as substitute I executors I nominate and appoint my sons, Kirk E. Jacobs and Brian L. Jacobs. 7. I direct that my personal representative Ind Trustee., as well_ 2s their successors, sha11 not be rER~~ired to f..ile bond or security in any jurisdiction. Ir? ?•JITD?FSS ?~'HL~ FQF', I have hereunto set my hand and seal r ~ this ~~ - day of r~ ~~,-- , i97~. ;; ~:. ~~.Jt_ ~~ ~,~~ (SEAL) Louise 3i. J co s I ?rrzTr~~s ~T~~~~ 2 - COP~QION4IEAI,TH OF PrNNSYLVANIA e SS. COUI~TTX OF CiTMBI?t'.L~ND I, Louise Ii. Jacobs, Testatrix, whose name is si_d ed to the attached or foregoing instrument, having been duly qualified. according to law, do hereby acknowledge that I signed and a};ecL?t the instrument as my Last Grill; that I si~m ed it willingly;. and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acktylowledged b~fore me, by Louise H. Jacobs, Testatrix, this 'y ,3 Y day of j ~.~ , 1978. I ,~f-c~.s.-a.t- /b~ i estatr JANICE E. NERTZLER, NOTARY PUBLIC ~^-~~ c. `' Cumberland county Carlisle, Pa. `~ My L'ommission E>;pires January 27, 1979 COMP~~ON~i1G;,hLTH OF PFNt1Sy.LV~.A7Ip SS. COiTNTY OF C'UI~1B,?.P.L~,I~TD . T.Je, Tom H. Bietsch and 1?oger M. Morgentha7_, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualif ied accozdi_ng to law, do depose and say that we were present and saw Testatrix Louise H. Jacobs,. sign and execute the instrument as her Last Grill; that: she signed willingl and that she exe clued it as her free and voluntary act for the purposes therein expressed; that both of us in the hearing and sight of the Testatrix signed the wi11 a.s witnesses; and that to the best of our know? dge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence, Sworn or affimted to and subscribed to before me k~y Tom K. Bietsch and Roger t~T. A7orgenthal, witnesses, this ~.? ~ day of I~~o,„ , 1978. ~, ANICE E. NERTZLER, NOTARY P1J81,1~ Cumberland County Carlisle, Pao y Commission Expires January 27, 7.979 r .. ~ // .%itness ~ ~ ~~ itne s s "'- ~, _ f( ~ y~~ - 3 - r~d~~1,/~ S )_!~ ~ ~ ~; 2 X _ ~ ~Q ~^ ~ ~~ tit j l i p l'~~ya y j ': x i J ~. _ _ _ ~ J _ ~'L~ __ _ - / I~ ICI J OMB Approval No 2502-0265 I~~I~, =, A. Settlement Statement (I~UID-1) ~~ FINAL 1. ~ FHA 2. ~ RHS 3. XQ Comr. Unins. 6. File Number: 7. Loan Number: S. Mortgage Insurance Case Number: 2012~4IJACOBS 217073 4. Q VA 5. [~ Conv. Ins. C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown. Items marked " " (p.o.c) were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. Name 8< Address of Borrower: E. Name & Address of Seller: F. Name 8 Address of Lender. Kirk E Jacobs, Linda F. Jacobs Members 1st FCU 300 Creek Road, Newville, PA 17241 5000 Louise Drive, P.O. Box 40, Mechanicsburg, PA 17055 G. Property Location: H. Settlement Agent: I. Settlement Date: OV22/2013 253 Walnut Street Baric Scherer LLC Disbursement Date: O'V22/2013 Carlisle, PA 17013 19 West South Street, Carlisle, PA 17013 Carlisle Borough Telephone:717-249-6873 Fax:717-249-5755 Place of Settlement: TitleExpress 19 West South Street, Carlisle, PA 17013 Printed O V22/2013 at 11:00 am by ALF 101. Contract sales price ~;~ i- 401. Contract sales price 102. Personal ro rt 402. Personal rt 103. Settlement charges to borrower (line 1400) 3,236.35 403. 104. Pa off of first mort loan #3300490822 to Quidce 404. Loans $47981.51 105. Purchase of 253 Walnut St. from Estate of L. Jacobs 124,568.00 405. Ad'ustments for items Id b seller in advance Ad ustments for items aid b seller in advance 106. Cityftown taxes to 406. Cityltown taxes to 107. County taxes to 407. County taxes to 108. Assessments to 408. Assessments to 109. School tax proration due back Estate of L. Jacobs 715.40 409. 110. 410. 111. 411. 112. 412. 120• Gross Amount Due from Borrower • .. r, 128,519.75 ,y 420. Gross Amount Dus to Seller ,r 201. Deposit or earnest nroney 501. Excess deposit (see instructions) _y 202. Principal amount of new loan(s) 108,320.00 502. Settlement charges to seller (line 1400) 203. Existin loa s taken sub ect to 503. Existin loa s taken sub ect to 204. 504. Pa off of first mort loan 205. 505. Pa off of second mort loan 206. Credit for Appraisal 425.00 506. 207. 507. 208. ~ 2~ 509. Ad'ustments (or items un id b seller Ad'ustmerKS for items un id b seller 210. Cityftown taxes to 510. Cityftown taxes to 211. County taxes 01122/2013 to 01/2212013 511. County taxes 01/2212013 to 0112212013 212. Assessments to 512. Assessments to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220• Total Paid b Ifor Borrower 108,745.00 520. Total Reduction Amount Due Seller 0.00 Gross amount due from borrower line 120 301 ( ) s~_ ._ . 302. Less amounts paid bylfor borrower (line 220) 303. Cash QX From ~ To Borrower ,s a, ims rom,. mess n a;~i,~z a ~,,,..~o„,,..w ~.~o .,,..,...~...._w..~_ °_..._ 128,519 75 108,745.00 19,774.75 ~. , 601. Gross amount due to seller (line 420) 602. Less reductions in amount due seller (line 520) 603. Cash X~ To ~ From Seller ro v , 0.00 0.00 0.00 s~oKroe~~ oro«ss. - _- ------.- ._ ..._.__._.,.......,..o,,,,,,~„ ,,, w,,,,,,,v „K,,,~,.~.o a nesra wverca vamacuon ~;m ~morom,oo eo,,,y me .... Previous editions are obsolete Page 1 of 4 HUD-1 '~'' ~~~~ -• Raid From Paid From 701 ` ©ivitsial oF~ainam .' ldllorrs: $0,00 to $nrrower's Wads at Seller's Fund t 702. $0.00 to 703. Commission paid at settlement SettieFnent s a Settlement .'ORY. v'. ~ - - 801, Our origination charge (Includes Origination Point 0.000°h or $0.00) $455.00 (from GFE #1) 802. Your credit or charge (points) for the specific interest rate chosen $ (from GFE #2) 803. Your adjusted origination charges (from GFE A) 455 00 804. Appraisal fee to (from GFE #3) . 425.00 805. Credit re ort to from GFE #3 806. Tax service to from GFE #3 807. Flood certification to from GFE #3 808. to *~~ a ~ ~ ~ ~ 901. Daily interest charges from from OV22/2013 to 02/01/2013 $12.9836/da @ Y (from GFE #10) ~ 129.84 902. Mort a e insurance remium months to from GFE #3 903. Homeowner's insurance months to from GFE #11 9~• months to from GFE #11 ,, _. ;~~ ~~.t ,,,...~ P ,~ ~., ,.~ M ~. , ~_ .. _ _ ~ , :.: 1001. Initial deposit. for your escrow account (from GFE #9) 1002. Homeowner's insurance months $ /month 1003. Mort a e insurance months $ /month 1004. Pro rt taxers months $ (month 1005. months $ (month 1006. Assessment<.~ months $ O.OO/month $ 1007. Aggregate Adjustment g 1101. Title services and lender's title insurance from GFE #4 255.00 11 D2. Settlement or closing fee to $ 1103. Owner's title insurance from GFE #5 1,025.00 1104. Lender's title insurance $225.00 1105. Lender's title policy limit $108,320.00 Lender's Policy 1106. Owner's title policy limit $124,568.00 Owner's Policy 1107. Agent's portion of the total title insurance premium $998.75 1108. Underwriter's portion of the total title insurance premium $25125 1109. _. . ~~ .~w= . . 1201. Government recording charges $ (from GFE #7) 158 00 1202. Deed $62.00 Mort $96.00 Release $ . 1203. Transfer taxes $ (from GFE #8) 1204. City/County tax/stamps peed $ Mort e $ 1205. State Taxlstamps peed $ Mort e $ 1206. Deed $ Mort $ _. _ _ _ , . 1301. Required services that you can shop for f ~ , (from GFE #6) 1302. Final Water/Sewer Acct #010572 to Borou h of Carlisle $168 64 P O C S' . . . . 1303. 2013 County(fownship Bill to Carlisle liorou h 788 51 1304. to . 1305. to .. .. - - .. - r ~ 3,236.35 0.00 'Paid outside of closing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. ""Credit by lender shown on page 1. '"'Credit by seller shown on page 1. Previous editions are obsolete Page 2 of 4 HUD-1 ,~. . 455.D0 455.00 0.00 0.00 455.00 455.00 0.00 0.00 Loan Terms ~, 0.00 0.00 230.14 12g,gq 350.00 0.00 1,362.88 255.00 0•~ 1,025.00 Previous editions are obsolete Page 3 of 4 MUD-1 ~•~•~• ~~ y~~ ~~a~~ a~.y yuGSUUns auou[ me aememem t;narges antl Loan Terms listed on this form, please contact your lender. HUD CERTIFICATION OF BUYER AND SELLER I have carefa~ty reviewed the HUD-t Settlement Statement and [o the best of my knowledge and belief, d is a true and accurate statement or all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. Kirk E Jacobs j i Lin a F. Jacobs The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disb in accordance with this statement. F ~~, SETTLEMENT AGENT r ~ I ~a ~ 13 DATE WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. Previous editions are obsolete Page 4 of 4 HUD-1 . . ~ Name of Borrower Name of Seller. File Number. Kirk E Jacobs 2012-441JACOBS Linda F Jacobs __ Prepared 01/22/2013 at 11:00 am Note: This page displays an itemization of the charges shown on line 1101 of the HUD-1 Settlem t St t en a ement This page accompanies brut is not a part of the HUD-1 Settlement Statement. If a discrepancy exists, the information on the HUD-1 Settlement Statement applies. ~ ..., :, r~. ~: ,. ... .. .,. , .. ,. - +, , ~.. . 1101. Title services and lender's title insurance to 255.00 0.00 Notary Fees to Cash $ 10.00 Borrower Overnight Fees to Baric Scherer LLC $ 20.00 Borrower Subtotal 5 30.00 1102. Settlement or closing fee to $ 0.00 1104. Lender's title insurance to Baric Scherer LLC $ 225.00 Borrower 4,.., r. ,.:. Previous editions are obsolete Page 1 of 1 HUD-1 1V ~ 1 ~