HomeMy WebLinkAbout03-20-13 1505610305
REV-15OO Ex(oz-ii}IFI)
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes DE"RTMENTOFREVENUE County Code Year File Number
PO BOX 28o6o1 INHERITANCE TAX RETURN
Harrisburg,PA 17128-0601 RESIDENT DECEDENT I _
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
: 110/08/2012 I
� 101/18/1944
Decedent's Last Name Suffix Decedent's First Name MI
BERKEBILE ! PHYLLIS V
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
i I
r
Spouse's Social Security Number
i
- - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
C@D 1.Original Return C:) 2.Supplemental Return C=:) 3. Remainder Return(Date of Death
Prior to 12-13-82)
C=) 4.Limited Estate O 4a.Future Interest Compromise(date of C= 5. Federal Estate Tax Return Required
death after 12-12-82)
C=) 6.Decedent Died Testate C=:) 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
C=:) 9.Litigation Proceeds Received C'a 10.Spousal Poverty Credit(Date of Death C=:) 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 Number
DAVID A BERKEBILE (717)763-7771 - I
RE
RSTER OF WILLEUSE ONLY
x M
C� M C.,y
First Line of Address
2700 LINCOLN ST `,,
Second Line of Address >_ � :.T C::)
C "
City or Post Office State ZIP Code DBE FILED =`
CAMP HILL ` PA 17011 -�
�►
Correspondent's e-mail address:
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the Crest of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF SON FILING RETURN D TE
3
r
ADDRESS
2700 LINCOLN ST. CAMP HILL PA 17011
SIGNATURE OF P PARE)itOTHER THAN REPRESENTATIVE DATE
ADDRESS
KERN AND COMPANY, P.C. 2331 MARKET STREET CAMP HILL, PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105
Now
,
1505610205
REV-1500 EX(Fl)
Decedent's Social Security Number
Decedent's Name: PHYLLIS V. BERKEBILE
RECAPITULATION
1, Real Estate(Schedule A), ................................... ...
156,900 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. 1 3,658.98
I a
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ..,.... 6. 1
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.....,.. 7. ? 58,365.80
8, Total Gross Assets(total Lines 1 7 through
g }....... 8. 218,924.78
3
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 22,563,7$
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. i 56,317.92
?$'881.71
11. Total Deductions(total Lines 9 and 10)................................. 11.
3
12. Net Value of Estate(Line 8 minus Line 11)..........................
.... 12. 14(},043.07
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which i
an election to tax has not been made(Schedule J) ........................ 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 140,043.07 1
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0- 15.
16. Amount of Line 14 taxable
at lineal rate X.0 45 140,043.07 16.! '
.� fi,301.94
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
G
19. TAX DUE ............. . .................. .... ............. . ....... 19,i 6,301.94
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610205 1505610205
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
PHYLLIS V. BERIKEBILE
STREET ADDRESS
3 MAYBERRY LANE
CITY STATE ZIP
MECHANICSBURG PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 6,301.94
2. Credits/Payments
A.Prior Payments 23.70
B.Discount
Total Credits(A+B) (2) 23.70
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) 6,278.24
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? ...................I...........................................................I........................................ ❑ ■
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 F2 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)
pennsytvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
PHYLLIS V. BERKEBILE
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. PERSONAL HOME-3 MAYBERRY LANE MECHANICSBURG,PA 17050 9
156,900.00
s.
TOTAL(Also enter on Une 1,Recapitulation.) 156,900.00
If more space is needed,use additional sheets of paper of the same size.
REV-1508 EX+(08-12)
o pennsytvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
PHYLLIS V. BERKEBILE
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. WEARING APPAREL 700.00
2. HOUSEHOLD GOODS&FURNISHINGS 1,000.00
3. AUTOMOBILE-1993 SUBARU 850.00
4. CHECKING ACCOUNT-MEMBERS FIRST FCU ACCT#36686 647.89
5. SAVINGS ACCOUNT-MEMBERS FIRST FCU ACCT#36686 461.09
MEMBERS FIRST FCU
5000 LOUISE DRIVE; P.O.BOX 40 MECHANICSBURG,PA 17055
TOTAL(Also enter on Line 5, Recapitulation) $ 3,658.98
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09) '
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
PHYLLIS V. BERKEBILE
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM F THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH °k OF DECD'S EXCLUSION TAXABLE
INCLUDE THE NAME O
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE VALUE
1. AMERIPRISE TRUST COMPANY A/C 0020146881543002 3,443.81: 3,443.81=
i
2.
AMERIPRISE TRUST COMPANY A/C 0020146067077002
6,877.18 6,877.18
AMERIPRISE TRUST COMPANY A/C 0.0101432327660002 '
3. 7,026 91 , 7,026.91
,
AMERIPRISE TRUST COMPANY A/C 0010143009560002
4, 3,09560: 3,095.60
'AMERIPRISE TRUST COMPANY A/C 0020145158380002
5.` 4,359.78- 4,359.78
6 AMERIPRISE TRUST COMPANY A/C 0010142757912002 2,906.80 x 2,906 80
7 -AMERIPRISE TRUST COMPANY A/C 0010136964045002 3,349.72' 3,349.72
8 'AMERIPRISE TRUST COMPANY A/C 0020149562371002 3,130.14° 3,130.14'
9 AMERIPRISE TRUST COMPANY A/C 0010142430718002 5,066.44 5,066.44
AMERIPRISE
TRUST COMPANY A/C 0010139376627002
10. 19,109.42 19,109.42
s
r ,
TOTAL(Also enter on Line 7,Recapitulation) $ 58,365.80
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09) ;
impennsy[vania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
PHYLLIS V. BERKEBILE
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' MALPEZZI FUNERAL HOME 7,441.07
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees:
3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
5. Accountant Fees:
b. Tax Return Preparer Fees: 750.00
7. SETTLEMENT COSTS-HOME 12,073.40
CERTIFIED COPIES OF WILLS 265.50
UTILITY COSTS-HOME 959.07
HOME SALE EXPENSES-REPAIRS&MAINTENANCE 1,074.75
TOTAL(Also enter on Line 9, Recapitulation) $ 22,563.79
If more space is needed,use additional sheets of paper of the same size.
i r
r
REV-1512 EX+(12-12)
lox pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES &LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
PHYLLIS V. BERKEBILE
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. MEMBERS FIRST FCU-LINE OF CREDIT 8,251.17
2. MEMBERS FIRST FCU-HOME EQUITY LINE OF CREDIT 47,930.79
3. CREDIT CARD-CAPITAL ONE 135.96
TOTAL(Also enter on Line 10, Recapitulation) $ 56,317.92
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10) `
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
PHYLLIS V. BERKEBILE
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. DAVID A.BERKEBILE SON h 50%4
2700 LINCOLN ST.CAMP HILL,PA 17011 }
2. JAMES A.BERKEBILE SON 50%
19199 S.SAGAMORE RD.FAIRVIEW PARK,OH 44126
i
1:
S'
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.
r ,
OMB Approval No.2502-0265(i) A. Settlement Statement (HUD-1) FINAL
1.Q FHA 2.Q RHS 3.QX Conv.Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number:
12-1795GC 12-0239658
4.❑VA 5.❑Conv.Ins.
C.Note:This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agents are shown Items marked
"(p.o.c)"were paid outside the closing;they are shown here for informational purposes and are not included in the totals.
D.Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender:
Edmundo Guadarrama Galeana,Jennifer The Estate of Phyllis Berkebile,David A Berkebile, Mortgage Master,Inc.
Ward-Guadarrama Executor 102 Elm Street,3rd Floor,Walpole,MA 02081
G.Property Location: H.Settlement Agent: I.Settlement Date:12/21/2012
3 Mayberry Lane Guardian Transfer Corporation Disbursement Date:1212112012
Mechanicsburg,PA 17050 4075 Market St.,Camp Hill,PA 17011
Silver Spring Township
717-90911700
Place of Settlement: TitleExpress
4075 Market Street,Camp Hill,PA 17011 Printed 1212112012 at 12:23 pm
by JMG
J.Summary of Borrower's
'100. Gros:AmounF bue tiom;Boitbwer.:`: kG ...: ta,'3¢71sr.
rots
101. Contract sales r
pots 156,900.00 401. Contrail sales pots 156,900.00
102. Personal property 402. Personal property
103. Settlement charges to borrower(line 1400) 5,868.75 403.
104. 404.
105. 405.
Adjustments for Items paid by seller in advance Adjustments for Items paid by seller in advance
106. Cityltown taxes to 406. City/lown taxes to
107. County taxes 12121/2012 to 12131/2012 14.54 407. County taxes 12/2112012 to 12/3112012 14.54
108. School taxes 12/21/2012 to 06/30/2013 747.76 408. School taxes 12/21/2012 to 06/308013 747.76
109. 409.
110. 410.
111. 411.
112. 412.
120. Gross Amount Due from Borrower 163,531.05 420. Gross Amount Due to Seller 157,662.30
200. °AniountsPaid;b:or;in Behalfof<Borrower
5t)0.:.;RdduCtipne lit�,Ani�trtt��IirletoSsller.
201. Deposit or earnest money 2,500.00 501. Excess deposit(see instructions)
202. Principal amount of new loan(s) 125,520.00 502. Settlement charges to seller(line 1400) 18,237.71
203. Existing loa s taken subject to 503. Existing 1 s taken subject to
204• 504• Payoff of first mortgage ban 8000003668610012 to 7,217.74
Members 1st FCU
205. Application Deposit Refund 400.00 505. Payoff of second mortgage loan 800000368861'0015 47,047.27
to Members 1st FCU
206. 506.
207. 507,
208. 508.
209. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210. City/town taxes to 510. City/town taxes to
211. County taxes to 511. County taxes to
212. School taxes to 512. School taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid b Hor Borrower 128,420.00 520. Total Reduction Amount Due Seller 72,502.72
300 Cash at:Slattlement:frofiltoBorrower-; 600.;:sCasli of S�tleierit_tolNii+sdlitar
� f )
1
L.Settlement Charges
7110. Total.Real Estate:Broker Fees $.9,939.00:.
POl d Frflm.
Division of commission iine_700 gas-follows: BOTt"tilNer$'.'. �1FQt'S
701. $4,932.00 to Prudential Homesale Services Group F}Ixidl9 •: Ftr1l5t;
702. $5,007.00 to Cotdwdl Banker Select Professkmas `�S ttC T11 " = $ ttlet t"fiat_:
703. Commission paid at settlement 300.00 9,639.00
800-,.;6etno We
801. Our origination charge (Includes Origination Point 0.000%or$0.00) $770.00 (from GFE#1)
802. Your credit or charge(pants)for the speditc interest rate chosen $ (from GFE#2)
803. Your adjusted origination charges (from GFE A) 770.00
844. Appraisal fee to Central Penn Apprajsals (from GFE#3) 400.00
805. Credit report to Kroll Factual Data (from GFE#3) 15.50
806. Tax service to Mortgage Master Inc. (from GFE#3) 80.00
807. Flood certification to Corel is (from GFE#3) 8.00
,BOB. to
900,-.;Items R uffed ti vt:iirider�to;be:Paid in Advancrr ;: �' ,
901. Daily Interest charges from from 12021/2012 to 01/01/2013 11.7675/day (from GFE#10) 129.44
902. Mortgage insurance premium for months to (from GFE#3)
903. Homeowner's insurance for 1 years to Liberty Mutual Ins. $412.00 P.O.C.B (from GFE#11)
904. months to from GFE#11
1001.Initial deposit for your escrow account (from GFE#9) 939.81
1002.Homeowner's insurance 3 months $ 34•33/month $102,99
1003.Mortgage insurance months $ 0.001month $
1004.Property taxes months @$ 0,00/month $
1005.County taxes 11 months @$ 40.321month $443.52
1006.School taxes 7 months @$ 118.461month $829.22
1007.Aggregate Adjustment -$-435.92
1100.Title Cha
1101.Title services and lender's title insurance from GFE#4 1,342.00 170.00
1102.Settlement or dosing fee to $
1103.Owner`s title insurance-Title Resources Guaranty Company from GFE#5 155.00
1104.Lender's fide insurance-Tide Resources Guaranty Company $1,255,00
1105.Lender's tide policy limit$125,520.00 Lender's Policy
1106.Owner's title policy limit$156,900,00 Owner's Policy
1107.Agents portion of the total tide insurance premium $1,157.25
to Guardian Transfer Corporation
1108.Underwriter's portion of the total title insurance premium $252.75
to Title Resources Guaranty Company
1109.
1200:13ovemment Recotdln endTraneferClta es
1201.Government recording charges $ (from GFE#7) 160.00
1202.Deed$62.00 Mortgage$98.00 Release$
1203.Transfer taxes i $ (from GFE#8) 1,569.00
1204.City/County taxistamps Deed$1569.00 Mort $
1205.State Tax/stamps Deed$1,569.00 Mortgage$ 1,569.00
1206. Deed$ Mat $
1207. $
1300.:Additionat.Settlement Cha es.
1301.Required services that you can shop for (from GFE#6)
1302.Final Sewer to Silver Spring Township Authority 95.
1303.Home Warranty to American Home Shield 600.Cq
1304.Inheritance Tax Escrow to Guardian Transfer Caporation
1305. to
5,868.75 18,237.71
'Paid outside of closing by(B)orrower,(S)eller,(L)ender,(I)nvesta,Bro(K)er.*"Credit by lender shown on page 1."`Credit by seller shown on page 1.
1
i I
°/C�btyyn
..�iltO
nxi6auort, 770.00 770.00
YourCr� v(,cft�r9e P� ..
Yoi�0adjtt�W101 i v ,
000 000
'% 770.00
- ,j 770.00
°_Transfet>ttazes 4 °«' a
.:.'. %�L� ;t«�, ••. :; 1,570.00 1,569.00
�M r tSlnpb ':
' 150.00 160.00
400.00 400.00
25.00 15.50
80.00
80.00
T. Will
8.00 8.00
1,460.00 1342.00
160.00 155.00
Total 2,283.00 2,160.50
Inciease• 5 -122.50 -5.3657%
k� .•i•'Y
In W'.
tni.' d 2,316.00 939.81
Ho
152.98 129.44 rneew,nefs�ns
y -.•,. 0.00 412.00
y
I.?y�Nf+.Y�:z� }�:, d -w�::fi:•x,>N1�.'/ .:•4'L:sr+cT.K:....
Loan Terns
$125,520.00
tYF� >
30.years
;u
YAnt��n 3.3750%
Y rTnitl� ifoRtlaT $554.92 includes
Principal
al t QX Interest
2 .iY:
F' }{Y:�, ' ❑Mortgage Insurance
Cen'yioptlRteSt [X No. ❑Yes,it can rise to a maximum of %. The first change
will be on and can than air change again every years after I / Every change date,your interest rate can increase or decrease by %. Over the Iffe of
,,,"�' °y,.• the loan,your interest rate is guaranteed to never be lower than %or higher
than %.
a� :.. ❑X No. ❑Yes,it can rise to a maximum of$
Evert:i frgtmaC �X No. ❑Yes,the first increase can be on I / and the monthly
pri "�aClntets" �rrft r amount owed can rise to$
The maximum it can ever rise to is$
XO No. ❑Yes,your maximum prepayment penalty is$
QX No. ❑Yes,you have a balloon payment of$ due in
TotaY"illy;T l r� ^ ❑You do not have a monthly escrow payment for items,such as property taxes
and homeowner's insurance. You must pay these items directly yourself.
You have an additional monthly escrow payment of$193.11
that results in a total initial monthly amount owed of$748.03. This includes principal,interest,any
mortgage insurance and any items checked below:
❑Property taxes QX Homeowners insurance
El
�F• Flood insurance
pia. rcv,�
County/Twp taxes 0 Scholl taxes
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender.
i
Signature ;
HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HUD4 Settlement Statement and to the best of my knowledge and belief,it is a true and accurate statement of all receipts and
disbursements made on my account or by me in this transaction I further certify that 1 have received a copy of the HUD-t Settlement Statement.
Bu ers
100 1,001
dmundo Guadarrama Galeana enn' and-Gtr ma
T e State a 10,UavtO A Berkebilb,Executor
The HUD-t Settlement Statement which t have prepared is a true and accurate account of this transaction I have caused or will cause the funds to be
disbursed in accordance with this statement.
SETTLE ENT aAGENTA DATE
MW
� r
temization of
Name of Borrower: Name of Seller: File Number.
Edmundo Guadarrama Galeana The Estate of Phyllis Berkebile,David A Berkebile, 12-1795GC
Jennifer Ward-Guadarrama Executor
Prepared 12121/2012 at 12:23 pm
Note:This page displays an itemization of the charges shown on line 1101 of the HUD-1 Settlement Statement.This page
accompanies but is not a part of the HUD-1 Settlement Statement.If a discrepancy exists,the Information on the HUD-1 Settlement
Statement applies.
1100 TitleChargits Total Charge ,BorXeWer Salley;
1101.Title services and lender's title insurance to
Wire In to Guardian Transfer Corporation $ 12.00 12.00
Notary Fee-Purchasers to Guardian Transfer Corporation $ 25.00 25.00
Courier Fee-Purchase to Guardian Transfer Corporation $ 15.00 15.00
Electronic Document Fee to Guardian Transfer Corporation $ 35.00 35.04
Notary Fee sellers to Guardian Transfer Corporation $ 20.00 20
Courier Fee-SEllers to Guardian Transfer CoMoration $ 15.00 15.
Tax Cart REimbursement FEe to Guardian Transfer Corporation $ 10.00 10.
Deed Prep Fee to Guardian Transfer Corporation $ 125.00 125.
1102.Settlement or closing fee to $ 0.00
1104.Lender's title insurance-Title Resources Gto Title Resources guaranty COMIX$ 1,255.00 1,255.04
Totals: 1,51200 0.001 1,342.00 170.
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