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03-20-13
J i EX(01-10) 1505610143 REV-1500 OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes OFRARTMaNT OF Ra°aRUR PO BOX.280601 INHERITANCE TAX RETURN 21 12 0254 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 02 20 2012 03 01 1922 Decedent's Last Name Suffix Decedent's First Name Ml MAURER JOHN g (If Applicable)Enter Surviving Spouse's Information Below li Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return r j 2. Supplemental Return �l❑ 3. Remainder Return(date of death prior to 12-13-82) 4. Limited Estate n 4a Future Interest Compromise p T 5. Federal Estate Tax Return Required (date of death after 12-12-82) DX B Decedent Died Testate 7 Decedent aint rued a Living Trust i—i M (Attach Copy of will ❑ (Attach Copy of rust) --_ 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Remi etl 10 Spousal Povert predit(date of death ❑ �—' �� ' between 12-31 X37 and T-1-95) 11.Election to tax under Sec.9113(A) (Attach Sch.0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAN M WILEY 7c267 432 :9'66 fb m rn m RGISTER OF*LLS�,XQ-ONLY First line of address f n1 r-0 Y,I rT 3 N BALTIMORE ST Second line of address ;1 Fill , City or Post Office DAT6 LEDary rl State ZIP Code DILLSBURG PA 17019 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 best of my knowledge and belief, File We,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge SIGNA�TT E OF PERSOTPONSIB FOR F IN RETURN DATE YE, p/(, j�� Anne M. Grable ADDRESS 116 If Drive Mechanicsbur PA 17055 SIGNATU OF PREPARER OTHER TH)N REPRESENTATIVE DATE Jan M Wiley CADDRESBaltimore St., Dillsbur , PA I Side 1 1505610143 1505610143 1 1505610243 _J REV-1500 EX Decedent's Social Security Number oeoeaems Name. Maurer, John F. RECAPITULATION 1. Real Estate(Schedule A)........ ............ ..__ ___.._ 1. 134 , 500 . 00 2. Stocks and Bonds(Schedule B).................. ............._..............,........ .___........ 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3. 6 , 373 . 04 4. Mortgages&Notes Receivable(Schedule D).................................._...._....-........ 4. 5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E). , - ... 5. 1 , 163 , 399 . 25 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested......,,._. 6. 39, 587 . 66 7. Inter-Vivos Transfers&Miscellaneous NtProbate Property (Schedule G) Separate Billing Requested,........... 7, 8. Total Gross Assets(total Lines 1-7).......... ......_.....,... .._ .. ...._ . . 8. 1 , 343 , 860 . 15 9. Funeral Expenses&Administrative Costs(Schedule H). __...... ......... 9. 94 , 452 . 25 10. Debts of Decedent, Mortgage Liabilities, &Liens(Schedule p_...__..................... 10. 29 , 681 . 04 11, Total Deductions(total Lines 9& 10)........ .__...... ......... _..... 11 124 , 133 . 29 12, Net Value of Estate(Line 8 minus Line 11) .._._. ..__. ......... 12. 1 , 219 , 726 . 86 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. 1 , 219, 726 . 86 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec.9116 15 0 . 00 (a)(1.2)X .00 16. Amount of Line 14 taxable 1 , 219 , 726. 86 16. 54 , 887 . 71 at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17 0 . 00 18. Amount of Line 14 taxable at collateral rate 15 0 ' 00 18. 0 . 00 19. Tax Due.........................................................,..............._.._ 19. 54 887 . 71.................,........,.,...... � I 20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Ii Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-12-0254 Decedent's Complete Address: DECEDENT'S NAME Maurer, John F. STREETADDRESS 711 S. 21st Street CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 21 Line 19) (1) 54,887.71 2. Credits/Payments A. Prior Payments 50,500.56 B. Discount 2,657.92 Total Credits(A + B) (2) 53,158.48 3. Interest (3) 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 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. (5) r 729,23 '.. I P Make CheckP Payable to: REGISTER OF WILLS AGENT.) 4 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;.,......,.. .,.,... __._. 11 1 ___.._.. ❑ ❑ b. retain the right to designate who shall use the property transferred or its Income _.. ....... _. I ❑ 9 P P Y c. retain a reversions interest, or. _. .__.., __. d. receive the promise for life of either payments, benefits or cares .......... __._.. ..__._ _._. r ❑ 2. If death occurred after December 12, 1962 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?..,.. _..... .,_..._. 1 11 11.__..'.. ......__.. ........... _ 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 dales of death on or after January 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)11)(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 1.2)[72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent 172 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. f Rey-1502 E%+(11-08) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Maurer John F. 21-12-0254 All real property owned solely or as a tenant In common must be reported at lair market value.Pair market value Is defined as Inc price at which proporty woi ld be I 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 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Property situate at 711 S. 21st Street, Camp Hill 134,500.00 I i I I TOTAL(Also enter on Line 1, Recapitulation) 134,500.00 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) Rev-1803 EX«(8-98) SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR COMMONWEALTH OF PENNSYLVANIA SOLE-PROPRIETORSHIP INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Maurer John F 21-12-0254 i Schedule C I or C-2(Including all supporting Information)must be attached for each closely-held corporabompartnership Interest of the decedent other than e sole-proprietorship See Instructions for the supporting Information to be submitted for sole-proprietorships. I ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Met Life Stock 6,373.04 TOTAL(Also enter on Line 3, Recapitulation) 6,373.04 III (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 C(Rev.6-98) Rev-0666 E%+(6-96) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX Iii RESIDENT DECEDENT ESTATE OF FILE NUMBER Maurer, John F. 21-12-0254 Include the proceeds of litigation and the dale the proceeds were received by the eeldle. All property jointly-owned with the right of survivorship must be disclosed on schedule F. it ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Members 1st CD 41068.42 123,539.50 2 Members 1 at CD 41068-43 155,263.22 3 Members 1st Savings 41068-00 45.00 4 PNC Investments (Including Allstate) 491,125.05 5 Susquehanna Bank CD 403500002346 45,626.46 6 Wells Fargo CD 54681181 65,767.43 7 Personal Property-Fahnestock's auctions 1,680.00 8 Jackson National Life Insurance 124,613.17 9 New York Life Annuity 122,156.71 10 New York Life Insurance 33,562.71 sill I TOTAL (Also enter on Line 5, Recapitulation) 1,163,399.25 l (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-1609 EX-(6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Maurer John F 21-12-0254 If an asset was made joint within one year of the decedent's date of death,It must be reported on schedule G. I SURVIVING JOINT TENANTS)NAME ADDRESS RELATIONSHIP TO DECEDENT A. I B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'$ DECEDENT INTEREST NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSET INTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. 1 PNC Checking Account 5005788178 79,175.71 50.000% 39,587.86 I it I TOTAL (Also enter on Line 6, Recapitulation) 39,587.86 (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 F(Rev. 6-98) REV-1151 EX.(10-06) SCHEDULE H CoMr ��7qqLry�{{EgF,e $R' NANIA FUNERAL EXPENSES & TENT O€L�o �1vr ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Maurer, John F. 21-12-0254 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: li See continuation schedule(s)attached 5,830.97 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Anne M. Grable Street Address 116 Holly Drive City Mechanicsburg State PA zio 17055 Year(s)Commission paid 44,000.00 2. Attorney's Fees The Wiley Group, PC 44,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State zio Relationship of Claimant to Decedent 4. Probate Fees 335.50 5. Accountant's Fees 6, Tax Return Preparer's Fees 7. Other Administrative Costs 265.78 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 94,452.25 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Maurer, John F. 21-12-0254 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Funeral Expenses 5,830.97 H-A 5,830.97 Other Administrative Costs 2 H 3 Cumberland Law Journal 75.00 4 The Sentinel 210.78 H-B7 285.78 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-96) I Rev-1512 EX.(12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT(DECEDENT ESTATE OF FILE NUMBER Maurer, John F. 21-12-0254 Report debts Incurred by the decedent prior to death that remained unpaid at the date of death,Including unreimbursed medical expenses. III ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH �I 1 Insurance 615.00 2 Medical Expenses 14,155.33 3 PAWA 314.51 4 PP&L 230.62 5 Repairs 12,302.51 6 Sewer 110.00 i 7 Taxes 1,738.17 8 Trash 107.90 9 UGI 107.00 TOTAL(Also enter on Line 10, Recapitulation) 29,681.04 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08) REV-1513 EX.(11-0a) SCHEDULE J CdM OAWT N R1x^"'" BENEFICIARIES ESTATE OF FILE NUMBER Maurer, John F. 21-12-0254 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT o List (Words) ($$$) TAXABLE DISTRIBUTIONS [include outright spousal I. distributions,and transfers Ili under Sec.91 16 a 1.2 Anne M.Grable Daughter 1,219,726.86 116 Holly Drive Mechanicsburg, PA 17055 i Total 1,219,726.86 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1560 cover sheet, as approPr iate. 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 COVER SHEET Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 11-08) trinst Will UnA C� t�xrrr�nt OF JOHN F. MAURER BE IT REMEMBERED,that 1,JOFIN F.MAURER,of711 S.21"Street,Camp llill, Pennsylvania,being of sound mind,memory and understanding,do make, publish and declare this es and fur nry Lust Will and I e;ttuncnt,hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1_, 1 direct that all my just debts and funeral expenses be paid as soon after my demise as tray be convenient. ITEM 2: All the rest, residue and remainder of my estate,of whatsoever nature and whcresuever situate,whether it be real,personal or mixed,including property over which I have a power of appointment, I give,devise and bequeath unto my daughter,ANNE M.GRABLE. Should my daughter,ANNE M. GRABLE, predecease me, I then give,devise and bequeath my entire residuary estate unto my son-in-law, WILLIAM 1). GRABLE. ITEM 3. I direct my hereinafter named Executrix to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise passing by reason of demise,may be subject and to charge such taxes against my residuary estate, it being my intention that none of the ❑Ihresaid taxes_ either Ibdcrul or state, on any property required to be included in my gross estate, under the provisions of-any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom anv benefit accrues. ITEM 4. I appoint my daughter. ANNE M. GRABLE, as Executrix of this my Last Will trod Testament. Should my daughter predecease me, fail to qualify, cease to act or renounce probate, I then appoint my son-in-law, qZ1 as contingent Executor of this my Last Will and l estament, ITEM 5. 1 direct that my Executrix other successor shall not be required to give bond Iorthe faithful performance of their duties in any jurisdiction. Page I of 3 ITEM 6• My Personal Representatives shall have the following powers in addition to those vested in them by Law and by other provisions of this, my Last Will and l estament. exercisable without court approval,and effective until distribution of all property: I. To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized tot Pennsylvania fiduciaries, as they hum time to time may deem proper,without regard to any principal ofdiversification or risk, 2. To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries, as they from time to time may deem proper, without regard to any principal of diversification or risk. 3. t o sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they from time to time may deem proper. 4. '1-o allocate receipts and expenses to principal or income or partly to each as they from time to time may deem proper. 5. 1 o borrow money from persons or institutions,themselves included,and to mortgage or pledge any of all real or personal property as they in their sue discretion shall choose,without regard to the dispositive provisions of this instrument. 6. To compromise any claim or controversy asserted by or against my estate or trust estate. 7, to make distribution in cash or in kind or partly in cash and partly in kind, and in such manner as they may determine, and at valuations linally to he 1ixcd by them- IN WITNESS WIIERLOV I have hereunto set my hand and seal this 21"day of.luly, 2011. 'I'I'NF?SS: Ll, (SEAL) JOIN4. MAURER p I Page 2 of 3 , COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF YORK Wc, JOHN F. MAURER, JAN M. WILEY,, ESQUIRE and M. SUSAN McMICHAEL, the 'testator and the witnesses respectively, whose names are signed to the attached of foregoing instrument, being first duly sworn,do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and,testament and that he had signed willingly (or willingly directed another to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed,and that each of the witnesses. in the presence and hearing of the"testator, signed this bast Will and Testament as witness and that ki the best of their knowledge the Testator was at the time eighteen(18)years ufage ur older, of sound mind and under no constralifl.Or undue influence. JOHN F. MAURER I'l F,SS Ml WITNESS Sworn to and subscribed before me this Z l'i day of Jul}',201 1- A}j"—�� NOTARY PUBLIC MY COMMISSION EXPIRES. CO_M_MONWEALTH OF PENNSYLVANIA I Noanai seal 5.Dawn Giatllellar Notary Puplic Dulsberg F)orp,York County My Commission Explrea May 1I,y013 Member,Pennsylvania Association of Notaries Page 3 of 3 Allstate You're in good hands. May 30, 2012 Ms. Holly O'Hara PNC Investments 4242 Carlisle Pike Camp Hill, PA 17011 Via Email: holly.chara @pnc.com Re: John F. Maurer Contract No: GA16879436 Dear Ms. O'Hara: We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. 1 can, however, provide the following information for estate purposes: of Death: February 20, 2012 Annuity Value as of Date of Death: $ 111,573.95* Basls: $ 87,633.00 Named Beneficiary: Ann M. Grable *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 24522. Sincerely, Lin Breckler Sr. Claim Examiner Allstae Life Insurance Comp�:ny, Life and Annuity Claims P.O. Box 94212, Palatine, IL 60094-4212 Phone 877-499.6418 Fax 866-635-4523 alma ml�z zz 0 z m 7 < z0oa 7. q 77 r mt" ZKW 00 mmxr 0 am > m x Y tlj vd 03 > > (n 3 M , E zz > > > < < w W m E ff Z G) Z M > :13 > m CO < m O > rn 3 �M200 Z mom Ln 0 UO) V-Al m T O O w X n ': T Z m O o g o _ oZ m _ n n n W D oZ m ... c m 3 Z D ZO J m N _ D . _ 0 > � - fJ O T (A 69 EA � _ W fD ffi A N N N cn t➢ u� C '. _ � OOi 0 0 N O �' c 69 fA E9 O O V . M fA to e � EA fA 69 W W W O O w O W w 0 O D O n o n ` D q O � r m l � _ v n � wN o = IJ Vt O NO (n W W V OJ N O C N m m W W W C yy Ir _ cm m ZD E Cc w b o N v: � N I ° � O a 9 O 3 F o G F = n 3 b 7 F F I A O 3 v N m m F m m b 0 w o p A n O I (t1 to w b c � — — 3 b 0 v Jp I Dr r 3 � " C ° � n •' o iZD a .ate v v o°- N N x �� �_ •.Cdy, ti p o v o - ° T D N aO V2 n T -o n G Nma \5 i 0 b fn F a n d q m n O VOO I D °n° 3 = G N D b M 7 � O ° b \v 0o MI vc m z� m f� I 377 0 V7 G� O °wm m 7. O r rt I D I } s �j zO zOm o z° � z D W Z Z o Q i va ov o3a 4 0 0 0 j B f " N N ti 13 3 �° _ o f T ovo zR va n j 7 I o m i I 3 i } 22 � 2 * ! 2k m / ) } � > 2 ! � \ 22 f! 2 \ - ! ) = 7 \ \ �\ © k ! ± _ . � ) \ ) ( \ (\ ) ) Cc \ \ \ \ 0 2 Winner of the Dalbar Service Award « from 2000-2010 , �„«...June 5, 2012 v'q ���ck� Jan Wiley, Esquire The Wiley Group 3 N. Baltimore Street Dillsburg, PA 17019 Policy Number: 75618779 Decedent: John F Maurer To Whom It May Concern: Thank you for your recent inquiry regarding the date of death value on the above policy. • The death claim payment was processed 03/07/2012 in the amount of$122,156.71. to the beneficiary Anne M Grable. • The amount of federal tax withheld was $1,593.16. • The taxable amount was $15,988.72. If you have any questions, our Client Services Representatives are available Monday through Friday from 8:30a.m. to 5:30p.m. Eastern Time at 1-800-762-6212. Sincerely, ! + Nichelle Church Senior Service Assistant New York Life Annuity Service Center•P.O. Box 9859•Providence, RI 02940• 1-800-762-6212 Annuities are issued by New York Life Insurance and Annuity Corporation(NYLIAC) (A Delaware Corporation) Variable annuities are distributed by:NYLIFE Distributors LLC, Member FINRA/SIPC NYLIAC and NYLIFE Distributors LLC are wholly owned subsidiaries of New York Life Insurance Company 51 Madison Ave, New York, NY 10010 2012-04-0411:35 Grable 7176971634» P115 II PERSONAL PROPERTY APPRAISAL for the John F. Maurer Estate April 2, 2012 Prepared by Nevlo Fahnes ock's Auction Service 495 Pisgah Mate Road Shortnans Dale, Pa 17090 717-582-8565 2012-04-0411.35 Grable 7176971634» P215 PERSONAL PROPERTY APPRAISAL for the .John F. Maurer Estate April 2, 2012 Prepared by Nevin Fahnes ock's Auction Service 495 Pisgah State Road Shamans Dale, Pa 17090 717-582-8565 201204-0411:35 Grable 7176971634» P315 Nevin Fahnes ock' s Auction Service 495 Pisgah State Road Shermans Dale, Pa 17090 717-582-8565 April 2. 2012 John F. Maurer Estate 711 S. '21" St. Carnp Hill, Pa 17011 Bedroom No.l 1. 3pe BR suite 150.00 2. Large wall mirror 30.00 3. Misc contents 50.00 Bedroom No. 2 1. Twin bed, box spring& mattress 75.00 2. Dresser& matching chest 100.00 ±. Misc contents 75.00 I,ivine Room 1. Sofa& matching arm chair 25.00 2. Comer table wldropleat, 50.00 Lamp stand 20,00 4. 4-table lamps 25.00 5. Misc Contents 35,00 Dining room I. Pine hutch 75,00 2. Dropleal'diningtable 50.00 3. 2-Captain chairs 30.00 4. Deacxm bench 40.00 Great room 1. 7-press board book cases 50.00 2 2-4 drawer metal tiling cabinets 25.00 ?. 6-metal folding chairs 30.00 I ' 2912-^4-0411:36 Grable 7176971634» - P415 4. Misc contents 50.00 Basement contents 500.00 Storaee shed 1. Toro 421 QF, snowblower w/electric start 200.00 2. Sears 5.5hp lawn mower 50.00 3. Misc contents 50.00 Total $1680.00 2912-04-0411:36 Grable 7176971634» P515 it The prices quoted above are based on my 23 years experience as an auctioneer. It is my opinion, the estimated price could be realized if the merchandise was offered at public auction. Nevin Fahnestock auctioneer/appraiser I Susquehanna ",ot March 22, 2012 „......, ..o,, 26 North Cedar Street P.O. Box 1000 Lititz,PA 17543-7000 Tel 1.800.311.3182 THE WILEY GROUP Fax 717 625,4478 3 N BALTIMORE STREET DILLSBURG PA 17019 RE: John F Maurer Estate DOD: 2/20/12 SS#: XXX-XX-8385 Tracking # 266685 To Whom It May Concern: In response to your letter of March 16, 2012, here is the above customer account information as of February 20, 2011 • Account Title: John F Maurer Anne M Grable POA 8/11/11 • Account Type/# CD 403500002346 • Date Opened/ Maturity 5/21/07 - 6/21/12 • Interest Rate: .45% • Account Balance*: $45,609.64 • Accrued Interest: $16.82 • YTD Interest: $17.40 *Account balance does not include accrued interest. ® There is no safe deposit box in the name of the decedent. If I can be of further assistance, please feel free to call. Sincerely, Dawn M Berrier Deposit Research - Reporting Department Lead 1-717-625-6546 DMB/aem ' 1i'inncr orrhe Dalbar Service Award j from 2000-201(1 April 5. 2012 Jan Wiley, Esquire The Wiley Group 3 N. Baltimore Street Dillsburg, PA 17019 Policy Number: 75613457 Decedent: John F Maurer To "A%hom it May Concern: Thank you for your recent inquiry regarding the date of death value on the above policy. • As of February 20. 2012 the value of the above-referenced policy was $33,582.71. • The policy was opened July 22, 2009. • The policy was a single owned non-qualified Lifetime Income Annuity if you have any questions, our Client Services Representatives are available Monday through Friday from 8:30a.m. to 5:30p.m. Eastern Time at 1-800-762-6212. Sincerely, - I - ' i Nichelle Church Senior Service Assistant New York Life Annuity Service Center• P.O. Box 9859• Providence, RI 02940• 1-800-762-6212 Annuities are issued by New York Life Insurance and Annuity Corporation(NYLIAC) (A Delaware Corporation) Variable annuities are distributed by NYLIFE Distributors LLC, Member FINRA/SIPC NYLIAC and NYLIFE Distributors LLC are wholly owned subsidiaries of New York Life Insurance Company 51 Madison Ave.. New York, NY 10010 JAC KS ,,�DN NAFIONAt. tIVE INSURANCI COMPANY April 30. 2012 Your representative: THL WILEY GROUP, P.C. GREGORY T MALIN ATFORNF.YS AT LAW C/O FULTOIV BANK, N.A. 3 N BALI (MORE STREET 3344 TRINDLE RD DILLSBURG PA 17019 CAMP HILL, PA 1 701 1-4453 Phone: (717) 763-2098 Policy Number(s): 1001456250 Insured Name: John Maurer Dear Jan M Wiley: Pleasc extencl our condolences to the family of John Maurer. We are available for any questions you may have. Thank you for your request. The value as of February 20, 2012 was $124,613.17. The cost basis was $101 ,805.90. John F Maurer was the sole owner and the issue date was November 16, 2004. Your service needs are very important to us. If you have additional questions or concerns, please contact our Service Center at (888) 565-4995, Monday through Thursday, 8:00 a.m. to 7:00 p.m. and Friday 8:00 a.m. to 6:00 p.m. (ET). You may also contact Jackson via email through "Contact Us" on our website at www.jackson.com. Sincerely, Toni Zvonar, AVP, Claims Administration cc: GREGORY T MALIN Jackson Service Center 1 Corporate Way, Lansing MI 48951 Toil Free Number: 800-777-7779 Email at CustomerCare @jackson.com; Om- Websile is wlvvv.jacksun.com FIODGeAJ;CLBLNF is, MEMBERS I" FEDEkA LCREDU UNION SAVINGS ACCOUNT: Account Number/Suffix 41068-00 Date Account Established 05/18/1984 Principal Balance at Date of Death $45.00 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest $45.00 Name of Joint Owner None CERTIFICATES OF DEPOSIT: Account Number/Suffix 41068-42 41068-43 Date Account Established 01/14/2003 06/07/2004' Principal Balance at Date of Death $123,241.19 $155,024.36 Accrued Interest to Date of Death $298.31 $238.86 Total Principal and Accrued Interest $123,539.50 $155,263.22 Name of ,joint Owner None None 'Opened by transfer of funds from 41068-00. ME B RS 1ST F DERAL R T UNION Danielle A. Kline Lending Insurance Support Specialist March 22, 2012 Estate of: JOHN F. MAURER Date of Death: 02120/2012 Social Security Number: 179-16-8385 5000 Louise Drive • Y.O. Box 40 • Mechanicsburg, Pennsylvania 17055 • (800) 283-2328 • www.membersl sc.org PVC LEADING THE WAY March 27, 2012 Jan M Wiley Esq. The Wiley group 3 N Baltimore St Dillsburg, PA 17019 RE: John F Maurer SSN: 179-16-8385 DOD: 02-20-2012 Dear Sir/Madam: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking Account Account# 5005788178 Established: 07-20-2011 J014N F MAURER ANNE GRABLE DOD balance: $ 79,175.22 + 0.49 accrued interest Interest paid 01.01-2012 thru 02-20-2012 $ 0.80 YTD Investment Account The decedent maintained Investment Account# 5304980 . For further information,you may call the Brokerage Department at 1-800-762-6111. Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK(1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Page I of 2 This message iy intended for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader oj'this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient,you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited. If you have received this communication in error, please notify me immediately by reply or by telephone at 800-762-1775 anti immediately destroy this faxed document. Pace 2 of 2 LISTING CONTRACT (SELLER AGENCY CONTRACT) XLS EXCLUSIVE.RIGHT TO SELL REAL ESTATE 1 Broker(Company) s CtR:i..0 Licensee(s) (Name) 2 3 Company Address Cl Direct Phone(s) 4 Cell Phone(s) `l I. — .S (— . 5 Company Phone — — Fax 6 Company Fax L4 -- — Of )4 c�, s Email ob �[Q 7 SELLER e -i N 4 u C I— U 8 9 SELLER'S MAILING ADDRESS d o.1 CM Z kt3GP_ r X t 10 1l PHONE _...._ 1 t --1 — Lo, o { _ FAX 12 E-MAEL 13 Seller understands that this Listing Contract is between Broker and Seller. 14 Does Seller have a listing contract for this Property with another broker? ❑ Yes o 15 If yes,explain: 16 I. PROPERTY LISTED PRICE$ 17 Address ZIP 1 7 p 18 Municipality(city,borough,townshi ) 19 County School District 20 Zoning C ri 21 Present Use 22 Identification(For example,Tax r IUD#;Parcel#;Lot,Block;;D�Ged Book,+Page,Recording Date) 23 l 0 3�— ` B ;Q z e g q �l 1 24 2. STARTING& ENDING DATES OF LISTING ONCNTTRACT(ALSO CALLED "TERM") 25 (A) No Association of REALTORS®has set or recommended the term of this contract. Broker/Licensee and Seller have discussed 26 and agreed upon the term of this Contract , 27 (B) Starting Date: This Contract starts when signed by Broker and feller,unless otherwise stated here: � ) cd 28 (C) Ending Date: This Contract ends at 11:59 PM on r C 112 .By law,the term of a listing contract may not 29 exceed one year. If the Ending Date written in this Contract creates a term that is longer than one year, the Ending Date is au- 30 tomatically 364 days from the Starting Date of this Contract. 31 3. DUAL AGENCY 32 Seller agrees that Broker and Broker's Licensees may also represent the buyer(s) of the Property. A Broker is a Dual Agent when a 33 Broker represents both a buyer and Seller in the same transaction. A Licensee is a Dual Agent when a Licensee represents a buyer 34 and Seller in the same transaction. All of Broker's licensees are also Dual Agents UNLESS there are separate Designated Agents for 35 a buyer and Seller. If the same Licensee is designated for a buyer and Seller, the Licensee is a Dual Agent. Seller understands that 36 Broker is a Dual Agent when a buyer who is represented by Broker is viewing properties listed by Broker. 37 4. DESIGNATED AGENCY 38 Designated Agency is applicable,unless checked below. Broker designates the Licensee(s) above to exclusively represent the inter- 39 ests of Seller. If Licensee is also the buyer's agent, then Licensee is a DUAL AGENT. 40 ❑ Designated Agency is not applicable. 41 5. BROKER'S COMMISSION 42 (A) No Association of REALTORS® has set or recommended the Broker's Commission. Broker and Seller have negotiated the 43 commission that Seller will pay roker. 44 (B) Broker's Commission is t q %of the sale price OR$ / ,whichever is greater,AND$ 45 paid to Broker by Seller as follows: 46 1. $ of Broker's Commission is earned and due (non-refundable) at signing of this Listing Contract, 47 payable to Broker. c_ 48 Broker/Licensee Initials:'? XLS Page 1 of 6 Seller Initials: L L Jack Gaughen REALTORS ERA-Dillsburg 19 North Baltimore Street Dillsburg,PA 17019 Phone.(717)432-0029 Fax (717)432-0042 Blake Miller Untitled Produced with 2,pFOrn✓C dy zip LOg,. 16070 Fifteen We Road,Fraser,Michigan 48026 wwri.=Lod,corn 49 2. Seller will pay the balance of Broker's Commission if: 50 a. Property, or any ownership interest in it, is sold or exchanged during the term of this Contract by Broker, Bro-', 51 ker's Licensee(s), Seller, or by any other person or broker, at the listed price or any price acceptable to Seller, OR,',. 52 b. A ready, willing, and able buyer is found, during the term of this contract, by Broker or by anyone, including Seller. A'' 53 willing buyer is one who will pay the listed price or more for the Property, or one who has submitted an offer accepted', 54 by Seller, OR 55 c, Negotiations that are pending at the Ending Date of this Contract result in a sale,OR 56 d, A Seller signs an agreement of sale then refuses to sell the Property, or if a Seller is unable to Sell the Property because 57 of failing to do all the things required of the Seller in the agreement of sale (Seller default),OR 58 e. The Property or any part of it is taken by any government for public use (Eminent Domain), in which case Seller will pay 59 from any money paid by the government, OR 60 f. A sale occurs after the Ending Date of this Contract IF: 61 (1) The sale occurs within _ �`g0 D1 �\ S of the Ending Date,AND 62 (2) The buyer was shown or negotiated to buy the Property during the term of this contract,AND 63 (3) The Property is not listed under an "exclusive right to sell contract" with another broker at the time of the sale. 64 (C)If a sale occurs, balance of Broker's Commission will be paid upon delivery of the deed or other evidence of transfer of title or interest If the 65 Property is transferred by an installment contract, balance of Broker's Commission will be paid upon the execution of the installment contract. 66 6. BROKER'S COMMISSION IF SETTLEMENT DOES NOT OCCUR 67 If an agreement of sale is signed and settlement does not occur, and deposit monies are released to Seller, Seller will pay Broker 68 of/from deposit monies. 69 7. COOPERATION WITH OTHER BROKERS 70 Licensees) has explained Broker's company policies about cooperating with other brokers. Broker and Seller agree that Broker will pay from 71 Broker's Commission a fee to another broker who procures the buyer, is a member of a Multiple Listing Service(MLS),and who: 72 (A) presents Seller(SUBAGENT). Broker will pay J% of/from the sale price. 73 (B) epresents the buyer(BUYER'S AGENT). Broker will pay r � of/from the sale price. 74 A buyer's Agent,even if compensated by Broker for Seller,will represent the interests of the buyer. 75 (C) ❑ Does not represent either Seller or a buyer(TRANSACTION LICENSEE). 76 Broker will pay of/from the sale price. 77 8. DUTIES OF BROKER AND SELLER 78 (A) Broker is acting as a Seller Agent, as described in the Consumer Notice, to market the Property and to negotiate with potential 79 buyers. Broker will use reasonable efforts to find a buyer for the Property. 80 (B) Seller will cooperate with Broker and assist in the sale of the Property as asked by Broker. 81 (C) All showings, negotiations and discussions about the sale of the Property, written or oral, will be communicated by Broker on 82 Seller's behalf. All written or oral inquiries that Seller receives or learns about regarding the Property,regardless of the source, 83 will be referred to Broker. 84 (D) If the Property, or any part of it, is rented, Seller will give any leases to Broker before signing this Contract. If any leases are 85 oral, Seller will provide a written summary of the terms,including amount of rent,ending date,and Tenant's responsibilities. 86 (E) Seller will not enter into, renew, or modify any leases, or enter into any option to sell, during the term of this Contract without 87 Broker's written consent. 88 9. BROKER'S SERVICE TO BUYER 89 Broker may provide services to a buyer for which Broker may accept a commission. Such services may include,but are not limited 90 to: document preparation; ordering certifications required for closing; financial services; title transfer and preparation services; 91 ordering insurance, construction,repair, or inspection services. 92 10.BROKER NOT RESPONSIBLE FOR DAMAGES 93 Seller agrees that Broker and Broker's Licensee(s) are not responsible for any damage to the Property or any loss or theft of personal 94 goods from the Property unless such damage, loss or theft is solely and directly caused by Broker or Broker's Licensee(s). 95 11.DEPOSIT MONEY 96 (A) Broker, if named in an agreement of sale, will keep all deposit monies paid by or for the buyer in an escrow account until the 97 sale is completed, the agreement of sale is terminated, or the terms of a prior written agreement between the buyer and Seller 98 have been met.This escrow account will be held as required by real estate licensing laws and regulations. Buyer and Seller may 99 name a non-licensee as the escrow holder, in which case the escrow holder will be bound by the terms of the escrow agreement, 00 if any,not by the Real Estate Licensing and Registration Act. Seller agrees that the person keeping the deposit monies may wait 01 to deposit any uncashed check that is received as deposit money until Seller has accepted an offer. 02 (B) Regardless of the apparent entitlement to deposit monies, Pennsylvania law does not allow a Broker holding deposit monies to 03 determine who is entitled to the deposit monies when settlement does not occur.Broker can only release the deposit monies: 04 1. If an agreement of sale is terminated prior to settlement and there is no dispute over entitlement to the deposit monies.A writ- 05 Broker/Licten agreement signed by both parties is evidence that there is no dispute regarding deposit monies. 06 e�I'mtials XLS Page 2 of 6 Seller Initials: � � en ,,Produced wph ztpFcrmO by zip Logix 18070 Fifteen Mile Road Fraser,Michigan 48026 w.rw zioLOOix corn Untitled 107 2. If, after Broker has received deposit monies, Broker receives a written agreement that is signed by Buyer and Seller, direct 108 ing Broker how to distribute some or all of the deposit monies. 109 3. According to the terms of a final order of court. 110 4. According to the terms of a prior written agreement between Buyer and Seller that directs the Broker how to distribute the 111 deposit monies if there is a dispute between the parties that is not resolved. 112 (C) Seller agrees that if Seller names Broker or Broker's licensee(s) in litigation regarding deposit monies, the attorneys' fees and 113 costs of the Brokers) and licensees) will be paid by Seller. 114 12.OTHER PROPERTIES 115 Seller agrees that Broker may list other properties for sale and that Broker may show and sell other properties to prospective buyers. i 16 13.ADDITIONAL OFFERS 117 Unless prohibited by Seller, if Broker is asked by a buyer or another licensee(s) about the existence of other offers on the Property, 118 Broker will reveal the existence of other offers and whether they were obtained by the Licensee(s) identified in this Contract,by an- 119 other Licensee(s) working with Broker, or by a licensee(s) working for a different Broker. ONCE SELLER ENTERS INTO 120 AN AGREEMENT OF SALE,BROKER IS NOT REQUIRED TO PRESENT OTHER OFFERS. 121 14.SELLER WILL REVEAL DEFECTS & ENVIRONMENTAL HAZARDS 122 (A) Seller(including Sellers exempt from the Real Estate Seller Disclosure Law)will disclose all known material defects and/or en- 123 vironmental hazards on a separate disclosure statement.A material defect is a problem or condition that: 124 1. is a possible danger to those living on the Property,or 125 2. has a significant,adverse effect on the value of the Property. 126 The fact that a structural element, system or subsystem is near, at or beyond the end of the normal useful life of such a stmc- 127 tural element, system or subsystem is not by itself a material defect. 128 (B) Seller will update the Seller's Property Disclosure Statement as necessary throughout the term of this Listing Contract. 129 (C) If Seller fails to disclose known material defects and/or environmental hazards: 130 1. Seller will not hold Broker or Licensee(s)responsible in any way; 131 2. Seller will protect Broker and Licensee(s)from any claims, lawsuits,and actions that result; 132 3. Seller will pay all of Broker's and Licensee's costs that result. This includes attorneys' fees and court-ordered payments or 133 settlements(money Broker or Licensee pays to end a lawsuit or claim). 134 15.IF PROPERTY WAS BUH.T BEFORE 1978 135 The Residential Lead-Based Paint Hazard Reduction Act says that any seller of property built before 1978 must give the buyer an 136 EPApamphlet titled Protect Your Family From Lead in Your Home .The selleralso must tell the buyerand the brokerwhat the seller 137 knows about lead-based paint and lead-based paint hazards that are in or on the property being sold. Seller must tell the buyer how 138 the seller knows that lead-based paint and lead-based paint hazards are on the property, where the lead-based paint and lead-based 139 paint hazards are, the condition of the painted surfaces, and any other information seller knows about lead-based paint and lead-based 140 paint hazards on the property. Any seller of a pre-1978 structure must also give the buyer any records and reports that the seller has 141 or can get about lead-based paint or lead-based paint hazards in or around the property being sold, the common areas, or other 142 dwellings in multi-family housing. According to the Act, a seller must give a buyer 10 days (unless seller and the buyer agree to a 143 different period of tune)from the time an agreement of sale is signed to have a"risk assessment" or inspection for possible lead-based 144 paint hazards done on the property. Buyers may choose not to have the risk assessment or inspection for lead paint hazards done. If 145 the buyer chooses not to have the assessment or inspection,the buyer must inform the seller in writing of the choice. The Act does 146 not require the seller to inspect for lead paint hazards or to correct lead paint hazards on the property. The Act does not apply to hous- 147 ing built in 1978 or later. 148 16.HOME WARRANTIES '.49 At or before settlement, Seller may purchase a home warranty for the Property from a third-party vendor. Seller understands that a 50 home warranty for the Property does not alter any disclosure requirements of Seller, may not cover or warrant any pre-existing de- 51 fects of the Property, and will not alter,waive or extend any provisions of the Agreement regarding inspections or certifications that 52 Buyer may elect or waive as part of the Agreement. Seller understands that Broker who recommends a home warranty may have a 53 business relationship with the home warranty company that provides a financial benefit to Broker. 54 17.RECOVERY FUND 55 Pennsylvania has a Real Estate Recovery Fund(the Fund) to repay any person who has received a final court ruling(civil judgment) 56 against a Pennsylvania real estate licensee because of fraud, misrepresentation, or deceit in a real estate transaction. The Fund re- 57 pays persons who have not been able to collect the judgment after trying all lawful ways to do so. For complete details about the 58 Fund,call (717) 783-3658, or(800)822-2113 (within Pennsylvania)and(717)783-4854(outside Pennsylvania). 59 18.NOTICE TO PERSONS OFFERING TO SELL OR RENT HOUSING IN PENNSYLVANIA 60 Federal and state laws make it illegal for a seller, a broker,or anyone to use RACE, COLOR, RELIGION or RELIGIOUS CREED, 61 SEX,DISABILITY(physical or mental),FAMILIAL STATUS(children under 18 years of age),AGE(40 or older),NATIONAL ORI- 52 GIN,USE OR HANDLING/TRAINING OF SUPPORT OR GUIDE ANIMALS, or the FACT OF RELATIONSHIP OR ASSOCI- 53 ATION TO AN'' INDIVIDUAL KNOWN TO HAVE A DISABILITY as reasons for refusing to sell, show, or rent properties, loan 54 money, or set deposit amounts, or as reasons for any decision relating to the sale of property. i5 Broker/Licensee Initials!- - XLS Page 3 of 6 Seller Initials: ' t' c d with zileFerm®by zipLogix 18070 Fifteen Mlle Road,Fraser,Michigan 48026 w .zioLoox core Untitled U 166 19.TRANSFER OF THIS CONTRACT 167 (A) Seller agrees that Broker may transfer this Contract to another broker when: 168 1. Broker stops doing business, OR 169 2. Broker forms a new real estate business, OR 170 3. Broker joins his business with another. 171 (B) Broker will notify Seller immediately in writing if Broker transfers this Contract to another broker. Seller will follow all re 172 quirements of this Contract with the new broker. 173 20.NO OTHER CONTRACTS 174 Seller will not enter into another listing contract for the property(s) identified in Paragraph 1 with another broker that begins before 175 the Ending Date of this Contract. 176 21.CONFLICT OF INTEREST 177 It is a conflict of interest when Broker or Licensee has a financial or personal interest in the property and/or cannot put Seller's inter- 178 ests before any other. If Broker, or any of Broker's licensees,has a conflict of interest, Broker will notify Seller in a timely manner. 179 22.ENTIRE CONTRACT 180 This Contract is the entire agreement between Broker and Seller. Any verbal or written agreements that were made before are not 181 a part of this Contract. 182 23.CHANGES TO THIS CONTRACT 183 All changes to this Contract must be in writing and signed by Broker and Seller. 184 24.MARKETING OF PROPERTY 185 (A) Where permitted, Broker, at Broker's option, may use: for sale sign, lock box, key in office, open houses and advertising in all 186 media,including print and electronic,photographs and videos,unless otherwise stated here: 187 188 1. ❑ Seller does not want the listed Property to be displayed on the Internet. 189 ❑ Seller does not want the address of the listed Property to be displayed on the Internet. 190 2. Seller understands and acknowledges that, if the listed Property is not displayed on the Internet, consumers who conduct 191 searches for listings on the Internet will not see information about the listed Property in response to their search. 192 (B) Seller understands and acknowledges that, if an open house is scheduled, the property address may be published on the Inter- 193 net in connection to the open house. 194 (C) There are many ways of marketing properties electronically. Some brokers may use a virtual office website (also known as 195 "VOW") or Internet data exchange (also known as "IDX"), which are governed by specific rules and policies. Sellers have the 196 right to control some elements of bow their property is displayed on a VOW and/or IDX websites. 197 Seller elects to have the following features disabled or discontinued for VOW and IDX websites(check all that apply): 198 ❑ Comments or reviews about Seller's listings, or a hyperlink to such comments or reviews, in immediate conjunction with 199 Seller's listing. 200 ❑ Automated estimates of the market value of Seller's listing, or a hyperlink to such estimates,in immediate conjunction with 201 the Seller's listing. 202 (D) Multiple Listing Services (MLS) 203 ❑ Broker will not use a Multiple Listing Service(MLS) to advertise the Property. 204 ED,15roker will use a Multiple Listing Service (MLS) to advertise the Property to other real estate brokers and salespersons. 205 Listing broker shall communicate to the MLS all of Seller's elections made above. !06 (E) Seller agrees that Broker and Licensee, and the MLS are not responsible for mistakes in the MLS or advertising of the Property. 107 (F) Other sob 25.PUBLICATION OF SALE PRICE 109 Seller is aware that the Multiple Listing Service(MLS), newspapers, Web Sites, and other media may publish the final sale price of 10 the Property. i 1 26.COPYRIGHT 12 In consideration of Broker's efforts to market Seller's Property as stated in this Contract, Seller grants Broker a non-exclusive, world-wide 13 license (the "License") to use any potentially copyrightable materials (the "Materials") which are related to the Property and provided by 14 Seller to Broker or Broker's representative(s). The Materials may include, but are not limited to: photographs, images, video recordings, 15 virtual tours, drawings, written descriptions, remarks, and pricing information related to Seller's Property. This License permits Broker to 16 submit the Materials to one or more multiple listing services, to include the Materials in compilations of property listings, and to otherwise 17 distribute, publicly display, reproduce, publish and produce derivative works from the Materials for any purpose that does not conflict with is the express terms of this Contract. The License may not be revoked by Seller and shall survive the ending of this Contract Seller also grants 19 Broker the right to sublicense to others any of these rights granted to Broker by Seller. Seller represents and warrants to Broker that the Li- 20 tense granted to Broker for the Materials does not violate or infringe upon the rights, including any copyrights, of any person or entity. Seller 21 understands that the terms of the License do not grant Seller any legal right to any works that Broker may produce using the Materials. y _0} ?2 Broker/Licensee Initials( XLS Page 4 of 6 Seller Initials: 7 roducea with an Form by zipLogix 18070 Fifteen Mile Road,Fraser,Michigan 48026 v z,Loa z.card Untitled 223 27.FIXTURES AND PERSONAL PROPERTY 224 (A) INCLUDED in this sale are all existing items permanently installed in the Property, free of liens, and other items including 225 plumbing; heating; radiator covers; lighting fixtures (including chandeliers and ceiling fans); pool and spa equipment (includ- 226 ing covers and cleaning equipment); electric animal fencing systems (excluding collars); garage door openers and transmitters; 227 television antennas; imported shrubbery, plantings and trees; any remaining heating and cooking fuels stored on the Property at 228 the time of settlement; smoke detectors and carbon monoxide detectors; sump pumps; storage sheds;fences;mailboxes;wall to', 229 wall carpeting; existing window screens, storm windows and screen/storm doors;window covering hardware,shades and blinds; 1,- 230 awnings; built-in air conditioners; built-in appliances; the range/oven, unless otherwise stated; and, if owned, water treatment 231 systems,propane tanks, satellite dishes and security systems. Also included: r� �_4 232 233 (B) The following items are LEASED (not owned by Seller). Contact the provider/vendor for more information (e.g., water treat- 234 ment systems,propane tanks, satellite dishes and security systems): 235 236 (C) EXCLUDED fixtures and items: 237 238 28.TAXES&SPECIAL ASSESSMENTS 239 (A) At settlement, Seller will pay one-half of the total Real Estate Transfer Taxes,unless otherwise stated here: 240 241 (B) Yearly Property Taxes$ Property Assessed Value$ 242 (C) Is the property preferentially assessed(including a tax abatement)? ❑ Yes ❑ No 243 If applicable,how many years remain? 244 (D) COA/HOA Name COA/HOA Phone 245 COA/HOA special assessments $ Buyer's required capital contribution$ 246 Please explain: 247 248 (E) Municipality Assessments$ 249 (F) COA/HOA Fees$ ❑ Quarterly ❑ Monthly ❑ Yearly 250 29.TITLE&POSSESSION 251 (A) Seller will give possession of Property to a buyer at settlement, or on 252 (B) At settlement, Seller will give full rights of ownership (fee simple)to a buyer except as follows: 253 ❑ Oil ❑ Gas ❑ Mineral ❑ Other 254 If checked,please explain: 255 256 (C) Seller has: 257 ❑ First mortgage with Amount of balance$ 258 Address 259 Phone Acct. # 260 ❑ Second mortgage with Amount of balance$ 261 Address 262 Phone Acct. # 163 ❑ Home Equity line of credit with Amount of balance$ 264 Address ?65 Phone Acct. # !66 ❑ Seller authorizes Broker to receive mortgage payoff and/or equity loan payoff information from lender(s). t67 (D) Seller has: '68 ❑ Judgments $ ❑ Past Due Municipal Assessment$ 's9 ❑ Past Due Property Taxes$ ❑ Past Due COA/HOA Fees$ 70 ❑ Federal Tax Liens $ ❑ Past Due COA/HOA Assessments$ .71 ❑ State Tax Liens$ 72 ❑ Other: $ 73 (E) If Seller,at any time on or since January 1, 1998, has been obligated to pay support under an order on record in any Pennsylva- 74 ma county,list the county and the Domestic Relations Number or Docket Number: 75 30.BUYER FINANCING Seller will accept the following arrangements for buyer to pay for the Property: 76 Cash ®'Conventional mortgage M-FHA mortgage [9-VA mortgage 77 ❑ Seller's Assist to buyer(if any) $ , or % 78 31.SPECIAL INSTRUCTIONS 79 The Office of the Attorney General has not pre-approved any special conditions or additional terms added by any parties. Any spe- 80 cial conditions or additional terms in this Contract must comply with the Pennsylvania Plain Language Consumer Contract Act. 81 Broker/Licensee Initials: ' XLS Page 5 of 6 Seller Initials: f 0 Ice4.1th xipFo1MS b1 zipLo9ix 18070 Fifteen Mile Road,Fraser,Michigan 48026 w zjol.cn xcm Untitled 282 32.SPECIAL CLAUSES 283 (A) The following are part of this Listing Contract if checked: 284 ❑ Property Description Addendum to Listing Contract(PAR Form XLS-A) 285 ❑ Single Agency Addendum(PAR FormSA) 286 ❑ Consumer Services Fee Addendum(PAR Form CSF) 287 ❑ Vacant Land Addendum to Listing Contract(PAR Form VLA) 288 ❑ Short Sale Addendum(PAR Form SSL) 289 ❑ 290 ❑ 291 (B) Additional Terms: 292 293 294 295 296 297 298 299 300 301 302 303 304 305 / Seller has read the Consumer Notice as adopted by the State Real Estate Commission at 49 Pa.Code§35.336. 306 Seller has received the Seller's Property Disclosure form and agrees to complete and return to Listing Broker in 307 a timely manner,if required. 308 /_ Seller has received the Lead-Based Hazards Disclosure form and agrees to complete and return to Listing Bro- 309 ker in a timely manner,if required. 310 Seller has read the entire Contract before signing. Seller must sign this Contract. 311 Seller gives permission for Broker to send information about this transaction to the fax number(s) and/or e-mail address(es) 312 listed. 313 Return of this Agreement,and any addenda and amendments,including return by electronic transmission,bearing the signatures 314 of all parties,constitutes acceptance by the parties. 315 This Contract may be executed in one or more counterparts, each of which shall be deemed to be an original and which coun- 316 terparts together shall constitute one and the same Agreement of the Parties. 317 NOTICE BEFORE SIGNING: IF SELLER HAS LEGAL QUESTIONS, SELLER IS ADVISED TO CONSULT A PENNSYL- 318 VANIA REAL ESTATE ATTORNEY. 3i9 SELLER `f d C� :�G f'7// / (GL Y DATE r/�,f /8 ,. . �� Izo SELLER 92 Z DATE 121 SELLER DATE 122 BROKER(Company Name) 23 ACCEPTED ON BEHALF OF BROKER B V-� DATE ) XLS Page 6 of 6 Produced with zlpFormE by zip Logix 18070 Fifteen Mile Road,Fraser,Michigan 48026 ww+ ioLoeix.Corn Untitled STATEMENT OF ESTIMATED SELLER'S COSTS Date Prepared; °� a I z_-)Ol Seller: �v ( � I Type Loan: Property; Sale Pdce; S C – Mortgage Amount; �- The following ESTIMATE is given so that the Sellers will understand Approximately what costs will be deducted from the Gross Sale Price At the time of settlement 1. Broker's Commission;. (•, %ofS / 3LI ...... S ?rs �c �- 2 1%Transfer Tax .,:..............:......................,.:,::..::...................... S �/l 3. Notary Fees :.,,...... ......................1............. S /0 4. Deed Preparation ..::...................................................... ...::....... S / v 5. Radon Certification .:::.:...:.:..:.,..,:.:.:.......11.11.........:::.:.: S 6. Wood Idestation Inspection ....................... ...........::.....:.:............ S 7. Private On-Lot Sewage System Inspection ...... S 8, Water Analysis Report ..................... $ 9, Roof Certification ............................................................. S 10. Home Warranty Program .............::..,.........,......................:::....... S 11. Home,Inspection Fee ...................... ...........,.,............................. 5 12. Buyers Closing Costs ........ S 13, Mortgage Discount of Placement Fee ( %of Mortgage amount) ........................................... S 14. Settlement or Disbursement Fee ................................................... $ 15. FHA/VA Fees($4 00 average-Fees vary according to lender*) ........11,1 $ 16. Broker Administrative Fee .....,................................................ 17. OTHER; $ TOTAL ESTIMATED SELLTNGEXPENSES ............................................. 'Above estimate includes a total of average fees for one FHA/VA Inspection,Flood Certification, Tax Service Fee,Notary and Miscellaneous fees. Total deductions at settlement are estimated as follows: S_ Estimated Selling Expenses i $ Estimate Payoff First Mortgage i $ Estimate PayoffAddldonalMortgaga/Lieas $ TOTAL ESTIMATED DEDUCITONS Based on the above estimates, approximate proceeds at settlement may be: S `r_ Gross Sale Price S �D L Less Total Estimated Deductions S stimated Proceeds at Settlement The above figures include payoff information provided by Sellers,and may not include payoff of all liens, encumbrances,property taxes or special assessments. All payoffs and/or release of existing mortgages and(lens will be deducted from yourproceeds at settlement, I 1/We acknowledge receipt of a copy of this Statement of Estimated Seller's Costs, and understand and agree to the above estimated charges. � (Seller) (Seller) (Seller) Rev. 5106 FORM 4,024 Regardless of the business relationship selected, all licensees owe consumers the duty to: • Exercise reasonable professional skill and care which meets the practice standards required by the RELRA. • Deal honestly and in good faith. • Present, as soon as practicable, all written offers, counteroffers, notices and communications to and from the parties. This duty may be waived by the seller where the seller's property is under contract and the waiver is in writing. • Comply with the Real Estate Seller Disclosure Law. • Account for escrow and deposit funds. • Disclose,as soon as practicable, all conflicts of interest and financial interests. • Provide assistance with document preparation and advise the consumer regarding compliance with laws pertaining to real estate transactions. • Advise the consumer to seek expert advice on matters about the transaction that are beyond the licensee's expertise. • Keep the consumer informed about the transaction and the tasks to be completed. • Disclose financial interest in a service, such as financial, title transfer and preparation services, insurance, construction, repair or inspection, at the time service is recommended or the first time the licensee learns that the service will be used. The following contractual terms are negotiable between the licensee and the consumer and must be addressed in an agreement/disclosure statement: • The duration of the licensee's employment,listing agreement or contract. • The licensee's fees or commission. • The scope of the licensee's activities or practices. • The broker's cooperation with and sharing of fees with other brokers. • All sales agreements must contain the property's zoning classification except where the property is zoned solely or primarily to permit single family dwellings. • The Real Estate Recovery Fund exists to reimburse any person who has obtained a final civil judgment against a Pennsylvania real estate licensee owing to fraud,misrepresentation, or deceit in a real estate transaction and who has been unable to collect the judgment after exhausting all legal and equitable remedies. For complete details about the Fund, call(717)783-3658. Before you disclose any financial information to a licensee, be advised that unless you select a business relationship by signing a written agreement,the licensee is NOT representing you.A business relationship is NOT presumed. ACKNOWLEDGMENT I acknowledge that I have received this disclosure. ��p Date: //—I- Ameg Cam/!s{� /� C (Consumer's Printed Name) (Consu er's Signature) Date: (Consumer's Printed Name) (Consumer's Signature) I certify that I have provided this document to the above consumer during the initial interview. Date: 74C f - = (Lices•ee's Printed Name) (Licen ignature) (License#) Adopted by the State Real Estate Commission at 49 Pa. Code§35.336. Produced with ZipFornng by zipLogix 18070 Fifteen We Road,Fraser,Michigan 48026 www.zioLoaix.com Untitled CONTACT NUAMERS CONTRACT TO SETTLEMENT I Please complete tke following: Your name(s): Current Address: * Address: Phone contact(s) May we leave voice message? Home V2 (° %%// ¢ Yes ✓ Cell— 7117 4W Yes Office Yes E-mail address(es): Do you have email scanning capabilities? ✓� Do you read your email daily?_ 4 Fax number: May we send without prior notification? Comments: PREFERRED KETHOD(S) OF COIM1CTACT: Phony Email *R6quired please i AaGH .�. REALTOWE RN UTILITY INFORMATION PROPERTY ADDRESS: �--�—`ll 1. Cable Company: jj�f7e A/' 1 d Phone#: 2. Electric Company: P f L Phone#: Approx. monthly expense or budget plan: $ 0t- -'10 3. Gas company; td�' Phone# /°' Approx. monthly expense or budget plan: $ 10fi, do : ess d�rr�y ur'm UJx 4. Oil Company: hone# Approx. monthly expense or budget plan: $ 5. Sewer Company: d�'�,f,ry lell Phone# �/7 �7,� /y r Approx/ monthly expense or budget plan: $ oa 6. Telephone Company: /B'/) Phone# f-rte 2371 0 6 7. Trash Collection: 1/C' Phone# _ i 'rl 7,>Z5 Approx. monthly expense or budget plan: S. S. Water Company: �14 6 Phone#_ /-00 6 ` ZO- / Approx. monthly expense or budget plan: $ -302 y HOME OWNERS ASSOCIATION:* l Name: Phone# . Contact Person: Monthly/Yearly Fee: $ Initiation Fee: $ Items included in fee: *Please provide resale cert. and by-laws 1 Other: Phone# 11, Schools: , j High School: Phone# Middle School: Phonc# Elementary School: Phone# SELLER'S PROPERTY DISCLOSURE STATEMENT SPI) This form recommended and approved for,but not restricted to use by,the members of the Pennsylvania Associatio of REALTORS®(PAR). i PROPERTY ` 1 J e Y� l G w> + ` 2 SELLER c y , ONl n 3 The Real Estate Seller Disclosure Law (68 P.S. §7301 et seq.)requires that a seller of a property must disclose to a buyer all known 4 material defects about the property being sold that are not readily observable. While the Law requires certain disclosures, this state - 5 ment includes disclosures beyond the basic requirements of the Law in an effort to assist sellers in complying with seller disclosure 6 requirements and to assist buyers in evaluating the property being considered. Sellers who wish to see or use the basic disclosure form 7 can find the form on the Web site of the Pennsylvania State Real Estate Commission. 8 This Statement discloses Seller's knowledge of the condition of the property as of the date signed by Seller and is not a substi 9 tute for any inspections or warranties that Buyer may wish to obtain. This Statement is not a warranty of any kind by Seller or 10 warranty or representation by any listing real estate broker, any selling real estate broker, or their licensees. Buyer is encouraged to 1 I address concerns about the conditions of the property that may not be included in this Statement. This Statement does not relieve 12 Seller of the obligation to disclose a material defect that may not be addressed on this form. Any non-exempt seller is obligated to 13 complete the disclosure form even if the seller does not occupy or has never occupied the property.For a list of exempt sellers, 14 see Information Regarding the Real Estate Seller's Property Disclosure Law found on the last page of this document. 15 A Material Defect is a problem with a residential real property or any portion of it that would have a significant adverse impact on 16 the value of the property or that involves an unreasonable risk to people on the property. The fact that a structural element, system or 17 subsystem is at or beyond the end of the normal useful life of such a structural element, system or subsystem is not by itself a mate- rs rial defect. 19 Check yes, no, unknown (unk) or not applicable (N/A)for each question.Be sure to check N/A when a question does not apply 20 to the property. Check unlmown when the question does apply to the property but you are not sure of the answer. 21 Yes No Unk N/A 11. SELLER'S EXPERTISE 22 A 1I (A) Does Seller possess expertise in contracting, engineering, architecture, environmental assessment 23 /r� or other areas related to the construction and conditions of the property and its improvements? 24 B (B) Is Seller the landlord for the property? 25 C (C) Is Seller a real estate licensee? 26 Explain any "yes" answers in section 1: 27 2. OWNERSHIP/OCCUPANCY 28 Yes No Uak N/A (A) Occupation 29 1 1. When was the property most recently occupied? � 30 75"M 2. Was the Seller the os recent occupant? If "no,' w did the Seller most recently occupy 31 2 the property? n��� _ 32 3 3. How many persons most recently occupied the property? 33 (B) Role of Individual Completing This Disclosure. Is the individual completing this form: 34 1 1. The owner 35 2 2. The executor 36 3 3. The administrator 37 4 4. The trustee 38 5 5. An individual holding power of attorney 39 C (C) When was the property purchased? 40 D (D) Are you aware of any pets havingg live the house of�p�othegy s tore durin our ownership? 41 Explain section 2(if needed): /'lFll1Q 1I7 1/ 42 3. CONDOMINIUMS/PLANNED COMMUNITIES/OTHER HOMEONVNERS ASSOCIATIONS 43 Yes No Uak I N/A (A) Type. Is the Property part of a(n): 441 1. Condominium 45 2 2. Homeowners association or planned community 46 3 3. Cooperative 47 4 4. Other type of association or community 48 B (B) If"yes," how much are the fees?$ paid(Lj Monthly)( Quartei Yearly) 49 (C) If "yes," are there any community services or systems that the association or community is 50 C responsible for supporting or maintaining? Explain: / SI //����JJ �7' .,p 52 Seller's InitialV46 / Date Z/!!/J SPD Page 1 of 9 Buyer's Initials / Date '� I Pennsylvania Association of REALTORS` f COPYRIGHT PENNSYLVANIA ASSOCIATION OF REALTORS®2/12 Jack Gaughen REALTORS ERA-Dillsburg 19 North Baltimore Street Dillsburg,PA 17019 Phone:(717)432-0029 Fax (717)432-0042 Blake Miller Untitled Produced with zipForme by xipLogix 18070 Fifteen Mile Road,Fraser,Michigan 48026 www zioLOaix corn PROPERTY 53 Yes No Unk N/A 54 D (D) How much is the capital contribution/initiation fee? $ 55 Notice to Buyer: A buyer of a resale unit in a condominium, cooperative, or planned community must receive al 56 copy of the declaration (other than the plats and plans), the by-laws, the rules or regulations, and a certificate of 57 resale issued by the association in the condominium, cooperative, or planned community. Buyers may be respon 58 sible for capital contributions, initiation fees or similar one-time fees in addition to regular monthly maintenance, 59 fees. The buyer will have the option of canceling the agreement with the return of all deposit monies until the cer- 60 t fcate has been provided to the buyer and for five days thereafter or until conveyance, whichever occurs first. 61 4. ROOF 62 Yes No Unk N/A (A) Installation 63 1 1. When was the roof installed? 64 2 2. Do you have documentation(invoice, work order, warranty,etc.)? 65 (B) Repair 66 1 1. Has the roof or any portion of it been replaced or repaired during your ownership? 67 2 2. If it has been replaced or repaired,was the existing roofing material removed? 68 (C) Issues 69 1 1. Has the roof ever leaked during your ownership? 70 2 2. Are you aware of any current/past problems with the roof,gutters,flashing or downspouts? 71 Explain any "yes" answers in section 4 kncl ding the location an a eat o ny pr blelnO nd an 2 repair or remediation efforts: 'es d 4,046m) GY 73 5. BASEMENTS AND CRAWL SPACEW 74 Yes No Unk N/A (A) Sump Pump 75 1 1. Does the property have a sump pit? If yes,how many? 76 2 2. Does the property have a sump pump?If yes,how many? 77 3 VP5 3. If it has a sump pump,has it ever run? 78 4 4 If it has a sump pump,is the sump pump in working order? 79 (B) Water Infiltration 80 1. Are you aware of any water leakage, accumulation, or dampness within the basement or 81 1 eS crawl space? 82 2. Do you know of any repairs or other attempts to control any water or dampness problem in 83 2 eJ the basement or crawl space? 84 3 3. Are the downspouts or gutters connected to a public system? 85 Explain any "yes" answers in this sec ion, including the location and jeyj nt of any pr b�em(s) and 86 any repair or [ion Efforts:'A G� 147 L/ 87 RGIP/Jlp l 90 rtis:4 [rY/ II r1a IN 5 /^ 88 6. TERMITES/WOOD- ES OWN iSECT OT,PESTS 89 Yes o Unk N/A (A) Status 'Ir r/(4 ye ,we,Q/�?r$ 3'/`Ll(7e 90 t I. Are you aware of any[emotes/wood-destroying insects,dryrot,or pests �t!mlthe property? 91 2 2. Are you aware of any damage caused by termites/wood-destroying insects, dryrot,or pests? 92 (B) Treatment 93 1 1. Is your property currently under contract by a licensed pest control company? 94 2 2. Are you aware of any termite/pest control reports or treatments for the property? 95 Explain any "yes" answers i� sse�ction 6 c_lud�ng�the name of any sere' e/ Batmen provider, if 96 applicable: _ebU !/»l1Cl''l0 f GIIL� A //D @l Ll7RAZ� �F j /�l� 97 98 Yes No Unk N/A 7. STRUCTURAL ITEMS 99 (A) Are you aware of any past or present movement, shifting, de��yyr�iora on, or other problems with 100 A j walls, foundations,or other structural components? ,SP2 gdBd� S xrl (B) Are you aware of any past or present problems with driveways, walkways, patios, or retaining 102 B b walls on the property? 103 (C) Are you aware of any past or present water infiltration in the house or other structures, other 104 C U than the roof,basement or crawl spaces? 105 (D) Stucco and Exterior Synthetic Finishing Systems 106 1 1. Is your property constructed with stucco? 107 2. Is your property constructed with an Exterior Insulating Finishing System (EIFS), such as 08 2 Dryvit or synthetic stucco, synthetic brick or synthetic stone? 109 3 3. If"yes," when was it installed? t0 E (E) Are you aware of any fire,storm, water or ice damage to the property? 111 F (F) Are you aware of any defects(including stains) in flooring or floor coverings? '.12 Explain any "yes" answers in s tion 7, inclu ing to tion s ex nt of ny problerl and a y 13 r pair o remediation effor s: ' B l 14 ® ZE1l 4 ' / °71 h taePa iaci p en S l rr� w ///9//z 15 Seller's Initials / Date SPD Page 2 of 9 Buyer's Initials / Date Produced with zip Form®by zipLogiz 18070 Fifteen Mile Road,Fraser,Michigan 48026 www zioLOa n coin Untitled PROPERTY 16 Yes No Uak N/A 8, ADDITIONS/ALTERATIONS 17 �r (A) Have any additions, structural changes, or other alterations been made to the property 18 A during your ownership?Itemize and date all additions/alterations below. 19 6 (B) Are you aware of any private or public architectural review control of the property other than 120 zoning codes? 121 Note to Buyer: The PA Construction Code Act, 35 P.S. §7210.101 et seq. (effective 2004), and local code 122 establish standards for building and altering properties. Buyers should check with the municipality to deter 123 mine if permits and/or approvals were necessary for disclosed work and if so, whether they were obtained 124 Where required permits were not obtained, the municipality might require the current owner to upgrade at 125 remove changes made by prior owners. Buyers can have the property inspected by an expert in codes corn 126 pliance to determine if issues exist. Expanded title insurance policies may be available for Buyers to cove 127 the risk of work done to the property by previous owners without a permit or approval. '. 128 Addition, structural Approximate date Were permits Final inspections/ 129 change, or alteration of work obtained? approvals obtained? (Yes/No/Unknown) (Yes/No/Unknown) 130 /Z-X Zo /_eem 117 aes 131 132 133 134 135 136 137 138 139 140 Ej A sheet describing other additions and alterations is attached. 141 9. WATER SUPPLY 142 Yes No Unk N/A (A) Source. Is the source of your drinking water(check all that apply): 1 43 1 1. Public 144 2 2. A well on the property 145 3 3. Community water 146 4 4. A holding tank 147 5 5. A cistern 148 6 6. A spring 149 7 7. Other 150 8 8. No water service(explain): 151 (B) Bypass Valve(for properties with multiple sources of water) 152 1 1. Does your water source have a bypass valve? 153 2 2. If"yes," is the bypass valve working? 154 (C) Well 155 1 1. Has your well ever run dry? 156 2 2. Depth of Well 157 3 3. Gallons per minute measured on(date) 158 4 4. Is there a well used for something other than the primary source of drinking water? 159 5 5. If there is an unused well, is it capped? 1 60 (D) Pumping and Treatment 161 I. If your drinking water source is not public, is the pumping system in working order? If "no," 162 1 explain: 163 2 2. Do you have a softener,filter, or other treatment system? 164 3 3. Is the softener,filter, or other treatment system leased?From whom? 165 (E) General 166 1 1, When was your water last tested? Test results: 167 2 p 2. Is the water system shared?With whom? 68 Seller's Initials / Date -� SPD Page 3 of 9 Buyer's Initials / Date Produced with zipform®hy zvLogix 18070 Fifteen Mile Road,Fraser,Michigan 40026 wow zioLoo'xcom Untitled PROPERTY 169 DVI No Unit N/A (F) Issues 170 1 / 1. Are you aware of any leaks or other problems,pastor present,relating to the water supply, 171 pumping system, and related items? 172 2 2. Have you ever had a problem with your water supply? 173 Explain any "yes" answers in section 9, including the location and extent of any problem(s) and any 174 repair or remediation efforts: 175 176 177 10. SEWAGE SYSTEM 178 Yes No Unit N/A (A) General 719 1 1. Is your property served by a sewage system(public,private or community)? 180 2 2. If no,is it due to availability or permit limitations? 181 3 3. When was the sewage system installed(or date of connection, if public)? 182 (B) Type Is your property served by: 183 1 1. Public(if"yes," continue to E,F and G below) 184 2 2. Community(non-public) 185 3 3. An individual on-lot sewage disposal system 186 4 4. Other,explain: 187 (C) Individual On-lot Sewage Disposal System. Is your sewage system(check all that apply): 188 1 I 1. Within 100 feet of a well 189 2 2. Subject to a ten-acre permit exemption 190 3 j 3. A holding tank 191 4 4. A drainfield 192 5 5. Supported by a backup or alternate drainfield,sandmound,etc. 93 6 ! 6. A cesspool 194 7 7. Shared 195 8 8. Other,explain: 196 (D) Tanks and Service 197 1 1. Are there any metal/steel septic tanks on the Property? 198 2 2. Are there any cement/concrete septic tanks on the Property? 199 3 3. Are there any fiberglass septic tanks on the Property? 200 4 '� 4. Are there any other types of septic tanks on the Property? x01 5 I 5. Where are the septic tanks located? 202 6 1 6. How often is the on-lot sewage disposal system serviced? 203 7 7. When was the on-lot sewage disposal system last serviced? 204 (E) Abandoned Individual On-lot Sewage Disposal Systems and Septic 205 1 1. Are you aware of any abandoned septic systems or cesspools on your property? 206 2 2. Have these systems or cesspools been closed in accordance with the municipality's ordinance? 207 (F) Sewage Pumps 208 1 1. Are there any sewage pumps located on the property? 209 2 2. What type(s)of pump(s)? 210 3 3. Are pumps) in working order? 211 4 l 4. Who is responsible for maintenance of sewage pumps? 212 (G) Issues 213 1 1. Is any wastewater piping not connected to the septic/sewer system? 214 2. Are you aware of any pastor present leaks, backups, or other problems relating to the sewage 215 2 system and related items? 216 Explain any "yes" answers in section 10, including the location and extent of any problem(s) and any 217 repair or remediation efforts: 218 219 11. PLUMBING SYSTEM 22' Yes No Unit N/A (A) Material(s).Are the plumbing materials (check all that apply): 221 1 1. Copper, 222 2 2. Galvanized 223 3 3. Lead 224 a d 4. PVC 225 5 5. Polybutylene pipe(PB) 226 6 6. Cross-linked yppolyetLhyline(PEX) 227 1 7. Other ! "!i�7 I!c t l 228 ' . (B) Are you aware o any problems with any of your plumbing fixtures (e.g., including but not lim- 229 B �'` ited to: kitchen, laundry,or bathroom fixtures; wet bars; exterior faucets; etc.)? DO Ii "yes," explain: !31 !32 Seller's Initials / Date SPD Page 4 of 9 Buyer's Initials / Date Proeuce0 with zipForm®by zlpLogix 18670 Fifteen Mile Road.Fraser,Michigan 48026 www zioLoQ x com Untitled I PROPERTY 233 12. DOMESTIC WATER HEATING 234 Yes No Unk N/A (A) Type(s).Is your water heating(check all that apply): 235 1 1. Electric 236 2 5 2. Natural gas 237 3 3. Fuel oil 238 4 4. Propane 239 5 5. Solar I, 240 6 6. Geothermal 241 7 7. Other 242 8 8. Is your water heating a summer-winter hook-up (integral system,hot water from the bo' er, tc. ? 243 B (B) How many water heaters are there? I When were they installed? / 244 C (C) Are you aware of any problems with any water heater or related equipment? 245 If"yes," explain: 246 13. HEATING SYSTEM 247 Yes No Unk N/A (A) Fuel Type(s).Is your heating source(check all that apply): 248 ] 1. Electric 249 2 e5 2. Natural gas 250 3 3. Fuel oil 251 q 4. Propane 252 5 5. Geothermal 253 6 6. Coal 254 7 7. Wood / / 255 8 8. Other Q u52- l�l�t?!I /'/?eA)ai f 1"Ilgr 256 (B) System Type(s) (check all that apply): �4 257 1 1. Forced hot air 258 2 2. Hot water 259 3 3. Heat pump J 260 4 4. Electric baseboard 261 5 5. Steam 262 6 6. Radiant 263 7 7. Wood stoves)How many? 264 s 8. Coal stow s)H w m y? C / / 265 9 9. Other 266 (C) Status /m 267 1 1. When was your heating systems)installed? 268 2 2. When was the heating system(s)last serviced? I 11f 269 3 3. How many heating zones are in the property? /M 270 a 4. Is there an additional and/or backup heating system?Explain: 271 (D) Fireplaces 272 1 1. Are there any fireplace(s)?How many? 273 2 2. Are all fireplace(s)working? 274 3 3. Fireplace types(s)(wood,gas,electric,etc.): L(ls4 275 4 4. Were the fireplace(s)installed by a professional contractor or manufacturer's representative? 276 5 5. Are there any chimney(s) (frojn a fireplace, water heater or any other hea ' system)? 277 6 6. How many chimney(s)? 3, When were they last cleaned?� / //(0 / 278 7 7. Are the chimney(s)working? 1f"no," explain: '_7 279 E (E) List any areas of the house that are not heated: 280 (F) Heating and Fuel Tanks 281 1 1. Are you aware of any heating fuel tanks)on the property? 282 2 2. Location(s), including underground tank(s): 283 3 3. If you do not own the tank(s), explain: 284 p Are you a are of y problems repairs $e ed regarding pny item in section 39 If "Yes," z8s explain: rt° dGe 3/2 �1� 71� 7/ qZ Q�By/ 286 O'Q /1, '. $ 287 14. AIR CONDITIONING SYSTEM ?88 Yes No Unk N/A (A) Type(s). Is the air conditioning(check all that apply): 289 1 ' 1. Central air ?902 2. Wall units &1,3f,l !9i 3 3. Window units 7� _C4k3 ryflZ� , !92 4 4. Other y 193 5 5. None yq Seller's Initials / Date SPD Page 5 of 9 Buyer's Initials / Date Produced with zipFormS by zipLogix 18070 Fifteen Mile Road Fraser,Michigan 48026 w i oLoy x cum untitled PROPERTY 295 Yes No Unit N/A (B) Status �1 296 1 1. When was the central air conditioning system installed? 292 2 2. When was the central air conditioning system last serviced? 298 3 3. How many air conditioning zones are in the property? _ 299 (C) List y azea, of th house that are not air conditioned: 300 `r 301 p Are you aware of any problems with any item in section 14? If"yes,"explain: 302 303 15. ELECTRICAL SYSTEM 304 Yes No Unk N/A (A) Type(s) 305 1 1. Does the electrical system have fuses? 306 2 2. Does the electrical system have ci. uit breakers? 302 B (B) What is the system amperage? 308 C (C) Are you aware of any knob and tube wiring in th6 home? 300 r Are y r`of y pro lens or re s needed in the lectrical s s e If"yes ' e pla' 311 16. OTHER EQUIPMENT AND APPLIANCES P� 312 This section must be completed for each item that will, or may, be sold with the property. Th fac 313 that an item is listed does not mean it is included in the Agreement of Sale. Terms of the 314 Agreement of Sale negotiated between Buyer and Seller will determine which items, if any, art 315 included in the purchase of the Property. 316 Item Yes No Item Yes No 312 Electric garage door opener Trash compactor 318 Garage transmitters Garba a disposal 6 319 Keyless entry Stand-alone freezer 320 Smoke detectors Washer 321 Carbon monoxide detectors Dryer Ve 322 Security alarm system Intercom p 323 Interior fire sprinklers Ceiling fans — 324 In-ground lawn sprinklers A/C window units 325 Sprinkler automatic timer Awnings 326 Swimming pool Attic fans) 327 Hot tub/spa Satellite dish 328 Deck(s) Storage shed 5 329 Pool/spa heater Electric animal fence 330 Pool/spa cover Other: 331 Whirlpool/tub 1. 332 Pool/spa accessories D 2. 333 Refrigerator(s) 3. 334 Range/oven 4. 335 Microwave oven 5. 336 Dishwasher 6. Yes No Unk N/A 332 P Are you aware of any problems or repairs needed regarding any item in section 16? If "yes," 338 explain: 339 340 341 17. LAND/SOILS 342 Yea No Unk N/A (A) Property 343 1 1. Are you aware of any fill or expansive soil on the property? 344 2. Are you aware of any sliding, settling, earth movement, upheaval, subside ce, sinkhole 345 2 earth stability problems that have occurred on or affect the property? 5W, -if'. IAO 346 3. Are you aware of sewage sludge (other than commercially available fertilizer pro f cts) 42 3 �0 1 being spread on the property, or have you received written notice of sewage sludge being 48 spread on an adjacent property? 49 Seller's Initials / Date SPD Page 6 of 9 Buyer's Initials / Date Produced with zipFormH by zipLogix 18070 Fifteen Mlle Road,Fraser,Michigan 48026 www zioLocix.com Untitled PROPERTY ... Yes No Unk N/A 351 ^q - 4. Are you aware of any existing, past or proposed mining, strip-mining, or any other excava 352 4 Vrl tions that might affect this property? 353 Note to Buyer: The property may be subject to mine subsidence damage. Maps of 354 the counties and mines where mine subsidence damage may occur and mine subsi- ',. 355 dence insurance are available through: Department of Environmental Protection,'' 356 Mine Subsidence Insurance Fund, 25 Technology Drive, California Technology Park 357 Coal Center, PA 15423 (800) 922-1678 (within Pennsylvania) or (724) 769-1100 358 (outside Pennsylvania). 359 (B) Preferential Assessment and Development Rights 360 Is the property, or a portion of it, preferentially assessed for tax purposes, or subject to limited 361 development rights under the: 362 t 1. Farmland and Forest Land Assessment Act- 72 P.S.§5490.1 et seq. (Clean and Green Program) 363 2 2. Open Space Act- 16 P.S. §11941 et seq 364 3 3. Agricultural Area Security Law-3 P.S. §901 et seq. (Development Rights) 365 4 4. Any other law/program: 366 Note to Buyer: Pennsylvania has enacted the Right to Farm Act (3 P.S. § 951-957) in an effort 367 to limit the circumstances under which agricultural operations may be subject to nuisance suits 368 or ordinances. Buyers are encouraged to investigate whether any agricultural operations cov- 369 ered by the Act operate in the vicinity of the property. 370 (C) Property Rights 371 Are you aware of the transfer, sale and/or lease of any of the following property rights (by you 372 or a previous owner of the property): 373 1 1. Timber 374 2 2. Coal 375 31 3. Oil 376 4 4. Natural gas 377 5 5. Other minerals or rights(such as farming rights,hunting rights, quarrying rights)Explain: 378 379 Note to Buyer: Before entering into an agreement of sale, Buyer can investigate the status of 380 these rights by, among other means, engaging legal counsel, obtaining a title examination of 381 unlimited years and searching the official records in the county Office of the Recorder of Deeds, 382 and elsewhere. Buyer is also advised to investigate the terms of any existing leases, as Buyer 383 may be subject to terms of those leases. 384 Explain any "yes" answers in section 17: 385 386 18. FLOODING,DRAINAGE AND BOUNDARIES 387 Yes No n N!A (A) Flooding/Drainage 388 1 1. Is any part of this property located in a wetlands area? 389 2 2. Is any part of this property located in a a FEMA flood zone? 390 3 3. Are you aware of any past or present drainage or flooding problems affecting the property? 391 4 4. Are you aware of any drainage or flooding mitigation on the property? 392 Explain any 'yes" answers in section 1S(A),including dates and extent of flooding: 393 394 Yes No Unk N/A (B) Boundaries 395 1. Are you aware of any encroachments, boundary line disputes, or easements affecting the 396 1 property? 397 Note to Buyer: Most properties have easements running across them for utility services and 398 other reasons. In many cases, the easements do not restrict the ordinary use of the property, 999 and Seller may not be readily aware of them. Buyers may wish to determine the existence of 400 easements and restrictions by examining the property and ordering an Abstract of Title or 401 searching the records in the Office of the Recorder of Deeds for the county before entering into 402 an agreement ofsale. 403 2 2. Do you access the property from a private road or lane? 404 3 / 3. If"yes," do you have a recorded right of way or maintenance agreement? 405 �( 4. Are you aware of any shared or common areas (driveways, bridges, docks, walls, etc.) or 406 4 /MGt maintenance agreements? 407 Explain any 'yes" answers in section 18(B): 408 409 ry Q 410 Seller's Initials / Date SPD Page 7 of 9 Buyer's Initials / Date Produced with zipFor—mQrr,by zi—pi-ogix 18070 Fifteen Mlle Road.Fraser,Michigan 48026 wnw zioLoolz.com Untitled PROPERTY 411 19. HAZARDOUS SUBSTANCES AND ENVIRONMENTAL ISSUES 4 ' Yes No Unk N/A (A) Mold and Indoor Air Quality (other than radon) 413 1 1. Are you aware of any tests for mold,fungi,or indoor air quality in the property? 414 2. Other than general household cleaning, have you taken agy efforts to control or remediate 415 2 65 mold or mold-like substances in the property? 52L. (G° eW 416 Note to Buyer: Individuals may be affected differently, or not at all, by mold contamination.' 417 If mold contamination or indoor air quality is a concern, buyers are encouraged to engage the 418 services of a qualified professional to do testing. Information on this issue is available from the a19 United States Environmental Protection Agency and may be obtained by contacting IAQ INFO, 420 P.O. Box 37133, Washington, D.C. 20013-7133, 1-800-438-4318. 421 (B) Radon 422 yy _ 1. Are you aware of any tests for radon gas that have been performed in any buildings on th 423 1tl property? If"yes," list date, type, and results of all tests below: 424 First Test Second Test 425 Date 426 Type of Test a27 Results(picocuries/liter) 428 Name of Testing Service 429 2 2. Are you aware of any radon removal system on the property? 430 If"yes," list date installed and type of system, and whether it is in working order below: 431 Date Installed Type of System Provider Working? 432 .q7 �/y,, 433 ,Q l�"—.Y/�" 0 1 / 434 (C) Lead Paint 435 If property was constructed, or if construction began, before 1978, you must disclose any 436 Yes No Unk N/A knowledge of,and records and reports about, lead-based paint on the property. 437 1 1. Are you aware of any lead-based paint or lead-based paint hazards on the property? 438 , . 2. Are you aware of any reports or records regarding lead-based paint or lead-based paint haz- 439 2 y ards on the property? 440 (D) Tanks 441 1 1. Are you aware of any existing or removed underground tanks? Size: 442 2 2. If"yes," have any tanks been removed during your ownership? 443 E (E) Dumping. Are you aware of any dumping on the property? 444 (F) Other a45 1. Are you aware of any existing hazardous substances on the property (structure or soil) 446 1 1 such as,but not limited to,asbestos or polychlorinated biphenyls(PCBs)? 447 2. Have you received written notice regarding the presence of an environmental hazard or bio- 448 2 hazard on your property or any adjacent property? 449 3. Are you aware of testing on the property for any other hazardous substances or environ- 450 3 mental concerns? 451 4. Are you aware of any other hazardous substances or environmental concerns that might 452 4 ! impact upon the property? 453 n any "yes" answer in ection 19: 454 E lai/1 455 456 d AP0117i OP 61,44Z-11 l 457 , '1 458 459 20. MISCELLANEOUS G�*a Y115W 710 1 14Wh 460 Yes No Unk N/A (A) Deeds,Restrictions and Title . 461 1 J V 1. Are you aware of any deed restrictions that apply to the property? w� �� 462 2. Are you aware of any historic preservation restriction or ordinance or az eo c grca esig- 463 2 { nation associated with the property? Ile 464 3. Are you aware of any reason, including a defect in title, that would prevent you from giving 465 3 { warranty deed or conveying title to the property? 466 4 4. Are you aware of any insurance claims filed relating to the property? 467 (B) Financial 468 1. Are you aware of any public improvement, condominium or homeowner association assess- 469 1 I, ments against the property that remain unpaid or of any violations of zoning, housing, boil - 47o ing, safety or fire ordinances or other use restriction ordinances that remain uncorrected? 471 2. Are you aware of any mortgage, judgment, encumbrance, lien, overdue payment on a sup- 172 2 vVC, ' port obligation, or other debt against this property or Seller that cannot be satisfied by the 173 proceeds of this sale? A 9q 174 Seller's Initials ! Date SPD Page 8 of 9 Buyer's Initials / Date Produced with ,bFurmS by zipLogix 18070 Fifteen Mile Road,Fraser.Michigan 48026 www.zdLoaix.com Untitled PROPERTY 475 Yes No Unk N/A (C) Legal 476 ^ 1. Are you aware of any violations of federal, state, or local laws or regulations relating to this 477 1 bIF property? 478 2 2. Are you aware of any existing or threatened legal action affecting the property? 479 (D) Additional Material Defects 480 1. Are you aware of any material defects to the property, dwelling, or fixtures wbicb are not 481 1 disclosed elsewhere on this form? 482 Note to Buyer: A material defect is a problem with a residential real property or any por- 483 tion of it that would have a significant adverse impact on the value of the property or that 484 involves an unreasonable risk to people on the property. The fact that a structural element, 485 system or subsystem is at or beyond the end of the normal useful life of such a structural) 486 element, system or subsystem is not by itself material defect. 487 2. After completing this form, if Seller becomes aware of additional information about the 488 property, including through inspection reports from a buyer, the Seller must update the 489 Seller's Property Disclosure Statement and/or attach the inspection(s). These inspection 490 reports are for informational purposes only. 491 Explain any "yes" answers in section 20: 492 493 494 495 496 21. ATTACHMENTS 497 (A) The following are part of this Disclosure if checked: 498 Seller's Property Disclosure Statement Addendum(PAR Form SDA) 499 500 ❑ 501 El 502 The undersigned Seller represents that the information set forth in this disclosure statement is accurate and complete to the 503 best of Seller's knowledge. Seller hereby authorizes the Listing Broker to provide this information to prospective buyers of 504 the property and to other real estate licensees. SELLER ALONE IS RESPONSIBLE FOR THE ACCURACY OF THE 5o5 INFORMATION CONTAINED IN THIS STATEMENT. Seller shall cause Buyer to be notified in writing of any informs- 506 tion supplied on this form which is rendered inaccurate by a change in the condition of the property following completion of 507 this form. 508 SELLER DATE 509 SELLER DATE 51 o SELLER DATE 511 INFORMATION REGARDING THE REAL ESTATE SELLER DISCLOSURE LAW 512 EXECUTOR,ADMINISTRATOR,TRUSTEE SIGNATURE BLOCK 513 According to the provisions of the Real Estate Seller Disclosure Law, the undersigned executor,administrator or trustee is not required 514 to fill out a Seller's Property Disclosure Statement. The executor, administrator or trustee, must, however, disclose any known mate- 515 rial defect(s)of the property. (/ [,�1� ,�y (� 516 1/YLC'. / DATE 0 d �J i 517 RECEIPT AND ACKNOWLEDGEMENT BY BUYER 518 The undersigned Buyer acknowledges receipt of this Disclosure Statement. Buyer acknowledges that this Statement is not a 519 warranty and that, unless stated otherwise in the sales contract,Buyer is purchasing this property in its present condition. It 520 is Buyer's responsibility to satisfy himself or herself as to the condition of the property.Buyer may request that the property 521 be inspected, at Buyer's expense and by qualified professionals,to determine the condition of the structure or its components. 522 BUYER DATE 523 BUYER DATE 524 BUYER DATE SPD Page 9 of 9 Produced with opForrti by zipLOgix 18070 Fifteen Mile Road,Fraser,Michigan 48026 www i oLoela cam Untitled Generally speaking, the Real Estate Seller Disclosure Law requires that before an agreement of sale is signed, the seller in a residen- tial real estate transfer must make certain disclosures regarding the property to potential buyers in a fort defined by the law. A resi- dential real estate transfer is defined as a sale, exchange, installment sales contract, lease with an option to buy, grant or other transfer of an interest in real property where NOT LESS THAN ONE AND NOT MORE THAN FOUR RESIDENTUL, DWELLING UNITS are involved. The Law defines a number of exceptions where the disclosures do not have to be made: 1. Transfers that are the result of a court order. 2. Transfers to a mortgage lender that result from a buyer's default and subsequent foreclosure sales that result from default. 3. Transfers from a co-owner to one or more other co-owners. 4. Transfers made to a spouse or direct descendant. 5. Transfers between spouses that result from divorce, legal separation,or property settlement. 6. Transfers by a corporation,partnership or other association to its shareholders,partners or other equity owners as part of a plan of liquidation. 7. Transfer of a property to be demolished or converted to non-residential use. 8. Transfer of unimproved real property. 9. Transfers by a fiduciary during the administration of a decedent estate,guardianship,conservatorship or trust. 10. Transfers of new construction that has never been occupied when: a. The buyer has received a one-year warranty covering the construction; b. The building has been inspected for compliance with the applicable building code or, if none, a nationally recognized model building code; and c. A certificate of occupancy or a certificate of code compliance has been issued for the dwelling. In addition to these exceptions, disclosures for condominiums and cooperatives are limited to the seller's particular unit(s).Disclosures regarding common areas or facilities are not required, as those elements are already addressed in the laws that govern the resale of con- dominium and cooperative interests. Seller's Initials Date �°' SPD Notices Page 1 of 1 Buyer's Initials / Date Produced with zipForm4t,by zipLoglx 18070 Fifteen Mile Road,Fraser,Michigan 68026 w .z,pLOO'x coin Untitled RESIDENTIAL LEAD-BASED PAINT HAZARDS DISCLOSURE FORM LPD This form recommcuded and approved for,but not restricted to use by,the members of the Pennsylvania Association of REALTORS®(PAR). THIS FORM MUST BE COMPLETED FOR Y PROPERTY BUILT PRIOR TO 1978 1 PROPERTY Z 2 SELLER 3 LEAD WARNING STATEMENT 4 Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 is notified that 5 such property may present exposure to lead from lead-based paint that may place young children at risk of developing lead poi- 6 soning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced 7 intelligence quotient, behavioral problems, and impaired memory. Lead poisoning also poses a particular risk to pregnant women. 8 The Seller of any interest in residential real property is required to provide the Buyer with any information on lead-based paint 9 hazards from risk assessments or inspections in the Seller's possession and notify the Buyer of any known lead-based paint haz- 10 ands,A risk assessment or inspection for possible lead-based paint hazards is recommended prior to purchase. 1l SELLER'S DISCLOSURE 12 /_ Seller has no knowledge of the presence of lead-based paint and/or lead-based paint hazards in or about the Property. 13 /_ Seller has knowledge of the presence of lead-based paint and/or lead-based paint hazards in or about the Property. (Provide 14 the basis for determining that lead-based paint and/or hazards exist, the location(s), the condition of the painted surfaces, and 15 other available information concerning Seller's knowledge of the presence of lead-based paint and/or lead-based paint hazards.) 16 SELLER'S RECORDS/REPORTS 17 /_ Seller has no records or reporlspertaining to lead-based paint and/or lead-based paint hazards in or about the Property 18 /_ Seller has provided Buyer with all available records and reports regarding lead-based paint and/or lead-based paint hazards in 19 or about the Property.(List documents): 20 21 Seller certifies that to the best of Seller's knowledge the above statements are true and accurate. 22 WITNESS SELLER DATE 23 WITNESS SELLER DATE 24 WITNESS SELLER DATE 25 AGENT ACKNOWLEDGEMENT AND CERTIFICATION 26 Agent/Licensee represents that Agent has informed Seller of Seller's obligations under the Residential Lead-Based-Paint 27 Hazard Reduction Act,42 U.S.C. §4852(d),and is aware of Agent's responsibility to ensure compliance. 28 The following have reviewed the information above and certify that the Agent statements are true to the best of their knowledge and belief. 29 Seller Agent and Buyer Agent must both sign this form. 30 BROKER FOR SELLER(Company Name) 31 LICENSEE DATE 32 BROKER FOR BUYER(Company Name) 33 LICENSEE DATE 34 BUYER 35 DATE OF AGREEMENT 36 BUYER'S ACKNOWLEDGMENT 37 _/_ Buyer has received the pamphlet Protect Your Family from Lead in Your Home and has read the Lead Warning Statement. 38 _/_ Buyer has reviewed Seller's disclosure of known lead-based paint and/or lead-based paint hazards and has received the records 39 and reports regarding lead-based paint and/or lead-based paint hazards identified above. 40 Buyer certifies that to the best of Buyer's knowledge the above statements are true and accurate. 41 WITNESS BUYER DATE 42 WITNESS BUYER DATE 43 WITNESS BUYER DATE COPYRIGHT PENNSYLVANIA ASSOCIATION OF REALTORS®2010 I? I Pennsylvania Association of REALTORS' 1/10 Jack Gaughen REALTORS ERA-r)lkburg 19 Ronh Baltimore Street Dahburg,PA 14019 Phoney(719)432-0029 F. (717)432-0042 Unfitted Blake MWcr Produced with Zipform®by zipLogix 18070 Fifteen Mile Road,Fraser,Michigan 48026 www zioLoeix.com RECEIPT FOR PAYMENT ------------------- GLENDA FARNER STRASBAUGH Receipt Date : 2/27/2012 ' Cumber'-and County - Register Of Wills Receipt Time : 11 : 49 : 05 One Courthouse Square Receipt No . : 1068911 Carlisle , PA 17613 it MAURER JOHN F Estate File No . : 2012-00254 Paid By Remarks : THE WILEY GROUP HEA - - - - - - - - - - - - - - - - - - - - - - - - Receipt Distribution - - - - -- - - -- - - -- - - - - -- -- - - Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 260 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 24 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN - - - - - - - - - - - - - - - - Check# 11521 $327 . 50 Total Received . . . . . . . . . $327 . 50 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date : 5/09/2012 ', Cumberland County - Register Of Wills Receipt Time : 11 : 38 : 35 ' One Courthouse Square Receipt No . : 1069812 '' Carlisle, PA 17013 MAURER JOHN F Estate File No . : 2012-00254 Paid By Remarks : THE WILEY GROUP HEA Receipt Distribution - - ----- - - - - - - --- - - - --- -- Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 8 . 00 CUMBERLAND COUNTY GENERAL FUN - - - - - - -- -- --- - - - Check# 11618 $8 . 00 Total Received. . . . . . . . . $8 . 00 I ICI ND w �flssoM��O I CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3166 Fax:(717)249-2663 !i April 20, 2012 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. T0: Jan M. Wiley, Esquire RE: John F. Maurer Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: April 6, April 13, and April 20, 2012 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director 2012 ,EXPENSE FOR 1 711 SO. 121RSTST. HOUSE AND PERSONAL FOR JOHN' MAURER j SEWER ^TAXES 1NSURANCEI,- MEDICAL FUNERAL MONTH PPL UGI PAWA I ITRASHI REPAIRS �, JAN FEB 19 95 30 29 16 - 580,78 615 4 250.33 MARCH - ---- ---.. APRIL 1825 30 i,. 30 07 1 L 9905.00 MAY 1453 310.45 JUNE 1567 10 30 95 55 53 95 2,500.00 JULY 17 15 37 31 03 2 611 00 1,147 59 I 5,520.52 } - 1 - -- �- AUGUSTI 3802 78 84 55 53.95 2,370 69 I I - - � SEPT. 66.81 44 88 it 2,147.36 9.8 2p OCT. ��, �� JJ. - ---- 2,673 46 NOV DEC -- 14.ill I I I -- i I I ! I I i TOTALS 1gP-38 107 885 110 107.9 12,302.51 1738.17 615 14,155.33 5830.97 ACCUM 'TOTAL FORYR 35,433 31 IPAle t � J •t ..:'Q p8.., J ///�0/e / .9_ �,�ii�/ � v �1J �y�'�yF ME _ ' Wit I , CCMMONwEAJI OF?E%%SrL ANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDiv'.DUA-TAXES DEPT.2806C1 IAR9I5BURG,PA 1 7 1 2 8-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 015986 GRABLE ANNE M 116 HOLLY DRIVE MECHANICSBURG, PA 17055 i ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 $50,500.56 ESTATE INFORMATION: SSN: FILE NUMBER: 2112-0254 DECEDENT NAME: MAURER JOHN F DATE OF PAYMENT: 05/17/2012 POSTMARK DATE: 05/16/2012 COUNTY: CUMBERLAND DATE OF DEATH: 02/20/2012 TOTAL AMOUNT PAID: $50,500.56 REMARKS: RECEIPT TO ATTY CHECK# 313 INITIALS: HEA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPAYER _ TT e room 1 24934 i EST OF JOAN F MAURER DECD DATE ��0��- 60-1273/313 ANNE GRABLE EXTRX PAY TO THE y f ORDER OF ( L(L�i -drK ('�✓ 2 $ 5� _ d0 DOLLARS PNC Bank, National Association � Central PA UPPER ALLEN 00112 Non-Negotiable Customer Cop MEMO re_ r ii1 ?�ji i�1�2� :�k'----- PAPER FOR GL `T'PC KETS AND CONVENIENCE CHECKS EFC H.V 124934 �re q EST OF JOHN F MAURER DECD DATE �.. l Z 60-1273/313 ANNE GRABLE EXTRX PAY TO THE ORDER OF $ DOLLARS PNC Bank, National Association Central PA UPPER ALLEN // 00112 yy7 MEMO__/ e _Z /7Pl�Lld�/GfPi ��/ ' x!>� lCQiX�- Jan M. Wiley David J. Lenox THE WILEY GROUP Attorneys at Law March 11, 2013 Register of Wills 1 Courthouse Square Room 102 Carlisle, PA 17013 In Re: Estate of John F. Mauer File No: 21-12-0254 3egister: Enclos,. i for filing please find the inheritance tax return in duplicate and the status report with regard to the above captioned estate. Also enclosed is a check in the amount of$1,729.23 representing the tax due, and a check in the amount of$615.00 representing the filing fee. Please return the recording receipts to my attention in the enclosed envelope. I Thank you for your cooperation. Sincerely, Sarah A. Kuhn, Legal Assistant /sak encl. 3 N. Baltimore Street • Dillsburg, PA 17019 • Phone: (717) 432-9666 • (800) 682-4250 • Fax: (717) 432-0426 i�+�g a� r °a i. L� � (T? p f;T i._I IAA � is s. � ^ i t� C'J `'7 C 1 yr/ nJ ,i ::_ _a h' G_ S.} t ��_ ����. Fly ',. CJ �_ cT_ ..: �. R O N a- .�.:) 3 � � i J J n � I p r, :, ,. ,� o m � �— a> ti p .� .� � C4 U � (� a ��h� a � � Va � � � ro v + oa Ho � � mom' �¢ M � W i x H _ ----- - , i