HomeMy WebLinkAbout03-21-13 J REV-1500Ex(01-10' � 1505610143
PA Department of Revenue 5yl OFFICIAL USE ONLY
p pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOx.280601 INHERITANCE TAX RETURN 21 11 00742
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
06 15 2011 01 16 1977
Decedent's Last Name Suffix Decedent's First Name MI
JOHNSON PAUL E
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return ❑ 2. Supplemental Return ❑ 3.Remainder Return(date of death
prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a.Future Interest Compromise ❑ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
❑ g Decedent Died Testate 13 7. Decedent Maintained a Living Trust 0 $. Total Number Of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
❑ 9. Litigation Proceeds Received ❑ 10,Spousal Poverty Credit(date of death 11.Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) ❑
(Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
THOMAS P GACKI 717 237 6000
REGISTER OF WILLS USE ONLY
First line of address
213 MARKET STREET rte-- w 7
d"t!
Second line of address r
8TH FLOOR `.
City or Post Office State 1QA! �k-ED �, r t
ZIP Code T
HARRISBURG PA 17101
' -. J ( .'1
Correspondent's e-mail address: tgacki @eckertseamans.com
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my IEflo ledge and`5b ief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer ha any knowledge.
SI RE P PERSON R LE FO FILING REFyRN A�
Z�Mel�issaobincheck
ADDRESS
1518 Tussey Court/4jechanicsburg, PA 17050
SIGNA OF PREP R MHTHA R EPRESENTATIVE DATE
Thomas P Gacki 3Z
ADDAESS
213 Market Street, Harrisburg, PA 17101
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: JOHNSON, PAUL EDWARD
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1. 230 , 000 . 00
2. Stocks and Bonds(Schedule B)............................................................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C).......... 3.
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5• Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 88 , 487 . 47
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7.
8. Total Gross Assets(total Lines 1-7)....................................................................... 8. 318 , 487 . 4 7
9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 71 , 590 . 9 4
10. Debts of Decedent, Mortgage Liabilities,&Liens(Schedule 1)................................ 10. 214 , 721 . 45
11. Total Deductions(total Lines 9& 10)......................................................................11. 286 , 312 . 3 9
12- Net Value of Estate(Line 8 minus Line 11).............................................................12. 32 , 175 . 08
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. 32 , 175 . 08
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 32 , 175 . 08 16. 1 , 447 . 88
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. Tax Due...................................................................................................................19.
1 , 447 88
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21 11 00742
Decedent's Complete Address:
DECEDENT'S NAME
Johnson, Paul Edward
STREET ADDRESS
3924 Brookridge Drive
CITY STATE ZIP
Mechanicsburg PA 17060
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,447.88
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits(A +B) (2) 0.00
3. Interest (3) 46.06
4. If Line 2 is greater than Line I +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2 Line 20 to request a refund
5. If Line I +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) ----1,493.93
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;........................................... .....................................E lx_�
b. retain the right to designate who shall use the property transferred or its income;................ ......._...E] Cx,l
c. retain a reversionary interest;or........................................................................... ....................... ...........1-7. rx
d. receive the promise for life of either payments,benefits or care?......_...... ..........__....__...._F I
2. If death occurred after December 12, 1982,did decedent transfer property within one year of death without
receiving adequate consideration?......................................................... ...........................................................[D [X—1
3, Did decedent own an"in trust for or payable upon death bank account or security at his or her death?.........
4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which
contains a beneficiary designation?......... ......... ................. ........... ........ .......... X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS is YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUR
For dates of death on or after July 1, 1994 and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent[72 P.S. §9116(a)(1.1)(i)].
For dates of death on or after 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)(1.1) ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of
assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
•The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)).
•The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in
72 P.S.§9116 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[72 P.S.§9116(a)(13 A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether by bloojor adoption.
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL EST/11 E
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Johnson, Paul Edward 21 - 11 -00742
All re—al property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
Attach a copy of the settlement sheet if the property has been sold.
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 3924 Brookiridge Drive, Mechanicsburg, PA Sale Price--settlement sheet attached 230,000.00
TOTAL(Also enter on Line 1, Recapitulation) 230,00-0.00-
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
----[FfLE NUMBER
ESTATE OF Johnson, Paul Edward 21 - 11 - 00742
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Reimburse County Taxes at Settlement 195.86
2 Reimburse County Taxes at Settlement 195.86
3 Reimburse Sewer and Trash at Settlement 79.21
4 2003 BMW M3--Sale Price 30,079.22
5 Miscellaneous Personal Property 2,000.00
6 2004 Chevrolet Silverado Pickup--sold for balance due on loan 11,234.58
7 Teamsters Pension Fund 25,09260
8 Wells Fargo Bank Account 19,610.14
TOTAL(Also enter on Line 5, Recapitulation) 88,487.47
SCFEDL LE H
COMMONWEALTH OF PENNSYLVANIA FUNERALEXPENSES&
INHERITANCE TAX RETURN
RESIDENT DECEDENT �S IY E CO
ESTATE OF Johnson, Paul Edward FILE NUMBER
21 - 11 -00742
Debts of decedent must be reported on Schedule I.
ITEM -----
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Musselman Funeral Home 3,369.62
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Years)Commission paid
2. Attorney's Fees Eckert Seamans 20,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register 158.50
Additional Probate Fee 20.00
5. Accountant's Fees Hamilton and Musser 956.00
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Seller Assist paid at closing 3,000.00
I
TOTAL(Also enter on line 9, Recapitulation) 71,590.94
Sched de H Q
COMMONWEALTH OF PENNSYLVANIA Funeral E4wim«
INHERITANCE TAX RETURN � ��c rxmd
RESIDENT DECEDENT l-
ESTATE OF Johnson, Paul Edward i
FILE NUMBER
21 - 11 -00742
2 Real Estate Commission paid at closing 13,620.00
3 Tax Certification paid at closing 10.00
i
4 Escrow Set up Fee paid at closing 25.00
5 Transfer tax paid at closing 2,300.00
6 School tax paid at closing 2,042.08
7 Engineering Inspection paid at closing 175.00
8 Home Warranty paid at closing 450.00
I
9 Water Test paid at closing 689.00
10 Rental Vehicle for out of sate administrator(since resigned) 235.34
I
11 Furnace Repairs 294.00
12 PPL 165.03
13 PPL 26.79
14 PPL 135.16
15 PPL 137.89
16 PPL 67.58
17 PPL 32.41
18 PPL
84.56
19 Wells Fargo mortgage payment 1,315.70
20 Wells Fargo mortgage payment 1,315.70
Page 2 of Schedule H
Schedule H
69wses&
COMMONWEALTH OF PENNSYLVANIA Funeral
INHERITANCE TAX RETURN AdT***aM Costs confted
RESIDENT DECEDENT
ESTATE OF Johnson, Paul Edward FILE NUMBER
21 - -
1 11 00742
21 Wells Fargo mortgage payment 1,368.74
22 Wells Fargo mortgage payment 1,361.53
23 Wells Fargo mortgage payment 1,308.49
24 Wells Fargo mortgage payment 1,308.49
25 Wells Fargo mortgage payment 1,318.74
26 Wells Fargo mortgage payment 1,308.49
27 Wells Fargo mortgage payment 1,308.49
28 Wells Fargo mortgage payment 1,308.49
29 Wells Fargo mortgage payment 1,308.49
30 Wells Fargo mortgage payment i 1,315.70
31 PPL 164.87
32 PPL 47.68
33 PPL 178.22
34 PPL i 54.47
35 PPL 35.80
36 PPL 79.51
37 Trash 170.56
38 Trash 155.05
39 Trash 155.05
Page 3 of Schedule H
Sched*-H
COMMONWEALTH OF PENNSYLVANIA Fweral EMmim&
INHERITANCE TAX RETURN A&T***aMCaftcortmad
RESIDENT DECEDENT,
ESTATE OF Johnson, Paul Edward 7 FILE NUMBER
121 - 11 -00742
40 Trash 150.00
41 State Income tax due 1.00
42 estimated state income tax payment 142.00
43 House Inspection 375.00
44 Joy Daniels Group--reimburse realtor for costs outside of closing 395.00
45 House repairs I 1,000.00
46 1 House repairs 2,084.00
47 House repairs 1,328.00
48 Storage 153.72
49 Storage 94.82
50 Storage 320.00
51 Storage 80.00
52 Pool table move 209.50
53 Roof repairs
375.68
Page 4 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONVRALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN LIABILITIES, & LIENS
RESIDENT DECEDENT
FILE NUM-BER"---------
ESTATE OF Johnson, Paul Edward 21 - 11 -00742
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Wells Fargo First Mortgage(payoff at settlement) 198,714.67
2 Auto Loan 11,067.75
3 Credit Card payoff 27.40
4 Verizon 121.51
5 Teamsters dues 127.48
6 Comcast 237.08
7 Teamsters mastercard payoff 2,058.17
8 Real Estate Taxes due 1,949.81
9 Credit Card Payoff 69.75
10 Verizon 121.51
11 Trash 150.00
12 Suburban Propane 76.32
TOTAL(Also enter on Line 10, Recapitulation) 214,721.46
Johnson, Paul 21-11-00742
Statement to Schedule H
Decedent died as a result of a shooting by Robert Liddick, who also murdered his former
girlfriend and then killed himself. Decedent's administrator has a claim, not yet resolved,
against the estate of Robert Liddick for the wrongful death of the Decedent, which will inure to
the benefit of Dylan Johnson, the sole beneficiary of Decedent's estate. A significant portion of
the legal fees claimed on Schedule H relate to pursuit of the death claims against the estate of
Robert Liddick. If and when a recovery is made, a supplemental return will be filed and any
additional legal fees will be claimed at that time.
REVA513 EX+It 1.08)
SCHEDULE J j
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Johnson, Paul Edward
_ 21 -_11 -00742
RELATIONSHIP TO — SHARE or ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee,
I TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Dylan Johnson Son 100% residue
1518 Tussey Court, Mechanicsburg, PA 17050]
2
i
i
i
I
i
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
I
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
-------- -------- -----
i
r' OMB Approval No.2502-0265
A.Settlement Statement(HUD-1)
B.Type of Loan
1.[-� FHA 2.r] RHS 3,FX COW UNINS. 1G.FlIeNuniber. 7.Loan Numbs a &MaRgage Insurance Cass Number.
4.0 VA 5.[] COW INS. CEN154-426 6600561291
C.Note:This torn is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shown,hems marked"(p.o.a)"were paid outside
the dosing:they are shmn here for informational purposes and are not Induded in the totals,
0.Name&Address of aorrowar. E Name&Address of Seder: F.Name a Address of Lender.
Neil R.Treeby and Alexis D.Rosoff Treeby, Melissa X Bobincheck,Administratrix for the Members 1st Federal Credit Union
husband and wife Estate of Paul E.Johnson 5000 Louise Drive
606 Georgetown Rd 3924 Brookridge Drive Mechanicsburg,Pennsylvania 17055
Mechanicsburg,PA 17050 Mechanicsburg,PA 17050
G.Property Location: H.settlement Agent: L Settlement Date:
3924 Broekridge Drive TA of Central PA,LLC August 15,2012
Mechanicsburg,Pennsylvania 17050 530 North Lockwillow,Avenue
Lot 117,Plan No.10 of Ridgeland,Book 40, Harrisburg,Pennsylvania 17112
Page 15,Cumberland County,Pennsylvania 717-724-3724 fax:866-858-2760
Place or ss"Mmem:
TA.of Central PA,LLC
530 North Lockwillow Avenue
Harrisburg,Pennsylvania 17112
Phone:(717)724-3724
J. Summary of Borrowef s Transaction K. Summary of Seller's Transaction
100.Gross Amount Due From Borrower: 400.Gross Amount Due To Seller:
101. Contract Sales Price 230,000.00 401. Contract Sales Price 230,000.00
102. Personal Property 402. Personal Property
103. Settlement Charges to Borrower tine 1400 6,699.62 401
Adjustments for Items Paid by Seller in Advance: Adjustments for Items Paid by Seiler In Advance:
106 2012 County t Twp Taxes Aug 15,2012 thru Dec 195.86 406, 2012 County 1 Twp Taxes Aug 15,2012 thru Dec 195.86
31 2012 31 2012
107. County/Parish Taxes 407. County/Parish Taxes
108, Assessments 408, Assessments
109 2012-13 School Taxes Aug 16,2012 thru Jun 30, 1,785.43 409. 2012-13 School Taxes Aug 15,2012 thru Jun 30, 1,785.43
2013 2013
110 Sewer&Trash-qtr Aug 15,2012 thru Sep 30, T9 21 410 Sewer&Trash-qtr Aug 15,2012 thru Sep 30, 79 21
2012 2012
120. Gross Amount Due from Borrower: 238 760.12 420. Gross Amount Due to Seiler: 232 060.50
200. Amounts Paid by or in Behalf of Borrower: 500. Reductions in Amount Due to Seiler:
201. Deposit or Earnest Money 6,000.00 501. Excess Deposit see instructions
202. Principal Amount of New Loan 195,000.00 502. Settlement Charges to Seller Line 1400 21,467.82
203. Existing Loan(s)taken subject to 503. Existing Loans taken subject to
Payoff of First Mortgage Loan#0316083864
20C Seller Assist 3,000.00 504. Instru#201100526 to Wells Fargo,NA"wire 198,714.67
out`
205. Credit for amount paid 375.00 505. Payoff of Second Mortg2ge Loan
206. 506. Purchase Money Mortgage
207. 507. Seiler Assist 3,000.00
Adjustments for Items Unpaid by Seller: Adjustments for Items Unpaid by Seller:
210. CI l Town Taxes 510. C /Town Taxes
211. County!Parish Taxes 511. County/Parish Taxes
212. Assessments 512. Assessments
220. Total Paid by/for Borrower: 203 375.00 520. Total Reductions in Amount Due Seller: 223182.49
300. Cash at Settlement from!to Borrower. 600. Cash at SaMement to/hoot Seller:
301. Gross Amount due from Borrower line 120 238 760.12 601. Gross Amount due to Seiler line 420 232,06D.50
302. Less Amount Paid b lfor Borrower line 220 203 375.00 1 602. Less Reductions Amount due Seller line 520 223,182.49
303. Cash From Borrower: $35,385.12 603. Cash To Seiler: $8,878.01
The Public Reporting Burden for this coitection,of information is estimated at 35 minutes per response for collecting,reviewing,and reporting the data,
This agency may not collect this information,and you are not required to complete this form,unless it displays a currently valid OMB control number.
No confidentiality is assured;this disclosure is mandatory.This is designed to provide the parties to a RESPA covered transaction with information
during the settlement p
Borrower Initials: Neil R.Treeby )6.P Alexis D.Rosoff Treeby
Seller Initials:
Previous editions are obsolete Page 1 of 4 HUD-1
August 15,2012 11:15 AM
Settlement Date:August 15,2012 File Number:CEN154-426
9 Loan Number.6800581291 FA L-5012742-0019326E 0-5011442-0047289E
L• Settlement Charges Paid from Paid from
700. Total Sales/Broker's Commission:$13,620.00 Borrower's Seller's
Division of Commission line 700 as follows Funds at Funds at
701. 6,810.00 to Jo Daniels Real Estate 3%N Settlement Settlement
702. 6,810.00 to Keller Williams of Central PA East 37b N
703. Commission Paid at Settlement 13,620.00
704. Additional Commission to Jo Daniels Real Estate oc$395.00 b Seller
705. Additional Commission to Keller Williams of central PA East 290.00
800. Items Payable in Connection with Loan:
801. Our origination charge (from GFE#1)
$830.00
802. Your credit or charge(points)for the specific Interest rate chosen (from GFE#2)
803. Your adjusted origination charges es from GFE#A 830.00
ee
804. Appraisal F
805. Credit Re ort
806. Tax Service
807. Flood Certification
900. Items R wired Lender to be Paid in Advance:
901. Daily interest charge from Aug 15,2012 to Sep 1,2012 @ 18.6986/day for 17
days (from GFE#10)
to Members 1 st Federal Credit Union 317 88
902. Mortgage Insurance Premium from GFE#3
903. Homeowner's Insurance (from GFE#11)
to State Farm Fire& Casual Co $745.00 b Borrower
1000.Reserves Deposited with Lender:
1001. Initial deposit for your escrow account (from GFE#9)
to Members 1st Federal Credit Union 825.74
1002. Homeowner's Insurance 3 months $62.08 oar month $186.24
1003. Mort-gage Insurance Q$40.63 per month
1004. Co&T Pro a Taxes 7 months $42.98 per month $300.86
1005. School Taxes 3 months $170.17 per month $510.51
1099. Aggregate Adjustment $-171 87
1100.Title Charges:
1101. Title services and lender's title insurance from GFE#4 1,722.00
1102. Settlement or Closing Fee
1103. Owner's Title Insurance(First American Title Insurance Company) (from GFE#5)
to T.A.of Central PA,LLC Risk Rate Premium:$1,550.00 175.00
1104. Lender's Title Insurance(First American Title Insurance Company)
to T.A.of Central PA,LLC
- Lender's Premium $1,375.00
PA 100,PA 300 Endorsements(Short form loan polic $100.00
900 Endorsement ALTA 8.1 $50.00
1105. Lender's Title Policy Limit$195,000.00
1106. Owner's Title Policy Limit$230,000.00
1107. A nt's Portion of the Total Title insurance Premium $1,445.00
1108. Underwriter's Portion of the Total Title Insurenee Premium $255.00
1109. Reimbursement for tax cart fee
to TA of Central PA,LLC 10.00
1110. Deed preparation fee n/a
1111. Escrow for PA Inheritance Tax
to Tide Abstract Company of PA 2,111.74
1112. Escrow set-up fee(up to 6 months)
to Title Abstract Company of PA 25.00
1113. Notary Fee
to Abby F.Wendel 25.00
1114. Wire Fee
to TA of Central PA,LLC 20.00
1200.Government Recording and Transfer Char es:
1201. Government Recording Ch a es from GFE#7 164.00
1202. Deed$64.00 Mort a e$100.00 Releases$0.00
1203. Transfer Taxes from GFE#8 2,300.00
-T2-04city/county taxistam s Deed$2,300.00 Mort a e$0.00
1205. State tax/stam s Deed$2,300.00 Mo a e$0.00 2,300.00
1206. Other Tax 1
1207. Other Tax 2
1300.Additional Settlement Charges:
1301. R wired services that you can sho for from GFE#6
1302. Survey
1303. Termite Inspection
to The Virtus Group 75.00
1304. 2012 County Two Taxes
to Michael Lan an,Tax Collector oc$515.73 by Seiler
1305. 2012-13 School Taxes(discount)
to Michael Lan an,Tax Collector 2,042.08
1305. Sewer&Trash(qtr July 1 to Sept 30)
to Hampden Townshi oc$155.05 b Seller
1307. Engineering Inspection
_ to The Vrtus Group
1308. Home Warranty - 175.00
to Home Warranty of America 450.00
1309. Water Test
to J.F.McGraw Company 689.00
1400. Total Settlement Charges(Enter on line 103,Section J and line 502,Section K) $6,699.62 $21,467.82
Borrower Initials: Neil R.Treeby f Alexis D.Rosoff Treeby
Seller Initials: �f
Previous editions are obsolete Page 2 of 4 HUD-1
August 15,201211:15 AM
, t
File Number.CEN154-426
Settlement Date:August 15,2012 Loan Number.6800581291 FA L-5012742-0019326E 0-5011442-0047289E
Comparison of Good Faith Estimate(GFE)and HUD Charges
Charges That Cannot Increase HUD Line No. Good Faith HUD
Estimate
Our origination charge #801 830.00 830.00
Your credit or charge(points)for the specific interest rate chosen #802 0.00 0.00
Your adjusted origination charges #803 830.00 830.00
Transfer taxes #1203 2,300.00 2,300.00
Charges That in Total Cannot Increase More Than 10% HUD Una No. Good Faith HUD
Estimate
Government Recording Charges #1201 238.00 164.00
Total 238.00 164.00
Increase between GFE and HUD Charges -74.00 -31.09%
Charges That Can Change HUD Una No. Good Faith HUD
Estimate
initial deposit for your escrow account #1001 600.00 825.74
Daily interest charge from Aug 15,2012 to Sep 1,2012 @ 18.6986 /day for 17 days #901 317.88 317.88
Homeowner's Insurance #903 600.00 745.00
Title services and lender's title insurance #1101 2,008.75 1,722.00
Owner's Tice Insurance #1103 175.00 175.00
Loan Terms
Your initial loan amount is $195,000.00
Your loan term Is 30 years
Your initial interest rate is 3.5%
Your Initial monthly amount owed for principal,interest,and $916.27 includes
any mortgage insurance is [X J Principal
(X J Interest
X Mortgage Insurance
Can your interest rate rise? [X J No. [ ]Yes,it can rise to a maximum of_%.The first change will be on
and can change again every after.Every
change date,your interest rate can increase or decrease by Over the life of
the loan,your interest rate is guaranteed to never be LOWER than_%or
HIGHER than %.
Even if you make payments on time,can your loan balance [X]No. [ ]Yes,it can rise to a maximum of$
rise?
Even if you make payments on time,can your monthly [X J No. [ ]Yes,the first increase can be on and the monthly amount
amount owed for principal,lnrerest,and mortgage owed can rise to$
Insurance rise? The maximum it can ever rise to is$
Does your loan have a prepa eM penalty? X I No. j Yes,your maximum prepayment penalty is$
Does your loan have a balloon payment? [X]No. [ ]Yes,you have a balloon payment of$ due in_years
on
Total monthly amount owed including escrow account [ J You do not have a monthly escrow payment for items,such as property taxes
payments and homeowners insurance.You must pay these items directly yourself.
[X J You have an additional monthly escrow payment of$275.23 that results in a
total initial monthly amount owed of$1,191.50.This includes principal,interest,any
mortgage insurance and any Kerns checked below.
[X J Property taxes (X]School taxes
( ]Flood Insurance ( ]
X Homeowners insurance
Note:If you have any questions about the Settlement Charges and Loan Terms fisted on this form,please contact your tender.
Previous editions are obsolete Page 3 of 4 HUD-1
August 15,2012 11:15 AM
File Number.CEN154-426
Settlament date:August 15,2012 Loan Number,6800581291 FA L-5012742-0019326E 0-5011442-0047289E
Buyers
Neil R:Treeby Maxis D.Rosoff Treeby
606 Georgetown Rd 606 Georgetown Rd
Mechanicsburg,PA 17050 :sburg,PA 17050
Sellers
Melissa A.Bobincheck,Administratrix for the
Estate of Paul E.Johnson
3924 Brookridge Drive
Mechanicsburg,PA 17050
Pro Addresses
3924 Brookridge Drive
Mechanicsburg,Pennsylvania 17050
I have carefully reviewed the HUD-1 Settlement Statement,and to the best of my knowledge and belief,it is a true and accurate statement of all
receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of HUD-1 Settlement
Statement.
l` Melissa A.B incheck,Administra " for the Estate of Pa E.
Borrower: `� ,� Seller. Jo s n
Neil R.T eby
Borrower.
Alexis .Ros eby
The MUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be
disbursed in accordance widA the instructions of the parties hereto. FA L-5012742-0019326E 0-5011442-0047289E
Settlement Agent: Date: August 15,2012
Abby endel'
WARNING: it is a crime to knowingly make false statements to the United States on this or any other similar form.Penalties upon conviction can
Include a fine and imprisonment. For details see Title 18 U.S.Code Section 1001 and Section 1010.
Previous editions are obsolete Page 4 of 4 HUD-1
August 15,2012 11:15 AM