HomeMy WebLinkAbout03-27-13 (2) REV-1500 EX (01-10) 1505610140
OFFICIAL USE ONLY
PA Department of Revenue
County Code Year F
Bureau of Individual Taxes File Number
PO BOX 280801 INHERITANCE TAX RETURN 2 1 1 2 1 0 3 7
Harrisburg,PA 17128-0801 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 8 2 7 2 0 1 2 1 0 0 4 1 9 3 2
Decedents Last Name Suffix Decedents First Name MI
P 0 W E R S J R E D W A R D F
(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
n 1.Original Return 2. Supplemental Return 3. Remainder Return(date of death
prior to 12-13.82)
4, Limited Estate 4a. Future Interest Compromise(date of 5. Federal Estate Tax Return Required
death after 12-12-82)
QX 8, Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received E) 10,Spousal Poverty Credit(date of death 0 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
B E N J A M I N J B U T L E R ? 1 7 2 3 6 1 4 8 5
c]
REG6�•f3F N1tLL5-4t6E OtAY r�rt
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m -V � `' co
First line of address %D S C- "'T
1 0 0 7 M U M M A R O A D a ^'
Second line of address
t
S U I T E 1 0 1 P
-J DATE FILM I
City or Post Office State ZIP Code - ---��- ',_ -.—%
L E M 0 Y N E P A 1 7 0 4 3 "0 n
Correspondent's e-mail address: LAWYERS(a)BUTLERLAWFIRM.COM
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNRT E OP RSON R PONSIBLE FOR Ff RETU D TE
ADDRESS
3933 BROOKR DRIVE ME H NICSBURG PA 17050
SIGNATURE OF PR RE THAN RE SE TE
ADDRESS
1007 MUMMA ROAD, SUITE 101 LEMOYNE PA 17043
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
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1505610240
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A) . . . . ... . .. . . . . . . .. . . . . . . . . . . . . . . . . . . 1. 1 2 6 0 0 0 . 0 0
2. Stocks and Bonds(Schedule 8) . .. . ... . ... ..... ... ... ... 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . . . 3.
4. Mortgages and Notes Receivable(Schedule D) ........... ... . .. 4-
5, Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 9 2 4 8 3
6, Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . 6-
7, Inter•Vivos Transfers&Miscellaneous N Probate Property
(Schedule G) Separate Billing Requested . . . . 7.
8, Total Gross Assets(total Lines I through 7) . ... ... 8. 1 6 2 9 2 4 8 3
9. Funeral Expenses and Administrative Costs(Schedule H) ... . .... ...... . ... 9 2 9 0 1 1 . 8 0
10, Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) .. .. . . . . . . . . . 10, 2 3 5 . 4 0
11, Total Deductions(total Lines 9 and 10) . . . .. . . . .. . . .. .. . .... . ......... 11. 2 9 2 4 ? . 2 0
12. Net Value of Estate(Line 8 minus Line 11) -- -- .. . . . . . . . . . . . . . . 12. 1 3 3 6 ? 7 . 6 3
11 Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ... . ..... ...... 13. 2 5 0 . 0 0
14, Not Value Subject to Tax(Line 12 minus Line 13) . . . .. . . . . . . . 14. 1 3 3 4 2 7 . 6 3
TAX CALCULATION•SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec. 9116
(a)(1.2)X.0 _ 0 a 0 is. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X-045 1 3 3 4 2 7 6 3 16, 6 0 0 4 . 2 4
17. Amount of Line 14 taxable
at sibling rate X.12 11 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 a 18. 0 . 0 0
19, TAX DUE . . . . . . . ...... ...... .. . ... . ...... 19. 6 0 0 4 . 2 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT RX
Side 2
1505610240 1505610240
REV-1508 EX±(11-10)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, & MISC.
RESISIIDENTT DEC DECEDENT U� PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
EDWARD F.POWERS }R 21 12 1037
Include the proceeds of IPogadon and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Adams Electric Cooperative, Inc.-Patronage Capital Checks 180.59
2. Washington National Insurance Company-Refund 52.28
3. 2012 1040-Refund 997.00
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4. 2010 Toyota Prins 19,500.00
value based on sale dated November 30,2012
5. PNC Bank-Checking Account No.51-8000-3235 14,78105 j
*net of checks written before death but clearing after death*
6. 2012-2013 School Real Estate Tax-Refund 492.74
7. Glock 250.00
8. Highmark-Refund 7.90
9. CVS Pharmacy-Refund 15.87
10. Comcast-Refund 11.40
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11. Personal Property-See Codicil 635.00
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TOTAL(Also enter on Line 5,Recapitulation) b 36 924.83
If more space is needed,insert additional sheets of paper of the same size
RF,V-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EDWARD F.POWERS JR 21 12 1037
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers-Buhrig Funeral Home and Crematory,Ltd. 2,384.05
2. Funeral Reception 450.00
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B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) Daniel K.Powers 2,250.00
Street Address 620 Evergreen Dr.
City York State PA ZIP 17402-8842
Years)Commission Paid: 2013 '.
2, Attorney Fees: Butler Law Firm 4,500.00
3. Family Exemption:(If decedent's address is not the same as claimants,attach explanation.) '..
Claimant
Street Address '..
City State ZIP
Relationship otCialmant to Decadent
4. Probate Fees: 330.50
5. Accountant Fees:
6, Tax Return Prepaser Fees:
7. Cumberland Law Journal-Estate Advertising 75.00 i
8. The Sentinel-Estate Advertising 263.88
9. Notary Fees 10.00
10. Repairs/Improvements for 4153 Mountain View Road(property reported at sale value) 3,923.60
11. Selling expenses for 2010 Toyota Prius(vehicle reported at sale value) 309.52
11 Sale of 4153 Mountain View Rd-Closing Costs(see attached HUD-1)(property reported at sale value) 9,890.00
13. Expenses for 4153 Mountain View Road(property was unoccupied and being maintained for sale) 1,999.15
14, Supplies 292.07
15. Uhaul 54.03
I6. Cumberland County Register of Wills-Filing Fee 30.00
TOTAL(Also enter on Line 9,Recapitulation) $ 29,011.80
If more space is needed,use additional sheets of paper of the some size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
EDWARD F. POWERS, JR 21 12 1037
Decedent's Name Page 1 File Number
Schedule H -Funeral Expenses &Administrative Costs-B1
ITEM
NUMBER DESCRIPTION AMOUNT
S. ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Narne(s)of Personal Representatives) Tara L.Plessinger 2,250.00
Street Address 3933 Brookridge Dr.
City Mechanicsburg State PA ZIP 17050-2104
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Year(s)Commission Paid: 2013
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Ill
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III
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SUBTOTAL SCHEDULE H-BI 2,250.00
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REV-1512 Eh-(12-08)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES,&LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EDWARD F.POWERS JR 21 12 1037
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Cumberland Crossing Retirement Community 185.95
2. Quantum Imaging&Therapeutic Associates 1.74
3. Hasko Jewelers 47.70
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TOTAL(Also enter on Line 10,Recapitulation) $ 235.40
If more space is needed,insert additional sheets of the same size.
R€V-1513 EX+x(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
EDWARD F.POWERS JR 21 12 1037
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Edward F.Powers,III Lineal 19,061.09
1713 Ziebach St.
Belle Fourche, SD 57717-7316
2. Daniel K. Powers Lineal 19,061.09
620 Evergreen Dr.
York, PA 17402-8842
3. Shawn M. Powers Lineal 19,061.09
614 NW 3rd St.
Eagle Grove,IA 50533-1010
4. Sharon Weaver Lineal 19,061.09
7765 S.US Highway 1,Apt. A
Titusville,FL 32780-8113
5. Elecia Carbaugh Lineal 19,061.09 1
11312 Rock Ridge Ln.
Belle Fourche, SD 57717-6119
6. Brian P. Powers Lineal 19,061.09
6720 Eureka Ave.
Cocoa,FL 32926-7903
7. Tara L.Plessinger Lineal 19,061.09
3933 Brookridge Dr.
Mechanicsburg,PA 17050-2104
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
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B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1. Eastern Adams Regional Police Department 250.00
780 Hanover Road
New Oxford,PA 17350-8433
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TOTAL OF PART I1-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 250.00
If more space is needed,use additional sheets of paper of the same size.
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LAST WILL AND TESTAMENT
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SCE
EDWARD F. POWERS, JR.
I, EDWARD F. POWERS, JR ., of Mechanicsburg, Cumberland County,
II Pennsylvania,being of sound and disposing mind,do make,publish and declare this
! as and for my Last Will and Testament,hereby revoking any and all Wills by me at any
f I time heretofore made,
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FIRST: I direct that all my just debts and funeral expenses, Pennsylvania
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Inheritance Tax, Federal Estate Tax, if any, and the cost of the administration of my
j I estate be paid by my hereinafter named Co-Executors as soon after my decease as may
(conveniently be done.
SECOND: All Pennsylvania Inheritance Tax,Federal Estate Tax, if any,or
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other such death taxes together with interest and penalties payable witb respect to
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!!property or interests subject to taxation by reason of my death and whether passing
under my will or any codicil, or otherwise, including jointly held and other non-
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testamentary property shall be paid out of the principal of my residuary estate without
apportionment by my hereinafter named Co-Executors as soon after my decease as
may conveniently be done.
5TONESIFER
AND KELLEY
A Pnjul>ndC pao.
ATTORNEYS AT LAW
249 Broadway
Hanover.Pennsylrania 17331
717.632-0163
THIRD: It is my intent to pre-arrange my funeral; however, if I have not
done so at the time of my death, I hereby direct my hereinafter named Co-Executors
to have my body cremated. If I have pre-arranged my funeral subsequent to the
execution of this Will, said arrangements shall take precedence over any directions
contained herein.
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FOURTH: I direct that my Glock Model 22 40 caliber serial number-
PHI 59 Pistol be donated to the EASTERN ADAMS REGIONAL POLICE
DEPARTMENT, at 780 Hanover Road, New Oxford, Pennsylvania, or to its
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uccessor.
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FIFTH: I direct that my residence at 4153 Mountain View Road,
Mechanicsburg,Pennsylvania be sold and I do give,devise and bequeath the proceeds
om said sale and all the rest,residue and remainder of my estate,of whatsoever type
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and wheresoever the same may be located,in seven(7)equal shares,share and share
dike, unto my children, EDWARD F. POWERS, III, DANIEL K. POWERS,
SHAWN M. POWERS, SHARON WEAVER, ELECIA CARBAUGH, BRIAN
P. POWERS,AND TARA L.PLESSINGER,orta their issue,per stirpes.
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AND LASTLY: I do hereby nominate, constitute and appoint
)DANIEL K.POWERS and TARA L.PLESSINGER, to be Co-Executors of this,
my Last Will and Testament. I direct my Co-Executors shall serve without bond.
STONESIFER
AND KELLEY
A N,f,,—1 o,a,aa,,,
ATTORNEYS AT LAW
209 Broadway
H.",Pennsylvania 17331
71774163
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IN WITNESS WHEREOF,I, EDWARD F. POWERS,JR., have to
This, my Last Will and Testament, contained on this page and the foregoing two (2)
ages, set my hand and seal this,-� day of 2004.
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it II!,
EDWARD F. POWERS, JR.
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igned, sealed,published and declared by the foregoing Testator, as and for
is Last Will and Testament, in the presence of us,who at his request, in
is presence o ach other, have hereunder set our hands as witnesses hereto.
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STONESIFER
AND KELLEY
A lie�eviaraf Capann.n
ATTORNEYS AT LAW
209 Bmdw y
Hlno a,Pennsylvania 17331
717-632-0163
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COMMONWEALTH OF PENNSYLVANIA }
SS:
j COUNTY OF YORK }
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1, EDWARD F. POWERS, J1L, the testator, whose name is signed to the
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(attached instrument consisting of three(3)typewritten pages,dated the :!�� day of
2004, having duly qualified according to the law, do hereby
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ii acknowledge that I signed and executed the instrument as my Last Will and Testament;
Ihat I signed it willingly and that I signed it as my free and voluntary act for the
(purposes therein expressed.
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Affirmed to and acknowledged before me,by EDWARD F. POWERS,JR.,
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the testator, this 0 2004.
Notary Public
NO i RAiA.L SEAL
Stacie A CW srdth,Wary PLMO
Hanauer Lzotonyh,Gwnty of York
My Can nmion Expires CV.10,2004
STONESIFER
AND KELLEY
AP-fnn, Ca.paAaoe+
ATTORNEYS AT W
209 B,.d.y
Hztw 't'ennryka-17331
717-632-0(63
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF YORK }
We, Scott L. Kelley, Esquire, and Rebecca A. Howard, the witnesses whose
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names are signed to the attached instrument,consisting of three(3)typewritten pages,
land dated the r C r`� day of u , 2004, being duly qualified
according to the law, do depose and say that we were present and saw the testator,
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'EDWARD F. POWERS,JR., sign and execute the instrument as his Last Will and
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6stament;that he signed and willingly and that he executed it as his free and voluntary
E�ct for the purposes therein expressed; that each of us in the hearing and sight of the
}estator signed the Will as witnesses;and that to the best of our knowledge the testator
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teas at that time 18 or more years of age, of sound mind and under no constraint or
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j rdue influence.
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iAffirmed and subscribed to before me by Scott L.Kelley,Esquire,and Rebecca
'A. Howard,witnesses,this fF flay of -f c.. ,2004,
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SCO4 ffkelleiV"Esquir e
tecca A. Howard
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Notary Public — ,
N{?TAF3tA1.::�.At-
STONESIFER �` n.
AND KELLEY Hanover Busocgn,Gau`;of"ofi; ff
My Comm+ssioo Er piras Oct 10,20',A
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AAa 4.al Cepann.a
ATTORNEYS AT LAW
209&madw y
HA-7'P-"y1Z-17331
717-632-0163 -_"-.
To My Children:Ned,Dan Shawn, Sharon,Elecia,Brian, and Tara;
Please accept this statement as a codicil to my Last Will and Testament regarding the
contents of my home,4153 Mountain View Road,Mechanicsburg,PA 17050.
In order to reduce the confusion of dividing up my household possessions,I have gone
through my things and have chosen certain items that I wish to be given to certain
individuals. Please be advised that it is my request that all items be divided between my
children. I do not wish to have my grandchildren going through my home. If there are
items that you would like for your child to have,it is your responsibility to secure that
item and then see that they are given the item.
Living room:
j To Dan: the Chippendale, Queen Anne chair and footstool and the desk rr
Cti and chair set.
(L 4 To Shawn: My Time Life Books on the History of US Wars. p�
"V To Tara: the 5 prints and tree wall hanging, sofa(pillows included) and`(C��p
flowered chair.
J To Ned III: My father's gold pocket watch(to be then passed on to my p 1
t grandson,Ned)
To a Family Member: Please keep together,my mother's hair,my parent's ` 1�•
wedding cake figurine's,my baby shoes,my first tooth and the gold box
and it's contents, located on the entertainment center.
Dining Room:
To Tara:The dining room table and chairs are on loan to me from Tara
and Matt. I would like it returned to them.
Master Bedroom:
To Ned: In front closet,my M130 cal Carbine,with 3 clips and my 12
gage double barrel Shotgun.
To a Family Member: I would like bedroom suit(which includes: Bed
frame,High boy,bureau, and side table)to remain as a set and Qo to any
family member who may be in need of a bedroom set. Also,the side table
and chairs should remain together, if possible with the bedroom set.
Spare Bedroom:
To Nancy: The twin bed, as she refurbished it during our marriage.
To a Family Member: Also#Large Picture and old Table Statue of St.
Joseph(belonged to Grandmother O'Brien and given to her as a @&g = r
child.) X
To Tara:The blond antique table,on loan to me from Tara and z
would like it returned to sr 4r. �j
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916.1 :z,' Qvi . a:sc.
ct Vic'
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Upstairs Bathroom:
To Tara:The bathroom accessory set belongs to Tara and Matt on Ioan to
me. I would like it returned to them.
Basement:
To Nancy: All Home Interiors wall hangings are to be returned to Nancy,
as they were purchases that we made during our marriage.
To: Shawn: The Swords hanging beside the TV.
To Ned:My gun collection and gun cabinet, expect for the Glock,which
is discussed in my will (to be then passed on to my grandson,Ned). , 4 f
To Dan and Tara:My photo albums. They will then distribute pictures to
family members, as they deem appropriate. uV r?
To a Family Member: My mothers Pullman Sofa an' Side Chair e rd
Chair is currently at Roche's Antiques,Littlestown(Phone: 354-
0902),to be repaired,$317.00 deposit,receipt in the bill box. Please keep
together as a set. This should remain in cooler climates as humidity will
affect it's wooden structure.
ward F.Powers,Jr. Date
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BEFORE THE REGISTER OF WILLS OF
CUMBERLAND COUNTY,PENNSYLVANIA
ESTATE OF EDWARD F. POWERS, JR.,
AKA EWARD FRANCIS POWERS,JR, DOCKET NO. 21-12-1037
DECEASED
DECREE OF THE REGISTER OF WII LS
AND NOW,this 9th day of October,2012,upon consideration of the Petition for Grant of Letters
filed by Daniel K. Powers and Tara L. Plessinger,by and through their attorney,Benjamin J.Butler,
Esquire, for the above decedent and the instruments offered for probate as the Last Will and Testament,
which is dated July 23,2004, and the Codicil which is dated January 17, 2006, and containing certain
modifications thereon,the Register of Wills having given consideration thereto,has made an official
determination regarding those documents and modifications and renders the following decision:
IT IS DECREED that the instrument, dated July 23, 2004,is admitted to probate as the Last
Will and Testament of Edward F.Powers, Jr. The document dated January 17,2006,is admitted to
probate as a Codicil to that Last Will and Testament with the provisions set forth in the Copy Fair
prepared by Benjamin J.Butler,Esquire.
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IT IS FURTHER DECREED that Letters Testamentary are hereby issued to Daniel K.Powers
and Tara L.Plessinger,who shall have all the rights and duties of fiduciaries under the laws of
Pennsylvania and shall proceed with the administration of this Estate according to law.
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Copy Fair
Codicil to the Last Will and Testament of Edward F. Powers, Jr.
To Tara on I1-12-10 E.P. (with arrow pointing to the word flowered chair): The
decedent gave Tara the flowered chair before he died so he documented this in his
Codicil.
also Two end tables + drum table. also white &gold lamp + 2 lamps in basement as
they are a set. EP 1-14-10: The decedent wanted Tara to receive these items when he
died so he documented this in his Codicil.
her EP 8-18-09: The decedent crossed out me and wrote her. This was done by the
decedent because he wanted the item returned to Tara(her) and not me.
Side Chair (circled) returned& is down stairs: The decedent circled the word Side Chair
to explain that this chair was no longer with Roche's Antiques and is down stairs at the
decedent's residence.
2-4-11 Aunt Mills diamond ring was placed in PNB Box 192. Upon my death it is to be
returned to Sharon or Sara to be given (or kept) to Kylie Rae Spears. Edward F Powers
Jr. 2-5-11: The decedent added this paragraph and we believe it is self-explanatory. The
ring was placed in his care on 2-4-11, but the decedent wrote the paragraph and signed
his name on 2-5-11.
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• • A w.caanswrtnMwYexinNStTawcem.M4wr ivn mvtl Gas W 2ba2.Dins
SETTLEMENT STATEMENT B' TYPE OF LOAN
i. FHA 2. FMNA a, cow.UNINS.
Select Platinum Settlement Services,LLP 4. []VA 6.❑cow..INS
3912 Market Street 8, ESCROW FILE NUMBER 7.LOAN NUMBER:
Camp Hill,PA 17031 00132452-001 MAW
(717)737-0884 S.MORTGAGE INSURANCE CASE NUMBER:
FINAL
C.NGTE: TM'sformis rMnishedbgNeyuuasbbme nlofeolustsepbmentcoa(s, Amountspaidb endDYND Sattlameotagmrtue snaxn.
Ra msmaked*(P.C.C)'wxapaid0daItta 9NdG5hV,'VW are shown tR rcrbtonnefiwairNapnsasaMare nU alcArda7ln am#a:a
D NAME OF BORROWER Miriam S.Arai
ADDRESS OF BORROWER 1616 Airport Drive
Mechantcsbu PA 17050
E NAME of SELLER: Estate of Edward F.Powers Jr.
ADDRESS OF SELLER:
F. NAMEGFLENOER:
ADDRESS OF LENDER: -
G.PROPERTY LOCATION: 4153 Mountain View Road
Mechanicsburg,PA 17050
Cumberland County 10.15-1285-181
Parcel#10-16-1285-181
H. SMLEMENTAGENr: Select Platinum Settlement Services,LLP
PLACE OF SETTLEMENT: 3912 Market Street,Camp.Hiil,PA 17011
L sflrn. Mr DATE: 2J6J2013 PRORATION DATE DISBURSEMENT DATE
2 62013
� S
RR K BU FS S TRANSACTION 80} 1WdGRM7AWtWl)
r=Y101. Contrecl Saba Pda . , rw .
, . 1. ..
Conbaot Saba Film 126,000,
102. Peramai Property 462. Personal PmpaRy
103. Settlement charges to Sommver(Nne 1400) 3A36.7D 401
104.
404.
105, 405
AAWSTMENTSFORrTEMSPAt08YSEI ERWADVANCE: A STMENTSFORtrEMSPAIDBYSELLE INAIYVANCE:
1D6. G /Town Taxes 408. C /Town Texas
107. Cmn Taxes 02/06/13 to 12131/13 321.00 407, Counq Taxes OVM13 to 12/31/13 321.
108. Assessments 406. Asawsmenla
109. sdww tax 02!08113 to D6t30P13 492.74 4% Shcool tax 02100113 to OM13 492.
110, Sawa' 02108713 to 03731113 66.38 410. Sewer 02/08/13 tO 03x31113 65,3
111. 4t T.
112. HOA Fees 02/08/13 l0 02/28! 3 63.29 412. HOA Fees 07/06/13 to 02!28113 63.
113,
413.
11A 414.
115. 415.
120. GROSS AMOUNT DUE FROM BORROWER: 130,080.09 420, GROSS AMOUNT DUE TO SELLER: 126,943.
201.
'201. ;
DenosB m soma nw . 501. Erweaa de see kroiruUlons
202. PrinUpai amount of new bans) 502. Sellbmeol Charges to Selbr line 7400 10,097.2
203. Exlaling loan(s)taken sub:;10 503. Emlatl 100)(s)taken sob U to
2 & b09. Pa of Brat Mortgage ban
20G5.
206. 505. Pa}KKtof second ban SX
207. SD7,
208. �7'
209. 606.
509.
ADJUSTMENTS FOR Few UNPAID BY SELLER. AOR/STMENTS FOR REMS UNPAID BYSECLER'
210. City/Town Tams Taxes 510. CN
211. County Taz !Town es 511, Count Taxes
212. Assessments Sit. Aasaeelrletyq
213
214. 513. j
514.
215. 515,
216. 516.
217, 517.
218. 518.
219. 519.
220. TOTAL PAIDBY/FOR BORROWER: . 0.00 520. TOTAL REDUCTONS IN AMOUNT DUE SELLER 10,097,21
. .. A
301. Gross amount due from Bortower(Nne 720} 130,080.09 Gross amount due to Seller(we 4201 128,943.3
302. Leas amount pakl by5or Bwr ar(line 220) 0.00 802. Lass reduUlon In amount due Salbr(line 5201 10,097.2
303.RASN(9lFROM) 1 ❑ TO)BORROWER 130,0110.09 603. CASH((] FROM) (h,1 TO)SELLER: 11084810
• I'87007!OTAL-.ALE319R.... CDNN9S N` etPoC �- P _..}kr;st, ..
BASED ON PRICES 126,000.00 ® 6.000" 57,560.00 PAID FROM PAID FROM
DIVISION OF COMMISSION(ONE 700)AS FOLLOWS: BORROWERS FUNDS SELLERS
701. S 3780.00 IO Keller Williams il Realty ATSETTLEMENT SFUND$AT
ETTLEMENT
702. $ 3 700.00 to ERA NRT Inc.
703. Commission paid al settlement 7,560.00
704. Additional Commission to Keller Willlams/ERA NRT Inc. 195.00 225.00
000;�fTEMS'PA1jAB1;,E'IN?CO ECYitOtY:WITH LOAN ta;';'�at gl F.,+r�€': LSI p,r.}}-,,`.i.upv Mura,Po c„ {'a �.3. v�=L t,
801. Loan Origination Fee
802. Loan Discount Fee
803. Appraisal Fee
804. Credit Report
805. Lenders Inspection Fee
806. Mortgage Insurance Application Fee
807. Assumption Fee
808.
809.
810.
all.
-.900:Y:ffEp75iR�t]U9tEDfB`(fI.EN Rtp{dB.RAtD N',.Y CF.47; " _ . ...3 n;ACa k4E.r�.��:%^dR� SUT'.tyk�:r, q.5� ';
901. Interest From to S/day % (days)
902. Mortgage Insurance Premium for Month(s)to
903. Hazard Insurance Premium for Years(s)to
904.
905.
k1000,FRESERVESatiF
1001. Hazard Insurance months®s per month
1002. Mortgage Insurance months®S per month
1001 City Property Taxes months®S permonih
1004. County Property Twos months a$ Per month
1005. Annual Assessments manao®S pr month
1006. rmnbs®$ pr month
1007. months®S par month
1008. months®S per mono
1100.. .EiC.� NZiES � a-,
,.. Jd 71 .
1101. Settlement or dosing fee
1102 Abstract or tab search
1103. Title examination
1104. Title insurance binder
1105 Document preparation to Breschl 8 Associates 115.00II
1106. Notary fees to Settlement Officer 10.00 10.00
1107. Aaoma 's Fees
(krdudea above Is.numbe c )
1108. Title Insurance to Soled PleUnum Settlement Services,LLP 1,030.00
Oedudssab ftzmemlmbrs: )
1109. Lenders coverage $
1110. Owners coverage, $ 126,000.00
1111. Overnight Fees to Select Plednum Settlement Services,LLP - 15.00
1112. Tex Cart Fee to Select Platinum Settlement Services,LLP 10.00 '.
1113.
•,120x. tOVEl3 ENXj,RECGIRRINOSAN4t'CjtANBF ibhfkYSD :,... .{,�. ,;DC to .. ;'.r ,ag,T.�;„ q;;�, '..
1201. Recording Fees: Deed$ 62.00 Mortgage$ ^Release$ 62.00
1202. City/County txy/slam Dead 1260.00 Mortgage$ 1,260.00
1203. Slate tax/stam s Deed$ 1,260.00 Mortgage$ 1,260.00
1204.
1205.
..1300:>jl/1TOD)TID 16la&:.' ;CFULN�3E6 ::GC rat."1,•.xII 1'9':,x,_,
1301, Survey
1302. Pest Inspection
1303. Trash 216113-Ml/13 to Hampden Township Sewer Authority 27.20
1304. 2013 Counly/Twp Taxes to Michael Langan 357.21
1305. HOA InIt aUOn Fee to Wyndham Place HOA 450.00
1306. HOA March Dues to Wyndham Plow HOA $7.50
1307. Home Womanly to American Home Shield 56000
14DO, TOTAL SETTLEMENT CHARGES(Entr on the 103AWlion J-and-Oro 902,Section K) 3,136.70 10,097.21
I have mmMly nwiewed the HUD-1 Settlement Statement and b iha bast dray knowledge and belief,It b a true and accurate statement of W rerelpls and digWrasmmte mode on my
.unl or by me In the becnucUCnn..�l bribe mrtxy that l have remWed a�of be FlUD-1 Settlement Statement
Miriam S.Arai - Estate of Edward F.Powers Jr.
Borrow vs Sell. �
f TTa)heeaHUD-1 Sellenen5tst.me.tw /p r a ndamnde,=ntoftNSbanmdkn. lhaweeear"mssa%ee Nnd/tobadbb=W awewbls
me / Santarem Agent
Deb
SelecfPlatlnum SeWement Services,LLP -
WARNING: IIbaalmabkmmNply,mkeraWsWome bleaUniMd StWUnpisoraMak rblm.Panflnuponwmidn'unIncludeaflatant Mpi nL Fordetass
see:mW is US.Cab Seceon.1001 and SecYm tam.
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0801
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 016834
POWERS DANIEL K
620 EVERGREEN DRIVE
YORK, PA 17402-8842
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 $6,000.00
ESTATE INFORMATION: SSN: 159-28-7982
FILE NUMBER: 2112-1037
DECEDENT NAME: POWERS EDWARD F JR
DATE OF PAYMENT: 11/27/2012
POSTMARK DATE: 11/27/2012
COUNTY: CUMBERLAND
DATE OF DEATH: 08/27/2012
TOTAL AMOUNT PAID: $6,000.00
REMARKS:
CHECK# 108
INITIALS: DMB
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
Adams Electric PLEASE DETACH AND RETAIN
re Bgw�mb as
Cooperative,Inc, Gi^y$BbUr9.PA 173M No. 21200688
'qh
Date: 01/29/2013
ATE INVOICE DESCRIPTION GLACCOUNT DEPT AMOUN
/201 7013012908584027-2- Estate Retirement 14 $—0 5fT
Customer: 69928875 ESTATE OF EDWARD F POWERS JR Totals: 52.6
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1338 Bl n,AA Rd
Cooperative,Inc, c3sa,�e�.Pa ir3ze No. 21200646
A T�.E—,l IOU_ Date: 01/28/2013
ATE INVOICE DESCRIPTION GLACCOUNT DEPT AMOUN'
TaRTUff 20130128151957351 Estate Retirement
Customer: 89928875 ESTATE OF EDWARD F POWERS IR Totals: 127.9!
THI S CHFC It I S V 01 D IN ITHOU I A C OLDS E D LIACKGROUN D AND WA7 ERMAHJULINES ON I H E LACK M OLD AT ANGLE TO VIEW
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Total Banking Statement QPNCBANK
PNC Bank
Primary account number:51-8000-3235
Page 1 of 4
For the period 00/22/2012 to 00/24/2012 Number of enclosures:0
002244 For 24-hour banking,and transaction or
EDWARD F POWERS JR interest rate Information,sign on to
4153 MOUNTAIN VIEW RD PNC Bank online Banking atpnc.com.
MECHANICSBURG PA 17050-7626 'a For customer service call 1-888-PNC-BANK
Monday-Friday: 7 AM-10 PM ET
Saturday&Sunday: 8 AM-5 PM ET
Para servicio on espaflol, 1-866-HOLA-PNC
Moving7 Please contact us at 1-888-PNC-BANK '.
®Write to:Customer Service
PO Box 609
Pittsburgh,PA 15230-9738
Visit us at pnc.com
TDD terminal:1.800-531-1648
For hearing impaired clients only
Reledonehip Overview
Bank 131"osi!Accounts
Description Account Number Deposit Balance
Free Checking 51-80048285 13,953.09
Total Deposits 13,953.09
UKPORTANT NOTICE ABOUT PNC POINTS®:The PNC points Program is being discontinued for customers with PNC Bank
Visa® Check Cards. However,the PNC Purchase Payback Rewards Program will be enhanced to offer cash rewards to eligible debit and
credit customers for qualifying purchases at participating merchants.PNC points®and PNC Flex®Visa credit card customers will continue to
enjoy the benefits of PNC points.
For PNC Bank Visa Check Card customers:
•You will no longer be able to enroll or link your Consumer or Business Check Card(s)in PNC points on or after November 1,2012.
•Any Check Cards enrolled or linked in PNC points before November 1,2012 will continue to earn points through January 31,2013.
•If your Check Card isn't linked to a PNC points participating credit card in your name,the points in your account must be redeemed before
December 1,2013 or they will be forfeited.
Look for exciting,new information about the PNC Purchase Payback Rewards Program later this fail.
(If your Check Card is associated with a Free Checking,Foundation or Virtual Wallet checking product and was previously enrolled or linked
in PNC points but is no longer earning points,you cannot reopen your PNC points account by changing your checking account type to one
that participates in PNC points effective November 1,2012.)
Free Checking Account Smnmary Edward F Powers Jr
A000ust number. 51-8000-3235
Overdraft Proteotion has not been established for this account.
Please contact us if you would like to set up this service.
Ovordraft Coverage-Your account Is currently0pted-Out.
You or your joint owner may revoke your opt-in or opt-out choice at any time.
To learn more about PNC Overdraft Solutionsvleit us online at pnc.comlavordraftsolutions.
Cell 1.977-58&3505,visit any branch,or Sign on to PNC Online Banking,and select the-Overdraft
Solutions-link under the Aocount Services section to manage both your Overdraft Coverage and Overdraft
Protection settings.
.........�... .....�.�,...,.,..,.,.,.,.. ....e,.,.e,...,,
Total Banking Statement
For the period 08/22/2812 to 08124/2013
For 24-hour Information,sign on to PNC Bank Online Banking EDWARD F POWERS JR -
on pnc.00m. Primary account number:51-8000.3235
Account number:51.8000-3235-continued Page 2 of 4
Balance Summary
Beginning Deposits and Checks and other Ending
balance otheraddRlons deductions balance
11,903.57 1,563.17 5,513.65 13,953.09
Awrege monthly Charges
balance and fees
15,267.37 3.00
Transaction Summary
Checks paid/ Check Card POS Check Card/Bankcard '..
withdrawals signed transactions POS PIN transactions
8 0 0
Total ATM PNC Bank Other Rank
transactions ATM transactions ATM transactions
0 0 0
Activity Detail
Deposits and Other Additions There was 1 Deposit or OtherAddkion
Date Amount Description totaling$1,803.17. '....
09/04 1,563.17 Direct Deposit-ACH Credit PNC Bank XXXXX7982 '..
Checks and Substitute Checks
Check Date Reference Check Date Reference j
number Amount paid number number Amount paid number j
7051 17.53 08/22 o85 ill 7059 280.00 09/05 086170348
7052 129.26 08/22 086003M 7060 100.00 09/04 084M1575
7057* 335.00 . 09/04 084818679 7062 * T 385.00 09/04 522047838
7058 75.00 09/04 084236995 7063 2,000.00 09/05 oe55e543s
"Gap Inchecksequence 'T'TeiierCashedCheck There were 8 checks listed totaling
$8,821.70.
Online and Electronic Banking Deductions There were 5 Online or Electronic Banking
Data Amount Description Deductions totaling$2,188A0.
08/23 269.00 Payment,E-Check Check Pmt Kohls Chg Pmt 7056
08/24 832.43 Payment,E-Check Checkpymt Old Navy Visa 7055
09/06 392.13 Direct Payment-PH PAC
Wash.Ntl.(pion)9WP11296982A
09/10 369.00 Payment,E-Check Check Pmt K01213 Chg Pmt 7066
09/11 326.30 PaymentyE Check Check Pymt Goodyear 7067
Other Deductions There was I Other Deduction totaling I
Date Amount Description $2.00.
09/24 3.00 Check Images In Statement Fee
Daily Balance Detail
Date Balance Date Balance Date Balance
08/22 17,756.78 09/04 17,323.52 09/10 14,282.39
08/23 17,487.18 09/05 15,043.52 09/11 13,956.09
08/24 16,65535 09/06 14,651.39 09/24 13,953.09
rrwrvnc=s:.n
i IGHMARK®
Date: 02/13/2013
This Month
Gross payment amount 7 . 90
Net payment amount 7 . 90
0415310
CVS/pharmacy'
CVS Caremark Corporation
Attn:Third Party CVS/Pharmacy has determined
1 CVS Drive that a refund is due to you for
Woonsocket, RI 02695 Y
the claim(s) listed below. For
questions concerning this
refund, call 800-494-4287 and
select Option 1. Thank you for
shopping at CVS
EDWARD POWERS 5246 0678-23-42-MAAD
4153 MOUNTAIN VIEW RD
MECHANICSBURG, PA 17050-7626
- IIhIIIIP�IIIhIhI�IIIIIIIII�IhIIrIII�P�u�llrlllhh�ul�i
PAYWATT SUMMARY
VENDOR NO: 000000000000000
CHECK NO: 0000202088 CHECKDATE: 09/25/12
STORE RX DATE OF SERVICE GROSS DISCOUNT NET
NUMBER ! NUMBER i AMOUNT AMOUNT
01639 ; 1081897 07/06/2012 15.871 .00 15.87
TOTAL 1 15.87
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COMCAST
1555 SUZY STREET
ATTN: LEBANON SUPPORT SERVICES
LEBANON, PA 17046
comcast
EDWARD POWERS JR 21545 0962-47-95-3DG
4153 MCN VIEW RD
MECHANICSBURG, PA 17050-7626
— Ii�dlld�i�ilm�gm�nigi�Irl�nP����IrhI���IPi�uulh '',
PAYMENT S U A ARY
CHECK NO: 0010181690
ACCOUNTNO: 09547-20285902 CHECK DATE: 01/07/13
Dear EDWARD POWERS JR, -
The attached check represents a-refund for account number 09547-20285902 in the amount of
$11.40.
If you are a Comcast BPINITY customer and have questions regarding your refund check, you
can write us at the address above, call Comcast's toll free customer service number at
1-888-COMCAST (1-888-266-2278), or chat with us at www.comcast.com/chat. Our
representatives are available to assist you 24 hours a day, 7 days a week.
If you are a COmcast Spotlight client or agency, please contact your local Spotlight
Office.
DETACH AND RETAIN THIS STATEMENT
THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED ABOVE
IF NOT CORRECT,PLEASE NOTIFY US PROMPTLY.NO RECEIPT DESIRED.
• :•it TWAN i