HomeMy WebLinkAbout04-1053Estate of Margo Eby
also known as
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
PETITION FOR GRANT OF LETTERS
21
, Deceased Social Security No 186-24-9835
R. Mark Thomas, Esq.
Petitioner(s), who is/are 18 years of age or older, apply)les) for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ~
[]Decedent, dated and codicil(s) dated
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs: :'~ ~
I Name Relationship Residence
Patdcia L. Metek Niece ,3637 Autumn~':ree Dr.
Medina, OH ~4256
Albert Capatch
Carol Wilson
Nephew
Niece
101 Viets Dr.-':;
Cortland,
3297 WakefieM Creek Rd.
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at 2862 Sunset Dr., Camp Hill, PA 17011
(list street, number and municipality)
Decedent, then 89 years of age, died August 29 2004 , at Mt. Nittany Medical Ctr., College Twp., PA
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property ......................................... $
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in PA Personal property in County .............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..................................................................................................................... $
Real Estate situated as follows: 2862 Sunset Dr., Camp Hill, PA
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
Typed or printed name and residence
2,000.00
80,000.00
82,000.00
R. Mark Thomas, Esq.
01 S. Market St., Mechanicsburg, PA 17055
Continuation of Petition for Grant of Letters
Margo Eby
Page 1
List of Surviving Spouse and Heirs
Name Relationship Residence
Farmdale, OH 44417
Cynthia Bauer
Williarn Capatch
Frank Capatch
Niece
Nephew
Nephew
Katherine Capatch Niece
4139 Smith Stewart Rd.
Vienna, OH 44473
1106 W. Avenida Del Sol
:eoria, AZ 85382
PO Box 1341
Pahoa, HI 96778
After following reasonable
investigation her whereabouts
remain unknown
105.112 REV 8/88
(FEE FOR THIS
CERTIFICATE $2 00)
WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. T 5722370
September 01, 2004
Date Of Issue of This Certification
Name of Decedent
Margo
Eby
Female First
Sex Social Security No.
06-24-1915
Date of Birth Birthplace
Mount Nittany Medical Center
Place of Death
186-24-983~® Last 08-29-04
Date of Death
Madera, Pennsylvania
Centre College Twp.
Pennsylvania
White Fa¢.i,i, N,,m¢ Fashion ~3del o,~ Borough or Township
Race Occupation Armed Forces? (Yes or No)
Widowed Decedent's PO Box 573, Madera, PA 16661
Marital Status Mailing Address
Raymond Cloud ~,~,h¢., s ..... Frank I~iffliT~
Informant Funeral Director
Name and Address of 14~uise Funeral Homes, Inc., Madera, PA 16661
Funeral Establishment
NO
State
Part I:
Immediate Cause
Sepsis
(a)
Interval Between
Onset and Death
Hours
(b)
(c)
(d)
Part Ih
Other SiA~ificant ~onditipns,
~nromc t~enm rauure, Multiple Myeloma, Probable Cirrhosis
Manner of Death
Natural E-~' Homicide
Accident [] Pending Investigation
Suicide [] Could not be Determined []
Name and Title of Certfier
David W. Wolfe, MD
Describe how injury bCcUrred:
"C:
(M.D., D.O., Coroner, M.E.)
Address
200 Scenery Drive, State College, PA
This is to certify that the information here given is c~:~rectl~cop~,.~d fro/m an or,ginal certificate
of death duly filed with me as Local Registrar. The~jbr,~,~.~ ce~vt'ifi~..~t/will be forwarded to the
State Vital Records Office for permanent filing.
Denise A. Sherkel l 7-183
Local Registra~ o~ Vital Records Distric~ NO.
September 0 l, 2004 986 Clam St. Hont~clale 1665
Date Received by Local Registrar Street Address CF[y, Borough, Township
Estate of Margo Eb¥
also known as
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
RENUNCIATION
.o.
, Deceased
The undersigned,Albert Capatch, nephew
(Relationship) (Capacity)
of
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters of Administration be issued to R. Mark Thomas, Esq.
Witness 7~iJ)~-~ F. ('4~¢~./T~and this /(¢ ¢41 ~~ ~
. .. - day of ,
(Signature)
1 O1 Viets Dr.
(Address)
OH 44410
(Signature)
(Address)
(Signature) ~.~ :~
(Address) ,-:~'_
Sworn to or affirmed and subscribed
before me this //0 day of
No~ ~bl~ ' AEDRgY ~, ~INSTEIN
M~ ~to~ Excres Mar. 13, 2005
(Signature and seal of Notary or other
efficial qualified to administer oaths. Show
date of expiration of Notary's commission.)
NOTE:
Renunciations executed outside the Office of Register of Wills are
required in some counties to be notarized.
RW-3
RENUNCIATION
To the Register of Wills of C~o~; ~'~* £/~--'M
The undersigned ~/~0~'~ T- ) of.
lh~ abo¥¢ d¢¢~d~nt, hereby ~¢no~¢¢(s) th~ fi~ht to administer thc ¢sl~t¢ a~d respectfully ask(s) that L¢tI¢~$
County, Pennsylvania.
be issued to
(Add~'ess)
'~($ignatur~
Sworn to or affirmed and :' -~'
subscribed before me this
15th day of October, 2004.
N~tary Public '.~
(Signature)
C:~,;, 3c~,, :,~ota~y Public
: :;,;,ps.burg Boro, Cumberland County
Expires Expires Mar. 11, 20C:::,
(Address)
O~.,T. *T'O4fh'ED] 10:59 R. >,'I.4RK' "' '
"' -, .. o.uu P, OOo
Estate of M_..~.go Eb¥
¢lso known as__
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
RENUNCIATION
DeceaseO
The undersigned,C--ynthia Bauer, niece
(CapaCity)
the above Decedent, hereby renounce(s) the right to administer the estate and respectfuliy request(s) that
Letters of Administration - be issued to R._.~,,M,,ark Thomas, Esq.
Witness -.~---~-.arid this / ~ d,y Of ~~ ~0 y
Sworn to or affirmec~ and subscril3ed
before me this ~/'~' day of
My Commission Expires: 7~~
[/u:ldres~)
data ol expif,~.Jon ~t Noi&ry'a cornmissior~ )
NOTE:
Ren~ncietiOm~ a>:ecuted outside the Office of R~glster 01' Wills ere
required in some -~our~ties to 13e notarized.
RW-2
Estate of Margo Eb¥
also known as
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
RENUNCIATION
, Deceased
The undersigned,william Capatch, nephew
(Relationship)
(Capacity)
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters of Administration be issued to R. Mark Thomas, Esq.
Witness
hand this dayof ~d~ ~__.~¢~/~
(Signature) U ~'
9106 W. Avenida Del Sol
Peoria AZ 85382
(Address)
(Signature)
(Address)
of
(Signature)'
(Address) --.,,J
Sworn to or affirmed and subscribed
before me this ~ dav of
~CommissionExpires: ~ ~~
(Signature and seal of Notary or other
official qualified to administer oaths. Show
,dale of expiration of Notary's commission.)
NOTE:
Renunciations executed outside the Office of Register of Wills are
required in some counties to be notarized.
RW-3
Estate of Margo Eby
also known as
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
RENUNCIATION
, Deceased
The undersigned,,carol Wilson, niece
(Relationship) (Capacity)
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters of Administration be issued to R. Mark Thomas, Esq.
Witness
(Signature)
32'97 Wakefield Creek Rd.
Farmdale OH 44417
(Address)
(Signature)
(Address)
(Signature)
of
,Sworn to or affirmed and subscribed
0efore me this ~ /day of
oo.9
(_.//1~4otary Pubiic -k_..,
M~ _~¢f[yf~.ry Public
state of Ohio
My Commission ExCres December 7, 2004
(Address) 7
IrSignature and seal of Notary or other
official qualified to administer oaths. Show
date of expiration of Notary's commission.)
NOTE:
Renunciations executed outside the Office of Register of Wills are
required in some counties to be notarized.
RW-3
Estate of Margo Eb¥
also known as
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
RENUNCIATION
, Deceased
The undersigned,Patricia Metek, niece
(Relationship) (Capacity)
of
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters of Administration be issued to R. Mark Thomas, Esq.
Witness ~ c.~ hand this ~=~3_¢..z~ day of ~ ~ ~ ,.¢ ¢ ~
(Signature)
3637 Autumn Tree Rd..
~ j~,~)li~"t4¢,~ OH 44256
(Address)
(Signature)
(Address)
Sworn to or affirmed and subscribed
before rne this ¢~. ¢ '~ day' of
My Commi~j~
~Y 1~ )
(~)gnature and sea) of ~ota~ OF other
o~c)am quam)fied to ad~msteF oaths. ~ho~
date of exp)rafion of ~ota~'s co~ss~on.)
NOTE:
(Signature) ~¢' , ~ '
(Address)
Renunciations executed outside the Office of Register of Wills are
required in some counties to be notarized.
RW-3
/ 7
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: MARGO EBY
Date of Death: 8/29/2004
. Estate No. 21-04-1053
SSN: 186249835 File No. 2004-01053
Date Letters Granted: 11/17/2004 Will or Administration No.
To the Register:
I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served
on or mailed to the following beneficiaries of the above-captioned estate on 11/22/2004
Name
CAROL WILSON
CYNTHIA BAUER
PATRICIA METEK
ALBERT CAPATCH
WILLIAM CAPATCH
FRANK CAPATCH
Address
3297 WAKEFIELD CREEK DR.
FARMDALE
5784 AMY BOYLE RD.
BROOKFIELD
3637 AUTUMN TREE DR.
MEDINA
101 VIETS DR.
CORTLAND
9106 W. AVENIDA DEL SOL
PEORIA
PO BOX 1341
PAHOA
OH 44417
OH 444O3
OH 44256
OH 4441O
AZ 85382
HI 96778
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
KATHERINE CAPATCH ENGLISH
Date: 11/22/2004
Capacity:
X Personal Representative
Counsel for Personal
Representative
Signature
R. MARK THOMAS, ESQ.
Name (Please type or print)
Address
101 S. MARKET ST.
MECHANICSBURG
Telephone No. 717-796-2100
PA 17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
Telephone
717 787-3930
July 5, 2005
Ms. Karen L.Starck
Register of Wills
Clearfield County Courthouse
P. O. Box 361
Clearfield Pa 16830
Dear Register of Wills:
Re: Estate of Eby Margo
File Number: 2104-1053
County: Cumberland
Date of Death:8/29/04
The subject decedent legally resided in Cumberland County as of the date of death.
Accordingly, you are authorized to cancel file number 1705-0323. All matters concerning this
estate should be maintained under Cumberland County File Number 2104-1053.
All original Inheritance Tax documents for the subject decedent should be forwarded to
the Cumberland County Register of Wills; however, you may wish to retain a copy, including
photocopies of all receipts for the collection of Inheritance Taxes in the subject estate which
have been issued by your office.
Please contact me at the telephone number above if you have any questions.
Claudia Maffei, Supervi
Document Processing ni
Inheritance Tax Division
.
.
~s:.'-?--
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
July 5, 2005
Telephone
717 787-3930
Re: Estate of Eby Margo
File Number: 2104-1053
County: Cumberland
Date of Death:8/29/04
.. 1'.c;:..C'f..
S\,r
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Ms. Karen L.Starck
Register of Wills
Clearfield County Courthouse
P. O. Box 361
Clearfield Pa 16830
Dear Register of Wills:
The subject decedent legally resided in Cumberland County as of the date of death.
Accordingly, you are authorized to cancel file number 1705-0323. All matters concerning this
estate should be maintained under Cumberland County File Number 2104-1053.
All original Inheritance Tax documents for the subject decedent should be forwarded to
the Cumberland County Register of Wills; however, you may wish to retain a copy, including
photocopies of all receipts for the collection of Inheritance Taxes in the subject estate which
have been issued by your office.
Please contact me at the telephone number above if you have any questions.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
.. PENNSYLVANIA a
wrNHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CF001 020
Received From:
RAYMOND L CLOUD
POBOX 585
MADERA, PA 16661
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ACN
ASSESSMENT
CONTROL
NUMBER
.;:--
.-:.~
AMOUNT
101
4,050.00
: ESTATE INFORMATION:
I
iFILE NUMBER---- - ----- - ------1
1705-0323 I
(LAST)--- ~-(FIRST)- ~--~If~
EBY MARGO E I
------------1
06/07/2005 I
---~
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~
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SSN: 186-24-9835
; NAME OF DECEDENT
I
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[bATE OF PAYMENT---
I
! POSTMARK DATE
I
I COUNTY----- -'-
I
06/07/2005
I
IDATE OF DEATH
I
CLEARFIELD
08/29/2004
REMARKS
TOTAL AMOUNT PAID
4,050.00
RECEIVED BY
/~/-dY~
SEAL
MY COMMISSION EXPIRES
FIRST MONDAY IN JANUARY 2008
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~EV.1500 EX (6.00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
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OFFICIAL USE ONLY
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
~2-~J _O_3~_
COUNTY CODE YEAR NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Eby Margo E.
DATE OF DEATH (MM-DD-YEAR)
08-29-2004
SOCIAL SECURITY NUMBER
186 - 24
- 9835
DATE OF BIRTH (MM-DD-YEAR)
06-24-1915
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SEC RITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
D 1. Original Return
o 4. Limited Estate
D 6. Decedenl Died Testate (Attach copy of Willi
D 9. Litigation Proceeds Received
~ 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (AttachcopyofTrust)
o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date of death priorto 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach SchOI
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NAME
COMPLETE MAILING ADDRESS
PO Box 585
Madera PA 16661
Raymond L. Cloud
FIRM NAME (If Applicable)
TELEPHONE NUMBER
(814) 378-5476
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
(1)
(2)
(3)
(4)
(5)
OFFICIl!lL USE ONLY
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billin9 Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
27,000.00
t,.)
(6)
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(7)
27,000.00
(8)
27,000.00
(9)
(10)
(11)
(12)
(13)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
27,000.00
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x.O_ (15)
x.O_ (16)
x .12 (17)
x .15 (18) 4050.00
(19) 4050.00
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
27,000.00
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
..
Decedent's Complete Address:
STREET ADDRESS
S ruce Street
PO Box 485
CITY
Madera
STATE
PA
ZIP
16661
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
4050.00
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
4050.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
4050.00
A. Enter the interest on the tax due.
Make Check Payable to: REGISTER OF WILLS, AGENT
..(iff:fjJP
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;.......................................................................................... D ~
b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~
c. retain a reversionary interest; or.......................................................................................................................... D 89
d. receive the promise for iife of either payments, benefits or care? ...................................................................... D ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. IT! D
3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? .............. D e9
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D e9
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury, I dedare that I have examined this ratum. 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.
b
DATE r
7.-- Q 7
PA 16661
H & R Block
DATE
06-06-05
530 State street
CUrwensville PA
16833
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 PS ~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% [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
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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive paren'
or a stepparent of the child is 0% [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%, 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% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as al
individual who has at least one parent in common with the decedent, whether by blood or adoption.
R8.510 EX 011..;;
e SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Margo E. Eby
This schedule must be completed and filed If the answer to any of Questions 1 through 4 on the reverse side oflhe REV-1500 COVER SHEET is yes.
ITEM
NUMBER
1.
DESCRIPTION OF PROPERTY
INClUOE THE NAME Of THE TRANSfERt:E, THEIR RaATIONSHIP TO DECEDENT AND THE DATE OF TRANSfER.
ATTACH A COfIV OF THE OECO FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
$30,000.00
%OF
DECO'S..,
INTERESf
100";6
EXCLUSION TAXABLE VALUE
nFAPl'UCAIllEl
$3000.00 $27,000.00
Raymond L. Cloud, companion of Decendent
Cash received on 08-24-04.
KAREN 0 STARCK
REGISTER IND RECORDER
CLEARFI LO COUNTY
Penns' Ivnn j u
INSTRUtll NT MUMBER
2005":18449
RECO OED OM
Jun 07" 2005
1=18=37 PM
FILE UMBER
170'-0323
Total ages: 5
RECORDING F ES - $10.00
ORPHANS COu! IREGISTER OF
WILLS
TOTAL $10.00
W TOMER
CLOUD 1 RA VM! 0
TOTAL (Also enter on line 7, Recapitulation) $ 27,000.00
(If more space IS needed, insert additionaf sheets of the same size)
.
REV.1513 EX + (1.97')
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Marqo E. Eby
e
e
SCHEDULE J
BENEFICIARIES
FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
1. TAXABLE DISTRIBUTIONS (include Dutright spousal distributions)
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) "
1. Raymond L. Cloud
PO Box 585
Madera PA 16661
Companion & friend
AMOUNT OR SHARE
OF ESTATE
$30,000.00
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE; ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
.
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
..
COMMONWEALTH OF
PENNSYL VANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
1 '
OFFICIAL U5~ ONLY
I
FILE NUMBER j
~L-J2}L~L~ <>.3
COUNTY COOE YEAR ' NUMBER
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DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
Eb Mar 0
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
SOCIAL SECURITY NUMBER
1 8 6 - 2 4 - 835
THIS RETURN MUST BE FILED DUPLICATE WITH THE
REGISTER F WILLS
SOCIAL SECURITY NUMBER
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08/29/2004 06/24/1915
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[Xl 1, Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2, Supplemental Retum
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy Of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Retum (date of death prior to 12-13-82)
o 5, Federal Estate Tax Retum Required
_ 8. Total Number of Saft Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach 5ch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE; (RECTED TO:
NAME COMPLETE MAILING ADDRESS
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IX:
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(.)
FIRM NAME (If Applicable)
TELEPHONE NUMBER
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4, Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(1)
(2)
(3)
(4)
(5)
231,000.00
OFFIC~"USE ONLy,'-j
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(6)
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110,132.53 I
I
0.00 X _(15) 0.00
0.00 X _(16) 0.00
0.00 X .12 (17) 0.00
219,997.30 X .15 (18) 32,999.60
(19) 32,999.60
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable atthe spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
30,000.00
(8)
371,132.53
16. Amount of Line 14 taxable at lineal rate
59,702.42
91,432.81
(11)
(12)
(13)
151,135.23
219,997.30
17. Amount of Line 14 taxable at sibling rate
(14)
219,997.30
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SORE TO ANSWEIt AlL;aOE$TlONS ON REVERSE SIDE AND RECHECK MATH < <
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I t Add
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Dece.ents omple e ress: I
STREET ADDRESS !
216 Spruce Street I
!
CITY I STATE I ZIP
Madera PA 1666l
Tax Payments and Credits:
1. T ax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
32,999.60
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check to: REGISTER OF WILLS, AGENT
0.00
0.00
32,999.60
32,999.60
II
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes NJo
a. retain the use or income of the property transferred; ........................................................................... 0 l&l
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 l&l
c. retain a reversionary interest; or ...................................................................................................... 0 l&J
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 l&J
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
3. ~:~h~~~:~~~~~;na:~~~::;u~~~~~d~~a~~;:~;~. ~;~ .~~~~~ .~~~.~ .~~~~~.~;. ;r' ~~~~';i;~'~; .~;~.;; ~~; ~~~;~.;.::::::::::::::::: ~ ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 rtJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF tHE RETURN.
I
ADDRESS 101 S. Market St.
Mechanicsburg
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
PA 17055
DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving.spouse is 3%
[72 P.S. 99116 (a) (1.1) (ill.
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% [72 P.S. 99116 (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 twenty-one years of age or younger at death to or for the use of a natural parenl,an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(l.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%, except as noted in 72 P.S. 99116{1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116{a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
, REV-150l EX + (6-98)
*'
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
E~ Ma~o I
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property wou'd 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 DrODertv which is iointlv-owned with riaht of survivorshio must be disclosed on Schedule F.
UT
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DESCRIPTION
ITEM
NUMBER
1.
2850 Sunset Drive
Camp Hill, PA 17011
2.
216 Spruce Street
Madera, PA
VALUE AT DATE
OF DEATH
180,000.00
51,000.00
TOTAL (Also enter on line 1, Recaoitulationl $
(If more space is needed, insert additional sheets of the same size)
231 000.00
~ REV-150tl EX + (6-98)
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eby Margo
ITEM
NUMBER
1,
2,
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate,
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
VALUE AT DATE
OF DEATH
1,104.00
Household furnishings
1993 Cadillac
1,240.00
M& T Bank
499 Mitchell St., Millsboro, DE 19966
Checking Acct. #28862996
3,155.68
M&T Bank
499 Mitchell St., Millsboro, DE 19966
Savings Acct. #15004206021559
99,497.09
Progressive Insurance Refund
1,098.00
Reimbursement of 2004-2005 School Taxes on Camp Hill Property
(See HUD-1)
1,018.61
Reimbursement of Trash/Sewer Camp Hill Property
(See HUD-1)
25.32
Reimbursement of Real Estate Taxes on Madera, Property
(See HUD-1)
42.30
County National Bank
2,558.05
Refund - Geisinger Health Systems
32.87
Refund - Clearfield Professional Group, L TD
9.61
Refund - Donegallnsuranc Company
351.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
110 132.53
\ REV-15~O EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eby Marr,;Jo
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
DESCRIPTION OF PROPERTY EXCLUSI~
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COpy OF THE OEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE! VALUE
1. Raymond Cloud 30,000.00 100. 30,000.00
- Companion of decedent
- Transfer 8/13/04 (See photocopy of check)
.
.1
TOTAL (Also enter on line 7 Recaoitulationl $ 30 000.00
I
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET iJ yes.
1
(If more space is needed, insert additional sheets of the same size)
, REV-151~ EX + (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eby Margo
ITEM
NUMBER
A.
1.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Debts of decedent must be reported on Schedule I.
FUNERAL EXPENSES:
Kruise Furneral Homes, Inc.
254 Lynn St., PO Box 587, Madera, PA 16661
DESCRIPTION
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) R. Mark Thomas
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 101 S. Market St.
25-1766036
State PA
Zip 17055
City Mechanicsburg
Year(s) Commission Paid: 2005
Attomey Fees R. Mark Thomas, Esq.
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
Probate Fees 264.00 on 11/17/04
Accountant's Fees
Tax Return Preparer's Fees
State
Zip
Leggett, Inc.
Barrett Sanitation, Inc.
Christoff Mitchell Petroleum, Inc.
Houtsdale Municipal Authority
Latosky Inspection Company
PPL Electric
Penelec
Shipley Oil (Camp Hill Property)
Adelphia
Pennsylvania American Water
Ritter's Hardware (keys to Camp Hill Property)
Charles Kleber, private investigator
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
r
I
i
I
I
I
i
I
AMOUNT
2,043.00
14,000.00
7,000.00
384.00
375.00
40.00
673.21
146.82
425.00
128.30
56.30
629.05
57.70
287.78
5.76
247.50
59 702.42
Eby. Margo
Decedent's Name
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Page 1
ile Number
Schedule H - Funeral Expenses & Administrative Costs - 87.
:
ITEM
NUMBER
DESCRIPTION
AMOUNT
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
Robert & Frances Greenway (Madera Property maintenance)
Tammy Shoop (Clean Camp Hill Property)
PA Turnpike tolls
Space Mart Self Storage
McCafferty Autorent (truck rental)
Gasoline for rental truck
Peter Thomas - labor on 5/27/05
Rowe's Auction Service
FedEx Charges
Postage
Settlement charges Camp Hili Property (See HUD-1)
Seller's assist on Madera property (See HUD-1)
County Taxes 1/1/05-2/11/05 Camp Hill Property (See HUD-1)
Repair Credits to buyer of Camp Hill Property (See Hud-1)
Settlement charges Madera Property (See HUD-1)
School Tax 7/1/05-8/4/05 Madera Property (See HUD-1)
Ace Hardware
349.00
180.00
13.75
247.51
167.87
38.00
150.00
386.00
205.86
9.25
15,088.65
1,530.00
75.39
10,000.00
4,708.03
40.72
12.97
SUBTOTAL SCHEDULE H.B7
33,203.00
REV-1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eby Margo
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
DESCRIPTION
Swales Style Line Upholstery
Barrett Sanitation, Inc.
PPL Electric (Camp Hill Property)
Penelec (Madera Property)
Verizon Communications
Pennsylvania American Water
Adelphia (Cable)
Washington Mutual Bank (Mortgage payoff) (See HUD-1 Camp Hill Property)
VALUE AT DATE
OF DEATH
169.60
80.00
13.68
71.66
81.77
42.62
44.47
90,929.01
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
91 432.81
. ''''~''''.".(*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Ehv. t.II~r,n
RELATIONSHIP TO DECEDENT A'v10UNT 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. Carol Wilson Collateral
3297 Wakefield Creek Rd.
Farmdale, OH 44417
2. Cynthia Bauer Collateral
4139 Smith Stewart Rd.
Vienna,OH 44473
3. Patricia Metek Collateral
3637 Autumn Tree Dr.
Medina,OH 44256
4. Albert Capatch Collateral
101 Viets Dr.
Crotland,OH 44410
5. William Capatch Collateral
9106 W. Avenida Del Sol
Peoria, AZ 85382
6. Frank Capatch Collateral
P.O. Bpx 1341
Pahoa, HI 96778 C.,lJ"ie~ I
7. Kathryn English
210 W. Hamilton Ave., Box 212
State College, PA 16801
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-150Q COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
l'
A. Settlement Statement
U.S. Department of Housing
and Urban Development
OMB Approval No. 2502-026~
I
B. Type of Loan
1. [ ] FHA 2. [ ] FmHA 3. [ ] Conv.Unins 6. File Number:
4. [ I VA 5. [ I Conv.lns.
7. Loan Number:
\
8. Mortgage Insurance Case Number:
400500075-CL
C. NOTE:
THIS NOTE IS FURNISHED TO GIVE YOU A STATEMENT OF ACTUAL SETTLEMENT COSTS. AMOUNTS PAID TO AND\BY THE
SETTLEMENT AGENT ARE SHOWN. ITEMS MARKED "(P.O.C.)" WERE PAID OUTSIDE THE CLOSING; THEY ARE SHO~N HERE FOR
INFORMATIONAL PURPOSES AND NOT INCLUDED IN THE TOTALS.
D. Name and Address of Borrower I E. Name and Address of Seller I F. Name and Address of Lender
DONALD W. SAMPLES AND ADELE D. R. MARK THOMAS, ADMINISTRATOR OF
SAMPLES THE ESTATE OF MARGO EBY
23 DARTMOUTH ROAD
HAVERFORD, PA 19041 ,PA
G. PROPERTY LOCATION H. Settlement Agent
2850 SUNSET DRIVE, SECURED LAND TRANSFERS - MECHANICSBURG
CAMP HILL, PA 17011 Place of Settlement I. Settlement Date 1
COUNTY: CUMBERLAND 101 OLD SCHOOLHOUSE LANE Disbursement Date
PARCEL ID: 09-19-1594-008 MECHANICSBURG, PA
TOWNSHIP: EAST PENNSBORO TOWNSHIP 2/1'1/2005 9:00:00
AM/2/11/2005
J. SUMMARY OF BORROWER'S TRANSACTIONS K. SUMMARY OF SELLER'S TRANSACTIONS
100. Gross Amount Due From Borrower 400. Gross Amount Due To Seller
101. Purchase Price $180,000.00 401. Purchase Price $180,000.00
102. Personal Property 402. Personal Property
103, Settlement Charges to Borrower $2.973.38 403.
104. 404.
105. 405
Adjustments For Items Paid By Seller In Advance Adjustments For Items Paid By Seller in Advance
106. CilyrTown Taxes 406. Cityrrow,' faxes
_.~---
107. County Taxes 407. County Taxes
108. Assessments 408. Assessments
109. School Taxes 2.655.66/yr 2/11/2005 to 7/1/2005 $1,018.61 409. School Taxes 2,655.66/yr 2/11/2005 to 7/1/2005 $1.018.61
110. Trash 46.50/qtr ror 2/11/2005 to 4/112005 $25.32 410. Trash 46.50/qtr for 2/11/2005 to 4/1/2005 $25.32
111. 411.
112. 412.
120. Gross Amount Due From Borrower I $184,017.31 420. Gross Amount Due To Seller I $181,043.93
200. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller
201. Earnest Money $9,000.00 501. Excess deposit
202. Principal Amount of New Loan(s) 502. Settlement Charges To Seller (line 1400) $15,088.65
203. Existing loan(s) taken subject to 503. Existing Loan(s) taken Subject To
204. 504. Net Payoff to Washington Mutual Bank $90,929.01
205 505. Payoff or Second Mortgage Loan
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller
210. Cityrrown Taxes 510. Cilyrrown Taxes
211. County Taxes 671.16/yr 1/112005 to 2/11/2005 $75.39 511. County Taxes 671.16/yr 1/1/2005 to 2/11/2005 . $75.39
212. Assessments 512. Assessments I o. r
213. 513.
214. 514.
-
215. 515.
216. 516.
217. 517. .
218. 518.
219. Repair Credit $10.000.00 519. Repair Credit $10.000.00
220. Total Paid By/For Borrower I $19,075.39 520. Total Reduction Amount Due Seller I $116.093.05
300. Cash At Settlement FromlTo Borrower 600. Cash At Settlement To/From Seller
301 Gross Amount Due From Borrower (line 120) $184.017.31 601. Gross Amount Due To Seller (line 420) $181.043.93
302. Less Amounts Paid By/For Borrower (line 220) $19.075.39 602. Less Deductions In I\mt. Due To Seller (line 520) $116.093.05
--'~.
400500075 . CL
L. Settlement Statement
700. Total Sales Commission 180000.00 @ 7 % = 12600.00
Division of Commission (line 700) As Follows:
701. $12600.00 to ERA-NRT, Inc.
702. Selling Agent Commission
703. Commission paid at selllement
706. Transaclion Fee to ERA-NRT, Inc.
800. Items Payable In Connection With Loan
801. Loan Origination Fee
802. Loan Discount
803. Appraisal Fee
804. Credit Report
805. Lender's Inspection Fee
900. Items Required By Lender To Be Paid In Advance
901. Interest From
902. Mortgage Insurance Premium for
903. Hazard Insurance Premium for
1000. Reserves Deposited With Lender
1001. Hazard Insurance
1002. Mortgage Insurance
1003. City Property Taxes
1004. County Property Taxes
1100. Title Charges
Page 2
Paid From Borrower's
Funds At Settlement
Paid From Seller's
Funds At Settlement
$12,600.00
$125.00
1101. Selllement or Closing Fee
1102. Abstract or Title Search
1103. Title Examination
1106. Notary Fees to Cash $2.00 $5.00
1107. Attorney's Fees
1108. Title insurance to Secured Land Transfers. Mechanicsburg $1,132.88
1109. Lender's Coverage $ ($)
1110. Owner's coverage $180000.00 ($1132.88)RI
1114. Overnight Delivery & Processing Fee to Secured Land Transfers. Mechanicsburg $15.00
1122. Sat Fee to Secured Land Transfers. Mechanicsburg $35.00
1200. Government Recording And Transfer Charges
1201. Recording Fees: Deed $ 38.50; Mortgage $
1202. City/County Tax/Stamps 1800.00
1203. State Deed Tax $ 1800.00
1205.
1300. Additional Settlement Charges
$38.50
$1,800.00
$1,800.00
1302. Pest Inspection to BIS Home Inspection Service (POC 0.00)
1303. Home Warranty to AON Home Warranty $409.00
1304. Trash through 3/31/05 to East Pennsboro Township $97.65
1305. Tax Receipts to Beth Williamson ; $2.00
1306. Home Inspection to BIS Home Inspection Service (POC 0.00)
1307. Radon Inspection to BIS Home Inspection Service (pOC 0.00)
1400. Total Settlement Charges (Enter On Lines 103, Section J And 502, Section K) $2.973.38 $15,088.65
I have carefully reviewed the HUD-l Settlement Statement and to the best of my knowledge and belief it IS true and accurate statement of all recelptsiand disbursements
on my account or by me in this transaction. I further certify that I have received a copy of the HUD-l Settlement Statement.
BUYERS ~
~J~, S......
Donald W. Samples
SELLERS. ;)~.
T~~
By; R. ark Thomas, dministrator
Adele D. Samples
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in
wi his statement.
""'"'::1. (J~
SECURED LAND TRANSFERS - MECHANICSBURG
Date
2/1112005 9:00:00 AM
11
HUD -1 UNIFORM SETILEMENT STATEMENT
OMB Approval No. 2502-D265
A. U.S. DEPARTMENT OF HOUSING AND URBAN DEVEiDPMENT SETILEMENT STATEMENT
B. TYPE OF iDAN 6. File Number: 7. loan Number:
1. FHA 2. FmHA 0030740468
3. Conv. Unins. 4. VA 5. X Conv. Ins. 8. Mortgage Insurance Case Number
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)"
were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
NOTE: TIN = Taxpayer's Identification Nwnber
D. NAME AND ADDRESS OF BORROWER: E. NAME, ADDRESS AND TIN OF SELLER: F. NAME AND ADDRESS OF LENDER:
CARRIE L. KIPP ESTATE OF MARGO EBY FIRST COMMONWEALTH BANK
00 - lP 3~ . ~ I 8~Z 2001 BISHOPS GATE BLVD
504 GEORGE STREET 216 SPRUCE STREET MT LAUREL, NJ 08054
HOUTZDALE, PA 16651 MADERA, PA 16661
G. PROPERTY iDCATION: H. SETILEMENT AGENT NAME, ADDRESS AND TIN
216 SPRUCE STREET DAVID R. THOMPSON 103-K14-487-5
MADERA, PA 16661 308 Walton Street" Philipsburg, PA 16866
PLACE OF SETILEMENT I. SETILEMENT DATE
308 WALTON STREET 08/04/2005
PHILIPSBURG, PA 16866
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SEllER:
101. Contract sales price 51,000.00 40 I. Contract sales price 51,000.00
102. Personal property 402. Personal property
103. Settlement charges to borrower (Line 1400) 4,032.29 403.
104. 404.
105. 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
106. City/town taxes 08/04/2005-12/31/2005 42.30 406. City/town taxes 08/04/2005-12/31/2005 42.30
107. County taxes 407. County taxes
108. Assessments 408. Assessments
109. 409.
110. 410.
Ill. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 55,074.59 420. GROSS AMOUNT DUE TO SEllER 51,042.30
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
20 I. Deposit or earnest money 100.00 501. Excess deposit 100.00
202. Principal amount of new loan(s) 51,000.00 502. Settlement charges to seller (Line 1400) 4,708.03
203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
204. 504. Payoff of fIfSt mortgage loan
205. 505. Payoff of second mortgage loan
206. 3 % SELLER ASSIST 1,530.00 506. 3 % SELLER ASSIST 1,530.00
207. 507.
208. 508.
209. 509.
Adjustments for items Wlpaid by seller Adjustments for items unpaid by seller
210. City/town taxes 510. City/town taxes
211. County taxes 51!. County taxes
212. Assessments 512. Assessments
213. 513.
214. School Tax 07/01/05-08/04/05 40.72 514. School Tax 07/01/05-08/04/05 40.72
215. 515.
216. Taxes Current Year 103.61 516.
217. Per Diem 0.284 517.
218. Seller Paid 103.61 518.
219. Seller Owes (days~ 216 519.
L. SETTLEMENT CHARGES
700. TOTAL SALESIBROKER's COMMISSION based on price $ 51, 000 . 00 @ 7.000% PAID FROM PAID FROM
Division of Commission (line 700) as follows: BORROWER'S SELLER'S
701. $ 3, 570. 00 to BURLEIGH REAL ESTATE ($100 POC) FUNDS AT FUNDS AT
702. $ SEITLEMENT SEITLEMENT
703. Commission paid at Settlement B U RLE I GH REAL ESA T E ($100 POC) 3,470.00
704.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
80 I. Loan Origination Fee $
802. Looo Discount $
803. Appraisal Fee to STARS 395.00
804. Credit report to FNMA CBC SYSTEMS 15.00
805. Lender's Inspection Fee
806. APPLICATION FEE TO FIRST COMMONWEALTH BANK 500.00
807. FLOOD CERTIFICATION FEE TO SrARS 19.50
808. DOCUMENT PREPARATION FEE TO FIRST COMMONWEALTH BANK 85.00
809. 60 DAY EXTENTION TO FIRST COMMONWEALTH BANK 150.00
810.
811.
812.
813.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. mterest from 08/04/2005 08/31/2005 @ $9.210 per day 257.88
902. MOItgage Insurance Premium for 469.20
903. Hazard insurance Premium for 1 year(s) to to INS. CO. ($512.00 POC)
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard insurance 4 mo nth ( s ) @ $34.14 per month 136.56
1002. Mortgage insurance
1003. City Property Taxes 4 month(s) @ $8.66 per month 34.64
1004. County Property Taxes
1005. Annual assessments
1006. School Taxes 2 month(s) @ $35.39 per month 70.78
1007.
1008. Aggregate Accounting Adjus1ment -85.64
1100. TITLE CHARGES
11 0 I. Settlement or closing fee to DA VI D R. THOMPSON 350.00
1102. Abstract or title search to
1103. Title Examination to
1104. Title insurance binder to
1105. Document preparation to
1106. Notary fees to
11 07. Attorney's fees to
(includes line numbers:
1108. Title msurance to APEX 564.75
(includes line numbers:
1109. Lender's coverage $ 510'00.00
1110. Owner's coverage $ 51000.00
1111. ENDORSEMENTS TO APEX 50.00
1112. SHORT FORM RESIDENTIAL LOAN POLICY CHARGE TO APEX 100.00
1Il3.CLOSING PROTECTION LETTER TO APEX 35.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording fees: Deed $ 45.50 Mortgage $ 54.50 Release $ 100.00
1202. City/cnty tax/stamps: Deed $ Mortgage $
1203. State tax/stamps: Deed $ Mortgage $
]204. PA TRANSFER TAX 1% BUYER 1% SELLER 510.00 510.00
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest inspection to
1303. KATHY KITKO TC-C/T TAXES 05 115.12
_ _~. ........,. ..-r>......r ........""T"rnT..._ rn,.-, ,.,"-'r'f/"'\r'\T mn,,~("1 r\[:: lAC . - . -
PROVOST REAL ESTATE APPRAISERS
7860135
File No. ki /30740468
April 15, 2005
First Commonwealth Bank/STARS
50 Jordan Street
East Providence, RI 02914
File Number: kipp/30740468
To Whom It May Concern:
In accordance with your request, I have personally inspected and appraised the real property at:
216 Spruce Street
Madera, PA 16661
The purpose of this appraisal is to estimate the market value of the subject properly, as improved.
The property rights appraised are the fee simple interest in the site and improvements.
In my opinion, the estimated market value of the property as of April 14, 2005
is:
$51,000
Fifty-One Thousand Dollars
The attached report contains the description, analysis and supportive data for the conclusions,
final estimate of value, descriptive photographs, limiting conditions and appropriate certifications.
Respectfully submitted,
Sonya L. Fla
RL-000370-l
Pennsylvania State Certified Appraiser
Michelle Passmore, Assistant to Certified Appraiser
SLF/mmp
302 E. Pine Street, Clearfield, PA 16830 (814) 765-5252 Fax: (814) 765-2425
~J FannieMae LIMITED SUMMARY APPRAISAL
D ktop Underwriter Quantitative Analysis Appraisal Report
7860135
es File No.: kipp/30740468
THIS SUMMARV APPRAISAL REPORT IS INTENDED FOR USE BV THE LENDER/CLIENT FOR A MORTGAGE FINANCE TRANSACTION ONL V.
Prooerlv Address 216 Spruce Street Cily Madera Slate PA Zi Code 16661
Leoaloeseri lion Deed Book 215 Paoe 528 Counly Clearfield
Assessor's Parcel No.1 03-K14-487-5 Tax Year 2005 RETaxes $ 507,53 Soecial Assessments $ NA
.. Borrower Carrie L. Kipp CUrrenlOwner Maroo Ebv Estate' Occupant:' 1 Owner I IT enanl IXIVacant
Nei hborhood or Pro.ecl Name Mader!! Proiecl Tvpe 1 Ipuo , 1 Condominium HOA$ NA/Mo.
Sales Price $ 59 900 Dale of Sale 5-05 oescriolionl$ amount of loan charoesleoncessions 10 be paid bv seller 3% of sales price
Prooertv riohts aooraised I X I Fee Simole r 1 Leasehold I Mao Reference Clearfield County Census Tracl 3316
- Note: Race and Ihe racial composltlon of Ihe neighborhood are nol appraisal faclors.
. Localion ~Urban Fx! Suburban R Rural ,I Property values R Increasing ~ Slable Woeclining ~WI~~ family hOA~Eg ~~
. Buill up X Over 75% 25-75% Under 25% Demand/supply Shortage ~ In balance DOver supply
$(000) (yrs) $(OO~ (NS)
. Growth rate Rapid X Stable Slow Markeling lime Under 3 mos. iX1 3-6 mos. n Over 6 mos. 15 Low 40 N Low~
..
Neighborhood boundaries All of the community known as Madera. 65 High 100+ NA High NA
L;'!;;'( Predominanl ii;;;;t 'Wi, Predominant;;
40 75+ NA NA
~imensions 50 X 150 Site area 7500 Sq.FI. Shape Rectangular
Specific zoning classification and descriplion No zon/no
Zoning compliance 0 Legal 0 Legal nonconforming (Grandlalhered use); U Illegal, attach description ~ No zoning
Hiohest and besl use of sub'ecl oroperlv as improved (or as oroposed per plans and specificalions): rxl Presenl use Other use, attach descriplion.
Ulllltles Public Other Public Olher I Off.site Improvements Type Public Privale
Beclric~y ~ Water [R) Street Asphalt ~ R
Gas SanitarY sewer n On site Allev NA
Ive Ihere anY aDDarent adverse site condilions (easements, encroachments, soecial assessment., side areas, ele:)? r 1 Yes rX No "Yes, attach description.
Source(s} used tor physical characteristics of property: 00 Interior and exterior inspection H ~xterior inspection tom street [J Previous appraisal files
rxl MLS rxlAsse..menl and lax records h Prior Inspection n Propertv owner Olher Wescribe):
No. of Slorie. Two TvoeIDet.lAll.) Detached Exlerior Walls Vinvl Roof Surface Shinale Manufactured HOllsino r ~ 1 Yes fxl No
Does Ihe orODerlv aenerallv conform to Ihe neiahborhood in lerms of sMe, condition. and construclion malerial.? Ix I Yes r -I No If No, allach description.
. Ive Ihere any apparenl physical deficioncies or condition. that would affect Ihe soundness or struclural integrity 01 the improvements or Ihe livability of Ihe property?
n Yes ixfNo If Yes, allach descriDlion.
Are there any apparent adverse environmental conditions (hazardous wastes, toxic substances, etc.) present in the Improvements, on the site, or in the immediate vicinity of
the sub'eel Prooertv? n Ve. rxl No If Yes, allach descriolion,
I researched Ihe subject markel area for comparable listings and sales Ihal are Ihe mosl similar and proximate 10 the subjecl property.
My research revealed a total 01 4 sales ranging in sales price from $ 52,000 to $ 63,000.
My research revealed a lotal of 3 listings ranging in lisl price from $ 35,00010 $ 57 ,900 .
TIre analvsis of the comparable sales below reflects markel reaction 10 sianifican! variations between the sales and the subiect Propertv.
FEATURE I SUBJECT , SALE 1 SALE 2 SALE 3
216 Spruce Street 252B Main Street 410 Red Schoolhouse Rd. 3311 Main Street
Address Madera Madera Osceola Mills Madera
Proximilv to Sub'ecl 0.40 MI_ 6.5 MI ENE ~
Sales Price 1$ 59 900 57 000 63 000 52 000
PricelGross Uv.lvea 1$ 41.111tl1$ 29.16 $ 41,50 $ 43,05
Data & Verij, &uces Files/Public Records MLS/Public Records Public Records/Broker
--ldl' """"~ I + (-)$ A4ust1hlWll DESCRIPTION I +(-IS~ DESCRIPTION , '(-)1_
Sales or Financing Seller Assist -3,000 Seller Assist -3,120
Concessions Conventional 0 Conventional 0 Conventional 0
Dale of SalelTime 5-04 : 0 4-04 : 0 4-05 , 0
,
Location Suburban Suburbanllnf 2500 Suburban 0 Suburban/lnf 2500
ste 50 X 150 .32 Acre+/- : -4 000 2 Acres : -6000 50 X 150 : 0
View Average Average : 0 Avera!le : 0 Averaoe : 0
oesian (SMe) 2 StOry 2 S torv 0 2 S torv 0 2 StOry 0
Actual Ace (Yrs.) 1925 1920 : 0 1900 : 0 1920 : 0
Condition Averaae I nferio r : 3. Average : 0 Averaoe : 0
Above Grade Total I Bftms I B.ths Total' Bftms I palhs Total I Bm-ms I Balhs Tal,l I Bm-ms 1 Baths
. Room Count 6 : 3 : 1.00 8 : 4 : 1.50 ; -3.000 7 : 3 : 1.00 0 6 : 3 : 2.00 : -2,000
Gr<JiS lMXJ /'lea 1 457 So. Ft. 1,955 Sa. Fl.: -2 500 1518Sa.Ft.: 0 1 208 Sq. Ft.: 1000
BasernenI and Fnshed 100% Bl% 100% Partial
. Rooms Below Grade Unfinished Full Bath -500 Unfinished 0 Unfinished 0
Garaae/CarDorl None None : 0 1 Det. Garaoe : -2 000 None : 0
Amenities No special 1 Fireplace -1500 No soecial 0 No soecial 0
PO"'" f"'iii I. ilrD~ : : o Wraoaround : o FronURear : 0
Nel AdUlol.1) + X - ' $ ""-' 11000 ..: 1620
Ad~ted Sales Price
of Comparables $ 51 000 $ 52,000 50 380
Date 01 Prior Sales NA NA NA NA
Price of Prior Sales I $ NA $ NAI$ NA $ NA
Analysis of any current agreemenl of sale, oplion, or listing oflhe subjecl property and analysis oflhe prior sales of subject and comparables: See Attached Addendum
Summary of sales comparison and value conclusion: All sales are older two stOry homes located in the same or comoarable market areas. Sales
#1 #3 and #4 are located in inferior hioh traffic areas. Site adjustments are based on site values due to location toooaraohvand
amenities offered. All sales are of similar aualitv construction with Sale #1 beino in inferior condition. Sale #1 offers superior room
count and GLA Sales #2 and #4 offer similar room count and GLA Sale #3 offers superior baths with inferior GLA. Due to the lack of
recenl similar sales there is limited market data available; therefore time distance and adiustments may exceed FNMA ouidelines.
Sales used were deemed the best and most recent similar sales available. Sales indicate a similar range of value.
Tn appraisal is made l!SJ "as-is", or U subjecl 10 oomplelion per plans and specifications on the basis of a hypothelical condition Ihallhe improvemenls have been compleled, or
subiectto Ihe followina repairs, alteralions or conditions:
BASED ON AN LJEXTERIOR INSPECTION FROM THE STREET OR AN ~MERIORANDEXTERIORNSPECT1ON.1 ESTNATE THE MARKET VALUE, AS DEFINED,
OFTHEREALPROPERlYTHATlSTHESUBJECTOFTHISREPORTTOBE$ 51,000 . AS OF Aoril14 2005
lOCH.
PAGE 1 OF 3
Fannie Mae Form 2055 9-96
A~cedusirtlilACI soIlw.., 8002301 8721_.c;iwllbC(lft
LIMITED SUMMARY APPRAISAL
Desktop Underwriter Quantitative Analysis Appraisal Report
7860135
File No' kipp/30740468
Projecllnlormallon lor PUO. (it appllcable)--Is Ihe developer/builder In control of the Home Owners' Association (HOAl? o Ves 0 No
Provide the follo.,;ng information fO( PUDs only if Ihe developer/builder is in control of the HOA and the subject property is an attached dwelling unit:
T oIal number of phases Total number 01 units Total number of units sold
ToIalnumber 01 units renled Total number 01 units for sale Data Source(s)
. Was the project created by the conversion of existing buildings Into a PUO? 0 Yes 0 No If yes, state date of conversion:
Does the project contain any multi-dwelling units? 8 Ves 0 No Data Source:
Are the common elements completed? 0 Yes No If No. describe status of completion:
Ive any common elements leased to 0( by the H()(Oe Owners' Association? o Ves 0 No If yes, attach addendum describing rental terms end options. I
Oescribe common elements and recreational facilities:
ProJecllnlormatlon lor Condominiums (if applicable}--Is Ihe developer/builder in control of the Home Owners' Associalion (HOA)? U Ves U No
Provide the following information fO( all Cond()(Oinium Projects:
T oIal number of phases Total number of units Total number of units sold
T oIal number of units rented Total number 01 units 10< sale Data Source(s)
Was the project created by the conversion of existing buildings into a condominium? 0 Ves 0 No If yes, date of conversieo:
Project Type: 0 Primary Residence 0 Second Home ()( Recreational 0 Row or Townhouse o Garden 0 Midrise 0 Higi1'ise 0
. Condilion 01 the projecl, quality of conslruction, unit mix, etc.:
.
. Ive the common elements compleled? o Ves 0 No If No, describe status of complelion:
Are any common elements leased to or by the Home Owners' Association? o Ves 0 No If yes, attach addendum describing rental terms and options.
Describe common elements and reaeational facilities:
PURPOSE OF APPRAISAL: The purpose of this appraisal is to estimate the market value of the real property that is the subject of
this reporl based on a quantitative sales comparison analysis for use in the morlgage finance transaction.
DEFINITION OF MARKET VALUE: The most probable price which a properly should bring in a competitive and open market under
all conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price is not affected
by undue stimulus. Implicit in this definition is the consummation 01 a sale as 01 a specified date and the passing of title from seller
to buyer under conditions whereby: (1) buyer and seller are typically motivated; (2) both parties are well informed or well advised, and
each acting in what he considers his own best interest; (3) a reasonable time is allowed for exposure in the open market; (4) payment
Is made in terms of cash in U.S, dollars or in terms of financial arrangements comparable thereto; and (5) the price represents the
normal consideration for the property sold unaffected by special or creative financing or sales concessions' granted by anyone
associated with the sale.
. Adjustments to the comparables must be made for special or creative linancing or sales concessions. No adjustments are necessary
for those costs which are normally paid by sellers as a result of tradition or law in a market area; these costs are readily identifiable
since the seller pays these costs in virtually all sales transactions. Special or creative financing adjustments can be made to the
comparable property by comparisons to financing terms offered by a third party institutional lender that is not already involved in the
property or transaclion. Any adjustment should not be calculated on a mechanical dollar for dollar cost of the financing or concession
but the dollar amount of any adjustment should approximate the market's reaction to Ihe financing or concessions based on the
appraiser's judgment.
STATEMENT OF LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION
CONTINGENT AND LIMITING CONDITIONS: The appraiser's certification that appears in the appraisal report is subject to the
following conditions:
1. The appraiser will not be responsible for matters of a legal nature that aflect either the property being appraised or the title 10 it. The
appraiser assumes that the title is good and marketable and, therefore, will not render any opinions about the title. The property is
appraised on the basis of it being under responsible ownership.
2. The appraiser has provided any required sketch in the appraisal report to show approximate dimensions of the improvements and
the sketch is included only to assist the reader of the report in visualizing the property and understanding the appraiser's determination
of its size.
3. The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless
specific arrangements to do so have been made beforehand.
4. The appraiser has noted in the appraisal report any adverse conditions (such as, but not limited to, needed repairs, the presence
of hazardous wastes, toxic substances, etc.) observed during the inspection of the subject property or that he or she became aware
of during the normal research involved in performing the appraisal. Unless otherwise stated in Ihe appraisal report, the appraiser has
no knowledge of any hidden or unapparent conditions of the property or adverse environmental conditions (including the presence of
hazardous wastes, toxic substances, etc.) that would make the property more or less valuable, and has assumed that there are no such
conditions and makes no guarantees or warranties, expressed or Implied. regarding the condition of the property. The appraiser will
not be responsible for any such condilions that do exist or for any engineering or testing that might be required to discover whether
such conditions exist. Because the appraiser is not an expert in the field of environmental hazards, the appraisal report must not be
considered as an environmental assessment 01 the property.
5. The appraiser obtained the information, estimates, and opinions that were expressed in the appraisal report from sources that he
or she considers to be reliable and believes them to be true and correct. The appraiser does not assume responsibility lor the accuracy
of such items that were lurnished by other parties,
6. The appraiser will' not disclose the contents of the appraisal report except as provided for in the Uniform Standards 01 Professional
Appraisal Practice.
7. The appraiser must provide his or her prior wrilten consent before the lender/client specified in the appraisal report can distribule
the appraisal report (including conclusions about the property value, the appraiser's identity and professional designations, and
references to any professional appraisal organizations or the firm with which the appraiser is associated) to anyone other than the
borrower; the mortgagee or its successors and assigns; the morlgage insurer; consultants; professional appraisal organizations; any
state or federally approved financial institution; or any department. agency, or instrumentality of the United States or any state or the
District of Columbia; except that the lender/client may distribute the report 10 data collection or reporting service(s) without having to
obtain the appraiser's prior written consent. The appraiser's writlen consent and approval must also be obtained before the appraisal
can be conveyed by anyone to the public through advertising, public relations, news, sales, or other media.
8. The appraiser has based his or her appraisal report and valualion conclusion for an appraisal thai is subject to completion per plans
and specifications on the basis of a hypothetical condition that the improvements have been completed.
9. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal that is subject to completion, repairs,
or alteratIOns on the assumption Ihat completion of the improvements will be performed in a workmanlike manner.
fOCH,
PAGE 2 OF 3
?toOOttd ulin1l1t.O &d\w... t1l23.t am WIIW ,ciwell can
Fannie Mae Form 2055 9-96
L1MITI:D SUMMARY APPRAISAL
Desktop Underwriter Quantitative Analysis Appraisal Report
APPRAISER'S CERTIFICATION: The Appraiser certifies and agrees thai: \
1. I performed this appraisal by (1) personally inspecting from the street the subject property and neighborhood and each of lhe
comparable sales (unless I have otherwise indica led in this report lhall also inspected the inlerior of the subject property); (2) collecting,
confirming, and analyzing data from reliable public and/or private sources; and (3) reporting the results of my inspection and analysis
in this summary appraisal report. I further certify that I have adequate information about the physical characteristics of the subject
properly and the comparable sales to develop this appraisal.
7860135
File No.: klpp/30740468
2. I have researched and analyzed the comparable sales and offeringsllistings in the subject market area and have reported the
comparable sales in this reportlhat are the best available for the subject property. I further certify that adequate comparable market
data exists in the general market area to develop a reliable sales comparison analysis for the subject property.
3. I have taken into consideration the faclors that have an impact on value in my development of the estimate of market value in the
appraisal report. I further certify that I have noted any apparent or known adverse conditions in the subject improvements, on the subject
site, or on any site within the immediate vicinity of the subject property of which I am aware, have considered these adverse conditions
in my analysis of the property value to the extent that I had market evidence to support them, and have commented about the effect
of the adverse conditions on the marketability of the subject property. I have not knowingly withheld any significant information from
the appraisal report and I believe, to the best of my knowledge, that all statements and information in lhe appraisal report are true and
correct.
4. I stated in the appraisal report only my own personal, unbiased, and professional analysis, opinions, and conclusions, which are
subject only to the contingent and limiting conditions specified in this form.
5. I have no present or prospective interest in the property that is the subject of this report, and I have no present or prospective personal
interest or bias with respect to the participants in the transaction. I did not base, either partially or completely, my analysis and/or the
estimate of market value in the appraisal report on the race, color, religion, sex, age, marital status, handicap, familial status, or national
origin of either the prospective owners or occupants of the subject property or of the present owners or occupants of the properties
in the vicinity of the subject property or on any other basis prohibited by law,
6. I have no present or contemplated future interest in the subject property, and neither my current or future employment nor my
compensation for performing this appraisal is contingent on the appraised value of the property.
7. I was not required to report a predetermined value or direction in value that favors the cause of the client or any related party, the
amount of the value estimate, the attainment of a specific result, or tha occurrence of a subsequent event in order to receive my
compensation and/or employment for performing the appraisal. I did not base the appraisal report on a requested minimum valuation,
a specific valuation, or the need to approve a specific mortgage loan.
8. I estimated the market value of the real property that is the subject of this report based on the sales comparison approach to value.
I further certify that I considered the cost and income approaches to value, but, through mutual agreement with the client, did not
develop them, unless I have noted otherwise in this report.
9. I performed this appraisal as a limited appraisal, subject to the Departure Provision of the Uniform Standards of Professional
Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were
in the place as of the effective date of the appraisal (unless I have otherwise indicated in this report that the appraisal is a complete
appraisal, in which case, the Departure Provision does not apply).
10. I acknowledge that an estimate of a reasonable time for exposure in the open market is a condition in the definition of market value.
The exposure time associated with the estimate of market value for the subject property is consistent with the marketing time noted
in the Neighborhood section of this report. The marketing period concluded for the subject property at the estimated market value is
also consistent with the marketing time noted in the Neighborhood section.
11. I personally prepared all conclusions and opinions about the real estate that were set forth in the appraisal report. I further certify
that no one provided significant professional assistance to me in the development of this appraisal.
SUPERVISORY APPRAISER'S CERTIFICATION: If a supervisory appraiser signed the appraisal report, he or she certified and agrees
that; I directly supervise the appraiser who prepared the appraisal report, have examined the appraisal report for compliance with the
Uniform Standards of Professional Appraisal Practice, agree with the statements and conclusions of the appraiser, agree to be bound
by the appraiser's certifications numbered 5 through 7 above, and am taking full responsibility for the appraisal and the appraisal report.
APPRAISER:
SUPERVISORY APPRAISER (ONLY IF REQUIRED):
Signature:
Name: Son ana
Company Name: Provo Real Estate A
Company Address: 302 E, Pine Street
Clearfield, PA 16830
Date of Report/Signature:April 15, 2005
State Certification #: RL-000370-L
or State License #:
State: Pennsylvania
Expiralion Date of Certification or License: 6-30-05
Michelle Passmore, Assistant to Certified Appraiser
Signature:
Name:
Company Name:
Company Address:
Date of Report/Signature:
State Certification #:
or State License #:
State:
Expiration Date of Certification or License:
ADDRESS OF PROPERTY APPRAISED:
216 Spruce Street
Madera, PA 16661
SUPERVISORY APPRAISER:
SUBJECT PROPERTY
o Did not inspect subject property
o Did inspect exterior of subject property from street
o Did inspect interior and exterior of subject property
COMPARABLE SALES
o Did not inspect exterior of comparable sales from street
o Did inspect exterior of comparable sales from street
APPRAISED VALUE OF THE SUBJECT PROPERTY $ 51,000
EFFECTIVE DATE OF APPRAISALIINSPECTION 4/14/2005
LENDER/CLIENT:
Name:
Company Name: First Commonwealth Bank/STARS
Company Address: 50 Jordan Street, East Providence, RI 02914
lOCH.
PAGE 3 OF 3
ProWceiluSlfIQACl so/tw"..lK0234 9121 _aoweb wn
PROVOST REAL ESTATE APPRAISERS
Fannie Mae FOfm 2055 9-96
~ FannieMae LIMITED SUMMARY APPRAISAL
Desktop Underwriter Quantitative Analysis Appraisal Report
SALE 5
FEATURE I
216 Spruce Street
Address Madera
Proximity to Sub'ect
Sales Price $
PriceJGross Liv.1vea $
Data & Veri!. Scuces
VAlUE ADJUSThENTS
Sales Of Financing
Concessions
Date of Salemme
Location Suburban
Sle 50 X 150
View A veraoe
. Desio" (Style) 2 StOry
Actual Aae (Yrs. \ 1925
Condition Averaoe
. Above Grade Tala! . Mm5' Baths
Room Count 6 : 3 : 1.00
Qossl.M1Qma 1 457 So. Fl.
Baso:rnenl '"'" Frished 100% 100%
Rooms Below Grade Unfinished Unfinished
GaragelCarport None 1 Del. Garaoe
Amenities No soecial No soecial
Porches ~ronVR FronVSide
Net Adi. Hotall r. .' $
AdjUsted Sales Price
of Comparables $
Date 01 Prior Sale. I NA NA
Price 01 PriOf Sale. I $ NA I $
SUBJECT
SALE 4
2437 Ginter Morann Hwy.
Houtzdale
4.5 MI ESE
59.,900 56 000
41.11 ill $
Public Records
DESCRIPTION DESCRIPTION I '(-)I~
DESCRIPTION I .(.)$M~
Conventional
6-04
Suburban/In!
1.77 Acres
Averaoe
2 StOry
1900
Averaae
o
o
2500
-5 000
o
o
o
o
Total I BG"mI I Baths
6 : 3 : 1.00
1 288 So. Fl.:
Total' Mms'
Baths
: :
o
o
So. Ft.:
,
, 0 ,
: -2 000 :
, 0 ,
: 0 :
4500~'
51 500 $
NAI$
Ptolln:ed\lWlll ACl sdlwwl, 8002348727 _.aDwetu:om
7860135
File No.: kinn/30740468
SALE 6
DESCRIPTION I .(.)I....~
Tecal I Ektms' Baths
: :
Sa. FI;
O~$
O~$
1$
ADDENDUM
Borrower: Carrie L. Kipp
ProDertv Address: 216 Spruce Street
City: Madera
lender: First Commonwealth Bank/STARS
Slale: PA
File No.: kioo/30740468
Case No.: 7860135
Zip: 16661
LIMITED APPRAISAL:
A Iimiled appraisal is defined as the act or process of estimating value or an estimate of value performed under and resulting
from invoking the departure provision.
EXPOSURE TIME:
Exposure time is defined as the estimated length of time the property interest being appraised would have been offered on
the market prior to the hypothetical consummation of a sale at market value on the effedtive date of the appraisal.
MARKETING TIME:
Marketing time is defined as the amount of time the subject property would take to sell after the effective date of the
appraisal.
Highest and best use of the subject property is its current use.
Property interest being appraised is fee simple.
There have been no prior sales of the comparable sales within the past 12 months. The subject property has not transferred
in the past 36 months. Deed is in the name of Frank Capatch and Assessment is in the name of Frank Capatch Heirs as
property is in Margo Eby name by will. The subject property is currently listed for sale at $59,900 with an agreement of sale
dated april3,2 005 for $59,900 with a 3% of sales price seller assist + $1050 credit for future sewer tap + home inspection
cost paid by seller
As this is a limited appraisal, the cost approach and income approach were not used. The market approach gives the better
indication of value for single family residential property.
LIMITED SUMMARY APPRAISAL
This is a Limited Summary Appraisal Report which is intended to comply with the reporting requirements set forth under
Standard Rule 2-2(b) of the Uniform Standards of Professional Appraisal Practice (USPAP) for a Summary Appraisal Report.
As such. it presents only summary discussions of the data, reasoning and analysis that were used in the appraisal process
to develop the appraiser's opinion of value. Supporting documentation concerning the data, reasoning and analysis is
retained in the appraiser's file. The depth of discussion contained in this report is specific to the needs of the client and for
the intended use stated below. The appraiser is not responsible for unauthorized use of this report.
This appraisal report is intended to be used for mortgage purposes by the client and its assigns as stated on the attached
2055-2 form. Use of this report by others is not intended by the appraiser. This report is not intended for use other than that
identified in the Definitions and Guidelines. The appraiser assumes no responsibility of liability for unauthorized use of this
report.
Standard Rule 1-2(a) and 1-2(b) of the Uniform Standards of Professional Appraisal Practice.
This appraisal invokes the Departure Rule of Standard Rule 1-4(b & c) as the Income Approach and Cost Approach was not
used and is therefore considered a Limited Summary Appraisal.
CONDITIONS OF APPRAISAUADDITIONAl LIMITING CONDITIONS
Information supplied by others, including public records, is deemed reliable.
This appraisal is prepared for the sole and exclusive use of First Commonwealth Bank/STARS to assist with mortgage
purposes. It is not to be relied upon by any third parties for any purpose whatsoever.
This appraisal report is prepared for the sole and exclusive use of the appraiser's client First Commonwealth Bank/STARS.
No third parties are authorized to rely upon this report without the express written consent of the appraiser.
The appraiser is not a home or environmental inspector. The appraiser provides an opinion of value. This report should not
be relied upon to disclose any conditions present in the subject property. The appraiser performs an inspection of visible and
accessible areas only. The appraiser is not required to disturb or move anything that obstructs access or visibility. The
appraiser has had no formal investigative training relative to environmentals problems caused by the presence of lead-based
paint, asbestos, radon gas, toxic waste, landfills, air-born pollutants, mold or other environmental concerns. The appraisal
report does not guarantee that the property is free of defects or environmental problems. A professional home and/or
environmental inspection is recommended.
CERTIFICATION ADDENDUM:
I certify that to the best of my knowledge and belief:
- the statements of fact contained in the report are true and correct.
- the reported analyses, opinons and conclusions are limited only by the reported assumptions and limiting
conditions and are my personal, impartial and unbiased professional analyses, opinions and conclusions.
I
Addendum Page 1 of 2
Borrower: Carrie L. Kipp
Properly Address: 216 Spruce Street
City: Madera
lender: First Commonwealth Bank/STARS
FRONT VIEW OF
SUBJECT PROPERTY
Appraised Dale: April 14, 2005
Appraised Value: $ 51,000
REAR VIEW OF
SUBJECT PROPERTY
STREET SCENE
11
I
I
I
I
I
I
ADDENDUM
Borrower: Carrie L. Kipp
Properly Address: 216 Spruce Street
City: Madera
lender: First Commonwealth Bank/STARS
File No.: kippl30740468
Case No.: 7860135
Zip: 16661
State: P A
_ I have no (or..the specified) present or prospective interest in lhe property that is the subject of this report
and no (or he specified) personal interest with respect to the parties involved.
_ I have no bias with respect to the property that is the subject of this report or the parties involved with this
assignment.
- my engagement in this assignment was not contingent upon developing or reporting predetermined results.
_ my compensation for completing this assignment is not contingent upon the development or reporting of a
predetermined value or direction in value that favors the cause of the client, the amount of the value opinion,
the attainment of a stipulated result or the occurance of a subsequent event directly related to the intended
use of this appraisal.
_ my analyses, opinions and conclusions were developed and this report has been prepared in conformity
with the Uniform Standards of Professional Appraisal Practice.
- I have made a personal inspection of the property that is the subject of this report.
Estimated Site Value: $6,000
The subject property is located in the community known as Madera which is a typical small community in Clear/ield County
offering a typical mix of residehtial property and a few small commercial property. Proximity to employment and amenities is
typical of other neighborhoods and communities. Major amenities are located in Philipsburg, Clearfield and Altoona. Based
on current market activity, marketing time is 3-6 months with a reasonable exposure time of 30-90 days. Sales and financing
concessions are not prevalent in the market area;however, seller assists are becoming more popular.
The subject property is an older two story home that is in overall average condition. Interior is dated but maintained. Second
floor offers limited electrical outlets which is typical of older two story homes.
Electric and heat were on at time of inspection; however,water was not.
Madera and Bigler Township do not have zoning regulations which is typical of other townships and communities within
Clearfield County.
Public sewage is slated for 2006-2007 per Bigler Township.
Analysis of Current Agreements
Subject property is currently listed for sale at $59,900 with an agreement of sale dated April 5, 2005 for $59,900 with seller
paying: 3% of sales price towards buyers closing costs + $1050 sewage tap on fee credit + $425 for home inspection.
Addendum Page 2 of 2
r
\
COMPARABLE PROPERTY PHOTO ADDENDUM
Borrower: Carrie L. Kipp File No.: kipp/30740468
Property Address: 216 Spruce Street Case No.: 7860135
City: Madera Stale: PA Zip: 16661
Lender: First Commonwealth Bank/STARS
COMPARABLE SALE #1
2528 Main Street
Madera
Sale Date: 5-04
Sale Price: $ 57,000
COMPARABLE SALE #2
410 Red Schoolhouse Rd.
Osceola Mills
Sale Date: 4-04
Sale Price: $ 63,000
COMPARABLE SALE #3
3311 Main Street
Madera
Sale Date: 4-05
Sale Price: $ 52,000
Borrower: Carrie L. Kipp
Property Address:216 Spruce Street
City: Madera
lender: First Commonwealth Bank/STARS
COMPARABLE PROPERTY PHOTO ADDENDUM
File No.: kipp/30740468
Case No.: 7860135
Zip: 16661
.
State: PA
COMPARABLE SALE #4
2437 Ginter Morann Hwy.
Houtzdale
Sale Dale: 6-04
Sale Price: $ 56,000
COMPARABLE SALE #5
Sale Date:
Sale Price: $
COMPARABLE SALE #6
Sale Date:
Sale Price: $
I
. .
.. ,
FLOORPLAN
Borrower: Carrie L. Kipp FileNo.: kipp/30740468
Property Address: 216 Spruce Street Case No.: 7860135
City: Madera Slale: PA Zip: 16661 I
Lender: First Commonwealth Bank/STARS
-
16.5' 16.5'
8.0'
Kftchen 12.0'
Bedroom
Pantry alt)' 14.0'
28.5' 28.5'
Dining LiVing
16.5' Bedroom Bedroom 16.5'
Room Room
Bath
30.5' 30.5'
I;
SKETCH CAlCULAllONS PllI'imet.. Iwa
0 A1: 1&7x&0= 1002
A2: 229 x&O = 137.4
A3 A3: 3J.7x16.6= all.6
nslFICXl' 71fl2
A4: 16.7x12.0= 200.4
0 A5: 3J.7x16.6= all.6
AS
Sen:rd FICXl' 710.0
T et.. living Iha 1457.2
302 E. Pine Street, Clearfleld, PA 16830 (814) 765-5252 Fax: (814) 765-2425
.
LOCA liON MAP
Slale: PA
File No.: ki /30740468
Case No.: 7860135
Zip: 16661
/
MAP (C > 1964-ZQQ3 TELE II TLIIS Nil. tHe IScale: 15.-4-9 mi lesl
Prep3red by: PROVOST REAL ESTATE APPRAISERS 814-765-5252
110 Addr... Data Prl.. RM BR Batl1 SQFt Proximity
s Spz:uc. St.r..t. 5-05 59900 6 3 1 0.00 HI
1 2528 Main S~E.a~ 5-04 51000 8 4 1.5 1955 0.40 MI WSW
2 410 RED SCHOOLHOUSE RD4-04 63000 7 3 1 1518 6.5 HI ENE
3 3311 Main S~E..~ 4-05 52000 6 3 2 1208 0.33 MI ENE
4 2437 GINTER I~ORANN HIIY 6-04 56000 6 3 1 1288 4.5 HI ESE
302 E. Pine Street, Clearfield, PA 16830 (814) 765-5252 Fax: (814) 765-2425
,eJ/
. '. \
AUCTION SERVICE (RH 7~L)
I
ROWE"S
""-
~
Bill Rowe (AU 1538L) 2505 Ritner Highway · Carlisle, PA
. Ben Rowe (AU 1092t);~249-2677 697-4794 249-1978
, \
. / Auction Is Action Call "Rowe" For Satisfaction
SELLERS N~ME ~",A-T" d I- """'''-''0 If >?>1 DATE rf J s- J..t) Y
ADDRESS ]Iv MAn/<- 7'"/UI/W~ <;; v1 7T'p /2- ,vJi '1 PHONE / .-'
OTHER IDo( ~'\.\<.J'\\ 'Sf" M!;q(..A,'c,A/.{/I'- AUCTIONEER% '3 J
IIO~"--
Bob Rowe (AU 2276L)
Dave Rowe !(AU 2295L)
,.!
AUCTION DATE/LOCATION
~.
l)CJ..)ff 0;)
f .
~,-.Ti~N
CLERK %
ESCRIPTION OF MERGHANDISE !
I
I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise
to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen-
tative of the merchandise, goods and or property and have good title and the right to sell and that they are free
from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of
~~~ ~ 1 agree w hold harmless the Auct\~neer~gainst ";;7 01 t~er$l w. in
AUCTION SIGNATURE /vJf~ SIGNATURE
--
Total Sales (Clerking Tickets Attached) $
\ \ c..> '{
Less Sale Expense:
."--
., \ % Commissiolil Auctioneer '$
'"3P~
-
% Commission Clerks"', {r . $
~;, -t"I' ') . .(;' .' ) ~'i l.'y
~ r ,.....
OTHER ,..!.," ...,.., '. """C <.
~:~)} \:;)' I ("
'-.' ..',' f "/', , LI. s' ,
',' . ....
'.,
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TOTAL SALE EXPENSE DEDUCTED $
I
SELLERS NET $
,1
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AUCTION SIGNATURE ...
":'~--'
.-
(\9)
SELLERS SIGNATURE
Kelley Blue Book - Trade-In Pricing Report - Cadillac, DeVille
.. ~!!'.!!
. ......
ovct.]5 years
advertisement
USED CA.RS
Q Quick Dealer Price Quote Q Search Used Car listin s t;;! lis
REVIEWS 8. RATINGS ADVICE FINANCING
BLUE BOOK- TRADE.I N VALUE
Pennsylvania · September 13, 2005
1993 Cadillac DeVille Sedan 40
"<II '"" )<
. ~
S~a[cl:1 Listings fQL ThisCaJ
Ljs! Your Car For Sale~oJine
Quick New Car Price Quote
Free CARFAX Record Chec
Auto Loans from 4.99% APR
111suJan.ce~UQte
Pgym~ll1- C~!cYlalQr
Engine: va 4.9 Liter
Trans: Automatic
Drive: FWD
Mileage: 90,000
Equipment
Air Conditioning
Power Steering
Power Windows
Power Door Locks
Tilt Wheel
Cruise Control
AM/FM Stereo
Cassette
ABS (4-Wheel)
Dual Power Seats
Alloy Wheels
- ad
(
Eml
Di~
Eve
YI
Consumer Rated Condition: Fair WHl
"Fair" condition means that the vehicle has some mechanical or cosmetic defects and Le!
needs servicing but is still in reasonable running condition. This vehicle has a clean title
history, the paint, body and/or interior need work performed by a professional. The
tires may need to be replaced. There may be some repairable rust damage.
Trade-In Value List Your Car For Sale Online $1,240
Trade-in Value is what consumers can expect to receive from a dealer for a trade-in
vehicle assuming an accurate appraisal of condition. This value will likely be less than
the Private Party Value because the reselling dealer incurs the cost of safety
inspections, reconditioning and other costs of doing business.
NEXT STEP: Q Get New Car Pricing
" BLUE BOOK" VALUE
! '9 FEEDBACK
http://www.kbb.comlkbIkLdlllkw.kc.ur?kbb.PA;961413;P A041& 17055;+t&278;Cadillac; 1 '" 9/13A2005
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FROM: Kruise Funeral Homes, Inc.
PHONE NO. : 814 378 8461
KRUISE FUNERAL HOMES, INC.
Deoor. A I(rutte
S~rvillOr
254 Lynn Street P.U. Hox SB r ^
~. P.M&y1vani;oll66el
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(81041378.71@;1
Frank A KlUise
Supervisor
~S50 IInlon Street POBox 164
R~fT1t'!v P~lHlsvlvanlA 18671
STATEMENT OF .'lINERAL GOODS AND SERVICES SELECTED
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SUB.TOTAL. rROFESSIONAI. SERVlf F.S
2. lISt OF FACII.ITlES ANI) SU{VIC.:S
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SliD-TOTAL FACILITIES AII/D EQl1IPMENT
j. AII.H.1MOTln: I!.Ql1IPMfNT
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TOTAl. SERVICES. FACILlTIE~. !\lITOMOBIU:
B. <.:HAR(;[S I'UR MUtCUANUlSt: SF..I.HTED
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Ol."~r R~ecl'laelc :Ii
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^eknnwl~d!.lrn~lll Card, :Ii
tlc~i~ler Bllf,'~ $
M~lIlnriall;nlt1~r~ ,.
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$
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ramify Car
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OUloftnWlIlranSfl\\113lioll
Date: or D~llth
P.O. Box SRS
Addr."
()Ill~ or ('onlracl
Madera I'^
lll.\ :"I1.lIt.
AUllusl 15. 2004
1666,1
Zip
$
$
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$
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$
$
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<:$
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1450.00
Al $
1.450.0()
SIJR-TO"'AI. IW WH.'IAI
D. CASH ADV ANUm
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StlMMARY OF CHARGES
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TOTAL (lI<' ALL SUTlOII/'>
I.I:SS. PaYlllent Mild,'
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$
$
$
$
$
2.0....'.00
1,0"3.00
REASOl'; H.IH HU)IIIH.II SI.H\IIIS IIR '\1I'.RIII.' ~I)IS.:
200 00
DISCLAIMER OF WARRANTIES
Our funeri11 h(lm.. makes no reprcsl"ntl:lliu", (If wl'rranlies reearding easket~
or outer buri.1 CQnlainer.. The only wBrrantic,. r)~p'(!(:r.4lrt or Implied, 9ranted
in conneclton with good" "(lId wilh Ihe funer..1 s..rvice ~'l) lh~ expre"~ wrilten
warranlles. if any. cXI~.,rtflfl by \he 1Tl3nuf3Clur9' 11,..,..,,1 No olh"r wllrrtnties
including Ihe "nplied wMI"'lt1ti"f, "f merch..ntability ~" fitness for p..rtj"ular
TOTAL MERCHANDISE SEU;Cn.,o B S 200.00 purpose are extend9<l by thr, ~el\er
I agree that' halle eX;1mined Ihe ilems 01 goods and services selected above lInd found Ihem 10 be co",,<:I and ac~..)rdinD In Ih.. llrr;m!Jp.mp.nl~ I havl!
ll:4ooslt:tl. I ..cl\IIOWledge rece1pl of a GOPY of Ihit; Slatement of runer.1 Good$ Clnd Service9 Selected I represent thai 1 ft;;JVC (;uffil;ienl fUnds available lor
pllymenl uf thl! cash price for the goods and services selected I ;rIM agree to make payment 01 $ 21M3.00 wilhi" 30 daYi> I agree (0 be jointly and &I!v"rally
liable with anyone else who sign$ bl.IClw A LATE CHARGE of 1.5% per monlh (18% per annum) Willbeipplied to the unpaid balance beginning 30 days aile,
the date of thiS conlract I willlllso PIIY the Funeral Director all reasonable cOlils paid by the runeral Director (0 colle,.1 lImOlJnt~ I \)We under this agreemenl
Those eos~s m8 include lJIttornev fees and tourt cosls Any items requestw lifter the dale of this agreement will be con!;lderlld lJ..rt of this agreement and wlli
bA refleeted 0 final bill
(Scul) ~ ~4-J ^ugu',12~.:?n(J.l
. V' --'''''''''", . - . ~ J 1L:"
1\0011 ",.h.." .I"-.;!d:,.",,,,,,,,. f{
Invoice
jJ~
LEGGETT INC.
1989 Hummel Ave.
Camp Hill, PA 17011 I
(717) 737-4562/770-COOL [2665]
Fax: (717) 737-8907
www.leQaettinc.com
Date: November 23,2004
"SERVING THE HARRISBURG AREA FOR 38 YEARS"
Plumbing, Heating, Oil Burners, Electrical, Snow Melt, Ale, Bathroom Rem deling
To: Attorney R. Mark Thomas
101 South Market Street
Mechanicsburg, PA 17055
Estate of Mrs. John Eby
2850 Sunset Drive
Camp Hill, PA 17011
Be ready for that unexpected power outage. Contact Jerry our Master Electrician At Leggett Inc. for
more information on our emergency generators. i
!
TECH NUMBER DATE F.O.B. tERMS
John 46075 11/22/04 P 3yments
dl e at this
If
i Ime
!
QTY. DESCRIPTION PRICE tOTAL
1 Performed check and service of oil forced hot air furnace. 253.00 253.00
Checked blower motor and brushed off as needed.
Serviced burner. Changed nozzle and oil filter. Cleaned
electrodes, cad cell eye, retention head and air vents.
Checked transformer, oil pump, and burner motor all okay.
Checked electrical and thermostat and okay. Set heat
anticipator at .4 as needed. Took down flue pipe brushed
and vacuumed out. Vacuumed out chimney base. Took
apart furnace and pulled turbulator, brushed and vacuumed
off. Brushed and vacuumed tubes. Put all back together
and cemented flue pipe. Cycled heat on had good flame
and draft. -.04 breech, +.01 fire, 0 smoke, 450 stack temp,
12 % C02, 83 % efficiency. All operating as it should at
this time.
1 Serviced electronic air cleaner. Removed cells and 61.00 61.00
cleaned with coil cleaner. Reinstalled and tested and it is
operational at this time.
1 Serviced humidifier. Cleaned and replaced humidifier 61.00 61.00
panel and tested and it is operational at this time.
NOTE: Upon completing the service, our technician set the
thermostat back to where it was when he arrived. It is
currently set on the lowest setting, which is between 40 and
42 degrees. As winter progresses you may want to turn
the heat up to 50 or 55.
Total amount due at this time I i $375.00
I
Thanks for the opportunity to be of service
BARRETT SANITATION, INC.
186THOMPSON ROAD SUITE 2
PHILLlPSBURG. PA 16866
342-6445
1...111,"111"..1.1..1.1...1.11
THOMAS. MARK R.
R. MARK THOMAS
101 MARKET ST.
MECHANICSBURG, PA 17055
late fee after 30 days
BARRETT SANITATION. INC.
1/15/05
Balance as of 12/31/04 :
Late Charge
Current
$10.00
30 Days
$10.00
Acct# 1789
60 Days
$10.00
Stateme~~
Th1 Fob 10. 2005
17$9
,..mlllmlll
Please Pay: $120)00
LOCATION: Page 1
THOMAS, MARK R.
FRANK CAPATCH ESTATE
MADERA
MECHANICSBURG, PA 17055
Tenns: Due before last day of month
Location: Madera. Mechanicsburg, PA
Balance Due:
$110.00
$10.00
$120.00
90+ Days Total
$90.00 $120.00
Grand Total: $120.00
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18113:15463 rom ::co\\ Latcs-..
.
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Invoice (Due Upon Receipt)
April 16, 2005
Attorney Mark Thomas
Scrvic:csRendcrcd for the property at 216 Spruce Street. l'vfadera, PA 16661.
Home Tnspection:
Radon 'fest:
Pest Inspection:
Dye Test:
$200.00
$100.00
$50.00
$7 5.00
Total:
$425.00*
tPlease make check payable to Latosky Inspection Company and mail to the
address listed below.
Thank you for your business.
.pc{ 4;1 g/txs
#009
'roll I'ree: 1 (877) .301-3552
I:' '. '1 (,.-,..,) 8')')'1 r4' ('"
"~l>;:. (>11 c,.... -) ..U
. /
28 Braddock Strcct, 11out'ld:iJc, P i\
1a tosky((-pyaho(), COIn
1 ()Gi) 1
01-03-2006
EBY
08-29-2004
21 04-1053
CUMBERLAND
101
APPEAL DATE: 03-04-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
9Y!_~~9~~_!~!~_~!~~______~___!~!~!~_~~~~!_~~!!!~~_~~!_y~~!_!~~~!~~--~--------------------
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
MARGO FILE NO. 21 04-1053 ACN 101
BUREAU OF INDIVIDUAL }AiE$'-1
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
uAPPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
;".l r.....~" "
-:.-1 _
d, ; f r", (-,
I;: U j
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
R M THOMAS
101 S MARKET ST
MECHANICSBURG
PA 17055
ESTATE OF
EBY
*'
REV-1547 EX AFP (06-05)
MARGO
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
DATE 01-03-2006
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ Abb returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
.00 X 00 = .00
.00 X 045 = .00
.00 X 12 = .00
219,997.30 X 15 = 32,999.60
(1'9)= 32,999.60
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
231, 000.00
.00
.00
.00
110.132.53
.00
30,000.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
59,702.42
91.432.81
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this for. with your
tax pay.ent.
371,132.53
151.135 23
219,997.30
.00
219,997.30
TAX CREDITS:
,.' .-.. ,,""......... . l+J AtfOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
06-07-2005 CFOOI020 .00 4,050.00
10-28-2005 CD005943 607.84- 33,700.34
TOTAL TAX CREDIT 37,142.50
BALANCE OF TAX DUE 4,142.90CR
INTEREST AND PEN. .00
TOTAL DUE 4,142.90CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE C
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
.
MONTHLY STATEMENT:
Account Adivif;y: (since last statement)
Invoice Date Posting Date Transaction Description
7/25/05 Previous Balance:
8/25/05 8/25/05 Finance Charge-Invoice #805
Amount
$629.65
$9.44
ACCOUNT BALANCE:
$639.09
TOTAL BALANCE DUE:
S6~9.09
If payment was made within the last J 0 days, please disregard this statement. The finance charge is computed
by applying a rate of J 112% per month (annual percentage rate of J 8%) on balances not paid within 30 days
of the original billing and after all payments and credits are applied to the closing date of this statement.
Shipley Energy
550 East King Street
PO Box 5006
York, PA 17405-5006
(717)848-4 I 00 or 1-800-839- I 849
or
Visit our website
www.shipleyenergy.com
Page: J
FORM # 711082
.
00024064959170000000000033043013
~~ Pe.nn.6yivan.ta
Ame.It.tc.an Wate.1t
PO BOX 578 ,-
ALTON, IL 62002-0578
ACCOUNT NUMBER
24-0649591!7
AMOUNT DUE $330. ~3
DUE DATE May 12, 20 5
For Service To: 2850 Sunset Dr
AMOUNT PAID
00002789901 AB 0.301
1..,11,11",11",11"."1111..,,1.1,1,,,1,.11,1,..1,.11..1.1.1
John Eby
PO Box 573
Madera P A 16661-0573
Please return this portion witll che:k
T Payable to the address below T
Pennsylvania American Water
PO Box 371412
Pittsburgh, Pa. 15250-7412
1,"11,1.1".1.1.1.1.11...11111.1..1,"11..1.1,,11.1
Closing Bill
O Please check here to add H20-Help to Others contribution to your monthly bill
or to change your address or telephone number, and print information on reverse side.
Customer Account Information
Billing Summary
.......... Prio r Bal a nc e........................
Balance from last bill
Payments prior to Apr 22, 2005. Thanks!
Total prior balance, Apr 22, 2005
..........Current Water Charges..........
Service Ch3rge
Water Volume ($.005735 x 7,900)
STAS PAWC Water-0.14%
OSI- PAWC Charge 1.81%
Total water charge Apr 22,2005
$272.67
.00
272.67
11..$0
45.$1
-.08
1.p
57.16
$330. ~31
For Service To: John Eby
2850 Sunset Dr
Account Number: 24-0649591-7
Premise Number: 24-0383530
Bifling Period & Meter Information
Billing Date: Apr 22, 2005
Billing Period: Mar 21to Apr 20 (30 days)
Next reading on/about: May 20, 2005
Rate Type: Residential
Meter readings in current billing period:
Meter Number N000502628 is a 5/8-inch meter.
Present-actual 560500
Last-actual 552600
Gallons used 1'fJ
.
FOR SERVICES RENDERED TO:
Mark R. Thomas, Esquire
101 South Market Street
Mechanicsburg, PA 17055
Re: Locate Kathryn English
Charles F. Kleber
Private Investigation
45 Kermis Court
Dover, PA 17315 - 2015
(717) 292-4351 Fax (717) 292-0296
E-mail: ckleber@att.net
DESCRIPTION AMOUNT
Private Investigative Services -- May 20,2005 to May 21,2005
1.50 hours @ $ 65.00 /Hr..................................................... $ 97.50
Records....... ( Six Paid Searches) ......................................... 150.00
Total $ 247.50
Sincerely,
e~" r: ttlJu.
Charles F. Kleber
May 31,2005
.
Sep 13 05 04:28p
Unit: 0108 Paid Thru: 9/2/05
Lease#: 1776 Lease: 5/27/05
Date Description
5/27/05 Master Card#***********~
5/27/05 Master CardH************
6/27/05 Master Card#************
7/27/05 Master CardH*********'**
SPACE MART Self-Storage
PAYMENT HISTORY
Raymond M.Thomas
Printed 9/12/2005 11:28 PM
Date Out: 9/2/05
SElC oap: $0.00
Melllo
New Tenant, Move-In Pmt
Avail Credit: $0.00
Balance: $31.30
Auto Bill d
Auto Bill-
717 790 1577
Receipt#
21491
21492
22004
22566
Subtotal
Total
p.2
Amount
$47.17
$11.66
$94.34
$94.34
$247 :51
$247.51
~
Space Mart Self Storage
4751 Westport Drive
Mechanicsburg, P A 17055
717-790-9100
717-790-1577 FAX
Payment Recei{!!
Raymond M. Thomas
913 Alison Ave
Mechanicsburg P A 17055
Date Printed
Payment Date
Unit 0108
Available credit 0.00
Current Balance 0.00
Paid Thru Jun 26, 2005
Receipt Number 21491
May 27, 2005
May 27,2005 5:44 PM
By RH
Date
OS/27/05
OS/27/05
Unit
0108
0108
Description
Rent 5/27 to 6/26
Rent 5/27 to 6/26
Charge
89.00
89.00
Tax
5.34
5.34
Payment Method
47.17 Master Card
47.17 Discount Credit
5.34
41.83
47.17
47.17
94.34
Total
94.34
94.34
Tax
Payment (less tax)
Payment Subtotal
Credits Applied
Total Applied to Account
Current Account Balance 0.00
Paid By Master Card *******9057
Paid Thru Date Jun 26, 2005
Expiration Date 09/05
Transaction Type Sale
Authorization 086663
Reference AUTH/TKT 086663
I agree to pay the above amount according to the card issuer agreement.
x
..
Space Mart Self Storage
4751 Westport Drive
Mechanicsburg, P A 17055
717-790-9100
717-790-1577 FAX
Payment Receil!!
Raymond M. Thomas
913 Alison Ave
Mechanicsburg PA 17055
Date Printed
Payment Date
Unit D108
Available credit 0.00
Current Balance 0.00
Paid Thru Jun 26, 2005
Receipt Number 21492
May 27, 2005 ~ bol05
May 27, 2005 5:47 PM
By RH
Date Unit Description
OS/27/05 0108 * Locks-round -2 key (1)
Charge Tax Total
11.00 0.66 11.66
Tax
payment (less tax)
Payment Subtotal
Credits Applied
Total Applied to Account
Payment Method
11.66 Master Card
0.66
11.00
11.66
0.00
11.66
Current Account Balance 0.00
Paid By Master Card *******9057
Paid Thru Date Jun 26, 2005
Expiration Date 09/05
Transaction Type Sale
Authorization 040822
Reference AUTH/TKT 040822
I agree to pay the above amount according to the card issuer agreement.
x
"
CUSTOMER RECEIPT
... McCafferty,:." "
'f'", ~.,
Autorent of MechElnlcsbtirg ,.
6320 Carlisle F.'1,ke .,.~. P.O. Box 7275
Mechanlcsburg; I'A17050
(717) 766-4733 :.~ (FAXP96-9804
" !f,:c",<""", ".
HOME ADDRESS
913 AUSON AVe.
f! 1 T'/3fl7" lW)7
STATE ZIP
CAR NO.
PHONE
CITY
M eCHANICSeU~G
DRIVER'S UC. NO. STATE
19531328
DATE OF BlRTIl ,
LICENSE NO.
PA
EXPIRATION DATE
17 5
COLOR & llODEl
DATE AND
TIME IN
DATE AND
TIME OUT
AIlOAESS
ODOMETER
READING IN
~100
STATE ZIP
ODOMETER
READING OUT
CITY
CRE~ CARD typE AN,D NUMBER OR OlllER IDENTIFICATION
Me 55SfOOOOO('JOCX 9057 0905
lOCAL CONTACT OR ADORESS
MILES DRIVEN
FUEL GAUGE POSIT1ON
OUT F 'I. 'I. ./. 1f2 'I. II. II.
RATES DO
NOT INCLUDE
GASOlINE
AGE
IN F 'I. 'I. 1/. 'h '/0 II. 'Ia
HOURS
0$
DAYS
'$
WEEKS
0$
MONTHS
0$
MILES
0$
TOTAL TIME AND
MilEAGE CHARGES
I tOO
, '"' '"
CUSTOMER WILl NOt UNDER ANY CIRCUMSTANCES SURRENDER THE USE.OF THE RENTED VEHICLE TO
ANY PERSON OTHER THAN THOSE LISTED BELOW WItHOUT HAVING OBTAINED THE WRITTEN CONSENT
OF lESSOR, (IF NONE NT NO ACROSS THIS SECTION)
$24,98
F-'r.ae iM
2
49,95
NAME
AGE
',~
,
.
$0.24
" ....,. --:......
NAME
91
REPLACEMENT RENTAL
D
TIllS VEHICLE IS NOT COVERED I'OR PUBlIC'lIA8ll/TY AND PHYSICAL DAMAGE INSURANCE.
RENTER MUST SUPPLY UABlutY AND/OR PHySICAL DAMAGE UNDER RENTER'S EXISTING
INSURANCE POLICY. .
-..
~
$15,00
Rente~llnllfall
SUB tOTAL
COLLISION DAMAGE WAIVER (COW)
BY INITIALS, CUSTOMER ACCEPTS OR DECLINES COu.lsloN DAMAGE WAIVER, AT THE RATES LISTED TO
THE RIGHT. IF THE CUSTOMER DECUNES TO PURCIlASE COLlISION DAMAGE WAIVER, THEY ACCEPT FUU
RESPOIlSlBlutY FOR AU DAMAGES INClUDING lOSS OF USE TO THE RENTED VEHICLE UP TO
$ FUll V.AlIU=
SALES TAX
6, oa~,~,
~
ACCEPTANCE OF COLUSJON DAMAGE WAIVER LIMITS
CUSTOMER'S DAMAGE R lB. TO $ W OQ
0$"'.013 PER DAY
$2.00
PA$SeNGe~ CAP.' .00%
PATRANSPORTATlONSURCHARGE
ACCEPTS cow.,
DECUNES CDW
REFUELING
CHARGES 0 $
$5.00
/GAL
NOTICE: ThlI conlr8cI oIferI, lor In .addItJoRII Chlrge,aco/lialon damage weJver 10 cOver your reaponllblllty MiSe .CHAr:!>^ES 6 eUl!'\"CHA""'GE
lor dlmagi 10 !hi vehicle. BaIoit deddlng llhelher Ib purdiat8 CDW, you may willi 10 delermlne wheIheI your ~..., ... '" r"- "
own vehfcle Inluranc:e aIIorde you.coYerIge lor damlgelO the rented vehicle and the lilnounl ollhe deductible
, under your own Inlll_ cOVIfIlie. The purchuli oIlh1i CDW Ie not mandIlOIy and may be walvtd, TOTAL CHARGE
!.......(,.
Renter'llnltlall
I AGREE TO RETURN,THE RENTED VEIftCLE TO tIlE ABOVE LOCATION ON OR BEFORE DATE AND TIME
DUE BACk.' ..' "..,' ">'J);. .
~~~IC . 0$l2712OO$"'At03:4e.Ptl" DAM 0 PM ,~~~~"~ .cc.,,"
" II Ie bIreby agreid end \IlidintUacIl!IIiIlht pi'OVIIJon II added 10 Ihe above captioned rentallgreement
lam raJeclIng illllneured rnotoilet COVerage undellhli rental ill Itaee ~ end eny polley ollnluranca CIf 181I-
, in$urance IeIUId lmdet thli agreement. lor myaeIlend 11I1 other pi....... 0111I11 vehicle. Unlneured cOverage
protactI me and oIheI pIUIRg8lIln lhli vehicle IClf '- ind damaget luttered "InJury II caUled by negligence oil
drfver who doee no! havllnr. ranctlo fII1lor I imi damelJI*. ,
All oIheIlenne end
ACC~1'tED BY: .
MINUS DEPOsrrs
NET DUE lESSOR
CUSTOMER
r
I
, 03:40 PM
~ FUEL UGE POSmON
/a "., 1ft '/2 'Ia I/.F uN E
I '/0 lJ.; I '/2 'Ia '/4 tla E
$3.03
1 ~
AUTHORIZED PAYMENT INFORMATIOtl
r
Ineurance Company:
AuthoItzed By:
Mailing AddI1Sl:
Does lhll policy cover eutJetIluIll vehIcte?:
...,----
From:
&Ii $f.""': '-:-+;. '-" ,,;,
Extd. By:
Claim No, :
Name ollnaured:
'"
'.'.;,
I'
\.
:j
l
,:
; ~,
"
'.1"
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128.0601
II
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
THOMAS R MARK
101 SOUTH MARKET STREET
MECHANICSBURG, PA 17055
____nn fold
ESTATE INFORMATION: SSN: 186-24-9835
FILE NUMBER: 2104-1053
DECEDENT NAME: EBY MARGO
DATE OF PAYMENT: 10/28/2005
POSTMARK DATE: 10/28/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 08/29/2004
REMARKS:
CHECK#1008
SEAL
NO. CD 005943
ACN
ASSESSMENT
CONTROL
NUMBER
AMouNT
101 I $33,700.)34
I !
I I
i
I ,
I
I I
I I
I
I
I i
I
I
TOTAL AMOUNT PAID:
i
$33,70q.34
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG, PA 17128-0601
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
: ";2
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NO.
COUNTY
ACN
REV-1547 EX (06-05) PC
} ;
01-24-2006
EBY MARGO
08-29-2004
21 04-1053
Cumberland
101
RAYMOND \-Cl.QUD
PO BOX 585
MADER~ PA 16661
Appeal Date: 03-25-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013
CUT ALONG THIS LINE r;> RETAIN LOWER PORTION FOR YOUR RECORDS ~
-REv:'154i EX-(06-ifsypc - - - - - - - - - - - - - -'~OtICE- of-fNI.fERffA-NCe- tA5( AP-PRAi~fEME-Nt-,-A-LLOWANd:- OR- - - - - - - - - - -- - - - - - - - - - - - - - - - - - ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
MARGO FILE NO. 21 04-1053 ACN 101
TAX RETURN WAS: ( ~ ) ACCEPTED AS FILED ( 0 ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN NO. 01
ESTATE OF
EBY
DATE 01-24-2006
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/ Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 0.00
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 0.00
11. Total Deductions (11) 0.00
12. Net Value of Tax Return (12) 27,000.00
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 0.00
14. Net Value of Estate Subject to Tax (14) 27,000.00
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16,17 and 18 will reflect figures
that include the total of ALL returns assessed to date.
(1 )
(2)
(3)
(4)
(5)
(6)
(7)
0.00
0.00
0.00
0.00
0.00
0.00
27,000.00
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
27,000.00
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 taxable at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
(15) .00 X .00 00
(16) .00 X .045 .00
(17) .00 X .12 .00
(18) 27,000.00 X .15 4,05000
(19) 4,050.00
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID 1-)
06-07 -2005 CT001020 .00 4,050.00
TOTAL TAX CREDIT 4,050.00
BALANCE OF TAX DUE .00
INTEREST .00
TOTAL DUE 00
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
1lJ
,"
L
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Margo Eby
Date of Death:
8/29/2004
Estate No.: 21-04-1053
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the acL.llli-llstration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes ~ No 0
2. Ift.1e anSVier is No, state when the rersonal representative reasonably believes that
the administration will be complete:
3. If the answer to No. I is Yes, state the following:
a. Did the personal representative file a fmal account with the Court?
Yes 0 No ~
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes }81 No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
Date: 7/6/06 atta<:hedtothisreport. ~~ ~
Signature
("')
R. Mark Thomas, Esquire
Name
101 South Market Street
Mechanicsburg, PA 17055
Address
717-796-2100
Telephone No.
Capacity: ~ Personal Representative
)Xl Counsel for personal representative
\,
cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/05/2006
THOMAS R MARK
101 S MARKET STREET
MECHANICSBURG, PA 17055-3851
RE: Estate of EBY MARGO
File Number: 2004-01053
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing lS due by:
8/29/2006
please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
wy~,L. JJ
/J?t./,/UM'~"~
//
(' ,)
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
~
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
phone: (717) 240-6345
Date: 7/05/2006
THOMAS R MARK
101 S MARKET STREET
MECHANICSBURG, PA 17055
RE: Estate of EBY MARGO
File Number: 2004-01053
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing lS due by:
8/29/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
. APPRAISEMENT , ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (06-05)
GRV RD
PA 17055
~ATE 06-06-2006
ESTATE OF SALONEY HELEN C
DATE OF DEATH 02-16-2005
FILE NUMBER ~1-(.'('i.N'(i9
COUNTY CUMBERLAND
,SSN/DC 211-38-5014
ACN 05131437
APPEAL DATE: 08-05-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CHARLES
LOT 97
1550 WILLIAMS
MECHANICSBURG
W SALONEY JR
CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
REV=is4S-EX-AFP-C03=OSj--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-06-2006
ESTATE OF SALONEY
HELEN
C DATE OF DEATH 02-16-2005
COUNTY
CUMBERLAND
FILE NO. S.S/D.C. NO. 211-38-5014
TAX RETURN WAS: (X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05131437
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK
ACCOUNT NO.
2176297
TYPE OF ACCOUNT:
DATE ESTABLISHED
()SAVINGS ~) CHECKING ()TRUST ()TIME CERTIFICATE
10-02-2004
X
.00
0.500
.00
.00
.00
.15
.00
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. *
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE !~_RE~L~C;!~D_~~__A_:~R~~!!:.L~~J.! Yl?U MAY BE DUE A REFUND.
'..d
(\' ,
,\\\)
BUREAU OF INDIVIDUAL TAXE:;.
INHERITANCE TAX DIVISION
PD BDX 280601
HARRISBURG PA 17128-0601
INHERITANCE TAX
RECORD ADJUSTMENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
REV-1593 EX AFP (03-05)
(""1 I'.
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-22-2006
EBY
08-29-2004
21 04-1053
CUMBERLAND
101
MARGO
R MARK THOMAS ,. ~
101 SOURTH MARKET ST
MECHANICSBURG PA 17055-3851
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
--+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
REV-1S93 EX AFP (03-05)
.. INHERITANCE TAX RECORD ADJUSTMENT ..
ESTATE OF EBY
MARGO
FILE NO. 21 04-1053
ACN 1 0 1
DATE
05-22-2006
ADJUSTMENT BASED ON:
VALUE OF ESTATE:
ADMINISTRATIVE CORRECTION
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
DEDUCTIONS AND EXEMPTIONS:
ll)
(2)
(3)
(4)
(5)
(6)
(7)
231,000.00
.00
.00
.00
110,132.53
.00
27,000.00
(8)
368,132.53
10.
11.
12.
13.
14.
TAX:
15. Amount of
16. Amount of
17. Amount of
18. Amount of
19. Principal
TAX CREDITS:
9. Funeral Expenses/Administrative Costs/
Miscellaneous Expenses (Schedule H)
Debts/Mortgage Liabilities/Liens (Schedule I)
Total Deductions
Net Value of Tax Return
Charitable/Governmental Bequests; Non-elected
Net Value of Estate Subject to Tax
(9) 59,702.42
1l0) 91,432.81
(11)
(12)
9113 Trusts (Schedule J) (13)
(14)
151,135.23
216,997.30
.00
216,997.30
Line 14 at Spousal rate (15) .00 X 00
Line 14 taxable at Lineal/Class A rate (16) .00 X 045=
Line 14 at Sibling rate (17) .00 X 12 =
Line 14 taxable at Collateral/Class B rate (18) 216,997.30X 15 =
Tax Due (19)
.00
.00
.00
32,549.60
32,549.60
. KI:l,;I:~"1 '''J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
06-07-2005 CFOOI020 .00 4,050.00
10-28-2005 CD005943 598.47- 33,700.34
TOTAL TAX CREDIT 37,151. 87
BALANCE OF TAX DUE 4,602.27CR
INTEREST AND PEN. .00
TOTAL DUE 4,602.27CR
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
J
"%
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME
REV-1470 EX (6-88)
REVIEWED BY
ITEM
SCHEDULE NO.
INHERITANCE TAX
EXPLANATION
OF CHANGES
FILE NUMBER
MARGO EBY
2104-1053
101
ACN
Dianne McClain
EXPLANATION OF CHANGES
The Notice of Inheritance Tax Appraisement, Allowance or Disallowance of Deductions
and Assessment of Tax has been adjusted to reflect Schedule G change based on a
duplicate asset.
ROW
Paqe 1
-T
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXElS:~t'\ol'I'T\ r,rF(l C'. :INHER:ITANCE TAX
INtERITANCE TAX DIVISION ,\, , _c) \J' -:STATEMENT OF ACCOUNT
PO BOX 280601
HARRISBURG PA 17128-0601
*'
R MARK THOMAS r^,!
101 SOURTH MARlEl ST
MECHANICSBURG PA 17
REV-1607 EX AFP (03-05)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-12-2006
EBY
08-29-2004
21 04-1053
CUMBERLAND
101
bount Re..itted
MARGO
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit t~ your account, sub..it the upper portion of this for.. with your tax p.yltBnt.
CUT ALONG THIS LINE
... RETAIN LOWER PORTION FOR YOUR RECORDS
4-
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REV-1607 EX AFP (03-05)
:~~~ INHERITANCE TAX STATEMENT OF ACCOUNT KKK
ESTATE OF EBY MAF GO FILE NO.21 04-1053 ACN 101 DATE 06-12-2006
THIS STATE"ENT IS PROVIDED TO ADVISI OF THE CURRENT STATUS OF THE STATED ACN IN THE N,"ED EST~TE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX ~ E, APPLICATION OF ALL PAY"ENTS, THE CURRENT BALANCE.. AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR R~CORD ADJUSTMENT: 05-19-2006
PRINCIPAL TAX DUE: 32..549.60
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
06-07-2005 CFOOI020 .00-) 4,050.00
10-28-2005 CD005943 598.47- 33,700.34
05-24-2006 REFUND .00 4,602.27-
TOTAL TAX CREDIT
BALANCE OF TAX DUE
.
IF PAID AFTER THIS DATE, SEE REfRSE
SIDE FOR CALCULATION OF ADDITIO L INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FO~ FOR INSTRUCTIONS. )
TOTAL DUE
32..549.60
.00
.00
.00
v
INTEREST AND PEN.