HomeMy WebLinkAbout05-14-13 (2) REV-1500 EX(02-11)(Fl) 1505611185
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of 60 Taxes
PO BOX 28080fi01 INHERITANCE TAX RETURN 21 12 1088
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Dale of Birth MMDDYYYY _
09302012 09261925
Decedent's Last Name Suffix Decedent's First Name M I
ROTHAUPT EILEEN C
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
51 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death
Prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required
death after 12-12-82)
❑X 6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
❑ 9. Litigation Proceeds Received ❑ .10. Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
KEITH 0 • BRENNEMAN , ESQ • ?176697-8S2_8
FRGIST ER OF WILLS USEANL
f' I—• �1 Fir st Line of Address - e 44 WEST MAIN STREET ;�Second Line of Address
i V Irt
L-� C
City or Post Office Slate ZIP Code DATJ FI ED 'rt
MECHANICSBURG PA 17055
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowedge.
SIGN9JURE OF PERSON RESPONSIBIeE FOR FILING RET - D,;TE. �
VSS LC4
NANCY A • JOHN. Ni EXECUTRIX 269 TALLOW TREE LANE, KIAWAH ISLAND
SIGNAT9IJ EOFPREPARER OTHER THAN REPRESENTATIVE DATE SC 29455-5799
ADDRESS
KEITH 0 • BRENNEMAN, ESQUIRE 44 WEST MAIN STREET, MECHANICSBURG
PLEASE USE ORIGINAL FORM ONLY PA 17055
Side 1
1505611185 OM46473.000 15DS611185
lW
1505611285
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: R 0 T H A H P T FILEEN
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 173,858 . 47
2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2 0 - 110
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C). , , , , 3. 0 - oil
4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , q 00
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , , 5, 30 1 973 • 51
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . 6. 2861002 . 88
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) 1-1 Separate Billing Requested . . . . 7. 491448 • 88
8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , 8 5401283 • 74
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9. 341891 •66
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) , , , , , , , . , 10. 133 • 00
11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11 351024 • 66
12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , 12 5051259 .08
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , 13. 201000 • 00
14. Net Value Subject to Tax(Line 12 minus Line 13) , 14. 4851259 • 08
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers unCer Sec.9116
(a)(1.2)X.0- 0 .00 15. 0 . 00
16. Amount of Line 14 t xable
at lineal rate x.0 4� 4851259 . 08 16. 211836 . 66
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17, 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18. 0 . 00
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 211836 . 66
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505611285 1505611285
OM4648 3.000
REV-1500 E%(FI) Page 3 File Number
Decedent's Complete Address: 21 12 1088
DECEDENTS NAME
ROTHAUPT EILEEN C
STREET ADDRESS
BOXWOQ LANE, UPPER ALLEN TOWNSHIP _
CUMB LAND_ COUNTY _
CITY STATE ZIP
MECHA ICSB G PA 17055-
Tax Payments and Credits:
1. Tax Cwe(Page 2,Line 19) (1) 21,836 .66
2. GredltstPayments
A. Prior Payments 21,000 - 00
B.Discount _ .,, 1,050. 00
Total Credits(A+B) (2) 22,05000
3. Interest
(3) 0 . 00
4. if Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT.
Fill in box on Page 2,Une 20 to request a refund. (4) 213-34
S. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
Make check payable to: REGISTER OF WILLS, AGENT,
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X"IN THE APPROPRIATE BLOCKS
t Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred . . . . . . . . . . . . . . . . . . I . . . . . ❑ 0
b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . ❑ (T;1
c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ (((.��d.1tt
d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . ❑
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 ❑
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? . X
4. Did decedent own an individual retirement account, annuity, or other non-probate property,which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ® ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(1)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
(72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are stilt applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent 172 P.S.§9116(a)(1.2)],
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in 172 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent (72 P.S.§9116(a)(1.3)]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
OM4671 2.000
REV_1502 E%,(m.te) SCHEDULE A
pennsylvania
DEPhRTMEM OF REVENUE
44HERITMCE TAX RETURN � REAL ESTATE V
RESICEM DECEDENT
ESTATE OF: FILE NUMBER:
Eileen C. Rothattrit 21 12 1088
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jomtly�owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold
ITEM Include a copy of the deed showing decedent's interest if Mined as tenant in common. VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t. Property known and numbered as 173,858.47
2204 Boxwood Lane, Upper Allen Township, Cumberland
County, Mechanicsburg, PA 17055. Sale value (see
attached settlement sheet)
TOTAL (Also enter on Line 1,Recapitulation.) $ _ 173,858.47
sw4695 2.wa If more space is needed,use additional sheets of paper of the same size.
REV-1508 EX�(M12)
pennsylvania SCHEDULE E
CEPART NTOF REVENUE CASH, BANK DEPOSITS &MISC.
INHERITANCE RESIDEMnECEENTT°R" PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Eileen C. Rothauot 21 12 1088
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 2007 Chevrolet Impala 9,129.00
Kelly Blue Book value (see attached appraisal)
2 Member's lst Federal Credit Union 20,011.51
CD #21999-52
3 United States Treasury 1,833.00
tax refund due the decedent on 2012 Final Individual
Income Tax
TOTAL(Also enter on line 5,Recapitulation) S 30,973.51
2w4eAD 2.000 If more space is needed,use additional sheets of paper of the same size.
REV-1509 EX.(0140)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT -
ESTATE OF: FILE NUMBER:
Eileen C. Rothauot 21 12 1088
If an asset became jointly owned within one year of the clecedem's date of death,it must be reported on Schedule G
SURVIVING JOINT TEMANT(S)NANE(S) ADDRESS RE ATIONSHIPTO DECEDENT
A Johnson, Nancy A 269 Tallow Tree Lane, Kiawah
Island, SC 29455-5799 Daughter
JOINTLY OWNED PROPERTY:
rfFM �rTER DATE DESCRPTION OF PROPDiN % DATE OF DEATH
FOR XXNT MADE wcLURE NAW OF FRUUCia.INSTrUt"rvoe�Nx�ccaiNT.1. 1A OR.1. DATE OF DEATH DECEDENTS VALUE OF
NIMER TENANT JOINT RDNTFYINGNc FR.ATTACH DEED FOR JONTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1 A DWS Investments 201,497.45 50.0000 100,748.73
as follows:
1. #26080717 - $115,345.05
- made joint 04/30/2008
2. #9993300082 -
$86,152.40 - made joint
11/16/1998
2 A Vanguard 70,039.61 50.0000 35,019.81
investment account as
follows:
a. #0051-09957480295 -
$36,069.16
b. #0036-09957480295 -
$17,296.32
C, #0077-09957480295 -
$8,199.59
d. #0084-09957480295 -
$8,474.54
To al from c ntinuation schedules . . . 150,234.34
TOTAL (Also enter on Line 6, Recapitulation) $ 286,002.88
9W46AE 2 000 If more space is needed, use additional sheets of paper of the same size.
Estate of: Eileen C. Rothaupt 21 12 1088
Schedule F Part 2 (Page 2)
Item Joint DOD Value of Perc DOD Value of
No. Cot. Date Description Asset Int. Interest
3 A Member's 1st Federal Credit
Union 206,949.96 50.0000 103,474. 98
various accounts as
follows:
1. Savings #130009-00 -
$26.41 - made joint
10/19/2005
2. CD #130009-42 -
$20,018.90 - made joint
11/02/2010
3. CD #1300009-43 -
$25,027.53 - made joint
5/16/2011
4. CD #130009-45 -
$25,025.48 - made joint
7/16/2010
5. - CD #130009-46 -
$35,033.08 - made joint
3/17/2009
6. Savings #21999-00 -
$161.04 - made joint
01/09/1991
7. Life Savings #21999-04
- $4,000.82 - made joint
01/09/1991
B. Money Management
#21999-05 - $17,634.31 -
made joint 01/10/1991
9. Checking #21999-11 - -
$19,798.33 - made joint
01/23/1991
10. CD #21999-44 -
$10,178.04 - made joint
06/08/2011
11. CD #21999-46 -
$20,018.90 - made joint
11/02/2010
12. CD #21999-48 .-
$20,018.08 - made joint
4/4/2011
13. CD #21999-49 -
$10,009.04 - made joint
12/27/2010
Total (Carry forward to main schedule) - 103,474.98
Estate of: Eileen C. Rothaupt 21 12 1088
Schedule F Part 2 (Page 3)
Item Joint DOD Value of Perc DOD Value of
No. Cot. Date Description Asset Int. Interest
4 A 3/8/1995 New Cumberland Federal
Credit Union 93,518.73 50.0000 46,759.36
various accounts under
#71578 as follows:
1. Savings (S1) - $80. 94
2. CD16 - $37,843.04
3. CD17 - $11,594.75
4. CD20 - $10,000.00
5. CD21 - $34,000.00
Total (Carry forward to main schedule) 46,759.36
REV-1510 EX.(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHER DECEDENT
INHERITANCE RETURN
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Eileen C. Rothaupt 21 12 1088
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM iN1lLETTEN^NEOFTTETRArGrEREE,THERRU_ATiC s ITODECEDEm AW DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBEF ATTACHACOar OF THEDEEO FOR REAL ESTATE. VALUE OF ASSET INTEREST IFAPPUCA6LE VALUE
1. St Elizabeth Ann Seton Church 20,000.00 100.0000 0.00 20,000.00
two charitable gift annuities
as follows:
1. #08-67930 - $10.000.00
2. #08-67931 - $10,000.00
2 Member's 1st Federal Credit
Union 25,025.48 100.0000 3,000.00 22,025.48
CD #21999-56. Jointly owned
with Nancy A. Johnson. Made
joint 10/18/2011 (within one
year of death) therefore asset
is fully taxable
3 Member's 1st Federal Credit
Union 7,423.40 100.0000 0.00 7,423.40
IRA Certificate of Deposit
#21999-10. Desginated
beneficiaries are decedent's
children
c
TOTAL(Also enter on line 7,Recapitulation)$
49 448.88
If more space is needed,use additional sheets of paper of the same size.
9 W46AF 2.000
REV-1511 Ex-(IM9)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
NRERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENTDEDEDENT
ESTATE OF FILE NUMBER
Eileen C. Rothauot 21 12 1088
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
f. Myers Funeral Home
funeral services 12,288.00
Total from continuation schedules . . . . . . . . . 1,144.11
B. ADMINISTRATIVE COSTS:
I. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: Snelbaker & Brenneman, P.C. (Estimated) 6,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City Slate ZIP
Relationship of Claimant to Decedent
4. Probate Fees: . 285.50 -
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
1 Cumberland Law Journal
advertise Executrix Notice 75.00
Total from continuation schedules . . . . . . . . . 15,099.05
TOTAL(Also enter on Line 9,Recapitulation) $ 34 891. 66
9w46AC 2.000 If more space is needed, use additional sheets of paper of the same size.
Estate of: Eileen C. Rothaupt 21 12 1088
Schedule H Part 1 (Page 2)
Item
No. Description Amount
2 Pealers Flowers
flowers 588.25
3 St Elizabeth Ann Seton Church
funeral luncheon 555.86
Total (Carry forward to main schedule) 1,144.11
Estate of: Eileen C. Rothaupt 21 12 1088
Schedule H Part 7 (Page 2)
2 Register of Wills
filing fee for Inheritance Tax and Inventory 30.00
3 The Sentinel
advertise Executrix Notice 232.02
4 Settlement charges associated with the sale of real
estate
a. Seller credit - $500.00
b. Remax Realty Assoc. , commission - $9,047.50
C. Transfer taxes - $1,725.00
d. Remax Realty Assoc. , deed preparation - $125.00
e. Notary fee - $10.00
f. Upper Allen Twp. , sewer - $224.00 11,631.50
5 Real Estate Expenses/maintenance as follows:
a. snow removal - $155.00
b. Electric - $251.57
C. water - $85.39
d. Sewer - $336.00
e. Heating oil - $496. 15
f. Real Estate taxes - $881.42 2,205.53
6 Reserve
for filing fees, accountant fees and other
miscellaneous costs associated with the
administration of the estate 1,000.00
Total (Carry forward to main schedule) 15,099.05
REV-1512 EX.(12-08)
pennsylvania SCHEDULE I
DEPARTMENT of REVENUE DEBTS OF DECEDENT,
INHERITANCE NT E RETURN
RES MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
Eileen C. Rothaupt 21 12 1088
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM
VALUE AT DATE
NUMBER DESCRIPTION
OF DEATH
PA Department of Revenue
taxes due on 2012 Final Individual Income Tax Return 133.00
TOTAL(Also enter on Line 10,Reca itulation $ 133.00
swasAH 2.000 If more space is needed, insert additional sheets of the same size.
REV-1513 EX.(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
Eileen C. Rothau t 21 12 1088
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
lEast NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS[Indude outright spousal distributions and transfers under
Sec.9116(a)(1.2)j
Daniel J. Rothaupt 25 Alexander Drive Lyme, CT 06333
One Quarter of Residue: 44,307. 68 Son 44,307. 68
2 Eileen M. Bangert
986 Jefferies Bridge Road
West Chester, PA 19382
One Quarter of Residue: 44,307. 68 Daughter 44,307. 68
3 Michael E. Rothaupt
986 Jefferies Bridge Road
West Chester, PA 19382
One Quarter of Residue: 44,307. 68 Son 44,307.68
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
i.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1 See Attached
1
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 COVER SHEET, E 20 000.00
9W46AI 2,000 If more space is needetl,use atltlitiona sheets of paper of the same size.
Estate of: Eileen C. Rothaupt 21 12 1088
Schedule J Part 1 (Page 2)
Item
No. Description Relation Amount
4 Nancy A. Johnson
269 Tallow Tree Lane
Kiawah Island, SC 29455-5799
Member's 1st Federal Credit Union
Inventory Value: 103,474.98
New Cumberland_ Federal Credit Union
Inventory Value: 46,759.36
DWS Investments
Inventory Value: 100,748.73
Member's 1st Federal Credit Union
Inventory Value: 22,025.48
Vanguard
Inventory Value: 35,019.81
One Quarter of Residue: 44,307. 68 Daughter 352,336.04
Estate of: Eileen C. Rothaupt 21 12 1088
Schedule J Part 2H (Page 1)
Item
No. Description Amount
1 St. Elizabeth Ann
Seton Church
310 Hertzler Road
Mechanicsburg, PA 17055
St Elizabeth Ann Seton Church
Inventory Value: 20,000.00 20,000.00
�4Yyi,r tri r�; OMB APPnwaI No.2502.0265
.. v4 HUD-1
A. Settlement Statement (HUD-1)
x
04N D6vt�` Page I of 3
S.Type of loan
1.Q FHA 2.❑RHS 3,E]Conv.Umns. 6.Fie Number: 7,Loan Number: 8.Mortgage insurance Case Number:
4.❑VA S.❑Conv.Ins. 401304831-CB 001123502362 446-1701672.703
C.NOTE; This form K Nmished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shown,
Items marked'(p.a.c.}°were paid outside the dosing;they are shown here for Wermatlonel purposes and are not inoWtled In the
totals.
O.Name and Address of Borrower €.Name and Address of salter P.Name and Address of Lender
GREGORY C.LENNON AND IENNIE O. NANCY A.JOHNSON,EXECUTRIX OF THE CITIBANK,N.A.
LENNON ESTATE OF EILEEN C.ROTHAVPr,A/K/A 1000 TECHNOLOGY DRIVE,
142 HOLDEN ST. EILEEN CATHERINE ROTHAUPT OTALLON,NO 63368
WORCESTER,MA 01606-3433 2204 BOXWOOD LANE -
MECHANICSBURG,PA 17055
G.Property Location H,Settlement Agent
SECURED LAND TRANSFERS,tLC
2204 BOXWOOD LANE, 485 ST.JOHNS CHURCH ROAD,
MECHANICSBURG,PA 17055 SHIREMANSTOWN,PA 17011
Phone:(717)9DI-8342
COUNTY: :42-29UND Place of Settlement I.Settlement Date 04/09/2013
PARCEL ID:42-29-2454-153
TOWNSHIP:UPPER ALLEN TOWNSHIP
HARRISBURG PIKE Disbursement Date 04(0412433
CARL
" CARLISLE,PAjW
J. Summary of Borrower's Transaction K. Summary of Seller's Transaction T
100.Gross Amount Due from Borrower .. 400.Gross Amount Out to Seller
103, Contract Saks Price T1172,500.00 401. Contract Sales Price .._----
102. Personal property ..-.--.._.-_...... 172 500.04
•le- � 402. Personal
303. Settlement Charges to borrower line 1400 $11 742.12 403.
104, 404.
105. 405.
Adjustment for items paid by seller in advance Adjustment for items paid by Wier in advarxe
106. CI flown Taxes 406, CI own Taxes
107. County Taxes 801.42001 r 04 09113 to 01/01114 5644.76 407. County Taxes 881.4200 r 04 04 13 to 01101/14 $644,76
108. Assessments 408. Assessments
109, School Taxes 2689.3800 r 04/09'13 to 07 01 13 $611.56 409. School Taxes 2689.3800 r 04 09 13 to 07/01113 611.56
`110 Sewer 8111 for 415/6 112-000014t,for 04/09f i3 to $142.15 412. Sewer 801 for 4/516 112.00001110 for 04/09113 to 5102.55
¢7101173 07 Oi 13
111. 411.
112. 432.
120,Gross Amount Due from Borrower $18KE00.59 1420.Gross Amount Due to Seller A173,858.T7
100,Amounts Paid by or in Behalf of Borrower $00.Redustians In Amount Due to"far
201. De Wk or earnest money 111.000.00 501, Excess De arils __
202. Principal Lawn Amount from Citibank,N.A. $169,375.00 502. Settlement Charges to Seller _ $11.131.50
203. Existing hum(s)taken subject to 503. Existing loan(s)taken subject to
204. POC by Borrower, _ 360.00 504.
205. _ 505. ����•..� .�.�
206. 506.
207. 507.
208. 508.
209, 509.
Adjustments for Items Unpaid b y seller Adjustments for Items umpold by setter
210. CI frown Taxes 510. Cltyfrovm Taxes
231. Couriv Taxes 511. County Taxes
212. Assessments 512. Assessments
213, Seller Credit $500.00 513. Seller Credit $500.00
214, 514.
215, 515.
216. 516.
217. 517.
218. 518.
219. 519.
220.Total Paid for Borrower 1$371,235.00 520,Total Reduction Amount Due Sailer 11 631,50
300.Cash at SeMamam from/to 8crrowar 600.Cash at Settlement tolfrom Sells,
301. Gross amount due from borrower(line 120 185,600.59 1601. Gross.amount due to sailer(line 420) - $173 858.47
302. Lass amounts paid by/for borrower(line 220) 4171 235.00 602. Less reductions In amount due seller(line 520) $11 631.50
303.Cash % From To 80 war 14,365.59 603,Cash X To ,From Seller 162,226.97
The Public Repotting Bunten for rat coikrctron rdinfonnalion is estimated W 35 mra t"per response Wr cosa�ing,rN itivoJ.anS rePWUng Lire tla8.ThisSgismy may
ooliect this infonnafron,and you are not mquxed to complete Nts form,unless Ii displays a o rrently valid OMB control number.No conkh mality is assured;this disc'
Is mandatory.This is assigned to provide the pants,to a PEEPS covered transa0ion will,information ruling the settlement process.
Initials
40130083140 NUD-i Page 2 of 3
L.Settlement Cha es
700.Total Real Estate Broker Fees$9047.50
DWisdn of Com o,"Jon firm 700 as follows: Paid From Paid From
701. 53872.50 to ReMax Realty Assotlates 3 622.50+$250.00 B At Setif s dent At Seller's ttl£Yens
At Settlement At Settlement
702.$517S.00 to EM-N0.T LLC
703, Commission paid at settlement $9 047,50
704.
$00.Items Payelate in Connection with Loan
801. Our Origination cha a 740A0 from GfE 11
802.Your credit or theme(points)For the sposcific Interest rare chosen - 77730 from GFE#2
803. Your ashurtcd pollination changes from GFE A 300
804. Appraisal Fee to LSI POC$360.00 from GFE 43 360.00
85.Credit report to EQUIFAX from GFE#3 2.25
806, Tax Service to C0RE LOGIC 1mm GFE 43 77.00
$07. Flood Cert.Fee to CORE LOGIC from GFE#3 $3.25
808.
900.Items Required b7 Lender to Be Paid in Advance
901 Daily interest charges from 4/912013 to 5¢/2013 @ 16.82/day Citibank, (from GFE 410) $370.04
N.A.
902. Mort a e Insurance to Department of HUD from GFE#3 $2.913.091
SQ3. Homeowrmr's Insu*ance 1 Year to HomeSRe Insurifim Company POC (from GFE a 13) $634.00
5634,00
9114,
1000.1fie"Mes Deposited with Lender
1001.Initial deposit for your escrow account - --- - ` -from GFE#9' ' - -5I337.49 1' -'-'- --
1002.Hazard Ins.Reserve 3 Months 52.53 r Monts s Citibank N.A. $158,50
1003.Mortgage Ins.Reserve @ 171.91 per Months Citibank,N.A.
1004-CoinoW property Taxes 3 Molm s 74.95 per Months Citibank,NA. $224.85
7005.School Taxes 11 Month 5 @ 224,12 par Months Citibank N.A. S2 465.32
1006.A re ate Accountin AJ ustment to Qtibenk N.A. -$511,18
7007.
1100.Title Charges
1101.T70e servitors and lender's title insurarK.e to Seared Land Transfers LLC from GFE#4 1 S1.720.01)]
1102.Settlement or c3dising fee to Secured Land Transfers,LLC $225.00
11103. ances title insurance to Secured land Transfers LLC thin.GFE#5 $15.00
1104.tender's title insurance W Secured Land Transfers LLC $IA00.00
1105.Lender's tide paltry limit 169375,00
1106.Owner's tfNe i Iknit 5372 500.00
1107.Agent's portlon of the torsi title.insurance premium to Seared Land $1,273.50
Transfers LLC
1108.Underwriter's portion of the total title insurance premium to TRGC-Sale 5141.50
1109.Insured Closinq Protectlon Letter to TRGC 575.00
1200.4government Retarding and Transfer Charges
1201.Government mortfing,charges foam GFE#7 $142,00
1202.. Deed$62.00 Mortgage 13 Pages) 80.00 Releases S
1203.Transfer taxes Isom GFE#8 $1,725,001
1204.City/County City/County tax stam s Deed$1725,00 Mortgage S
1205.Swte tax/stmoss Deed 53725,00 Mortgage$ S3 725.00
1206.
1300.Additional Settlement Charges
1301.Resulted servkes drat ou can sheept for (from GFE#6 55.00
1302.Past ins onion to Homechek 55.00
1303.Deed Free In Reflex Realty AssoclateS $125.00
1304.Ntlta fee to]utl Paim $10.00
1305.Sewer Bill for 1 213 and 41516 to Upper Allen Townshio Authority $224.00
1306.Home Inspection to Homechak $285.00
1307.Radon Inspection to Homechek 300.00
1308.Home and Past Ins action for 508 Colon Rd.to Momechek 340.00
1400.TOtai Settlement Charges(enter on fines 10$Section 1 and 502,Section K) I- 511,742.11 531,1 i. v '
11 you have any questions about the settlement charges antl loan terms listed on this form,please Gamma your lender.Seldemenl agent is oat responsible for coolant of
lenders ass.. can
The seller nd a ngnaWresh rl a othelrappmval and elgnay Mea imaomtandbg that tax and Insurance proration and reserves are based an
figures I the ce year at a red by era o $Braaten cur the rumen[year,and in The evens of any change for the cunenl year,ea nemssary,adjustments will ore
made in t and i . kof de0r�ert taws w mortgage payoffs will bs promptly reimbursed w the aeifkment agent by the sa4br.
I ha an utl owed M U tge Statement end to the best of my knowledge and bittier,It to We and accurate statement of e.6 reaipla and dlsbursemaMs
mad o n unt or by asoinn.I Near pertly that I bane receiwd a cagy of the HUDI Settlement Statement.
E +/ SELLERS J
r Eii t WO egary G. enno: A.3ohno1s ).Lannon HucD I Seasonal Star m of which i have proposed is a Lve ant.=rate% msoami VSe tha Nnds to ore dlabprsed le
ocodente with this statement.
Settlement Agent Data
A/ ')9'2_td1..�..: )f.N 0 410 91201 3
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LAST WILL AND TESTAMENT
OF
EILEEN C. ROTHAUPT
I, EILEEN C. ROTHAUPT, of Upper Allen Township, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory
and understanding, do hereby make, publish and declare this as
and for my Last Will and Testament, hereby revoking and making
void any and all wills by me at any time heretofore made.
S� 1. I direct that all my debts and funeral expenses be paid
as soon as practicable after my death by my Executrix or
Y
r` Executor, whichever the case may be, hereinafter named.
I� 2. All the rest, residue and remainder of my estate, real,
personal and mixed, and wheresoever the same may be situate, I
give, devise and bequeath in equal shares to my children, their
S
heirs and assigns, whose names and dates of birth are set forth
as follows:
NANCY A. JOHNSON, born January 1, 1949
MICHAEL E. ROTHAUPT, born July 8, 1950
DANIEL J. ROTHAUPT, born August 6, 1951
EILEEN M. BANGERT, born February 11, 1954
Should any child of mine predecease me, I direct the share such
deceased child would have received shall pass to my surviving
children in equal shares above named, said share to pass per
capita and not per stirpes.
3. I hereby nominate, constitute and appoint my daughter,
NANCY A. JOHNSON, as Executrix of this my Last Will and
Testament, but should she predecease me or fail to qualify, then
in such event, I nominate, constitute and appoint my son,
MICHAEL E. ROTHAUPT, as Executor of this my Last Will and
aNELaAKER a ELI=KER Testament, and I further direct that no person serving as
-Executrix or Executor shall be required to post any bond to
secure the faithful performance of her or his duties in the
Commonwealth of Pennsylvania or in any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this my Last Will and Testament written on two (2 ) pages
this ttday of 7 1991./�I .,
Cam- G" J( � .�!.uta (SEAL)
Eileen C'. RothaUVt
Signed, sealed, published and declared by EILEEN C.
ROTHAOPT, the Testatrix above named, as and for her Last Will and
Testament, in our presence, who, in her presence, at her request,
and in the presence of each other, have hereunto subscribed our
names as attesting witnesses.
(SEAL)
pp' /
(SEAL)
SN EIBAKERFB ELIC KER '
-2-
COMMONWEALTH OF PENNSYLVANIA)
SS.
COUNTY OF CUMBERLAND)
We, EILEEN C. ROTHAUPT, E. ROBERT ELICKER, II, and SUSAN
L. ZYCH, the Testatrix and the witnesses, respectively, whose
names are signed to the attached or forgoing instrument, being
first duly sworn, do hereby declare to the undersigned authority
that the Testatrix signed and executed the instrument as her
Last Will and Testament and that she had signed willingly, and
that she executed it as her free and voluntary act for the
purposes therein expressed, and that each of the witnesses, in
the presence and hearing of the Testatrix, signed the Will as
witness and that to the best of her knowledge the Testatrix was
at that time eighteen years of age or older, of sound mind and
under no constraint or undue influence.
Testatrix
e st atrr i x
Witness
Witness
Subscribed, sworn to and acknowledged before me by EILEEN C.
ROTHAUPT, Testatrix, and subscribed and sworn to before me by E.
ROBERT ELICKER, II, and SUSAN L. ZYCH, witnesses, this �i•''0
day of Jla ie 1991.
Notary Public
SNELBRKE RFB ELICKER I� � •/
fJ_,L..I v'Ifl j Afl A0.1NlI O,N0�25