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05-31-13 (2)
J 1505610143 REV-1500 EX,°2-,,, '�' OFFICIAL USE ONLY PA Department of Revenue pennsylvania coumv code vear Fiie Numoar Bureau of Individual Taxes 0°""*"`"'°`"`"`"�` PO BOX280601 INHERITANCE TAX RETURN 21 12 01104 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Securiry Number Date of Death Date of Birth 09 26 2012 02 12 1954 DecedenYs Last Name Suffix Decedent's First Name MI SMITH WALTER J (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Retum � 2. Supplemental Retum � 3. Remainder Retum(Date of Death Pnorto 12-13-82) � 4. Limited Estate � qa FuWre In�eresl Com�romise � 5. Federal Estate Tax Return Requiretl ��aaieoraaamana� z-iz-ez7 � g DeceEent�ietl Testete � 7 foe��er�opy o�4iu e��iving Tmsi � e. Total Number of Safe Deposit Boxes - (AVachCOpyofWill) � 9. LitigationProceedsReceived � ���b�Mreen1231�J1end�TDa�S�(Deeth � ��,ElectiontotaxunderSec.9113(A) (Attach Schedule O) CORRESPONDEN7-THIS SECTION MU57 BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL�(INFORMATI6�SHOULD�DIRECTED 70: Name D�ir�e Telephsne Nu�em MARK A MATEYA T�,Z'�241 �SO�F n rr� .;i n - rn � 3��15�2 OIFWILLS_U�,�NLY C.�� _ ,-. L. �.�w First Line of Address '-' --.j ��� 55 W CHURCH AVENUE r-• `� Second Line of Address U� � _ � � � DATE FILED Cily or Post Office State ZIP Code CARLISLE PA 17013 Correspondent�s e-maii address: mam@mateyalaw.com Untler penallies of peryury,I tleclare that I have erzamined this 2tum,including accompanying scheAUles and statements,antl to the Dest of my knowledge and belief, it is true,correct and complete.DeGaration of preparer other than the personal representative is based on all informalion of which preparer has any knowledge. SIGNATURE OF PERSON RF$PONSIB�R FILING RETURN , DATE in . i >�i�J iCJ%/'�C.�L DelbertSmith AO�ftE55 2544 Kinaston Drive Florence SC 29505 SIGNATUREOF REPARE OTHERTHANREPRESEN TNE DATE � �����+ Mark A. Mateya 5' >C�l f � ADDRE55 V 55 W. Church Avenue, Carlisle, PA Side 1 � 1505610143 1505610143 J / ,/ , n�.(/ J 1505610243 REV-1500 EX Decedent's Social Securiry Number oe�tla�rsNema: Smith, WalterJ RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... � 85,000 . 00 2. Stocks and Bonds(Schedule B)............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)._...... 3. 4. MoAgages&Notes Receivable(Schedule D).......................__........._.................. 4. 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 125, 825 . 12 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 51 � 650 . 00 7. Inter-Vivos Transfers&Miscellaneous�{oq-Probate Property (Schedule G) U Separete Billing Requested............ 7. g. ToWI Gross Assets(lotal Lines 1 through 7)..._.........._..._.........._...................... 8. 262 , 475 . 12 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 40, 718 . 95 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 1� 967 . 88 11. ToWI Deductions(total Lines 9 and 10).._.._.........._..__..........._............_........... 11. 42 � 686 . 63 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 219� �88 .2 9 �3. Charitable and Governmental Bequests/Sec 9113 Trusts for which an eleclion to tax has not been made(Schedule J)............................................... 13. �a. Netva�ueSubjecttoTax(Line �2minus�ine�3)............................................... 14. 219� 788 . 29 TAX COMPIJTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 �5 Q . Q Q (a)(12)X .00 16. Amount of Line 14 taxable 0 . Q Q 16. 0 . �0 at lineal rete X .045 17. Amount of Line 14 taxable 2( 374 . 5 9 at sibling rate X.12 219� �8 8 ' z 9 ». ' 18. Amount of Line 14 taxable 0 . 00 18. 0 . 00 at collateral rate X.15 19. TAXDUE.......... . 19. Z6,374 . 59 . .._.........__...._....._..._...................................__.......................... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 � 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-12-01104 DecedenYs Complete Address: DECEDENT'S NAME Smith,Walter J STREETADDRESS 422 Walnut Street CITY STATE ZIP Boiling Springs PA 17007 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 26,374.59 2. Credits/Payments A. Prior Payments 23,452.00 B. Discount 1,234.32 Total Credits(A +B) (2) 24,686.32 3. Interest �3) q. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the diffe2nce. This is the TAX DUE. (5) ��s$$.27 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a trensfer and: Yes No a. retaintheuseorincomeofthepropertytransferred:..............._................._..._......._..........._..........._... ❑ 0 b. retain the right to designate who shall use the property trensferred or its income;.._..............._............. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... x d. receive the promise for life of either payments,benefits or care?............................_........................._... ❑ � � 2. If death occurred after Dec. 12, 7982, did decedent transfer propeM1y within one year of death without ❑ ❑ receiving adequate consideration?.................................................................................................................... x 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 olher non-probate property which contains a beneficiarydesignation?......._._................_............_..............................................._..................... ❑ ❑X 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 t, 1994 and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S. §9116(a)(1.1)(i)]. For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of � assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(12)]. . The tax rate imposed on the net value of transfers to or for the use of the decedenPs lineal beneficiaries is 4-5 percent,except as noted in [�2 P.S.§9116(a)(1)1. . The tax rate Imposed on the net value of transfers to or for the use of the decedenPs 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. Rev-1502 EXt�01-10) SCHEDULE A pennsylvania REAL ESTATE OEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith WalterJ 21-12-01104 All mal property owned solely or ae a tenant in common muat be repotleE al fair market value.Fair merket velue is tlafned es Ihe price e�whic�proparty woultl be exchangetl betwaen e willing buyer entl e willinp seller,neilher EeinB�mpalled to buy or sell,bot��eving raesoneEle knawlatlBe ot the relavenl(acts. Real propsrty Mat in jointlyownetl with right of aurvivonhip muat be tliaclosstl on echetlule F. Atlach a copy of Me eeltlement aheet if Me property hae bean aoltl Include a copy of the deeA s�owing decatlanl'e inlarest if ownatl aa tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real Estate-422 Walnut Street, Boiling Springs- See Attached Settlement Sheet 85,000.00 TOTAL(Also enter on Line 1, Recapitulation) 65,000.00 (It more space is needed,atltlitional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev.01-10) aa�-�eoe ex«���-�o� SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. OEPARTMENTOFREVENUE pERSONAL PROPERTY INMEftITANCE TA%RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith WalterJ 21-12-01104 Inclutle t�e pracaetls ot IiliBelion entl lhe Ee�e tha pmceetla were receivetl by�he astele. All propaM lointlyowned wlih Me rigM of aurvivo�ahip mual�e tliacloeetl o�ec�edule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Sean House-Deposit on purchase of real estate located at 422 Walnut Street, Boiling 500.00 Springs, PA 2 M8T Bank-Decedent's Checking Account;Account No. 9653812486 106,607.12 3 Rowe's Auction Service-Proceeds from sale of household/personal effects-See attached 18,718.00 Settlement Sheet TOTAL(Also enter on Line 5, Recapitulation) 125,825.12 (If mo2 space is neetled,additional peges of the same size) Copyright(c)2010 form soTtware only The Lackner Group, Inc. Form PA-7500 Schedule E(Rev. 11-10) Rev-1509 E%�(01-10) pennsylvania SCHEDULE F DEPAftTMENTOFREVENUE JOINTLY-OWNED PROPERTY INHEftITANCE TAX RETURN RESI�ENT OECEDENT ESTATE OF FILE NUMBER Smith WalterJ 21-12-01104 H an easel wu meAe joiM within one year of ihe Eecedenl's tlate of deaM,it mual be reportetl on sehedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Delbert H Smith 2544 Kingston Dr Brother Florence, SC 29505 B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY o�o OF OATE OF DEATH ITEM LETTER DATE INCLU�E NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT DATE OF DEATH DECD'S pECE ENT'S INTEREST NUMBER FOR JOINT MADE NUMBER OR SIMIUIR IDENTIFVING NUMBER.ATTACH�EEO FOR VALUE OF ASSE INTEREST TENANT JOINT JOINTLKHELD REAL ESTATE. � Real EsWte-Indian Peg Road,Cumberland 103,300.00 50.000% 51.650.00 County, PA-Jointly owned with DelbeR H. Smith TOTAL(Also enter on Line 6, Recapitulation) 51,650.00 (If more space is needed,atlditional pa9es of the same size) Copyright(c)2010 form soRware only The Lackner Group,Inc. Form PA-7500 Schedule F(Rev.01-10) HEV-1bH EX«(�OJ19) pennsylvania SCHEDULE H oeanarmeNTOFaeveNUe FUNERAL EXPENSES AND RESIDENTOEC ENTUftN ADMINISTRATIVECOSTS ESTATE OF FILE NUMBER Smith,Walter J 21-72-01104 DecedenYs debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N ER p. FUNERAL EXPENSES: See continuation schedule(s) attached 11,752.9a B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Slreet Address City State _ Zio Year(s)Commission Paid p. Attornev's Fees Mark A. Mateya 11,000.00 3, Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio Relationshio of Claimant to Decedent 4. Probate Fees 373.50 5. Accountant's Fees 6. Tax Retum Preparer's Fees 50.00 7. Other Administrative Costs 17,542.51 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 40,718.95 Copyright(c)2009 fortn software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Smith,Walter J 21-12-01104 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Hoffman Roth Funeral Home-Funeral Expenses 11,752.94 H-A 11,752.94 Other Administrative Costs 2 Bouder's Trash Removal&Hauling Services -Trash removal from residence 4,060.00 3 Cumberland County Recorder of Deeds -Obtain current deed 3.00 4 Cumberland Law Journal-Legal Advertisement of Estate 75.00 5 Leffler Energy-Heating oil for residence-Account No. 10�617360; Invoice No. 970248 622.35 6 Met Ed-Electric Service at residence;Account No. 100 020 172 613 27.16 7 Michael D. Hansen -Repairs for water damage to ceiling at residence in preparation for sale 1,707.64 of real estate B Michael D. Hansen-Repairs to residence in preparation for sale of real estate 329.32 9 Patriot Oil -Heating fuel for residence 538.50 10 Rowe's Auction Service-Auctioneer Commission for sale of personal/household effects 6,557.30 11 Rowe's Auction Service-Hauling fee 425.00 12 Settlement Charges-Real EsWte settlement charges for sale of 422 Walnut Street, Boiling 1.343.35 Springs property. See attached settlement sheet 13 South Middleton Township-Water service at residence;Account No. 007075 112.32 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Smith,WalterJ 21-12-01104 ITEM NUMBER DESCRIPTION AMOUNT 14 South Middleton Township-Water/Sewer bill 121.31 15 Sfate Farm Insurance-Homeowners policy No. 38-NS-8804-2 599.00 16 The Sentinel -Legal Advertisement for Estate 221.40 77 William Fry-Costs associated with clean up of trash from property 7,411.84 H-B7 77,542.51 Copyright(c)2002 form software only The Lackner Group, Inc. Fortn PA-�500 Schedule H(Rev.6-98) Rev-1512 EXi�11-O8) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPAR1hiENT OF REVENUE INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS RESI�ENT DECE�ENT ESTATE OF FILE NUMBER Smith Walter J 21-12-01104 Report tlebb incurtetl by the decedent p�lor to Ceath ihal remainetl unpaiA et t�e CHe of death,inclutling unreimbuneE meCical expensea. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 7 LefFler Energy-Heating oil for residence-Account No. 70�611360; Invoice No. 1453 622.35 2 Met Ed -Electric Service at residence;Account No. 700 020 172 673 40.01 3 Met Ed-Electric Service at residence;Account No. 100 020 772 613 19.29 4 Met Ed -Electric service at residence Account No. 100 020 172 673 76.28 5 Met Ed-Electric Service at residence;Account No. 100 020 772 613 7.32 6 Michael D. Hansen-Repairs at residence in anticipation of sale 55.13 7 MRMC Family Medicine Ctr-Medical care;Account No. 1249832 443.00 8 MRMC Hosp Palliative Care-Medical services-Account No. 1249832 545.00 9 Peerless Indemnity Insurance-Premium on Automobile Insurance 9.50 10 William Fry-Lawn care at residence 120.00 11 William Fry-Lawn care for residence October 3, 12,25 90.00 TOTAL(Also enter on Line 10, Recapitulation) 7,967.88 (If more space is nee0ed,additional pages ot the same size) Copyright(c)2008 form software only The Lackner Group, Inc. Fortn PA-1500 Schedule I(Rev. 12-OB) _ _ _ REV-151J EXi(01-10) pennsylvania SCHEDULE J DEPARTMENTOFREVENUE INHERITANCETA%RETURN BENEFICIARIES � RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith,Walter J 21-12-01104 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (�n/ords) ($$$) TAXABLE DISTRIBUTIONS [include outright spousal I• distribu6ons,and transfers under Sea 9116 a 1.2 Delbert Smith Brother 219,788.29 2544 Kingston Drive Florence, SC 29505 Total 219,78829 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form soTlware only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.07-10) , � ` • • / �V� � LAST WILL AND TESTAMENT OF WALTER J. SMITH I, WALTER J. SMITH, of the 422 Walnut Street, Boiling Springs, Cumberland County, Pennsylvania, make this my will. I revoke any other wills or codicils to wills made by me. ARTICLE I. DISTRIBUTION OF MY ESTATE A. I give my tangible personal property to my brother, Delbert Smith. Tangible personal property includes stamp or coin collections but does not include other money ar stock certificates or other evidences of intangible rights or interests. Tangible personal property does not include any property that is held primazily for inveshnent purposes or used in connection with any business in which I may be engaged or in which I may have any interest at the time of my death. B. I give the residue of my estate, including any and all real property which I own at the time of my demise,to brother, Delbert Smith,per stirpes. ARTICLE II. PAYMENT OF EXPENSES AND OTHER CHARGES I desire a modest Christian funeral. It is my desire to be buried in the Burgett family plot at the cemetery in Churchtown, Pennsylvania. I d'uect my Executor to pay my funeral and burial expenses (including the cost of a monument or marker over my grave). The estate, inheritance and similar taaces (including those not passing under this Will), assessable on my death shall also be paid as a cost of administering my estate and my Executor shall not request any beneficiary to pay any part of such tax. ARTICLE III. APPOINTMENT OF FIDUCIARIES AND POWER5 A. I name my brother Delbert Sm.ith to be my Executor. Should ha fail Gr cesse tc act, I name Cazol Devore to be my Executrix (hereinafter "Executor"). If administration of my estate ar trust should be necessary in any jurisdiction where my Executor or my Trustee is unable to qualify, or if my Executor or my Trustee deems it necessazy for any other reason, I give to my Executor and my Trustee the power to designate any individual or corporation with trust powers to serve with my Executor or my Trustee or in my Executor's or my Trustee's stead. I request that no security be required of any Executor or Trustee, including an Executor or Trustee named pursuant to the preceding sentence. References in my will to my `Bxecutor" and my "Trustee" are to the one or ones acting at the time, except where otherwise specifically provided. B. Any cotporate Executor or Trustee shall receive for its services the compensation for which it is willing to undertake similar services for others at the time such services are rendered, as evidenced by its published fee schedule in effect from time to time, unless it is willing to agree upon a fee that is less than its customary fee. Any individual who serves as Page 1 of 3 W' T l' W.J.S. . � � Executor or Trustee sha11 be entitled to receive reasonable compensation for his or her services and, whether or not such individual receives compensation, shall be entitled to be reimbursed for expenses incurred for such services. C. I grant my Executor and my Trustee the powers set forth in 20 Pa.C.S. §§ 3311- 3332 and 20 Pa.C.S. §§ 7771-7780 respectively. In addition, my Trustee may merge any trust under this will with any trust having the same trustee and substantially the same dispositive provisions. If at any time after my death the size of any trust under this will is so small that, in the opinion of my Trustee,the trust is uneconomical to administer, my Trustee may terminate the trust and distribute the assets to the person or persons authorized to receive the trust income in such shazes as my Trustee may deem appropriate. No Trustee who is also an income beneficiazy of the trust at issue shall exercise any discretion granted in the preceding sentence. My Executor and my Trustee may distribute tangible personal property passing to a minor to any adult person with whom the minor resides, and that person's receipt shall be a sufficient voucher in the accounts of my Executor and my Trustee. D. It is my desire that my Executor or alternate Executrix consult with Mateya Law Firm in the handling of my estate, they being familiar with my affairs. ARTICLE IV. DEFINITIONS The following definitions shall be applicable to all of the provisions of my Will except where otherwise specifically stated: 1. The use of the masculine shall include the feminine or neuter and the use of the singulaz shall include the plural, and vice versa. 2. The term"estate,"where appropriate, shail include any trust hereunder. 3. The term "minor" sha11 mean an individual who has not attained the age of twenty-one yeazs. Executed this �"""" day of , 2012. �a.�AC. 1?' � ��- Walter J. Smith Signed, sealed, published, and declared for and as his last will and testament by the testator in our presence, we all being present at the same time; and we, in his presence and at his request and in the presence of each other, have subscribed our names as witnesses whereof, all on the date last above written. �ti�, A �M�� oF s�('G„�St. C'�Y(-s�� ��(�-U�3 , � � %��..�c�.o `���e�� oF 4 � ��( � r�.��-l.��i . + �.��e PA �-�� �3 Page 2 of 3 �T-t W.J.S. "• - � � COMMONWEALTH OF PENNSYLVANIA CUMBERLAND COLINTY, to wit: Before me, t e undersigned authority on this date personally appeazed Walter J. Smith, and_ �Q,� . A�(' A , and �NV LLI S � �0 L! known to me to be the te tor and wimes es, respectively, wh se names aze signe to the foregoing instrument and, all of these persons being by me first duly sworn, Walter J. Smith,the testator, declazed to me and to the witnesses in my presence that said instrument is his last will and testament and that he had willingly signed and executed it in the presence of said witnesses as his free and voluntary act for the purposes therein expressed, that said witnesses stated before me that the foregoing will was executed and acknowiedged by the testator as his last will and testament in the presence of said witnesses who in his presence and at his request and in the presence of each otner did subscribe their names thereto as attesting witnesses on the day of the date of said will and that the testator, at the time of the execution of said will, was over the age of eighteen years and of sound and disposing mind and memory. Sworn and acknowledged before me by Walter J. Smith, the testator, �la�,�( 1�• �p�iE�/,4 , witness, and �'HTd LL 1_ 5 `�{� ��0�, �'itness, this ��day of �L , 2012. d✓a.Lt3�i � -8 rn.C.P.R- Walter J. Smith �� h� witness ?`J�i�� ,LLe:� �L�I C�C r-v W�s �,�I��.v11+0 Q �L°NUXX Ph�/ Notary Public C9MMONWEAL7H OF P[NNSYI.VAN[A Notadal Seal Frances A.Aumlller,Nolary Public South Middlemn Twp.,Cumberland Counry My Commission Expires Ma�r.h 16,2014 M}' COTTITR1SS10I1 0X�71L0S: Member,Pennsyiv:;n�a A=sociation of Notaries Page 3 of 3 W�S W.J.S. OMBA rwalNo.3503A205 - � •A. SETTLEMENT STATEMENT(Hl1D-1J � B� NPE OF LOAN �. FHA 2. RHS 3. CONV.UNINS. ^ hh�, Abstract Land Associates, Inc. a. � va 5.O CONV.MS. sa`III1�11 V Jf SJ'IY MBfKE�SI�BBt . e. ESCROW fllE NUMBER: L LOAN NUMBER: I I��� 01316093-001 MAW 1145935455 E Camp Hill, PA 17011 (7'I��7E3-'I4$O � e. MORTGAGEINSURANCECASENUMBER: � FINAL C.NorE�.� Tlx�s lorm is fumished to giva you a stafement ofactual settlement cosh. Amounts paid to and by fhe seftlemenf agenl are s/pwn. '; Items marked"(P O.0)"were paid outside the closing;Ney are shown here for inlormeh'onal purpases and ara nof incltidetl in Ihe fotals. D. NAMEOFBORROWER�. SI18Wf1 A. HOUSB ADDRESSOFBORROWER: � A'IBW8If1UIS�(BE� � � Boilinq Sprinas PA 17007 � � e. Nnone oF se��Ea-. Estate of Walter J. Smith - nooeess oF seueR: c/o Delbert H. Smith Jc 2544 Kingston Drive � Florence SC 29505 - F. NnmeoF�eNOea: � Reliant Funding Group, Ina � nooaess oF�eNOeR: 1910 Cochran Road, Suite 545 Pittsburgh, PA 15220 c. PROaeaTV�ocnnoN: 422 Walnut Street Boiling Springs, PA 17007 � Cumbedand County 4030-2659-020 . Parcel#40-30-2659-020 � n. seraeMeNrneeNr: Abstraet Land Assoeiates, Inc. (717)763-1450 � PLACE OF SETTLEMENT' 3J�Y M8(KB�SV2BL, Camp Hill, PA 17011 � ` I. SETTLEMENT DATE:5/6/2013 PRORATION OATE: 5/6/2013 DISBURSEMENT OATE: 5/6/2�13 J. SUMAMRVOfBORftOWERSTPANSACTION K. SUMMARYOFSELLERSTRANSACTION �100JGRO55AMOUNT E'ftYOMBORROWERr = ^,•»�^�° � +^ .�'.IOO.�G 63 �i iA0 NTdU�7Y �SELL`�`R:=..�'t��?^�*^ �'• • ` • '' '�� " 101. Contract Seles Price 80 500 00 401. Contract Sales Price 80,500.00 102. PersonalProperty 402. PersonelPropehy 103. Setllemenl char9es to Borrower(line 1400) 8,054.64 403. 104. � 404. � . 105. 405. � . ADJUSTMENTS FOR REMS PAID BY SELLEft IN ADVANCE: ADJUSTMENTS FOR REMS PAIU BY SELLER IN ADVANCE: 106. CIIY/TOWOT2XC5 � 4�. C1� /TOW0T8%23 107. CounryTaxes 05/O6/13 to 12/37113 267.58 407. Count �Taxes OS/06/13 to A2/31l73 267.58 � 108. Assessments 408. Assessments 109. Schoollaxe 05/O6/73 to Ofi/30/13 206.68 409. Schooltaxe O5/O6/73 to O6/30/13 206.68 110. 41Q 1 N. 411. 112. 412. 173 413. 114. 414. t 15. 415. 120. GROSSAMOUNTDUEFROMBORROWEft: 89,028.90 q20. GROSSFMOIINTDUETOSELLER: � 80,974.26 200:�AMOUNTS��PNDBYOR'INBF}1ACFOF�.BORROINER^:='� % �:'+600:`REDUCTIONSIINAMOUNTDUETOSELL4t� "."'� �'� '�< 201. Deposit or earnest money 500.00 501. 6ecess de osit see instructions 500.00 202. Principal amounl of new loan(s) 82,742.00 502. Sattlement cha es to Seller Qina 1400) ' 1.343.35 203. Ezisting loan(s)taken subject to 503. Ezisting loan(s)taken sub�ect to pOq 504. PayoH pf first mortgage loan - 205. 505: Pa oR of second mort age loan 208. SellerASSisI 500.00 506. SellerASSist 500.00 207. 507. 208. New Second Loan fmm Cumberland Counry 5,000.00 SOfl � 209. 50& A�JUSTMENTS FOR REMS UNPAIO BY SELLER�. ADJUSTMENTS FOR ITEMS UNPAID BV SELLER: � 210. Citylfown Taxes 510. Ci ?own Taxas � 271. Counry Tazes 511. Coun Taxes 212. Assessments 512. Assessments 213. 513. 214. 514. 215. 515. 21G 516. 217. . 517. . ' 278. 51 B. 219 519. 22p. TOTALPAIOBYIFORBORROWER: 88,142.00 520� TOTALNEDUCTIONSINAMOUNTDUESELLER: 2,343.35 �300. CA$HA'FSHTTLEMEFiT`•ROM/f060RROWER. �x;}-� ��.•',_ ''�'�88 :'CA�HY1T86TT4fM@NT,1'OIFRdN.B LER;h'"�'c:�' � " � ' `� - '� 301. Gmss amount due from Bormwer(line 120) 89,028.90 601. Gross 8mawt due to Seller fline 4201 80,97426 302. Less amount paid by/for Borrower(line 220) 88,142.00 fi02. Less reduction in amounl due Seller(line 5201 2,343.35 . L. SETTIEMENTCHAftGES ESCROWFlLENUMBER 01316083-001MAW �-70U�:TOTACRE7(L`ESTATEBROKERFEES: 'S 'f ;'�,"-" ' r= � �: � : „ ��" �;� . � � DIVISION OF COMMISSION(LINE]00)AS FOLLOWS:� PAID FROM �� PFID FHOM BORROWER'S FUNDS SELLER'S �Q� g. �a ATSETTLEMEM FUNDSAT SETTLEMENT 702. 8 lo 7p3. Cbmmission peitl at samemenl 704. 705. � 800:'.JT�MS PAYAgLEIN"CAdNECTI0a�N11`I1#I,QAN w'%:V"x.�'� .�"�'"d�:�.''x r *�P:& t ',ta,. x'�.P�6.Cf. k`. : .„'x��t�ie�ib rs , r: Y g01. �Lroriginationcharge 53p20.58 (immGFe;rtl gpp, Vour cretlit ar charge(poinu)for ihe speci6c inlerest mte chosan (51,111.38)(Imm GFES2) � B03. Vour aCjusteG otlgination cheryes to Reliant Funtling Graup,Inc. (��^�FE'�) ', 2,30920 804. ApPraisalfeetoAppraisalGua2n�ee(POCBOtrowep prwnGPEM3� (fi00.0018 � 805. CreaitreportioCls (ImmGFEM3) 15.62 � 806. Texservic¢ (immGFE:Y3) 807. Flootl certilcation to RelianlFuntling Gmup,Inc � 0��GFE ita� 20.00 808. ' 809. 810. . 900:��JTEMS�REWIREDBYtENDERTO:BE�RAIDINADVANCB., , y, � :t'rs�.i .c, � ;' '";.p:+OC� ;'="t,'Y°°`n�"n*� ' '' �"�` 901. Dailyinterestchaiges (rcomcFea�o� 192.81 fmm 5lBI2013 ro 6/V2013 ((Q S].4156/tlay % (28 tlays) gpp. MatgaBeinsurancepremiumbrOmont�(s)toUSDA OmmGFE#3) �. �,842.84 903. Homeownarsinsu�anceforlyear�s)toE�ialnsuronceCOmpany ((mmGFEtlit) 493.00 904. 905. ��.100U. RESERVEB�DEPOSRED.WI7}�LENDER: ° _Lt :=.;` �`, .na. � '77ax 'v„��^, . k�:�!. �{a%kd?, 334h �4��,ar',A�xrP,��.i ,• �.�i "d . 1001. IniYditlepwi�(0ly0u�eu�OwdCG�unl (iramGFEYB) ��217.67 � 1002- HomeowneYa insurance 5 monihs�S 41.09 per monN 5205.45 � 1003. MortAaBe insurance monlhs�E 27.13 per mont� � � 1004. Ciy pmperty tazes months(@ S per monih 1005� Counrypropeitytares 4months�E 34.ZZ permontli 513688 � 1006� A�nual assessmenis � mont�s�E per monm 1007� SchoolWzes 11mon�hs�5 129.95pe�mon�h 51,�]4.45 1008. - monms�f per monih 1009� A99regeteACCtAtl� mont�s�5 permonN E49911 �1100. TITLH CHAROES t ' sf�,��„t3�t-�'z x�..s !„� t �.4�d�.'ps. .t3�4�°�'�bP O C °f�.. y�.�,+n`,�� .3I, , d .- ��p�. Titleservicesandlentlefstitleinsurance (fromGFEZa) . 1,156.50 1102. Setllementorclosing(ee 11W. owner'stiUeinsurance pranccexs� ' 1704. Lenaefs�ipa insutance•�o AbsVact Lantl Associa�es,Int. f808.50 1105. LenEerstl0epolicylimit 582,142.00 1106. Owner's title policy limit 580,500.00 ��p7, FganPs potllon of Ihe lotal tille insurance premium 51ZB.02 to AbsVacl LanE Aseociates,Inc. ��pg. Undetwnter's poNOn of ihe lotal li�le insurance premium E203A8 lo Old Rapublic NationAl Tipe Ins.Co. 1104 Entl.100,304,0.1•la Ab512d Lantl Associa�es,Inc. E750.00 �- 1110. Insuretl Closing Letler•to Oltl Republic National Title Ins.Co. E75.00 �� ����. Notary Pee•to SeNement OKCer E45.00 5.00 1112. "Saeatlachetlkrbreakdavn $80.00 �� : 70.00 �1�00.'GQVERNMENTREQORUINGAN4TRAHSFERCHARGESt��`xe ':�s, 3�YbE,;, �'i'�'f� A�iP"(f,att�FOC� .ci.?tvj;+�r.xn�?sria., a+ v= .,- :'t' �. �pp7. Govemmenirawrtlingcharges promerer�� 175.00 �Zpy, Deetl 564.00 Mortgage SB9.00 Release 50.00 1203. Trans(ertaxes (ImmGFE:Ye) 805.W � �ppq. ClryiCounrytaxlatamps Deetl5805.00 MortgaBeSODO �� � 805.00 1205. Slatetax/aWmps DaetlS805.00 MohBegef0.00 ' ' 1206. Gfant Agreement•ro Racartlerof Oeetls 527.00 ` 1207 . .�1300.��. �ITIONAL°SETTLHMENTCHARO�S!cs a.�r.sa.4,,,:,�,:,#�a '�it�.:+,� zr�.;�fii`+�a '"Ea; "� ;...'.,�R o$,�'• .-.i�`i,�'�ss'x". #:+�a'�i� . :k�y. ' 1301. Requiretlaervicesthatrouwnshop(or (hamGFEYfi) � 1302 201 J Coun�y/�wp Taxes(�16)to RobeM1 C.Caims 36.89 1303. 20t3COUnty/rwpTaxes(o2o)mRObehC.Caims � - 363.58 1304. ���ontRaleaseFeetoReEEvelopmenlAUthoriry 27.00 1305. FIIialWateASewertoShIIMA 4�'88 1306. DEetl Prep Fee lo Mateya Ltiw Firm � 75.00 / 1400. TOTALSETTLEMENTCHARGES(Enteronllne103,5ac�lonJ-antl-fine50Y,6ectlonK) � 8,054.64 �1,343.35 ✓ I have cerd�Wly raviewatl ihe Hll�-i y�ettlemanl Statement entl b iha besl af m/krwwledga end Oelie(il is a iruh erd eccurete sletemenl at ell remipta antl tlie WrSerrenb maEe on my arcount o 6/y/jme in Nis Vansection. I fu�r,l��a certifythal I have remivatl a mpYOf Na HUD-1 Se��temen�S�e�ent �A!/;f_ �.4ff(J�"`� ��„�,�� . "'� 16� 1 �Jp�„v� �i�.�1'^/ c-XC S�iaw A.House Eslate of WalteN.Smi h� - Borrowers Sellen 5 aHU�D�tSetuament5te�heve atatli WeantlacmreleaccaunLO��0ia�2nsattim. Ihawtausetlorwillcause�ha/undetoCetlisbueetlinaccardencewtththis � � � 5 /v�I�� Date Setllemen�Agent Abstra t LBntl Associates,Inc. EscrowNUmbeo 07316093-001 MAW �.COmpatiaonof:GObdFalthEstlrttate�OPE�SndHU�-tCNarges +4y�?;-�i":� .. . -2�+�,��'+��" �Fr +�vtld��teEatlihete � v..,'� t �.;: HUDd���''%� �� . ChargeS That Cannot Increase � HUD-0 Line Number Ouroriginationchar9e #801 3,420.SB 3,420.58 Your crbtlit o�charge(points)for the specific interest rate chosan #802 4,111.38 -1,711.38 Your ad�usted origination charges #b03 2,309.20 2,30920 TransfeV�taxes #1203 805.00 805.D0 ��Cpar9��.ThatlnTo4lCanndT!IncreaseMoieThaqtOYg=:,`�,y} ,r =.,t . , �„z, s'�„' '`' �"#„�tlOPtl�aUhENiriste� ��t','��,'r:�HU0.7 p `'. .-�.. Governthent recortling fees ' #1201 � 775.00' ti5.00 Appraisqlfee #B04 600.00 6b0.00 Credit r�poR #B05 � 12.44� h5.62 Floodd'rtification #807 20.00� Y0.00 Mortga9einsurance �. #902 1,642.86��. 1,642.84 Title serVices and lentler's title insu�ance #7107 � 1,186.50�• 1,iS6.5� Owner's9i�leinsurance � #1103 - 20.00��� ��:0.00 # + 7ota1 3,656.80� 3,6b9.96 Increase Celween C,FE and HUD-1 Char9es $ -46.84 or -12809%� �Chv9e TMaC�.CgnCManps;tR,'kr���xes �':e,Y?x� ,i w.a' n,`'a`dise 1�+!FSSi��;r."��'�a�.� �;,�.l�Si'# :'. . cO6ttd,FaltlN•WMete`8�.`S�lt`fi"+3��, ts U.D1L`.�,���. Initial daposit for your escmw account #1001 1,87820, 1,217.67 � � Oaily in�erest charges #907 5 7.4156/day 71123 182.81 , HomeoV4ner's insurance M903 600.00,. 483.00 # # # Loan Terms Your iniiial loan amount is $82,142.00 - � Your lo5n term is 30 yeers ' Your ini�ial interest rale is 32500% � Your iniiial monthy amount owed(or principal,interest,end erty $384.62 includes mortgage insurance is OX Principal . �X Intarest � y , aMortBaga Insurenca Can your iMerest rate rise? Q No,Q Yes,il can rise lo a madmum of 0,0000%.The first change wYl be on antl can change again every after.Every change tlele,your mterest rgle � can intrease or decrease by 0.0000%.Over the Gfe bf the loan,your intereat rale is guaranteed to newr be lower than D.00OD%or hiyher lhan 0.0000%. Even U yau make your paymeflts on time,can your loan balance rise7 %�No.� Yes,it tan rise to a maximum of S 0.00: Even if�ou meke yoor paymerYts on time,can your monthly amourn �x No.❑ Yes,ihh first increase can be on and tfia monthy amount oxEd can ovred(d't principal,interest,and mortgape Insurance r'se7 �ise to E�0.00. � . The mabmum d can ever rise to is$0.00. Does your loan have a prapayment penalty? %Q No.❑ Ves,your maxfinum prepayment penalfy k S 0.00. Does your loan have a balbon payment9 �No.Q Yes,you have a balloon paymenl of$0.00 due in 0 years on. Total mbnthly amount oned including escrow accounl payments ❑You do not havea mon(hy escrow peyment for ilems,such as property tazes and homeaxner's insurenca.You must pay thase il�ms tlirectly yourself. � []X Vou have an edditional monthy escrow paymanl of S 20026 that resulls in a ldal inRiel monlhly emouN w+ed ot$584.88.This�iclutlas pnncipal,interLst, any moAga9e insurgnce and any items chacketl be1Lw: ' Qx Property teaes Q HomeowneYs insurence � .. ❑Flood insurenca Q School taAes � ❑ ❑ NWe:1f you heve any queslions about�he SelflamaM Charges and Loan Tarms listed on�his Porm,please contacl yaur lender. Escrow Number: 01316093-001 MAW HUD 1112 DETAILED BREAKDOWN OF ADDITIONAL TITLE CHARGES � Delail Selier Oescription Amomt Amount 1113. Doc/Wire Fee•to Abstrect Land Associates, Inc. $50.00 � . 1114. Ovemight Fee•to Abstract Land Associates, Inc. $30.00 . � 1115. Tax Cert to Abstract Land Associates, Inc. 10.00 Total as shown on HUD page 2 Line#1112 . 10.00 HUD 1200 DETAILED BREAKDOWN OF GOVERNMENT RECORDING AND TRANSFER FEES Buyer Beller . Amount Amount City&�ounty TaxlStamps dity Tax/Stamps: Deed $805.00 Total as shown on HUD page 2 Line#1204 805.00 � �Buyer 8eller AmouM Amount State TaxlStamps � $tate Tax/Stamps: Deed $805.00 � � Total as shown on HUD page 2 Line#1205 805.00 ROWE'S AUCTION SERVICE �RH 79L) 2505 Ritner Highway • Carlisle,PA 17015 Bill Rowe (AU 1538L) 249-1978 215-1044 574-1008 Dave Rowe (AU 2295L) Auction Is Action C¢ll "R.owe" For Satisfaction SELLERS NAME 4`� `�»T,"�'�I# z n r f- �7 '�� DATE 1' �t: ` 'a "Y �`. ` ' r" ^" p . . ' ' rv' ADDRESS ^ , ._ . ,_,.,..;� ,_, w ;i�.,�. <;� ,,a i.t�r x��� .,,** PHONE -:2 �_, ; � ,<:; ;. , OTHER �� r h _..� � ,�. '� y� -��-e�- � .�-t> "� � --AUCTIONEER�% �,, , .. AUCTION DATEILOCATION 1.��'�: �" `p =•� '+- CLERK %d`� :1_ara c , :_.,. � ?, ;� . , ,, DESCRIPTION OF MERCHANDISE �µ' '�'�'� � � �a 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 incumbrancea. I agree to accept all responsibility for providing merchantable title and for delivery of title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in this agreement. ,w ' ..---_" - .. t ` i i � ' F^ � .�� . C . +4 , � ,,, ... , . ....... ...._.,.. - .._.�..�...�.,_, � a . .�_ . . . ._ .. - . . :� n AUCTION SIGNATURE ` SELLERS SI,GAF RE Total Sales �Clerking 't5ckets Attached) $ � � �� O � ✓ g Less Sale Expense: 3�,_ 35 qa CommissionAuctioneer $ � g�� �/ G' S , .. o--`—' � V ��" � \" ���/o Comn�iesie�-6lerks g_ � �'�'25— �, ✓ OTHER: L�1ca �n 'TfV>-�L� �� L V � '� c� '�"_-' TOTAI. SALE EXPENSE DEDUCTED $ —t v "� 42� 1 �---- SELLERS NET $ /3/j 3 INVOICE BOUDER'S TRASH REMOVAL & HAULING SERVICES ("?17-7A 1-9096) TRASH REMOVAL FOR: Estate of Walter Smith (Mataya Law Firm) First Floor $625.00 Freezer/Washer/Dryer Disposal 150.00 Second Floor 750.00 Attic 375.00 Basement 775.00 Paints/Oils/Fluids 180.00 Small Shed 175.00 Garage (garbage bags of trash) 680.00 Glass Window Panes (Outside) - 3 Loads 350.00 Trash Removal Cost $4060.00 TOTAL COST: $4060.00 Please make check payable to Shane Bouder , - Thanks �or Year Businessr j� :1�' : ' -' _. , i � ���/�- ti,,� �1t� �� --�� � �J� ..\/ L � l•. � Shane K. 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