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Home My WebLink About06-12-13 (2) _ _ _ _ �^,� � 1505611185 REV-1500 EX�°Z-,,,�F'> PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po aox zeosoi INHERITANCE TAX RETURN 21 ],2 �2 5 8 Harrisburg,PA 1 7 1 28-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 12292011 06141943 Decedent's Last Name Suffix DecedenYs First Name M I BROZACK BARBARA A ' (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW � 1. Original Retum � 2. Supplemental Retum � 3. Remainder Retum(Date of Death Priorto 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required death after 12-12-82) � 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust 1 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 Schedule0) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATtON SHOULD BE DIRECTED TO: Name Daytime Telephone Number KEITH 0 • BRENNEMAN, ESQ • ?17-697-8528 REGISTER OF WILL�SE ONLY � c `"' rn � � � �- � � First Line of Address � � c — –°� � G''y %� 44 WEST MAIN STREET � �_.. r i--� tY; rn Second Line of Address �" � � � � � � - � �3 � P . 0 • BOX 318 � � �? � � � City or Post Office State ZIP Code G DATE FILED - C'> � � �-- MECHANICSBURG PA 1?055 �,�,.� E-�► � °� cv� Correspondent's e-mail address: Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and beliei, it is true,correct and complete. Declara[ion of preparer other than the personal representative is based on all information of which preparer has any knowledge. �SI6 RE OF PERSON RESPONSIBLE FOR FILING RETURN DATE _%fZ -(�-�-- ��s� �, . j-� 'J ADDRESS ROXANNA RAE KUYKENDALL, EXECUTRIX 1348 ZIMMERMAN ROAD, CARLISLE, PA SI� TURE OF PREPARER OTHER THAN REPRESENTATIVE DATE S ADDRESS G" /1!/� KEITH 0 - BRENNEMAN, ESQ - 44 WEST MAIN STREET, MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA, 17055 Side 1 � 15�5611185 OM46473000 1505611185 ,� ! . A�� J 1505611285 REV-1500 EX(FI) �eoede�es Narr�e: B R 0 Z A C K B A R B A R A q RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . � ],2 5,5 0 8 • 2 5 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . Z � .�� 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C), , , , , 3 � • �� 4. Mortgages and Notes Receivable(Schedule D) 4 O •0 O 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , _ , . 5. 2 8 i 0 3 7 •17 6. Jointly Owned Property(Schedule F) � Separate Billing Requested , , . , g � •�� 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) � Separate Billing Requested . . . . 7. 9,3 7 6 • 6 3 8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , 8 ],6 2,9 2 2 • 0 5 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . g. ],5,9 5 9 • 6 8 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) , , , . _ , , . . �� ],4,0 2 6 • 2� 11. Total Deductions(totai Lines 9 and 10), , . , , , _ , . . , . �� 2 9,9 8 5• 8 B 12. Net Value of Estate(Line 8 minus Line 11) . , , , , , , , , �2, ],3 2,9 3 6 •17 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J), , , . , . . . . . , . �3 O • 0 0 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . �4 ],3 2,9 3 6 •17 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers un�jer Sec.9116 (a)(1.2)X.0�� 0 . �� 15. � • �� 16. Amount of Line 14 t xable at�inea�ratex.o4� 132�936 • 17 �s. 5,982 -13 17. Amount of Line 14 taxable at sibling rate X.12 � • �� 17. � • 0� 18. Amount of Line 14 taxable at collateral rate X.15 0 , �Q �g 0 • a O 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. S,9 8 2 •13 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Slde 2 � 15�5611285 1505611285 � OM4648 3A00 - _ .. _ . __ .. �. _ _ _ _ __ . � � REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 2], 12 0 2 5 8 DECEDENTS NAME �ROZACK BARBARA A STREET ADDRESS PENNSBORO TOWNSHIP CUMBERLAND CITY STATE ZIP ENOLA PA 17025- Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) i�) 5�9 82 •13 2. CreditslPayments A. Prior Payments � • �0 B. Discount Q• Q 0 Total Credits(A+B) (2) 0 • �� 3. Interest cs) � • 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,Line 20 to request a refund. (4) � •a 0 5. If Line 1 + Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 5�9 8 2 • 13 Make check payable to: REGISTER OF W{LLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred . . . . . . . . . . . . . . . . . . . . . . . X b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . ❑ 0 c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . ❑ � 2. If death occurred atter Oec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 0 3. Did decedent own an"in trust for"or payable�upon-death bank account or security at his or her death? . ❑ � 4. Did decedent own an individual retirement account, annuity,or other non-probate property,which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � ❑ IF THE ANSWER TO ANY OF THE A80VE 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)(i)J. 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.§91 16 (a) (1.1)(ii)J. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disc4osure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)j. = The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.�9116(a)(1)]. = The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent [72 P.S.�9116(a)(1.3)]. A sibling is defined, u�der Section 9102,as an individual who has at least one parent in common with the decedent,whether by biood or adoption. �nnas�i z.000 _ _ _ _ _ _ _ _ �i: _ _ . _ _ _ _ ._w��. __. REV-1502EX�,o,_,o, � � SCHEDULE A pennsylvania DEPPRTMEM OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENTpECEDENT ESTATE OF: Fi�E NuMa�R: Barbara A. Brozack 21 12 0258 All real properry 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 propeAy would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or selt,both having reasonable knowledge of the relevant facts. Real property that is joint�y-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the propeAy has been sdd. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Property known and numbered 125,508.25 as 914 Wertzville Road, East Pennsboro Township, Cumberland County, Enola, PA 17025. Sale value (see attached settlement sheet) TOTAL (Also enter on Line 1,Recapitulation.) $ 125,508.25 swasss z.000 If more space is needed, use additional sheets of paper of the same size. _ _ _ _ i;, ,— . . _ �� REV-1508 EX+(11-1p) pennsylvania SCHEDULE E DEPARTMEMOF REVENUE CASH, BANK DEPOSITS, &MISC. RESIDENT DECE ENTTURN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Barbara A. Brozack 21 12 0258 Include ihe proceeds of litigation and the date the proceeds were received by the estate. All property 'ointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH �• 2005 Jeep Grand Cherokee 11,500.00 sale value 2 East Pennsboro Ambulance 658.80 ' refund due the decedent 3 Highmark 10.80 premium refund on health insurance due the decedent 4 Household goods 4,735.10 ° net proceeds from sale of household goods sold at auction by Erb Auction Escrow 5 Medco 9 99 refund due the decedent 6 Member's lst Federal Credit Union 2,135.29 savings account #221999-00 7 Meatber's lst Federal Credit Union 7,654.35 checking account #221999-11 8 Member's lst Federal Credit Union 1,300.10 investment savings account #221999-05 9 State Farm Insurance 32.74 premium refund due the decedent on auto policy TOTAL(Also enter on line 5,Recapitulation) $ 28,037.17 owqsnD 2.00O If more space is needed,use additional sheets of paper of the same size. — . _ — - — _ i 1._ _ _ _ _ ��., REV•1510EX+(08-09) SCHEDULE G pennsylvania DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDEt�fT ESTATE OF FILE NUMBER Barbara A. Brozack 21 12 0258 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 ir�a�rr�rwnneoFrr�rwwsFeRee.T�iaRE�TiorrsHiPTOOECeoenrrnnro DATEOFDEATH %OFDECD'S EXCLUSION TAXABLE NUMBE TFE DATE OFTRNSFER ATTp1'jlq('ppy OF THE DEED FOR REAL ESTATF VALUE OF ASSET INTEREST IF APPIJCABLE VALUE � American National Insurance Co. 9,376. 63 100.0000 0.00 9,376.63 IRA annuity #19366446 in which Roxanne Kuykendall was the listed beneficiary. TOTAL(Also enter on line 7,Recapitulation)$ 9 376. 63 If more space is needed,use additional sheets of paper of the same size. 9W46AF 2A00 . . . . .. _. .. _ . .. . . - . . .. _ _ _ . . .. . ... . i 1�._�.. _ _ _ �,R„�. REV-1511 EX+�,ao9> . �SCHEDULE H � pennsylvania DEPARiMENTOF REVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRAT{VE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Barbara A. Brozack 21 12 0258 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: � None B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)ot 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 claimanYs,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 323.50 5. Accountant Fees: 80.00 6. Tax Return Preparer Fees: 7. 1 Cumberland Law Journal advertising Executrix Notice 75.00 2 Penn Waste, Inc waster container 450.00 Total from continuation schedules . . . . . . . . . 9,031.18 TOTAL(Also enter on Line 9,Recapitulation) $ 15 959.68 9W46AG 2.000 If more space is needed,use additional sheets of paper of the same size. ' . _ _ .. .. . _ . . _ . . . _ _ . . . ... .. _. . . _ .. _ . . . _ I.i..�_.. _ _ . �„�� Estate of: Barbara A. Brozack 21 12 0258 Schedule H Part 7 (Page 2) 3 Pennsylvania American Water water service 102.50 4 PPL Electric electric service 215.35 5 Register of Wills filing fee for Inheritance Tax Return and Inventory 30.00 6 Settlement charges on sale of 914 Wertzville Road, Enola, PA as follows: a. Tammy Erb, auctioneer fee - $5,000.00 b. Transfer Tax - $1,250.00 c. County/Twp Taxes - $597.41 d. Tax certification - $10.00 e. Sewer/Trash - $151.60 7,009.21 7 Suburban Propane . propane service 452.72 8 The Sentinel advertising Executrix Notice 221.40 9 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) 9,031.18 _ ��: .. _ _ - - _ _ _ . _ _ '1� . REV-1512EXt�,z_�, SCHEDULE I pennsylvania pEpPRTMEtYTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILIT{ES 8� LIENS RESIDENT DEGEOENT ESTATE OF FILE NUMBER Barbara A. Brozack 21 12 0258 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 � AT�T Services check number 4284 written by the decedent prior to death but cleared checking aacount after death 152.52 2 Claremonti Nursing Home � Rehabilitation Center nursing home care 9,478.85 3 Cumberland Goodwill Fire Rescue ambulance service 50.00 4 Donald A. Leiby outstanding loan balance 3,900.00 5 Home Depot check number 4287 written by the decedent prior to death but cleared checking account after death 99.00 6 Lawall at Hershey, Inc. ' medical services 295.83 7 Physicians of Rehabilitation, Industrial & Spine Medicine, P.C. medical services 50.00 TOTAL(Also enter on Line 10,Recapitulation $ 14 026.20 awasnr+z 000 If more space is needed,insert additional sheets of the same size. - - _ _ iJ,�. _ _ _ - �,,�,� _ REV-1513EX+(01-10) SCHEDULE J pennsylvania �EFARTMENTOF REVENUE BENEFICIARI ES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Barbara A. Brozack 21 12 0258 RELATIONSHIP TO DECEDErlT' AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE � TAXABLE DISTRIBUTIONS[InGude outright spousal distribulions and transfers under Sec.9116(a)(1.2).] �. Roxanna Rae Kuykendall 1348 Zimmerman Road Carlisle, PA 17015 All of Residue: 132,936.17 Daughter 132,936.17 ENiER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 151HROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NOfwTAXABLE DISTRIBUTIONS A.SPOUSAL DIS1f216UT10NS UNDER SECl10N 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLEANDGOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. a 0.00 swasni 2 00o If more space is needed,use additional sheets of paper of the same size. _ _ _ ��:,_ _ _,�� _ A. SEttlell7ellt StateTIlf:llt U.S.Department of Housing and Urban Development �.T e of Loan OMB A roval No.2502-0265 1. �FHA 2. ❑FmHA 3. ❑Conv.Unins. 6.File Number 7.Loan Number S,Mortgage Insurance Case Number 4. ❑VA 5. ❑Conv.lns. PY013-48RCS is orm is urnis e o gi�e you a s a emen o ac ua se emen ws s. moun s pa o an y e se emen agen are s ow�. TitleExpress Settlement System C.NOfE: items marked"(p o.c.)"were paitl outsitle the closing;they are shown here for�inlortnalan purposes aM are rwt�included in t�e totals. WARNING.II is a crime lo knowingly make fal5e Slalemenis to Ihe Uni�eG S�ates on IhiS Or any other 5imilar fOrm.Penallie5 upon conviCt�ion tan mclutle a Gne antl im risonment FOr dela�tl5 5ae�.Tille 78 U.S.Code Seclion 1007 antl SeCtion 7010. D.NAME OF BORROWER: Dannielle Taft ADDRESS: E.NAME OF SELLER: Estate of Barbara A.Brozack ADDRESS: F.NAME OF LENDER: ADDRESS: G.PROPERTY ADDRESS: 914 Wertzville Road,Enola,PA 17025 Parcel 09•14-0836•138 East Pennsboro Townshi H.SETTLEMENT AGENT: Pyramid Land Transfer LLC PLACE OF SETTLEMENT: 26 West Hi h Street Carlisle PA 17013 I.SETTLEMENT DATE: 0 513 1 12 01 3 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 rice 125 000.00 401. Contract sales rice 125 000.00 102. Personal Pro rt 402. Personal Pro ert 103. Settlement char es to borrower line 1400 2 348.50 403. 104. 404. 105. 405. Ad'ustments tor items aid b seller in advance Ad'ustments for items aid b seller in advance 107. Count taxes 05131113to12131113 344.86 407. Count taxes 05131113to12131113 344.86 108. SchoolTaxes 05/31N3to06/30113 151.67 408. SchoolTaxes 05131113to06/30113 151.67 109. 2nd�irSewer/Trash 05/31113to06130113 11.72 409. 2nd Qtr SewerlTrash 05131113to06l30113 11.72 110. 410. 111. 41 L 112. 412. 120.GROSS AMOUNT DUE FROM BORROWER 127 656.75 420.GROSS AMOUNT DUE TO SELLER 125 508.25 200.AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER 201. De osit or eamest mone 10 000.00 501. Excess De sit see instructions 202. Princi al amount of new loans 502. Settlement char es to seller line 1400 7 009.21 203. Existin loan s taken sub ect to 503. Existin loan s taken sub'ect to 204. 504. Pa oi(of First Mort a e Loan 2�5. 505. 206. 506. Claremont Nursin &Rehab Ctr 9 478.85 207. 507. 208. 508. 209. 509. Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220.TOTAL PAID BYIFOR BORROWER 10 000.00 520.TOTAL REDUCTION AMOUNT DUE SELLER 16 488.06 300.CASH AT SETTLEMENT FROM OR TO BORROWER 600.CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower line 120 127 856.75 601. Gross amount due to selier line 420 125 508.25 302. Less amounts aid b/for borcower line 220 10 000.00 602. Less reduction amount due seller line 520 16 488.06 303.CASH FROM BORROWER 117 856.75 603.CASH TO SELLER 109 020.19 SUBSTITUTE FORM 1099 SELLER STATEMENT:The mlormation containe0 herein is importanl taz mlormation and is Deing furnished b the Inlemal Revenue Service.If you are requiretl to file a relum, � a negl�igence penatty or other sanction will be imposed on you R this ilem is requiretl ro be reponed and the IRS tlelermines thal it has nol been reportetl.The Convact Sales Price tlesviDetl on line 40'I a�ove constiWtes ihe Gross ProceeCS of t�is transaction. SELLER INSTRUCTIONS'. It this real estate was your principal residence.(le form 2119.Sale or Exchange o(Principal Resiaence,for any gain,with your Income tax retum;tor other Iransact�ons, complele the applicable parts Of Form 4797,Form 6252 and/or ScheAUle D(FOlm 1040). nomare required by law io provide Ihe settlement agent(Fed.7ax ID No�. )with your cortect taxpay itlentificalion number.If you tlo not provitle your correct ta�cpayer itlenlification u ber,you may be sub�ecf to civil or cnminal penalbes imposeC by law. ntler penall�es o perjury,I cenify ihaf ihe number shown on ihis stalemenl�is my CArrect taxpayer�itlenti(iCalion numher. TIN: / SELLER(S)SIGNATURE(5)�. / SELLER(S)NEW MAILINGADDRESS�. _ _. _. .. _ ._ . __ _ _ _. _. . . _ .. . . . I_l�.,. . _ „�� U.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number:PY013•48 PAGE 2 SETTLEM�Nt STATEMENT TitleEx ress Settlement S stem L. SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALESBROKER'S COMMISSION based on rice$125 000.00 O.00O= BORROWER'S SELLER'S Division of commission(line 700)as follows: FUNDS AT FUNDS AT 701. $ ta SETTLEMENT SETTLEMENT 702. $ to 703. Commission aid at Setllement 704. Auctioneer Fee 4/a to $2 500 Tamm Erbl$2 500 Lorne Crawford 5 000.00 800.ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee % 802. Loan Discount % 803. A raisal Fee 804. Credit Re ort 805. Lender's Ins eclion Fee 806. Mort a e A lication Fee 807. Assum tion Fee 808. 809. 810. 81t 900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to $ Ida 902. Mort a e Insurance Premium for to 903. Hazard Insurance Premium for fo 904. 905. 1000.RESERVES DEPOSITED WITH LENDER FOR 1001.Hazard Insurance mo. $ Imo 1002. Mort a e Insurance mo. $ !mo 1003.Cit Pro rt Tax mo. $ /mo 1004.Count Pro rt Tax mo. $ 48.79 Imo 1005. School Taxes mo. S 148.82 Imo 1009.A re ate Anal sis Ad'ustment 1100.TITLE CHARGES 1101.Settlement or closin fee 1102.Abstract or titie search 1103.Title examination 1104.Title insurance binder 1105.Document Pre aration 1106.Nota Fees ��07.Attorne's fees to Snelbaker&Brenneman POC SELLER includes above items No: 1108.Title Insurance to ramid Land Trensfer LLC 1 025.00 includes above items No: 1109.Lender's Polic 1110.Owner's Polic 125 000.00 •1 025.00 111L 1112. 1113. 1200.GOVERNMENT RECORDING AND TRANSFER CHARGES 1201.Rewrdin Fees Deed$54.00 Mo�t a e$ Release$ 54.00 1202.Cit/Count taxlstam s Deed$1 250.00 Mort a e$ 1 250.00 1203.State Tax/stam s Deed$1 250.00 Mort a e 1 250.00 1204.Parcel Certitication to ACCP Electronic Filin 15.00 1205.Electronic Filin Fee to ACCP Electronic Filin 4.50 1300.ADDITIONAL SETTLEMENT CHARGES 1301.Surve 1302.Pestlns ection 1303.2013 Count/Tw Taxes to Debbie Lu old 597.41 1304.Tax Certification to Saidis Sullivan 8 Ro ers 10.00 1305.2nd Qtr Sewer/Trasn to East Pennsboro Townshi 151.80 1306 1307. 1308. , 1400.TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Sedion K 2 348.50 7 009.21 HUD CERTIFICATION OF BUVER AND$ELLER l�have'[are Ity re��ewed the HUD-�Senlement Statement antl to the best of my knowle0ge and be0ef,it is a vue and accurete stalemenl of all receipts antl Oisbursements matle on my accouM or by me �in this irans lion.I furiher cer(Ily ihat I have receivetl a copy of Ihe HUD-1 Sefllemenl Statement. % i W�.�•' ,� . anniee a_i / .� �� .i� . f, _. -r ' i __ >!..� _ _. � _. xc.. ,,.f s a e o ar ara . mza . � WARNiNG�IT IS A CRIME TO KNO WINGLY MAKE FALSE STATEMENTS TO THE The HUD-7 SettlemeN Statemenl which I have preparetl is a true antl accurele account of Nis Irensaction UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON CONVICTION 1 have causetl or will cause!he funds to De disbursed�in accoraance wilh th�is slalement. CAN INCLUDE A FINE AND IMPRISONMENT FOR DETAILS SEE TITLE 18- U.S.CODE SECTION 100'I AND SECTION 1070. ��- � ' /`-'�"�� '' a'��`�t_.�7 .? ; ?J � �i Bv: - I DA - _ .. . . _ . . .. . _ _ . . . .. _ _ . .. _ iJ. _ _ _ .,�� f LAST WILL AND"1�LS"Tf1MLNT •� �- � OI' ��, BARI3ARA A.BROZACIC _I 4 , �� l,13AI2BARA A.BROZACK,of East Peiuisboro Torvnslup,Cumberlaud Counly, � � Peiu�sy!vania,bei,ng of scunu and disposivg mind,n;emoiy and understanding,do hereby malcea a � publish an�declare tl�is as and for my Last Will aud"restament,liereby revokiug and making � void any and all wills by me al any tiiue heret�ofore�made. �� L L ocder ancl direct that all my jusl debts aild f�meral e�cpenses be paid by nry�seciitor'� � � or Gxecutris,whatever the case may be,hereinafier named as soon as practicable afier my deatlh: I direct ihat all laxes�hat may be assessed as a consequei�ce of my dealh shall be pai��, Li�oni my residuary estate as parl of the expenses of tl�e administ�ation of my estate. 2. A1J tlte rest,residue and remainder of my Estate,real,personal and mixed�id wlieresoever th�same may be situate,I give;devise and bequeatl�to my l�usband,JO�IN G. � 13ROL1�CK,JR.,provided he shall suivive nie for a period of sitty(60)days. 3. lii the event my said husband,JOHN G.BROZACK,JR.,sl�ould predecease�ne or fail to survive�ue by the aforesaid period of sixty(60)d1ys,I give,devise and bequeatl�all the rest, residue aud remainder of my Estale,real,persoval aud mixed and wheresoever tl�e satne may b�' siti�ate,to iny daughter,ROXANNA RAE�KUS'KFNDALL,absolutely. In tlie evenl my �laughter,ROXANNA RAE KUYK�NDALL,sl�ould predecease me,I�ive,devise and � be�queatli aLl tl�e rest,residue and reinainder of my Estate,real,personal and mixed and wheresoever tl�e sauie may be sitLiate,to uiy grandsoti,JEREMY LL�ICUYKENDAL,L. ��. 1 liereby nominate,constitute and apj�oiut my liusband,.iOHN G.BROZACK,JR., �� as I�xecutor o;t}iis u�y Las[Will and Teslameut. li�tl�e event he sliould pi•edecease me,fail to � qualifg or f�il to seive as Executor of this my Last Will and Testament,I nomivale,constitute � and appoint my daughter,ROXANNA RAL KUYKTNDALL, as rxecutrix of this iny Last � LAW OFFICES SNEL6l�KER d( BRENNEMAN, P.C. ��1��alll� TCSl3(]l��ril. 1 JW'C�lOP Clll'eCt C�781 Il0 J)ePS011 SeCVlllg 8$E'XeCllIOC Of�XBCllt1'IY � . . . _ . . -_ - - . . . . . . . . _. .. _ . . .I�:_ . . _ _ _ .__ .- _ _ _ .. wrnw _ _ 'J I I�ereuuder shall be required to post ai�y bond to secure the CaiUifttl perform�tnce of his or her duties in t(ie Commonwealth of Penilsyl��ania or in an} other jtuisdiction. 1N WI7'NL:SS WHER�OF,1 h�ve liereuuto set my]laiid and seal to tlus uiy Last Will aiid Testa�nei�t ivritteu ou l��vo(2)pages this 18°i d�y of M�trch,2010. � ___-----.__� -------� , � r.` � `rJ _ s �__--�, u.��;.cLC�L._C-{l\_��.Q►._ e SCf1L) — I3arbara A.13rozacic �\` Sigiled.sealed,published aud aeclaced by BARBARA A. 13R0'LACK,the Testatrix above n�mied,as and foc l�er Last Will and Testameut,in our presence,who,ii�her presence,at I�er request,ancl in tlle prESence of eacll otlter,have l�ereunto subscribed our names as attestiilg wituesses. ,� ,, � +,'1; t :` �,/_",,�� , � +` (S�AL) •';�,t,�.., ,,� f �s��f t _ (S�AL) �nw or-ncES � � �NEL13Al(ER�C ENNEMAN, P.C. -7- . . _ .. . . _ .. _ .. _.. _ _ - - _. - _ .. _ . _ _ _. . _. . . . .. I.i..i__ _ _ _ •R�,r � COMI�40N��'i;AL"[`II O��P�,N7vS1'LViWi�) : SS. COUN1'�'Ol�CUMB�;RLAND ) �\%e, I3�UZB�IRA A.I3R07ACI�,I��1TH O. I3RF,NNEMAN and SUSAN L.MATI�7I, the�'estatri� aud the�vitiiesses,respeclivcly.�v6ose names are sigiled to the attaclled or Coregoing iiistrumcilt,being firsl duly sworn,do hereby�leclare to ihe un�lersigiied autliority that the Testatrix signed a��d e�ecuted tlie iustrwueut as licr 1._ast Will and Testament and that she had signed 4�illinbly,and tl�at slie executcd it as her free and voluntary act for the piu�oses therein �� e�presseci,aod tl�at each of the witnesses,in the��resence and hearing of lhe Testatrix,signed il�e � Will as�vitness�lnd tl��it to tlie best of his o��lier la�o�vledge lhe'I�estalrix�vas at that litne eigliteeai years of age oc oldei•,oP sound mind and un�le�r�lo constraint or undue intluence. � ,---`—� ,---- �,/ t,) f �=�,_i.��.�,L�'a��r� �..r� ' Tcst�ttnx --J r � 1 i::�- �'-----� __.. �'Jitr�css �,? �=�� n � "� /'�3 � �1' �/�- �. L., � WIYt10S5 Subscribed,swaru to aud ackuo�vledged before nle by BARBARA A.BROZACK,Testatrix,aud subscribed and swoi7i to befoi�e me by K�ITH O.BIZENNEMAN and SUSAN L.MATRAZI, wifncsses,il�is ]S`�'day of March,2010. �� i� ;�'t�,'��i��f�G�� _� Notaiy Public f`.?iotf�iUPIW`t'Ai_l i-;�3"�%�:I,�i?_:'i t:41P71:`1 •_.-��`•NJI2fic'SP.Ji '.�_'__,•.� �.. ^aiti�lra K S?7owers,iVot��j�Fu6fti: F?�.i�ank.:�+��rq Lbir�,Cunb�iisn�i f;cu;ity LAW CJf'FIC:ES `�:!'V{lA/l!3ti1C'ilr7(f1�7��'!ftY.?.d�{)l� � �NEL9AKER�( � -..' I�. � . ..�?�IGI`C S �.._o . '.ENNEMAN, P.C.