HomeMy WebLinkAbout06-25-13 . .,_.-.-
J REV�7 r'J�0 �`�07�10� ,� �505610743
OFFICtAL U8E ONLY
PA Department of Revenue ponnsylvanie cwnrycoae veu FNe Number
Bureau of Individual Taxes o�M*+�+���F
Po eox.z8oso� INHERITANCE TAX RETURN 2 1 12 0 10 5 8
HertiBburg,PA 17128-0801 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Soaal Security Number Date of DeaM Date of BiAh
09 04 2012 02 04 1930
Decedenfs Last Name Sutfix DecedenPS First Name MI
BRYSON JOANN
(H ApplkabN)EiHsr SurvlNng Spouss's Information 8slow i>
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Sotlal Securiry Number
THIS RETURN MUST BE FILED IN DUPLICATE WITN THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
- � 1. Oripinel ReWm ❑ 2. Supplementel Retum � 3.RemalMer Ratum(date otdeath
pibrto 12-13-82) .
� 4. Limtted Eatate � 4a,F�+��m�^��w�• � 5. Federal Esfate Tex Retum Required
�a.n a e.am.n.�iz-izax>
� 6, oscaaen�oiw issqte � 7. O�cetlyn�MgyOaimC e LiWrg Tnul 8. Total Number of Sate De sk Boxes
(Anacncopyaww) (wacncaqorrnuq — P�
❑ 9. Lltlge6on Proceeds Receivetl � 10.�����^��t e�n{�d aee�h � i 1.Electlon to tax under Sec.9113(A)
(AtlacM Soh.O)
CqtRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL 7A7C INFORMATION SHOULD BE DIRECTED TO:
Nams
Daytims TsNphorN Number
3AMII8L L AND83 717n761 �61
�
� � � m
RE� "l�t OF WI�US�O�1'
m � ea � a
FIM Ilne of atldms � a � rv � rn
A Z � � � �
525 NORTH 12TH STRBBT z �-' � o �
v � o � � �
c� Q � � _ '�
Seeond Ilns of addnss � C � � n
� �_ � m
CUy w Post Offlea � DATE FI � N �
Sbh ZIP Coda �
LSMOYNS PA 17043
comspona.nrs sman■danss: lawandes�aol.com
Undar penapbs of perJury.I AerJns tMt I haw sxamhad iMa roWm,lncludlnp aar.onpHrrylnp sUbtlubs aM aUtemeMS,erM to 1M bsat oF my kMwlsdpe�ntl ballaf,
n is aw. mtl�onpNOe.DaUa�atlon of P'sWrar whx Man the V�I rcpiaaerhative Is Easetl on ali iMortnatbn of whkh
WeD�hn my kriowledpe.
SIGNATURE RS RE8 FlLING DA7E
Judy Fries
nooRESs
769 Lancaster Awnuo, Enola, PA 17025
SIGNA P TNE ��
Samuel L Andes
�oone�"— '
525 North 1Zth Stnet, �emoyne, PA 17043
Side 1
L 1505610143 1505610143 J
V�
J 1505610243
REV-1500 EX
DecedenPs SoGat Security Number
o��m:r+a,�: BRYSON, JOANN
RECAPRULATION
1. Real Estate(Schedule A).......................................................................................... 1. 4 4 , 9 0 0 . 0 0
2. Stocks and Bonds(Schedule B)............................................................................... 2.
3. Closely Held Corporatlon,PaMerehip or Sole-Proprietorship(Schedule C).......... 3.
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5. Cash,Bank Deposits 8 Miscellaneous Personal Property(Schedule E)................ 5. 4 7 , 0 9 9 . 8 8
B. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Trensfere 8 Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested............. 7,
8. Totel Gross Assets(total Lines 1-7)....................................................................... e. 9 1 , 9 9 9 . 8 8
9. Funeral E�enses&Administrative Costs(Schedule H)......................................... 9. 14 , 6 5 3 . 5 3
10. Debts of Decedent,Mortgage Liabilfties,&Liens(Schedule I)................................ 10. 1 , 2 3 6 . 1 6
11. Total Deduetiona(total Lines 9 8 10)...................................................................... 11. 1 5 . 8 8 9 . 6 9
�2� Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 7 6 , 1 10 . 19
13. Charitable and Govemmental BequestslSec 9113 Tr�sts for which
an election to tax has not been made(Schedule J)................................................. �3. 7 6 0 . 5 7
14. Net Valw Subjeet to Tax(Line 12 minus Line 13)................................................. 14. 7 5 , 3 4 9 . 6 2
TAX COMPUTATION-SEE INSTRUCTIONS FOR MPLICABLE RATES
15. Amounl of Line 14 taxable .
at the spousal tax rete,or
transfers unde�Sec.9118
(aX12)X .00 15.
16. Amount of Line 14 taxable
at Ilneal rate X .045 76.
17. Amount M Line 14 taxable
at sibling rete X .�2 15 � 0 6 9 . 9 2 ��� 1 , 8 0 8 . 3 9
18. Amount of Line 14 ta�ble
at collateral rete X .15 6 0 , 2 7 9 . 7 0 �e� 9 , 0 4 1 . 9 6
19. Tax Due..................................................................................................................... 19. 1 O , 8 5 0 . 3 5
20. FILL IN THE OVAL IF YOU ARE REQUE$TING A REFUND OF AN OVERPAYMENT. �
Side 2
L 1505610243 1505610243 �
REV-1500 EX Page 3 Ffle Numbarr 21 - 12 - 01058
Decedent's Complete Addr�s:
Bryson, JoAnn
STREETApDRESS
114 Wiitaw Mili Park Road
CITY — -- - -- -- -STATE --- ZIP ' -
Mechanicaburg PA 17055
Ta�c Payman#s and Credits:
1. Taxpue(Page2,Linet9) (1) 10,$50.38
2. CreditslPayments
A ���,�„Bn,S �s,000.aa
B. Discount 542.52
Totat Credits(A +s) (2) 13,542.52
�. ��t�st ts� a.aa
4. If Li�2 is greatet than line i+Line 3,enter the tliHerenca. This is the OVERPAYMfENT. {4} 2,692.4 7
Chack bax on Psge 2 Um 20 to raqwat a refumi . _'
5. It Line 1 +Line 3 is greater ttian Line 2,enter the difference. This is the TAX DUE. (5)
Make Check Payable to: REGISTER OF WILL3, AGENT.
PLEASE ANSWER 7HE FOLLOWINCa 4UESTIQNS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
t. Did decedeM make a tra�ster and: Yes No
a. retain the use or income of the property transferred:.................................................................................. � �
4. refain Me dght to de8lgnate who shall use ffie property hanaferted or ita income:.................................... x
c. retain s reversionary iMerest;or.................................................................................................................. x
d. receive the P�ise for life of eifher Psymenis,benefib or care?.............................................................. x
2. If death occurced after December 12, 1982,dld deCedent tran8fer property within one year of death without
receiving adequata consideretion?....................................................................................................................... ❑ �
3. Did daced�rt crim an°in trust far° a peyabk�m death beMc accaunt or security at his a her deaHs?......... ❑ �
4. pid decedent own an IndiWdusi Retirement Accaunt,annuity,or other non-probate property which
coMeins e beneflciary deslgna8on?...................................................................................................................... ❑ �
IF THE AMSWER TO ANY OF THE ABOYE qUEST10N8!S YES,YpU MUST COMPLETE SGHEDUI.E GlW4 FILE iT 14S PART 8F THE#tETtIRN.
For dates of death on or after Jul 1,1994 and before Jan.1, 1995,the tax rate imposed on the net value of tranafe�s to o�for the use of the surviving
saouse is s percenc[7z as.§si�e(a)(�.t)(ql•
For datea of death�or af�JanuarY 1.1995.ttie tsx rste imposed on the net vaiue of#ranafers ta or tor the�rse of ttre surviving spouse is 6 per�nt
I (72 PS.§8116(a){1.1} ii}j. Tha statute does not euernpt a transfer to e surviving spouae irom tex.arM the staturory requirements for disdasura of
assets and 8ftng a tax r m are sNll applicable even if ffie surviving sppuse is tbe only beneNciary.
- Far dates of deaM on or after Juty t,20�0:
•The tax rate imoasad on the�et vaiue oF UBnafers from a decessed chiW 21 years of age or younger at desih to or for the uae aF a naturai parent,an
sdoptive parent,or a stapparent of the chiitl is 0 parcent p2 P.S.§9118(a)(12)j,
•The tax rete imposed on the net value of tranafers to or fqr the use of the decedenPs lineal baneficiades is 4.5 percant,excepR as noted in
72 P.S.§9it8 12)[T2 P.S.§9t16(a)i�)7�
•The tax rete imposeG!on fhe net veWe of transfers M or for the use of the decedenPs sibiinge is 12 perceM[72 P.S. 91�6(a}(1.3). A
sibling is defined under Section 81p2,as an individual wha has at least ona parent in common with the decedent, etlier by bl�or atloption.
I
r� SCHEDULE A
caw�w�wsn�morv�HSnv�HU REAL ESTATE
NMERR�NCETA%RENHN
REeI�ENTDECEDENT
ESTATE OF B�Ol1, JoAnn F�LE NUMBER
21 - 12-01058
All roal property ownW solely or as a bnant in common must be roportsd at fair market valw. Fair market value is defined as the price
at which property would be exchanged belween a witling buyer and a wilNng seller, neither belrg compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property whlch la JolMly-owned wkh right o}surviw�ship must be disclosed on
scMdule F.
Attach a copy of the settlement sheet if Me property has been sold.
Indude a copy of the deed showing decedenPs interest if owned as tenant in common.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Bungalow at 110 Willow Mill Park Road, Mechancisburg, PA. Value based upon sale of 44,900.00
property in April, 2013
TOTAL(Also enter on Line 1, Recapituladon) 44,900.00
� SCHEDULE E
CASH, BANK DEPOSITS, 8 MISC.
`°'"""'"�"'TM°�°�""an°""" PERSONAL PROPERTY
NHERRANCE T/Jt HETUNN
REeOENTpECEDENT
FILE NUMBER
ESTATE OF g�on, JoAnn 2� - �2-o�o5s
InGude the proceeds of litigation and the date the proceeds were received by the es[ate.All property jointly-ownad with tha rlght of
survivorship muat bs disclwed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Checking account at Orrstown Bank 24,031.40
2 Certificate of Deposit at Orrstown Bank 20,025.22
3 2000 Buick Custom automobile in fair condition 2,000.00
4 Highmark(insurance premium refund) 643.26
5 Miscellaneous items of household furnishings and personal effects all in poor condition 400.00
TOTAL(Alao enter on Line 5, Recapitulation) 47,099.88
� SCM�E H
cor.w�onwE,ut«oFaEHHenvu�w ��` �
MHERRAHCETN(pENRN ArV��"�SAT1�L/�/Y�`M
HEeI�ENT pECEDENT �+w��wa��w��rc wa�a
ESTATE OF Bryson, JoAnn FILE NUMBER
21 - 12 -01058
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A• 1 Sullivan Funeral Home(expenses prepaid) 0.00
2 Honoriam to minister for funeral services 100.00
3 Gingrich Memorials(headstone) 165.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commiwions
Name of Personal Representative(s)
Judy Fries 4,400.00
sereei nddress 769 Lancaster Avenue
Ciry Enola S�ate PA z�p 17025
Year(s)Commission paid 2013
2. Attomeys Fees Samuel L. Andes 4,000.00
3. Family Exemption: (If decedenPs address is not the same as GaimanYs,attach explana8on)
Claimant
SVeet Address
Ciry State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of W ills 315.50
5. AccountanPs Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs
1 Cumberland Law Journal(advertising) 75.00
TOTAL(Also eMer on Ilne 8, Recapitulation) 14,653.53
� Sd�d��e H
F��eral E�er�es 8,
COMMONWEpLTH pf PENNSYLVANIA
INHERRANCE TAX RERIRN ���' �
RESIDEHI'DECEOEN�
ESTATE OF Bryson, JoAnn FILE NUMBER
21 - 12 -01058
2 The Sentinel (advertising) �57�
3 Clauser Real Estate Appraisals (appraisal of home) 375.00
4 Auto repair bill (to prepare it for sale) B9.54
5 Postage 2�5o
6 EXPENSES TO MAINTAIN REAL ESTATE UNTIL SOLD:
7 PPL (electric service) 147.10
8 Keystone Oil (fuel oil) 1,158.43
9 Penn Waste(refuse bilis) 115.60
10 Jody Hocker(lawn maintenance) 140.00
11 COSTS INCURRED TO SELL REAL ESTATE:
12 Keller Williams (real estate sales commission) 2,838.18
13 Deed preparation 100.00
14 Tax certificate 10.00
15 Notary fees 10.00
16 Realty transfer tax 449.00
Page 2 of Schedule H
� SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
cwwaHwewrHOraEr�r�snvu�w LIABILITIES
MHENRANCETR%RETUqN , & LIENS
FEBDENTDECE�ENT
FILE NUMBER
ESTATE OF B�O�, JoAnn 21 - 12-01058
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Verizon (final phone bill) 7.70
2 PA Department of Revenue(taxes) 13.50
3 Albert Pharmacy(final bill) �g y$
4 Claremont Nursing Home 1,010.00
5 Allstate Insurance(final auto insurance bill) �gq.gg
TOTAL(Also enter on Line 10,Recapitulatlon) 1,236.16
nev.�sfa[lc.�++oe) �
SCHEDULE J �
COi*"ONiNFA1"6FP�""'"""" BENEFICiAR1ES
INHEftITANCE TIU(RETURN
RESIDEM OECEDENT
" _
ESTATE OP Fi1.E NUMBER
Beyson,JOAnn
21 - 12-01058
--- - - - - — -
RELATIONSHIP TQ $HARE OR ESTATE AMOUNT OF ESTATE
NUM6ER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words} {$$$)
RECEIVING PR4PERTY mtwtwtt�{a}
--- - -..... . -- ---- — -
I, TAXABLE DIS7RIBUTIONSQnGude outright spousel
distrtbu�ons and translers
under Sec.�t 18(a)(12)]
1 Judy Fries Niece 20°h of residue
789 Lancaster Avenue
Enala, PA 17025
I
2 Kathryn Knaby Niece 20% of residue
16 West Pine Street
� Enola, PA 17025
3 De6ra Yohe Niece 2p%of residue
15 Windsor Way
Camp Hili, PA 17011 (
Enterc dailer amtrunis fot dtsMbutions stwwn abave on lines 16 through 1$On Rev 1500 caver sheet,as appropriats.
� NpN-7AXABLE DISTRIBUTIONS:
A SPOUSAL DI3TRIBUTIpNS UNDER SECTION 9113 FOR W HICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1 Ona percent of net estate to Bethesda Mission 760.57
�
� (
� '
- TOTAL�PART�-ENTER TOTAI NdN-TAXABI£DISTRIBUTIONS 4N IINE 13 dF REV-1500 COVER SHEET T60.5T
i _ .
REV-1513 EX�1990) �
SCHEDULEJ
corar.anwe,un�ov rErmsv�v,ww
INHERRANCETAXRE7URN BENEFICIARIES continued
RESIOEtf�DECEDENT
ESTATE OF B�on, JoAnn FILE NUMBER
21 - 12-01058
NAME AND ADDRESS OF PERSON S RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER RECEIVINGPROPERTY ( � �DIXUnDNN�., (Words) ($$$)
I, TAXABLEDISTRIBUTIONSpnGudeoutrightspousel
disMbutions,and transfere
under Sec.9118(a)(1.2)]
4 Sondra Kauffman Niece 20% of residue
900 Valley Road
Enola, PA 17025
5 Beatrice Quigley Sister 20%of residue
11 West Pine Street
Enola, PA 17025
Page 2 of Schedule J
I■
�,. ' . ��"s"'4*� OMB Approwl No.Y302-0t85
�,���`� A. Settiement Statement (HUD-1)
ti...�t�`
8.T ottan
1.�FHA 2.Q RHS 3.O Conv.Unin9. 6. Flle Num4er: 7. Loen Numbec B. Alprlg�ge Inau2nCe Cese Number:
4.�Va S.QGonv.ins. WAL21-/3 9101388&1
C. Nob: TNafamistrwMeMrctio9ive}outateMmenfofactHBtrotllemeMCOd16.AmouMapaMioa�CDyfhessftlemenfepeMa2sluwn
Itema ma�ketl'(P.O.C)�were Pefd oulake Ha cbaNg�fheYare aMWn Mn/orMkvmBfbne/purp)Ybs eiMan nol picludetl in IM lotel&
p, Neme entl Atltlnsn ot Bortovror: E. Nam!en0 AEEreaB of Salbr: f. Name anE Addrpa of Lender
PAUGD.WAltER�CK,.Ri ESTAiEGF,A}NM+%iBRYSW7 FAIRWAYiNDEPENDENiMORTCv4GE
1t94RA1JAVILtAAVENUE tiOWILIOWiAILLPARKROAD CORPORl1TION
GAMP MILL,PA i7q11 MECHANICSBURG,PA 17050 8662 PINECRE3T DRNE.SUITE P00
PUNO.TX 7502A
G. PrcWnYlacaiiWl: H. SBCMmartAganF i.StrUMm6MOete:
110WILLQWM14tPARKROAD TRICOUNiVA&SiRACTSERVICE
MECMANICSBUR4,PA t70W 18 CENTRAL BLVD. Ap�l 16,2013
CUMBERLANO Cwnry,Pannbylvenla CAMP HILL.PA 17071 P�. (777)781-0870
e�,a seubmem:
ae cEt�.�w.
GMPHI4l PA77011
J. Swixn WBarow�fsb�iwrctbn K. 8umm dS�MrStMnxcUOn
toa, crmsAmourrtu,sfmm8orro�wr: nao.cras.nnww�ou.ro&ewr:
t01. GmtractseM9 4690P.W �61. CaMmU,Wuprtce.._. . -0iAW.�
t02. F�xsar� 402. Panon,pl.P�..., ....,
t03. Samemem ena n ro eorrower �u�e leao 1 655.00 103.
704. AM. " -.. -.
10b. .105.
tofibms 6 MaW MtihMM SfINr6�
188. mmTaxa � A08. amTam io
10'7. Tua OMiB/13 ta O1/Oi/14 228.85 40T.Cou Ta� 8Ni&73 M 61Nt/14 22g.g5
70d, $CNOOLUXES 04/iA/73 ro OIPoi/73 170.83 40B.SCFIOOLTAXES WHB/19 l0 07Po1H3 170.&3
109. 109.
110. 1Q.
ttt. 115.
tt2. �14.
t]0.43roxAmeiMltDwhombu�vw�r 18.952.48 /M.GrorAmw�lDwb1BNW 0.5.297.48
100. NnwnbP orInMMMMBortoxMr D00.RMuMIWnInMw�ItUwBNNr:
201. metmat 200U.W 5D3.�caM mlrNNUCFbns
2Q2. emOwlt�new 6 42855.W 302.SetlkmMt IoSeXer i� STL9.09
Y03. EtU t takanauC ctlo b0;i. Etls' be s Wwn b
204. 604.P Fket e
205. .Pa 0 Mo e
206. SO6.
2k7. $+JT. deb.ae
2i8. 508.
208.&ELIERASSIRT 1 347.00 SOB.SELLERASSIST 7,367.Op
IpMMn�u WNNr farlMm�u W SNNr
210. ovmT8ze6 M 370.q olmTaves W
217. Taw ta 611. T#r.0 b
212.3CH60LTAXF.$ M 5i2.SCN00lTAXES W
213. Si9.
174. b1a.
215. 815.
' Yi6, 5te.
2tt. 51�.
218. 57E.
219. 319.
Yl&ToW PYQ BamMr �b.002.90 DtO.Tq17R'MUCWnAmWlHOueSNht S.PT8.09
386.CYI��t tranRDllonorwr t60.Ca�OMHIWm�M1Dlra�nlN�r
307. Qvaasw�wntdusfromeortower Nrmt40 a8952M 80t. Gmea�mourdEUetoSeilx 420 45297.A8
302. Llse emaaM r Boirower Iine 220 ( 48,00200 802. Laa roduCtlons Oue 5949I Ilne 520 5,0I6.U6
]03. Ca� X�Fram � To Barowsr 950.48 l03. GM �To � Frdn SNMr 10,P11.4tl
�Waevw.em.np W��fll+�t�)���++e+�+N�)
Thb t�MBbYacktwwilC4M�seeiG1ofaCanQietedc9PYoftldsstehm&ItSarryatteCiSnteMSrofinedttlheroin
Borrower Seller ESTAIE pF JO ANN BRV$ON
�AUL 0.WALTERICK,JR. ,
BY:
T4 Ttff�ST QF MY KNOWLEIX'iE,THE MIlO-t SETTiEMEM STATEd/ENT WtYCN i HAYE PAEnARED IS ATFiUEAPIOACCUflATE ACCOWTQF Tt�FtA1�
WF9CM WE�RECElVEDApD H4YE BEEN 6R Wli.t 8E OISBtAiS80 BY Tf1E UMDER9IGNED AS PAIiT OF itff SETitEh1ENT OF TMISTRANSACTK3N.
SETTLEMENT OFFICER,SMtlxnent Ogent
WMNING:aTl5ACRIMETO�YMnitEFM�SFATEMENTST(SIHEUNlTEDSTATESbNTt950RANY51M9.ARi0Rb1. PENAi.TiE3UPONCIXJVICTN7N
{.M1N HiCIWE A FINE RND IMPRiSpNMENL.FpR[�tA1tS SEE 71TL€t$U.S.CAOE SECTiQN 1061 t$ECi10N t410.
TMI+�S[RN�W48wimMNbmNCWrd�tJmnNOrvbuYmiitl]SeMN�ixeiY�iormXabO��kH+w4.vdrN�a6qYn4nTM���ruYM"M[wWCiNaXMmNWi.aMW mmttpWNb
m�YYIFY1um.�nWtRO r�M��BY�fi.Smrtttlan�Ne.N¢a^lhrYMIY4�re�Stl#tl4Ce�xnPmm4�'Y.TNahp�bM4bPT"b�M9�Mb�NF.frAmwMiYlnwev�rMMmnM�
N1�1p M NN�ixnl WKM�.
Pege 1 9�3 HU[k1
(W AL247 9.PFDIN/AL20.13!])
. �,s.m.m.M c
PNtl Fmm vak Fmm
Diviaion o/wmmraebn(Ihle /aa M1�9ows; eonww's Se�eYm
7Pi. t i31.53 to PRUpEN7UL HOI�SALE SFRYICES Flabs at Flxn1s M
702.S t,306.i9 W iCELtER WitlUi��F CEtifRAl PA ���+ �
1 . mm i aettlem p �g
7IM.BROKERS FEE to NELLER WILLWAS pF CEMRAL PA 176.00
795.
i. n m t
'1 in � ec ra FE
V W'ue inatlon c a m
I f
BQi.Credit M ltan(#E A3
m E
rtifl m f3FE
e . GFE N3
E
8t0. hom GFE;l3
811. i�m GFE;q
A01.OMI inNresl kom W/78l13 to OSA1H3 1II i/Ca finmGFEM/0
902. fMwanee O�emNim M montlre io frmn GFE#C4
963.Maneowne�'s itmurrse br b hom GFE;Ytt
904. from GFE pt t
9tl8. MMI GFE N11
t�i.IMtW ftt eecrfiviCCauM {romC�E#4
t002.ltomeownar"aNUUrance mpnNs � b ver mmHh S
7003. elnaurence monUS r monU
1004.Pro tue6 S
Co T�9s manMS ; mor+ih
SCHOOItA%ES mcMhs S ma�
7
10q8.COUNTY/iQWNSHIP7AXE5 mwiMa S per moMh $
1007.gCHOOLTA%ES moM�s S r moMh f
1008. 5
7 W9.AGGREGATE ESCRQW FAiUSTMq S
' t. Y�
h Y 5 . 4 � A S. !v 'Z.r
1701.71tle ssrACaa aM NMSfa qde Ineurarwa � Irom GFE 7Fi ���884.00
�ioz.s.m�smwaa rae s
t103.OwneYS�llekrurmeetaFHtSTAMERiCeWTRtE�StIMDiCE�, frmnGFE#5 3HORFFOiiM t&00
7104.4snEefs Hke Y�#urance ro fiR5'f MiERtt:AN T(RE NiSttRANCE CD. S 736.50 END 8.1
7105.LenOe�e lidu Nmk % 42.685.Ii0 5012762-0027472q
1106.OwneYStiN! IImM 5 M.9IX).W 5071M2�083170e
�tOT.A a �ofMetoWBtleMawancepramium WTR1-CWNfYAe57MCTSERYICE S 633.37
t108.iktdarmitetE W9wtWNtldeNnnatme bFiR5TAAtEFtICAMTfTIEM�NCfCA. 5 i72.t3
1709.RE{yg�Jq$��p{FORTRXCERT t0 TftICOUMYABSTRACTSEPVICE S 7q.00
7110.DEED PREPAMTION to SAMUEL L,ANDES.ESa. E 100.Op
1111.NOTARV FEE in CASM S 10.00
�i�z. s
1tt3.
1Yf17.6nv�mmsnl cM t W RECOROER OF DEE05 � from GFE kt �� 151.Op
1202.DeeA S B2.W Mo S 92.00 Wluses f OUwr S
7�(Y3.'ftmixte�ea � REGoRDERSSF0EE65 GFE#8 A9$.00
12J4. I8slSb 449.06 M9.06
1205.$late IexhGm 449.00
tYtl6.
i
,� „t .�`1s' F',+" .
t� L asrNqec qrt u un Mwp r .��..
13D2.2Q73COUNTY/TWPTA% to pEBRABASENQREWIEST,TAXCALU 'j 39-761070-025 311.90
7303. S
t3P1. 3
t�5. 5
r , . . ._ .. , .'..,Ma :f' a ' s.±. -:t ` :u:. . K,.:' .. .. ,'
`Md wue.neb+aMb.�nuniRl,tiu(91.Miax0.A or man�MT)
BY Wi�Mq MPo�b��bMm�M IM�T�>'pKMnMMPo�''�IM!wmplWE mpyMppe 36]MIF4 MM Wp�bbmsil.
SkiREMEMOFFiCER,Settbrrront Apent
CERTff1E0,iRUE AND CORRECT
I
Pepa 2 0/3 HU�-i
(W ALY4-13.PFDrW AL2413f/)