HomeMy WebLinkAbout08-12-13 (2) � 1505610140
REV-1500 EX (01-10)
PA Department of Revenue OFFiCIAL USE ONLY
Bureau of Individual Taxes �NHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601 2 1 1 2 0 6 2 5
Harrisbura,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
s Last Name Suffix Decedent's First Name MI
M C G I N N I S S J A M E S M
(If Applicable)Enter Surviving Spouse's tnformation 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
a 1.Original Return � 2.Supplemental Retum � 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)
� 6.Decedent Died Testate � 7.Decedent Maintained a Living Trust � 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust}
� 9.Litigation Praceeds Received � 10.Spousal Poverty Credit(date of death � 11.Election to tax under Sec.9113(A)
befinreen 12-31-99 and 1-1-95) (Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULQ BE DIRECTED T0:
Name Daytir�Telephone�ber �
L I N U S E . F E N I C L E 7 � � 7 6� ��8 3
' �? Q
c� �" �
EpST�OF S U$ d0A�1(
�." �' �" �,y�
t"'�'� f--'' ��
First line of address � � ���`� � '`"� �
� � �'`� � �
2 3 3 1, M A R K E T S T R E E T � � �.�`; � -�� "�
c;:� <=r: `''�: �j
Second line of address � �y N �:... �,�
ro � ��
�' � cr' `4n
Cify or Post Office State ZIP Code DATE FILED
C A M P H I L L P A 1 ? 0 1 1
Correspondent's e-mail address: LFENICLEaREAGERADLERPC•COM
Under penalties of perjury,1 declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE O,PE SON RESPO SIBLE FO FILING RETURN DATE
.��
ADDRESS
128 MEYE OVAL PEARL RIVER NY 1�965
SIGNATURE REPA OT T PRESEAIT E DATE
- �/3
ADDRESS
2331 MARKET STREET CA�1P HILL PA 17D11,
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 15056101,40 1,5056101,40 �
J 150561024D
REV-1500 EX
Decedent's Sociai Security Number
oecedent'sName: JAMES M• MCGINNISS
RECAPITULATION
1. Real Estate(Schedule A) ...... . ........ .......................... �. 1 1 5 D 0 0 , 0 0
2. Stocks and Bonds(Schedule B) . . .................................... 2. •
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C} ..... 3. .
4. Mortgages and Notes Receivable(Schedule D) .......................... 4. .
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 3 1 1 1 4 0 . 6 0
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested ....... 6. .
' 7. Inter-Vivos Transfers 8�Miscellaneous N�n-Probate Property
; (Schedule G) u Separate Billing Requested ....... 7.
.
8. Total Gross Assets(total l.ines 1 through 7) ........................... 8. 4 2 6 1 4 0 . 6 0
9. Funeral Expenses and Administrative Costs(Schedule H) .................. 9. 2 6 3 2 5 . 8 9
10. Debts of Decedent,Mort a e Liabilities,and Liens Schedule I 10. 1 2 1 5 5 9 . 1 4
9 9 ( ) .............
11. Total Deductions(total Lines 9 and 10) . .............................. 11. 1 4 7 8 8 5 . 0 3
12. Net Value of Estate(Line 8 minus Line 11) ................ .. .. ... ..... 12. 2 7 8 2 5 5 . 5 �
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ........ ....... ....... 13. .
14. Net Value Subject to Tax(Line 12 minus Line 13) ....... ............... 14. 2 7 8 2 5 5 . 5 7
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X•0 � . 0 � 15. � . � �
16. Amount of Line 14 taxable
at lineal rate X.0 0 • � 0 16. 0 . 0 0
17. Amount of Line 14 taxable
at sibling rate X.12 2 ? 8 2 5 5 . 5 7 ��. 3 3 3 9 0 . 6 7
18. Amount of Line 14 taxable
at collateral rate X.15 0 . � 0 18. � . � 0
19. TAX DUE ........... ....... .................................... 19. 3 3 3 9 0 • 6 �
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 1,505610240 15056],0240
�
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 12 0625
DECEDENT'S NAME
JAMES M• MCGINNISS
STREET ADDRESS
1463 CLOVER ROAD
CITY STATE ZIP
CAMP HILL PA 17011
Tax Payments and Credits:
�� Tax Due(Page 2,Line 19) (1) 3 3,3 9�•6 7
2. CreditslPayments
A.Prior Payments 3 6,6 0 0•�0
B.Discount 1,6 6 9•5 3
Total Credits(A+B) (2) 3 8,2 6 9-5 3
3. Interest
(3)
4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a�efund. (4) 4,8 7 8•8 6
5, If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.0 0
Make check payable to: REGISTER OF WILLS, AGENT
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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 prope�ty transferred: ...................................................................... ❑ Q
b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ X�
c. retain a reversionary interest;or ................................................................................................ ❑ 0
tl. receive the promise for life of either payments,benefits or care? ....................................................... ❑ �
: 2. (f death occurred after December 12,1982,did tlecedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ XQ
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ OX
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designaUon?.................................................................................................. ❑ �
IF THE ANSWER TD ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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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)].
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 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 yaunger 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)].
• 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(1.2)[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P,S,§9116(aj(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 EX+(01-10)
� pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FtLE NUMBER:
JAMES M. MCGINNISS 21 12 0625
All real property owned solety o�as a tenant in common must be reported at fair market value.Fair market value is de�ned as the price at which property
would be exchanged between a willing buyer and a willing selier,neither being compelled to buy or seil,both having reasonabie knowledge of the relevant facts.
Real property that is jointlyowned 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 owned as tenant in common, VALUE AT DATE
NUMBER
DESCRIPTION OF DEATH
1463 CLOVER ROAD, CAMP HILL, PENNSYLVANIA 17Q11 115,000•00
SETTLEMENT ON JULY 17, 2013 — SETTLEMENT SHEET ATTACHED
TOTAL(Also enter on Line 1,Recapitulation,j $ 115,D 0 0•0 0
If more space is needed,use addi6onal sheets of paper of the same s1ze.
REV-1508 EX+(11-10)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
JAMES M. MCGINNISS 21 12 0625
Indude the proceeds af litigation and the date the proceeds were received by the estate.
All property jointiy owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PSECU — SAVINGS ACOCUNT 58•09
PO BOX 67D13
HARRISBURG, PA 171�6-7013
2• PSECU — CHECKING ACCOUNT 3,624•99
PO BOX 67013
HARRISBURG, PA 17106-7013
3• PSECU — MONEY HANDLER ACCOUNT 62,181•11
PO BOX 67013
HARRISBURG, PA 17106-7013
4. CHARLES SCHWAB — INVESTMENT ACO�UNT #5383-4204 138,499�80
5. COMMONWEALTH OF PENNSYLVANIA FOR UNUSED SICK/VACATION TIME 60,466•30
6• COMOMNWEALTH OF PENNSYLVANIA — DEFERRED COMPENSATION 270•81
7• 2010 HONDA FIT 14,�41•0�
8• 2�11 TOYOTA AVALON 24,95?•00
9• PERSONAL PROPERTY 500•00
1D• COUNTY/SCHOOL/SEWER/TRASH PRO RATIONS FROM SALE OF 2,420•28
1463 CLOVER ROAD, CAMP HILL, PA
11. IRS TAX REFUND 2012 3,057-0�
12• HEALTH INSURANCE CHECK FOR EMS 1,�00•22
13• UNITED CONCORDIA — DENTAL REFUND 64.0�
TOTAL(Also enter on Line 5,Recapitulation) $ 311,],4 0•6 0
If more space is needed,insert additional sheets of paper of the same size
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JAMES M• MCGINNISS 21 12 0625
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A• FUNERAI EXPENSES:
�• LAWRENCE FUNERAL HOME 8,025.00
2• MYERS—HARNER FUNERAL HOME 7,638•�0
3• OPEN GRAVE 1,1p0.45
4• PRIEST FOR FUNERAL 300•�0
5• GIOVIANNI'S FUNERAL LUNCH 1,373.51
6. FOOTSTONE ST. JOHN CEMETARY 659•08
B• ADMINISTRATIVE COSTS:
1• Personal Representative Commissions:
Name(s}of Personal Representative(s}
Street Address
City State ZIP
Year(s)Commission Paid:
2, AttomeyFees: REAGER & ADLER, PC 5,0�0•00
3. Family Exemption:(If decedenPs address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4� ProbateFees: CUMBERLAND COUNTY REGISTER OF WILLS 377-50
5 Accountant Fees; H & R B L 0 C K 12 5•9 9
6. Tax Return Preparer Fees:
7. ADMINISTRATOR (ELEANOR MCGINNISS) BOND 780.00
; 8• AMINISTRATOR (ELEANOR MCGINNISS) EXPENSES 926.36
9• CUMBERLAND COUNTY REGISTER OF WILLS — SHORT CERTIFICATES 20•00
TOTAL(Also enter on Line 9,Recapitulation) $ 26,325•89
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-08)
pennsylvania SCHEDULE !
DEPARTMENT OF REVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN M�RTGAGE LIABILITIES &LIENS
RESIDENT DECEDENT �
ESTATE OF FILE NUMBER
JAMES M• MCGINNISS 21 12 0625
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
1. REAL ESTATE COMMISSION FROM SALE OF 1463 CLOVER ROAD, 7,125•0�
CAMP HILL, PA 17011
2• TRANSFER TAX FROM SALE OF 1463 CLOVER ROAD 1,150•00
3. 2013/2014 SCHOOL TAX PAID AT SETTLEMENT OF 1463 CLOVER ROAD 2,093•77
4• SEWER/TRASH PAID AT SETTLEMENT OF 1463 CLOVER ROAD 138-00
5• SEWER/TAX CERTIFICATION AND WTRE FEE FROM SALE OF 1463 C�OVER ROAD 40•DO
tAMP HILL, PA 17011
6• PSECU VISA PAYOFF 183•26
7• PSECU MORTGAGE PAYMENT AND PAYOFF 67,936•71
8. 2011 HONDA FIT CAR PAYOFF 4,499•03
9• 2011 TOYOTA AVALON CAR PAYOFF 20,516•77
10• PPL ELECTRIC FOR REAL ESTATE AT 1463 CLOVER ROAD 7�3•27
11- AT & T FINAL BILL 219•68 �
12. CARPET REMOVAL/PAINTING AT 1463 CLOVER ROAD 800•00
13• GARBAGE REMOVAL AT 1463 CLOVER ROAD 45�•DO
14• HOME DEPOT — REPAIRS/MISC CLEAN CLEANING SUPPLIES FOR 1463 CLOVER 400•0�
ROAD
15• WASTE MANAGEMENT — CONTAINER FOR 1463 CLOVER ROAD 1,504•DO
TOTAL(Also enter on Line 10,Recapitulation) $ 121,5 5 9•14
If more space is needed,insert additional sheets of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
JAMES M.MCGINNISS 21 12 0625
DecedenYs Name Page 3 File Number
Schedule i-Debts of Decedent, Mortgage Liabilities,8� Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16• PENN NATIONAL INSURANCE HOMEWONER'S FOR 1463 CLOVER ROAD 684•70
17. USPS - ADDRESS CHAN6E 1-00
18• ELEANOR MCGINNISS - THANK YOU CARDS 161•65
19. ELEANOR MCGINNISS - STAMPS 50-00
2�• AMERICAN WATER - FOR 1463 CLOVER ROAD, CAMP HILL, PA 606.62
21• WEST SHORE EMS 1,0�0•22
22• DE86IE LUPOLD, TAX COLLECTOR - 2012 SCHOOL REAL ESTATE TAXES AND 2,693•54
2013 COUNTY/TOWNSHIP REAL ESTATE TAXES - 1463 CLOVER ROAD
23• EAST PENNSBORO TOWNSHIP - SEWER FOR 1463 CLOVER ROAD 7�3•80
24. VERIZON FINAL BILL 91•55
25• LARRY PATES -SECURE/GET MAIL AT 1463 CLOVER ROAD 800•00
26• SHIPLEY ENERGY - HEATING OLI/UNIT COVERAGE/TANK COVERAGE 2,706.73
AT 1463 CLOVER R4AD
27. PENN PEST - TERMITE TREATMENT FOR 1463 CLOVER ROAD 609.50
28. ENVIROQUEST - RADON FOR 1463 �LOVER ROAD 760•00
29• PA DEPARTMENT OF REVENUE FOR 2012 TAXES 2.00
3�. RUPPERTS LANDSCAPING FOR 1463 CLOVER ROAD 2,700.50
SUBTOTAL SCHEDULE I 13,57Z.81
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
JAMES M.MCGINNISS 21 12 0625
Decedent's Name Page 4 File Number
Schedule I -Debts of Decedent, Mortgage Liabilities,&Liens
ITEM
NUM6ER DESCRIPTION AMOUNT
31• HOME DEPOT - DEHUMIDIFIER/KEYS/MSIC- FOR 1463 CLOVER ROAD 227•84
SUBTOTAL SCHEDULE I 227.84
GRAND TOTAL SCHEDULE I � 121,559.14
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
. DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JAMES M. MCGINNISS 21 12 0625
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSQN(S)RECEIVING PROPERTY Do Not List Trustee(sj OF ESTATE
I TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfe�s under
Sec.9116(a)(1.2).]
1. ELEANOR M�GINNISS Sibling 69,563-90
128 MEYER OVAL
PEARL RIVER, NY 10965
�• KATHLEEN M. HADDOW Sibling 69,563.89
13516 COMPLON ROAD
CLIFTON, VA 20124
3• THOMAS MCGINNISS Sibling 69,563•89
273 MCMURRAY ROAD
PITTSBURGH, PA 15241
4. THERESA MCGINNISS GALLOWAY Sibling 69,563.89
5564 WILKINS AVENUE
PITTSBURGH, PA 15217
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 TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
rt�viv�a vuruvi�n aa�owo�w . , ,
A. S�'��E'111�11� �tr�.�C'•111E�11t U.S.Department of Housing and Urbart Development
B.T e of Loan OMB A rovat No.2502-0265
1. ❑FHA 2. ❑FmHA 3. ❑Conv.Unins. 6.File Number 7.Loan Number 8.Mortgage Insurance Case Number
4. VA 5. Conv.ins. 13-2883NM
a arm e a g a you a men a a us sa e n co . ou s pa n y e se en apen wn.
C.�IO�@: itema marked"(p.o.c.j"wore paid outslde the closing;they are shorm here tor intormeUon purposes and are nol induded In the totafs. TItIBEXPfeSS SBttI@�Yi@tit S}/SfBtli
WARhiiNG:it la a crtme to knawingry make fialse statements fa the tlntted States on fhla or en}+ottrer slmHar farm.Penafties upon
convicUon can ir�dude a�ne and lm aonment Fcrdetaits see:TIUe'!8 U,s.Code Saction 1op�and Sad�on 10�0. PClf11@d 07/151ZO1�2t 10:26 BG
D.NAME 4�BORROWER: K�B Development LLC
ADDRESS: 130 Reeser Road Cam Hi1! PA 97491
E.NAME��SELLER: Esta#e of James M.McGinniss
ADDRESS:
F.NAME QF LENDER:
ADDRESS:
G.PROPERTY ADDRESS: 1463 Cfover Road,Camp Hiil,PA 17011
09-17-1042-�541 East Pennsboro Townshi
H.SETTLEMENT AGENT: North Mountain�ettlement Services,L.P.,Telephone:717•364-3140 Fax:717-364-3144
PlAGE OF SETTI.EMENT. 1250 North Mountain Road Harrisbur PA'(T112
1.SETI'�.EMENT DATE: � 0711712013
J.SUMMARY t�F BORROINER'S TRANSACTl4N: K.SUMMARY QF SELLER'S TRANSACTlON:
100.GRpSS AMC3UNT DUE FRt3M BORR�WER 400.GROSS AMOUNT DUE TO SELLER
101. Cantract sales rice 11$8�0.40 40f, Cantract sales rice 915 OOQ.00
102. Personal ro e�t 402. Personai ro e
103. Settlement char es ta borrawer line 1400 2 202.00 4U3.
104: 404.
145. 405.
Ad ustmett#s fo�items aid b sellec in advance Ad'ustmen#s for items aid b selle�in advance
107. Coun taues 071'17113 ta 12i31113 304,3Q 407. Count taxes 07117/'13#012131l13 304.30
108. Schoo{t�es 471171't 3 to 06130114 2 001.98 408. Schooi#axes 07!'4 7!3 3 to 06/34!'I4 2 QO'1.98
109. Sewer 8�Tresh 07117/13 to 09130/13 '�14.00 409. Sewer&Trash 07f 4 7/13 ta 09134f"t 3 114.Q0
110, 410.
111. 411.
��2. 4�z.
12U.GROSS AMQUNT DUE FR4M BORROWER 919 622.28 420.GROSS AMOUNT DUE TO SELLER 1'il 420.28
200.AMC?UNTS PAlD BY K?R ON BEHAl.F OF BC?RROWER 500.REDUCTIONS 1N AMUUNT DUE T4 SELLER
201. De sif ar eamest mone 2 004.U4 509. �cess De osi# see instructions
202. Pnnci a1 amaunt ofi new laans 5Q2. Set�ement char es to seller line 140Q 10 546.77
203. Existin ioan s taken sub'ect to 503. EXiStltl laan s #aken sub'ect#o
204. 5�4. Pa aff of First Mort a e l.aan
205. 505.
' 206. 506.
207. 507.
zaa. �os.
209. 5Q9.
Ad ustmer�ts for i#ems un aid b seller Ad'ustmen#s for Items un aid b seUer
z�s. ���.
214. 514,
215. 515.
216. 516.
217. 597,
218. 518.
2�9. 519.
220.Tt3TAL PAtD BYIFOR BORROWER 2 4Q4.40 52Q.Tt}TAI.REDUCTIC}N AMQUNT DUE SELLER 10 546,77
300.CASH AT SETTLEMENT FROM aR Tt3 BORROWER 600.CASH AT SETTLEMENT TQ UR FROM SEI.LER
301. Gross amount due from barrower {ine 120 1'19 622.28 609. Gross amount due ta seller line 420 4'17 424.28
3Q2. Less amaunts sid b/for borrower line 220 2 000.00 602. Less reduction amaunt due seller iine 520 10 546.77
303.CASH FR4M BORR4WER 117 622.28 603.CASH TO SELLER 106 873.51
SUBSl"ITUTE FORM 1089 SELLER STAT�NIEt3T:The EMamatlsan contained herein is tmportant ta7t lniorrnatlan and!s bsir�fumished to the intsmal Revenue SeMce. It you are required to 81e a retum,
a negIfgence pe�alty ot other aenctian wil!be imposed on you H this Itern is requlred to 4e repoRed and the IRS detsrmines that it hes not been reported.The Cantract Sales Pricss described on
(ine d01 abova constituies the Gross Proceads of this Uansadion.
You are raqWrod by law to provide Rhe setUement agent(Fed.Ta�c t0 Fla:_ _ 1 witlt your correct taxpayer identiStcapon number.K you do not provide your caxrect ta�cpay�kte�tlfica�on
number,you msy be wt�Jsd to dviE or crim�at penaltles lmposed by iaw.�nder pena es of par�ury,I r.artify that tha number ahown on thia atatement is my correcl taxpeyer idenptication number.
TiN: 1 - SEI.IER{S)StCaNA7URE(S}: I
SELIER(S}NEW AAAIi.tNG ADDRESS:
SELtER j3}PHOIVE 13UM9ERS: ��a �
rrawoua eu�cwtis nru vuuu�u�u .,,........,. .�..._,.,._...�,____...___._
U.S.D�PARTMENT OF Ht�USING AN�URBAN DEVEi.�PMENT �i1e Number.'l3-2883NM PAGE 2
SETTLEMEIVT STATEMENT TitieEx ress Settlement S stem Printed 07115/2013 at f0:2s aG
: L. SETTLEMENT CHARGES � pA�o FROnn �A�o FRa�
700. TOTAL SALES/BROKER'S COMMISSION based on rice$fi't5 OOOAO=7'125.00 B�RROWER`S SEILER'S
Division of commission line 7Q0 as fo(lows: FUNDS AT FUNDS AT
741, 3 45Q.00 to For Sale B Owne1"Plus Realtors SETTIEMENT SETTLEMENT
?02. 3 675.04 to ReMax Rea! Associates
703. Commission aid at Settlement 7125.40
800.ITEMS PAYABI.E IN CONNECTIt3N WITH L4AN
801. �oan Ciri inatian Fee °�
802, �oan Discounf °k
803. A raisaf Fee
804. Credit Re o�t
8Q5.
$E?6.
807.
808.
809.
810.
811.
900.1TEMS REQUIRED BY LENDER TO BE PAiD iN ADVANCE
941. Interest From to /da
942. Mort a e lnsurance Premium for 4 mont to
903. Hazard Insurar►ce Premium for Q mQnt to
904. �
905.
1�00.RESERVES DEPt}SiTED WiTH LENDER FOR
1001. Haza�d(nsuranca mo. /mo
1002. Mort a e lnsurance mo. Imo
1003.Ci Pro e�f Tax mo. /ma
1004.Coun# Pro Tau mo, /mo
1005.Scho�l#�es mo. !mo
1009.A re ate Anat sis Ad'ustment 4.00 4.04
�100.T1TLE CHARGES
1101. Setflement or Clasin Fee
9102.Abstract or Title Search
1143. Title Examination
1104.Title insurance 8inder
1105. Document P�e aration
1946. Nota Fees to Qeborah K.Bacian 10,00
1107.Attame s fees
includes above items Na
1108.Title insurance to North Mauntain Settlement Services L.P. 975.00
includes abave items No: '1101-'1104
1109. lsnd�r's Polic 0.00
1110.Owner's Poli 115 OQ0.00 -975.Q0
1111.
9112.
1i13.
1200.GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordi Fees Deed 67.00 �Morf a e •Re(ease 87.OQ
4202.Ci /Coun# taxlstam s Deed '1 150.00 •Mort a e 9 15Q.40
1203.State Taxlstam s Deed 1 150A4 •Mort a e 1 150.00
4204. Qeed 'Mort a e
1205. Oeed •Mort a e •Release
�300,ADDITIt�NA�.SETTLEMENT CHARGES
1301. Sewer Certification to E2►st Pertnsbora Townshi 9 O.OQ
1302.Ta7c Ce�tification to North Mountain S�ttlement Services 14.04
1343.2013 Co&Tw Ta7c to Debbie Lu old P.O.C. 661.13 Selier
1304.2013-2414 Schaol Ta�c to Debbie Lu old 2 093J7
1305. Out oin YVire!Proceeds to North Mountain Settlement Services L.P. 20.00
13Q6. Sewer&T�ash to East Pennsboro Towr�shi 138,00
140fl.T�TAL SETTLEMENT CNARGES �enter Qn lines 103 Section J and 502 Section K 2 20Z.00 1�546.77
HtlD CERTIFICATtQN OF HUl'ER ANC7 SEICER
i have carefuity reviewed tl�e HtJd-1 SetOement Statement arxt to the 6est ot+ny kncn�+Iedge and belief,it is a true and accurate atatemer�t of al!receipts and dfsbursements made on my axovnt
or by me in B�,s tEatsssction.f turther certtty fhat{have recefved a cqpy oi the#iUD-1 Settlement 5tatement
K i�B Development LtC
-.--
ron a, am r
Eatete at James M.McG3rw�iss
i
�
Y: S!, 8CU
WARNING:IT IS A CRIME TO KNOWIFJGLY MAKE FALSE 3TATEMENT5 TO 7HE TFre MUd-i SeUiernent Siat ent whtch 1 haw proparod ir a irue and�teattrat+�account of this
UNiTED STA�'ES ON THi5 Oit ANY StM11.AR FORM.REt3ALTtES UPON CONV1CTiQN transacxton. 1 nave caussd w!N ceuse the!un to be dlsbursed!n aocordance with this stelemenL
CAN lNCIUDE A FINE AND IMPRISONMENT.FOR QETAILS SEE TITLE 18:
U.S.CODE 5ECT10N tfl01 AND SECTIdN 18t4. /
SETTIEMENT AGENT: �1AT'E; (