HomeMy WebLinkAbout09-12-13 � �sns61o�a1
REV-15Q0 fx<�'�,�>
OFFIGAi.USE ONIY
PA Departrne�t aE Revenue Pe�Y��� �p�y� Year File Number
Bureau of Individuat Taxes INHERITANCE T,AX RETURN �, '. 6
PO BOX 260601 � • ; �i 9'� .. �
` Harris6urg,PA x7u8-o6ot RESIQENT DECEDENT „L,,: �, :�, r;,�'
ENTER DEGE6EHS INF4Rt�iATi6N SEL{1W
Sociai Seourity Number pate of Death MMPDYYYY Oate of Birth MMD�YYYY
i
� � -' � ��� ���� ��� 12 � '�' ;l � !�7�"�0; ,� '�� �� �1 �
- DecedenYa Last Name Suffix DecedenPs First Name M{
C. `��S � o � `Ffl ��i - �� �
;"� r
{tf Appiicabie}EMer Sur�ving Spause's Infotmation Below �
Spouse's Last Name Suffix Spouse5 Pirst Name MI
� ����*+���� �
Spovse's Socia�secur'rty Number 7HIS RETURN MUST BE FILED IN DUPUCATE WfTH THE
� 1 ����� REGISTER OF WILLS
FIIL IN ApPROPRIATE OVALS BELOW
p t. Odginal Ratum � Z.Supplementat Rekurn O 3. Remainder Retum(date of death
� priorto 12•13-82)
, p 4. Umtted Estate p 4a.Future Interesl Compromise{tlete of p 5. Pederal Egtste Tau Retum Required
d92th after 12-52-82)
Q 6. pecedent Died Testate Q 7.Decedent Maintained a Living Tmst _ 8, Total Number of Safe Depasit Boxes
(Attach Copy of Wilq - (Attach Copy of Trust) �
p 9.litigaGon Proceeds Recefved (',� 10.Spousai Poverly Gredit{dete of death O �h. Electioo to Iaz under Sec.9'H3(A)
between 1231-91 and'1-1-g6} (AtEach Sch.Q}
CORRESPONbENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPpNdENCE AND CONFIDENTIAL TAX INFpRMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
� R f � � �y � � � 3 �'�'n��
��.
REqSTER pF WILLS USE ONLY,
C.-. � , ... . .'_�
First line of address ' � - � � � �
� J .� f � � �f, . � , . �
Second�{�ne of addra&s - � �
'�EN�� F'� �L ;�� '��� �� Ac�Q �F " ; i f ` -
�� �
Clty or PoSt O�ics � I��� State ��ZIP Code DATE�Fft•ED �
�qim��-,.�.,�- .��.w��,�. �� -
tl��.�;R � 'i 5 �,�?��,.«,� ! f i � �w �„�..`?�/i / D"��,�'�2,��'S :
IlOM�'�fY 1 ee$04"M111Ri9lXIWt19��('. l.BYmL'n L ryy�� ' �
CorrsspondenPs e-maii addrexs: .�C7,J�,�t�
Under penallies of perjury,I dedare thet I have examined this retum,Inclutling accompenying schatlules snd stetements,and to the best of my knowledge end balief,
it is true,correct antl complete.DeGaraUon of preperer other than the parsonel represenfative is besetl on sll infortnation of which preperer has&ny knowledge,
�SIG URE OF PJ��5 ''RES BlE FOR FI�IN� URN
nn,�.,r-f� �E�CFc c��c�i�'c. � .fl�S` ✓��'vl3
ADDRESS �-"
11 r.,�'��.. Tl'2.1 r n/ E dc���,�A,��Pr_t`�i'�,R�',�f� /�i /�v-2�'�
SIGNATUftE QF F�EP/3tgRER OTHEft THAN REPftESENTATlVE 6ATE
%\%�Iry
ADDftESS /S
1��lA
PI.F_ASE USE ORI6iNAt FQRM ONLY
Side 1
� 150561�101 3,5656Z01GL �
�
J 1505610105
REV-15p0 EX pecedenYS Social 5ecurity Number I
ct�denrs Ha„�e: .�i1J�/ali�l�.� � �� • 1�(C7 !`ll�.I.!
.
" RECAPRULATIpN
.wu..»a�.r....�.�..u.w�.v-�..�: .x�r �+mm m/c/�:,�.��wwf
t. Real Estate(Schadule A). ... . .. ... . .. . .... ... .. .. . ... .. ... .. . . . 1 � '�:�,�� ,✓ �' / •-C�:'c/.:. . .
2. Stocks and Bonds(Schadule B) .. . . .. . . . .. . . .. . .... ..... . . .... . . . 2. ` . � �"' `• �. .
3. Closely Held Corporation, Partnership or Sole-Pmprietorship(SOhedule C) . .. . 3. � n k
k � ` LL '`
4. Mortgages and Notes fteceivable(Schedule D). . . .. ... . . .... . .... . .. . 4. � - < . . ` `
k { } rn
- ' .`' .. '. .. .
�
5. Cash, Bank Depasits snd Miscellaneous Personal Properry(Schedule E). .. . . . 5. r .
, . ,. , ... ,.�u
t ��i
. , ;.. - ' t � � I,
fi. JoinUy 4wned Property(Schedule F) p Seperate Billing Requested .. ... . . 6 i� „
7. Inter-Vlvos TranaPers&Misceilanepus Non-Prqbate Propetty . ^' � " � � �� `�`�"�"�
(Schedule G) . p SeRarate Billing Repuestetl.. .... 7. � R �% �; .
r, a: • °••` k P�' F� �,,:..�
. . ..� o. � . tr {�t'/_"1�
8. 7ota1 fiross Assets{tokal Lfnes t lhrough 7)......... ...... .. ........ 8. , p J � (7 ��"'7 V;-;
.._ . _. ,. , ..::. ".. ;..__
9. Funerai Expenses snd Administrative Cosls(Schedule H�......... .......... . 9 ` ' �� `y �
,
. �. . fiC"° - .
. . o. .ti.� , a. ..
10. Debts of Qecedent.AAartga9e Liabiifties.and Uans{ScheduVe!) .... . ... .. . 10. '. . . �,;. 'r �': . .. '. .
..,.�_r,= . "� ,.,`-�x^,`�
,.. �, . . � :.. .. ..
tt 7otat peduetiar�s{tatal Lines 9 and 14}. . .... ... ........... 11 �� � '�� � � � �: � `
.. .. .
. , - .. ..,,'.
,...+�.. �. ...... ,.:_ �, .��.z.,..:.�_.�
�2. Naf Value of Estate{�ine 8 minus tine 11) . ...... ........ . ......_ 12. „ ' �:
13. Charitable and Governmentel Bequests/Sec 9113 Trusts for which '`'�' � .,
,;. x�. , ,...,. �";:�� . ..s�z .�,
an eiecti�n to tax has not been made{5chedule J) . ......... .......... 13 � .� � v.
14. Net Vaiue Subject to Tsx(Line 12 minus line t3) .. .... .... .......... . 14. � � � ' .. � ;.
..:_�-., . . _..,. _ . .�....,_... . , � _.. ...
TAX CALCULATi4N-SEE IN3TRUCTiONS FOit APPtICABLE#tATE6 �
15. Ampuni oF Line 14 faxable � .
at the spousa!tax rate,or �
transfersunderSec.�9116� �.-.w,u:•..^,:,.�.,`."'�'""",.�."°:.�."''""`:".�"' „""a.�'"'""'�."°"'°�"u""""""".�.`"'�."f*.,A'..."m,
{a){1.2)X .0_ . I .. . �� � � � 15. ' 4, c
16. Amount of Line 14 texable �. - , " ��". , t';`� '�;�?°`�-�"`
at Gneai rate X.0_.. .. „ ,� �:...�.; ✓ 16.' �.� G I; " .° , :..
F
17. Amount of Line 14 taxable ` ''"'"'' """'""�"�. " '" �' '""�'"""'�""�'�':�`�'�
at slbiing rate X.12 . , "+ ��,r . ` r... � � `
y _: :;aa. ` r � � '�'�""mt"
18. Amount of Line 14 taMable �`� f �5' � � ��•" � ����� bu. �
at catiaterai rate X.15 � ` .': '* 18 "' '' � �.. k r ,�.
' �
�vmr..vru.,.veim.,N �mctti..�s4�vw�w.vl:uar�.,.rcr.�wo-: �� � . � y:- '�+,'1s����,
79. TAX pUE . ... . . .. .. ... .. ... ... ... ..... ...... .......... .... 19. (. � ; r x' "^�- �' s
=�.wrv�seux.�:�we ,w ,�,��ww�va. �mmwwamecn
20. FtL4 tN THE QVAI 1F YOU ARE itEQUESTfNG A REPUND 6f AN OVERPAYMENT p
Side 2
� 1505610105 15D561�b05 �
REV-t560 EX Page 3 Ftie Numirer � �� 7 � �� u � 1 } I
Decedent s Complete Address: r � � �j�
aec�oENrs ran�
4�V�t—���L^-1�.�,��� _—.�,�r' C%t t�o�.' �tC,l��.��_
STREETADpRESS �
-,��___�' ���- � P� - ._ - - --���r<f`� �n/�.
�_— --- --- —
(`��tJ�/Jrfl �,f� !h� il
4CItt��{7 t N ---------- -- . TSTATE __..--.._T21P �� �
�
Tax Payments and Credits: ��{�
1. T�Due{Page 2,Llne 99} (1)
2. CreditslPayments
A.Prior Payments _�_ _ �
8.Discount
----------— 7aia1 Credits(A+S} (2}
3. interest
(3)
4. If Line 2 is greater lhan Line 1 +Line 3,enter the diHerence. This is the OVERPAYMENT.
Fiti in oral on Page 2,Lina 2Q ta request a refund. {4}
5. If Line 1 + Line 3 is grester than Line 2,enter the difference.This is the TpJ(DUE. (5)
Make check payable to: REGISTER pF WILLS,AGENT.
: ;
� � . . �. �. , -u
PLEASE ANSWER THE fOLLOWING QUESTIONS BY PLACINC AN "X" IN THE APPROPRIATE BLOCKS
1. Did deced�t make a transfer a�d: Yes No
a. retain the use or income of the property transferrad�.......................................................................................... ❑ �
b. retain the ri ht to d�si nate who shall use the ro transferred or its income:.:..:...:...........::.:.............._.. ❑ �
8 9 . P..Pe�Y
c retain a reversiona mierest,oc.......... ......... Q
d. receive the promise fa�ffe of eifher payments,henefits or care?...................................................................... ❑ �(
2. If death occurred after Dec.12, 1982,did decedent transfer property within one year of death
withaut receiving adequate cqnsideratlon?.................:...._............,..............,................._................................_..... ❑ �
3. Did decedent own an m trust fw'or payable-upan-dea#h banK accounf or security a#his or her death?.............. ❑ �
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneflciary designation? .............................................._...._..........................................................._..... ❑ �
iF THE ANSWER Tp ANY OF THE ABOVE QUESTIONS�S YES,YOU MU5T COMPLETE SCHEDULf G ANd FILE iT AS PART OF THE REFURN.
ror dates of death on or a(ter 3uly 1, 1994,and before Jan. 1, 1995,the ta��rafe impased on the net vaiue of fransfets to or far the use of the suroiving spavse is
3 percent[72 P.S.§9t16(a}(t.ty(i}).
'ar dates of death on or a(ter Jan. 1, 1995, the tax rete imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
72 P.S.§9116 {a){i.1j {ii}j.Ttre statute 6oes not ea�empt a transfer to a surviving spouse from iax,and the statutory requirer�n#s for disciosure of assets and
iling a tax retum are stili appiirable even if the surviving spouse is the only beneficiary.
�or dates of death on ar after July 1,2000:
t The tax rate imposed on #he net value of iransfers from a deceased chitd 21 years of age or younger at death to or fa the use o{a naWral parent, an
atic�gtive parent or a stepparent of fhe chiW is 0 percent�?2 P.S.§9118{a}(1.2}].
� The tax rate imposed on the net value of transfers to or far the use of the decedenYs lineal beneflciaries is 4.S percent, except as noted in
72 P.S.§9116{1.2)(72 P.S.§911&(a)(7)J.
� The tax rate imposed on the net vaiue af transfers fo or for fhe use of the decedenfs siblings is 12 percent[72 P.S.§9116{a)(1.3}].A sibiing is defined,urrcfer
Section 9102,as an individual who has at least one parent in common with the decedent,whether by biood or adaption.
• REV45�2 EX+ (O1-10)
� � pennsylvania SCHEDULE A
�EPa�1MENT oF RE�FN�E REAL ESTATE
INHEN7TANCE 7H%REfURN
RESIDENT DECEDENT
ESTATE Of: FILE NUMBER:
JoS p�'I�//�Jt /�I �(Fl��/-� n/ Z�� �— �v
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchangetl between a willing buyer and a willinq seller, neither being compelled[o buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must 6e disclosed on Schedule F
Attach a wpy of the settlement sheet if the property has been soltl.
ITEM Indude a copy of the deee showing decedenPs interest if owned as tenant in common. VALUE AT DATE
� NUMBER . OF DEATH
DESCRIPTION
�. ����,�r�LT�' /�T d �� �1��� ��,�i� � �
�'�l/�� l�.�f- / -� ��.5`
��� S� � � %� : �T7`E�' �E�
� �+sso� �.�:���� G t� .
/�'�D G2c�'�.�1'/'��R l��/
���1�, �.� i ��f� ��
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— CoP� a� S<-_7TLcF/�E ��� S l��f�i
q�/� c;l�Cfl
�
TOTAL (Also enter on Line 1, Recapitulation.) $
If more space is needetl, use additional sheets oP paper of the same size.
i -
A. Settlement Statement
U.S.Depadment of Hausiny and Urban Development
OM6 No.2502-0265
B.TYPE OF LOAN
I. I]FHA 2. ❑FrriHA 3. QConv.Unins.
A. pVA 5. 6Conv.tns.
6.FILE NUMBER 7.LOAN NUMBER
13•1244
9.MORTGAGEiNSURANCEGASENUMBER
s arm um s g va yeu a s man o ss ermn ¢w n pa p sm a8art aro s ewrt.
C.Note: �mms marxw°(p.o.a)"ware pNd outnirla ihe eicainB:�+�y ma nhown haro tor t»tarma8on pmposes and an not Ineiudse�n the totais. T1IIBEXPl83S S2#llBtTietif SYSf9tii
WARNING:It Is a edms ro knowlnply maka Talse elabma�l410 ihq UOISotl SIYlOS O�Mlb 4f a0y W�ef BIINIIY!fOfrtl.PBp01lIB8 U(!op
aomkflrn ee�Inelutle�9ne a�d Im tlsonment Fpr tlsblls ase:Tlqs 18 U.5.Cpd�9a¢tlon 100i antl Saetlon t010.
�.NAME OF BORROWER: Otter Creek Assqciafes,LP
ADDRESS: 1650 Greenbriar Road Yark PA 174Q4
E.NAME OF SELLER: Estate of Josephine M.Heiman
ARDRESS:
F.NAME OF I.ENDER: CASH
ADDRESS:
G.PROPERTY AQDRESS: 109 Arnold Rd.,Enola,PA 17025
East Pennsboro Township
N.SETTLEMENT AGENT: Anchor Abstracting Company,Inc.,Tetephone:797-&99-4800 Pax:717•699�0687
PLACE OF SETTLEMENT: 27 East Philadel hia Street York PA 1T401
I.SETT(.EMENT DATE: 4$t2912413
J, SUMMARY OF BORROWER'S TRANSACTION: K, SUMMARY OF SELLER'S 7RANSACTfON:
100.GROSS AMOUNT dUE PROM BdRROWER 40d.GROSS AMOUI+lT Dt3E TO SELLER
101. Contract salss rice 5S OQ0.00 401. Contreot sales rice 55 000.00
102. Personal Pru ert 4p2. Personai Pro ert
103. Settiement oha to borrawer line 140Q 1 3Q4.5Q A03.
104. 404.
505. 405.
Ad�ustmenis for items aid b seller in advance Ad'ustments for items aid b seller in advance
106. Cit /fowntaxes 08129/13to12131i13 42,55 406. Cit/towntaxes 48129/13to12131113 d255
507. Coun taxes QSl29l13to12l31l13 101.12 407. Courtt taxes 09129H3to12131!'!3 101.12
1p8. Schooltaxes 0$129113ro06130114 1076.A5 408. Sohooitaxes 08129113to0&(38114 1078.45
109. 3rd 4tc Sewer 8 Refas�f6l29113 to4913Ql13 49.54 409. 3rd 4tr.Sewer&Refus�8129113 to49130113 49.50
110. 410.
111. �„ 411.
112. 412.
110.GROSS AMOUNT DUE FROM BQRROWER 57 574.12 426.GROSS AMOUN'f DtlE TO SELIER. 56 2fi9.62
2Q4.AM4UNTS PA1D BY 4R aN BEHALP 4f BORR4WER 5QQ.REDUC?IONS IN AM4UNT OUE TQ SELLER
201. De osil or earnest mone 501. Encesa De osif see instructions
242. Princi al amount 4f new loans Bfl2, SetBsment char es fo selier line 1400 684.OQ
203. Existin loan s taken sub ecl to 503. Existin loan s taken sub'ect to
204. 5d4. PavoFf of First Mortga�e(.oan
205. 505.
206. 508.
2Q7. 5Q7. Pa ment for Estate Tax 2 501.22
Cumberland Coun Reqister of
2d8. 508.
209. 509.
Ad'ustments for ifems un aid b seiter Adiustments far items un aid b selter
21Q. Ci ltawn taYes 51Q. Cit ltown taxes
211. Count taxes 511. Count taxes
212. Schooltaxas 5i2. Sch�itazes
213. 513.
zia. s�a. _
215. 515.
z�s. s�s.
a�7. 5�7.
218. 51 B.
218. 519.
220.TOTAL PAID BYIFOR BORROWER 520.TOTAL REDUCTION AMOUNT DUE SELLER 3185.22
300.CASH AT SETTLEMENT FROM OR TO BORROWER 646.CASH AT SETTLEMENT TO OR FROM SELLER
. . ... .__, o�c�n n o an� r_.,,�o�..,,,��,a n:�r.i��onA,rr„p a�n�, 58,269.62
... .. . _ ���mnuu.��wee��nnwuww.�ruva.s
U.S.4EPARTMENT OF HOUStNG AND URBAN DEVE�OPMEN7 FiVe Number:l3-7244 PAGE 2
SETTLEMENTSTATENiENT TitleExpresssetilement5 tem
L. SETTLEMENT CHAROE$ � PAID FRQM PAID FROM
700. TQTAL SALES/BROKER'S COMMI5SION based on pdce$55 000.00= 60RROWER'S SEI.IER'S
Division of commission{Iine 700}as toilows: FUNOS AT FUNDS AT
701. $ to SETTLEMENT SETTLEMENT
• 702. $ to
� 703. C�mmission eid at Settiemenf
80Q.REMS PAYABLE tN CONNECTtON W{TH tOAN
' 801. Loan Ori inetipn Fee % - T�_
602. Loan Discount °!o
8Q3. A raisai Fee
804. Credit Re ort
805. Lenders Ins eotion Fee
806. Mort a e A icafion Fee
807. Assum 6on Fee
808.
809.
81d.
811.
900.I7EMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to !d
902. Mori a e Insurance Premium tor to
903. Nazard Insurence Premium for to
904.
905.
1000.RESERVES pEPOSI7ED WITH LENDER FOR
1001. Hazardfnsurance mo. Imo
1002 Marf e 3nsurance mo. tmo
1003. Cit Pro ert Tax mo. 7p.36 /mo
1004. Count Pro ert Tax mo. 24.B1 /mo
1005. SchoW ta�cas rrro. 147.00 !mo
1009. A re ate Anai sis Ad ustment 0.04 0.00
1700.TITLE CHARGES
1101. SetUement or closin fee
1 t02.Abstrad flr tikle search
t103. 7itle examinetion
1104. Title insuranoe binder
t105. Doc�mentPre ara6on to AncharAbstracti� Cam an Inc. 1Q0.00
t1o6. NoSar Fees to Darren Miltar 35,40 14.00
1107. Attome 's faes
inuiudes above items No: 1
t168. Tftle insurance to Chisa a Tltle lnsurance Com aa 652.5Q
includes a6ove items Na; j
1109. Lender's Polic NONE
1110. Ownets Polic 55 Q�0.04 -852.50
ttti.
1112. SewerCertfee toEastPennsboroTownshi 10,00
1113. TaxCertfce to AnchorAbstractin Co. 10.00
12Q0.G4VERNMENT RECORDtNG AND TRANSFER CHARGES
1201. Recordin Fees Deed 67.00 Mort a e Release 67.00
1202. Cit /Count ta�stam s Deed$550.00 Mort a e 550.00
M1263. State Ta�stam s Deed$554.OQ •Mprt e fi50,�
1204.
1205.
1300.ADDITIONAL SETTLEMENT CliARGES
7301. Surve =_�
1302. Pest Ins eotian
1400.TdTAI SETTLEMENT CHARGES enter an lines 103 Section J and 542 Section K 4 304.50 68d.00
HUD CERTFlCA710N OF BOYER AND SELLER
I havB aarefully rovleWbtl tha HUD•1 8s81sment Stabment antl to ths 4set o}my knewledp�qntl bsllef,lt Is a troe enE�ccu�atb atabmsnt nf all me�lpts arvtl tlls�umembnfs matla on my aeeount
ar Oy me In thla VmsuotlonJ Nrthsr eertlry thN 1 hava roesimtl A aopy o/tha NUDd Settlemmt Statsmant.
4tter Geek Assxiafes,LP
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RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date : 9/12/2013
Cumberland County - Register Of Wills Receipt Time : 13 :48 : 00
One Courthouse Square Recei�>t No . : 1075547
Carlisle, PA 17013
HELMAN JOSEPHINE M
Estate File No . : 2013-00384
Paid By Remarks : DANIEL P HELMAN
CJ
- - - -- - - - - - - - --- - ---- Receipt Distribution -- - - - ----- - - - -
Fee/Tax Description Payment Amount Payee Name
INH TAX RETURN 15 . 00 CUMBERLAND COUN7'Y GENERAL FUN
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Check# 1107 $15 . 00
Total Received. . . . . . . . . $15 . 00