HomeMy WebLinkAbout08-29-13 (! 15�56101�5
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PA Llepartment of Revenue Pennsylvania OfFICIAL USE ONLV
6ureau of Individuat TaxeS ""�"`" �� ` County Code Year 6ile Num4er
, t>0 eax z�o6os INHERITANCE TA?C RETURN : /} F )1j ���
Narrisburg PA 17i�8-o6oi RESIDENT DECEDENT A-�� J„l�
ENTER DECEDENT INFORMATION BELpW �^
Social Security Num6er Date of�eath MMDDYYYY Date of Birth MMDDYYYY
02/0712dt3 47J16t1980
DecedanPs Last Narne Suffix becedenPS First Name MI
Gray Wayne A
ilf Applicable)Enter Surviving 3pouse's Information 8e�ow
Spouse's Last Name SuHix Spouse's First Name MI
spouse's socia�Securiry Number THIS RETURN MUST BE FILED IN DUPLICATE WITH 7HE
REGISTER OF WIL�S
FIIL IN APPROPRIATE OYALS BEIOW
� 1.qriginal Return p 2. SupRlemental Return p 3. Remainder Ret�am(Date of Death
Pnorto 12-13-82)
p 4.limitetl Estate O 4a.Future interest Gompromise{date of p 5. Fgderai Estate Tax Retum Required
death after'12-12-&2}
O ti, �eceden!Died Testate O 7. Decedent Maint�sined a Living Trust __.�0 8. Inlal Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy oPTrust.)
O 9.Litigation P.��ceetls Received O 10.Spousai Poverty Credit{Date of�eaih O 71. Eiection to Tax under Sec.9'i t 3{A)
8etween 52-3'i-&1 and'1-'f-95) (Attach Schedule O}
CORRESPqNDENT- THIS SECTION MUST fiE COMpLE7ED.ALL CORRESPON�ENCE ANO GONFIDENTIAL TFX INFORMATION SHOULD BF DIREC7Ep T0:
Name Daytime Telephone Num6er
Micbael A. Scherer, Esq. {717}2d9-6PY3 � H
c � r;i
asaisTr�oF"�vi��s us�mN�v ���'
e,.:
� z
� c� ' \)
Frst Line af Addresa �� �
Baric Scherer LLC � �� - �- � �
:-� �� -
Second�ine of Address � �� �a -
19 West South Street � � c.� "
City or Post Office Siate ZIP Code �oaTE FILeo� � � ,�
�� i%
Carlisle P,4 170�3
Correspondent�s e-mai�address:mschererQbaricscherer.com
Un�er penaities of perjury,i tleciare thet i have ezamined this reWrn,inciuding accompanying schedules antl strttements,antl to the best M mY knowletl9e antl belie(
it is ime,cprrect antl complete.Declaretion of preparer ot�er than Ihe personal representative is based on all infnrma�ion of which prepa�er has any knowledge.
SIGNAT RE OF PERSON RESP SIBIE FOR FILING RE N �' . DA E //
l6�= � >t/Jft/F�.. _/t ��i/i�/il/'_--1� ��l��
ADDRE'SS ` I !
158 Crossro s School Road, Newville, Pennsylvania 17241
SIGNATUR" pAftEROTN/ERTHANREPRF.SENTATIVE �p)ATE
f��/ k.�'Z�/ s�
ADDftES
19 West South Street, Carlisle, Pennsylvania 17013
PLEA$E USE ORIf31NAL FORM ONLV
Side 1
� 15�56101�5 15056101CJ5 �
��
J 1505610205
REV-1500 EX(FI)
DecedenPs Social Security Number
oecedeorsName, Wayne A. G�By
RECAPITULATION
1. Real Estate i5chedule A). . .. . . ... . .. .. . . .. . .... .. . .. .. .. .. . .. .. .. . .. . t 249,900.00
2. Stocks and Honds(Schedule B) . . . . .. . . .. . .. .. . .. . . . ... . .. .. . ... . . . . .. 2.
3. Closely Heltl Corporetion, Partnership or Sole-Pmprietorship(Schedule C) . .. . . 3.
4. Morigages and Notes Receivable(Schedule D) .. . .. . . ... .. .. . ... . .. ... .. . 4.
5. Cash.Bank Deposits and Miscellaneous Personal Propehy(Schedule E). . .. . .. 5. 66,608.96
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . . .. . . 6.
7. Inter-Vivos Transfers 8 Miscellaneous Non-Proba[e Property
(Schedule G� O Separa[e Billing Requested... . .. .. 7.
8. To[al Gross Assets(total Lines 1 through 7)._. ... .. . . .._. .. .. . .. .. . ... 8. 316,508.96
9. Funerel Expenses and Administrative Costs(Schedule H).. ... .. .. .. . .. .. . .. 9. 61,551.35
10. De6ts of Decedent, Morigage Liabilities and Liens(Schedule I). ... .. . .... . .. . 10. 1,100.47
11. Total Deducfions Qo[al Lines 9 and 10).. .. . . . . .... . .. .. .. .. . .. .. .. . .. . . 11. 62,651.82
12 Ne[Value of Estate(Line 8 minus Line 11) . .. . .... .. . .. .. .. ... .. .. . .. ... 12. 253,857.14
13. Charitable and Govemmental Bequesis/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. � 253,857.14
TAX CALCULATION-SEE IN57RUCTIONS FOR APPLICABLE RATES
15. Amount of Line 74 taxable
atthe spousaltax rate,or
transfers under Sec.9116
(a)(12)X.0__ 16.
i 6. Amount of Line 14 taxable � � � �� � � � � � � �� � -��� �� �
at lineal rate X .0_ 76 �.
17. Amount ot Lir�e 14 taxable � � � � � � � � � � �
at sibling rate X.12 253,857.14 �7. 30,462.85
18. Amoun�ot Lire 14 taxable � � � �
at collateral rate X .15 �g
19. TAX DUE . . .. .. . . . . . . ... .. . . ... .. . .. . . .. .. ... .. _.. . .. _ . .. . . .. . .. 19. 30�462.85
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
L 15[]5610205 1505610205 J
REV-1500 EX(FI) Fage 3 File Number
Deaeden#'s Gample#e Address:
DEQEDENT'SNAME
Wayne A. Gray
--- -
STREETADDRESS � �`
176 Kercsvilie Road
_ _._._. —
CITY T S7A7F _---.- ZIP _ ___.__._
Cariisie PA 17p15
Tax Payments and Credits:
'I. Tax Due(Page 2,Line 197 (1) 30,462.86
2. CreditslPayments �
A Pnor Peyme�ts 36,000_00
B.Discouni 1,523.i d
� TolalCredits(A+B) (2) 37,523.1d
3, Interest —` '
t3�
4. !f Eine 2 is greater than Line t+�(pe 3,enter the diff�rence. This is the OVERPAYMENL i`- —
Fili in ovai on Page 2,Line 20 fo requesl a refund. (4j 7,060,29
5, If Line i+(.ine 3 is greater than Line 2,enter the diKerence.This is Ihe TAX DUE. {5}
Make check payable #o: REGISTER OF WI��S,AGENT.
. . ;''6 e^'. „°.°4i"A(�i:SS'° �' , ° " :i:m�L �..i4Poa 'ws:k F�itr . _ �" a§$�n�f�i'�u`.r4e�.;�.. '. . . _ ..
PLEASE ANSWER THE FOLLOWING QU6STIONS BY PLACING AN "X" fN THE APPROPRIA7E BLOCKS
1. Did decedent make a tra�sfer and: Ves No
a. retain the use or income of ihe property iransferred.......................................................................................... � �
b. retain the right to designate who shall use ihe propedy iransferred or its income ._........_.....___._..._......._... � �
c. retain a reversionary interest......................................._........_......_............._.............................._.................._ C] �
d. receive the promise for li(e of either payments,benefits or care?...................................._......................,......_. [] �
2. If dealh occurred after Dec. 12,1982,did decedent transfer properry within one year of death
withoutreceivingadequateconsideration?............__._................................._._............_......_......_._.........._..._...... I� �
3. Did decedent rnm an"in trust fpr°or payable-upa�•death bank account or seeurity ai his or her death?.............. j� �
4. Did decedent own an individual relirement acsaunt,annuity ar other non-probate pmperty,which
containsa6eneficiarydesignation? ..................................................._......................_......,.,......_............_............ � �
IF TNE AN5WER TO ANY 4F 7HE ABOYE 4UESTIONSIS YES,YOU MUST COMPLETE SCHEDULE G ANp FILE IT AS PART OF THE RETURN.
. � � ,. ._ FR�'��t�Yiv.�t�Vb�', . ��`�k' `� .. . . .
For dates of death on or after July t,1994,and betore Jan.1,1995,the taY rate impased on the net value of transfers to or for the use af the surviving spouse
is 3 peroem[72 P.S.§91�8{aj{1.1}{i)(.
For dates of dea�h on or efter Jan. 1, 1995, the tax rate imposed on the net value of transfers to pr for the use of the sun�iving spouse is 0 percent
[72 P.S.§9116(a){1.1?(ii)].The statuta tloes not exempt a Uansfer to a surviving spouse from tax,antl the statuCory requirements ior disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only bene6ciary.
For dates of death on or after July 1,200D:
. The tax rate imposed on the net value of transfers from a deceased chiltl 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a stepparent af the chiid is 4 percent[72 P.S.§9118{a}(1.2�].
• The tax rate imposed on the net value of transfers tn pr(or the use of the decedenPs lineal benefciaries is AS percent,except as noted in(72 P.S.§9116(a�(1)}.
• The tax rate imposed on [he net value of transfere to or tor lhe use of Che decedent's alblings is 12 percent(72 P.S.§9118(aj(1.3J]_A sibling Is defined,
under Sec6on 9302,as an individuai who has at least one parent in common with#he decedenf,whether by blood or adaptian.
REV-1502 EX+(12-12J
�pennsylvania SCHEDULE A
DEPAq7MENTOFREVENUE
INHERITANCE TA%RETl1RN REAL ESTATE
0.ESIDENT DECEDENT
ESTATE OF:
Wayne A. Gray FILE NUMBER;
21-13-0304
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 exchanged 6etween a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
I7EM Indude a copy of the deed showing decedent's interest if owned as[enant in common.
NUMBER VAWE AT DATE
OESCRIPTION OF DEATH
1' Sale of 176 Kerrsville Road, Carlisle, Pq 17015
249,900.00
copy of HUD1 attached
TOTAL(Also enter on Line 1, Recapitulation.) $ 249,900.00
IF more space is needed,use additional sheets of paDer of the same size.
. _ . . . . _ . _ . . _
REV-i5o8 EX+(o8-ia)
�pennsylvania SCNEDULE E
ei1 DEPARTMENTOFPEVENUE CASH, BANK DEPOSITS & MISC.
aES oeN NoECEOEN1TUR" PERSONAL PROPERTY
ESTATE OF:
Wayne A. Gray FILE NUMBER:
21-13-0304
Indude the proceeds of litigation and the date the proceeds were received by the estate,
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1. Edward Jones Cash Account#528-98626-1-6
49424
2. Edward Jones Mutual Funds Account#528-98626-1-6
17,098.86
3. 1991 Chevrolet Corvette: Edmond.com value
5,087.00
q. M&T Bank Checking Account#1130064
22,786.95
5. 2013 Counry Taxes: proration in favor of estate on HUD-1
320.90
6. 2013 School Taxes: proration in favor of estate on HUD-1
2,799.15
7. 2007 Ford F-150 XLT: sale amount in arm's length transaction
14,051.86
g. Dental Dental Reimbursement
519.00
g. Personal Property Auction Proceeds
3,451.00
TOTAL(Also enter on Line 5, Recapitulation) g 66,608.96
[f more space is needed, use additional sheets of paper of the same size.
REVd510 E%+(OB-09)
� pennsylvania SCHEDULE G
°E`"RT"F"T°`R`°E"°E INTER-VIVOS TRANSFERS AND
�NNea�.nncer,ucaeruaN MISC. NON—PROBATE PROPERTY
RESIDENT�ECEDENT
ESTATE OF
Wayne A. Gray FILE NUMBER
21-13-0304
7his schedule must be completed antl filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ffEM DESCRIP710N OF PROPERTY
NUMBER ��'cwoerxExnnEarrxeraarvsrEaee,rxEiaaEUnorvsxmrooECEOEUraxo DATEOFDEATH °/aOFDECD'S EXCWSION TqXABLE
THEORiEOFTMN5FE0.. AIIACHpCOPYOfTNEDff�FOP0.EAlfSiqiE. VALUEOFASSET INTEREST �
p�npoucne�E VALUE
1 Transamerica 401 k Retirement: Stephany France,friend
273,763.68 100 100.00 0.00
2 Central PA Teamsters Retirement Fund, Norma Mellott,friend
56,977.23 100 100.00 0.00
3 Central PA Teamsters Retirement Fund, Lisa Browne,sister
56,977.23 100 100.00 0.00
TOTAL(Also enter on Line 7, Recapitulation) ; 0.00
If more space is needed,use additional sheets of paper of the same size.
REVdSll EN+(]0-09)
�pennsylvania SCHEDULE H
oeaaArneru*oFaeveNUe FUNERAL EXPENSES AND
,rvr+eR�raNr,E rax aeruaN ADMINISTRATIVE COSTS
RESIOENT UECEDENT
ESTATE OF
Wayne A. Gray FILE NUMBER
21-13-0304
Decedent's debts must be reported on Schedule I,
ITEM
NUMBER DESCRIPTION
A� FUNERALEXPENSES: AMOUNT
1 Eby Granite Works
2,137.00
z Hoffman Roth Funeral Home
3. Burial Plot 12,519.82
400.00
4. Funeral dinner
300.00
e. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) '
Street Address
City_ State ZIP
Year(s)Commission Paid:
Z� Attarney Fees:
15,825.00
3� Family Exemption; (lf decedent's address is not the same as daimant's,attach explanation.)
Claimant
Street Address
City State Z1P
Relationship of Claimant to Decedent
4� Probate Fees:
428.50
5� Acrountant Fees:
6� Tax Return Preparer Fees:
350.00
� The Sentinel(legal advertising)
157.68
8� Cumberlarid Law Journal (legal advertising)
75.00
9� Estate check fee at Members First Federal Credit Union
16.25
�o� Kohls's
12.05
>>. PPL
551.57
................«...,«..„SEE ATTACHED SHEET«.«..,,..,.«..._....««„,..,«..„«.,.«.„,.......,».,......
TOTAL(qlso enter on Line 9, Recapitulation) $ 61,551.35
If more space is needed,use additional sheets of paper of the same size.
Estate of Wayne A. Gray
Estate No. 21-13-0304
SCHEDULE H CONTINUED
12. Garbage bill $ 50.00
13. Sollenberger's -vehicle title transfer $ 103.50
14. Seller's assist $ 7,497.00
15. Real estate commission $14,544.18
16. Brokerfee $ 195.00
17. Title insurance $ 15.00
18. Transfer tax $ 2,499.00
19. Pest Inspection $ 50.00
20. 2013 County Taxes $ 738.67
21. Septic Pumping $ 200.00
22. 2013 School Taxes 2 886.13
Total: $28,778.48
REV-1512 E%+p2-1T)
�pennsylvania SCHEDULE I
oeanarMeNroFaevENUE DEBTS OF DECEDENT�
�mHea�TaNCe r�ix aeruaN MORTGAGE LIABILITIES & LIENS
RESIDENT UECEDENT
ESTATE OF
Wayne A. Gra FILE NUMBER
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,includinq nreimbu�rsed medical expenses.
ITEM
NUMBER DESCRIPTION VAWE AT DATE
1 OF DEATH
Target Store
40.48
2. Chase cre:dit card
280.00
3. Kohls
12.05
4 Comcast
58.36
5. Dr. Blashford
704.00
6. ATBT
5.58
_ TOTAL(Also enter on Line 10 Recapitulation) $ 1 100 47
If more space is needed,msert addrtional shee[s of[he same sae.
REV-1513 EX+ (01-10)
� pennsylvania SCHEDULE ]
�EPAqTMENTOFFEVENUE
�NHea�TnNCe.wc nen�nN BENEFICIARIES
RESIDENT pECEDENT
ESTATE OF:
Wayne A. Gray FILE NUMBER:
21-13-0304
NUMBER NAME AND ADDRE55 OF PERSON(5)RECEIVMG PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
I 7AXA8LE DiSTRIBUTIONS pndude outright spousal distributions and transfers wder po Not List Trushe(s) Of ESTATE
Sec. 9116(a)(1.2).]
1 Lisa Browne sister o
100/o
158 Crossroads School Road
Newville,Pennsylvania 17241
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
�t NON-TAXABLE DISTRBU710N5
A. SPOUSAL DISTRIBUIlONS UNDER SFCTION 9113 FOR WHICH AN ELEQION TO iAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON�INE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
' ��'I„`I� �. Se�#lerr�ent Statement HUD'� UMB APPro�ial No.2502-0265
_ '.:'��i�;;' { )
�.� � y
l [ ,� =HA 2�]ftHS 3.Q Conv.lJnins. 6.File Number: 7.Loan Number: 8.Martgage Insurance:Case Num6en
Y3-itt 13066t3513 16-108-0650291
4.[)�,�✓N 5.�Conv.Ins.
C.N���ie:This form is furniahed to givC yau a statement M actual setllemant costs.AmouM9 pa�to antl kry the setNemerA a9e�ts are si�own.items maACed
"�p.o.c)"were paid outside the closing;they aro shown here for in(p�mational purposea antl are nW inclutletl in the to�als
D.N a ne&Addn=ss of Borrowec E.Nama 8 Atldress of Sellec F.Name 8 Address ot Lender:
tv*cron _Sm�N,zMtrey M.Sm1h Wayoe A.Gray Vision MorigaBe Gapital,a Divleion of
L570��awvilla Roed.Carl'�sle,PA 17�15 7I6 Kemv7le Roed,Csrlisle,PA ttQ15 Cor�ti�Bank 626 West C�rmar�trnm Fika,
Suit,PlymoNh Meeting,PA 194fi2
G.Prcperty location: H.SettiameM Agent: I.Settlement bete:07/1?2073
1761 u>rrsville Road The Ww OHice of P.�uhew H.Shaw,PG Dis6ursen'�ent Date:0711712t7t3
Cadisle,PA 7�Ot 5 200 S.Spnng GaMen Svcet Suite it,Cadisle,PA 17013
Wes=PennsCOroTrnm5hip
Telepiwne:717-2C3-7135
Place of Settiament: TitleE�ress
200 S.Spnng Gartlen Street,Suite 11,CBrlisle,PA 17013 Printed 07/72/21113 at 9:24 am
by MAC
tOU. GrossMwuntDuefromNortqwer 460. GroaaAmomrtDueloS�eller
101. Gontr�ts�esp6ce 2&Q . OL Ckmtrac[s�s{xiee,_,,,`_� 7C9,B�0.66
702. F'ersanal OroPerty 402. Pe(ao�al pmCe�ty �
103. Setliemeni cAarges t4 borcower(line 1400) 14,293.18 403,
tCA. AD4.
105. 405.
Ad usiments kr Ibme aitl 6 seller io advan�e ustmenh iw itemc b seller in Wvance
ip6. Cityttpwntaues ro 406. Cirytlown�ates lo -
;Q7. CouMyi�es 07tt?12613tot2(311201"s 326.90 C07. Courtytanes 07I17J2013to12t3112613 320.96
tOB. SchadTazes 07717I2013m06l30l2044 2,799.75 448. SchooiTai� 07112t2013W�l201d 2,7g9.t5
109. 409.
no aia.
�;�. a��.
»z a�z.
120. GroasAmountDuefirom6onawer Y67,31321 4Y0. GropAmountDueb9ellar 253.020.a`
2q0. AmouMS Paitl ar i�Behai(o(Bartowe� 500. Reductlans In AmouM�ue ta Seller
2(it. OeQosltae�naalrtqneY t,W0. 60i. Excessdeposiriseain�s)
2�2. PrincipalamountMnewloan(sa 255,897.9p 6�2. SelllamentchargesWSeUer(8rre1400) 21,127.98
203. F�isU'n b sitakensu6'ectto 503. ExiSUn Ip s takensub'ectto
gpq, 504. Pa oB of frst mo a e ioan
205. SQ5. Pay�WSec�drtbrtgageban
206. 506.
207. SellerAssis� 7,497.00 5W. SellerAssist 7,497.00
N73, 508.
209. �.
Ad'ueGnantaforkemsun aid seller uatmenhfo+ikmsun ' h aeNer
216. Ciryflrrxn ia�ees �0 410. Cityltavn tenes to
211, fountytaees to 5't. Ca,ntytazes to
2i2. SehoolTaves ta 912 SchwlTa�ces to
213. 513.
214. u 574.
215. 515.
216 51&
277. E�77.
218 518.
255. 519.
120. 7ota1 Paltl p Nor Botrov.er 1W,J94.00 5tU. ToW Redustb�Mwunt Due Sdkr S&624A8
700. Cash at 9ottlameM homRO 8orrowar 6W. Caeh at 5ettlemenl WThom Seller
api. ��y��dueimm0o�*ower{Ii�f7Jj 2f7,31321 5p1. GrossartwunttlusSasHler(Iine420} 253,020.65
302. Less artwunts P�byflw bortowar{li�ce 220j 264,3gp.qp 6p2. �s retludions in azrwunt aue SeHer(k�re S20} 2&,624.98
103. Cash Q From ❑ To9orrower $91821 693. Cash XQ 7a ❑ PromSeee t24.395A7
Mn11ENpryau�urmmUyv�l1<tlMBW�urrmb�.WOOnFNMYIryNeuvp:ulftlrlaurolam�Nelory.TaµJVlpMbpevly���pWe�psREHPPmw�afM1�melbn'Mt�4NeimWUnJUrMqme �
�N
Previous e��tions arn o6soleCe Page i qf 4 HVD-1
• 706. TMelRealESWteBrokerPeBS $74�`.�M4.18 PBid FfoRl Pdid F�OITi
qivisiaiotcaiumsvo�[ne700 asfdt�: Borrower's Sel�er's
701. ;717209 roJackGaughenRealtorERA Fundsat FUndSat
���. $7272.09 �o P�+tlen�ialHomesaleServicesGroup Se[[lem2nt 5ettlement
70.3. Commissbnpaitla[urilement tA,544.18
704. BrokerFC: �p WAIVED
705. BrokerFee �p JackGaughenRealtorERA 195,00
BW. kems Po 6Ie in Connectton wiFh Loan �
801. Ourorigina�'ancharge {InclurksOrigin�nPqntO.OW%or54.W} $R500 {ham�iFE#1}
802, Vour credi:or charge(points)or Ihe speC�c iMeres�rate chosan $ (from GFE# !
8(i3. Your adjusi��rigination charges ( an GFE A) 775.Op
804. Apprasalfee to ' },��p p�. (4mmGFE#3) 3'7500
8�5. Credilrepotl WKrdlfactualData {fromGFE#3j 89,44
CO6. Tat service �o (hom GFE#3)
9�7. Flooa certification Co Yvdi�aau�Dala (fran GFE#3) 806
808. Ellie Mae Closing Fse to Vision Motl e Ca ital a Division of {hom CrFE 7l3j 1q0.p)
fl03. ReinspeN�m Fee to Ritl e Marketin Assoc. (from C,FE#3) 100.00
9�. ttems utred lenderta be Pqid in Advance
907. Daityiotaresichargeshom trom07l11l2Q73to48/07fL013�$24.53817tlay (fromGFE#10} +90.7fi
902. Motigage insurance premium fpr months to (from GFE 3)
9a3. Horr�eownets insurarrce fa 1 ear to Erie insurance (from G E#i i) 604 WI
904. mcnihs t� flrnn GFE#t'!
905. VAFuntlinuFee tor rnonihsto �fromGFEMJ) 5,99L6(�
1000.Re rv Oe os wi L der
1909. initi�depositforyouresprnra�rt (immGfEA9S 74A.3E�
tOD2.Homeownei^sinsurance 3�{hy g �.34{��h $151.02
1003.Mortgaga insurance man�hs $ 0.001month 8
1004.PropeRytazes & monihs $ 5G.42ImaMh 5338.52
1�05. 2 months S O.IX77rtronth 5
1006.School i3�es Z rtpnihs $ 245.42/rtwnth $�+��54
h607.Aggrega�e ptljustment 8-276.p2
it00.7NeChar es
11�t.Titieservicesandkndetsiitieirc,�¢axe toihet�v�tYiceofAndrewh (romGFE#d Z,05 .00 15.00
1102. Setllement cr closing fee to $
1103, Ownerstitleinsurance-FirstAmencanTltlelnsuranceCO. tromGFE#5
11a0.lendetsiiHeinsurence-FirstAmericanTlflelnsurdnCeCO. $1,690.00
11Q5.Len�ielsJile,�licyldnft$2`a5.887.90 LentletaRoBty
1106.Oimefs litle policy limtt$249,9q0A0 Q+mefs PoliLy
5107.AgenfspotlionMihetotalMleinsurancepremium $1,344.00
to The taw tNtice NAntlreau H.Shaw PC
1708.Under�ntefspatianWthatokN�tleinsurmxepr�um $336.�
to First Amercan Title Insuranca Co.
1109. to 8
tI06.Govemment Record'm and Tranetar Che ee
1207.Govermientr��ngch2rges $ {from6FE#7j 170.60
1202. p�86700 MM e$iQ3.00 Release$
1203.Trensfert�eu $ {fromGFEttB) 2,499.W
1204.CdytCo�,mty taxtstamps Oeetl$2,-099.00 Mon a e$
1205.SEateTa+Jstaips peed$2,4E9W e$ 2.A99.00
1206. UPIFee py�$ �
72W. $
13W.AdditiaeaiSettiertrentCh es
1301.Required servicps Ihat you can shop or {from G E } .�
1302. Suney �o
1393.Pestlnsp�tion W!n PlNOmsl� imts $ 50.00
1304. 2013 County Taxes t4 De6orah Pi TaY Cd�Cbr .6
1365. Septic Pumping (o Swda 5e�ip 5ervice S 2� .
t3C6.Waferinspedi>,r tains aPlHOmesins �on 5230.
1307. Septiclnspectinn toSurMa Se�bSenices 1��
1308.261 School T�es to Oeborah Pi eL 7ar Collector $ .7
� 74,293A6 27,727.
'?a�tl ouisian of dnsinc by(6}mrower�,(S)ener,(Ljantler,(i}nvesior,8ro(K�ec°Cretlit by Iender sham on page i.^"Credit by seller shavn on page i.
Previous etli[ions are obsdete Paflp Z of 4 HUDQ
:omparsqn of Good Faith Estimate(GFE)and HUU-t Charges Good FaiM Estlmate HUQ-t
, Ch . Th�U�nnotincrease HUD-0LineNumber
Ourod9ina�ionchar9a $ &(!1 RS,W 775.06
°uurcreditorchurge(ooin�s)(orthespeclACinterestra[eqhosen p 802 O.W G.CO
�curudi��ta�fo�i7insl�nukazges g 803 775.00 775.00
Tra_s°e��.axes � � 12Q3 2,499.� 2,qgg.pp
Char es That in To[ai Cannot Increase More T�an 10% Good Faitli Esdmate HUD�1
Fove«rrisnlieC+HC6ngcharges # t241 207.06 170.W
Appreisal fee � g 804 450.G0 37$.�
CreditrEppn � p 805 50.00 3 .44
7a.seniss � �&0& 606 0,06
Fiootl aertificatian q 807 S.�Q g,pp
EIIi=MaeCiosin�Fee q 808 10 .00 10 .00
Relnapeeticr.Fee.-' g �9 125.00 100.00
V4fundingFee � tl 905 5,99764 5,�7.60
Pesi�nsUw%BOn p 130 0.00 0.40
2�;35cheoiTaxe- g 130 006 .0�
"� g 130 OOQ 0.�
,830.6� 8,780.04
$ .1A0,56ar -2.0261%
Cha es That Can Change Good FaiM EsUmate HUQ!
initi�depasitiwycwrescrcrwaa'AUnt g 16ai 9,11 .04 704.36
�ailyintereslcharc�esfrom p90i 24.5381M 3t902 496.7&
Nomernvners insurance q 903 84 ,00 E44.fl0
Titie services and 6�tlefs ime insurance # �id1 2,071.00 .,05�.0�
Ownets Utle lnwrence-Fkst Ar�lcan FIt1e lowraece Go- p t9Q5 G.O� .00
Walerinspectiun $ 15 OQ 23R.W
Septic ins cfion # 0.00 150. 0
LaanTerms
Your,r,iga�iazn amcm;tis $255.887A�
Your Poan term i; 30.years
Your ini0ai nter�st r,�ta fe 3.500p%
Yourinitiaimomhryamountuwetlforpnncipai,interesLandanymotlgage $1,149.09includes
������ Q Principai
Q Inlaresf
❑Mwtg�e Ir�suranCe
Canyourirteresttat�rise? QX No. QYes,itcanrise�oam�irtnimot %. Thefiretchange
wlll tie on 1 ! antl can Gu�gs�n evety Yeazs aft& t ! Every
Glangedate,yourinterestretecanincreaseartlecreaseby %. Overthelifetl4
the ioan,your iNerest raie is guaranteed io never be�ov,er Ihan %pr higher
than %.
Even it you make paymenis tln tlane,can your ben 6alame rise? Xe]Na. Q Yes.it c�rise ta a manirmm#5 .
Even if yca make paym�ts on tur�e.can yar m�NiY�+r�tew�#a' �No. Q Yes,ihe first inerease can be on t 1 and ihe monNiy
pdncipal,interest,anA motlgage insurance dse? amount mved can nse to$ .
The maximum it r,�n eVef rise to i9$
Does your loen have a prepaymeM penalty.� Q No. ❑Yes,your maeimum prepayment penalty is$ .
poes your loan hnve a balloon paymenf? Q No. Q Yes,you have a balloon payment M$ due i�
years on ! !
totai rtronthry amoum owetl indutling escrrnv accoum paymenis ❑You do not have a monlhy escmw payment for items,such as property Cares
ar�d harr,ecvmer'S insurm�ce. Yw musf pay these items tlaecity yourseH.
�X Youhareana9�tia�alma�thryes:rowPeYment�S352t8
�hat msults in a rotal initial monNly amount owetl o�$1.501 27. This inclutles principal,interest,a�
mqrtgege insurance and any items checketl beiow;
X❑Ampely i�¢S �HOme�m�t5 m5urance
�Fbctlin5urance Q
❑ ❑
Note: If you have any questlons about ihe Settlement Chargas and Loan 7arms listed on Nis form,please wnract your lender_
Arr,viaus editions arc otrso�ete �age 3 of 4 HU41
' HUD CERTIFICATION OF BUYER AND SELLER
I have cnrefwry�reviewed the HU0.1 Settlement Statement and to ihe best of my knowleGge antl beliaf,it is a true antl accurate statemem ef atl receipts antl
disbursements made on my account or by me in ihis iransaction.I fuhher certi(y ihat I have receivetl a copy of Me HUDt Settlement Statement.
� ///
j G✓t'�// .� '__"'L��rt�l' // . ��/�
�� �
Nicole I_Smilh
Jeffrey M nn /
WAYNE A.,GRA`i
i �
�`�� ,.� �-n a�,�i,
�, � �
L�rz �3�aU�v
The HU61 Settlement Statament which I heve preparetl is a tme antl accurate eccount o!this t2neattion.I have causad or will eause the funtls lo be
disbursetl in accoMance with ihis statement.
/
SETfL MENTAGENT � /`� _ /�
DATE
WARNING:IT IS A CRIME TO KNOWINGLV MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANV SIMIL4R FORM.PENALTIES UPON
CONVICTION CAN WCLU�E A FINE AND IMPRISONMENT.POR DETAILS SEE TITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010.
Previous editions are obsolete Page 4 of 4
HUD-1
.
� Nv��e ut&artvmer Name af Selier: Fie Number.
Nicwle L Smith Wayne A.Gray 13411
JEiRrey N'�..Sm ih
Pr�azx1 OT�'i2t2013 ai 9.34 ert�
Note:This page tlisplays an itemization qf the charges shown an line 1101 of the HUD4 Settlement Statemen4 Thia�page
accompanizs but is not a part of the HUD-t Settlement SWtement.If a discrepancy ezists,the information on the HU�d Settlement
Statemenf applies.
1100.Title Charye�s Total Charge Borroner Seller
��p�,Titleservip�sandlentlefstlelneurance ipTheLawOffiaeo[An�rewH.Shaw,PC
Natarp Fee t9 Mdrflw Shaw $ 25 W 26.IX)
Ovemicp;tFee foTheLawO(ficeMAntlrewH.Sh�$ N7.06 2q.IX�
Duwment Prep.Fee Iq The Law OfOce qf Antlrew H.Sh�$ 100.00 1IXI,IXI
T;�Cen,F� a Ww Offce of Antlrew H.Shaw T$ 5 00
5.
NNary�ee to Mtlrew Straw $ "0.06 10.
�IXl No VroIN66 to pmarp,v y.ShawrFATiCO $ �.� 50.q0
3WSurvey'3W toAndrewH.ShawIFATICO $ 50.00 50.OG
900EPL�Re918.i toAndrewH.Shaw/FATICO $ 50.00 50AG
CWsir.gSvCi.IdCL toAndrenKShawlFATiGO $ 7flL�(1 7�,pg
11025etikment�Nd4si�fee �p g p.dp
itOA.�enaef;tiVeinsurance-Firs�AmencanTittoAnarewH.ShawIFATICO $ 7,880.00 '�,680.00
tias. a $ a.00
rwets s s,o so� o.aa z,oso.00 �a.
SeiierlLendercredibshavmon et POC=PaidOutsideCWain CR=LenderCrecGt
�
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AUTHORIZED PFPRESENTATNE � DATE
MAILIIVG PG�RESS
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AUTHOIi12F.0 REPRESENTATNE
tdAYNE A GRAY
176 KERRSVIL.IE RD
CkRIISLE PA 17Q15
' ALLEN D BIEHLER
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$6;484
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Private Party Sale � � � �� �
Pricing Details for a 1990 Chevrolet Corvette $5,087
ZRl 2dr Car
Customized True Market Value� Prices
Tcade-In. �:Private.Party DealerRetail
National Base Price �� �
Optional Equipment $3'fiZ$ �$4�,468 $5,868
Targa Top - Solid and Glass ��$ � $47 $107
Color Adjustment - Light Blue $18 � . . $47 $107
Regional Adjustment- for Zip Code 17013 �O � $� $�
Mileage Adjustment - 72,000 miles � � $-150�� . . :` ��$-1'85 $-243
Condition Adjustment - Clean $757 ��757 � �75�
Total $0 $0, $0
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Buying a Certified Used VehicleDealer Retaii
Certified Used Pnce
For Sale in Your Area Vehicle not eligible for certification.
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Photo not provided
Price: Not Listed
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AutoCheck Vehicle History Report
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499 Mitchell Road,Millsboro,DE 19966 Adjustmen[Services
Phone 888-502-4349
F az (302)934-2955
April IQ 2013
Baric Scherer LLC
Attorney at Law
19 West South Street
Carlisle, PA 17013
Re: Estate of Wayne A.Grav
Social Security: 167-56-0153
Date of Death: Febniary 7,2013
Dear Sir or Madam:
Per your inquiry on April 5,2013,please be advised thaz at the time of death,the above-named decedent had on
deposit with this bank the fotlowing:
l. Type ofAccount Checking Account
AccountNumber 1130064
Ownership(Names oJJ Wayne A.Gray
OpeningDate 09/11/1992
Balance on Date ojDeath 8 22,786.95
Accruedln[erest $ 00
__-- __ . .
Toral S 22,7S'695
2. Type ofAccoun[ lnstallment Loan
Accot�ntNumber 12044440922114998
Ownemship(Names o� Wayne A. Gray
Opening Date 08/21/2002
Balance on Date ofDeath $0.00*"This amaunt is not to be used for
payoJjpurposes. For a payofjbalance,
please eall 1-8 00.72 4-2 44 0
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For any addiNooal inPormaHOn oo the above accoun[s,including ownership aod any cAanges,closures and/or reimbursement of fuods,
please call the Carlisle Pike at 717-7951710.
We were uneble to locafe any safe deposit box(or the above-menfioned decedent
This letter daes not include eny accounb in which Ne deceased may have been IisOed as Power of Attorney,Custodien of Uniform TransRrs,
Representative Payee,or Trustee under a Written Agreemeot
Sincerely,
Valazie Mercer
Adjustrnent Services
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IdAYNE A GRAY �
Y76 KERRSVILLE RD
CARtISLf IPA 17015
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E OA PRINT)Certificate of Title must be submitletl within 20 days,unless ihe purchaser is a registered dealer holding the vehicle for resale. �
WARNI NG - FEOERhL ANO STATE lAWS REOUIRE THAT YOU STATE THE MILEAGE IN CONNECTION WITH THE TRHNSFER OF OWNERSHIO FAIIURE �
TO WMPLEfE OR PROVIOING A FPLSE STATEMENT MAY RESULT IN FINES OR IMPRISONMENT. �
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b C � I ����fI�PNING OW�Bftl C�p9�Y $1pEEi � `0.f sFS�,. �
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90 PURCHASER MUST i I
HANOPflINTNAMEHERE MM1�I i�l�i pY�
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"i' SELLERMUST �" �"��TMr���i �'.:
HANOPflINTNAMEAERE � �
C�IF�,C�,�„F�,�E,,i{E,IF Ap,P,UOATION FOR DEALER,TITLE�ANp,COMPLETE SECTIOND TITLING FEF�$„$., ,,,,,,,,,,,,,,,,,,,,,__.,,,,,
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P:O. Bax I87, Newvilte, Pa. 1724I-b18 ' S�t
Fhone: (717) 77b-S118 � �,;�.�,.f..
Name �. �:�:�d r�,:f�,`.r.=� ��.�.�1 Date ����"��
A£�(jC@SS :�':�t�' f IG :•d- ry°7e1i? :�`<. + ';;:. ek�;F: . r�,,�c dr'i.�t;.t4�' ,�� zlp. 1�.7�wY/
Phane �`B.��',�'�t= '� %�t.?� Gorner F'ost� .' `""".�""`"""'`'
Monumenfi ,,: �r , � a ..;:~ ,� ` � .:u,l.�a Flower Vases [�] ~-"°"�'""��
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8evel � � � , � EeFtte#eryAS�-a'tr:�s;�:.��rn�:ria ��'rr�rr, h� �r, <
Grass Marker Name �n back �p��pAT10N
Design � �1� � %s,s� <-;F ?�� -� `" Ye§ ; �la, , W�AF3RAI�TY
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N..:. . �,., a�:.;. � , �.r:.. .*"iJ..r�.....:..... take full resp�nsibility for the accuracy y;B 8�J '
af the above speliings and dates.
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❑ Check How to (�atter ` .. Letfer this way-�pposife
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Jnit Price $.�%:_;Er,��:� Flower��Vase��$� - � �� Corn�r Past $� �� ,�Mis�.$ �� �
—� _ To#al $ �� . ., .� =`� DeposEt $ .2/.��7:aa ' B�lanc�'.$��______
. �{ �99�gC� .
1 agree that said rr+emarial,with title tkereto and right ot possession thereof,sheii remain your peisohal properiy,u�tii i have paid for it in
.tn default of any payment.hereunder, l Ucanse you m repossess artd remova the said m�moriei wfthtiat,g4�t o�ttespass ar oMer wrong.
€auUwrtre and empc�ver yau,in my name and on my behalf to appty to 1he managemeM of sdid c&�t�e�o��at€ieyp�5em�ses;ior a pertnh
rts removat and fo take any other steps you may deem necessary,or a�edient andYurtt�ei4agreQ�Ca,save��ipu'�a,�ntkss Erom any,entry,
�sSe�sion andilremoval yau may retam sai'd memonal or c�s�loss,o€ifi af your oivn diseretiq�;w�tKocR�l�e,i�g�g��`�^texia*`me for•it ot any
:§eii�^tlterefirck�i:�'� _ _ -
Orde[s subject to cencellation.AU coniracts contingent upon strikes,accidents,and other causes beyond our cnr�traL
!u�dersisnd that30 d8ysafterpiacement of the memoriai a FINANCE CHARGE:wi�l be entered on thebiiMiFig date.lYisedrt�puted byaper}odic
�f t'h°k permonth wt�icfi is an ann�at psreentagerate:of•t&%appiletl to ihe previous batence kiefare deducting creiiits;payments or adding
tases appeadng on ttiis siatsmeM.Ta ayoid FINAN,CE CNARGE pay tfie''New balance"before ihe.tiiiimg°d`ata nszi rcionth:
AGREE TMAT ALL CETTEHiNG ANDDATESGIVEN ON ABOVE OHQER"AHE GORRECT. `
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' 214 Narth HanOVerStreei
Carlisle,Pennry!vanira 7 7013
�)7.243.4571
� `�l toli free 1.866.451.451 1
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www.hoftmonroth.corr�
j�/� FUNERAL HOME &z CREMATORY, IN C. into�hottmamotn.com
March 28, 2D13
Lisa Srowne
15S Crassroad Schooi Rd.
Newviile, PA 17241
Stat_ement of F�nerai E_xpenses for: Wayne A. Gray _
-_. ___ _ _. _
Date of Death: February 7, 2013 Accou�t id: 16798-042
PACKAGE:
Traditionai Funeral Service
TRADITIONAL FUNERA�SERVICE PAGKAGE $ 4,850.Q0
Sub ToWL $ 4,$5Q.40
MERCHANDISE:
Casket: Montgomery S 3,545.0�
Outer Container. Monticella $ 1,62Q0�
Sub Totai: $ 5,765.04
AUTOMOTIVE EQUIPMENT:
Transfer of Remains $ 985.00
Suk Totai: $ 985.00
TOTAL FUNERAL HOME CHARGES: $ 11,000.00
CASH ADYANCES:
Reiber's Church Cemetery � 550.Op
20 Certified Death Certificakes at$ 12.00 each $ 24Q.00
Newspaper Notice-Sentinei $ 208.02
Newspaper Notice-Washington Observer $ 125.06
Glergy $ 1Q0.00
Flowers $ 2'12.00
Flawers (companion) $ 84.80
Su6 Totai: $ 1,519.82
Totai Funerai Expense: $ 12,519.82
Payments Made:
Balance: S't�19`92
SERVING OUR CONiMUNIl' Y SINCE 1907
._