HomeMy WebLinkAbout09-27-13 }" permsylvania 1505610143
OCPPPTI.E lor.M.uE Ex t06.-13)
REV-1500 OFFICIAL USE ONLY
County Code Year File Number
Bureau of Individual Taxes
PO 60x.280601 INHERITANCE TAX RETURN 21 12 0477
Harrisburg,PA 17128-6601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Binh
04 09 2012 09 25 1932
Decedent's Last Name Suffix Decedent's First Name Mf
WILLIAMS NANCY E
(if Applicable)Enter Surviving Spouse's Information 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
1. Original Return ❑ 2. Supplemental Return 3, Remainder Return(Date of Death
Prior to 12-13.82)
4. Limited Estate 0 4a.Future°"¢rest Compromase L] 5. Federal Estate Tax Return Required
(date of death after 12-12$2)
u 6 Do dent Died Toslan, f—1 DeGetlent PY�of�NSna Living Trust D 8. Total Number of Safe Deposit Boxes
u (Attach Copy of Will lJ (A11aGh Ga
a. Litigation Proceeds Received �� 14.e ivr e�P2-31-91 ar�f ipa2SeS}f Osath 11,Election to tax under Sec.el 13(A)
(Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
DAVID W DELUCE 717 761 4540
First Line of Address
301 MARKET STREET
Second Line of Address
PO BOX 109
City r Post Office _ ^• '�
tY State ZIP Code `
LEMOYNE PA 17043
REGISTER;OF WILLS US£ONLYt
REGISTER OF WILLS USE ONLY ,.0
$11 ,1) ID l y `I Y Y ra c`
Correspondent's e-mail address: dwd dsw.com
DATE FILED STAMP
Under penalties of perjury,I declare that I have examined this reform.induding accompanying schedules and statements.a d to the best of,my knowlpdgerand belief,
it is true,correct and complete Declaration of preparer other than the personal Ivpresentabve is based on all information oflahich prepare has any TCnowledge.
SI TURE OF PE ON 0O IBL' OR FILING RETURN ATE.
"'Au, /{ltts7 Danny E Parthemer 7��a��
ADDRESS
40Aro-hIev Land, E erS PA 1419
SI AT R OF PRE 0 H N R P ENTATIVE TE
t DAVID W DELUCE 9 l
A D E
301 Market Street, Lemoyne, PA
Side 1
1505610143 1505610143
-J 1505610243
REV-1500 EX -
Decedent's Social Security Number
t Decedent's Name' Nancy E
RECAPITULATION
1. Real Estate(Schedule A)..................................................................,.................... 1. 134 , 900 . 00
2. Stocks and Bonds(Schedule B)................................. ........... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3. -
4. .Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 10 ,369 . 75
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 0 . 00
7. Inter-Vivos Transfers&Miscellaneous I(oq Probate Property
(Schedule G) (J Separate Billing Requested............ 7. 41 , 244 . 14
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8, 186, 513 . 89
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 9, 115 . 65
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 19, 693 . 29
11. Total Deduct ions(total Lines 9 and 10)_........ .. .. ............................................... 11. 28 , 808 . 94
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 157 , 704 . 95
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, 157 , 704 . 95
TAX COMPUTATION-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.00 15. 0 . 00
16. Amount of Line 14 taxable 157 , 704 . 95 16. 7 , 096 . 72
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18, 0 . 00
19. TAX DUE......................... ........................ 19. 7 , 096 . 72
...............................................................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. _ El
Side 2
150561,0243 1505610243
Rev-102 EX+(01.10)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Williams, Nancy E 21-120477
All neat property owned solely or as a tenant In common must Comported at fair market value.Fair market va ue is defined as Pro price at which property would be
exchangad between a willing buyer and a willing se0er,neither being compailod to buy or salt,both having reeameba knowledge of the relevant facts
Real property that is jointly-owned with night of as rvivorship must be disclosed on schedule F,
Attach a Copy of the settlement ant at if the property has been sold
Include a copy of the dead showing decedents interest if awned as tenant in Common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real Estate located at 18 Essex Road,Camp Hill,Lower Allen Twp.,Cumberland County,PA 134,900.00
Contracted Sales Price. Real Estate sold on September 3, 2013.
TOTAL,(Also enter on Line 1, Recapitulation) 134,900,00
(if mere space fs needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA•15DO Schedule A(Rev.01-10)
Rev-1508 EX-(11-11))
SCHEDULE E
Pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Williams, Nancy E 21-12-0477
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 PA Department of Revenue-Property Tax Rebate Check 250.00
2 Teamsters Union -Survivor Benefit-Paid to Estate 495.00
3 Citizens Bank Personal Checking Account 1,901.97
4 1994 Chevrolet Caprice-75000 miles-Sold At AL ction. 2,300.00
5 Personal Property-Sold at Auction on June 11, 2012 by Chuck Bricker,Auctioneer. 3,436.00
6 AARP Refund 43.00
7 Health Insurance Supplement-Refund/Reimbursement 568.07
8 People Magazine-Refund/Reimbursement 135.78
9 Real Estate located at 18 Essex Road, Camp Hill, Lower Allen Twp. PA 256.57
10 ReimbursemenVRefund 53.00
11 Strock Insurance-Refund of Homeowners Insurance 630.00
12 U.S. Department of Treasury-2012 Federal Income Tax Refund 300.00
13 Verizon 0.36
TOTAL(Also enter on Line 5, Recapitulation) 10,369.75
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev-0509 EX+(01.10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Williams, Nancy E 21-12-0477
If an asset was made joint within one year of the decedent's date of death,It must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Danny E Parthemer 40 Conley Lane Son
Etters, PA 17319
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF
NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE DECEDENT'S INTEREST
TENANT JOINT JOINTLY-HELD REAL ESTATE. INTEREST
1 A 11/28/2008 Susquehanna Valley Federal Credit Union 0.00 50.000% 0.00
Savings Account-Date of Death Value of
Account$ 19,956.22. 112 the value of the
Estate of$9,976.11. Inheritance Tax of
$440.91 plus interest in the amount of$6.29
has been paid. A copy of the Receipt of
Payment has been attached to this Return
TOTAL(Also enter on Line 6, Recapitulation) 0.00
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10)
i EX-(09-09)
SCHEDULE G
Pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Williams Nancy E 21-12-0477
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.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECDS EXCLUSION TAXABLE
NUMBER THE DATENOF TROANSFER SATfACH THEIR COPY OF THE DEED FOR ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Sun Life Financial Annuity Contract No. 79-7900 41,244.14 41,244.14
-275949-Date of Death Value of Annuity.
Beneficiaries-Danny E. Parthemer,Son- Diana L.
Parthemer, Daughter-Aaron M. Shaffer, Grandson
and Ryan S. Shaffer, Grandson
TOTAL(Also enter on Line 7, Recapitulation) 41,244.14
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev. 08-09)
REV-1511 EX.J10-09)
Pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
RESIDENT
INHERITANCE NT URN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Williams Nancy E 21-12-0477
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 243.62
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission Paid
2. Attornev's Fees Johnson Duffie 4,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees 323.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 4,048.53
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 9,115.65
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Williams, Nancy E 21-12-0477
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Musselman's Funeral Home 243.62
H-A 243.62
Other Administrative Costs
2 Chuck Bricker,Auctioneer-Expenses for Auction held on June 11,2012 1,877.00
3 Cumberland County Register of Wills Office-Filing Fees for Inheritance Tax return and 30.00
Inventory
4 Perry Pest Control 915.84
5 Reserves:Additional Miscellaneous Administrative Expenses 250.00
6 Strock Insurance-Homeowners Insurance 763.00
7 Susquehanna Valley Federal Credit Union Estate Checking Account-Payment for Estate 14.31
Checks
8 The Cumberland Law Journal -Notice of Estate Administration 75.00
9 The Patriot News Company-Notice of Estate Administration 123.38
H-B7 4,048.53
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 Ex.(12A9)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Williams, Nancy E 21-12-0477
Report debts Incurred by the decedent prior to death that remained ummid atthe date of death,Including unreimbursedmedical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Bonnie K. Miller,Tax Collector-School District Taxes 1,280.32
2 Bonnie K. Miller,Treasurer-County/Township Real Estate Taxes 720.24
3 Boscov's Department Store 26.69
4 Citizen's Bank Card Services 75.93
5 Comcast Cable 2.29
6 HSBC Retail -Bon Ton Credit Card 113.31
7 Lower Allen Township-Sewer-Residential 321.60
8 Pa American Water-Residential Utility 320.45
9 PPBL-Residential Utility 545.12
10 Real Estate located at 18 Essex Road,Camp Hill, Lower Allen Twp. PA-Settlement Charges. 15,295.66
A copy of the HUD-1 Settlement Sheet is attached
11 Strock Insurance-Homeowners Insurance 368.00
12 UGI -Residential Utility 494.20
13 Vascular Associates 40.14
14 Verizon 89.34
TOTAL(Also enter on Line 10, Recapitulation) 19,693.29
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08)
REV-1513 EX-(01-10)
pennsylval SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Williams, Nancy E 21-12-0477
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not ist Tmsieefisl
I TAXABLE DISTRIBUTIONS (include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Danny E. Parthemer Son 112 of Tangible
40 Conley Lane Personal
Etters, PA 17319 Property; 1/3rd
of Residue
2 Diana L. Parthemer Daughter 112 of Tangible
214 East Jefferson Street Personal
Olyphant, PA 18447 Property; 1 13rd
of Residue
3 Aaron M.Shaffer Grandson 116th of Residue
373 River Oaks Circle
Apt. 2012
San Jose, CA 95134
4 Ryan S Shaffer Grandson 1/6th of Residue
2509 NE 30th Street
Bremerton,WA 98310
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)
ESTATE OF NANCY E. WILLIAMS
SCHEDULE OF EXHIBITS
EXHIBITA Last Will and Testament for Nancy E. Williams signed and dated
January 10, 2007
EXHIBIT B Request for Extension on Filing PA Inheritance Tax Return
EXHIBIT C HUD-1 Settlement Sheet for Real Estate located at 18 Essex Road,
Camp Hill, PA 17011. Property sold on September 3, 2013
EXHIBIT D Chuck Bricker, Auctioneer — Receipt of Auction held on June 11,
2012
EXHIBIT E PA Department of Revenue Information Notice on the Potential
Tax Due on Joint Asset at Susquehanna Valley Federal Credit
Union
EXHIBIT F Delinquent Tax Notice on Asset held at Susquehanna Valley
Federal Credit Union and Receipt of Payment by Cumberland
County Register of Wills of Tax and Interest.
EXHIBIT G SunLife Financial Date of Death Letter for Value of Annuity
Contract 79-7900-275949
:582064
Last Will and Testament
OF
NANCY E. WILLIAMS
I, NANCY E. WILLIAMS, of Lower Allen Township, Cumberland County, Pennsylvania, do
make, publish and declare this to be my Last Will and Testament, hereby revoking and making
void any and all former Wills made by me.
ARTICLE I
I direct that all my legal debts and funeral expenses including my gravemarker and all
expenses of my last illness that my Executor is obligated to pay, shall be paid from my residuary
estate as soon as practicable after my decease as a part of the expense of the administration of
my estate.
ARTICLE H.
I direct my Executor to pay all inheritance, transfer, estate and similar taxes (including
interest and penalties) assessed or payable by reason of my death on any property or interest in
property which is included in my estate for the purpose of computing taxes. My Executor shall not
require any beneficiary to reimburse my estate for taxes paid on property passing under the terms
of this Will or otherwise.
ARTICLE Ill
I bequeath my automobile or automobiles, household and personal effects and other
tangible personal property of a like nature (not including cash or securities), together with any
existing insurance thereon to my children, DIANA L. PARTHEMER and DANNY E. PARTHEMER,
to be divided between them in as nearly equal shares as possible. In the event any of this
tangible personal property is not distributed, those remaining items shall be sold and distributed
as part of the residuary of my estate.
EXHIBIT A
ARTICLE IV
I give, devise and bequeath all the rest, residue and remainder of my estate, of every
nature and wherever situate, as follows:
A. One-third (1/3)to my daughter, DIANA L. PARTHEMER;
B. One-third (113)to my son, DANNY E. PARTHEMER;
C. One-sixth (116)to my grandson, AARON M. SHAFFER; and
D. One-sixth (116)to my grandson, RYAN S. SHAFFER.
ARTICLE V
I appoint my son, DANNY E. PARTHEMER, Executor of this my Last Will and Testament,
and direct that he shall serve without bond. Should my son, DANNY E. PARTHEMER, fail to
qualify or cease to act as Executor, I appoint my daughter, DIANA L. PARTHEMER, as Executrix
of this my Last Will and Testament and direct that she serve without bond.
IN WITNESS WHEREOF, I hereunto set my hand and seal this 16 day of
J G�t� • 2007: may/ ! ,
11 C Sri a• V-W _ (SEAL)
NANCY E WILLIAMS
Signed, seated, published and declared by the above-named Testatrix as and for her Last
Will and Testament in the presence.of us, who, at her request, in her presence and in the
presence of each other have hereunto subscribed our names as witnesses.
AFFIDAVIT AND ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
We, NANCY E. WILLIAMS, A • F&le-rho-- and
Xc)bin C. Mumma the Testatrix and the witnesses, respectively,
whose names are signed to the attached or foregoing instrument, being first duly sworn, do
hereby declare to the undersigned authority that the Testatrix signed and executed the instrument
as her Last Will and that she had signed willingly and that she executed it as her free and
voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence
and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge
the Testatrix was at that time eighteen years of age or older, of sound mind and under no
constraint or undue influence.
NANCY E. WILLIAMS
tness
° Witness
Subscribed, sworn to and acknowledged before me by NANCY E. WILLIAMS, Testatrix,
and subscribed and sworn to before me by e Her-196 9 and
4bin C LUn M a. , witnesses, this day of N 2007.
Notary Publi
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL I
CARLEEN S. JENSI N, Notary Public
Lemoyne Boro.,Cumberland County
My Commission Expires Dec. 17,2007
:155489v2
JERRY R.DUFFIE ELIZABETH D.SNOVER
RICHARD W.STEWART CAROLYN B.MCCLAIN
EDMUND G. MYERS L A W 0 F F I C E S JOHN A.LUCY
DAVID W.DELUGE ^T T T^O, T ULYSSES S.WILSON
JOHN A.STATLER (V\1�1JI11�\�II�J N JULIA A.PHILLIPS
JEFFREY B.RETTIG MATTHEW RIDLEY
MARK C. DUFFIE DUFFIE
JOHN R.NINOSRY OF COUNSEL
MICHAEL J. CASSIDY HORACE A.JOHNSON
MELISSA P.GREEVY C.ROY WEIDNER,JR,
WADE D.MANLEY CONSTANCE P.BRUNT
:'!tii'1'i5W: F::(I'.NV, 288
January 4, 2012
VIA EMAIL RA-InheritanceTaxExtgstate.pa.us
Department of Revenue
Bureau of Individual Taxes
Inheritance Tax Division
P.O. Box 280601
Harrisburg,PA 17128-0601
RE: Estate of Nancy E. Williams
Date of Death: April 9, 2012
File No. 21-2012-0477
Our File No. 7668-1
Ladies and Gentlemen:
This firm represents Danny E. Parthemer, Executor of the Estate of Nancy E. Williams. Ms. Williams
died April 9, 2012. The inheritance tax return is due by January 9, 2013.
As of this date of this correspondence, the Executor is completing information necessary for the
Return. There is real estate that needs to be sold. We request to have a 6 month extension of time to file the
Inheritance Tax Return. Please indicate your approval of this request in due course via fax at (717) 761-3015
or email to my paralegal at dlw@idsw.com. We thank you in advance.
Very truly yours,
J S4DF TEW T& WEID NER
avid W
c: Danny E. Parthemer, Executor
DWD:dlw:532433
301 MARKET STREET P.O.BOX 109 LEMOYNE,PENNSYLVANIA 17043-0109
WWW.JDSWCOM 717.761.4540 FAX: 717.76' -�
EXHIBIT B
JOHNSON,OHNSON, DUFFIE, STEWART ,
,,.rv,�if o
OMB Approval No.2502A265
9. � JZ' A. Settlement Statement (HUD-1)
fl�h
�H OZJO�
B.nType of Loan
J
1. FHA '2,❑SHE 3,E]Conv.Ur ins. 6. Fla Number: 17. Loan Number: 8, Mortgage Insurance Case Number
4.q VA 5.0 Con¢Ins. ' TCSS2013-107.1 206402116 10-10-6-0651113
C. Note: This form is furnished to give you a statement ofactual settlement bast& Amountspald to and bythe settlement agent are shown.
Items masked"(p.o c)"warepaxtoutsde the Cbak ,thayare shown here for krformatianatpurposesandare not brauded in tire mrais
'D. Name and Address of Borrower E. Name and Address of Seller. F. Name and Address or Lander.
Joseph C.Andrews and Estate of Nancy E.Williams Primary Residential Mortgage,
Chelsey M.Andrews 18 Essex Road Inc.ISACA/ATIMA
4181 ER Coourt Apt 101 Camp N0,PA 17011 14W North 2200 West
Mechamrcsburg,PA 17050 Salt Lake City,UT 84116
G. Property Location: H. Settlement AgenC I. Settlement Date:
18 Essex Road TC Settlement SeMods,LLC
Camp Hill PA 17011 $0066 East Takata Rd. September 3,2013
Cumberland County,Pennsylvania Mechanicsburg,PA 17050 Ph. (717)715-0562
Place of Settlement:
801 East Park DrW,Suite 106
Harrisburg,PA 17111
J. Summary of Borrower's transaction K. Summary of Seiler'stransadion
100. GrossAmount Due from Borrower: 400 GrossAmount Due to Seller:
101. Conirad salesprice 134900.00 401. Contrail sales price 134,900.00
102. Personal property 402. Persunaip o day
101 Settlement Char es to Borrower Line 1409 10.303.18 403,
104. 404. - ..- .....
105. 405.
Adjustments for items paid b Seller in advance _ Adjustments foritems paitl by Sellerin ativance
106. C' rrown'faxes 09103/13 to 01/01/14 114,06 408.CA!Town Texas 09/03!73 to Ot(Ot/74 114,06
`-07. County Taxes 09113!13 to 01/91114 122.73 437, Can Taxes 09103113 to 41101114 12273
108. School Tax to 408. School Tax to
109. Pro-rated Sewer 09/03113 to 10/01/13 19.78 409, Pro-rated Sewer 09/03113 to 101D1/13 1978
110. 410.
111. 411.
I Z. 412,
920. Gross Amount Duefrom Borrower 145,459,75 420.Gross Amount Due to Seller 135,156.57
200. Amounts Paid by or in Behalf of Borrower 500. Reductions in Amount Due Seller.
201. Deposit or earnest money 500.00 501. Excess deposit(see insirudionsl
202 Punci al amount of new bans 137,800.00 502. Settlement charg tsto Setter{Line 1400) 17,43535
203 Eristin loan{s taken sub' to 503. Existin roan s'taken sumed to
204. 504.Payoff First Mortgage
205. 505. Pa off Semntl Mgrt a e
206. 506,
207, 507. Da osit disc, as proceeds
2043, SO&
209. Seilees Assist 5,74500 509.Seder's Assist 6,745.00
Adjustments for items unpaid by Seller Atl'ustments for items unpaid by Seller
21D. Cfyrrmn Taxes to 510.City/Town Taxes to
211. County Tares to 511. Coun Faxes to
212. Sdroci Tax 07101113 to 09m3r13 220,66 512. School Tax 07101113.to 09/03113 220.66
213, 513,
214. 514.
215. 515.
216. 516.
217, St7.
218. 518,
219. 519.
220. Total Paid by/for Borrower 145,265.66 520, Total Reduction Amount Due Seller 24,401.41
300. Cash at Settlement fnarrate Bonawar 600. Cash at settlement to from Seiler
301. Grces amount due from Borrower ime 120 145,469,75 501. Gross amount due to Satkr Fee 420) 135,15657
302. Less amo�unt paM bylfor Borrower tiino 220) ( 245,265'fib) 602. Less reductions due Seller line 520) ( 24,401.41
IJ
303. Cash From 1:1 To Borrower 194.09 603. Cash X]To - ❑ From Seller 110,755.16
Pais unimaignodoh ma nor lB*rclnls),;ee-ecei. to tecoT)
The undersignM hereby cknewptlge receipt ate completed copy of this statement&arty attachments 2terrotl to herein
Borrower Seller Este] fNanq EWid�f
be ntlr ll�b..VV i
BY:
Danny E. dhemer,Executor
isay M, t
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Page 1 of 3
(ANDREWS,JOS
EXHIBIT C
L.Settlement Charcies
700.Total Real Eslale Broker Fees S 6,941.00 Paid Fhon Pad Fhcm
DMCbn of oemmLssbn(line 700)as folbws Boemees Sellers
701.$3.56B.00 to ERA-NRT Funds et Furls at
702.S 3,373.00 to REM✓O(Reafy Select Solue nett SelUenKH
703.CommMoa paid at settlement 6841.00
704.Buyer Broker Fee 195.00
705.
8DO.Items Payable in Connection with Loan
801.Our origination charge $ 2373.00 from GFE#1)
802.Your credit or charge(Pointsl for the scedric Interest rate chosen -1 378.00 from GFE#2
803.Your adfusted origination charges from GFE#A 995.00
804.Arioratsal fee to Dena ottis&Associates from GFE 03 375.00
8D5.Credit Report to CREDCO from GFE n) 17.50
806.Tax service to from GFE#3
807.Flood cedli'mlon to FAFDS from GFE 431 9.00
808.In ecton Fee to Den oltis B Associates from GFE#3) 100.00
809.VA Funding Fee to VA from GFE 43) 2900.35
810. from GFE#3
811. (from GFE#3)
900.Items Required by Lender to Be Paid in Advance
901.DBRY Interest cha es from 09103/13 to 10101/13 28 $16.989000/0 from GFE#10) 475.69
902.Mortgage Insurance premium for months to (from GFE#3)
903.Homeowner's insurance for 1.0yearsto Enders Insurance Associates (from GFE#11), 393.01)
904. (from GFE 911)
905. (from GFE#it
1001).Reserves Deposited with Lender
1001.Initial deposh for your escrow account •(from GFE#9) 592.94
1002.Homeowner's Insurance 2.000 months @ S 32.75 per month $ . 65.50
1003.Mortgage Insurance months Q S per month $
1004.Pro taxes $ 629.68
Court Taxes 7.000 months A 5 31.11 per month
Cityrrown Taxes 7.000 months a S 28.91 per month
School Tax 2.000 months @ S 104.87 per month
1005.
1006. months @ S per month S
1007. months @ $ per month $
1008. S
1009.AggregeteAd' stment S -102.44
H00.Title Charges
1101. The seMzs and lenders rile Insurance (from GFE 94) 1,470.00
1102. Settlement or closing fee b
1103. Owners tale Insurance to First American This Insurance Company (from GFE#5)
1104. Lenders idle Insurance to First American Title Insurance Company $ 1,240.00
1105. Lenders title policy fmhit $ 137,800.00
1106. 0wmers rile policy fmh $ 134,900.00 .
1107. Agent's portion of the total We insurance premium to TC Settlement Services,LLC S 1,054.00
1108. Underwriters Portion of the total title insurance premium to First American Title Insurance Company S 186.00
t109. Notary Fea to TC Settlement Services,LLC $ 20.00 1
1110. Remb for Tax Cart to Search One Abstracting,Inc $ 20.00
1111. $
1112. S
1113. $
1200.Gowamm ant Recording and Transfer Charges
1201.Government recording Charges to Search One Abstract ,Inc from GFE V7) 156.00
1202.Deed S 63.00 Mart a e $ 93.00 Releases S Other $
1203.Transfer taxes to Search One Abstracting.Inc from GFE 98 1,349.00
1204.City/County taylstamps Deed S 1,349.00 Mortgage$
1205.State to Jstam s Deed 5 1,349.00 Mortitage$ 1,349.00
206.
207
1300.Additional Settlement Charges
11301.Requhed services that you can shop for (from GFE#6)
11302. Pest Inspection to 45.00 P.O.C.$45.00(B)'
1303. Home Inspection to 295.00 P.O.C.$295.00(B)'
1304. Pest Trealmem to b P.O.C3915.84(S)'
1305. See addht'I d'sb.e)Mbd to S P.O.C.$65.00(S' 1,274.701 9,105.75 I 1400.Total Settlement Charges(enter on lines 103,Section J and 502,Section K)^� -- 10,303.18 t 117,435.75
'Mcw ddarge vru.n(euMnS),h.nvl4.aarpl yR)
e/NeiryhyeltlMrlamRt+rhpmrhn�FrhawgTrenpp�mmpeN gpprhi3d apWe I
. TC Sect ,Settle
Certified to be a true copy. /
Page 2 of 3 HUD-1
(ANDREWS,JOSEPH CHELSEY.FDfrCSS201}1074/34)
Comparison of Good Faith Estimate(GFE)and HUD-1 Charges Good Faith Estimate HUD-1
Charges That Cannot Increase HUD-1 Line Number
Our origination charge # 801 2,373.00 2,37300
Your credit or charge(paints)for the spec rate chosen #802 -1,378.00 -1,378.00
Your adjusted origination charges #803 995.00 995.00
Transfer taxes #1203 1,349.00 1,349.00
Charges That in Total Cannot Increase More than 10% Good Faith Estimate HUDA
Government recording charges #1201 150.00 156.00
Appraisal fee #804 375.00 375.00
Credit report #805 18.00 17.50
flood certification # 807 1800 9.00
Inspect3n Fee # 808 0.00 100.00
VAFunding Fee # 809 2,900.35 2,900.35
Pest Inspection #1302 75.00 45.00
Home Inspection #1303 250.00 295.00
Total 3,786.35 3,897.85
Increase between GFE and HUD-1 Charges $ 111.50 or 2.94
Charges That Can Change Good Faith Estimate N1470.00 Initialdeposit foryour escrow account #1001 2,136.00 Dily terest chage; # 901 $ 16989000/day 424.75 Homeowners insurance # 903 504.00 Title services antl lender's title insurance #1101 1,430.00
Loan Terms
Your initial loan amount is $137,800.00
Your loan term is 30.00 years
Your initial interest rate Is 4.5000%
Your initial monthly amount owed for principal,interest and $698.21 includes
any mortgage insurance is ❑X Principal
❑
X Interest
❑ Morgagelasurance
Can your interest rate rise? ❑X No ❑ Yes,It can rise to a maximum of %. The first
change will be on and can change again every_months after
. Every change date,your interest rate ran increase or decrease
by %. Over the Ida of the loan,your interest rate is guaranteed
to never be lower than %or hg her than %.
Even if you make payments on time,can your loan balance rise? ❑X No ❑ Yes,it can rise to a maximum of$
Even if you make payments on time,can your monthly [X] No ❑ Yes,the first increase can be on and the monthly
amount owed for principal,interest,and mortgage insurance rise? amount owed ran rise to$
The maximum It can ever rise to is$
Does your loan have a prepayment penalty? ❑X No ❑ Yes,your maximum prepayment penalty is$
Does your loan have a balloon payment? ❑X No ❑ Yes,you have a balloon payment of$
due in_years on
Total monthly amount owed including escrow account payments ❑ You do not have a monthy escrow payment for items,such as property
taxes and homeowner's insurance. You must pay these Items directly
yourself.
❑X You have an additional monthly escrow payment of$197.64 that results
in a total initial monthly amount owed of$895.85. This includes
principal,interest,any mortgage insurance and any items checked below:
❑X Property taxes X❑ Homeowner's insurance
❑ Flood insurance X❑ School taxes
❑ ❑
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender.
Page 3 of 3 HUD-1
(ANDREWS,JOSEPH CHELSEYPFD[rCSS2013-107.1134)
HUD-1 Attachment
Borrower(s):Joseph C.Andrews and Chelsey M. Selle(s): Estate of Nancy E.Williams
Andrews
4181 Elk Court,Apt 101 18 Essex Road
Mechanicsburg, PA 17050 Camp Hill,PA 17011
Lender:Primary Residential Mortgage, Inc. ISAOA/ATIMA
Settlement Agent:TC Settlement Services, LLC
(717)715-0562
Place of Settlement:801 East Park Drive, Suite 106
Harrisburg, PA 17111 - - -
Settlement Date:September 3,2013
Property Location:18 Essex Road
Camp Hill, PA 17011
Cumberland County, Pennsylvania
Additional Adjustments For Items Paid By Seller In Advance(Borrower Debit)
Description Amount From/Through Prorated Amount
Pro-rated Sewer 65.D0 07/01/13 through 09/30/13 19.78
Total Line 1091409 19.78
Additional Disbursements-
Payee/Description Note/Ref No. Borrower Seller
Bonnie K. Miller 1,258.46
2013/14 School Taxes
9,105.75
Escrowed Inheritance Taxes
Lower Allen Township Authority
Final Sewer P.O.C.$65.00(S)*
Lower Allen Township Authority 16.24
Trash from 913/13-9/30113
Total Additional Disbursements shown on Line 1305 $ 1,274.70$ 9,105.75
Adjusted Origination Charge Details
Origination Charge
Origination Points 1,378.00
to Primary Residential Mortgage, Inc. ISAOA/ATIMA -
Application Fee 245.00
to Primary Residential Mortgage, Inc. ISAOA/ATIMA
Underwriting Fee 400.00
to Primary Residential Mortgage, Inc. ISAOA/ATIMA
Processing Fee 350.00
to Primary Residential Mortgage, Inc. ISAOA/ATIMA
Total $ 2,373.00
Origination Credit/Charge(points)for the specific interest rate chosen
Credit//Charge -1,378.00
to Primary Residential Mortgage, Inc. ISAOA/ATIMA
Total $ -1,378.00
Adjusted Origination Charges $ 995.00
WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can
include a fine and imprisonment. For details see: Title 18 U.S.Code Section 1001 and Section 1010.
(ANDREWS,JOSEPH CHELSEY.PFD/iCSS2013-107.1134)
HUD-1 Attachment- Continued
Reserves Deposited with Lender
Homeowner's Insurance 65.50
2.000 at 32.75 per month
County Taxes - 217.77
7.000 at 31.11 per month
City7Town Taxes 202.37
7.000 at 28.91 par month
School Tax 209.74
2.000 at 104.87 per month
Aggregate Adjustment -102.44
Total $ 592.94
Title Services and Lender's Title Insurance Details BORROWER SELLER
Notary Fee 25.00
to TC Settlement Services, LLC
Wire Fee 30.00
to TC Settlement Services, LLC
Overnight Fee 50.00
to TC Settlement Services, LLC
E-Mail Doc Fee 50.00
to TC Settlement Services, LLC
CPL 75.00
to First American Title Insurance Company
Lender's title insurance 1,240.00
to First American Title Insurance Company
Total $ 1,470.00 $ 0.00
Lender's Title Insurance - BORROWER SELLER
'fees also shown above in Title Services and Lenders Title Insurance Details
Lender's Policy Premium 1,090.00
to First American Title Insurance Company
Lender's Endorsement Charges 150.00
Endorsement Endorsement Charge.
ALTA Endorsement Form 8.1 (Environmental Protection 50.00
Lien)
Endorsement 100 50.00
Endorsement 300 - - 50.00
Total $ 1,240.00 $ 0.00
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and
accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further
certify that I have received a copy of the HUD-1 Settlement Statement.
Estat f Nancy E.Wil n
4elsey
BY:
Danny E. arthemer, Executor
WARNING: It is a crime to knowingly make false statements to the United States on this or any similar farm. Penalties upon conviction can
include a fine and Imprisonment. For details see: Title 18 U.S.Code Section 1001 and Section 1010.
(ANDREWS,JOSEPH CHELSEY.PFD/rCSS2013-107.1134)
Chuck Bricker, Auctioneer
Buy Sell on Commission - Complete Sale Service
88 Texaco Rd.,-Mechanicsburg, PA, 170551766-Z785
Personal Property of L G N1S X51
Address
Soid At Public � l � 2D 12-,
outstanding Total Sala 3 6 p a
Total Checks �5
Total cash
Cash Alter Payout
Expenses
Auctioneer& Clacks a t bD
Adv. Cost
i
Pmperty Fee 20
Sale Setup or Helpr>�j` p[y
Total Expenses / Y;'01 06
FIAA
EXHt9IT D
PENNSYLVANIA INHERIT, :E TAX
INFORMATION NOTICE
j BUREAU DE INDIVIDUAL TAXES _ FILE ND. 21
PO BOX 280601 pennsylvania AND ACN 12126666
HARRISBURG PA 17125-0601 DEPARTMENT OFAEYENOE TAXPAYER RESPONSE DATE 04-20-2412
try-l"3 Ex aR UR-1U
TYPE OF ACCOUNT
EST. OF NANCY E WILLIAMS ® SAVINGS
SSN 203-24-8543 ❑ CHECKING
DATE OF DEATH 04-09-2012 El TRUST
COUNTY CUMBERLAND ❑ CERTIF.
REMIT PAYMENT AND FORMS TO:
DANNY PARTHEMER REGISTER OF WILLS
40 CONLEY LN 1 COURTHOUSE SQUARE
ETTERS PA 17319-9764 CARLISLE PA 17013
SUSQUEHANNA VALLEY FCU provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you are the spouse of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART I below and writing "spouse" in PART 2.
IT 7ou believe the information is incorrect. please obtain written correttion from the financial institution, attach a COPY 10 this form and return
it io the above address. Please call 717-787-8327 with Questions.
COMPLETE PART 1 BELOW if SEE' REVERSE SIDE FOR FILING AND' PAYMENT INSTRUCTIONS
Account No. 15555 Date 11-28-2008 To onsuro proper credit to the account, two
Established copies of this notice must accompany
te 19,596.22 payment to the Register of Wills. Make check
Account Balen
$ payable to "Register of Wills. Agent".
Percent Taxable X 50.000
NOTE, If tax payments are made within three
Amount Subject t0 Tax $ 4,798.11 months of the detadent's data of death,
,
Tax Rata X .045 deduct a 5 portent discount on the tax due.
Any inheritance tax due will becnmo delinquent
Potential Tax Due $ 440.91 nine months after the date of death.
POT TAXPAYER RESPONSE
FAILURE. TO RESPOND WILL,.RESULT. IN AN OFFICIAL TAX ASSESSMENT
A. The above information and tax duo is correct.
React payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or return this notice to the Register of Wills and
ONE so official assessment will be issued by the PA Departmont of Revenue.
[ BLOCK a. F1 Tho above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
ONLY filed by the estate representative.
C. ❑ The above inforea��}Ban is
r incorrect and/or debts and deductions yore paid.
Complete PART 1 21 and/or PART Q below.
PART If indicating a different tax rate, please state I - OFFICIAL USE ONLY AAFI
0 relationship to decedent: { PA DEPARTMENT OF REVENUE
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD - -
LINE I. Date Established 1
2. Account Balance 2 $ 2 = f
3. Percent Taxable 3 X .3 _ -
4. Amount Subject to Tax 4
S. Debts and Deductions 5 - 5
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X 7 -
8. Tax Due a
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) 4
Under penalties of perjury, I declare that the facts I rep EXHIBIT E
complete to the best of my knowledge and belief.
TAXPAYER SIGNATURE ,r1 rrnnrvr rvOri Ni-w nATP
BUREAU OF COLLECl7°NS& pen n sylva ni a 7�
TAXPAYER SERVICES
PO BOX 281041
HARRISBURG PA 1'1128-INI DEPARTMENT OF REVENUE I
NOTICE OF DELINQUENT INHERITANCE TAX REV-sea PO APP boa-u>
PARTHEMER DANNY Notice Date: 06/21/2013
40 CONLEY LN Estate of:
ETTERS PA 17319 WILLIAMS NANCY E
SSN: 203-24-8543
Date of Death: 04-09-2012
File Number: 21 12-0477
Date of Assessment: 03-18-2013
ACN: 12126666
Department records indicate a delinquent inheritance tax liability for the estate identified above. Below is
a summary of the delinquency. To avoid additional costs and interest,please pay the amount due within 15
days of the date of this notice.
TAX INTEREST PENALTY CREDIT BALANCE
440 . 91 6. 29 . 00 447 .20
The Inheritance and Estate Tax Act mandates the filing of a tax return and payment of all
outstanding liabilities by a personal representative or a transferee of an estate within nine months
of a decedent's death.
We encourage you to take this opportunity to address your tax delinquency. If you fail to do so,
your account may be referred to a collection agency and additional fees up to 39 percent of the
amount due will be added to the liability.
Please detach and return the lower portion of this notice with your payment to the Register of Wills of
the county indicated. Make check or money order payable to: Register of Wills,Agent.
If the above balance due was paid recently,please disregard this notice. Q(� 7/ QA
If you have any questions regarding this notice,please contact:
Harrisburg Call Center
717-783-3000
1-800-447-3020 (Services for taxpayers with special hearing and/or speaking needs)
EXHIBIT F
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTIVENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
BERT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 017795
PARTHEMER DANNY E
40 CONLEY LANE
ETTERS, PA 17319
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
--------- --------
12126666 $447.20
ESTATE INFORMATION: SSN: 203-24-8543
FILE NUMBER: 2112-0477
DECEDENT NAME: WILLIAMS NANCY E .
DATE OF PAYMENT: 06/26/2013
POSTMARK DATE: 06/26/2013
COUNTY: CUMBERLAND
DATE OF DEATH: 04/09/2012
TOTAL AMOUNT PAID: $447.20
REMARKS:
CHECK# 730
INITIALS: CJ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
From: 04/24/2012 14:54 #024 P.001/001
a e e gaq Sun Life Assurance
Company of Canada(U.S.)
SUri " P.O.Box 9133
` Wellesley Hills,MA 02481-9133
Life Financial' Tel: 800-752-7216
Fax: 781-304-5383
April 24, 2012
David W. DeLuce
Johnson Duffie Stewart&Weidner
Via Fax: 717-761-3015
RE: Contract value
Contract number: 79-7900-275949
Owner(s): Nancy E. Williams
Dear W. DeLuce,
Thank you for writing to us about this Sun Life Financial annuity.
As of April 9, 2012 the contract value of this annuity was$41,244.14.
If you have any questions, please call our Customer Service Center at 800-752-7216.
Sincerely,
Elizabeth Matisz
Annuity Operations & Customer Service
92776908
Sun Life Assurance Company of Canada(U.S.)
is a member of the Sun Life Financial group of companies.
ww .sunllfexom --- - -
EXHIBIT G