HomeMy WebLinkAbout02-0387IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
PETITION FOR GRANT OF LETTERS
Estate of ROSEMARY C. KELLY No. 2,~ - O ~-- -,,,~ ~ "~
also known as
, Deceased Social Security No,202-10-1666
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/a~ the execUt rix
['~ Decedent, dated 6/10/98 and codicil(s) dated
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with l~i~/her last family or principal
residence at 302 Manchester Road, Lower Allen Township, Camp Hill, PA 17011
(list slreet, number and municipality)
Decedent, then 87 years of age, died March 24, ,2002 , at Holy Spirit Hospital, Camp Hill, PA 17011
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA) All personal property ......................................... $
(if not domiciled in PA) Personal property in Pennsylvania .................... $
(If not domiciled in PA) Personal property in County .............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..................................................................................................................... $
Real Estate situated as follows:
302 Manchester Road, Camp Hill, PA 17011
20,000.00
50,000.00
70,000.00
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
Signature
Typed or printed name and residence
Kathleen M. Cleveland
2231 North Third Street
Harrisburg, PA 17110
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent,
Petitioner(s) will well and truly administer the esta!e_e..ac~cording to law.
Sworntoand affirmed and subscribed '~/~"--'- '~,' ~-/~~
K~leen M. Cleveland
before me this 12th. day of
DECREE OF REGISTER
Estate of ROSEMARY C. KELLY
also known as
Deceased No ~1- 1~,7..-~.~
Social Security No:202-10-1~ Date of Death: 3~24~02
AND NOW, APRTT, 1R. 2002 , 2002 , in consideration ofthe Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters i~1 Testamentary i-I of Administration
(c.t.a., d.b.n.c.t; pendente lite; durante absentia; durante minoritate)
are hereby granted toKathleen M. Cleveland
in the above estate and that the instrument(s), if any, datedJune 10, 1998
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
115.00
Letters .................................... $
Short Certificate(s) ............... $ 18.00
Renunciation .......................... $
Affidavit ( ) ....................... $
Extra Pages ( ) .............. $ 9.00
Codicil ................................. $
JCPFee ................................. $ 5.00
Inventory & Tax Forms ............. $
Other ...................................... $
RW-7A
147.00
TOTAL ............................. $
mailed to atty 4-15-02
Register of V'VilI~/' ~
Attorney: Jill M. Wineka, Esquire
I.D. No: 58802
Address: 1719 North Front Street
Harrisburg,
Telephone: (717) 234-4178
DATE F,,ED:
PA 17102
2~02-387
LAST WILL AND TESTAMENT
OF
ROSEMARY C. KELLY
I, ROSEMARY C. KELLY, of Camp Hill, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament, and
revoke any and all previous Wills and Codicils made by me.
ITEM I: I direct that all my just debts and
funeral expenses, including all expenses of my last illness,
shall be paid from my residuary estate as soon as practicable
after my death, as a part of the expense of the administration of
my estate.
ITEM II: All federal, state and other death taxes
payable because of my death with respect to the property forming
my gross estate for tax purposes, whether or not passing under
this Will, including any interest or penalty imposed in connec-
tion with such tax, shall be considered a part of the expense of
the administration of my estate and shall be paid out of the
residue of my estate, without apportionment or right of reim-
bursement.
ITEM III: I give, devise and bequeath all the
rest, residue and remainder of my estate of every nature and
wheresoever situate to be divided equally among my three
children, KATHLEEN M. CLEVELAND of Harrisburg, Pennsylvania,
JEANNE R. KELLY of Camp Hill, Pennsylvania and PATRICK M. KELLY
of Lititz, Pennsylvania. In the event any of my children should
predecease me, then his or her share shall be divided equally
between my remaining living children.
ITEM IV: My daughter, JEANNE R. KELLY is unable
to live independently and requires assistance with her daily
living and personal needs, as well as financial guidance.
Therefore, I nominate my daughter, KATHLEEN M. CLEVELAND to serve
as my daughter, Jeanne R. Kelly's Guardian of the Person.
ITEM V: With regard to my daughter, JEANNE R.
KELLY's portion of my Estate which is to be distributed in Item
III, her share should be held IN TRUST and be used for her
support and daily living expenses as deemed in the discretion of
her Trustee and Guardian of the Person.
ITEM VI: I hereby appoint my daughter, KATHLEEN
M. CLEVELAND, as Trustee for my daughter, JEANNE R. KELLY.
ITEM VII: I hereby appoint my daughter, KATHLEEN
M. CLEVELAND, as Executrix of this my Last Will and Testament.
Should my daughter, KATHLEEN M. CLEVELAND fail to qualify or
cease to act as such, I then appoint my son, PATRICK M. KELLY,
Executor of this my Last Will and Testament.
ITEM VIII: I direct that no Executrix, Executor,
Guardian of the Person or Trustee serving hereunder be required
to post bond or enter security in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this l0 ~ day of ~~ , 1998.
/
ROSEMARY~ ~. KELLY--
SEAL)
LAST WILL AND TESTAMENT
OF
~OSEMARY C. KELLY
I-om_-
I, ROSEMARY C. KELLY, of Camp Hill, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament, and
revoke any and all previous Wills and Codicils made by me.
ITEM I: I direct that all my just debts and
funeral expenses, including all expenses of my last illness,
shall be paid from my residuary estate as soon as practicable
after my death, as a part of the expense of the administration of
my estate.
ITEM II: Ail federal, state and other death taxes
payable because of my death with respect to the property forming
my gross estate for tax purposes, whether or not passing under
this Will, including any interest or penalty imposed in connec-
tion with such tax, shall be considered a part of the expense of
the administration of my estate and shall be paid out of the
residue of my estate, without apportionment or right of reim-
bursement.
ITEM II~: I give, devise and bequeath all the
rest, residue and remainder of my estate of every nature and
wheresoever situate to be divided equally among my three
children, KATHLEEN M. CLEVELAND of Harrisburg, Pennsylvania,
JEANNE R. KELLY of Camp Hill, Pennsylvania and PATRICK M. KELLY
of Lititz, Pennsylvania. In the event any of my children should
predecease me, then his or her share shall be divided equally
between my remaining living children.
ITEM IV: My daughter, JEAN-NE R. KELLY is unable
to live independently and requires assistance with her daily
living and personal needs, as well as financial guidance.
Therefore, I nominate my daughter, KAT~LEEN M. CLEVELAND to serve
as my daughter, Jeanne R. Kelly's Guardian of the Person.
ITEM V: With regard to my daughter, JEANNE R.
KELLY's portion of my Estate which is to be distributed in Item
III, her share should be held IN TRUST and be used for her
support and daily living expenses as deemed in the discretion of
her Trustee and Guardian of the Person.
ITEM VI: I hereby appoint my daughter, KAT~LEEN
M. CLEVELAND, as Trustee for my daughter, JEANNE R. KELLY.
ITEM VII: I hereby appoint my daughter, KATHLEEN
M. CLEVELAND, as Executrix of this my Last Will and Testament.
Should my daughter, KAT~LEEN M. CLEVELAND fail to qualify or
cease to act as such, I then appoint my son, PATRICK M. KELLY,
Executor of this my Last Will and Testament.
ITEM VIII: I direct that no Executrix, Executor,
Guardian of the Person or Trustee serving hereunder be required
to post bond or enter security in any jurisdiction.
IN WITNESS W~EREOF, I have hereunto set my hand and seal
this /0 ~ day of ~~- , 1998.
'- 'RO~~ 6. KELLY
(SEAL)
2
The preceding instrument, consisting of this and two other
typewritten pages, was, on the date thereof signed, published and
declared by Rosemary C. Kelly, the Testatrix therein named, as
and for her Last Will, in the presence of us, who, at her
request, in her presence, and in the presence of each other, have
subscribed our names as witnesses hereto.
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF DAUPHIN :
ss:
WE, ROSEMARY C. KELLY,
and ~ 4- ~~ ~. , 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 witnesses and that to the best of their
knowledge, the Testatrix was at that time eighteen years of age
or older, of sound mind and under no constraint or undue
influence.
ROSEMARY C. K~LY
Subscribed, sworn to and acknowledged before me by ROSEMARY
C. KELLY, the Testatrix, and subscribed, and sworn to before me
Notary
4
'"' Not~rt~l Seal. .
Bonita ~. LOcflb~dl, Notary Public
Harri~burg~ Dauphin County
ion Expires Sept. 24, 2001
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
Name of Decedent:
Date of Death: 3/24/02
Will No. 2002-00387
To the Register:
CERTIFICATION OF NOTICE
UNDER RULE 5.6(a)
Rosemary C. Kelly
Adm. No.
! certify that notice of estate administration required by Rule 5.6(a) of the Orphans'
Court Rules was served on or mailed to the following beneficiaries of the above-captioned
estate on 4/19/02 ·
Nalne
Jeanne R. Kelly
c/o Kathleen M. Cleveland
Kathleen M. Cleveland
Patrick M. Kelly
Address
302 Manchester Road
Camp Hill~
302 Manchester Road
Camp Hill~
218 Swarthmore Drive
LititzT
PA 17011
PA 17011
PA 17543
Notice has now been given to ail persons entitled thereto under Rule 5.6(a) except:
Date:
(Signa~/~
Name: Jill M. Wineka, Esquire
Address: 1719 North Front Street
HarrisburflT
Telephone (717) 234- 4178
PA 17102
Capacity:
X
Personal Representative
Counsel for Personal
Representative
HOWARD B. KRUG
LEON P. HALLER
JOHN 'kX/'. PURCELL JR.
JILL M. '~INEKA
BRIAN J. TYLER
NICHOLE M. STALEY O'GORMAN
LAW OFFICES
1719 NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA 17102-2392
TELEPHONE (717) 234-4178
FAX (717) 233-1149
HERSHEY
(717) $33-3936
JOSEPH N1SSLEY (1910-i982)
JOHN W. PURCELL
VALERIE A. GUNN
0t' Co zi~Jsel
June 4, 2002
Register of Wills
Cumberland County Court House
Carlisle, PA 17103
Re:
Estate of Rosemary C. Kelly
No. 2002-00387
Date of Death: March 24, 2002
Dear Register of Wills:
Enclosed is a check in the amount of $4,300.00 as payment of the estimate of the inheritance taxes
owed on the Estate of Rosemary C. Kelly. I am also enclosing a self-addressed, stamped envelope for you to
return the receipt to my specific attention. Please contact me directly if you have any questions.
Sincerely,
JMW/bas
Enclosures
cc: Kathleen M. Cleveland, Executrix
(estatcs~k¢lly\06-04-02 ltr to Register)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 001 254
JILL M WINEKA ESQUIRE
1719 NORTH FRONT STREET
HARRISBURG, PA 17102-2392
........ fold
ESTATE INFORMATION: SSN: 202-10-1666
FILE NUMBER: 2102-0387
DECEDENT NAME: KELLY ROSEMARY C
DATE OF PAYMENT: 06/05/2002
POSTMARK DATE: 06/04/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 03/24/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $4,300.00
TOTAL AMOUNT PAID'
$4,300.00
REMARKS: KATHLEEN M CLEVELAND
C/O JILL M WINEKA ESQUIRE
SEAL
CHECK# 508
INITIALS: CW
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
LAW OFFICES
1710 N. FRONT STREET
HARRISBURG, PA 17102-2392
I,,,111,,,I,,,1111,,,,,,11,1,,I,I
Register of WlJIs ~
Cumberland County Court House
Carlisle, PA 17103
h,,llh,,llh,,,,,Ih,ll,,,ll,,,lh hl,,,,hl,,I,II
HOWARD ]3. KRUG
LEON P. HALLER
JOHN W. PURCELL JR.
JILL M. WINEKA
BRIAN J. TYLER
NICHOLE M. STALEY O'GORMAN
LAW OFFICES
1719 NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA 17102-2392
TELEPHONE (717) 234-4178
FAX (717) 233-1149
October 17, 2002
HERSHEY
(717) 533-3836
JOSEPH NISSLEY (1910-1982)
JOHN W. PURCELL
VALERIE A. GUNN
0£ Cot~nsel
Register of Wills
Cumberland County Court House
Carlisle, PA 17103
Re:
Estate of Rosemary C. Kelly
No. 2002-00387
Date of Death: March 24, 2002
Dear Register of Wills:
Enclosed for filing, please find an original and three copies of the Inheritance Tax Return in the above-
captioned Estate, together with a check in the amount of $15.00 for the filing fee. Please return two date-
stamped copies of the document to me in the enclosed stamped, self-addressed envelope. Thank you.
Sincerely,
i~. V~inek~a'
JMW/bas
Enclosures
cc: Kathleen M. Cleveland w/o enc.
(estates\kelly\l 0-17-02 Itr to Register)
REV-15OO EX +~%00)
COMMONWEALTH OF
PENNSYLVANIA
' DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
I.-
Z
LU
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LU
o
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL
KELLY, ROSEMARY C.
DATE OF DEATH (MM-DD-Year)
03~24~2002
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DATE OF BIRTH (MM-DD-Year)
03/17/1915
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 2 0 3 8 7
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
2 0 2- 1 0- 1 6 6 6
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
[~]1. Odginal Return
D4. Limited Estate
[~]6. Decedent Died Testate (Attach copy of Will)
9. Litigation Proceeds Received
NAME
Jill M. Wineka~ Esquire
FIRM NAME (If Applicable)
Purcell, Krug & Hailer
TELEPHONE NUMBER
(717) 234-4178
['--~ 2. Supplemental Return
O4a. Future Interest Compromise (date ofdeath after 12-12-82)
['~7. Decedent Maintained a Living Trust (Attach copy of Trust)
10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
COMPLETE MAILING ADDRESS
1719 North Front Street
Harrisburg,
r'-] 3. Remainder Return (date of death pdor te 12-13-82)
D5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
~'~ 11. Election to tax under Sec. 9113(A) (Attach Sch O)
PA 17102
1, Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal ProperW (5)
(Schedule E)
6, Jointly Owned Property (Schedule F) (6)
E~ Separate Billing Requested
7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
Total Gross Assets (total Lines 1-7)
Funeral Expenses & Administrative Costs (Schedule H) (9)
Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
Total Deductions (total Lines 9 & 10)
Net Value of Estate (Line 8 minus Line 11)
9.
10.
11.
12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
73,,333.33
17,158.38
3,679.92
16,000.10
OFFICIAL USE ONLY
(8)
(11)
(12)
110~171.73
19,787.35
11,170.24
30,957.59
79~214.14
(13)
(14)
79,214.14
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17, Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
X
79~214.14 x .045
X .12
X .15
(15)
(16)
(17)
(18)
(19)
3~564.64
3,564.64
D. eced~nt's Complete Address:
STREET ADDRESS
302 Manchester Road
CITY Camp Hill, ISTATE PA IZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
4,300.00
Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E )
(3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
3~564.64
4T515.00
950.36
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 property transferred; ........................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ........................................ [] []
c. retain a reversionary interest; or ...................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ............................................................. [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................... [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, 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 OF~ERSON RESPONSIBLE FOR F~LING RETURN
ADDRESS' ~I Kathleen M. Cleveland, 2231 North Third Street
HarrisburgT
SIGNATURF~,~F..PREPAEER OTHER T~AN REPRESENTATIVE
DATE
PA 17110
ADDRESS //i-Jill M. Wineka, Esquire, 1719 North Front Street,
v Harrisburg~
PA 17102
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. {}9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [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%, 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% [72 P.S. §9116(a)(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.
LAST WILL AND TESTAMENT
OF
ROSEMARY C. KELLY
I, ROSEMARY C. KELLY, of Camp Hill, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament, and
revoke any and all previous Wills and Codicils made by me.
ITEM I: I direct that all my just debts and
funeral expenses, including all expenses of my last illness,
shall be paid from my residuary estate as soon as practicable
after my death, as a part of the expense of the administration of
my estate.
ITEM II: All federal, state and other death taxes
payable because of my death with respect to the property forming
my gross estate for tax purposes, whether or not passing under
this Will, including any interest or penalty imposed in connec-
tion with such tax, shall be considered a part of the expense of
the administration of my estate and shall be paid out of the
residue of my estate, without apportionment or right of reim-
bursement.
ITEM III: I give, devise and bequeath all the
rest, residue and remainder of my estate of every nature and
wheresoever situate to be divided equally among my three
children, KAT~LEEN M. CLEVELAND of Harrisburg, Pennsylvania,
JEANNE R. KELLY of Camp Hill, Pennsylvania and PATRICK M. KELLY
of Lititz, Pennsylvania. In the event any of my children should
predecease me, then his or her share shall be divided equally
between my remaining living children.
ITEM IV: My daughter, JEANNE R. KELLY is unable
to live independently and requires assistance with her daily
living and personal needs, as well as financial guidance.
Therefore, I nominate my daughter, KATHLEEN M. CLEVELAND to serve
as my daughter, Jeanne R. Kelly's Guardian of the Person.
ITEM V: With regard to my daughter, JEANNE R.
KELLY's portion of my Estate which is to be distributed in Item
III, her share should be held IN TRUST and be used for her
support and daily living expenses as deemed in the discretion of
her Trustee and Guardian of the Person.
ITEM VI: I hereby appoint my daughter, KATHLEEN
M. CLEVELAND, as Trustee for my daughter, JEANNE R. KELLY.
ITEM VII: I hereby appoint my daughter, KATHLEEN
M. CLEVELAND, as Executrix of this my Last Will and Testament.
Should my daughter, KATHLEEN M. CLEVELAND fail to qualify or
cease to act as such, I then appoint my son, PATRICK M. KELLY,
Executor of this my Last Will and Testament.
ITEM VIII: I direct that no Executrix, Executor,
Guardian of the Person or Trustee serving hereunder be required
to post bond or enter security in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this /~ ~ day of ~~-~ , 1998.
'ROSEMARY~.
(SEAL)
2
The preceding instrument, consisting of this and two other
typewritten pages, was, on the date thereof signed, published and
declared by Rosemary C. Kelly, the Testatrix therein named, as
and for her Last Will, in the presence of us, who, at her
request, in her presence, and in the presence of each other, have
subscribed our names as witnesses hereto.
residing att~~~- ~
residing at ~, ~.z/
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF DAUPHIN :
ss:
WE, ROSEMARY C. KELLY, ~Q~,~ ~. ~j~,~/
and J~ 4- ~-~; ~. , 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 witnesses and that to the best of their
knowledge, the Testatrix was at that time eighteen years of age
or older, of sound mind and under no constraint or undue
influence.
ROSEMARY C. KELLY
wit.~ ~
Subscribed, sworn to and acknowledged before me by ROSE~RY
C. KELLY, the Testatrix, and subscribed, and sworn to before me by
witnesses, this /~ day of ~~
NoIArlitl Seal
Bonita E. Lonll~trdl, Notary Public
Harrisburg Dauphin County
Myrrh ssion 'E~,pires Sept. 24, 2001
R~-I~2EX + (1-977~ ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
KELLY. ROSEMARy (~, 21 02 0387
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
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned v~th right of
survivorship must be disclosed on Schedule F.
ITEM I VALUE AT DATE
NUMBER I DESCRIPTION OF DEATH
1. 1302 Manchester Road, Camp Hill, PA 17011. See attached Sales Agreement and
ISettlement Statement for fair market value. See also attached Deed dated January 30,
1952 into Decedent and her husband, Patrick S. Kelly, as tenants by the entireties of
an undivided one-half interest and into Decedent's brother, James H. Hammon of the
other undivided one-half interest. The Decedent's husband, Patrick S. Kelly predeceased
her on March 21, 1985 and by operation of law, his interest passed to Decedent. The
Decedent's brother, James H. Hammon predeceased her on May 28, 1976, dying
intestate, leaving no spouse, no issue and no parents, dames H. Hammon was survived
by his sister, the Decedent and the issue of his deceased brother, Irvin Hammon, who
died intestate on duly 24, 1967. Irvin Hammon was survived by his children, Rosemary
Bascelli, Jeanne Bucher and James Hammon, who each owned a one-twelfth interest
in the real estate. Rosemary Bascelli and Jeanne Bucher waived their interest in the
real estate. One-twelfth of the net proceeds of the real estate passed to the Decedent's
nephew, James Hammon and eleven-twelfths of the net proceeds were retained by the
Estate. See attached notarized Statements of Rosemary Bascelli and Jeanne Bucher
waiving each of their one-twelfth interests in favor of the Estate.
TOTAL (Also enter on line 1, Recapitulation)
73,333.33
73~333.33
(If more space is needed, insert additional sheets of the same size)
08/05/2002 )iON 16:56 FAX 717 731 1798 RE~AX REALTY
STANDARD AGREEMENT FOR THE SALE OF REAL ESTATE
TI~ ~or~ r~emm~ded and approved tot. t~ ~ r~ic~d ~o u~ by. ~ m~b~ o( d~ ~yl~fia ~o~a~o~ o~ ~0~ ~A~).
q$002
SELLER'S BUSINESS RELATIONSHIP WITIt PA LICENSED BROKER
BROKER (Cutup, my) ~l~'//J/~ /(~/~7'y -- , . __ P~O~~~~
C4 /-/.; /
~RO~R ~ T~: AGENT FOR ~ D~a~ AgenRs) for $ell~, d ap~li~bl~
Broker ~ NOT th,~ lg~t for S~ ~d Is ~: ~ AG~T F~ B~R ~ T~CTION H~E
~O~t IS ~ AGE~ FOR B~ D~ated ~t(s) for Bu~, · appli~ble:
OR
B~ker ~ NOT tile Ag~t fOr Buy~ ~d ~ alan: ~ AG~ ~R SF~ ~ 5U~ FOR ~R ~ ~NSA~'I~ ~5~E
~3en the same Brigcer is A gent for Seller and ~gent for Buyer, Braker Is a Dual Ag~nL All of Broker's licensees are also D~ml Agents UNLESS
there nre separate D.~ta.d A,cnt~ for Buyea' and Seller. If the same. Licensee is .i~at; '~ S~ ~uy~, 'e Li~-- ~ · ~ Ag~
3
~ called "Seller," and
? , ~ed '~uyec" 7
~ 2. PRO~ (1.~8) S~ h~by ~ ~ s~ a~ ~nvey ~ Buyer, who h~by ag~ to p~: a
~ ~L ~T ~E ~ lot or pi~ of g~d ~, b~ ~d ~p~*em~ ~n e~ct~ ~ ~y, ~o~ ~:
11 ~ the of , 11
,~ co~,~,r co~ a~& .. ~co~o,,~a~,,,~z~pcoa~. /7ol /
, ~3 Ideation (*.~); ~r~ ~ Lo~ Block; D~d Boo~ Pa~ Re~ing D~e) ~ ~--~ ~ ~
/~ 2. ~h or ~ ~ ' ~ys of ~ execution of ~ Agre~t: ~ $ ~
24 ~ ¢) D~o~ paid on ~coum of ~h~: ~ ~ bc h~ by ~mkcr f~ Sdl~, ~s oth~c ;~ ~: ~ '
29 ~
30 (F) Paymen£ of tran.~fer taxes wm be divided equally between Buyer and Seller unless othcrwiac s~ ~: 30
31
33
36
(G) At Qme of s '-rdemeat, the followiag will be adjusted pro.rata on a daily basLs between Buyer and SeL~, rebnbursLog where applicable: taxes 3~
(sc<: Tml'orm,~ion Regarding Tax Proration); renL% intcxc.st on loor~gagc assulTlption$; coadominium f~a and ho~ow'acr a~socialioll :fccs, ff 33
any; wat~:r ~lnd/or scwcr fc~, if any, togc~.hcr with any other//enable muaicipsl scr~cc. Thc charges arc to be pro-~ted for the period(s) aa
cove-~d: Se ~er will pay up to and lo. lading the date of setQe~nenC Buyer will pay for all days following settlement, ualess o~etwLse ~ ~s
here: 36
37
ss 4. FIXTURES & PERSONAL PROIW_.R~ (1-00) ~t
~9 (A) INCLUDED in this sale and purchase price ar= all cxi~ting itcm~ permancntly i~slalled in the Property, fr~ of lieut, including plumbing; 39
40 he. ting; hgJtfiag fixt~cs (i~cludi~g cha~clici~ snd c~g fa~s); water ~earmeat systcms; pool ~ spa equipment; garage door openers 40
41 and r. rmlsmittexs; television ant~; shrubbery, plantings and twpotied tre~; aay remaining he,ting u. nd eook/ng lucia storod oo :he 11
42 }:~'O~..c~' at :he time 0£ setQement; wall to wall ~g; window ~ovc~ng hardware, sbadr_~ and. bliods; built-in air condilioneis; bulk-in
as (B) LEASED i~:m.s (aot ownod by $:11=-): iS
46
,n (C) EXCLUDED :l~xtur~s and item~: ~7
5. DATE$/TIM~ IS OF Tiff/ESSENCE (1-02) (A) The said da~ for $c~tl¢lll¢llt aud ~ ot~ ~t~ ~ ~s I~ ~ for ~ p~n~ of any of ~c ob~ ~ ~ A~t ~e 50
a~d to be ~ ~e ess~e of ~ ~e~t ~d ~ ~g.
~) For ~e pu~os~ of fl~ A~enL n~b~ ~' ~ys wjl] b= ~um~ from ~e ~te ~ ~e~d~, by
~ ~,t ~du&ng the ~t ~y of ~= 5m~ ~od.
(C) ~ da~ of ~t is n~ c~cad~ by ~y o~ pw~n of ~ A~mcnt ~d may only be
· e p~. 55
~) ~ ~ P~ods ~e ~e-pt~ted ~ ~ A~t ~ a convince ~ ~e Buy~ and Syn. Any p:~p~ t~e go,OdS ~e aegot~lc
~ m~ bc ~ by s~ out ~c pr~p~ted ~x: ~d ~g a d~ent ~c p~od ~g~blc to
.~-~ P~ 1 of S Sell~ ~: , 5g
0Z~2
05/05/200~ MU~ 16:57 FAX 7~? 731 1798
B~
71
75
7~
79
77
7§
91
07
~9
91
~7
188
101
REMA2t REALTY ~ 003
6. MORTGAGE coNTI~GEN CY (1-02)
WAIVED. 'Fl~ ~e ~ NOT con~g~t ~ mo~e
(A) T~ sale ~
5, D~mt point, ~ od~o~ loan pl~ ~ o~ f~ ~ b~ I~ ~ a p~ge ~ ~e
~v~ S~ fi~ a S~'s sole opfi~ ~ ~l ~d by ~e mongag; ~ ~ app~ hws, ~ co~t~ ~d~y, ~out
~ o~mb~en~ ~ ~c Buyer ~or ~ ~e I~ ~o ~ ~ above l~ av~e ~ ~ ....
for ~e m~ge ~ s~fi~ ~o~ m a r;s~e ~ 1~. ~e B~ for Buy~ ~ ~, o~se ~e B~k~
au~o~ ~ co~te ~ ~ mo~g! le~ ~ ~ ~ ~ a~g ~ ~ ~e ~
~d Sdl~ ~ ~ ~tend ~e m~ c~ ~ unffi S~ ~ ~s Ag~ ~ ~g bY ~ to BuY~
2. Up~ ~d~ of a mo~e co~n~ Buy~ ~ ~ompQy ~iv= a c~y ~ ~ co~t ~ S~.
If ~t ~d until ~ ~ ~ s~amen~ OR
h. Is c~ed upon ~c sale ~d ~fft~q ~ any o~er prop~, OR
c. CouPs ~y o~ con~n nat s~led ~ ~ ~ ~t ~ ~ ~!~ a~ ~oved ~ ~g by
x~ 7 DAYS ~ ~c ~e ~e~t ~ ~ ~a~ph 6 (C) ~1.
4. ~ ~ ~cnt ~ ~d ~ ~fi~ ~ ~ 6 (C) (1)or (3), or ~: m~age loan is ~o~ for s~u~
~) H ~ m~a~ len~ ~ ~i~ m ~ Pmp~. Buy~ ~flL u~n ~ deliver a copy ~ ~ m~g~.~'s ~ W Seller.
at S~'s e~e.
2. If Se~ ~oos~ =o~ ~ ~nt~ ~ ~t~ m~, or if ~1~ ~ ~ ~ond ~ ~e g~ ~ B~y~ w~ ~
.~. _. DAYS of Se~'s d~, ~ ~s A~ ~ w~ ~s~ ~ ~p~t m~ ~d o~ ~o~
~ N~ ~LIC~
~ '~'PL~B~. S~ ~ pay:
~ S , ~ ~w~ Buy~'s ~s~ ~ p~ed by ~e ~Rgagc l~d:r.
106
~11
112
115
117
111]
119
12D
121
1~4
12~
129
130
1.12
1~4
157
138
139
1~0
141
(E) It is cxpr~sly agreed that uotw~s~ding any o~ provh~m ~ ~ ~vtr~ Buy~ ~not be ohh~ m ~mp~e ~ ~a~ of ~ 108
P~y d~i~d h~ ~ ~ ~c~ ~y p~ by ~ of ~t mo~y d~o~ ~ O~L~ ~l~ B~ ~ b~ ~vc~ ~ a~-
~ ~ ~D~ or VA ~r~, a wr~ smut by ~ P~ H~ Commis~o~. Ve~ Admlni,~O~ ~ u D~t
E~a ~ s~g f~ ~e app~ ~ ~ ~ ~p~ of not l~s ~ $ ~ (~ d~ ~o~t m ~ ~09
Dcp~ of II~ ~d Urb~ ~vd~ ~11 i~. ~ d~ not w~t ~ ~ nor ~ c~oa of l~ ~. Buy~ shoed ~ ~l
~ ~a~f~f ~ ~e ~cc ~d c~ of ~ ~y ~ ~ 113
W~: Se~ 1010 of ~flg t8, U.S.C.. Dc~t O¢ H~ng ~ Ur~ D~v~opl~ ~d F~ Hou~ A~s~on
~ac6~m, ~°vi~. "~ ~ ~c ~sc o~ -. - ~n~n8 ia ~Y ~Y ~ ~ of ~ D~ ms~% p~s~s. ~ ~ pu~ 115
~ a~y :,~. ~g ~o sa~ mbc f~l~... ~l ~ ~ ~ ~ fiQc ~ i~d ~t ~m ~ ~o y~. or bo~.'
~ C~flfl~fi~ Wc~~S~l=(s)~Buy=(s)~~~~~con~ctf~c~ 122
BW~ ~ amy be r~ bY ~e m~ge ~, ff~, ~ ~ ag~. Sc~ f~ ~ to p~t ~y o~ ~c~m ~d by 127
or ~d~l for ~ ~ ~ of ~ A~m~t Buy~ ~ ~ fig~ to a~d ~ ~=c~ona 12~
(C) S~ ~ bare ~ ~ ~ ufiliti~ (indUing fu~(s)) on f~ Qm ~cfio~, 131
(D) ~ in~toc~, i~lu~g ~ in~, ~ au~z~ by Buy~ ~ p~c a c~y of ~y ~p~ to.~o~ for Buy~. 132
PRO~RTY ~/SPECTION CO~G~CY (1 ~2)
W siom; of ~ ~nt may ~vide for i~p~o~ ~or c~ca~ Ihat ~ ~t wMv~ or ~d by Buy~'s ~cc~ hcm. ~3~
D. Buy~' und~ t~ Ruy~ h~i ~e o~on m ~est ~s of ~ Prop~ (s~ PW~ ~pccfi~ Nog~ ~d
' Eu~cnu] Notice). B~ WA~S ~S O~ON ~ a~es to ~ ~ set ~ ~ p~ph 25 of ~ A~nC 1aa
~ ~C~ ~a7
Nofi~). ~ ~n~gm~ d~s not apply ~ ~ foRo~g ~i~fi~ ~ a~O~ i~: 14~
141
14Z (B) Sh~u~dBu.ve~e~e~tt~hav~ah~mei~.~eeti~n~i-thePr~peny~a~inthePen~y~va:~aH~mc~t~`Pcc~aLaw~(~cLqf~mati~n~egar~iag 14Z
14,t thc I'Iome Inspection Law) sur~h home inspection sha.ll be pe. dbla:arxt by a full menlber in good standing of n national home inspection ~soci. 1~
1..4 aQen, orb) apc~n~up=~isedbya~u~member~fana~.~na~h~mcir~$pe.~i~cia~i~n~inacc~xda~ewi~hthe~M~nd~ 144
145 o~ c~:mduct or t:R'acti~ Of that aslociafion. 145
14~
]53
1~2
!70
171
17Z
17~
178
179
18D
181
1~,
(C) If Buyer is ~ot sadsfied with the condition of thc Property as stated in any writte~ rcporL, Buyer wi~
[] Opt/on 1. ¥~thi. tile time given tot completing inspections:
1. Accept tl~ Property with the infonnerlon state~ in thc tcl~orl(s) and ag~c to fl~e R!:T I~4~5E ~ forth ia patagaph 25 of this Agreement, OR ia
2. T~mina~e ~L~s Ai~uent ~'~ v~?&ag by n~t~c~ to Se~er~ i~ which case a~ ~cpo~t m~J~es p~d ~n ~un~ of ~ ~c ~I be r~ed
pwmpfly to Buy:r and this Ag.rccmcrtt ~ bc VQID. OK 151
3. Ent:ri:tt~amutua.L~ya¢¢e~tablewti~cna~cancntw$th`~e~erpr~vidingforanyr:paksorimpr~vcmc~tstoth¢Pwperty~`d/~rsnyc~:~ 15l
to Buy,=r al seltl~m,.~t, as may be acceptable to th~ mortge~e leuder, if any.
Should e~forcs ~ reach a mutu~y acceptable aleut fail, Buyer mutt choose to accept thc Property or ,..min~,~ this Agreement within
the time given for enmpleting inspecdons Iud acoording to the provisions in para. apb 8(C) (Op~oe 1) 1 and 2, 155
Option 2. ¥/ithln the ~ime given for completing it~pecllons:
1. ^ccei~ thc Prop~t~ with the iffom~ion star~l in t~ report(s) and a~'~ to thc RBI.EA~E set ionia in para.apb 25 of this Agr~,~,~,~,
T~3S thc total co.~t to corre~ ~: c~nditions con,~i.~,~ in ~ z~poti{s) is mor~ than $
2, l~ the ~o~ cost to correct Cae conditions co~min~ in the repcrit(s)EXCEUaD$ tl~ amount specified th paraglaph $(C) (Optiou 2) 1,
Buyer will deliver the repert(s) to Seller within file' time given for i~.~peclio,,
a. S,'.ller will, within __.L._ DAYS of ~,=~iviug t~¢ report(s), i~n~ Buyer in writing of Seller's choice to:
(1) fv~ak~ repairs before s~fdclll~alt ~o that the rem'loin! codt to r~IXlir collditiolmi cout.lined in th~' Ieporl(s) is l~s than or eclual to
th~ m'nount speaLtied in para~ph 8 (C) (O£tion 2) 1. 1{3
(~,) ~--'~xlil Buyer at s~rdcll~nt for Ibc difference betwccu thc eacim~ted co~t of repairing the condidon.s conlained in ~ reports) 164
and i.he amoum sp~cLficd in paragraph 8 (C) (Option 2) 1, ThL~ oplion mua't be acceptable m thee mortgagc Ice.t, if a~y.
(~,) Not make repairs ~ not crcdit Buyer at .~le~ne~t ~o~ any cns~ to repair conditions co~ained in thc rcport(s). ISa
b. if Scllcr chcose.~ to msl~ rcpai~ or cr~iit Buyer ~ seF. lcmcllt as Sl~.ified ill pala~a~ 8 (C) (Opt[oil 2) 2, Buyer ~ aCCel~ thc 167
l~:opctty and a~ree to the REI.,~ASI~ ~=t £orth in paragraph 2~ of ~ A~'m. .
c, It S¢]Icr chooses no~ to makc rcpal~ ~d not to credit Buyer at sc~t]=meuL or if Seller rails to cho~e say option within fl~e time 1
I~:ven, Buyer will, within ~ DAYS:
(1) Acc~pt the Pwper~7 with tb= in~n~nad~n sr~ted in thc tcp~rt(~) and a~Fcc to the RELEASE set f~n~ in para~-aph 2~ o[ this ~7~
Agreement, OR .
(2) Tcrw~rmtothisAgreemm:inwridn~byn~dcetoSe11er~inwhichca.~eE~de~v~siim~inspa/d~nacz:~uni~p'~rc~1ascpd~x:wil~ 17~
bc r~-,u~ed promptly to Buyer and Lhis A~--menI will be VOID. ~74
WOOD INFESTATION INSPECTION CONTINGENCY 0-02)
[] WAIVED. ~Buyerund~`~mnd`sthatBuyerha~the~Ixi~ut~rcqu~s~tha~thePwpe`rtyb=inspec~edforw~dinfes~ati~nbyac~r1`~edPes~C~ir~
Opcrator. BI~'YER W~ ~S OFI'ION and al~ees to thc R.HL£.a,-'i~ se~ forth in l-~ra~raph 25 of This A/re~:~L ~??
~ ELECTED ,: 178
(A) Vv3thin--DAYS(~5daysif~tspeci~ed)~fthe~cu~iou`~£thisA§re~m~t~Buyer~atBuyer~sexpense.wi~btain~wriu*n"W~d~ I78
D~t.royio§ in~ect Inl%~a~ion lu~pecgon Report" imm a cerlifi~d P~t Control Operator end ~ deliver i! and ali suppoliing c}ocumunLs and
drawings py~vided by thc P~i Control Ope.~or to Sellei; Thc repoil is to be mad-. ssd~tot'y ~ and in compliance with applicebl~ laws, mur~-
8s~e lenders, aud/or l%deral Insuring ,nd Ouat'umccing Ager~cy ruqui~.m..+% .i~: eny. Thc inspect~ ~ illclud¢ nll readily vhib]c and
accessible am.~ of all structures ou ~he Projp~rry ~x~--pl thc following structure, wllich will,no~ t~ illsp~ed:
186
166
186
19D
'191
t92
'193
195
166
197
196
2(]1
2~
204
Il>)
/~)
~)
206 10, I~EN'I~I, LEAD-ILt.SED PAINT ItA.ZARD RED{ICI'ION ACT NO'lICE P, EQUI~ ]FOR PR01'ER~ : '
II thc inspccfon r~eal~ evidence of active kffcs~adou[s), Sc~ a~ a S~'s ~se ~'d ~e s~T, to ~t for acgvc
don(s), ~ atonce wi~ app~aMe h~. 166
~' ~e ~p~fi~ ~ls ~ge ~m a~ve ~fion(s) ~ p~ ~6~(s), Buy~, at Bhy~.s ex~sej b~ ~e opfi~ to o~ a ~/- 187
~ rep~ ~, a ~cssional con~ctor. ~ ~p~fion s~, or s~ cn~ne~ ~t ~ ~ ~ S~ ~{e W ~e ~
by w~de~g org~ms ~d a ~pos~ to mp~ ~e ~e. Buy~ ~ ~[vef ~e ~c~ ~Ec ~ ~ c~ve
ScUer ~in 7 ,. DAYS ~ d~v'~ ~e o~ ~sp~on r~m 1
~ ~_ DAYS of re~ ~ s~c~ ~ ~ ~d ~ve pmpos~, Sc{I~ ~1 ~e Buy~ w~ S~ rep~,
s~ f~ in p~ph 25 of ~ ~nt, 15a
~ S~ ~cos~ not m ~ ~ ~aic ~-~ by ~c ~ or ~ ~ r~ wi~ ~c time giv~ Buy~, wi~
2. ~ the mp~ b~rc s~ ff ~u~d ~ ~ ~gc 1~, ~ ~y, at Buyg's ~ ~ ~ S~'s p~o~ w~
not b~ un~o~bly wi~& ~ w~ ~ Buy~ ~p~ ~e ~ ~ a~ m ~ ~ WT P~E s~ fo~ in p~ph
~u~ H S~I~ ~es Buy~ p~ou:to ~,~ ~; ~uy~ ~y, ~in 5 DAYS of~ S~l~'s ~i~, ~
A~ ~ bc VO~, OR :, 20~
3. Tek, ate ~ A~, ~ w~ c~ ~ dc~t m~s pad ~ ~ of ~me price wiI1 be ~rn~ prom~y ~ Buy. ~d
2O7
209
210
211
:'12
215
Seller Ia.s la~owlcdgc of thc pre.ncc of Icacl-bascd paint and/or lcad-basexl palnt hazardsja, ol abo~ ~e ~. ~ ~e ~s f~ .212 .
~t~ ~t ~d-b~ P~t ~or ~s ~L ~ lo~(s). ~ ~un of fl~ pa~ surf~, and o~cr av~b]~ ~u~. 213
~on ~n~ming S~'s ~w~gc ~ ~ ~'of l~-b~ed ~ut ~ l~-b~ p~ h~s.) ' : ' '
215
· 216 .'
217
216
219
221
('B) Record~R. eports: ScUe~ has no repons .or ~xds lX~tainiug to lcad-bu.w.d paint and/or lead-based paiat I~az~ds ~u'or'about ~ Prc, j~ty, .: tT~
tmless cl~c~d ~}ow. '. ·
["1 S¢licr has tn'ovlded Buyer with all available tr.~ords 'and ~r,'po~ pertaining ~o lei~!.;ba,sed paint anti/or lead..l~ed pain~ llazatcls in or about ' 21
th~ Propamy. fList docum~ts) ~ ' .
21~
' .220
(C) Bayer's AdmowledEemenl~ Buyer h~ r~c/ved ih= pamphlct Protect You~ F~dly/~Om r~ad i~ 1~' ,'/om.c a~d h~ ~ the Lead Warning P.21
227 SLlte.lllenl c(,nlai=ed in this ASrccment (sec Environmc~tal Notices). Buyer has r~vlew~d Seller;s d~c~su.,e o~ ~nowu lead-based p~ut and/or
213 !ead-,',b~ed I:alat b. az~. _ds, as id~mti.ficd in p~"agraph 10(A) and ~ received the tec0rds a.ad reports p~g TO lead-.based paint and/oi; lead- 223
2z{ uascopaintJk, izarclsit, l~ntil~etlic,.lla~Rr~ph ]0('8). ' ' ._ /_ /
2ZE; (D) I~.SKA$S~M'ENT/LNSPEC'f~ON: BuyetacLTmw~edgesthatbeforeBuyeris~bhgatcdt~buy.ar~idcn~a~w~fing-bu~tbcf~9?$~Buycr :~
22? has , 1 fl DAYS m conduct a risk assessme,ur or inspection of ~he Property for ~c pr~s~oce of I~l-b~.~ed paint ~d/or I~i-bazcd paint hazards.
~2} f'l WAIVED. Buyer uudcrs~auds dia~ Buyer bas thc rlgl~ ro ¢onduc~ a risk as.~.,,smeul ~r h~spec~ion of the Property to delermiae ~e presmwe of
~ lcad-baso, lpaincand/orl~d-I~zedpainlhazard.s. BUYEP, WAIVES THIS I,UL~fr and ~gre~s to the REI..EASB set forth in paragraph 2$ o£ 229
~O this Agt:xan,mt.
2al [] HI.~CTtZD . 231
2~?. 1. Buyer, at Buyer's c:xpcnsc, choosca to obtain a risk asscssmcat and/or i~.~pection of tl~ Property for lced-bas~xi pa~t and/or ]=ad-based
:~ Pyth.'~az~ls_tThc~.~k~sc'~memancl/oriusl:~honwillb¢completodwifhiu ,{O DAYSorthee:,,~,donofthis, q~p~-eement
08/05/2002 H0N 16:$9 FAX 717 7,31 1795
23,5
285
~37
~88 3.
235
4,
~4~
5.
~5a
~5
~7
z~
;63 ~ 2.
2S5
270
274
~O
285
286
RE,fAX REALTY ~] 005
'WlthhL the time set I~orth above tar ob~3ing the risk assessment ami/or ln~eclioo of the Property for lead-based paint andror 3os
lead-based paint hazards, Buyer may deliver lo Seller a written list of ~he specific hazardous comiitions cited in thc rcpor~ ami those gas
corrections requc~d by Buyer, along with a copy of thc risk asscssment and/or i~pe~X~oa zq:~. 2~t
Sc"er =~ay, within 7 DAYS of ~zeivlng thc list and mpor~s)~ submix awfit~n con'eO, ive proposal to Buyer. TI~ corrective l~opos~l z3e
Mil include, but not bc l~mlted m, thc n~me ~ff thc r~medi~fion company ~nd a ~j~ c~pl~ ~e fw ~ec6vc mc~. Scll~
w~ ~o~ c~c~n ~ a ~ ~s~ or ~ ~t c~ve m~es have b~n ~sf~y c~ple~d on ~ b~om ~ 240
p~j~c~ ~mpl~i~ ~te.
U~g ~c ~vc ~s~, Buy~, wi~a ~ DAYS, wi~: 242
b. ~e ~s A~e~nt ~ ~, ~ w~ c~ ~l deposit mo~ p~d ~ ~t of ~ price ~ b= ~ed ~y
~ guy~ ~d ~ ~t ~ ~ VO~. . '
Should S~ ~ ~o mb~t · ~ ~ve p~pos~ ~b~u ~e ~e ~ ~ ~ ~ph 1~ ~ ~s A~e~ Buy~.
~ ~ DAYS, w~ ~4~
~ Buy~ ~ ~ ~' ~ ~ VO~.
guye~s ~u~ to ~se ~y of g.ycr's opfi~ ~ifl~ ~e ~e ~ s~ea ia ~ p~ph ~ ~a~;mte a WA~ of
~ con~gmcy and Buy~ a~ ~ P~ ~d ~ m ~e ~EASE ~ forth ~ p~ph 2S of ~ A~L
STA~S OF ~ON (1~2) 254
I)~E ~PE O~T ~U~ ~~ or w~g ~v~)
CO~ OF ~ AV~. ~T ~S w~ be dcSv~ to Buy~ ~ ~s A~m_ S~ DO~ NOT W~-
])~ ~ON ~U~ON ~OD 2~4
~) ~ON IN~C~ CO~G~CY
m~ N~J~: ~don). B~ W~ ~'~ O~ION ~d a~ to ~c ~E s~ ~ ~ p~aph ~ ~ ~ ~L
~o~)
~ Op~on 1
~ Acc~t ~ Prop~ ~ W~ng ~ ~ ~ ~ ~ f~ ~ p~ ~ ~ ~enL OR 278
c. Sub~t a ~ ~ve ~os~ m S~ ~ c~e~ve prop~ ~ill ~u&, but not ~ ~gd ~ ~c n~e ~ ~ c~ ~ti-
ga6ou ~mp~y; pro~i~s ~or pa~ ~clu~g ~s; ~ ~ ~j~ c~on ~m tbr co~c6vc m~um~.
(1) ~in ~ DAY5 of ~fiv~g ~c ~vc pm~s~, SeRcr ~I:
~r ~ASE ~ ~ in ~ 25 ~ ~s A~enL OR
(b) Not a~ m ~et~ of ~ ~ve p~ 286
(2) Shoed S~ not a~ m ~ ~ of ~e ~vc prop~8 ~ ff S~ ~ls to ~ wi~in ~e flme~v~, Buy~ ~L ~
.~ DAYS, ~t m; 288
(a) A~pz ~e Pmp~ ~ ~g ~d a~ m ~e pF~ ~E s~ ~ ~ p~agr~h 25 ~f ~ ~ent OR
Opfioa.2
~ A~ep~ ~ l~p~y in wr~ng ~ a~ ~ ~ ~ ~t f~ h ~gmph 25 of ~ A~ OR
b. Su~ a ~n, ~ve pto~sal ~ ScU~. ~ c~6ve p~ ~ ~. but am be ~ m. ~c n~ of ~ ~d ~6-
i~ of $ ~ mw~ ~c m~] ~st of t~on ~d ~t~. which w~ be c~ ~ ~eut
(l) ff ~c &~ ~st of r~dia6on ~d ~L~ ~S ~ ~t s~ ~ p~ph 11~) (~on 2) b, Sell~ ~, ~
5 DAYS of rec~ of ~c cost ~ ~me~ no~ Buy~ in whig of S~'s ~i~ ~: 298
(a) Pay f~ ~e m~ cost of ~on ~d re~, ~ w~& cg~ Buy~ ac~ ~e Ptop~ ~ a~ ~ ~e R m ~ ~R s~ fo~h
3~0 ia paragraph 25 of this Ag~:cment, OR 300
301 Cb) Contributr toward ~e m~ ~st ~ ~i~on ~d m~ o~y
$02 (2) ~S~l~scsnotm~yfor~eto~stof~~L%~ffSc~lsto~o~e~opfion~iu~e~e ~2
3on given, ~uy~ ~ ~n,,. 5 DAYS, ~ ~ in ~g of Buy~'s ~ic~
3~4 (a) P~y ~ ~ b~w~ S~'s c~o~ ~ ~a~ ~d ~ a~d ~e ~ ~st ~ ~ whi~ ~ 304
30~ Buyer ~ce~ ~ ~ ~d a~ To ~e ~E~ set fo~
3a~ (b) T~ ~ ~n~ in w~ ~ ~ dc~it mo~s p~d on ~t of
~7 I:o Buy~ ~ ~ ~t w~ ~ YO~.
3~a ~. STATUS OF~FA~R (~2)
30g (A) ~ ~pl~m ~t ~e ~y ~ s~ed by: 309
310 ~ ~b~c W~ 310
311 ~ ~-aig Wa~ 311
3~2 ~ Com~ W~ 312
313 ~ Nou(~ 313
31~ ~
3~5 ~) WA~ :~CE ~SPEC~ON CO~GEN~
316 ~ W~. B~ow~dges~Buy~o~on~t~ionof~wa~s~ice~~y. B~W~ 318
31~
1. Buyrxhas~hcoptio~wi~u DAY S ( ~ 5 days ~ n~t sped~ed) of thc execu~ion ~f t~is Agteement and at Buy~r~s ex~ense~ ~ ~cr~vor 31o
t~ ~c lJ~r a wriRe. V. iaspcc6on ~p(x'X by a qusli~d, l:n~f~sional water tgsgng col:npany of the quality and/or quantity of the water sctvie.=. 320
Buy Initials: ..... AfS-ZK iasc 4 of 8 Seller rnl~ls: ~ ~,- 321
RJ:L~IA~. R~ALT¥ ~ 0 0 $
i~pecSOn ~mp~y. Sc~= ~1~ a~s to r~ ~e P~pe~, at S~'~ ~n~c, p~or ~ ~L 3Z~
~h~ rq,ort, notify Buyer in wri~ug of Seller's choice to: ~Z7
a~ TJpg~dc ~he waze~ sen/cc to th~ m/aimum acceptable l,:w.h, bef~c sctflemenL in wblch ca~e Buye~ accepts thc l~erty and agrecs
~,~ the RELEASE set forth Lu pazagraph 25 of thh Agrccn~nt, OR
b. NOt upgr~e thc water service. '..
4, If Sell,.~ chooses no: to upgrade the service to m;r~mum acceptabk lcvrJs, or f~ to ~ ~ the ~e givm, Buyer ~L ~n
5 DAYS, dth~
a. .g~ccept the ]:Mape.~ and the water service ~ if requizrA by the mortgage lender, if an),, and/or a~y gov~ authority, upgradc
Ihe wamr service before ser, lement or withje the tmae require~ by ~ mortgage le~c~r, if any, aud/or any gove. mmcatal authority, at
~uYer's expcnr, e and with SeUe~'s l~CaTaiss~on, which wilt not be unreasonably witlfladd, and. astra: to the ILELEAS~ sci £orth i" pa~- 3.~6
graph 25 of th/s Ag~.meal. 1/Se[lor &mi~s Buyer permission m upl~c~ the water s~-vi~x:, Buy~ may, wi~ DAYS of
Seller's deMa/, t:rmJnate tl~ Ag~emcat hi writing, in which ca.~e all deposit mo~ies paid on accounL cfi ptffc, has¢ pri~¢ will be 337
r:tum~d promlrdy to Buyer a~d this Agrc=mont will be vOID, OR
b. Termiaat¢ this Agreement in writlng, in which case all deposit monice p~d on a~um of purdu.se price will be returned pr0mptl7
~ Buyer aud fl~is Agteem~t ~ be VOID.
13. STATUS OFSIiWER (1-02) 341
(A) ~ repfcr~o,~ ~hat the l~op~rty is served
by.
L~ Publk S~wer aaa
[] hld~'vi.:lual O~-lot S~,vag¢ Disposal Systclzl (~,~c~ Semage Noiice 1) 3~4
r-I I. udividual On.lot Se'wage Disposal System in Proximity to Well (S== Sewatc Notice 1; seo Sewage Notice 4, ff applicable)
: [] Community Sewage DisIx~e, al System · '
[] 'l'en-a,:re Permit F. az'mprion (See Sewage Notice 2) a47
[] HokLb3g Tank (See Sewage Notice 3)
[] None Availablr.,'perrmt.! Jm~t-~fions ~ Effect (See S6'wag¢ Notice 5) . .; . : 350
354
3~7
3~3
36?
37~
372
373
376
ST/
3?9
$82
as9
394
[]
INDIVIDUAL ONa,OT SEWAGE DISPOSAl; INSI~CTION CONTINGENCY : .
WAIVED. Buyer ackn°wled§es that Buyer ~s the °Ptlon t° requ~ ~m individual °n'l°t s~wag= disP°~aI i~upocfi°n of thc PropeaT. BUrR
WAirV'F~ IlIIS OPTION and agrees to thc RELEASE se~ ferth in immgraph 25 o£ this Agl~cm~mL
1- Buy~', baa ~e option, within ~ DAYS (IS day.~ if oo: spcCifie. A) of (he c=ecution of this A~c~m~ent aud al Buyer% expense,
cIel/ve~ to Seller a written in~e~ou report by a qualified, professional inspectoz of the individtml on-lot aewage disposa~ system.
Sellez, at Seller's expea~$¢, agree~, i~ ~nd a~ requi:od by Lbe impection company, to loeam, pwvide access W and empty the it~ividual on.
lot s~,~rag¢ disposal system. Seller also ,l~ees to zeator= the PzopraW, az Se/~'s cxj~mse~ prloz m scttlem~L
If the report reveals clcfccts ~t do ~ot requi~ =pansioa or z~.phcemant of the existing scwagc clisposal sTsum~ SoUer will, wifl~a aaa
7 . DAYS cfi receipt of the re~erL no6~y Buyer in wfir./ng of Seller's choice to:
a~ Cerre~ the defects before se~emeat, bachding retests, at Scllcr's expcasc, in which ca~ Buyer accepts the Propcrty and agrees to
~/~ RELF_P~E set forth in paragraph 2:5 of this Agreemcat. OR
b. ]got correct ~ dcfccLt.
4. If Seller chooses not to cor~cc: ~e defects, or if S~ ~alls to respond wtUdn the ~ given, Buyer will, within 5 DAYS. ei0aer.
a. ~'cept thc Propeny aud thc sy~lcra and, it* required by the mongag¢ Ir. nde. r, if any, :md'or ~y govemm~tal authority, co=cct thc
dc£e,:cs b~ore settlement or witl~ia thc time required by thc mot*t~age leader, if .,-y. and/or any goverumca~ amt~ity, a~ Buyer's
,;olc expense and with Seller's pe.m~sion, which will not bc umeasonably withheld, ~d ag~c ~o the ~SE sct forth in para.
~raph 25 of :his ,A4r=:ment. If Seller dcaics Buyer pemaisslon to co:reef the de~ect$, ~uyer may, wiLhitl _~.~_ DAYS of Seller's aM
,:legal, termln.~e this Agreement ia w'xi~ i~ which ce.so all deposit monies paid ola aoeount of ImtCha,se price will be returned
'promptly to Buy~ ged ~ Ag~ec~at will be VOID, OR
b. Tcrai~ate this A$-~mant ia wrili~, /~ wbi~ case all deposit moni~ paid on acco:mi of purab~.le price w/fl be re~,u'ned
promptly to Buycr and this A&reemcat will bc VOID. 37~
5. If thc r~port revca. Ls ~ nceA lo exp~ or tcp[ac¢ thc existiag iadivldual on-lot ~ewage di~pos,'d sy~t~ro, Seller may, wil:hil~ .. ~15 DAYS
of :ex'Pt o£ thc rePo:t, submit a correcllve Fmposal m Buyc: The co:rectivc pwposal wiU include, but ~ot be limimd to, the mu~e of t~
r~a~liatlon company; provisiona for payment, including re~sts; a~l a pmjec~.d compl~ion date for cotzecfiv~ mr.a.sure.~ Within
__~.__ DAYS of receiving Seller's oon-~ive proposal, or if no correc~ve prOposal is rece/vcd vl'~lln the time given, Buyer will: 377
a. Agree to the terms of the co~eetiv¢ ProPosal, if cay, ia writing, in which ce-~ 13uTer accepts thc Psoperty ami agrees to thc Rr~ ;~;E
set £om't i~ paragraph 25 of this AglcemenL OR 17a
b, AccepL the Propcrty and ~e system ..md, if requited by the mortgage lander., il' any, and/or any govcrnmental authority, ~ the
def,'ets before seRlcmca: or withi~ the time le, qui:ed by the mo:tgage le~clcc if any, aud/or any gov~a~m~ authority, at Buyer's
sole cxpense and with S¢l}er's perm.LssioD, which wj]l not be um'casona~ly ~vith~]d, aud. agree to t~ P,.~-L 'F..ASE set forth in para-
graph 2~ of chis Ag,~cel:I~lL h' Seller deaies B~y~r permission to correct the dc;~cis, Buyer may, wi~ill ~ DAYS of Seller's
danial, Wrminate ~ Aglv. r. ment ia writ~, ill which case all deposit monies paid on ac:coual o1: pu.rcha,~ p'~ce will be relvrncd.
promptly to Buyer and this Agreement will be VOID, OR 385
c. Term/nato figs Agleemcnt i~ wri~ng, ia which case ull depos/l monic,~ paid on account of purchase price will be retunled prempUy
w Buyer und fhLe Ag2ec'menL will be VOID. 3~7
14. NOTICES, ASS,ESSM]~NTS & CERTII~CATE,S Of? OCCI/PANCY (~ -02)
(A) Sell~ repiesents, as of Selle. r's =irmufion o[ this AgreemeaL thui ~,, public imploveme.nt, condominium or homeown~ asociaion a.sscs~_-,uents
Imvc been made aguin~t cbe ?wperty whic~ remain tmpaid, and the ~o ~otic= by any gov~rmnan~ or fmblk authazity bas been servcd upo~
Sdl= or anyone on Seller's behs/~ kmludin§ an6~es relating Io vlolafiom of zoning, housing, build, ag, safely or ~re ordinances which remain
~menrrected, and that Seller Lmows o£ no condition flint would cons6m:e viol~tion.of any au=h or, ti,~es which zr, m~ns uncorrectc~ uale.~
oth:rwise speci~ccl here:.
~4
3is (B) SeUer lmows of no other potential ~o:ices (iacludi-g violations) trod assessme,~ts cacept as follows: a95
097 (C) Intbeeveatany~t~ces~n~ludi~gvi~ati~ns)a~.da~sscssm=eLsaremce/vcd~eter.~:cuti~n~fthisAgrec~mrmtandbe/~msettiemcnLSeI~erwi~ ~?
398 no~y Buyer ia writing~ withia S DAYS of rec, eivil~ th~ notice or asscssme~ that Seller will: 338
3~ 1. Comply with ~otice.s aod ~sc,~menu; at Seller's expcnse, in whiah ces= Buyer aceepLs the Property laid affn:e.a to the RELF.,ASI~ se~ lotth
a0o ia para~'~ph 25 ot",hLs Ab, r~--~--~ OR 40n
4~*~ 2. NOt comply with Dotic~ Ired a.Sses$11F.~L,i az Seller's expc~'c. 401
aO2 3. If~1erch~s~tto~m~ywith~ce.~andessessm;ut~rfal~swithj~tbe~megive~n~tifyBuyerifS~UerwU~c~mp~y~Buyer 4~2
4~ wLll :notify Sellor within __~_ DAYS in w~itiag tt~t Buyer will eithec
~ a. Comply with notices and assosm~:nB at Buyer's expcase and agTeC to the R/:2.1;A.RP- sot forth In paragraph 25 o.f ~hi~ AgreemenL OR
4o~ b. '/'edax~a~ tiffs Agreem_~tt, in which case ,all &p~sat monies pa~ on account of purchase price ~ be returned prmnptly to Buyer
~OS and this Agreement wil~ be VOID.
,~ll7 ff Buyer fa~Ls to aotlfy Seller witl~ the time glven, Buyer accepts the Pruporty and agrees 1o the R~LEASE ~t fo~ ~ p~.
408 graph 25 of thia Agrcem~mt
4t1~ cD) Buyer is~dvi~eal that ac~sa~lo n public.read.u~y r~lmre L~sua~cc of a hi&hway o¢enl:mi)cy permit [rom the Dep,qr~t ~pozlatiolL
08/05/2002 ~0N 17:01 FAX 717 731 1798 RE)iAX REALTY ,uu/
411 (E) II t~qoked by law, withln__l$ DAYs~f~h=cxecuti~n~f~Agr~cm~ntSc~crwi~c~rf~rdc~ivcry~Buyei.~rbe~i~rcscm~mra~L~.
41Z 1. A r~fication from ~e a~ro~nm m~ ~t ~ dep~ ~clo*~ng no~c~ ~ ~ u~d violates ~ zone, ho~
~1~ 2. A c~ficam p~tdng occupm~ ~ ~c ~op~. ~ ~ ever ~g~vm~ ~e ~uu~ for ~ resource ~ ~c =mQ~tc, Scar
req~ r~gimpmvem~ at Se~er'~ ~p~.
417 ff Scg~ ~oos~ m ~e ~e requk~ ~p~s~v~, Buy~ a~s m ~pt ~ ~ ~ ~pa~ ~d a~ ~ ~e ~R~ set 417
nofi~ Sc~er in ~g of Buy~'s ~we W ~te ~ A~t. OR ~ ~e..~/~Pwv~- at Buy~. s exp~e, md. wt~ ~cr s
of ~sc ~ce ~ be ~ ~fly ~ Buy~ ~d ~s A~e~nt wffi bo VO~.
425 ' '
427 ~ be g~d ~ m~lc ~d su~ ~ ~1 ~ ~d by a repu~lc ~fle ~c C~pmY at ~e ~gul~ rates.
(2) ~d t~t~ce, ~ ~ ~ ex~d ~v~a~ ~c sub~d~ J~ ~ f~ f~ c~ou of s~ ~ ~y; (3) Ap~s~
fees ~d ch~g~ p~ in adv~ to ~gg~= len~, ~ ~ (4) Buy~'s ~to~ s~cm~t ~ ~ ~.
(C) ~y su~' ~ s~s w~ ~y ~ teq~ by ~ ~go ~u~e Cow~y ~ ~e ~s~g a~m~ f~ ~ p~afon of ~ ~
~ui~d by thc mo~gsgc 1~ ~ be ~ed ~ ~d for by Buy~.
434 (D) ~ ~e ev~t Scll~ ~ unflble t° ~c a g~d ~ ~lc dale ~ au~ ~ w~ be ~u~ by a ~u~l~ ~e C°m~any a ~ rcgul~ ~s' m
rc~d ~ nto~ p~ bv Buy~ to 5~ ~ ~t of p~h~ price a~ b~g r~bms~ by $~ ~ ~Y ~ ~d by Bdy~ f~ my insp~
sol~y ~ p~Y m ~t singl~f~y dwi) ~ ~u~ ~ A~t v~ at ~e op~u ~ t~ Buy~', ~d, ~ v~ ~y d~oi~ 441
c~se ~ deco, it m~ p~d on ac~t of p~e ~c ~ be re~ ~ompfly ~ Buy~ Buyers f~ to ~pond ~ ~e ~ ~7
~ ~ ~usgmte a WA~ of ~ confi~ ~ aH ~h~ t~ of ~ ~t ~ain in ~ fore and ~'e~
17. C~NOTI/E
455 no~ ~ ~t f~ in ~e ~ provided ~ S~on 1 ~ ~A~ of l~y 17, 19~, p~ 984.) ,,B~ ~]edges ~t ~ ~y not be ~ng ~e
d~ to ~ne sul)~d~ by a ~va~ ~n~ ~ ~ own~ off ~ ~o~c ~tcr~ ~ ~ ~- ~ ~ow~emmt h ma& f~ ~ ~o~ ~7
~ c~yiu g u i~ ~c pm~om of S~ion14 of ~c Bimminom ~ ~e ~d ~e ~d C°~°n Act ~ A~12 7 '1966'" Buy~ ~
lez I. ~y/i~ pos~iou 1o ~ut ~p~ ~ee of d~, wid~ ~ s~c~S b~om-~ ~ ~Y ~d time ~ se~emcuL A~/OR
exec~fi~ of ~ A~UL ~ mfl~s o~c ~ed h~. B~ ~ ~owlcdgo ~is~g leme(s) by ~fi~ing s~ ~s)
~e of ~ccugon ~ ~ ~
~7
count of Buy=.
and if Bu~ c~ ~ p~ ~is Agent to be ~ S~ ~y =]~t to ~t s~ ~: ~ a ~h ~ ~ A~L
47Z A~t ~th~t ~e ~ ~ ~ Sc~
47~ 2L D~POSIT & ~CO~R~ ~D (1-02) ~7a
,175 paint ~md ~e ~on ~i~ted ~ pa~, ~l be ~d ~ U~. Doll~ to ~k~ ~ P~ i~tifi~ ~ ~h 3~L who w~ ~ th~ 475
...... -
47~ ~) Up~ ~n~on ~ ~ A~ ~ ~ holing ~ dc~t moni~ ~ z~e~e ~ d~olR moni~ ~ ~co~cc with ~ ~ of a 476
479 fully execu~ ~t a~t be~ Buy~ ~ Sc~. 479
dm~a~:R~l~m~Co~ssiou(49P~C~{35327)mr~e~~w~e~lv~ In ~ ev~t of ~on
for ~e re(urn of ~t m~, a b~ ~ disi~%u~ ~e ~mcs ~ d,~ by a ~ or~ o f court or ~ ~ ~t ~ ~c p~c$.
as4 fecs and cos~ ~ ~ bmr(s) ~d hc~q~s) ~ b~ p~ by ~e p~ j~ng ~.
a8~ ~) A Rc~ Esmm Recov~ ~md ~ m ~m~se ~y ~rsom w~ ~vc ob~ed a fx~ dv~ jud~cm aga~t a P~lv~ia r~ ~tc
as0 ~e~c (,wing to ffau~ misrep~li~ or ~it ~ a ~ ~$~m ~6on ~d who have ~ uuabk m collect ~ indent ~ ~st- 400
a~7 ~g ~l lel~ ~ ~ui~Me r~. F~ com~e~ d~s about ~ ~u& ~ ~17) 783-3658, ~ (8~) 8~2113 (~ pcpnsylv~ ~ ~7
48~ (717) 782,4854 (ou~e y~n~ylv~).
~e9 ~. C~O~~CO~0{OMEOW~RASSO~TIO~ENOTI~(I'02) 4~
491 ~ ~I'~CABLE: CO~O~M. Buy~ ~d~ ~ ~e Pmp~ is a ~t of a ~m ~at is pr~y nm by a ~t o~'
493 of ~e ~]~o~;um &~afi~ (~= ~ pl~ ~d plum), ~ bylaws, md ~ ~ ~d ~lafi~ of ~ ~c~fi~. 493
491 ~ ~C/~LE: ~NE~ COMITY ~O~0~ ~SO~TIO~. Bu~ a~w~g~ ~at ~ ~ is p~ of a pl~ed 494
~5 ~l~u~ ~s d~mcd by ~e U~o~ ~ Co~ ~ (See D~eon of ~ ~ No6ce). tS~7(a) of ~ Act req~cs
4~ Se~ ~ [~h Buyer w[~ a co~ of ~e D~on (o~ ~ ~ ~ P~). ~ bylaws, ~ ~s and ~g~fio~ ~ ~c ~c~o~
4~ a C~ca~ c~g ~ pm6~o~ set fo~ ~ i5407(a) of ~ Ac~ ~
08/05/2002 ,~{0N 17:02 FAX 717 731 1798
499
5~8
~11
514
521
526
s3z ~.
5~
~4~
544 ~.
545
556
564
5~7
5~
5~
5~
576
516
519
5~
REMAX REALTY ~] 008
TEUt FOLLOWING APPLrE$ TO PRO~R~ T~T ~ P~T OF A CO~O~I~ ORA P~D C~. 4~
~n~ ,ecess~ ~ ~ab~ S~ w ~ply wi~ ~e ~t. ~c Act pmvi~s ~ ~ ~s~a~ ~ r~ m pro~ ~ doc~m ~
1 O days of ~ eg~'s ~u~L
~) S~ ~ p~mpfly ~v~ to Buy~ ~ docum~ ~ved ~om ~e ~so~ Und~ ~e Ac~ Sell~is ~ ~e ~ Buy~ f~ ~ ~ ~
d~y ~ ~c ~so~6~ m pro.de ~e ~g ~ a timely ~n~, nor is S~ ~ble to Buy~ f~ ~y ~neo~ ~o~ pm~d
Bu~f~al,mo~sp~dbyBuy~a~oa~tofp~e~f~ycosts~dbyBuy~or: (1) ~s~kfifl~ing~or ~1~
si~nce ~u~n~, or ~e f~ ~nc~aron of s~c, ff ~y; (3) A~ f~s ~ ~g~ p~d ~ ad~ ~ m~g~e l~d~, ff ~y.
~~C~ & RUSK O~ LOSS (1-02)
w~ ~d ~ ~c~ 515
~) ~ ~e ev~t ~y sys~ or apph~ in~uded m ~ ~ ~ ~ ~e~ ~ ~d $~ ~cs ~t ~p~ ~ ~h~ ~c i~ S~ ~ ~P~Y
~ or appE~ (~ option m~t ~ ac~mMc ~ ~e m~gag¢ 1~, ff ~y). In ~ c~, Boy~ ~p~ ~ Prop~ a~d ~
· e ~ set fo~ M p~ph 25 of ~ A~L OR
2. Not ~?~ ~ ~lace ~ ~ystem or a~, md ~t ~t Bay~ at severest ~ ~ ~ m~ v~ue d ~ ~cd ~ystem or
~ce, H Sell~ d~s ~ ~air, ~ace or off~ a ~t ~ ~e f~ ays~or ~ or ~S~ [a~ to no~ Bu~ o[ Sdlc~s
~oi~. Buy~ w~ ~ S~ in.w~g ~ ~ DAYS or ~orc sePaL whic~ h so~c/. ~t Buy~ ~:
~ ~,~t ~e p~ Sod a~ ~ ~ ~.~ ~ f~ ~ ~ph 25 ~ ~s A~L OR : 524
b. ~na~ ~ ~g M ~ c~c ~ ~t mo~ paid on ~ount of p~ ~ w~ ~ ~d p~mp~y ~ Buy~
a~ ~is Agre~nt will ~ VO~, SiS
~y induced ~ ~$ s~e ~t is not mp~ed ~ :~la~ ~or to s~g Buy~ Mll We ~ ~n of ~g ~ A~I
~e ~ ~ ~tion of ~ A~L
~ ~ A~e~t i~ cen~g~ ~ B~er's fi~t ~ ~p~t ~or ~p~ ~c ~p~. Buy~'s ~ to ~e ~ ~ Buyer's opfio~ ~
~e fi~ ~ set fo~h m ~Ag~ ~ comfimtc a W~ of ~ c~m~ ~ Buyer ae~p~ ~e~p~ and ~ ~ ~e
Ba~ h~by ~t~s, q~t d~ims ~d fo~v~ ~ ~L~R, ALL ~O~, ~gr ~, g~LO~ ~ ~ O~-.
~R or p~R or ~ o~ of ~ ~ ~ a~r ~ON, ~ or CO~O~TIO~ who. rosy be ~bl6 b~.or~&~r~ ~m
~I ~ ~ d~as, I~ or dmsO, ~d~ but not I~1~ ~, pm~ sa~ p~I ~age ~d~ ~.le co ns~ia~ t~-
0~ whe&~ sow ~o~ or nog ~ m~ urge ~ the p~ 0[ ~ or ~ wood-b~ ~ ~do~.l~a-b~ p~ h~,
or ~y d~eca cr ~6~s on ~ ~y. Shoed ~ be in d~a~ ~ ~e ~ of this ~ ~ ~sc do~ sot depfiw
Bayer ~ ~ rii~l ~ p~sue ~y rem~ ~ may be sv~b~ ~d~ law or equil~. T~ ~e ~ ~ve ~ffi~L
~P~S~A ~ONS (1 ~2)
(A) Buy~ unde~t~& ~ =y ~camfio~, cl~ ~v~ pro~6~ ~vifi=, ~ch~ ~ pl~ ~ ~y ~na ~ ~ Scar, ~k~s, 545
A~e~t will ~t ~ ~ ~d, c~g~ ~ ~ed ~ccpt ~ wring ~ ~ ~o p~e~
~' ~d he~n), o~ h~ ~i~ed ~e ~ght ~ do so, and ~ ~ ~ p~e ~e P~ ~ 1~ p~t condl~ou ~
o~ ~t~ ~ ~ Agr~c ~uy~ n~wl~ ~t B~ ~ H~n~ ~ploy~ O~ or p~ ~nv~ not ~de
~m~ ~fiom, ~e pe~ ~ or of c~fiom ~ in ~ ~ wh~ ~ P~p~ is ~t~ ~r ~ ~ made a
m~hnnir~ i iasp~on ~ a~ ~ ~ ~ ~n~ed ~ SSs
(C) Any rep~; ~ ~ ~ ~: w~ be c~p~ ~ a w~t~li~c m~.
{~ Tho h~diugi, ~pfi~, ~d ~ne n~b~ ~ ~ A~t m m~at only to m~e it ~i~ to ~d t~ p~gmp~.
27. DEFAULT (1-02)
(A)Set}er h~ Ibc ~fio~ ~ remi~ing ~ sums p~d by Bay~ ~cl~ing ~z d~R ~M~, shoed Buy~:
1. Fal m ~c ~y ~dir~ pa~ ~ sp~ in p~a~ph 3; OR
~ ~t to co~ ~ ~e p~gng of ~e ~n~ge 1o~ appH~og wM~ ~ would ~ult in &e ~l~e to o~ ~ ~v~
m~f~c 1o~ co~ OR
3. ~ola~ ~ f~l m ~ ~d ~form ~y o~ ~ ~ ~fio~ of ~ A~ 565
fo~o~ Kg )l~ann~;
1. On ~:o~t of p~e ~; OR
~ ~ EC{~ d~s for ~ b~a~
will be ~<aa~ from fi~ ~li~ or o~fi~ ~ ~is A~t ~11 be VO~.
~D~'rlON ly~6)
~ W~. Buy~ ~ S=fl~ ~md ~t ~ may choose m ~m a a ~= ~g, ~o~ a ~g ~=, ~t ~t ~== ~ b= no ob~-
ga~ ~ the p~ of ~y pa~y to ~ so.
E~ 578
(A) Buy~ ~d S~ ~1 ~ m r~lvc any dispute or ~ ~t may ~se ~m ~is A~t ~u~ ~ ~ ~ wi~ ~¢ RuI~ 570
and ~eedures of ~e Ilome Se~o~ Buy~ D~pug R~g~u~ Sy~ ~ a~m~t l~ ~u~ a me~afion ~
si~ by 1~ p~ ~ill be b~ 5al
~spute ~s~u~on Sys~ (seg ~alion Notice).
(C) ~is ~eem~t ~ me~ ~]tcs arising from ~A~ ~ ~vc ~l~c
~S-2K P~ 7 of 8 S~ ~:
D~/U$/2UU~ .~UR 17:U$ FAX 717 7~1 17~
~? 2~. SPECIAL CLAUSES (1-02)
(A) The foUow~ s~ p~ of th;s A~nt ff ~c~:
~ Sale &
C~ting~ Adden~ ~ F~ SSP)
~ S~c & Senle~t ofO~ ~o~ C~tingeacy
~A~ F,~ SSP-CM)
~)
RE.~IAX REALTY ~ 009
~ Settlem;nt of Other Property Contingcmcy Addendum (PAR Form SOP)
[] Tenant-Occupied Pwpcrty Addendum ~AR Form TOP)
Buyer m~l Seller ac~mowlec~e ~ecelvlng a ~y ~ ~ A~t at O~e ~e ~ ~ , ~
~ Buy~ h~ ~t~ ~e C~ No~ ~ ado~ by ~ Sm~ R~ ~ C~min~n ~ 49 P~ Code ~336.
~ ~y~ has ~v~ a S~'s Pm~ ~a~ S~t bdo~ sl~g ~s~g if ~ by ~w (see l~mfiou R~g
M B~ ~S ~e Dcpa~t ~y No~ (for cad.five ~1~ w~ B~r for S~ ~ ho~ deport ~ncy) b~ i~g. ~;s
593
594
598
6C0
601
;92
603
§88
610
613
819 BUYER'S CONTACT NUMI3ER(S):
~ WITNESS
$~t
· ';" ! ' 626
536 SELL.ER'S MAIY,13~OGADDRESS:
6~o
841 SELLER'S C~TA~ ~S):
6~s WITNESS.__
~ wn'NE~$
651
ss~.
SELLER DATE.
$S~.
~52 Broker's/Licensees' Cer'dficntions (check all that are applicable):
;40
;44
;~ I-I P.~gatnlin!g Lead-Based Paiat Hazards Di~'.Jo~m'e: R~d
654 ~s ~ on~ of ~v~ ~d thei~bmk~ ~ ~t ~ ~ ~ ~c to ~=.~t of ~ ~o~gc ~d b~
5~ A~owlc~t: ~L~volv~h~n~c~~of~e~'so~u~id~fi~B~ 655
sss P~ ~d R~ AcL 42 U.S.C ~2(d).
~s7
658 ~ ~g~ding ~ Mor~g~:' ~ ~ed ~e~ ~volv~ ~ ~ ~s~o~ on b~alf of ~elv~ ~d thor ~s, ~ ~at asa
~ ~ R~iug ~fion: ~e ~s~
~65 BRO~ FOR ~LLER (Compa~ N~e)
670 67~
571 ~-~
~'S COPY
U.S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT
SETTLEMENT STATEMENT
Phone:
SECURED LAND
TRANSFERS, INC.
5006 East Trindle Road
Suite 203
Mechanicsburg, PA 17055
(717) 591-8500 FAX: (717) 591-8506
OMB No. 2502-0265
TITLEPRO
La$erprinl
TYPE OF LOAN
1. [ I FHA 2. [ ] FMHA 3.X] CONV. UNINS.
4 [ I VA 5, [ ] CONV. INS,
6 FILE NUMBER: I 7. LOAN NUMBER:
130027
8. MORT. INS. CASE NO,:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amcunts paid to and by the settlement agent are shown, Items marked
'(p.o c )' were paid outsid,~ the closing; Ihey are shown here for informational purposes and are not included in the totals.
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Fadil Jusovic Estate of Rosemary C. Waypoint Bank
Kelly, Rosemary Bascelli
G. PROPERTY LOCATION:
Jeanne Bucher, James
Hammon and Elaine Hammon
H. SE~LEMENT AGENT:
Secured Land Transfers, Inc.
PLACE OF SE~LEMENT:
3915 Market Street Camp Hill PA 17011
302 Manchester Road
Lower Allen TOWNSHIP
CUMBERLA/~D County
101 S. GEORGE STREET
YORK PA 17401
,J. SUMMARY OF BORROWER'S TRANSACTION:
lOO GROSS AMOUNT DUE FROM SORROWER
lol Contract sales price 80000 . 00
lO2. Personal property
'~0,3 Settlement charges to borrower (line 1400) 3 19 2 . 5 8
lO4
lo;' Counly tax
lO8 Assessments
Adjustments for items paid by seller in advance
~o6 Ci~y/Town tax ~o /31/02
09/12/02to 12 106. 09
109 School
110 to
tO
09/12/02~o 06/30/03! 740 . 42
4.73
8.58
120. GROSS AMOUNT DUE FROM SORROWER I
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER
84052.40
201. Deposit or earnest money
5000.00
75000.00
I SE~LEMENT DATE:
09/12/02
K. SUMMARY OF SELLER'S TRANSACTION:
40o GROSS AMOUNT DUE TO SELLER
4o~Contract sales price 80000 . 00
402.Personal property
403
404
405
Adiustments for items paid by seller in advance
406 City/Town (ax to
a07 County tax 09/i2/02to 12/31/02
408. Assessments to
40~ SchooZ 09/12/02to 06/30/03
410 tO
411Sew:$24/q endin9 9/30
4~2 Ref:$43.50/q endin9 9/30
106.09
740.42
4.73
8.58
80859.82
420 GROSS AMOUNT DUE TO SELLER
50O REDUCTIONS IN AMOUNT DUE TO SELLER
5oi Excess deposit (see instructions)
sos. PayoffofSecondMortgageLoan
James Hammon
Elaine Hammon
202. Principal amount of new loan(s) 502 Settlement charges to seller (line 1400)
203 Existing loan(s) taken subject to so3.Existing loan(s) taken subject to
204 5o4.Payoff of First Mortgage Loan
None
205
Assignment Credit 17.00
8570.00 i
3012.08
3012.08
207.
507
208 508 I
209
Adjustments for items unpaid by seller
210 City/Town tax to
211 County tax to
212 Assessments to
213. School to
214.
215.
Adjustments for items unpaid by seller
51o City/Town tax to
511 County tax to
512 Assessments to
5t3 School tO
515
216 516
2~7. 5t7
218 518
219 519,
22O TOTAL PAID SY/FOR SORROWER 8 0 0 1 7. 0 0 520 TOTAL REDUCTION AMOUNT DUE SELLER
300 CASH AT SETTLEMENT FROM OR TO SORROWER 6O0 CASH AT SETTLEMENT TO OR FROM SELLER
301 Gross amount due from borrower (line 120) 6o~ Gross amount due to seller (line 420)
302 Less amount paid by/for borrower (line 220)
3o3 CASH (D(] FROM) ([ ] TO) RORROWER 4 0 3 5.4 0
84052.40
80017.00
602 Less reduction amount due seller (line 520)
6o3 CASH ([~ TO) ([ ] FROM) SELLER
14594.16
80859.82~
14594.161
66265.66~
Buyer or Borrower's Signature
Seller's Signature
HUD-1 Rev. 5/86
L~- SETTLEMENT CHARG ES 130027
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
OMB No. 2502-026
Pag~
PAID FROM
7r'~O0. TOTAL SALES/BROKER'S COMMISSION based on price $
Division of Commission (line 700) as follows:
7ot. $ 2775.00 to
702, $ 2825, 00 to
703. Commission paid at Settlement
704. Trans. Fee
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee %
602~ Loan Discount %
803. Appraisal Fee to
804, Credit Report to
$05, Lenders Inspection Fee
806. Mortgage Insurance Application Fee to
807. AsSumption Fee
808 Doc. Prep.
809. Tax Serv.
810. Undw. Fee
8t1. Fld. Cert.
900, ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest from 09~ @$
80000 . 00 7 o 0 I BORROWER'S SELLER'S
~ FUNDS AT [ FUNDS AT
Total: $5, 600.00 ~ i S~'~M%~T
_Ja c---~~
ReMax Realty_
ERA-NRT, Inc
Wa_y_point Bank
Wa~t Bank
Waypoint Bank
Waypoint Bank
13.2 8/day
100.0-~0'L 5600.00
290.00
91.00
zoo.%-6-
14.00
_~.____~.52.32L
902. Mortgage insurance Premium for
903. Hazard Insurance Premium for
904. A~ . Fee
905. Mail F~-~
1000. RESERVES DEPOSITED WITH LENDER FOR
o01. Hazard Insurance 3 mo. @ $
mo to
yrs, to ($~)
yrsto Waypoint Bank ($325-POC)
Way_p_~int Bank
18 . 17 /mo.
002. Mortgage Insurance mo @ $ /mo,
lOO3. City/Town tax mo, @ $ /mo.
1004, Countytax 8 mo.@$ 29 .34 /mo.
10o5. Assessments
mo. @ $ /mo
m06, School Tax 4 mo.@$ 75.84 /mo.
1007r ma. @ $ /mo.
foo8. AggrAdj ust mo. @ $ /mo.
1100. TITLE CHARGES
I101. Settlement or closing feeto
1102. Abstract or title search to
:103. Title examination to
104. Title insurance binder to
105, Document preparation to
t 106. Notary fees to
1107. Attorney's fees
(includes above items No.:)
1108. Title Insurance to
Cash
Purcell Kru~ and Halle--~--
Commonwealth Land Titl-i~--
(includes above items No:) Ends ;~900
H09. Lender's coverageS 75, 000
10. Owner's coverages 80, 000
~11t. ICPLtr
Commonwealth Land Title
lt2.
113. Mail Fee Secured Land Transfers
200 GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording fees: DeedS 42 . 00 MortgageS 56 . 50 Misc,$
1202. City/county tax/stamps: Deed $ 8 0 0 . 0 0 Mortgage $
1203, State tax/stamps: DeedS 800.00Mortgage $
1204. Rec.Asslgn Recorder of Deeds
t20s. Proc. Fee ReMax Realty Associates
1300, ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest Inspection to
1303. Radon Tst. TCS Industries
~304. Radon Mit. Biechler & Tillery
3o6. Home Wry. American Home Shield
54
234
3O3
-222
10.00 10.00
800.00
888.75
35.00
15.00
98:.~._.~
800 00i 800.00
17 00!
I 250.00
95.001
665.00
445.00
400. TOTAL SETTLEMENT CHARGES (enter on lines 103 and 502, Seclions J and K) [ 3 I 9 2 . 5 8 8 5 7 0. 0 0
Padies agree Ihal no liability Is assumed by Setllement Agent for Ihe accuracy ol Informalio~ lurnished by others as shown on Ihe HUD-1 Selllem~nt Slalemer,t Selllemenl Agent hereby expressl}
reserves the nghl Io deposit arW amounts collected lot disbursement in en interest bearing accounl in a Federally insured mslitu~ion and ~o credil any mteresl so earned to ils own account as addihona
compensation lot its services in this 1ransaction.
HUD CERTIFICATION OF BUYERS AND SELLERS
I have carefully reviewed the HUD- I 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 by me in this transaction. I further cattily Ihat I have received a copy of the HUD- 1 Seldement Statement.
://"'n'D / C
Buyer or Borrower's Signature
euyer's Address & Phone:
Seller's Slgnalute
Seller's New Address & Phar~e:
~The HUI~;I/ S~lllefnel~t Statement which ~ ha~ prepared is a rue a.d accurate account ol this ansac an t have caused or w,II cause he ends Io be disbu sad in accordance with lhis stalemenf,
WA f lie 18: U.S, CodJ Section 1001 and S~ction 1010. Dale
08/05/2002 ~[ON 17:03 FAX 717 731 1798
YEAR tN THIS CERTIFICATI'~ FIRST ABOVE ¥/RITTEN,
RE.~L~Y REALTY ~ 010
WITNES.c; WHEREOF~ I HAVE HEREUNTO SET I~Y HAND AND AFFIXED NY OFFICIAL SEAL THE DAY A~D I ':~'l;~
STATE 0F CALIFORNIA )
SS:
COUNTY .OF LOS A~G£LES)
CHAS. KAPLAN
NOTARY PUBLIC IN AND FOR SAID
COUNTY AND STATE.
NY CON. EXP[ OCT. [4.TH,1952.'
'I, HAROLD d. uSTLY~ COUNTY CLERK OF THE SUPERIOR COURT oF TiE STATE OF CALIFORNIA, IN
AND FOR THE COUNTY OF LOS .zt6~vLES, WHICH COURT IS,~ COURT OF RECOR, HAVING BY LAW A SEAL, DO
HEREBY CERTIFY ]'HAT CHAS KAPLAN WHOSE NANE IS SUBSCRIBED TO THE ATTACHED CERTIFICAT~ OF ACKNOW-
LEDGNENT, PROOF OR AFFIDAVIT, WAB AT THE TltVt. OF TAKING SAID ACKNO,qLEOGN~NT, PROOF' DR AFFIDAVIT~
A NOTARY PUBLIC IN AND FOR LOS ANGELES COUNTY~ DULY C(3~NISSIONt:D AND SWORN AND Nc. SIDING IN SAID
CouNT,Y, ANL~ WAS., AS SUCH, AN OFFICER OF' SAID STATF, DULY AUTHORIZED BY THE LAWS THERFOF'~ TAKE
AND CERTIFY THc SAI~£, AS WELL AS TO TAKE AND CERTIFY THE pROOF AND ACKNO~LEDGIVt:NT OF DEEDS
oTHER INSTRIJNgNTS OF' WRITING TO BE RECORUEO IN SAIO STATE,.TO TA~<E DISPOSITIONS AN~ AF~'IDAVITS,
ANU [0. AUI~INISTI.'R OATHS OH AFFIRNATIONS, ANU THAT FULL FAITH AND CREDIT ARE AND OUGHT TO BE
GIVEN TO HIS 0f.'FICIAL ACTS; THAT THE C£RTIFICATE OF SUCH OFFICER IS REQUIRE[; TO BE UNDER SEAL;
THAT THE INPRES:~ION OF HIS oFFICIAL SEAL IS NOT REQuIRt. U BY LAW TO RE ON FILE IN THE OFFICe' OF
THF COUNTY CL£R~,; I FLRTHER CERTIFY THAT I AN WELL ACGUAINTED WITH HIS HANO~/RITiNG AND V[RILY
BELIEVE THAT TItlE SIGNATURE T~TH~' ATTACHED CERTIFICATE IS HIS GENUINE SIGNATURE~ AND FuRTFER
THAT TH[ ANNEXEI3 INSTRU~lr;NT tS LXECUTr-D ANDACI(N0~/LEDG~U ACCCHDING TO [Pt. LAWS OF THE STATE OF
CAL~FORNIA.
IN wITNESS WHEREOF~ I HI, AtE HEREUNTO ::~T MY HAND AND A NNEX£D THE SEAL OF THe.. SUIPERIOR CouRT
OF THc. STATE Og CALIFORNtA~ IN AND FOR ~HE COUNTY OF LOS ANGELES, THIS 14. DAY ~ ,JAN, 19~2. ,
HAROLD d. OSTLY CO. CLK. AND CLK.
OF GOURT OF T.E 'i i,
OF' CALIFORNIA, IN AND FOR THE .
OF LOS A~IO£LESo ~ ~
BY A. ~TRtuB D~PUTY :,{;
I H£REBY CERTIFY THAT THE .-R~SIDENCE AND POST-OFFICE OF WITHIN GRANTEE IS t, IARYSVILLE~
R.U.:I.,
THONAS I. I~IYE
,JO GRANTE/:: OR ATTY.
.............. ............. ................ , ....
DE~D ~:~h~. i~;~='~":, /.A~ T.E ~OTH DAY 0~ ,JA.UARY ,. T.E Y~AR ~ Om
N.P. NINN~I~AN, INC. {~ ~.0Ct.1~i~.~3'J~52;;,. Jl LORb ONE THOU~ND NINE HUNDRED AND Fl ~TY-TWO . .
TO B~.3'IN~:EN N.P. NINNgNAN~ INC~P~AT[D, A CORP~A-
PATRICK S. KI~LLY ET AL TION~ ORG~IZ[O AND E~tSTI~ UNDER THE ~WS OF PENNSYLVANIA, HAVING
CONS=~I. OO ITS PLACE OF BUSINESS IN THE T~NSHIP OF Lu~R ALL[N, COUNTY OF
LOC. LO~R A~EN TWP. ~ CUhBERLANU AND STATE OF PLNNSYLVA~IA~ PARTY OF THE FIRST P~T, .
DATED: dAN. 30~ 195Z AND PATRICK S. K~LLY AN~ R~ENARY C. KELLY~ HIS WIFe, AND
H. H~NON~ OF TH~ S~ PLACE~ ~AR~[S~.OE THE SECOND PART,.
ENT~: dAN..)1, 1~52
WITN[SSETH~ THAT THE SAI~ PARTY ~ THE FIRST PART FOR .~D
CON8I D[RATION ~ T~ ~UN OF ~E DOLLAR (~1,00) ANg OTHER VALU~ CONSID~RATIO~ LAWFUL NON-
EY OF ~g uNITED STA~ES OF ~[RI~ uNTO IT ~LL AND TRULY PAID BY T~ SAID PARTIES OF
THE SECOND PART AT A~ BEFORE THE SEALING AND O[LIVEY OF TH~SE PRESENTS, TIE ~CEIPT WHEREOF
tS HEREBY ACKN~LEDGED~ HAS GRANTED~ BAR~N~ 5~ ALI[N~U~ (NFEOFFED~ RELEASED AND CO~IR-
N~U~ AN~ BY T~SE PRESENTS D~S GRANT~ BARGAIN ~ ~LL~ ALIEN~ EN~OFF~ RELEASE AND CONFIRN
UNTO THE 5~lb PARTIES OF T~ SECOND PART~ THEIR H[I~ A~D ASSlGNS~ Ih THE FOLLOWING ESTATES
.......... , e ,/~llV A~lr) g~'~ARY C. KELLY. HIS WlF[~ AS TENANTS BY T~ ENTIR~TIES~ AN
u~/uo~zuuz .~lu~ 1/:u4 Yii 717 7~1 1799 RE,IA% REALTY ~011
UNDIVIDED ONE-HALF INTEREST. AND JA/~E~ H. HANNON, AN UNDIVIDED ONE-HALF INTEREST.
ALL THAT CERTAIN LUT UF LAND SITUATe IN THE TOa/NSHiP OF LOWER ALLEN, C[)UNTY OF CLt.IBERLAND AND
STATE .OF PENNSYLVANIA,'BOUNOED AND DESCRIBi'.D AS FOLLOWS:
'"e BEGINNING AT A POINT ON THE NORTHERLY LINE OF MANCHESTER ROAD, NINETY (90) FEET EAST OF THE
NORTHEAST CORNER OF MANCHESTER AND KINGSLEY ROADS AT THE THE EASTERLY LINE OF LOT NO. [, BLOCK
"S", ON THE HERE INAFTER MENTIONED PLAN; TH(NCc: ALONG THE LATTER LOT IN A NORTH~RLY DIRECTION
RIGHT'f('80) FEET TO A.P01NT AT LINE OF LOT NO. 2, BLOCK "S", ON SAID PLAN; THENCE ALONG THE
· E.ATTER LOT IN A NORTHEASTERLY DIRECTION F0~TY (i~O) FEET TO A POINT, THENCE CONTINUING ALONG THE
LINE OF LOT NO. 2 AND LINE OF LOT NO. 3, BLOCK "S", IN AN EASTERLY DIRECTION. PARALLEL WITH NAN-
. !!~*CHESTER ROAD, TW£NT~-FIvE AN~ THIRTY-SiX HUNDREDTHS (;~5.36) FEET TO A POINT AT LINE OF LOT NO.
!.~13~, BLOCK "S"; THENCE ALONG THE LATTER LOT IN A SOUTHERLY DIREC¥ION ONE HUNDRED (].00) FEET TO A
:;:.'POINT ON TIE NORTHERLY LINE OF MANCHESTER ROAD; .THENCE ALONG MANCHESTER ROAD IN A WESTERLY UIREC-
. ' TitON SIXTY ~O} FEET TO A POINT, THE PLACE OF BEGINNING.
~ '* .HAVING THEREON ERECTED THE PREMISES NO. 302 MANCHESTER ROAD.
BEING EOT NO. 3&., BLOCK "S~, ON THE PLAN OF LOTS OF A PORTION OF' HIGHLAND PARK, WH'ICH IS
REC[RDED IN CUMBERLANO COUNTY IN PLAN BuOK ~, PAGE
. . BEING A PORTION OF THE PREMISES WHICH ELI~ER E. ZtNN~R/~AN; DY DEED DATED AUGUST ~IST, 1951,
AND'RECORDED IN SAID OFFICE IN DEED BOOK "V"~ VOL. 1~., PAGE 29~ GRANTED AND CONVEYED'UNTO
NINNEMAN, INCO~PORATEU, GRANTOR HERE IN.
TuGF..THER '//ITH ALL AND SINGULAR TI-E: WAYS, WATERS, 'a/AT(R-COURSES, RIGHTS, LIB(ERTl(S, PRIVI-
LEGES, HEREOITe, NI-'NTS AND APPURTENANCES WHATS.JEVER THEREUNTO BELONGING~ OR IN ANY ~/ISE. APPER-
TAINING, AND ]'HE REVERSIONS AND REMAINDERS, RENTS~ ISSUES AND PROFITS THEREOF; AND ALL THE
ESTATe, RIGHT~ TITLE~ INTEREST, PROPERTY~ CLAIM AND [;EMAND~ %~'IATSOEVER~ OF PARTY OF TI~ FIRST
PART IN LAW, E:~UITY, OR OTHERWISE HOWSOEVER, OF , IN ANU ~0 THE SANE AND EVERY PART THEREOF,
TO HAVE AND TO HOLD THE SAIU PARTY OF THE FIRST PAR1 HEREDITANENTS AND PR£NISES HEREBY
OR MENTIONED AND INTENDED SO TO BE, WITH THE APPURTEI'A',~ES, UNTO THE SAID PARTIES OF THE St:CON/)
PART, THEIR HEIRS AND ASSIGNS, TU AND FOR THE ONLY PROPER USE AND BEHOOF OF THE SAID PARTIES OF
TH~ SEC0NU PAR'r, THEIR .HEIRS AND ASSIGNS FOREVER.
AND THE SAID PARTY OF THE FIRST PART q0ES BY THESE PRESENTS, COVENANT, GRANT AND AGREE, TO
AND WITH THE S,%ID PARTIES iJF THE SECOND PART, THEIR HEIRS AND ASSIGNS,, THAT IT THE SAID PARTY
i0.F/~.HE FIRST I~ART ALL AND SINGULAR THE HEREBITANENTS AND PREMISES HEREIN ABOVE DE'SCRIBt-_D/AND
GRANTED~ OR ~ENTIONED AND INTENOEU S0 TO BE, WITH THE APPURTENANCES, UNTU THE SAID PARTIc:S OF
i THE SECONO PART, THEIR HE.IRS AND ASSIGNS, AGAINST IT THE SAID[PART~ OF THE FIRST PART AND AGAI
: ALL AND EVERY ~;:'ERSON OR PERSONS WHI::J~SOEVER LAWFULLY CLAIMING OR TO CLAIM THE SANE 0RA'4Y PART
THEReoF, SHALL AND WILL WARRANT AND FOREVER DEFEND.
AND THE SAID N.F:. NINN~ENAN, INC0RPORATEu DOTH HEREBY C0NSTITI. Rt; ANU APP0tNT N;Po NINNEhAN
TO BF' ITS ATTORNI{Y ~ FOR IT A'ND IN IlS NAME ANU AS ~%ND FOR ITS CORPORAT£ ACT AND UEED TO ACKNO,¥
LEDGE THIS INDI*',NTURE BEFORE ANY PERSON HAVING AUTHORITY BY THE LAWS OF THE C(:~INONWEALTH OF PENN-
SYLVANIA, TO TAKE SUCH ACKN0WLEDGt4ENT, TO THE INTENT THAT THE SAN,' NAY Bt. DULY RECORUEDo
il ? IN WITN£S.'~ WHEREOF,' THE SAID N. P. NINNEMAN, INCORPORATED, HAS HEREUNTO CAUSED ITS CORPORATE
T E AFFIXED.AND ATTESTED THIS 3OTH DAY OF ,JANUARY, A.U. ONE THOUSAND NINE HUNDRED ANU
~': SEALED' AND OELrIVERED ~ H.P. NINNEMAN, INCCRPORATED
;ii: iiN..TH.~?ESENCE OF US: BY M.P. N'NNEMAN, ~'RES,DENT.
ATTEST.' NAOMI S. NINNE/~AN, SECRETARY.
STAT[': OF PENNSYLVANIA :
SS;
cOUNTY OF DAUPHIN :
I HEREBY Ct. RTIFY, THAT ON THIS 30 DAY OF ,JAN[N THE yEAR OF OUR LORU ONE THOUSAND NINE HUND-
RED AND FIFTY-TWO BEFORE I~1~, THE SUBSCRIBER, A NOTARY RBLIC, I:~SIDING IN TPE COLNTY OF DAUPHIN
PERSONALLY APPI.'AREU N.P. NINNEt4AN, THc: ATTORNEY NAMED IN THE F~EG01NG INDENTURE, AND BY VIRTUE
AND IN PURSUANCE OF THE AUTHORITY THEREIN C,.~NFERRED UPON HIN,ACKN0WLEDGED TI-~ SAID INDENTURE TO
BE THE ACT Arid I)EIfD OF THE SAID N.P. NINNENAN, INCORPORATED.
~""~- NotariaTSeal '
Lisa
! ?.ros?ct Park Boro. Delaware County
My Commission Expires May 10 2004
Member Pe nns ylva~i~'A'Ssociatio~,~
[.."',. ,' ', L / '
STATE OF FLOR!DA
COUNTY OF LAKE
SV~gR~ TO AND SUBSCRibED BEFORE ME THiS
IBPERSO~ALLY KNOW~.~ TO MECR ., ~ .
~P~ OF IDENTiF~ATI~
~6~fURE OF NOTARYPUSUC-S~ATE OF FLORlUA
REV-1508 EX + (1-57) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
KELLY. ROSEMAp~y (;;;, 21 02 0387
Include the proceeds of litigation and the date the proceeds were received by the estate. All properDj jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 97.25
Reimbursement of County taxes for real estate - eleven twelfths of amount
See attached Settlement Sheet
Reimbursement of School taxes for real estate - eleven twelfths of amount
See attached Settlement Sheet
Reimbursement of sewer - eleven twelfths of amount
See attached Settlement Sheet
Reimbursement of refuse - eleven twelfths of amount
See attached Settlement Sheet
The Patriot News - refund
AIIfirst Golden Age Checking Account No. 0050775464
See attached Statement
Verizon - refund
Nationwide Mutual First Insurance Company - refund of hazard insurance premium
TOTAL (Also enter on line 5, Recapitulation) $
678.72
4.34
7.86
102.30
16,078.79
3.12
186.00
17r158.3R
(Ifmorespaceisneeded, inse~additionalsheetsofthesamesize)
U.S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT
SETTLEMENT STATEMENT
Phone:
SECURED LAND
TRANSFERS, INC.
5006 East Trindle Road
Suite 203
Mechanicsburg, PA 17055
(717) 591-8500 FAX: (717) 591-8506
OMB No, 2502-0265
TITLEPRO
Laserprint
B. TYPE OF LOAN
1. [ 1 FHA 2. [ ] FMHA 3.~] CONY. UNINS.
4 [ ] VA 5, [ ] CONY. iNS,
6 FILE NUMBER: I 7. LOAN NUMBER:
130027
I
8. MORT. INS. CASE NO.:
C. NOTE: This form is furnished to give you a statement of actual settlement costs, Amounts paid to and by the settlement agent are shown. Items marked
'(p.o.c,)' were paid outside the dosing; lhey are shown here for informational purposes and are not included in the totals,
D, NAME AND ADDRESS OF BORROWER: E, NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Fadi! Jugovic Estate of Rosemary C. Waypoint Bank
Kelly, Rosemary Bascelli
Jeanne Bucher, James 101 S. GEORGE STREET
Hammon and Elaine Hammon YORK PA 17401
G. PROPERTY LOCATION: H. SE'FTLEMENT AGENT: J. SETTLEMENT DATE;
302 Manchester Road Secured Land Transfers, Inc. 09/12/02
Lower All en TOWNSHIP PLACE OF SE]-FLEMENT:
CUMBERLAND County 3915 Market Street Camp Hill PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
tOO GROSS AMOUNT DUE FROM BORROWER 400 GROSS AMOUNT DUE TO SELLER
1oi Contract sales price [ 80000 . 00
lo2 Personal property
401 Contract sales price I 80000 . 00
4o2 Personal property
lO3. Settlement charges to borrower (hne 1400) 3 1 9 2 . 5 8 ,~o3
1o4. 404
lO5.
I 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
106 City. own tax to
ro?.Countytax 09/12/02,o12/31/02 106.09
I08 Assessments to t
,08 schooZ 09/12/02~o06/30/03.1 740.42
110 tO
4.73
8.58
12o GROSS AMOUNT DUE FROM BOR ROWER 8 4 0 5 2. 4 0
20o. AMOUNTS PAID BY OR IN BEHALF OF BORROWER
201. Deposit or earnest money
5000.00
75000.00
406. Cily/Town tax to
'~07 County tax 09/12/02to12/31/02
408. Assessments to
488 ~¢nool 09/12/02to 06/30/03
410 tO
4,I Sew:$24/q ending 9/30
4,2 Ref:$43.50/q ending 9/36
420 GROSS AMOUNT DUE TO SELLER
202. Principal amount of new loan(s)
203 Existing loan(s) taken subject to 503 Existing loan(s) aken subject to
204 504 Payoff of First Mortgage Loan
None
205.
Assignment Credit 17.00
206.
207
Adjustments for items unpaid by selter
210 City/Town tax to
21 ~ County tax to
Assessments Io
School to
106.09
740.4~
4.73
8.58
80859.82
500 REDUCTIONS IN AMOUNT DUE TO SELLER
5Ol Excess deposit (see inslructions)
502 Settlement charges to seller (tine 1400) 8 5 7 0 . 0 0
505PayoffofSecondMortgageLoan
James Hammon
$06 Elaine Hammon
507.
508
509
Adjustments for items unpaid b seller
510 City/Town tax to
511 County tax to
512 Assessments [o
3012.08
3012.08
513 School
215
517
218
220. TOTAL PAID BY/FOR BORROWER 8 0 0 1 ?. 0 0
300 CASH AT SETTLEMENT FROM OR TO BORROWER
301. Gross amount due from borrower (line 120)
84052.40
302 Less amount paid by/for borrower (line 220) 8 0 0 1 7 . 0 0 602 Less reduction amount due seller (line 520)
303 CASH (D~] FROM) ([ ]TO) BORROWER 4035 .40 6o3 CASH ([X] TO) ([ ]FROM) SELLER
519.
570 TOTAL REDUCTION AMOUNT DUE SELLER
600 CASH AT SETTLEMENT TO OR FROM SELLER
601 Gross amount due to seller (line 420}
14594.16]
80859.82
14594.16
66265.66
Buyer or Borrower's Signature
Seller's Signature
HUD- I Rev. 5/86
U.S. DEPARTMENT CF HOUSiNG AND URBAN DEVELOPMENT OMB No 2502-026
SETTLEMENT STATEMENT Pac,
L. SETTLEMENT CHARGES 130027
I PAID FROM i PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on price $ 80000.00 7.0 I BORROWER'S J SELLER'S
Division of Commission (line 700) as follows: FUNDS AT ! FUNDS AT
Total: $5,600 . 00 ] SETTLEMENT } SETTLEMENT
7o1.$ 2775.00 to Jack Gau~hen Realtor ERA
7o2.$ 2825.00 to ReMax Realty Associates
_ :::::::::::::::::::::::::: ::::::::::::::::::::::: :: :::::::::::::::::::::::::::::::::::::::::::::::::::
703. Commission paid at Settlement I ',l ...........
~04. Trans.Fee E~-NRT, Inc I 100.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee %
802. Loan Discount %
803. Appraisal Fee to
8o4. Credit Report to
805 Lenders Inspection Fee
806 Mortgage Insurance Application Fee to
807. As§,umption Fee
808. Doc. Prep.
Waypoint Bank
290.00
809. Tax Serv. Waypoint Bank
'sto, Undw. Fee Waypoint Bank
811. Fld. Cert. Waypoint Bank
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest from 09/12/02 to09/30/02 @$ 13 . 28/day
902. Mortgage Insurance Premium (or mo. to( $ 3 2 5 - POC )
903. Hazard Insurance Premium for yrs to ( $ 2 1 8 - POC)
9o4~ Appl. Fee yrs. to Waypoint Bank
905. Mail Fee Waypoint Bank I 16.00 i
1000. RESERVES DEPOSITED WITH LENDER FOR
100t Hazard Insurance 3 mo @ $
91.00
100.00
14.00
18 . 17 /mo
54.51
234.72
303.36
-222.58
1002. Mortgage insurance mo @ $ /mo
003. City/i'own tax mo @ $ /mo.
004. County tax 8 mo. @ $ 29.34 /mo.
1005 Assessments mo. @ $ /mo.
lo05. School Tax 4 mo. @ $ 75.84 /mo
1007 mo. @ $ /mo
I0O8. AggrAdj ust mo @ $ /mo,
1100. TITLE CHARGES
101. Settlement or closing fee to
102. Abstract or title search to
It03. Title examination to
~104. Title insurance binder to
105. Document preparation to
i106. Notary fees to Cash 10.00 10.00
107. Attorney's fees to Purcell Kruq and Hal ler
(includes above items No.:)
108. Title Insurance to
Commonwealth Land Title
(includesaboveitemsNo:) Ends;100/300/900
109. Lender's coverage $ 75, 000
1110. Owner's coverages 80, 000
t111. ICPLtr Commonwealth Land Title
1112.
888.75
35.06
800.00
~n3. Mail Fee Secured Land Transfers 15.00'
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording fees: DeedS "~2.00 MortgageS 56.50 Misc $ 98.50 I
1202. City/countytax/stamps DeedS 800.00MortgageS 800.00
12o3. State tax/stamps: DeedS 800 . 00Mortgage $ 00 800 . 00
1204, Rec.Assi~n Recorder of Deeds 17.
,20s, Proc. Fee ReMax Realty Associates i 250.00
300. ADDITIONAL SETTLEMENT CHARGES
301. Survey to
302. Pest Inspection to
1303 Radon Tst. TCS Industries
t304. Radon Mit. 95.00
Biechler & Tillery I 665.00
13o5. Home Wry. American Home Shield 445.00
t400 TOTAL SETTLEMENT CHARGES (enter on lines 103 and 502, Sections J and K) 3 1 9 2. 5 8
8570.00
Padies agree Ihe[ no liability is assumed by Setllement Agent for Ihe accuracy el ,rdorrnalio~ furnished by others as shown or~ Ihe HUD-1 Seltlemenl Slalemer,t Seltlemenl Agent hereby expressl~
reserves the dghl ~o deposJl any amounts collecled Icl disbursement in an ~nlerest bearir~g accounl in a Federally msufed inslitu~ion and to credil any ,nlerest so earned to ils own account es addihe~a
compensation lo: its services tn this Iransaction.
HUD CERTIFICATION OF BUYERS AND SELLERS
I have carefully reviewed ~he HUD-1 Settlernent 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 by me in this transaction. I further certify that I have received a copy of the HUD- 1 Settlement Statement.
Buye~ or Borrower's Signature Seller's Signature
Buyer's Address & Phone: Seller's New Address & Phone:
Se,~e,,, Ajrif-' /1 ; i Da e
WARNING: II is a crime to k~wingly make a se s atements to the UnHed S a es o~ h s o any si:mia: lerm Penalties u on conviction can
Title 18: US Cede Section 1001 and Section 1010 P inc ude a fine and imprisonment. For details see
HUD-1 Rev. 5/86
all rst
April 23, 2002
Purcell, Krug ~ Hailer
Att: Jill M. Wineka
1719 North Front Street
Harrisburg, PA 17102-2392
Allfirst Financia| (',cnte~
t~O. Bo,x 900
N'lillsboro, DF
RE: Estate of Rosemary C. Kelly
Date of Death: March 24, 2002
Social Security Number: 202-10-1666
Dear Ms. Wineka:
In response to your request, please be advised that at the dme of death, the above-named
decedent had on deposit with this bank the fol[owing account.
Account Type ........................... Golden Age Checking Account
Account Number. ...................... 0050775464
Ownership (Names of) ............... Rosemary C. Kelly
Opening Date ........................... 08/28/64
Balance on Date of Death ........... $16,078.79
Accrued Interest ....................... 0.00
Total ...................................... $16,078.79
This response does not apply to any assets held with Allfi~t Brokerage, where Allfirst Bank is serving as a trustee, nor to any credit
cards owned by Bank of America bearing Allfirst Banks's name
This letter does not include any accounts in which the deceased may have been listed as Power of ^ttomey, Custodian of Uniform
Transfers, Representative Payee, or Trustee under a Written Agreement
If you have any further questions on these accounts, please contact the branch of record: ~344
South 10~ Street, Lemoyne, PA 17043, telephone 717-737-3:~22.
Sincerely,
Mary Anne Macielag
Associate I/CIS
(302) 9~4-2240
REV-1509 EX * (1-~?) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
KELLY. ROSEMARy ~, 21 02
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
0387
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Patrick M. Kelly Son
B Jeanne R. Kelly
C Kathleen M. Cleveland
218 Swarthmore Drive
Lititz, PA 17543
Keystone Residence
6 South Road
Mechanicsburg, PA 17050
2231 North Third Street
Harrisburg, PA 17110
Daughter
Daughter
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES
1. ^,B,C 1-17-75 Waypoint Savings Account No. 101217325 14,719.69 25. 3,679.92
See attached Statement
TOTAL (Aisc enter on line 6, Recapitulation) $
............. 3~679.92
(If more space is needed, insert additional sheets of the same size)
LOOK FOR US. WE'LL GET YOU THERE.
04/25/2002
PURCELL KRUG & HALLER
1719 N FRONT ST
HARRISBURG PA 17102
The information which you requested on the account(s) of ROSEMARY KELLY DECEASED
(Social Security Number 202-10-1666) is/are as follows:
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint
Owner, if any
Date Ownership
Was Established
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint
Owner, if any
Date Ownership
Was Established
101217325
SAV1NGS
01/17/75
14712.19
7.50
14719.69
JTO
PATRICK
KELLY
01/17/75
Additional
Information
Requested
PLEASE COMPLETE W-9
S~. cerely~,l
SENIOR SERVICES REP.
RO. Box 171 I, HARRISBURG. PENNSYLVANIA 17105-1711
Toll Free 1-866-WAYPOINT (I-866-9E~9-7646) · IN YORK AREA 717/815-4500 · vvvvw, wagpointbank, com
REV-1510 E,X + (1-9'7} ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
KELLY. ROSEMARY (;:;. 21 Q~ Q;~I~7
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is ',es.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIPTO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE)
1. Metropolitan Life Insurance Company Annuity Contract No. 10,258.56 100. 10,258.56
073 308 892 AB - See attached Statement of Value with
written confirmation of the Decedent's three children
as the beneficiaries
2. MetLife Investors USA Insurance Company Policy No. 5,741.54 100. 5,741.54
iA,?.050438 - See attached Statement of Value with written
confirmationn of the Decedent's three children as the
beneficiaries
TOTAL (Also enter on line 7, Recapitulation) $ 16r000.10
(If more space ~s needed, insert additional sheets of the same size)
Metropolitan Lite Insurance Company
MetLife Customer Service Center - Tulsa
12902 East 51st Street, PO Box 22069
Tulsa, OK 74121-2069
JILL M WINEKA
ATTORNEY AT LAW
1719 NORTH FRONT ST
HARRISBURG PA 1 7102-2392
RE
ANNUITY DEATH CLAIM
ANNUITANT ROSEMARY C KELLY
CONTRACT 073 308 892 AB
Dear Ms. Wineka,
This is in response to your request for a Statement of Values for the above annuity
contract.
As requested, the values are enclosed.
If you have any questions, please feel free to call our toll-free number at 1-800-638-
7732, One of our Customer Service Consultants will be happy to assist you.
Sincerely
Connie S Brown
Annuity Death Claim Unit
Annuity Administrative Operations
June 17, 2002
Enclosure
MetLife'
Statement of Value of Annuity Contract
1. Name and address of Insurance Company
Metropolitan Life Insurance Company, One Madison Avenue, New York, NY 10010
2. Name of Annuitant 3. Date of Annuitant's Death 4. Annuitant's Social Sec. No.
ROSEMARY C KELLY MARCH 24, 2002 202 10 1666
5. Contract Number 6. Type of Annuity 7. Date of Issue
073 308 892 AB DEFERRED ANNUITY OCTOBER 22, 1998
8. Owner's Name 9. Assignee's Name 10. Date Assigned
(Attach copy of Application) (Attach copy of assignment)
ROSEMARY C KELLY N/A N/A
11. Name(s) of Beneficiary(ies)
KATHLEEN M CLEVELAND
PATRICK M KELLY
JEANNE R KELLY
12. Description of Contract
PREFERENCE PLUS ACCOUNT
13. Value of annuity contract on date of death of Annuitant
This represents the death benefit as follows:
Accumulation Value on Date of Death $10,258.56
Cost Basis/Return of Payments 97,334.82
Interest $2,927.16
Total Payout 910,261.98
14. How payable: One Sum
X I See Remarks
15. Remarks
CLAIM WAS PAID ON APRIL 23, 2002 TO THREE BENEFICIARIES.
The undersi~lned hereby certifies that this statement sets forth true and correct information,
16. Date of Certification Sign Title
MetLifelnve o ®
May 31,2002
JILL M WINEKA
1719 N FRONT ST
HARRISBURG PA 17102-2392
RE: Policy NumberA2050438
Company: MetLife Investors USA Insurance Company
Dear MS. WINEKA:
Thank you for your request for information for the above-referenced policy owned by
Rosemary C Kelly, deceased. The date of death value amount is: $5741.54. The
beneficiaries named are: Kathleen Cleveland, Patrick M. Kelly, and Jeanne R Kelly.
If you have any questions concerning the above, please call an Annuity Policy Service
Representative at (800)284-4536. Our staff will gladly assist you between the hours of
7:30 a.m. and 5:30 p.m., Central Time, Monday through Thursday, and from 7:30 a.m.
until 5:00 p.m., Friday.
Sincerely,
Marilyn C. Hall
Annuity Policy Service Department
C Free Form
P.O. Box 14593
Des Moines, IA 50306-3593
R~-1511~*{1-9~) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
KELLY. ROSEMARY C.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 02
0387
ITEM
NUMBER DESCRIPTION AMOUNT
1.
2.
3.
4.
8.
9.
10.
11.
12.
13.
14.
FUNERAL EXPENSES:
Parthemore Funeral Home & Cremation Services,Inc.
Gate of Heaven Cemetery - digging fee
Parthemore Funeral Home & Cremation Services, Inc. - death certificates
Van rental and post-funeral luncheon
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Kathleen M. Cleveland
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address 2231 North Third Street
City Harrisbur.q, State PA
Year(s) Commission Paid: not paid
AttomeyFees Purcell, Krug & Hailer
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Jeanne Kelly
StreetAddress 302 Manchester Road
Zip 17110
City Camp Hill,
Relationship of Claimant to Decedent daughter
State PA
Zip 17011
Probate Fees Register of Wills of Cumberland County
Accountant's Fees
Tax Retum Preparer's Fees
Register of Wills - Short Certificates
Register of Wills - J.C.P. fee
The Sentinel - advertising
Register of Wills - additional Short Certificates
Register of Wills -- fee to file PA Inheritance Tax Return
Register of Wlils -- fee to file Family Settlement Agreement
AIIfirst Bank - fee to order Estate checks
AIIfirst Bank - stop payment fee
TOTAL (Aisc enter on line 9, Recapitulation) $
6,111.00
650.00
8.00
200.00
4,500.00
4,500.00
3,500.00
124.00
18.00
5.00
87.35
9.00
15.00
17.00
13.00
30.00
19,787.35
(If more space is needed, insert additional sheets of the same size)
RE~-1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
KELLY. ROSEMARY q;.
Include unreimbursed medical expenses,
FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
1. Lower Allen Township - real estate taxes 910.13
10.
11.
12.
13.
14.
15.
Lower Allen Township - personal tax
Lower Allen Township - sewer and refuse services
UGI - gas services
PP&L - electric services
Comcast - cable services
Verizon - phone services
PA Water Company - water services
PP&L - electric services
Comcast - cable services
UGI - gas services
AT&T - phone services
PP&L - electric services
Verizon - phone services
PA Water Company - water services
TOTAL (Also enter on line 10, Recapitulation)
9.80
74.25
71.35
61.45
150.00
39.99
31.64
45.67
56.79
64.00
7.51
75.83
31.99
52.23
10~985.79
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
KELLY, ROSEMARY C. 21 02
Page 1
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
0387
ITEM
NUMBER
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
DESCRIPTION
UGI - gas services
PA Water Company - water services
Verizon- phone services
PA Water Company - water services
UGI- gas services
PP&L - electric services
Verizon- phone services
Ladies Home Journal - outstanding subscription invoice
Comcast - cable services
R.T. Wagner- homeowner's insurance
Sears - credit card
AT&T- phone services
UGI- gas services
Comcast - cable services
PP&L - electric services
SUBTOTALSCHEDULEI
AMOUNT
64.00
15.73
6.70
32.69
64.00
29.77
51.75
25.46
56.79
269.00
293.30
13.03
64.00
56.79
32.59
1,075.60
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
KELLY, ROSEMARY C.
Pa,qe 2
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
21 02 0387
ITEM
NUMBER DESCRIPTION
31. True Green - lawn care
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
UGI- gas services
PA Water Company - water services
PA Water Company - water services
PP&L - electric services
Verizon- phone services
Lower Allen Township - sewer and refuse services
Verizon- phone services
Real estate settlement costs assessed against the Estate as the Seller -
eleven-twelfths of costs
PA Water Company - water services
Lower Allen Township - sewer and refuse services
AT&T - phone services
Comcast - cable services
PA Water Company - water services
UGI- gas services
SUBTOTAL SCHEDULE I
AMOUNT
19.84
136.90
17.94
25.82
30.75
31.82
67.50
30.06
7,855.83
11.10
75.25
6.78
17.63
2.47
16.55
8,346.24
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
KELLY, ROSEMARY C. 21 02
Pa§e 3
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
0387
ITEM
NUMBER DESCRIPTION
46. PP&L - electric services
47.
Charlie Knipe - lawn care services
SUBTOTAL SCHEDULEI
GRAND TOTAL SCHEDULE I
AMOUNT
15.77
50.00
65.77
11,170.24
REV-151A,, EX ~ (9-nm
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
KELLY. F',OSEM,ARy G,
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [includeoutdghtspousaldistdbutions, and transfers under
Sec. 9116 (a)(1.2)]
Kathleen M. Cleveland
2231 North Third Street
Harrisburg, PA 17110
Jeanne R. Kelly
Keystone Residence, 6 South Road
Mechanicsburg, PA 17050
Patrick M. Kelly
218 Swarthmore Drive
Lititz, PA 17543
FILE NUMBER
21 02
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
daughter
daughter
son
0387
AMOUNT ORSHARE
OF ESTATE
1/3 of residuary
/3 of residuary
/3 of residuary
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(If more space is needed, insert additional sheets of the same size)
FI
IL
FROM
LAW OFFICES
1719 N. FRONT STREET
HARRISBURG, PA 1710,2-2392
TO
Register of Wills
Cumberland County Court House
Carlisle, PA
BUREAU OF ZNDZVZDUAL TAXES
ZNHERZTAHCE TAX DZ¥ZSION
DEPT. 180601
HARRTSBURG, PA 17128-0601
COHHONWEALTH OF PENNSYLVANZA
DEPARTHENT OF REVENUE
NOT/CE OF ZNHERZTANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTZONS AND ASSESSNENT OF TAX
REV-lSd7 EX AFP
JILL N WINEKA ESQ
PURCELL ETAL
1719 N FRONT ST
HBG PA 171~01
DATE
ESTATE OF
DATE OF DEATH
FZLE NUNBER
i ~..!~ ~ i ii .~COUNTY
ACN
12-0Z-Z00Z
KELLY
05-24-2002
21 02-0387
CUNBERLAND
101
Amount RaeLt'lced
ROSEHARY C
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUH]~ERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THZS LZNE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-0:~) NOTZCE OF ZNHERITANCE TAX APPRAZSENENT, ALLOWANCE OR
BZSALLOWANCE OF DEDUCTZONS AND ASSESSHENT OF TAX
ESTATE OF KELLY ROSEHARY CFZLE NO. 11 02-0587 ACN 101 DATE 12-02-2002
TAX RETURN #AS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (Schedule A)
2. Stocks and Bonds (Schedule
3. Closely Held Stock/Partnership Znterest (Schedule C) ($)
4. Nortgages/Notas Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) ($)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED BEDUCTZONS AND EXEHPTZONS:
9. Funeral Expenses/Adm. Costs/H/sc. Expanses (Schedule H) (9)
10. Dabts/Nortgaga L/abilities/Lians (Schedule I) (10}
11. Total Deductions
12. Nat Value of Tax Return
75~333.33
.00
.0O
.0O
17~158.38
$z679.92
16z000.10
(8)
19,787 .$5
NOTE: To insure proper
credit to your account,
submit the upper portion
of th/s form w/th your
tax payment.
13.
14.
NOTE:
110,171.73
111170.24
(11) 30.q57.~9
{12) 79,214.14
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J] (13)
Net Value of Estate Subject to Tax
Zf an assessment ~as issued previously, 11nes 1~, 15 and/or 16, 17,
reflect figures that /nclude the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
1.6. Amount of L/ne 14 at Spousal rata (15)
16. Amount of L/ne 14 taxable at Lineal/Class A rata (16)
17. Amount of Line 14 at Sibling rate (17)
18. Aeount of Line 14 taxable at Collateral/Class B rata (18)
19. Principal Tax Due
TAX CREDITS:
PAYHENT RECETpI
DATE NUHBER
06-04-2002 CD001254
.00
79,214.14
18 and 19 Nlll
4,$00.00
TOTAL TAX CREDZT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
( ZF TOTAL DUE Zs LESS THAN $1, NO PAYNENT ZS RE~UZRED.
ZF TOTAL DUE 1S REFLECTED AS A "CREDZT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THZS FORH FOR ZNSTRUCTZONS.)
IF PAZD AFTER DATE ZNDZCATED, SEE REVERSE
FOR CALCULATZON OF ADDZTZONAL ZNTEREST.
4,478.23
913.59CR
.00
913.59CR
178.23
DISCOUNT (+)
/NTEREST/PEN PAZD (-)
ANOUNT PAID
· O0 X O0 = . O0
79,214.14 x 045= 3,564.64
· 00 x 12 = . O0
· O0 x 15 = . O0
(19)= 3,564.64
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. ZSO60Z
HARRISBURG., PA 171Z8-0601
CONNONWEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
INHERITANCE TAX
STATEt4ENT OF ACCOUNT
REV-1607 EX AFP COZ-OS)
JILL H WINEKA ESO
PURCELL ETAL
1719 N FRONT ST
HBG PA 11.7102
DATE 12-$0-200Z
ESTATE OF KELLY
DATE OF DEATH 05-24-2002
FILE NUNBER 21 02-0587
COUNTY CUHBERLAND
ACN 101
Amoun'~ Rem i'l:'l:ed
ROSENARY C
HAKE CHECK PAYABLE AND RENZT PAYHENT TO:
REGISTER OF WILLS
CUH]}ERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credi~ ~o your account:, submit: ~he upper pore/on of ~:his fore wi~:h your ~:ax payment:.
CUT ALONG THIS L'rNE I~* RETA'rN LOWER PORTION FOR YOUR RECORDS ~.~
REV-1607 EX AFP (01-03) #~ INHERITANCE TAX STATEHENT OF ACCOUNT ~
ESTATE OF KELLY ROSENARY C FILE NO. 21 02-0:387 ACN 101 DATE 12-$0-7007
THIS STATENENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHO#N BELO#
ZSA SUNNARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYNENTS, THE CURRENT BALANCE, AND., ZF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTNENT: 11-25-2002
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYNENTS (TAX CREDITS):
$,564.64
PAYHENT RECEIPT DISCOUNT (+)
DATE NUNBER INTEREST/PEN PAID (-) AHOUNT PAID
178.25
06-04-2002
12-15-2002
CD001254
REFUND
.00
4,$00.00
915.59-
ZF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR),
TOTAL TAX CREDIT
$,564.64
.00
BALANCE OF TAX DUE
INTEREST AND PEN. .00
TOTAL DUE .00
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. )
IN RE:
ESTATE OF ROSEMARY C. KELLY
IN THE COURT OF COMMON PLEAS
CUMBERLAND CO., PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 2002-00387
PA No.: 21-02-0387
FAMILY SETTLEMENT AGREEMENT AND FINAL RELEASF
IN ESTATE OF ROSEMARY C. KELLY~ DECEASED
KNOW ALL MEN BY THESE PRESENTS, that:
WHEREAS, Rosemary C. Kelly, late of Lower Allen Township, Camp Hill, Cumberland County,
Pennsylvania, deceased, died testate on March 24, 2002;
WHEREAS, Letters Testamentary on the Estate of the Decedent were duly issued by Mary C. Lewis,
the Register of Wills of Cumberland County to the Executrix, Kathleen M. Cleveland on April 15, 2002;
WHEREAS, the Executrix has gathered the assets of the Estate of the Decedent and the assets
consist of real and personal property with a total value of $90,680.28, as set forth in the Statement of Account
which is attached hereto and marked Exhibit "A";
WHEREAS, the Executrix has paid the debts of the Estate in the amount of $28,964.53, as set forth
in the Statement of Account;
WHEREAS, the present balance for distribution, after taking into account the unliquidated value of
the MetLife stock, is in the amount of $61,092.45, which will be distributed in accordance with the Statement
of Distribution which is attached hereto and marked Exhibit "B";
NOW, THEREFORE, WE, KATHLEEN M. CLEVELAND, individually and as the Court-appointed
Guardian for her sister and residual beneficiary, JEANNE R. KELLY, an Incapacitated Person, and PATRICK
M. KELLY, being the only residuary beneficiaries of the assets of the Estate of Rosemary C. Kelly, do hereby
acknowledge that we have this day received all sums of money which are given to each of us, by virtue of the
Decedent's Last Will and Testament, with the exception of the liquidation value of the Met Life Stock, which
is in the process of being sold.
AND, we do hereby stipulate that in order to avoid the expense and time involved in the filing of a
formal account and schedule of distribution, we agree that no account is necessary and we agree that we
consent to distribution being made without the formal filing of an account and schedule of distribution, the
same to be with the same force and effect as if the documents had been filed and confirmed by the Orphans'
Court Division of the Court of Cumberland County.
THEREFORE, we do hereby release and forever discharge the Executrix, Kathleen M. Cleveland, Jill
M. Wineka, Esquire and the law firm of Purcell, Krug & Hailer, the Attorneys for the Estate, their assigns,
executors and administrators, from all actions, suits, payments, accounts, and claims whatsoever, touching
upon the Estate of the Decedent. We do also agree that should any liability come due to the Estate of the
Decedent after the signing of this Agreement, each of us do covenant and agree that, after the escrowed
funds identified in the Statement of Distribution have been exhausted, we will contribute equally our share of
the Estate which we each have received in order to satisfy any and all taxes, liabilities, claims, demands, suits
or causes of action which may be successfully prosecuted or assessed against the said Estate or the
aforesaid Executrix after the signing, sealing and delivery of this Family Settlement Agreement and Final
Release.
The parties acknowledge that this Family Settlement Agreement and Final Release will be signed and
notarized separately by each of the three beneficiaries. The three original signatures will be attached to the
original Family Settlement Agreement and Final Release and filed of record with the Cumberland County
Orphans' Court.
IN WITNESS WHEREOF, I have set my hand and seal to the Family Settlement Agreement and Final
Release on the date as indicated below.
WITNESS:
EVELAND
COMMONWEALTH Of
COUNTY OF
· SS:
On this, the /~9~day of -,.J'"~/tJ~"' ,2003, before me, a Notary Public,
the undersigned officer, personally appeared KATHLEEN M. CLEVELAND, known to me (or satisfactorily
proven) to be the person who name is subscribed to the within instrument, and acknowledged that she
executed this Family Settlement Agreement for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
ary Public /
(SEAL)
NOTARIAL SEAL
BARBARA A.'SHADEL, Notary Public
City of Harrisburg, Dauphin County
.~M~.~_om_m!~lon Expires March 19, 2007
IN WITNESS WHEREOF, I have set my hand and seal to the Family Settlement Agreement and Final
Release on the date as indicated below.
WITNESS:
JEANNE R. KELLY, an Incapacitated Person
COMMONWEALTH OF
COUNTY OF ~)FI. ui°HtI, J
· SS:
On this, the / o~/~day of ,~'~'A..)~ ,2003, before me, a Notary Public,
the undersigned officer, personally appeared KATHLEEN M. CLEVELAND, Guardian for Jeanne R. Kelly, an
Incapacitated Person, known to me (or satisfactorily proven) to be the person who name is subscribed to the
within instrument, and acknowledged that she executed this Family Settlement Agreement for the purposes
therein contained·
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
I[~ o-tary Public
(SEAL)
NOTARIAL SEAL ....
BARBARA A. SHADEL, Notary Public
City of Harrisburg, Dauphin County
My Commission Expires March 19, 2007
IN WITNESS WHEREOF, I have set my hand and seal to the Family Settlement Agreement and Final
Release on the date as indicated below.
PATRICK M. KELLY
COMMONWEALTH Of '~/~ -
COUNTY OF J.~/1L'~S~---~ ·
ss:
On this, the '~J %ay of J~ ,2003, before me, a Notary Public,
the undersigned officer, personally appeared PATRICK M. KELLY, known to me (or satisfactorily proven) to
be the person who name is subscribed to the within instrument, and acknowledged that he executed this
Family Settlement Agreement for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
o'~ary Pub]ic~/?' '
' Notarial Seal J
Tara Jane Riss~r, NoteO, Public I
Lititz Boro, Lancaster County J
My Commission Expires Nov. 10, 2003J
Member, Pennsylvania Association of Notarl~
(SEAL)
STATEMENT OF ACCOUNT
ASSETS:
302 Manchester Road, Camp Hill, PA 17011 - 11/12 of total sales price
or .91666666 of $80,000.00
Reimbursement of County taxes for real estate - 11/12 of amount
Reimbursement of School taxes for real estate - 11/12 of amount
Reimbursement of sewer for real estate - 11/12 of amount
Reimbursement of refuse for real estate - 11/12 of amount
The Patriot News - refund
AIIfirst Golden Age Checking Acct. No. 0050775464 (liquidation value after digging
fee and misc. utilities were paid)
Verizon - refund
Nationwide Mutual First Insurance Company - refund of hazard ins. premium
Metropolitan Life Stock -23 shares of common stock @ $27.10 per share
Met Life - dividend
PA Dept. of Revenue - refund of PA Inheritance Taxes
TOTAL ASSETS
DEBTS:
Parthemore Funeral Home - funeral bill
Death Certificates
Van rental and post-funeral luncheon
Register of Wills - probate fees
Register of Wills - Short Certificates
Register of Wills - J.C.P. fee
Register of Wills - additional Short Certificates
Cumberland Law Journal - advertising
The Sentinel - advertising
$73,333.33
97.25
678.72
4.34
7.86
102.30
14,725.64
3.12
186.00
623.30
4.83
913.59
$ 6,111.00
8.00
200.00
124.00
18.00
5.00
9.00
75.00
87.35
EXHIBIT "A"
Register of Wills - fee to file PA Inheritance Tax Return
Register of Wills - fee to file Inventory
Allfirst Bank - fee to order Estate checks
AIIfirst Bank - stop payment fee
Lower Allen Township - real estate taxes
Lower Allen Township - personal tax
Lower Allen Township - sewer and refuse services
UGI - gas services
PP&.L - electric services
Verizon - phone services
PA Water Company - water services
PP&L - electric services
Comcast - cable services
UGI - gas services
AT&']' - phone services
PP&L - electric services
Verizon - phone services
PA Water Company - water services
UGI - gas services
PA Water Company - water services
Verizon - phone services
PA Water Company - water services
UGI - gas services
PP&L - electric services
Verizon - phone services
Ladies Home Journal - outstanding subscription invoice
Comcast - cable services
15.00
13.00
13.00
30.00
910.13
9.80
74.25
71.35
61.45
39.99
31.64
45.67
56.79
64.00
7.51
75.83
31.99
52.23
64.00
15.73
6.70
32.69
64.00
29.77
51.75
25.46
56.79
R.T. Wagner - homeowner's insurance
Sears - credit card
AT&T - phone services
UGI - gas services
Comcast - cable services
PP&L - electric services
Verizon - phone services
Real estate settlement costs assessed against the Estate as the Seller - eleven twelfths
of costs
PA Water Company - water services
Lower Allen Township - sewer and refuse services
AT&T - phone services
Comcast - cable services
PA Water Company - water services
UGI - gas services
PP&L - electric services
Charlie Knipe -lawn care services
Register of Wills - additional probate fees
Register of Wills - PA Inheritance Taxes
Kathleen Cleveland - personal representative commission
Purcell, Krug & Hailer - attorney's fees
Register of Wills - fee to file Family Settlement Agreement and Final Release
Register of Wills - Short Certificate
269.00
293.30
13.03
64.00
56.79
32.59
30.06
7,855.84
11.10
74.25
6.78
17.63
2.47
16.55
15.77
50.00
85.00
4,300.00
4,500.00
2,662.50
17.00
3.00
TOTAL DEBTS
STATEMENT OF DISTRIBUTION
TOTAL ASSETS
TOTAL DEBTS
BALANCE FOR DISTRIBUTION
MONIES TO BE ESCROWED
(Value of Met Life Stock in the process of being liquidated)
BALANCE FOR DISTRIBUTION AFTER ESCROW
$90,680.28
$28,964.53
$61,715.75
$ 623.30
DISTRIBUTION:
Kathleen M. Cleveland
Patrick M. Kelly
Kathleen M. Cleveland, as Guardian for Jeanne R. Kelly
TOTAL DISTRIBUTED
$20,364.15
$20,364.15
$20,364.15
EXHIBIT"B"
(estates~kelly~fsa)
INVENTORY
Estate of KELLY~ ROSEMARY C.
also known as
, Deceased
No. 21 02 0387
Date of Death 3~24~2002
Social Security No. 202-10-1666
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory, lANe
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Attorney: Jill M. Wineka, Esquire . ,
58802 Kathleen M. Cleveland
I.D. No.:
Address: 1719 North Front Street Dated .~'"-//~O"O,,.~
Harrisburg PA 17102
Telephone: (717) 234-4178
Description
302 Manchester Road, Camp Hill, PA 17011
Reimbursement of County taxes for real estate - eleven twelfths of amount
Reimbursement of School taxes for real estate - eleven twelfths of amount
Reimbursement of sewer - eleven twelfths of amount
Reimbursement of refuse - eleven twelfths of amount
The Patriot News - refund
(Attach Additional Sheets if necessary)
Total
Value
73,333.33
97.25
678.72
4.34
102.30
91,115.01
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW--4
KELLY, ROSEMARY C.
Description of Inventory
Continuation of inventory
Pa,qe 1
21
02
0387
Description
AIIfirst Golden Age Checking Account No. 0050775464
Verizon - refund
Nationwide Mutual First Insurance Company - refund of hazard
insurance premium
Metropolitan Life Stock - 23 shares of common stock
@ $27.10 per share
Subtotal
Grand Total
Value
16,078.79
3.12
186.00
623.30
16,891.21
91,115.01
CERTIFICATION OF NOTICE UNDER RUI,E 5.6(a)
Name of Decedent:
Date of Death:
Will No.: N/A
Marie B. Fagan
January_ 9, 2003
Adm. No.: 21-03-0098
To the Register:
I certify that notice of beneficial interest and/or estate administration required by Rule
5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the
above-captioned estate on June 11, 2003
Nanle:
Address:
Rosemary F. Keegan
Marytheresa Mazzuca
145 St. Andrews Lane
5035 Moonlight Dr.
Etters, PA 15319
Indianapolis, Indiana 46226
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
No Exceptions
Date:
~~ e~Esquire
Address: Pete~L)Daley & Associates, P.C.
242 Wood Street
California, PA 15419
724-938-8953
Telephone:
Capacity:
X
Personal Representative
Counsel for Personal Representative
STATUS REPORT UNDER RULE 6.12
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND , PENNSYLVANIA
Name of Decedent: ROSEMARY C. KELLY
Date of Death: 3/24/2002
File No. 2002-00387
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to the completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
YES X NO __
2. If the answer is "No", state when the personal representative reasonably believes that the
administration will be complete:
If the answer to No. 1 is "Yes", state the following:
a. Did the personal representative file a final account with the Court? YES __
b. The separate Orphan's Court No. (if any) for the personal representative's account is:
NO
Date:
c. Did the personal representative state an account informally to the parties in interest?
YES X NO
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may
be filed with the Clerk of the Orphans' Court and may be attached to this report.
J il~.. v~ir~e ka, Esquire
Name (Please type or print)
1719 North Front Street
Address
~O~ ~,{[']!- ~'0, Harrisburg,
PA 17102
(717) 234-4178
Tel. No.
Capacity: ~ Personal Representative
X Counsel for personal representative