HomeMy WebLinkAbout10-02-13 J gyp. 1505610105
REV-1500 EX(02-11)(Fit p!2r
1. OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes `""'I`1 County Code Year File Number
PO BOX 28o6o1 INHERITANCE TAX RETURN �3 O�`J
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
' 05117/2013 07/26/1944
Decedent's Last Name Suffix Decedent's First Name MI
Thrush Alan H
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
oD 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Michael A. Scherer, Esq. (717) 249-6873
REGISTER OF WILLS,USE ONLY
C3 LI
73
-„• .� r1T �
First Line of Address i
_
Banc Scherer LLC _ va
r t t
Second Line of Address
C� C>
19 West South Street ' 3
GATE FILED
City or Post Office_ State ZIP Code
Carlisle PA 17013 - c� ,- rn
Correspondent's e-mail address: mscherer@baricscherer.com
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.
SIGNATU E OF PERSON SPON IBLE FOR FILING RETURN DATE
ADDRESS
105 Hicko Road, Carli le, Pennsylvania 17015
SIGNATU PRE.PAF;E OT ER THAN REPRESENTATIVE DATE
_ �7.•1TIKL//////// /0 - f • /3
ADDRE
19 West South Street, Carlisle, Pennsylvania 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105 J
Y✓
-! 1505610205
REV-1500 EX(Fl)
Decedent's Social Security Number
1
Decedent's Name: Alan H. Thrush i
RECAPITULATION
1. Real Estate(Schedule A). ............................................ 1. 136,000.00 ,
2. Stocks and Bonds(Schedule B) ....................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) ..... 3.
I
4. Mortgages and Notes Receivable(Schedule D)........................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 12,146.95 ;
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. + r
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property } ii
(Schedule G) O Separate Billing Requested........ 7.11
• 8. Total Gross Assets(total Lines 1 through 7)............................. 8. 148,146.95
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 14,585.71
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 148,587.57 I
11. Total Deductions(total Lines 9 and 10)................................. 11. 163,173.28 i
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 15,026.33
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made(Schedule J) ........................ 13. /
14. Net Value Subject to Tax(Une 12 minus Line 13) ........................ 14. I 15,026.33 j
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 r- -------�
(a)(1.2)X.0_ I 15. __ 1
16. Amount of Line 14 taxable
at lineal rate X.0_ 16.
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE ......................................................... 19. I
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=3
Side 2
1505610205 1505610205
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Alan H. Thrush
STREETADDRESS
720 North Front Street
CITY STATE ZIP
Wormleysburg PA 17043
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
3. Interest Total Credits(A+B) (2)
4. If Line 2 is greater than Line i+Line 3,enter the difference. This is the OVERPAYMENT. (3)
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line t+Line 3 is greater than Line 2,enter the difference.This Is the TAX DUE. (5)
Make check payable to: REGISTER OF WILLS, AGENT.
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.......................................................................................... ❑ E
b. retain the right to designate who shall use the property transferred or its income............................................ ❑ 0
c. retain a reversionary interest.............................................................................................................................. ❑ M
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ 0
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.
For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5 percent,except as noted in P2 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(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.
REV-1502 E%+(12-12)
0 pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Alan H. Thrush 21-13-0613
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 that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy or the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's Interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. Proceeds from sale of 720 North Front Street,Wormleysburg,PA 136,000.00
copy of HUD-1 attached hereto
TOTAL(Also enter on Line 1, Recapitulation.) $ 136,000.00
If more space Is needed,use additional sheets of paper of the same size.
REV-1508 Ex+(08-12)
0 pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
INHERITANCE TAXRE
ESTATE OF: FILE NUMBER:
Alan H. Thrush 21-13-0613
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION
OF DEATH
1. Proceeds from auction of personalty 10,518.00
2. refund of 2013 prorated county taxes 270.61
3. refund of 2013 prorated school taxes 1,338.79
4, refund of sewer bill 12.35
5. refund of trash bill
4.26
6, Sovereign Bank account 2.94
TOTAL(Also enter on Line 5, Recapitulation) $ 12,146.95
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Alan H. Thrush 21-13-0613
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
1' Malpezzi Funeral Home 7,636.12
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
Z. Attorney Fees:
1,123.70
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 338.50
S. Accountant Fees:
6. Tax Return Preparer Fees:
7 Franklin Real Estate-title search on real estate 150.00
e. Sovereign Bank: date of death balance fee 20.00
9. The Sentinel: legal advertising 157.68
10. Cumberland Law Journal: legal advertising 75.00
11. •Patient First 139.13
"""""CONTINUED ON ATTACHED SHEET"'"""'"'""
TOTAL(Also enter on Line 9, Recapitulation) $ 14,585.71
If more space is needed,use additional sheets of paper of the same size.
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REV-1512 Ex+(12-12)
`i�Jpennsylvania SCHEDULE I
��7 DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Alan H. Thrush 21-13-0613
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Borough of Wormleysburg 2013-14 school taxes 1,739.00
2. Citi Mastercard;Acct.No. 5256505211851337 1,794.24
3. Citibank Goodyear;Acct.No.6035510146361294 839.38
4. GE Capital: WalMart;Acct.No.6032207580729119 3,595.93
5. Lowe's;Acct.No.81602210001927 205.17
6. Americhoice;Acct.No.xxxxxxx106 8,27328
7. Patient First;Acct.No.0008785672 179.20
8. Metro Bank mortgage payoff 131,961.37
TOTAL(Also enter on Line 10, Recapitulation) ; 148,587.57
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE ]
DEPARTMENT OF R EVE NUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Alan H.Thrush 21-13-0613
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
I. Bonnie L.Kreiger sister 100%
105 Hickory Road
Carlisle,Pennsylvania 17015
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,A5 APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
OMB Approval No.2502-0285
N A. Settlement Statement {HUD-1}
:R Type of Loan
1.❑FHA 2.❑RHS 3.Q Conv.Unins. 6.File Number 7.Loan Number: 8.Mortgage insurance Case Number;
13130547
4.[J VA S.Q ConvAns.
C.Note:This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agents are shown.(tams marked
"(p.o.c)"were paid outside the closing;they are shown here for informational purposes and are not Included in the totals
D.Name&Address of Borrower E.Name&Address of Seller: F.Name&Address of Lender.
Jeffrey Tinsman,Elizabeth Tinsman Estate of Alan H.Thrush Centric Bank
706 N.Front Street,Wormleysburg,PA 17043 720 N.Front Street,Womileysburg,PA 17043 4000 Crums Mill Road,Harrisburg,PA 17112
G.Property Location: H.Settlement Agent; I.Settlement Date:09/23/2013
720 North Front Street Barristers Land Abstract Company Disbursement Date:09/2312013
Wormleysburg,PA 17043 3310 Market Street,Camp Hill,PA 17011
Wormleysburg Borough
717-761-6190
Place of Settlement TitleExpross
3310 Marker Street,Camp Hill,PA 17011 Printed 09/2312013 at 1:19 pm
by LM
100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller e
_
701. Contract sales price 136,000A0 401 __.
. Contract sates price 1361OOOAp
102. Pers. ai property 402. Personal property .
103. Settlement charges to borrower(line 1400) 4,887.29 403.
104. 404,
105. 405.
Adjustments for items paid by seller to advance Adjustments for items paid by seller in advance
106, atyllown tares to 406. Cityltown taxes to
107. County taxes 09/2312013 to 12/31/2013 270.61 407. County taxes 09/23/2013 to 1213112013 270.61
108, School Taxes 0912312013 to 061302014 1,338.79 408, School Taxes 09232013 to 06 13012014 1,338.79
109, Sewer 0923013ia09r30013 12.35 409, Sewer O323t20i3to OPdOf20t3 1235
110, Trash 092312013 to 0913012013 4.26 410. Trash 09123/2013 to 09/30/2013 4,26
117, 411.
112. 412
120. Gross Amount Due from Borrower 142,513.30 420. Gross Amount Due to Setter 137,626.01
200. Amounts Paidb orin Behalf of Borrower 500. Reductions to Amount Due to Seller
201. Deposit orearnost money 5,000.00 501. Excess deposit(see instructions)
202. Amount of Loan$114,000.00 502. Settlement charges to seller(line 1400) 5,684.64
203. Exstrigi loart taken subject to 503. Exist s taken sulned to
204. 504. Payoff of first mortgage loan to Metro Bank 131,961.37
205, Loan Advance 108,800.00 505. Payoff of second mortgage loan
206. Future Draws-$5,200.00 506. Future Draws-$5,200.00
TT. 507
206. 508.
209. 509.
Ad'usttnen4s for0ems unpaid b seller Adustments for items unpaid b seller
210. GityAces saxes to 510. Cityr1own taxes to
211. County taxes W 511. County taxes to
212. School Taxes to 512. School Taxes to
213. 513.
214. $14.
215. $15.
216. 516.
217. 517,
218, 518.
215. 519.
220. Total Paid b Bor Borrower 1f3,800.00 520. Total Reduction Amount Due Seller 137,626.01
300. Gash at Settlement fromito Borrower 600. Cash at Settlement tolfrom Seller
301. Gross amount due from borrower(line 120) 142,51330 601. Grass amount due to se0er(the 420) 137,626A1
3C2. Loss amounts pad bylfor borrower(IMe 220) 113,80100 W2, Less reduc4tans in gnmmt due pater(One 520) 137,626.01
303. Cashry QX From ❑ To Borrower 28,713.30 603. Cash Q To ❑ From Seller 0.00
yylmn^'nleif YUbpleyae wtlLXlMve J OMB mnl,d numMe.NotonMenIWIIVN euuvM Nle EttlOfUm bmeMelory TFblf dybnelbporpe Ne pWe51o�RE8VNmvxM VvaWOn WI Infom,elbn EuMgIXe m a
me MMEv
Previous editions are obsolete Page 1 of 3 HUD-1
' 700. Total Real Estate Broker Fees Paid From Paid From
Division of commission line 700 as follows Borrower's Seller's
751. Fdo to Funds at Funds at
702. $0,00 to I Settlement Settlement
703. commission paid at sentiment
800, Home Payable in Connection vn'Ih Loan
801. Our origination charge (Includes Ongmation Point0.000%or 0.00) $575.00 (from GFE fl)
802 Your credit or charge(points)for the specific interest rate chosen $ (from VE 42)
803. Your adjusted ancestor charges (from GFE A) 575,00
804. Appraisal fee to Centric Bank {from GFE 43} 375.00
805. Credit report to Centric Bank (from GFE#3) 9.29
806. Tax service to from GTE#3
807. Flood cer ificanin to Centric Bank (from GFE#3) 19.00
608_ Documentation Fee to Centric Bank (from GFE d3) 50-0
809, Wire Fee to Centric Bank (from GFE#3) 25.00
810. Final Inspection to Centric Bank (from GFE#3) 100.00
900. Hems Required by Lender to be Paid in Advance
901. Daly internal charges iron from 09(1312013 to 1087112013 Q$0.061day (from GFE#10)
902. Mortgage ins,Premium for mantis to (from GTE Q)
903. Homeowners insurance for months to (from GFE#11)
90k months to from GFE#it
1000, Reneven;Deposited with Lender
1001, Initial deposit for your escrow account (from GFE#9)
1002,Homeowners insurance months @$ 0A0/month $
1003,Mortgage Insurance months 0$ 0.00 1month $
1004.City Properry Tu moi @$ Co wntth $
1005.County Property Tax months @$ 82.311monih $
1006.school Taxes months 0$ 144.921month $
1007,Aggregate Adjustment $
5100.Tide Cha es
1101, TiBe services and lenders no insurance from GTE#4 1274.00
1102. Settlement or closing fee to $
1101 Owner's fire insurance-Stewed Title Guaranty Company $ from GFE#5 110.00
1104, Losers 00e insurance-Surat Title Guaranty Company $1245.00
1105. Lenders title policy limit$114,000.00 Lender's Policy
1106. Owners title policy limit$136,000.00 Owners Policy
1107. Agents potion of the total title insurance premium $1,088,00
1108.Undenwiers potion of the total this insurance premium $267.00
1109.Preparation of Release of Mortgage to Banisters Land Abstract 50.00
General-Hog
1200,Government Recording and Transfer Charges
1201,Government recording charges $ (from GFE#7) 225.00
1201 Deed$67.00 Mortgage$83.00 Release$
1203. Transfer taxes $ (from GTE#8) 1,360.00
1204.City/County tax/atamps Deed$1,360,00 Mad e$
1215.State Taxlstamps fazed$1300.00 Mortgage It 1,360.00
1206. Deed$ Mortgage$
1207. Record Assignment of Rents $75.00
12(18. Record Release of MOdgage 65.50
1300.Additional 8a1116ment Char as
1301, squired services that you can shop for (from GFE#6)
1302, Notary Fee, to Undo McBeth 10.
1303,Pori Nome Inspections to Inspect a Home 315.
1304,Tax Cert Reimbursement to Barristers Land Abated Cost-Hb 10.46
1305. 2013-14 School Tax to Bo rou hot Womnle stlu 1,739.0(
1306..Overnight Fee-royal to Barristers Land Abstract Postage-Hbq .68
1307.Document Preparation Fee ro Bane Scherer LLC 125.
1308.Attorneys Fear to Baric Scherer LLC 1,300.
1309 Auctioneer Fees to Chuck Bricker 745,00
1310. SenlemermQlosing Fee to Baric Scherer LLC 2 .00
1311.Additional Tax Cedirkalion to Alma 8otmsford,Tax Caiac!or 10.
i s . - t , r d,887.29 5,684.64
'Paid outside of closing by(B)orrowe6(Slater,(L)ender,(I)nvestor,Bro(K)er.-Credit by lender shown on page 1.-Credit by seller shown on page 1.
Previous editions are obsolete Page 2 of 3 HUD-1
itemization of Lines 1101,1103 ,.
Name of B6rmwer Name of Seller. File Number
Jeffrey Tinsman Estate of Alan H.Thrush 13.01-30547
Elizabeth Tinsman
Tideexpress
Prepared 0923013 at 12:34 pm
Note: This page is furnished to give you an itemization of the amounts shown on 5, e aid fore.+ s .ai rom
Lines 1101, 4103 and 1104 of the Settlement Statement{HUO-i}.This page rrowe
accompanies but is not a part of the settlement statement.if a discrepancy an S-a
exists,the Information shown on the Settlement Statement(HUD-1)applies. eme x eft e men u
1100..Tift Chargea:,...,.,.w-..a..,.. .re-.+nn ..,.re,...r—.rr a•++r Amounts tnCludld'•�^-'•.sr. a....-......+,w,-:.....,..^.r.+ mc••n-r..re m.^�
-,v.�s-sin tine 1161,:,,. °__.0->:-. -o•x: .: �.
I 105 Tole sevim-a-Wiendets file Insum os Y 1274.00 rys
a.N Fees § 19.00
b.Wire Fee 10.00
r«
§ 29.00
1102. Settlement a olosing fee '
1103. Owners fille hiWrasce § 110.00 110.00
1104. Lenders title Insurance Oel 970.00 § 1,24540
a.Endorsement 710 VRM 50.00
b.EndonenM 900 EPL-Resfdanfiat 50.00
C.aosing Service Letter 75.00
d.ALTA Shpt Fare Loan 100.00
(Teal 1103.1104)
1105.-Lentletsti0e CmdF§itd'000.00 s..- -::,�`._.��
1106, OneestitleDdivIldt §136000.00.
1107.'A em's.oortion of the total title insurance pretWOm` ' '1066.00
1109:UrMenttilefs bn ofthe lota190efnswanoa " -267.00 -
otel1107+1109
1109,
tt10.
1111.
1112.
;Additional Information for Line 1101 Items
.;.r. ..,.r.r^rr•+.'�e-•:.+.�.•-•...:�.r,••�—..•>._- __ _ -,TWaI;' -iiw.e 6aRONlr
« POC or Credit ..�Line 1101 Paid 100. TPoe Cha a wtth Pay" Che e
1101. TI6e senloes and lendes title Insurance .ten
§
a.Notary Fees to Unda McBeOs 19.00 19.00
b.Wae Fee to Baulsters Land Absttaa Wire-H 10.00 low
1104, Lenders 11001nsumnce to BaMMM Land Abstract Company 1,245.00 1,245.00
.. +-:+=:--...-,:�a-.:^..-:—x%*ri,:-+-y-.r.+.,,-+-.+ ..«-,-•- § ..1274.00*o Y...�.�..+..^.:.• .—a„-,-7 274.00^^, .^-•.-^^^.-^!-•*..y
HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is a true and accurate statement of all receipts and
disbursements made an my account or by me in this transaction.I further certify that I have received a copy of the HUD-1 Settlement Statement.
Jeffrey nsman
i
Elizabeth 'Elizabeth sL
ESTATE OF ALAN K.THRUSH
I�� Xsni6Ll�
Bonnie L.Kreiger,Administrator
Settlement Agent
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction.I have caused or will ea use the funds to be
disbursed in accordance with this statement.
LEM NT AGENT DATE
WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010.
Previous editions are obsolete Page 4 of 4 HUD-1
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