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HomeMy WebLinkAbout10-24-13 I Ex(02-11) 1605610143 - J REV-15002± OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Nunber Bureau of Individual Taxes Dw<RnewT O.REVENUE PO BOx.280601 INHERITANCE TAX RETURN 2 1 11 01385 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 12 22 2011 03 04 1929 Decedent's Last Name Suffix Decedent's First Name MI ANTHONY NANCY T . (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ❑ 1. Original Return ® 2. Supplemental Return ❑ 3,Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a.Future Interest Compromse ❑ 5. Federal Estate Tax Return Required (date of death after 121282) 8 Decedent ece Died Testate 7, Ddent Maintained a Uwng Trust 0 8. Total Number of Safe Deposit Boxes ❑ (Attach Copy of Wilt ❑ (Attach Copy of Trust) ❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 11.Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TA INFORMATIOiOULD B&PIRECTED TO: Name Date Telephon"uni r'r1 III ROBERT G FREY 7 � �43 `5,?a30 o rn pp c, --`1 rn x' VIPJErt'10F / S I1k[OILY V O t7 First Line of Address a o © nl 5 SOUTH HANOVER STREET o = '`� z cti M Second Line of Address tir O _TT DATE FILED City or Post Office State LP Code - CARLISLE PA 17013 Correspondent'seanaifaddress: rfrey @freytlley.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 a complete. aeration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATURE OF SON RE ONS FOR FILING RETU ATE Sharon A.Wang o 'Z / 1187 Greenfield Drive, MeiahZanicsburg, PA 17050 SIGNATU OF PRE E T REP TATIVE DATE Robert G Frey 0 2 f 1, 3 ADDRESS Frey and Tiley 5 South Hanover Street, Carlisle,Q 17013 Side 1 1505610143 1505610143 V I 1606610243 J REV-1500 EX RECAPITULATION 1. Real Estate(Schedule A).......................................................................................... 1. 291 , 000 . 00 2. Stocks and Bonds(Schedule B)............................................................................... 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3. 4. Mortgages&Notes Receivable(Schedule D).......................................................... 4. S. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. - 1 , 856 . 32 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 43 , 850 . 00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............. 7. 8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 336 , 706 . 32 9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 50 , 603 . 40 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 12 , 374 . 47 11. Total Deductions(total Lines 9 and 10).................................................................. 11, 62 , 977 . 87 12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 273 , 728 . 45 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)................................................. 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. 273 , 728 . 45 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 273 , 728 . 45 16. 12 , 317 . 78 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. 12 , 317 . 78 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1606610243 1606610243 J REV-1500 EX Page 3 File Number 21 - 11 - 01385 Decedent's Complete Address: DECEDENTS NAME Anthony, Nancy T STREETADDRESS 1810 Lambs Gap Road CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 12,317.78 2. Credits/Payments A. Prior Payments 14,982.72 B. Discount Total Credits(A +B) (2) 14,982.72 3. Interest (3) 396.00 4. If Line 2 is greaterthan Line 1 +Line 3,enterthe difference. This is the OVERPAYMENT. (4) 2,268.94 Check box on Page 2,Line 20 to request a refund 5. If Line 1 +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;................................................................. ❑ x b. retain the right to designate who shall use the property transferred or its income;.................................... x c. retain a reversionary interest;or.................................................................................................................. x d. receive the promise for life of either payments,benefits or pre?.............................................................. x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?....................................................................................................................... ❑ ❑x 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?......... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?...................................................................................................................... ❑ ❑x 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 January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent 172 P.S.§9116(a)(1.1)(u)]. 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 decedent's lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.§9116(a)(1)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.69116(a)(1.311. A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether y blood or adoption. pennsyIV2nia DEPARTMENT OF REVENUE SCHEDULE A INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT FILE NUMBER ESTATE OF Anthony, Nancy T 21 - 11 -01385 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 with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold. Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 1810 Lambs Gap Road, Mechanicsburg, PA, assessed value 291,000.00 TOTAL(Also enter on Line 1, Recapitulation) 291,000.00 pennsylvania SCHEDULE E DEPARTMENT OF AXRET CASH BANK DEPOSITS AND MISC. INHERITANCE TAX RETURN RN � RESIDENT DECEDENT PERSONAL PROPERTY FILE NUMBER ESTATE OF Anthony, Nancy T 21 - 11 -01385 Include the proceeds of litigation and the date the proceeds were received by the estate. All propertyjointlyowned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE DEATH DATE OF 1 Tax proration, Sample Bridge Road 289.85 2 Tax proration, 1810 Lambs Gap Road 1,566.47 TOTAL(Also enter on Line 5, Recapitulation) 1,856.32 REV-1509 EX-(01.10) pennsylvania SCHEDULE F s.� DEPARTMENT OF REVENUE I NHERITANCE TAX RE rURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Anthony, Nancy T 21 - 11 - 01385 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT. John & Lavone Kobierecki 238 Sample Bridge Road, Mechanicsburg, None . A PA 17055 JOINTLY OWNED PROPERTY: ❑ N oO P ITEM LETTER DATE Include name 0q%Sanaa InaN ution ar°d bank account numbe DATE OF DEATH %OF DATE OF DEATH NUMBER FOR JOINT MADE or similar identifying number.Attach deed for jointly-held real VALUE OF ASSET DECD'S DECEDENT'S INTEREST TENANT JOINT estate. INTEREST 1 A 09/18/1990 Vacant Land, Sample Bridge, assessed value 87,700.00 50% 43,850.00 TOTAL(Also enter on line 6, Recapitulation) 43,850.00 REV-1511 EX+(10-09) 1' SCHEDULEH enns Ivania P Y DEPARTMENT OF REVENUE FUNERAL DWEMESAND MERITANCE TAX RESIDENT DECEDENT RETURN wry, NSTRATNECOM /'VJ111��VJ�w1 �M� FILE NUMBER ESTATE OF Anthony, Nancy T 21 - 11 -01385 Decedent's debts must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A B. ADMINISTRATIVE COSTS: t, Personal Representative's Commissions Name of Personal Representative(s) Sharon A. Wang 5,000.00 Street Address 1187 Greenfield Drive city Mechanicsburg state PA zip 17050 Year(s)Commission Paid 2013 2. Attorney's Fees Frey&Tiley 9,420.00 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 S. Accountant's Fees 6. Tax Return Preparer's Fees 7, Other Administrative Costs 1 Expenses from sale of 1810 Lambs Gap Rd (Itemization attached) 33,951.41 TOTAL(Also enter on line 9, Recapitulation) 60,603.40 Schedule H COMMONWEALTH OF PENNSYLVANIA ��yy..,,,,�.,,,y,yyy,,,,��//��.�,.��,..�.�,,�yy INHERITANCE TAX RETURN Adrwi Ntidkm Costs y{,�vrwed RESIDENT DECEDENT ESTATE OF Anthony, Nancy T FILE NUMBER 21 - 11 -01385 2 Expenses from sale of Sample Bridge 1,963.76 3 Consultation - Keith Brenneman 75.00 4 Kennel License 100.00 5 Miscellaneous expenses 78.48 6 Bank Check fee 14.75 Page 2 of Schedule H I pennsylvania SCHEDULE I DEPARTMENT ANCE TA RETURN DEBTS OF DECEDENT MORTGAGE INHERITANCE TAX RETURN f RESIDENT DECEDENT LIABILITIES & LIENS FILE NUMBER ESTATE OF Anthony, Nancy T 21 - 11 -01385 Report debts incurred by the decedent pr or to death that remained unpaid at the date of death, including unreimbursed medical expenses. TENT NUMBER DESCRIPTION AMOUNT 1 Dr. Guistwite 290.89 2 Cumberland Goodwill EMS 81.58 3 Claire Grant- Debt owed at time of death 3,000.00 4 Pa. Department of Revenue 2.00 5 Richard T.Anthony, Sr. - Debt owed at time of death 9,000.00 TOTAL(Also enter on Line 10, Recapitulation) 12,374.47 REV-1513 EX•(01.10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INH9nTANCETAXRErURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: RLE NUMBER: Nancv T Anthon 21-11-1385 RELATIONSHIPTODECEDEW AMOUNT OR SHARE NUMBER NAIVE AND ADDRESS CF PERSONS)RECEIVING PROPERTY Do Not Lint Tnu *(b) OF ESTATE I TAXABLE DISTRIBUTIONS Undude cutdght spousal dWMuU=and tranateu under - aee.9118(a)(1.nl 1 Sharon Wang 1187 Greenfield Drive,Mechanicsburg,PA 17055 daughter 0.25 2 Richard H.Anthony,Jr. 707 Range End Road,Dillsburg, PA 17019 son 0.25 3 John M.Anthony 373 Rupp Road,Elliottsburg,PA 17024 son 0.25 4 Ronald D.Anthony do John Anthony 373 Rupp Road, Elllottsburg, PA 17024 son 0.25 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON ONES 15 THROUGH to OF REV-1500 COVER SHEET,AS APPROPRIATE. It NCN-TAXASLE DISTRISUTIONS A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOTTAKEN: 1. B. CHARITABLE AND GOVERNMENTAL 013MBU71ONS: 1. TOTAL OF PART 9—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0.00 11 more apace Is needed,use addMonel sheets of paper of the mm eiM. LAST WILL AND TAMMENT O NANCY T. ANTHONY 1, NANCY T. ANTHONY, of Hampden Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all Wills and Codicils previously made by me at any time heretofore. FIRST: I hereby direct that my personal representative(s), hereinafter named, to pay all of my just debts, not barred by any statute of limitations, as well as my funeral and testamentary expenses, including Pennsylvania Inheritance Taxes, as Cy\ , soon after my demise as may be practicable. J SECOND I hereby give, devise and bequeath all the rest, residue and remainder of my estate, equally and per capita, among my four children: Richard H. Anthony Jr., Sharon Anthony Wang, act John M. Anthony, and o Ronal! D. Anthony T yl ; THIRD: Be it known that I desire to be cremated and request thine be no maudlin funeral or memorial services conducted following my demise. Fougrul, I hereby nominate,constitute and appoint my daughter Sharon A.Wang,as Exeoutdx of this,my Lest WIN and Testament M the event that Sharon predeceases me,falls to quality.teases to act. or for some reason is incapable of pwformirg such task, 1 Own nominate, constitute and appoint my son,John Michael Anthony. as exeaRa. in the event that John predeceases me,fairs to quality. ceases to act. or for some reason Is Incapable of performing such task, I nominate. conBtiNne and appoint my sort.Ronald D.as executor. FI.E'1;: : The above nsa wd persons stall not be required to pmt bond or surety In this or any other jurisdiolion for falthful compliance of the duties as personal representative of my estate. IN WITNESS WHEREOF, I hereby set my hand end seal and declare Oft to be my, LAST WILL AND TESTAMENT. consisting of this and one tither typewrillerr page, identified by nV s(� relture.dated on this, the day of -,tLt-V °_._ . _ . 2009 Nagy T (T' BE IT KNOWN, that at the request of the testatrix,we have witnessed the signing of this document, in her presence. and In the presence of each o0w. (Address). o1!} rti 6tYe„ Or_ +iisi4t'x —�. l iucy''n'pt _ .c� ,(Address) o!�J. ?n�GtYPh J9 jU_ ttItri7L.arp [f�irie tYiati, t 7oQ COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) r3rcJC� 5hf:..pe n` �NAN Y T. ANTHY, and l .6 — Cfan• a . the T v��,qjxrtha witnesses, rfaspec6vely, whose names are signed m the attached and fbf"egoing Instrument, tieing first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and Testament. Furthermore, she signed and executed it willingly. as a tree and volurtery act for the purposes therein expressed. Each of us, as witnesses, in the presence and hearing of the Testatrix and each other. signed the Will as wiU>asses, and that to the best of our knowledge and sight the Testatrix. was at the time eighteen (18) or more years of age. of sound and disposing mind, memory and understan ng er no rt, duress or undue influence. NCY ANTHONY (restib:) a:ie- WITNccmz WMIESS Subscribed. sworn to and acknowledged before me by. NANCY T. ANTt10j1Y, the Tesld and by and � J AteKy S Cyzri a f)tybzt E the wNiesses, an of whom per red before me, the undersigned officer, on fts, the f day of Le.r a 2009 NOTARY PUBLIC My Commission Expires.March 3) IJOO , COMMONWEALTH OF PENNSYLVANIA NOWW$991 Elizabeth K Hull.MiM Pubk SMer SPrrQ TWP.,Cumberland CW* My Caroniffsbn EVvoo Mar.20.2010 Member.Pennsylvania Assodason of Notaries Property Mapper Cumberland County, PA p 0. 3 2 Deedbook: 201236 SMPRAME Land Use Code, 105 r �C Property Type: RC Acreage: 3.26 Square Feet: 2538 Taxable Status:T Clean&Green Status: Y 1 YORK COUNTY Land A�ed Value$: 117800 A/ fl— Building A�sed Value S: 149900 X.. _.:y,� ��//•- q}'r�.^ '- � 111 // r'�„� l �5�k. i`r 1 1 1 i 0I 0 T 101vn (�.�.t} A lj , � PM Year Built: Copyright 2011 Esri. All rights reserved. Wed Oct 16 2013 02:23:46 PM. 1810 LAMBS GAP ROAD PIN: 10-14-0844-041 Deedbook: 201236111 Owner: GELLATLY, DOUGLAS &STEPHANIE Land Use Code: 105 Property Type: RC Acreage: 3.26 Square Feet: 2538 Taxable Status: T Clean &Green Status: Land Assessed Value $: 117800 Building Assessed Value $: 149900 Total Assessed Value $: 267700 Sale Price $: 291000 Sale Date: Tue Nov 20 2012 07:00:00 PM Year Built: 1900 Municipality: HAMPDEN TOWNSHIP Height in Stories: 2 Type of Dwelling: DETACH Primary Exterior: Vinyl - Basement Percentage: 100 Air Conditioning: NO Total Rooms: 8 Bedrooms: 3 Full Bath: 1 Half Bath: 1 OMB Approval No.2502-0265 `Iu�lt A. Settlement Statement(HUD-1) 88*A oxJ'c�� B. Type of Loan 1.Q FHA u 2,0n RHS 3.❑X Con¢Unins. 6. FJe Number: 7. Loan Number: 8. Mortgage Insurance Case Number: Q 5, 4. VA Con,.Ins. IA-2012-085-C C. Note: This form is flunnshed fe gne you a shipment of ashen settlement cost& Amounts Raid to and by the settlement agar are shown. Items marked'(p.o,c.)'were paid outside the closing,they are shown here for informational purposes and are not induced in the totals D. Nameand Addressof Borrower: E. Name and Address of Seller: F, Nameand Addressof Lender: Douglas L Gabody Esideof Nancy T.Anthony hid Perm Bank Submerse Gella0y Sharon A,Wang,Exeatr& 349 Union Street 1810 Lambs Gap Road Millersburg,PA 17061 Mechanicsburg,PA 17055 G. Property Location: H. Secument Agent 1. Settlement Date: 18101-ambs Cap Road lonniA otrdcl Company Moohanicsburg,PA 17055 November e,2012 Cumberland County,Pennsylvania Ph. Place of Settlement. lei Perm Bank 5500Agentown Boulevard,Harrisburg.PA J- Summary of Borrower's transaction K. Summary of Seller's transaction 100. Gross Amount One tram Borrower: 400. Gross Amount Duets Seller: 101. Cosurestsbrosprice 1 291,000,00 401. Contract Sam price .... 251,000.00 102, Perwnai property 402. Personal Property ._. 103. Settlement Charges to Sorrower fUne 1400 8.535.00 403. _ 104. Pa ff-Mortgage 710 Ed 26,134.27 404, 105: 405. Ad ustments for items send b Se4ar in advance Adjustments for items aid h Seiler in advance 106, CWT .Texts 1/108102 to 121311112 85.33 406.Cuffwp.Tares itfO8ti2 to 12731112 107. Sdtooi Taxes 11/08112 to 06130113 1 1,457.82 407,School Taxes 11/08/12 to 06/30/13 1457.82 108. Trash 111DW12 to 12/31/12 23.32 408.Trash 11/08112 to 12/31/12 23.32 109. 409. 110. 410. 111. 4fl. 112 412. 120" Gross Amount Due from Borrower 427,235]4 420.Gross Amount Due to Seller 292,566.47 200. Amounts Paid by or in Behalf of Borrower 500. Reductions in Amount Due Seller: 201, Deposit or earnest money 15,0001J0 601. Excess deposit see bsttuctlons 202. Pin I amount of new loansi 1 460,000.00 502. Settlement charges to SeW Lore 14D9 28,173.11 203, Edstin loan 5 taken subject to 503. Existing loans taken Subject to 204. 504. Payoff First Mortgage to Cumb Ca Housing BRededev 11,428,00 205. 505. Payoff Second Mora e 206. 506, 207. 507,(Depost dOb.as propsedd 208. 508. 209. 509. Adjustments for items un ald by Seller Adjustments for items unpaid b Seller 210. Cc1Tw .Taxes to 510.Ca/T.P.Taxes to 211. Sr}wpi faxes to 511. SdmN Taxes is 212.Trash to 512.Trash to 213, 513. 214, 514. 215. 515. 216. 515. 217. 517, 216. 518. 210, 519. 220, Total Paid b Ifor Borrower 475,000.00 $20.Total Reduction Amount Due Seller 39,601 Al 306, Cash at Settlement f dwould Borrower 664. Cash at settlement toffrom Seller 301. Grass amount do from BOrtpwar ifine 120 427,235.74 801. Gross ameur4due to Sager(lon 420) 292 586.47 302. Lassamoun[ aidbyFr Borrmair(line 220) ( 475,000.00) 602. Less reductions due SePar line 520) ( 39,601.11 301 Cash El From E To Borrower 47,764.26 603. Cash E To 11 From Seller 252,965.36 The h o,tsderfGmcp+trr�N*�^a{aJ. tsl.h�+(u.rmiro-pmry(r} ur.Q of Nis statement&any at(adlmenfs referred to herein Borrower �� t. Seller ougl sL.Geller Q( Estaleo YJancy T. En"�- ._1 apt�rve G89atty aronA.Wang,EzecuMx ThePW k Rq:smermn en e+scme4mt:mrmaFmn eem�:ta a m,r.�s oe+raam+otroncirs rw"s4m mrpuSnoUa�b.irts+9mMmwm�pta I,tzmwm aarw me rarw+rmmcawan 619¶FII�,�/reasit45p"�saCVrmpyvBiEOMB4nYtl ntnb+.NOttlfl6£v4 Yif/isxssaYM Wsda.Jwuai5T9diby.Tfrs Is HSiglpjppcviW N¢pgUpS�08REfipACwN0yYM5Y4mvSN„RCTHpMMrytlexNpPoi,bR pO i. Page 1 of 3 HUD-1 (IA-2012-085-C.PFD/IA"2012-085•C/14) !.Settlement Charges ]00.Total Real Estate Broker Fens Pap Fnvn Pap Fm DASnofa tsbn(ke 7(10)asfokw Banexr's SeW4 Fu m Fu st 702. In Se:ikmeM Seloonet 76 .Coirmission paid at ent ]04. ]05. e00Jtems Pa Mein Fectloa with Loan 80Y.Our tpn e $ 2.300.00 from GFE#t E3-�-.r:, °'• r m 802.Ybw aedO or chae points}for the spedfic interest rate drown $ from GFE 421 -k'i Ai'>'.^.+:.,Y+r;•"....�:`?l 803.Your&Oraed origiratka,dar es firm GFE#A 2.300.90 - 804,Apfradmil fee h from GFE#3) 1•>.:'a':M.:, 805.Credit Report b from GFE#3 805.Tax swore in hom GFE#3 807.Plead mrtif®tion to Mid Perm Bank firm GFE#3) 22.00 It 808.Erntronmmtel SaarN Fr to Md Penn Bank from GFE#3) 7600 :*,s 809.Doco nmt Pr ep Fee to Mid Penn Bank ffrom GFE#3 50040 •a -!...•aim. 810. from GFE 03 811. (from GFE#K31 '.i;N7i_••-,3 i" 900.items Rxlalrod0 Lenderto Be Paid in Advance 901.Da Ntaest the es hom 1110112 to 12/01112 23 $/de from GFE#10 902, a e Nwmnm wandm,fix months to (from GFE 03 ,�:5'+•3-°:�,' ' 903,tignagwrees in r ron n gill ^napru".� 904 b (FE#113 905. from GFE#111 1000.Reserves Deposited with Lander tMi.IniSal tleposlllo resaow account (hom GFE#9) 5$?:!•3• .rs.°' 7002.Honeowner'sNwmnrs manft $ mpnal b '* t ,�,+,;_.,•...;:: IW3,momme inewanes months a S per morih a H"•.3J T..,. sav'y32 r�".'n 1OD4.PLOP"taxes a 1005 1006. morals A $ py month $ '+?Sr:.G"-FS'r+cvw��i r,,: 1007. monde $ per moral $ 1009. $ 1100.Title Charges 1101. Title semAm and fenders He inwrance from GFE 0 2,545.00 1102. Syttlerrent IX 11 ees top hsuranm io 5ewar Tale fftpnGFE#5) 110C Lendees 08e insurance to Ste%,arl Ple Guaran ry Colrim $ 2470.Op 1105, Lendees trip Pcio,I'ma 460,000,00 �r�'t--vnkm i•-;`.�7,'iL*:,. 1108. Owners dtp poky[knit $ 29100040 -+'.'-3::>+aet 1:ves. +•e:aa t 0?. of the total Oft ba"roo vemkim :.'^-Fi:*h-•'%� 1108. Underwriters porder,of as mail aide Nauance prearkon a Steuart Tik Gtmramy Ca s 150,06 "ih i.Fi'J:is Ccs 3.:a ?j 1109. $ 1110. $ 1111. S 1117 $ 1113. s 1114, inhcBaTax ant to Ronste,ofWas $ 15000.00 1115, Tax Cert fee in IonniADstrad Company s 10,00 1200.Government Recording and Transfer Charges 1201.Guremmenl reonding car es to Reoxders CRee from GFE#7) 188.00 120Z DgN S 64.00 mcwtiage,$ Bam Releases Otter s 90.56 "cF..Exa -; 5tso 1203.Transfer Mal to RecordeSOMM (from GFE 2,910.00 12 C,.ty taxtstamps $ 2,910.00 1205.State taxIstamps $ 2.910.00 $ +'r.'d-'>:"'r '=':", 2,910.W 1208, 1207. 1300.Additional Settlement Charges 1301,Required seMCes that you can ship for from GFE#0 1302.Artier Fees to ColdierAnticaues $ 1471,81 1303.CanmkS!m lot Sale of M CorckeAntiquas $ 8,730,00 1304. $ 1305. $ 1400.Total Settlement Charges(enter on lines 100.Section J and 502•Section K) 8,535m 28,173.11 '9a4aubbdtlmimbt ares(91,sd(fi},IaWtt}.a aa�4gaa1tl Cam• 8r lMnprptdehLllbnaR4aYpa4lt,aehe.�KpeeaiadbmndW¢gdeM).2b 2dHahw Ion ad Company,Set M Agent Page 2 of 3 HUD-1 (IA-2012.085•C.PFOnA 2012.085-G11) 10/18/2013 11 : 17 FAX 7179013586 Wix Wenger & Weidner 002/009 MB 2 A. Y A : U.S.DEPARTMENT OF HOUSING&URBAN DEVELOPMENT 1. FHA 2.�FmHq 3. CONV.UNINS. 4. VA 5. CONY INS. 5, 1LE NUM LOAN NUM R: 5004-15921* SETTLEMENT STATEMENT 6. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement Costs. Amounts paid to aril by the settlement agent are shown, Items marked JPOCJ"were paid outside the closing,they are shown here For lm;1rmaocnat purposes and a not included in the totals. 0 3ma 5604.r69p5 K68 ER-10 re 3.i O5D04- y9et.xOa ER.ta! D. NAMEAND ADDRESS OF BORROWER; E, NAMEAND ADDRESS OF SELLER: F. NAMEAND ADDRESS OP LENDER: John E.Kobierecki and Estate of Nancy T.Anthony _ Cash Leven T Kobieracki G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 1. SETTLEMENT DATE: Lot on Sample Bridge Road American Heritage Abstract Sliver Spring Twp..Cumb.Co.,PA October 16,2013 PLACE C F SETTLEMENT 508 North Second Street Harrisburg,PA 17101 F BORROWEKIN TRANSACTMM I&4VMMAMY WC It Contract Sales Price 20000.00 401. Contract Sales Price 20000.00 102. Personal Property 402. Personal Property y 103. Settlement Charges to Borrower Line 1400 1,11O&DO 403. - u 104. 404, 105. 405. 106. Clt /rownTaxes to 406. CII rrownTaxes to 107. County Taxes 1011 3 to 01101114 27.18 407 County Taxes 1011$/13 to 01101114 27,18 108. Assessments 10118!13 to o07/01114 262.67 40B. Assessments 10/16/13 to 07/Di/14 262.67 109. 409. 110. 410. 111. 411. 112, 412. 120. GROSS AMOUNT DUE FROM BORROWER 21,397.65 V. GROSS AMOUNT DUE TO SELLER 20,269.85 200. AMOUNTS PAID BY OR IN BEHALF OF RROW 0.REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest mone 501. Excess Deposit See instruc8ons 202. Principal Amount of New Loans 502. Settlement Charges to Sailor Line 1400 91760:5F 203. Existing loans taken sub act to Sting loans taken subject to 204. 504. C fBarsct o ""I" 205. 50P o a e 208. 506. 207. 507. 208. Payment of 112 of Taxes 06.80 508. Pa en of 1/2 of Taxes $06.80 209. 11 A01 us mans F Or Itiams Unpaid BY 5011 ar i For items da=7 er 10. Cii rrawn Texas to 510. Ci frown Taxes to 211. Coun Taxes to 511. County Taxes to 212. Assessments to $12. Assessments to 213. 513. 214. 52#. 215. 515. 216. 516. 217. $17. 218. 518, 219. 1519. 20, TOTAL PA/0BY/FORBORROWER 506,80 1 $20, TO 7X REDUCriON AMOUNTDUESELLER 10,268.60 300 CASH AT SETTLEMENT FROMRO BORROWER' - CASH ATSErTLEMrNT 011FROM SELLE : 301. Gross Amount Due From Borrower Line 120 21,3016 41. Grass Amount O o Satter Lure 42 0 289.85 302. Less Amount Paid ByiFOr Borrower iLlne 0) i 508.80} 602. Less Reductions Due Setter(L ne 520) i 10 288.80 303. CASH( X FROM)( TO)BORROWER 20 691.05 503. CASH X TO FROM SELLER 10.023.05 The undersigned hereby c n. le a receipt�of�a�c�g�mplated copy of Pages 1&2 of this statement&any attachments referred to herein. Borrower S- G�'VwW^ Seller Estate of Nancy T.Anthony Jo E,Kobierecki BY Sharon E.Wang, Executrix Lavon T.Koo erecki HUD-1(390)RESPK H64306.2 10/18/2013 11 : 17 FAX 7179013586 Wix Wenger & Weidner 16003/008 L.SETTLEMENT CHARGE 790.TOTAL200MMI SION Based I e a PAID FROM Division of Commission line 700 as Pollaws: aDRRDYJflR'6 SaLeks 701.5 to Ft7NOSA FUNDEAT 7152.S t0 aEfTLEMENT eE IRAENT 703, Commission Paid at Settlement Od. 1 lCQNNECTIOtMTH L6141 R 8 oan r naton ee Utoo 602.Loan discount % t0 03. Appraleel es to 804. Credit Report to 805. Lender's Inspection Fee to 808. Mof a e Ins.A ,Fee to 807. Assum lion Fee to 808. 09, 810. 11 IT IN ADVANCE- $01,interest Prom to S /day { days %) W. MIP T61ins.for LifeO Loan for months to 903.Hazard Insurance Premium for 1.0 years to 04, 905, RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months $ par month 1002.Mort a e Insurance months ( per month 1003. Utyfrown Taxes months Q $ per month 1044. Count Tares months $ per month 1005. Assessments months $ r month 1008. months er mont 1007, per month 1008, moats 0, $ per momh TITLE 1101. Settlement or Closing Fee to 1102. Abstract or Title Search to 1103. Title ggirnination to 1104. Title insurance Binder to 1105. Document Preparation to 1106. Notary Fees to Lisa M.Sites 1000 10.00 1107. Adorn s Fee$ to lnDiu above item numbers: 1108 Title Insurance American Haritafto.Abstract TI I n urard 82300 inoludea above item numbars1101.11104 1109.Lender's Cover S 11`10,owner's Coverage S 85, 3.00 $ 1111. 1112. 1113. GOVERNMFNT RECORDING AND 1201.Recordin Fees: Deed S 75.001 Mortgage S Releases S 75.00 i 202.CI / Oun Taw5wrl s: sad 200. �Mortgage 200.00 1203-State Tar;/Stamps: Revenue Strr 200.00:Mortgage 200.00 1204. 1205. 1300.ADDITIONAL SETTLEMENT CHARGES 1301. Survey to 1302. Pest Impaction to 1303. Inheritance Tax Escrow to WhL Wenger S Weidner Escrow Account 9,500.00 1304, EncrowApreement Preparation to Wlr Wenger&Weidner .50.00 1305. 1400,TOTAL SETTLEMENT CHARGES Enter on Lines 109 Section i and 602.Section K 1,108.00 9,760.00 By signing page 1 of this statement,thesignatorles acknowledge receipt of a completed py page 2 of this two page statement. Certified to be a true copy Am sort Heritage AO$>�t- Settlement Agent sobt.tso81- ofliER.t$rsoo°.ts$el.xo aER.to 13) Expenses of Lambs Gap Road Property PPL $ 206.30 PPL $ 84.60 Verizon $ 38.65 Keystone Oil $ 423.09 Keystone Oil $ 230.04 Erie Insurance $ 184.00 PPL $ 84.08 PPL $ 58.66 PPL $ 57.60 PPL $ 27.13 Verizon $ 35.15 County and Township Tax $ 577.42 Mower Transport $ 40.00 Lawn Mowing $ 150.00 Verizon $ 50.97 Lawn Mowing $ 75.00 PPL $ 53.92 PPL $ 27.14 Erie Insurance $ 184.00 Lawn Mowing $ 75.00 Lawn Mowing $ 75.00 Lawn Mowing $ 60.00 Lawn Mowing $ 75.00 PPL $ 29.98 PPL $ 64.52 Appraisal $ 375.00 Lawn Mowing $ 75.00 Lawn Mowing $ 75.00 House Maintenance $ 1,370.00 Lawn Mowing $ 75.00 Painting and repairs $ 280.00 PPL $ 121.86 PPL $ 33.61 Air conditioning unit $ 116.59 Lawn Mowing $ 75.00 Painting $ 100.00 Lawn Mowing $ 75.00 Lawn Mowing $ 65.00 Lawn Mowing $ 75.00 Repairs $ 220.00 Erie Insurance $ 220.75 Lawn Mowing $ 75.00 Interstate Waste $ 137.40 PPL $ 125.19 PPL $ 34.07 Lawn Mowing $ 75.00 Lawn Mowing $ 65.00 Lawn Mowing $ 10.00 Yard Work $ 50.00 Yard Work $ 20.00 Lawn Mowing $ 75.00 Lawn Mowing $ 65.00 Lawn Mowing $ 75.00 Lawn Mowing $ 75.00 Plumbing repairs $ 247.31 Lawn Mowing $ 75.00 PPL $ 121.84 Lawn Mowing $ 85.00 Stove installation $ 70.00 Kitchen upgrades $ 400.00 Verizon . $ 53.50 School taxes $ 2,426.36 Interstate Waste $ 370.08 Verizon $ 50.00 Cleaning expenses $ 192.94 Cleaning expenses $ 443.07 Cleaning expenses $ 206.31 Cleaning expenses $ 409.09 Cleaning expenses $ 350.45 Associated Products $ 330.72 Lawn Mowing $ 75.00 PPL $ 114.74 Lawn Mowing $ 75.00 Maintenance $ 170.00 Supplies $ 43.67 Supplies $ 150.00 Repairs $ 3,250.00 Repairs $ 2,570.00 Supplies $ 521.42 Maintenance $ 300.00 PPL $ 226.87 PPL $ 48.32