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HomeMy WebLinkAbout11-19-13 (2) J 1505610105 REV-1500 EX(02-11)(R) fi7 OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes ............E�e��E County Code Year File Number PO BOX 28o6o1 INHERITANCE TAX RETURN I � �Q Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDWYY Date of Birth MMDDWYY 03/19/2013 11/19/1931 Decedent's Last Name Suffix Decedent's First Name MI Campbell Coralyn S (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI n/a Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW p 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) p 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) C@D 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 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 Paul L. Zeigler, Esq. (71720-8420 w c rnt, EGISTER OF W .-S US�NCY M = � N ::a 3� r— ►—, --I rat First Line of Address D :z- � � " co t 300 Bridge Street -� Second Line of Address P.O. BOX B ~ r" f ri DATE FH=ED City or Post Office State ZIP Code New Cumberland PA 17070 Correspondent's e-mail address: 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 ,OF SON RFSPONSI FOR FI IN RETURN 1 t C DATE ADDRESS 455047 St. VJ.Apt. 1526 Bradenton, FL 34210 SIGNATU F P E A OTHER THAN REPRESENTATIVE 11li��l_DATE ADDRESS •� 300 Bri ge Stre , nd Fl., P.O. Box B, New Cumberland, PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J W"` 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: Coralyn S. Campbell RECAPITULATION 1. Real Estate(Schedule A). ..... . . .. . ..... . . . .. . .... ....... . ... .. .. . .. 1. 153,000.00 2. Stocks and Bonds(Schedule B) .. . .. ..... . . . .. ...... ....... . ..... .. . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .. . .. 3. 4. Mortgages and Notes Receivable(Schedule D) ..... ...... .. ....... . ..... . 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).... . .. 5. 227,594.36 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. ..... 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested... ..... 7. 8. Total Gross Assets total Lines 1 through 7 8. 380,594.36 9. Funeral Expenses and Administrative Costs(Schedule H)..... ..... ... .. ... . 9. 45,015.32 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).. . .......... .. 10. 1,639.71 11. Total Deductions(total Lines 9 and 10).. ... . ........ . .... . ..... ..... ... 11. 46,655.03 12. Net Value of Estate(Line 8 minus Line 11) ... . . .... .... . ..... ..... ..... . 12. 333,939.33 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. 333,939.33 TAX CALCULATION-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.0_ 15. 16. Amount of Line 14 taxable at lineal rate X.0_ 16. 333,939.33 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. 15,027.27 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Coralyn S. Campbell STREET ADDRESS 1442 Maplewood Drive CITY STATE ZIP New Cumberland PA 17070 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 15,027.27 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 15,027.27 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.......................................................................................... El 0 b. retain the right to designate who shall use the property transferred or its income ............................................ El 0 c. retain a reversionary interest.............................................................................................................................. El 0 d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 2. If death occurred after Dec. 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? ........................................................................................................................ ❑ 0 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 decedent's lineal beneficiaries is 4.5 percent,except as noted in[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 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. � ,�fr;�!kn eus,n" wraorcmbn. f ,, f '•. ..f . :� }7,:�f�z.5 ti 1iS i l •( ,�y.`ycc.y k ar r � 2.! v �^nJ,t�, Ar.ty.`�.� S,t+. �,•:. r�Vil.4�• -• tw .{, sr; ..� 'I,.' �;s^ > T�'n 1',Y r ?i `Ij`'r 1 ,Y, •A I. ni,!.i+,.^`,rr�j:c r."•,•'ht� `�w�Z��ix4rc��:� `�'1,�' '.." �Ya.i,y4 :�.af'da' 'i!4.e:'�:._, �1G: •`'T c ,�ry^t-Jy .C,y + •�t of � `�±4 1( �"� { z'r i' 7 F:F`�+'u`,�z`'1%'yftl�rL�="'�i�-��1 "�E•t'� �+�h � r t �{u•+�r1:Y f ,yRG' , • n1 rC'�lr,..�µv:�T 1:9�:r vv., �"{:.w,!. �.,�Y.,:.�� •,ItL/�,\..?'t `1'^" i�•�ti'. �i�_'try..,�;7`i,':2(1.1{��:1lLt-I�•hM�•��to�,�,''�W^nJ',����1`,•;��"s4�,°'i .i"�,�.:: o.' 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T.r.:n4i^�vE•Y '.U,tk,:4+�`T li.wA _a r•.�rv^ .t "1.?�.+. °3v._�<+.w 2 a kr. � - REV-346 EX(03-09) 3460009101 ESTATE INFORMATION SHEET pennsylvania FOR REGISTER'S OFFICE USE ONLY �.y DEPARTMENT OF REVENUE County Code Year File Number DECEDENT INFORMATION: Enter data as it will appear on all documents submitted to the Department. Decedent's Social Security Number Date of Death Date of Birth. 03/19/2013 11/19/1931 Last Name Suffix First Name MI Campbell Coralyn ...��.�......� El TYPE FILING: Fill in oval to indicate the nature of the return to be filed with the department. O Probate Return O Joint Assets Only O Non-probate Assets Only O Litigation Purposes(no other assets) LETTERS GRANTED: Fill in oval to indicate the nature of the proceedings at the Register of Wills Office. (Attach additional sheets if explanation is necessary.) CID Testamentary O Administration O'No Letters O Other(Please Explain.) ATTORNEY/CORRESPONDENT INFORMATION:Enter all information for the attorney or individual to receive tax information and correspondence. Last Name Suffix First Name• MI Zeigler Paul Supreme Court I.D.# Telephone Number Attorney/Correspondent's e-mail address: 19603 (717)920-8420 —� paul @plzpc.com First Line of Address 300 Bridge Street, 2nd Floor Second Line of Address P.O. Box B City or Post Office State ZIP Code New Cumberland El 17070-2144 PERSONAL REPRESENTATIVE INFORMATION: Enter all information for the personal representative(s)of the"estate authorized by the Register of Wills. Executor/Administrator Social Security Number Telephone Number 1175-48-7275 (717)421-6927 Last Name Suffix First Name MI Campbell Andrew First Line of Address 4550 47th St. W Apt 1526 OFFICIAL USE ONLY Second Line of Address TRANSACTION COUNT City or Post Office State ZIP Code Bradenton FL 34210-2835 Complete general estate information questions and indicate additional personal representatives on reverse side. PLEASE USE ORIGINAL FORM ONLY Side 1 3460009101 3460009101 3460009201 REV-346 EX(03-09) Decedent's Social Security Number Decedent's Name: Coralyn S. Campbell Co-Executor/Administrator Social Security Number Telephone Number Last Name Suffix First Name MI .mow 0 First Line of Address . Second Line of Address City or Post Office State ZIP Code Co-Executor/Administrator Social Security Number Telephone Number Last Name Suffix First Name MI First Line of Address Second Line of Address City or Post Office State ZIP Code General Instructions: This form should be filed with the Register of Wills of the county of which the decedent was a resident at death. Please be aware the correspondent identified will receive all correspondence from the department. It is the responsibility of the personal representative to notify the department if the correspondent contact information changes. The department is authorized by law, 42-U.S.C. §405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The department uses the Social Security number to identify the decedent and personal repre- sentatives of the estate. The commonwealth may also use the information in exchange-of-tax-information agreements with fed- eral and local taxing authorities. State law prohibits commonwealth personnel from disclosing confidential tax information except for official purposes. Side 2 3460009201 3460009201 1 LAST WILL AND TESTAMENT OF CORAL YNS. CAMPBELL I, CORALYN S. CAMPBELL, of 1442 Maplewood Drive, New Cumberland, Lower Allen Township, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby expressly revoking all wills and codicils made by me heretofore, and dispose of my estate as follows: ITEM 1: I direct the payment of my just debts and funeral expenses. ITEM 2: I direct all State and Federal Transfer Inheritance Tax, Estate Tax, Succession Tax or any other tax, including any interest, assessments or penalties thereon, that may become due and payable by virtue of my death, or by virtue of the passing of any property either under my Last Will and Testament, or in any other manner, shall be paid by my estate,just as if such taxes were my debts, and no beneficiary shall be required to pay or refund any part thereof. This shall not, however, include taxes for assets to be administered in any foreign country. Taxes on future interest may be prepaid. � 1 ITEM 3: I give, devise and bequeath all of the residue of my estate of whatever nature and wherever situate,to my son, ANDREW GEORGE CAMPBELL. ITEM 4: I nominate, constitute and appoint my son, ANDREW GEORGE CAMPBELL, 1442 Maplewood Drive, New Cumberland, to be the sole Executor of this my Last Will and Testament. Should ANDREW GEORGE CAMPBELL be unable or unwilling to act or continue to serve, then I nominate, constitute and appoint BRIAN JAMES CAMPBELL, 2667 Timberwyck Trail, Troy, Michigan 48098,to be the sole Alternate Executor of this, my Last Will and Testament. ITEM 5: My Executor and/or Alternate Executor shall have the following powers in addition to those invested in them by law and by other provisions of my Will applicable to all property, whether principal or interest, exercisable without Court approval, and effective until distribution of all property: (a) To retain any or all of the assets of my estate, real or personal, on their sole discretion. (b) To exercise any options to subscribe for stocks, bonds, or other investments. (c) To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any trust may hold stocks, bonds or other securities. 2 � t I� 1 COMMONWEALTH OF PENNSYLVANIA: : SS.. COUNTY OF CUMBERLAND We,the Testatrix, CORALYN S. CAMPBELL, and Co 14M G h and �' L ' ���� ,the witnesses,respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. i�ORALNN S. CAMPBELL Wi Wi s Subscribed, sworn to and acknowledged before me by the Testatrix, CORALYN S. CAMPBELL, and subscribed and sworn to before me by and witnesses,this a day o July 2012. Notary ublic My Commission Expires: com R PENNSYLVANIA Notarial seal Elizabeth M.Maioli,Notary Public New CWrJxdaod 60ro,Cumberland County My Commission Expires Dec.31,2014 MEMBER.PENNSYLVANIA ASS"TION OF NOTARIES REV-1502 EX+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Coralyn S. Campbell 21-13-0460 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 of the settlement sheet if the property has been sold. VALUE AT DATE ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common, OF DEATH NUMBER DESCRIPTION 1 1442 Maplewood Drive, New Cumberland,PA 17070 153,000.00 TOTAL(Also enter on Line 1, Recapitulation,) $ 153,000.00 If more space is needed,use additional sheets of paper of the same size. 'iilil�i A. Settlement Statement (HUD-1) OMB Approval No.2502-0265 FINAL Type of Loan 1.f-I FHA 2,❑RHS 3.0 Conv. Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number: 13-1904GC 0251536603 4,E]VA 5,❑Conv. Ins. 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.Items marked (P-0.0 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: Janice M.Vollero, Andrew G.Campbell,Executor of the Estate of Coralyn SunTrust Mortgage,Inc. S.Campbell 901 Semmes Avenue,Richmond,VA 23224 G. Property Location. H.Settlement Agent: 1. Settlement Date: 1011120113 1442 Maplewood Dr. Guardian Transfer Corporation Disbursement Date: 10/11/2013 New Cumberland,PA 17070 4075 Market St.,Camp Hill,PA 17011 Lower Allen Township 717-909-4700 Place of Settlement: TitleExpress 4075 Market Street,Camp Hill,PA 17011 Printed 10/11/2013 at 3:25 pm I by SLC [J.Sum a"of Borrower's Transaction K.Summary of Seller's Transaction 100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller 101. Contract sales price 153,000.00 401. Contract sales price 153,000.00 102. Personal propeq 402. Personal property 103. Settlement charges to borrower(line 1400) 5,419.89 403. 104. 404, 105. 405. Adjustments for items paid by seller in advance Adjustments for Items paid by seller in advance 106. Cityltown taxes to 406. City/town taxes to 107. County taxes 10/1112013 to 1213112013 17291 407. County taxes 10/1112013 to 12131/2013 172.91 108. School taxes 10/11/2013 to 06/30/2014 1,029,59 408. School taxes 10/11/2013 to 06/30/2014 1,029,59 109. Sewer Due OIN/D 10111/2013 to 1213112013 57.93 409. Sewer Due OINID 10/11/2013 to 12/31/2013 57.93 110. Refuse Due O/N/D 10111/2013 to 12131/2013 46.97 410. Refuse Due O/N/D 10/11/2013 to 12/31/2013 46.97 111.- October HOA 10/1112013 to 10/3112013 74.52 411. October HOA 10/1112013 to 10/3112013 74.52 112. 412. 120• Gross Amount Due from Borrower 159,801.81 420. Gross Amount Due to Seller 154,381.92 200. Amounts Paid by or in Behalf of Borrower 500. Reductions In Amount Due to Seller 201. Deposit or earnest money 1,000.00 501. Excess deposit(see instructions) 202. Principal amount of new loan(s) 122,400.00 502. Settlement charges to seller(line 1400) 18,715.16 203. Existing loan(s)taken subject to 503. Existing loan(s)taken subject to 204. 504. Payoff of first mortgage loan___ 205. 505. Payoff of second mortgage loan 206. Origination Charges Paid Outside of Closing 50.00 506. 207. Application Fee* $50.00 507. 208. 508. 209. 509. Adjustments for items unpaid by seller Adjustments for items unpaid by seller 210. City/town taxes to 510. City/town taxes to 211. County taxes to 511. County taxes to 212. School taxes to 5120 School taxes to 213. 513. 214, 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220• Total Paid by/for Borrower 123,450.00 520. Total Reduction Amount Due Seller 18,715.16 300. Cash at Settlement from/to Borrower 600. Cash at Settlement tolfrom Seller 301, Gross amount due from borrower(line 120) 159,801.81 601. Gross amount due to seller(line 420) 154,381.92 302. Less amounts paid by/for borrower(line 220) 123,450-00 602. Less reductions in amount due seller(line 520) 18,715.16 303. Cash ❑ From f-1 To Borrower 36,351-81 603. Cash nX To ❑ From Seller 135,666.76 the Pub I is Me porlinj tsurden="-I le5w.n.o.l=a V,.Onm,,s as,=a I n-."mur,`ser nn;pns.1.1 co I..Ing.WF­.ng,.1 repo mg I dTh�, ,,neEl mnec,uu,mumn.un.and you are not require ToMiMplele id I. d lt:=�m 8 " his farm,unless it displays a 'tientlelity is assured;this disOosum Is mandatory.This I. covered transaclion with information during the settlement process. Previous editions are obsolete Page 1 of 4 HUD-1 700. Total Real Estate Broker Fees $9,105.00 Paid From Paid From Division of commission line 700 as follows: Borrower's Seller's 701. $4,120.00 to Century 21 Realty Services Funds at Funds at 702• $4,985.00 to Caldwell Banker Homestead Group Settlement Settlement 703. Commission paid at settlement 395.00 8,710.00 800. items Payable in Connection with Loan 801. Our origination charge (Includes Origination Point 0.000%or$0.00) $1,349.00 (from GFE#1) 802. Your credit or charge(points)for the specific interest rate chosen $-1,224.00 (from GFE#2) 803. Your adjusted origination charges (from GFE A) 125.00 804. Appraisal fee to James R.Perr $380.00 P.Q.C.B' (from GFE#3) 805. Credit report to CoreLa is Credco (from GFE#3) 12.50 806. Tax service to from GFE#3 807. Flood certification to CoreLo is Flood Services (from GFE#3) 6.00 808• to (from GFE#3) 900. Items Required by Lender to be Paid in Advance 901. Daily interest charges from from 10111/2013 to 11101/2013 @$15.4300/day (from GFE#10) 324.03 902. Mortgage insurance premium for months to (from GFE#3) 903: Homeowner's insurance for 1 years to Erie Insurance Co. (from GFE#11) 435.00 904. months to from GFE#11 1000. Reserves Deposited with tender 1001. Initial deposit for your escrow account (from GFE#9) 662.36 1002.Homeowner's insurance 2 months @$ 36.251month $72.50 1003. Mortgage insurance months @$ 0.00/month $ 1004.Property taxes months @$ 0.00/month $ 1005.County taxes 2 months @$ 64.14/month $128.28 1006.School taxes 4 months @$ 119.07/month $47628 1007.Aggregate Adjustment $-14.70 1100. Title Charges 1101. Title services and lender's title insurance from GFE#4 1,387.00 25.00 1101 Settlement or closing fee to $ 1103. Owner's title insurance-First American Title Insurance Company $ from GFE#5 150.00 1104. Lender's title insurance-First American Title Insurance Company $1,015.00 1105. Lender's title policy limit$122,400.00 Lender's Policy 1106. Owner's title policy limit$153,000.00 Owner's Policy 1107. Agents portion of the total title insurance premium $990.25 to Guardian Transfer Corporation 1108. underwriter's portion of the total title insurance premium $174.75 to First American Title Insurance Company 1109. 100 No Violt100 to First American Title $50.00 Insurance Company 1110. 300 Survey1300 to First American Title $50.00 Insurance Company 1111. 820 PUMA to First American Title $50.00 Insurance Company 1112. 900 EPL-Res18.1 to First American Title $50.00 Insurance Company 1113. ClosingSvcLtACL to First American Title $75.00 Insurance Company 1200. Government Recording and Transfer Charges 1201. Government recording charges $ (from GFE#7) 170.00 1202. Deed$67.00 Mork a e$103.00 Release$ 1203. Transfer taxes $ (from GFE#8) 1,530.00 1204. City/County tax/stamps Deed$1,530.00 Mortgage$ 1205. State Tax/stamps Deed$1,530.00 Mortgage$ 1,530.00 1206. Deed$ Mortgage$ 1207. $ 1300. Additional Settlement Char es 1301. Required services that you can shop for (from GFE#6) 83.00 1302. 2013 School Taxes Due to Bonnie Miller 1,428.90 1303. to $ 1304. Resale Certification to PMi 150.00 1305. October HOA Dues to Beacon Hill Community Association $110.00 P.O.C.s 1306. HOA Initiation Fee to Beacon Hill Community Association 110.00 1307. Home Warranty to American Home Shield 480.00 1308. Inheritance Tax Escrow to Guardian Transfer Corporation 6,391.26 130$. Tax service Fee to Valutree R.E.Tax Service $83.00 1310. Reimbursement of HOA master insurto Calvin Williams 30.00 111.11NERRIF-MIRM. .:� n . n 5,419.89 18,715.16 "Paid outside of closing by(B)orrower,(S)eller,(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 4 HUD-1 I Comparison of Good Faith Estimate(GFE)and HUD-1 Charges Good Faith Estimate HUD-1 Charges That Cannot Increase HUD-1 Line Number Our origination charge # 801 1,349.00 1,349.00 Your credit or charge(points)for the specific interest rate chosen # 802 -1,224.00 -1,224.00 Your adjusted origination charges # 8p3 , 125.00 125.00 Transfer taxes 1203 1,530.00 1,530.00 Charges That in Total Carinot•titcrease More Than 1{I%.' . Good.Faitti Estimate HUM . Government recording charges # 1201, . 275.00 170.00 Appraisal fee # 804 380.00 380.00 Credit report # 805 12,50 12.50 Flood certification # 807-. 6.00 6.00 # 808• 0.00 0.00 # 1303 0.00 0.00 Tax Service Fee - #1309 83.00 83.00 756,50 651.50 between Increase $ -105.00 or 13,87970/6 Charges That Can Change Good faith Estimate HUDA Initial deposit for your escrow account # 1001 1,748.69 662.36 Daily interest charges from # 901 $15.4300/day 324,03 324.03 Homeowner's Insurance,., # 903, 435.00 435.00 Title services and lender's title insurance # 1101.. 1,5902 1,387.00 Owner's title insurance-First American Title Insurance Company # 1103 175.00 150.00 # Loan Terms Your initial loan amount is $122,400.00 Your loan term is. 30.years Your initial interest rate Is 4.6000% Your initial monthly amount owed forprincipal,interest,and any mortgage $627.48 includes insurance is Principal ❑X Interest ❑Mortgage Insurance Can your interest rate'die? ❑X No. ❑Yes,it can rise to a maximum of %. The first change will be on / I and can change again every years after / 1 Every change date,your interest rate can increase or decrease by °!°. Over the life of the loan,your interest rate is guaranteed to never be lower than %or higher than %. Even if you make payments on time,canyour loan balance rise? ❑X No. ❑Yes,it can rise to a maximum of$ Even if you make payments on time,can your monthly'amount owed for . Q No. ❑Yes,the first increase can be on 1 / and the monthly principal,interest,and'mortgage insurance rise? amount owed can rise to$ The maximum it can ever rise to is$ Does your loan have a prepayment penalty?, ❑X No. ❑Yes,your maximum prepayment penalty is$ Does your loan have a-bailoon�payment? No. ❑Yes,you have a balloon payment of$ due in years on t I Total monthly amount owed including escrow account payments. ❑You do not have a monthly escrow payment for items,such as property taxes and homeowner's insurance. You must pay these items directly yourself, ❑X You have an additional monthly escrow payment of$219.46 that results in a total initial monthly amount owed of$846.94. This includes principal,interest,any mortgage insurance and any items checked below: ❑Property taxes n Homeowner's insurance Flood insurance ❑ Q Countyffownship taxes Q School taxes Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender. Previous editions are obsolete Page 3 of 4 HUD-1 IQ,gnature Page 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 on my account or by me in this transaction.I further certify that I have received a copy of the HUD-1 Settlement Statement. Jarge M.Vollero I Andrew G.Campbell,Executor of the Est of Coralyn S.Campbell Agent Settlement The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction.I have caused or will cause the funds to be disbursed in accordance with this statement. /3 SETTLEMENT ENT DATE i 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 1014. Previous editions are obsolete Page 4 of 4 HUD-1 I Name of Borrower: Name of Seller: File Number: Janice M.Vollero Andrew G.Campbell,Executor of the Estate of Coralyn 13-1904GC S.Campbell Prepared 10/11/2013 at 3:25 pm Note:This page displays an itemization of the charges shown on line 1101 of the HUD-1 Settlement Statement.This page accompanies but is not a part of the HUD-1 Settlement Statement.If a discrepancy exists,the information on the HUD-1 Settlement Statement applies. I 1100.Title Charges Total Charge Borrower Seller 1101.Title services and lender's title insurance to Wire In to Guardian Transfer Corporation $ 12.00 12.00 Notary Fee-Purchasers to Guardian Transfer Corporation $ 35.00 35.00 Courier Fee-Purchase to Guardian Transfer Corporation $ 15.00 15.00 Electronic Document Fee to Guardian Transfer Corporation $ 35.00 35.00 Notary Fee-Sellers to Guardian Transfer Corporation $ 15.00 15.00 Tax Cert Reimbursement Fee to Guardian Transfer Corporation $, 10.00 10.00 I 1102.Settlement or closing fee to $ 0.00 1104. Lender's title insurance-First American Tit to First American Title Insurance Cc$ 1,015.00 1,015.00 1109, 100 No Vio11100 to First American Title Insurance Cr$ 50.00 50.00 1110.300 Survey1300 to First American Title Insurance Ci$ 50.00 50.00 1111.820 PUMA to First American Title Insurance Cs$ 50.00 50.00 1112.900 EPL-Res18.1 to First American Title Insurance C($ 50.00 50.00 1113.ClosingSvcLtACL to First American Title Insurance Ci$ 75.00 75.00 Totals: $ 1,412.00 0.001 1,387.001 25.0p Seller/ ender credits shown on page 1 POC=Paid Outside Closing CR=Lender Credit . I i I i I Previous editions are obsolete Page 1 of 1 HUD-1 REV-15o8 EX+(o8-12) Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Coralyn S. Campbell 21-13-0460 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. Merrill Lynch Wealth Management 110,187.14 2. Deutsche Asset&Wealth Management 101,352.59 3. Susquehanna Valley Federal Credit Union 6,144.63 4_ Auto:2005 Buick LaSabre 7,395.00 5. Home Furnishings 1,500.00 6. Jewelry 500.00 7. Cash(IRS Refund) 515.00 TOTAL(Also enter on Line 5, Recapitulation) $ 227,594..36 If more space is needed, use additional sheets of paper of the same size. P W N v 0 fD � 4. . . v. D ai � o > � n :3 0 R c co p � to w ��! co -4 rn o o � Rin o" CA o O m o) o O o C�— Z. W z 0 W 0r.. .« WO >rOZ 0 0� � � co .� n -� DDvm en c� CO c�0mr cnm � m �j' c°,� � •• prim N N N N C N v C A 0 ;u < N O r%) 0 > DO oz m o �o � w can ° ofJ o '� w w w W .: W D O O � W 'O N W p \Oi 7 ;0— - N ° .. Z X.. W CA) A C0J1 m: m D o c�, o c, p m y cn z z .: ° > n m N rn: •-O .. N O 0 V W C m w -0 CD o D ° Z w _ o. —I w' CO m ' V m 000 0 U) 00 cr mf N O 's O W O O U) (� � srt c m N ::. 00 co r N C G C ao 91 p C m N O p O o co) 7 O w., -% -p -0 �r o az D m a n O n n �:. � .. r Q CD CT o v m D -� 00 w. m On c Co cn o co N nr O' IQ N. 0p 7 CLM o o CD- m p ter-. (n 00: O N 0 m y W 2 M n N r y -....- . '- S 0 Q 0 D < X Im W ' 7 r to _ W �I Q Z �1 N.. ODD H OD v C CD bo Ab C O :0D 00 O <p 20 Mm C.) =r $ . � (040(040 CL �) R@ (4) _ ? n MAS ■ ; E E U) ; CL —; ee CL, p ; � � . �g � CL M g ®© G ; § . ; , go ■ 06E CO) CO) %7 § ■ 0A 00 so @ � E CL CL in E E c g a , =r m E ƒ 0 2 0 » 0 / / k m s 0Q g L & 0 # ; ■ • p ƒ 0 a ® ■ g » E . o § § m w f [ E ; o / 2 0 . c ■ A 2 § 0 CL J 0 w % E E a * ■ 2 § cr ; E 0) o 0 CL a E . § E , 3 7 § w r to CL E \ o k ° cr 0 \ 0 z § E ■ { g a @ X ¢ p 0 m 0 E . o 0c t. 25. 2013 8: 13AM No. 7167 P. 2/2 Deutsche Asset P.O.sox 219151 &Wealth Management Kansas City MO 64121-9151 October 23,2013 (717) 920-8421 Attn Paul Veigler Inquiry#: 21134053 Fund: Multiple Funds-Class S Account#: )DD XXXX9223 Registration: DWS Trust Company Cust For The IRA of Coralyn S Campbell Dear Mr, Veigler: Please extend our condolences to the family of Coralyn S. Campbell, I am writing in regard to an inquiry. Balance of Account Below I have provided the number of shares, share prices, and dollar values of the funds in this account as of March 19,2013. Fund Name Class S Number of Shares Share Price Dollar Value DWS Core Equity Fund 2,439.737 $20.34 $49,624.25 DWS Capital Growth Fund 813.083 $63.62 $51,728.34 Contact Us If you have any questions,please contact one of our Shareholder Services representatives at(800)728-3337. A mpresentative will gladly assist you Monday through Friday between the hours of 7:00 a.m. and 7:00 p.m. Central Time. Sincerely, Sam Nero Mutual Fund Representative DWS Investments Distributors,Inc. ("DWS Investments")now operates under the Deutsche Asset&Wealth Management brand. This new brand identity combines the asset and wealth management capabilities of Deutsche Bank in a single division. 3850 Hartzdale Dr. Camp Hill,PA 17011-7809 SUSQUEHANNA 339 East Park Dr.Harrisburg,PA 17111-2730 ALLEN Toll 717-737-4152 Free: 800-948-1454 FEDERAL CREDIT UNION Fax:717-737-0589 March 21, 2013 To Whom It May Concern: In reference to Account#20 belonging to Coralyn S. Campbell,please be advised that upon the date of her death,March 19, 2013,the following amounts were in the account: Share Savings(00) - $1,670.61 Christmas Club (06)-$10.00 Share Draft(40)- $4,464.02 If you have further questions, please contact me at 717.737.4152 x 100. Sincerely, s/ Patricia Shaffer, Sec. www . SVFCU . org REV-1511 EX+ (08-13) i� Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Coralyn S. Campbell 21-13-0460 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Auer Cremation 256.00 1st Christian Church of Lemoyne 250.00 Minister 250.00 Organist 100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 13,500.00 Name(s)of Personal Representative(s) Andrew G. Campbell Street Address 4550 47th St. W. Apt. 1526 City Bradenton State FL ZIP 34210 Year(s)Commission Paid: n/a 2. Attorney Fees: Paul L. Zeigler, Esq. 10,000.00 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: 463.50 5. Accountant Fees: Richard S. Simpson II 250.00 6. Tax Return Preparer Fees: 7• Patriot News-Publication 116.45 TOTAL(Also enter on Line 9, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. Schedule H(Continued) Estate of Coralyn S.Campbell Estate Expenses Utility Expenses $ 2,094.60 PP&L-$918.00 Water-$314.16 Phone&Cable-$627.04 Sewer&Refuse-$235.40 Medical Expense: $ 2,461,40 Diamond Pharmacy-Medicine-$196.64 Cumberland Physical Therapist-$13.68 Hampden Township EMS Co/pay-$75.00 Country Meadows Assisted Living-$1,701.08 Hazen Elder Law-$325.00 Pinnacle Hospital Co/pay-$150.00 Credit Card Payments $ 1,995.15 Capital One-$789.96 Discover-$872.50 L.L. Bean-$332.69 Insurance: $ 404.32 Travelers(Car)-$308.00 Travelers(Home)-$96.32 Beacon Hill Association Fees $ 550.00 Estate Cost Estimate Attributable to Real Estate Sale $12,323.90 See attached statement of estimated Seller's costs $18,715.16 Less Inheritance Tax Escrow- 6,391.26 $12,323.90 $45,015.32 REV-1512 EX+(12-12) x Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Coralyn S. Campbell 21-13-0460 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. Mortgage payments-Wells Fargo($345.98 x 3) 1,037.94 2. 2013 County-Township Taxes($774.68-$172.91 =$601.77) 601.77 TOTAL(Also enter on Line 10, Recapitulation) $ 1,639.71 If more space is needed,insert additional sheets of the same size,