HomeMy WebLinkAbout12-26-13 (2) pennsylvania 1505613110
DEPARTMENT OF REVENUE EX(06-13)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 1
Harrisburg,PA 17128-0601 RESIDENT DECEDENT c9
�� I�
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
07262013 04051934
Decedent's Last Name Suffix Decedent's First Name MI
MALLISON LAWRENCE
(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
FILL IN APPROPRIATE BOXES BELOW REGISTER OF WILLS
0 1. Original Return Q 2. Supplemental Return Q 3. Remainder Return(date of death
Prior to 12-13-82)
Q 4. Agriculture Exemption Q 5. Future Interest Compromise(date of Q 6. Federal Estate Tax Return Required
date of death on or after 7-1-2012) death after 12-12-82)
0 7. Decedent Died Testate Q 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
0 10. Litigation Proceeds Received Q 11. No Taxable Asset Return Q 12. Election to Tax under Sec.9113(A)
(Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
ROBERT G . FREY 717-243-5838
First Line of Address
5 S . HANOVER STREET
Second Line of Address
o
City or Post Office State ZIP Code rn r`-" C5
c-7 (n
CARLISLE PA 17013
rri
REGISfEkZ 5�11LLS USE ON1 -�
REGISTER OF WILLS USE ONLY �? ��'...� `T1 --n
DATE FILED 2!
C.-
(n
c�
Correspondent's email address: R F R E Y a@ F R E Y T I L E Y. C O M DATE FILED STAMP
Under penalties of perjury,I declare 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.
SI9TU.RE OF ERSON RESPONSIBLE FOR FILING RETURN -2
/ �z <Y113
ADDRESS
101 WILLOW MILL DRIV MECHANICSBURG PA 17050
SIGNAT R F PREPA OT N REr-E)ItATI VE JDATE
ADDRESS
5 SOUTH HANOVER STREET CO—LISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505613110 1505613110 J �\
J 1505613210
REV-1500 EX
Decedent's Social Security Number
DecedenrsName: LAWRENCE MALLISON
RECAPITULATION
1. Real Estate(Schedule A). . . . . . . .. . . . . . ... . . .. . . . .. .. . . .. ..... .. . . .. 1. 0 .1111
2. Stocks and Bonds(Schedule B).. . .. . . .. . .. .. .. .. .. . . . .. . . . .. .. ... .. 2. 0. 00
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C). .. 3. 0 . 00
4. Mortgages and Notes Receivable(Schedule D).. . . ... .. . .. .. ... .. .. . . . . 4. 0. 00
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . .. 5. 40431.00
6. Jointly Owned Property(Schedule F) =Separate Billing Requested. .. . . .. 6. 171738. 00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) =Separate Billing Requested.. . . .. . 7, 0 . 00
8. Total Gross Assets(total Lines 1 through 7).. .. .. .. . .. . . ... . . .. .. .. .. . 8. 212169. 00
9. Funeral Expenses and Administrative Costs(Schedule H). . .. ... .. .. ... . .. 9. 21771. 00
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). . ... .. .. .. ..10. 121356 . 00
11. Total Deductions(total Lines 9 and 10).. .. . . . .. . . . . .. .. . . ... . . ... . . . 11. 143127.00
12. Net Value of Estate(Line 8 minus Line 11).. . . .. .. .. .. . .. . . ... . . .. .. . . 12. 69042. 0 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J). . . .. . . .. .. .. .. . . . . ... .13. 0• 00
14. Net Value Subject to Tax(Line 12 minus Line 13). .. . . . . . . .. .. . . . . .. .. . 14. 69042. 00
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 0 15. 0. 00
16. Amount of Line 14 taxable
atlinealrateX.o 45 69042. 00 16. 3106. 89
17. Amount of Line 14
taxable at sibling rate X . 12 17. 0.00
18. Amount of Line 14 taxable
at collateral rate X . 15 18. 0 . 00
19. TAX DUE. .. .. .. . .. .. .. . ... . . . . .. . . . .. ... .. .. .. .. .... . . . . .. . . . .. . 19. 3106. 89
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT F xx
Side 2
L 1505613210 1505613210 J
REV-1500 EX Page 3 File Number 099-28-8776
Decedent's Complete Address: 21-13-0825
DECEDENT'S NAME
LAWRENCE MALLISON
STREET ADDRESS
940 GOBIN DRIVE
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 3106.89
2. Credits/Payments
A.Prior Payments 3346.02
B.Discount
Total Credits(A+B) (2) 3346.02
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in box on Page 2,Line 20 to request a refund. (4) 239.13
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
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 b. retain the right to designate who shall use the property transferred or its income............................................ ❑ ❑
c. retain a reversionary interest............................................................................................................................. ❑ ❑
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?........................................................................................................................ ❑ ❑
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 F2 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-1508 EX+(08-12) SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF RETURN PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Lawrence Mallison 21-13-0825
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 Tax proration from HUD-1 Settlement statement 1,040
2 Sovereign Bank Acct. 1921081066 3,152
3 Sovereign Bank Acct. 7675388887 1
4 Members 1st Acct. 134921-00 18,732
5 Members 1st Acct. 134921-05 1,148
6 Members 1st Acct. 134921-11 4,336
7 2011 Toyota Camry 12,022
TOTAL(Also enter on line 5, Recapitulation) $ 40,431
If more space is needed,use additional sheets of paper of the same size.
REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
i
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Lawrence Mallison 21-13-0825
If an asset became jointly owned within one year of the decedents date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. Stacy Zorn 101 Willow Mill Park Road Daughter
Mechanicsburg, PA 17050
B. Lavan Zorn 101 Willow Mill Park Road Son-in-law
Mechanicsburg, PA 17050
C.
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 DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE, VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 2/23/11 940 Gobin Drive, Carlisle. Residence of Decedent, 100% 170,500.00 100.00% 170,500.00
Taxable. HUD-1 settlement statement attached
2. B 9/20/05 Members 1st Acct. 182527-00 905.00 50.00% 452.50
3. B 9/20/05 Members 1st Acct. 182527-11 1,571.00 50.00% 785.50
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL(Also enter on Line 6, Recapitulation) $ 171,738.00
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DECEDENET URN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Lawrence Mallison 21-13-0825
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Ewing Brothers Funeral Home 4,040
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: 5,000
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:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. Settlement charges from HUD-1 settlement statement 12,466
8. Advertising in Cumberland Law Journal and The Sentinel 265
TOTAL(Also enter on Line 9, Recapitulation) $ 21,771
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
Pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN DEBTS OF DECEDENT,
RESIDENT DECEDENT MORTGAGE LIABILITIES&LIENS
ESTATE OF FILE NUMBER
Lawrence Mallison 21-13-0825
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.
First mortgage to CitiMortgage 101,121
2. Second mortgage to Santander Bank. Note: HUD-1 payoff figure includes a$10,000 escrow 14,879
until written payoff statement was delivered.
3. Members 1st Acct. 134921-01, automobile loan 2,747
4. Visa credit card with Members 1st 1,335
5. EMT bill 50
6. Final Electric to PPL 135
7. Final cable bill to Comcast 128
8. Final gas bill to UGI 164
9. Final bill to Culligan 18
10. Final lawn service bill 90
11. Final cell phone bill 16
12. Furnace bill owed at death 606
13. Final bill for security service 67
TOTAL(Also enter on Line 10,Recapitulation) $ 121,356
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Lawrence Mallison 21-13-0825
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).]
Stacy J.Zorn
1 101 Willow Mill Park Drive, Mechanicsburg, PA 17050 Daughter 100%of residue
ENTER DOLLARAMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,ASAPPROPRIATE.
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.
0.00
If more space is needed,use additional sheets of paper of the same size.
Sovereign 4o Santander
s Court Ordered Processing\Decedents- MA1-MB3-02-10 - P. O.Box 841005 - Boston,MA 02284
3
a
August 7, 2013
a -
Robert G. Frey
Frey & Tiley
5 South Hanover St.
Carlisle, PA 17013
RE: Estate of Lawrence Mallison
Date of Death: 07/26/2013
5
Z Dear Robert G. Frey:
Per your request, enclosed please find the account information as of the date of death
for the above-named decedent. For your information, accrued interest is not included in
the date of death balance.
Please feel free to contact me if I can be of any further assistance.
n Very truly yours,
j Ashley Nob ga
z [COP Specialist III]
617-514-5189
Y
o
i
a
9
e
i
S
U_
6
Z
3
S
m
Sovereign Bank
ESTATE OF Lawrence Mallison
SOCIAL SECURITY#:
DATE OF DEATH: July 26, 2013
Account#: 1921081066 Type: Checking Open date: 11/3/2012
In the name of. Lawrence Mallison or Stacy J Zorn
Date of Death Balance: $3,152.47
Int.(YTD) from 1/1/2013 to 7/26/2013 $0.17
Accrued interest to date of death: $0.02
Other Info:
Account#: 7675388887 Type: Money Market Open date: 11/3/2012
In the name of: Lawrence Mallison or Stacy J Zorn
Date of Death Balance: $1.07
Int.(YTD) from 1/1/2013 to 7/26/2013 $0.00
Accrued interest to date of death: $0.00
Other Info:
Page 1 of 1
St
MEMBERS 1St
FEDERAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 134921-00
Date Account Established 08/24/1993
Principal Balance at Date of Death $8,731.11
Accrued Interest to Date of Death $0.90
Total Principal and-Accrued Interest $8,732.01
Name of Beneficiary Stacy J Zorn
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix 134921-05
Date Account Established 07/31/1996
Principal,Balahce at Date of Death $1,148.11
Accrued Interest to Date of Death $0.04
Total Principal and Accrued Interest $1,148.1.5
Name of Beneficiary Stacy J Zorn
CHECKING ACCOUNT:
Account Number/Suffix 134921-11
Date Account Established 08/24/1993
Principal Balance at Date of Death $4,335.51
Accrued Interest to Date of Death $0.18
Total Principal and Accrued Interest $4,335.69
Name of Beneficiary Stacy J Zorn
LOAN ACCOUNT:
Account Number/Suffix 134921-01
Date Opened 10/28/2010
Principal Balance at Date of Death $2,746.96
Loan Type Used Vehicle Loan
Collateral Secured 2011 Toyota Camry VIN#I4T1BF3EK6BU181387
Interest Rate 4.29%
Name of Co-Borrower None
VISA CREDIT CARD ACCOUNT
Account Number. 4672090000275578
;Date`.Account Establishedi 08%21/1996
Balance'at Date of Death $1,334.92
Joint Cardholder None
MEMBERS 1sT FEDERAL CREDIT UNION
Tessa L Klugh
Lending Insurance Support Specialist
August 5, 2013
Estate of: LAWRENCE MALLISON
Date of Death:W/26/2013
Social Security Number: 099-28-8776
5000 Louise Drive P.O. Box 40 Mechanicsburg Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org
St
MEMBERS 1St
FEDERAL CREDTT UNION
PRIMARY OWNER: Stacy J Zorn
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 182527-00
Date Account Established 03/12/1999
Principal Balance at Date of Death $905.39
Accrued Interest to Date of Death $0.09
Total Principal and Accrued Interest $905.48
Name of Joint Owner Lawrence Mallison Lavan Zorn
Date Joint Added 03/12/1999 09/20/2005
REGULAR.SAVINGS ACCOUNT:
Account Number/Suffix 182527-11
Date Account Established 03/12/1999
Principal Balance at Date of Death $1,570.72
Accrued Interest to Date of Death $0.00
Total Principal and Accrued Interest $1,570.72
Name of Joint Owner Lawrence Mallison Lavan Zorn
Date Joint Added 03/12/1999 09/20/2005
MEMBERS IT FEDERAL CREDIT UNION
Tessa L Klugh
Lending Insurance Support Specialist
August 5, 2013
Estate of: LAWRENCE MALLISON
Date of Death: 07/26/2013
Social Security Number: 099-28-8776
5000 Louise Drive P.O. Box 40 Mechanicsburg,Pennsylvania 17055 (800) 283-2328 www.memberslst.org
2011 Toyota Camry Sedan 4D Trade In Values-Kelley Blue Book e 19 O 9/27/13 1:37 PM
ZIP CODE:17013 I Sign in(or Sign up)
home ( car values cars for sale car reviews KBB top picks research toots
�GOaaA Popular at KBB.com i
w a
l� I The 40 mpg Cars of 2013
I
advertisement why ads?
Home > Car Values > Toyota > Camry> 2011 > Style > Options > Sedan 4D �ioyota �� }_ _ �' Go
Your Blue Book' Value Show Used Car Prices I Price Your Next Car
2011 Toyota Camry �� y
Style: Sedan 4D
1 — � 4
i edit options check
( specs j I Mileage: 150000 Change Like this car 4 +�
Trade-In Value Private Party Value
when trading in at a dealership when selling the car yourself Print Repolt
TOYTA
1 Ocxm zxw+. ;JI s°.sr+axr�ues
Excellent
advertisement why ads?
$12,922 Shop for your next car Price a new car
Very Good
� I THE NEW
$12,422 Faulkner
Good Instant Trade-in Offer Get the offer I TOYOTA !sct=n
$12,022
Ago T
Fair
$10,872
Own it? Love it? Tell Us. write a review
Verify Condition
Track this car's
values 866-688-4649
Valuesvalid until Sell your current car Place an ad i
10/03/2013 advertisement why ads?
(updated weekly) -.--_-_._....._-.----- __- __I
Helpful Resources from KBB.com New Cars You Might Like
Apply for Financing ' Get Selling Advice Check Local Prices
Lock in your loan,then See the pros and cons , See what people near you
shop for your next car. I of different ways to sell., are asking for their cars. i - 2014 Toyota Camry
- - I View
Cars for Sale Get a Used Car Report i
http://www.kbb.com/toyota/camry/2011-toyota-camry/sedan-4d/?vehicle...7&intent=trade-in-sell&mileage=50000&pricetype=private-party#survey Page 1 of
U11111 OMB Approval No.2502-0265
A. Settlement Statement (HUD-1)
Type of Loan
1.❑X FHA 2.❑RHS 3.❑Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
4.❑VA 5.❑Conv. Ins. CN13-00708 000071087 446-1978224-703
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
"0-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:
DAVID MCGL'YNN STACY J.ZORN HomeSale Mortgage,LLC
107 Green St.,,Waynesboro,PA 17268 940 Gobin Drive,Carlisle,PA 17013 215 S.Centerville Road,Lancaster,PA 17603
G. Property Location: H. Settlement Agent: I. Settlement Date: 12/20/2013
940 GOBIN.DRIVE, NORTH MIDDLETON Homesale Settlement Services Disbursement Date: 12/20/2013
TOWNSHIP 730 Norland Avenue,Chambersburg,PA 17201
CARLISLE;PA 17013
North Middleton Township Telephone:717-267-3222/Fax:717-671-9676
Place of Settlement: TitleExpress
730 Norland Avenue,Chambersburg,PA 17201 Printed 12120/2013 at 12:59 pm
by LB
J.Summa of Borrower's Transaction K.Summary of Seller's Transaction
100. :GrossiAmount Due from Borrower 400. Gross Amount Due to Seller
101. Contract sales price 170,500.00 401. Contract sales price 170,500.00
102. Personal property 402. Personal property
103. Settlement charges to borrower(line 1400) 9,769.71 403.
104. 404.
105. 405.
Adjustment%for items paid by seller in advance Adjustments for items paid by seller in advance
106. City/town taxes 12/20/2013 to 12/31/2013 3.74 406. City/town taxes 12/20/2013 to 12/31/2013 3.74
107. County taxes 12/2012013 to 12/31/2013 12.24 407. County taxes 12120/2013 to 12/31/2013 12.24
108. School taxes 12/20/2013 to 06/30/2014 1,023.86 408. School taxes 12/2012013 to 06/30/2014 1,023.86
109. 409.
110. 410.
111. 411,
112. 412.
120. Gross Amount Due from Borrower 181,309.55 420. Gross Amount Due to Seller 171,539.84
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) 167,411.00 502. Settlement charges to seller(line 1400) 25,751.55
203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
204. 504. Payoff of first mortgage loan#1120067461 to 101,121.20
CitiMort a e,Inc
205. 505. Payoff of second mortgage loan#231372691 to 24,878.69
Santander Bank,NA
206. 506.
207. Seller Contribution 5,115.00 507. Seller Contribution 5,115.00
208. 508.
209. 509.
Ad'ustmentslor 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 512. School taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519,
220• Total Paid b Ifor Borrower 173,526.00 520. Total Reduction Amount Due Seller 156,866.44
300. Cash at Settlement fromito Borrower 600. Cash at Settlement to/from Seller
301. Gross amount due from borrower(line 120) 181,309.55 601. Gross amount due to seller(line 420) 171,539.84
302. Less amounts paid by/for borrower(line 220) 173,526.00 602. Less reductions in amount due seller(line 520) 156,866.44
303. Cash ❑X From ❑ To Borrower 7,783.55 603. Cash ❑X To ❑ From Seller 14,673.40
e u i epo alg burden or is collection o m ortna ion rs es ima a mmu es per re nse or co e i ,revs an repo mg e a a. a agency may no co a is m onna you are n rerymr o corn e
this forth,unless it displays a currently valid OMB control number.No confidentiality Is assuretl:this tlisGosure Is mandatory.TTis Is designed to provMa the parties to a RESPA covered trensagion with information dudrig the
settlement process.
Previous editions are obsolete Page 1 of 4 HUD-1
r
��►iauiauianaf�ru�
700. Total Real Estate Broker Fees $10,230.00 Paid.From . Paid:
„From
Division of commission line 700 as follows: BOrr
FuO,wer's Seller's
701. $5,115.00 to Coldwell Banker Homestead Group nds at Funds.at.
702• $5,115.00 to PRUDENTIAL HOMESALE SERVICES GROUP Settlement Settlement
703. Commission paid at settlement 10,230.00
704. Broker/Admin Fee to Coldwell Banker Homestead Group 300.00
705. Broker/Admin Fee to Prudential Homesale Services Group 345.00
800. Items Payable in Connection with Loan
801. Our origination charge (Includes Origination Point 0.000%or$0.00) $795.00 (from GFE#1)
802. Your credit or charge(points)for the specific interest rate chosen $ (from GFE#2)
803. Your adjusted origination charges (from GFE A) 795.00
804. Appraisal fee to HSM fbo Capitol Property Appraisers (from GFE#3) 400.00
805. Credit report to HSM fbo Equifax (from GFE#3) 30.00
806. Tax service to from GFE#3
807. Flood certification to HSM fbo CLFS (from GFE#3) 12.50
808. to
900. ftems Required,by Lender to be Paid in Advance
901. Daily interest charges from from 12/20/2013 to 01/01/2014 @$18.6000/day (from GFE#10) 223.20
902. Mortgage insurance premium for months to Dept of HUD (from GFE#3) 2,879.31
903. Homeowner's insurance for 12 years to Allstate Insurance (from GFE#11) 452.55
904. months to from GFE#11
1000:'Reser res Deposited with Lender
1001. Initial deposit for your escrow account (from GFE#9) 1,009.65
1002.Homeowner's insurance 4 months A$ 37.71/month $150.84
1003. Mortgage insurance months @$ 183.62/month $
1004. Property taxes 11 months @$ 9.66/month $106.26
1005.County taxes 11 months @$ 31.67/month $348.37
1006.School Taxes 7 months @$ 164.65/month $1,152.55
1007.Aggregate Adjustment $-748.37
1100.,Title Charges
1101. Title services and lender's title insurance from GFE#4 1,633.00
1102. Settlement or closing fee to $
1103. Owner's title insurance-Old Republic Title Insurance Company from GFE#5 140.50
1104. Lender's title insurance-Old Republic Title Insurance Company $1,240.00
1105. Lenders title policy limit$167,411.00 Lender's Policy
1106. Owner's title policy limit$170,500.00 Owner's Policy
1107. Agent's portion of the total title insurance premium $1,228.64
to Homesale Settlement Services Ltd.
1108. Underwriter's portion of the total title insurance premium $151.86
to Old Republic Title Insurance Company
1109.
1200. Government Recording and.Transfer Charges
1201. Government recording charges $ (from GFE#7) 144.00
1202. Deed$67.00 Mortgage$77.00 Release$
1203. Transfer taxes $ (from GFE#8) 1,705.00
1204. City/County tax/stamps Deed$1,705.00 Mortgage$
1205. State Tax/stamps Deed$1,705.00 Mortgage$ 1 1,705.00
1206. Deed$ Mortgage$
1300. Additional Settlement Charges
1301. Required services that you can shop for (from GFE#6)
1302. to $
1303. to $
1304. Wire Fee to Homesale Settlement Services 40.00
1305. Final Water/Sewer to North Miiddleton Township $ 83.07
1306. Refuse to Advance Disposal $ 47.46
1307. REgister of Wills to Register of Wills $ 3,346.02
1308. Escrow to Frey&Tile $ 10,000.00
r r • • -- rl M., WIT-TURIM 769.71 25,751.55
*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
sCom Anson of CoodxFaithFEstrmat GF tand'HUDr1Char esr r {R."'> x MMO—Faith€ stimat THUD 1�
795.00 795.00
Ourongina6onchargerF� tr� � rrX� ;# 801�wr �
You"fir cfedit „charge(pomts}rfor the speclficYmterest rateehosen; � #� 802w , „�* 0.00 0.00
lYour ad ustetl'on matron char es : rk ` z�y ° x4 795.00 795.00
:_
1,705.001 1,705.00
Clrrrdes ThatfimtTotalCannot`Increa More;Than 10% 1 ti,. u* ; GoodFaith°Est m_ate' YFIUD
Government"recordingeharges t�, a i J , #71201 f � 250.00 144.00
414"isal;fee c: X S' u i 804 'i � ,�
425.00
#t. r * 4 ' r 400.00
"C�editFre((i1
�' F
60.00 30.00
Floodceitification r �_� � , X807 a � � 12.50
� < #r � ���� s ,-,a 12.50
FiMortgage is rancerpremium � i
y 2,879.31 2,879.31
Title ,rag-
1,675.00 1,633.00
®caner's�titleansurariceOld Republic Title Insurance Company "Q= *h#s1103 � ,ru 165.00 140.50
. ,
i.•y '`Sr<"�°•'?„�"�^'� d'i^ r tJ s � +�. N }�,,,�` dvT�y s,yt3' fn t"£� �y�.,�-�
�r.'�'�i.�.�.•t:..e�.J,_.'u��' S..�a.�:.R•. .:x ."±lf.�_ ?8.:i' ''S.. ...u,{•.t.S`;�-�.?�?r,`r�.?,°w.'�" �.��:.C3,�tr',v'S'af*k
5,466.81 5,239.31
$ -227.50
or 4.1615%
I
�..`t?T.rwF—L+ vz.' ^sR,,unr j ”,.:_'x`�..-s�i, .f 'f,K ry nfL'-;' ,t" ^*w.ti,a+rd .t m "'� "",y,Ys
Char es�ThattCar Chan e < � w {4 t �� 3 Gootl3Faith Es" mate ;v .
i HUD�1 ±• .
E,r nigo oposit�foryourescrowbaccount�.�� , s�; z s «^ #X<100f1 � 4;, ; 2,600.00 1,009.65
Dailydmtecest eharges$fromtNy e = tv # .gp� „, $18s6000/d'a" 409.20 223.20
I0R1e0WL18rS insurances ; r zf �'� T c�t�H, y s C rt rnt
452.00 452.55
n
�;;<5, 1 x�.r, .i i1`,w�''".xY,:S,7,.lxtP,u;• S.tie. `l > ' *�.
:7,i k++ �''i�•':F:' x'd d'-ra3'fa•K:h r k."" - i '`. 1 Y #s6 :k yw'r„�. .Rr� s Y'
WFUR,�.,�����MMe
Loan Term`s
-i'-'..4`4-f -w`k}i•t(y 7A'.,i°i.�. z df+ ^i. r.�R.1r'�s�:aia SSW
Y¢ourndial loan arnount4isf3 ' i r
$167411•00
"1Ih'.�c��r q�r F f i'7 a ,. �15L d. r r-. r F r i• 5.a rr;,Yy
:eYouloaneterris ,, - _ 30.years -
T.�?�..,rr;e..
r � � P
r� .t ns” J
q`( Mitalw�n�erest atei�s t.`..: .�� ,��.�s�t 4.0000%
7W Y g�x,
$982.87 includes
< ,Qa ,� Qrs�. q? ,,y'^'i7°er r 3 u t�x�t "'•;s J�,r �-��» <�':
InSUfanceISs ,,yy� RfY h zytra4 Fri✓f N ��t
Al {, h Principal
g`07 l Rk.
}a ,�R.� <yfi S.�`s'4 k� '�r , K•.w s .R��r
❑X Interest
Mortgage Insurance
?tia'.ti., `FS�1C`-r7r .�^`.f,•' ',`„'+'��1 �S�^v. •. 'fh ry{n t,-S.+a.g u*,rt-.cf.s n -
iCan yournterest rate rise?� f3 ;# rr "m. ❑X No. ❑Yes,it can rise to a maximum of %. The first change
� ��� ��{�Yx� � rN � ti 4 w, will be on I I and can change again every years after I / Every
change date,your interest rate can increase or decrease by %. Over the life of -
the loan,your interest rate is guaranteed to never be tower than %or higher
k,r 4 w
� �>° 't''���� Q� K � ��" a' t a I�•$ a t ��s �r than
1Mt
EylerifFyou2mae payments on time;can your`loan balance nse`� t „ ❑X No. ❑Yes,it can rise to a maximum of$
k,� {
ven f< o make pa HUM LO me can your mo lily amount owed for d ❑X No. ❑Yes,the first increase can be on I I and the monthly
pnnapal�ihterest,fand mo�tgageeinsurance nse?yK ' k Z w � amount owed can rise to$
The maximum it can ever rise to is$
2 x� rf t rctnS p �+ �9yih y' �
Dos,�your loan haveprepayment�penalty?t`�x Y x�i, ❑ No. ❑Yes,your maximum prepayment penalty is$
t e�-sk" i.s 5 f
Does your loanhave a�balloon payrnent� n b� 3 J c� x ❑X No. ❑Yes you have a balloon payment of$ due in
n.^ `�-4 r
years on
kr� r rr�^ �.'a r f t •t'liz�,;,r� ,,., i •� Fly,� � �xy.
Total rnorithi'yamoi nt;owed includmg,escrow account(payments, ❑You do not have a monthly escrow payment for items,such as property taxes
=�a� �4 ery� 31'�£a;
k r R c 1;!
Fr� j and homeowner's insurance. You must pay these items directly yourself.
i t .+ `ryjt,�-x-'' r y,�iF'•�. S? t'°•""TS*","f.��Yu�.'
fy�l,R1}�f- 4,xrs,r �
,x k �� aa`7+a r "�r�4 .k?F s�; ,<L i,•;a i t h f 7 .
jw+� � � .�X �kc:� „ f��� X❑You have an additional monthly escrow payment of$243.69
firs 7443 that results in a total initial monthly amount owed of$1,226.56. This includes principal,interest,ac
.� ',7ff7- 1 .3YS,r Ian''`�''m� 1
a ram F mortgage insurance and any items checked below:
t`,�,�X�'�-taw c.+5'�yrs{J..CY y „aye^•�� t �t ��x�}e} �' ��f",,'�': ..
.r�r �a �'; `�4 �r ; 'r s ❑X
Property taxes X Homeowner's insurance
U P Y
S'ry+�,4y�ak fC .. WF i� ¢s3y{f.l fi Ss".? '`'� S+} rhr� !'i - School Tax
q7y n ❑Flood insurance X❑
:sari r§, ❑ ❑
_ .�'.�Y.�3"'��'`��3�Af �;'_w.•ra'S.'Pr�.'}`; a�.'k...,'9•�iy.r...?,f,.� . y_;.'�u�.�:�' �:�k��.. :t,F� - -
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender.
I` ..
l
Previous editions are obsolete Page 3 of 4 HUD-1
emization ot Line 1101
Name of Borrower: Name of Seller: File Number.
DAVID MCGLYNN STACY J.ZORN CN13-00708
i
Prepared 12120/2013 at 12:59 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.
1100:Title.oLges Total Charge, Borrower Seller
1101,Title services and lender's title insurance to
Notary;Fee to Lisa A.Baublitz $ 35.00 35.00
Internet Doc Prep to Homesale Settlement Services $ 50.00 50.00
Wire Fee to Homesale Settlement Services $ 15.00 15.00
Express Handling to Homesale Settlement Services $ 18.00 18.00
Tax Certification Fee to Homesale Settlement Services $ 50.00 50.00
100 to Old Republic Title Insurance Cor$ 50.00 50.00
300 to Old Republic Title Insurance Cor$ 50.00 50.00
900 to Old Re ublic Title insurance Cor$ 50.00 50.00
Closing Service Ur to Old Republic Title Insurance Cor$ 75.00 75.00
1102.Settlement or closing fee to $ 0.00
1104.Lender's title insurance-Old Republic Titleto Old Republic Title Insurance Cor$ 1,240.00 1,240.00
Totals: $ 1,633.00 0.001 1,633.00 0.00
SellerlLender credits stsovun on page 1 POC=Paid Outside Cfdsin CR,..."L dder Credit c
i
i
I
Previous editions are obsolete Page 1 of 1 HUD-1
i ignature Page
i HUD CERTIFICATION OF BUYER AND SELLER
I have carefully ly 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
Buyers
DAVID M LYNN
STACY J.ZOR N� V'u
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 cause the funds to be
disbursed in accordance with this statement.
gETTI:EMENT AGENT C) 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