HomeMy WebLinkAbout12-20-13 (3) i
1505610140
REV-1500 EX (02-11)(FI)
PA Department off Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 2 0 2 8 3
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
F ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of death MMDDYYYY Date of Birth MMDDYYYY
0 3 0 1 2 0 1 2 1 1 0 6 1 9 3 1
Decedent's Last Name Suffix Decedent's First Name MI
RUHL P A T R I CI A L
(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
Q 1.Original Return E] 2.Supplemental Return 3.Remainder Return(Date of Death
Prior to 12-13-82)
4.Limited Estate 4a.Future interest Compromise(date of 5.Federal Estate Tax Return Required
death after 12-12-82)
❑X 6.Decedent Died Testate 7.Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
F] 9.Litigation Proceeds Received 10.Spousal Poverty Credit(Date of Death F1 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 TAX INFORMATION SHOULD BE DIRECTED TO: `
Name Daytime Telephone Number
SUSAN H CONFAI R 71 7c763 1:5-3 mV-
REGISt-Fft 66WILLS U NLY(n 'O
!'1"1
First Line of Address
'v ;
(/> p CD
CD-> G'3
Second tine Of Address <->
- t17 1'T t
2331 MARKET STREET - c)
City or Post Office State ZIP Code
ATE FILED
C A MP H I L L P A 1 7 0 1 1
Correspondent's e-mail address: SCONFAIRODREAGERADLERPC.COM
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE(-FOR�FILING RETURN r� DATE
ADDRESS C
8424 N. 35TH AVENUE PHOENIX AZ 85051
SIGNATURE OF PREPARFA OTHER THAN REPRESENTATIVE DATE
ADDRESS
2331 MARKET STREET CAMP HILL PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140 1505610140
�t
1505610240
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: PATRICIA L. RUHL
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . .. . . .. . . ... . . . . . . . . . . . . 1. 1 2 3 5 0 0 . 0 0
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. 4 9 4 0 2 4 3
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . .... . 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property ,
(Schedule G) ❑ Separate Billing Requested . . . .. .. 7. 1 1 6 2 4 2 8
8. Total Gross Assets(total Lines 1 through 7) . . . .. . . . . . . . . . . . . .. . . . . . . . . 8. 1 8 4 5 2 6 . 7 1
9. Funeral Expenses and Administrative Costs(Schedule H) . . .. . . . . . .. . . . . . . . 9. 1 0 5 1 0 . 4 9
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . .. . . . . .. . . .. 10. 1 1 7 0 8 1 1
11. Total Deductions(total Lines 9 and 10) . . . . . .. .. . . . . . .. . . . . . .. .. . . . . . . 11. 2 2 2 1 8 . 6 0
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . .. . . . . ... . . . . . . . . . . . 12. 1 6 2 3 0 8 . 1 1
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. 1 6 2 3 0 8 . 1 1
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 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X.045 1 6 2 3 0 8 . 1 1 16. 7 3 0 3 . 8' 6
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18, 0 . 0 0
19. TAX DUE . . . . . . . . .. . . . . . . .. . . . . . . .. ... . . . . . . . . ... . . . . . . . . . . . . . . 19. 7 3 0 3 . 8 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q
Side 2
1505610240 1505610240
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 21 12 0283
DECEDENT'S NAME
PATRICIA L. RUHL
STREET ADDRESS
9 BELLMORE ROAD
CITY STATE ZIP
CAMP HILL PA 17011
Tax Payments and Credits:
I. Tax Due(Page 2,Line 19) {1} 7,303.86
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
3. interest
(3) 255.14
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) 0.00
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. {5} 7,559.00
i
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 ...................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ 0
c, retain a reversionary interest ..................................................................................................... ❑ 0
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ 0
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? .......1. 0 ❑
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 V2 P.S.§9116(a)(1)).
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1502 EX+(12-12)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
ESTATE
INHERITANCE TAX RETURN READ.
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
PATRICIA L. RUHL 21 12 0283
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.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. 9 BELLMORE ROAD, CAMP HILL, PA 17011 123,500.00
SOLD ON JULY 10, 2012, COPY OF SETTLEMENT SHEET ATTACHED
I
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TOTAL(Also enter on Line 1,Recapitulation.) $ 123 500.00
If more space is needed,use additional sheets of paper of the same size.
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
PATRICIA L. RUHL 21 12 0283
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, 2 BURIAL PLOTS AT WOODLAWN MEMORIAL GARDENS, INC. 4,000.00
4855 LONDONDERRY ROAD
HARRISBURG, PA 17109
2. CITZENS BANK-CHECKING ACCOUNT 17,750.61
PO BOX 7000
PROVIDENCE, RI 02940
3. CITIZENS BANK-CHECKING 5,004.50
PO BOX 7000
PROVIDENCE, RI 02940
4. 1990 GEO PRIZM 400.00
5. PERSONAL PROPERTY 500.00
6. TAX PRO RATIONS/SEWER PRO RATIONS FROM SALE OF 9 1,564.66
BELLMORE ROAD, CAMP HILL, PA(SEE ATTACHED SETTLEMENT SHEET)
7. SUSQUEHANNA VALLEY FEDERAL CREDIT UNION -REGULAR SHARES 9,687.33
3850 HARTZDALE DRIVE
CAMP HILL, PA 17011
8. SUSQUEHANNA VALLEY FEDERAL CREDIT UNION -CHRISTMAS CLUB 100.05
3850 HARTZDALE DRIVE
CAMP HILL, PA 17011
9. SUSQUEHANNA VALLEY FEDERAL CREDIT UNION -SPECIAL CLUBS 1,795.33
3850 HARTZDALE DRIVE
CAMP HILL, PA 17011
10. SUSQUEHANNA VALLEY FEDERAL CREDIT UNION - 1 YEAR CD 8,599.95
3850 HARTZDALE DRIVE
CAMP HILL, PA 17011
TOTAL(Also enter on Line 5,Recapitulation) $ 49 402.43
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
PATRICIA L. RUHL 21 12 0283
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TODECEDENTAND DATE OF DEATH % DEWS EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. CITIZENS BANK-CD IN TRUST FOR 11,624.28 100.00 11,624.28
LILLIAN RUHL- DAUGHTER
PO BOX 7000, PROVIDENCE, RI 02940
TOTAL (Also enter on Line 7,Recapitulation) $ 11 624.28
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
RESIDENT EDEN TURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
PATRICIA L. RUHL 21 12 0283
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. NEILL FUNERAL HOME 7,666.99
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Years)Commission Paid:
2. Attorney Fees: REAGER&ADLER, PC 2,500.00
3. Family Exemption:(If decedents address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 343.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9,Recapitulation) $ 10 510.49
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 DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
PATRICIA L. RUHL 21 12 0283
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. COMMISSION FROM SALE OF 9 BELLMORE ROAD, CAMP HILL, PA 7,705.00
2. TRANSFER TAX FROM SALE OF 9 BELLMORE ROAD, CAMP HILL, PA 1,235.00
3. EXPENSES FROM SALE OF REAL ESTATE-SEWER, TAXES, DEED PREP., HOME 2,768.11
WARRANTY, ETC. FROM SALE OF 9 BELLMORE ROAD, CAMP HILL, PA
TOTAL(Also enter on Line 10,Recapitulation) $ 11 708.11
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:
PATRICIA L. RUHL 21 12 0283
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).]
1. LILLIAN C. RUHL Lineal 162,308.11
8424 N. 35TH STREET
PHOENIX, AZ 85051
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
tD
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Ail
�p a� LAST WILL AND TESTAMENT OF PATRICIA L. RUHL
I, RICIA L. RUHL, of the Township of Lower Allen, County of
umberland, and State of Pennsylvania, being in good bodily health .
nd of sound and disposing mind ,and memory, and not acting under
uress, menace, fraud, or undue influence .of any person whomsoever,
ta. rely calling to mind the frailty of human life, and being desirous
f disposing of my worldly goods. while I have the strength and
apacity so to do, I do make, publish and declare this my LAST WILL
ND TESTAMENT. I hereby revoke, cancel and annul all my former Wills
and Testaments, including codicils thereto, by me at any time made,
and declare this alone to be my LAST WILL AND TESTAMENT.
AS TO SUCH ESTATE AS IT HAS PLEASED GOD TO ENTRUST ME WITH IN
HIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ:
ITEM 1. I direct that my Executors hereinafter named pay and
discharge all of my just debts, funeral and testamentary expenses.
ITEM 2. I order and direct that I be buried in a lot which I
own situate in Indiantown Gap Cemetery, Indiantown Gap, Pennsylvania.
ITEM 3. All the rest, residue and remainder of my entire
state, wheresoever situate and whatsoever it may consist of, I give,
devise and bequeath, absolutely and in fee to my dearly beloved
Daughter, LILLIAN C. RUHL, per stirpes.
4
� ITEM 4. I nominate and appoint LILLIAN C. RUHL as Executrix of
�. his my Last Will. Should the Executrix named herein fail .to qualify
u $ g 7 r cease to act-as Executrix, then I nominate and appoint PATRICIA
ELOVICH Executrix in her stead. 014 J-II Iv =NP11,54
g
Jo
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ITEM 5. I direct that my personal representatives, as well as
their successors, shall not be required to give bond for the faithful
performance of their duties in any jurisdiction.
PATRICIA L. RUHL
1
ITEM 6. I direct that all estate, succession, legacy,
inheritance or other transfer taxes, however designated that shall
become payable by reason of my death in respect of all property
comprising my gross estate for tax purposes, whether or not such
property passesunder this Last Will, shall be paid by my Executor out
of my residuary estate.
ITEM 7. I grant to my personal representatives herein named,
in addition to, but not in limitation of those powers vested by law,
to be exercised without prior application to or approval of any
court, the power and authority to retain indefinitely any property,
to invest and reinvest any assets or the proceeds derived from the
sale of assets, although said investments may not be of the character
prescribed by law, to sell, convey, assign, transfer and encumber any
property, to.pay, settle or compromise all claims, to make
distribution or divisions in cash or in kind, and in general to
exercise all powers in the management of any property hereunder which
any individual could exercise in the management of similar property
owned in his own right, and to execute and deliver any and all
instruments and to do all acts which may be deemed necessary and
proper.
PATRICIA L. RUHL
---------------------------------END----------------------------------
2
COMMONWEALTH OF PENNSYLVANIA )
Be .
COUNTY OF CUMBERLAND Y
I, PATRICIA L, .RUAL . ,TESTATRIX., whose name is.
signed, to the attached or .forego.i.ng' instrument, having been•..
duly qualified according to law., do hereby acknowledge that`I
signed and executed the instrument as my LAST WILL; that I
signed it willingly; and that I signed' it as my free and
voluntary act for the 'purpose ther.ein .expressed..
Sworn or affirmed to and acknowledged before me,
by PATRICIA L. RUHL the .TESTATRIX., this 26th day
of October 1990.
NOTARY Y PUBLIC
Mechanicsburg, PA
My Commission Expires:
The preceding instrument consisting of this and two (2)
other typewritten pages, identified by the signature of the
TESTATRIX, was on the date .thereof signed, published and
declared by PATRICIA L. RUHL , the TESTATRIX therein named
as and for her LAST WILL AND TIETTKMENT.
JAMh BACH Residing at 352 S. Sportinq Hill Road
Mec anicsburg,. PA 17055
BARBARA A. GLESSNER
Residing at 352 S.. Sporting Hill Road
Mechanicsburg,. PA "17055
A F F I D A V I T
COMMONWEALTH OF PENNSYLVANIA )
ss
COUNTY OF CUMBERLAND )
We JAMES M. .BACH and BARBARA A. GLESSNE4 the
witnesses whose names are signed to the attached .or foregoing
instrument, being duly qualified according to law,."do de.po$ and
say' that we were present and.saw TESTATRIX sign and execute the
instrument as her LAST WILL; that she signed willingly and.-that she
executed it as her free and voluntary act for the purpose therein
ex,Ore6sed.; that each of us in the.hearing .and sight of the :".. '
, .TE,$TkTRIX signed the WILL as witnesses; and that to the beat.of. our
knowledge the TESTATRIX.was at the time 18 or more years of`.'age, of
sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by
:11-JAMES M. BACH and BARBARA A. GLESSNER, witnesses, this
26th day of October . 1990.
NOTARY' UB I. � .:,.
Mechanicsburg, PA
My Commission Expires:;;.,.
3
Q>"`M'ny ti OMB Approval No.2502-0265
o �!■�!I ht =p
�RIIIII�II �_ �• Settlement Statement (MUD-1)
BAN oeJE�d�
B. Type of Loan
1.❑FHA 2.Q RHS 3.RConv.Unins. 6. File Number, 7. Loan Number: 8. Mortgage Insurance Case Number:
4.Q VA 5.Q Conv.Ins. 00-951.001 6800558854
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked"(p.o.c.)"were paid outside the closing;they are shown here for informational purposes and are not included in the totals.
D. Name and Address of Borrower: E. Name and Address of Seller. F. Name and Address of Lender:
James M.Nihoff Estate of Patricia Ruhl Members 1st F-CU
9 Bellmore Road 5000 Louise Drive
Camp Hill,PA 17011 Mechanicsburg,PA 17055
G. Property Location: H. Settlement Agent: I. Settlement Date:
9 Bellmore Road Midstate Abstract Company
Camp Hill,PA 17011 2331 Market Street July 10,2012
Cumberland County,Pennsylvania Camp Hill,PA 17011 Ph. (717)763-1383
Place of Settlement:
2331 Markel Street
Camp Hill,PA 17011
J. Summary 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 123,500.00 401. Contract sales price 123,500.00
102. Personal property 402. Personal property
103. Settlement Charges to Borrower Line 1400 4,830.69 403.
104. 404.
105. 405.
Ad ustments for Items paid by Seller In advance Adjustments for items paid by Seller in advance
106. City/Town Taxes to 406.City/Town Taxes to
107. County Taxes 07/10/12 to 01/01/13 293.75 407.County Taxes 07/10/12 to 01/01/13 293.75
108. Assessments 07/10/12 to 07/01/13 1,172.62 408.Assessments 07/10/12 to 07/01/13 1,172.62
109. 3rd Qtr.Sewer/Refuse,07/10/12 to 10/01/12 98.29 409. 3rd Qtr.Sewer/Refuse 07/10/12 to 10/01/12 98.29
110. 410.
111. 411.
112. 412.
120. Gross Amount Due from Borrower 129,895.35 420.Gross Amount Due to Seller 125,064.66
200. Amounts Paid by or In Behalf of Borrower 500. Reductions In Amount Due Seller:
201. De osit or earnest rnone 2,000.00 501. Excess deposit see Instructions
202. Principal amount of new loans 68,000.00 502. Settlement charges to Seller Line 1400 11,708.11
203. Existin g loans taken subject to 503. Ebstin bans taken subject to
204. Credit for Amount Paid 375.00 504.Payoff First Mortgage
205. 505. Payoff Second Mortgage
206. 506.
207. 507.(Deposit disb.as proceeds)
208. 508.
209. Seller Assist 1,250.00 509. Seller Assist 1,250.00
Ad ustments for Items unpaid by Seiler Ad ustments for Items unpaid by Seller
210. City/Town Taxes to 510.City/Town Taxes to
211. County Taxes to 511, County Taxes to
212. Assessments to 512.Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518. Escrow for Inheritance Taxes to Rea er&Adler,P. 8,775.00
219. 519.
220. Total Paid b /for Borrower 71,625.00 520. Total Reduction Amount Due Seller 21,733.11
300. Cash at Settlement from/to Borrower 600. Cash at settlement to/from Seller
301. Gross amount due from Borrower line 120 129,895.35 601. Gross amount due to Seiler line 420 125,064.66
302. Less amount pail by/for Borrower line 220 ( 71,625.00) 602. Less reductions due Seiler(line 520) ( 21,733.11
303. Cash Q From [:] To Borrower 58,270.35 603. Cash ❑X To From Seller 103,331.55
'Paid outside of closing by boomer(B),seler(S),lender(¢),or rhlyd�parlNT)
The undersigned hereby acknowledge receipt f a completed copy of this statement&any attachment red to herein
Borrower Seller
James 4holf Estate of Patricia Rut O /
The Pudic Raporthg Burden low the eelleetlon of hfwmatlon is eattneted at 35 rdnules pot hesponse for col9etlrg,mvlewhp,and repo Mng Ma Gala.Thb aaercy may not catecl lHe lnlonnelbn,and you are trot ten Jred ro
canplate tis tom,unless r displays a cuteney valid OMB-Iml number No cmfdenlialiy,b assured;this disclosure Is mandatory.Ttis Is designed to pmvide the parties to a RESPA covered Ir-lion with irlrormfion
durhgthe settlelneM process.
Page 1 of 3 HUD-1
(N IHOFF.JAME 8.PFD/00-951.001/5)
L.Settlement Charges
700.total Real Estate Broker Fees $7,705.00 Paid From Paid From
D/v/slon of commission(line 700)as follows: Borrower's Sellers
701,$4-000.00 to REIMAX 1st Advantage Fundsat Fundsal
702. 3705.00 to RE/MAX Realty Associates Settlement Settlement
703.Commission paid at settlement 7,705.00
704.
705.
800.Items Payable In Connection with Loan
801.Our origination charge $ 830.00 from GFE#1
802.Your credit or charge(points)for the specific Interest rate chosen $ (fro m GFE#2)
803.Your adjusted origination charges from GFE#A 830.00
804.Appraisal fee to fro m GFE#3
805.Credit Report to from GFE 93
806.Tax service to from GFE#3
807.Flood certificaUon to from GFE#3
808. from GFE#3
809. from GFE#3
810. from GFE#3
811. (from GFE#3)
900.Items Required by Lender to Be Paid in Advance
901.Daily interest charges from 07/10/12 to 08101/12 22 $6.520500/da from GFE#10 143.45
902.Mortgage insurance premium for monthsto from GFE#3
903.Homeowner's Insurance for 1.0 ears to Allstate Property and Casualty Insurance Cc from GFE#11 100076215853598 504.24
904. from GFE#11
905. (from GFE#11
1000.Reserves Deposited with Lender
1001.Initial deposit for your escrow account (from GFE#9)
1002.Homeownersinsurance months @ $ per month $
1003.Mortgage Insurance months per month
1004.Prop rty taxes $
County Taxes months per month
Assessments months A. $ per month
1005.
1006. months @ $ per month $
1007. months $ per month $
1008. $
1009.Aggregate Escrow Adjustment $
1100.Title Charges
1101,Title services and lenders title insurance from GFE#4 1,039.00
1102.Settlement or closing fee
1103.Owners Ulle Insurance to Midstate Abstract Company Insurance Aod. from GFE#5 296.00
1104.Lenders title insurance to Midstate Abstract Company Insurance Acct. 874.00
1105.Lenders title policy limit 68000.00
1106.Owners title policy limit $ 123,500.00
1107. Agent's portion of the total title insurance premium to Midstate Abstract Company 1.047.60
1108. Underwriter's portion of the total title Insurance premium to Midstate Abstract Company Insurance Ac $ 122.40
1109. $
1110. $
1111. $
1112, $
1113. $
1200.Government Recording and Transfer Charges
1201.Government recording charges to Recorder of Deeds Office from GFE#7 158.00
1202.Deed 62.00 Mortgage 96.00 Releases$ Other
1203.Transfer taxes to Recorderof Deeds Office from GFE#8 1,235.00
1204.City/County City/County taxistam s Deed 1,235.00 Mortgage
1205.State tax/slams Deed $ 1,235.00 Mortgage $ 1,235.00
1206.
1207.
1300.Additional Settlement Charges
1301.Required services that you can shop for from GFE#6
1302. $
1303. $
1304. $
1305.See addil'I disb.exhibit to $ 1,983.11
1306.Home/Pest Inspections to Pillar to Post $ Inv.#21683-1040 400.00
1307.Broker Fee to RE/MAX Realty Associates $ 225.00
1308.Tax Certification to Bonnie Miller,Tax Collector $ 10.00
1309.Deed Preparation to Reager&Adler,P.C. $ 175.00
1310.Home Warranty to American Home Shield $ Contract#114490002 600.00
1400.Total Settlement Charges(enter on lines 103,Section J and 502,Section K) 4,830.69 11,706.11
Pad outside of dosing by bonower(0),seler(S),lendei(L),or Mird-pady(T)
By signing page 1 d this statement the signatories a dcnoWedge swept of a wrnpleted copy d page 2 6 3 of this three page state
Midstate Abstract Company,Settlement Agent
Certified to be a true copy.
Page 2 of 3 HUD-1
(N I H OF F.J AM E S.P F D/00-951.0 01/5)
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 #801 830.00 830.00
Your adjusted origination charges #803 830.00 830.00
Transfer taxes #1203 1,235.00 1,235.00
Charges That in Total Cannot Increase More than 10% Good Faith Estimate HUD-1
Government recording charges #1201 238.00 158.00
Title services and lend ees title insurance #1101 1,478.75 1,039.00
Owner's title insurance to Midstate Abstract Company Insurance 1 #1103 277.50 296.00
Total 1,994.25 1,493.00
Increase between GFE and HUD-1 Charges $ -501.25 or -25.13
Charges That Can Change Good Faith Estimate HUD-1
Initial deposit for your escrow account #1001 0.00 0.00
Dally Interest charges # 901 $ 6.520500/day 110.85 143.45
Homeowners insurance #903 400.00 504.24
Loan Terms
Your initial loan amount is $68,000.00
Your loan term Is 30.00 years
Your Initial Interest rate Is 3.5000
Your initial monthly amount owed for principal,Interest and $305.35 includes
any mortgage insurance is 0 Principal
Q Interest
❑ Mortgage Insurance
Can your Interest rate rise? ❑X No ❑ Yes,It can rise to a maximum of %. The first
change will be on and can change agaln every_months after
. Every change dale,your interest rate can increase ordecrease
by _%. Over the life of the loan,your interest rate is guaranteed
to never be lower than__%or higher than
Even If you make payments on time,can your loan balance rise? Q No ❑ Yes,it can rise to a maximum of$_
Even If you make payments on time,can your monthly ❑X No ❑ Yes,the first increase can be on and the monthly
amount owed for principal,Interest,and mortgage Insurance rise? amount owed can dse 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 balloon payment? ❑X No ❑ Yes,you have a balloon payment of$_
due in_years on _
Total monthly amount owed Including escrow account payments Q You do not have a monthly escrow payment for items,such as property
taxes and homeowner's insurance. You must pay these items directly
yourself.
❑ You have an additional monthly escrow payment of$N/A that results
in a total initial monthly amount owed of$N/A. This includes
principal,interest,any mortgage insurance and any items checked below:
❑ Property taxes ❑ Homeowners insurance
❑ Flood insurance ❑
❑ ❑
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender.
Page 3 of 3 HUD-1
(N IHOFF.JAME S.PFD/00-951.001/5)
HUD-1 Attachment
Borrowet(s):James M.Nihoff Selle(s): Estate of Patricia RUN
9 Bellmore Road
Camp Hill, PA 17011
Lender:Members 1st FCU
Settlement Agent:Midstate Abstract Company
(717)763-1383
Place of Settlement:2331 Market Street
Camp Hill,PA 17011
Settlement Date:July 10,2012
Property Location:9 Bellmore Road
Camp Hill,PA 17011
Cumberland County,Pennsylvania
Additional Adjustments For Items Paid By Seller In Advance(Borrower Debit)
Description Amount From/Through Prorated Amount
3rd Qtr.Sewer/Refuse 108.95 07/01/12 through 09/30/12 98.29
Total Line 109/409 98.29
Additional Disbursements
Payee/Description Note/Ref No. Borrower Seller
Bonnie Miller,Tax Collector 671.89
__2012 County/Township taxes 13-25-0020-033
Bonnie Miller,Tax Collector 1,202.27
2012/2013 School taxes 13-25-0020-033
Lower Allen Township Authority 108.95
3rd Qtr.Sewer/Refuse
Total Additional Disbursements shown on Line 1305 $ 0.00$ 1,983.11
Adjusted Origination Charge Details
Origination Charge
Origination 830.00
to Members 1st FCU
Total $ 830.00
Origination Credit/Charge(points)for the specific interest rate chosen
Total $
Adjusted Origination Charges $ 830.00
Title Services and Lender's Title Insurance Details BORROWER SELLER
Closing Service Letter 75.00
to Midstate Abstract Company
Electronic Doc.Preparation 50.00
to Midstate Abstract Company
Wire Fee 15.00
to Midstate Abstract Company
Notary Fee 10.00
to Midstate Abstract Company
Overnight Fees 15.00
to Midstate Abstract Company
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 16 U.S.Code Section 1001 and Section 1010.
(N IHOFF.JAME S.PFO/00-951.001/5)
HUD-1 Attachment- Continued
Lender's title insurance 874.00
to Midstate Abstract Company Insurance Acct.
Total $ 1,039.00 $ 0.00
Owner's Title Insurance BORROWER SELLER
Owner's Policy Premium 296.00
to Midstate Abstract Company Insurance Acct.
Total $ 296.00 $ 0.00
Lender's Title Insurance BORROWER SELLER
'fees also shown above In Title Services and Lender's Title Insurance Details
Lender's Policy Premium 724.00
to Midstate Abstract Company Insurance Acct.
Lender's Endorsement Charges 150.00
Endorsement Endorsement Charge
PA 100,300,8.1 150.00
Total $ 874.00 $ 0.00
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.
(N IHOFF.JAME S.PFD/00-951.001/5)