HomeMy WebLinkAbout02-19-14 REV-1500 EX(02-11) 1505610143_
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes iar.R�M°Hie°lnlEN°r
PO 60X.280601 INHERITANCE TAX RETURN 21 13 1306
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
12 01 2013 07 19 1930
Decedent's Last Name Suffix Decedent's First Name MI
BOLASH PETER E
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
❑ 1. Original Return ❑ 2. Supplemental Return El 3. Remainder Return(Date of Death
Prior to 12-13-82)
4. Limited Estate 4a Future Interest Compromise 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
6 Decedent Died Testate T. Decadent o a�ntained Living Trust 0 8. Total Number of Safe Deposit Boxes
(Altach Copy of Will) Copy
❑ 9. Litigation Proceeds Received to baweanl P2e �J1ediit fDat95�f Death 11.Election to tax under Sec.9113(A)
T (Attach Schedule O)and
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO;
Name Daytime Telephone Number
DAVID W DELUCE 717 761 4540
REGISTER OF WILLS USE ONLY
First Line of Address
C7 r.-
301 MARKET STREET
Second Line of Address r - r,- l
OrD
PO BOX 109
AfeFILED
City or Post Office State ZIP Code --' 1—;
LEMOYNE PA 17043 `Dc,
y y r o>
_ 7TH
\) 1:0
Correspondent's e-mail address: dwd(rDidsvv ccm "`1 19
Under penalties of perjury, tleclare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct an wmpl .Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNAT EOF SO SPON OR FILING URN 2�I� / DATE
Robert S Bolash Sr kl1 44
ADDRE5%
(AR amb Ga Uoad chanics bur PA 17050 E OF EPA PRESENTATIVE DATE
DAVID W DELUCE
301 Market Street Lemoyne PA
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedents Name', Boiash, Peter E
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 74 , 000 . 00
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 84 , 153 . 75
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous f�oq Probate Property
(Schedule G) u Separate Billing Requested............ 7,
B. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 158 , 153 . 75
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 21 , 706 . 21
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10.- 1 , 802 . 56
11. Total Deductions(total Lines 9 and 10)............... ._._.......................................... 11, 23 , 508 . 77
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 134 , 644 . 98
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. 134 , 644 . 98
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 15 0 . 00
(a)(1.2)X .00
16. Amount of Line 14 taxable 134 , 644 . 98 16. 6, 059 . 02
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18. 0 . 00
19. TAX DUE...... ............. ........................................... ....... .... 19. 6, 059 . 02
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. El
Side 2
1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-13-1306
Decedent's Complete Address:
DECEDENT'S NAME
Bolash, Peter E
STREETADDRESS
692 Front Street
CITY STATE ZIP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 6,059.02
2. Credits/Payments
A. Prior Payments
B. Discount 302.95
Total Credits(A +B) (2) 302.95
3. Interest (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2,Line 20 to request a refund
5. If Line i +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 5,756.07
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................... ....................__..........................- ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;....... ..................... ❑x
c. retain a reversionary interest;or............................................................................................................... ❑
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.........................................-......................................................................... ❑ ❑x
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑x
4. Did decedent own an individual retirement account, annuity,or other non-probate property which ❑ ❑
contains a beneficiary designation?..................................................................................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(11)(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,ore 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 .§9116(a)(1)3.
• 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.(01-10)
SCHEDULE A
pennsylval REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bolash, Peter E 21-13-1306
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,bath 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
Include acopy of the deed showing decedent's interest if awned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real Estate located at 692 Front Street,West Fairview, Cumberland County,PA-Contracted 74,000.00
Sales Price. Real Estate sold on February 17,2014. A copy of the HUD-1 Settlement Sheet is
Attached
TOTAL(Also enter on Line 1, Recapitulation) 74,000.00
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1600 Schedule A(Rev.01-10)
w
Rev-1508 EX+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bolash, Peter E 21-13-1306
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosedon schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 PNC Bank Checking Account No. 5006626509-Date of Death Letter is Attached. 1,235.15
2 PNC Bank Savings Account No.5006626509-Date of Death Letter is Attached. 78,686.85
3 2002 Chevrolet Cavalier 1,500.00
4 Personal Property/Contents of Real Estate 1,000.00
5 2013 Federal Individual Income Tax Refund-Refund on Final 2013 Taxes 710.00
6 2013 Pennsylvania Individual Income Tax Refund-Refund on Final 2013 Taxes 60.00
7 Highmark Insurance Refund 163.75
8 Real Estate located at 692 Front Street,West Fairview,Cumberland County, PA- 456.10
Reim bursement/Refunds on School Taxes and Sewer Payments. A copy of the HUD-1
Settlement Sheet is Attached.
9 Sadler Oil -ReimbursemenVRefund 288.90
10 Wolfs Bus Line-Reim bursement/Refund 53.00
TOTAL(Also enter on Line 5, Recapitulation) 84,153.75
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10)
REV-1511 EX-(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Bolash, Peter E 21-13-1306
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 4,305.07
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Robert S Bolash Sr
Street Address 1203 Lambs Gap Road
city Mechanicsburg State PA zio 17050
Year(s)Commission Paid 2014 7,000.00
2. Attorney's Fees Johnson Duffie 7,000.00
3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees 358.50
5. Accountant's Fees
6. Tax Return Preparer's Fees 221.00
7. Other Administrative Costs 2,821.64
See continuation schedule(s)attached
TOTAL(Also enter on line 9, Recapitulation) 21,706.21
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Bolash, Peter E 21-13-1306
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Funeral Luncheon 300.00
2 Richardson Funeral Home 3,715.00
3 Richardson Funeral Home 290.07
H-A 4,305.07
Other Administrative Costs
4 BP Appraisal Services-Appraisal of Real Estate 300.00
5 East Penn Ambulance 35.00
6 PP&L 92.46
7 PP&L 90.00
8 Reserves: Additional Miscellaneous Administrative Costs and Expenses 200.00
9 Sadler Oil 743.87
10 Sadler Oil -Final Oil Bill 1,000.00
11 The Cumberland Law Journal -Notice of Estate Administration 75.00
12 The Patriot News Co. -Notice of Estate Administration 130.31
13 Visiting Angels 155.00
H-137 2,821.64
Copyright(c)2002 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule H(Rev.6-98)
Rev4512 EX.(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bolash, Peter E 21-13-1306
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,Including unmimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Checks Clearing After Date of Death 718.00
2 East Pennsboro Township-Sewer Payment 138.00
3 Erie Insurance-Automobile Insurance Payment 3.00
4 Pinnacle Health 92.00
5 PP&L 80.41
6 Real Estate located at 692 Front Street,West Fairview,Cumberland County,PA-Settlement 58.42
Charges Associated with Sale of Real Estate on February 17, 2014. A copy of the HUD-1
Settlement Sheet is attached
7 Sadler Oil 663.30
8 West Shore EMS 49.43
TOTAL(Also enter on Line 10, Recapitulation) 1,802.56
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule 1(Rev. 12-08)
REV-1513 EX.101-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bolash, Peter E 21-13-1306
NUMBER NAME AND ADDRESS OF DECEDENT RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S)RECEIVING PROPERTY
D Not List rus[ee s (Words) ($$$)
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec. 9116(a)(1.2)]
Robert S Bolash, Sr. Son 1/3rd of Residue
1203 Lamb's Gap Road of Estate
Mechanicsburg, PA 17050
Robin J Bolash Daughter 1 13rd of Residue
129 Bungalow Road of Estate
Enola, PA 17025
Tina M Robertson Daughter 113rd of Residue
19 Stewart Lane of Estate
West Fairview, PA 17025
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as a im riate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS .
TOTAL OF PART If-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)
ESTATE OF PETER E. BOLASH a/k/a PETER ELI BOLASH
SCHEDULE OF EXHIBITS
EXHIBIT A Last Will and Testament for Peter E. Bolash signed and dated June
14, 1977.
EXHIBIT B Calculation of Discount and Payment for filing.
EXHIBIT C HUD-1 Settlement Statement for Sale of Real Estate located at 692
Front Street, West Fairview, Cumberland County, PA. Rea; Estate
sold on February 17, 2014
EXHIBIT D Date of Death Letter from PNC for Checking and Savings
Accounts of Decedent.
606469
CJ.
C= s M
M s c) :n
CCS� All U10 C)Ftot IYl mt r- D r W �a m
D Z � W � ��
OF C O CD
D C"}
PETER E. BOLASH L
a uD r m
CO
r
I, PETER E. BOLASH, of the Borough of West Fairview, Cumber- > Ul
land County, Pennsylvania, declare this to be my Last Will and
Testament, hereby revoking and making void any and all wills
previously made by me.
1. I direct my Executrix hereinafter named to pay my just
debts and funeral expenses as soon after my decease as conveniently
may be.
2. I give and bequeath my automobile, household goods,
sporting and recreational equipment, jewelry, clothing, decorative
articles and other such tangible personal property unto my wife,
GERALDINE E. BOLASH, if she survives me. Should my wife not
survive me, I give and bequeath the same unto my children equally,
as they may agree. If my children fail to agree in any respect,
I direct that the Executor cause the articles so bequeathed to
be appraised and that each child in turn select an article at its
appraised value until all have been selected. Any article not
selected by a child or as to which my children cannot agree, shall
be sold and the proceeds made part of my residuary estate.
3. All the rest, residue and remainder of my estate, of
whatsoever nature, I give, devise and bequeath unto my wife,
GERALDINE E. BOLASH, if she survives me. Should my wife fail
to survive me, I give, devise and bequeath the same unto my
children equally, the issue of any who may be deceased to take
the share of the parent by representation.
4. I name, constitute and appoint my wife, GERALDINE E.
BOLASH, to be the Executrix of this my Will. .should my said
wife fail to survive me, or fail for any reason to complete
the administration of my estate, I appoint my son, ROBERT S.
BOLASH, to be the Executor in her stead.
EXHIBIT A
5. In the event my wife should fail to survive me, I -
appoint my son to be the guardian of the person and of the
estate of my daughter, ROBIN, during her minority, and I direct
i
that he be excused from entering security as such. '
IN WITNESS WHEREOF, I have hereunto set my hand and seal
l cuti_
this �y day of s 1 1977.
�! / C
(SEAL)
Pei E. Bola h.
Signed, sealed; published and declared by the above-named
Testatrix as and for his Last Will and Testament in the presence
of us, who at his request, in his presence and in the presence
of each other, have hereunto subscribed our names as witnesses.
/ /`r
Peter E Bolash
• PA Estate Tax 0.00
Date of Death I Sun, Dec 01,2013 Optimal Discount Paymen 5,756.07
3 Months After DOD I Mon, Mar 3, 2014
0090- 11111. Click here
if Paid Total Paid at Not Paid at
at Discount Date Paid Tax Paid Discount Discount
Ell
Ell
•
Tax Discount
A. Tax Paid at Discount(per above) x 5195 =
B. ®Tax Due if Entire Balance paid on/before Mon. Mar 3. 2014 5,756.07 x 5/95 = 302.95
C. Total NET Tax Paid/To be Paid at Discount 5,756.07 x 5195 = 302.95
D. Discount C. 5,756.07 x 5/95
F. 6,059.02 x 5% = 302.95 (2)*
Lesser of(1)or(2)above 302.95
E. Tax Credit(C + D) 6,059.02
F. GROSS Tax Due (Page 1, Line 19) 6,059.02
G. Balance of Tax Due 0.00
The calculations in (1)and (2)are intentionally different. Item (1)computes the amount of discount
based upon an assumed NET payment. Item (2)computes the maximum potential discount based upon an
actual GROSS principal tax due. Thus,a discount always equals the NET payment x 5 195,or the GROSS tax x 5%.
EXH1131T B
"i'r OMB No.2502-0265
B. TYPE OF LOAN
A. SETTLEMENT STATEMENT (HUD-1) 1. ❑ FHA 2. ❑ FNMA 3. ❑ Cow ONMs.
a
6 4-E NUMBER: 7.LOAN NUMBER
8.MORTGAGE MS.CASE NO.:
I 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.oe.)"were paid outside the closing'they ere shown here for informational purposes and are not included in the totals
).NAME&ADDRESS Tina M.Robertson
OF BORROWER: 19 Stewart Lane,Enola,PA 17025
3. NAME&ADDRESS Estate of Peter E.Bolash a/k/a Peter Eli Bolash
OF SELLER: C/O Robert S.fichuh Sr. 1203 Lambs Gap Road Mechanicsburg PA 17050
'. NAME&ADDRESS
OFLENDER:
3.PROPERTY LOCATION: 692 Front Street,West Fairview,PA 17025
4. SETTLEMENT AGENT: Johnson,Duffie,Stewart&Weidner
PLACE OF SETTLEMENT:301 Market Street Lemoyne PA 17043(717)761-4540
SETTLEMENT DATE: 2/17/2014
I. Su an once of Borrower's Transaction K. Smarnmev of Seller's Transaction
100.Gross Amount Due From Borrower: 400.Gross Amount Due To Seller:
01.Contract sales price 74000.00 401.Contract sales price 74000.00
02.Personal property 402.Personal property
.03.Settlement char es to bormwec(line 1400) 10.00 403.
N. 404.
05. 405,
Adjustments For Items Paid Bv Seller In Advance: Adjustments For Items Paid By Seller In Advance:
106.CityROwn taxes to 406.City/town taxes to
107.County taxes to 407.County taxes to
108.Assessments to 408.Assessments to
109.School Taxes 2/IM014to 6/30/2014 392.58 409,Sebool Taxes 2/17/2014to 6/3020/4 39158
110.SewerrUsuh 2/178014 to 3212014 63.52 410.Sewer/fmsb 2/178014 to 3/31/2014 6152
111. 411.
112, 412.
113. 413,
114. 414.
115. 415.
116, 416,
120.Gross Amount Due From Borrower: 74,466.10 420.Gross Amount Due To Seller: 74,456.10
ZOO.Amounts Paid Bv Or In Behalf Of Borrower: 500.Reductions In Amount Due To Seller:
201 Deposit or tamest money 501,Excess deposit see immuctions
M.Principal amount ofnew ton(s) 502.Settlement charges to seller(line 1400) 10.00
203.Existing loan(s)taken subject to 503.Existing loans)taken subject to
204. 504.Payoff I st Mt&Ln,
205. 505.Payoff2nd Mg,Ln.
206.Future Payment To Be Paid To Seller By 8/12014 49 000.00 506.Future Payment To Be Paid To Seller By 8/12014 49 000.00
207. 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 01/01/14 to 02/17/14 48.42 511.County taxes 01/01/14 to 02/17/14 48.42
212.Assessments to 512.Assessments to
213. 513.
214. 514,
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220.Total Paid By/For 048 520.Total Reductions
Borrower: 49, .42 In Amount Due Seller: 49,058.42
0 I men r m o B mower Cash At ettlement From/To Seller:
301.Gross amount due from borrower(line 120) 1 74 466.10 601.Gross amount due to seller(line 420) 74 456.10
302.Less amount paid by/for borrower(line 220) 49 048.42 602.Less reductions in amount due seller(line 520) 49 058.42
303.Cash(®FROM) i❑TO) Borrower:
25,417.68 603.Cash(LNJrO) (❑FROM) Seller: 25,397.68
eveme,Edition is Obsolete
am No.1581
86 x Page I of 3 x EXHIBIT C
x x
SETTLEMENT CHARGES Escrow:14-00004-JD
00.Total SalesBroker's Commission: Paid From Paid From
Based On Price $ 7400000 G. /= Borrower's Seller's
1' isi n ofComorission(lin F ll Funds Funds
At At
2 S to Settlement Settlement
03.Commissm paid at sgftIgJpgDt
04.
D,Q,Ifemn Pavablp In Connection With Lana-
01.Loan Origination fee
02.L an Discount %
Appraisal fee to
04.Credit recort to:
5.Lender's inspection fee
Mortgage insurance application fee to
07.Assnumthp fee
Oa,Yield Spread Premiu .
11
:12.
:I
4
'l
177.
:19.
:20.
:21.
Interest from 2 to days)
2 hdqltgage insurance premman for mo.to
103 Hazard ffis.rarQo premium for
104.EIQQd insurance prernium to
106.
001. Hac,and insurance 0 months S 0.00 per month
002 Mortgage insarance 0 months n$ 0.00 per month
003, Ch,property taxes 0 months 0,00 e'month
004, County Property taxes 0 months 0.00 per month
Annual assessments 0 months S 0.00 per month
006. Flood insurance 0 months S 0.00 per month
School Tax Re ery 0 months S 0.00 per month
eat
09.
enlement or closing feet
102. Abstract r title
. Title examination to
file insurance binder to
Document preparation fie Stewart&Weidner
106, Notar,fees to
.107. Attorneys fees to To Be Determined
(includes above item Numbers: )
.108. Title insurance W Johnson,Dufie,Stewart&Weidner
(includes above item Numbers: )
Lencler's coverage . 0 Premium'
Owners covem a S 74.000.00 Premiu
1I1.
172.
11
.114.
1200, Government Recordim,and Transfer .
.201. Recording fees Deed I Ho Mortgage S 0.00 :Releases S 0.00
202. /c un w tax/smarps.Deed Moruzage S 0.00
.203. State t tam a ed$ 0.00 Mortgage 0
.205.
O1 Survey to
.302, inspection to
U0. Buyer To Pay S 1,000 Em Personal roe 8111 to Estate ofPeter o
1304, Transfer Fee Re Sewe,&Trash to East Penusbono Townshin 10.00
�305, Reimbursement For Tax Certification hn n.D.frie.Stmart Weidner
1306.
17
1308.
Hier on line 103,Sctio.J-and-larc 2 Section 10.001
mn No.1582 Page 2 of3 SB 4-35384004
X X X
SELLER'S AND/OR BORROWER'S STATEMENT Escrow: 14-00004 41)
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
lisbursements made on my account or by mein this transaction.I further certify that I have received a copy of the HUD-1 Settlement Statement.
lormwers/Purchasers Sellers
Estate of Peter E.Bolas
4aMbb�rtson Eli to of
By
'he HUD-1 So t S atement whi I hav pre ared is a e and accurate account of this transaction.I have caused or will cause the funds to be
lisbursed in actor ante ith this sta Went.
iettlemen[Ag [: Date:
Z /7
nson,Du ,Stewart Veidn r
WARNING:It is a crime to knowingly make false statements to the United States on this or any other similar form.Penalties upon conviction can include a
ine or imprisonment.For details see: Title 18 U.S.Code Section 1001 and Section 1010.
Page 3 of
Jan. 31, 2014 11 : 35AM PNC Bank No. 4888 P. 1/2
;.PNC
January 31, 2014
Dana L Wieseman
Johnson, Duffie, Stewart& Weidner
301 Market St
PO Box 109
Lemoyne, PA 17043-0109
RE: Name: Peter E Bolash
SSN: 168-24-2936
DOD: 12-01-2013
Dear Sir/Madam:
In response to your request for Date of Death (DOD)balances for the customer noted above, our
records show the following:
Checking Account
Account# 5006626509 Established: 10-23-2009
PETER E BOLASH
DOD balance: $ 1,235.15 +0.00 accrued interest
Interest paid 01-01-2013 thru 12-01-2013 $ 0.05 YTD
Savings Account
Account# 5112690328 Established: 06-22-2012
PETER E BOLASH
DOD balance: $ 78,684.24+2.61 accrued interest
Interest paid 01-01-2013 thru 12-01-2013 $ 22.10 YTD
Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and
Savings). We do not process any financial transactions or provide statements. If you need assistance with
any of these items, please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank,N.A.
Member FDIC
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