HomeMy WebLinkAbout02-28-14 (2) REV-1500 Ex(02-11) 1505610143
PA Department of Revenue y OFFICIAL USE ONLY
p penns Ivania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOX.280601 INHERITANCE TAX RETURN 21 13 0560
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
04 11 2013 01 13 1953
Decedent's Last Name Suffix Decedent's First Name MI
HERSHEY ROBERTA F
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return 2. Supplemental Return 3. Remainder Return(Date of Death
Prior to 12-13-82)
4. Limited Estate 4a.Future Interest Compromise F—] 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
O g Decedent Died Testate 7• Decedent ain#fined a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) Copy of rust)
9. Litigation Proceeds Received 10.Spousal Pover creditt(Datte of Death 11,Election to tax under Sec.9113(A)
between 12-31- and -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
JOHN R ELLIOTT 717 846 8811
REGISTER OF-WILLS USE ONLY
First Line of Address
117 E MARKET ST ,; co
Second Line of Address Wit:
DAVE FILED >
City or Post Office State ZIP Code
YORK PA 17401
Correspondent's e-mail.address: )elliott@anStineSparler.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,correct4rid complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE�FERSON RESPONS%,F,FOR.FILING-RETURN DATE
-� " Scott L. Elliott
ADDAESS-
4210 Druck Valley Road,York, PA 17406
SIGN TURE OF PREPARER,9THER THAN REPRESENTATIVE DATE
John R. Elliott
AD R SS
117 E. Market St,York, PA
Side 1
1505610143 1505610143
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF FILE NUMBER
Hershey, Roberta F. 21-13-0560
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 prepayy r has any knowledge.
Signature#2 /l J
Name tAmy .Nt come
Address'! 725 Range End Road
Address2
City, State,Zip Dillsburg,PA 17019
Date
I
1505610243
REV-1500 EX
Decedent's Social Security Number
,Decedent's Name: Hershey, Roberta F.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1 100 ,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. 5,700 . 16
6. Jointly Owned Property(Schedule F) F-1 Separate Billinq Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous Non Probate Property
(Schedule G) u Separate Billinq Requested............ 7. 41, 830 . 00
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 147 ,530 . 16
. 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 19,433 . 35
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 72 ,502 . 87
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 91, 936.22
12. Not Value of Estate(Line 8 minus Line 11).......................................................... 12. 55,593 . 94
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. 55,593 . 94
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14,taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.00 15. 0 . 00
16. Amount of Line 14 taxable
at lineal rate X .045 55,593 . 94 16. 2 , 501 . 73
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. 2 ,501 . 73
210. FILL IN THE OVAL IF YOU ARE REQUESTING AREFUIND OF AN OVERPAYMENT. ❑
Side 2
1505610,243 1505610243
Rev-1502 EX+(01.10)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hershey, Roberta F. 21-13-0560
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as lhe,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
Include a copy of the deed showing decedent's Interest if owned as tenant in common.
ITEM VALUE AT DATE
DESCRIPTION
NUMBER OF DEATH
1 ALL that certain tract of land with the improvements thereon erected,situate,lying and being 100,000.00
in Upper Allen Township, Cumberland County, Pennsylvania,sold to Alicia Rogers on
12/30/13
TOTAL(Also enter on Line 1, Recapitulation) 100,000.00
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev.01-10)
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
Hershey, Roberta F. 21-13-0560
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 disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Members 1st Federal Credit Union-Checking Account No. 154924-11 813.25
2 Members 1st Federal Credit Union-Savings Account No.159924-00 486.96
Accrued interest on Item 2 through date of death 0.03
3 1999 Volkswagon Beetle 2,028.00
4 Refund,Chase-mortgage 1,318.26
5 Refund,County taxes 12/30113 to 12/31/13 2.48
6 Refund, HOA dues 12/30/13 to 12/31/13 8.39
7 Refund, PP&L 84.79
8 Refund, School taxes 12/30/13 to 6130/14 648.44
9 Refund,Sewer 12/30/13 to 12/31/13 0.43
10 Refund, State Farm Insurance -homeowners 189.41
11 Refund,York Waste 39.03
12 Refunds from overpayment of medical bills 80.69
TOTAL(Also enter on Line 5,Recapitulation) 5,700.16
(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-1510 EX+(08-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hershey, Roberta F. 21-13-0560
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.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECD'S EXCLUSION TAXABLE
NUMBER HINCLUDE ATE ONAME RANSFERS ATTACH THEIR A COPY OF THE RELATIONSHIP FFOREREAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Members 1st Investment Services-IRA Account No. 41,830.00 41,830.00
5ZV-403158
beneficiaries: Scott Elliott and Amy Newcomer,
children of the decedent
TOTAL(Also enter on Line 7, Recapitulation) 41,830.00
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09)
REV-1511 Ex+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DEC ENTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Hershey, Roberta F. 21-13-0560
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
Cocklin Funeral Home-funeral
I
3,667.56
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zia
Years)Commission Paid
2. Attornev's Fees Anstine&Sparler 2,000.00
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 360.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 13,405.79
See continuation schedule(s)attached
TOTAL(Also enter on line 9,Recapitulation) 19,433.35
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
Hershey, Roberta F. 21-13-0560
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 Barristers Land Abstract -escrow fee for inheritance tax 25.00
2 Barristers Land Abstract -tax certification 15.46
3 Barristers Land Abstract -wire mortgage payoff 25.00
4 Home Depot-items for real estate prior to sale 40.00
5 Howard Hanna Camp Hill-real estate commission 3,045.00
6 HSA Home Warranty-home warranty 405.00
7 Joy Daniels Real Estate-real estate commission 3,760.00
8 Joy Daniels Real Estate-brokerage fee 350.00
9 Kandi Lenker-notary fees at real estate settlement 10.00
10 Members 1st Federal Credit Union-estate checks 10.25
11 Members 1st Federal Credit Union-checks for estate 10.25
12 Miscellaneous administrative expenses: photocopies,long distance telephone calls, 20.00
facsimiles,etc.
13 011ies-shelves for real estate 189.15
14 Paint condo prior to listing for sale 1,833.35
15 PP&L -electric 70.88
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hershey, Roberta F. 21-13-0560
ITEM
NUMBER DESCRIPTION AMOUNT
16 PP&L-electric 69.99
17 PP&L-electric 51.63
18 PP&L-electric 63.99
19 PP&L-electric 52.98
20 Real Estate Agent-deposit to list real estate 395.00
21 Recorder of Deeds-transfer stamps/tax 1,000.00
22 Require-mortgage release track/search fee 35.00
23 Southpoint Condominium Association-resale cert fee 75.00
24 Southpoint Condominium Association-condo fee 130.00
25 Southpoint Condominium Association-condo fee 130.00
26 Southpoint Condominium Association-condo fee 130.00
27 Southpoint Condominium Association-condo fee 130.00
28 Southpoint Condominium Association-condo fee 130.00
29 Stanley Siemos-work done to real estate prior to listing 179.14
30 State Farm-insurance 207.00
31 Transfer title of Volkswagon to beneficiary 106.00
32 Truck Rental-to remove items from real estate 300.00
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hershey, Roberta F. 21-13-0560
ITEM
NUMBER DESCRIPTION AMOUNT
33 United Water-water 11.49
34 United Water-water 11.32
35 United Water-water 11.36
36 United Water-water 17.47
37 United Water-water 11.36
38 United Water-water 11.42
39 United Water-water 11.42
40 United Water-water 5.77
41 Upper Allen Township Authority-October, November and December sewer 112.00
42 Upper Allen Township Authority-sewer 117.63
43 Upper Allen Township Authority-sewer 11.42
44 York Waste-sewer 39.03
45 York Waste-refuse 39.03
H-B7 13,405.79
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 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
Hershey, Roberta F. 21-13-0560
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 Chase-mortgage payoff 59,248.39
2 Chase-mortgage 961.36
3 Chase-mortgage 480.68
4 Chase-mortgage 497.77
5 Chase-mortgage 480.68
6 Chase-mortgage 480.68
7 Chase-mortgage 480.68
8 Chase-mortgage 480.68
9 Chase-mortgage 490.43
10 Chase-mortgage 490.43
11 Chase-mortgage 490.43
12 Hartizall Rupp-eye doctor 45.00
13 Hershey Medical Center-medical services 15.00
14 Hershey Medical Center-medical services 90.00
15 Hershey Medical Center-medical services 3,202.00
16 Members 1st Federal Credit Union-credit card 3,239.82
17 PA Department of Revenue-income taxes 194.45
Total of Continuation Schedule See attached page
TOTAL(Also enter on Line 10, Recapitulation) 72,502.87
(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 I(Rev. 12-08)
Rev-1512 EX+(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Hershey, Roberta F. 21-13-0560
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
18 PPBL-electric 70.00
19 Southpoint Condominium Association-condo fee 130.00
20 State Farm-automobile insurance 19.24
21 United Water-water bill 11.32
22 Upper Allen Township-sewer 112.00
23 Verizon-telephone service 75.22
24 West Shore EMS-medical serivices 677.58
25 York Waste-refuse 39.03
TOTAL(Also enter on Line 10,Recapitulation) 72,502.87
Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF OEVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hershey, Roberta F. 21-13-0560
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trustee(s)I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
Scott L. Elliott Son 50%of residue
4210 Druck Valley Road
York, PA 17406
Scott L. Elliott,Jr. Grandson 1999 Volkswagen
4210 Druck Valley Road Beetle valued at
York,PA 17406 $2,028.00
Taylor Jo Knisley Granddaughter 20%of residue
c/o Amy Newcomer
725 Range End Road
Dillsburg, PA 17019
Amy J. Newcomer Daughter 10%of residue
725 Range End Road
Dillsburg, PA 17019
Jayden Leanne Newcomer Granddaughter 20%of residue
725 Range End Road
Dillsburg, PA 17019
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
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 II -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)
LAST WILL AND TESTAMENT OF ROBERTA F. HERSHEY
I,ROBERTA F.HERSHEY,single woman,currently of 49 Southpoint Drive,Mechanicsburg,
Cumberland County,Pennsylvania,being of sound and disposing mind,memory and understanding,do
make,publish and declare this my Last Will and Testament,hereby revoking and making void any and
all prior Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as the
same can conveniently be done.
2.
I give and bequeath any motor vehicle that I may own at the time of my death to my grandson,
SCOTT L.ELLIOTT,JR. Any inheritance taxes,fees,commissions and the like that would
typically be assessed against its value shall be paid from the residue of my Estate. In the event my said
grandson has predeceased me,this gift shall lapse and shall become part of the residue of my Estate.
3.
All the rest,residue and remainder of my Estate,real,personal and mixed,whatsoever and
wheresoever situate,I give,devise and bequeath to be divided into the following percentage shares and
distributed as follows:
A. Fifty(50%)percent to my son,SCOTT L.ELLIOTT,per stiMes._
B. Ten(10%)percent to my daughter,AMY JO NEWCOMER,per stirpes.
C. Twenty(20%)to my granddaughter,TAYLOR JO KNISLEY.
D. Twenty(20%)to my granddaughter,JAYDEN LEANNE NEWCOMER.
In the event that any recipient under this Will is under the age of twenty-five(25)at the time of
my death,then I nominate,constitute and appoint his or her aunt or uncle named hereinabove,as the case
may be,Trustee,in Trust for the benefit of him or her. My Trustee is hereby directed to establish Trust
accounts at a bank or financial institution,brokerage house,or a combination of the same,as he/she
deems best. He/she is to hold and invest the assets in good and safe income producing investments.
The income therefrom and so much of the principal thereof as he/she,in his/her sole and absolute
discretion,is to be used for the further education of my said recipients. Such education shall not be
limited to a standard four(4)year college program. It may also include associate degree programs,
internships,clerkships,apprenticeships,vocational-technical schools and the like. My Trustee is to take
Page 1
into consideration alternative sources of educational funding such as,but not limited to,the ability of
their parents to pay for advanced education,their own earning capacity,and the availability of
scholarships,grants,subsidies and the like. It is my intention herein to aid their education and to
augment but not to supplant other sources of funds.
Upon the attainment of age twenty-five(25)by each of them,the then remaining principal and
any income accumulated thereon shall be paid over to each recipient outright and absolutely.
In the event any of my said recipients predeceases me or dies during the term of his/her
respective Trust,then his/her share shall go to his/her issue,per stirpes. However,if he/she is not
survived by issue,then to his/her sibling or a deceased sibling's surviving issue,per stirpes,as the case
may be.
4.
Spendthrift Clause. No interest(whether in income or principal,whether or not a remainder
interest,and whether vested or contingent)of any beneficiary hereunder shall be subject to
anticipation,pledge,assignment,sale or transfer in any manner,nor shall any beneficiary have power
in any manner to charge or encumber his or her said interest,nor shall the said interest of any
beneficiary be liable or subject in any manner while in the possession of the Trustee for any liability of
such beneficiary,whether such liability arises from her debts,contracts,torts,or other engagements of
any type.
5.
In the event that my said Trustees are unable or unwilling to serve as Trustees for any reason,I
appoint ORRSTOWN BANK,to act in his/her place and stead. No Trustee need post a bond for the
faithful performance of his or its duties.
6.
I nominate,constitute and appoint my son,SCOTT L.ELLIOTT,and my daughter,AMY JO
NEWCOMER,to be the Co-Executors of this my Last Will and Testament.In the event that they are
both unable or unwilling to act as Executor,I appoint ORRSTOWN BANK,to be the Executor in their
place and stead.I further direct that they shall not be required to file bond or other security in the Office
of the Register of Wills for the purpose of administering my Estate.
C IN WITNESS WHEREOF,I have hereunto set my hand and seal this Uf4 day of
A.D.2011.
(SEAL)
ROBERTA F.HERSHEY
tsy�xcafq
Page 2
Signed,sealed,published and declared by the above-named ROBERTA F.HERSHEY,as
and for her Last Will and Testament,in the presence of us,who at her request and in her presence,
and in the presence of each other,have hereunto subscribed our names as witnesses.
Page 3
OMB Approval No.2502-0265
A. Settlement Statement HUD-1
.-of Lo
1.❑FHA 2.❑RHS 3. X❑Conv.Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number:
13-01-31607 1380292
4.❑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.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:
Alicia A.Rogers Estate of Roberta F.Hershey Susquehanna Bank
320 Lamp Post Lane,Eaters,PA 17319 4210 Druck Valley Road,York,PA 17406 3501 Concord Road,York,PA 17402
G.Property Location: H.Settlement Agent: 1.Settlement Date:12(30/2613
49 Southpoint Drive Barristers Land Abstract Company Disbursement Date:12/30/2013
Mechanicsburg,PA 17055 3310 Market Street,Camp Hill,PA 17011
Upper Allen Township
717-761.6190
Place of Settlement: TitleExpress
3310 Market Street,Camp Hill,PA 17011 Printed 1 212 7/2 01 3 at 10:23 am
by LM
'J.Summary of:, Transaction
100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller.
101. Contract sales price 100,000.00 401. Contract sales price 100,000.00
102. Personal property 402. Personal property _
103. Settlement charges to borrower(line 1400) 6,781,73 403.
104. - 404.
105, 405.
Adjustments for items paid by seller in advance Adjustments for Items paid by seller in advance
106. City/town taxes to 40. City/town taxes to
107. County taxes 12/30/2013 to 12/31/2013 2.48 407. County taxes 12/30/2013 to 12/31/2013 2.48
108. School Taxes 12130/2013 to 06/30/2014 648.44 408. School Taxes 12/30/2013 to 06/3012014 648.44
109. Sewer 12130/2013 to 1221/2013 0.43 409. Sewer 1 213 012 01 3 to 12/31/2013 0.43
110. HOA Dues 12130/2013 to 12/31/2013 8.39 410. HOA Dues 12/30/2013 to 12131/2013 8.39
111. 411.
112. 412.
120. Gross Amount Due from Borrower 107,441.47 420• Gross Amount Due to Seller . 100,659.74
200. Amounts Paid b.or in Behalf of Borrower 500. Reductions In Amount Due to Seller,
201. Deposit or eamest money 1,000.00 501. Excess deposit(see instructions)
i
202. Principal amount of new loan(s) 97,000.00 502. Settlement charges to seller(line 1400) 11,632.46
201 Existing loan(s)taken subject to 503. Existing loos taken subject to
204. 504. Payoff of first mortgage gage loan#1970250952 to Chase 59,248.39
205. 505. Payoff of second mortgage loan
206. 506.
207. 507.
208. 508.
209. Seller Assistance 6,000.00 509. Seiler Assistance 6,000.00
Adjustments for items unpaid b seller Adjustments for items unpaid b 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. _ 5%
219. 519.
220. Total Paid b(for Borrower 104,000.00 520. Total Reduction Amount Due Seller 76,880.85
300. Cash at Settlement fromfta Borrower 600. Cash at Settlement tolfrom Seiler
301, Gross amount due from borrower(line 120) 107,441.47 601, Gross amount due to seller(line 420) 100,659.74
302. Less amounts paid by/for borrower(line 220) 104,000.00 602. Less reductions in amount due seller(line 520) 76,880.85
303. Cash ❑X From ❑ To Borrower 3,441.47 603. Cash QX To El Seller 23,778.89
Ihl9 fgml'unle55 it dls W mg ie is m yno is in orm a you n report mpee
9 playsepineMlY ValiO OMBegnlml number,No confidenllailty is assu,ed;IMSdis�gsumnis mendalory�7his is designed iq provNe the parties to eRESPA Cgyered lnnsAGlba with lnf-Mlon dumpthe
betiiement ProtAas. -
Previous editions are obsolete Page 1 of 3 HUD-1
L.Settlement Charges
700. Total Real Estate Broker Fees $6,805.00 Paid From Paid From
Division of commission line 700 as follows: Borrower's.' Seller's
701. $3,760,00 to"Joy Daniels Real Estate Funds at 'Funds at
702• $3,045.00 to Howard Hanna Camp Hill Settlement Settlement
703. Commission paid at settlement 225.00 6,580.00
704. Broker Fee to Joy Daniels Real Estate $395.00 P.O.C.S' 350.00
800. items Payable in Connection with Loan
801. Our origination charge,(includes Origination Point 0.000%or$0.00) $895.00 (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) 895.00
804. Appraisal fee to Logistics Solutions,Inc. (from GFE#3) 460.00
805. Credit report to Corer' is CREDCO (from GFE#3) 28.00
806. Tax service to First American Real Estate Tax Service (from GFE#3) 93.00
807. Flood certification to Cores is Flood Services (from GFE#3) 12.50
808. to
900. Items Required by Lender to be Paid in Advance
901. Daily interest charges from from 1213002013 to 01/0112014 @$i2.8000/day (from GFE#10) 25.60
902. Mortgage ins.Premium for months to (from GFE#3)
903. Homeowner's insurance for 12 months to AIIState Insurance (from GFE#11) 288.43
904. months to from GFE#11
000. Reserves Do sited with Lender
1001.Initial deposit for your escrow account (from GFE#9) 909.69
1002.Homeowner's insurance 3 months @$ 24.03/month $72.08
1003.Mortgage Insurance months @$ 0.00/month $
1004.City Property Tax months @$ 0.001month $
1005.County Property Tax 11 months @$ 41.501month $456.50
1006.School Taxes 7 months @$ i05.62/month $739.34
1007.Aggregate Adjustment $-35824
1100.Title Char as
1101. Title services and fender's title insurance from GFE#4 1,244.01
1102.Settlement or closing fee to $
1103.Owner's title insurance-Stewart Title Guaranty Company $ from GFE#5 16.50
1104.tender's title insurance-Stewart Title Guaranty Company $1,158.50
1105.Lender's title policy limit$97,000.00 Lender's Policy
1106. Owner's title policy limit$100,000.00 Owner's Policy
1107.Agenrs portion of the total title insurance premium $935.
1108. Underwriter's portion of the total title insurance premium $240.00
1109. Escrow fee-Inheritance Tax to Banisters Land Abstract 25.40
General-Hbg
1200.Govemment Recording and Transfer Cha es
1201.Government recording charges $ (from GFE#7) 164.00
1202.Deed$67.00 Mort a e$97.00 Release$
1203.Transfer taxes $ (from GFE#8) 1,000.00
1204.City/County tax/stamps Deed$1,000.00 Mortgage$
1205. Stale Tax/stamps Deed$1000.00 Mortgage$ 1,000.00
1206. Deed$ Mortgage$
1207. $
1300.Additional Settlement Charges
1301.Required services that you can shop for (from GFE#6)
1302. Notary Fee to Kandi Lenker 10.00
1303.Home/Pest Inspection to Inspect A Home $325.00 P.O.C.B'
1304.Tax Gen Reimbursement to Barristers Land Abstract Cost-Hbg 15.4
1305.Condo Assn Questionnaire Prep to Sterling Property Management,Inc. 30.00
1306.Home Warranty to HSA Home Warranty 405.
1307.Resale Cert Fee to South point Condominium Association 75.00
1308.Capital Expenditure Fee to Soulhpoint Condominium Association 1,260.00
1309.January 2014 HOA Dues to South point Condominium Association 130.00
1310.OM/D Sewer to Upper Allen Township Authority 112.00
1311. Wire Payoff to Barristers Land Abstract Postage-Hbq 25.00
1312.Mtg Release Track/Search fee to Require 35.11
1313. Inheritance Tax Escrow to Barristers Land Abstract Escrow-Hbg 1 3,000.00
r r _ r 6,781.731 11,632.46
`Paid outside of dosing by(B)orrower,(S)eiler,(L)ender,(I)nvestor,Bro(K)er.-Credit by lender shown on page 1."'Credit by seller shown on page 1.
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Previous editions are obsolete Page 2 of.3 HUD-1
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 # 801 895.00 895.00
Your credit or charge(points)for the specific interest rate chosen # 802 0.00 0.00
Your adjusted origination charges # 803 895.00 895.00
Transfer taxes # 1203 1,000.00 1,000.00
Charges That in Total Cannot Increase More Than 100/6 Good Faith Estimate HUD-1
Government recording charges # 1201 160.00 164.00
Appraisal fee # 804 460.00 460.00
Credit report #805 28.00 28.00
Tax service # 806 93.00 93.00
Flood certification # 807. 12.50 12.50
#
#
#
753.50 757.50
Increase between GFE and HUD-1 Charges $ 4.00 or 0.5309%
Charges That Can Change Good Faith Estimate HUD-1
Initial deposit for your escrow account # 1001 2,063.04 909.69
Daily interest charges from # 901 2.8000/day 192.00 25.60
Homeowner's Insurance # 903 360.00 288.43
Title services and lender's title insurance # 1101 1,395.00 1,244.01
Owner's title insurance=Stewart Title Guaranty Company # 1103 11.00 16.50
#
Loan Terms
Your initial loan amount is $97,000.00
Your loan term is 30.years
Your initial interest rate is 4.75000/6
Your initial monthly amount owed for principal,interest,and any mortgage $506.00 includes
insurance.is ❑X Principal
❑X Interest
❑Mortgage Insurance
Can your interest rate rise? ❑X No. ❑Yes,it can rise to a maximum of %. The first change
will be on / ! and can change again every years after I I Every
change date,your interest rate can increase or decrease by %. Over the life of
the loan,your interest rate is guaranteed to never be lower than %or higher
than
Even if you make payments on time,can your loan balance.rise? Q No. [:]Yes,it can rise to a maximum of$
Even if you make payments on time,can your monthly amount owed for ❑No. [:]Yes,the first increase can be on I I 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? 0 No. ❑Yes,your maximum prepayment penalty is$
Does your loan have a balloon payment? 0 No. ❑Yes,you have a balloon payment of$ due in
years on 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$171.15
that results in a total initial monthly amount owed of$677.15. This includes
principal,interest,any mortgage insurance and any items checked below:
❑X Property taxes ❑Homeowners insurance
❑Flood insurance ❑
0 School Tax ❑
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 3 HUD-1
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 l have received a copy of the HUD-1 Settlement Statement
Alida A.Rogers
Estate of Roberta F.Hershey Estate of Robe Q F.Hddhey
Agent:Scott L.Elliott,Executor Agent:Amy J.Newcomer,Executrix
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
Jisbursed in accordance with is statement
3efTLEMENT AGENT -DATE
VARNING IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON
:ONVICTION CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010.
revious editions are obsolete Page 4 of 4 HUD-1
Itemization of i 1,1103 and 1104
Name of Borrower: Name of Seller. File Number
Alicia A.Rogers Estate of Roberta F.Hershey 13-01-31607
TitleExpress
Prepared 12/27/2013 at 10:22 am
Note: This page is furnished to give you an itemization of the amounts shown on Paidfrorn ,, Paid,From
Lines 1101,1103 and 1104 of the Settlement Statement(HUD-1).This page 'Borrowers ; Sellet's
accompanies but is not a part of the settlement statement.If a discrepancy :Funds at 'Funds at"
exists,the information shown on the Settlement Statement(HUD-1)applies. Settlement; :Settlement
1100. Title Charges Amounts included
In Line 1101
1101. Title services and iend&s title insurance 1,244.01
a. Notary Fees $ 25.00
b.Wire Fee 5.00
c. Ovemi ht Fee 10.51
d.Electronic Doc Transmittal Fee 45.00
$ 85.51
1102. Seftlement or dosing fee
1101 Owner's title insurance poll $ 16.50 18.50
1104. Lender's title insurance (policy) 883.50 $ 1,158.50
a.Endorsement 810 Condo 50.00
b. Endorsement 900 EPL-Residential 50.00
c.Closing Service letter 75.00
d.ALTA Short Form Loan 100.00
(Total 1103+1104) $ 1 17500
1105. Lender's title policy limit$97,000.00
1106. Owner's title policy limit $100;000.00
1107. Agent's portion of the total title insurance premium $ 935.00 1
1108. Underwritees portion of the total Utle insurance prem. 240.00 }
(Total 1107+1108) l
1109.
1110.
1111.
1112.
Additional • • for i
n �. ?Totatq ;$oorower t_rBosrower'` Seller
1100. Title Charges with Payee .. w Char a ";POC or Credit: `'Uru 1101 Paid
1101. Title services and lender's title insurance $
a.Notary Fees to Kandi Lenker 25.00 25.00
b.Wire Fee to Barristers Land Abstract Wire-Hbg 5.00 5.00
c. Overnight Fee to Barristers Land Abstract Postage-Hbg 10.51 10.51
d.Electronic Doc Transmittal Fee to Barristers Land Absirad General-Hbg 45.00 45.00
1104. Lender's title insurance to Banisters Land Abstract Company 1,158.50 1,158.50
$ 1,244.01". '1,244.01" .
02-04-1 4; 14:13 From:Members 1st FCV Invest To:88528915 ;7'177955176 #
ZDL Members 1st Investment Services Andrew Steele
Located at Members '1st FCU Senior Investment Considtatrt
5000 Louise Drive
Mechanicsburg, PA 17055
717-795-6051
MEMBERS 1St
800-237-4054
FEDERAL CREDIT UNION 717-795-51.76
fax
February 4, 2014
Anstine & Sparler
FAX: 717-852-8915
RE: Roberta F Hershey
Individual Retirement Account
Account 5ZV-403158
To Whom It May Concern:
Following are the date of death (April 11, 2013) values for the
positions held in the above referenced account.
Quantity Description Value
HSBC BK USA MCLEAN VA CTR DEP ACT/365
OPPTY US INDY TITANS SER 9
18, 000 DUE 08/31/2016 $18, 000
ADVISORS DISIPLINED TR UNIT 540 ACT
17, 000 CUTWATER INCOME OPPS PORT SER 1 $16, 221
PERSHING GOVERNMENT ACCOUNT (CASH) $ 7, 609
TOTAL VALUE $41,830
Please feel free to contact me should you require any additional
information.
Sincerely,
J\QcQ-�J Jam-
J ne Lowe
egi tered Sales Assistant to
W1 iam A Steele
Sr. Investment Consultant
Registered Representative of,securities and certain insurance products are offered through INVEST Financial Corporation(INVEST),
member FINRA,SIPC and affiliated insurance agencies.INVEST is not affiliated with Members Ist Investment Services.Products and
services offered through INVEST are:•Not NCUA Insured•Not a deposit of or guaranteed by any credit union•May lose value
02-04-14; 14: 13 ;From:Memhers 'Ist FCV Invest To:88528915 ;7'177955'176 # 3/
Page 2
February 4, 2014
This "date of death" values report is a consolidation of assets
that has been prepared from sources deemed to be reliable,
however, no representation is made as to its accuracy or
completeness and it is not a guarantee of positions owned or
their market value. The report may include information on
certain assets that INVEST Financial Corporation' s clearing firm
does not hold on your behalf and which are not included on
INVEST Financial' s books and records. Such assets may not be
covered by SIPC. This report is not intended for tax reporting,
lending, legal or other non-financial planning purposes and
should not be relied upon by third parties . The account
statements you receive from your respective custodian (s) are
your official account statements and should be compared with
this report to confirm its accuracy. Please promptly report any
discrepancies to the INVEST Financial Compliance Department at
800-242-4732, option 1, option 4 .
2014/01 /15 14:26:55 2 12
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S�
MRMRRRS 13t
FEDERAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 154924-00
Date Account Established 10/27/1995
Principal Balance at Date of Death $486.96
Accrued Interest to Date of Death $0.03
Total Principal and Accrued Interest $486.99
Name of Joint Owner None
CHECKING ACCOUNT:
Account Number/Suffix 154924-11
Date Account Established 10/27/1995
Principal Balance at Date of Death $813.26
Accrued Interest to Date of Death $0.00
Total Principal and Accrued Interest $813.25
Name of Joint Owner None
HOLIDAY CLUB ACCOUNT:
Account Number/Suffix 154924-02
Date Account Established 01/16/1998
Principal Balance at Date of Death $0.00
Accrued Interest to Date of Death $0.00 j
Total Principal and Accrued Interest $0.00 ! .
Name of Joint Owner None
VISA CREDIT CARD ACCOUNT
Account Number 4672090000379669"
Date Account Established 05/27/2010
Balance at Date of Death $3,239.82
Joint Cardholder None
*Contractual Pledge of Shares
SAFE DEPOSIT BOX: NONE
MEMBERS IT FEDERAL CREDIT UNION
Tessa L Klugh
Lending Insurance Support Specialist
January 15, 2014
i
Estate of: ROBERTA F HERSHEY
Date of Death:04/11/2013
Social Security Number: 190-44-9482
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5000 Louisc Drive P.O. Box 40 Mechanicsburg,Peinlsylvauia 17055 - (800)283-2328 - wwwmemberslst.org