HomeMy WebLinkAbout03-11-14 (2) J 1505610105
REV-1500 EX(02-11)(FI)}1!1�
OFFICIAL USE ONLY
PA Department of Revenue pennsytvania
Bureau of Individual Taxes OERARIN[NlOiREVENUE County Code Year File Number
INHERITANCE TAX RETURN "-""- - f""-
PO BOX 280601 ----.._.____.__._ . .._
.. ..._.
Harrisburg,PA 17128-06oi RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number_ Date of Death MMDDYYYY Date of Birth MMDDYYYY
06/21/2013 - 11/05/1941
Decedent's Last Name Suffix Decedent's First Name MI
b rn _—_. _�_. = Lois
i
(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
CID 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
p 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
Q>p 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust U 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Patricia Albert I L(717) 802-1945
REGISTER 111LLS USE
L- �
First Line of Address r_ r'
CD
6416 Terrace Court _ � v'J. .. ` '
TY
Second Line of Address C7C5' r
t_.-....__... ___..__.__.._...._....--_--...__.__._...___........................."_..------....__.__...._..___...____.__. "v FILED X_ �a
-e 7
City or Post Office State ZIP Code DAT-
Harrisburg PA 17111 (
Correspondent's e-mail address: tcoburn1 p@rnsn.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 per§6—n9-9re—pr4i9ktative is bqsed on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE b' //q
ADDRESS W q I u -i _ee Act= L Yr,
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105 J
J 1505610205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: 'Coburn, Lois M '
i
RECAPITULATION
1. Real Estate(Schedule A). ............................................ 1. 123,000.00 �
2. Stocks and Bonds(Schedule B) .................................. ..... 2. i
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. 1,208.07
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7. 1
8. Total Gross Assets(total Lines 1 through 7).........:................... 8.I 124,208.07
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 41,217.67
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 74,025.03 !
11. Total Deductions(total Lines 9 and 10)................................. 11. 115,242.70
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. , 8,965.37
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which f
an election to tax has not been made(Schedule J) ........................ 13.
a
14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 8,965.37
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 I 15.i 0.00
16. Amount of Line 14 taxable ---- !!
at lineal rate X.0 45 8,965.37 16. 403.44
17. Amount of Line 14 taxable r
at sibling rate X.12 17. 0.001
18. Amount of Line 14 taxable
at collateral rate X.15 1 18. -0.00
19. TAX DUE ......................................................... 19. 403.44
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Coburn, Lois M
STREET ADDRESS
1192 Lowther Road
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 403.44
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. if Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 403.44
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.......................................................................................... ❑ E
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0
c. retain a reversionary interest.............................................................................................................................. ❑ N
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑
2. If death occurred after Dec. 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.........................................................................................................:.... ❑
3. Did decedent own an"intrust for"or payable-upon-death bank account or security at his or her death?.............. ❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
containsa 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 F2 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 172 P.S.§9116(a)(1)J.
• 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)J.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.
ESTATE OF
LOIS M COBURN
21 - 13-0891
LAST WILL
AND
TESTAMENT
COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE
COUNTY OF CUMBERLAND
I, GLENDA FARNER STRA SBA UGH
Register for the Probate 'of Wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
the 15th day of August, Two Thousand and
Thirteen,
Letters TESTAMENTARY
in common form were granted by the Register of
said County, on the
estate of LO/S M COBURN(first, late of LOWER ALLEN TOWNSHIP
,
Middle,Lastl
in said county, deceased, to PATRICIA KALBERT
(First,Middle,Lest)
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 15th day of August
Two Thousand and Thirteen.
File No. 2013- 00891
PA Fi 1 e No. 21- 13- 0891
Date of Death 612112013
S. S. #
eg/ster /is
W
e uty
I
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NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
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REGISTER OF WILLS
CUMBERLAND COUNTY CERTIFICATE OF
PENNSYLVANIA GRANT OF LETTERS
No. 2013- 00891 PA No., 21- 13- 0891
Estate Of: LOTS M COBURN
(First,Middle,Lest)
Late Of: LOWER ALLEN TOWNSHIP
CUMBERLAND COUNTY
(D Deceased
Social Security No:
WHEREAS, on the 15th day of August 2013 an instrument dated
May 30th 2007 was admitted to probate as the last will of
L OIS M COBURN
(First,Middle,Lest)
late of LOWERALLEN TOWNSHIP, CUMBERLAND County,
who died on the 21st day of June 2013 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH
Register of wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
PA TRICIA K ALBERT
who has duly qualified as EXECUTOR(R/X)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURTHOUSE,
CARL ISLE, PENNSYL VA NIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
Of my office on the 15th day of August 2013.
egtste o it s
ty
i
I
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
WILL OF
LOIS M. COBURN
I, Lois M. Coburn of Cumberland County, Camp Hill,
Pennsylvania, declare this to be my last Will and hereby revoke all
prior Wills and Codicils.
1. 1 direct that all my just debts, funeral expenses,
graverrlarker and administrative expenses shall be paid
from my residuary estate as soon as practicable after my
death.
2. 1 direct that all inheritance, estate, transfer, succession
and death taxes of any kind whatsoever which may be
payable by reason of my death shall be paid out of my
residuary estate.
3. 1 direct that my entire estate be distributed as follows:
A. I direct that my entire estate go to my husband,
Robert L. Coburn.
B. Should Robert L. Coburn predecease me, then I
direct that my entire estate go to my daughter,
Patricia K. Coburn.
L_ cc
1 appoint Robert L. Coburn, as Executor of this my last
U-1 -:° C\4 C.. Will. If Robert L. Coburn should predecease me or cease
,., o to actin such capacity, I appoint Patricia K. Coburn as
° Q alternate.
L,W z _' e "1Z CC L "' , --J 5. The Executor of this Will shall have the power to
C 7 J _�
m distribute my estate in kind or in cash, or partly in either.
c� 6. 1 direct that no Executor acting under this Will shall be
required to enter bond in any jurisdiction.
IN W T6ESS WHEREO have hereunto set my hand this
day of , 2007.
Lois M. Coburn
LAW OFFICES OF
iTEPHEN J. HOGG
19 S.HANOVER STREET
SUITE 101
CARLISLE,PA 17013
The preceding instrument consisting of this and one other page
was on the day and date hereof signed, published and declared by
Lois M. Coburn as and for her last Will in the presence of us, who at
her request, in her presence and in the presence of each other have
subscribed our names as witnesses hereto.
WITNESS TNESS
;
LAW OFFICES OF
TEPHEN J. HOGG
t-9 S.HANOVER STREET
SUITE 101
CARLISLE,PA 17013
ACKNOWLEDGMENT
State of Pennsylvania
County of Cumberland ss
I, Lois M. Coburn, the Testatrix, whose name is signed to the
attached or foregoing 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 as my free and
voluntary act for the purposes therein expressed.
Lots M. Coburn
Sworn to or affirms nd acknowledge fore me by Lois M.
Coburn the Testatrix, this Oday of
2007.
Notary Public/Attor y
AFFIDAVIT
State of Pennsylvania
County of Cumberland ss
We, and _ �dthe
witnesses whose names are signed to the foregoing
instrument, being duly qualified according to law, do depose and say
that we were present and saw the Testatrix sign and execute the
instrument as her last Will; that the Testatrix signed willingly and
executed it as her free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of
the Testatrix signed the Will as a witness; and that to the best of our
knowledge the Testatrix was at that time 18 or more years of age, of
sound mind and under no constraint orAindue influence-
Sworn to or affi nscribed before me by witnesses,
this ` day of
2007.
LAW OFFICES OF
`EPHEN J. HOGG
'S. HANOVER STREET
SUITE 101 "�°"Ek�=Aftk SEAL
CARLISLE,PA 17013 � ..
�zs
i
ESTATE OF
LOIS . M COBURN
21 - 13-0891
SCHEDULE A
REV-1502 Ex+(12-12)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Coburn, Lois M 21-13-0891
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 Real Estate located at 1192 Lowther Road,Lower Allen Township,Cumberland County, PA- 123,000.00
Contracted Sales Price. Real Estate sold on October 15,2013. A copy of the HUD-1
Settlement Sheet is attached.
TOTAL(Also enter on Line 1, Recapitulation.) $, 123,000.00
If more space is needed,use additional sheets of paper of the same size.
O�rA�NEN qc o`N OMB Approval No.2502-0255
A. Settlement t Statement (HUD 1)
B. Type of Loan
1.Q FHA 2.0 RHS 3.QCohv,Unins. 6. Pte Number. 7. Loan Number: 8. Mortgage Insurance Case Number:
4.E]VA 5.®Conv.Ins. 13.201 104305193 83334316
C. Note: This form is furnished to glue you a statement of actual settlement costs Amounts paid to and by the settlement agent are shown.
Items marked"(p.o.c)°were paid outside the dosing;they are shown here for informational purposes and are not included In the totals.
D. Name and Address of Borrower; E. Name and Address of Seller. F. Name and Address of Lender.
Lisa M.Southers Estate of Lots M.Coburn Primary,116Ndahlial Mortgage,
5308 Word Ctrde 1192 Lowther Road Inc,
Mechanicsburg,PA 17055 Camp Hill,PA 17011 1480 North 2200 West
Salt Lake City,UT 64116
G. Property Location: H. Settlement Agent I. Settlement Date:
1192 Lowther Road Midstate Abstract Compahy
Camp Hit,PA 17011 2331 Market Street Octobef 16,2013
Cumbedand County,Pennsylidnla Camp HID,PA 17011 Ph: (717)76.3-1383
Place of Settlement-.
2331 Market$treat
Camp Hit,PA 17011 . ..
J. Summary of Borrowers transaction _,•, K. -Summary of Sauees transaction
100. Gross Amount Due from Borrower. 400. Gross Amount Due to Sener.
101. Contract sales price T 123,000.00 401. Contract sales price 123,000.00
102. Personal property 402. Personal property
103. Settlement Charges to Borrower Line 1400 .5,707.58 403.
104. 404.
105. 405.
Ad ustrnentt for Items paid by S611er In advance I Adjustments for Items paid by Seller In advance
106. City/Town Taxes to 1 406.C /Town Taxes to
107. Countyfrwp.Taxes 10/15/13 to 01101/14 150.74 407. Countyrrwp.Taxes 10/15/13 to 01/01/14 150,74
108. School Taxes 10/15/13 to 07/01/14 ' 904.54 408. School Taxes 10/15/13 to 07/01/14 904.54
109. 4th Qtr.Se*erfTrash Proration,1 0/15113 to 01/0111 99.79 409.4th Qtr.Sewer/Trash Proration 10/15/13 to 01/01/1 99.79
110. 410.
111. 411.
112. 412., ..
126. Gross Amount bub frofil Boltowo. ,_„ ,,,. -.. 129,862.65, 42b._Groat.Ariidutit_bup to SrilltiP
200. Amounts Paid by or Id Bahalf of Bott•ower 500. RedubUont.In Amount but,Sbgel:_
201. Deposit or eamest money . .2,000.00 501. Excess deposit see instructions .
202. Principal amount of new loans 110,700.00 502. Settlement charges to Seller ne 1400 14,452.17
203. E)dstiir loans taken subject to 503, Existin lochs taken sUb
504. Payoff First Motta a to Cled oto
204. ttM g
age,IncAoah# 55,972.86
205. 505. Payoff Second Moftage
206. 506.
207. 507. De osil disb.as rooeeds
208. 508.
209. Seller Assist 3,600.001 509, SellerAssist 3.600.00
Ad Ustmetfts for hems Uh aid bY Sailer Adjustments for Itatns Un ald by Sellar
210. City/town Taxes to 510.C /Town Taxes. to..
211. CountylTwp.Taxes to 511,Countyl'rwp.Taxes to
212. School Taxes to 512.School Tastes to
213. 513.
214. 514.
215. 515,
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid b'Rof Borrower- ...... 116,300.00 520.Total Reduction Amount Due Seller,: 74,025,03
300. Cash at Settlement from/to Borrower 600. Cash at settlement toffrotn Seller
301. Gross amount due from Borrower Olne 120 129 862.65 601. Gross amount due to Seger fine 420 124,155.07
302. Less amount paid by/for Borrower fine 220 ( 116,300.00 602. Less reductions due Seger tine 520), ,. . ( 74,025.03
303. Cash ❑X From ❑ To Borrower 13,562.65 11603. Cash ❑X To ❑ From Seller. 50.130.04
'Paid odsife ofdpsinp by boaaver(B),m1WS),NndeQy,Or Gird- d)(T)
The undersigned hereb a owl receipt of ompleted c py of this statement&any attachment 'ed to he
Borrower Sellar
U Sou ers Estate of Lots M`Coburn
The Publt Pnporfhp B rdon for brb colkctim of hfvrnition to asdnaied et ffi rrimbs per msporee forodrMCtinp,m0erwhp.endreporriry thedaie Thh agencymy nd collectttis Momirtbn endyou■,e rotr"Umd to
compote tris roan,urim l 6spleys a wRSnfiy velfd OMB cortml relnba.No cmrdmtiaitty b essue4Iris dsdosum is nerdstory.TNS b deebned to provide the pontes to a RESPA covered transadon-th hiorrre8m
dur)rp the sedlom rA process. Page 1 of 3 HUD-1
(SOUTHERS.LISAAP FD/13-201/6)
L Settlement Charges
700.Total Real Estate Broker Fees $7,164.00 Paid From Paid From
Divsion of commission(fine 700)as folbws.' Borrowers Sellers
Fundsat Funds at
702.$ 3,582.00 to RE/MAX Really Associates Settlement Settlement
703.Commission paid at settlement 7.164.00
704.
705.
800.items Payable In Connection with Loan
801.Our origination charge $ 995.00 from GFE#1
802.Your credit or charge(points)for the specific Interest rate chosen $ (from GFE#2) "
803.Your adjusted origination char es from GFE#A 995.00
[81057..Appraisal fee to Nations Valuation SeMces from GFE#3 425.001- M
.Credit R rt to from GFE#3)
.Tax service to from GFE#3
Flood certification to from GFE#3• from GFE#3. from GFE#3• from GFE#3(from GFE 43)
900.Items Required by Lender to Be Paid In Advance
901.Daily interest rha es from 10/15/13 to 11101/13 17 @ $14.606300/da (fro m GFE#10 248.31
902.MorigaQe insurance premium for months to Radian from GFE#3
903.Homeowner's insurance for 1.0 years to State Fans from GFE#1R Iic #38-CD-F406-8 425.00 .
904• from GFE#11
905. from GFE#11)
1000.Reserves Deposited with Lender
1001.Initial deposit for your escrow account (from GFE#9) 601.27
1002.Homeowner's insurance 2.000 months @ $ 35.42 per month $ 70.84
1003.Mortgage insurance 0.00 months 45.20 per month $
1004.Property taxes $ _
Countyrrwp.Taxes months $ per month
School Taxes months $ per month c
1005. $
1006.Countyrrwp.Taxes 8.000 months @ $ 58.78 per month $ 470.24
1007.School Taxes 4.000 months @ $ 106.23 per month $ 424.92
1008. $ -
1009.Aggregate Escrow Adjustment $ -364.73 y N•:-M
1100.Title Charges
1101.Title services and lenders title insurance. from GFE#4 1,270.001 30.00
1102.Settlement or closinp fee
1103.Owners title Insurance to Mldstate Abstract Com an•Insurance Aoci from GFE#5 60.00
1104.Lenders title Insurance to Midstate Abstract Company Insurance AccL $ 1 105:00
1105.Lenders title policy limit 110700.00 •:?;:_r`. .
1106.Owners We policy Omit $ 123,000.00
1107.Aaents obrtion of the total title Insurance premium to Midstate Abstract Company $ 1,043.20
1108. Underwriter's portion of the total We insurance premium to Midstate Abstract Company Insurance Ac $ 121.80
1109. $
1110. $
1111. $
1112.Escrow for Inherftanoe Taxes to Rea er8 Adler,P.C. $ 4,675.00
1113. $ _...
1200.Government Recording end Transfer Charges
1201.Government recording charges to Recorder of Deeds Office from GFE#7 156.00 :.
1202.Deed$ 69.00 Mortgage 89.00 Releases$ Other
1203.Transfer taxes to Recorderof Deeds Office from GFE 1 j230.00
1204.C /County tax/stamps beed $ J,230:00 mortgage$
1205.State tax/stamps Deed $ 1.230.60 Morf a e$ 1,230.00
1206.
1207,
1300.Additional Settlement Charges.
1301.Required services that you can shop for from GFE#6 295.00
1302. $
1303.Broker Fee to RE/MAX Realty Associates $ 295.00
1304. $
1305. $
1306.Tax Certification to Bonnie Miller,Tax Collector $ 10.00
1307.3rd and 4th C*.Sewer/Trash to Lower Allen Township Authority $ Acct#10130800 247.17
1308.Home Wenanty to Amedran Home Shield $ Contract#137962072 . 460.00
1309.Pest Treatment to Sudden Death Termite&Pest Control $ 636.00
1400.Total Settlement Charges(enter on lines 103,Section J and 502,Section K) 1 5.707.581 14,452.17
*Paid oLd be of clos ing by boov-(B)•eefw(s)•le'+de4U,or aird•pad)(T) `
eysrprkppapst ofuft Shle tma stnabiae sd=Wedge reoept of cornpteted copy orpa0e 2d 3 of this tree pace sbtrrert r
Midstate Abstract CorWAny,Settlement Agent
Certified to be a true copy.
Page 2 of 3 HUD-i
(SOUTH ERS.LISAP F'D/13-201/6)
Comparison of Good Faith Estimate(GFE)and HUDA Charges Good Faith Estimate HUD-1
ICharges That Cannot Increase HUD-1 Line Number
Our origination charge # 801 995.00 995.00
Your adjusted origination charges # 803 995.00 995.00
Tran star taxes #1203 1,230.00 1,230.00
Charges That in Total Cannot Increase More than 10% Good Faith Estimate HUDA
Government recording charges #1201 175.00 158.00
Appraisal fee # 804 450.00
425.00
Total 625.00 583.00
Increase between GFE and HUD-1 Charges $ -42.00 or -6.721
Charges That Can Change Good Faith Estimate HUDA
Initial deposit for your escrow account #1001 2,124.96 601.27
Daily interest charges # 901 $ 14.6063001day 204.54 246.31
Homeowners insurance #903 450.00 425.00
Title services and lenders Ube insurance #1101 1,280.00 1,270.00
Owners title insurance to Midstate Abstract Company Insurance i 91103 50.00 60.00
Broker Fee #1303 295.00 295.00
Loan Terms
Your initial loan amount is $110,700.00
Your loan tern Is 30.00 years
Your Initial Interest rate IS 4.7500%
Your Initial monthly Amount owed for principal,Interest and $622.66 includes
any mortgage Insurance is ❑ Prindpal
O Interest
Q Mortgage Insurance
Can your Interest late rise? ❑X No ❑ Yes,it can rise to a maximum of %. The first
change will be on and can change again every_months after
Every change date,your Interest rate can Increase or decrease
by %.Over the life of the loan,your kderest rate IS guaranteed
to never be lower than %or hig her than %.
Even if you make payments on rim@,bdtl your loch balance rise? ❑X No ❑ Yes,it can rise to a maxkrium of$
Even if you make payment's bh time,can your monthly ❑X No ❑ Yes,the fits}increase can be on and the monthly
amount owed tot principal;Inter6mi and mortgage lrlaurance rise? amount owed can dse to$
The maximum it can ever rise to Is$
Doc§your loan have a prepayment pehAlty? 0 No ❑ Yes,your maxmum prepayment penalty is$
Does your loan have a balloon payhiaht? ❑X No ❑ Ye§,you have a balloon payment of$
due in_years on
Total monthly amount owed including escroW account payinerit8 ❑ You do not have a monthly escrow payment for items,such as property
taxes and homeowner's insurahce. You must pay these Items directly
yourself.
X❑ You have an additional monthly escrow payment of$200.43 that results
Ina total Initial monthly amount owed of$823.09. This includes
principal,interest,any mortgage Insurance and any Items checked below:
fL^J Property takes ❑X Homeowneslnsurance
❑ Flood Insurance L_l School taxes
❑ ❑
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
(SOUTH ERS.LISAPFD/13-2 01/6)
HUD-1 Attachment
Borrower(s):Lisa M.Southers Selle(s): Estate of Lois M.Coburn
5308 Oxford Circle 1192 Lowther Road
Mechanicsburg,PA 17055 Camp Hill,PA 17011
Lender:Primary Residential Mortgage,Inc.
Settlement Agent:Midstate Abstract Company
(717)763-1383
Place of Settlement:2331 Market Street
Camp Hill,PA 17011
Settlement Datei October 15,2013
Property Location:1192 Lowther 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
4th Qtr.Sewer/Trash Proration 117.70 10/01/13 through 12/31/13 99.79
Total Line 109/409 99.79
Seller Loan Payoff Details
Payoff First Mortgage to CitiMortgage,Inc. Re:Loan#2136856
Loan Payoff 55,972.86 As of 10/17/13
Total Additional Interest -2 days @ Per Diem
Total Loan Payoff 56,972.86
Adjusted Wigiriatioh Charge Details
Origination Charge
Administration Pee 245.00
to Primary Residential Mortgage,Inc..
Underwriting Fee 400.00
to Primary Residential Mortgage,Inc.
Processing Fee 350.00
to Primary Residential Mortgage,Inc.
total $ 995.00
Origiriation credit/chatge(pbirlt9)for the specific interest rate chosen
Total $
Adjusted Origination Charges $ 995.00
Reserves Deposited with Lender
Homeowner's Insurance 70.84
2.000 at 35A2 per month
County/Twp.Taxes 470.24
8.000 at 58.78 per month
School Taxes 424.92
4.000 at 106.23 per month
Aggregate Escrow Adjustment -364.73
Total $ 601.27
WARNING: it is a crime to knowingly make faise statements to the United States on this or any similar form. Penalties upon conviction can
Include a fne and Imprisonment. For details see:Title 16 U.S.code Section 1001 and Section 1010.
(SOUTHERS.LISAP FD/13-201/6)
HUD-1 Attachment- Continued
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 . 5.00
to Midstate Abstract Company
Overnight Fees 15.00
to Midstate Abstract Company
Wire Out Payoff 25.00
to Midstate Abstract Company
Lender's title insurance 1,105.00
to Midstate Abstract Company Insurance Acct.
Total $ 1,270.00 $ 30.00
OWnees Title InsUrgrit a BORROWER SELLER
Owner's Policy Premium 60.00
to Midstate Abstract Company Insurance Acct. ,
total $ 00.00 $ 0,00
Lender's Title Insuranfib 19ORROwtil SELLER
'Fees alsd sho*n 66yo hi tali Sarvitas end Lenders title Insurance datails
Lender's Policy Premium 955.00
to Midstate Abstract Company Insurance Acct.
Lender's Endorsement Charges 150.00
Endorsement Endorsement Charge
PA 100,300,8.1 150.00
Total $ 1;105.00 $ 0.00
WARNING: It Is a crime to knowingly make false statements to the United States on this or any simllar forth. Penalties upon conviction can
Include a fine and imprisonment. For details see:Title f8 U.S.Code Section 1001 and Section 1010.
(SOUTH ERS 11SAY FD/13-201/6)
ESTATE OF
LOIS M COBURN
21 - 13-0891
SCHEDULE E
REV-1508 EX+(o8-12)
Zpennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE DECEDENT URN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF:
Coburn, Lois M FILE NUMBER:
21-13-0891
Include the proceeds of litigation and the date the proceeds were received by the estate.
ITEM All property jointly owned with right of survivorship must be disclosed on Schedule F.
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1. Real Estate located at 1192 Lowther Road, Lower Allen Township,Cumberland County,PA
43.00
Reimbursement/Refund
2 Bank Account-Checking-PNC-5006447463
10.00
3 Real Estate located at 1192 Lowther Road, Lower Allen Township,Cumberland County, PA
. 1,155.07
Reimbursements of County&School taxes paid to date; Reimbursement of Sewer/Trash.A copy of the
HUD-1 Settlement Sheet is attached
TOTAL(Also enter on Line S, Recapitulation) $ 1,208.07 i
If more space is needed,use additional sheets of paper of the same size.
I
ESTATE OF
LOIS M COBURN
21 -13-0891
SCHEDULE H
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
' DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Coburn, Lois M 21-13-0891
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Weidman Funeral Home
6,654.21
2 Elan Memorial Park 7,363.82
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 5,000.00
Name(s)of Personal Representative(s) Patricia Albert
Street Address 6416 Terrace Court
city Harrisburg State PA zip 17111
Year(s)Commission Paid: 2014
L.0'w 0�(�C'L 66hns 3c_ac�I p 4,237.50
2. Attorney Fees: ate, � . 9
5?A I.10'4 3 3,500.00
3. Family Exemption: (If decedeg's address is not the same as claimant's,attach explanation.)
Claimant Debra Wright
Street Address 1192 Lowther Road
City Camp Hill State PA zip 17011
Relationship of Claimant to Decedent Daughter
4. Probate Fees: 353.50
S. Accountant Fees:
6. Tax Return Preparer Fees:
7• Other Administration Cost 14,108.64
Bowmans-furnance repalacement for estate sale 2371.00
Brian Albert-Contractor work for estate sale 3280.00
Lisa Southers- A/C repair for estate sale 2549.00
Patricia Albert-expenses to prepare estate for sale 5693.33
Cumberland law journal and Patriot News Co 209.31
TOTAL(Also enter on Line 9, Recapitulation) $ 41,217.67
If more space is needed,use additional sheets of paper of the same size.
i e d e m a n ackler-Wiedeman.
FUNERAL HOME', INC:. F U N E R A L H O M. E
357 South Second Street 23rd and Derry Streets
Steelton,PA 17113-2524 Harrisburg, FA 17104-2726
717.939.2344 , 717.564.1434
Dennis L.Wiedeman,F-D.;Supervisor - .I. . . James W.Taljan, F.D.—Supervisor
STATEMENT OF • •
Charges are only for those items that you selected or that are required. If we are required by law or by'o cemetery or crematory to use any items,we will explain in writing below.
If you selected a funeral that may require embalming,such as a funeral with viewing,you may have to pay for embalming. You do not have to pay for embalming you did not
approve if you selected arrangements such op a,direct cremotion or irn ediate burial. If we charge for-embalming,we will explain why below.
For the Service of: �'`= � l ' ' !�`��� ✓ Date of Death:
-7-
''• , r /`, r.'; t'
Charge to:,
jC_'6s.'z. .lr'
Name Address City State Zip
• . SELECTED: Flowers.....................................................................
�' ✓
1. PROFESSIONAL SERVICES _
Services of Funeral Director/Staff................................. $ f;w ove Cremation Urn $
..• ..........................................................
Embalming................................................................ $ I / Description
Dressing, Casketing and Cosmetology......................... $
Other preparation of body.......................................... $ Urn Appliques/Medallions .......................................... $
Engraving ......... $
Interior and Exterior Crucifixes ....................................'' $
(Al) SUB TOTAL OF PROFESSIONAL SERVICES..............$ _d � •0'n Refrigeration.............................................................. $
(B) TOTAL MERCHANDISE SELECTED ... $
2. FACILITIES/SERVICES/EQUIPMENT
Use of facilities and services for viewing SPECIAL.CHARGES:
(Visitation/Wake)........................................................ $ Forwarding of remains to............................................ $
Additional staff and equipment for viewing in
church or residence ................................................... $ (funeral home)
Use of facilities and services for funeral ceremony or Receiving Remains from.............................................. $
additional staff and equipment for service in church
orresidence .............................................................. $ Y�s7(y (funeral home)
Use of facilities and services for Memorial Service......... $ Immediate Burial ....................................................... $
Use of equipment and services for Groveside Service.... $ Direct Cremation ....................................................... $
(A2) SUB TOTAL OF FACIUTIES/EQUIPMENT.................$ (C) SUB TOTAL OF SPECIAL CHARGES. $ ' v
3. AUTOMOTIVE EQUIPMENT D. CASH ADVANCES:
Vehicle to transfer remains to Funeral Home—Local ..... $ Opening Grave/Crypt/Niche...................................... $
Hearse (Casket Coci6)—Local................................... $ Cemetery
Equipment $
Limousine—Local ...................................................... $ Newspaper mot $Notices—Loca
Family Car—Local..................................................... $ Newspaper Notices—Out-of-town .............................. $
Useof Utility Vehicle................................................... $ rp,.t�s Honor Guard ............................................................ $
Out of town transportation ......................................... $ Airfare ...................................................................... $
Clergy Honorarium $ /��r• '`d
....................................................
(A3) SUB TOTAL OF AUTOMOTIVE EQUIPMENT............$ 7h,/7 Pallbearers ..............................................,................. $
(A) TOTAL OF PROFESSIONAL SERVICES, FACILITIES r�./ `�
Certified Copies of Death Certificate ,:st....Ct,.....f.�r✓..$
Crematory Charges .4 l 1 ...;"r;?.... $
AND AUTOMOTIVE EQUIPMENT ... $ J `.r",r� ry g "' �� f %"""'
Coroner Cremation Authonzatiori..t�rtr .c� .r....
• . Organist...................................................................$ -
Soloist.......................................................................
Casket......................... .......................................... $ /:<' Altar Servers..............................................................
��ro
Descript�t n 4 :1d.s''W'-r4,
D SUB TOTAL OF CASH ADVANCES.. $ c �
Other Receptacle.....................:................................. $ . . •
�. . . Description •,, _., ., � � 1•.
A 'f'rofessi000l Services,Faltttes aid 1 qurpmenf arrc)r d
^�.
(-•--.•Outer Burial Container........:...................................... $
_ TMI
De�cnptiora
B.-,- Mer. ondise
Specia) Charges
$ P,rr{C4� AdvF�AL15ECT10 . $ ,
} � a1M�'OF� N$ ARRAN;.
it RR1bR TO t CEMENTS
et71C1ry rOfdflr5' x
('rayei-Cards .................
T
REASON FOR EMBALMING:
emporary Grave Marker.............
............,. $
Check Images . Page 1 of 1
METRO
BANK
Check Images
Account: ESTATE CHECKING(*1683) 1 Check Number. 102 Date Posted: 11/6/2013 1 Amount: $6,654.21
Zoom In 4 Zoom Out Q Print
ESTATE OF LOIS U COSURK 10-18 102
6416MRACE Cr
HMFUSMGFPA 17111 ea�ttvsta
enA ui`GO Dollars
METRO
BARK
For
1`0313a184Grt: 2843?41683n8 01G2
y�
Cr
M
Technical Support: 800-204-0541
Copyright 02009 Metro Bank Online Banking.
mam Member
&.3Y FDIC
Ali Rights Reserved.-Metro Bank is a wholly owned subsidiary of Metro Bancorp,Inc,and is not affiliated with Metro Bank Ltd,Great Britain
https://online.mymetrobank.com/Accounts/ChecklmageViewer.aspx?i=3&n=102&d=2013-... 3/8/2014
zINVOICE:=56952:`.�- ,
�. �- ,-
ELAN MEMORIAL PARK
5595 Old Berwick Road
Bloomsburg PA 17815
ors
Patricia Albert ,3
6416 Terrace Ct
Harrisburg PA 17111 113
717 802 1945
Quantity Description Unit Price r24 l
1 Adult Burial Enclosure 2495.00 0
Eagle Corinthian
1 Temporary Grave Marker 27,00
1 Plot Location 49-B—Green Lawn Section 1500.00 0 Opening/Closing of Grave 600.00 .
1 Marker-Companion Dynasty Rose 2325.00 2325.00
56"a 16" Bronze
Lois M Coburn and Robert L Coburn
Total including Tax 7363.82
I
Make all checks payable to ELAN MEMORIAL PARK z i
THANK YOU FOR YOUR BUSINESS! � �
��IW 129M in
`;NAME' "C�
. :. . .. .....
13 319'
DATE.. .. .
PAY TO THE
ORDER 04F
�.� s
,. D.OI:I:ARS B.�
: .. :
SANK-4
.. .... . . ..
. .... .....
:0:3: `3 L846a °:°:_2:8::43'.7.k-It8 '3'n':.:0'1S3::: ;.:::;
i
i
301 AL4RKET STREET L r
�1� ' O! T' P1 �'
P.O. =109
LEMOYNE,PA 17043-0109
717.761.4540 ' '
EIN:25-1802360
February 18,2014
Estate of Lois M. Coburn Statement No. 98658
c%.Mrs. Patricia K. Coburn Albert,Executrix 017730-00001 EGM
6416 Terrace Court Billed through 02/18/14
Harrisburg,PA 17111
Re:'Estate Administration
FOR PROFESSIONAL SERVICES RENDERED
07/31/13 Office conference,with Ms.Patricia K. Albert re Mother's death;Family;
Review Will; General administration;Assets;Liabilities;Listing/value of
real estate; Tangible personal property; Probate;Inheritance tax
07/31/13 Office conference with Mrs.Albert;Open Estate Administration files
08/08/13 Review Petition for Probate, Grant of Letters Testamentary; Will.
08/08/13 Process data into Estate accounting system;Draft Petition for Probate and
Estate Information Sheet; Organize estate files
08/12/13 Telephone conference with Ms.Albert re Probate proceeding before
Register of Wills
08/14/13 Revise probate documents; Calculate probate fees; Telephone conference
with Ms.Albert reprobate costs
08/15/13 Meet Ms.Albert @ Register of Wills,Carlisle to present Petition for j
Probate and Grant of Letters
08/29113 Email to EGM re: owner search of Real Estate;to Ms.McNally at
Lawyers Realty re: Owner Search;,to Ms.Albert re: information needed 3
on assets and debts for Estate;Prepare Notice to Beneficiary,Certificate
of Notice,Notice of Estate Administration,correspondence to Register of 1
Wills re:Certification to PA Treasury re:claims to Patriot News and
Cumberland Law re:Notice for Publication;Email to Ms.Albert re:
i
address for sibling i
09/05/13 Review and respond to email; Telephone conference with Ms.Albert; j
Discussion of
. .a_d. i..n.istr_ati.on issues with EGM re:payment of funeral bill .. .. ,. . .�.... .. ,..� -
PLEASEMAKECHECKPAYABLE,TO "JOHNSONDUFFIE"
AND INCLUDE STATEMENT NUMBER ON'
N YOUR CHECK. TRANS YOUI***
j
Statement.No. 98658 017730- 00001 Page 2
09/13/13 Review and respond to email; Discussion of issues with EGM re: sale of
residence; Draft DPW letter
09/14/13 Draft Deed;Revise Certification of Notice'
Forward documents to Register of Wills and Ms.Albert
09/25/13 Review Pest Inspection Report;Home Inspection Report
09/26/13 Review Notice from Patriot News;Data entry into estate accounting
. . system;Review of email re:inspection
10101113 Review data and update estatefile;Respond to email
10/03/13 Review Estate Recovery Claim from DPW; Telephone conference with
Mr. Coburn re same;Forward to Ms. Albert
10/03/13. Review of documents;Research PEF Code;Review of issues re
transferee liability for Estate Recovery claim with EGM
10/08/13 Acquire EIN number for Estate; Email to Ms. Albert
10/08/13 Review correspondence;Update Fiduciary Income Tax Returns
10/09113 Conference with DLW re settlement;Review/revise proposed deed;
Conference with Lawyers Realty re Agreement of Sale; Telephone
conference with Ms.McNally;Review easements;Telephone conference
with Ms. Albright re Notice of DPW claim;Escrow for inheritance tax;
Presettlement possession;Research nature of DPW Estate Recovery
Claim;Liability of Personal Representative;No liability of transferee for
value
10/09/13 Telephone conference with Sue,Reager&Adler;Review file;Revise
Deed; Telephone conference with Lawyers Realty and Ms. Albert re
settlement;Edit Deed;Email settlement documents.to Reager&Adler;
Email to EGM re: voice mail;Discussion with EGM re:DPW Claim
-10/10/13 Telephone conference with Attorney Confair re proposed escrow for
DPW claim; Review regulations re sale for fair market value;No liability-
of transferee
10/10/13 Review email re:Estate Recovery Claim;Discuss Estate Recovery issues
with EGM;Email estate documents to Reager&Adler and payoff of
Mortgage-
10/11/13 Email to Ms. Sather at Reager&Adler re:payoff and HUD-I reminder;
Telephone conference with Ms. Sather
10/15/13 Review HUD-1; Prepare for and attend settlement with Ms. Albright at
Attorney Confair's office
Prepare documents for settlement for EGM review
*PLEASE MARE CHECK PA YA BLE TO VORNSON D UFFIE,,
AND INCLUDE STATEMENT NUMBER ON YOUR CHECK
THANK YOU/***
Statement No. 98658 017730- 00001 Page 3
10/17/13 Update estate accounting system;,Email to Ms.Albert re: expenses to be
paid; Email re: fees
10/30/13 Review DPW claim re hospital bed; Other items in question;Telephone
conference with Ms. Albert re questions about charges from Office of
Aging;Her contact with caseworker- Oct. 07;Draft letter to R.
Messersmith, Claims Investigation Agent re dispute of charges; letter to
Mr.Messersmith re question's on Estate Recovery Claim
11/13/13 Draft correspondence to Ms.Albert re:documents needed for
administration
11/14/13 Review of administration file re: costs to be paid
12/05/13 Attempt to reach Mr. Messersmith re Estate Recovery claim;Letter to
Mr.Messersmith
12/06/13 Reviewei -mails re disbursements by Ms.Albert
12/10/13 Telephone conference with Mr.Porter,Chief,Recovery Section,re lack
of response from Mr. Messersmith
Review and respond to email with document requested
12/13/13 resp
12/17/13 Telephone conference with Ms.Hughes, Supervisor,Bureau of Program
Integrity,Division of Third Party Liability,Recovery Section, DPW re
our letters and questions;Their role;Payments of provider charges;
Challenges must go to providers
12/20/13 Attempt to reach ATG re charge on Estate Recovery claim for rental;
Telephone conference with Ms.Albert re status;Telephone conference
with Ms.Johnson of Cumberland County Aging and Community
Services re nature of challenge to Estate Recovery claim
01/14/14 Conference with DLW re advance payment;Amount of tax; DPW Estate
Recovery claim;Telephone conference with C.Landis of Cumberland
County Office of Aging-no record of Lois Coburn;No record of
services to Robert Coburn;Telephone conference with C. Johnson of
Cumberland County Office of Aging-review of charges; Explanation
and request questions;E-mail to Ms.Johnson re Claim
01/14/14 Update estate accountin system with payments received;Discussion of
tax issues with EGM;Draft inheritance tax return;Email to Ms.Albert
02/17/14 Review email from Ms.Albert re: alternate arrangements for completion
of inheritance tax return;assemble documents in file for delivery to Ms.
Albert; Review time to date;Prepare Receipt and Invoice
***PLF-4SEjMXECffECKPAYABLE TO"JORANONDUFFLE"'
AND 17VCLUDE STATEMENT NUMBER ON YOUR CHECK. THANK YOUI***
Statement No. 98658
017730- 00001 page 4
Total Services $4,237.50
BILLING SUMMARy
Total Services $4,237.50
Total Disbursements $0.00
Total Services and Disbursements $4,237.50
Total Amount Due $4,237.50
i
I
***PLEASE MAKE CHECK PAYABLE TO VOHNSONDUFFIE"
AND INCLUDE STA TEMENTNUMBER ON YOUR CHECK THANK YOUI***
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Account: ESTATE CHECKING(•1683) 1 Check Number. 104 Date Posted: 3/5/20141 Amount: $4,237.50
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ESTATE OF LOIS M COBURN 10-18 . ,�
6416 TERRACE Cr
HARRISBURG.PA 17111 MMM3
JOHNSON.WMF,SiEN(f�C B
P
25-TSOM Y>"� Date
order o II $ LlI,7 w. Jp
(tim r��1 1 t nA► �{ u�,t aa=�f` ollers 8 ....�,
METRO
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For ITIJ --1
"1:0 1130 18461: 284374.168 u' O 104 M
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Mid. Penn Bank #017
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Technical Support: 800-204-0541
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is
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Account:TOTALLY FREE CHECKING ("6673) Check Number. 5391 Date Posted: 8/19/2013 J Amount:
$353.50
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JOHN 0 ALBERT 1042 ® 539
8188 SPRING KNOLL DR
HARRISBURG,PA 17111 ' 60-t84AIa
5 13
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PAYTO THE Regf DATE
of VIPs 5Q
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Phone: 717-532-6114
Bus Date: 08/16/2013 r_
Branch/Teller 0008/0122
08/16/2013 11:05:36
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Account: ESTATE CHECKING (*1683)1 Check Number. 101 Date Posted: 10/30/2013 1 Amount: $2,371.00
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ESTATE of LOTS M COBURN 10-13 '101 .
e418 TERRACE CT
HARRISBURG,PA 17111
ld-96-1,3
P nth
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1:031301a4G1: 2843?416a3'* 0101
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Brian Albert
146 W.Market St#3
Marietta Pa 17547
Estate of Lois Coburn
1192 Lowther Road
Camp Hill Pa 17011
8/8/2013
General Contractor Services at said above premises to prep estate for sale. Price includes
labor and materials. Painting of 9 rooms and ceilings,install plywood along kitchen and dining room,
lay in self adhesive floor tile in the entire kitchen area,install new baseboard trim,pull up carpet in
living and dinning area, yard maint,removal of furniture.
We propose hereby to furnish material and labor—complete in accordance with the above
specifications for the sum of $Three Thousand Two Hundred Eighty dollars. ($3280.00) . With
payments to be made as follows: When job is complete and estate is settled.
Any alteration or deviation from above specifications involving extra costs will be executed only upon
written order,and will become an extra charge over and above the estimate. All agreements contingent
upon strikes,accidents, or delays beyond our control.
See proposal for detailed items.
Respectfully Submitted
Brian Albert
' .
-
�
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Account: ESTATE CHECKING(*1683) 1 Check Number: 555 Date Posted: 10/17/2013.1 Amount $3,280.00
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Lois e6bLjPn 0555
�-YfIkL-.f W184
ACCOUNT NO. DATE 10— 12— 13 313
ORDER OF $f
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H.L.
2259\-V00DLA«7NT ST. PO Box 35
HARRISBURG PA 17104-2799 INC. LEN40YNE PA 17043-0035
mai1'�lilboum ui.com FUC#PA019662
Plumbing-Heating-Air Conditioning
Phone (717) 561-1206 Fax (717)561-0110
PROPOSAL & AGREEMENT
TO: Estate of Lois Coburn DATE: September 25,2013
1192 Lowther St
Camp Hill Pa 17011 JOB:
We submit the following quotation:
1.) To replace present air conditioning equipment with the following:
I—Goodman GSX13030125 ton air conditioning outdoor unit 28400 btuh cooling capacity 13 seer .
1—Goodman CAPF3030C6 cased evaporator coil
1—Pre insulated refrigerant line set
2.) To recover and dispose of any remaining refrigerant in present system according to EPA specifications.
3.) To connect new air conditioning equipment to present power and control wiring,to include new disconnect and
whip
4.} To connect new air conditioning equipment to present condensate piping using PVC pipe and fittings.
5.) To furnish and install a plastic equipment pad for new air conditioning outdoor unit
6.) To remove and dispose of existing air conditioning equipment
7.) All material and labor is warranted for 1 year from date of installation_
All material and labor fiamished complete.
For the sum of S 2,549.00
NOTE: Price firm for 30 days.
TERMS: One signed copy of proposal if accepted. Payment in full at time of settlement.
This Proposal is Accepted by: L BOW INC.
Purchaser ar .Powers
Date
H L Bowman,Inc.is an Equal Opportunity Employer
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Account: ESTATE CHECKING (*1683) 1 Check Number. 1031 Date Posted: 11/1/2013 1 Amount: $2,549.00
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https://online.mymetrobank.com/Accounts/ChecklmageViewer.aspx?i=3&n=103&d=2013-... 3/8/2014
5101 JONESTOWN RD LOWER PAXTON PA, 17112
STORE MGR: CHRIS HAMILTON 717-651-9699 i
4138 00057 78717 08/15/13 06:28 PM
CASHIER SELF CHECK OUT - SCOT57
r 073257132428 TRASH BAGS <A> - 16,84
3 HOST 42G 32CT 3MIL CONTRACTOR BAG
043318130052 SIMPLE GREEN -A>
SIMPLE GREN 9,g7
Z 043168702713E60WAA19P12P �AEANER 1260$$
GE 60W A19 DOUBLE LIFE SOFT WHITE 12
011les Barsaln Outlet SUBTOTAL 33.69
SALES TAX 2,03
----- --- --717-657-8243 TOTAL $35.72
---------=---=-=�= XXXXXXXXXXXX7899 VISA 35.72
ITEM Description QTY Item Total AUTH CODE 406236/7575371 TA
805862 CASCADE ACTPK 1 ` $3.99
569003 ANTIQUE WHT 1 t $7.j9 II f 1
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569003 3 ANl,1 , - II IIIIIIIIIIIII�I�IIIIIIII�II�IIIIII�IIIIIIIIIIIII
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5-{7185 1 .=° MASKINU 1 %2.29 4138 57 78717 08/15/2013 1218
53*113;, 1 .5" MAL.KIN6 1 V.29 RETURN POLICY DEFINITIONS
R18770 !.017 SCRUG R 1 $2.49 POLICY ID DAYS POLICY EXPIRES ON
A 1 90 11/13/2013
Sub Total 827.04 THE HOME DEPOT RESERVES THE RIGHT TO
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S11.62 LIMIT / DENY RETURNS. PLEASE SEE THE
RETURN POLICY SIGN IN STORES FOR
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$28.66 DETAILS.
BUY ONLINE PICK-UP IN STORE
AVAILABLE NOW ON HOMEDEPOT.COM•
CONVENIENT, EASY AND MOST ORDERS
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4000 UNION DEPOSIT RD.
HARRISBURG, PA 17109 (717) 540-0660
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E SALES#: FSTLANE2 13 TRANS#: 66897623 08-30-13
0 506325 MNWX WOOD FINISH CLOTHS N 7.97
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E o i SUBTOTAL: 27.71
TAX: 1.66
k. INVOICE 41691 TOTAL: 29.37
VISA: 29.37
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E� v'. a VISA:)0000000000Q(4882 AMOUNT:29.37 AUTHCD:694375
E ?;_ SWIPED REFID:897643052241 08/30/13 17:20:43
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STORE: 0522 TERMINAL: 41 08/30/13 17:20:50
o � �' # OF ITEMS PURCHASED: 4
EXCLUDES FEES, SERVICES ANn SPFCIAL ORDER ITEMS
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ITEM Description QTY Item Total
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53870° 9" GR ERGO 41 $3. z 569003 ANTIQUE WHT I 1 $7.c9
516A 2 1/2' AINT $1 .1' 569003 ANTIQUE WHT I 1 $7.99
53876 PURDY 2i' WOOD ' I $2.5
ft 569003 ANTIQUE WHT I 1 $7.99
538767 PURDY 2 WOOD 1 ' $2.5 801474 COFFEE MAKER 1 $19,99
537317 3PK ROL ER CO 1 $2:7 E : A
� 537482 TWIN DOOR LOC 1 $19.99
537317' 3PK ROLTER CO 1 $2.79
. Sub Total $63.95
Sub 143b1 $15.9 Tax
Tax 1 . 1'. 50.96' Total $67.79
Total' . 516 90'.
U1sa " $16.90}
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LOWE'S HOME CENTERS, INC. #
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1 HARRISBURG, PA.17109 (717) 540-0660 11
4200 DERRY ST HARRISBURG, PA 17111
STORE MGR. SCOTT SAURS 717-558-8105 !I - SALE -
SALES#: FSTLANE3 13 TRANS#: 24612019 08-27-13
4113 00059 35200 08/31/13 10:08 AM
CASHIER SELF CHECK OUT - SCOT59 LARGE SANDING
214335 3M 8PK60 GRIT NAD SANDING 1.97
043374185041 OAK TRANS <A> 15.97 SUBTOTAL: 12.94
1-5/8"X36"HRDWD TILE/VNYL TRANSITION
041116005923 CANDY <A> 1.78# { TAX: 0.78
TOPPS JUICY DROP POP LAYDOWN INVOICE 14385. TOTAL: 13.72
CASH : 20.00
SUBTOTAL 17.75 CHANGE: 6.28
SALES TAX 0.96 STORE: 0522 TERMINAL: 14 08/27/13 10:00:44
TOTAL $18.71 # OF ITEMS PURCHASED: 2
18.71 EXCLUDES FEES, SERVICES AND SPECIAL ORDER ITEM.'
XXXXXXXXXXXX4882 VISA TA , r
AUTH CODE 230215/1590128 4!
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LOBE'S HONE CENTERS, INC.
4000 UNION DEPOSIT R0. LOWE'S HOME CENTERS, INC.
HARRISBURG, PA 17109 (717) 540-0660 4NO-UNION DEPOSIT RD.
HARRISBURG, PA 17109 (717) 540-0660
- SALE -
SALES#: S0522YSI 978221 TRANS#: 22577034 08-15-13 - SA LE -
SALES#: S0522STI 1809165 TRANS#: 21729919 08-28-13,,,
447510 UAL 5-6AL PRO 4000 FLAT P 62.86
459027 3N 3-PACK 1.41-IN ON PAIN 15.48 447508 UAL GAL PRO 4000 FLAT PAS 13.97
16639 PROJECT SOURCE PAINT TRIM 3.08 219873 10-OZ ALEX PLUS WHITE (10 2.28
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2 6 1.54 246677 1/16"X1/16"X3/32" U NOTCH 3.58
235048 BLUE HAVK WELL PLASTIC TR 2.94 126143 BOS 168 1 1/2" FINISH NAI 9.97
3 6 0.98 459119 TEC SS GAL MULT FLOOR ADM 11.97
475933 I/O VISIONS BEIGE VINYL T 77.60
SUBTOTAL: 84.36 1 80 @ 0.97
TAX: 5.06 95840 11/16-IN X 8-FT WHITE COU 35.76
INVOICE 51961 TOTAL: 89.42 11 @ 2.98
VISA: 89.42 12246 3/81418' RATED SHEATHIN 17.35
HYLOWE'S CARD NUMBER: 481000367319116 1 SUBTOTAL: 172.48
I TAX: 10.36
UISA:XXXXXXXXXXXX7899 AMOUN1:89.42 AUTHCD:453869 I INVOICE 10750 TOTAL: 182.84
SWIPED REFID:577055052251 08/15/13 10:30:55 VISA: 181.84
UISA:XXXXXXXXXXXX7899 ANOUNT:182.84 AUTHCD:710776
SWIPED REFID:729940052210 08/28/13 18:45:40
STORE: 0522 TERMINAL: 51 OG+15/13 10:31:05
# OF ITEMS ''t1frtCHASED: T .- ,/
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® Questions?Please Visit us online at Page 1
contact us by Aug 5. U pplelectric.com
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1-800-DIAL-PPL D'u'e • s
PP (1-800-342-5775) 70500-73005 Aug 5, 2013
PPL M.�c unlreos M-F:8am to 5pm $383.69 f
Your Electric Usage Profile Billing Summary (Billing details on back)
Service to: Balance as of Jul 15,2013 $158.11
LOIS COBURN Charges:
1192 LOWTHER RD Total PPL Electric Utilities Charges $225.58
CAMP HILL, PA 17011
Meter:31725117 Total Charges $383.69
Your next meter reading is on or about Aug 13,2013. "mount Due By Aug;5;2D13} ��� r ! ka�> ;' ,r � kh,$3869
This section helps you understand your year-to-year Account Balance $383.69
electric use by month. Meter readings are actual unless PPL Electric Utilities'price to compare for your rate Is$0.08227 per kWh.
otherwise noted. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com
02012 02013 or www.oca.state.pa.us for supplier offers.
r
go 5 Your Message Center
x 50 • The$158.11 balance includes$1.11 in prior late
payment charges.
45 • With paperless billing,you can receive and pay your
30 PPL Electric Utilities bills online.The process is free,
1 15 quick,convenient and secure.To learn more or sign up,
visit pplelectric.com.
0 • Information about appliance energy use and tips on
J F M. A M J A A S. O N D saving energy are available through the Energy Library 8
Months on our Web site,pplelectric.com.
• Close drapes,blinds and shades on the sunny side of
Monthly Days Average Average your home during the hottest part of the day. It eases
• the load on your cooling system and saves energy.
Jul 2013 :32,"f :181' S8 ::a ,.., q.
r'. 'L,..f r ,
Ju12012 30'. 23`93... 80-' 771F —
• •• Payment Methods
Jul 15 Actual 28553 Online at: ®By phone:1-800-342-5775
Jun 13 Actual 26682 pplelectric.com or call BillMatrix(service fee applies)
at 1-800-672-2413 to pay using Visa,
32 Days kWh Billed 1871 MasterCard,Discover or debit card. =_
YcarIV.ComP _ ® By Mail: Correspondence should be sent to:
Aug 2012-Jul 2013 16147 1346 2 North 9th Street Customer Services =
CPC-GENN1 827 Hausman Road —
Aug 2011-Jul 2012 15906 1326 Allentown,PA 18101-1175 Allentown, PA 181049392
Other important information on the back of this bill 4
.._�............................ ................. ...........:........
m
•.\`�a��
® Return this part in the envelope _ . .
provided with a check payable
pp. to PPL Electric'Utilities. 70500-73005 Aug 5, 2013 $383.69
aPl�•atWC ut111U�s
Amount Enclosed:
AV 01 005999 84131B 23 A*.5DGT
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LOIS COBURN _� PPL ELECTRIC UTILITIES
1192 LOWTHER RD 1 (S� 2 NORTH 9TH STREET CPC-GENN1
CAMP HILL,PA 11011-7530 ALLENTOWN, PA 18101-1175
. .: III'111111,.1'lllll ( 111111111111111�1'111I11111.11Lilll'lll
1 0900003836990000383697 7050073005
U-1-AmrP as Bill Informaon-UGIti �r Customer Number
aAd dfdrief The account balance on your last bill was.._.............. $199.37 '^ '-' '• �' - 5=�-�
Billing Summary for Service to: Thank you for your payment of_........:: ,.. :. ..... -200.00 218194559055
LOIS COBURN Your balance as of 07/01/2613
1192 LOWTHER RD
CAMP HILL PA 17011
Rate Classification:
Residential Heating Current Bill Information-UGI Utility
Billing Period: Customer Charge... _ „„.. ......_.._:... ..:._ .... 8.55
05/29/2013 to 06/26/2013(28 days) Commodity Charge(21 CCF at$0.68429) .......... 14.37
Remote Device Read Distribution Charges(First 21 CCF at$0.33619) _. 7.06
Questions? PA State Tax Surcharge hang ...____... »^_ -„A_ _ .____.... ..__ _ $29.22
-0.13
Call 800-276-2722 or write to UGI at Total Current Charges-UGI U61i
PO BOX 130Q9 UGI Utility charges owed this bill
Reading.PA 19612-3009 Total Amount Due,Please Pay by Due Date(07/22/2013).„_„_..__.. _„_.. $29.22
Your current UGI charges include
State taxes totaling about$0.96.
Meter Information.7 Next Read Date July 29,2013
710 Average CCF Per Day Meter Number Previous Reading Present Reading CCF Used
6.39 1313446 853(remote) ' 874(remote) 21
5.68
4.97 Messages from UGI
4.26 Your current price to compare is$0.68919/CCF.
3.55
2.84 Your total annual usage is B69 CCF. Your average monthly usage is 72 CCF.
2.13 ■We can make your energy costs easier on your budget with our 12 month Budget Billing .
1.42 plan. Your monthly payment would be approximately$83.00. For more information
0.71 about this plan call UGI.
0.00 ■Help prevent pipeline damage,accidents and service disruptions.Call 811 before you dig.
J J A S O N O J F M A M J ■Save time.Save the planet Sign up to view and pay your UGI bills online at www.ugi.com.
2012 Months' 2013.
33.5 C_QX*:z RYA.- Ck�i CrV I
Last This AQa I I Z _ Vlsf� 3y / qD!
Average Year Year 1
CCF/day 0.75 .0.75
Daily temperature 70°F 72*F If you pay at a payment agent please take your entire bill. Make check payable to,UGl.
Keep this part for your records. Important information Is on the back of this bill.
t
UGI Utilities,Inc. Customer Number Please pay by the due daf
PO Box 15523 21819455955 to avoid the late charge.
Wilmington,DE19886-5523... Please return this portion
VAS af;#rief with your payment '
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2181945598550722020000.292200003700.00000000000000000006
Past Bill Information-UGI Utility' .USfQ11ICrtUt11bR f
�
rErrice The account balance on your last bill was.„..... $56.45
Thank you for your payment-of„„„....„..„„....w............ -29.59 218194559055
Billing Summary for Service to: Late Charge .. 0.34
LOTS COBURN r9 ..„„..,.......„„..„... ............_...,........„..„..„„..
1192 L0IMTHER RD
Your balance as of 08/29/201$(due.now).... .....:... 27.20
CAMP HILL PA 17011
Rate Classification:
Residential Heating Current Bill Information 'UGI Utility
Billing Period: Customer Charge.„..„......„„ ..„.„„„„..„„ .:„„„„„„„:.. 8.55
07/26/2013 to 08/2612013(31 days) Commodity Charge(12 CCF at$0:69000 8.28
Remote Device Read Distribution Charges(First 12 CCF at$0. 3583)•„. 4.03
Questions? PA State Tax Surcharge -_„„ „ „„„__„_„„ -0.09
Call 800-276-2722 or write to UGI at UGI Utility harass owed this lbill „ „„ „„_„„„„„„„„_ 7
PO BOX 13009 „„„„_„.._„„..„„., _„„„ $47.97
Reading,PA 19612-3009 Total Amount Due,Please Pay by Due Date(09/19/2013)-------------------- $47.97
Your current UGI charges include .'
State taxes totaling about$0.67.
, yt�+�rr. r��'`d�.`S �;:mrra� �""a fl»t i r �°fn���1�<S�`L•n�rz}"x:,,z v r`t�' S`"!t s 7"J?�1 a .
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x Average CCF Per rt r dinrr Dy' a CCF Ued 7.10 g
5
1313446 p92(remote)•.
5.68 -7--
4.97 Messages from UGI
4.26 •Your current price to compare is$0.68919/CCF..
3.55 ■Your total annual usage is 857,CCF. Your average monthly usage is 71 CCF.
2.84
■Help prevent pipeline damage,accidents and service disruptions..Call 811 before you dig.
1'42 ■Save time.Save the planet Sign up to view and pay your UGI bills online at www.ugi.com.
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Average Year Year.
CCF/day 0.69 0.39 If u a 'at4a payment agent lease take. ur entire bi.IL Make check payable to UGI.
Daily temperature 75°F 71°F you P Y PaYm 9 P Yo P Ya -
Keep this part for your records. I(nportant information Is on the back of this bill.
UGI Utilities,Inc Customer Number Please pay by the duedah
PO Box 15523 218.194559055 to avoid'the fate charge.
Wilmington,DE 19886-5523 Please return this portion
oei rr�riee with your payment
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Past Bill Information=UGI:Utility <' UStimer Number.. '
s l s sES riec The account balance on your last,bill $30.25 : �. rrtiaI
Payments.........„:.„...........:„„..::.. ..:.......„:.„..::..:...„„....... 0.00 218194559055
Billingg Summary for Service to: .Late Charge 0.38
LOIS COBURN rg ..„......„.w_.„............_.... _ ..........„.........._.
1192 LOWTHER RD Your balance as of 10/29/2012(due now}..:..... .:.:. 30.63
CAMP HILL PA 17011
Rate Classification:
Residential Heating Current Bill Information=UGI Utility
Billing Period: Customer Charge._ ..„ ..„..„.... :.„..........„„...:..„ ..„... -8.55
09/2512012 to 10/24/2012(29 days) Commodity Charge(31 CCF at$0.58839) _. 18.24
Remote Device Read Distribution Charges(First 31 CCF at$0.40258)„_. 12.48
Questions? PA State Tax Surcharge.„„„......ttyy„..„„„......_...._..„.._. -0.15
Cali OX 800-276-2722 or write to UGI at UGI Utility harg Charges'....oed this bill „„ „_,„ »»„»„••„_„„39.12„„.•_„ `„^„ „ $69.75
PO BOX 13009
Reading,PA 19612-3009 Total Amount Due,Please Pay by Due Date(11119/2012)..;--------------- $69.75
Your current UGI charges include
State taxes totaling about$.1.26.
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4.46 '::^ N`:`mot -^ Messages from UGI
3.84 Your current price to compare.is$0.60244/CCF.
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■Your total annual usage is 738 CCF. Your average monthly usage is 61 CCF.
2.56
1.92 ■Help prevent pipeline damage,accidents and service'disruptions.Call 811 before you dig.
9'28 ■Save time.Save the planet Sign up to view and pay your UGI bills online at wwwugi.com.
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CCF/day 58O 1.07 If u at a payment agent lease take your entire bill. Make check payable to UGI.
Dairy temperature 58°F 57°F � you P Ym 9 P yo P Ya
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PO Box 15523 =• 218194559055, to avoid the late charge.
Wilmington,DE 19886-5523.. , Please return this portion
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SERI;)'R.DUFFIE BARFIE B.GHHRj.EIN .
RICHARD W.STE)5'ART ANTHONY T.LUCIDO
EDMUND G.MYERS 1, A W 0 F ,F 1 C L- S CAROLYN B.MCCIAIN
JOHN A.S DELUGE OFNSON (olt.A.Luc)'
JOHN A.STATLER ULYSSES S.td'11SON
JEFFREY B.RETTIG JULIA A.MORRISON
1\IARA C.DUFFIE DUFFIE
n2ATTHEIY RIDLE)'
JOHN R.NINOS1:Y
MICHAEL).CASSIDY OF COUNSEL
MELISSA P.GrEEvy HORACE.A.JOHNSON
NVADE D.MANLEY C.ROY WEIDNER,JR,
November 14, 2013
Mrs. Patricia K.Albert
6416 Terrace Court
Harrisburg, PA 17111
RE: Estate of Lois M. Cobum
Our File No. 17730-1
FOR PROFESSIONAL SERVICES RENDERED:
DESCRIPTION
COSTS ADVANCED
The Cumberland Law Joumal
Notice of Estate Administration $ 75.00
The Patriot News Co.
Notice of Estate Administration
$ 134.31
BALANCE DUE $ 209.31
***PLEASE MAKE CHECK FAYABLE TO"JOHNSONDUFFIE"
AND INCLUDE STATEMENT NUMBER ON YOUR CHECZ THANK YOU!*** EGM
:591852
301 MARI{ET STREET P.O.Box 109 LEAlOYNE,PENNSYLVANIA 17043.0109
'VA-N1d'.JDSkCOM 717.761.4540 FAX:717.7613015 MAIL @IDSWCOM
JOHNSON, DUFFIE, STEWART & WEIDNER, P.C.
Check Images Page 1 of 1
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Account: ESTATE CHECKING(*1683) Check Number. 554 Date Posted: 1/17/2014 (Amount: $209.31
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https://online.mymetrobank.com/Accounts/CheckImageViewer.aspx?i=3&n=554&d=2014-... 3/8/2014
ESTATE OF
LOIS M COBURN
21 - 13-0891
SCHEDULE I
REV-1512 EX+(12-12)
1 pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Coburn, Lois M 21-13-0891
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 CitBank-CitiMortgage 55,972.86
I
2 :Real Estate Located at 1192 Lowther Road, Lower Allen Township,Cumberland County, PA- 18,052.17
;Settlement Charges for Sale of Real Estate sold October 15,2013. A copy of the HUD-1
i
i
Settlement Sheet is attached
I
i
fi
i
TOTAL(Also enter on Line 10, Recapitulation) $ 74,025.03
If more space is needed,insert additional sheets of the same size.
/""""\® CitiMortgage,Inc
Payoff Statement
PO Box 6243
Sioux Falls,SD 57117-6243 Statement Date: September 30,2013
Loan Type: CONVENTIONAL
Payoff Good Through: October 17,2013
Customer Name and Address:
LOIS M COBURN
00000821 6B i0Z273SIS0090DAM1 247 6416 TERRACE CT ='
Irll�rl�rl�l���lll�l�rirl�llll��l"il"�""t"�ill�"�""l�lnlrl►�lul HARRISBURG PA 17111.7033
Property Address: Z.-
""'"' 1192 LOWTHER ROAD
LOIS M COBURN CAMP HILL PA 17011 ;■
ESTATE OF �.
6416 TERRACE CT
HARRISBURG PA 17111-7033 Z=
Visit us at www.Cifimortgage.com
Principe!Balance as of 07/01'/13 $54,415.6 5 '=
Interest from 07/01/13 to 10/17/13 at 08.500°A 1,359.07 z
Escrow Overdraft 89.08 z
Late Charge(s) 53.56 z
Recording Fee 55.50 z
rotal secured 6y Mortgage 55,972,66 z"`
Total To Pay Loan in Full $55,972.86 z'
int per diem at 08.500000%-. $12.67• Escrow $0.00 I.
Interest: z
If the current months payment has not been received by CitMortgage on or before 15 days after the due date,please include a fate fee of:$26.78 in
the payoff amount.
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IMPORTANT: Please reforto the rovers*side of this statement for important information.This Payoff amount Is good through the data shown above,unless
additional account activity occurs prior to this data.(Refer to reverse of statement.)Fleas*call 1.800-283-7918;to confirm the amount prior to
sending Payof.Monthly mortgage payment must be made as scheduled.Please send a copy of the Payoff statement with the payoff funds.TTY
services available:dial 711 from the United States;dial 1.866.280.2050 from Puerto Rico.
Escrow Balance -89.08 :-'PLEASE iNCLUbE THE FORWARDING ADDRESS.Fbk', -.
,�, ,HE-"C'STOYER t9! THE'P,-YOFF TO ENSURE PROPER to:
c of{$iff P »; ex Dve1 a 1 p SAii i 6 OF AN�R'EFUN S OR 666 AIT
6 t: . �� 31.: ..t .... 'a�c ta .s. i*.,.sarrw raH,,s.?x rk ��.+.*«a .
LAST TAX PAID
SCHOOL TAX 08/15/13 -1,249.25
NAME •
ADDRESS
CITY
STATE ZIP
Tax and Insurance payment(s)may be made during the Payoff Statement period.We are
responsible for and will pay any Tax/Insurance bill(s)we receive before the payoff.We will
look to the closing agents for total funds If duplicate tax payment occurs.The above
Information covers a 60-day period from this statement date.The Mortgagor,not
CitiMortgage,Inc.,will be responsible for their own Tax and Insurance payments after payoff
of the loan.
See reverse side for wire Instructions.Closing agents,please provide a copy of this statement to our borrower.
'Calls are randomly monitored and recorded to ensure quality service.
ESTATE OF
LOIS M COBURN
21 -13-0891
SCHEDULE J
REV-1513 EX+(01-10)
pennsylvania SCHEDULE 3
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Coburn, Lois M 21-13-0891
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. Patricia Albert Daughter 100%
6416 Terrace Court
Harrisburg PA 17111
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:
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.