Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
03-12-14 (2)
_J 1505610140 REV-1500 EX (02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 1 2 6 4 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 1 2 2 2 0 1 3 0 2 0 8 1 9 2 3 Decedent's Last Name Suffix Decedent's First Name MI B I X L E R S R W I L L I A M H (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Q 1. Original Return 2.Supplemental Return 3.Remainder Return(Date of Death Prior to 12-13-82) 4.Limited Estate 4a.Future Interest Compromise(date of El 5. Federal Estate Tax Return Required death after 12-12-82) ❑X 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) 9.Litigation Proceeds Received 10.Spousal Poverty Credit(Date of Death 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 S U S A N J H A R T M A N 7 1 7 2 4 9 7 7w8 0 Q. t W , REGISTER d S USE ONLY j rrJ First Line of Address : .', —' r-'"'ri-i 1 I R V I N E R 0 W C"1 C3 Second Line of Address City or Post Office State ZIP Code DATE FILED C A R L I S L E P A 1 7 0 1 3 Correspondent's e-mail address: susan(pduncanhartman law.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.Declaratio f p!parer other than the personal representative is based on all information of which preparer has any knowledge. SIG O RSO ON LE R FILING RETURN ATE _;; Xy AD SS LINDSA LANE-,— CARLISLE, PA 17015 IGNA E OF PREPARER OT THAN REPRESENTATIVE ATE A?zy D ES PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J J 1505610240 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: WILLIAM H . BIXLER, SR RECAPITULATION 1. Real Estate(Schedule A) . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . 1. 1 6 6 0 0 0 , 0 0 2. Stocks and Bonds(Schedule B) 2. 4 1 3 4 6 , 9 6 . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . 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. 7 9 7 0 9 • 0 3 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . . . . 7. 2 6 5 3 0 6 , 3 8 8. Total Gross Assets total Lines 1 through 7 8, 5 5 2 3 6 2 • 3 7 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . .. . . . . . . . . . . 9• 2 2 7 0 1 • 4 8 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . . .. . . . . . 10. 1 7 3 4 9 . 4 2 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 4 0 0 5 0 . 9 0 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . .. . . . . . . . . . . . 12. 5 1 2 3 1 1 . 4 7 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. 5 1 2 3 1 1 . 4 7 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec. 9116 (a)(1.2)X.0 _ 0 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate x.045 5 1 2 3 1 1 . 4 7 16. 2 3 0 5 4 . 0 2 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 0 0 18. 0 . 0 0 19. TAX DUE .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 19. 2 3 0 5 4 • 0 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 13 1264 DECEDENT'S NAME WILLIAM H. BIXLER SR STREET ADDRESS 105 BRIGHTON DRIVE CITY STATE ZIP CARLISLE PA 17015 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 23,054.02 2. Credits/Payments 21,700.00 A.Prior Payments B.Discount 1,142.07 Total Credits(A+B) (2) 22,842.07 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) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 211.95 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 ...................................................................... ❑ ❑ b. retain the right to designate who shall use the property transferred or its income ............................... ❑ 0 c. retain a reversionary interest ..................................................................................................... F-1 d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ Q 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?.................................................................................................. ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S,§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in F2 P.S.§9116(a)(1)I. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 EX+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: WILLIAM H. BIXLER, SR 21 1�1 1264 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. 105 BRIGHTON DRIVE 166,000.00 CARLISLE, PA 17015 [SEE HUD ATTACHED] TOTAL(Also enter on Line 1,Recapitulation.) $ 166 000.00 __ ___ If more saace is needed use additional sheets of Daoer otthesame size. REV-1503 EX+(B-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER WILLIAM H. BIXLER, SR 21 13 1264 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PRUDENTIAL 104 SHARES @ 89.76 9,335.04 [SEE ATTACHED] 2. PPL CORPORATION 1,038 SHARES @ 30.84 TOD WM BIXLER JR 32,011.92 [SEE ATTACHED] TOTAL(Also enter on-Line 2,Recapitulation) $ 41 346.96 If more space is needed,insert additional sheets of the same size ___ REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: WILLIAM H. BIXLER, SR 21 1; 1264 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MEMBERS FIRST SAVINGS ACCOUNT#34531-00 54,226.39 [SEE DATE OF DEATH LETTER ATTACHED] 2. MEMBERS FIRST SAVINGS ACCOUNT#34531-11 22,293.86 [SEE DATE OF DEATH LETTER ATTACHED] 3. SALE OF 2002 CHEVY IMPALA 1,500.00 4. ERIE INSURANCE CAR INSURANCE REFUND 99.00 5. PRUDENTIAL DIVIDEND 55.12 6. COMCAST REFUND 34.21 7. TYCO ELECTRONICS PENSION 401.71 8. HIGHMARK REFUND 286.64 9. ERIE INSURANCE - HOMEOWNER'S- REFUND 202.00 10. PPL REFUND 41.27 11. TAX REIMBURSEMENT FROM CLOSING 480.07 12. HOA DUES REIMBURSEMENT FROM CLOSING 88.76 TOTAL(Also enter on Line 5,Recapitulation) $ 79 709.03 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER WILLIAM H. BIXLER, SR 21 1.3 1264 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. OPPENHEIMER IRA ACCT. #8818811179552 21,734.66 100.00 21,734.66 WILLIAM H. BIXLER, JR. & SALLY BOBB & SUSAN COWLEY-CHILDREN 2. NATIONAL WESTERN ACCT. #01-1230777 7,199.59 100.00 7,199.59 WILLIAM H. BIXLER, JR. & SALLY BOBB & SUSAN COWLEY-CHILDREN 3. NATIONAL WESTERN ACCT. #01-1230778 55,238.45 100.00 55,238.45 WILLIAM H. BIXLER, JR. &SALLY BOBB & SUSAN COWLEY-CHILDREN 4. ING ACCT. #90175504 19,265.83 100.00 19,265.83 WILLIAM H. BIXLER, JR. & SALLY BOBB & SUSAN COWLEY-CHILDREN 5. LINCOLN BENEFIT IRA ACCT. # LBCA141587 11,901.36 100.00 11,901.36 WILLIAM H. BIXLER, JR. & SALLY BOBB & SUSAN COWLEY-CHILDREN 6. FIDELITY&GUARANTY IRA ACCT. # L9099323 12,049.51 100.00 12,049.51 WILLIAM H. BIXLER, JR. & SALLY BOBB& SUSAN COWLEY-CHILDREN 7. FIDELITY&GUARANTY ACCT.# L9099324 20,972.96 100.00 20,972.96 WILLIAM H. BIXLER, JR. & SALLY BOBB & SUSAN COWLEY-CHILDREN 8. FIDELITY&GUARANTY ACCT. #L9131849 40,048.32 100.00 40,048.32 WILLIAM H. BIXLER, JR. & SALLY BOBB & SUSAN COWLEY-CHILDREN 9. FIDELITY& GUARANTY ACCT. #L91311854 40,084.06 100.00 40,084.06 WILLIAM H. BIXLER, JR. & SALLY BOBB & SUSAN COWLEY-CHILDREN 10. FIDELITY&GUARANTY ACCT. # L9131855 36,811.64 100.00 36,811.64 WILLIAM H. BIXLER, JR. & SALLY BOBB & SUSAN COWLEY-CHILDREN TOTAL (Also enter on Line 7,Recapitulation) $ 265 306.38 If more space is needed,use additional sheets of paper of the same size. 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 WILLIAM H. BIXLER, SR 21 13 1264 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN ROTH FUNERAL HOME 10,236.11 2. FUNERAL LUNCHEON 342.95 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: DUNCAN & HARTMAN, PC 11,000.00 3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 368.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. CUMBERLAND LAW JOURNAL- LEGAL NOTICE 75.00 8. THE SENTINEL- LEGAL AD 178.92 9. HELD IN RESERVE 500.00 TOTAL(Also enter on Line 9,Recapitulation) $ 22 701.48 If more space is needed,use additional sheets of paper of the same size. i I REV-1512 EX+(12-12) i pennsylvania SCHEDULE DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER WILLIAM H. BIXLER, SR 21 1;? 1264 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. APRIA HEALTHCARE 35.47 2. T.E. CONNECTIVITY- REIMBURSE PENSION 401.71 3. DIAKON -CUMBERLAND CROSSINGS 925.00 4. OMNICARE OF KING OF PRUSSIA 103.12 5. PPL 39.35 i 6. UGI 48.32 i 7. JARUSEWSKI OVERHEAD DOOR SERVICE INC. 600.00 8. CENTURYLINK 26.75 9. UGI 123.02 I 10. SOUTH MIDDLETON TOWNSHIP MUNICIPAL AUTHORITY 121.31 11. FIRST CHURCH OF THE BRETHERAN 2,000.00 12. APRIA HEALTHCARE 35.47 13. PPL 45.06 14. DELUXE CHECK FEE 15.50 15. PPL 41.27 TOTAL(Also enter on Line 10,Recapitulation) $ 4,977.04 If more space is needed,insert additional sheets of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent WILLIAM H. BIXLER, SR 21 1-4 1264 Decedent's Name Page 1 File Number Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. U-HAUL TRUCK RENTAL 107.75 17. MOVING EXPENSES 87.38 18. UGI 42.91 19. PPL 52.65 20. GROUPS TAX & PAYROLL SERVICES 125.00 21. PRUDENTIAL HOMESALE SERVICES GROUP 10,185.00 22. DUNCAN & HARTMAN, PC 325.00 23. RECORDER OF DEEDS TRANSFER TAX 1,660.00 24. SOUTH MIDDLETON WATER & SEWER 60.68 25. RESALE CERTIFICATION SUMMERFIELD 100.00 26. TAX PRO-RATON DUE PURCHASER 41.70 SUBTOTAL SCHEDULE 1 12,788.07 GRAND TOTAL SCHEDULE 1 $ 17,349.42 REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: WILLIAM H. BIXLER SR 21 13 1264 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. WILLIAM H. BIXLER, JR. Lineal 60 LINDSAY LANE 1/3 SHARE CARLISLE, PA 17015 2. SALLY BOBB Lineal 275 HIGH MOUNTAIN ROAD 1/3 SHARE SHIPPENSBURG, PA 17257 3. SUSAN COWLEY Lineal 216 PINTAIL LAKE DRIVE 1/3 SHARE GILBERT, SC 29054 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. WILLIAM H. BIXLER, SR. ell William H. Bixler, Sr. , of South Middleton Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will or codicil previously made by me. My wife' s name is Calantha T. Bixler and is hereinafter referred to as "my spouse. " I have three children living at the time of the execution of this my will: Susan E. Cowley, born January 1, 1948; Sally A. Bobb, born April 14, 1953; and William H. Bixler, Jr. , born .october. 1, 1951 In this will, the words "child" or "children" shall mean my above-named children and all my children hereafter born or adopted, but excluding stepchildren and foster children. • II. PAYMENT OF DEBTS AND EXPENSES I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate; provided that, if any property (including life insurance) , owned by me jointly or individually and passing under this will or otherwise, shall be 't n LAST WILL OF WILLIAM H. BIXLER, SR. PAGE 2 encumbered, the indebtedness secured by such encumbrance shall not be paid by my estate and such property shall pass subject to all encumbrances existing at my death. III. PAYMENT OF TAXES All federal, state-; and other- death taxes (except those payable=' in respect tv any property 'located outside of the. 'United States of America) payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this will; including any interest or penalty imposed in connection: with such tax, shall be considered a part of the expense of the- administration of my estate and shall be paid out of the principal allocable to my residuary estate, if any, otherwise from legacies last preferred in distribution, without apportionment or right of reimbursement. All such taxes on present or future interests shall be paid at such time or times as my executor or my trustee may think proper, regardless of whether such taxes are then due. I'V SPECIFIC GIFTS OF TANGIBLE PERSONAL PROPERTY I make the following specific bequests: a) I give to my son, William H. Bixler, Jr. my. diamond 32 ring. b) Household furnishing and effects. I give and bequeath unto my spouse all of my tangible personal property and household effects of personal use, such as clothing, jewelry, precious stones, LAST WILL OF WILLIAM;H. BI%LER, SR. PAGE 3 books, pictures, rugs, musical instruments, china, glass and silverware, furniture, vehicles, tools, hobby items, boats and pets, of every kind and description and wherever located, and any policies of insurance on any of said property, the same to belong to my spouse absolutely. I do not intend hereby to claim an interest in any such property which may already belong to my spouse and I authorize my Personal Representative to honor,, in the discretion of my Personal Representative, any claim, of ownership with reference to any such property. C) Alternate disposition of household furnishings and effects. If my spousQ `does not survive me, then I give and bequeath all of my said tangible per property and any policies of insurance on any of said property, to my children living at the time of . my death, share and share alike. I give my personal representatives full power and authority to determine the property, real and personal, referred to in the paragraph- above, and their determination shall be binding and conclusive upon all persons. If any personal property passes to more than one child enumerated in the paragraph above, and .such children or their conservator, if any child is . .a, . minor,; do not agree among,,, themselves as to the division of personal property within 60 days after my death, I give my personal representative full power and authority to divide such articles among such children/conservator as nearly equal in value as may be and their determination of shares shall be binding and conclusive upon such children/conservator. LAST WILL OF WILLIAM H. B-IXLER, SR. PAGE 4 c) If my spouse fails to survive me by thirty (30) days and my youngest surviving child has attained age 18, I give my personal property to my surviving children, to be divided by them as they agree, or if they fail to agree within four mouths after my personal representative is appointed, , in shares of equal value, the specific items to be included in each share to be determined in the sole discretion of my personal representative. d) I give my policies of insurance on the life of my spouse of which I may be the owner at the time of my death to my children or to the survivor of them. e) Should any.or all of the above-named legatees predecease me or fail to survive me by thirty (30) days, I direct that his or her share of my estate become a part of my residuary estate and be administered and distributed as provided in the "Residue" paragraph of this will. V. RESIDUE I devise and bequeath the residue of my estate of every nature and wherever situate to my spouse providing my spouse shall survive me by thirty days. Should my spouse predecease me or die on or before the thirtieth day following my death, I give the residue of my estate of every nature and wherever situate, but not including any property subject to any power of appointment which I may now have or hereafter acquire, to my children in equal shares, provided that the share of any child who predeceases me or dies on or before the thirtieth day following my death shall be distributed to his or her •1 • N LAST WILL OF WILLIAM H. BIXLER, SR. PAGE 5 issue per stirpes living on the thirty-first day following my death and in default of any such then living issue such share shall be added to the share or shares for my other children. Should all of the above- named beneficiaries predecease me, I direct that his or her share of my estate shall be distributed under the Commonwealth of Pennsylvania intestacy laws. VI. PERSONAL REPRESENTATIVE I appoint, my spouse personal representative of this my last will. Should my spouse fail to qualify or cease to act as personal representative, I appoint my children, Susan E. Cowley, Sally A. Bobb, and William H. Bixler, Jr. , personal representatives of this my last will. VII. POWERS OF PERSONAL REPRESENTATIVE I give the following powers to my personal representative: a) To invest or reinvest in any property, real or personal. bj, To borrow or lend.,.mopey, with or without security, upon such terms, and from and to such persons and entities, as my personal representative shall deem advisable, including the power to borrow from a corporate personal representative or any affiliate, with any such loan to be repaid from estate assets only. c) To retain and continue indefinitely, or sell, any business or business interest in which I am engaged or which I own; provided that, my personal representative shall not be liable for any LAST WILL OF WILLIAM H. BI%LER, 3R. PAGE 6 loss resulting from the retention and operation of such business or business interest unless such loss results directly from my personal representative' s gross negligence or willful misconduct. d) To sell, exchange, lease or give options upon real or personal property at private or public sale for any price and on any terms my personal representative deems advisable. e) To petition for the 'appointment of or actually appoint an ancillary estate fiduciary to pay ` the expenses of ancillary administration. f) To disclaim any part or all of any interest in any property, real or personal. g) To distribute , my estate in cash or in kind or partly in cash, to make non prorata distributions, to value assets for non prorata distributions as of the date of distribution, to make distributions without considering tax cost basis, and to satisfy a specific dollar amount gift in hand. h) To make all tax elections permitted by law and to impose a lien on estate assets to secure tax. payments, and if such election is made, my personal representative shall not be required to apportion the consequences thereof among 'the recipients of my estate. In addition to the powers listed above, my personal representative shall have all the powers granted by the Fiduciaries Act of 1949, P.L. 512, 99 501-549, 20 P3 9S 320.501 - 320.549 or any similar successor statute, to the extent such statutes are not in conflict with the provisions of this article. LAST WILL OF WILLIAM H. BISLER, SR. PAGE 7 VIII. BOND I direct- that my personal representative and guardians, and their successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction.. I%. NON-RECIPROCITY Although I understand that my spouse is executing a Last Will and Testament at or about the time I execute my Last Will and Testament, it is not my or our intention that such Wills shall be construed or deemed to be mutual, reciprocal or dependent one upon the other. IN WITNESS WHEREOF, I have hereunto set my hand this &1-3_,/day of 1988. • ct "44- The preceding instrument, consisting of this and 6 other typewritten pages, each identified by the signature of the testator, was on the date thereof signed, published and declared by William H. Bixler, Sr. , the testator therein named, as and for his last will, in the presence of us, who at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. ,sue � residing at residing at • LAST WILL OF WILLIAM H. BI%LER, SR. PAGE 8 COMMONWEALTH OF PENNSYLVANIA) ss. . COUNTY OF TIOGA ) We, William H. Bixler, Sr. , Lisa D. Rockwell and Esther M. Harer the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the. testator signed and executed the instrument as his last will and that he has signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in. the presence apd hearing of the testator, and in the presence of each other, signed the Will as witness and ,that. to the best of, .our; knowledge,,. the.,,Testator is eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. Subscribed, sworn to and acknowledged before me by William H. Bixler, sr. , the Testator, and subscribed and sworn to before me by Lisa D. Rockwell and Esther -t: Harer witnesses on this 23rd day of November 1988. NtaryP i NO $EAL LINDA J.LAUDERMILCH, No Public Richmond Twp., Tioge County, Pa. My Commission Expires Sept,9, 1991 rVI St MEMBERS 1St FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 34531-00 Date Account Established 09/02/1983 Principal Balance at Date of Death $54,219.55 Accrued Interest to Date of Death $6.84 Total Principal and Accrued Interest $54,226.39 Name of Joint Owner None CHECKING ACCOUNT: Account Number/Suffix 34531-11 Date Account Established 10/04/1983 Principal Balance at Date of Death $22,293.03 Accrued Interest to Date of Death $.83 Total Principal and Accrued Interest $22,293.86 Name of Joint Owner None ME RS 1sT FEDER CR UNION D A. Kline Lending Insurance Support Specialist December 11, 2013 Estate of: WILLIAM H. BIXLER SR Date of Death: 11/22/2013 Social Security Number: 204-03-8878 5000 Louise Drive • P.O.Box 40 • Mechanicsburv.Pennsvlvania 17055 • (900) 293-2328 wwv�rmPmhPrcl ct nr_e Copyright©2014 Morningstar. Quotes supplied by Morningstar Inc. Stock price data provided by Morningstar Inc. Quotes delayed 20 minutes. PPL Corp (ppl) Weekly DATE,OPEN,HIGH,LOW,CLOSE,VOLUME 01/10/2014,29.9,30.34,29.89,30.29,4978715 01/03/2014,30.02,30.06,29.4,29.62,4209477 12/27/2013,29.84,29.9,29.67,29.85,1648464 12/20/2013,29.42,29.74,29.41,29.68,5819595 12/13/2013,29.36,29.39,29.06,29.25,3881278 12/06/2013,30.05,30.25,29.75,29.98,7009954 11/29/2013,30.56,30.92,30.46,30.71,2671974 H . 3►.o S 11/22/2013,30.68,31.05,30.63,30.7,5171759 '`1 11/15/2013,30.85,31.08,30.74,31.08,4282429 L t� 30.63 11/08/2013,30.5,30.61,30.1,30.51,4550953/2013,30.68,30.89,30.52,30.73,3481354 ��0`� 11/01 10/25/2013,30.55,30.81,30.44,30.79,3269838 10/18/2013,30.43,30.54,30.28,30.3,5794332 10/11/2013,30.56,30.68,30.42,30.5,3614984 10/04/2013,30.21,30.31,30.05,30.13,3102569 09/27/2013,30.67,30.82,30.2,30.34,7053542 09/20/2013,30.61,30.7,30.11,30.11,9801147 09/13/2013,30.06,30.2,29.92,30,2585874 09/06/2013,30.09,30.41,30.04,30.07,4494292 08/30/2013,30.85,31.03,30.59,30.7,5306149 08/23/2013,30.61,30.94,30.45,30.88,9605493 08/16/2013,30.84,30.97,30.45,30.55,4037606 08/09/2013,31.88,32.05,31.82,31.9,2855186 08/02/2013,32,32.03,31.77,31.93,2044581 07/26/2013,31.2,31.41,31.07,31.33,3291650 07/19/2013,31.59,31.68,31.38,31.55,3262116 07/12/2013,30.4,30.48,30.14,30.45,3392582 07/05/2013,29.56,29.61,29.03,29.35,13294573 06/28/2013,30.3,30.43,29.75,30.26,10941466 06/21/2013,28.67,29.04,28.48,28.98,7593645 06/14/2013,28.87,29.26,28.87,29.13,5730217 06/07/2013,29.49,29.73,29.25,29.29,5672707 05/31/2013,29.82,30.22,29.7,29.7,6345998 05/24/2013,30.88,30.98,30.53,30.59,12386840 05/17/2013,32.01,32.18,31.93,32.15,5675166 05/10/2013,31.8,31.88,31.34,31.84,5271336 05/03/2013,33.02,33.16,32.72,32.73,5796486 04/26/2013,32.8,33.15,32.77,33.03,3714462 04/19/2013,32.16,32.58,32.08,32.57,8732655 04/12/2013,31.89,32.03,31.85,31.99,2120839 04/05/2013,31.07,31.48,31.07,31.44,3822461 03/29/2013,31.31,31.31,31.31,31.31,0 03/22/2013,30.16,30.21,29.99,30.09,4382939 03/15/2013,30.08,30.49,30.06,30.49,5699071 03/08/2013,30.56,30.73,30.36,30.64,3865501 03/01/2013,30.8,30.91,30.6,30.82,3608803 02/22/2013,30.56,30.79,30.54,30.79,9037043 02/15/2013,30.6,30.6,30.33,30.41,4088983 02/08/2013,30.3,30.36,30.15,30.31,2188519 02/01/2013,30.42,30.55,30.3,30.37,5390282 01/25/2013,29.57,29.66,29.42,29.6,2901897 01/18/2013,29.15,29.38,29.1,29.38,3679443 Report- MSN Money Page I of 2 PPL Corp (NYSE:PPL) 30.13 4 -0.01 -0.03% Open:30.14 High:30.25 Low:30.04 Volume:1.15 Mil MSN Money Report Print Page generated 1114120114 11:58 AM ET I YEAR CHART .............Y, .1, .................. ..........-................................................................................................................................ ........................................................................... .............................. ........ ...................... .................. .................... .................... ................. ...................................... ............ ........... .......................................... ............... .................. .............................. .............................. ............................. ................................................... ....................................... .................................................................................... .................................................. ............................. ............ ..................................................................... 21.W ....................b ..........Apr.................. .................................................. ............................-............ ....... ... COMPANY REPORT QUICK FACTS PPL Corp is an energy and utility holding company that was incorporated in 1994. Location Two North Ninth Street Through subsidiaries,PPL generates electricity from power plants in the northeastern, Allentown,PA 18101-1179 northwestern and southeastern U.S..markets wholesale and retail energy mainly in the northeastern and northwestern portions of the U.S.,delivers electricity to customers in USA-Map Pennsylvania,Kentucky,Virginia,Tennessee and the U.K.and delivers natural gas to Phone:+1610 774-5151 customers in Kentucky.PPL is organized into four reportable segments:Kentucky Regulated,International Regulated,Pennsylvania Regulated and Supply.Kentucky Fax:+1610 774-5106 Regulated Segment(PPL)Consists of the operations of LKE,which owns and .....Web site .h.t.t..p.1Avwvv.p p We.b�c I o.nn operates regulated public utilities engaged in the generation,transmission.distribution .... .. .. and sale of electricity and the distribution and sale of natural gas,representing Industry: Utilities-Diversified primarily the activities of LG&E and KU.The Kentucky Regulated segment also includes interest expense related to the 2010 Equity Units that were issued to partially Employees: 18,000 finance the acquisition of LIKE.International Regulated Segment(PPL)Includes WPD, ....... a regulated electricity distribution company in the U.K.ViJPD,through indirect wholly Exchange: New York Stock Exchange .......................................................................................................... ......................................................................- ........... owned subsidiaries,operates four of the 15 distribution networks providing electricity service in the U.K.Pennsylvania Regulated Segment(PPL)includes the regulated FINANCIALS electric delivery operations of PPL Electric.PPL Electric delivers electricity to approximately 1.4 million customers in a 10,000-square mile territory in 29 counties of LAST 12 MONTHS 5 YEAR GROWTH .11-1........... ........................ ................... ..........- ............ eastern and central Pennsylvania.PPL Electric also provides electricity supply in this Sales 12.23 Bil 13.59% territory as a PLR.PPL Electric is authorized to provide electric public utility service throughout its service area as a result of grants by the Commonwealth of Pennsylvania Income 1.59 Bit 8.20% in corporate charters to PPL Electric and companies to which it has succeeded and as Dividend Rate 1.47 3.37% a result of certification by the PUC.PPL Electric is subject to regulation as a public ........ utility by the PUC,and certain of its transmission activities are subject to the Dividend Yield 4.88 4.90% jurisdiction of the FERC under the Federal Power Act.The Company is subject to certain existing and developing federal,regional,state and local laws and regulations More financials with respect to air and water quality,land use and other environmental matters. FUNDAMENTAL DATA STOCK ACTIVITY Debt/Equity Ratio 1.55 Last Price 30.14 Gross Margin 60.72% ........................ 52 Week High 33.55 Net Profit Margin 12.97% 52 Week Low 28.44 Total Shares Outstanding 630.25 Mil Volume 1.15 Mil Market Capitalization 19 Bil Average Daily Volume(13wk) 3.96 Mil Eamings/Share 2.47 Volatility(beta) 0.31 Stock Scouter Rating 7 ........................................... ........................... ................................ ..................................................................... Detailed quote More financial ratios Financial Data in USD EARNINGS ESTIMATES INSTITUTIONAL STATISTICS Qtr(12/13)EPS Estimate 0.51 Analyst Consensus Moderate Buy FY(1 2/13)EPS Estimate 235 Institutional Ownership 68.69% Current PIE 12.21 ................................. ...................................................................................................................................................................................... FY(12/14)EPS Estimate 2.17 Report- MSN Money Page 2 of 2 More Analyst Ratings Forward P/E 14.21 .—_._. --......................................_........................_.............................._..........._...,,,......._.._......__._.................._................__..... More analyst estimates DATA PROVIDERS Copyright©2014 Microsoft.All rights reserved. Fundamental company data and historical chart data provided by Morningstar Inc.Real-time index quotes and delayed quotes supplied by Morningstar Inc.Quotes delayed by up to 15 minutes,except where indicated otherwise.Fund summary,fund performance and dividend data provided by Morningstar Inc.Analyst recommendations provided by Zacks Investment Research.StockScouter data provided by Verus Analytic s.IPO data provided by Hoover's Inc.Index membership data provided by Morningstar In PRU- Stock chart-MSN Money Page 1 of 2 PRUDENTIAL FINANCIAL Inc (NYSE: PRU) 84.57 * +0.41 +0.49% MORE ON PRU PRUDENTIAL FINANCIAL Inc Mu SUMMARY DATE HIGH LOW OPEN CLOSE VOLUME Quote 02/21/2014 84.4 83.7 83.96 83.93 1,676,955 Options _ 02/14/2014 85.23 84.22 84.38 84.99 1,995,383 Historical Prices _... _ _..... .... .. ... 02/0712014 83.61 81.74 82.54 83.41 4,519,555 CHARTS 01/31/2014 85.5 83.35 83.74 84.39 2,228,825 Interactive Chart 01/24/2014 87.33 84.35 86.82 84.36 3,554,157 NEWS Headlines 01/17/2014 90.79 89.9 90.28 90.23 2,348,008 _.. _ .. Key Developments 01/10/2014 91.19 89.84 90.97 90.73 1,804,561 FUNDAMENTALS 01/03/2014 91.05 90 90.06 90.21 1,660,229 Financial Highlights 12/27/2013 92.68 91.74 92.5 91.83 913,765 .. ....... _...... ... ... .. . . ..... Profile 12/20/2013 91.68 90.01 90.19 91.33 2,996,009 _...._ ......_...................... .. .._... ........... .. _. _.._ ..._ ..._..._ . .................. ...... . .................... .........._........._........_.. Key Ratios 12/13/2013 88.96 87.87 88.46 88.19 1,533,329 10-Year Summary ...... 12/06/2013 89.7 88.83 88.98 88.91 2,202,680 Earnings 11/29/2013 89.87 88.73 89.43 88.76 1,249,364 SEC Filings 11/22/2013 90.12 89.4 89.5 90.07 1,868,587 RATINGS/ANALYSIS _......_............ ._....... .... ......... StockScouter Report 11/15/2013 89 87.6 88.41 88.62 2,501,425 _ ... ...................I..................... .... .- Analyst Ratings 11/08/2013 87.85 83.95 84.03 86.9 4,144,359 ............ ........ ....... . _ ... _. INSIDER ACTION 11/01/2013 81.67 80.6 81.6 81.19 1,557,783 Insider Trades 10/25/2013 82.03 81.23 81.5 81.41 1,761,183 Ownership 10/18/2013 82.65 81.76 82.63 82.53 1,704,297 ...... ............ ......._..... _........ .............. ......._ .__._ .... .......... .._ FINANCIALS 10/11/2013 79.88 78.81 79 79.87 1,407,041 Income Statement 10/04/2013 78.59 76.9 77.25 78.4 1,626,184 Balance Sheet 09/27/2013 78.64 77.75 78.27 78.41 1,170,683 Cash Flow 09/20/2013 79.24 78 78.75 78.24 3,363,022 ............ ..... _... _ . .... ........... .. 09/13/2013 80.3 79.36 80.3 79.69 1,275,684 09/06/2013 78.4 76.13 78.12 77.55 2,097,410 08/30/2013 75.66 74.54 75.56 74.88 1,474,283 08/23/2013 79.48 78.23 79.08 78.7 1,433,778 _........ ........ _.. ._._.... ......... _ ._...__... ......... __._... 08/16/2013 79.78 78.44 78.44 79.61 2,780,038 .......... .... .. .. ..... ._- _. ._.._.._. .. ... _.._. ........_..... 08/09/2013 81.26 80.03 80.33 80.58 2,845,897 . ....................._.._._... ...__.... ..... Oppenheimer unF d S.6 ceS, - s �i OPPENHEIMERFUNDS" P.O.Box 5270 V �a }' THE RIGHT WAY TO INVEST Denver,CO 80217-5270 ,,, ;. f www.oppenheimerfunds.com January 17, 2014 SUSAN J HARTMAN DUNCAN& HARTMAN PC ONE IRVING ROW CARLISLE PA 17013 Dear Ms. Hartman: We received authorization from William H. Bixler, Jr., requesting that we provide you with information about William H. Bixler, Sr's account. Please forward our condolences to Mr. Bixler's family. The following value was effective November 22, 2013: Account Number Share Balance Share Price at Net Total Dollar Value Asset Value 008818811179552 3,586.578 $6.06 $21,734.66 If you have any questions, please call the Estate Team at 1-800-228-7774. We are available Monday through Friday from 8:00 a.m. to 7:00 p.m. Eastern Time. Any of us will be glad to assist you. Sincerely, Sandra Spradlin Oppenheimer Funds The Right Way to Invest IDOC# 106563419 f NATIONAL �r WESTERN LIFE INSURANCE COMPANY® January 20, 2014 Susan J. Hartman DUNCAN &HARTMAN, PC 1 Irvine Row Carlisle, PA 17013 Subject: Certificate Nos. 0101230777 and 0101230778 Annuitant: William H. Bixler, deceased Dear Ms. Hartman: The above referenced policy contracts were issued as non-qualified deferred annuities in March 2010 with William H. Bixler as both the Annuitant and Owner. The Accumulation Account Values of the annuities as of November 22, 2013 are as follows: 0101230777 $ 7,199.59 0101230778 $55,238.45 For additional information concerning the annuities, please refer to the enclosed copy of our letter which was sent to the servicing agent, Troy Landis, on December 11, 2013. Claim forms were furnished to Mr. Landis at that time. We are also enclosing another set of claim forms for the designated beneficiaries. Should you have any questions, or if we can be of further assistance, please contact our Policy Benefit Department at 800-531-5442, ext. 585; we will be happy to help you. POLICY BENEFIT DEPARTMENT Dc I 850 EAST ANDERSON LANE • AUSTIN,TEXAS 78752-1602 • 512-836-1010 AUTOMATED VOICE RESPONSE TOLL-FREE 888-695-5001 • TOLL-FREE 800-531-5442 CLIENT SERVICES DIRECT TOLL-FREE LINE 800-922-9422 • CLAIMS 800-531-5442 W W W.NATIONALWESTERNLIFE.COM LINCOLN BENEFIT LIFE AN A L L S T A T E C O M P A N Y January 22, 2014 Susan J. Hartman 1 Irvine Row Carlisle, PA 17013 Re: William H. Bixler Contract No: LBCA141587 Dear Mrs. Hartman: We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. 1 can, however, provide the following information for estate purposes: Date of Death: November 22,2013 Annuity Value as of Date of Death: $ 11,901.36" Named Beneficiary(ies): Susan E. Crowley William Bixler, Jr Sally A. Bobb *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 22679. Sincerely, Cory Connor Sr. Claim Examiner Lincoln Benefit Life Company Life and Annuity Claims P.O. Box 94212, Palatine, IL 60094-4212 Phone 877-499-6418 Fax 866-635-4523 Td: Pege 3 of-Is '1/20/20'14 11:35:29 AM CST '14106305672 From: GJml-1 n- FIDELITY& GUARANTY LIFE Fidelity FICG�I INSURANCE COMPANY Nj. uar s"n 777 Research Drive, Lincoln,NE 68521 �.n ty:.. � P O Box 82068, Lincoln,NE 68501 ...... 866-702-2194(Office) 402-479-0198(Fax) www.fglife.com 1/6/14 Estate of William Bixler 105 Brighton Drive Carlisle,PA 17015 Policy: L9099323, L9099324, L9131849, L9131854, L9131855 William H l3bder Sr Dear Estate of William Bixler: We have been notified of the death of the policy owner. We wish to convey our sincere sympathy to the family in their recent loss. Please see the below requested information; CHOICE B POLICY L9099323 OWNER BIXLER SR! WILLIAM H DATE OF DEATH 11/22/2013 CURR AV AS OF DOD : 12,049.51 CHOICE B POLICY L9099324 OWNER BIXLER SRI WILLIAM H DATE OF DEATH 11/22/2013 CURR AV AS OF DOD : 20,972.96 CHOICE B POLICY L9131849 OWNER BIXLER! WILLIAM H DATE OF DEATH 11/22/2013 CURR AV AS OF DOD : 40,048.32 CHOICE B POLICY L9131854 OWNER BIXLER! WILLIAM H DATE OF DEATH 11/22/2013 CURR AV AS OF DOD : 40,084.06 CHOICE B POLICY L9131855 OWNER BIXLER! WILLAIM H DATE OF DEATH 11122/2013 CURR AV AS OF DOD : 36,811.64 L9099323(qua/ified) Fidelity&Guaranty Life Is the marketing name of Fidelity&Guaranty Life Insurance Company and,In New York only,Fidelity&Guaranty Life Insurance Company of New York.Only Fidelity&Guaranty Life Insurance Company of New York is authorized to sell Insurance and annuities In New York. Pt Tyne of Loan OMB Anoroyal N!2 qnq- 5 i 1. ❑FHA 2. ❑FmHA 3. ❑Conv.Unins. 6.File Number 7.Loan Number 8.Mortgage Insurance Case Number (IVA 5 IlCony Ing. 1 2014-023 This torn Is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shovm. C.Note: Items mariced'(p.o.c.)'were paid outside the dosing;they are shown here for Information purposes entl are not included In the totals. TldeExpress Settlement System WARNING:It h a crime to knowingly make false statements to the United States an this of an other similar toms.Penalties upon alo- Printed 09/11121114 at 111:115 KRr For D.NAME OF BORROWER Katherine B.Russell E.NAME OF SELLER The Estate of William H.Bixler F.NAME OF LENDER N/A G.PROPERTY ADDRESS: 105 Brighton Drive,Carlisle,PA 17015 South idd eto H.SETTLEMENT AGENT: PA Real Estate Settlement Services,LLC,Telephone:717-249-6333 Fax: 717-249-7334 PLACE OF SETmEMENL 354 Alexander ad.Carlisle 1.SETTLEM DATE- 02/11/2014 J.SUMMARY OF BORROWER'S TRANSACTION: K.SUMMARY OF SELLER'S TRANSACTION: 100, GROSS AMOUNT DUE FROM BORROWER 400, GROSS A OUNT DUE TO SELI FR 101 Contract salpg nrice 166,000-00 166 000.00 I Q3. Settlement chaEges to borrower(fine 1400) 3,602.00 JQ4 And 10-9 405 Ad'ustments for items paid by seller n advance - r' paid by seller 107, County tax— 407- County taxes 108 School taxes 02/11/14t,06/30/14 480.07 4o& school taxes 02 11 14 06 30 14 480.07 109 409, 14 to 12 31/14 88.76 14 to 12 31 14 88.76 BORROWER ill 411 112, d19 120, GROSS AMOUNT DUE FROM 170 170.83 420, GRQSS AMOUNT DUE TO SELL R 166 568.83 200, AMOUNTS PAID BY OR ON BEHALF OF BORF OWER 500, REDUCTIONS IN AMOUNT DUE To SELLER 201, Deposit or eamest money 5,000.00 202- Pdncfnni amount of new loans 502 Settlement ch ra—to-seller(line 14001 12 330.68 204 504 Payoff of First Mortgage Loan 205 n!mmrtgage Inan 2ns Sol, 207 5137 709 509, 209, 509, Adiustments for items unpaid by sell Ir Adjustments for items Unpaid by sell�r 210 Cityltam texas 510, City/town taxes 211, County taxes 01/01/14 to 02/11/14 41.70 01 O1 14 02 11 14 41.70 212, School t.... 512 School taxes 213 5114, 214 514 215, 51S. 216- 516, 217 517 21A . 518 91Q 11Q 220, TOTAL I S,041.70 520, TOTAL REDUCTION AMOUNT DUE SELLER 12 372.38 300, CASH AT SETTLEMENT FROM OR TO BORRQWER 600, CASH AT SETTLEMENT TO OR FROM SFI I F 301 Gmss amount due from borrower(line 1201 1 170 170.83 166 568.83 31712 1—amounts paid byApr bormyver fling 220) 5,041.70 12 372.38 303, CASH FROM BORROWER 165 129.13 154.196 45 SUBSTITUTE FORM 1099 SELLER STATEMENT:The information contained herein is important tax Information and is being furnished to the Internal Revenue Service.If you are required to file a return, =v ence penalty or other sanction vAll be Imposed on you it this item is required to be reported and the IRS determines mat it has not been reported.The Contract Sales Price described on above constitutes the Gross Proceeds of this transaction. You are required by law to provide the settlement agent(Fed.Tan ID No: 1 vAth your correct taxpayer Identification number.If you do not provide your correct taxpayer Identification number,you may be subject to civil or criminal penalties imposed by low.Under penalties of perjury,I eenify that the number shown on this statement is my correct taxpayer identification number, SELLER(S)SIGNATURE(S): / SELLER(S)NEW MAILING ADDRESS: SELLER(S)PHONE NUMBERS: (H) fW) L. T CHARGES PAID FROM PAID FROM 700 TOTAL.SALES/BROKER'S COMMISSION based on price 166 000.00 = 10 185.00 BORROWER'S SELLER'S Division of commission fline 700)as follows, FUNDS AT FUNDS AT 701- S to SETTLEMENT SETTLEMENT 10 185.00 to Prudential Homesale Services Group 703, Comm!sion naid at Settlement 10 185.00 704 Broker ee to Prudential Homesale Services Group 225.00 800. ITEMS PAYABLE IN CONNECTION WITH A 801, Loan Origination Fee % 802 Loan Discount 803 Anoraisal Fee 804- Credit Report RIO ITEMS U R 902, Mortgage Insurance Premium for tr, 903 H—rd Insurance Premium for to 1000,RESERVES D WITH LENDER 1002, Mortaaae Insurance Mo.(a)$ /Mo 1003, City Property Tax mo.65D$ /Mo 1004 County Property Tax Mo,(a)$ /Mo 1005, School taxes Mo C&$ /Mo 1009, Agarettate Analysis Adiustment 0.001 0.00 1100.TITLE CHARGES 1101, Settlement or Cl—Ino IF- 1102 Abstract or Title Search 1104 Title Insurance Binder 1105, Document Prenaration to Duncan & Hartman 325.00 1107, Attorneo fees (includes above items No- Stewart Title Guarani PA RE SS 1,230.00 (includes above items No- 1109 Lender's Policy 1110, Owner's Policy 166 000.00 – 1,230.00 GOVERNMENT I AND TRANSFER CHARGES 1201. Recordina Fees Deed S 67.00 67.00 1 660.00 1,660.00 1201 State Tax/stamns 1 660.00 1,660.00 1300.ADDITIONAL SETTLEMENT CHARGES 1301, Home Warranty to AHS 420.00 1302. Final Water/Sewer Bill to South Middleton 60.68 1303. Resale Certification to Summerfield 100.00 1400.TOTAL SETTLEMENT 3,602.00 12 330.68 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUO-1 SetOement 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 1 an9action,I further certify that 1 have-received a copy of the HUD-i Settlement Statement- KaNen6 sell T state of William H.BiAer WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Settlement Statement which I have prepared Is a true and accurate account of this transaction. UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON CONVICTION I have caused or will cause the funds to be disbursed in accordance with this statement. CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 18: A /` J U.S.CODE SECTION 1001 AND SECTION 1010. BY��_ ,{ ^ , "_)—/1/l (//V