HomeMy WebLinkAbout03-06-14 J 1505610140
REV-1500 �` `02_,,,�F',
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 0 6 9 9
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 6 0 9 2 0 1 3 0 3 2 7 1 9 1 4
Decedent's Last Name Suffix DecedenYs First Name MI
CLI PPI NGER VESTA S
(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 � 5.Federal Estate Tax Retum Required
death after 72-12-82)
❑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)
Befinreen 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD�E,I�IRECTED T0:
Name Daytime Telep�e Number � �T ��
J O E L R . Z U L L I N G E R 7 1 7 ;�� ._4 �0 ��=j
r'`�.�•-� � ��.�:> ':�;�
REGIST��"Y�.1S US�ONLY E'>`� �-:`s
_..�..� :�__� C„�
f.i�i-:.-
Q�-'r.�:-.., � (.�. !�
First Line ofAddress ��:" '' `.;,, -- "��
�',��
14 NORTH MAI N STREET ��1 N `�
Second Line ofAddress .,,t
S U I T E 2 0 0
City or Post Office Stete ZIP COde DATE FILED
C H A M B E R S B U R G P A 1 7 2 0 1
CorrespondenYs e-mail address:
Under penalties of peryury,I deGare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.DeGaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN RE OF PE,SON R�SPONSIBLE FOR FILING RETU DATE
���.� « ,ti-v v�. ;�:�=�z�,�C��t.�/ ;.�. /��,��>�`f
ADDRESS
8 GARLAND COURT CARLISLE PA 17013
SI TU E OF P ARE THE REPR PrTNE DAT
r
AD SS
1 ORTH MAIN S ET, SUITE 00 CHAMBERSBURG PA 17201
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610140 1505610140 J
� 1505610240
REV-1500 EX(FI) DecedenYs Social Security Number
DecedenYSName: VESTA S. CLIPPINGER
RECAPITULATION
1. Real Estate(Schedule A) ....... . . . .... . . . . . . . . . . ........ . . . . . ...... �•
50794 , 96
2. Stocks and Bonds(Schedule B) . . . ... . . . . .............. . . . . . . ....... . 2• '
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. •
4. Mortgages and Notes Receivable(Schedule D) . . .. . ......... . . . . . . ...... 4. •
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)...... . 5. 2 $ 3 1 6 9 � 9 $
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested .. . . . . . 6. •
7. Inter-Vivos Transfers&Miscellaneous N n-Probate Property
(Schedule G) � Separate Billing Requested . . ..... 7. .
8. Total Gross Assets(total Lines 1 through 7) .............. . . . . . ........ 8. 3 3 3 9 6 4 , 9 4
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . ........ . . . . . 9• 2 � 3 � 7 . 9 �
10. Debts of Decedent,Mortgage Liabilities,and�iens(schedu�e�) ... . . . . . .. ... 10. 4 4 6 3 . 4 2
11. Total Deductions(total Lines 9 and 10) . . ............... . . . . . ....... . . 11. 2 '4 7 7 � . 3 2
12. Net Value of Estate(Line 8 minus Line 11) .. . . . . . . . . . . . ......... . . . . . . 12• 3 O 9 1 9 3 . 6 2
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. 3 0 9 1 9 3 . 6 2
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 � 15. � . � �
16. Amount of Line 14 taxable
at�inea�rate X.045 3 0 9 1 9 3 . 6 2 �6. 1 3 9 1 3 . 7 1
17. Amount of Line 14 taxable
at sibling rate X.12 0 . � 0 17. � . 0 �
18. Amount of Line 14 taxable O . O O 1 g. 0 . O 0
at collateral rate X.15
19. TAX DUE . ...... . . . . . . . . . . .... . . ........ . . . . . . . . . .......... . . . . 19. � 3 9 1 3 . 7 1
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: 2� 13 0699
DECEDENT'S NAME
VESTA S. CLIPPINGER
STREET ADDRESS
23 WYRICK AVENUE
��Ty STATE ZIP
SHIPPENSBURG PA 17257
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 13,913.71
2. Credits/Payments
A.Prior Payments 12,825.00
B.Discount 675.00
Total Credits(A+B) (2) 13,500.00
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) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 413.71
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred ...................................................................... ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ ❑
X
c. retain a reversionary interest ..................................................................................................... ❑ ❑X
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? ....................................................................................... ❑ ❑X
3. Did decedent own an"in trust for"or payable-upon�ieath bank account or security at his or her death? ......... ❑ ❑X
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. ❑ ❑X
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
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[�2 P.s.§s��s(a)(�)�.
• 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:
VESTA S. CLIPPINGER 21 13 0699
All real property ovmed 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 decedenYs interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. Gross proceeds from sale of real estate, together with improvements thereon, situate at 50,000.00
23 Wyrick Avenue, Shippensburg, Cumberland County, PA, to Andrew L. Spotts and
Pamela A. Spotts, his wife
2. Received on proration of real estate taxes at closing on above sale 794.96
TOTAL(Also enter on Line 1,Recapitulation.) S 50 794.96
If more space is needed,use additional sheets of paper of the same size.
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS � MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
VESTA S. CLIPPINGER 21 13 0699
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. Checking Account#97168017, M&T Bank, including interest accrued to date of 9,684.96
death
2. Savings Account#15004205985045, M&T Bank, including interest accrued to date of 76,147.13
death
3. Savings Account#21000001218008, M&T Bank, including interest accrued to date of 1,614.19
death
4. Certificate of Deposit#31003918499409, M&T Bank, including interest accrued to date 69,586.54
of death
5. Certificate of Deposit#31003916125501, M&T Bank, including interest accrued to date 48,924.36
of death
6. Certificate of Deposit#4000039085, Orrstown Bank, including interest accrued to date 73,654.53
of death
7. Refund, Christian Companion Senior Care 285.00
8. Refund, Comcast Cable 25.14
9. PA Department of Revenue, property tax rebate 250.00
10. Net proceeds from sale of personal property by Rowe Auction 2,686.13
11. Refund of homeowner's premium 312.00
TOTAL(Also enter on Line 5,Recapitulation) $ 283 169.98
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VESTA S. CLIPPINGER 21 13 0699
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Fogelsanger-Bricker Funeral Home, funeral services 8,958.14
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
Ciiy State ZIP
Year(s)Commission Paid:
2, anomey Fees: Joel R. Zullinger 7,000.00
3, Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: JCS fee-28.50; automation-5.00; letters-310.00; will-15.00; short certificates- 458.50
25.00; additional probate 50.00; filing return 15.00; filing inventory 15.00
5 Accountant Fees:
6. Tax Retum Preparer Fees:
7. Borough of Shippensburg, water service to residence 38.20
8. C.F.J.M.A., sewer service to residence 105.00
9. Penelec, utilities 2�.42
10. 2013/14 School real estate taxes due on residence 936.14
11. Supplies for cleaning residence prior to public sale 7.63
12. Postage for estate administration 11.20
13. Replacement seat for toilet in residence prior to public sale 8.45
14. Charge for estate checks 12.50
15. Shane Bouder, hauling trash from residence prior to public sale 250.00
16. Penelec, utilities to residence 27.01
17. Centurylink, telephone service to residence 54.24
18. Penelec, final utilities to residence 22.42
TOTAL(Also enter on Line 9,Recapitulation) $ 20 307.90
If more space is needed,use additional sheets of paper of the same size.
_ _
Continuation of REV-1500 inheritance Tax Return Resident Decedent
VESTA S. CLIPPINGER 21 13 0699
DecedenYs Name Page 1 File Number
Schedule H - Funeral Expenses 8�Administrative Costs -B7.
ITEM
NUMBER DESCRIPTION AMOUNT
19. Rowe's Auction Service, commission and expenses of public sale 1,433.60
20. C.F.J.M.A., final sewer service to residence 99.25
21. Borough of Shippensburg, final water service to residence 58.20
22. Ausherman Bros Real Estate, appraisal of real estate 325.00
23. Darlene M. Kelly, CPA, prepare final life returns and fiduciary returns 475.00
SUBTOTAL SCHEDULE H-B7 2,391.05
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABILITIES 8� LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VESTA S. CLIPPINGER 21 13 0699
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. Penelec, utilities 5.57
2. Comcast, cable service 23.50
3. Thornwald Home, balance due for supplies and care services 4,383.59
4. Millennium Pharmacy Services, balance due on account 50.76
TOTAL(Also enter on Line 10,Recapitulation) $ 4 463.42
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENTOF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
VESTA S. CLIPPINGER 21 13 0699
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 [Indude outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Carol Ann Drachbar, 8 Garland Court, Carlisle, PA 17013 Lineal
entire residue of estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
�. 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.
' o �� , ' �
� LAST WIZL AND TESTAMENT �
�
� I, VESTA S. CLIPPINGER, of 23 Wyrick Avenue, Shippensburg,
� Cumberland County, Pennsylvania; being of sound mind, memory and
F
� understanding, do make and publish this my Last Will and Testa-
� ment, hereby revoking and making void any and all former wills by
6
� me at any time heretofore mac�e.
�
� FIRST. I direct my hereinafter named Executor to pay all my,
just debts and funeral expenses as soon as conveniently may be
after my decease.
SECOND. I g.ive, devise and bequeath all my property, real,
personal and mixed, whatsoever and wheresoever situate, to my
beloved husband, DONALD EARL CLIPPINGER, absolutely.
� �'.HIRD. I hereby nominate, constitute and appoint my said
� husband, DONALD EARL CLIPPINGER, thf� sole Executor of this my '.
Last Will and Teszament. c:o G' rn. �
�-� c � Q
FOURTH. Provi�ed, however, that if my sa�.��ba�nd, ��ALD
� y � N TTt �
EARL CLTPPINGER, should p.redeceas? me� or if w Z��.ld"�C.ie.��i� a
� � ��
common disaster, then in either of said events,�I���ve�de�i�e an
° � o �� �'
bequeath all my property, real, personal and m�ec�N to � d�u�hter
� A N
CAROL ANN DRACH�AR.
FIFTH. Provided further, that in the event my said husband,
DONALD EARL CLIPPINGER, should predecease me or if we should die
in a common dis�s-ter, then in either of_ said events , I hereby
nominate, constitute and appoint my daughter, CAROL ANN DRACHBAR, '
as the Executrix of this my Last Will and Testament, my said
Executrix to have full power and authority to do any and all �
things necessary for the complete administration of my estate, �
including the power to sell any and all real and personal propert
. j
� of which I may die seized, at public or private sales, in her
� discretion, and without any Order of any Court; and i further
. , f ', � . ,. �� -
. _. . . . ..�. . . _, .
,� . . . _ . . E ..� ... a ..' . �. . .___ . . . '.. �. �
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. . - ;.'. � ._ �. ....._ . . .... �, � � .
, ., �-'
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. : �... .�: . .. i . ... , :.'
..` - � __' . L.�� �_�a .T�:f�3_ r _ � ' _
i
direct that my said Executrix not. be required to file any Bond
in connection with the settlement of my Estate.
IN WITNE5S WHEREOF, I, VESTA S. CLIPPINGER, have hereto set
my hand and seal to this my Last Will and Testament, written on
two (2) sheets of paper, this 5th day of July, 1974.
� f
.`. . . . . . .
,� (SEAL)
Signed, sealed, published and
declared Ly VESTA S. CLIPPINGER,
the Testatrix as and for her
Last Will and Testarnent, writie�
on two (2� sheets of paper, in the
presence of us who have, at her
request, signed our names as
wit sses hereto in tlie presence
of th said Testatrix and of eac.h
ot�he .
�
! /
�
� � _
n
A. Settlement Statement U.S.DepartmentofHousing ��
and Urban Development OMI3 No.2502-02G5(1'agc i)
B.Type of Loan
1. ❑FHA 2. ❑FmHA 3. U COnv.UnitiS. �6.File Number -.7.Loan Numbcr .3.Mongagc l�uusuicc C:uc Numbar
4. ❑VA 5. ❑Conv.Ins. �
L'.11(O(e' 1LUformufumuhcdbgiveyouaslatemenlafacbulsclU�mmtrnstvAmouu�paidtoandbyl6eseltlemmtaLrntartsbavalteaumar4cJ"(p.ac)^nuxpaiUovuWeWcdu�ie=;Wrrartabonvhaxxfor
� �rmaGoualpurposoandusm�indudcdinl0etolaLc
D.Name and Address ofBorrower E.Name,Address,and Taxpayer idcntifiwtion R of Scllcr � �l'.Namc and Addras oC Lcndcr
Andrew L.Spotts and Estate oF Vesta S.Clippinger N/A-CASI1
Pamela A_Spotts Cazol Ann Drachbar,Executr'u:
12564 Mongul Hill Road
Shippensburg,PA 17257
G.PropeiTy I.ocahon iH.SetUcment Agcnl Namc,Address and Ta�paycr ldcnliGcation Numbcr
23 Wyrick Avenue,Shippensburg,PA 17257 ! Zullinger-Davis,Profcssional Corporation
Shippensburg Borough,Cumberland County ' 20 E.Burd SL,Stc_6,PO Box 40,
Tax Parcel#36-35-2388-031 Shippcasburg,YA 17257
,Placc of Sctllcmcnt L Sctqcmcnt Datc
1ce1 R Zullinger,Gsq.,20 C.Burd S�,Shipperuburg, 925/2013
J.Summary of Borrorver's Transactions 1 K.Summary of Sellcr's Transac[ion
100. Gross Amouut Due From Borrower 400. Gross Amount Due To Sehcr
101. Contract sales price ; 50,000.00 401. Contract salcs pricc �0,000.00
102. Personal Property ' 402. Pe�onal Propcny �
103. Settlement chazges to borrower(line 1400) j 1,117 00 403.
104. -- _ ,
� 404.
105. j 405. --- - �
Adjustments for items paid by seller in advance Adjustmentr for items paid by sellcr in advancc
106. Citykown taxes to 406. Ciry/to�m taxes to
107. Countytaaces 09/25/13 to 12/31/l3 i 3195 407. Countytaa:es 09/25/13 to 1J31/13 51.95
108. Assessments to � 408. Assessments �o '
109. School Ta�c 09/25/13 to 06/30/14 � 713.01 409. Sc6001 Tax 09/25/13 to O6/30/14 713.01
110. Gazbage Fee f 410. Garbage Pce
I11. ----
� 411.
ll2. i 412_ - � .
i ---__ _ .
120. Gross Amount Due From Borrower � 51,911.96 420. Cross Amount Duc To Seller �0,79d.9G
i
200. Amounts Paid By Or in Behalf Of Borrower 500. Reductions in Amount Duc To Seller
201. Deposits or eamest money 5,000.00 501. Excess deposit(see instructions) S,U00.00
202. Pnncipal amount of new loan(s) : 502. Settlement chargcs to scllcr(linc 1400) �,U)I.O�
203. E�stmg loan(s)taken subject to 503. L�isting loan(s)I:il:cn subjcet to
20`�' SO4. PayotPoffirst mortgage loan
205. 505. PayoffoFsecond mortgagcloan
206. 506. -- -
207. SOZ ----- •
208. 508. --- ._ ,
209- 509. -- ,
Adjustments for items unpaid by seller Adjustments for items unpaid by sellcr
210. Citykown taxes to ; 510. Ciq�/town tazes to
211. County taxes to 511. County tar.es to
212. Assessments to I 512. Assessments to
213. SchoolTax to � 513. SchoolTax �o
� -- - - -
214. 514.
215. ' S15. ---- .
216. ! 516. �
217. ' S17. ----
I
218- j 518. ----- .
219. i 519. -----
220. Total Paid By/For Borrower j �,000.00 520. Total Reduction Amoun[Duc Scllcr 7,091.05
300. Cash At Settlement From/To Borrower 600. Cash At Settlement To/From Sellcr
301. Gross Amount due from boao�ver(line 120) � 51,911.96 601. Gross Amount duc to scller(]inc 420) 50,79�7.9G
302. Less amounts paid by/for borro�ver(line 220) ( 5,000.00 602. Lcss rcductions in amL duc scllcr(linc 520) ( 7,091.05)
303. Cash X From ❑To Borrower I $46,911.96 b113. Cash �X To __. From Scllcr S 43,703.91
�.have efiilly eviewe the IiUD-I ettlemeu m [aud to Ihe bes[of my luowledge and bclic[it it a Icuc and accwate slalnnu�t of all reccipls and disbursrnirms nude on my
wco t or by i¢thi ctian Cu�ther have received a comple�ed copy oFpages 1 and 2 of�his �)D-I SeWemeu�Siatcmeni. .n
� i���V y��.�/��c.y/
lo e ��` --- � '"-
drew L. � Seller Carol Ann Drach6ar,Grec of Vesla S_Clippingcr L•sL
�
;orzower p�elaA.Spotts Seller
SETTI,ENIENTAGENT CERTIFICATION Scller's Taxpaycr ldcoGfcatiou Numbcr5ulicilaUUU aud Ccrtifintiun
te HU0.1 Senlement Sta[ement which I have pret�ed is a we md a¢uam accomt oF ihis o-msaaioa 1 have l'ou ue requ'vd 6y I.w Io ym�ide�he SeWane��Agrn�iwncd.pu.a Mi�h�ou,mn.a uxpq�r,�p,��,,,,
3uced�he fimds m 6e disbursed in ccordav ��h tW's swrmeo� bc.If you do oot pronde�he Sauwrni ih) ea�upa v Wrnulawn mmlv.).w`u.
• �o un oca�o avil w vimi`ul pwllic im h a�Velury.I caufy�ul�hc numtc
sh w Ihis tuwml is my co ca�az �� w.Uudvpasa I�
RYc drn�finuon numl�.
Settleme A nt ate
i c:i��,a��m mo.�ir r�e,w�m�m a��a swa ao u�o��y om�,m;�,.r�.
��e�� o oo���;oo�;��m��a ,�a mP�oom�c ae���rm��s us.coa�xa;oo�oo�ma ----
eaioo mPo.` ScI1cPs Siana�urc Dalc
3UD-1 3/91 RL=SPA,I IL3 4305.2
.Settlement Charges - pas�2
]0. Total SalesBroker's Commission based on$ @ %= O.40i Paid Prom Paid From
Division of Commission(line 700)as follo�vs: Borrower's Scller's
Funds at . Funds at
�1• � to Settlemen[ SetUcment
7?- � to
]3. Commission paid at Settlement ~ 0.00
]4. I ----._ __ _ _
�0. Items Payabte in Connection With Loan
)l. Loan Origination Pee % � ,-- --
i
------- ---- ---
)2. Loan Discount �/
)3. Appraisal Fee �o
---------�-- __ _
J4. Credit RepoR ro ---------
-1_.--
]5. Lender's inspec[ion Fee to � - - -
)6. b[ortgage Insurance Application Fee to � - -. - "" -
)7. Plood cemfication _ �
----- - ---
]3. j- -_ --
l9. --- -
10. ------ --_ _
I1. i---- _ _
i
)0. [tems Required By Lender To Be Paid In Advance
)l. Intcrest Gom to @$ /day � - , -
)2. Mortga�e Insurance Premium£or months to - -
- --_: _ _ - --
73. Hazard Insucance Premium for years to •
)4. i - -
li. i- � -
)00. Reserves Deposited With Lender
)Ol. Hazard[nsurancc 5 @ $ per � �
)OZ. Mor[gage I�surance 5 @ $ � � -- ------�-
Pe
)03. City ProPertY taYes 5@ 5 per --- - -- -
)04. County Property[a�ces S $ per � �---- ---- -
)O5. Annual asscssments s @ $ � - � _ _ -
per
106. School Taxes S @ � per i ---- ' - - -
i �
107. s @ $ e� i ----- --- -
P
108. A�pregate Ad�ustment � - "- � -
00. Title Charges
� --- ------
. cttlement or closing fee to ,
� ---!-----
02. Abstract or hNe search to -
03. Title examination to � - --'- -
04. T�tle msurance binder to ---�-- ---
i
---- .. __.._._ ._-- .
�. Document p�eparauon to i
06. Notary's fees to ; -'
07. Attomey's fees to Jcel R.Zullinger,Esquire 550.00 ;
(mcludes above dems numbers: �� ---- ,
08. Trtle msurance to � --- -- -- -
(includes above items numbers: �� ---- - -
09. Lender's coverage $ i - �---"
10. Owner's covera�e $ i
---- - -- --
ll. -----�- ------
�?_ ' ----�-- ----
13. -- ! --1-- -
00. Government Recording and Transfer Charges
Ol. Recording fees:Deed$ 6Z00;Mortgage$ ;Releases� � 67.00� 0.00
02. City/county ta�c/stamps:Deed$ 500.00 ;Mortgage S � 500.00 ; 0.00
03. State ta.�c/stamps:Deed$ �00.00 ;Mortgage S j 0.00 500.00
04. - -- -_- ---
i
O5. � ----r---- - -
00. Additional Settlement Charges �� � �
)l. Reqmred sernces you can shop tor i
]2. Auctioneers Fee to: Rowe's Aucfion Service �• --�---�---�-�-""
i 1:000.00
)3. Advertising Costs ro: Rowe's AucROn Service ' 433.60
M. Final Scwcr ro: CFJMA ' 99.25
)5. Final�Vatcr to: Borough of Shippcnsburg � � SS20
)6. ----__+-------- . .
-
)Z I - -�----- -- ----
)8. i---� --------
_ ' -- --r---- -- �
)9. I
i
00. Total Settlemen[Charges(enter on Iines 103,Section J and 502,Section 3n 1,117.00 2,091.05
- . � Inifial�scrow Accovnt Sh[ement Aeqnirxd by Sectiou 10(c)(1)of the Real Estate Settlemeut Procedurcs Act(RESPA)
hecked,[,I the[erms of your loan requ've you ro have an escrow accoun[to assure that the certain obli�ations relating to ihe mortgaged property,such as lar.es,insurance
miums and olher charaes are paid.7'he amount specifed below�vill be collectect,along wi[h your moRgage principal and inlertst payments,during ihe 5rs1�12 months a11er
�,r acwunt is opened to pay ffiese anricipated espenses: g��A��
ginnin�Date: Your escrow account paymeo[will be S ��
Payee Purpose Anticip�ted Due Date Estimahd Amount
D-1 3/9( RESPA,HB 43052
p M�s�
499 Mitchell Road,Millsboro,DE 19966 Adjustment Services
Phone 888-502-4349
F ax (302)934-2955
July 29,2013
Law Offices Of
Zullinger-Davis
Professional Corporation
20 East Burd Street
P.O.Bog 40
Shippensburg,PA 17257
Re: Estate of Vesta S. Clippinger
Social Security: 174-OS-1987
Date of Death: June 9,2013
Dear Sir or Madam:
Per your inquiry on June 21;2013,please be advised that at the time of death,the above-named decedent had on
deposit with this bank the following:
1. Type ofAccount CheckingAccount
Account Number 97168017
Ownership(Names o� Yesta S.Clippinger
Carol C.Drachbar(POA)
Opening Date 01/28/1980
Balance on Date of Death $9,684.95
Accrued Interest $ .01
__............_...._..----............................................-.._.._.._....._---......._......._
Total $9,684.96
2. TypeofAccount SavingsAccount
Account Number 15004205985045
Ownership(Names o� YestaS. Clippinger
Carol C.Drachbar{POA)
Opening Date 08/27/1991
Balance on Date of Death $76,147.01
Accrued Interest $ .12
-----------------___----------------------------------------
Total $76,147.13
J u 1. 15. 2013 9:24AM HC DAV I S N o. 1642 P. 1
�_-----�
�RRSTawN
��
A Tradttion of Excetlence
Yuly l l,2013
Law Offices of Zullinger-Davis
Professional Corporation .
20 E Burd St,P4 Box 40
Shippensburg, PA 17257
Fax 717-530-5222
Re� Estate of Vesta S Clippinger
� Social SecuriryNumber 174-OS-]987
Date of beath 6/09/2013 .
T'f IS HEREHY'CERTIFIED THAT Tt�ABO'VE NAMED bECEDENT HAD THE
FOLLOWING ACCOUNT'WTI'H ORRSTOWN BANK:
TlME DEPOSIT
Account No.� 4000039085
Account Typ� CD 6-1 1 Month Growth
Date Opened- 9/2/2010 '
Lest Renewal Date 3/2/2013
Joint Account(name/dater No
Balance- 573.649.99
Accrue�cl�nterest- $4.54 .
. ._ .._.__ $estRogards, .__..... _ _......__ ...._._.. ,.. ... _ .. ....._.__. .. . . . _. _ .. _._
`�'""'" �' r�x�""
T,.isa R.Kline
Deposit Processing Clexk III
2695 Philadelph�a Avenue•Chambersburg,PA 17201
. "
LAW OFFICES OF
ZULLINGER-DAVIS
PROFESSIONAL CORPORATION
JOEL R.ZULLINGER SUZANNE M. TRINH HAMILTON C.DAVIS
jzullin_e�r(a�zullinger-davis.com strinh(a�zullinger-davis.com hdavis(a�zullin�er-davis.com
14 North Main Street,Suite 200 20 East Burd Street,P.O.Box 40
Chambersburg,PA 17201 Shippensburg,PA 17257
717-264-6029 717-532-5713
717-264-1884(FAX) 717-530-5222(FAX)
March 4, 2014
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Register of Wills . �� _ {_��
Cumberland County Courthouse � �,,, ���;
1 Courthouse Square '''
Carlisle, PA 17013
Dear Register:
RE: Estate of Vesta S. Clippinger
File No. 21-13-0699
In connection with the above estate, enclosed for filing in your office are the
following.
• Original of the Inventory;
• Original and one copy of the PA Inheritance Tax Return;
• Check payable to "Register of Wills, Agent" in the amount of $413.71,
representing payment of the bala.nce due for inheritanc� tax;
• Check payable to "Register of Wills" in the amount of $50.00 for addirional
probate fee.
, '
If you have any questions, please contact my Chambersburg office. Thank you.
Very truly yours, ,
� /�°
J�oel R. Zullin r ' �
�
Encls. .
Cc: Carol Ann Drachbar, Executor
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