HomeMy WebLinkAbout04-01-14 aev.�raz-�ax ieoe>
OFFICIAL USE ONIY
pennsylvania lNNERII'ANCE TAX RETURN
°�'�"�"`�� NONRESIDENT DECEDENT FtLENUMBER
PQ BOX 280601
NARRISBURG.PA 17128-0601 .�� � Q���
OECEDENTS NAME(IAST,FI�tST,AND MIDDLE IHI'f1At) SOCIAL SECUR(TY R{UMBER
Z Shaw Patricia M.
� �are aF a�n��a�-oo-r�oR� aa��oF e�rH�.��
� 11/13/1894 12/28/1937
W {!F APPIiCABIE}SURVlVJNG SPt3USE'S NAME(iAST,FiRST AidD b6DdLE lNiTiAI) SOCIAL SECtfRITY NUMBER
�
�' � i.0�nalReWm � 2.SupplementalRetum � 3.RemainOerRe&�m �brarawaoaorw�t•��
4
��� � d.tlmhed F.sta�Fe � 4a Future k�rest Gomprar3se 1�araee.m,ner t2-�s.az� � 5.Fedarai Estale T�Retum Required
W
c=i��' ❑ 6.Decedent Di�t Tesffite�u�ra,a,�d� � 7,DecedeM Maintabied a i.krkxj Tn�t Wmc�c�ratrusq ,_ 8.Tota!f�i4ar o(Safe Deposit 8oxes
❑ 9.l�gaUan Prooeeda Received � 10.Spousaf Paverty CredN�we a ee.�a oeewa��2•�-v�.a�-s•� � 1 t.ElecUon�a taoc under Sec.St 13(A)(N.d�scn o1
� _, _ . . �. , . . . �'1'�1° :;" ';;:
� NAM� CC�P�ETE MA�MG AQDRESS
o Theresa L. Si�ie W�C Es uire 4705 �uke Street
a FliNd t+tM�{NApp�shie}
� Wix Wen er 8�Weidner Harrisburg, PA 17709
o TflEPH4NE NU#+�ER
" ?17 652-&455
[tEFER TO METHOD OF COMPUTATI�+t IN THE NOAlRES10EMT DHCEDF.NT INSTRUCTION BQOKIET(REV-'i?36) c�
C�Urne: Flat Rate P na#e Com �
� roportEo ( DtMa Woric�t�eet on lieverse Sidey n � � nt
1,Reet Estale(Sd�edule A) (1) 8 500.00 �OFF�CI�� tn %^3
2.Slodca�d Bonds(Schedule B) (2l .:� �, � :�:� �
3.Cfosety Held Corpor�bon.Partnersh;p or Sote�P+�o�uietorahQ (3) �';�;, � r,, F", �' �
(Scttedule C} � :%`� �:�' C�
� � C:.7 �? ....j 'n
. "'r1
4.Matgageg 8 Nofise Rea�vable(SchedcAe D) (4) ,c'a o -� � :�- .-
� 5.CasH.Bank Depoei�&�ous Personai Prepertg (5i 'I fi1.21 !I-:° � N � m
p (Sd�euteE� �;� r�� � °
6.Jointly Owned Properq�(Schedule Fj (8) �
_ ❑ s�e�a r�au�a �
~ 7,h�r•Vlvos Tcansfers&Miscellar�eous Non-Probate ProPenY (7}
a �scn�e c��>
<t
W 8.T�i t3roas Assels(tafal I�►es 1-7} (8j $681_29
� 9.Funer�Expenses$Admirtis4�tive C961s(Schedule ki) (9} $7�6.�$
18.Del�of Dac�deriL hkxt986e L.iab�es arxf Liens(Schedufe I) (40)
11.rotal De�ctt�ons(�I unes a�10} t��� 8,736.46
t2.Net vai�e af Eetate(Lirre 8 minus t.+ne 1 t� {12} -75.25
13,Cheriteble and Govemrrrer►G�BequesbJSec 9113 Tn�tor which 8n efes;tion to 2ax has�wt been (13j
mede{Sdteduie J)
14.Net Value Sttbject to Tax(lMe 12 ndtws line 131 {14) -75.ZS
� SEE AiSTRUCTiOkS Of!RE11ER5E S1DE FOR APPUCABtE RATES
15.Arrau+�t of L'a�e 14�xabte eF Ihe sptwaa9 t�
�O fl.04 x .0 0.00
_� �ate,a�transte�s+�r Sec.2116(aX1.2� (15)
t)►a- 16.AmouM af Li�e 14�o.aMe�Nneai r�s -75.25 X .O6 (16} "�.�2
V� 17.Amoum of Line 14 t�xabte at sibfing rate 0.d0 X .12 (f l) 0.00
(=j C3 18.AmouM of Lirx fA ta�tabi�at oaf�terai rabe �.00 X .t5 {18} 0,00
�� 19.Ts�c due-Ma[ue chacic payab�to CommanweMth�aA (19) '`#.��
� �
�.
� � r�`'��.x #W
:a`a., :i.�'Yxf�
� � � g ,� �
�
� ���� � � � Q � � � � . N S. � �
� O � w _, � g �� �'ffi � nv','�
� w � �� �-' i- .� ,� � u� c� �
��p� � �- L7�� o❑ ❑ ❑ � a� � '/� � "' � ��'� � � G�
O � V + � � � �'!5 �
�� m 53 D� � O � ��� e ��
� ,� � � W —v � � g � �
� � o � � �� N � � ��� � � � �
� . . . � . � m g o
W � � � � � � � � � � � � � ��
� �� � � � �� � m � m� � ��
� r � .� � : � � �a � � � � � � �� � ��
W � ~ � � o � �� m,i, � �$ � ��e
� �� � � � � � . W� �c � � �� � �
m �� � � � � � � � �� °�� � � � ��
� � �$ � � m ~ � � h "� �� � �' g
� � � u� �� �.�'� � .�.., � t$
i �
t�41 � � �O . � � � � �� LL �� � `��' �`"� �.� S.xa ��
� d � � � � � � Cj � _ �G. c'ra� '�' � m � c
c�o � � � � � �; � . � �� a �c �^� ,� ° ��, �
� n � � o � 8 � ,� -,r� .� �;a; ��„
$ � o � � � o � � � ; � � � �-- � ��� .� �sa �s
N ° �c� � � � � � � � � � � �� � � �� �a� �$ �c .���`
� W „d � • � ,� � C � � LL �'S O '��'A4 N '� «�� �� �6
� � � �m � � � � � �„ : � � Z �'� � � ,� � �c �� `W � 44
� � �
� .8 � � �6 N � : C t �� � � 16 � � W� �1L> �,�@�
oe � � � �g � � � °° � � � o � � w� g�� �� . � N �� S $
� � w � " � � � � ` � A \� � S'fQ �� 0. �
� � � � � .� � �� � a � � � � �� � �� �N �^
�, � �. � � � � � � g � �,� p �� � �m� � o� �� ��
�� ° o � � �sti � � o �s $ � W �� �N� � c—� �a �, �� �,�� �� ��
q^ � � �
y� lV f7 � �._. Q �
Q a.�1�'t�CL� � �I �� � ��� O� � LL�.ia 4�. ��� ttQ �G F'C- t6 ��
!- . . ����.7ir°..`.��::..;a:G:?'�'.�c�,
�n
t� O O C p O N O O
s�' O C1 O .- O � Ci Q
i
c
.... �. v � v ,r� ,°� ='. '�. C �? � �
a
.••. ..... u a �� n E
p p 0
U w `' `� �
N N � N O O O G7
40 p e(p- r�p CC tn c� r e- .- �
+ cd t� n ~ m
� �
`t N 40 oD $
� y :
` . T
� r �
� � � � � � � r � �
� �" � �
3
� � c � Z � x x x x �
� � � � �t Y � � N �
F, v w v � ; o
� ' .��.. � � � � � � �i
� � � m � � �. :� � � ~ �
,� o � m � N .� $ � �; �
a � � � � � � � � � �y' � � � �
L '� a- � W ro � % N �.- .� � � K �
� c�°o � V �Z �' � � �+ g £� � � � � ' � " x " � s
Q' � O C °' � � � � c `� � °' � � � �'' � c ��' � ~ c'. � � �° w
p N 0 � � � � � a � a�i � � J a � � � � � � � � � '� 8 �
�1 _T q� � � �/; ,� �` n `� Z � � �'p ye ��C ,w
V i L. � e— � � M � O .� 61 �y Tj �� �^y � � Pi �e7 �M
�; � °C' N � �' � ��. � �o ,� �� _ � �" � n � � � .� bK � ��� ��yp � �
� �G Z '�' +� �N � p� � �+ � � V � � � � � � � 1R , � � �' b4 � � `N Q
� b � � yg
� W� c � {y�c � �� � � � � .� � .SQ � N � YQ� �F�
W � C � "- • � m U C � � = F- � F Q � O � � � � � �� �� �� �0. K � K � �
� �CpD � � t� H� 4 U — �+ �
� v>00 c�H F• r c�i c� v �ri a .- e�i ai v �ci m r: od oo f-
REV-1737-1 EX(6-08)
:�._��
�������:A� pennsylvania NONRESIDENT DECEDENT
DEPARTMENTOFREVENUE AFFIDAVIT OF DOMICILE
PO BOX 280601
HARRISBURG,PA 17128-0601
This affidavit must be completed and sworn to by a person having personai knowledge of these
facts, preferably by a surviving spouse or member of the decedent's family.
Name of Decedent Date of Death
Shaw Patricia M. 11/13/1994
Legal Address at Time of Death:
Street Address City/Borough State Zip Code
8601 Temple Hills Road Lot 105 Temple Hills MD 20748
The following information is submitted in support of the statement that the above individual was
not domiciled in the Commonwealth of Pennsylvania at the date of death.
1. Names and addresses of the decedenYs surviving spouse and members of hislher immediate famity:
Name and Relationship to Decedent
Vernon Edwards Son
Street Address City/Borough State Zip Code
12 517 Kent Road Kinq Georqe VA 22485
Name and Relationship to Decedent
Euqene Edwards Son
Street Address CitylBorough State Zip Code
2314 Riverview Ter Alexandria VA 22303
Name and Relationship to Decedent -
Bonnie VanGundy Stepdauqhter
Street Address CitylBorough State Zip Code
5431 Pearson Chapel Road Alexander City AL 35010
2. Did the decedent ever live in Pennsylvania? ❑ Yes � No
If yes,during what periods?
3. Did the decedent spend time in Pennsylvania during the five years preceding death? ❑ Yes � No
If yes,during what periods and at what address(es)?
4. What was the nature of decedenYs place(s)of residence during the five years immediately preceding death?
Indicate whether decedent resided in a house or apartment and whether it was rented or owned by the decedent,andlor whether decedent resided in a
hotel or the home of relatives or friends.
Decedent resided in a trailer at the time of her death. It is unknown whether or not she owned the trailer.
5. Was the decedent employed during the five years preceding death? u Yes XI—'i No
If yes,list the name(s)and address(es)of employer(s).
Decedent was disabled due to a stroke.
6. Did the decedent leave a will? C�l Yes � No
If yes,state the couR that admitted the will to probate,the date admitted,and attach a copy(including all codicils)and a certificate of issuance of
letters testamentary.
7. If the decedent did not leave a will,has an administrator of the estate been appointed? � Yes ❑ No
If yes,state the court that appo�inted the administrator and the date of appointment,and attach a certificate of the issuance of letters of administration.
The decedent resided in Maryland, but an Administrator was not appointed in Maryland. An Administrator was appointed in
Pennsylvania solely for the sale of the decedent's property in PA. Cumberland County Register of Wills-August 7, 2013.
8. At any time during the last five years did the decedent execute a will,a codicil,trust indenture,deed,mortgage,lease or any other document in which
the decedent was described as a resident of Pennsylvania? �--! Yes � No
If yes;describe such document.
NONRESIDENT DECEDENT AFFIDAVIT OF DOMICILE (cont�nued) Page 2
9. Did the decedent pay a tax on income or on intangible property to any state,county or municipality during the last five years?
If yes,where and when was it paid? ❑ Yes �', No
10. To what regional office of the Internal Revenue Service did the decedent forward his federal income tax returns during the last flve years
preceding death?
The decedent died in 1994, and the answer to this question is therefore unknown.
11. At the time of death,did the decedent own,individually or jointly,any interest in real property,including lease-holds,or tangible personal property
located in Pennsylvania? �j Yes ❑ No
If yes,describe the property in detail.
The decedent inherited a piece of real estate located at 1759 Sheepford Road, Mechanicsburg, PA
12. In what business activities was the decedent engaged during the last five years preceding death?
Indicate whether decedent was employed or otherwise engaged in business,and state the names and the addresses of the persons,firms or corpora-
tions with which the decedent had such business affiliations.(Except for employer listed in#5)
The decedent was unemployed and not otherwise engaged in business at the time of time of her death. The decedent had a
stroke prior to her death and was disabled as a result of the stroke
13. What is the estimated gross value of the decedenYs estate,exclusive of real property and tangible property located outside of Pennsylvania?
The decedent died in 1994 and her estate was never probated. It is believed that her estate had little or no value. The value
of her estate is unknown.
14. At the time of death,did the decedent own or operate an automobile? ❑ Yes ❑ No
If yes,in which state was it registered?
It is believed that the decedent owned a vehicle with at the time ofher death. It would have been registered in Maryland.
15. At the time of death,was the decedent a member of a church or any other organization? � Yes ❑ No
If yes,provide the name and address of the church or any other organization.
. The decedent probably did go to church, but it is unknown whether or not she was a member of a church.
16. State the purpose or reason the decedent ovmed real property in Pennsylvania.
The decedent inherited the property from her mother.
17. Include any other information you wish to submit in support of the contention that the individual was not domiciled in Pennsylvania at the time
of death.If more space is needed,use additional sheets of paper of same size.
Name of Person Completing Affidavit Relationship to Decedent
Vernon Edwards Son
Street Address City State Zip Code
12517 Kent Road King George VA 22485
Under penalties of perjury, I declare that based on my personal knowledge of the decedent,
the information provided on this form is true, correct and complete.
Sign f Person Comp tin davi� �/2,., � Date
%/�-�--- �� I � I `�
REV-1737-2 EX+(6-08) SCHEDULE A, PART 1
pennsylvania REAL ESTATE
DEPARTMENTOFREVENUE �N PENNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF FILE NUMBER
Shaw, Patricia M. 21 13 0815
Part 1 must include all real property owned by the decedent individually or as a tenant in common with another party(ies), having its
situs in Pennsylvania. Property jointly-owned with right of survivorship should be disclosed on Schedule F.Ali real estate must be
reported at fair market value,which 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 and both having reasonable knowledge of the relevant facts.
ITEM
NUMBER DESCRIPTION VALUE AT DATE OF DEATH
1. 1759 Sheepford Road, Mechanicsburg, Lower Allen Township, Cumberland County, PA 8,500.00
(Owned by Patricia M. Shaw who died on November 13, 1994. The Estate of Patricia M.
Shaw conveyed said property unto Joseph L, Otto and Dixie L. Otto on January 7, 2014)
(See Schedule A, Exhibit 1)
""Vernon D. Edwards, Administrator of the Estate of Paticia M. Shaw, filed a Petition for
the sale of the real estate on August 27, 2013. On November 25, 2013, the Honorable
Thomas A. Placey Ordered and Decreed that the property could be sold. Attached hereto is
a copy of the Petition for Approval of the Sale of Real Estate and the Court Order dated
November 25, 2013.
PART 1 TOTAL
$ 8 500.00
PART 2 TOTAL
(From reverse side.) $
TOTAL (Also enter on Line 1, Recapitulation) $ 8 500.00
(If more space is needed, use additional sheets of paper of the same size)
THIS DEED
Tax Parcel No. 13-27-1877-010
Made the �� day of J ud�u,� , in the year of our Lord Two Thousand and
Fourteen (2014) �
Between Vernon D. Edwards, Administrator of the Estate of Patricia M. Shaw
("Grantor")
AND
Joseph L. Otto and Dixie L. Otto, husband and wife, parties of the second
part ("Grantees")
WHEREAS, the said Patricia M. Shaw became in her lifetime seised, in fee, of a certain
tract or parcel of ground situate in Lower Allen Township, Cumberland County,
Pennsylvania, and more particularly described hereafter; and
WHEREAS, Theodore Barker died testate on December 12, 1984, and bequeathed the
property to his heir and wife, Margaret E. Barker. The said Margaret E. Barker died
testate on December 29, 1993, and bequeathed the property unto her daughter, Patricia
Margaret Shaw. Patricia Margaret Shaw died intestate on November 13, 1994.
WHEREAS, Letters of Administration were duly issued to Vernon D. Edwards on
August 7, 2013, by the Cumberland County Register of Wills, recourse thereunto being
had, appears.
WHEREAS, on November 25, 2013, the Honorable Thomas A. Placey ORDERED AND
DECREED that the sale of the property located at 1759 Sheepford Road, Lower Allen
Township, Mechanicsburg, Cumberland County, Pennsylvania 17055 is approved for
the total purchase price of $8,500.00, and Vernon D. Edwards, Administrator of the
Estate of Patricia M. Shaw, is authorized to execute the respective Deed conveying
good and marketable title and all other documents necessary to effectuate the sale of
this property.
WITNESSETH, that the said Grantor for and in consideration of the sum of EIGHT
THOUSAND FIVE HUNDRED 00/100 ($8,500.00) lawful money of the United States of
America, unto him well and truly paid by the said Grantees, at or before the sealing and
delivery hereof, the receipt whereof is hereby acknowledged, have granted, bargained
and sold, released and confirmed, and by these presents do grant, bargain and sell,
release and confirm unto the said Grantees, Grantees' heirs and assigns:
� ALL THAT CERTAIN tract or parcel of land with improvements thereon erected situate
in Lower Allen Township, Cumberland County, Pennsylvania, more particularly bounded
and described as follows:
Schedule A, Part 1 , Exhibit 1
BEGINNING at a point on the northerly line of Sheepford Road which point is 80 feet
east of Legislative Route #21014 and at easterly line of land now or late of Eugene F.
Bentizel; thence along the said Bentizel property north thirteen degrees thirty minutes
west (13° 30' W) finro hundred eighty-eight and seven tenths (288.7) feet to a point;
thence south eighty degrees no minutes east (S 80° 00' E) sixty-one and four tenths
(61.4) feet to a point at westerly line of land now or late of John R. Goudy; thence along
same south fourteen degrees no minutes east (S 14° 00' E) two hundred seventy-seven
and three tenths (277.3) feet to a point at northerly line of Sheepford Road aforesaid;
thence along same south eighty-eight degrees no minutes west (S 88° 00' W) fifty-nine
and four tenths (59.4) feet to a point and the place of BEGINNING.
Being premises formerly known as 5 Sheepford Road, and now known as 1759
Sheepford Road.
BEING the same premises which Joan E. Renninger and Jack Renninger, her husband,
by their Deed dated April 11, 1978 and recorded on April 14, 1978 in the Cumberland
County Recorder of Deeds Office in Deed Book S, Volume 27, Page 896 granted and
conveyed unto Theodore R. Barker.
Together with all and singular ways, waters, water courses, rights, liberties, privileges,
hereditaments and appurtenances whatsoever thereunto belonging, or in anywise
appertaining and the reversions and remainders, rents, issues and profits thereof; and
also all the estate, right, title, interest, use, trust, property, possession, claim and
demand whatsoever of Grantor, in law, equity or otherwise, of, in, to, or out of the same.
To Have and to Hold the said hereditaments and premises hereby granted and
released, or mentioned and intended so to be, with the appurtenances unto Grantees,
Grantees' heirs and assigns, to and for the only proper use and behoof of the said
Grantees, Grantees' heirs and assigns forever.
And the Grantor, for Grantor, and Grantor's heirs, executors and administrators, does
covenant, promise and agree, to and with the said Grantees, and assigns, by these
presents, that he, the said Grantor, has not done, committed, or knowingly, or willingly
suffered to be done or committed any act, matter or thing whatsoever whereby the
premises hereby granted, or any part thereof, is, are, shall or may be impeached,
charged or encumbered, in title, charge, estate or otherwise howsoever.
In Witness Whereof, the Grantor has hereunto set his hand and seal the day and year
first above written.
WITNESS: i
�J�r��,v � � / lU % �'�-� �`;/ ��. � �°Z •2�'t-� �
L�� �
Vernon D. Edwards
Administrator, Estate of Patricia M. Shaw
Previaus etlilions are obsoleta fortn HUD-7(3/86)ref Handbook 4305.2
A. SettIP'ment Statement U.S.Department of Housing and Urban Development
B.T of Loan OMB A roval No.2502-0265
1. ❑FHA 2. OFmHA 3. ❑Conv.Unins. 6.File Number 7.Loan Number 8.Mortgage Insurance Case Number
4. ❑VA 5. Conv.lns. PY013•104RCS
o p a s eme emen cos s. ou pa o a y me ape are s n.
C.Note: i�s m�rxea-�P.o.c.��re�a«,�a�a�ao8�;�ero,iwwr,rrere rw�,r«meuor�v�,rco:e:&,a ere�a�r�waa:,ma w�ai:. Ti�eExpress Settlement System
WARNING:It ia a Wme lo kno+iviply maka false stalemenb to the UMted Sletes on thia w eny other similar form.Pena�ias upon
mnviclim cen indutla a fire en0 im ' menL Fw Eetails see:TRb 18 U.S.Cotle Section 1001 antl Sectim 1070.
D.NAME OF BORROWER: Joseph L.Otto and Dixie L.Otto
ADDRESS:
E.NAME OF SELLER: Estate of Patricia M.Shaw
ADDRESS:
F.NAME OF LENDER:
ADDRESS:
G.PROPERTY ADDRESS: 1759 Sheepford Road,Mechanicsburg,PA 17055
Parcel 13•27-1877-010 Lower Alien Townshi
H.SETTLEMENT AGENT: Pyramid Land Transfer LLC
PLACE OF SETTLEMENT: 26 West Hi h Street Cariisle PA 17013
I.SETTLEMENT DATE: 0110712014
J.SUMMARY OF BORROWER'S TRANSACTION: K.SUMMARY OF SELLER'S TRANSACTION:
100.GROSS AMOUNT DUE FROM BORROWER 400.GROSS AMOUNT DUE TO SELLER
101. Contracl sales rice 8 500:00 401. Contract sales rice 8 500.00
102. Personal ro 402. Personal ro rt
103. SetUement char es to borrower line 1400 851.50 403.
104. 404.
`105. 405. .
Ad'ustments for ftems aid b seller in advance Ad'ustrnents for items aid b seller in advance
108. School Tanes 01/07H4to06130114 161.21 408. School Taxes 01107N4to06130114 161.21
109. 409.
110. 410.
111. 411.
112. 412.
120.GROSS AMOUNT DUE FROM BORROWER 9 512.71 420.GROSS AMOUNT DUE TO SELLER 8 661.21
200.AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER
201. De sit or eamest mone 1 000.00 501. Excess De sit see instructions
202. Prind al amount of new loans 502. Settlement char es to seller line 1400 7 783.69
203. Existin loan s taken sub'ect to 503. Existin loan s taken sub'ect to
204. 504. Pa off of First Mort a e Loan
205. 505. Pa off of second mort a e loan
206. 506.
207. 507. Escrow Wix Wen er 874.75
208. 508.
209. 509.
Ad'ustments for items un aid b seller Ad'ustments for items un aid b seiler
211. Coun taxes 01101N4to0110T114 2.77 511. Coun taxes 01101N4to01107114 2.77
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220.TOTAL PAID BYIFOR BORROWER 1 002.77 520.TOTAL REDUCTION AMOUNT DUE SELLER 8 661.21
300.CASH AT SETTLEMENT FROM OR TO BORROWER 600.CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due irom borrower line 120 9 512.71 601. Gross amount due to seller line 420 8 661.21
302. Less amounis aid b/for borrower line 220 1 002.77 602. Less reduction amount due seller line 520 8 661.21
303.CASH FROM BORROWER 8 509.94 603.CASH TO SELLER 0.00
SUBS7ITUTE FORM 1099 SELLER STATEMENT:The iMOrtnation mMeineE herein is unparlaM tax intormation arM is Deing fumisheG ro the Intemal Reverwe Service.M you are requireC to file a retum,
a neglipence penelty a other sanclion will be enposed m you d this itam is requved to Ee reponed antl the IRS tletermines Ihat it�as nol been reported.The Contrea Sales Price tlescnbetl on
line 401 abova constiwtes Ihe Gross Proceeds M this transadion.
SELLER INSTRUC710NS:tl tliis real estate wes yourprmc�paI residence,file Fortn 2719,Sale or Exchange of Principal Residence,tor a�y gain,wilh your Inwme Wx retum;for other Vansaclions,
complete Me applicable paris of Fwm 47 W,Fam 6252 entllor SU�etlule D(Form 7640).
Yau are requ"vaC by law to provide the settlemenl agent(Fed.Tex ID No: wilhyour cortecl la<payer iOeMifiwUOn number.tt you do not provide your mrtect tazpayer itlent�cation
number,you may be subject to civil or aiminel penatties imposetl by law. n er pena t�es perjury,I certify that the number shown on this stetemeM�s my correct taxpayar ideMifiratian number.
TIN: / SELLER(S)SIGNATURE(S): /
SELLER�S)NEW MAILING ADDRESS:
Schedule A, Part l , Exhibit 1
PreNOUS ndRions ere obsolate torm HUD-1(3/86)ref Hendbook 43052
U.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number.PY013-104 PAGE 2
SETTLEMENT STATEMENT Tt�e�c ress sett�ement s stem
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700.TOTAL SALES/BROKER'S COMMISSION based on rice$8 500.00 35.294=3 000.00 BORROWER'S SELLER'S
Division of commission Iine 700 as follows: FUNDS AT FUNDS AT
701. 3 000.00 t0 ERA-NRT It1C. SETTLEMENT SETTLEMENT
702. to
703. Commission aid at Settlement 3 000.00
704. Additional Broker Commission to ERA-NRT INC. 195.00 195.00
800.ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Ori ination Fee %
802. Loan Discount %
803. A raisal Fee
804. Credit Re rt
805.
806.
807.
808.
809.
610.
811.
900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to Ida
902. Mort a e Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000.RESERVES DEPOSITED WITH LENDER FOR
1001.Hazard Insurance mo. Imo
7002.Mort a elnsurance mo. Imo
1003.Cit Pro Tax mo. Imo
1004.Count Pro A Tax mo. 14.08 Imo
1005.School Taxes mo. 28.02 Imo
1009.A ate Anal sis Ad�ustment
1100.TITLE CHARGES
1101.Settlement or Closin Fee
1102.Abstract or Title Search
1103.Title ExaminaGon
1104.Costs to Wix Wen er&Weidner 293.69
1105.Document Pre aration to Wix Wen er 8 Weidner 200.00
1106.Nota Fees
1107.Atlome's fees to Wix Wen er 8 Weidner 4 000.00
includes above items No:
1108.Title Insurance to ramid Land Transfer LLC 500.00
indudes above items No:
1109.Lendefs Polic
1110.Owners Polic 8 500.00 -500.00
1111.
1112.
1113.
1200.GOVERNMENT RECORDING AND TRANSFER CHARGES
1201.Recordin Fees Deed 67.00 •MoA a e •Reiease 67.00
1202.Cit ICount taxlstam s Deed 85.00 •Mort a e 85.00
1203.State Tanlstam Deed 85.00 •Mort a e 85.00
1204.Electronic Filin Fee to ACCP Electronic Filin 4.50
1205.
1300.ADDITIONAL SETTLEMENT CHARGES
1301.Tau Certification Fee to Saidis Sullivan S Ro ers 10.00
1302.
1303.
1304.
1305.
1306.
1307.
1308.
1400.TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 851.50 7 783.69
HUD CERTIFICATION OF BUYER AND SELLER
I heve careWlly reviewetl It�e HUD-i Setllement Statement arM b tlie Deat of my knowledge and belief,il is a true antl accurete statement of all receipts arM disDursements matle on my account a by me
in ihis Iransadi . furiher certify that�I have received a copy of Ne HUD-1 Se�enl ���� �/�
osep . o �.� o
a a iG . w
WARNING:R IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 SettlemeM Slatemenl whichA have prapared is a true antl accurate accoum of this transadion.
UNITED STATES ON THIS OR ANY SIMILAft FORM.PENALTIES UPON CONVICTION I have caus�d or I cau the funds be disburjed in a �orderxe with this statement.
CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 18: �i ,' /
U.S.CODE SECTION 1001 AND SECTION 1010. � /
eY`���1�,:��U � /
;
�:
c�
c w :� ,.�,�
� � �-; f�'' c�
czr �, �-..- :� �
F�'1 � c, c�� ',.;a :]
�
�^✓� '� ~ � +''�
� � . � .�..
THE MATTER OF : CUMBERLAND CC�tJ9�T�' -=� �_
THE ESTATE OF : OFFICE OF REGISTE�t ��WIL�LS - '
PATRICIA M. SHAW : NO. 21-13-0815,y' ~ -,, ;;:, <�
c� ..�
Petition for Approval of the Sale of Real Estate
TO THE HONORABLE, THE JUDGES OF SAID COURT:
AND NOW comes the Petitioner, Vernon D. Edwards, Administrator of the Estate
of Patricia M. Shaw, deceased, by and through his attorney, Theresa L. Shade Wix,
Esquire, of Wix, Wenger &Weidner, and hereby respectfully avers as follows:
1. Petitioner, Vernon D. Edwards, is the Administrator of the Estate of Patricia M.
Shaw.
2. Theodore R. Barker is the titled owner of property located at 1759 Sheepford
Road, Lower Allen Township, Mechanicsburg, Cumberland County,
Pennsylvania (hereinafter referred to as the "Property"). A copy of the Deed to
the Property is attached hereto as Exhibit "A".
3. Vernon D. Edwards is the grandson of Theodore R: Barker.
4. On April 22, 2013, Vernon D. Edwards, as the grandson and heir of Theodore R.
Barker, entered into an Agreement of Sale with Joseph L. Otto and Dixie L. Otto
for the sale of the Property located at 1759 Sheepford Road.
5. Pursuant to the Agreement of Sale, the total purchase pric� of th� Property is
$8,500.00.
6. There are title issues with the Property as set forth in the ensuing paragraphs.
7. Theodore R. Barker died testate on December 12, 1984 in West Virginia. His
estate was probated in Jefferson County, West Virginia. His heir was his wife,
Margaret E. Barker. Theodore Barker's estate was not probated in
Pennsylvania.
8. Margaret E. Barker died testate on December 29, 1993. Her estate was probated
in Jefferson County, West Virginia. Margaret Barker's estate was not probated in
Pennsylvania.
9. In her Will, Margaret E. Barker bequeathed the Property located at 1759
Sheepford Road to her daughter, Patricia Margaret Shaw.
10. Patricia M. Shaw died intestate on November 13, 1994 and was a resident of
Maryland. Her estate was not probated in IVlaryland nor in Pennsylvania. She
was survived by her husband, James E. Shaw; two sons, Vernon D. Edwards
and Eugene P. Edwards; and a step-daughter, Bonnie Van Gundy.
11. Mrs. Shaw's husband, James E. Shaw, died on May 15, 2012 and was a resident
of the state of Alabama. Mr. Shaw is survived by his daughter, Bonnie Van
Gundy and his two step-sons, Vernon D. Edwards and Eugene P. Edwards.
12. Theodore R. Barker's estate never transferred title to the Property to his wife,
Margaret E. Barker; nor did Margaret E. Barker's estate transfer title to the
Property to her daughter, Patricia M. Shaw. Therefore, there are title issues
regarding the Property.
13. On August 7, 2013, Vernon D. Edwards was appointed Administrator of the
Estate of Patricia M. Shaw with his sole purpose of his appointment being to sell
the Property.
14. The sole item in Mrs. Shaw's estate is the Property located at 1759 Sheepford
Road, which she inherited from her mother, Margaret E. Barker.
15. Any and all Pennsylvania lnheritance Taxes due and owing will be paid by the
Estate of Patricia M. Shaw from the proceeds of the real estate settlement.
16. The Buyers of the Property through their Counsel, Robert C. Saidis, Esquire, of
Saidis Sullivan & Rogers, have requested a Court Order approving the sale of
the Property due to the title issues created by the omission of Deed transfers in
the chain of title of the Property.
17. The three interested parties regarding the Sellers of the Property; Vernon
D. Edwards, Eugene P. Edwards and Bonnie Van Gundy, have all received
notice of the sale of the Property. Eugene P. Edwards and Bonnie Van
Gundy have executed Renunciations appointing Vernon D. Edwards as
2
Administrator of the Estate of Patricia M. Shaw.
18. No judge has ruled upon any issue in this matter or any issue regarding
the Estate o#Patricia M. Shaw.
19. On August 20, 2013, Robert C. Saidis, Esquire, of Saidis Sullivan 8�
Rogers, counsel for the Buyers, stated that he concurs with the allegations
set forth herein.
20. Petitioner requests that the Court approve the sa(e of the Property and
grant Petifioner the authorit�r to execute the respective Deed and all other
documents related to the sale of the Property as Administrator of the
Estate of Patricia M. Shaw.
WHEREFORE, Petitioner requests and prays your Honorable Court to
approve the sale o# the Property located at 1759 Sheepford Road,
Mechanicsburg, Cumberland County, Pennsylvania.
PETITIONER
Date: 8��,p1 t '3
Vernon D. Edwards, Administrator of the
Estate of Patricia M. Shaw
RespectFully sUbmitted,
Date: $�a�I�o[3 gy`�.�.�ll�/� Cx��� ljt,��G
l
Theresa L. Shade Wix, Esq., ID#43089
Wix, Wenger&Weidner
4705 Duke Street
Harrisburg, PA 17109
(717) 652-8455
Attorneys #or Petitioner
VERIFICATIONPRIVATE
I, Vernor� D. Edwards, Petitioner, hereby acknowiedge that I have read the
foregoing Petition for Approval of the Sale of Real Estate and verify that the facts
stated herein are true and correct to the bes# of my knowledge, information and
belief. I understand that false statements made therein are subject to the pena�ies
of 18 PA. C.S.A. §4904, relating to unswom falsfica#ion to authorities.
Date g�Z D�/�j
Vernon D. Edwards
ATRUE CUt'r rri:��:+ r�«t.:vi-tl.� ��`�,'�
in Testimony wherof, i hereunto . ' �
set my hand and the seal
of said,C�ourt a �lisle, P A
��y o� o.�- �
_ � �: �
w � m
m
CN�1c ot the rpfiana Court m � .�. c� °
Cumbe�lend County rn s c� c � c�,
� z> r— rv r-;; �
� Z � U1 �� t'�
�= �: � O `"�
C'j n :'� -?� -ry _
� C.:? -rry --�-3 .
•`�, E.',`,
` THE MATTER OF : CUMBERLAND COUNTY=' ��' - �-_
THE ESTATE OF : OFFICE OF REGISTER OF�/VILLS �; �' =�
PATRICIA M. SHAW : NO. 21-13-0815
ORDER
AND NOW, this �CJ da of N p t��P�tn�t,.��a� 2013 u on
Y , , p
consideration of the Petition for Approval of the Sale of Real Estate, IT IS HEREBY
ORDERED AND DECREED that the sale of the property located at 1759 Sheepford
Road, Lower Allen Township, Mechanicsburg, Cumberland County, Pennsylvania
17055, is approved, for the total purchase price of $8,500.00, and Vernon D. Edwards,
Administrator of the Estate of Patricia M. Shaw, is authorized to execute the respective
Deed conveying good and marketable title and all other documents necessary to
effectuate the sale of this property.
- -...J:_
� "�hh�mas�.Rlacey
C�mmon Pf�c�s�ucige
Distribution:
Theresa L. Shade Wix, Esq., 4705 Duke Street, Harrisburg, PA 17109
Robert C. Saidis, Esq., 26 West High Street, Carlisle, PA 17013
Vernon Edwards, 12517 Kent Road, King George, VA 22485
Eugene Edwards, 2314 Riverview Ter, Alexandria, VA 22303
Bonnie VanGundy, 5431 Pearson Chapel Rd., Alexander City, AL 35010
---._..__._,.__....�_.�._._. __.._.__.
, __ _. . _._........------..---......._._._.._
� __ . -----
' ��.�_
, .. 1 School Dist.Cumb,Co.,P�, �•��+�,w .11lst.�!jf�
� l s t..��,i.i.�...,r..r.. Cumb. Co., Pa.
� z- ,�s w.,�.�.«.T....r«r�
� o.►. .�-r.g��s�,���.. �4.. �j�75
� __yE� D•M '/¢•�7fAmt.�:l.'�vi:.
. v� <
' 0..4 c.o+.�.at�-.,,� Llis� ,�.!f r.�« �.
f
G+r.G.DI.1.Gl�41./(/'i�
r
`.r ; _ � , ,j i
f I ' 3
� ;
' I No.s�b� I�EEBI]iPLE DEED-17prwrftar 7 �
� t -s
i ! ��t� �Yt�PYtt1�P �dttdr ���e .
� � �
} � d� a�°'�`'� -
� dOy°1 !w tke year oJ our Lord pM
� ? Thowand Fine l/rwlred and Seventy-Eight (1978).
i
� � 7R
f � 1�Ft1111'PIT JOAN E. RENNINGER and JACK RENNINGEft. Her Husband,
! of South Hanover Township, Dauphin County, Penasylvania,
� i Partiea of the First Part, .
' . A
f ' N
i ' D
� �
• THEODORE R. BARKER, of Lower AlYan Township,
: Cumberland County, Pennsylvania, party
i
I
�uJ ih.e ieeosd part� yWjt1lP58PTI�Ti�t�he�aidpart lee o/!Ae/iro!part,for ond in rnnifderotioe . .
01�k�•��o! Five Thoueand Five Hundred Dollara ($5,500.00)
I bo::un,la¢fid aioncg v/lNe Uuitn!Sfatu uf dracricw,rcll and lruly paid Gy the iaid part y of ihe
i ttcund part to!hc raid part lee of thc/ir�t port�af cnd bcfort 16c acafing and dAitery oJ thrrr
prucnp,Ike rcccipt¢hereo/i�kere6y acknwcleJgcd, have
qranfed,Lorgaiecd,iofd,aliened,eR/cuf/evl,rcltarcd,roncryrd and cwnJinned aad by fhue prurnb do
grael,6nrgnin.s�1l.alirn.�nJroJJ.rcicase.cunrry,a�d rnn/irm nnfo fht raid parf y �f
. (AC aecond perf h18 Aein and a+ai.Ona. .
` 1�j� THAT CERTAIN tract or parcel of land with improvements thereon erected
� situate in Lower Allen Township, Cumberland County, Pennsylvania. more particularly
buunded and described as follows:
T3;'�.1NNING at a point on the northerly line of Sheepford Road which poiat is 80 feet
ea�: of Legislative Route H21014 and at easterly line of land now or late of Eugene F.
Be::i.izel;thence aloag the sai d Bentizel propertq north thirteen degrees thirty minutea
; h;:si (N 13° 30' W)two hundred eighty-eight and seven tenths (288.7)feet to a point;
i thence south eighty degrees no minutes east (S 80° 00' E) sixty-one and four tenthe
, (61.4) feet to a poi� at westerly line of land now or late of John A. Goudy;thence along
s�-ie south fourteen degrees no minutes east (S 14° 00� E)two hundred se�emy-seven
and three teTrths (277,3) feet to a point at northerly line of Sheepford Road aforesaid;
thcace along same south eightq-eight degrees no minutes weat (S 88° 00' W)fiPty-nine
and four tentha (59.4)feet to a point and the place of BEGINNING. �
BEING premiaes known as 5 Sheepford Road. -. .
Br^.P_�TG the sazne premises which Neai J. Hardy, Federal Aoueing Commieaioner. by
, de=d dated October 25. 1961 and recorded in Deed Book"J", Volume 20. Page 116
cor.•reyed to Joaa E. Renninger, Gratrtor herein. �
, Tf1;s above premiaes are conveyed aubject to�a 22 foot wide easement aver existing
xvadway from Sheepford Road on the w to adjoining premiaes on the east.
; b00K '� PACE S9� �
� . i
.' �J`:'r,+,:::cY:EA"I:OF fF��V — I
'. G_fi,::L'.1ud�Uf REVrbJij9 a'f_'�Cq�.�;;_
.I 1� v. p.-:.LT�/ �'_- n.+C"1. - . ' .
7�:.,�;::iS r••.,i_�
'� -. � � ao ^' Inl, f.PRIS'1! ��i:��� : 5.5.Q Q = .
W I— • � ��
�•,. r.e.ii�sz
Q _
- 1 - _ _ �
, W�. �
W���
�> O
� L� �'W;'n _. �
, ���_ .
� QOm� T
`� oW�
:oco C
i _I Q .i
�
! •
� ,
}
� �
�ngrti�rr w(tk oll and rin!/ular,thc[cncmcnla, henJilamenta and appurtcnanaca to the aamr j
6elunying or in any�oise appertaining,and fJ�e rcrr.reion nnd rei•r.r«inn�, rcmniuder and remaindcra, .
. rcnta,iianca,aad proJita thcrcuJ; '�p� S{gD a/! the catate,rigl�t, title,iatcrcat,properly,claim
nnd danand wTaatsocecr,both in la�a and equity,oJ ll�a.n;�1 pnrt ieS o�the�ir.f ynrt,oj,ia,So l
nr out o/the said pmni�u,nnd trerV lw�rt nnd JNt)fr!flrrrnf
t
. �V11 iTttu� �ttU t11 1�nID � ��.�.u;���..•.,�rifh u/7 anJ aingufar!he appurtenanccs,untu %
;
ll�c said part'y oJ the aacnxd part� Fi1S Lcirr and uxaigna,to ond Jor 1hc un(y propa I
ute and Geho��o)the raid parl y o�the iecund tmrl, hls hcirt anel aasigni �
Joroner� ,
; , �lj� � TOE Sd/D parties of the first part, for themselves. their , .
1 ' "
� �
� � ,
Acirt,esecuton and administralun,du Ly fhtie prescnls,c.�rrnaut,gruut und oyrcc tu nnJ
�oith the said par!q of tlat secund purt, h15 heira and
� assigni,that they �hc,aid parties of the first part, for themselves, their
J�eiri o1l and aingular the hercditomenb and prcmiaca hrnrinaLurr dcacriLeJ and grmtled ur mcnfiuncd.
aad intcnded to to Lq�oitk appurtcnancca,ttnto 1he aaid )wrt y uJ thc aceond�Nirt, h1S
ktin and uieig�u,a�tinat the taid part lES oJ (Ge Jirxf jmrt and their 1�cira and agrfinit el! �
j aad roery uther ycraun ur persons uGomrocccr,►ntr;u!(� cluiming ur tu e(uim tLe a�unn ur any �mN
� tLtrtof, s/m11 ared+ei!!,Ly�Ar.st prcnenla,1S'd1UGd\'T ASlJ F'G/f
� EVER DEFEND
i �Jit 3�itnr�� 311hrrrnf �hc�uid parries oJ thc Jint part Rare
� hereunto aet their hrtnd S aad irrt►S fhe Ju� nnd rtr r�xt�iGore t�riftcv.
J I'
� c � t
i' : . .('{.'.�.�'t.�.'...: . ��'�-G�:S..p�.... (SEdLI :
• / n� �oan E:'Re'nn��ng r
[/,:1...(�f'r/�'//1-.��.......... (SEd1,t
....... ..
1 Jack h��inger �
� �ignnl, Bruled an1 llrlircml ........_.........................•••••-••.._._..................-••. (SEdL�
� ' ' c.....,). ..,in tLc Prerence f
_...................••••--.............•••_......._•••....»......... {SE:11.�
, ... � , '
.�
I . ., . ..........._........._._.........._.........._.••••••-.._.._......�(SEdL�
II ......»............_._......... ... .. .............. .................
� , ._._..__............_.............................................. (SL.1Li
....._..............._..............................._.........._.......... .._._..................._...._....._......_........................... (SE:SI,�
.......................................••-.......................-••.... (SE:1I,1
......_
. ........................................................................ (SE=1L�
..............................._.........._......_........................_
.............................••••.....................»................ (SE.iI,�
......_........».........................:.................................». .»..._............ (SF,.iLi
..........•-•.....•••................................
--•._.»..»......................•»••••••••••....._.................... ' ......_......�.._................................................... (:F,.4 L�
; D00�7 PACE �
. �
__i
t ' . r S .. �� • ,
' . /� .
f ;
4
I
" I
_ � I
I�
;� ' COYYOYWSALTII OY PENXSPL� ' .
N� ` COaBTY OF .... � BB: �
�. On thu,tAt_.......�..1T1»day of.......».....»...._...........''�''�.'��-,�,���`'X•�- 7 '
;; ^• _...._....__......�.._.._........_»....... C�V _.w.» _. _ , 19... 8, bcJore in� i
� ......... ». .....
' ""• ».....,the underrig�ted `•
; • .................. �;
` ' o/)iccr, nonaiJ a Joan E_,, '
, n� Y PPcared_...... ....•_•r R�z�n�r���:.an�_Jael�.�i�mai.n�e�,..k��.r..husk.�na_... �:
�
� knowyt to mt(or�atuJectorily prooen)to Le ihe �ron 5........�.Nw�Y�y���WY �~����.�.. ;
1� ...... �rho,et name�.....A��.iubieribt��to� �
tht mithin iastrument,and ackno�c/�dgrd that......,..,.theX.._..,.., erccutcd the �ame Jur (he'p�i �•.y .. '
16ereia contained. � �4(, ;. i
L ' _'��\�`Ll)-f,P ��c•�'� - ,
s i 'r':
' !]V SV/TBESC 1VIfEl1F:0 �rcunlo �r rn � '
;. t F,/ h l g l�an.....nd of n 1�ul '�:'3�' �Q'�••. 7
� �RONA[D �__ •;��- 'iu� :
. WDG Notary Pu6►le ..........».. �-.:CS� a�2:
- Akchaniaburp.[um '7t ••�. .�• .�,r ';� .
? 6eda"dyQ�VlVnmi�aioa erpirc •• .•,, '-. .•';�,'.> .
..._.........!here6y certi`�h�irrec ie fii�nce o !ke fir .....»..._...........................::i�..�A-.. ,�i:
Z J antce,in the uithin Decd ii.�Z ,�..
L/�.. ' r"'LC'�
._.._._..............._......_......__..�✓„�.,,..,Ye�r:e�,u.ti-,,,,_„z Sy 3 p"' .._......_......_...._...:�::........... • .
' .r......�... orn���l�, ..
f ' �
, 1 C � i _
: ; � :w : -� �: � i ;
t : �, � �: �: �€ � � ,
• � ' pG c: •°•'E cE + e
c x
; ! `° r. � � �' V� � o� H t; �'
� �y � Gq c.e 'o• o, ` o
' ��f ('}� � Q, t�� O � ��„ I ,e° w o .
�1 � z� a a,,: �° �` � , '? � � oy
� � � wzrax ": �: �,: : b I s
� aw�A °°` a: ">€ o � � a�
� x o ; ;: �E >,€ � ` s` e >
. I � W • 4: 3: �: '—' ° : - � ' .
� �' u ++; °
w O: a7: °� o �
O y E Q � �: a: U a w ,� o 0
� 8
; ,
I ' L'O]f�ON7VEdLTX OF P6\'NSYLYdNId •
i .
' � . ......._._. OITNTY, SS: .
� � __...._.....
, ' �rrcr,�r�l In ff�for�tecording of Deeds, Mortg es, ete,, in and `
' for the Coun �� ' �
�-'t��� Deed Book � VoL __oZ.�'. '
Page.,�.�.�.',�.. � �
--.:= �
' ' �i.'.ttrss My Han nd Seal of Office, this ......................_._.
.. ....._.�.....1 ay ot : .
: ._......___....._.._..._.. ...............' Anno Domini 19 �,� '
;
�
4001�7 PACE �$ � .V '.-.+�� ,
CERTIFICATE OF SERVICE
AND NOW, this 20th day of August, 2013, I, Gaye Crist, an employee of the
firm of Wix, Wenger&Weidner, attorneys for Plaintiff, hereby certify that I served the
within Petition for Approval of the Sale of Real Estate this date by depositing a copy of
same by faxing a copy of same addressed as follows:
Robert C. Saidis, Esq.
Saidis, Sullivan & Rogers
26 West High Street
Carlisle, PA 17013
WIX, WENGER &WEIDNER
Gaye C t
REV-1737-4 EX+(6-08) SCHEDULE E, PART 1
pennsylvania MISCELLANEOUS
DEPARTMENT OF REVENUE pERSONAL PROPERTY
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF FILE NUMBER
Shaw Patricia M. 21 13 0815
Part 1 must inciude all tangible personal property having its situs in Pennsylvania. Examples of tangible personal property are
jewelry,furniture, paintings, etc.All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
Complete Part 2 on reverse side ONLY when the proportionate method of tax computation is elected.
ITEM
NUMBER DESCRIPTION VALUE AT DATE OF DEATH
1. Sell Decedent's property at 1759 Sheepford Road, Mechanicsburg, PA 17055 161.21
Reimbursement of School Taxes
(See Schedule E, Exhibit 1)
PART 1 TOTAL
$ 161.21
PART 2 TOTAL
(From reverse side.) $
TOTAL (Also enter on Line 5, Recapitulation.) $ 161.21
(If more space is needed, use additional sheets of paper of the same size)
Previcus eaitions ere obsolele form HUD-1(3186)ret Hantlbook 4305.2
A. Settlem�'nt Statement U.S.Departrnent of Housing and Urban Deveiopment
B.T of Loan OMB A roval No.2502-0265
1. OFHA 2. ❑FmHA 3. ❑Conv.Unins. 6.File Number 7.Loan Number 8.Mortgage Insurance Case Number
4. ❑VA 5. OConv.ins. PY013•104RCS
�s ortn K �s o pne a s em a a se emen s s. aun pa a y men egen are s n.
C.Note: u�s ma,k,a•�P.o.ap v.ere pea«ns�ae me cao.;np;u,ey ar„no,Y„na,e r«;MO,,,,aua,P,,,posas and a,e nrn;,�a�daa;n me�wais. TitleEx ress Settlement S stem
WARNING:It is a aime to knowinpty meke false stelemeMa ro tM Urwtetl Stetes on Mis or eny oNer similar fortn.PenalUes upon P y
mnvidim can indutle a fine en0 im ' .Fw tletails see:Trtle 18 U.S.Cotle Section 1001 antl Sectim t010.
D.NAME OF BORROWER: Joseph L.Otto and Dixie L.Otto
ADDRESS:
E.NAME OF SELLER: Estate of Patricia M.Shaw
ADDRESS:
F.NAME OF LENDER:
ADDRESS:
G.PROPERTY ADDRESS: 1759 Sheepford Road,Mechanicsburg,PA 17055
Parcel 13-27-1877-010 Lower Allen Townshi
H.SETTLEMENT AGENT: Pyramid Land Transfer LLC
PLACE OF SETTLEMENT: 26 West Hi h Street Carlisle PA 17013
I.SETTLEMENT DATE: 0110 712 01 4
J.SUMMARY OF BORROWER'S TRANSACTION: K.SUMMARY OF SELLER'S TRANSACTION:
100.GROSS AMOUNT DUE FROM BORROWER 400.GROSS AMOUNT DUE TO SELLER
101. Contract sales rice 8 500,00 401. Contract sales rice 8 500.00
102. Personal ro rt 402. Personal ro rl
103. Settlement char es to borrower line 1400 851.50 403.
1�• 404.
`105. 405. .
Ad'ustments for ftems aid b seller in advance Ad'ustments for items aid b selier in advance
108. SchoolTaxes 01107h4to06130N4 161.21 408. SchoolTaxes 01107114to06l30114 161.21
109. 409.
110. 410.
111. 411.
112. 412.
120.GROSS AMOUNT DUE FROM BORROWER 9 512.71 420.GROSS AMOUNT DUE TO SELLER 8 661.21
200.AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER
201. De osit or eamest mone 1 000.00 501. Excess De sit see instructions
202. Princi al amount of new loans 502. Settlement char es to seiler line 1400 7 783.69
203. ExisGn loan s taken sub'ecl to 503. Existin loan s taken sub'ect to
204. 504. Pa off of First Mort a e Loan
205. 505. Pa off of second mort a e loan
206. 506.
207. 507. Escrow Wix Wen er 874.75
208. 508.
209. 509.
Ad'ustments for items un aid b seller Ad'ustments for items un aid b seiler
211. Coun taxes 01101114to01107N4 2.77 511. Count taxes 01101N41o01107N4 2.77
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220.TOTAL PAID BYIFOR BORROWER 1 002.77 520.TOTAL REDUCTION AMOUNT DUE SEILER 8 661.21
300.CASH AT SETTLEMENT FROM OR TO BORROWER 600.CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower line 120 9 512.71 601. Gross amount due to seller Iine 420 8 661.21
302. Less amounts aid b/for borrower line 220 1 002.77 602. Less reduction amount due seller line 520 8 661.21
303.CASH FROM BORROWER 8 509.94 603.CASH TO SELLER 0.00
SUBS7ITU7E FORM 1 W9 SELLER STATEMENT:The iMarmation mrnaineC herein is important tex intormation and is being Wmishetl to the Intemal Revenue Service.It you are required m file a retum,
a negligence penelty or other sanqion will 6e vnposetl on you if ihis item is requiretl to be reported and the IRS detertnirres thal it has not baen reported.The Contratl Sales Pnce dasaibad on
iine 401 above conautwes tlie Gross Pioceatls of this vensadion.
SELLER INSTRUC710NS:tl this real estate wes your principel resiCence,file Farm 2719,Sale or Exchange oF Pnncipal ResiCence,for any gain,with your Income tax retum;for other transaclions,
complete Ihe applicable parts of Fam 4797,Form 6252 aMlor Schedula D(FOrtn 7040).
You are requ'vetl by law W pmvide the settlem�t egent(Fed.Tex ID No: 1 withyo ur corteU tarzpayer identifroalion number.If you do no1 provide your mrtecl tazpayer iCeMification
rwmber,you may be subjed to civil a u'vninal penatties imposed by law.under penanies m perjury,I certify thet Ihe number shown on this statemeM�s my mrract taxpayer ideMiFication numDer.
TIN: ! SELLER(S)SIGNAiURE(S): /
SELLER(S)NEW MAILINGADDRESS:
Schedule E, Part 1 , Exhibit 1
PreNOUS ntlflions ara obsolete (orm HUD-1(3186)ref Handbook 43052
U.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number.PY013-104 PAGE 2
SETTLEMENT STATEMENT TitleEx ress Settlement S stem
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700.TOTAL SALES/BROKER'S COMMISSION based on rice$8 500.00 35.294=3 000.00 BORROWER'S SELLER'S
DiviSiOn Of commiSSion Iine 700 as f011owS: FUNDS AT FUNDS AT
701. 3 000.00 t0 ERA-NRT I�C. SETTLEMENT SETTLEMENT
702. $ to
703. Commission aid at Settlement 3 000.00
704. AddiGonai Broker Commission to ERA-NRT INC. 195.00 195.00
800.ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Ori ination Fee %
802. Loan Diswunt %
803. A raisal Fee
804. Credit Re rt
805.
806.
807.
808.
609.
810.
811.
900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to Ida
902. Mort a e Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000.RESERVES DEPOSITED WITH LENDER FOR
1001.Hazard Insurance mo. Imo
1002.Mort a e Insurance mo. Imo
1003.Ci Pro Tax mo. Imo
1004.Count Pro rt Tax mo. $ 14.08!mo
1005.School Taxes mo. 28.02/mo
1009.A ate Anai sis Ad'ustment
1100.TITLE CHARGES
1101.Settlemenl or Closin Fee
1102.AbsVacl or Title Search
1103.TiGe Examination
1104.Costs to Wix Wen er 8 Weidner 293.69
1105.Document Pre aration to Wix Wen er 8 Weidner 200.00
1106.Nota Fees
1107.Attome's fees to Wix Wen er 8 Weidner 4 000.00
indudes above items No:
1108.Title Insurance to ramid Land Transfer LLC 500.00
includes above items No:
1109.Lenders Poli
1110.Owners Polic 8 500.00 -500.00
1111.
1112.
1113.
1200.GOVERNMENT RECORDING AND TRANSFER CHARGES
1201.Recordin Fees Deed 67.00 •Mort a e •Release 67.00
1202.Ci ICount ta�stam Deed 85.00 •MoR a e 85.00
1203.Staie Taxlstam s Deed 85.00 •Mod a e 85.00
1204.Electronic Filin Fee to ACCP Electronic Filin 4.50
1205.
1300.ADDITIONAL SETTLEMENT CHARGES
1301.Tax Certification Fee to Saidis Sullivan&Ro ers 10.00
1302.
1303.
1304.
1305.
1306.
1307.
1308.
1400.TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 851.50 7 783.69
HUD CERTIFICATION OF BUYER AND SELLER
I have carefulty reviewed Ihe HUD-7 Settlement Slatement antl!o ihe Eest ot my knowletl9e end belie[it is a We antl accurate statement o!all recaipts antl Cisbursements matle on my account w by me
in ihis VansaUi . }uMer certify ihet�l heve receivetl a copy of Ne HUO-1 SetllemeM Sta�ement . //
osep . o � u�ie ."o " /���__�l F
e o a ra .
WARNING:R IS A CRIME TO KNOVJINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Settlemern SWtement whichA have preparetl is a trua and acwrete account of lhis transaqion.
UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON CONVICTION I�ave w d a I ceu e the fuads be disburppped in ayyyEorEance with this slatement.
CAN INCLUDE A FINE AN�IMPRISONMENT.POR DETAILS SEE TITLE 18: ��� �/� / /� /
U.S.CODE SECTION 7001 ANO SECTION 1010. �/.��/ /
By !/ / ���;�;���'l✓ ���j,/
REV-1737-6 EX+(6-08)
REVERSE SCHEDULE H
pennsylvania FUNERAL EXPENSES & Use Schedule H ONLY for proportionate
DEPARTMENT OFREVENUE
ADMINISTRATIVE COSTS method of tax computation.
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF FILE NUMBER
Shaw Patricia M. 21 13 0815
Debts of decedent must be re orted on Schedule I.
ITEM NUMBER DESCRIPTION AMOUNT
q, FUNERAL EXPENSES:
1. George P. Kalas Funeral Home, 6160 Oxon Hill Rd., Oxon Hill, MD 20745 950.00
Cremation and Funeral Refreshments
g, ADMINISTRATIVE COSTS:
1. Personal Representative's Commission(s)
Name(s)of Personal Representative(s)
(Submit requested information for additional personal representative's on additional sheets)
Sociai Security Number(s)or EIN Number(s)of Personal Representative(s)
Street Address(es)
City(ies) State(s) Zip(s)
Year(s)Commission Paid
2. attomeyFees Theresa L. Shade Wix, Esquire, Wix, Wenger&Weidner 4,000.00
3, Probate Fees Cumberland County Register of Wills 143.50
4, AccountanYs Fees
5, Tax Retum Preparers Fees
6. Miscellaneous Expenses
Sale of Decedent's property at 1759 Sheepford Road, Mechanicsburg, PA 3.492.77
Realtor Commission -$3,000.00
Realtor Transaction Fee-$195.00
Real Estate Transfer Tax-$85.00
Tax Certification -$10.00
Deed Preparation -$200.00
County Taxes 01/01/14-01/07/14-$2.77
(See Schedule H, Exhibit 1)
7. Expenses of Wix, Wenger&Weidner 150.19
Postage and Photocopies-$39.55
Travel to Cumberland County Courthouse (2 trips) -$53.28
Filing fee for Cumberland County Register of Wills for Petition -$15.00
UPS overnight delivery-$42.36
TOTAL (Also enter on Line 9, Recapitulation) $ 8 736.46
(If more space is needed, use additional sheets of paper of the same size)
��.ro�.
. . form HU0.7(3186)ref Handbodc 43052
A. S�'ttlf'ment Statement U.S.Departrnent of Housing and Urban Development
B.T of Loan OMB roval No.2502-0265
1. ❑FHA 2. pFmHA 3. pConv.Unins. 6.Fie Number 7.Loan Number 8.Mortgage Insurance Case Number
4. VA 5. pConv.lns. PY013-104RCS
C.Note: �ns maniea�a.ar w�e Pea aaiae ms aa:�nsy re a,am nere rar:ramauon waoses and are no�:�duoea�me rots� TitleExpress Settlement System
. wnHrau+c:n k■cime w wnwtqy mrc.mb.uawn.ro.ro u,.urnea smms m m�.warry onw.:nu.r�oim.wn.me,upon .
mrni�tion M Yxld6 a fro arW' For tleuds s0a:Tkb 78 U.S.Cotle Settion 1001 en0 SMim 1010.
D.NAME OF BORROWER: Joseph L Otto and Dixie L.Otto
ADDRESS:
E.NAME OF SELLER: Estate of Patricia M.Shaw
ADDRESS:
F.NAME OF LENDER
ADDRESS:
G.PROPERTY ADDRESS: 1759 Sheepford Road,Mechanicsburg,PA 17055
Parcel 13-27•187T•010 Lower Allen Townshi
H.SETTLEMENT AGEN7: Pyramid Land Transfer LLC
PLACE OF SETTLEMENT: 26 West Hi h Stree Carlisle PA 17013
I.SETTLEMENT DATE: 01f0712014'
J.SUMMARY OF BORROWER'S TRANSACTION: K.SUMMARY OF SELLER'S TRANSACTION:
100.GROSS AMOUNT DUE fROM BORROWER 400.GROSS AMOUNT DUE TO SELLER
10L Contract sales ' 8 500.00 401. Conuact sales 'ce 8 500.00
102. Personal 402. Personal ro
103. Settlement cha es to bortower line 1400 651.50 403.
104. 404.
`105. 405.
Ad'ustrnents for ftems aid seiler in advance Ad'ustrnents for items aid b seller in advance
108. SchoolTa�ces 01107H4to06130114 16121 408. SchoolTaxes 01I07h4to06l30h4 161.21
109. 409.
110. 410.
111. 411.
112. 412.
120.GROSS AMOUNT DUE FROM BORROWER 9 512,71 420.GROSS AMOUNT DUE TO SELLER 8 661.21
200.AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER
201. De ft a eamest mone 1 000.00 501. Excess De it see instructions
202. Prina al artrount of new loans 502. Seltlement char es to seller line 1400 7 783.69
203. Existin loan s taken su'ect to 503. Ebstin loan s taicen sub'ect to
2U4• 504. P off of Rrst Mort Loan
205. 505. Pa off of second mort a e loan
206. 506.
207. 507. Esaow Wix Wen er 874.75
208. 508.
209. 509.
Ad'ustmerds for items un aid b seller Ad'ustments for items un aid b seller
211. Coun taxes 01101h4to01107114 2.T7 511. Coun taxes 01101114to01107H4 2.77
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220.TOTAL PAID BYIFOR BORROWER 1 002.77 520.TOTAL REDUCTION AMOUNT DUE SELLER 8 661.21
300.CASH AT SETTLEMENT FROM OR TO BORROWER 600.CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from bonower Me 120 9 512.71 601. Gross amount due fo seller line 420 8 661.21
302. Less amounts aid b/for borrower line 220 1 002.77 602. Less redudion amount due seller line 520 8 661.21
303.CASH FROM BORROWER 8 509.94 603.CASH TO SELLER 0.00
SUBSTIME FORM 1099 SELLER STAiEMENT:The idortnation�ed hereei is impartara tex idormatim aritl is beinp fumished lo the Memel Revern�e Service.If you ere raquirad to file a rdum,
a neplpence penalry.or otlbr sanction will Da imposetl m you d tivs ilem is requved w be ieported arW Ihe IRS datermines thal rt has rot baen reported.The Contr-act Seks Price tlesa�betl on
line 401 ebwe mnshhrtes tl�e Cxou Piocaeds of Cus hansec4at
SELLER INSTRUCTIONS:It ihis real eatale was Drineipel resderra,file Form 2119,Sale or Excharipa d Prmdpel Residance,iw arty gain,wdh ywr Inmme tmc rauan;tor olher trarsactiofn, �
mnplete tha eppNceble paits d Fam 4797.Farm�aMlw Stledub D(Fam 1640j.
�You are requ'retl by law b pa'itle 1M aM�kmanl e9��(Fed.Taz ID No� wNhy�+r wmct taxpayar IOeMifwation rnunbar.tt you do rrot P�'ide your mrrecl tmcpayar itleNifiplion
rnanber.Ya mry be a�eU ro dril a aiminel penakies inposeO bY�'��P�1�Y�I w1ifY Mat the rumber stwxm on this slalemeM is my mrtaC fazDayer iderddxafion rnunbef.
TIN: I SELLER(S)SIGNANRE(SJ: I
SELLER(S)NEW MAILING ADDRESS:
Schedule H, Exhibit 1
Prsvious e0pian ara a0solete . (orm HU0.1(3R6)raf HaM6oak 43052
U.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Fle Number.PY013•104 PAGE 2
SETTLEMENT STATEMENT r�ie ess sett�ement s tem
L SETTLEMENT CHARGES PAi�FROnn PAID FROM
700.TOTAL SALES/BROKER'S COMMISSION based on rice$6 500.00 a5.2sa=s 000.00 BORROWER'S SELLER'S
Division of canmission Iine 700 as foAows: FUNDS AT FUNDS AT
701. 3 000.00 to ERA-NRT Inc. SE7TI_EMEn�T SETitEMENT
702. to
703. Commission aid at Settlement 3 000.00
704. Add'Aiaial Broker Commission to ERA-NRT INC. 195.00 195.00
800.REMS PAYABLE IN CONNECTION WITH LOAN
$01. Loan Ori ination Fee %
802. Loan Discount %
803. raisai Fee
804. Credit Re rt
805.
806.
8D7.
808.
809.
810.
811.
900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From ro Ida
902. Mort e Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000.RESERVES DEPOSRED WRH LENDER FOR
1001.Hazard Insurance mo. Imo
7002.Mort e insurance mo. Imo
1003.C' Pro Tax mo. $ Imo
1D04.Coun Pro Tax mo. 14.08 Imo
1005.School Taxes mo. 28.02 Imo
1009.A ate Anal sis Ad'ustrnent
1100.TITLE CHARGES
1101.Settlement or Closin Fee
1102.AbsVact or Title Search
1103.Title Examination
1104.Costs to Wix Wen er&Weidner 293.69
1105.Document Pre aration to Wix Wen er 8 Weidner 200.00
1106.Nota Fees
1107.Attome s fees to Wbc Wen er&Weidner 4 000.00
indudes above items No:
1108.Title Insurance to ramid Land Transfer LLC 500.00
includes above ilems No:
1109.Lenders Pd'
1110.owners Por 8 500.00 -500.00
1111.
1112.
1113.
1200.GOVERNMENT RECORDING AND TRANSFER CHARGES
1201.Record'm Fees Deed 67.00 •Mort a e •Release 67.00
1202.C' /Coun tan/stam Deed 85.00 •Mort a e 85.00
1203.Stale Taxlstam Deed 5.00 •MoA a 85.00
1204.Elechonic Ftlin Fee to ACCP Electronic Filin 4.50
1205.
1300.ADDITIONAL SETTLEMENT CHARGES
1301.Tax Certificatiai Pee to Saidis Sullivan 8 Ro ers 10.00
1302.
1303.
1304.
1305.
1306.
1307.
1308.
1400.TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 851.50 7 783.69
HUD CERTIFICATION OF BUYER AND SELLER
I heve�arefuly raviewetl Cie HU0.1 Setllemenl StaemaM and ro Uie Dest afmy knowletlpe mW Oelief,d is a true aM acmate statemmit of all receipis end disbwsemenls matla on my acownt or by me
in this . futher cerUy tha41 heve received a rnpy of tlie HUD-1 SetlbmeM Stalemenc �
�i� � ���.__L��'/\
(SK,L�RV / LJ
ose uie o /
ae a
WARNING�IT IS A CRgdE TO KNOVJINGLY MAI�F/LL5E STATEMENTS TO THE The HU0.1 SetllemeN Statemen�whichl have prepaied"s e M�e and acaaate aawnt of this transaqion.
UN(fED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON CONVICTION 1 heve ceus�d w 'I w thp�hmtls be disD�;ed ii with this StatemeM
CAN INCLUDE A FINE ANU IMPRISONMENT.FOR DETAILS SEE TRLE 18: � �� _ �' /� �/ / �
U.S.CODE SECTION 1001 AND SECTION 101Q �
i �
By %
REV-1737-7 EX+(6-08)
REVERSE
SCHEDULE J
pennsylvania BENEFICIARIES
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF FILE NUMBER
Shaw Patricia M. 21 13 0815
When flat rate method is elected, list the beneficiaries of the Pennsylvania property.
When proportionate method is elected, list all beneficiaries.
ITEM 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 spousai distributions,and transfers under Sec.2116(a)(1.2)]
1. Vernon D. Edwards, 12517 Kent Rd., King George, VA 22485 Son 0.00
2. Eugene P. Edwards, 2314 Riverview Ter., Alexandria, VA 22303 Son 0.00
3. Bonnie Van Gundy, 5431 Pearson Chapel Rd., Alexander City, AL 35010 Step-daughter 0.00
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE SIDE
OF REV-1737 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II
(Enter total non-taxable distributions on Line 13 of REV-1737 cover sheet.) $
(If more space is needed, use additional sheets of paper of the same size)
WIX, WENGER & WEIDNER DEANA.WEIDNER
A PROFESSIONAL CORPORATION Of Counsel
RICHARD H.WIX ATTORNEYS AT LAW Downtown Office:
STEVEN C.WILDS 4705 DUKE STREET 508 North Second St.
THERESA L.SHADE WIX` Harrisburg,PA 17101
DAVID R.GETZ HARRISBURG, PENNSYLVANIA 17109-3041
STEPHEN J.DZURANIN Mailing Address:
JEFFREY C.CLARK P.O.Box 845
PETER G.HOWLAND (717)652-8455 HARRISBURG,PA 17108-0845
BR,4DLEY R.GORTER FAX(717)652-6290 �7)2344182
www.wwwpalaw.com n o �
'Also Member Massachusetls Bar � .-� � rn
March 31, 2014 p � ..� � a
-a � cn �
� -;- c-' ...jv
� r rn rn
;� � rn
Lisa M. Grayson, Esq., �� "'- :: ~ � �
��� o
Register of Wills & Clerk of Orphans' Court ; ; ° 3 � -�'
1 Courthouse Square, Suite 102 � � ti � �
Carlisle, PA 17013 � '� �`' r' rn
N � �
cn
Re: Estate of Patricia M. Shaw
No. 2113-0815
Social Security No. 236-56-3484
Dear Ms. Grayson:
I enclose the following documents for filing with your office:
1. The original Pennsylvania lnheritance Tax Return Nonresident Decedent, which
also includes a Nonresident Decedent Affidavit of Domicile
2. A copy of the Pennsylvania lnheritance Tax Return Nonresident Decedent,
including a copy of the Nonresident Decedent Affidavit of Domicile
3. An original Inventory
4. An original Pa. O.C. Rule 6.12 Status Report
I include the following documents that I would request you please time stamp and return
to me in the enclosed, self-addressed stamped envelope:
1. Copy of the Pennsylvania lnheritance Tax Return Nonresident Decedent
Rev-1737
2. A copy of the Nonresident Decedent Affidavit of Domicile
3. A copy of the Inventory
4. A copy of the Pa. O.C. Rule 6.12 Status Report
Lisa M. Grayson, Esq.
Page 2
March 31, 2014
If you have any comments or questions regarding this correspondence and the filing of
the documents I have enclosed, please contact me at(717) 652-8455. If I am unavailable,
please speak to my secretary, Gaye Crist.
Thank you for your anticipated cooperation regarding this matter.
Very truly yours,
v�,.� �°. :��� ��
Theresa L. Shade Wix
TLSW/gc
Enclosures
cc: Vernon D. Edwards, Administrator
�
a
, ..-
� - - -
__s __V
_ _ _._.
RECORDEG OFFlC� A� ____ _
: R�GIST�; �F }�ILLS
.
� 0 2019 fl�� � P'� �� ,�
rr
� w CLE��K t��'
� � � t�RPNAlVS' C(���7 y
v 9
�° ° �UMBERL.94ND G4., p,� � `
a'
O � c ,to,'
C ; � °� � °
> a _ �v �
a O c :.� x > _
� v � W V N
� y =
Z C L � ° �n � ; q
� " q 3 r
y N C � �,� 3 �
i.r ` � � C �O ` , v �
c
ir � o u` � � 3° N r � ¢ �
�n �n v� �n Q J Q:
y c a� ,, ,
C � o » » W�++ �; (L � ° o
Z v� T- � •q
0
6°o d � ' V �
� � . . �S Q o_` �
�F� C- � � � � o,
� �L� W � a`� m'.
�N J _ N
�OT q � o �.
. ��7� ¢ � . ��� Q�.
��y � � r �_ r,
z °a'
, � a`
� ��
� 3.
w y
v u:
`o °
m;
c
v-
0 0
T V
U IO
� C:
C .�
� Vi
~ i �
�1 ~ �
`o �
O o 0
� o � �� �
� a
� �
p G
M urt
1 ��� � --�� > �
� � ��� � �.
--�
a � N � -� � c
� _� �
rn � j M !""'� = �� � o �
� o � M � �� � � o u �
o x aM �_ N ° '
c4 7 � r"� � �j �° �� °,�
�
� �
O W W U� O ��� � n ° v �
�d x� � � a �
v� �F �j �� � �� � '
c� w �Z � � � o �� ° ° �
� � �o aoa � � � . s � �
��
z a �� WU � ' °
w ?� �Ca w � y
3 �^ c4 �cv x z G/� ;�;�•�_t't�s "`�.�y.�'' �E"� N -- .�,�
� a a W �o F.•� F-i •�• t►.�..�r��'p' ,� 1ry "� - a �4
v�WZ �v��i �W,�� ��t�+► y W �k � �
W°?x m [-�C7 d� O,�' :?� O�..� '� � y o"
3�4� p,,W�� �� � ��O• � Z a s �
>C��•' "'a N�•-]v5 ti C� .�. .4.�.�"+';'� � (/] a " �
�' •:,,,� � � v
��� � /� �,
3 t�v Z y +�ti.�.�,�.S�.' '�:► h'ri Z ' u
w�
�T- •ti�•.ti•.Y � J a `o
� �] m o�
rt
� ��
a ti
..-. __ v c.t
� �
ai c
w` �
r m
� �
T �
htt S;// � �
P www.ups.com/uis/create?ActionOriginPairdef �I�
� � °
= lt
a� � �� o� q x - - _ au Prin Z �
� t �.,-�, •� °nao ", e N a� �u; � aN, n t W 117C�OW� � �
.� . u ar � aLa, � avE •- a � . u
in �^ E �� 'a�� e ? � ° ��u ..'�n. .c a°�i L ., __ .a�