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03-27-14
J 1505610140 REV-1500 E` (°' '°' 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 0 4 8 3 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 2 0 5 2 0 1 1 0 1 0 2 1 9 2 7 Decedent's Last Name Suffix Decedent's First Name MI H 0 R N D A V I D R (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 R 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 Return Required death after 12-12-82) 0 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 E] 10.Spousal Poverty Credit(date of death El 11.Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTKDTO: Name Daytime Telephone NLrer D 0 U G L A S G M I L L E R 7 1 7 2 4 jR' 3 ^1Crn, m V s " a ZZ2 CAP :a REGISTER OF � 1*SrONLYN -. rrI °/? v -zi L7 First line of address coi o O —0 n 3 I R W I N & M C K N I G H T , P C •° =r w c-.) Second line of address a ~ _ r rn 6 0 W E S T P 0 M F R E T S T R E E T � � 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: 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 We,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG ATURE OF PERS RESPONSI LE FOR FILING RETURN DATE D ESS 7000 WERTZVILLE ROAD MECHANICSBURG PA 17050 SI N RE PREFARERAT H THAN REPRESENTATNE D E ADD SS 60 WE T POMFRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 \ L 1505610140 1505610140 J 1505610240 REV-1500 EX Decedent's Social Security Number Decedents Name: DAVID R - HORN RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . .. .. . . .. . . . . . . . . . . . . . . . . .. . . . . . . 1. 1 7 6 0 0 0 . 0 0 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. 8 4 0 . 9 8 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested .. . . . . . 6. 5 . 0 0 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested .. . . .. . 7. 8. Total Gross Assets(total Lines 1 through 7) ... . . .. . .. . .. . .. .. .. . . . . .. . 8. 1 7 6 8 4 5 . 9 8 9. Funeral Expenses and Administrative Costs(Schedule H) . .. . . .. .. .. . . . . .. . 9. 3 1 4 3 2 . 4 4 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) .. .. . . . . . . .. . 10. 1 2 2 9 7 6 . 8 3 11. Total Deductions(total Lines 9 and 10) .. . . . . . . . . .. . . . . .. .. . . . .. . . . .. . 11. 1 5 4 4 0 9 . 2 7 12. Net Value of Estate(Line 8 minus Line 11) . . .. . . . .. . . . . .. . .. .. .. . . . . . . 12. 2 2 4 3 6 . 7 1 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. 2 2 4 3 6 . 7 1 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 2 2 4 3 6 . 7 1 16. 1 0 0 9 . 6 5 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. 1 0 0 9 . 6 5 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 L 1505610240 1505610240 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 11 0483 DECEDENTS NAME DAVID R. HORN STREET ADDRESS 7000 VVERTZVILLE ROAD CITY STATE ZIP MECHANICSBURG PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1,009.65 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+8) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,009.65 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; ...................................................................... ❑1:1 IXI ❑ b. retain the right to designate who shall use the property transferred or its income; x c. retain a reversionary interest;or ................................................................................................ ❑ 0 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? ....................................................................................... ❑ 3. Did decedent own an"in trust for"or payable-upon-death 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?.................................................................................................. ❑ I] 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 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent p2 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: DAVID R. HORN 21 11 0483 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 fads. Real property that Is Jointly-owned with right of survivorshlp 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. 609 ROBERT STREET, MECHANICSBURG, PENNSYLVANIA 176,000.00 SOLD-SETTLEMENT SHEET ATTACHED 1 TOTAL(Also enter on Line 1,Recapitulation) $ 176 000.00 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: DAVID R. HORN 21 11 0483 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. PNC BANK-CHECKING ACCOUNT#5070080571 275.98 2. PERSONAL PROPERTY-APPRAISALATTACHED 565.00 TOTAL(Also enter on Line 5,Recapitulation) $ 840.98 If more space is needed,use additional sheets of paper of the same size. REV-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: DAVID R. HORN 21 11 0483 If an asset was made jointly owned within one year of the decedent's date of death,It must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. KELLY F. STANLEY 7000 WERTZVILLE ROAD DAUGHTER MECHANICSBURG, PA 17050 B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH ITEM FORJOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTSINTEREST 1. A. 05/2004 MEMBERS 1ST FEDERAL CREDIT UNION 5.00 50. 2.50 SAVINGS ACCOUNT#50278-00 2. A. 0512004 MEMBERS 1ST FEDERAL CREDIT UNION 5.00 50. 2.50 CHECKING ACCOUNT#50278-11 TOTAL(Also enter on Line 6,Recapitulation) $ 5.00 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 INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER DAVID R. HORN 21 11 0483 Decedents debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MALPEZZI FUNERAL HOME 3,764.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Names)of Personal Representative(s) Street Address City State ZIP Years)Commission Paid: 2, AttomeyFees: IRWIN & McKNIGHT, P.C. 8,825.00 3. Family Exemption:(If decedents address is not the same as claimants,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 323.50 6 Accountant Fees: 6. Tax Return Preparer Fees: PATRICIA A. ROSEN DALE, CPA 375.00 FINAL FIDUCIARY TAX RETURN 7. REGISTER OF WILLS-FILING FEE 30.00 8. CLOSING COSTS FROM SALE OF REAL ESTATE 17,010.50 9. CUMBERLAND LAW JOURNAL- ESTATE NOTICE 75.00 10. THE SENTINEL- ESTATE NOTICE 219.40 11. CERTIFIED MAIL POSTAGE 5.54 12. MECHANICSBURG BOROUGH - RENTAL INSPECTION NOTICE 60.00 13. HOME PARAMOUNT PEST CONTROL- PEST CONTROL 159.00 14. WAYNE MYERS AUCTION SERVICE 40.00 TOTAL(Also enter on Line 9,Recapitulation) $ 31 432.44 If more space is needed,use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent DAVID R. HORN 21 11 0483 Decedents Name Page 1 File Number Schedule H -Funeral Expenses&Administrative Costs-B6.Tax Return Preparer Fees ITEM NUMBER DESCRIPTION AMOUNT 2. MICHAEL A. KUNISKY, CPA INC 545.00 INCOME TAX RETURNS SUBTOTAL SCHEDULE H-B6 545.00 REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER DAVID R. HORN 21 11 0483 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 i. PAYOFF OF CITIMORTGAGE-FIRST MORTGAGE 60,560.27 LINE#504 OF SETTLEMENT SHEET 2. CLAREMONT NURSING AND REHABILITION CTR 28,399.72 LINE#505 OF SETTLEMENT SHEET 3. BOROUGH OF MECHANICSBURG - SEWER 1,039.06 LINE 515 OF SETTLEMENT SHEET 4. 2013 COUNTY TAXES 1,066.81 LINE 516 OF SETTLEMENT SHEET 5. 2013/14 SCHOOL TAXES 2,700.87 LINE 517 OF SETTLEMENT SHEET 2700.87 6. MEMBERS 1ST FEDERAL CREDIT UNION 100.00 LOAN ACCOUNT#50278-03 $2,720.48-SETTLEMENT AMOUNT$100.00 7. MEMBERS 1ST FEDERAL CREDIT UNION 500.00 VISA ACCOUNT#4287590020502783 $13,143.06-SETTLEMENT AMOUNT$500.00 8. M&T BANK- LOAN#11070064720001 9,135.13 9. PP&L- ELECTRIC 2,318.83 10. CUMBERLAND COUNTY TAX CLAIM BUREAU 3,674.21 2009 REAL ESTATE TAXES 11. CUMBERLAND COUNTY TAX CLAIM BUREAU 3,763.97 2010 REAL ESTATE TAXES 12. CUMBERLAND COUNTY TAX CLAIM BUREAU 3,864.28 2011 REAL ESTATE TAXES 13. CUMBERLAND COUNTY TAX CLAIM BUREAU 2,400.00 2012 REAL ESTATE TAXES(PARTIAL PAYMENT) 14. INTERNAL REVENUE SERVICE 2,850.68 2009 INCOME TAXES 15. INTERNAL REVENUE SERVICE 603.00 2010 INCOME TAXES TOTAL(Also enter on Line 10,Recapitulation) S 122 976.83 If more space is needed,insert additional sheets of the same size. REV-1613 EX-01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: DAVID R. HORN 21 11 0483 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 [Includeoutri ht spousal dishibutions and transfers under Sec.9176(a)(1.2).] 1. KELLY F. STANLEY Lineal 11,218.36 7000 WERTZVILLE ROAD 1/2 REMAINDER MECHANICSBURG, PA 17050 2. CAROL HORN Lineal 11,218.35 8 TEXACO ROAD 1/2 REMAINDER MECHANICSBURG, PA 17055 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. r.5r-w.5t a r t s - ,s, s '�,�. n � y-r spy, F t '�cK' .� t � t - ~' ��t Trot 4s��u %to �tt �t�� �� sf .� sCJI� u�°11 [J 1J�t1ni)Illl l(.�� �_ 4 � � - tF '�. •}. _ . ��..'r.Y♦�..-� �,� t �,� 4� yt Fi' ♦ 1 ,{n♦r� l1tlUVl 4 ♦/ /1.' F y.+=� 3 -. n j' t'7 � � t4t}v 4 ,� 4� iJ rr �IY�t rn�l{�I>���h {�t���Il �J��tI`� hll4fit j.a � ~ e FC% tF t . SR's t l'f L�lK1 rGY Cj` Y' �'~ LF4 Y 4 FS�' FJU "i kl I r }� ♦I/ 1{ `I "hFl � � - ( 1' 7 lVt .>.� � L � . 2vY„ L�r3l '- '� l+' 'i t v � r.h Si e's' eT t..x, ' tf����1���-rl ��1 t'U�tt{St Yt lr����� s '�th < }- y i' . Y.rr y+iST �� 5,x.3, t�r I s �1 LX. t t. .Ly'� � I t' rY " v �t3i ,.c -ti;. P t .c, sa v � t3 '�etj <Y, w c �t{(t�!'f'�)1 '�Srll�t�i{y U i(<'�'iNJ�nZ„N a17�1 3 �. r xry' y��rt'L.k�e,t�'w°` eeNr}Wr Y.".r � .� `K ysc � ..j ik t I�3 r-1. +x Ft r w r,to f'a r 4.r1't � :nctrylti}A x�< `r��"�� t+.. v.h. _.kn t'M x,...e.�..+�'" K'�� n.xS ....Nd., i.�j+te.G::.�ls� ?j.;d�"txt...:�,rt,. � .,3:..Ss.�.t .t�Y>w,.a.. ;,h 1� � � � � �' � • � � " • � ' • � � � • �<t � - t " t •_ • - � �• •_ - � ' � . t • t •• � � !• "� � � • � � _ � �• • • � � • � '� �' • t '• • '• �' - � � � - • � � � ��• • � • '� ' • • •• � • � � • � • • t • ' • � � '� • •• • � /�f// � � • • . • \7L4L/ � � � . • � • Y 1 9 0 The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by David R. Horn 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. A ESS , WITNESS LAW OFFICES OF 'EPHEN J. HOGG S.HANOVER STREET SUITE 101 CARLISLE,PA 17013 ACKNOWLEDGMENT State of Pennsylvania ss County of Cumberland I, David R. Horn, the Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. �ilu A ;2 .I .1 David R. Horn Sworn to or affirmed and acknowl ged fore me by David R. Horn the Testator, this day of 20 LYY ca�flsfznaw�,cumn�uumca.,rn CCkIHBBION ENPJIFS�;r.�' Notae Public/Attorry y AFFIDAVIT State of Pennsylvania ss County of Cumberland We, 56way% yOtIYIC(S and b,�' Lkj 1 iry,6le the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his last Will; that the Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the Will as a witness; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or aff' ed d subscrib to before me by witnesses, this —� Z day of . 2006 LAW OFFICES OF TEPHEN J. HOGG Not y Public/Attor y 9 S. HANOVER STREET =W :7 SUITE 101 CARLISLE,PA 17013 ) v A. Settlement Statement (HUD-1) OMB Approval No.2502-0285 Type of Loan 1.❑FHA 2.❑RHS 3.®Corn.Unins. 6.File Number: 7.Loan Number: S.Mortgage Insurance Case Number: 2013063AB 910200532 4.❑VA 5.❑Corrv.lns. G Note:This tone Is famished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agents are shown Items marked •too.c)•were pail outside the closing:they are shown here for Informational purposes and are not Included In the totals. D.Name 8 Address of Borrower: E.Name 8 Address of Seller. F.Name&Address of Lender. Robert H.Wertz,Jr.,Tracy W.Wertz Estate of David Hoe Fairway Independent Mortgage Corporation 2201 Canterbury Delve,Mechanicsburg,PA 17055 7000 WeltzvlTe Road,Medwlcs xsg,PA 17050 4720 Carlisle Pike Suite 300,Mechanicsburg ,PA 17050 G.Property Location H.Settlement Agent: I.Settlement Date:121312013 609 Robert Street Absolute Abstract,LLC Mechanicsburg,PA 17055 125 West Harrisburg Streel,D'llsburg,PA 17019 Mechanicsburg Borough Telephone:717432-7102 Fac 717432-1535 Place of Settlement: TltleEzpress 125 West Harrisburg Sine,Dinsburg,PA 17019 Printed 1 2/3 112 01 3 at 3:09 pm by CEC 101 Gross Amount Dub from Borrater 40G Gross Amount Due to Seller 101. Contract sales price 176,000.00 401. Contract sales price 176,000.00 102. Personal propirly 402. Personal property 103. Settlement charges to borrower(rim 140D) 5,945.19 403. 184. 4(14. 105. 405. Adjustments for Name paid by seller in admits AAustments for Items paid by seller In advance 106. G1yRawn takes to 406. Cityllown Imes to 107. County tines 1213 112 0 13 to 12131)2013 2.66 407. County takes 1213 110 13 to 12!31/2013 2.66 10B. Strad tees 12131 01310 061302014 1,224.31 408. Sd 00I isms 12131013 to 06002014 1,224.31 109. SasenTrash-4th Olt 121312013 to 12131/013 1.37 409. Sewer/Trash-4N Oil 1214112013 to 12/312013 1.37 110. 410. 111. 411. 112. 412 120. Gress Amount Wefrom Banurcr 193,17=1 420. Groh Amount Due to Sella 177,228.34 280. Amounts Paid ar In Behaff of Bartower 580 Reductions m Amend Due to Seflff 201. Depose a earnest money 2,000.00 501. Excess deposit(see instructions) 202 Principai amount of new loa (s) 140,800.00 502. Settlement charges to seller(11m 1400) 13,490.50 203. Existing low(s) taken subject to 503. Existing s taken sutiect to 204. 504. Payoff of Firm nangige loan 92710798600 to 60,560.27 alimodam Inc 205. 505. Payoff of second mortgage ban 9Davld Hem to 28.399.72 Gameant Nursing and Rehabilitation Ctr 206. 506. 287. 507. 208. Seiler Assist 3,520.00 508. Seiler Assist 3,520.00 209. Lender Credit 1,120.00 509. ustmema tar items unpaid setter ustinenta for Sam unpaid seller 10. Gry4w+n tines to 51 . Oty own tees to 211. County taxes to 511. County taxes to 212 Sdmd tines to 512. School takes to 213. 513. 214. 514. 215. 515. Sewer(Ouu 12131) 1,039.06 216. 516. 2013 County lakes- 1,066.81 217. 517. 2013114 School tams 2,700.87 218. 518. 219. 519. ESCROW-Estate Return 5,805.08 220. Total Paid bliffor Borrower 147A40.00 520. Tow Reduction Amount Due Seller 116,582]7 300. Cash at SettlementfromRo Borrower 60G Csshat Sememanttoftinseller 301, Gross amount due from bonemar(line 120) - 183,173.53 601. Gm entouniduetosefferViN420) 177,22834 - 302. Less amounts paid bitter bonower(lure 220) 147,440.00 602. Lass reduction in amount due send(line 520) 116,58231 7W. Cash [g] Free ❑ To BOrroaer 3;733.57 603. Cash ❑)I To ❑ From Selller 60,646•03 Mhm.Y1m. •mYM•MOMGmGY,rib.IMaiMmO-bbv,C�W QMVnbnwbtYl iMbbp-lbP-M,Ow�YIUY.PFLMm,wl..�9Y.AKemNw MFOYw rYOeYYe�m Previous editions are obsolete Page 1 of 4 HUD-1 .L.Settlement Charges 700. Total Reel Estate Broker Fears $9,680.00 Paid From Paid From Divisionofmmmission IIne700 mfollows: Borrower's Seller's 701. $4,840.00 10 ERA-NRT,Inc. Funds at Funds at 702. $4,840.00 to RF/MAX A-1 Realty,Inc. Settlement Settlement 703. Commission paid at settlement 9,680.00 704. Broker Service Fee to REIMAX A-1 Realty,Inc. 195.00 705. Add'I Brokerage Commission to ERA-NRT,Inc. 195.00 800. Remo Payable in Connection with Loan 801. Our origination charge (Includes Origination Pdnt0.000%or$0.00) $961.00 (from GFE#1) 802. Your credit or charge(points)for the specific Interest rate chosen $ (from GFE#2) 803. Your adjusted origination charges (from GFE A) 951.00 804. Appraisal fee to FIMC for FLS (from GFE#3) 550.00 805. Credit report to FIMC for Kroll (from GFE#3) 33.65 806. Tax service to ham GFE#3 807. Flood certification to FIMC for FLS (from GFE#3) 9.75 808. to 90D. Remo Required Lender to be Paid In Advance 901. Daily interest charges from from 12131YLO13 to 01/01yAN@$16.8767/day (from GFE#10) 16.88 902. Mortgage insurance premium months to (fmm GFE#3) 903. Homeowner's insurance fort yearstoShinerIns. (from GFE#11) .659.001 904. months to from GFE#11 1000.Reserves Deposited with Lender 1001. Initial deposit for your escrow account (from GFE#9) 1,723.41 1002.Homeowners insurance 3 months $ 54.921month $164.76 . 1003.Mortgage Insurance months Q$ /month 1004.Property taxes months @$ /month 1005.County taxes 11 months a$ 80321month $889.02 1006.School taxes 7 months A,$ 204.61/month $1,432.27 1007.Aggregate Adjustment $-762.64 1100.TtUeCharga 1101.Titre services and lenders true insurance from GFE#4 1,465.50 1102.Settlement or closing fee to $ 1103.Owners title insurance from GFE#5 175.00 1104.Lenders titre insurance $1,105.00 1105.Lenders titre policy limit$140,BOD.00 Lender's Policy 1106. Owners title policy limit$176,000.00 Owners Policy 1107.Agent's portion of the total title Insurance premium $1,062.40 1108. Undemrilers portion of the total title insurance premium $217.60 1109. 1200.Government Recording and Transfer Charges 1201.Government recording charges $ (from GFE#7) 156.00 1202.Dead$62.00 Mortgage$94.00 Release$55.50 55.50 1203.Transfer taxes $ (from GFE#B) 1204.City/County tax/stamps Deed$1,760.00 Mortgage$ 1,760.00 1205.State Tax/stamps Dead$1,760A0 Mortgage$ 1,760.00 1206. Deed$ Mortgage$ 1207. $ 1300.Additional Settlement Ch a 1301.Required services that you can shop for (from GFE#6) 1302. to 1303. to 1304.Tax Cam.Fee to Absolute Abstract,LLC 10'00 1305.Wire Fee/Payof to Absolute Abstract,LLC 30.00 r r i r 5,9d5A9 13,490.50 'Paid outside of dosing by(B)onower,(S)eller,(L)ender,(I)nveslor,Bro(K)er.-Credit by lender shown on page 1.-Credit by seller shown on page 1. Previous editions are obsolete Page 2 of 4 HUD-1 'Comparison of Good Faith Esthnote G and HUD-1 Charges Good Faith Estimate HUD-1 Changes That Cannot Increase HUD-11 Line Number Our origination charge if 601 961.00 961.00 Your credit or change(points)for the spedfic interest rate chosen if BU2 0.00 0.00 Your adjusted odglnadon charges p 803 961.00 961.00 Transfer razes is 1203 1,760.00 0.00 Changes That In Tool Cannot Increase More Than 10% Good Faith Estimate HUD-1 GOwanment remNirg Charges W 1201 2DO.OD 155.00 Appraisal fee p 804 475.00 550. Credit report W 805 50.00 33.65 Flood certification If 807 9.75 9.75 W W p W 734.75 749.40 r 14,65 1.9939% Ch Good Faith Estimate HUD-1 Init C w account p 1001 1,523.01 1,723.41 Daly Interest loges from is 901---7168767/day 95.56 16.88 Homeowners Insurance p 903 1,140.00 659.00 Tills services and fanciers tale Insurance is 1101 1,415.00 1,465.50 Ownefs fitla Insurance p 103 160. 175.00 is p Loan Terms Your initial ban amount Is $140,800.00 Your loan term is 15.years Your initial Interest rate is 4.3750% Your Initial monthly amount owed for principal,IMereg and any mortgage $1.068.14 Includes hiwrance Is ❑X Prindpal ❑X Interest ❑Mortgage Insurance Can your Interest rate rise? [X]No. ❑Yes,It an dse to a madmum of %. The first change m'H be on I l and an dange again every years after I I . Every dangeedate,yourintal Irateanincreamordeaeaseby %. Ovarths Ufa of the ban,your Interest rate Is guaranteed to never be lower than %or higher awn %. Even it you make pafrrents an Urns,an your ban balance rise? [@ No. ❑Yes,ft can rite to a madmum of$ Even It you make payments on time,can your mmthly amount owed for (K]No. ❑Yes,the first increase an be on I I and the monthly principal,Interest,and mortgage Insurance rise? i mmmt owed an rise to$ The mazenum It an ever rise to is$ Does your ban have a prepayment penalty? ❑Q No. ❑Yes,your modmum prepayment penalty is S Does your loan have a bancon payment? Q Nor ❑Yes,you have a balloon payment or$ due in years" I / Total monthly amount owed Wang escrow account payments ❑You do not have a monthly escrow payment for Hems,such as property taxes and homeovmefs insurance. You mud pay these hems directly yourself. 0 You have an additional nronthty escrow payment of$340.35 that results In a total initial monthly amount owed of$1,408.49.This Includes principal,Interest mortgage Insurance and any items dhecked below ©Property,taxes ❑Homewmers Insurance ❑Flood insurance ❑ ❑X School taxes Q Note: If you have any questions about the Settlement Charges and Loan Tens listed on this form,please contact your lender. Previous editions are obsolete Page 3 of HUD-1 Name of Bommser: Name of Seller: File Number: Robert H.Wertz,Jr. Estate of David Hom 2013063AB Tracy W.Wertz Prepared 12r3112013 at 3:09 pm Note:This page displays an itemization of the charges shown on line 1101 of the HUD-1 Settlement Statement This page accompanies but Is not a part of the HUD-1 Settlement Statement If a discrepancy exists,the information on the HUD-1 Settlement Statement applies. 1100.Title Charges Total Charge Borrower Seller 1101.Title services and lenders title insurance to Wire Fee to Absolute Abstract,LLC $ 30.00 30.00 Overnight Mail to Absolute Abstract,LLC $ 15.50 15.50 E-coc Fee to Absolute Abstract,LLC $ 50.00 50.00 Notary Fee to Came E.Ragan $ 40.00 40.00 100 No Vo0100 to Absolute Abstract,LLC $ 50.00 50.00 300 Survey1300 to Absolute Abstract,LLC $ 50.00 50.00 900 EPL-Res%.1 to Absolute Abstract,LLC $ 50.00 50.00 ClosingSwLtdCL to Absolute Abstract,LLC $ MOD 75.00 1102.Settlement or closing fee to $ 0.00 11D4.Lenders title insurance to Absolute Abstract,LLC $ 1,105A0 1,105.00 Totals: $ 1,465.50 0.00 1,455.50 0.00 Sellerkender credits shown on page 1 POC=Paid Outside Missing CR=Lender Credit Previous editions are obsolete Page 1 of 1 - HUD-1 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,It is e true am accurate statement of all receipts and disbursements made an my account or by me N this transaction I further certify that 1 have received a copy of the HUD-1 Settlement Statement Robed H.Wertz,Jr. tj - racy edz I ESTATE OF DAVID HORN- SettlementAgent The HUD-1 Settlement Statement which I have prepared is a true and accurate accourd of this transaction I he caused or will cause the funds to be dlsburs n a ordance Wth this statement SETTLEM AG DATE WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010. Previous editions are obsolete Page 4 of 4 HUD-1 _�. May. 5. 2011 12: 15PM PNC BANK 412-105-2141 No. 5441 P. 2/2 I f PNC t.UOMTHEWAY May 5,2011 Keith O. Brenneman, Esq. Snelbaker &Brenneman,P.C. 44 West Main St. Mechanicsburg, PA 17055 RE: David R Horn: SSN: 201-16-6569 DOD: 02/05/2011 Dear Mr.Brenneman: In response to your request for Date of Death(DOD)balances for the customer noted above,our records show the following: Checking Account i Account#5070080571 Established: 01/01/1978 I DAVID R HORN DOD balance: S 275.98+0.00 accrued interest PIease note that this office provides date of death balances for deposit accounts(HLAs,CDs,Chaddng and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items,please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank,N.A. Membcr FDIC This message is intended for the use of the individual or entity to which it is addressed and may 1 contain it formation that is privileged; confidential and exempt from disclosure under applicable law. E If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient,you are hereby notified that any dissemination, . distribution or copying of this communications is strictly prohibited If you have received this communication in error,please notify me immediately by reply or by telephone at 500-762-1775 and immediately destroy this faxed document. { i Page 1 of 1 WAYN E 92 Greens Valley Road MYERS Landisburg, PA 17040 Phone: 717-789-4264 Fax: 717-789-4692 SERVICE • AUCTIONEER • APPRAISER go Gam° S'o.o� Ao /V', Kam, / f G44,t , s'ev • P Appratier J (ferlti *,ate 1, the undersigned, do hereby certify that I have personally inspected the property appraised, that I have no present or contemplated future interest therein, that the fee received for this assignment is in no manner contingent upon the value reported, and that no important factors affecting the value of this property were knowlingly overlooked or withheld. The information contained in this report is not guaranteed; however, it has been gathered from sources we believe to be reliable. The appraiser certifies that to the best of his knowl- edge and belief, the statement, information, and materials contained in the appraisal are correct as set forth. I certify that this report has been completed in conformity with recognized industry standards. The appraisal assignment was not based on a requested minimum valuation or specific valu- ation for approval of a loan. Signed Firm Date 3J KAS-660 0 1996 Kiefer Supply Co. Fergus Falls, MN (800)435-2726 St I MEMBERS 1' PRDRRALCRROrr UNION ' REGULAR SAVINGS ACCOUNT: Account Number/Suffix 50278-00 Date Account Established 12/21/1972 i Principal Balance at Date of Death $5.00 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest $5.00 Name of Joint Owner Kelly Stanley Date Joint Ownership Established 05/1112004 CHECKING ACCOUNT: Account Number/Suffix 50278-11 Date Account Established 06/17/1976 Principal Balance at Date of Death $5.00 Accrued Interest to Date of Death $.00 i Total Principal and Accrued Interest $5.00 Name of Joint Owner Kelly Stanley Date Joint Ownership Established 05/11/2004 LOAN ACCOUNT: Account Number/Suffix 50278-03* Date Opened 03/11/1986 Principal Balance at Date of Death $2,720.48 jl Loan Type Personal Service Loan Contractual Pledge of S Interest Rate 11.00% Name of Co-Borrower None C J *Loan does not have life coverage. 1 j VISA CREDIT CARD ACCOUNT: j Account Number 4287590020502783 - Date Account Established 08/06/1996 � t Balance at Date of Death $13,143.06 Name of Joint Cardholder None ALP tE ERS 1sT F�EQDER P7 �QV Danielle A. Kline Lending Insurance Support Specialist April 21, 2011 i Estate of: DAVID HORN Date of Death: 02105/2011 Social Security Number: 201-16-6569 5000 Louise Drive * P.O. Box 40 * Mechanicsburg,Pennsylvania 17055 * (800) 283-2328 • www.memberslst.org may is -iu uo:wsp p.3 •••^• ��+•� i�•�u rv'um•I'Ie9'1OCRJ r71 rl(r955207 To:87909124 A MEMBERS 19 MERALCREW UMON March 13,2014 The Estate of David R. Horn c/o Kelly Stanley 7000 Wertzville Road Mechanicsburg, PA 17050 Re:Account A50278, Loan ID:0003 Per the discussions of March 13th,we will agree to settle the unsecured ban (current We lance of $2,720.48) upon payment of$100.00,payable to Members V FCU. Upon receipt of that payment.we will cease all further collection activity in regards to th loan, mark the balance as settled for less than full on any credit reports,and not assign the remainder V I a 3rd parry collection agency. Please cal:me with any questions or concerns concerning this arrangement. Sincerely, ar.� Dan Summers Collections Manager 51N101ovisrDriv; P.O.IImc40 MedrmnesbwgPemsylvunia11455 (801,1283-2128 www.mem i�tc : May 19 10 05:43p p.2 •- --• �..+ _�•.,,, runi.r�rio�rco =ar nrr ey-r To:817177%9I24 P.1'1 St MEMBERS i# FE7TERALCRIDIf UMOM March 13,2014 The Estate of David R. Horn c/o KeliV Stanley 7000 Wertmille Road Mechanicsburg,PA 17050 Re:Account#50278. Visa Ending in-2783 Per the discussions of Mar& 13th,we will agree to settle the Visa card for less than full balanc upon payment of 5500.00,payable to Members 1"FCU. Upon recelpt of that payment,we will cease all further collection activity in regards to the carc. mark the balance as settled for less than full on any credit reports,and not assign the remainder to a 3'°party collection agency. Please call me with any questions or concerns concerning this arrangement. Sincerely, Dan Summers Collections Manager 51100Loubcori.c P.0.13=40 A/cchmicOm.g Pw %yi %%17M - ti1N1)2N7-�a1 - nr.rmMhmist n< SU(1b LNUiat Lkerc P.b.Daa[D - MecB,wirsEulg Pm{sylvaain 171155 (Aaol za3-ZUf uww.memAmisl. rB Tuesday, February 04, 2014 3:24 PM Malpezzi Funeral Home 7176972414 p.01 Malpezzi Funeral Home 8 Market Plaza Way Mechanicsburg,PA 17055 (717)697-4696 Michael J.Malpezzi,Owner,FD Jeremy J Shartzer,FD Kyle C Knipe FD February 4,2014 Kelly Stanley 7000 Wertzville Road Mechanicsburg,PA 17050 The Funeral Service for David R.Hom We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES,FACILITIES,AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES: Direct Cremation $2,095.00 FUNERAL HOME SERVICE CHARGES $2,095.00 SELECTED MERCHANDISE: Transporter Cremation Container $165.00 Solid Marble Um $375.00 Natures Tranquility Register Package $95.00 Marble Keepsake Um $65.00 THE COST OF OUR SERVICES,EQUIPMENT,AND MERCHANDISE THAT YOU HAVE SELECTED $2,795.00 AT THE TIME FUNERAL ARRANGEMENTS WERE MADE,WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES: Certified Death Certificates $30.00 Newspaper Notices-Patriot $335.22 Newspaper Notices-Sentinel $167.40 TOTAL CASH ADVANCES AND SPECIAL CHARGES $532.62 CONTRACT PRICE S3,327.62 HISTORY: 03/14/2011 Payment Cumb.Co.VA $100.00 05/11/2011 Interest Charge $35.04 06/01/2011 Account Adjustment Collection Agency Fee $110.00 05/15/2012 Interest Charge $391.84 TOTAL AMOUNT DUE S3,764.50 a S (A0 °H _ FN L00 ryry cc(D W M N\ V ON MO r f K N O N N O i •• O •. v m M 4a m C H HO rl O V 0 r C r N 0 V 7 r U- N L N O ri U U L 0 N °a aZZ v r0 I O`', O x D 1%,0 O b 1 LL 00 iO O n I � O y . O NO 0 v0 !+ Q O N W U' X O L O HW a H O Q Y WO W H ZOUO H (L ZKzwg M ZZJ r0 OH m ZIF/1a 'H OH Hm O. . UU WZl7 Lm0 NNm ULOO W WX W W /� 4a >-F- o C aJ J7 I� J mU •r 1AmLI j H a' J W H L a HUOaU v aY3Q a z J Z 0(Az •• >OOU QQ7 WQ W Q\OW L J W zuce U O DUNE CL WWOLDW L LN Z mammm m >-H K Q J r m F Z 4+ w O cc e-p � Residential Limited Service Program Agreement Home/'bi�IIIIU/1!. ► Home Paramount Pest Control 888.888.HOME www.homeparamount.com The Leader Since 1939 PO Box 850,Forest Hill,MD 21050 License/Phases: b L/ HDate: - Agreement.Customer is the owner/authorized agent of the property.This Agreement constitutes the entire understanding between the parties.No other terms are binding unless made in writing and signed by a Home Paramount Officer. Service.Customer has elected Home Paramount Pest Control's Residential Limited Service Program.This Agreement coversonly the target pest below.It is expressly understood that no other pests,including termites,are covered under this Agreement.Home Paramount will provide service as necessary during a thirty(30)day non-refundable warranty period.,,. , Target Pest: 0 Customer Information Billing Information Service Information Name(First,Last) Address Address Telephone City,St City,St (('' Mobile Zip Zip - ( E-mail Day Telephone Evening Service Confirmation Telephone Structure(s)Covered: Equipment Purchased: Scope of Service: Inspection Comments: ;4.2 p Payment.No cash accepted.Please make check/money order payable to Home Paramount Pest Control Companies,Inc.Payment is due at time of service. One-Time Program Fee Equipment Cost Subtotal Less Discount Plus Tax Agreement Total $ $ $ $ $ $ Amount 0 Money Order# 0 Check# 0 Finance# $ 6'Q (St•00 # Cardholder Name Exp.Date ,it 0 MC 0 Disc 0 visa 0 AmEx Customer Acknowledgement.Customer has ead and accepts his Agreement including the Terms and Conditions on the reverse.Customer acknowledges receipt of the Notice of Cancellation Form and the Customer Information Handout. Customer Signature Hom Pammount Signature Print Name ID# BUYER'S RIGHT TO CANCEL.YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. OVER This Agreement is contingent on management approval.Home Paramount reserves the right to revoke this Agreement if not accepted within thirty(30)days. Tap Copy—Branch/Middle Copy—Service Department/Bottom Copy—Customer iff"I L20101.10 02010 Home Paramount Pest Control Companies,Inc. YEARS OF SERVICE WAYN E 92 Greens Valley Road MYERS I andisburg, PA 17040 ' Phone: 717-789-4264 Fax: 717-789-4692 "SERVICVIC • AUCTIONEER • APPRAISER Da-tt�. �YA �A 1 M&T Bank Understanding what's important' a May 19, 2011 Estate of David R Horn C/o Keith O Brenneman,Attorney at Law 44 W Main St. Mechanicsburg, PA 17055 Acct#: 11070064720001 Doc#: 21-11-0483 County: Cumberland Dear Keith 0 Brenneman: Enclosed please find a proof of claim against the above-mentioned estate. Please inform me as soon as you know the distribution that we will be awarded. If you have any questions, regarding this claim please feel free to contact me at the number listed below. 1-800-837-7689 ext 8481 Thank you for your time and attention to this matter. Respec Ily, Luveena A/and Probate Estate Specialist Cc: Kelly Stanley M&T Bank Luveena A Ward Probate/Estate Specialist 1100 Wehrle Drive Williamsville, NY 14221 Phone:800-837-7689 EXT 8481 E-Mail:laward@mtb.com Fax:716-630-4925 STA-fE OF PENNSYLVANIA County of Cumberland In The Matter Of: PROOF OF CLAIM FILE Number#21-11-0483 David R Horn (Deceased) TO:Register of Wills Cumberland County: 1. I,the undersigned,am a Collections Manager of Manufacturers and Traders Trust Company,doing business as M&T BANK (hereinafter the "BANK"), a New York banking corporation with a principal place of business located at One M&T Plaza, Buffalo, New York 14203. I am duly authorized to submit this claim for the Bank which is based upon my personal knowledge and/or upon records kept in the ordinary course of the Bank's business. 2. The decedent is indebted to the Bank in the amount set forth in paragraph 3 below. The amount claimed is correct as of the date of indicated below all appropriate payments or other credits. There are no set-offs or counterclaims. This claim is free from any charge forbidden by applicable law and excludes all unmatured interest. 3. The sum owing to the Bank as of the date indicated below$9,135.13 (adjusted) 4.The nature of the debt is the following: (Check item(s)applicable.) ( X ) (1) Note or agreement payable to Bank,signed by decedent. ( ) (2) Note or agreement payable to third party now owned by Bank. ( ) (3) Revolving loan or line of credit(for example,Visa Agreement,commercial line of credit,Heq Line of Credit). ( ) (4) Amount owing under Equipment Lease Obligation. ( ) (5) Guaranty by decedent of debt of another. ( ) (6) Judgment. ( ) (7) Other(specify on reverse side). 5. Supplementary information: (1) Date of note/agreemenVguaranty/Judgment June 13,2005 (2) Bank account or file number: 11070064720001 (3) The per diem per day is$1.78 6.The bank requests all notices and/or dividends to be sent to the following address: Manufacturers and Traders Trust Company Attention:Mayranna Mikolajek 1100 Wehrle Drive Special Services,Ground Floor Williamsville,NY 14221 Manufacturers and Traders Trust Company Dated May 18,2011 By: Q(s'V1n./`" Amy Madison Banking Officer 1100 Wehrle Drive Special Services Supervisor,Ground Floor Subscribe and sworn to before me Williamsville,NY 14221 This /�r day of May 2011 VINCENTE GUZMAN / Notary Public,State of New York / / f�✓r-� No.0IGU6211218 Notary Pub 6c Qualified in Erie County My Commission Expires: 1 Page;? 1 .D5cument Name: untitled S140 POLN LOAN PAYOFF 05-18 14 : 54 :51 05/18 ASSOC 1 APPL IL BANK 110 BRANCH 0001 PRODUCT COLL VIEW 99 PAGE 1 HOLD RE: HORN DAVID R LOAN TYPE 3 SIMPLE INTEREST THE TOTAL PAYOFF BREAKDOWN IS AS FOLLOWS: PRINCIPAL BALANCE: $8, 374.58 INTEREST DUE: $110.11 LATE CHARGES DUE: $650.44 INSURANCE REBATE: $ . 00 MISC CHARGES DUE: $.00 TOTAL PAYOFF DUE: $9, 135.13 THIS PAYOFF QUOTE IS GOOD UNTIL 05/18/11. AFTER THIS DATE, INTEREST WILL ACCUMULATE AT A DAILY PER DIEM: 1 . 77586 CUSTOMER 7006472 LOAN 0001 DATE 0518112 PART LOG N TYPE PF05=5130 09=STLN 10=TRAC ll=STCM 12=STPS )ate: 5/18/2011 Time: 2 : 57 : 57 PM O O O I O O I O O I O I r r I r r I r r I r Y 1 r Y 1 !�•r l 0 0 1 0 1 0 0 0 1 0 1 0 0 0 1 0 0 [J ',tl J SI N N N I r Y I Y Y I r I N N l N N I r r I Y r 1 0 0 1 O O 1 1010 I b I W W W I W I J J J I J J •T� J @@ W 11 N N N I N N I N N I Y I N N I N N I N N I N N I N N I N N I N N I N I N N N I N I N N N l r r M J PF W O N N N I W U T A A I r I J J l N N I W w l N N I N N 1 0 0 1 W W 1 0 1 AAA I W 1 0101 T I A A "K n O C \\\ I \\ 1 \\ I \ I \\ 1 \\ 1 \\ 1 \\ 1 \\ I \\ I \\ 1 \ 1 \\\ 1 \ 1 \\\ 1 \\ W 1 I1 N N N I N N I N N I N I N N I N N I N N I N N I N N I N N I N N I N I N N N I N I N N N I N N tD 41 rt J� o00l 001 ool of ool ool 00l 001001001 ool of 000l of 000l oo roN W rrrl rrl rrl rl rrl rrl Yl+ I rrlYrl rrl rrl rl rrrl rl rYYl rr 1 Wm o NNN 1 NN 1 NN I N I rY 1 rr 1 rr 1 Yr 1 rr I rY i Yr I r l rrr I r l rrr 1 rr AK W I 1 1 1 1 1 1 1 1 1 1 1 1 I 1 N J ro t 'A M 1 ['1 L^ 1 ro 1 'Jp 1 C'1 [' I '•tl M 1 [�r I '.tl M 1 ['C'� I }I M I L� 1 7)CJ L�/ 1 [' I tl M 1 ro ro 0 � w l P N 1 a 1 P N t Lrl 1 P a 1 o C I W W I C I W 1 M CM i Prt i CM i � a W » rt rt 1 10 m rt 1 ��qp 1 rt rt I lq 1 rt A I I rt 1 11�p M ��IJ1 1� » a a 9 I G 2 1 N N 1 9 I G 1 (P ID 1 C n 1 N N 1 F � I a (P 1 F � 1 n I F o n 1 0 1 M n 1 a 8 » 7rryP I 1-'1'3 1 1 I r 1 1 1-� 1 1 r 1 I r I I r N I 1 Y W I roro I � � Irorol �° I �I Iroro1NNIrorola Irorola lrol � H lrol �l .3 to w a rt 1 l aq w I rt l l a w 1 I a N I ry l a w 1 li I w l H I a l H I p �1�y11yppp�p�j[1 I [n� I aa1q�p1�� I i n 1 rypry 1 n 1 I n I (a�K�ppp 1 n 1 I [nq I ry¢ I n I pFn fl I �� Irtl INyi rttN[yNyJ IIYNI Rrt 1 ~'(WyPIIMr ,h111t1 F{ Ia O P Rol 1 C 1 1 1 1 1 C 1 I C 1 1 C 1 1 C 1 1 ^G1 1 p F] G rt IIF--111 1 (] I FI 1 n 1 FFF111 1 n 1 1-1 n 1 H 1 O •KO IY[y i n 1 Cf'J' 1 I I {Y{Y I n 1 'J• I n 1 !Y 1 n 1 5 1 n 1 1 'J' I f] 11P PPPIII Ma 1 M 1 W IPiI 1 I I IWP{1 tWNS I M 1 1(lil I M I w IPtI 1 M 1 IN{ I M 1 lai 1 U7 I M ry 1 1 K 1 1 1 1 I 1 1 li I I I I 1 I Iq 14 1 114 W I I 1 1 I W 1 114 IR 1 I W I 1 W 1 1 O a s 1 1 N a 1 1 1 a a 1 1 N N 1 1 a N 1 I a 1 1 N 1 1 W2W2W2p 1 1 1 1 1 1 1 1 I I I 1 I I 1 1 1 1 1 1 1 1 1 I 1 I 1 I 1 1 I 1 I I 1 1 1 1 I 1 I 1 1 I I � � N• 1 1 1 1 1 1 1 1 I 1 1 1 1 1 I 1 1 I I 1 1 1 1 1 I 1 1 1 I I �� Y• � I 1 I I 1 1 1 1 1 I 1 1 1 I I 1 i 1 1 1 1 1 1 1 I 1 1 1 1 I O H » 1 1 1 1 I 1 1 1 1 I I I 1 1 I 1 1 1 I 1 1 N I 1 1 1 I 1 1 1 I 1 I 1 1 1 1 H 1 1 1 1 I 1 1 1 I 1 1 1 I I 1 1 0 1 1 1 0 I I Y 1 I Y 1 I r 1 1 0 1 1 0 1 I N 1 1 I r I I N 1 I r 1 1 0 1 1 t0 1 I W I I r 1 1 I r I I r I I r 1 I r 1 I Y I I Y I I w 1 1 I J 1 1 tl\ 1 1 w 1 I A 1 I A 1 I T 1 1 1 1 1 I I 1 1 i 1 1 1 1 1 1 1 1 1 I I I 1 I 1 - 1 1 1 I 1 I ro 1 I 1 1 1 1 1 1 I I 1 I I I 1 I 1 I 1 1 1 1 I I I I 1 1 1 1 r n J O Vow N_� 10 N I N N 1'ylnl.l NIP I N N I m N I N N I A N I N N I r W I N I J 01 A I N 101 01 i0 1 NN W fT 'PI 1 ' I�-• � I 11 1 1 1 1 • 1 1 1 1 • • • 1 •L-I' O N lb 1' t0 A I O W I'm"I 1D W I J O I N A I O A I W A l o o I J W I J I J J W I N I N J W I N N_ n 190110'.1. 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W W I N N N I N N N N I N [Ij N Y r I O1 T 01 I W W W W I N N N N I N N N I N N N N I N N ool 000l0000l0 0 rrl rrrlYrrrlr 1 1 t+t+t+tl 1 Y W7ry0 m � tt�1:ppphp m� i N N N W i m yNy� Y (mCy N m i 1�m-II � p 0�p @ 0'$d ap i H y 0 R O W 1w Z r x1-11 rl„) 1 nrrrttt 1 r I1 _ zii i H 1 i pp W 1 1 1 0 D OQ Q J 1 m 1 1 1 0 1 I 1 w 1 1 1 J 1 1 1 1 1 1 1 1 1 1 1 I 1 1 I 1 I 1 1 1 I I I 1 I I 1 I I 1 I I 1 I 1 i o l0 1 Ir tl � \ I \ I I \ H N I Y I I Y p1 Y 1 01 I I w 1 I I 1 1 1 i i i H n �/V �011 Wm� 14tNNN1 H ON K m iP I Y IP N I N O O V I Y GOG SI � �NNI NOrIiPYWOIr 2H A O 1 I 1 z < W I A I I N O N Y 1 0 I I O (t .✓ UI 1 r 1 1 Ja � m 1 N 1 1 W ly b O 1 V W ('j C//V/ i N i i to M U W N b 1 1D 1 1 J \ N I r I I Y n C] Vr.t o 1 0 1 1 o IC 0 l 0 1 1 0 0 10 1 0 O 1 0 1 I O 1 1 I 1 1 I I 1 I m 1 m 1 1 m N I Y I I m Y I N 1 1 IP 1 I 1 1 1 1 l7 � ry 1 1 1 •• •• 1 1 1 1 1 1 r 1 1 1 \ 1 1 1 N I 1 1 A 1 1 1 \ VI 1 J 1 I Ol UI I N 1 I Y 1 1 1 1 1 I 1 t 1 1 1 I 1 I I 1 1 I 1 I 1 1 1 1 m I 1 1 Y i �r7 1 1 1 L•7 I 1 I I 1 I I 1 I I 1 PPL Electric Utilities 2 North 9th Street CPC-GENNt Allentown, PA 18101-1175 •° ° Tel.800.358.6623 Fax 484.634.3713 P1° pptelectric.corn �+ PPL M*a *UdIMOe AV 01 008631 70469E 38 A"5DGT I�I'II�III�'I�1,11.��„I111�11111„II,I,I��1�I,IIIIII��I"���„1, SANDY GORHAM January 28,2014 7000 WERTZVILLE RD MECHANICSBURG PA 17050-1542 Bill Account No: 78980-78037 Amt Past Due: $669.25 Dear Customer: Your final bill with PPL Electric Utilities is overdue for the amount shown above. We $ understand it is easy to forget a final bill when moving or changing service. For this reason,PPL Electric Utilities offers various methods of bill payment such as credit card payment, speed pay (we automatically process your check over the phone), and payment agreements. If your account remains overdue,we may refer your balance to one of our collection agencies or attorneys. An unpaid account balance could have a negative effect on your credit rating. To avoid collection action,please contact us within the neat 10 days. Our telephone number is 1-800-358-6623 and our hours are 8 AM to 5 PM. When you call,you can either pay the r amount you owe or set up a payment agreement. If you have already paid this bill,thank you for your payment. If you have any questions please call us at the above telephone number. Mailed payments must be sent to PPL Electric Utilities, Attn: CPC-GENNI, 2 N. 9th St.,Allentown,PA 18101. Revenue Collections Supervisor PPL Electric Utilities 827 Hausman Road Allentown,PA 18104-9392 Tel. 800.342.5775 Fax 484.634.3484 �� www.pplelectric.com •.�•. . TM SANDY GORHAM Service Address: 7000 WERTZVILLE RD 609 ROBERT ST MECHANICSBURG,PA 17050 MECHANICSBURG, PA 17055 January 24, 2014 Bill Account Number: 78980-78037 Dear Sandy Gorham: Enclosed is the information you recently requested from PPL Electric Utilities. We hope this is satisfactory. If you have any questions,please do not hesitate to contact us. You are a valued customer, and we appreciate the opportunity to serve you. Sincerely, PPL Electric Utilities Enclosure Wo matioo Request .. t >,.;... DENNIS N)% GARY EICHELBERGER i CHAIRMAN ',a . CHIEFOPERATI` ^ 1 RICHARD ROVEGNO EDWARD SC�Ie , VICE CHAIRMAN SOLICITOR BARBARAB.CROSS TAX CLAIM BUREAU OF CUMBERLAND COUNTY STEPHEN O.TILEY' SECRETARY One Courthouse Square,Room 106,Carlisle,PA 17013-3389 ASSISTANT SOLICITOR£ (717)240-6366 Receipt No. : 84E7 Printed: 9/20/11 C P 12 : 16 : 17 Receipt Date: 9/20!/2011 Control Number: 17-000249 **** RECEIPT **** Page: 1 Property Description: HORN, DAVID R & JANET BLACKBURN VILLAGE 7000 WERTZVILLE ROAD LAND LESS THAN 1 ACRE MECHANICSBURG PA 17050 Residential (Under 10 Acres) Situs Information: 609 ROBERT STREET Map No: 17-23-0563-046 MECHANICSBURG BOROUGH Tax Penalty & Year Description Face Interest Costs Total 2b09 CTY-MECHANICSBURG 2 355 .94 88 . 99 444:93 "2009 CLB-MECHANICSBURG 2 26 .71 6 . 67 33 :38 2009 MUN-MECHANICSBURG 2 445.11 : 111.31 556 :42 2009 SCH-MECHANICSBURG 1979 .50 494 . 95 14 .28 2474...45 2009 BUREAU COSTS 150 . 75 150 '5 Received For Year Of 2009 $36742;21 Total Received $3674 .21 Tendered > CASH Received By > JC Paid By KELLY STANLEY Remarks > Balance Dtie As Of 9/20/2017. Claim Year:. 2010 3555 .32 Claim Balance : 3555 .32 Receipt Number: 8418'7 Total Received: $3674 . 21 ii i BARBARA B CROSS DENNIS MARION CHAIRMAN CHIEF OPERATIONS OFFICER EDWARD SCHORPP JIM HERTZLER SOLICITOR VICE CHAIRMAN STEPHEN D.TILEY lk ASSISTANT SOLICITOR GARY EICHELBERGER TAX CLAIM BUREAU OF CUMBERLAND COUNTY SECRETARY MELISSA F.MIXELL One Courthouse Square,Room 106,Carlisle,PA 17013-3389 TAX CLAIM DIRECTOR (717)240-6366 Printed: 6/29/12 C Receipt No. : 89337 14 :24 : 13 Receipt Date: 6/29/2012 Control Number: 17-000249 **** RECEIPT **** Page : 1 Property Description: HORN, DAVID R & JANET BLACKBURN VILLAGE 7000 WERTZVILLE ROAD LAND LESS THAN 1 ACRE MECHANICSBURG PA 17050 Residential (Under 10 Acres) Situs Information: 609 ROBERT STREET Map No: 17-23-0563-046 MECHANICSBURG BOROUGH Tax Penalty & Year Description Face Interest Costs Total 2010 CTY-MECHANICSBURG 2 355 . 94 80 . 98 436 . 92 2010 CLB-MECHANICSBURG 2 26 . 71 - 6 . 07 32 . 78 2010 MUN-MECHANICSBURG 2 482 .20 109 . 76 591 . 96 2010 SCH-MECHANICSBURG 2181 . 04 496 .22 16 . 00 2677 .26 2010 BUREAU COSTS 9 . 05 9 . 05 Received For Year Of 2010 $3763 . 97 Total Received $3763 . 97 Tendered > CASH Received By > JC Paid By > HORN, JANET Remarks > Balance Due As Of 6/29/2012 Claim Year: 2011 3839. 12 Claim Balance: 3839 . 12 Receipt Number: 89337 Total Received: $3763 . 97 BARBARA B CROSS DENNIS MARION CHAIRMAN CHIEF OPERATIONS OFFICER EDWARD SCHORPP JIM HERTZLER SOLICITOR VICE CHAIRMAN STEPHEN D.TILEY ASSISTANT SOLICITOR GARY EICHELBERGER TAX CLAIM BUREAU OF CUMBERLAND COUNTY SECRETARY MELISSA F.MIXELL One Courthouse Square,Room 106,Carlisle,PA 17013-3389 TAX CLAIM DIRECTOR Reprinted: 7/11/13 C (717)240-6366 Receipt No. : 89656 14 : 57 :59 Receipt Date : 7/24/2012,'; Control Number: 17-000249 **** RECEIPT **** Page: 1 Property Description: HORN, DAVID R & JANET BLACKBURN VILLAGE 7000 WERTZVILLE ROAD LAND LESS THAN 1 ACRE MECHANICSBURG PA 17050 Residential (Under 10 Acres) Situs Information: 609 ROBERT STREET Map No: 17-23-0563-046 MECHANICSBURG BOROUGH Tax Penalty & Year Description Face Interest Costs Total 2011 CTY-MECHANICSBURG 2 380 . 02 55 . 10 435 . 12 2011 CLB-MECHANICSBURG 2 28 . 57 4 . 12 32 . 69 2011 MUN-MECHANICSBURG 2 515 . 48 74 . 77 590 .25 2011 SCH-MECHANICSBURG 2431 . 17 352 . 50 15 . 00 2783 . 67 2011 BUREAU COSTS 7 . 55 7 . 55 Received For Year Of 2011 $3864 .28 Total Received $3864 .28 Tendered > CHECK Received By > JC Paid By >' CITIBANK __... . . . ... . . Remarks > 640018595 Balance Due As Of 7/24/2012 Claim Balance: . 00 Receipt Number: 89656 Total Received: $3864 . 28 BARBARA B CROSS DENNIS MARION CHAIRMAN CHIEF OPERATIONS OFFICER ,. EDWARD SCHORPP JIM HERTZLER SOLICITOR VICE CHAIRMAN STEPHEN D.TILEY ASSISTANT SOLICITOR GARY EICHELBERGER TAX CLAIM BUREAU OF CUMBERLAND COUNTY SECRETARY One Courthouse Square,Room 106,Carlisle,PA 17013-3369 MELISSA TAX CLAIM DIRECTOR (717)240-6366 Printed; 7/11/13 C Receipt Na. : 96522 14 :55 :47 Receipt Date: "7/11%2013;` Control Number: 17-000249 **** RECEIPT **** Page: 1 Property Description: HORN, DAVID R & JANET BLACKBURN VILLAGE 7000 WERTZVILLE ROAD LAND LESS THAN 1 ACRE MECHANICSBURG PA 17050 Residential (Under 10 Acres) Situs Information: 609 ROBERT STREET Map No: 17-23-0563-046 MECHANICSBURG BOROUGH Tax Penalty & Year Description Face Interest Costs Total 2'012 .CTY-MECHANICS13URG 2 380.02 ' 55. 10 435 . 12 2012 CLB-MECHANICSBURG 2 28 .57 4 . 12 32 . 69 2012 MUN-MECHANICSBURG 2 515 .48 74 . 77 590 .25 2012 SCH-MECHANICSBURG 963 . 14 356 . 05 15 . 00 1319 . 19 2012 BUREAU COSTS 7. 75 7 . 75 Received For Year Of 2012 $2400 .00 Tendered > CASH Total Received $2400. 00 Received By > JC Paid By > HORN, KELLY Remarks > Balance Due As Of 7/11/2013 Claim Year: 2012 1492 .20 Claim Balance: 1492 .20 Receipt Number: 96522 Total Received: $2400.00 Apr 14 10 01:31p p.1 Notice CP503 D artment of the Treasury Tax Year 2009 IRSInternal Revenue Service Notice date June 4,2x12 Andover,MA 01810-9041 Social Security I iumber 201-16.6569 To contact us Phone 1-800-829-0922 Your Caller to 966467 026176.204060.0125.003 a AB 0.374 1064 Page 1 of Illlhllhldr111P1rrlrohr4dl lgdullllllIUIIIIrrllurIl 181 llll l l III�IIIIn�91[I II I011[VIIIII Illi(� DAVID R HORN DECD '201166569101` 7000 INERTZVILLE RD 176 MECHANICSBURG PA 17050-1542005 Second reminder: You have unpaid taxes for 2009 Amount due: $2,850.68 As we notified you before, our records show you Billing Summary have unpaid taxes for the tax year ending December 31, 2009 (Form 1040). If you don't Amount you owed 82,832.74 pay 52,850.68 by June 14, 2012, interest will Failure-to-pay penalty 9,78 increase and additional penalties may apply. Interest charges 8,16 Amount due by June 14, 2012 $2,850.68 What you need to do immediately Pay immediately • Send us the amount due of$2,850.68 by June 14,20 to avoid additional penalty and interest charges. Continued on back... - ..... ...........------------ ..........._--------------......----- ..._---............................... ............ ... __.. - - --y — — - - - - DAVID noan°ECID Notice rae°wFi:1aL a° June 4 Notice date June 4,2012 - rA- M MCSJRCCA M-045Q: D5 --SvdalSecurity num er 261-16-6569 - --- IRS • Make your check or money order payable to the United itates Treasury. • Write your Social Security number(201-16-6569),the v x year(2009), and the form Payment number(1040) on your payment and any corresponden e. Amount due by INTERNAL REVENUE SERVICE June 14, 2012 2,850.68 FRESNO, CA 93888-0419 11uurgPthrL• IhhIP•l,gllrlhtlutnlulut•• dln! / ant 7r r rr o n+ -. r -rn ------ - --- MICHAEL A KUNISKY, CPA INC 400 N HOUCKS ROAD HARRISBURG, PA 17109-1647 (717)545-8102 MARCH 8, 2014 DAVID R HORN ESTATE 7000 WERTZVILLE. ROAD MECHANICSBURG, PA 17050-1542 DEAR KELLY, ENCLOSED ARE THE DECEDENT'S 2010 INCOME TAX RETURNS. THE "TURNS SHOULD BE SIGNED AND DATED BY THE EXECUTOR OF THE ESTATE. SPECIFIC FILING INSTRUCTIONS ARE AS FOLLOWS. FEDERAL INCOME TAX RETURN: MAIL YOUR FEDERAL RETURN AS SOON AS POSSIBLE. MAIL TO - INTERNAL .REVENUE SERVICE CENTER P.O. BOX 37008 HARTFORD, CT 06176-0008 ENCLOSE YOUR CHECK FOR $603, PAYABLE TO THE UNITED STATES TREASURY. INCLUDE YOUR SOCIAL.SECURITY NUMBER, DAYTIME PHONE NUMBER AND THE .WORDS "2010 FORM 1040" ON YOUR CHECK. ALSO ENCLOSE FORM 1040-V. DO NOT ATTACH FORM 1040-V OR YOUR PAYMENT TO YOUR RETURN OR TO EACH OTHER. PLEASE LEAVE FORM 1040-V.. AND YOUR PAYMENT LOOSE IN THE ENVELOPE. YOUR.COPIES OF THE RETURNS ARE ENCLOSED FOR YOUR FILES. I .SUGGEST THAT YOU RETAIN THESE COPIES INDEFINITELY. SINCERELY, /�6 MICHAEL KUNISKY