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Home My WebLink About05-22-14 � 1505611185 REV-1500 EX(02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes Po aox zsoso� INHERITANCE TAX RETURN 21 13 0 9 5 5 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMD�m�v Date of Birth MMD�vvYY 08242013 07061923 Decedent's Last Name Suffix DecedenYs First Name M I BORZOK JULIA (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BEL'JW � 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) � 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOUWQ�E DIRECTED TO: Name Daytime T�phone Numt� � rn GREGORY S• CHELAP, ESQ • 717—��100Q� c� o � RE§�S 12 ILLS�VUSE�+Il}Yp i— � ry� � �"1 t'tl ,':� � ,� "%J C7 First Line of Address �� t-� �� —fl �'� � CJ --r7 Z'1 17 S 2ND STREET, 6TH FL � � �' �. � �=, Second Line of Address ` � N �'�"' rn � _o F�-� C!� � � 0 City of Post Office State ZIP Code DATE FILED HARRISBURG PA 17101 correspondent'se-ma��address: GCHELAPaSKARLATOSZONARICH- COM Under penalties of perjury, I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete. Declaration of preparer other than the personal representative is based on all information ofwhich preparer has any knowledge. SI RE OF PERS PONS FOR FILING RETURN TE l R 5 R COURT HARRISBURG, PA 17112 SIG RE P ARER O ER THAN R ESE TATIVE ��_T��l�/ �� r ADDRESS 17 S. 2ND STREET, 6TH FLOOR HARRISBURG, PA 17101 PLEASE USE ORIGINAL FORM ONLY Side 1 � 15 0 5 61118 5 oMasa�s.000 15 0 5 61118 5 � J 1505611285 REV-1500 EX(FI) DecedenYs Social Security Number DecedenYs Name B 0 R Z 0 K J U L T A RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . � 7 8,9 7 5•0 0 2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2. Q.�Q 3. Closely Heid Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , , 3. 0 • �� 4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , 4. 0•0� 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , , 5. 13 8,4 7 8 • �0 6. Jointly Owned Property(Schedule F) � Separate Billing Requested , , , , g. 0•0� 7. �nter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) � Separate Billing Requested . . . . 7. 2 2,9 0 7 • 0 0 8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , g 2 4 O,3 6 0• 0 0 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . g. 2 9,7 6 6 •�0 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) , , , , , , , , , �p. 16,9 4 5 •�� 11. Total Deductbns(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , ��, t}6�71], •�� 12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , �2. ],9 3,6 4 9 • 0� 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) , , , , , , , , , , , , , , , �4. ],9 3,6 4 9 • �� TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers unsier Sec.9116 (a)(1.2)X.OU �• 00 �5. 0 • 00 16. Amount of Line 14 t xable at�inea�ratex.o4� 193,650•00 �s. 8,714 -00 17. Amount of Line 14 taxable at sibling rate X.12 0 • �❑ 17. 0 • �C 18. Amount of Line 14 taxable at collateral rate X.15 �.�� 18. 0'�� 19. TAXDUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 8�714 -0� 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Sld@ 2 � 1505611285 1505611285 � OM4648 3.000 REV-1500 EX(FI) Page 3 File Number DecedenYsCompleteAddress: 21 13 0955 DECEDENTS NAME BORZOK JULIA STREET ADDRESS CUM R AND C TY C�Ty STATE ZIP CAMP HILL PA 17011- Tax Payments and Credits: 1. Tax Due(Page 2,�ine 1s) (1) 8�714 •�� 2. Credits/Payments A. Prior Payments 10�0 D 0•0 0 B. Discount 4 3 6•0 0 Total Credits(A+g) �2� 10,4 3 6 • 0 0 3. Interest (3) �•�� 4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2,Line 20 to request a refund. (4) 1 i 7 2 2 •�0 5. If Line 1 +Line 3 is greater than line 2,enter the difference.This is the TAX DUE. (5) �-�� Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑X b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . ❑ ❑X c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . ❑ � 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : ❑❑ � 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? 4. Did decedent own an individual retirement account,annuity, or other non-probate property,which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � � IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.�9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.$9116 (a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse fran tax,and the statutory requirements for disciosure 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.g9116(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. OM4671 2.000 REV-1502EX+(�2-�2) SCHEDULE A pennsylvania DEPPRTMENTOF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENTDECEDENT ESTATE OF: Fi�E NuMe�R: Julia Borzok . 21 13 0955 All real property owned solely or as a tenaM 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 c�mpelled to buy or sell,both having reasonable knowledge of the relevant facts. Real properly that is joinUyowned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sdd. ITEM Include a copy of the deed showing decedenYs interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Proceeds from sale of 151 N. 21st Street, Camp Hill, Cumberland County, PA 17011 78�9�5 TOTAL (Also enter on Line 1,Recapitulation.) $ 7$,975 swasss z.000 If more space is needed,use additional sheets of paper of the same size. REV-1508 EX+(p�12) pennsylvania SCHEDULE E DEPPRTN�NTOF REVENUE CASH, BANK DEPOSITS 8 MISC. fRESIDENTDECEDENTTURN pERSONAL PROPERTY ESTATE OF: FILE NUMBER: Julia Borzok 21 13 0955 Include the proceeds of litigation and the dffie the proceeds were received by the estate. All propert 'ointl owned with ri ht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Woodmen of the World - Refund 59 2 CVS Caremark - Refund 150 3 Messiah Village Refund 177 4 M&T Money Market Account No. 15U04224864709 110,121 Interest accrued to 8/24/2013 16 5 M&T Checking Account Number 16624750 20,132 6 Sovereign Checking 2,480 Interest accrued to 8/24/2013 0 7 Sovereign Certificate of Deposit 5,145 Interest accrued to 8/24/2013 3 8 Peerless Insurance Company - Refund 195 TOTAL(Also enter on line 5,Recapitulation) $ 138,478 2wasAD 2.o0o If more space is needed,use adddional sheets of paper of the same size. REV-1510EX+(08-09) SCHEDULE G pennsylvania DEPARTMEMOFREVENUE INTER-MIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC.N�JN-PROBATE PROPERTY RESIDENT DECEDEM ESTATE OF FILE NUMBER Julia Borzok 21 13 0955 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIP110N OF PROPERTY ITEM INCLLDEThE W+7r1EOFThETFLWSFEREE,TFEIR RELATIONSHIP TO DECEDEM APD DATE OF DEATH %OF DECD�S �CLUSION TAXABLE NUMBE 1}fDN7EOFTRMSFER.ATfPLHACAPYOFTI-EDEEDFORREALESTATE. VALUEOFASSET INTEREST IFPPPUCABLE VALUE �• Ameriprise Financial Annuity Account 0108 9,580 100.0000 0 9,580 (transferred at DOD to decedant's children Gregory Borzok and Jean Walters Riss in equal shares) 2 Ameriprise Financial Annuity Account 0678 13,327 100.0000 0 13,327 (transferred at DOD to decedant's children Gregory Borzok and Jean Walters Riss in equal shares) TOTAL(Also enter on line 7,Recapitulation)$ 22 90� If more space is needed,use additional sheets of paper oi the same size. 9W46AF 2.000 Rev-ts��ex.c�aos> SCHEDULE H pennsylvania DEPPRTMENTOF REVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENTDECEDENT ESTATE OF FILE NUMBER Julia Borzok 21 13 0955 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: �. Myers—Harner E`uneral Home 12,065 Total from continuation schedules . . . . . . . . . 3,149 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attomey Fees: 10,000 3. Family Exemption:(If decedent's address is not the same as claimanPs,attach e�lanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 404 5. Accountant Fees: 6. TaxReturn Preparer Fees: 900 7. 1 PPL 223 2 Cumberland Law Journal 75 Total from continuation schedules . . . . . . . . . 2,950 TOTAL(Also enter on Line 9,Recapitulation) $ 29 766 swasn�2.00o If more space is needed, use additional sheets of paper of the same size. Estate of: Julia Borzok 21 13 0955 Schedule H Part 1 (Page 2) Item No. Description Amount 2 American Legion Post 109 - Funeral Luncheon 1,454 3 Sandy Schwalm Provide food and lodging for out-of-town family members attending funeral 200 4 Rolling Green Cemetery 1,495 Total (Carry forward to main schedule) 3,149 Estate of: Julia Borzok 21 13 0955 Schedule H Part 7 (Page 2) 3 Sentinel - Estate Advertisement 233 4 Borough of Camp Hill - Sewer Dept 165 5 Pennsylvania American Water 85 6 Peerless Insurance Company Homeowner's insurance 360 7 UGI 334 8 Clauser Real Estate Appraisals 375 9 Jim Riss Remove shed from property 100 10 Skarlatos Zonarich LLC - costs Accrued and anticipated disbursements for copies, postage, travel, filing fees, etc. 85 11 Santander Bank Date of death value on Sovereign bank accounts. 2� 12 Costs relating to sale of real estate located at 151 N. 21st Street 1,028 13 Gegory Borzok - Reimburse for Bagster Co. to clean house 165 Total (Carry forward to main schedule) 2,950 REV-1512EX+��Z-�Z) SCHEDULE I pennsylvania DEPARTMENTOF REVENUE DEBTS OF DECEDENT, INHERITANCETAXRETURN MORTGAGE LIABILITIES 8� LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Julia Borzok 21 13 0955 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 �• Janet L. Miller, Tax Collector 2013 School real estate taxes (check cleared after date of death) 1,905 2 PPL 59 3 Chad Gallagher (Lawn Care) 125 4 Penn Waste 54 5 Pennsylvania American Water 15 6 Quantum Imaging 6 7 UGI 101 8 Alert Pharmacy Services 109 9 Messiah Lifeways 14,402 10 Riversource Life Insurance Company - Return of Benefit 154 11 Janet L. Miller, Tax Collector 2013 Per Capita tax (check cleared after date of death) 15 TOTAL(Also enter on Line 10,Recapitulation) $ 16 945 2W46AH 2.000 If more space is needed,insert additional sheets of the same size. REV-1513EX+(01-10) SCHEDULE J pennsylvania DEPARTMENT OF REVENUE BEN EFI CIARI ES INHERITANCE TAX RETURN RESIDEM DECEDENT ESTATE OF: FILE NUMBER: Julia Borzok 21 13 0955 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[InGude outright spousal distributions and transfers under Sec.9116(a)(1.2).] �. Gregory Borzok 5530 Merivale Court Harrisburg, PA 17112 Ameriprise Financial Annuity Account 0108 Inventory Value: 4,790 Ameriprise Financial Annuity Account 0678 Inventory Value: 6,663 One Half of Residue: 85,288 Son 96��42 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. �� NOf�TAXABLE DISTRIBUTIONS A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLEANDGOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 0 If more space is needed,use additional sheets of paper of the same size. 9 W46AI 2.000 Estate of: Julia Borzok 21 13 0955 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 2 Jean Walters (Riss) 2081 Dartmouth Street Camp Hill, PA 17011 Ameriprise Financial Annuity Account 0108 Inventory Value: 4,790 Ameriprise Financial Annuity Account 0678 Inventory Value: 6,663 One Half of Residue: 85,288 Daughter 96,742 3 Monson A. Borzok 708 4th Street Oakmont, PA 15139 General Bequests: 0 Specific Bequest 1,500 Grandson 1,500 4 Sharon C. Mayberry 30318 Via Brisa Temecula, CA 92592 Specific Bequest 1,500 Granddaughter 1,500 5 Susan J. Chelap 106 N 25th Street Camp Hill, PA 17011 Specific Bequest 1,500 Granddaughter 1,500 6 Sandra C. Schwalm 308 W Maplewood Avenue Mechanicsburg, PA 17055 Specific Bequest 1,500 Granddaughter 1,500 ,r ��.,��. __ � . �.�-.�.�. �,;:. � � �- � ��° � �,�t � � �.. �. �� ,,...�.. ,. �'` �� ,. �,:.�. ., _ . CERTIFICATE OF CUMBERLAND COUNTY GRANT OF LETTERS PENNSYLVANIA � .. No. 20�3- 00955 PA No. 2�- 13- 0955 Es ta te Of: JULIA BORZOK (Fi�st,Middle,LasU a/k/a: JULIE BORZOK La te Of: CAMP HILL BOROUGH CUMBERLAND COUNTY Deceased Soci al Securi ty No: WHEREAS, on the 6th day of September 2013 an instrument dated May 19th 1988 was admitted to probate as the last will of JULIA BORZOK (First,Middle,LastJ a/k/a JULIE BORZOK late of CAMP H/LL BOROUGH, CUMBERLAND County, who died on the 24th day of August 2013 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Regi s ter of Wi 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: GREGORY BORZOK who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, alI of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 6th day of September 2013. � .� .f ��J�� F �-� ,�(..o'z.r�• �` " RegisY � Wills ; � � � � Deputy s C **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) • � �— s�,�� - H � . ---.�.,-.�,,-n..��.�._�, .�.��.��,�.. .. �._ � �.��sr.�.'��, �� . � ,. ..��-� 5..�.� .� _. ,_ .bN:. �. ..�, �- ---� � � . , y�.�� _ _ ��,�.��,� _. _. _ _ _ _ _ _ �� . <`F '��;�d �, � . b' �. , : k �s�,� -�.,x„.�.�.� � `"�g��=xi'��'b 1"a:�^ 5C3��'� g f. � � — F � �'�fi�£t' '� _ '� ��... � � r `� �. �w�:,, �'��"„�L��' -� � �' - � x'-'�"'�� . .* _ ..� �'��ZErs - � � - � fi � -�� - ' .�_ ��.., �.,z�'.. _ _�_ �. . ;� ' ::i ��. � �t11 �xn� C� ��tmaext� � of J[IGIA H(lltZ(HC I, J[TI,IA BORZOK, of Camp Hill, CLUnberland County, Pennsylvania do make, publish and declare this to be my Last Will and Testa�ment, hereby revoking all fornter W�lls made by me• , " AR'iTTC[� I: I direct that all my legal debts and funeral expenses and the cost of ' admin.istration of my estate be paid as soon as practical after my death. I direct that my Executor pay out of my estate, as a general charge thereon, al1 inheritance, estate, succession and other taxes together with any interest or penalty thereon assessed by reason of my death with regard to all properties � and assets subject to such t�es, whether such property and assets pass under this Will. ARLr.CCLE II. I ]�queath my motor vehicles, household and personal effects and other � , tangible property of like nature, together with any exi.sting insurance thereon, to my husband, AN'I'fIONY BORZOK, provided he survives me by thirty (30) days. �� 4 Shcyuld my hr:s�and, AN'rHONY, ,E30RZOK, fail to be living on the thirty-first �_� � ��(�3�st) day tollowing riiy death, then I give to my 'son, GREGORY BOFtZOK all my vehicles, �ools, and equi�ar�ent. AftPICLE III. I give $1,500 to each grandchild that survives me. Att'�IGGE N. I give, devise and beqizeath al1 the rest, residue and reanainder of my estate to my husband, ANI'HONY BORZOK, provided he sur.vives me by thirty (30) days. � � �: ��.�.��-�� N �� —v a _., __ __ --- �.,,��,�� ,,.�.�� _ , . � , � ,� ,,�,� .�_�..�� . :.,, .. _ .; ,,1_.. .�rscr� v. 5hould my husbanci, ANTHONY B�RZOK, not be liv.ing on the thirty-first (31st) day follawing my death, then I give, devise and bequeath all the rest, residue and r�nainder of my estate to my son, GREGORY BORZOK and to my daughter, JEAN ! Tn4�I,TER5. AI�.LCGE Vl. I appoint my husband, ANTHONY BORZOK, Executor of this my Last Will and 7�estament. Should my husband, ANi2i0NY BORZOK, fail to qualify or cease to act as Executor, I then appoint my son, GREGORY BORZOK, Executor of this my Last Will and Testament. IN WITNESS WHEREOE', I hereunto set my hand and seal this / 9 day of ' `,��y. ' 1988. . 0 � (s�) �vr,� BoRZOx Signed, seal.ed published and declared k7y the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her :presence and in the presence of each other have hereunto subscribed our E` �names as witnesses. r; ,_.� , _�„_, _ , ,�— _.,:. . _ - -- - ,� �, _ _ ;�e-� :.�.�.M .�.:.-r .�.:�� : �;:.��a �.: , _ 4 ��...< , ��:=�� :: �_ ,. _ _ . - —_ _ _ - ��- � CONlMONWEALTH OF PENNSYLVANIA : : ss: . COUNTY OF CUMBERLAND . I, JULIA BORZOK, Testatrix, whose name is signed to the foregoing 7 T1.Rtrimlent, having been duly qualified according to law, do hereby ac3mowledge that I signed and executed the instr�nr�ent as my Last Wi1.1 and Testament; that T signed it willingly; and that I signed it as my free and voluntary act fo� the purposes therein expressed. JULIA BORZOK Sworn or affirmed to and aclrnowledged before me, ,7ULTA BORZOIC, the Testatr�, this � q�Il day of 'vY�w,C-� , 1988. '�J �R 0 �,`�� 'g G�� - .: � �'��.� ' �, ;� �.�..� � NOt�3.'C�r Publl �.,��y ; ��: �z � �� ,� �� -�- . = . � � : r - ��, � `� � �� DIANNE LENIG. Notary !'ub11o':�� `�'�� ,' My Commlssion Expires Dea. 21�� '1989:�_ . �;° . < ._. � � ��__ - 4emoyne. PA 'Cumbertend County i- — — - — - :,� �<�,�.,. �� ,.�-.�,� _ : : . . . ,�.�- ��-. ..�� .: ,�: _ -� - -_ - - a- - - - � � '. _ +k '^,�;r ;� _ - � _ h�•l:1LlKY 11 COMMONWEALTH OF PIIQ[�ISYLVANTA . . ss: COUNTY OF C[7NlBERLAND , � WE �!`�"`�'`° '�' `�w�-'-�' and C�...,:��I,s � �..�i,,..�,� , the witnesses whose names are signed to �he foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatr� sign and execute the foregoing instr�nnent as her Last Will and Testament; that � she signed willing and that she executed it at her free�and voluntary act �or the purposes therein e�ressed; that each of us in the hear.ing and sight of �he Testatr� signed the Will as witnesses; and that to i:he best of our ]mawledge, the Testatrix was that time at least 1$ years of age, of sound mind and under no constraint or undue influence. �J � ; � � � � � � ��vorn. qr affis�med to and subscribed before me '�-�.�.. n,�-M.,...,�.,r.�, andC�.�.,,,�..Q,� . �..�"-�A-- , witnesses, this 1q'�day of �m , 1988. � � p • • . � .'�i 1 . NOtc3L'y �Z1C DIANNE LENIG� i��tary Public My Coamission Expires Deca 21. 198' `�oy�g� pp �Cumberlond C•uoty _�:��. ,�.�.v.�,�-��; :�,:.. . -� -- =----- - - -_ ___-- -- - � � ,=° OMB N0.2502-0265 � A. � � . : B. T`� iF LOAN: U.�S.DEPARTMENT OF HOUSING&URBAN DEVELOPMENT ��C�FHA 2.QFmHA 3.QX COivv.(JNINS. 4.QVA 5.QCONV.INS. 6. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT EM e- - - T 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is fumished fo give you a statement of actual setdement costs. Amounfs paid to and by the settlement agent are.shown. /tems marked"(POC)"were paid outside the closing;they are shown here for in�oo�8na/pE�ONES51nN-2aST.FD/�MO�NE-151 tN 2,sot9ls. D. NAME AND ADDRESS OF BORROWER:, E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Lemoyne Land Corp.,Inc. Estate of Julia B.Borzok Centric Bank 319 South Third Street,P,O.Box 31 by Gregory Borzok 4320 Linglestown Road Lemoyne,PA 17043 Harrisburg,PA 17112 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE: 151 N.21st Street Kerwin&Kervvin,LLP Camp Hill,PA 17011 January 28,2014 Cumberland County,Pennsyivania PLACE OF SETTLEMENT Tax Parcel No.01-21-0271-168 Centric Bank,1625 Market Street Camp Hill,PA 17011 J.SUMMARY OF BORROWER'S TRANSACTION K.SUMMARY OF SELLER'S TRANSACTION 101. Contract Sales Price 78,000.00 401. Contract Sales Price 78,000.00 102. Personai Pro e 402. Personal Pro e 103. Settlement Charges to Borrower Line 1400; 2,513.00 403. 104. i 404. 105. 405. i v � 106. Sewer Bill 01/29/14 to 04/01/14 113.67 406. Sewer Bili 01/29/14 to 04/01/14 113.67 107. County Taxes to 407. County Taxes to 108. School Taxes 01/29/14 to 07/01/14 861.80 408. School Taxes 01/29/14 to 07/01/14 861.80 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 81,488.47 420. GROSS AMOUNT DUE TO SELLER 78,975.47 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500.REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De sit or eamest money 5,000.00 501. Excess Deposit See Instructions 202. Princi al Amount of New Loan(s) 62,400.00 502. Settiement Charges to Seller(Line 1400) 965.00 203. Existing loan s taken subject to 503. Existin loan s taken sub'ect to 204. 504. Payoff of first Mortgage 205. 505. Pa off of second Mort a e 206. 506. 207. 507. Zag 508. 209. 509. us men s or tems n ai e er us men s or ems n a� e er 210. Sewer Biii to 510. Sewer Biil to 211. Coun Taxes 01/01/14 to 01/29/14 63.46 511. Coun Taxes 01/01/14 to 01/29/14 63.46 212. School Taxes to 512. School Taxes to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 2�8 518. 2�9 519. 220. TOTAL PA/D BY/FOR BORROWER 67,463.46 520. TOTAL REDUCTION AMOUNT DUE SELLER 1,028.46 300. CASH AT SE7TLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 301. Gross Amount Due From Borrower(Line 120 81,488.47 601. Gross Amount Due To Seller Line 420) 78,975.47 302. Less Amount Paid By/For BoROwer(Line 220) ( 67,463.46) 602. Less Reductions Due Seller(Line 520) ( 1,028.46 303. CASH(X FROM)( TO)BORROWER 14,025.01 603. CASH(X TO)( FROM)SELLER 77,947.01 The undersigned hereby acknowledge receipt of a completed copy.of pages 1&2 of this statement&any attachments referred to herein. Borrower Lemoyne Land Corp.,Inc. Selier - Estat of Julia B.Borc BY• � _ � ' Michael L.Coons,President ' G� fzo > HUD-1(3-86)RESPA,HB43052 ' � � L.JC 1 1 LCItIGI\1 V f7MRV CJ i ^ a i �� PAID FROM pAID FROM 700.TOTAI:,COMMISSION Based on Price � C� �o Division of Commission pine 700)as Follc. soRROweR�s SELLER�s 70 j,$ t0 FUN0.SAT FUNDSAT 702.$ t0 SETTLEMENT SETTLEMENT 703.Commission Paid at Settlement 704. to 800.ITEMS PAYABLE IN CONNECTION WITH LOAN 801.Loan Origination Fee 0.00 % to 802.Loan Discount % to 803. Real Estate Evaluation Fee to Centric Bank 150.00 804. Documentation Prep.Fee to Centric Bank 250.00 805.Wire Fee to Centric Bank 25.00 806. Flood Search to Centric Bank 19.00 807. Assumption Fee to aoe. sos. s�o. 811. 00.ITE S RE UIRED BY LEND R TO E PAID IN ADVANCE 901.Interest From 00i00/00 to @ $ /day ( days %) 902. Mort age Insurance Premium for months to 903.Hazard Insurance Premium for 1.0 ears to 904. 905. 1000.RE ERVES DEPOSITED WITH LENDER 1001.Hazard Insurance months $ per month 1002.Mo a e Insurance months $ er month 1003. Sewer Bill months $ er month 1004. Coun Taxes months $ er month 1005. School Taxes months @ $ per month 1006. months $ er month 1007. months @ $ per month 1008. months $ er month 1100.TITLE CHARGES 1101. Settlement or Closing Fee to 1102.Abstract or Title Search to 1103. Deed Pre aration to Skarlatos&Zonarich POC:S0.00 1104.Title Insurance Binder to 1105. Document Pre aration to 1106. Nota Fees to Kerwin 8 Kenxin,LLP 20.00 10.00 1107.Attomey's Fees to (includes above item numbers: ) 1108.Title Insurance to Stewart Title Guaran Com an 779.00 includes above item numbers: 1109.Lender's Coverage $ 62,400.00 696.50 1110.Owner's Coverage $ 78,000.00 82.50 1111. Endorsements 100,300,710,900 to Stewart Title Guaranty Company 200.00 1112. Closing Protection Letter to Stewart Title Guaranty Company 75.00 1113. Incoming Wire Fee to Mid Penn Bank 10.00 1200.G VERNMENT RECORDING AND TRANSFER CHAR ES 1201.Recording Fees: Deed $ 68.00;Mortgage $ 95.00; Releases $ 163.00 1202.Ci /Coun Tax/Stamps:Deed 780.00•Mort age 780.00 1203.State TawStam s: Deed 780.00;Mortgage 780.00 1204. 1205.Assignment of Rents to Recorder of Deeds 42.00 1300.ADDITIONAL SE LEM NT CH RGES 1301. Surve to 1302. Pest Ins ection to 1303. 1304.Tax Certification to Janet L.Miller,Tax Collector 10.00 1305. Sewer Bill to Camp Hill Borough 165.00 1400.TOTAL SETTLEMENT CHARGES (Enter on Lines 103,Section J and 502,Section K) 2,513.00 965.00 By signing page 1 of this statement,the signatories acknowiedge receipt of a completed copy of page 2 of this two page statement. � �-^� Certified to be a true copy. erwin&Kerwi P Settiement Ag (LEMOYNE-157-N-21ST/LEMOYNE-151-N-21ST I 9) �v�,�� :��.�. � .��.> ..�..-� ��-� � � MBTE�u1k 499 Mitchell Road,Millsboro,DE 19966 Adjustment Services Phone 888-502-4349 F ax (302)934-2955 November 25,2013 Skarlatos Zonarich LLC 17 South Second Street, 6th Floor Harrisburg,PA 17101-2039 Re: Estate of Julia Borzok Social Security: 206-12-5293 L'ate of Leath:August 24,2013 Dear Sir or Madam: Per your inquiry on November 13,2013,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: 1. Type ofAccount CheckingAccount Accaunt Number 16624750 Ownership(Names o� Gregory Borzok(POA) Julie Borzok Jean A. Walter(POA) Opening Date 08/28/1964 Balance on Date of Death $ 20,131.74 Accrued Interest $ .02 _...__....---..._....----------._.....----------...-----------------.._..-- Total $20,131.76 2. Type ofAccount Savings Account AccountNumber 15004224864709 Ownership(Names o� Gregory Borzok(POA) � Julie Borzok Jean A. Walters(POA) Opening Date 02/04/ZOl l Balance on Date ofDeath $ 110,120.83 Accrued Interest $ 16.44 -------------------------------------------------------------- Total $110,137.27 .w.-�.��. �� ,.. ,��ro _ --��- -� �_ ��_ :��.� .�,_.�>..� , For any additional information on the a�.,.e accounts,including ownership and any changes,c1osL..�and/or reimbursement of funds, please call the West Shore P1a7a at 717-731-1730. We were unable to locate any safe deposit boa for the above-mentioned decedent. T6is letter does not iaclude any accounis in w6ich the deceased may have been list�d as Power of Attomey,Custodian of Uniform Transfers, Representative Payee,or Trustee under a Written Agreement S1riCCfCly, Valarie Mercer Adjustment Services ��-�.,.�.,�.-u, .� _ � � -��,�..; � , Santander Bank ESTATE OF Julia Borzok SOCIAL SECURITY#: 196-28-8986 DATE OF DEATH: August 24,2013 Account#: 0354001372 Type: Checking Open date: 1/1/1971 In the name of: JuTia Borzok(Jean Riss or Gregory Borzok POA added 3/8/2013) Date of Death Balance: $2,48038 Int.(YTD)from 1/1/2013 to 7/27/2013 . $0.74 Accrued interest to date of death: $0.10 Otherinfo: Account#: 1715548341 Type: CD Open date: 2/8/2011 In the name of: Julia Borzok(Jean Riss or Gregory Borzok POA added 3/8/2013) Date of Death Balance: $5,144.97 Int.(YTD) from 1/1/2013 to 8/4/2013 $34.14 Accrued interest to date of death: $3.10 Other Info: Page 1 of 1 -� 4�.�- ..��:� � �w-- , _ : ��..9--�M� __=�, Ameri rise , p � Financia2 Account Summary for the Estate Settlement of Julia Borzok, Client ID 11085164 1)Type of investment: Deferred Annuity-Benef(ciary Product Name:Deferred Annuity-Benoficiary Total Account Value(as of Date of'De+ath):$9,580.09 Account Number:93005330108 004 Account Registration:Julia Borzok Beneficiary Designation: . PRiMARY BENEFICIAFiY . � .' LIVING, LAWFCTLkCHILDREN IN EQUAL SHARES 100.00% : ' , . IF A CH1LD IS DECEASED,HiS OR HER SHARE TO BE PAID TO HIS OR HER LIVING,LAWFUL CHILDREN IN EQUAL SHARES How the account(s)proceeds will be settled: We will distribute proceeds to the beneficiary. Imn�:tant Details about this account: . __ _ . 2)Type of jnvestment:Deferred Annuiry-Successor annuitant possible Product Name: Deferred Annuiry-Successor annuitant possibie _�.. Total Account Value(as of Date of Death):$13,326.94 _. . ._ Account Number:93007010678 004 Account Regis#ration:Julia Borzok Beneficiary Designation: PRIMARY BENEFICIARY LIVING, LAWFUL CHILDREN IN EQUAL SHARES 100.00% IF A CHILD IS DECEASED,NIS OR HER SHARE TO BE PAID TO HIS OR HER LIVING,LAWFUL CHILDREN IN EQUAL SHARES How the account{s)proceeds will be settled: We will distribute proceeds to the beneficiary. Important Details about this account: N/A a, � � � Ameriprise � F�nancial Account Summary for the Estate Settlement,of Juli� Borzok, .Client ID 11085164 1)Type of investment: Payout Annuity� "• • • •�• � � � '. • • . � • . ' •. �' •. �. Product Name: Payout Annuity To#al Account Value(as of Date of Death):The date of death was not provided � Account Number:93004423569 004 Account Registration:Julia Borzok Beneficiary Designation: � How the accoun�t(s)proceeds will be settied: • Important Detaifs about this account: N/A ----- ---- T T 17 South Second Street,6`h Floor Skarlatos �_��.�.��;�� LL� Harrisburg,PA 17101-2039 Sound 1ldvice.Smarter Decisions. 717.233.1000 Voiee 717.233.6740 Fax www.ska rlatoszona rich.com May 21, 2014 Office of Register of Wills 1 Courthouse Square Suite 102 � N Carlisle, PA 17013 � � � ,-�'� � � � � a °' � c c,� � rn � � RE: Estate of Julia Borzok "' � "� N r� � � � r��, � �a�� cY No. 21-13-0955 _;r �? �;;� �., �, ::.7 �"} C.'.? _� �i'g -17 �j C� _r7 � .�- � Dear Sir or Madam: � c� N � � Please find enclosed the following: m -`—'�. "' -n (1) Original and one copy of Inheritance Tax Return. (2) Original and one copy of Inventory. (3) Additional signature pages for time-stamping and returning in the envelope provided. If you have any questions regarding these documents, please don't hesitate to give me a call. Sincerely, ��,� .,� Trina M. Runkle Estate Administrator Enclosures A Member of LawPactTM-An International Association of Independent Law Firms - ______ 062S0006654622 �� p�tW7 N�O��,� o�g�N E�q �o�.u~i�a Tn �� s�,'et � � _ � �i � "_ 0 L � � �- N .� � � � � � � � ,._. � � � O � N U � � = O � T� M � c � ! � � N � V N � � Q � � o c� 0- � � �� N � � O ��T_ = EU �� , U � cnU :� ch , � 0