HomeMy WebLinkAbout06-05-14 (3) � 1505610143
REV-1500 EX`°2_,,,
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individuai Taxes �P�TMENTOFREVENUE
Po aox.2sosoi INHERITANCE TAX RETURN 21 13 0792
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
06 28 2013 09 02 1924
DecedenYs Last Name Suffix Decedent's First Name MI
�'IN CLARENCE E
(If Applicable)Enter Surviving Spouse's information Below
Spouse's Last Name Su�x Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FlLL;N A�PROPRIATE�VALS BC�t7i�V
� 1. Original Retum � 2. Supplemental Return � 3. Remainder Retum(Date of Death
Prior to 12-13-82)
� 4. Limited Estate � qa.Future Interest Compromise � 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
� g. Decedent Died Testate � Decedeot Maintained a living Trust � 8. Total Numbe�of Safe Deposit BOxeS
(Attach Copyof Will) ❑ (Ariach copy of Trust)
� 9. Litigation Proceeds Received � �p. Spousal Povert Credic�(Date of Deacn � 11.Election to tax under Sec.9113(A)
between 12-31�1 and -t-95) (Atf2Ch SChedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
MARIELLE F HAZEN ESQ 717 540 ,�332
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R�IS-�R OF 1K1�S 1�,��?I.�VLY
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First Line of Address =--� ,,� r- °°-� �
x� ��� ��'@ f�'�
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2000 LINGLESTOWN ROAD ��> : `
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Second Line of Address `; C.� � � _T�
SUITE 202 `' `�' � =�= c�
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City or Post Office "'t7 '� DATE ILED��`"'
State ZIP Code O �
HARRISBURG PA 17110
CorrespondenYs e-mail address: mhazen@hazenelderlaw.com
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and Complete.Declaration of preparer other than the personal representative is based on ail information of which preparer has any knowledge.
SIGNATURE OF PERSON ESPONSIBLE FOR ILING RETURN DATE
C �
G�� _ �,, C. Diane Hain ,�j���
ADDRESS
714 Barbara St. New Cumberland PA 17070
SIGNA U OF PREPA R OTH T N REPRESENTATIVE ATE
Linda J. Olsen Esq. (o I� �
AD SS
2000 Linglestown Road, Ste 202, Harrisburg, PA 17110
� Side 1 �
1505610143 1505610143
� 1505610243
REV-1500 EX
DecedenYs Social Security Number
DecedenYsName: Halll� Clarence E.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 15 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&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 30 , 695 . 03
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 24 , 95 9 . 9 9
7. Inter-Vivos Transfers&Miscellaneous fy�n;Probate Property
(Schedule G) �� Separate Billing Requested............ 7,
8. Total Gross Assets(total Lines 1 through 7)........................................................ g. 2OS , 655 . �2
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 4 0 , 0 8 5 . �$
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 68 7 . 8 9
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 4� , 7 72 . 97
12. Net Value of Estate(Line 8 minus Line 11).......................................................... �2, 164 , 882 . 05
�3. 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. 164 , 8 82 . 05
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 �5 0 . 0 0
(a)(1.2)X.00
16. Amount of Line 14 taxable 16 4 , 8 8 2 . 0 5 �s. 7 , 419 . 6 9
at lineal rate X .045
17. Amount of Line 14 taxable 0 . 0 0 17. 0 . 0 0
at sibling rate X.12
18. Amount of Line 14 taxable � . �� 18. � . ��
at collateral rate X.15
19. TAX DUE................................................................................................................ 19. 7 , 419 . 6 9
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-13-0792
Decedent's Complete Address:
DECEDENT'S NAME
Hain, Clarence E.
STREET ADDRESS
120 N. 36th St.
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 7,419.69
2. Credits/Payments
A. Prior Payments 6,800.00
B. Discount 357.89
Total Credits(A +g) (2) 7,157.89
3. Interest (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. �4�
Check box on Page 2,Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 26�.8�
Make Check Pa able 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;or............................................................................................................... ❑ ❑x
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?.................................................................................................................... ❑ ❑x
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?.................................................................................................................. ❑ ❑X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994 and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after January t,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 disciosure of assets and
filing a tax retum are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after Juty 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 decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
__ ..
Rev-1502 EX+�01-10)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hain, Clarence E. 21-13-0792
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on schedule F.
Attach a copy of the settlement sheet if the property has been sold
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real Est. -120 N. 36th St. ,Camp Hill, PA-selling price--see attached HUD-1 150,000.00
TOTAL(Also enter on Line 1, Recapitulation) 150,000.00
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev.01-10)
_. __ __ . . ._
Rev-1508 EX+(��-�0)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hain, Clarence E. 21-13-0792
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Members 1st FCU Checking 213307-11 999.08
2 Members 1st FCU MM 213307-05 18,998.16
3 Members 1st FCU Savings 213307-00 5.00
4 Auto-2001 Buick LeSabre 1,730.00
5 Westminster Cemetery, Inc.(vault&casket) 7,093.00
6 Adjustment on sale of residence-Co./Town taxes HUD-1 Line 406 263.43
7 Adjustment on sale of residence-School taxes HUD-1 Line 407 296.36
8 Adjustment on sale of residence-Sewer/Water HUD-1 Line 409 15.00
9 Refund-Allstate Ins. Premiums(auto 8�house) 386.40
10 Refund-Monumental Life Ins.Overpayment of premium 381.80
11 Refund of Comcast-final cable bill 69.35
12 Refund-Tru Green overpayment 62.78
13 Woods at Cedar Run-resident refund 394.67
TOTAL(Also enter on Line 5, Recapitulation) 30,695.03
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev-7509 EX+�01-10)
pennsylvania SCHEDULE F
DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hain, Clarence E. 21-13-0792
If an asset was made joint within one year of the decedenYs date of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. C. Diane Hain 714 Barbara Street Daughter
New Cumberland, PA 17070
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY a�a�F DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE INTEREST DECEDENT'S INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 09/08/1953 NCFCU Cking Act.76067 jt w/Diane 8,177.22 50.000°/a 4,088.61
2 A 09/08/1953 NCFCU MM Act.76067 jt w/Diane 41,637.93 50.000°/a 20,818.97
3 A 09/08/1953 NCFCU Savings Act.Jt w/Diane 104.81 50.000% 52.41
TOTAL(Also enter on Line 6, Recapitulation) 24,959.99
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule F(Rev.01-10)
REV-1511 EX+(�0-09)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
RESIDENNDECEDENTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Hain, Clarence E. 21-13-0792
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 591.22
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
C. Diane Hain
StreetAddress 714 Barbara St.
city New Cumberland state PA zip 17070
Year(s)Commission Paid 6,500.00
2. Attorney's Fees Hazen Elder Law 7,200.00
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zip
Relationshiq of Claimant to Decedent
4. Probate Fees 358.50
5. AccountanYs Fees
6. Tax Return Preparer's Fees 120.00
7. Other Administrative Costs 25,315.36
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 40,085.08
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hain, Clarence E. 21-13-0792
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Funeral luncheon-John's Diner 243.47
2 Funeral-Patriot News-obituary 347.75
H-A 591.22
Other Administrative Costs
3 Allstate Ins. -homeowners premium 97.71
4 Central Penn Business Journal-Estate Notice 167.00
5 Closing costs on sale of real estate -See attached HUD-1, Lines 502 and 509 15,158.02
6 Cumberland Law Journal-Estate Notice 75.00
7 Duane Smith-lawn care and snow removal at residence while for sale 1,250.00
8 Easy Moves - -fee to move decedenYs belongings from retirement facility 215.87
9 Hampden Twsp-sewer/water maintained while residence is for sale 310.10
10 Hazen Elder Law-disbursements 19.91
11 J C Erlich Co. -pest/lawn maintenance continued while residence is for sale 347.68
12 John's Carpet-carpet cleaning to get residence ready for sale. 212.00
13 Joy Daniels Real Estate listing fee to sell real property. 695.00
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hain, Clarence E. 21-13-0792
ITEM
NUMBER DESCRIPTION AMOUNT
14 N Langan,Tax collector-real estate taxes for 2013 for real property-maintained while 1,124.64
residence for sale
15 PAW-utility maintained while residence for sale 354.74
16 PP8�L Electric-utility maintained while residence is for sale. 449.43
17 Stephen Brink Construction- repairs made for safety issues found in Home inspection for 250.00
sale of residence.
18 Steve Gentile - fee to wash windows,siding, paint where needed in preparation of selling 3,000.00
residence.
19 TheVertis Group-home inspection in preparation for selling residence 300.00
20 Tru Green- Lawn service 347.69
21 UGI-gas utility maintained while residence is for sale 940.57
H-B7 25,315.36
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+�12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hain, Clarence E. 21-13-0792
Report debts incurted by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Comcast-final cable bill 69.35
2 Duane Smith-Yard maintenance for June/before death 75.00
3 Hampden Twsp-sewer/water 155.05
4 J C Erlich Co.-pesUlawn 79.13
5 PAW-utility 40.77
6 Spartan Pharmacy-prescriptions 70.76
7 Tmobile-phone -final bill 70.88
8 Verizon Financial-phone at the Woods 65.15
9 VETS Ins.-Insurance premium 61.80
TOTAL(Also enter on Line 10, Recapitulation) 687.89
(If more space is needed,additionat pages of the same size)
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
_ _
__ . _
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN BEN EFICIARI ES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hain, Clarence E. 21-13-0792
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S)RECEIVING PROPERTY (Words) ($$$)
o is rustee s
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116 a 1.2
1 Shirley J.Ackenbach (Achenbach) Stepchild 16.7 percent of 27,480.34
523 Carol Street the residue
New Cumberland, PA 17070
2 C. Diane Hain Daughter Twenty-five 41,220.51
714 Barbara Street percent of
New Cumberland, PA 17070 residue
3 Galen E. Hain Son Twenty-five 41,220.51
541 Tawnyberry Lane percent of
Collegeville, PA 19426 residue
4 Test.Trust f/b/o Michael Gerald Vaughan Stepchild 16.7 percent of 27,480.34
c/o Shirley Achenbach residue
523 Carol Street
New Cumberland, PA 17070
5 Linda Vaughan Daughter-in-Law 16.6 percent of 27,480.34
3902 Church Street the residue
Camp Hill, PA 17017
Total 164,882.04
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
i�`�'� �� �W Estate P[anning • Elder Law • Specia[Needs Planning
2000 Linglestown Road �r�.,:(71� 540-4332
Suite 202 Fnx: (71�540-4313
Harrisburg, PA 17110 www.HazenElderLaw.com
February 24, 2014
i�IA F�ICSIMILE(7I7) 772-0412 AND FIRST-CLASS MAIL
PA Department of Revenue
Bureau of Individual Taxes
Inheritance Tax Division
ATTN: Laurel Fulmer
PO Box 280601
Harrisburg, PA 17128-0601
Re: Estate of Clarence E. Hain
County: Cumberland
File No. 21-13-0792
SSN:
Date of Death: 6/28/2013
Inheritance Tax Return —Extension of Time to File
Dear Ms. Fulmer:
Our office represents C. Diane Hain in her capacity as Executrix of the Estate of
Clarence E. Hain. We are writing to request an extension of time to file the Pennsylvania
Inheritance Tax return— REV-1500, because the decedent owned residential real property
which had been listed for sale and has now sold. Settlement is scheduled for March 27,
2014. We would like to be able to report the actual sale price of the property and to
properly deduct the expenses incurred to prepare the property for sale, as well as the costs
associated with the sale including transfer taxes and real estate commissions on the
Pennsylvania lnheritance Tax Return. An extension of time to file the tax return would
save the estate time and the additional expense of having to file a supplemental return.
Please let me know at your earliest convenience whether our request for an
extension of time to file the REV-1500 is granted. Should you have any questions or
need any additional information, please do not hesitate to contact me.
Sincerely,
�
G�,�„�..�`"` Q C�S�---
Linda J. Olsei�
C£�
LJO/cew
cc: C. Diane Hain
REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVANIA
_; ,
�.� �� �
e er
No. 2013- 00792 PA No. 21- 13- 0792
Es ta te Of: CLARENCE E HA/N
(First,Midd/e,Lastl
La te Of: HAMPDEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Securi ty No:
WHEREAS, on the 22nd day of July 2013 an instrument dated
August 29th 2005 was admitted to probate as the last will of
CLARENCE E HAIN
(First,Middle,Last1
late of HAMPDEN TOWNSH/P, CUMBERLAND County,
who died on the 28th day of June 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 Commonweal th of Pennsylvania, hereby
certi fy tha t I have thi s day gran ted Let ters TESTAMENTARY to:
C DIANE HAIN
who has duly qualified as EXECUTOR(R/XJ
and has agreed to administer the estate according to law, all of which
fully appears of record in my offi ce a t CUMBERLAND COUNTY COURT HOUSE,
CARL/SLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 22nd day of July 2013.
`t �' �
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1^ /� �
.,�. �� ����
egisier of i//s
F� � �
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e ty
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
c� :`�_-
LAST WILL AND TESTAMENT � �, `-' ;`'; 4�
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CLARENCE E. HAIN - �' • � r:� �
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I, CLARENCE E. HAIN, now domiciled in Cumberland County, Pennsylvania, declaze
this to be my Last Will and Testament. I revoke all other wills and codicils that I may have
previously made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate
shall be paid by my Executor from the principal of my residuary estate as soon as practicable
after my death.
Article II
All inheritance, estate, and succession taxes (including interest and penalties thereon, but
not including any generation skipping tax) payable by reason of my death shall be paid out of
and be charged generally against the principal of my residuary estate without reimbursement
from any person. This provision is not a waiver of any right which my Executor has to claim
reimbursement for any such ta�ces which become payable as the result of any property over
which I have the power of appointment.
Article III
I give, devise and bequeath my tangible personal property in accordance with any
memorandum I have handwritten or signed, located with my will or with my valuable papers and
found within 30 days of the probate of my will. Gifts may only be to persons who survive me or
to organizations which exist at my death, and if there is a conflict, the memorandum having the
latest date shall govern. To the extent no such memorandum is found, or all of my tangible
personal property is not disposed of pursuant thereto, my tangible personal property shall be
added to my residuary estate and pass under Article IV hereof.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath according to the following schedule:
A. ONE-THIRD (1/3) of my estate to be held in trust for the benefit of my wife,
MARY GAYLE HAIN, to be held, managed, and administered according to Articles V and VI
herein. In the event MARY GAYLE HAIN predeceases me or fails to survive me by thirty(30)
days,then her share shall be distributed according to the terms in Paragraph B. hereunder.
B. TWO-THIRDS (2/3) of my estate to be distributed as follows:
1.) FIFTY PERCENT (50%) to be divided IN EQUAL SHARES between
my daughter, C. DIANE HAIN and my son, GALEN E. HAIN, Per Stirpes. In the
event either C. DIANE HAIN or GALEN E. HAIN predeceases me or fails to survive
me by thirty (30) days, leaving no surviving issue, then his or her share shall be
distributed to the survivor of them; and
2.) FIFTY PERCENT (50%) to be divided IN THREE (3) EQUAL
SHARES and distributed as follows:
2
(a.) One share to my stepson, MICHAEL GERALD VAUGHAN, to
be held in trust for the benefit of MICHAEL GERALD VAUGHAN, to be held,
managed, and administered according to Articles VII and VIII herein. In the
event MICHAEL GERALD VAUGHAN predeceases me or fails to survive me
by thirty (30) days, then his share shall be equally divided and distributed to
SHIRLEY J. ACKENBACH and LINDA VAUGHAN according to the terms
of Pazagraphs (b.) and (c.) hereunder;
(b.) One share to my stepdaughter, SHIRLEY J. ACKENBACH, Per
Stirpes; and
(c.) One share to my wife's daughter-in-law, LINDA VAUGHAN. In
the event LINDA VAUGHAN fails to survive my death by thirty (30) days, her
share shall be distributed in equal shares to the issue of my stepson, PHILLIP
VAUGHAN,Per Stirpes.
Article V
In the event that a Trust is created for the benefit of my wife, MARY GAYLE HAIN, by
or as a result of any part of this Will, the terms and conditions of the Trust for the benefit of
MARY GAYLE HAIN shall be as follows:
A. To expend and apply so much of the net income and so much of the principal of
the Trust as the Trustee shall consider advisable for the support, health, and care of MARY
GAYLE HAIN for the remainder of her lifetime.
B. In the event of MARY GAYLE HAIN's death, the trust shall terminate, and the
remaining income and principal of the trust shall be distributed as follows:
3
1.) FIFTY PERCENT (50%) to be divided IN EQUAL SHARES between
my daughter, C. DIANE HAIN and my son, GALEN E. HAIN, Per Stirpes. In the
event either C. DIANE HAIN or GALEN E. HAIN predeceases me or fails to survive
me by thirty (30) days, leaving no surviving issue, then his or her share shall be
distributed to the survivor of them; and
2.) FIFTY PERCENT (50%) to be divided IN THREE (3) EQUAL
SHARES and distributed as follows:
(a.) One share to my stepson, MICHAEL GERALD VAUGHAN, to
be held in trust for the benefit of MICHAEL GERALD VAUGHAN, to be held,
managed, and administered according to Articles VII and VIII herein. In the
event MICHAEL GERALD VAUGHAN predeceases me or fails to survive me
by thirty (30) days, then his share shall be equally divided and distributed to
SHIRLEY J. ACKENBACH and LINDA VAUGHAN according to the terms
of Paragraphs (b.) and (c.)hereunder;
(b.) One share to my stepdaughter, SHIRLEY J. ACKENBACH, Per
Stirpes; and
(c.) One share to my wife's daughter-in-law, LINDA VAUGHAN. In
the event LINDA VAUGHAN fails to survive my death by thirty (30) days, her
share shall be distributed in equal shares to the issue of my stepson, PHILLIP
VAUGHAN,Per Stirpes.
C. No beneficiary or remainderman of this Trust shall have any right to alienate,
encumber, or hypothecate his interest in the principal or income of the Trust in any manner, nor
4
shall any interest be subject to claims of his creditors or liable to attachment, execution, or other
processes of law.
Article VI
In order to carry out the purposes of the Trust established by this Will for the benefit of
MARY GAYLE HAIN, the Trustee, in addition to all other powers granted by this Will or by
law, shall have the following powers over the Trust estate, subject to any limitations specified
elsewhere in this Will:
(a) to retain in the form received and/or to sell either at public or private sale, any real
estate or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any
beneficiary,
(� to file fiduciary/income t� returns and pay the tax due for any year for which
such a return is required,
(g) to make distributions in cash or in kind, or in both, and to determine the value of
` any such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by
my Executor; to pay from my estate reasonable compensation for all their services,
(i) to conduct along with or with others, any business in which I am engaged in or
have an interest in at the time of my death,
5
(j) to receive reasonable compensation in accordance with their standard schedule of
fees in effect while their services are performed, and
(k) to make unlimited gifts from the trust to my stepchildren and/or child(ren),
including the Trustee hereunder, or to a trust for the benefit of my spouse. The amounts and
nature of such gifts shall be in the sole discretion of my Trustee. It is my specific intention that
gifting to protect assets from the costs of long term care shall be permitted.
Article VII
In the event that a Trust is created for the benefit of my stepson, MICHAEL GERALD
VAUGHAN, by or as a result of any part of this Will, the terms and conditions of the Trust for
the benefit of MICHAEL GERALD VAUGHAN shall be as follows:
A. To expend and apply so much of the net income and so much of the principal of
the Trust as the Trustee shall consider advisable for the support, health, and care of MICHAEL
GERALD VAUGHAN for the remainder of his lifetime.
B. In the event of MICHAEL GERALD VAUGHAN's death, the trust shall
terminate, and the remaining income and principal of the trust shall be distributed outright to my
stepdaughter, SHIRLEY J. ACKENBACH,Per Stirpes.
C. No beneficiary or remainderman of this Trust shall have any right to alienate,
encumber, or hypothecate his interest in the principal or income of the Trust in any manner, nor
shall any interest be subject to claims of his creditors or liable to attachment, execution, or other
processes of law.
Article VIII
In order to carry out the purposes of the Trust established by this Will for the benefit of
MICHAEL GERALD VAUGHAN, the Trustee, in addition to all other powers granted by this
6
Will or by law, shall have the following powers over the Trust estate, subject to any limitations
specified elsewhere in this Will:
(a) to retain in the form received andlor to sell either at public or private sale, any real
estate or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any
beneficiary,
(fl to file fiduciary/income tax returns and pay the tax due for any year for which
such a return is required,
(g) to make distributions in cash or in kind, or in both, and to determine the value of
any such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by
my Executor; to pay from my estate reasonable compensation for all their services,
(i) to conduct along with or with others, any business in which I am engaged in or
have an interest in at the time of my death, and
(j) to receive reasonable compensation in accordance with their standard schedule of
fees in effect while their services are performed.
Article IX
A. I hereby appoint my daughter, C. DIANE HAIN as Trustee of any Trust(s)
created in this Will for the benefit of my wife, MARY GAYLE HAIN. In the event C. DIANE
7
HAIN is unable or unwilling to act as Trustee, I hereby appoint my stepdaughter, SHIRLEY J.
ACKENBACH, as successor Trustee of any Trust(s) created in this Will for the benefit of my
wife, MARY GAYLE HAIN.
B. I hereby appoint my stepdaughter, SHIRLEY J. ACKENBACH as Trustee of
any Trust(s) created in this Will for the benefit of my stepson, MICHAEL GERALD
VAUGHAN.
Article X
I nominate, constitute and appoint my daughter, C. DIANE HAIN, as Executrix of my
Last Will and Testament. In the event of the renunciation, death, or inability to act, for any
reason whatsoever of my Executrix, I nominate, constitute and appoint my son, GALEN E.
HAIN, as successor Executor of my Last Will and Testament. I direct that my Executrix or
successor Executor be permitted to serve without bond. In addition to those powers granted by
law, I grant them power to distribute in cash or in kind, in like or in unlike shares, and to file any
qualified disclaimer I could have filed if living. My Executrix or successor Executor shall
receive reasonable compensation for services rendered to my estate.
Article XI
In addition to the powers conferred by law, I authorize my Executrix and successor
Executor, in his/her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real
estate or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
8
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any
beneficiary,
(� to file any federal income tax return for any year for which I have not filed such
return prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of
any such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by
my Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have
an interest in at time of my death, and
(j) to receive reasonable compensation in accordance with their standard schedule of
fees in effect while their services are performed.
IN WITNESS WHEREOF, I, CLARENCE E. HAIN,hereby set my hand to this my
Last Will and Testament, on ,G° , 2005, at Harrisburg, Pennsylvania.
�j �--G �.�,�
CLARENCE E. HAIN
In our presence, the above-named CLARENCE E. HAIN signed this and declared this
to be his Last Will and Testament and now at his request, in his presence, and in the presence of
each other, we sign as witnesses.
N e � Address
F �� , ` 2000 Linglestown Rd., Suite 202, Harrisburg, PA 17110
� ��,�' ' `kt�... 2000 Lin�lestown Rd., Suite 202, Harrisbur�, PA 17110
9
I, CLARENCE E. HAIN, Testator, who signed the foregoing instrument, having been
duly qualified according to law, acknowledge that I signed and executed this instrument as my
Will, and that I signed it willingly as my free and voluntary act for the purposes therein
expressed.
Sworn to or affirmed and
Acknowledged before me by
CLA �NCE E. HAIN,the Testator
on c .� , 2005.
9
� �
Notary Pu ` c _ CLARENCE E. HAI
CUM1�ii:;NVJLd�t��'H OE PENNSYLVANIA
No[arial Seal
. Marielle F. Hazen, Notary Public
Susquehanna Twp., Dauphin County
My Commission Exp�res Sept. 23, 2006
We,the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testator sign and execute this
instrument as his Will; that he signed and executed it willingly as his free and voluntary act for
the purposes therein expressed; that each of us in his sight and hearing signed the Will as
witnesses, and that to the best of our knowledge, that he was at that time eighteen (18) years or
more of age, of sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
Subscribed to before me '
bY i 1_ �v1� ���. �, ,
and � -t1�2�,uE (Y�. :�:.—r��.� itness
witnesses, on� o?�'' , 2005.
�� ' -
���,�u-a,� ��1 , �.���
Witness
r ,,, r`;
c.�`
Notary Public 'I �
�
�p�q�R{�t,;W�;Ni:1'ti UF NENNSYLVANIA
Notarial Seal
Marieile F. Huen. Not h Coi��
Susquehanna Twp•..D�P
Mj y Commissipon Expires Sept. 23, 2006
�.�.��_�.., -m—�-°-_—.°-�"`
�ptMENi�,o
OMB Approval No.2502-0265
' �k I�II���= A• Settlement Statement HUD-11
9oRN oNQ�O � /
B. Type of Loan
6. Fle Number. 7. Loan Number. 8. Mortgage Insiranoe Case Number.
1.❑FHA 2.Q RHS 3.QX Conv.Unins. 140013 7700417593
4.Q UA 5.Q Conv.Ins.
C. Note: This fortn k fumished to g'�s you a s[atement of aCual settkment msts Amountspaid to and bythe�ttkmerd agent a�e slrow�,
Ifems marked"(p.o.a)"were paid outside fhe qosing;fhey ere SypN,n here fpr"vrformafbnal puiposes and are nof'riduded in the tofa/s.
0
D. Name and Address of Borrower. E. Name arcl Address of Seper.
F. Name and Address of Lender.
Trewr L.Robhson
2805 Warren Wa Mor�qage Netvwrk,Inc,
y C.Diane Hain,Exeatrbc DB.AMNET Mor�qage Corp.
Medianksburg,PA 17050 of the Estate of qarenoe E Han ISAIA/ATIMA
120 North 3Fth Street 300 Rosevwpd prive
Camp Hill,PA ��0�� Darners,Mq 01923
G. Property Loration: H. SettlementAgent: 20-2339545
120 North 3f,th Street AbstractAmerip Real Estate SettlemeM Soiutions �• ��ent Date:
Camp lill,PA 17011 65 Ken-Mar Drive
Cumberland CountK Pennsylvania Shertnansdale,PA 17090 Mardi 28,2074
Ph. (717)514-4114
Place of Settlement:
Joy Daniels Real Estate(3oup
3800 Madcet Street,Camp FGp,PA 17011
J. Summary of Borrowers transaction K Summary of Sellers transaction
100. QossAmount Due from Borrower: 400. QossAmount Due to Se9er:
101. Contract sales rice 150,000.00 401. Contrad sales rice 150,OOO.a
102. P�rsonal ro e 402. Personal ro e
103. Settlement Cha es to Borrower Line 1400 5,887.92 403.
104.
404.
105. 405.
Ad'ustments for items aid b Seller in advance Ad ustments for items aid b Seller in advance
106. Co/Town Taxes 03/28/14 to 12/31/14 263.43 406.Co/Town Taxes 03/28/14 to 12/31N4 263.4<
107. Sdiooi Taxes 03/28/14 to 06/30/14 296.36 407.Sdwol Ta�aes 03/28/14 to O6/30/14 296.3f
108.Assessments to 408.Assessments to
109. Sewer/Water 03/28/14 to 03/31/14 15.00 409.Sewer/Water 03/28/14 to 03/31A4 15.0(
110.
410.
111. 411.
112. 412.
120.Gross Amount Due from Borrower 156,462.71 420.Gross Amount Due to Seller 150,574.7�
200. Amounts Paid b or in BehaH of Borrower 500. Reductfons in Amount Due Seller.
201. De osit or eamest mone 1,000.00 501. E�roess d st see hstrudions
202. Rind al amount of newban s 145,500.00 502. Settlement cha es to Seqer Line 1400 10,658.0:
203. 6d ' ban s taken sib'd to 503. E�dstin ban s talaen sub'd to
204. Cumberland Coun Qant 3,000.00 504.Payoff Fxst Mortgage
205. 505.Pa ff Seoond Mo a e
206. 506.
207� 507. De st d'sb.as roceeds
208. 508.
209. Seler Paid Cbsin Costs 4,500.00 509.SeYer Paid Cbsin Costs 4,SOOA(
Ad ustments for items un aid b Seller Ad ustments for items un aid b Seller
210.Coffown Taxes to 510.ColTown Tams to
211. School Taxes to 511. School Tazes to
212.Assessments to 512.Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218• 518.
219. 519.
220. Total Paid b /for Borrower �54,000.00 520. Total Reductlon Amount Due Seller 15,158.0:
300. Cash at Settlement fromfto Borrower 600. Cash at settlement to/from Seller
301. (}oss amount due fAm Borrower line 120 156,462.71 601. Qoa amount due to 3:Ner Gne 420 150,574.7!
302. Le$amount pad byffor Borrower(line 220 ( 154,000.0� 602. Less redud'ans due SeBer line 520 ( 15,158.0�
303. Cash X❑From � To Borrower 2,462.71 603. Cash a To � From Seller 135,416.7i
The undersigned he�eby adv�owV dge receipt of a mm leted oopy of thts statement S�any attad�ments referred to herein
Borrower ���� Seler ' _'
rewr L. � inson C.DTiane lia' ,n 6ce Vix of Uie Estat��
of qarence E.Hain
The Pudic ReporUrg Butlen fur Ws cdlectlm at IMormaCm is es6maletl at 35 min�per resppuelur cdlectinp,revie.Jnp,ard repvpng IhsOMS.rns aga�cy may M cdlect Ihis InWrmafian,and yau ere nol repuire0 to canpete
ma rum,u+ess�t 6apeys a wrauy vg�a oM1S c«va n,noer.No canaerineNry b mwea ws asaosire�s matletay.rhia�s deaiqed Eoprwiaz me pau�ro e Resm cwaea aaeewmvAm�rrammm auirg me
seltlemeM pocess.
Page 1 of 3 HUD-1
(14-0013.PFD/14-0013/27)
L Settlement Charges
700.�otal Real Fstate Broker Fees $8,730.00 �dF,a,,, �dk�
� Dirision of commission(dne 700)as/o�ows: �� �iag
701. 4 365.00 to Jo Daniels Real Estate Grou Fv�.� Fu�a�
702. 4 365.00 to JPJLex Real Estate Servioes LLC
703.Commission aid at settlement �tl°"B1� �"'"�
704.Broker Fee to .b Daniels Real Estate trou 8 730.01
705. �C:$695.00-
800.16ems Pa able in Connection with Loan
801.Our or' inafan char e a 550.00 from GFE#1
802.16ur Qedit or charge(ponts)for the spedfic interest rete diosen $ (from CfE#2)
803.Your adjusted origination charges trom C�E#A
804. raisal fee to Affirmative Certi('�ed ra��s 550.00
805.Qed�Re rt to Birdiwood Credk Serv�oes,��, from CfE#3 425.00
806.Tax service to from CfE#3 60.00
807.Fbod certfiicatan to LPS Natanal Fbod (from GFE#3)
808. FNMA LQI Update to Bhchwood Credd Servioes,�nc. �frO��E#3� �p•�
809. (from GFE#3) 25.00
810. (from GFE#3)
8�� (from GFE#3)
(from GFE#3
900.Items Re uired b Lender to Be Paid in Advance
901.�ady(nterest diarges from 03/28H4 to 04/OU14 4@ $20.430000'day (from GFE#10) 81,72
902.Mo�t e hsurance remium for monthsto from GFE#3
903.Homeowner's insurance for 1.0 ars to State Farm Fire and Casua Co. from GFE#11 580.00
�4' from C�E#11
905. (from GFE#11)
1000.Reserves De osited wkh Lender
1001.Intial depost for your esaow a000unt (from GFE#9) 803.65
. omeownersnsurance mon s per mon
1003.Mort a insurance months $ r month y
1004.Property tazes $
Counry Taxes months @ g per month
C lTown Taxes months $ r month
1005. $
1006.2015 Co/Twp,Tax 2.000 months (a� $ 28,01 per monfh $ 56.02
1007.20142015 School Tax 10.000 months � $ 95.63 per month $ 956.30
1008. $
1009.Aggregate/4djustment
$ -353.66
1100.Tkle Cha es
1101. Tdle servioes and lender's tdle insurance (from GFE#4) �4��
1102. Settlement or dosin fee a
1103.Oyvner's tdle insurance to Fidelity Natbnal Tdle Insurance Co. from GFE#5 2p,pp
1104. Lender's tdle insurance to Fidelity Natanal Tdle Insurance Co. $ �,Zgp,pp
1105. Lender's fdle f imit $ 145 500.00
1106.Owner's fitle i limit $ 150,000.00
1107. enPs ortbn of the total trtle insuranoe remum to ABSTRACT AMERICA REAL ESTATE SE $ 1 105.
1108. Undervvrfter's ortion of the totaltitle nsuranoe remium to Fide National Title Insirance Co. $ 195.
1109.Cbsting Protedion Letter to Fideity National Title Insiranoe Co. 75.00
1110. Overnight Defrvery to USPS $ 45.00
1111. Tax CertiFication Fee to Abstrect America Real Estate Settlement Solutbns 15A(
1112.
1113.
1200.Govemment Recording and Transfer Charges
1201.(�vernment reoord� diar es to Cumberfand Coun Reoorder of Deeds from GFE#7 245.50
1202.Deed $ 68.00 Mortgage $ 80.00 Releases $ Other$ 87.5
1203.Tra�sFer taxes to Cumberla�d County Reoorder of Deeds (from C�E#8) �,5pp,pp
1204.(]tylCountytax/stamps Deed$ 1,500.00 Mortgage $
1205.State tax/�am s Deed$ 1,500.00 Mo a e $ 1,500.0t
1206.
1207.
' 1300.Pdditfonal Settlement Cha es
1301. uired services that u mn sho for from GFE#6
1302.2014 CoIT .Tax to Michael La n,Treasurer 338.0;
1303.Termite/Structural Cert. to THI 75.0(
1304.U front Release Fee to Cumberland Co.Redeoeb ment 3p,pp
1305.SewerlWater April-June) to Hampden Township 155.05
1400.Total Settlement Cha es enter on lines 103,Sectfon J and 502,Sectfon ' S 887.92 10 658.0�
.. BysigNnppepaldtlYSSUtanenClheslgr�atorigackm�rAeagareceiqdacompeledcapydpage283dWStlree s
�f
�
e eal tate ttlem�rrt So tions,Settlement Pgent
Page 2 of 3 HUD-1
(14-0013.PFD/140013/27)
Comparison of Good Faith Estimate(GFE)and HUD-1 Charges Good Faith Estimate HUD-1
Cha es That Cannot Increase HUD-1 Line Number
' Our originafbn diarge #801 974.00
Your Qed'R or diar e 550.00
g (po�ts)for the�edfic interest rate ttrosen #802
Youradjusted originaUon diarges #803
TransFerta�s 974.00 550.00
#1203 1,500.00 1,500.00
Charges That in Total Cannot Increase Mare than 70% Good Faith Estimate HUD-1
Govemment recording diarges #1201 175.00
Appraisal fce #$� 245.50
Credit report 4�•� 425.00
Fbod oertiFicadpn #805 60.00 60.00
FNMALQI Update #807 21•� 10.00
# 808 25.00 25.00
Title serNoes and lenders Mle h�ranoe #1101 1,568.00 1,400.00
W�mer's tiUe hsurance to Fideity National Title Insuranoe Co. #1103 5.00 20.00
Total 2,339.00 2,185.50
InQease between t�E and HUD-1 Charges $ 153 50 or 6 56'
Charges That Can Change Good Faith Estimate HUD-1
Initial depost for your escrow a000unt #1001
Daiy interest charges ����•� 803.65
#901 $ 20.43000Q�daY 102.15 81.72
Homeo�nner's insuranoe #903 540.00 580.00
Loan Tertns
Your Initial loan amount is $145,500.00
Your loan term is 30 years
Your initial interest►ate is g 12�%
Your iniHal monthly amount owed for principal,irderest and $792.23 hdudes
any mortgage insurence is Q Prinapal
� Interest
� Mor�qage I�surance
Can your interest rate rise? �X No � Yes,�pn rise to a ma�unum of °k. The first
change v�i�be on and an diange agah eeery_monthsafter
. Every dia�ge date,your interest rete�n nQease or deQease
by %. O✓er the ffe of the ban,your nterest rate's guaranteed
to neeer be bwer than %or higher than /,
Even if you make payments on time,can your loan balance rise? �X No � Yes,t pn r'�se to a ma�dmum of$
Even if you make payments on time,can your monthly �X No � Yes,the first haease pn be on and the monthy
amount owed for principal,irrterest,and mortgage insurance rise7 amount oHed pn rise to$
The mabmum it can e�,er rise to's$
Does your loan have a prepayment penaltyl QX No � Yes,your maximum prepayment penalty is$
Does your loan have a balloon payment7 QX No � Yes,you have a balbon payment of a
due h_years on
Total monthly amount owed including escrow account payments ❑ You do rot ha�e a monthy esaow payment for items,such as property
taxes and homeowner's hsuranoe. You must pay these Rems diedly
ynurselF.
�X You ha�e an addtanal monthy esaow payment of$171.97 thatresults
in a total hRial monthFj amount oHed of$964.20. This hdudes
prindpal,hterest,any mortgage nsuranoe and anykems diedced bebw
� Property taxes QX Homeowner's hsurance
� Fbod insurance �X Co/Twp.Real Estate Tax
❑ QX School Real Estate Tax
Note: If�ou have any questbns about the Settlement Charges and Loan Terms isted on th's fortn,please mntad your lender.
Page 3 of 3 HUD-1
(14-0013.PFD/14-0013/27)
- HUD-1 Attachment
Borrower(s):Trevor L.Robinson Selle�s): C.Diane Hain, Executrix of the Estate of
Clarence E.Hain
2805 Warren Way
Mechanicsburg,PA 17050
Lender:Mortgage Network,Inc.,D/B.A MNET Mortgage Corp.ISAIAlATIMA
Settlement Agent:Abstract America Real Estate Settlement Solutions
(717)514-4114
Place of Settlement:Joy Daniels Real Estate Group
3800 Market Street,Camp Hill,PA 17071
Settlement Date:March 28,2014
Property Locatio�:120 North 36th Street
Camp Hill,PA 17011
Cumberland County,Pennsylvania
Additional Adjustments For Items Paid By Seller In Advance(Borrower Debit)
Description Amount From/ThrouAh Prorated Amount
Sewer/Water 155.05 03/28/14 through03/30/14 15.00
Total Line 109/409 15.00
Adjusted Origination Charge Details
Origination Charge
550.00
to Mortgage Network,Inc.,D/B/A MNET Mortgage Corp.
Total $ 550.00
Origination Credit/Charge(points)for the specific interest rate chosen
Total $
Adjusted Origination Charges $ 550.00
Reserves Deposited with Lender
Homeowner's Insurance 144.99
3.000 at 48.33 per month
2015 Co/Twp.Tax 56.02
2.000 at 28.01 per month
2014-2015 School Tax 956.30
10.000 at 95.63 per month
Aggregate Adjustment -353.66
month
Total S 803.65
Title Services and Lenders Title Insurance Details BORROWER SELLER
Lender's title insurance 1,280.00
to Fidelity National Title Insurance Co.
Closing Protection Letter 75.00
to Fidelity National Title Insurance Co.
Overnight Delivery 45.00
to USPS
Total $ 1,400.00 S 0.00
WARNING: It is a cdme to knowingly make false sfateme�ts to the United States on this or arry similar fortn. Penalties upon conviction can
include a fine and(mprisonment. For detafls see:Title 78 U.S.Code Section 1007 and Section 1010.
(14-0013.PFD/14-0013/27)
, � HUD-1 Attachment- Continued
Owner's TiUe Insurance BORROWER SELLER
Owner's Policy Premium 20.00
to Fidelity National Title Insurance Co.
Total $ 20.00 ; 0.00
Lenders Title Insurance
'fees also shown above in Title Services ard Lender's Title Insurance Details BORROWER SELLER
Lender's Policy Premium 1,130.00
to Fideliry National Title Insurance Co.
Lender's Endorsement Charges 150.00
Endorsement Endorsement Charge
ALTA Endorsement Form 100 50.00
ALTA Endorsement Form 300 50.00
ALTA Endorsement Form 8.1 (Environmentai Protection Lien) 50.00
Total $ 1,280.00 $ 0.00
WARNING: It is a cdme to knowingly make false statements to the United States on this or any simllarfortn. Penalties upon convlction can
include a fine and imprisonment. For details see:Title 18 U.S.Code Section 1001 and Section 1010.
(140013.PF Dl14-0013/27)
St
�
MEMBERS 1St
FEDERAL CREDIT UIVION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 213307-00
Date Account Established 01/22/2002
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 None
CHECKING ACCOUNT:
Account Number/Suffix 213307-11
Date Account Established 04/30/2002
Principal Balance at Date of Death $999.08
Accrued Interest to Date of Death $.00
Total Principal and Accrued Interest $999.08
Name of Joint Owner None
INVESTMENT SAVINGS ACCOUNT:
, Account Number/Suffix 213307-05
Date Account Established 01/22/2002
Principal Balance at Date of Death $18,996.05
Accrued Interest to Date of Death $2.11
Total Principal and Accrued Interest $18,998.16
Name of Joint Owner None
M M ERS 1ST FED RAL EDIT UNION
. �� �
� ��
' Danielle A. Kline
Lending Insurance Support Specialist
July 26, 2013
Estate of: CLARENCE HAIN �€��'���
Date of Death: 06/28/2013 �-°`°���"� f
Social Security Number: 207-07-4608 `� �, � P,� t,
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5000 Louise Drive • P.O. Box 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • wwwmemberslst.org
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New Cumberland Federal Credit Union
Your Community Credit Union
P.O. Box 658,New Cumberland,PA 17070-0658
Phone: (717) 774-7706• 1-800-716-2328 •Fax: (717) 774-7996•Web: wwwncfcuonline.org
August 27, 2013
Hazen Elder Law
2000 Linglestown Road
Suite 202
I�Earrisburg, PA 17110
RE: Estate of Clarence E. Hain
SSN:207-07-4608
Dear Tiffany,
Pursuant to your letter dated July 25, 2013, in regards to Estate of Clarence E.
Hain the information is as follows:
Account Number: 76067
Owner(s) on Account: Clarence E. Hain or Charlotte D. Hain
Date acct opened: September 8, 1953
Date of Death Balances: S 1 (Savings) $ 104.81
S3 (Money Market) $41,637.93
S4 (Checking) $ 8,177.22
Dividends as of Date of Death: $134.52
Sincerely,
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Barb J. Wright
Branch Manager
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