HomeMy WebLinkAbout06-05-14 (2) � 15�5610143
REV-1500 Ex�o2_„> �
OFFICIAL USE ONLY
PA Department of Revenue pennsyivania co�nty code Year File Number
Bureau of Individual Taxes �EPARTMENTOFREVENUE
Po Box.2aosol INHERITANCE TAX RETURN 21 13 01208
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
11 07 2013 07 21 1925
DecedenYs Last Name Suffix DecedenYs First Name MI
GARRETT SR ROGER C
(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
FILL IN APPROPRIATE OVALS BELOW
� 1. Original Return � 2. Supplemental Return � 3. Remainder Return(Date of Death
Prior to 72-13-82)
� 4. Limited Estate � 4a. Future Interest Compromise � 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
� g Decedent Died Testate � �� �qn h CoMaiotained a Living Trust � 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) py f Trust)
9. Litigation Proceeds Received 10.Spousal PovertY Credit(Date of Death 11.Election to tax under Sec.9113(A)
❑ between 123151 and T-1-95) (Attach Schedule O) �
�
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOR(d1�►TI,Q�N SHOUL E Dlqtt'� TO:
Name Daytime Tefephe,�e Numb� Cu? £�
DAVID W DELUCE 717 7�i1�;-4s540� �'� C�
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REGISTEf�OFrtl�'14-tsS USE ONLI�:? '
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C.�� C� �.,,� `rl
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First Line of Address <:, r:�� -�-� .,,,i::. ��
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301 MARKET STREET � -°; � � �
Second Line of Address y �
PO BOX 109
DATE FILED
City or Post Office State ZIP Code
LEMOYNE PA 17043
CorrespondenYs e-mail address: dwdCNidsw.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 representafive is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RE URN D E
L �f Jeffre L Garrett b �3�� 4
RE
201 A South oi rive Hummelstown PA 17036
SIG AT RE OF PR ARE OTH R T REPRESENTATIVE AT
� � DAVID W DELUCE (0 3 �
AD RESS
301 Market Street, Lemoyne, PA
� Side 1 �
1505610143 1505610143
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PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF FILE NUMBER
Garrett, Roger C Sr 21-13-01208
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 all
information of which preparer has any knowledge.
Signature#2 ���!, �
Name Cecelia J Kent
Address1 sss,antnony�rive -
Address2
Cliy,State,Zlp Mechanicsburg PA 17050
Date � f
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� 1505610243
REV-1500 EX
Decedent's Social Security Number
Decedenr5r,am8: Garrett, Roger C Sr
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 12 7 , 9 0 0 . 0 0
2. Stocks and Bonds(Schedule B)............................................................................. 2. 1 � 069. 72
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits 8�Miscellaneous Personal Property(Schedule E)............... 5. 99�3 E G. 3 6
6. Jointiy Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 28, 4 60 . 4�
7. Inter-Vivos Transfers&Miscellaneous I�nn;Probate Property
(Schedule G) U Separate Billing Requested............ 7.
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 2 5 G, 7 9 6 . 4 8
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 17 , 95 6. 67
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 14 , 6 6 6. 7 7
11. Total Deductions(total Lines 9 and 10)................................................................ ��_ 32 , 623 . 44
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 224 , 173 . 04
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. 224 , 173 . 04
TAX COMPUTATION-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.00 15. 0 . 0 0
16. Amount of Line 14 taxable
atlinealrateX .045 224 , 173 . 04 �s. 10 , 087 . 79
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. 10 � �87 . 79
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
L 1505610243 1505610243 J
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REV-1500 EX Page 3 File Number 21-13-01208
Decedent's Complete Address:
DECEDENT'S NAME
Garrett, Roger C Sr
STREET ADDRESS
8 Forge Road
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 10,087.79
2. Credits/Payments
A. Prior Payments 8,000.00
B. Discount 421.05
Total Credits(A +B) (2) 8,421.05
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) �,666.']4
Make Check Payable to REGISTER OF WILLS, AGENT.
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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,benefds or care?............................................................ ❑ ❑x
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?....... ❑ ❑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.
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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 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 retum 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.§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.
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Rev-1502 EX+(01-10)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN �
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Garrett, Roger C Sr 21-13-01208
All real property owned solely or as a tenant in common must be repoRed at fafr market value.Fair market value is d�ned 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 relevent facts.
Real property that is jointlyowned with right oi survivorship must be disclosed on schedule F.
Attach a copy of the settlement sheet H the property has been sold
Include a copy of the deed showing decedenYs interest'rf owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real Estate located at 8 Forge Road,Camp Hill,Lower Allen Township,Cumberland County, 127,900.00
PA-Contracted Sales Price. Real Estate sold on December 4,2013.A copy of the HUD-1
Settlement Sheet is attached
TOTAL(Also enter on Line 1, Recapitulation) 127,900.00
(if more space is needed,additional pages of the same size) .
Copyright(c)2010 form software only The Lackner Group, Inc. Fortn PA-1500 Schedule A(Rev.01-10)
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Rev-1503 EX+(6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Garrett, Ro er C Sr 21-13-01208
All property jointlyownedwith right of survivorship must bedisclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 13 United States Series EE Savings Bonds-Valued using 1,069.72
Savings Bond Calculator and is attached to this Return
TOTAL(Also enter on Line 2, Recapitulation) 1,069.72
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98)
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Rev-1506 EX+(��-�0)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, � MISC.
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Garrett, Ro er C Sr 21-13-01208
Include the proceeds of litigation and the date the proceeds were received by the estafe.
All property jointly-owned with the right of survivorshfp must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 State Employee Retirement System-Remaining retirement benefit 170.24
2 PNC Bank Individual Checking Account No.5115131142 -Date of Death Letter is Attached 97,794.06
3 Personal property-Most/All decedenYs personal property was sold/disposed of prior to 250.00
death
4 Hartford Insurance-Refund on Account/Policy Cancellation 120.00
5 PPBL-Refund on Account 187.31
6 Reai Estate located at 8 Forge Road,Camp Hill, Lower Allen Township,Cumberland County, 844.75
PA-Reimbursements/Refunds for County&School Taxes and Sewer Payments
TOTAL(Also enter on Line 5, Recapitulation) 99,366.36
(If more space is needed,addiUonal pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
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Rev-1509 DC+(01-10)
pennsylvania SCHEDULE F
DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Garrett, Roger C Sr 21-13-01208
If an aaset was made joint within one yearof the decedenYs date of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Jeffrey L Garrett 2015 A Southpoint Drive Son
Hummelstown, PA 17036
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY o DATE OF DEATH
LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT /o OF
ITEM FOR JOINT MADE DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR ALUE OF ASSE �NTEREST DECEDENT'S INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 07/23/2008 PNC Bank Individual Checking Account No. 56,920.80 50.000% 28,460.40
5140022693-Date of Death Letter is Attached
TOTAL(Also enter on Line 6, Recapitulation) 28,460.40
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Fortn PA-1500 Schedule F(Rev.01-10)
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REV-1511 EX+��O-08) _ �
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
RESIDENNDECEDENTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Garrett, Roger C Sr 21-13-01208
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N MBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 9,510.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
C�ry State Zio
Year(s)Commission Paid �
2. Attorney's Fees Johnson Duffie 7,500.00
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zio
Relationshio of Claimant to Decedent
4. Probate Fees 403.50
5. AccountanYs Fees
6. Tax Return Preparer's Fees
7. OtherAdministrative Costs 543.17
See continuation schedule(s)attached
TOTAL(Also enter on line 9,Recapitulation) 77,956.67
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09)
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SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Garrett, Roger C Sr 21-13-01208
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex enses
1 Jeffrey Garrett-Reimbursement for Funeral Expenses(Rolling Green Payment&Patriot 1,690.00
News)
2 Musselman Funeral Home 7,820.00
H-A 9,510.00
Other Administrative Costs
3 Cumberland County Register of Wills Office-Additional Short Certificates 20.00
4 Expenses for prepare real estate for sale-Drapery Cleaning 150.00
5 Reserves: Additional Miscellaneous Estate Expenses 150.00
6 The Cumberland Law Journal-Notice of Estate Administration 75.00
7 The Patriot News Company-Notice of Estate Administration 148.17
H-B7 543.17
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
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Rev-1512 EX+(7 2-0B)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERffANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Garrett, Ro er C Sr 21-13-01208
Report debts incurred by the deeedent prior to death that remained unpafd at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Country Meadows 104.21
2 PA American Water 33.56
3 Real Estate located at 8 Forge Road,Camp Hill, Lower Allen Township,Cumberland County, 14,529.00
PA-Settlement Charges. A copy of the HUD-1 Settlement Sheet is Attached
TOTAL(Also enter on Line 10, Recapitulation) 14,666.77
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
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REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Garrett, Ro er C Sr 21-13-01208
RELATIONSHIP TO
NAME AND ADDRESS OF SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSONIS)RECEIVING PROPERTY DECEDENT �ords) ($$$)
tes
I� TAXABLE DISTRIBUTIONS [include outright spousal
distnbutions,and transfers
under Sec.9116 a 1.2
Jeffrey Lee Garrett Son 1/5th of Estate
2015 A Southpoint Drive
Hummelstown, PA 17036
Michael C Garrett Son 1/5th of Estate
3806 Notch Street
Macungie, PA 18062
Roger C Garrett,Jr. Son 1/5th of Estate
1135 Fircrest Drive
Tacoma,WA 98466-6592
Steven P Garrett Son 1/5th of Estate
5221 Windsor Bivd
Mechanicsburg, PA 17055
Cecelia J. Kent Daughter 1/5th of Estate
836 Anthony Drive
Mechanicsburg, PA 17050
Total
Enter doilar 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)
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ESTATE OF ROGER C. GARRETT, SR.
SCHED ULE OF EXHIBITS
EXHIBIT A Last Will and Testament for Roger C. Garrett a/k/a Roger Craig
Garrett signed and dated October 19, 1991
EXHIBIT B Receipt of Inheritance Tmc Prepayment postmarked February 4,
2014
EXHIBIT C HUD-1 Settlement Sheet for Sale of Real Estate located at 8 Forge
Road, Camp Hill, PA
EXHIBIT D U.S. Treasury Direct — Valuation of 13 United States Savings
Bonds—Series EE
EXHIBIT E Date of Death Letter ff-om PNC for Decedent's Individual
Checking Account and Joint Checking Account
:629724
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COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 018728
KENT CECELIA JANE
836 ANTHONY DRIVE
MECHANICSBURG, PA 17050
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-- fold
101 � $8,000.00
ESTATE INFORMATION: SSN: 1s6-14-2953 �
FILE NUMBER: 2113-1208 �
�ECE�ErvT NAIViE: GARRETT ROGER C SR �
DATE OF PAYMENT: 02/05/2014 �
POSTMARK DATE: 02/04/2014 � �
COUNTY: CUMBERLAND � �
DATE OF DEATH: 1 1/07/201 3 �
�
TOTAL AMOUNT PAID: �8,000.00
REMARKS: RECEIPT TO ATTY
CHECK# 107
INITIALS: CJ -
s�� RECEIVED BY: LISA M. GRAYSON, ESQ.
� REGISTER OF WILLS
_____o_w__
'� REG��Ol1�[�
TAXPAYER
� F'� � :� ��13
— ._ _ � IAl Ifti[� t �
� EXHI6IT B
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OMB Approval No:2502-0285
•;���- A. Settlement Statement (HUD-1) .
_ , ..
1.Q FHA 2.Q RHS 3. X�Conv.Unlns. B'File Number: 7.Loan Number. S.Martgage Insurence Case Number:
HS13148 130238324
4.Q VA 5.Q Conv.ins.
C.Note:This form is iumished to give you a statement of actuai settleme�eosts.Amounts paid to and by the settlement agents are shown Items macked
"(p.o.c)•we2 paid oufside the closinq they are shown here for infortnaHonai purposes end are not inciuded in the totals.
D.Name&Address of Borrower. E.Name&Address of Selier: F.Name&Address of Lender:
Robert R Rockey Estate ot Roger C.Garrett,Sr.,alkla Roger Craig 6arrefl Real Estate Mortgage Network,Ina
8 Forge Road,Camp H11,PA 17D11 499 ThomaO Street,2nd Floor,Edison,NJ 088;
Q.Property Locadorc H.Setilement Agent i.Settlement Oate:1?J04J2013
� 8 Forge Road Heritage Settlement Services,LLC� Disbursement Data 1?J04r2013
Camp Hiii,PA 17011 4705 E,Trindle Road,Mechanicsburg,PA 17050
Lower Alien Towrtship
717-730-9664
Place of Settlament T'�leExpress
4705 E.Trindle Road,Mec.hariicsburg,PA 17D5D Printed 12/04/2013 at 1D:04 am
by JS
. -. . . . .
1DD. Gross�lmoum Due hrom Borrovue� . . . 40D. Gross�AmouM Due to 5eiler
• 101. Conhact sales price .. 127,9DO.D0 401. Conhact sales price 127,9DO.D0
102, Personal 4�2 Personal
1D3. Settlement charges to bortrnver�ine 1400) 6,596.22 403.
104. 404.
1D5. 405.
ustmerits for iteems seller in advance ustrnents for items atd seller in edvance
106. GtyRown taxes to 406. GtYltown taxes to
1 p7. Gowty fs�ces 12Ki412013 l012131/2013 55.87 407. County taxes 12/0412D13 to 12l3112013 55.87
108. Assessments to 408. Assessments to
i0.9. Sc�ool Tazes 121D4/2013 to 0613D@014 753.06 409, Schod Texes 12/04l2013 to DfiJ302014 753.06
11D. SewedRe(use O,N,D 12!(MJ2013 to 12131I2013 35.ffi 410. SewedRafuse�,N,D 12I04/2013 to 12/31/2013 " 35.82
111. 411.
112 412
120. Gross Amount Due from Borroxrer 135,340.97 420. Gross Amourd Due ta Seller 128,744.75
�20D, Arttbunb Paid or in�B2half ot Borrower 500. •Reduetlons In Amount Due to•Seller'. ' '
2ot oeposlt or eamest money 5,000.00 50t. Excess deposil(see Inswdions)
202. Prindpal amount of new loan(sj 102,320.00 502. Sedlement chmges to seller�ine 1400) 16,229.00
203. ExisBn lo s taken sub to 503. ExisUn I s taken sub ect to
�.• 504. ofl of fust mort e ban
�. 5D5. Payofl of second mortgage loan
206. Se�erAssist 5,900.00 506. SeilerAssist 5,900.00
207. 507.
208. 508.
209. 509.
Ad usfinents for ifems un aid b seiler Ad ustments for Items un sel(er
210. Cityftown taxes to 510. Cityftown taxes to
211. County taxes to 511. County taxes to
2�2 p9sessmp.nts ta 512 Assessments to
213, School Taxes to 5]3. to
2�4. 514.
215. 515.
216. 516.
217. 597.
218. 518,
219 519.
22U• Total Paid b lfor 8orrower 113,220.00 520. Totai ReducNon Amourd Due Seller 22,129A0
300.• Cas'h�at.Settleioentfrbmfto6orrcwer ' . •. . 60Q-CaslratSettlementtbffromSeli€'r : • .•:�• .
3D1. Gross amount due from borrower(CNe 120) 135,340.97 gp�, Gross amount due to selle�(We 420) �28,7'44.�5
gp2, Less amounis paid byJFor borcower(fine 220) 113,224,00 602 �s reductions in amount due selier{qne 52(I) 22,129.00
309. Cash []X, From ❑To Borrower 22,120.97 5U3. Cash QX To ❑from Seller 106,615.75
�
�p� °°n°N�vaWammimdoumhr.NemAWaA.�i'kamaa4��NStlo�xekmmddwXi7tichtl�qnminOmWdelhePutluW��aAwvueetreauceanru�imfwnnim ws
Prevlous edttlons are obsolete Page 1 of 4 EXHIBIT C
�� ��. :��:�,._,� � ,_ � . �a��� � ,.�
_
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700. Total�RealEstafeBrokerfees 87,320.oD � Paid From Paid From
. Dtvisbnbfwmmission ne700 as�foliwrs: ' Botrower's Seller's
7ot, $3,660.00 to R5R Realtors,LLC -.Funds at ' Fund3�at •
7D2 $3,660.00 ta �ub&Assodates Settiement. S�tElement
703, Commission pafd at seWement �'�'�
704, Proces�ng Fee to 5traub&Assoclates 295.00
800. �ems Pa bie[n Conneccfion with Laan
801. Our ai�nafion charge (Indudes Originatlon Point 0.000%or tD.00) $1,045.00 (from GFE�`'I)
8D2 Your aEdfl a charge(points)for the specffic fnteresl rete chosen S (����
803. Your adJusted originaGon charqes (from GFE Aj 1,045,00
804. MP�sal fee to Max Advanta e (fr�m GFE#3) 425.00
805. C2dit report to CIS{nformatlon Services (ftom GFE#3) 28•63
806. Ta�c service to Investor (from GFE#3) 70.00
807. Flood certificatlon to Itluwer Finandal Services (from GFE#3) 10.00
808, �0
900. ftems uired b -Lender to be Paid in Advance• . •
9D1. Daity interest charges irom from 1210M2013 to 01/012D14 @$13.32001day (from GFE#10) 37296
9D2 Mortgage Ins,Pramtum for months to tfrom GFE#3)
903. Homeowners insurance for ears to Krwn Insurance A (from GFE#11) 517.00
gpq, months to from GFE#11
1DOD.Reaerves D os"iteed viri6�Lender
1001.IniB�deposil for your esaow ac�nt (from GFE#9) 976.63
1002 Homeovmei's insurance 3 months S 43.08/rtronth $129.24
1003.Matgage lnsurance rrronlhs E O.OD/monih �
1004,City Property Tax monfhs t O.DOlmonth 3 '
1005,County P�ope�ty Tax 11 �onths i 60.69fmonffi �7.59
1008,School Property Tax 7 monffis S 1D9,60/month 576720
1007,AggregateAdJustrnent �587.40
1100.TfHe es
1101.Title services and lender's tlfle insur�ce from GFE#4 1,215.00
1102 SettlemeM a dosing fee io �
1703.Ovmets tide insurance-Old RepubGc National Title Insurance Ca trom GFE ��•�
1104.Lenders Mle Nsurance-OId Republic Natlmal Title Insurance Co, $1,!40.00
1105.Lendaz's tide poiicy Iknit$1�2,320.OD Lenders Poficy
1106.Own�s Htle poficy iimit 5127,900.00 Oumers Po6cy
1107,Agent`s po�ion of the fotai dtle insurance premium � $1,011,50
1108,Underv�nilei's poAion of the total Mie insurance prerNum $253.50
1109,E-Doc Dellvery Fee to ' e Setdertrent ServicE$35.00
1110,CourierAMre Fee to H e SetUement S�vk��15•�
1111.Notary Fee to Valerie Priest $�.� �.�
1112 Reimburse iwTax Ce�iffcation to H Settlement Servic�� 10.OD
120D:Governmet�t Reco and Transfer Ch es • �
12(11.Governmentrecord'ingcharges $ (ftomGFE#� 162.�
�2p2,p�gs7,pp a s$95.00 Release S
1zo3,rra�,sfertaxes s (tromcFE#8) 1�z7s.D0
1204.CHylCowty t�lstamps Deed$1279,00 Mo e S
1205.State T�Istamps Deed$1279.00 Mod a e 3 1,279.00
1206. �Dced$ Mort a $
1207. �
1300.•A�3dltlonalSetdemefitCha es fromGFE#6)
1301.Required services that you can shop for �
1302 Survey to �
1303. to
1304.Escrow fa Inheritanca Tax to Herita Settlement Servlces,LLC �'�'�
1305.Tertntte Cai to Ins ai Center 75.00
�� . . • . .. . , � • . . � � 6,596.22 16,229.00
'P�d outsfde of dosing by(B}orrower�(6)e�er,IL�nder,(I)nv�ta,Bro(KJec"Credft by lender shrnm on page 1,"`CredH by seller shown on page 1.
Prevlous editlons are obsolete Page 2 of 4 HUD-1
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:.com aris'.on;ot:�o'tid�Fai�i::�stiinate� ;aii [�fi�H' '°�'• :`,;:^" -.��o�d'Falfff.E"t.siAn'�' �HUD:1;
�Ctia"=es`�.Jhal;Eait�of�(tictease� <.HUOt�;LifieNurtibe'rti�` `�'`�
! . ....: .•.;: ,.
.•. :.�::.::.: .� . . ::: .
. . . ., • ...:. ;:: :.:... � gp' ',", �.. ..:. :.: � 1�045.00 1,045.00
Ou�o�igiSiaUBti.��:.::�4::`�"�• .` : _ .•.': • • ... ... .. .. #: :�
�Y�ix�dft.��of�fi�r9�;�Pr�!�1 f�the sp,'ea�c interest rate ctio§en�".,••�:_;:�?.802;;;:., 0.00 0.00
�.Yout,adjifsted,odgi.(iafign�chafge9�:.�.- ':�:;Bp3..;.,,p, ,' - 1�045.00 1�045.00
�'ffaris 'tffiiesi.� .:>:�; .'•..;r .1203a 1�279.D0 1�279.00
,.�,.
�'G e��i�a{:(�.T'��anro�IrtcreaselDfoie: a�'1iS.%�'��r� •., <,.;�.:.::z?,�. -�. .:L =•Good=F.alth'F§tima�et•;�.: ,���NUat�::,�-:..-:�
•�::. �1�2p•t . �"'''' - 175.00 16200
kCo�&fi'Hi�rS�reczSNin§'f�3r�e'�>� :• �... •����,.. �..:>.•�."". ."..;.�F�
.,s4p',P�2{sal'fe9"�:f'tar:_c._ :i'_ -`..1 z:�=:'�'.$(�41e:':%�,I'�;�:«���:�.,v.r;r•, 400.OD 425.OD
"C[�'t!'�'YeQ,Grt;,:�:."- ;i•r - - ,i>.-. ":i:' ;''�'8D5'?'.. °A::�y�: 20.00 28.63
'�?�c�,ser�i�e;r�.-�=:':k�:.:>, :.>;' t•���f=:..=',•- - 70.OD 70.00
•�dod;i�itilfpa9om:�:;:a.:.,;;.�.. • ' '•;�e9D_7.;';t...;:':.��:��r..;,,'•:•;? 10.D0 10.00
• `�"~''�.:�.:` �,r �'.1906:.:. :;�r O.DO 0.00
�.0 ,v'*�..•(i._ '.?.:. . ..�*:..i�:T
:b':• '- �'.Ci _ 't:..�' ^{x� .���' l..
':":""`•:: - 675.00 695.63 �
, , � $ 2D.63 a 3.0563% '
.Gha_��3:TFi_ur_#��it'�G. ..:�:,'. .°..,.�.�.::r'':.��: �•, • � � �.:.• :�::G6o7F�Itli.�sH'qYAt@:�-:�. ;.-�,,:;;:liUQ1..;:' ::. _.
. ; : ,:_ :•
,:Initial.tlSPbsitibt:Yot�;espraFac�o�ht�• -=: ...� . : �.:#.10D�`•;-; .. ,�,•,. •: 2,500.00 976,63
�-Dally;liiFe.restictiarge6 frortj: '.''•';_ : ~�'�>.`�'• #;9D.1'. ..:;$13.32001.da 19973 37296
•:Hotnedyi�e�s_InsOrarifie'; :;; :'a' . :903=-c. 600,0� 517.00
sTIH�s�,'ervl'ce"s�aridJenBer's°t�e irisu`ar�ce� � �_� ;� t.�:'11D1 r '�"� �,120.00 1,215.D0
:�O�rriet"s'tltle�lri'slir@iice=;qld Repiibfic•Natiai�Titlelnsurance,Go:`,�=;;:��1,1D3:•:.'.',:": :_ 150,00 125.00
- :U•s . �:}•;��C:.�:;p
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Loan Terms
��°��,�rv j�foaii;a'r�'jg�mt�is; _ :�s:. `� 5102,320.00
Wr"C`:,`."•� �.:.
�oYi�;l�i�anY�`EiriY,ls; �'` . . . . . ..� ', ,�� 30.ye2rs
S'ogrin�tl�;ini'ere'st'retels: -'_ • 4.750D96
�"'Xcn.:;ry ;•
Yourinkl�;oi_oNhfy.^amotmt owed fof�prindp�;Interest,and.�y mortgage S533J5 Indudes
iiis�,raijce�is•,:•:r'�.. . � .' , • ' • XQ Princip�
� ' ` � � . � X�Interest
- . . . +.t � . . . .. � ❑Adortgage Insurance
:`:':��.."',,::�;� ;:''::;��.. •.
��an yoarinleiesf�Fdie.iisel.;'.,;�`'� „�. .: � ' � „ X[�No. ❑Yes,it can rise to a ma�dmum af %,The first changa
• •� � �.��� w�11 be on 1 I and can change agatn every years aR� ! / . Every change
�� ' � • � . � •�- '': date,your Int�est rate can increase w deaease by %,Over ihe I'rfe of the loan,your
- � , • � ' � � . �. ��. lnterest rate is guaranteed to neve�be lower than 96 or htgher than %.
.F}'.x� :.�. . . . � .
:Eyeri`l��y.op;makepa"yrnenLS'on�tlme,.canyourloan�belanrk rfseT"���' X�No. ❑Yes,it can rise to a ma�timum of$ .
s,:,:. -4"y,�`s,;:_:.. •�:,':,
Eveq�ff�yo�l,�nake�ps'yr�ienls wi;Ume,�cao yotir;monthly amourd owed#or. QX No. ❑Yes,the first Increase can be on 1 1 end tha monthly
{u;hicip�aF.�n}ei�sl;t�ri�:m`prl9agelnsufeii�e rise?. _ arnount owed can rise ro S ,
- �;�;:;,�:. ••.� : ThemarJmumitcaneverdsetofs$ .
- •:���;• -
�Does yolu loarl fiave•a'piepsyinent perialty7� � [�X No. ❑Yes,your maximum prepeymeni penalty is 5 .
- �tic�:�..,Y-::.�_r,-,::;.,.,:�:. �
Ddes your.loarrhav,e a baltooil paymenYd�' � � ' �X Na ❑Yes,you have a balloon payment of S due in
. . , . .. . years on I 1 .
T;ola(�iiioiittily attial.M'piv�lndutllrig rscrow accounl paymehfs �xr.';'c ❑You do not have a rtanthly esaow payment for items,such as property taxes �
� . � . ' � . �•. .. and homeov+ners Insurance.You must pay fhese items dUecfly yourself.
_ -- , � X[�You have an addiUonal monthly esaow paymeni of$213.37
� •- � .� • ' �.' that resulls(n a total initf�monthty amount owed of$747,12.This Indudes prindpal,interest,any
:��{:., . . • . . . . . ' mortgage insurance and any fiems check�bebw:
-_.:" . . � . ' � ' X[�propertytaxes X[�Homeowners insurance
.� Y'.• . . Q Schod Taxes
>;,�_ . ' • . • , �Flood Insurance
i:f'f^���;Y .�'t.� . � �
Note: ��you have any questions about the Se�lement Charges and Loan Terms�sted on this fortn,please contect your lender.
Previous edltions are o6solete Page 3 of 4 HUD�i
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HUD CERTIFICATION OF BUYER AND SELI FR
I have carefully reviewed the HUD-1 Settlement Stetement and to the bast of my Icnowledge and 6elief,k is a true and accurate statemeM of all receipts and
disbursements made on my account or by me in this transacHon.I further certify that 1 have rece(ved a copy of tha HUD-1 SetUemant Statement
'��b'�-(/1 � ��{9^��
Rohart R Rockey
Cec-t,�.c ` Q � , �x�c .
Estate of Roger C.G rte�,Sr., da Rager C g�arre�
The HUD-1 Settlement Statement whlch I have prepared is a We and axurate acmunt of this transacUon.I have ceused or m11 causa the funds to be
disbursed In accondance wtth this state�nent
,ot?��-� �a-��//�.
SETTLEMENT AGENT DAi'E
WARNIN(�IT IS A CRIME TO IWOWINGLY MAKE FALSE STATEMEtdTS TO 7HE UNI'I'ED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT,FOR DETAILS SEE TITLE 18:U.S.COOE SECTION 1001 AND SECTION 1010,
Previous editlons are obsolete Page 4 of 4 HUD-1
.������,.,�.��.=.E.:�_ ��_�� � „�
. . . .. • .
Name of Borrower: Name of Selier: File Number:
Robert R,Rodcey Esiate of Roger C.Garretl,Sr.,alkla Rog�Craig GaRett HS13148
Prepared 12!(114/2013 at 10�4 am
Note:This page dispiays an itemizatlon of the adjusted origina8on charges shown in sectlon 800 of the HUD-1 Settlement Statemen
This page accompanies but is not a part of the HUD-1 Settlement Statement ff a discrepancy exists,the(nformation on the HU0.1
Settlement Stafement applies
Your Loan Orig(rtaBon Charges Borrower Se11er
801. Our originafion charge (Indudes OrigNation Po(nt O.DDD%or 50.0�
AppGption Fee to Reai Estate Mort e NeNvork,I$ �.�
Loan OriglnaCwn Fee to Reai Estate M. e Network,I$ 595.D0
802 Your credit a d�arge(potnts)for the spedfic interest rale chosen
to S � 0.00
803, Your adjusted originaUw�c�arges 1,045.00 0.00
. . - �
Name of 8orrower: Name of Sep�: Flle Number:
Royert R Rodcey Estate of Roger C.Garzett,Sr.,a1kJa ftoger Craig Garrett HS13148
12f04J2013 at 10:04 am
Note:This page dispiays an itemization of the charges shown on Iine 110i of the HUD-1 Settlement Statement This paga
accompanies but is not a part of the HUD-1 SetHement Statement If a discrepancy extsts,the infortnation on the HUD-i Settlement
StatemenY appilea
11D0.Title Charges • " Borruwer � •Seller..
1101.Title services and lenders titla insurance �0 1,245.OD 0.00
Subtatal S 0.00
1102 Settlement�dosing fee to � O.OD Bortower
1104.Lender's Gtie inaurence-Old RepuWlc Natbio Herit e SeWement Services,LL$ 1,140.00 g�
1109.E-Doc Delivery Fes to Harit e Settlement Services,LLS �.�B�'�
1110.CouriedWire Fee to He e Setllemeni Servkes,LL$ 15,00 Bo�rov�'er
1111.Notary Fee to Valerie Priest � 25.00 Manu� 2D.00
1112 Reimhurse for Tax Ce�iific�ion to H ' e Settlement LL; �•�� 1aD0
SellerJLender credib s6own on a e 1 POC=Pald Oulside Closin
Prevlous editlons are obsolete Page 1 of i HUD-i
�,;� ,�����,-� �.� �,�. �� ���, ,: �=��. ,:. ..,�
Calculated Va1ue of Your Paper Savings Bond(s) Page 1 of 1
Calculated Value of Your Paper Savings Bond(s)
Calculator Results forRedemption Date li/2013
. - . . - � -
325.00 $1 069.72 $744.72 38.52
Bonds: 1-13 of 13
. . .
. .
L436098087EE' EE ' $50'06/1990;12/2013: 06/2020� $25.00. $53.58' 4.00% $78.58
L436070631EE� EE $50�04/1990 04/2014�.04/2020 $25.00 $55.16 4.00% $80.16
L436042588EE EE $50 OZ/1990 02/2014, 02/2020 $25.00. $55.16 4.00% $8�.16,
L426556074EE EE . $50 12/1989 12/2013. 12/2019, $25.00 $55.16 4.00%. $80.16,
L426537152EE EE $50 11/1989 05/2014, 11/2019. $25.00 $56.76 4.00% $81.76
L404730094EE EE $50 08/1989 02/2014 08/2019 $25.00 $56.76 4.00% . $81.76.
_ L404698872EE EE $50.07/1989 01/2014 07/2019, $25.00. $56.76 4.00% $81.76
L404669143EE EE $50 05/1989 05/2�14 05/2019 $25.00 $58.40 4.00% $83.40.
L404637537EE EE $50 03/1989 03/2014 03/2019 $25.00 $58.40 4.00% $83.40
L378851713EE EE $5U 01/1989 O1/2014. 01/2019 $25.00 $58.40 4.00% $83.40,,
L378820023EE .. EE . $50 .11/1988 05/2014,_11/2018, $25,00. $60.06 . 4..00%. $85.06.
L378801967EE EE _ $50.09/1988_03/Z014: 09/Z018: $25_00: $60.06 4.00%_ $85.06
L378749987EE: _ EE.. ,_._._.�5Q_ 08�1988 02/20].4: 08[2018 . .$25.Q0;. $60.00 _ 4.00%:. $85.06
Totals for 13 Bonds $325.00 $744.72 $1 069.72
NI Not Issued , .
NE Not eligible for payment •
P5 Includes 3 month interest penalty
MA Matured and not earnin interest '
_ �
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l�,ttr�•/%znzn�v frPaciirvr�irP�t anv/R(�/�RC',PriCe
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Dec. 30. 2013 2:20PM PNC Bank No. 2591 P. 1
������ . .
R�C�iV�D
I7ecernber�0, 2013 ,
. ��d� p � 2013
Aaza.aL�Jieseman � �pHI�SON DUF�RE
L�w O�ceS JOhzzSOn Du�ie
301 Market St �
PO Box 109 � �
Lemoyne,PA 17045-0109
R,E: Name_ Roger C Crarrett '
S SN: 195-14-2953 �
DOD: I 1-07-2013 .
Dear Sir/Nladam:
Izz xesppnse to your request for 17ate of Y?eath(DOD)baiances for the customer noted above, our
records sk�o'vv the following:
. Checl�vng Account
Account# 5115131 I42 . Established: 09-13-2013
ROGER C CrARRETT
J�OZ?baiance= $ 97,793.32+0.74 accrued i�terest
Interest p2ad 0 X-0�-20�3 thru 11-07-2013 $ 0_67 YTD
Account# �140022693 Est�blashed: 07-23-2,008
�tOCE1�C GARRETT'
YEFFI�E��. GAkTt�TT
DOD balan,ce: � 56,920.77+0.03 accnr.ed intsrest
Interest paid O1-01-2013 tkizu I.�-07-2013 $ 5.74 YTD .
Please note that this office provides date of dear.h baIances for deposrt accounts(IRAs,CDs,Checking and
Sa�ings). We do t�ot pXOCess a�a���artcxal transactions or pro�viide�tatements. T�you�eed assxsta�ce�Z
any of these items,�lease ca.11 1-888-PI�C-BAl�(1-$SS-762-2265)or swp b�'�our local pN'C Bauk br2nch
off"ice.
Sincerely,
National Finaneial Services Center
��tC Bank,N"-A-
Membez FAZC � �
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