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HomeMy WebLinkAbout06-11-14 J �,� 1505610105 REV-1500 Ex(02-11)(Fp, �j1 PA Department of Revenue permssyyllva ria OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE County Code Year File Number PO BOX 28o6m Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ,03/17/2013 (01/07/1938 Decedent's Last Name _ Suffix _ DDeecedent's First Name MI Pressley 1 Kandall (If Applicable)Enter Surviving Spouse's Information Below LJ Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW GID 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) . CID 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 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 SHOULD BE DIRECTED TO: Name _ Daytime Telephone Number Michael A. Scherer, Esci _J (717) 249-6873 p m � REGISTER OF WIl_LSIISE ONL G n r'1 - L co 77 First Line of Address r`1 W �-r,., F ' r M tzp Baric Scherer LLC `. _D C, o Second Line of Address J c-> <� =3 ,� -,•t } C= 19 West South Street i w m City or Post Office State ZIP Code DATE`kILED C p `Carlisle PA 17013 Correspondent's e-mail address:mscherer @baricscherer.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 prepare,other than the personal representative is based on all information of which preparer has any knowledge. SI NATURE OF PERS ESPONSIRq FOR FILING RETURN DATE ADDRESS p�_..,L"/y tQ )I T Renata S. Snavely/25p6 Austin Drive, Gran ille, PA 17028 / SIGNATURE! R /R`1'THER HAN REPRESENTATIVE DATE �C ADDRESS r' `[A.1 Michael A. Scherer, Esq.,/19 West South Street, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J J 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Randall 1. Pressley RECAPITULATION 1. Real Estate(Schedule A). ...... .... ... ....... ............ ......... ... 1. 74,500.00 2. Stocks and Bonds(Schedule B) ... ....... ....... ..................... . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) ..... 3. 4. Mortgages and Notes Receivable(Schedule D) .......... .. .. ....... ... .. . 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 9,619.52 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested... ..... 7. 8. Total Gross Assets(total Lines 1 through 7).......... .. ..... .... ..... ... B. 84,119.52 9. Funeral Expenses and Administrative Costs(Schedule H)........ ... ....... . 9. 12,843.98 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)....... ........ 10. 49,087.87 11. Total Deductions(total Lines 9 and 10).. ...... .... ..... .... .......... .. 11. 61,931.85 12, Net Value of Estate(Line 8 minus Line 11) .. ....... ... .... .. .......... .. 12. 22,187.67 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . .. ..... .. .. ... .. ..... .. 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) . ......... ............ .. 14. 22,187.67 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec. 9116 (a)(1.2)X.0- 15. 16. Amount of Line 14 taxable at lineal rate X.0 45 22,187.67 16. 998.45 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18. 19. TAX DUE .... .. .... ... ... . .... ...... . ..... ... ......... .......... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (381) Side 2 1505610205 1505610205 J REV-1500 EX EI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Randall I. Pressley STREET ADDRESS 551 Ridge Road CITY STATE ZIP Lewisberry PA 17339 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 998.45 2. Credits/Payments A.Prior Payments 1,000.00 B.Discount Total Credits(A+B) (2) 1,000.00 3. Interest (3) 13.34 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 11.59 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.......................................................................................... ❑ E b. retain the right to designate who shall use the property transferred or its income ......... ......................_.._ ❑ 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?.............. ❑ E 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ ❑ N IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and fling a lax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(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+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Randall I. Pressley 21-13-0691 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. - ITEM Include a copy of the deed showing decedent's Interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 7 Sunset Circle 74,500.00 Mechanicsburg, Pennsylvania 17050 Parcel#10-21-0281-013 copy of HUD-1 attached �SSL. I I - N w.. TOTAL(Also enter on Line 1, Recapitulation.) g�_ 74,500.00 If more space Is needed,use additional sheets of paper of the same size. REV-1508 EX+(08-u) pennsylvania SCHEDULE E 117 DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE RETURN PERSONAL PROPERTY RESIDENT DECEDENT ENT ESTATE OF: FILE NUMBER: Randall I. Pressley 21-13-0691 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION _ OF DEATH ' I 1.h lAllstate: homeowners insurance refund 214.35 coins �` - L� I 273.13 3, Citizens Bank;checking account#610076-344-7 ! 1,526.00 4, Citizens Bank;savings account#6140-219809 7,414.04 5, Internal Revenue Service refund;2012 income lax L 192.00 ) L C C --j TOTAL(Also enter on Line 5, Recapitulation) $ 9,6199.52 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(08-13) , pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND ETAXRETURN RESIDE NT D ADMINISTRATIVE COSTS RESIDENT ESTATE OF FILE NUMBER Randall I. Pressley 21-13-0691 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: _ 1' Myers Buhrig Funeral Home and Crematory 73.25] B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address - City State_ZIP Year(s)Commission Paid: 2. Attorney Fees: 4,182.07 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State_ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: Y f 6. Tax Return Preparer Fees: 5O.00w. 7. r,ealty transfer tax:sale of 7 Sunset Circle,Mechanicsburg,PA 4 8.; 1 real estate commission:sale of 7 Sunset Circle,Mechanicsburg, PA 3,295.00 i 99 closing costs:sale of 7 Sunset Circle,Mechanicsburg, PA 230.00 It 10. Citizens Bank:mortgage payments �1 763.1 711. Citizens Bank:service charges — 8.70 NNf"""" M11lfIMMI'*Nf1X SEE ATTACHED SHEET" Hf1 "*"*MlflfR}Y;yMlilff XfflffflfNNlf!} TOTAL(Also enter on Line 9, Recapitulation) $1 _12,843.98 If more space Is needed,use additional sheets of paper of the same size. Estate of Randall I. Pressley Estate No. 21-13-0691 SCHEDULE H CONTINUED 12. Citizens Bank: line of credit satisfaction fee $ 55.50 13. Allstate Property Insurance: 7 Sunset Circle $ 591.00 14. PPL Electric $ 131.94 15. UGI Gas Utilities $ 217.90 16. PA American Water $ 315.06 17. Hampden Township: sewer service $ 714.66 18. Renata Snavely: out of pocket expenses $ 440.75 19. Rick Uhrich: coin appraisal $ 30.00 Total: $2,496.81 REV-1512 EX+(12-12) y pennsylvania SCHEDULE I DEPARTMENr OF REVENUE DEBTS OF DECEDENT, wRERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS ` RESIDENT DECEDENT ESTATE OF FILE NUMBER Randall I. Pressley 21-13-0691 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. r ITEM - VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. iCibzens Bank: mortgage on 7 Sunset Circle,Mechanicsburg, PA 12,029.05 r3as B2. real estate school tax on 7 Sunset Circle,Mechanicsburg, PA 692.32 3. real estate county/township tax on 7 Sunset Circle,Mechanicsburg PA 196.44 �4. Pennsylvania Department of Public Welfare 32,7g7,g1 5, IManorCare Nursing Home 1,797.25 6. • .'Holy Spirit Hospital(computer credit) 1,575.00 TOTAL(Also enter on Line 10, Recapitulation) - • If more space is needed,insert additional sheets of the same size. - REV-1513 EX+(01-10) i pennsylvania SCHEDULE J OEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Randall 1. Pressley 21-13-0691 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. Renate S.Snavely daughter 276 Austin Drive r { Grantville,Pennsylvania 17028 t L 2.� 'Rhonda K.Heiges ' T daughter L5 Enck Circle F � ] Enola,Pennsylvania 17025 � 3.! Ruslin L.Pressley , son 1/3 (P3.,y Li i 508 Ridge Road ___111 � LLL............ �J Levdsberry,Pennsylvania 17339 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS _ A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: !.�_ T:m_� ..:s-�-��. -mom_a.-s-4-_..�.-. �� .� --•-- , . - _ �_ _�. _ �! - B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $� If more space is needed,use additional sheets of paper of the same size. ���•••rrr�+��� LAW OFFICES - BATURIN&BATURIN 2604 NORTH SECOND STREET HARRISBURG, PENNSYLVANIA 17716 4 TELEPHONE:(717)•294-2427 " FA S( I : (7171234-7544 i LAST WILL AND TESTAMENT OF RANDALL L PRESSLEY I, RANDALL I. PRESSLEY, presently residing at Lewisberry, York County, Pennsylvania,being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this instrument to be my LAST WILL AND TESTAMENT, hereby revoking any and all Wills or Codicils by me at any time heretofore made. FIRST: I direct my hereinafter named Executrix to pay all of my just debts, funeral expenses, administration expenses and inheritance, estate, succession or excise taxes, which I owe or may become due on account of my death, as soon as may be convenient after my decease. SECOND: I give, devise and bequeath my coin collection to my grandchildren in equal shares. THIRD: All the rest, residue and remainder of my estate, consisting of real and personal property, of whatever nature and wherever situate,which I may own or have the right to dispose of at the time of my decease, I give devise and bequeath unto my beloved children, RENATA SUE SNAVELY, of Grantville, Pennsylvania, RHONDA KAY HEIGES, of Mechanicsburg, Pennsylvania, and AUSTIN LEE PRESSLEY, of Lewisberry, Pennsylvania, in equal shares. AL) RAND LI. PRESSLEY, T r FOURTH: I hereby nominate, constitute and appoint my daughter, RENATA SUE SNAVELY, to act as Executrix of this my Last Will and Testament, with full power, in her sole discretion to do any and all things necessary for the complete and proper administration of my estate,with full power to sell at public or private sale or sales and without Order of Court, any real or personal property belonging to my estate, and to compound, compromise or otherwise settle or adjust any and all claims, charges, debts and demands whatsoever against or in favor of my estate, as fully as I could if living. FIFTH: In the event my daughter, RENATA SUE SNAVELY, shall become funable to act as my Executrix for any reason whatsoever, then I do hereby make, constitute and appoint my son,RUSTIN LEE PRESSLEY, as my Contingent Executor,with the same powers. SIXTH: I hereby waive any requirement which may have been otherwise imposed upon the Executrix,or Trustee,of this, my estate and/or trusts, to post a bond in connection with the administration of said estate and/or trusts, in this or any other jurisdiction,where permitted by law. i IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this day of —9)J� , 2411. (SEAL) RANDA L I.PRESSLEY,T r Signed, sealed, published and declared by the above Testator, as and for his Last Will and Testament,in the presence of us,who have hereunto at his request, subscribed our names in his presence and in the presence of each other as witnesses hereto. _ A^ C � Address"160 Mtr1z7Et-�fi,�1lq, S 1 , .iAk R 6 13dR(e, (. 15 .i«Q •^ Address vX&ytf Vi11�__ COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF DAUPHIN ) WE,RANDALL I. PRESSLEY, p q V 1 9 PF and 4M 49p4 ,the Testator and the witnesses respectively, whose names are signed to the attached or foregoing instrument,being first duly swom, do hereby declare to the undersigned authority that the Testator signed and executed this instrument as his Last Will and Testament and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, in that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses and to the best of their knowledge, the Testator was at the time eighteen years of age or older, of sound mind and under no constrain undue influence. i (SEAL) DALL I. PRESSLI Y, Te to A (SEAL) WITNESS (SEAL) WITNESS Sworn to and Subscribed before me this -6 4-h day o 201 Notary Public My Commission Expires: COMMONWIZALTH OF PENNSYLVANIA NOTARIAL SEAL ANTOINETTE F.HORNE,Notary Public City of Harrisburg,Dauphin County My Commission Expires April 24,2013 tbmi App,oNtl DMaNO]5 @ bt 0. ucncT•narwwropeausmanxs wuxoavG.orwswr B. TYPE OF LOAN SETTLEMENT STATEMENT 1 FHA 2 FMHA -- Abstract Land Associates, Inc. 4. ❑VA 5.d CONV.I.S 3. CONV.UNINS 3912 Market Street s.Escaow lxE rn'sun R: r. LOAN NUMBER: 013181994001 MAW - Camp Hill,PA 17011 (717)763-1480 8, MORTGAGE INSURANCE CASE NUMBER FINAL C.NOTE This to=is fumANSdtogeve}vuashstemerN Wachtel sehternenl costs Amoan(speidb and BS'Uie sstttemenfagantare shown. Items MR ked'(P.O,C.)"seers samoutside Iha closing;they are shown hero tor,inlbrmahonal ptrryoses and are not included/n Ina tota/s. O NAME OF BOftBOWER: Shabnam SachdeVa \ ADDRESS OF BORROWER: 5735 Aspen Lane EnOta PA 17025 E. NAJ4E OF SELLER, Estate of Randall 1.Pressley ADDRESS OF SELLER: F. NAMEOF LENDER; ADDRESS OF LENDER: O.PROPERTY LOCATION: 7 Sunset Circle Mechanicsburg,PA 17050 Cumberland County 10-21-0281-013 Parcel#10-21-0281-013 H.6ETTLEMENTAGENT: Absh'aCt Land ASSOCIateS,Inc. PLACE OF SETTLEMENT, 3912 Market Street,Camp Hill,PA 17011 -{. SETiLEMENTDATE 12)01 @013 PRORATION DATE; 1 2131/2 01 3 DISBURSEMENTDATE: 12131/2013 GROS-'AMOUNT DUEF. .-- 'ROV(IER''ION K SUMMARYOFSELLER'S TRANSACTION i� S. UM YOF BORROWERSTRANSACT .c ts+ I +400!stGR036'AMOUN[DUEJO`SEtYFR _ 101. Personal e Sales Pace 74,50E DO OF Contract sates Price 74.500.00 f02. PropertY 402. Personal Property 103. Settlement charges to Borrower(line 1400) 1,599.50 403, 104. 404. 105, 405. ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTSFORREMS PAID BY SELLER IN ADVANCE: 100. CIty/rown Taxes 406. Cit/Town Tazes 107, County Taxes 407. Count Taxes _ 108. Assessments- 408. Assessments T 109. School tax 12/31/13 fo 06/30/14 568.31 409. Schoottax 72/31113 to 06/30/14 566.31 110. Sewer?rash 12/31/13 to 03/31114 155.05 410. Sewer (Trash 12/3183 40 03131/14 155.05 111. _ 411. 112. 412. 3, 413, 114. 414. 115, 415. 120, GROSS AMOUNT DUE FROM BORROWER: 76,822.86 420. GROSS AMOUNT DUE TO SELLER: 75,223.36 201 ARDepoitorearnestM1N BEFV±I:FOE WNRO'ASi. y,v..i` '.:'506.xREb1 TlO['tS!It1 .. 'DUE.TO,SELL'fR. is:r,"_ } 2131 Depositormount of 10 W000 501. Excess deposit(see Instructions 202. Pnncipal amount k rues,subjec(s) 602. Settlement charges to Seller(line 1400) 63,194.31 203. Existing loan(s)taken subject to 503. Ezistin ban(s)laken subject to 204. Commission Credit(Cavalry) 1,500.04 504 PaV0ff of 1st m99.ben to Ci ixens Bank 12,029.05 2 605. Payoff at secorW modgaga loan 20066. - 506. 207. 507. 207' SOB. 249. 509 ADJUSTMENTS FOR nEMS UNPAID 8Y SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: 210. City?own Taxes 510. CitV/1'own Taxes 211. County Taxes _511. Count Taxes 212. Assessments 512, Assessments 213. 513. 214. 514. 216. 515. 218. �St6. 217. 517. 278. 510. "- 219. 519. 220. TOTAL PAID BYTOR BORROWER: 11,500.00 520. TOTAL REDUCTIONS W AMOUNT DUE SELLER: 75223.35 '306.•'CAHH.AT,'SETT'IkEB�NT'F.ROMLi'080ttR0?JVF.R. '::,; r �-600=ASHAT3 301. Gross amount due loom lie mover(tine 120) 76,822 86 601. Gross amount due to Seller(line 4201 75,223.36 302. Less amount paid by/for aorrower(line 220) 11,500.00 602. Less reduction in amount due Seller(line 5201 75,223.36 303. CASH(®FROM) 1 ❑ TO)SORRGWER: 65,322.86 603. CASH(( FROM) {❑ TO)SELLERZ Dpg L SETTI-EMEtECRARPES R LN E B 99 01 MAW (,"700.';TOTAUSAILESISROKE LS WhlM!ISSIOIN. BASED ON PRJCE3 74,500.00 0 %= $3.000.00 PAID FROM DFROM BORROWERS AdI.I.E. DIVISION OF COMNUSSION(LWE 700)AS FOLLOWS' 'umba PU 701. S 1.500,00 is Straub and Associates Real Estate-­_ AT SETTLEMENT FUNDSAT SETTLEMENT 702. 5 1.500SQ is rgykv Realty LLC 703, Commission paid at settlement 3.000-OD 704. Transaction'Fee to Straub&Associates 29650 Z� 801. Loan OqImWon Fee 801 Loan Discount Fee 803, Appraisal Fee 804. Credit Report 805. lenders ln5pec0on Fee-_ 805. Mortgage insurance Application Fee 807. Assumption Fee BIDS. 810. all, [,',909L"I7EM'.R�QUREOBY,LENDE TQBE�P D, FADV M AN ;L 0' 901. Interest From is @$/day % (days) 902. Mortgage Insurance Prenwhon for Monthly)to 903. Hazard Insurance Premium for Years(s)to 904. 905. 10 60.'VRES ERV ES' EINJ S IT 6 WITH�UMM U L _ le_ I lail 1001. Hazard Insurance ..th.@$ per avail 1002 Mortgage Insurance sax ere gs per month 1003, City Property Taxes months @$ set March 1004. County Property Taxes months a S pe'W.-Mill 1005, Annual Assessments per monin 1006. samthe @ S per month 1007, ca.ace a 5 per month -700-8 hasenteas per month 66; n TLE 6 HA K(k B. ;;�', I 11" 1101. Settlement or closing fee 1101 Abstract or UUe Search 1103. Title examination IID4. Title sarcomas,binder 1105. Document preparation to Abstract Land Associates,inc. 125.00 1106. Notary fees to Settlement Officer moo 10.00 1107, Attorney's Fees (inalvacarsare hours numbers. 1108. Title Insurance to Abstract Land Associates,Inc. 762.50 (casuchy,above ft.havaboss,. 1109. Lender.coverage $ 7110' Omer.coverage $ 74,500.00 1111. Overnight Fees to Abstract two Associates,Inc. 15.00 15.DD 1112. Doe Prer,Fee to Straub&Associates RE 70.00 ,1113. Tax Cart Fee to Abstract Land Associates,Mo. 1000 1201 R.Wml.g Fees: Dead$ 67.00 mortgage$ Release$ 67.00 1202. CRY/Conenly tax/stamps $ 745.06 MOtgage§ 74566 1203. State taxtstanum, Dead$ 746.00 Mort gage$ 745.00 1204. 1205. EN k,„'... 1301. Survey 1302. Pact Inspection 1303. Inherilancerrax Escrow to ALAI 57,312A9N1 1304. 2013 CouMyfrwp Taxes to Michael Laotian 351.49 1305. 2013114 School Texas to Michael Leader, 1,260.63 ISM 1307, 1400, TOTAL SETTLEMENT DIV flave coeflbwieved1ce MD-1 Seteemmt SWimcentaM$the bsel4r my Xnvatad9a andbellef,it 15a UUeardaCLataM niatemantaf Mrsaxace and dittionvarents made oh my asonaftow by main this vareachan. Itu ormMryMM)bavemowedamMofMcHUD-ISetMmentStatement Estate of Rand f.Pros I Shabnam Saclideve Renate Sue Snavely,Executrix Oorrrnvars Gau." The 14[ 1 SNOcadn't swe7 I I how wowd wW1 cause thatunds lobe disbursed In accantans,Win this enL t'a GottlementAgent -Date 11, 1 Land A.a...I.. As' WARNING Fordelao.sve, MHNIS US.GodeEaxtlonlopl and seftnlolo. REV485 EX{0544} 48500041046 SAFE DEPOSIT BOXINVENTORY PA Departaw"of Revenue PLEASE USE ORIGINAL FORM ONLY Social Security or Death CeNBcato Number Date of Death County Code Year File Number o 131 Deeoderd's Last Name SuDrX First Name M1 ©ADDRESS 07ZCED tq�, CRY: 1� S TE ZIP CODE NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX 7 NAME . f v STREET J � A Z!p Yti7T{{i I I k- • NAME,ADDRESS AND RELATI�O�NS+HHIIP(I(IF,A`N,Y�)TO DECEDENT,OF PERSON(S)PRESENT AT THE BOX OPENING a. N� JJ2&t/t ejL4 RELATIONSHIP'S�r _ 1 4YYva S STREET ADDRESS: 4 _T CITY: TA ZIP CODE to b. NAME: RELATIONSHIP: STREETADORESS: CITY: STATE: ZIP CODE o. NAME: RELATIONSHIP: STREETAQDRESS: CITY: STATE: ZIPC0DE NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME .J STREETTAADDRESS� l// CITY: STATE ZIP EOF PERSON G LAq ENTRY DATE 0 E LAST ENTRY . 9U DATE QE CWPA A TO RENT DOX hta pF ROK 1 T NDER IC O t$REQU D Q Q C NAME AD A96RESS OF PERSONS)HAVING ACCESS TO BOX ndal qTp�,!sl.—gal NAME: s7VDRESS: STREETA D m,,; SS: Cm': STATE: ZIP CODE: CITY., S 'f,F�: 22P 00DE• VY\P W '1 (•'I' NAME AND TITLE OF EMPLOYEE T G THE INVENTORY nA WAS A WtLL W THE BOX? 0 YES NO tf yea• a.Date of MII: b. Name arM address of personal representafhro.If named In the vAll NAME: STREETADDRESS: CRY: STATE: ZIP CODE: c Name and address of attorney,If any NAME: STREETADDRESS: CITY: STATE ZIP CODE 48500041046 48500041046 REV-485 EX SAFE DEPOSIT BOX INVENTORY page °` INSTRUCTIONS (1) Cash:Report total only. (2) Stocks:List in detail every common or preferred certificate,warrant or other rights found In box.Stocks are to be designated by name of company,certificate number,date of certificate,name In which stock is registered,and number of shares and class of stock. (3) Obligations of U.S.Government:Number of items,date of Issue,face value,names in which registered and type of ownership, i.e.,jointly held,payable on death,etc. (4) Bonds:Designate by name,amount,serial number,or other designation.(Bearer Bonds) (6) Bank and Savings and Loan Passbooks:State name of depositor,number of book,last date appearing in book,name of bank and branch,and balance. (6) Jewelry,Cons,Stamps,Manuscripts,at=Ust and describe as fully as possible. (7) Deeds,Mortgages,Current Insurance Policies or other evidences of indebtedness:List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT.288801 HARRISBURG,PA 17128-0801 REM NO. REM DESCRIPTION 00 I n,'S I r Cc�i t S T f,S I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY: 5 RE SIGNATURE PRWTNA PRINT NAME AND CHECK APPROPRIATE BOX SFUDW PRINTTRLE DATE CHECKAPPROPRIATE90X 0 E-40fKAX) ❑AUrousavatwterx} �. \ �' 3 []Eafete Repme.onnm ❑Joint uvmer unsafe depose aoX NOTE:Attach additional 8V x 11"sheet(s)if necessary or use duplicates of this page of form. The Depatmentoatdmdzedby law,,42 US.C.g405(cX2XCri),omomdsdmaofS Sacskyrembersh connectionv sty tax[an Tha Depstmantusesthe Social afitam ode RrfyYedacademaell p offtadds.The Otermornaft may also Use theIntonation to wicharge oftaxInformatiDn againinnsift With Federal and local using authorities.The soot law prohitilb The Commonwealth's personnel Won disclosing confidential tax infmrreiion for official