HomeMy WebLinkAbout08-21-14 (2) REV-1500 EX(02-11)(FI) 1505611185
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes
PO BOX 280601 INHERITANCE TAX RETURN 21 13 1192
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Dale of Death MMDDYYYY Date of Birth MMDDYYYY
10282013 11141924
Decedent's Last Name Suffix Decedent's First Name M I
GRISSINGER WINIFRED L
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
- - REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
® 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death
Prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
KEITH 0 • BRENNEMAN 717-697-8528
REGISTEROF WILLS USE CP_Cy
C-) _ --ID
K: A n
First Line of Address
44 WEST MAIN STREET ro it
Second Line of Address
�_ 00
City or Post Office State ZIP Code 15-MLED •. o d
a
MECHANICSBURG PA 17055
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this relum,including accompanying schedules and statements,aqd to the best of my knowledge and belief,
it is true.correct and complete. Declaration of pre parer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
/yj> (Y-- 8 ./•/Y
ADDRESS
GREGORY GRISSINGER, EXECUTOR HC2 BOX 6650, 15-1378 22ND AVE - ,
SIG,T RIJ E OF PREPARER OTHER THAN REPRESENTATIVE �D TE eaau, I 9674`
'rte 1����
ADDRESS
KEITH 0 • BRENNEMAN, ESQUIRE 44 WEST MAIN STREET, MECHANICSBURG
PLEASE USE ORIGINAL FORM ONLY PA 17055
Side 1
1505611185 OM46471000 1505611185 ' �
1505611285
REV-1500 EX(Fl)
Decedent's Social Security Number
Decedent's Name. 6 R I S S I N G E R WINIFRED L
RECAPITULATION
-i. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 166,013 • 89
2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . 2 0 - 00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , . 3. 0 - 00
4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . q 0 . 00
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , . 5. 31617 •10
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested , , , , 6. 628 • 02
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . 7. 0 •0O
8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , 8 1701259 • 01
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9, 30 1603 • 50
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) , , , , , , , . . 10. 31671 • 05
11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11, 34 1274 • 55
12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , 12 135,984 • 46
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J). . . . . . . . . . . . . . . . 13. 0 . 00
14. Net Value Subject to Tax(Line 12 minus Line 13) . 14. 135,984 • 46
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.o- 0 . 00 15. 0 . 00
16. Amount of Line 14 t xable
at lineal rate X.0 413 135,984 - 46 16. 61119 - 30
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18. 0 . 00
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 61119 . 30
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT A I
Side 2
1505611285 1505611285
OM4648 3.000
REV-1500 Ex(F0 Page 3 File Number
Decedent's Complete Address: 21 13 1192
DECEDENTS NAME
GRISSINGER WI IFRED L
STREET ADDRESS
8 AR D BOROUGH
CUM13FRILAND COUNTY
CITY STATE ZIP
NEW CUMBERLAND PA 17070-
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 6,119 - 30
2. Credits/Payments
A, Prior Payments 6,500 - 00
B. Discount 325 .00
Total Credits(A+B) (2) 61825 . 00
3. Interest
(3) 0 . 00
4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT.
Fill in box on Page 2,Line 20 to request a refund. (4) 7 0 5 •7 0
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0 . 00
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 ❑❑
b. retain the right to designate who shall use the property transferred or its income . . . . . . . . X
c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . El d. receive the promise for life of either payments,benefits a care? . . . . . . . . . . . . . . . . . . ❑ EZ
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 a security at his or her death? ❑
4. Did decedent own an Individual retirement account,annuity,or other non-probate property,which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994, and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent(72 P.S.§9116(a)(1.1)(1)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
(72 P.S.§9116 (a)(1.1)(ii)).The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value Of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent(72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)I.
• 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.
OM4671 2.000
REV 15D2 EX-(12-12)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECE DENT
ESTATE OF: FILE NUMBER:
Winifred L. Grissinoer 21 13 1192
All real property owned solely or as a tenant in common must be reported affair market value.Fair market value is defined as the once at which property
would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,bath having reasonable knmMedge of the relevant fads.
Real property that isjointlyawned 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 dawned as tenant in common. VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Property known and numbered as 166,013.89
8 Ardmore Circle
New Cumberland Borough
New Cumberland, PA 17070
Sale value (see attached settlement sheet)
TOTAL (Also enter on Line 1,Recapitulation.) $ 166,013.89
2w4695 2.000 If more space is needed, use additional sheets of paper of the same size.
REV-1508 EX.(W12)
pennsylvania SCHEDULE E
DEPARTMENTOF REVENUE CASH, BANK DEPOSITS & MISC.
ESDENEo N RETURN DC PERSONAL PROPERTY -
ESTATE OF: FILE NUMBER:
Winifred L. Grissincer 21 131192
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1_ Member's 1st Federal Credit Union 3,005.42
savings account #525815-00 .
2 Member's 1st Federal Credit Union 600.00
checking account #525815-11
3 U.S. Treasury 11. 68
refund due the decedent on 2013 income tax
TOTAL(Also enter on line 5, Recapitulation) $ 3,617. 10
2w56AD 2.000 If more space is needed,use atldtional sheets of paper of the same size.
REV-1509 EX-(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
INIFERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Winifred L. Grissinger 21 13 1192
If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G
SURVIVING JOINT TENANT(S)NAWS) ADDRESS RELATIONSHIP TO DECEDENT
A Grissinger, Bradley S 7 Oak Ridge Road, Carlisle, PA
17015 Grandson
B Grissinger, Gregory HC 2, Box 6650, 15-1378 22nd
Avenue, Keaau, HI 96749 Son
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPSM %OF DATE OF DEATH
flEvt R00IODT MADE LI wn xcl
NAFE of FAL msnnnwu AxD SnxrcnccwNT HUMOR OR SIMIAN DATE OF DEATH DECEDENTS VALUE OF
NLMER TENANT JOINT IDENTIPONONUMER ATTACH DEED FOR JONTLY HELD REAL ESTATE. VALLE OF ASSET INTEREST DECEDENTS INTEREST
1 AB 12/28/1980 MET Bank 1,884.06 33.3333 628.02
checking account #38792249.
Jointly owned with Bradley
Grissinger and Gregory
Grissinger
TOTAL (Also enter on tine 6, Recapitulation) E 628.02
9w4eAE 2.000 If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX-(1008)
pennsylvania SCHEDULE H
DEPARTMENTOF REVENUE FUNERAL EXPENSES AND
RMEPoTAiCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Winifred L Grissinger 21 13 1192
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Gregory Grissinger
funeral expenses paid on behalf of the estate 456.79
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 8,400.00
Name(s)of Personal Representalive(s)Gregory Grissinger
Street Address HC 2, Box 6650, 15-1378 22nd Avenue
City Keaau State HI ZIP 96749
Year(s)Commission Paid:
2. Attorney Fees: Snelbaker & Brenneman, P.C. (Estimated) 2,860.00
3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation) 3,500.00
Claimant Gregory Grissinger
Street Address HC 2, Box 6650, 15-1378 22nd Avenue
City Keaau State HI ZIP 96749
Relationship of Claimant to Decedent SON
(Claimant resided in the same household at me or
a. Probate Fees: Decedent's death) 228.50
5. Accountant Fees:
6. Talc Return Preparer Fees:
7.
1 Cumberland Law Journal
advertising Executor's Notice 75.00
Total from continuation schedules . . . . . . . . . 15,083.21
TOTAL(Also enter on Line 9,Recapitulation) $ 30 603.50
9w46AG 2.000 If more space is needed,use additional sheets of paper of the same size.
Estate of: Winifred L. Grissinger 21 13 1192
Schedule H Part 7 (Page 2)
2 Gregory Grissinger
U-haul rental to move household contents from
apartment to donation centers 75.00
3 Gregory Grissinger
repairs to real estate 79. 62
4 Settlement charges for property located in New
Cumberland PA
a. seller assistance $2,000.00
b. Sewer adjustment $25.85
C. Realtors commission $8,400.00
d. Title services $5.00
e. Transfer taxes $1,650.00
f. Tax certification $10.00
g. County/Borough taxes $1,031.30
h. Home warranty $460.00
i. Sewer/trash adjustment $135. 66 13,717.81
5 The Sentinel
advertising Executor's Notice 210.78
6 Reserve
for filing fees, accountant fees and other
miscellaneous costs associated with the decedent's
estate 1,000.00
Total (Carry forward to main schedule) 15,083.21
REV-1512 EX-(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OR REVENUE DEBTS OF DECEDENT,
INHERITANCE TM RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Winifred L. Grissinger 21 13 1192
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Bank of America
balance due on credit card 133.16
2 Check written from Member's 1st checking
prior to death which cleared the bank on 10/29/13 3,475.00
3 Country Meadows Retirement Community
apartment expenses 50.46
4 Verizon Wireless
cell phone service 12.41
TOTAL(Also enter on Line 10,Recapitulation) $ 3,671.05
2w46AH 2.000 If more space is needed, insert additional sheets of the same size.
REV-1513 EX.( SCHEDULE J
Pennnsns ylvania
OEPMWENTOF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Winifred L. Grissinger 21 13 1192
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. Bradley S. Grissinger
7 Oak Ridge Road
Carlisle, PA 17015
M&T Bank
Inventory Value: 314.01 Grandson 314.01
2 Gregory Grissinger
HC 2, Box 6650
15-1378 22nd Avenue
Keaau, HI 96749
M&T Bank
Inventory Value: 314.01
758 of Residue: 101,517.33 Son 101,831.34
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NONITAXABLE DISTRIBUTIONS
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
i.
TOTAL OF PART II•ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. E 0.00
9W46AI 2.000 If more space is needed, use additional sheets of paper of the same size.
Estate o£: Winifred L. Grissinger 21 13 1192
Schedule J Part 1 (Page 2)
Item
No. Description Relation Amount
3 Jamie Yost
32 West Simpson Street
Mechanicsburg, PA 17055
25% of Residue to Jamie Yost:
33,839.11 Great Grandchild 33,839.11
OMB Approval No.2502-0265
A. Settlement Statement (MUD-1)
B. TypeofyLOan
L FHA 2.E)RHG 3.❑X Carry.Unins. 6. File Number.- 7. Loan Number: 8. Mortgage Insurance Case Number
14-038 6800766682
VA 5.Q Conv.Ins.
C. Notes This form is furnished t°give}rouasla(ementofactual WIdernentcns(s. Amounts paid to and by the settlement agen(are shown.
Items marked"(p.O.e f'were paid outside the closing:they are shown here for inlormational purposes end are not inclutled in the totals
E. Name and Address of Seller: F. Name and Address of Lender.
D. Name and Atldress of Borrower' Members let FCU
Alexander S.Thomas and P.O.Box 40
Kendra E.Thomas Estate of Winifred L,Grissinyer
Mechanicsburg,PA 17055
1290 North Mountain ftoatl
Hardsburg,PA 17112
G. Properly LocallOn:
H, Settlement Apat: I. Selllemenl Date.
8 Ntlmore CIrGe Mldstate Abstract Company
2331 Market Street April 25,201d
New Cumberland.PA 17070 Ph. (717)763-1303
Cumberland Covnty,Pennsylvania Camp Hill.PA 17011
Place of Settlement:
2331 Market Street
Camp Hill.PA 17011
section
J. Summary of Borrower's transaction K. Summary of SelleYS tran
ec
100. Gross Amount Due from Ben°wer: 400. Gross Amount DUe to Sell 1fi5.000.00
101. Conlmd sales price 165,000.00 401. ConlraG Sales rice
102. Peisnal to Pit 402. Personal ro ert
103. Settlement Char es to Borrower Line 1400 6,986.97 A03.
4M.
104. 405.
105.
Ad'uslmenls for items aidb Seller in advance Ad'ustmenls for items aidb Seller in advance
to 406. Cit Rown Taxes to
106. Cil (Town Taxes 709.20
107. Count IBOra Taxes 04125114 to 01101115 709.20 407. Count IBOro Taxes 04125/14 l0 01101115
100. School Taxes 04/25/14 to 07101114 27627 408. School Taxes 07/01/14 to 07101114 228.44
109, 2nd Qtr.Trash 04125114 l0 0]101/14 28.42 409. 2ntl Qlr.Trash 04/25114 to 07101114
110, 410.
111. 411.
412.
112.
120. Gross Also,Due from Borrower
173,000.86 420. Gross Amount Due to Seller 166,013.89
us Seller:
200. Amounts ous Paid b or in Behalf of Borrower 500, Reductions in Amount D
201. De oeitoreamestmone 3,000.00 501. Excess de osil seems eller(Li 11,691.96
202. P4nci al amount sinew loan s 146,500.00 502. Selllemen-.-ha ken Sell se Line 1400
203. Exislin loans taken sub'ed to 503. Existin loans taken Sup set to
204. Credit for A sisal Fee 425.00 504. Payoff First Mortgage
505. Pa ish Second Mod a e
05' 506,
206.
507. De osit tlisb.as roceeds
0T 508,2pg. 2,000.00
209. Seller Assist 2,000.OD 509. Seller Assist
Ad',,mramisforitemsun aidb Seller Ad'ustmants forneme un aidb Seller
to 510. CII /TOwn Taxes lO
210. Cit /Town Taxes to Boro
211. Count IB°ro Taxes to 511. Count Ilaxes xes
to 512. ScM1Oal Taxes t°
212. School Taxes 25.85
213, 2nd Qtr.Sewer 04101/1410 04125/14 25.85 513. 2nd Qlr.Sewer 04101/14 l0 04/25/14
214, 514.
215. 515.
517.
216.
2 518.
17 10,000.00
518. Escrow for btheritance Taxes to Misstate Abstract
218. 519.
219.
220. Total Paid b :for Borrower
153,950.85 520. Total Red uctmn Amount Due Seller 23.717.81
300. Cash at Settlement fromlte Borrower Ill! Gash al settlement Seller m Seller 166,013.89
301. Gross amount due from[conower line 120 15395085) 602. Less reductions tlueOSeller(Ine 52 0) ( 23,717.81 173,000,86
302 Less amount paid bylfor BOrm•wer(line 220) ( I 142,296.08
303. Cash X From To Borrower 19,050.01 603. Cash ❑X To From Seller
'ea'E ONSneorcl ming ey Mnwttl9l.sern(91.IantleAl).orrnr0.pe4y,T1
tement8 any a ltadt
The dersigned hereby acknowledge receipt of a completed copy of this Ste
m enls^refe�rre n
Gtl is he
un
Seller
p
Borrower, r. ,- <„ 'L'-' Estate of Wlnitre L Grissinger
�-Alexander S.Thomas
Kendra E. In0lias
�L.SetGement Charges
7UD.l otal Real Estate Broker Fees $8,400.00 Paid Fmm Paid From
DpIa/ m s 8ellefn w
y¢.04 i FRA-tdRT 'nt Funtlsat
t Wndael
702.$ 4075.00 to RFJMA%M1Si Alva tia9e _ Settkmart SeIDemrm_
703.Comniseon a'didse111ement 8400.00
704___
705.BrokerFee to RE/MAX tat Advanla e 400.00
800.items Pa able in Connection with Loan
BGi.Our or'gr-mmcnane _ F 69500 (fmm GFE#1)
802.Vourttetlit or charya(pain ts)tor the spedlici_nler Ii techosen S (from GFE#2)
803.Voor n�d'usted oiiglna0on charges from GFE#A7 59500
804.App,aiser fee to Maisie me lst FCU (fmn GFE V3 425.00
80.5-Crett at to (from GFEE#3ji_
8B6.Tax service to (from GFE#3 _
807.Flood oedifl.tton to ((mm GFE#3}
808. _ (Imrxl GFE#3
809. ry (from GFE#3
810 {(mm GFE#3
811 (from GFE'43)
900.Items Required by Lender to Be Paid in Advarme
901.Del1y interest rl)erpeeirom 04/1SIi4 to 06101/14 6 $17.79971 Imm GFE#10 100.80
9202,Me insuranpe premium for months to (from GFE#3)
90.1 HOmerovaoets insurd E 10 ears to Hpme le trxv2nwC
from GFE#11Pd'gv NP 32598285 911D0
904. _ _, S:mm Gp£#11
905 (from GFE#11}
1000.Reserves Deposited with Lender
1001.Initial deposiUor your escrow amount (fmrn jGFE#9) 1,190.17
hs @ S 7692 per mon7]0 1003-(dogglqe'rsumfCe oW f1 $ 3460 er month $1004. 9.63 „
. ty/Bpm Taxes 3000 Iun lh an 8 8594 per mnnth
School Taxes 1}000 months na $ 12291 per month
1005. $
1006. moorage (7g $ R o m $
1007 rnpnlhs @ $ per month $
1008. $
1009.Aggregate ESaow Adjustment S -647.42
1100,Title Charges
1101 Ron services and lenders bile insurance {from GFE#4 i,d60.00
1102. 5 tll nenl or dgsinq(ee $
1103.Owners title Insurance to Midsla to Abstract COP yl Asti IInmGFE#5) 80.00
1104,Lwdrai till MSSllfpnge to Khoo!lo AbshaIX Com an Insu wA t $ 1285.00 _
1105-L¢�ersi'tte po`wq later S 148:0000
1106.Owners title poikyl1 $ 165,000.00 -
1107.At ant's onion of the total line insurance mmlum to Midstate Abstract C p )v $ 1228.00
1108. Untlerwriter's portion of the total title insurance premium to Midstate Abslwol Cgmpanv Insu lance Ac „$ 147.00
109. $
1110. $
1111. $
1112. $
1113.
1200,Government Recording and Transfer Charges
1201.Government r Wav g P-g t C mbetand Cwniv ftemNerpf Deeds {(ran GFE#7} 160,00
1202.Deed $ 68.00 Mat $ 101 00 Releases S Other$
1203.1'ransler faxes t C b d ntlC nl Rewrtlor fDe d (t GfE#81 _ ifi5000
1204.Cil IComt to#shams Deed 1 050.00 Mort a p $
1,651-
1205.Slate tax [a
tsmp5 Deed $ 1 650 00 hhortasgx$ -
1206
1207.
1300.Additional Settlement Charges
1301.R uiletl services that vcan sho for _ {from GFE No
13322. $
1303. $
1304. $
1305. $
1306.Tax Cmifficaten to Robin Gaspero6i $ 10'00
13022014 CouNyiBOro Taxes to Robin Gasparelil,Tax Coitectnr $ 20-24-0809-265 1A31.30
1306.Home Wananly 1p Amenran Home Shield $ #145591722 460,00
1309.15IQ1r.Se...w1 dQlr.Trash to New Cumbedend Borough $ 135.66
1400.Total S-Wernent G6arge5{enteron lines"'I Section J and 502,Section N) j 8,986.97 11,691.96
'PalEpufsneottluinA�Y hortw+n{e).saiciS{.im4eAtY ar8ie6oa+l5(i}
By siglinA peeal WlaisslPlPMSnI,L O54�a1vl�PChmWN'�IRPp10{i CVnGeled apYdpage3dl0{INI61ryc6 PaAP5lafeP%ek
Mldeate Abstract G.n y,SettlementAgent
Cee4Ped to be a amt copy-
Co...paunch of Good Faith Estimate(GFE)and li Charges Good Faith Estimate HUD-1
Charges That Cannot Increase HUD-1 Line Number
Our origination charge
# 801 595.00 595.00
Your adjusted origination charges # 803 595.00 595,00
Transfer taxes M203 1,650.00 1,650.00
Charges That In Total Cannot Increase More than 10% Good Faith Estimate HUD-1
Government recording charges #1201 238.00 169.00
Appraisal tee # B04 425.00 425.00
Total 663.00 594.00
Increasebetween GFE and HUD-1 Charges $ -69.00 or -10.41
Good Faith ellon"s
Charges That Can Change
MUD-1
Initial deposit for your escrow account wool 1,454.73
# 901 $ 17]997001day 106.80 106.80
Daily interest charges . 500.00 911.00
Homeown ers insurance # 903
Title services antl lend era line insurance #1101 1,683.75 1,460 00
Ownefs title nsuroncelo MidslMe Abstract Company Insurance, #1103 82.50 80.00
Loan Terms
Your initial loan amount is $148,500.OD
Your loan term is 30.00 years
Your Initial interest rate Is 4.3]50%
Your initial monthly amount owed for principal,interest and 5781.04 includes
any mortgage insurance is Q Principal
O Interest
Q Mortgage Insurance
X ❑
Can your interest rate rise? Yes,it can rise to a maximum of _%. The first
❑ No
orange will be on_and can Grange again every_man Uts after
. Every change date,your Interest rate can increase or decrease
by %.Overtime life of the loan,your interest rate is guaranteed
to never be lower than %or higher than %.
Even if you make payments on time,can your loan balance rise? ❑X No ❑ Yes,it can rise to a maximum of$
Even If you make payments on time,can your monthly
❑X No ❑ Yes,the first increase can be on and the monthly
amount owed for principal,Interest,and mortgage insurance rise? amount owed can elo$
The maximum it w rann ever rise to is$__
Does your loan have a prepayment penalty? ❑X No ❑ Yes,your maximum prepayment penalty h$
Does your loan have a balloon payment? ❑X No ❑ Yes,you have a balloon payment Of$
due In_years on
Total monthly amount owed including escrow account payments ❑ You do not have monthly escrow payment for items,such as Property
taxes and homeowner's insurance. You must pay these items diredly
yourself.
❑X You have an additional monthly escrow payment of$284]]that results
in a total Initial monthly amount owed of$1,065.81. This Indudes
principal,interest,any mortgage insurance and any items checked below:
❑
X Property taxes ❑X Homeowners insurance
❑ Flood insurance ❑X School taxes
❑ ❑
Note: If you have any questions about the Settlement Charges and Loan Terms listed on Ihisform,please contact your lender.
HUD-1 Attachment
Borrower(s):Alexander S.Thomas and Kendra E. Selle(s): Estate of Winifred L.Grissing
Thomas
1290 North Mountain Road 8 Ardmore Circle
Harrisburg,PA 17112 New Cumberland,PA 17070
Lender:Members 151 FCU
Settlement Agent:Midslate Abstract Company
(717)763-1383
Place of Settlement:2331 Market Street
Camp Hill,PA 17011
Settlement Date:April 25,2014
Property Location:8 Ardmore Circle
New Cumberland,PA 17070
Cumberland County,Pennsylvania
Additional Adjustments For Items Paid By Seller In Advance(Borrower Debit)
Description Amount From/Through Prorated Amount
2nd Qtr.Trash 38.60 04/01/14 through 06/30/14 28.42
Total Line 1091409 28.42
Adjustments For Items Unpaid By Seller(Seller Debit)
Description Amount From/Through Prorated Amount
2nd Qtr.Sewer 98.00 04/01/14 through 06130/14 25.85
Total Line 213/513 25.85
Adjusted Origination Charge Details
Origination Charge 595.00
Origination Fee
to Members 1st FCU
Total $ 595.00
Origination Credit/Charge(points)for the specific interest rate chosen
Total $
Adjusted Origination Charges $ 595.00
Reserves Deposited with Lender
227.76
Homeowner's Insurance
3.000 at 75.92 per month 257.82
County/Boro Taxes
3.000 at 85.94 per month 1,352.01
School Taxes
11.000 at 122.91 per month -647.42
Aggregate Escrow Adjustment
Total $ 1,190.17
Title Services and Lender's Title Insurance Details BORROWER SELLER
75.00
Closing Service Letter
to Midstale Abstract Company
50.00
Electronic Doc. Preparation
to Midslate Abstract Company
WARNING: It is a crime to knowingly make false statements to the United Stales on this or any similar form. Penalties upon conviction can
include a fine and imprisonment. For details see: Title 18 U.S.Code Section 1001 and Section 1010.
HUD-'I Attachment- Continued
15.00
Wire Fee
to Midstate Abstract Company
N 10.00 S.OD
Notary Fee
to Midstate Abstract Company
Overnight Fees
5.00
to Midstate Abstract Company
Lender's title insurance 1,295.00
to Midstate Abstract Company Insurance Acct.
Total $ 1460.00 $ 5.00
Owner's Title Insurance BORROWER SELLER
Owners Policy Premium 80,00
to Midstate Abstract Company Insurance Acct.
Total $ 80.00 $ 0.00
Lender's Title Insurance BORROWER SELLER
'fees also shown above in Title Services and Lender's Title brsurance Details
Lender's Policy Premium 1,145.00
to Midstate Abstract Company Insurance Acct.
Lender's Endorsement Charges 150.00
Endorsement Endorsement Charge
PA 1 D0, 300,81 150.00
Total $ 1,295.00 $ 0.00
WARNING: It is a crime to knowinglymake false statements to the United stales on this orany similarform. Penalties upon conviction can
include a fine and imprisonment. For details see: Title 18 U.S.Code section itiol and section 1010.
I, WINIFRED L. GRISSINGER, of the Borough of New Cumberland, Cumberland
County, Pennsylvania, declare this to be my last will and revoke any will previously made by
me.
ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker
and all expenses of my last illness, and any and all taxes and assessments imposed by any
governmental body as a result of my death,whether on property passing under this will or
s otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a
part of the expense of the administration of my estate.
ITEM H. I give and bequeath all of my household goods, automobiles,jewelry, and all
other articles of household and personal use, equipment and ornament, together with all
insurance thereon and relating thereto, as follows:
A. Seventy-five (75%) Percent to my son GREGORY GRISSINGER
provided he survives my death by sixty days. Should he predecease me or not
survive my death by sixty days, then fifty (50%) percent of his share hereunder
shall go to my great-granddaughter JAMIE YOST and the remaining fifty (50%)
percent shall go to my grandson,BRADLEY SCOTT GRISSINGER,
B. Twenty-five (25%) Percent to my great-granddaughter JAMIE YOST
provided she survives my death by sixty days. Should she predecease me or not
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survive my death by sixty days,then her share hereunder shall go to my grandson
BRADLEY SCOTT GRISSINGER.
ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my
possessions and estate of every nature and wherever situate as follows:
0
A. Seventy-five (75%) Percent to my son GREGORY GRISSINGER
provided he survives my death by sixty days. Should he predecease me or not
survive my death by sixty days,then fifty (50%) percent of his share hereunder
shall go to my great-granddaughter JAMIE YOST and the remaining fifty (50%)
percent shall go to my grandson, BRADLEY SCOTT GRISSINGER.
B. Twenty-five (25%)Percent to my great-granddaughter JAMIE YOST
provided she survives my death by sixty days. Should she predecease me or not
survive my death by sixty days,then her share hereunder shall go to my grandson
\v
BRADLEY SCOTT GRISSINGER.
ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to
anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or
attachment.
ITEM V. I appoint my son GREGORY GRISSINGER executor of this my last will.
Should my son predecease me or otherwise fail to qualify or cease to serve as executor of this my
last will, I appoint my grandson BRADLEY SCOTT GRISSINGER executor of this my last will.
ITEM VI. In addition to the other powers and authorities granted to my personal
representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby
give to my personal representatives the following powers and authorities effective without court
2
approval and until actual distribution of all property: to compromise any claim or controversy;
to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as
my personal representatives may determine and at valuations finally to be fixed by them; to
invest in all forms of property, including any stock or other securities in any corporate fiduciary
or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my
personal representatives deem proper, without regard to any principle of risk or diversification;
to retain any or all assets of my estate, real or personal, without regard to any principle of risk or
diversification; to sell at public or private sale,to exchange, or to lease for any period of time,
any real or personal property and to give options for sales, exchanges, or leases, for such prices
and upon such terms or conditions as my personal representatives deem proper; and to allocate
receipts and expenses to principal or income or partly to each as my personal representatives
deem proper in their sole discretion.
ITEM VII. I direct that my personal representatives and fiduciaries shall not be required
to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this day of
i,c.• _ 2007.
r
4L'
WINIFRED L. GRISSINGER
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The preceding instrument, consisting of this and THREE other typewritten pages, each
identified by the signature of the testatrix was on the date thereof signed, published, and declared
by WINIFRED L. GRISSINGER, the testatrix therein named, as and for her last will, in the
presence of us, who at her request, in her presence, and in the presence of each other, have
subscribed our names as witnesses hereto.
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COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF CUMBERLAND )
The undersigned,being the testatrix whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, does hereby acknowledge that I signed and
executed the foregoing instrument as my last will,that I signed it willingly; and that I signed it as my free
and voluntary act for the purposes therein expressed.
WINIFRED L_'GRISSINGER
SSt,Qrn or affirmed to and acknowledged
before m^by the testatrix named above
this day off ' J j /��tz 2007.
-:I otary Public. , Noads!SS !
ta':•rer Fdl v:Tub.,C_r Na.and Ce¢rty
i My Com m is�on E:.T;res"0 ,j 10,2011
Pennsylvania Associa on cf Notades
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF CUMBERLAND )
\'!
WE, and the
witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according
to law,do depose and say that we were present and saw the testatrix sign and execute the instrument as
her last will; that she signed it willingly and that she executed it as her free and voluntary act for the
purposes therein expressed;that each of us in the hearing and sight of the testatrix signed the will as
witnesses; and that to the best of our knowledge,the testatrix was at that time 18 or more years of age, of
sound mind, and under no constraint or undue influence.
$worn.o;affirmed to-and acknowledged
before `ie this. . 1r' R'�-day of
�: .( '4�.(.cl 1' 2007.
Qla.Ti,♦'3Pl3hilieTFi OF PPNidfi1�.VAh{F1' ,
IVC4.r,'al:adi
v✓�-r.�;r..srrc�.;data: ,p.,wl!c.
j �a:arH!i�,'s.x•1z.:;umt'e�t:,u Ccunt�,
Nry cor,!�:15alCn G�'Ni25 1l1?y 1v�,2�1 1
Pannsylvunla;kssociation of No':abess
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