HomeMy WebLinkAbout10-02-14 (2) J 1505610105
REV-1500 EX(e2-I1)(n,
enns Lvania
Bu -OFFICIAL USE ONLY
Department of Revenue P Y County Code Year File Number
Bureau of Individual Taxes
PO BOX 28o6o1
INHERITANCE TAX RETURN �
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
01101/2014 06/18/1927
Decedent's Last Name Suffix Decedent's First Name MI
Amig Donna B
--- ...._. ----
(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
j REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
OD 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)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust B. 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
..........
Laura C. Reyes Maloney (717)233-5292c> o
------ - -- --- ---- �- -- — a
REGISTER 0F' 0C 6 USE O� rn fT1
t-,,
T n y O
2'a
First Line of Address ? :,> "-1 O
----------- Cr: ::T N 'IT M
1119 N. Front St. c�
Second Line of Address
ATE FILED N r R7
City or Post Office -- - --_ State ZIP Code
tn.p
^Harrisburg PA 17102 N _
Correspondent's e-mail address: maloneydirect @gmail.com
Under penalties of perjury,1 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.Dectaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE ORSOy RESPONSIBLE FOR FILING RETURN DATE
ddCCAAII�� ddYY "/A//L`9BLE 10101/2014
ADDRESS
115 N. Sporting Hill Rd., Mechanicsburg, PA 17050
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
(V S� . l�arrTSbv�l , PA ;�Iioa
PLEASE UTG ORIGINAL FORM ONLY
Side 1
1505610105 1505610105
1505610205
REV-1500 EX(Fl)
RECAPITULATION
1. Real Estate(Schedule A). . .. ... .... . . . .. . ..... ... . .. . . . ... .. . 1. ! 122,000.00
2. Stocks and Bonds(Schedule B) .............. . ......... . ....... . .... .. 2. 0.00
1
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) .. . . . 3. L 0.00 '.
i
4. Mortgages and Notes Receivable(Schedule D)... ............. . .... . ..... 4. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).. ..... 5. 9,697.13
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 0.00
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) C=) Separate Billing Requested........ 7. 0.00
8. Total Gross Assets(total Lines 1 through 7)... ..... ..................... 8.
131,697.13
9. Funeral Expenses and Administrative Costs(Schedule H). ........ .... ...... 9. 44,982.92
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 60,355.94
11. Total Deductions(total Lines 9 and 10).......... ..................... .. 11. 105,338.86
12. Net Value of Estate(Line 8 minus Line 11) ........ ...................... 12. 26,358.27
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. - 26,358.27
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 -__-- ---- -___-- _-_--
at lineal Xf L X.0 45 24,358 27 15.
16. Amount of Line 14 taxable r
16.1 1,096.12
17. Amount of Line 14 taxable -----'®®. �.-.----------
at sibling rate X.12 17.
18. Amount of Line 14 taxable
�.
at collateral rate x.15 2,000 00 18 300.00
19. TAX DUE .... .... .. ___ ........ ..... .... 19. 1,396.12
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=)
Side 2
1505610205 1505610205 J
. .
REwmwEX(R) Page; File Number
Decedent's Complete Address:
DECEDENT's NAME
Donna B. Amig
529 Brighton Place
CITY I -STATE -T
Mechanicsburg
PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2.Line iN (1) 1,396.12
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B> (2) 0.00
1 |otemo
pV 0.00
4. |f Line 2is greater than Line i +Line l enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2'Line 20tv request arefund. (*) 0.00
5. |f Line 1 +Line 3isgreater than Line 2'enter the difference.This io the TAX DUE. (5) 1'386.12
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING ANnXoIN THE APPROPRIATE BLOCKS
1. Did decedent make u transfer and: Yes No
u. retain the use vr income of the property transferred.......................................................................................... [] N
b. retain the right to designate who shall use the property transferred or its income ............................................ [l N
c retain u reversionary interest............................................................................................................. ............... [] 0
d. receive the promise for life o/either payments,benefits m care?..................................................................... [] 0
l If death occurred after Dec.12,1982,did decedent transfer property within one year mdeath
without receiving adequate consideration?.............................................................................................................. Fl 0
1 Did decedent own om"in trust for"or bank account msecurity at his'x her death?............ [] E
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains o beneficiary designation? ........................................................................................................................ [] E
|F THE ANSWER TO ANY OFTHE 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 o/the surviving spouse
io3 percent[72PS.§9116(a)(11)(i)]
For dates o<death onor after Jan. 1' 1985, the tax rate imposed onthonetva|ooufkandemtoorfnr@ymmo( theoumivin0opoon* is0poneN
[72 PD.§9116(a)(1.1)(ii)].The statute does not exempt a transferto a surviving spouse from tax.and the statutory requirements for disclosure oy assets and
filing a tax return are still applicable even ifthe surviving spouse is the only beneficiary.
For dates of death ono,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 t>or for the use o(a natural parent,an
adoptive parent ora stepparent n(the child io0 percent[72P8.§0116(a)(12)].
* The tax rate imposed on the net value m[transfers toorhx the use o|tho decedent's lineal b000fiduriooio4.5 percent,except uo noted in[72PS.§9110(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 172PV.§9110(a)(13)].A sibling iodefined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND SS File Number 2014-00011
Personal Representative(s)of the Estate of DONNA B.AMIG
deceased,depose(s)and say(s)that the items appearing in the following inventory include all of the personal assets wherever situate
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent,that the valuation placed opposite each item of said
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory.
I verify that the statements made in this Inven-
tory are true and correct. I understand that false state-
ments herein are made subject to the penalties of
18 Pa.C.S. § 4904 relating to unswom falsification to
authorities.
Attorney-- (Name) Laura C.Reyes Maloney,Esquire (Supreme Court I.D.No.) 78075
(Address) 1119N.Front St.,Harrisburg,PA 17102
(Telephone) 717-233-5292
DATE OF DEATH LAST RESIDENCE DECEDENPS SOC.SEC.NO.
01/01/2014 529 Brighton Place,Mechanicsburg,PA 17055 210-18-8879
FIGURES MUST BE TOTALED
1. RE: 529 Brighton Place,Mechanicsburg,PA 17055 122,000.00
2. House contents,furniture,antiques 2,003.65
(Attach additional sheets as needed)
TOTAL: 124,003.65
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each
item,but such figures should not be extended into the total of the Inventory. (See 20 Pa.C.S.§3301(b))
Form RW-09 rev.10.13.06
REV-1502 EX+ (12-12)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DONNA B. AMIG 2014-00011
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,.bath 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 OF DEATH
DESCRIPTION
1529 Brighton Place,Mechanicsburg,PA 17055 see enclosed settlement statement 122,000.00
t
I
i
' I
I
I
I
,
I
i d
I-- — -
TOTAL(Also enter on Line 1, Recapitulation.) 1 1
If more space Is needed,use additional sheets of paper of the same size.
REV-150}EX,(a-v)
fi pennsylvania SCHEDULE B
•• ��rr DEPARTMENTOFREVFNUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DONNA B. AMIG 2014-00011
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1' NONE 0.00
1
I
~ I
TOTAL(Also enter on Line 2, Recapitulation) ; 0.00
If more space Is needed,Insert additional sheets of the same size
REV.r5o4 a.(9-W
. pennsylvania SCHEDULE C
1 DEFARrMENTOFREVENUE CLOSELY-HELD CORPORATION,
INHERITANCE TAX RETURN PARTNERSHIP OR
RESIDENT DECEDENT SOLE-PROPRIETORSHIP
ESTATE OF FILE NUMBER
DONNA B. AMIG 2014-00011
Schedule C-I or C-2(including all supporting information)must be attached for each closely-held corporation/partnership interest of the decedent,
other than a sole-proprietorship.See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM NUMBER VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t, NONE 0.00
I
— - I
I 1
t-
I
TOTAL(Also enter on line 3, Recapitulation) 0.00
(If more space is needed,insert additional sheets of the same size)
REV-1507 EX+(04-13)
pennsylvania SCHEDULE D
DEPARTMENT OF REVENUE MORTGAGES & NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DONNA B. AMIG 2014-00011
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
NONE I 0.00.
I
'
I --- --- -
1.I-.------
_--JN
L -
TOTAL(Also enter on Line 4,Recapitulation) $ _ _ _ 0.00'
(If more space is needed,Insert additional sheets of the same size.)
REV-i5o8 EX+(o8az)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DONNA B. AMIG 2014-00011
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. Members 1st Federal Credit Union-Checking Account(see enclosed statement) 949.21
2. Members 1st Federal Credit Union-Savings Account(see enclosed statement) 6,294.54
3. Members 1st Federal Credit Union-Supplemental Savings(see enclosed statement) 153.85
4. Members 1st Federal Credit Union- Money Market(see enclosed statement) 295.88
5. House contents,furniture,antiques 2,003.65
I
li
I •-- — I
I
II
TOTAL(Also enter on Une 5, Recapitulation) $ i i 9,697.13
If more space is needed,use additional sheets of paper of the same size.
' REV-J5og EX+(oJno) '
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE J
INHERITANCE TAX RETURN OINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DONNA B.AMIG 2014-00011
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)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.None ... - .
I i
I , �
i
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH
ITEM FOR XHMT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUWT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT ���JOINT "�� IDFNnFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
❑ =1 ____..�____----.— _--� _ _ar ❑ ❑❑
FE
❑ ❑ ---_._ ..........
.
Ell D ED
❑ ❑ I ❑
❑ __ _ . _.____---____-._ ._._-__._-.-.
❑ L )I
TOTAL(Also enter on Line 6, Recapitulation)
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
i pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DONNA B. AMIG 2014-00011
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION TH PROPERTY DATE OF DEATH %OF DECO'S EXCLUSION TAXABLE
InauoE ra nne a ra Tnu+srRrE•rain uunorrsav ro oEaoEm um
NUMBER raven or inNl4FR Araa Aavram[o¢oronRw rsrAn:. VALUE OF ASSET INTEREST oranuuNEl VALUE
1. 'None L _ 0.00
fi
i
f
n
I
—..J ._.__...._._:—_..____.�.�.�...._-......
i U __• \
L. - -
__ _._____�_-.---.-._____
TOTAL(Also enter on Line 7, Recapitulation) ¢ r 0.00
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
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DONNA B. AMID. 2014-00011
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Myers-Harner Funeral Home, Inc.(funeral goods and services) 7,881.00
2.1 'Flowers Blooms by Vickrey
L 3 4 Mechanicsburg Cemetery —� 664.00)
L4 j ILGingrich Memorials(engraving stone) --- - �u—- — -�--`~ —�� ��80.0
F1 F-
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 3,928.44
Name(s)of Personal Representative(s) Donna Wood
Street Address 115 N. Sporting Hill Rd.
City Mechanicsburg State PA ZIP 17050
Years)Commission Paid: 2014
5,
2. Attorney Fees: - 611.82
3. Family Exemption:(If decedent's address is not the same as daimant's,attach explanation.)
Claimant
Street Address -
city State_ZIP
Relationship of Claimant to Decedent
�r
4. Probate Fees: 163.50
5. Accountant Fees: 800.00
6. Tax Return Preparer Fees: 0.00
7. Real property maintenance(including taxes,condo fees,PP&L,sewer bill,waste disposal,water,etc.) 7,858.19
s. Advertising Notice-Cumberland Co.Law Journal v — -- � 75.00
Cs� IAdvertising Notice_The Sentinel _^ — _ 126.82
to. Selling Costs(see enclosed settlement statement) 17,685.67
F-2] —
TOTAL(Also enter on Line 9, Recapitulation) $ — 44,982.92
If more space is needed,use additional sheets of paper of the same size.
REV-1512 Ex+ (12-12)
pennsylvania SCHEDULE I .
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHEWANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DONNA B. AMIG 2014-00011
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 Manor Care Health Services 1,295.00
2.1 Quicken Loans-mortgage(see enclosed statement) 58,919.98
East Pennsboro Ambulance
4.1 Heartland Pharmacy X12.11
5.i CVS Caremark-medicine 28.88 -
6. Special Event Emergency(ambulance) 40.98
7.l PinnacleHealth , 23.99
i -
J I —
TOTAL(Also enter on Line 10, Recapitulation) $
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+ (01-10) '
pennsylvania SCHEDULE
DEPARTMENT DF REVENUE
INHEMANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DONNA B. AMIG 2014-00011
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).) '
I. 'Brenda Lutz Friend $1,000.00 ,
-
_
J Donna Wood f ;Friend $1,000.00
3 Michael C. Stoner _ V _ —� Grandson --- -ter mafnder
�
,
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:
El1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
I
!......J L._._._ _.._..__—...- ___...._.__.r......_..v.------i ..
t--J L —
TOTAL OF PART H- 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. -
REGISTER OF WILLS _ ERTIFICATE OF
CUMBERLAND COUNTY Q�� V,RANT OF LETTERS
PENNSYLVANIA ! '
� � s
No. 2014- 00011 PA No. 21- 14- 0011
Estate Of: DONNA B AMIG
/Firs/,M;ddla.Cast)
Late Of: L 0 WER A L L EN TO WNSHIP
CUMBERLAND COUNTY
WHEREAS, on the 7th day of January 2014 an instrument dated
April 23rd 2013 was admitted to probate as the last will of
DONNA B AMIG
LFYst Middla.Leso
late of LOWER ALLEN TOWNSHIP, CUMBERLAND County,
who died on the 1st day of January 2014 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, LISA M. GRAYSON, ESQ. Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARYto:
DONNA L WOOD
who has duly qualified as EXECUTOROIX)
and. has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURTHOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 7th day of January 2014.
eg (
e9lste r a a s
Gl iti e, /Vl--k f14
e, ut
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
RECORDED OFFICE OF
-7
REGISTER OFYPLLS
LAST WILL AND TESTAMENT-1111 ,if'I�J 1 Fin I 8 lg
CLERK OF
BE IT REMEMBERED THAT
ORPHANS' COURT
CUMBERLAND CO., PA
1, DONNA B. AMIG, a resident of Cumberland County, Pennsylvania,
being of sound mind, memory and understanding, do make, publish and
declare this to be my LAST WILL AND TESTAMENT, hereby revoking any and
all Wills and Codicils previously made by me.
I
I direct that all my just debts and funeral expenses shall be paid from my
residuary estate as soon as practicable.after my decease.
II
I direct that all taxes that may be assessed in consequence of my death,
of whatever nature and by whatever jurisdiction imposed, shall be paid from
my residuary estate as a part of the expense of the administration of my estate.
III
I give and bequeath the sum of ONE THOUSAND DOLLARS ($1,000.00) to
BRENDA LUTZ, per capita and the sum of ONE THOUSAND DOLLARS
($1,000.00) to DONNA L. WOOD, per capita.
IV
All the rest, residue and remainder of my property, whether real or
personal, wherever situate, including any property over which I may have a
power of appointment I give, devise and bequeath to my grandson, MICHAEL C.
STONER, per stirpes.
I ",,III inr(c, o,lvdih.ttc i,wd ;ipj)uint DONNA I,. WOOD, ns Gxc<:ul rix of this
LAST WILL, to scree without_ bond.
IN WITNESS WHEREOF, 1, DONNA B. AMIG, have set my hand to this
LAST WILL this day of 2013.
t76
DONNA B. AMIG
Signed, sealed, published and declared by the above-named DONNA B.
AMIG, as and for her Last Will and Testament, in the presence of us, who, at her
request and in her presence, and in the presence of each other, have hereunto
subscribed our names as witnesses.
j
��fvlhAf�(dWtsAI,TJ=1 t�[�i�t�NNf;�Y[.UANln
COUNTI' 01' CIJMI,iIi RLANIS
I, DONNA 13, AMIG, Test,ntrie, whose nanlc is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my LAST WILL; that I
signed it as my free and voluntary act for the purposes therein expressed.
DONNA B. AMIG
Sworn or affirmed to and acknowledged before me by DONNA B. AMIG, Testatrix,
this ,, "4 day of i'1 2013.
COMMONWEALTH OF PENNSYLVANIA n
Notarial'Seal Public
Sumn L.Houck,Mecryanl�urg Room Cumba land O unry Notary Public
My CommbSaGA UPIM Dec.3,2016
MEMBER,.ENNStVANIA ASECCATIDN pF rypTApIES
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND/
We, / u '12 � and -6
being the witness whose names are signed to the attached or foregoing instrument,
being duly qualified according to la do depose and say that we were present
and saw Testatrix sign and execute the instrument as her LAST WILL, that-
DONNA B. AMIG signed 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 the time 18 years of age or more, of sound mind
and under no constraint or undue influence.
/t Sri////.i"A//J' "✓/���C�(.f
Sworn or affirmed to and-acknowledged before me
this � th day of 1 pr 1 I 2013.
COMMONWEALTH OF PENNSYLVANIA -
Not Set
Susan L.Houck,Notary Public
UanYSBurg glom,CmDetlaod county
Commtsalon Er uas Dm 3,2016 1 Notary Public
MEM&^R eENNSYIVANIA L50OAT10N 01 WTWU
..Settlement Statement U.S.Department of Housing OMB Approval No.2502-0265
and Urban Development
3.Type of Loan
.( ]FHA 2.[ ]RHS 3.[ ]Conv.Unins. 6. File Number: 7.Loan Number: 8.Mortgage Insurance Case Number:
[ ]VA 5 [ ]Conv. Ins. 401401909-SW ri t JM
NOTE:This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shown.items
marked '(p.o.c.)"were paid outside of the closing:they are shown here for informational purposes and are not included in the totals.
).Name and Address of Borrower E. Name and Address of Seller F.Name and Address of Lender
>TEVEN M.KRANTZ THE ESTATE OF DONNA B.AMIG
PA
529 BRIGHTON PLACE
MECHANICSBURG,PA 17055
G.Property Location H.Settlement Agent
29 BRIGHTON PLACE, SECURED LAND TRANSFERS,LLC
1ECHANICSBURG,PA 17055
Place of Settlement I.Settlement Date 07/14/2014
:OUNTY:CUMBERLAND 485 ST.JOHNS CHURCH ROAD
ARCEL ID:42-24-0791-164-U529 SHIREMANSTOWN,PA 17011 Disbursement Date 0711412014
OWNSHIP:UPPER ALLEN TOWNSHIP
I.SUMMARY OF BORROWER'S TRANSACTIONS K.SUMMARY OF SELLER'S TRANSACTIONS
00.Gross Amount Due From Borrower 400.Gross Amount Due To Seller
01.Contract Sales Price $122,000.00 401.Contract Sales Price $122,000.00
02.Personal Property - 402.Personal Property
03.Settlement Charges to Borrower $2,938.00 403.
ldjustments For Items Paid By Seller In Advance Adjustments For Items Paid By Seller In Advance
13.City/Town Taxes 413.City?own Taxes
14.County Taxes 689.7900/yr 07/14/14 to 01101115 $32316 414.County Taxes 689.7900/yr 07114/14 to 01/01/15 $323.16
15.School Taxes 1,971.77/yr 7/1412014 to 7/1/2015 $1,901.54 415.School Taxes 1,971.771yr 7/1412014 to 7/1/2015 $1,901.54
18.Assessments 418.Assessments
19. 419.
21.3rd Quarter Sewer Bill 718/9 112.00/qtr for 7/14/2014 $96.17 421.3rd Quarter Sewer Bill 7/819 112.00/gtr for 7/14/2014 $96.17
310/112014 to 1011/2014
22.Monthly HOA Dues for July 157.00/mo for 7/1412014 $91.16 422.Monthly HOA Dues for July 157.00/mo for 7/14/2014 $91.16
a 811/2014 to 8/112014
20.Gross Amount Due From Borrower $127,350.03 420.Gross Amount Due To Seller $124.412.03
:00.Amounts Paid By Or In Behalf Of Borrower SOO.•Reductions In Amount Due To Seller
.01.Deposit or earnest money $20,000.00 501.Excess Deposits -
:02.Principal 502.Settlement Charges to Seller - $17,685.67
:03.Existing Loan(s)Taken Subject to 503.Existing Loan(s)Taken Subject to
:04. 504.Payoff First Mortgage to Quicken Loans $58,728.77
ldjustments For Items Unp0id By Seller Adjustments For Items Unpaid By Seller
10. 510.
11. 511.
:12. 512.
13.City/Town Taxes 513,Cityrrown Taxes
.14.County Taxes 514.County Taxes
:18.Assessments 518.Assessments
:19.HOA 1519,
:20.Buyer's Total Credits $20,000.00 520.Seller's Total Charges $76,414.44
',00.Cash At Settlement From/To Borrower 600.Cash At Settlement To/From Seller
.Ol.Gross Amount Due From Borrower(line 120) $127,350.03 601.Gross Amount Due To Seller(line 420) $124,412,03
:02.Less Amounts Paid By/For Borrower(line 220) $20,000.00 602.Less Deductions In Amt.Due To Seller(line 520) $76,414.44
�03.Cash[X]From[ ]To[X]From To Borrower�$107,350.031603.Cash[X]To[ ]From Seller $47,997.59[X]To[ ]From Seller�$47,997.59
401401909-SW Page 2
L.Settlement Statement
700.Total Sale Commission 122000.00 @ 3%=3660.00
Division of Commission(line 700)As Follows: Paid From Borrower's Paid From Seller's
701.Commission Listing Funds At Settlement Funds At Settlement
702.$3660.00 to Cordier Auctions&Appraisals
703.Commission paid at settlement $3,660.00
800.Items Payable In Connection With Loan
801. Loan Origination Fee
802.Loan Discount
803.Appraisal Fee
804.Credit Report
805,Lender Inspection Fee
900.Items Required By Lender To Be Paid In Advance
901 . Interest
902.Mortgage Insurance Premium
903.Homeowner's Insurance
904 .Flood Ins.Premium
1000.Reserves Deposited With Lender
1001.Hazard Ins.Reserve
1002.Mortgage Ins.Reserve
1003.City Property Taxes
1004.County Property Taxes
1010.Aggregate Accounting Adjustment
1100.Title Charges
1101,Settlement/Closing Fee to Secured Land Transfers,LLC $100.00
1102.Abstract or Title Search
1103.Title examination
1104.Title Insurance Binder
1105.Document preparation Deed Prep.Fee to Secured Land Transfers,LLC $100.00
1106.Seller Notary Fee to Secured Land Transfers,LLC $10.00 $10.00
1107.Attorney Fee
1108.Title Ins.Total to Secured Land Transfers,LLC $1,010.00
1109.Lender's Coverage$0.00($)
1110.Owner's Coverage$122000.00($1010.00)
1119.Wire Transfer Fee Wire Payoff to Secured Land Transfers,LLC g45,00
1200.Government Recording And Transfer Charges
1201.Recording Fees foI Deed 67.00;Recording Fees for Mortgage $67.00
1202.City/County Tax/Stamps 1220.00 $1,220.00
1203. State Deed Tax 1220.00 $1,220.00
1300.Additional Settlement Charges
1305.Advertising Fee to Cordier Auctions&Appraisals $1,070.90
1306.2nd Quarter Sewer Bill 4/516 to Upper Allen Township Authority - $112.00
1307.July HOA Due Flue Late Fee to Brighton Place Condominium Association $157.00
1308. 2014 School Taxes to Dennis Zerbe,Tax Collector $1,971,77
1309. Escrow for Inheritance Taxes to Secured Land Transfers-Mechanicsburg $8,235.00
1310.HOA Resale Cart.to Brighton Place Condominium Association $75.00
1311.Capital Expenditure Fee to Brighton Place Condominium Association $471.00
1312. Unpaid Special Assessment to Brighton Place Condominium Association $917.00
1313.HOA Questionnaire Fee to Sterling Property Management,Inc. $60.00
1314.3rd Quarter Sewer Bill 7/8/9 to Upper Allen Township Authority $112.00
1400.Total Settlement Charges $2,938.00 $17,685.67
have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief it is true and accurate statement of all receipts and disbursements
made on my account or by me in this transaction.I further certify that 1 have received a copy of the HUD-1 Settlement Statement.
BUY SELLERS
Krantz
The state of Donna B.A m ig
M.
.W-4 oS•f'AN A/O/IU�iZi
Ist Members Ist Federal Credit Union 01/01/2014 01/31/2014 1 of 3 XXXXXXX717
5000 Louise Drive
P.O.Box 40
Mechanicsburg PA 17055-0040
o (800)237-7288
1° 017)(.97-5312 0 fearing Impaired)
MEMBERS
rrmnucn rnrt nmos "'"'"'.mcmhcrslst.org
m
DONNA B AMIG
C/O DONNA WOOD
115 N SPORTING HILL RD
MECHANICSBURG PA 17050
28M
ACCOUNT
Your current Member Loyalty Rewards level is Silver. Your aggregate balance as of January 1 st is$7;693.48,y
An aggregate balance of$15,000 and having 3 products will move you to the Gold level.
CHECKING 0.00
SAVINGS 0.00
CERTIFICATES 0.00
LOANS 0.00
CHECKING 0t
BEGINNING BALANCE:.. $949.21
Eff. Post
Date Date Description Deposits Withdrawals Balance
01/02 01/02 Deposit Transfer From Share 0000 413.45 1,362.66
01/02 01/02 Deposit ACH FIDELITY INVESTM 708.02 2,070.68
TYPE: PENSION ID: 9000676483 DATA: DB729155-008729155
CO: FIDELITY INVESTM
01/03 01/03 Deposit Transfer From Share 0000 1,273.00 , 3,343.68
01/06 01/06 Check 005336 Tracer 0000298494 11.42 3,332.26
01/06 01/06 Check 005335 Tracer 0000275304 187.19 3,145.07
01/07 01/07 Withdrawal Transfer To Share 0000 1,273.00 1,872.07
01/15 01/46 Check 005334 Tracer 0000350126 157.00 1,715.07
01122 01/22 Deposit 14.00 1,729.07
01/22 01/22 Withdrawal 1,729.07 0.00
01/22 CHECKING CLOSED
'This is the final statement presenting information on this product
Please retain this final statement for tax reporting purposes.
ENDING BALANCE: $0.00
Check# Date Amount Check# Date Amount Check# Date Amount
5334 01116 157.00 5335 01106 187.19 5336 01/06 11.42
Indicates check out of sequence 3 Checks Cleared for 355.61
Total Deposits 2,408.47 Total Wthdrawals 3,357.68
n
DATE FROM DATE TO PAGE ACCOUNTNUMBER
r 1 MEMBERS 1"
veuenAILMMITU'non 01/01/2014 jUl/31/20141 2013 XXXXXXX717
REGULAR SAVINGS rrrt
BEGINNING BALANCE: $6,294.54
Eff. Post
Date Date Description Deposits Withdrawals Balance
01/02 01/02 Deposit ACH 48 HAMPDEN NON-U 413.45 6,707.99
TYPE: RET PMT ID: 1251900215 DATA:A10LETORT TRUST
CO:48 HAMPDEN NON-U
01/02 01/02 Withdrawal Transfer To Share 0011 413.45 6,294.54
01/03 01/03 Deposit ACH XXSOC SEC 1,273.00 7,567.54
ID: 9031736042 CO:XXSOC SEC
01/03 01/03 Withdrawal Transfer To Share 0011 1,273.00 6,294.54
01/07 01/07 Deposit Transfer From Share 0011 1,273.00 7,567.54
01/03 01/07 Withdrawal ACH XXSOC SEC 1,273.00 6,294.54
MEMBER DECEASED DOD 1/1/14
01/22 01/22 Deposit 2,178.82 8,473.36
01/22 01/22 Deposit Dividend 0.52 8,473.88
Annual Percentage Yield Earned 0.150%from 01/01/14 through
01131/14
01/22 01/22 Withdrawal 8,473.88 0.00
01/22 REGULAR SAVINGS CLOSED
'This is the final statement presenting information on this product
Please retain this final statement for tax reporting purposes.
ENDING BALANCE: $0.00
Total Deposits 5,138.79 Total Withdrawals 11,433.33
trr
BEGINNING BALANCE: $153.85
Eff. Post
Date Date Description Deposits Withdrawals Balance
01122 01/22 Deposit Dividend 0.01 153.86
Annual Percentage Yield Earned 0.110%from 01/01/14 through '
01/31/14
01/22 01/22 Withdrawal 153.86 0.00
01/22 SUPPLEMENTAL SAVINGS CLOSED
*This is the final statement presenting information on this product . .
Please retain this final statement for tax reporting purposes. .
ENDING BALANCE: $0.00
Total Deposits 0.01 Total Withdrawals 153.86
MONEY rrl
BEGINNING BALANCE: $295.88
Eff. Post
Date Date Description Deposits Withdrawals Balance
01/22 01/22 Deposit Dividend 0.01 295.89
Annual Percentage Yield Earned 0.060%from 01/01/14 through
01/21/14
01/22 01/22 Withdrawal 295.89 0.00
01/22 MONEY MANAGEMENT CLOSED
'This is the final statement presenting information on this product
Please retain this final statement for tax reporting purposes.
ENDING BALANCE: $0.00
Total Deposits 0.01 Total Withdrawals 295.89
S"
MEMBERS 1°' �
rFDFAALCRMIT UNION 01/01/2014 01/31/2014 3 of 3 XXXXXXX717
TOTAL DIVIDENDS PAID
0000 REGULAR SAVINGS 0.52
0001 SUPPLEMENTAL SAVINGS 0.01
0005 MONEY MANAGEMENT 0.01
0011 CHECKING 0.00
Total Year to Date Dividends Paid (Includes Closed Shares) 0.54
r
aj ng �cenwans STATEMENTS BIDING STATEMENT
Engineered TG Amaze STATEMENT ENCLOSED
+ 0459071 000000815 09QLB1 0098670 P6 -Ay ONLINE ak
Com
DONNA B AMIG
529
529 BRIGHTON PL Statement Date Due Date Amount Due
MECHANICSBURG PA 17055-5483 12118/13 02/01/14 $526.47
IIIIII�IPIIII-Ir-IdIIIhIII IIIIJill IIII III IIIIIIIII1r1IIIII --�
Quick and Easy Pay Options
�d Pay online at MyQL.com. Pay-by-Phone with 24/7 access by calling
so r24) (800)508-0944,Option 1.
Call (800)508-0944,Option 3
Monday-Friday,8:30 a.m.-9:00 p.m.ET Send check payable to Quicken Loans Inc.
and Saturday,10:00 a.m.-4:00 p.m.ET. — by mail using the coupon below.
Loan Information Loan Details Payment Breakdown
Loan Number: Current Principal Balance*: Principal Et Interest: $311.83
3306682523 $58,919.98 Escrow: $214.64
Late Fees: $0.00
Property Address: Escrow Balance: $2,371.60 Other Fees: $0.00
529 BRIGHTON PL Interest Rate: 4.625% Past Due Amount: $0.00
MECHANICSBURG, PA Interest Paid, Year-to-Date: Servicing-Related Expenses: $0.00
17055 $2,750.60
Total Amount Due: $526.47
'This is not your payoff amount.
Please contact a client advocate at
(800)508-0944,Option 3 to request a payoff.
Important Messages
Sign Up For Paperless Statements Today!
Put an end to paper cuts! Log in to MyQL.com and click on the banner on your home page or call
(800) 508-0944, option 3 to get an email when your most recent statement is ready. Your fingers
will thank you!
...............................................................................................................................................................................
Thinking of Purchasing a Home? Know Someone Who Is?
Taking advantage of a buyer's market and historically low rates is a smart move.
Call 888-900-1914 to speak with a Quicken Loans Home Loan Expert to see how much you
prequalify for today.
Receive a Tax Bill and Not Sure What to Do with It?
No worries! We've got you covered.
We've already received a copy from your tax authority.
Keep your copy for your records, then sit back and relax.
•OOG602-Need to Contact Us? Call: (800)508-0944, Option 3 • Email: Help @quickenloans.com -- - —