HomeMy WebLinkAbout10-22-14 (2) REV-1500 Ex(02-11) 1505610143
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOX.280601 INHERITANCE TAX RETURN 21 14 0421
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
01 22 2014 04 28 1955
Decedent's Last Name Suffix Decedent's First Name MI
BOLEN H. W
(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 OVALS BELOW
1. Original Return F—] 2. Supplemental Return 3. Remainder Return(Date of Death
Prior to 12-13-82)
4. Limited Estate 4a.Future Interest Compromise5. Federal Estate Tax Return Required
(date of death after 12-12-82)
8 Decedent Died Testate 7. Dee dent Maintained s)a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) C
❑ 9. Litigation Proceeds Received 10.b�lvieen i2 3i1 a Cit1(Da95�f Death 11.Election to tax under Sec.9113(A)
(Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JOHN JAMES MOONEY III 717 632 4656
REGISTER OF WILLS USE ONLY
C:: c
First Line of Addressc-� t O
230 YORK STREET „ '� `� cr. -
r.._ hf�7 fU C:3
f r7
Second Line of Address Z_'."
N R r, Q:3
DATE,71Lra
City or Post Office State ZIP Code - _y }� `•�
HANOVER PA 17331 - , N r- M
Correspondent's e-mail address: jjm(a�mooney4law.com
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
IGNATURE OF PERT SPON ISLE FOR FILING RETURN ,fDATE
Nancy L. Shenk (,1,DATE
1 U l
ADDRESS
1820 Mountain Road, Newburg, PA 17240
SIG NA RE OF PREPARER OTHER T AN REPRESENTATIVE DATE
"AA141 J, John James Mooney III
ADDRESS
230 York Street, Hanover, PA
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Bolen, H. William
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 70 , 133 . 90
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 327 . 54
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous N Probate Property
(Schedule G) �J Separate Billing Requested............ 7.
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 70,461 . 44
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 14 ,518 . 29
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 48 , 464 . 46
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 62 , 982 . 75
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 7 , 478 . 69
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. 7 , 478 . 69
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 0 . 00
(a)(1.2)X.00
15.
16. Amount of Line 14 taxable 7 , 478 . 69 16. 336 . 54
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18. 0 . 00
19. TAX DUE......................................................................................................... 19. 336 . 54
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21-14-0421
Decedent's Complete Address:
DECEDENT'S NAME
Bolen, H.William
STREET ADDRESS
1831 Mountain Road
CITY STATE ZIP
Newburg PA 17240
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 336.54
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +B) (2) 0.00
3. Interest (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2,Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 336.54
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;or..............................................................................................................
El x
d. receive the promise for life of either payments,benefits or care?............................................................ ❑
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receivingadequate consideration?.................................................................................................................... ❑ 0
3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?....... ❑ ❑x
4. Did decedent own an individual retirement account,annuity,or other non-probate property which El ❑
containsa 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)(i)].
For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax 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+(01-10)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bolen, H.William 21-14-0421
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on schedule F.
Attach a copy of the settlement sheet if the property has been sold
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real estate situate at 1831 Mountain Road, Upper Mifflin Township,Cumberland County, 70,133.90
Newburg, PA-See HUD attached
TOTAL(Also enter on Line 1, Recapitulation) 70,133.90
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule A(Rev.01-10)
Rev-1508 EX+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bolen, H.William 21-14-0421
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 AdamsElectric Cooperative, Inc.-Patronage Capital Retirement 79.69
2 Carlisle Regional Medical Center-Refund for overpayment 84.69
3 County taxes 7/31/14 to 1/1/15 prorated at settlement-See HUD attached 133.90
4 Direct TV-Refund 29.26
TOTAL(Also enter on Line 5, Recapitulation) 327.54
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
REV-1511 EX+(10-09) SCHEDULE H
pennsylvania
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Bolen, H.William 21-14-0421
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s)attached 10,123.40
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Paid
2. Attorney's Fees John James Mooney III 3,800.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
RelationshiD of Claimant to Decedent
4. Probate Fees 228.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 366.39
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 14,518.29
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Bolen, H.William 21-14-0421
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Fisher's Florist&Greenhouse 371.00
2 Fogelsanger-Bricker Funeral Home 8,277.40
3 George Hoover-preparation of grave and burial 500.00
4 Wagoner's Memorials-Memorial 975.00
H-A 10,123.40
Other Administrative Costs
5 Cumberland County Law Journal-Estate notice 125.00
6 The Sentinel-Estate notice 241.39
H-B7 366.39
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-08)
SCHEDULE I
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bolen, H.William 21-14-0421
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 Adams Electric Cooperative, Inc. -Final bill 30.88
2 Adams Electric Cooperative,Inc.-5/31-6/30/14 Statement 32.32
3 Adams Electric Cooperative,Inc.-4/30-5/31/14 Statement 34.82
4 Adams Electric Cooperative,Inc.-3/31-4/30/14 Statement 50.93
5 Adams Electric Cooperative,Inc.-2/28-3/31/14 Statement 108.56
6 Adams Electric Cooperative,Inc.-1/31-2/28/14 Statement 126.11
7 Adams Electric Cooperative, Inc. -12/31-1/31/14 Statement 154.11
8 Assessments paid at settlement-(See HUD attached) 118.45
9 Bank of America-Account ending 8602(See letter attached) 1,993.04
10 Bank of America-Account ending 6083(See letter attached) 1,137.41
11 Bank of America-Payoff 2nd mortgage#6881180(See HUD attached) 24,218.17
12 Bluestone Investments,Inc. -See Notice of Judgment attached 4,250.00
13 City/County tax/stamps-(See HUD attached) 700.00
14 Cumberland County Clerk of Courts-Fines(See attached invoice) 2,805.14
15 Cumberland County Recorder of Deeds-Deed recording fee(See HUD attached) 79.00
16 Frances Oiler,Tax Collector -2013/14 county taxes at penalty(See HUD attached) 317.37
17 Internal Revenue Service-2011 taxes owed(See attached notice) 862.18
Total of Continuation Schedule See attached page
TOTAL(Also enter on Line 10, Recapitulation) 48,464.46
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08)
Rev-1512 EX+(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Bolen, H.William 21-14-0421
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
18 Linebarger Goggan Blair&Sampson, LLP-PA State Income Taxes(see attached Notice) 297.04
19 Mooney&Associates Settlement or closing fee-(See HUD attached) 530.00
20 Old Republic National Title Insurance Co.-Owner's title insurance(See HUD attached) 735.00
21 Orrstown Bank-Payoff first mortgage#1020002561 (See HUD attached) 8,515.54
22 Orrstown Bank-Personal loan payoff#208490 (See HUD attached) 67.44
23 State taxes-(See HUD attached) 700.00
24 Title services and lender's life insurance-(See HUD attached) 210.00
25 Tuscarora Wayne Insurance Company-Homeowner's Insurance Premium 130.45
26 Tuscarora Wayne Insurance Company-Homeowners' Insurance Renewal 260.50
TOTAL(Also enter on Line 10, Recapitulation) 48,464.46
Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bolen, H.William 21-14-0421
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDEDo Not s s NTs (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
• distributions,and transfers
under Sec.9116(a)(1.2)]
Nicolas Bolen Son 1/2 residue
4699 Country Meadows Lane
College Station,TX 77845
Karen E. Krupa Daughter 1/2 residue
705 Champlain Ct.
Midlothian,TX 76065
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)
WI
raDepartment of the Treasury Notice CP523
Internal Revenue Service Tax Year 2011
In C+ Andover,MA 01810-9041 Notice date Social Security number 459er 20, 414
LW 7161 7 618 3637 5549 6346 To contact us Phone 1-800-829-0922
Your Caller ID 828612
154363.495734.243450.12885 2 AB 0.406 1150 Page 1of4
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H WILLIAM BOLEN I
1819 MOUNTAIN RD IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
154363 NEWBURG PA 17240-9119196
Notice of intent to levy
Intent to terminate your Installment Agreement
Amount due immediately: $862.18
The monthly payment for your installment
agreement is overdue. Since we did not receive Billing Summary
one or more payments from you as agreed to in
your installment agreement,your installment Amount you owed $708.81
agreement will be terminated on Failure-to-pay penalty 74.59
November 19,2014. Interest charges 78.78
In addition,the IRS may seize("levy")any state Amount due immediately $862.18
tax refund to which you're entitled and apply it
to your$862.18 in overdue taxes on or after
January 18, 2015.
Continued on back...
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1 WILLIAMNAN Notice CP523
1EW MOUURGNTA1724 Notice date October 20,2014
NEWNURG?A 11240.9119196
IRS Social Security number
1111 R&0. �I (I I • Make your check or money order payable to the United States Treasury.
Payment • Write your Social Security number(XXX-XX-4594),the tax year(2011),and the form
y number(1040)on your payment and any correspondence.
Amount due immediately 1$862.18
INTERNAL REVENUE SERVICE
P.O.BOX 37004
HARTFORD, CT 06176-0004
.11lllllll'111111..X111111111111.I1�ll�.11ll'll'llllllll"IIT
XXXXX4594 BX BOLE 30 0 201112 670 00000086218
WI
Notice CP523
Tax Year 2011
Notice date October 20,2014
Social Security number
Page 4 of 4
Interest charges We are required by law to charge interest on unpaid tax from the date the tax return
was due to the date the tax is paid in full.The interest is charged as long as there is an
unpaid amount due,including penalties,if applicable.(Internal Revenue Code section
6601)
Description Amount
Total interest $78,78
The table below shows the rates used to calculate the interest on your unpaid amount
due. For a detailed calculation of your interest,call 1-800-829-0922.
Period Interest rate
October 1,2011 through December 31,2011 3%
January 1,2012 through March 31,2012 3%
April 1,2012 through June 30,2012 3%
July 1,2012 through September 30,2012 3%
October 1,2012 through December 31,2012 3%
January 1,2013 through March 31,2013 3%
April 1,2013 through June 30,2013 3%
July 1,2013 through September 30,2013 3%
October 1,2013 through December 31,2013 3%
January 1,2014 through March 31,2014 3%
April 1,2014 through June 30,2014 3%
July 1,2014 through September 30,2014 3%
October 1,2014 through December 31,2014 3%
Additional information • visit www.irs.gov/cp523.
• For tax forms,instructions,and publications,visit www.irs.gov or call
1-800-TAX-FORM(1-800-829-3676).
• Paying online is convenient,secure,and ensures timely receipt of your payment. To
pay your taxes online or for more information,go to www.irs.gov/e-pay.
• Review the enclosed IRS Collection Process(Publication 594).
• Generally,we deal directly with taxpayers or their authorized representatives.
Sometimes,however, it's necessary for us to speak with other people,such as
employees,employers,banks,or neighbors to gather the information we need about
a taxpayer's account.You have the right to request a list of individuals we've
contacted in connection with your account at any time.
• Keep this notice for your records.
If you need assistance,please don't hesitate to contact us.
WI
Notice CP523
Tax Year 2011
Notice date October 20,2014
Social Security number
Page 3 of 4
If we don't hear from you—continued
• If you don't pay the amount due or call us to make payment arrangements,we can
y file a Notice of Federal Tax lien on your property at any time,if we haven't already
' done so.
• If the lien is in place,you may find it difficult to sell or borrow against your property.
The tax lien would also appear on your credit report--which may harm your credit
54363 rating--and your creditors would also be publicly notified that the IRS has priority to
seize your property.
• If you don't pay your tax debt,we have the right to seize("levy")your property.
Penalties We are required by law to charge any applicable penalties.
Failure-to-pay, oescnpuon Amount
Total failure-to-pay $74.59
When you pay your taxes after the due date,we charge a penalty of 0.5%(reduced to
0.25%on installment agreements)of the unpaid amount due per month,up to 25%of
the amount due.Beginning 10 days after we issue this notice,the penalty increases to
1.0%for each month the amount remains unpaid. We count part of a month as a full
month.(Internal Revenue Code Section 6651)
For a detailed calculation of your penalty charges,call 1-800-829-0922.
Removal or reduction of penalties We understand that circumstances—such as serious illness or injury,a family member's
death,or loss of financial records due to natural disaster—may make it difficult for you
to meet your taxpayer responsibility in a timely manner.
If you would like us to consider removing or reducing any of your penalty charges,
please do the following:
• Identify which penalty charges you would like us to remove or reduce(e.g., 2005
late filing penalty).
• For each penalty charge,explain why you believe removal or reduction is .
appropriate.
• Sign your statement,and mail it to us with any supporting documents.
We will review your statement and let you know whether we accept your explanation
as reasonable cause to reduce or remove the penalty charge(s).
Removal of penalties due to erroneous If you were penalized based on written advice from the IRS,we will remove the penalty
written advice from the IRS if you meet the following criteria:
• If you senna Written request to-the IRS forwritten advice on a specific issue :.. .
• You gave us complete and accurate information
• You received written advice from us
• You reasonably relied on our written advice and were penalized based on that
advice
To request removal of penalties based on erroneous written advice from us,submit a
completed Claim for Refund and Request for Abatement(Form 843)to the IRS service
center where you filed your tax return.For a copy of the form or to find your IRS service
center,go to www.irs.gov or call 1-800-829-0922.
Continued on back....
IN-MMO ®III
WI
Notice CP523
Tax Year 2011
Notice date October 20,2014
Social Security number
Page 2 of 4
What you need to do immediately Pay immediately
• Pay the past due amount or we will terminate your installment agreement under
Internal Revenue Code Section 6159(b)and the full amount you owe will be due
immediately. You can pay online now at www.irs.gov/e-pay.
If you think there's been a mistake
If you've already paid your balance in full or think we haven't credited a payment to
your account,please call 1-800-829-0922,and have your payment information
available to review with us. You can also contact us by mail.
Right to request an appeal
If you don't agree,you have the right to request an appeal under the Collection
Appeals Program. Please call 1-800-829-0922 or send us a Collection Appeal Request
(Form 9423)to the address at the top of the notice by December 19, 2014. Download
Form 9423 from www.irs.gov,or call 1-800-TAX-FORM(1-800-819-3676)to request a
copy.
If we don't hear from you • If you don't pay the amount due,we may seize("levy")any state tax refund to
which you're entitled on or after January 18, 2015.
• This is your Notice of Intent to Levy(Internal Revenue Code section 6331(d)).
• If you still have an outstanding balance after we seize("levy")your state tax refund,
we may send you a notice giving you a right to a hearing before the IRS Office of
Appeals,if you have not already received such a notice. We may then seize("levy")
or take possession of your other property or your rights to property. Property
includes:
— Wages,real estate commissions,and other income
— Bank accounts
— Business assets
— Personal assets(including your car and home)
— Social security benefits
..........................................------------........................------------......--...........---------------......------------......---
HNAWNotice CP523
1619 MOUNTAIN
RD
Notice date October 20, 2014
NEW6URG PA 172440.9119196
I-D Q Social Security number
If your address has changed,please call 1-800-829-0922 or visit www.irs.gov.
o Please check here if you've Included any correspondence. Write your Social Security
Contact information number(XXX-XX-4594),the tax year(2011),and the form number(1040)on any
correspondence.
0 a.m. O a.m.
❑p.m. ❑P.M.
Pnmary phone Best time to call Secondary phone Best time to call
INTERNAL REVENUE SERVICE
AMATO KEATING AND LESSA, P.C.
Pittsburgh Office: RONALD AMATOt
4232 Northern Pike,suite 202 107 NORTH COMMERCE WAY, SUITE 100 JOHN R.KEATING1 tt
Pittsburgh, PA 15146.2719 MICHAEL R.LESSAt
Tel:(412)856-8484 BETHLEHEM,PA 18017-8930 DAVID A.LOVEJOYt
Fax:(412)856-4444 DANIEL A.WECHSLERt
TELEPHONE(610)866-0400 PAUL F.TROISI t
AdmPermiyly to Practice m: FACSIMILE (610)866-9155
Pennsylva,ua OnIYt
Pennsylvania and New Jersey t t WEBSITE WWW.AMATOLAW.COM
Pennsylvania and West VLginia ttt EMAIL EMAIL@AMATOLAW.COM
A DEBT COLLECTION LAW FIRM
August 14, 2014
John J. Mooney, III, Esq.
Mooney & Associates
230 York Street
Hanover, PA 17331
Name of Creditor: Bluestone Investments, Inc.
Account Debtor: Harry Bolen
Court: Magisterial District Court 09-2-01 (cumberland)
Civil Action No.: CV-007-12
Firm Reference #: 1112703
Dear Mr. Mooney:
This letter is to confirm that our client, Bluestone Investments, Inc., has agreed to accept
$4,250.00 from your client in full and final settlement of all claims arising out of Chase Bank
USA, N.A. Credit Card Account Number 441 71 291 361 30271 . The settlement is to be
funded by your client in one lump sum payment, which is due in our office on or before
September 30, 2014. Once we are in receipt of cleared funds we will satisfy the judgment
entered of record by the court against your client.
The settlement check under this agreement is to be made payable to "Amato Keating and
Lessa P.C. --Attys for Bluestone Investments, Inc." and forwarded to our Bethlehem office.
Please note that our office also accepts payments directly on our website either by using
your client's checking account information or by credit card. Direct your client to go to
www.amatolaw.com and select the "Make A Payment" option. It is your client's
responsibility to make sure that this lump payment is made on time.
Very truly yours,
AMATO KE SSA, P.C.
By:
Paul F. Troisi
FORWARDED VIA EMAIL ONLY TO: cal@mooney4law.com
Bankof America Previous account ending:
7335
New account ending:
LL 0610 H 343 000 00204 #@01 SP 0.000 6083
ESTATE OF HARRY W BOLEN
C/O JOHN J MOONEY III
230 YORK ST
HANOVER PA 17331
June 06, 2014
Dear Sir or Madam:
Please accept our condolences on the loss of Harry W Bolen.
The previous account listed above has been charged off. As a result,
for internal processing purposes only, a new account number was
established. Both of the above referenced accounts are closed.
We're writing to inquire about the updated status for the Estate of
Harry W Bolen and whether funds are available to pay our claim of
$1 , 137.41. Please contact us at your earliest opportunity. Please be
advised that we are not attempting to collect this debt from you
individually. We are seeking payment from the assets of the
decedent' s Estate.
If funds are available to pay the claim, please use one of these
convenient payment options available to you:
- Overnight a payment by express delivery to Bank of America,
Retail Payment Services, MS: DE5-023-03-02, 900 Samoset Drive,
Newark, DE 19713. Please write the full new account number on
the front of the payment
- Mail a payment to Bank of America, PO Box 15019, Wilmington,
DE 19850-5019. Please write the full new account number listed
above on the front of the payment
- Make a payment over the phone by calling us toll-free at
1.888.339.6262, 24 hours a day, seven days a week. Please have
a checkbook available when you call
MBM ESCU 1-1 US-EN 01 of 02 -
Bankof America Previous account ending:
2377
New account ending:
LL 0610 H 343 000 00237 #@01 SP 0.000 8602
ESTATE OF HARRY WILLIAM BOLEN
C/O JOHN J MOONEY III
230 YORK ST
HANOVER PA 17331
June 06, 2014
Dear Sir or Madam:
Please accept our condolences on the loss of Harry William Bolen.
The previous account listed above has been charged off. As a result,
for internal processing purposes only, a new account number was
established. Both of the above referenced accounts are closed.
We're writing to inquire about the updated status for the Estate of
Harry William Bolen and whether funds are available to pay our claim
of $1,993.04. Please contact us at your earliest opportunity. Please
be advised that we are not attempting to collect this debt from you
individually. We are seeking payment from the assets of the
decedent' s Estate.
If funds are available to pay the claim, please use one of these
convenient payment options available to you:
- Overnight a payment by express delivery to FIA Card Services,
Retail Payment Services, MS: DE5-023-03-02, 900 Samoset Drive,
Newark, DE 19713. Please write the full new account number on
the front of the payment
- Mail a payment to FIA Card Services , PO Box 15019, Wilmington,
DE 19850-5019. Please write the full new account number listed
above on the front of the payment
- Make a payment over the phone by calling us toll-free at
1 .888.339.6262, 24 hours a day, seven days a week. Please have
a checkbook available when you call
MBM ESCU 1-1 US-EN 01 of 02 -
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Linebarger Goggan Blair&Sampson,LLP Linebarger Goggan Blair & Sampson, LLP
Attorneys At Law ATTORNEYS AT LAW
PO Box 90128 Phone Number: (717)236-7666
Harrisburg PA 17109-0128 Toll Free: (888)999-1455
ADDRESS SERVICE REQUESTED Fax Number: (717)_236-7695
Linebarger Goggan Blair&Sampson,LLP
PO Box 90128
5080708-223 @@@ 247212524 Harrisburg PA 17109-0128
'��II"I�III1�1'�III1�1�11'II'1"I�II�III'II111'I'���11III�II1"t II11"'IIIIIItlllllllll'IIIIIIIIIII'illlllll'i11I1II11111111I'
H William Bolen
1831 Mountain Rd
Newburg PA 17240-9119 1 �oi-
SA
***Detach Upper Portion and Return with Payment***
February 19, 2014
RE: Pa Personal Income Tax
Account#: 5080708
Tax ID #: Not printed for privacy purposes
Amount Due: $ 297.04
Please note the above amount may not include accruing interest, penalties and additional periods.
Dear H William Bolen:
This account has gone unpaid for far too long. We have offered you our assistance yet you continue to
resist facing this overdue obligation. You can decide to address and resolve this liability voluntarily.
Call our legal aide Marc Hauser at(888) 999-1455 Ext. 849435 immediately to discuss the options
available.
Please be advised that under Act 40 of 2005, an additional twenty-five percent(25%) collection cost has
been imposed on your total liability as of April 1, 2006. If you have already forwarded payment in full
disregard this notice. If not,please detach the upper portion of this letter and return with your payment in
full in the enclosed envelope.
If you are in bankruptcy, please disregard our attempt to collect this debt and contact this office with your
bankruptcy information.
Sincerely,
Linebarger Goggan Blair& Sampson, LLP
This is an attempt to collect a debt. Any information obtained will be used for that purpose.
IHWSCOL02223
o-dt4NY OMB Approval No.2502-0285
as �G
>t 1 A. Settlement Statement (HUD-1)
B. Type of Loan
1.D FHA 2.[]RHS 3.0 Conv.Unins. 6. File Number: 7. Loan Number. 8. Mortgage Insurance Case Number:
4.[]VA 5,[]Conv.Ins. 217835
C. Note: This form/s furnished to give you a statement of actual settlement costs. Amounts paid to and 4y the settlement agent are shown.
Items marked(p.o.c j'were paid outside the closing;they are shown here for informational purposes and are not included in the totals.
0. Name and Address of Buyer. E. Name and Address of Seller: F. Name and Address of Lender;
Aaron S.icing The Estate of H.William Bolen
Marian Ann King
1528 Mountain Road
Newburg,PA 17240
G. Property Location: H. Settlement Agent: I. Settlement Gate.
1631 Mountain Road Mooney&Associates
Newburg,PA 17240 230 York Street July 31,2014
Cumberland County,Pennsylvania rHanover,PA 17331 Ph. (717)632-4656
f Setttemenl:k Street
r,PA 17331
J. Summary of Buyer's transaction K. Summary of Seller's transaction
100. Gross Amount Due from Buyer: 400. Gross Amount Due to Seiler:
101. Contract sales price 70,000.00 401. Contract sales price 70,000.00
102. Personas ptMrty 402. Personal property
103. Settlement Charges to Buyer Line 1400 1,441.18 403,
104, 404.
105, 405.
Adjustments for Items paid by Seller In advance Ad ustments for Items eald by Seller in advance
106, Ci frown Taxes to 406. Cil/Town Taxes to
107. Coun!y Taxes 07131114 to 01101115 133.90 407. County Taxes 07131114 to 01101115 133.90
108. Assessments to 408.Assessments to
109. 409.
110. 410.
Ill. 411.
112, 412.
120. Gross Amount Rue from Buyer 71,575.08 420, Gross Amount Due to Seller 70,133.90
200. Amounts Pald by,or in Behalf of Buyer $00. Reductions in Amount Duo Seiler,
201. DB sit or earnest.money 501. Excess deposit see instructions
202. Principal amount of new loans 502. Settlement charges to Seiler Line 1400 3,271.37
203. Existing loans taken subject to 603. Existing loans taken subject to
204. 504, Payoff First Mortgage to Orrstown Bankiti1020002551 8,515.54
205. 505. Payoff Second Mortgage to Bank of Americalr1S881180 24,218.17
206, 506.
207. 507, Personal Loan Payoff to Orrstown Banktlf208490 87.44
208. 508,
209. 509.
Adjustments for Items unpaid by Seller Adjustments for Items unpaid by Seller
210. Cit frown Taxes to 510. Ci rrown Taxes to
211. County Taxes to 511. Count Taxes to
212. Assessments 07101114 to 07131114 118.45 512. Assessments 07101/14 to 07131/14 118.45
213. 513.
214. 514.
215. 515.
216. 516,
217. 517,
218. 518.
219. 519.
220. Total Paid b ifor Buyer 118.45 520. Total Reduction Amount Due Seiler 36,190.57
300. Cash at Settlement fromito Buyer 600. Cash at settlement tolfrom Seller
301. Gross amount due from Buyer line 120 71.576.06 601. Gross amount due to Seller line 420 70133.90
302. Less amount paid by Buyer(line 220) { 118.45} 602. Less reductions due Seiler(fine 520} { 36,190.97,
303. Cash From ❑ To Buyer 71,456.63 603. trash Q To From Setter 33,942.93
Paid auisida atcsostng 4Y borrower{B},sailer{S},tangor{t.},ar d0rq-parry{Ty
The undersigned hereby acknowledge rece t of completed copy of this statement&any attachments referred to herein
Buyer lA gV1 Seller The tale of H.0111 m Bkan,
ZAarr .King.
jtr,.c Am5/1'1'11 Nancy L.S nk,Administratrix
Mar€m Ann King fit
f
The Pubtio Reporting Burden for thin colle Won Of Information Is astma ted 01 35 minutes par response for coueang,reviewing,and reporting the 0410.This agency may not collect this Information.and you are
no"
requiretl Ie,complela this form,unle ss h displays a currency valid OMB control number,tdo confidomisity is assured:this disclosure is mandatory.This Is designed to provide,the parrms fa a RESt=A covered
transacdonwtih lnrormation during the saAtemantprac4ss,
Page 1 of 3 HUD-1
(217835.PFDj2l783S/I6)
L.Settlement Charges
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Paid From Paid
aid From
Ft}i
Division ofcommission(fine 700)as follows: 8uyef s Setters
701.$ t0 Funds at Funds at
702.$ to Settlement Settlement
03.ComM scion paid at settlement
744. Realtor Admin.Fee
705.
'lf<j,r .yr'.?i¢; fir[: rs ,..,•lir
�! QZ"t rfi$�f>it!�allfQ'i Cohlj@C{tQl�; ritltsl:'piin'[1'
601.Out origination char $ from GFE#1
802.Your credit or charge(points)for the s e ific int rest rate chosern f om GFE 02
803 Your adlusted orf Ina lon charges from GFE#A 0.00
804 A ratsat fee to fr m GFE#3
805.Credit Report to from GFE#3)
80$.Tax s rvice to from GFE#3
807.F19A certification to Vrorn GFE#3
808, (from QFE 03
809, from GFE#3
810. from GFE#3
811. (from GFE#3)
WO",
7. r :.req:. .TS^" '?st: E+ ,P:•. -r;:`Yu:^ i':�'":- T n,as'it�`.�Ye:t..,,.ia"-i'
n F i ,t•'7 tt.� ;i=k:` ;•Yia :^.n s,x.�i" -c.; .0.. -�.r..�,.,...:. .}:}.:r,5$,=`.:. a.a::.:,:e
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901.Daily interest char es from to @ Slda from GFE#10
902.MIP Tot Ins.for Life of Loan months to from GFE 1P)
903.Homeowner's insurance for years to (from GFE#11)
904. (from GFE 411)
905. (from GFE#11)
'4 ,t
:::,�:;f-".. ��i:,,,J n ,:.. 1 :.�i. n•'r'. .r4,,. u, 'zt
iI.400,.)t�s0.v.lf�s.a#�t .i.Wlt :1:.8. dsn:R;v.a,<a:,:.l.y.,,.,�l�+;fi;[w:t,.,,xt, �r,�?:.i:t,;rrs :t,.,,.•.::,,.pi,r.r:3*.,:r,.,.., r�>.r.k r..�s;;.,r,,. [5.ra..xpt. ,:s'x:
1001,Initial deposit for your escrow account from GFE#9)
1002.Homeowner's insurance monthsoQ S per month $
1003.Mortgage insurance months S per month $
1004.Property taxes $
Assessments months S per month
County Tom months $ per month
1005, S
1006. months Q $ per month $
1007. months S per month $
1008, $
1009. Aggregate Adjustment S
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ft,F..r ,.5:: .t., n�•«�;.. t.,.. t`r'.:,, S.f u�'#4`:,k ..k ::lei`...
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-.:[,. :, ,:,':,s• ..,,.,t t y, '.i•. ..,y:., T;,. ;'pkat?w.. .h`t�". h'�. ,.>7�
y� /�4}y�� "1X`"�'s..u,F.1.} >N. '•"Y.::} :,}ii ��.�s S;Y:+..5....rof vv y y i.Yf,r. •.r^t..--' f�k�)�n's :`i}}::..(^:rte*; tfLn':fl 3 t ,f�.
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1�.. .•',,,t r 4;}.�. ,z,'�.a.t:+,. ,,3t`• a<.,: 't n� •t?b.; .:t'r<F3.X, .'�+f,:::. :%:'9,f,_=,.,..uxttz�,:?'<i'_F.,..nt..
.,:3: .�...eda'u.< nt:•$xr.A. ,.Vi..J.,..,.r... '+`t..:tc ��i''._;s3t�:.:Ri.: ;tixw•;.k,ry}:itY2t, ,,rke,,:,s':St.`.-;':4rr,�:.F. .s'�.,. -{+._ S' r. n
1101. Title services and lender's title insurance (from GFE#4) 185,00
1102, Settlement or closing fee to Mooney&Associatas $ 530.00
1103. Owner's title insurance to Old Republic National Title insurance Company (from GFE#5) 040 735.00
1104. Lender's title insurance to Old Republic National Title Insurance Company $
1105. Lender's title j2licy limit S
1106. Owner's title policy limit $ 70.000.00
1107. Agent's portion of the total title Insurance premium to Moone &Associates $ 624,75
1108. Underwriter's portion of the total title insurance premium to Old Republic National Title Insurance Cams $ 110.25
1109. $
1110. S
1111, $
1112. $
1113. 5
,V 4.t il*iqJ./ty F'" {S i•1'$,�>.\:i 'Y•. �, ::1„ �.1,.".,�f i;.J�.?�',Y :':r',.2`.'i' `i�tt f 7 Z.ti':1,='r•t:'U;,v 't r`::
3'20.O,,.Gcva'
WW ..►�k+., ...rd. an...f ,un.�ha. a�:,,.,..� r �>_. .., ,..:
1201.Government recording charges to Cumberland County,Recorder of Deeds from GFE#7
1202.Deed $ 79.00 Mortgage 5 Releases $ Other S 79.00
1203.Transfer taxes from GFE#8)
1204.Cit lGoun laxlsta s 5 700.00 $ 700,30-
1205.State tax/stamps $ 700.00 $ 700.00
1206.
1207.Walk Thru Rec.Fee to Moonev&Associates 25.00
1�(f ` (� ".:!. ', .it` '.li. Jrq ,+" '%?: '51..•..:,: a.l•-,;;.•v'v'rE '"t.."'.::::,,-..•,
f„..nn s qri• z?- ..la. ":};: `?'IC. {, xi .7:' }�f�, 1 Q2"
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"l.�i ,1,)t:l':,..V.s7.1T „l. 7 :kll (£. r,.l.r .kT..,
301.Required services that you can shop for (from GFE#6
1302. 2013114 County Taxes at Penalty to Frances Oiler,Tax Collector $ 317.37
1303. 2014115 School Proper! Taxes at Disct, to Frances Oiler,Tax Collector $ 1,441.18
1304. $
1305. $
Klf �i d r` llfrit3s�: �SeC 3,_ .';3'"'iii1,60ti-� •Cto 'iK •,r,: r.v:.,. "37
w !r. .,...,,i'S..,.. �1'...,,,.,,. •,y,a, lYv �{::.ti;: ;tI:;JS' .4;T;�Ft,. :!.; ..tk,_
'Paid outsida ofttosing oy Darrawor;a},satiar(5}.candor{Ll.ar third.pacty{T}
ay slgnmg pago s attn s Statement,the slonatonas aemowledge recolptofa completed copy of pago 2&3 oft"' ree gaga state m nt.
Mooney&Associates,Settlement Agent
Certified to be a true copy.
Page 2 of 3 HUDA
(217835,PFDf217835116)
Attachment
Buyer(s):Aaron S. King and Marian Ann King Sellegs): The Estate of H.William Bolen
1528 Mountain Road
Newburg, PA 17240
Settlement Agent,Mooney&Associates
(717)632-4656
Place of Settlement,230 York Street
Hanover, PA 17331
Settlement Date:July 31, 2044
Prop"Location: 1831 Mountain Road
Newburg, PA 17240
Cumberland County, Pennsylvania
Setter Loan Payoff Details
Payoff First Mortgage to Orratown Bank Rez#1020002561
Loan Payoff As of
Total Additional Interest days a Per Diem
Total Loan Payoff 8,515.54
Payoff Second Mortgage to Bank of America Re:#68811800678399
Loan Payoff As of
Total Additional Interest days @ Per Diem
Total Loan Payoff 24,218.17
Title Services and Lender's Title Insurance Details BORROWER SELLER
Title Abstract 135,00
to Patricia A. Black Abstracting
Title Review Fee 50.00
to Mooney&Associates
Total $ 0.00 $ 185.00
Settlement or Closing Fee Details BORROWER SELLER
Deed preparation 100-00
to Mooney&Associates
Notary Fees for Buyers/Seller 50.00
to Mooney&Associates
Payoff Pkgs. FEDEX Fee 30.00
to Mooney&Associates
Settlement Fee 350.00
to Mooney&Associates
Total $ 0.00 $ 630.00
Owner's Title Insurance BORROWER SELLER
Owner's Policy Premium 735.00
to Old Republic National Title Insurance Company
Total $ 0.00 $ 736.00
WARNING' It Is a crime to knowingly make false statements to the United states 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.
(217835.PFDM7835116)