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HomeMy WebLinkAbout10-22-14 REV-1500 EX(02-11) 1505610143 OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County cone Year File Number' Bureau of Individual Taxes DEPAR7WK OF REVENUE PO BOx.280601 INHERITANCE TAX RETURN 21 14 0079 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 01 16 2014 03 09 1944 Decedent's Last Name Suffix Decedent's First Name Ml MEYERS BARBARA G (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 Retum ❑ 2. Supplemental Return ❑ 3_Remainder Return(Date of Death Prior to 12-13.82) ❑ 4. Limited Estate ❑ 4a.Future Interest Compromise ❑ 5. Federal Estate Tax Return Required (date of death after 12-12-82) Il g Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Wit) (Attach Copy of Trust) ❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 11,Election to tax under Sec.9113(A) between 12-3i-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 SCOTT M DINNER ESQ 717 761 5800 REGISTE"F WILLS UMONLYY First Line of Address c <:> 3117 CHESTNUT STREET r�1 t�7 rxl r ! Second Line of Address �- City or Post Office State ZIP Code DATE FILED ) - M CAMP HILL PA 17011 - _i r n I—� Correspondent's e-mail address: smdinner@yahoo.com Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and sta#emerrts,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of pre rer other than the personal representative is based on all information of which preparer has any knowledge. NATURE OF PERSON R PONSIBLE FOR FILING RN DATE Jennifer M.Foster D Ess 4 S ne Run Drive,Mechanicsburg,PA 17050 SIGNA REOF PREP E HE N RESENTATIVE DATE Scott M Dinner Esq OCT 10 2014 KESS Law Office of Scott M.Dinner 3117 Chestnut Street, Camp Hill, PA 17011 Side 1 L 1505610143 1505610143 J 1505610243 REV-1500 EX Decedents Social Security Number DecedenrsName: MEYERS, BARBARA G RECAPITULATION 1. Real Estate(Schedule A).......................................................................................... 1. 172 , 000 . 00 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. 14 , 725 . 00 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 19 , 692 . 07 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............. 7. 123 , 894 . 91 8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 330 , 311 . 98 9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 21 , 014 . 71 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 72 , 062 . 69 11. Total Deductions(total Lines 9 and 10).................................................................. 11. 93 , 077 . 40 12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 237 , 234 . 58 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. 237 , 234 . 58 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.00 0 . 00 15. 16. Amount of Line 14 taxable at lineal rate X .045 237 , 234 . 58 16• 10 , 675 . 56 17. Amount of Line 14 taxable at sibling rate X .12 0 . 00 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 00 18. 19. TAX DUE................................................................................................................... 19. 10 , 675 . 56 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 - 0079 Decedent's Complete Address: DECEDENT'S NAME Meyers, Barbara G STREET ADDRESS 48 Longwood Drive CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) {Z) 10,675.56 2. Credits/Payments A. Prior Payments 10,500.00 B. Discount 394.74 Total Credits(A +B) (2) 10,894,74 3. Interest 4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. (4) 219.18 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) Make Check Payable t0: 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;.... ............................__.............................­ ransferred:............................................................................. lil b. retain the right to designate who shall use the property transferred or its income-,.............................. F c. retain a reversionary interest,or.................................................................................................................. x d. receive the promise for life of either payments,benefits or care?.........................................................._ H Ex-1 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?....................................................................................................................... ❑ 0 3. Did decedent own an'in trust for" or payable upon death bank account or security at his or her death?......... o 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?........................................................ 0 ❑ 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 January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is a 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 reum 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,'Xther by blood or adoption. pennsylvania DEPARTMENT OF REVENUE SCHEDULE INHERITANCE TAX RETURN RESIDENT DECEDENT REAL ESTATE ESTATE OF Meyers, Barbara G FILE NUMBER 121 - 14-0079 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 which 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 contract sales price of decedents principal residence located at 48 Longwood Drive, Silver 172,000.00 Spring Twp., Cumberland County, Pennsylvania 17050. [line 401 of HUD-1 Settlement Statement, see Attachment#1 TOTAL(Also enter on Line 1,Recapitulation) 172,000.00 pennsylvania SCHEDULE E DEPARTMENT OF REVENUE INHERITANCE TAX RETURN CASH, BANK DEPOSITS AND MISC. RESIDENT DECEDENT PERSONAL PROPERTY FILE NUMBER ESTATE OF Meyers, Barbara G 121 - 14-0079 include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the eight of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 2010 Chrysler Town &Country Touring minivan [average of trade-in and private party market 13,490.00 values per Edmunds.com] miscellaneous personal property 1,235.00 TOTAL(Also enter on Line 5,Recapitulation) 14,725.00 REV-1505EX+(0140) Pennsylvania t DEPARTMENT Or REVENUE INHERITANCE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Meyers,Barbara G 21 -14-0079 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT Jennifer M.Foster 4 Stone Run Road Daughter A Mechanicsburg, PA 17050 JOINTLY OWNED PROPERTY: LETTER — DATE DESCRIPTION OF PROPERTY DATE OF DEATH OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number,VALUE OF ASSET DECD'S VALUE OF NUMBER TENANT JOINT similar identifying number.Attach deed for jointly-held real estat INTEREST DECEDENT'S INTEREST I A 09/11/2007 Members 1st FCU Acct.#112641 2,055-26 50% 1,027.63 Checking (0011) [see Attachment#2] 2 A 09/11/2007 Members 1st FCU Acct.#112641 17,379.95 50% 8,689.98 Regular Savings(0000) [see Attachment#21 3 A 09/11/2007 Members 1st FCU Acct.#112641 220.18 50% 110.09 Supplemental Savings(0001) [see Attachment#2] 4 A 09/11/2007 Members 1st FCU Acct.#112641 19,728.73 50% 9,864.37 Money Management(0005) [see Attachment#2] TOTAL(Also enter on line 6,Recapitulation) 19,692.07 REV-1510 EX+(08-09) pennsylvania DEPARTMENT OF REVENUE SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Meyers, Barbara G FILE NUMBER 21 -14-0079 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET DECD'S QF APPLICABLE) TAXABLE VALUE and the date of transfer. Attach a copy of the deed for real estate. INTEREST 1 Lincoln Fin'I Group IRA contract#EQ5368121 74,260.83 100% 74,260.83 [see Attachment#3];decedent's three children are the designated beneficiaries. 2 Lincoln Fin'I Group annuity contract#EN5368120 49,634.08 100% 49,634.08 [see Attachment#4];decedents three children are the designated beneficiaries. TOTAL(Also enter on line 7,Recapitulation) 123,894.91 REV-1511 EX+(10-0) pennsylvaniaSCFEDULEH DEPARTMENT OF REVENUE RNM&DO)MMAM INHERITANCE TAX RETURN RESIDENT DECEDENT AMMNSM7WOOM ESTATE OF Meyers, Barbara G FILE NUMBER 21 -14-0079 Decedent's debts must be reported on Schedule 1, ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. I Myers-Hamer Funeral Home 3,928.00 2 repaste/luncheon 285,00 B. ADMINISTRATIVE COSTS: 1. Personal Representatives Commissions Name of Personal Representative(s) Street Address City State Zip Year(s)Commission Paid 2. Aftomey's Fees Scott M. Dinner, Esq. 2,575.00 3. Family Exemption: (if decedents address is not the same as claimants,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 358.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs net Settlement Statement charges[line 502 less lines 407 thru 410 of HUD-1, see 12,359.98 Attachment#1]. See attached 1,508.23 TOTAL(Also enter on line 9,Recapitulation) 21,014.71 SchedtdeH FuwWEvmm& COMMONWEALTH OF PENNSYLVANIA IN itVMWIS.1aleme nt chargeof HUD-- , see 12,359.98 mstm=� - j. FILE NUMBER ESTATE of Meyers, Barbara G 21 -14-0079 2 listing fee-Joy Daniels Realtor 395.00 3 roof repair(Charlie Swartz) 315-00 4 estate notices-Cumb. Law Journal/The Sentinel 195.00 5 utilities: gas&electric(PPUUGI), sewer(Silver Spring Twp.), trash(Penn Waste), 603.23 water(United Water) Page 2 of Schedule H Pennsylvania SCHEDULE [ DEPARTMENT OF REVENUE DEBTS OF DECEDENT, MORTGAGE INHERITANCE TAX RETURN RESIDENT DECEDENT LIABILITIES & LIENS FILE NUMBER ESTATE OF Meyers, Barbara G 21 -14-0079 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Payoff of first mortgage loan to JP Morgan Chase Bank NA 68,248.15 [line 504 of HUD-1, see Attachment#1]. 2 Thornwald Nursing Home 1,408.24 3 mortgage payments made prior to sale of personal residence 2,29T 16 4 sewer charges-Silver Spring Twp. Auth. 109.14 TOTAL(Also enter on Line 10,Recapitulation) 72,062.69 REV-1513 EX+(01-10) --I pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Meyers, Barbara G FILE NUMBER 1 21 -14-0079 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trusteqs) TAXABLE DISTRIBUTIONS[include outrightusal distributions,andimnsfers under Sec.9116(a)(1 2)l 1 Michael R.Meyers Son 1/3 of residue 141 Peach Lane Carlisle, PA 17013 2 Jill S. Navarrete Daughter 1/3 of residue 601 E.Coover Street Mechanicsburg,PA 17055 3 Jennifer M.Foster Daughter 1/3 of residue 4 Stone Run Drive Mechanicsburg,PA 17050 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART It-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI 0.00 Fite # 21-14-0079 Estate of Barbara G. Meyers �� Attachment # 1 �� OMB APWMl No.2502-U65 A. Settlement Statement (HUD-1) 1.u FHA 2.0 RHS 3.❑Cony,Unins. 6.File Number: [0255174 .Loan Number. 8.Mortgage Insurance Case Number. 14-1540 4 756703 4.❑VA - 5.[]Comr.Ins. C.Note:This form is furnished to glue you a statement of Actual sefflamerd costs.Amounts paid to and by the settlement agents are shown Items marked "(p o.or were paid outside the dosft they,are shown here for Infoormational purposes and are not included in the totals D.Name&Address of Borrower. E.Name&Address of Seller. F.Name&Address of tender: Umbch H.F dhm Jemrfer M.Foster,Executrix fa the Estate of Barbara a HomeBrAp Flnend2i Se€vioes,Inc. 2214 Market STt*Camp Hill,PA 17011 Mayers 433 Hadkmsack Avenue,5th Floor, 48 Longwood Ddve,Medoftburg,PA 17050 Hx keraadt,NJ 07501 G:Property Locatiotc H.Settlement Agent: L Settlement Date:051=014 48 Longwood Drive W ifiam Perm SatBenent Agency Disbursement Dat-OW202014 MechanicsburS PA 17050 5405 Jaresrovm Road,Surle 101,Harrisburg,PA 17112 P5405 lace of Settlement Express Jonestown RoAd,Suite 101,Harrisburg,PA 17112 Printed(ISH9=14 at 4:26 pm LB j.aurn-mary of Borrower's Transacti�r iROMii91z E E 101, comm scles price 1 O00.00 401. Contract sales plica 1 O00.00 102. Personal proialy 402. Personal property 103_ Setilermakticharges to borrotvsr(11a 1400) 10,346.77 403. 104. 404. 105. 405. AdiustmootsforitemspaldbysellerinaMnos Adjustments for ftems pid by seller m advance 106. Cdyltaem terms to 406. Cryllown taxes to 107. County tams 05/2012014 to 12!31/1014 314.24 407. County taxes 0512(N1014 to 12131014 31424 106. Assessments to 406. Assessments fo 109. Schod taxes 0512011014 to06130/2014 155.32 409.'Sdwol taw 05f1Q11014 to06f30014 155.32 110. HOA 05t2tN2014 to f2t311Y014 74.30 410. HOA 05!'1020'14 to/213 W14 74.30 11t. 411. 112 412 120. 'Gross Amount Due from Borrower 18$85288 420. Gross Amount Due to Selo 172,54586 '. � � a � 201. or earnest mroney 1,000.00 501. Etcess deposit(see ) 202. Pdrtcipsi WON of new loan(s) 15709.00 502. Seiftement dirges to seller(fie 1400) 12,903.64 203. Erdsti s taken!g9d to 503. Fxistln 1 s taken suW to 204. 504. Payoff of fast m m%W batt to JP Morgan Chase 68,248.15 Bank NA 205. 505. Paydfof secandmortgapkw 206. 506. 207. 507. 208. 508. 209. `W Adfushaeftfar Items unpald by segs[ fort seller 210. CflyAown tease to 510. UW10vm fetes to 211. Countytmes to sit. County tams to 212. Assessments to 512. Assessments to 213. 513. 214. 514. 215. 515. 216: : ... .. . .,._,.,_.. ...-. .. .... ..... 516. 217. 517.' 7 - 2% 518. 219, 519, 720„ TOW PWd bAw SomRw 158,509.00 520. Told Reduction Amount Due Seller 81,15199 __�C',. -x'.�sWc' .af b Mass amount due from borrower(One 120) 182,852.63 601. Gross amoiud due to seller(5ne420) 172,543.85 302. Less amounts paid by/for bomowe(tine 220) 158,r4g.ODI 60'1. Less reductions in emtount due seller(One 520) 81,151 303. Cash ❑X From ❑To Borrawer 24,343.83 fi Catstr ©To ❑From Setter 91,39187 11Wfata0. � �alapaOYbOtM6a,61nlnuMer.qo 'Ise�mamgFbd%EM..=p�W1a}ttlllsNlpnglbfn�0"paMb.fiESfMcawwtl4mroa,Qm+MmOnrOm err See attached addendum for additional infor matlon Previous editions are obsolete Page 1 of 4 HUD-1 I rd IME M-�Tm iK, ;�701. $6,160.00 to WekWRedbm-FkstChoIce 702. $5160.00 to Joy Daniels Red Estate,LTD 703. Co wise paid at seftftt 10,320.00 704. Brokers U�-Fee Ia, Welched Reabs-ft Choice 29 80I Our tabancharp Qndud9aOMFktonPaIntOOW%orsGOD) $1,045-00 (from #1) k Your credit or charge(pc*b)for the spoft Intamst rale dmm $ (Iran GIT q 803 Your a*mW ac*tdon dages Mm GFE A) 1,045 804. Appraisal fee 10 MaMft,48 App*g MM89WWt Co (1mmGFE#3) 475.00 605. cruet"ad 10 cis khmwmm SWAM (from 33 .43 1806. Tax smlw 10 (fmmCFE#3) 1807. Fbodcmffim#w tD Walters Kkw Financial Swilm (from GFE q 16,001 1808. to I *Mft,ffeNftgV-mAft Owu wko* wl�, mgxiff-wgm w"w"mi-mgm 901. Daityfalawchnaftm fMmOMM14IoOWlrM4@$1&34WMay GFE#10) 220.06I 902. Mm-Op Ins.Podum for iyeamipDepoment of HUD (trap GFE#3) 2.7MOD.001 903. HarnemnWswazanca for I yews to Efie hwrmw (from GFE#11) 45424 904. mmu to (frarn GFE Al) 1001.Inflialdeposfifor yourescmwaccount GFE#M 1,349.76 1002.Hwwwnees Insurance 3 moqfto$ 37MftfM $113.49 lam mmm inwrance mwMs Q$ 166.41ftnant $ 1004.City Pq"Tvm months @$ 0.0mmAh $ 1005.COMW Rq"Tam 5 months gb ,$ 4230hnwth $211.50 1006.Schad Tam 12 nonft gg$ j 12.48hordh $1,349.76 1007.AgpoeMustmert S-32AS 1101,Title services and tender's ftInsurance Mw GFE A) 1,610.00 1102.Sefflomatcrdwkifee to $ 1403,OwnAtitle intra m (ftm GTE M MOD 1104.Lendees w inmirince 1105,Lenders ftpoficy"$157,60.00 tenders Policy 1106.Owner's WepdIqyfimft$17ZODOA OwneesPdlcy 1107.Agenfs pMw d the W Me Inmrance pradwn $1,071.00 1108.Urdm;iFA 3 porkn of the total ffb Inwram premium $189.00 1109.Notary Fee to fauna K BMrl9 90-0 1110.Ovankjd Fee to Man;Penn Settlement Ac- 2000 ilit Tax Cart toWMamPerri SeWwwdAc 2D.00 1201.Gmwffad mm dM dOW $ GFE V) 160.501 1202 Deed$71.00 m2!1R2E$89.50 Release$ 1203.Transfertaxes $ (fromGFENB) 1,720.00 1204.City/Co"Wstanp Dead$1,720.00 Malt"$ 1206.State Tmdftnps Deed$1,72D.OD mW98904 1,720.00 1206. Deed$ MWWW$ 1207. $ WM, 1301.RaCpAW WVIM M YOU Can SWU (fmm GFE#6) 1302. tD 1303. to MW 1304.WA lnla#DR Fee tD EVOMM Rmw fit HOA 1305. ID SW Tamnship Aidafty 6• 1306.fWm W*dm to Centrad Penn Radon,Inc. 748.1 1 $ 1,400. *pW mbde of ctaft by(B*me(SW pandw(Qm%,"wopq-"Cre&ty Wider amn on page i.-Creallt by W.-,ftm on PW i. See attached addendum for additional Information Previous ec[tUom are obsolete Page 2 of 4 HUD-1 [-t1CiH b}O£e6ed GWjOSQO ase ss pa S-!Aald uapeuua;ul leuontppe ja;wnpuappe patpepe as sam i lam"' aMmsut p00W D f l =nmaq Vm=wH 0 sm 4mftd Aula9 pq-p swag Am pus wumanq 06ebZbui. }samm to ipo Sm"18'££vmo ps+ea wwwe Fw pR e tqqrm yea tgwjowww ftm pwom ueamortrmAC{. MOVA 4MIP On assn fled Fm noA•3 ►SAUTOW"u pUe SriAva"segsns%URJ%W8 Wx=s0"MaemPuapWk0. ! UD SMA WOW SP7 WOM a aaeq WA%D k[] 'ONE] 3St d�wnu=modV6A[] t sza asp sacra UM 4 WIWU au $%QW uD loin ;4um m pUs f t 'ON g to umurp=u e a aW uw 11%9A 0 nN[Z] `% Ue+a wjo% umamAqa9—(tp >5stam t A(A`uuoj O%y0 eltl n JGAO'% &q asmsaap-a w—ayes PaM4 z"'4W aUMP hm3' f t 9204 dram ue6e B&OP M PUS 1 1 w aR t% ptsu}a41 % PWrAWMaetS&P ump'SaA❑ vNQ musut emm paMLq Q �, �upd[1 S sztt mA oo�`lats sous,{treo^t ODW 00'01._._ OO'OM '00`0M 00't+56 OD'09.9 won oval 91'6V£'t 91't+t�'E %6£Z0't' £6'68E'£ 00'Stti`£ NO — i. 00'0 00'0 00'0 00'601'Z Oo'601'z w9t lw% No oo a w6z 00'09 00'S1ti 00 9a 09'091 00'911 00'oz1`t 00'07,1'4 .00`9wL 00'960'1 00'0 00'0 00'960'4 00'96o't x HUD CERTIFICATION OF BUYER AND SELLER I have carefully mvievred the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction I further car*that 1 have received a copy of the HUD-1 Settlement Statement ETir H.Hoffman Lag" r JeOFFostar66wW(!rPoEstdsotBabaraG.Meyam The HUD-1 Setflemeni Statement which I have prepared is a t-and arxvr da account of this transaction.I have mused or will cause the funds to be disbursed In ac ordartmwith the StatrenenL AL SETT ENT IRATE WARNING IT ISA CRIME TO KNOWINGLY MAKE FALSE STATHUIENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TTTIF 18:U.S.CODE SECTION 1 W1 AND SECTION 1010. See attached addendum for additional information Previous editions are obsolete Page 4 of 4 HUD I File # 21-14-0079 Estate of Barbara G. Meyers �� Attachment # 2 �� DATE FROM DATE TO PAGE ACCOUNT NUMBER St Members I st Federal Credit Union 01/31/2014 1 of 3 XXXXXXX641 5000 Louise Drive P.O.Box 40 Mechanicsburg PA 17055-0040 (800)237-7289 MEMBERS I't (717)697-5312(Hearing Impaired) FEDERALCREMUMON www.memberslst.org BARBARA G MEYERS JENNIFER M FOSTER 48 LONGWOOD DR MECHANICSBURG PA 17050 71 ACCOUNT BALANCES AT A GLANCE 77� Your current Member Loyalty R-eW6edsi[6v6l.isPlatinum. Your aggregate balance'6-s-.-6fignticiT'.,Y,- 2,20 74. q -7. IstisU 461V -tw ' An:aggre&ft balance.�Of:$75,Q QO and havirig3prp.ducts will rn,oveyou, . the-T-Ofn -el, CHECKING 5,127.71 SAVINGS 33,272.96 CERTIFICATES 0.00 LOANS 0.00 SWIPE 5 YTD REWARD 0.15 CHECKING (0011) 3$ ;377 .42 Eff. Post Date Date Description Deposits Withdrawals Balance 01/02 01/02 Deposit Transfer From Share 0000 100.16 3,477.58 01/02 01/02 Deposit Transfer From Share 0000 287.00 3,764.58 01/02 01/02 Withdrawal ACH PENN WASTE 38.14 3,726.44 TYPE: BT1231 ID:9087438010 DATA: PENN CO: PENN WASTE 01/02 01/02 Withdrawal ACH.COMCAST CENTRAL 160.74 3,565.70 TYPE:CENTRAL PA ID:0000009547 CO: COMCAST CENTRAL 01/02 01/02 Withdrawal ACH JPMORGAN CHASE 574.29 2,991.41 TYPE:CHASE ACH ID: 1000008113 DATA:JPMORGAN CHASE ACH CO:JPMORGAN CHASE .01/07 01/07 Withdrawal Debit Card CHECK CARD 239.95 2,751.46 01/07 800-342-5775 FSI*PPL ELEC UTIUBMC PAUSIN7 01/08 01/08 Check 000053 Tracer 0000387789 461.00 2,290.46 01/09 01/09 Check 000052 Tracer 0000307596 4.04 2,286.42 01/10 01/10 Withdrawal Debit Card CHECK CARD 40.01 2,246.41 01/09 TURKEY HILL#294 MECHANICSBURG PA 01/10 01/10 Withdrawal ACH ERIE INS GROUP 56.25 2,190.16 TYPE: ERIEXPSPAY ID: 1256038677 CO: ERIE INS GROUP 01/10 01/10 Check 000051 Tracer 0000374377 52.50 2,137.66 01/13 01/13 Withdrawal ACH UGI UTILITIES 82.40 2,055.26 TYPE: UGI BILL ID:3231174060 CO: UGI UTILITIES 01/17 01/17 Check 000055 Tracer 0000254209 128.65 1,926.61 01/18 01/18 Withdrawal Debit Card CHECK CARD 42.00 1,884.61 01/18 GIANT 6005 MECHANICSBURG PA 01/22 01/22 Deposit Transfer From Share 0000 1,449.00 3,333.61 Estate of Barbara G. Meyers -- Attachment # 2 DATE FROM DATE TO PAGE ACCOUNT NU BE N, MEMBE ,st -FW1!RALCRJWrr JON01/01/2014 101/31/20141 201`3 1 XXXXXXX641 Eff. Post Date Date Description Deposits Withdrawals Balance 01/22 01/22 Withdrawal ACH UNITED WATER PEN 11.54 3,322.07 TYPE:WATER BILL ID:0020797347 CO: UNITED WATER PEN 01/24 01/24 Deposit 860.00 4,182.07 01/28 01128 Check 000057 Tracer 0000064886 226.51 3,955.56 01/29 01/29 Withdrawal ACH PPL EU 61.35 3,894.21 TYPE:ELEC SVC ID: 1230959590 CO:PPL EU 01/31 01/31 Deposit Transfer From Share 0000 1,233.23 5,127.44 01/31 01/31 Deposit Dividend 0.050% 0.12 5,127.56 Annual Percentage Yield Earned 0.050%from 01/01/14 through 01/31/14 01/31 01/31 Deposit Swipe 5 Rebate 0.15 5,127.71 ENDING BALANCE: $6,127.71 Check# Date Amount Check# Date Amount Check# Date Amount 51 01/10 52.50 52 01/09 4.04 53 01/08 461.00 55* 01/17 128.65 57* 01/28 226.51 Indicates check out of sequence 5 Checks Cleared for 872.70 ," T91i n sib ,3, ;929'.66 Avera I lan Im2,903.41 '2;179:37 REGULAR SAVINGS (0000) Eff. Post Date Date Description Deposits Withdrawals Balance 01/02 01/02 Deposit ACH XXCIV SERV 100.16 18,980.11 ID:3121736156 CO:XXCIV SERV 01/02 01/02 Withdrawal Transfer To Share 0011 100.16 18,879.95 01/02 01/02 Deposit ACH CNTRL PEN 287.00 19,166.95 TYPE:MON PF CKS ID: 1236262789 DATA:MONTHLYPF CHECKS CO: CNTRL PEN 01/02 01/02 Withdrawal Transfer To Share 0011 287.00 18,879.95 01/06 01/06 Withdrawal at ATM#005368 500.00 18,379.95 MEMBERS 1ST FCU 1166 WALNUT BOTTOM ROAD CARLISLE PA 01/07 01/07 Withdrawal at ATM#007913 500.00 17,879.95 MEMBERS IST FCU 6280 CARLISLE PIKE MECHANICSBURG PA 01/15 01/15 Withdrawal at ATM#002371 500.00 17,379.95 MEMBERS IST FCU 5211 SIMPSON FERRY ROAD MECHANICSBURG PA 01/17 01/17 Withdrawal at ATM#002000 600.00 16,779.95 MEMBERS 1ST FCU 6280 CARLISLE PIKE MECHANICSBURG PA 01/20 01/20 Withdrawal at ATM#003428 600.00 16,179.95 MEMBERS 1ST FCU 6280 CARLISLE PIKE MECHANICSBURG PA 01/22 01/22 Deposit ACH XXSOC SEC 1,449.00 17,628.95 ID:9031036360 CO:XXSOC SEC 01/22 01/22 Withdrawal Transfer To Share 0011 1,449.00 16,179.95 01124 01/24 Withdrawal by Check 2,858.00 13,321.95 Check 00 882598 Disbursed 2,858.00 01/31 01/31 Deposit ACH XXVA BENEF 1,233.23 14,555-18 ID:3111036002 CO:XXVA BENEF 01/31 01/31 Withdrawal Transfer To Share 0011 1,233.23 13,321.95 01/31 01/31 Deposit Dividend 0.150% 2.10 13,324.05 Estate of Barbara G. Meyers Attachment # 2 -- st . • -• . • • ACCOUNT .MEMBERS 1ON 01/01/2014 101/31/20141301`3 xxxxXXX641 Eff. Post Date Date Description Deposits Withdrawals Balance Annual Percentage Yield Earned 0.150%from 01/01/14 through 01/31/14 ENDING BALANCE: $13,324.05 Total Deposits 3,071.49 Total-Withdrawals; 8;627:39 SUPPLEMENTAL SAVINGS 000 B GINf�IBG BAL/kNCc: $220.1.5 Eff. Post Date Date Description Deposits Withdrawals Balance 01/31 01/31 Deposit Dividend 0.150% 0.03 220.18 Annual Percentage Yield Earned 0.160%from 01/01/14 through 01/31/14 ENDING BALANCE: $220.18 Total;Deposits: 0:03 MONEYiii 'BECZPI NIi G,'B iL CE. $15,726.22 Eff. Post Date Date Description Deposits Withdrawals Balance 01/31 01/31 Deposit Dividend Tiered Rate 2.51 19,728.73 Annual Percentage Yield Earned 0.150%from 01/01/14 through 01/31/14 ENDING BALANCE: $19,728.73 Total.Deposits 2,51 YTDSUMMARY DIVIDENDS PAID 0000 REGULAR SAVINGS 2.10 0001 SUPPLEMENTAL SAVINGS 0.03 0005 MONEY MANAGEMENT 2.51 0011 CHECKING 0.12 Total Year to Date Dividends Paid(Includes Closed Shares) 4.76 Estate of Barbara G. Meyers -- Attachment # 2 �-- File # 21-14-0079 MEMBERS IS, HMWLUCRWrr LWON 5/13/2014 Jennifer Foster 4 Stone Run Road Mechanicsburg,PA 17050 To whom it may concern, Jennifer Foster was added to account number 112641 of Barbara G Meyers on 09/11/2007 as a Joint Owner. If and ftirther verification is needed please contact me at 717-766-9102 ext. 76204 or stop into any local branch for assistance. Sincerely, Laramie Smith Member Service Representative 11 Members 1st FCU Estate of Barbara G. Meyers Attachment # 2 5400 Louise Drive • PO.Box 40 • Mechanicsburg,Pennsylvania 17055 (800)283-2328 • www.memberslst,org File # 21-14-0079 Estate of Barbara G. Meyers �� Attachment # 3 �� ��- Attachment # 3 Gontract#EQ5368121 - Barbara Meyers (secure) Brown, Karen <Karen.Brown@lfg.com> Thu, Oct 2,2014 at 4:05 PM To: "drfosterhome@gmaii.com"<drfosterhome@gmail.com> Good Afternoon Mrs. Foster, We are in receipt of your request for the value of the above named contract as of the date of death,January 16, 2014. The value as of the date of death, January 16, 2014, was$74,260.83. Should you have any questions or need additional assistance, please contact our office toll free, 1-800-454-6265, ext. *8200. Thank you, Karen H. Brown Annuity Claims Examiner II Life&Annuity Claims and Unclaimed Property Partner Solutions for Life,Claims and Distribution Lincoln Financial Group 100 N.Greene St., Mail Code 5310 Greensboro NC 27401 Toll Free Phone: 1-800-454-6265,ext.*8200 Fax: (260)455-9419 E-mail: karen.brown@lfg.com You're In Charge-' Find us on facebook: www.facebook.com/LincoInFinancialGroup Follow us on twitter: @LincolnFinGroup Notice of Confidentiality: "This E-mail and any of its attachments may contain Lincoln National Corporation proprietary information,which is privileged, confidential, or subject to copyright belonging to the Lincoln National Corporation family of File # 21-14-0079 Estate of Barbara G. Meyers �� Attachment # 4 �� G Attachment # 4 Contract#EN5368120 - Barbara Meyers (secure) Brown, Karen<Karen.Brown@lfg.com> Thu, Oct 2, 2014 at 4:09 PM To: "drfosterhome@gmail.com"<drfosterhome@gmail.com> Good Afternoon Mr. Foster, We are in receipt of your request for the value of the above named contract as of the date of death,January 16, 2014. The value as of the date of death, January 16, 2014,was$49,634.08. Should you have any questions or need assistance in the future, please contact our office toll free, 1-800-454-6265, ext. *8200. Thank you, Karen H. Brown Annuity Claims Examiner II Life&Annuity Claims and Unclaimed Property Partner Solutions for Life,Claims and Distribution Lincoln Financial Group 100 N.Greene St.,Mail Code 5310 Greensboro NC 27401 Toll Free Phone: 1-800454-6265,ext.*8200 Fax: (260)455-9419 E-mail: karen.brown@Ifg.com You're in Charge— Find us on facebook: www.facebook.com/LincoInFinancialGroup Follow us on twitter: @LincolnFinGroup Notice of Confidentiality: **This E-mail and any of its attachments may contain Lincoln National Corporation proprietary information,which is privileged, confidential, or subject to copyright belonging to the Lincoln National Corporation family of SCOTT M. DINNER, ESQUIRE TEL: (717) 761-5800 3117 CHESTNUT STREET FAX: (717) 761-5008 CAMP HILL, PA 17011 1> October 20, 2014 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 Re: Estate of Barbara G. Meyers #21-14-0079 On behalf of the above referenced estate, enclosed for filing are two original REV-1500's. Thank you. Scott M. Dinner, Esquire enclosures (2) cc: Jennifer M. Foster, Executrix N_ Q rr1 G7 Cf-) ..3 it tT! FA r O. �y (a� T �:xw�z►b�`ttr RECORDE0 OFFICE OF U.S.POSTAGE C is REG!Q.TFr,, n7 M L L S MECHANICSBURG,PA 17055 .1 OCT �j? (� OCT 21,14 ?0'19i LL FI ! 1 31 599LLURWCCE. AMOUNT 1000 $2.87 C LisF 17019 00112591-07 ORF'HA,;iJ: ,- ~ CUMRERLf Cumberland County Register of Wills Office One Courthouse Square Carlisle,PA 17013