HomeMy WebLinkAbout11-19-14 (3) REV-1500 EX(0140) 1505610143
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania county code Year Ffle Number
Bureau of Individual Taxes oeeaaruExroraEvaxE
PO BOX.280601 INHERITANCE TAX RETURN 21 14 0414
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
12 31 2013 11 28 1942
Decedent's Last Name Suffix Decedents First Name MI
HECK AGNES M
(if Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name ml
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Origina!Return ❑ 2. Supplemental Return ❑ 3.Remainder Return(date of death
prior to 12-1382)
❑ 4. Limited Estate E] 4a.Future Inter"compromise ❑ 5- Federal Estate Tax Return Required
(date of death atter 12-1240 0
6.Decedent Died Testate [3 7. Decedent Maintained a Ltvhq Trust S. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach copy of Trust)
[3 9. Litigation Proceeds Received [3 1 o.=Poverty Credft(date of death E3 11.Election to tax und er Sec.9 113(A)
12-31-91 and f-1-95) (Attach Sch.0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone"bar ;Z
JOSEPH D KERWIN 717c-)362 llgl� 5 ;z rn
rn
REG ii*
FjMLLS�U-SE6&1-16
11
First line of address 1CO
4245 STATE ROUTE 209 -,j
C:)
Second line of address r— r'li
City or Post Office state ZIP Code DATE FILEQ-r—
ELIZABETHVILLE PA 17023
Correspondent's e-mail address: jdk@kerwinlawfirm-com
Under penalties Land are 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 compleiDeclaration of preparer other than the persondl representative is based on all Information of which pfeparer has any Immiuledge.
SIGNATURE 0PIP111IN 11111NIII ,F07RF NG RETURN DATE
rA I Karen Sholly lill-TIly
ADDRESS (
105 East 4/berfild'dRoad,Enola,PA 17025
SIGNATURE OFZPYAAR THER THAN REPRESENTATIVE DATE
Joseph D Kerwin
ADDRESS to Route 209, Elizabethville,PA 17023
Side I
1606610143 1605610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: HECK, A G N E S M A E
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1. 120 , 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. 968 . 43
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7.
8. Total Gross Assets(total Lines 1-7)....................................................................... 8. 120 , 968 . 43
9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 17 , 317 . 33
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I)................................ 10. 8 , 702 . 58
11. Total Deductions(total Lines 9&10)...................................................................... 11. 26 , 019 . 91
12. 94 , 948 . 52
Net Value of Estate(Line 8 minus Line 11)............................................................. 12.
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.
94 , 948 . 52
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 15.
16. Amount of Line 14 taxable
at lineal rate x .045 94 , 948 . 5 2 16. 4 , 2 7 2 . 68
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18. .
19. Tax Due..................................................................................................................... 19. 4 , 2 7 2 . 68
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 - 0414
Decedent's Complete Address:
DECEDENT'S NAME
HECK, AGNES MAE
STREET ADDRESS
532 South Enola Road
CITY STATE ZIP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 4,272.68
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits(A +B) (2) 0.00
3. Interest
(3) 17.53
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) 4,290.21
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;.................................................................................. ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;.................................... ❑ ❑x
c. retain a reversionary interest;or.................................................................................................................. ❑ ❑x
d.\ receive the promise for life of either payments,benefits or care?.............................................................. ❑ ❑x
2. If death occurred after December 12, 1982,did decedent transfer property within one year of death without
receiving adequate consideration?......................................................................................................................: ❑
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?......... ❑ ❑x
4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which
contains a beneficiary designation?...................................................................................................................... ❑ ❑x
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 retfurn 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 1.2)[72 P.S.§9116(a)(1)l.
•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)1. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,w ether y blood or adoption.
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF HECK, AGNES MAE FILE NUMBER
21 - 14-0414
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 wilting 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 All that certain piece or parcel of real estate situate at 532 Enola Road, Enola, East Pennsboro 120,000.00
Township, Cumberland County, Pennsylvania (See attached Settlement Statement)
TOTAL(Also enter on Line 1, Recapitulation) 120,000.00
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAXAXRETURN
RESIDENT DECEDENT
NUMBER
BER
ESTATE OF HECK, AGNES MAE 21 -ILE NN - BER
0414
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 OF
NUMBER DESCRIPTION DEATH
1 Reimbursement for payment of 2014 county/township real estate taxes 85.62
2 Reimbursement for payment of 2014/15 school real estate taxes 882.81
TOTAL(Also enter on Line 5, Recapitulation) 968.43
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES&
INHERITANCE TAX RETURN
RESIDENT DECEDENT AMINwUR T MSTS
FILE NUMBER
ESTATE OF HECK, AGNES MAE 21 - 14-0414
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Musselman Funeral Home and Cremation Services 8,840.00
2 Rolling Green Cemetery Company 3,704.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission paid
2. Attorney's Fees Kerwin & Kerwin, LLP--Joseph D Kerwin 4,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills 348.50
5. Accountant's Fees H & R Block 87.43
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Cumberland Law Journal -advertisement of estate 75.00
TOTAL(Also enter on line 9, Recapitulation) 17,317.33
Schedule H
Funeral Expenses&
T
INHERITANCE TAX RETURN
COMMONWEALTH PENNSYLVANIA Administrative Costs continued
RESIDENT DECEDENT
ESTATE OF HECK, AGNES MAE FILE NUMBER
21 - 14-0414
2 The Sentinel -advertisement of estate 222.40
3 Notary fees 15.00
4 Releases 25.00
Page 2 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS
INHERITANCE TAX RETURN 1
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF HECK, AGNES MAE 21 - 14-0414
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Credit to Buyers for closing costs on real estate estate 3,600.00
2 Kerwin & Kerwin - Deed Preparation and Agreement of Sale 250.00
3 Recorder of Deeds- 1% Transfer tax 1,200.00
4 Debbie Lupold, Treasurer-2014/15 school real estate taxes 1,284.39
5 Debbie Lupold, Treasurer-Tax Certification 10.00
6 Debbie Lupold, Treasurer-2014 county/township real estate taxes 416.69
7 East Pennsboro Township-Sewer/Sanitation 552.00
8 Travelers- homeowners insurance 562.50
9 Penn Pest, LLC-renewal fee 85.00
10 Penn Pest, LLC -treatment 742.00
TOTAL(Also enter on Line 10, Recapitulation) 8,702,58
REV-1513 EX+(11-08)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF HECK, AGNES MAE FILE NUMBER
21 - 14-0414
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I, TAXABLE DISTRIBUTIONS(include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Karen Sholly Daughter 1/4 of estate
105 East Cumberland Road
Enola, PA 17025
2 Joseph Heck, Jr. Son 1/4 of estate
108 Rosenhaven Circle
Madison, AL 35756
3 George Heck Son 1/4 of estate
2381 Powells Valley Road
Halifax, PA 17032
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
REV-1613 EX+(9-00) SCHEDULE
COMMONEALTH OF PENNSYLV
INHERWITANCE TAX RETURNANIA BENEFICIARIES continued
RESIDENT DECEDENT
ESTATE OF HECK, AGNES MAE FILE NUMBER
21 - 14-0414
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trusteem
TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
4 Charles Heck Son 1/4 of estate
51 Sutherland Way
Mechanicsburg, PA 17050
Page 2 of Schedule J
LAST WILL AND TESTAMENT
OF
AGNES MAE HECK
1, Agnes M. Heck of West Fairview, Cumberland County, Pennsylvania, being of
sound mind, memory and understanding, do hereby make and publish this, my Last Will
And Testament hereby revoking all previous Wills and Codicils made by me.
Item 1. 1 declare for the purposes of this Will that, as of the date of its
execution, my immediate family consists of the following:
My spouse, Joseph D. Heck predeceased me.
The names of my children are: Karen Sholly
Joseph Heck, Jr.
George Heck
Charles Heck
All references to my spouse and family are to them.
Item Il. I direct that all debts enforceable against me during my lifetime and
duly allowed in the administration of my estate, the expenses of my last illness and
funeral, including the cost of a suitable monument at my grave-, unpaid cha,-;*abl-
pledges whether or not the same are enforceable obligations against my estate, and the
costs of administration of my estate be paid as soon as practicable after my death. My
Personal Representative may, in her sole discretion, pay from my domiciliary estate all
or any portions of the cost of ancillary and similar proceedings in other jurisdictions.
Item Ill. All of the rest, residual, and remainder of my estate, real, personal
and mixed of whatever kind and wheresoever situated, shall be sold. The proceeds from
the sale I give and bequeath to my children in equal shares. Should any child
predecease me, then their share shall lapse.
Item IV. I hereby nominate and appoint my daughter Karen Sholly, to be the
Personal Representatives of my estate. If she is unwilling or unable to serve then I
nominate and appoint my son Charles Heck. Neither of these persons shall be required
to serve with bond.
Item V. I confer on my Personal Representative, in addition to those
powers granted by law, the following powers to be exercised in a prudent manner and
applicable to all property constituting a part.of my estate:
A. To retain and to invest in all forms of real and personal
property, without being confined to investments authorized by a statutory list, without
being required to diversify and regardless of any principal of law limiting delegation of
investment responsibilities by personal representatives or trustees;
B. To compromise claims and to abandon any property which,
in my Personal Representative's opinion, is of little or no value;
C. To sell at private or public sale, to exchange or to lease for
any period of time, any real or personal property, and to give options for sales or
leases;
D. To borrow from anyone, even if the lender is a personal
representative hereunder, and to pledge property as security for repayment of the funds
borrowed;
E. To join in any merger, reorganization, voting-trust plan or
other concerted action of security holders, and to delegate discretionary duties;
F. To employ and to rely upon the advice given by investment
counsel, to delegate discretionary.authority to make changes in investments to
investment counsel, and to pay investment counsel reasonable compensation in
addition to any fees otherwise paid to my Personal Representative(s);
G. To employ a custodian, to hold property unregistered or in
the name of a nominee (including the nominee of any institution employed as
custodian), and to pay reasonable compensation to the custodian in addition to any fees
otherwise payable to my Personal Representative(s);
H. To procure and carry at the expense of my estate insurance
of kinds, forms and amounts deemed advisable by my Personal Representative(s) to
protect my estate and my Personal Representative(s) against any hazard;
2
I. To commence or defend at the expense of my estate any
Litigation affecting my estate;
J. To conduct alone or with others any business in which I am
engaged or in which I have any interest at my death, with all the powers of any owner
with respect thereto, including the power to delegate discretionary duties to others, to
invest other property held hereunder in such business and to organize a partnership or
corporation to carry out such business; and
K. To distribute in cash or in kind.
Item VI. My Personal Re presentative(s) shall be reimbursed for all
reasonable expenses incurred in the administration and management of the assets of
my estate and shall be entitled to receive a fair and reasonable compensation for her/his
services.
Item VII. Anyone named in this Will who dies within 30 days after my death
(or dies under circumstances such that it cannot be determined whether such individual
died within 30 days after my death) shall be deemed, .for purposes of this Will, to have
predeceased me.
IN WITNESS WHEREOF, I, Agnes M. Heck, have to this my Last Will And
Testimony hereunto set my hand and seal this L day of G.Q(;, tn..- , 2011.
Agnes M. Heck
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named
Testatrix, Agnes M. Heck as and for her Will, in the presence of us who, at her request,
in her presence, and in the presence of each other, all being present at the same time,
have hereto set our hand as witnesses:
NAME A ' A54PY RESIDING AT �JC4 (.,`,JLe Pdl Qt
NAMES i4l" RESIDING AT "CV,
3
STATE OF PENNSYLVANIA
SS.
COUNTY OF
I, Agnes M. Heck, having been duly qualified according to law,
acknowledge that I signed the foregoing instrument as my Will, and that I signed it as
my free and voluntary act for the purposes therein expressed.
Agnes)M. Heck
We, having been duly qualified according to law, depose and say that we
were present and saw Agnes M. Heck sign the foregoing instrument as her Will; that
she signed it as her free and voluntary act for the purposes therein expressed; that each
of us in her sight and hearing and at her request signed the Will as witnesses; and that
to the best of our knowledge, she was at the time 18 years or more of age, of sound
mind, and under no constraint or undue influence.
Wit ess
�-!r::
"Witness
Subscribed, sworn to, or affirmed, and acknowledged before me by the
above-named Testatrix and by the witnpses whose names appear, on this I S4 day of
201
F „
t
Notary P` blic
COMMONWEALYH OF KNNOYLVANiA
Notarial Seal
Hope A.Mattos,Notary Public
Hampden Twp.,Cumberland County
My Commission Expires Oct.11,2012
Member.Pennsylvania Association of Notaries
4
N)
e OMB Approval No.2502-0265
� A. Settlement Statement(HUD-1)
e�N oeJE�d�
B. Type of Loan
1.❑FHA 2.❑RHS 3.RConv.Unins. 6. File Number. 7. Loan Number: 8. Mortgage Insurance Case Number:
4.E]VA 5.E]Conv.Ins. QUI GLEY.CQ 900002163
C. 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 the closing;they are shown here for Informational purposes and are not included in the totals.
D. Name and Address of Borrower: E. Name and Address of Seller: F. Name and Address of Lender.
Chad E.Quigley Mid Penn Bank
Alicia L Sholly Agnes Mae Heck Estate 349 Union Street
532 South Enola Road c/o 105 Fast Cumberland Road Millersburg,PA 17061
Enola,PA 17025 Enola,PA 17025
G. Property location: H. Settlement Agent: 23-2083639 I.Settlement Date:
532 South Enola Road Kerwin&Kerwin,LLP
Enola,PA 17025 4245 Route 209 October 17,2014
Cumberland County,Pennsylvania Elizabethville,PA 17023 Ph. (717)362-3215
Tax Parcel 45-16-1050-061 Place of Settlement:
1001 Peters Mountain Road
Dauphin,PA 17018
J. Summary of Borrowers transaction K. Summary of Sellers transaction
100. Gross Amount Due from Borrower. 400. Gross Amount Due to Seller:
101. Contract sales price 1 120 000.00 401. Contract sales price 120 000.00
102. Personal property 402. Personal property
103. Settlement Charges to Borrower Line 1400 4,448.29 403.
104. 404.
105. 405.
Adjustments for items paid by Seller in advance Adjustments for Items paid by Seller in advance
106. School Taxes 10/18/14 to 07/01/15 882.81 406.School Taxes 10/18/14 to 07/01/15 882.81
107. CounWhNp Taxes 10/18/14 to 01/01/15 85.62 407.CountyAwp Taxes 10/18/14 to 01/01/15 85.62
106. Assessments to 408.Assessments to
109. 409.
110. 410.
111. 411.
112. 412
120. Gross Amount Due from Borrower 125,416.72 420.Gross Amount Due to Seller 120,968.43
200. Amounts Paid by or in Behalf of Borrower 500. Reductions in Amount Due Seller.
201. Deposit or earnest money 501. Excess deposit see Instructions
202. Principal amount of new loans 116 400.00 502. Settlement charges to Seller Une 1400 2,754.39
203. Existing loans taken subject to 503. Existing loans taken subject to
204. 1 504.Payoff First Mortgage
205. 505.Payoff Second Mortgage
206. 506.
207. 507.
208. Seller credit for closing cost 3,600.00 508.Seller credit for closing cost 3,600.00
209. 509.
Adjustments for items unpaid by Seller Adjustments for Items unpaid by Seller
210. School Taxes to 510.School Taxes to
211. Coun Taxes to 511.CountyAwp Taxes to
212.Assessments to 512.Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid by/for Borrower 120,000.00 520.Total Reduction Amount Due Seller 6,354.39
300. Cash at Settlement from/to Borrower 600.Cash at settlement tolfrom Seller
301. Gross amount due from Borrower line 120 125 416.72 601. Gross amount due to Seller line 420 120 968.43
302. Less amount paid b&r Borrower line 220 ( 120,000.00) 602. Less reductions due Seller line 520 ( 6,354.39
303.Cash 0From ElToBorrower 5,416.72 603. Cash E]To E] From Seller 114,614.04
Paid ouWdeoldoslnpbyborrower(8. eertsmender(L,orrtlyd-party(T)
The undersigned hereby ac lige rec pof plated co this statement&any attachments referred o herein
Borrower Seiler ' f
IF
had E.Quig Agnes Mae Heck
cl II
The W btc Reporting Burden for this collection of Information is estimated at 35 minutes per response for colleting,renewing,and reporting the data.This agency may not collect this Inkrmation,and you aro
not required to mmplete this form,unless Ildisplays a currently valid OMB control number.No confidentiality is assured;this disclosure Is mandatory.This Is designed to provide the parties to a RESR4cdvered
transaction with Informeron during tie settlement process.
Page 1 of 3 HUD-1
(QUIGIPLCQ.PFD/QUIG LEY.CQ/12)
L.Settlement Char es
700 _dtb�l;RealtBrokeyees F n. c_ Pak/From Paid From
Division ofcommission(line 700)as follows: Bonowefs Seller's
701.$ to Funds at Funds at
702.$ to Settlement Settlement
703.Commission paid at settlement
704.
705.
l#00=(tams, a6telitYGonnettoarittiat:=aan
f"ay t,�--•rte
_..�.� *�
801.Our ori ination charge $ 725.00 from GFE#1
802.Your credit or charge ints for the specific interest rate chosen from GFE#2
803•Your adlusted origination charges from GFE#A 725.00 '
804.Appraisal fee to Caitland Inc. from GFE#3 P.O.C. 395.00 8
805.Credit Report to CBC Innovis from GFE#3 12-85
806.Tax service to from GFE#3
807.Flood certification to CBC Innovis from GFE#3) 9.00
808.We of Lean Flood Searc to CBC Innovis from GFE#31 2.00
809. from GFE#3
810. from GFE#3
811. (from GFE#3)
9;OOfeni'ssRagreit)b'leftde"r3f5BejP,aiiftn`<Aiivance
901.Daily Interest charges from 10/17/14 to 11/01/14 15 15.762500/da from GFE#10 236,44
902.Mortgage insurance premium for months to (from GFE#3)
903.Homeownees Insurance for 1.0 years to Erie lnsurance Co. (from GFE#11) PO.C-$509.00(8)'
904. (from GFE#it)
905. (from GFE#11)
1001.Initial deposit for your escrow account from GFE#9) 552.55
1002.Homeowner's Insurance 4.000 months @ $ 42.42 per month $ 169.68
1003.Mortgage Insurance months @ $ per month $
1004.Property taxes 10.000 months 0 $ per month $ 347.20
CountVftwp Taxes 10.000 months 0 $ 34.72 per month
School Taxes months @ $ per month i
1005. f
1006.School re.taxes 6.000 months @ $ 107.03 per month $ 642.18
1007. months (off $ per month $
1008. $
1009.Aggregate Adjustment $ -606.51
Ai)d. � �3���a ...�.�'•,'.-�t`F-fa y �: ,: ..-..,, r,�,.>..L{,.5u; ..... , �.. _.,�y•a_ •-_§�'�%`x i r r'� - r a - 3
1101. Title services and lender's title Insurance from GFE#4) 1,449.95 260.00
1102. Settlement or closin fee $
1103. Owner's Utle Insurance to Stewart Title Guaranty Company (from GFE#5) 115.00
1104. Lender's UUe Insurance to Stewart Title Guaranty Company $ 1,135.00
1105. Lender's title policy limit $ 116,400.00
1106. Owner's Me policy limit $ 120,000.00
1107. AgeM's potion of the total Ude insurance premium to Agent $ 977,50
1108. Underwriters portion of the total title Insurance premium to Stewart Title Guaranty Company $ 172.50
1109. $
1110. $
1111. $
1112. $
1113. $
�2b0Go,eie�if�itiirdi jand�Tiansf$1.Cha; r� " _.x'""^ rtrr" `'r `w:it. �, "�°X pi .
1201.Government record!ng charges to Recorder of Deeds fron GFE# 245.50
1202.Deed$ 79.00 Mortgage $ 99.00 Releases $ Other$ 67.50
1203.Transfer taxes to Recorder of Deeds (from GFE#8) 1,200.00
1204.ClitylCountytaylstamps $ 1,20D.00 $
1205.State tax/stamps $ 1,200.00 $ 1,200.00.
1206.
1207.
1,StSO-�A'8'dlftonai_�SeftTement
1301.Required services that you can shop for (from GFE#6)
1302.Pest Inspection $
1303. $
1304.2014115 school r.e.taxes to Debbie Lu old,Treasurer $1 1 45.16-1050.061 1,284.39
1305.Tax Certification to Debbie Lupold,Tax Collector $1 IL 10.00
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Page 2 of 3 HUD-1
(QU I G LEY.CQ.PFD/QUIG LEY.CQ/12)
Comparison of Good Faith Estimate(GFE)and HUD-1 Charges Good Faith Estimate HUD-1
Charges That Cannot Increase HUD-1 Line Number
Our origination charge #801 725.00 725.00
Your credit or charge(points)for the specific rate chosen #802 0.00
Your adjusted origination charges #803 725.00 725.00
Transfer taxes #1203 1,200.00 1,200.00
Charges That In Total Cannot Increase More than 10% Good Faith Estimate HUDA
Government recording charges #1201 300.00 245.50
Appraisal fee #804 395.00 395.00
Credit report #805 12.85 12.85
Flood certification #807 9.00 9.00 i
Life of Loan Flood Search #808 2.00 2.00
Title services and lender's title insurance #1101 1,480.00 1,449.95
Owners title insurance to Stewart Title,Guaranty Company #1103 15.00
Total 2,198.85 2,129.30 j
Increase between GFE and HUD-1 Charges $ -69.55 or -3.16°I
i
Charges That Can Change Good Faith Estimate HUD-1
Initial deposit for your escrow account #1001 1,312.49 552.55
Daily interest charges #901 $ 15.762500/day 236.44 236.44
Homeowner's insurance #903 850.00 509.00
Pest inspection #1302 75.00
Loan Terms
Your Initial loan amount Is $116,400.00
Your loan term Is 30.00 years
Your€niUal Interest rate is 4.8760%
Your initial monthly amount owed for principal,interest and $616.00 includes
any mortgage insurance is Principal
® Interest
❑ Mortgage insurance
Can your interest rate rise? ❑X No ❑ Yes,it can rise to a maximum of °!°.The first
change will be on and can change again every,_months after
. Every change dale,your Interest rate can increase or decrease
by %.Over the life of the loan,your Interest rate Is guaranteed
to never be lower than %or higher than °A.
Even H you make payments on time,can your loan balance rise? ❑X No ❑ Yes,it can rise to a maximum of$
Even If you make payments on time,can your monthly 0 No ❑ Yes,the first increase can be on and the monthly
amount owed for pdncipal,interest,and mortgage Insurance dse? amount owed can rise to$
The maximum It can ever rise to Is$
Does your loan have a prepayment penalty? ❑X No ❑ Yes,your maximum prepayment penalty Is$
a
Does your loan have a balloon payment? 0 No ❑ Yes,you have a balloon payment of s i
due in_years on
i
Total monthly amount owed Including escrow account payments ❑ You do not have a monthly escrow payment for Items,such as property
taxes and homeowners Insurance.You must pay these Items directly I
yourself.
[91 You have an additional monthly escrow payment of$184.17 that results
in a total initial monthly amount owed of$800.17.This Includes
principal,interest,any mortgage insurance and any Items checked below.
❑X, Property taxes ❑X Homeowners insurance
❑ Flood insurance ❑
❑ ❑
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender.
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Page 3 of 3 HUD-1 i
(QU IGLEY.CQ.PFO/QUIGLEY.CQ/12)
HLIDA Attachment
Borrower(s):Chad E.Quigley and Alicia L.Sholly Selleqs): Agnes Mae Heck
532 South Enola Road c/o 105 East Cumberland Road
Enola,PA 17025 Enola,PA 17025
Lander.Mid Penn Bank
Settlement Agent:Kerwin&Kerwin,LLP
(717)362-3215
Place of Settlement:1001 Peters Mountain Road
Dauphin,RA 17018
Settlement Date:October 17,2014
Property Location:532 South Enola Road
Enola,PA 17025
Cumberland County,Pennsylvania
Tax Parcel 45-16-1050-061
Adjusted Origination Charge Details
Origination Charge
Administrative Fee 725.00
to Mid Penn Bank
Total $ 725.00
Origination CreditiCharge(points)for the specific Interest rate chosen
Total $
Adjusted Origination Charges $ 726.00
Reserves Deposited With Lender
Homeowner's Insurance 169.68
4.000 at 42.42 per month
County/twp Taxes 347.20
10.000 at 34.72 per month
School re.taxes 642.18
6.000 at 107.03 per month
Aggregate Adjustment -606.51
Total $ 652.55
Title Services and Lender's Title Insurance Details BORROWER SELLER
Atty Fees/Doc Prep 150.00 250.00
to Kerwin&Kerwin,LLP
Notary fees 20.00 10.00
to Kerwin&Kerwin,LLP
Insured Closing Protection Let 125.00
to Stewart Title Guaranty Company
Courier Fee 19.95
to U.S.Postmaster/FedEX
Lender's title insurance 1,135.00
to Stewart Title Guaranty Company
Total $ 1,449-95 $ ?60-00
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.
(QU1GLEY.CQ.PFD/QU1GLEY.CQ112)
HUD-1 Attachment- Continued
Owner's Title Insurance BORROWER SELLER
Owner's Policy Premium 15,00
to Stewart Title Guaranty Company
Total 16.00 $ 0.00
Lender's Title Insurance BORROWER SELLER
*fees also shown above In Title Services and Lenders Title Insurance Details
Lender's Policy Premium 985.00
. to Stewart Me Guaranty Company
Lender's Endorsement Charges 150.00
Endorsement Endorsement Charge
ALTA Endorsement 100 50.00
ALTA Endorsement 300 50.00
ALTA Endorsement Form 8.1(Environmental Protection 50.00
Lien)
Total $ 1,135.00 $ 0.00
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.
(QUIGUEY.CQ.PFD/QUIGLEY.CQt12)