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DECEDENT'S ESTATE
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF Robert A. Barge DECEASED
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No. 21 -12 -01272
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PETITION FOR ADJUDICATION I -' c� X Co
STATEMENT OF PROPOSED DISTRIBUTIONCo
PURSUANT TO Pa. O.C. RULE 6.9 < -T1
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This form may be used in all cases involving the Audit of the Account of a Decedent's Estate. If
space is insufficient, riders may be attached. Attach the spouse's election, if any; the papers
required under items 8-19 inclusive; and any instrument pertinent to the adjudication.
INCLUDE ATTACHMENTS AT THE BACK OF THIS FORM.
Name of Counsel: Robert P Kline
Supreme Court I.D. No.: 58798
Name of Law Firm: Kline Law Office
Address: 714 Bridge Street
New Cumberland, PA 17070
Telephone: 7171770-2540
Fax: 7171770-2553
E-mail: rkline@klinelawoffice.com
Form OC-01 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc. Page 1 Of 10
Estate of Robert A. Barge Deceased
1. Name(s)and address(es)of Petitioner(s):
Name. Bruce J. Barge
Address: 600 Steinhour Road
York Haven, PA 17370
Identify any executors or administrators who have not joined in the Petition for
Adjudication and Statement of Proposed Distribution and Account and state reason:
Is this the first accounting by this fiduciary?.......................................................................... 0 Yes ❑ No
If not, identify prior accountings, the accounting periods covered, and the date of
adjudication of the prior accounting.
2. Decedent died on 11/24/2012
Q Letters Testamentary or ❑ Letters of Administration were granted to Petitioner(s)on
12/6/2012
Date of Will (if applicable): 11/112012
Date(s) of Codicil(s) (if applicable):
Date of probate (if different from date Letters granted):
Was a bond required? ❑ Yes 0 No If yes, state amount:
Are proofs of advertising of the grant of Letters attached? .......................................... Q Yes ❑ No
Dates of advertising of the grant of Letters:
12/21/2012 12/28/2012 1/4/2013 3/11/2014 3/18/2014 3/2512014
Form OC-01 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group.Inc. Page 2 of 10
Estate of Robert A. Barge Deceased
3. Was decedent survived by a spouse?........................................................................ Q Yes 0 No
If yes, name of the surviving spouse: Bethany Barge
4. Has the surviving spouse filed to take an elective share?......................................... Yes 0 No
(See Section 2201 et sem. of the Probate, Estates and Fiduciaries Code)
If yes, date of election:
5. In the case of an intestacy, state the names of the decedent's surviving children or
surviving issue of deceased children (if none, so state):
6. Did the decedent marry after execution of Will or Codicil(s)?............................................... Yes Q No
Were any children born to decedent after execution of
Willor Codicil(s)? ................................................................................................................ ❑ Yes Q No
If yes, give names and dates of birth:
Name: Date of Birth:
7. If required by the Medical Assistance Estate Recovery Act,
62 P.S. §1412, was a request for a statement of claim sent to
the Department of Public Welfare? ..................................................................................... ❑X Yes ❑ No
Form OC-01 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc. Page 3 of 10
Tj,
Estate of Robert A. Barge Deceased
8. Written notice of the Audit as required by Pa. O.C. Rules 6.3, 6.7 and 6.8 has been or will
be given to all parties in interest listed in item 9 below, all unpaid creditors and all
claimants listed in item 10 below. In addition, notice of any questions requiring
Adjudication as discussed in item 14 below has been or will be given to all persons
affected thereby.
A. If Notice has been given, attach a copy of the Notice as well as a list of the names
and addresses of the parties receiving such Notice.
B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and
addresses of the parties receiving such Notice shall be submitted at the Audit
together with a statement executed by a Petitioner or counsel certifying that such
notice has been given.
C. If any person entitled to Notice is not sui juris(e.g., minors or incapacitated
persons), Notice of the Audit has been or will be given to the appropriate
representative on such party's behalf as required by Pa. O.C. Rule 5.2.
D. If any charitable interest is involved, Notice of the Audit has been or will also be
given to the Attorney General as required under Pa. O.C. Rule 5.5. In addition,
the Attorney General's clearance certificate (or proof of service of Notice and a
copy of such Notice) must be submitted herewith or at the Audit.
9. List all parties (charitable and non-charitable) of whom Petitioner(s) has/have notice or
knowledge, having or claiming any interest in the estate as beneficiaries under the Will or
Codicil(s)or as intestate heirs if there is a complete or partial intestacy:
A. State each party's relationship to the decedent and the nature of each party's
interest(s):
Name and Address o/Each Part in Interest Relationship and Comments,i/any Interest
April C. Frock Stepchild 30%
629 Herman Avenue
Lemoyne, PA 17043
Danielle R. Barge Daughter 35%
Last Known Address:
139 East Columbia Road
Enola, PA 17025
Form OC-01 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc. Page 4 Of 10
Estate of Robert A. Barge Deceased
Name and Address of Each Party in Interest Relationship and Comments,if any Interest
Ryan R. Barge Son 5%
c/o Cumberland County Prison
1101 Claremont Road
Carlisle, PA 17015
B. Identify each party who is not sui juris(e.g., minors or incapacitated persons).
For each such party, give date of birth, the name of each Guardian and how each
Guardian was appointed. If no Guardian has been appointed, identify the next of
kin of such party, giving the name, address and relationship of each.
C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed for
this Audit(see PA. O.C. Rule 12.4).
D. If distribution is to be made to the personal representative of a deceased party,
state date of death, date and place of grant of Letters and type of Letters granted.
Form OC-01 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc. Page 5 of 10
Estate of Robert A. Barge Deceased
10. Other than the claim for the family exemption, list the names of all known claimants and
the amount of their claims and state whether each claim is admitted.
Name and Address of Each Claimant Amount of Claim Claim Will Claim
Admitted? Be Paid in
Full?
L
Above
Attachment
Total
If the estate is insolvent, attach a schedule setting forth the order of preference under
20 Pa.C.S. § 3392 and the proposed payments.
11. Was family exemption claimed?.......................................................................................... Yes No
Was family exemption allowed?........................................................................................... El Yes 0 No
Family exemption claimant's name and relationship:
Name: Relationship:
Form OC-01 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc. Page 6 of 10
Estate of Robert A. Barge Deceased
12. The amount of Pennsylvania Transfer Inheritance Tax and additional Pennsylvania Estate
Tax paid, the date(s) of payment(s), and the interest(s) upon which paid, are as follows:
Date Payment Interest
06/11/2014 0.00 0.00
13. On the date of death, was the decedent a fiduciary
(personal representative, trustee, guardian, agent under power
of attorney) or surety on the bond of a fiduciary?................................................................. Yes ❑X No
If yes, provide the name of the estate, indicate whether an account has been filed and
confirmed absolutely and all awards performed, or, in the alternative, how the
decedent's estate will be discharged for the decedent's fiduciary administration of the
estate.
14. A. Describe in detail any questions requiring adjudication and state the position of the
Petitioner(s) as to each question:
B. Has notice of the question requiring adjudication been given
to the parties identified in Paragraph 9 above?............................................................. Yes Q No
15. If Petitioner(s) has/have knowledge that a share has been assigned, renounced, disclaimed
or attached, provide a copy of the assignment, renunciation, disclaimer or attachment,
together with any relevant supporting documentation.
Form OC-01 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc. Page 7 of 10
Estate of Robert A. Barge Deceased
16. Had the decedent been adjudicated an incapacitated person?............................................ Yes No
If yes, attach a copy of the Order if available; otherwise state Court, term, number,
date, and name of Hearing Judge.
17. A. List or attach a separate list of additional receipts and disbursements since the closing
date of the Account.
Date Description Amount
B. Has notice of the additional receipts and disbursements been
given to the parties identified in Paragraph 9 above?.................................................... E] Yes FK No
18. If a reserve is requested, state amount and purpose.
Amount:
Purpose:
If a reserve is requested for counsel fees, has notice of the
amount of fees to be paid from the reserve been given to the
partiesin interest?.................................................................................................. Yes ❑X No
If so, attach a copy of the notice.
19. Is the Court being asked to direct
the filing of a Schedule of Distribution?................................................................................ 0 Yes No
Asto real estate only?.......................................................................................................... El Yes 0 No
Form OC-01 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc. Page 8 of 10
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Estate of Robert A. Barge Deceased
Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the parties entitled
and suggest(s) that the distributive shares of income and principal (residuary shares being stated
in proportions, not amounts) are as follows:
A. Income:
Proposed Distributee(s) Amount Proportion
B. Principal:
Proposed Distributee(s) Amount Proportion
Danielle R. Barge 32.94
Ryan R. Barge 32.94
April C. Frock 28.22
Submitted By:
(A//petitioners must sign.
Add additional lines if necessary):
Name of Petitioner: Bruce J. Barge
Name of Petitioner:
Name of Petitioner:
Form OC-01 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc. Page 9 of 10
.,5; •1:'<'4y
Estate of Robert A. Barge Deceased
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies ` [that helshe is title
of the above-named name ofcorporation
and]that the facts set
forth in the foregoing Petition for Adjudication/Statement of Proposed Distribution which are
within the personal knowledge of the Petitioner are true, and as to facts based on the
information of others, the Petitioner, after diligent inquiry, believes them to be true; and that any
false statements herein are made subject to the penalties of 18 Pa. C.S. §4904 (relating to
unsworn falsification to authorities).
Signature of Petitioner Bruce J. Barge
Signature of Petitioner
Signature of Petitioner
•Corporate petitioners must complete bracketed information.
Certification of Counsel
The undersigned counsel hereby certifies that the foregoing Petition for Adjudication/
Statement of Proposed Distribution is a true and accurate reproduction of the form Petition
authorized by the Supreme Court, and that no changes to the form have been made beyond the
responses herein.
Signature of Counsel for Petitioner
Robert P Kline
Form OC-01 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc. Page 10 of 10
Estate of Robert A. Barge Deceased
Wherefore, your Petitioner(s) ask(s)that distribution be awarded to the parties entitled
and suggest(s) that the distributive shares of income and principal (residuary shares being stated
in proportions, not amounts) are as follows:
A. Income:
Proposed Distributees) Amount Proportion
B. Principal:
Proposed Distributee(s) Amount Proportion
Danielle R. Barge 32.94
Ryan R. Barge 32.94
April C. Frock 28.22
Submitted By:
(All petitioners must sign.
Add additional lines if necessary):
4441� SL' /" - ,
Name of Petitioner: aBrude J. Ba0e
Name of Petitioner:
Name of Petitioner:
Form OC-01 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc. Page 9 Of 10
Estate of Robert A. Barge Deceased
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies [that he/she is title
of the above-named name of corporation
and]that the facts set
forth in the foregoing Petition for Adjudication /Statement of Proposed Distribution which are
within the personal knowledge of the Petitioner are true, and as to facts based on the
information of others, the Petitioner, after diligent inquiry, believes them to be true; and that any
false statements herein are made subject to the penalties of 18 Pa. C.S. §4904 (relating to
unsworn falsification to authorities).
Signature of Petitiorfetr puce J arge
Signature of Petitioner
Signature of Petitioner
•Corporate petitioners must complete bracketed information.
Certification of Counsel
The undersigned counsel hereby certifies that the foregoing Petition for Adjudication/
Statement of Proposed Distribution is a true and accurate reproduction of the form Petition
authorized by the Supreme Court, and that no changes to the form have been made beyond the
responses herein.
1
Signature of Counsel for Petitioner
Robert P Kline
Form OC-01 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc. Page 10 of 10
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L.1784
COMMONWEALTH OF PENNSYLVANIA :
ss.
COUNTY OF CUMBERLAND
Lisa Marie Coyne,Esquire, Editor of the Cumberland Law Journal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952,been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
viz:
December 21, December 28, 2012 and January 4, 2013
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are true.
L' a Marie Coyne, itor
SWORN TO AND SUBSCRIBED before me this
4 dM of January, 2013
Notary
Barge,Robert A.,deed.
Late of East Pennsboro Township. i
Executor: Bruce J. Barge c/o NOTARIAL S ��
Robert P. Kline, Esquire, Kline
Law Office, P.O. Box 461, New DEBORAH A COLLINS
Cumberland,PA 17070-0461. Notary Public
Attorneys: Robert P. Kline, Es- CARLISLE BOROUGH,CUMBERLAND COUNTY
quire,Kline Law Office, P.O. Box My Commission Expires Apr 28,2014
461,New Cumberland,PA 17070-
0461.
The Patriot-News Co.
2020 Technology Pkwy t4e atr1*otwXews
4 ' Suite 300
Mechanicsburg, PA 17050 Now you know
Inquiries - 717-255-8213
KLINE LAW OFFICE
ATTN: ROBERT P. KLINE
714 BRIDGE STREET
P.O. BOX 461
NEW CUMBERLAND PA 17070
THE PATRIOT NEWS
THE SUNDAY PATRIOT NEWS
Proof of Publication
Under Act No. 587, Approved May 16, 1929
Commonwealth of Pennsylvania, County of Dauphin} ss
Marianne Miller, being duly sworn according to law, deposes and says:
That she is a Staff Accountant of The Patriot News Co., a corporation organized and existing under the laws of the
Commonwealth of Pennsylvania, with its principal office-and place of business at 2020 Technology Pkwy, Suite 300, in the
Township of Hampden, County of Cumberland, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday
Patriot-News newspapers of general circulation, printed and published at 1900 Patriot Drive, in the City, County and State
aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949,
respectively, and all have been continuously published ever since;
That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular
daily and/or Sunday/Community Weekly editions which appeared on the date(s) indicated below. That neither she nor said
Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as
to the time, place and character of publication are true; and
That she has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on
behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the
stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds
in and for said County of Dauphin in Miscellaneous Book"M", Volume 14, Page 317.
PUBLICATION COPY This ad# 0002292362 ran on the dates shown below:
March 11, 2014
March 18, 2014
Letters have been granted on the March 25, 2014
Estate of Robert A.Barge,late of East
Pennsboro Township,Cumberland
County,Pennsylvania,to Bruce J.
Barge,Executor,c/o Robert P.KIIne,
Esquire,Kline Law Office,P.O.Box 461, • • • ' ' ' • • ' ' ' ' • • • ' ' ' ' • • • • ' '
New Cumberland,PA 17070.0461. All
persons having Claims against the
Estate are requested to present them In'
writing and all persons Indebted to theSworn S=ubscribed subscribed befor a this 28 day of March, 2014 A.D.
Estate to make payment to It In care of
i
the attorney noted above.
tary Public
COMMONWEALT14 aF PENNSYLVANIA
Notar1a15ea' public
Holly Lynn Wedel,NO 117Y
was ingwnTWp•,Dauphin county
My .►ox. 1?ec•
12 2016
MEM13FR,PENN NIA AS ON OF NOTARIES
ESTATE OF ROBERT A. BARGE, DECEASED
LATE OF EAST PENNSBORO TOWNSHIP, CUMBERLAND COUNTY, PA
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-12-01272
FIRST AND FINAL ACCOUNT OF BRUCE J. BARGE, EXECUTOR
Date of Death: November 24, 2012
Date Letters Testamentary Issued: December 6, 2012
Accounts Dated to November 20, 2014
Assets:
Integrity Bank Checking Account $ 3,017.59
Unim Insurance Proceeds 4,404.87
Lord& Taylor Credit 1,354.62
Chrysler Automobile 300.00
Washer and Dryer 100.00
Hershey Medical Center Refund 180.00
Hershey Medical Center Refund 78.00
Home Equity Loan Refund 707.65
Personal Property (Auction Proceeds) 5,639.73
823 S. Humer Street, East Pennsboro 20,000.00
Township
Credits at Settlement for Prepaid Taxes and 1,134.89
Services
IRS Refund 560.34
Progressive Insurance Refund 99.02
Total Gross Assets 37,576.71
Administrative Expenses:
P. Scott Archibald, Appraiser 225.00
Fire Mountain 196.05
Tiger Trash (Dumpster) 425.00
M.S. Hershey Medical Center 1,056.59
MSHMC Physicians Group 555.12
Camp Hill Emergency Physicians .1,246.00
Tax Claim Bureau(2012 Real Estate Taxes) 1,580.58
Register of Wills 338.50
Cumberland Law Journal 75.00
Patriot News 95.66
Stone& Murray Funeral Home 8,561.00
Romberger Memorials 1,265.00
Tri-County Abstract 135.00
823 S. Humer Street Settlement Costs 1,312.99
Debbie Lupold, Treasurer (2013 Co/Twp Tax) 330.57
Kline Law Office 5,000.00
Expenses Reimbursed to Bruce Barge 812.00
Register of Wills/Clerk of Orphans' Court 300.00
Total Administrative Expenses 23,510.06
Debts and Other Obligations:
M&T Bank 1,146.60
Comcast 78.50
Verizon 95.70
Pinnacle Health Cumberland Family Practice 10.00
PPL 493.91
United States Treasury (20 I I Income Tax) 569.84
Hershey Medical Center Outpatient Services 29.75
East Pennsboro Township (Sewer &Trash) 414.00
Holy Spirit Hospital 337.50
Jeremy Helm(Tool Account) 365.73
Oakwood Center 35.00
FIA Card Services,NA (MBNA/Bank of 2,772.43
America) c/o Portfolio Recovery Associates,
LLC
Comcast Harrisburg c/o Eastern Account 108.59
System of CT
Holy Spirit Hospital
Verizon PA c/o AFNI, Inc. 438.00
Personal Loan from Bruce Barge 4,500.00
Camp Hill Emergency Physicians 837.00
Camp Hill Emergency Physicians 1,491.00
Holy Spirit Hospital 249.00
Total Debts and Other Obligations 13,972.55
Net Remaining Balance 94.10
Proposed Distribution:
April C. Frock(30%) 28.22
Danielle R. Barge(35%) 32.94
Ryan R. Barge(35%) 32.94
VERIFICATION
I verify that the foregoing First and Final Account and Statement of Proposed Distribution
are true and correct. I understand that false statements herein are made subject to the penalties of
18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Date BRUCE J. BARGE, xecuto
k Settlement Statement U.S.Department of Housing
and Urban Development ONO
it
OMB Approval No.2502.0265
B.Type of Loan
1. ❑ FHA 2. ❑ FmHA 3.❑ Conv.Unins. 6.File Number 1.Loan Number 6.Mortgage Msurence case Number
4. ❑VA 5. ❑Conv,Ins.
C. Note:This form is fumished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are
shown. Items marked"(p.olr were paid outside closing: they are shown here for Informational purposes and not
included In the totals.
D.Nam*and Address of Borrower E.Name and Address of Sailer F.Name and Addteas of tender
Ryan Rodgers Robert A.Barge Estate
Andy Pequignot
G.Property tocetmn 'Rob
agent r
823 South Hunter Street Rob A.Kru Esquire
East Pennsboro Township Place of Settlement 1.Sat6ement0ete
53 East Canal Street 8/20/2013
Dover PA 17315 Dletxxsement Date
Lot: Block: 8/20/2013
' J.Summary of Borrower's Transaction K.Summary of Setter's Transaction
100,Gross Amount Due From Borrower 400.Gross Amount Due To Seller
101.Contract sales price 20 000.00 401.Contract sales price 20 000.00
102,Personal property 402.Personal property
103.Settlement charges to borrower line 1400 667.00 403.
104. 404.
105. 405.
Adjustments for items paid by setter in advance Adjustments for Items paid by seller In advance
106.city/town taxes 8/201201112/31/2013 35.41 4o6.citynowntaxes 8/20/2013u 12/31/2013 35.41
107.county taxes 8/20120130 12/31/2013 84.14 407.Colin taxes 8120/2013312131/2013 84.14
108.Assessments 8120/2013u 6/30/2014 953.17 408.Assessments 8/20/20133 6/30/2014 953.17
109. to 409. to
11o.Sewer 8/20/20133 9/30/2013 62.17 410.Sewer 8/20/20133 9/3012013 62.17
111. to 411. to
112. to 412. to
113. to 413. to
114. to 414. to
115. to 415. to
120.Gross Amount Due From Borrower 21,801,89 420.Gross Amount Due To Setter 21,134.8$
200.Amounts Paid By Or In Behalf Of Borrower $00.Reductions In Amount Due To Seller
201. Deposit or earnest money 21000.00 501.Excess deposit see instructions 2000.00
202.Principal amount of new loan(s) 502.Settlement charges to seller line 1400 1312.99
203.Existing loans taken subject to 503. Existing loan(s) taken subject to
204. 504.Payoff of first mortgage loan
205. 505. Payoff of second mortgage toan
206. 506.
207. 507.
208. We.
209. 509.
Adjustments for Items unpaid by seller Adjustments for Items unpaid by seller
210.Ci own taxes to 510.Cl~taxes to
211.County taxes to 811. County taxes to
212.Assessments to 512.Assessments to
213. to 513. to
214. to 514. to
215. to 515. to
216. to 516. to
217. to 517. to
218. to 518. to
219. to 1519. to
220.Total Paid By/For Borrower 2,000.00 520.Total Reduction Amount Due Seller 3,312 99
300.Cash At Settlement Fromfro Borrower 600.Cash At Settlement TofFrom Seller
301.Gross Amount due from borrower line 120 21 801.89 1601.Gross amount due to seller line 420 21 134.89
302.Less amount paid b Bor borrower line 220 Z000.00 602.Less reductions In amt due setter fine 520 L_3,312.99)
303.Cash ®From ❑To Borrower 19,801.88 603.Cash ® To ❑ From Seller
17,821.90
SUBSTITUTE FORM 1099 SELLER STATEMENT
The Information contained in Stocks E,G.H,and I and on line 401(or,line 403 and 404)Is important tax Information and Is being furnished to the Internal Revenue
Service.0 you are required to file a return,a negligence penalty or other sanction will be Imposed on you If this Item Is required to be reported and the IRS determines
that It has not been reported.If this real estate is your principal residence,file Form 2119,Sale or Exchange of Principal Residence,for any gain,with your income tax
return;for other transactions,complete the applicable parts of Farm 4797,Form 6232 and/or Schedule D,Form 1040).You are required to provide the Settlement Agent
(named above)with your correct taxpayer Identification number.N you do not provide the Settlement Agent with your correct taxpayer identification number,you may be
subject to civil or onminal penalties Imposed by law.Under penalties of perjury,I certify that the number shown on this statement is my correct taxpayer identification number.
J ,�"�' �-
(SelleD Signature)
L Settlement Charges
700.Total Sales8roker's Commission based on price$ 20 000.00 @ % 0.00 Paid From Paid From
Division of Commission line 700 as follows: Borrower's Sellefs
Funds At Funds At
701•$ to Settlement .Settlement
702.$ to
703.Commission paid at Settlement
704.
800.Items Payable In Connection With Loan
801.Loan origination Fee %
802.Loan Discount %
803.Appraisal Fee to
804.Credit Report to
805.Lender's Inspection Fee
806.Mortgage Insurance Application Fee to
807.Assumption Fee
808.
809.
810.
811.
812.
813.
900.items Required By Lender To Be Paid In Advance Exclude last day In talcs-line 901
901.Interest from to $ 1da
902. Mortgage Insurance Premium for months to
903.Hazard Insurance Premium for years to
904. years to
905.
1000.Reserves Deposited With Lender
1001.Hazard insurance months $ per month
1002.Mortgage Insurance 1 months2$ per month
1003.City propertytaxes 1 monthso$ per month
1004.County roe taxes months2$ per month
1005.Annual assessments 1 months @$ per month
1006. 1 months @$ per month
1007. months @$ per month
1008.Aggregate Accounting Adjustment
1100.Title Charges
1101.Settlement or dosing fee to
1102.Abstract or He search to
1103.Title examination to
1104.Title insurance binder to
1105. Document preparation to
1106.Notary fees to cash 5,00
1107.Attorney's fees to Rob A.Krug 400.00
Includes above Items numbers: 1101 1102 1107
1108.Title Insurance to
Includes above Items numbers:
1109.Lender's coverage $
1110.Owner's coverage $
1111.
1112.
1113.
1200.Government Recording and Transfer Charges
1201. Recording fees: Deed $ 67.00 : mortgage $ ;Releases $ 67.00
1202.CI /coup tax/stam :Deed $ 200.00 :Mortgage $ 200.00
1203.State tax/stamps: Deed 200.00 ;mortgage $ 200.00
1204.
1205.
1300.Additional Settlement Charges
1301.Survey to
1302.Pest Inspection .10
1303.
1304.2013/14 School taxes 1 107.99
1305.
1306.
1307.
1308.
1400.Total Settlement Charges(enter on lines 103,Section J and 502,Section K) 667.00 1 312.99
CERTIFICATION
I have carefully reviewed 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
any ount or by me in�this transaction.I further certify,that I have received a copy of the HUD-1 Sent pt`tatement
RoberVA, a e Es ate Seller �r� y R s Borrower
Seller orr
y Pdwlgnot
Fo st o y knowledge the D-1 Settlement Statement which I have prepared is a true and accurate account of the funds which were received and have been or will
isburs y u sign s part of the settlement of this transaction.
Settlement Agent 8/20/2013 Date
Rob A.Krug,Esqu'e
WARNING:it is a crime to ngly make false statements to the United States on this or any other similar form.Penalties upon conviction can Include a fine and
Imprisonment.For details s • de 18 U.S.Code Section 1001 and Section 1010.
rxa GovasWER Pxrxtwa orate tmswtus
ESTATE OF ROBERT A. BARGE,DECEASED
LATE OF EAST PENNSBORO TOWNSHIP, CUMBERLAND COUNTY,PA
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-12-01272
FIRST AND FINAL ACCOUNT OF BRUCE J. BARGE,EXECUTOR
Date of Death: November 24, 2012
Date Letters Testamentary Issued: December 6, 2012
Accounts Dated to November 20, 2014
0
C
Assets: _ a m
a a? o
Integrity Bank Checking Account $ 3,017.59 X a r �
Unim Insurance Proceeds 4,404.87
Lord & Taylor Credit 1,354.62 f, n
Chrysler Automobile 300.00 o { ?'
Washer and Dryer 100.00 ►�' M
Hershey Medical Center Refund 180.00 �-A Cn Co
Hershey Medical Center Refund 78.00
Home Equity Loan Refund 707.65
Personal Property (Auction Proceeds) 5,639.73
823 S. Humer Street, East Pennsboro 20,000.00
Township
Credits at Settlement for Prepaid Taxes and 1,134.89
Services
IRS Refund 560.34
Progressive Insurance Refund 99.02
Total Gross Assets 37,576.71
Administrative Expenses:
P. Scott Archibald, Appraiser 225.00
Fire Mountain 196.05
Tiger Trash (Dumpster) 425.00
M.S. Hershey Medical Center 1,056.59
MSHMC Physicians Group 555.12
Camp Hill Emergency Physicians 1,246.00
Tax Claim Bureau(2012 Real Estate Taxes) 1,580.58
Register of Wills 338.50
Cumberland Law Journal 75.00
Patriot News 95.66
Stone& Murray Funeral Home 8,561.00
Romberger Memorials 1,265.00
Tri-County Abstract 135.00
823 S. Humer Street Settlement Costs 1,312.99
Debbie Lupold, Treasurer (2013 Co/Twp Tax) 330.57
Kline Law Office 5,000.00
Expenses Reimbursed to Bruce Barge 812.00
Register of Wills/Clerk of Orphans' Court 300.00
Total Administrative Expenses 23,510.06
Debts and Other Obligations:
M&T Bank 1,146.60
Comcast 78.50
Verizon 95.70
Pinnacle Health Cumberland Family Practice 10.00
PPL 493.91
United States Treasury (2011 Income Tax) 569.84
Hershey Medical Center Outpatient Services 29.75
East Pennsboro Township (Sewer& Trash) 414.00
Holy Spirit Hospital 337.50
Jeremy Helm (Tool Account) 365.73
Oakwood Center 35.00
FIA Card Services, NA (MBNA/Bank of 2,772.43
America) c/o Portfolio Recovery Associates,
LLC
Comcast Harrisburg c/o Eastern Account 108.59
System of CT
Holy Spirit Hospital
Verizon PA c/o AFNI, Inc. 438.00
Personal Loan from Bruce Barge 4,500.00
Camp Hill Emergency Physicians 837.00
Camp Hill Emergency Physicians 1,491.00
Holy Spirit Hospital 249.00
Total Debts and Other Obligations 13,972.55
Net Remaining Balance 94.10
Proposed Distribution:
April C. Frock (30%) 28.22
Danielle R. Barge (35%) 32.94
Ryan R. Barge (35%) 32.94
VERIFICATION
I verify that the foregoing First and Final Account and Statement of Proposed Distribution
are true and correct. I understand that false statements herein are made subject to the penalties of
18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
P.
Date BRUCE J. BARGE, xecuto