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Home My WebLink About12-05-14 � 15�561�105 REV-1540 EX`O2_",`�j> � OFFICIAL USE ONLY PA Department of Revenue pennsytvania Bureau of Individual Taxes County Code Year File Number , Po sox zso6oi INHERITANCE TAX RETURN n � ,� /,�� Harrisburg PA 1'7i28-o6oi RESIDENT DECEDENT G V ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 09/24/2014 09/05/1925 DecedenYs Last Name Suffix DecedenYs First Name MI Sholiey Lorraine D (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 REG{STER OF WILLS FILL IN APPROPRIATE OVALS BELOW (� 1. Original Ret4rn O 2.Supplementai Return O 3. Remainder Return(date vf Death Prior to 12-13-82) p 4. Limited Estate O 4a. Future interest Compromise(date of p 5. Federai Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Uecedent Maintained a Living Trust � II. Total Number of.Safe Deposit Boxes (Attach Copy of Wiil) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Craig B Sholley, Executor (717)243-7443 REGISTER OF WILIS USE ONLY N First Line of Address n � �7 � 1618 Walnut Bottom Rd � � � � � 5econd Line of Address � y f'y � �a '� �7 x,. C"' ty.S � �'..' �W �' (,j� ;� C:� �.., - City or Post Office State ZIP Code - ��A�� FILED +�"� � �"� <'7 � � "�'i PA 17015 �:-� Carlisle ,� � ''� � � rn .,., =-i W c,�rs � CorrespondenYs e-maii address:C�aig.sh011ey@y2hOO.COm � Under penalties of perjury,I declare that I have examined this return,inciuding accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and co aration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI A URE OF S SPONSI RUNG RETURN D TE , �� ADDRES 1618 Walnut Bottom Rd, Carlisle, PA 17015 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 � 15�5610105 1,50561a105 � � 1505610205 REV-150Q EX(FI) DecedenYs Social Security Number oecedent's Name: Lo��Bine D Sh011ey RECAPITULATION 1. Reai Estate(Scheduke A). . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 83,510.00 2. Stacks ar�d Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 3. Ciosely He!d GorporaTion; Parinership or Sole-Qroprietorship{Schedule C) . . . . . 3. 4. Mortgages and Notes Rer,eivable(Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. Cash, Bank Deposits and Miscelianeous Personal Property(Schedule E).. . . . .. 5. 58,527.22 6. Joincly Owned Property{Scheduie F) O Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers&Misceilaneous Non-Probate PropeRy (Schedule G) O Separate Biiling Requested.. . . . . . . 7. 8. Totai Gross Assets total Lines 1 ihrou h 7 s. 142,037.22 � 9 ). . . . . . . . . . . . . ... . . . . . . . . . . . . . 9. Funeral Expenses and Administrative Costs(Schedule Hj. . . . . . . . . . . . . . . .. . . 9. 11,830.34 10. Debts of Decedent, Mortgage Liabilities and Liens{Schedule i). . . . . . . . . . . . . .. 10. 267.5� 11. Totai Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 Z,097.85 12. Net Value of Estate{Line 8 minus Line 11) . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 12. 'I ZJ,939.37 13. Charitable and Governmental BequestslSec 9193 Trusts for which an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . .. . . . . . 13. 14. Net Value Subject to Tax(Lirie 12 minus Line 13) . . . . . .. .. . . . . .. . . . . . .. . . 14. 129,939.37 TAX CALCULATION-SEE INSTRUCTIONS FOR APP�ICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X A_ 15. 16. Amount of Line 14 taxable at�inea�rate x.0 45 53,542.25 �6. 2,409.40 17 Amount of Line 14 taxabie at sibling rate X.12 �� 1$. Amount of Line 14 taxable 76,397.12 �g 11,459.57 at collateral rate X.15 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 13,868.97 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 � 15t7S61,0205 Z50561Ci2�5 � REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Lorraine D Sholley STREET ADDRESS Chapel Pointe At Carlisle 770 S. Hanover St CITY 1 STATE ZIP Carlisle � PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 13,868.97 2. Credits/Payments A.Prior Payments -_---_- —_--_--.--_- B.Discount 729.92 Totai Credits(A+B) (2) 729.92 3. Interest (3) 4. if Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in.oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 13,139.03 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PIACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred.......................................................................................... ❑ � b. retain the right to designate who shali use the property transferred or its income ............................................ ❑ � c. retain a reversionary interest.............................................................................................................................. ❑ � d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ � 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ � 3. Did decedent own a�"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ � 4. Did decedent own an individuai retirement account,annuity or other non-probate property,which contains a beneficiary designation? ......................................................................... ❑ � ............................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)). For dates of death on or after Jan. 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.§911fi(aj(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 61ing a tax retum 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(aj(1.2j]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries 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 decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. _.----_." -._ _-- REGISTER OF WILLS CERTtFICATE OF CUMBERLAND COUNTY � GRANT OF LETTERS PENNSYLVANIA ; __ ; z , - � �� ClIlb�� .,' � oer. ,� � ;� e�� No. 2014- 00932 'PA No. 21- 14- 0932 �n `\ y . o� � ��° ` � =. Es ta te Of: LORRAINE D SHOLLEY � �`;r{`� ' ��q (First,Middle,Lest1,. . f� � f�qS ��rtr_ �/��:��:��, ��y�-�': iG ^ . �`�" � ,�`� �� La te Of: CARLISLE BOROUGH ` ��,, � � ��-" � CUMBERLAND CO{!IVTY � _ .,, �-�-=-�= � ,�. \=`-j-'• -,%,-4-i , —=�4��,� Deceased ''- Soci a1 Securi ty No: �75n WHEREAS, on the 29th day of September 2014 an instrument dated August 29th 2007 was admitted to probate as the Iast will of LORRAINE D SHOLLEY lFirst,Middle,Last) late of CARLISLE BOROUGH, CUMBERLAND County, who died on the 24th day of September 2014 an WHEREAS, a true eopy of the wi11 as pz�obated is annexed hereto. THEREFORE, I, L/SA M. GRAYSON, ESC2. � , Register of Wills in and for CUMBERLAND County, in the Commonwea2th of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: CRA/G B SHOLLEY who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, a11 of which fu1.I y appears of record in my offi ce a t CUMBERLAND COUNTY COURT H�USE, CARLISLE, PENNSYL VANiA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixcd the seal of my office on the 29th day of Septembe� 2014. �� ` �: � � �,, , � ' � '� �� ' � i1��; �. i' .r' .�/t. � {,tiw , ��, ' eyisfer of.Wif� �j� r-`+;� ,� 7� t; �' ' �`,� �¢ "'�!�'�' j"�`1 ��.�. r s�� ._�,.�` �'. ��f, .� ,� �. � �putY **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) - 4 ' � . . i�.,�-��.x:1 �'` - :. �.c�� . iHOLLE�-, �: =�� __.��_ a... L�._{. � _..�.�__- _. -_ __ l_ --'"-_--_--= i.- '�:, ?�:.r�t iE-ania, beir.; ot 5ound and disp��ir� ��.3d. memor� �.n�: — -,� ;-. ��::�rsz_�:r._. ,:o hereb�-ri�'ake, publish and declare this as and for m��Last �Z'ilI a�d��estam�t. - �;.reb�-re�-okina an��and all other��ills �nd codicils heretofore made bv me. : , - _ � . =: ==; ` _ __ � -=; : � FIRST. I direct that all my just debts and funeral expenses be paid from rriy es�ate as �n t^_ r�,-"i after my death as practically and conveniently may be done. _ N c� o cn SECOND. I direct that my remains cremated and my ashes intened at Memorial Shrine Cemetery, Easton, Perinsylvania, in accord with my expressed wishes. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give,devise and bequeath a certain Empire Clothing Chest, free of tax which is to be paid by my Estate, unto my friend, Arthur J. Tangeman, FIFTH. I give, devise and bequeath any and a11 tangible personal property owned by me at the time of my death unto my son, Craig B. Sholley,provided.he survives me by thirty(30)days. In the event he fails to survive me by thirty(30)days,I give, devise and.bequeath all said tangible personal property unto my daughter-in-law, Bonnie Sholley. In the event she fails to survive me by thirty(30)days, I give, devise and bequeath all said tangible personal property unto rny friend, Denise Digusseppi. SIXTH. I co-own realty with Arthur J. Tangeman, any inheritance or estate taxes resulting from such ownership shall be paid by my Estate and if he shall survive me, Arthur J. Tangeman shall receive such realty free and clear of any such tax liability. I give, devise and bequeath any and all real estate owned by me at the time of my dearh, u.nto my sc�n, Craig B. Sh�lley,proyided he survives me by thirty days. In the event he fails to survive me by thirty(3Q).days,I give, devise and bequeath all said real estate unto my daughter-in-law, Bonnie Sholley. In the event she fails to survive me by thirty(30) days, I give, devise and bequeath'all said real estate unto r�y friend, Denise Digusseppi. - SEVENTH. I give, devise and bequeath all the rest, residue,and remainder of my estate unto my son, Craig B. Sholley, provided he survives me by thirty(30)days. In the event he fails to survive me by thirty(30)days, I give, devise and bequeath all the rest, residue and remainder of my estate unto daughter-in-law, Bonnie Sholley. In the event she fails to survive me by thirty (30)days, I give,devise and bequeath all the rest,residue and remainder of my estate unto my friend, Denise Digusseppi. �'�A� �i.�� .-..�._ ... � .._.. �"__ _..__.._ _. .__' _� _ _�.�_...� �' __.... � _. 3' __ �.+ i � � ` � � � �- ._. "�.�.._� �„__�_..��. .-\ _ .. __ . � .. . ._ _. � . _ �.. �..._ _ ..... .__� __ � . � �� ♦ _ . � _ �- . _ . � _ '_ _� __' `._�.. � .__ _.. _�� _` � � f.. � � _ . __ . _ _ - _ -_ __ _ _ _ .� - ---__�--_ -:. �e�L�. rz�i�natiori or inabilit�� - __- �-- �_- =___' ------- �- -_ _-_-- �. `._:--_ ; �c_..:r�ate, constitute and appoinE my __ -_--_ __� . __--=� �=�. e�:. a` L��:.utr� of tnis m�-Last `Vill and Testament:'In the event :: .:_�-�_�._�-. �_��, r�si�nation or ina�ility to act for any reason whatsoever of Bonnie �_�::-. : .-��r�:nate, constitute and appoint my friend, Arthur Tangeman, as Executor of this my ��=t��-�il and Testament. I hereby relieve my Executor from the necessity of posting security in �onnection u-ith his duties, as such, in any jurisdiction in which he may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executor, in his absolute discretion,to retain in the form received,and to sell either at public or private sale any real or personal property owned by me at the time of my death. TENTH. I have made,or may from time to time make,a written memorandum expressing my desire to give certain items of personal property to specific persans. I urge my Executor and beneficiaries to respect these wishes. Such a memorandum,if made,shall be stored in conjunction with this Will. IN WITNESS WHEREOF,I have hereunto set my hand and seal to this, my Last Will �.�� '� �� i da of �L��—S and Testament, consisting of two typewritten pages this �.. y , 2007. ` /,/� //' f/!� (/l� / ; / ` �L Lt�-L.l_.L"C-!i;�z-�. �('` . f.��/"4�1�-`^-�.� _ / /� LORRAINE D. SHOLLEY Signed, sealed,published and declared by the above named Testatrix Lonaine D. Sholley as and for her Last�'ill and Testament, in the preser.ce af us, who, at hcr rcqu�st, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. " � ; :� .��,�'�✓�. !, � �� `' , r�,�.v - ; .. ` CO.�I_3I0_��E-��'��Q�"r��"�:`�S<�.��:Z�-� , S�'. _ COL:\-TF OF CL:1IBER�-��D I, Lorraine D. Sholley, Testatrit «-hose name is signzd �� :::�;-_::;�� _-�_-��-_-_ instrument, having been duly qualitied according to law, do here�.��.:;:-_-.�.::=_� -�-- �� _ _L� and executed the instrur�er�as my Last Will; that I signed it��-illin�i�:: a-�;: �:w: � �:_��`::� -r_�: free and voluntary act for the purposes therein expressed. � . 4,. - �=�'(A L l �� C ,. . �- `- .`.". i_ �_ - �i LORRAINE D. SHOLLEY Sworn or affirmed to and ackno«-1ed�ed before me, oy � ��M�^�:r�:��z�o��v�sY�y:;N:„ Lorraine D. Sholle��this 2q �� ' ' �''F`'``�� day ,!�;-:t'_ _ . ..-;�f^.4,;� of ,%��% �'S , 2007. Ct,�:�: �.. __ .__.?�...,.r;i�:�; � MyC�m;ni�s;:;,�cxpires',:arc.�7,��;i� - � ��t/�'1rU'�'' ..__.__..__-__.._.�__ Not Public COM1tiiONWEALTH OFPENNSYLVANIA . . SS. COUNTY OF CUM�ERLAND . � We, Y�t I r 1 GI 1M A� ��i�Yi and �LI-H� �� 1��7''-� the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Lonaine D. Sholley sign and execute the instrument as her Last Will; that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed;that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge,the Testatrix was at that time eighteen (1$) or more years of agc;, of sound mind and under no constraint or undue influence. : :; 1� � � - t��,,�'�.��t � r/ �� - � -" � 7 I _ r�� / y Sworn or affirmed to and '� subscril�ed before me b YYI II � A�'M A • ��'J�/�� and ��'t�i9��T�`J;'=ALThi L7F PE�VI4SYLV:1NiA i___:_._._�..�.�__ _,,,,�_.� f�-A'-�'fi1�' �-. /�v1/�"t/i/�-�� , witnesses, �r-� ��;:?;;�:A�_S�A! �,.. ! i �� .i:'.�i:r� t,l�,��Jr P�F;,t•. � this ��-y� day of .�'��" , 2007. i :::.::::..�;�:.,.,c:,�F�;:o�,ri�;��ou�,y � � �y C�r�:rr:�s:o:��x�ires P,�arch 7,201�.�6 ' �r (/ N ary Public "i` pennsylvania �CHEDULE A �� DEPARTMENT OF REVEfJU[ IN„ER,T„N�E;FX REr�RN REAL ESTATE RESIUENT DECEDENT ESTATE OF: FILE NUMBER; Lorraine D Sholley Ail real property owned soiely 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 exthanged between a willing buyer and a wifring seller, neither being compe!led to buy or sell,both having reasonable knowiedge of the re!evant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Atta�h a copy cf the settlem�nt sheet if the property has been sold. ITEM Include a copy cf the deed showing decedent'S interest if owned as tenant in commor. VALUE AT DATE NUMBER OF DEATH DESCRIPT[ON 1� House and lot,467 Montour Rd,Landisburg, PA,Arthur JTangeman and Lorraine D Shol�ey, 83,510.00 tennants in common.Appraised at$167020.00 net proceeds to seller by Mr.Vincent Mellot, Century 21,Carlisle,PA. 50%ownership by Lorraine D Sholley x$16020.00=$83510.00 TOTAL(Also enter on Line 1, Recapitulation.) $ $3,510.00 If more space is needed,use additional st�eets of paper of the same size. REV-i5o8 EX+(o8-i2) �.�i �� pennsylvania SCHEDULE E � DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Lorraine D Sholley Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Members 1ST Bank 55,685.55 2. Fumiture&Misc Personal Property 625.00 3. Maple Empire Chest of Drawers left to Arthur Tangeman 150.00 4. Gold/Silver&Costume Jewelry 427.00 5 Partial Refund of Room Charges,Chapel Pointe Nursing Home,Carlisle,PA 1,639.67 TOTAL (Also enter on Line 5, Recapitulation) $ 58,527.22 If more space is needed, use additional sheets of paper of the same size. K` ,.�t, . - '_ _ i ' pennsytvania SCHEDULE H �' �EPnRrr�ENroFaEVENUE FUNERAL EXPENSES AND i"""ERiTA"�E TAx a-T��t" ADMINISTRATIVE COSTS RESIDENT DECEDENT ES7ATE OF FILE NUMBER Lorraine D Sholiey Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: i� Ewing Brothers Funeral Home, Inc. Funeral Expenses 2,843.00 Northampton Memorial Shrine, inc.Grave Opening&Marker 3,026.84 e. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) __ _ . __ _ Street Adtlress __ _ _ . _ _ ___ City _. ___ _ _ State . . ZiP __ _ Year(s)Commission Paitl: 1,500.00 2. Attorney Fees: 3• Family Exemption: (If decedert's address is not the same as daimant's,attach explanation.) 3,500.00 ciaimant Craig B_Sholley _ _ _ _ __ Street Address 1618 Walnut Bottom Rd _ _ __ __ __ __ _ c�cy Cariisle _ _ _ state PA_ zlP 17015_ Relationship ot C!aimant to Decedent SOtI 4. Probate Fees: 385.50 5. Accountant fees: 6. Tax Return Preparer Fees: 400.00 7� Real Estate Appraisal,Century 21,Carlisle,PA 125.00 Personal Property Appraisal,Fahnestock's Auction Service, Marysville,PA 50.00 TOTAL(Also enter on Line 9, Recapitulation) $ 11,$30.34 If more space is needed,use additional sheets of paper of the same size. i pennsylvania SCHEDULE I � DEPARTMENTOFREVENUE DEBTS OF DECEDENT, INHER�TA"�=TAX RET�R,� MORTGAGE LIABILITIES & LIENS RESIDEtiT UECEUENT ESTATE OF FILE NUMBER Lorraine D Sholley Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medicai expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATN 1� Cumberland Goodwill Fire and Rescue(ambulance transport tolfrom Carlisle Hospital) 113.55 2. Pharmacy Services,Pinker&Assoc,Carlisle,PA 4329 3 Milfenium Pharmacy 110.67 TOTAL{Also enter on Line 10, Recapitulation) $ 267.51 If more space is needed,insert additional sheets of the same size. REV-1513 EX+ (01-10) � pennsylvania SCHEDULE � DEPARTMENTOFREVENUE INHERITANCE TAX REfURN B E N E FICIARI ES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Lorraine D Sholley RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1� Craig B Sholley, 1618 Walnut Bottom Rd,Carlisle,PA 17015 Son 53542.25 Arthur J Tangeman,467 Montour Rd,Landisburg,PA 17040 Friend 76397.12 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FaR WHICH AN ELECTION TO TAX IS NOT TpKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. . ' Net rroceeds to 5e��er tor ' - The following data is for information purposes only and accuracy of the figures hereinafter set forth is not guaranteed. The actual costs with respect to each trasaction will vary depending upon the circumstances. Sale Price $180,000.00 Estimated Closing Costs Present Mortgage Balance -Loan 1 $0.00 Present Mortgage Balance -Loan 2 $0.00 Broker Fee $10,800.00 Seller Discount Points $0.00 Tax Service Fee $10.00 Notary Fee $20.00 Document& Deed Preparation $150.00 State Transfer Tax $1,800.00 Estimated Repairs $0.00 Home Warranty $0.00 Hydraulic Load Test $0.00 Locate and Pump Septic $200.00 Private Water Testing $0.00 Resale Certification Fee $0.00 Overnight Fee $0.00 City Fees $0.00 Buyer Closing Costs Paid by Seller $0.00 Total Expenses $12,980.00 Net Proceeds to Seller $167,020.00 THE ABOVE PROCEEDS AT SETTLEMENT DO NOT INCLUDE PRO-RATION OF REAL PROPERTY TAXES AND RENTS, MORTGAGE LIENS, MUNICIPAL ASSESSMENTS, CONDOMINIUM CHARGES OR APPLICABLE CERTIFICATION AND/OR INSPECTION FEES. THE AMOUNTS ABOVE ARE ESTIMATES. ACTUAL COSTS WILL VARY WITH EACH PROPERTY. I/We hereby acknowledge receipt of a copy of this Statement of Estimated Seller's Costs, and understand and agree to the charges indicated herein. Witness: Seller Seller Seller Prepared by:CPML on September 29,2014 � �� A Better Way 398 East High Street Carlisle, Pennsylvania 17013 Office(717)243-4929 www.c21 abetterway.com September 29,2014 Craig&Bonnie Sholley 1618 Wainut Bottom Road Carlisle,PA 17015 Re: 467 Montour Road,Landisburg,PA 17040 Dear Craig and Bonnie, Please find enciosed the market analysis that I have prepared for the property located at 467 Montour Road in Landisburg,Pennsylvania. In my analysis,f have considered,in my opinion,the best available comparable recent sales as wetl as what you would be competing against if you were to put the home on the market today. In the report,I have adjusted the comparables for signi�cant differences in bathrooms,square footage of gross living space,garages,basement finish,{ot size,etc.... After personafly viewing the interior and exterior of the subjert property and carefut consideration of the adjusted comparable data,it is my opinion that you could establish$I89,900 as a reasonable asking price with an expectation of a sales price of$180,000. Do not hesitate to call if you need any assistance in understanding the report or the methodology that I have utilized in my analysis or if I can be of help in any other way with respect to this property. Respectfully submitted, � Vincen ott Broker Each Office Is Independent/y Owned And Operated � �� MAD�the 28`"day of July in the year two thousanc�five{24()5) BE'��VEEN ELLSWORTH L. STiTZEL a�id�-IELEN C. STIT7EL,l�is wife,of Ty��one To�vnship,Perry County, Pennsylvania, Grantors and ARTHUR 3. TANGEMAN and LURRAINE�. SHOLLCY,bath of Dickinson Township, Cunlberland County, Pennsylvant�,i1S tG'1�b121tS ltl C01111;1{)?�j Grantees WITNESSETI-�,That in consit3eration af------------------ONE HLTNDRED NINETY THOUSAI�,�D----------------- ____------------__-----------______-------(�190,OOQ.04)DOI.,LARS, in hand paid,the receipt��rhereof is hereby ackuo�vledged,the said grantors do he�'eby grant and convey to the said grantees, their heirs a��cl assigns, - ALL that cez�ain tracl of la�id situate in Tyrone Tawilship,Perry County,Pennsylvania,boundecl and described as i'allows: BEGINNING at an iron pin`a#the Eastert�edge of State Route 850 ai the intersection af another road, said iro�7 pin beia�D 1 mile Northwest of Landisbiirg; then�e alo�.ag State Route 85� North I S deg. 35 min. West,a distance of 347 feet to an iron pin; thencc alon�;lancls noti�or fonnerly of Walter Faose Sautli 86 de�;. 55 min. East, a dist�uice of 1G2.59 feet to an iron pin; thence along oti�er lands no�,v or forrzierly of Lawrence E. Armstrong,et ux, South 15 deg. 35 miii. East, a distance of 239.28 feet to an iron pirz; ttzenc�along same South 4fl deg. 26 min. West, a distance oi'S3.8$ feet fio an iron pzn at the Northern edgc of a road; thence alang the Nortliern edge of a raad South 61 deg. 15 inin. «'est, a distance of 112.32 feet to the�lace of BEGINNING,containing l.OG acres, accarding to a survey by Earl D. Yalrn�4i Sons,recarded in Perry Couiity Plan Book 9 at Page 2. The above described pY'operty is subject to tlle follo�ving coz►ditions ancl restrictions,which shall bind the Grantees, tl�eir heirs alid assigns: 1. No traiiers or mobile homes shall be a�lo�ved. 2. The above land shall be used for residential pu�poses only and said d«-ellin�;shalt have a value af at least$20,404.0�based au 1976 values, �:�� 3. The above land shall not be usec� for any business or commercial activities. GERALOKbSOfN2190N 4, No aceumulation of junlc, trasli, garbage or unlicensed vehicles sliall Ue allor��ed on said ��g��z ��-z land, �,�:�;,��.�, „� BEING the same�roperty conveyeti to Grantors herein by cleed of Lawren.ce E.Artnstrong, et ux,dated October 27, 1976 and recordetl in Perry County Deed Baok 256 at Page 213. AI�D the said grantors will specially WARRANT AND FOREVER D�FEND ihe pro�erty hereby conveyed. IN WITNESS VVHEREOF,said grantors havc hereuntQ set their hands aiad seals,the day and year frst al�ove-�vritten. Sealed and delivered in the preseuce of C W /�,.�-2._----.�-�--- ��,�:��-` ��' (SEAL) ELLSWORTH ,. T�j��L AS TO BOTH `y �v �; g��.�ZK�. {SEAL) H�LEN C. STZT�L (SEAL) CEIt'i'iFICATL C?F l2ESiDENCE I liereby certify, that the precise residence of the gra�itees hereiu is as follows: , ��Si��1,_. �]� r � � ltL� ��i�" ` � - �r'� J Attarney«r Agcnt for Grantees �� l � �C� �� GFRALO K MORWSON Genter S4.:a;^ FO 9cx 272 tinw�.�G'rf,;�lJ,F't1 � 17�c State of Pem�sylvania SS: County of Perry On this, the 28`h dayo uf July 2005,before me � �t o� � . N� ��s vv� the ut�dersigned officer,pers4tlally appcared Ellsworth L. Stitzel and Helen C. Stitzel,his vsTife, lulo��vn to me (ar satisfactorily proven) to be tlle persons whose names are si�hscribed to the within instrument, and acicnowleciged that they executed the sa�1�e for the p�irpose therein contained. IN WITNES5 WI�iEREOi�, I llave Iiereunto set m}�nai�d an notarial seai. c �.?�� _ . � — — lviy Comrnission�:cpires HOTARIAL SEAL SCOtT�t.NlQRRISOM,NOt1!!tl'PUBLfC BLOOMFIEID BORQ.�PE!?iiY COUNIY :- M'!CAMRIt3Sl4 tRES 1►Y 2 ':�n- a:� ,, W� ,�, ,�, ; �;• t„- �'" ,- - C: � r; ', . , �, .. t;;.v afrr+ GERALD K MORRlSON Ce.M�SG�a;a P0.&"a 2�2 Ucvt[3iax*`.red.P.4 ;7{)Cr9 Recorded nn 8/1/2005 Af 10:0'1:33 AVI inst�•uuient 1!'trmbcr-20050�485 *Lzs#r��ment Type-DEED *Total Yages-4 Iarvoice Namber�38065 *Grantor-STITZEL,ELLS`'VORTII L *Grantee-TANG�MAN,A,RTHiUR J *Custorner-DtINCAN & k1ART1YIAN '"FEES STATE TRANSFER TAX $1,900. 00 STATE WRIT TAX $0.50 JCS/ACCESS TO JUSTZCE $10.00 RECORDING FEES -- $I3.00 RECORDER OF DEEAS AFFORI)ABLE HOUSING S�o.oo This is a certificatian page CQUNTY ARCIiIVES FEE $2.00 RECORDER'S �xcH�vEs F�� So.so DO NOT DETACH - TO COUN�Y RECORDER IMPROVEMENT $2.50 FUND - TO OFFICE Tliis page is now part w�s� ��r�xY scxoo�, $95Ci.o0 of this legal document. bISTRICT REAI�TY 'rAX TYR4NE TOWNSHIP $950.�0 TOTAL $3,838.50 RETiTR_V DOCGMENT TU: ' DU�ICAi� S�.HARTMAiY 1 IRVINE RC)��' Ca,IZI.ISLE,PA]7413 1 herebp CERTIFY that this documeut is recorded in the Recordcr of Deetis t)f�ce oi'Perry County,Pennsyh>ania. ,-�:�,..,,. � - "�'''' f'il;t'� .;. / ,� if y,� `1�t.t1 n � _.`� �. ,,^-`� ,'`.''`'c/a"s: Vt_!� (( :> {�,� -,•. ``,•.: ;r, PA.8�223 lJ :a .•� Y � _� �� c:=; New Bloo�nfielcl,PA t70G8 : -` ;R�;t"�'�,��'` � � _ .�ar��•`,r,�:��Y ,�` �.'-,';�.'�-` ''.'`l.`. ��4,yr1�.RY..��••••'Z j��, f ,�� 'Iv..kerl-tllt'��l' *-Information denoted by av asterisk may change dw•ing the verificateon process and may not be reflected on this page. Instrumenf Number:200507485 oo�D�E ��III II�III��I I I II 1I��il'll - � Full Report C A ' B Master District 270 Owner Name TANGEMAN,ARTHUR J ETAL Parcel ID 27012600057000 Mail Addr 467 MONTOUR ROAD Property Addr 467 MONTOUR ROAD Mail Addr2 LANDISBURG PA 17040 City State 2ip Subdivision Owner Display ARTHUR J TANGEMAN ETAL House Number Last Sale Date 8/1/2005 Year Built 1977 Last Sale Price $190,000.00 Bulk_Mail_Occupant or Current Occupant Property and Owner Information Plat Image Click here to view Property Type R RESIDENTIAL BUILDING Care of Name Land Use Code 101 RESIDENTIAI 1 FAMILY School District 5 Land Description PB9-2 Neigborhood 270 Lot Condo Unit ID Census Tract Latitude Census Blk Grp Longitude Building Characteristics Year Built 1977 Deeded Acres 1.06 Eff Year Built 1990 Stories 1 Living Area SF 1812 Dwelling Type DETACH Living Area Factor 94.34 Sewer Type SEPTIC Living Area Total 0 Road Type PAVED Limiting Factors Water Source WELL Assessment Values Land Value $30,600.00 Building Value $179,400.00 Total Value $210,000.00 Clean And Green Transfer(Sale)History Sale Date 8/1/2005 Deed Book 02005 Sale Price $190,000.00 Deed Page 07485 VINCE MELLOTT CENTURY 21 A BETTER WAY 398 E HIGH STREET CARLISLE, PA 17013 CELL: (717) 385-4039 vincent.mellott@century2l.com � � � � � � � � � � � ' ' . • � �� - ..- �_. -- . � .. • 1 � - .� � - �-� _�: y,..,�; .. ._ -. This Analysis Has Not Been Performed In Accordance With The Unifortn SUndards Of Professlonal Appraisal Practice which Require Valuers To Act As Unbfased,Disinterested Third Parties With Impartiality,Ob]ec[Ivity And Independence And wfthout Accomodadon Of Personal Interest.It is Not To Be Considered As An App2isal And May Not Be Used As Such For Any Vurpose. COMPAR14BLE REPORT r---____ _�.�.�__�. � _ � � �--�r�_._._. a ,� � �,��u ��.t � ; ��. .� � � � � � ! '� % �. r� ,�. ., y�5 k ,iv �.. _q, � r. ro ."__"_ ""__.___,_....__._.�.� '. A*_�:s � _ � �� . . . . Status Subject Property . _......_....Active Active ._............._.......__..................Active ._ ... ............................__.............. __..._................_....._..._.._......... Closing Date _.................................__.................._........._.....................,..........._.........................._..............__.....__....................................._..................._......._....__..........._............. Address 467 Montour Road 103 S Church Street 946 Shermans View Road 211 PIKE RD __..........................__......_..............._,__..._.._................................................_......_........_._......_._.................._.._............._..........._........................................._.........._.. Original PNce .._....$164,900.___........._........................$165,900............_.._..._..................._$205,000.._..........._............ ....._.........................._... Price �180,000 ..........,.$154,900..........................................$.165,90.0...................................._.....$199.�9.9.Q.......................................... . <...................... Days On Market 45 66 77 ................_.......................,.................................................,............................._..............,............,......................................................................_......._..............._.........._........._ Cumulative DOM 45 272 77 ............................_.........................,.....................................................................�........................................................._...........,................,............................................... # Bedrooms 3 3 3 3 ........_..........................................................................._..........................._..................._......................................................................................._........................................... # of Full Baths 1 1 2 3 ._................................................._..._..._........................_........_..._............................................._._.........._.......,.........._........................................................_.......... #of Half Baths 1 0 0 _.................................._.._....................................._............................................_..........................................._...,._........._..............._......_........_..._.................................. Square FeetAbove 1,812 1,952 1,696 1,628 Grade ...._.................................. ...._........._......._......_..._.... _........_................,......... ..................................... ....._.._......... ......_............ _..._.._........._. ......__.. Acres 1.0600 0.3500 0.5800 1.4600 ......_............................ .........................................................................................................................................,.........._......................... Year Built 1977 1964 1972 1993 _......................................._....._....................................._.............._..............._....._......_.................._.....___....._............._......_........................................_...._....................... Seller Help Closing Cost ._.............................................._........._.................._...............................................................,......_....._,............................................._.......................................................,.... # of Half Baths $Q.............._..............._.._......................_.(�2,000)................................_............��......_... ......_.......................................$�._............__......._............................ . SquareFeetAbove $p ($2,100) $1,740 $2,760 Grede ................................................................................................................................._.............................................._..._.................._..,......................._.............._......_....... Acres $Q.............................................................$2,500................. �2,000...........................,..................:....�$1,000)...................... ................................ ..................... Parking $�........................................... $4 OOO..................................................��.............................................................�Q..............................._..._..................._... .. ......_...... r. BasementFinish �Q..............................................................$3,000......,.........................................._$3,000....................................,.............$3,000,.......... ...................................... #of Full Baths �0........_......_....................._._._..............$�...............,_...___..._._._.................._.._�$4,000)......._......................._.._.........(�8,000)...__....._...._........._.............._.. Seller Help Closing $0 $0 $0 $0 Cost ......................................................................................................................................................................................................._.................................................................... $180,000 $160,300 $168,640 $196,660 _...................................................._....._........_..............................................._._......_.................__..,............................_....._......................_.............._.............._.....__......... This Analysis Has Not Been Performed In Accardance With The Unifortn SWndards Of Professional Apprelsal PrecUce which Require Valuers To Act As Unbiased,Disinterested 7hird Parties With Impartiality,Ob�ectivity And Independence And wfthout Accomodation Of Personal Intercst.It Is Not To Be Considered As An Appraisal And May Not Be Used As Such For Any Purpose. COMPARABLE REPORT ---- -r — - N� y� �— — � I I � i--- ----------—' Status Subject,Pro.Pe!tX...................._...Sold............_.....................................Sold. Sold ......... _.............._._..._.......................,...............,............._......._......_............._.. Closing Date 8/28/2014 7/11/2014 11/15/2013 _............................................_._........._......................._............_........._................,....................._........................._......__...._._.............................._.................._.._.. Address 467 Montour Road.................6795 Spring Rd, 1866 LANDISBURG RD 5355 Spring Rd___ ., _ . _............... .... .. .. ._..,................ .............................. .._........... Original Price _............._...._........................................$174,900._................._......_..._.........$199,90.0....................... _ ...$210,000.................._....................... . . PNce $180,000.. ....$169_,900...................._................._..$189,500...,........................................$175,00.0................ . ........................_.......... ........................... Days On Market 13 18 94 ..............._.............................................. .............................................................._.....,........,..............,....................................._._.............................._.............................. Cumulative DOM 13 18 94 _....................................................................................................................._......................................................_.........._.............,................_._............................................ # Bedrooms 3 3 3 3 ........................................._..................................................._..............................................__............................................................_..............................................._.............. #of Full Baths 1 1 3 1 .........................................................................................__..._..._.._....._.._.........____......................._........................,...................................._......_......._...._._.............._. #of Half Baths i 0 1 ...._.........................................................................._.._............._................._.._..........................._............................................,........._...................._.._............................_... Square Feet Above 1,812 1,531 2,009 1,524 Grede .................................................................._..............._....._......_._..................................................................................................................._......................_.............._......... Acres 1.0600 1.0100 2.6200 2.5000 ........................................................................................................_.............._.....................................................................................................__......................................... Year Built 1977 1987 1979 1987 _..............................................................__..........................._......_............_.........................................._..._....................................................................................................... Seller Help Closing 9,000.00 0.00 0.00 Cost ........................................................................................................_..........._...................................,...........................................,........................................................................ #of Half Baths $0 ($2,000) $0 ($2,000) _........................................................_..........,...._...._................................__...._......_............._......_..............._..............._....._.............._.................................................. Square FeetAbove $0 $4,215 ($2,955) $4,320 Grade ....................................................................................................................................................................................................................._............................................... Acres $�.............................................................$�............................................................�$4,000)..............................................�.�4,000)...........,.................................. Parking $0 $o $0 $0 ........,._.............._...........,..............,................,......................._...............................................................................................,...,...,..........._........................_........................ BasementFinish �o.........................................................._.$1,500..................................................�Q......,........,..............................................�3,000.................... .............................. #of Full Baths �o_._...................................._._....._.......�o.._......._........._.._.._........._.................(.�s,000)....................._.......... o................_....................._.. .........._�._ Seller Help Closing $0 ($9,000) $0 $0 Cost ............................................................................................_.._..........................................._...._...................,............................................................................................. $180,000 $164,615 $174,545 $176,320 ......_....____........................................_..........._........__........._.__............_.............._................................_.,.................._..........._.._....._................_......................................... . HIGH LOW AVERAGE MEDIAN LP: $199,900 $154,900 $182,416 $186,950 SP: $189,500 $169,900 $178,133 $175,000 7his Analysis Has Not Been Performed In Accordance With The Unifortn Standards Of Professional App2isal Practice whith Require Valuers To Act As Unbiased,Disintercsted Third Partles With Impartiality,Objectivity And IrWependence And wkhout Accomodation Of Personal lnterest.It Is Not To Be Considered As An Appraisal And May Not Be Used As Such For Any Purpose. CMA SUMMARY REPORT . HIGH LOW AVERAGE MEDIAN LP: $199,900 $154,900 $182,416 $186,950 SP: $189,500 $169,900 $178,133 $175,000 . • BR # FBth # Half Bth Acres SqFt Abv G DOM LP �/SqFt Abv G SP ;/SqFt Abv G 3 1 1 0.3500 1,952 45 $154,900 $79.35 3 2 0 0.5800 1,696 66 $165,900 $97.82 3 3 0 1.4600 1,628 77 $199,900 $122.79 Avg Avg Avg Avg Avg 62 #173,566 �99.99 . - . . BR # FBth # Half Bth Acres SqFt Abv G DOM LP ;/SqFt Abv G SP ;/SqFt Abv G 3 1 1 1.0100 1,531 13 $174,900 $114.24 $169,900 �110.97 3 1 1 2.5000 1,524 94 $199,000 $130.58 $175,000 $114.83 3 3 0 2.6200 2,009 18 $199,900 $99.50 $189,500 ;94.33 Avg Avg Avg Avg Avg 41 �191,266 $114.77 �178,133 ¢106.71 This Analysis Has Not Been Perfortned In Accordance With The Unifortn Standards Of Professional Appraisal Practice which Require Valuers 7o Act As Unbiased,Disinterested Third Parties With Impartiality,ObJettivity And Independence And wtthout Accomodatlon Of Versonal Interest.It Is Not To Be Considered As An Appraisal A�d May Not Be Used As Such For Any Purpose. COMPARABLE PROPERTY STATISTICS �oac►aa-- , ; ; ; , , ; , ; , , ; : ; ; ; ; ; ; ; ; � , ; ; ; YSoo€�-- ------ ---------------------�----- ---------------------;------ --------------------- ; ; , , : ; ; ; , , ; , , ; ; ; ; , ; ; ; , , � � List Price 1�0-- ' ------ ---------------------y------ ----------------------•------- --------------------- � � � � . , � t � � � � � t � � t � � ; � � � t � ; o � , �-- ----- ------------------+----- ---------------------i------- ---------------------- � � � ' � � � � � � � � � � � � � � � � � � � � � � tU3 s church street �94G�hermans view road ��11 pike rd Active Pro erties Total # of Listings 3 Lowest List Price $154,900.00 Average List Price $173,566.00 Highest List Price $199,900.00 Average Price/SqFt Abv G $99.99 Average Days On Market 62 This Analysis Has Not Been Performed ln Accordance With 7he Uniform SWndards Of Professional Appralsal Practice which Require Vatuers To Act As Unbiased,Disinterested Third Parties With Impartiality,ObJectivity And Independence And wkhout Accomodation Of Personal Interest.It Is N�To Be Considered As An Appralsal And May Not Be Used As Such for Any Purpose. COMPARABLE PROPERTY STATISTICS ��-- , , �.w ,. ; ;�', ; � ,i� � � � � � � � � � � i i ��' � i i i i � � i i 15�UG0-- ------ ------�------ -------�------- ------- i,y, ; � � � i ; ; � � ; � � � t ' � � � ; ; ; List Price 1�-- ------ ------�------ -------;------- ------- .Sold Price � � � ' � � � � � � � � ; o � � � ; � , ; 9 �- ------ ------+------ -------�------- ------ ; ; ; ; : ; ; ; , ; ; . ; ; , ; 9 ; ; ; ? �-- Si95 sExing r�. ,1$G6'I$ndisburg rti �53�5 spring rd Sold Pro erties Total # of Listings 3 Lowest List Price $174,900.00 Average List Price $191,266.00 Highest List Price $199,900.00 Lowest Sold Price $169,900.00 Average Sold Price $178,133.00 Highest Sold Price $189,500.00 Average Price/SqFt Abv G $106.71 Average Days On Market 41 This Analysis Has Not Been Pertormed in Accordance With The Unifortn SWndards Of Professlonal App2isal Prectice which Require Valuers To Act As Unbiased,Disinterested Third Partles With lmpartialiry,ObJectivity And Independence And without Accomodation Of Personal Interest.It Is Not To Be Considered As An ApD��sal And May Not Be Used As Such For Any Purpose. MAP OF PROPERTIES :�• ra �,,� , New�ort � � �;�.�r �Ya��`�y Walnur Grrsve 1 uniat3 �U�flrJtC �SClV1��E `Jlannsvilfe �rla�stabet€o New a�oomfield xi�: b �,� �tleattsta�rq � � c��? � �� LoysviUe � Itoavre � r;;;�vlu�fvtG'�•'.?C:unftlr�i 51�erinar�s{3ale �cyst�e ]4 I ,�, � .�� r�r a-� _ _ � _ _ C)onned±ytt�wn � -- r� t�rtisFt � �rw�s�'� SR��95 �o yr I�i-�,1 ��-�'�b):*?f8h.�Ot�'i1�Or'�e�'�NG��i Map No. MLS# Address City/State/Zip Price 1 Sub. 467 Montour Road Landisburg PA 17040 $180,000 Property 2 10257872 103 S Church Street New Bloomfield PA 17068 $154,900 3 10256789 946 Shermans View Shermans Dale PA 17090 $165,900 Road 4 10256327 211 PIKE RD Landisburg PA 17040 $199,900 5 10256191 6795 Spring Rd. Shermans Dale PA 17090 $169,900 6 10249665 1866 LANDISBURG RD Landisburg PA 17040 $189,500 7 10241000 5355 Spring Rd Shermans Dale PA 17090 $175,000 This nnalysis Has rvot eeen Performed tn nccordance with The un�form Swndards Of vrofessional nppra�sal vradice whkh rtequire valuers To nct qs unbiased,Dlsinterested Thtrd Partles With Impartialiry,ObJectivlty And Independence And wRhout Accomodation Of Personal Interest.It Is Not To Be Considered As An Appraisal And May Not Be Used As Such For Any Purpose. CONSUMER SERVICES FEE ADDENDUM CSF TO BUSIlVESS RELATIONSI�IP/LISTING CONTRACT 1 BROKER(Company)Ceatury 21 A Better �vay 2 LICENSEE(S) vincant D. Mella�t 3 CONSUMER Craig & Soaaie 'Shpllny 4 , 5 Broker v�ill order or provide the following services: . 6 O Tide insurance from a reputable.tide insurance company � Use and Occupancy permits 7 ❑ Property/liability insurance - ' O Mortgage payoff 8 ❑ Flood insurance . � � �� ❑ Second mortgage/home equity payoff 9 O New Deed ❑ Condominium/Homeowners association documents 10 O Sewer cerfification O Trash certification 11 ❑ Water certification O Notification of settlement 12 [7 Tax certifications 13 ❑ GeneraUprocessing services: 14 15 16 � Other�rket 1�,aalyais 17 � 1$ 19 Broker's Fee for providing these servi is$ 2 5 0 - 20 21 CON5UMER � � - DATE / 21J/ 22 _ _T——� 23 CONSUMER " DATE 24 25 CONSUMER DATE 26 27 BRORER(Company Name) Cent $ette 2s ./ 29 ACCEPTED BY DATE 30 Vi cent 'I Pennsylvania Association of REALTORS• ��'�GgT PENNSYLVANIA A3SOCIATION OF REALTORS�� • ' � . s�r.. .. :,i.,� . . . ... CEIVTURY 21 A Better Way 398 E High St Carlisle,PA 17013 �one:717-243�929 Fex: 717-243-5325 Vince,at Mellott C21ASW Produced wlth ZipForm�by ziplopix 18070 Fifteen Mfle Road.Fraser,Michigan 48026 www.�' eaix.com , 726 N. Hanover St. CITY__ _� Carlisle, PA 17013 STATE _______.____ZIP (717}243-5802 (717)243-9744 PNONE — Layaway policy:20% deposit required (non refundable) held for thirty days ALL SALES FINAL _ VENDORT ITEM -----J —__.--- —_-- --- ITEM DESCRIPTION PRICE PRICE NUMBER NUMBER _ � ��-��---- — - --- --- r' /��j�� . . ; �` �!v��,6rK-K. � ' �� ___� �.z /� F _ � �. - = �� .�_- - - -- _��f�- ��__ _- � ____�____ __--__----_--_____- _- _ _ _.__ __ __ _ __ ____ ___________-___�__ __ _-______ ___ __-�___ _ _ _ _ ____.__ ____________ _ _ ___ SU9 TOTAL ------ ----I--- TAX I ` _----------------------- --- - TOTAL PRICE i certify that unless I advise you to the contrary in writing of property purchased above is exempt from tax because: __-- —_ Property will be resold in ordinary course of purchaser's business. under___ ___Tax License No. ___,_ __ — I DATE �7 __ ___ SIGNED _ _ eooth No. . � � ..: . t, .. �_ 57 West Main Street, Mechanicsburg, PA 17055 (717} 805-9257 Cell (717) 766-1697 Land Date / / Time AM PM BiLL OF SALE That I, Phane# Address Driver's# Birth Date In�:onsideration.of$ � value received,l do hereby seti and assign aH E properties listed on this bill of saie to Gold Mine/Mobile Merchants,and warrant that l have lawful authority to dispose of same.t further warrant the � . right that i shall delend my right and title to dispose of said property. . l�. QUANTITY DESCR(PTfON PRICE AMOUNT � U.S.90% U.S.40% w.s.� CANADA CURRENCY COINS � FOREIGi�i C�iWS SCRAPIOK 14K 16K 18K �{AMONDS WATCHES STERtiNG GQLD BtlLUON .999 Fine Totai _ _ __ _ _ _ _ _. _, � ,.; Nevin Fahnes k' ac s Auction Service 96 Cherry Drive Marysville,Pa 17053 717-853-4025 November 4, 2014 Subject: Loraine Sholley personal property appraisal 1. Pennsylvania House dresser $175.00 2. Pennsylvania House 6 drawer chest 175.00 3. Empire chest-of-drawers 150.00 4. Cherry drop leaf gate leg table 175.00 5. Double brass bed 100.00 Total $775.00 The prices quoted above are based on my 26 years experience as an auctioneer. It is my opinion, the estimated price could be realized if offered at public auction. Nevin Fahnestock, auctioneer _�,�j� Mcui(urs Ist Fedcral�'rc�3it Union 10(11/2014 10131/2014 ��1 Of 2 � �XXXXXXX938� � _ �GCN)Loi�tse Dri�c �' �a` P.Q.I3o��In �� ` Mechunic�bur�P:� 17(1»-OOdO _.__--__.. }� �`� � (8�0)2�7-7�RS M��E�"1� (7171697-3:i2(Hearing Impaired) Withdrwl from AEGULAR SAViNCsS 0000 �nenr�.enEntr�^�iox ��'�*�c.memberl�t.org Prev Sal: 55,686.55 Amount: 55,686.55 Naw Ssl: 0.00 ��.•,.�• Sgq� #400200 �,1��,'.' Depo�it to REGULAR SAVINGS 0000 Acct XXXXXXX938 ap LORRAINE D SHOLL Amount: 55,686.55 :7eH Bal: LORRAINE D"SHOLLEY ESTATE Smq� #400202 C/"J CRAIG B SNOLLEY --- 161$ WALNUT BOTTOM RD• t•� CARLIS�E PA 17015. " � � .. . �1IIPOA � 9 �,� ,9 v��,vi"I=�`l''.�r� p°� Authorized by �` �� _ ' �� + ID 5ource: � �� `� a �' � ;� Drv Lio ' � 9 � � �h�x. �.�` :� ❑ 5igCard ❑ Known WITH UVGAL NEWS 8'S MII � Other dISA Balnnae Transfer 1.90�a APR NO � WI N�E R EA C H WE E K $50 �� foramoretdmtails,foma. Ask an aasociate ViSA Gift Card Details Here: http://www.members1st. LORRAINE D SHOLLEY � �. - � d"�' �t? �e� � '� �-.�� u �`Y��^:�°w��y`�` ��`� .r�- ? �'�'w � .�e�� „� ,s� � ai�; �� °'y aE k, ... ��. �ti3 �;��c`�`�^r x �� s „ 3 n . a K�¢' � . .� �t�€i,�r t�'.;��tr"� k` 5^`',��,Y'.*s ,� ..r'.`��,�'a,.� r3r,� �`� �.*,'�S, .. ;.,s.a,.��.s�a '+ `. . � .-G � .. :�.�`_�,..._ _�_ __`��_ _ , .�____ �.�__ ..._. ..'`�*��'�a ,.�,.'�'m�...��b3..�:"��. '_. _�.�_. .A_., �_�.._...... _ _..._r.:_ _.. .=„��.._�...._�._,..� .._._.__ _ : :; ; E; m ��. CHECKING 25,151.59 SAVI NGS 25,746.03 CE RTI Ff CATES 0.00 LOANS 0.00 'p -X '. � �-� :: '� `"s4�. �,. ke."'�r�a�` ,r } ,.,�, - v�...x� �„� e „ >�,z • �"�' +.�-+Rx. u. .�. �� .s ��i�'��'� ��.c . x t �w�''�� tw` xa��.^�,�. Y� � �� 9's 5 �'��u �-s��s��x� ��. 'd�``��: ��r5�xf�.�:. ' � . �s z . � :��e a a, �s, � .� � _ . . � .. �r... , w. .� �' ,s s x*; S�M s ? � ,.�`� _._��J<:�"�:�'�"�_� ,. ��x r�v��_��:,�*s:-_ _._ .�.._ � ' � � _w, ,_....�,..�_� ..w �. 3 : _r ,_,_W_._.._.;_. ._... __ � __.. „� ._..,_,�.�,�...d�'z._ . u , �. . _, BEGlNNING BALAIVCE: $0.00 Eff. Post _ Date Date Description __ Deposits Withdrawais_ Balance 10/11 10/11 Deposit 30,000.00 30,000.00 10/14 10/14 Deposit by Check 377.00 30,377.00 10/14 10l14 Check 000054 Tracer 0000091998 632.50 29,744.50 10/17 10/17 Check 000053 Tracer OOOQ056455 110.67 28,633.83 10/20 10/20 Check 000055 Tracer 0000005897 113.85 29,519.98 10/20 10l20 Che�k 000052 Tracer 0000022764 �: 2,843.00 26,676.98 10/20 '10/20 ��heck=000051 Tracer 0000015830 3,026.84 23,650.14 10/21 10/21 rDeposit by Check 1,639.67 25,289.81 10/27 10/27 Check OOQ056 Tracer D000006755 139.00 25,150.81 10/31 10/31 Deposit Dividend 0.050% 0.78 25,151.59 Annual Percentage Yield �am�d 0:050%from 10/11l14 through 10/31/14 _. - ENQING BALANCE: $25,151.59 Check# Date Amount Check# Date Amount Check# Date Amount 51 10/20 3,026.84 52 10J20 2,843.00 53 10/17 110.67 54 10/14 . 632.50 55 10l20 113.85 56 10/27 139.00 *indicates check out of sequence 6 Checks Cleared`�-� �� =: Totai Deposits 32,017.45 .� _= i: �� _-_� 27,108.48 Total Withdrawals 6,865.85 ��sZw �.;;'�r ��a �'s,h;,�. ! 4. j. . � , '. d...� �'°5�� u>.".*.� ' ta �,..,n.,, -e *r # y x N ��R�� ',��`� �''= ��:'*.,.F-;. y T 9�A��. a�-"�`'' rt'`..r ` � �*�''�, �-&.•^a+'��'�2',�;,,'�'r�< �- : �r 1r'�'a.;��'�. `"�t'� �'St��,�c s.?��,�"�- �%a`�:, � � t -.� ...-� ' .. ' x�" r' 's '``� �;.'��-�u'��`5� � � ... ... _ _ � ��... -�. � ��-��'��=.a��rfaa��'�� __w.__.. ....._...��.,..e�, ...e.... ... ,_3.r,. __ _ ..- .�__� _ x _ts �'�'t`"�-. Y..,&;'r�'; aY".�_,�.�-t �`�r,z,.�.�s...;_�s �,. "�"�''y'?,b,�,ko� x.,.'r�,'�.�.�Y. BEGtNNING BALANCE: $0.00 Eff. Post Date Date Description C2posits Withdrawals Ba{ance 10/11 10/11 Deposit Transfer ��.086.55 55,686.55 + From SHOLLEY,LORRAIiv XXXXXXXX x� S-a_e ::.:_� l 10/11 10/11 Withdrawai 30,000.00 25,686.55 ' 10/16 10116 Deposit 30.00 25,716.55 OUTSIDE RET CK FEE�533533 10/30 10/30 Deposit 14.00 25,730.55 � ` OUTSIQE RET CK FEE#533633 10/30 10/30 Deposit ' - 14.00 25,744.55 OUTSIU€�GK R�T F�E#533633 - 10/31 iQ/31 Deposit Dividend 0.100% 1.48 25,746.03 ' Annual Percentage Yield Earned 0.100%from 10.?11i14 through ' 10;31/14 E{UDlNG BALAtVCE: S25,746.03 Totai Depasits 55.746.03 Total UUth�rawals ?,�.;;��.�;, n�� '� ��`�� ' �'� '� � rf��, �r x� �c� �� r +.� � t'� t�, � �'�`�' �. ��_"_... �`�..�v,.�, a..,._h,.��..c,�..+�.w_ze..'`�,.��t��w%'`"�� ._.......:":�� ,R£ ��4-�, ��'� ._'�5,.`.,�.,..,�,..�3TV.�"...��y�,.:��`"'�.,;��^....�..��;..�;_..�',,,_��._.�.,.��.. .2..-:av�¢,`'�"",. TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS 1.48 0011 CHECKING 0.78 Total Year to Date Dividends Paicf{!ncludes Closed Shares) 2.26 . • ,.; ; ', K�1 t1ki�# !UF'1'U!�9 iUN•K�iE�t1�9 L(.g4f+S�i�:i-'+..Et:i 94at*i � Appointment Service Description Charge Payment Adjust Patient 01/10/14 - LORRAINE - Golec, Mark S., DPM DEBRIDE NAILS ANY METHOD 11721 110.1 60.00 43.29 01/28/14 MEDIC DEDUCT Payment 0.00 01/28/14 Accept Assign Adj. -16.71 02/13/14 UNITED AMERI Payment ` 0.00 This bill applied against your deductible. You are responsible to pay us. � � . . . ', � ; ;„ �� r � ;, � �r y� ,.�tF;;: s � � �i. . . ��; �- ' —1 � LAST PAYMENT RECEIVED ' Current Over30 Over60 Over49 Over120 Patient � 08/86/00 6 90 43 29 0 00 0 90 0 0"0 0 00 � 43.29 / «ASE Pinker � Associates . � -- - �� -"� IAKE CHEClC 47 Br`ookwood Ave '� aY�B�r�: Carlisle, PA 17015-9126 Payment Due Upon Receipt � 43.29 � �; Ph:(717)-243-2236 Statement Date: 02/18/14 Acct#:4968 Page 1 of 1 J MEDN 14021913007.005096.01.01.010000 t Remit Payment To: e i_ � _ �� _ � � e� � Cumberfand Goodwill Fire Rescue EMS {n Billing Offic� 14-206508 10/7/2414 $113.85 PQ Box 726 New Cumberiand, PA 17070-0726 QUESTIONS ABOUT THIS BILL3 Phone: 877-214-6018 Espanoi: 866-724-4114 Fax: 717-214-6020 Email: tnfa�.9ambutancebiilingoffice.com Dete of Service: 9/8/2014 12:50 P�Ease visit our website to provide insurance or make payment, and PatienE Name: SHOLLEY,LORRAINE for additional payment options and frequently asked questions: Ftom: Cariiste Regional Medica{Cerrter �yWy,at�tbulancebitlingo�ce.com To; CHAPEL POfNTE AT CARLtSLE _ . � . . . e g = i . e receive noti cation onr ozcr an thcrt yaur check�vas returnec�due to Drawn Against U�acollected. A bnnk fee has been applied ta tliis aecozrnt..Payirre�at in full is your responsibility. Please Yenzitpayment. _ _ _ __ 9/08l14 Stretcher Van One-Way Transpa AQ130 1.0 80.00 80.00 9/08/14 Mileage S0209 2.2 1.75 3.85 9/08/14 Retumed Check Fee-$30 1.Q 30.00 30.00 9/29/14 Paymen# -83.85 10/Q7/14 Rayment - 83.85 Total _ 113.85 4.00 0.00 10 �'�� , . � J � - - t (�.�-� ,' S DETACH AND RETURN Rr1TfOM PORTION WITH Y�UR PAYMENT. _ � � � �� - --Q------------------------- _-_----------------------------------------------------- __-____-------------------------- n''��`�f�j'��'``� /��Invoice Date:09/30/2014,Acct#:CHAP1327,SHOLLEY,LORRAINE D,Chapel Pointe NC,P,BRANSCUM,GEORGE �- '� Rx Number Quantitv Descrintion AmouM �alesTan I�I Tvoe -- .. ._ 09/20/2014 7053181 14.00 Amiodipine Besylate Oral Tablet 5 MG 68382-0122-05 S 4.82 C $ 0.00 $ 4.82 RX 09/20/2014 7053185 90.00 Albuteroi-Ipratropium Inhalation Solution 2.5-0.5 MG/3ML $ 17.62 C $ 0.00 $ i 7.62 RX 00487-0201-01 09/20/2014 7053186 3.50 Metoprobl Tartrate Oral TaWet 5o MG $ 1.25 c $ 0.00 $ 1.25 RX •� 00093-0733-10 � � 09/20/2014 7055933 7.� Furosemide Oral Tablet 4o MG '$ 1:67 c $ 0.00 $ 1.67 RX fi3304-0625-10 09/20/2014 7059674 21.Od BusPlRone HCI Oral Tablet 5 MG $ ':2:62 C $ 0.00 $ 2.62 RX 00591-0657-01 , 09/20i2014 7059675 7.00 DOK Oral C9psuie 100 MG $ 0.14 $ 0.00 � $' 0.14 OTC oosoa-78s9-eo . . 09/20/2014 7060461 28.00 Potassium Chioride CR Oral Capsuie Extended Reiease 10 MEQ $ 10.05 c $ 0.00 $ 10.05 RX 68382-0701-05 Q9/20/2014 7065233 1.00 PredniSONE Oral Tabiet 1 o MG $ 0.30 c $ 0.00 $ 0.30 RX 00603-533&21 09l22/2014 7061447 113.00 Risamine Extemai Oiniment o.44-2o.s25% $ 3.56 $ 0.00 $ 3.56 OTC 64980.0322-12 09/22/2014 2Q55553 30.00 MorFhi�Sulfate Orai Solution 20 MG/ML $ 13.09 C $ 0.00 $ 13.09 RX 00406-8003-30 09/24/2014 7063321 12.00 Acetaminophen Redal Suppository 650 MG 45802-0730-32 $ 5.70 $ 0.00 $ 5.70 OTC 09/24/2014 7Q63855 15.00 Atropine Sulfate Ophthalmic Solution 1°h $ 49.85 $ 0.00 $ 49.85 RX 2a2os-msaos -- - --___ _ � �� _ �'� �_� s� ��,t� < ;/ _ I � 6� � � �v/� G �� . - / ��-� . �, �:; � �-�$� �.t Last Pay� Finance Cha. YTD Fin Chg,, �ther R� OTC �VSP IVPR � $ 0.00$ 0.00 $ o_oo $ o.00 � o.00 $ �0�.2� $ 9.ao $ o.00 $ o.00 ,io.s� RX-Prescription OTC-Over the Counter NPR-IV Pump Rental IVSP-tV Supply c-Insurance Co-P�y _ . �