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HomeMy WebLinkAbout01-09-15 REV-1500 EX(02-11) 1 7 1505610143 OFFICIAL USE ONLY PA Department of Revenue permsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 21 14 0376 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 04 12 2014 11 08 1925 Decedent's Last Name Suffix Decedent's First Name MI HOMCHECK CECELIA 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 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 0 1. Original Return FJ 2, Supplemental Return 3. Remainder Return(Date of Death Prior to 12-13-82) 4. Limited Estate 4a.Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) (Attach Copy of Will) 7. 8. Total Number of Safe Deposit Boxes FX 6, Decedent Died Testate Decede�,Maintained a Living Trust (Attach opy of Trust) beptoueseanl Poe of Death V, 2!3 11.Election to fax under Sec.911 3(A) 9. Litigation Proceeds Received 10, 1 1 and -1-95) (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MICHAEL L BANGS 717 730 7310 REGISTER OF WILLS USE ONLY First Line of Address C'> cin � 1-171 C 429 SOUTH 18TH STREET C G*> Cr) Second Line of Address r-n co q) DATE FILED City or Post Office State ZIP Code 17011 CAMP HILL PA C-> M to C> Correspondent's e-mail address: Mi keba ngs(?_Dverizon.net Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATUREJQIF VERSON RESPONSjJBLE FOR ILP RETURN Peggy A. Homcheck DAT ADDRESt 24 Circle Drive,Camp Hill, PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE L�2=�Z 442 Michael L. Bangs vi S ADDRESS 10— 429 South 18th Street, Camp Hill, PA 17011 Side 1 1505610143 1505610143 1505610843 REV-1500 EX RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 196, 068 . 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, 29, 914 . 62 6. Jointly Owned Property(Schedule F) El separate Billing Requested............ 6. 7. Inter-Vivos Transfers&MiscellaneousProbate Property (Schedule G) t Separate Billing Requested............ 7. 115 ,574 . 83 8, Total Gross Assets(total Lines 1 through 7)........................................................ 8, 341,557 . 45 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9, 11 , 770 . 12 10, Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 3 , 896 . 33 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 15, 666 . 45 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 325,891 . 00 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, 325, 891 . 00 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. 0 . 00 16. Amount of Line 14 taxable 325 , 891 . 00 16. 14 , 665 . 10 at lineal rate X .045 17, Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................. ...... .....................-............. ............ 19. 14, 665 . 10 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. F-1 Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-14-0376 Decedent's Complete Address: DECEDENT'S NAME Homcheck,Cecelia D. STREET ADDRESS 408 Deerfield Road CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 14,665.10 2. Credits/Payments A. Prior Payments 10,000.00 B. Discount 526.32 Total Credits(A +B) (2) 10,526.32 3. Interest (3) A. 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) 4,138.78 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and; Yes No a. retain the use or income of the property transferred;................................... .................................­....... b. retain the right to designate who shall use the property transferred or its income;.............. ................._ c. retain a reversionary interest;or............................................................................................................... ❑ ox d. receive the promise for life of either payments,benefits or care?............................................................ ❑ 1�1 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?................... .................................................... ........................................... El 1�1 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... El F_x] 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?.... ....__....._...._........_...................._.................__..........._.......... F_x] El IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan, 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)). For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1,2)], • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.§9116(a)(1)). • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. Rev-1502 EX+(01-10) SCHEDULE A pennsylvania REAL ESTATE DEPARTMENT OF REVENUE ' INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Homcheck, Cecelia D. 21-14-0376 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet If the property has been sold Include a copy of the deed showing decedent's interest If owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real Estate-408 Deerfield Road, Lower Allen Township. Tax Parcel No. 13-24-0809-036. 196,068.00 Sold on 11/14/14;see HUD attached. Total proceeds due estate equal$196,068.00; $7,943.00 is being held pending approval of this inheritance tax return. TOTAL(Also enter on Line 1, Recapitulation) 196,068.00 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev.01-10) Rev-1506 EX+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Homcheck, Cecelia D. 21-14-0376 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Automobile-2006 Saturn Ion sold to Leonard Semick 4,000.00 2 M&T Bank-Checking Account 23,122.56 3 M&T Bank-Savings Account 1,719.31 4 Refund from Allstate 27.00 5 Refund from Comcast Cable 5.75 6 Refund from Encompass-cancelation of automobile insurance 446.00 7 Refund of balance of unearned homeowners insurance 344.00 8 Rent rebate from Department of Revenue 250.00 TOTAL(Also enter on Line 5, Recapitulation) 29,914.62 (if more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev1514 EX+(08-09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Homcheck, Cecelia D. 21-14-0376 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1504 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH r OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF NAME OF THEIR A COPY OF THE DEED FOR P TO REAL ESTATNT E VALUE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Allianz-Annuity Policy No.00070149090; Decedent's 115,574.83 115,574.83 daughter Peggy Homcheck was the sole beneficiary o the cash value of the annuity. TOTAL(Also enter on Line 7,Recapitulation) 115,574.83 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09) REV-1511 EX+(10-09) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Homcheck, Cecelia D. 21-14-0376 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 1,763.18 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s)Commission Paid 2. Attornev's Fees Michael L. Bangs 6,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD Relationship of Claimant to Decedent 4. Probate Fees 398.50 5. Accountant's Fees 1,000.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs 2,108.44 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 11,770.12 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Homcheck, Cecelia D. 21-14-0376 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses nses 1 Parthemore Funeral Home 1,763.18 H-A 1,763.18 Other Administrative Costs 2 Cordier Antiques-clean out of residence 225.00 3 Cumberland Law Journal-estate advertisement 75.00 4 Dale Stipe-payment for miscellaneous expenses related to house 400.00 5 Peggy Homcheck-reimbursement for various expenses 109.03 6 Peggy Homcheck-reimbursement of miscellaneous house expense 121.63 7 Peggy Homcheck-lawn cutting and miscellaneous expenses 11/11/14 425.00 8 The Patriot News Co. -estate advertisement 173.78 9 Vicki Weger-reimbursement for travel expense 579.00 H-B7 2,108.44 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Homcheck, Cecelia D. 21-14-0376 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER. DESCRIPTION OF DEATH 1 Bonnie Miller,Tax Collector-2014-15 school real estate tax paid at discount 2,207.77 2 Greensward Turf Care 58.59 3 Greensward Turf Care 58.59 4 Greensward Turf Care 58.59 5 Lower Allen Township-sewer/refuse 122.70 6 Lower Allen Township-sewer/trash 7/1/14 to 9/30/14 122.70 7 Lower Allen Township-sewer/trash 10/1/14 to 12/31/14 122.70 8 PA American Water-4/25/14 26.24 9 PA American Water-5/22/14 26.24 10 PA American Water-5/3/14 to 6/3/14 18.06 11 PA American Water Company-6/4/14 to 7/2/14 21.13 12 PA American Water Company-7/3/14 to 8/4/14 15.00 13 PA American Water Company-8/5/14 to 9/3/14 28.28 14 PA American Water Co. -9/4/14 to 10/2/14 20.11 15 PA American Water Company-10/3/14 to 11/4/14 19.09 16 Peggy Homcheck-reimbursement for lawn maintenance(5/20/14) 75.00 17 Peggy Homcheck-reimbursement for grass cutting 7/10/14 75.00 Total of Continuation Schedule See attached page TOTAL(Also enter on Line 10, Recapitulation) 3,896.33 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08) Rev-1512 EX+(12-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Homcheck, Cecelia D. 21-14-0376 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 18 Peggy Homcheck-payment of lawn care 9/10/14 79.76 19 Peggy Homcheck-lawn care and miscellaneous expenses 9/23/14 66.96 20 PP&L Electric-5/20/14 383.18 21 PP&L Electric -3/28/14 to 4/24/14 36.36 22 PP&L Electric-5/28/14 to 6/26/14 42.70 23 PP&L Electric-6/26/14 to 7/28/14 28.21 24 PP&L Electric-7/28/14 to 8/26/14 25.87 25 PP&L Electric-8/26/14 to 9/25/14 32.83 26 PP&L Electric-9/25/14 to 10/27/14 49.85 27 PP&L Electric-final bill 57.84 28 Verizon-5/20/14 16.98 TOTAL(Also enter on Line 10, Recapitulation) 3,896.33 Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08) REV-1613sX+(01'10) DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Hlomcheck, Cecelia D. 21-14-0376 RELATIONSHIP TO NAME AND ADDRESS OF SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT Do Not L"st Trust e(s) (Words) ($$$) TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers Peggy A.Homcheck Daughter one-half 24 Circle Drive Camp Hill, PA 17011 Victoria Weger Daughter one-half 304 Dorchester Drive Egg Harbor Township, NJ 08234 Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOT I AL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1 500 COVER SHEETI Copyright kVuo1nform software only The Lackner Group,Inc. Form PA1mVVSchedule J(Rev.o1'1O) A. Settlement Statement (HUD-1) OMB Approval No.2502-0265 1.❑FHA 2.❑RHS 3.❑Conv.linins. 6.Fite Number. 7.Loan Number. 8.Mortgage Insurance Case Number. 14453 5701631880 4.❑VA 5.®Conv.Ins. C.Note:This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agents are shown Items marked '(p.o.o)'were paid outside the dosing;they are shown here for informational purposes and are not included in the totals. D,Name&Address of Borrower. E.Name&Address of Seller. F.Name&Address of Lender. Jeremy R Shuttleworth,Noemi Shut les onh Estate of Cecelia D.Homchack Fulton Bank,NA 880 Cedar Road,Lewisberry,PA 17339 408 Deerfield Road,Camp Hill,PA 17011 One Penn Square,Suite 304,Lancaster,PA 17602 G.Property Location: H.Settlement Agent: I.Settlement Date:1 V1412O14 408 Deerfield Road 1st Advantage Settlement Services Inc. Disbursement Date:1 V14/2O14 Camp Hill,PA 17011 6375 Mercury(hive,Suite 102,Mechanicsburg,PA 17050 Lower Allen Township 717591.7755 Place of Settlement T'(deF�ress 6375 Mercury Drive,Suite 102,Mechanicsburg,PA 17050 Print 1 V1 4/2014 at 1226 pm by VW K.Sum m ary of Seller's Transaction 100. Gross Amount Due from Borrower 400. Gross Amount Due to Seger tot. Cort-act sates price 210,000.00 401. Contract sales price 210,000.00 102. Personal property 402. Persona(Mperty 103. Settlement charges to bo rower(line 1400) 7,871.16 403. 104. 404. 105. 405. Adjustments for items paid by seller In advance Adjustments for kerns paid by sella in advance 106. Citydavn taxes to 406. Cttydown taxes to 107. County taxes 11/14/2014 to 12,11014 148.83 407. County taxes 11/142014 to 12/31 x2014 148.83 108. School Taxes 1//142014 to 061302015 1,385.15 408. School Taxes 11/142014 to 06/302015 1,385.15 109, 4,Qtr Sewer 11/142014 to 12/3112014 64.02 409. 4th Qtr Sewer 11/142014 to 12/31/2014 64.02 1% 410. 111. 411. 112. 412. 120. Gross Amount Due from Borrower 219,469.16 420. Gross Amount Due to Seller 211,598.00 200, Amounts Paid by or in Behalf of Borrower 500. Reductions In Amount Due to Seller 201. Deposit or earnest money 2,000.00 56T Excess deposit see instructions) 202. Principal amount of new loan(s) 189,000.00 502. Settlement charges to seller(Gne 1400) 23,473.00 203. s talo subject to 503. Existing s taken subject to 204. 504. Payoff of first mWaw loan 2t%. 505. Payoff of second mortgage loan 208. 506. 207. 507. 208. 508. 209. 509• Ad is for kerns unpaid by seller Adjustments for items unpaid by seller 210. City2owr,taxes to 510. CityRown taxes to 211. County taxes to 511. County taxes to 212 School Taxes to 512 Scrod Taxes to 213. 513. 214. 514. 215. 515. 216, 516. 217. 517. 218. 518. 219. 519. 220, Total Paid b dor Borrower 191,000.00 520. Total Reduction Amount Due Seller 23,4T3.00 300. Cash at Settlement fromlto Borrower 600. Cash at Setlfematt tof rn Seller 301, Gross amount due from borrower(tine 120) 219,469.16 601. Gross amount due to seller pine 420) 211, 8.00 302. Uss amour is paid by/for bom wer(line 220) 191,000.00 602. Less redtrctiots in amount due Geier(One 520) 23,473.00 303. Cash ❑X From ❑ To Borrower 26,469.16 603. CashX❑ To ❑ From Seiler 188,125.00 x,fas� .ka,f .o.r.er•,woaamvaOsn�R.rlogflAMCaCyLLl1/J,GV4mfE0,T4midaM.T,'YYOnbr�Ctap[OMC,MpNMWiNEVAOMu.CUiluiCyaO YPom�fblYYpW -a.omc c.pun Previous editions are obsolete HUD-1 700. Total Real Estate Broker Fees $12,600.00 Paid From Paid From Division ofcornmission Oine700 asfolloas: Borrower's Seller's 701. $6,30D,00 to CodWI8anker Residential Brokerage Funds at Funds at 707 $6,30D.00 to Re/Max lstAdvantage Settlement Settlement 703. Commission paid at settlement "2,600.00 704. Commission to RafMaxlstA antage 395.00 1705. Broker Fee to CoWwW Banker ResidenW Brokerage 3DO.00 600. Items Payable in Connection with Loan 1. Our origination charge (Includes Origination Point 0.000`16 or$0.00) 5795.00 (from GFE#1) 802. You credit or charge(points)for the specific Interest rate chosen $ (from GFE#2) 803. Your adjusted crighadon Charges (from GFE A) 5.00 804. Appraisal fee b Bassett Appraisals 5450.00 P.O.0 (om GFE*s) 805. Credl report to Credsta (from GFE A3) 4272 806. Tax service to (from GFE#3 807. Flood certification to Corel is Flood Services (from GFE#3) 11.50 808. to 900. items Required by Lender to be Paid in Advance 901. Daily interest charges from from 11/14W4 to I 2N1W4 Q$20.71231day (from GFE#10) 352-ffF-- 902. Mortgage Ins.Prerrium for months to (from GFE#3 903. Homeowners insurance for 1 years to Don Jacobs Insurance Serv. (hom GFE 411) 835.00 904. months to from GFE#11 1000. rves Deposited with Lender 1001. Initial deposit for your escrow account (from GFE 99) 1,287.83 1002.Homeowners insurance 3 months @ S 69.581month $208.74 1003.MoIM Insurance months 0 S 55.131month $ 1004.City Property Tax months gb S O.00frnonth $ 1005.County Properly Tax 10 months AD$ 96.0irrmth 5964.90 1006.School Taxes 6 months $ 187.741month $1,128-44 1007.Aggregate A4usbTwd $.1,012.25 1100.Tie Charges 1101. Title services and lenders title Insurance $ from GFE 94 1,755.00 1102 Sedlement or dosing fee to $ 1103. Owners title insurance-First American Title Insurance Conpany 5 from GFE 105.00 1104.tenders title Insurance-First American Tide Insurance Company $1,620.00 1105. Lenders title poky rent$189,000.00 Lenders Policy 1106.Ownees title policy Smit$210,000.00 Owners Policy 1107.Agents portion of the total title insurance prembm $1,360.00 to ist.Advantage Settlement Services Inc. 1108.Ur&v(fees portion of the total title insurance'premium $365.00 to First Amerlem Title Insurance Co an 1109. 1 i 10.Notary to vdde Welker 10.00 1111.Tax Cert ficalion Fee to 1 st Advantage Settlement 20.00 Services Inc. 1112. to S 1200.C,ovenunent Recording and Transfer Charges 1201.Government recording charges $ (from GFE#7) 192.00 1202.peed$79.00 Mo a$113.00 Release$ 1203.Transfer taxes $ (fin GFE#8) 2,100.00 1204.City/Canty tax/stamps Deed$2,100.00 Mort $ 1205.State TvJstamps Deed S2,100.00 Mortm 5 2,100.00 12'16. Deed$ M $ 12(7. $ 1300.AddWorW SeHlement Charges 1301.Required services that you can shop for (trom GFE 46) 1302.Storey to $ 1303. to W.Escrow for Inheritance tax to 1 st Advantage Settlement Services 7, 1305.Legal Fees to Banos Law Office,LLC r i ,;. _ n r 7,871.16 23,473.0-01 'Fait outside of closing by(8)o rower,(S)eller,(L)ender,(I)nvestor,Bro(K)er.-WI by lender shown on page 1.-Credit by seller shown on Page 1. Previous editions are obsolete HUD-1 Cyrnparlson of Good Faith.Estimate GF and HUD-1.Charges Good Faith Estimate HUD-1 Char TlutCarnotlncresse HUM Line Number,: Our origination charge 480, 795.00 795.00 Your credit or charge for On specific interest rate chosen :#:.802 0.00 0.00 our ackusted o ina6on charges 795.00 795.00 ran taxes t 4,200.00 2,100.00 Charges That In Total Cannot Increase More Than 10% Good Faith EsUrnaee HUM Government recording charges # 1201 220.00 19200 Appraisal fee #,804 450.00 450.00 C(edg rem # 80. 42.72 Flood certification # 807 11.50 11.50 Tille services and lenders title insurance # 1101 1,734.00 1,755.00 Owners title in=-am-Flrsst American Title Insurance Company. # 1103 105.OD 105.00 # 2,580.50 Y,55822 MIMIS -2426 or -0.9409% a That.Can Chane Good Faith Estimate HUM Initial deposit for your escrow account # 1001 : 2,887.50 i, 7.63 Daily interest charges from: #.90t 520.7123Ida 248.55 _ 352.11 Homeowners insuartce .#.903. 550.00 835.00 Loan Terms Your initial loan amount is s189,000.00 Your ban term is 30.years Your initial interest rate is 4.0000% Your initial monthly amount owed for principal,interes4 and any mortgage 4957.44 includes insurance is Q Principal X❑Interest X❑Mortgage Insurance Can your Interest rate rise? ❑X No. ❑Yes,it can rise to a ma 6mum of %. The first change will be on ! I and can change again every years after 1 I . Every charge date,you Interest rate can increase or decrease by %. Over the fife of the ban,your interest rate Is guaranteed to never be lower than %or higher than %. Even 6 you make payments on time,can your loan balance rise? ©No. ❑Yes,it can rise to a maximum of S Even if you make payments on time,can your monthly amount owed for ❑X Ne. ❑Yes,the first increase can be en I ! and the monthly principal,interest,and mortgage insurance rise? amount owed can rise to S The mapmum it can ever rise to is S Does your loan have a prepayment penalty QX No. ❑Yes,your rr Amm prepayment penalty is$ Does your loan have a balloon payment? QX No. ❑Yes,you have a balloon payment of S due in years on Total monthlyamount 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 yourself. ❑X You have an additional monthly escrow payment of$353.81 that results In a total Initial monthly amount owed of S1,31125. This inckides principal,interest,any mortgage Insurance and any items checked below: Q Property taxes Homeowners Insurance Flood insurance ❑X School Taxes Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender. Previous editions are obsotet:e HUD-1 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 Settlement Statement and to the beat of my knowled"and belief,it is a true and accurate statement of alt receipts and disbursements made on my account or by me in this transaction I further certify that I have received a copy of the HUD-1 Settlement Statement. Jeremy R SNAtlesworth Noemi Shuttlesvrath Estate of Ce erla D.Homcht The H1.10-1 Settlement Statement which I have prepared is a true and accurate account of this transaction I have caused or will cause the funds to be disbursed In accordance with this statement. e=- /II( l`11t �' SETTLEMENT AGENT �� DATE — WARNING;IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010. Previous editions are obsolete HUD-1 Elroy. Name of Borrower. Name of Seller: Fie Number I Jeremy R.Shuttlesworth Estate of Cecelia D.Homchack 14453 i Noemi Shuttlesworth I Tr1feExpress Prepared 11!142014 at 11:14 am Noce: This page is furnished to give you an itemization of the amounts shown on ;` axi;Frat 'PaPtfFotri Lines 1101, 1103 and 1104 of the Settlement Statement(HUD-1)_This page r$ORie>?s t 'Seliel'S f accompanies but is not a part of the settlement statement. if a discrepancy t7radsat_:::G;FundaY:`:: exists,the Information shown on the Settlement Statement(HUD-1)applies. sSe{ffei ie if:` `,)$8tt f 2ilV Zp',• .r..-_.......,;.,•: .�. .. -.: . ... ...........::..._>._.:<_._.:.�„�tn:L61e�4161Eae'`�� r:�!=. 1101. rr0e services and tender's title Insurance 1,75500 a Wire In Fee S 15.00 I b.ETdWoc Copy Fee 50.00 c Ovemight Delivery Fee? a 25.00 d Notary Fee 45.00 S 135.00 1102 SetCemerif of dosiN fee I 1103. Owner's title insurance $ 105.00 105.00 1104. LeWees title insurance (pdicy) 1,345.00 S 1,520.00 a"Endorsement 900 EPL-Residential. 50.00 b.Endorsement 100 No Violation 50.00 c. ErdorsemeM 300 Survey 50.00 I d.Closiag Service Luer 125.00 �otal•1103+1104) i . 3; M'ens°altle-0ollcyTriit=521M'.00.':- 1107: "eMa offi6tiiCaittlie:ihsui lies iii:t<:";:$rj;380:00`.'' X108::�Uiid"eiviilfelspoitibiioflfis'ti>ha7�title'iiisiraiice-pieni''"-:aid:`::'365:00 I (Tb''W 08)'. I ::1i{ 1109. 1110. 11 i 1. 71112 r r ToW ; Borrower r 13� * Se1Ter. riti0';Titie.G6 ''esvih r:._. 4:'ch e.." P:oCoft;redrt+'R<3.the:tl6i.. `. xPaid - 1101. Title services and tender's title insurance b a.Wee In Fee to 1st Advantage SetUement Services Inc. 1500 15.00 _ b.EmaADoc Copy Fee to tst Advantage Seitlernent Servtcas Inc 50.00 50.00 c Ovem t Delivery Fee-Package to 1st Adna--tage Settlement Services Inc. 25.00 25.00 d.Notary Fee to Vickie Welter 45.00 45.00 1104. Lender's We lnswooe to Ist Advantage Settlement Servioes Inc, 1,620.00 1,620.00 .. Y'ni::-:... w. < 1. ! - 7 -• S P .Aa _ .: ;:y. , ?.._':.,... .. '�'z.�....�P.,.~-a G ..-�'•r_)�x S{r 4;7,SS.00z:r:c.::✓an:.:-• �'.,., ,_-1iZ55:00 !.�t,. assistance: please canraci-me-at-uvv:���:r3o uUr-� „�u� r.-. agent of record. Thank you, in advance, for your prompt response. We look forward to serving you. Sincerely, Cheryl McCollam (ext 36261) Claims Case Manager LCL-1005 r 8.31.2012 LAST WILL AND TESTAMENT OF CECELIA D . HOMCHECK I, CECELIA D. HOMCHECK, of 408 Deerfield Road, Camp Hill, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, revoking hereby any prior Wills . FIRST : I direct that the expenses of my last illness and funeral, including the costs of an appropriate gravemarker, shall be paid from my estate . _ SECOND: All the rest, residue and remainder of my estate, real, personal mixed, of whatsoever nature and wheresoever situate, I give, demise and bequeath to my daughters PEGGY HOMCHECK and VICKY WEGER. THIRD: I nominate, constitute and appoint, in the order named, my daughters PEGGY HOMCHECK and VICKY WEGER to be the Executrix under this my Will . 1 . I direct that the Executrix shall not be required to furnish bond in any jurisdiction, but if a bond is nevertheless required, it shall be without surety. 2 . In addition to powers granted by law, my Executrix shall have power to compromise claims and controversy; to sell, lease or exchange real or personal property; and to make distribution of my estate in cash or in kind. IN_�jF1ITNESS WHEREOF, I have hereunto set my hand and seal this `� day of, August 1998 . (SEAL) Cecelia D. Homcheck Page 1 of 3 SIGNED, SEALED, PUBLISHED and DECLARED by the above named Testatrix, CECELIA D. HOMCHECK, as and for her Last Will and Testament, 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 hereunto set our hands as witnesses . Name Address 4jl fid'-'- Name Address Name Address Page 2 of 3 COMMONWEALTH OF PENNSYLVANIA ) SS . COUNTY OF DAUPHIN ) I, CECELIA D. HOMCHECK, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and exEiCUted the Inst ument amy Last Will and Testament dated the �� day of 1998; that I signed it as my free and voluntary act for the ' P-LiMoes therein contained. Sworn or affirmed to and acknowledged before me, this 1-7 day of v t, �- 1998 . Notary Public My Commission Expires '-, - COMMONWEALTH xpires ;COMMONWEALTH OF PENNSYLVANIA ) NCT,'SiAL S%AL SS . KATHERINE D. 4.4kMUN, t4.:;ary Public. COUNTY OF DAUPHIN New-bwry Trip., York aunty, PA ^/ ) My Commi'.,%-n Ex N;E± :J, <000 / We, /" and two of the witnesses whose na es are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix, CECELIA D. HOMCHECK, sign and execute �he instrum nt as her Last Will and Testament dated the ? day of1998; that she signed willingly and that she executed it efree and voluntary act for the purposes therein contained; 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 (18) or more years of age, of sound mind, and under no constraint or undue influence . Wi ess Witness Sworn to and subscribed before me this day of 1998 . -Notary -Public -My Commission ExpirQs : NCTAFIAI SEAL KATHERINE D. HAMU`2, ty,ary Public Wwbt-ry Twp;, York County, PA My Commis i x &airet Sept. 25, 2000