HomeMy WebLinkAbout02-26-15 (3) . ,
� 1505610140
RE�-1500 EX (02-11)(FI)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 � � y 0 � � �
Harrisburq, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 1, 2 9 2 0 1, 4 � 6 1, 7 1, 9 1, 9
DecedenYs Last Name Suffix DecedenYs First Name MI
B e n f e r R u t h A
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security humber
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE Ot/ALS BELOW
O 1. Original Return � 2. Supplemental Return � 3. Remainder Return (Date of Death
Prior to 12-13-82)
� 4. Limited Estate � 4a. Future Interest Compromise(date of � 5. Federal Estate Tax Return Required
, death after 12-12-82)
� 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust _ 8.Total Number of Safe Deposit Boxes
(Attach Copy of V`lill) (Attach Copy of Trust.)
� 9. Litigation Proceeds Received � 10. Spousal Poverty Credit(Date of Death � 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 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
S t e p h e n J • H o g g � E s q • 7 1, 7 2 4 5 2 6 9 8
REGISTER OF WILLS USE ONLY
First Line of Address ' � c:_� ��
1, 9 S • I' a n o v e r S t r e e t `' �� ���� "�'
w � +T� �
w -�
a ; `� r-� , <_�
Second Line ofAddress � �'�� ,_� c� , ��
, r
S t e • 1, l7 1 �_, � '
City or Post Office State ZIP Code _ flATE FI�LED ��'
�
--� r
C a r 1 i s L e P A 1, 7 � 7, 3 . -=� ;��
: �v ��
_ ;....
i-;.t
CorrespondenYs e-mail address: --� ��"' ��'
_.�.�
Under penalties of perjury,I dei`are that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.�Elaration of preparer other than the personal representative is based on al�information of which preparer has any knowledge.
SIGNATURE OF PERSON R :P IBLE WG RETURN ATE -
�.. ��
�- ' _, '
ADDRESS
1,9 S • Hanover St , te • 1,01, Carlisle PA 7,701,�
SIGNATURE OF PREPARER C.THER AN REPRESENTATIVE DATE
ADDRESS
1,9 S • Hanover St • , Ste • 1,01, Carlisle PA 1,7�1,3
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1,505610140 ],5�561,01,40 �
� W
� 1505610240
REV-1500 EX (FI) DecedenYs Social Security Number
oecede�rs Narr�e: R u t h A • B e n f e r 1 9 8 0 1, 3 2 5 3
RECAPITULATION
1. Real Estate(Schedule A) L 2 9 9 � � , � �
1.
2. Stocksand Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z '
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. '
4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4. '
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5.
7 4 0 . 6 0
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 8 3 4 , 4 L
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested . . . . . . . 7. •
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. � 3 1 4 7 5 , � 1
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9 2 L 9 5 5 . � 7
10. Debts of Decedent, Mortgage Liabilities, and Liens(Schedule I) . . . . . . . . . . . . . 10. L 5 4 6 � . 5 3
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 3 7 4 1 6 . 3 �
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 9 4 0 5 8 . 7 1,
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. 9 4 � 5 8 . 7 L
TAX CALCULATION-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.0 _ 0 . � 0 15. � . � �
16. Amount of Line 14 taxable
at�inea�rate X .045 9 4 0 5 8 . 7 1, 16. 4 2 � 2 . 6 4
17. Amount of Line 14 taxable
at sibling rate X .12 • 17. � • � �
18. Amount of Line 14 taxable
at collateral rate X .15 � • � 0 1 g. 0 . � D
19. TAX DUE 4 2 � 2 • 6 4
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL,IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
� 1,50561,024� 1,5�561,0240 J
REV-1500 EX(FI) Page 3 Fiie Number
Decedent's Complete Address: 2� 14 0112
DECEDENT'S NAME
Ruth A. Benfer
_ _ _ ___ __ _ _ _
STREET ADDRESS
__
__ _ _
CITY _ _ , STATE ___ ZIP
Tax Payments and Credits:
�. Tax Due(Page 2,Line 19) (1) 4,232.64
2. CreditslPayments
A. Prior Paymenls 4,000.00
e.Dlscount 210.52
Total Credits(A+B) (2) 4,210.52
3. Interest
(3) 0.21
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) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the tlifference.This is the TAX DUE. (5) 22.33
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decetlent 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 ..................................................................................................... ❑ ❑
d receive the promise for life of either payments,benefits or care? .......................................................
2. If death occurred after December 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ �
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her tleath? ........ ❑ ❑
4. Did decedent own an individual 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, antl 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. §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
f ling 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 benefciaries is 4.5 percent,except as noted in ��2 P.s.§s��6(a)(���.
• The tax rate imposed on the net value of transfers to or for the use of the decedenPs 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-150?,EX+(12-12)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
REAL ESTATE
INNERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Ruth A. Benfer 21 14 0112
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 selier,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.
ITEM Include a copy of the deed showing decedenYs interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRiPTION
1. Real Estate-5050 Highland Street 129,900.00
Harrisburg, PA 17111
Settlement date: May 1, 2014
TOTAL(Also enter on Line 1,Recapitulation.) $ 129,900.00
If more space is needed,use additional sheets of paper of the same size.
REV-1508 FX+(G8-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Ruth A. Benfer 21 14 0112
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. Proceeds from Jack Benfer estate 740.60
TOTAL(Also enter on Line 5,Recapitulation) $ 740.60
If more space is needed, use additional sheets of paper of the same size.
REV-1509 EX+!01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE �OINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Ruth A. Benfer 21 14 0112
If an asset was made jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
a. Richard J. Benfer 102 Ewe Road son
Mechanicsburg, PA 17055
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL�NSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTIY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 07/1992 M&T Checking Account Acct#14933241 463.10 50. 231.55
2. A. 07/2009 M&T Saving Account Acct#15004219762851 1,205.72 50. 602.86
TOTAL(Also enter on Line 6,Recapitulation) $ $34.41
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
°EP"RT"'E"TOFRE�E""E FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ruth A. Benfer 21 14 0112
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Neill Funeral Home, Inc. 7,824.35
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) Richard J. Benfer 6,573.75
StreetAddress 102 Ewe Road
aty Mechanicsburq State PA ziP 17055
Year(s)Commission Paid:
2 AttorneyFees: Stephen J. Hogg, Esquire 6,573.75
3, Family Exemption:Qf decedent's address is not the same as claimant's,attach explanation.)
Claimant
StreetAtldress 19 S. Hanover Street Ste. 101 _
city Carlisle state PA ziP 17013
Relationship of Claimant to Decedent
4. Probate Fees:
358.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. Advertising Costs: Cumberland Law Journal 75.00
The Sentinel 190.42
8. Accounting (est_ 200.00
g. Probate - Letters Administration (est) 140.00
10 Letters of Administration Pendente Lite 20.00
TOTAL(Also enter on Line 9,Recapitulation) $ 21,955.77
If more space is needed,use additional sheets of paper of the same size.
RE'-=-?51:'FX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ruth A. Benfer 21 14 0112
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. Commission from real estate sale 7,344.00
2. Selier Broker Fee 350.00
3. Notary Fee 20.00
4. Reimbursement for Tax Certification 20.00
5. Deed Search -Search One Abstracting, Inc. 1,299.00
6. 2014 County Taxes 1,325.00
7. Seller Credit 250.00
8. Gerberich Hoffman Septic Fees reimbursed to Richard Benfer 900.00
9. Secco Electrical Fees reimbursed to Richard Benfer 3,702.53
10. Deed Preparation 250.00
TOTAL(Also enter on Line 10,Recapitulation) $ 15,460.53
if more space is needed,insert additional sheets of the same size.
. .
REV-1513 EX.+(01-'.0)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Ruth A. Benfer 21 14 0112
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1 TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Richard J. Benfer Lineal
102 Ewe Road
Mechanicsburg, PA 17055
2. Patti Griffin Lineal
1506 Passion Vince Circle
Weston, FL 33326
3. Dennis McGraw Lineal
1201 Florence Drive
Harrisburg, PA 17112
4. Ronald McGraw Lineal
115 Saint Nicholas Avenue
South Plainfield, NJ 07080
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 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
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 additionai sheets of paper of the same size.
� ; 1
' 'PtN6N>pe
�,g9����� OMB Approval No.2502A265
�, A. Settlement Statement (HUD-1)
�PN ox,�E�
B.Type of Loan
1.�FHA 2.0 RHS 3.❑Conv.Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
4.Q VA 5.Q Conv.Ins. TCSS2014018 206402245 446-2036534703
C. Note: This form is fumished to give you a statement of actual settlement casts. Amounts paid to and by the settlement agent are shown.
Items marked(p.o.c.)'were paid oufside the closing;they are shown here fo�informaBonal purposes and are not included in the tota/s.
D. Name andAddress of Borrower: E. Name and Address of Seller: F. Name and Address of Lender:
Justin Uselton Primary Residential Mortgage,
5050 Highland Street Estate of Ruth A Benfer Inc.ISAOA/ATIMA
Hartisburg,PA 17111 c/o Stephen J.Hogg Law Offices 1480 North 2200 West
19 S.Hanover St#101 Sait Lake City,UT 84116
Carlisle,PA 17013
G. Property Location: H. SettlementAgent 1. Settiement Date:
5050 Highland Street TC Settlemerrt Services,LLC
Harrisburg,PA 17111 5006 EastTrindle Rd. May 1,2014
Dauphin County,Pennsylvania Mechanicsburg,PA 17050 Ph. (717)715-0562
Place of Settlement
250 East Park Drive
Harcisburg,PA 17111
J. Summary of Borrowers transaetion K. Summary of SeUers transaction
700. Gross Amount Due from Bortower: 400. Gross Amount Due to Seller:
101. Contract sales rice 129,900.00 401. Cantract sales rice 123,900.00
102. Personal ro 402. Personal ro
103. Settlement Char es to Borcower Line 1400 9,807.99 403.
704. 404.
105. 405.
Ad'ustments for items aid b Seller in advance Ad'ustrnents for items aid b Selier in advance
to6. Ci lfown Taues to 406.Ci /Town Ta�res to
107. Coun Taxes to 407.County Taxes to
108. Schooi Tax 05/01N4 fo 07/01/14 192.50 408.School Tax 05J01/14 to 07/07/14 192.50
109. 409.
110. 410.
111. 411.
112. 4t2.
120. Gross Amount Due from Borrower 139,900.49 420.Gross Amount Due to Seller 130,092.50
200.Amounts Paid b or in Behalf of Borrower 500. Reductions in Amount Due Seller.
201. De osit or eamest mon 1,000.00 501. Excess de osit see i�structions
202. Princi I amount of new loan s 127,546.00 502. Settlement char es to Seller Line 1400 44,688.03
203. F�6sting Ioan(s taken su6'ect to 503. F�dsting loan s taken sub'ect to
2�' 504.Payoff First Mortgage
205.
505.Pa ofr Second Mo a e
206. 5�.
207.
507. De osit disb.as roceeds
208. 508.
209. Selier'sAssist 7,500.00 509.Seller'sAssist 7,500.00
Ad'ustrnents for items un aid b Setler Ad'ustments for items un aid b Seller
210. Ci /Town Taxes to 570.Ci liown Taxes to
211. Coun Taxes 01/01/14 to 05/01/14 325.18 511. Coun Taxes 01/01/14 ip OS/07/14 325.18
212. School Tax to 512.School Tax to
213. 513.
214. 514.
215. 515.
216.
516.
217.
218.
517.
219.
518.
519.
220.Total paid 6 lfor Borrower 136,371.18 520. Total ReduCtion Amount Due Seller 52,51321
300. Cash at Settlement fromlto Borrower 600. Cash at settlement to/from Seller
307. Gross amount due from Bortower line 120 139,900.49 601. Gross amount due to Seller line 420 730,092.50
302. Less amount paitl bylfor Barrower(line 220) ( 136,371.18) 602. Less reductions due Seiler(line 520) ( 52,513.21
303. Cash X❑From � To Borrower 3,529.31 603. Cash �To � From Seller 77,57929
•raia auwae or�asmg by eorreweqs),seneqs�,ienaer(y,or nurapary�r�
The undersigned hereby ack iedg�receipt of a completed copy of this statement&any attachments referred to herein
� �� �-�
Borcower ��j- ,.-��/fr� Seiler
��hn Uselton Estate of Ruth A Benfer, ,;�
BY ��� .. �'�' _ ; /� '2G ,..
Stephen J Ho ,E,y'quire �� ,f� , ,L:,y���-
AdmmisVator.Pendente Lite � '��1i IC ! L �-?
1Te Publie Repor4ng BurEen lor mis mpectlon ofinlormatio�is esfimaled at 35 minubs par response br collacting,reviawing,an0 rcpottiny Me GaC.This agenry may nat coUed Mis intormafion,and you are
not requiretl b mmpleb tl�is h�m,uniess ilElsplays a airtently qlitl OMB wntrol numbec No mnfEenealiry is assuretl;9�is Eisdown is mantlarory.This is OesiB�eC b proviCe Ihe parties fa a RESA4covaroA
tnnsac6on wiN informaGon Ouring Te seltlementprocess.
Page 1 of 3 HUD-7
(USELTON,JUSTIN.PFDffCSS201M4�
. '
L.Settlement Char es
700.Total Reai Estafe Brokerfees $7;344.00 Paid Fmm Paid Fmm
Division ofcommission pirte 700)as follows: Bonowers Sellers
701.$3,672.00 to Keller Williams of Central PA Funds at Funds at
702.$ 3,672.00 to RFJMA)C Realty Select Settlement Settlement
703.Commission id at seltlement 7 344.00
704.Buyer Broker Fee to RFJMAX Real Select 195.00
705.Seller Broker Fee to Keller Williams of Central PA 350.00
800.Items Payable irt Connection wkh toan
801.Ourori inationchar e $ 2,248.53 fromGFE#1
802.Your credit or cha e oints for the s ecific interest rete chosen S-1 275.46 from GFE#2
803.Your ad'usted ori ination char es from GFE#A 973.07
804. raisal fee to AMC LINKS from GFE#3 450.00
805.Credit Re ort to CREDCO from GFE#3 18.00
806.Ta�c service to from GFE#3
807.Flood certification to FAFDS fram GFE#3 9.00
808.Ins ecGon Fee to AMC LINKS from GFE#3 155.00
809.Ins ection Fee ro AMC LINKS from GFE#3 155.00
810' from GFE#3
$��' (from GFE#3)
900.kems Required,by Lender to Be Paid"in Advance
901.Dail interestcha es from 05/01l14 to 05/01/14 $14.851200/da from GFE#10
9�2.Mortgage insurance premium for moMhs to HUD (from GFE#3) 2,193.68
903.Homeowner's insurence for 1.0 years to Jim Ferster (from GFE#11) 735.00
904.
905. (from G FE#11)
(from G FE#17)
1000.Reserves.Deposited with Lender
1001.Initial deposit for your escrow account (from GFE#9) 912.14
1002.Homeowner's insurance 2.00D months @ $ 61.25 per month $ 122.50
1003.Mo a e insurance 0.00 months $ 139.94 er month $
1004.Pro �s $ 1,207.19
County Taxes 3.000 months $ 82.43 r month
School Tax 10.000 months @ S 95.99 per month
1005.
��6• months @ $ per month $
1007. months @ $ per month $
1008. $
1009.qqgregateqdjustrnent
$ -417.55
1�00.Title Cha►ges
1101.Title services and lender's 6tle insurance (from GFE#4) 1,420.00
1102. Settlement or closin fee $
1103. Owner's title insurance to FirstAmerican Title Insurance Company (from GFE#5) 10.00
1104. Lender's title insurance to FirstAmerican Title Insurance Company $ 1,190.00
1105. Lender's title policy limit $ 127,546.00
1106. Owner's 08e policy limit $ 129,900.00
1107. AgenPs portion of the rotal tiGe insurance premium to TC Settlement Services,lLC $ 1,020.00
1108. Underwriter's portion of the total tiUe insurance premium to FirstAmerican TiUe Insurance Company $ 180.00
1109. Notary Fee ro TC Settlement Services,LLC $ 20.00
1110. Reimb for Tax Cert to Search OneAbstracting,inc. $ 20.00
1111. $
1112. $
1113. $
1200.Govemment Recording and TransferCha►ges
1201.Govemment recordin cha es to Search OneAbstractin ,Inc. from GFE#7 144.00
1202.Deed $ 65.00 Mo a e$ 79.00 Releases $ Other$
1203.Transfer talces to Search OneAbstracting,Inc. (from GFE#8) 1,299.00
1204.Ci /Coun tax/stam Deed$ 129g.00 Mo a e$
1205.State tax/stam s Deed $ 1,299.00 Mo a e$ 1,299.00
1206.
1207.
1300,Additionai`SettlemeM Charges
1301.Required services that you can shop for (from GFE#6)
1302.Home Inspection to Inspection Center for Mike Biechier 295.00P.O.C.$295.00(B)'
1303.Pest Inspection W Inspection Center for Mike Biechier 45.00 P.O.C.$45.00(B)`
1304.Water Test to Inspection Centerfor Mike Biechler $ P.O.C.S185.00(6)'
1305.See addit'1 disb.e�Qiibit to $ 1,139.10 35,655.03
'1400.Total Settlement.Charges(entecon lines 103;'Seetion J and 502,Section K) 9,807.99 44,688:03
•Paitl oulsitle af Uosing by borrower(�,seller(b7,lentlar(L),or MirO-pary('f)
Bysigningpagetoflhisstalement,NosgnabriesacknowleCgerecaiptofacompleledcopyotpage283oftl�i�a��emenL _i%%` � �
�%
�- �- "�-.�_
TC Settlement Services,LLC,SettlementAgent
Cer6fied to be a Vue copy.
Page 2 of 3 HUD-1
(USELTON,JUSTIN.PFD/iCSS2014/47)
Y • '
• Comparison of Good Fakh Estimate(GFE)and HUD-1 Charges Good faith Estimate HUD-1
Charges That Cannot Increase HUD-1 Line Number
Our originadon charge #801 2,248.53 2,248.53
Your credit or charge(points)for the specific rate chosen #802 -1,275,46 -1,275.46
Your adjusted origination charges #803 973.07
Transfertaxes 973.07
#1203 1,299.00 1,299.00
Charges That in Total Cannot Increase More than 10% Good Faith Fstimate HUD-1
Governmentrecording charges #1201 150.00 144.00
Appraisal fee #804 550.00 450.00
Credit report #805
Flood certification t8•�� 18.00
Inspection Fee #8�� 9•00 9.00
Inspection Fee #808 135.00 155.00
#809 0.00 155.00
Mortgage Insurance Premium #902
Homelnspection 2•�93-6$ 2,193.68
#1302 295.00 295.00
Pestinspection #1303
45.00 45.00
Total 3,395.68 3,464.68
Increase between GFE and HUD-1 Charges g 69.00 or 2.03
Charges ThatCan Change Good Faith Estimate HUD-1
Initial deposit for your escrow account #1001
Homeowner's insurance 2,232.00 g�2,�q
#903 504.00 735.00
Title services and lender'S title insurence #1101
Owner's tiUe insurence to FirstAmerican Title Insurance Compai #1103 1,490.00 1,420.00
10.50 10.00
Loan Tertns
Your inkial loan amount is $127,546.00
Your loan tertn is 30.00
years
Your initial interest rate is 4.2500%
Your initial monthly amount owed for principal,interest and $767.39 includes
any mortgage insurance is
QX Principal
Q Interest
QX Mor�qage Insurance
Can your interest rate rise7 QX No � Yes,it can rise to a ma�dmum of %. The first
change will be on and can change again every_months after
. Every change date,your interest rate can increase or decrease
bY %. Over the Iife of the loan,your interest rate is guaranteed
to never be lower than °/,or higher fhan /,.
Even'rf you make payments on time,can your loan balance rise? QX No � Yes,it can rise to a ma�dmum of$
Even ff you make payments on time,can your monthty QX No � Yes,the first i�crease can be on and the monthly
amount owed for principal,interest,and mortgage insurance risel
amount owed can rise to$
The ma�timum it can ever rise to is$
Does your loan have a prepayment penalty7 X No Yes, our ma�dmum re a
❑ ❑ Y p p yment penalty is$
Does your loan have a balloon payment? � � yo payrt�ent of$
X No Yes, u have a balloon
due in_years on
Total monthly amount owed including escrow aecount payments � You do not have a monthly escrow payment fo�items,such as property
taxes and homeowner's insurance. You must pay these items direcUy
yourself.
QX You have an additional monthly escrow payment of$239.67 that results
in a total initial monthly amount owed of$1,007.06. This includes
principal,interest,any mortgage insurance and any items checked below:
QX Property taxes QX Homeowner's insurance
❑ Floodinsurance QX Schooltaxes
Note: If you have any questions about the Settlement Charges and Loan Terms lis�on this form,piease contact your lende❑r.
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