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Home My WebLink About03-23-15 � � pennsylvania 15 0 5 61410 5 otvnHlwENrorrevenue EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year � File Number PO BOx 280601 INHERITANCE TAX RETURN ' ,-�I ' ��/ �, Harrisburg, PA 17128-0601 RESIDENT DECEDENT Q� �O ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _ __ _ _._.. __ __ __ _ _ _ _ ; 01072012 ' 02231917 _..__. __ . , __ . .._... ___ . . _._. _.. _.� � .__ . __ , _: DecedenYs Last Name Suffix DecedenYs First Name MI _ _ __ __ __..__ __.. _ __ _ . ' SUMMY ' ' ANNA W (If Appiicabie)Enter Surviving Spouse's Information Below Spouse's Last Name Su�x Spouse's First Name M� _ _ _ _ __ _ _ _ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return p 2. Supplementai Return p 3. Remainder Return(date of death prior to 12-13-82) p 4.Agricuiture Exemption(date of � 5. Future Interest Compromise(date of � 6. Federai Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) p 7. Decedent Died Testate p 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) p 10. Litigation Proceeds Received p 11. Non-Probate Transferee Return p 12. Deferral/Election of Spousai Trusts (Schedule F and G Assets Only) O 13. Business Assets O 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number __ _ __.. _ __ _ _ __..._ _.. __.. JAMES H TURNER ESQUIRE ; (171) 232-4551 _ . _ _ _ ; _._._ _ _ __ First Line of Address _... _ _ ___ _ _, 4701 NORTH FRONT STREET Second Line of Address , _ _ __... _. __.. .. . _. _�.. _.._ City or Post O�ce State ZIP Code _..._._ _.. __ . _ _........._. __ _ _ __ HARRISBURG i PA '17110 , _ , _ _ ,-j__ , .., .:"1 ht turnerandoconnell.com �� ' CorrespondenYs email address: 1 @ '"'' _. �._,, , � ,.., :� , - :.-> � REGISTER OF WIELS ONLY : ' � .. ,....., ^� , ; REGISTER OF WILLS USE ONLY �,.� DATE FILED MMDDYYYY __.., ' �. � ; � r��j � .: -.., DATE FILED STA � "" �;� PLEASE USE ORIGINAL FORM ONLY Side 1 � I��'I'I II"I'III�"I'I(II�"II'I II'II�I"I II'll"I�I�III I"I ],505614105 ],505614105 � � � � 1505614205 REV-1500 EX(FI) DecedenYs Social Security Number oecedent's Name: ANNA W SUMMY RECAPITULATION __ _ _ 1. Real Estate(Schedule A). .. . .. . . ... . . ... .. .... ... .. . .. . . ... .. ... . .. .. 1. 450.24 2. Stocks and Bonds(Schedule B) . . . . . . . . . . .. . . . . . . . . . . . . .. . . . .. . . . . .. . . 2. ' 3. Ciosely Heid 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. : 46.29 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .... . . . 6. ' 7. lrter-Vivos Transfers&P✓liscellanecus Non-Probate Property ', (Schedule G) O Separate Biiling Requested.. . . . . . . 7. ' 8. Totai Gross Assets(total Lines 1 through 7). . . . .. . .. . . . .. . . . .. . . ... .. . . . 8. ' 496.53 9. Funeral Expenses and Administrative Costs(Schedule H)... .. .. ...... .... . . 9. ; 9,137.17 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). ... . .. .. ... .. . 10. ; 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . 11. ', 9,137.17 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. -8,640.64 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. : -8,640.64 " 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_ 15. 16. Amount of Line 14 taxable .. at lineal rate X.0_ -8,640.64 I 16. 0.00 : _�__ _.__._.__. .._.W.. .__.._.,.._...__. .__ _.._ w.___._._.._._._ _._,.,m.._...._...._ �.,..... .. 17. Amount of Line 14 taxable at sibling rate X.12 17. '' ._........ . ,.., _,.. _ .. . . ..... . . . ._.. _ . . 18. Amount of Line 14 taxabie ' at collateral rate X.15 ' ' 18. 19. TAX DUE . . . .. . . . .. . . .. . . . . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . . . . . . . . . . . 19. 0.00 20. FILL IN THE OVAI IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Under penalties of perjury, I declare 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 person responsible for filing the return is based on all information of which preparer has any knowiedge. SIGNATUR E S N RESPONSIB OR FILING RETURN DATE - � ' � ADDR 57 CENTER DRIVE, CAMP HILL, PA 17011 SIGNATURE OF P T E N PERSON RESPONSIBLE FOR FILING THE RETURN DATE __. ��/ 7 /�_.. ADDR S 4701 NORTH FRONT STREET, HARRISBURG, PA 17110 I I�'I�I II"�'ll�l�'I'I'III�'�I'I II'��I'�'��'ll"I'I'lII I'�I Side 2 � 7,505614 05 15056142�5 � REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME ANNA W SUMMY STREETADDRESS 770 POPLAR CHURCH ROAD CITY i STATE I ZIP CAMP HILL i PA � 17011 Tax Payments and Credits: t. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments _____________0_00 B.Discount 0.00 (See instructions.) Total Credits(A+B) (2) 0.00 3. Interest (3) 0.00 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 difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Ditl 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 .............................................................................................................................. ❑ � 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 tleath without receiving adequate consideration?.............................................................................................................. ❑ � 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ � 4. Did decedent own an individual retirement account,annuity or other non-probate property,which containsa bene6ciary 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.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disciosure 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 step-parent 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 decedenYs 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 decedenYs siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is tlefined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME ANNA W SUMMY STREETADDRESS 770 POPLAR CHURCH ROAD ---- ---_—_ - --- - - CITY STATE ZIP CAMP HILL PA , 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) ��y 2. Credits/Payments A.Prior Payments B.Discount __ (See instructions.) Total Credits(A+B) (2) 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) 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 .............................................................................................................................. ❑ � 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 tleath without receiving adequate consideration?.............................................................................................................. ❑ � 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ � 4. Did decedent own an intlivitlual retirement account,annuity or other non-probate property,which containsa 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 fior 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 tleath on or after July 1,2000: . The tax rate imposed on the net value of transfers from a deceased chiltl 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. . The tax rate imposetl on the net value of transfers to or for the use of the decedenYs 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 comman with the decedent,whether by blood or adoption. REV-15G2 EX+(12-12j � pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: PILE NUMBER: ANNA W SUMMY 21-12-0260 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. ITEM Include a copy of the deed showing tlecedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' NET PROCEEDS FROM SALE OF 4009 CHEROKEE AVENUE,CAMP HILL, PENNSYLVANIA 450.24 TOTAL(Also enter on Line 1, Recapitulation.) $ 450.24 ---- ----- If more space is needed,use additional sheets of paper of the same size. REV-15o8 EX+(o8-iz) � pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH� BANK DEPOSYTS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ANNA W SUMMY 21-12-0260 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 �, Account#832253 with Jonestown Bank 46.29 TOTAL {Also enter on Line 5, Recapitulation) $ 46.29 If more space is needed, use additional sheets of paper of the same size. REV-].SII EX+ (0�-].3� � pennsylvania SCHEDULE H DEPARTMENT OFREVENUE F U N E RAL EXP E N S ES AN D INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OP FILE NUMBER ANNA W SUMMY 21-12-0260 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: l� Buse Funeral Home 7,720.25 2. Funeral luncheon(The Manada Hill Inn) 1,110.42 B, ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Na me(s)of Personal Representative(s) _ __ Street Address Clty 5tate______..___ZIP_ Year(s}Commission Paid: __. __ __ _ _ __.._ —_. (1,000.00) 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Ciaimant __ __ __ Street Address City State ZIP Relationship of Claimant to Decedent_ 4. Probate Fees: 306.50 S. Accountant Fees: 6. Tax Return Preparer Fees: �• Advertising costs (326.40) TOTAL (Also enker on Line 9, Recapitulation} $ 9,137.17 If more space is needed, use additional sheets of paper of the same size. Rev-isis ex+roi-loi � ? pennsytvania SCHEDULE ] .. � DEPARTMENT OFREVENUE - - BENEFICIARIES INHERITANCE TAX REfURN RESIDENT DECEDENT ESTATE OF; FILE NUMBER: ANNA W SUMMY 21-12-0260 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. Roger A.Summy,57 Center Drive,Camp Hill, PA 17011 son 0 2. Stephen 0.Summy,9535 Allentown Blvd.,Grantville, PA 17028 son � 3. Charles E.Summy,4055 Seneca Avenue,Camp Hill,PA 17011 son 0 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 additional sheets of paper of the same size. =+,re��.� OMB Approval No.2502-0265 d'` `o_ ' ' '� A. Settlement Statement(HUD-1) _� _ �ORN oaJE O� B.Type ot Loan 1.�FHA 2.0 RHS 3.�Conv.Unins. 6. File Number: 7. Loan Number: 8. Mor�qage Insurance Case Number: 4.Q VA 5.�Conv.Ins. 201411607.PFD H&1014102200 446-2022961-703 C. Note: This fumr is furnished fo gi�e yvu a sfatement oJ aduaf settlement costs Amounts paid to and by the settkment agent are shown. ltems marked"(p.o.c)"were paid outsde the c/avng;fhey are shown here/or informaUona!purposes and are not induded in the rohafs. D. Name and Address of Borrower. E. Name aM Address of SeMer: F. Name and Address of Lender: John 1.Noble Esta[e ofMna W.Summy Tidewater Mortgage Services, Cindy L Noble 4055 SenecaAve Inc 4009 Cherokee Avenue Camp Hdl,PA 17tr11 200 Goklen Oak Court,Ste.1 DO Camp HiA,PA 17011 V�rignia Beach,VA23452 G. Property Loption: H. Settlement AgenL I. Seltkment Dale: 4009 CherokeeA+renue Centrai Penn Land Transfer,LLC Camp Hill,PA 17011 3800 Market Street ,fanuary 9,2015 Cumberland County,PennsyNania Camp H�I,PA 17pt1 Ph. (717)6Yr3166 Place of SetllemenC 3800 Markel Street Camp HiN,PA 77011 J. Summary of Borrowers transactio� K. Summary of Sellers transaction 100. GrossAmount Due from Borrower: 400. GrassAmount Due to SeOer; 101. ContraQ sales rioe 105,0�.00 401. CoMract sales ice 105,000.00 102. Personal 0 402. Personal r 103. Seltlement Char to Borrower Line 1400 8,028.77 403. 104. 404. 105. 405. Ad'ustments for items aid b Seller in advance Ad'ustments for items aid b Seller in advance 106. C /Town Taxes to 406. C4/Town Taxes to 107. Coun Taxes to 407.Coun Taxes to 108. SchoolTaxes O1/10115 to 07/01/15 522.26 408. SchoolTaxes 01/10/15 to 07/01/15 522.26 �09. 1st rwateNsewer .01/10/15to04/Ot/15 116.16 409. lstqtrwaledsewerpd.01l10/15to04/01l15 116.16 710. 410. �11. 411. 112. 412. 120. Gross Amount Due from Bortower 113,667.19 420.Grass Amount Due to Seller 105,638.42 200. Amounts Pald b or in Behatf of Borrower 500. Reductions in Amount Due Seller. 201. De or earnest mo� 10,000.00 501. Excess d sit see instrudions 202. Prin'al amount of new ban s 99,943.00 502. SettlemeM char s to Seller Line 1400 2,505.47 203. F�osf ban s taken sub'ct l0 503. Exist' loa s taken sub'ed to Zpq_ 504.Payofr First Mortgage to WeAs Fargo Bank 88,542.56 Zpg, 505. Pa Second Mort a e �, 506. De d retained b seller 10,000.00 207. �7. 208. 508. 2pg, SelerAssist a,035.00 509. SelerAss'st 4035.00 Ad'ustments tor kems un aid b Seller Ad ustments for kems un aid b Seller 210. C' /Town Taxes to 510. C' lTawn Taxes to 211. Coun Taxes Ot/01/15 to 01110l15 15.15 511. Coun Taxes 01/01/15 to Otl10/15 �5.15 212. SchoolTaxes to 512. SchoolTaxes lo 213. Seler Paid do cost 90A0 513.Seler Paid dosin cost 90.00 Z�q. 514. 215. 515. 216. 516. 217. 517. 2t 8. 518. 219. 519. 220. Total Paid b ffor Borrower 114,083.15 520. Total Reduction Amount Due Seller 105,188-18 300. Cash at Settlement fromlto Bortower 800.Cash at settlement toffrom Seller 301. Cxoss amount due from Borrower ine 120 113,667.19 601. Gross amount due to Selier line 420 10.5 638.42 302. Le55 amount paid b/for Borrower(Gne 220) ( 114,083.15) 602. Less redudbns due Seler(ine 520} ( 105,188.18 303. Cash �From a To Bortower 415.96 603.Cash X�To � From Seller 45024 � •aaiaaAsl�atdo�kai�imrtwer(Bl.sel�a(s),ieMrily.arc+ra�rty(T> The undersgned hereby adcnowledge receipt of a completed copy of this statement 8 any attachments referred to herein 9otrower �� Estate ofAnna W.Summy ,bhn I.Noble BY: RogerA.Summy,Executor Cindy L.Noble Tfe FLlic Reporerp&rGen hr Cia cdleram af irtammm is estimaroa a�35 mimn.c per raappue la cdNding reviening eM reporting ine tlal9.7nis agar�ey may ro�ca�ect uha irtarmaum.av ya+xa ro�req.irm ro eanpas. Ovs lorm,uYess it tlisplays a arraUy vaIlO0M8 ca7tl nmbar.NocafidenUaliry I s a5sureQ ttis 65dosue ia ma�qalay.Tlts is OeSigreC to praiiEe Ne paNes to e RESF74cwereC Va�sec4m wiVi iriformetimNif'pCie s�lem erG v� HUO-1 Page 1 of 3 (201411607.PFD201411607.PF D120) L.Settlement Cha es 700.7otal Real Estate Broker Fees Paid From Paid From Divis(on ol commisston(I'e�e 700}as toUows Borrarrefs Sellefs 701 $ to Funds al Furxk at Settlemerd Settlemmt 702.$ to 703.Commission aid at settlement 704. 600.Items Payable in Connection with Loan 801.Our or' mation char e $ 1,426.00 ftom GFE#1 802.Your cred'd or char oints for the s edF�c iMerest rate chosen from GFE#2 803.Your atl usted or' natan char es from GFE fFA �426.00 804.A reisalfee to Ca italPr A ra'isers fromGFE#3 350.00 805.Cred't Re R to Fundin Suite trom GFE#3 83.50 806.Tax service lo Tidewater Mort a e Serv�es Inc. from GFE#3 90.00 807.Fbod ceRfication to Coreb ic from GFE#3 t7.00 80g from GFE#3 � from GFE#3 g�p ftom GFE#3 S11 (fran GFE#3) 900.Items Required by Lenderto Be Paid in Advance 901.Dai interest�ha es from 01/09/15 to 02/Q1/15 23 $10.952700ld from GFE#10 251•91 902.Mortgage insurance premium for months to Dept.of HUD (from GFE#3) 1.718.9a 903.Homeowner's insurance for 1.0 years to Erie I nsuranee (from GFE#11) 600.00 �y (from GFE#11) 905 (irom GFE ptt) 7000.Reserves Deposited with Lender 100'1.Iniial deposit for your escraw aaount (from GFE#9) 948.42 1002.Homeowner's insurance 3.000 months @ $ 50.00 per month $ 150.00 1003.Morl 'nsurance months $ 1p5.56 r momh $ 1004.Pro tazes S fi1428 Coun Ta�s 12.000 months S 51.i9 r month SchoolTaxes months @ $ per month 1005. 1006.School Tax 8 000 months @ S 92.36 per month $ 738.88 ipp7_ moMhs @ $ per moMh $ 10�8. $ 1009.Aggr teAdjustment $ -554.74 1700.Title Charges 11p1. Tdle servioes and lender's tdle insurance (from GFE U4) 1,314.00 1102. Settlemenl or�Jo� fee $ 11Q3. Owner's title insurence to First American Tdle Insurance Company (from GFE#5) 15.00 1104. �erMer's title iuurance ro FirslAmerican 7itle Insurance Gompany $ 1,060.00 1t05. lender's tiqe pofu,y 6mR $ 99,943.00 1706. Owner's t�le polic,y IinR S 105.000.00 1107. AgenYs portbn of the total trtle insurance premium lo Central Penn Land Transfer,LLC S 9t3.75 7708. Underwr�er's portion of the total tdle insurance premium lo First American Tdle Insurance Company $ 16125 1109. a 1110. $ '111'I. $ 1112. $ 1113. $ 1200.Govemment Recordin and Transfer Charges 1201.Government recordin char es to Cumberland Coun Recorder of Deeds from GFE#7 164.00 12p2.Deed $ 77.00 Mort a e S 87.00 Releases$ Other $ 1203.Transfer tmes to Cumberland County Recorder of Deeds (from GFE#8) 1,050.00 1204.C� lCoun tax/stam Deed 5 1,050.00 Mort $ 1,050.00 1205.State taxlstam s Deed $ 1,050.00 Mort a e$ 1206. 1207. 7300.Additanal Settlement Charges 1301.Required services that you pn shop for (from GFE#6) 7302.Attorney Fee to Turner and O'Connell $ 1,326.40 7303. 1st Quarter Sewerlfrash Due lo LowerAllen Townshy $ 129.07 1304. � 13Q5. $ 1400.Total Settlement Charges(enter on lines 103,Section J and 502,Section K) 8,028.77 2,505.47 •vaaduweacasmo�7��+(�.,d�c(s1.�aanrly.«wro-wMicT1 Hy sigiing py01 W tlis sklandY�+e signalories eCbfvMatl9e reca�lQ a comqeleE Wq<1 Page 4&3d Uis tnree p33a bmrertielt CenVal Penn Land Transfer,LLC,SetflementAgent Page 2 of 3 HUD-1 (201411607.PFD/201411607.PFD/21) HUD-1 Attachment- Corikinued Electronic Document Retrieval 40.00 to Central Penn Land Transfer,LLC Wire Fee 15.00 to Central Penn Land Transfer,LLC Overnight Delivery Fee 29.00 to Central Penn Land Transfer,LlC Closing Protection Letter 125.00 to First American Title Insurance Company Notary Fee 45.00 to Jeanette L. Pennington Lender's title insurance 1,060.00 to FlrstAmerican Title Insurance Company Total $ 1,314.00 5 0.00 Owner's Title Insurance BORROwER SELLER Owner's Policy Premium 15.00 to FirstAmerican Title Insurance Company Total $ 15.00 S 0.00 Lender's Title Insurance BORROWER SELLER 't¢es also shown above in Title Senices and Lenders Title Insurance Details Lender's Policy Premium 910.00 to FirstAmerican Title Insurance Company Lender's Endorsement Charges 150.00 Endorsement Endorsement Charge ALTA Endorsement Form 8.1 (Environmental Protection 50.00 Lien) ALTA Endorsement 100(Restrictions No Apparent 50.00 Existing Volation) ALTA Endorsement 300(Mortgage Survey Exception) 50.00 Total $ 1,060.00 S 0.00 WARNING: It is a crime to knowingly make false statements to the United States on this or any similar fortn. Pena�ties upon conviction fan include a fine and imprisonment. For details see: Title 18 U.S.Code Section 1001 and Section 1010. (201411607.PFD/201411607.PFD/23) HUD-1 Attachment BorroweRs):John I. Noble and Cindy L. Noble, Selle�(s): Estate ofAnna W.Summy husband and wife 4009 Cherokee Avenue 4055 Seneca Ave Camp Hill, PA 17011 Camp Hili,PA 17011 Lender:Tidewater Mortgage Services,Inc. SetdementAgent:Central Penn Land Transfer,LLC {717)695-3166 Place of Settlement:3800 Market Street Camp Hill,PA 17011 Settlement Date:January 9,2015 ProperlyLocation:4009 CherokeeAvenue Camp Hill, PA�701� Cumberland County,Pennsylvania Additional Adjustments For Items Paid By Seller In Advance(Borrower Debit) Description Amount Fromfihrough Prorated Amount lstqtrwater/sewerpd. 129.07 01/01/15 through03/31l15 116.16 Total Line 1091409 1'16.16 Seller Loan Payoff Details Payoff First Mortgage to Welis Fargo Bank Loan Payoff 88,542.56 As of 02/01/15 Total Additional Interest -23 days @ Per Diem Total Loan Payoff 88,542.56 Adjusted Origination Charge Details Origination Charge Underwriting Fee 1,426.00 to Tidewater Matgage Services, Inc. Total $ 1,426.00 Origination CrediUCharge(points)for the specific interest rate chosen Total $ Adjusted Origination Charges $ 1,426.00 Reserves Deposited with Lender Homeowner's Insurance 150.00 3.000 at 50.00 per month County Taxes 614.28 12.000 at 51.19 per month School Tax 738.8$ 8.000 at 92.36 per month Aggregate Adjustment -554.74 Total $ 948.42 Title Services and Lender's Title Insurance Details BORROWER SEL.I.ER WARNING: k is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction wn include a fine and impriso�ment. Fordetails see:Title 18 U.S.Code Section 1001 and Section 7010. (20t 4t 1607.PF Df201411607.PFD/23) Comparison of Good Faith Estimate(GFE)and HUD-'I Charges Good Faith Estimate HUD-1 Cha es That Cannot Increase HUD-1 Line Number Our originalion charge #801 1,426.00 7,426.00 Your adjusted orlginat'ron charges #803 1,426.00 1,426.00 Transfer ta�s #1203 1,050.00 1,050.00 Charges That in Total Cannot Increase Mo�e than 10% Good Faith Estimate HUD-1 GooernmeM reaordn9 charges #1201 250.00 764.00 Appraiselfee #804 425-00 350.00 Credl report #805 55.00 83.50 Tax servioe #806 90.00 90-00 Fbod certiFration #807 17.00 17.00 Mortgage Insurance Premium #902 1,718.94 1,718.94 Total 2,555.94 2,423.44 Inaease belween GFE and HUD-1 Charges $ -132.50 a -5.18° Charges That Can Change Good Faith Estimate HUD-1 Initial deposit for your esaow a000unt #'1001 395.04 948.42 Daiy interest�arges #90'1 3 10.952)DO/day 142.39 251.91 Homeowners insurance #903 600.00 600.00 Tdle services and knder's tAle insurance #1101 1,270.00 1,314.00 Owner's tile inwrance to Fist American Title Insurance Comparry #1103 100.00 15.00 Loan 7e�ms Your initial loan amount is $99,943.00 Your loan tertn is 30.00 years Your inittal interest rate is 4.0000% Your initial monthly amount owed for principal,interest and $582.70 indudes any moRgage insurance is O Princpal O Interest Q Mortgage Insurance Can your interest rate rise? �X No � Yes,it pn rise to a maximum oi °/. The firsl rhange wip be on and can change again every_manths after . Every cAarge date,your interest rate nn inaease or decrease by %. Over lhe life of the ban,your interest rate's guararrteed to never be lower than h or hgher Ihan %. Even if you make payments on time,can your loan balance rise9 QX No � Yes,it can rise to a maximum of$ Even if you make payments on time,can your monthly QX No � Yes,the fusl ncrease qn be on and the monthy amoun!owed for principal,interest,antl mortgage insurance rise? amount owed pn rise to$ The max'unum d pn ever rise to is$ Does your loan have a prepayment penalty9 �X No � Yes,your maximum prepayment penally is$ Does your loan have a balloon payment? QX No � Yes,you have a balloon payment of$ due in_years on Total monthty amount owed including escrow account payments ❑ You do nol have a monthy escrow payment for dems,such as property taxes and homeowner's insurance. You must pay these iems direUly yourseK. QX You have an adddional monthy escrow payment of$193.55 that resutts h a total initial monihy amount owed of$77625. This indudes prineq�a�,interest,any mortgage insurance and any dems chedced bebw: XQ Property taxes XQ Homeowner's insuranoe � Ffood insurance QX School Tax ❑ ❑ Note: If you have arry questbns aboul lhe Settlement Charges and Loan Terms listed on this(orm,please mntad your lender. Page 3 of 3 HUD-1 (201a11607.PFD/201411607.PFD/22) $us� �UN�E��L �O1VI� 145 North Grant Street 9066 Jonestown Road 2 East Main Street Palmyra, PA 17078 Grantvills, PA 17028 Hummelstown, PA 17036 717-838-7034 717-469-2341 717-566-2016 Jeffrey W. Buse Nati►an W. 8use, Supervisor ponna R.G. Buse Funeral Director Branch Location Funeral Director Charles E. Summy January 20, 2012 4055 Seneca Aveiiue Due Date: February 21, 2012 Camp Hill, PA 17011 FUNER.AL EXPF,NSES FOR ANNA W. SUMMY: PROFESSIONAL SERVICES Services of Funeral Director and Staff $ 2,350.00 Other Preparation of the Body $ 160.00 Embalming $ 725.00 $ 3,235.00 OTHER STAFF AND RELATED FACILITIES Services and Facilities for Viewing $ 200.00 Services and Facilities for Funeral Ceremony $ 300.40 $ 500.00 TRANSPORTATION Transfer of Remains to Funeral Home $ 175.00 Hearse to Cemetery $ 350.00 $ 525.00 MERCHANDISE 20 Gauge Silver Clair $ 685.00 Concrete Grave Liner $ 625.00 $ 1,310.00 CASH ADVANCES Opening Grave $ 925.00 Cemetery Equipment $ 180.20 Clergy Honorarium $ 125.00 Certified Copies of the Death Certificate $ 36.00 Flowers $ 178.88 Inscription $ 57.00 $ 1,502.08 TOTAL CHARGES $ 7,072.08 BALANCE DUE: ``� $ 7,072.08 �� f % � �� p.� �� a�� ,�y�/ �� , �{ �`, � �:, $Us� �UN��Z�L �OjVi£ 145 North Grant Street 9066 Jonestown Road 2 East Main Street Palmyra, PA 17078 Grantville, PA 17028 Hummeistown, PA 17036 717-838-7034 717-469-2341 717-566-2016 Jeffr+ey W. Buse Naihan W. Buse, Supervisor ponna R.G. Buse Funeral Director Branch Location Funera!Director Charles E. Summ;� January 20, 2012 4055 Seneca Avenue Camp Hill, PA 1 i O 11 FUNERAL EXPF:NSES FOR ANNA W. SUMMY: CASH ADVANC�:S Newspaper Noticu-Hanisburg $ 558.17 Newspaper Notia;-Sun $ 90.00 $ 648.17 TOTAL CHARGES $ 648.17 Payments -$ 648.17 January 23,2012 Check#113 $ 648.17 BALANCE DUE: $ 0.00 �� , . . � i , ;' / � � ' TF , � �1 ;',1 . � e'� ', ``-..1 �`� - 1 rI'':� '� \ �•.. � � 1 1 ,. " 1 -c- , , ��• , , -� =� � . .� _. . • - '�V�Q+r""�'� k�l�� tnn, I�- ��F�a�� Invoice � �,,,�� v�n►v�t� In Ac�oo�onc w'rth: . �'6O7��atA�. �� _ Nat�isborg. Pa�rrsy�v�nt�t7`!13 G�antvl�e. 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