Loading...
HomeMy WebLinkAbout04-07-15 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX�11-96) OEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 020461 WARNER CHERYL L 1 10 PENNSYLVANIA AVE CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold 101 � S416.70 ESTATE INFORMATION: ssrv: � � FILE NUMBER: 2113-0176 I DECEDENT NAME: TOOMEY PAUL B I DATE OF PAYMENT: 04/07/2015 I POSTMARK DATE: 04/03/201 5 I COUNTY: CUMBERLAND � DATE OF DEATH: 01/08/201 3 I � TOTAL AMOUNT PAID: 5416.70 REMARKS: CHECK# 1015 INITIALS: HMW SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS . . March 20,2015 Pa Department of Revenue Bureau of Individual Taxes Post Assessment Review Unit PO Box 28Q601 Harrisburg,PA 17128-0601 RE: Administrative Correction � ) J a � .� Estate of Paul B.Toomey � � -� v '� �� 7 � � To Whom It May Concern: This fetter is to correct a miscalculation as to the value af a property ttaa�n��a�s included in Paul Toomey's Estate. The value of the property located at 1249 Snowdate Rd.,Upp�r��I�a�uonoy Towrtship, Northumberland County,Pa.was listed on the Inheritance Tax Retum as�:i9,690.00. We sold the property and received a value af$30,000.00 less the closing costs of$1,05�t�+..QO,a difference of an additional$9,260.00. Due to this miscalculation of the property's val��u�u��,submit that we owe an additional$416J0 in inheritance ta�ces. This amount was calcutated c�sirig eN�e lineal rate 0.045 X $9,260.00. Enclosed with this letter are the following documents ta sc�b��t:�,��•�tiate this information: 1) A copy of the Inheritance Tax Return, induding Sr.hecl��le A 2) A copy of the explanation of how the origina!value caf�Ine property was obtained 3) A copy of the Settlement Statement 4) A check in the amount of$416.70 for the additior�ai ta�x�s owed If you have any questions,please contact me at 717-433-5142. Thank yt�u�'i�r your assistance in this matter. Si cerely, �,. (,Jc.�,r,,c„ Cheryll. arner Executrix of the Estate of Paul B.Toomey 110 Pennsylvania Ave. Camp HiN,PA 17011 rv � :L7 � � ,—�.� � CJ FT}. � C� � ..�,.{ C7 :� p C" .� C"�1 r" ,�-_ +�i Q� �� CJ �`> � ,. .�, ,'- � '� c a �-� � ..� ..'"� "�*1 --� �:a -� � ;,� ca ',;`'� t�a r' r� r _� -� � � � 3A!" � � - 3Sa5�1�1�� � . �"�.��`��� �rc����;���r�+a�rur ����AR' � �Gph'pJl��0�' �i ��E a!!!�E flf AfdiVidUat TilS ��T���, PQ B00(z8o6oi �'D�' Harr�P111Tt�B�6o� _...._.. BRER 06l�Ef�IT rIPORYA110N BBbIM Soci�i Sea�Ndmbef i]de d#�e� 1�O�YY111f Da�s d�rt �itl�^!'r O1/0�'#3 �PJO�If!'�' DecedenCs l.ast Naxe S1�itt Dso�dsn�s��It i���dRa�e #� Toon�e1► � B l��PP�N��o��s�iwr $pOtJfIB$t��MIIB � �S�'d��I�IImAuRR � �10{i�6 f,�i�L'��� �������������"����H�� R'CGISTER� 1I�'�i.S FR.t.N APPIi0PR11?�tMtS B�OMr � 1-CAiynei fierum O 2 5uppiwenloi Raium ��t :3.ANrrindsr��W�e d Oisrlh ,p 4_l.ianisd Es� O 4a Fuh�e Inie�et C,anpoai�s tdels d ��1 5�.�adar�i Eaiole TaK ii�t�aqiuied deedt�a�er 12-t2-82) 41 s.oeoaaak oiem se.�ale o� 7.�eoaderK r�teirMainea a ci�iry Ti�usc _�,_ �.Taa Ma�ear a sd�e oepo.ic�awes fA�ar,h Co{gr d MI!) f��PY d Tn�at.) O 4.t�ig�ion Fxioeeds Nearire� O �1-Spasrl Pb�ahi G1��sdt([►W at Dsdh ���M �!t_B�cion 1a Tioc�ar+d�r Sec.9113(I►? Belwsen 12-31-9f and f-1-86j {Abctt SdNdub O) (�O�If-1I��:7d�TE O�R�.Atl. 11�l�0�!�3WlI NNI�?»N#N01�8 E�CIEY� �� IN�r,llfine Teieplw�Me Nin�ber Cheryl L.yy�tne�' ��'�'1!7)�33-51�2 �+oFnua�ar�ar i ���� 'I 110 Per�tsyhta��ia AMe � t Secad I.i�s af Add�eas � C�!O�PObt O�0@ Sfa�s 2P t'•otle �. Olof sa� �� � in»� co�n.�o.a.e�t"a.�o.+��aan..�:�.com IJ�rlrPsi�sdP�psi�.!A�d�etNt 1lws�aimiwd tiis�n.i�a000mps�i+pst�is aud��n��ell�.aidb/�eb�etdiuYi�o�Sad6efaE. it is lrus,aonact and maPlMe-DecNralion a�DnPanr atl�er fpr�ris pwao�rl�p�e�ar�he is bersif on aN�i�aNbam,re�lfon d rricl�piap�ner he ary�• � ��� � DiitTE ._._.,.... f' ���1`� � ��o P��rw�a�.,c�t�,� ��oi� .__..._. �n�o���r►��ww w�+� Q1►'� � K�usE o��o�a.Y �.... side 1 � 1505630105 15DS6101U5 � • J 15ti5b102D5 F�1f-2�oo Elt(Ft) ��y,��,i�l�a6ar c�o.a�.�w� Paul B.Toomeg► .... 1. 1ie�iEahls(Sd�ediMly............................................. �_ 19,+Bt90.00 2 SIot:l�adBonds(9rhsduis8)....................................... :�" 3. Cb�ay Haid C�oepa�sian;PaArealdp ar 9,oi►Peap�ielo�P(�dred�i�C? --.._ ?�.. 4. Ma�yes ad Flalas�ecsiraiMs(Sd�edoie D}........................... �. 5. Ca�l�,8oenk Depoei�ls ard Mieae�arMaus Piera�ant Pb"opsrb�Ej-....�� �V,. 23.�7.fi2 6- Joii!►Owueid P�pa�l��d�e�is� O�apa�1�8ig�d-._.__. (�'"_ 7. inleral[ws'Tiawlss��lia�Rmb�r P�o�x�rl�I (Sd�edule�) Q 9eptais�q�Osqns�bd------.. �". 8. Ta�Y��ws/1or�ls(ItAel l.i�es 1 l�a�"�............................. ��. '�-� 9. �eRal►E�pa�s s�d/Yd��i�e�ai�e Cro�ls�s�ie F fl------------------- fl� 7,257.a6 t0. Floh�c d Drood�,Yoe�I.i�s sd Li�s�d�i!�...............1id'�. 4,527.82 t1. TBMIO��fi��s(loiel!'s�sc9aM�+D)�---•--•-•-----•-----------•-�•.- 11',_ 11,7$538 �2 wtwMw.rr�e.r.p.�.aw�.,st�»�.---•-------•-•-----•-------_. a��.. 31,87224 '13. a�e�idfale ana�oraennwr+�l gsq�ec 91ta fiiue�wr wl�ids an aleclirat b tax hss�tot lir�s�amde(Sctedit,1) .......---•.---•--•-._.. a":�. fl_� 1s. NMt 11Yi�r s��ct to F�(i�eie t2,�ir�s ts�s t3) ........................ 1��. g��� TA][i'JILl:t�Jl710M-�N61w1/Cl10118�OR AP�tJCJ1BLE RA7S ..�..�. ts �.�t.�r e�u�e�e ac 1r+e s�,ou..t teec w1er,or �s undar Se�c.9t16 (ax1.�X.0_ '�p1a. 18. M�ount d i.i�s 14�aNie at inad a�s X.0�' t�l�. 1.�34.25 17. M�ou�t d llne t��mt�is at abing rs/e X_f2 '.�w_ 1s. Amor.�t or t3ne u t�ie �aoMslara!�a1e X.15 i N'�, 18 T111xD[E--•--•--......_. •---..�.__ 1��. 1r'�.3'4.2� •...............•----•._.._._.. 20. F!1 M 7!E OAML F�OlM ME f�A�OF At1�lNY�!�If O S�de 2 L 3505b10205 1505610205 . J . , �r-t9oo�c E��3 ' r��u.��a�u� �'S COI��' .�.,.... 11ME Paut B.Toornay ----._---_...__ sii1�►IlOotrFSs Curr�berlar�d Cto�ings _._..__..__. 1 Longsdorf Vlfay � #�i�ii�:- aP � u Pa � 17Q15 Taac Payn�and Credits: t_ Tanc Due{Pape 2.tins 1� (t) i,43425 2 � A.Ptior Pa� . S.ffisoaunt 7c1�t t�.��;�� r s 1 Ra 3. k�leieet � I. If tins 2 is gader�t i�s 1+lise 3�.+�al�r t�e�weno�. �is es�s� Fi b�onl a�Pa�e�tM 1�ts w�t a wf�t Ni 5. If Li�s i+tite 3 is}�ei'!an tirs 2,enler Ibe�fe�o�,7Nis islrt��E. � I� 7.31.�CJ �C@ t�1�C���: ��i���.�..�,d�l� PLFASE A�THE Ft!l.LA�NG QIJE'�t10NS BY PlA�lIG AN'"��€"�i��!E APPROPRIATE 8LOp4S t. ixd�eoedent wl�e a 1�ader art l�s No b. �ie 1M ti�t b de�i wliD ai�1 t�se�!p�o�Mfy ir�gsfen�ed or�s irK�o�ne_._..__.... .._�__,.�._._._....._ ❑ � a. refan�e u�e at i�oame d tie pape�11rar�eierned..............._.,__..................._,,... �..._..._...,..a.._._. -- � � c. ��8�e�sio�t)r iMe�est.._..._._........_...............___._,......._.........__..._..._........._.... ._._._..�. _ d �eoeiYe ire paaiee for ie d eiM�p�emis,�a css?..................._.. .�.............�.__.._....._.�. ❑ � Z f dealh ooar�e0 a�rr Dac.12,,19�'1.did dea�Mnt lraa�iar piopa�w�h a�e yeat c�a��h wi�p�t�oei�i�gadeqn�conideraioM..___._ __....._.__r__................._.._.._..... .__.�._� � 3. Oid deoedert awti an'in fiemt bf"a pupbtaapa��b�nk a000uue�t a ae�jt�t I�ar Ns�,nr de�M+f? Q � +1. Oid dooedert awn an iMfwidurl wfiw�eiat a000uaR aae�a c�r no�po�e��'aw�'iicfi mioinc a 6�rMiria�►de�iprioa? • ..�... __.__.._,.._........_.__ � � F�����������������.�s����������. FwdrAesaFdeawanerra�er.�ijt 4,19�4.and beixeia�1.1l�iet�c�aiei�on�au�re�et���e�,r�if�aae�sbariotNe u�ed�a�igspouse is 3 pe�oet�t f l2 P.S-�116(a�(1-1)f�. �YY�iV Vf\Ioil�e ilf!M ���l �����T"'Vl������{�I! ,���i ��9 M������ {/2 P.s.§�'118(a)(t.'1��.Th��is aoes aat.e�eu�t a�a a su�vi�in�9ponte rrom aaoc,a����o4�nlon e+equi�e�e�e far�c�osue af aa�ls and Rng a tanc re6�m ae s�appical�ie enen�ihs suviring spot�e is fis dry beneid�rx Fordales dde�an a�et.liia►t.200i1: . The taoc�aie itQoeed oa�e nd veMie d tansfets tPo�a deoeaee6 did 21 Ye�s d age ar��n�r at da�b a ior�re u�e d a e�sa!p��,an �p�e Pa��eptcra�le�p�witdMre ckid+�0pert�sit(72 P.S.�(1�. • ThetaoctaieinQo�lanheaetwi�eaflr�deabattiri�eu�edrie�eoedsiNciaeolbeae��i���;��pe�os�,a�oe�ta�Aale�d�(72R.S.�t�a�(1�. . The�ax raie inpo�ed an�e net wbe d t�lsa io�ar iorl�e uta d�e deoed��a�i���1'2��:��i[Tl P.S.�t16(aI(13�.Aa�l'i+g is dei+ed. u�der Secioa9�12,as�in�iridua��ho�s�t ka�tone p�ertin aoiq�on�f�edeoede+ni.��d��rb�r blood aradaplion. REV-1502 E)(+�12-12) - �p�yl� SCHEDULE A ��,�„�, �u. EsrArE �� _ �, esr�h oF: �� Paul B Toomey ����� w rw�eo�.lr wi..i sw�r.r as s i�t i�+r...�w..rc ie�a�wai at alr..rrt wl�e.N�a�sin��!t whe is ddlaea as�e�iCe ac.lid��r�perlr wouW be ezdian�eQ belweee a��ls�er aaAi a�ig sder.�bein9 oanpded�0 6�l►ar se�,,�i�ai�qg�sereble�af lat�d�at bas. rl�q YrR i�}�w�i�ti�t�f wnh�sM�a�tl���oll�SeYiria F. 1�a w�d tbe se�dned sheet if the propety�a iee�smN�3. � �drdt a aopy ef Ne deed sMorii�Aeaede�R's inte�[if ow�ed is�i��aiwe��±s�. iN1llE A�0�1�E � ��� CF Ofil'�! I. 1249 Sncrrdale I�d..uAP��'!►Twp.,NaYNn+be�land Ca�,PA . 19,fi9Q.00 T'O�i'Al(lUso er�er an E.ine n„ I�ecapitulation.) ; 19,690�_00 If�ore�aCs is need[0,�se additlonat sfie�ls of pap�dr d��saune��;iae. Reverence: Paul B.Toomey File#Z023-Qf}].7b To Whom It INay Concern: The tax assessment(copy enclosed with this lnheritance Tax Returra)��ar t�'x�.'- PraPertY a�1249 Snowdale Rd., Domsife,Pa,is$5,5UU.00_ We obtained the vatue of$19.590_Oa����-�Ifr��i purpose of this tax return by using the common level ratio of 3.58 that was in place fa�Nortt�utr��t�ierr�l�:ind County at ihe time the decedent passed away,January 8,2U13• Alsa,the assessment tists��������i�rs of the ProPenY as Paui B. Toomey and Marian H.Taomey. Mar"�an H,Taomey has bee have e�n��:�sw:�k:^'a copy of he death father had never removed my mother's name from the properly certificate.This property passed directly to tt�e d�cecienYs daughter,�C�''ni'°:�'r�Hatch as per his bequest in the wilt. Sincefely, (���-��� �� _�''u,a.�,.��, ��- Cheryi L.Wamer Executrix of the Estate of Paul B.Toomey � �- Settlement Statement ti.S.Department of Hoasing ^ and Lrban Development ,r o�m a�,�vo.-�2-�a25_ B.T�� of Loan l` FH.� 2._ F:fat?-1 3._Gnrv.tir.ins.� 6. F31e\umber �7. Loan\umber j 8. Viorte�ae Iaasauaa�:c�Case\urnber 4:= V_1 5.= Conu.Ins. ! TOO'�[EYESI:aTE 3 �;A � \:'� C.tiOTE:This form is fiunished to give you a statement of actual sett(ement cosu. A�oumu paid to and by the se�lesa�eaa age�s are sho�vn. Items marked'°(p.o.c.3°'uc,e paid outside the closin¢;shev am shown here for immforveata�putposes azad aze mex i�islcu9x�iei 3he tota�s. D.N��tE OF BORROW'ER Timothy L Viasser .ADDRESS OF BORROVIiER: 299 Bover Road.Dor�sife.P_A 1a823 E.��HE OF SELLER: Estate o€Paui B.Toomec,by Chen,�9 L.�am�r Exzc�and Kendra C.T--flatcfi, Individuallv .�DDRESS OF SELLER �10 Peruesyl��ania A�enue,Camp Hiil,PA 1;ffiI 1 F.\,�HE OF LE�'DER: !�p?�*� ADDRESS OF LENDER G.PROPERTY 12d9 Snowdale Road LOCATIOr: Domsife,PA 17823 x.SETTLErtE�i'T�GB�T: �CHOLAS LAVIi OFFICES.P.C. 2215 FOREST HII.LS DRIVE,SUI1'E 37,Hf1RRiSB[:�RG,PA 27112-1099 (7H�)�40-7746 PI.ACE OF SETI'LE�iE�'1': 2215 FOREST HILLS DRIVE,SL'ITE 37,HARRISB[3KG,PA 17112-1099 I.SETIZEiiE.VT DATE: � � J.SUMMARY OF BORROWER"S TRA.hSACTION K.SU,'1�1�'tiiARY OF SELLER'S TRA\SACtIUti 100.GROSS AMOL�'T DUE FRObi BORROVI'ER 400.GROSS A.�IOU'tvT DL'E TO SELLF�R l O1.Contract sales rice 30 000.00 401.Contrad sales rice _.. �0 009.00 102.Personai ro Rv 402.Personal ____.. 103.Settlement ch es to borrower line i400 3�350 403. ___. 104. " 404. 105. 405. Ad'ustmenu for items 'd bv seller in advance Ad�ustments for items id b seller in ad�ance i06.Cirvitowniazes 6i'>��'2014to 12131i2014 92.48 406.Ci howntaxes 6��3/2014to 12i31;<6➢# 9:.48 107.Coun ta�ces to 407.Coim tares to 148.Assessments to 408.Assessments to 109.School Taac 6r23/2014 to 6130/201A 7.24 409.School Ta�c 6;'23I2014 ao 6.�'34;�O1A�,_ 7.24 110. m 410. to __- 111. to 411. to _ 122. to �12. to 120.GROSS A.�SOU^_vT D[:E FAOivf BORROK'ER , 30,453.22 4?O.GROSS Ab40L'IS1'IDL'E TO SELLEit � 30,099.72 200.:�\40[;NCS PAID BY OR IN BEFS.4LF OF BORRO�VER SOO.iLFAUCS/OtiS L'�?A.�40L;\'4"DL'E TO SELLF:;3t 20I.De osit or earnest mone SO1.Escess sit see instructions ___ 20�'..Princi al amount of new loan s 502.Settiemrnt es to selle line 1449 203.Existin loans takensub'ectto 503.E�stin lo s takensub'ectto ___ 204. 504.Pavoff of fiist mo e!oan ___ 20�. �OS.Pa offofsecond m loan _ 206.Princi al amount of seller finacscin 506.Princi aenawnt of se9l�5�cin _ 207. SOZ __ 208. 508. -_- 209. �09. -_-- 209a �09a __._ �09b 509b ___ Adjustments for items unpaid by seiler Adjustrnents for items unpaid by seller _ 210.Ci /town taxes to SIO.Ci /town taxes to ___ 2 i 1.Ccuntv tases ___ to �1 I.Coun �tares ta ___;�-----� � 512.Assessments to --� y ' - - tc + _ ---- - �t_,_�n:essT2=---- �'_,; e-h �'T�t :^ _-° jr d:Scnoc�°Ta� ---- �-;- ! �-----� :q ' ��i�2. � �� =1-�. "` --- _ � ; i� �2�. �°---- �1.,. 215. to 516. �O ------ -- 2]7. to 51?. �O ------ 218. to �P 8. LO -- 219. ta �i 9. to �20.TOTALA,bIOL�TSP.AID J�O.TO'�#LREDLCTiO\S�\ � 1,0�0.00 8Y OR L�I BEH.ALF OF BORROW�R � �VIOL1-d�ili��E SE[..L.ER 300.CASH AT SETTLE!��'T FROt��,TO BORRO�V£R 600.CASH AT'S�T't�.4Y£\�1'TO:IRO'.�i S£.�it 301.Gross amount due from borrow•er line 120 30.453.22 601.Gross a.maun4 due�o se[ler(line 420 30,099J2 �02.Less amounis aid b�r"for borrow�er line 220 602.Less reducfs�eas ia�asvount due se(ler ane�2{}' 1.4�0.00 3U3.C�+iSH X Fmro �To BORROWER � 3Q,453.22 603.C�SH �To -From SELI.ER � 29,049.72 TITLE�iEFTHER SEARCHED NOR CERTIFIED L.s.�Ee•vz�-r oe xo�:sr�G.a.��i�us���E��Lor�,¢ti-r SETiT.E�tiT ST.hTEME�T P.AGE 2 L. Settlement Cha es 700. TOTAL SALESiBROKER'S COVf.based on rice 30 000.00 n °10= Paid Fram Paid From Division of Commission line 700 fol(ows: Boanirer's Seller's ? 1. to Funds.�t Funds At 702. to Sett(ement _.,__ Settlement 703. Commission aid at Settlement 704. to 800. items Pavable In Connection With Loan 801. Loan Ori ination Fee % to __._ 80?. Loan Discount % to 803. A rai al Fee to 3 4. redi R rt to I 0" n r' i F to 806. Mort a e Insurance A lication Fee to 307. to ---- 808. to ------ 0 to �0. to -- 11. to ____ 12. to 813. to 14. o __ 815. to 900. Items Re uired B Lender To Be Paid In Advance 901. Inter st fr m /2 /2 4 to 7/1/2014 !da _._._ 902. Mort a e Insurance Premium for months to _ 903. Hazard Insuranc Premium for eazs to _._ 904. ears to ___ 905. ears to 1000.Reserves De sited With Lender 1001 Hazard insur nce mon r h __ 1002.Mort a e insurance months r month 1003.Ci ro e taxes month er month _ 1004.Coun ro e taxes nth r m th ___ 1005.Annual assessments months er momh __ 10�6.__ _ ___ __ months�a oer month ----- -- - ---- __ .._ .__. i 1 Q:�7. _ ' m nths^a r aeevnth �__ 1�"J8. ___ months a', er month _______ ?009. i 100.Title Charaes 13 O l.Settlement Qe clQsin fee to 1102.,abstraet r title search to __ 110=.Title examination to ____ 1104.Title in uranc bi er to __ I dfl�.Document re azation to __ i 106.'.`etan�fees to _____ 1;�?.?.rerne�` fezs to �icholaz Law Oftices PC ?��.�1d �ncludes above items numbers: ___- 1 t 08.Tit?e insura �e tn ___ �in;lodes aL��z itzms nar�ecbers: _ e:i�9.Len�;er's C�veraIIe: NS Ai1T: �i 11 Q O:+ner s Ceveraue: L\S AAdT: � � ;'!�a ..---- P111. 20 13i2. to i113. to 1200.Government Recordina and Transfer Char es 1201. 'S � rt -1� •Releases ---�- 1202.Cit !coun •tax�stam s:Deed 300.00•L-Mo s •S-Mo e s 150,00 150.00 1203.State taw'stam s:Deed 300.00•L_�to a s •Shio s fl50.(30 IS0.00 1204. -----_ t 205. 1300.Additional Settlement Cha es 1301. to -----_- 1302. to ___ =�= n° --�-- I�'u'�. SJ .____ - 13QJ. t0 _.__-__ _ 1306. te ___ 1307. ta 1308. to ---._-- li09. to 1400.Total Settlement Charges (enter on lines 1Q3,Sectioo 7 and�02,SectionK) � 353_�0 1,0�0.00 CERTtFiCATiO:� �°T�� 6123i2014 I have carefully reviewed the HGD-1 Settlement Statemen[and to the best of m}'Imowiedge and beiief,it as a�rue and acc:�ate..•zter:e.�t of all rece�pts and disbursements made on ac:v acco.�aat or�y sne in�is iraasa.-taon. I�er ce;tif}that I hav�receive�a cflp��of!he Hti D-�Se::tes�;er:t Statement. Estaze of Paul�Tooac�ey,b}f.'hcry4 L.Rarner. l//�1 ,� E�e �u ' 1 a -�Y, q " BorroH�er Bv f�,�,�. V ' _`r�o;, • �,fc.«<,t-�� Se3ier e imoihe-I.\4 er Cher}�L.�S�¢m ,�te:u�+c � � x �. Borrower � � '' -- Seller Ketidra C.Haicfi,ieditii�aily T!�e HUD-1 Setilememt Stateme v I�ave r pared is mae and accura[e accou�[of this Yaansac4ion.I hace caused Lfiz;u::a.o b�disbuned in accord- anc�uith tl�is statement � tilCHOLAS L4d��OFF[CES,P.C. Settlement Agent _�'?3!2014 Date VVARNL\G: It is a criane to know�inely make faise statemenu to the Unized States on this or an}ottaer similar foran. Per:zJtie�+a�on cc>?�icc3on can inciude a fine and imprisonment For details see:Title IS L`.S.Code Section[OOl and Section 1010. TOO�IEY ESTATE .. .� • �, ,-� . ��� ^, � , o.y :' t--• rr� '�� "� c' R �1 !-� � � �J �.�I <") S.L n� . �, �-�" �.j r�`� '1 �` L:.) � "`i � '� �..' 4 ;�s . 1 >: � P. � � � ;, � � � i-' �;,.... a 1 n � n � � ql �� � (L tn �. p J cf� Sv cn � ts U� z � 3 � � - -D o � G} D � _� � �, � � � �� a � o � c �1� � W r+ `Zl �� � . � � r,- (D O > � � � N � O �.,.� . c!� 6� r-�-�+ c� � Q � rnrn � � 'D � c7 'v 'd ta . � � c7 � r.n ae� . .'t }!�"'-� -^q+y1 �c}�� 4 y +C.. �`1 /�}�� ty"�y/ ��'y1 .. ��w �� ��"'Y� v� W ti./ .. :�:�,�� ��'^^��`,, r�rc� �� � �..,., ��� '1 � �-rY � c_.. -•._� c'r � .. ,� � n .. �.� ~i � t'ri ,.� .. �O C�7_�, .. �4+ts�� t:�_u:,, .. ���� � �,� .�p•�,; � ;e,. _. �iY �°, _. �, � ''�',� �. ;,,���° '�,'#'�,a c�� '�° a� _. �;�; ',ti' ����e ������i�u'r 9� r-- ;:• b_. .:. �j _:, ��``3� c::� a,' c., c�;, �,.. �."..} i'j� � ,i � 'I ;y �,a� r" r�a t �'�.�> ��,; ..'��"� . �,;:..,2 �) a s,..� �� I .� ..� , v, t,i flT, +:r;