HomeMy WebLinkAbout04-22-15 pennsytvania 15051314105
DEPARTMENT OF REVENUE
EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN g�
Harrisburg, PA 17128-0601 RESIDENT DECEDENT i
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW
108022014 02031929mm � �
Decedent's Last Name Suffix Decedent's First Name _ MI
Thumma_....__.._..,_._____ F-oster
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix �j Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
cD 1. Original Return O 2.Supplemental Return O 3. Remainder Return(date of death
prior to 12-13-82)
O 4.Agriculture Exemption(date of 0 5. Future Interest Compromise(date of 0 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
cD 7. Decedent Died Testate O 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
O 10. Litigation Proceeds Received O 11.Non-Probate Transferee Return O 12. Deferral/Election of Spousal 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 TO:
Name Daytime Telephone Number
Adam R. Deluca, Esquire 1 1(717) 249-1177
_-------------.__...._. __... _. __ _.._..._ __ _..._ ._.__...._—
First Line of Address
61 West Louther Street
i
Second Line of Address
City or Post Office State ZIP Code
Ll::arlisle I PA 17013
...._..._..�..........u.....,�........... _.._ .. L.._..........._._..................._. .........._.....--------------------
i -
Correspondent's email address: adeluca@alliedattorneysllc.com
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REGISTER OF WILLS USED ILY
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STER OF WILLS USE ONLY G7 c r7 rn
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DATE FILED S AMP _,3 ..
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PLEASE USE ORIGINAL FORM ONLY O
Side 1
111111 IIIII 11111 IIIII IIIII IIIII IIIII IIID IIIII IIIII IIII IIII
L 150561410 1505614105 J
1505614205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: FOSTER E. THUMMA
RECAPITULATION
1. Real Estate(Schedule A). ...... .. ... ... ....... .... .... ... .. .. .. ..... . 1. 36,000.00
2. Stocks and Bonds(Schedule B) ... .. ...... .. .. .. . ... ..... .... . .. .... . . 2.
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. ` 2,140.55
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . .. .... 6. 866.62
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property �-
(Schedule G) O Separate Billing Requested........ 7. I
8. Total Gross Assets(total Lines 1 through 7)....... .. ..... ... .. .. ... .. ... 8. 39,007.17
9. Funeral Expenses and Administrative Costs(Schedule H).. .. ..... .. .. .... .. 9. i 11,398.56
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1). .. .. ... . ...... 10. 6,234.76
11. Total Deductions(total Lines 9 and 10). . ..... ..... .... . .. ... .. ... .... .. 11. 1 17,633.32
12. Net Value of Estate(Line 8 minus Line 11) ... .. .. ..... .. ...... .... ... .. . 12. 21,373.85
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. 21,373.85 ;
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.f
16. Amount of Line 14 taxable
at lineal rate X.0 45 21,373.85 16. 1 961.82
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable i
at collateral rate X.15 18.
19. TAX DUE .. .. .. .. .... ..... .. .. .. .. ..... .. ... . .. . ..... ... .. .. .. .. .. 19. 961.82
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ( )
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 knowledge.
SI6NA URE OF P SON RESPONSIBLE FOR FILING RETURN DAT
ADDRESS
6 Maurice Drive, Mt. Holly Springs, PA 17065
SIGN RE F PR E THA RSON RESPONSIBLE FOR FILING THE RETURN r/�DpTFf
ADDRESS
61 W. Louther St., Carlisle, PA 17013
11111111111111111111111111111111111111111111111111111111111I Side 2
L 1505614205 1505614205 J
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
FOSTER E. THUMMA
STREETADDRESS
221 Cranes Gap Road
CITY STATE 717013
Carlisle PA
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 961.82
2. Credits/Payments
A.Prior Payments 3,300.00
B.Discount 48.09
(See instructions.) Total Credits(A+B) (2) 3,348.09
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) 2,386.27
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.
r w
r
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.......................................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0
c. retain a reversionary interest .............................................................................................................................. ❑ 0
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ N
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ E
3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?.............. ❑ E
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ ❑ 0
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
ercent[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 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 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+(02-15)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
FOSTER E. THUMMA 21-14-0834
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 decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1' 221 Cranes Gap Road,Carlisle,PA 17013 36,000.00
"settlement sheet attached
TOTAL(Also enter on Line 1, Recapitulation.) $ 36,000.00
If more space is needed,use additional sheets of paper of the same size.
FOSTER E. THUMMA 2144-083
REV-1509 EX+(02-15)
pennsylvania SCHEDULE F
L�1 DEPARTMENT OF REVENUE 30INTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
FOSTER E.THUMMA 21-14-0834
If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.Christine E.Celona 6 Maurice Rd.,Mt. Holly Springs, PA 17065 daughter
B.Scott L. Thumma 6 Young Lane,West Hartford, CT 06110 son
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'SINTEREST
1. A. 06/20/12 Memberslst FCU Savings Account#125704-00 436.50 50 218.25
2. A. 05113/97 Citizens Bank Checking Account#6100886484 1,719.52 1/3 573.17
B. 05/13/97 Citizens Bank Checking Account#6100886484 1,719.52
3. B. 06/06/96 Citizens Bank Checking Account#6100727653 150.40 50 75.20
TOTAL(Also enter on Line 6, Recapitulation) $ 866.62
If more space is needed,use additional sheets Of paper of the same size.
REV-1511 EX+ (02-15)
iffpennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FOSTER E. THUMMA 21-14-0834
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Ronan Funeral Home(cremation service,casket, monument,urn,grave open/close,
certified death certificates,newspaper advertisements,cemetery equipment) 4,143.03
2. Faith Chapel Church rental 200.00
3. Pianist for memorial service(Vinh Le) 50.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2• Attorney Fees:
3,790.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 355.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. see attachment 2,860.03
TOTAL(Also enter on Line 9, Recapitulation) $ 11,398.56
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(02-15)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FOSTER E.THUMMA 21-14-0834
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. Carlisle Digestive Disease Associates 66.10
2. Calaman's Lawn Care 141.75
3. Cumberland Goodwill Fire and Rescue 183.25
4. North Middleton Authority 168.07
5. Forest Park Health Center and Rehabilitation 15.50
6, Memberslst FCU Visa Credit Card balance(account#4672090000063636) 4,368.11
7. In-home caretaker services-Jack Landis 70.00
8. Alert 1/ResponseLink(green button alert necklace) 39.95
9. Comcast Cable Company 21.58
10, Westfield Insurance-Homeowners Insurance policy 618.00
11. CenturyLink phone service 42.45
12. Shipley Energy 500.00
TOTAL(Also enter on Line 10,Recapitulation) $ 6,234.76
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(02-15)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
FOSTER E. THUMMA 21-14-0834
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).]
I. Christine E.Celona:6 Maurice Rd.,Mt.Holly Springs,PA 17065 daughter 1/3
2. June E.Landis: 187 Country Club Rd.,Coatesville,PA 19320 daughter 1/3
3. Scott L.Thumma:6 Young Lane,West Hartford,CT 06110 son 1/3
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.
ESTATE OF FOSTER E.THUMMA: FILE NO:21-14-0834
ATTACHMENT TO SCHEDULE H
ITEM NUMBER 7—MISCELLANEOUS ADMINISTRATIVE EXPENSES
a. Patriot News Company—Estate Advertisement $166.26
b.Cumberland Law Journal—Estate Advertisement $75.00
c. Calaman's Lawn Service (lawn care August—October, 2014 pending sale;two dumpster
rentals;trash removal) $922.14
d. PPL Electric service pending sale (August 2014—January 2015) $260.48
e.Shipley Energy (150 gallons of oil pending sale) $499.82
f. North Middleton Authority(water/sewer pending sale) $170.30
g. Estate Account checks $9.00
h.SAC Energy(heating oil#2—100 gallons pending sale) $239.00
i. North Middleton Township County taxes (for sale of home—see settlement sheet) $44.19
j. North Middleton Township Authority final water/sewer(sale of home—see settlement sheet) $103.84
k.Tax Certification paid to Saidis Sullivan & Rogers (sale of home—see settlement sheet) $10.00
I. Realty Transfer Tax charge (sale of home—see settlement sheet) $360.00
$2,860.03
LAST WILL AND TESTAMENT
OF FOSTER E. THUMMA
1, FOSTER E. THUMMA, of Carlisle, Cumberland County, Pennsylvania,
declare this to be my Last Will and Testament and hereby revoke all prior Wills and
Codicils.
1. I direct that all my just debts, funeral expenses and administrative
expenses shall be paid from my estate as soon as practicable after my death. It is my
wish that upon my death my body shall be buried in our family burial plot, next to my
wife, at North Middleton Church of God Cemetery, Carlisle, PA.
2. 1 direct that my real property and all personal property that I own at the
time of my death shall be given to my three children, Scott L. Thumma, Christine E.
Celona, and June E. Landis, in equal shares,per stirpes.
3. I appoint my daughter, Christine E. Celona, as Executrix of this my Last
Will and Testament. In the event that my daughter is deceased, unable or unwilling to
serve or shall cease to serve for any reason whatsoever,then I nominate, constitute and
appoint my daughter, June E. Landis, as alternate Executrix of this my Last Will and
Testament.
5. The Executrix or Executor of this Will shall have the power to distribute
my estate in cash or in kind, or partly in either.
6. 1 direct that no Executor acting under this Will shall be required to enter
bond in any jurisdiction.
7. 1 recommend that my Personal Representative retain the law firm of Allied
Attorneys of Central Pennsylvania, L.L.C., to probate my estate.
J
IN WITNESS WHEREOF, I have hereunto set my hand this day
of Wuj-m 2012.
F3STER E. THUMMA
Page 1 of 4
The preceding instrument consisting of this and three other pages was on the day and date
hereof signed, published and declared by FOSTER E. THUMMA, as and for his Last
Will and Testament in the presence of us, who at his request, in his presence and in the
presence of each other have subscribed our names as witnesses hereto.
Witness fitness
l
Page 2 of 4
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF CUMBERLAND
1,FOSTER E.THUMMA,the TESTATOR,whose name is signed to the attached
or foregoing instrument,having been duly qualified according to law,do hereby
acknowledge that I signed and executed the instrument as my Last Will and Testament;that
I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein
expressed.
FOSTER E. THUMMA
Sworn or affirmed and acknowledged before me by FOSTER E. THUMMA,the
TESTATOR,this day of k6aj�ow 2012.
/-�aubilic/Attomey
NOTARIAL S9L
STEPHANIE E CHERTOK,Notary public
CCIIVISIO SOTO CumbedOnd COunly
MY COMMISS101�E>
Page
Match 24,2111
Page 3 of 4
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF CUMBERLAND
WE, A�D6VV\v P- and YST,
the witnesses whose names are attached to the foregoing document, being duly qualified
according to law, do depose and say that we were present and saw testator sign and
execute the instrument as his Last Will;that he signed willingly and that he executed it as
his free and voluntary act for the purposes therein expressed; that each subscribing
witness in the hearing and sight of the testator signed the Last Will and Testament as
witnesses and that to the best of our knowledge the testator was at the time 18 or more
years of age, of sound mind and under no constraint or undue influence.
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Sworn or affirmed and subscribed before me by
I9 -Y\
and S�aw
� this
day of R6(ve'v 2012.
/Notarj P—u-blic/Attomey
NOTAR14K SE4
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COMSIG BOro,Cumberland County
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MY Commission Bores March 2:4,2016
Page 4 of 4
Previous editions are obsolete form HUD-1(3186)ref Handbook 4305.2
A. Settlement Statement U.S.Department of Housing and Urban Development
B.Type of Loan OMB Approval No.2502-0265
1. ❑FHA 2. ❑FmHA 3. ❑Conv.Unins. 6.File Number 7.Loan Number 8.Mortgage Insurance Case Number
4. OVA I 5. Conv.lns. MT2015-11RCS
is o"isrms e o give you a s amen a ua se amen costs. oun s poi o an y e se emen agen ere s own.
C.Note: Items marked'(p.o.c.)"were paid outside the closing;they are shown here for information purposes and are not included in the totals. TltleEXpre55.Settlement System
WARNING:It is a vime to knowingy make false statements to the United States on This or any other similar form.Penalties upon
conviction can include a fine and imprisonment.For details see:Title 18 U.S.Code Section 1001 and Section 1010.
D.NAME OF BORROWER: Troy Landis and Michelle Landis
ADDRESS:
E.NAME OF SELLER: Estate of Foster E.Thumma
ADDRESS:
F.NAME OF LENDER:
ADDRESS:
G.PROPERTY ADDRESS: 221 Cranes Gap Road,Carlisle,PA 17013
Parcel 29.15.1251.009 North Middleton Township
H.SETTLEMENT AGENT: ACCP,Inc.
PLACE OF SETTLEMENT: 26 West High Street Carlisle PA 17013
I.SETTLEMENT DATE: 0212512015
J.SUMMARY OF BORROWER'S TRANSACTION: K.SUMMARY OF SELLER'S TRANSACTION:
100.GROSS AMOUNT DUE FROM BORROWER 400.GROSS AMOUNT DUE TO SELLER
101. Contract sales price 36 000.00 401. Contract sales price 36 000.00
102. Personal Property 402. Personal Pro ert
103. Settlement char es to borrower line 1400 1,362.90 403.
104. 404.
105. 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
108. School Taxes 02125115to06130115 386.91 408. School Taxes 02125115to06130115 386.91 .
109. 409.
110. 410.
111. 411.
112. 412.
120.GROSS AMOUNT DUE FROM BORROWER 37 749.81 420.GROSS AMOUNT DUE TO SELLER 36 386.91
200.AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deposit or earnest money 100.00 501. Excess Deposit see instructions
202. Principal amount of new loans 502. Settlement charges to seller line 1400 473.84
203. Existing loans taken subject to 503. Existing loans taken subject to
204. 504. Payoff of First Mortgage Loan
205. 505.
206. 113 Estate Distribution 12 000.00 506. 113 Estate Distribution 12 000.00
207. 507.
208. 508.
209. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
211. County taxes 01/01/15to02125115 44.19 511. County taxes 01101115to02125115 44.19
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220.TOTAL PAID BYIFOR BORROWER 12144.19 520.TOTAL REDUCTION AMOUNT DUE SELLER 12 518.03
300.CASH AT SETTLEMENT FROM OR TO BORROWER 600.CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower line 120 37 749.81 601. Gross amount due to seller line 420 36 386.91
302. Less amounts paid by/for borrower line 220 12 144.19 602. Less reduction amount due seller Iline 520 12 518.03
303.CASH FROM BORROWER 25.605.621 603.CASH TO SELLER 23 868.88
SUBSTITUTE FORM 1099 SELLER STATEMENT:The information contained herein is important tax information and is being furnished to the Internal Revenue Service.If you are required to file a return,
e negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported.The Contract Sales Price described on
line 401 above constitutes the Gross Proceeds of this transaction.
SELLER INSTRUCTIONS:Ifthis real estate was your principal residence,file Form 2119,Sale or Exchange of Principal Residence,for any gain,with your Income tax return;for other transactions.
complete the applicable parts of Form 4797,Form 6252 and/or Schedule D(Form 1040).
You are required by law to provide the settlement agent(Fed.Tax ID No: I with your cored taxpayer Identification number.If you do not provide your cored taxpayer idents ication
number,you may be subject to civil or criminal penalties Imposed by law.under penalties o perjury.I certify that the number shown on this statement is my correct taxpayer identthcation number
TIN: I SELLER(S)SIGNATURE(S): f
SELLER(S)NEW MAILING ADDRESS:
Previous editors are obsolete form HUD-1(3/66)ref Handbook 4305.2
U.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number:MT2015-11 PAGE 2
SETTLEMENT STATEMENT TitleEx ress Settlements stem
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700.TOTAL SALES/BROKER'S COMMISSION based on price$36,000.00 A,0.000= BORROWER'S SELLER'S
Division of commission line 700 as follows: FUNDS AT FUNDS AT
701. $ t0 SETTLEMENT SETTLEMENT
702. $ to
703. Commission paid at Settlement
800.ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee %
802. Loan Discount %
803. Appraisal Fee
804. Credit Report
805. Lenders Inspection Fee
806. Mort a e Application Fee
807. Assumption Fee
808.
809.
810.
811.
900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to A$ /day
902. Mortgage Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000.RESERVES DEPOSITED WITH LENDER FOR
1001.Hazard Insurance mo. $ /mo
1002.Mort a e Insurance mo. $ Imo
1003.City Property Tax mo. $ ho
1004.County Property Tax mo. $ 24.44 Imo
1005.School Taxes mo. $ 93.40 Imo
1009.Aggregate Anal sis Adjustment
1100.TITLE CHARGES
1101.Settlement or closing fee
1102.Abstract or title search
1103.Title examination
1104.Title insurance binder
1105.Document Preparation
1106.Notary Fees to Saidis Sullivan&Ro ers 10.00
1107.Attorney's fees to Saidis Sullivan&Rogers 319.00
includes above items No:
1108.Title Insurance to Abstract Company of Central PA Inc. 592.90
(includes above items No:
1109.Lender's Policy
1110.Owner's Policy 36 000.00 -592.90
1111.Attorney Fees to Adam R.Deluca Esquire POC SELLER
1112.
1113.
1200.GOVERNMENT RECORDING AND TRANSFER CHARGES
1201.Recording Fees Deed$81.00 ;Mortgage Release 81.00
1202.Cit/Count tax/stamps Deed$360.00 Mortgage$ 360.00
1203.State Tax/stamps Deed$360.00 Mortgage$ 360.00
1204.
1205.
1300.ADDITIONAL SETTLEMENT CHARGES
1301.Survey
1302.Pest Inspection
1303.Tax Certification Fee to Said!Sullivan&Rogers 10.00
1304.Final Water/Sewer to North Middleton Township Authority 103.84
1305.
1306.
1307.
1308.
1400.TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 1,362.90 473.84
HUD CERTIFICATION OF BUYER AND SELLER
MI have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is awe ajaccuraw statement of all 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.
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WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Settlement Statement which I have prepared is a hue and aurate account of this transaction
UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON CONVICTION 1 have caused or will cause the funds to be disbursed in accordance wit hccthis statement.
CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 16: BY
U.S.CODE SECTION 1001 AND SECTION 1010. .0/051(5-
DATE