HomeMy WebLinkAbout05-18-15 i pennsytvania 15051314105
DE-TMENT OFF ENUE EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN2
Harrisburg, PA 17128-0601 RESIDENT DECEDENT �"�
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
07232013 09101920
Decedent's Last Name Suffix Decedent's First Name MI
King ..........
= [j]
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
n/a _..........______
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
CW 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 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)
CMD 7. Decedent Died Testate p 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 p 11.Non-Probate Transferee Return p 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
iAdam R. Deluca, Esquire
First Line of Address
[61 West Louther Street
Second Line of Address
City or Post Office State ZIP Code
[Carlislemm� :PK
17013 rn
�., rrn
Correspondent's email address: adeluca@alliedattorneysllc.com � %"1 n
- ca _.Ira
REGISTER OF WILL'S.4JSE MY
J
REGISTER OF WILLS USE ONLY '
co
DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY
Side 1
i 111111 11111 11111 11111 11111 viii
1505 1410 1505614105
1505614205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: BETTY J. KING
RECAPITULATION
1. Real Estate(Schedule A). ..... ... .... ..... ..... ........ ... .. ... ...... 1. 77,500.00
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. € 7,813.85
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . .... .. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. .... .. 7. '
8. Total Gross Assets(total Lines 1 through 7). . .. ....... ..... . ........ .. .. 8. ( 85,313.85
9. Funeral Expenses and Administrative Costs(Schedule H)..... .... ....... ... 9. 28,979.50
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).. .... .. ..... .. 10. 2,204.85
11. Total Deductions(total Lines 9 and 10). .. . ..... .. ..... ............... .. 11. L 31,184.35
12. Net Value of Estate(Line 8 minus Line 11) ............ .................. 12. 54,129.50
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. 54,129.50
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 45 54,129.45 16. 2,435.83
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE . .... ... .... .... .... .. . .... .......... . .... ..... ...... .... 19. 2,435.83
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. r�,
SIGNATI ER�ON RR S, F R RETURN 6-11TE
ADD SS
542 Wilson Street, Carlisle, Ph 17013
SIG TU5E OF PRE ERT PERSON RESPONSIBLE FOR FILING THE RETURN DAT
RESS
61 West Louther Street, Carlisle, PA 17013
1111111111111111111111111111111111111111111 Side 2
150561420 1505614205
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
BETTY J. KING
STREET ADDRESS
225 WEST SOUTH STREET
CITY STATE 717013
CARLISLE PA
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 2,435.83
2. Credits/Payments
A.Prior Payments 5,850.00
B.Discount 121.79
(See instructions.) Total Credits(A+B) (2) 5,971.79
3. Interest
(3) 77.89
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) 3,458.07
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 .......................................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0
c. retain a reversionary interest .............................................................................................................................. ❑ N
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 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?.............. ❑
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 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:
BETTY J. KING 21-13-0845
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 fads.
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' 225 West South Street,Carlisle,PA 17013 77,500.00
(settlement sheet attached)
1
TOTAL(Also enter on Line 1, Recapitulation.) $ 77,500.00
If more space is needed,use additional sheets of paper of the same size.
REV-15D8 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
BETTY J. KING 21-13-0845
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. M&T Bank 100 S.Spring Garden Street,Carlisle,PA 17013-Checking Acct#893633 1,834.91
2. Santander Bank 269 Penrose PI.,Carlisle,PA 17013-Club Acct#2894303987 1,041.76
3. Century Link account refund 2.73
4. National Enquirer subscription refund 12.00
5. TV Guide subscription refund 6.44
6. Highmark insurance premium refund 207.42
7. Sarah A.Todd Memorial Home refund 823.79
8. Carlisle Regional Medical Center refund 256.96
9. All personal property sold at auction(Dan Hershey Auction Service,LLC)License#A0003968L 2,580.00
10. Reimbursement for County/Boro Taxes after sale of home(see settlement sheet) 576.23
11. Reimbursement for School Taxes after sale of home(see settlement sheet) 345.56
12. Sale of estate crystal 126.00
13. SafeCo homeowner's insurance refund 60.57
TOTAL(Also enter on Line 5, Recapitulation) $ 7,813.85
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+ (02-15)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BETTY J. KING 21-13-0845
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: _
1' iHollinger Funeral Home(Traditional Package) � 5,150.00
t _- -- —
2 Hollinger Funeral Home(Casket) 2,395.00 j
3. Hollinger Funeral Home(Memorial Package) I _ 175.00'1
a. Hollinger Funeral Home(newspaper ads,grave opening,cemetery equipment,death certificates
clergy,organist,flowers) ? 2,435.92,f
_ _
(total to Hollinger($10,155.92) !
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
'ff 5,452.00
2. Attorney Fees: —.
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: 363.50
5. Accountant Fees: `
6. Tax Return Preparer Fees:
7• see schedule H attachment 13,008.08
El F-
TOTAL(Also enter on Line 9, Recapitulation) $�; 28,979.50 l;
d-
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(02-15)
pennsytvania SCHEDULE
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BETTY J. KING 21-13-0845
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. Highmark Medigap Blue Plan 8 163.75
2. Charles Holtry-Tax Collector 1,784.36
3. Borough of Carlisle-water/sewer 72.90
4, Millenium Pharmacy 26.98
5, PPL Electric 42.02
6. UGI 114.84
TOTAL(Also enter on Line 10, Recapitulation) $ 2,204.85
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(02-15)
pennsylvania SCHEDULE 7
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
BETTY J. KING 21-13-0845
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. Carol A.Greenholt 542 Wilson Street,Carlisle,PA 17013 daughter 50%
2. Karen Sue Keith 18 York Way,Hockessin,DE 19707 daughter 50%
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:
i.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II— ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
ESTATE OF BETTY J. KING: FILE NO: 21-13-0845
ATTACHMENT TO SCHEDULE H
ITEM NUMBER 7—MISCELLANEOUS ADMINISTRATIVE EXPENSES
a. Patriot News Company—Estate Advertisement $99.66
b. Cumberland Law Journal—Estate Advertisement $75.00
c. Chem-Dry—clean household upholstery for sale $90.10
d. Grime Solutions—exterior house cleaning pending sale $238.50
e. Steve Naugle—waste disposal $110.00
f. PPL Electric pending sale of home (September 2013—April 2015) $413.59
g. Estate Account checks $25.20
h. Borough of Carlisle water/sewer pending sale of home (September 2013—April 2015) $612.59
i. Cumberland County/Carlisle Boro taxes (Charles Holtry,T/C—2014 and 2015) $1,703.04
j. Cumberland County School Taxes 2014(Charles Holtry,T/C) $1,962.03
k.Tax Certification paid to Purity Abstract Company(sale of home—see settlement sheet) $4.00
I. Realty Transfer Tax charge (sale of home—see settlement sheet) $775.00
m. Notary Fees paid to Century 21 (sale of home—see settlement sheet) $10.00
n. UGI pending sale of home (September 2013—April 2015) $2,240.12
o. Fickel Insurance Agency(homeowner's insurance pending sale of home $601.00
p. Safeco Insurance Company(homeowner's insurance pending sale of home) $173.25
q. Realtor Commission—Spencer and Spencer/Century 21 A Better Way(see settlement sheet) $3,875.00
$13,008.08
WILL OF
BETTY JUNE KING
1, BETTY JUNE KING, of Carlisle, Cumberland County, Pennsylvania, declare
this to be my Last Will and hereby revoke all prior Wills and Codicils.
1. I direct that all my just debts, funeral expenses, grave markers and
administrative expenses shall be paid from my residuary estate as soon as practicable
after my death.
2. 1 direct that all inheritance, estate, transfer, succession and death taxes of
any kind whatsoever which may be payable by reason of my death shall be paid out of
my residuary estate.
3. I direct that my entire estate be divided as follows:
A. I leave my entire estate of whatever nature and wherever situate to my two
daughters, CAROL A. GREENHOLT and KAREN SUE KEITH.
B. Should either of my daughters predecease me,then that daughter's share
shall pass to her child(ren).
4. 1 appoint my son-in-law, KEVIN GREENHOLT, as Executor of this my
Last Will.
5. The Executor of this Will, shall have the power to distribute my estate in
kind or in cash, or partly in either.
6. 1 direct that no Executor acting under this Will shall be required to enter
bond in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this_LJ�_day
of 2011.
BETT �� E KING
1 of 4
The preceding instrument consisting of this and one other page was on the day
and date hereof signed,published and declared by Betty June King, as and for her Last
Will in the presence of us, who at her request, in her presence and in the presence of each
other have subscribed our names as witnesses hereto.
Witness Witness
2 of 4
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF CUMBERLAND
I,BETTY JUNE KING,the TESTATRIX,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.
BETTY KING
Sworn or affirmed and acknowledged before me by BETTY JUNE KING the
TESTATRIX,this 1-0- day of 2011.
Nctarygublic/Attorney
NOTARIAL SEAL
STIEPHAmE F CHERTOAK, Notary pub!��'c
certil—Rollo. Cumber!;,)nGi co,
.F,P,>p U.i
11 MY Comn.--nission Expir"
2e) 20j !
3 of 4
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF CUMBERLAND
WE,A5h�-_,A A . and
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 testatrix sip and
execute the instrument as her Last Will; that she signed willingly and that she executed it
as her free and voluntary act for the purposes therein expressed; that each subscribing
witness in the hearing and sight of the testatrix signed the Last Will and Testament as
witnesses and that to the best of our knowledge the testatrix was at the time 18 or more
years of age,of sound mind and under no constraint or undue influence.
Sworn or affirmed and subscribed before me by
and I lit, L I Rez V14-410 —this
day of F�kO ,ti 24 12011.
/KotarPublic/Attorney
NOTARLAL SEAL
STEPHANIF f, CN_PffTgtKf Npory 01i
x
4 of 4
A.
OMB NO-2,502-022665,
U.S.DEPARTMENT OF HOUSING&URBAN DEVELOPMENT 2. FmHA B TYPE U LOAN:
1. FHA [� 3.❑CONN.UNINS. 4. Vq
SETTLEMENT STATEMENT 6' P15-d71MBER: ❑ 5.[]Conly INS.
7. LOAN NUMBER;
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furmished to give youa statement of actual settlement costs
Items marked TPOC]'were paid outside the dosing,they are shown here forPa
informat otsettle purposes andwent agent ducted in the totals.
D. NAME AND ADDRESS OF BUYER:
E. NAME AND ADDRESS OF SELLER: I'0 (cuArtmoxzs.a
Robert S.Guarino F. NAMEANp ADDRESS
OOF:F LENDER:
5 McCoy Lane Estate of Betty J.King
Carlisle,PA 17015 225 W South Street
Carlisle,pA 17013
G. PROPERTY LOCATION:
225 West South Street H. SETTLEMENT AGENT: 23-2402316
Carlisle,PA 17013 PURITYABSTRACT COMPANY I. SETTLEMENT DATE:
Cumberland County,Pennsylvania
PLACE OF SETTLEMENT April 29,2015
Century 2f A Better Way
398 E.High Street,Carlisle,PA 17013
J.SUMMARY OF BUYER'S TRANSACTION
100. GROSS AMOUNT DUE'FROM BUYER: K.SUMMARY OF SELLER'S TRANSACTION
101. Contrail Sates price 400. GROSS AMOUNT DUE TO SELLER:
102. Personal Pro 77,500.00 401. Contract Sates Price
103, Settlement Charges to B er Line 1400 402. Personal Pro 77 500.00
104• 1,903.00 403.
105. 404.
Ad'ustments For Items Paid B Seiler in advance 405.
106. COun /Koro Taxes 04/29/15 to 01/01116 Ad'ustments For Items Paid B Sellerin advance
107. C' Tax 576.23 406. Coun /Koro Taxes
108, School Tax 2° 407. C' Tax 04/29/15 to 01/01/16
04729/15 to 07/01/15 to 576.23
109, 345.56 408,School Tax
110. 409. 04/29/15 to 07/01/15 345.56
111' 410.
t12. 411.
120, GROSS AMOUNT DUE FROM BUYER 412.
200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: 80,324.79420- GROSS AMOUNT DUE TO SELLER
201. D sit or earnest move11 78,421.79
500. REDUCTIONS IN AMOUNT DUE TO SELLER
202. Priv'at Amount of New Loans 1,000.00 501. Excess De sit See tnstrudions
203. Exist in loan s taken'subject to 502. SeHlement Char es to Setter Line 1400
205' 5,610.96
503. Exist(n bans taken sub'ect to
205' 504. Payoff of first Mortgage
206. 505. Pa off of second Mort a e
207, 506.
208. 507. De it disb,asrooeeds
209. 508.
Ad'usfmants For items Un aid B Seller 509.
210. Coun Boro Taxes
'
211. S Tax to Ad stmants For Items Un aid B Selier
510. Coun /Boro Taxes
212. School Tax to 511. C' Tax to
213. to 512. School Tax to
214. 513. to
215. 514.
216. 515.
217. 516.
218, 517,
219, 518,
220. TOTAL PAID BY/FOR BUYER 519.
1,000.00 520. TOTAL REDUCTIONAMOUNT DUE SELLER
300. GASH AT SETTLEMENT FROM/TO BUYER: 5,610.96
301. Gross mount Due From B er Line 120 600. CASH AT SETTLEMENT TOIFROM SELLER:
302. Less Amount Paid /For Buyer(Line 220) 80,324.79 601, Gross Amount Due To Seller Line 420
( 1,000.00) 602, Less Reductions Due Seller Line 520) 78'421'79
303. GASH(X FROM)( TO}BUYER ( 5,610.96
79,324.79 603. CASH(X TO)( FROM)SELLER
The undersigned hereby acknowledge receipt of a Completed copy of pages,i&2 of this statement&any attachments referred to herein. 72,810-83
Buyer
Robert S Cx:arino Seller /� .. 4�
state Of Betty J.King -
Page 2
L.SETTLEMENT CHARGES
709.TOTAL'COMMISSION Based on Price $ 77,500.00 @ 5.0000% 3,875.00 RAIDFROM FIND FROM
Division of Commission ffi7e 700)as Follows: BUYERS SELLERS
701.$1,937.50 to SPENCER&SPENCER REALTORS FUNOSAT FUNDSAT
702.$ 1,937,50 to CENTURY 21 ABETTER WAY SETTLEMENT SETTLEMENT
703.Commission Paid at Settlement 3,875.00
704. BROKERAGE FEE . to CENTURY 21 ABETTER WAY 265.00
800.ITEMS PAYABLE IN CONNECTION WITH LOAN
801.Loan Origination Fee % to
802.Loan Discount % to
803.Appraisal Fee to
804. Credit Report to
805. Lender's Inspection Fee to
806. Flood Cent Fee to
807.Tax Service Fee to
808. Document Prep Fee
C0-9
810.
811.
900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901.Interest From to @ $ /day days %)
902. Mortgage Insurance Premium for months to
903.Hazard Insurance Premium for years to
904.
905.
1000.RESERVES DEPOSITED WITH LENDER
1001.Hazard Insurance @ $ per
1002.Mortgage Insurance @ $ per
1003.CountylBoro Taxes @ $ per
1004. City.Tax @ $ per
1005.School Tax @ $ per
1006. @ $ per
1007. 0 $ per
1008. AGGREGATE ADJUSTMENT 0 $ per 0.00
11100.TITLE CHARGES
1101. Settlement or Closing Fee to
1102. Abstract or Title Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Document Preparation to DEED
1106. Notary Fees to C21 A Better Way 5.00 10,00
11107. Attorneys Fees to
(Lncfudes above item numbers:
1108. Title Insurance to PURITY ABSTRACT COMPANY 779.00
indudes above item numbers:
1109.Lender's Coverage $
1110.Owner's Coverage $ 77,500.00 779.00
1111. Tax oerfee to PURITY ABSTRACT COMPANY 4.00
1112.
1113.
1200.GOVERNMENT RECORDING AND TRANSFER CHARGES
1201.Recording Fees: Deed $ 79.00;Mortgage $ Releases$ 7900
1202.CWountyTax/Stam ps: Deed 775.00:Mortgage 775.00
1203.State TayiStamps: Revenue Stamps 775.00;Mortgage 775.00
1204. RECORDER OF DEEDS
1205. RECORDER OF DEEDS
1300.ADDITIONAL SETTLEMENT CHARGES
1301.Survey to
1302,Pest Inspection to
1303. FINAL SEWER&WATER to BOROUGH OF CARLISLE 95.44
1304. 2015 COUNTY/BOROUGH TAXES to CHARLES HOLTRY,TAX COLLECTOR 851.52
1305.
11400.TOTAL SETTLEMENT CHARGES (Enter on Lines 103,Section J and 502,Section K) 1,903.00 5,610.96
By sigring page I dais statement,W*$190orim ackmWedga receipt of a canpietexf copy dpage 2ofhs two page Stefan
7141
PURITYABSTRAC TMPANN�
Settlement Agent
Certified to be a true copy,