HomeMy WebLinkAbout06-10-15 (2) J pennsytvania 15051314105
DEVA-EW DE REVENUE EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
INHERITANCE TAX RETURN .PO BOX 280601 ( I ` -�
Harrisburg, PA 17128-0601 RESIDENT DECEDENT ! I 14- l cll
ENTER DECEDENT INFORMATION BELOW
Social Secu_dtyW_Number Date of Death MMDDYYDate of Birth MMDDYYYY
( ..........._...........__........._..._..._..__........_........... --..........
_.
. .__ .._...........__..... _.._......_ ......
.. _....,__....... _- (^09102014...._._......_._........__....... _- 07041961......................._..-.....-......__..........._I
Decedent's Last Name Suffix Decedent's First Name Mi
Do
Gettel nald [—]
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
.. ...
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
(W 1. Original Return Q 2. Supplemental Return Q 3. Remainder Return(date of death
prior to 12-13-82)
Q 4.Agriculture Exemption(date of Q 5. Future Interest Compromise(date of Q 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
Q 7. Decedent Died Testate Q 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
Q 10. Litigation Proceeds Received Q 11. Non-Probate Transferee Return Q 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
Q 13. Business Assets C=:) 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
Tricia D. Naylor, Esquire (717) 249-6873
First Line of Address
119 W. South Street
Second Line of Address
i E�
- -
-----...-----------__.__ _�.____ 1�r1
City or Post Office State ZIP Code _ .......... �
Carlisle PA 17013 2M u{
Correspondent's email address: tnaylor@baricscherer.00111 r r-1 C) ;:0
REGISTER OF WILLS USE 45 Y ~
_r
I- REGISTER OF WILLS USE ONLY * N 1 "• C-
DATE FILED MMDDYYYY W r°
- - - r"'
Cf) ,
=
Cil1
DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY
Side 1
4 1505614105
1505614205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: Donald L. Gettel
RECAPITULATION
1. Real Estate(Schedule A). . .. . .. .... ... .... .. .. .... ... .. ... ... ..... ... 1. 60,000.00
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. 8,514.61
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. 68,514.61
9. Funeral Expenses and Administrative Costs(Schedule H).. .. ......... . .... . 9. 13,597.03
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).. .... ......... 10. 5,911.29
11. Total Deductions(total Lines 9 and 10).. . .... ... .......... .... .. .. ... .. 11. 19,508.32
12. Net Value of Estate(Line 8 minus Line 11) .. . . .... ....... . ... ...... .... . 12. 49,006.29
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. 49,006.29
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 49,006.29 16. 2,205.28
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. 2,205.28
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
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.
SIGNATURE OF PERS RESPONSIBLE FOR ILIfJ,G RETURN DATE
ADDRESS
1 qP Logan Dr, Rm. 107, Dillsburg, PA 17019
SIGRE OF PRE R OTHE PERSON RESPONSIBLE FOR FILING THE RETURN DIE
a s
ADD SS
19 W. South Street, Car Is , 17013
111g11111111 1111t111111111 Side 2 J
L 6 4 1505614205
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Donald L. Gettel
STREETADDRESS
19 N. Queen Street
CITY '^ �^ STATE ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 2,205.28
2. Credits/Payments
A.Prior Payments
B.Discount
(See instructions.) Total Credits(A+B) (2) 0.00
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) 2,205.28
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?.............................................................................................................. ❑
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? ........................................................................................................................ ❑
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)j.
• 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.§911 6(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
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Donald L. Gettel 21-14-1017
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
I' 19 North Queen Street,Shippensburg,PA 17257 60,000.00
TOTAL(Also enter on Line 1, Recapitulation.) $ 60,000.00
If more space is needed,use additional sheets of paper of the same size.
REV-1508 EX+(02-15)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Donald L. Gettel 21-14-1017
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- Misc.Personal Property-sold at auction(net proceeds) 905.93
2. Orrstown Bank checking account#000625736 6,958.68
3. PA Property Tax Rebate 650.00
TOTAL(Also enter on Line 5, Recapitulation) $ 8,514.61
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
Donald L. Gettel 21-14-1017
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Fogelsanger-Bricker Funeral Home Inc. 3,786.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representatives)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: 2,400.00
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: 215.50
5. Accountant Fees:
6. Tax Return Preparer Fees: 120.00
7• Legal Advertising-CCLJ$751 Sentinel$158.68 233.68
8. Orrstown Bank-estate account checks 16.75
9.. Cumberland County Landfill-dispose of trash 33.35
10. Walmart-cleaning supplies to prepare real estate for sale 33.00
11. Lowes-cleaning supplies to prepare real estate for sale 23.20
12. See attached Continuation Schedule 6,735.55
TOTAL(Also enter on Line 9, Recapitulation) $ 13,597.03
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
Donald L. Gettel 21-14-1017
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
I Forest Park Health Center-nursing home care 4,329.20
2. Walgreens Specialty Pharmacy-medicine 86.34
3. Carlisle Medical Group,Inc.-medical 30.00
4. Pinker&Associates-medical 85.00
5. Hershey Kidney Specialists Inc.-medical 80.00
6. Carlisle Regional Medical Center-medical 1,300.75
TOTAL(Also enter on Line 10, Recapitulation) $ 5,911.29
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(02-15)
V& pennsylvania SCHEDULE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Donald L. Gettel 21-14-1017
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. Anna G.Gettel, 153 Logan Dr.,Rm.107,Dillsburg,PA 17019 mother 100%
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.
t OMB Approval No.2502-0265
A. Settlement Statement (HUD-1)
of Loan
1.❑FHA 2.❑RHS 3. XQ Conv.Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number:
MH15-42215 7529023
4.E]VA 5.❑Conv.Ins.
C.Note:This form is fumished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agents are shown.Items marked
"(p.o.c)"were paid outside the closing;they are shown here for informational purposes and are not included in the totals.
D.Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender:
BROCK D.GRIM,BROOKS J.GRIM ESTATE OF DONALD L.GETTEL ACNB BANK
BOX 171,ARENDTSVILLE,PA 17303 16 Lincoln Square,Gettysburg,PA 17325
G.Property Location: H.Settlement Agent: I.Settlement Date:05/08/2015
19 NORTH QUEEN STREET HomeSale Settlement Services Disbursement Date:05/08/2015
SHIPPENSBURG,PA 17257 BHHS HomeSale Services,1444 Baltimore Street,Hanover,
Shippensburg Borough PA 17331
Place of Settlement: TitleExpress
BHHS HomeSale Services,1444 Baltimore Street,Hanover, Printed 05/07/2015 at 10:55 am
PA 17331 by TOM
of Borrowers
J.Summ Transaction K.Summary of Seller's Transaction
100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller
101. Contract sales price 60,000.00 401. Contract sales price 60,000.00
102. Personal property 402. Personal property
103. Settlement charges to borrower(line 1400) 3,841.66 403.
104. 404.
105. 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller In advance
106. City/town taxes 05/08/2015 to 12/31/2015 148.36 406. City/town taxes 05/08/2015 to 12/31/2015 148.36
107. County taxes 05/08/2015 to 12/31/2015 136.82 407. County taxes 05/08/2015 to 12/31/2015 136.82
108. School taxes 05/08/2015 to 06/3012015 123.89 408. School taxes 05/08/2015 to 06130/2015 123.89
109. Library taxes 05/08/2015 to 12/31/2015 8.92 409. Library taxes 05/08/2015 to 12/31/2015 8.92
110. Fire taxes 05/08/2015 to 12131/2015 13.09 410. Fire taxes 05/08/2015 to 12/31/2015 13.09
111. Street light taxes 05108/2015 to 12/31/2015 8.10 411. Street light taxes 05/08/2015 to 12/31/2015 8.10
112. I 412.
120• Gross Amount Due from Borrower 64,280.84 420. Gross Amount Due to Seller 60,439.18
200. Amounts Paid by or in 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 loan(s) 4800.00 502. Settlement charges to seller(line 1400) 9,048.21
203. Existing loa s taken subject to 503. Existing loa s taken subject to
204. 504. Payoff of first mortgage loan
205. 505. Payoff of second mortgage loan
206. 506.
207. 507.
208. 508.
209. Application Fee Credit 600.00 509.
Ad ustments for Items unpaid by seller Adjustments for items unpaid by seller
210. City/town taxes to 510. City/town taxes to
211. County taxes to 511. County taxes to
212. School taxes to 512. School taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220• Total Paid by/for Borrower 49,600.00 520. Total Reduction Amount Due Seller 9,048.21
300. Cash at Settlement fromlto Borrower 600. Cash at Settlement tolfrom Seller
301. Gross amount due from borrower(line 120) 64,280.84 601, Gross amount due to seller(line 420) 60,439.18
302. Less amounts paid by/for borrower(line 220) 49,600.00 602. Less reductions in amount due seller(line 520) 9,048.21
303. Cash ❑n From 1:1m o To
Borrower posse 14,6m80n.w8m4p,• 603. Cash ❑ To iFnrnossmalSeller
ellertormstbn OuNq t,he
e
51,390.97
'^b lW . eoZeEeremOeom ey sesptlbnThEp ; WkaiR
ebn pu
Previous
editions are obsolete Page 1 of 4 HUD-1
L.Settlement Charges
700. Total Real Estate Broker Fees $3,600.00 Paid From Paid From
Division of commission line 700 as follows: Borrower's Seller's
701. $1,800.00 to SHHSHOMESALEREALTY-H Funds at Funds at
702• $1800.00 to Remax Associates of Lancaster Settlement Settlement
703. Commission paid at settlement 3,600.00
704. Seller Broker Flat Fee to Remax Associates of Lancaster r 295.00
800. Items Payable in Connection with Loan
801. Our origination charge (Includes Origination Point 0.000%or$0.00) $615.00 (from GFE#1)
802. Your credit or charge(points)for the specific interest rate chosen $ (from GFE#2)
803. Your adjusted origination charges (from GFE A) 615.00
804. Appraisal fee to ACNB BANK/1 st American (from GFE#3) 500.00
805. Credit report to ACNB BANK/Equifax (from GFE#3) 31.66
806. Tax service to from GFE#3
807. Flood certification to ACNB BANK/1st American (from GFE 93) 10.00
808. to
900. hems Required by Lender to be Paid in Advance
901. Daily interest charges from from 0510812015 to 06/01/2015 @$6.1667/day from GFE#10) 1 148.00
902. Mortgage Ins.Premium for months to (from GFE#3)
903. Homeowner's insurance for 12 months to Montgomery&Weigle Insurance (from GFE#11) 729.00
904. months to from GFE#11
1000.Reserves Deposited with Lender
1001. Initial deposit for your escrow account (from GFE#9)
1002.Homeowner's Insurance months @$ 0.00/month $
1003.Mortgage Insurance months @$ 0.00/month $
1004.City Property Taxes months @$ 0.00/month $
1005.County Property Taxes months @$ 0.00/month $
1006.Assessments months @$ 0.00/month $
1007.Aggregate Adjustment $
1100.Title Charges
1101.Title services and lender's title insurance $ from GFE#4 952.00
1102.Settlement or closing fee to $
1103.Owner's title insurance-Old Republic Title Insurance Company $ from GFE#5 66.00
1104. Lender's title insurance-Old Republic Title Insurance Company $889.00
1105. Lender's title policy limit$48,000.00 Lender's Policy
1106.Owner's title policy limit$60,000.00 Owner's Policy
1107.Agent's portion of the total title insurance premium $738.70
to Homesale Settlement Services
1108. Underwriter's portion of the total title insurance premium $216.30
to Old Republic Title Insurance Company
1109. Deed Prep to Homesale Settlement 75.00
Services
1200. Government Recording and Transfer Charges
1201.Government recording charges $ (from GFE#7) 190.00
1202• Deed$79.00 Mortgage$111.00 Release$
1203.Transfer taxes $ (from GFE#8) 600.00
1204.City/County tax/stamps Deed$600.00 Mortgage$
1205.State Tax/stamps Deed$600.00 Mortgage$ 600.00
1206. Deed$ Mortgage$ Release$
1207. $
1300.Additional Settlement Charges
1301.Required services that you can shop for (from GFE#6)
1302. to $
1303.Tax Certification Fee to Shippensburg Borough Tax Office 20.00
1304.2015 County/borough taxes to Borough of Shippensburg 485.57
1305. to $
1306. Inheritance Tax Escrow to Homesale Settlement Escrow 3,750.00
1307.Final Water/Sewer/Recycle/Trash to Borough of Shippensburg 222.64
I I r M M Fl M I I IM 3,841.66 9,048.21
'Paid outside of dosing by(B)orrower,(S)eller,(L)ender,(I)nveslor,Bro(IQer."Credit by lender shown on page 1.-Credit by seller shown on page 1.
Previous editions are obsolete Page 2 of 4 HUD-1
Comparison of Good Faith Estimate GF and HUD-1 Charges Good Faith Estimate HUD-1
Charges That Cannot Increase HUD-1 Line Number
Our origination charge # 801 1,215.00 615.00
Your credit or charge(points)for the specific interest rate chosen # 802 0.00 0.00
Your adjusted origination charges # 803 1,215.00 615.00
Transfer taxes 1203 600.00 600.00
Charges That In Total Cannot Increase More Than 10% Good Faith Estimate HUM
Government recording charges # 1201 225.00 190.00
Appraisal fee #804 505.00 500.00
Credit report # 805 31.66 31.66
Flood certification # 807 10.00 10.00
# 1302 0.00 0.00
#
771.66 731.66
Increase between GFE and HUD-1 $ A0.00 or -5.1836%
Charges That Can Chane Good Faith Estimate HUD-1
Initial deposit for your escrow account # 1001 0.00 0.00
Daily interest charges from # 901 $6.116671day 97.50 148.00
Homeowner's insurance # 903 480.00 729.00
Title services and Iender'slitle insurance #.1101 . 1,099.00 952.00
Owner's title insurance-Old Republic Title Insurance Company. # 1103 66.00 66.00
#
Loan Terms
Your initial Than amount is $48,000.00
Yo&loan term is 30.years
Your initial interest rate is 4.8760%
Your initial monthly amount owed for principal,interest,and any mortgage. $254.02 includes
insurance is ❑X Principal
❑X Interest
❑Mortgage Insurance
Can yourinteresl rale rise? ❑X No. ❑Yes,it can rise to a maximum of %.The first change
will be on I I and can change again every years after I / . Every
change date,your interest rate can increase or decrease by %. Over the life of
the loan,your interest rate is guaranteed to never be lower than %or higher
than %.
Even if you make payments on time,can your loan balance rise? ❑X No. ❑Yes,it can rise to a maximum of$
Even if you make payments on time,can your monthly amount owed for ❑X No. ❑Yes,the first increase can be on / / and the monthly
principal,interest,and mortgage Insurance rise? amount owed can rise to$
The maximum it can ever rise to is$
Does your loan have a prepayment penalty? ❑X No. ❑Yes,your maximum prepayment penalty is$
Does your loan have a balloon payment? ❑X No. ❑Yes,you have a balloon payment of$ due in
years on I / .
Total monthly amount owed including escrow account payments (K You do not have a monthly escrow payment for Items,such as property taxes
and homeowner's insurance. You must pay these Items directly yourself.
❑You have an additional monthly escrow payment of$
that results in a total initial monthly amount owed of$ This includes
principal,interest,any mortgage insurance and any items checked below:
❑Property taxes ❑Homeowner's insurance
❑Flood Insurance ❑
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender.
Previous editions are obsolete Page 3 of 4 HUD-1
Itemization of Line r
Name of Borrower: Name of Seller: File Number:
BROCK D.GRIM ESTATE OF DONALD L.GETTEL MH15-42215
BROOKS J.GRIM
Prepared 05/07/2015 at 10:55 am
Note:This page displays an itemization of the charges shown on line 1101 of the HUD-1 Settlement Statement.This page
accompanies but is not a part of the HUD-1 Settlement Statement.if a discrepancy exists,the information on the HUD-1 Settlement
Statement applies.
1100.Title Charges Total Charge Borrower Seller
1101.Title services and lender's title insurance to
Notary Fee to TOM COYNE $ 30.00 30.00
Wire Fee to Homesale Settlement Services $ 15.00 15.00
Overnight and Handling Fee to UPS $ 18.00 18.00
1102.Settlement or closing fee to $ 0.00
1104.Lender's title insurance-Old Republic Titleto Old Republic Title Insurance Cor$ 889.00 889.00
Totals: $ 952.00 0.00 952.001 0.00
Seller/Lender credits shown on page 1 POC=paid Outside Closing CR=Lender Credit
Previous editions are obsolete Page 1 of 1 HUD-1
Signature Page
HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is a true and accurate 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.
BROC D.GRIM
BROOKS J.GRIM
ESTATE OF DONALD L.GETTEL
7V=A ayzk 0�
Settlement Agent
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction.I have caused or will cause the funds to be
disbursed in accordance with this statement.
1
SETTLEMENT AGENT DAT
WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010.
Previous editions are obsolete Page 4 of 4 HUD-1
Continuation of Schedule H
Estate of File Number
Donald L. Gettel 21-14-1017
ITEM
NUMBER DESCRIPTION AMOUNT
1. Tonya Crouse—cleaning/maintenance 575.00
2. Bob O'Donnell—cleaning/maintenance/hauling 530.00
3. Corey O'Donnell—trash removal/hauling 450.00
4. Shippensburg Borough - water/sewer/trash 321.52
5. Remax Associates of Lancaster(broker fee and 3,895.00
Commission)
6. Homesale Settlement Services—deed prep 75.00
7. PA Realty Transfer Tax 600.00
8. Tax Certification Fee 20.00
9. 2014-15 Real Estate Taxes (taxes paid of$485.57 46.39
minus tax reimbursement $439.18)
10. Shippensburg Borough- final water/sewer/trash 222.64
Total $ 6,735.55