HomeMy WebLinkAbout06-22-15 (2) � 15�5614134
EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 0 6 2 9
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 6 1 9 2 0 1 4 0 4 3 0 1, 9 4 1,
DecedenYs Last Name Suffix DecedenYs First Name MI
S H E L L E N B E RG E R D 0 R C A S M
(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
� 1.Original Return � 2.Supplemental Return � 3. Remainder Return(date of death
Priorto 12-13-82)
� 4.Agriculture Exemption � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required
(date of death on or after 7-1-2012) death after 12-12-82)
Q 7. Decedent Died Testate � 8. Decedent Maintained a Living Trust � 9.Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
� 10. Litigation Proceeds Received � 11. Non-Probate Transferee Return � 12. Oeferral/Election of Spousal Trusts
(Schedule F and G Assets only)
❑ 13. Business Assets ❑ 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
J A C Q U E L I N E A K E L L Y 7 ], 7 5 4 1 5 5 5 0
First Line of Address
J A N L B R 0 W N & A S S 0 C
Second Line of Address
B 4 5 S I R T H 0 M A S C T S T E 1, 2
City or Post Office State ZIP Code
H A R R I S B U R G P A 1 7 1, � 9
Correspondent's e-mail address: JACKIE@JANBROWNLAW.COh1
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I REGISd'BR OF WILLS l�ONL"Y' � �
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STER OF WILLS USE ONLY , � f�-'= > r.>
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PLEASE USE ORIGINAL FORM ONLY
Side 1
I IIIII)IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII I'II IIII
� 1505614134 ],50561,4134 J
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� 1505614234
REV-1500 EX(FI) DecedenYs Social Security Number
oecedent'sName: DORCAS M - SHELLENBERGER
RECAPITULATION
1 3 0 � 0 0 . 0 0
1. Real Estate(Schedule A) �
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 1 6 1 . 8 6
6. Jointfy Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. •
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested . . . . . . . 7. •
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 3 2 1 6 1 , 8 6
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9 2 3 3 3 4 . 4 3
10. Debts of Decedent,Mortgage Liabilities, and Liens(Schedule I) . . . . . . . . . . . . . 10. 8 3 9 D 8 . 9 6
��. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 0 7 2 4 3 . 3 9
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . �z 2 4 9 1 8 . 4 7
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. 2 4 9 1 8 . 4 7
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 _ � . � O 15. O . � �
16. Amount of Line 14 taxable
at linea�rate X.045 2 4 9 ], 8 . 4 7 �g. 1 1 2 1 . 3 3
17. Amount of Line 14 taxable
at sibling rate X.12 � . � � 17. 0 • � 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 • � � 18. 0 • � �
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1 1 2 1 • 3 �
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 staterrients,and to the best of my knowledge and belief,
it is true,correct and complete.Declar tion pr parer other than the person responsible for filing the return is based on all information of which preparer has
any knowledg .
SIGNATUR F RS S�S FOR FILING RN DATE
,� � 6/12/201,5
ADDRESS '�
7732 JONESTOWN � HARRISBURG PA 171],2
SIG TURE OF P PARER OTH R T AN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
^ 6/12/2015
RES
45 SIR THOMAS CT STE 12 HARRISBURG PA 171,09
I IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII I�II IIII Side 2
� 1505614234 15�5614234 �
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 2� �a 0629
DECEDENT'S NAME
DORCAS M. SHELLENBERGER
_ _ _ — __ . ______ _ – -
STREET ADDRESS
211 Wood Street
East Pennsboro Township
__ __ ___ _---- ---
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,121.33
2. Credits/Payments
A.Prior Payments
B.Discount
(See instructions.) Total Credits(A+B) (2) 0.00
3. Interest
(3) 8.45
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) 1,129.78
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 ............................... ❑ ❑
X
c. retain a reversionary interest ..........................................�......................................................... ❑ ❑X
d. receive the promise for life of either payments,benefits or care. .......................................................
2. If death occurred after Dec.12, 1982,tlitl 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? ......... ❑ ❑X
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,antl 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 tlates of death 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 imposed on the net value of transfers to or for the use of the decetlent'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 decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is definetl,
under Section 9102,as an individual who has at least one parent in common with the tlecedent,whether by blood or adoption.
REV-1502 EX+(12-12)
pennsylvania SCHEDULE A
DEPARTMENT Of REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DORCAS M. SHELLENBERGER 21 14 0629
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market ualue is defined as the price at which property
woultl be exchanged between a willing buyer antl a willing seller,neither being compelled to buy or sell,both having reasonable knowletlge of the relevant facts.
Real property that is jointlyowned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Inclutle a copy of the deed showing decedenYs interest if owned as tenant in common. VALUE AT DATE
NUMBER OFDEATH
DESCRIPTION
1 211 Wood Street, East Pennsboro Township, Cumberland County, PA 130,000.00
Property ID 09-20-1850-218
Value as shown on Settlement Statement dated 1/30/15
TOTAL(Also enter on Line 1,Recapitulation.) $ 130 000.00
If more space is needed,use additional sheets of paper of the same size.
REV-1508 EX+(OS-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCETAXRETURN pERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DORCAS M. SHELLENBERGER 21 14 0629
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. PSECU Savings (S1) 48.67
2 PSECU Checking (S4) 211.06
3 Tax and sewer reimbursement per Settlement Statement dtd 1/30/15 910.13
4 2003 Lincoln Town Car Signature Sedan; VIN 1 LNHM82W43Y672006 992.00
Value based upon Kelley Blue Book
TOTAL(Also enter on Line 5,Recapitulation) $ 2 161.86
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DORCAS M. SHELLENBERGER 21 14 0629
DecedenYs debts must be reported on Schedule[.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Heritage Cremation 1,389.02
B, ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paitl:
2, attomey Fees: Jan L Brown &Associates 6,671.00
3, Family Exemption:(If decedenYs atldress is not the same as claimanYs,attach explanation.)
Claimant
Street Atldress
City State ZIP
Relationship of Claimant to Decedent
4, Probate Fees: Cumberland County Register of Wilis 383.50
5 AccountantFees: Parks & Company 305.00
6. Tax Return Preparer Fees:
7. Adm expenses incurred to preserve/liquidate real estate:
8 Pennsylvania American Water 302.29
9 PPL Electric Utilities 952.80
10 Presale cleaning and hauling 600.00
11 Smart Clean 329.95
12 UGI Utilities 380.49
13 Settlement charges per Settlement Statement dated 1/30/15 12,020.38
TOTAL(Also enter on Line 9,Recapitulation) $ 23 334.43
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DORCAS M. SHELLENBERGER 21 14 0629
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. PSECU Equity Loan L50; payments 516.52
secured by 211 Wood Street, East Pennsboro Township, Cumberland County
2 PSECU Equity Loan L50; payoff per Settlement Statement; 55,566.98
secured by 211 Wood Street, East Pennsboro Township, Cumberland County
3 PSECU Equity Loan L51; payments 141.87
secured by 211 Wood Street, East Pennsboro Township, Cumberland County
4 PSECU Equity Loan L51; payoff per Settlement Statement; 17,408.64
secured by 211 Wood Street, East Pennsboro Township, Cumberland County
5 AscensionPoint Recovery Services LLC; 1,290.40
fbo Comenity Capital Bank- HSN claim
6 AscensionPoint Recovery Services LLC; 2,722.22
fbo Synchrony Bank- PayPal Extras MasterCard claim
7 EnerBank USA; Loan 1107200141 3,000.00
8 PSECU PSL Loan L1 262.33
9 PSECU Visa Loan L9 3,000.00
TOTAL(Also enter on Line 10,Recapitulation) $ g3 908.96
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(Ot-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DORCAS M. SHELLENBERGER 21 14 0629
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. Robert L Shellenberger Jr, son Lineal
7732 Jonestown Rd, Harrisburg, PA 17112 100% residue
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 atlditional sheets of paper of the same size.
LAST WILL AND TESTAMENT
� OF
DORCAS M. SHELLENBERGER
I, DORCAS M. SHELLENBERGER, now domiciled in Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament. I revoke all other wills and codicils
that I may have previously made.
Article I
My just debts and expenses of my last illness,funeral, and administration of my estate shall
be paid by my Executor from the principal of my residuary estate as soon as practicable after my
death.
Article II
All inheritance,estate,and succession taxes(including interest and penalties thereon,but not
including any generation skipping tax) payable by reason of my death shall be paid out of and be
charged generally against the principal of my residuary estate without reimbursement from any
person. This provision is not a waiver of any right which my Executor has to claim reimbursement
for any such taxes which become payable as the result of any property over which 1 have the power
of appointment. -
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Article III
I give, devise and bequeath in accordance with any memorandum which I have either
handwritten or signed, located with my will or with my valuable papers and found within 30 days of
the probate of my will. Gifts may only be to persons who survive me or to organizations which exist
at my death, and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate,I give,devise and bequeath to my son,ROBERT L. SHELLENBERGER,Jr.,of Dauphin
County,Pennsylvania. In the event that ROBERT L.SHELLENBERGER,Jr.predeceases me or
fails to survive me by thirty (30) days, I give, devise and bequeath the remainder of my estate, of
whatsoever nature and wheresoever situate to ROBERT L. SHELLENBERGER, Sr., of
Cumberland County, Pennsylvania. In the event that ROBERT L. SHELLENBERGER, Sr.
predeceases me or fails to survive me by thirty(30)days, I give,devise and bequeath the remainder
of my estate,of whatsoever nature and wheresoever situate to my sister-in-law,MARILYN MILES,
of Cumberland County, Pennsylvania.
Article V
I nominate, constitute, and appoint my son, ROBERT L. SHELLENBERGER, Jr. as
Executor of my Last Will and Testament. In the event of the renunciation, death,or inability to act,
for any reason whatsoever of my Executor, I nominate, constitute and appoint ROBERT L.
SHELLENBERGER, Sr., as successor Executor of my Last Will and Testament. In the event of
the renunciation, death, or inability to act, for any reason whatsoever of ROBERT L.
....,«�w iA��ia-�:ir�e•rnr� r
SHELLENBERGER, Sr., I nominate, constitute and appoint YIARILYN MILES as successor
Executrix of my Last Will and Testament. I direct that my Executor or successor Executors be
permitted to serve without bond and in addition to those powers granted by law, I grant them power
to distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could
have filed if living. My Executor or successor Executors shall receive reasonable compensation for
services rendered to my estate.
Article VI
In addition to the powers conferred by law,I authorize my Executor and successor Executors,
in his/her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real estate or
personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(� to file any federal income tax return for any year for which I have not filed such return
prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
- 3 -
Executor; and to pay from my estate reasonable compensation for ail their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have an
interest in at time of my death, and
(j)to receive reasonable compensation in accordance with their standard schedule of fees in
effect while their services are performed.
IN WITNESS WHEREOF, I, DORCAS M. SHELLENBERGER, hereby set my hand to
this my Last Will and Testament, on � "` � 2007.
�, � f ��: �,��.��
T �.�0 1 �7�c F� �
_ DORCAS M. SHELLENBERGER
In our presence, the above-named DORCAS M. SHELLENBERGER signed this and
declared this to be her Last Will and Testament and now at her request, in her presence, and in the
presence of each other, we sign as witnesses.
Name Address
845 Sir Thomas Court,Suite 12,HarrisburQ,PA 17109
1 • � '�� 845 Sir Thomas Court,Suite 12,Harrisburg,PA 17109
- 4 -
I, DORCAS NI. SHELLENBERGER, Testatrix, who signed the foregoing instrument,
having been duly qualified according to law, acknowledge that I signed and executed this instrument
as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein
expressed.
Sworn to or affirmed and
acknowledged before me by
DORCAS M. SHELLENBERGER, the Testatrix
on / � ;� 2007.
, �' /�
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�1ota�'y, Public DORCAS M. SHELLENBERGER
�
COMMONYVEACTH OF PENMSVIVANiA
NQTRRlAL SEAL
JACQUf.LINE A.KELLY,NOiARY PUBLIC
LOVrER PAXTON TW�,DAUPH{N COl1NTr
MYCOh1iviiSSION E:tPlfiES CEC.!7,2007
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute this
instrument as her Will;that she signed and executed it willingly as her free and voluntary act for the
purposes therein expressed;that each of us in her sight and hearing signed the Will as witnesses,and
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me �
by�Z3-�dra _
and �f c�� ;�{j � 5�7�° , Witness
witnesses, on �� o� , 2007. � ��/� �/
� ��C��l/L � - l ,c.Sl�
/ �� � � tness
,�-'l�-C 'CCt�,/ � /�--C��
Nptary ;� blic �
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COMMONYYEALTH OF PENNS1f1.VANU
NOTARIAL SEAL - S -
UtCQUELINE A.KEILY,NOTARY PUBLIC
tDWER PAXTON TWP.,DAUPNIN COUNir
MN COMMISSION IXPIRES DEC.1),2D01
�aar��orir �n a�m� ..
�4�a� OMB A
''�; pproval No.2502•0265
��,��j�j��a A. Settlernenf Statement (HUD-'1) F�NA�
�����
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1.Q FHA Q.�]RH5 3.Q Conv.Unins. 6.File Number: 7.Loan Numbec 8.Mortgage Insurance Case Number.
CEi5-013A4
4.❑VA 5.❑Conv.Ins.
C.Note:TMs form is furnished to give you a slatement of aGual setttement costs.Amounla paid to anA by the seltlement agenls era snown.Items markeA
"(p.o.c)"were paid outside tho closin9;lhey are shown hera for infortnational pu�posas and ere not included in lbe tolols.
D.Name 8 Address of 8orrower: E.Name&Address of Seller: F.Name$Atldress of Lender:
JOHN J.LYNG THE ESTATE OF DORCAS M.SHELLENBERGER
53 Center SL,Nomell,NY 14843 7732 Joneslown Rd„HarrisWirg,PA 17112
G.Property Localion: H.Set�lemenl Agent: !.Seftlemenf Dale:0'U302015 �
211 WOOD STREET,EAST PENNSBORO Hnmesale Selllemenf Services,LTO Disbursemenl Uate:0'U;02015
TOWNSHIP 13�Cenleroille Road,Lancaster,PA 17603
CAMP HILL,('A 17011
tast Pennsboro 7ownship
Piace of Senlement: 7it�eF.xpress
131 Cen�erville Road,Lancasler,PA 17"op3 Prinled Oy28/2015 a( 1:36 pm
by BM
100. Gross Amounf Due'from Borrower d00. Gross Amount Due ta.Seller
101. ConiraCt sales price 130,�0.00 a01. Conlracl sales price ;30,ppp,r�p
102. Personal o ert 402. Persona! opert
1Q3. Selfemenl ctiaraes lo Eorraver;line 1400) 2,118.50 403.
104. 404.
105. 40.5.
Ad ustmenle for items aid b selier(n advance Ad ustments tar items afd b seller in advance
106. CilyAaxn laxes to 406. Cityltown laaes lo
107. County iaxes l0 407. County t�ces lo
108. Schod ta�ces 011301201510 O6(30/2015 816.fA 408. School tazes Otl30l20 1 5 10 0613012()15 815.66
109. Sewer and Trash 01130l2015 to 03131I2015 93.53 409. Sevrer and Trash 01130/2015!0 03/3112015 93.53
1t0. 41�,
tU. 4U.
112. 412.
10� Gross Amount Due from Borrower i39,028.63 q20. Gross Amount Due to SeUer 130,910.13
200. Amounts Paid b or in Behalf oi Borrower 500, Reductfons In Amount Due to 5eller
2Q1. Deposlt or eamest money 1,000.00 50t. Excess deposit(see inslruclbns)
202. Prindpal art�ounl ot newloan(s) 502. Setllement charges lo selter(line 1A00) 19,028.Jt
203. Existl loa s taken su 'ect to 503. Exislin loar�'s taken su ect lo
�' �� Payoff ol Ilrsl nwr4gage loan k0210302J5E-LOAN 50 55,566.98
to PSECU
�5' S�• Payoff ol second mortgage ban 1 i,408.64
�0210302358•LOAN 51 to PSECU
2(N'i. �
20). 507.
208, February Renl 700.00 508. Febnrary Reni 700.00
209. January Rent 45.56 509. January Renl q,.7&
Ad'usfinents forltems un atd b sNler Ad ustment9 for Items un ald b aallor
210. CityAovm laxes 01l01 Oi510 0113017.015 15.18 510. Cily/lown laxos O1f01120�5 to 07130/2015 15.18
211. County taxes 01/01l2015 l0 01l30I2015 33.89 511. Counly taxes 01l0112015 to 0113012015 's3.89
212. Schod laxes �0 512. Schod laxes Io
213. 513.
21A. 514.
215. 515. -
2tfi• 516.
217. 517.
218. 510.
219. 5f9. ~
220. Total Pald b IforBorrower 1,794.23 520. Tolal Redudion Amount Due 5eller 93,5gg,16
300. CashatSefUementfromRoBortower fiQO. CashafSettlementto(fromSelier
301. Gross arraunl due(rom hortower(line 120} 133A28.63 sp�. Gross artaunt due to seHer(line 420j 130,910.13
302. Less amounls pald bydw borrower(fine 220) 1,79A.23 602. Less reductions in ama;nl due seller(Gne 520) 93,59d.15
303. Cash .QX From � To Borrower 131,234.40 603. Cash QX To ❑ From Seller 37,311.97
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Previous editions are obsolete ~ Page 1 of 4 HUD-t
T00. Total Real Esfate Broker Fees S 7,80U.0;1 Paid From Paid From
Divfsionolcommission Iine700 aslWlows: Borro�n�er's Seller'.^,
��� ���•� �p BHHSFbmesaleRealty FUndS at FundS dt
70z• �9�� �o BHHSHc,mesaleReally Settlemert Settlement
�03. Commissbn paid a1 selllement ���
704. Buyer and Selier&dcer Fiat lee a BHHS Nwnesale Realty 225.00 22,.pp
800. Ilems Pa able In Connection with Loan
8D1. Our origina!ion charge (Includas Originaiion Ppin10.000%a$0.00) S (hom GFE#i)
802. Your credi(or charge(poinis)tor Ihe spedfic inleresl rate chosen y (from GFE 82) '
803• Your adjusled originalion charges �from GFE A) �'
004. A ais�fee lo from G�E�3
005. Credit re fo Irom GFE#3
8()6. 7ax service lo from GFE tl3
807. Flood ceriifica(ion ro irom GFE#3
�� lo
900. Items Re uired b Lender to be Paid In Advance
901. paily inlerest charges(rom irom OtI30lZp15 to 021Di12�t 5@ b0.00lday (Uan GFE gf0)
902. Mat e insurance remium moMhs lo from GFE q3
903. Hanernmets insurance mmlhs lo from GFE R11
�• monlhs to tran GFE A11
1000. eserves De sited with Lend r
1001.IniUal deposit tor your escrow accoun! ((ran GrE�9)
1002, Homeovmels insurance mc�n�hs�S Imonlh -
1003.Mort a insurance months 5 lmonlh
��•PfO��y��eS monlhs S 15.92/monih 5
1005.Counly taxes monihs 5 35.541monlh $
t006.School laxes monlhs 5 163.411rrqnlh S
10p7.Aggregale Adjusiment S
1100.Title Ch es
1101.7ipe seMces and lender'stifle insurance 5 from GFE#4 25(1.00
t 102.Settlement a cbsing lee lo Homesale SetOemem 5250.00
Services
1103. S trom GFE d5 �
1104.Lenders Ulle insurance y
1105.Lerbefs UUe pdicy limil E0.00 Lender's Pdicy
1108.Own�s lille policy lirtdt 5130,�00.00 Owners Policy
110).AgenCs porilon ot lhe tofal fitle insurance premfum g
lo CenUal Penn Seltiemenl Services,LLC
i108.Urdenvr4er's ponion ot the lolal titie insurance premium g
ro
ttos. �o ,
1110.Tiile Search Io Nomesale Selliement ygq.pp
Services
1111.NGary Io Nol Publk 5�
1200.Govemment Recordin and Transtor Char es
1201.Gwernment recording charges f (from GFE�7) ?g.pp
1202.Deed S79.D0 Mor!ga9e 3 R��lease b
1203.Ttans(er laxes S (from GF[#8) 1,30().00
72p4.City/Counly laxlslaunps Deed E1,300.00 Mori a e 3
12W.Slale Taz/s�amps peed S1,3pp.pp A�oA a e S 1.300.00
1206. DeedS Mon S
1207.e{le 4.�
1300.Additionai SetUement Char es
1301.Requlred services thal yqu can shop for (from GFE Nfi)
1302. to
1303. to
1304.Tax Cerl.Reimbursement to Homesale Seltlernent Servlees 10.
1305.2104 Sthool tax to Tax Clalm Bu2au of Cumberland Coun! 2,189,71
1306.Sewer Transfer(ee to"cast Pennsboro Trnmshi �p.pp
1307.Sewer and Trash l0 3131 lo Eas!Permsboro Townshi qq�
1 8.Legal lees lo Jan L Brown 8 Associates 6.671.0
1309,P In eritarxe Tax to CPSS Escrow Hd6 P.cco;ml f,186.
i i , :.:. : . �.:: , . : ' . '.,. , .. .' : :.1 .... . . � .. 2�118.50 19,828.31
'Pald oulslde of dosing by(B)arower,(S�ell�,(L�nder,(I)nvesta,Bro(i(�r."Credi!b lender stiown on
Y Pa9e i "'C��1 by seller shown on page t.
Previous editions are obsolete Page 2 0 4
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NUD CERTIFIrA71pN OF BUY@R pND SELI,ER
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