HomeMy WebLinkAbout07-01-15 1505610101
REV-1500 a(oi_io) 10
OFFICIAL USE ONLY
PA Department of Revenue pennsytvania
280601 OEIA-ENT OF NEVENVE County Code Year File Number
PO BOX
Bureau Individual Taxes INHERITANCE TAX RETURN
-=tl
Harrisburg,PA 1128-0601 RESIDENT DECEDENT !0
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 1 Z U13
J1 jgMEe_ _ ___13
Decedent's Last NameII Suffix Decedent's First Name MI
MMI
Z, / ED
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
I ____ — 1 0 0
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE.
IFF_[YLHJ_L1 11 REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1.Original Return O 2.Supplemental Return O 3. Remainder Return(date of death
- prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9:Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Sch.O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: -
Name Daytime Telephone Number-,3
--� F
REGI R-bF rqLLS USE ON )5
s— M M rT �.
r First line of address '
•/'' .". Ci' CD •'r-1 yip
Second line of address
r" rr
City or Post Office State ZIP Code DATE FILE
� 12Mc. b � �jo �
Correspondent's e-mail address: L--r&,),44+3 v ' 6A \) e 6 _ 4 I L C`
,41
Under penalties of pe'ury,I declare that I hsve examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,corn t and Omplete.DeclaratioV§f preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATUR PE ON ESPO S B FOR FILING RET -N DATE
ADDRESS b
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610101 1505610101
1505610105
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: r�
RECAPITULATION
1. Real Estate Schedule A. ...... ....... .... .. . ... ..... .... .... .... .... 1. I�I� I CT
c ) 7
2. Stocks and Bonds Schedule B . . ... .. .... . .... .... ....... ..... ....... 2. `J'L L�, �L�fl• �
( ) f �
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . ... 3. J U I i�;� •�
4. Mortgages and Notes Receivable(Schedule D) ..... ...... . .... ........ ... 4. J L_ J i,� J-� • �
I I ���� ia
5. Cash,Bank De osits and Miscellaneous Personal Pro e ) ��II�J L�J �J 7���J_lJ.J.I�.,•�J�,�
Deposits Property(Schedule E . ... ... 5. �,_
6. Jointly Owned Property(Schedule F) p Separate Billing Requested . .. .... 6. 'LJ L Lq! L '
I� O
7. • _J
C=D Separate Billingng . 7
Requested.. .... . .
Inter- ivos Transfers Miscellaneous Non-Probate Property
(Schedule G)
8. Total Gross Assets(total Lines 1 through 7)... .... .... .... .... .. .. ...... 8. fk �I' ;' I.
f .
L.��1J J� �
9. Funeral Expenses and Administrative Costs Schedule H . .... ........ .... 9. I
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) ....... . .... .. 10. f u u' � �'5311JC�,.'
11. Total Deductions( ) I !�si`LI �J -r-
Ll �
� ` of
( ) . .. .. ... 12.
12. Net Value of Estate(total
8 minus Line 11 11.
J �J z�LlJ�l
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ®•J-I
an election to tax has not been made Schedule J .......... .............. 13. Jl
14. Net Value Subject to Tax(Line 12 minus Line 13) ... ....... .... .... .... .. 14. J< lZ J I�IJ . I'�
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax ra
transfers and r c.9 _
X. 15
(a)(1.2)
16. Amount of Line 14 to lei {
at lineal rate X.0 16
17. Amount of Line 14 taxable
at sibling rate X.1217 u
C
18. Amount of Line 14 taxable
at collateral rate X.15 -� r • 18. f� •
19. TAX DUE .... .... ....... .... .... .. ......... .... .... ........ .... .. . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
1505610105 1505610105
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
STREET ADDRESS
CIN ' ^ 1 0 _ J� STATE ZIP /
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19)
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2)
3. Interest
(3) Q
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)
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;.......................................................................................... IDb. retain the right to designate who shall use the property transferred or its income;............................................ ❑
c. retain a reversionary interest;or.......................................................................................................................... El
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?.............................................................................................................. El3. 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 stepparent 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(1.2)[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 EXE(02-15)
Ti : pennsytvania SCHEDULE A
' DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF' FILE NUMBER:
�, �� �1 - 13 M- 0?--b r
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
IT I
p,4,6 �-
J
Awa
TOTAL(Also enter on Line 1, Recapitulation.) $ Da0.00
If more space is needed,use additional sheets of paper of the same size.
REV-1508 EX+ (02-15)
e' pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: „,y J` �`�� _ ? FILE NUMBER:
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
o
CA5 441,0 ,moo 1
sus��'�•��� ���
TOTAL(Also enter on Line 5, Recapitulation) $
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
A—I 'V,C.S , J C1 7c)1. 0
Cie
PDtiT Owp of-
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission Paid:
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
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL(Also enter on line 9, Recapitulation) $ i
(If more space is needed,insert additional sheets of the same size)
REV-1512 EXE(02-15)
pennsylvania
SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF /) Aa
c` �E NUMBER C)Z(6>
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
w I
TOTAL(Also enter on Line 10, Recapitulation) $ C 5 3l-0.00
If more space is needed,insert additional sheets of the same size.
Certificate of Cremation
We Certify that
Dorothy J Holtzman
(Name of Deceased)
Who died on the 2nd day of January 920 13
Was cremated by ICS Crematory on the 7th
day of January 2013
Permit No. 2013FO548655000 Tag No. 7366
ICS Crematory
By: �
"Serving All Of Florida"
Betty Newhouse,L.D.D.
Family Counselor
Cell:
941-626-6091
Ctrmation Society Inc.
Home
1-800-862-9602 941-743-0226
www.icscremation.com
+- ... __.. ...ev+-�T....�..fi- ...... ....._._.'r-. n-C.-at1h^�Y y...w -. _ 5 .. ..... _. ,01 .ts«a. p, . .e..'•r.,wt'^•+i h .A
i
•�~ I.C.S. CREMATION
0
SOCIETY, INC.
"Serving all of Florida!"
TEL: (800) 862-9602 FAX: (239) 549-9436
PAYMENT SHEET
NAME OF PURCHASER-_0 f tJ A, NUk7_, r CONTRACT
Check one: PAID IN FULL F PAYMENTSd
TOTAL AMOUNT OF CONTRACT$ f�A 4�0 PAID AMOUNT$ U
PAID BY: CHECK# 12-` AMOUNT_ r d t
PROCESSING FEE: CHECK# ------- -- AMOUNT
TRAVEL PROTECTION: CHECK# �- AMOUNT
CREDIT CARD: OUNT$ V�_
KIND: VISA MC
Name: 1
Account#
Expiration Date:
CAS $
PAID BY. RELATIONSHIP: .�
�j
ACCEPTED iB�'
I.C.S.CREMATION SOCIETY,INC.
t�UTHORIZED SIGNATURE DATE: j' f
ATTACH THIS COPY TO CONTRACT
FORM,Q218
C13
2620 Highlands Road #B •.Harbour Heights, FL 33983
,118 S. Market Street
103 W. M.ain.Street
Nfillersburg, PA 17061 Elizabetliville, PA 17023
P?PqPRP7""G0VER-E30YER
Bradley S. Boyer,CFSP FUNERAL HOMES, INC, Robert M.Stiaricbe,jr.
President dent/Supervisor Supervisor
The Rev.Nathan Corl Minnich, wrs,CFSP.MBIE
Funeral Director
DOROTHY HOLTZMAN:
Use of funeral home for Memorial Service..............................$400.00
Daily-Item..................................................................._120.00
Hurnmelstown Sun.............................................................45.00
Guestbook............... ................................................. ....50.00
Memorial folders............. ...... ...........................................50.00
Total............................................................................$665.00
Thank you,
Bradley Boyer
Hoover-Boyer Funerat Homes
Pborie:7 1.7.692.3298 or 717.361852? Fax:717.692-4.399 or 717.362.91345
Jfii6 !I)eed
TAX PARCEL NO. 47-19-1590-088
MADE THE l day of in the year two thousand twelve (2012)
BETWEEN MICHELLE M. GRASSI, single woman, of Wormleysburg, Pennsylvania,
Grantor,
AND
JOHN A. HOLTZMAN, single man, and DOROTHY J. HOLTZMAN, single
woman, of Shamokin Dam, Pennsylvania, as Joint Tenants with the
Right of Survivorship, Grantees,
WITNESSETH, that in consideration of ONE HUNDRED FIFTY-SEVEN THOUSAND---------
-----------------
--------------------------------
HOUSAND---------
-------------------------------------------------($157,000.00)----------------------------------Dollars,
in hand paid, the receipt whereof is hereby acknowledged, the said grantor does hereby
grant and convey to the said grantees, their heirs and assigns,
ALL THAT CERTAIN lot or parcel of land situate in the Borough of Wormleysburg, Cumber-
land County, Pennsylvania, bounded and described as follows:
BEGINNING at a point upon the western line of North Second Street and at the southern line
of Lot No. 286 on the hereinafter mentioned Plan, said point being 100 feet south of the
southwest comer of Second and Edna Streets; thence along the southern line of Lot Nos.
286 and 287 on said Plan, South 66' 30' West, 100.00 feet to a point; thence through Lot
Nos. 285, 283, 281, 279, 277, 275 and 273, South 23* 30' East, 140.00 feet to a point;
thence along the northern line of Lot Nos. 270 and 271 on said Plan, North 66' 30' East,
100.00 feet to the western line of North Second Street; thence along the western line of
North Second Street, North 230 30' West, 140.00 feet to the place of BEGINNING.
BEING Lot Nos. 272, 274, 276, 278, 280, 282 and 284 and the eastern 25 feet of Lot Nos.
273, 275, 277, 279, 281, 283, 285 as shown on Plan of RiverView as recorded in the Office of
the Recorder of Deeds in and for Cumberland County in Plan Book 1, Page 103.
And the said grantor does hereby Warrant Specially the property hereby conveyed.
IN WITNESS WHEREOF, said grantor has hereunto set her hand and seal the day
and year first above written.
Signed, Sealed and Delivered
in the Presence of
MICHELLE M. GRAS�j
STATE OF ' 1 �''�'U �l 'r COUNTY OF
On this, the M U1 day of Li[&C44'LILI2- , 2012, before me, a Notary Public,
the undersigned officer, personally appeared MICHELLE M. GRASSI, single woman, known
to me (or satisfactorily proven) to be the person whose'name is subscribed to the within
instrument, and acknowledged that she executed same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set m and and official seal.
_(SEAL)
Notary Public6/ `
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Teri L Walker,Notary Pubkc
Lemoyne Boro,Cumberland County
My Commisslon Expires Jan.20,2015
MEMBER,PENN MANIA ASSOCIATION OF NOTARIES r
'1
CERTIFICATE OF RESIDENCE
I do hereby certify that the precise residence of the within named grantee(s) is:
Attorney/Agent for Grantee(s)
Prepared by: Jack Gaughen Realtor ERA
s
HAVING THEREON ERECTED a dwelling commonly known and numbered as 644 N. Second
Street, Wormleysburg, Pennsylvania.
TOGETHER WITH the free and uninterrupted use, liberty, privilege of and passage to the
said Joel D. Henery and Jean J. Henery, his wife, their heirs and assigns, in or along a
certain alley or passage, of 5 feet in breadth and 50 feet in depth, extending out of and from
North 3rd Street, over Lot No. 273, as reserved in a prior Deed of George A. Ream and Mabel
Ream to Robert C. Sheely and Bobbie J. Sheely, his wife.
UNDER AND SUBJECT, NEVERTHELESS, to all restrictions, reservations, conditions,
covenants, easements and rights-of-way of prior record.
BEING THE SAME PREMISES which Joel D. Henery and Jean J. Henery, husband and wife,
by Deed dated October 25, 2006, and recorded October'30, 2006, in the Office of the
Recorder of Deeds in and for Cumberland County, Pennsylvania, in Deed Book 277, Page
1637, granted and conveyed unto Michelle M. Grassi, a single person, Grantor herein.
P�tppEN7OA-y OMB Approval No.2502-0265
,04 III�III ON
* * A. Settlement Statement (HUD-1) HUD-1
�Gr✓ 11!11111 ��
9B4N pEvE�O Page 1 of 3
B.Type of Loan
1.a FHA 2.❑RHS 3.❑Conv.Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number:
4.❑VA 5. X❑Conv.Ins. 401202859-SK 7126387591
C.NOTE: This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent 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 and Address of Borrower E.Name and Address of Seller F.Name and Address of Lender
JOHN A.HOLTZMAN AND DOROTHY J. MICHELLE M.GRASSI ERA HOME LOANS
HOLTZMAN 644 NORTH SECOND STREET 1 MORTGAGE WAY,
388 NORTH OLD TRAIL WORMLEYSBURG,PA 17043 MOUNT LAUREL,NJ 08054
SHAMOKIN DAM,PA 17876
G.Property Location H.Settlement Agent
SECURED LAND TRANSFERS,LLC
644 NORTH SECOND STREET, 485 ST.JOHNS CHURCH ROAD,
WORMLEYSBURG,PA 17043 SHIREMANSTOWN,PA 17011
Phone: (717)901-8342
COUNTY:CUMBERLAND
PARCEL ID:47-19-1590-088 Place of Settlement I.Settlement Date 11/19/2012
TOWNSHIP:WORMLEYSBURG BOROUGH 5050 LINGLESTOWN ROAD Disbursement Date 11/19/2012
HARRISBURG,PA 17112
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 $157,000.00 401. Contract Sales Price 157 000.00
102. Personal Property 402. Personal Property
103. Settlement charges to borrower line 1400 $6,319.67 403.
104. 404.
105. 1 405.
Adjustment for items paid by seller in advance Adjustment for items paid by seller in advance
106. Cit/Town Taxes 406. Cit/Town Taxes
107. County Taxes 769.0500/yr 1119 12 to 01/01/13 $90.35 407. County Taxes 769.0500/yr 1119 12 to 01/01/13 $90.35
108. Assessments 408. Assessments
109. School Taxes 1371.6600/yr 1119/12 to 07/01/13 $841.79 409. School Taxes 1371.6600/yr 1119/12 to 07/01/13 $841.79
110. Sewer 4th Qt 92.00/qtr for 11/19/2012 to 1/1/2013 $43.00 410. Sewer 4th Qt 92.00/qtr for 11/19/2012 to 1/1/2013 43.00
111. Trash 4th Qt 49.00/qtr for 11/19/2012 to 1/1/2013 22.90 411. Trash 4th Qt 49.00/qtr for 11/19/2012 to 1/1/201
22.90
112. 412.
120.Gross Amount Due from Borrower 1$164,317.7d 1420.Gross Amount Due to Seller 157,998.04
200.Amounts Paid by or in Behalf of Borrower 500.Reductions In Amount Due to Seller
201. Deposit or earnest money $2,000.00 501. Excess Deposits
202. Principal Loan Amount from ERA Home Loans $149,150.00 502. Settlement Charges to Seller $11,240.00
203. Existing loans taken subject to 503. Existing loans taken subject to
204. Seller Paid Closing Costs $2,000.00 504. Payoff of First Mortgage Loan to CitiMorta e Inc. $138,856.02
205. 505.
206. 506. Seller Paid Closing Costs $2,000.00
207. 507.
208. 508.
209. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210. Cit /Town Taxes 510. Cit /Town Taxes
211. County Taxes 511. County Taxes
212, Assessments 1 512. Assessments
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. SIB.
219. 519.
220.Total Paid b for Borrower $153 150.00 520.Total Reduction Amount Due Seller 152,096.02
300.Cash at Settlement from/to Borrower 600.Cash at Settlement to/from Seller
301. Gross amount due from borrower line 120 164 317.71601. Gross amount due to seller line 420 $157,998.04
302. Less amounts paid b /for borrower line 220 153 150.00 602. Less reductions in amount due seller line 520 $152,096.02
303.Cash X From L I To Borrower t $11,167.71 603.Cash X To From Seller 1 $5,902.02
The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting,reviewing,and reporting the data.This agency rpay not
collect this information,and you are not required to complete this form,unless it displays a currently valid OMB control number.No confidentiality is assured;thtd'"
Is mandatory.This is designed to provide the parties to a RESPA covered transaction with Information during the settlement process.
Initials
401202859-SK HUD-1 Page 2 of 3
L. Settlement Charges
700.Total Real Estate Broker Fees$9690.00
Paid From Paid From
Division of Commission line 700 as follows:
Borrower's Funds Seller's Funds
701. $4845.00 to ERA-NRT LLC(4,650+195 At Settlement At Settlement
702. $4845.00 to ERA-NRT LLC(4,650+195
703. Commission paid at settlement $195.00 $9,495.00
704.
800.Items Payable in Connection with Loan
801. Our origination charge $585.00 from GFE#1
802.Your credit or charge(points)for the specific interest rate chosen from GFE#2
803.Your ad usted origination charges from GFE A 585.00
804. Appraisal Fee to STARS from GFE#3 440.00
805. Credit report to CBC INNOVIS INC. from GFE#3 10.47
806.Tax Service from GFE#3
807. Flood Cert.Fee from GFE#3
808. Lenders Inspection Fee to STARS 75.00
809. Scoring Fee to FNMA 16.75
900.Items Required by Lender to Be Paid in Advance
901. Daily interest charges from 11/19/2012 to 12/1/2012 @ 14,50/day ERA (from GFE#10) $174.00
Home Loans
902. Mortgage Insurance Premium from GFE#3
903. Homeowner's Insurance USAA from GFE#11 673.29
904.
1000.Reserves Deposited with Lender
1001.Initial deposit for your escrow account from GFE#9 $747.66
1002.Hazard Ins.Reserve 3 Months @ 56,11 per Months ERA Home Loans $168,33
1003.Mortgage Ins.Reserve 0 Months @ 73.33 per Months ERA Home Loans
1004.City Property Taxes 10 Months @ 64.09 per Months ERA Home Loans $640.90
1005.School Taxes 2 Months @ 116.64 per Months ERA Home Loans $233.28
1006.A re ate Accounting Adjustment to ERA Home Loans 294.85
1007.
1100.Title Charges
1101.Title services and lender's title Insurance to Secured Land Transfers LLC from GFE#4 $1,620.00 $75.00
1102.Settlement or closing fee to Secured Land Transfers LLC $225.00
1103.Owner's title insurance to Secured Land Transfers LLC from GFE#5 $35.00
1104.Lender's title insurance to Secured Land Transfers LLC $1,300.00
1105.Lender's title policy limit $149,150.00
1106.Owner's title policy limit $157,000.00
1107.Agent's portion of the total title insurance premium to Secured Land $1,201.50
Transfers LLC
1108.Underwriter's portion of the total title insurance premium to TRGC-Sale $133.50
1109.Insured Closing Protection Letter to TRGC $75.00
1200.Government Recording and Transfer Charges
1201.Government recording charges from GFE#7 158.00
1202.Deed$62.00 Mortgage$96.00 Releases
1203.Transfer taxes from GFE#8 $1,570.00
1204.Cit Court tax Stam s Deed$1570.00 Mortgage
1205.State tax/stamps Deed$1570.00 Mortgage $1,570.00
1206.
1300.Additional Settlement Charges
1301.Required services that you can shop for from GFE#6 $19.50
1302.Pest inspection to Home Spec Inspections POC(Buyer)$45.00
1303.Fl000d Certification to STARS $19.50
1304.Deed Preparation to ERA-NRT LLC $100.00
1305,Radon Test and Home Inspection to Home Spec Inspections POC(Buyer)
305.00
1400.Total Settlement Charges(enter on lines 103,Section 3 and 502,Section K) $6,319.671 $11,240.00
If you have any questions about the settlement charges and loan terms listed on this form,please contact your lender.Settlement agent is not responsible for content of
lender's assessments on HUD.
The seller's and borrower's signatures hereon acknowledge their approval and signify their understanding that tax and insurance prorations and reserves are based on
figures for the preceding year or supplied by others or estimated for the current year,and in the event of any change for the current year,all necessary adjustments will be
made between borrower and seller directly.Any deficit delinquent taxes or mortgage payoffs will be promptly reimbursed to the settlement agent by the seller.
I haveefully revle ed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it Is true and accurate statement of all receipts and disbursements
made o y accou or by me in is transaction.I further certify that I have received a copy of the HUD-1 Settlement Statement.
BUYE S
John A- oltzman Michelle M.Grassi
Doroty J.Holtz /
The H D-1 Se lenient 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
accordanc ith this statement.
Settle ent g t� /i / e Date
11/19/2012
401202859-SK HUD-1 Page 3 of 3
Comparison of Good Faith Estimate GFE and HUD-1 Charges
Charges That Cannot Increase HUD-1 Line Good Faith HUD-1
Number Estimate
Our origination charge #801 $585.00 $585.00
Your credit or Charge(points)for the specific Interest rate chosen #802
Your adjusted origination charges #803 $585.00 $585.00
Transfer taxes #1203 $3,150.00 $1,570.00
Charges That in Total Cannot Increase More Than 10% HUD-1 Line Good Faith HUD-1
Number Estimate
Government recording charges #1201 $279.00 $158.00
Appraisal Fee #804 $440.00 $440.00
Credit Report Fee #805 $10.47 $10.47
Lender Inspection Fee #808 $17S.00 $75.00
Scorin Fee #809 16.75 16.75
Flood Certification #1303 19.50 19.50
Total [_ $940.721 $719.72
Increase between GFE and HUD-1 Charges 221.00 or -23.490to
Charges That Can Change Good Faith HUD-1
Estimate
Initial deposit for your escrow account #1001 $849.97 $747.66
Daily Interest charges #901 $74,50/day $174.00 $174.00
Homeowner's Insurance #903 $500.04 $673.29
Title Services-Lender's Insurance #1101 $365.00 $1,620.00
Owner's Title Insurance #1103 $1,208.75 $35.00
Loan Terms Loan Number: 7126387591
Your Initial loan amount is $149,150.00
Your loan term is 30 years
Your initial interest rate is 3.5 %
$743.09 Includes
Your initial monthly amount owed for principal,interest X Principal
and any mortgage insurance is X I interest
❑Mortgage Insurance
ElNo.❑Yes,it can rise to a maximum of %.The first
change will be on and can change again
Can your interest rate rise? every after _.Every change date,
your interest rate can Increase or decrease by %.Over
the life of the loan,your Interest rate is guaranteed to never be lower
than _%or higher than %.
Even if you make payments on time,can your loan balance X
rise? ❑No.❑Yes,It can rise to a maximum of$
Even if you make payments on time,can your monthly ❑No.❑ Yes,the first increase can be on and the
amount owed monthly amount owed can rise to$ The maximum It can
for principal,interest and mortgage Insurance rise?
ever rise to is$
aNo.❑Yes,your maximum prepayment penalty is$
Does your loan have a prepayment penalty? -
Does your loan have a balloon payment? Q No.❑Yes,you have a balloon payment of$ due in
years on
❑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.
QYou have an additional monthly escrow payment of$ 236.84
that results in a total initial monthly amount owed of$ 979.93
Total monthly amount owed including escrow account This Includes principal,Interest,any mortgage Insurance and any Items
payments 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.
Initials An
N��
HUD-1 Addendum
File Number: 401202859-SK Settlement Agent/Place of
Settlement:
Property Address: 644 NORTH SECOND STREET, Secured Land Transfers,LLC
WORMLEYSBURG,PA 17043 485 ST.JOHNS CHURCH ROAD,
SHIREMANSTOWN,PA 17011
COUNTY:CUMBERLAND Phone:(717)901-8342
PARCEL ID:47-19-1590-088
TOWNSHIP:WORMLEYSBURG BOROUGH
Seller(s): MICHELLE M.GRASSI
Buyer(s): JOHN A.HOLTZMAN AND DOROTHY J.HOLTZMAN Settlement Date: 11/19/2012
5:00:00 PM
Disbursement Date:11/19/2012
Loan Number: Lender:ERA Home Loans Mortgage Broker:
7126387591
Buyer Charges Seller Charges
New Loan Fees:
Loan Origination Fee%to ERA Home Loans $585.00
Line 803 Total: $585.001 $0.00
Appraisal Fee to STARS $440.00
Credit report to CBC INNOVIS,INC. $10.47
Lenders Inspection Fee to STARS $75.00
Scoring Fee to FNMA $16.75
Additional Settlement Charges:
Pest Inspection to Home Spec Inspections POC(Buyer)$45.00
Fl000d Certification to STARS $19.50
Line 1301 Total:1 $19.501 $0.00
Title and Escrow Charges:
Settlement/Closing Fee Buyer to Secured Land Transfers,LLC $225.00
Notary fee to Secured Land Transfers,LLC $20.00 $10.00
Lender's Coverage to Secured Land Transfers,LLC $1,150.00
100/300/900 to Secured Land Transfers,LLC $150.00
Insured Closing Protection Letter to TRGC $75.00
Payoff to Secured Land Transfers,LLC $45.00
Processing/Tax Cert.to Secured Land Transfers,LLC $20.00
Line 1101 Total:j $1,620.00 1 $75.00
Owner's Coverage to Secured Land Transfers,LLC $35.00
Line 1103 Total-1 $35.00 1 .00