HomeMy WebLinkAbout07-09-15 J ' pennsylvania 1505618403
DEPARTMENT OF REVEN
`EX(03-14)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburq, PA 17128-0601 RESIDENT DECEDENT 21 15 0043
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
01 06 2015 10 10 1959
Decedent's Last Name Suffix Decedent's First Name MI
BROCCOLO CARLO G
(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
prior to 12-13-82)
❑ 4. Agricultural Exemption(date of 5. Future Interest Compromise(date of 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
❑X 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. Deferral/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 TO:
Name Daytime Telephone Number
HUBERT X GILROY 717 243 3341
First Line of Address
10 EAST HIGH STREET
Second Line of Address
City or Post Office State ZIP Code
CARLISLE PA 17013
Correspondent's email address: hgilroy(cD_martsonlaw.com
REGISTMOF WILLS USNLY
S :;0 .
REGISTER OF WILLS USE ONLY Grn
._
DATE FILED MMDDYYYY p C`
D (�i7 CA
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D TETILEDDISTAM B rl
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Side 1
1505618403 1505618403 J
1505618411
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Broccolo, Carlo G.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 1-,030-,000 . 00
2. Stocks and Bonds(Schedule B)............................................................................. 2. 451,779 -85
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. 32,261 - 72
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 84,884 - 17
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............ 7. 387,136 - 07
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 1,986,061 - 81
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 168-,110 .00
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 8-,260 -16
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 176-,370 • 16
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 1,8 0 9,6 91 . 65
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. 1,809,691 •65
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.00 15. 0 . 011
16. Amount of Line 14 taxable
at lineal rate X .045 118091691 -65 16. 81, 436 - 12
17. Amount of Line 14 taxable
at sibling rate X.12 0 .00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18. 0 . 00
19. TAX DUE................................................................................................................ 19. 81, 436 - 12
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.
SIGNATURE R PON$I11W G� URN Maria G. BtOCCOIO DA7 6
ADDRESS ^-�(f�Q 't
139 OXWOIQ R0.1d, ech csb g, PA 17055
SIrZIE,��//L
A OTH HAN RESENTATIVE Hubert X. GilroyDATAD RESS
10 East High Street, Carlisle, PAI
1111111111111111111111111111111111111 IN Side 2
1505618411 1505618411
REV-1500 EX Page 3 File Number 21-15-0043
Decedent's Complete Address:
DECEDENT'S NAME
Broccolo, Carlo G.
STREET ADDRESS
139 Brindle Road
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 81,436.12
2. Credits/Payments
A. Prior Payments 70,000.00
B. Discount 3,684.21
Total Credits(A +B) (2) 73,684.21
3. Interest (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2,Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 7,751.91
Make Check Pa able 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;............................................................................... ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x
c. retain a reversionary interest;or............................................................................................................... ❑ ❑x
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑x ❑
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 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 January 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+(12.12)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Broccolo, Carlo G. 21-15-0043
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
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real Estate-605-607 Bridge Street-Real estate located at 605-607 Bridge Street, New 427,000.00
Cumberland Borough,Cumberland County, PA, known as Parcel No. 25-24-0811-042 and
being described in that certain Deed dated August 14, 2013 and being recorded on August
15, 2013 in Cumberland County at Instrument Number 201327113,and being conveyed to
Carlo Broccolo, Decedent herein.
Value is is sale price. See attached.
2 Real Estate-99 W Portland St, B&C -Real estate parcels located at 99 W Portland Street, 603,000.00
Mechanicsburg Borough,Cumberland County, PA, known as follows:
(1)Parcel No. 19-22-0519-071 B and being described in that certain Deed dated January 6,
2003 and being recorded on January 6, 2003 in Cumberland County Deed Book 255, Page
1118,and being conveyed to Carlo Broccolo, Decedent herein.
(2)Parcel No. 19-22-0519-071C and being described in that certain Deed dated April 15, 1996
and being recorded on April 16, 1996 in Cumberland County Deed Book 137, Page 764,and
being conveyed to Carlo Broccolo, Decedent herein.
Value is sale price. See attached.
TOTAL(Also enter on Line 1, Recapitulation) 1,030,000.00
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev. 12-12)
Rev-1503 EX+(08-12)
SCHEDULE B
pennsylvania STOCKS & BONDS
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF �21-15-0043
LE NUMBER
Broccolo, Carlo G.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
Charles Schwab Account#36812922
1 0401OL103 1,808 shares of Ares Cap Corp-Com 15.6825 28,353.96
2 293792107 4,109 shares of Enterprise Products Partners L-Com 33.5650012 137,918.59
3 42217K106 1,120 shares of Health Care REIT Inc-Com 77.36 86,643.20
4 58503F106 1,400 shares of Medley Cap Corp-Com 9.18 12,852.00
5 637417106 1,014 shares of National Retail Pptys Inc-Com 41.01 41,584.14
6 681936100 972 shares of Omega Healthcare Investors Inc-Com 41.67 40,503.24
7 780910105 1,013 shares of Royce Value Trust Inc-Com 13.8350049 14,014.86
8 872447109 2,286 shares of Ticc Capital Corp-Com 7.585 17,339.31
9 92276F100 970 shares of Ventas Inc-Com 74.815 72,570.55
TOTAL(Also enter on Line 2, Recapitulation) 451,779.85
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.08-12)
Rev-1508 EX+(08-12)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF F21-15-0043
NUMBER
Broccolo, Carlo G.
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 "Moore v.Verizon"Settlement 40.00
2 Charles Schwab Account#36812922-Cash account,see attached 9.42
3 2014 Ford Explorer-Date of death value 27,000.00
4 Goodville Mutual Casualty Company-Refund of insurance premium for 607 Bridge Street 504.00
Property
5 Goodville Mutual Casualty Company-Refund of insurance premium for 99 West Portland 300.00
Property
6 Highmark-Refund 162.57
7 Progressive-Auto insurance refund 188.00
8 Refuse proration at real estate settlement-607 Bridge Street-05/18/15-06/30/15 115.92
9 Sewer proration at real estate settlement-99 W. Portland Street-06/04/2015 to 07/01/2015 219.56
10 Tax proration at real estate settlement-607 Bridge Street-County taxes 05/18/15-12131/15 1,349.70
11 Tax proration at real estate settlement-607 Bridge Street-School taxes 05/18/15-06/30/15 396.74
12 Tax proration at real estate settlement-99 W. Portland Street-County Taxes 06/04/2015 to 1,540.00
01/01/2016
13 Tax proration at real estate settlement-99 W. Portland Street-School Taxes 06/04/2015 to 435.81
07/01/2015
TOTAL(Also enter on Line 5, Recapitulation) 32,261.72
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.08-12)
Rev-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Broccolo, Carlo G. 21-15-0043
If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Maria G. Broccolo 139 Brindle Road Mother
Mechanicsburg, PA 17055
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ER DATE
ITEM FOR JOINT MADE (NCLUDE NAME OF NUMBER OR IMILARnANCIAL IDENTIFY NG INSTITUTION
B R.ATTACH DEED OUNT FOR DATE OF DEATH DECD'S DECE ENT'S NTEREST
B
NUMVALUE OF
ER TENANT JOINT VALUE OF ASSE INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 06/03/2013 Integrity Bank Time Deposit-Account No. 45,003.70 50.000% 22,501.85
1056151 ($45,000.00+$3.70 accrued interest),
see attached.
2 A 12/05/2013 Members 1st Federal Credit Union Certificate 50,008.84 50.000% 25,004.42
of Deposit-Account#230873-43($50,000.00
$8.84 interest),see attached
3 A 01/09/2008 Members 1st Federal Credit Union Savings- 5.00 50.000% 2.50
Account#321166-00($5.00+$0.00 interest),
see attached
4 A' 06/17/2010 Metro Bank Checking-Account#833377740 10,385.90 50.000% 5,192.95
($10,835.82+$.08 interest),see attached
5 A 03/16/2000 Santander Checking-Account#1681726068 2,050.33 50.000% 1,025.17
($2,050.33+$0.00 interest),see attached
6 A 04/10/1996 Santander Checking-Account#2331028079 30,700.30 50.000% 15,350.15
($30,700.07+$0.23 interest),see attached
7 A 11/05/2013 Susquehanna Bancshares, Inc.CD-Account 30,001.65 50.000% 15,000.83
No. 10012852405($30,000.00+$1.65 interest),
see attached
Total of Continuation Schedule 5ee attached page
TOTAL(Also enter on Line 6, Recapitulation) 84,884.17
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule F(Rev.01-10)
Rev-1509 EX+(01.10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT continued
ESTATE OF FILE NUMBER
Broccolo, Carlo G. 1 21-15-0043
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
JOINTLY OWNED PROPERTY
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
ITEM FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT JOINTLY-HELD REAL ESTATE. VALUE OF ASSETINTEREST DECEDENT'S INTEREST
8 A 04/03/2007 Susquehanna Bancshares,Inc.Checking- 1,612.60 50.000% 806.30
Account No. 103500001583($1,612.57+$0.03
interest),see attached
TOTAL(Also enter on Line 6, Recapitulation) 84,884.17
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10)
Rev-1510 EX+(08-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF
AXRET
INHERITANCE TAX RETURRNN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Broccolo, Carlo G. 21-15-0043
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSNAME OF FERS ATTACH THEIR COPY OF RELATIONSHIP
DEIED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Integrity Bank Time Deposit-Account No.601002755 100,035.95 100.000% 100,035.95
($100,000.00+$35.95 accrued interest),see attached.
Transferee=Maria Broccolo,mother;account opened
and jointly held on 06/26/2014.
2 Members 1st Federal Credit Union Certificate of 130,023.86 100.000% 3,000.00 127,023.86
Deposit-Account#321166-40($130,000.00+$23.86
interest),see attached. Transferee=Maria Broccolo,
mother;account opened and jointly held on
12/20/2014.
3 Members 1st Federal Credit Union Certificate of 50,009.18 100.000% 50,009.18
Deposit-Account#230873-44($50,000.00+$9.18
interest),see attached. Transferee=Maria Broccolo,
mother;account opened and jointly held on
09/30/2014.
4 Metro Bank CD-Account#7700183365($110,033.54+ 110,067.08 100.000% 110,067.08
$33.54),see attached. Transferee=Maria Broccolo,
mother;account opened and jointly held on
07/12/2014.
TOTAL(Also enter on Line 7, Recapitulation) 387,136.07
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09)
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DECENT RETURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Broccolo, Carlo G. 21-15-0043
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 15,372.40
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Paid Waived
2. Attorney's Fees Martson Law Offices 60,551.54
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) 3,500.00
Claimant Maria G. Broccolo
Street Address 139 Brindle Road
City Mechanicsburg state PA Zio 17055
RelationshiD of Claimant to Decedent Spouse
4. Probate Fees 995.50
5. Accountant's Fees
6. Tax Return Preparer's Fees 300.00
7. Other Administrative Costs 87,390.56
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 168,110.00
Copyright(c)2013 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.08-13)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Broccolo, Carlo G. 21-15-0043
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Catholic Cemeteries-Crypt and internment fee 7,600.00
2 Neill Funeral Home,Inc.-Funeral expenses 7,772.40
H-A 15,372.40
Other Administrative Costs
3 99 West Portland-Security Deposit Refund-Security deposit refunded to Scott&Staci 715.00
Drinkwater
4 99 West Portland-Security Deposit Refund-Security deposit refunded to Stacy Zellers 710.00
5 Albert Anspach-Snow removal services for 607 Bridge Street rental property, pending 120.00
disposition of real estate
6 Albert Anspach-Snow removal services for 607 Bridge Street rental property, pending 60.00
disposition of real estate
7 Albert Anspach-Snow removal services for 607 Bridge Street rental property, pending 60.00
disposition of real estate
8 Albert Anspach-Snow removal services for 607 Bridge Street rental property, pending 60.00
disposition of real estate
9 Albert Anspach-Snow removal services for 607 Bridge Street rental property, pending 60.00
disposition of real estate
10 Assured Land Transfers, Inc.-Notary fee for real estate settlement-607 Bridge Street 10.00
11 Borough of Mechanicsburg-Sewer bill for 99 West Portland rental property, pending 740.00
disposition of real estate
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Broccolo, Carlo G. 21-15-0043
ITEM
NUMBER DESCRIPTION AMOUNT
12 Coldwell Banker NRT, LLC-Commissions paid at settlement-99 W. Portland Street 14,775.00
13 Coldwell Banker NRT, LLC -Additional brokerage fee paid at settlement-99 W. Portland 300.00
Street
14 Coldwell Banker Residential Brokerage-Commissions paid at settlement-607 Bridge Street 21,350.00
15 Deluxe Checks-Order of checks for the estate checking account 29.20
16 EstateVal-Stock valuation fee 18.00
17 Harrisburg Wall&Flooring-Carpet cleaner unit rental for 99 West Portland rental property, 104.94
pending disposition of real estate
18 Harrisburg Wall&Flooring-Carpet cleaner unit rental for 99 West Portland rental property, 104.94
pending disposition of real estate
19 Johnson, Duffle,Stewart&Weidner-Reimbursement for tax certification fees paid for real 15.00
estate settlement-607 Bridge Street
20 June Rents Adjustment at real estate settlement-99 W. Portland Street-Adjustment for item 4,617.00
unpaid by seller/estate(06/04/2015 to 07/01/2015)
21 Keller Williams of Central PA East-Commissions paid at settlement-99 W. Portland Street 15,075.00
22 LandEx-Search for deed and open mortgages 0.92
23 LandEx-Printed mortgage and mortgage satisfaction information 0.87
24 LandEx-Copies of deeds 0.88
25 Legal Advertising-Cumberland Law Journal 75.00
26 Legal Advertising-The Sentinel 201.16
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Broccolo, Carlo G. 21-15-0043
ITEM
NUMBER DESCRIPTION AMOUNT
27 Mario Cabari -Painting services for 99 West Portland rental property, pending disposition of 400.00
real estate
28 Mechanicsburg Borough,Adjustment at real estate settlement-Usage charge(Units 9, 11, 14 25.00
&16)
29 New Cumberland Borough-Sewer and trash bill for 607 Bridge Street rental property, 860.76
pending disposition of real estate
30 Realty Transfer Tax-607 Bridge Street-Paid at settlement 4,270.00
31 Realty Transfer Tax-99 W. Portland Street-Paid at settlement 6,030.00
32 Register of Wills-Additional probate fees 100.00
33 Rents Adjustment at real estate settlement-607 Bridge Street-Adjustment for item unpaid 1,990.69
by seller/estate(05/18/15-06/01/15)
34 Republic Services-Trash bill for 99 West Portland rental property, pending disposition of 89.29
real estate
35 Republic Services-Trash bill for 99 West Portland rental property, pending disposition of 88.09
real estate
36 Republic Services-Trash bill for 99 West Portland rental property,pending disposition of 88.29
real estate
37 Robin Gasperetti,Tax Collector-County/Municipal Taxes for 607 Bridge Street property, 2,170.21
pending disposition of real estate
38 Robin Gasperetti,Tax Collector-County/Municipal Taxes for 99 W Portland Street B 1,305.35
property, pending disposition of real estate
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Broccolo, Carlo G. 21-15-0043
ITEM
NUMBER DESCRIPTION AMOUNT
39 Robin Gasperetti,Tax Collector-County/Municipal Taxes for 99 W Portland Street C 1,305.35
property, pending disposition of real estate
40 Santander Bank N.A.-Fee for date of death valuation 20.00
41 Santander Estate Checking Account#3572409764-Returned check fee(Erin M.Otto's 15.00
2/13/2015 rent check returned as"Not Sufficient Funds")
42 Security Deposit Adjustment at real estate settlement-607 Bridge Street-Adjustment for 4,225.00
item unpaid by seller/estate
43 Security Deposit Adjustment at real estate settlement-99 W. Portland Street-Adjustment 4,052.00
for item unpaid by seller/estate
44 Sewer charge Adjustment at real estate settlement-607 Bridge Street-Adjustment for item 334.82
unpaid by seller/estate(04/01/15-05/18/15)
45 Tri-County Abstract Service-Notary fee for real estate settlement-99 W. Portland Street 10.00
46 Tri-County Abstract Service-Reimbursement for tax certification fees paid for real estate 20.00
settlement-99 W. Portland Street
47 United Water-Water bill for 99 West Portland rental property, pending disposition of real 167.69
estate
48 United Water-Water bill for 99 West Portland rental property, pending disposition of real 154.99
estate
49 United Water-Water bill for 99 West Portland rental property, pending disposition of real 174.04
estate
50 United Water-Water bill for 99 West Portland rental property, pending disposition of real 154.99
estate
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Broccolo, Carlo G. 21-15-0043
ITEM
NUMBER DESCRIPTION AMOUNT
51 United Water-Water bill for 99 West Portland rental property, pending disposition of real 136.09
estate(final bill)
1-1-137 87,390.56
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-12)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Broccolo, Carlo G. 21-15-0043
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 Albert Anspach-Snow removal services for 607 Bridge Street rental property,account 240.00
payable
2 Borough of Mechanicsburg-Sewer bill for 99 West Portland rental property,account 750.00
payable
3 Holy Spirit Hospital -Medical bill,account payable 135.00
4 New Cumberland Borough-Sewer and trash bill for 607 Bridge Street rental property, 817.44
account payable
5 New Cumberland FD Ambulence-Emergency transportation fee,account payable 730.00
6 PA Department of Revenue-Tax due on 2014 PA-40 return 958.00
7 Republic Services-Trash bill for 99 West Portland rental property,account payable 91.70
8 United States Treasury-Tax due on 2014 1040 return 4,206.00
9 United Water-Water bill for 99 West Portland rental property,account payable 199.42
10 Verizon-Cable bill,account payable 132.60
TOTAL(Also enter on Line 10, Recapitulation) 8,260.16
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-12)
REV-1513 EX+(01.10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Broccolo, Carlo G. 21-15-0043
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S)RECEIVING PROPERTY (Words) ($$$)
Do Not List T s
I TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
Maria G. Broccolo Mother Sole beneficiary 1,809,691.65
139 Brindle Road
Mechanicsburg, PA 17055
Total 1,809,691.65
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
F.\FILES\Clients\12850 Broccolo\12850.12 Estate Planning\I2850.12.cgb.wilLwpv
LAST WILL AND TESTAMENT
I, CARLO G. BROCCOLO, of Monroe Township, Cumberland County, Pennsylvania,
being of sound and disposing mind and memory,do hereby make,publish and declare this to be my
Last Will and Testament, hereby revoking any and all former Wills or Codicils made by me.
1.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and
all death taxes(whether such taxes may be payable by my estate or by any recipient of any property)
shall be paid from my residuary estate as soon as practicable after my decease and as part of the
administration of my estate. My Executrix, or her successor, shall have no duty or obligation to
obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other
property not passing under this Will.
2.
I give, devise and bequeath all the rest, residue and remainder of my estate, both real and
personal property,unto mother,MARIA G.BROCCOLO. Should my said mother predecease me,
I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal
property, unto my spouse,PICHITRA LAWSON, should I be married at the time of my death.
3.
1 nominate, constitute and appoint my mother, MARIA G. BROCCOLO, as Executrix of
my estate. In the event she shall be unable or unwilling to so serve, then I appoint my spouse,
PICHITRA LAWSON,should I be married at the time of my death, to act in such capacity.
4.
1 direct that all fiduciaries acting under this Will, whether or not named herein, shall not be
required to give bond for the faithful performance of their duties in any jurisdiction.
5.
I authorize and empower my Executrix,or her successor, in her sole and absolute discretion,
to purchase or otherwise acquire and retain any investments of which I die seized or any real or
personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or
CJ _
[Initials]
Page 1 of 3
J
grant options in regard to any or all property of any kind forming a part of my estate for such terms
and such prices as they may deem advisable;to borrow money for any purposes connected with the
protection and preservation of my estate;to mortgage or pledge any real or personal property forming
a part of my estate or to join in or secure the partition of same; to compromise any claims or
demands of my estate against others or of others against my estate;to make distribution in kind and
to cause any share to be composed of cash, property or undivided fractional shares in property
different in kind from any other share; to employ agents, attorneys and proxies and to delegate to
them such powers as my Executrix, or her successor, considers desirable and to pay reasonable
compensation for such services as may be rendered by such agents, attorneys and proxies; and to
execute and deliver such instruments as may be necessary to carry out any of these powers. In
addition, I direct that my Executrix or her successor, shall have the power to conduct an inventory
of any safe deposit box necessary to the administration of my estate.
IN WITNESS WHEREOF I have hereunto set my hand and seal this I" day of December,
2014.
(, ti (SEAL)
Carlo G. Broccolo
SIGNED,SEALED,PUBLISHED AND DECLARED by the above-named Testator,as and
for his Last Will and Testament,in the presence of us,who at his request,have hereunto subscribed
our names as witnesses there o, in the presence of the said Testator and of each other.
Page 2 of 3
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
We,Carlo G.Broccolo,Hubert X.Gilroy and 60"MN ,the Testator
and the witnesses,respectively,whose names are signed to the foregoing instrument,being first duly
sworn, do hereby declare to the undersigned authority that the Testator signed and executed the
instrument as his last Will and that the Testator has signed willingly,and that the Testator executed
it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in
the presence and hearing of the Testator, signed the Will as a witness and that to the best of his/her
knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no
constraint or undue influence.
Carlo G. Broccolo, Tes or o
AV
Witness
—A
G � 1- 1
Wits �
Subscribed, sworn to and acknowledged before me by Carlo G. Broccolo, the Testator, and
subscribed and sworn to before me by Hubert X. Gilroy and `19M20i,4 y 60"R7Z&,1 , the
witnesses, this I" day of December, 2014.
5�/
Notary Kublic
COMMONWEALTH OF PENN§YLVANIA
NOTARIAL SEAL
Dena S,Brumbaugh,Notary Public
Carlisle Boro,Cumberland County
My Commission Expires Feb. 18,2018
MEMBER, PENNSYLVANIA ASSOCIATION OF NOTARIES
Page 3 of 3
OMB No.2502-0265
B. TYPE OF LOAN
A. SETTLEMENT STATEMENT (HUD-1) 1.❑ FHA 2. ❑ FHMA 3. ❑ CONV.UNINS.
F�<uG!nar
s ea 4. ❑ VA 5. ❑ Cow ims.
6.FILE NUMBER: 7.LOAN NUMBER
15-00083-ALT
8.MORTGAGE INS.CASE NO.:
C.NOTE:This form is furnished to give you a statemcnt 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&ADDRESS Hoang Phan and Thu Nguyen
OF BORROWER: 2466 Carriage Drive,Lancaster,PA 17601
E.NAME&ADDRESS The Estate of Carlo G.Broccolo
OF SELLER: 139 Brindle Road,Mechaniesbure,PA 17055
F. NAME&ADDRESS Metro Bank
OF LENDER: 3801 Paxton Street,Harrisburg,PA 17102
G.PROPERTY LOCATION: 607 Bridge Street,New Cumberland.PA 17070
H. SETTLEMENT AGENT: Assured Land Transfers,Inc.301 Market Street,Lemoyne,PA 17043(717)761-4720
PLACE OF SETTLEMENT:Metro Bank 1416 Lititz Pike,Lancaster.PA,17601(717)761-4720
1. SETTLEMENT DATE: 5/18/2015
J. Sum m ary of Borrower's Transaction IG Summary of Seller's Transaction
100.Gross Amount Due From Borrower: 400.Gross Am aunt Due To Seller:
101.Contract sales price 427 000.00 401.Contract sales price 427 000.00
102.Personal property 402.Personal prope
103.Settlement ch es to borrower. line 1400 10 609.50 403.
104. 404.
105. 405.
Adjustments For Items Paid By Seller In Advance: Adjustments For Items Paid By Seller In Advance:
106.Ci /town taxes to 406.Ci /town taxes to
107.County taxes 05/18/15 to 12/31/15* 1,349.70 407.County taxes 05/18/15 to 12431/15 1349.70
108.Assessments to 408.Assessments t0
109.School Taxes 5/18/2015 to 6/302015 396.74 409.School Taxes 5/18/2015 to 6/30/2015 396.74
110.Refuse 04/01-06/30 51182015 to 6/302015 115.92 410,Refuse 04/01-06/30 5/182015 to 6/30/2015 115.92
111. 411.
112. 412.
113. 413.
114. 414.
IIs. 415.
116. 416.
120.Gross Amount Due From Borrower: 439,471.86 420.Gross Amount Due To Seller: 428,862.36
00.Am6untq Paid RX Or To Behalf f Rnrrnw r: 506.Reductions In Arnnunt Due To Seller-
20 1.
II r-201.Dc ositor earnest money 1,000.0 501.Excess deposit see instructions
202.Principal amount of new loans 213 500.00 502.Settlement charges to seller(line I400 25 645.00
203.Existing loans taken subject to 503.Existing loans taken subject to
204. 504.Payoff 1st Mtg.Ln.
205. $05.Pa off2nd Mtg.Ln.
206. 506,
207. 507.
208. 508.
209. 509,Inheritenec Tax Escrow 10 000.00
Adjustments For Items Unpaid By Seller: Adjustments For Items Unpaid By Seller:
210,Ci /town taxes to 510.Ci /town taxes to
211.County taxes to 511.County taxes to
212.Assessments to 512.Assessments to
213.Security Deposit 4.225.001 513.Security Deposit 4,225.00
214.Sewer Chart 04/01.06/30 4/01/2015 to 5/18/2 334.82 514.Sewer Charge 04/01-06/30 4/01/2015 to 5/182 334.82
215.Renu 5118/2015 to 6/012015 1,990.69 515.Rents 5/182015 to 6/01/2015 1990.69
216. 516.
217. 517.
218. 518.
219. 519. -�
220.Total Paid By/For 221,050.51 520.Total Reductions 42,195.51
Borrower: In Amount Due Seller:
300.Cash At S ttl m nt Frnm/Tn Rnrrower: 600. .ash t Settlement From o S ]ler:
301.Gross amount due from borrower line 120 439 471.86 601.Gross amount due to seller(line 420) 428 862.36 {u
302.Less amount paid by/for borrower pine 220) 221 050.51 602,Less reductions in amount due seller(line 520) Q195.51 J
303.Cash(®FROM) (TO) Borrower: 218,421.35 603.Cash(®TO) (FROM) Seller: 386,666.85
Previous Edition Is Obsolete SB-4-3538.000.1 NJ
Form No.1581 HUD-1(3-86)
3/86 X Page I of 3 X RESPA,HB 4305.2
X X
L. ETTLE NT CUaGES Escrow:15-00083-ALT
700.Total SalestBrokti s Commission: paid From Paid From
Based On Price $ 5 %= 10675.00 Borrower's Seller's
Division of Cnatmission(line 7ADIs Fall wc: Funds Funds
701 $ In.17SO(I to At At
701$ M05-0t) to Coldwol]BankcrPwidotialBrokcra= Settlement Settlement
703-CommisqiQn paid at settlement
704.Exhibit"A"Attached Hereto 1 300.001 300.0
0
80 Loan Disemant
6
803,Am isal fm to
C
806,Mortagge insurance 1.
�atjon fee toMstimntiom foe
80a,Tax Men Search To.Metro Bank 4�,Q
80�..Document J!rcparation Tw Metro Bank 475.00
8 10.Commitment Foe n 6 Metro Bank 2,135,00-
8 11 El oo 'fication Fee To,U=Bank 7,00
314,
815
917,
818,
821
days)9W Ttems ReQuired RX Lender To Be Paid In Ady DCC
DLmijum for mo,to
903.Hazard inurance prernium for YM,to
904,Flood i
905
906,
insurancec
1002, Mortg, inSgra ce Q oonths_Q$ 0.00 per month
1003. Cil nrgo„rw taxes 0 months 0.$ 0.00 per month
1004County p=zrty=4ts 0 motha A S 0.00 Rcr month
1005 Annual assessments 0 months A$ 0.00 n&r.month
insurance1006, Flood
1007 months S UG per month
1009, Agmgmte Adjustment
1009.
11W Title Chatgeq
1101, S to
a
Title, Ab 9A or bile search to1101
1104-Title insurance bindMIo
1106,Notaly fees to
1107. Attorney's fees to
(includes above item Numbers: )
1108. Title insurance to.Assured hand Transfers,Inc.(Sale Rate)
(includes above item Numbers: 2,535.00
1109, Lenden covera2e $213.500.00 Premium, S0,00
1110, Owner'smam S427,00,00 Premium $2,535.00
AssuredUll. Endqrments 100,300,910&710 to-Assured Land Transfers,Inc, 200.0
1112, Endorsement to C
1113 Closing ServiceLetterto Fi=AmeriM Title Insurance Company
1114. Exhibit"B"Attached Hereto 50.nol 10.00
C• C
1203, State s ;Mortgage S 0,K 4170,001 4,270.00
1205 s 1801, Survey to
171
1301 Pest inMoction ja
1304,
1305.
6
1307,
1400- Total Peftlement i2barge,Xhicron line JQJ,Section J-and-line 502.Section
4 "
Form No.1582 Page 2 of3 SB4-3538.000-1
X X X X
SELLER'S AND/OR BORROWER'S STATEMENT Escrow: 15-00083-ALT
1 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.
Borrowers/Purchasers Sellers
A"�_�"" The Estate of Carlo G.Broceolo
Hoang Phan 1"
Hy:,z 1-QzA u� yr xN.GU�Y�.X.
Maria G.Binceolo,Executrix
Thu Nguyhiii
The HUD•1 Settiem at ment whi I hav pr pared' a e and accurate account of this transaction.I have caused or will cause the funds to be
disbursed in accord ce wi this stat en y�
Settlement Ag Date: "
Officer,, red L d T fers Ino.
WARNING:It is a crime to knowingly make false statements to the United States on this or any other similar form.Penalties upon conviction can include a
fine or imprisonment.For details see: Title 18 U.S.Code Section 1001 and Section 1010.
. w
5
Page 3 of 3
ATTACHMENT TO HUD 1 Escrow No.: 15-00083-ALT
Settlement Date: 511812015 Title No.: 15-00083-ALT
Page: l
EXHIBIT A:(HUD Section 700) Buyer Amount Seller Amount
Division of Commission(Line 700)As Follows:
Additional Commission to Coldwell Banker Residential Brokerage 300.00
Additional Commission to Coldwell Banker Residential Brokerage 300.00
Total: 300.00 300.00
EXRIBIT B:(HUD Section 1100) Buyer Amount Seller Amount
Title Charges:
Notary Fee to.Assured Land Transfers,Inc. 25.00 10.00
Wire Fee to.Assured Land Transfers,Inc. 25.00
Total: 50.00 10.00
w
r"
OMB NO.2602-0266
A. B.TYPE OF LOAN:
U.S.DEPARTMENT OF HOUSING&URBAN DEVELOPMENT 1.E]FHA 2.E]FMHA 3,EX]CONV.LININS. 4,OVA 5.[]CONV.INS.
6, FILE NUMBER: 7. LOAN NUMBER:
SETTLEMENT STATEMENT LEG83-15
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs,Amounts paid to and by the settlement agent we shown.
items marked":!POC)"were paid outside the closing;they are shown here for informationat purposes and are not included in the totals.
1.0 M (LEG83-1sPFD1L8383-i5M)
D, NAMEANDADORESS OF BORROWER: E. NAMEAND ADDRESS OF SELLER: F. NAMEAND ADDRESS OF LENDER'
LEGACY PROPERTIES-2,.LLC
ESTATE OF CARLO G,BROCCOLO, JONESTOWN BANK&TRUST CO.
434 SANTAANITA DRIVE 139 BRINDLE ROAD 2 W.MARKET STREET
DILLSSURG,PA 17019 MECHANICSBURG,AN 17065 JONESTOWN,PA17038
G. PROPERTY LOCATION: H. SETTLEMIENTAGENT: I. SETTLEMENT DATE:
99 W.PORTLAND STREET WM.D.SCHRACK III,ESO
MECHANICSBURG,PA 17056 June 4,2015
PLACE OF SETTLEMENT
48 CENTRAL BLVD,
CAMP HILL,PA 17011
J.SUMMARY OF BORROWERS TRANSACTION K.SUMMARY OF SELLER'S TRANSACTION
AMOUNT DUE FROM BORROWER: 400,GROSS AMOUNT DUE TO.SELLER:
ift-, 9 Mt-Tt Sales Price 1 603.000.00 .401. Contract Sales Price 603,000,00
102.Personal property 402, Personal Property
103. Settlement Charges to Borrower(Line 1400) 12,502.00 403.
104. 404.
105. 405.-
Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Setter in advance
106, Ci /town Taxes to 406.Ci /Town Taxes to
107. County Taxes_, 06/04115 to 01101/16 1,540.00 407.County Taxes 06/04/15 to 01101/16 1,540.00
108. SCHOOLTAX 06104115 to 07101116 435.81 408.SCHOOL TAX 06104115 to 07/01115 436.81
109. SEWER ALL UNITS 06104/15 to 07/01115 21-956 409.SEWER ALL UNITS 06/04115 to 07101/15 219.56
1% 410.
111. 411.
112. 412,
120. GROSS AMOUNT DUEFROM BORROWER 617,697.37 420, GROSS AMOUNT DUE TO SELLER 605.195.37
200.AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 600. REDUCTIONS IN AMOUNT DUE TO SELLER:
201.Depositor earnest money 10,000.00 501. Excess Deposit(See instructionsl
202. Principal Amount of New Loan(s) 482,400.00 502. Settlement Charges to Seller(Une 1400) 36 235.00
203. Existing loan(s)taken subject to 503. Existinp loan s!taken subject to
204. 504,Payoff of first Mortgage
205. -5-0-57Vayoff of s000ndMort gage
206. 506.
207. 507.(Deposit disb.as faLggetids)
206, 508.
209. SECURITY DEPOSITS 4,052.001 509.SECURITY DEPOSITS 4,052.00
Adjustments For Items Unpaid By Seller AdJustments For Items Un aid j�_;Setter
210, City/Town Taxes to 510.Ci own Taxes to
211. County Taxes to 511, County Taxes to
212..SCHOOL TAX to 512.SCHOOLTAX to
213, JUNE RENTS 06104/15 to 07101/16 4,617.00 513.JUNE RENTS 06104/15 to 07101/15 4,617,00
214. 514,
215. 515.
216. SIG.
217. 517,
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 501,069.00 520. TOTAL REDUCTION AMOUNT DUESELLER 44,904,00
300.CASH AT SETTLEMENT FROMITO BORROWER: 600, CASH AT SETTLEMENT TOIFROM SELLER:
301, Gross Amount Due From Borrower(Une 120) 617.697.37 1601. Grose Amount Due To Seller(Line 420) 805195371
302, Less Amount Paid By/For Borrower(Line W) 6011069.00} 1 602. Less Reductions Due Seller(Line 520) i( 44,904.001
.303. CASH(XFROM)( TO)BORROWER 1 116.628.37 1603. CASH(XTO)( FROM)SELLER 1 500,291.37
The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement&any attachments referred to herein,
lHAVE CAREFULLY REVIEWED THE HUD-1 SETTLEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF,IT IS ATRUEAND
ACCURATE STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME INTHIS TRANSACTION. I FURTHER CERTIFY
THAT I HAVE RECEnPY OF THE TLEMENT STATEMENT.
r/
sorrowe Seller
4,4 ,,,
L Y PROPERT11 ESTATE OF CARLO G,BROCCOLO
L Y
FIGWLPEDGE,THE HUD-1 tLEM
TO THE BEST OF MY D ;T�JSTATEMENT WHICH I HAVE PREPARED ISATRUEAND ACCURATEACCOUNT OF THE
I
FUNDS Wf- RE DAND A HE UNDERSIGNED AS PART OF THE SETTLEMENT OF THIS
TRANSACTION,
Set ENT FFICER
FFICE51k
I go.
Set lementAgent
WARNING; IT ISACRIMETO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON
CONVICTION CAN INCLUDEA FINEAND IMPRISONMENT. FOR DETAILS SEE:TITLE 18 U.S,CODE SECTION 1001&SECTION 1010,
Page 2
L.SETTLEMENT CHARGES
700.TOTAL COMMISSION Based on Price $ % 29,850.00 TND FROM R+ID FROM
Lvision Commiaslon line 700 as Follows: 90RROWEMS sELLEWS
701.$15,076, to WILLIAMS OF CENTRAL PAEAST FUNDSM FUNDSAr
702.$ 14,775.00 to COLDWELL BANKER NRT,LLC SErTLEMEW SETTLEMENT
703.Commission Paid at Settlement 29,850.00
704.ADDITIONAL BROKERAGE FEE to KELLER WILLIAMS/COLDWELL BANKER 275.00 300.00
800.ITEMS PAYABLE IN CONNECTION WITH LOAN
801.62e2 Ori inatlon Fee % to
802.Loan Discount % to
803.Ap raise!Fee to JONESTOWN BANK FOR MARK HECKMAN REAL ESTATEAPPF 1,800.00
804.Credit Report to JONESTOWN BANK FOR MERCHANTS CREDIT 30.00
805.Lenders Inspection Fee to
806.MortIna. p.Fee to
807.Assum Ion Fee to
808.DOCUMENT PREPARATION to JONESTOWN BANK&TRUST CO. 300.00
809.FLOOD CERTIFICATION FEE to JONESTOWN BANK FOR LARETA 12.00
8 0.ENVIRON ENTAL SEARCH to JONESTOWN BANK&TRUST CO. 55.00
811.
900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901.Interest From to $ /day ( de %
902.Mortgage Insurance Premium for months to
903.Hazard Insurance Premium for 1.0 years to
904.
905.
1000.RESERVES DEPOSITED WITH LENDER
1001.Hazard Insurance monthsper month
1002.Mortgage Insurance months @ $ ar month
1003.Ci frown Taxes months 0 $ -per month
1004.County Taxes months @ $ per month
1005.SCHOOL TAX months (� $ per month
1006• months $ per month
1007. months @ $ per month
1008.AGGREGATE ESCROW ADJUSTMEI months $ per month
1100.TITLE CHARGES
1101. Settlement or Closing Fee to
1102.OVERNIGHT FEE to TRI-COUNTY ABSTRACT SERVICE
1103. REIMBURSEMENT FOR TAX CERT to TRI-COUNTY ABSTRACT SERVICE 20.00
1104. SEARCH&HUD PREP to TRI-COUNTY ABSTRACT SERVICE 200.00
1105. Document Preparation to
1106. Notary Fees to CASH 15.00 10.00
1107. Attorneys Fees to WM.D.SCHRACK III,ESC. 1,602.00
(includes above Item numbers:
1108.Title Ins ranee to TRI-COUNTY SERVICEIAGENT FOR ST ERC 0.00
Includes above Item numbers5011442-0148938e&5011342-017326le
109.Lenders Coverage $ 482,400.00 307.00
1 10. wner's Coverage 603,000.00 1,403.00
1111. ENDORSEMENTS 100,300,710&900 to TRI-COUNTY CT SERVICE 200.00
1112.
1113.
1200.GOVERNMENT RECORDING AND TRANSFER CHARGES
1201.Recording Fees: Deed$ 96.00;Mort a e$ 124.00; Releases $ 220.00
1202.CI /Coun Tex/Slam s:Deed 6030.00 a Mortnage, 6030.00
1203.State Tax/Stem : Revenue Stamps 6,030.00;Mortgage 6,030.00
1204.RECORD ASSIGNMENT OF RENTS to County Realster of Deeds 53.00
1205.OVERNIGHT/COURIER FEES
1300.ADDITIONAL SETTLEMENT CHARGES
1301.Survey to
1302.Pest inspection to
1303.USAGE CHARGE to MECHANICSBURO BOROUGH UNITS 811 14&16 25.00
1304.
1305.
1400.TOTAL SETTLETAENT CHARGES jEnter on Lines 103,Section J and 602 Sectio K 12,502.00 36,235.00
By dgning pageofNia atetemanl No elgnatedee dduuxdedge MCelpl ale completed Copy of page 20lNn aro ge temanl
OETTLEMENT OFFICER
Settlement Agent
Certified to be a true copy.
A
(LEGBJ-16!LEXie3.16!fl l
Estate Valuation
Date of Death: 01/06/2015 Estate of: Carlo G. Broccolo Estate
Valuation Date: 01/06/2015 Account: 12650.13
Processing Date: 02/13/2015 Report Type: Date of Death
Number of Securities: 9
File ID: 12850.13.Broccolo
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
1) 1808 ARES CAP CORP (040101,103)
COM
The NASDAQ Stock Market LLC
01/06/2015 15.86500 15.50000 H/L
15.682500 28,353.96
2) 4109 ENTERPRISE PRODS PARTNERS L P (293792107)
COM
New York Stock Exchange
01/06/2015 34.76000 32.37000 H/L
33.565000 137,918.59
3) 1120 HEALTH CARE REIT INC (42217K106)
COM
New York Stock Exchange
01/06/2015 79.41000 75.31000 H/L
77.360000 86,643.20
4) 1400 MEDLEY CAP CORP (58503F106)
COM
New York Stock Exchange
01/06/2015 9.29000 9.07000 H/L
9.180000 12,852.00
5) 1014 NATIONAL RETAIL PPTYS INC (637417106)
COM
New York Stock Exchange
01/06/2015 41.57000 40.45000 H/L
41.010000 41,584.14
6) 972 OMEGA HEALTHCARE INVS INC (681936100)
COM
New York Stock Exchange
01/06/2015 42.09000 41.25000 H/L
41.670000 40,503.24
7) 1013 ROYCE VALUE TR INC (780910105)
COM
New York Stock Exchange
01/06/2015 13.97000 13.70000 H/L
13.835000 14,014.86
8) 2286 TICC CAPITAL CORP (87244T109)
COM
The NASDAQ Stock Market LLC
01/06/2015 7.67000 7.50000 H/L
7.585000 17,339.31
9) 970 VENTAS INC (92276F100)
COM
New York Stock Exchange
01/06/2015 75.66000 73.97000 H/L
74.815000 72,570.55
Total Value: $451,779.85
Total Accrual: $0.00
Total: $451,779.85
CPSH ACCOur)-L-
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 8.0.2)
SC44Jb w( f3 r # 1 -- 9
(:�C4qEDwUE� !E� , J:� 2
L.B. SMITH i
DATE:
Oftl*p L I H C o L N CHECK#
CHECK REQUISTION
Draw check to order of: ;yt 0(- CAA L o co W
Amouf�c /Dollars$ 15, 300
In payment of: x ��r�"r u si Q-
Charge )3(P O -TD &(P3 J t Requested by:
7
Approved by:
SC�� � 3
.......... ...... .......... .......................................
Legal Discialme
This Ford Credit account Information Is provided for the sole purpose of facilitating a motor vehicle
purchase or lease.By accessing this information,you agree that it will not be used for marketing or
any other purpose.You also agree to protect the security,confidentiality,and Integrity of this
information.
Payoff
.......................................................................... .......................................................................... ..................
AcctNbr; 050506783 Finance Label: Ford Motor Credit Company-US
Status: ACTIVE Collat 2014 FORD EXPLR
VINISN: 1FM5K8D85EGC32019 Product; RETAIL
Rbt Mthd: SIMPLE INTEREST;CREDIT LIFE,WARRANTY,AND ADD-ONS
REFER TO POLICY
Add On Detail
SIF Details ESP, Insurance Company
Today's Payoff: $11,700.00 Credit Life:
SffFactor: 0.000000000000 Disability:
Daily Int Chrg: '00
Lst Pmt Date: 12118/2014
Quote Details
Retail Payoff Good Thru Fin Rebate Amt
$11,700.00 02/0612015 $0,00
$Uo
$0.00.
.................................................................... ................................................ ...................................
Buyer info
Last: BIOCOOLO
First: CARLO Middleinit: G Gen:
Business:
DOB., —[—/1959 SSN: --1573
Street: ESTATE OF City: MECHANICS6
URG
State: PA ZIP.- 17055 Phone: 7179790285
........... ........... .............................................................................. ....... .............................
Details
"0
5-z
Ch �A
..................................... ................................... .................... .................................................. ...............
Quote Details Contract Details
Good Thru 0210612015 Contract Date: 0711612014
Retail Payoff. $11,700.00 Amt Financed: $33,100.00
Fin Rebate Amt: $0.00 FIftal Pett Date: 07/30/2019
Late Charges Due: $0.00
Payment Amt: $551.67
Payment Frequency: Monthly
Tenn: 60
APR: 0.00%
Mlies/Krn Allowed: 0
Payment History
Pmts Made Pmts Rem
6 54 Lst Pmt Date:
12/1812014
Nxt Pmt Due date
02/28/2015
.......................................................................................... ............................. ..........................
Air M
(-I
— — — '`
To: pNertoonLaw Office
Re:Carlo GBrocco|oEstate
Social Security No.
The following accounts were held|nCarlo GBrncco|oname atthe time ofhis death ooJanuary 6, 2015.
Time Deposit, Account number 1O56151(opened and held jointly with Maria G.Bnocco|oon6/3/13)
Balance:$45,000 QL\ �� I��
^° o �
Accrued Interest: $ A3.7O +4 |
Interest Paid YTD 2014: $409.53 (paid bymonthly checks)
Time Deposit,Account number 601002755(opened and held jointly with Maria G. Brocco|oonG/26/14)
Balance:$100'000
Accrued Interest:$35.95
Interest Paid YTD 2O14: $598.11 (paid bymonthly checks)
if you need further assistance, please feel free to contact the Camp Hill office at 717-920-6028.
S�JMGRegionalSinc el
YM.�Jiannin`ey
334SMarket Street,Camp Hill RA17O5S
St
MEMBERS 1ST
FEDERAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 321166-00
Date Account Established 01/09/2008 n � ��
Principal Balance at Date of Death $5.00 SC )
Accrued Interest to Date of Death $0.00
Total Principal and Accrued Interest $5.00
Name of Joint Owner Maria G Broccolo
Date Joint Added 01/09/2008
CERTIFICATE OF DEPOSIT:
Account Number/Suffix 321166-40
Date Account Established 12/20/2014 SC 1
Principal Balance at Date of Death $130,000.00 l
Accrued Interest to Date of Death $23.86
Total Principal and Accrued Interest $130,023.86 Ifi�'>7
Name of Joint Owner Maria G Broccolo
Date Joint Added 12/20/2014
PRIMARY OWNER: Maria Broccolo
CERTIFICATE OF DEPOSIT:
Account Number/Suffix 230873-43
Date Account Established 12/05/2013
Principal Balance at Date of Death $50,000.00 SCm'1>ck[C -Fj
Accrued Interest to Date of Death $8.84 —4t
Total Principal and Accrued Interest .$50,008.84 2--
Name of Joint Owner Carlo G Broccolo
Date Joint Added 12/05/2013
CERTIFICATE OF DEPOSIT:
Account Number/Suffix 230873-44
Date Account Established 09/30/2014
Principal Balance at Date of Death $50,000.00
Accrued Interest to Date of Death $9.18
Total Principal and Accrued Interest $50,009.18
Name of Joint Owner Maria G Broccolo
Date Joint Added 09/30/2014
MEMBERS 1ST FEDERAL CREDIT UNION
Tessa L Klugh
Lending Insurance Support Specialist
February 3, 2015
Estate of: CARLO G BROCCOLO
Date of Death: 01/06/2015
Social Security Number: 209-52-1573
5000 Louise Drive - P.O. Bos 40 - ?Mechanicsburg, Pennsylvania 17055 - (800) 283-2328 - wwxv.members lst.org
01/27/2015 1e*55 717-920-4666 DEPOSIT SERVICES PAGE 02/02
MET
RO
3801 Paxton Street 88.937. 04
BANK Harrisburg, PA 17111 m8yrrietro00bank.com
January 27, 2015
Dena 8 Brumbaugh
Martson Law Offices
10 E High St
Carlisle PA 17013
RE: Estate of. Carlo G Broccolo
Tax Identification Number:
Date of Death: January 6, 2015
To Whom It May Concern:
This letter is in reference to decedent account information you requested for the
individual listed above.
We are able to provide the following;
Account Type:Checking
Account Number: 833377740 sooa�,u F
Date Opened: 8/17/2010
Primary Owner: Carlo G Broccolo
,Secondary Owner: Maria G Broccolo (added at opening) rrFm4i: 4
Date of Death Balance: $10,385.82
YTD Interest: $.00
Principal Balance: $10,385.82
Accrued Interest": $.08
** Please note* The accrued interest will not be paid if the account is closed prior
to the date the interest is scheduled to post.
Account Type:60 Month CD
Account Number. 7700183365
Date Opened. 7/12/2014 scm,
Primary Owner: Carlo G Broccolo,
Secondary Owner: Maria G Broccolo (added at opening)
Date of Death Balance: $110,033.54
YTD Interest: $208.06
Principal Balance: $110,000.00
Accrued Interest": 33.54
Please feel free to contact me at(868) 937-0004 if I may be of further assistance.
Sincerely,
Cindy Stan ery
Support Associate/Deposit Services
Metro Bank
Santander
ESTATE OF: CARLO BROCCOLO
SOCIAL SECURITY#:
DATE OF DEATH: 01/06/2015
Account#: 1681726068 Type: CHECKING (INTERESTOpen date: 03/16/2000
BEARING)
In the name of: MARIA G BROCCOLO or CARLO BROCCOLO
Date of death balance: $2,050.33
Int.(YTD)from: 01/01/2015 To: 01/06/2015 $0.00
Accrued interest to date of death:$0.00
Otherinfo:
Account#: 2331028079 Type: CHECKING (INTERESTOpen date: 04/10/1996
BEARING)
In the name of: CARLO BROCCOLO or MARIA G BROCCOLO --cm e I
Date of death balance: $30,700.07
Int.(YTD)from: 01/01/2015 To:01/06/2015 $0.00
Accrued interest to date of death: $0.23
Otherinfo:
Page 2/2
Susquehanna
January 21, 2015 Susquehanna Bancshares,Inc.
26 North Cedar Street
P.O. Box 1000
Lititz,PA 17543-7000
Tel 1,800.311.3182
MARTSON LAW OFFICES Fax 717.625.4478
10 EAST HIGH STREET
CARLISLE PA 17013
RE: Carlo G.*Broccolo Estate
DOD: 1/06/2015
SS#:
Tracking# 401144
To Whom It May Concern:
In response to your letter of January 15, 2015, here is the above customer account information
as of January 6, 2015.
Account#I Account#2 Account#3
• Account Title: Maria G Broccolo Maria G Broccolo
Carlo G Broccolo Carlo G Broccolo
• Account Type/# Checking CD
103500001583 10012852405
• Date Opened/Maturity 4/03/07 11/05/13
02/05/15
• Interest Rate: 0,050% 1.01%
• Account Balance*: $1,612.57 $30,000.00
• Accrued Interest: $0.03 $1.65
• YTD Interest: $0.00 $303.00
*Account balance does not include accrued interest.
Z There is no safe deposit box in the name of the decedent.
F-1 There is a safe deposit box# 0 in the name of the decedent located at the branch name.