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PETITION FOR GRANT OF LETTERS
Estate of BASOM, Gladys A. No. aJ -0/- a 5 ~
also known as QI_J.! Rmter
, Deceased
Social Security No. 20509459~
Petltioner(s), who is/are 18 years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
GJ
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rixes
Decedent, dated 1/18/1991 and codicil(s) dated
. . J A
lVIII/elm (0, /YJ &~'-rl1 is' C~ecea5E'{;:{
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
o
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
I
Name
Relationship
Residence
I.
(COMPLETE IN ALL CASES:) Attach additional sheets If necessary.
Decedent was domiciled at. death in Curnberl.and County, pennsylvania, with his/her last family or principal
residence at 590 Grandvlew Ave., Carn HIli, PA 17011 VJ~,m /~ bur
(list street, number and mu cipality)
Decedent, then 84 years of age, died February 26 ,2001, at 5g0 ~r;:mdvip.w Ave. .C~ Hill. PA 17011
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property......................................... $
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in P A Personal property in County.............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..................................................................................................................... $
Real Estate situated as follows: 590 Grandview Ave., Camp Hill, PA 17011
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
250,000.00
120,000.00
370,000.00
Typed or printed name and residence
Brenda L. Smith, 487 E. Elmwood Ave. Mechanicsbur
Karen L. Allen, 590 Grandview Ave., Carn Hill, PA
/ t -dIS-- 6
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
and correct to the best of tile knowledge and belief of Petitioner(s) and that, as personal representative(s) of the
Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed ~~ rYf _~d f/
before me this 7th
March
day of
2001
d.uA1!1.JJld,uu~ IlIud4 ~M.cY a/~
Estate of BASOM Gladys A
DECREE OF REGISTER
Deceased
No.
21-?OOl-?l:)?
also known as Gladys Rlltter
Social Security No: 205094592 Date of Death: 2/26/2001
AND NOW, March 7th 2001 , in consideration of the Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary 0 of Administration
/I1!it#t- . ~ x: ~~.t.; pendente lite; durante absentia; durante minoriate)
are hereby granted to Brenda L_ Smith and Karen "- Allen .- ~ iA yt-
in the above estate and that the instrument(s), if any, dated January 18, 1991
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters .................................... $ 305.00
Short Certificates(s) .....10......
Renunciation ..........................
Extra Pages (2 ) ...............
I.T.R...................................... .
JCP Fee .................................
Inventory............................... .
Other..................................... .
$
$
$
$
$
$
$
$
30.00
6.00
Signature
5.00
Attorney: R. Mark Thomas
1.0. No: 41301
Address: 101 S. Market St.
Mechanicsburg
Telephone: 717-796-2100
DATE FILED: March 7,2001
PA 17055
TOTAL .............................$ 346.00
MAILE,l) LETTERS AND ORDER TO A'ITORNEY
TI . . t -ert1' 1.:, that the information here given is correctly copied from an original certificate of death duly filed with me as
. 11 ~ 1S 0 C 1 ~ . ~ ~ fi r
Lo,'a] Registrar.' The original certificate will be forwarded to the State Vital Records Ofhce or permanent 1 mg,
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Fce for this certi flcate. $2. 00
Local Registrar
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Date
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21-2001-252
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COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
NAME Of DECEDENT IF"S!. MKldIe, LasI'
t. Glady.6 A. Ba.6om
AGE (LaS! BwlhOay) UNDER I YEAR
~ha Oaya
5. 3 'l Yra.
COUNTY Of DEArH
SEX
2,fema-ie
STATE FOlE NUMBER
SOCIAL SECURITY NUMBER
3. 205
09 -
UNDER I DAY
Houq loIinul..
BIRTHPLACE Ie-ty ar.d PLACE OF DEATH (Check ""'yon. h __ .n,uueloOn9 on omeo """'.
Sial. 01 Fcreogn Coonuyl HOSPITAL
M-iU eA..6 b UJl. 9 , P A Inpahenc 0 ER/Oulpalle". 0 OOA 0
7. ...
FACILITY NAME (It nol ,nsNUI,on. 9've Slleel and numb.."
.. CumbeA..land
DECEDENT'S USUAL OCCUPlVION
(~"':::~:"O:='::::'.l:i' US Ve.pt. On
t1L Se.CJtetaJt 1111. A }[-ic.u.ltwr.e
DECEDENT'S MAIlING ADORESS (SIr..., CIIy/lOwn, ~. Zip Codel DECEDENT'S
590 G}[andv-ie.w Ave.nue. ~~~~E
Camp H-i.l.l,PA 17011 ~~~
Wh-ite
SURVIVING SPOUSE
(n ""'e. (111/8 m-. namel
17e. Slace
PA
Did
'*-
IiYe in .
1Owns/lip?
17C.0 ...., ,*-Iived in
iW:
CumbeA..land
atJ 13 50
t7d.0 ~~'=oIWo}[mle.Y-6bUJl..g BO}[O
CllyA;;;;..
1..
FATHER'S NAME (Fits!. Modde. Last)
W-i.l.l-iam RutteA.
171t. Cou
o ~~~5;;/o /
RSON ACTING AS SUCH LICENSE NUMBER
21C.
2211.
"lll!le best of my knowlcldge. delath aceu,,"" allhe I.me, dale and place slaled
(S'llnalUfe and Hie)
JCO\
\iT'f\l
,
~~1\~
C 01 resp"alory allesl. shock or heettladule
a._f1\7:V\el~Y)erS \)l~
DUE 10(00 AS A CONSEOUENCE Of):
I :
WERE AUlOPSY FINOtNGS
"""'lA8LE PRIOR 10
COMPLETION Of CAUSE
OF DEArH7
DUE 10 (OR AS A CONSEOUENCE Of):
DUE 10 (OR AS A CONSEOUENCE Of):
IolANNEA Of DEATH
Halur" ~
Accident /[5.
DATE OF INJURY
(Monlll. Day. Year)
TIME OF INJURY
INJURY I\T WORK?
DESCRIBE HOW INJURY OCCURRED.
HomJCodCl
o
o
o ~E OF INJURY. AI home. fall:~;"I. faclory. office
building. etc. ISpeedyl
30e.
....0
NoD
....0
,Z{
Y.. D
Noj
Pend"'lIlnveslic;lalion
Suicide
o
Could not be delenmned
101. 3Oc.
o
.'!IIar1
... 21b.
CERTIFIER ICheck oniy onel
"CERTIFYING PHYSICIAN (PhySIC_ ce<1oCyong cause ~ death when another phy"",,,,,, has pfOnoonced dealh ano completed Item 231
_ To.... ..... 01 my knowledge, deeth occun-ed due eo the ceuHislend menner ae slaCed. . . . . . . . . . . . . . . . . . . . . . . . . , . , .
I "1'ftOHOUNCIHG AND CERTIFYING PHYSICIAN IPhySlClaO OOIh ;>ronounc'/19 dealh and certlfyong 10 cause of dealhl
_~. To.... _, of my knowledg.., death occUfred a'.... lime, dale, and place. and due 10 the cause(s) and manna, ae s.ated.. . . . . . . . . . . . . .
,," 'MEDICAL EXAMINER/CORONER
-- On Ihe ba.i. 01 e..mination and/or investigation. in my opinion, deeth occurred at Ihe time, date, and place, and due 10 the cause(s) and
mann.,.. s'aled.. . . . . . . . . . . . . . . . , . . . . . . . . . . . , , . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . .
31a
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29.
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32.
DI\TE FILED (Month Day. Yea"
PA- 17{
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34.
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21-2001-252
OATH OF NON-SUBSCRIBING WITNESS
8rettrk. t. 5mif~ and /{Qretl 1-. 1J1!ey/
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that ;-h e(J
ate familiar with the signature of 6/g~'$ 11. &..:i?n1 ,testat ~of(OQe sftll@
codicil l
Mlb~€~iBiftg '.yitA~~~~8 t9) the~!Vpresented herewith and that file!)
~ r L J..L IJ A...JA _ J C
~s in the handwriting of ~o the best of -rn~/,fl
~/La-/ ~ ~,d)
(Name)
believes the signature on the
knowledge and belief.
Sworn to or affirmed and sub-
scribed before me this
7th d f
ay 0
'-I~? E. E/n,wooc/ live. } lYled,an/~!!J I ;;/9
(Address)
~~ cJ~J~~
(Name)
March
2001
1ffi1/ !l:rguH.:v/~4 ~
..' . For the Register ~
Mary c. LeWlS . v tf
Register of Wills-
5'10
braJI/HiIO /!ve,} CaMI' HIlI) j//J
(Address)
-
t:-
::.---
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Gladys A. Basom
Name of Decedent:
02/26/01
Date of Death:
21-2001-252
Admin. No.
Will No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 03 / 07/ 2001 :
Name
Address
Brenda L. Smith
487 E. Elmwood Ave., Mechanicsburq, PA 17055
Karen L. Allen
590 Grandview Ave., Camp Hill, PA 17011
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: 06/13/01
~
Signature
Name R. Mark Thomas, Esq.
Address 101 S. Market st.
Mechanicsburg, PA 17055
Telephone ( 7 1 )7 7 9 6 - 21 0 0
Capacity: _ Personal Representative
~Counsel for personal representative
LAST WILL AND TESTAMENT
OF
GLADYS A. BASOM
I, GLADYS A. BASOM, a resident of the State of
Florida, 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 wills,
codic ils and testamentary instruments of whatsoever
nature heretofore made by me.
ARTICLE I.
I direct my Personal Representative hereinafter
named to pay all my just debts and funeral expenses as
soon after my death as may be practicable.
ARTICLE II.
I may I eave a signed wr it ten sta temen t or list
disposing of certain items of my tangible personal
property not otherwise disposed of in this Will. Any
such statement or list in existence at the time of my
death shall be determinative with respect to all items
devised therein. If no written statement or list is
found and properly identified by my Personal
Representative within thirty (30) days after his
qual ification, it shall be presumed that there is no
such statement or list and any subsequently discovered
statement or list shall be ignored.
ARTICLE III.
All the rest, residue and remainder of my estate
and property, real, personal and mixed, of whatsoever
nature, wherever situated, of which I may die seized
page 1 of 3
and possessed, and to which I may be or become in any
way ent i tl ed or have any in terest, and over wh ich I
may have any power of appo i n tmen t, I dev i se to my
husband, WILLIAM G. BASOM, absolutely and in fee.
ARTICLE IV.
In the event my husband, WILLIAM G. BASOM, shall
not survive me, or if we shall die simultaneously or
under circumstances making it difficult or impossible
to determine which one of us survived the other, I
then devise my entire residual estate in equal shares
to my children, KAREN L. SANDERSON and BRENDA L.
SMITH, absolutely and in fee.
ARTICLE V.
I nominate and appoint my husband, WILLIAM G.
BASOM, to be Personal Representative of this, my Last
Will and Testament, or in the event of his failure so
to act for any reason, I then nominate and appoint my
daughters, KAREN L. SANDERSON and BRENDA L. SMITH, to
be Co-Personal Representatives. I direct that no bond
be required of my personal Representative or
Co-Personal Representatives.
I hereby grant to my Personal Representative or
Co-personal Representatives the continuing, absolute,
discretionary power to sell, exchange, assign,
transfer and convey any proper ty, real or per sonal,
held in my estate, at public or private sale, at such
time and pr ice and upon such terms and condi t ions as
he or they may determine. Such power may be exercised
independently and without the prior or subsequent
approval of any court or judicial authority.
IN WITNESS WHEREOF I have caused these presents
page 2 of 3
to be duly executed this
IY~
day of J an uary,
in
the year of our Lord, one thousand nine hundred
ninety-one.
~~)f! 4-- 75~
GLADYS A. S6M
(SEAL)
The foregoing instrument, consisting of three pages,
including this page, each page being typewritten only
on one side, was at the date thereof by the said
GLADYS A. BASOM signed, sealed, published and declared
to be her Last Will and Testament in the presence of
us, who, at her request, in her presence and in the
presence of each other, have subscribed our names as
attesting witnesses thereto.
~~
~ ~~/~
address: 4930 park Boulevard
pinellas park, Florida
address: 4930 Park Boulevard
pinellas park, Florida
Page 3 of 3
STATE OF FLORIDA
COUNTY OF PINELLAS
We, GLADYS A. BASOM, ROBERT W. HOLMAN and MARVIN L. IVEY
, the
testatrix and the witnesses respectively, whose names are signed to the
foregoing instrument, being first duly sworn, do hereby declare to the
undersigned officer that the testatrix signed the instrument as her
Last Will and that she signed voluntarily and that each of the
witnesses in the presence of the testatrix, at her request, and in the
tJ.Lt:::i::)~n~e of each other signed the Will as a witness and that to the
best of the knowledge of each witness the testatrix was at that time 18
or more years of age, of sound mind and under no constraint or undue
influence.
4~~A/ ~/
Testatrix
,/~/
~ .---WTE:iess
~tC~
subscr ibed and acknowl edged before me by GLADYS A. BASOM, the
testatrix,
and
subscribed
and
sworn
to
before
me
by
RORRRT W HOT MAN
and
MARVIN L. IVEY
the witnesses, on
January
lH
, 1991.
;;;!o~ dJ.<< ~~
otary Public
My Commission Expires: 3/18/91
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
THOMAS R MARK
101 SOUTH MARKET STREET
MECHANICSBURG, PA 17055
-------- fold
ESTATE INFORMATION: SSN: 205-09-4592
FILE NUMBER: 21 - 2001 - 0252
DECEDENT NAME: BASOM GLADYS A
DA TE OF PAYMENT: 11/26/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 02/26/2001
NO. CD 000557
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,300.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$1,300.00
REMARKS: R MARK THOMAS
CHECK#1517
SEAL
INITIALS: SK
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
~ /{; - (21-5-~ 6
. BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-In7 EX AFP COI-02l
l ' !
J{_
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-10-2002
BASOM
02-26-2001
21 01-0252
CUMBERLAND
101
GLADYS
A
THOMAS R MARK ESQ
101 S MARKET ST
MECHANICSBURG PA 1~~~~
AMount ReMitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17013
NOTE: To insure proper credit to your account~ subMit the upper portion of this forM with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV =i '6cfj-Ex-AFP--foi-:02)-------...--zNif€RITANci--TAx-STA-fEHi-NT-'ifF'-Accouiff--...---------------------
ESTATE OF BAS OM GLADYS A FILE NO.21 01-0252 ACN 101 DATE 06-10-2002
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE~ APPLICATION OF ALL PAYMENTS~ THE CURRENT BALANCE~ AND~ IF APPLICABLE~
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-06-2002
PR I NC I PAL TAX DUE: ..........................................................................................................................
17~898.38
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-25-2001 AA496651 842.11 16~000.00
11-26-2001 CDOOOSS7 .00 1~300.00
05-23-2002 REFUND .00 243.73-
TOTAL TAX CREDIT 17~898.38
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
* IF PAID AFTER THIS DATE~ SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $l~
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
',.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
of
Recof CU '
He:1;"';
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-21-2002
BASOM
02-26-2001
21 01-0252
CUMBERLAND
101
.02
JAN 18
P 3 :14
R MARK THOMAS
101 S MARKET ST
MECHANICSBURG
*
,'-..
REY-1547 EX AFP (12-00)
GLADYS A
, ~
Allount Remitted
Cl:=";;
r*7r~~~?~
F'\~,-- -
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV = iS4-j-Ex-AFP-fi'2-:0(ir-NCfficE--oF-YNHEifiTANci-"-Ax-APPRAisEifENT-,--ALi-oWAifci-cfri----------- - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BASOM GLADYS A FILE NO. 21 01-0252 ACN 101 DATE 01-21-2002
TAX RETURN WAS:
) ACCEPTED AS FILED
( X) CHANGED
SEE ATTACHED NOTICE
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
303,591.62 X 045 = 13,661.62
.00 X 12 = .00
.00 X 15 = .00
(19)= 13,661.62
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
303.049.99
.00
.00
18.900.01
1.999.90
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
13,911.00
6.447.28
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
323,949.90
:?O 358 :?R
303,591.62
.00
303,591.62
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-25-2001 AA496651 683.08 16,000.00
11-26-2001 CDOO0557 .00 1,300.00
TOTAL TAX CREDIT 17,983.08
BALANCE OF TAX DUE 4,321.46CR
INTEREST AND PEN. .00
TOTAL DUE 4,321.46CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
~ ..,.
REV-1470 EX (6-68)
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
GLADYS A BASOM
FilE NUMBER
John Kealy
ACN
2101-0252
101
REVIEWED BY
ITEM
SCHEDULE NO.
A 1
EXPLANATION OF CHANGES
The value of this item has been suspended from the appraisement of the return until the
final value can be determined. A supplemental return must be filed when the value of the
suspended item is determined.
ROW
Page 1
I / . ) / COMMONWEAL TH OF PENNSYLVANIA Il'
~ /;~'....(/< ;5-- CO . DEPARTMENT OF REVENUE /. :~ ;~I " (,'
BUREAU OF INDIVIDUAL TAXES ~ ,--,,- 'V ,,:.:::::....~
INHERITANC:: TAX DIVISION NOTICE OF INHERITANCE TAX' /
DEPT. 2806tl APPRAISEMENT ALL()WANCE OR DISALLOWANCE.. I (j
HARRISBURG, PA 17128-0601 '- -
OF DEDUCTIONS AND ASSESSMENT Of TAX .~ '", REV-l547 EX AFP CU-OOl
DATE 01-21-2002 ~
ESTATE OF BASOH ,'GLADYS
DATE OF DEATH 02-26-2001
FILE NUMBER 21 01-0252
COUNTY CUMBERLAND
ACN 101
~
R MARK THOMAS
101 S MARKET ST
MECHANICS BURG
A
Amount Remitted
PA 17055
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE __ RETAIN LOWER PORTION FOR YOUR RECORDS ..
REv; 151'-, ~'E:X-AF-p--ri2-:o(ff-NCf{icE:-OF-'rNHE:ifi;:AtfCE-T-AX-A-PPRA-isE;''-ENT~--A[ioWANCE-OR----------- - - - ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BAS OM GLADYS A FILE NO. 21 01-0252 ACN 101 DATE 01-21-2002
TAX RETURN WAS: ( ) ACCEPTED AS FILED
( X) CHANGED
SEE ATTACHED NOTICE
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
303,591.62 X 045 = 13,661.62
.00 X 12 = .00
.00 X 15 = .00
(19)= 13,661.62
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
303,049.99
.00
.00
18,900.01
1.999.90
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
13,911.00
6.447.28
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
323,949.90
(1lJ
(12)
(13)
(14)
70.3514 28
303,591.62
.00
303,591.62
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-25-2001 AA496651 683.08 16,000.00
11-26-2001 CDOO0557 .00 1,300.00
TOTAL TAX CREDIT 17,983.08
BALANCE OF TAX DUE 4,321.46CR
INTEREST AND PEN. .00
TOTAL DUE 4,321.46CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SlOe OF THIS FORM FOR INSTRUCTIONS.)
REV-1470 EX f&-88)-
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEP ARTMENT OF REVENUE
BURf:AU OF INDIVIDUAL TAXES
DEPT. 280601
H ",RRISBURG PA 17128-0601
DECt:.')ENT.:) NAME
FILE NUMBER
REVIEWED BY
ACN
2101-0252
101
GLADYS A BASOM
John Kealy
ITEM
SCHEDULE NO.
A 1
EXPLANA liON OF CHANGES
The value of this item has been suspended from the appraisement of the return until the
final value can be determined. A supplemental return must be filed when the value of the
suspended item is determined.
FILE
Page 1
X 16 --02/6--6
BURE~ OF INDIVIDUAL TAXES
JNHERITANCE TAX DIVISION
'JEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
-1 -
I ,
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-13-2002
BASOM
02-26-2001
21 01-0252
CUMBERLAND
101
THOMAS R MARK ESQ
101 S MARKET ST
MECHANICSBURG PA 17055
REY-1547 EX AFP 101-02)
GLADYS
A
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-V = is'4-j-Ex--AFP-((ff=o21--NcfficE--oF-YtiHEifiiAifci-i"-Ax-jfPPRAisEifiNi"-,--Aii-oWAN-ci-oi----------- - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BASOM GLADYS A FILE NO. 21 01-0252 ACN 101 DATE 05-13-2002
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
397,741.75 X 045 = 17,898.38
.00 X 12 = .00
.00 X 15 = .00
(19)= 17,898.38
NO. 01
97.318.89
.00
.00
.00
.00
.00
.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
35.00
(9)
(10)
3.133.76
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
(8)
97,318.89
3.168 76
94,150.13
.00
397,741.75
..-ft, I~n' K~l,;~U'1 II (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-25-2001 AA496651 842.11 16,000.00
11-26-2001 CDOO0557 .00 1,300.00
TOTAL TAX CREDIT 18,142.11
BALANCE OF TAX DUE 243.73CR
INTEREST AND PEN. .00
TOTAL DUE 243.73CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
~.
REV-1..70 EX (6-88)
~ .
INHERITANCE TAX
EXPLANA TION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME FilE NUMBER
GLADYS A BASOM 2101-0252
REVIEWED BY ACN
John Kealy 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The value of the estate has been adjusted as the result of the correction of an error in
arithmetic.
ROW
Page 1
':II
.
I
.~ '/\
C,;o~
STATUS REPORT UNDER RULE 6.12
Name of Decedent: G;/~~ It. &~
Date of Death: ;{P6/IJ /
. , ,
Will No. ~OO/ -oo;z5~ Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1.
State whether administration of the estate is complete:
Yes ;< No
,
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal r~resentative file a final
account with the Court? Yes No .
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative :><te an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
~d~
Signature
;f /Yk ~ k 7ltJml1t.>
Name (Please type or print)
/()/ 5. /llaylef 57: t?1ec/. fJl /~
Address /'
( 7/7) 796 - ex/a;;
Te 1. No.
Date:
oz /1I/()3
I I
Capacity: Personal Representative
~counsel for personal
representative
(MAH:rmf/AM3)
'~
.
REV.1WOEX+(f1.00r
*(l COMMONWEALTH OF
, ' PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT,280601
HARRISBURG, PA 17128-0601
fir ,;2./$ ~ f,
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I-
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DECEDENT'S NAME (lAST. FIRST, AND MIDDLE INITIAL)
BASOM, Glad sA.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
c
OFFICIAL USE ONLY
FILE NUMBER
.4. L-LL L .fL 12,L~~
COUt>lTYCODE YEAR NUMBER
SOCIAL SECURITY NUMBER
2 0 5 - 0 9 - 4 592
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date of death prior to 12-13-S2)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
z
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~
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~
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02/26/2001 12/25/1916
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE !NITIAL)
00 1, Original Return
o 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will}
o 9. LItigation Proceeds Received
o 2. Supplemental Return
o 4a, Future Interest Compromise (dale of death after 12.12-62)
o 7. Decedent Maintained a LIving Trust (Attacll copy ofTrusij
o 10. Spousal Poverty Credit (daleofdealhbetwoon 12-31-91 and 1-1-95)
I-
Z
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COMPLETE MAILING ADDRESS
101 S. Market Street
NAME
Thomas, R. Mark
FIRM NAME (II Applicable)
TELEPHONE NUMBER
7962100
Mechanicsbur
1. Real Eslale (Schedule A)
2, Slocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. MortgageS & Noles Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (Iolal Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts 01 Decedent. Mortgage Liabilities, & Uens (Schedule I)
11. Total Deductions (Iolal Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Une 12 minus LIne 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x _(15)
403,591.62 X .045 (16)
X .12 (17)
X .15 (18)
(19)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rale
19. Tax Due
20. 0
. > > ii BE SURE TO ANSWER ALL QUESTIONS ON.REVERSE SIDE AND llECHECKMATH"<,!:',h,..",,,,,,,,,,,,,,,,,,,
,;,,;'.;-.
><'L
(8)
(11)
(12)
(13)
(14)
100,000.00
303,049.99
PC
-g:
~ --
0- ,,'
',;t,"
18,$00.Q1
1,9!ll9.90
I..'.
-'-,
:p':
13,911.00
6,447.28
PA 17055
OFFICIAL USE ONLY
9
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cv
Q
(;~;'
<:::J
C"':J
I
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Li
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fL_____
423,949.90
20,358.28
403,591.62
403,591.62
18,161.62
18,161.62
D
d t' C
I t Add
ece en s omDle e ress:
STREET ADDRESS
590 Grandview Avenue
CITY Camp Hill I STATE PA I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A Spousal Poverty Credil
8. Prior Paymenls
C. Discount
(1)
18,161.62
16.000.00 .
800.00
3. InleresVPenally if applicable
D.lnlerest
E. Penally
Tolal Credils (A + 8 + C)
(2)
16,800.00
TolallnteresVPenally (0 + E) (3)
4. if Line 2 is grealer Ihan Line 1 + Line 3, enler Ihe difference. This is Ihe OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater Ihan Line 2, enter the difference. This is the TAX DUE. (5)
A Enter the interesl on the tax due. (SA)
8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check to: REGISTER OF AGENT
1,361.62
1,361.62
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
No
[2Q
[2Q
[2Q
[2Q
1. Did decedenl make a transfer and: Yes
a. retain the use or income at the property transferred; ........................................................................... 0
b. retain Ihe righl to designate who shall use Ihe property transferred or its income; .................................:...... 0
c. retain a reversionary interest; or ..........,........, '" ,...................,....,. .................................................... 0
d. receive Ihe promise for life of either payments, benefits or care? ............................................................. 0
2. If death occurred after December 12,1982, did decedent transfer property wilhin one year of dealh
without receiving adequate consideration?.............................................................................................. 0
3. Did decedent own an 'in trust for' or payable upon death bank account or securily at his or her death? ................. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
conlains a beneficiary designation? ....................................................................................................... 0
[2Q
[2Q
[2Q
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under penalties of perjury, I declare thai I have examined this return, including accompanying schedules and statements, and \0 the best of my knowledge and belief, it is true, correct
and complete
Declara~on of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRESS 'fn e- ~ ~
. fJ" 7<1
R THAN REPRESENTATIVE
ADDRESS /Y1
/tl/ 6, /'(~
ef 51:
?Il
p55
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)].
For dates of dealh on or after January 1, 1995, the lax rale imposed on the nel value of transfers to or for Ihe use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemol 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 dealh on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one 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% [72 P.S. ~9116(a)(1.211.
The lax rate impcsed on Ihe nel value of Iransfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(l)).
The tax rate imposed on Ihe net value of transfers 10 or for Ihe use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has alleast one parent in common with Ihe decedent, whether by blood or adoplion.
R"".""IWIW
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE A
REAL ESTATE
ESTATE OF
BASOM Gladys A
All real property owned solely or as a tenant In common must be reported at fal, 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 which Is Jointly-owned with
right of
survlvorshin must be disclosed on Schedule F.
ITEM
NUMBER
1.
FILE NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
100,000.00
Ranch style dwelling located at:
590 Grandview Ave.
Camp Hill, PA .17011
An Agreement for the sale of the house in the amount of $112,500.00 was signed on
September 21, 2001. However, following a home inspection the buyers refused to
perform claiming that there were at least $12,000.00 in upgrades in the form of a new
roof and furnance. This matter appears headed for litigation which will entail added
expense. Therefore, we have placed a value of $100,000.00 on the property.
(See Sales Agreement and Notice from buyers attached hereto.)
TOTAL (Also enler on line 1, Recapitulation) $
100,000.00
""'~3EX'I''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE B
STOCKS & BONDS
ESTATE OF
BAHOM GlAdys A
All property jolntty-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Massachussetts Investors Class B 53,838.00
2894.524 shares @$18.60/share
2. MFS Municipal Bond Fund Class A 4,030.00
382.694 shares @$10.53/share
3 Putnam Income & Growth Class A 62,126.00
3187.577 shares@$19.49/share
4 Putnam Assets All Growth Class A 44,705.86
4201.679 shares @ $10.64/share
5. Putnam Tax Exempt Income Fund Class A 18,363.42
2093.890 shares @ $8.77 /share
6. Hartford Director Select Annuity 119,986.71
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
303,049.99
,
""''''".".,,'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC,
PERSONAL PROPERTY
ESTATE OF
BASOM GlAdys A
Include the proceeds of litigation and the date the proceeds were received by the estate, All pro~rty jointlYo.Owned with the right of survivorship must be disclosed on Schedule F.
FILE NUMBER
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE
OF DEATH
15,699.89
2
CAP Checking Accl. #9070023885
First Union National Bank
PO Box 40028, Roanoke, VA 24022-7313 (See attachment dated 4/13/01)
Savings Accl. #3082794368073
First Union National Bank
PO Box 40028, Roanoke, VA 24022-7313 (See attachment dated 4/13/01)
Household furnishings (estimated)
2,450.12
3.
750.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space Is needed, insert additional sheets of the same size)
18,900.01
,
,
''''''''''''''''*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
BASOM Glady~ A
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
FILE NUMBER
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Karen Allen
212 S. Seventh SI.
Lemoyne, PA 17043
Daughter
B
c
JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE ll'lclude name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for joln~y-held real estate, VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 3/3/97 Checking Accl. #0512100579 1,162.67 50. 581.34
. Commerce Bank
100 Senate Ave., Camp Hill, PA 17011
2. A. 3/3/97 Savings Acct. #0410161470 2,837.12 50. 1,418.56
Commerce Bank
100 Senate Ave., Camp Hill, PA 17011
TOTAL (Also enter on line 6, Recapitulation) $ 1,999.90
(If more space is needed, insert additional sheets of the same size)
"""""."."''*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
BASOM Gladys A
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER . DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1. Cremation Society of Pennsylvania 65.00
4100 Jonestown Rd., Harrisburg, PA 17108
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (5) WAIVED
Social Security Number(s} I EIN Number of Personal Representative(s)
Slreet Address
City Stale lip
Yea~s) Commission Paid:
2. Attorney Fees R. Mark Thomas, Esq., 101 S. Market St., Mechanicsburg, PA 17055 10,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00
Claimant Karen Allen
SlreelAddress 212 S. Seventh St.
City Lemoyne Slale P A lip 1 7043
Relationship of Claimant to Decedent Daughter
4. Probale Fees Register of Wills of Cumberland County 346.00
5. Accountant's Fees
6. Tax Return Prepare~s Fees
7.
TOTAL (Also enler on line 9, Recapitulation) $ 13,911.00
(If more space is needed, insert additional sheets of the same size)
Estate of:
BASOM, Gladys A.
Explanation - Schedule H(B)(3)
On date of decedent's death Karen Allen had been living with her mother, Gladys
Basom, for approximately the last ten years to take care of her. Several months after the
death of Gladys Basom, Karen Allen moved to a new residence and decedent's house
was placed on the real estate market for sale.
'REV'''''''''''''.
COMMONWEALTH OF PENNSYLVAN'A
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BASOM Gladys A
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
Include unrelmbursed medical expenses,
ITEM
NUMBER
1,
2000 PA Income Tax
DESCRIPTION AMOUNT
467,00
2,
House repairs, cleaning, lawn care, preparation for sale
3,849,00
3,
Real estate taxes/school
1,066,83
4,
Borough of Wormleysburg (sewer and refuse)
332,80
5
PPL Utilities
147,02
6,
Bekelja Fuel Service (fuel oil)
81,00
7,
Eichelbergers, Inc,
60,00
8,
2001,2002 Per Capita Tax
11,00
9,
2001 Personal Tax
11,00
10,
2001 County/Borough Real Estate Taxes
421,63
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
6,447,28
REV."" EX. 1_...
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
A
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 OU\righl9~U9a\ d~\ribu\ions, and tran91ers under
Sec. 9116('1(1. II .
1- Brenda Smith Daughter 50%
487 E, Elmwood Ave.
Mechanicsburg, PA 17055
2. Karen Allen Daughter 50%
212 S. Seventh SI.
Lemoyne, PA 17043
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
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, insert additional sheets of the same size)
10/02/2001 14:38 717-597-0822 JACk SAUGHt:N MECH
STANDAIW AtjK.b;~M~N 1 (fVR 'BU.. ~J\.L.r. VI;' JU'~n.L.c" .11U Co
This foon rocommeode..l .n4 ~Fprovcd lor, ~ut ~oll"t_llrimd tg UII b~, the: melDber~ or Ill, f'enmiylvarlia ^lll)e,ation of REALT()1lS. (PAR),
PAGE 02
PA LICENSED BROKER
LlSTING BROKER '(Com,p.any)
ADDRESS
PH }l'~X
DESIGNA.TED AGENT )10R BUYER (If appliuble)
PI! FAX
DESIGNATED AGENT FOR SELLER (l( applicable)
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1. t~[B lI~ment, d.l.d ~~tr"~~ i' 6l.?)t
SELLER(S);' t?A.JDA, l.. ~ ,CI. "...... \
,isbelWl;:l'n
Uoi. ~ .".d"S''',,:'..d
BUYER(S), OI1~nlU\ )Jf~'~-t--S'\I^-lJ.O ~~.~
,called "Buyer,"
2. PltQPERl'Y (1.98) Seller henby agreel to nil and convey to D\lyer, who hl!Nby ognes to purcho.se:
ALLTH~<<;4RTAUj..lpY4l.r"pleteOrllrQUndwithbull' and I fnve1JWllJth nnerect ,If a y,~
_O'-ln ~~\:'.'IN')l-
In Ih. or
County or---.ru01 (~{;;LLJ,^ U~ In thf: Commonw~aHll or P!nnsylvlInil, Zip Code
Identification (e,g.. l'ax ID#j Parcel Hi Lol, B1ufk; Dte.d Book, Jl'agc, Recordine Due)
"
>. TERMS (1-00) . ,.1_ I I}, j--:- /"
(A) "."h...Pd" t)ftJ!== j.J.i.JI\JI'lO P1)-n lIP} J )(:::;:.., rn'"lC-flYlr: J:lLJ2" rrufY. fi'<Q15
~,u'"
wlllell will ble paid to SeUtt by Buyer IS follows: 1~
(B) Cull or cheek al 8lgn(ng thu Agreement $ \. H
(C) ~eheckwllhin...J::l-dp->~oftheexeCUllOnQflh)~Agrtemenl 1(~- $ ~$ J - !o
(D) $ 21
(E) Cash,c<lshicr'~()rcertifiede~ckaltill1.:of~elllemellt: 5 I.J.L.,,~ 22
$ --'..' 8:./ ""fLJO.. "
TOTAL
(F) Deposits paid on Ilccounll,l'f ptlrchase pl'ice to be, held by Ustii'l& Broker, unlrm otherwile staled her~:
Seller'swril1e:n approvllltc beon or before:
Settlement to be made on or befme' 00\
Conycyftncl) r~om Seller will be by fee ~il)'1ple deed of specilll warranty I,Inle..~$ otherwise stated hcre
(G)
(HI
(!)
(J) P.1yment of t.r1lf1~fl:T tuxe, will be dIvided equ.l1~ be/weerl Buyer and Sellcr unh:~o other\\lise stated hert:
(Kl
Alltme ofsettlement.lhll folJowing will be adjusle(j pro.ratn ~l" Q daily bub between Buyer ~nd Seller, reimb.zfsinS where applicGbJe: \.II~e$;
lcnt~~ inLertst on nlorlsa,e as5umpti0f1~; eonllo:rnillium fees and homcOWDCrll$snC;~lion fees, if any: water and/of 'ewer fees, If any, together
wilh "n~ other 1i1:mablc municipal service, The ehargc~ lire 10 be llro.lllted for Ihl: Jleriod(~) l.iovered: Seller \l.'jlJ pay up to and i\ld\ldi~B the
d((t~ of setUement: Buyer will P(IY f(lr all dol)'S following settlement, un\e~s othi:.rWi;;e s\~ted hel'e:
4, FIXTURES & PERSONAL PROPERTY (1-<10)
(A) fNc:r..UDEj) in lhi~ /;;lIe and purchase price r.rc all cr..i~tinllltettl8 l'efmllnel\lly installed ill the l'lopehy, free of liens, inl.ilutJing pl1lmbing;
heating; Iightln!;:\Jdur:es (includina cha.ndeliers a11d eclHn,flUls); wll~er lIe.1tment SySlems: pool and spa equipmcnt; garllSc door openers
:md u-"nsmlncrs; tclcyi~iorl Qnlerlrlas; shrubbery, plantings nnd unpolted Iree~; IIny remairling healinll and cookin,g fucls 5lore(jQn tile
Property at the time ofseulemcnt; wldllo will clltpeting; window eoverini hardwllfl:o, snllde.;, blind,' buill'. in a.i con 't'onets: buill-in ~ppfi-
an .; I ~be r8llge!oVel unless otherwise state ,A\~u im::luded: j~
(B)
(el EXCLUDED fil(tures and item~:
5. SPECIAL CLAUSES (1-00)
(A) ,.~ 4!ld Si:Il~ hAve rectived the COrlsume( Notice os adopted by tho Slate ReMl ,6utltl: Commission at 49 Pa. Code f3S.336.
(8) )(Bu}'I!.l' and Seller heve received a starement of thcir u:$p~tivt estimated closing eost!! befl,)re signing Ibis Agrc~mcnt.
(C) l<<~ hilS received tlll: Seller's Property DisclosllrIlSlatemcn~befo(e 5iglling Uti! Agreement. if reqUIred by law, (See Notice, .Tnf'mnouon
~~sardjrlg the Seller', Property Disclosul'C Ac!.)
(D) ~ Ill! rc:eelved the Deposit Moncy Notice (-ror cooperative sale' whl:l'l Usting Broker Is 'holuing depo5it mOlley) before .lgn;ng thIS
~reement.
(E) The followinl: arc part ofthill Al;fumcnt if checked:
o Sale & Settlement o~ Other Prop~fly 0 Settlement of Other Propel1y Contingency Addendum (PAIt Form 133)
Contingency Addendum (PAR Ponn 130) 0 Tenant-Occupied PropcI1y Adclendllm (PAR Porm TOP)
CI Sale lit Settlement of Other Property ContiJ)~ency 0
with Righi' to Conllnue Mllrk:eting Addendum L]
(PAR Form 131) CJ
5e\\~ -ro "(,OJICl~ -to'o.Jl/erS 1\ ?o.\d, O(If '-(fOlZ A~S lJ.J1"1(2.(2~MY
Pr+-I-\\'V\e ~:R+\-\eme"\l",
.vS.2K PM!,:\: 1 or 8
SelltrInillal':~ pJ(
B"Y"'.ItI""~ J: K.L. .f1JJ...
, . .... ,
m P.nn.yIYllnla: "'..acl.tion of
La. REALTORSO
.....,0Ii" __.._11_..'.._.....
CQfYJUGIlT I'llNNIlYI.vi\NlA ASSOCIATtoN 01'" NF....I.TOnS~ 1998
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1a1fJ2/2fJtJ1
14:38
717-537-fJ822
JACK GAUGHEN MECH
PAGE
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h. 1\'JUKI\JoIH"I~\....UI~IIJ~VLI'~1 \'-"'"
o WAIVED, Thi~ sale. IS N01' ~ooliT"lgent on TJ\(utSo1ge ftnancing
~ ELECTED
(A.) This sale i~ ~onLio~nt upon B'Jyer ob~!J14 JJ'\.2!!Bagt finRnclng D$ tallows:
I, A~aunlafmortg!gC~,"$~_\o(jO
2 Mmllnllm Tenn _ _ l:llrS
3. Type of mortj.llg~ =-= 'nil. J
4. ]nteresr T1ltt;bJ..aS. %~ huweve.r, Buy.r It;!:Vs.to Iccfptlhe interest nt\! ll.$ may be commiUed by the morl'1:_gc lender, not LQ
e,'(eeedlim.1ximm11interc.~('rateof ~f 'd;,.%
5 l)iscounl j'lQillts, 10al1 ori.(lination, ]opnplocemelll and ott'lerfel!s charged by le lelldl!.r"'~llpercelltalle oflhc mortgage loan (c:o.,duding
.1oy mortgllge il1lUranCc premiums or VA funding fee) nOllO exceed % ofthc rnortg~ge loan
T!II~ intel'esl roll: \lnd fees proYI~lons l'tqulred by Bllyel'llre slIl.hfied ir a mong~~ It:nder makes ~\lllilllble to Buyer the right to guaranlee <In
j"lerest l.1te nt or below tile MI\~imllm Interest Rille. specified hen:in with the pcn:entDgt! lees at or ~low lhe amount ~pecified herein. .Buyer
!,!i\le~ Sell~r thl: right, 111 Sellcr'~ sole option and ~$ ~tmitled by the lendil1& ]1I11til...ti(lrl and appJicllble l/lws, to contribute fin:ulciAlJy, Wilhout
('Jromise of reimbu~ement, to lh~ Buyer and/or lender 10 mnkc the nbewe lenns Ilvllihlble 10 BLlyer,
(B) Willllll 10 days of the execlltion of this Agreement, Buyer wHl ml\\len completed, wrillen mortgllgc IIpplic:Lliol1to n rC5ponsible ll1ong;lGe Ie.lld-
Ins institution, The Sc:llln~ Br(lku, ir ll.ny, ojhn~'ise the Li,Unll ntoker, is aulhori"l,'d III eommllnif.;lltc wlth the It!nder ror the purposes
Orllss;5Iinginlhemortgllgeloal1pmceiS.
(C) 1. Upon receipt of a mortil\gc commitment: Bllyer and/or Selling Ihoker will pr(H'lljltly deliyer II cllpy oj' the commitment to Listing Broker,
if llny, othetwi~e 10 Selle.I', ~ I --.J.. JJA "I')
2. Morl'[;ngecommltT1lentdall! ~,"':l~l .If~ wrin:er. commilrnefl~ i~ not received by
Li$ting Broker, if llny, otheNfi~~ by Seller. by Ih~ nbove datc, l1\1yer llOtl Seller llQ;ree to extt!nd Ih~ commitment 1l~lc until Setl~r (cr.
min.ales thb Agreement in writing.
3. S1ilJer tJu (he option to ~crminate this A,teement in writing, O~ or after ttJ~ mClr1sase commil'lnenl dale, if Ille I'TIlJrt!;~ge commiUTlent:
II, I~ not vnlid \lnlil lne date of se..ulement. OR
b Is comliti'.lrLed IJpon Ihe sule llnd seUlemltRt or any oth~r property, OR
e Contllin$ any othercolldition not spc:cifiedin this Ail'l;elTlen{
4. (n tilt c\lenl Seller docs Mltermimle thl~ Agreemellt ns provided above. Bllyer hll.s Ille option to terminllte Ihis Agreemenr in writing if
themortgQXer.:ommifment;
a. Is not obtllined uy or valid until thedatc C1!'seltlenlent, OR
b_ Is conditiOned llpon the swle llnd selllenll.!nt of any other prup~rty which do not occur by the dale of settlement, OR
c, Con~>lin~ any olhcl condition not spl:cified in IhlS Aal'eemenl which Buyer j~ unable ID ~llti,f)' by 1he datc ur ~eHtemelll,
Tf tbi~ Agreemell1 is 1errninatl!d as specified ill paragraph! 6 (Cl (2), (3) Ot (4), ull dleposlt melll!es p3id Otlll.CC()Un! of purchllse price will
b~ retLU'ned to Buyer. Buyer will bc rC,\jp(lMib\~ for flny premiums/or meclllani.;~ \Jen in.~u(ance Mdlor title :;I:urch, orree for entlct;\l.:tlion
nf same, if any, AND/OR :o.ny prcmium~ ror flood insuT1lo<,:e andjol' fire in!uTltl\ce ",ilh eXlended covcrngc, insur.lnce binder cha!l;es or
ealleCUnlion fee, If any; AND/OR any appminl rc~~ unci cllll.tges paid in ad~l:Ince ~n mort~3ge lender,
(D) Ifthc mortb~g~ lenderl'equirt~ fepoir~ to tlle Property, Buyer will, UpOIl receipt, deliver a copy of thc mortg~se lender'sMqlliremenls to I,.'~linp;
Sroker, ifQIIY. otherwise to St;.lJer. Seller will, willlin 5 dilY~ of rw!lpt of tht lender's requirements. notify Buyer whether Seller will m~ke [he
rCCjuired repairs "-I Seller's c;>;pen~e
I, If Setter choo!es to rnWc:~ repairs, 9\1)'tr wilt .oeept the Pl'Openy Hnd Qij:ree co the RELEASE ~"l forth in porllgl'aplt 2S of this Agreement
2 Ir SelleI' ehoosc~ not 10 make tlle rcquirell repilirs, Buyer will, Wll'hilJ 5 clay~, notify Seller in writing ur Bllyer'~ choice 10 terminilte ,his
Agrecmcnl OR malee 1he l'l'quircd n~puir~ at Buyer's expense und Wilh Sellel"s pennjs~ion, wh;cl; will rlCt be Lmreasonlbly withheld If
Scner <Jeni~ Buyer pwni5sion to make the 1'!CJldrcci repuir~, Buyer mai', within ,5 <luy, of SelJer's deniO\!, lerminate tlll5 Agreement If
BL<Y~f lermiMtl!S this Asreemenl. ~JJ deposit monieS pAid On Qcco~nt of p~relw~e price "",ill be l'et~med promptly to 9lly~r and this
Agreemellt will be VOID.
(E} Seller.\ui3t
)It NOT APPLICABLE
o AfPlTCABlE Seller will pi)':
o $
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101
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111
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,n1aximlllll, tOWllro Boye~'5 CO$L~ as pemlitled by the mongllge lender.
fHAfVA, IF APl'LlCADLE
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(Fl It 1~ el<pressly agreed tll;!t notwilhS~di((B any otller provjsion~ of this contract, Buyer ""IIlaot be obligaled t<:I Cl.1mptele lhe purchase of the 118
Property described here;n or to incur any penalty by folfeiture o-f eamest money dcpo!ilS or olherwise unJe~~ BlIyer has heen given. in uccor-
dlll1(x: with BUD/FHA or VA requiremcnts, II wrillen ~tal~memt by the Fedentl Hou~in!:\ Cot!'II'f1i~sioner, Vetel'lllls Administration, or u Dife~\
Endoll>emenl LeTldel' setting forth lhe llPl'rtIi$ed vlllue of the Properly of nOI tess than $ (the dolhlf ~moun! 10 be
in:;erted is the sales price as mlted In lhis Agreement) HIlyer wj1\ have Ihe privilege and optiOtl of proceeding with consumm~li()n of the con-
me! without teBi'ml to the amount of the lll"Praised v~luation, The apprw6ed liBlllBlion is <:'Il'rived atlo detennjn~ the mlli'liml,lm mOl'lg.:1Be lhe
Depzutmcnt of l.{ollsinB and Ul'bt.n D~~'e1opmenl \'v'iIl insure. MUD doe! not war:rlmtthe \lll.lue nor the condition of the. Property. Bllyer $bOllld
S311St'y himsdf/hcrgelf that the price ~nd condition or fhe Propelty are acc0pt~bh:.
Wllrning: Section 1.010 of'Title 18. LS,C.. P~parlmel\t 01 HouSioi l\nd Urblln Development provides, "Whoever for the PUrp05= I)f. innu-
'encing III l\ny w~)' lhe nctiol1 of such depanmcot, . rnakes,paS!es, Ullers or publishes any ~tBlement kl10wing th~ Slll11~ to be fwl~e. . Sh311 be
'fined not mo~ thlln $5,000 01' imprisoned not more lhan Iwo years. or both"
(0) U.S. D~partment or Housinll: llnd Urhnu Development mUD) NOTICE TO ,'UUCHASERS:
nl1yer'l Aeknowlerlgt!ml:nl
o Buyer hM~ recei~ed fhe HUD Noticc "For Your P,'Olectlon: Get II Home Ins;peelloll" (see Notices and Infonnlition On Prupel'ty Condition
Inspections). Buyer underSlnnds the importance of K2ttlng mn InUependent tlOme inspection and hMS thought llboLlltllis belon! signin& lhb
AgrtcmCnl.
8u)er'sInllials Dote
(H) C~rtille::atilJn Wc the undersigned, Scllct1.~) lod Buyer(s) plMy to thh tr~n5AClirm each certify tlUl1lhe I",rm~ or l.hi$ COni/Bet for purchase II~
tnlt {(I the best of out knowledge alld belief, :lIld t}ull any other agreement ~J1tered iMo by any of th~!C pltrlie~ In cc>nnecliQn with thit tr~ns~l::
tlQn i~ ~!tached to this AGreemenl
7, INSPEC1'lONS (1.g8)
(A) Seller h~by ~Srees Lo permitlmpecliQIU byaulhorizcd Npprlliser~, tepllt;!ble cenifiels, il1f,urer'~ represematives, surve~on;, municipal officials
and/or Bll~ef D~ may be required by lh~ lending in!lituri~'ns, if any. OJ' ins(lring agelJcie:S. Seller fW1her tlgrees to permil tiny other il1speetiol1~
requirelJ by orproYided forJI1 IhelenllS of this Agr:eement
(B) Buy~r resetve.~ the righlto mMke Q pre-settlemcllt wllJiNhrough inspection of (he Propel1}'.1311yer'J ril[ht to mll!:.c (his Illspeclion Is not wl\i~ed
by any other pro"isiQll of thi! A~ment
(C) Seller will hll~ehellt(n8andallurilities(ineludinifueJ(s))on {otlheinlpections,
A/S.2JC Pale Z or8
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10/02/2001 14: 38 717-5'37-13822
)j.. It l'IUl1'1!:l(1 Y IN.'iI'I':LIIUI'I LUI'Il.II'II,CI'I\..1 ~1'1JVI
l~S 0 WAIVED, Buyer 1I11(klscands that Buyer has the option to l'tqtles~ in~pecllons o~- the Propel'Y (~ee Pror~rtl" 1nsrl;uion ~nd Envlcol1l\lellwl Ij,;
1~~ Noticc~), BUYER WAIV'l::S THIS OPTrON and agrees to the RC:LEAS~ ~el fonh in pHt'llgraph 25 of thj~ Agreement. 1~5
1~1 .... I!LECTED 1~-1
1~8 (A) Within JO...-.- d~y~ (If llle exccutil.Jn Millis Ag~cment, BLI)'tr, lit Buyel"s tJlpC!1!\:, mil)' clloo,e to hll~e ;n'peclions lIrullur cenific:t!ion~ corn- 1~e
1511 pItted by ]iccn~ed or otherwise '1ualitied profetlsiol1als (see Pruperlylnspcction and Ell\'lron'l'Jcnrul Notices1. ThiS contingency does not .\Ppll' 15q
150 lotilefolluwin[lexislingcOTldilioIlStlnd/orlleml: 11jO
1G'1 (D) Other provisions Oflh.~ Agreement fTllI) provide for i~Sf.ecriolls lind/or cenificatlons th.1I ;lre not WlIived O~ 31lercd by Buyel"s ei~elion here, lBl
162 (C) If Buy(,:r lb r'lOt satisfi~d with lh~ condition of the Propert)' ~s sMcd in any wl'incn repDrt, 13tlycr will, wlthin the time givell for completing 16Z
m "'\J inspecUons' 163
164 "Optionl H4
1.0 1, ACl;ept lhe Propel1Y wilh the information st~ted in lhe l'epoI1(s) Mnd agree to thl: RELEASE set fonn LIl p:u'3gl'aph 25 of lhl! Agre<:T11ent, I.~
156 00 1~
161 , 2, Tel'min:ue the Agre.ement in wrilin& by OOlice to Lisllng Broke', if any, olhcl..,...i<;e to Seller, withil\ Ihe time glven For inspection, in which 167
I~g C3se ~) dcposit monies [lIIid em llCCOutlt O[plltchase pdce wjll be l'etumcd pn)mptly to Bllyet end rhis Agrcemel\\ will be YOlD, 1n
U9 0 Qpl'ion:Z' 16~
110 I, Accept lhe Property wilh the il'lfo!1nation $r~ted ill the rep(Jrt{.) 3.~d :l,ircc 10 Ih~ RELEASE 5~t fOlth in p;lf~Smph 25 of this Agfeemelll, no
17,' UNLESS the total CQSIIO COlTect fhe'Cof1ditions contaiI1=d in 1I1e reporl(~) i~ 1l\01~ thllt! $ \11
m 2. Il Ihe tOlal COSt to COlTCe\ Ihe conditiom cOrlt.:1ined in the report(~) EXCIiliDS the llI1lount spedfied in pUr~gl'i1ph 8(C) (Option 2) 1. 172
173 Dtlyer will deliver the repllrt(sl If! Lining Ul"ok~r, If an), oth~l'wise to Stller, within tht time r;:ivell tor lnspe:clii'ln. 113
114 Seller will, wilMin _ t1.ys of l'eceivin~ the I'epon(s), inform BUllei' in wming of Seller'~ d10ice to~ 174
17S (1) Make l';p~irs before ~elll~rnent ~o thn! tl;~ remaining COSt to tepair condlthJlIs cC1r1.uilled in th~ repOI1(s) is less th'Jrl or equlllw
176 the amount $pecltied in pll1Ugt3.ph 8 (C) (Option 2) 1,
171 (2) O'l0it Buyer at settlement for the diffcJ1:n~e between the c~tilT\.:1led cost of r~puir,ng the conr:lition~ \;()(\llI.illed in Iho:: teporl(s)
17e and tho:: .mC1Ulll st'ecified \n paragraph 8 (C) (Option 2) 1. Thi~ option must be ~CCepl.:1bie to thc rnC\rlgJge lender, if !Iny
179 (3) Nol m~ke repairs and nor credil Buyer ~t M~rtlemel1t for "f1)' d~rects in conditjon~ oo,."olned il1th~ r~J'lI"lI'\(S).
no b If Seller chooses 10 muke repail's or credit Buyer at ttUlemeOl as specili~d in pll.ruglil.ph B (C) (Opliur> 2) 2, BtlyeT will Olccept th~
15'1 Pfu~rty Md !tgrce to the RELEASE set fOtlh in pnt.grOlph 25 at' this Agrcement.
182 c. If Seller choose! not to m:lke repairs end rlOI to credit B~yeT o.tselllement, or If Seller fails to choose any option within the lime
183 clvcn,Bu)'el'will,within_dll)'!i:
181 (I) Accept tho:: ProperlY with the information ,taled in the repotl(s) and ItgTCC to thr; RELEASE set forth in paragraph 25 of thiS
185 Agleement, OR
lec, (2) 1'elTTlinate the Agrcement \1\ wdcillg by nolice 10 Li~lillg Bl'oker, if nny, ulhetwi:>e to Selkr, in wnich CWie all deposit monie$
187 p3id on aCCO\lnt of Plltt:buc plice will be retl.ln\ed promptly 10 BlIycr nmi thIS Agrtement wlll be YOID
lSB 9, WOOD INFILSTATION CONTINGENCY (1.0(J)
leg 0 WAIVED, Buyerundersta.nds that Buyer ho~ the option to req\lo~n thut ~he p,{lperty be inspected fOI wood inr~tatioll by f\ cejtifiedP<::~t Control
lno Openuor. BUYER WAIVES nllS OPTION nnd ngrecs to the RELEASE set fortll in pamgtllph 2,~ C1f this Agreement,
H1 ~ ELECTED
192 (A) Within:15...- days of Ihe \:XeC~IIOn of this Agreemcnt, Buyer, ul ,aLl>'el"~ e~pense, Will o'btoin It wriuM "Wood-Destroying Insect rnfe~\iIlion
193 Tl'\spection Repolt" from a cer\'ifit::d [>est Control OPCl1l10rllnd will del,ver it and 1I11 SllpportJng documents and dr3wings pLOvided by the Pest
19~ Contloi Optrutor Ie U$tinll.BlU1cel', jfnny, othoJ'V<i~e tn S~11el', The repotl is 10 be m~dc "ltbfuetory -Ie> und in compliance with IIpplic~ble ll/ws,
1~~ mOlting; .nll l~d;ng iru[jmtions, 3ndlor Fede.ralln~Lltinll and GUIII'IUltte'lna Agoncy rcquirements, if any. The inspcction will inelllde III re~d_
19~ 1I't vbible IIl1d accessible lIe,lS of ~1I mUCILlres on the Pl'opel1Y exetplthf: foltowms Sltu~(ure~, which WillllOl be inspected:
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JACK GAUGHEN MECH
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(a) If the inspection reyeul~ eVldence of ftctivt inre~t1uiOl1($), Stller .:1grees, ;Il Seller's expcmc /Ind befo1'll settlement: to treM 1'01' activl: jnfc~tll-
lion(s), in 1l000otdonce with appliclble luws, .
(C) IftllO:: ilj,pection fevealJ damage from uctive inl'estatioll(S) or previous infeslllliorJ(s), Buyer, al Buyer's expellSe, 11ns Ihc (lption to oblain a "'fit-
ten report by lI. professiollal contractor, ~ome inspection $tl'vlce, or Slfllcturlllenr;itleer lhalls limired to stl\lcturn! d3m~g~ to \h~ Property caused
by wood.de~troying otglUlisms and II proposal 10 repail' the dnmage, BllYf:r will deli~'er l'he strUctural damage rcpOf1 ~nd co~eClive proponlto
Listing Broker, if any, otllerwbt to Soller, within ~ d.,ysof delivtring the ori~inol inspection repOl1.
(0) WiThin 5 do.ys of receiving the sfI\letuUd do.mo.p;e report and corrective propos~l. Seller will advise Buyer whether Seller will rcpllir, n Seller's
cxpense and before settlemenT, an~ .truC;tllral dalnage from active or pl'C'I"ious Jnfil.Milll1(~).
(E) If Sel1er chooses to rep:lir str\letllllll ollmoge reveal~ by the l'epOIt, Buyer IIllr~es 10 aeceptthe Propwy:iS l'epaired and agrees to the RELEASE
$elfOl'thinpal'lgnph2SuflhisAgreemem.
(P) If Seller choose~ nOf to Te,,~ir sttuctunl damnge revclllo::d hy the report or laU" 10 respond within Ihe timt given, Buyer, withill S dltys of
teceiving Sdler'~ T1Olioe, .....ill notify SeUer In wrilins of Buyer'$ choice to'
I. Aceept me Propelty with the defect! Itl"'e/lled b}' the inspection, without ttbntement ofprico:: und a!lle<; 10 the RELEASE! set fonh in pM.-
gnph 25 of thIS Agrument, OR
2. Mal;ethe repltir~ befl)rt settlemelll, if required bYlhe mortg~Q;e lender, if 4n~, ~t Buyer's expCl1se Md with Seller's ptrrnissi(1n, whIch will
not be unreasonably witl1held. in which cnse Buyet ICctpB the Propeny llnd agtees to the RELEASa set fonh in pUllgrnph 25 of this
Agl~ement If Seller deni~ BUl'et pennission 10 make (he rcp~ir~, Buyet moly, within 5 d~ys of Sellel"s acnial, terrninlltt lhi~ Agreement.
If BlIycr temttOllte5 lhis Agreement, 1111 de\?Osi\ monk~ pMl(1 on OCCOunt 01 pllf'Cl11lSe pJ'ice shall be retllrned proml'c]) 10 Buyer and this
Agreement win bl: YOlO, OR
;. Tcrmln~te Ihi~ Agreement. In wl,ich CM~e ull de:posit monies paid on /lccounl of purcllll~t price will b~ ret~l'ned Vl'omprly to :Buycr and
this Aereement will be YOlO.
10" RESIDENTIAL LEAD-BASED PAIN'r klAZARD REDUCTION ACT NOnCE REQU1R.ED FOR PROPERTIES
nUILT BEFORE 1978 (1-00) .
o Nor APPL.!CABtE
}( APPLICABLE
(A) Seller nprenntli that: (check I OA. 2)
CI I, Seller hu no knowledge concerning the prcseno::e of lead-hued ptUllt ~nd/or It/lcl.bll,ed puim hllt.:1tw in 01' :lbollt lhe Propert'f.
o 2, Seller 11.11 k.nowk,dgc Or the presence of le3d-bllSed painlllnd/or le",d.llued p[lint h4~lIrd~ in C( aboullhe I'l'operty, (Provide the basis I'or
detelminlng th,,~ lead-blued paint/l.nd/or hlll.lon:1.s.eltisl. the loc~tlon(s), tne \:o'ndilioJn or the p~inted surflee~, ~nd othl'r IIv:tilable irli"olma.
lion coneem1ng S.eller's knowledge of the presence of le~d.bl~ed [Jlllnt and/or It':Id-'blls~d paint hlt2:ard~.)
(Bl
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Reeotd~l~epotts (check I OR 2)
I Seller l'1a$ ll(ll'epOns OI rceonls perlllnillg to le~d-b~s~d [J~;nlllnd/Ol' lead-based p~lnl h~l:,,'ds in M a\.lollt ti,e Property,
2. Seller hu provilled Bu)'er with allllvailable ~eOfd~ And T\:I'OrlS pertaining 10 lC:ld-bll.'Jcd puim ~n.vol'lead.blSed pall'll hl\t~r<.k; in or abollt
lhe Propcny, (j..,iSldocuml!lnts)
~ 811yer'~ AcknowledgeJJlent
~ 1, BiJycr hus received 1he pumphlet Pml"a .Y"l,r Family jiO"1 Lem/ i1J fmff" Hom!! ~l1d hal reud Ine Lead Wal'lli Ilg Sratement c',"l,\illed in tlm
Agreement (See Environ e fal Notion), . Q .... J 'I
nuyer'slnltial! '.".. Dille /<--",,_-10
CJ '- Buyer h~s rl!Vicwc Seller's dls osure of kno n lead-bMed plllnl and/or lead-based p:tint h~}:ard" lI$ identified In parugT\lph lO(A) and m
has received Ihe :recOrds and report~ peneinin& 10 lead-based pllll'll <llld/or lead.based [JlliOl' huzard~ ,dentitied in purllgrupl'1 IO(B) ng
Bu}"u'sInitillLs Dolt [;{>I.I 24C
lA1 Buyer1nitI1l.Is:jJJ.,f '/~"L).:r. \<..L. AIS.2KPo~e3orS SellerTnitIKl~: tltl f ,~1
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10/82/2001 u:~~~_~__ 717-697-0822 ,JACK GAUGHE~ MECH PAGE 05
~. , Buyer h~~ .1 JO day pe1'lod (lInlm Buyu ~nd Seller agree in wrltlns to., U iJifltrt:. 11\ P cliud of lime) to COllduCI il.TiSk 9Ssessmem or inspc:lion 01
l\, L V th\l Properl)' for the prtM:ncc of klld.based paint 3nd/or lend.bused p\l.lnl hoUlI.I'ds.
, f\. WAIVED. Buyer UJldel5tand51h~t Buyer r.a~ the dahllO condutlll n~k us~el~ment or inspection of the Properly (0 determine the pr~sence of
g4f,~', leud.b.~ed {I:linl a.lld/or lud-bGScd pllint hazards. BUYER WA1VES THlS RIGHT and agrees 10 the RELEASE ~l fOl1h in f,l9ngruph 25 of
~ lhisAgreemen1.
24B tI ELeCTED
24~ I, Buyer, III Bu)'cr's expense, choo$e.~ to obtain:l. rl!k llUCnml.l1l1 lind/or ill~J'ection of the Froperty for le~rJ-based pailll ~nd/or ]e\ld.bu~ed
250 p~inl haz.ards. The li,k 1S!~mnenr andlol' inspection wi)1 b~ c~lmpleled within ~ c1~y! of the execution of this AgrCt/Ylenl (insw
l~1 "10" IJnlessat1yerantISI:J1l;:'ta!lreetoadiffer~ntpcritltllJ'time).
25~ 2, Within the lime set furth IIbove for obtainine the rIsk IlSStssmenl and/oJ' inspection uf the Properly ror IClllJ-bastd painlllnd/o,'
253 lcllLl.based pnlnt hlll:ard~l lIu)'cr may dtlinr to Listing Draller, if IIny, (lthtrwjs~ to Stller,.c. wr;tlell list of the spcl,:itie h~l:ll'dous
254 ccmdltions cited in the report and lhose corrections reqUe$hld by Buyer, along with,.. C~lpy ~lf the risk assessmenl <lnd/oT il'ls~ction l'epOrt,
m 3. Sellet m:\y, within _ days of receiving lhe list llnd report(~), submit II writtcn cO/Teeli'~e proposal to Buyer. The l,:orrective proposal
255 will include, but not be limiled to, th! n~tne of the r~medillLion Cl)mpany Md a cOlllplt.:thm d.lle rOT con'ectlve m!ll~Ute~. Seller will pro-
2~r vidt; t::erliflCatlol1 from a risk USICSSClr or inspector lh~l com:,tive m~a~urc. Illiye ooen mild\: ~atisfuclorily 011 or bdori: lhc ~lJmrl11li(l1l dat~
2Se 4 Upon re':ei\f'rlg the correctiyc prop063J, Bu.yel', within 5 UIIYS. wiU.
259 rI. Accept Ihe con'ectiYI! l'ropoSlllllrld th! PI'Opelt)' in writing, llnd llStee to the I{ELEASG set forth in p~ragrnph 25 of ,his Agreement,
m OR '
2~1 1:1 j''ennltltlc this Agr!ement in wrilltlg, \n which clIn all d!.:pusit mOllies paid on llCCOllnluf purchase price wiJl bc returned promptly
162 10 Buyel' a.nd thj~ Agreelnent will be YOlO, '
zr,~ 5. Should Sell!I' fa.il tu ~ubmit.c. written eorr~tiu prnpnlal within the tlm~ sel rnrlh in pal''''jraph 10(D)~ oflhisAS1'eemem, :hen Rl,I.y~r,
264 wilhin5 day~, will:
266 a, A~'()eptlhe Propmy 1n writing, and agre! to th~ RELEASE sel f0l1h in pllr~grllph 2:; flf this Agl'eemcnt, OR
2U h, Terminate nus AgI<;:t;menl ill writing, in which CO$e a.1l deposit monks pili\! on ~ccount of pmcllllSC price will be l'!turned promptly 2GB
m loBuye\'andthi~Agrellmelltw1Jl1x:YOJD. m
268 (E) CnLincation By signing this Agreemelll, Buyer ~nd Sell~r c~rtlfy the BCClJrlll,:y of Iheir respeclive stntCTlleT!t'>, 10 lhe be~t of their kllowledg~ 2Gn
2~1iI 11. RADON CONTlNCENCY (1-00) 26D
27D (A) Scll~r Tepresenls tlut: (check llppmpriate respon~(~)) nD
27t 0 1. Seller hus no knowledge !':ol'lceming IIle presetlcl.\ or ~bsence of r~don. 171
l72 0 2, Seller h:lS lc.nowkdge lhllt the PI'Opel1Y WlIS tested on lhe dales, by lhe mct!1Q,b (e,g., charcoal canister, ~lpha trllck, etc.}, 3nd will1lhe
2;J l'esuHsoflllll,eminJicatedbelow
2"1 DATE- TYPE OF TBST
RESULTS (pjcoclllj~slJjlcr N wnrklngleveb)
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COPIES or ALL AVAIl.ABLE TEST REPOItTS will be d<:livered !C Bllyer wllh Il1is Ag:lument. SELLER DOES NOT WARRANT
EITl'IER THS i\1ETHODS OR RESULTS Of THE TESTS,
Sellel has Kllowlcdge thot the Propel'lY underwenl rndon Il:thlt'tion m~lL!;I,l(e~ on I'h! da.ll~(s) :lnd by Ule method(s) indiclIled b!low'
DATE RADON REDUCTION METHOD
'rJ...
WAIVED. 'Buycr und~rslllfld$ that BiJyel' has the option to rcquc~l !,h~l th~ Prflpertr b! insp!Cled fo!' radon by a certified .inspo.:c;lOr (~ee Radon
Notice). BUYER. WAIVES nus OPTION Md agl'Ce$to the RELEASE seL lorlh ill p!rai'l':lph 25 OfllllsAgrccmcnt.
ELECTED .
Buyer, at Ruy!\"~ !l:.pens!, has I'he option 1(1 oblnill, il'On! a celtifled 1l1spector, 1\ rndOIlIC5t of the Pwt't:Jty Ilnd w1l1 d~!ivel' 21 copy Oflhc tCSI
report to Li~lins Bl'Olcer, if any, otllcrn'ise to Sell~~, within _ days of 111~ exccution of this Agreement. (See Rlldon NOIICll,)
1, Tfthe te$t repot! r!yeala the pl"Csence of .Adon 1::lll1\IW 0,{]2 working levels (4 picoeurie~/Iitcr), Buyer HCl,:CpIS lhc Properry alld agrees 10 lhe
RELEASE set forrh in paragraph 2S ofthisA~menl
2, If the le.l' Teporl revea.ls the pr!$!nee of tadon ll.lur e~ceeLlin8 002 working lev~ls (4 picoculies/lilcr), Buy,r ",'11, witbin _ days
of recdpt ofrhe lest re~ults'
Opl'ion1
,
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(8)
o
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Accept the 1'lOptrly in wrlllng nnclllgree to Ihe RELEASE sel fOI1'h in pUl~llr:~pil 25 of this Agrl;'cmcnl, OR
Thlmilll\tt 1hJ~ AG't\'emenL in wrilhli, in which cas! ~ll depo,it monies pllid on IlCCGll'lt \lr purcl'~,e price WII\ be retul'lled promptly
to Buye~ Il.nlllhi~ Agreelll~l1t will be vOrD. OR
SllbM1itll writlen, COI1'!ctive proposal to Lislinll Brok<;T, if IIny, l.Iiht:rwi')! f(' S~l1er The cM'ective pl'oposal will inch.lde, but not be
1i1T1'led 10, [he (l:L!n! of the cenified mitlglltlon comp~ny; provisions for f'a~'melu. ill~I\.Idil\g rel!Sts; :Lnd completion dale for <;011<;C-
Ilvl1lT1C1:l$\lre$
(,I) Wilhil'l5 ,101)'$ ol,'receiving the COITC<;liyc propo~(\l, Seller will:
(11) Agree tn Ihe telms of the COlTeellYC Pl'oposill il'l writlns, in which C~$e Bu)'er accepts the Property ~nd !llrecs to the
RELEASE ~et fOl1h in p.ragr~ph:2.S of lhi~ AgreemerLL, OR
(b) Not "f;lee to the tcmlS of the correClivll j'lrnpoul
(2) ShOtlld SellcT tIOlll.!,lroe l'(llhe temlS c~ lhe cOI'l'ecti~e proposKI or fnll tu rO'spopd "il'hin Ihe Lime (l1~{'Il, B~fer wi11, within 5
d~y~, cleeL 10'
(~) Accept the Property in wrlllngll.nd ~glee to lhe RELEASE set fortl1 in pllrKllrapll25 Qf thl~ Agreemenl, OR
(b) Term1nlllc Ibis Ayrtemenl in writing, in which Ca30 ll.:il deposit monll1~ [l'Iid IJn IIceOl.lnl' \lr pt.m::hase plic! will be returned
promplly to BlJyllr ~nd IhiS Agreement will be VOID,
o
Olltiun2
a, Accept the Properl)' ill writing and tll1rce tu the RF::LEASB S!t fMIl in pnlagrllph"25 of Ihl~ Al:reem!n\, OR
b, Submil a written, cOI'teCl1ve proposal to Listing Bl'oke!', if "ny, oll1erwi!c 10 Seller. The t::On:el,1live proposal will il1c1l1dc, bm nG!, be
limited to, the nllme 01 the certified mitilllllilJll compllny; J'ro\lisions fol' p"ymcnl, in.;l.l.ldiflS tcle!l$; and completion dlle fOT GOlTl,:G-
(IV'; mQU$'-rcs. Seller will p:!y II mR~irUljm of $ toword the lvtll.l ('O~t of remedi~tion nnd retest!, which wiJlbol
completed by settleml;[Il.
(I) If the tot~l cost of remediauon and retests BXCE~DS the llmount specified in P3!l1gl~ph I I (Et} (Option 2) b, Seller will, whh.ln
5 d~y~ Ornlceipt ol"the cost of TCmcrJillliun, IIOt;!")' BII)'!r III writing of Sellcr'~ choice t'o
(II) PMY fO'l' lh! lotal cost ofremedllltion lind l'elem, In which case Buy!.:r Ilccepls the Property and agrees 10 the RE;I~EASE ~el
forthinparllgrapI12:5ofthisAgreemenl,OR
(b) Notpayforlhelota]ctl9tofremediatlon;mdleluts.
(2) If S~lIet chooses not to pay ror lhe IOt41cO$1 of l'emedl~tion lme! rt:lcsiS, or if Seller tails to choose dthu (Iplhm within the
time ginn, Buyet wilt. within S day" flOtiry Sellllr in wl'iting of Buyer's choi()(: 10
(0) Ptty the difference betWUI\ S~l!er's contriblltion 10 rcmediatioll and telcsts 11lld the 1lC1'l.lal COSI th!reof, in whi.;h C4,I::
BlI)'eT ACCepts lhe Property lLnclRI;n:.e5 to the RELEASE Stl fooh io pOrflgrnph 25 oftl\isAgreemc1'll. OR
(b) 'lbnnioQ\.t this Agreement, 1n which case :\11 deposit monleJl puid (In .ltcounl of pUl'ChlLSe pricc will be relUOled promptly
to BI.l)'er :lnd Ihis Agre.;mel)t will be VOlD
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10/02/2001 14:.38 717~597-0B22
IL. ~IAILJ~Ul' "'AI.tl.t~tr.uUJ
tA) Seller represents that this propolft)' IS. ~ervcd by~
o Public Water
)( On-site Water
o Communit}' Wll.1.ti
o NOlle
o
(B) WATER SERVICE ll"o'srECTlON CONTINGENCY
Cl WAJVED. Buyer ack.1'lowledges that BllY~ has tht option to rcqu~l an inspecHon I)f lilt water !ct'lj<:e for lhe Propeny. UUYER WAfYES
7H1S OPTION and lIgfCcS \0 l11e R..E.LBASE set fo(lh In paracral'h 2S of tllls Agreement.
)( ELECTED
1, Buyer ha~ the option, within lS.- days aCthe eMcutiOtl of tltI.i Agreemem. (J,M at BU:'I':r'a el',peMe, \0 ddi\.ct II) Lislil\g BI()ktt, it all)',
oUlerwise 10 Seller, 0 wri"en Inspection report by a q\ulUficd, ptoress.ion~l Wllter testiuj: compln)' of Lhe quality and/or quantify of tbe water
service
2. Seller ogren 10 locale and provide IlCCCSS 10 the on.sile (or individual) waler s}'Mem, if appli<:l\bJc, at Sellar's c.l;pcnse, if l'tquirc~ by th~
inspection company. Seller ~lso agree' to "eUore the Property prior to setllemellt
3. If Ihe fl!port !evenb that the water ,ervicl:: does not meet thl:: minimum standi\rd~ of any IQplltlllbh:. ~o~emrntC\~'J.t\mrlty Mdfor r~i\'i. to
$i1.tisfy the requirements for quality andlQr ql,lllloti[)' set by the: mortgage lemler, ir aT'l)', then Seller will, withiu ~ days of receipt of
the report, nol:ify Bu)'erin writmg ofSeller'sehoice to:
~. Upgnck the wQtel' service to!'ne minimum acceptQ"ble levels, befOre Gl:!ltJernent, in whict'! case Eu)'cr ~c~e"ts the Property and egrecs
ID Ole RELEASE ~et felth in pllJ."'lgf8ph 25 of thb Aguement, OR
b. Not upgrade the wllerSef'llce.
4. l[ ~Uer chooscs not 10 upgnde the service to minimum IICcepUlble Jevc19, or foils to rCllpul'Id wilbin the time given, Buyer will, withtn 3~~
~_day"either: m
ll_ AC'Cql\.ne Propeny an~ \hewOlter ,eNleC and, if tequired by the mortgage lender, if uny, ..ud/or any gove::nment~l authority, up,rade
fh~ ""tlLet service before ~eUlemeot or within the time required b}' the mongagc lender, it' illly, and/or uny gove,lllmental tl",thorit}', !l
13uyds expenso and with Seller's pcmJ!sSI()l1, which will not be ullreasonably withheld, and ag~ to the R~LEASE sell'OI1l1 in
purClgraph 25 of IhiJAgreemenl, If SelJerl.lenies Buyer pcrmi~si('ln In upgl'3de thl: water $trvlce, Buyer ffiDy, within ~ day~ or Seller's
dM;al, terminate this A~emenr If BllY~f t",l11inates thIs ^erI:I$lCnt, all dep051t monies p3id on ICCOUlll of purchase pricc win be
~etumed proml?ll) l<J lh)'tf znd t\\i~ Agi~mtl'it wm b& VOID, OR
n. Temlinale this Aweement, in,whlch cu~e nil deposit monin puid 0(1 aCCOLlnt of purct]llse price will be ~ll,lmed promptly to Buye,-
and thi, Agree:mMt wUl be VOID.
13. STATUS OF SE"''ER (1,OD)
(A) Sene'-repres~lltsthlltprtlpertyis&el'Yed by
.. PublieScwer
[f Indivir."..ll On-lot Sewage Di,pol/u! System (See Sewage Notice 1)
o Individulll On-)ot Sewage Dbpo9111 Sy~tem III Pro:drnlty to Well (See Sewage Notice I; ~ee Scwase Notice 4, If Rpplicllble)
o COnunUl1;fy Sewage Disposal SY~lC",
o Thn-acre Pertnit Ex.emption (Sce Sew"ge Notice 2)
CJ HQldlog Tllnk (See Sew~ge Notice 3)
o NOMe (See Sewase Notice I)
CJ NOM Available/Permit Umil'Qtions ill Eff'tct (See Sewagc NOlice 5)
Q
(B) INDJ\'IDUAL ON,LOT SEWAGE DISrOSAL INSPECTION CON'flNGENCY
o WAIVED. Buyer tlcknawledgestllat Buy.;r hu the I,)ptiol'l to request an indlvldu~l ~ll1-lot sewate dispoMl in!~ction of.t\t.e Propelty. BI.JYf.R
WAIVES rHTS OPTION and ~grccs to the RELEASE set fonh In p~rllgrQph:2S Qt this Ar;teemt:nt,
o ELECTED
1. Bu~er hll$ the O~;Cl\, wiU'!ill _ ~1l'j$1lf the e:r.:!:culion of \hIs Agrcem<:lIt lInd al Buye.r's ex.pe.osc, to dehver to Listing Broker, if
any, olherwise to Seller, a written inspection ~plJrt by a qualified, profes!ionmJ in~pectQr olthe indlvidual on-lot Sewage disposalsy!tern,
2, S~lkr 1lJ.'rees ro locale and provide acce~' to th.e individual on.lot KWa~ disped"!. ~y~tem, and, if required D~ tbe jll~pection com\lP.ny,
cmpt;.- the ~eptic tank, at Seller's e;o[pe[\~e, S;l\er also asrees (0. restoro fhe: Property pM('lI' 10 setllement
3. If ttle repnrt reve31s defects that do nOlrel.j\Lire expansion or replncemenl or the eJi~ling s~wal!:a disposal '~~tem, Seller will, wit~in
_ days of ftccipt Qf l.h<: cepQ:rt, notify Buyoe~ Lt\ wdtil\i of Senet\. cooic~ 10'
a. COlTect the dC-(el:I$ before settlement, incl\ldilll fcte't~, ijt S~ller's ex.pense. in whieh ca~c Bllyct accept. th~ Prop!ny and agn:es to
the REI-EASB set forth in pMagraph 2S of thb Agreement, OR
b NOI correct !he defects, or If Sc1ler tails 10 n,pnnd wlthill the lime given. BI,l)'CT will, \liithill_ dnys, either:
(I) Accept the Property and lhe system lind, irreq~i1'ed by the mortgnsc lender, if "ny, and/or any goverumentalllllbority, COrrecl
thc defC(ib> before settlement Of wJtllin the time required by tlle. mott':J.ge \ender, if \In)', Il.l\dior ~y %O'l~\,\\neT1ta\ l'Illhor\I)', III
Buycr's sole expense and willl S~ller's penni~sion, which will not be utllca,olnbly wil'hhJ:ld, 0l1lc1 :lgree to lhe RELEASE set
forth in pllrAlo'rr.ph 2.S of this Agreement. If Se:ller denie.~ Buyer pe!mission to I;omcr the dertclS, Uuyer molY, within S d.ilys \lr
Seller's d~hl.l, tetnunate tills AgrJ:cmcnt, lfBI,lyeT terminates this AIr'Ccmont, Il\ (lc:pOSil monies paid on account of PUtChllse
price will be reNrned promptly 10 Buycr und this Asreemtnl will be yaw, OR
(2) Terminate this Agreemen~ irt writing, in which c:llie all deposit mOll\l:S pwd on acCQuC\t of ?Utcha~c I'uce will ~ I~\U~
promptly to Bny~r Irld tilts Agre=r'Ilent will bl! VOID,
4, trtbe report reveals lh~ n~eJ to e~p~nd or repllc~ the e"'i~tirjS: individual on.jot s~wll.S~ rli~p"~DI ~j"slem, SelieI' may, within _ days
()f rec~il?\ of the ttpmt ~\:lbmit II co1f'~clive prop!))a\ to Selling BroKer, If :my. olhuwi~e f() Buyer T1\e corrective propo~Dl will include, bllt
not be limited to, the name (If the remedl:ltion cumJl~!lY; provision5 for pHymcnt, irJt;luuing rete~ts; nnd eompleu(ln d~le [(lrCml'Cc!ivemeu-
sun:s. Within 5 days of receiving Seller's corrective ",opos~J, 01 If no corrective proposal is receivl/d "iL'hin tbe time giun, B\lyer will.
a Agree to the term~ oflhe cOJ'rectlve pcoJ?O~1l1, it flllY, hI writing, In which CllSe Buyer accepts the Properly flnd agl'Ces to the RELEASE
set forth In pangClllph 25 of this Agreement, OR
b, Accept the propeny md the sy,tenl and, if r:quired by the mol.1&loge. Ie:M'Ct, jf any, lolidloI MY gO"l'crnmental authority, Cl:lrrecl Ule
defect. before ,elllemertl or wilhinthe time required by Ille mortgace l~ndcr, If IIny, :l.lldlor llllY eovcrnmenlal .l\\thority, at Bl,lyer's
sole cx~Me lll'ld with Se1lcr'8 pennilsjoll, which willl'lot be ulU"ClISollllbly wit,hheJd, atld agree 10 the RELEASE set forth in plll".il-
grnph 25 of tl:li$ Agl'eement. If SeUer clenie, Buye:( permlbsion to <<UTeet the defects, Buyer m~y, within S d~rs of Seller'~ denial, tet_
min:l.lc this Asroeinenl. If Buyer terrnilllltes this Agreemenl, llll deposil monle, pAid on account of l'\l~chase price will be r-etutned
promptly to Buyer and tillS A~ment will be VOID, OR
c. Tenn;l1ate this Agn::ement in writing, in which case all dtposit !'rl(llJies p~id on llC(;Ol.lnt of purchas~ price: will De returned prQmptly
toBo,l~er and this Atre>:.ment will be VOID.
14, NOTlcr.S, ASSESSMENTS &: CERTIFICATES OF OCCUP/lNCY (1-00)
(A) Seller represents IS of Seller', eJCecUllon of U'1is Agreement, !h~t no public improvement, condooUflil.lm or h(lmr:owner associRtjon a~S~UmlmfS
hll"'c beeT' made against We PNpetty which remairll,lnpllid and tltal no notice by aIlY &o"'cmm~t m publk authoril.~ hIlS beeT'l suved upon Sellcr
or In)'One on Sellcr'~ behall, inclodinl notlce~ relatilll to VIOJlIliQIl$ of zonini:, housing, building, sai..ty vr 'lire ordinances ""hich remain
unconccted, Ind that Selle!' knows of no condition fhlr w~luhl. cOl'l5lltule viol~~on of :my s\Ich ordin14rlee~ which reDlnlnS ullcorrc:cled, unle"
olhetV/i!CspeciHedhe.o:e:
JACK GAUGHEN MECH
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10/El2/2ElEH 14: 38 717-597-0822 JACK GAUGHEN MECH
(B) Seller kno\>ls 01 no otl'1er polell[13J llOUceS llnCII.IWIl~ VlU"HlV"~J ...,,, 'u...'o"...,.... ~~.~t'..... .w,,_..w,
PAGE
(el In the event any notite5 (incl~ding violatiolu) MIIJ QS$eSlment~ are recIlvedtther e~cUllo!l oftnis Agreemenllllld before scltlemetll, Sdlt. wlll
nOli!} Buyer irl writing, within S days of receiving the Mliet or lI.S$es~m.enl, that. Seller will:
1, Comply wilh notices Il\d asse!~menIS al Seller's e,,~el1~e, ill which case Bllyer accepts the Praperl)' and agrees (0 the RELEASE set fol1'!'
in p.rltglt~1I25 of thiS Agrumcnr. OR
NOT comply with nOlices Ind Msessmenlllll Sl;\l\~'s e)';pense, in wlliell CMC Buyer will notify Seller witbirl 5 da>'! in wliling thM a..yer
will:
II. Comply with notices and aueW:l1ents at Buyer's txptnJe IrlO agree to thl;'i RELEASE 51;'it forl'h in paragraph 2S of th;~Agreemcnt, OR
b. 1ermitlate tllis AEn:emenl, in whl~h C3se 1111 depOSit monies paid on accounfOf pu'lchuc price will be n:tomed prompl'ly to Bl.lyer
and this Agreement will be VOID.
If Buytr tll.llalo notify SeUer within Ihe lime liven, Buyer !lcceptalhe Properly and /Ignes to lhe REI,EASE nt forth in pllra-
graph.2Jofth[sAa;recment.
(0) Buyer lllld~l,ed thllt I\cce.~ m a PUbUi; rOlld may l'Iq\llre iuuance Qfll highwlY QC~lIpancy permit (mm the Dcplll1ment ofTrlll'1S'jlortatlclrl,
(E) If 1'equhed by law, wilhin_ days of the execulion o(lllil AgreeMelll, Scllc.. will DI'der fot delivery to Selling Broker, if IIny, othcrwise
to Buyer. on or bet'Ol'eSClllement;
1, A cenificution from Ihe IpplOprlllte lJ'Iunicipal dcpu(menl or departments dbclusll,g notice of uny 1l11correclcd vioJatiOrl of 1-Millg. hOll~'
inS', building. safety or fire ord.irlances,AND/OR 435
2, A certificlllc: permitting OCCU.pllllty of the: Propel1Y. In tile evtnt repxirs/implovemcnt~ nre required for the issuance of the certificlille. Seller 4~6
wm. willl!n ~ dllYS of Seller's ~ceipt of tb~ reqUoiremcnlS, notify Buyer of the l"eCjllircmCJ'\t5 3Ild whether Seller wi][ mll\<e lhc rttlui~d ~!7
repwl'S/improvc:tl\ents at S~ller'>e)(pens~, 438
If Selle. choosu not to make the r~(luired repair5/llJ'Iptovemenl~. Buyer wilL within S dzlys, llotify Seller jll writing uf Buyer's choice to tCllJ\i. 439
nate 1n.16 Agl'eemeRl OR make the repg,irs/im1?l'oVl:mC:l\t~ 3t Buyer'9 expense and w\th Seller's permiSSion, which will !'lOt be unreasonably wilh. 440
held, If Sellcr denies Buyer p"'...rmi~~ion to make the required TepQirs. 'Buyer mu,y, within 5 dlY~ of Seller's deniul. terminate thi~ Agreement, If 441
Buyet lermiftlltt$lh.is Agrcl;TTlent, aU depo~it monies paid on lICCount ofp\lrch~se price will be reUltnecl promptly to Buyer lmd thi~ Agrecmcnr 442
will be VOID. 443
IS. TITLE, SURVEYS & COSTS (14)0) 444
(A) The Property is 10 be conve)'cd free and deu or 111\ hens, encllmbra1'lces, nnd n.ernents, EXCEPTING HOWEVl:\R the following: eAi~lins ~~5
deed festrictions, historic ?rc~ervation restdctlofl6 Of ordll"lanct~, bllilding restrictions, Ol'dinallces, C~5ert1enl$ of foads. cu~ements visible upon 445
lhl!: llrollnd, C:4oemenls of record, privileges or riglltS or public strvlc~ companies, if IIn)'~ olherwise the title to the a.bo~e dc~cribed l'eal c~ltlte 441
will be good alld mukctable and sllch as will be insured by a rep..tQbJe Title In~llr~n<:e Compll11Y Zll thc I'\'&lilal' rates, 448
(B) In tht ~vent Seller is llTluble to give a good "nd marketable title IInd hlCh as will be Insured by a reputable Tille Company tll the regula! ratc~, An
u Specified. in par.grllph 15(A),Sllyer will have the optio~ oflakin& sllch tille $l$ Seller can give wi1hout ehazlglng tile priee Of of belrtg r<;pllrd 450
alImonies paId hy Buyer to SaUttOn accollllt OfpuTchue price :md Seller will reimburse Buycr for !In)' costs incl1ml:! by Buyer for those ilems 451
spccified In p:lIl\gl'.1ph lS(C) Ilnd in panguph 15(0) items (I), (2), (3); llnd ia tltelnnerevcnr lhere will be no fUrl her lill.bi1it)' or obliX~rion on
cilb~r of the pM'Cies h=reIO l\nd ulis Agrtcro=lll win become vom,
(e) An)' wne;l OJ' survey~ which may be.rcqulred by the Tillc In~lIt~IlCe CompMY Ot the ~l:>stractil1& atlOlne)', for lhe I'rtpal'a,tion of un IIdequate
legal description oflhc Propert)' (or 111~ corrcctiQTllhereof), wllllw ~eclired :md. p~id fOT bY-Seltet Uowever, any s",,,,,cy or surveys desired. by
Bu)'et or required by the mortgage lender will b~ secl.ll'ed and p~id for by Buyer,
(0) Buyer will pa)' for the follnwit\g: (1) The premillm ,'oJ' mechallic~ lien inSl.lrallce andlor title i>ellJ'Ch, or fee fo: cuncellalioll of !11me, iF any;
(2) The plemiulll! for {lond irlsurancc unl!/M fil'll insurance Wllh extended coveruge. ;IISUl'anCe binder chllrBe~ or cailce!l;ll;on fee, if ~ny:
(3) Appl'~isnl fcc~ ani;! ch:ll'ses paid .;n udvallce to mortg~!;e lellder, if allY: (4) Bu)'et's caslomnry senlemMt com and accruilk
1'. ZONING CLASSIFICATION (1-00)
FQiI~re of lhis Agleemellt to conlllia l'he :LOningclt.~niflc"tinn (except in c~~<;s where tbe property {lInd each parc~l thereuf. ~r slJbdiv)d.1ble) b Wiled
~olely or prim~ril)' to permit slrl3le.family dwclliogs) will rendcr ,hi, Agreemetlt voidllble .t Ihe option of the Buyer, ami, it' voided, any deposits
tend.ercd by lhe Bayer will be f\:\yrned to lhe BlIYI:l" without llrIy reql.lin:ment lor COl.lrl at~on
ZonlnllCllIsslncallon:
CJ ELECTED WilltLn _ !lays of the execution of thl, Aaleemenl. Buyer wi\i verify th~t the el(i~tillg usc of \he Property :u
is perrl'llrted. In Ihc evcnl tlle use is notpclTTlilled,Hll}'er will,withlrl lhe'im\!
l:iVell for vcrilicati~n, JlOtify USlll1g Broker, if ilI1y.otbcrwlse Seller, in writing thul the existll\C !lSC of Ihe Propel1y is not pc::rmitled and this
Agrr.;emenl will be VOID, in whicll cllse ~ll deposit moni~s pllid on l\~~ounl of purch~ lll'ice will be returnetl promptl)' tu Buye.r, 'Buyer's
fltilurc 10 respond within tbe lime l:lven will consllllltr a WAIVER ofthi~ c(lnlingcncy and Ill! vlhcr terms of this Al:rt'cl1lenl remllin in
fuJlrol'ce:m~tffcct.
17, COAL NOTICE
~ NOT APPLICABLE m
o APPLlCABLE m
"H\$ OOCUMt!N'T MAY 1407 SEt..L, CONVI!:Y, TRAt-'Sr~R, )NCLUJ)~ OR INS URn 'lll! TtTL.& TO THI'i COAl ANO mOHfS Of' SUPPORT IJNbl'iRNlOATH TIIP. SURFACe LAND 414
OESC~JBEOOJl, RI'r-IlRaI.ID TO HERIN", AND -tHe O\l,'N~ll. OR DWNbl\S or SI,ICH COAL MAY HAY!! ,,~~ COMI'L!r~ LEOAl ~lClI[1'1'0 IUiMOYE ALLSUCll COAl AND 47~
tN TnA1' CONNECTION, DAMAGE M.4V RE!lJL'tTO nm SURr>l\Cli Of THE !..AND AND ANy ffOI,lSE, llllll.OINC 01{ orrJer: ST'RUcnJRTi ON ORIN SlJClIl.ANO_ (This
notice is set forth in the manner prOvided. in Sccr.ion I ot' the Act of Jllly 17, J 957, P,L. 9M) "Bllyer n~lcnowlcdges that he mllY not be obtaining the
riB,ht of protection agairlS[ slIbsidence tesultillg fram cOill mining operlltions. nnd. thllt the properly describcd hereill m~l' be prol~~led from d/lrn~!:e
dlle to mfne sabsltlence by lI. private conlfllet WIth lhe owners of I'he economi.. inlerests in the CQIII, Thj~ ack.nowloogcmenl' is made fOI lhe p1Jrpose
of compl}'in~ with the provisions of SecllOn 14 of thc Bltumic'\Olls Mine Sub~idence and the 1.1Ind CDnservation Aetor Aplil Z1. 1966." Buye.' agrees
10 sign the deed from SelleJ.'whlch<ieedwiUcontlintheal'OJ'esaldprovib iOn.
18. POSSESSION (1-99)
(A) po~session Is to be deliverc!;! b)' deed, Ice)'! 1tntt
\, Physic~1 pusses~ion to a vacllnl building (if uny) bfOOm_cIClln, free of debri~ III d.a)' and limc ofseUlement, AND/OR,
2, Assignment of existing lease(s), togetber witb "11y secudt), depo~it~ and intcn::~l, 11\ time ofsenlemel;lt, [t"Propen) Is tenant-occupied gllhe
execlllion of thisAgrecnleJlt or llnless othe.r\Vise ~pe~ilied herein, Bcyet will acknowledge eXisting leuse(s) by initilllnS ~aid IC/lsc(~) Ml
lime of ~ignjllg of this Agreement, If Property is len.nt.occllpied
(Is) Seller w,ll not cJ\lerinto !lny new )ea.ses. wriuen extension of e(istil'I& leases, if o.n)', or ftddilion;<1 leases for lbe Property withouf expl"essed
writter,consemofBllyel',
19, RECORDING (3-85) This ^g~T11ent will not be .ecorded in the Oltlce fot the Recording Qf Deed. or in any otller office or place of pul>lic record
and if Buyer causes or pelmils lhis Agreemcl1t l'O be recorded, Sellel' m.ty e1cct to treat sllch ~clll~ a bl'e.teh of Ihis Agreement,
zO, A.SSIGNMENT (3-85) This Agreement will be binding upon the pinks. their respectiv~ heir~, personll[ represetllatives. gUl1l'dinns Md. ~llcc~sors,
and to the extcnt ~~$iSllable. orllhe assigrls of the panies herelo, it being e:J\press\y Und(;[~IOOd, however, lhltt Ihlyer will nol transfer or "~sign {his
AiJt:ementwlthDullhewrlnellclJn,eatofSeller,
21. OEl)OSlT & RECOVERY FUND (1-00)
(A) Depo~\l~ paid by Btly~r within 30 du)'s of settlcment will be by clI~h. cashier's or centfiecl c\leck. Depo~ils, l'C,gMdlc~s (If (he form of p.l~ment
and the p..-rtOll designltted .l! payee, will bll paid 10 Broke,. OJ' party hJenlifled in par~glllph 1(P). who will ret:lin them In llll escrow acclJunl until
consummiltj(lIlOr ;emlinllllon oftl1is Al:reemenl inconfolTTlil)' willi all applicllble laws nnd r~SllJlllions, An)' une.~h"d check 11lT1<;1c::red a~ deposit
ma.)' beheld. pendin&the~cceptan(;eaflhil offcr,
(8) In lIle event of II dispute over entitlemelllto deposit monks, Il brok.er holding the dtposH is rcqujrcd by tlle Rules and Regulations of t\1e Slale
Real Estllte Commission (49 Pa, Codc ~3S.3Z7) 10 l\':t~in the monies ill .;scr\lW UlIlllthc <Jbpule i.~ resolved, In the event of lhi~.tlon for lhe
relurn of deposit monies, a broker will distl'ibutc tit~ !'T10niell1s dircclJ;ll b~ a flllal ordcr uf (;Olirt or tlle Wl'iucn Ab'Teemel)t of tbe partles_ Buyer
and Sll'lkr agree that, in lbt cvenL allY broker or ~H'ilialed licensee i~joined j111ltig~tltln ror ~he !'etumof dCflO~11 monies, the attorneys' Fees and
costs oflhe broker(s) and Jioensee(l) .....ill be raid by the pll!1)' Joining them, rY'
505 Duyerlnitinb: ItJL/~"S'\-"1J"l.\:(.Ll A/S.:i!:K PII!:e' ors Seller Initials: ~
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~u~ 10/~~; 2,~~,:,,, },~:",3,~~w.~}: ?~~6w::.~.0.~~~...v".." -'J r-'" ,,_ .."" ~~,~Kww GAUGHEN ME~~.__". .. -0- .. _ _. _, PAGE 08
SUi licensee OWll1~ tofr/md. misrepre.~elll'atjon, 01 deecllln a f"CQl e.!Jlte tt31'~~cuon :tr.d who h~~.;l beel\ un3ble to cnllect tilC judgment !fler exh~u~l. m
$08 ing2111legal and cquitMble {cmedies. florcomplctcde!ails aboutt~... F'll'ld, call (717) 183-3658,0[(800) 82'2-2113 (withil\ PennsylvYri.i_) 1m.:!
509 (717) 783.4B54 (oulside PenM)'lv3(U3)
510 22. CONDOMINIUI\VPLANN,ED COMMUNITY' (HOMEOWNER ASSOCIATION) RESALE NOTICE (1-00)
511 ~ NOTAPPLlCADLE
m 'tEl APPLlCAJH..R CONOOMINjUM
513 Buyer ~c1o;nowli!:dSes that the I'ropcny l~ ~ unit of n Mndominiunl that i~ primuril} run b)' 3 l.llli\ ownet's' association. 33407 01' the Uniform
514. Condomlni\jrn Act ot Pellluylvl\nl.. rt:ql,!ir(s Seller to flltr'lish Buyer with ~ C(:rtifi~Ule 01' R~~ale :llld copies of the eond\)minlLlIl1 decl~rlltioll
(other than plllt, nd pl::aM), Iht bylaws, Md lhe nll~s IInd regLllaLions of the II!SOcilltion,
a APPLICABLE: PLANNED COMMUNITY (HOMEOWNER ASSOCIA1'ION)
Buyer :\cknowletJ'e8 [hilt the Propelty L~ pllrt of II plJlnnod community :I..S defln~d by lhe Uniforn\ Planned Community Act (See Delillilion of
PIIIl\ned ('ommu'llIY Notice 1'01 lhe definition conlll.l1'1ed in the Act). ~~407{ft) of th; A~t ,(quires Selh~I' 10 fllmish Buyer witn a copy of t~e
Deehl,rlltit;ln(Vlherth.:Ulph\tS.ndplan~), ttlt:ibylaw., thel'\lJeslllldregl.llmions'Jflbeassoeiatioll, IIndaCertifiealeI;'GnlUinin8tl1eprovls!on,set
forth in ~5407(a}oftheAet.
(A) Within ~ days of theeUCl11ion of thiSA[!:~ement, Seller will submit II tb.l.1.le!lto the associ.ulan for lI. Certiflcllte of Resale and the doc-
IIments llecessnry to o.:ntlble Seller to comply with thi:: Aot. Th~ Act provides thllt Ih~ IISsociotion h rell~i~d to provide th~s~ documents within
10 d~ys ()f S~lIer's request.
(B) Under lhe ACI, Sclk:r Is nctlialJle to Buyer for dti:: rllilure ordel.1Y of the ll"l;>CilltiO" to provide the Ceniflc~lc ill Q ILmely nUUlller, nor is Seller
IhlbletoBuyerfor:myclTOneOI,l.$lnt'orm.1tionprovidlldbylheassociatio113ndino.:ludetJinuleCertificllte.
(ClBuyer may dedarc this A~ement voro 3t any Il!Tlt:i btrore BU)'tr's receipt of [.he os.oeiation documents 'lld for 5 dayt thereafter, OR unhl
~etllemem, whichc)'~r occurs first. Buycr's "Olltt decwing this Agreement void must be in writing~ ti,<;n!:o.fler all deposit monies will be
remmedto 9uyer.
52D' (0) In th.e event the assoei~tion hn thl;: ri~l# II) buy the Property (righl ofntst !'!fusal), IInd tbe lL$socinlion exercises that right, Seller willl"1!lmbum
5~C Buyer for all moniu p.id by Bllyer on IIccounf of purcl1.ise price and for an)' co~t~ incurred by Buyer for: (I) The premium for nu:ehlnies lien
531 il\SUrllnce lind/or title $e:lJ'Ch, D.I' ke for "fleel1l1tion of same, if M)'; (2) 'fhe premium! for flood inSI,lIltnCt l1lldJor fu'f: insufltllee with ~telld-
532 ed coverlf.ge, inSllr:lnCe binder ch"q;~ (lr cll.n~ellalic)U fu, If ~IlY; ()) AppraisaL fecs ftnd chlll"J:fC8 paid in advance 10 mortltlf.ge lender, it" any:
in (4) Buyer', eu~tomary settlement co~tO and ~ccroals..
.34 .23. MAINTENANCE & RISK OF LOSS (1.00)
535 (A) SeJlu will mnil\b.in the Propcm, grouod~. rixtuI'es, alld an)' rx:r~ona) property specifically s('hedul~ herein in its pr~sent conditiOn, oorm~1 535
53~ wear and le~r excepted. 51e
531 (B) In the e"enl ~ny system or lIppliarlce Il1c]uded in the ~lIle of Ihe Property f/'lib and Seller uoes /lot rep:lir or replace lh~ il~m, Seller wlll prompfly 537
53~ notify tlllyer in WTlting: of Seller's choiel;' to ~I~
539 \. Rep~lr01' I.eplace fh~ fllilcd syStem ur appliance Pefore settJemerlt Of credit Blly~r at settlement fOi the fair ma.rxet vllllle of the failed sys- ~39
54D ~m or applillnc<: (thi~ option must be lIeceptab]e to the mortgage lender, jf any), In ewch ca~e, BL.lyer lIceepts the Property Br'Ld aglus to 5U
5~1 the REUA.SE set fClnh in pDr:l8l'aph 25 cf this Ag~ertl, OR 541
542 2. Malee no Iepl\irs or replace,nents, I\I\d not cretlit 9uytr 0.1 settlelllent for tile f~ir morket v:llue of the f:\lled sy:lt~m Or Dpp1i>1Jlee, in which 542
$<l3 c~se Buyer will /lCllify Seller in writing will1\n 5 dllY. or before le\1'lemulll, whicheve,' is sooner, tltM BllYl:r will ~n
~44 a. Accept lhe Pli.\perty and agree to the RELEASE ~el forth in pllfllp-lIpb '25 of this Agreemenl, OR
~45 Terminate Ih;~ Agteel'ller1t, )n which cll~e all deposit monies p:rid on UCUI)unt of lIUi"Ch:lSe price will be r<:tum~d promptly to BIl)'er 5.\5
540 Hlld thi~ A8ruet\\ent will be YOID
5H (C) Sellcr Yril1l:>~ll' ri~k oC loss from fire or lIther c~sunllier IInlil time of~e\tlelne,lt. In the eveN of d~muge hyiirt or olllel' tllsunltk~ t(lll">, prop-
!4U crt)" ilJchld~d ill this 5(\le thaI j~ nl,lt repniled 01" lepl~ced priG' 1(' "elllement, auyer will hwve the cptiotl of reSCinding this Agreemenl ~Ild
S4~ prornptly reecivio/l: 1111 mC\nie. paid Olt l\eeollnt of plllchn~e price or of 3.eceplin& the ProperlY i(\ its then condilion tOSlllher wilh tbe proceed!
5~O of IIIlY in~ur~nct recovery Obll\inllblc by Selltr. Buyer is 11ereby Ilotifll:d that Buyer mllY jnslln: allyer'~ e'i,,;table interesl il1th;s Prnpcrty as of
551 the timeofe'.(eCUliol1ol'thi~Allleerntlll.
m 24. WAlYER 0[;' CON'flNGENCmS (1..00) m
553 10 tile evenllhil; Agreement is eonlingclll 011 Buycr.s rig;l1llU in"~pecl and/or l'eJl~ir the Pr\,pl:rIY, nu}'~r's failure to enrclse Mny of Buyer's options (;~3
554 within the tilnt limits specified in the,colttingel1<:Y pru1'biOn(S) will c:onstlllJte a WAIVF-R orthnlcontingeney and Buyer Dccepts filii l)rtlp~rty ~~4
llnd Dgl'tts 10 the RELEASE 8tt forth in paraGraph 23 of this Agreement.
m 2:3, RF.LEASIi (1-00) Buyer "~rt'\)}' rtle:;ues, quit claims llnd I'orevel' dlseharlll!:S SF.l.Llm, ALL BROKERS, Ih~jr UCENS[ES, EMPLOY-
[U;:S, Ilnd :tny OFFICER 0"- PARTNER of any 0"1 of them ~nd .:I.ny other PERSON, r;'IRM, or CORPORATION whll In.:l.y lie lh..b1e by ur 557
through them, frOln Oil)' a.nd :tll cJaim~, Il,Is.~c~ or dt:m.mdl, including, hut not limited 10, per.~onlll jn.1l1rifl:!; and property dnmagt llnd nil nf 5~6
5~9 Ihe (,:unscquclu.:es thereDf, whethcl' n(ll,. ](!lOWll or not., ,~'hldl1l\II)' I!ri~,~ !h:l1T! (h~ prl.'senc~ uf lcrmilcs Ill.' other wllcd.tmring imecl!l, r::adoTl. ~ti~
iiHi IClld.bn~ed p:\inl l;;U3I'ds, Ilnvirnnnlental hllurds, on)' d~fcclli in ti,t, jmjlVillu'll \,"-]ut ~I/:'ta~t: dlspO.!lill sYJllcl11 01' Ih,fki~ncit:~ in Ihe ol1.sit~ ~;'il
~61 wllltr It,'vic:e sy,t~m, ur al\Y ddetts or c:onditiuM (In tht Property. 'l'hls rtlust will $,uf\.ive settlement. 561
S62 26. RIiPRIi;SENTATIONS (1-00) m
$63 (A) Bu)'er l!nderSl~nd~ thll.I .ny representations, ~l!l.ltr\~, lllh"erusltig. ptollloliom),lllQli\oitie~, bl'oehtlres 01' plan~ of ll"y Utld m<lde by Scllc(, Brokers, 553
564 their lic~llsees, employee,. o-ff'lcers, or partncr~ llr: not It part of this Allrccmcnlllniess ~~prenly incorvorated or ~M(:d inlhis Agrctlllent. !C4
555 (B) It is uodtrstood thal Bl1y~r hiS Inspected tht Properly berOl'! signing this "l:~tlnent (illCludlnR fbltllrt~ and on}' penonnJ prUpl!rty 5fi5
5~D !(le~lficl1l1y se'hcduled hltr,in), or has waived th~ right to do 10, and hll! lll:rc~d (0 purehll5e il in its prtsen! cnndltion unless uthen.'l.~~ ~66
551 sl~tl!d in IhisAl!:reement. Duyer ll(kno~'ltd!:tS that Broken, dlelr lietn~et', employees, offletrs ur PllrtncrS hll\.e not mad~ lI.n indepcll- 5G"
56& dent t.nmln.:l.tion Dr determination ufthe 'trllctural $oundneu of the Property, the age or condition oflhc cnmponentJ, enY~nll'lnlellllll '66
5tg conditions, tbe permltt\!d liSts, or of c:ondltiuns vxlsUng in lite loen]e wl1~rlt tile- Propel'ty Is 5ltuftted; nor ha~c (hey matle a mechllllicDI ~6~
:)70 in~pcction or any (Jfthe ~y~lelns contllln.tI therein. m
571 (C) It is fLuthel' understood that lhis Agreement cconlains Ihe whole Msre~ent belween Seller ILl'll Buyer :lru.l tl1.ere tITC no other turns, obligutiotJs, 5J1
~H ~oveoants, reprcsenl~tiotJs, statements or Ci.\ndilions, oml OI otherwise ot any kind what~Gever concel'l1ing thi~ sMlt. FLlrthermore. lhj~ 572
51) Agreement will not be altered, lILTIendtd. chunged, or modificd el\cepl in writIng CKccullltJ hy (he parties. 513
514 (D) Th~ headings, c3ptions, ~I\d line numbers l(llhi~ Asreemenl arc me~nl (lnl~' to malee it eusler ICl find lh.e ~ar:>.gmphs 5H
m 27. TIME OFnlIi: ESSENCE-DEFAULT (1-00) m
$lij The said tlmt for senlement ~nd all other times rcfwed 10 fOI" the perfonuunce of (tI1~ of the oblilS~ti(lI1.~ of this Agreement are hertby ~grecd tl) be 575
571 of lhe e~~ence Clftl1is Agreement. For lhe purpo~es of rhis Agreement, TlLlmbtr of d~ys will be c,lunted trolll the date or ellecul'ion, by cKcJllding the ~7T
5,~ day this Agreement Wll~ e~ecuted "'Ild jncllJdinS tile l.a~t lIl\y cf the tinleperiod. Shou'ir.J Buyer. ii'J~
'Ii (A) Fail to make IIny lldctitio'I.11 paymenl.. DS ~pecifie.d 11\ pUl"llyrllph 3; OR
'80 (B) Fumisl1 fnls..: 'Jr ;Ilcomp[ete illfcrmDlicn to Seller. U~ting Bl'ok.eJj Scllinlil Bmktl', or the !l1ortg~gc lender, it any, eonecminl; Buyer.s leglti or 5sa
5~t tillarlci~1 stll.llIs, Or tail to COllperlllt i" lhe processing of llle morlgllge ](1lIf! upplieatioll. whi~h ~Cls would l"1!sult in t~e fu;lure 10 obtlli!\ tho.: 56t
582 ,j},ppro~al of a nlvrtg;~gt loan commitment; OR
UJ (C) Viol:lt~ or f~lI to fulfillllrld pedonn uny \l!her lerms 01' eOl1di\i[)ll~ Oflhis Agreeln~nt;
5a~ tltl'n in stich case, Seller has Iile option ofrel:lilll!\j ~II svrns pllid by Buyer. indudius lhe deposit monies. I) OIl !\ceOUIll of purchase price. or 5a4
Sa! 2) ~s monies to be' Ilpplied to Seller's damages, or 3) (t~ iiquidated d.1ITlllgcs for such brel\ch, us Selier may elect, unless otherwile cheel-ed 565
below
o Selin i~ li<nited to fet~iningSllllU pllJr,l by Buyer, incll.ll;lillS deposlt monic" Il~ l1yuidated d1tfll",ges
If Seller c1ect~ 10 rer.ail\ ull ~um~ p~itJ b)' Buyer, ,ttclLldin.\! deposll manics, .1S llqllillMcd dumllges, Onyel' 3nd Scll~r will be rele~~ed fron"' !'cor_ S~~
ther Hllbilll'Y 01' obligation ~nd Ihis Agrcell1enl will be VOID,
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Sgs. ch~ckedbelow.
m (A) T11eLisllng:BrokHisAgentforSelle.l'.
597 (B) The Selling Broker is Allen! for Buyer.
,se8 (C) When the Listing Broktr Mild Sellin!: Brokl:r ll~ the Slime., the Broker is a DUlll Ageot Dunl Agency applies 10 all Jicensus, UNLESS there is 598
~99 I Designated Agmt(~) for Seller \lntl II O~sil."lJllle(l ^gent(s) tOr Bu)'er. Tf lilt ~~me Licensee is (]esignate<l foe Selle!' and Bu~el', the LiCCflS:C is ~91
~Oo (\ DUKI Alent.
.001 i\ BllsJn~ss R~llItlonshlp tlI.hl:s thlllls c1llftrtl\l rl'l]m Ibove, O~ :rollow~'
aOt . The Selling Broker is lhe AscmllSubllge\'11 for Seller.
603 b- The Selling Brokcrb. Trlln"IlCtion LlceMee.
604 Ll Tile Listing Brokc:t i~ ~ Trllns.ction Licensee. 604
, 6~S (D) Brokt:T(~) m~)' perfOtm servioes to ll~sist unrepresented p~l'Iles III complying with the tcrro,~ of thb Allreem~nt, GO~
BPS'. 29,' MEDIATION (1-96) G05
607 ~q. NOT AVAILABLE 507
DOS ~ WAIVED, B;iyer lInd Seller undel'Stand th~l they muy choose 10 mcdj~le n! u lole~ dule, should a di,<:pllle ~I'ise, bullhat there will be no obl!- GU~
609 ~ation on file r~rt of ~n)' part)" to do so 50~
5'0 0 ELECTED 510
611 (A)SLlyer and Seller willlT)' to re,,-otve an>' di~pllle or el~im tht\t m~y flrj~c from 111;:; Agreement IhroClgh mediatioll, in :J.ceold~nce with the R.des 511
611 and Procedures of the Home Sellers!l.!o..ne Buyer~ Dispute Resolution Syslem, Any Ilgreem~n\ tI:a~hed through a mediation conkrence (lnd 512
013 sisned by tllepllltiu will be binding, 513
~u (In Buyer tuld Seller 3cknowledle tllllt ihcy heve received, f!ild, ...nd undexst(\nd the R\.Ile~ IInd PrQctdlJ~~ of the Home SeIJenlHomc Buyers 514
615 Di'l"ul<". Relolution Syst~m, (Stt Medllltioll NOliee,) Sl~
~16 {Cl Thi~ llgreement 10 mediatc disputes !lrisin!!: from Ihi~ ASt1!;~l1\el1l will ~\ll'\livc senJcmcnl.
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~'Ia Duytl' :md Seller acknuwledge Ihlltlht)' hove reod and underst:lnd lb. l'1utlct~ and tXplllnotory Inl'o.'mallon set fDrth In Ihis "Gr~menl.
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520 Duyer .1I;knowl(!dges receiving l:l cop~ of this A~reem~nl at the tlfne orstaning.
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717-Sg7-B822 JACK GAUGHEN MECH PAGE 0g
'IN D~,H'''n ...e'"pu",,"J." """1.''''';:~1I "'~ r::l'u....CJ\s/lI"".;II;:",,, ..1I......r::l"Y<::, ..,<::.., 'UlIV"", "..,.r..,., II u"'e"''', '~''''''''''JU)' "
NOTICE TO PARTIES; WI'TEN SIONttO,1'HIS AGREEMENT lS A DINDlNQ CONTIlACT. Return by fllcsimlle trlln,mbSion (FAX) or Ihis
Agreement, lInd \lllll.ddellda, bwrinl! the signatures of all pllrtll!S, ~)nstltutc' l:Icce'f'tance orlhis Agreement Pl'lrtie5 to Ihi, InnSllcHon l:lre advised
to Consu.1t 111'1 altorlll~Y before sll'lnlne If they desire It~al advice.
t:2tt", ~ DATE 9-jJ-Oj
, v 55 '7/-.lf!!.-I7T2..
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PAXH
BUYER
DATE '1, - JJ -DI
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WITNESS
BClyer Nllme (prinl)
Mailing Add en
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SellerhercbyappravC3IhC8boyeCOJltrllctl:hi$(date) 49. ~"""'i-...l~, '2.c:ol
and jn'ccn~iderlltion ofthc service! rendeted in procwing the Buyer. Seller larces to pAy Ihellllmed Li$ting Broker II fee of :} l;\ "15
of/From-lhe herein 5 ecified sllle price. In the event Buyer defaults hereunder,'lltly monll;s paid en llCCOllnt \\lilt be divided . \n %
Seller, > 0 ,Lis'ng Brok.er, bllt il'L 110 event willlhe sum paid 10 thc Listing Brolter b~ in <".xee.ls Oftll<". above specified Broker's fee,
WITNES' SELLER ~ .!.u...J~ ..,,1. DATE ~~A /0/
SellerN8 c(prinll ~JIl'poI J\~ !v.~ ~~::: SSIt /Jf-/_.':t:2_ .~>r/,~
MMiJi1l8 ddrcs' 4P ~ F./. ,.. ;},- 1?1t.t.IJ'IIllv~hfLrf) p,..,
Ph"'~ PAX 0 ' -0- v E-M.B -0-
WITNESS, . :.I~ ' SEI-LER ~~Ptn..j9J//~ DATE 9tf~/f'
Sellcr NI priot) ). 5S It ...Rn 7_ ~.;.t'_ 7//
M~IIIll!lA dreli$
Phone Its FAXH
E-MQl\
WITNESS
Seller Name (print)
Ma.ili!1SAi1!iIeS$
Phonefl'S
SELLEU
DAtE
SH
PAX#
E.Mllil
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Brokcrs'/Llee;ue<'i' Ct'rtlfie~tion$ (check all thlt llrl/: opplicable):
)it. RI/:gardlnl; Lead-nesed Paint'Hazerd$ Diselosu....: _Requil"Cld if Pt-oP0"I)' was bullt bero!"\! 1978: The undcrsign..d Lh:cnsecs invoJvQd in
, !hI!; InlmllCtioTJ, On behalf of themselves ltlnd- their brokel1, certify l"'llf lhr;ir 8wtemen\s lire true to the best of their knowledge IInd !xllef.
Aeknowledeemenl: The Lit:ef\,en lnvOlvedin this tranSaction hll~e informed'Seller of Seller's ob1i&"lItio"~ under The Re,idential wd Painl
Hn:anl Rl'duCliOn AI'I, 42 U.S.C. 48S2(d), lInd llt<". o1Wllte of Ih<".ir l'e~pon~ibi]i\)' to <".1I~UI't compliance.
...
587 0 Regardlnlll<"HA MorlgOl!lel: The lJndat~llned Lieensccl Involved in Ihl~ tnI~ll.ction, on beh~lf of thcm,\:ly\:~ and their brokers, eerti [y lhat
6U the letm~ of this COnll\"lct for purchl3c Ire true 10 the best of tt1elt k.nowlcdge ani! belie'f, llnd that any other ll!l:reem~n( entered Into by al'lY of
fi59 these p3l'tie~ in conn&Clion with rJlis rrln,acllo;ZiS niched r,o 1h1~Aircemen,'
17.
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m graph 29 o( this AIl'lement.
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m ACC.EPT.EDBY ~;"'~ _ DATE _~/r7 _~\
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Laws, Staruch. & Pisarcik
20 Erford Road, Suite 305, Lemoyne, PA 17043-1163
(717) 975-0600 Fax (717) 975-3871 LSPlaw@aol.com
October 17, 2001
Jennifer Warner
C-21 Walak Associates
3803 Cedar Ave.
Camp Hill, PA 17011
Re: Arthur, Shirley & Jay Lutz
590 Grandview Rd., Camp Hill, PA 17011
Dear Ms. Warner:
Our office represents Arthur, Shirley and Jay Lutz, prospective purchasers oHhe
above-referenced property under that certain Agreement dated 9/21/01, with Brenda Smith and
Karen Allen as sellers.
The Agreement of Sale was properly terminated by Art Lutz on, 10/10/01. Please
effect the prompt return of his $1,000 downpayment to him.
. \
When you filled in the wood infestation and water service inspection contingency
timetables, you provided 15 days to obtain a report and 3 days for the buyer to notify the seller
of its intentions. When you filled in the property inspection contingency, however, you provided
only 10 days to both acquire the report and notify the seller of the buyer's intentions.
As the Consumer Notice you signed and provided to the Lutz's provides, you had
an obligation to "provide assistance with document preparation and advise the consumer
regarding compliance with laws pertaining to real estate transactions"; "advise the consumer to
seek expert advice on matters about the transaction that are beyond the licensee's expertise"; and
"keep the consumer informed about the transaction and the tasks to be completed." You did not
advise the Lutz's to seek expert advice, and you advised them that their only obligation with
respect to the property inspection is that they should have it performed within the 10 days. Based
upon your advice, Art Lutz understood that there was a reasonable time thereafter to assess the
impact of the report and make a reasoned determination as to whether to proceed with the
purchase of the house at the price previously negotiated.
When you presented the Agreement to the Lutz's for signature, you failed90
discuss the options available under Paragraph 27, the "Default" clause. The Lutz's do not
understand the meaning of the language and the choices available to them, specifically including
that your failure to check the liquidated damages box was certainly not in their interest.
The above is not indicative of dealing in good faith with the Lutz's and certainly
appears to involve matters that may be beyond your expertise.
~
~t~
~
. .
Jennifer Wamer
Page 2
October 17,2001
Upon execution ofthe Agreement, you suggested to the Lutz's that Enviroquest be
engaged to perform the property inspection. While the Lutz's signed the;m'ns ction~th rization
on 9/21, you did not obtain the seller's signatures until 9/27. ' j)
01. 1 .1
You told Mr. Lutz you would call Enviroquest on Monday, 9/24, to let them know::>r. I-J~ "
Lutz would be calling to arrange an inspection. Mr. Lutz likewise called Enviroquest that same I ro^Jf'{
date, and an inspection was scheduled for their first available day, Wednesday, 10/3/01.. ~ ~
On the day of, and following, the inspection, Mr. Lutz was advised of a number of U I ~
necessary repairs which were estimated by the inspe r in cost from $6,200 to $15,500. ~o..A.
In addition, Mr. Lutz was advised of the presence 0 sbestos t' in the basement which would ~-
present a very expensive cost to remova and replace e desire to remodel the basement . .~~
at any future date. \ f" t'
Even as of 10/3, however, the seller had faile to unlock the garage so as to allow
entry to perform the property inspection. The garage was ot unlocked until late on 10/10/01. }.
Thus, October 11 was the first day on which a complete pr perty inspection could have been f
performed. ~~
Similarly, the water pump was broken and re Ired repair before a complete ~
inspection of the water service could be performed. '. ~t#~~/
Immediately following receipt of the inspection, and ursuant to his understanding
of the contract as explained by you, Mr. & Mrs. Lutz contacted vario businesses to obtain quotes
for the replacement of the roof and fumace. By the following ednesday, 10/10/01, it was
apparent that the cost of repairs would likely be in the upper end of he range suggested by the \
home inspector, and you were immediately notified by Mr. Lutz to te inate the Agreement. / . ~~
Your statement to Mr. Lutz that he had terminated the ntract too late is wrong. ~. ~v
Mr. Lutz acted precisely in accordance with the understan ing of the mechanics Of;::.{\ .
this transaction and the "tasks to be completed" as you explained them t him. ,-
Likewise, under the terms of the Agreement itself, as a resul of the actions of the
sellers in denying access to the entirety of the property, a proper insp ction could not be
performed prior to 10/11/01, which date properly commenced the running of t 1 D-day inspection
period.
Please see to the prompt retum of the Lutz's deposit.
Sincerely,
~ ~
~~~.
~~~
W. Scott Staruch
WSS:dpe
cc Arthur L. Lutz, Shirley J. Lutz, Jay K. Lutz
~t-
17
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Securltl..
First Union Securities
WF3240
3401 North Front Street
Harrisburg, P A l7110
Tel 717 238-9636
800 254-8211
Fax 717 238-9789
April 17,2001
Mr. Mark Thomas
101 South Market Street
Mechanicsburg, PA 17055
RE: Gladys A. Basom
Account #: 1389-6121
Dear Mr. Thomas:
Per your request, I am providing you with the date of death values as of February 26,
2001 for the assets held in the above referenced account.
Description
# of shares
Closinq Price
V Massachusetts Investors Class B 2894.524
v MFS Municipal Bond Fund Class A 382.694
1/ Putnam Income & Growth Class A 3187.577
V Putnam Assets All Growth Class A 4201.679
v Putnam Tax Exempt Income Fund CL A 2093.890
Hartford Director Select Annuity
$18.60
$10.53
$19.49
$10.64
$8.77
$119,986.71
Should you require additional information, please do not hesitate to give me a call at
(717) 231-7205.
First Union Securities, InG.
Membe! NYSE
. '
f~N.
Reference 10: 154908
First Union National Bank
Attn: Account Verifications
POBox 40028
Roanoke VA 24022-7313
April 13, 2001
R MARK THOMAS
A TIORNEY AT LAW
101 SOUTH MARKET STREET
MECHANICSBURG, PA 17055-3851
SUBJECT:
Verification I Confirmation of Account and Balance Information provided for:
GLADYS A BASOM (SSN# 205-09-4592)
Date of Death: February 26, 2001
Account
Type
Account
Number
DeDosit Account Information
Date of Death Average Date Maturity Interest Accrued YTD Date
Balance Balance'" Opened Date Rate Interest Interest Paid Closed
$15,699.89 \119/1999 $66.53
$2,450.12 51111993 $0.35 $7.04 )12712001
CAP CHECKING ACCOUNT
9070023885
LEGAL TITLE, GLADYS A. BASOM
SAYINGS 3082794368073
LEGAL TITLE, GLADYS A. BASOM - MINOR
BRENDA LEE SMITH - CUSTODIAN
. Due to system limitations, we can only provide a twelve month average balance on depository accounts.
II< Date of death balance does not include accrued interest.
... If date of death Qccurrs on a weekend or a holiday, date of death balance does not include any transactions that were
made during that time period.
April 13, 2001
Date
Drema Rubinoff
Depository Representative
abs; kt
Servicenter Associate
Title
(540)563-7323
Phone Number
001032
~OV:2yol (MaN) 1215
CMMRCE BNK-SP. ROAD
TEL 7I7 766 8244
PODS
Commerce
"Bank
comm.reo B.nWH~"',bufJJ N.A.
100 Senate A...enue
P.o. Boll DB9S
Ciltflp HIli, PA 11011
STATEMENi OATE
GLADYS A BASOM
KAREN L ALLEN
590 GRANPVIEW AVENUE
CAMP ~ILL PA 1701~
03/28/01
ACCOUNT NO
0512100579
... CHECKING .., SO PLUS CLUB BEGIN~ING
ACCOUNT NUMBER 0512100579 TAX ID NUMBER
PREVIOUS STATEMgNT SALANCE AS OF 02/28/01 ..
PLUS 2 DEPOSITS ANP OT~ER ~K~~rT5
LESS 1 CHECKS AND OTHER DEBITS.
CURRENT STATEMENT BALANCE AS OF 03/28/01
NUMBER OF DAYS IN THIS STATEMENT PERIOD 28
CYCloE-009
RATE 1. 60000
<05.09-~592
1,152.67
~ I 5 l..l. "i~
1,56977
1,16~.J3
_ _ _ ~ _ _ _ _ _ _ ~ _ _ . _ _ _ _ _ _ _ _ .. _ _ _ _ _ _ .. _ _ _ .. _ _ .. _ _ _ r _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
... CHECKING ACCOUNT TRANSACTIONS ...
DATE DESCRIPTION
03/01 AC-US TREASURY 312 -CIVIL SERV
03/06 ACH RETURN ITEM 3/1
03/26 INTEREST PAYMENT
DEBITS
1,569.77
CREDITS
1,569.77
1 .66
.... - -- - -.. - -.. - -.. - -- - -.. - -.. - - - - --.. - -..- - -.. - -.. --.... - -.. - -.... - -.. -- - ---
... BALANCE BY DATE ...
02/28 ~,162.67 03/01
03/28 1,164.33
PAYER FEOERAL 10 NUMBER
INTEREST PAIP YEAR TO PATE
2,732.44
03/06
'1,10.67
23"2324730
6.04
.. - -.. - -.. - -.. - -.. - -... - -- - -.. - - -..- -.. - - - - - -... -- -.. - -.. - -.. - - -... --
... INTEREST EARNED THIS STATEMENT PERIOD
DAYS IN PERIOD .......................
INTEREST EARNED ......,.................
ANNUAL PERCENTAGE YIELD EARNED (APY)..
. . .
26
1.66
1.51\
.. - - .. - - ... - - .. - - - - - .. - - - - .. - - - .. - - .. - - .. -- .. - - - .. - - .. - - .. - - - - - - - -
/'1
(
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J
NOV.:2.6' 01 (MON) 1216
CMMRCE BNK-SF. ROAD
TEL 7I 7 766 8244
Commerce
"Bank
CDmmtwe. 8~nkIHarr1liburg N.A.
100 S~n,.l~ Avenue
P.O,Boa 8159.
Camp Hill, pA 17011
GALDYS A BASOM
KAREN L ALLEN
590 GRANDVIEW AVEMUE
CAMP HILL Ph 17011
... SAVINGS ... YES ADVAN'IAGB B~GINNING
ACCOUNT NUMBER 0410161~70 TAX ID MUMBER
PREVIOUS STATEMENT BALANCE AS OF ~~01 ....
PLUS 3 DEPOSITS AND OTH~TS
LESS 2 WITHDRAWALS AND OTHER DEBITS
CURRENT STAT~MENT BALANCE AS OF 03(31/01
NUMBER OF DAYS IN THIS STATEMENT P~RIOD 31
STAT EMf NT OATE
03/31/01
ACCOUNT NO.
0410161470
CYCLE-052
RN~E 2.50000
205-09-4592
2,ar.12
~ ~.;i5
999.50
2,647.57
DEE ITS
_ _ ~ ~ _ r _ _ _ _ _ _ _ _ . _ ~ _ _ _ _ _ _ _ ~ _ _ _ ~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ _ _ _ _ _ _ _ _ _ _ _
... SAVINGS ACCOVNT TRANSAC~IONS ...
DATE DESCRIPT,ON
03/0~ AC-US TREASURY 303 -SOC SEe
03/05 DEPOSIT
03/05 WTHDRL SAV ~3a4 03/03 17,19
GATEMIDER CH RACET CHARLESTOWN
03/~9 ACff RETURN ITEM 3/2
03/31 INTEREST P~YMENT
401.50
498.00
... BALANCE EY D~TE ...
02{29 2,837.1203/02
03{29 2,840.62 03/31
3,335.12
2,847.57
03(05
PAYER FEDER~L 10 NUMBER
INTEREST PAID YEAR TO D~TE
23-~324730
17.86
... INTEREST EARNED THIS STATEMENT PERIOD
DAYS IN PERIOD............... .........
INTEREST ~ARNED .............,..........
ANNUAL PERCENTAGE YIELD EARNED (APY)....
CREDITS
498.00
405.00
6.95
3,338.6.
. . .
31
6 .95
2 .53 %
P 006
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128.0601
DECEDENT'S NAME (LAST, FlR$T, AND MIDDLE. INITIAL}
BASOM, Glad sA
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
02/26/2001 12/25/191 6
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
o 1. Original Return
o 4, Limited Estate
o 6, Decedent Died Testate (I>.ttacl'lcopp\W~I\
o 9. Litigation Proceeds Received
[&J 2. SUP~lemental Return
o 4a. Future Interest Compromise (dateofdealh afler 12.12.82)
o 7, Decedent Maintained a living Trust (AllachcopyofTrusl)
o 10. Spousal Poverty Credit (date afdeath between 12-31-91 and 1-'-95)
OFFICIAl USE ONlY
1{f-~/5-{p
FILE NUMBER
21-010252
COU'i7TY""C"05E ----yEA~ - - NUMBER- -
SOCIAL SECURITY NUMBER
205-09-4592
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date ofdealh prior to 12-13--82)
o 5. Federal Estate Tax Return Required
_ a. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Atta:tISttl0)
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8
THIs,;se ,ON,;'Mllilt'l!lli!'cb. iJiEll!;AIlt::C
NAME
Thomas, R. Mark
FIRM NAME (If Applicable)
Thomas, R. Mark, Es uire
TELEPHONE NUMBER
717-796-2100
Ii.. 'I'lIliN'Alilii::'. J
COMPLETE MAILING ADDRESS
101 S. Market Street
Mechanicsbur
1. Real Estate (Schedule A)
2. Slocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Noles Receivable (Schedule D)
(1)
(2)
(3)
(4)
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5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Joinlly OWned Property (Schedule F) (6)
o Separate BWing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or LI
8. Total Gross Assets (total Lines 1-7}
9, Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) (10)
11, Total Deductions (total lines 9 & 10)
12. NetValue of Estate (line 8 minus line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts lor which an election to tax has not been
made (Schedule J)
14, Net Value Subject to Tax (line 12 minus line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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I-
15. Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x _(15)
93,968.89 X ~(16)
X .12 (17)
X .15 (18)
(19)
16. Amount of line 14 taxable at lineal rate
17, Amount of line 14 taxable at sibling rate
18. Amount of Line 14 ta:<able at collateral rate
19. Tax Due
PA 17055
97,318.89
OFFICIAL USE ONLY
,-;
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R
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o
(8)
97,318.89
35.00
3,133.76
(11)
(12)
(13)
3,168.76
94,150.13
(14)
94,150.13
4,228,60
4,228.60
20. [8]
Decedent's Comolete Address:
STREET ADDRESS
CITY I STATE I ZIP
Tax Payments and Credits:
1 Tax Due (Page 1 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
B Prior Payments
C. Discount
(1)
4,228.60
4,321.46
3. InteresUPenalty if applicable
D.lnterest
E. Penally
Total Credils (A + B +C)
(2)
4,321.46
Totallnterest/Penaity ( 0 + E) (3)
4. II Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a retund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference This IS the TAX DUE. (5)
A. Enter the inleresl on the lax due. (5A)
B Enler the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF AGENT
92.86
0.00
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACiNG AN "X" IN THE APPROPRIATE BLOCKS
Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ...........,... ........................................................". 0 0
b. relain the right to designate who shall use Ihe property transferred or its income; ........................................ 0 0
c. retain a reversionary interest; or ....................... ....................................................................... 0 0
d. receive the promise for iife of either payments, benefits or care? ............................................................. 0 0
2. If dealh occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?........ ...................... ........................... ..... .". ,........................... 0 0
3. Did decedent own an "in trusl for' or payable upon death bank account or security at his or her death? ................. 0 0
4. Did decedent own an Individual Retirement Account, annuily, or olher non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS is YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare thai I have examined this relum, including accompanying schedules and slatemenls, and to the best of my knowledge and belief, it is lrue, correct
and complete
DeclarallonofpreparerolherlhanthepersonalrepresenlallVelsbased on all information of which preparerhas any knowledge
SIGNATUR F PERSON RESPONSIBLE FOR FILING RETURN OATE
.3 '/f', Z?-<.
AODRESS '1'7 ".,,,,IP' .
1Yle~l0b~ flIl 17".&5
SIGNATURE~~NTATIVE
ADDRESS I /)/}
/tJ/ s, /1l~f. 51. I . /Jle~/~';j.t':: .
.
/700
DATE
<3 ~7' ~::<.
. .
/7C25Cf)
For dates of death on or after Juiy 1, 1994 and before January 1, 1995, the lax rate imposed on the net value of transfers to or for Ihe use of Ihe surviving spouse is 3%
[72 PS. 39118 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rale Imposed on the net value of transfers 10 or for the use of the surviving spouse is 0% 172 P.S. 39116 (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 dales of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one 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% 172 P.S. 39116(a)(12)1
The lax rate imposed on the net value of transfers to or for the use of the decedenl's lineal beneficiaries is 4.5%, except as noled in 72 P.S. 39118(1.2) 172 P.S. 39116(a)(I)).
The tax rate imposed on the net value of transfers to or for Ihe use of the decedent's siblings is 12% 172 PS. 39116(a)(1.3)). A sibling is defined, under Section 9102, as an
,ndividual who has alleast one parent in common with the decedent, whether by blood or adoption.
,. iiij;j1iil:1\H:i':;JJ!;jji,!j;ji;;\ ,,:';\~;;,;;jE:,hmhn~\\j;ilm\\\li!;\ji fi':s!'';:
'/;';'/C",,'
"{dC'''''' "'C'
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COMMONWEALTH OF PENNSYLVANIA
lNHERlT ANCE TAX RETURN
SCHEDULE A
REAL ESTATE
"" .
ESTATE OF FILE NUMBER
BASOM Gladys A 21 01 0252
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 which is jointly-owned with
right of
survlvorshln must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
97,318.89
Ranch style dwelling located at:
590 Grandview Ave,
Camp Hill, PA 17011
TOTAL (Also enter on line 1, Recapitulation) $
97,318,89
"'Y'''''''''"''W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
EST ATE OF
BASOM Gladys A
FILE NUMBER
21
01
0:>52
Debts 01 decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representati"le {os)
Social Security Numbe~s) / EIN Number of Persona! Representative(s)
Street Address
City State Zip
YeaTts) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Additional 35.00
5. ACCOLlntanfs Fees
6. Tax Return Preparer's Fees
7.
7.
TOTAL (Also enter on line 9, Recapitulation) $ 35.00
(If more space is needed, insert additional sheets of the same size)
'''''''''''''''''.
COMMONWEALTH OF PENN5'<lVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
BASOM Gladys A
FILE NUMBER
21 01
0252
Include unreimbunled medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
Allstate Insurance (Hazard Insurance on Real Estate 12/01 .2/28/02)
56.00
3
M&Z Carpets
6029 Carlisle Pike. Mechanicsburg. PA 17055
New carpeting in decedent's residence
Maintenance of Real Property
2,201.50
2
339.00
4
Eichelbergers Well Drilling (Repairs to private water)
78.00
5
PPL Utilities (electric bills 7/01 - 2/02)
264.26
6
Capitol City Oil (fuel oil 10/19/01 and 12/31/01)
195.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3,133.76
A U.S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT OMS No. 2502-0265
SETTLEMENT STATEMENT
TITLEPRO
SECURED LAND Laserprint
TRANSFERS, INC. B. TYPE OF LOAN I
I
5006 East Trindle Road 1 [ ] FHA 2. [ ] FMHA 3. [ ] GONV. UNINS 1
Suite 203 4. [ I VA 5. [ I CONV. INS. I
Mechanicsburg, PA 17055 6. FILE NUMBER: I 7. LOAN NUMBER:
503539 22879
Phone: (717) 591-8500 FAX: (717) 591.8506 8. MORT. INS. CASE NO. I
c. NOTE: This form is furnished 10 give you a statement of actual settlement costs, Amounts paid to and by the settlement agent are shown. Items marked
'(p.Q,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:
George DiCarlantonio The Estate of Pennsylvania State Employ
Gladys A. Basom ees Credit
1 Credit Union Place
Harrisburg, PA 17108
G. PROPERTY LOCATION: H. SETTLEMENT AGENT I. SETTLEMENT DATE,
Lots16&17 Grandview Heigh I
590 Grandview Avenue Secured Land Transfers, Inc. 02/28/02 I
,
,
Wormleysburg BOROUGH PLACE OF SETTLEMENT' I
CUMBERLAND County 101 Old Schoolhouse Ln. Mech. PA 17055
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
lOa. GROSS AMOUNT DUE FROM BORROWER 4oo,GROSS AMOUNT DUE TO SELLER
101, Contract sales price 1 105000.00 401, Contract sales price 105000.00
102. Personal property 4o?.Personal property
103. Settlement charges to borrower (line 1400) 8222.10 403
"4 404
10S , 40S
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
106_ City!Town lax to 1 406,CilyfTown tax to i ,
107, County tax 02 I 28 I 021012/31/021 345.51 407.County tax 02/281 02to 12/31/021 345.511
108, Assessments to 1 4GB_Assessments to I I
109 School 02/281 02to 06/3 0102 356.58 409 school 02728 I 02to 061301 02! 356.58
110 R&S:$104.00/q eil5ldlng 3/31 35.33 410 R&S:S104.00/q eil5ldlng 3/311 35.33
t11 411 :
112 1 412 i
I 113959.52 i 105737.42 I
120. GROSS AMOUNT DUE FROM BORROWER I 42o,GROSS AMOUNT DUE TO SELLER
i
200 AMOUNTS PAID BY OR IN BEHALF OF BORROWER 500 REDUCTIONS IN AMOUNT DUE TO SELLER
201 DepOSIt or earnest money I 5000.00 sOl,Excess deposit (see instructions) I
202 Principal amount of new loan(s) 65000.00 s02,Settlement charges to seller (line 1400) I 8418.53
203 Existing loan(s) taken subject to . s03Existing loan(s) taken subject to :
204 s04Payoff of First Mortgage Loan i
NONE i
20S . sosPayoff of Second Mortgage Loan 1
,
i I i
206 1 S06 ; I
207 : S07 !
208. S08 I
209 S09 i
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210. CitylTown Lax to 510CityITown tax to
211. County lax to I 511,CountYlax to
,
212 Assessments to i 512.Assessments to
213 school to 513 School to i
214. 1 514. I ,
21S , 515 I
216 516 1
217 517
216 516
219 519
220. TOTAL PAID BY/FOR BORROWER 70000.00 520.TOTAL REDUCTION AMOUNT DUE SELLER 8418.53
300, CASH AT SETTLEMENT FROM OR TO BORROWER GOO, CASH AT.SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower (line 120) i 113959.52 fio1,Gross amount due to seller (line 420) 105737.42
302 Less amount paid by/for borrower (line 220) I 70000.00 flo2,Less reduction amount due seller (line 520) 8418.53
303 CASH (IX] FROM) ([ ] TO) BORROWER , 43959.52 '03GASH (IX] TO) ([ ] FROM) SELLER 97318.89
!
Buyer or Borrowor's Signature
Seller's Signature
HUD- 1 Rev. 5/86
ERA-NRT,
Inc.
OMB No. 2502-0265
Page2
PAID FROM
SELLER'S
FUNDS AT
SETTLEMENT
u.s. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
L. SETTLEMENT CHARGES 503539
700. TOTAL SALES/BROKER'S COMMISSION based on price $ 105000 . 00
Division of CommIssion (line 700) as follows:
701.$ 6300.00 to
702, $ to
703. Commission paid at Settlement
704. TransaFee
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee %
802. Loan Discount %
803. Appraisal Fee to
804. Credit Report to
805. Lenders Inspection Fee
806. Mortgage Insurance Application Fee to
807, Assumption Fee
808. Flood Cert
809. Underwri te
810 Roof Escrow
811
900.
Total:
ERA NRT,
$6,300.00
Inc.
PSECU
PSECU
($125.00 POC)
($ 14.00 POC)
PSECU
PSECU
PSECU
15.00
100.00
5775.00
901
902.
ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
Interest from 02 02 to02 28 02 @$
Mortgage Insurance Premium for mo to
Hazard Insurance Premium tor 1 yrs to
yrs to
11.35/day
11.35
903.
904,
905.
1000.
OOL
1002.
1003.
1004.
1005.
1006
1007,
008
100. TITLE CHARGES
1101. Settlement or closing fee to
102. Abstract or title search to
1103. Title examination to
104. Title insurance binder to
1105. Document preparation to
1106. Notary fees to
1107. Attorney's fees to
(includes above items No,:)
1108. Title Insurance to
(includes above items No :)
1109. Lender's coverage $
1110. Owner's coverage $
1111. Mail Fee
1112 ICPL
1113.
1200
1201
1202.
RESERVES DEPOSITED WITH LENDER FOR
Hazard Insurance mo. @ $
Mortgage Insurance mo @ $
City!Town tax mo. @$
County tax mo @ $
Assessments mo @ $
mO.@$
mo.@$
mo @$
/mo
/mo
/mo
/mo
/mo
/mo
/mo
/mo
Secured
Cash
Land Transfers
Secured
End.100,300,900,
65,000
105,000
Land Transfers
10.00'
75.00
10.00
Secured Land Transfers
First American Title
1203.
204.
1205
GOVERNMENT RECORDING AND TRANSFER CHARGES
Recording lees Deed $ 25 . 50 Mortgage $ 51 . 50
City/county tax/stamps Deed $ 1050 . 00 Mortgage $
State tax/stamps Deed $ 1050 . 00 Mortgage $
02Ct Boro Dennis
R&Sl 2 3 Wormle
Misc $
77.00
1050.00
1300.
1301
1302.
1303.
1304.
1305.
400.
ADDITIONAL SETTLEMENT CHARGES
Survey to
Pest Inspection to
Well Cert
HoIns ect
HoWarrant
TOTAL SETTLEMENT CHARGES (enter on lines 103 and 502, Sections J and K)
1050.00
404.13
114.40
Biechler
Biechler
Biechler
ERA-NRT,
(POC
(POC
(POC
Inc.
B)
B)
B)
8222.10
365.00
8418.53
Parlies <Igree ttl<lt no liability is assumed by Selllemer,l Agerillor 11101 accuracy o! illformalio(ll'lrr,isrled by OtfltHS as s~lowrl ulIlhe HUD.l SfJtllernOlfll Slalement. Set1lemenl
Agenl rlereby expressly
reserves tria rlgt,t to deposit any <ImolJnts collm;lnd for (jisolJrsement rn an interest be<lrlng aCCOljfl\ in a Feder<llly IrIsured IfIslitutioll ar.d to credit any inlerHsl so earned
10 Its own ilccount as ilddilional
compensation lor lIS services In ttristransactlOlI
HUD CERTIFICATION OF BUYERS AND SELLERS
I have carefully reviewed the HUD-1 SeUlemenl 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 by me in this transact' n. I furl r certify that I have received a copy of the HUD-1 Settlement Statement.
. /L4.'~" oe~"
'-L
.. 'II.
KdA~~' J
Sell"r'sSignature
Seller's New Address & P~lorre
~ a~"I"-
uealld aGGurale <lGcOIHII oj thist[am;a7~~?cause till] funds l() be disbursHdlri aGGo[d,IfIGe willi Ihisstaterw![,1
SetltementAyent
WARNING: It is a crime 10 knowingty make lals" st lements
Tille 18: U,S. Code Section 1001 and Se 'Iion 1
Date
Ihe United Slales on Ihis O[ allY similar torm POrlalties UPO[I conviction Garl include a fine and irnpris<Hlrnenl For details see
HUD.I Rev. 5/86
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