HomeMy WebLinkAbout07-24-15 (3) J �pennsylvania 15 0 5 61410 5
DE➢pRTMENTOFREVENVE EX(03-14)(FI)
REV���OO OFFICIAL USE ONLY
Bureau of Individual Taxes Cuunry Code Year File Number
PO BOX 2so601 INHERITANCE TAX RETURN ��� /5 � ��
Harrisburg, PA 17128-0601 RESIDENT DECEDENT �,!' ,
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
, ' 02182015 ' 03151955
DecedenYs Last Name Suffix Decedent's Firs1:I`Jame MI
', DO KHANG ' T '
(if Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First�l��rne MI
. _
TRAN CHAU M
THIS RETURN MUST BE FILED IN DUPLICATE WiTF��f•IE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Return p 2. Supplemental Return G� 3. Remainder Return(date of death
prior to 12-13-82)
p 4.Agriculture Exemption(date of � 5. Future Interest Compromise(date of �, 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
p 7. Decedent Died Testate p 8. Decedent Maintained a Living Trust ____ 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
p 10. Litigation Proceeds Received p 11. Non-Probate Transferee Return C;�� 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13. Business Assets O 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX IAIFORMATION SHOULD BE DIRECTED T0:
Name d�ytime Telephone Number
;CHAU M TRAN (117) 713-4344
First Line of Address
;3 KWGSBRIDGE CIRCLE
_ _ .
Second Line of Address
City or Post Office State ZIP Code
CARLISLE ' PA ' 17013
Correspondent's email address: UNDERPERSIMMONTREE@YAHOO.COM _____
! REGISTER OF WILLS USE ONLY
REGISTER OF WILLS USE ONLY
DATE FI[,ED MMDDYYYY rv
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PLEASE USE ORIGINAL FORM-'��+t�Y � �
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Side 1 "''7 ' r�"� � ►'s�
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I I'II'I II"I'IIII I'I'I)II�III I II'I 'I II IIIII IIIII I�I)I"I �� �
L 15056�4��5 1505614105 J
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� 15�5614205
REV-1500 EX(FI)
Decedent's Social Security Number
___ _
oecedenrs Name: KHANG THI DO 586-
�
1. Real Estate(ScheduleA). .... . . .. . . . .. .. .. .... .. .. . ..... .. .. ... ... .. . 1, 0.0�
2. Stocks and Bonds(Schedule B) 2. 0.00 '
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) .. .. . 3. 0.00
4, Mortgages and Notes Receivable(Schedule D) .. .. . .. .. . .. . . . . . ... . . .... . 4. 0.00 '
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). .. .. . . 5. 10,725.79
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. .. .. . 6. 75,874.74
_ , ___. __ _
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. .. .. .. 7. 0.00
8. Total Gross Assets total Lines 1 throu h 7 8. 86,600.53
� 9 ).. . .. .. .... .. .. .. . ... .. .... . .
9. Funeral Expenses and Administrative Costs(Schedule H). . .. .. . .... .. . .. .. . 9. 4,690.00
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)... .. .... .. .. . . 10. 121,978.24
11. Total Deductions(total Lines 9 and 10). . . . . .. ... .... .. .. ... ... . .. .. .. . . 11. 126,668.24
12. Net Value of Estate(Line 8 minus Line 11) . .. .. . .. .. ... .. . ..... .. .. .. .. . 12. -40,067.71
_..__. . ___ . . _.. _. �...
13. Charitable and Governmental Bequests/Sec.9113 Trusts for which
an election to tax has not been made(Schedule J) . ... .. ... . .. .. .. . .. .. .. . 13. 0.00
14. Net Value Subject to Tax(Line 12 minus Line 13) .. . .. . .. . . . . . .. . .. .. ... . 14. -40,067.71
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES �
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 40,067.71 ',
(a)(1.2)X AQ - 15. 0.00
. _ .._...._. ._.. ._...._.. ._..,.�. .. ._... _,..... .. _.. ._
16. Amount of Line 14 taxable
at lineal rate X.0_ ' 16. 0.00
_ __._.._ _ ._._.__ ... �,._.... _. __, ___ � __.,.._. __._.._.._ . _ ...._._.;
17. Amount of Line 14 taxable
at sibling rate X.12 17. �.��
_,__ .�. ..� . _._.u_ e_ _ __� _.._.._.. .. .. ..,._ _. _ _ �
18. Amount of Line 14 taxable TT _ r v� . ��u� -
at collateral rate X.15 18. 0.00
19. TAX DUE ... .. . . . . .. . .. ... .. ... . .. .. .. . .... .... .. .. ... .. .. .. . . .. . . 19. 0.0�
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Under penalties of perjury,I declare I have examined this return,induding accompanying schedules and statemer is,and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the person responsible for filing the rk:turn is kiased on all information of which preparer has
any knowledge.
SIGNATURE OF PERS RESP N�FILING RETURN - DA E
07 ���o2c���
._ ,
ADDRESS
3 KINGSBRIGDE, CARLISLE PA 17013
SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FIL�NG THE RETURN !�� DATE
ADDRESS .
2501 PAXTON ST, HARRISBURG PA 17111 ___
i iiiiii iiiii iiiii i�iii�iu iiiii iiiii i�i�iiiii iiiii iiii iiii Side 2 �
L 5 56142 15056142�5
. . . I .I.II II 11I• �
REV-1500 EX (FI) Page 3 File Numk�e:r
Decedent's Complete Address: __
DECEDENT'S NAME
KHANG THI DO
STREETADDRESS
3 KINGSBRIDGE CIRCLE
CITY T ST��TE ZIP
CARLtSLE ' PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. CreditslPayments
A.Prior Payments
B.Discount
(See instructions.) Total Credits(�4 � B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in ovai on Page 2,Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
Make check payable to: REGISTER OF WILLS, ��GENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "K" I�� 'fHE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the properry transferred........................................................................................ ❑ �
b. retain the right to designate who shall use the property transferred or its income ........................................... ❑ �
c. retain a reversionary interest ............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefits or care?..................................................................... ❑ �
2. If death occurred after Dec. 12, 1982,did decedent transfer properry within one year of tlE�a�h
without receiving adequate consideration?................................................................................. ............................ ❑ �
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his c�r hE;r death?.............. ❑ �
4. Did decedent own an individual retirement account,annuity or other non-probate property,whiich
containsa beneficiary designation? ........................................................................................... ............................ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS 1S YES,YOU MUST COMPLETE SCHEDUL�:G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net valu����1 iiransfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to ��r f��r the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and ttie:,tatutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a tleceased child 21 years of age or youn�ae;r<at death to or for the use of a natural parent, an
adoptive parent or a step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfe�s to or for the use of the decedent's lineal beneficiaries is 4!i percent,except as noted in[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 pe�rcent[72 P.S. §9116(a}(1.3)].A sibling is defined,
under Section 9102,as an individua►who has at least one parent in common with the decedent,whethF r by blood or adoption.
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REV-1502 EX+ (02-15)
'�i�pennsytvania SCHEDULE A
� DEPARTMENT OFREVENUE
INHERITANCE TAX(1ETURN REAL ESTATE
RESIDEN7 DECEDENT
ESTATE OF: FILE NUMBER:
KHANG THI DO
All real property owned solely or as a tenant in common must be reported at fair market value.Fair ma�k�et vaiue is defined as the prlce at which property
would be exchanged between a wi�ling buyer and a wflling seller,neither being compelled to buy or sell,both havinc�reasonable knowledge of the relevant facts.
Real property that is jointly-owned with rigbt of survivorship must be disclasn��un 5chedule P,
Attach a copy of the settiement sheet iF the properry has been sold. `
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in cormman, VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1' NONE
TOTAL(Also enter on Line ]., Recapitulation.) ; 0.00
If more space is needed,use additional sheets of paper of the same siaE�.
. . . I1.II. .II 11II■ �
aev-iso3 ex+�oz-is)
�pennsylvania SCHEDULE B
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF �� FILE NUMBER
KHANG THI DO
All property jointly owned with right of survivorship must be disclosed on Schedule P.
ITEM � VALUE AT DATE
NUMBER DESCRIPTION .___ OF DEATH
1' NONE
TOTAL(Also enter on Line 2, Fte�:apitulation} $
If more space is needed,insert additional sheets of the same siz4:
REV-i5oq EX+(g-iz)
SCHEDI�ILE C
�pennsylvania CLOSELY HELD CORPORATION
DEPARTMENT OFREVENUE /
INHERITANCE TAX RETURN PARTNERSHIP OR
RESIDENT DECEDENT SOLE-PROPRIETORSHIP
ESTATE OF � FILE NUMBER
KHANG THI DO
Schedule Gl or G2(including all supporting information)must be attached for each closely-heid carpoiati�rn/partnership interest of the decedent,
other than a sofe-proprietorship,See instructions for the supporting information to be subrnittE�d for sole-proprietorships.
ITEM NUMBER �! VALUE AT DATE
NUMBER DESCRIP'fION ____ OF DEATH
�. NONE
TOTAL(Also enter on line 3,, ft�:r.apitulation) $ 0.00
(If more space is needed,insert additional sheets of the same s�iz��')
REV-1507 EX+(02-15)
�� pennsylvania SCNEDULE D
DEPARTMENT OF REVENUE MORTGAGES & NOTES
INHERITANCE TAX RENRN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF PiL�N�IMBER
KHANG THI DO
All property jofntly owned wfth rfght of survivorship must be disclosec!on Scl+��dule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION .____ ��EATH
NONE I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
TOTAL(Also enter on Line 4,�iecapitulation) $ 0.00
(If more space is needed,insert additional sheets of the same size.)�
I .I.II. II IIII.■ I
REV-1508 EX+(02-15)
�pennsylvania SCNEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX AETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: � FILE NUMBER:
KHANG THI DO
Indude the proceeds of Iitigation and the date the proceeds were receive�i h�;the estate,
All property jointly owned with right of survivorship must be disclos�d on Schedule F.
ITEM �� VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
�• ORRSTOWN BANK 10,725.79
TOTAL(Also enter on Line 5� ftf:capitulation) $ 10,725.79
If more space is needed,use additional sheets of paper of the same size.
REV-1509 EX+ (02-15)
� pennsylvania SCNEDULE F
�i7 DEPARTMENTOFREVENUE )OINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT ,�._
FILE NUMBER:
ESTATE OF:
KHANG THI DO .—__.
If an asset became jointly owned within one year of the decedent's date of death,it mast_be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS �__ RElATIONSHIP TO DECEDENT
A•CHAU M.TRAN 3 KINGSBRIDGE CIRCLE, CARLISLE PA 17013 SPOUSE
B.
C.
JOINTLY OWNED PROPERTY: ___._ —
LE7TER DATE DESCRIPTION OF PROPERTY °/OF DATE OF DEATH
ITEM FOR]OINT MADE INCLUDE NAME OF FINANCtAL INSTIfUTION AND BANK ACCOUNT NUMBER OR SIMILAR DAT'E Of DEATH DECEDENT'S VALUE OF
NUMBER TENANT ]OINT IDENTIFYING NUMBER.AITACH DEED FOR70INTLY HELA REALESTATE. _. VA'�..UE OF ASSET INTEREST DECEDENT'SINTEREST
1' A' 01101/11 TOYOTA COROLLA 2009 5,500.00 50 2,750.00
2 A SANTANDER BANK-CHECKING ACCOUNT 1,447.47 50 723.74
3 A 03119/14 3 KINGSBRIGDE CIRCLE,CARLISLE,PA 17013 144,802.00 50 72,401.00
75,874.74
TOTAL(Also enter on Llne 6, Recapitulation) $ _
If more space is needed,use additional sheets of paper of the sarr?e size.
REV-1510 EX+(02-15)
�� pennsylvania SCHEDULE G
DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX REfURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDEM
ESTATE OF ��� FILE NUMBER
KHANG THI DO ___
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page�h•ee of the REV-1500 is yes.
DESCRIPTfON OF PROPERTY DATE OF DEATH �'!o OF DECD'S EXCLUSION TAXABLE
ITEM INCLUDE THE NAME OF THE TRANSFHtff,THEIR RELATfONSHIP TO DK�BdT AND
NUMBER THE DATE OF TRANS�Ht.A7TACH A COPY OF THE D�FOR REAL ESTATE. VALUE OF ASS� INTEREST tF acvucaB� VALUE
1. NONE
I
i
i
i
�
TOTAL(Also enter on Line 7, I�e�c�ipitulation) $ 0.00
If more space is needed,use additional sheets of paper of the same si�E�.
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REV-1511 EX+ (02-15)
� pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FU N E RAL EXP ENSES AN D
INMERITANCE TAX REiURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF �R FILE NUMBER
KHANG THI DO
Decedent's debts must be reported on Schedule T. J
ITEM `—� ��
NUMBER DESCRIPTION AMOUNT
A, FUNERAL EXPENSES:
1' HOFFMAN ROTH-FUNERAL HOME&CREMATORY, INC 4,365.00
219 NORTH HANOVER STREET,CARLISLE PA 17013
B, ADMINISTRATIVE COSTS;
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
��tY Stdte Z:[f�
Year(s)Commission Paid:
2. Attomey Fees:
3. Family Exemption: (If decedent's address is not the same as ciaimant's,attach explanation,)
Claimant
Street Address
City State__._____Z:[F�
Relationship of Ciaimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees: 325.00
7,
TOTAL(Also enter on &.inE: 9, Recapitulation) $ 4,690.00
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(02-15)
�'i�j pennsylvania SCHEDULE I
�y DEPAfiTMENTOFREVENUE DEBTS OF DECEDENT,
INHERITANCETAX(iEfURN MORTGAGE LIABILITIES 8c LIENS
RESIDENT DECEDENT
ESTATE OF � FILE NUMBER
KHANG THI DO
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,iiaclui�ing unreimbursad medical expenses.
ITEM �� VALUE AT DATE
NUMBER DESCRIPT[ON OF DEATH
1� JPMORGAN CHASE BANK NA-MORTGAGE 121,978.24
TOTAL(Also enter on Line i(1, Recapitulation) � 121,978.24
If more space is needed,insert additional sheets of the same sii;e.
REV-1513 EX+(02-15)
� pennsylvania SCHEDULE )
DEPARTMENT OF REVENUE
INHERIiANCE TRX RETURN BENEPICIARIES
RESIDENT DECEDENT
ESTATE OF� � FILE NUMBER:
KHANG THI DO
RELATIONSH[P TU DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List�'rustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under �
Sec,9116(a)(1.2).j
1. CHAU M.TRAN SPOUSE 100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-150�D :'OVER SHEET,AS APPROPRIATE.
���� ��
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKE�:
1• CHAU M.TRAN 100%
B. CHpRITABLE AND GOVERNMENTAL DISTRIBUTIONS;
TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-150U COVER SHEET. $
If more space is needed,use additional sheets of paper of the same siz?.
. . . I .I..II.. II .I�Y• �
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'`i �'i;';I� �,; i'(� 1 `�? TaxParcel #
THIS DEED
MADE this 'r�� day of 111Ci r'L��.. , 2004,
;
BETWEEN S & A CUSTOM BUILT HOMES,INC., a Pennaylvania Corporation,
of Carlisle, Cumberland County, Pennsylvania,
"GRAl�'TOR",
AND CHAU MINH TRAN and KHANG THI DO, �usband and wife, of
Carlisle, Cumberland County, Pennsylvania,
"GR.�]`JTEES",
WITNESSETH, that in consideration of the sum of One Hundr�d Forty-four Thousand
Eight Hundred Two and 00/100 ($144,802.00)Dollars, in hand p�,id, the receipt whereof
is hereby acknowledged, the said GRANTOR does hereby grant a:n� convey in fee simple
to said GRANTEES,their heirs and assigns,
ALL THAT CERTAIN tract of land situated in the Borough c>�'Carlisle, Cumberland
County, PA being Lot No. 103 as shown on plan entitled, �:;hesterfield, Formerly
Greystone Manor,Final Subdivision/Land Plan, Section 2A, dated :December 8, 2000, by
PennTerra Engineering, Inc., State College, PA, in Plan Bc�c>k 85, Page 88, being
bounded and described as follows:
BEGINNING at an iron pin, being a northerly corner of Lot Td��. 102 and lying in an
easterly right of way line of Kingsbridge Circle (60 foot righl: �f way, 28 foot wide
cartway); thence along said right of way along a curve to the le��y �.►aving a chord bearing
of North 00 degrees 50 minutes 19 seconds East, a chord distan.ce of 30.84 feet, a radius
of 180.00 feet and an arc length of 30.88 feet to an iron pin; theaic�; continuing along said
ri�ht of way, North 04 degrees 04 minutes 35 seconds West, 3:1,K7 feet to an iron pin,
lying in an easterly line of said right of way and being a souther�l�� �;orner of Lot No. 104;
thence along said lot, North 85 degrees 55 minutes 25 seconds ]:;ast, 100.00 feet to an
iron pin, being a southerly corner of said lot and lying in a wester-ly right of way line of
Meetinghouse Spring Road (60 foot right of way); thence alon�; s��.id right of way, South
04 degrees 04 minutes 35 seconds East, 80.39 feet to an iron pin, lying in a westerly line
of said right of way and being a northerly corner of Lot No. 102.; thence along said lot,
North 84 degees 14 minutes 47 seconds West, 104.17 feet to am i��on pin, being the place
of BEGINNING.
�i;�.�, yW':ili: .r,�.,: ��i�
CONTAINING 0.165 acre.
SUBJECT to 10-foot wide utility easement along its street front<�g;e.
UNDER AND SUBJECT to Master Declaration of Protective �c�venants for
Chesterfield Manor recorded in Misc. Book 589, Page 65.
ALSO, UNDER AND SUBJECT to Master Declaration af' Protective Covenants,
Reservations and Easements for Chesterfield Manor recorded ir� Misc. Book 589, Page
76.
BEING part of the same premises which Kruger Dairy Far�ls, a Partnership by Deed
dated and recorded April 18, 1986, and recorded in the Office c�i'the Recorder of Deeds
in and for Cumberland County in Deed Book V-31, Page 35�, conveyed unto S & A
Custom Built Homes, Inc., grantor herein.
This Deed is executed by Donald W. Thompson, Attorney-in-Fac,t: for S&A Custom Built
Homes, Inc., pursuant to authority as granted in Power of Att�:r�ley as set forth in Misc.
Book 400, Page 530.
AND the said GRANTOR hereby warrants specially the propegty herein conveyed.
IN WITNESS WHEREOF, the said S&A Custom Built Hu�r�es, Inc. has caused this
Deed to be signed in its corporate name by it Attorney-in-Fa�ct, Donald W. Thompson,
the day and year first above written.
Witness: S&A Custom B�.i�t. Homes, Inc.
;? ;�` �� �-�`. 7,.� By: f� �� .�',�.
� �
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COMMONWEALTH OF PENNSYLVANIA .
: ss.
COUNTY OF CUMBERLAND .
On this the ���day of lti�r����- , 2004, before me, tl�ie undersigned officer,
personally appeared Donald W. Thompson, Attorney-in-Fact f'c�r S&A Custom Built
Homes, Inc., known to me (or satisfactorily proven) to be th� �serson whose name is
subscribed to the within instrument, and acknowledged that he ��xecuted same for the
purposes therein contained as and for the act of his principal a.nd the capacity therein
stated.
WITNESS my hand and official seal the day and year first abov�wrritten.
�
; .� `����;��: ��;���i�---'(SEAL) �'�
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Notary Piabl ic �, ' ��
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Commonwealth Of Penns�iv�ania y. �'s.,'�� ,�:F,. ,y
Notarial Seal � �" :?�� ''� 6�i.; ��
Colleen F.Thompson,Natary�F'u��lic �"�SyZ�� �� ;�; :
South Middleton T Cumber�nd t,'�oun F� y�' ' `�- _
wp•, be �
MY Commission Expires June�G,:?007� ���+�;���, �•'�.=
Member�Pennsyivania A.ssociation C)F Nola�es �'�"yi Y,'�/��'+'!`��. ��•
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I hereby certify that the, recise residence and comp te post of�icf; address of the within
...��" '�P.�r �..�/��.�/,��'. ���� ,f,�.__._
named Grantees is �i� .�". � .
�'��.�'���s���. �'���-� /'��.>�' `' .
�����-�`�.'�1 /�.� 2004. ���''��-,t� �4 _ A ��'�� ��-'4 ��f���
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`�or.�ey for Gr�ntees
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I �;e�-��i I�:,` t�1is to be record�;d
In ��tz����.}�rland �ounty l��
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`"'� �•''���`� .�`�`�i�."e"'`
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`t .�i
' ��"' Recorder of I�eeds
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REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVANIA ADMINISTRATION
� �
OF CUIy
,�y ��,� @F9 No. 2015- 00225 PA No. 2�- �5- 0225
02 �y►Z Es ta te Of: KHANG THl DO ___
lFirst,Middle,Last)
. v � a/k/a: KHANG_DO KHANC,_7:DO
La te Of: CUMBERLAND�O�!TY �
Deceased
1750 Social Security No: 586-
WHEREAS, KHANG THl DO
(First,Mrddle,Lastl
a/k/a KHANG_DO KHANG_T DO
late of CARLISLE BOROUGH CUMBERLAND COUNTY
died on the 18th day of February 2015 and,
WHEREAS, the grant of Letters of Administrativn
is required for the administration of the estatF.
THEREFORE, I, L/SA M. GRAYSON, ESQ. _. 1:egister of Wills in and
for CUMBERLAND County, in the Commonwealth of Per.ir�sylvania, have
this day granted Letters of Administration to:
CHAU MINH TRAN
who has duly qualified as ADMINISTRATOR (RIX) of:� �he estate
of the above named decedent and has agreed to ac�rni.nister the estate
according to law, all of which fully appears of r�_�cord in my office at
CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VAPVI,��.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 3rd day of March 2015.
�..�,�} )'
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�`'--`� Register of ils
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C H a5 E ' r CllatOPil@f S@(VIC@ 1-800-848-9136
'� � Monday-Friday 8 a.m.•midnight(ET)
Saturd�.y 8 a.m.-8 p.m.(ET)
Deaf or Hard of Hearing (TT`n 1-800-582-0542
� cM�se,:om
�i�nilrrll�li�ll�in����iil�l�l��li�lr���ilin�i�������i�lill
Mortcq��:;��� L.a�.�n Staternent
12238 MSD Z 01215 C- YRE BR2 TI PL �---
CHAU MINH TRAN Loan Number 1176446715
KHANG THI DO Statement d��tE� 01/12/2015
3 KINGSBRIDGE CIR
CARLISLE PA 17013-4806 Property AdcNre�s� 3 Kingsbridge Cir
Carlisle,PA 17013
. Total Atraou�ht[��cte $932.30
Payment Due Cinte 02/01/2015
A late charge�of gi37.29 may apply if received after
0?J16/2015.
Loan Overview(as of 01/12/2015j
ExpNz:iri�,rsi:�c�ri of Amount Due
Orfginai Pnncipal Balanco $125,787.00 ---�--�--�
Unpaid Principal Balance - � �C�Z�,g�g,24 Principal $217.08
Interest Rate 3.25000% �nterest $330.36
Escrow Balance �2,165.98 Escrow F'aym��rf(Taxes and/or Insurance) $384.86
Monthly P�ynnismt $932.30
Past Payments Breakdown Prior Fea�s/(,hi�rges $o.00
Peld Since Last Statement Paid Year-to-Date Fees/Chargc,s��ince Last Statement $0.00
Principal $216.60 $216.50 Total Arrioun4 I[�ue $932.30
Interest $330.94 $330.94
Escrow Payment(Texes and/or Inaurance) $384,86 $384.86
----.__-----______ _----..._,...__..._�_.___---.._...__...__.. -
Total $932.30 $932.30
Transaction Activity Since Your L.ast 5tatement(inciudes Fees/Charcp�.���:�)�
Transaction Date Descriptlon Total Received Principal Intf::re;:�t� Escrow Fees Unapplied Funds
-- ��.��.
01/03/2015 MORTGAQE INSURANCE PAID `_ __ _ ___ �.. __ $55.96 � ^ _
Ot/09/2015 PAYMENT �932.30 $216.50 $330.9�3 �384.86
Important Messages �
Important Tax Intormation Enclosed
Your 2014 IRS Form 1098(Mortgage Interest Statement)is enclosed. it's also available to view and�rir�t at chase.comlTaxStatement.Most accounts
can be viewed online.
Be entered for a chance to win$35,000 when you enroll in paperless mortgage statements.Enroll nc�+nr�it chase.com/VUinWithPaperless.
Servicemember Protections:You may be entitled to certain legal rights and protections if you or arry c�auner or occupant of your home are or
recently were on active dury or active service as a federal or state Military Servicemember,or if you're G�dependent of such a Servicemember.For
more information,please call us at 1-877-469-0110, 1-318•340-3308 if you're calling from overseas,or t••800-582-0542 for TrY services,
If you receive or expect to receive an insurance claim check for damages to your home,you can visit ctiase.comAnsuranceClaim for information
about our claim process.If you have any questions,please cali us at 1-866-742-1461 Monday throua,�Fi f"riday from 8 a.m.to midnight and Saturday
from 8 a.m.to 8 p.m.Eestern Time.
�
� Please detach and relum the bottom pottion of this statement with your payment u:=.�inc�tlhe enclosed envelope. �
nnni.i.��,uu�,�i.Gi, �i.annn nnn9�a�n fi`'1f1q1�9 S9 nnna�a�n nnnn�
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CHAU MINH TRAN
KHANG THI DO
Deposit Attounts Account Number Average Daidy&3alance Current Balance
SANTANDER VALUE CHECKING 2891037707 $�?,184.86 59,723:17
STATEMENT SAVINGS 1684002577 � 562.60 $62.60
Total Deposits � $9'785'��
, , � � � � � � i�
CHAU MINH TRAN ACtOunt#2891037707
KHANG THI DO
Balances
Beginning Balance $2,613.91 �urrent Balance J___ 59,723:17
Deposits/Credits +$11,606.63 AverageDailyBalance $2,184.86
WithdrewalslDebits "-$4,497.37 - �.
Checks Posted
Check# Date Paid Amount Reference Check# Date Paid Amount Reference
2027 0225'' $80.00 0978138910' 2028 03/02 $345.50 0971831255
2 Check(s)Posted=$425.50 �
Account Activity
Date Description Additinnx Subtractions Balance
02-07 Beginning Balance ___ $2,613.91
02-10 BOROUGH OF CAR17172494422150209 $143.36 $2,470.55
02-11 T.M.C.0 LOAN PMT 150209 � $9�•�8 �2,3�9•��
02-11 1PMorgan Chase Ext Tmsfr150211 ' �i_ $932.30 $1,447.47 '
02-19 RED LION CONTROL PAYROLL 150216 010Z27 $1,115,92� $2,56339
02-19 REO UON CONTROL PAYROLL 150216 010227 $491.57_._ $3,054.96-.
02-23 BK OF AMER VI/MC ONLINE PMT150223 � _ 5549.46 $2,505.50
02-24 SamsLlub MC SAMS EPAY 022315 $264:48 $2,241.02
02-25 CHECK 000000002027 � b80.00 $2,161.02
02-26 UGI-UTILITIE IMG UTIL.PYMT150225 � � $103.53 $2,057.49
02-26 BK OF AMER VI/MC ONLINE PMT150226 �� $549.46 $1,508.03
02-27 Sams Club MC SAiv1S EPAY o22515 $291.33 $1,216.70 '
03-02 XXSSA TREAS 310 SOC SEC 030215HY*********03062 $354.Ci0 81,570.70
03-02 PPL EU ELEC SVC ��_ 875.69 $1.495.01
03-02 CHECK000000002028 $345.50 $1,149.51
-03-03 XXSSATREA5310 SOC SEC 030315HY****"****03062 $368.C10� $1,5]7.51 '
03-04 DISCOVER E-PAYMENT 150303 �� $671.48 $846.03
03-OS 'RED'610N CONTROL PAYROLL T50303 010227 $916.35� $1,762.38
03-06 BRANCH TRANSACTION AT NEWBERRY COMMONS -CHECK �8,3�O.i'9� $10,123.17
DEP051T.
03-06 BRANCH TRANSACTION AT NEWBERRYtOMMONS -CASH ' $400.00- $9,723.17
WITHDRAWAL. �_._
03-06 Ending Balance $9.�Z3.��
Page 2 of 4 2891037707