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Home My WebLink About08-07-15 - 505610143 1 REV-1500 EX(01-10) i71 PA Department of Revenue y OFFICIAL USE ONLY p Penns Ivania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO BOx.280601 INHERITANCE TAX RETURN 21 14 0404 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 04 02 2014 06 20 1926 Decedent's Last Name Suffix Decedent's First Name MI WEARY LOIS N (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI -Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return El 2. Supplemental Return 3. Remainder Return(date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) g Decedent Died Testate 7. DecedentMaintained a Living Trust .8Total Number of Safe Deposit Boxes (Attach Copy of Will) Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit(date of death 11.Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach SCh.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number BRADLEY L GRIFFIE 717 243 5551 REGISTER OF WILLS`d E ONLY �13. rn C rm n First line of address C=: <n 200 NORTH HANOVER STREE rn z n Second line of address City or Post Office r,9ATE FILLED State ZIP Code r" rri CARLISLE PA 17013 -{ W CD Correspondent's e-mail address: bgriffie@griffielaw.com Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE �i�tir l 91 W. Weary -7 ADDRESS 1070 YgXk�Road, Dillsburg, PA 17019 S19M7MU—REffPREPARER OTHER THAN REPRESENTATIVE DATE Bradley L Griffie A-9 16- �orth H Hover Str , Carlisle, PA Side 1 L 1505610143 1505610143 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: Weary, Lois N. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 60 , 000 . 00 2. Stocks and Bonds(Schedule B)............................................................................. 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages&Notes Receivable(Schedule D)........................................................ 4. 5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 8 , 192 . 42 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 106 . 01 7. Inter-Vivos Transfers&Miscellaneous ion Probate Property (Schedule G) u Separate Billing Requested............ 7. 6, 476 . 58 8. Total Gross Assets(total Lines 1-7)..................................................................... 8. 74 , 775 . 01 9. Funeral Expenses&Administrative Costs(Schedule H)....................................... 9. 20 ,268 . 37 10. Debts of Decedent, Mortgage Liabilities,&Liens(Schedule 1).............................. 10. 192 , 899 . 50 11. Total Deductions(total Lines 9&10)................................................................... 11. 213 , 167 . 87 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. -138 , 392 . 86 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. -138 , 392 . 86 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.00 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X .045 0 . 00 16. 0 . 00 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. Tax Due.................................................................................................................. 19. 0 . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-14-0404 Decedent's Complete Address: DECEDENT'S NAME Weary, Lois N. STREET ADDRESS 1000 Claremont Drive CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +B) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;............................................................................... ❑ ❑x b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... ❑ Fil d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................................................................................................................... ❑ ❑x 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑x 4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which contains a beneficiary designation?.................................................................................................................. ❑ 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. For dates of death on or after July 1, 1994 and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a).(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in 72 P.S.§9116 1.2)[72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. Rev-1502 EX+(11-08) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF [FILE NUMBER Weary, Lois N. 21-14-0404 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 survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Residential Real Estate- 60,000.00 2142 Ritner Highway, Carlisle Cumberland County, PA (See attached HUD-1 Settlement Sheet) TOTAL(Also enter on Line 1, Recapitulation) 60,000.00 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A(Rev. 11-08) Rev-1508 EX+(6-98) SCHEDULE E t CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Weary, Lois N. 21-14-0404 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 M&T Bank - 4,771.88 Checking Account No.XXX394 (See attached statement) 2 M&T Bank- 33.16 Savings Account No.XXXXXXXXX3453 (See attached statement) 3 Real Estate Tax Rebate Check 975.00 4 Personal Property(Auction) - 1,758.00 (See attached statements) 5 Real Estate Tax Pro-ration at Settlement- 654.38 (See attached HUD-1 Settlement Statement) TOTAL(Also enter on Line 5, Recapitulation) 8,192.42 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.6-98) Rev-1509 EX+(6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Weary, Lois N. 21-14-0404 If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. David P.Weary 2144 Ritner Highway Son Carlisle, PA 17015 B. Dean W.Weary 2142 Ritner Highway Son Carlisle, PA 17015 C. Harold J.Weary 2146 Ritner Highway Son Carlisl, PA 17015 D. See attachment JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF DATE OF DEATH LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DECD'S VALUE OF ITEM FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR DATE OF DEATH DECEDENT'S INTEREST NUMBER TENANT JOINTVALUE OF ASSE INTEREST JOINTLY-HELD REAL ESTATE. ' 1 A, B, C, D 12/31/1996 Bank of Landisburg- 530.07 20.000% 106.01 Passport Savings Account No.XXXX6120 (See attached statement) TOTAL(Also enter on Line 6, Recapitulation) 106.01 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.6-98) Rev-1510 EX+(6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Weary, Lois N. 21-14-0404 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF RANSFERSATTTACH A COPREE THEIR Y OF RELATIONSHIP DEIED FOR REAL ESTATE. VALUE OF ASSET EDENT AND INTEREST (IF APPLICABLE) VALUE 1 Western&Southern Life Annuity- 6,476.58 100.000% 6,476.58 (Named beneficiaries: Decedent's four sons: Harold Weary, Kenneth Weary, David Weary and Dean Weary) (See attached statement) TOTAL(Also enter on Line 7, Recapitulation) 6,476.58 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.6-98) REV-1151 EX+(10-06) Lk , SCHEDULE H COMMONWEALTH T PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE DECEDENT C RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Weary, Lois N. 21-14-0404 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 48.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Kenneth W. Weary Street Address 1070 York Road City Dillsburg State PA Zio 17019 Year(s)Commission paid 2015 3,000.00 2. Attornev's Fees Griffie &Associates, P.C. 5,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 413.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 11,806.87 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 20,268.37 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Weary, Lois N. 21-14-0404 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Hoffman-Roth Funeral Home&Crematory, Inc. - 48.00 Additional Death Certificates H-A 48.00 Other Administrative Costs 2 Cumberland Law Journal -(Advertising) 75.00 3 The Sentinel -(Advertising) 169.30 4 Brethren Mutual Insurance Company- 319.50 Homeowner's Insurance 5 Auctioneer Costs - 640.30 (See attached statements) 6 Suburban Propane 63.19 7 Michael Young,Constable- 160.00 (Eviction Notice Service) 8 Shane Bouder(Trash Removal) 375.00 9 Bank Fees to Orrstown Bank 16.75 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Weary, Lois N. 21-14-0404 ITEM NUMBER DESCRIPTION AMOUNT 10 Real Estate Settlement Fees- 9,487.83 (See attached HUD-1 Settlement Statement) Realtor's Commission -$5,895.00 Notary Fees -$10.00 Realty Transfer Tax-$600.00 2014 Delinquent Real Estate Taxes-$2,600.17 2015 Real Estate Taxes-$372.66 Tax Certification-$10.00 11 Reserves 500.00 H-137 11,806.87 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+t12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Weary, Lois N. 21-14-0404 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Department of Public Welfare- 176,415.00 Third Party liability Claim 2 Aero Energy(Heating Oil) 594.50 3 Redevelopment Authority of Cumberland County- 15,890.00 Payoff of Mortgage at Settlement (See attached HUD-1 Settlement Statement) TOTAL(Also enter on Line 10, Recapitulation) 192,899.50 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08) REV-1513 EX+(11-08) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Weary, Lois N. 21-14-0404 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT Do Not List Trustees (Words) ($$$) I. TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] David J.Weary Son Twenty-five 2144 Ritner Highway percent of net Carlisle 17015 distributable estate Dean W.Weary Son Twenty-five 2142 Ritner Highway percent of net Carlisle 17015 distributable estate Harold J.Weary Son Twenty-five 2146 Ritner Highway percent of net Carlisle 17015 distributable estate Kenneth W.Weary Son Twenty-five 1070 York Road percent of net Dillsburg, PA 17019 distributable estate Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 11-08) will allb wotaluent .............................. . ........... ........ ...... ...............Of tile City oc Countyof ... ..................................................and State of .......................... being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my last Will and Testament, lici-cby revoking and annulling any and all Wills by me at any tinic heretofore made. fir0t. I order and direct all my just debts, funcrall expenses as well as the cost of ad- ministration and settlement of my estate to be paid by my i- .... Executor-Execu rik V hereafter named, as soon after my decease as conveniently may be. *CE011b. All of my estate, real, personal and mixed, of whatever kind and nature and wheresoever situate, remaining after pay)pent of my debts and full,-a expenses, I give, devise and and untojily . ....... --------------- ---- ...Ital . ... 246 IV-4 244 ----------------- ............................ eirs and assigns,absolutely nd in (cc. His or Her 'Idzeji- I hercl)v nominate, constitute and appointzL4704- -10 be the ................ • SOJCZ. . ........of this last Will and Testament and I direct that....-;o-_-:-----------------shall not Executor-ExerntrixHe-sho be obligated to file any bond, inventory or appraiscment or accounting in any public office or tri- bunal whatsoever, and further I hereby give and grant un(o my said.111.01..................................... ti full power and authority at any time to sell any real estate which may at any time form part of my estate, for such price, upon such terms, in such way and manner as may be deemed wise, and to make good and sufficient deeds to the purchaser or purchasers thereof without any obligation on the latter to see to or lie responsible for the application of thc'purchasc price. 3n Wituirms ENbertot, 1, the said ......... .... have hereunto Your set my hand and scat this........ ! C/ 90 ..............day of ...... ..... A.D. ig.. ...... i. ftneb, healrb, JM(WI)eb anti Medareb by the above named testator,_.................... ........... ... ..... .......as and for..........h6�sv:��..............last Will and Testament in d u 'r Named! Ilia, Her the presence of us who have at... request and in.....................................presence and His-Her in the presence of each other hereunto subscribed our names as witnesses hereto. ............. ---------- .............................. Witness Address MAXINEL.BARRICKNOTARY L� � ARY PUBLIC ............... ............................................................................... MY COMMISSION EXPIRI Address Member,Pennsylvania Association of Notaries Attachment to Schedule "A" A. DIMS NO.2502-0265 1POF U.S.DEPARTMENT OF HOUSING&URBAN DEVELOPMENT. I-E]FHA 2.[]F'mHA 3 B. TYPE.E]CONV.U .LOAN: 4NINS 6. FILENUMB_ -EIVA 5- CONV.INS, SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUMBER: 7. LOAN NUMBER: C. NOTE: This form is furnished to give you a statement actual settlement...costs. Amounts !tams marked"IPOCj,,were paid outside the claos'aing;the un sPa'd to andby1he settlement agen PY are shown here for informational purposes t are shown. ::R: E. NAMEANDADDRESS OF SELLER: I included in the totals, D. NAMEAND ADDRESS OF BORROWER: urPoses and are no Steven L.McCullough F. NAME AND ADDRESS OF LENDER: Sharon E.McCullough Estate Of LOIS T.Weary 548 Crossroad School Road 2142 Ritner Highway Carlisle,PA 17015 Carlisle,PA 17015 G. PROPERTY LOCATION: 2142 Ritner Highway H. SETT E ENTAGENT: 4t)-4273976 Carlisle,PA 17015 Bradley L.G iffle I. SETTLEMENT DATE: Cumberland County.Pennsylvania PLACE OF SETTLEMENT April 16,2015 200 North Hanover Street Carlisle,pA 17013 J.SUMMARY OF BOR OWER',S jANSACTION 100- GROSS AMOUNT DUE FROM BORROWER: SUMMARY OF SELLER'S TRANSACTION 101, Contract Sates price K. 102- 400. GROSS AMOUNT UETOSELLER: 103. Settlement Char as art 60,000-00 401, Co Ira Sates I ce 10 . to Borrower Line 1400 402. PersonalPro erl 60,00o,00 105. 2.273.50 403. 404' A 'stments For -!leets Paid nce 10 . Count lawn Taxes !:�ii Seller in 405.CQjJA __ ants For Items- B�V Seller in advance 107. School Taxes 041 t15 to 12131/15 264.44 406.Count 108. Assessments ""0110 to 06/30115 -11 Taxes 00161 5 to 12,31/15 109. to 389.94 407.School04(16� 264.44 110. 408, 0 389.94 111. 409. t 112. 410. 411. 120. GROSS AMOUNT DUE FROM BORROWER 200. AMOUNTS PAID By OR IN BEHALF OF BORROWER: 62,927.88 GROSS AMOUNT DUE TO SELLER 201. D - 202. a osit or earnest mone 500. REDUCTIONS 60,654.38 Pfind alAmount of New Loans 1.000.00 501. 1 N I'' ''I I INT DUE TO ELLER Excess De 05it See Instructions 203. Exislin loan s taken ub'ct to 502. Sell dions) 204. lament Char as to Seller Line 1400) eil to 205. Existin loan 9.487.83 f r 206. 4. 0 0 first Mortgage to Red,Authority Of Cumb 207. a I second MON a a 15,890.00 208, 506. 209. 507• De osit isb-as ErcOeeds) Ad"ustments For ttems Un Count"-"faxes aid 8 Seller 210, 211. schootTaxe to 509. A Un aid B Seller 212. Assessments to 510. Count n Taxes 213. to 511. School Taxes to Assessments tO 214. 512. 215. 513, to 216. 514. 217. 515. 218. 516. 219. 517. 518. 220. TOTAL PAID By/FOR BORROWER 519. 300 CASH AT SETTLEMENT FROMITO BORROWER; 00 520. TOTAL REDUCTION AMOUNT DUE SELLER 301. GrossAmount Due From Borrower Line 120 600. CASH AT SETTLEMENT 25,377.83 302. Less mount Paid By/For Borrower(Line 220) 601, Gross IOM SELLER- 303.. unt Due To Setter'Line 420 I`X FROM ( TO)BORROWER Reductions Due Seller(Line 520) 60.65438 TO ( FROM)SELLER The undersigned hereby acknowledge receipt of a completed OOPY Of Pages 1&2 of this statement&any attachments referred to herein. 35,276.55 Borrower n L. Seller Estate of Lois T.Weary Sharon E.McCullough 700.TOTAL COMMlSS)QN Based on Price !'SETTLEMENT CHARGES Rage2 Divis on of Commission line 700 as Fo!lows. S 701.s 5,200.00 % 5,200.00 to Berkshire Hathaway Homesafe Realty R4 D FROM PAD FROM 702.S to BORROWERS 703.Commission Pa d at Settlement SELLERS 744. FUNOSAT SETTLEMENT 800,ITEMS PAYABLE!N CQNNECTtON WITH LOAN to Berkshire Hathaway Homesate Really SETTLEMENT 80t.loan Or' ination Fee 5,200A0 695.00 695.00 802,Loan Discount �O to 803.Appraisal Fee % to 804.Credit Report fO 805.Lender's Inspection Fee to 806, Mort a e Ins.ADD.Fee to 807.Assumption Fee to 808, to 809. 810. 811. 900.ITEMS REQUIREp gy LENDER TO BE PAID!N ADVANCE 901.Interest From to 902.Mort a e insurance premium(or @ /day ay ( days %)9 months to 903.Hazard insurance Premium far 904. ars t° 905. 1000.RESERVES DEPOSITED WITH LENDER 1001.Hazard Insurance 1002.Mort a e Insurance S 1003.Coun ffwnTaxes per er s 1004.School7axes s 1005.Assessments er Taos. s er 1007, per S 1008. @ S er 1100.TITLE CHARGES Per S er 1101. Seittement or ClosinFee 1102. Abstractor Title Search to 1103• Title Examination to Tri-Counly Abstract Svcs. 1104, Title Insurance Binder to 1105• A rovedAit. Tilte Ins. to Tri-Count Abstract Svcs. 145.00 1106. Nota Fees to Griff a&Assodates 1107. Attorneys Fees to Robin J.Bassett,Nata 222.50 to 457.50 1108. Title iIudas above item numbers. 7,00 nsnsurance 10.00 ino(udes above item rs•, to numbe 1109.Lender's Coverage 1110.Owner's Coverage $ 1111. S 60,000.00 1112. 1113. 1200.GOVERNMENT RECORDING qND TRANSFER CHARGES 1201.Recording Fees: Deed $ 79.00;Mortgage $1202.Cit JCouni Tax(Stam s: Deed 1203.State Tax/Stam s: 600.04•Mort a e Releases S 67.50 1204. Deed 146.50 205. 600 00,Mott a e 600.00 i 1300.ADO)TIQNALSETTLEMENT CHARGES 600.00 1301.Sur ve 1302.Pest Ins action to 1303.2014 Cl wand School Taxes to 1304.201SCI t!w Taxes 10 Cumb.Couni Tax Claim Bureau 130& Tax Cert to Cara n R.McQuillan Tax Col. 1400.TOTAL SETTLEMENT CHARGES to Caroyn R.McQuiifen,Tax CoI. 2'6°0.17 Bysigri (Enteron Lines 103,Section J and 502,Sectia 372.66 r9Faga 1 aUis stattrnem,iMslgre!«Les ackwedgerece g as c°mgetea 10.00 �°Py a Page 2 aws Mapagas 2,273.50 9,487.83 na en Ageates i fMrcuLLouGHI/5T Attachment to Schedule "E" Q M8T Bank 499 Mitchell Road,Millsboro,DE 19966 Adjustment Services Phone 888-5024349 Fax (302)934-2955 May 13,2014 Griffie & Associates, P.C. 200 North Hanover Street Carlisle,PA 17013 Re: Estate of Lois N. Weary Social Security: Date of Death: April 2, 2014 Dear Sir or Madam: Per your inquiry on April 29,2014,2014,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 811394 Ownership(Names oj9 Harold J. Weary,Jr.(POA) Lois N. Weary Opening Date 01/01/1978 Balance on Date of Death $ 4,771.88 Accrued Interest $ .00 --------------------------- --------------------------------- Total S4,771.88 Type of Account Savings Account Account Number 15004214053453 Ownership(Names oJ) Harold J. Weary,Jr.(POA) Lois N. Weary Opening Date 06/01/2006 Balance on Date of Death $ 33.16 Accrued Interest $ .00 Total $33.16 3. Type of Account Safe Deposit Box Box Number/Location 206/Stonehedge Ownership(Names of) Lois W.Weary Opening Date 02/07/1992 For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds, please call the High Street Carlisle at 717-2404536. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transfers, Representative Payee,or Trustee under a Written Agreement Sincerely, Valarie Mercer Adjustment Services DateN 10-07-2014 1049: 17 Rowe" s Auction Service 2505 RiKer Hjghwa�y Car} islew PA 17015 717-571. 10Q2 lindenhallgaol' com Sott ] e*cxt Louis Weary Este Pages 1 Seller: 13 Brad Griffie item Description Price Oty Total - Jelly cupboard 1 180. 0(',i - Cottage dre� ser 1 55. 0@ Oak side-by-side 1 200. 01,71 - Meat bench 35. 00 ltems : 4 Amount : 170. Q8 Commission at 35. 00M 124. 5� Less adjustments : -164. 50 --- -' -- ' Nei du* to seller : 305. 5@ Thank you for your businozs ` do id ROWS ACJ 10N SERVICE (RH 79L) 2505 Ritner Highway • .Carlisle,PA 17015 Bill Rowe (AU 1538L) 249-1978 215-1044 574-1008 Dave Rowe (AU 2295L) Auct' n Is Action Call "Rowe" For Satisfaction p SELLERS NAME . -e DATE ADDRESS S '�tle4� PHAP OTHER AUCTIONEER % —= AUCTION DATE/LOCATION CLERK % DESCRIPTION OF MERCHANDISE _42ak Lie J9%1 <,leye I -r3� 4 �'4SL1411W OLSK—Cle- f J r-L 4 / i Ss,( Gl'�cze d`D I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sol s i & grouped a ssary to obtain bids. I certify that I am the owner or authorized represen- tative o t e erchan s and or property and have good title and the right to sell and that they are free from a ' c bra agree to accept all responsibility for providing merchantable title and for delivery of title t urc ee to hold ess the Auctioneers against any claims of the nature referred to in this en AUCTION SIGNATURE —SELLERS SIGNATURE Total Sales (Clerking Tickets Attached) $ Less Sale Expense: %Commission Auctioneer $ 4 5-W %Commission Clerks $ OTHER: I jL TOTAL SALE EXPENSE DEDUCTED $ SELLERS NET $ OMB NO,2502-0265 1r A. B. TYPE OF LOAN: U.S.DEPARTMENT OF HOUSING&URBAN DEVELOPMENT, 1.QFHA 2.QFmHA 3.QCONV.UNINS. 4.[]VA 5.QCONV.INS. 6. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT 8, MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked"(POC)'were paid outside the dosing;they are shown here for informational purposes and are not included in the totals. D. NAMEAND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Steven L.McCullough Estate of Lois T.Weary Sharon E.McCullough 2142 Rilner Highway 548 Crossroad School Road Carlisle,PA 17015 Carlisle,PA 17015 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 45-4273976 1. SETTLEMENT DATE: 2142 Ritner Highway Bradley L.Griffie Carlisle,PA 17015 April 16,2015 Cumberland County,Pennsylvania PLACE OF SETTLEMENT 200 North Hanover Street Carlisle,PA 17013 J.SUMMARY OF BORROWER'S TRANSACTION K.SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 60,000.00 401. Contract Sales Price 60,000.00 102. Personal Property 402. Personal Property 103. Settlement Charges to Borrower Line 1400 2,273.50 403. 104, 404. 105. 405. Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance 106. Count rfwn Taxes 04/16/15 to 12/31/15 264.44 406.Count Ifwn Taxes 04/16/15 to 12/31/15 264.44 107. School Taxes 04/16/15 to 06/30/15 389.94 407.School Taxes 04/16/15 to 06/30/15 389.94 108. Assessments to 408.Assessments to 109. 409. 110. 410. 1i1. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 62,927.88 420. GROSS AMOUNT DUE TO SELLER 60,654.38 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposit or earnest money 1,000.00 501. Excess Deposit See instructions 202. PrincialAmount of New Loans 502. Settlement Charges to Seller Line 1400 9,487.83 203. Existing loans taken subject to 503. Existing loans taken subject to 204. 504.Payoff of first Mortgage to Red.Authority of Cumb 15,890.00 205. 505.Payoff of second Mortgage 206. 506. 207. 507.(Deposit disb.asproceeds) 208. 508. 209. 509. A*ntments For Items Unpaid By Seller Adjustments For Items Unpaid By Seiler 210. Counlyffwn Taxes to 510.Count/fwn Taxes to 211. School Taxes to 511. School Taxes to 212. Assessments to 512.Assessments to 213. 513. 214, 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220, TOTAL PAID BYIFOR BORROWER 1,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 25,377.83 300. CASH AT SETTLEMENT FROMITO BORROWER: 600.CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower Line 120 62.927.88 601. Gross Amount Due To Seller Line 420 60,654.38 302. LessAmount Paid By/For Borrower(Line 220) { 1,000.00) 602. Less Reductions Due Seller(Line 520) ( 25,377.83 303. CASH(X FROM)( TO)BORROWER 61,927.88 603, CASH(X TO)( FROM)SELLER 35,276.55 The undersigned hereby acknowledge receipt ttttof f a completed copy of pages 1&2 of this statement&any attachments referred to herein. Borrower T Seger Estate of Lois T.Weary en L.McCuulllough �� G..m G BY✓Yrttew� 2/ Sharon E.McCullough 700.TOTAL COMMISSION Based on Price L•SETTLEMENT CHARGES Pis t?... of Commission tine 700 S 701,$5,200.00 as Fo!lowx �" 5,200.00 702.$ !0 8erkshireHathawayHomesaleRealty »voFROM PAID FROM to BORROWERS 703.Commission Pa d at Settlement seuFRs 704, FUNa5A7 FUNOSA7 SETTLEMENT SETTLEMENT 800.ITEMS PAYABLE5,7EONNECTION WITH LCAN to Berkshire Hathaway Homesale Realty 801,Loan Or nation Fee 802 , 5,200.00.Loan Discount �Q to 695,00 695.00 803.Appraisal Fee % to 804.Credit Report to 805. Lender's Inspection Fee to 806• Mort a e Ins.A .Fee to 807.Assumption Fee to 808. to 809. 810, 811. 900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901.Interest From to 902.Mort a e insurance Premium for S /day ( days %� 9 months to 903.Hazard Insurance premium for 904. ears to 905. 1000.RESERVES DEPOSITED WITH LENDER 1001.Hazard insurance 1002.Mort a e Insurance S 1003.Coon /1wn Taxes S er er 1004.School7axes $ 1005•Assessments er S 1006. per � S 1007. S per 1008. ev $ er 1100.TITLE CHARGES per S er 1101. Settlement or Closin Fee 1102. Abstract or Title Search to 1103. Title Examination to Tri-Coun Abstract Svcs. 1144. Title InsuranceBinder to 1105. A rovea It. Title Ins. to Trig Ount Abstract Svcs. 145.00 1106. Nola Fees to Gritfe&Ass___ 1107.Attorneys Fees to Robin J.8assetl,Nota 222.50 includes above item numbers: to 457.50 1108• Title Insurance 7.00 10.00 rndudes above item numbers to 1109.Lender's Coverage 1110,Owner's Coverage $ 1111. S 60,004.00 1112. 1113. 1200.GOVERNMENT RECORDING AND TRANSFER CHARGES 1201.Recording Fees: Deed_$ 79.00;Mortgage $ 1202. if 1Counf TaxfStar s: Deed 1203.State TaxlStam s: 600.00•Mort a e Reuses S 67.50 1204. Deed 146.50 600.00;Mart a e 600.00 1205. 1300,ADDITIONALSETTLEMENT CHARGE$ 600,00 1301.Surve 1302.Pest Ins action to 1303.2014 Ct fiiN and School Taxes to 1304.2015 CI!Tw Taxes t0 Comb.Count Tax Claim Bureau 1305.Tax Cert t0 Caro n R.MLCluillen,Tax Col, 1400.TOTAL SETTLEMENT CHARGES (Enteron Lines 103, acI Carolyn R. tion and 502,$actio 2,640.17 'sigNngPaga s erws siatanen4 un si 372.66 p'�lartes receipt or 10.00 crov of page z of urs Mopage statemen 2,273.50 9,487.83 n to ales en Age t (/MCCULLOUGHI/5) Attachment to Schedule "F" Estate of Lois N. Weary Attachment to Schedule "F": Surviving Joint Tenant(s)Name Address Relationship to Decedent D) Kenneth W. Weary 1070 York Road Son Dillsburg, PA 17019 Bank records indicate the following account balances on 04/02/2014 for LOIS WEARY SS # 162-22-3648 2142 RITNER HIGHWAY CARLISLE, PA 17013 Balance Acct Sole Jt Acct Account Prior to Interest Accrued Opened Ownership . With Number Type Interest Bearing Interest 12/31/1996 NO DAVID P WEARY 60706120 PB SAV 529.89 YES 0.18 DEAN W WEARY HAROLD J WEARY KENNETH WEARY BY M K REISINGER Attachment to Schedule "G" Annuity Operations Western & Southern Life PO Box 2918 Cincinnati,OH 45201-2918 A member of Western&Southern Financial Group toll free 800.926.1702 fax 513.362.2353 Date: 05/12/2014 GRIFFIE &ASSOCIATES C/O BRADLEY GRIFFIE 200 N HANOVER ST CARLISLE PA 17013 Re: Contract Number W0020570679 Dear Mr. Griffie: Please accept our condolences on the death of Lois Weary. We are here to serve you during this difficult time. As a designated beneficiary, Harold Weary, Kenneth Weary, David Weary & Dean Weary are entitled to receive payment on the Western-Southern Life annuity referenced above. Payment of benefits under the contract is the obligation of, and is guaranteed by, Western-Southern Life Assurance Company, Cincinnati, Ohio. The following settlement option is available to you: • Lump sum. You can receive your settlement in one installment. Any earnings on this contract may be subject to tax. Western-Southern Life encourages you to seek tax or legal advice before selecting this option. If you choose this option, a check for the entire amount, including any interest, will be mailed directly to you. The date of death value as of April 4, 2014 is $6,476.58. No withdraws were made for the past year. The enclosed claim form is for your use in selecting a settlement option. Please return your completed form, along with a certified death certificate, using the postage-paid envelope provided. Our goal is to serve your needs and we will implement your selection as quickly as possible. Western-Southern Life Assurance Company Please note if this contract is a Qualified Annuity, a Required Minimum Distribution may be due by 12/31 of this year. Please contact your tax advisor with additional questions. We understand that decision-making may be difficult right now. If you have questions or wish to discuss your options, a representative is ready to help you. Call toll-free at (800) 926-1702 Monday through Thursday, 8:00 a.m. to 6:00 p.m. Eastern time and Friday, 8:00 a.m. to 5:00 p.m. Eastern time. Sincerely, Teresa Fleisch Annuity Administrator Annuity Operations Department F021/FI-42-015-1312 Attachment to Schedule "H" C77 04- R® E AUCTIO l SERVICE (RH 79L) 2505 Ritner Highway - .Carlisle,PA 17015 Bill Rowe (AU 1538L) 249-1978 215-1044 574-1008 Dave Rowe (AU 2295L) Auct' n Is Action Call "Rowe" For Satisfaction PA SELLERS NAME DATE eh'? ` ADDRESS S Se4 PHOS OTHER AUCTIONEER % AUCTION DATE/LOCATION CLERK % �— DESCRIPTION OF MERCHANDISE //V &C c his^ r1C 4 Z r SiGv� Gig GCcjloo,� d`O I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sol s i & grouped a ssary to obtain bids. I certify that I am the owner or authorized represen- tative o t e erchan s and or property and have good title and the right to sell and that they are free from a c bra agree to accept all responsibility for providing merchantable title and for delivery of title t h urc ee to hold ess the Auctioneers against any claims of the nature referred to in this en , AUCTION SIGNATURE SELLERS SIGNATURE y u Total Sales (Clerking Tickets Attached) $ l v Less Sale Expense: % Commission Auctioneer $ 5� %Commission Clerks $ OTHER: (4-" TOTAL SALE EXPENSE DEDUCTED $ SELLERS NET $ i �- �� 11 11 OMB NO.2502-0265 ir A. B. TYPE OF LOAN: U.S.DEPARTMENT OF HOUSING&URBAN DEVELOPMENT 1,E]FHA 2.[]FmHA 3.[JCONV.LININS. 4.[]VA 5.[JCONV.INS. 6. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costa Amounts paid to and by the settlement agent are shown. Items marked'(POC)"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. NAMEAND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Steven L.McCullough Estate of Lois T.Weary Sharon E.McCullough 2142 Ritner Highway 548 Crossroad School Road Carriste,PA 17015 Carlisle,PA 17015 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 45-4273976 1. SETTLEMENT DATE: 2142 Ritner Highway Bradley L.Griffle Carfiste,PA 17015 April 16,2015 Cumberland County,Pennsylvania PLACE OF SETTLEMENT 200 North Hanover Street Carlisle,RA 17013 J.SUMMARY OF BORROWER'S TRANSACTION K.SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 60,000,00 401. Contract Sales Price 60,000.00 102. Personal Property 402. Personal Property 103. Settlement Charges to Borrower(Line 1400) 2,273.50 403, 104. 404. 105, 405. Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance 106. County/Twn Taxes 04116115 to 12131/15 264.44 406.Count n Taxes 04/16115 to 12/31M5 264.44 107. School Taxes 04116115 to 06/30115 369.94 407.School Taxes 04/16/15 to 06/30/15 389.94 108. Assessments to 408.Assessments to 109. 409. 110. 410. Ill. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 62,927.88 420. GROSS AMOUNT DUE TO SELLER 60,654.38 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER.* 201. Deposit or earnest money 1,000.00 501. Excess Deposit(See Instructions) 202. Principal Amount of New Loan(s) 502. Settlement Charges to Seller(Line 1400) 9,487.83 201 Existing loan(s)taken subject to 503. Existing loan(s)taken subject to 204, 504. Payoff of first Mortgage to Red.Authority of Cumb 15,890.00 205. 505.Payoff of second Mortgage 206. 506. 207. 507. (Deposit dish.as proceeds) 208. 508. 209. 509. Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid BySe&r 210. CountytTwn Taxes to 510.Countvfrwn Taxes to 211. School Taxes to 611. School Taxes to 212. Assessments to 512.Assessments to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 216. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 1,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 25,377.831 300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 301. GrossAmount Due From Borrower(Line 120) 62,927.88 601, GrossAmount Due To Seller(Line 420) 1:2?7 Nl - 302. Less Amount Paid By/For Borrower(Line 220) 1,000.00) 602 Less Reductions Due Seger(Line 520) 2=71.2.1% 303. CASH(X FROM)( TO)BORROWER 61.927.88 r603! CASH(X TO)( FROM)SELLER 35.276.55 The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement&any attachments referred to herein. Borrower T Seller Estate of Lois T.Weary an L.McCullough Sharon E.McCullough �.j 700.TOTAL COMMISSION Based on price L•SETTLEMENT CHARGES R 2 Div Sion of Commis on line 700 as Follows. S 701.S 5,200.00 °� 5,200.00 to Berkshire Hathaway Homesale Reaity AVD FROM rWOFROM 702.$ to BORROWERS 703.Commission Paid at Settlement sEUERs FUNDSAT 704. FUNDSAT SETTLEMENT 800.ITEMS PAYABLE IN CONNECTION WITH LOAN fo Berkshire Hathawa SETTLEMENT y Homesale Really 5MENT 0 801.Loan Or'ination Fee o 695.00 695.00 802.Loan Discount 0 t0 803,Appraisal Fee % to 804.Credit Report to 805, Lender's InspeIX!on Fee to 806• Mort a e Ins.A ,Fee to 807.Assumption Fee to 808• to 809. 810, 811. 900.ITEMS REQUIREp By LENDER TO BE PgID IN ADVANCE 901,Interest From to 902.Morta e Insurance premium for @ S /day ( days %)9 months 903.Hazard Ito nsurance Premium for 904. ears to 905. 1000.RESERVES DEPOSITED WITH LENDER 1001,Hazard Insurance 1002.Mort a e Insurance 5 1003,Coun lrwn Taxes er S er 1004,SchoalTaxes S 1005.Assessments er 1006. S o $ er per 1007. $ 1008. @ S per 1100,TITLE CHARGES Per S er 1101. Settlement or Closin Fee 1102, Abstractor Title Search to 1103. Title Exa11T natbn to Tri-Count Abstract Svcs. 1104. Title insurance Binder to 1105• A rovedAll. Title Ins. la Tri-Count Abstract Svcs, 145.00 1106• Nota Fees to Gr"BAssociates 1107. Attorneys Fees to Robin J.Bassett,Nota 222.50 includes above ilem numbers: to 457.50 1108. Title Insurance 7 00 10.00 includes above item numbers.• to 1109.Lender's Coverage 1110.Owner's Coverage S 1111• S 60,000.00 1112, 1113. 1200,GOVERNMENT RECORDING AND TRANSFER CHARGES 1201.Recording Fees: Deed S 1202,Ck/Count Tax/Stam s: Deed 79.00;Mortgage $ 1203.State Tax/Stam s: 600,00•Mortgage Releases$ 67.50 1204. Deed146.50 600.00; Mortgage 1205. 600.00 1300.ADDITIONAL SETTLEMEh1i CHARGES 600.00 1301,SUrve 1302. Pest Ins eIXion to 1303.2014 Ci/Tw and School Taxes to 1304.2015 Ct frw Taxes to Cumb.Count Tax Claim Bureau 1305,laXC rt to Caro n R.McQuillen,Tax Col. 1400.TOTAL SETTLEMENT CHARGES (Enter on Lines 103,Se10 Carol�n R. ct an J and 502,Sectio 2600.17 n,Tax Col B's'4"egPaga t dvis statem 372.66 em,vie sigr�lla)es ara^attebgerereipt dacanptetty 10.00 'apaga 20f jNs"•°page sLw= 2,273.50 9,487.83 r es en Age L (1MCCULLOUGH115) Attachment to Schedule "I" OMB NO.2502-0265 A. B. TYPE OF LOAN: U.S.DEPARTMENT OF HOUSING&URBAN DEVELOPMENT 1•[]FHA 2.[]FmHA 3,[]CONV UNINS. 4,E]VA 5.[]CONV.INS, SETTLEMENT STATEMENT & FILE NUMBER: 1 7. LOAN NUMBER: 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked'jPOCJ"were paid outside the closing;they are shown here for informational purposes and are not included in the totals. D. NAMEAND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Steven L.McCullough Estate of Lois T.Weary Sharon E.McCullough 2142 Ritner Highway 548 Crossroad School Road Carlisle,PA 17015 Carlisle,PA 17015 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 45-4273976 I. SETTLEMENT DATE: 2142 Ritner Highway Bradley L.Griffie Carlisle,PA 17015 1 April 16,2015 Cumberland County,Pennsylvania PLACE OF SETTLEMENT 200 North Hanover Street Carlisle,RA 17013 J.SUMMARY OF BORROWER'S TRANSACTION K.SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price -- 60,000.00 401. Contract Sales Price 60,000.00 102. Personal Property 402. Personal Property 103. Settlement Charges to Borrower(Line 1400) 2,273.50 403. 104. 404. 105. 405. Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance 106, County/Twn Taxes 04/16115 to 12/31/15 264,44 406, Couni tTwn Taxes 04/16115 to 12/31/15 264.44 107. School Taxes 04116/15 to 06/30/15 389.94 407. School Taxes 04/16/15 to 06/30115 389.94 108. Assessments to 408.Assessments to 109. 409. 110. -4-1-0. - Ill. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 62,927.88 420. GROSS AMOUNT DUE TO SELLER 60,654.38 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposit or earnest money 1,000.00 501. Excess Deposit(See Instructions) 202. Principal Amount of New Loan(s) 502. Settlement Charges to Seller(Line 1400) 9,487.83 203. Existing loan(s)taken subject to 503. Existing loan(s).taken subject to 204. - 504. Payoff of first Mortgage to Red.Authority of Cumb 15,890,00 205. 505, Payoff second Mortgage 206. 506, 207. 507.(Deposit dish,as.proceeds) 208. 508. 209. 509. Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller 210. County/Twn Taxes to 510.County/Twn Taxes to 211. School Taxes to 511. School Taxes to 212. Assessments to 512.Assessments to 213. 513. 214. 514. 215. 515, 216. 516. 217. 517. 218. 518. 219, 519. 220. TOTAL PAID BY/FOR BORROWER 1,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 25,377.83 300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER: - 301. Gross Amount Due From Borrower(Line 120) 1 62,927.88 601. Gross Amount Due To Seller(Line 420) 7T--60,65438 302. LessAmount Paid By/For Borrower(Line 220) 1,000.00) 6026 Less Reductions Due Seller(Line 520) J( 25,377.81 303. CASH(X FROM)( TO)BORROWER 611,927.88 603. CASH(X TO)( FROM)SELLER 1 35,276.551 The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement&any attachments referred to herein. Borrower T Seller Estate of Lois T.Weary n L McCullough Sharon E.McCullough r 700.TOTAL COMMISSION Based on Price Division of Commission line 700 as Fellows: $ L.SETTLEMENT CHARGES Paget % 5,200.00 PAID FROM 701.$5,200.00 to Berkshire Hathaway Homesale Realty BORROWERS PAID FROM SELLERS 702.$ to FUNDSAT FUNOSAT 703.Commission Pa-at Settlement SETTLEMENT 704, SETTLEMENT 800.ITEMS PAYABLE(N CONNEC7tON WITH LOAN to Berkshire Hathaway Homesale Realty 5,200.00 801.Loan Or inatian Fee % fo 695.00 695.00 802.Loan Discount % to 803.Appraisal Fee to 804.Credit Report to 805. Lender's Inspection Fee to 8 .11-W-U-111S.App.Fee t0 807.Assumption Fee 80to 8. 809, 810. 811, 900,ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901.Interest From to @ $ 902. Mort a e insurance Premium for months to /day { days %) 903.Hazard Insurance Premium-, ears to 904. 905. 1000.RESERVES DEPOSITED WITH LENDER 1001.Hazard Insurance 1002.Mort a a Insurance $ er 1003. Count ITwn Taxes $ per 1004. School Taxes per 1005.Assessments $ r 1006. @ $ per 1007. per 1008. @ $ per 1100.TITLE CHARGES per 1101. Settlement or Glosin Fee to 1102. Abstract or Title,arch 1103. Title Examination to Tr Conn Abstract Svcs. 1104. Title InsuranceBinder to 145.00 1105. A TO Binder . inditle ens. to Tri-CountyAbstract Svcs. 1106, Neta Fees to Griffie&Associates 222.50 1107. Attorney's Fees 10 Robin J.Bassett,Notar 457.50 ncudes above item numbers- t0 7.00 f0.00 1108. Title Insurance to ncludes above item numbers: 1109.Lender's Coverage $ 1110.Owner's coverage 1111, S 60,000.00 1112. 1113. 1200.GOVERNMENT RECORDING AND TRANSFER CHARGES 1201.Recording Fees: Deed $ 79.00;Mortgage $ 1202.Cit/Count Tax/Slam s: Deed Releases $ 67.50 1203.State Tax/Stam s: Dsed 600.00 Mort a e 146.50 1204. 600.00;Mort a e 600.00 1205• 600.00 1300.ADDITIONAL SETTLEMENT CHARGES 1301.Sury to 1302.Pest In action to 1303. 2014 Ct!Tw and School Taxes 1304.2015 Ct/Tw Taxes to Cumb.Count Tax Claim Bureau 1305.Tax Cert to Caro n R.McQuillan,Tax Cal. 2,600.17 1400.TOTAL SETTLEMENT CHARGES (Enter on Lines 103,McQuillan, n and 502,Sectio 37266 Section10.00 al'si9ning Page t or(Ns stalemern,uta signatories ackrvM 2,273.50 edgo recelPt a a competed copy of page 2 of ttgs two page s{atem 9,487.83 r ates e en Age i I/MCOULLOUGHi/5)