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Home My WebLink About08-26-15 � 1505614134 EX(03-14)(FI) REV-1500 County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po eox 2soso� 2 1 1 5 0 1 1 2 Harrisbury, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth nnnnDOYYYY 0 0 1 1 8 2 0 1 5 0 6 0 2 1 9 3 3 Decedent's Last Name Suffix DecedenYs First Name MI MASKREY I I I ALFRED E (If Applicabie)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL tN APPROPRIATE OVALS BELOW � 1.Original Return � 2.Supplemental Return � 3. Remainder Return(date of death Priorto 12-13-82) � 4.Agriculture Exemption � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required (date of death on or after 7-1-2012) death after 12-12-82) ❑X 7. Decedent Died Testate � 8. Decedent Maintained a Living Trust � 9.Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) � 10. Litigation Proceeds Received � 11.Non-Probate Transferee Return � 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets only) ❑ 13. Business Assets ❑ 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number MURREL R . WALT ERS , I I I 71 7 697 4700 First Line of Address WALTERS & GALLOWAY , PLLC Second Line of Address 5 4 E . MA I N S T . City or Post Office State ZIP Code M E C H A N I C S B U R G P A 1 7 0 5 5 ,� � � CorrespondenYs e-mail address: filUPPeI U�Waltel'SgallOWa_y.00111 n J � _� .-.' �� ..� REGt�iT AF WILL�E ON�Y^� �.,'1 -*' C"') ; ':_7 REGISTER OF WILLS USE ONLY �� f�"- N �.�� i�`l DATE FILED MMDDYYYY r - ' � � _7 - _� � . i , ' � —=3 _.,._ - .� " .._�: c::7 c� r__ r.� DATE•FILED STAMP ',� p . � �l PLEASE USE ORIGINAL FORM ONLY Side 7 I IIIIII IIIII IIIII IIII)IIIII III�I(IIII IIII)IIIII IIIII IIII I'll � 1505614134 1505614134 � � � 1505614234 REV-1500 EX(FI) DecedenYs Social Security Number Decedent's Name: ALFRED E. MASKREY, III RECAPITULATION 1. Real Estate(Schedule A) � 1 4 5 0 0 0 , 0 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Stocks and Bonds(Schedule B) 7 2 7 3 7 , 4 � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. • 4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 5 1 1 �J , 4 4 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. � � 9 � $ , $ 9 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 6 9 $ 7 3 , 9 2 (Schedule G) � Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 3 O 3 6 3 5 , 6 5 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9 2 6 5 0 � . 5 6 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. 7 7 � 6 . 1 5 ��. Total Deductions(total Lines 9 and 10) . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . 11. 3 4 2 � 6 . 7 � 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12� 2 6 9 4 2 8 . 9 4 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. 2 6 9 4 2 8 . 9 4 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0 _ 0 . 0 � 15. � . � � 16. Amount of Line 14 taxable � 2 � 2 4 . 3 � at�inea�rate X.045 2 6 9 4 2 $ • 9 '-� �s. 17. Amount of Line 14 taxable at sibling rate X.12 � . � � 17. � . � � 18. Amount of Line 14 taxable at collateral rate X.15 � • � � �g� � • � � 19. TAX DUE 1 2 1 2 4 . 3 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the person responsible for fili�g the return is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN �� gj25/2015 . ADDRESS ERIC MICHAEL Y 2 � BONNYBROOK RD. CARLISLE PA 17015 SIGNATURE OF PREPA R HE .'f P SON RESPONSIBLE FOR FILING THE RETURN DATE 8/25/2015 ADDRESS MURREL R. ALT RS, III 54 E. MAIN ST. MECHANICSBURG PA 17055 I IIIIII IIIII IIIII III�I IIIII IIIII II�II IIIII IIIII IIIII IIII II'I Side 2 � 1505614234 1505614234 � REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: 21 15 0112 DECEDENT'S NAME ALFRED E. MASKREY, III STREET ADDRESS 333 CAVALRY RD CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 12,124.30 2. CreditslPayments A.Prior Payments 8,000.00 B.Discount 400.00 (See instructions.) Total Credits(A+B) (2) 8,400.00 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fitl in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 3,724.30 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 ...................................................................... a Q b. retain the right to designate who shall use the property transferred or its income ............................... X 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 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? ......... ❑ � 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 Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 EX+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ALFRED E. MASKREY, III 21 15 0112 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. Reai property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OFDEATH DESCRIPTION 1. 333 CAVALRY RD 145,000.00 CARLISLE, PA 17013; CUMBERLAND COUNTY PARCEL NO. 29-18-1367-048 GROSS SALE PRICE TOTAL(Also enter on Line 1,Recapitulation.) $ 145 000.00 If more space is needed,use additional sheets of paper of the same size. REV-1503 EX+(8-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCETAXRETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER ALFRED E. MASKREY III 21 15 0112 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PRECISION FINANCIAL SERVICES, INC. 72,737.40 MUTUALFUNDS TOTAL(Also enter on Line 2,Recapitulation) $ 72 737.40 If more space is needed, insert additional sheets of the same size REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8� MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: ALFRED E. MASKREY III 21 15 0112 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 1997 HONDA ACCORD 300.00 NET SALE PRICE 2. 1989 ALUMACRAFT JON-BOAT WITH 9.9 HP MOTOR 700.00 1989 COX TRAILER NET SALE PRICE 3. LPL FINANCIAL 400.00 IRA MONTH�Y DISBURSEMENT 4. SOCIAL SECURITY 1,715.00 5. HO�Y SPIRIT HEALTH SYSTEM 80.00 REFUND 6. GEISINGER HEALTH CARE 80.00 REFUND 7. PROPERTY TAX 250.00 REBATE 8. 1975 BROWNING CANOE 100.00 NET SALE PRICE 9. HOUSEHOLD GOODS 1,360.00 NET SALE PRICE 10. CENTURYLINK 9•`� REFUND 11. ERIE INSURANCE 121.00 REFUND TOTAL(Also enter on Line 5,Recapitulation) $ 5 115.44 If more space is needed, use additional sheets of paper of the same size. REV-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ALFRED E. MASKREY III 21 15 0112 If an asset was made jointly owned within one year of the decedenYs date of death,it must be repo�ted on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. ERIC MICHAEL MASKREY 293 BONNYBROOK RD SON CARLISLE, PA 17015 B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 9/30198 SANTANDER 20,815.56 50. 10,407.78 CHECKING ACCOUNT-x4155 2. A. 9130198 SANTANOER 1,002.22 50. 501.11 SAVINGS ACCOUNT-x3656 TOTAL(Also enter on Line 6,Recapitulation) $ 10 908.89 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ALFRED E. MASKREY, III 21 15 0112 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND NUMBER THE DATE OF TRANSFER.ATfACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. PRECISION FINANCIAL SERVICES, INC. 69,873.92 100.00 69,873.92 IRA-BENEFICIARIES: SON-ERIC MASKREY-1/3 DAUGHTER- KRISTEN E. ESKELSON-1/3 SON-ALFRED E. MASKREY,JR.-1/3 TOTAL (Also enter on Line 7,Recapitulation) $ 69 873.92 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ALFRED E. MASKREY III 21 15 0112 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOLLINGER FUNERAL HOME, MT. HOLLY SPRINGS, PA 2,709.19 2. GINGRICH MEMORIALS-Grave Marker 2,600.00 3. MECHANICSBURG CREMATION SOCIETY 700.00 4. FUNERAL MEAL-JUICE AND JAVA CATERING 432.29 5. WAKE 371.59 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)ofPersonalRepresentative(s) ERIC MICHAEL MASKREY 5,000.00 StreetAddress 293 BONNYBROOK RD City CARLISLE State PA ZIp 1701;i Year(s)Commission Paid: 2015 2, Attorney Fees: WALTERS &GALLOWAY, PLLC 9,100.00 3, Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4, Probate Fees: REGISTER OF WILLS-CUMBERLAND COUNTY 470.50 5 Accountant Fees: 6. TaxReturnPreparerFees: ALFRED L.WHITCOMB, C.P.A. 50.00 7. ACS SECURITIES SERVICES, INC- LIQUIDATE PRECISION ACCOUNT 50.00 8. ESTATE CHECK PRINTING 29•95 9. REAL ESTATE SALES ADJUSTMENTS 4,987.04 SETTLEMENT CHARGES LESS PRORATIONS TOTAL(Also enter on Line 9,Recapitulation) $ 26 500.56 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(�2-12) pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES 8�LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER ALFRED E. MASKREY III 21 15 0112 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. PPL ELECTRIC SERVICES 386.76 2. CENTURY LINK 43.12 INTERNET 3. ADVANCED DISPOSAL 676.19 TRASH 4. NORTH MIDDIETON AUTHORITY 332.28 WATER 5. MCI 50.98 TELEPHONE 6. CABELA'S 1.05 CLUB VISA-BALANCE 7. JC LEBO&SONS 1,575.00 REMOVE POOL AND DECK 8. KRISTEN ELIZABETH ESKELSON 200.00 REIMBURSE DAUGHTER FOR CARE DURING FINAL WEEK FOR SUPPLIES AND GROCERIES 9. JC LEBO &SONS 205.66 HOME REPAIRS 10. BIS HOME INSPECTION SERVICES 375.00 11. MELANIE STRICKLAND,TAX COLLECTOR 498•�2 MUNICIPAL REAL ESTATE TAXES 12. UGI GAS UTILITIES 529.15 13. SOLLENBERGER 293.00 TRANSFER BOAT/TRAILERICAR TITLES 14. CARLISLE REGIONAL MEDICAL CENTER 247.93 MEDICAL PROCEDURE 15. CHUCK'S ELECTRIC 1,935.00 REPAIRS TO HOUSE TOTAL(Also enter on Line 10,Recapitulation) $ 7 706.15 If more space is needed,insert additional sheets of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent ALFRED E. MASKREY, 111 21 15 0112 Decedent's Name Page 1 File Number Schedule I - Debts of Decedent, Mortgage Liabilities, 8� Liens ITEM NUMBER DESCRIPTION AMOUNT 16. DISH 63.82 TELEVISION 17. ERIC MASKREY 292•49 REIMBURSE FOR HOUSE AND AUTO SALE PREPARATION EXPENSES SUBTOTAL SCHEDULE I 356.31 GRAND TOTAL SCHEDULE I (Also enter on Line 10,Recapitulation) $ 7,706.15 REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ALFRED E. MASKREY III 21 15 0112 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 outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. ERIC MICHAEL MASKREY Lineal 0.33 293 BONNYBROOK RD CARLISLE, PA 17015 2. KRISTEN ELIZABETH ESKELSON Lineal 0.33 PO BOX 2489 MEEKER, CO 81641 3. ALFRED ERNEST MASKREY,JR. Lineal 0.33 224 JACKSONVILLE R� LINCOLN PARK, NJ 07035 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 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,use additional sheets of paper of the same size. Y�evlOus BO�IbnS en�oDSolela brm HUD-1(3/B6)ref Handbook 4305.2 A. Settlf'+111e11t .7tSteTllellt U.S.Department of Housing and Urban Development B.T e of Loan OMB A roval No.2502-0265 1. pFHA 2. ❑FmHA 3. �Conv.Unins. 6.File Number 7.Loan Number 8.Morlgage Insurance Case Number 4. VA 5. OConv.lns. PY015-73RCS is orm is umis e o grve you a s a emen o ec ue sa eman ws . m un s pai o a y e se e ag n ere a own, (�,.NO�B: Itams merked"(D�a.c.)"were paid ouleida the closing;lhey are shown here lor infarmation purposes and are nol included In Ihe lofals. TI��2E%Pf0S5.Set��2ffIB(1�.SyS�Bfil WARNING:It is a crime lo knowinply meke false sletemenls la Ihe Uniled Sletes on Ihia or eny olher similar fortn.Penaltles upan convicllon wn Include e fine arW im risonmenl,For deleils see:Tille 78 U.S.Code Seclion 1001 end Secllon 1010. D.NAME OF BORROWER: Randy J.Potteiger ADDRESS: E.NAME OF SELLER: Estate of Alfred Maskrey ADDRESS: F.NAME OF LENDER: ADDRESS: G.PROPERTY ADDRESS: 333 Cavalry Road,Carlisle,PA 17013 Parcel 29•18•136T•048 North Middleton Townshi H.SETTLEMENT AGENT: Pyramid Land Transfer,LLC PLACE OF SETTLEMENT: 26 West Hi h Street Carlisle PA 17013 I.SETTLEMENT DATE: 0810712015 J.SUMMARY OF BORROWER'S TRANSACTION: K.SUMMARY OF SELLER'S TRANSACTION: 100.GROSS AMOUNT DUE PROM BORROWER 400.GROSS AMOUNT DUE TO SELLER 101. Contract sales rice 145 000.00 401. Contract sales rice 145 000.00 102. Personal Pro rt 402. Personal Pro ert 103. Setllemenl char es lo borrower line 1400 3138.00 403, 104. 404. 105. 405. Ad ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance 107. Count taxes 08107115to12131115 200.85 407. Count taxes 08107H5to12131115 200.85 108. School Taxes 08107N 5 to 06130116 1 793.78 408. School Taxes 08107N 5 to 06130N 6 1 793.78 109. 409. 110. 410. 111. 411. 112. 412. 120.GROSS AMOUNT DUE FROM BORROWER 150132.63 420.GROSS AMOUNT DUE TO SELLER 146 994.63 200.AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER 201. De osit or earnest mone 1 000.00 501, Excess De osit see instruclions 202. Princi al amou�t of new loans 502. Seltlement char es to seller line 1400 6 981.67 203. Existin loan s taken sub'ect to 503. Existin loan s taken sub ect to 204. 504, Pa oH oi First Mort a e Loan 205, 505. 206. 506. 207. 507. 208. 508. 209. 509. Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller 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 6 981.67 300.CASH AT SETTLEMENT FROM OR TO BORROWER 600.CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due irom borrower line 120 150132.63 601. Gross amount due to seller line 420 146 994.63 302. Less amounts aid b Ifor borrower line 220 1 000.00 602. Less reduction amount due seller line 520 6 981.67 303.CASH FROM BORROWER 149132.63 603.CASH TO SELLER 140 012,96 SUBSTITUTE FORM 1099 SELLER STATEMENT:The Inlarmatlon wnleined herein la impananl lax informalion aM ia being Nmishatl lo lhe Intemal Revenue Servica.if you ere required lo Ne a reWm, a negllgence penally or olher senctia�will be impoaetl on you it Ihls itam is reQul�ed to be reported end Ihe IRS delertninea Ihat il has not been reporletl.The ConlraU Salea Prica desuibeA on Iina 401 above wnelllutes Ihe 6ross Proceeda ol lhis Iransaclron. SELLER INSTRUCTIONS:I/Ihla real eslele wes your pdncipal reslAenca,file Form 2119,Sale ar EKchange of Prinalpal Realderne,lor any geln,wilh your inwma tax relum;for olhe�Irensecliana, completa Ihe aDDliwble part5 ot Form 4797,Fortn 6252 and/or Schadule D(Fartn 1040). Vou are reQulred by law lo provlde Ihe selllamenl eqent(Fed.Te�c ID No: )wilh yaur co�ecl lazpayer ldenlificelion number.if you do nol provide yuur wrract lexpayer ldentifieetion number,you mey be subjecl lo aivil or uim'mal penaltiea Impoaed by law. n ar pena hes o parjury 1�ertily lhal e umber sMwn on Ihis slalement Is my corteU lazpeyer idenlificallon number. / � TIN: / SELLER(S)SIGNATURE(S):� � �`� � SELLER(5)NEW MAILING ADDRESS: ,�o.��o e...�i..��....�.,..,....�i��., iv��i��ivv.�1��!ie�riai uvuvn r��:i.< L-'.S.�EPv;RTMENT OF HOUSING AND URBAN DEVELOPMENT File Number:PY015-T3 PAGE 2 SETTLEMENT STATEMENT TitleEx ress Settlement S stem L. SE7TLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on rice$145 000.00 2.379=3 450.00 BORROWER'S SELLER'S Division o(commission line 700 as follows: FUNDS AT FUNDS AT 701. $ 3 450.00 to Hel U Sell Detwiler SETrLEMENT SETrLEMENT 702. $ to 703. Commission aid al Settlement 3 450.00 800.ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee % 802. Loan Discount % 803. A raisal Fee 804. Credit Re ort 805. Lender's Ins eclion Fee 806. Mort a e A li:,ation Fee 807. Assum tion Fee 808. 809. 810. 811. 900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to Ida 902. Mort a e Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905. 1000.RESERVES DEPOSITED WITH LENDER FOR 1001.Hazard insurance mo. $ /mo 1002.Mort a e Insurance mo. $ Imo 1003.Cit Pro ert Tax mo. $ Imo 1004.Count Pro ert Tax mo. 41.56 Imo 1005.School Taxes mo. $ 166.29 Imo 1009.A re ate Anal sis Ad'ustment 1100.TITLE CHARGES 1101.SelUement or closin fee 1102.Abstraci or title search 1103.Title examination 1104.Title insurance binder 1105.Document Pre aration 1106.Notar Fees 1107.Attorne's fees includes above items No: 1108.Title Insurance to P ramid Land Transfer LLC 1 125.00 includes above items No: 1109.Lender's Polic 1110.Owner's Polic 145 000.00 •1 125.00 1111. 1112. 1113. 1200.GOVERNMENT RECORDING AND TRANSFER CHARGES 1201.Recordin Fees Deed$79.00 •Mort a e$ �Release$ 79.00 1202.Cil ICount taxlstam s Deed 1 450.00 •Mort a e 1 450.00 1203.State Tax/stam s Deed$1 450.00 •Mort a e 1 450.00 1204. 1205. 1300.ADDITIONAL SETTLEMENT CHARGES 1301.Surve 1302.Pest Ins ection 1303.wre Transfer Fee to P ramld Land Transfer LLC 20.00 1304.2015-i6 Schooi Taxes to Barbara Matter 1 995.52 1305.Tax Cert Fee to Saidis Sullivan&Ro ers 10.00 1306.Home Warrant to First American 464.00 1307.Final Readin 04001310 to North Middleton Townshi Authorit 76.15 1308. 1400.TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 3138.00 6 981.67 HUD CERTIFICATION OF BUVER AND SELLER I heva wre(ully revlewed Ihe HUO-1 Setllement Slatement and to Ihe best of myknowledpe end beliel,It is a true and arcurele slalement of all receipls entl disbursements made on my accounl or�y me in�his Iren riher �/y�,thehFh�ve ved a copy ol lhe HUD-t Selllamenl Slatement. ./�-- 'S�/ �'� a i y eiger sETale ol7(lir� rey � �� WARNING:R IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-7 Seltlemenl Slalement which I have prepared Is e Irue and eccurale eccounl ol lhis Iransacllon. UNITED STATES ON THIS OR ANV SIMILAR FORM.PENALTIES UPON CONVICTION I have cqqq��sed or will cauae 1 sWn a to be diabureed In eccordanca wilh lhis slelemenl. CAN INCLUDE A FINE AND IMPRISONMENT,FOR DETAILS SEE TITLE 18: 'l / U.S.CODE SECTION 1001 AND SECTION 1010. / �,/ /� �� h ey:�_ '�ATE