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Home My WebLink About09-22-15 _J 1505618627 3M464710.000 pennsylvania OEPA ENT OF REVENUE Ex(03-14)(TP) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 21 15 0223 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 02142015 11061933 Decedent's Last Name Suffix Decedent's First Name MI BAHN ROBERT E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return 2. Supplemental Return 3. Remainder Return(date of death prior to 12-13-82) El4. 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) 0 7. Decedent Died Testate 8. Decedent Maintained a Living Trust 1 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) 10. Litigation Proceeds Received 11. Non-Probate Transferee Return F 12. Def erraUElection of Spousal Trusts (Schedule F and G Assets Only) 13. Business Assets F-1 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number KEITH 0 • BRENNEMAN 717-697-8528 First Line of Address 44 WEST MAIN STREET Second Line of Address City or Post Office State ZIP Code r�..) MECHANICSBURG PA 17055 r 1 Correspondent's email address: REGISTER,610 WILLS.USE Y I T t REGISTER OF WILLS USE ONLY 3 3 DATE FILED MMDDYYYY :.� '� —r '> r} 13 y I CO t" rT -{ I— N Cf3 DATE FILED STAMP N PLEASE USE ORIGINAL FORM ONLY Side 1 IIIII IN IIII 1505618627 1505618627 J \ -1 1505618635 REV-1500 EX(TP) Decedent's Social Security Number Decedent's Name,BAHN ROBERT E RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 110,10 5 . 5 3 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . 2. 11,[329 -12 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. 850,702- 29 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested. . . . . 6. 0 - 00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested. . . . . 7. 10131418 - 87 8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , 8. 1-1078-1855 - 81 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9, 213,328 - 91 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1). . . . , . , , , , 10, 1,989 - 37 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . 11. 28 -,318 -28 12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , 12. 1-10501537-53 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. 1105{1-1537 - 53 TAX CALCULATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers uWer Sec.9116 (a)(1.2)X.04.__ 0 . 00 15. 0 . 00 16. Amount of Line 14�3xable at lineal rate X.044- 1,050,537 . 53 16. 471274 .19 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. 47,274 - 19 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q 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 person responsible for filling the return is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPO I L R FILI R N DATEq ADDRESS HOLLY A . POPLASKI, EXECUTRIX 12 MORARI DRIVE, DILLSBURG, PA 17019 SIGNA /RE OF PREPPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE.. P �"�r or-/L///j- DRESS /jDRESS KEITH 0 - BRENNEMAN, ESQUIRE 44 W . MAIN STREET, MECHANICSBUG, PA IIIIII I III VIII I1505VIII II II5 III 1111111111111 Side 2 17055 616 1505618635 3M464810.000 REV-1500 EX(TP) Page 3 File Number Decedent's Complete Address: 21 15 0223 DECEDENTS NAME BAHN ROBERT E STREET ADDRESS 21 S . WALNUT STREET, MECHANICSBURG BOROUGH CUMBERLAND COUNTY CITY STATE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 47,274 - 19 2. Credits/Payments A. Prior Payments 301000 - 00 B.Discount 11S00 - 00 (See instructions.) Total Credits(A+B) (2) 311500 -00 3. Interest (3) 0 . 00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill 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) 151774 - 19 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ NXI b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . . . . . ❑ c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . F-1 0 d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . . . . . ❑ FRI 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FU ❑. 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 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. 3M4671 4.000 REV-1502 EX+(12-12) SCHEDULE A Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Robert E. Bahn 21 15 0223 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 fads. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Real estate known and numbered as 110,105.53 21 South Walnut Street, Mechanicsburg Borough, Cumberland County, Mechanicsburg, PA 17055, sale value (see attached settlement sheet) TOTAL (Also enter on Line 1,Recapitulation.) $ 110,105.53 2w4695 2.000 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 STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert E. Bahn 21 15 0223 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Manulife Financial Corporation 7,590.76 436 shares of common stock valued at $17.41 per share 2 Prudential Financial, Inc. 2,883.24 36 shares of common stock valued at $80.09 per share 3 Virtus Investment Partners, Inc. 1,155.12 8 shares of common stock valued at $144.39 per share TOTAL (Also enter on Line 2.Recapitulation) $ 11,629.12 2w4696 2,000 If more space is needed, insert additional sheets of the same size REV-1508 EX-(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS& MISC. INHERITANCE TAX RESIDENT ECEDENTTURN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Robert E. Bahn 21 15 0223 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 I AXA 239,551.01 annuity account #308 655 178 2 Equitrust 54,280. 95 annuity account #EQ0001158419F 3 PNC Bank, N.A. 48,293.12 investment account #97787450 4 PNC Bank, N.A. 470,918.00 investment account #1245038 5 Proceeds from sale of 2010 Cadillac DTS auto 12,000.00 6 United States Treasury 600.00 refund due the decedent on 2014 income tax return 7 Western & Southern Life 25,059.21 annuity account #W0020208324. TOTAL(Also enter on line 5,Recapitulation) $ 850,702.29 2w48AD 2.000 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) SCHEDULE G pennsylvania DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert E. Bahn 21 15 0223 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 ITEM NC-LOETFENAME OFTHE TRANSFEREE,THEIR RELATIONSHIP TODECEDENT AND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH ACOPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST IF APPLICABLE VALUE 1. Banker's Life and Casualty Company , 39,287.38 100.0000 0.00 39,287.38 annuity, account #2800245. Decedent's children, Louella Sanders, Robert Bahn, Jr. , Brian P. Bahn, Victor S. Bahn and Holly Poplaski were the designated beneficiiares .in equal shares 2 Banker's Life and Casualty Company 33,138.44 100.0000 0.00 33,138.44 annuity, account #7851667. Decedent's children, Louella Sanders, Robert Bahn, Jr. , Brian P. Bahn, Victor S. Bahn and Holly Poploski were the designated beneficiaries in equal shares 3 Equitrust 21,515.67 100.0000 0.00 21,515.67 annuity, account #EQ0001126249F. Designated beneficiary on account was decedent's son, Victor S. Bahn 4 Midland National Life 12,477.38 100.0000 0.00 12,477.38 annuity, account #8500275116 Listed beneficiary on the account was the Decedent's son, Victor S. Bahn TOTAL(Also enter on line 7,Recapitulation)$ 106 418.87 If more space is needed,use additional sheets of paper of the same size. 9W46AF 2.000 Estate of: Robert E. Bahn 21 15 0223 Schedule G (Page 2) Item DOD Value Taxable No. Description of Asset % Interest Exclusion Value 5 John Hancock Investments 0.00 100.0000 0.00 0.00 mutaul fund, account #2040266. Date of death value $11,783.55. Payable on death to decedent's children, Louella Sanders, Robert Bahn, Jr. , Brian P. Bahn, Victor S. Bahn & Holly Poplaski in equal shares. This is listed for informational purposes only, the Tax Liability on this account has been paid by the beneficiaries Total (Carry forward to main schedule) 0.00 REV-,51,EX-(0a,3) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert E. Bahn 21 15 0223 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Myers Buhrig Funeral Home funeral services 4,957.81 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: LAW OFFICE OF KEITH 0. BRENNEMAN, P.C. (Estimated) 1,000.00 3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 770.50 5. Accountant Fees: 285.00 6. Tax Return Preparer Fees: 7. 1 Cumberland Law Journal advertisng Executrix Notice 75.00 Total from continuation schedules . . . . . . . . . 19,240.60 TOTAL(Also enter on Line 9,Recapitulation) $ 26,328.91 3w46Ac 2.000 If more space is needed, use additional sheets of paper of the same size. Estate of: Robert E. Bahn 21 15 0223 Schedule H Part 7 (Page 2) 2 Law Office of Keith O. Brenneman, P.C. attorney fees from 2/26/15 to 8/25/2015 2,080.00 3 Register of Wills short certificates 15.00 4 Settlement charges relating to the sale of property on S. Walnut Street as follows: 1. Remax 1st Advantage, realtor commission - $6,540.00 2. Coldwell Banker, broker commission - $300.00 3. Notary fee & tax certification - $20.00 4. Transfer taxes - $1,090.00 5. American Shield, home warranty - $655.00 6. County Taxes - $778.20 7. Seller help - $6,540.00 15,923.20 5 The Sentinel advertising Executrix Notice 222.40 6 Reserve for filing fees, accountant fees and other miscellaneous expenses associated with the administration of the decedent's estate 1,000.00 Total (Carry forward to main schedule) 19,240. 60 REV-1512EX+(12.12) SCHEDULE Pennsylvania DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert E. Bahn 21 15 0223 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. Commonwealth of Pennsylvania tax due on personal income tax return for 2014 tax year 90.9.00 2 Holy Spirit EMS medical expense 156.88 3 Holy Spirit Hospital medical expense 63.14 4 Hospice of Central Pennsylvania medical expense 750.00 5 PPL Electric electric service for property on S. Walnut Street 31.41 6 UGI Gas Service gas service for property on S. Walnut Street 76.19 7 United Water Pennsylvania water service for property on S. Walnut Street 2.75 TOTAL(Also enter on Line 10,Recapitulation) $ 1,989.37 2w46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Robert E. Bahn 21 150223 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2)] 1. Holly A. Poplaski 12 Morari Drive Dillsburg, PA 17019 Banker's Life and Casualty Company Inventory Value: 6,627. 69 Banker's Life and Casualty Company Inventory Value: 7,857.48 22.50 of Residue: 212,426.70 Daughter 226,911.86 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0.00 9W46At 2.000 If more space is needed, use additional sheets of paper of the same size. Estate of: Robert E. Bahn 21 15 0223 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 2 Louella K. Sanders 429 Old Stage Road Lewisberry, PA 17339 Banker's Life and Casualty Company Inventory Value: 7,857.48 Banker's Life and Casualty Company Inventory Value: 6,627.69 10% of Residue: 94,411.87 Daughter 108,897.03 3 Robert E. Bahn, Jr. 406 North Market Street Mechanicsburg, PA 17055 Banker's Life and Casualty Company Inventory Value: 7,857.48 Banker's Life and Casualty Company Inventory Value: 6,627.69 22.5 of Residue: 212,426.70 Son 226,911.86 4 Brian P. Bahn 410 North Market Street Mechanicsburg, PA 17055 Banker's Life and Casualty Company Inventory Value: 7,857.48 Banker's Life and Casualty Company Inventory Value: 6,627.69 22.5 of Residue: 212,426.70 Son 226,911.86 Estate of: Robert E. Bahn 21 15 0223 Schedule J Part 1 (Page 3) Item No. Description Relation Amount 5 Victor S. Bahn 146 Woods Drive Mechanicsburg, PA 17050 Equitrust Inventory Value: 21,515.67 Midland National Life Inventory Value: 12,477.38 Banker's Life and Casualty Company Inventory Value: 7,857.48 Banker's Life and Casualty Company Inventory Value: 6,627.69 22.5 of Residue: 212,426.70 Son 260,904. 91 OMB Approval No.2502-0265 A. Settlem t Statement (HUD-1) pe of Loan 1.0 FHA 2.❑RHS 3.❑Conv.Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number: 15054 MBG1412066978 446-2371393-703-203B 4.❑VA 5.❑Conv.Ins. C.Note:This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agents are shown Items marked "(p.o.c)"were paid outside the closing;they are shown here for informational purposes and are not included in the totals. D.Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender: William A.Palmer The Estate of Robert E.Bahn Residential Mortgage Services,Inc. 699 East Simpson Street,Mechanicsburg,PA 17055 21 South Walnut Street,Mechanicsburg,PA 17055 24 Christopher Toppi Drive,South Portland,ME 04106 G.Property Location: H.Settlement Agent: I.Settlement Date:03/16/2015 21 South Walnut Street 1st Advantage Settlement Services Inc. Disbursement Date:03/16/2015 Mechanicsburg,PA 17055 6375 Mercury Drive,Suite 102,Mechanicsburg,PA 17050 Mechanicsburg Borough 717-591-7755 Place of Settlement: TitleExpress 6375 Mercury Drive,Suite 102,Mechanicsburg,PA 17050 Printed 03/16/2015 at 3:34 pm by AM J.Summary of Borrower's Transaction K.Summay of.Seller's Transaction 100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller 101. Contract sales price 109,000.00 401. Contract sales price 109,000.00 102. Personal property 402. Personal property 103. Settlement charges to borrower(line 1400) 8,662.77 403. 104. 404. 105. 405. Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance 106. City/town taxes to 406. City/town taxes to 107. County taxes 03/1612015 to 12131/2015 620.43 407. County taxes 03116/2015 to 12131/2015 620.43 108. School Taxes 0311612015 to 06/30/2015 469.99 408. School Taxes 03116/2015 to 06/30/2015 469.99 109. 1 st Qtr.Sewer J-M 03/16/2015 to 03/31/2015 15.11 409. 1st Qtr.Sewer J-M 03/16/2015 to 03/31/2015 15.11 110. 410. 111. 411. 112, 412. 120. Gross Amount Due from Borrower 118,768.30 420. Gross Amount Due to Seller 110,105.53 200. Amounts Paid by or in Behalf of Borrower 500. Reductions In Amount Due to Seiler 201. Deposit or earnest money 1,000.00 501. Excess deposit(see instructions) 202. Principal amount of new loan(s) 107,025.00 502.. Settlement charges to seller(line 1400) 14,288.20 203. Existing loans taken subject to 503. Existing loans taken subject to 204. 504. Payoff of first mortgage loan 205. 505.: Payoff of second mortgage loan 206. 506. 207. 507. 208. 508. 209. Seller Help 6,540.00 509. Seller Help 6,540.00 Adjustments for items unpaid by seller Adjustments for items unpaid by seller 210. City/town taxes to 510. City/town taxes to 211. County taxes to 511. County taxes to 212. School Taxes to 512. School Taxes to 213, 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. . 220• Total Paid b Ifor Borrower 114,565.00 520. Total Reduction Amount Due Seller 20,828.20 300. Cash at Settlement from/to Borrower 600. Cash at Settlement tolfrom Seller 301. Gross amount due from borrower(line 120) 118,768.30 601. Gross amount due to seller(line 420) 110,105.53 302. Less amounts paid by/for borrower(line 220) 114;565.00 602. Less reductions in amount due seller(line 520) 20,828.20 303. Cash ❑X From ❑ To Borrower 4,203.301603.: Cash ❑X To ❑ From Seller 89,277.33 es per response arw a mg,revmxanBan rape ug e e nagency may no co a is normeion,an yaa are no requve oc c this form uurminx nless it diapleys a wrrently valid OMBIcontml numbers No wnfldentliany Is assured;MIS disclosure Is mandolpry.Ibis Is deslgnedto provkethe padles too RESPA covereO lrensecllon wtlh Informallan dudnp the settlement process. .L�Settlement Charges 700. Total Real Estate Braker Fees $6,540.00 Paid From Paid From Division of commission line 700 as follows: Borrower's Seller's 701. $3,270.00 to Coldwell Banker NRT,LLC Funds at Funds at 702. $3,270.00 to Re/Maxlst Advantage Settlement Settlement 703. Commission paid at settlement 6,540.00 704. Commission to Re/Max 1st Advantage 595.00 705, Broker Commission to Coldwell Banker NRT,LLC 300.00 800. Items Payable in Connection With Loan 801. Our origination charge (includes Origination Point 0,000%or$0.00) $1,074.00 (from GFE#1) 802. Your credit or charge(points)for the specific interest rate chosen $ (from GFE#2) 803. Your adjusted origination charges (from GFE A) 1,074.00 804. Appraisal fee to Charles E.Gamer (from GFE#3) 450.00 805. Credit report to (from GFE#3) 806. Tax service to from GFE#3 807. Flood certification to Aitisource Flood (from GFE#3) 11.00 808. Final Inspection to Residential Mortgage Services Inc. (from GFE#3) 1 100.00 900. Items Required by Lender to be Paid in Advance 901. Daily interest charges from from 03116/2015 to 04/0112015 @$10.6292/day (from GFE#10) 170.07 902. Mortgage Ins.Premium for months to FHA (from GFE#3) 1,840.74 903, Homeowner's insurance for 1 years to Sheely Insurance (from GFE#11) 716.00 904. months to from GFE#11 1000. Reserves Deposited with Lender 1001. Initial deposit for your escrow account (from GFE#9) 1,086.96 1002.Homeowner's insurance 3 months @$ 59.67/month $179.01 to Residential Mortgage Services 1003,Mortgage Insurance months @$ 73.87/month $ to Residential Mortgage Services 1004.City Property Tax months @$ 0.00/month $ to 1005.County Property Tax 2 months @$ 64.85/month $129.70 to Residential Mortgage Services 1006,School Taxes 10 months @$ 133.60/month $1,336.00 to Residential Mortgage Services 1007,Aggregate Adjustment $-557.75 to Residential Mortgage Services 1100.Title Charges 1101. Title services and lender's title insurance $ from GFE#4 1,350.00 1102. Settlement or closing fee to $ 1103. Owners title insurance-First American Title Insurance Company $ from GFE#5 5.00 1104. Lender's title insurance-First American Title Insurance Company $1,215.00 1105. Lender's title policy limit$107,025.00 Lender's Policy 1106. Owner's title policy limit$109,000.00 Owner's Policy 11107.Agent's portion of the total title insurance premium $930.75 to 1 st Advantage Settlement Services Inc. 1108.Underwriter's portion of the total title insurance premium $289.25 to First American Title insurance Company 1109. 1110.Notary to Annette Myers 10.00 1111. Tax Certification Fee to 1 st Advantage Settlement 10.00 Services Inc. 1200.Government Recording and Transfer Charges 1201.Government recording charges $ (from GFE#7) 174.00 1202. Deed$79.00 Mortgage$95.00 Release$ to Cumberland County Recorder 1203.Transfer taxes $ (from GFE#8) 1,090.00 1204.City/County tax/stamps Deed$1,090.00 Mortgage$ to Cumberland County Recorder 1205.State Tax/stamps Deed$1,090.00 Mortgage$ to Cumberland County Recorder of 1,090.00 1206. Deed$ Mort a e.$ to 1207. $ to 1300.Additional Settlement Charges 1301.Required services that you can shop for (from GFE#6) 1302.Home Warranty to American Home Shield 655.00 1303. to 1304.211154Ty1Twp Taxes to Barry Heckard -7a.ZQ 1 . Escrow for Inheritand to 1 st Advantage Settlement Services Inc. 11111 FUM r r 8,662.77 1 14,288.20 *Paid outside of closing by(B)orrower,(S)eiler,(L)ender,(i)nvestor,Bro(K)er."Credit by lender shown on page 1.*-Credit by seller shown on page 1. comparison of Good Faith Estimate(GFE)and HUD-1 Charges Good Faith Estimate HUD-1 Charges That Cannot Increase HUD-1 Line Number 1,474.00 1,474.00 Our origination charge # 801 Your credit or charge(points)for the specific interest rate chosen # 802 0.00 0.00 Your,adjusted origination charges # 803 1,074.40 1,074.00 Transfer taxes # 1203 1,090.00 1,090.40 Charges That in Total Cannot Increase More Than 10% Good Faith Estimate HUD 1 Government recording charges # 1201 250.00 174.00 Appraisal fee # 804 475,00 450.00 Credit report #805 0.00 4.00 Flood certification # 807 11.00 11.00 Final Inspection # 808 150.00 .100.00 Mortgage Ins.Premium # 902 1,840.74 1,840.74 Title services and lender's title insurance # 1101 1,495.00 1,350.00 Owner's title insurance-First American Title Insurance Company # 1103 100.00 5.00 4,321.74 3,930.74 Increase between GFE and HUD.'I Charges $ 391.00 or -9.0473% Cha as That Can Chane Good Faith Estimate _ HUD-1 Initial deposit for your escrow account # 1001 2,514.00 _ 1,086.96 Daily interest charges from # 901 $10.62921da 170.07 170.07 716.04 Homeowner's insurance # 903 6txI.40 # # Loan Terms Your initial loan amount Is $107,025.00 Your loan term is 30.years Your initial interest rate is 3.6250% Your initial monthly amount owed for principal,Interest,and any mortgage $561,96 includes insurance is Q Principal ❑X Interest QX Mortgage Insurance Can your interest rate rise? ❑X"No. ❑Yes,it can rise to a maximum of %, The first change will be on ! ! and can change again every years after I I Every change date,your,interest rate can increase or decrease by %. Over the life of the loan,your interest rate is guaranteed to never be lower than %or higher than;'' Even if you make payments on time,can your loan balance rise? [XQ No. ❑Yes,it can rise to a maximum of$ Even if you make payments on time,can your monthly amount owed for ❑X No. ❑Yes,the first increase can be on t 1 and the monthly principal,interest,and mortgage insurance rise?. amount owed can rise to$ The maximum it can ever rise to is$ Does your loan have a prepayment penalty? ❑X No. ❑Yes,your maximum prepayment penalty is$ Does your loan have:aballoon payment? ❑X. No., ❑Yes,you have a balloon payment of$ due in years on I 1 Total monthly amount owed including escrow account payments ❑You do not have a monthly escrow payment for items,such as property taxes and homeowner's insurance.You must pay these items directly yourself. 0 You have an additional monthly escrow payment of$258.12 that results in a total initial monthly amount owed of$820.08. This includes principal,interest,any mortgage insurance and any items checked below: 0 Property taxes Homeowner's insurance ❑Flood insurance ❑X School Taxes Note: if you have any questions about the Settlement Charges and Loan Terms listIe don this form,please contact your lender. HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it Is.a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction.I further certify that I have received a copy of the HUD-1 Settlement Statement. William A.Palmer THE ESTATE OF ROBERT E.BARN Holly A.Popiaskl,Executrix SettlementAgent The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction.I have caused or will cause the funds to be disbursed in accordance with this statement. SETTLEMENT AG DATE s WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE•fITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010. Name of Borrower: Name of Seller: File Number William A.Palmer The Estate of Robert E.Bahn 15054 TitleExpress Prepared 03/16/2015 at 3:27 pm Note: This page is furnished to give you an itemization of the amounts shown on Paid From Paid From Lines 1101, 1103 and 1104 of the Settlement Statement(HUD-1).This page Borrower's Sellers accompanies but is not a part of the settlement statement.if a discrepancy Funds at Funds at exists,the information shown on the Settlement Statement(HUD-1)applies. Settlement Settlement 1100. Title Charges Amounts Included in Line 1101 1101. Title services and lender's title insurance 1,350.00 a.Wire In Fee $ 15.00 In.Email\Doc Copy Fee 50.00 c.Overnight Delivery Fee-Package 25.00 d.Notary Fee. 45.00 $ 135.00 1102. Settlement or closing fee 1103. Owner's title insurance (policy) $ 5,00 5.00 1104. Lender's title insurance (policy) 940.00 $ 1,215.00 a.Endorsement 900 EPL-Residential 50.00 b.Endorsement 100(No Violation) 50.00 c. Endorsement 300 Survey 50.00 d.Closing Service Letter 125.00 (Total 1103+1104) 290 00 1105. Lender's title policy limit$107,025.00 1106, Owner's title policy limit$109,000.00 1107. Agent's portion of the total title insurance premium $. 930.75 . 1108. Underwriter's portion of the total title insurance prem. 289.25 (Total 1107+1108) 1109. 1110, 1111. 1112. BE•. r Total Borrower Borrower Seller 1100, Title Charges with Payee Charge POC or Credit Line 1101 Paid 1101. Title services and lender's title insurance $ a.Wire In Fee to 1 st Advantage Settlement Services Inc. 15.00 15.00 b.EmaillDoc Copy Fee to 1 st Advantage Settlement Services Inc. 50.00 50.00 c.Overnight Delivery Fee-Package to 1 st Advantage Settlement Services Inc. 25.00 25.00 d.Notary Fee to Annette Myers 45.00 45.00 1104. Lender's title insurance to 1st Advantage Settlement Services Inc. 1,215.00 1,215.00 $ 1,350.00 .. 1;350.00 LAST WILL AND TESTAMENT I,ROBERT E.BARN,of the Borough of Mechanicsburg,County of Cumberland,and Conunonwealth of Pennsylvania,being of sound and disposing mind,memory and understanding,do make,publish and declare this as and for my Last Will and Testament, hereby revoking and making void ail former wills and codicils by me at anytime heretofore made. FIRST. I order and direct that all my just debts,taxes and funeral expenses be paid by my Executrices or Executrix,as the case may be,hereinafter named,as soon as conveniently may be done after my decease. SECOND. I am the registered owner of 5,000 shares of the common stock of The PNC Financial Services Group,Inc.which I order and direct be divided and distributed in kind in accordance with the following bequests: 'wl A. I give and bequeath one thousand(1,000)shares of said stock unto my daughter,namely,LOUELLA K.SANDERS,absolutely. Jy B. I give and bequeath one thousand(1,700)shares of said stock urrtu ray son, namely,ROBERT E.BAHN,JR.,absolutely. .� C. I give and bequeath one thousand(1,000)shares of said stock unto my son, namely,BRIAN P.BAHN,absolutely. D. I give and bequeath one thousand(1,000)shares of said stock unto my son, namely,VICTORS.BAHN,absolutely. E. I give and bequeath one thousand(1,000)shares of said stock unto.my daughter,namely,HOLLY A.POPLASKI,absolutely. THIRD. I give,devise and bequeath all the rest,residue and remainder of my estate, real,personal and mixed,whatsoever and wheresoever situated,to the persons and in the LAW OFFICES amounts as follows: (a)ten percentum(10%)unto my daughter,namely, LOUELLA K. SN£LBAKER a SANDERS;(b)twenty-two and t:ve-tenths percentum(22.5%)unto my daughter,namely, BRENNEMAN HOLLY A.POPLASKI;(c)twenty-two and five-tenths percentum(22.5%)unto illy son, namely,ROBERT E.BARN,JR.;(d)twenty-two and five-tenths percentum(22.5%)unto my son,namely,BRIAN P.BARN;(e)twenty-two and five-tenths percentum(22.5%)unto my son,namely,VICTOR S.BAI-IN,absolutely and in fee simple. FOURTH. If any of my said children named hereinabove shall predecease me,I order and direct that the foregoing gifts in Items Second and Third attributable to each such deceased child shall be distributed equally unto the then living children of such deceased child,share and share alike. LASTLY.I nominate,constitute and appoint my daughter,namely,HOLLY A. POPLASKI,to be the Executrix of this my Last Will and Testament,to serve without bond or other security as a condition of qualification hereunder. If my said daughter should fail to qualify as my Executrix or cease so to serve,then and in that event,I nominate,constitute and appoint my son,namely,ROBERT E.BAHN,JR.,to be the Executor of this my Last Will and Testament,to serve without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF,1,ROBERT E.BARN,have hereunto set my hand and seal to this my Last Will and Testament;which consists of two(2)typewritten pages to each of which I have affixed my signature this 17"'day of October,2013. (SEAL) Robert E.Balu1 The preceding instrument,consisting of this and one(1)other typewritten page,each identified by the signature of the Testator,was on the date thereof signed, sealed,published and declared by ROBERT E.BAIIN,the Testator therein named,as and for his Last Will and Testament,in the presence of us,who,at his request,in his presence and in the presence of each other,have subscribed our names as witnesses hereto. LAW OFFICES SNELBAKER a BRENNEMAN -2- COMMONWEALTH OF PENNSYLVANIA) : SS. COUNTY OF CUMBERLAND ) We,ROBERT E.BAHN,RICHARD C. SNELBAKER and SANDRA K. SHOWERS, the Testator and the witnesses,respectively,whose names are signed to the attached or foregoing instrument,being first duly sworn,do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly,and that he executed it as his free and voluntary act for the purposes therein expressed,and that each of the witnesses,in the presence and hearing of the Testator, signed the Will as a witness and that to the best of his or her knowledge,the Testator was at that time eighteen years of age or older,of sound mind and under no constraint or undue I influence. o. x�! Testator Witness { �, Witness Subscribed,sworn to and acknowledged before me by ROBERT E.BAI-IN,the Testator,and subscribed and sworn to before me by RICHARD C.SNELBAKER and SANDRA K. SHOWERS,the witnesses,this 17`I'day of October, 2013. Notaiy 'ubliJ COMMIONINEAI_TI-1OF('Eit2 hlotaritl Seal '- – — Susan I_.htairaci,"O"a y PuNk MechanIcsburg I3oro,Cuml:crland Counq'_l1J My cornmission E�olrea r+ev,24,2015 uw OFFICES NIEr40ER,FFNr;SrLl'ANSA s 1r].oN SNELBAKER OF NOINUES BRENNEMAN