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Home My WebLink About05-25-05 ,~;:'Ii.F I '.'" <:-(;.~t ~.~ '; ;r; ;'1; :?~ ?-, '.'! !-!.~.!!!.~~-~ i'lil ~~! ~ ~ vi ~~~ 'c~~~,I!--- .~::L I~.:F '/~~~:t:;JI ~ ~ '''\1;'$_;;1",,; :~~.: < \ '" if' ',. \ ),,0. ~~ ;~) )ii\,} ;, U,,, "'\"; '" ". U 'D Q, '1" - - c:~- WaJR ..J~...-4 Cl~ <~<( c>J aJ Q. ~-~ a::'ro= W:;:J: III _ c. <l:ME ~gJB ".1 :!'! ~ ~ ~ o 00 ~ a ,~~ " 0 IZU OO~r<l SS"o o 0 C"'r- UU~- '1;:l'1;:loo-.< aag", 'C'C~ . d) tU ~ "'''' 00 n8~ UU_U REAGER & ADLER, PC ATTORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET CAMP HILL, PENNSYLVANIA 17011-4642 717-763-1383 TELEFAX 717-730-7366 WEBS1TE: ReagerAdlerPC.com THEODORE A, ADLER + DAVID W, REAGER CHARLES E. ZALESKI LINUS E, FENICLE THOMAS O. WILLIAMS SUSAN J. SMITH SUSAN H. CONFAIR TIFFANY M. CARTWRIGHT PETER R. WILSON JOHN H. PIETRZAK Writer's E-Mail Address:MZercher@ReagerAdlerPC.com + Certified Civil Trial Specialist ~I -05 - 0'-113 May 25, 2005 Cumberland County Register of Wills Cumberland County Courthouse I Courthouse Square Carlisle, PA 17013 RE: Estate of Carrie I. Laubach ""'.,", C": -n Dear Register: 1"',,") .r.;- Enclosed for filing please find ajoint asset Inheritance Tax Return for the above-referenced estate along with an Inventory, Estate Information Sheet and Death Certificate. Also enclosed is the tax due and the required filing fee for the Inventory. Please time stamp the additional copies and return them to me in the self-addressed, stamped envelope enclosed. Thank you for your attention to this matter. Very truly yours, l~t2- Moitica D. Zercher Legal Assistant Enclosures CUMBERLAND COUNTY REGISTER OF WILLS INVENTORY , Deceased No. ;).,l-{)S-('}LJi3 Date of Death 1/9/2000 Social Security No. 203090464 Estate of LAUBACH, CARRIE I. also known as Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no reat estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. lANe verify that the statements made in this inventory are true and correct. IfWe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. ". Personal Representative: Name of Attorney: DAVID W. REAGER I.D. No.: 20868 Address 2331 MARKET STREET Ii' Dated 5"/A'I/or CAMP HILL PA 17011 Telephone: 717-763-1383 Description Value All property was jointly held r.,.,", CJ-; {'\.) ,J:.~' Total (Attach Additional Sheets if necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. ' RW-4 REV-1500EX+(fi.OO) '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FilE NUMBER ~ook-- QRS- -=- 0 ?b! ~ DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Z W C W () W C LAUBACH CARRIE I. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 203-09-0464 THIS RETURN MUST BE FILED IN DUPLICATE wrrH THE REGISTER OF WILLS 01/09/2000 09/11/1912 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER w .... ::.::~CI) 0"'''' lU~O :I:a::9 00.'" 0. < US] 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Allach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date ofdeath.aft& lZ-1Z-8Z) D 7. Decedent Maintained a Living Trust (Attach copy ofTrusij o 10. Spousal Poverty Credit (date of death between 12.31-91 and 1-1.95) o 3. Remainder Return (date of dea\t1 prior to 12-13.82) o 5. Federal Estate Tax Return Required ~ 8. Totar Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIOENTIAL TAxIN~ORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS DAVID W. REAGER 2331 MARKET STREET FIRM NAME (If Applicable) REAGER & ADLER PC. TELEPHONE NUMBER 717-763-1383 CAMP HILL PA 17011 O#ICIAi:~E ONLY I.,... c,n 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. T obll Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an erection to tax has not been made (Schedule J) .... z w c z o .. '" w '" '" o o z o i= :3 ~ l- ii: <C () w It: r', ~ 0: \1 114,750.00 I I r",,) -r~'. (8) 114,750,00 1,532,00 97,576,00 (11) (12) (13) 99,108,00 15,64200 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 15,642.00 z o I- ~ ~ Q. :!i o () >< ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16, Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 0,00 X _(15) 0.00 0.00 X _(16) 0.00 0.00 X .12 (17) 000 15,642.00 X .15 (18) 2,34630 (19) 2,346,30 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONSONREVERSESIDEANO RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS 3818 CHIPPENHAM ROAD CITY I STATE !IIP MECHANICSBURG, PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 2,346.30 Total Credits (A + B +C I (2) 0.00 3. InteresVPenalty It applicable D. Interest E. Penalty l/''52., 2> T 5. TotallnteresVPenalty ( 0 + E) It Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) If Line I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total at Line 5 + 5A. This is the BALANCE DUE. (5BI Make Check Payable to: REGISTER OF WILLS, AGENT (3) !? 5 l.'3.8' 0.00 2,CJ'i8'.tFt 4. 2, qq'('&,,. PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Ves No a. retain the use or income of the property transferred; ........................................................................... D 1KI b. retain the right to designate who shall use the property transterred or its income; ........................................ D 1KI c. retain a reversionary interest; or ...................................................................................................... 0 00 d. receive the promise for life of either payments, benefits or care? ............................................................. D 1KI 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................... .......................................................................... D 1KI 3. Did decedent own an "in truslfor" or payabie upon death bank accounl or security at his or her death? ................. D 1KI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................. ................. .................................................... D 1KI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjUf'J, I declare that 1 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 I/lan the personal representative is based on all informalion of which preparer has any knowledge. SIGNATURE OF..PEllSON.R ON ISLE FOR FILING RETURN DATE.. ...--- 5/.2-".j ?'-> DATE ADDRE ADDRESS 2331 Market Strfet Camp Hill PA 17011 For dates of death on or after July " 1994 and before January " 1995, the tax rate imposed on the net value of transfers to orlor the use of the surviving spouse is 3% [72 PS. ~91 16 (al (1.1) (ill. 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 SDOIIS;A is; nOj" r7? p c: ~a11~ f,.,\ f~ ~ \ 1::\1 The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets ane the surviving spouse is the only beneficiary. For dates of death on or after July " 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the or a stepparent of the child is 0% [72 P.S. !l9116(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%, except as noted i The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sib individual who has at least one parent in common w',th the decedent. whether by biood or adoption. n~(JD REV-1509 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF LAUBACH CARRIE I. FILE NUMBER 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. RICHARD A. NEFF 3818 CHIPPENHAM ROAD MECHANICSBURG, PA 17055 NEPHEW B SHELLY J. BRADY-BEYAR 3818 CHIPPENHAM ROAD MECHANICSBURG, PA 17055 NIECE IN LAW c JOINTLY.OWNED PROPERTY: lETTER DATE DESCRIPTION OF PROPERTY %DF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A&B 1997 3818 CHIPPENHAM ROAD, MECHANICSBURG, PA 229,500.00 50. 114,750.00 TOTAL (Also enter on line 6, Recapitulation) $ 114750.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF LAUBACH CARRIE I. FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ZIMMERMAN FUNERAL HOME - CREMATION 1,032.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Numbe~s)/EIN Numberof Personal Representative(s) Street Address City State Zip Yea~s) Commission Paid: 2. Attorney Fees REAGER & ADLER, P.C. 500.00 3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship 01 Claimant to Decedent 4. Probate Fees 5. Accountanfs Fees 6. Tax Return Preparers Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 1 532.00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LAUBACH CARRIE I. FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. ORIGINAL AMOUNT OF MORTGAGE: $160,000 DECEDENT'S SHARE OF THE BALANCE UNREDUCED FOR ANY REDUCTION IN PRINCIPAL: $80,000 50% OF THE INTEREST PAID ON BEHALF OF DECEDENTS AS AN EFFECTIVE LOAN ($35,152 DIVIDED BY 2): $17,576. 160,000 - 80,000 = 80,000 + 17,576 = 97,576 VALUE AT DATE OF DEATH 97,576.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space IS needed, insert additional sheets of the same size) 97576.00 REV_1513EX.(,* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER I AIIRAf: L RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trusteels) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outnght spousal distribulions, and transfers under Sec. 9116 (a) (1.2)] 1. Richard A_ Neff Collateral 7,821.00 3818 Chippenham Road Mechanicsburg, PA 17055 2_ Shelly J_ Brady-Beyar Collateral 7,821_00 3818 Chippenham Road Mechanicsburg, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) . . REAGER & ADLER, PC ATTORNEYS AND COUNSELORS AT lAW 2331 MARKET STREET CAMP Hill, PENNSYLVANIA 17011-4642 717-763-1383 TElEFAX 717-730-7366 WEBSITE: ReagerAdlerPC.com THEODORE A. ADLER + DAVID W. REAGER CHARLES E. ZALESKI LINUS E. FENICLE THOMAS O. WILLIAMS SUSAN J. SMITH SUSAN H. CONFAIR TIFFANY M. CARTWRIGHT PETER R. WILSON JOHN H. PIETRZAK +Certified Civil Trial Specialist Wlilers E-Mail Address:DWReager@ReagerAdlerPC.com May 20, 2005 DepartrnentofRevenue Dept. 280601 Harrisburg, PA 17128-0601 RE: CARRIE I. LAUBACH Ladies and Gentlemen: Please find an Inheritance Tax Return for the referenced decedent, Carrie 1. Laubach, who died on January 9,2000. This return is being filed on behalf of a nephew and his wife, Richard A. Neff and Shelley J. Brady- Beyar, who lived with Carrie 1. Laubach at the time of her death and held real estate as joint tenants with rights of survivorship. At the time of Ms. Laubach's death, she was 87 years old and she lived with her nephew and his wife who cared for her and her husband who predeceased her. At the time of her death, she had no assets other than some minimal personal clothing, and there was no Will to be probated. Richard Neffwas advised at the time there was no inheritance tax due, so therefore, no return was filed. Recently, the property has been put under an Agreement of Sale and our firm was engaged to prepare title insurance. On the basis of our evaluation, we have determined that inheritance tax should have been paid on the value of the property owned by Carrie at the time of her death (her one-half (Y:,) interest). Our basis for preparing the enclosed Inheritance Tax Return it is an extrapolated value based on records available at the time and enclosed with this letter is a schedule of various exhibits including deeds, amortization tables, mortgage, etc. During the time that Carrie and her husband lived with her nephew and his wife, they did not have any assets and, therefore, made no contributions toward payment upon the property, upon the understanding that the parties felt when they died, Richard and his wife would own the property. Accordingly, if we are to determine the value of their interest, I think it is appropriate to include in the statement of liabilities the remaining mortgage balance adjusted to reflect that any reductions in the 'Department of Revenue Page 2 May 20, 2005 mortgage balance would not have accrued to them and also one-half of the interest expended would be added to their balance as follows: Original amount of mortgage $160,000 Decedent's share of the balance unreduced for any reduction in principal 50% of the interest paid on behalf of decedents as an effective loan ($35,152 divided by 2) Total $80,000 $17,576 $97,576 lnasmuch as the parties did not believe it was necessary to file a return, they did not obtain a market appraisal at the time of Carrie ' s death, so I am submitting Exhibit G indicating comparables for the property and suggesting an appropriate value at the time of her death is $229,500, of which $114,750 would be the fair market value of the one-half interest. The net value for the real estate in the estate is $17,174. The Inheritance Tax Return has been prepared in accordance with this calculation and reflects only the value of this jointly held property since there were no other assets of the decedent and the administrative costs and funeral expenses were prepaid by others and no records are available. The return includes the penalty sum $652.38 for a total balance due of $2,998.68. Should you require any additional information in order to finalize and accept this Inheritance Tax Return as written, please contact the undersigned. Very truly yours, David W. Reager DWRJdlb Enclosures Exhibit A Exhibit B Exhibit C Exhibit D Exhibit E Exhibit F Exhibit G EXPLANATION OF EXHIBITS 3818 ChiDDenham Road. Mechanicsbnn!. PA Deed dated March 19, 1996, conveying the referenced property to Kenneth A. Laubach and Carrie 1. Laubach, husband and wife, as between them, and Richard A. Neff, taking title as joint tenants for consideration of $249,900. Deed dated March 20, 1997, from Kenneth A. Laubach and Carrie 1. Laubach and Richard A. Neff, to Kenneth A. Laubach and Carrie 1. Laubach, husband and wife, as tenants by the entireties, as between them, and Richard A. Neff and Shelley J. Brady-Bayer, husband and wife, as tenants by the entireties, as between them, taking title as joint tenants with right of survivorship as between Richard A. Neff, Shelley J. Brady-Bayer, Kenneth A. Laubach and Carrie 1. Laubach. Certificate of Death for Kenneth A. Laubach indicating a date of birth of November 30, 1909, and a date of death of December 1, 1998 (age at date of death was 89), with a Social Security No. of 198-09-2238. Certificate of Death for Carrie 1. Laubach indicating a date of birth of August 11, 1912, and a date of death of January 9, 2000 (age at date of death was 87), with a Social Security No. of203-09-0464. Mortgage dated March 19, 1996, between Richard A. Neff, Kenneth A. Laubach and Carrie 1. Laubach for the total amount of $160,000 secured by the referenced property. Amortization table for $160,000 mortgage amortized over 360 months at an interest rate of 6% with monthly payments of $959.28. This amortization table indicates that at January 2000 there was a balance due of$151,984.32 and total interest paid to date of$35,151.96. Multilist examples of homes sold in the Kingswood area for the period July 2, 1999 to May 8, 2000, setting forth four properties considered to be comparable with a range of $202,000 to $235,000. The property known as 1009 Chippenham Road is indicated as having an adjusted value of $229,500 and indicated as the property most like the subject property. rCy\Io-lu,r ~vJ-~~~ " 0">.' \.od '" '" 'I 0' cS S' ~'^ ' "",V If'" 0> c.."' .'1", ",,', ,j-J)/l/ ~, -o-\,O I'e\'\' ~ ~ ~'tO .).e I:-y,'l-~ O,-,S'?P ,}\,I:-i' I:-Y,e G~ :'i>i. 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",I:- ' 'j)'j)e>' -0- v 0'0' · 0'" .0 0' C", .e'\' ,e'" '" ,000 ,.,'1 cooO> ,e 0' c"oo" "'" 0 ,6 ,e.~,.G' \, "" ,c,'" '{>- \,\}>;:.e5 -p"il:s-<,."t<.. -o-'{e tee 1:-0 ~, 0 0' > ,,," 13>"~S'" ,,00' , <Vo '" " ..6 ~< ""OV'~"O'oo'"; ",,,,#', "" ?~~~; ,eco'''' #"~.,, 6e~~' ,":," ,0 '''~O~C ~~~ >>';., g' " ~",o",o ," "0'> "" \)"~ 'I:-'l-o 'i>C"'- I :'i>"'-- j \,e ",,0 co\'o>' l;;o-p3, 1:-'.1.0\''''' '{oeo \} ~~~c' <> _~ <>'e~I:-'{>'c" -s;eco ce ~" _...-o~" }'I.>'- ,,'" \'v < t >- \)"_ e,,>;:.5' 9'01 -0- 0" ~-o-5e~ \ Cl I \ \)ee05 j\}\,e oe'{ o~ ,?-eco'{ e-o-' . t. an SlG in t\ A1"I 1 he' herein is ' on \:~b ~l--<;'\. '.J~b i'0,~t . COMMOm<EhL 'fH \ COUNTY OF cuMB ,996, before me the undersigned officer &OO~ 136 filet 537 -: ____..:0 e 3-{\.o. ,{\.'C~ ' 0.3- 'Ceo. 'o'0-{\.'Ci ~v.o.'l-{\.0 - 05/13/2005 14:09 71 72580852 TRI COUNTY ABSTRACT PAGE 05 ,,' " 7'fJ 7 02.--' THIS DEED M.de \~~.24 d.y of /JIJ'J y".{ , 1997; BETWEEN KENNETH A. LAUll",CR II1d CARRlIi I, VoUllAClf, huoborld ,od w;I., """ 0/ Cumberland Co~ty. Pennsylvania. .. tenllllll by elle enIircty 81 between &hem. IBId RIClJAlttJ A. NsPF, a rrwrritd penQ(l, Df Meeblf1iaburg. Cumberland County, p.-nay"''''', laJclng title IS Joint teDaDra with right of survlvorahip P Mtwef:n RWulrd A. Na1and Ke",neth A. LAub'lCh .00 Carrie I. Laubeeh. hel1!lln delJlgnarBd u dMl GratUOi'l!I; AND KBNNBTH A. LAUBA.CH and CARRIS 1. l-AUBACH. hutband and wlflll!!, now or- Cumbcr1;u1d CoUIK)", Pennsylv8Jli2I. a& blnarJI:$ by the entlt~ as btltWtcl1 diem. aad RICHARD A. NEFF ~ SHELLEY J. BRADY-BEY AR. hulbaml and wife, .,: tenInU by the entirety beLwecn Utem. takrn, tlU. B.l!I join~ lenuu.s wilh liSht. af .,niYorshJp I.. be~ Rml'llrrd A. Neff. Shetley J. Bf'ldy" Bc)'at'. Kenneth A. Laubach Jll1d Carrie t. Ultibacl1., hft'ein designatEd III Orantl!ell; 'WlTNESSETH. that die Onlnt()rll, for and in c.oNlderatlon or 1M l(IUI;n of ONE DOLLAR (SI.OO) mone;y of Ibe Unlled SUU., 0( Amen!:.. 10 Ihe OraDl:OI'S in hand well .nd troly pIIid by lhe Gnlntees. at or before the lJCaI.inl and. delivery of &h~ pr8ICI'ltl. Ihe recl!lipt whereof Is l1efBby acknQwledge:l and lhe OnmtDQ ~JlIlS therewilh fully ntlafied. do by lhese pn!lt8nl,grM1., bIIrpin. Ell and convey unto the Grantees forever. ALL THAT CHRT AIN lot of lood .u...t. Ie H........ 'l'ownohip, Cumborlond C<>unly, PeMt.ylyania. being lot "74~ J-tampdcn Square. Plan No. S. PhsIMl JJI, .II ~ed In lhe Cumberland County R.ecorder"s Ofrlce In plan Book 52. Pap 145, amended in Final Resubdivl$lon PIliP lGl1ISwood. Phue 1. 1'JI: recorded Irl Plan Book 54. Page 95. (Q ",ie: BEGINNING It a JKIinl on the NQrthllr'll rigJt\ of WIly ~f Chippenham Iloecl, "lei pQint being a1 UI'IC ct bnd noW" 01" lote of South Central SeNko Corpontlon, ct..I; THENCE: by nme North 22 dq:~ IS mill~ 25 lIet:DndI Besla d.Jstaftce ol1l7.65 feet to. point; THENCJ::.". Dl'IIe South 67 dcgrllC5 56 mmules U aoc:onds Eut II distance of 100.62 (est to a point I; 11M. Dr Lot No. 73; THENCE by Sl:Me south 22 dcgreetl 03 mlnutel 34 sec:onct. W_ I distance of 117.tSS fBet 10 8 point on the Northem right of 'fit., of CMppenham ROId; ~CB by same Norah 67 degRIIIB 56 mlnules .2.6 BeC(lnds ~est, H diRlanee of 101.03 fBl!lllo. POD1t. the place of BEGINNING. CONTAINING t 1,863 8lJuare (eet. more Of lu._ UNDER AND SUBJECT. NEVERTHELESS, '0 mtrictiom, ......enl. ood ccndlll... cf prior recorn. lOOK 15.5 rAC[ 4.17 05/13/2005 14:05 71 72580852 TRI COUNTY ABSTRACT PAGE 07 UNDER AND SlJBJECT. NEVERTHELJ!SS, on Doclvatioo. of C""........ -..... Remiccions, Equitable Servitudes. Olarps and Lied$ dI~ed.Jane to, 1987.,d reClOfded.J~ t I. 1987 In 111e- Cumbllrf.,d Coudty Reeo. o~ need. Office in MYe. Bc:d:: 335, rap 119. includIng n:5pOrI3iblUty of PAMA Y [Xwelopmedt COo.. Inc:. tI) imttll ,ldewallcs within Ute riJht of WilY. BEING ihe 1IlImI! premilllC& ...,hidl Rodney l(. OIMn MId CInd&ce B. O1sen, hWlbattd and wU@. hy Dcc::d aiillled MlIfdt 19. 1996. .m. mcorrl~d in &he: Ot'fiet of the Recorder of Deed. in and '01" CuEtlbcrland County on March 2.5, 1996. in D~ lJootr. 136. Pill. 536. sr-ted qd CQftve)'lild unlo Kenneth A. Laubech.nd Clrrie I. uUbKh, hlJMllnd and wife, I.IIdRlch.-rd A_ Nef', Grlllttol'S ~rein. TH,tS .S ^ 'J'RANSPBJl BET"W"EEJ"t HURBAND AND WIFE AND IS I!XBMI"T FROIII 'I1IANSPRIt TAX. TOGETHER with n.n ;ll;nd singular the bulldhlp, improvemcrt&5, 'NIY.!I, ....ooda, watw!. wftlercoU~. righcs, liberties, privileges, herediblmllot and ~urtflnmc:I!lIIIO the sme belOJ1p (If in :1l'l)'w\Je apper1alnlng: 800 the reVllf'lllort 8IId rsvenions. rwnaindl!r and l'emIinde~, renu. bsues and flrofics lhcreot. ROd or every part and ptrcellhereof; AND ALSO ell tke estIU!', right. title. j"~i, use, pouesslon. ~ropeny. claim and demand ....twaorIer of the GrsnlQr!.' bDl.I'! \n law fl.nd in .equity I of, In and to the prsmillES hen:in described .nd evmy p8Tt IIOd parcsllhereof wIth the appurterllnOO!, TO lJA VB ANV TO HOLD _It cmd sl"suh~r lhe premises herein described togl!thM ."Ith the hcm:lilament Rl1d IIIppurtetmr1C'CS unto the Gr8n1tce.s and 10 Gnntctllll' proper we 1M beneril totever, AND the Gnmtonr. co"el1ant thBt, except WI may be herein set forth, they do ami will FOREVER SPECIALL y WARRANT and DEF'ENV the I,.d> IIJId pnnoi..., h".dl......l .nd R(lPUrtClUll1OC. hCrtlby conveyed, tgt.inst tM: OnblbJrs, In atl re(cr(:rtCt$ herein tG any partia, permns! e"dt~ or C'OrporltiOnl, lhe U!V! of lIny pllrt.i.eulllr seJ'Wler or the p}"'I'~l or .ingular number is intended 10 lndude [he ftppropmhl gender C'II' nUlnber as the text or lhl! within j"-"III~t mlllY n:quin::. Whl!rever il1 IhlJ ;mtf'Urncml any ~r[y IhaU be dMlBMted or ",'ilIil'1"ed to by r1IIfnC or senernl refe~, auch de.-.lsnat1on Is Irttended .0. &rid .hall h."e the i!lIPIIl! effl!ll:f RS Jf the words .twIll'l'l. cxecutors, Bdmmiatrtlton. penOnal 01f' legal ~YeI. iluCt:le.&lKIl"1 and ...Ip. hlId been inserted afler each and l!Vl!!ry such desl8d1.11Q\1, , 100' 155 rAG( 418 " 05/13/2005 14:09 7172580852 TRI COUNTY ABSTRACT PAGE 08 ", IN WITNESS 'WHERBOF t Q1c (]rantOI3 hllVe 'htl'leUR1.0 set tlIeit h.nda IBd ,_1& the day and yOlltr first Above written. SIGNED. SEALEP. and DELIVEREP ;n the presence of or A '!TESTED by; ~ss ;:- ~s~:: gJP ~S2.~~ C Ill. LAUBACH COMMONWIlALnI 01' PENN9YJ.VANL\ ,55. COUNl"Y 01' CUMBERUND , 0. ",~.,;)f"" d'Y.f /")~ ' '991. bcl_ me,' Notary PubU., ,t>e undersigned oFfieer. pCT'sCll"l'Uy IlppCIt!d A. LAVJM.CH. know!1 .0 nil!: to be the per90n whole name i:lllUblJcnbed 10 the withl," lMtrumcnt. _ ~ledpd rhlt he a:eculad the faregolng DEED in lhe c.apacilY tf'tereln stated IlQd fOl' &he PUJ'POR8' therein contained. IN Wl1'NESS WHEREOF. I hereunto act my hllhd and olfielaJ sell. /;;!'~'d '<t'tf.,.c Np' Publl, My commi,"lan expi~: I , .......... ..ldI''''-~~NItr EMl,?,,:llI1:1l1&tlilCl..~l'\lld~ "'tr'~~&r.lI"'OllL::r;I.lort ~;~'IIiI III J BOOK 155 '~~E 419 ~5(13(2~~5 14:~9 71 72580852 COMMONWEALTH OF PENNSYLVANIA , ss. TRI COUNTY ABSTRACT PAGE 09 COUNTY OF CUMBERLAND On Ihia~.JJ.tJ' day of '/~J~"'AA.1 . 1991. bet~re me, II. Nocary Public. the underftlgned officer, peraomdly IfPpeli'cd CAIUUE 1. LAUBACH. known to mt \0 be lhe pmracm woo.!le nBme i.subscribed to the ",Hhin i~1., .nd "C!k~ ttul she elteCuted the (OrCIpn,g DEED in the: CIpac:Hr lt1etein $l4ted .nd tor" the PUrpoRl ~In oontaJned. IN WITNESS WlIEUOP. I hereunlo see my"aNi l'lnd offrc:j~1 $ellr, / ..')n.4df((Jr./~.'..~' ~A.~~~F\.efc ~Noraty pubrlc: ~pg,.,*.:.:fllw..('~OlI"" ~)' C1)l'l'lM~~\~ ex.p-Ift:ft: lotfCal~bI*llIlQ:l.,:n,\!:J7 """""'t:o..r.,.~,..,...lilASoWl:lll.~Qjii':looI'.tI,I COMMONWllAL TH OF l'l!NN5YL V ANlA ,55. _';',:.~.....lfll~' COUNTY Of' CUMBERLAND 'f4 ~. 011 thiS t.:2e: d~)' of ~ I 1997, bafof'B me, :I NOI:fIry PubUc, the I.lndel"!lllgned officer. penlonally apPel;red JUC&RD A. N8P']l', known to me (d be.iM. ~ w~ name's subscribed to the wlthin inlllnnn.e!'lt. Qd acknowledged that he CMCUled Ihe fDft.;o~ng DEED in lhe capaci flnrln st.ared and for the ~ tl1ercin contained. ~818 Chippenborn Road '-~A- F. , he~F,fIltt) ~ my hand and omcial seal. I ItOT......Sl!AI. ~.-"p 1 - 1\. w.r,PI*k ....~....CIlll'MllWlOO. IMt~~Now.1lS.1"" f SEltbY CERTIFY !hat tbe prt~i!e ItSdreN 01' '\:hE Grnntee.~ henein Is: ., .... ..-. .,., eo 0..- ." , I"' :.. "",":::: ',,'.., . ~ (;\ -=> ..' 0 ,;~, 0 .,' ,- .~ ,. --.:.t ,- "..' . " '.' .,-;;- ... "" ~ S; ~OiJK 155 Mil 420 4 "", ~"o;.>t.Ll~dI,i;~A ~jW!",~'rB"''';'''.. . "',r..,;. , r~'~, . ~1f.~~1;' . ~~h~l& ~r~~~~/'';'~''~ j: ii.: >i#);'~!'I';' ." ,,!. "~'t~~~~~~" This is fa certify dUI the information here given is correctly copied from an original c~l~tifJc:HC of death dll~~ flied with me as Local Registrar. The original certificate will be forwarded to the State Vital Ri:'cords Office tor permanent hlll1g. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~ P? %:~4/b'-cr Local Registrar Fee for this certificate, $2.00 5392974 DEC 0 1 1998 Date R.~ 2161 COMMONWEALTH OF PENNSYlVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH NAJ.lE OF DEaDENT If.... M';;", ~.ISl1 .. Kenneth A. L<11J.bo.ch '" .. Ma..l'e ST,o,JEFIlEM.J"'BER SQC.1ALSECURrT'I'NU"'6ER ,. 198 - 09 2238 DATE OF DEATH ,1.\CtIIh. o.~. '_I .. Vece.mbvr " 7998 JlGE{Lasl!lonrloan UNDER 1 \'EM ..... - UNOER I OW ..... ..- OATE OF EMTH \"""""'.t>>-t..--. PL..ACEOFDfArHlCl>eCk<ll'l>j_ __ua<lo\Of'l'**--' """''''' ,. Q.uo.kvrtown, PA:""" 0 ''''''''''''''" 0 fACllnY NAME{1l noto:>sloMlaO. ~1lI'__""""~' 61RT/4PlACE(C.....~ SIalooo<fae.gnClU'lIrn "",0 ="YlO .. COUNTY OF OE.A1H 89 '" .. 17 -30-09 ClT'I.ilOfW.).TWPOl'DE.ArH ~. Cumbvr.eo.nd .f.Mt PenMbollo Twp KINOOf' BU$IHESS/lNOllSTRY We~t Sholle Heo..eth & Rehab. Wh.<te 1h. 11C>. Set!e..6 DECEDENT'S MAIUNG AOOAeSStSlr_. C4yIb.o.n.~. Z",CoOeI ~OECEOENTEVERIN U,S.AflUEDFOfICES? .....0 Mol8l l. Sp.<d.ee .~. .. --. ....in. CumbVr.land ---'" 17d.O :.w..-::=':'::oI MOTHfR'SKNAElf.., ModdIoo. ~s..._1 Ama.ndo. S. Go./t.<n vr UAAITALSWUS ''''-*l N_r.c....*I.Widowed. -- Mo./tll.<ed Co./tll.<e Hampden SlJAVIVINGSPOUSE lR_.OMO~_1 ". 3818 Ch.<ppenham Road ". Mec.han.<c.~bUltg, PA 17055 fA:l"kER'SNN.lElhSl.~.li:ll1 Jo.c.ob Henll Lo.ubac.h QECEDENT'S ,.cr"",- flESlOE~ (SefI--..;hor.. on_..o.1 nl.SIaM 17~~ ....~..w.dlp - """""' ". 1NF000000rs NAIoIE {T 'fPI*'f"""J _. MIl. R.<c.ho./td Ne UETHOO OF OlSf'QSrTION &un.lOc.-_~ -- ~"omsc.I'O 7998 ". lNFQfUMNrs/olAIUNQ ADORESStSlr....~.SI.&loI.Z-'PCock\ ~ 3818 Ch.< enham Road Mec.ho.n.<c~bUlt PA 17055 Pl.ACf Of' DISPOSlTlON -,..... 01 c.......oy. C.lMal<lfY lOCATION. CiIyfTown. Sial.. .top C""- ._- Cllemo.tion Soc.<ety 06 2tc. PA CJr.em oJ/..' 214. Ha.J!.II..(.-6buJt ...........'00..."""""" CllemaUo~ Soc.~e.tu ~. 4100 JoneMown ~oad Ho./tll.wbwl lICENSE HUl.l8ER DAre SIGNED (MonIl\.~._\ PA 17109 06p~e1n~~Vo.Mo. ~i1_23H""'Vwn."~ ~._.~.rtinwol_"1O <:et\of)'_oI.,...... 2211. Tol1MbHlot"'Yt~...athoce""'IOd.c""......_Andpla.:."'led ~._l*"l 1998 H. ,~. 'inlM..-.l_n ~__"Uh , : ~O .......24.20_"~1..:lb'f' pw-.who_o...lh. 21. "'. u. Ve.c.emb Vr. 1 27. NAT I: E_....diu_.........iaOlcomplicalionf,whic"~rhild..I" OO_.......""'..-."'dyinQ.sucn.Ica/~O/'-.piralOO)l."_.Sf\odl...,.."",...... l_~"","_"",__ OAl'EPf\ONOlJHCEDOEAtI{MonIl.o.y......1 PAKJR' ou..~OIIf>dll;ono~IO.Mh.bIIf _..-itIginthe~_g;..ninPAAT1. ~..~ iI.......~IO__. ~.~lJfolOUIi.ylNQ CJlUSE(OoMaM"'.....y ....~- '--.g"'_ILAST L WERE AUtOPSY flNOlHGS AAlL\8t.E PAlOR 10 COMPl.EnOH OF CAUSE OF~'" eM (L~ :rd tv <..l,....., OlJENCEOf'l' IIIMf:DlATf:c.IlllH(F~ _.~ ......-.g..._l_ DUE 10(00 ASJlCQNSEOUENCE Of) wo'sAHAUlOf'SY M::RFQflMEOl UANNEl'lOF OEolXH -. iB"' o o OJlTEOFIN.JUAY l_,l)oY,~1 flUE OF INJUAY INJURY R WORK? OESCAlBE HOW INJURY OCCURRED. P.fWljng......slio}o'io<> o o o PlACEOf'INJUA'f................_._.l&c:uHy.oIlIc. "'. ~"C.lSpoocill'J _. ... 0 NoD .... .........,.. >> R€GISTFV.R'S SIGNATURE A.NQNU"'8ER ~ I..;l,j '''''/,-1 o ",0 ~ ,-0 ~IB Suicid. Co..ldnolbe~""""'" u.. '1"'- CERTIFIEA ICI1_""",onorl 'CEA1"IFVINGI"HY$~(Ph~~c.auud~~_,"""",...pl'I\'$oC_h.ospr<lllOUt>C<<ldeall>anocornpleIOl<lllemnl To__.'...yknow'-dg<o......"occ....,..,_...u..c.......(.l_............o&t&t..a. . H. '''AONOUNCI/'fG A.NO CERTifYING PHYSICI....., lPhysoc..o txJltl """"""",,,"'0 .....il!> Mid '"""'1'<'lI1O O:i"'" 01 """'1 1'0__0I..Yknow'-~.._"'oc:c_odalu.........doo~.at>dp.......at>dd...Iou..C.....{.I_...........u.._.. 'UEOICAL EXAUINER/COAONER On tho b.aI. 0' .......I....t.on ofMIIMlnYUllgaliOn. in my opinion. d..th occ..rr.d.t lho 11m.. dol.. and pliC'. arid du. to 1hc c.M.I"(t.\and ....n_f..~al"..........,",.... ............... ............................................................. ". n. OAlfFIlED(tolonlrl.Da.1....." j..1dl f,> o ,. / / ~r ,;,,~ Iq~\' ''!/In ~r'1 .,- '" I'(l '-'rl:(' that rhe inForm8.r.loll here "jVCl1 is corr~Cllv copied (rom an origi!1:11 ccrriFicltc oC dc;nh duly J-lll'd 1 'C,:';,]"[) "('~.'~"\'1'~- )']'hc ori()inal ceni{-IGnc ",viII tlw rorwardcd rc~ the Suee Vit:,] Rccc;rds OIl-lee fClr pCrnUl1Cllt fIling. .0 < \.\.:t", h. , " with me JS WARNING: It is illegal to duplic~te this copy by photostat or photograph. No. ~""""T"""~ II'f{'~~\HJI Pl~>-- /,~\..~._~ ',--~.!;;J;..';. """'>'/ '. ~~\ .""~ " Il!;\~, y.:<\~ /i~(, .]..."" '\~% I~= _- ',' ._~ I,,-,I~.,,,,,,,..'h' ~' \ ,I,,'J.. '.:;' ::. * -{ '" ,..\i,......::,_r'/ ~ ,,,,,. ....-. '",",I ~-~, ,~ /{.~/' '~- "Iii............. ' / '~'f'11 '(?:~lM[ijf\)\~~';\" "'::~:'!!!P!!!!!'!'~ -::?~~l}~.~ .1';,;." /. .~) '" I ~ /". / /?;,. >~j.",-:::~~ ;':"!_d>.::.~~ /;f . Fec (or [his ccrtiflClte, $2.00 1,0<'::11 Regiscrar 6237203 \li\'\1 -~.._~ I':) ;:ni~n Datt: .' 1191 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (Coroner) ;.,AI ~ I'll ['''--''-'Ufll Ml.lloOF [Jcr;rDHH \(.,< \,\,~\',~,l"'\l ;;OCIAI ~Eculll"iYlUi:illll-~-----r)AIEOf Gl:Af~7;~--e_-1 1. Carrie I Laubach J 2fr_Q~fiA j~ January 9, ')000 \ AtoE(I."I!)" "<I,'yl M~~,~~I.1...2-.":~.A!~ -~~~[~~2~1-;" I;~~J~;I\O~.~.\I~:~I ,U'fl1tl);lA<:;[I~:"Y"'''\ .P'"~C[(~~:-'f'.!.!'~':'K',(1"'YO"U_"""''''''''>C'",;\,;"",,,,,,,,,,C,",,! '_, _ ,'_ i D,,,, , _I"'~'" '''"'':J'' "WI''', PA l,asl'liAtr, -- -.- ~--~_.--;--------.:~---~-------r~~;;~~--~-~--'--'.-'~--~._' I I 87 Yo; \u?. ll, 191.2 71I.iedlQ..l1.tc....~buJ!. ~~"",,,,,,,_J fH.'tl"'("'''<I\lL.l (.lClAlJ, )11"'''" [1 n,sid,,,..a1)l [I! ~()U,,'lY(JFrJFA111 I.,fy.aOH WP l-lJC.\I,j. rAt:'Ul\'NA~:"It", 'J"""'~"'"'d;;:;;;;(;~-~---J'~--'.ASlfat;;:N.li).ri~'~i::.I'1 fl'\C['A"Jo,i":;OI,.Jlil-;;:-~~~-:-=--' '1' CUlllberl.:111d Hampden 3818 Chlppenllam ROEl,J ~~!i~n.~:,:,~;~k:'~~~~~'~~\\l'C"b"" (~\i.jd<) 3b, at. ~", 9 10 V.lftJ..:te _......Q1~9J1~-!::!L:iU~-':!!.:h.L.)C9!I_~~'i!!'_:!_1_ ____.J0~p_Q.uMirTi~~!~'!!~~~I1lY_~.__ W!\~ DfC..'.-DfNT I Vl fill, -- mel ['<IlT i"iO\;' AIIOI. I.~-:T1ii')'~'I- ---:ijl~iJiNG ::."i""OV"'-~ -1 I(;"~""d~' '.'''' ej"'''''!;''''''J'',Q"1 U J Alll.1(1) rclHr,r ~I ~~_ ..J2L~li'" I.!.:'!ll'lc"-"-,' on.!..'" ~"c!;;"J _ _ No,,", 1.1.,,"," ~I, """d 111, '" J ,c" "Ie" \' 01 "I "c"k,ng I,I~, "" >I,,' "'~ 'ul"o" ) l-j ~J [\~ "~tL'",YI',"~";~(:a;y-l'-"--- C,I ova D "~,".(I (I" 1,1 ! '18goofzf~eep{UllSe.c.J[e.taJ[IjI!1b_ We....-sLingfJotl-6!!.. 12 YO" No () 1012) ~ 111"Jtl 14 (1Jcdc'wed 1~ I )[Ct;DLN1"~I.1AllI',GADDflI'SShl,~"'_CdYI1~,.,,,,S:'I,,,l'jI(;<j(jq Uf.t:Elll'.Nl"S FA- ~-~ -------;:-) ~--~Ii~a---;;drl.,-T' ,--- --.'--i ACTUAL IH'ilotu_______ -____ 01 I1cl_, Y""T<CaJ."'''"'',,,.__~_~]l~~~_ _ _~r!._._ -~--~-----\\ I 3818 CI1.tppe.11ham Road :i~~:~~;,~,~,~,,,, ~:.;~,~':nl b. Afe.c-ltan~ic.--6uuJrg, PA 77055 (muHo~"'''"1 11l>CQU"'V__~~l}.Il:qg.!i~CIJ3~__ .lowu,l"p7 l1d[1~~I\G:~~~:;:~n;~.h-:;;:==-=--=_-=-=----~"::::=-=__-_==---'~~I'" ~l~(,,,,,,Mi<l.n~,(a'll MOII(lll~:-JAM~(, ", '1"J"~ 11"I",o~~"'L"cl - ,~C1LllJ.t2J1c.L.4!i.d1r !01a1.~c......tkl,it.Hi!l,Di:.iL.__.____~ ',F;"MAU I '0, I"AM[ IIYIMd""JI) 11011 ORMAN r SMAil ,NG A[)UfU';~ 0'00' <. 'yl Ow' .1,1". I Cn",,! !]l!-Jk~ R.iehal1d NC_hh 10b 38~?-0ril2l2eYlhaIJl__R.Q.gsl---.l'1J0;jwl1.ie1Qli!WJA 17055 I 'E I' ,lJl) ur I1ISf'OSI f ION DArE Of DlsrO:;ITH.lN PLACe OF ()I:.I'O~'TI()N. l.""",. O. (.Cb"\~lb'~C'"n"~'~'.,. '. 1I.OCAT!OU' C;"fl~"", s,,"~, l,p c""" II I,). 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PhlOH TO Ilo1wLI", I.>~y, Yy~1) g~~~,~~I:I?NOFCAl)~E NOI",ol IX. lIo'''b.l0 CJ Yo, fJ No [J - ,\( ACt"I.", r 1 P'''d'''9 I"v"",~"'io" [1 308 ~Oh M JOe 30d J' i-I "...)\1\ Va, [J No r~J 0= L'] PLA'croFlNJUFiV~~I"",,:,,;;;;;;:r:;Zl"'YOII'G; .-- .m_~OCAtlot:i\s"e;:;;c~;;;-''-;;;:;---~ - -----\1 Y" SoicW. Co"i~ "QI t,. <l"'~"Hi,,,,<.t fu>,IC"'Il, <>It, \S,-"""Iy) m'm'""c.",,,",,,~,:~ ". "0. :',','I':IUH~!~.~ C,,;:0,.~~~'2~_~-~/')J/ / / _~..II .~,;;:,~~:~7~/::'~Y:':~~~~'II~~:~~~,'~ ":~~'~;;~J~~~',~ :~:J~~:~'~;~t':~~''::,~':::,~:''~'~L~~~~~:t''''.''L0'f u~"n"to(I """'/.1"'0><11'", I ~:II 1]" /a--L, ff~"" ~ L. CO ro ne r _ _ _ LICfN1iENUMJlEfl /' t DAlE SIQNE8(Mo'''I,.lJ~", ~".') .~:~~~~:;~"~~/:'O~;;I~I~~~:~I~.~I;:~~~~7~~~i;;I:~~',~~:~ '~~':~:~~:~";:;:'~';: ~1~~'~~O~~I:~',~I~~~~~(,"~l:~"Q:t~8~~~~'.S .'81~d_. U 3~ Jld. J an. 10, 2000 NAI~~nr-ssorr::~coMrl-r.::IEbcAUSEUF6~--.--- 1"~'n~lJlyp"o(rJ"nl Michael L. Norris, Co Toner ~ 6375 Basehore Road, Suite 1 J2. Mcchanicsburg, Pa. l7055 1.:::1 / -- VM[FILUjll~"'''IJ, D"y Y~,,,, ~.B', c',::,J " A 4/ / .) d o.c''7) - "------.;;L-c:...~.-...-__.__ "lu.n"""yli"~on<f"ou"" "'V_,"",jIHu'''''''''''''''.'. u'u Ft"., urjll~!lll'IIlG tU..IO\(l>.....",~~,)< ~'~"Y """,'.,~,I ,,"Co"" ''''''''"'''jLAST .Mf'OICAL EXAMINER/CORONEFl On lhe buis 01 ,,'~mlnBtlon and/or Inv"uigaHon. In my opinion. dealh occurrud ~llhe lime, d~te. ~l1d pl"ce, 8M! due 10 tho ceuu(aj ,,<\4 mann"rll'$lat~,L. 11l<.,o;lllf,~SI'-'W1UI1EANIJNlIl~U(R ~/"""""'f">A"'~ ~~/~"--1.~--l:""~..e---- 03008477 --- .. AFTER RECORDING RETURN TO: columbia National Incorporated P.O. Box 3050, Columbia, MD 21045-6050 Attn: Document Control [Space Above This Line For Recording Data] MORTGAGE J THIS MORTGAGE ("Security Instrument") is given on March 19, 1996 Richard A. Neff, Kenneth A. Laubach and Carrie T. Laubach . The mortgagor is ("Borrower"). This Security Instrument is given to Columbia National Incorporated which is organized and existing under the laws of State of Maryland address is P.O. Box 3050, Columbia, MD 21045-6050 , and whose One Hundred Sixty Thousand and 00/100 ("Lender"). Borrower owes Lender the principal sum of Dollars (U.S. $160,000.00 ). This debt is evidenced by Borrower's note dated the same date as this Security Instrument ("Note"), which provides for monthly payments, with the full debt, if not paid earlier, due and payable on April 1, 2003 This Security Instrument secures to Lender: (a) the repayment of the debt evidenced by the Note, with interest, and all renewals, extensions and modifications of the Note; (b) the payment of all other sums, with interest, advanced under paragraph 7 to protect the security of this Security Instrument; and (c) the performance of Borrower's covenants and agreements under this Security Instrument and the Note. For this purpose, Borrower does hereby mortgage, grant and convey to Lender the following described property located in Cumberland County, Pennsylvania: SEE EXHIBIT 'A' FOR LEGAL DESCRIPTION (STRIKE OUT IF INAPPLICABLE) BORROWER ACKNOWLEDGES THAT THE SUM SO RECEIVED FROM LENDER UNDER THE NOTE SECURED BY THIS INSTRUMENT IS, IN WHOLE OR IN PART, IN PURCHASE MONEY OF THE PROPERTY SECURED HEREBY. which has the address of 3818 Pennsylvania 17055 (Zip Code] Chippenham Rd., Mechanicsburg ("Property Address"); [Street. CityI. PENNSYLVANIA-Single Family-Fannie Mae/Freddie Mac UNIFORM INSTRUMENT Page 1 of 8 to: -6RIPA) (9105) VMP MORTGAGE FORMS -(313)293-8100 - (800)521-7291 @ Form 3039 9/90 Amended 5/91 Initials: 487352 TOGETHER WITH all the improvements now or hereafter erected on the property, and all easements, appurtenances, and " fixtures now or hereafter a pan of the property. All replacements and additions shall also be covered by this Security Instrument. All of the foregoing is referred to in this Security Instrument as the "Property." BORROWER COVENANTS that Borrower is lawfully seised of the estate hereby conveyed and has the right to mortgage, grant and convey the Property and that the Property is unencumbered, except for encumbrances of record. Borrower warrants and will defend generally the title to the Property against all claims and demands, subject to any encumbrances of record. THIS SECURITY INSTRUMENT combines uniform covenants for national use and non-uniform covenants with limited variations by jurisdiction to constitute a uniform security instrument covering real property. UNIFORM COVENANTS. Borrower and Lender covenant and agree as follows: 1. Payment of Principal and Interest; Prepayment and Late Charges. Borrower shall promptly pay when due the principal of and interest on the debt evidenced by the Note and any prepayment and late charges due under the Note. 2. Funds for Taxes and Insurance. Subject to applicable law or to a written waiver by Lender, Borrower shall pay to Lender on the day monthly payments are due under the Note, until the Note is paid in full, a sum ("Funds") for: (a) yearly taxes and assessments which may attain priority over this Security Instrument as a lien on the Property; (b) yearly leasehold payments or ground rents on the Property, if any; (c) yearly hazard or property insurance premiums; (d) yearly flood insurance premiums, if any; (e) yearly mortgage insurance premiums, if any; and (f) any sums payable by Borrower to Lender, in accordance with the provisions of paragraph 8, in lieu of the payment of mortgage insurance premiums. These items are called "Escrow Items." Lender may, at any time, collect and hold Funds in an amount not to exceed the maximum amount a lender for a federally related mortgage loan may require for Borrower's escrow account under the federal Real Estate Settlement Procedures Act of 1974 as amended from time to time, 12 U.S.C. Section 2601 et seq. ("RESPA"), unless another law that applies to the Funds sets a lesser amount. If so, Lender may, at any time, collect and hold Funds in an amount not to exceed the lesser amount. Lender may estimate the amount of Funds due on the basis of current data and reasonable estimates of expenditures of future Escrow Items or otherwise in accordance with applicable law. The Funds shall be held in an institution whose deposits are insured by a federal agency, instrumentality, or entity (including Lender, if Lender is such an institution) or in any Federal Home Loan Bank. Lender shall apply the Funds to pay the Escrow Items. Lender may not charge Borrower for holding and applying the Funds, annually analyzing the escrow account, or verifying the Escrow Items, unless Lender pays Borrower interest on the Funds and applicable law pennlts Lender to make such a charge. However, Lender may require Borrower to pay a one-time charge for an independent real estate tax reporting service used by Lender in connection with this loan, unless applicable law provides otherwise. Unless an agreement is made or applicable law requires interest to be paid, Lender shall not be required to pay Borrower any interest or earnings on the Funds. Borrower and Lender may agree in writing, however, that interest shall be paid on the Funds. Lender shall give to Borrower, without charge, an annual accounting of the Funds, showing credits and debits to the Funds and the purpose for which each debit to the Funds was made. The Funds are pledged as additional security for all sums secured by this Security Instrument. If the Funds held by Lender exceed the amounts permitted to be held by applicable law, Lender shall account to Borrower for the excess Funds in accordance with the requirements of applicable law. If the amount of the Funds held by Lender at any time is not sufficient to pay the Escrow Items when due, Lender may so notify Borrower in writing, and, in such case Borrower shall pay to Lender the amount necessary to make up the deficiency. Borrower shall make up the deficiency in no more than twelve monthly payments, at Lender's sole discretion. Upon payment in full of all sums secured by this Security Instrument, Lender shall promptly refund to Borrower any Funds held by Lender. If, under paragraph 21, Lender shall acquire or sell the Property, Lender, prior to the acquisition or sale of the Property, shall apply any Funds held by Lender at the time of acquisition or sale as a credit against the sums secured by this Security Instrument. 3. Application of Payments. Unless applicable law provides otherwise, all payments received by Lender under paragraphs I and 2 shall be applied: first, to any prepayment charges due under the Note; second, to amounts payable under paragraph 2; third, to interest due; fourth, to principal due; and last, to any late charges due under the Note. 4. Charges; Liens. Borrower shall pay all taxes, assessments, charges, fines and impositions attributable to the Property which may attain priority over this Security Instrument, and leasehold payments or ground rents, if any. Borrower shall pay these obligations in the manner provided in paragraph 2, or if not paid in that manner, Borrower shall pay them on time directly to the person owed payment. Borrower shall promptly furnish to Lender all notices of amounts to be paid under this paragraph. If Borrower makes these payments directly, Borrower shall promptly furnish to Lender receipts evidencing the payments. Borrower shall promptly discharge any lien which has priority over this Security Instrument unless Borrower: (a) agrees in writing to the payment of the obligation secured by the lien in a manner acceptable to Lender; (b) contests in good faith the lien by, or defends against enforcement of the lien in, legal proceedings which in the Lender's opinion operate to prevent the enforcement of the lien; or (c) secures from the holder of the lien an agreement satisfactory to Lender subordinating the lien to this Security Instrument. If Lender determines that any pan of the Property is subject to a lien which may attain priority over this Security Instrument, Lender may give Borrower a notice identifying the lien. Borrower shall satisfy the lien or take one or more of the actions set forth above within 10 days of the giving of notice. ~ -6RIPA) (9105) <!> Form 3039 9/90 Page 2 of 6 Initials: 5. Hazard or Property Insurance. Borrower shall keep the improvements now eXlstmg or hereafter erected on the Prop~rty insured against loss by fire, hazards included within the term "extended coverage" and any other hazards, including floods or flooding, for which Lender requires insurance. This insurance shall be maintained in the amounts and for the periods that Lender requires. The insurance carrier providing the insurance shall be chosen by Borrower subject to Lender's approval which shall not be unreasonably withheld. If Borrower fails to maintain coverage described above, Lender may. at Lender's option, obtain coverage to protect Lender's rights in the Property in accordance with paragraph 7. All insurance policies and renewals shall be acceptable to Lender and shall include a standard mortgage clause. Lender shall have the right to hold the policies and renewals. If Lender requires, Borrower shall promptly give to Lender all receipts of paid premiums and renewal notices. In the event of loss, Borrower shall give prompt notice to the insurance carrier and Lender. Lender may make proof of loss if not made promptly by Borrower. Unless Lender and Borrower otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, if the restoration or repair is economically feasible and Lender's security is not lessened. If the restoration or repair is not economically feasible or Lender's security would be lessened, the insurance proceeds shall be applied to the sums secured by this Security Instrument, whether or not then due, with any excess paid to Borrower. If Borrower abandons the Property, or does not answer within 30 days a notice from Lender that the insurance carrier has offered to settle a claim, then Lender may collect the insurance proceeds. Lender may use the proceeds to repair or restore the Property or to pay sums secured by this Security Instrument, whether or not then due. The 3D-day period will begin when the notice is given. Unless Lender and Borrower otherwise agree in writing, any application of proceeds to principal shall not extend or postpone the due date of the monthly payments referred to in paragraphs I and 2 or change the amount of the payments. If under paragraph 21 the Property is acquired by Lender, Borrower's right to any insurance policies and proceeds resulting from damage to the Property prior to the acquisition shall pass to Lender to the extent of the sums secured by this Security Instrument immediately prior to the acquisition. 6, Occupancy, Preservation, Maintenance and Protection of the Property; Borrower's Loan Application; Leaseholds. Borrower shall occupy, establish, and use the Property as Borrower's principal residence within sixty days after the execution of this Security Instrument and shall continue to occupy the Property as Borrower's principal residence for at least one year after the date of occupancy, unless Lender otherwise agrees in writing, which consent shall not be unreasonably withheld, or unless extenuating circumstances exist which are beyond Borrower's control. Borrower shall not destroy, damage or impair the Property, allow the Property to deteriorate, or commit waste on the Property. Borrower shall be in default if any forfeiture action or proceeding, whether civil or criminal, is begun that in Lender's good faith judgment could result in forfeiture of the Property or otherwise materially impair the lien created by this Security Instrument or Lender's security interest. Borrower may cure such a default and reinstate, as provided in paragraph 18, by causing the action or proceeding to be dismissed with a ruling that, in Lender's good faith determination, precludes forfeiture of the Borrower's interest in the Property or other material impairment of the lien created by this Security Instrument or Lender's security interest. Borrower shall also be in default if Borrower, during the loan application process, gave materially false or inaccurate information or statements to Lender (or failed to provide Lender with any material information) in connection with the loan evidenced by the Note, including, but not limited to, representations concerning Borrower's occupancy of the Property as a principal residence. If this Security Instrument is on a leasehold, Borrower shall comply with all the provisions of the lease. If Borrower acquires fee title to the Property, the leasehold and the fee title shall not merge unless Lender agrees to the merger in writing. 7, Protection of Lender's Rights in the Property. If Borrower fails to perform the covenants and agreements contained in this Security Instrument, or there is a legal proceeding that may significantly affect Lender's rights in the Property (such as a proceeding in bankruptcy, probate, for condemnation or forfeiture or to enforce laws or regulations), then Lender may do and pay for whatever is necessary to protect the value of the Property and Lender's rights in the Property. Lender's actions may include paying any sums secured by a lien which has priority over this Security Instrument, appearing in court, paying reasonable attorneys' fees and entering on the Property to make repairs. Although Lender may take action under this paragraph 7, Lender does not have to do so. Any amounts disbursed by Lender under this paragraph 7 shall become additional debt of Borrower secured by this Security Instrument. Unless Borrower and Lender agree to other terms of payment, these amounts shall bear interest from the date of disbursement at the Note rate and shall be payable, with interest, upon notice from Lender to Borrower requesting payment . 8. Mortgage Insurance. If Lender required mortgage insurance as a condition of making the loan secured by this Security Instrument, Borrower shall pay the premiums required to maintain the mortgage insurance in effect. If, for any reason, the mortgage insurance coverage required by Lender lapses or ceases to be in effect, Borrower shall pay the premiums required to obtain coverage substantially equivalent to the mortgage insurance previously in effect, at a cost substantially equivalent to the cost to Borrower of the mortgage insurance previously in effect, from an alternate mortgage insurer approved by Lender. If substantially equivalent mortgage insurance coverage is not available, Borrower shall pay to Lender each month a sum equal to one-twelfth of the yearly mortgage insurance premium being paid by Borrower when the insurance coverage lapsed or ceased to be in effect. Lender will accept, use and retain these payments as a loss reserve in lieu of mortgage insurance. Loss reserve Form 3039 9/90 .. .6R(PAll9105l <!> Page 3 of 6 Initials: payments may no longer be required, at the option of Lender, if mortgage insurance coverage (in the amount and for the period that r:ender requires) provided by an insurer approved by Lender again becomes available and is obtained. Borrower shall pay the premiums required to maintain mortgage insurance in effect, or to provide a loss reserve, until the requirement for mortgage insurance ends in accordance with any written agreement between Borrower and Lender or applicable law. 9, Inspection. Lender or its agent may make reasonable entries upon and inspections of the Property. Lender shall give Borrower notice at the time of or prior to an inspection specifying reasonable cause for the inspection. ro. Condemnation. The proceeds of any award or claim for damages, direct or consequential, in connection with any condemnation or other taking of any part of the Property, or for conveyance in lieu of condemnation, are hereby assigned and shall be paid to Lender. In the event of a total taking of the Property, the proceeds shall be applied to the sums secured by this Security Instrument, whether or not then due, with any excess paid to Borrower. In the event of a partial taking of the Property in which the fair market value of the Property immediately before the taking is equal to or greater than the amount of the sums secured by this Security Instrument immediately before the taking, unless Borrower and Lender otherwise agree in writing, the sums secured by this Security Instrument shall be reduced by the amount of the proceeds multiplied by the following fraction: (a) the total amount of the sums secured immediately before the taking, divided by (b) the fair market value of the Property immediately before the taking. Any balance shall be paid to Borrower. In the event of a partial taking of the Property in which the fair market value of the Property immediately before the taking is less than the amount of the sums secured immediately before the taking, unless Borrower and Lender otherwise agree in writing or unless applicable law otherwise provides, the proceeds shall be applied to the sums secured by this Security Instrument whether or not the sums are then due. If the Property is abandoned by Borrower, or if, after notice by Lender to Borrower that the condemnor offers to make an award or settle a claim for damages, Borrower fails to respond to Lender within 30 days after the date the notice is given, Lender is authorized to collect and apply the proceeds, at its option, either to restoration or repair of the Property or to the sums secured by this Security Instrument, whether or not then due. Unless Lender and Borrower otherwise agree in writing, any application of proceeds to principal shall not extend or postpone the due date of the monthly payments referred to in paragraphs 1 and 2 or change the amount of such payments. II. Borrower Not Released; Forbearance By Lender Not a Waiver. Extension of the time for payment or modification of amortization of the sums secured by this Security Instrument granted by Lender to any successor in interest of Borrower shall not operate to release the liability of the original Borrower or Borrower's successors in interest. Lender shall not be required to commence proceedings against any successor in interest or refuse to extend time for payment or otherwise modify amortization of the sums secured by this Security Instrument by reason of any demand made by the original Borrower or Borrower's successors in interest. Any forbearance by Lender in exercising any right or remedy shall not be a waiver of or preclude the exercise of any right or remedy. 12. Successors and Assigns Bound; Joint and Several Liability; Co-signers. The covenants and agreements of this Security Instrument shall bind and benefit the successors and assigns of Lender and Borrower, subject to the provisions of paragraph 17. Borrower's covenants and agreements shall be joint and several. Any Borrower who co-signs this Security Instrument but does not execute the Note: (a) is co-signing this Security Instrument only to mortgage, grant and convey that Borrower's interest in the Property under the terms of this Security Instrument; (b) is not personally obligated to pay the sums secured by this Security Instrument; and (c) agrees that Lender and any other Borrower may agree to extend, modify, forbear or make any accommodations with regard to the terms of this Security Instrument or the Note without that Borrower's consent. 13. Loan Charges. If the loan secured by this Security Instrument is subject to a law which sets maximum loan charges, and that law is finally interpreted so that the interest or other loan charges collected or to be collected in connection with the loan exceed the permitted limits, then: (a) any such loan charge shall be reduced by the amount necessary to reduce the charge to the permitted limit; and (b) any sums already collected from Borrower which exceeded permitted limits will be refunded to Borrower. Lender may choose to make this refund by reducing the principal owed under the Note or by making a direct payment to Borrower. If a refund reduces principal, the reduction will be treated as a partial prepayment without any prepayment charge under the Note. 14. Notices. Any notice to Borrower provided for in this Security Instrument shall be given by delivering it or by mailing it by first class mail unless applicable law requires use of another method. The notice shall be directed to the Property Address or any other address Borrower designates by notice to Lender. Any notice to Lender shall be given by first class mail to Lender's address stated herein or any other address Lender designates by notice to Borrower. Any notice provided for in this Security Instrument shall be deemed to have been given to Borrower or Lender when given as provided in this paragraph. 15. Governing Law; Severability. This Security Instrument shall be governed by federal law and the law of the jurisdiction in which the Property is located. In the event that any provision or clause of this Security Instrument or the Note conflicts with applicable law, such conflict shall not affect other provisions of this Security Instrument or the Note which can be given effect without the conflicting provision. To this end the provisions of this Security Instrument and the Note are declared to be severable. 16. Borrower's Copy. Borrower shall be given one conformed copy of the Note and of this Security Instrument. Form 3039 9/90 cD -6R(PAll9105l <!> Page 4 of6 Initials: 17. Transfer of the Property or a Beneficial Interest in Borrower. If all or any part of the Property or any interest in it is solb or transferred (or if a beneficial interest in Borrower is sold or transferred and Borrower is not a natural person) without Lender's prior written consent, Lender may, at its option. require immediate payment in full of all sums secured by this Security Instrument. However, this option shall not be exercised by Lender if exercise is prohibited by federal law as of the date of this Security Instrument. If Lender exercises this option, Lender shall give Borrower notice of acceleration. The notice shall provide a period of not less than 30 days from the date the notice is delivered or mailed within which Borrower must pay all sums secured by this Security Instrument. If Borrower fails to pay these sums prior to the expiration of this period, Lender may invoke any remedies permitted by this Security Instrument without further notice or demand on Borrower. 18. Borrower's Right to Reinstate. If Borrower meets certain conditions, Borrower shall have the right to have enforcement of this Security Instrument discontinued at any time prior to the earlier of: (a) 5 days (or such other period as applicable law may specify for reinstatement) before sale of the Property pursuant to any power of sale contained in this Security Instrument; or (b) entry of a judgment enforcing this Security Instrument. Those conditions are that Borrower: (a) pays Lender all sums which then would be due under this Security Instrument and the Note as if no acceleration had occurred; (b) cures any default of any other covenants or agreements; (c) pays all expenses incurred in enforcing this Security Instrument, including, but not limited to, reasonable attorneys' fees; and (d) takes such action as Lender may reasonably require to assure that the lien of this Security Instrument, Lender's rights in the Property and Borrower's obligation to pay the sums secured by this Security Instrument shall continue unchanged. Upon reinstatement by Borrower, this Security Instrument and the obligations secured hereby shall remain fully effective as if no acceleration had occurred. However, this right to reinstate shall not apply in the case of acceleration under paragraph 17. 19. Sale of Note; Change of Loan Servicer. The Note or a partial interest in the Note (together with this Security Instrument) may be sold one or more times without prior notice to Borrower. A sale may result in a change in the entity (known as the "Loan Servicer") that collects monthly payments due under the Note and this Security Instrument. There also may be one or more changes of the Loan Servicer unrelated to a sale of the Note. If there is a change of the Loan Servicer, Borrower will be given written notice of the change in accordance with paragraph 14 above and applicable law. The notice will state the name and address of the new Loan Servicer and the address to which payments should be made. The notice will also contain any other information required by applicable law. 20. Hazardous Substances. Borrower shall not cause or permit the presence, use, disposal, storage, or release of any Hazardous Substances on or in the Property. Borrower shall not do, nor allow anyone else to do, anything affecting the Property that is in violation of any Environmental Law. The preceding two sentences shall not apply to the presence, use, or storage on the Property of small quantities of Hazardous Substances that are generally recognized to be appropriate to normal residential uses and to maintenance of the Property. Borrower shall promptly give Lender written notice of any investigation, claim, demand, lawsuit or other action by any governmental or regulatory agency or private party involving the Property and any Hazardous Substance or Environmental Law of which Borrower has actual knowledge. If Borrower learns, or is notified by any governmental or regulatory authority, that any removal or other remediation of any Hazardous Substance affecting the Property is necessary, Borrower shall promptly take all necessary remedial actions in accordance with Environmental Law. As used in this paragraph 20, "Hazardous Substances" are those substances defined as toxic or hazardous substances by Environmental Law and the following substances: gasoline, kerosene, other flammable or toxic petroleum products, toxic pesticides and herbicides, volatile solvents, materials containing asbestos or formaldehyde, and radioactive materials. As used in this paragraph 20, "Environmental Law" means federal laws and laws of the jurisdiction where the Property is located that relate to health, safety or environmental protection. NON-UNIFORM COVENANTS. Borrower and Lender further covenant and agree as follows: 21. Acceleration; Remedies. Lender shall give notice to Borrower prior to acceleration following Borrower's breach of any covenant or agreement in this Security Instrument (but not prior to acceleration nnder paragraph 17 unless applicable law provides otherwise). Lender shall notify Borrower of, among other things: (a) the default; (b) the action required to cure the default; (c) when the default mnst be cured; and (d) that failure to cure the default as specified may result in acceleration of the sums secured by this Security Instrument, foreclosure by judicial proceeding and sale of the Property. Lender shall further inform Borrower of the right to reinstate after acceleration and the right to assert in the foreclosure proceeding the non-existence of a default or any other defense of Borrower to acceleration and foreclosure. If the default is not cured as specified, Lender, at its option, may require immediate payment in full of all sums secured by this Security Instrument without further demand and may foreclose this Security Instrument by judicial proceeding. Lender shall be entitled to collect all expenses incurred in pursuing the remedies provided in this paragraph 21, including, but not limited to, attorneys' fees and costs of title evidence to the extent permitted by applicable law. 22. Release. Upon payment of all sums secured by this Security Instrument, this Security Instrument and the estate conveyed shall terminate and become void. After such occurrence, Lender shall discharge and satisfy this Security Instrument without charge to Borrower. Borrower shall pay any recordation costs. 23. Waivers. Borrower, to the extent permitted by applicable law, waives and releases any error or defects in proceedings to enforce this Security Instrument, and hereby waives the benefit of any present or future laws providing for stay of execution, extension of time, exemption from attachment, levy and sale, and homestead exemption. 24. Reinstatement Period. Borrower's time to reinstate provided in paragraph 18 shall extend to one hour prior to the commencement of bidding at a sheriffs sale or other sale pursuant to this Security Instrument. 25. Purchase Money Mortgage. If any of the debt secured by this Security Instrument is lent to Borrower to acquire title to the Property, this Security Instrument shall be a purchase money mortgage. 26. Interest Rate After Judgment. Borrower agrees that the interest rate payable after a judgment is entered on the Note or in an action of mortgage foreclosure shall be the rate payable from time to time under the Note. .. -6RIPAl19105l '" Form 3039 9/90 Page 5 of6 Initials: 27. Riders to this Security Instrument. If one or more riders are executed by Borrower and recorded together with this J Security Instrument, the covenants and agreements of each such rider shall be incorporated into and shall amend and supplement the covenants and agreements of this Security Instrument as if the rider(s) were a pan of this Security Instrument. [Check applicable box(es)] D Adjustable Rate Rider D Graduated Payment Rider I1(X] Balloon Rider DV.A. Rider D Condominium Rider D Planned Unit Development Rider D Rate Improvement Rider [X] Other(s) [specify] Legal D 1-4 Family Rider D Biweekly Payment Rider D Second Home Rider BY SIGNING BELOW, Borrower accepts and agrees to the terms and covenants contained in this Security Instrument and in any rider(s) executed by Borrower and recorded with it. Witnesses: Richard A. Neff (Seal) .Borrower (Seal) Kenneth A. Laubach -Borrower (Seal) -Borrower (Seal) Carrie I. Laubach -Borrower Certificate of Residence I, the within-named Mortgagee is , do hereby certify that the correct address of Witness my hand this day of Agent of Mortgagee COMMONWEALTH OF PENNSYLVANIA, County ss: On this, the personally appeared day of , before me, the undersigned officer, known to me (or satisfactorily proven) to be the person whose name subscribed to the within instrument and acknowledged that executed the same for the purposes herein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. My Commission Expires: Title of Officer 4G: -6R{PA) (9105) ., PagEl 6 of 6 Form 3039 9/90 lJ'3UOIJ4"1"1 oJ i ' ~ BALLOON RIDER (CONDITIONAL RIGHT TO REFINANCE) THIS BALLOON RIDER is made this Nineteenth day of March 1996 , and is incorporated into and shall be deemed to amend and supplement the Mortgage, Deed of Trust or Deed to Secure Debt (the "Security Instrument") of the same date given by the undersigned (the "Borrower' ') to secure the Borrower's Note to columbia National Incorporated (the "Lender") of lhe same dale and covering the property described in the Security instrument and localeu at: 3818 Chippenham Rd. Mechanicsburq, PA 11055 [Propeny AllJressJ The interest rate stated on the Note is called the "Note Rate." The date of the Note is called the "Note Date." I understand the Lender may transfer the Note, Security Instrument and Ihis Rider. The Lender or anyone who takes the NOle, the Security Instrument and this Rider by transfer and who is entitled to receive payments under the Note is called the "Note Holder." ADDITIONAL COVENANTS. In addition to the covenants and agreements in the Security Instrument, Borrower and Lender further covenant and agree as follows (despite anything to the contrary contained in the Security Instrument or the Note): t. CONDITIONAL RIGHT TO REFINANCE At the maturity date of the Note and Security Instrument (the "Maturity Date"), I will be able to obtain a new loan ("New Loan") with a new Maturity Dale of 04/01/03 ,and with an interest rate equal to the "New Note Rate" determined in accordance with Section 3 below if all the conditions provided in Sections 2 and 5 below are met (the "Conditional Refinancing Option"). If those conditions are not met. I understand that the Note Holder is under no obligation to refinance or modify the Note, or to extend the Maturity Date, and that I will have to repay the Note from'my own reSources or find a lender willing to lend me the money to repay the Note. 2. CONDITIONS TO OPTION If I want to exercise the Conditional Refinancing Option at maturity. certain conditions must be met as of the Maturity Date. These conditions are: (1) I must still be the owner and occupant of the property subject to the Security Instrument (the "Property"); (21 I must be current in my monthly payments and cannot have been IDQre than 30 days late on any of the 12 schedu ed monthly payments immediately preceding the Maturity Date; (3) no lien against the Property (except for taxes and special assessments not yet due and payable) other than that of the Secunty Instrument may exist; (4) the New Note Rate cannot be mor~ than 5 percentage points above the Note Rate; and (5) I must make a written request to the Note Holder as provIded in Section 5 below. 3. CALCULATING THE NEW NOTE RATE The New Note Rate will be a fixed rate of interest equal to the Federal National Mortgage Association's required net yield for 3D-year fixed rate mortgages subject to a 6O~"day mandatory delivery c~mmitment, plus one-half of one percenlage point (0.5%). roundea. to the nearest one-eighth of one percentage pomt (0.125 %) (the "New Note Rate"). The required net yield shall be the applicable net yield in effect on the date and time of day that the Note Holder receives notice of my election to exercise the Conditional Refinancing Option. If thiS ~equired. net yield is not available, the Note Holder will determine the New Note Rate by using comparable mformatlOn. 4. CALCULATING THE NEW PAYMENT AMOUNT Provided the New Note Rate as calculated in Section 3 above is nOl greater than 5 percentage p'oints above the Note Rate and all other conditions required in Section 2 above are satisfied, the Nole Holder Will determine the amount of the monthly payment Ihat will be sufficient to repay in full (a) the unpaid p'r\ncipal, plus (b) accrued but unpaid interest, plus (e) all other sums I will owe under the Note and Security Instrument on the Maturity Date (assuming my monthly payments Ihen are current, as required under Section 2 above), over the term of the New Note at the New Note Rate in equal monthly payments. The result of this calculation will be the amount of my new principal and interest payment every month untillhe New Note is fully paid. 5. EXERCISING THE CONDITIONAL REFINANCING OPTION The Note Holder will notify me at least 60 calendar days in advance of the Maturity Date and advise me of the principal. accrued but unpaid interest, and all other sums I am expected to owe on the Maturity Date. The Note Holder also will advise me that I may exercise the Conditional Refinancing Option if the conditions in Section 2 above are met. The Note Holder Will provide my payment record information, together with the name, title and address of the person representing the NOIe Holder that I must notify in order to exercise the Conditional Refinancing O~ion. If I meet the conditions of Section 2 above, I may exercise the Conditional Refinancing Option by noti ing the Note Holder no later than 45 calendar days prior to the Maturity Date. The Note Holder will calculare t e fixed New Note Rate based upon the Federal National Mortgage Association's applicable published reql!-ired n~t yield in effect ~n the date and lime of day notificatio~ is received by the Note Holder and as calculated In Section 3 above. I Will then have 30 calendar days to prOVide the Note Holder with acceptable pr:oof of. my required own~rship, occupancy and property lien status. Before the Maturity Date the Note Holder Will adVise me of the new Interest rate (the New Note Rate), new monthly payment amount and a date, time and place at which I must appear 10 sign any documents required to complete the required refinancing. I understand the Note Holder will charge me a $250 processing fee and the costs associated with updating the title insurance policy. if any. BY SIGNING BELOW, Borrower accepts and agrees to the teOlls and covenants contained in this Balloon Rider. (Seal) -Borrower Kenneth A. Laubach (Seal) Richard A. Neff -Borrower (Seal) -Borrower (Seal) -Borrower {Sign Original Only] Form 3180 12/89 Carrie I. Laubach MULTISTATE BALLOON RIDER - Single Family - Fannie Mae Uniform Instrument ..~ .872191051 \IMP MORtGAGE FOAMS _13131293_8100 - 18001521"7291 490798 ::r::JJJJJJI AMORTIZATION SCHEDULE ASSUMPTIONS First Payment Date 01-May-96 Principal Borrowed $160,000 Term in Months 360 Beginning Interest Rate 6.000.'" Payment $959.28 Bi-Weekly Payment AMORTiZATION TABLE Payment Payment Curren! Payment Interest Principal Principal Number Date Rate Amount Portion Portion Balance 1 01-May-96 6.000% $959.28 $800.00 $159.28 $159,840.72 2 01-Jun-96 6.000% $959.28 $799.20 $160.08 $159,680.64 3 01-Jul-96 6.000% $959.28 $798.40 $160.88 $159,519.76 4 01-Aug-96 6.000% $959.28 $797.60 $161.68 $159,358.08 5 01-Sep-96 6.000% $959.28 $796.79 $162.49 $159,195.59 6 01-0ct-96 6.000% $959.28 $795.98 $163.30 $159,032.29 7 01-Nov-96 6.000% $959.28 $795.16 $164.12 $158,868.17 8 01-Dec-96 6.000% $959.28 $794.34 $164.94 $158,703.23 9 01-Jan-97 6.000% $959.28 $793.52 $165.76 $158,537.46 10 01-Feb-g7 6.000% $959.28 $792.69 $166.59 $158,370.87 11 01-Mar-g7 6.000% $959.28 $791.85 $167.43 $158,203.44 12 01-Apr-97 6.000% $959.28 $791.02 $168.26 $158,035.18 13 01-May-97 6.000% $959.28 $790.18 $169.10 $157,866.08 14 01-Jun-97 6.000% $959.28 $789.33 $169.95 $157,696.13 15 01-Jul-97 6.000% $959.28 $788.48 $170.80 $157,525.33 16 01-Aug-97 6.000% $959.28 $787.63 $171.65 $157,353.67 17 01-Sep-97 6.000% $959.28 $786.77 $172.51 $157,181.16 18 01-0ct-97 6.000% $959.28 $785.91 $173.38 $157,007.78 19 01-Nov-97 6.000% $959.28 $785.04 $174.24 $156,833.54 20 01-Dec-97 6.000% $959.28 $784.17 $175.11 $156,658.43 21 01-Jan-98 6.000% $959.28 $783.29 $175.99 $156,482.44 22 01-Feb-98 6.000% $959.28 $782.41 $176.87 $156,305.57 23 01-Mar-98 6.000% $959.28 $781.53 $177.75 $156,127.82 24 01-Apr-98 6.000% $959.28 $780.64 $178.64 $155,949.18 25 01-May-98 6.000% $959.28 $779.75 $179.53 $155,769.64 26 01-Jun-98 6.000% $959.28 $778.85 $180.43 $155,589.21 27 01-Jul-98 6.000% $959.28 $777.95 $181.33 $155,407.87 28 01-Aug-98 6.000% $959.28 $777.04 $182.24 $155,225.63 29 01-Sep-98 6.000% $959.28 $776.13 $183.15 $155,042.48 30 01-0ct-98 6.000% $959.28 $775.21 $184.07 $154,858.41 31 01-Nov-98 6.000% $959.28 $774.29 $184.99 $154,673.42 32 01-Dec-98 6.000% $959.28 $773.37 $185.91 $154,487.51 33 01-Jan-99 6.000% $959.28 $772.44 $186.84 $154,300.67 34 01-Feb-99 6.000% $959.28 $771.50 $187.78 $154,112.89 35 01-Mar-99 6.000% $959.28 $770.56 $188.72 $153,924.17 36 01-Apr-99 6.000% $959.28 $769.62 $189.66 $153,734.51 37 01-May-99 6.000% $959.28 $768.67 $190.61 $153,543.90 38 01-Jun-99 6.000% $959.28 $767.72 $191.56 $153,352.34 39 01-Jul-99 6.000% $959.28 $766.76 $192.52 $153,159.82 40 01-Aug-99 6.000% $959.28 $765.80 $193.48 $152,966.34 41 01-Sep-99 6.000% $959.28 $764.83 $194.45 $152,771.89 42 01-0ct-99 6.000% $959.28 $763.86 $195.42 $152,576.47 43 01-Nov-99 6.000% $959.28 $762.88 $196.40 $152,380.07 44 01-Dec-99 6.000% $959.28 $761.90 $197.38 $152,182.69 45 01-Jan-00 6.000% $959.28 $760.91 $198.37 $151,984.32 $35,151.96 46 01-Feb-00 6.000% $959.28 $759.92 $199.36 $151,784.97 47 29-Feb-00 6.000% $959.28 $758.92 $200.36 $151,584.61 48 28-Mar-00 6.000% $959.28 $757.92 $201.36 $151,383.25 49 28-Apr-00 6.000% $959.28 $756.92 $202.36 $151,180.89 50 28-May-00 6.000% $959.28 $755.90 $203.38 $150,977.51 51 28-Jun-00 6.000% $959.28 $754.89 $204.39 $150,773.12 52 28-Jul-00 6.000% $959.28 $753.87 $205.42 $150,567.70 53 28-Aug-00 6.000% $959.28 $752.84 $206.44 $150,361.26 54 28-Sep-00 6.000% $959.28 $751.81 $207.47 $150,153.79 55 28-0ct-00 6.000% $959.28 $750.77 $208.51 $149,945.27 56 28-Nov-00 6.000% $959.28 $749.73 $209.55 $149,735.72 57 28-Dec-00 6.000% $959.28 $748.68 $210.60 $149,525.12 58 28-Jan-01 6.000% $959.28 $747.63 $211.66 $149,313.46 59 28-Feb-01 6.000% $959.28 $746.57 $212.71 $149,100.75 60 28-Mar-01 6.000% $959.28 $745.50 $213.78 $148,886.97 61 28-Apr-01 6.000% $959.28 $744.43 $214.85 $148,672.12 62 28-May-01 6.000% $959.28 $743.36 $215.92 $148,456.20 63 28-Jun-01 6.000% $959.28 $742.28 $217.00 $148,239.20 64 28-Jul-01 6.000% $959.28 $741.20 $218.08 $148,021.12 65 28-Aug-01 6.000% $959.28 $740.11 $219.18 $147,801.94 66 28-Sep-01 6.000% $959.28 $739.01 $220.27 $147,581.67 67 28-0ct-01 6.000% $959.28 $737.91 $221.37 $147,360.30 68 28-Nov-01 6.000% $959.28 $736.80 $222.48 $147,137.82 69 28-Dec-01 6.000% $959.28 $735.69 $223.59 $146,914.23 70 28-Jan-02 6.000% $959.28 $734.57 $224.71 $146,689.52 71 28-Feb-02 6.000% $959.28 $733.45 $225.83 $146,463.69 72 28-Mar-02 6.000% $959.28 $732.32 $226.96 $146,236.72 73 28-Apr-02 6.000% $959.28 $731.18 $228.10 $146,008.63 74 28-May-02 6.000% $959.28 $730.04 $229.24 $145,779.39 75 28-Jun-02 6.000% $959.28 $728.90 $230.38 $145,549.01 76 28-Jul-02 6.000% $959.28 $727.75 $231.54 $145,317.47 77 28-Aug-02 6.000% $959.28 $726.59 $232.69 $145,084.78 78 28-Sep-02 6.000% $959.28 $725.42 $233.86 $144,850.92 79 28-0ct-02 6.000% $959.28 $724.25 $235.03 $144,615.89 80 28-Nov-02 6.000% $959.28 $723.08 $236.20 $144,379.69 ROjU0k-~ V{~ .:tJ. cJW.oro ~crA .It J2lS,Ux., 'M"Ysf; I~-L~d $ ')~1, /)-00 ~dj v:,hJ ~ o-Q}..\Q jl a30 I<- Multilist examples of homes sold in the Kingswood area You will see examples from 07/0211999 to 05/08/2000 1004 Baythorne Kingswood Development Built: Data not provided however, this property is ~ same section as subject Sa1esPrice$194,000 ~U""W iJ~ T ~dOo c /I ,;JOd/,6(J() Sold: 07/02/1999 approx 400 SF smaller than subject 1007 Kent Highlands of Hampden Development Built 1988 same year as subject Sold: 12/13/1999 4t Sales Price: $240,000 - ,).35>000 Approx 200+ SF larger than subject ($20 square feet value range = value of$235,000) - i11~1~ E1u,:) OEV8-<.'FIYlFi/T ffiuc!.QJY'0 'S~ ~ o-Oj u:,li(YlQ.~ ~ SL>CD 1~09 Chippenham Road Adctl tHI'()(:0 ~dJ'lJ..S~~ Kingswood Development p 'if, . Built 1990 Two years newer than subject (adjusted val e $234,500) jC!a'l' JIO"~ ~;V~..f.. Sold: 05/08/2000-.it StJ7YO f tHQJ2.t bCl.a'~L(" Sales Price $239,000 (adjusted value $23~,500) ":;Do Approx, same square footage iZ9:p - .fJ oere:, ,.;I J '1. ") d~9, ~Ull 3806 Dorset Kingswood Development Built 1991 Three years newer than subject Sold: 06/23/2000 If ell "\1- _ Sales Price: $242,000 'cL.:Jb ,OlD w '^^ "'" ,~.~_. +\-'on o"h;p~t ('l:?O omlHre feet value range;;; value of ,\II- _, "IItIJ . f. rcharz;l neM BoP -3 ~ 18' ~qo em hCl1'V\ . c- roeD~QJYllhJ bwvj. -p)- /( 0;.) 0 f Of'.241UOO LP-Z499Oll $P.239.OO0 MunHAMPDEN De~ DirORltSBR E LF I IPP NHAM NRGH r lo z11tlX10f6 krO,OQ '(f6\\ lVI_ HAL E)(\8It1CK,VlNYl TotSQFtll46 P m U FI H" r 'File I 18r4 .Bth:F2 H1 IRma 10 Tax3110 Yr1m Fee Lvi Apl.,Sl LvI Apx,St Api . W H ,0 ER LR M 13X16 MBflU 13Xt7 OthRmFAMllYROOM,OFF1Cf/CQMPU' DR M 13Xf3 GRl U 13X14 Haat HEAT PUMP FR M UI(Z1 BR2 U 13X13 Coo\tElftRAi..Alfl WarY DEN M l1Xl3 SRJ U l1Xf3 IntF WALK-IN ClOSn5.S0ME WIND' KI 1 SR4 Wt wPUBUC EWfRPUBLlCWATER BII FRONT RBEDR MlAR LOT&SlOEUmV GARAGE IS WAITING FOR YOUr LARGE MASTER BEDROOM SUITE, CATHEDRAL CE:IUNGS. 1ST FLOOR DEN, OVER "OOSE KITCHEN WICHEMY CA81N!!TS, CENTER ISLAND, JENN AIM: RANGE, \HoGROUNDJlOOL AND faa. ~ @ ~ ',,1lO9 t\W'llf.MlAM ROAD "m6 MLS.,0048683 1 (j). !Mun HAMPDEN Dav K1NGSWOOO Sch CUMB i 'IDir WEST ONM..!i!KET RIORRS BRIDGE RIGOLFIEW l/CHIPp{NI1AM ~_.__I 0" _JLotS,mxm Atrl).i2 '1r13lt.:-19Wi !StyleTRAOmONAL t.:tVINYL TutSqF\2$10 OWNER iBsmt FUllGARAGE A' .~VDORfTT3.CARGAR ____~.r \#814 #Bth:F2 Hl #Rmsl0 ,Ta;2153 Y(19!l8199 feelS ' ,l~1 Ap~,Sl lvl ApA.Sl IApIRANGE,DISHWASHER,oisPOSAL -l iLR M 14X15 MBR U 15X1S IOthRm FAMILY ROOM,FOYER,LAUNeR' ~DR M 13X13 BAl ~H~otFORCEOAIR,GAS , iI-A M 15~18 BR2 U m:ll jCooICfNTRALA1R WoIN: IDEN BR3 U 10Xta lintFWALK.1NCLOSETS,SKVUGHT,' I 1m M 16X20 BR4 U 21X19 Wt5wPUBLlCSEWERPUBLlCWATER ',CAREO FORWn'H PP.\OE ,'I \lWKEAS. T\1\S FOUR 8E.DROOM, 2,5 BATH 'I-HOME HAS AN OVERSIZED THREE CAR GARAGE WITH TALL DOORS MASTER SUITE WITH WHIRLPOOl.. TUB & SHOWER WITH STEAM SYSTEM SECOND FLOOR BOASTS FOUIl.SKyUQH.TS,I..AUNORV &~TIt8EORM OytR GARAGE. KITCHEN WITH CENrnlISlANO CN'fN TO FAMILY RM WITH FIREPlACE INTEIlCOM WAlkO Sf FROM BASE NT T GARAGE City MECHAN S RG LBx CP B L 001 161-A800 SAC 3 BAC3 OAC TLC LTERS LACQSTELLOTIM l1~80LA2 "' SAC, aAC' l8xCPl.& OAO 532-.8120LA2 LO UG1181-4BOO TLC3 LTERS -.'n'. \~\I'I ~'(" 'h I t the .,n'ntrnation here given is correctly copied from an original certificate of deHh duly filed with liS IS to cerol/ t 13 [I '- . ,-' - '--.'~' rr Local Registrar. The original certificate will he forwarded to the State Vital Records Othce tor permanent I mg, WARNING: It is illegal to duplicate this copy by photostat or photograph. me as 6237203 lfIi/iimm~~~IIIII~ ,""'~~\\" Of PEl..... " ~y~4'.F~. ~l~/_ ,~~ _ ."\'1-.\ l~~!'lI'~,~' ~:JEI . .~ \~~ ~~Id,. ,Ii;;~ ::. "'-". ,'I ~~ . ... ~ \*'.~~ -,'..-~'_... ..~/*~ \a >~-' I~l '"~ -- (~\\\ .'-~"!,p,MfNT~{~':""'" I;"'''~#/#/''IIJI'III a.').?/;l'l!~> /I:?-". v:;--/ /a,.~,-<,........7..~~l,.' /~'!_~.1.:(~ Fee for thlS certificate, $2,00 Local Registrar No. ! .\ ~, ~ 1 0;')'" I Date tf 7;'\~n o ::~J -.".( IRa. 1191 621-0S--0i../73 COMMONWEALTH OF PENNSYlVANIA. DEPARTMENT OF HEAL"TH. VITAL RECORDS CERTIFICATE OF DEATH (Coroner) f",,':' (,)'i Hampden 3818 Chippenham Road '" 2,Female STATE FI~E NUMBER SOCIALSECURIT'l' NUMBEA NAME OF DECEDENT (Fi<,t. Mlools. la>!) Carrie I Laubach , 2 4 AGE(l~SI B,rthday) UNDER 1 I'EAR Momhs 'Days UNDER 1 DAI' HOlJrs MinlJleS DATE OF BIRTH IMnnlllDa,'.Yea<l BIRTHPLACE lC"y and PLACE OF DEATH (eh"". Mly o,le see IOS'hJct,o",.m othe, .~d9) Slal9o<FOIeigroCQU"r'Y1pA iiO$PITAL IOpa1l9ntr1 ... fACILlTI'NAME(rl"ol""lil""Ofl.~i'-9S\[eal."'dn"n.Lcr) 7.Mec..han.{c.-,~bwr EAIOulpalianl [] DOA[] Re..dencel)l g~="YID f\"'CE-"'lY'9Iic9nln~i,n.Blac.,WhH9,elc (Spedy) 87 ,,, ug.ll,1912 , COUNTI' OF DEATH Cumberland CITY. BOA P FDEATH " WhLte MAf\\TAl5TATUS-Matlied SURVIVING SPOUSE Never Ma"ied,Wido.,ed, {II wile. \JIve rndic!en name) Di.Q,ced(Spocil,') 14. W.i..dowed Her) YeS,decede[lIIL.edin~ Hampden Twp. '"" DECEDENTS USUAL OCCUPATION \~;":;'1~gtt9~~O(j~~eu'~';~?r~JI1 ,,,Bookf1eepeJt!SeCAetM '" Wesunghou~e DECEOEN1'S MAJllNG i\OORE$S\SI,_. Ciiyl1o-"" Sw\e. ZIf!Code) DECEDENTS ACTUAL RESIDENCE (S~'<llC,SIIlJ",iofls onon'CI,.ae) KIND OF BUSINESSIINDUSTRI' WASDECEOENTEVERIN us ARMEO FORCES? l'eoO NO~ .. " 17..Slale PA 3818 Ch~ppenham Road ". Mechan~c~bWlg, PA 17055 FATHER'SNAMf(hSl,Mldale.I asl) 17b,CoUOI Cu.mbe~land Did ~eeede,," ilveilla townShip? l?d.O ~~h~e~~I~:'I'\'~i~~ of city/bOlO '" To\het>eololmy'nowledge.dealhoccu"edatlhetime.daleandplaceslaled IS'(Iro"I,"oanaT,tI~1 " INFOAMANT' MAIUNGADDR S IS""~I,City owro,5Iale.ZipCoda) '" 3818 Ch~ ~"h"-m Road Meeh"-Yl.ic-,bWlg. PA 17055 PLACE OF DISPOSITION. Name of.Cemele')'. Clem~wry LOCATION - CityfTown, Slale, ZIP Code olOth.'PI~ee Ckemat--<'On :jOc...tety 0 2'e PA CJtematox 21d HaJrltl-6buJr. , PA 77109 NAMEANOADDRESSOFFACILlTY C/[ema.t-i.on Soc.i..ety at. PA '" 4100 Jonestown Rd HMlt.chbWl p~ 17109 liCENSE NUMBER OATESIGNED (M,"'lh,Oay,l'ealJ " INFDRMANT'SNAME(Tvp~!PIlr'I) ". 11ME OF DEATH -prx. OATE PRONOUNCED DEAD ~Monlh Day_ Year) 24 2: 00 A. M 25. January 9, 2000 27. PART I: Enlel Ihe di.u.es, injurieSOI compliealiOll' whiCh caused 1M ooalh. Do MlS,,"'" lOO"~ <>l <1yi(\Q, ~I>C"<.$ ca'<1iac 01 le,pilalory aHe"l, SnOCK 01 nearllailule llSlonlyonecau'eMeachi.ne 23.b. l~c. WAS CASE REFERRED TO MEDICAL EXAMiNER/CORONER? ,..I\l(FV NoD IMMEOIATECAUSEIF"\~1 <l''''a""mw~dl(JUro '''''''~,n\lll1(j~a\l')-''' Occlusive Coronary Axtery Disease DUE TO (OR ASACONSEOUENCE OF) ". :App,o.imale r",le"'al~elweefi ion.elan<ldeath PI\.RTU: Olhe,.i\lfiificanl eonditio~.eon"ibulin\ltodeeth.bul nol re.lJltin\l in Ihe unde,lying cauSe \Ii.e" in PART I Sequenlrallyll.,c.ond,uOIl' \\..,,~, leil<lingl<>imm<I<1IM" calJ...Ente,UNDERLYING CI\.USE IDI",aS<J 01 "'Iu'y Illatln,l,at€Je""rlIS res"",nQI"ue<lll,)lAS.T DUl':. TO lOR AS 1\ CONSEQUENCE OF) '. DUETO(ORASACON$EOUENCEOF) WAS AN AUTOPSI' PERFORMED? , WEREAUTOPSVFINDINOS AI/AIl.A6lE PRIOR TO COI.IPlETlONOFCMJ5E OFDEATli? MANNEAOF DfATH NatlJral i:& II [I DATE OF IN.JURV (M(lnlh Day.l'ea.) TIME OF IN.JURI' INJURI' AT WORK? DESCRIBE HOW INJURI' OCCURREO HomiCide o o 30~. 30. M. D PLACE OF iNJURI' - AI home, la(m. Weel, faclory. oMice buiidln\l,alc.(Sp0Cd1J 30~. I'~. 0 NoD Yes [1 ,o~ YuO ml'9 Accld9nl Pend,n\lIMeSli\leuon ~. LOCA110N(Sll""t, CilylTown, Slala) 2B.. 28b. CERTIFIER ICI,..-;I< on1i one) "CER1lFYlNG PHYS1CIM4 \l'1'.y~"""" ""'l'\Yo,\) G""w '0 d~,,\\\ w)'en arounle' ph\,",~"'" Ila' (jr<mounceu J"~lh anc:l compleled Il~rn lJ) T<>lhet><>.IOlmy.ni>wledlle,dealhoc<,u",l<ld"eloltleceu.elljan<lma""",..alalad,. S"iclde " Co"I<I"olbadelelmina<l [J Coroner "PRONOUNCING AND CEAT IFYING PHVSICIAN (pHv"e,,,,, W~\ ~'o<\O<.>!v:.><'Il <i9~U, D\\<1"I>'\"Y"'\j \<0 cau,"", I>t <.'1""\\\) To ihe bUI of my knowh!dge, delltl oe~urred allheUme, dele. end pl.ce, M"d due to Ih. cause(a) .nd mann.. aa 81eled. DATESIG.NED(IWl,\(l\,o..y.Y"-"'l o HC. 31d. Jan. 10, 2000 NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH (11~m27)TypeoIP'int Michael L. Norris~ Coroner ~ 6375 Basehore Road, Suite 1 )"'\32. Mechanicsburg. Pa. 17055 DATE FILED (Momh. Day, V~a<l "MEDiCAL EXAMINER/CORONER Onlhe ba.leOf....ml...aUOO."d/or l"veellg.Uon, I" myoplnhlll,deal 1I0cCurred.llllelime,dale,end plllee,aoddue lolheeauBe{a) an d manner IUI sl.ted.. '" REGISTR~SIGNATUREANONUM6ER ~I/I/ I " . ~. ..-0/ ~_ ". ~/.l d~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128~0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REAGER DAVID W ESQ 2331 MARKET ST CAMP Hill, PA 17011 ---fold ESTATE INFORMATION: SSN: 203-09-0464 FILE NUMBER: 2105-0473 DECEDENT NAME: lAUBACH CARRIE I DATE OF PAYMENT: OS/25/2005 POSTMARK DATE: OS/24/2005 COUNTY: CUMBERLAND DATE OF DEATH: 01/09/2000 NO. CD 005364 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,998.68 I I I I I I I I TOTAL AMOUNT PAID: $2,998.68 REMARKS: CHECK# 5416 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS