HomeMy WebLinkAbout01-0764
also known as
PETITION FOR GRANT OF LETTERS
No. s:2,1- [) I - 7~ ~
,-tLf - \ ?).:s
Social Security No. 196 1.4 82 ~
, Deceased
Estate of BERNICE P. SCOTT
Petitioner(s), who is/are 18 years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
Gl
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ors
Decedent, dated 6/3/70 and codicil(s) dated None
Decedant's husband and first named executor, Herbert L. Scott died prior to her death
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
o
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
I
Name
Relationship
Residence
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at 7 North HiQh Street, NewburQ, Pennsylvania (NewburQ BorouQh)
(list street, number and municipality)
Decedent, then 91 years of age, died July 29 ,2001 , at Swaim Health Center, Newville, Pa.
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property......................................... $
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in PA Personal property in County.............................. $
Value of real estate in Pennsylvania ....... ......... ........... .......................... ................................... $
Total ....................... ...... .......... .................................................. ............................ $
Real Estate situated as follows: 7 North HiQh Street, NewburQ, Pa.
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
500.00
19,200.00
19,700.00
Typed or printed name and residence
Gerladine L. Wheeler 5 North Hi h Street Newbur Pa.
Chester Wheeler 5 North Hi h Street Newbur Pa.
RW-1
//-.J I - if
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner( s) and that, as personal representative( s) of the
Decedent, Petitioner(s) will well and truly administe.rr ~ h slale aCCO~din~l~ ~. . JJ. f),
Sworn 10 and affirmed and subscribed 11 JI "1.C{/~ff-< J.-;.<cr< d!1L I f(~
before me this /7 day of /) j -I)- I I I f)
Auaust. 2001 L:I1.JU;~_ IfJI? t/./~
ryNy0jJ.lj?~)~'~ ~ ~ UH
DECREE OF REGISTER
Estate of BERNICE P. SCOTT
also known as ~t1
Social Security NO:.,e-14-U~ I q6 --fl(-O;);;.J Date of Death: 7/~9/D1
AND NOW,~TOBER_ 5. 2001 I in consideration oHhe Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters W Testamentary 0 of Administration
Deceased
21-01-764
No.
((c.t.a., d.b.n.c.t.; pendente lite; durante al5!entia; durante minoriate)
are hereby granted to Geraldine L. Wheeler and Chester Wheeler
in the above estate and that the instrument(s), if any, dated June 3, 1970
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters............. .......................
Short Certificates(s) ...............
Renunciation ..........................
Extra Pages (
) ...............
I. T. Roo.....................................
JCP Fee .................................
Inventory ................................
Other ......................................
TOTAL............................ .$
$
50.00
7~7~~~'l~"j~;/ 4--~'{
Reg er of Wills
$
$
$
$
$
$
$
$
6.00
3.00
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Signature
5.00
Attorney: Adams H. Anthony
1.0. No: 25502
Address: 128 East KinQ Street
ShippensburQ
Telephone: 5323270
DATE FILED:
Pa 17257
64.00
21-01-764
OATH OF NON-SUBSCRIBING WITNESS
Geraldine L. Wheeler and Chester Wheeler
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that they each
, testat ~ of (one of the
familiar with the signature of Bernice P. Scott
codicil
subscribing witnesses to) the will presented herewith and that each
codicil
will is in the handwriting of Bernice P. Scott to the best of their
~kk.-~, ~(
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believes the signature on the
knowledge and belief.
Sworn to or affirmed and sub-
scribed before me this 17
day of
~
(Name)
1I)<;.1l()<; Q.I''' ClI~r;
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
7619156
No.
21-01-764
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:ea! Registrar
JUL 31 2001
Date
;....2117
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
NAME cw DECEDENT If".. M_. las,
1.
SEX
. c.e. P. Sc.oti
UNDER 1 YEAR UNDER 1 OM
Monltla Daye Holn!..--
v... .
Fe.male
AGE (I... ~yt
~: a 91
. .COUNTVCW DERH
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bvr.la.nd
DECEOENT'SUSUAL OCCUMION
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Old
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MOTHER'S NAME (""'II. MocldIeo ....... Surnamel
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210.
ICENSE NUM8ER
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DUE 10 (OR AS ACONSEOUENCE OF):
to ASCv},. A 0.. PIS
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DUE 10 lOR AS" CONSEQUENCE Of):
DUE 10 (OR AS A CONSEOUENCE OF):
-.s AN AU10PSY WEAE AU10PSY fINDINGS =ROFo;! DATe OF IHJUAY
PEftFOflfoIE07 MULA8LE Pl'lIOfllO (Month. Day. _,
COW'lIET1OH CWCAUSE
CW DEATH? Homicide
No~ Accidenl 0 1"encIng~1on
..0 ..0 NoDI Suicide 0 COuld IIllllle daIennIned
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CUlT..... ~ only DMl
'CEllTII'YINQ PHYSlClAM (Ph,-~ ~oIllHlh _ _llhytlC..... has pronounced delIIIIlIIl<I cam~ nem 231
Te............,.....-..._______...CIIUM(.)II...._......................... 0....................................
'PIIONOUNClHG AND CUtTIFYING PHYSICIAN IPhytIcllIn boIh ;lI'onoutIC"'O 0Mlh lIf>d cer1llyvlo.. c.... 01 "''''''1
To 1M..... oI-.y 1Inowte4ge, 1IH1IIOCCIIIfM .......... .Ie. ..... phlce. ..... _ to... cauM(.) ..... mann...UllI_.. . . . . . . . . . . . .. . 0 . 0 . . . . . . .
'MEDICAL EXAlllNEAlCORONEA
On !he"'" of .....Inatlon andIfItr Invesllgation,In my opinion. death occurred alllle time. dat.. and place. and due to ItIe UUM(S) and
_ as ...teel.. . . . . . . . . . . . . . .. . . . . . ... .. . . . . . . . . . . .. .. . . ... . . .. . .. . . . ... . . . . . . . . . . . .. . .. .. . . .... . . . . . .. . . . . . . . .
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AEGISTRAR'S S1GNAfURE AND NU"BER
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W\S CASE REfERReD TO MEDICAl
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INJURY J{I WORK? 0ESCAI8E HOW INJURY OCCURRED.
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21-01-0764
LAST WILL AND TESTAMENT
I, BERNICE P. SCOTT, of the Borough of Newburg, Cumberland County t
Pennsylvania, being of sound mind, memory and understanding, do make and
publish this my Last Will and Testament, hereby revoking and making void
any and all former wills by me at any time heretofore made.
FIRST. I direct my hereinafter named Executor to pay all my just debts and
funeral expenses as soon as conveniently may be after my decease.
SECOND. I give, devise and bequeath all my property, real, personal and
mixed, whatsoever and wheresoever situate, to my beloved husband, HERBERT L.
SCOTT, absolutely.
THIRD. I hereby nominate, constitute and appoint my said husband, HERBERT L.
SCOTT, the sole Executor of this my Last Will and Testament.
FOURTH. Provided however, that if my said husband, HERBERT L. SCOTT t should
predecease me or if we should die in a cammon disaster, then in either of
said events, I give, devise and bequeath all my property, real, personal and
mixed, whatsoever and wheresoever situate, to my daughter, GERALDINE L.
WHEELER, and my son-in-law t CHESTER WHEELER, or the survivor of them; provide
further, that in the event my said husband, HERBERT L. SCOTT, should pre-
decease me or if we should die in a cammon disaster, I hereby nominate,
constitute and a.ppoint my daughter, GERALDINE L. WHEELER, and my son-in-law,
CHESTER WHEELER, or the survivor of them, to be the Executors of this my Last
Will and Testament t the said Executors to have full power and authority to do
any and all things necessary for the complete administration of my estate,
inclUding the power to sell any and all real and personal property of which
I may die seised, at public or private sales, in their discretion, and
without any Order of any Court, and I further request my said Executors not be
required to file any Bond in connection with the settlement of my said Estate.
~7 \ P
, Y) {t9<nL-cC
k-~tt-
(SEAL)
IN WITNESS WHEREOF, I, BERNICE P. SCOTT, have hereto set my hand and
seal to this my Last Will and Testament, written on two (2) sheets of paper,
this
J--'<. cl day of
:J IA~rUc. · 1970.
8~{ p c-d~
( SEAL
Signed, sealed, published and
declared by BERNICE P. SCOTT,
the Testatrix, as and for her
Last Will and Testament, written
on two (2) sheets of paper, in
the presence of us who have t at
her request, signed our names
as witnesses hereto in the presence
of the said Testatrix and of
each other.
-2-
E
CERTIFICATION OF NOTICE UNDER RULE 5.6'a)
Name of Decedent: Scott Bernice P.
Date of Death: 7/29/01
Will No.
Admin. No. 2001-00764
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 1/3/02
Name Address
Geraldine L. Wheeler 5 North High Street
Newbura Pa 17240
Chester Wheeler 5 North High Street
Newbura Pa 17240
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
None
Date: 1/3/02
Name: 128 East Kina Street
Address:
Shiopensburg
Pa 17257
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Personal Representative
Counsel for Personal
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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
ADAMS H ANTHONY
128 EKING ST
SHIPPENSBURG, PA 17257
-------- fold
ESTATE INFORMATION: SSN: 196-14-0223
FILE NUMBER: 2101-0764
DECEDENT NAME: SCOTT BERNICE P
DA TE OF PAYMENT: 02/25/2002
POSTMARK DATE: 02/22/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 07/29/2001
NO. CD 000887
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $18.02
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$18.02
REMARKS: H ANTHONY ADAMS ESQUIRE
CHECK# 6250
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
\ /~- 1-...3
~ BUREAU OF INDIVIDUAL TAXES
INHERtflNCE TAX DIVISION
~EPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
Ru"u.
REV-1547 EX AFP (01-02>
.02
APR 1 2
DATE
ESTATE OF
DATE OF DEATH
1f-l~~r5~UMBER
COUNTY
ACN
04-08-2002
SCOTT
07-29-2001
21 01-0764
CUMBERLAND
101
BERNICE
P
H A ADAMS
128 EKING ST
SHIPPENSBURG
PA 17257
C
Clrnf..;
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
i "E-y= iS47-EX--AFP--coi-:02")--N()TiCE--OF-YNHEitiTAirCE-"-A'X-A"ppRA"isEM-ENT-,--AL.i-Q'WAN-CE-'Q-R"----------- ------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SCOTT BERNICE P FILE NO. 21 01-0764 ACN 101 DATE 04-08-2002
TAX RETURN WAS: ( ) ACCEPTED AS FILED
( X) CHANGED
SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
19,250.00 NOTE: To insure proper
.00 credi t to your account,
.00 submit the upper portion
.00 of this form with your
1,767.24 tax payment.
.00
.00
(8) 21,017.24
APPROVED DEDUCTIONS AND EXEMPTIONS:
9.
10.
ll.
12.
13.
14.
Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
Debts/Mortgage Liabilities/Liens (Schedule I)
Total Deductions
Net Value of Tax Return
(9)
(10)
4,606.75
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Net Value of Estate Subject to Tax
16.225.64
(11)
(12)
(13)
(14)
?O.R~? ~9
184.85
.00
184.85
If an assessment was issued previouslY, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS.
NOTE:
(19)=
.00
8.32
.00
.00
8.32
(15)
(16)
.00 X
184.85 X
.00 X
.00 X
00
045 =
12 =
15 =
.
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-22-2002 CDOO0887 .00 18.02
04-01-2002 REFUND .00 9.70-
TOTAL TAX CREDIT 8.32
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REV-1470 EX (6-1'11)
.. .
t INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME FILE NUMBER
BERNICE P SCOTT 2101-0764
REVIEWED BY ACN
John Kealy 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
J The net value of the estate is taxable at 4%% because a daughter and a son-in-law are both
lineal heirs.
ROW
Page 1
I?- 1- 0
'. BUREAU OF INDIVIDUAL TAXES
~ INHERITANCE TAX DIVISION
DEP",. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*
REY-l'07 EX AFP (01-02)
POZ
11;\Y -3 f111 .:J 1
,\ f ',_
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-15-2002
SCOTT
07-29-2001
21 01-0764
CUMBERLAND
101
BERNICE
P
H A ADAMS
128 EKING ST
SHIPPENSBURG
Allount Rellitted
PAlil~57
rktnL
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV: i6"ifj-ix--AFP--fol-.:oi.r------...-iNHERiTANc"E--fAx--sTA'fEH"E-tif-ifF-Accouiff--.-i.---------------- -----
ESTATE OF SCOTT BERNICE P FILE NO.21 01-0764 ACN 101 DATE 04-15-2002
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT DR RECORD ADJUSTMENT: 04-08-2002
P R I NCI PAL TAX DU E : ...........................................................................................................................................................................................................................
8.32
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-22-2002 CDOO0887 .00 18.02
04-01-2002 REFUND .00 9.70-
TOTAL TAX CREDIT 8.32
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
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STATUS REPORT UNDER RULE 6.12
Name of Decedent: ~.'{'''- \ l~(~ ~. Sc C>-++-
Date ofDeath: -y (1- "110 {
Will No.: 1 \ - () \ -- 0 7" c..j'
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State~ether administration of the estate is complete:
Yes J.\l No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. lfthe answer to No.1 is Yes, state the following:
a. Did the personal wsentative file a final account with the Court?
Yes _ No ~
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal~resentative state an account informally to the parties
in interest? Yes~ No 0
oo::::r
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to thi;~. ~
ignatur~
~. ~~~Nb~
Name
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Address J \
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Telephone No.
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Capacity: CJ .rIersonal Representative
~'Counsel for personal representative
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
*~
Date: 6/10/2003
WHEELER GERALDINE L
5 NORTH HIGH STREET
NEWBURG, PA 17240
RE: Estate of SCOTT BERNICE P
File Number: 2001-00764
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 7/29/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
cc:
JFile
Counsel
Judge
REV-1500 EX + (6-00)
'*
COMMONW~AL TH OF
,PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
6
/7 - I '.. ,3
FILE NUMBER
~L-J2L__ '7 ~~
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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Scott Bernice P.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
SOCIAL SECURITY NUMBER
96-- 1-4 02.3
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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07/29/2001 09/27/1909
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8 Total Number of Safe Deposit Boxes
o 11 Election to tax under Sec. 9113(A) (Attaer Seh
[X] 1. Original Return
o 4. Limited Estate
[X] 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12.12-82)
o 7. Decedent Maintained a Living Trust {Attach copy ofTrust)
o 10. Spousal Poverty Credit {dateofdea1h between 12-31-91 and 1-1-95)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Adams H. Anthon 128 East King Street
FIRM NAME (If Applicable)
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TELEPHONE NUMBER
5323270
Pa 17257
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
~fBOOO .
_."c 0
::j- N
OFFICIAL USE ONLY
JJ
r::~'
3. Closely Held Corporation Partnership or Sole-Proprietorship
~1
D.;
I'd
'JI
1,767.24
"0
4. Mortgages & Notes Receivable (Schedule Dj
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
(,-,1..)
J:;.
0-',
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. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
X _(15)
9243 X .045 (16) 4 16
X 12 (17)
92.43 X .15 (18) 13.86
(19) 1802
14. Net Value Subjectto Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
(8)
21,017.24
4,606.75
16,225.64
(11)
(12)
(13)
20,832.39
184 85
(14)
184.85
.
Decedent's Complete Adqress:
STREETADQRESS .
7 North Hi h Street
CITY
Newburg
STATE
Pa,
ZIP
17257
Tax Payments and Credits:
1, T ax Due (Page 1 Line 19)
2, Credits/Payments
A, Spousal Poverty Credit
B, Prior Payments
C, Discount
(1 )
18,02
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D, Interest
E, Penalty
Total Interest/Penalty ( D + E) (3)
4, If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5, If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (5)
A, Enter the interest on the tax due, (5A)
B, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
18.02
18.02
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; ........................'.'........... 0 0
b, retain the right to designate who shall use the property transferred or Its income; 0 0
c. retain a reversionary interest; or .................................................................................... 0 0
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 0
2, If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?................................................. ............................................. 0 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 0
4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................. .................... ................................ 0 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN URE OF PERSON RE PONSIBLE FOR FILING RETURN DATE
eibt/
ADDRESS
7
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the se of the surviving spouse is 3%
[72 P,S, 99116 (a) (1,1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviVing spouse is 0% [72 PS 99116 (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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 PS. 99116(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 45%, except as noted in 72 PS 99116(1,2) [72 PS 99116(a)(1))
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, 99116(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,
"~'~"'''~ '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
..
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Scott Bernice P.
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with
right of
survivorshio must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
1.
Old frame dwelling house located on 28 foot x 169 foot lot as per Cumberland County
Deed Book "T" Volume 18 at page 11 (appraisal attached)
19,250.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
19,250 00
~""'"""., '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
..
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Scott Bernice P.
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
0"' n",.~ TU
1.
Refund from Presbyterian Homes Inc
71.20
2.
Property sold at public auction by Hershey Auctioneers
1.696 04
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
1 767.24
REV.1511EX + 11-97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Scott Bernice P.
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES
1.
1. Cremation Society 1,22000
2. Eby Granite Works 8500
3. Opening of Grave 189.00
B ADMINISTRA TIVE COSTS
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees H. Anthony Adams 750.00
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 Register of Wills 79.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
7. RWC Corporation (expense of last illness) 22.67
8. Swaim Health Center 388.60
9. Mann Real Estate (appraisal) 225.00
10 Rae Ann Sprecher (taxes on real estate) 647.48
TOTAL (Also enter on line 9, Recapitulation) $ 4,606.75
(If more space is needed, insert additional sheets of the same size)
~~''''~''~' '*
,'"
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Scott Bernice P.
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
AMOUNT
1.
Pa. Departmerfof Public Welfare
16,225.64
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
16,225.64
RE"'513EX'[197J ~_
'WlI
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Scott Bernice P
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Geraldine Wheeler daughter 50%
1 Chester Wheeler son-in-law 50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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.
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
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)
II. ..,,,
RESIDENTIAL APPRAISAL REPORT
Property Location:
7 N. High Street
Newburg, Pa. 17240
Homeowner/Borrower Name:
Bernite Scott
Prepared for:
Berniee Scott
&
Mrs. Chester Wheeler, Executrix
Prepared by :
Roy R. Monn, Jr.
Property Description
UNIFORM RESIDENTIAL APPRAISAL REPORT File No.
Proper.ty Address 7' M U~","h c::~,..=,-,.~ City ,..'" State Prl Zip Code 17?..1n
Legal Description 18 T 11~ ~ County ~ , 1nnn
Assessor's Parcel No.? 4 ? 1 .0::1 q 0 -0 R h Tax Year R.E. Taxes $ Special Assessments $ h n E:; n n
: Borrower 'R p rn i ;. p <' .L Current Owner Occupant: 1 Owner ['" 1 Tenant Lrl Vacant
Property rights appraised I X I Fee Simplel I Leasehold Project Type I PUD I I Condominium (HUDIVA only) HOA$ /Mo.
Neighborhood or Project Name 1=1 rHO,..... ,..... -F . Map Reference 2 4 21 390 136 Census Tract 11 ?
Sale Price $ Date of Sale :7 Description and $ amount of loan charges/conscessions to be paid by seller
Lender /Client r'np,:;d-pr TArh",,,,1,-,.,.. k'V''-''i"' Address
AppraiserP\:~ ~,~ D M~~~ .T,.. Address 2 2 1 F. Kina <' C:::..r.llrn p~ 17?r:,7
Location Cil Urban U Suburban 0 Rural Predominant Single family housing Present lana use % Land use change
PRICE AGE
Built up Over 75% 025-75% 0 Under 25% occupancy $(000) (yrs) One family 70 ~ Not likelyO Likely
Growth rate D Rapid ~ Stable 0 Slow @ Owner 30, Low 5 0 2-4 family 4 In process
Property values D Increasing ti Stable D Declining o Tenant RO HighllO Multi-family 1 To:
Demand/supply D Shortage In balance 0 Over supply LX] Vacant (0-5%) t:;..1( Predominant 70'; Commercial ':l
Marketing time n Under 3 mos. 3..6 mos.~ Over 6 mos. n Vacant (over 5%) ~ ,.. 22
Note: Race and the racial composition of the neighborhood are not appraisal factors.
Neighborhood boundaries and characteristics: ,., ~ . , _r<
'-'v....v '-'.... n~ _ =>
Factors that affect the marketability of the properties in the neighborhood (proximity to employment and amenities, employment stability, appeal to market, etc.):
: I ,nv' enient location across from the ra Fire Company Nn 'Wnt.pr excent
. 't.Tn", f- ~ 11 i pH bv neiahbor.
.
,
.
.
.
Market conditions in the subject neighborhood (including support for the above conclusions related to the trend of property values, demand/supply, and marketing time
.. .. such as data on competitive properties for sale in the neighborhood, description of the prevalence of sales and financing concessions, etc.):
1\T,..... '" r\ "',... ~ :> 1 -F~ '".,,,, ~"., ~...~..... ..,,..,......, that 'Wn1J1n be rnn<=:inprpn ::l<=: f-vnirorll
~
. Project Information for PUDs (If applicable) - .. Is the developer/builder in control of the Home Owners' Association (HOA)? U Yes UNo
. Approximate total number of units in the subject project Approximate total number of units for sale in the subject project
Describe common elements and recreational facilities:
Dimensions ')Q ..,. 'hn = 4 4RO <=: f Topography T ~..~,
Site area .11 acrc Corner Lot [X] Yes 0 No Size 11~~rrp
Specific zoning classification and description R p,c:; i n p n t. i rl 1 Shape pp""+-~nnll1rlr
Zoning compliance [iJ Legal 0 Legal nonconforming (Grandfathered use) 0 Illegal o No zoning Drainage ,...,.....I"\~
Highest & best use as improved: rxl Present use n Other use (explain) View 'T'vnirorll
Utilities Public Other Off-site Imp~~vements Type Public Private Landscaping Yrlrn
Electricity 6 60-nmn Street Macadam ~ 0 Driveway Surface l\Tnnp
Gas Curb/ gutter Concrete 0 Apparent easements N n n p n n <=: p rvl'> n
Water o F'rnm npi an Sidewalk Concrete [Xl 0 FEMA Special Flood Hazard Area 0 Yes Q No
Sanitary sewer R Street lights ~ R FEMA Zone Map Date
Storm sewer Alley FEMA Map No.
Comments (apparent adverse easements, encroachments, special assessments, slide areas, illegal or legal nonconforming zoning use, etc.):
Nn rtnvpr<=:p <=: nr pnrrnrlrr ~ nr. New assessment is 60,910
GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNDATION BASEMENT INSULATION
. No. of Units One Foundation St.nnp Slab Area Sq. Ft. c:; 7 ? Roof _0
No. of Stories Twn Exterior Walls ~<=:nnrl 1 T. Crawl Space % Finished Nonp Ceiling _0
Type (Det./Att.) At t.n rnpn Roof Surface MPT.rl 1 Basement 720/,., Ceiling None Walls _D
. Design (Style) 2-<=:t.nrv Gutters & Dwnspts. M p T rl 1 Sump Pump No Walls S to-n&- Floor _0
Existing/Proposed l<'v i '" f- Window Type n,..",~".,..,1 Dampness v,-,.co Floor T'I ~ .....J.. None _0
.
Age (Yrs.) lQnn Storm/Screens C:::,.....,:;;'" Settlement YP~ Outside Entr'ly p '" Unknown _ [X]
Effective Age (Yrs.) nn Manufactured House Nn Infestation Nn
i ROOMS Foyer Living Dining Kitchen Den Family Rm. Rec. Rm. Bedrooms # Baths Laundry Other Area Sq Ft.
Basement 'iT '" iT,.... iT,..... iT,..... 1\1 nnp~ sf.
. Level 1 , , 1 1 Ann C! -F
Level 2 4 ROO <=: f
. Finished area above grade contains: R Rooms: <1 Bedroom(s); 1 Bath(s); 1"nn Square Feet of Gross Living Area
. INTERIOR Materials/ Condition I HEATING I ~~~:~:.~:.Q~ I ~::~C YelL, I ~~E,NIT~E,S. ,----, I CAR STO~E:
. ~Irr.nr~ T,,'T""''''''M T\/na U fTAT
Valuation Section
UNIFORM RESIDENTiAL APPRAISAL REPORT File No.
ESTIMAT~D SITE VALUE .'. 2 8. X . 270 . . . . . . . . = $ ..L '7 t:;e::.n Comments on Cost Approach (such as, source of cost estimate.
,
ESTIMATED REPRODUCTION COST-NEW-OF IMPROVEMENTS site value, square foot calculation and for HUD, VA and FmHA. the
. Dwelling J , nOO Sq. Ft @ $ 48.00=$ 76,800 estimated remaining economic life of the property):
'C'...~ /......,........~'h Sq. Ft @ $ 14. 00 = 2,464 12 X 19 = 228
...... -'- ~. 92x70 & Shed = 3,944 22 x 26 = 572
. 800
. l}{<l(@*,Carport.3..6..0.- Sq. Ft @ $ 14.00 = 5.040
. Total Estimated Cost New. . . . . ...=$ 88,248
. . . . .
. Shed 330 s.f.
I Less 69% Physical 22%unctional External
. Depreciation 60, 8 9 1 I 19, 414 I = $Qn ':lnt:; Car/porc 360 s.f.
Depreciated Value of Improvements. . . . . . . . . . . . . . . . =$ -l- '7 aLl?
"As-is" Value of Site Improvements. . . . . . . . . . . . . . . . . = $ .L , t:;nn
INDICATED VALUE BY COST APPROACH . . . . . . . .=$ l7.nf)?
ITEM SUBJECT COMPARABLE NO. 1 COMPARABLE NO.2 COMPARABLE NO.3
7 N. High Street 309 E. King Street 225 E. Orange St. 25 S. Washington St
Address Newburq S-burq S-'burq S-burq
, Proximity to Subject III ~? ri les 7-miles 7 I'll i les
I Sales Price $ $30,000 ~
Price/Gross Liv. Area $ 0 $ 16.16 0%\: $ 12.27 0 $1 3 . S 3 0
Data and/or Inspection Court/House Court/House Court/House
Verification Source
VALUE ADJUSTMENTS DESCRIPTION DESCRIPTION 1+ (-) $ Miustment DESCRIPTION I + (-) $ Adjustment DESCRIPTION I + H $ Adjustment
Sales or Financing COny. , Cony. , Cony. :
I , ,
Concessions Publie/W , -S,OOO PUblic/W l-S,ooo public/W I-S,OOO
I
Date of Sale/Time 4/28/00 I 9/1/99 1 1714/00 ,
, , ,
Location Urban Urban , Urban I Urban ,
, 1 1
Leasehold/Fee Simple Fee/simDle Fee/simDle' Fee/simDle' "'ee/simDle !
Site 28x160 .11 D .1400 ! .06 1+1,000 .15 1
View TYDical Typical I Typical , TVDical I
I I I
Design and Appeal 2-S-attach 2/storv , 2/story I 2/story ,
, , ,
Quality of Construction Asphalt/S Brick : -2,000 Alum./Fr. , P-r . ,
. , I
Age 1900 1900 ! 1900 1 1900 ,
Condition Poor Poor I Poor -I !Poor I
Above Grade Total : Bdrms I Baths Total I Bdrms , Baths , Total ,Bdrms, Baths , Total TBdrms , Baths ,
I 1 ,
Room Count 8:4 I One 10' 4'Two ~1,000 9 '4 I 1.5 , 500 6 ! 3 :2 1-1,000
. ,....
Gross living Area 1,600 Sq.Ft. 1.857 Sq. Ft. \- 2 , 570 2.283 Sq. Ft. f-6.830 1 664 Sq. Ft. '
. Basement & Finished Partial Partial , Partial 1 Partial I
I , I
. Nnnp , None , Nonp 1
. Rooms Below Grade l\Tnnp , , 1
Functional Utility Averaae (lP I "..~-~~~ , ~vera(le ,
p" , I ,
Heating/Cooling H/W No H/A - No 1 H7A No I H/A - No ,
I I - , ,
Energy Efficient Items None None I None I None I
Garage/Carport 1 -C'ar ~/p None ' +1 . snn None '+1 . snn 1\T n n P '+l.SOO
. I , ,
Porch. Patio, Deck. porch/Ene. Porch/Nonel + 7S0 Porch/Nonel+ 7S0 Porch i+ 7S0
. Fireplace(s). etc. PorC'h , , ,
, I I
Fence, Pool. etc. C:::npn Nnnp i+ ~nn 1\Tnno i+ c:;nn I1\Tnnp i+ ~nn
, , I
Net Adj. (total) + - $ 7 R?O__ 8.S80 ~_ 3 250
Adjusted Sales Price
of Comparable $ 22,180 $ 19,420 $19,250
Comments on Sales Comparison (including the subject property's compatibility to the neighborhood, etc.): C::::> 1 0 :ll: , Old dwellina con-
verted into d"n1ov w; t.h nuhl;C' w~t.pr ::.nn r\l1hl;,... ~pW::'(lP - S~lp :ft 2 Durchased
hv RedeveloDement Auth. to be un.(lraded for "'ale. Sale :tI: 3 is most like the
subiect. All comns. are from the S-bura School District as is the subiect.
ITEM SUBJECT COMPARABLE NO. 1 COMPARABLE NO.2 COMPARABLE NO.3
Date, Price and Data No prior
Source, for prior sales sale with/
Same Same Same
within year of appraisal ~~ , ..~~-
Analysis of any current ag~emen7 of ~ale, option, or lisling of the subject properly and analysis of any prior sales of subject and comparables within one year of the dale of appraisal:
M....'" ~ . tJon-l- -I-n ::. nnmo +-n;~ ;C' "''ho ....o:>C'l"\n -F"I"\.... -1-1-.';", ; "'::. 1
INDICATED VALUE BY SALES COMPARISON APPROACH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19.2S0.00
INDICATED VALUE BY INCOME APPROACH Ilf Annli""hjP\ F"tim"tprl M"rkpt Rpnt <l: /Mn. x r-.",,,-,,- !:lont M"ltinli;or -<l; N/A
, "
" ,
MAP SKETCH ADDENDUM
Borrower I Client 'Aernite Scott
Property Address 7 N. High Street
City Npwhllrg County r.llmhp.r1 and State Pa. Zip Code 17240
Lender - r-
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LOCATION MAP [*SUBJECT PROPERTY]
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Borrower I CI ient Bernite Scott
Property Address 7 N. High St~ee~
City Newburg Count umber1 and Slale PrI. Zip Code 17240
Lender
PHOTOGRAPH ADDENDUM
FRONT OF
SUBJECT PROPERTY
REAR OF
SUBJECT PROPERTY
STREET SCENE
. '\
PHOTOGRAPH ADDENDUM
Borrower I Client
Property Address
City Newburq
Lender
Ber~ Scott
7 N. High Street
County Cumberland
State Pa. Zip Code 17240
/
COMPARABLE SALE #1
COMPARABLE SALE #2
COMPARABLE SALE #3
, . ~ ~
DEFINITION OF MARKET VALUE: The most probable price which a property should bring in a competitive and
open market under all conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably
and assuming the price is n~t affected by undue stimulus. Implicit in this definition is the consummation of a sale
as of a specified date and the passing of title from seller to buyer under conditions whereby: (I) buyer and seller
are typically motivated; (2) both parties are well informed or well advised, and each acting in what he considers his
own best interest; (3) a reasonable time is allowed for exposure in the open market; (4) payment is made in terms
of cash in U. S. dollars or in terms of financial arrangements comparable thereto; and (5) the price represents the
normal consideration for the property sold unaffected by special or creative financing or sales concessions* granted
by anyone associated with the sale.
*Adjustments to the com parables must be made for special or creative financing or sales concessions. No adjustments
are necessary for those costs which are normally paid by sellers as a result of tradition or law in a market area;
these costs are readily identifiable since the seller. pays these costs in virtually all sales transactions. Special or
creative financing adjustments can be made to the comparable property by comparisons to financing terms offered
by a third party institutional lender that is not already involved in the property or transaction. Any adjustment
should not be calculated on a mechanical dollar for dollar cost of the financing or concession but the dollar
amount of any adjustment should approximate the market's reaction to the financing or concessions based on the
appraiser's judgment.
STATEMENT OF LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION
CONTINGENT AND LIMITING CONDITIONS: The appraiser's certification that appears in the appraisal report
is subject to the following conditions:
I. The appraiser will not be responsible for matters of a legal nature that affect either the property being appraised
or the title to it. The appraiser assumes that the title is good and marketable and, therefore, will not render any
opinions about the title. The property is appraised on the basis of it being under responsible ownership.
2. The appraiser has provided a sketch in the appraisal report to show approximate dimensions of the improvements
and the sketch is included only to assist the reader of the report in visualizing the property and understanding the
appraiser's determination of its size.
3. The appraiser has examined the available flood maps that are provided by the Federal Emergency Management
Agency (or other data sources) and has noted in the appraisal report whether the subject site is located in an
identified Special Flood Hazard Area. Because the appraiser is not a surveyor, he or she makes no guarantees,
express or implied, regarding this determinatio.n.
4. The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in
question, unless specific arrangements to do so have been made beforehand.
5. The appraiser has estimated the value of the land in the cost approach at its highest and best use and the
improvements at their contributory value. These separate valuations of the land and improvements must not be
used in conjunction with any other appraisal and are invalid if they are so used.
6. The appraiser has noted in the appraisal report any adverse conditions (such as, needed repairs, depreciation, the
presence of hazardous wastes, toxic substances, etc.) observed during the inspection of the subject property or that
he or she became aware of during the normal research involved in performing the appraisal. Unless otherwise stated
in the appraisal report, the appraiser has no knowledge of any hidden or unapparent conditi6ns of the property or
adverse environmental conditions (including the presence of hazardous wastes, toxic substances, etc.) that would
make the property more or less valuable, and has assumed that there are no such conditions and makes no
guarantees or warranties, express or implied, regarding the condition of the property. The appraiser will not be
responsible for any such conditions that do exist or for any engineering or testing that might be required to discover
whether such conditions exist. Because the appraiser is not an expert in the field of environmental hazards, the
appraisal report must not be considered as an environmental assessment of the property.
7. The appraiser obtained the information, estimates, and opinions that were expressed in the appraisal report from
sources that he or she considers to be reliable and believes them to be true and correct. The appraiser does not
assume responsibility for the accuracy of such items that were furnished by other parties.
8. The appraiser will not disclose the contents of the appraisal report except as provided for m the Uniform
Standards of Professional Appraisal Practice.
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APPRAISER'S CERTIFICATION: The Appraiser certifies and agrees that:
I. I have researched the subject market area and have selected a minimum of three recent sales of properties most
similar and proximate to the subject property for consideration in the sales comparison analysis and have made a
dollar adjustment when appropriate to reflect the market reaction to those items of significant variation. If a
significant item in a comparable property is superior to, or more favorable than, the subject property, I have made
a negative adjustment to reduce the adjusted sales price of the comparable and, if a significant item in a comparable
property is inferior to, or less favorable than the subject property. I have made a positive adjustment to increase the
adjusted sales price of the comparable.
2. I have taken into consideration the factors that have an impact on value in my development of the estimate of
market value in the appraisal report. I have not knowingly withheld any significant information from the appraisal
report and I believe, to the best of my knowledge, that all statements and information in the appraisal report are
true and correct.
3. I stated in the appraisal report only my own personal, unbiased, and professional analysis, opinions, and
conclusions, which are subject only to the contingent and limiting conditions specified in this form.
4. I have no present or prospective interest in the property that is the subject to this report, and I have no present
or prospective personal interest or bias with respect to the participants in the transaction. 1 did not base, either
partially or completely, my analysis and/or the estimate of market value in the appraisal report on the race, color,
religion, sex, handicap, familial status. or national origin of either the prospective owners or occupants of the subject
property or of the present owners or occupants of the properties in the vicinity of Hie subject property.
5. 1 have no present or contemplated future interest in the subject property, and neither my current or future
employment nor my compensation for performing this appraisal is contingent on the appraised value of the property.
6. I was not required to report a predetermined value or direction in value that favors the cause of the client or
any related party, the amount of the value estimate. the attainment of a specific result, or the occurrence of a
subsequent event in order to receive my. compensation and/or employment for performing the appraisal. I did not
base the appraisal report on a requested minimum valuation, a specific valuation, or the need to approve a specific
mortgage loan.
7. I performed this appraisal in conformity with the Uniform Standards of Professional Appraisal Practice that were
adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place as
of the effective date of this appraisal, with the exception of the departure provision of those Standards, which does
not apply. I acknowledge that an estimate of a reasonable time for exposure in the open market is a condition in
the definition of market value and the estimate I developed is consistent with the marketing time noted in the
neighborhood section of this report, unless I have otherwise stated in the reconc.iliation section.
I
8. I have personally inspected the interior and exterior areas of the subject property and the exterior of all properties
listed as com parables in the appraisal report. I further certify that I have noted any apparent or known adverse
conditions in the subject improvements, on the subject site, or on any site within the immediate vicinity of the
subject property of which I am aware and have made adjustments for these adverse conditions in my analysis of
the property value to the extent that I had market evidence to support them. I have also commented about' the
effect of the adverse conditions on the marketability of the subject property.
9. I personally prepared all conclusions and opinions about the real estate that were set forth in the appraisal report.
If I relied on significant professional assistance from any individual or individuals in the performance of the
appraisal or the preparation of the appraisal report, I have named such individual(s) and disclosed the specific tasks
performed by them in the reconciliation section of this appraisal report. I certify that any individual so named is
qualified to perform the tasks. I have not authorized anyone to make a change to any item in the report; therefore,
if an unauthorized change is made to the appraisal report, I will take no responsiblity for it.
SUPERVISORY APPRAISER'S CERTIFICATION: If a supervisory appraiser signed the appraisal report, he or she
certifies and agrees that: I directly supervise the appraiser who prepared the appraisal report, have reviewed the appraisal
report, agree with the statements and conclusions of the appraiser, agree to be bound by the appraiser's certifications
numbered 4 through 7 above, and am taking full responsibility for the appraisal and the appraisal report.
ADDRESS OF PROPERTY APPRAISED:
APPRAISER:
'J N, J./ 2 j 2 J
SUPER I~ORY APPRAISER (only if required):