HomeMy WebLinkAbout01-1066
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Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of
BETTYJ.CROSSLAND
No. ~\- D\ - \\)tD~
also known as
, Deceased
Social Security No. 182-14-8196
Petitioner(s), who isJare 18 years of age or older, apply(ies) for:
(COMPLETE "A" OR "B" BELOW:)
c;I
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut_ named in the Last Will of the
Decedent, dated and codicil(s) dated
Stale 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 incompetent:
II B. Grant of Letters of Administration
(c.t.s., d.b.n.c.t.a.: pendente lite; durante absentia; durante minoritate)
heirs:
Petitioner after a proper search has ascertained that Decedent left no Will and was survived by the following spouse (if any) and
Name
Relationship
Residence
Dale S. Crossland
Son
300 Third Street, Summerdale, PA 1093
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal
residence at 57 Oliver Road. East Pennsboro Township. Enola. Pennsylvania
(list street, number and municipality)
Decedent, then.lL years of age, died November 12.2001 ,at Holy Spirit Hospital. East Pennsboro Township. Camp Hill, PA
(Locatkln)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property ............................................... $
(If not domiciled in PAl Personal property in Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
(If not domiciled in PAl Personal property in County. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Value of real estate in Pennsylvania ........................................................... $
Total ........................................................................... $
Real Estate situated as follows: 57 Oliver Road, East Pennsboro Township, Enola, PA
5,000.00
82,500.00
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:
Typed or printed name and residence
El6tl) d. Sressls"d 7)..q /~. S C r (),SJ I.} ",jL
S7 Oliver I'(oaa 300 -r/"'j'r<A 11. -g.:)~ 137
EMllI,f'A 110:25 SJMfl.'Il:...-J"/.r,, P.'\- 17oQ3
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Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner above-named swears and affirms that the statements in the foregoing Petition are true and correct
to the best of the knowledge and belief of Petitioners and that, as personal representative of the Decedent, Petitioner will
well and truly administer the estate according to law. -{k /J .J ;J /l _ /
Sworn to and affirmed and subscribed ~~~ _~L
before me this 20TH day of ria e S. Crossland
NOVEMBER 2~1.
~d"?t~A~~'~ i)/nUk91
DECREE OF REGISTER
Estate of
BETTYJ.CROSSLAND
Deceased
No. 21-01-1066
also known as
Social Security No: 182-14-8196
Date of Death:
11/12/01
AND NOW, NOVEMBER ?1 ,2001, in consideration of the Petition on the reverse
side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 0 Testamentary. of Administration
(c.I.a.; d.b.n.c.t.; pendente lite; durante absenlia; durante minoritate)
are hereby granted to
DALE S. CROSSLAND
in the above estate and that the instrument(s), if any, dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters........................... $ ?OO. 00
/
Short Certificate(S).~..? $ 1 5.00
Renunciation.................. $
Affidavit ( )................. $
Extra Pages ( )............ $
Cod i ci I. .. .. .. . .. . . . .. . .. . .. .. .. . $
JCP Fee........................ $ 5.00
Inventory & Tax Forms... $
Other............................ $
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TOTAL................ $ 220.00
Attorney: Vicky Ann Trimmer
1.0. No: 49679
Address: 3401 North Front Street
Harrisbura. PA 17110-0950
Telephone: 717-232-5000
DATE FILED: NO\lEMER 21. 2001
Letters to be picked up on 11-21-01
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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.
7702189
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Local Registrar
Fee for this certificate, $2.00
p
NOV 1 3 2001
No.
Date
H105.143 Rev. 2187
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
~l
East Pennsboro
0<.
SEX
2. Female
SlATE FilE lIIUM6ER
SOCiAl SEcuRITY NUMBER
.. 182 - 14
TYPEJ'fUNT
'N
PEAMAN~T
BLACK INK
NAME OF DECEDENT IFIISI MIOOle. Lag!
J. Crossland
AGE tlaSl8lf1hOlvl UNDER 1 YEAR UNDER I DAY
J.4omta Days Houq Z," t,linut..
79 Yn
.. C'OUNTY Of OEArH
BIRTHPLACE {C,ly ar,a
3\.Ile'" FCflqlCounlfy!
... Cumber land
White
SUfMvlNG SPOUSE
'ltWll..g.....n\aldennamel
DECEDENT'S USUAL OCCUPRION
IGive Iund of \O/OfkdOl\l!l duJll"Ig molt
.. lla. hod~~'t1~~U~p1~yee 11".
DECEDENT'S MAILING ADDRESS ($!relit Cllyltown. Stale. Zip Codel
11a. Stale
PA
ora
_.
57 Oliver Road
'0. Enola, PA 17025
FArHER'S NA....e (rvsl:. Middle. Last)
'0. Kenneth DeArment
1Nf000000'S NAME (T ypetPtint)
.'". Dale S. Crossland
METHOO OF OtSPOSITlON
Bunal 00 C,ematiOn 0
OtMt cSpedy
17b.Coun
Cumberland ,...0 ::"'-==01
MOTHER.~~F'Q;rtID;b'r~-
10.
:oRM300Thi:'dstre~!rUi:ne~ale, PA 17093
PlACE OF DISPQSITKJN. NanIe at CerNlety, CfematOfY LOCAnON. CIl:,nown. &.\0. ZIp CodIt
Of ou.., Ptace
cityl'tKwO.
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, DUE TO ,OR AS A CONSEOuENCE OF): V
tb: C,.~..H, I ,.d' 0.1,.. >,.J-
DUE AS A CONSEQUENCE Of):
C H lE 10 lOA AS A CONSEOUENCE OF);
N.:C .
WERE AUTOPSY FINDINGS MANNER Of DEATH
AVAILABLE PRIOR 10
COMPLETION OF CAUSE
Of DEATH?
23". 23c.
WAS CASE REFERREO TO ~~OAl EXAMINERICOAONEA1 NoQ{
20.
I ApplOxQna11
I inlefV&l between
I OnMI Ind dellth
! l )4-1
PART II:
Other 5ignificanl condWons COOIribuling 10 dea"'. buI
noI'rnlAiI\ginlhe ~caUMgivenin PART I.
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DATE Of INJURY
t""onm, Day, ~afl
TIME OF INJURY
INJUflY /(f WORK?
DESCRIBE HOW iNJURY OCCVRREO.
Nalural
EX
o
o
Homicide
Ac:cidltll
Pending lnyesllgalion
o
o
o ~~CE OF INJURY. AI home. I.rr~~et. laciOtY. olfie. M.
building. IIC. ISp8Cllvl
'00.
Yoo 0 '00
NO~
Yes 0
'0 0
Suicide
Could nol be delotmlned
LOCATION ($...... ClIVfTown. Stale)
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CERTIFIER cCl'leck oniy one)
'CERTIFYING PHYSICIAN (phy$lCoan cflflolrll\l) cauMl of d..11l .....1'1... iloolhel phV5tC..n has plOflOVnced deal" ano compleled Item 231
To V.a beat of my knowladga,dellhOC(:uITedduetolh.cau:IIe{$landmatlnera.lStated.................................
29.
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"'''ONOUNCING AND CERTIFYING PHYSICIAN lPhrSIClafl 00Ih Ol'OflOUn<::1f'l9 oealh and centlyulfJ 10 cause 01 aealhl
To lha blnt 01 my knowlodQCt. death occurrad.' lhsllrn.. dat.. Ind !)hc., IlId du. to Ih. clul.jlllllld matlll.' "':II slaled..
"MEDlCA.l EXAMINER/CORONER
On the ba.is of examination and/or InvestlgaUon.ln my opinion, death occurred at the time. date, ~nd place, and due to the cause(s) and
11..~.nner as st. tad. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .... .................... .........
REGISTRAR'S SIGNATURE AND NUMBEA
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CERTIFICATION OF NOTICE UNDER RULE 5.6la)
Name of Decedent:
BETTYJ.CROSSLAND
Date of Death:
November 12,2001
File No.
21-01-1066
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate
on December 5.2001:
Name
Add ress
Dale S. Crossland
300 Third Street, Summerdale, PA 17093
Date: December 5.2001
Notice has now been given to all persons entitled thereto under Rule 5.6(a)
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Signatur~
Vicky Ann Trimmer, Esquire
3401 North Front Street
Harrisburg. PA 17110
Address
(717) 232-5000
Telephone
Capacity:
_ Personal Representative
Vel
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~ Counsel for Personal Representative
LO: It\1 9- 310 lO.
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:279852 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
VICKY ANN TRIMMER ESQUIRE
3401 NORTH FRONT STREET
HARRISBURG, PA 17110-0950
___Un_ fold
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: SSN: 182-14-8196
FILE NUMBER: 21-2001- 1066
DECEDENT NAME: CROSSLAND BETTY J
DATE OF PAYMENT: 01/16/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 11/12/2001
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
REMARKS: DALE S CROSSLAND
C/O VICKY ANN TRIMMER ESQUIRE
CHECK#103
SEAL
INITIALS: DO
RECEIVED BY:
REV-1162 EX(11-96)
NO. CD 000758
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
AMOUNT
$3,084.99
$3,084.99
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of
BETTYJ.CROSSLAND
No.
21-01-1066
also known as
Date of Death November 12,2001
Deceased
Social Security No. 182-14-8196
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 real estate outside of the Commonwealth of
Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We verify that the statements made in this Inventory are true
and correct. l!We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification
to authorities.
Name of
Attorney:
Vicky Ann Trimmer, Esquire
Personal Representative:
Dale S. Crossland
[)ah 4~
Dated: /-II:rt:ii..
1.0. No.:
49679
Address
3401 N. Front Street, Harrisburg, PA 17110-0950
Telephone:
(717) 232-5000
DESCRIPTION
VALUE
1. 57 Oliver Road, Enola, East Pennsboro Township, PA
$ 82,500.00
$ 6,500.00
2. 1997 Olds Cutlass Supreme
3. Household items & personal property
4. 45 shares of Prudential Financial stock
$
500.00
$ 1,318.50
TOTAL:
$ 90,818.50
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may. at the election of the personal representative, indude the value of each item. but
such figures should not be extended into the total of the Inventory.
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 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
ReCUt;
of DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
'J ftOUNTY
.L1CN
VICKY ANN TRIMMER
METTE ETAL
PO BOX 5950
HBG
'02 MAH-1
fill
ESQ
(';:f:fl<.
02-26-2002
CROSSLAND
11-12-2001
21 01-1066
CUMBERLAND
101
Allount Re.itted
_0/
REY-1547 EX AFP 101-021
BETTY
J
PA 111 (Oumbu,
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 ~
REV=is'4-j-Ex--AFP--foY:02Y-riio'TicE--oF-YNHEifiTANCE-YAX-A-PPRA-isEi'-iriiT~--ALi-oWAN-CE-(fR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CROSSLAND BETTY J FILE NO. 21 01-1066 ACN 101 DATE 02-26-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgeges/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
82,500.00
1,318.50
.00
.00
7.504.37
12.366.52
.00
(8)
18.947.69
12.578.24
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
103,689.39
31.525 93
72,163.46
.00
72,163.46
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate
16. Allount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rate
18. Allount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
(15) .00 X 00 = .00
(16) 72,163.46 X 045 = 3,247.36
(17) .00 X 12 = .00
(18) .00 X 15 = .00
(19)= 3,247.36
TAX CREDITS:
.... .-... .-. l+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
PAYMENT MUST BE MADE BY o8-12-2oo2~. TOTAL TAX CREDIT .00
BALANCE OF TAX DUE 3,247.36
INTEREST AND PEN. .00
TOTAL DUE 3,247.36
. 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.)
\ //}- c2(;2 - 9
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-IU7 EX AFP <DI-021
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-04-2002
CROSSLAND
11-12-2001
21 01-1066
CUMBERLAND
101
Allount Relli Hed
BETTY
J
R':J:~_ .
VICKY ANN TRIMMER
METTE ETAL
PO BOX 5950
HBG
EsQ2 11AR -8 P 1 :1 9
Gf.'H
P~l~1iU~
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO 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-i3f-AFP-foY=o2Y------...--iNirERITANc'E-TAx--STAfEME-tiT-'ifF'-Ac-couiif--.-..---------------- -----
ESTATE OF CROSSLAND BETTY J FILE NO. 21 01-1066 ACN 101 DATE 03-04-2002
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 OR RECORD ADJUSTMENT: 02-19-2002
P R I NC I PAL TAX DU E : ....._._......_._._.._.__....._............._...................................................................._..................................................................._..._._._............
3,247.36
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-16-2002 CDOO0758 162.37 3,084.99
TOTAL TAX CREDIT 3,247.36
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 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. )
&V/
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE
ESTATE. IF THE ESTATE IS NOT COMPLETED, FILE A 6.12 FORM YEARLY UNTIL COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Bettv J. Crossland
Date of Death:
11/12/01
Will No.
Admin. No. 21-2001-01066
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 whether administration of the estate is complete:
Yes..L No
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative 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 representative state an account informally to the parties
in interest? Yes1L- No
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached to this
report.
Date:
7/;/ !o l--
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Signature
Vickv Ann Trimmer
Name (Please type or print)
3401 N Front Street
Address
5
Harrisbur2'. PA 17110-0950
717 -232-5000
Telephone
Capacity:
_ Personal Representative
~ Counsel for Personal
Representative
:299714 _1
REV-1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECE-
DENT
CHECK
APPRO-
PRIATE
BLOCKS
COR-
RE-
SPON
DENT
RECA-
PITULA-
TION
TAX
COMPU-
TATION
,..
OFFICIAL USE ONLY
REV-1500
/ 7 - ;1. ~ -. q
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 2001
01066
COUNTY CODE
YEAR
NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
Crossland, Betty J.
DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
11/12/01 08/26/1922
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
182-14-8196
THIS RETURN MUST BE FILED IN DUPLICATE
WITH THE REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1. Original Return
4. Limited Estate
6. Decedent Died Testate
(Attach copy of Will)
9. Litigation Proceeds Received
~ 2. Supplemental Return
4a. Future Interest Compromise
(date of death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach a copy of Trust)
10. Spousal Poverty Credit (date of death between
12-31-91 and 1-1-95)
3. Remainder Return
8 (date of death prior to 12-13-82)
5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
O 11. Election to tax under Sec. 9113(A)
(Attach Sch 0)
.'fflI~.$i<<tJQtil..MQ$t.iggQMeQri#.P;.AttgQijijg$PQ_.-8(.gQtilfim;ijtIAt.]A*'jijfQijMA1jQij'$ijQiji:b..li\..~Ql$.P..tQt..
NAME COMPLETE MAILING ADDRESS
Vicky Arm Trirrrrer, Esquire 3401 N. Front Street
FIRM NAME (If Applicable) ro Box 5950
I'IIette, Evans & Woodside Harrisburg, PA 17110-0950
TELEPHONE NUMBER
717-232-5000
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"'OFFICIAl:: LISE ONLY
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1 )
(2)
::! =.' -
(S ."
82,500r'OO
1, 318~SO
NPne
None
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3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal
Property (Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
(5)
7,504.37
J.,
12,366.52
(6)
7. Inter-Vivos Transfers & Miscellaneous
Non-Probate Property (Schedule G or L)
(7)
None
(8)
18,947.69
12,578.24
(11 )
(12)
(13)
103,689.39
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)
14. Net Value Subject to Tax (Line 12 minus Line 13)
31,525.93
72, 163 .46
None
(14)
72,163.46
SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (aX1.2) X.O _ (15)
16. Amount of Line 14 taxable at lineal rate 72,163 .46 X.O ~ (16)
17. Amountof Line 14 taxable at sibling rate 0.00 X .12 (17)
18. Amount of Line 14 taxable at collateral rate 0.00 X .15 (18)
19. Tax Due (19)
20. 0 lett~Kiij!.RjgIFyQijMotfl~Q.ij~~Aa$WNbQFAAQY!.6PAvMENtI
3,247.36
0.00
0.00
3,247.36
. ...... ....................................................................................*.ti:lI;SQReiTQANSWImA@QU!i;STlPN$QNeAG!i;~ANPR!i;GtU;GKMATH~{...<>.....................................
....... .......
o PA15001
NTF 29755
Copyright 2000 Greatland/Nelco LP - Forms Software Only
Estate of: Betty J. Crossland
SUVfv1ARY OF AI...I..IX1ITICNS 'ill BENEFICIARIES
Taxable at lineal rate
Dale S. Crossland
72 1163 .46
21-2001-01066
PA REV-1500 EX (6-00)
D d t'C It Add
Page 2
ece en s ampl e e ress:
STREET ADDRESS
57 Oliver Road
CITY I STATE 1 ZIP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
3,247.36
3,084.99
162.37
Total Credits (A + B + C)
(2)
3,247.36
3. Interest/Penalty if applicable
D. Interest
E. Penalty
(3) 0.00
(4)
(5) 0.00
(5A) 0.00
(5B) 0.00
Total Interest/Penalty (D + E)
4. If Une 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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; .......................................
b. retain the right to designate who shall use the property transferred or its income; .................
c. retain a reversionary interest; or. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . . .
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 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 information of
which re arer has an knowled e.
SIGNA EO PERS N SPONSIB E FOR FI NG RETURN DATE
'tJ
Yes No
~ I
8 ~
~
DAT
I ft., 0'-
Front Street, ro Box 5950, Harrisburg, PA 17110-0950
[72 P.S. jj 9116 (il) (1.1) (i)].
For dates of death on or af1er January 1.1995, the tax rate is imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 89116(a)(1.1)(ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure aT assets and 'filing a tax return are still applicable even jf
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 youngerat death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 89118(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 in 72.P.S. 8 9116(1.2) [72 P.S. 8 9116(a)(1)].
The tax rate imposed on the net value of transfers to orforthe use of the decedent's siblings is 12% [72 P.S. 89116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual
who has at least one parent in common with the decedent, whether by blood or adoption.
o PA15002
NTF 29756
Copyright 2000 GreatlandlNelco LP - Forms Software Only
Estate of: Betty J. Crossland
21-2001-01066
The following person (s) are signing the retUlll as representative (s) of the estate:
nile S. Crossland
300 Third Street
ro Box 137
Surrmerdale, PA 17093
REV-1502 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Betty J. Crossland
SCHEDULE A
REAL ESTATE
FILE NUMBER
21-2001-01066
All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the
price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which Is Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NO. DESCRIPTION
VALUE AT DATE
OF DEATH
1 57 Oliver Road, Enola, East Pennsboro Township, Cumberland
CbLmty, PA. Contracted for sale prior to death. See attached
settlement sheet.
82,500.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
82,500.00
7 CPA21 NTF 10904
Copyright Forms Software Only, 1997 Nelco, Inc.
REV-1503 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Betty J. Crossland
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
21-2001-01066
All property JoIntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NO. DESCRIPTION
VALUE AT DATE
OF DEATH
1 45 shares of Prudential Financial
1,318.50
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,318.50
7 CPA31 NTF 10905
Copyright Forms SoHware Only, 1997 Nelco, Inc.
REV-1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Betty J. Crossland
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21-2001-01066
Include proceeds of litigation & date proceeds were received by the estate. All prop. Jointly-owned with right of survivorship must be disclosed on Sch. F.
ITEM
NO. DESCRIPTION
VALUE AT
DATE OF DEATH
1 Household items & personal property
500.00
2 1997 aIds Cutlass Supreme
Sold 12/15/01
6,500.00
3 Reirnburserrent fran settlerrent sheet for sale of real estate
listed on Schedule A. (real estate taxes, sewer & trash)
504.37
7 CPA81 NTF 10908
Copyright Forms Software Only, 1997 Nelco, Inc.
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
7,504.37
REV-1509 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Betty J. Crossland
SCHEDULE F
JOINTL V-OWNED PROPERTY
FILE NUMBER
21-2001-01066
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
A Dale S. Crossland
ADDRESS
300 Third Street
PO Box 137
Surnrerdale, PA 17093
RELATIONSHIP TO DECEDENT
Son
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
Include name of financial institution and bank
ITEM FOR MADE account number or similar identifying number. DATE OF DEATH DECD'S VALUE OF
JOINT
NO. TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1 A 11/12/91 Waypoint Bank Certificate of 5,501.22 50 2,750.61
Deposit #966216652
A 11/12/91 Accrued interest on aOOve 56.66 50 28.33
aCCOlIDt
2 A 4/6/00 Allfirst Bank Checking AcCOlIDt 1,053.55 50 526.77
#0950268510
3 A 4/6/00 Allfirst Bank Certificate of 18,000.00 50 9,000.00
Deposit #80000002186567
A 4/6/00 Acc:rued interest on aOOve 121.62 50 60.81
aCCOlIDt
TOTAL (Also enter on line 6, Recapitulation) $ 12,366.52
7 CPA91 NTF 10909
(If more space is needed, insert additional sheets of the same size)
Copyright Forms Software Only, 1997 Nelco, Inc.
REV-1511EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Betty J. Crossland
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21-2001-01066
Debts of decedent must be reported on Schedule I.
ITEM
NO. DESCRIPTION
A. FUNERAL EXPENSES:
AMOUNT
1 Heller-Hoe.nstine Funeral Hanes, Ine.
6,429.00
2 Funeral Lnncheon
100.00
3 Headstone - add date
58.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN No. of Personal Representative(s)
Street Address
0.00
City
State
Zip
Year(s) Commission Paid:
2.
3.
Attorney Fees Narre : Mette, Evans & Woodside
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
3,000.00
0.00
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
220.00
5.
Accou ntant's Fees
0.00
6.
Tax Return Preparer's Fees
0.00
See Schedule attached
'Ibtal fran cont.i.rruation page (s)
9,140.69
7 CPA11 NTF10911
Copyright Forms Software Only, 1997 Nelco, Inc.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
18,947.69
Estate of: Betty J. Crossland
SCEEI:XJLE H, PARI' B -- Administrative Costs
Item
No. Description
7 CUmberland law JOlU11al - legal advertising
8 The Sentinel - legal advertising
9 Settlerrent Charges for sale of :real estate listed on Schedule A
10 Credits given to buyer for repairs and Buyers Association made
to :real estate listed on Schedule A (required under sale
contracct executed prior to death) .
11 Vehicle Inspection prior to sale
12 Patriot-News - classified ad for sale of vehicle
13 ~' s - naterials for repairs to real estate listed on Schedule
A prior to sale
14 K-Mart - new lock for real estate listed on Schedule A prior to
sale
TOrAL. (Carry forward to nain schedule) . . . . . .
Page 2
21-2001-01066
Arrount
75.00
97.07
5,994.50
2,700.00
21.00
22.00
221.59
9.53
9,140.69
REV-1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Betty J. Crossland
Include unreimbursed medical expenses.
ITEM
NO.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FilE NUMBER
21-2001-01066
DESCRIPTION AMOUNT
1 Verizon - telephone
10.39
2 illr - gas
97.93
3 PP&L - electric
54.63
4 Carcast - cable
11.26
5 PA Water
33.50
6 Allfirst Bank Second Mortgage Account #23000000000641
12,251.40
Accrued interest on above IIDrtgage
119.13
7 CPA12 NTF 10912
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
12,578.24
Copyright Forms Software Only, 1997 Nelco, Inc.
REV-1513 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
Bettv J. Crossland
No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Dale S. Crossland
300 Thivd Street
Fa Box 137
Sunmerdale, PA 17093
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not LIst Trustee(s)
Son
21-2001-01066
AMOUNT OR
SHARE OF ESTATE
72, 163 .46
ENTER DOLLAR AMTS. FOR DISTRIBS. 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
None
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
NOne
7 CPA13 NTF 10913
TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
0.00
Copyright Forms Software Only, 1997 Nelco, Inc.
(If more space is needed, insert additional sheets of the same size)
Historical Quotes
~!FlNANCE~
Page 1 of2
Finance Home - Yahoo! - Help
Historical Quotes
NYSE:PRU
More Info: QUQte I News I profile I R~s~;l.rch I Msgs
Month Day Year
Start: IOct .~. ~ JOl
End: IJan~' [l4 [02
(i Daily
r Weekly
r Monthly
r Dividends
Ticker Symbol: Ipru
Date Open High Low Close Volume Adj.
Close*
II-Jan-02 31.01 31.15 30.75 30.90 1,966,200 30.90
10-Jan-02 31.12 31.68 31.01 31.01 1,689,400 31.01
9-Jan-02 31.95 31.95 31.25 31.30 1,639,100 31.30
8-Jan-02 31.25 31.85 31.25 31.78 1,766,500 31.78
7-Jan-02 31.75 32.05 31.37 31.95 2,449,300 31.95
4-Jan-02 31.20 32 31.10 31.95 3,086,000 31.95
3-Jan-02 31.30 32.75 30.82 31.25 2,906,500 31.25
2-Jan-02 32.61 32.80 31.12 31.30 5,168,900 31.30
31-Dec-Ol 33.11 33.74 32.72 33.19 5,532,800 33.19
28-Dec-Ol 32.86 33.10 32.58 32.94 4,174,800 32.94
27-Dec-Ol 32.20 32.97 31.52 32.85 4,447,500 32.85
26-Dec-Ol 31.50 32.74 31.50 32.20 2,456,300 32.20
24- Dec-O 1 30.75 31.49 30.75 31.45 976,900 31.45
21-Dec-Ol 30.40 30.99 30.25 30.99 3,429,100 30.99
20-Dec-Ol 30.25 30.98 30.12 30.17 3,914,200 30.17
19- Dec-O 1 29.85 30.19 29.62 30.15 3,693,200 30.15
18- Dec-O 1 29.50 29.95 29.39 29.95 5,167,700 29.95
17-Dec-Ol 29.95 29.95 29.40 29.45 5,110,900 29.45
14-Dec-01 29.90 30.10 29.52 29.68 9,676,300 29.68
13-Dec-Ol 29.10 30 29 29.30 49,466,000 29.30
http://table.finance. yahoo .com/t?s=pru&g=d
ADVERTISEMENT
\\\\'V\01
1/14/2002
~IWay~qi!1J
LOOK FOR US. WE'LL GET YOU THERE.
12/06/2001
METTE EVANS & WOODSIDE
3401 N FRONT ST
HARRlSBURGPA 17110
The information which you requested on the account(s) of BETTY CROSSLAND DECEASED
(Social Security Number 182-14-8196) is/are as follows:
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership JTO
Name of Joint DALE
Owner, if any CROSSLAND
Date Ownership 11/12/91
Was Established
966216652
CERTIFICATE
11/12/91
5501.22
56.66
5557.88
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint
Owner, if any
Date Ownership
Was Established
Additional
Information
Requested
Sincerely,
ja:t ft:u:l
SENIOR SERVICES REP.
PO. Box 1711, HARRISBURG. PENNSYLVANIA 17105-1711
Toll Free 1-866-WAYPOINT (1-866-929-7646) . www.waypointbank.com
!l allfirst
AlIfirst Financial Center N.A.
P.O. Box 900
Millsboro. DE 19966
December 10,2001
Mette, Evans & Woodside
Attomeys At Law
3401 North Front Street
P.O. Box 5950
Harrisburg, PA 17110-0950
RE: Estate of Betty J. Crossland
Date of Death: November 12,2001
Social Security Number: 182-14-8196
Dear Ms. Otto:
In response to your request, please be advised that at the time of death, the above-
named decedent had on deposit with this bank the following accounts.
1. Account Type. . .. . ... . .. ... .. .. ..... . ... Checking Account
Account Number....................... 0950268510
Ownership (Names of}.............. Betty J. Crossland or Dale S. Crossland
Opening Date. .... ... .. ... . .. . ... .. ... . .04/06/00
Balance on Date ojDeath.........$1,053.55
Accrued Interest
$
0.00
Total. . .. . .. . .. ... . ... .. . .. . ... .. . ... .. . .... $1,053.55
2. Account Type.. .. ..... .. ....... .. ....... Certificate of Deposit
Account Number.... ................... 80000002186567
Ownership (Names of}........ ...... Betty J. Crossland or Dale S. Crossland
Opening Date.......................... .04/06/00
Balance on Date of Death....... ..$18,000.00
Accrued Interest
$ 121.62
Total...................... ............. ....$18, 121.62
. Page 2
December 10, 2001
3. Account Type........................... Second Mortgage
Account Number. ............ . ......... 23000000000641
Ownership {Names oj).............. Betty J. Crossland
Opening Date.......... ................ .10/21/99
Principal on Date of Death....... .$12,251.40
Current Interest
$
119.13
Total..... ...... ........................ ....$12,370.53
TIlls amount is not to be used for payoff purposes. For payoff figures please call1-800-44l-8319.
TIlls letter does not include any accounts in which the deceased may have been listed as power of attorney,
custodian of uniform transfers, representative payee, or trustee under a written trust agreement.
For any additional information on these accounts, please contact our branch at:
5528 Carlisle Pike
Mechanicsburg, PA 17055
Phone: (717) 255-2293
Sincerely,
Charl~A~T
(302) 934-2722
A. Settlement Statement
U.S. Department of Housing
and Urban Oevelopment ~
,r
E. NAME AND ADDRESS OF SELLER:
B. Type of Loan
1. @ FHA 2.0 FmHA 3.0 Conv. UninsFi1e Number
cutl ip
4. 0 VA 5.0 Cony. Ins.
C. NOTE: This form is furnished 10 give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
items marked "p.o.c." were paid outside of closing; they are shown here for informational purposes and are not included in the totals.
D. NAME AND. ADDRES$qF.'.~9RROWER: "NI~~()LEM.JUTpe".."'.'<i<<</..">"
lQl$PUR 'ROAD. '.CARLl$LE.iPENNSYLVANIAl7Qia
DALE S. CROSSLANDESTATE OF BErry J. CROSSLAND
57 OLIVER ROAD. ENOLA. PENNSYLVANIA 17025
iWAyp01NT~ANK. ".<< .... ..... ... . '..i<: ......
AOfSOl1lfj'.. GEb!lGES"tREf:-CVORK......PAJ740J. ..' .
OMU No. 2502.0265
Loan Number
50097569
Mortgage Insurance Case Number
F, NAME AND ADDflESSOFL,gNPER
G. PROPERTY 57 aLl VER ROAD
.... LOCATION: ENOLA. PA 17025
H. :~E6:~~~~NT:>.......!R~lN.HCKNIGI1T&hU<iHES.. .................:.............
(TIN . .23.14:}~53,l )/iPpWEH PQHfBETSTREEl.(;ARl..ISLEP PA. }zola.
SETTLEMENT DATE: November 27. 2001
J. SUMMARY OF BORROWER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER:
201. Deposit or earnest money
20:2. Principal-amouflt 'ot riew'-:iban(I)--'"
203. Existing loan(s) taken subject to
204.
104.
101. Conlract sate. "prlc8 _:.0_
-~ 102. PeTsonal property
105.
109.
110.
111.
112.
205
208.
207.
208.
209.
501. EXCelS deposil (s.e instructions)
50ZSitU.",."iclJar.'.I."li.'{li~.'<lOoj 5,994 ;50
03. Exi'llng loan(s) taken lubject to
~04,P'..lf.ili,~,..."....IQ.~AllFl RST #230000000006 12,481 . 64
219.
220. TOTAL PAID BY/FOR
BORROWER:
300. CASH AT SETTlEMENTfROM/TO BORROWER:
301. Gross amount due from borrower (1 i ne 120)
302. Less amount aid b. !forbortower(Jine 220)
303. CASH (E]FROM) ( 0 TO) BORROWER:
85,249.00
. ~l."
520. TOTAL REDUCTIONS
IN AMOUNT DUE SELLER:
600. CASffAT SmLEMENTTOIFROM SEtLER:
601. Gross amount due to seller (1 i ne 420)
602. Less reduct' n~i n amLdueselJ er(l i ne 520
603. CASH EBTO) (0 FROM) SELLER:
HUD-l (3-86) - RESPA, HB 4305.2
21,176.14
86,567.28
85249.00
1,318.28
83,004.37
21176.14
61,828.23
PAGE 1
L.-;'/'U~ ~. I i~ ,- J
HUD-1_ (~ov.__3/,8,6)
L.
700. TOTAL SALES/BROKER'S COMMISSION
BASED ON PRICE
OMB No. 2502-0265
SE.TTLEMENTCHARGES
701.
702. S
DIVISION OF COMMISSION (LINE
245 O. 00 t.
2 500.00
AS FOLLOWS:
PAID FROM
BORROWER'S
FUNDS
AT
SETTLEMENT
PAID FROM
SELLER'S
FUNDS
AT
SETTLEMENT
82,500.00 @6.00o...
4,950.00
703. -:CQ~ri,i$aiOn-' -~tit:~t.' se~ll~m.nt
704.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN:
4
801: 'loin --od inatltlnfee.
80.2. Loan discount
a03'>A ralui'fee:"to:
804. Credit ra or! to:
805. lander's 'Ins &chOn -f.oe
806. Mort a e insurance a lication 10
8a7. Asaum t[on'lee
BOB. FLOOO CERT WAYPOINT
B09. REINSPECT ION FEE WAY POI NT SANK
325.00P~O;C.
8.00
810.
811-
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE:
901. 1n'"ooHr.", 1127 01. to 12. 1...01." .14.78 da
902. Mort a e insurance remium lor WAYPOINT BANK
903. Haz.rd.;nnr.n.o 'om',m f., ERIE OlNSURANCE 243 .0 OP :O..C.
59.11
1 209.60
904. Flood insurance remlum for
905-;
1000. RESERVES DEPOSITED WITH LENDER:
1001. Haz.rd "'s,ran.s ...3
1002. Mort a e insurance . 2
rs. 10
A re ate Accountin EscroW Ad'ustmerit
1100. TITLE CHARGES:
10
mo_nlh5- @'.$
monlhs @ $
monlha @$
months @ $
m-9n.\h.i . @ ~
months @ $
maniha @-.$
months @ S
. 20.25 .0' m.nt~
33 43 per month
pe.r m.onth
16 . per month
p.r'",onth
month
~ 1003. elt '0 art -1axes-
1004. Count ro on taxes
1005~ Annualasse..umenl::i
1006. Flood insurance
1007. SCHOOL
5
1008.
per month
"01. Selllamenl or closin lee 10
1102. Abslracl or Hlle search to
t 1 03. Tille examination 10
1104. TIUa irHluranC . bindir 10
'105. Document f. aralion 10
1106. Nelia.rlees te
"07. Attorney's lau to
MARCUS A.
10.00
4.00
75.00
nos. TlllelnSl,lri.nce
includill$ above
, 109.
'11D. Owner's
1111.
1112~
" 13.
1200. G VERNMENT RECORDING AND TRANSFER CHARGES:
1201,'Rltcordin tees, Deed 25.50 ,'Mort a &--$ 39,.'50"Aaluaes. $
1202. eit count lax Slam 5: Deed $ 825 . 00 . MOrl a e
1203. State.taxstam s: Diad $ '825.'00 '.Mort 'a Ii
1204. ASSIGNMENT OF MORTGAGE
1;?05.
1300. ADDITIONAL SETTLEMENT CHARGES:
65.00
825.00
825.00
14.00
1301.Sur~e 10
, 302. Pest ins action Ie
1303.
1304.
1305.
1306.
1307.
OVERNIGHT MAIL (2)
23.50
15.50
1400. TOTAL SETTLEMENT CHARGES
5,994.50
I have carefully reviowed the HUD-' Soltlement State mom and Ie the boal at my knowledge and belief
on my accoun or by me In this Iransaclion. I fUrlh8r certily thai J haVe received a copy of the HUO?,
Borrower:
Borrower:
Date:
Sallaf .or
Agent:
Dale:
The HUO-1 Se!Uament Statement which I have prepared Is a true and accurate account of this transilction.
with this statement.
disbursed in accordance
Dale:
Settlement Agent:
0':').1/27/01
WARNING: It is a crime to knowingly mike faIn statements 10 the United Slales on Ihis or any other aimllar
ment. For delails 8ee: Title 18 U.S. Code Section 1001 and Section 1010.
tion can include a fjne and imprison-
~
~
STANDARD AGREEMENT FOR THE SALE OF REAL ESTATE
This form reconuncnded and approved for, but not restricted to use by, the members of lhe Pennsylvania Associalion of REALTORSS (PAR).
AlS-2K
PA LICENSED BROKER
SELLING BROKER (Company)
fi.- /y .if" q <. y
ADDRESS /" :3 ',A/. /.,1'''-'1 cv~_.. sr
(1..10/4 p;f I 7 ""J
PH ,{ yJ- /" 00 FAX al YJ -/:?i' k
DESIGNATED AGENT FOR BUYER (if applicable)
PA LICENSED BROKER
LISTING BROKER (Company)
C:'lTvrv.i/
ADDRESS I
PH 737- 6// J FAX
DESIGNATED AGENT FOR SELLER (if applicable)
::::r;;.j IE Sit.. V fJ -t. '" ....,
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1. itbig lt~reementl dated SF IrE.., 0 .e i?
SELLER(S): /1 c T 7)1 ::.r t... tJ (.' /~... <I
, is between
/~
.! o~ I
,called'~eller:'and
BUYER(S): Ah t '" I'
/1.
(v -r/I'
.
, called ''Buyer.''
2. PROPERTY (1-98) Seller bereby agrees to sell and convey to Buyer, who hereby agrees to purchase:
ALL THAT CERTAIN lot or piece of ground with buildings and Improvements thereon erected, if any, known as:
s-7 O/i"..... /{J. I&^"/,, rl1
I in the 7;;...." .., j, I II of F'l.J' r ~tJf"J ~"". "
County of c...,,,, b Co,. I q /I I in the Commonw:Wth of Pennsylvauia, Zip Code J"7 0 riI-5:"
Identification (e.g., Tax ID#; Parcel #; Lot, Block; Deed Book, Page, Recording Date)
3. TERMS (1-00)
(A) PurchaSe Price A
- TtPo r)"~'.I..1 I,-..-c
,," 1...,.1 /"/!if.r?
""if :ro..~)
Dollars
which will be paid to Seller by Buyer as follows:
(B) Cash or check at signing this Agreement:
(C) Cash or check within ~ days of the execution of this Agreement:
(D)
(E) Cash. cashier's or certified check at time of settlement:
$
$
$
$
TOTAL $
(F) Deposits paid on account of purchase price to be held by Listing Broker, unless otherwise stated here:
7oP, "f!7
9S
/.1
I
! 0 0 _ 00
.5 () o. ,."
Seller's written approval to be on or before: .> ~ ~ .t;. '" ""...
Settlement to be made on or before: A/o", <,,., ~ r .{ t1'
.
Conveyance from Seller will be by fee simple deed of special warranty unless otherwise stated here:
.J
/ 7 '" Oc7 I
4,,-:"'/
..:r: ., p " ,.,.
(G)
(H)
(I)
(J) Payment of transfer taxes will be divided equally between Buyer and Seller unless otherwise stated here:
(K) At time of settlement, the following will be adjusted pro-rata on a daily basis between Buyer and Seller, reimbursing where applicable: taxes;
rents; interest on mortgage assumptions; condominium fees and homeowner association fees, if any; water and/or sewer fees, if any, together
with any other lienable municipal service. The charges are to be pro-rated for the period(s) covered: Seller will pay up to and inciuding the
date of settlement; Buyer will pay for all days following settlement, unless otherwise stated here:
4. FIXTURES & PERSONAL PROPERTY (1-00)
(A) INCLUDED in this sale and purchase price are all existing items permanently installed in the Property, free of liens. inciuding plumbing;
heating; lighting fixtures (inciuding chandeliers and ceiling fans); water treatment systems; pool and spa equipment; garage door openers
and transmitters; television antennas; shrubbery, plantings and unpotted trees; any remaining heating and cooking fuels stored on the
Property at the time of settlement; wall to wall carpeting; window covering hardware, shades, blinds; built-in air conditioners; built-in appli-
ances; and the range/oven unless otherwise stated. Also. included: A ~ If -<" L ~ .i ... , J' J. .. -..J " "" 'f
J /.$ r, ~ '" ',y ....., r.,l1~.
(B) LEASED items (items n owned (y Seller):
(C) EXCLUDED fixtures and items:
5, SPECIAL CLAUSES (1-00)
(A) ~yer and Seller have received the Consumer Notice as adopted by the State Real Estate Commission at 49 Pa. Code ~3S.336.
(B) J3"~yer and Seller have received a statement of their respective estimated closing costs before signing this Agreement.
(C) la'1Iuyer has received the Seller's Property Disciosure Statement before signing this Agreement. if required by law. (See Notice, Information
~arding the Seller's Property Disciosure Act.)
(D) la'1Iuyer has received the Deposit Money Notice (for cooperative sales when Listing Broker is holding deposit money) before signing this
Agreement.
(E) The following are part of this Agreement if checked:
o Sale & Settlement of Other Property
Contingency Addendum (PAR Form 130)
o Sale & Settlement of Other Property Contingency
with Right to Continue Marketing Addendum
(PAR Form 131)
o Settlement of Other Property Contingency Addendum (pAR Form 133)
O. Tenan;;Jccu~property Addendum (PAR Form TOP)
~Mi j~ fLl11
/0_'
o
Buyer Initials: \\) \\rr' .)
A1S-2K Page 1 of 8 Seller Inltiab,}f; (J.
COPYRIGHT PENNSYLVANIA ASSOCIATION OF REALTORSoIl998
1/00
m Pennsylvania Association of
L.J:! REALTORS"
REAl.'~ n..............--..In~
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6. MORTGAGE CONTINGENCY (1-00)
o WAlVED. This sale is NOT contingent on mortgage financing.
W ELECTED
"(A) This sale is contingent upon Buyer obtaining mortgage financing as follows:
1. Amount of mortgage loan $ 9' (J , CI c:>
2~ Minimwn Term J 0 years
3. Type of mortgage r # A
4. Interest rate ~ %; however, Buyer agrees to accept the Interest rate as may be committed by the mortgage lender, not to
exceed a maximum interest rate of "7. ~l.s' %.
5. Discount points, loan origination, loan placement and other fees charged by the lender as a percentage of the mortgage loan (excluding
any mortgage insurance premiwns or VA funding fee) not to exceed CJ % of the mortgage loan.
The interest rate and fees provisions required by Buyer are satisfied if a mortgage lender makes available to Buyer the right to guarantee an
interest rate at or below the Maximum Interest Rate specified herein with the percentage fees at or below the amount specified herem. Buyer
gives Seller the right, at Seller's sole option and as permitted by the lending institution and applicable laws, to contribute financially, without
promise of reimbursement, to the Buyer and/or lender to make the above terms available to Buyer.
(B) Within 10 days of the execution of this Agreement, Buyer will make a completed, written mortgage application to a respoosible mortgage lend-
ing institution. The Selling Broker, if any, otherwise tbe Listing Broker, is authorized to communicate with the lender for tbe purposes
of assisting in the mortgage loan process.
(C) I. Upon receipt of a mortgage commitmen~ Buyer and/or Selling Broker will promptly deliver a copy of the commitment to Listing Broker,
if any, otherwise to Seller.
2. Mortgage commitment date M v E A 0 E L " .1 .,. of. If a written commitment is not received by
Listing Broker, if any, otherwise by Seller, by the above date, Buyef and Seller agree to extend the commitment date until Seller ter-
minates this Agreement in writing.
3. Seller has the option to terminate this Agreement in writing, on or after the mortgage commitment date. if the mortgage commitment:
a. Is not valid until the date of settlement, OR
b. Is conditioned upon the sale and settlement of any other property, OR
c. Comains any other condition not specified in this Agreement.
4. In the event Seller does not terminate this Agreement as provided above, Buyer has the option to terminate this Agreement in writing if
the mortgage commitment: ~
a. Is not obtained by or~valid until the date of settlement, OR
h.. Is conditioned upon the sale and settlement of any other property which do not occur by the date of settlement, OR
c. Contains any other condition not specified in this Agreement which Buyer is unable to satisfy by the date of settlement.
5. If this Agreement is terminated as specified in paragraphs 6 (C) (2), (3) or (4), all deposit monies paid on account of purchase price will
be retl1I11ed to Buyer. Buyer will be responsible for any premiums for mechanics lien insurance and/or title search. or fee for cancellation
of same, if any; AND/OR any premiums for flood insurance and/or fire insurance with extended coverage, insurance binder charges or
cancellation fee, if any; AND/OR any appraisal fees and charges paid in advance to mortgage lender.
(D) If the mortgage lender requires repairs to the Property, Buyer will, upon receipt, deliver a copy of the mortgage lender's requirements to Listing
Broker, if any, otherwise to Seller. Seller will, within 5 days of receipt of the lender's requirements, notify Buyer whether Seller will make the
required repairs at Seller's expense.
I. If Seller chooses to make repairs, Buyer will accept the Property and agree to the RELEASE set forth in paragraph 25 of this Agreement.
2. If Seller chooses not to make the required repairs. Buyer will, within 5 days, notify Seller in writing of Buyer's choice to terminate this
Agreement OR make the required repairs at Buyer's expense and with Seller's permission, which will not be unreasonably withheld. If
Seller denies Buyer permission to make the required repairs, Buyer may, within 5 days of Seller's denial, terminate this Agreement. If
Buyer terminates this Agreement, all deposit monies paid on account of purchase price will be returned promptly to Buyer and this
Agreement will be VOID.
(E) Seller Assist
o NOT APPLICABLE
)i:f~ APPLICABLE. Seller will pay:
~ $ Ii( I .f <J p. ~ (7 , maximum, toward Buyer's costs as permitted by the mortgage lender.
o
FHA/VA, IF APPLICABLE
(F) It is expressly agreed that notwithstanding any other provisions of this contract, Buyer will not be obligated to complete the purchase of the 116
Property described herein or to incur any penalty by forfeiture of earnest money deposits or otherwise unless Buyer has been given, in accor- 11:1
dance with HUD/FHA or VA requirements. a written statement by the Federal Housing Commissioner, Vete~ Administration, or a Direct 12!!
Endorsement Lender setting forth the appraised value of the Property of not less than $ 'is'"). 5' e> c:. (the dollar amount to be
inserted is the sales price as stated in this Agreement). Buyer will have the privilege and option of proceeding with consummation of the con-
lract without regard to the amount of the appraised valuation. The appraised valuation is arrived at to determine the maximum mortgage the
Department of Housing and Urban Development will insure. HUD does not warrant the value nor the condition of the Property. Buyer should
satisfy himself/herself that the price and condition of the Property are acceptable.
Warning: Section 1010 of TItle 18, I.S.c., Department of Housing and Urban Development provides, "Whoever for the purpose of. . . inftu- "'i
encing in any way the action of such department. . . makes, passes, utters or publishes any statement knowing the same to be false. . . shall be 'n
fmed not more than $5,000 or imprisoned not more than two years, or both."
(G) U.S. Department of Housing and Urban Development (HUD) NOTICE TO PURCHASERS:
Buyer's Acknowledgement
o Buyer has received th D Notice "For Your Protection:
Inspections). auyer nders
Agreement.
Buyer's Initials
(H) Certitlcation We the undersigned, eller(s) and Buyer(s) party to this IT
true to the best of our knowledge and
tion is attached to this Agreement.
7. INSPECTIONS (1-98)
(A) Seller hereby agrees to permit inspections by authorized appraisers, reputable certifiers, insurer's representatives, surveyors, municipal officials
and/or Buyer as may be required by the lending institutions, if any, or insuring agencies. Seller further agrees to permit any other inspections
required by or provided for in the terms of this Agreement.
(B) Buyer reserves the right to make a pre-settlement walk-through inspection of the Property. Buyer's right to make this inspection is not waived 142
by any other provision of this Agreement.
(C) Seller will have heating and all utilities (including fuel(s)) on for the inspections.
rll'l/al
Date
e terms of this contract for purchase are t35
parties in connection with this transac-
\J
Seller Initials:
,~7)
e.
AlS-2K Page 2 of 8
Buyer Initials:
67
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BO
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8. PROPERTY INSPECTION CONTINGENCY (1-00)
o WAIVED. Buyer understands that Buyer has the option to request inspections of the Property (see Property Inspection and Environmental 150
Notices)_ BUYER WAIVES THIS OPTION and agrees to the RELEASE set forth in paragraph 25 of this Agreement.
~ ELECTED
(A) Within ~ days of the execution of this Agreement, Buyer, at Buyer's expense, may choose to have inspections and/or certifications com-
pleted by licensed or otherwise qualified professionals (see Property Inspection and Environmental Notices). This contingency does not apply
to the following existing conditions and/or items:
(B) Other provisions of this Agreement may provide for inspections and/or certifications that are not waived or altered by Buyer's election here.
(C) If Buyer is not satisfied with the condition of the Property as stated in any written report, Buyer will, within the time given for completing 162
inspections:
)( Option 1
1. Accept the Property with the information stated in the report(s) and agree to the RELEASE set forth in paragraph 25 of this Agreement, 165
OR
154
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161
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2. Terminate the Agreement in writing by notice to Listing Broker, if any, otherwise to Seller, within the time given for inspection, in which lG7
case all deposit monies paid on account of purchase price will be returned promptly to Buyer and this Agreement will be VOID- 'D8
o Option 2 16;,
1. Accept the Property with the information stated in the report(s) and agree to the RELEASE set forth in paragraph 25 of this Agreement, '70
UNLESS the total cost to correct the conditions contained in the report(s) is more than $ 171
2. If the total cost to correct the conditions contained in the report(s) EXCEEDS the amount specified in paragraph 8(C) (Option 2) I, 172
Buyer will deliver the report(s) to Listing Broker, If any, otherwise to Seller, within the time given for inspection. 173
a. Seller will, within _ days of receiving the report(s), inform Buyer in writing of Seller's choice to: 111
(I) Make repairs before senlement so that the remaining cost to repair conditions contained in the report(s) is less than or equal to 175
the amount specified in paragraph 8 (C) (Option 2) I. 176
(2) Credit Buyer at settlement for the difference between the estimated cost of repairing the conditions contained in the report(s) In
and the amount specified in paragraph 8 (C) (Option 2) 1. This option must be acceptable to the mortgage lender, if any. 17B
(3) Not make repairs and not credit Buyer at settlement for any defects in conditions contained in the report(s). 179
b. If Seller chooses to make repairs or credit Buyer at settlement as specified in paragraph 8 (C) (Option 2) 2, Buyer will accept the 180
Property and agree to the R!'LEASE set forth in paragraph 25 of this Agreement. ,61
c. If Seller chooses not to make repairs and not to credit Buyer at settlement, or if Seller fails to choose any option within the time 1U<,
given, Buyer will, within _ days: 183
(I) Accept the Property with the information stated in the report(s) and agree to the RELEASE set forth in paragraph 25 of tltis 184
Agreement, OR 185
(2) Terminate the Agreement in writing by notice to Listing Broker, if any, otherwise to Seller, in which case all deposit monies '86
paid on account of purchase price will be returned promptly to Buyer and this Agreement will be VOID. 187
9. WOOD INFESTATION CONTINGENCY (1-00) 188
o WAIVED. Buyer understands that Buyer has the option to request that the Property be inspected for wood infestation by a certified Pest Control lE"
Operator. BUYER WAIVES THIS OPTION and agrees to the RELEASE set forth in paragraph 25 of this Agreement. 1~0
j)( ELECTED 191
(A) Within --1L days of the execution of this Agreement, Buyer, at Buyer's expense, will obtain a wrinen "Wood-Destroying Insect Infestation 192
Inspection Report" from a certified Pest Control Operator and will deliver it and all supporting documents and drawings provided by the Pest 193
Control Operator to Listing Broker, if any, otherwise to Seller. The report is to be made satisfactory to and in compliance with applicable laws, 194
mortgage and lending institutions, and/or Federal Insuring and Guaranteeing Agency requirements, if any. The inspection will include all read- 195
ily visihle and accessible areas of all structures on the Property except the following structures, which will not be inspected: 196
197
(B) If the inspection reveals evidence of active infestation(s), Seller agrees, at Seller's expense and before settlement, to treat for active infesta- ; 1'1
tion(s), in accordance with applicable laws. I".
(C) If the inspection reveals damage from active infeslation(s) or previous infestation(s), Buyer, at Buyer's expense, has the option to obtain a writ- 2UIl
ten report by a professional contractor. home inspection service, or structural engineer that is limited to structural damage to the Property caused ?U-~
hy wood-destroying organisms and a proposal to repair the damage. Buyer will deliver the structural damage report and corrective proposal to ,02
Listing Broker, if any, otherwise to Seller, within _ days of delivering the original inspection report. ?I!3
(D) Within 5 days of receiving the structural damage report and conective proposal, Seller will advise Buyer whether Seller will repair, at Seller's 204
expense and before settlement, any structural damage from active or previous infestation(s). 205
(E) If Seller chooses to repair structural damage revealed by the report, Buyer agrees to accept the Property as repaired and agrees to the RELEASE 206
set forth in paragraph 25 of this Agreement. 207
(F) If Seller chooses not to repair structural damage revealed by the report or fails to respond within the time given, Buyer, witltin 5 days of 208
receiving Seller's notice, will notify Seller in writing of Buyer's choice to: 209
1. Accept the Property with the defects revealed by the inspection, without abatement of price and agree to the RELEASE set forth in para- 210
graph 25 of this Agreement, OR 211
2. Make the repairs before settlement, if required by the mortgage lender, if any, at Buyer's expense and with Seller's permission, which will 12
not be unreasonably withheld, in which case Buyer accepts the Property and agrees to the RELEASE set forth in paragraph 25 of this 213
Agreement. If Seller denies Buyer permission to make the repairs, Buyer may, within 5 days of Seller's denial, terminate this Agreement. 214
If Buyer terminates this Agreement, all deposit monies paid on account of purchase price shall be returned promptly to Buyer and this 215
Agreement will be VOID, OR 2j ,
3. Terminate this Agreement, in which case all deposit monies paid on account of purchase price will be returned promptly to Buyer and 217
this Agreement will be VOID. '10
10, RESIDENTIAL LEAD-BASED PAINT HAZARD REDUCTION ACT NOTICE REQUIRED FOR PROPERTIES 219
BUILT BEFORE 1978 (1-00) 120
o NOT APPLICABLE 221
.p.< APPLICABLE 222
(A) Seller represents that: (check I OR 2) 223
):!( I. Seller has no knowledge concerning the 'Presence of lead-based paint and/or lead-based paint hazards in or about the Property. 22'
o 2. Seller has knowledge of the presence of lead-based paint and/or lead-based paint hazards in or about the Property. (Provide the basis for 225
determining that lead-based paint and/or hazards exist, the location(s), the condition of the painted surfaces, and other available informa- <26
tion concerning Seller's knowledge of the presence of lead-hased paint and/or lead-based paint hazards.) 227
1/i9
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171
1/!
173
174
175
171i
177
178
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184
185
186
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197
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204
205
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220
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(B) Records/Reports (check I OR 2) 229
~ 1. Seller has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in or ahout the Property. 23U
o 2. Seller has provided Buyer with all available records and reports pertaining to lead-based paint and/or lead-based painl hazards in or about 231
the Property. (List documents) 232
2~3
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231
232
233
241
2.~,'_1
~
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Family from Lead in Yow- Home and has read the Lead Warning Statement contained in tltis 235
2~1[;
731
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239
Date 9//Y jc/
wn lead-based paint and/or lead-based paint hazards, as identified in paragraph IO(A) and
ing to lead-based paint and/or lead-based paint hazards identified in paragraph lO(B).
Date / 0
:.(38
23<:;
24~
)( 2.
2:~~
241 Buyer Initials:
AlS-2K Page 3 of 8
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(D) RISK ASSESSMENT/INSPECTION: Buyer acknowledges that before Buyer is obligated to buy a residential dwelling built before 1978,
Buyer has a 10 day period (unless Buyer and Seller agree in writing to a different period of time) to conduct a risk assessinent or inspection of
~' the Property for the presence of lead-based paint and/or lead-based paint hazards.
y\ WAIVED. Buyer understands that Buyer has the right to conduct a risk assessment or inspection of the Property to determine the presence of
lead-based paint and/or lead-based paint hazards. BUYER WAIVES TIDS RIGHT and agrees to the RELEASE set forth in paragraph 25 of
this Agreement.
o ELECTED
1. Buyer, at Buyer's expense, chooses to obtain a risk assessment and/or inspection of the Property for lead-based paint and/or lead-based
paint hazards. The risk assessment and/or inspection will be completed within _ days of the execution of this Agreement (insert
"10" unless Buyer and Seller agree to a different petiod of time).
2. Within the time set forth above for obtaining the risk assessment and/or inspection of the Property for lead.based paint and/or 2S?
lead. based paint hazards, Buyer may deliver to Listing Broker, if any, otherwise to Seller, a written list of the specific hazardous 253
conditions cited in the report and those corrections requested by Buyer, along with a copy of the risk assessment and/or inspection report.
3. Seller may, within _ days of receiving the list and report(s), submit a written corrective proposal to Buyer. The corrective proposal
will include, but not be limited to, the name of the remediation company and a completion date for corrective measures. Seller will pro-
vide certification from a risk assessor or inspector that corrective measures have been made satisfactorily on or before the completion date.
4. Upon receiving the corrective proposal, Buyer, within 5 days, will:
a. Accept the corrective proposal and the Property in writing, and agree to the RELEASE set forth in paragraph 25 of this Agreement, ?59
OR
b. Terminate this Agreement in writing, in which case all deposit monies paid on account of purchase price will be retwned promptly Zlii
to Buyer and this Agreement will be VOID.
5. Should Seller fail to submit a written corrective proposal within the time set forth in paragraph IO(D)3 of this Agreement, then Buyer,
within 5 days, will:
a. Accept the Property in writing, and agree to the RELEASE set forth in paragraph 25 of this Agreement, OR
b. Terminate this Agreement in writing, in which case all deposit monies paid on account of purchase price will be returned promptly
to Buyer and this Agreement will be VOID.
(E) Certification By signing this Agreement, Buyer and Seller certify the accuracy of their respective statements, W the best of their knowledge.
11, RADON CONTINGENCY (1-00)
,(A) Seller represents that: (check appropriate response(s))
;s., 1. Seller has no knowledge conceming the presence or absence of radon.
o 2. Seller has knowledge that the Property was tested on the dates, by the methods (e.g., charcoal canister, alpha track, etc.), and with the
results of all tests indicated below:
DATE TYPE OF TEST
N2
243
214
245
;46
2.17
246
:'49
2;'::,',\
2Si
254
'~55
~':16
:>,7
~58
,(Sf!
25~'
263
264
~t15
266
~57
,3
269
270
271
272
213
RESULTS (picocuries/liter or working levels)
Ti~
215
276
217
COPIES OF ALL AVAILABLE TEST REPORTS will be delivered to Buyer with this Agreement. SELLER DOES NOT WARRANT 716
EITHER THE METHODS OR RESULTS OF THE TESTS. 279
o 3. Seller has knowledge that the Property underwent radon reduction measures on the daters) and by the method(s) indicated below: ~6~
DATE RADON REDUCTION METIiOD 2B1
232
283
284
2a5
2a6
:ri
WAIVED. Buyer understands that Buyer has the option to request that the Property be inspected for radon by a certified inspector (see Radon
Notice). BUYER WAIVES TillS OPTION and agrees to the RELEASE set forth in paragraph 25 of this Agreement.
ELECTED
Buyer, at Buyer's expense, has the option to obtain, from a certified inspector, a radon test of the Property and will deliver a copy of the test
report to Listing Broker, if any, otherwise to Seller, within _ days of the execution of this Agreement. (See Radon Notice.)
1. If the test report reveals the presence of radon below 0.02 working levels (4 picocuriesJliterl, Buyer accepts the Property and agrees to the
RELEASE set forth in paragraph 25 of this Agreement.
2. If the test report reveals the presence of radon at or exceeding 0.02 working levels (4 picocuriesJliter), Buyer will, within _ days
of receipt of the test results:
Option 1
a. Accept the Property in writing and agree W the RELEASE set forth in paragraph 25 of this Agreement, OR
b. Terminate this Agreement in writing, in which case all deposit monies paid on account of purchase price will be returned promptly
ta Buyer and this Agreement will be VOID, OR
c. Submit a written, corrective proposalta Listing Broker, if any, otherwise to Seller. The corrective proposal will include, but not be ,9B
limited to, the naroe of the certified mitigation company; provisions for payment, including retests; and completion date for correc-
tive measures.
(I) Within 5 days of receiving the corrective proposal, Seller will:
(a) Agree to the terms of the corrective proposal in writing, in which case Buyer accepts the Property and agrees to the
RELEASE set forth in paragraph 25 of this Agreement, OR
(b) Not agree to the terms of the corrective proposal.
(2) Should Seller not agree to the terms of the cOITective proposal or fail to respond within the time given, Buyer will, within 5
days, elect to:
(a) Accept the Property in writing and agree to the RELEASE set forth in paragraph 25 of this Agreement, OR
(b) Terminate this Agreement in writing, in which case all deposit monies paid on account ofpurcbase price will be returned
promptly to Buyer and this Agreement will be VOID.
o
(B)
:"'87
23B
?~9
'2fUt
291
o
292
293
?q4
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296
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302
303
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3g6
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311
311
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o Option 2
.. Accept the Property in writing and agree ta the RELEASE set forth in paragraph 25 of this Agreement, OR
b. Submit a written, corrective proposal to Listing Broker, if any. otherwise to Seller. Tbe corrective proposal will include, but not be
limited to. the name of the certified mitigation company; provisions for payment, including retests; and completion date for correc-
tive measures. Seller will pay a maximum of $ toward the total cost of remediation and retests, which will be
completed by settlement.
(I) If the total cost of remediation and retests EXCEEDS the amount specified in paragraph II(B) (Option 2) b, Seller will, within
5 days of receipt of the cost of remediation, notify Buyer in writing of Seller's choice to:
(a) Pay for the total cost of remediation and retests, in which case Buyer accepts the Property and agrees to the RELEASE set
forth in paragraph 25 of this Agreement, OR
(b) Not pay for the total cost of remediation and retests.
(2) If Seller cbooses not to pay for the total cost of remediation and retests, or if Seller fails to cboose either option within the
time given. Buyer will, within 5 days, notify Seller in writing of Buyer's cboice to:
(a) Pay the difference between Seller's contribution to remediation and retests and the actual cost thereof, in which case :,<3
Buyer accepts the Property and agrees to the RELEASE set forth in paragraph 25 of this Agreement, OR
(b) Terminate this Agreement, in wbich case all deposit monies paid on account of purchase price will be returned promptly
~and tbisAgreement will be VOID.
'->\
./.) '.J
Buyer Initials: A/S.2K Page 4 of 8 Seller Inltials'flJ' e.
31,
31L
117
318
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12.
STATUS OF WATER (1-00)
(A) Seller represents that this property is served by:
~ Public Water
o On-site Water
o Community Water
o None
o
3 WATER SERVICE INSPECTION CONTINGENCY
~ WAIVED. Buyer acknowledges that Buyer has the option to request an inspection of the water service for the Property.
THIS OPTION and agrees to the RELEASE set forth in paragraph 25 of this Agreement.
o ELECTED
I. Buyer has the option, within _ days of the execution of this Agreement and at Buyer's expense, to deliver to Listing Broker, if any,
otherwise to Seller, a written inspection report by a qualified, professional water testing company of the quality and/or quantity of the water
service.
2. Seller agrees to locale and provide access to the on-site (or individual) water system, if applicable, at Seller's expense, if required by the
inspection company. Seller also agrees to restore the Property prior to settlement.
3. If the report reveals that the water service does not meet the minimum standards of any applicable governmental authority andlor fails to
satisfy the requirements for quality and/or quantity set by the mortgage lender, if any, then Seller will, within _ days of receipt of
the report, notify Buyer in writing of Seller's choice to:
a. Upgrade the water service to the minimum acceptable levels, before settlement, in which case Buyer accepts the Property and agrees
to the RELEASE set forth in paragrapb 25 of this Agreement, OR
b. Not upgrade the water service.
4. If Seller chooses not to upgrade the service to minimum acceptable levels, or fails to respond within the time given, Buyer will, within
_ days, either:
a. Accept the Property and the water service and, if required by the mortgage lender, if any, andlor any governmental authority, upgrade
the water service before settlement or within the time required by the mortgage lender, if any, andlor any governmental authority, at
Buyer's expense and with Seller's pennission, which will not be unreasonably withheld, and agree to the RELEASE set forth in
paragraph 25 of this Agreement. If Seller denies Buyer pennission to upgrade the water service, Buyer may, within 5 days of Seller's
denial, terminate this Agreement. If Buyer terminates this Agreement, all deposit monies paid on account of purchase price will be
returned promptly to Buyer and this Agreement will be YOID, OR
b. Terminate this Agreement, in which case all deposit monies paid on account of purchase price will be returned promptly to Buyer
and this Agreement will be YOID.
STATUS OF SEWER (1-00)
(A) Seller represents that property is served by:
)( Public Sewer
o Individual On-lot Sewage Disposal System (See Sewage Notice I)
o Individual On-lot Sewage Disposal System in Proximity to Well (See Sewage Notice I; see Sewage Notice 4, if applicable)
o Community Sewage Disposal System
o Ten-acre Pennit Exemption (See Sewage Notice 2)
o Holding Tank (See Sewage Notice 3)
o None (See Sewage Notice I)
o None Available/Permit Limitations in Effect (See Sewage Notice 5)
o
. (8) INDIVIDUAL ON-LOT SEWAGE DISPOSAL INSPECTION CONTINGENCY
)( WAIVED. Buyer acknowledges that Buyer has the option to request an individual on-lot sewage disposal inspection of the Property. BUYER
WAIVES THIS OPTION and agrees in the RELEASE set forth in paragraph 25 of this Agreement.
o ELECTED
l. Buyer has the option, within _ days of the execution of this Agreement and at Buyer's expense, to deliver to Listing Broker, if
any, otherwise to Seller, a written inspection report by a qualified, professional inspector of the individual on-lot sewage disposal system.
2. Seller agrees to locate and provide access to the individual on-lot sewage disposal system, and, if required by the inspection company,
empty the septic tank, at Seller's expense. Seller also agrees to restore the Property prior to settlement.
3. If the report reveals defects that do not require expansion or replacement of the existing sewage disposal system, Seller will, within
_ days of receipt of the report, notify Buyer in writing of Seller's choice to:
a. Correct the defects before settlement, including retests, at Seller's expense, in which case Buyer accepts the Property and agrees to
the RELEASE set forth in paragraph 25 of this Agreement, OR
b. Not correct the defects, or if Seller fails to respond within the time given, Buyer will, within _ days, either:
(I) Accept the Property and the system and, if required by the mortgage lender, if any, andlor any governmental authority, correct
the defects before settlement or within the time required by the mortgage lender, if any, and/or any governmental authority, at
Buyer's sole expense and with Seller's pennission, which will not be unreasonably withheld, and agree to the RELEASE set
forth in paragraph 25 of this Agreement. If Seller denies Buyer permission to correct the defects, Buyer may, within 5 days of
Seller's denial. terminate this Agreement. If Buyer terminates this Agreement, all deposit monies paid on account of purchase
price will be returned promptly to Buyer and this Agreement will be YOID, OR
(2) Terminate this Agreement in writing, in which case all deposit monies paid on account of purchase price will be returned
promptly 10 Buyer and this Agreement will be YOID.
4. If the report reveals the need to expand or replace the existing individual on-lot sewage disposal system, Seller may, within _ days
of receipt of the report, submit a corrective proposal to Selling Broker, if any, otherwise to Buyer. The corrective proposal will include, but
not be limited to, the name of the remediation company; provisions for payment, including retests; and completion date for corrective mea-
sures. Within 5 days of receiving Seller's corrective proposal, or If no corrective proposal Is received within the time given. Buyer will:
a. Agree to the terms of the corrective proposal, if any, in writing, in which case Buyer accepts the Property and agrees to the RELEASE
set forth in paragraph 25 of this Agreement, OR
b. Accept the Property and the system and, if required by the murtgage lender, if any, and/or any govemmental authority, correct the
defects before settlement or within the time required by the mortgage lender, if any, andlor any governmental authority, at Buyer's
sole expense and with Seller's permission, which will not be unreasonably withheld, and agree to the RELEASE set forth in para-
graph 25 of this Agreement. If Seller denies Buyer pennission to correct the defects, Buyer may, within 5 days of Seller's denial, ter-
minate this Agreement. If Buyer terminates this Agreement, all deposit monies paid on account of purchase price will be returned
promptly to Buyer and this Agreement will be YOID, OR
c. Terminate this Agreement io writing, in which case all deposit monies paid on account of purchase price will be returned promptly
to Buyer and this Agreement will be YOID.
NOTICES, ASSESSMENTS & CERTIFICATES OF OCCUPANCY (1-00)
(A) Seller represents as of Seller's execution of this Agreement, that no public improvement. condominium or homeowner association assessments
have been made against the Property which remain unpaid and that no notice by any governrneOl or public authority has been served upon Seller
or anyone on Seller's behalf, including notices relating to violations of zoning, housing, building, safety or flIe ordinances which remain
uncorrected, and that Seller knows of no condition that would constitute violation of any such ordinances which remains uncorrected, unless
otherwise specified here:
337
BUYER WAIVES 338
~39
13.
14.
,_~~~~\Y~'(j
A1S-2K Page 5 of 8
/) \ ....
Seller InI~;--;,Q' ,--J .V
I.
330
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J1Y
(B) Seller knows of no other potential notices (including violations) and assessments except as follows;
42C
(C) In the event any notices (including violations) and assessments are received after execution of this Agreement and before settlement, Seller will
notify Buyer in writing, within S days of receiving tbe ttotice or assessment, that Seller will:
L Comply with notic~s and assessments at Seller's expense, in which case Buyer accepts the Property and agrees to the RELEASE set forth
in paragraph 2S of this Agreement, OR
2. NOT comply with notices and assessments at Seller's expense, in which case Buyer will notify Seller within S days in writing that Buyer
will:
a. Comply with notices and assessments at Buyer's expense and agree to the RELEASE set forth in paragraph 2S of this Agreement, OR
b. Terminate this Agreement, in which case all deposit monies paid on account of purchase price will be returned promptly to Buyer
and this Agreement will be YOID.
If Buyer fails to notify Seller within the time given, Buyer accepts lbe Property and agrees to the RELEASE set forth in para-
graph 25 of this Agreement.
(D) Buyer is advised that access to a public road may require issuance of a highway occupancy permit from the Department of Transportation.
(E) If required by law, within _ days of the execution of this Agreement, Seller will order for deliveI)' to Selling Broker, if any, otherwise
to Buyer, on or before settlement,
I. A certification from the appropriate municipal department or departments disclosing notice of any uncorrected violation of roning, hous-
ing, building, safety or fire ordinances, AND/OR
2. A certificate permitting occupancy of the Property. In the event repairs/improvements are required for the issuance of the certifrcate, Seller
will, within 5 days of Seller's receipt of the requirements, notify Buyer of the requirements and whether Seller will make the required
repairs/improvements at Seller's expense.
If Seller chooses not to make the required repairsfunprovements, Buyer will, within 5 days, notify Seller in writing of Buyer's choice to termi-
nate this Agreement OR make the repairs/improvements at Buyer's expense and with Seller's permission, which will not be unreasonably with-
held. If Seller denies Buyer permission to make the required repairs, Buye{ may, within 5 days of Seller's denial, terminate this Agreement. If
Buyer terminates this Agreement, all deposit monies paid on account of purchase price will be reuuned promptly to Buyer and this Agreement
will be YOID.
TITLE, SURVEYS & COSTS (1-00)
(A) The Property is to be conveyed free and clear of all liens, encumbrances, and easements, EXCEPTING HOWEVER the following: existing
deed restrictions, historic preservation restrictions or ordinances, building restrictions, ordinances, easements of roads, easements visible upon
the gro~nd, easements of record, privileges or rights of public service companies, if any; otherwise the title to the above described real estate
will be good and marketable and such as will be insured by a reputable Title Insurance Company at the regular rates.
(B) In the event Seller is unable to give a good and marketable title and such as will be insured by a reputable Title Company at the regular rates,
as specified in paragraph 15(A), Buyer will have the option of taking such title as Seller can give without changing the price or of being repaid
all monies paid by Buyer to Seller on account of purchase price and Seller will reimburse Buyer for any costs incurred by Buyer for those items
specified in paragraph 15(C) and in paragraph 15(0) items (1), (2), (3); and in the latter event there will be no further liability or obligation on
either of the parties hereto and this Agreement will become VOID.
(C) Any surveyor surveys which may be required by the Title Insurance Company or the abstracting attorney, for the preparation of an adequate
legal description of the Property (or the correction thereof), will be secured and paid for by Seller. However, any surveyor surveys desired by
Buyer or required by the mortgage lender will be secured and paid for by Buyer.
(D) Buyer will pay for the following: (1) The premium for mechanics lien insurance and/or title search, or fee for cancellation of same, if any;
(2) The premiums for flood insurance and/or fire insurance with extended coverage, insurance binder charges or cancellation fee, if any;
(3) Appraisal fees and charges paid in advance to mortgage lender, if any; (4) Buyer's customary settlement costs and accruals.
ZONING CLASSIFICATION (1-00)
Failure of this Agreement to contain the zoning classification (except in cases where the property \ and each parcel thereof, if subdividable) is zoned
solely or primarily to permit single-family dwellings) will render this Agreement voidable at the option of the Buyer, and, if voided, any deposits
tendered by the Buyer will be r med to the Buyer without any requirement for court action.
Zoning Classilication: / ' " <-
o ELECTED. Within _ days of the execution of this Agreement, Buyer will verify that the existing use of the Property as
is permitted. In the event the use is not permitted, Buyer will, wilbin the lime
given for verilicalion, notify Listing Broker, if any, otherwise Seller, in writing that the existing use of the Property is not permitted and this
Agreement will be VOID, in which case all deposit monies paid on account of purchase price will be returned promptly to Buyer. Buyer's
failure to respond within the time given wiiJ constitute a WAIVER of this contingency and all other terms of this Agreement remain in
full force and effect.
COAL NOTICE
}( NOT APPLICABLE
o APPLICABLE
Tms DOCUMENT MAY Nar SElL, CONVEY, TRANSFER, INCLUDE OR INSURE mE TII1.E TO TIlE COAL AND RIGHTS OF SUPPORT UNDERNEATH TIlE SURFACE LAND
DESCRIBED OR REFERRED TO HEREIN, AND THE OWNER OR OWNERS OF SUCH COAL MAY HAVE TIlE COMPlETE LEGAL RIGHT TO REMOVE ALL SUCH COAL AND
IN THAT CONNECTION, DAMAGE MAY RESULT TO THE SURFACE OF THE LAND AND ANY HOUSE, BUILDING OR OTHER SllWCfURE ON OR IN SUCH LAND. (This
notice is set forth in the manner provided in Section I of the Act of July 17, 1957, PL. 984.) "Buyer acknowledges that he may not be obtaining the
right of protection against subsidence resulting from coal mining operations, and that the property described herein may be protected from damage 4'0
due to mine subsidence by a private contract with the owners of the economic interests in the coal. This acknowledgement is made for the purpose
of complying with the provisions of Section 14 oflhe Bituminous Mine Subsidence and the Land Conservation Act of April 27, 1966." Buyer agrees
to sign the deed from Seller which deed will contain the aforesaid provision.
POSSESSION (1-98)
(A) Possession is to be delivered by deed, keys and:
I. Physical possession to a vacant building (if any) broom-clean, free of debris at day and time of settlement, AND/OR
2. Assignment of existing lease(s), together with any security deposits and interest, at time of settlement, if Property is tenant-occupied at the
execution of this Agreement or unless otherwise specified herein. Buyer will acknowledge existing lease(s) by initialing said lease(s) at
time of signing of this Agreement, if Property is tenant-occupied.
(B) Seller will not enter into any new leases, written extension of existing leases, if any, or additional leases for the Property without expressed
written consent of Buyer.
RECORDING (3-85) This Agreement will not be recorded in the Office for the Recording of Deeds or in any other office or place of public record
and if Buyer causes or permits this Agreement to be recorded, Seller may elect to treat such act as a breach of this Agreement.
ASSIGNMENT (3-85) This Agreement will be binding upon the parties, their respective heirs, personal representatives. guardians and successors, '9:1
and to the extent assignable, on the assigns of the parties hereto, it being expressly understood, however, that Buyer will not transfer or assign this
Agreement without the wrinen consent of Seller.
DEPOSIT & RECOVERY FUND (1-00)
(A) Deposits paid by Buyer within 30 days of settlement will be by cash, cashier's or certified check. Deposits, regardless of the form of payment
and the person designated as payee, will be paid to Broker or party identified in paragraph 3(F), who will retain them in an escrow account until
consummation or termination of this Agreement in conformity with all applicable laws and regulations. Any uncashed check tendered as deposit
may be held pending the acceptance of this offer.
(B) In the event of a dispute over entitlement to deposit monies, a broker holding the deposit is required by the Rules and Regulations of the State
Real Estate Comntission (49 Pa. Code ~35.327) to retain the monies in escrow until the dispute is resolved. In the event of litigation for the
return of de osit monies, a b er will distribute the monies as directed by a fmal order of court or the written Agreement of the parties. Buyer
and Sell agr ve any broker or affiliated licensee is joined in litigation for the return of deposit monies, the attorneys' fees and
e b i enscte(s) will be paid by the party joining them.
AlS-2K Page 6 of 8
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22.
(C) A Real Estate Recovery Fund exists to reimburse any persons who have obtained a fmal civil judgment against a Pennsylvania real estate
licensee owing Lo fraud. misrepresentation, or deceit in a real estate transaction and who have been unable to collect the judgment after exhaust-
ing all legal and equitable remedies. For complete details about the Fund, call (717) 783-3658, or (800) 822-2113 (within Pennsylvania) and
(717) 783-4854 (outside Pennsylvania).
,~9NDOMINIUMlPLANNED COMMUNITY (HOMEOWNER ASSOCIATION) RESALE NOTICE (1-00)
~ NOT APPLICABLE
o APPUCABLE: CONDOMINIUM
Buyer acknowledges that the Propeny is a unit of a condominium that is primarily run by a unit owners' association. ~3407 of the Uniform
Condominium Act of Pennsylvania requires Seller to furnish Buyer with a Certif,cate of Resale and copies of the condominium declaration
(other than plats and plans), the bylaws, and the rules and regulations of the association.
o APPLICABLE: PLANNED COMMUNITY (HOMEOWNER ASSOCIATION)
Buyer acknowledges that the Propeny is pan of a planned community as defined by the Uniform Planned Community Act. (See Definition of
Planned Community Notice for the definition contained in the Act). ~5407(a) of the Act requires Seller to furnish Buyer with a copy of the
Declaration (other than plats and plans), the bylaws, the rules and regulations of the association, and a Certificate containing the provisions set
fonh in ~5407(a) of the Act.
(A) Within _ days of the execution of this Agreement, Seller will submit a request to the association for a Certificate of Resale and the doc-
uments necessary to enable Seller to comply with the Act. The Act provides that the association is required to provide these documents within
10 days of Seller's request.
(B) Under the Act, Seller is not liable to Buyer for the failure or delay of the association to provide the Certificate in a timely manner, nor is Seller
liable to Buyer for any erroneous information provided by the association and included in the Certificate.
(C) Buyer may declare this Agreement VOID at any time before Buyer's receipt of the association documents and for 5 days thereafter, OR until
settlement, whichever occurs first. Buyer's notice declaring this Agreement void must be in writing; thereafter all deposit monies will be
returned to Buyer.
(D) In the event the association has the right to buy the Propeny (right of first refusal), and the association exercises that right, Seller will reimburse
Buyer for all monies paid by Buyer on account of purchase price and for any costs incurred by Buyer for: (1) The premium for mechanics lien
insurance and/or title search, or fee for cancellation of same, if any; (2) The premiums for flood insurance and/or fire insurance with extend-
ed coverage, insurance binder charges or cancellation fee, if any; (3) Appraisal fees and charges paid in advance to mongage lender, if any;
(4) Buyer's customary settlement costs and accruals.
MAINTENANCE & RISK OF LOSS (1-00)
(A) Seller will maintain the Propeny, grounds, fixtures, and any personal propeny specifically scheduled herein in its present condition, normal
wear and tear excepted.
(B) In the event any system or appliance included in the sale of the Propeny fails and Seller does not repair or replace the item, Seller will promptly
notify Buyer in writing of Seller's choice to:
1. Repair or replace the failed system or appliance before settlement or credit Buyer at settlement for the fair market value of the failed sys- 5~9
tern or appliance (this option must be acceptable to the mongage lender, if any). In each case, Buyer accepts the Propeny and agrees to 540
the RELEASE set fonh in paragraph 25 of this Agreement, OR
2. Make no repairs or replacements, and not credit Buyer at settlement for the fair market value of the failed system or appliance, in which
case Buyer will notify Seller in writing within 5 days or before settlement, whichever is sooner, that Buyer will:
a. Accept the Propeny and agree to the RELEASE set fonh in paragraph 25 of this Agreement, OR
b. Terminate this Agreement, in which case all deposit monies paid on account of purchase price will be returned promptly to Buyer
and this Agreement will be VOID.
(C) Seller will bear risk of toss from fire or other casualties until time of settlement. In the event of damage by fire or other casualties to any prop-
erty included in this sale that is not repaired or replaced prior to settlement, Buyer will have the option of rescinding mis Agreement and
promptly receiving all monies paid on account of purchase price or of accepting the Property in its then condition together with the proceeds
of any insurance recovery obtainable by Seller. Buyer is hereby notified that Buyer may insure Buyer's equitable interest in this Property as of
the time of execution of this Agreement.
WAIVER OF CONTINGENCIES (1-00)
In the event this Agreement is contingent on Buyer's right to inspect and/or repair the Propeny, Buyer's failure to exercise any of Buyer's options
within the time limits specified in the contingency provision(s) will constitute a WAIVER of that contingency and Buyer accepts the Property
and agrees to the RELEASE set forth in paragraph 25 of this Agreement.
RELEASE (1-00) Buyer hereby releases, quit claims and forever discharges SELLER, ALL BROKERS, their LICENSEES, EMPLOY.
EES, and any OFFICER or PARTNER of anyone of them and any other PERSON, FIRM, or CORPORATION who may be liable by or
through them, from any and all claims, losses or demands, including, but not limited to, personal injuries and property damage and all of ",,8
the consequences thereof, whether now known or not, which may arise from the presence of termites or other wood-boring insects, radon, '59
lead. based paint hazards, environmental hazards, any defects in the individual on-lot sewage disposal system or deficiencies in the on-site 560
water service system, or any defeCts or conditions on the Property. This release will survive settlement. 561
REPRESENTATIONS (1-00)
(A) Buyer understands that any representations, claims, advertising, promotional activities, brochures or plans of any kind made by Seller, Brokers,
their licensees, employees, officers, or partners are not a pan of this Agreement unless expressly incorporated or stated in mis Agreement.
(B) It is understood that Buyer has inspected the Property before signing this Agreement (including fIXtures and any personal property
specifically scheduled herein), or has waived the right to do so, and has agreed to purchase it in Its present condition unless otherwise
stated in this Agreement. Buyer acknowledges that Brokers, their licensees, employees, officers or partners bave not made an indepen- 557
dent examination or determination of the structural soundness of the Property, the age or condition of the components, environmental
conditions, the permitted uses, or of conditions existing in the locale wbere the Property is situated; nor have they made a mechanical
inspection of any of the systems contained therein.
(C) It is further undersrood that this Agreement contains me whole agreement between Seller and Buyer and there are no other terms, obligations,
covenants, representations, statements or conditions, oral or otherwise of any kind whatsoever concerning this sale. Furthermore, this
Agreement will not be altered, amended, changed, or modified except in writing executed by the parties.
(D) The headings, captions, and line numbers in this Agreement are meant only to make it easier to find the paragraphs.
TIME OF THE ESSENCE-DEFAULT (1-00)
The said time for settlement and all other times referred to for the performance of any of the obligations of this Agreement are hereby agreed to be
of the essence of this Agreement. For the purposes of this Agreement. number of days will be counted from the date of execution, by excluding the 5T1
day this Agreement was executed and including the last day of the time period. Should Buyer:
(A) Fail to make any additional payments as specified in paragraph 3; OR
(B) Furnish false or incomplete information to SeHer, Listing Broker, Selling Broker, or the mortgage lender, if any, concerning Buyer's legal or
fmancial status, or fail to cooperate in the processing of the mongage loan application, which acts would result in the failure to obtain the Ga1
approval of a mongage loan commitment; OR
(C) Violate or fail to fulfill and perform any omer terms or conditions of this Agreement;
then in such case, Seller has the option of retaining all sums paid by Buyer, including the deposit monies, I) on account of purchase price, or
2) as monies to be applied to Seller's damages, or 3) as liquidated damages for such breach, as Seller may elect, unless otherwise checked
below.
X Seller is limited to retaining sums paid by Buyer, inCluding deposit monies, as liquidated damages.
If Seller elects to retain all sums paid by Buyer, including deposit monies, as liquidated damages, Buyer and Seller will be released from fur-
ther li~(llY liga. an . s Agreement will be VOID.
Y ~ .
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/}
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28. BROKERS (1-00) The Business Relationships between the Broker(s) and Seller and Buyer are as follows, UNLESS a different relationship is
checked below.
(A) The Listing Broker is Agent for Seller.
(B) The Selling Broker is Agent for Buyer.
(C) When the Listing Broker and Selling Broker are the same, the Broker is a Dual Agent. Dual Agency applies to all licensees, UNLESS there is
a Designated Agent(s) for Seller and a Designated Agent(s) for Buyer. If the same Licensee is designated for Seller and Buyer, the Licensee is
a Dual Agent.
A Business Relationship exists that is different from above, as follows:
o The Selling Broker is the Agent/Subagent for Seller.
o The Selling Broker is a Transaction Licensee.
o The Listing Broker is a Transaction Licensee.
(D) Broker(s) may perform services to assist unrepresented parties in complying with the terms of this Agreement.
29. MEDIATION (7-96)
o NOT AVAILABLE
o WAIVED. Buyer and Seller understand that they may choose to mediate at a later date, should a dispute arise, but that there will be no obli-
gation on the part of any party to do so.
'!'If' ELECfED
i(}) Buyer and Seller will try to resolve any dispute or claim that may arise from this Agreement through mediation, in accordance with the Rules
and Procedures of the Home SellersfHome Buyers Dispute Resolution System. Any agreement reached through a mediation conference and
signed by the parties will be binding.
(B) Buyer and Seller acknowledge that they have received, read, and understand the Rules and Ptocedures of the Home SellersfHome Buyers
Dispute Resolution System. (See Mediation Notice.)
(C) This agreement to mediate disputes arising from this Agreement wiIl survive settlement.
Buyer and Seller acknowledge that they have read and understand the notices and explanatory information set forth in this Agreement.
Buyer acknowledges receiving a copy of this Agreement at the time of signing.
NOTICE TO PARTIES: WHEN SIGNED, THIS AGREEMENT IS A BINDING CONTRACT. Return by facsimile transmission (FAX) of this
Agreement, and all ;lddenda, bearing the signatures of all parties, constitute acceptance of this Agreement. Parties to this transaction are advised
to consult an attorney before signing if they desire legal advice.
WITNESS BUYER DATE
Buyer Name (print) SS II
Mailing Address
Phone #s FAXlI E-Mail
WITNESS BUYER DATE
Buyer Name (print) SSlI
Mailing Address
Phone #s
Seller hereby approves the above contract this (date)
and in consideration of the services rendered in proc g the uyer, Seller agrees to pay the named Listing Broker a fee of
of/from the he~spe . led sale price. In the event Buyer defaults hereunder, any monies paid on account wiIl be divided I ")--;!)~
Seller" , Listing Broker, but in no event will the sum paid to the Listing Broker be in excess of the above specified B
~
WITNE
Seller - e
Mailing Address
Phone lis 7 ~.;) - d-. 'f fp 7
E-Mail
WITNESS
Seller Name (print)
Mailing Address
Phone lis
SELLER
DATE
SS#
FAX #
E-Mail
WITNESS
SelIer Name (print)
Mailing Address
Phone #s
SELLER
DATE
SS#
FAX #
E-Mail
BrokV"lLicensees' Certifications (check all that are applicable):
>"\ Regarding Lead-Based Paint Hazards Disclosure: Required if Property was built before 1978: The undersigned Licensees involved in
this transaction, on behalf of themselves and their brokers, certify that their statements are true to the best of their knowledge and belief.
Acknowledgement: The Licensees involved in this transactiJn have informed SelIer of Seller's obligations under The Residential Lead Paint
Hazard Reduction Ac~ 42 U.S.C. 4852(d), and are aware of their responsibility to ensure compliance.
~
Regarding FHA Mortgages: The undersigned Licensees involved in this transaction, on behalf of themselves and their brokers, certify that
the terms of this contract for purchase are true to the best of their knowledge and belief, and that any other agreement entered into by any of
these parties in connection with this transaction is attached to this Agreement.
;q- Regarding Mediation: The undersigned 0 Listing Broker
graph 29 of this Agreement. (J
u~=,,::,~p..kv.~ ~I
SELLING BROKER (Company Name)
ACCEPTED BY
?"se~ing Broker
12A.x:J~ ;')'lVi{ ~
agree to submit to mediation in accordance with para-
';/?5j6 /
DATE
DATE
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