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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 05
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
00160
NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
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DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
Tasseff, Mary
180-07 -2995
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
Decedent Died Testate (Attach copy
01 Will)
Litigation Proceeds Received
4a. Future Interest Compromise (date of death alter
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10. Spousal Poverty Credit (date of death between
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
Original Return
2. Supplemental Return
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
COMPLETE MAILING ADDRESS
714 Bridge Street
P.O_ Box 461
New Cumberland, PA 17070
(1 ) 21,500.00
(2) 807.36
(3) None
(4) None
(5) 6,658.35
(6) 433.35
(7) None
(8)
(9) 25,021.60
(10) 108,148.48
OFFICiAL USE ONLY
29,399.06
04/12/2002
08/15/1917
(11 )
133,170.08
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL)
Limited Estate
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~ IRM NAME (If applicable)
~ Kline Law Office
ELEPHONE NUMBER
717/770-2540
1_ Real Estate (Schedule A)
2_ Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(12)
insolvent
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z .045 (16)
0 16. Amount of Line 14 taxable at lineal rate x
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II. 17_Amount of Line 14 taxable at sibling rate x .12 (17)
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~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
46 Erford Road
CITY
Camp Hill
STATE PA
ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
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.
(3) 0.00
(4)
(5) 0.00
(5A)
(5B) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
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? ...... .............. .............................................................. ........... ........... ....... .......
Yes No
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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 pe~ury, 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 compiete. Declaration of
preparer other than the personal representative is based on all infonnation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS 514 Eutaw Avenue DATE
Ma Goetz
New Cumberland, P A 17070
FOR FILING RETURN
ADDRESS
ADDRESS
714 Bridge Street
P.O. Box 461
New Cumberland, P A 17070
DATE
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For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value 0
[72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spo
of assets and filing a tax return are still applicable even if the surviving spouse is the or
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 ye
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (a) (1.2)].
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Ig spouse is 0%
nts for disclosure
le use of a natural
The tax rate imposed on the net value of transfers to or for the use of the decedent's lin
1.2) [72 P.S. 99116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's sit
under Section 9102, as an individual who has at least one parent in common with the dE
"3 ~ ~i-lto
j in 72 P.S. 99116
sibling is defined,
__..__._. Ul ",vuu or aooption.
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
I FILE NUMBER
21 - 05 - 00160
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 wilfing 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.
Tasseff, Mary
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE OF
DEATH
21,500.00
909 Sunbury Road, Primrose, PA 17954 (Cass Twp., Schuylkill Co.)
TOTAL (Also enter on Line 1, Recapitulation)
21,500.00
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SCHEDULE B
STOCKS & BONDS
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Tasseff, Mary
I FILE NUMBER
21 - 05 - 00160
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
1 Metropolitan Life Ins Co., 24 shares 33.64 807.36
TOTAL (Also enter on line 2, Recapitulation) 807.36
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ff M
Tasse, ary
I FILE NUMBER
21 - 05 - 00160
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
1 Camp Hill Care Center refund
DESCRIPTION
VALUE AT DATE OF
DEATH
995.35
2
Farmers Fire Insurance refund
196.00
3
First National Bank of Minersville
5,467.00
TOTAL (Also enter on Line 5, Recapitulation)
6,658.35
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Tasseff, Mary
I FILE NUMBER
21 - 05 - 00160
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A Mary Goetz
514 Eutaw Avenue
New Cumberland, PA 17070
daughter
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM LETTER DATE Include name of financial institution and bank account number DATE OF DEATH
FOR JOINT MADE DECD'S VALUE OF
NUMBER TENANT JOINT or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT'S INTEREST
estate.
1 A First Union National Bank Statement Savings 866.70 50% 433.35
#3014174561390
TOTAL (Also enter on line 6, Recapitulation) 433.35
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SCHEDU..E H
FUNERAL EXPENSES &
ADlVlNlSTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Tasseff, Mary
I FILE NUMBER
21 - 05 - 00160
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Mahal-Ritzel Funeral Horne, Inc., 104 S. 4th Street, Minersville, PA 17954
5,750.00
2
Hazelton Memorial Co., 731 South Church Street, Hazelton, PA 18201
95.00
3
Hillcrest Catering, 631 Minersville-Llewwllyn Hwy, Minersville, P A 17954
542.08
B.
ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Mary Goetz
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address 514 Eutaw Avenue,
City New Cumberland
Year(s) Commission paid 2.005
Attorney's Fees Kline Law Office
1,470.00
State
PA
Zip 17070
2.
2,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Real Estate taxes 2,030.19
2 Padfield Plumbing & Heating (oil) 3,319.73
Total of Continuation Schedule(s)
9,314.60
25,021.60
TOTAL (Also enter on line 9, Recapitulation)
.
Schedule H
Fu1eraI Expenses &
Ach1inistralive CosIs continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Tasseff, Mary
I FILE NUMBER
21 - 05 - 00160
3
Blythe Twp Municipal Authority (water)
756.25
4
PPL (Electric for home)
293.11
5
Farmers Fire Insurance Co. (Hazard Insurance)
839.00
6
Branch-Cass Regional Sewer Authority (Sewer connection fees)
1,050.00
7
Ed Bass Contracting (sewer hook-up)
1,000.00
8
Padfield Plunbing & Heating (furnace service)
160.00
9
Elmer D. Strausser Carpentry & Remodeling (porch repairs)
395.00
10
Bob Buglea (bathroom floor repair)
175.00
11
Rick Chapman (painting)
450.00
12
Mary Goetz (painting supplies)
26.47
13
Net Settlement Costs (sale of909 Sunbury Road) see attached settlement statement (Line 602
reduced by Lines 407 & 409)
4,169.77
Page 2 of Schedule H
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SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Tasseff, Mary
I FILE NUMBER
21 - 05 - 00160
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
AMOUNT
Commonwealth of Pennsylvania, Department of Public Welfare, Class 3 claim
15,554.40
2
Commonwealth of Pennsylvania, Department of Public Welfare, Class 6 claim
86,796.69
3
Mary Goetz (Reimbusement for pre-death expenses inluding oil, water, electric, real estate tax, hazard
insurance & repairs to 909 Sunbury Rd, Primrose, PA)
5,797.39
TOTAL (Also enter on Line 10, Recapitulation)
108,148.48
III
E:-;.ecutor9. Trustee., or Guardians Deed. No. 656
Printed and Sold bf John C. Clark Co., 1'''0 S. P.a.a Square, Phil...
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Fourth day of November in the year of our
Lord one thousand nine hundred and forty-eight (1948)
iSefuteeu 1fYJL}~I:~; 130::"'1.;8 and JOSEPH CAll.'-tOL, Execut aI'S of the last
Will and Testament of John P. Brennan, late of the Borough of
l,Linersville, 00unty of -.lCllUylkill and Jtate of J!enn8ylvania, of' the
one pal't,
and
JOHN 'l'ASSEF1' and 1tlAR.Y J.'lI.SSElj'J;', his wife, of the
Township of Gass, \Jaunty of' Jclluylkill and state of' pennsylvania,
of the othe.l' ]}art ~
f!lherras! the said John 1'). Drennan was seized in fee of e.nd
~n a certa~n messuage or tenement and tract of land, here inhft<:;x'
described; and
,{I-iEL\EAS. th8 said John p. Brennan departed this life on the ~8th da:;'
of Lay, 1948, leaving a last Will and 'l'estaD.ent dated the <:lst
day ot' June, 1943, and proved and registered in the office of the
r{egister of \Iills in and for the Uounty of Schuylkill, in .Jill
Book 52., pae;e 567. by which he appointed John J. Boyle. Hellie
:3oyle and Jo:oellh Carrol, or the survivor ox' survivors uf them,
as Executors of his last Ifill and 'l'estament, and the said John J.
Boyle renounced his right as such .Jxecutor. Letters Testamentary
were granted to the said Nellie Boyle and John Carrol; and .
'ilHSilli;A;:>, in said last Ifill and 'l'estament it is pI'ovicled, inter
alia, as follows:
"I direct ffiJ' ~xecutors above menti oned to sell my
real estate, either at public or private sale, and
to execute good and sufficient deeds to the pur-
chaser 01' purchasers thereof at any time the:i' deem
it advisable, having in raind at all timest-he best
interests of my son. John IJatrick Brennan. The
proceeds of said real estate I declare and d~rec~
shall be considered and disposed of as constltutlng
a part of my personal estate."
N ~42
OW tbill IUll.e-utur.e- wiht.e-lls.~tln~ That tlu sqid Nellie Boyle and
T l' . ' .
"oS81) 1 0a1'1.'01, -,.xecutors as a.foresaid
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for and in consideration of
the sum of liifty-1'ive Hundred ($5000.00) Dollars
lawful money of the United States, to them well and truly paid by the Baid .John l'asse1'1'
and lwary !asseff
at and before the sealing and delivery hereof, the receipt whereof is hereby acknowledged,
ha'le
granted, bargained, Bold, aliened, released, and confirmed and by theBe presents,
by force and 'lirtue of the said last recited vlill, do
prant, bargain, sell, alien, release and confirm unto the said John Tas<!eff' and 1.1ary
'~as seff, the ir he iI's and as signs,
, AI~ THA~ OERTAIn lot or piece of ground situate on the
:,esterly s~de 0,:1: the public road leadillg from 1:iinersville to lit.
.J;'leasan~, in th~ Village of Erimrose, Township of Cass, County of
::;clmyllall and vtate of Pennsylvania, bounded and described as
fOll?ws, to wit ~ BEGllUrrnG at a point on the westerly side of the
publlC road aforesaid, thence Westwardly along the property now or
late of James Donnelly, ninety (90) feet to a point, thence South-
wardly along the same, eleven (11) feet to a twenty feet wide alley,
thence ~lestwardly along said alley, ninety-five (95) feet, more or
less, to a point on said twenty feet wide 1;l.l;J,.ey;said point being
.~he southwestwardly corner of the property'now or late of EllaE.
hcDonald and Joseph McDonald, her husband, thence Eastwardly along
the property now or late of Ella E. llcDon~ld and JOE;eph lIcDonald,
her husband, one hundred eighty-five (18,5) feet, more or less, ana
running through the partition wall o~ a double two and one-half
story frame dwelling house to a point on the Westwardly s'ide of the
pUblic road leading from l1Iinersville to H.t. :Pleasant, and thence
Southwardly along said road, fifteen (10) feet seven (7) inches to
the place of beginning. Having ther~on erected the southern half of
a double twc and one-half story frame dwelling house.
BEING the same preI;lises v.rhich jUla E. kcDonald and Joseph
t.:cDonClld, her husband, by their deed dated the 10th day of Harch,l93n,
and which deed is duly recorded in the Cffice for the Hecording of
Deeds in and for Schuylkill County, in Deed Book 606, page 12, granted
and conveyed unto John 1). Brennan ancl }?ay G. Brennan, his wife. And
the said Fay G. Brennan predeceased her said husband after wllich the
said p:celuises became vested in the said John P. Brennan.
ALL THAT CElt'fA!N lot 0 l' piece of ground si tuate on the ;ifesterly
side of tr~ public road leading from liinersville to Mt. Pleasant, in
the 'Village of Primrose, Township of Cass, County ?f' ochuylki~l and
State of Pennsylvania, bounded and described as fo~lowsJ to-Wlt: BE-
GINlJIHG at a po~nt at the Southwest COrner of the crossing of the
public road leading from 1iinersville to lIt. Pleasant and the I'oad
leading from l'rimrose to It'orestville, thence Jestwardly along the
30ut11 side of said. public road leading from primrose to })'orestville
one hundred and e ighty-fi 'Ie (185) feet, more or less, to a twenty (20)
feet wide alley, thence .ulastwardly along the prolJerty n:ow or late of
John P. Brennan, one huhdred and eighty-five (185) feet through the
partition wall of a double twu and one-half story frame dwelling house
to a point on thedestWardly side of the public road leading ,from
l"inel'SV ille to k.t. Pleasant, and thence llol'thwardly along sal,d rohad
fourteen (14) feet five (5) inches, more or less, to,ths place.,or be-
ginning. B01..ltlued .l:']astwardly by the public l'oad leadltlg fr?ml.1;uers-
ville to Ut. Pleasant, 1!orthvlardly by the public road le~Ldlng J.rom
.t'riIl1rOse to 1'0restville, and Southwardly by property now"or f lat~o~~le
John P. Brenan. Having there on erected the HOL'thern hall 0 a
two and one-half story frame dwelling house.
I
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BEING the saJ11f~ premises which Bl1a 1:. McDonald and JoseI}h I1cDona1d, I
her husband, by their deed dated the 29th day of December, 19,JA, ctnd 1
which deed is duly recorded in the Office for the llecording of ~eedB inl I
and for Schuylkill County, in .L!eed Book 661, page 226, granted Hnd
.'n..y.' wrt, J,.. F. Brenaan. I
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mngetqer with all and lIingular
ways, waters, water-coursell, rights, liberties, privileges, hereditamentll and
appurtenances whatsoever thereunto belonging, or in any wise appertaining, and the reversionll
and remainders, rents, issues and profits thereof; and also, all the estate, right, title, interest,
use, trust, property, possession, claim and demand whatsoever, of the sai d J olln 1'.
I~
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Brennan at and imllediately befol'e the time of his decease,
in' la,w, equity, or otherwise howsoever, of, in, to, or out of the same:
atn qnu.e null tn qnIll the said buildings,
hereditaments and premises hereby granted
and released, or mentioned and intended so to be, with the appurtenanc66, unto the said
John 'I'asseff and Hary 'l:asseff, l:h~ir heirs
and a8lligns, to and for the only proper use and behoof of the said
John 'I'asseff and lIary '.i.'asseff, thbir heirs
, and aSlligns forever.
~ubject to the exceptions and reservations as in former deeds con-
tained.
Aub thesaid nellie Boyle and Joseph Carrol, ~xecutors a:foresaid,
for tllelIlselves, tileir heirs, exec Lltor's, and auministrators, do
covenant, promise and agree, to and with the said
John '.i.'as:aeff and l.iary '.i.'asseff, their heirs
and assigns,
that they thesaid Hellie Boyl,a and JOSC1,h Carrol, Executors afuresaid
have
not done, committed, or knowingly or willingly suffered to be done or committed, any
act, matter or thing whatsoever, whereby the premises hereby granted, or any part thereof, is,
are, shall, or may be impeached, charged or incumbered, in title. charge, estate, or otherwise
howsoever.
In mitu.e.a.a BllJereof thesaid Hellie Boyle and Jose,,'h Carrol, ~~xecutors
of the last ~ill and Testament of John P. Brennan, Deceased, lmve
hereunto set the ir handS and lIeals the day and year first above written.
i:;jb~
2Z..dL'{2~----e
~~~~~~~~~~a-
ment of J'Ohn .P. Brennan, DedeElsed.
'f
I\lary
in full.
- 'l'esDuaent
County of SClIUYJ~KILL
} 88.
State of PE])T.NSYLVAHI,'j.
On this, the Fourth
day of
November
,1948 , before me,
, the undersigned officer, personally appeared lW:LLII~ BOYLE and
JOSEPH CARROL, Executors
of the State of l'ellnsylvania,
known to me (or satisfactorily proven) to be the person described in the foregoing instrument, and
acknowledged that they executed the same in the capacity therein stated and for the purposes there-
in containe-l.
In Witness Whereof, I hereunto set my hand and official seal.
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The address of the within-named Grantee
is ...~.~.~.~.....~:.~.~:..~.~.~.~.~..V.~._.~..~~~_.~......~_~~.!......J.?.~.. .
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On behalf of the Grantee
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iRerllrbeb in the .Office fOT- Recording of Deeds in and for
Schuylkill County
in Deed Book
No. 752
page 141 &c.
mitm~!ill my hand and seal of Office this:' . "l~th .,'
Deputy Recorder
Anno Domini 19:,48~
~ \'h<~_,
\JV~I 1
,'".,r,./I.
:';:":"
.,\if:
,r#''''
I
day of November
Recorder W.
A. Settlement Statement u.s. Department of Housing
~
and Urban Development ,r
OMB No. 2502-0265
B. TVDe of Loan
1.0 FHA 2.0 FmHA 3.0 Conv. uninsl6. File Number 17. Loan Number 18. Mortgage Insurance Case Number
4.0 VA 5.0 Conv.Ins. C911-7330 C. NOTE: This form is furnished to 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 the closing; they are shown here for informational purposes and are not included in the totals.
D. NAME OF BORROWER: Brett H. Strough
ADDRESS OF BORROWER: 113 N. Miller StreetShillinl>1:on PA 19607
E. NAME OF SELLER: Mary Goetz, Administratrix of the Estate of Mary Tasseff, deceased
ADDRESS OF SELLER: c/o Robert P. Kline Eso. fii) 714 Bridge Street. New Cumberland PA 17070
F. NAME OF LENDER: .
ADDRESS OF LENDER:
G. PROPERTY 907 Sunbury Road, Cass Township
LOCATION: Pottsville, P A 17901
10# 5-17-36
H. SETTLEMENT AGENT: PENN NATIONAL ABSTRACTS~RVICES, INC.
PLACE OF SETTLEMENT: TEN WESTWOOD ROAD, P.O. BOX 1190, POTTSVILLE, PA 17901-1190
TEN WESTWOOD ROAD P.O. BOX 1190 POTTSVILLE PA 17901-1190
I. SETTLEMENT DATE:
J. SUMMARY OF BORROWER'S TRANSACfION K. SUMMARY OF SELLER'S TRANSACTION
I OO.GROSS AMOI TNT DUE FROM 'R()1l1l OWER 400. GROSS AMOUNT DUE TO SELLER
101 rnntract .ole. nrice '" <00.00 AOlrnntract .ale. nrice 21 500.00
1102.Per .102 P"r'onol nrnn"rtv
11 01 Settlement charlfe< to horrnwer (]inp 140m ~oo <0 .101.
104. .10.1.
105. .105.
Adiustmpnt. fnr 'tpm ... II n"" Adill.tmen.. fnr ite ler in advance
I
1 06.ritv/tnwn taxe. to '^ ~. /town taxe< tn
107.Countv taxes 3/T'l17005 to 12/1117005 7<<.85 407 FOllntv to"". 1/21/2005 to 12/11/2005 233.R<
108. A<<e<<m"nt. to 408. A<<essments to
109. Schonl Taxe. </21/2005 to 6/30/200<; 185.74 40o.Schonl Taxes 3/21/2005 tn 6/30/2005 185.74
110. tn 410 to
III tn .111 tn
112. to 412. to
120.GROSS AMOUNT DUE FROM BORROWER ~ 22,610.09 420.GROSS AMOUNT DUE TO SELLER ~ 21,919.59
200.AMOUNTS PAID BY OR IN BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER
20l.Deno<it or earnest money 1 000 00 501.Excess denosit (see instruct' ons)
202 Princinol amnunt ofn"w lnan(s) <0" "ettl"ment choru". to .eller(ljne 1400) ~ 000 ~"
203.Existin" )oan(s) taken subiect tn 503.Existinuloan(s)-taken .ubiect to
204. 504.Payoff of first mort"a"e loan
205. 505.Payoff of second mort"a"e loan
206.Princinal amount of seller financina 506.Princinal amount of seller financina
207 ""lI"r'. A..i.t tnworrl< 1 <;00 00 507. ""II"r'.' A<<i.t t. 1 <00 00
208. 1<08.
209. 509.
209a 509a
209b 1<0%
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210.ritv/town taxes tn 51O.ritv/town taxes to
211.Countv ta"es to 511. COllntv taxes to
212.Assessments to 512. Assessments to
213. to I<n tn
214. to 514. to
215. tn ' <Is. tn
216. tn 516. to
217. tn 517. tn
218. tn 518. to
219. to 519. to
220.TOTAL AMOUNTS PAID ~ 2,500.00 520.TOTAL REDUCTIONS IN ~ 4,589.36
BY OR IN BEHALF OF BORROWER AMOUNT DUE SELLER
300.CASH AT SETTLEMENT FROM/TO BORROWER 600.CASH AT SETTLEMENT TOIFROM SELLER
30 I.Gross amount due from borrower ((ine 120) 22610.09 601.Gross amount due to seller (line 420) 21 919.59
302.Less amounts naid by/for borrower ((ine 220) 2 500.00 602.Less reductions in amount due seller (Jine 520)1 4589.36
303.CASH IXI From 0 To BORROWER ~ 20,110.09 603. CASH IXI To o From SELLER ~ 17,330.23
PAGE 1
C2004 Display Systems, Inc.. (863) 763--:555:5 - Laser Generated
HUD-I (3-86) RESPA, HE 4305.2
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
PAGE 2
L. Settlement Char"es
700 TOTAL SALFSIRROKER'S COM. based on nrice '), <1\1\ 1\1\ (Q:j %' Paid From Paid From
Di . . .r~_ mmission (line 70m .. follow<: Borrower's Seller's
701. 2.500.00 to - Funds At Funds At
702. to Settlement Settlement
70,. rommi<<ion naid at Settlement 2.500.00
704. to
800. Items Pavable In Connection With Loan
RO I I.oan Ori"ination F~e % to
R02 1 .oan Di<cmmt % to
Rm to
804. C~ to
RO< I. , to
806. Mortaaae Tn<lIr~nce Annlication Fee to
R07. to
808. to
ROQ. to
RIO to
811 to
812. to
Rn to
R1.1 to
815. to
900. Items ReQuired Bv Lender To Be Paid In Advance
901 Interest trom to 4/1/2005 (Q:j /dav
902. Mort"a"e In<urance Prem'um for months to
903. Hazard Insurance Premium for vear< to
904. years to
905. vears to
1000. Reserves Deposited With Lender
IOnl 1-I.7.r" in<nron~p month., ner rnnnth
1002. Mort"aae insurance npr rnnnth
1003. i r rnnnth" opr rnnnth
1004.CounNnronertvtaxe< rnnnth" n~r month
1005. A nnual assessments mnnth., ner month
1006. month., oer month
1007 npr month
1008. months oer month
1009.
1100. Title Charges
1101. Settlement or closinl!: fee to
1102. Abstract or title search to
1103. Title enmination to
1104. Title insurance binder to
110<. Document nrenaration to
1106. Notarv fees tn Ppnn.Naf ".~,;~.. Tn~ 4.00 400
I J 07. A ttomev's fees to
(include< .hove items nllmber<:
1 lOR Titlp in<nron~e to P.nn. "T. . " A ."OM' ".~,;~.. Tn~
(include< above items numbers: lIIII-" .)'i;";
1109. Lender's Coveral!:e: TNS AMT'
1110. Owner's Coveral!:e: TNS AMT: 21.500.00 I::::.E'.::
II lOa
1111. to
1112. to
1113. to
1200. Government Recordin" and Transfer Charl!:es
'')1\1 . T'I.." "'A 1 ,,1\. T. . S- . Releases .11 <0
1202. c;iN/counN tax/stamns: Deed $215.00, L-Mort"al!:e(s) . S_Mnriaa"p(<) 10750 \07.'10
120< . npPn $215.00: L- . "_Mnriaa"e(<) 10750 107'10
1204. UPI Certification Charl!:e Schuvlkill County Treasurer 10.00
1205.
1300. Additional Settlement Charges
1301. tn
1,02. to Ann U"i. Stllcllack. tor 301.61
130'. Final Water to Blvthe . . A nthoritv 6R 7<
1'104 to
1305. to
1306. to
1307. to
1308. to
1309. to
1400. Total Settlement Charges (enter on lines 103, Section J and 502, SectionK) .. 690.50 3,089.36
CERTIFICATION DATE: 3/2,12005.
I have carefully reviewed the HUD - I Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement oriilnecelpts and
disbursements made On my account or by me in this transaction. I further certifY that I have received a copy of the HUD - 1 Settlement Statement.
Mary Goetz, Administratrix of the Estate of Mary
Tasself, deceased ~
Bv.~L
Mary Goetz, A~stiatrix
:159
~
Borrower
Seller
Borrower
Seller
The Hl,JD-I Settlement Statem t~' C.h I hay lared if a ~ and accurate account of this transaction. I have caused the funds to be disbursed in accord-
ance WIth thiS statement. .A {, PENN NATIONAL ABSTRACT SERVICES, INC.
-./ '-..-' c, Settlement Agent 3/23/2005 Date
WARNING: It is a crime nowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a
fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. C 911-7330
-
.
, .
BALANCE SHEET
BUYER: Brett H. Strough FILE NUMBER: C 9] ]-7330
SELLER: Mary Goetz, Administratrix ofthe Estate of Mary Tasseff, deceased SETTLEMENT DATE: 3/23/2005
PROPERTY ADDRESS:
907 Sunbury Road, Cass Township
Pottsville, PA ]790]
SCHEDULE OF INCOMING FUNDS
Due From Buyer $ 20,] 10.09
Deposit Paid to Escrow Account of: $ ],000.00
TOTAL INCOMING FUNDS 21,110.09
SCHEDULE OF DISBURSEMENTS
CKNO PAYEE DESCRIPTION AMOUNT
- -
Ann Marie Studlack, Tax Collector
2005 County Taxes 301.6 ]
Blythe Township Municipal Authority
Final Water 68,75
Prudential Pinebrook-Higgins Realty
Real Estate Commission 2,500.00
Penn-National Abstract Services, Inc.
Notary fees 8.00
Title Insurance 420,00 428.00
Schuylkill County Treasurer UPI Certification Charge ]0.00
A. Matthew Dudish, Recorder of Deeds
Record Deed 41.50
Local Deed Tax 2]5.00
Deed Documentary Stamps 2]5,00 471.50
Mary Goetz, Administratrix of the Estate
SALES PROCEEDS 17,330.23
TOTAL OUTGOING FUNDS 21,110.09
LOAN SUMMARY SELLER CLOSING STATEMENT SUMMARY
LOAN AMOUNT AMT DEP BROKER RETAINED
Less Items Held By AMT DEP LEFT IN ESCROWS
PLUS BAL DUE SELLER 2],9]9.59
Lender SUBTOTAL 2],9]9.59
SUBTOTAL LESS SELLER EXPENSES 4,589.36
Plus Deposits Paid To NET CASH TO SELLER 17,330.23
Lender PLUS HUD 403,404 & 405
NET LOAN PROCEEDS TOTAL DUE TO SELLER 17,330.23
ITEMS IN CONNECTION WITH LOAN THAT BUYER CLOSING STATEMENT SUMMARY / CASH RECAP
LENDER REQUIRES TO BE DISBURSED
FROM NET LOAN PROCEEDS BUYER EXPENSES 22,610.09
LESS BUYER CREDITS 2,500.00
TRANSACTION SUMMARY NET DUE FROM BUYER 20,1 ]0.09
LESS LOAN &/OR CREDITS
TOTAL INCOMING FUNDS 2],] 10.09 SUBTOTAL 20,110.09
TOTAL OUTGOING FUNDS 2],] 10.09 PLUS LOAN EXPENSES TO BE
PAID FROM NET PROCEEDS
BALANCE IN ESCROW .00 FUNDS DUE FROM BUYER 20,110.09
Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle. PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
ROBERT P. KLINE,ESQ.
714 BRIDGE STREET
P.O. BOX 461
NEW CUMBERLAND, P A 17070
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
420
6/23/2005
MARYTASSEFF
21-05-0160
Bill To:
JA
Qty
1
Fee Description
Additional Probate
Fee
Total
30.00
$30.00
Total:
$30.00
Checks should be made payable to the Register of Wills. Tetms: Net 30.
Please return one copy of this invoice with your payment. Thank you.