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HomeMy WebLinkAbout08-15-05 rJ".__+.ci' . REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COIIIMClfMlEAllH Of PEfrHM.VMIA OEPARTIIENT Of REVENJE DEPT.28llIlI1 HMRISBURG, PA 171:ze.olJ01 I QECEDENT'S NAME (lAST, FIRST, AND MIDDLE INmAL) Robinson, William F. OFFICIAL USE ONLY FILE NUMBER 21 05 00137 COUNlY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 120-20-8245 01/28/2005 08/2611926 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 1. Original Return 2. Supplemenlal Return DAlE OF DEAlH (MM-DD-YEAR) DAlE OF BIRTH (MM-OO-YEAR) REGISTER OF WILLS SDaAL SECURITY NUMBER ~ "Sl! IIllEg li~i1 c OF APPLICABLE) SlJRVMNG SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) 3. Remainder Retum (date otdeath priorto 12-13-82) 8. ~OiedT_(AIlach""", of Will) 9.Liligation~_ o 48. Future InterestComplOll'lise (date of deaIh 1lller12.12~ o 7. Decedent Mainl8lned a LiYlng Trust ("-h copy of TrusQ o 10. SpouoaI Powlrty Credb (_ of __ ....... 1 1-81 1-1 .. o 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes o 11.EIection to tax under Sac. 9113(A) (Alia'" SchO) *JJJii.. o 4. Limbed Emma lID o U 82 ..... COMPLETE MAlUNG ADDRESS 28 South Pitt Street Carlisle, P A 17013 (1) 165,000.00 (2) 224,287.11 (3) None (4) None (5) 69,395.28 (6) None (7) 30,958.96 (9) 11,335.32 (10) 7,686.90 15. Amount of Une 14 _ at the -' tax rate, x .00 (15) or transfers under See. 9116(a)(1.2) z 470,619.13 .045 (16) !l 16. Amount of Une 14laxable at lineal rate x ~ .. 17. Amount of Une 14laxable at sibling rate x .12 (17) :E 8 ~ 18. Amount of Une 14laxable at coIlalenll rate x .15 (18) 19. Tax Due (19) 13. Charllabie and G<Mlmmental Bequests/See 9113 Trusts for which an eIecIion 10 tax has not been __ (Schad\lle J) 14. Net Value Subject to Tax (Une 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES iIlU. z o ~ I .. 1. Real E_ (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. ~ & Notes Receivable (Schedule 0) 5. Cash, Bank DeposlIs & MisoeIlaneous P_ Properly (Schedule E) 6. Jointly Qwned Properly (Schedule F) o Separate BUHng Requested 7. Inter-VIVOS Transfenl & MisoeIlaneous Non-P_ Properly (Schedule G or L) 8. Total Gross _ (Iolal Unes 1-7) 9. Funeral Expenses & AdministrallVe Costs (Schedule H) 10. Debls of~, Mortgage Lia_, & liens (Schedule I) 11. Total Deductions (tolal Lines 9 & 10) OFFICIAL USE ONLY "-' = C~-:::> <J"> f:"2 _0 . ~ -' ) . --O:Q .'-._1 i.1l ::'J ~~ :-'1 C) , ) ~=J 'J J- C:9 -'. "'---1 12. Net Value of EmMe (Une 8 minus Une 11) :-:.. c:: G-) (Jj /.., , -, i1 _= . _~:J ,o489,64p5 "."., (6):; -I w (11) (12) (13) (14) 19,022.22 470,619.13 470,619.13 21,177.86 21,177.86 20. 0 CHECK HERE IF YOU ARF REOUESTI'.l", A REFU~JD OF A~~ OVERPD.Y"lENT .._"'_))1 .)liilil'l.'_~ 1~._ll(___*I.Cf;lIIIII'" Copyrighl2000 form sollware only The Lackner Group, Inc. Fonn REV-1&OO EX (Rev, 8-00) Decedent's Complete Address: STREET ADDRESS 508 Eighth Street CITY New Cumberland ISTATE PA I ZIP 17070 Tax Payments and Credits: 1. Tax Due (Page 1 Une19) (1) 2. Credits/Payments A. Spousal Poverty Credft B. Pllor Payments C. Discount 21,177.86 Total Credits (A + B + C) (2) 0.00 3. Inte_enalty if applicable D. Interest E. Penalty TotaIlnlereslIPenalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Uno 20 to request a refund 5. If Line 1 + Line 3 is greater than Une 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) 0.00 (4) (5) 21,177.86 (SA) (5B) 21,177.86 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PlACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did _nt make a transfer and: Yes No a. retain the uee or income of the property transferred;..................................................................................... ~ I :: ::~:he.;::.~i=::..~".':.~.~~....~"'.'llCl.~.~.i.n"':';::::::::::::::::::::::::::::............. d. receive the promise for life of either payments, benefIls or care?.................................................................. 2. If deeth occurred aller December 12, 1982, did decedent transfer property within one year of deeth without receiving adequate consideration?......................................................................................................................... 0 ~ 3. Did decedent own an 'in trust for" or payable upon deeth bank account or security at his or her death?............... 0 ~ 4. Did decedent own an Individual Retirement Aooount, annuity, or other non-proIlaIe property which contains a beneftclary deaignalion?........................................................................................................................ ~ 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 penelties of perjU'Y, 1 declarethat 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. Oed8ndion of preparerol:her than the penIOnlIl ~ is based on all information ofwhictl prepImM' has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN ADDRESS DATE _C.Ra 1436 Sconsett W!IY... New Cumberland,'P A 17070 'is -13. -oS- ADDRESS DATE ADDRESS DATE 28 South Pitt Street Carlisle, PA 17013 ;j-/3-OS _ of deat 00 or after July 1, 1994 and before January 1, 1995, the tax rate impoeed 00 the net value of transfers to or for the use of the surviving spouee is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For _ of deeth on or after Januery 1, 1995, the tax rate impoeed on the net value of transfers to or for the use of the surviving spouse is 0'l6 [72 P.S. ~116 (a) (1.1) (ii)]. The statute does not exemDla transfer to a surviving spouse from lax, and the statutory requirements for disclosure of assets and filing a tax retum are slillappllcable even if the surviving spouse is the only beneficiary. For _ of deeth 00 or after July I, 2000: The tax rate impoeed 00 the net value of transfers from a deceesed child 1Mnty-one years of age or younger at deeth to or for the use of a natural parent, an adoptive parent, ora stepparent of the child is 0'l6 [72 P.S. ~116 (a) (1.2)J. The tax rate impoeed on the net value of transfers to or for the use of the _'s linee! beneficiaries is 4.5%, exoeptas noted in n P .5. ~9116 1.2) [72 P.S. ~9116 (a) (1)]. The tax rate impoeed on the net value of transfers to or for the uee of the deoedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is defined, under SeclIon 9102, as an individual who hes at 1easl one parent in commoo with the decedent, whether by blood or adopIion. *' SCHEDULE A REAL ESTATE COIIMONNEALTHOf PBHM.VANIA NERfTNCE TAX RETURN RESIDENT DECEDENT ESTATE OF Robinson. WilliamF. I FILE NUMBER 21 - 05 - 00137 All real propel1Y 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 properlY would be exchanged between a Willing buyer and a wiUing seller, neither being compelled to buy or sell, both having reasonable knoWledge of the relevant facts. Real property Which Is jolnlly-owned with righf of survivorship must be disclosecl on schedule F. ITEM NUMBER I DESCRIPTION 508 Eighth Street, New Cwnberland, Cwnberland County, Pennsylvania Property sale price VALUE AT DATE OF DEATH 165,000.00 TOTAL (Also enter on Line 1, Recapitulation) 165,000.00 . SCHEDULE B STOCKS & BONDS COMMOJMEALTH OF PEtN;YLVNtA INiERrrANCE TAX RETURN RESIDENT DECEDENf ESTATE OF Robinson, WilliamF. I FILE NUMBER 21 - 05 - 00137 AD properly jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE NUMBER OF DEATH 1 Citigroup 48.40 66,534.66 2 Exxon Mobil 51.50 81,576.00 3 IBM 92.95 41,269.80 4 PPL Corporation 53.6 17,473.60 5 St. Paul Travelers 36.9 2,730.60 6 JP Morgan Chase 37.03 10,109.19 7 Prudeutial Financial 53.41 4,593.26 TOTAL (Also enter on line 2, Recapitulation) 224,287.11 . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMOHNEAL 1H OF PBffSYlVANlA INiERrTMCETAXftETURH RESIDENt' DECEtlENT ESTATE OF R b' W'!li F o mson, 1 am . I FILE NUMBER 21 - 05 - 00137 Include the proceeds of litigation and the date the proceeds were received by the estate. All property joinUy-owned with the right of survivorshIp must be disclosed on schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 6,347.77 Cili=1s Bank Checking Acct. 610070-651-6 2 Cili=1s Bank Money Marlcet Ace!. 620479-838-7 53,016.59 3 Cili=1s Bank Certificate of Deposit 6140-697387 10,030.92 TOTAL (Also enter on Line 5, RecapitulaUon) 69,395.28 '* SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Robinson, William F. FILE NUMBER 21 - 05 - 00137 This schedule must be completed and filed if the answer to any of Questions 1 throuah 4 on paae 2 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF Include the name of the transferee, their relationship to cIecedenl: and the date d transfer. EXCLUSION TAXABLE VALUE NUMBER VALUE OF ASSET DECO'S OF APPLICABLE) Attach a CQ9Yofthe deed for real estate. INTEREST I Prudential Financial Life InSUTance Policy 5,000.00 100% 5,000.00 Contract No. 17 048 123 2 Prudential Financial Life Insurance Policy 5,000.00 100% 5,000.00 Contract No. 21 057 110 3 Prudential Financial Life !nSUTance Policy 3,000.00 100% 3,000.00 Contract No. 25 182 235 4 Transamerica Life Insurance and Annuity Company 12,958.96 100"10 12,958.96 Contract No. 26142950 5 IBM Group Life Insurance 5,000.00 100% 5,000.00 TOTAL (Also enter on line 7, Recapitulation) 30,958.96 *' SCHEDULEH ~EXPB\ISES& ADNNSTRA11\IECOSIS COIIlMaNWEALTH OF PBfiSYl.VNM NERfTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF R b. Will. F o mson, lam. I FILE NUMBER 21 - 05 - 00137 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: I Parthemore Funeral Home and Cremation Services, Inc. 9,186.83 2 Rolling Green Cemetery 995.00 3 Sears - Shirt for Decedent 18.00 4 Food for Post-Ceremony Gathering 243.46 5 Gingrich Memorials 145.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of PeI$OIllIl Representative(s): street Address City state - Zip Year(s) Commission paid 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Slate Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 535.00 Cwnberland Law Journal 75.00 The Sentinel - Legal 137.03 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. other Administrative Costs I TOTAL (Also enter on line 9, Recapitulation) 11,335.32 . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS CO..M0fMIEAL1l1 OF P~VANIA .....ERITANCE TAX RETURN RESIDENT DECEDENT I FILE NUMBER 21 - 05 - 00137 ESTATE OF R b. Willi. F o mson. am.. Include unreimbursed medical expenses. ITEM NUMBER I US Treasury - 2004 Income Tax DESCRIPTION AMOUNT 2,134.00 2 Individual Healthcare Providers 1,165.14 3 Griswold Special Care 298.75 4 Central Medical Equipment Co. 303.64 5 Robin Gasperetti, Tax Collector - Real Estate Taxon 508 8th Street 511.18 6 Roger Hwnmel - Lawn Care 395.00 7 Kemper Auto & Home - Homeowners Insurance 190.00 8 Borough of New Cwnberland - Sewer & Trash 134.94 9 PPL Electric Utilities 304.48 10 Pennsylvania American Water Company 107.26 11 UPS Overnight packages 110.00 12 IBM - January health insurance coverage 78.00 13 AT&T 40.77 14 Verizon 39.D9 15 Equiserve - Replace lost certificates 27.10 16 Quantwn Imaging 27.60 17 Interuists of Central P A 20.15 18 P A Department of Revenue - 2004 Income Tax 20.00 19 Expenses to Sell 508 8th Street 1,779.80 TOTAL (Also enter on Line 10, Recapitulation) 7,686.90 Jruf ~U(OJ ana ~l'1fnllll'ltf 101 WILLIAM F. ROBINSON I, William F. Robinson, of 508 Eighth Street, New Cumberland, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. FIRST I order and direct my personal representative hereinafter named to pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my personal representative need not accelerate and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. If I do not own a burial plot or a grave marker at the time of my death, I authorize my personal representative, in his, her or its sole discretion, to purchase a burial plot and to erect a suitable marker at my grave, and to expend sums from my estate for this purpose. SECOND I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wheresoever situate in equal shares, share and share alike, per stirpes to my sons, Dennis W. Robinson, of Boiling Springs, Pennsylvania, Richard E. Robinson, of Largo, Florida, James M. Robinson, of New Cumberland, Pennsylvania, William W. Robinson, of Longmont, Colorado, and David C. Robinson, of New Cumberland, Pennsylvania. THIRD If, at the time of my death, any beneficiary of this my Last Will and Testament is under the age of twenty-five (25) years or is, in the judgment of my personal representative, mentally disabled, I give, devise and bequeath said beneficiary's share to my Trustee, James M. Robinson, of New Cumberland, Cumberland County,. Pennsylvania, in Trust for said beneficiary, in accordance with the paragraphs below. In the event James M. Robinson is deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint David C. Robinson, of New Cumberland, Cumberland County, Pennsylvania, to serve instead. FOURTH During the terms of any trust created pursuant to this Will the Trustee is authorized to expend and apply so much of the net income and principal of each such Trust as the Trustee shall consider advisable for the health, maintenance, support and education (including college education, undergraduate and graduate) of each such beneficiary until he or she attains twenty-five (25) years of age, or until all such amounts are paid out of the Trust. When the beneficiary attains the age of twenty-five (25) years or is in the judgment of my Trustee mentally sound, whichever occurs later, the Trust shall terminate and the remainder thereof shall be paid to said beneficiary. If said beneficiary shall die before the termination of said Trust, the Trust shall terminate and the remainder thereof shall be paid in accordance with the paragraph above. I direct that no Trustee shall be required to give or post bond for the faithful performance of the Trustee's duties in this or any other jurisdiction. FIFTH My executor and trustee are authorized and empowered to exercise from time to time in his/her/its sole discretion and without prior authority from any Court, in respect of any property forming part of any trust hereby created or otherwise in its possession hereunder all powers conferred by law upon trustees or executors and the testator intends that such powers be construed in the broadest possible manner. SIXTH I nominate, constitute and appoint my son, David C. Robinson, of New Cumberland, Cumberland County, Pennsylvania, Executor of this my Last Will and Testament. In the event David C. Robinson is deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint my son James M. Robinson, of New Cumberland, Cumberland County, Pennsylvania, to serve instead. I direct that my personal representative shall not be required to give or post bond for the faithful performance of his/her/its duties in this or any other jurisdiction. SEVENTH I hereby declare it to be my expressed desire that my personal representative employ Turo Law Offices of Cumberland County, Pennsylvania, for legal advice and assistance regarding this my Last Will and Testament, they having considerable knowledge of my affairs, views and wishes respecting any matters that may arise at the probate of this instrument, the administration of my estate, and the execution of the powers herein mentioned. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament this I (.,1"1\ day of OC'"TODeR.. , 2003. ~. .,,?~J,.-Z/! Witness !/iL/1 , 0J&/l!;,,~r-;c 'tfr'.. n~V'Y',4>~ William F. Robinson ~_ a (bi;"""", ( itness ~ '-::) ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : SS COUNTY OF CUMBERLAND I, William F. Robinson, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to the law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. /~ ~-~.'- 4Qg- ~. (j . --, .-'-. ',) . P~i/'vll{, '. - < .~ ~F Wdiam F. Robinson ~ Sworn or affirmed and acknowledged before me by William F. Robinson, the Testator, this IlDll-l- day of OC106C12-., 2003. .~/ ~/' - ,'1' Notary ~ IC . ~ Nolarial Seal Robert J. Mulderig, NOla'" Public Cart Isle Boro. Cumberland County My Commission Expires Nov. 13, 2Ot14 ,,---......_-----" ,.' i J. /I,: .__{,>~.- ..,_ u..-~ V < . '.0;) ...oJ":;;'::--, _::'_ c' ;0(,.,.>' -."",": "...J-=-. - tJ:. ,- [;;: _~- . : c':: r" -,\ . /'" .-...1'--....- . -:~.~~~f . ,{;..... """" AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : SS COUNTY OF CUMBERLAND We, \~."", \Jt:>r'Y)E-~ and -Je'S"S,cAA. HoC'{E'I<..s,.y"i)/, the witnesses whose names are attached to the foregoing document, being duly qualified according to the law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the Last Will and Testament as witnesses and that to the best of our knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. L1 ) )C~-uY7 ,^ 1/ /' IltlMI.?cL . J (f ,I fIu:k/~!!f~ Sworn or affirmed and subscribed before me by K:m iVd;77ER and ;J~58 it! /1- n !/t?tl6;-as.;n,4his /,/ day of (IJ~(;;'I:3cRu ,2003. . ~\ '-'. ;:'.;,. , ':"- .,' ,0 " '.'< .'. ~~ Notary P lie ,,. .. "<~'.~ >. ,J..., ..-,-.., '/':'~>.1 , -~ ,,' -'- -'. :..,i. O~ =-: - , : C): "-. .-. .'.; ...; l L:;.:" -. -~ "::-' ~/ . (~ p<.....?......~./ . ~ ..,:;: I :~:'. '~, , :,.: . ,. Notarial Seal Robert J. Mulderig, Notarv Public Carlisle ,Boro, Cumberland County My Comml~sio~ ~:~~.:: ~~~'._~ ~__~~~~_<, A. S.ttle....nt State....nt U.S. Department of Housing and Urban Development OMS Approval No. 2502-026E B. Type of loan 1.[ JFHA 4. [ lVA 2. [ ] FmHA 5. [ J Conv.!n.. 3. [ J Conv.Unins. 6. File Number: 7. loan Number: 8. Mortgage Insurance Case Number: 400501098-CB 0031245475 C. NOTE: THIS NOTE IS FURNISHED TO GIVE YOU A STATEMENT OF IICTUIIL SETTLEMENT COSTS.IIMOUNTS PAID TO AND BY THE SETTLEMENT IIGENT ARE SHOWN. ITEMS MARKED "(P.O.C.)" WERE PAID OUTSIDE THE CLOSING; THEY ARE SHOWN HERE FOR INFORMATIONAL PURPOSES AND NOT INCLUDED IN THE TOTALS. D. HIIme and Addre.. of Borrower I E. Name and Address of SeUer RONALD J. VASILOFF WILLIAM F. ROBINSON 303 TENTH STREET NEW CUMBERLIIND, PII17070 ' PA IF. Name and Addre.. of Lender PHH MORTGAGE CORPORATION 3000 lEADEN HALL ROAD, MOUNT LAUREL, NJ 08054 G. PROPERTY LOCATION 508 EIGHTH STREET. NEW CUMBERLAND, PA 17070 COUNTY: CUMBERLIIND PARCEL 10: 26-24-0811-392 TOWNSHIP: NEW CUMBERLAND BOROUGH H. Settlement Agent SECURED LIIND TRANSFERS. MECHANICSBURG Place of Settlement I. Settlement Date I 485 ST. JOHNS CHURCH ROAD.. Ol.bu....m.nl Dote SHIREMANSTOWN. PA 17011 8/1120054:00:00 PM/8I1I2OO5 J. SUMMARY OF BORROWER'S TRANSACTIONS K. SUMMARY OF SELLER'S TRANSACTIONS 100. Gron Amount Due From Borrower 400. Gros. Amount Due To Sener 101. Purchase Price $165.000.00 401. Purchase Price . 5165,000.00 102. Personal Property 402. Personal Property 103. Settlement Charg.. to Borrower 55,745.70 403. 104. 404. 105. 405. Adjustments For Items Paid By SeUer In Advance Adjustments For Items Paid By Seller In Advance 106. CityfTown Taxes 406. CltyfTown Taxes --,- 107. County Taxes 740.45001yr for 08/01/05 thru 01/01/06 $308.52 407. County Taxes 740.45001yr for 08101/05 thru 01/01106 5308.52 108. Assessments 408. Assessments 109. School Taxe. 1485.2200/yr for 06101105 Ihru 07/01106 $1,361.45 409. School Texe. 1485.22001yr lor 08l011051hru 07101106 51,361.45 110. 3rd QIr Refuse (7/819) 38.60/qlr lor 81112005 10 $25.59 410. 3rd Qtr Refuse (7/819) 38.601qlr for 8111200510 $25.59 10/112005 10/112005 111. 411. 112. 412. 120. Gross Amount Due From Borrower I 5172,441.26 420. Gross Amount Due To Seller I $166,695.56 200. Amounts Paid By Or In Behalf Of Sorrower SOO. Reductions In Amount Due To Seller 201. Deposit Held by Seller 51.000.00 501 . Deposit Held by Seller 51,000.00 202. Principal from PHH Mortgage Corporation 5155.800.00 502. Settlement Charges To Seller (IIn. 1400) 51,729.80 203. Existing loan(s) taken subject to 503. Existing Loan(s) taken Subject To 204. Lender Contribution from PHH Mortgage Corporation $194.75 504. Payoff of First Mortgage Loan 205. 505. Payoff of Second Mortgage Loan 206. 506. 207. 507. 208. 508. 209. 509. Adjustments For Items Unpaid By Seller AdJusbnents For Items Unpaid By Seuer 210.CI~lTownTexos 510. CityfTown Taxes 211. County Taxes 511. County Taxes 212. Assessments 512. Assessments 213. . 513. 214. 3rd Olr Sower (7/819) 26.20/qlr for 7/1/2005 10 $8.83 514. 3rd Qlr Sewer (7/819) 26.20/qlr for 7/112005 10 58.83 81112005 ..' 61112005 215. . . 515. .' , 216. 516. 217. 517. 218. 518. 219. 519. 220. Total Paid By/For Borrower 300. Cash At Settlement FromITo Borrower 301. Gro&8 Amount Due From Borrower (tine 120) 302. Less Amounts Paid By/For Borrower (line 220) I $157,003.58 520. Total Reduction Amount Due Sener I 600. Cash At Settlement To/From Seller $172,441.26 601, Gross Amount Due To Seller (line 420) I $157.003.58 602. Less Deductions In Ami. Duero Seller (line 520) I 52,736.63 T I $166.695.56 $2,738.63 303. C..h [X] From I ) To Borrower $15.437.68 603. Cash [Xl To [ ] Front Seller 5163.956.93 400501098 - CB L. Settlement Statement Page 2 700. Total Sale. Com million Division of Commission (line 700) As Follows: Paid From Borrower's Paid From Seller's 701. Listin'g .Agent Commission Funds At Settlement Funds At Settlement 702. Selling Agent Commission 703. Commission paid at settlement 800. Items Payable In Connection With Loan 801. Loan Origination Fee 802. Loan Discount 803. Appraisal Fee to STARS $325.00 804. Credit Report to cee Systems $15.00 805. lender's Inspection Fee 809. Document Preparation to PHH Mortgage Corporation $85.00 811. FlOod Cart. Fee to STARS $19.50 814. Application Fee to PHH Mortgage Corporation $450.00 900. Items Required By Lender To Se Paid In Advance 901. Interest from 08/01/05 to 09/01/05@29.75/day $922.25 902. Mortgage Insurance Premium for 903. Hazard Ins Premium State Farm Ins, (POC 395,00) 1000. Reserv.. Deposited With Lender 1001, Hazard Ins Reserve 3 mo @ 32.92/ mo PHH Mortgage Corporation $98.76 1002. Mortgage Insurance 1003. City Property Taxes 1004. County Tax Reserve 7 mo@ 43.39/ mo PHH Mortgage Corporation $303.73 1006. School tax 3 mo@ 131.n I mo PHH Mortgage Corporation $395.31 1009. Aggregate Accounting Adjustment from PHH Mortgage Corporation -$173.60 11 QO. Title Charge, 1101. Settlement or Closing Fee 1102. Title Evidence Short Form Residential Policy Charge to Apex Real Estate Information Services $100.00 1103. Title Examination 1106. Notary fees to Cash $20.00 $10.00 1107. Attorney's fees 1108. Title insurance to Secured land Transfers. Mechanlcsburg $1,183.75 1109. Lende~s Coverage $155800.00 ($) 1110. Owner's coverage $165000.00 ($1183.75) 1111. Endorsement 900nl 0 to Apex Real Estate Information Services / Secured land Transfers. Mechanicsburg / $100.00 Secured Land Tran 1113. Insured Closing Protection Letter to Apex Real Estate Information Services $35.00 1114. Overnight Delivery & Processing Fee to Secured Land Transfers. Mechanicsburg $20.00 1116. Wire Fee to Secured land Transfers. Mechanicsburg $35.00 1120. Doc Print to Secured Land Transfers. Mechanlcsburg $50.00 1122. Tax Cert to Secured Land Transfers. Mechanicsburg $5.00 1200 Government Recording And Tl"llnsfer Charge. 1201. Recording Fees: Deed $ 38.50; Mortgage $ 72.50 $111.00 1202. Clty/CountyTaxlStamps 1650.00 $1,650.00 1203. Slale Deed Tax $ 1650.00 $1,650.00 1205. 1300 Additional Settlement Charge. 1305. 3rd Otr Refuse (7/819) to New Cumberland Borough Office $38.60 1306. 2nd air Sewer (4/516) to New Cumberland Borough OffIce $26.20 1400. Total Settlement Charge. (Enter On Lln..103, Section J And 502, Section K) $5,745.70 $1,729.80 . . I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief It IS true and accurate statement of all receIpts and disbursements on my account or by me In this transaction. I further certify that I have receIved a copy of the HUD~l settlement Statement. . Ronald J. Vasiloff The HUO.1 sattternen Statement which I have prepared is a true and accurat with this statement. setttementAge(7 ~f2~ SECURED LAND TRANSFERS - MECHANICSBURG Date 8/1120054:00:00 PM COMMONWEALTH Of PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-l t62 EXit 1-96/ RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ROBINSON JAMES M 28 SOUTH PITT STREET CARLISLE, PA 17013 n__n__ tClld ESTATE INFDRMATIDN: SSN: , 20-20-824S FILE NUMBER: 2105-0137 DECEDENT NAME: ROBINSON WILLIAM F DATE OF PAYMENT: 08/15/2005 POSTMARK DATE: 08/15/2005 COUNTY: CUMBERLAND DATE OF DEATH: 01/28/2005 NO. CD 005684 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $21,177.86 I I I I I I I I TOTAL AMOUNT PAID: $21,177.86 REMARKS: J M ROBINSON ESQ CHECK# 146 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS