HomeMy WebLinkAbout08-16-05
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ADAMS H ANTHONY
49 WEST ORANGE STREET
SUITE 3
SHIPPENSBURG, PA 17257
______n fold
ESTATE INFORMATION: SSN: 180-05-7462
FILE NUMBER: 2105-0015
DECEDENT NAME: FULLER LESTER C
DATE OF PAYMENT: 08/16/2005
POSTMARK DATE: 08/16/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/31/2004
NO. CD 005690
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,984.42
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TOTAL AMOUNT PAID:
REMARKS:
CHECK#126
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$3,984.42
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REV-1500 EX + (6-00)
.
'* COMMONWEALTH OF
, PENNSYLVANIA
, DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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Fuller Lester C.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
OFFICIAL USE ONLY
FILE NUMBER _
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SOCIAL SECURITY NUMBER
1 80- 0 5 - 7 4 6 2
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (dale of death priorto 12-13-82)
D 5. Federal Estate Tax Return Required
Q.. 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Soh 0)
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X _(16)
X .12 (17)
362,562.84 X .15 (18) 54,384.43
(19) 54,384.43
12/31/2004 12/29/1912
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[KIt Original Return
D 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy oITruS!)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
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NAME
H.Anthon Adams
FIRM NAME (If Applicable)
COMPLETE MAILING ADDRESS
49 W. Orange Street
Suite 3
TELEPHONE NUMBER
717~532-3270
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o 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)
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/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
:> >BEiSURt: T.OAN&WGR Al.l.l QUES'tfONS 'd.u~;rwsR&E 'SIDE AND RECHECK MATH < <
PA 17257
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99,900.00 I
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327,083.60T
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14,795.771
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OFFICIAL USE ONLY
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(8)
441,779.37
38,931.78
(11) 38,931.78
(12) 402,847.59
(13) 40,284.75
(14) 402,847.59
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Decedent's Complete Address:
STREET ADDRESS
111 E. OranQe Street
CITY I STATE I ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
54,384.42
48.000.00
2.400.00
Total Credits (A + B + C)
(2)
50,400.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2. enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check to: REGISTER OF WILLS, AGENT
0.00
3,984.42
3,984.42
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. 0 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS
DATE
Bitt
PA
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net v
[72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for
The statute does not exempt a transfer to a surviving spouse from tax. and the statutory requirements for
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 y
or a stepparent of the child is 0% [72 P.S. ~9116(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
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~911
individual who has at least one parent in common with the decedent, whether by blood or adoption.
(1.1) (ii)l.
able even if
REV-1502 EX + (6-98) ,
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Fuller. Lester C.
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 iointly-owned with right of survivorship must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
Lot of land together with improvements thereon in the Borough of Shippensburg,
Cumberland County, Pennsylvania known as 111 East Ornage Street per Deed Book 147
page 1054 Map Ref. 33-34-2415-111
VALUE AT DATE
OF DEATH
99,900.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
99900.00
REV-1503 EX + (6-98) .
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Fuller. Lester
FILE NUMBER
c.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
327,083.60
Orrstown Bank Investment Services
Account #500000006010
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
327 083.60
REV-1508 EX + (6-98) .
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Fuller. Lester C.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
19.35
Refund from Sprint
2.
Refund from Blue Cross
367.32
3.
Refund from Comcast Cable
44.84
4.
Household Items and tangible personal property sold at public sale
10,013.50
5.
Refund of County/Borough Real Estate Tax
249.69
6.
Refund of Shippensburg Area School District Real Estate tax
88.21
7.
Orrstown Bank checking
Account # 640182
4,012.86
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
14.795.77
REV-1511 EX + (12-99~
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Fuller.
ITEM
NUMBER
A.
1.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Lester
C.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
Fogelsanger -Bricker Funeral Home
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Annette Hewitt
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City Shippensburg
Year(s) Commission Paid: 2005
State P A
Attomey Fees
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Probate Fees
Accountanfs Fees
Tax Retum Prepare(s Fees O.B. Investment Fee 10/1/04-12/31/04
Ausherman Brothers (Real Estate Appraisal)
Borough of Shippensburg (Waterbill on Estate Property)
HDI, Inc (medical supplies)
Lisa Helm (County Borough Taxes)
Cumberland Valley Medical Services
Cumberland Law Journal
Records of Deeds - Realty Transfer Tax
Borough of Shippensburg (work of Estate Property)
Borough of Shippensburg (Waterbill on Estate property)
Carl L. Cramer Insurance
Sailhamer Real Estate (Sales Commission on real estate)
Borough of Shippensburg (Sewer and water)
FILE NUMBER
AMOUNT
8,734.00
9,000.00
Zip 17257
9,000.00
Zip
417.00
456.88
250.00
258.06
117.52
408.34
26.00
75.00
999.00
79.90
168.61
91.00
5,994.00
132.41
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
38931.78
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Fuller, Lester C.
Decedent's Name
Page 1
File Number
Schedule H - Funeral Expenses & Administrative Costs - 87.
ITEM
NUMBER
DESCRIPTION
AMOUNT
19.
20.
21.
22.
23.
Dan Hershey Auctioneering
Pa. Dept of Revenue
News- Chronicle (Advertising grant of letters)
Sprint
First Energy
2,085.00
421.00
84.50
93.94
39.62
SUBTOTAL SCHEDULE H.B7
2,724.06
"""'''''.'. .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Fuller Lester
SCHEDULE J
BENEFICIARIES
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S} RECEiVING PROPERTY Do Not List Trustee(s} OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Frederick Reddig nephew 7%
108 Park Place West
Shippensburg, PA 17257
2. Debbie Brenize neice 8%
1054 Ashton Drive
Shippensburg, PA 1727
3. Nan Hogan neice 8%
83 Laurel Drive
Fayetteville, PA 17222
4. Peggy Jo Bodge neice 10%
280 Sawyer Street
Portland, Maine
5. Phillip Fague nephew 10%
9754 Forest Ridge Road
Shippensburg, PA 17257
6. Susan Filer neice 2%
308 North Reading Road
Shippensburg, PA 17257
7. Jeffery Fague nephew 10%
556 Cameltown Hill Road
Danville, PA
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. Grace United Church of Christ .570
Shippensburg, PA 17257
2. Prince Street United Brethern Church SID
Shippensburg, PA 17257
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
C
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Fuller, Lester C.
Decedent's Name
Page 2
File Number
Schedule J - Beneficiaries - 1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (include outright spousal distributions)
8. Michael Fague nephew 10%
216 North Prince Street
Shippensburg, PA 17257
9. Annette Hewitt friend 25%
580 Newburg Road
Shippensburg, PA 17257
LAST WILL AND TESTAMENT
KNOW ALL MEN BY THESE PRESENTS, that I, LESTER C. FULLER, of
Pennsylvania, being of sound and disposing mind, memory and understanding,
do make, publish and declare this my Last Will and Testament hereby revoking
all prior wills and codicils by me at any time heretofore made.
FIRST: I direct the payment of all my legal debts, funeral expenses
including my grave marker and all expenses of my last illness, state, federal
estate and inheritance taxes and administration costs shall be paid as soon as
may be conveniently done following my decease leaving all specific bequests free
of tax to the legatee.
SECOND: I give, devise and bequeath all my property be it real, mixed or
personal, of whatever nature or kind and wherever situate as follows:
a. I give and bequeath 5% of my net estate to the Grace United Church
of Christ of Shippensburg, Pennsylvania.
b. I give and bequeath 5% of my net estate to the Prince Street United
Brethren Church of Shippensburg, Pennsylvania.
c. I give and bequeath 7% of my net estate to Frederick Reddig of 108
Park Place West, Shippensburg, Pennsylvania.
d. I give and bequeath 8 % of my net estate to Debbie Brenize of 1054
Ashton Drive, Shippensburg, Pennsylvania
e. I give and bequeath 8% of my net estate to Nan Hogan of 83 Laurel
Drive, Fayetteville, Pennsylvania.
f. I give and bequeath 10% of my net estate to Peggy Jo Bodge of 280
Sawyer Street, Portland, Maine.
g. I give and bequeath 10% of my net estate to Phillip Fague of 9754
Forest Ridge Road, Shippensburg, Pennsylvania.
h. I give and bequeath 2% of my net estate to Susan Filer of 308 N.
Reading Road, Shippensburg, Pennsylvania.
i. I give and bequeath 10% of my net estate to Jeffery Fague of 556
Cameltown Hill Road, Danville, Pennsylvania.
j. I give and bequeath 10% of my net estate to Michael Fague of 216
North Prince Street, Shippensburg, Pennsylvania
k. I give and bequeath 25% of my net estate to Annette Hewitt of 580
Newburg Road, Shippensburg, Pennsylvania.
THIRD: I direct that my Executrix not be required to post bond of any
nature or kind for the performance of any duties in any jurisdiction.
FOURTH: I nominate and appoint Annette Hewitt as Executrix of this my
Last Will and Testament. .
IN WITNESS WHEREOF, I, LESTER C. FULLER to this my Last Will and
Testament set my hand and official seal, this _, b~ day of May 2002.
: . -
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LESTERC. FULLER
Sworn to and subscribed, declared and
Published by Lester C. Fuller as
His Last Will and Testament, and so
Done in the presence of we the
Witnesses, who sign at his request,
And in his presence, and in the presence
Of each other.
a,d %MrJz
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
I, Lester C. Fuller, ",/hose name is signed to the foregoing instrument;
having been duly qualified according to law, do hereby acknowledge that I
signed it willingly; and that I signed it as my free and voluntary act for the
purpose therein expressed.
~~~
Lester C. Fuller
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Sworn to and acknowledged, before me,
By Lester C. Fuller, the Testator,
ll::!is i ~ay of May 2002.
II
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Notary Public
NOTARIAL SEAL
PAM El.A, A SWITALSKI Notary Public
Shippensbuq Cu('!'">oerland Cot,;nty
My Commission expires Feb 9, 2004
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
WE, '1~. ~~l MQ~and~e~ ~;-H-, the witnesses whose
names are signed to the foregoing instrument, being duly qualified according to
law, do depose and say that we saw the Testator sign and execute the
instrument as his Last Will and Testament; that he signed it willingly and that he
executed it as his free and voluntary act for the purposes therein expressed; that
each of us in the hearing and sight of the Testator signed the Will as witnesses,
and that to the best of our knowledge and belief the Testator was at the time at
least eighteen (18) or more years of age and of sound mind and under no
constraint or undue influence.
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~wornto and ubscribeq before m~ by, ....J.
~, .' '-; (}( - a nd f\1Jk;Qt-\e \~W( 1 I
The witne ses, this J Di~ day of May 2002.
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~WT.A.RIAL SEAL
PM.1c\..!l. A. S\/]:,;l..L.SKI Notary Public
Shippens8urs C';xi12er!and County
My Commission bO"':'; Feb. 9. 2C04
--
Settlement Statement
A.
U.S. Department of Housing and Urban Development
B. Type of Loan OMB No. 2502-0265 REV. HUD-113/86)
1. OFHA 2. OFmHA 3. OCony, Unins. I 6. File Number I 7, Loan Number I 8. Mortgage Insurance Case Number
4. OVA 5. OCony. Ins. 051536NEALY
C. Note: I nls TOrm IS umlshed to give you a statemen at actua settlement costs. Amoun~s palO, to ana oy me selllemen agen are sown. I TilleExpress Settlement System
lIems marked "(p.o.c.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals.
WARNtNG: II is a crime to knowingly make fatse statements to the United States on this or any other similar form. Penalties upon Printed OS/27/2005 at 14:29 RLH
conviction can include a fine and imprisonment. For details see: Tille 18 U. S. Code Section 1001 and Section 1010.
D. NAME OF BORROWER: Matthew T. Nealy
ADDRESS: 48 Fish Hatcherv Road Newville PA 17241
E. NAME OF SELLER: The Estate of Lester Fuller
ADDRESS:
F. NAME OF LENDER: Adams County National Bank
ADDRESS: 675 Old Harrisbura Road. P.O.Box 3129 GettvsburQ, PA 17325
G. PROPERTY ADDRESS: 111 and 1111/2 E. Orange St, Shippensburg, PA 17257
Oranae Street East
H. SETTLEMENT AGENT: South Central Home Settlements, Inc., Telephone: 717-532-7387 Fax: 717-532-6552
PLACE OF SETTLEMENT: 126 East Kina Street Shiooensbura. PA 17257
I. SETTLEMENT DATE: OS/2712005
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales mice 99.900.00 401. Contract sales orice 99 900.00
102. Personal Prooerty 402. Personal Prooertv
103. Settlement charoes to borrower (line 1400\ 4.584.47 403.
104. 404.
105. 405.
Adiustments for items paid by seller in advance Adiustments for items paid by seller in advance
107. County taxes 05127105 to 12131105 249.69 407. County taxes OS/27/05 to 12131105 249.69
108. School Taxes 05/27/05 to 06130/05 88.21 408. School Taxes 05127/05 to 06/30/05 88.21
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 104 822.37 420. GROSS AMOUNT DUE TO SELLER 100.237.90
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deoosit or earnest money 1.000.00 501. Excess Deposit (see instructions)
202. Princioal amount of new loans 104.000.00 502. Settlement charaes to seller (\jne 140m 7210.41
203. Existino loan(s) taken subiect to 503. Existino loan(s\ taken subiect to
204. 504. Payoff of First Mortoaoe Loan
205. 505.
206. 506.
207. 507.
208. 508.
209. 509.
Adiustments for items unoaid bv seller Adiustments for items unoaid bv seller
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 105.000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 7.210.41
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower lIine 120\ 104,822.37 601. Gross amount due to seller !line 420\ 100.237.90
302. Less amounts oaid by/for borrower (line 220\ 105,000.00 602. Less reduction amount due seller lIine 520\ 7210.41
303. CASH TO BORROWER 177.63 603. CASH TO SELLER 93 027.49
SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is important lax information and is being furnished to the tnternal Revenue Service. If you are required to file a return.
a negligence penally or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. The Contract Saies Price described on
line 401 above constitutes the Gross Proceeds of this transaction.
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
r
File Number: 051536NEAL Y
PAGE 2
SETTLEMENT 5 A TEMENT REV. HUD-1 (3/86\ TitleExoress Settlement System Printed 05/27/2005 at 14:29 RLH
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on Drice $99.900.00 {(j) 6.000 = 5 994.00 BORROWER'S SELLER'S
Diyision of commission (line 700\ as follows: FUNDS AT FUNDS AT
701. $ 5.994.00 to Sailhamer Real Estate SETTLEMENT SETTLEMENT
702. $ to
703. Commission naid at Settlement 5.994.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Oriaination Fee %
802. Loan Discount 1.500 %Adams County National Bank 1 560.00
803. Aooraisal Fee to Adams County National Bank 900.00
804. Credit Reoort to Adams County National Bank 9.50
805. Flood Cert. Fee to Adams County National Bank 29.00
806. Oveniaht Fee to Adams County National Bank 12.75
807. Underwritina Fee to Adams County National Bank 245.00
808. Document Preo. Fee to Adams County National Bank 85.00
809. Aoolication Fee Credit to Adams County National Bank -540.00
810. Couoon for Settlement Fees to Adams County National Bank .100.00
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From OS/27/2005 to 06/01/2005 (ij)$ 17.6900 Idav 5 Days 88.47
902. Mortaaae Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mO.@$ Imo
1002. Mortaaae Insurance mo. (a) $ Imo
1003. City Prooertv Tax mO.@$ Imo
1004. County Prooerty Tax mo.@$ 34.68 Imo
1005. School Taxes mO.@$ 76.66 Imo
1009. Aaareaate Analvsis Adiustment
1100. TITLE CHARGES
1101. Settlement or c10sina fee
1102. Abstract or title search to South Central Home Settlements. Inc. 125.00
1103. Title examination
1104. Title insurance binder
1105. Document Prenaration to H. Anthony Adams. ESDuire 85.00
1106. NotarvFees
1107. Attornev's fees
(includes aboye items No: )
1108. Title Insurance to SCHS Aaent for Old Reoublic Title Ins. Co. 878.75
(includes above items No: )
1109. Lender's Policy 104.000.00 . 20.00
1110. Owner's Policy 99.900.00 .858.75
1111. END 100 300 8.1 to SCHS Agent for Old Reoublic Title Ins. Co. 150.00
1112.ICPL to Old Republic National Title Ins. Co. 35.00
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordina Fees Deed $ 38.50 . Mortaaae $ 68.50 . Release $ 107.00
1202. City/County tax/stamos Deed $999.00 . Mortaaae $ 999.00
1203. State Tax/stamos Deed $999.00 . Mortaaae $ 999.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Suryev
1302. Pest Insoection
1303. Final WaterlSewer cut-off to Borouah of Shiooensbura 132.41
1304.
1305.
1306.
1307.
1308.
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