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Home My WebLink About09-20-05 REV-1500EX+ (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT W t- ~:;!;rn ~o::.:: Uc..u woo :I:o:..J Uc..m c.. -< DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I- Z u.J Cl u.J U LLJ Cl HORN, IRA T. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) OFFICIAL USE ONLY FILE NUMBER 21 -0 5 0 2 3 5 COUNTYCOOE ----vEAA- - - NUMBER- - SOCIAL SECURITY NUMBER 1 88- 1 2 - 5 678 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3, Remainder Return (~ate of death priorlD 12-13-82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Saf~ Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach SchO) ;:THIS'.'SEbj;lofi,JjiMt.isijaEljoPMe:L..iI~.,rnibp'RReSRijNlitXij'fl'llillboNEIDEf,imi~l.!(li;fjX"NFORil;fii'f,i!isHfiiii!ll:w", NAME COMPLETE MAILING ADDRESS HAROLD S. IRWIN, III 64 SOUTH PITT STREET FIRM NAME (If Applicable) IRWIN LAW OFFICE CARLISLE PA 17013 TELEPHONE NUMBER 717 -243-6090 z o I- <t: ~ ::> I- a. <t: U w 0::: z o i= <t: l- => a. :a:E o u >< <t: I- 0.00 X _(15) 0.00 56,590.10 X .045 (16) 2,546.55 0.00 X .12 (17) 0.00 0.00 X .15 (18) 0.00 (19) 2,546.55 03/05/2005 02/16/1922 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) (8) (11) (12) (13) (14) 81 ,000.00 410.07 0.00 0.00 21,247.84 OFFICI L USE ONLY !Xl 1. Original Return o 4. Limited Estate !Xl 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) :--1;, r15 <--in in . I.) [",) C;,J 0.00 Fl:~ C) ) C:J " f;i~ I 'i'l '~.:J C) -j .= C) ~ ITl ") (-___J r-l f- :z UJ Cl :z o C- en UJ 0:: 0:: o U 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 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 & Adrninistrative 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 rnade (Schedule J) (6) (7) (9) (10) 14. Net Value Subject to Tax (Line 12 rninus 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 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT '-I o.ooL (~n qn 102,657.91 18,098.93 27,968.88 46,067.81 56,590.10 0.00 56,590.10 20. 0 . . \,: <<'<>'>:>"';! BEi,SURE~.:r.a~~NSWER~I!U\Qt!lE$mn:::JNS1lD ' ~RESt.ERSE1SIDEANIll1RECIllEeKWMAii'"a~'<)l<;~Mk<;!; ". Decedent's ~omplete Address: STREET ADDRESS UNITED CHURCH OF CHRIST HOMES SARAH TODD MEMORIAL HOME 1000 WEST SOUTH STREET CITY STATE CARLISLE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 2,546.55 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 2,546.55 2,546.55 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; ........................................................................... D III b. retain the right to designate who shall use the property transferred or its income; ........................................ D III c. retain a reversionary interest; or ...................................................................................................... D lID d. receive the promise for life of either payments, benefits or care? ............................................................. D III 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. D [%I 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. D III 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... D [iJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief. it is true. correct and complete. Declaration of preparer other than the personal representative is based on all infonmation of which preparer has any knowledge. SIGNAT OF PERSON RESPONSIBLE FOR FILING RETURN DATE I (! 09 7200 DATE ADDRESS SIGNATURE 0 ADDRESS 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 of transfers to or The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements 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 ] or a stepparent of the child is 0% [72 P.S. s9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiari The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% I individual who has at least one parent in common with the decedent, whether by blood or adoption. 2 P.S. ~9116 (a) (1.1) (ii)]. on are still applicable even if 0i'HP D -I ~Sl II parenl, an adoptive parent, 6(1.2) [72 P.S. 99116(a)(1 )]. under Section 9102, as an REV-1502 EX + (6-98) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER HORN. IRA T. 21 05 0235 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 prooertv which is iointlv-owned with riaht of survivorshio must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION CONDO LOCATED AT 1416 BRADLEY DRIVE, H112, CARLISLE, PA 17013 Value Based on Sale Price See HUD-1 attached as Exhibit "B" VALUE AT DATE OF DEATH 81,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 81,000.00 R EV-1503 EX + (6-98) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF HORN. IRA T. FILE NUMBER 21 05 0235 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 410.07 U.S. SAVINGS BONDS Attached as Exhibit "e" TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 410.07 11 REV-1504 EX + (6-98) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY .HELD CORPORATION, PARTNERSHIP OR SOLE.PROPRIETORSHIP ESTATE OF HORN. IRA T. FILE NUMBER 21 05 0235 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH NONE 0.00 TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 0.00 REV-1507 EX + (6-98) O. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF HORN. IRA T. FILE NUMBER 21 05 0235 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH NONE 0.00 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 R EV-1508 EX + (6-98) '. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HORN. IRA T. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. FILE NUMBER 21 05 I nclude 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. 0235 DESCRIPTION MEMBERS 1 ST FEDERAL CREDIT UNION Savings Account No. 258596 - 00 Value based on bank letter attached as Exhibit "0" MEMBERS 1 ST FEDERAL CREDIT UNION Savings Account No. 140918 - 00 Value based on bank letter attached as Exhibit "0" MEMBERS 1 ST FEDERAL CREDIT UNION Checking Account No. 258596 - 11 Value based on bank letter attached as Exhibit "0" MEMBERS 1 ST FEDERAL CREDIT UNION Checking Account No. 140918 -11 Value based on bank letter attached as Exhibit "0" 1990 GEO PRIZM Value based on sale price Attached as Exhibit "E" MISCELLANEOUS HOUSEHOLD CONTENTS VALUE AT DATE OF DEATH 25.00 83.84 2,118.55 403.09 1 ,000.00 1 ,500.00 SCUDDER INVESTMENT ACCOUNT Account No. 89691193 Value based on letter attached as Exhibit "F" PRORATIONS FROM BUYER OF REAL ESTATE Taxes and Association Dues See HUD-1 Attached as Exhibit "B" SOCIAL SECURITY DEATH BENEFIT Due for spouse, Edna Horn, but recevied after death of decedent 14,629.63 930.97 255.00 UNITED AMERICAN INSURANCE COMPANY Refund of Unused Car Insurance Premium 247.20 GRUNER & JAHR USA PUBLISHING Subscription Refunds 54.56 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 21 247.84 R EV-1509 EX + (6-98) '. SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HORN. IRA T. FILE NUMBER 21 05 0235 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. B c JOINTL Y.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. NONE 0.00 0.00 TOTAL (Also enter on line 6, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) R EV-1510 EX + (6-98) 'W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT E STATE OF HORN. IRA T. SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21 05 0235 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A CDPY DFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPlICABLEI VALUE 1 . NONE 0.00 0.00 TOTAL (Also enter on line 7 Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) R EV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HORN. IRA T. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 05 0235 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. CARLISLE MEMORIAL SERVICE, INC. - Grave Marker Engraving 215.00 B. ADMINISTRA TIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Numbe~s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees IRWIN LAW OFFICE 6,000.00 3. Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 272.00 5. Accountant's Fees 6. Tax Return Prepare~s Fees 7. DONEGAL MUTUAL INSURANCE COMPANY - Car Insurance 143.00 8. ROBIN SOLLENBERGER - TAX COLLECTOR - Property Taxes 1,087.93 9. PHEASANT RUN CONDO ASSOCIATION - Monthly Dues 300.00 10. ERA-NRT, INC. - Real Estate Commission 4,985.00 11. RECORDER OF DEEDS - PA Real Estate Transfer Tax 810.00 12. OTHER CLOSING COSTS ON REAL ESTATE (See Exhibit "B") 140.59 13. CUMBERLAND COUNTY REGISTER OF WILLS - Filing Costs 30.00 14. CUMBERLAND COUNTY REGISTER OF WILLS. Additional Probate Fees 50.00 15. ADDITIONAL DEATH CERTIFICATES 54.00 16. REAL ESTATE REPAIRS 4,011.41 TOTAL (Also enter on line 9, Recapitulation) $ 18,098.93 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) . , '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF HORN. IRA T. FILE NUMBER 21 05 0235 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. NORTH MIDDLETON AUTHORITY Utility Bill VALUE AT DATE OF DEATH 159.80 2. KUNKLE SURGICAL GROUP Medical Bill 9.96 3. UNITED CHURCH OF CHRIST HOMES Nursing Home Bill 388.40 4. MEMBERS FIRST FEDERAL CREDIT UNION Mortgage Payoff See HUD-1 Attached at Exhibit "B" 27,410.72 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 27,968.88 "v.'"'~~.'". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER HORN IRA T. 21 05 0235 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)J 1. DARLENE E HEBERLlG Lineal 11 Ridge Avenue 25% RESIDUE Carlisle PA 17013 2. KAREN J. GETTYS Lineal 314 Old Stonehouse Road 25% RESIDUE Carlisle PA 17013 3. PAMELA J SHORB ESTATE Lineal 64 South Pitt Street 25% RESIDUE Carlisle PA 17013 4. T K HORN Lineal 8008 Sacks Drive 25% RESIDUE New Tripoli PA 18066 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. NONE 0.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. NONE 0.00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) -- E~\-\\B\l ,~' -- 1 ' .I LAST WILL AND TESTAMENT I, IRA T. HORN, of 1416 Bradley Drive, Unit H112, Carlisle, Cumberland County, Pennsylvania 17013 do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to al! property, whether or not such property passes under this Will, shall be paid by my personal representative out of my estate. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my spouse, EDNA M. HORN. 4. If my spouse does not survive me by a period of at least sixty (60) days, then my estate I give, devise and bequeath as follows: A. A life estate in my residence and the household contents thereofto my daughter Pamela J. Shorb for and during the term of her natural life or for as \ I . . long as she shall maintain said real estate as her personal residence. During the term of this life estate, Pamela J. Shorb shall be responsible for the real estate taxes, homeowners' insurance and any necessary repairs or maintenance to the home. B. All the rest, residue and remainder of my estate I give, devise and bequeath to my children, share and share alike, the child or children of any deceased child taking the share their parent would have taken if living. 5. I nominate and appoint my spouse to be the personal representative of my estate, to serve without bond. If my spouse cannot or does not serve, then I appoint my daughter, Darlene E. Heberlig, to be the substitute personal representative with the same powers and also without bond. 6. I suggest that my personal representative retain the services of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 30th day of November, 2001 . cf!~ ;1. ~ (SEAL) IRA T. HORN Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. 'tJltt/ & 4 ~ ~/7Jdtu..J tJ~ '" ACKNOWLEDGMENT AND AFFIDA VIT WE, IRA T. HORN, HEATHER A. BARBOUR and RHONDA S. IRWIN, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. \~~ d IRA T. HORN ?h-z-~ ~LL/L r4' /lL#~~ H A HER A. BARBOUR " {imlA.,.J :k~ RHONDA S. IRWIN COMMONWEALTH OF PENNSYLVANIA :55: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by IRA T. HORN, the testator herein, and subscribed and sworn to before me by HEATHER A. BARBOU~ and RHONDA S. IRWIN, witnesses, this 3 TH Y of November, 2001 lf~,~,~;~' ~;~;~l"2iS~!~:(~~~'~~~~~09 MY' ('r'....,...,.T.'v~,.'..-1 Exr;!~I~~S Oept. Lv:';" '-- I -"~~"~:"'::;::::~~~-'P:--~~~"--'~""iiion c-t N')taries Member, '''~, -- EXHlBlT 'B' - 0_____""-'.....,..........._,___...'-"-'__,._.......,.,........._'...'''"-''.____..._.' " SeUlemellt Statement t ...... U.S Department of Housing and Urban Development 8 Type ot oan , OMS ADorDval ND. 2502-0265 (expires 9/30/2006) FINAL 1. OFHA 2 OFmHA 3. OConv. Unins. I 6 File Number I 7. Loan Number 18 MDrtgage Insurance Case Number 4. OVA 5 OCDnv Ins. ST2005.82GD C NDte: ~ nlS lQrm \$ ut,nlsruro 0 give you 8 Slffiernem 0 Be ual selllemem cos S AmOunts PSI 0 ana oy me se~"emen agen are' s,.~own I TitleExpress Setllement System Items marked' (p oc )" were paid outSide the clOSing, they are shown here for ,nformation purposes and are not Included In the [olals WARNING II IS a crime to knowulgly make false statements to the United States on this Ot any other Similar form f'enalt\BS upon convICtion can Include a fme and Impnsonment For details see' Title 18 U S Code Section 1001 and Section 1010 Printed 08/09/2005 al1254 KLL D. NAME OF BORROWER Senad Camdzic and Sevleta Camdzic ADDRESS E NAME OF SELLER Estate of Ira T. Horn ~_ADDRESS Cash F. NAME OF LENDER ADDRESS G. PROPERTY ADDRESS 1416 Brandly Drive, Carlisle, PA 17013 North Middleton H. SETTLEMENT AGENT Saidis, Shuff, Flower & Lindsay, Telephone: 717.243-6222 Fax: 717.243.6486 PLACE OF SETTLEMENT 26 West Hiah Street Carlisle PA 17013 I. SETTLEMENT DATE 08/10/2005 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 81 000.00 401. Contract sales price 81 000.00 102. Personal PrDoertv 402. Personal ProDerty 103 Settlement charaes to borrower (line 1400) 1 522.78 403. 104. 404. 105 405 Adiustments for items paid bY seller in advance Adiustments for items paid by seller in advance 107 Countv taxes 08/10/05 to 12/31105 87.55 407. County taxes 08/10/05 to 12/31/05 87.55 108. School Taxes 08/10105 to 06130106 771.10 408. School Taxes 08/10105 to 06/30/06 771.10 109 Assn Dues 08/10/05 to 08/31/05 57.86 409 Assn Dues 08/1 0105 to 08/31 105 57.86 110. Roof Asssesmenl 08/10/05 to 08/31105 14.46 410. Roof Asssesment 08/10/05 to 08/31/05 14.46 111. 411 112 412. 120. GROSS AMOUNT DUE FROM BORROWER 83 453.75 420. GROSS AMOUNT DUE TO SELLER 81 930.97 200. 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 DeDOsit (see instructiDns) 202. Principal amount of new loans 502. Selllement charaes to setler (line 14001 5 935.59 203 Exislina loanls) taken sublect tD 503 Existina loanisl taken subject to 204 504. Payoff of First MDrtoaae Loan 27410.72 Members First Federal Credit 205 505. 206. 506 207. 507. 208. 508. 209. 509. Adiustments for items unpaid bv seller Adiustments for items unpaid bv seller 213. 513. 214. 514. 215 515 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 1 000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 33 346.31 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301 GrDss amount due from borrower (line 1201 83 453.75 601. Gross amount due to seller (line 420) 81 930.97 302 Less amounts paid bylfor borrower (line 220\ 1 000.00 602. Less reduction amount due seller (line 520) 33.346.31 303. CASH FROM BORROWER 82453.75 603. CASH TO SELLER 48 584.66 SUS::::TITUTE FORM 1099 SELlER STATEMENT The information contained herein is imoortan\ lall information and is being furnished \0 the Internal Revenue Service If you are reqUired to file a return a negligence penalty or other sanction will be Imposed on you if thiS item is required to be reported and the IRS delermines thai il has not been repOr1ed The Contract Sales Price described on hlle 401 above conslltutes the Gross Proceeds of thiS transaction SELLER INSTRUCT IONS Illhis real estate was your prinCipal residence, rile Form 2119, Sale or Exchange of Prlncipa! Residence, ror any gain With your Income lax return, for other transactions complele the applicable parts of Form 4797, Form 6252 and/or Schedule D (Form1040) ~~;::,~:, r;~~ady bJ'el~~b~~~r~oVi~ill~~ ~~~I~~le~~~~I~~~ (;;;gos~a; ~~ I~~, Under penalties of pe;J~~~ t~~;li~~~~ea~' t~:~~~~~~~~l~~l~~ t~~~~~~~l~tUisd~l~~~;~~I~::pOa~e~j~~;I;f\~~~~~~g~~~icalion TIN SELLeR(S) SIGNATURE(S) SELLER(S} NEW MAILING ADDRESS \ I L'S DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SEtTLEM~ 5T A TEMENT File Number: ST2005-82 TI E S PAGE Z FINAL L. SETTfEMENT CHARGES II express elllement Svslem Printed 08/09/2005 a112:54 KLL PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on once $81 000,00 /1i) 6.000 = 4 860,00 BORROWER'S SELLER'S Division of commission i1ine700) as tollows FUNDS AT FUNDS AT 701 $ 4 860.00 10 ERA NRT Inc. SETTLEMENT SETTLEMENT 702 $ to 703 Commission oaid at Seltlement 4860.00 704 Transaction Fee to ERA NRT Inc. 125.00 ~JTEMS PAYABLE IN CONNECTION WITH LOAN 80 ,. Loan OriQlnation Fee % 802. Loan Discount % 803 Aooraisal Fee 804. Credi\~ ~Lender's Inspecllon Fee 806 Mortg~t.6QQllcallon Fee 807 Assumption Fee 808 -- ~, ~- 811 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901 Interest From 10 'r<i)$ Idav 902. MortQaQe Insura~ce Premium tor to ~azard Insurance Premium tor to ~-----_. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001 Hazard Insurance 010 @$ Imo 1002. MortQaQe Insurance n~$ Imo 1003 Cltv Property Tax mo. (oJ $ 1010 1004 Counlv Property Tax mo.@$ 18.49 Imo '- ~~hool Taxes mo. (a) $ 72.17 Imo ...1~r~?te AnalysIs Adiustment 1100. TITLE CHARGES 1101 Settlement or closinQ tee 1102 Abstracl or title search 1103 Tille examlnalion 1104 Tille Insurance binder 1105 Document Preparation 1106 Notary Fees 10 Saidis, Shuff, Flower & Lindsay 4.00 1107 Allornev's tees 10 Harold S.lrwin, Ill, Esq. POC Seller .,,-- _~udes above Items No ) 1108 Title Insurance to ACCP, Inc. 670.28 - (Includes above items No ) .'- 1109 Lender's PoliCY --'llO.Owner's PoliCY 81 ,000.00 . 670.28 1111 -- ~-,~_. -- ,J.llL__ -- -..- -.-.- 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201 Recordina Fees Deed $38.50 . Mortnane $ Release $ 38.50 .JlQLc;i!YICounly tax/stamps Deed $810.00 ; MortQaQe $ 810.00 1203. StaleI~xlstamps Deed $810.00 MortqaQe $ 1---_ 810.00 1204 - ---- 1205 -'--" 1300. ADDITIONAL SETTLEMENT CHARGES -.--- 1301 Resale Cert 10 Pheasant Run Condominium Assn 50.00 1302 OvernlQht Payoff to Said is, Shuff, Flower & Lindsay 20.00 1303 Water/Sewer Act #06000670 10 North Middleton Authoritv 70.59 1304 ._~--- 1306 ...J;JQ7__ -- i308, -- c.l~00. TOTAL SETTLEMENT CHARGES ( enter an lines 103 Seelion J and 502 Section K) 1 522.78 5935.59 j HUP CERTIFICATION OF BUYER AND SELLER Il1a\j€ carelu\\y le\l\ew~d the HUO-i Selllemen\ Statement and 10 the best 0' my knowledge and belieL It IS a (rue and accurate statement of all receipts and disbursements made on mV account or by me 111 lhis Ir~_~.sa~1I01l Iluflyr Cfll11fy that I h8_~_'!.'ir.ecep..ed a co~y 01 the HUO.1 Settlement Statement ,., . ') "", -. r'. j-,. ,--<;>./.1 (" \2 '/'> '"::---)L-C.~~-J__:--, ~\"VL\'::\( . ,_,.x:L ~ -Ljt,t.-l-IL-' "J\-. senacrcamOZlc - - ~evlela camClzlC t1~ 1ll' . ............ /( \,. "'_). \ ....\......r-....,., .., WARNING IT IS A CRIME TO KNOWINGL Y MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMilAR FORM PENAL TIES UPON CONVICTION C^H INCLUDE A FINE AND IMPRISONMENT FOR DETAILS SEE llTLE 1 B US CODE SECTION 1001 AND SECTION 1010 The HUD-l Settlemenl Statement WtllCh I halle prepared is a true and accurate aCCOllnt of this transaction I tla'le caused or Will cause the funds to be disbursed In accordance WIth th\~ statement ~ 'l'I..... , I.. ' ~) i (~I C( 8y '/J.~, C JJ.,;VP/I.Il'v 'ilL , J DATE , I EXHIBIT 'c' .,~"/- ,itl~ 104/2005 ..YP,(Ji1!~, Page 1 of 1 Savinc ~ :Bond Info Series IE Bonds Denominatioll Serial Number ~ $)50 ~ ,,' Results # Bonds 2 Total Price $75.00 Total I nterest $335.07 Total Value $410.07 Issue Interest Serial Number Issue Date ~ Denom Price Interest Value Rate 12029205488 07/1976 $50 $37.50 $219.42 $256.92 4.00% - k24381856 12/1982 EE 75 37.50 115.65 153.15 4.00% --- le end Note Description NI Not Issued NE Not Eligible for Payment P5 Includes 3-month interest penalty MA Matured and Not Earning Interest Issue Date YTD In $5.0 Next Final Accrual Matu rity 07/2005 07/2006 06/2005 12/2012 A((~o~\.S CJ1h~~ F\\,<5) ~~ OF MO . Please rate this service. (Please print and/or save this page before submitting your survey) Service Excellent Good Fair Poor Savings Bond Calculator r r r Submit SUNey Reset I E[ , A(CRUill e <0 110 IK>TER\JALS 1/-{-04 (!JE:'!.1 -\ ~ - \ - OS") E: ris SIA1E.~ ntR~ D(')(j \jAlUE at: ~ER GH<S) L B()tv~S ~ ]-S-OS"' http://wwws. publicdebt. treas.gov /BC/SB CPrice r 12.- YJ-oy ~ \5'3 I t5 250, <1 '[ Y 1 O. O~ ,.. 4/25/2005 ~""~''''''_~_~~',",_.'''''_q,_, '""..-..._....._......._=v>>,.,...~"'."'.._..;. -- E~}\\B\" '0' - . ,:-- ..",...,.. Primary Owner: SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established Estate of: IRA T. HORN Date of Death: 03/05/2005 Social Security Number: 188-12-5678 fvlR MEMBERS 1st FEDERAL CREDIT UNION Ira T. Horn Edna M. Horn 258596 -00 01/25/2005 $25.00 $.00 $25.00 None 140918 -00 06/14/1994 $83.84 $.00 $83.84 Ira T. Horn 06/14/1994 258596 -11 01/25/2005 $2,118.55 $.00 $2,118.55 None 140918 -11 03/05/2003 $403.09 $.00 $403.09 Ira T. Horn 03/05/2003 IJBERS 1S~FE"DERAL CREDIT UNION .;r/d< /d)-e.i enise A. Wolfe 1_ Insurance Services Supervisor March 25, 2005 5000 Louise Drive · Po. Box 40 · Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.members1st.org -- EXt-\\B\" 'E' -- , . Car Sales Ho~l\l Esnrn=' . ~U1D S'~U: P~OO~bPS ........----" u The cars were just sitting on Lebo's lot. Larry did not sell them. He called me when someone was interested and I /we sold them. ......... - As executrix, I sold mom and dad's car on Saturday, July 2nd. We went to Sollenberger's Messenger Service to complete the transaction. We sold the car, 1990 Geo Prizm, for $1,000. ........- - - .J TK, Karen and I sold Pam's car on Friday, July 15th. We completed this transaction at Lebo's garage using the notary Larry usually uses. We sold the car, a 1992 Geo Prizm, for $1000. I brought in $1,000 in cash from this sale to your office the following week. . r>\h.. I think it was on either Tuesday the 19th or Wednesday the 20th of July. C. ('d -, ~>>th,-,..) 5}~ (J 1J~). Darlene E. Heberlig I' .. .. EXHIBIT 'F' " . t ". ..__-..._."'" <1._ t. \..'- " SCUDDER INVESTMENTS Scudder Distributors, Inc. 222 So. Riverside Plaza Chicago, IL 60606-5808 Phone. 1-800-(,21-1048 www.scudder.com March 29, 2005 Irwin Law Office Attention: Harold S. Irwin, III 64 South Pitt Street Carlisle, P A 17013 Dear Mr. Irwin: I am writing in response to your recent letter regarding Scudder Strategic Income Fund-A IRA Rollover, account number 89691193. Please extend my condolences to Darlene E. Heberlig for the passing oflra T. Horn. Since March 5, 2005 was not a business day, I have listed below the value of the account on March 4, 2005 and March 7, 2005. Account 89691193 Scudder Strategic Income Fund-A SCUDDER TRUST COMPANY CUST IRA RIO IRA THORN March 4, 2005 Share Price Share Amount $4.89 2,985.638 Dollar Value $14,599.77 March 7, 2005 L:. Share Price Share Amount Dollar Value $4.90 2,985.638 $14,629.63 Regrettably, we are unable to redeem the account with the documentation you have provided. I have provided below the beneficiary information listed on the account. Primary Beneficiary Name Relationship Edna M. Horn Spouse Allocation 100% The account does not list a secondary beneficiary. ....,.....'"""""'<'''''-',_.~,.,..,..-....-'''_. \ . REGISTER OF WILLS CUMBERLAND COUNTY INVENTORY Estate of IRA T. HORN also known as , Deceased No.21 05 0235 Date of Death 3/5/2005 Social Security No. 188-12-5678 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 the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INJe verify that the statements made in this inventory are true and correct. INJe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relati g to nsworn falsification to authorities. Name of Attorney: HAROLD S. IRWIN III J.D. No.: 29920 Address: 64 SOUTH PITT STREET CARLISLE PA 17013 Telephone: 717-243-6090 Description CONDOMINIUM UNIT H112, 1416 BRADLEY DRIVE, CARLISLE, PA Value based on sale price U.S. SAVINGS BONDS MEMBERS FIRST FEDERAL CREDIT UNION Savings Account No. 258596-00 MEMBERS FIRST FEDERAL CREDIT UNION Savings Account No. 140918-00 MEMBERS FIRST FEDERAL CREDIT UNION Checking Account No. 258596-11 MEMBERS FIRST FEDERAL CREDIT UNION Checking Account No. 140918-11 (Attach Additional Sheets if necessary) Personal Representative: DARLENE E. HEBERLlG ~~ r. '1-tLy Dated SEPTEMBER 16, 2005 Value 81,000.00 410.07 --) f....~ :::; 25.00 c_;-" ~'rJ I --~ 'OJ "1 ,-"""', ,~--< - .--1 tJ~ ['l...) 83.84 j:"i::l o .J ":.::7 C) " '"I -n ~ 118.5$('3 _. "". III t'_n CJ1 :' t"") . II 403.09 Total 102,657.91 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW,4 II Continuation of Inventory . IRA T. HORN 21 05 0235 Paqe 1 Description of Inventory Description Value 1990 GEO PRISM Value based on sale price 1,000.00 MISCELLANEOUS HOUSEHOLD CONTENTS 1,500.00 SCUDDER INVESTMENT ACCOUNT Account No. 89691193 14,629.63 PRORATIONS FROM BUYER OF REAL ESTATE Taxes and Association Dues 930.97 SOCIAL SECURITY DEATH BENEFIT Due for spouse EDNA HORN, but received after death of decedent 255;00 UNITED AMERICAN INSURANCE COMPANY Refund of Unused Car Insurance Premium 247.20 GRUNER & JAHR USA PUBLISHING Subscription Refunds 54.56 Subtotal $ 18,617.36 102,657.91 Grand Total $ II COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRIS8URG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005816 IRWIN HAROLD Sill 64 SOUTH PITT STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER n______ fold ---------- -------- 101 I $2,546.55 ESTATE INFORMATION: SSN: 188-12-5678 I FILE NUMBER: 2105-0235 I DECEDENT NAME: HORN IRA T I DATE OF PAYMENT: 09/20/2005 I POSTMARK DATE: 09/20/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: 03/05/2005 I I TOT AL AMOUNT PAID: $2,546.55 REMARKS: CHECK# 09876 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS