HomeMy WebLinkAbout09-16-05 (2)
REV-1500EX(6.(lO)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COUNTY CODE YEAR
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REV-1500
FILE NUMBER
21 05
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Long, Frankie E.
---------------.------ ------
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
01/05/200~~__ _~3/1920
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
I SOCIAL SECURITY NUMBER
--t 578-32-1260
, THIS RETURN MUST BE FILED IN DU L1CATE WITH THE
I REGISTER OF W LLS
------tsOcIAL SECURITY NUMBER
I
~ 1. anginal Return
o 4. Limited Estate
o 6. Decedent Died Testale (Attach copy 01 willi
o 9. Litigation Proceeds Received
o 2. Supplemental Return
D 4a. Future Interest Compromise (date of death afler 12.12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofT~S1)
o 10. Spousal Poverty Credit (dale 01 death between 12-31-91 aod 1-1-95)
D 3. Remainder Return (daleofdeat prior to 12-13-82)
o 5. Federal Estate Tax Return R quired
J.- 8. Total Number of Safe Depesi Boxes
o 11. Election to tax under Sec. 9 13(A) (Attach Sch 0)
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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
Z (Schedule E)
0 6. Jointly Owned Property (Schedule F)
~ o Separate Billing Requested
...J 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
~ (Schedule G or L)
~ 8. Total Gross Assets (totat Lines 1-7)
U 9. Funeral Expenses & Administrative Costs (Schedule H)
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0:: 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)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(1)
(2)
(3)
(4)
(5)
134,624.25
91,263.58
(6)
(7)
220,175.90
(9)
(10)
(8)
39,943.66
1,106.09
(11)
(12)
(13)
41,049.75
05,013.98
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
x .0
(15)
(16)
(17)
18,225.63
405~QJ:'L98 x.O 4!:i
x .12
x .15
(18)
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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
(19)
18225.63
pt.
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Decedent's Complete Address:
STREET ADDRESS
--- ---~ --. -
816 Linwood Street ------ -----.. ---------~------- --
f-,------..
CITY New Cumberland I STATE I ZIP
PA 17070
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 18,225.63
2. Credits/Payments
A. Spousal Poverty Credit ------- -------
B. Prior Payments --------"
C. Discount
Total Credits ( A + B + C ) (2)
3. InterestJPenalty if applicable
D Interest .. ----
E. Penalty
TotallnterestJPenalty ( 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) 18,225.63
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BlO( KS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... D [K]
b. retain the right to designate who shall use the property transferred or its income; ............................................ D [K]
c. retain a reversionary interest; or....................................,..................................................................................... D [K]
d. receive the promise for life of either payments, benefits or care? ..............................................,....................... D [K]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D [K]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............. D [K]
4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which
contains a beneficiary designation? ............................. ............................... ...... ... ............................... ................. [K] D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF "HE RETURN.
Under penanies of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and 10 the best of my knowledge and belief, it is true, correct and complete.
DecJaralion of preparer o'ttmunan the personal representative is baseQ. on all information of which preparer has any knowledge.
SIGNATURE e.RSON R!NSIBLE F~R FiLl~R~/ DATE !r
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ADDRESS ."'".. .' !
Suzann R. Micha~)10 W. Custis Avenue, Alexandria, VA 22301
SIGyt OF..PREPARER Oi~tZtEPRESENTATIVE OAT;;: los
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ADDRESS
Saidis, Shuff, Flower & Lindsay, 2109 Market Street, Camp Hill, PA 17011
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 spou~ e is3%
[72 PS. ~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 use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)l.
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are sti I applicable even if
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 younger at death to or for the use of a natural parent, n adoptive parent,
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 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. 9116(a)(1)].
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. ~9116(a)(13)]. A sibling is defined, under ~ ection 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
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REV-1502 EX+ (6.9. SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FRANKIE E LONG 21-05-0030
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 prope y would be
exchanged between a willing buyer and a wiiling seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant lac s.
Real property which is Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT[ ATE
NUMBER DESCRIPTION OF DEA H
1. House and lot at 816 Linwood St., New Cumberland, sale proceeds (HUD 1 attached) 13 ,624.25
I
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TOTAL (Also enter on iine 1, Recapitulation) $ 1~ 4,624.25
(If more space is needed, insert additional sheets of the same size)
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REV.15G8 EX+ (6-98) . SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FRANKIE E. LONG 21-05-00< 0
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 VALUE A DATE
NUMBER DESCRIPTION OF DE ATH
1 Household goods, net auction proceeds 2,998.46
2 Wachovia Bank, c1d #247423060999603, principal $18,178.81 plus accrued interest $266.68 18,445.49
3 Wachovia checking #1000324352624, principal $13,307.11 plus accrued interest $0.56 13,307.67
4 Wachovia checking #10100098400414, principal $4,814.41 plus accrued interest $0.49 4,814.90
5 Evergreen Investments, mutual fund Blue Chip - A, 617.125 shares at $24.72 ~
15,255.33
6 LeggMason cash account #363-004433 21,484.92
7 LeggMason stock account #363-004433 8,653.43
8 Metlife stock, 55 shares at $39.95 2,197.25
9 Metlife Total Control Account #404-0596103 4,106.13
..
TOTAL (Also enter on line 5, Recapitulation) $ , 1,263.58
(If more space is needed, insert additional sheets of the same size)
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REV-1510 EX+ (6.98)
*' SCHEDULE G
COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS &
INHERITANCE TAX RETURN MISe. NON-PROBATE PROPERTY
RESIDENT OECEDENT
ESTATE OF FILE NUME ER
FRANKIE E. LONG 21-05-00 30
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 DECEDENI AND DATE OF DEATH % OF DECD'S EXCLUSION AXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. ING annuity contract#1093591-AP, paid to decedent's son and daughter after 179,615.30 10D 179,615.30
the date of death.
!
2. Transamerica annuity contract #268591 98, paid to decedent's son and 40,56060 100 40,560.60
daughter after the date of death.
TOTAL (Also enter on line 7 Recapitulation) $ 2 0,175.90
(If more space is needed. insert additional sheets of the same size)
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REV-1511 EX+ (12'99)* SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FRANKIE E. LONG 21-05-0030
Debts of decedent must be reported on Schedule I.
ITEM AMOL
NUMBER DESCRIPTION NT
A. FUNERAL EXPENSES:
1. Parthemore Funeral Home, traditional service 4,959.00
2 steel casket 2,850.00
I
3 Obituary notice 140.00 !
4 death certificates 18.00
5 hairdresser and fiowers 195.00
6 Clergy and Organist Honoraria 200.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions 2,000.00
Name of Personal Representative(s) Suzann R Michael
Social Security Nurnber(s)/EIN Number of Personal Representative(s)
-
Street Address 10 W. Custis Ave.
City Alexandria State VA Zip 22301
Year(s) Commission Paid: 2005
2. Attorney Fees 5,151.59
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 535.00
5. Accountant's Fees
6_ Tax Return Preparer's Fees
7. publish estate notices, Patriot & Cumbo Law Journal 344.34
8. Leffler Energy, heating fuel for Feburary and March 638.10
9. Erie Insurance, property insurance 355.00
10. Painting, repairs, lawn maintenance and cleaning, 816 Linwood SI., prior to sale 1,945.00
11. County real estate taxes, 2005 (less prorated amount repaid at settlement) 379.79
12. Utilities for first three months following date of death, PPL-49.74, UGI-80.48, water-37.82, trash-64.80 232.84
TOTAL (Also enter on line 9, Recapitulation) $ 39,943.66
(If more space is needed, insert additional sheets of the same size)
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REV-1512 EX_ (12-03)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
REStDENT DECEDENT
ESTATE OF
FRANKIE E. LONG
FILE NUMBE
21-05-0030
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreirnbursed medical expense .
ITEM VALUE A DATE
NUMBER DESCRIPTION OF DE TH
1.
Verizon, phone bill
2.
Leffler Energy, fuel oil
3.
PPL, electric bill
4.
Don Haines, repair man's bill for lifetime services
5.
West Shore EMS, ambulance service
6.
Aves, Weisleder, Katz, dental bill
7.
Comeast, TV cable
8.
PA Dept of Revenue, personal income tax
9.
Medco Health Solutions, unreimbursed medical expense
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
57.07
603.70
28.89
105.00
91.89
39.00
84.62
33.31
62.61
1,106.09
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REV-1513 EX+ (9'()O)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FRANKIE E. LONG 21-05-0030
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTPE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1 Robert S. Long, 3728 E. Marcus Dr., Saginaw, MI 48603 son 0.50
2 Suzann L. Michael, 10 W. Custis Ave., Alexandria, VA 22301 daughter 0.50
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHE ET
II NON.TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- 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)
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LAST WILL AND TESTAMENT
OF
FRANKIE E. LONG
I, FRANKIE E. LONG, of New Cumberland, Cumberland County, Pennsylvania, teing
of sound and disposing mind, memory, and understanding, do hereby make, publish and de lare
this as and for my Last Will and Testament, hereby revoking all other Wills and Coe icils
heretofore made by me.
ITEM 1: I direct the payment of my debts and expenses of my last illness and funeral fror[1 my
estate as soon after my death as conveniently may he done. If there be no cemetery lot avai able
for my interment owned by me at the time of my death, I authorize my personal representa ives
to purchase such cemetery lot with a contract for perpetual care, using therefor funds fron my
estate in such amount as they shall consider necessary and desirable, and I authorize my pen onal
representatives to cause title to or ownership of such lot so purchased to be vested in such pe rson
as my personal representatives shall designate.
Further, I authorize my personal representatives to expend funds from my estate, in uch
amount as my personal representatives shall consider necessary and desirable, for the purcl ase,
erection and inscription of a suitable marker for my grave.
Rupp & Meikle
355 North 21" Street, Suite 205
Camp Hill, PA 17011
717-761-3459
Page 1 Df 3
Initials 3(,;/
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ITEM II:
I give, devise and bequeath all the rest, residue and remainder of my estate, real,
personal, and mixed, in eq1ta1 shares to my children ROBERT S. LONG and SUZANN R. LOrG
MICHAEL, per stirpes.
ITEM III: I specifically direct that my step-daughter, CAROLYN LONG HESSER, sha1l o.ot
receive anything whatsoever from my estate.
ITEM IV:
I appoint my daughter-in-law, SHARON L. LONG, to act as guardian of the
property received by any minor beneficiary under this instrument.
ITEM V:
I direct that any and all inheritance, estate and transfer taxes imposed upon my
estate passing under this Will or otherwise shall be paid out of the principal of my residuary est te.
ITEM IV: In addition to the powers conferred by law, I authorize any personal representa ive
acting under this instrument, in his or her absolute discretion:
(a) to retain in the form received, or to sell either at public or
private sale any real or personal property;
(b) to manage real estate;
(c) to invest and reinvest in all forms of property without being
confined to legal investments and without regard to the
principle of diversification;
Page 2. cf 3
Initials .3 {/'
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(d) to exercise any option or rights arising from ownership or
investment.
ITEM VI:
I do hereby nominate, constitute and appoint my daughter, SUZANN R. L G
MICHAEL, and my son, ROBERT S. LONG, to act as Executors of this my Last Will and
Testament. In the event that either is unwilling or unable to serve, I direct that the dutie of
Executor be performed by the other of them.
I direct that no personal representative appointed under this instrument shall be requ 'ed
to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I, FRANKIE E. LONG, have hereunto set my hand and eal
to this my Last Will and Testament, consisting of three typewritten pages, the fIrst two of w ich
'I
bear my initials in the margin for identification, this ';/j~ay of October, 1999.
/:t' ,J.. (? -<7J...b.'/
:; /t.t:t/)l/r~ l:.. 17' ~
FRANKIE E. LONG
(SE )
Witnesses:
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residing at
C}A<+< r:;I~.l... ,",iding at
Page 3 f 3
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A. Settlement Statement u.s. [ epartrnent of Housino
I and U ban Development ~
, 1r
OMS No. 2502-0265
B Type of Loan
1. DFHA 2. o FmHA 3. ~ Conv. Unins File Number Loan Number Mortgage Ins urance Case Number
27309 - P 875944
4. OVA 5. 0 Conv. Ins.
C. NOTE:This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are s hown.
Items marked "p.o.c" were paid outside of closing; they are shown here for informational purposes and are not included in th e totals.
D. NAME AND ADDRESS OF BORROWER: LISA J. WA YNE
103 OLD FORD DRIVE, CAMP HILL, PA 17011
E. NAME AND ADDRESS OF SELLER: SAMUEL S. LONG FRANKIE E. LONG
816 LINWOOD STREET, NEW CUMBERLAND, PA 816 LINWOOD STREET, NEW CUMBERLAND,
17070 PA 17070
F. NAME AND ADDRESS OF LENDER: TA YLOR, BEAN & WHITAKER MORTGAGE CORP.
1417 NORTH MAGNOLIA AVENUE, OCALA, FL 34475
G. PROPERTY 816 LINWOOD STREET
LOCATION: NEW CUMBERLAND, PA 17070
H. SETTLEMENT AGENT: CEDAR CLIFF ABSTRACT AGENCY, INC.
PLACE OF SETTLEMENT:
TIN: 23.2133165
I. SETTLEMENT DATE: 08/30/2005 RESCISSION DATE:
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SEI..LER'S TRAN 5ACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price $144 900.00 401. Contract Sales Price $144,900.00
102. Personal Property 402. Personal property
103. Settlements charges to borrower: 403.
(from line 1400) $4,333.79
104. 404.
105. 405.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN I DVANCE:
106. City/town taxes to 406. City/town Taxes to
107. County Taxes 08/30/2005 to 12/31/2005 $195.92 407. County Taxes 08/30/2005 to 12/31/2 05 $195.92
108. Assessments 08/30/2005 to 06/30/2006 $957.70 408. Assessments 08/30/2005 to 06/30/2 06 $957.70
109. REFUSE - 08/31/05 - 09/30/05 $12.98 409. REFUSE - 08/31/05 - 09/30/05 $12.98
110. 410.
111. 411.
112 412.
120. GROSS AMOUNT DUE FROM BORROWER: $150,400.39 420. GROSS AMOUNT DUE TO SELLER: $146,066.6C
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201 Deposit or earnest money $2,000.00 501. Excess deposit (see Instructions)
202. Principal amount of new loan(s) $115,900.00 502. Settlement charges to seller (line 1400) $11,425.27
. HUD.1 (R~v. 3/86) OMS No. 2502.0265
L: SETTLEMENT CHARGES
700. TOTAL SALES/BROKER'S COMMISSION PAID FRCM PAID FROM
BASED ON PRICE $144,900.00 @ % = $8,279.00 BORROWE R'S SELLER'S
FUNDS FUNDS
DIVISION OF COMMISSION (LINE 700) AS FOLLOWS: AT AT
701 $3,907.00 to THE HOMESTEAD GROUP SETTLEM NT SETTLEMEN'
702 $4,372.00 to HOWARD HANNA DETWEILER REALTY
763 $0.00 to
704. $0.00 to
705. Commission paid at settlement $8,279.0
706.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN:
801. Loan origination fee % to TAYLOR, BEAN & WHITAKER MORTGAGE
802. Loan discount % fo TAYLOR, BEAN & WHITAKER MORTGAGE
803. Appraisal fee to: BENTZ MORTGAGE GROUP $27 .00
804. Credit report to: TAYLOR, BEAN & WHITAKER MORTGAGE CORP.
805. Lender's inspection fee TAYLOR, BEAN & WHITAKER MORTGAGE CORP.
806. Mortgage insurance application fee to TAYLOR.. BEAN & WHITAKER MORTGAGE CORP.
807, Assumption fee TAYLOR, BEAN & WHITAKER MORTGAGE CORP.
808 PAR PREM TO BENTS MTGE GRP - $1,238.97 - POC
809. TBW - TAX SERVICE FEE $7 .00
816. TBW - ADMINISTRATION FEE $51 .00
811
812
813
814
815
816
817
818
819
820
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE:
901. Interest from 08/30/2005 to 09/01/2005 @ $20.24/day $4 n.48
902. Mortgage insurance premium for mas. to
903. Hazard insurance premium for yrs. to TRAVELERS ( $314.00 P.O.C.)
904. Flood insurance premium for yrs. to
90S
1000. RESERVES DEPOSITED WITH LENDER:
1001_ Hazard insurance 3.00 months @ $26. 17 per month $7 8.51
1002. Mortgage insurance months @ per month
1003. City property taxes months @ per month
1004. County property taxes 8.00 months @ $46.96 per month $37 5.68
1005. Annual assessments months @ per month
1006. Flood insurance months @ per month
1007. SCHOOL TAX 2. 00 months @ $94.19 per month $18 8.38
1008 months @ per month
1009. Aggregate Accounting E:;;;crow Adjustment ($308 .01)
1100. TITLE CHARGES:
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siMbS- Seller or
Date: L,I Agent:
SAMU
. I have (A!ilreful~ reviewed the HUD~1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts a
un illY account or by me in this transaction. I further certify that I have received a copy of the HUD-l Settlement Statement.
B~rrower: tf,vil q lUJt{Jl
LISA J. WA YNE
Borrower:
Date:
Seller or
Agent:
FRANKIE E. LONG
Borrower:
Date:
Seller or
Agent:
Borrower:
Date:
Seller or
Agent:
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction.
with this statement.
Date:
Settlement Agen
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form.
rnent. For details see: Titte 18 U.S. Code Section 1001 and Section 1010.
d disbursements made
!irTJ-
Date:
Date:
Date:
ursed in accordance
Date: fr 3..--.1 {
a fine and imprison-
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CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 19/2
2009 LINCOLN STREET. CAMP HILL, PA 1701'
717-761-2763
Public Auction for Estate of Mrs. Samuel "Frankie" Long
Date JLlly 9, 2005
)ujdress 816 Linwood Street, New Cumberland, PA 17070
Auction Gross .................................$ 5,463.00
EXPENSES
Shoppers Guide )ujv. & Sale Bills ..............$
Pa triot News )ujv. .............................
Paxton Herald )ujv. ............................
Other )ujv. ....................................
Other )ujv. ....................................
Other )ujv.
.. . .. .. .. .. ........ . .............. .. .... ........ .... .... . ....
Sign for Property.. . . . . . . . . . . . . . . . . . . . . . . . . . . .
State Fumigation Tags.. .......................
Registration Numbers..... ........ .............
Tent/Tarp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Misc. Expenses. Tr.ash. bauUt1Q. . . . . . . . . . . . . . . . . . . .
4 Clerks at $ 70.00 each
.. . .. .. .. .. .. ... . ........
4 Runners at $ 70.00 each ...............
Labor Sale preparation . . .
Labor
Labor
Labor
Personal Items Fee at 10
Total Expenses for Auction
% . .. ... .. ..........
........ ..... .. ........ ............ .... ..
Real Estate Gross
.... .... ........ .......... ...... .. .. ...... ................
Real Estate Fee at % (Due at Settlement) .
269.15
44.94
118.15
25.00
10.00
10.00
135.00
280.00
280.00
746.00
546.30
. $ 2 464.~4
$ 5.463.00
- 2 . 464 . 54
2.998.46
- 3.636.00
637.54
Auction Gross
Expenses
Net
\,1) ,\~ ,Q/LVu ('A"". '
Auctio~e~ or ca~ier:
Checks
Owed to~ Auctioneer
Approved by:
..
_":4~,
--/'~-
W-\.CHOVIA
Reference ID: 112857
WachovJa Bank N.A.
Balance Contlrmation Services
POBox 40028
Roanoke, V A 24022-7313
February 2, 2005
SAIDIS SHUFF FLOWER & LINDSAY
ATTN: THOMAS E FLOWER
2109 MARKET STREET
CAMP HILL, PA 17011
SUBJECT: Verification / Confirmation of Account and Balance Information provided for:
Customer: FRANKIE E LONG (SSN# 578-32-1260)
Date of Death: January 5, 2005
Deposit Account Information
Account Account Date of Death Average Date Maturity Interest Accrued "TD Date
Type Number Balance Balance*' Opened Date Rate Interest Inter sl Paid Closed
CERTIFICATE OF DEPOSlT 247412060999603 $18,178.81 12/16/1999 3/16/2006 $266.68 $ .00
LEGAL TlTLE FRANKJE E. LONG
CHECKtNG
1000324352624
$13,370.11
9/11/1989
$0.56
$ .00
1.EGAL TITLE: FRANKIE E LONG
FORW ARDED YOUR REQUEST !'OR CLOSING TO OUR
CORRESPONDENCE TEAM
CHECKING
1010009840014
$4,814.41
12/18/2001
$0.49
$ .00
LEGAL TITLE FRANKJE E LONG
* Due to system limitations, we can only provide a twelve month average balance on depository accounts.
Revolvine: Credit Information
Account
Type
Account
Number
Date of Death
Balance
Credtt
Limit
Date
Opened
Dale
Closed
Times Legal Title
Late
EQUITY LINE
4386542211576605
$0.00
8/1012002
FRANK1E E. LON,
Other Account Information
Account
Type
Account
Number
Date of Balance
Date
Opened
Date
Closed
Ledger
Collected
ANNUITY
LEGAL TITLE: FRANKJE E LONG
TRANSAMERlCA - For infonnation regarding annuities, please call 800-258-4260
TAFSI26859198
2/16/2000
0000 000614
. ~
.'
LF.GG
MASON
Legg Mason Wood Walker, Incorporated
214 Senate Avenue, 7th Floor, P.O. Box 8853, Camp Hill, PA 17001.8853
717.737 - 6500 800.433.8186 Fax; 717 - 737 -0800
Member New York Stock Exchange, Inc/Member SJPC
March 30, 2005
Thomas E. Flower, Esq.
Saidis, Shuff, Flower & Lindsay
2109 Market Street
Camp Hill, P A 17011
Re: Date of Death Balances for Account # 363-04433/ Frankie Long
Dear Mr. Flower,
This letter is in response to your written request from March 21,2005 regarding date 0
death balances for the account of Frankic E. Long, held with our firm:
1.) Title/registration of account - Frankie E. Long
2.) Account # 363-04433
3.) Balance as ofJanuary 5, 2005
a.) 107 shares American Electric Power Co Inc.
b.) 500 shares Dreyfus Municipal Income Inc.
c.) 617.125 shares Evergreen Blue Chip Fund A
d.) 19,177 .190 Legg Mason Cash Reserve Trust
e.) Cash
f.) ING Annuity Contract #I093591-AP
$3,583.43
$5,070.00
$15,255.33
$19,177.19
$2,307.73
$179,615.30
4.) Date the account was established - September 21, 1987
5.) Any indication that a jointly owned account which was established less than thr e
years prior to the date of death was a rollover of another account formerly held with Le g
Mason - Not applicable
If any additional information is needed, please call me at 717-737-6500 ext. 2251.
~incerely,
\',.) /")fA I) Ii "
. .~ (;2,v\/v}4V-.
jU- c-ceL
Tricia Mankoski
Marketing Associate
1~
a. ; TRANSAMERICA
..LIFE AND ANNUITY
Transamerica Life nsurance and
Annuity Compa y
Home Office:
Charlotte, North arolina
Administrative Off ceo
4333 Edgewood R ad NE
PO Box 3183
Cedar Rapids, low 52406-3183
March 5, 2005
Thomas E Flower
2109 Market Street
Camp Hill PA 17011
RE: Annuity Number(s) 26859198
Dear Thomas E Flower:
Our office has received your request concerning the above liste non-
qualified tax deferred annuity.
The taxable portion of this policy will be reported on a Form
as taxable to the beneficiary upon receipt of the funds. The
of 01/05/2005, is $40,560.60.
This annuity was paid out in a death claim to the named benefic'aries
on March 1, 2005.
Any additional questions regarding this annuity can be directed to the
Annuity Service Center at 1-800-553-5957. A Transamerica Life
Insurance and Annuity Company representative will gladly assist you
with any questions you may have regarding this annuity and help you
meet your financial goals.
Sincerely,
Uutlt elLlit]
Carrie Allen
Claims
Transamerica Life Insurance and Annuity Company
Member of the _EGON. Group
.
Evergreen Service Company, LLC
Post Office Box 8400
Boston, MA 02266-8400
. .
.
Evergreen Investments'"
March 29, 2005
Saidis, Shuff, Flower & Lindsay
Attn: Thomas E. Flower
2109 Market Street
Camp Hill PA 17011
RE: Corr #: 01006739
Blue Chip-A
#0000649-01002472521
Frankie E. Long
Dear Mr. Flower:
We are writing in regard to the enclosed letter we received requesting to forward
information to you regarding the above account.
The above account is a mutual fund account and it is registered exactly as shown above
and no dividends or capital gains have been paid on the account in 2004 or 2005.
Also, in response to the request for the account valuation, we wish to inform you that 0
January 5, 2005, the total number of shares in the account was 617.125. The net asse
value per share was $24.72. The total dollar value for the account on that date wa
$15,255.33.
If you have any questions, please call us on our toll-free number, 1-800-343-2898. Ou
Client Service Representatives are available 8:00 a.m. to 6:00 p.m. Eastern time an
will be happy to assist you.
Carol Traill
Service Representative
Enc1osure(s): Photocopy of Original Documentation
A ..
..
Mellon Investor Services
P.O. Box 3333
South Hackensack, NJ 07606
February 7,20.0.5
~ Mnllon
Saidis, Shuff, Flower & Lindsay
Thomas E. Flower
2109 Market Street
Camp Hill, P A 170. 11
l~;~~~_l ~~TLIFE, INC.
IACCO. unt Key I LONG-----
L ,. _.~ FRA?~_ODOO
IInv~st~r _~ #..J ?D6?2,?43.2?45 !
Control 2DD5D2D3DD061:ns
Number
Dear Mr. Flower:
Thank you for contacting Mellon Investor Services regarding the above referenced MetLife, Inc
common stock account.
A review of our records indicate that on 040.7/00 FRANKIE E LONG was allocated 55 shares iI the
form of Met Life, Inc. common stock. The stock is being held in the Policyholder Trust, which" as
established at the time of the Initial Public Offering (IPO). The IPO occurred on April 5, 20.0.0.. The
value of the stock was initially determined by the lPO, and subsequently depends on the market value of
MetLife, Inc. stock. MetLife is listed on the New York Stock Exchange and trades under the tic ker
symbol "MET."
The closing market price as of 0.2/0.4/0.5 was $40..52 per share. MetLife, Inc. currently pays a aIll~ual
dividend. The dividend issued in 20.0.4 was paid at a rate of$o..46 per share.
The closing market price as of 0.1/05/0.5 was $39.65 per share.
If you have any additional questions or concerns, please call our Customer Service Center at l-l 0.0.-649-
3593. You may also access your MetLife, Inc. common stock account on the Internet at
https://vault.melloninvestor.com/isd.
Sincerely,
Fina Reyes
Mellon Investor Services
/
_.0<:' "'"
0~~~. -?'
c~ ~~~~
f~:~ /7
>0l .--.,\:;- ,0
-...Y/I/
- '- ~
a.-.:: 'If> ----.J ~
-. ~\ '
Total Contr~l Account@
Account No. 404-0596103
Statement Period From 1/01/05
Page 1 of 1
AH-156167-TCA1 PB16
FRANKIE E LONG
816 LINWOOD ST
NEW CUMBERLAND PA 17070-1442
Your Representative: WALN GERALD L
Branch servicing
you r accou nt:
CENTRAL PENN FI GP
4550 LENA DR S-101
MECHANICSBURG
(717) 691-5900
(800) 638-7283
Telephone:
Customer Service:
As noted in the Total Control Account fTCA) Custumer Agreement, ONLY insurance proceeds payabl-
under policies and contracts issued by the same Company that established your TCA can be added t the
account. For other funds, you may want to consider our affiliate, MetLife Bank, NA, which offers mo ey
market accounts and CDs at competitive interest rates. For more information, call MetLife Bank, at
1-800-753-6802 and mention code NPD1.
TeA MONEY MARKET OPTION (MMO)
Effective Annual Yield 3.00% as of 01131105
Account Summary
$4,106.13
$10.23
$4,116.36
$10.23
$145.29
Interest
rransaction Details
131
(S-
Interest
$10.23
I~ Ijl'UI"'I~{~r~lm
PA 17055