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Home My WebLink About10-07-05 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX( 11-96) . DEPARTMENT OF REVENUE , BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005871 PNC BANK N.A. 4242 CARLISLE PI KE CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER __nnn fold ---------- -------- 101 I $1,639.18 ESTATE INFORMATION: SSN: 172-01-6564 I FILE NUMBER: 2105-0082 I DECEDENT NAME: MARTZ MIRIAM M I DATE OF PAYMENT: 10/07/2005 I POSTMARK DATE: 10/07/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: 01/16/2005 I TOTAL AMOUNT PAID: $1,639.18 REMARKS: PNC CHECK# 455786 INITIALS: CMM SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS r .' o PNCBAN< ESTATE OF MIRIAM M MARTZ ALSO KNOWN AS MIRIAM MARTZ DECEASED (DIED 01/16/05) LATE OF THE BOROUGH OF LEMOYNE CUMBERLAND COUNTY PA WILL NO 21-2005-0082 --) INVENTORY :<J COMMONWEALTH OF PENNSYLVANIA f'-J SS COUNTY OF CUMBERLAND LINDA J LUNDBERG ASSISTANT VICE PRESIDENT OF PNC BANK, NATIONAL ASSOCIATION, EXECUTOR OF THE ESTATE OF MIRIAM M MARTZ ALSO KNOWN AS MIRIAM MARTZ DECEASED HAVING BEEN DULY AFFIRMED ACCORDING TO LAW DID DEPOSE AND SAY THAT THE ITEMS APPEARING IN THE FOLLOWING INVENTORY ARE PERSONAL ASSETS WHEREVER SITUATE AND REAL ESTATE IF ANY 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 THE DECEDENT OWNED NO REAL ESTATE OUTSIDE THE COMMONWEALTH OF PENNSYLVANIA EXCEPT THAT WHICH APPEARS IN A MEMORANDUM AT THE END OF THIS INVENTORY AFFIRMED AND SUBSCRIBED BEFORE ME "~ i( r: _~ THIS d 7" DAY OF(~ 20~ : ~~.- &- - 1 - r", L_J :':~.J C~-., ::(J I'll C') (~;?, :".J ,", 1 "' '-:':J '-.;~ -n . (c") '1"/ ":) I --1 TRSNOI (10/02) C' L~l\lI\ {/~ l' PNC ADVISORS MIRIAM M MARTZ REAL ESTATE 236 WALTON ST LEMOYNE PA PROCEEDS ON SALE VACANT LOT #414 ADJOINING 512 WARREN ST LEMOYNE PA PROCEEDS ON SALE 512 WARREN STREET LEMOYNE PA MISCELLANEOUS S THOMAS HOWER JR SALES AGMT 745-747 HUMMEL AVENUE LEMOYNE PA CASH PNC BANK NATIONAL ASSOCIATION CHECKING ACCOUNT #5140129059 DATE OF DEATH BALANCE 9,234.86 INTEREST TO 01/16/05 .48 GE CAPITAL ASSURANCE CO REFUND LONG TERM HEALTH CARE INSURANCE STATE FARM MUTUAL AUTO INSURANCE CO REFUND AUTOMOBILE INSURANCE PNC BANK NATIONAL ASSOCIATION SAVINGS ACCOUNT #5080169721 DATE OF DEATH BALANCE 15,015.40 INTEREST TO 01/16/05 1.96 STATE AUTO INSURANCE CO REFUND HOMEOWNERS INSURANCE NATIONAL GEOGRAPHIC SOCIETY REFUND CASH FOUND IN DECEDENTS HOME COMMONWEALTH OF PENNA RETIREMENT BENEFIT GROSS PROCEEDS OF SALE OF PERSONAL PROPERTY PENNA DEPARTMENT OF REVENUE 2004 INDIVIDUAL INCOME TAX REFUND - 2 - - o PNCBAN< 27-27-004-3664162 70,000.00 39,000.00 116,000.00 26,745.54 9,235.34 298.32 33.18 15,017.36 170.00 22.67 .49 397.19 2,663.00 4.00 TASN02flO/02> i MIRIAM M MARTZ CONTINUED: CASH PNC ADVISORS o PNCBAN< 1,750.00 281,337.09 27-27-004-3664162 PROCEEDS ON SALE OF 1989 BUICK LESABRE TOTAL INVENTORY - 3 - ------------ ------------ TRSN02<10/02J o PNC ADV1S0RS PO Box 308 Camp Hill Pa 17001-0308 (717) 730-2265 Toll Free 1-800-846-2265, ext. 2265 October 7, 2005 Register Of Wills Cumberland County Courthouse South Hanover St Carlisle, PA 17013 j I ....,/ Re: Miriam M. Martz Estate, Date of Death 1/16/2005, File #: 21-05-0082 Dear Register Of Wills: f\~) :1 On behalf of the Corporate Executor of the above-referenced Estate, I enclose a check in the amount of $1 ,639.18 for the balance due on account of Pennsylvania Inheritance Tax along with two original completed copies of the tax return. I have also enclosed the final Inventory along with a check in the amount of $30.00 for filing fees. Please note that the estate has Jointly Owned property with the decedent's three daughters. Two of the daughters are listed on Schedule F. For property held with joint tenant "A", Sally Carlisle, the estate will be including the tax due with this estate return. I am enclosing a copy of the notice that Mrs. Carlisle signed and returned to the Commonwealth stating the tax due would be paid with the Pennsylvania Inheritance Tax Return. For property held with joint tenant "B", Barbara L. Crossland, Deceased, please send a separate billing to the estate's attomey: David H. Stone, Esquire, Stone, LaFaver & Shekletski, 414 Bridge St., New Cumberland PA 17070 For property held with joint tenant, Wendy Harper, the State has already billed Mrs. Harper separately and Mrs. Harper has paid the tax due as evidenced by the enclosed receipt #CD005651 dated August 4, 2005. Thank you for your assistance. S.ince. rely, _.~. 1\ "J" , ~~~.~~ Linda J. Lundberg <.~ Estate Administrator Assistant Vice President Enclosures A member of The PNC Financial Services Group 4242 Carlisle Pike Camp Hill Pennsylvania 17011 Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: PNC ADVISORS PO BOX 308 CAMP HILL, P A 170010308 Qty 1 Fee Description Additional Probate Total Fee 50.00 $50.00 Total: $50.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. 575 10/7 /2005 MIRIAM MARTZ 21-05-0082 CMM . REV.1500 EX (6-00) OFFICLt.L USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 05 0082 COUNTY CODE YEAR NU~ER DECEDENTS NAME (LAST, FIRST. AND MIDDLE INITIAL) ~ Martz Miriam ~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) ~ 1/16/2005 4/9/1918 W (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL) C M SOCIAL SECURITY NUMBER 172-01-6564 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w ~ ~~CIl ult:~ wll.U :I:~ Ull.'" 11. <[ 001 04 006 09 Original Retum Limited Estate o 2. Supplemental Retum 0 3. Remainder Retum (date of death prior to 12-13-82) o 4a. Future Interest Compromise (date of death after 12-12-8.2) 0 5. Federal Estate Tax Retum Required o 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 8. Total Number of Safe Deposit Boxes o 10. Spousal Poverty Credit (dale of death between 12-31.91 ard 1+~) 0 11. Election to tax under Sec. 9113(A)(AttachSchO) Decedent Died Testate (Attach copy of Will) Litigation Proceeds Received THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS I- Z W o z o "- Cf) w Ill: Ill: o '-' Linda Lundberg FIRM NAME (If Applicable) PNC Advisors TELEPHONE NUMBER 717-730-2265 P.O. Box 308 Camp Hill, PA 17001-0308 2. Stocks and Bonds (Schedule B) (2) 225,000.00 0.00 i...._l ,- 9FFICIAL US~2iI,JLY 1. Real Estate (Schedule A) (1) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) Z 6. Jointly Owned Property (Schedule F) (6) 0 [!] Separate Billing Requested i= ~ 7. Inter-Vivos Transfers & Miscellaneous Non~Probate Property (7) ::> (Schedule G or L) l- ii: 8. Total Gross Assets (total Lines 1-7) <( (,) W g. Funeral Expenses & Administrative Costs (Schedule H) (9) a: 10. Debts of Decedent, Mortgage Liabililies, & Liens (Schedule I) (10) 11. Total Deductions (total Lines g & 10) 0.00 "- _I 26,745.54 29,591.55 10,007.15 r"',,) 0.00 291,344.24 (8) 41,041.89 2,180.15 (13) 43,222.04 248,122.20 0.00 1 2. Net Value of Estate (Line 8 minus Line 1 1) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (11) (12) 14. Net Value Subjectto Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 248,122.20 15. Amount of Line 14 taxable at the spousal tax 0.00 ~(15) z rate, or transfers under Sec. 9116 (a)(1.2) x .0 0 >= 16. Amount of Line 14 taxable at lineal rate 248,122.20 x .0 ~(16) <[ I- ::> 0.00 11. 17. Amount of Line 14 taxable at sibling rate x .12 (17) :IE 0 0.00 U 18. Amount of Line 14 taxable at collateral rate x .15 (18) x <[ 19 Tax Due ~ (19) 0.00 11,165.50 0.00 0.00 20 D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 11,165.50 > > BE SURE TO ANSWER All QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W4645 1.000 Decedent's Complete Address: STREET ADDRESS 512 Warren St. . Cumberland CITY Lemoyne STAlE PA ZIP 17043- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 11,165.50 0.00 9,050.00 476.32 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 9,526.32 0.00 0.00 Total Interest/Penalty (0 + E) (3) 0.00 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) 0.00 5. If Line 1 + Line 3 is greater than Line 2. enter the difference. This is the TAX DUE. (5) 1,639.18 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check to: 1,639.18 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1 . Did decedent make a transfer and: a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . D b. retain the right to designate who shall use the property transferred or its income; . D c. retain a reversionary interest; or ... . . . . . . . . . . . . . . . . . . . . . D d. receive the promise for life of either payments, benefits or care? . . . . . . . . . D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [J!j 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 retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true. correct and complete. Declaration preparer other than the personal representative is based on all information of which preparer has any knowledge. F PERSON RESPONSI an , Yes No og og og Oil OJ QlJ DATE \.U - 'S -Os. SIGNATURE OF PREPARER OlHER lHAN REPRESENTAllVE DATE 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 sulViving spouse is 3% 172 P.S. 99916 (a) (1.1) (I)]. For dates 01 death on or after January 1, 1995, the tax rate imposed on the net value 01 transfers to or for the use olthe suNiving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)J 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 still applicable even if the surviving spouse is the only beneficiary For dates 01 death on or after July 1,2000: The tax rate imposed on the net value of transfers from a deceased child tvventy-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent 01 the child is 0% [72 P,S. 99116(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. 9 9116(1.2) [72 P.S. g9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use ofthe decedent's siblings is 12% (72 P.S. 9 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 3W4646 1.000 REV-1502 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Miriam M. Martz 2105 0082 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 jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 512 Warren Street Lemoyne, Cumberland Co, PA Sales Price (See Statement of Settlement) 116,000.00 2 Vacant Lot #414 Adjoining 512 Warren Street Lemoyne, PA Sales Price (Settlement Sheet attached) 39,000.00 3 236 Walton Street Lemoyne, Cumberland Co., PA Appraised By: L.G. Connor Real Estate Appraisers, LTD (Copy of Appraisal attached) 70,000.00 TOTAL (Also enter on line 1, Recapitulation) $ 225,000.00 3W4695 1.000 (If more space is needed, insert additional sheets of the same size) REV-15()7 EX + (6-98) COMMONWEALTH OF PENNSYL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miriam M. Martz SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER 21 05 0082 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 70,000 Par S. Thomas Hower Jr. Mortgage Re: 745-747 Hummel Ave, Lemoyne, PA Dated 4/2/84 & 5/1/86. Interest rate 10% Due 3/09 Principal and unpaid interest balance as of 1/16/05 26,745.54 TOTAL (Also enter on line 4, Recapitulation) $ 26,745.54 3W46AC 1.000 (If more space is needed, insert additional sheets of same size) REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Miriam M. Martz FILE NUMBER 21 05 0082 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointJy-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 1989 Buick LeSabre Auto Sales price 1,750.00 2 PNC Bank, N.A. Savings A/C # 5080169721 Balance as of 1/16/05 15,015.40 Interest accrued to 1/16/2005 1.96 3 PNC Bank, N.A. Checking a/c #51401290959 Balance as of 1/16/05 9,234.86 Interest accrued to 1/16/2005 0.48 4 G.E. Capital Assurance Co. 298.32 Refund Long Ter.m Health Care Insurance benefit 5 State Far.m Mutual Auto Ins Co. 33.18 Refund automobile insurance premium 6 National Geographic Society 22.67 Refund subscription 7 Cash found in decedent's home 0.49 8 Commonwealth of Pennsylvania 397.19 Retirement benefit accrued to date of death 9 Tangible personal property located at decedent's residence 2,663.00 Gross sale proceeds 10 Pennsylvania Department of Revenue 4.00 Total from continuation pages 170.00 3W46AD 1.000 TOTAL (Also enter on line 5 Recaoitulation) $ (If more space is needed, insert additional sheets of the same size) 29,591.55 Schedule E (Page 2) Estate of: Miriam M. Martz Item No. Description Value at Date of Death Refund 2004 PA state income tax 11 State Farm Mutual Ins Co 170.00 Refund homeowner's insurance premium Total (Carry forward to main schedule) 170.00 REV-l509 EX . (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miriam M. Martz SCHEDULE F JOINTL Y.OWNED PROPERTY FILE NUMBER 21 05 0082 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 A Carlisle, Sally A ADDRESS 633 Pennsboro, Mechanicsburg, PA 17050 RELATIONSHIP TO DECEDENT Daughter B. Crossland, Dec I d, Barbara L c/o Stone LaFaver & Shekletski, 414 Bridge Street, New Cumberland, PA 17070 Daughter c. JOINTL Y.OWNED PROPERTY: LET1ER DATE DESCRPTlON OF PROPERlY %OF DATE OF DEATH ITEM FOR JOINT MADE I NCLUOE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECO'S VALUE OF f'U.A6EROR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR NUMBER TENANT JOINT JOINTLY-f-ELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A, 1 B 7/10/1997 Waypoint Bank Savings Certificate A/C # 555311192 Balance as of 1/16/05 6,000.00 50.000 3,000.00 :Interest accrued to 1/16/2005 9.69 50.000 4.84 2 A 2/3/1994 Waypoint Bank Savings Certificate A/C # 561247587 20,000.00 50.000 10,000.00 :Interest accrued to 1/16/2005 14.30 50.000 7.15 TOTAL (Also enter on line 6 Recaoitulation) $ 10,007.15 * * 3W46AE 1.000 (If more space is needed, Insert additional sheets oftha same size) * Bill separately. Send bill to address listed as "B" above. REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miriam M. Martz ITEM NUMBER A. B. 2. FUNERAl.. EXPENSES: 1. Flinchy's Funeral luncheon SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. DESCRIPTION Total from continuation pages Claimant Street Address City Relationship 01 Claimant to Decedent 5. Accountant's Fees Probate Fees 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) PNC Bank, N. A. Social Security Number(s) I EIN Number 01 Personal Representative(s) Street Address 4242 Carlisle pike City Camp Hill Year(s) Commission Paid: To be paid Attorney Fees State P A Zip 17001 3. Family Exemption: (II decedent's address is not the same as claimant's, attach explanation) 4. 7. 6. Tax Return Preparer's Fees 1 3W46AG 1.000 Claude C. Wolfe & Associates Auctioneer's commissions and expenses Total from continuation pages State Zip FILE NUMBER 21 05 0082 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ AMOUNT 480.74 5,564.82 11,253.00 11,253.00 310.00 2,347.67 9,832.66 41,041.89 Schedule H part 1 (Page 2) Estate of: Miriam M. Martz Item No. Description Amount 2 parthemore Funeral Home Funeral services 5,564.82 Total (Carry forward to main schedule) 5,564.82 Schedule H part 2 (Page 3) Estate of: Miriam M. Martz Item No. Description Amount 2 Duty's Lock Safe & Security Inc. Door lock replacement at 512 Warren St., Lemoyne, PA 112.87 3 Expenses re maintenance of 512 Warren Street, Lemoyne, PA (See attached) 1,386.57 4 Expenses re sale of 512 Warren Street, Lemoyne, PA (See attached) 4,615.62 5 Expenses re sale of vacant lot adjacent to 512 Warren Street, Lemoyne, PA (See attached) 1,660.00 6 L.G. Connor Real Estate Appraisers Real estate appraisal fee re 236 Walton Street, Lemoyne, PA 300.00 7 L.G. Connor Real Estate Appraisers Appraisal fee re 512 Warren Street, Lemoyne, PA 600.00 8 Settlement costs re payoff of S. Thomas Hower Jr Sales Agreement 745-747 Hummel Ave, Lemoyne, PA 1% transfer tax on original loan $800.00 Deed preparation $100.00 900.00 9 Stone Lafaver & Shekletski Reimbursement for legal advertising expenses: Cumberland County Legal Journal 75.00 The Patriot News 119.94 194.94 Total (Carry forward to main schedule) 9,770.00 Schedule H part 2 (Page 4) Estate of: Miriam M. Martz Item No. Description Amount 10 Stone LaFaver & Shekletski Reimbursement for deed recording 45.50 11 UGI Utilities Inc. Service 17.16 Total (Carry forward to main schedule) 62.66 Estate of Miriam M. Martz File No: 21-05-0082 Date of Death: 1/16/2005 Expenses re Maintenance and Upkeep of 512 Warren Street, Lemoyne, PA pending its disposition UGI Utilities Inc - service PPL Electric Utilities - electric service Pennsylvania American Water -service D& F Lawncare - lawn maintenance Billy Lundberg - lawn service for auction Gingrich's Plumbing - plumbing service Derry Oil Co. - oil delivery SES Insurance Services Inc - insurance premiums Lemoyne Borough - sewer and refuse payment $63.27 $56.86 $70.76 $445.20 $50.00 $107.40 $242.00 $255.00 $96.00 Total $1,386.49 Estate of Miriam M. Martz File No: 21-05-0082 Date of Death: 1/16/05 Expenses Re Sale of 512 Warren Street, Lemoyne. PA City/County Transfer tax Commonwealth of PA - transfer taxes Stone Lafaver & Shekletski - document preparation Claude C. Wolfe & Associates - auctioneer commission Lemoyne Bom - unbilled 4th qtr 2003 sewer/water $580.00 $580.00 $100.00 $3,480.00 $60.00 Subtotal Less: Adjustments Assessments: 5/20/05 - 6/30/05 Sewer/Refuse $4,800.00 Total Expenses of Sale ($140.28) ($44.10) ($184.38) $4,615.62 Estate of Miriam M. Martz File No: 21-05-0082 Date of Death: 1/16/05 Expenses Re Sale of Vacant Lot Adjacent to 512 Warren Street, Lemoyne, PA Commonwealth of PA - transfer taxes Stone Lafaver & Shekletski - document preparation Claude C. Wolfe & Associates - auctioneer commission $390.00 $100.00 $1.170.00 Total Expenses of Sale $1,660.00 REV-1512 EX + (6-98) COMMONWEALTl-I OF PENNSYLVANIA INHERITANCE TAX RETLRN RESIDENT DECEDENT ESTATE OF Miriam M. Martz SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 05 21 0082 Include un reimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. AT&T Service 18.19 2 Bethany Village Beauty shop charges 57.00 3 Comcast Cable Balance due 1.37 4 Critical Care Systems Balance due for professional services 479.99 5 Faith A. Nicola, Tax Collector Real Estate Tax less reimbursement 249.08 6 Internal Revenue Sevice Balance of U.S. Income tax for 2004 personal income tax 27.00 7 Lemoyne Borough Sewer and refuse service 1st quarter 2005 96.00 8 Pennsylvania American Water Water service for December and January 18.39 9 PNC Bank, N.A checks drawn prior to death and honored subsequently 1,144.29 10 PPL Electric Utilites Balance due for electric service for December and January 20.68 11 Smi th Radiology Inc Professional services 9.21 Total from continuation pages 58.95 3W46AH 1.000 TOTAL (Also enter on line 10. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,180.15 Schedule I (Page 2) Estate of: Miriam M. Martz Item No. Description Amount 12 UGI Utilities Inc. Utility service 17.22 13 Verizon Balance due 41. 73 Total (Carry forward to main schedule) 58.95 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miriam M. Martz FILE NUMBER 21 05 0082 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1 Sally A. Carlisle 633 Pennsboro Mechanicsburg, PA 17050 Daughter 94,064.68 2 Barbara L. Crossland, Dec'd c/o Stone LaFaver & Shekletski 414 Bridge Street New Cumberland, PA 17070 Daughter 70,000.00 3 Wendy Harper 1112 Musket Lane Mechanicsburg, PA 17050 Daughter 84,057.52 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 3W46A11.000 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space IS needed, Insert additional sheets of the same Size) $ 0.00 .,,~ ....,_."'~"". AF 'VER"'Si,,;SB TONE, L 1)._ . '" .. ,'-' . "'\ATi~~;:i~,~~.,.~.~:~,_:~\_>",:, ;, ;:,:0-(;'~j~-Ji:':!-_'- c....:. ,,~,:6::'I-~~~."..,* , c414 BRIDGE .~E ,~~"~, ",'", ,.<r. .,L!-,<:.._:" :--"1.,-- . W GUMBER~: ::\:~:~~~~~-Z::fltl!l~:,J:\~;i'Y): LAST WILL AND TESTAMENT OF MIRIAM MARTZ I, MIRIAM MARTZ, of the Borough of Lemoyne, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. 1T8M I: I direct that my Executor hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease from the residue of my estate. ITEM II: I devise my house and lot situate at 236 Walton Street, Boroug~ of Lemoyne, Cumberland County, Pennsylvania, to my daughter, BARBAPA L. CROSSLAND, or to her issue, per stirpes. ITEM III: I devise and bequeath all the rest, residue and remainder of my estate, of every nature and wherever situate, in equal shares to my daughters, SALLY A. CARLISLE, and WENDY L. HARPER, or their issue, per stirpes. ITEM III: I appoint my Executor guardian of any property which passes, either under this will or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discre- tion to distribute a share where possible to the minor or to another Page 1 of 4 , for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and under- graduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. ITEM IV: I appoint PNC BANK, N.A., Executor of this my last will. ITEM V: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of her duties in any jurisdiction. IN WITNESS WHEREOF, I, MIRIAM MARTZ, have hereunto set my hand and seal this do. .r:t day of Dllr1__4........... , 2001. ~ ~f a~ ' _ tZA:- MIRIAM MARTZ SIGNED, SEALED, PUBLISHED and DECLARED by MIRIAM MARTZ, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presence of each other, have subscribed our names as witnesses. Page 2 of 4 , ~Z!i(~~ Wl \ ~~~\-'\ '--~! . "'\\ (l~'- , /1}( · lu^~ ~ . a. Address Witness ~\'--\ \\-\'-, . ~ C\ Address ~ \ COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF CUMBERLAND I, MIRIAM MARTZ, the Testatrix whose name is signed to the at- tached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. /?2~C?7?'./ '--J77~,{ MIRIAM MARTZ t7' Sworn to or affirmed to and acknowledged before me by MIRIAM NOTARIAL SEAL . ^F L KA'" I "'I"TV "l!hl'~ CONSTAN'V_. riL, "" U. ',,~. ,', i~"'N Cumberland, PA CU:,lb~i IGnd Co. My Commission Expires Apnl13, 2C:J.'l ;;l.'1 d~'y of 0P('/ ~...... , 2001. // I~ / ~'~~c<"'j ~ f\ C&~ Notary Public MARTZ, the Testatrix, this COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Page 3 of 4 I II , We, OA..h..., 1-4 J~ and C\~x.':':'l L ~'\Jl~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. ~~~ Wi ess ~- '0( J 1 ~\~~ J .,,~\ \ j \\ Witness \ Sworn to or affirmed to and <0A1.h.., "'-\ ~ aCknow~ged and L\t~ before me by l '-\t ~-tL ~ witnesses, this ~:1- day of ()..n~ , 2001. (LL1~j ,X k_~ Notary Public NOTARIAL SEAL ~ONSTANCE L KARLI, Nata,ry Publir. l~eVl Cumberland. PA Cum~elk:;d Co. My CommissIon expires April 13,2003 Page 4 of 4 . A. Settlement Statement u~.s. Department of HousinQ and Urban Development ~ ,r B Type of Loan 1. o FHA 4. OVA OMS No. 2502-0265 2. 0 FmHA 3. D Cony. Unins File Number 24347 - P Loan Number Mortgage Insurance Case Number 5. 0 Cony. 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 shown. Items marked "p.D.C" were paid outside of closing; they are shown here for informational purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWER JOHN C. WALTERS, JR. 706 NORTH PITT STREET, CARLISLE, PA 17013 E. NAME AND ADDRESS OF SELLER ESTA TE OF MIRIAM MARTZ 512 WARREN STREET, LEMOYNE, PA 17043 F NAME AND ADDRESS OF LENDER: G. PROPERTY LOCATION: 512 WARREN STREET LEMOYNE, PA 17043 H. SETTLEMENT AGENT: PLACE OF SETTLEMENT TIN: I. SETTLEMENT DATE: CEDAR CLIFF ABSTRACT AGENCY, INC. 23-2133165 05120/2005 I RESCISSION DATE: 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 Price S116 000. 00 401. Contract Sales Price $116,000.00 102. Personal Property 402. Personal property 103. Settlements charges to borrower: 403 (from tine 1400) $1,548,50 104. 404. 105. 405. ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: 106. Cityltown taxes to 406. Cityltown Taxes 10 107. County Taxes OS/20/2005 10 12/31/2005 $300.58 407. County Taxes OS/20/2005 10 12/31/2005 $300.58 108. Assessments OS/20/2005 10 06/30/2005 $140,28 408. Assessments OS/20/2005 10 06/30/2005 $140.28 109 SEWER/REFUSE-05/20/05-06/30/05 $44.10 409. SEWER/REFUSE-05/20/05-06/30/05 $44.10 110. 410 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER: $118,033.46 420. GROSS AMOUNT DUE TO SELLER: $116,484.96 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money $11,600.00 501. Excess deposit (see instructions) $11,600.00 202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400) $4,800.00 203. Existing roan(s} taken subject 10 503. Existing loan(s) taken subject to 204. 504. Payoff of first mortgage loan 205 505. Payoff of second mortgage loan 206. 506 207. 507 208. 508. 209. 509. ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: 210. City/town taxes 10 510. City/town taxes 10 211. County taxes 10 511. County taxes 10 212. Assessments 10 512. Assessments 10 213. 513. 214. 514. 215 515. 216. 516. '17 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR $11,600.00 520. TOTAL REDUCTIONS $16,400.00 BORROWER: IN AMOUNT DUE TO SELLER: 300. CASH AT SETTLEMENT FROMrrO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER 301. Gmss amount due from borrower {tine 120} $118,033. 46 601. Gross amount due to seller (line 420) $116,484.96 302. Less amount paid by/for borrower (line 220) $11,600. 00 602. Less reductions in amI. due seller (line 520) $16,400.00 303. CASH ( ~FROM ) ( OTO) BORROWER: $106,433.46 603. CASH ( 0 FROM) ( ~TO) SELLER: $100,084.96 HUD-1 (3-86) - RESPA, HB 4305.2 PAGE 1 HUD-1 (Rev. 3186) L. SETTLEMENT CHARGES 700. TOTAL SALES/BROKER'S COMMISSION BASED ON PRICE $116,000.00 @ %= DIVISION OF COMMISSION (LINE 700) AS FOLLOWS: 701. 702 703. 704. to to to to 705. Commission paid at settlement 706. 800. ITEMS PAYABLE IN CONNECTION WITH LOAN: 801. Loan origination fee % 802, Loan discount % e03. Appraisal fee 10 804. Credit report to 805. Lendefs Inspection fee a06. Mortgage insurance application fee to 807. Assumption fee 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE: 901.lntcroSlfrom 05 20 2005 to 06 01 2005 @ I day 902. Murtgaga insurance premium for 903. Hazard insurance premium for 904. Flood Insurance premium for 905. 1000. RESERVES DEPOSITED WITH LENDER: mos. 10 yrs.to yrs.to 1001. HazardinsurBnce 1002. Murtgaga insurance 1003. City property taxes 1004. County propertylaxes 1005. Annual assessments 1006. flood insurance 1007 1008 1009. Aggregate Accounting 1100. TITLE CHARGES: months@ monlhs@ monlhs@ months@ months@ monlhs@ monlhs@ months@ EscrOh' Adjustment per month per month per month permonlh permonlh per month per month permonlh 1101. Settlemenl or closing fee to 1102. Abstract or title search to 1103. Title examination to 1104, Title Insurance binder to 1105. Document preparation to STONE LAFAVER & SHEKLERSKI 1106. Notary fees to 1107. Attorney's fees to STONE LAnVER &' SHEKLERSKI (includes above Items Numbers: 1108. Title insurance 10 (includes above items Numbers' 1109. Lender's coverage 1110. Ownefscoverage 1111. 1112 1113 1200. GOVERNM RECORDING AND TRANSFER CHARGES: 1201. Recording fee,,: 1202. City/counlylaxlstamps 1203. Slatetaxlstamps: 1204 1205 1300. ADDITIONAL SETTLEM NT HARGES: Deed 38,50 Mortgage Deed $1,160.00: Mortgage $1,160.00 ;Mortgage : Releases Dood : other 1301. Survey to 1302. Pes! inspection to 1303. CLAUDE C. WOLEE & ASSOC - AUCTIONEER COMMISSION 1304 LEMOYNE BORO-t7NBILLED 4TH QTR 2003 1305 1306 1301 1400. TOTAL SETTLEMENT CHARGES OMB No. 2502-0265 PAID FROM BORROWER'S FUNDS AT SETTLEMENT PAID FROM SELLER'S FUNDS AT SETTLEMENT $100.00 $350.00 $38.50 $580 _ 00 $580.00 $580.00 $580.00 $3,480.00 $60.00 $1,548.50 $4,800.00 I have carefully reviewed the HUD.1 Settlement Statement and 10 the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by in thi ansaclion. I further c that I have received a copy of the HUD-1 Settlement Statement. ~ - (/.' eUeror' \? ----=0 Date: .r:';; O~~"t: . . ~ Oat., 5 at:> ;J5> ESTATE OF MIRIAM MARTZ Borrower: Borrower' Date' SeJleror Agent The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction with this statement. Dale; Settlement Agent: Date: u the funds to be disbursed In accordance Daf(~ WARNING: It is a crime to knowingly make false statements 10 the United Slates on this or any other similar form. Penalties upon conviution can include a fine and imprison- ment. For details see: Tille 18 U.S. Code Section 1001 and Section 1010 .I OMS NO. 2502-0285 cfr:l I'c . B. TYPE OF LOAN: . l-DFHA 2.QFm':iA . 3. OCQNV. UNINS. 4.QVA 5.0CONV. INS. I . U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT '.' e. KNOUSE, ELIzABETH /7: ~OAN NUMBER: . ';:;.ij}.:.<' '.' 8ElTLEMENT STATEMENT . ,.". " . 8. MORTGAGE INS CASE NUMBER: '. . . . .. l:RNOTE: This form Is furnished to give you e stelement of ectuel settlement cost.. AmOjlnt. peld to end by the sefflement egent ere shown. Items marked "[POC)" were peld outside the closing; they ere shown h.re for InIOrmeUonel purposes end ere not Included In the totels. 1.0 3198 (KNOUsE, ElIZASErn,PFO/KNOU5E, EUZAeETI-V15) D.NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: . . Elizabeth P. Knous. end The Eslale at Mlrlam M. Martz J.m.. A. Prler ..: . L G.PROPERTY LOCATION: H. SETT~EMENT AGENT; 21-1590084 I. SE1"rLEMENT DATE: Clarklon Court. Lot 414 Riverfront Settlement Senrlcee, Ino. Lamoyna, PA 17043 July 27. 2005 cumberland County, Pennsylvania PLACE OF SEmEMENT '. 305 Nor1h Front Street HarriSburg, PA 17101 . .. . . . J. K. , vr ""LL""" '", ..""" "v.. 100: GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT'DUE TO SEI:I'ER: 1101.. Contract 5alos Prlce 39.000.00 01. Contract Sa'os Price 39,000.00 102.. Persona' ProP<lrty 02. "'arsona' Property . . 03.. 5etuement Chargoslo Borrower (Une 1400). 1,063.75 403. 104. . 404. 05. ,405. Adjustments For Items Paid By tie/ler n aavancs Adjustments ror Items ~8fa By :ieller In savance 1100.'Cfty lax 10 400. CIIV,ax 10 1lO7. l;ounty Taxes 01/27/05 to 011Ul106 28.14 407. County Taxes 07/27/05 to 01/01/0e 28:14 108. SChool Tax 07127/05 to 07/01/06 198.16 408. 5ctiOOlTax 07127/05 10 07l011lJ(j 196.16 fT09. . . . 1409. 110. lOW. . 111. . . 411. 12. 1412. 120. GROSS AMOUNT DUE FROM BORROWER 40.288.05 420. GROSS AMOUNT DUE TO SELLER 39,224.30 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or eamesf money 3,900.00 501. Excess Deposit (see Instructions, 202: PrinCIpal Amount or New Loan(s) 502. Settlement Charges to Seller (Line 1400) 1,871:2ll 203. Existing loan(s) taken subject to 503. ~X1sang lOan(s) laken subject to 204. . . I 504; Payoff.OI first Mort9age 205. I 50S;. Payoff.ot second Morf9age . 206. I 506. Deposit retainea by seller 3.900.00 207. 507. 206. 508. 209. 509. Adjustments For lIems Unpaid By Seifer Adjustment. For Items Unpaid By Seller 210:G'lty Tax to '>10. ",ty 'ax to :fl1. COunty Taxes 10 511. County Taxes to 212. School Tax to 512. School Tax to 213. 513. 214. 514. 2T5. 515. 216. 516. m. . 517. 216. 'SI8. :fro. . 519. r 220. TOTAL PA/D BY/FOR BORROWER 3.900.00 520. TOTAL REDUCT/ON AMOUNT DUE SELLER 5,771.20 'UU. "A"" AT IUI : I BOq: "A"H A' ,,~, 'L~M~N I 'UI"KUM SEUER: 301. Gross Amounl Due From Borrower (Line 120) 40.288.05 r 601. Gross Amount Due To Seller (L1na 420) 39,224.30 lO2.LOss Amount Paid By/For BOlTOwer (Une 220) . 3,900.00 602. less Reductions Due Seller (Une 520) It 5,771.20 103. CASH ( X FROM) ( TO) BORROWER 36,388.05 603. CASH ( X TO) ( FROM) SELLER 33,453.10 The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein. f --~...ti~ ames. ar Seller ~Il-- ~.S~~~ 1",0 s~leo i~~_~~' ( L. SETTLEMENT CHARGES L. . _...AL COMMISSION Based on Price $ 39.000.00 @ 3.0000 % 1.170.00 PAID fROM ~ PAJOFROM 70 -' LJIVISlon or tiommlSSlon (line fW) as t"OIIOWS: BORROWER'S SellER'S IUI.~ 1,I/U.W lQ Uouue nOue "''',wnoers FUNOSAT FUNlJS AT IU<c! w SETTlEMENT SETTlENENT ~m...,on rela o,..e"emen, ~/U."" '",,' lQ 800.ITEMli PAYABL" IN CONNECTION ""11 LOAN au' . Loan vnglnauon res '" to OUA:. Loan UIScount % lQ ouo. ""pre'se, ..e lQ aU4. "'ra,,,, "epOn N ouo. ,L.Cnuer. nspeCluon rei 0: ow. ege 'ns. Al>p. Fee 0: a,ut "-,,,",umpuon ree N oua. .... alU. a". . 000. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interesl From to @ $ Idey ( days %) I:1U.c:;. IVII. ouns. TOr LlTeun..oan lQr monms to 9~a~':1_azara Insurance t'Temlum TOr .0 years to 'U4. 905. .' 1000. RESERVES DEPOSITED WITH LENDER .' 1001.. Hazard Insurance . months @ $ per month 1002. Mortgage ,"surance . monms per monm 10ua, vny lax monlhs per month 1004. County Taxes monDls per monttl 1005. "enool Tax manDlS per month IUUO. monUlS per monm 1007. monms ~ per manm 1000. AGGREGATE ADJUSTMENT months @ $ per month 1100. TITLE CHARGES r 101. Settlement or Closing Fee to 1102. Transaction I"ee to 1103. Title Examination to 1104. 'f!tIe Insurance Binder to 1105~ee{] ....reparation to stone. LaFaver .. Shekletsk! 100.00 1106. Notary Fees to Kiverfront settlement ServIces. Inc. 1107. Attorneys Fees to (tn~I'!5!es aoave (rem numDers: ) 108. Title Insurance to Riverrront Settlemenl t ervfces, Inc. 485.25 (incJuaes above item numbers: ) lUI:l. Lenaer S l.ioverage ~ nu. uwners ","uerage . o..UUU.UU 4"".'" -1-11. I::.naorsements IO Klverrrom ~erneme~Jt ,:;,erv/ces, Inc. '"v.VV 112,-,nsurea ""osong Lener 113. 200. GOVERNMENT RECORDING AND TRANSFER CHARGES 201. Recording Fees: Deed $ 38.50; Mortgage $ ; Releases $ 38.50 ~V'&'. \",hYIl.AJUnLY ,a mps: Ueea "ou.uu; MOrtgage O'U.UU 203. State Tax/Stamps: Kevenue Stamps 390.00; Mortgage 390.00 204. 205. 300. ADDITIONAL SETTLEMENT CHARGES 301. Survey to 302. Pest Inspection to 303. 2005-2008 School Taxes to faiUl Nicola. Tax Collector . 12-22-0020,088 211.20 304. 305. 400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103. Secllon J and 502,.Soclloil K) / \ 1.063.75 1.071.20 By signing page 1 of this slat9m9n~ lI.e ~lgnatOlj8S aelc:nowledge receipt of 9 completed t:Opy of page 2 of this two page slate ::.0~ l__ ....... ~--\ Settlement Agent.... :::ertified to be a true copy. (KNOusE, ELIZABETH I KNOUSE. ElIZABETH 116 ) A. Settlement Statement U.S. Department of Houslnl'l and Url1lin Developm~nt .".". ,r OMS No. 2502~0265 3. Type of Loan 1. 0 FHA 2. 0 FmHA 4. 0 VA 5. 0 Conv. Ins. :. NOTE:This form is furnished to give you a statement of actu<il,settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "p.a.c" were paid outside of closing; thEW are shown here for Informational purposes and are not included In the totals. 3. 0 Cony. Unlns File Number 24347-P Loan Number Mortgage Insurance Case Number J. NAME AND ADDRESS OF BORROWER: S. THOMAS HOWER. JR. ,PA o. NAME AND ADDRESS OF SELLER: THE ESTA TE OF MIRIAM M. MARTZ 745 AND 747 HUMMEL A VENUE. LEMOYNE, PA 17043 F. NAME AND ADDRESS OF LENDER: ::; PROPERTY LOCATION: 745 ANO 747 HUMMEL A VENUE LEMOYNE. PA 17043 H. SETTLEMENT AGENT: PLACE OF SETTLEMENT: TIN: CEDAR CL/FF ABSTRACT AGENCY, INC. 23.2133165 I. SETTLEMENT DATE: 06/24/2005 RESCISSION DATE: 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 Price 0'90 000.00 401. Contract Sales Price $90 000.00 102. Personal Property 402. Personal property 103. Settlements charges to borrower; 403. (from Jine1400) $940.50 104. 404. 105. 405. ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: 106. City/town taxes to 0 406. City/town Taxes to 107. County Taxes 10 . 407. County Taxes 10 108. Assessments 10 . 408. Assessments to 109. 0 409. 110. 0 410. 111. 411. 112. . 412. 120. GROSS AMOUNT DUE FROM BORROWER: $80,940.50 420. GROSS AMOUNT DUE TO SELLER: $80;000.00 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or eamest money 501. Excess deposit (see Instructions) 202. Principal amount Of new loan(s} 502. Settlement charges to seller (line 1400) $900.00 203. ExlslJng loan(s) taken subject to 503. Existing Joan(s) taken subject to 204. 504. Payoff of flrst mortgage loan 205. 505. Payoff of second mortgage loan 206. 50s. 207. PAID VNDE1l AGREEMENT OF SALE $56,074.92 507. PAID VNDE1l AGREEMENT OF SALE $56;074.92 208. 508. 209. 509. ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: 210. City/town taxes to 510. Cityltown taxes to 211. County taxes to 511. County taxes 10 212. Assessments to 512. Assessments 10 213. 513. 214. 514. 215. 515. 216. 518. . 217. 517. 218 o' 518. 219, 519. 220. TOTAL PAID BY/FOR $56,074,92 520. TOTAL REDUCTIONS BORROWER: IN AMOUNT DUE TO SELLER: $56,974.92 300. CASH AT SETTLEMENT FROMITO BORROWER: : 600. CASH AT SETTLEMENT TO/FROM SELLER 301. Gross amount due from borrower (line 120) ..$80,840.50 601. Gross amount due to seller (line 420) $80,000.00 302. less amount paid by/for borrower (line 220) $56,074.92 602, Less reductions in amt. due seller (line 520) $55,974.92 303. CASH ( t?JFROM) ( DTO) BORROWER: '~$24, 765.58 603. CASH ( DFROM) ( t?JTOl SELLER: $23,025.08 HUD-1 (3-S6) . RESPA, HB 4305.2 PAGE 1 HUD-1 (Rev. 3186) l. OMS No,.2502.0265 700. TOTAL SALES/BROKER'S COMMISSION PAID FROM PAID FF>OM BASED ON PRICE $80,000.00 @ %' BORROWER'S SELLER'S .' FUNDS FUNDS DIVISION OF COMMISSION (LINE 700) AS FOLLOWS: . AT AT 701 to SETTLEMENT SETTLEME~ 702. to 703. to 704. to 70S. Commission paid at settlement 706. 800, ITEMS PAYABLE IN CONNECTION WI H LOAN: 801. Loan origination fe8 % 802. Loan discount % 803. Appraisal rseto; 804. Credit report to' 805. Lender's inspection fee 806. Mortgage insurance application fee to " 807. Assumption fee SETTLEMENT CHARGES 900 ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest from 06/24/2005 to 07/01/2005 @ /day 902. Mortgage insurance premium for 903. Hazard Insurance premIum for 9O-i. Flood lnsuranoe premlum for 905. mos. 10 yrs.to y~.to 10 0, RESERVES 1001, Hazardinaurance 1002,Mortgagelnsurance 1003. City property taxes 1004. County property t8)[8S 1005. Annual assessments 1006. Flood Insurance 1007. 1008. 1009 Aggregate Accounting 1100, TI LE CHARGES: 1101. SetUement orclOl1ng fee to 1102. Abslract or title seerchto 1103. Title examination to 1104. TlUe Inauraoce binder 10 1105. Document preparation to STONE LAP'AVER " SHZKIZrSKI 1106. Nolaryfeesto 1107. ~t1omey's fees to monthlC: montha@ montl1s@ months@ months@ months@ months@ rrnJnths@ Escrow 'Adjustment par month (parmonth . per month per month per month per month per month per month 1200, 1201. ReGOrdlng fees: 1202. City/county tax/stamps: 1203. Statele)(/stamps' 1204 1205. 1300, ADDITIONAL ~lo TT~EMENT ARGES: 1301, Survey to 1302. P8stinspection to 1303. 1304. ECORDING AND TRANSFER HAR ES: Deed $40.50 ;Mortgege Deed $800.00; Mortgage Deed $800. 00 ; Mortgage $100. I . I I I ; ReIOOSGS ~40. 50 $400,00 $400. ; Other $400,00 $400, {includes aoolle Items Numbers' 1108. Title insurance to (includes above ltem$ Numberi: , 109. lender's coverage "10. Owner's coveraae $80 1000.00 1111. 1112. 1113. 1305 1306. 1307 1400, TOTAL SETTLEMENT CHARGES $840,50 $900, I have carefully reviewed thht~~HUO-1 Settl ~~Stateme and to the best of my kfO~Wl8dge and behef. It 18 8 true and accurate statement of all receipts and disbursements made on my a:::zcountor by nthlstra Ifurt c Ify_t7hatlha~erece:d~;oft _HUD~1~settleLenw~ment\0 .C:; ~~~ "" ./ / '~lIeror L \[)...~~ Borrower De~'7 gent Date 'Q -~ ~ S, THOMAS HOWER, JR. THEESTATEO MIRIAMM. TZ Borrower: Date: Seller or Agent: Date: Date: s to be disbursed in accordance The HUO-1 Settlement Statement which I have prepared is a true and accurate account of this transactio'n. I with this statement. D,le G2'1'\J{ WARNING: It is a crime to knowingly make faJse statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprison- ment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. . ~ PNCBAN< February 4,2005 PNC Trust Dept POBox 308 Camp Hill, PA 17001-0308 scp RE: Estate of Miriam M Martz (Deceased) SSN: 172-01-6564 DOD: 01-16-2005 Dem- Sir or Madam: In response to your request for Date of Death balances for the customer noted above, our records show the following; Certificate of Deposit Account #2100 J 031473 Established 08-10-1995 MIRIAM M MARTZ * WENDY HARPER DOD balance: $10,000.00 + $2.67 accrued interest Interest paid 01-0 I-OS thru 01-16-2005 $11.81 YID Checking Account Account#5J40129052 Established 07-01-1978 MlRIAM M MARTZ DOD balance: $9,234,86 + $0.48 accrued interest Interest paid 01-01-05 thru 01-16-2005 $0.00 YTD Savings Account Account #5080169721 Established 03-07-1994 MlRlAM M MARTZ DOD balance: $15,015.40 + $1.96 accrued interest Interest paid 01-01-05 thru 01-16-2005 $0.00 YTD Page I of2 * Tax paid by joint tenant on 8/3/2005. See ACN 05118564 .' ", . ,;.- .. . Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do Dot process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. ' Sincerely, ~:1.~ Erica L Schlegel 1-800-762-1775 P7-PFSC-04-F 500 Firsl Ave. Pittsburgh PA 15219 Member FDIC Page: 2 of2 TOTAL P.02 ClIIlMlINIlEAl TH OF PENNSYLVANIA DEPARTHENT OF ~ENUE BUREAU'OF INDI~DUAL TAXES IlEPT. Z8060l HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 05-0082 ACN 05118564 DATE 05-31-2005 .,...1541 EX AFP n'-II) WENDY L HARPER 1112 MUSKET LN MECHANICSBURG PA 17050 TYPE OF ACCOUNT EST. OF MIRIAM M MARTZ 0 SAVINGS 5.5. NO. 172-01-6564 DCHECXIMll DATE OF DEATH 01-16-2005 0 TRUST COUNTY CUMBERLAND IX] CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the Depart.ent lIith tha infor.ation listad belo11 IIhich has baan usad in c.lculating the potential tax due. TheIr records Indlc.te that at the death of the above decedent, you WBre a joint owner/beneficiary of this account. If yoU f..l this infer.ation is incorrect, please obtain written correction fro. the financial institution, attach a copy to this for. and ....turn it: to the abavR address. This account Is taxable In accordance wi'th the Inheritance Tax Laws of the Co..onwealth of P.nn!;ylva,.1a. QUtiuitlan5 IlaY b. ana...8I"'ed b~ calling (717) 707-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001031473 Date 08-10-1995 Established Account Balance Percent Taxable Alnount Subject to Tax Rate Potantial Tax Due x 10,002.67 50.000 5,001.34 .15 750.20 TAXPAYER RESPONSE To insure propBr credit to yaur account, two (2) copies of this notice .ust acco.pany your p8~ent to the Register of WIlls. Make check payable to: "Register of WillS, Agent". x NOTE: If tax paYllents arB .ade wi thin three (3) .anths of the decedent's date of death, you ..y deduct a 5Z discount of the tax due. Any inheritance tax due will beco.. delinquent nine (9) ..-.ths after the date of death. Tax PART [!] A. 0 The above infor.atlon and tllX due is carrBct. 1. Yau .BY choose to ~it pay..nt to the Register of WIlls with two copies of this notice to obtain a discount or avoid Interest, or YOU .ay check box "A" and return this notice to the Register of Wills and an officialllss8s~BOt will be issued by the PA Depart.ent of Revenue. [CHECK ] ONE BLOCK ONLY PART ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Anount Subject to Tax 5. Debts and Deductions 6. Anount Taxable 7. Tax Rate 8. Tax Due B. 0 The above asset has baen Dr will be reported and tax paid with the Pennsylvania Inheritance Tax return ta be filed by the decedent's representativu. c. ~The above infor.atlon l~ncorrect and/or debts and deductions wera paid by you. i'Y You .ust coaplete PART L!J and/or PART ~ below. OF TAX 0 JOINT/TRUST ACCOUNTS ~ ~ tl'J J 1"1 ~.2. h1 3 X ,f!l ~ 4 (57'~ ()-r. :<.Jj- ~ ' ~ :~]ro~i PART I!J DATE PAID PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and conplete to the best of .y knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER 'i/2/~ DATE TAXPAYER SIGNATURE . ~ 2/7/2005 PNC ADVISORS PO BOX 308 CAMP HILL PA 17001-0308 VIWayRqint RECEIVED PNC ADVISORS FEB 1 0 (UUj The infonnation which you requested on the account(s) of MIRIAM MARTZ (Social Security Number 172-01-6564) is/are as follows: Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership JTO ( 1 ) Name of Joint WENDY Owner, if any HARPER 531149685 CERTIFfCATE 060689 10989.40 5.15 10994.55 Date Ownership 060689 Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established 55531 I 192 CERTIFICATE 071097 6000.00 9.69 6009.69 JTO (2) BARBARA L CROSSLAND 071097 561247587 CERTIFICATE 020394 20000.00 14.30 20014.30 JTO (3 ) SALLY A CARLISLE 020394 (1) Tax paid by joint tenant on 8/3/2005. See ACN 05116337 (2) Bill: Estate of Barbara L. Crossland c/o Stone LaFaver & Shekletski 414 Bridge Street New Cumberland, PA 17070 (3) Tax to be paid by Executor. See ACN 05116336 Additional Information Requested SENIOR SERVICES REP. PO. 80x J7J I. HARRISBURG. PeNNSYUfANIA 17105-1711 Toll Free 1-866-WAYPOINT (1-866-929-7646) . IN YORK AREA 717/815-4500 . www.waypointbank.com CoMMONWEALTH OF PENNSYLVANIA IIEPARTI1ENT OF REVENUE BUREAUbF INDIVtouAL TAXES DEPT. Z80601 HARRIS8URG, PA 171Z8-0601 '*' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21- 05-0082 ACN 05116337 DATE 04-27-2005 REV-154S EX AFP U'~IIJ WENDY HARPER 1112 MUSKET LN MECHANICSBURG PA 17050 TYPE OF ACCOUNT EST. OF MIRIAM MARTZ 0 SAVINGS 5.S. NO. 172-01-6564 0 CHECKING DATE OF DEATH 01-16-2005 0 TRUST COUNTY CUMBERLAND [X] CERTIF. REMIT PAYMENT AND F9~MS t : REGISTER OF WILLS fl CUMBERLAND CO COURT USE CARLISLE, PA 17013 lfAYPOINT BANK has provided the Depar~t with tha infonlletion listed below which has baen used in calculating the potential tax due. Thel~ records Indicate that at the death of the above decedent, you Mare a joint owner/beneficiary of thIs account. If you feel this infor..tian is incorrect, pleasB obtain written correction fro. the financIal institution, attach a copy to this fo~ end return it to the above address. this account Is taxable in accordance with the Inheritance Tax laws of the Ca..onwealth of Pennsylvania. QUBstions .ay ba answared by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 531149685 Date 06-06-1989 Established Account Balance Percent Texable Anount Subject to Tex Rate Potential Tax Due x 10,994.55 50.000 5,497.28 .15 824.59 To insure proper credit to your account, two {Zl copies of thIs notice must Bcco.pany your pSY88nt to the Register of Wills. Make check payable to: "Register of WillS. Agent". x NOTE: If tax pay.ents are made within three (3) ~nths of the decedBnt.s date of death, you .ay deduct a 5% discount of the tax due. AnY inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART TAXPAYER RESPONSE [!]lIr~I~~M!im~~!~!~1d~!~IIIIII~~~!I!lllg~~!ii![~11~la..~I~I~i!i~~UJ!!!:I'~H"j!!!I_!!~B~!!m~lilll~~W1~~!!fi!ll A. D The above lnfar_atlon and tax due Is correct.. 1. You .ay choose to remit pay-.nt to the RegIster of Wills with two copies of this notice to obtain IS discount Dr avoid intersst, or you may check box -Aft and return this notice to the Registe~ of Wills and an official Bsses~t will be issued by the PA Depa~t.Bnt of RBvBnue. [CHECK ] ONE BLOCK ONLY B. D The above asset has been or will be ~8pa~t8d and tax paid with the Pennsylvania Inhe~itancB Tax return to be filed by the decedent.s representative. c. ~ The above information is incor~ect and/o~ debts and deductions were paid by you. ~ You .ust co.plete PART ~ end/or PART ~ below. your DEBTS AND ACCOUNTS PART If you indicate a different t ~ relationship to decedent: TAX RETURN - COMPUTATION OF LINE 1. Dste Established 1 2. Account Balance 2 3. Percent Texable 3 X 4. Anount Subject to Tax 4 5. Debts and Deductions 5 6. Anount Taxable 6 7. Tex Rete 7 X 8. Tax Due 8 PART .:l '1,/38 [!] ~ DATE PAID $ Lf71 E ~?it:.~ ::;:;ifi 1l/7/,t/f I TOTAL IEnter on Line 5 of Tax ConputationJ DESCRIPTION AMOUNT PAID I $ Under penalties of perjury, I declare that the fects I have reported above are true, correct and conplete to the best of ny knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER tr '"' ~ DATE TAXPAYER SIGNATURE r-rom.r;.1 . l)UI~I~ IIIIUU.x1..c.U UUI 1-.)1 "UU..."J IU....J'- TT,..,v I .VV41 VV,,", ~ caNKONWEALTH OF ~ENHSYLVANIA aEPART"ENT g, REVENUE IURl!AU a, INDIVIOUAL TAXES DEPT. za0601 HARRISBURG, PA 171Z&-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 05-0082 ACN 05116336 DATE 0~-27-2005 IIMI4I II UP "'.1Il SALLY A CARLISLE 6333 PENNSBORO DR HECHANICSBURG PA 17050 TYPE OF ACCOUNT EST. OF MIRIAM MARTZ D SAVIHC;S 8.S. NO. 172-01-6564 0 CI1EClCINIi DATE OF DEATH 01-16-2005 0 TRUST COUNTY CUMBERLAND 00 CERTIF. REHIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 WAYPOINT BANK hilS ~rllvldod the aopart".n1: ..ltll fIl. Infor"ation 1i.tod balo. vhloh has bun U88d in calculating tho pot.n'181 ~. dU8. Thalr r.cord. Indiolto thet lit the doeth of tho IIbovII d".d.nt, you ..... . joint o.nor/bonoflola.y of thl. aocount. If ~GU fo.l thIs Info.MStlon i. inoorr.ot, p1...0 ODtaln ..rltt.n corraotion f.oll tho financial in.titution, IttACh a oopy to this forM and ~etur" It tD thQ abovv addr*ts. T~l. Bccaunt ia ....ble In eOQOrdance with thl lnhlritano8 Tex Laws of the CD~.DnWBglth of P.nnsy1venlB. Qua.tion. ..y b. IIn,wI..d by 0.111ng (717) 7a7-aSZ7. COM~lETE PAR~ l ~ELO" . M . SEE REVERSE SIDE FOR FILING AND PAYMENT %NST~UCTIONS Account No. 561247587 Date 02-03-1994 Establishad Aooount Balance Percent Taxable ~ount Subject to Tax Rete Potent1al Tax Due lC 20,014.30 5D.00D 10,007.1.5 .IS 1,501.07 TAXPAYER RESPONS~ TO lnlure proper credit to your account, twa Cl) copius gf 1n1s not!c. MU.t acea.p.", ,our pa~lI.nt to the Ro.lstor of Will.. "ok. oheck paylblo to: ".81118t.r of Willo, A..ntft. x NOTE a If tIIx JlB~J118ntll lira ..de ..lttdn thr-e. (S) month. of tho d.o.dont'. ~ata of daath, ~ou m.~ doduot . S~ ~i.count of th. to. du.. Any inhGrit.noe te. dU. ~111 bleama dalinquunt n1nl (9) 1I0nth. Btts. 'h. dote of de.th. Tax , 'r.i:i: !'I": 1..1 , ~ ,I ,1'1'" 'I' A. 0 T/lo ellovo lnforllatlon ami ta. due i. corr.ot. 1. You may chaD.. tD ~emit pay..n~ ~ ~ Re.later of Wills Kith t~o oop!.. of this notioe to obtain II dJscount Dr .vg.id inter.st, Of" ~ l1li)" chBek box .'A-' .nd ,..turn this nDtic. to the Ruei.t.r Gf Will. .nd In offlcl.1 ...a....nt ';11 II. i..... Dy tho PA D.pa.t-ent of R.wonu.. 8. IX! Th. .lIove eH.t h.. b.en o. will be .....or19d Ind tII. peld with tho P.M.~lv.nb Inh.rl tence TIlX ,.turn to D. filed b~ tho decod.nt.. r.p'....,.tlv.. C. [] The above Jnformgtion i~oorr.at andIDr d.bt. and dlduot1ons were psld b~ ~au. Vou "v.t oo"plet. PART L!J end/or PIIT (!] bo10w. [CHECK ] ONE BLOCK ONLY PART ~ TAX RETURN . COMPUTATJON LINE 1. Oat. h+.....li...,..d 2. Aooount Balance 3. Parcent Taxable 4. A~Dunt Subjeot to T8x S. Debts and Dcduct10ns 6. A~ount Taxable 7. Tex Rate e. TalC Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X II If you 1nd1oeta a different tex rate, please .teta your relatlonah1p to deoedent: PART [!] DATE PAID PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter cn L1na 5 of Tax COMputat10nJ deolare ~h8t the facts I and beUaf. I . ~ true, oorraot an - 76-6 DATE . COMMONWEALTH OF PENNSYLVANIA REV-1162 EXI' 1-96) OEPARTMENT OF REVENUE ~ BUREAu OF INOIIl1'OUAL TAXES OEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005651 HARPER WENDY 1112 MUSKET LN MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER ......-- fOld ---------- -------- 05118564 I $225.06 ESTATE INFORMATION: SSN: 172-01-6564 05116337 I $246.38 FILE NUMBER: 2105-0082 I DECEDENT NAME: MARTZ MIRIAM M I DATE OF PAYMENT: 08/04/2005 I POSTMARK DATE: 08/03/2005 I COUNTY: CUMBERLAND I - DATE OF DEATH: 01/16/2005 I I TOTAL AMOUNT PAID: $471.44 REMARKS: CHECK# 135 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPAYER I I I I j