HomeMy WebLinkAbout11-15-05
REV.1600 EX + (6-00)
*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
II 2005
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
402
NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SCHWARTZ, Donald H.
168-36-6585
I-
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DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
03-11-2005
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
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o 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach
copy of Will)
o 9. Litigation Proceeds Received
o
o
D
D
4a. Future Interest Compromise (date of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10 Spousal Povertv Credit (date of death between
. 12-31-91 and 1-1-95)
2. Supplemental Return
o 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS$ECTION MUST BE 'COMPI.ETED.ALI.:CORRESPONOENClfANDCONF,QENTLAI..TAXINfORMATioNSHOULO' BE[)IRECTEO.TO,:
NAME COMPLETE MAILING ADDRESS
JERRY R. DUFFIE
....
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FIRM NAME (If applicable)
JOHNSON, DUFFIE, STEWART & WEIDNER
301 MARKET ST.
PO BOX 109
Lemoyne, PA 17043-0109
TELEPHONE NUMBER
(717) 761-4540
1. Real Estate (Schedule A)
(1 )
70,500.00
None
None
None
4,169.75
None
None
(8)
14,834.62
70,323.26
OFFICIAb-llSE ONLY
C"-"~
-'.-)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
z 6. Jointly Owned Property (Schedule F) (6)
0 o Separate Billing Requested
i=
c( 7 . Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
...J
;:) (Schedule G or L) D Separate Billing Requested
I-
0:: 8. Total Gross Assets (total Lines 1-7)
c(
u 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
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10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
t...:._"l
LI
. -:1
(...)
74,669.75
(11 )
85,157.88
(12)
insolvent
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)
(13)
0.00
(14)
0.00
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) 0.00
z or transfers under Sec. 9116(a)(1.2)
0 (16)
i= 16.Amount of Line 14 taxable at lineal rate 0.00 x .045 0.00
~
;:)
11. 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) 0.00
::iE
0
u 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18) 0.00
)( x
~ 19. Tax Due
(19) 0.00
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
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>>BE'SURE~TOA~SW;R'AJ+i[q~~~:n(j~$;6J1j;R~((ERSE;~il)!!.'AND fiEC4fi~c~:MATH <'<;.<".:. . .k'. .... .
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00;
RK.
1lI~
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 [!J
b. retain the right to designate who shall use the property transferred or its income;.................................... D [!J
c. retain a reversionary interest; or.................................................................................................................. D [!J
d. receive the promise for life of either payments, benefits or care?.............................................................. D [!J
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ................. .... ........................................................................................... ....... D [!J
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... D [!J
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?..................................................................................................................... D [!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 pe~ury. 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 information o~ whi"h preparer has any knowledge. .. _~_u_,_..___
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE
Y M. Wood 305 Georgetown Road
. : m Ii )IJ:tX Mechanicsburg, PA 17050 1/-, l-Cfi
S ATURE F: ERSON RESPONSIBLE FOR FTClNG RETURN ADDRESS -----~,-------------~- - -----------, .-----
~ ~w:,~, :::~~~~,~ '00"''' 6~~~~ ~t1~~;; "<ee' u _~ (-ILOS ,,,,_
JERR DUFF
Decedent's Complete Address:
STREET ADDRESS
25 Sussex Road
CITY Cam p Hill
STATE P A
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
0.00
Total Credits (A + 8 + C)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
~
301 MARKET 51
Lemoyne, PA 17043-0109
ZIP 17011
(1 )
0.00
(2)
0.00
(3)
(4)
(5) 0.00
(5A)
(58) 0.00
DATE
II-Jl-{f;
For ate 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
su .. g 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 for the use of the surviving spouse is 0%
[72 P.S. 99116 (a) (1.1) (ii)]. 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 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, an adoptive parent, or a stepparent of 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.
99116 1.2) [72 P.S. 99116 (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. 99116 (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.
Rev-1602 EX+ (6-98)
.
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHWARTZ, Donald H.
FILE NUMBER
21-2005-402
All re.1 property owned solely or as a tenant In common must be reported at fair market value. Fair mar1<et value is defined as the price at which property would be
exchanged between a willing buyer and a wiliing seller, nerther being compelled to buy or sell, both having reasonabie knowledge of the relevant facts.
Real property which is Jointly-owned with right of survivorship must be disclosed on schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Real Estate -located at 25 Sussex Road, Camp Hill, Lower Allen Township,
Cumberland County, Pennsylvania. Tax Parcel No. 13-24-0797-224. Property sold
on September 2,2005. The settlement sheet is attached to this Return.
70.500.00
TOTAL (Also enter on Line 1, Recapitulation)
70.500.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule A (Rev. 6-98)
Rev-160S EX+ (6-9S)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHWARTZ, Donald H.
FILE NUMBER
21-2005-402
Include the proceeds of I~igetion and the date the proceeds were received by the estate.
All property jolntly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Citizens Bank - Checking Account
VALUE AT DATE
OF DEATH
2,500.00
2 Citizens Bank Savings Account
237.00
3 Fulton Bank Checking Account
120.00
4 Postmark Federal Credit Union - Checking Account
50.55
5 Reimbursement - to Estate for County Taxes (173.53); School taxes (864.52) and
Sewer (24.15)
1,062.20
6 Automobiles - 2 Automobiles owned at Death
200.00
TOTAL (Also enter on Line 5, Recapitulation)
4,169.75
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
REV-1161 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHWARTZ, Donald H.
FILE NUMBER
21-2005-402
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 6,897.50
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid 3,735.00
See continuation schedule(s) attached
2. Attorney's Fees 3,735.00
See continuation schedule(s) attached
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 125.00
See continuation schedule(s) attached
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 568.71
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 15,061.21
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rov-1602 EX+ (6-98)
.
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHWARTZ, Donald H.
FILE NUMBER
21-2005-402
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Myers Funeral Home, Inc. - Funeral Expenses
6.897.50
Subtotal
6.897.50
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rov-1602 EX+ (6-98)
.
SCHEDULE H-B1
PERSONAL REPRESENTATIVE'S
COMMISSIONS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHWARTZ, Donald H.
FILE NUMBER
21-2005-402
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Judy M. Wood - Administratrix Commission
1.867.50
2
Kathy L. Smith - Administratrix Commission
1.867.50
Subtotal
3.735.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B1 (Rev. 6-98)
Rev-1602 EX. (6-98)
*'
SCHEDULE H-B2
ATTORNEY'S FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHWARTZ, Donald H.
FILE NUMBER
21-2005-402
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Johnson Duffie Stewart & Weidner
3.735.00
Subtotal
3.735.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B2 (Rev. 6-98)
Rev-1602 EX+ (6-BS)
*'
SCHEDULE H-B4
PROBATE FEES
continued
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHWARTZ, Donald H.
FILE NUMBER
21-2005-402
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland County - Register of Wills Office - Probate Fees
125.00
Subtotal
125.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B4 (Rev. 6-98)
Rev-1602 EX+ (6-98)
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHWARTZ, Donald H.
FILE NUMBER
21-2005-402
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland County - Register of Wills Office - Filing Fees for Inheritance Tax
Return ($15.00) and Inventory ($15.00)
30.00
2
L.G. Conner Real Estate Appraisals
312.12
3
The Cumberland Law Journal - Notice of Estate Administration
75.00
4
The Patriot News - Notice of Estate Administration
151.59
Subtotal
568.71
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1612 EX+ (6.98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHWARTZ, Donald H.
FILE NUMBER
21-2005-402
Include unrelmbursed medlcll expenses.
ITEM
NUMBER DESCRIPTION
1 Associated Cardiologists - Account No. 214808
VALUE AT DATE
OF DEATH
150.00
2 Checks written for benefit of estate
480.32
3 Cingular Wireless - Account No. 34489332-001-40
149.40
4 Citizens Bank - Loan Balance. Account No. 002
184.47
5 Citizens Bank - Mortgage Account No.
49,258.76
6 Com cast Cable Television - Account No. 09547219608-01-0
29.16
7 Engle Publishing - Advertising costs prior to Death
746.14
8 Fulton Bank Check Credit Account - No. 0563083490
201.35
9 George K. Shahinian
1,400.00
10 MBNA America - Account No. 4313040501822712. Credit Card Account
3,710.37
11 MBNA America - Account No. 6011002950624999. Credit Card Account
2,307.02
12 Moffet Heart Assoc. - Account No. 0001
4,405.00
13 Pennsylvania American Water - Account No. 24-0640902-5
161.30
14 Pennsylvania Power & Light - Account No. 31660-78005
172.22
15 Postmark Federal Credit Union - Visa Account No. 4184920000019397
3,226.19
16 Settlement Charges - for property that sold on September 2,2005. A copy of the
settlement sheet is attached
2,526.95
17 UGI - Account No. 218719532002
877.71
Total of Continuation Schedule(s)
See attached page
TOTAL (Also enter on Line 10, Recapitulation)
70,096.67
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 Schedule I (Rev. 6-98)
Rov-1512 EX+ (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHWARTZ, Donald H.
FILE NUMBER
21-2005-402
ITEM
NUMBER
18
DESCRIPTION
XO Communications - Account No. 001000000070277
VALUE AT DATE
OF DEATH
110.31
TOTAL (Also enter on Line 10, Recapitulation)
70.096.67
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV.1613 EX+ (9..00)
.
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SCHWARTZ, Donald H. 21-2005-402
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
00 Not List Trustee(s)
I. TAXABLE DISTRIBUTIONS [include outright sfrousal
distributions, and ransfers
under Sec. 9116(a)(1.2)]
1 Kathy L Smith Daughter
40 West Baltimore Street
Carlisle, PA 17013
2 Judy M Wood Daughter
305 Georgetown Road
Mechanicsburg, PA 17050
Total
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
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
LISTING OF EXHIBITS FOR
ESTATE OF DONALD H. SCHWARTZ
EXHIBIT A
Settlement Sheet for ale of property located at 25 Sussex
Road, Lower Allen Township, Camp Hill, Pennsylvania
:262951
-
L. SETTLEMENT CHARGES Case # 1214 Paid From Paid From
700. Total Sales Commission based on Price: $ % Borrower's Seller'.
Division of Commission at: $ Total Funds At Funds At
70L Sell/ement Settlement
702.
703. Commission paid at Settlement I I
704. I I
800. Items Payable In Connection With Loan
801. Loan Origination Fee
802. Loan Discount
803. Appraisal Fee to
804. Credit Report to
805. Inspection Fee to
806. Flood Certification Fee
807. Document Preparation Fee
808.
809.
810.
811.
900. Items Required By Lender To Be Paid In Advance
90L Interest from 0.0000 IDay
902. Mortgage Ins. Premium 0 Months to
903. Hazard Ins. Premium 0 Years to
904. 0 Years to
905. 0 Years to
1000. Reserves Deposited With Lender For
1001. Hazard Insurance 0 Months @ $ IMonth
1002. Mortgage Insurance 0 Months @ $ IMonth
1003. CitylTown Taxes 0 Months @ $ IMonth
1004. County Taxes 0 Months @ $ 43.99 /Month
1005. Assessments 0 Months @ $ IMonth
1006. School Taxes 0 Months @ $ 87.37 IMonth
1007. 0 Months @ $ /Month
1008. 0 Months @ $ 87.37 /Month
1100. Tille Charges
1101. Settlement or closing fee
1102. Abstract or tille search
1103. Title Examination
1104. Title Insurance Binder
1105. Document preparation Johnson Duffie 858.00
1106. Notary fees
1107. Attorney's fees
(includes above items No :)
1108. Tille Insurance Assured Land Transfers -
(includes above items No :)
1109. Lender's coverage $
1110. Owner's coverage $
1111.
1112. I
1113. I
1200. Government Recording and Transfer Charges
1201. Recording Fees: Deed $ 39.50 Mortgage $ Release $ 39.50
1202. City/County tax/stamps: Deed $ 705.00 Mortgage $ 705.00
1203. State tax/stamps: Deed $ 705.00 Mortgage $ 705.00
1204. Recorder of Deeds
1205.
1300. Additional Settlement Charges
1301. 2005 County and 2005/2006 School District Taxes to Bonnie Miller, Tax Collector 1,576.17
1302. Delinquent Sewer/Refuse to Lower Allen Township Authority 245.78
1303.
1304.
1305.
1400. Total Settlement Charges (enter on lines 103 & 502, Sections J & K) 1,602.50 2,526.95
Parties agree that no liability is assumed by Settlement Agent for the accuracy of information furnished by others as shown on the HU0-1 Settlement Statement.
HUD CERTIFICATION OF BUYERS AND SELLERS
I have carefully 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 and
disbursements made on my account by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement.
Exchangor: Est e of Dona . art
Perms Ivan' Pro rties B
Seller's New Address & Phone:
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed In accordance with this
smt~~// '
~ement Agent
/~ a? .l.."CJ S
Date '
U.S. DEPARTMENT OF HOUSING and URBAN Ut::Vt::LU~IVlt:" 1
SETILEMENT STATEMENT Titlepro for Windows ™
JOHNSON, DUFFIE,
STEWART, WEIDNER B. TYPE OF LOAN
301 Market Street ol.FHA o 2. FMHA 03. CONV.UNINS.
Lemoyne, PA 17043 04.VA o 5. CONV. INS.
(717) 761-4540 6. FILE NUMBER: r LOAN NUMBER:
1214
MORT. INS. CASE NO.:
5279-1
C. NOTE: This form is furnished to 9ive you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "(p.o.c.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals.
D. NAME AND ADDRESS OF E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER
Herbert C. Moore and Richard W. Moore, Estate of Donald H. Schwartz CASH SALE
Co-Partners, tla Pennsylvania Properties,
Exchangor
G. PROPERTY LOCATION: H. SETILEMENT AGENT: Assured Land Transfers I. SETILEMENT DATE:
25 Sussex Road, Lower Allen Township Sep 02 2005
Friday
Camp Hill, PA 17011 PLACE OF SETILEMENT: 301 Market Street, Lemoyne, PA 09:00 AM
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. Gross Amount Due From Borrower 400. Gross Amount Due to Seiter
101. Contract sales price 70,500.00 401. Contract sales price 70,500.00
102. Personal Property 402. Personal Property
103. Settlement Charges (line 1400) 1,602.50 403.
104. 404.
105. 405.
Adjustments for items paid in advance by selter(s) Adjustments for ttems paid In advance by seller(s)
106. Cityrr own tax 406. Cityrrown tax
107. County/City tax 09/02/05 to 12/31/05 173.53 407. County/City tax 09/02/05 to 12/31/05 173.53
108. Assessments 408. Assessments
109. School Tax 09/02/05 to 06/30/06 864.52 409. School Tax 09/02105 to 06/30/06 864.52
110. 410.
111. Sewer/Refuse 09/02/05 to 09130/05 24.15 411. Sewer/Refuse 09/02105 to 09/30/05 24.15
112. 412.
120. Gross Amount Due from Borrower 73,164.70 420. Gross Amount Due to Seller 71,562.20
200. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Salter
201. Deposit or earnest money 501. Excess deposit (see instructions)
202. Principal Amount of new loan(s) 502. Settlement charges to seller (line 1400) 2,526.95
203. Existing loan(s) taken subjeclto 503. Exlstin9 loan(s) taken subject to
204. 504. Payoff of First Mortgage Loan
Citizens Bank 49,258.76
205. 505. Payoff of Second Mortgage Loan
06. Proceeds - Salem Church Road (Purchase Price) 70,500.00 506. Proceeds _ Salem Church Road (Purchase Price) 70,500.00
207. Proceeds _ Salem Church Road (Closing Costs) 2,664.70 507.
208. 508.
209. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210. Cityrrown tax 510. Cityrrown tax
211. County/City tax 511. County/City tax
212. Assessments 512. Assessments
213. School Tax 513. School Tax
214. 514.
215. 515.
216. 516.
217. 517.
218. . 518.
219. 519.
220. Total Paid By/For Borrower 73,164.70 520. T olal Reduction Amount Due Seller 122,285.7
300. CASH AT SETILEMENT Fromrro BORROWER 600. CASH AT SETILEMENT ToJFrom SELLER
301. Gross Am\. due from borrower (line 120) 73,164.70 601. Gross Amount due Seller (line 420) 71,562.2
302. Less Am\. paid by/for borrower (line 220) 73,164.70 602. Less reduction In Am\.due Seller (line 520) 122,285.7
303. Cash t8J FROM oTO Borrower 0.00 603. Cash 0 TO t8J FROM Seiter 50,723.!
* All references herein to "Borrower" shall mean "Exchangor"