HomeMy WebLinkAbout11-30-05
REV-15oo EX 16-(0)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SHEARER, EMILY H.
REV-1500
FILE NUMBER
21 05
0156
COUNTY CODE YEAR
NUMBER
SOCIAL SECURITY NUMBER
201-16-7267
DATE OF DEATH (MM-DD-YEAR)
02/06/2005
DATE OF BIRTH (MM-DD-YEAR)
07/31/1919
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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~ 1_ Original Retum
o 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrusl)
o 10. Spousal Poverty Credit (date of death between 12-31.91 and 1-1-95)
o 3. Remainder Retum (dale of death prior 1012-13.82)
o 5. Federal Estate Tax Retum Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AltachSch0)
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NAME COMPLETE MAILING ADDRESS
THOMAS E. FLOWER, ESQ. 2109 MARKET STREET
FIRM NAME (If Applicable) CA H LL PA 1
SAlOIS, SHUFF, FLOWER & LINDSAY MP I, 7011
TELEPHONE NUMBER
(717) 737-3405
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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)
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14. Net Value Subject to Tax (Line 12 minus Line 13)
(1)
(2)
(3)
(4)
(5)
122,500.00
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15,010.74
c..:'
(6)
_._~'\
(7)
(9)
(10)
(8)
34,776.48
4,536.91
(11)
(12)
(13)
137,510.74
39,313.39
98,197.35
0.00
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
98,197.35
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15. Amount of Line 14 taxable at the spousai 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
> > BE SURf: TO ANSWER ALL QUf:STIONS ON REVERSE SIDf: AND RECHECK MATH < <
X .0___ (15)
__~~_1jlL~Q._ x .0 ~Q._ (16)
4,418.88
x .12 (17)
x .15
(18)
(19)
4,418.88
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
'. Decedent's Complete Address:
STREET ADDRESS
336 EAST NORTH STREET
CITY CARLISLE
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE
PA
ZIP 17013
(1)
4,418.88
Total Credits ( A + B + C ) (2)
0.00
3.
Interest/Penally if applicable
D. Interest
E. Penalty
14.53
4.
Total Interest/Penally ( D + E )
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
(3)
(4)
(5)
(5A)
(5B)
14.53
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
4,433.41
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
4,433.41
Make Check Payable to: REGISTER OF WILLS, AGENT
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 [XI
b. retain the right to designate who shall use the property transferred or its income; ............................................ D [XI
c. retain a reversionary interest; or.......................................................................................................................... D [XI
d. receive the promise for life of either payments, benefits or care? ...................................................................... D [XI
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D [XI
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D [XI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D [XI
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 thai 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 of pre parer other than the personal representative is based on all information of which preparer has any knowiedge.
J!GN(\..I.U~E OF PERSON RESPOYE F~FILlNG RETURN
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ADDRESS
MARJORIE S. HOUCK, 325 MARKET STREET, NEW CUMBERLAND, PA 17070
-. "
SIG E OF PREPARER OTH R T N P. ESENTATIVE
DATE
1)- :3 0 -() 5,-
DATE --
1(, ~O ~
ADD SS
SAlOIS, 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 spouse is 3%
[72 P.S. 39116 (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. 39116(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-1502 EX+ (6-9.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
EMILY H. SHEARER
FILE NUMBER
21-05-0156
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 jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
DWELLING HOUSE AND LOT, nominal gross sale price less "seller assist" contribution,
1~lln_1 "tt""han\
VALUE AT DATE
OF DEATH
122,500.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
122,500.00
REV-1508 EX+ (6-98) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
EMILY H. SHEARER
FILE NUMBER
21-05-0156
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
iTEM
NUMBER
1. M&T Bank checking acct #77408241
DESCRIPTION
VALUE AT DATE
OF DEATH
2. M&T Bank savings acct #015004204274697, principal bal. $760.41, plus $0.16 accrued interest
5,599.40
760.47
3. M&T Bank, funeral fund escrow account payable to Ewing Bros. Funeral Home
5,504.32
2,793.00
4. Household furniture, furnishings and personal effects, per attached appraisal
5. return of unused health insurance premium
132.75
6. reissued life-period annuity check
220.80
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
15,010.74
REV-1511 EX+ (12-99).
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21-05-0156
ESTATE OF
EMILY H. SHEARER
ITEM
NUMBER
A.
B.
1.
4.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
EWING BROTHERS FUNERAL HOME, professional services
CASKET
VAULT
CLERGY HONORARIUM
GRAVE OPENING and INTERMENT
HAIRDRESSER (35.00) and FLOWERS (159.00)
DEATH CERTIFICATES
ADMINISTRATIVE COSTS:
3,580.00
2,995.00
1,175.00
75.00
990.00
194.00
60.00
2.
3.
4.
5.
6.
7.
Personal Representative's Commissions
Name of Personal Representative(s) Marjorie S. Houck
Social Security Number(s)/EIN Number of Personal Representative(s) 206-34-7916
Street Address 325 Market Street
5,000.00
City New Cumberland
Year(s)'Commission Paid: 2005
State PA Zip 17070
2.
Attorney Fees
6,400.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
Jip
Relationship of Claimant to Decedent
Probate Fees
302.00
7.
6. Tax Return Preparer's Fees
5. Accountant's Fees
10.
11.
12.
8.
Publish Estate Notices: Cumbo L. Jrnl. - $75, Sentinel- $158.81
Appraisal fees - real estate ($275); household goods ($360)
Dan Raudebaugh - Borough required sidewalk section replacement
Said is, Shuff, Flower & Lindsay - lifetime legal services
Utilities: UGI gas heating fuel ($484.18), water/sewer svce. ($149.51), PPL electric svce. ($145.74)
Continuation Sheet total
233.81
635.00
770.00
787.00
779.43
10,800.24
9.
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
34,776.48
SCHEDULE H
(Continuation Sheet)
ESTATE OF
EMILY H. SHEARER
FILE NUMBER
21-05-0156
12. Homeowners insurance premiums 269.23
13. Real Estate Tax 507.01
14. Home warranty 409.00
15. Repair credit to buyers 200.00
16. Window repair 40.00
17. Real estate sales commission 7,4 75.00
18. Rubbish removal & hauling 470.00
19. Real estate transfer tax 1,250.00
20. Mowing 180.00
Continuation Sheet Total 10,800.24
REV-1512 EX+ (12-03)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
EMILY H. SHEARER
FILE NUMBER
21-05-0156
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
PPL - electric bill
49.93
2.
UGI - gas heating fuel bill
93.00
3.
Sprint - phone bill
158.81
4.
Bora. of Carlisle - water bill
32.36
5.
West Shore EMS - ambulance service
178.00
6.
Peerless Insurance - homeowner's insurance, first quarter premium
133.50
7.
Carlisle Pathology Associates - lab work
140.00
8.
Pharmerica - medications
1,056.73
9.
PA Dept of Rev - income tax
9.05
10.
United Church of Christ Homes, Sarah Todd Home - nursing home bill
2,254.30
11.
City/County per capita tax
11.00
12.
City/County real estate tax
420.23
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4,536.91
REV-1513 EX. (9-00) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
EMILY H. SHEARER
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Connie S. Uzee, 5015 E. Lake Rd., Livonia, NY 14487
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
21-05-0156
AMOUNT OR SHARE
OF ESTATE
1.
daughter 0.25
daughter 0.25
daughter 0.25
.--
son 0.1J.,jj;)
,-
grandson 0.1 t.~
2. Carolyn S. Ursa, 251 W. Oekalb Pike, Apt. E908, King of Prussia, PA
3. Marjorie S. Houck, 325 Market St., New Cumberland, PA 17070
4. Barry L. Shearer, 219 W. Springville Rd., Boiling Springs, PA 17007
5. Casey L. Shearer, 219 W. Springville Rd., Boiling Springs, PA 17007
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
(If more space is needed, insert additional sheets of the same size)
11ictgt Will Club Wtslctttttttl
OF
EMILY H. SHEARER
I, EMILY H. SHEARER, of 336 East North Street, Carlisle, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory and understanding,
do make, publish and declare this as and for my Last Will and Testament, hereby
revoking and making void any and all former Wills, Codicils, or writings in the nature
thereof, by me at any time heretofore made.
FIRST: I hereby order and direct my Executrix or Executor,
hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses
and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be
conveniently done after my death, out of my residuary estate.
SECOND: All the rest, residue and remainder of my estate, be it real,
personal or mixed, of whatsoever kind and wheresoever situate, i give, devise and
bequeath to my children, per stirpes, as follows:
A. One-quarter (1/4) to my daughter, MARJORIE S. HOUCK, of
New Cumberland, Pennsylvania;
B. One-quarter (1/4) to my daughter, CONNIE S. SHEARER, of
New York state;
C. One-quarter (1/4) to my daughter, CAROLYN S. URSO, of
King of Prussia, Pennsylvania;
D. One-eighth (1/8) to my son, BARRY L. SHEARER, of Boiling
Springs, Pennsylvania; and
E. One-eighth (1/8) to my son, BARRY L. SHEARER, of Boiling
Springs, Pennsylvania, IN TRUST for the benefit qf my grandson, CASEY LEE
SHEARER, of Boiling Springs, Pennsylvania. The Trustee shall invest the funds in good
and safe securities, legal for Trust funds in the Commonwealth of Pennsylvania and may
use the income derived therefrom for the support, maintenance, health, education and
general welfare of my said grandson. In addition, I hereby authorize and empower the
Trustee to use as much of the principal as he in his sole discretion shall deem necessary
and proper for the support, maintenance, health, education and general welfare of my
said grandson, and to distribute absolutely to him the principal and accumulated income,
if any, upon their attainment of the age of twenty-five (25) years.
The difference in the shares above e
daughters who have helped me with my personal expenses over the years.
THIRD: I intend to leave with my Will a list of personal property to be
designated to be received by various relatives. I instruct my Executor, herein named, to
respect said list as my intentions and to treat it as being incorporated in my Will. To the
extent that I do not specify all items of personal property, I direct that my children, as
2
supervised and directed by my Executor, shall have the right to receive in kind any items
of personal property not so specified, the value of which unspecified items shall be
utilized to adjust the proportionate shares of my residuary estate as set forth above. Any
items not so sold may be sold by my Executor at public or private sale, the net proceeds
of which shall be added to my residuary estate.
LASTL Y:
I nominate, constitute and appoint my daughter, MARJORIE
S. HOUCK, to be the Executrix of this my Last Will and Testament. In the event that the
said MARJORIE S. HOUCK shall be unable to serve as Executrix for any reason, I
appoint my daughter, CAROLYN S. URSO, as Executrix. No Executor or Executrix shall
be required to file bond in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
/O/t
.
day of
1Hp..
,2000.
S6:==> . 7 h ,"""" I
y-}1/!...; ~rr . /Y--Yz/!rj Lv j
I Emily H. Shearer
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
~~
3
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
I, EMILY H. SHEARER, Testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that I signed it
willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
Sworn or affirmed. to and acknoViledged before me, by
SHEARER, the Testator, this Io+k.. day of "-1YVO-
EMILY H.
2000.
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Emfly H. Shearer, Testator
It.
NOTARIAL IlEAL
""ERLENE J. MARHeYKA. NOTARY PU8UC
CARU8l.E. ClJMBERlNI) COUNTY, PA
. .~y COMMISSION EXPlAE8 JUNE 8.1002
4
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
We, James D. Flower, Jr. and Thomas E. Flower
the witnesses whose names are signed to the attached or foregoing instrument, being
duly qualified according to law, do depose and say that we were present and saw
Testator sign and execute the instrument as her Last Will; that she 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 Testator signed the Will as witnesses; and that
to the best of our knowledge the Testator was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
and
Thomas E. Flower
Sworn or affirmed to and subscribed to before me by James D. Flower, Jr.
this ~daYOf~d
2000.
~~qy~
Witness
NOTARIAL 8EAL.
MEALENE J. MARHEYKA. NOTARY PU8UC
CAAUSLE. CUMBeRI.AND COUNTY, PA
MY COMMISSION EXPIRES JUNE 8, IDOl
5
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u.u. ........, "'" 'V......., v,- "vu"'"~\.:J f"\1~LJ Ur\Of"\I~ UJ::VJ::LUt"'IVll::N I
OMS No. 2502-0265
B. Tvoe of Loan' . .
.1.0FHA 2. [JFm,~A 3.0Conv.Unihs."
4. OVA 5. OConv. Ins.
.... "". "
6. File Number:
RE05-250
7. Loan Number:
225-238551
B. Mortg"age Insurance Case Number:
..
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.o.c.Y' were paid outsidf3lhe closing; they are. shown here for Informational purpos~s~!ld arer?t included in the totals.
D. Name and Address ofBorrower(s):
Amanda R. Hoover
Donald R. Hoover
Eo Nclrne and Address of Se/ler(s):
Estate of Emily I-j. ~hearer
66 E. Main SI. ,
n
G.property Location:
336 East North Street, Carlisle, Pennsylvania 17013
Carlisle Borol.\gh, Cumberland County
02-21-0318-136
F. Name and Address of!-ender:
American Mortgage Network Inc, dl1:l/~ t.mNet Mortgage
10421 Wateridge Circle-Suite 250
San Diego CA 92121
Place of Settlement:
Irvine Row, Carli:;le, fA 17013
H. Name ofSettlemen.t Agent:
Orchard Settiement Services,LLC
Funding Date:
11-29-2005
to
11-29~2005 to 12-31-2005
36.84
11-29-2005 to
6-30-2006
589.02
11 069.32
205.
505. Payottof second mortgage loan
2500.00 506. Seller credittoBu er
2 500.00
20B.
209.
~ ~- - - - -~,..---~
__ ____.__. _' I .:. ,
SOB.
509,
214.
215.
I'.,
Bl.1r~taif51twm
based on price $ 122,500.00 @l 6. % =" 7,350.00
Division of Commission (line 7001 as'follows'
701. $ 3,700.00 to ERA-NRT .
702. $ 3,650.00 to Hooke, Hooke & Eckman
:Irf; ~:~"{al3'':':- -.'Q....' I ~....,-..:~~~...~~.::l:;jJill~~~FI :t,~i}:"'l~' ,.\, (1~-,:.Jj:~ :~~L"r;.~1ql:r~"l~~t~~<~~;;~
Paid From
Borrowers
Funds at
Settlement
Paid From
Seller's
Funds at
Settlement
Fee
35.00
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Ilii;;I1fflt.';.-'.'il~{:"lillil:I'iJo\:d4:j'I'I:II_ "oJ'l:iJ2r.jl'UnOlJ_I:.'J-;IOI,j:~_.___.. .__._ _ ,_.""~,_ _~._..~_~___"..-=-l~~""
813.
814
49.62
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905
1107. Attorney's fees to Saidis, Shuff, Flower & Lindsay POC
includes above item numbers:
1108. Title ins\lrance tq Orchard Settlement Services, LLC, Agent for Fidelity National Title
1 250.00
~~~1''T~:;;rij ~1:.&._~.__~4~_.1_~_ ~_~___~~~"-_,_~~_-.. ~_~_._ ~.~_-,~~~~_~~~_ _~~~..~-~-~_~=.~~~.~U~~~K~{lf~Q~j:i:;1I\3
1205.
1305. Sidewalk Re air
1400. Total Settlement Char es ente~ioh; IInes103Sectlort ..Jahd 5ois~eh6" K 6 157.39
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CERTIFICATION: I have carefuIlYrevleWl:lclth:eHUp-1~ettll:lrnl:lnt ~t~ternent lind to the best of my knowledge and belief, it is a true and
accurate statement of all receipts and disbursementsmaqe on my ac~bunt or I>Y me in this trClnsaction. l further certify that' recejveda copy
ai;~:Jf;;:t; · :,g~~~ - J!/4.~~, 5~",I","fSe"er
1 132.96
310.00
770.00
11 069.32
The HUD-1 Settlement Statement which I hClve prepClred Is a trUe and accurate llccount of the funds qlsbursed or to be disbursed by the
undersigne part of the settlement of this . nsaction.
J(;1~-S-
Date
WARNING: It is a crime to knowingly make false statements to the United States on this or anY other similar form. Penalties upon conviction
can include a fine and imprlsionment. For details see: Title 18 U.S, Code Section 1001 and Section 1010.
m1 M&fBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
March 30, 2005
Law Offices
Saidis, Shuff, Flower & Lindsay
2109 Market Street
Camp Hill, Pennsylvania 17011
Re: Estate of' Emilv H Shearer
Social Security: 201-16-7267
Date of Death: Februarv 06, 2005
Dear Sir or Madam:
Per your inquiry dated March 15, 2005, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1.
Type of Account
Checking Account
Account Number
77408241
Ownership (Names oj)
Emily H Shearer *
Marjorie E Houck, Connie S Uzee, POA's
Opening Date
10/28/68
Balance on Date of Death
$5,599.40
Accrued Interest
$ 0.00
Total
.n . ..... 'n. ""H ..," ..~. ...~ ....._... ....._ ..........__..... ..... ...n..... ....... ,,,.._.,..._ _......._............ _.. ......._ __..... .....__..___...___.__.._____............._.
$5,599.40
2.
Type of Account
Savings Account
Account Number
015004204274697
Ownership (Names oj)
Emily H Shearer *
Marjorie E Houck, Connie S Uzee, POA's
Opening Date
11/7/03
Balance on Date of Death
$760.31
Accrued Interest
$ 0.16
Total
$760.47
3.
Type of Account
Certificate of Deposit / Escrow Account for Ewing
Brothers Funeral
Account Number
031003910676576
Ownership (Names oj)
Emily H Shearer *
Marjorie E Houck, Connie S Uzee, PDA's
Opening Date
2/7/00 Closed 2/15/05
Balance on Date of Death
$5,208.47
Accrued Interest
$ 295.85
Total
$5,504.32
Please be advised, there was no safe deposit box found for the above decedent.
In response to your request to close the accounts, I am forwarding your request to the decedent's branch of record today.
* If you have any further questions or need additional account information, regarding ownership, closures and/or
reimbursement of funds, etc., please contact our Spring Garden Office at 100 South Spring Garden Street, Carlisle,
Pennsylvania 17013 or phone the branch at # 717-240-4525.
Sincerely,
~d~
Nancy Clagett
Records Management
APPRAISAL REPORT
OF
PERSONAL PROPERTY
OF
Emily Shearer, deceased
date of death (d.o.d.) February 06, 2005
336 East North St.
Carlisle, PA 17013
for:
Marjorie Houch, Executrix
AS OF:
d.o.d. February 06, 2005
Reported on May 31, 2005
,
BY:
IBIS APPRAISAL
SER VICES
14.5 N Hanover St.
P'QBox24
Carlisle, P A 1701J
(717) 24.5-3474
lax 2.58-9502
Ibisas@eartJJink.net
APPRAISAL SUMMARY
It is in my opinion, that as of d.o.d. February 06, 2005, the Fair Market Value ofthe
personal property of Emily Shearer, deceased:
(Two Thousand Seven Hundred Ninety Three Dollars and Zero Cents)
($2,793.00)
" IBIS APPRAISAL
SER VICES
Alyssa . L ney, .A.P.P.
The report must be read in its entiretv. The Appraisal Summarv ONLY is
not the appraisal report.
4