HomeMy WebLinkAbout12-21-05
REV. 1100 EX + ('-00)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128.0601
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I DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Guy, William W.
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
06/09/2005
09/28/1919
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
CH::!CiAl.. USE ONLY
FILE NUMBER
21 05
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
00574
NUMBER
315-12-1094
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1. Original Return 0 2. Supplemental Return
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.... D D Future Interest Compromise (date of death after
lO:~Ul 4. Limited Estate 4a.
ull:lO: 12-12-82)
wo..u IX D
:rOO 6. Decedent Died Testate (Attach copy 7. Decedent Maintained a Living Trust (Attach
ull:..J
o..m of Will) copy of Trust)
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< D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death between
1 -
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (AMch Sch 0)
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::i ~ IRM NAME (If applicable)
8 ~ Kline Law Office
ELEPHONE NUMBER
717/770-2540
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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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)
714 Bridge Street
P.O. Box 461
New Cumberland, PA 17070
(1 ) 112,500.00
(2) None
(3) None
(4) None
(5) 2,000.00
(6) 26,373.04
(7) 51,311.83
(8)
(9) 18,832.02
(10)
OFHGjAL U::jE qf'Jl..Y
(-'~'
192,184.87
(11 )
18,832.02
(12)
173,352.85
13. Charitable and Governmental Bequests/Sec 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)
(14)
173,352.85
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z 173,352.85 .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
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0.. 17.Amount of Line 14 taxable at sibling rate .12 (17)
:;; x
0
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>< 18. Amount of Line 14 taxable at collateral rate
< x .15 (18)
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19. Tax Due (19)
7,800.88
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
7,800.88
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
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Decedent's Complete Address:
STREET ADDRESS
811 Rosemont Avenue
CITY
New Cumberland
I STATE PA
I ZIP 17070
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
7,800.88
Total Credits (A + B + C)
(2)
0.00
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty (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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 7,800.88
(5A)
(5B) 7,800.88
Make Check Payable to: REGISTER OF WILLS, AGENT
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................... ........................ .................. ................ ..................... .................
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;.................................................................................. ~ I
~: ~::::~ ~~e~;~~i~~~~:~~e~=s~~~. .~.~.~~~. ~~~ .~~~. :.~~:..~.~. .t.~~.~.~.~~~~~~.~~ .i.t.~. ~~~~~~~::::::::::::::::::::::::::::::::::::
d. receive the promise for life of either payments, benefits or care?..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?..... ....................................... .......................................... ...................... .......... 0
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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 retum. 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 of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
William . uy
DATE
T
SIGNATURE OF PERSON RESPONSIBL
333 Evergreen Street
New Cumoerland, PA 17070
()OJ
DATE
ADDRESS
SIGNATURE OF PR
Robert P. Kli
ADDRESS
714 Bridge Street
P.O. Box 461
New Cumberland, PA 17070
DATE
)2
-
OJ
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot 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.
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
I FILE NUMBER
21 - 05 - 00574
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 wilflng 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.
Guy, William W.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE OF
DEATH
112,500.00
811 Rosemont Avenue, New Cumberland Borough, Cumberland Co., P A 17070
TOTAL (Also enter on Line 1, Recapitulation)
112,500.00
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF G W'II' W
uy, 1 lam .
I FILE NUMBER
21 - 05 - 00574
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorshIp must be disclosed on schedule F.
ITEM
NUMBER
1
DESCRIPTION
1996 Ford truck VIN#IFTCRlOA8TUC83357
VALUE AT DATE OF
DEATH
2,000.00
TOTAL (Also enter on Line 5, Recapitulation)
2,000.00
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Guy, William W.
I FILE NUMBER
21 - 05 - 00574
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 William T. Guy
ADDRESS
RELATIONSHIP TO DECEDENT
811 Rosemont Avenue
New Cumberland, PA 17070
Son
B Mary Susan Bianchi
4306 Hillsdale Road
Harrisburg, PA 17112
Daughter
C Rebecca E. Theurer
900 Drexel Hills Boulevard
New Cumberland, PA 17070
Daughter
see continuation
JOINTLY OWNED PROPERTY:
DATE DESCRIPTION OF PROPERTY %OF
ITEM LETTER Include name of financial institution and bank account number DATE OF DEATH DATE OF DEATH
FOR JOINT MADE DECD'S VALUE OF
NUMBER TENANT JOINT or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT'S INTEREST
estate.
I A&B PNC Bank Checking Acct #51-4002-5464 21,564.84 33.33% 7,187.56
2 B PNC Bank CD #31300197453 6,418.01 50% 3,209.01
3 B 11/05/1984 Susquehanna Valley FCU Acct # 1 0 18 8,018.93 50% 4,009.47
4 C 11/01/1986 United States Savings Bonds (3), Series E & EE 6,415.00 50% 3,207.50
5 0 01/01/1978 United States Savings Bonds (3), Series E 7,519.00 50% 3,759.50
6 A 06/01/2004 United States Savings Bonds, Series HH 10,000.00 50% 5,000.00
TOTAL (Also enter on line 6, Recapitulation) 26,373.04
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
J
SCHEDULE F
JOINT OWNERS
FILE NUMBER
21 - 05 - 00574
ESTATE OF
Guy, William W.
SURVIVING JOINT TENANT'S) NAME
D Teresa A. Rillo
ADDRESS
RELATIONSHIP TO DECEDENT
401 E. Ontario St., Apt 201
Chicago, IL 60611
Daughter
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Guy, William W.
FILE NUMBER
21 - 05 - 00574
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF
Include the name of the transferee, their relationship to decedent and the date of transfer. VALUE OF ASSET DECO'S EXCLUSION TAXABLE VALUE
NUMBER Attach a copy of the deed for real estate. (I F APPLICABLE)
INTEREST
1 AllState Annuity #GA0590446 25,655.92 25,655.92
Beneficiary: Mary Susan Bianchi
2 AllState Annuity #GA0590452 25,655.91 25,655.91
Beneficiary: Rebecca E. Theurer
I
TOTAL (Also enter on line 7, Recapitulation) 51,311.83
*'
SCHEDULEH
FUNERAL.. EXPENSES &
ADMINIS1RA11VE COS1S
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Guy, William W.
I FILE NUMBER
21 - 05 - 00574
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Auer Memorial Home and Cremation Services, Inc.
1,227.00
2
Catholic Cemetaries
500.00
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State
Zip
2.
Attorney's Fees
Kline Law Office -- Robert P. Kline
2,250.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
Probate Fees Register Of Wills
Cumberland Law Journal
Patriot News
5. Accountant's Fees
State
Zip
4.
330.00
75.00
71.63
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Pennsylvania American Water
46.78
2
VGl
58.01
Total of Continuation Schedule(s)
14,273.60
18,832.02
TOTAL (Also enter on line 9, Recapitulation)
*'
Schedule H
FmeraI Expenses &
MninislralNe Costs continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
\ FILE NUMBER
21 - 05 - 00574
ESTATE OF
Guy, William W.
98.20
3
PPL
4
New Cumberland Boro (sewer/trash) (adjusted to account for proration per attached settlement
sheet)
84.61
5
Basement Doctor Waterproofing Co (mold remediation @ 811 Rosemont)
5,465.00
6
Nick Bianchi (Electrical Repair/Upgrade @ 811 Rosemont)
502.25
7
Real Estate Taxes (adjusted to account for proration per attached settlement sheet)
101.04
8
Settlement Costs (sale of 811 Rosemeont (see attached settlement sheet) )
7,997.50
9
William T.Guy (reimburse out of pocket expenses)
25.00
Page 2 of Schedule H
REV.1513 EX+ (9-00)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Guy, William W.
I FILE NUMBER
21 - 05 - 00574
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
.T.".'_f.\
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Mary Susan Bianchi Daughter One-fourth
4306 Hillsdale Road
Harrisburg, P A 17112
2 William T. Guy Son One-fourth
333 Evergreen Street
New Cumberland, P A 17070
3 Rebecca E. Theurer Daughter One-fourth
900 Drexel Hills Boulevard
New Cumberland, PA 17070
4 Teresa A. Rillo Daughter One-fourth
401 East Ontario Street, Apt. 201
Chicago, IL 60611
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
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LAST WILL AND TESTAMENT
OF
WILLIAM W. GUY
I, WILLIAM W. GUY, of New Cumberland, Cumberland County, Pennsylvania, being of
sound and disposing mind, memory and understanding, do make, publish and declare this to be my
Last Will and Testament, hereby revoking and making void all previous Wills and Codicils
heretofore made by me.
FIRST
I order and direct my personal representative hereinafter named to pay all of my just debts,
funeral expenses and expenses involved or connected with the administration of my estate as soon
after my death as is reasonably possible. However, my personal representative need not accelerate
and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more
advantageous to retain or renew and pay as they become due and payable. In do not own a burial
plot or a grave marker at the time of my death, I authorize my personal representative, in his, her, or
its sole discretion, to purchase a burial plot and to erect a suitable marker at my grave, and to
expend sums from my estate for this purpose.
Page 1 of 5 Pages
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SECOND
I give, devise, and bequeath my entire estate together with all insurance proceeds thereon of
whatever nature and wheresoever situate in equal shares to my children, MARY SUSAN
BIANCID, REBECCA E. THEURER, WILLIAM T. GUY, and TERESA A. RILLa, who
survive me by sixty (60) days.
THIRD
My Executor is authorized and empowered to exercise from time to time in his, her or its
sole discretion and without prior authority from any Court, in respect of any property forming part
of my estate or otherwise in its possession hereunder all powers conferred by law upon executors
and I intend that such powers be construed in the broadest possible manner.
FOURTH
I nominate, constitute and appoint my son, WILLIAM T. GUY, Executor of this my Last
Will and Testament. In the event WILLIAM T. GUY is deceased, unable or unwilling to serve or
shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint my son-in-
law, JOSEPH L. THEURER, JR., to serve instead. I direct that my personal representative shall
not be required to give or post bond for the faithful performance of his, her or its duties in this or
any other jurisdiction.
Page 2 of 5 Pages
FIFTH
I hereby declare it to be my expressed desire that my personal representative employ
Kline Law Office of New Cumberland, Pennsylvania, for legal advice and assistance regarding this
my Last Will and Testament, said attorneys having considerable knowledge of my affairs, views
and wishes respecting any matters that may arise at the probate of this instrument, the
administration of my estate, and the execution of the powers herein mentioned.
IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and
Testament this 2 c'J-
day of /I /fr
,2004.
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Jh~ T~r~.,,-
/ Witness
tvitt{~~ G~ ~~ul
~j?k<
Wltne s
Page 3 of 5 Pages
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF CUMBERLAND
I, WILLIAM W. GUY, the Testator whose name is signed to the attached or foregoing
instrument, having been duly qualified according to the law, do hereby acknowledge that I signed
and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I
signed it as my free and voluntary act for the purposes therein expressed.
IiJ~t} J "'~1 ~) d~ tI'
WILLIAM W. GUY
Sworn or affirmed and acknowledged before me by WILLIAM W. GUY, the Testator, this
z.s T-~ day of
~'-I
,2004.
~9Mo
NOTARY PUBLIC
NOTARIAL SEAL
ROBERT PETER KLINE, Notary Public
~ew Cumberland Bora., Cumberland Co
My Commission Expires June 21, 2004'
.J
Page 4 of 5 Pages
AFFIDA VIT
COMMONWEAL TH OF PENNSYL VANIA
SS
COUNTY OF CUMBERLAND
We, ;:5/-!#ft2o;rJ J!. ffJe'S7EJC and J...,Y dAlE r I]L/--VE , the
witnesses whose names are attached to the foregoing docwnent, being duly qualified according to
the law, do depose and say that we were present and saw the Testator sign and execute the
instrwnent as his Last Will and Testament; that he signed willingly and that he executed it as his
free and voluntary act for the purposes therein expressed; that each subscribing witness in the
hearing and sight of the testator signed the Last Will and Testament as witnesses and that to the best
of our knowledge the Testator was at the time 18 or more years of age, of sound mind and under no
constraint or undue influence.
,x?vz; ~
4~r M-
Sworn or affirmed and subscribed before me by :$ J-h--1?Z(J;J e, FE} ~ 7i::.~ and
)... y>tJ/t/~ P J(L/ Nc=
/
this 2..<5" ~ day of ~
,2004.
~?),~,
NOTARY PUBLIC
NOTARIAL SEAL
ROBERT PETER KLINE. Notary Public
New Cumberland Bora., Cumberland Co
My Commission Expires June 21, 2004'
Page 5 of 5 Pages
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MADE THE ~. II ~ day of December , in tlu year of our Lord
One Thousand Nine Hundred and Forty-six (1946)
1Bdweeu
ERNESTINE L. COOPER,foithnerly ERNESTINE L. LINGLE,
and ALFRED B. COOPER, her husband, of the Borough
of New Cumberland, County of Cumberland,and Sta.te
of Pennsylvania, GRANTORS, plrties of the first part
~~AND-r.-
~iILLIAMW. GUY and VIRGINIA A. GUY, his wife, of the
Borough of New Cumberland, County ofj Cumberland, and
state of Pennsylvania, GRAtITEES, parties
of the second part: mitne.a.aet4. That the said part ies of the first part, for a1ld in
consideration of the sum of One ($1.00) Dollar and other valuable considerations.
lawful money of the United States of America, well and t,'uly paid by tlte said part ies of the
second part to the said parties of the first part, at and before the sealing and delivery of these
presmts, th~.receipt whereof is hereby acknowledged, have granted, bargaz'ned,
sold, aliened, enfeoffed, released, conveyed and confirmed, and by these presents do grant, bargain,
sell, alien, enfeoff, release, couvey and confirm unto the said parties of the second part, their
heirs and assigns, -
1\.11 that certain lot or piece of land situate in the Borough of New ClllUberland,
County of Cumberland and state of Pennsylvania, more particularly bounded and
described as follol'TS, to wit:
BEGINNING at a point on the Western side of Rosemont Avenue on the
dividing line between Lots Nos. 6 and 7, Section "D", of the hereinafter mentioned
Plan of Lots; thence in a Southerly direction along Rosemont Avenue, fifty (50)
feet to a point at Lot No.8; thence in a Northwesterly direction along Lot No.8,
one hundred (100) feet to a point; thence in a Northeasterly direction along Lot
No. 16, fifty (50) feet to a point; thence in a Southeasterly direction along Lot
No.6, one hundred (100) feet to a point on Rosemont Avenue, the point or place
of Beginning.
BEING Lot No.7, Section "D", Plan No.5, Rosemont Addition. 'fhereon
erected a single frame dwelling house, No. 811 Rosemont Avenue, New Cumberland,
Pennsylvania.
BEING the same premises which Frank R. Leib, II and Huth E. Leib, his
wife, by deed dated June 19, 19lf4 and recorded in the Cumberland County Recorderls
Office in Deed Book "V", Vol. 12, Page 268, granted and conveyed unto Ernestine L.
Lingle, now intermarried "lith Alfred B. Cooper, who are the parties of the first
part hereto.
REGISTERED FV lHE:
80RGUGIi OF !{Li CliMBU1AND
12 DecernQe~19~
B. Pa1tUO.Yl.l"AY _
Secretary
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IDngrtl1rr wit/t all and singular, tlte buildings, improvements, woods, ways, rig/tts, liber.
ties, privileges, lureditaments alld appurtenances, to tlte same belonging, or in a1lJ'wise appertaining,
and tlte reversion and reversions, remainder a1ld remainders, rents, issues and profits tltereof, ami
of every part and parcel t/tereof; Anb nlsu, all the estate, rigltt, title, interest,
property, possession, claim and demand what-
soever, both in law and equity, of tlte said parties of the first part, of, in, to or out of tlte said
p,'emises, and every pal't and parce! thereof, with the appurtmances:
Wn .qnur nub to holb the said premises, with and singular the appurtmances, unto
the said parties of tlte second part, their /teirs and assigns'; to and for the
only proper use, benefit and be/zoof of the said parties of tlte st'cond part, their heirs
and assigns forever.
.i\ui) THE SAID parties
of tlie first part,
their
heirs, executors and administrators, 110 by these presents, covozant, grant alld ag'ree,
to and with the said parties oJ t/te second part, their heirs and assigns (01'-
ez/er, that they tlte said part ies of the first part, their
Iteirs all and singular the hereditaments and premises herein above described and graltted or men.
tioned, and intended so to be, witlt the appltrtenances, unto the said parties of the second
part, their heirs and assigns, a;;ainst tlte said part ies of the first part and their
heirs, against all and every otlter person or persons whomsoever, lawfully claiming or to c!aimt/te
same or any part thereof,
SHALL and WILL,
b). these presmts, WARRANT and/orever DEFEND.
lJu 1ltIItturnn 1ltIIqrrrof. the said parties 0/ the first part to tltese presmts have
hereunto set their hands and seal s Dated tlu day and year first above writtm.
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hwwn to me (or satisfactorily proven) to be the persons. .. whose names.. ar.e. subscribed to the
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and desired the same might be recorded as stich.
In witlless 'i.vlureof, .f lureunto set my Itand and ..I1QtQ-r;LaJ... . . .. seal.
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Notary Public
My commission t'~i~_~~~'~_~~__,'-h_-- -_:"':"_~---Ci\.ji^~;-:------
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Recorded IN THE OFFICE FOR RECORD.fNG OF DEEDS, IN AND FOR THE
COUNTY OF....~.......IN DEED BOOK..K.vot../a..PAGE..9:~.
Witness MY HAND AND SEAL OF OFFICE, THIS............./;J, '~"""""'"
DAYOF..~..~......ANNODOlYfINI, 19.".~ . ; ~
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Previous editions ar€l obsolele
form HUD-1 (3/86) ref Handbook 4305,~
A. Settlement Statement
U.S. Department of Housing and Urban Development
S. Tvpe of Loan OMS Approval No. 2502-0265 (expires 9/30/2006)
1. DFHA 2. DFmHA 3. K1Conv. Unins. I 6. File Number I 7. Loan Number /8. Mortgage Insurance Case Number
4. OVA 5. DConv. Ins. 05-3184EMLC 702089625
C. Note: .I_IIIS lorm IS urms leu..~o give you a s a emen~ 0 ac ua_l. se\lleme0l cos~s, Amoun~s pal~. 0 anu uy Ule se~lIemen agen are Sf~own. II TitleExpress Settlement System
Items marked "(p.o. c.)" were paid outside the closing; they are shown here for rnformalion purposes and are nol included in tile tolals
WARNING: II i~ a crime t~ knowingly make false statements to tile United States on this or any otller similar form. Penalties upon Printed 09/2212005 a114:44 MLC
conviction can Include a fine and imprisonment. For details see: Title 18 U. S. Code Section 1001 and Section 1010.
D. NAME OF BORROWER: Kendra E. Stauffer
ADDRESS: 103 Meadow Hill Drive, York, PA 17402
E. NAME OF SELLER: William W. Guy Estate
ADDRESS: 811 Rosemont Avenue New Cumberland PA 17070
F. NAME OF LENDER: USAA Federal Savings Bank
ADDRESS: 10750 McDermott Freewav, San Antonio TX 78288-0558
G. PROPERTY ADDRESS: 811 Rosemont Avenue, New Cumberland, PA 17070
Borouah of New Cumberland
H. SETTLEMENT AGENT: Homesale Settlement Services
PLACE OF SETTLEMENT: 2525 Eastern Boulevard, York PA 17402
I. SETTLEMENT DATE: 09/22/2005
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Conlract sales price 112 500.00 401. Contract sales price 112500.00
102. Personal ProDertv 402. Personal Property
103. Settlement charaes to borrower !line 1400\ 4 488.46 403.
104. 404.
105. 405.
Adjustments fpr items paid bv seller in advance Adiustments for items paid bv seller in advance
106. City/town taxes 09/22/05 to 12/31/05 68.92 406. City/town taxes 09/22/05 to 12/31/05 68.92
107. County taxes 09/22/05 to 12/31/05 57,94 407. County taxes 09/22/05 to 12/31/05 57.94
108. School Taxes 09/22/05 to 06/30/06 710.50 408. School Taxes 09/22/05 to 06/30/06 710.50
109. 3rd Qtr Sewer/Refuse 09/22/05 to 09/30/05 6.39 409. 3rd Qtr Sewer/Refuse 09/22/05 to 09/30/05 6.39
110. 410.
111. '411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 117832.21 420. GROSS AMOUNT DUE TO SELLER 113343.75
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. DeDosit or earnest money 2 000.00 501. Excess DeDosit (see instructions\
202. Princinal amount Df new loans 90 000.00 502. Settlement charaes to seller (line 14001 8962.10
203. Existina loanls\ taken subiect to 503. Existino loanls\ taken subiect to
204. 504. Payoff of First Mortoaae Loan
205. 505.
206. 2nd Mta (#3944461 16875.00 506.
207. Lender Credit to Buver 11 stl 350.00 507.
208. Lender Credit to Buver (2nd\ 200.50 508.
209. 509.
Adiustments for items unoaid bv seller Adiustments for items unoaid bv seller
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 109 425.50 520. TOTAL REDUCTION AMOUNT DUE SELLER 8962.10
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower lline 1201 117 832.21 601. Gross amount due to seller (line 420\ 113,343.75
302. Less amounts paid by/for borrower lline 2201 109425.50 602. Less reduction amount due seller !line 5201 8962.10
303. CASH FROM BORROWER 8 406.71 603. CASH TO SELLER 104381.65
SUBSTITUTE FORM 1099 SELLER ST~TEMENT: The information.contained ~erein is important tax information and is being fl.:lrnislled to the Internal Revenue Service. If you are required to file a return,
a negligence penalty or other sanction will be imposed on you if lI1is Item is reqUired to be reported and the IRS determines that It Ilas not been reported. The Contract Sales Price described on
line 401 above constitutes the Gross Proceeds of this transaction
You are required by law to provide the settlement agent (Fed. Tax 10 No: ) with your col'recllaxpayer identification number. If you do not provide your correct taxpayer identification
number, you may be subject to civil or criminal penalties imposed by law. Under penaltlBs of pe~ury. I certify that the number shown on this statement is my correct taxpayer identification number.
TlN:_-__-_,_-_-_ SELLER(S)SIGNATURE(S):
SELlER(S) NEW MAILING ADDRESS:
SELLER(SI PHONE NUMBERS (HI
('IV)
Previous editions are obsolete
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
File Number: 05-3184E
form HUD-1 (3186) ref Handbook 4305.2
PAGE 2
TitleExnress Settlement Svstem Printed 09/22/2005 at 14:44 MLC
l. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on price $112 500.00 IiiJ 5.500 = 6187.50 BORROWER'S SELLER'S
Division of commission lline 7001 as follows: FUNDS AT FUNDS AT
701. $ 3118.75 to REMAX REALTY SETTLEMENT SETTLEMENT
702. $ 3068.75 to COLDWEll BANKER BOB YOST HOMESAlE SERVICES
703. Commission oaid at Settlement 6 187.50
704. Administrative Services Fee to COLDWEll BANKER BOB YOST HOMESAlE SERVICES 95.00
800. ITEMS PAYABLE IN CONNECTION WITH lOAN
801. Loan Orininalion Fee %
802. Loan Discount %
803. Annraisal Fee to USAA Federal SavinQs Bank 210.00
804. Credit Renort to USAA Federal Savinas Bank 12.00
805. Processinn Fee to USAA Federal Savinas Bank 250.00
806. Annlication Fee
807. Tax Related Service Fee to USAA Federal Savinas Bank 85.00
808. Document Preoaration
809. Fiood Certification to USAA Federal Savinas Bank 8.00
810.
811.
900. ITEMS REQUIRED BY lENDER TO BE PAID IN ADVANCE
901. Interest From 09/22/2005 to 10/01/2005 (a)$ 14.3750 Idav 9 Davs 129.38
902. Mortnane Insurance Premium for to
903. Hazard Insurance Premium for to USAA Insurance 436.27
904. Lender Credit to Buver to USAA Federal SavinQs Bank $350.00 POC bv lender
905.
1000. RESERVES DEPOSITED WITH lENDER FOR
1001. Hazard Insurance 3 mo. @ $ 36.36 Imo 109.08
1002. Mortnane Insurance mo. (a) $ Imo
1003. City Pronertv Taxes 8 mo. (a) $ 38.99 Imo 311.92
1004. County Pronertv Taxes mO.@$ Imo
1005. School Taxes 3 mo. @ $ 78.20 Imo 234.60
1009. Annrenate Analvsis Adiustment to USAA Federal Savinas Bank -195.04 0.00
1100. TITLE CHARGES
1101. Settlement or closino fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Document Prenaration
1106. Notarv Feesl1 st & 2nd) to CLERK 35.00 15.00
1107. Attornev's fees
!includes above items No: )
1108. Title Insurance to lawyers Title 923.75
!includes above items No: 1101-1104,1108 ( Ratel \
1109. Loan Policv 90 000.00 -
1110. Owner's Policv 112500.00 - 923.75
1111. End 100 End 300 End900 to lawyers Title 150.00
1112. Wire Fees 11st & 2nd) to Homesale Settlement Services 40.00
1113. ClosinaSvcLtr to lawyers Title 35.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordinn Fees Deed $38.50 . Mortaaoe $ 64.50 . Release $ 103.00
1202. City/County tax/stamas Deed $1125.00 . Mortoane $ 1125.00
1203. State Tax/stamos Deed $1 125.00 . Mortnane $ 1125.00
1204.
1205. Rec Fee 12nd Mta) to RECORDER OF DEEDS 50.50
1300. ADDITIONAL SETTLEMENT CHARGES
1301. 2005/06 School Taxes to New Cumberland Boro CIO Robin Gasoeretti 938.40
1302. Whole House/Pest Insnectian to Homechek Inc. 315.00
1303. 3rd Qtr Sewer to NEW CUMBERLAND BOROUGH 26.20
1304. Transaction Fee to REMAX REALTY 125.00
1305. Home Warranty to AMERICAN HOME SHIELD 415.00
1306. Tax Certification to Homesale Settlement Services 5.00
1307. Overniaht and Handlina Fees to Homesale Settlement Services 25.00
1308. Mold T estina to MIKE BIECHlER 125.00
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Section J and 502 Section K\ 4 488.46 8.962.10
HUD CERTIFICATION OF BUYER AND SELLER
e ~~~ S.ta~~~~~p~n~f tt~~h~8g:~ O~~tYe'::;~~1~1~t~~~~t~eljef. it IS a true and accurate statement of all receipts and disburse~ents made on my account or by me
Jd.~7 ~ l3xecvlor
WARNING: IT IS A CRIME TO KNOWlNGL Y MAKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION
CAN INCLUOE A FINE ANO IMPRISONMENT. FOR OETAILS SEE TITLE 18,
U.S, CODE SECTION 1001 AND SECTION 1010.
By:
The HUD.1 Settlemenl Statement which J 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 statement.
~~~ '1-22~