The URL can be used to link to this page

Home My WebLink About12-27-05 W I- It:: :!U) ult:lt:: WILU zOO .. 1t:...J ~ ILCD IL c( REV-1500<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 2 1 -05 0 3 1 1 ""CoUNTY"CoiiE -VEAR- - - Nii'MaER- - ~ Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD-Year) 1 84- 1 2 - 0 165 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS Hoffman Frederick A. Jr. DATE OF DEATH (MM-DD-Year) 03/27/2005 01/12/1922 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) !Xl 1. Original Return o 4. Limited Estate !Xl 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received SOCIAL SECURITY NUMBER o 2. Supplemental Return o 4a. Future Interest Compromise (date 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 Return (dat6 of death prior to 12-13-82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 1. Real Estate (Schedule A) (1) 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) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 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) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) z o i= :5 :J ~ a: <( o w a::: I- Z W C Z o IL U) W It: It: o U NAME Robert A. Bull Es uire FIRM NAME (If Applicable) Bull Bull & Knecht LLP TELEPHONE NUMBER 570759-1231 Berwick PA 18603 OFFICIA!..,USE ONLY I 185,900.00 179,894.11 74,528.52 ;"...J J c" . 127,117.391 (8) 567,440.02 20,105.30 6,166.39 (11) (12) (13) 26,271.69 541,168.33 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= ~ :J a. :IE o o >< <( to- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate (14) 541,168.33 0.00 X _ (15) 541,168.33 X .045 (16) 0.00 X .12 (17) 0.00 X .15 (18) (19) Decedent's Complete Address: STREET ADDRESS 5213 Cobblestone Drive CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 24,352.57 20,900.00 1.100.00 Total Credits (A + B + C) (2) 22,000.00 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check to: REGISTER OF WILLS, AGENT 0.00 2,352.57 2,352.57 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; ........................................................................... 0 IXI b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 IXI c. retain a reversionary interest; or ...................................................................................................... 0 IXI d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IXI 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?....... ................ ....... ..... ........ ........... ................. .... ... .... ............ 0 IXI 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. 0 IXI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... IXI 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. PA 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. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P,S. ~9116 (a) (1.1) (ii)]. 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. ~9116(a)(1.2)], The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(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 + (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER H ffman Fr d ri k . Jr. 21 11 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. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION Real Estate situate at 5213 Cobblestone Drive, Mechanicsburg Book 201, Page 1123 Cumberland County Sales Price $185,900.00 VALUE AT DATE OF DEATH 185,900.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 185,900.00 REV-1503 EX + (6-98) *' SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hoffman. Frederick A. Jr. FILE NUMBER 21 05 0311 All property jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION ITEM NUMBER 1. United States Savings Bonds 2. Columbia County Farmers National Bank Bancorp Inc, 5,376.Shares @ $27.18 a share 3. Nationwide Financial 136 Shares @ $35.73 4. Prudential Financial 295 Shares @ 56.99 a share VALUE AT DATE OF DEATH 12,103.10 146,119.68 4,859.28 16,812.05 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 179 894.11 REV-1508 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Hoffman. Frederick A. Jr. FILE NUMBER 21 05 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. 0311 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 3,682.85 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. M & T Bank Account #43361382 2004 Buick LeSaber 18,000.00 Prudential Command Account 47,657.06 Patriot News, Refund 160.90 Nationwide Financial - Dividends 51.68 Marsh Affinity Practice 34.22 Asbury Services, Inc., Refund 547.84 Highwark He alth Insurance, Refund 446.40 Continental Casualty, Refund 289.86 U. S. Treasury, Refund 2,560.00 Columbia County Farmers National Bank - Dividends 967.68 Pruco Securities 127.53 Verizon Wireless, Refund 2.50 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 74 528.52 REV-1510 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hoffman. Frederick A. Jr. SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21 05 0311 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INClUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAl ESTATE VALUE OF ASSET INTEREST VALUE (IF APPliCABlE) 1. Fulton Bank IRA 321-1434649 1,223.74 100. 1,223.74 Beneficiary Kathryn Wadsworth - Daughter 2. Merrill Lynch Annuity # 950871220 42,194.93 100. 42,194.93 Beneficiaries - Kathryn Wadsworth (Daughter) David Hoffman & Richard Hoffman (Sons) 3. Prudential Financial Investor IRA 42870375 15,864.07 100. 15,864.07 Beneficiaries - Frederick A. Hoffman Jr. Estate 4. Prudential Financial Annuity # E0200002 67,834.65 100. 67,834.65 Beneficiaries - Kathryn Wadsworth (Daughter) David Hoffman & Richard Hoffman (Sons) .., , TOTAL (Also enter on line 7 Recapitulation) $ 127117.39 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Hoffman. Frederick A. Jr. FILE NUMBER 21 05 0311 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Parthemore Funeral Home 10,137.16 2. Cemetery 995.00 3. Funeral Dinner 300.00 4. James R. Gingrich, Memorials 145.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Bull, Bull & Knecht, LLP 350.00 3. Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip RelaUonship of Claimant to Decedent 4. Probate Fees Register of Wills, Cumberland County 512.00 5. Accountant's Fees Barbush & Hoffman, CPA Tax Returns 385.00 6. Tax Return Preparer's Fees 7. Verizon Wireless, Service 41.38 8. Bonnie K. Miller, Treasurer, 2005 County Taxes & School Taxes & Tax Certification 718.50 9. Lower Allen Township, sewer service 156.47 10. Penn National Insurance, prem due 80.00 11. Stone, La Faver & Shekletski, Attorney Fees & Legal Notices 1,169.94 12. Wesley Mews Condo Association, Condo Dues 516.00 13. PA American Water Co., Service 112.92 14. Verizon, Service 72.76 15. P P L Electric Utilities, Service 240.07 16. UGI Utilities, Service 101.83 17. Corncast Cable, Service 90.54 18. First National Bank of Berwick, Checkbook Charges & Signature Guaranty 25.00 TOTAL (Also enter on line 9, Recapitulation) $ 20,105.30 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent Hoffman, Frederick A. Jr. Decedent's Name Page 1 21 05 0311 File Number Schedule H - Funeral Expenses & Administrative Costs - 87. ITEM NUMBER DESCRIPTION AMOUNT 19. 20. 21. 22. 23. 24. 25. UPS Overnight Letters Appraisal Solutions, Consultant fee Transfer Taxes Notary Fees Kathryn Wadsworth, reimburse carpet cleaning Donald Wadsworth, reimburse moving van rental & expenses Kathryn Wadsworth, Expenses as Executrix 15.51 50.00 1,859.00 10.00 295.72 238.70 1,486.80 SUBTOTAL SCHEDULE H.B7 3,955.73 REV-1512 EX + (6-98) '* SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hoffman. Frederick A. Jr. FILE NUMBER 21 05 0311 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Citizens Automobile Financing, Payoff Car Loan VALUE AT DATE OF DEATH 5,981.84 2. Mobile X-Ray Imaging Inc., Balance Due by patient 35.26 3. Alert Pharmacy Systems, Inc., Balance Due by patient 43.50 4. GM Card member Services, Balance Due 105.79 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6 166.39 . . .",.,,,,,,, "" COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hoffman Fredp.rir.k A. Jr. SCHEDULE J BENEFICIARIES NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (al (1.2)] Kathryn H. Wadsworth 256 New Castle Drive, Shillington PA 19607 FILE NUMBER 21 05 RELATIONSHIP TO DECEDENT Do Not list Trustee(s) 0311 AMOUNT OR SHARE OF ESTATE 1. Lineal One Third of Residue 2. David M. Hoffman 105 Red Brush Trail, Harmony PA 16037 Lineal One Third of Residue 3. Richard F. Hoffman 1602 E Camino Cielo, Tucson AZ 85718 Lineal One Third of Residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 11. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 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) REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death:_.____~_~.____:2QJilQO.QQ Discount: .1, 100.00 Interest Table Year Days [)eli~que~t I this time period Balance Due this year Interest this period Before 1981 1982 - - ____ __u'._ 1983 1984 1985 J 91!6 _______ 1987 -- . ___.'___m___._______ I 1988through199_1 /1992 1993through.1994 ~1995 through 1998 1999 --- --- - -- - -------- 2000 - ---- --- - ---- --- --- - 2001 r~2002-_.n---- 2003 2004 - -----------. ~ .---- .-------.- -~._-----_.__.-._--_.__.~.._--- -- - ---------.,-- -- .----,.---. -_._-----_._~-------_._-- ----- - ---- ____m__. __ __ _ __u._________.. '_ _m___.______ _____, _____m"_____'",__ _..________.___________.___ ______ ___ TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: _. LAST WILL AND TESTAMENT OF FREDERICK A. HOFFMAN also known as FRED A. HOFFMAN. JR. I, FREDERICK A. HOFFMAN also known as FRED A. HOFFMAN, JR., of the Township of Lower Allen, County of Cumberland, and Common- wealth of Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I devise and bequeath all of my estate, of every .nature and wherever situate to my wife, JEANNE M. HOFFMAN, providing she shall survive me by thirty days. ITEM II: Should my wife, JEANNE M. HOFFMAN, predec~ase me . or die on or before the thirtieth day following my death, I devise and bequeath all of my estate, of every nature and Wherev- er Situate, in equal shares to such of my Children, KATHRYN MILLER, DAVID M. HOFFMAN and RICHARD F. HOFFMAN, as survive me by thirty days. Should any of my above named children predecease me or die on or before the thirtieth day following my death, I devise and bequeath the share of such child to his or her issue per stirpes living on the thirtY-first day following my death; and should any of such child of mine leave no such issue living on the thirtY-first day following my death, I devise and bequeath the share of SUch child to my issue per stirpes living on the thirtY-first day following my death. ITEM III: I appoint my wife, JEANNE M. HOFFMAN, and her SUccessors, guardian of any property which passes either under this will or otherwise to a minor and with respect to which 1 am -1- ----..---- ~--"--, ..._~..,_.....~.~~.J . ~-'., ~". '~.~'~..... 6 ,.;., ,.' 'J ~t U..... J. "ri.'.::JIJ ' ! -. --".-.. ..--' .. ..-------..------:---. --...-.--.- -..----. -~_..__._. ....----.------ ._-~-.._.._- cally done so, provided that this appointment of a guardian shall authorized to appoint a guardian and have not otherwise specifi- distribute a share where possible to the minor or to another for not supersede the right of any fiduciary in its discretion to 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 undergraduate) 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 ~esponsibility, to the minor or to the minor's parent or to any person taking care of the minor. "ITEM"IV: I appoint my wife, 'JEANNE M. HOFFMAN, Executrix of this my last will. Should my wife, JEANNE M. HOFFMAN, fail to qualify or cease to act as Executrix, I appoint my daughter, KATHRYN MILLER, Executrix of this my last will. ITEM V: I direct that my Executrix Or-Guardian, or their performance of their duties in any juriSdiction. successors, shall not be required to give bond for the faithful IN WITNESS WHEREOF, I, FRED A. HOFFMAN also known as FRED A. HOFFMAN, JR., have hereunto set my hand and seal t~is 17 day .of /Y'JI.L!"'H~&/? , 1990. ~A._~_~ _ FREDERICK A. HOFF ~~'~;;;.0 ~RED A. HOF JR. v -2- f--. ,I 1... .~ u "':.......:.::t..,.:..d~".Ll.".!..!lJ~lLl;i.(...".~I~!,J.,~d.l~;...-_II . - -.--------r...----.-. - ---________._____~-____ __ .. _____..._ SIGNED, SEALED, PUBLISHED and DECLARED, by FREDERICK A. HOFFMAN also known as FRED A. HOFFMAN, JR., the Testator above ence of us, who, at his request, in his presence and in the named, as and for his Last Will and Testament, and in the pres- ~f each . ~ Wl.tness other, have subscribed our names as witnesses. f1a/ti,~~",o .fl., Address I ~. dt rj)(j~ A./l-n '!k071 Witness 1JLf./J) 0 }nJbtll lal7d~ P/1 Address COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND :SS: . . ~, :.:, ~ JR., the Testator whose name is signed to the attached or forego- ing instrument, having been duly qualified according to law do hereby aCknowledge that I signed and executed this 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 contained. I, FREDERICK A. HOFFMAN also known as FRED A. HOFFMAN, ~~~-,~ REDERICK A. HOF ~~_._-~ RED A. HOF1!' ,. . FREDERICK A. HOFFMAN also Testator, this /9 -tit day of Sworn to or affirmed to and acknowledged before me by known as FRED A. HOFFMAN, JR., the Yl.M~~ ' 1990. ~~~-' Notary Publ c . ~"j.. -. . -3- NOTARW. SEAl CONSTANCE L KABU. Ncl3fy P1dc New Cumberland. F'A Cumberland Co. My Conmssion Expies~113. '991 ..~t.." ~"'!t;".. ';."1!~I" ~'''-O:, '. iJ"1 L..l;:'; " I.t ":'ll.'L:..1.i: ( r ;,.i"al' .,I.', ....1. .....h..,~. -..'...1" , 'r''''.~'V:'~Jli......... .i" nflxrV"""" COMMONWEALTH OF PENNSYLVANIA : COUNTY OF CUMBERLAND :SS: . . We, (;f) C't:/' ~ and :ffi f j ~ A. Il-nd; /JSO;7 , 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 Testator sign and execute the ~ instrument as his last will; that Testator signed willingly and that he executed it as his ,.~~~e and voluntary act for the purp~s- / es therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; that to the best of' our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. . .": .). (]Qed ~ Witness -;1;)(-1' j A. A. I1n1 J /l~(JY) Witness t? /J Sworn to or affirmed to ~ J~-L-/ . tlr , witnesses, this /9 day of jf, and ac~edqed and ~Ln ~) - ~n ~~ ' Notary Public by 1990. , ,.~"4-""'."'. . .... . -4 - . NOTAR/AlSEAl " CONsr ANCE l.l<AAtl, Ntay PubIc New CUmber~1tId, PI\ Cumbetfand Co MYCo:misSlonExPhs""3,'GG" , .- .- 4.J '," I . ~:'.I" L- S DEPARTMENT OF HOU::iING and UKtlAN UI::VI::LUI-'Mt:N I VIVID l'\lU. ~JU.::.-VLU.J SETTLEMENT STATEMENT Titlepro for Windows T. ASSURED LAND TRANSFERS, INC. 301 Market Street B. TYPE OF LOAN PO Box 109 D1.FHA o 2. FMHA 03 CONVUNINS. Lemoyne, PA 17043-0109 04.VA o 5. CONV. INS. (717) 761-4720 6. FILE NUMBER: 17. LOAN NUMBER: 143117 MORT. INS. CASE NO.: 5286-3 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.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER William H. McLaughlin, Shirley E. McLaughlin Estate of Frederick A. Hoffman CASH SALE cia Law Offices of Bull, Bull & Knecht, LLP 106 Green Lane Drive 106 Market Street Camp Hill PA 17011 Berwick, PA 18603 G. PROPERTY LOCATION: H SETTLEMENT AGENT: Assured Land Transfers, Inc. I. SETTLEMENT DATE: 5213 Cobblestone Drive Sep 09 2005 Unit 5213, Wesley Mews Condominium Friday Lower Allen Township PLACE OF SETTLEMENT: 301 Market Street, Lemoyne, PA 03:00 PM Mechanicsburg, PA 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 185,900.00 401. Contract sales price 185,900.00 102. Personal Property 402. Personal Properly 103. Settlement Charges (line 1400) 3,199.25 403. 104. 404. 105. 405. Adjustments for items paid in advance by seller(s) Adjustments for items paid in advance by seller(s) 106. CityfTown tax 406. CityfT own tax 107. County/City tax 09/09/05 to 12/31/05 186.94 407. County/City tax 09/09/05 to 12/31/05 186.94 108. Assessments 408. Assessments 109. School Tax 09/09/05 to 06/30/06 1,166.08 409. School Tax 09/09/05 to 06/30/06 1,166.08 110. 410. 111. Sewer/Refuse 09/09/05 to 09/30/05 18.11 411. Sewer/Refuse 09/09/05 to 09/30/05 18.11 112. Condo Fees 09/09/05 to 09/30/05 84.00 412. Condo Fees 09/09/05 to 09/30/05 84.00 120. Gross Amount Due from Borrower 190,554.38 420. Gross Amount Due to Seller 187,355.13 200. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller 201. Deposit or earnest money 5,000.00 501. Excess deposit (see instructions) 5,000.00 202. Principal Amount of new loan(s) 502. Settlement charges to seller (line 1400) 3,454.62 203. Existing loan(s) taken subject to 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, CityfT own tax 510. CityfT own 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 5,000.00 520. Total Reduction Amount Due Seller 8,454.62 300. CASH AT SETTLEMENT FromfTo BORROWER 600. CASH AT SETTLEMENT To/From SELLER 301. Gross AmI. due from borrower (line 120) 190,554.38 601, Gross Amount due Seller (line 420) 187,355.13 302. Less AmI. paid by/for borrower (line 220) 5,000.00 602, Less reduction in Aml.due Seller (line 520) 8,454.62 303. Cash ~ FROM OTO Borrower 185,554.38 603. Cash ~ TO o FROM Seller 178,900.51 Buyer or Borrower's Signature Seller's Signature L. SETTLEMENT CHARGES Case # 143117 .I Paid From Paid From 700. Total Sales Commission based on Price: $ % Borrower's Seller's Division of Commission at: $ Total Funds At Funds At 701. Settlement Settlement 702. 703. Commission paid at Selllement 704. 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. Mortgage Insurance to 807. Assumption Fee to 808. 809. 810. 811 900. Items Required By Lender To Be Paid In Advance 901. Interest from 0.0000 /Day 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 @ $ /Month 1002. Mortgage Insurance 0 Months @ $ /Month 1003. CitylT own Taxes 0 Months @ $ /Month 1004. County Taxes 0 Months @ $ 50.33 /Month 1005. Assessments 0 Months @ $ /Month 1006. School Taxes 0 Months @ $ 120.65 /Month 1007. 0 Months @ $ /Month 1008. 0 Months @ $ 120.65 /Month 1100. Tille Charges 1101. Selllement or closing fee 1102. Abstract or title search 1103. Title Examination 1104. Title Insurance Binder 1105. Document preparation 1106. Notary fees Cash 10.00 10.00 1107. Attorney's fees (includes above items No :) 1108. Title Insurance Assured Land Transfers, Inc. .. (includes above items No :) 1101 thru 1104 and 1108/ Basic 1109. lender's coverage $ 1110. Owner's coverage $ 185,900.00 1111. 1112. I 1113. I 1200. Government Recording and Transfer Charges 1201. Recording Fees: Deed $ 41.50 Mortgage $ Release $ 41.50 1202. City/County tax/stamps: Deed $ 1,859.00 Mortgage $ 1,859.00 1203. State tax/stamps: Deed $1,859.00 Mortgage $ 1,85900 1204. Recorder of Deeds 1205. 1300. Additional Settlement Charges 1301. Tax Certification Fee to Bonnie K. Miller, Tax Collector 10.00 1302. 2005/2006 School District Real Estate Taxes to Bonnie K. Miller, Tax Collector 1,44768 1303. Delinquent Charges to Lower Allen Township Authority 7.94 1304. Condominium Association Fees to Wesley Mews Condominium Association 120.00 1305. 1400. Total Settlement Charges (enter on lines 103 & 502, Sections J & K) 3,199.25 3,454.62 Parties agree that no liability is assumed by Settlement Agent for the accuracy of information furnished by others as shown on the HUD.1 Settlement Statement HUD CERTIFICATION OF BUYERS AND SELLERS t Statement d to the best of my knowledge and belief, it is a true and accurate statement of all receipts and ') this tra a I n) further certify that I have received a copy of the HUD-1 Settlement Statement. Buyer's Address & Phone: ~,uJW~ Seller's New Address & Phone: Settlement Agent AIIUIlIP WHD TR1\NU'..".., ...tiC. _. ~1~J.b.~ Date c;/7(o r- ~. INVENTORY Estate of Hoffman, Frederick A. Jr. No.21 05 0311 also known as , Deceased Date of Death 3/27/2005 Social Security No. 184120165 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the fol/owing inventory include all of the personal assets wherever situate and aI/ of the real estate 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 Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. J!We verify that the statements made in this inventory are true and correct. l!We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Name of Attorney: Robert A. Bull, Esquire I.D. No.: 25892 x~ttJ~ K~adsworth f/k/a Kath n Miller Address: 106 Market Street Dated Berwick PA 18603 Telephone: 570759-1231 Description Value Stocks & Bonds United States Savings Bonds 12,103.10 Columbia County Farmers National Bank Bancorp Inc, 5,376.Shares @ $27.18 a share 146,119.68 Nationwide Financial 136 Shares @ $35.73 4,859.28 Prudential Financial 295 Shares @ 56.99 a share 16,812.05 Cash, Bank Deposits, & Misc. Personal Property Total (Attach Additional Sheets if necessary) c! .~:: t; . 440,322.63 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Continuation of Inventory Hoffman, Frederick A. Jr. 21 05 0311 PaQe 1 Description of Inventory Description M & T Bank Account #43361382 Value 3,682.85 2004 Buick LeSaber 18,000.00 Prudential Command Account 47,657.06 Patriot News, Refund 160.90 Nationwide Financial - Dividends 51.68 Marsh Affinity Practice 34.22 Asbury Services, Inc., Refund 547.84 Highwark Health Insurance, Refund 446.40 Continental Casualty, Refund 289.86 U. S. Treasury, Refund 2,560.00 Columbia County Farmers National Bank - Dividends 967.68 Pruco Securities 127.53 Verizon Wireless, Refund 2.50 Real Estate Subtotal $ 74,528.52 ~ Continuation of Inventory Hoffman, Frederick A. Jr. 21 05 0311 PaQe 2 Description of Inventory Description Real Estate situate at 5213 Cobblestone Drive, Mechanicsburg Book 201, Page 1123 Cumberland County Sales Price $185,900.00 Value 185,900.00 Subtotal $ Grand Total $ 185,900.00 440,322.63 COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 006149 BULL ROBERT A 106 MARKET STREET BERWICK, PA 18603 ACN ASSESSMENT CONTROL NUMBER AMOUNT nu_n_ fold 101 $2,319.37 ESTATE INFORMATION: SSN: 184-12-0165 FILE NUMBER: 2105-0311 DECEDENT NAME: HOFFMAN FREDERICK A DATE OF PAYMENT: 12/27/2005 POSTMARK DATE: 12/22/2005 COUNTY: CUMBERLAND DATE OF DEATH: 03/27/2005 TOTAL AMOUNT PAID: $2,319.37 REMARKS: ROBERT A BULL, ESQ CHECK#149 SEAL INITIALS: RSK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 006150 BULL ROBERT A 106 MARKET STREET BERWICK, PA 18603 ACN ASSESSMENT CONTROL NUMBER AMOUNT nn____ fold 101 $33.20 ESTATE INFORMATION: SSN: 184-12-0165 FILE NUMBER: 2105-0311 DECEDENT NAME: HOFFMAN FREDERICK A DA TE OF PAYMENT: 12/27/2005 POSTMARK DATE: 12/22/2005 COUNTY: CUMBERLAND DATE OF DEATH: 03/27/2005 TOTAL AMOUNT PAID: $33.20 REMARKS: ROBERT A BULL, ESQ CHECK#155 SEAL INITIALS: RSK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS r--"-"---"-----"" "_____d__"_ ~nd your address label )cument ,bill TFROM II FE8855 REFERENCE NUMBER .',1,) 'f' {f.~ " TELEPHONE 570.-759-1231 BULL, BULL & KNECHT , ! 106 MARKET 5T BERWICK PA 18603 . . TELEPHONE -I',} i, ~. .r',:'_:h " ~, ;,", ;)' ~ r- i ,,~ _ t ' ,~,U' :. 010191120260911/00 MW MW123.0A 071200iJnited Parcel Service, Louisville, KY DIMENSIONAL WEIGHT O EXPRESS (INT'L) " 0 DOCUMENTS ONLY SATURDAY DELIVERY 0 1Z FE8 855 2210009453 The shipper authorizes UPS to act 811 forw.dln1il8g.mforuportcontroland custornspurpo'ss, The shipper certifies thattnese commodities, technology or software wereexportedlromlneUnitedSla-.sin accordance with the Export ~:;;"~~t:tiJ.;' ~::~~~~;~ib~I:~ion i 1 ~ 1111111111 I II I1I1 III 1111" 1111111 I 111I I 111""11 I III i l1J 1Z FE8 855 2210009453 EE ~ ~ 1Z FE8 855 22 1000945 3 11\111111I111\ \11 o 1Z FE8 855 221000945 3 DATE OF SHIPMENT