HomeMy WebLinkAbout01-03-06
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 -0 5 0 6 2 2
COuNTY"CoiiE --vEArr- - - NUMsER- -
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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BUERDSELL
DATE OF DEATH (MM-DD-Year)
NORMAN
DATE OF BIRTH (MM-DD-Year)
SOCIAL SECURITY NUMBER
1 66- 1 6 - 2 1 1 5
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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06/11/2005 05/09/1920
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
D 3. Remainder Return (date of death priorto 12-13-82)
D 5. Federal Estate Tax Return Required
_ 8. Total Nurnber of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Atlach Sch 0)
[Xl 1. Original Return
D 4. Limited Estate
[Xl 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy oITrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
ROGER B. IRWIN ESQUIRE 60 WEST POMFRET STREET
FIRM NAME (It Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717 249-2353 CARLISLE PA 17013
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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)
D 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)
OFFICIAl. USE ONLY
.,
172,500.00
2,500.00
30,737.90
0.00 X _(15) 0.00
157,503.85 X .045 (16) 7,087.67
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 7,087.67
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
(8)
205,737.90
27,419.63
20,814.42
(11)
(12)
(13)
48,234.05
157,503.85
16. Arnount of Line 14 taxable at lineal rate
(14)
157 ,503.85
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
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I t Add
ece en s ampl e e ress:
STREET ADDRESS
50 HICKORY ROAD
CITY I STATE I ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
7,087.67
3. InteresVPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
0.00
TotallnteresVPenalty (0 + 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)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check to: REGISTER OF WILLS, AGENT
0.00
0.00
7,087.67
7,087.67
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 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?........................ ........................................................... ........ ... 0 00
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... [ ] ~
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 RESP~SIBLE FOR FILING RETURN DATE
;.. . C i 2.. ~
ADDRESS PO BOX 574
ORGAN NM 88052 88052
SIGNATUREJfPREF.'~R~~ R DATE
.....
ADDRESS
For dates of death on or after Ju!y 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 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 Ju!y 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 ta* 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 )J.
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 + (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BUERDSELL N RMAN 21 05 0622
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.
FILE NUMBER
ITEM
NUMBER
1.
DESCRIPTION
50 Hickory Road, Middlesex Township, Carlisle, Pennsylvania
SOLD - Settlement Sheet Attached
VALUE AT DATE
OF DEATH
172,500.00
TOTAL (Also enter on line 1, Recapitulation) . $
(If more space is needed, insert additional sheets of the same size)
172 500.00
REV-1503 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
BUERDSELL
NORMAN
FILE NUMBER
21 05
0622
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
25 Shares of Frog Switch Stock - Sold to 6 different individuals at $100.00 per share
VALUE AT DATE
OF DEATH
2,500.00
~
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2 500.00
REV-15GB EX + (6-9B)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BUEROSELL
FILE NUMBER
NORMAN 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.
0622
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
1,931.00
Personal Property
2.
Morgan Stanley OW Inc Cust for Norman Buerdsell #410-028500
18.855.00
3.
Manulife Financial Corporation - 126 Shares at $47.3300
5,963.58
4.
M&T Bank - Checking Account #23486767
3,988.32
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
30.737.90
REV-1511 EX+(12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
BUERDSELL
FILE NUMBER
NORMAN
21
05
0622
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Ewing Brothers Funeral Home 1,923.20
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. Attomey Fees Irwin & McKnight 9,925.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship 01 Ciaimant to Decedent
4. Probate Fees 298.00
5. Accountant's Fees
6. T ax Return Preparer's Fees Patricia A. Rosendale, CPA 350.00
7. Cumberland Law Journal - Estate Notice 75.00
8. The Sentinel - Estate Notice 137.03
9. Rowe's Auction Service 9,580.00
10. Closing Costs - From Sale of 50 Hickory Road 3,686.79
11. Overnight Mail 143.50
12. Roy D. Gottshall - Appraisal on Personal Property 75.00
13. The Sentinel - Advertising 76.55
14. Paul A. Bahn - Moving Expense 240.00
15. Steven W. Barrett Real Estate - Appraisal on Real Estate 275.00
16. Register of Wills - Short Certificates 8.00
17. York Waste Disposal, Inc. - Trash Removal 450.00
18. Register of Wills - Filing Fee 30.00
TOTAL (Also enter on line 9, Recapitulation) $ 27,419.63
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
BUERDSELL
Decedent's Name
NORMAN
Page 1
21 05 0622
File Number
Schedule H - Funeral Expenses & Administrative Costs - 87.
ITEM
NUMBER
DESCRIPTION
AMOUNT
19.
20
Hanson Building Materials America Retirement - Reimbursement of Pension
Notary Fees
136.56
10.00
SUBTOTAL SCHEDULE H-B?
146.56
REV-1512 EX + (6-98)
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BUERDSELL
FILE NUMBER
NORMAN
21
05
0622
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
M& T Bank - Payoff of Home Equity Loan #1363760
VALUE AT DATE
OF DEATH
1.
19,818.17
2.
M& T Bank - Loan Payments - Home Equity Loan #1363760
522.24
3.
Sprint - Telephone
76.81
4.
PP&L - Electric
293.36
5.
Kilmore Eye Associates, Medical
10.00
6.
Metro Med Services, Medical
56.25
7.
York Waste Disposal, Inc. - Trash
37.59
TOTAL (Also enter on line 10, Recapitulation) $
20814.42
(If more space is needed, insert additional sheets of the same size)
",.""" '''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
BUERDSELL
NORMAN
0622
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)}
1. Karen A. Buerdsell Lineal
PO Box 574 1/2 Remainder
Organ, NM 88052
2. Sherri L. Buerdsell Lineal
PO Box 574 1/2 Remainder
Organ, NM 88052
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - 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)
FILE NUMBER
21 05
LAST WILL AND TESTAll1ENT
I, NORMAN BUERDSELL, of 50 Hickory Road, Carlisle, Cumberland County.
Pennsylvania, declare this instrument to be my Last Will and Testament. hereby expressly
revoking all Wills and Codicils heretofore made by me.
L I direct my Executrices to pay all of my debts, funeral and administrative expenses as
soon as may be done conveniently after my decease.
2. I authorize and empower my Executrices to sell any realty owned by me at my death.
and not specifically devised herein, at either public or private sale, and to give good and
sufficient deeds therefor, in fee simple, as I could do if living.
3. I give, devise and bequeath all of my estate of every nature and wherever situate to my
two (2) daughters, KAREN A. BUERDSELL and SHERRI L. BUERDSELL, share and share
alike.
4. I nominate and appoint KAREN A. BUERDSELL and SHERRI L. BUERDSELL to
be the Executrices of this my Last Will and Testament; they are to serve as such without bond.
Should they die before my death, renounce or refuse to serve for any reason, or die leaving any
of my estate unadministered, I nominate and appoint ROGER B. IRWIN as substitute Executor,
also to serve as such without bond and with the same powers as are given herein to my
Executrices.
5. I hereby suggest that my personal representative retain the servIces of Irwin &
McKnight as attorneys in the settlement of my estate.
,
IN \VITNESS \VHEREOF, I have hereunto set my hand and seal this ~ day of
June, 2005.
(SEAL)
NORMAN BUERDSELL
Signed, sealed, published and declared by NORMAN BUERDSELL, the Testator
above-named, as and for his Last Will and Testament, in the presence of us, who, at his request,
in his presence and in the presence of each other have subscribed our names as witnesses hereto.
2
ACKNOWLEDGMENT AND AFFIDA VIT
\VE, NORMAN BUERDSELL, KAREN S. NOEL and SHARON L. SCHWALM,
the Testator and witnesses respectively, whose names are signed to the foregoing instrument.
being first duly sworn, do hereby declare to the undersigned authority that the Testator signed
and executed the instrument as his Last Will and Testament, that he had signed willingly, that he
executed it as his free and voluntary act for the purpose herein expressed, and that each of the
witnesses, in the presence and hearing of the Testator, signed the Will as a witness and that to the
best of their knowledge the Testator was, at that time, eighteen years of age or older, of sound
mind and under no constraint or undue influence.
NORMAN BUERDSELL
KAREN S. NOEL
SHARON L. SCHvV ALM
COJ\1IMON\VEAL TH OF PENNSYL VANIA
SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by NORMAN BUERDSELL, the
Testator herein, and subscribed and sworn to before me by KAREN S. NOEL and SHARON L.
SCHWALM, witnesses, this ~ day of June, 2005.
Notary Public
3
A. Settlement Statement
U.S. Deportn'.ent of Housing
ancf Urban D9velopment
~
,r
8. Type of Loan
C)L18 /.l"L1pmVC1! No 2502-02t-)5
o Ff-JA 2. LJ FrnHA 3. 0 Con". Unins. '3. Frle ~Ium~,:r
4 0 VA LJ Conv. Ins.
~'i . ,:-:-;: '0'
~. '.f:>c"!'Jaq~ irs:)r;~nc~=~'s~ "),,-r-:e:P'
c. Note: This form is furnished to give you a statement of actual settlement costs. A.mounts paid ;0 and b/ tI~e setrlement agent ar~
shown. I.tems marked "{p.D.C.}" were paid outside closing; they are shown hen2 for informational purposes and not
Included In the totals.
D N,:;""e 2nd /\(jdre~5 (~I Borrow",r
E. Name anljAddres5 01 S~I'E"
~: rIa'T'e 'i":d ,:.\I;r,res<;:::.f IJ'r'~~p'
Ronald L. ('Iites
Stcph"lllc K. C1llls
Norman Bucrdsell ESlak
:"allonal Clt;. flank oi" II1dlal13
_~232 0Jc;.'.'Illark Pl"I\C
M I a 111 i3l1urg OIJ 4,'d,
G Pr00e~v L'ZJticr'
H .se~:!"'rne'11."w":
Gerald K, A-fplTIsuil. Esquire
50 Hickory R<'ad. Middlesex Township.
Cumberland Coullty. Carlisle. Pennsylvallla
Pl3ce ::Jf Seltlerne"l
! S",tl'~""e,,1 I;.:!:.~
:-..~('\V I31U(lll1rlCld, PA
J, Summary of Borrower's Transaction
100. Gross Amount Due From Borrower
101, Contract sales price
102 Personal property
103 SeWerrent ch~rge5 to borrower (line 1400)
104
12']405
K. Summary of Seller.s Transaction
400. Gross Amount Due T(I Seller
172,500.00 401 Conlracl ,ale, pnce
402 ?erso~.al voperly
5.652.81 403
172.500IJI)
41J4
11)5
405
106 Cily/lcwn taxes
Adjustments for items paid by seller in advance
10
11,~
to
10
to
Adjustments for Hems paid by seller in advance
406 Cily/tC?~'0_ taxe_s jo
26.57 407 Counlv taxes 12/1..j..()~ to i :::31,'(:5
.108. Assessments Ie
967.46409 School 12,'14n:, 1C6,]I)':()(1
J1C
26.57
1-');' Counly t?xes 1 :':,'J 4/05 to I ~/J I iOS
tO~ Assessm~(lts to
109 Schooi t :::,'l-t'DS 10 (J/JO/06
9();.46
111
4t t
to
120. Gross Amount Due From Borrower
179.14().S~l 420. Gross Amount Due To Seller
17_~.~r)4.i)3
200. A01o~_nts Paid _B_y _q!:J!1_~_!!.h~aJL9.! ~~~~~~!~_
201._ D~posil or earnes! mO!1ey
202 PrinCipal amclJnt of n~\y loan(s) _ Na~~~na!__~!_ty
2('3 Exislin'd 10.;n(sl taken subject to
20..1
500. Reductions tn Amount Due To Seller
17.250.00 501
138, OOO:lO S02
50:\
_~X,CE!'s~_j,,!:pc5il (see i~slrllc!icns,j
Setllernent c::harges iO s""lIer (Iin"? 1 J,:)O}
Exisling 10'3n1S) lal<:en SU~)Jec.t to
17,25U(IO
3.6S0,'/9
~~'._.' ,)
5(14 Paycrf offjrst mongage loan
50S Pavnff of secc~rj rTlor.gw_:e :c'a"
I ~ ~_
:)1)1;
\1&
I q,,~ 18. J '7
2eG
:'07
507
208
508
209
t)09
21Cl
Adjustments for items,_ u_npaJd by sell_~(_
to
Cily/lo\'m !.lxes
.'310
Adjustments for items unpaid by seller
10
Cityito....,.n taxes
21 ~ County la,xes 10
2~2 Cl,ss~ssments 10
213 10
214 to
215 10
216 10
217 to
213 to
219 10
220. Total Paid SJrlFor Borrower
511 Saunty t2H':'S 1c;
512 A.ssessments Ie
513 to
514 10
S~.S to
516 Ie
517 '0
518 Ie
5'19 to
155.250.00 520. Total Reduction Amount Due Seller
40.754.%
300. Cash At Settlement FromfTo Borrower 600. Cash At S9lt1ement To/From S~J1er
301 q~o_~_s___AmQun~due fro~-bo~r;:~~_(lj-~~_~_?O) -r79, 146.8~fl-~01 Gr(J~~.~~;-unt dL)~t~s~lIer (!!~e -12())
302 L_es~__r::n:oU_rll paj_~~_t_f~_~__~{)~rl?_~~~.\~!1~ 2?~t 15 5,2jO. O{)) A02less re.ju_c!;ons in amt ..due seller I.lin_9 520)
303. Cash [K) From 0 To Borrower 23,896.S'~ /S03. Cash [K) To 0 From Seller
The l,"d<?:rslgn~d r'ere~v 8cknow!edge the receipt of a completed copy oJ pages 1 ,~;? Of this SI..:!tC1l1p.nr & Jny att::JC!lments rdwrerj to Il8re;1l
I HAVE CAREFULLY REVIEWED THE HUD-1 SETTLEMENT STATEMENT NliJ TO THE BEST OF MY KNOWLEDGE f<j>O BELIEF. IT:0 ~ [RUE At'l:;
STATEMENT OF ALL REc;~IPTS AND DISBURSEMENTS MADE ON MY ACCOUtJT OR 8, '-IE I', THIS m.;NSAC.TIC)fJ I Furn..HER CERTIFY TI-,/"
RECEIVED A COF', OF M HUD.1.SETJLF~jENT STATEMENT KrL'-"_ /+ ,~, ~I'''''.u '
SOP,ROWER>( /(fl1tJ uI../,. (~tz:~. S=.LLER ".... L . 'J.c,-< ~< pll
80RROWER +-.(f(.f.":llJ{ n (L k SEl.Li:R ' LA.. t \ ') C U_b._
r<:) THE aC:ST '~F r..1Y Kr'J':)\VL~~ HUD-1 SETTLEMENT STAT=~1E(\rr 'lv'HiCH: H_""/E A TRUEPN~ ^\CC~;P.l\r::
Wl-jICH WERE F:ECEI"/ED AN'((jt/t.~1~~~~E lil.IDER5:C.'.IED t,S )F THE ,sa r-i:'JE'i"; GF
',..:"p!miC. !, IS" '-Rlr.'E TO KrIOWI~IGl.t MAKE FALSE STATEME'ns T'l THE U'i1TED STA res "'I I T,% DR 0,1"" S!!.IILAR e:,p,.1 F'[".;~c 11!C3 UPL"'!
'.:C31\'ICTION '~>~r J I:-Y). iJDE A FINE ,o,ND fl\,'PRrSONt--1ENT J:'OR QET.'\ILS SO:::E T'"TLE 1 r:. I) s, r: (:;r)E S~(~T'(:'r! 1 r)il13, ,'';;;:':': T:r:': j 1~~:'"1
! 73A9--U!J
40.754 (i(,
1_:'=..!~~9_[r'
Previous Edition Is Obsolete
Hl_':J-~ 1:j.i3i-"ii
PESP..'1, HO .1?n.S 2
L. S_ettlement Charges
lOa. Total Sdlesi8roker'~ Commission based on price $
DivISlcf1 'Jf CCr:lITlISSif)rl Oine 700) as fellows
@
O.Oil
p~;,~ F"rorn
t)c;r(.vr:;("
Faic
;-01
')"'::H-'
~02
10
10
::: tI fI ~: j S : , :
F\H":'Jc; hI
3et~I,;nlr;r:t
Sel~lc:ln~ll+
703 COrTJrTl;ssion ~d'C .Jt S~tllefllent
704
800. Items Payable_In Connectio!1~ft~ _~?an
801 LOAn Orit;inak:n Fee 1.00 - - ---
802 Loan D:sc_'unt I.O/)
S03 Al1praisal ~f'e
804 Cf'2dl! Repcrl
805 Lender's Insoectlo'1 F~~
" National City Bank uf Indiana
" National City Bank of It,,knEl
10 James D. '{Dung
10 CBC Credit Services
1.380.00
-1.,18000
:'I)().lil)
20.00
aC6 ~.Iortgage Icsurc:lnce /"Opllc?llon__~_e.': to
807 Assumption Fe~
8C8. Loan ProccsslIlg Fce-N~t[(JnaU::ltyBank of Indiana
809 UnderWrIting fee - National City Bank of indiana
810. Flood Cert fcc - NationalC'ity Bankofrndial13
811
900:,_ttems Required By Lender~o _Be_Pa~~_ ~n ~d~ance
901 In'ereslfrom 12,14/05 to 12/31105" @$_22.21
902. Mortgage Insurance Premi'Jm for
903: _~iazard inwrance Premium for
904
905 Tax Ser;ice fee to La;,dAmel'ica
17500
15000
7.50
I day
399.78
mvnlhs I:;
years to
years to
77.00
1000. Reserves Deposited With Lender
1001 Hazard Insurance 4
1002 Mortgage insurance
1003 City prope0y faxes
1004 County proper1y tay.es 12
1005 Annual assessments
1006 School S
_months@$
_~o~t~"s@ $
__~~~,~h~@$_
_11l,?,nt~s@$
!T10':!'0,s.@$__
__~_onl.h~@$
months@S
39.25
per month
157.00
per month
per m::mth
47.54' per mon'h
pBr monlh
] 48.62 per '"Gnlh
570.48
100~
1008 Aggregal:~ Adju51Jrll?nt
1100. Ti_tle ~harges
1,188.96
p8r month
-504.16
1101 S"'!ttI",m~nt N ":iooo:ici] tCr'l
~ 102 Abstract cr tille se:'ll ch
1103 Title examln~lion
to (jerald K. :Vlorrison, Esqnlrc
10
to Gerald K. ""lorrison, EsqUire
7500
450.lJO
1104 Title insurarlco bindRr
10
1105 Document preparation
111J6 Notary fees
1107 _Attorney's fees
_(Ir:c:l~~p.s abl)~~ 11<;n1S .!1Ur!l~_~r5
1 :08 Title insurance
10
10
10
10 Elizabeth P. Quigley. ES4111re
738.25
(Includes abQ'.e it'~nls numbers
11 C9 Ler,dp.r'S co'/er;);;,,:
11111 (..J\^'(1er'~ CC\'<::f.?';:e
1111
1112
1113
120.0: G_overnm_ent Recording and Transfer Cha~g~.~
120;--Reco_rdi~~fe~s:..oee~_~$-_~-'" - ----38.50- Mortgage
1202 C,I/roOunly tax/stamps Deed .1.725.00 . Mortgage
1203 Stale lax/stamps Oped 1,725.00 . tvlortgage
1204
1205 Ovcrnight "'Iail fee 20.00
64.50 Releases
Ifl3.00
l.725.00
1.725.(JO
1300. Additional Settlement Charges
1301 _ Sury~_x to
1302 Pest inspection 10
1303 Penny Da\'ls - 2005-06 School Taxes
1304
1.% 1.79
1305
1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) .5.652.3 I 3.(18(1.79
(~~~!~d~~~~~~c~~e~YEt~~~~~~~g~dh~1~6:ri~tEo-Ht~o~~e+egig~~~ftt\j~~N1~~8f i~~ :~~t~~o~ t1~nk~7~~~t~'6~~ r1~~~e~EIE:~~~~~ :s .t> :RUc ~NDAC ::Ui?A iE
STATEMENT OF .4LL R9O':.. fPTS A~E D..ISB.URSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRMJ.SAC.TION.. I FURT. HE. R CER...TIFY THAT I HAVe
::~:I;:~:~~~(l~~EaH~'frU&r~TST:TEM~N~ SELLER. ~~~:- :lm~~~~:: .
~g~~~\~~~T i'MY~:.~ :~~':~~/~H~'HU~':::SETrLEMENT ST4TEMENT 'IIHiCH I H:V~L~~~. PARE~'rS A ;~~i Af. ID'~cc~f~E~COL~f1~ THE F.UfiDS
WHICH WERE FlECErVED~~ VE ~EEN OR WILL BE OISBURSED BY THE U~IDERSIGNED ~S A P.'\RT OF Tt;E S LEMENT OF THIS TRANSACT!ON
.--- '//1"" I
,\/ "'II f...~'---
WAR.I'I~JG IT IS f\ CRII"E TO KNCWINGL Y MAKE FALSE STATEMENTS TO THE UNITED ST,~TES 0-'1 THiS OR "-IIY SIMILAR FeR!,1 PENPLTiES UPON
CON\jICT!O~~ CAN INCLUDE ,A. FINE AND !MPRISONMENT. FOR DETAILS SEE: TITLE 18 U,S. CODE SECTiCN 1001 & SEc~rGN 1J10
Public Reporting Burden for this collection of information is estimated to average 0.25 hour, per response, including the time for reviewing inslrucll')ns,
searching existing data sources. gathering and maintaining the data needed. and completing and revieWing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden. to the Reports
Management Officer. Office of Information Poiicies and Systems, U.S. Department of Housing and Urber Development, Washinglon. D.C. 20410-3600;
and 10 the Office of ~1Jn3g8ment and Budget, PapelWork Reduction Project (2502-0265), vVaship\;t::m, D_C. 20503
~M&I'Bank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
June 28, 2005
Law Offices
Invin & McKnigh
West Pomfret Professional Building
60 West Pomfret Street
Carlisle, Pennsylvania 17013-3222
Re: Estate of' Norman Buerdsell
Social Security: 166-16-2115
Date of Death: June 11. 2005
Dear Sir or Madam:
Per your inquiry dated June 21, 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
23486767
Ownership (Names oj)
Norman Buerdsell *
Opening Date
07/28/84
Balance on Date of Death
$3,988.09
Accrued Interest
$ 0.23
Total
$3,988.32
2.
Type of Account
Home Equity Loan
Account Number
1363760
Ownership (Names oj)
Norman Buerdsell *
Opening Date
01/27/04
Balance on Date of Death
$19,790.01 **** This amount is not to be used for payoff
purposes. For apayoffbalance, please call 1-800-724-2440.
Current Balance
$19,799.33 *** This amount is not a payoffbalance.
Please be advised, there was no safe deposit box found for the above decedent. * For further account information,
regarding ownership, closures and/or reimbursement of funds, etc., please call the High Street Carlisle Office # 717-
240-4536.
Sincerely,
Nancy Clagett
Records Management
ROWE'S AUCTION SERVICE (RR 79L)
Bill Rowe (AU 1538L)
Ben Rowe (AU 1092L)
2505 Ritner Highway · Carlisle, PA
249-2677 697-4794 249-1978
Bob Rowe (AU 2276L)
Dave Rowe (AU 2295L)
Auction Is Action Call ''Rowe'' For Satisfaction
SELLERS NAME j\.Jv .~"'v'- :'\-,0
/)(L_ ~...'L..i";) r':;, '7. L L
1/7 ~:> '(;l"T-€..
DATE
t:')fS; '- C~ l._ --."
ADDRESS
OTHER
.S'..:;;:;. lj-< '-16'-..-"''4-1 ;2,,)
0' l/k1-L-i ~ \;7 /).4- I 7 OJ '~
-'
AUCTION DATE/LOCATION
PHONE:) Y' 9- 2-'3 ;,-S
AUCTIONEER % i
CLERK %
/2./7,...4-<" 117;..,., -j,4'7'~
DESCRIPTION OF MERCHANDISE
<S:c. s (--:s I !k:)l/ /1. ,.1- '-["1 S i ,u &
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j..... f 0.-' lJ S.4-7
13 '-Z ( L_ I (1./),-
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I Commission the Auctioneers to seil the merchandise to the highest bidder by Public Auction. Merchandise
to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen-
tative of the merchandise, goods and or property and have good title and the right to sell and that they are free
from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of
title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in
this agreement.
AUCTION SIGNATURE
SELLERS SIGNATURE
Total Sales (Clerking Tickets Attached) $
Less Sale Expense:
i % Commission Auctioneer $
G G( C'~,~'':'>'
% Commission Clerks $
OTHER: /21-;4-'- Ii"N174 Gc<:"t-"'-::.
2: /', '. ,'-1
c- ~"".', c' ") "'-'
,- J ......:.,...."_,-t.
TOTAL SALE EXPENSE DEDUCTED $
SELLERS NET $
~- \)-
~~~~;~E
q L-\ t3 (~), ,:)
SELLERS SIGNATURE
Mello~-ctrivestor Services
P.O. Bo~< 3333
SC'r-'.lrl1 Hackensack, NJ 07606
June 25, 2005
@ Mellon
ESTA TE OF NOR:\L-\N BUERDSELL
ATTN ROGER B IRWIN
60 "VEST POMFRET STREET
CARLISLE PA 17013
'MANULIFE
i
[FINANCIAL
'CORPORA IION
. ......._..,.._.._.............". ,', ',_ '_ ..............M '".,.. _,
,~~--_._.__.__."...----_._-, r---------------"--."--~.__.__.-
iAccount [BUERDSELLNORlvI-
iKey 10000
,-.-..----....-.---..-..-.-- ------_.._--_._--_...,._-_..~.._.,-......_~...__..,,_.----..,
;Control 1200506240005177 i
'i I
[Number I
!Company
IName
. .
. .
"'.-', ........ ".,."
.[T~i~-Ph;~-~-] rOO~249- 7702
INumber I
,~~_;;.;'.....:.;::':':""'-'.~~~.' ___...____-1 _______n..
'.':"="~_;;;_=-":"';:'J
Dear Sir or tvladam:
Thank YOL! for your inqL:iry regarding the re-registration of shares. Plea~:e be informed that the above mentioned
account has 126 shares and the closing price as of 06/10105 was $47.3300 per share and that on 06/13/05 was
$46.8100 per share. This letter contains instructions for transferring shares from an account when the owner(s) is
deceased and the estate has been probated. If you cannot locate the stock certificate(s), 01' if the estate has
not been probated, please call the toll-free number shown above to obtain further information and requirements.
i 50 Shares or Less
I Submit items 1 and 2
I
[
I
I
More than 50 up to 250 Shares More than 250 Shares
Submit items 1,2,3 and 4 I Submit items 1 through 5
or
Submit items 1, 2,3 and 5
Required Items
1. Completed Transfer of Stock Ownership form signed by the Executor or Authorized Representative.
'1 The original stock certificates (if applicable).
3. Lnheritance Tax Waiver (if applicable). lfthe deceased owner resided in one of the following states, please
obtain an L'1heritance Tax Waiver from the state's Tax Department Office. AL, CT, IN, MT, NC, NJ, NY,
OH, OK, Rl, SD, TN and Puerto Rico.
4. A certified copy, with original signature and seal affixed, of the Certificate of Appointment of Executor(s)
dated with one year of the transfer.
) MedalE.-:n Signature Guarantee on Stock Ownership form.
Note: All submitted documents will be kept as part of the perm~nent record of transfer and will NOT be returned.
Please be sure you keep a copy for your records.
Send the required items to:
First ClasslRegistered/Certified Mail
Mellon Investor Services
POBox 3310
South Hackensack NJ 07606
Overnight/Express Mail (only)
Mellon Investor Services
85 Challenger Road
Ridgetield Park NJ 07660
VIsit Investor ServiceDirect<B) at ~'.:-'~~'~,Dle]loninvestor.collliisd to sign up for Mlink, a secure server enabling you
to view information or perform various transactions on your account.
Sincerely,
~~organ
4th And Wunur Streets
P.O. Box 12053
Harrisburg, PA 17108
toll-free 8006760673
tel 7172556666
fax 7172556651
June 27, 2005
~~~~uw~~
,.;\ 2;; 2005
Irwin & McKnight
Attention: Roger B. Irwin
West Pomfret Professional Building
60 West Pomfret Street
Carlisle, P A 17013-3222
" ,) , j j t" It'; ,., '1 l/:>.. rI" 7 '1'
I h' \Iv ,r\J,'~',' PI (' r', i \j I ~ M ,
t..,l ~ ,~ <l}, , ,",'''" ..'~ '..... .'"..., ~..t......
Re: Estate of Norman Buerdsell
Date of Death: June 11,2005
Social Security #: 166-16-2115
Dear Mr. Irwin:
In response to your letter of June 22, 2005, we are providing the following information:
1. The registered owner of the account is Norman Buerdsell. The exact
account title is "Morgan Stanley DW Inc Cust for\ Norman Buerdsell
\IRA Rollover dtd 2113/86".
2. The date the account was established is February 13, 1986.
3. There "vas no change of ownership or registr:ltion of the account.
4. There were no accounts closed within one year prior to date of death.
5. The amount of dividends earned this calendar year (January 1 through
May 31,2005) is $489.66.
6. The date of death balance is attached.
Sincerely, .,<-'J
l/ (........ Ir-
/ bl"'. ,', ""
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Senior Client Service Associate
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