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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
II 05
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
0533
NUMBER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Bower, James Roy
DATE OF DEATH (MM-DD-YEAR)
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06-10-2005
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
[!] 1. Original Return
o 4. Limited Estate
[!] 6. Decedent Died Testate (Attach
copy of Will)
o 9. Litigation Proceeds Received
150-12-5601
DATE OF BIRTH (MM-DD-YEAR)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
10-13-1924
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o
o
o
o
2. Supplemental Return
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
D 11.Election to tax under Sec. 9113(A) (Attach Sch 0)
4a. Future Interest Compromise (date of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10 Spousal PovertY Credit (date of death between
. 12-31-91 and 1-1-95)
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NAME
Richard L. Webber, Jr., Esquire
FIRM NAME (If applicable)
Weigle & Associates, P.C.
TELEPHONE NUMBER
(717) 532-7388
1. Real Estate (Schedule A)
COMPLETE MAILING ADDRESS
126 East King Street
Shippensburg, PA 17257
(1 )
OFFICIAL USE ONLY
None
None
None
None
117,709.00
None
None
(8)
12,924.97
3,266.65
117,709.00
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
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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) D Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(5)
(6)
(7)
. ;,
(9)
11. Total Deductions (total Lines 9 & 10)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
(11 )
16,191.62
101,517.38
0.00
12. Net Value of Estate (Line 8 minus Line 11)
(12)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
(14)
101,517.38
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
0.00
4,568.28
0.00
0.00
4,568.28
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
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0 .045 (16)
i= 16.Amount of Line 14 taxable at lineal rate 101,517.38 x
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Co) 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-0\ r ~~
Decedent's Complete Address:
STREET ADDRESS
164 CME, Lower Mifflin Township, Newville, PA
CITY Newville
I STATE PA
IZIP 17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
4,568.28
4,400.00
228.41
Total Credits (A + B + C)
(2)
4,628.41
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + 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.
(3)
(4)
60.13
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
A. Enter the interest on the tax due.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "XU IN THE APPROPRIATE BLOCKS
No
D ~
D ~
D ~
D ~
D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?............................ ......... ................................................................................. D ~
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
James Wesley ower-
k'
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;..................................................................................
b. retain the right to designate who shall use the property transferred or its income;....................................
c. retain a reversionary interest; or...................................................... ................................. ...........................
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?........................................ ............................................. ....... ..........................
Yes
DATE
9 Shea Court
Carlisle, PA 17013
17- ~I/o5
ADDRESS
DATE
ADDRESS
/ 2-/~J.lcJ /
DATE
126 East King Street
Shippensburg, PA 17257
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 39116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 39116 (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. 39116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S.
39116 1.2)[72 P.S. 39116 (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. 39116 (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-1508 EX+ (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERrrANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bower, James Roy
FILE NUMBER
21-05-0533
Include the proceeds of I~igati!)n 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 DESCRIPTION
1 1995 Chevrolet Motor Vehicle
VALUE AT DATE
OF DEATH
1.200.00
2 2002 Fleetwood Mobile Home - VIN PAFL222AB49894AV13
30.000.00
3 2005-06 School Tax - Refund at settlement
332.90
4 Comcast Cable - Refund
8.87
5 Erie Insurance - refund of fire insurance
93.00
6 Farmers & Merchants Trust Company #015-2975013 - Certificate of Deposit
10.717.07
Accrued income on Item 6 through date of death
77.53
7
Farmers & Merchants Trust Company #015-2975032 - Certificate of Deposit
35.000.00
Accrued income on Item 7 through date of death
124.27
8
Farmers & Merchants Trust Company #015-2975082 - Certificate of Deposit
15.000.00
Accrued income on Item 8 through date of death
2.94
9
Farmers & Merchants Trust Company #015-2977499 - Certificate of Deposit
10.099.97
Accrued income on Item 9 through date of death
21.69
10
Farmers & Merchants Trust Company #08-09972 - Savings Account
8.212.22
Accrued income on Item 10 through date of death
5.65
11
Farmers & Merchants Trust Company #34-22089 - Checking Account
6.205.49
Total of Continuation Schedule(s)
See attached page
TOTAL (Also enter on Line 5, Recapitulation)
117.709.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rev-1508 EX+ (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bower, James Roy
FILE NUMBER
21-05-0533
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
Accrued income on Item 11 through date of death
1.45
12
Propane - Reimbursement at settlement
471.66
13
Suburban Energy - Refund
134.29
TOTAL (Also enter on Line 5, Recapitulation)
117.709.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bower, James Roy
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-05-0533
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
See continuation schedule{s) attached
452.00
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
9 Shea Court
City Carlisle State
Year(s) Commission paid 2005-06
See continuation schedule{s) attached
PA
Zip 17013
5,708.36
2.
Attorney's Fees
5,708.36
See continuation schedule{s) attached
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
315.00
See continuation schedule{s) attached
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
See continuation schedule{s) attached
741.25
TOTAL (Also enter on line 9, Recapitulation)
12,924.97
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-9B)
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bower, James Roy
FILE NUMBER
21-05-0533
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Carlisle Memorial Service - Engraving for Cemetery Marker
160.00
2
Hoffman - Roth Funeral Home - Obituary Notices in the Patriot and Sentinel
292.00
Subtotal
452.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H-B1
PERSONAL REPRESENTATIVE'S
COMMISSIONS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bower, James Roy
FILE NUMBER
21-05-0533
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
J. Wesley Bower - Personal Representative Commission
5.708.36
Subtotal
5.708.36
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B1 (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H-82
ATTORNEY'S FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bower, James Roy
FILE NUMBER
21-05-0533
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Weigle & Associates, P.C. - Attorney Fees
5.708.36
Subtotal
5.708.36
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B2 (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H-84
PROBATE FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENrT DECEDENT
ESTATE OF
Bower, James Roy
FILE NUMBER
21-05-0533
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland County Register of Wills
315.00
Subtotal
315.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B4 (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Bower, James Roy
FILE NUMBER
21-05-0533
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland County Law Journal - Legal Advertisement
75.00
2
Cumberland County Register of Wills - Filing fee for inheritance tax return
15.00
3
F&M Trust Company - Research Fee
15.00
4
J. Wesley Bower - Moving Expense
300.00
5
J. Wesley Bower - Reimbursement for stamps, advertising, sign and miscellaneous
expenses
100.00
6
Pat Shearer - Cleaning of trailer
50.00
7
Postmaster - Postage
33.25
8
Rick Stryker - Lawn Care
40.00
9
Rick Stryker - Lawn Care
30.00
10
The Valley Times-Star - Legal Advertisement
83.00
Subtotal
741.25
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
SCHEDULE .-
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bower, James Roy
FILE NUMBER
21-05-0533
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Adams Electric
VALUE AT DATE
OF DEATH
33.47
2 Adams Electric
58.59
3 Adams Electric
62.91
4 Adams Electric
43.71
5 Adams Electric
28.63
6 Adams Electric - Final Bill
5.99
7 CME - July 2005 Lot Rent
218.00
8 CME - August 2005 Lot Rent
218.00
9 CME - September 2005 Lot Rent
218.00
10 CME - October Lot Rent #164
218.00
11 CM E - November Lot Rent #164
218.00
12 Shelby Winter, Tax Collector - 2005-06 School Taxes
554.84
13 Sprint - Final Telephone Bill
36.33
14 Suburban Energy Services - Propane
92.00
15 Suburban Energy Services - Propane
92.00
16 Swaim Health Center - Final Bill
1,124.54
17 Swaim Health Center - Telephone and van
43.64
Total of Continuation Schedule(s)
See attached page
TOTAL (Also enter on Line 10, Recapitulation)
3,266.65
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV-1513 EX+ (9-00)
.
SCHEDULE ..
BENEFICIARIES
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Bower, James Roy
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
FILE NUMBER
21-05-0533
RELATIONSHIP TO
DECEDENT
Do Not List Trusteels1
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
James W Bower
9 Shea Court
Carlisle, PA 17013
Son
One-half
50,758.69
Kenneth R Bower
1029 3rd Avenue
Leavenworth, KS 66048
Son
One-half
50,758.69
Total 101,517.38
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
II
fiLE COpy
LAST WILL AND TESTAMENT
I, J. Roy Bower, presently residing at Lot 164, CME, Newville, Lower Mifflin
Township, Cumberland County, Pennsylvania 17241, being of sound mind, memory and
disposition, do hereby make, publish and declare this my Last Will and Testament, hereby
revoking and making void all wills by me at any time heretofore made.
FIRST. I order and direct the payment of all my legally enforceable debts and
funeral expenses as soon as may be convenient after my decease.
SECOND. I give, devise and bequeath all my estate, real, personal and mixed,
whatsoever and wheresoever situate, to my sons, Kenneth R. Bower and James W.
Bower, in equal shares, on a per stirpes (by representation) distribution basis.
THIRD. I nominate, constitute and appoint my sons, Kenneth R. Bower and
James W. Bower, to be the Co-Executors oftbis my Last Will and Testament.
FOURTH. I direct that my personal representative(s) shall not be required to give
bond for the faithful performance of their duties in any jurisdiction.
FIFTH. I hereby direct that all federal, state and other death taxes payable
because of my death, with respect to the property forming my gross estate for tax purposes,
whether or not passing under this Will, including any interest or penalty imposed in
connection with such taxes, shall be considered a part of the expense of administration of
my estate and that such be paid out of the rest and residue of my estate.
IN WITNESS WHEREOF, I, J. Roy Bower, have hereunto set my hand and seal to
this my Last Will and Testament, written on one (1) page, this 16th day of November, 2004.
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WEIGLE & ASSOCIATES. P.c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
,I
This instrument was by the Testator, on the date hereof, signed, published and declared by
him to be his Last Will and Testament, in our presence, who at his request and in the
presence of each other, we believing him to be of sound and disposing mind and memory,
have hereunto subscribed our names as witnesses.
COMMONWEAL TH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
I, J. Roy Bower, the person whose name is signed to the foregoing instrument, having been
duly qualified according to law, do hereby acknowledge that I signed and executed the
instrument as my Last Will; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
/712 &
r' Mf.c- ,. 1/1)--U-
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Sworn or affirmed to and acknowledged before
me by 1. Roy Bower>!, e Testator,
this JtJ,-M day of "--1 : I , ? /
cr)/wndc. (/2, .J ..
2004.
,j
.' ,f
Notaril\J 00 .
Rhonda A. Wolford. Notary PublIC
hippensburg t1-1rQ Cumber1and Cou
My Commission t~;;'plt\lS Jan. 20, 2005
WEIGLE & ASSOCIATES. P.c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG DA 17?<;7,'''C>7
II
COMMONWEAL TH OF PENNSYL VANIA
SS
COUNTY OF CUMBERLAND
We, f-'~~~,,-.?i L. C'-/r~bt,,)J--; 7A-+~I~ir-t L_ ~m-,<--
andD(l, (" () en. ~~:hc({-') , the witnesses whose names are signed to
the foregoing instrument, being duly qualified according to law, do depose and say that
we were present and saw J. Roy Bower, the Testator, sign and execute the instrument as his
. Last Will; that he signed willingly and that he executed it as his free and voluntary act
for the purposes therein expressed; that each of us in the hearing and sight of the Testator,
signed the will as witnesses; and that to the best of our knowledge the Testator was
at the time eighteen (18) or more years of age and of sound mind and under no constraint or
undue influence.
/jJ~ d.~~-/
~ PrA,. t;;:t"H.J. ~ rfi. T rn Q
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Sworn or affirmed to and subscribed before me
L. ~(FLbrc:r.> J {' ._ ,
2004.
Notanal 001
Rhonda R. Wolford, Notary Public
hippensburg Boro, Cumberland Cou
Commission Expires Jan. 20, 2005
WEIGLE & ASSOCIATES. Pc. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBlJRr, Pi> 170>007 <~n7
A. Settlement Statement
U.5. DEPARTMENT OF HOU51NG AND URBAN DEVELOPMENT
B. ,Type of loan
1.0 FHA 2. 0 FmHA 3. iii Conv. Unins.
4. 0 VA 5. 0 Conv. Ins.
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 informational purposes and are not included in totals:
D. Name and address of borrower: ..
6. File number
7. Loan number
8. Mortgage Insurance case number
E. Nnme and address of seller:
Nancy C. Herlt
633 Brandy Run Road
Nmrville, PA 172H
J. Roy Bower Estate
c/o J. Wesley Bower
9 Shea Court, Carlisle, PA 17013
F. Name and address of lender:
N/A
G. Property location:
2002 Fleetwood Mobile Home
Lot 164 Serial # PAFL222AB49894AV13
Newville, PA 17241
Richard L. Webber, Jr., Esquire
126 East King Street, Shippensburg, PA 17257
H. Settlement agent:
Place of settlement:
I. Settlement date:
November 23, 2005
J. SUMMARY OF BORROWER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER:
102.
103.
104.
105.
30,000.00
K. SUMMARY OF SELLER'S TRANSACTION
400. GROSS AMOUNT DUE TO SELLER:
401. Contract sales rice 30,000.00
402. Personal ro ert
403.
404.
405.
106. C /Tn Tx
107. Co Tx
108. Assess.
109. School Tax
jiG. Pro ane
Adjustmentsfor items paid by seller in advance
to
to
to
11/24/05
to 6/30/06
Adjustmentsfor items paid by seller in advance
to
to
to
Tax 11/24/05 to 6/30/0
332.90
471. 66
111.
112.
120. GROSS AMOUNT DUE FROM BORROWER
,
\ \.\
\ \;
'"
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER\\\
4 b. GROSS AMOUNT DUE TO SELLER
30,804.56
201.
202.
203.
204.
205.
206.
207.
208.
209.
210. C /Tn Tx
211. Co Tx
212. Assess.
213.
214.
215.
216.
217.
218.
219.
Adjustmentsfor items unpaid by seller:
to
to
to
510. C /Tn Tx
511.CoTx
512. Assess.
513.
514.
515.
516.
517.
518.
519.
Adjustmentsfor items unpaid by seller:
to
to
to
220. TOTAL PAID BY/FOR BORROWER
1,000.00
520. TOTAL REDUCTION AMOUNT DUE SELLER
300. CASH AT SETTLEMENT FROM/TO BORROWER
301.
302.
600. CASH AT SETTLEMENT TO/FROM SELLER
601.
602.
30 804.56
0.00
I
30,804.56
303. CASH (0 FROM) (0 TO) BORROWER
29,804.56
603. CASH (0 TO) (0 FROM) SELLER
SUBSTITUTE FORM 1099 SELLER S! A TEMENT: Theinlorm~lion conlained in Blocks E, G, H, and I and on line 4~I (m, if line 401 is asIeri~k~d, li~es 40~ and 404) is important tax informalion and is being
[urOlshcd 10 Ihe Inlernal Revenue ServIce. If you are requIred 10 hie a return, a neghgence penally or olher sanclIon w,lI be Imposed on you ,Ilh,s Ilem IS requIred 10 be reported and the IRS determines lhat il has
nol been reported. i
SELLER INSTRUCTIONS: I1lhis real eslate was your principal residence, Iile Form 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax return; lor olher transaclions, com~lete1he
applicable parts 01 Form 4797, Form 6252 and/or Schedule D (Form 1040). i
You are required by law \0 provide the Settlemenl Agenl (named in Block H) wilh your correcllaxpayer identificalion number. If you do not provide the Selllemenl Agent with your correcllaxpayer identilicalion
number, you may be subjecllo civil or criminal penalties imposed by law. Under penalties 01 perjury, I certify thallhe number shown on this statemenl is my correcllaxpayer.identilication number.
I
.......... I _ I,.,,,, _,.,......_/L.#'..,..,'''L..r-1I ~ ....,VIVI1VII~~IVI... uCl~eu un Division o( commission PAID FROM PAID FROM
price $ @ %= (line 700) as/ollow.\': BORROWER'S SELLER'S
701. $ to FUNOS AT FUNOS AT
.' . SETTLEMENT SETTLEMENT
'M.~~ to
703. Commission paid at Settlement i
704. !
800. ITEMS PAYABLE IN CONNECTION WITH LOAN I
I
801. Loan oriqination fee % I
802. Loan discount % I
803. Appraisal fee .to
804. Credit report to
805. Lender's inspection fee
806. Mortqaqe insurance application fee to
,807. Assumption fee
808.
809.
810.
..... -.. ..-.---
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest from to (ci)$ /day
902. Mortqaqe insurance oremium for months to
903. Hazard insurance premium for yea rs to
904. years to
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard insurance months (ci) $ per month
1002. Mortqaqe insurance months @ $ per month
1003. City property taxes months (ci) $ per month
1004. County property taxes months @ $ per month
1005. Annual assessments months (ci) $ per month
1006. months (ci) $ per month
1007. months (ci) $ per month
1008. months (ci) $ oer month
1100. TITLE CHARGES
1101. Settlement or closinq fee to
1102. Abstract or title search to
1103. Title examination to
1104. Title insurance binder to
1105. Document preparation to
1106: Notary fees to
1107. Attorney's fees to
(includes above items numbers; )
1108. Title insurance to
.-. ----
(includes above items r.umbers; )
1109. Lender's coverage $
1110. Owner's coveraqe $
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordinq fees: Deed $ ; Mortqaqe $ . Releases $
1202. City/county tax/stamps: Deed $ ; Mortqage $
1203. State tax/stamps: Deed $ ; Mortqaqe $
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest inspection to
1303.
1304.
1305.
1306.
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103. See/ion J and 502. Section K)
I have carefully reviewed the H UD-] Settlement Statement and to the best of my knowledge and belief, it is a true and aCCUrate
statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of
th, HUD-' S"tk~atem'nt. ,J /1 d- 1 dA.a /'. . ec-
BO"OW'r.~ 0 &L~ s'".r.T!!.~ QL~ . 2X
The H U D-' Set H,men t Stat,m,nt whi,h , have p 'pneed i, a tcu, an~ceuen" aceount nf t hi, ,tenn"'tinn. : havoenu,"d 0< wi"
cause the funds to be disburse..? in a9cordance with this tatement.
Settlement Agent ~L-:;:./ A ,~ Date. / /-,;;) 3 -oS
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and
imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010.
J
I
I:\2005\RLW\Bower, James Roy Estate #10114\Agreement of Sale 10-6-05 Robert Herlt and Nancy.doc
AGREEMENT OF SALE
KNOW ALL MEN BY THESE PRESENTS, that the undersigned, James W. Bower,
Executor of the Estate of James R. Bower aka J. Roy Bower (hereinafter "Seller"), for and in
consideration of Thirty Thousand ($30,000.00) Dollars, payable as set forth below, does hereby
bargain, sell, transfer, assign, and deliver a 2002 Fleetwood mobile home, serial number
PAFL222AB49894A V13, owned by the undersigned and being transferred and sold to Robert W.
Herlt and Nancy C. Herlt (hereinafter "Purchasers") on the date hereof, subject to the terms
below.
1. The total purchase price of$30,000.00 shall be paid as follows:
A. A payment ofGne Thousand ($1000.00) Dollars upon the execution of this
Agreement, receipt of which is hereby acknowledged, to be placed in
escrow with Seller's attorney.
B. The remainder, Twenty-Nine Thousand ($29,000.00) Dollars, payable at
final settlement, which shall be held on or before November 30,2005.
C. Purchasers intend to pay a portion of the remainder prior to settlement, and
shall receive credit therefore as per discussion between Seller and
Purchasers, all said payments to be held in escrow by Seller's attorney.
2. Purchasers shall take possession of the mobile home at time of final settlement.
3. The Certificate of Title shall be transferred to Purchasers at final settlement.
4. The mobile home is being sold "as is," and there are no warranties given by Seller.
5. The stove, dishwasher, refrigerator freezer, washer, dryer and drapes (at
Purchaser's discretion) artificial fern and ivy, and 8 x 8 shed shall transfer to
Purchasers.
6. Purchasers shall pay all sales tax and transfer and registration fees associated with
this transaction.
7. The County/Township and School real estate taxes on the mobile home shall be
prorated as of the date of final settlement.
8. Seller will clean the trailer prior to settlement.
WEIGLE & ASSOCIATES. EC. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
I:\2005\RLW\Bower, James Roy Estate #10114\Agreement of Sale 10-6-05 Robert Rerlt and Nancy.doc
9. In the event Purchasers fail to make settlement as provided, violates, fails to
perform or fulfill any of the terms or conditions of the Agreement, then in such
case all deposit money and other sums paid by the Purchasers on account of the
purchase price, whether required by this Agreement or not, may be (a) retained by
Seller on account of the purchase, or (b) as monies to be applied to Seller's
damages, or (c) as liquidated damages for such breach, as the Seller may elect, and
in the event that Seller elects to retain the monies as liquidated damages in
accordance with this paragraph, the Seller shall be released from all liability or
obligations and this Agreement shall be null and void and all copies will be
returned to Seller for cancellation.
10. This Agreement. contains the whole agreement between the Seller and the
Purchaser and there are no other terms, obligations, covenants, representations,
statements or conditions, oral or otherwise of any kind whatsoever.
the
IN WITNESS WHf:REOF, the undersigned have set their hands and seals on this
I ~tZ day of Oc -h~f If ,2005.
JAMES R. BOWER, aka J. ROY BOWER ESTATE
7fl::Jt1~A ;!
WITNESS
tJ.
AMES W. BOWER, Executor
Seller
(SEAL)
/z~w JJt.Jr
RbBERT W. HERLT
Purchaser
(SEAL)
~/l~dl
WITNESS
4m G (d~J-
NANC . HERLT
Purchaser
(SEAL)
WEIGLE & ASSOCIATES, P.c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
jUL 1 1\\\\S
June 30,2005
Weigle & Associates, P.C.
Attorneys-at-Law
126 East King Street
Shippensburg, PA 17257-1397
RE: J. Roy Bower
Mr. Webber:
In reference to the above customer, our records show the enclosed information to be
accurate as of June 10, 2005. Our researching fee for the information we have provided
is .$ 15.00. Please send your remittance to the following address:
77
/
Farmers and Merchants Trust Company
A TIN Karen Davis
20 South Main Street
Chambersburg, PA 17201-0819
lJ-'\)
I J{;l \ ether
LdP (j -"-
)J If I may be of any further assistance, please contact me.
() [L.lL
Sincerely,
~8~
Karen E. Davis
Deposit Operations Manager
717-264-6116 888-264-6116 P.O. Box 6010 Chambe~burg, PA 17201-6010
'FINAN.CTAl:-SOl,~TI().~.~.. FROM eEOP.lE Y.ou_~~_ow',
RE: J. Rov Bower
DATE OF DEATH June 10, 2005
ACCOUNT INFORMATION
x
CHECKING
SAFE DEPOSIT
SAVINGS ____CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED 02/11/2002
ACCOUNT NUMBER 34-22089
ACCOUNT BALANCE AT DATE OF DEATH
ACCRUED INTEREST
TOTAL ACCOUNT BALANCE
NAME(S) ON ACCOUNT
REGISTRATION OF ACCOUNT
DATE CLOSED
still open
$ 6,205.49
$ 1. 45
$ 6,206.94
J Rov Bower or Jean H Bower
Joint
ACCOUNT INFORMATION
CHECKING
SAFE DEPOSIT
x
SAVINGS ___CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED 04/26/2002 DATE CLOSED still open
ACCOu!~T ~llliffiER 08-09972
ACCOUNT BALANCE AT DATE OF DEATH $ 8,212.22
ACCRUED INTEREST $ 5.65
TOTAL ACCOUNT BALANCE $ 8,217.87
NAME(S) ON ACCOUNT J. Rov Bower or Jean H. Bower
REGISTRATION OF ACCOUNT Joint
RE: J. Roy Bower
DATE OF DEATH June 10, 2005
ACCOUNT INFORMATION
CHECKING
SAFE DEPOSIT
SAVINGS ~CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED 03/20/2002 DATE CLOSED
ACCOUNT NUMBER 015-2975013
ACCOUNT BALANCE AT DATE OF DEATH
ACCRUED INTEREST
TOTAL ACCOUNT BALANCE
NAME(S) ON ACCOUNT
REGISTRATION OF ACCOUNT
still
open
$ 10,717.07
$ 77.53
$ 10,794.60
J Roy Bower or Jean H Bower
Joint
ACCOUNT INFORMATION
CHECKING
SAFE DEPOSIT
SAVINGS X__CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED 05/14/2002 DATE CLOSED still open
ACCOu~T NUMBER 015-2975032
ACCOUNT BALANCE AT DATE OF DEATH $ 35,000.00
ACCRUED INTEREST $ 124.27
TOTAL ACCOUNT BALANCE $ 35,124.27
NAME(S) ON ACCOUNT J. Roy Bower or Jean H. Bower
REGISTRATION OF ACCOUNT Joint
RE: J. Roy Bower
DATE OF DEATH June 10, 2005
ACCOUNT INFORMATION
CHECKING
SAFE DEPOSIT
SAVINGS ~CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED 12/06/2002 DATE CLOSED
ACCOUNT NUMBER 015-2975082
ACCOUNT BALANCE AT DATE OF DEATH
ACCRUED INTEREST
TOTAL ACCOUNT BALANCE
NAME(S) ON ACCOUNT
REGISTRATION OF ACCOUNT
still open
$ 15,000.00
$ 2.94
$ 15,002.94
J Roy Bower or Jean H Bower
Joint
ACCOUNT INFORMATION
CHECKING
SAFE DEPOSIT
SAVINGS X__CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED 11/08/2004
ACCOUNT NUMBER 015-2977499
ACCOUNT BALANCE AT DATE OF DEATH
ACCRUED INTEREST
TOTAL ACCOUNT BALANCE
NAME(S) ON ACCOUNT J. Roy Bower
REGISTRATION OF ACCOUNT Individual
DATE CLOSED
still open
$ 10,099.97
$ 21.69
$ 10,121.66