HomeMy WebLinkAbout12-16-05
RE~-1500 EX + (6~OO)
'*
COMMONWEAL TH 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
026
COuNTYCOOE ---VEA;;-- - - NuMaER- -
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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Goodall, Nanc H
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
SOCIAL SECURITY NUMBER
1 8 1 - 3 2 - 5 329
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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3/16/2005 1/5/1941
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
[Xl 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy 01 Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date 01 death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Aftach copy ofTrust)
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
David H. Stone, Es uire 414 Bridge Street
FIRM NAME (If Applicable)
Stone LaFaver & Shekletski
TELEPHONE NUMBER
717 774-7435 New Cumberland PA 17070-
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3 Closely Held Corporation, Partnership or Sole-Proprietorship
(1)
(2)
(3)
(4)
(5)
OFFICIAL USE ONLY
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402,900.00
39,125.00
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4. Mortgages & Notes Receivable (Schedule D)
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(6)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
(7)
525,954.52
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
(9)
(10)
117,204.09
975.12
0.00 X _(15) 0.00
0.00 X .045 (16) 0.00
407,775.31 X .12 (17) 48,933.04
0.00 X .15 (18) 0.00
(19) 48,933.04
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)
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)
16. Amount of Line 14 taxable at lineal rate
(11)
(12)
(13)
118,179.21
407,775.31
17. Amount of Line 14 taxable at sibling rate
(14)
407,775.31
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Qecedent's Com lete Address:
STREET ADDRESS
1134 Atland 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)
48,933.04
50.000.00
2.446.65
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
52,446.65
TotallnteresUPenalty ( 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 Payable to: REGISTER OF WILLS, AGENT
0.00
3,513.61
0.00
0.00
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... D [2g
b. retain the right to designate who shall use the property transferred or its income; ........................................ D [2g
c. retain a reversionary interest; or ...................................................................................................... D [2g
d. receive the promise for life of either payments, benefits or care? ............................................................. D [2g
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?......................................... ...................................................... D [2g
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. D [2g
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... D [2g
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, 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 PERS ESPONSIBLE FOR Fill G RETURN
ADDRESS
SIGNA TURE
PA 19380
DATE
12- ~J
ADDRESS
PA 17070
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)l.
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 39116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4,5%, except as noted in 72 P.S. 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.
RE;V-1502 EX + (6-98)
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SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Goodall. Nancv. H 21 05 0261
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 richt of survivorshio must be disclosed on Schedule F.
ITEM
NUMBER
1
DESCRIPTION
Property located at 1134 Atland Dr. Mechanicsburg
Upper Allen Twp., Cumberland County, Pennsylvania sold to C. David
Shaffer and Yong S. Shaffer, his wife, on May 25, 2005
Property located at 5 Beilman Ct. Mechanicsburg
Upper Allen Twp., Cumberland County, Pennsylvania sold to Shawn M. Boone
on August 25, 2005
2
VALUE AT DATE
OF DEATH
230,000.00
172,900.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
402,900.00
RSV-1503 EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Goodall Nancv. H
FILE NUMBER
21 05
0261
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
DESCRIPTION
100 shares Disney (Walt) Productions stock @ $28.65 each
VALUE AT DATE
OF DEATH
2,865.00
2
400 shares IBM stock @ $90.65 each
36,260.00
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
39,125.00
R~V-1508 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Goodall. Nancv. H
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.
0261
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
1,750.00
1987 BMW at Kelley Blue Book value
2
AM-refund
40.00
3
Allstate Insurance CO.-refund for 1134 Atland ins
138.00
4
Bank of America-Checking Acct. #000038458675
266.77
5
Donegal Insurance-refund from ins. on 5 Beilman Ct
57.00
6
Geico-refund on car insurance
159.00
7
Lump sum payment from retirement
6,234.05
8
Money received as reimb. from Kathyrn Goodall Est
8,830.00
9
PNC Bank-Checking Acct. #5004022656
66,405.10
10
Refund check
20.00
11
Waste Management refund at 5 Beilman Ct. property
29.60
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
83 929.52
R~V-1511 EX +(12-99)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Goodall. Nancv H
FILE NUMBER
21
05
0261
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Parthemore Funeral Home-funeral expenses 1,599.10
Rolling Green Cemetery-services rendered 2,385.00
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 David H. Stone, Esquire 21,038.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills-Probate and short cert. 478.00
5. Accountant's Fees
6. Tax Return Pre parer's Fees
7. Cumberland Law Journal-advertising grant of letters 75.00
2 The Patriot News Co.-advertising grant of letters 113.61
3 United States Treasury-decedents fed income tax ($48,538) less refund ($6,636) 41 ,902.00
4 PA Dept. of Revenue-decedents state inc tax ($9,118) less refund ($9,108) 9.00
5 Marlin A. Yohn, Sr.-taxes due at 1134 Atland 584.18
6 Marlin A. Yohn, Sr-pers. taxes @ 5 Beilman 9.80
7. Marlin A. Yohn, Sr-taxes due @ 5 Beilman 450.68
8. PPL Electric Utilities-services at 5 Beilman from 3-29 to 8-30-05 188.83
9. PPL Electric Utilities-services at 1134 Atland from 3-29 to 5-31-05 62.35
10. Waste Management-services at 5 Beilman from 4-1 to 7-14-05 92.65
11. Waste Management-services at 1134 Atland 45.70
12. Verizon-services rendered to 4-18-05 18.64
TOTAL (Also enter on line 9, Recapitulation) $ 117,204.09
(If more space is needed, insert additional sheets of the same size)
Goodall, Nancy, H
Decedent's Name
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Page 1
21 05 0261
File Number
Schedule H - Funeral Expenses & Administrative Costs - 87.
ITEM
NUMBER
AMOUNT
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
DESCRIPTION
UGI-gas services at 5 Beilman from 4-15 to 8-31-05
UGI-gas services at 1134 Atland from 4-15 to 5-31-05
Comcast Cable-services at 5 Beilman
Upper Allen Township-sewer services at 5 Beilman
Upper Allen Township-sewer services at 1134 Atland
United Water PA-services at 5 Beilman from 5-10 to 9-7-05
United Water PA-services at 1134 Atland from 5-10 to 6-13-05
Securities Services Network-commission on sale of 2 stocks
Settlement costs on sale of 1134 Atland ($16,335) less reimb. ($630.79)
Settlement costs on sale of 5 Beilman ($15,640) less reimb. ($2,108.02)
Kathryn Blackburn-Reimb. for stamps, trash pickup, etc
Cleaning services and landscape cleanup at 5 Beilman
Bob Lutz Home Improvements-services rendered at 5 Beilman
Faxing, notary and postage services
Delaware Division of Revenue-Delaware income tax due
Closing costs
276.57
171.67
13.93
200.00
100.00
24.85
9.00
397.89
15,704.21
13,531.98
88.00
400.00
3,373.45
34.00
13,326.00
500.00
SUBTOTAL SCHEDULE H-B7
48,151.55
R'EV-1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Goodall. Nancv H
FILE NUMBER
21
05
0261
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. George K. Shakinian, MD-services rendered
VALUE AT DATE
OF DEATH
358.00
2 Timothy A. Clark, MD-services rendered
52.50
3 Moffit Heart & Vascular Group-services rendered
166.00
4 Internists of Central PA-services rendered
138.00
5 Central PA Hema & Med Quc Assoc-services rend
52.50
6 Nephroloty Assoc. of Central PA-services rend
51.50
7 Kantoo & Tkatch Assoc.-services rendered
28.00
8 Associated Cardiologists-services rendered
2.42
9 Holy Spirit Hospital-services rendered
100.00
10 West Shore EMS-ambulance service
26.20
TOTAL (Also enter on line 10, Recapitulation) $
975.12
(If more space is needed, insert additional sheets of the same size)
"'."B~'("
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
II Nancv. H 21 05 0261
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Daniel E. Goodall Lineal 203,887.65
5202 Fino Drive
San Diego, CA 92124
2. Kathryn C. Blackburn Lineal 203,887.66
422 Barker Drive
West Chester, PA 19380
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)
) , 're\ded\NGOODALLshaffer-exdeed
PARCEL #42-30-2106-044
DEED
THIS INDENTURE made the
~S~
day of
(YJ Ii'd
Administratrix
, in the
year 2005, between KATHRYN C. BLACKBURN,
of the Estate
of NANCY H. GOODALL, late of Upper Allen Township, County of Cumber-
land and Commonwealth of Pennsylvania, of the first part, hereinafter
called the Grantor,
-AND-
C. DAVID SHAFFER and YONG S. SHAFFER, husband and wife, of the
second part, hereinafter called the Grantees;
WHEREAS, the said NANCY H. GOODALL became in her lifetime seised,
as of fee, of and in to a certain tract of land, together with the
improvements thereon erected, situate in Upper Allen Township, County
of Cumberland and Commonwealth of Pennsylvania, and more particularly
described hereinafter; and being so thereof seised, died on March 16,
2005, without having first made a Last Will and Testament in writing;
and
WHEREAS, Letters of Administration were upon her estate duly
issued by the Register of Wills of Cumberland County on March 21,
2005, to said KATHRYN C. BLACKBURN.
NOW THIS INDENTURE WITNESSETH, that the said Grantor, for and in
consideration of the, sum of TWO HUNDRED THIRTY THOUSAND and NO/lOO
($230,000.00) Dollars, which has been paid to her by the said Grantees
-1-
at or before the sealing and delivery hereof, receipt whereof is
hereby acknowledged, has granted, bargained, sold, aliened, released
and confirmed, and by these presents does grant, bargain, sell, alien,
release and confirm unto the said Grantees,
ALL THAT CERTAIN lot in the property known, names and identified in
the Declaration referenced below, as "Ashcombe Farms P.R.D., a Resi-
dential Planned Community," located in Upper Allen Township, Cumber-
land County, Pennsylvania, which has heretofore been submitted to the
provision of the Pennsylvania Uniform Planned Community Act, 68
Pa.C.S.A. S5101, et. seq., as amended by the recording in the Office
of the Recorder of Deeds of Cumberland County, Pennsylvania, the
Declaration for Ashcombe Farms P.R.D., a Flexible Residential Planned
Community ("Declaration"), dated April 6, 1998, recorded April 13,
1998, in Miscellaneous Book 573, Page 407, as amended by First Amend-
ment to Declaration for Ashcombe Farms P.R.D., a Flexible Residential
Planned Community, ("First Amendment"), dated March 13, 1999, recorded
March 19, 1999, in Miscellaneous Book 607, Page 440, by Second Amend-
ment to Declaration for Ashcombe Farms P.R.D., a Flexible Residential
Planned Community, dated September 29, 1999, recorded October 13,
1999, in Miscellaneous Book 627, Page 652, as by Third Amendment to
Declaration for Ashcombe Farms P.R.D., a Flexible Residential Planned
Community ("Third Amendment") dated December 2, 2000, recorded Febru-
ary 26, 2001, in Miscellaneous Book 667, Page 650, by Fourth Arr'endment
to Declaration for Ashcombe Farms P.R.D., a Flexible Residential
Planned Community ("Fourth Amendment") dated July 23, 2001, recorded
October 9, 2001, in Miscellaneous Book 681, Page 2801, and by Fifth
Amendment to Declaration for Ashcombe Farms P.R.D., a Flexible Resi-
dential Planned Community, dated January 29, 2003, recorded February
7, 2003, in Miscellaneous Book 694, Page 1120, being and designated in
such Declaration, as amended, as Lot No. 137 (Identifying Number),
described in Paragraph 3 of the First Amendment and shown (and de-
scribed) in Exhibit B-1 of the First Amendment.
LOT NO. 137 contains 7,187.70 square feet, more or less.
BEING LOT NO. 137, Ashcombe Farms P.R.D. Final-Phase 2A Site Plats and
Plans, dated June 11, 1997, recorded in the Office of the Recorder of
Deeds of Cumberland County in Plan Book 78, Page 37.
BEING THE SAME PREMISES WHICH Sewalt, Inc., a Pennsylvania corpora-
tion, by its deed dated October 29, 2004, and recorded November 4,
-2-
2004, in the Office of the Recorder of Deeds in an
County, Pennsylvania, in Record Book 266, Page 415
conveyed unto Nancy Goodall, deceased.
UNDER AND SUBJECT to restriction and covenants of
but not limited to, Declaration for Ashcombe Farms
Residential Planned Community, dated April 6, 1998
Office of the Recorder of Deeds of Cumberland Coun
Book 573, Page 407, First Amendment to Declaration
P.R.D., a Flexible Residential Planned Community,
1999, recorded in the Office of the Recorder of De
County in Miscellaneous Book 607, Page 440, Second
Declaration for Ashcombe Farms, P.R.D., a Flexible
nity, dated September 29, 1999, recorded in the Of
of Deeds of Cumberland County, Pennsylvania, in Mi
627, Page 652, and Third Amendment to Declaration
P.R.D., a Flexible Residential Planned Community,
2000, recorded in the Office of the Recorder of De
County, Pennsylvania, in Miscellaneous Book 667, P
Amendment to Declaration for Ashcombe Farms, P.R.D
Residential Planned Community, dated July 23, 2001
the Office of the Recorder of Deeds of Cumberland
nia, in Miscellaneous Book 681, Page 2801, and Fif
Declaration for Ashcombe Farms, P.R.D., a Flexible
Community, dated January 29, 2003, and recorded in
Recorder of Deeds of Cumberland County, pennsylvan
Book 694, Page 1120, and under and subject to ease=
way of record and visible by inspection.
TOGETHER with all and singular the buildings,
streets, alleys, passages, waters, water-courses,
privileges, hereditaments and appurtenances whatso
belonging or in any wise appertaining and the reve
remainders, rents, issues and profits thereof, and
right, title, interest, property, claim and demand
the said NANCY H. GOODALL, at and immediately befo
-3-
decease, in law, equity, or otherwise howsoever, of, ln, to or out of
the same.
TO HAVE AND TO HOLD the said lot or piece of ground above de-
scribed, with the buildings and improvements thereon erected,
hereditaments and premises hereby granted or mentioned, and intended
so to be, with the appurtenances unto the said Grantees, to ana for
the only proper use and behoof of the said Grantees, forever.
And the said Grantor, for herself and her respective heirs,
executors and administrators, does covenant, promise and agree to and
with the said Grantees, their heirs and assigns, that she, the said
Grantor, has not heretofore done or committed any act, matter or thing
whatsoever whereby the premises hereby granted, or any part thereof,
is, are, shall or may be impeached, charged, or encumbered in title,
charge, estate or otherwise howsoever.
IN WITNESS WHEREOF, the said Grantor has hereunto set her hand
and
and year first above written.
. _ ( SEAL)
ATH N C. BLACKBURN, Administratrix
of the Estate of NANCY H. GOODALL
"-,_.~_.-.~~
-4-
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF
~
SS:
On this, the ClSih day of ~ ' 2005, before me a Notary
Public, the undersigned officer, personally appeared KATHRYN C.
BLACKBURN, Administratrix of the Estate of NANCY H. GOODALL, known to
me or satisfactorily proven to be the person whose name is subscribed
to the within instrument, and acknowledged that she executed the same
for the purposes therein contained.
IN WITNESS WHEREOF, I have hereto set my hand and notarial seal.
COMMO~TI-I OF PENNSYLVANIA
Notarial Seal bl'
, L W rtz Notary Pu Ie
Ha~;d~: ~p.~ C~mberland Co~
My Commission Expires Apr, 8.
, A -......atlon of NotarIeS
Member, Pennsylvama """'^"
~dW
Notary PU~
lS
I hereby certify that the precise address of the Grantee
\ \ 3'-1 ~ Idtive. ~i'?~ I Q... IICf55
-5-
r~\ded\N(~00DALL~oone-exdeed
PARCEL #42-30-2106-006
DEED
THIS INDENTURE made the
t') -\"
,Ab day of
, in the
;:'\VC\U-1 \"
year 2005, between KATHRYN C. BLACKBURN, Administratrix of the Estate
of NANCY H. GOODALL, late of Upper Allen Township, County of Cumber-
land and Commonwealth of Pennsylvania, of the first part, hereinafter
c...:u~~<.:-.:i the: Grant0r,
- AND -
SHAWN M. BOONE, a single man, of the second part, hereinafter
calle~ the Grantee;
WHEREAS, LIt.: :;,lld tJid.JC'{ II. COODtlf,L L',,;,![f\C i[, It<:t. lif,::Lir;,' :;'::L:;o-:l,
d:~ o( fec, of and ][1 to d c!~rl:ain tract of land, toget.her wit~: t.he
improvements thereon erected, situate in Upper Allen Township, County
of Cumberland and Commonwealth of Pennsylvania, and more part.icularly
de :3 r; r-i bed her c i n aft e r; and be i n 9 sot her e 0 f s e i s p d , die don ~,j;H c h 1 6 ,
2005, without having first made a Last Will and Testament in writing;
and
WHEREAS, Letters of Administration were upon her estate duly
issued by the Register of Wills of Cumberland County on March 21,
2005, to said KATHRYN C. BLACKBURN.
NOW THIS INDENTURE WITNESSETH, that the said Grantor, for' and l!1
consideration of the sum of ONE HUNDRED SEVENTY-TWO THOUSAND NINE
HUNDRED and NO/100 ($172,900.00) Dollars, which has been paid to her
-1-
oil
I
by the said Grantee at or before the sealing and delivery hereof,
receipt whereof is hereby acknowledged, has granted, bargained, sold,
aliened, released and confirmed, and by these presents does grant,
bargain, sell, alien, release and confirm unto the said Grantee,
ALL THAT CERTAIN tract or parcel of land situate in Upper Allen
T ') ':!" S hip, r:: u m b "" r 1 a n ri r:: ') un t: 'I, rr1') r P [';=J r t i (' 111 ;=J r 1 'I b n lln rl p rl ;=J n ri rl p .'" (' r i h p 'i
as follows: ,
BEGINNING at a point on the northern right-of-way line of Beilman
Court, a 50 foot wide street, said point being the southeastern corner
of Lot No. 102; thence along the eastern line of said lot North 41
degrees 21 minutes 13 seconds West a distance of 107.78 feet to a
point, said point being on the eastern line of Lot No. 179; thence
,tl () n 'J t h n c a :) t ern ] i. n e () f ::-; ai d ] () t ~ J () r t h tJ 1 rire, 0 r (~ i" .',: 0 () r\ i nut f? S "Jr1
seconds East a distance of 28.25 feet to a point, said point being on
U\ (~ nor t h we s t~ e en cor n e r () f L () I~ No. l. 0 4; the n c e ala n q the we s tee n 1 i [k:
,J :;,lid ~,)t :;'Hll1th tJ1 rI"(J~''''':: ~1 rnirlll!":; 11 ."',,'nll'!-: r~.I::" 1 'Ii.'.t-Hl'~n I
116.24 feet t~o Cl. point, said point bei.ng on the northern right-of-way
line of Beilman Court; thence along said right-of-way line along a
curve to the left having a radius of 825.00 feet and an arc length of
28.39 feet, said arc being subtended by a chord of South 58 degrees 10
minutes 37 seconds West a distance of 28.39 feet to a point, the Place
of Beginning.
CONTAINING 3,133.94 square feet or 0.0719 acres.
BEING Lot No. 103, Aschcombe Farms P.R.D. Final Phase 1 Site Plat,
dated August 29, 1994, last revised August 12, 1996, recorded in the
Office of the Recorder of Deeds of Cumberland County in Plan Book 73,
Page 13.
BEING THE SAME PREMISES WHICH Anderson-Stern, Inc., by deed dated
October 15, 1998, and recorded October 30, 1998, in the Office of the
Recor.-der of Deeds in and [or. CUII\Der.ldllu COUllly, tellJl::;y';"vdllid, .ill
Record Book 188, Page 120, granted and conveyed unto Nancy H. Goodall,
deceased.
-2-
UNDER AND SUBJECT to restrictions and covenants of record, including,
but not limited to, Declaration for Ashcombe Farms P.R.D., a Flexible
Residential Planned Community, recorded in the Office of the Recorder
of Deeds of Cumberland County, on April 13, 1998, in Miscellaneous
Book 573, Page 407.
UNDER AND SUBJECT, nevertheless, to all restrictions, easements,
covenants and rights-of-way of record, or visible upon inspection of
premises.
UNDER AND SUBJECT to a five (5) foot access easement extending along
LIte S0ULllen~j j:J0l.:ti0rl 0[ L0t H0. 103 being rrL'.::a.3ureQ five (S) fe:::::: f~c...~.'.
the existing' stone retaining wall constructed upon or adjacent to said
Lot No. 103 for the purpose of providing pedestrian access to Lot No.
101, Lot No. 102, Lot No. 103, Lot No. 104, Lot No. 105, and Lot No.
106. The easement hereby reserved and created is in addition to the
easement created pursuant to Section 4.1.9, Declaration. The easement
herein created is intended to burden Lot No. 103 and is intended to
benefit Lot No. 103, Lot No. 101, Lot No. 102, Lot No. 103, Lot No.
1 0 -'1, Lot No. 1 0 ') , and L 0 t_ N <). lOG. I n LIt ':; c, v <.:: [ I L , i r I t h (; :: u t u r '::: , U I d '.
flow(~r- beels or- landscaping areas ano planted i--,ithin the ar-eas of thi:,
(;a:Jc:mc:nl~ by Gr-antee (or' Gr'antee's successor- in title), then the five
(')) lL~)uL. dl~l:'~:;.; '.:d:~;';III!~rIL :;II<lJI l,,; LUL,.:;JI.!.::d i.rlllil!;,.li,I:.,;Lj' :~ui.;:...ll u~ ,~di,.l
flower bed or landscaped areas.
TOGETHER with all and 3ingular the buildings, improvements, ways,
streets, alleys, passages, waters, water-courses, rights, liberties,
privileges, hereditaments dnd appurtenances whatsoever, thereunto
belonging or in any wise appertaining and the reversions and
remainders, rents, issues and profits thereof, and all the estate,
right, title, interest, property, claim and demand whatsoever of her,
the said NANCY H. GOODALL, at and immediately before the time of her
decease, in law, equity, or otherwise howsoever, of, in, to or out of
the same.
-]-
TO HAVE AND TO HOLD the said lot or piece of ground above de-
scribed, with the buildings and improvements thereon erected,
hereditaments and premises hereby granted or mentioned, and intended
so to be, with the appurtenances unto the said Grantee, to and for the
only proper use and behoof of the said Grantee, forever.
And the said Grantor, for herself and her respective heirs,
executors an@ administrators, does covenant, promise and agree to and
with the said Grantee, their heirs and assigns, that she, the said
Gran tor, has not here to fore done or commi t ted any ac t, ma t te r or thi :--lg
whatsoever whereby the premises hereby granted, or any part thereof,
1:-" dr::-(3, shall or::- may b(~ irnpeaCrlf?d, char::-cl'?d, or::- f:ficUrnb(~n3d in titl.e:,
('~) If'f}", (I"j',lt'(., (-)r' ('II ~!(lr.t"/i:-~(, h(-)\'!"()/'~_fl\r.
IN WITNESS WHEREOF, the said Grantor has her::-eunto set her hand
and seal the day and year first ahove written.
Witness
- 4-
"
:1'
Ii
COMMONWEALTH OF PENNSYLVANIA:
SS:
COUNTY OF
On this, the
day of
, 2005, before
me a Notary Public, the undersigned officer, personally appeared
KATHRYN C. BLACKBURN, Administratrix of the Estate of NANCY H.
GOODALL, known to me or satisfactorily proven to be the person whose
name is subscribed to the within instrument, and acknowledged that she
executed the same for the purposes therein contained.
\
\
IN WITNESS WHEREOf, I have hereto set my h~nd and notarial sea~.
, '
) .' .J I, .1 :_1, i. . :_.; _~,
JAN~ ,Ii,;. I.' J / ['I:~;:r;
"'rr-r: H~~" ,.,. .' I 'r! (:I"I,I~r'l
, ., I ; " ") 70f}:'\
/1 I ,
.' I ,.
Nn!-,1t'Y [lllhl ir'
/
//
I hereby certify that the preCIse address of the Grantee
is
Attorney for
-5-
~SN Money - IBM - Stock chart, Index chart
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Quote, Chart, News Name or Symbol: IBM
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Inti Business Machines
Date High Low Close Volume
3/31/2005 91.4100 90.2200 91.3800 4,418,600
3/30/2005 90.8800 90.3200 90.6800 5,253,900
3/29/2005 91.0700 90.1800 90.6000 6,070,400
3/28/2005 91.6300 90.6200 91.0400 4,088,900
3/24/2005 91.5500 90.7000 90.7000 4,577,100
3/23/2005 91.1700 89.8200 90.5200 5,472,100
3/22/2005 90.3400 89.2600 89.5000 4,452,500
3/21/2005 90.2800 89.2700 89.5100 4,402,400
3/18/2005 89.9000 89.0900 89.2800 7,541,500
3/17/2005 90.6800 89.7000 89.8600 5,562,100
3/16/2005 91.4000 90.2500 90.6500 5,065,300 400 s-hs. 'j. 'I D. ~~ ....
-
3/15/2005 92.2700 91.2000 91.3800 3,663,100 'A 3(" J.kO.cru
3/14/2005 92.0400 91.5000 91.9000 3,935,500
3/11/2005 92.4100 91.2000 91.5100 4,494,300
3/10/2005 92.8000 92.0900 92.4100 3,422,500
3/9/2005 93.0000 92.0100 92.3500 4,511,200
3/8/2005 92.5600 91.7000 92.1300 5,087,800
3/7/2005 92.5100 91.5900 91.6000 7,046,900
3/4/2005 93.1800 92.3600 92.3700 4,754,000
3/3/2005 93.2100 92.2000 92.4100 4,037,800
3/2/2005 93.7300 92.7500 92.9200 4,467,400
3/1/2005 93.4300 92.5900 93.3000 3,819,900
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.MSN Money - DIS - Stock chart, Index chart
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Disney (Walt) Productions
Date High Low Close Volume
3/31/2005 28.8500 28.2500 28.7300 6,356,600
3/30/2005 28.4500 27.9700 28.3500 4,857,300
3/29/2005 28.2500 27.8000 27.9000 6,159,900
3/28/2005 28.4200 27.9100 28.1700 5,121,100
3/24/2005 28.1500 27.7500 27.7500 4,776,000
3/23/2005 28.0300 27.7300 27.7800 5,188,800
3/22/2005 28.4100 27.7800 27.7800 5,067,400
3/21/2005 28.3900 27.9000 28.1800 4,363,500
3/18/2005 28.4400 27.8200 28.0900 11,587,800
3/17/2005 28.8900 28.3200 28.3700 6,391,300
3/16/2005 28.9200 28.4000 28.6500 9,724,800 100 sJu. 4
X .:tf. (.S"
3/15/2005 28.9700 28.3000 28.6000 10,716,800 11 ~ '" ._
./ ~.(}D
3/14/2005 28.1000 27.6300 28.0200 7,877,000
3/11/2005 28.2100 27.4700 27.5900 6,875,100
3/10/2005 28.2100 27.8100 28.0000 4,910,900
3/9/2005 28.5200 27.6900 27.9800 9,170,800
3/8/2005 28.7600 28.4300 28.5300 6,346,600
3/7/2005 29.0000 28.7500 28.9600 4,056,400
3/4/2005 28.9700 28.6100 28.8800 6,052,900
3/3/2005 28.7700 28.4100 28.5700 6,836,500
3/2/2005 28.8500 28.3000 28.6900 4,631,100
3/1/2005 28.5100 27.9000 28.4800 7,472,700
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.
BankofAmerica ~
~~~
Bank of America, N.A. ,.-.
P.O. Box 25118
Tampa, FL 33622-5118
IH
Page 1 of 2
Statement Period
02-18-05 through 03-23-05
Number of checks encIosed= 0
B 14 0 C P 14 0035129
Account Nwnber: 0000 3845 8675
1...111.11111....1.1..1.1..1.1...11..1.1.1..1.11....1.1..11..1
00007402 1 KB 0.309 13 24295 001 SCH999 II 34
NANCY H GOODAll
5 BEILMAN CT
MECHANICSBURG PA 17055-5358
Our free Online Banking service allows you to check balances, track account activity, pay bills and more.
With Online Banking you can also view up to 18 months of this statement
online and even turn off delivery of your paper statement.
Enroll at www.bankofamerica.com.
Account
Name
Your Bank of America Advantage Summary
Account Qualifying Type of
Number Balance. Balance Date
Total
Deposit Accounts
Regular Checking 0000 3845 8675
Total Deposit Account Balance
266.77
Average
03-22
$266.77
* Balances in your linked accounts that are used to avoid a monthly maintenance fee are listed here. These balances reflect the average or principal ballillce ill your
account - for your actual ending account balances, please see the 'Your Account at a Glance" section on your statement for each of your accowlts.
Your Account at a Glance
Account Number .......................................... 0000 3845 8675
Begi!lnin-8 Balance on 02-18-05................... $ 266.77
Ending Balance on 03-23-06................. $ 266.77
'0 Recycled Paper
'OIM I l:J-' <='l:Jl:J-' J. r '-'<='
rl~""DH'~1'\
qlcf. O(btl ..)q::;;'tl
t-'.I:jl/I:jl
~ PNCBAN<
May 4, 2005
David H. Stone
414 Bridge Street
P.O. Box E
New Cumberland) PA 11070
RE: Estate of Nancy H. Goodall, deceased
SSN: 181-32-5329
000: 3/1612005
Dear Mr. Stone:
In response to your request for Date of Death balances fOf the customer noted above, our
records show the following:
Checking Account
Account #5004022656
Established 01/24/2003
NANCY H GOODALL
DOD balance: $66,405.10 (non-interest bearing)
Please note that this office only provides date of death balances for deposit accounts
(lRAs, CDs, Checking and Savings accounts). We do Dot process any financial
tn.nsactioDs or provide statements. If you need assistance with any of these items,
please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
g<at!hl& /)Julh.
Rachelle Wells
1-800-762-1775
P7-PFSC-04-F
500 first Ave.
Pittsburgh PA 15219
Member FDIC
TOTAL P.01
,Kelley Blue Book - Private Party Pricing Report - BMW, 3 Series
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HC,M:
Nt~,'~;".r~S .'E*~.IoJ"'.". REV'EWS A RATINGS >\DIIICE fl'<'"
..~ r
delle rti SF~:'llI.~ nt
BLUE BOOK' PRIVATE PARTY REPORT
Pennsylvania · June 3, 2005
1987 BMW 3 Series 325is Sedan 20
Engine: 6-Cyl. 2.5 Liter
Trans: 5 Speed Manual
Drive: RWD
Mileage: 115,000
SearJ,:;hJ.jsting~ JorThis Car
l..I~t'(QLJLQgLEoL~C::ileQnlin~
Ql,Jj~~~w_ CflrJ'rice ql,JQte
fre_~U:;_~RF .A.2<Hec::ocdCttec.k
,t\.l,Jtol..QC::iosJrom4.55% AEB
In~!1LaJlGeQLjote
Print "For Sale" SigO
Payment Calculator
Equipment
Air Conditioning
Power Steering
Power Windows
Power Door Locks
Cruise Control
AM/FM Stereo
Cassette
ASS (4-Wheel)
Leather
Sliding Sun Roof
Alloy Wheels
Consumer Rated Condition: Good
"Good" condition means that the vehicle is free of any major defects. This vehicle has a
clean title bisJOfY , the paint, bOdy and interior have only minor (if any) blemishes, and
there are no major mechanical problems. There should be little or no rust on this
vehicle. The tires match and have substantial tread wear left. A "good" vehicle will
need some reconditioning to be sold at retail. Most consumer owned vehicles fall into
this category.
Private Party Value Search LocalLi~tings Il..istThis C:Clr for Sale $1,750
Private Party Value is what a buyer can expect to pay when buying a used car from a
private party. The Private Party Value assumes the vehicle is sold "As Is" and carries
no warranty (other than the continuing factory warranty). The final sale price may
vary depending on the vehicle's actual condition and local market conditions. This
value may also be used to derive Fair Market Value for insurance and vehicle donation
purposes.
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http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb.P A;503607;P A041 & 170 11 ;+p&722;BMW; 198... 6/3/2005
A Settlement S~temenl U.S. Department of Housing OMB Approval No. 2502.026~
and Urban Development
B Type oJ Loan
1.[ JFHA 2 I JFmHA 31 J Conv.Unins /6. File Number: 17. Loan Number: 18. Mortgage Insurance Case Number:
41 jVA 5. [ J Conv.lns
400500722.CL
C. NOTE THIS NOTE 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 NOT INCLUDED IN THE TOTALS.
D. Name and Address of Borrower I E. Name and Address of Seller I F. Name and Address of lender
C. DAVID SHAFFER AND YONG S. KATHRYN C. BLACKBURN,
SHAFFER ADMINISTRATRIX OF THE ESTATE OF
NANCY H. GOODAll, AKA NANCY
824 LIS BURN ROAD GOODAll
CARLISLE. PA 17013
,PA
G. PROPERTY lOCATION H. Settlement Agent
1134 ATlAND DRIVE. SECURED LAND TRANSFERS - MECHANICSBURG
MECHANICSBURG, PA 17055 I
Ii Place of Settlement I. Settlement Date I
COUNTY: CUMBERLAND 101 OLD SCHOOLHOUSE LANE Disbursement Date
PARCEL 10: 42-30-2106-044 MECHANICSBURG, PA
TOWNSHIP: UPPER AllEN TOWNSHIP 5/25/2005 10:00:00
AMI5I2512005
J. SUMMARY OF BORROWER'S TRANSACTIONS K. SUMMARY OF SEllER'S TRANSACTIONS
100. Gross Amount Due From Borrower 400. Gross Amount Due To Seller
101. Purchase Price $230,000.00 401. Purchase Price $230.000.00
102. Personal Property 402. Personal Property
103. Settlement Charges to Borrower $4,074.25 403.
104. 404.
105. 405.
Adjustments For Items Paid By Seller In Advance Adjustments For Items Paid By Seller In Advance
106. CilylTown Taxes 406. CilylTown Taxes
107. Counly Taxes 596.1 Olyr 5/25/2005 10 1/1/2006 $357.66 407. Counly Taxes 596.10/yr 5/25/2005 10 1/1/2006 $357.66
108. Assessmenls 408. Assessments
109. School Taxes 1 ,581.31/yr 5/25/200510 7/1/2005 $158.13 409. School Taxes l,581.31/yr 5/25/200510 7/1/2005 $158.13
110. 410.
111. 411.
112. 412.
113. HOA Dues 125.00/yr for 5/25/2005 to 1/1/2006 $75.00 413. HOA Dues 125.00/yr for 5/25/2005 to 1/1/2006 $75.00
114. Sewer 1 OO.OO/qlr Jar 5/2512005 10 7/1/2005 $40.00 414. Sewer 100.00/qlr for 5/2512005 10 711/2005 $40.00
120. Gross Amount Due From Borrower I $234,705.04 420. Gross Amount Due To Seller I $230,630.79
200. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller
201 Earnest Money $5,000.00 501. Excess deposit
202. Principal Amount of New Loan(s) 502. Settlement Charges To Seller (line 1400) $16,335.00
203. Existing loan(s) taken subject to 503. Existing loan(s) taken Subject To
204 504. Payoff of Firsl 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. CllylTown Taxes 510. CitylTown Taxes
211 County Taxes 511. Counly Taxes
212. Assessments 512. Assessments
213. 513.
214 514.
215 515.
216 516.
217 517. I
218 518.
219 519.
220. Total Paid By/For Borrower I $5.000.00 520. Total Reduction Amount Due Seller I $16.335.00
300. Cash At Settlement FromlTo Borrower 600. Cash At Settlement To/From Seller
301. Gross Amount Due From Borrower (line 120) I $234.705.04 601. Gross Amounl Due To Seller (line 420) $230,630.79
302. Less Amounls Paid By/For Borrower (line 220) $5,000.00 602. less Deductions In AmI. Due To Seller (line 520) I $16,335.00
303. Cash [ X l From [ ] To Borrower I $229.705.041603, Cash ( X ] To [ ] From Seller I $214,295.79
/(" 3J5~(/'b .'"J
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/\.,(l.~. &Jo. 17
"'"
illS )()Y;u
I
----.::..= ..
A. Settlement Statement
U.S. Department of Housing
and Urban Development
OMB No. 2502-0265
B. Type of Loan
I. 0 FHA 20FmHA 3.IiJConv. Unins
4. 0 VA 5_ oCon\'. Ins.
6. File Number
7. Loan Number
8. Mortgage Ins. Case umber
GR05.1175REP
77775124
C. This form is furnished as a statement of acrual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked
(p.o.c) were paid outside the closing; they are shown for informational purposes and are not included in totals.
D. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of Lender
Shawn M. Boone Es tate of Nancy H. Goodall COOImerce Bank/Harri sburg N .A.
3 Crossgate Dr
423 BloOOlfield Ave Mechani csburg. PA 17050
Montc I ai r. NJ 07042
G. Propercy Location H. Settlement Agent Great Road
5 Bei Iman Court Sett 1 ement Servi ces. LLC.
Place of Settlement I. Settlement Date
Mechanicsburg. Pennsylvania 17055
Upper Allen Township. Cumberland County 2157 Market Street OB/25/2005
Camp Hi 11 PA 17011
I.S1)MMARY OF BORROWER'STRANSACTION: "i" .... K.SUMMARYOFSELLI!R'STRANSACnON: ........ ........... ............
100. GROSS AMOUNT DUE FROM BORROWER ..... 400...GROSSAMOUlfI\DUB'):'O S~l$R" i..>.... ..i'
10 I. Contract sales price 172.900.00 401. Contract sales price 172.900.00
102_ Personal property 402. Personal property
103. Settlement ch<trges to borro\'''~((line 1400) 4.949.52 403.
104. overnight 25.00 404.
105. wi re 25 :''00 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
106. City/town taxes to 406. City/town taxes to
107. COUnty taxes 08/25/20000 12/31/2005 157.68 407. County taxes 08/25/20000 12/31/2005 157.68
108. Assessments 08/25/20000 06/30/2006 1.906.82 408. Assessments 08/25/20000 06/30/2006 1.906.82
109. AshcOOlbe HOA 08/25 -12/31 43.52 409. AshcOOlbe HOA 8/25-12/31 43.52
110. 410.
Ill. 4]1.
112 4]2
........ . . ..... .... ..... ............,.2_
.120. GROSS AMOUNT DUE FROM BORROWER 180.007.54 175.008.02
200; AMOUNTS PAID BY ORIN BEHALF OF BORROWER .. .. i............. .....
20 I. Deposit or eamest money 3.000.00 501. Excess deposit(see Instructions)
202. Principal amount of new loan(s) 138.320.00 502. Settlement charges to seller(Jine ]400) 14.828.96
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. repai r credi t 750.00 507_ repai r credi t 750.00
208. seller assist 2.000.00 508. seller assist 2.000 . 00
209. 2nd mortgage proceeds 33.602.17 509.
Adjusrmems for items unpaid by seller Adjustments for items unpaid by seller
210. City/town taxes to 510. City/town taxes to
211. County taxes to 51 ]. County taxes to
212. Assessments to 5] 2. Assessments to
213. sewer - 7/1-8/25 (S100 Qtr) 61. 04 513. sewer - 7/1-8/25 ($100 Qtr) 61. 04
214. 514.
215. 5]5.
~
5]6.
$df&~ cJb.r~a- . 517.
5]8.
It..; r;;z'ir90 519.
1750. Ob .>....... ;~ c~c.lIIIIL-.
177 . 733 . 21 17.640.00
&1.6 i.j t .................... .......
~ 180.007.54 60]. Gross amount due to seller(line 420) 175,008.02
15 ~ If 0 .66 " 177,733.21 ) 602. Less reduction amount due seller(line 520) ( 17.640.00 )
/' ^ ..... ....ij{ __ ..... .............
()~~ .... >i.
/O~. '~.-".,b . 2 .274.33 157.368.02
d
~ /3);;-"31 . ~g
nformation contained in Blocks E, G, H and I and on line 401 or, if line 40] is asteri'ked,
rni$hed to the Internal Revenue Service. If you are required to file a return, a negligence
s required to be reported and the IRS determines that it has not been reported.
~ c.r7ro, Vb Q.~~~ r
C/1 qf on .,L.-( ~../
HUD-I SETTLEMENT STATEMENT
., Brainstorm Software 1-540-665-0800
WARNING: It is a crime to knowingly make false statements to the United Stales
on this or any other similar form. Penalties upon conviction can include a fine
and imprisonment. For details see: Title 18 U.S. Code Seclion 1001 & 1010.
SETTLEMENT STATEMENT
PAGE 2
L.$errLEMENTCHARGES.. .'. ... .. ... ... ..._____i };7..i.T 7 PAlO FROM PAlD FROM
700. TOTAl.. SAl..ES/BROKER's COM1USSION based on price S 172.900.00 @ % = $ BORROWER'S SELLER'S
Division of commission (line 700) as folloll's: FUNDS AT FUNDS AT
701. $ 10.254.00 to Exit Realty Capital Area SETILEMENT SETTLEMENT
702. $ to
703. Commission paid at Settlement 10.254.00
704. Transaction Fee. Exit $125 (s); $125 (b) 125.00 125.00
800. ITEMS PAYABLE IN CONNECTION WlTH LOAN --:-.. .. .....<i . .............};7--:---:-:--:---:-S ...~..................~
801. Loan Origination Pee %
802. Loan Discount %
803. Appraisal Fee 275.00 '0 The Appraisal Firm 275.00
804. Credil Report to
805. Lender's Inspection Fee
806. Mortgage Insurance Application Fee 10
807. Assumption Fee
808. Canmerce Bank . acini ni strati on fee 575.00
809. .
810.
811.
.900. ITE!.<!S REQUIRED BY LENDER TO BE PAlD IN .----- ii.i 'i.~
901. Interest from 08125/200:,0 09/01/2005 @$ 23.533600 /day 164.74
902. Mortgage Insurance Premium for momhs to
903. Hazard lmurance Premium for 1 years to Erie Insurance (POC $326)
904.
905.
I 1000; RESERVES DEPOSITED V,lTH LENDER ... ..........."... ........i.. .,.. .... ~ ..... -----
1001. Hazard insurance: 3 months @ S 27.17 per month 81. 51
1002. Mortgage insurance months @ S .w per month
1003. Cily property taxes months @ S per month
1004. County property taxes 8 months @ S 37.57 per month 300.56
1005. Annual assessments 3 months @ S 192.05 per month 576.15
1006. months @ S per month
1007. months @ S per month
1008. aggregate adjustment --187.82
1100. . TITLE CHARGES ...... .. ....0. ...i:........:.ii. ......i.:..:,..::,... ..0"T07
1101. Settlemenl or closing fee to GRSS ORO/terrori st search 10.00
1102. Abstract or title search to GRSS Ianni (POC $115.00)
1103. Tith: examination to GRSS
1104. Title insurance binder 10 GRSS
1105. Document preparation to GRSS -
1106. Notary fees 10 cash 10.00 5.00
1107. Attorney's fees to GRSS
(includes above items Numbers: )
1108. Title insorance to GRSS (Stewart Title Guaranty) 948.38
(includes above items Numbers: )
1109. Lender's coverage S 138.320.00 Canmerce Bank
I I 10. Owner's coverage S 172.900.00 Boone
1111. endorsements 100. 300. 900. 820 200.00
1112. closing service letter 35.00
1113. Marlin Yohn . 05 school tax 2.258.56
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES .... · .... . ......}....i .. --:---:- ----- ~ ...S1\? ...._____.... T ...
1201. Recording fees: Deed S 38.50 ;Mortgage $ 68.50 ; Releases $ 107.00
1202. City/county lax/stamps: Deed S 1. 729 .00 ;Mortgage $ 1. 729 .00
1203. State tax/stamps; Deed S 1.729.03 ;Mortgage $ 1. 729 . 00
1204.
1205.
1300. APDlTIONAL SETTLEMENT CHARGES ..... ..... ... ........ ..U.} ... ~~.............
130 I. Survey to
1302. Pest inspection to
1303. AHS . HOlDe Warranty 457.40
1304.
1305.
1400. . TOTAl.. SETTLEMENT CHARGES (emer on line 103. Section iand ....7.<___70 4.949.52 14,82B.96
CERTIFICATION
I have carefully reviewed the HUD.[ Settlemem SI;,remem and 10 the besl of my knowledge tl belief, it is a true and accurate statement of all receipts and
disbursements "E'ge my in-lll~action. I further certify Ihat I hav ecei
~
Borrowers seUers
The HUD-I Settlemem Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause Ihe funds t,) be disbursed
in accordance with this statement. ~
_c~1 ~ August 25, 2005
Settlement Agent Great Road Settl ~ent er'/ices. LLC Date