HomeMy WebLinkAbout01-11-06 (2)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Jan L Brown
FIRM NAME (If Applicable)
Jan L Brown & Associates 845 Sir Thomas Court Suite 12
TELEPHONE NUMBER
717-541-5550 Harrisbur P-A 17109
141,OOO.00.j ,\ OFFICIMAJSE ONLy: -~
'.... '-,
-'j
420,382.50 --)._ .1
0.00 X _(15) 0.00
574,889.69 x .045 (16) 25,870.04
0.00 x ,12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 25,870.04
RE\i-1500 EX + (~OO)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128.Q601
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
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M ers C Jane
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
08/15/2005 04/07/1918
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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[RJ 1. Original Return
o 4. Limited Estate
00 6. Decedent Died Testate (Allach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12.12.82)
o 7. Decedent Maintained a Living Trust (Allach copy 01 Trus!)
o 10. Spousal Poverty Credit (date of death between 12.31.91 and t. t-95)
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1. Real Estate (Schedule A)
(1)
(2)
(3)
(4)
(5)
2. Stocks and Bonds (Schedule B)
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. JoinUy Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line B minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
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 < <
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OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 5 0 7 8 3
""COUNTY'CciiiE -VEAR- - - NuMBER- -
SOCIAL SECURITY NUMBER
1 99- 0 7 - 8 5 1 0
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum (date of death prior to 12.13-82)
o 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Allach Sch 0)
27,710.94 .'
19'239'89[ >,
19,757.87 ___
___J
(8)
628,091.20
48,423.82
4,777.69
(11)
(12)
(13)
53,201.51
574,889.69
(14)
574,889.69
Decedent's Complete Address:
STREET ADDRESS
318 Fifth Street
CITY I STATE I ZIP
New Cumberland PA 17070
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
25,870.04
25 000.00
1 293.50
Total Credits ( A + B + C )
(2)
26,293.50
3. Interest/Penalty if applicable
D. Interest
E. Penalty
4.
T otallnterest/Penalty ( 0 + E )
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
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(3)
0.00
A. Enter the interest on the tax due.
(4)
(5)
(SA)
8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
423.46
0.00
5.
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; ........................................................................... 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? .................. ................................................. ................. ........ ........... 00 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury, I declare thaI 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. '
SIGNA TUR F PERSON RESPONSIBLE FOR FILING RETURN DATE
1110/2006
ADDRESS
IVE
PA 17070
DATE
1/10/2006
PA 17109
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. 99116 (a} (1.1} (i}J.
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 July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2} [72 P.S. S9116(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. S9116(a)(1.3)J. 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.
I REV-1502 EX T (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Myers C Jane 21 05 0783
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 Drooertv which is iointlv-owned with riaht of survivors hiD must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
318 Fifth Street, New Cumberland Borough, Cumberland Co. PA
HUD Settlement Statement dated 11/10/2005 attached.
VALUE AT DATE
OF DEATH
141,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
141 000.00
'REV-1503'EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Myers C Jane
FILE NUMBER
21 05
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0783
ITEM
NUMBER
1.
DESCRIPTION
US Savings Bonds; Series HH; Quantity 4; Denomination $500
VALUE AT DATE
OF DEATH
2,000.00
2
American Funds; Capital Income Builder - A
3,193.859 shs @ $53.69/sh
171,478.29
3
American Funds; The Income Fund of America -A
6,753.060 shs @ $18.70/sh
126,282.22
4
American Funds: American Balanced Fund - A
6,627.582 shs @ $18.20/sh
120,621.99
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
420 382.50
.
REV-150B EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Myers C Jane
ITEM
NUMBER
1.
2
3
4
5
6
7
8
9
10
11
12
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
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.
0783
DESCRIPTION
American Funds; Capital Income Builder - A
Accumulated Dividends as of 8/15/05
VALUE AT DATE
OF DEATH
913.72
American Funds; The Income Fund of America -A
Accumulated Dividends as of 8/15/05
636.72
Cash on hand
150.00
Sovereign CD 2295282814
5,422.34
Sovereign CD 2295282806
17,039.97
Refund: The Patriot-News
47.75
Refund: United American Insurance Company; Health Policy 574501022
417.76
Refund: Real estate tax
762.46
Refund: AT&T
16.61
Refund: Peerless Insurance Company; homeowner insurance
339.00
Refund: PA Department of Revenue; 2004 tax
464.61
Household goods; 318 Fifth Street, New Cumberland, PA
1,500.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
27 710.94
~EV-1509 EX + (6-98)
*'
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Myers C Jane
FILE NUMBER
21 05
If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G.
0783
SURVIVING JOINT TENANT(S} NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Bonnie L Moyer
506 Eutaw Avenue
New Cumberland, PA 17070
daughter
B
c
JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY ,HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 2/2001 Sovereign Ckg 2291024213 8,280.64 50. 4,140.32
2 A 2/2001 Sovereign Svgs 2294019316 30,199.13 50. 15,099,57
TOTAL (Also enter on line 6, Recapitulation) $ 19.239.89
..
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
'*
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mvers C Jane
FILE NUMBER
21 05
0783
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPVOF THE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST VALUE
(IF APPliCABlE)
1. Prudential Financial Annuity EO 103134 19,757.87 100. 19,757.87
Children & grandchildren (9), beneficiaries
TOTAL (Also enter on line 7 Recapitulation) $ 19757.87
(If more space is needed, insert additional sheets of the same size)
COMMONWEAl.TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mvers C Jane
REV-1511 EX + (12-99)
*'
ITEM
NUMBER
A.
1.
2
B.
1.
2.
3.
4.
5.
6.
7.
8
9
10
11
12
13
14
15
16
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21
05
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
Stone & Murray Funeral Home
Gingrich Memorials; inscription
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Bonnie L Mover
Social Security Number(s)/EIN Number of Personal Representative(s) 161-34-0516
Street Address 506 Eutaw Avenue
City New Cumberland State PA Zip 17070
Year(s) Commission Paid: 2006
Attorney Fees Jan L Brown
Family Exemption: (If decedenfs address is not the same as daimanfs, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
Probate Fees Register of Wills, Cumberland County
Accountanfs Fees
Tax Return Preparer's Fees Parks & Company; personal/fiduciary tax preparation
Cumberland Law Journal; legal advertising
The Patriot-News; legal advertising
Postage
Pennsylvania American Water
PPL Electric Utilities
UGI Gas Service
Roy Fritz Detailing & Elec; presale electrical work
Borough of New Cumberland; presale electrical inspection
Peerless Insurance Company; homeowners
Real estate closing costs; see HUD Settlement Statement dated 11/10/05
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
0783
AMOUNT
749.00
100.00
15,000.00
18,843.00
565.00
400.00
75.00
256.80
4.42
43.80
60.22
43.77
778.00
119.62
245.00
11,140.19
48.423.82
REV-1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mvers. C Jane
FILE NUMBER
21 05
0783
Include unreimbursed medical expenses.
ITEM.
NUMBER
1.
DESCRIPTION
Check 768 payable to Joan Costello (caregiver) dated 8/12/05; cashed after death
VALUE AT DATE
OF DEATH
195.00
2
Real estate taxes
1,063.12
3
Chapman's; furnace cleaning
69.25
4
United States Treasury; delinquent balance; tax year ended 12/31/03
2,942.61
5
Holy Spirit
53.74
6
Quantum Imaging
45.00
7
AT&T
62.24
8
Comcast
89.94
9
Pennsylvania American Water
43.34
10
PPL Electric Utilities
167.28
11
UGI Gas Service
46.17
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4.777.69
."'-,,,,,, '.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Mvers C Jane 21 05 0783
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 pnclude outright spousal distributions. and transfers under
Sec. 9116 (al (1.2)J
1. Bonnie L Moyer, daughter Lineal
506 Eutaw Avenue, New Cumberland, PA 17070 17% residue
2 Susan D Wertz, daughter Lineal
1703 Bridge Street, New Cumberland, PA 17070 17% residue
3 Charles M Moyer, grandson Lineal
782 Heck Hill Road 8.25% residue
4 Jill Morales, granddaughter Lineal
1036 Teakwood Lane, Enola, PA 17025 8.25% residue
5 Matthew J Wertz, grandson, c/o James Murphy Wertz, POA Lineal
1703 Bridge Street, New Cumberland, PA 17070 8.25% residue
6 Jennie S Jones, granddaughter Lineal
822 Limekiln Road, New Cumberland, PA 17070 8.25% residue
7 Abigail Moyer, great granddaughter Lineal
782 Heck Hill Road 6.60% residue
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 n - 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)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Myers, C Jane
Decedent's Name
Page 1
21 05 0783
File Number
Schedule J - Beneficiaries - 1
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)
8 Kathryn Adams, great granddaughter Lineal
1036 Teakwood Lane, Enola, PA 17025 6.60% residue
9 Sarah Adams, great granddaughter Lineal
1036 Teakwood Lane, Enola, PA 17025 6.60% residue
10 Michael Morales, great grandson Lineal
1036 Teakwood Lane, Enola, PA 17025 6.60% residue
11 Kyle M Jones, great grandson Lineal
822 Limekiln Road, New Cumberland, PA 17070 6.60% residue
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1,OFHA 2.0FmHA
6. FILE NUMBER:
05-655
8. MORTGAGE INS CASE NUMBER: ?}g MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts peid to end by the settlement agent are shown.
Items marked 1pOCr were paid outside the closing; they ere shown here for informational purposes and are not includad in the totals.
1.0 3198 CMARTIN.THOMAS.PF0I05-855l22)
F. NAME AND ADDRESS OF LENDER:
,....
SETTLEMENT STATEMENT
B. TYPE OF LOAN:
3. [BlCONV. UNINS. 4. OVA
17. LOAN NUMBER:
5.0CONV./NS.
THOMAS F. MARTIN and
NANCY J. MARTIN
539 7TH STREET
NEW CUMBERLAND. PA 17070
ESTATE C. JANE MYERS
E. NAME AND ADDRESS OF SELLER:
Adiustments For Items Unoaid Bv Seller Adiustments For Items Unpaid Bv Seller
210. CitvfTown Taxes to 510. CltvfTown Taxes to
211. CountvTaxes to 511. CountvTaxes to
212. School Taxes to 512. School Taxes to
213. Sewer Proration 10/01/05 to 11/10/05 11.39 513. Sewer Proration 10101/05 to 11/10/05
214. 514.
215. 515.
216. 516.
217. 517.
216. 516.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 132.845.53 520. TOTAL REDUCTION AMOUNT DUE SELLER
300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER:
301. Gross Amount Due From Borrower (Line 120\ 145944.10 601. Gross Amount Due To Seller (Line 420)
302. Less Amount Paid BvlFor Borrower (Line 220) . (132.845.53) 602. Less Reductions Due Seller (Line 520\
303. CASH ( X FROM) ( TO) BORROWER 13.098.57 603. CASH ( X TO) ( FROM) SELLER
". ,........ ,"........."""".. -:Ji"~" "'... 1&2 ".. ..._"'. '"' -"" -. h....
"","',." ~I '''1 l _. /VC-. ' "".'>~MJi~~
V!~uA.ufl )f/~ ....TJ-
NAfolCY J. MArt!JIO
D. NAME AND ADDRESS OF BORROWER:
G. PROPERTY LOCATION:
316 5TH STREET
NEW CUMBERLAND, PA 17070
Cumberland County. Pennsylvania
H. SETTLEMENT AGENT:
Midstate Abstract Company
PLACE OF SETTLEMENT
2331 Market Street
Camp Hili. PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER:
101. Contract Sales Price 141000.00
102. Personal Proaertv
103. Settlement Charaes to Borrower (Line 1400\ 4181.64
104.
105.
Adiustments For Items Paid Bv Seller in advance
106. CitvfTown Taxes to
107. County Taxes 11/10/05 to 01/01/06 76.34
106. School Taxes 11/10105 to 07/01106 666.12
109.
110.
111.
112.
120. GROSS AMOUNT DUEFROM BORROWER 145,944.10
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER:
201. DeDosit or earnest money 2 000.00
202. Princinal Amount of New Loan(s) 116981.64
203. Existino 108n(s\ taken subiect to
204. 2nd Morto8oe Proceeds 13,852.50
205.
206.
207.
206.
209.
WACHOVIA BANK. N.A.
PO BOX 13687
ROANOKE, VA 24036-3687
25-1857112
I. SETTLEMENT DATE:
November 10, 2005
K. SUMMARY OF SELLER'S TRANSACTION
400. GROSS AMOUNT DUE TO SELLER:
401. Contract Sales Price
402. Personal ProoertV
403.
404.
405.
141 000.00
Adiustments For Items Paid Bv'Seller in advance
406. CitvfTown Taxes to
407. County Taxes 11/10/05 to 01/01/06
408. School Taxes 11/10/05 to 07/01/06
409.
410.
411.
412.
420. GROSS AMOUNT DUE TO SELLER
500. REDUCTIONS IN AMOUNT DUE TO SELLER:
501. Excess Deoosit ISee Instructionsf
502. Settlement Charaes to Seller (Line 140m
503. Existloo'loarils\ taken subject to
504. Payoff of first Mortgage
505. Pavaff of second MortQage
506.
507. (Deoosit disb. as oraceeds\
508.
509.
76.34
686.12
141,762.46
11 128.80
11.39
11,140.19
141 762.46
11,140.19
130,622.27
L SETTLEMENT CHARG
psge 2
700. iOTAL COMMISSION Based on Price ES
$ 141 000,00 ({f)- 6.0000 % 8460.00
OMsion o'-Commission nine 700 as Follows: PAlO FROM PAlO FROM
701, $ 4,255,00 to RSR Realtors BORROWER'S SELLER'S
702. $ 4,205,00 to ERA-NRT, Inc, FUNOS AT FUNOS AT
703, Commission Paid at Settlement SETTLEMENT SETTLeMeNT
704. to 8,460.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801, Loan Orio/nation Fee % to
802. Loan Discount % to
803. Appraisal Fee to
804. Credit Report to
805, Pre-Paid Finance Chame to WACHOVIA BANK, N.A.
806. Flood Cert. to WACHOVIA BANK N.A. 1,128.00
807. Assumption Fee to 15,00
808.
809,
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901, Interest From 11110105 to 12101/05 @ $ /day ( 21 days %)
902. MortaaOe Insurance Premium for months to
903, Hazard Insurance Premium for 1.0 vears 10
904,
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance months $ Der month
1002, Mortoaae Insurance months $ oer month
1003. CltvlTown Taxes months $ ner month
1004. Cou~Taxes months $ Der month
1005, School Taxes months @ $ per month
1006, months -~ $ oer monlh
1007. months @ $ per month
1008. months ({f) S ""r month
1100. TITLE CHARGES
1101. Settlement or Closino Fee to
1102. Abstract or Tnle Search to
1103. Tille Examination 10
1104, Title Insurance Binder to
1105, Electronic Document Preo, to
1106, ClosinnServlce Letter to Midstate Abstract Comnanv 35,00
1107. Attorney's Fees to
includes above item numbers: I
1108, Tille Insurance to MIDSTATE ABSTRAr 861.64
(includes above item numbers,11 02 1103&1104 )
1109. Lender's Coverage $ 116,981.64
1110. Owner's Coverage $ 141,000.00 861.64
1111, Endorsements 100, 300, 8,1 to Midstate Abstract Company 150.00
1112, Notary Fee to Midstate Abstract Company, 10.00
1113. Notary Fee Midstate Abstract Company
1114, Ovemight Fees & Handling
1115, Home Inspection to Inspections by Mike POC:B275.00
1116. Radon Test to Inspections by Mike POC:B95.oo
1117. Transaction Fee to ERA-NRT, Inc. 125.00
1118. Transaction Fee to RSR Realtors 125.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 40.50; Mortaage $ 46.50; Releases $ 87.00
1202. Cilv/Countv Tax/Stamos: Deed 1 410.00' MortliaCe 1410.00
1203. State Tax/Stamos: Deed 1,410.00; Mor1ci8Oe 1410,00
1204.
1205, ERA Warrantv to Aon Home Warrantv Services, In~. 409.00
1300. ADDmONAL SETTLEMENT CHARGES
1301. Survev to
1302. PestlnsDection to Insoections bv Mike POC:B35.oo
303, Sewer & Trash Bill to New Cumberland Borounh 64,80
304, AttorneY'S Fees to Jan L. Brown & Associates 260,00
305. Radon Mitigation to Enviroquest A 360.00 400.00
400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103. Section J and 502 Section Kl // 4,181,64 11,128,80
By slgnlng page 1 or thlI stalament, tho s1gnltortoa Ic:l<nowto<Ige nIClIlpl or I alITljllllad a>py or page 2 or this two page statement 7~
Midstale Abfdract Com an
Certified to be a true copy.
Settlement Agent
p y
( 05-855/05-655 / 22 )
LAST WILL AND TESTAMENT
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OF
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C. JANE MYERS
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I, C. JANE MYERS, of Cumberland County, Pennsylvania, declare this to be my Last Will
and Testament. I revoke all other Wills and Codicils that I may have previously made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate shall
be paid by my Executor from the principal of my residuary estate as soon as practicable after my
death.
Article II
All inheritance, estate, and succession taxes (including interest and penalties thereon, but not
including any generation skipping tax) payable by reason of my death shall be paid out of and be
charged generally against the principal of my residuary estate without reimbursement from any
person. This provision is not a waiver of any right which my Executor has to claim reimbursement
for any such taxes which become payable as the result of any property over which I have the power
of appointment.
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Article ill
I give, devise and bequeath in accordance with any memorandum which I have either
handwritten or signed, located with my Will or with my valuable papers and found within 30 days of
the probate of my Will. Gifts may only be to persons who survive me or to organizations which
exist at my death, and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath to the following:
THIRTY-FOUR PERCENT (340/0) of my estate to be divided IN EQUAL SHARES
between my daughters, BONNIE L. MOYER, of Cumberland County, Pennsylvania, and SUSAN
D. WERTZ, of Cumberland County, Pennsylvania;
THIRTY-THREE PERCENT (330/0) of my estate to be divided IN EQUAL SHARES
among the following grandchildren: CHARLES M. MOYER, of York County, Pennsylvania;
JILL MORALES of Cumberland County, Pennsylvania; MATTHEW J. WERTZ, currently of
SAIPAN; and JENNIE JONES, of Cumberland County, Pennsylvania; and
THIRTY-THREE PERCENT (330/0) of my estate to be divided IN EQUAL SHARES
between my living great grandchildren.
If any of my beneficiaries predecease me or fail to survive me by thirty (30) days, I give,
devise and bequeath his or her share to his or her issue (blood relations, not stepchildren) who
survive me, per stirpes, or ifhe or she have no issue (blood relations, not stepchildren), the share(s)
are to be added equally to the other shares.
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Article V
Ifa beneficiary under this Will has not attained the age of twenty-eight (28) years, the share
of the beneficiary shall be placed in a separate trust, for the benefit of that beneficiary according to
the terms in Article VI.
Article VI
In the event that a Trust is created by or as a result of any part of this Will, the terms and
conditions of the Trust shall be as follows:
A. To expend and apply so much of the net income and so much ofthe principal of the
Trust as the Trustee shall consider advisable for the support, health, care and education of the child
until the child attains the age of twenty-two (22) years.
B. Upon attaining the age of twenty-two (22), one-third (1/3) of the child's share shall be
distributed outright to the child.
C. Upon attaining the age of twenty (25), one-third (1/3) of the child's remaining share
shall be distributed outright to the child.
D. Upon attaining the age of twenty-eight (28), the remaining principal and accumulated
income of the child's share shall be distributed outright to the child.
E. No beneficiary or remainderman of this Trust shall have any right to alienate,
encumber, or hypothecate his or her interest in the principal or income of the Trust in any manner,
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nor shall any interest be subject to claims of his or her creditors or liable to attachment, execution, or
other processes of law.
Article VII
In order to carry out the purposes of the Trust established by this Will, the Trustee, in
addition to all other powers granted by this Will or by law, shall have the following powers over the
Trust estate, subject to any limitations specified elsewhere in this Will:
(a) to retain in the form received and to sell either at public or private sale, any real estate
or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such
return prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct along with or with others, any business in which I am engaged in or have
an interest in at the time of my death, and
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G) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services are performed.
Article VIII
A. I hereby appoint CHARLES M. MOYER, as Trustee for his children for any
Trust(s) created in this Will. If CHARLES M. MOYER is unable to act as Trustee, then I appoint
GLENDA K. MOYER as successor Trustee for their children.
B. I hereby appoint JILL MORALES, as Trustee for her children for any Trust(s)
created in this Will. If JILL MORALES is unable to act as Trustee, then I appoint CHARLES M.
MOYER as successor Trustee for JILL MORALES' children.
C. I hereby appoint MATTHEW J. WERTZ, as Trustee for his children for any
Trust(s) created in this Will. If MATTHEW J. WERTZ is unable to act as Trustee, then I appoint
CHARLES M. MOYER as successor Trustee for MATTHEW J. WERTZ's children.
D. I hereby appoint JENNIE JONES, as Trustee for her children for any Trust(s)
created in this Will. If JENNIE JONES is unable to act as Trustee, then I appoint CHARLES M.
MOYER as successor Trustee for JENNIE JONES' children.
Article IX
I nominate, constitute, and appoint my daughters, BONNIE L. MOYER, and SUSAN D.
WERTZ Co-Executors of my Last Will and Testament. I direct that my Co-Executors be permitted
to serve without bond and in addition to those powers granted by law, I grant them power to
distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could
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have filed ifliving. My Co-Executors shall receive reasonable compensation for services rendered to
my estate.
Article X
In addition to the powers conferred by law, I authorize my Co-Executors in his/her absolute
discretion:
(a) to retain in the form received and to sell either at public or private sale, any real estate
or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
( e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such
return prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Co-Executors; and to pay from my estate reasonable compensation for all their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have an
interest in at time of my death, and
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G) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services are performed.
IN WITNESS WHEREOF, I, C. JANE MYERS, hereby set my hand to this my Last Will
3//;-1 ff-tJ }
,
,2001, at Harrisburg, Pennsylvania.
and Testament, on
(); ?J Cl-nY- '11 LJ4/
c. J~ MYERS
In our presence, the above-named C. JANE MYERS signed this and declared this to be her
Last Will and Testament, and now at her request, in her presence, and in the presence of each other,
we sign as witnesses.
Name
Address
'?Lts ~ J!,71fYl11.l11 (Ii.) ~., p!J I Q /{)9
fr.r~.~ c? ~~h
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I, C. JANE MYERS, Testatrix, who signed the foregoing instrument, having been duly
qualified according to law, acknowledge that I signed and executed this instrument as my Will, and
that I signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
C. JANE MYERS, the Testatrix,
on 3 - J fJ. ,200l.
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NQt~Public .
c, 2 t'~ 'P11rAAM
c. J~E MYERS /-
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r\lOTAmAL SEAL ..
, JAN L BROlfJN. f/.otiry PubUc
, Lower Pcalon TWjl., ~lIpfiln Count:1 g
f. p ~y l'^m..u~'~I.'"'' !;:"nI.."", U"I'''''' "il!!\ 'i.'.J!..~,
trill. . \IU 'He~un ~JoF",gr3 f'~W~~
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute this
instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the
purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me
bY(~::t.~j{liJ , 1'1 .;-hIla fl{J/~fuli(' tD Jl cLW-htd
and, I ohr'<:'" rli--.,,;,A,- /J-L ~l ess
witnesses, on ,? "- If! , 2001. \ \ I /2_ y--
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~~~ Wilnes. /'
Notary,--Pu~lic
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JA.\~ Lr~~~"i~~ Puh!ie 1
! UJ\f!er Paxton Twp., l}auptdn CoUffi'11
f My Commi$SJoo Exp1res March a 20041
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