HomeMy WebLinkAbout01-18-06
R:::V-1500EX (6..uO)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
FILE NUMBER
21 06
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NUMBER
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COUNTY CODE YEAR
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
CASSARO, MARY A.
SOCIAL SECURITY NUMBER
089-24-7313
: DATE OF BIRTH (MM-DD-YEAR)
104/12/14
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DD-YEAR)
07/02/01
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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~ 1. Original Return
D 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy at Will)
D 9 Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12.12.82)
D 7. Decedent Maintained a Living Trust (Attach copyofTrust)
D 10. Spousal Poverty Credit (date at death between 12-31-91 and 1-1-95)
D 3. Remainder Return (data of death pnor 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. 9 113(A) (Attach Sch 0)
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THIS SECTION MUST BE cOMPLETED.ALLCORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
James D. FI~lJVer, Jr. 26 West High Street
FIRM ~AME (If Applicable) . Carlisle PA 17013
Said IS, Flower & Lindsay ,
TELEPHONE NUMBER
(717) 243-6222
Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
(6) 32,334.07
(7)
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
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)
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)
(8)
20,877.19
0.00
32,334.07
11. Total Deductions (total Lines 9 & 10)
(11)
(12)
(13)
20,877.19
11,456.88
0.00
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)
(14)
11,456.88
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)
0.00 x.O
11,456.88 xO 45
0.00
(15) 0.00
(16) 515.55
(17) 0.00
(18) 0.00
(19) 515.55
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
x .12
0.00
x15
18. Amount of Line 14 taxable at collateral rate
19 Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
1]30 Dovg1as Drive __
CITY Carlisle
STATE
PA
ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
515.55
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
A. Enter the interest on the tax due.
(5A)
(5B)
0.00
0.00
515.55
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
515.55
Make Check Payable to: REGISTER OF WILLS, AGENT
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 [KJ
b. retain the right to designate who shall use the property transferred or its income; .................. .. 0 [KJ
c. retain a reversionary interest; or................................................................................................. ........................ 0 [iJ
d. receive the promise for life of either payments, benefits or care? ..................... ........................... 0 [iJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........ ................... ..................... 0 [iJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ....... 0 [KJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ......... ............................................................ .................... 0 [KJ
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 pre parer has any knowledge.
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ADDRESS. .', ~"n7l: /7~
GNAIu({of.~REPA1~;,:'~~V,E {i'/J/-,- f-~~
~a e; D. F~~,~;:e,~;~ ~;sle, PA 17013
DATE
/JJ-/70/J____ I/; 7/L? ~
DATE
r-II-D6
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 PS. 39116 (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. 39116 (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. 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 )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. 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-1509 EX+ (6-98)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MARY A. CASSARO
FILE NUMBER
21-06-
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Isabelle M. Casaro
160 Virginia Avenue, Carlisle, PA 17013
Daughter
B Charles A. Cassaro
3 Chandler Court, Plainsboro, NJ 08536
Son
C.
Salvatore Cassaro
784 Karingway Lane, N.W., Kennesaw, GA 03152
Son
D. Angelo P. Cassaro
41 Eiseman Avenue, Piscataway, NJ 08854
Son
JOINTLY-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 DECEDENTS INTEREST
1 A.
1. A-D 11/12/93 Real estate situate at 1730 Douglas Drive, Carlisle, PA- Actual Sale Price 142,000.00 20% 28,40000
2. A-D 11/12/93 2005 County Township Real Estate Tax Proration 73.89 20% 14.77
3. A-D 11/12/93 2005-2006 School Real Estate Tax Proration 927.74 20% 185.54
4. A Checking Account #202855, M & T Bank 7,467.53 50% 3,733.76
TOTAL (Also enter on line 6, Recapitulation) $ 32,334.07
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
MARY A. CASSARO
FILE NUMBER
21-06-
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
A.
AMOUNT
DESCRIPTION
1.
FUNERAL EXPENSES:
Hoffman-Roth Funeral Home, Inc., funeral
St. John's for Opening of Grave
St John's for Soldering of Casket
6,833.50
1,115.00
85.00
2
3.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
2.
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
Attorney Fees
750.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
Zip
4. Probate Fees
Relationship of Claimant to Decedent
5. Accountant's Fees
7.
6. Tax Return Preparer's Fees
8.
9
10.
11.
Irwin & McKnight, attorneys fee for real estate settlement
North Middleton Township Municipal Authority, 20% (real estate sale)
150.00
15.98
4.00
10,830.71
800.00
288.00
Jacqueline Verney, Esquire, overnight mail fee, 20% (real estate sale)
National City Mortgage, payoff of mortgage, 20% (real estate sale)
Seller's Assistance with settlement costs, 20% (real estate sale)
Recorder of Deeds, 1% Transfer Tax on real estate sale, 2-%
TOTAL (Also enter on line 9, Recapitulation) $
20,872.19
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MARY A. CASSARO
PAGE 2
FILE NUMBER
21-06-
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
1.
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
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
5. Accountant's Fees
6. Tax Return Preparer's Fees
8.
Balance carried forward from page 1
Register of Wills, Filing Fee, Inheritance Tax Return
20,872.19
15.00
7.
9.
10.
11.
TOTAL (Also enter on line 9, Recapitulation) $
20,887.19
(If more space is needed, insert additional sheets of the same size)
REV-1737-7 EX + (9-00) .~~.
REVERSE ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
MARY A. CASSARO
21-06-
When flat rate method is elected, list the beneficiaries of the Pennsylvania property.
When proportionate method is elected, list all beneficiaries.
RELATIONSHIP TO
DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)J
1.
Isabelle M. Cassaro, 160 Virginia Avenue, Carlisle, PA 17013 Daughter
2. Charles A. Cassaro, (Address) Son
3. Salvatore Cassaro (Address) Son
4. Angelo P. Cassaro, 41 Eiseman Avenue, Piscataway, NJ 08854 Son
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE SIDE
OF REV-1737 COVER SHEET, AS APPROPRIATE.
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 $0.00
ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1737 COVER SHEET
(If more space is needed, insert additional sheets of the same size)
I \
HUD - I r;-;IFOR'j SETTLEMF::\T STATE\IE'iT
I' S DEPARTMENT OF HOl'SINC 'D URB N DEVE[ OP~IENT
Oivl!3 Approval No
SETTU~IENT ST v'
, I " I iAN A, " ':1 '
B. TYPE OF LOAN 6 File Number: 7 Loan Number'
I FHA 2. FmHA
3 )( Conv Unins. 4. VA 5 Conv, Ins. 8 Mongage Insurance Case Number
C NOTE TillS form is furnished to give you a statement of actual settlement costs, Amounts paid to and by thc settlement agent arc shown. Items marked "r,po,c.)"
were paid outside the closing: they are shown here for informational purposes and are not included in the totals,
NOTE TIN = Taxnaver's Identificatinn Number
D. NAI'vIE A\lD ADDRESS OF BORROWER E, NAIYIE. ADDRESS AND TIN OF SELLER: F. NAME AND ADDRESS OF LENDER.
~r:...Iidrev,,r L . Hosenber.::-y Isabelle ,,1. Cassaro P-....-:le:-ican tvIortgage Ne::w8~k.,
Charles ~. Cassaro I:l.c. d/b/a 1'11NST
1824 Suncrest D::-. 10421. Waterridge Ci::-cle
Carlisle, Pl'. 17013 r< __~ Diege, c.r., 92121
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Carlisl~, PA :7013
G. PROPERTY LOCATION H. SETTLEMENT AGENT i'<A;VIE. ADDRESS AND Tli'i
1730 Douq13s Dr. Jacqueline t<l. Ver:1ey, Esquire
Carlisle, P1'. 17013 44 South Hanover St:cpe~ Carlisle P.~ 1701 3
PLACE OF SETTLEMENT I. SETTLEIYIE)\;T DATE
44 Sout.h Hanover Street 10/28/2005
Carlisle P1', 17013
.I. SUMMARY OF BORROWER'S TR-\'iS,\CTIO'l
100. GROSS .-\\lOl''iT Ol'E FRO\I BORROWER:
101 Contract :;ales nrice 1 42 000. 00
102. Personal nronertv
103. Settlemenr charges to borro\\erlLine 1.+00) 5 092.17
104
105.
K SlM\IARY OF SELLER'S TR\"iS.-\CTIO,,",
GROSS AMOUNT DUE TO SELLER
Contract sales price 1 J ~,
Per:;onal proDertv
00:: . CC
,Adiustments for items paid bv seller in advance
106 Citv/town taxes
107 Countvtaxes -:;-0//8/2005-12/31/'005
lOX. Asscssm~nts
10Y.
110 Schoo' 'I3.X 'u/28/05-0c/30/05
III
112.
120 GROSS AivlOUNT DUE FROIvl BORROWER
i -<'. :::,"j
.+00
,)01
'+02.
'+03.
,)04.
I '+05.
I
I 406.
I 407
i .+OR
I .+09
I ,)10
1,)11
I 412
I .+20
Adlustments Il)r items mid bv seller in advance
Citv/town taxes .
Countv taxes 10/28!2;]:)5 - 1 ~, 131 !2 005
Assessments
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G'J7 '[~
Schoo.::' T2X ',0/28/0:;-06/3:']/06
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148,093.80
GROSS AivlOUNT OUE TO SELLER
200. ;\\10[',\,T5 PAlO BY OR 1[\ BF:IL\LF OF BORROWER: 500 REDUCTIONS IN AMOUNT DUE TO SELLER
201 Deposit or earnest mone, LO%.C0 501 Excess depOSit I
207. Princioal amount of ne\\ loanl s) I 1 , 3, 600.Cr 502 Settlement charges to seller (Line 14001 ,":. r;, Q::' 9
L . L ,~. "
203 Existing Ioan(:;) taken subiect to I 503 Existing loanls) taken subiect to I
204 5114. Pavoff of tirsl mortl!age loan Na'_~onal Citv I 5~ :53.5~
205 505 Pavoff of second mortgage loan I
206 npl: oroceeds from 2nd loan 17 366. 62 506. I
207 507 I
70R 50R. I
209, 509. I
Adiustments ~or items unpaid bv seller Adiustments for items llnnaid bv seller
210 Cltvltown taxes 510 Cit\/to\vn ta:'\es I
2 I I Count, ta,xes 5 I I Countv ta.xes I
212 Assessments 512. Assessments I
211 S~l i ers' !'-.ss i st 4 GGO.GO 513 Sellers ~n.S;::,iST .:,1 , (I \,~I .~ .riC
21.+ 514
215 515
216. 516
2[7 517
218 SIR
219. 519
220 TOTAL PAID BY/FOR BORROWER 1 ':J - ,....~ r 62 520 TOTAL REDUCTION A~IOUi'iT DUE SELLER 6;' 4 ~ ":; "
~ _.J.), 'j 00. !..) r,
300. CASH AT SETTLEME:-;T FROM/TO BORROWER 600. CASH AT SETTLEMENT FRO\ITO SELLER
301 Gross amount due from borrower (Line 1201 ! 148,093. SO 601 Gros:; amoul1l due to se[kr I Line 420 I I 1,1 ~ ,.,' , 50
..1--::-./
302. Les:; amount naid bylfl)r borrower I Line 220) I 135 966. 62 602 Less reduction in amount due :;eller (Line 520) I r, ~~3.4c
C,lj'
3D3 CASH FEY" BOP.POifJ::::? I 12,127. 1R (i03 CASH TO r<"r"-""-" I 82 ....., - "" l
::or.,l_jl.!:...:-'-
SELLE~SSTATEMENT
The information contained in B[ocks E, G. H. and I and on line 40 I (or. if line 40 I is astcrisked. line .+03 and '+(4) is important ta,x information and is being rum ished 10 the
Inlemal Revenue Ser.ice (see Selkr Cenitication) If)'ou arc required to Ilk a return. n negligence penalt)' or other sanction wiii be imposed on you if this item is required
to be reported and the IRS determines that it has not been reponed. You arc required to provide the Settlement Agent with vour correct taxpayer identification numkr If)'C'u
du not pro, Ide the Settlement /\gent \\itl1 your correct ta.xpa)'er identiticatlon number. you may be subject III civ il or cnminaI penalties imposed by la\\. Uncler penalties of
p~rjllry, I certify that the number sho\'.n on this statement is my' correct taxpayer iJ":lltiJj~3til)fl number.
I Seller's Signature)
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lS-:lkr!~ Si!..:!l1~ltLlrc)
~s3b211e ~. Cessaro
'OIL TOTAL SALES/BROKER', COM\1ISSIO:\' h"scd onprict' S 142,000.00 @ PAID FROM
DIvision "[Commission (line 7001 as follows' BORROWER'S
70 I $ I FUNDS AT
702 $ i S [TTLEiv! U'H
703 CommiSSion paid at Settlement L
704. I
SilO. ITE .\IS PA y., IlU: IN CO'\:\' ECTlO'\ \\TII( LOA'\'
801 Loan Origmation Fee S
R02. Loan D,scounI S I
803 AppraIsal Fee to Kennedv Me1.1SSC1 H. 30e.Oo
804 Cred it report to
805 Lender's Inspection Fee
806 Underwritina fe~ to AJvlNET 375.00
807 ~]irina Fee to N'lNET 35.00
808 Tax S,:::.r'Iice tQC,. to A.r..-rNET 90.00
R09. Flood Cert to .nl~NE T 1 0.00
810 Docume:1t E'reo Fee to lU'1NET /10.00
811 B:::-oke:::- Premium to Commonwe>alt:-: Fund-inQ Grauo Inc(POC 25')8.74)
812 Broke:::- P remi li..-rn l'c."lNET credi t( POC 2528 .74 )
813 Processina fee to Commonweal th Fundina GrOUD 488.00
900. ITEMS RE:Ql'IRED BY LENDER TO BE PAID 1'\ ADVA'\"CE
901 Interest from 10/28/2005 1110112005 @ S 1 9. 060 Der- dav 76. /4
902 Mortgage Insurance Premium tor
90] Hazard insurance Premium tor
904.
905.
]1l00. RESERVES DEPOSITED WITH LL'\'DER
1001 Hazard insurance 3 month/sl @ 529. 00 Dee month 87. 00
1002. /,Yfortgage Insurance
100] Cit". PrQj1env T a'\es
1004. County Proper!'y Ta,es 9 mon~h(sJ @ 535.12 oer Ir.on th ]1 6.08
1005. Annual assessments
]006 sc::hool taxes 5 month (s ') @ 51 15. 1 S' Der mO:1th 575.90
1007
I 1008. Aegregale Accounting Adiusrment -nO.55 I
1100. TITLE GL\RGES
J IOJ Senlemel1t or closing fee to Jacque1ine i\.r \-'erne'.;, EST.1' -"-c. j5C.C:O I
Ifll2 Abstract or title search to K2Y'e:!. Coon I , 19 .::)0 I
1103 Title Examination to I ,
I 104. Titk insurance binder to I I
I 1105. Document preparation to I I I
1106. Notarv fees to 'ilale:-ie Gsell 1 :;'.00 I I
I 1107. Attomev's fees to Irwin & rJJ.::Kr. i ernt 750. CC I
I (includes line numbers: I i
I 1108 Title Insurance to P2nn ,72..:: :::':::-n::::.'/s -Litle 1!1C: I 33 3 . O:-} i
I (lI1cJudes IlOe numbers: lCD 300 8.1 C~~-S35 .00 I
1109 Lender's coverag~ .$ :;':;']60iJ.00 I
1110 Ov.:ner's coverage $ 144000.00 I
II I I I
I I ]2. I
1113
1200. GO\'EW'\ILVr RECORDI'iG .\"'D TR.-\:\SFER CHARGES
1201 RecordlOg fees: Deed .$ 38.50 i\!ortgaee $ 64.:J!J Rekase .$ :1.03. 00
1202 Citv/cntv tax/stamps' Deed .$ 1. 440.00 Mortgaee $ 1 440.00 I
1203. State tax/stamps' Deed $ 1 44C!.OC I\fortgage $ 1 440.00 I
1204. !
1205 I
IJOO. A 00 IT I 0'\..\ f. SETTI.E\IE.\'T CHARGES I
l3u I Survev to I
11110 Pest inspection to I
1311] North Niddleton TltiG ~Jj:lni ci ::'31 P'.'lt-horit'i i 9. S"J I
131lc! I"..; -i :::-e fe-2-S?O;e-mai1 fee-S20;0vernlchi :ee-S2'O to 1.-7[\1 'Verne\! Ssa 60 .0:) 20. r,J I
I.Hh Crejit ~lclr,aaeme[', '- #:'8362835 (POC S337.C:C:'1
1306 Com.2. Acceot #l 0 293. 00
I-lOO. TOTAL SETTLEME'\iT CH\HGES (enter on lines I OJ. Section.! and 50:!, Section ~ 5 092. 1 7 2 289. ~v
L. SETTLE:\IE.'IiT CHARGES
l'ERTIFICATION: r hnve carefully reviewed the HUD-I Senlement Statement nnd to the best of my knowledge and beliee it is a true and nccurate statement 01'<111 receipts and
d"",,""",, ,",d, eo my ;~'""~"" m ",;; ""=r""",, "",,y ",,' I "":;t";, ;=;:]~sC:"'
72; ~t~';;;ZZr.(//;C_ S"""", , !,,,drew I R"errber~
Selb V Charle3.~:\. /C3.ssaro BOrrO\\Cf
The HUD-J Settlement Statement )"11ich I ve prep<1red is a true and accurate account oi'the funds disbursed or to be disbursed by the undersigned as part oCthe senlement of
rl1i:, rnll1sacrion
lO/28/2iJC5
C/lt J2cque~ir'ie ~!. 'Je-=-:-le,/,/ squire Date
'is a crime to knowingly make t"lse statement; I~ 1e United Slates on this or <1ny other similar form. Penalties upon conviction can include" line <1nd
ImpriSonment For dctarls see: Title! 3 U.S. Code Section 100 I and Section 10 I IJ.
I FASY SOFT. IllC. 2IJiJ I PrevIous edrrions arc obsolete p"",> 0