Loading...
HomeMy WebLinkAbout01-26-06 t/ '_1500 EX~' {~) , ',* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 5 0 7 4 3 COuNTY'Co5E ----vEA~ - - NUMsER- - ~ Z W o W () W o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Bawn, Jo ce, E DATE OF DEATH (MM-DD-Year) SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD-Year) 1 7 1 - 2 8 - 0 2 2 5 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 7/31/2005 6/5/1936 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER W f- ::.::~lI) <..) It:::.:: wCL<..) :LOO "It:-l ...., CLeo CL <( [X] 1. Original Return D 4. Limited Estate [X] 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy of Trust) D 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95) D 3. Remainder Return (dale ofdealh 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) f- Z W C Z o CL lI) W It: It: o <..) 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 :P.A 17070- z o ~ <( ...J ~ t: Q. <( () w 0:: 1. Real Estate (Schedule A) (1) 159,000.00 OFFICIAL USE ONLY, 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (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) 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 (5) 2,375.14 (6) 8,629.96 '-t '. (7) I LH__ (8) 170,005.10 (9) 34,719.39 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) (12) (13) 34,719.39 135,285.71 1,000.00 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 Subjectto Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 134,285.71 z o ~ <( ~ ~ Q. :E o () X <( ~ 0.00 X _(15) 134,285.71 X .045 (16) 0.00 X .12 (17) 0.00 X .15 (18) (19) 0.00 6,042.86 0.00 0.00 6,042.86 20 D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C/ > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < ~) 0;.- ~ ,Q:,- 0 ~ " ,Decedent's Complete Address: STREET ADDRESS 1816 Willow Road CITY I STATE PA T ZIP 17011- Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 6,042.86 Total Credits (A + B + C ) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 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) 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 0.00 6,042.86 6,042.86 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? ............ ... ....... ...... ............................ ..... ....... ..... .............. ................ 0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DATE -&-vI::. PA 17011 DATE 1~20'Q 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. 99116 (a) (1.1) (i)l. 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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(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. 99116(1.2) [72 P .S. 99116( 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. 99116(a)(1.3)). A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. '\ ,REV-1502 EX . (6-. SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sawn Jovce E 21 05 0743 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 orooertv which is iointlv-owned with riaht of survivorshio must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION Property located at 1816 Willow Rd., Lower Allen Twp., Cumberland County, PA by deed dated November 30, 1984 and recorded in the Office of the Recorder of Deeds in and for Cumberland County, PA in Deed Book A-31 , Page 175, granted and conveyed unto Clifford R. Sawn and Joyce E. Sawn his wife. The said Clifford R. Sawn having died July 13, 1994, thus vesting title in Joyce E. Sawn, the decedent herein. The said property was sold to Martha Fellman on November 18, 2005. VALUE AT DATE OF DEATH 159,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 159,000.00 \ , REV-'508 EX' i6. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Bawn Jovce E 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. 0743 ITEM NUMBER 1. DESCRIPTION 1987 Chrysler Fifth Avenue Sedan 40 sold to Brandon Taylor VALUE AT DATE OF DEATH 1400.00 2 Bethlehem Steel pension 235.81 3 Car insurance refund 48.58 4 Net proceeds of household goods sold at Haars Auction on August 19, 2005 690.75 TOTAL (Also enter on line 5, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same size) 2,375.14 REV-1509 EX + (6-98) '* SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bawn Jovce E FILE NUMBER 21 05 0743 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. Larry J. King 43 S. Thirty-Ninth St., Camp Hill, PA 17011 Son 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 DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL Y.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTSINTERES 1. A. 2/7/05 PNC Bank-Checking Acct. #5140116067 joint w/Larry 1,690.08 100. 1,690.08 J. King on Feb. 7, 2005, Prine. $1690.02, Int. $.06 2 A 2/7/05 PNC Bank-Savings Acct. joint w/Larry J. King 6,939.88 100. 6,939.88 on Feb. 7, 2005 TOTAL (Also enter on line 6, Recapitulation) $ 8,629.96 T (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ESTATE OF Sawn Jovce E Debts of decedent must be reported on Schedule I. 21 05 0743 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Rollling Green Cemetery-marker 1,626.00 Parthemore Funeral Home-funeral expenses 6,939.97 Rolling Green Cemetery-grave opening and closing 995.00 Parthemore Funeral Home-bal. of funeral expenses 2,134.03 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 8,535.00 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. 302.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Checks written but not cleared until after death 304.96 2 Cumberland Law Journal-advertising grant of letters 75.00 3 The Patriot News Co.-advertising grant of letters 113.61 4 Settlement costs ($13041.41) less reimb. ($908.16) 12,133.25 5 PPL Electric-electric services at property 185.64 6 MCI-telephone services at property 28.88 7 UGI-gas services at property 126.00 8 PAWC-water services at property 35.38 9 PPL Electric-electric services at property 119.51 10 Lower Allen Twp.-sewer and refuse 76.35 11 PPL Electric-electric services at property 93.36 12 PAWC-water services at property 16.75 TOTAL (Also enter on line 9, Recapitulation) $ 34,719.39 (If more space is needed, insert additional sheets of the same size) Sawn, Joyce, E Decedent's Name Continuation of REV-1500 Inheritance Tax Return Resident Decedent Page 1 21 05 0743 File Number Schedule H - Funeral Expenses & Administrative Costs - B7. ITEM NUMBER AMOUNT 13 14 15 16 17 18 19 19 20 21 DESCRIPTION UGI-gas services at property PAWC-water services at property PPL Electric-electric services at property UGI-gas services at property UGI-gas services at property PAWC-water services Com cast-cable services at property UGI-gas service at property Register of Wills-filing Inh. Tax Return and Inventory Reserve for closing expenses 1 04.00 27.43 64.43 1 05.60 126.00 49.97 45.27 126.00 30.00 200.00 SUBTOTAL SCHEDULE H.B? 878.70 .ReV.""," .". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES FILE NUMBER ESTATE OF Bawn Jovce E 21 05 0741 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Cris A. King Lineal 17,904.76 690 Penn Drive Bressler, PA 17113 2. Jeffrey B. King Lineal 17,904.76 496 Ebert Clark Road Edmonton, KY 42129 3. Timothy L. King Lineal 17,904.76 PO Box 781 Talihina, OK 74571 4. William P. King Lineal 40,285.72 6335 W. Reilly Road Houghton Lake, MI 48629 5. Larry J. King Lineal 40,285.71 43 S. Thirty-Ninth Street Camp Hill, PA 17011 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. Mt. Zion Lutheran Church 1,000.00 863 Lewisberry Road Lewisberry, PA 17339 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 1,000.00 (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF JOYCE E. BAWN I, JOYCE E. BAWN, of Lower Allen Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I TEM I: I direct that my Executor.hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease from the residue of my estate. ITEM II: I bequeath my household and personal effects and other tangible personalty of like nature (not including cash, securities or my automobile) to such of my children as are then living, to be divided among them by my Executor with due regard for their personal preferences in as nearly equal shares as practical. ITEM III: I bequeath the sum of $1,000.00 to the Mount Zion Lutheran Evangelical Church, Lewisberry, Pennsylvania. ITEM IV: I devise and bequeath the all the ~est, residue and remainder of my estate of every nature and wherever situate as fol- lows: A. 40% thereof to be divided equally between my sons, eRIS A. KING, JEFFREY B. KING, and TIMOTHY L. KING. Page 1 of 4 _ ____ ~~_ .__' _ _ _._~.~_ _..,,______.~_ .__~.__._~~._._'_. .__'__"~._~.'__.~"~'- ~_. -'--'-___.._._"'"-________~__;,,~.,;._'__',~.....___~...:.__..;.,_____...:..n~C'_ B. 60% thereof to be divided equally between my sons, WILLIAM P. KING and LARRY J. KING. Should any of my above-named children fail to survive me, the share of such child shall lapse and shall be distributed between his surviving brothers in the same portion as they now bear to each other. ITEM V: I appoint my son, LARRY J.. KING, Executor of this my last will. ITEM VI: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his/her duties in any jurisdiction. IN WITNESS WHEREOF, I, JOYCE E. BAWN, have hereunto set my hand and seal this ~\.' day of AefJ-,l , 2005. ~ f . ~ ..~"'" JOYCE E. BAWN Page 2 of 4 , SIGNED, SEALED, PUBLISHED and DECLARED by JOYCE E. BAWN, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the have subscribed our names as witnesses. Witness ~,...(;h~4" 4- Address ' ~~ ~j=:=~,~_\-_\~ Address COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF CUMBERLAND I, JOYCE E. BAWN, the Testatrix whose name is signed to the at- tached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. ~i [. \\~ OYCE E. BAWN' Sworn to or affirmed to and acknowledged before me by JOYCE E. BAWN, the Testatrix, this 1~'-cra y '."0' , 2005. 1.-/ COMM WEAlTH OF PENNSYlVANIA . NOTARIAL SEAL DANiel M. HARTMAN, Notary Public New Cumberland Boro., Cumberland Co My Commission Expires Jan. 21, 2009' .. COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND We, ~ Ir.r~ and C" "'~"- ~-:\:~\, , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. wts 0.. Sz~~ \.\ Witness Sworn to or affirmed to and of before me by ~ 1 "'~ witnesses, this c2 p+ day - ~'- ~. . '"W COMM WEAlTH OF PENNSYLVANIA . NOTARIAL SEAL DANIel M. HARTMAN, Notary Public New Cumberland Boro., Cumberland Co My CommiSSIon Expires Jan. 21, 2009' Page 4 of 4 re\ded\BAWNESTATEkellman PARCEL #13-23-0547-382 DEED THIS INDENTURE made the day of , in the year 2005, between LARRY J. KING, Executor of the Last Will and Testament of Joyce E. Bawn, late of Lower Allen Township, County of Cumberland and Commonwealth of Pennsylvania, of the first part, hereinafter called the Grantor, - AND - MARTHA FELLMAN, of the second part, hereinafter called the Grant- ee; WHEREAS, the said Joyce E. Bawn 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 Lower Allen Township, County of Cumberland, and Commonwealth of Pennsylvania, and more particularly described hereinafter; and being so thereof seised, died on July 31, 2005, having first made her Last Will and Testament in writing dated April 21, 2005, duly probated and registered in the Office of the Register of Wills of Cumberland County on August 19, 2005, wherein and whereby she appointed as Executor, the said Larry J. King, to whom Letters Testamentary were duly issued by said Register of Wills on August 19, 2005, wherein and whereby said premises hereinafter de- scribed were not specifically devised, all as in and by said Will and the records of said Register of Wills more fully appears; -1- , NOW THIS INDENTURE WITNESSETH, that the said Grantor, for and in consideration of the sum of One Hundred Fifty-Nine Thousand and NO/lOa ($159,000.00) Dollars, which has been paid to him 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 of land situate in Lower Allen Township, Cumberland County, Pennsylvania, bounded and described as follows: BEGINNING at a point on the North side of Willow Road as shown on the hereinafter mentioned Plan of Lots, which point is 640 feet West of the Northwest corner of the intersection of Willow Road with State Highway No. 21019; thence along Willow Road, South 78 degrees 54 minutes West 75 feet to a point at the corner of Lot No. 10, North 11 degrees 06 minutes West 120 feet to a point at lands of Rolling Green Cemetery; thence along said lands North 78 degrees 54 minutes East 75 feet to a point at the corner of Lot No. 8 on said Plan; thence along the western line of Lot No. 8 South 11 degrees 06 minutes East 120 feet to the place of BEGINNING. BEING Lot No.9, Block A, on the Plan of Lots of Cedar Village, as recorded in Plan Book 7, Page 26, Cumberland County records. HAVING thereon erected a single brick dwelling house, No. 1816 Willow Road. UNDER AND SUBJECT, nevertheless, to the restrictions and covenants recorded June 9, 1955, in the Recorder's Office aforesaid in Miscella- neous Book 115, Page 69. BEING THE SAME PREMISES WHICH Michael J. Macgee and Cynthia A. Macgee, his wife, by their deed dated November 30, 1984, and recorded December 4, 1984, in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Deed Book A31, Page 175, granted and conveyed unto Clifford R. Bawn and Joyce E. Bawn, his wife. Clifford R. Bawn -2- ~ died on July 13, 1994, thus vesting title in Joyce E. Bawn, by opera- tion of law. TOGETHER with all and singular the buildings, improvements, ways, streets, alleys, passages, waters, water-courses, rights, liberties, privileges, hereditaments and 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 Joyce E. Bawn, 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 himself and his respective heirs, executors and administrators, does covenant, promise and agree to and with the said Grantee, her heirs and assigns, that he, the said Grantor, has not heretofore done or committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, -3- . ~ is, are, shall or may be impeached, charged, or encumbered ln title, charge, estate or otherwise howsoever. IN WITNESS WHEREOF, the said Grantor has hereunto set his hand and seal the day and year first above written. (SEAL) LARRY J. KING, Executor of the Last Will and Testament of Joyce E. Bawn Witness COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF On this, the day of , 2005, before me a Notary Public, the undersigned officer, personally appeared LARRY J. KING, Executor of the Last Will and Testament of Joyce E. Bawn, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereto set my hand and notarial seal. Notary Public -4- ~ ; I hereby certify that the precise address of the Grantee is Attorney for -5- ~ ~~I ~~ ~~~~ .~-.w I r '1\...'unl 'fr'\ 41<:::(bCl ..:J4~i:j t-'.k::11/01 ", o PNCBAN< September 06,2005 Stone LaFaver & Shekletski Attn: David H Stone 414 Bridge St. P 0 BOJt E New Cumberland, PA 17070 /scp RE: Estate of Joyce E Bawn (Deceased) SSN: 171-28-0225 DOD: 07-31-2005 Dear Mr. Stone: In response to your request for Date of Death balances for the customer noted above, our records show the following: Che~kiDg AccouDt Account #5140 116067 Established 02-07-2005 JOYCE E BA WN LARRYJKING DOD balance: $1,690.02 + $0.06 accrued interest Savings Account Account #5080418345 Established 02-01-2005 JOYCE E BA WN LARRY J KING DOD balance: $6,939.88 + $0.00 accrued interest Please note that this office only provides date of death balances fOT deposit accounts (lRAs, CDs, Checking and Savings accounts). We do not process aay financial transactiODS or provide statements. If you need assistance with any of these items, please call1.888-PNC-BANK (1-888-162-2265) or stop by your local PNC>Bank branch office. Sincerely, ~;;? ~ Erica L Schlegel 1-800-762-1775 P7 -PFSC-04-F 500 First Ave. Pitt~b\Jrgh P A J 5219 MembcrFDIC TOTRL P.01 '. M, ~, I y,.,~ UI- LUAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1,QFHA 2.oFmHA 3,OOCONV UNINS, 4,OVA 5,OCONV, INS, 6. FILE NUMBER: 17, LOAN NUMBER: SETTLEMENT STATEMENT 05-835 121970641 8, MORTGAGE INS CASE NUMBER: OLD MORTGAGE INS CASE NUMBER: 7,8%\F\539 JSG C. NOTE: This fonn is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. ' Items marked "[POC]" were paid outside the closing; they are shown here for infonnational purposes and are not included in the totals. 1,0 3196 (FELLMAN.MARTHA,PFDIO~35117) D, NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: MARTHA G. FELLMAN ESTATE OF JOYCE E. BAWN AMERICA'S WHOLESALE LENDER 1816 Willow Road 2375 N, GLENVILLE DRIVE RGV-B-195 Camp Hill, PA 17011 RICHARDSON, TX 75082 G, PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1857112 \. SETTLEMENT'OATE: 1816 Willow Road Midstate Abstract Company Camp Hill, PA 17011 November 18, 2005 Cumberland County, Pennsylvania PLACE OF SETTLEMENt 2331 Market Street Camp Hill, PA 17011 J, SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 159000.00 401. Conlract Sales Price 159,000.00 102, Personal ProperlY 402. Personal ProoerlY 103. Settlemenl Charoes 10 Borrower lLine 1400\ 6,147.02 403. 104. 404. 105. 405. Adjustments For Items Paid Bv Seller in advance Adiustments For Items Paid Bv Seller in advance 106, CltVfTown Taxes to 406. CitvfTown Taxes to 107. Counlv Taxes 11/18/05 to 01101/06 69,48 407. Counlv Taxes 11/18/05 to 01101/06 69.48 108, School Taxes 11/18105 10 07/01/06 602.16 406. School Taxes 11/16/05 10 07/01106 802.16 109. Sewer & Refuse Proration 11/16/051001101/06 36,52 409. Sewer & Refuse Proration 11/16/051001/01/06 36.52 110. 410. 111. .. 411, 112, 412. I 120. GROSS AMOUNT DUE FROM BORROWER 166,055.18 420. GROSS AMOUNT DUE TO SELLER 159,908,16 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: SOO. REDUCTIONS IN AMOUNT DUE TO SELLER: I 201, Deoosit or earnest money 5,000.00 501. Excess 0800sit ISee Instructionsl 202. PrinciDal Amount of New Loanls\ 75.000.00 502. Settlement Charoes to Seller lLine 1400) 23041.41 203, Existin!:! loanls} taken subiect to 503. Existill\lloanls\ taken subiect to 204. 504. Payoff of first Mortgage 205, 505. Payoff of second Mortaaae 206, 506. 207. 507. lDeDosit disb, as Droceedsl 208, 508. 209. 509. Adiustments For Items UnDaid Bv Seller Adiustments For /terns Unpaid Bv Seller 210, CilvlTown Taxes to 510. CitvfTown Taxes to 211, Counlv Taxes to 511. Counlv Taxes to 212. School Taxes to 512. School Taxes to 213. 513. 214. 514. 215. 515. 216. 516. 217, 517. 218. 518. 219, 519. 220, TOTAL PA/D BY/FOR BORROWER 80,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 23,041.41 300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301, Gross Amount Due From Borrower lLine 120\ 166,055.18 601. Gross Amount Due To Seller lLine 420\ 159,908,16 302, Less Amount Paid BvlFor Borrower (Line 220) ( 80,000,00) 602, Less Reductions Due Seller (Line 520) ( 23,041.41 303. CASH ( X FROM) ( TO) BORROWER 86,055.18 603. CASH ( X TO) ( FROM) SELLER I 136,666.75 " " The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachmenls referred to herein. Borrower ~ It,.._r~ ~~ MAR A G. FEL.LMAN ~ Seller ~ TEO J CE. N L. ::it: I J Lt:Mt:NT CHARGES 700. TOTAL COMMISSION Based on Price $ 155,000.00 @ 6.0000 % 9,300.00 PAID FROM J PArD FRO Division of Commission (line 70d) as Follows: BORROWER'S SELLER' 701. $ 9,300.00 10 RElMAX R~AL TV ASSOCIATES FUNDS AT FUNDS A 702. $ 10 SETTLEMENT SETTLEME 703. Commission Paid at Settlement t --. 9,3 704. to 1 J___ ~ -- 800.ITEMS PAYABLE IN CONNECTION WITH LOAN -- -- 801. Loan Origination Fee % to 1--- - 1 802. Loan Discount % to L ____ __L ___ 803. Appraisal Fee to CAPITAL PROPERTY POC:B275.00r - -- -~'::=_n_ 804. Credit Report to I 1-----'--:-- 805. Flood Check Fee to LANDSAFE FLOOD , 26,00[ - - 806. Tax Service Fee to COUNTRYWIDE TAX SERVICE ~_ ----=--.eo ooL - - - -- 807. Underwriting Fee to AMERICA'S WHOLESALE LENDER I 795.001 808. Broker Loan Fee to !3entiMortgageGroup - -- - -- -- ----.-.--- 1 750.001 B09. Broker Processing Fee to Bentz Mortgage Group I _ _395,001 810. Premium Paid from AWL to Bentz Mortgage Group - --- POC:375.00 LL_-=-~_ Ln___ 811.. I -- I -- I r - I J 1 I 1 r-- I 50.00'--- - I 35.00L__ pocl I n-------T-t---- ---I _1~153.75~____ --___-t___ 1_ 150-.-0bl-_______~__ -10.0or-- - __n _un L___ 5.00 _15.061....:::____ 10,00L__ ,--- 10,oob.00 I ----- ----.l ~ #. ,. J 900 ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 16.03oooo/day J I POC $427.00bl _ ___1. -- --- -- ---I' 901. Interest From 11/18/05 to 12101/05 @ $ 902. Mortgage Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 vears to STATE FARM INSURANCE 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 3.000 1002. Mortgage Insurance 1003. CitvlTown Taxes 1004. County Taxes 1005. School Taxes 1006. 1007. 1008. Aggregate Adiustment 1100. TITLE CHARGES 1101. Settlement or Closino Fee 1102. Abstract or Tttle Search 1103. Title Examination 1104. Title Insurance Binder 1105. Electronic Document PreD. 1106. ClosinQ Service Letter 1107. Attorney's Fees (includes above item numbers: 1108. Title Insurance to MIDSTATE ABSTRACT (includes abo\le item numbers.11 02, 1103 & 1104 1109. Lender's Coverage $ 75,000.00 1110. Owner's Coverage $ 159,000.00 1111. Endorsements 100,300,8.1 to MidstateAbstractCompany 1112. Notary Fee to Midl;tate AbstractCo/TlParlY'_ 1113. Notary Fee to Midstate Abstract Company 1114. Overnight Fees & Handling to Midstate Abstract Company 1115. Wire Info 10 Midstale Abstract Company 1116. Escrow for Inhertiance Tax to Stone LaFaver & Shekletski 1117. 1118. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 40.50: Mortgage $ 66.50; 1202. City/County TaxlStamps: Deed 1,590.00' Mortoaoe 1203. State TaxlStamos: Deed 1590.00: Mortoaoe 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survev to 1302. Pest Insoection to 1303. 2005 School Taxes to Bonnie K. Miller Treasurer 1304. Transaction Fee to RelMax Realtv Associates 1305. Home W.lTllnly to AHS 1400. TOTAL SETTLEMENT CHARGES tEnter on Lines 103 Section J and 502 Section K) ./? By signing page 1 of this stalement, !he signatories acknowledge recolpl of a completed <x>py of page 2 of this two page ..._.,/'.---. 13 days %) 10.000 5.000 months ( $ months $ months $ months $ months @ $ months lW $ months IfiJ $ monthslfiJ - $ 35.58 per month per month oer month 47.11 per month 106.27 per month -oer month oer month oer month ---.L 1 J I 1 I I I to to to to to Midstate AbstractC_ompany to Midsta!e Abstract- Company to Stone LaF aver & Shekletski . .nJnm -r, - 1 I 1 I I I I I I 1 1,.!?3.75 Releases $ Midstat~stract Company Certified to be a true copy. Settlement Agent M S NT 00.1 208._39L__~_=- . I u.._ u__ ~ n F=--- I 106.741- I r 471.101_ 531.351 I I -542,.311 - - 107.00 1,590.00 1,590.00 195.00 1431.41 250.00 465.00 23,041.41 6,147.02 ( 05-835 I 05-835/19 )