HomeMy WebLinkAbout02-03-06 (2)
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REV-1500 EX + (6-00)
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
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0 (16)
;:: 16. Amount of Line 14 taxable at lineal rate 47,560.19 x .045
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Q. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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0
() , 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
x
~ 19. Tax Due
(19)
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i OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I-
I FILE NUMBER
II 05
COUNIYCOpE n Y!':AR
SOCIAL SECURITY NUMBER
00026
DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
NI.JTI.1El.e:R
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Z
W
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W
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WEAR, VERNA A.
DATE OF DEATH (MM-DD-YEAR)
i DATE OFBIFhH (MM-DD-YEAR)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
201-18-8581
12-31-2004
09-05-1924
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
x 1. Original Return
2. Supplemental Return
3. Remainder Return (date of death prior to 12-13-82)
4. limited Estate
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'1 4a. Future Interest Compromise (date of death after
12-12-82)
I 7. DeCedent Maintained a living Trust (Attach
copy of Trust)
10 Spousal Poverty Credit (date of death between
. 12-31-91 and 1-1-~5)
[!HIS SECTI-2!! I\nU~T_BJ:"<;~lETED. ALL CORRESPoNDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE D!RECrED TO:
' NAME I COMPLETE MAILING ADDRESS
Jan M. Wiley
i 5. Federal Estate Tax Return Required
x 6. Decedent Died Testate (Attach
copy of Will)
9. litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
11, Election to tax under Sec. 9113(A) (Attach Sch 0)
FIRM NAME (If applicable)
Wiley, Lenox, Colgan, & Marzzacco, P.C.
TELEPHONE NUMBER
717-432-9666
130 W. Church St
Dillsburg, PA 17019
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
65,517.08 OFFICIAL USE ONLY
None
None -~ '. ,
None
3,461.12 c ."\
None . , ~ . 1
i I
None L:
,
J' f";.
(8) c'68,978.20
18,937.38
2,480.63
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
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IX:
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) Separate BiJling Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
(5)
(6)
(7)
I 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
(11 )
21,418.01
47,560.19
0.00
12. Net Value of Estate (Line 8 minus Line 11)
(12)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
(14)
47,560.19
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
0.00
2,140.21
0.00
0.00
2,140.21
'20.0
~_.~~..- "'_'_'__''''~__.~m__.__.___,"-
.. -->;-BESURET~'~"'~~'t~_~.9!/l!siiONS ON RiVEJct~E_~II:)I!!_A~~!CJ:!'i~I5.~!~~~~-~ _____-=-=-_ .__-~___. -~~
Copyright 2002 form software only The Lackner Group, Inc.
I
Form REV-1500 EX (Rev. 6-00;
Rt.
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Decedent's Complete Address:
STREET ADDRESS
3907 Rosemont Avenue
CITY Camp Hill
STATE P A
I
ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
2,140.21
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
0.00
36.94
Total Interest/Penalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
Make Check Payable to: REGISTER OF WILLS, AGENT
(3) 36.94
(4)
(5) 2,177.15
(5A)
(58) 2,177.15
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?............................. ................... ................. ........ ............................................. ~x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury. I declare that I have examined this return, including accompanying schedules and statements. and to the best of my knowledge and beiief, it IS true, correct and
complete. Declaration of preparer other Ihan the personal representative is based onnformation of which preJlarer has any knowledge
SIGNATURE OF PERSON RESPONSIBLE FOR FiLING RETURN .' AD RESS
l/ R5~z:, ~}--1 .
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
Nancy L. Burgard
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;..................................................................................
b. retain the right to designate who shall use the property transferred or its income;....................................
c. retain a reversionary interest; or..................................................................................................................
d. receive the promise for life of either payments, benefits or care?..............................................................
2. If death Occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.............. ...................... ....... ......................................... .............................. .....
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
No
Ix 1
x
I X
X
x
IX
,.
328 Coffeetown Road
Di/lsburg, PA 17019
DATE
328 Coffeetown Road
Di/lsburg, PA 17019
2 _IJ/~
bATE
<-!o~J 0 ~
ADDRESS
130 W. Church St
Di/lsburg, PA 17019
L.., os.
Fates 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
urviving spouse is 3% [72 P.S. 99116 (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. 99116 (a) (1.1) (ii)1. 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)1.
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 PS. 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.
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{[jas! mill altu (IT.ell!am.rnt
OF
VERNA A. WEAR
BE IT REMEM3ERED, that I, VERNA A. WEAR, of 3907 Rosemont Avenue, Carrp Hill,
Cumber land County , Pennsylvania, being of sound. mind, rrerno:z:y am. understaming,
do make, publish am declare this as am for my Last Will am Testament, hereby
revoking and rraking null am void any and all Wills am Testarrents and writings
in the nature thereof by Ire at any t.irne heretofore rrade.
ITEM 1: I direct that all my just debts and funeral expenses be paid as soon
after my demise as rray be convenient.
ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature
am wheresoever situate, whether it be real, personal or mixed, including property
over which I have a power of appointrrent, I give, devise am bequeath unto my son,
l\niIALD L. BURGARD and my daughter-in-law, NAN:Y L. BURGARD, or the survivor of
them.
ITEM 3: Should my son, ~ L. BURGARD am my daughter-in-law, NAN:Y L.
BURGARD, fail to survive Ire for a pericxl of thirty (30) days or should we die simul-
taneously, I then give, devise am bequeath my entire residuary estate unto my
four (4) gramsons, RJilALD R. BURGIUID, KEI'lH B. BURGARD, JAS:N L. BURGARD and CHAD
L. BURGARD, in equal shares, per stirpes.
ITEM 4: I direct that my hereinafter narred Co-Executors pay all inheritance,
estate, succession and legacy taxes of whatsoever nature am kind, to which my
Estate or the transfer of any property passing hereunder or otherwise passing py
reason of my demise, rray be subject am to charge such taxe.s against my residuary
estate, it being my intention that none of the aforesaid taxes, either federal
or state, or any property required to be included in my gross estate, under the
provisions of any state or federal law now in force or hereafter enacted, shall
be prorated arrong the persons interested in my Estate to whcm such property is
or rray be transferred or to whcm any benefit accrues.
ITEM 5: I appoint my son, R:mLD L. BURG/\RD am my daughter-in-law, NAN:Y
~
0.JL
I . / 1
-r /J-i.-,..,trX C2 ' L{/_~
VERNA A. WEAR
(SEAL)
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L. BURGARD, as Co-Executors of this my Last Will and Testarrent. Should my son,
~ L. BURGARD and my daughter-in-law, NANCY L. BURGARD, predecease me, fail
to qualify, cease to act or renounce probate, I then appoint MY OI.JEST LIVING
~, as alternate Executor of this my Last Will and Testarrent.
rrm 6: I direct that my Co-Executors, guardian or treir successors shall
not be required to give bond for the faithful perfonrance of their duties in any
jurisdiction.
m WI'INESS WHEREOF, I have hereunto set my hand and seal this 4Si'tJday of
tvO\,..p.<<\b 1-1 ,1991.
l!t~(z-
A. WEAR
~-- , e-J
Lei &1:vc (SEAL)
,
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CCMmwFAr.m OF PENNsYLVANIA
ss
CXXJNTYOFYORK
We, VERNA A. WEAR, JAN M. WILEY, FSJUIRE, and PATRICIA A. OGG, the Testatrix
'and the witnesses respectively, whose narres are signed to too attached or foregoing
instrurent, being first duly sworn, do hereby declare to the undersigned authority
that the Testatrix signed and executed the instnrrent as her Last Will and Testanent
and that she had. signed willingly (or willingly directed another to sign for her),
and that she executed it as her free and voluntary act for too purposes therein
expressed, and that each of the witnesses, in the presence and hearing of the Testa-
trix, signed this Last Will and Testament as witness and that to the best of their
knowledge the Testatrix was at the tima eighteen (18) years of age or older, of
sound mind and under no constraint or undue influence.
~U~'4k O,{C)~L-
VERNA A. WEAR
~~ cJ~
~~~
Sworn to and subscribed
before me this Jo-0 day
of '-n~1 }...(J\ ' 1991.
s A~)J2 l1l/Ad!, I iu
NOTARY PUBL C
MY CCMMISSlrn EXPIRES:
Notarial Seal
S. Dawn Gladlelter, Nl1tarY PubIlc
CarToD Thp., YoI1I CoUnty
My Commlsslon Expires May 17, 1993
anlB Association of Nolana.
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Rev-1502 EX+ (6-98)
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SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WEAR, VERNA A.
FILE NUMBER
21-05-00026
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 Jolntly-owned with right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Sale of property situate at 3907 Rosemont Ave., Camp Hill, PA:
VALUE AT DATE
OF DEATH
65,000.00
2 Tax proration due estate from sale of real estate:
517.08
TOTAL (Also enter on Line 1, Recapitulation)
65,517.08
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule A (Rev. 6-98)
A. Settlement Statement
u.s. Department of Housing ~
and Urban Development ,r
OMB No. 2502-0265
B. Tvile of Loan
1.0 FHA 2.0 FmHA 3.1X1 Conv. unins./6. FileNumber /7, Loan Number /8, Mortgage Insurance Case Number
4.0 VA 5.0 Conv.lns. FP-234I 05-D77235 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 "(p.o.c.)" were paid outside the closing; they are shown here for infonnational purposes and are not included in the totals.
D. NAME OF BORROWER: John Sterling Helwig
ADDRESS OF BORROWER:
E. NAME OF SELLER: The Estate of Verna A. Wear
ADDRESS OF SELLER: 3907 Rosemont A venue, Camp Hill, P A 170 I I
F. NAME OF LENDER: NovaStar Mortgage, Inc., ISAOA
ADDRESS OF LENDER: 6200 Oak Tree Boulevard, 3rd Floor, Independence, OH 44131
G. PROPERTY 3907 Rosemont Avenue
LOCATION: Camp Hill, PA 17011
H. SElTLEMENT AGENT: UNIVERSAL CLOSING SERVICES,LLC
PLACE OF SE'ITLEMENT: 341 N. SCIENCE PARK ROAO, SUITE 205, STATE COLLEGE,PA 16803
341 N. SCIENCE PARK ROAD, SUITE 205, STATE COLLEGE,P A 16803
L SElTLEMENT DATE: 1?/ll/?/1M
J. SUMMARy OF BORROWER'S TRANSACfION K. SPMMARY OF SELLER'S TRANSACfION
I OO.GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
I 01. Contract sales nrice 65 000.00 40 I. Cnntract sales orice 65 000.00
102.Personal orooertv 402.Personal nrnnertv
103.Settlement charl>es to borrower (line 1400) 6278.75 403.
104. 404.
105. 405.
Adiustments for items naid bv seller 'n advance Adiustments for items naid bvselIer in aelvance
106.Citv/town taxes 12/8/2005 to 12/3112005 8.09 406. Citv/town taxes 12/8/2005 to 12/3112005 8.09
'1 07.Countv taxes 12/8/2005 to 12/3112005 i 160 407.Cnunh, tov~o 12/8/200510 12/3112005 11.60
108.Assessments to 408. Assessments to
109.School Taxes 12/8/2005 to 6/30/2006 492.32 409. School Taxes 12/8/2005 to 6/30/2006 492.32
II O.Debt Servo Tax 12/8/2005 to 12/31/2005 2.95 410.0eht Servo Tax 12/8/2005 to 12/31/2005 2.95
111. Librarv Tax 12/8/2005 to 12/31/2005 1.0~ 41 I. T .ibrarv Tav 12/8/20/15 tn 12/3112005 1.06
112.LilZht Tax 12/8/2005 to 12/31/2005 1.06 412 Light Ta" I 2/8/2005 to 12/31/2005 1.06
120.GROSS AMOUNT DUE FROM BORROWER ., 71,795.83 420. GROSS AMOUNT DUE TO SELLER ., 65,517.08
200.AMOUNTS PAID BY OR TN BEHALF OF BORROWER 500.REDUCTIONS TN AMOUNT DUE TO SELLER
20 I.Deoosit or earnest monev 501.Excess denosit (see instructions)
202.Princinal amount of new loan( s) 2. Settlement CharlZes to selIenline 1400) 7?,7?Q
203.ExistinlZ loan(s) taken subiect to 503. ExistinlZ loan(s) taken subiect to
204. 504.Pavoff of first mort"alle loan 9.178.38
M"mh~ro-Id
205. 505.Pavoffofsecond mortlla"e loan
206.Princinal amount of seller financinll 506.Princinal amount of seller financinll
207. 507.
208. 508.
209. 509.
209a 509a
209b 509b
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210.Citv/town taxes to 51O.Citv/town taxes to
211.Countv taxes to 511. County taxes to
212.Assessments to 512. Assessments to
213. to 513. to
214. to 514. to
215. to 515. tn
216. tn 516. to
217. to 517. tn
218. tn 518. to
219. to 519. to
220. TOTAL AMOUNTS PAID ., 72,000.00 520. TOTAL REDUCTIONS TN ., 9,915.67
BY OR TN BEHALF OF BORROWER AMOUNT DUE SELLER
300.CASH AT SETTLEMENT FROMITO BORROWER 600. CASH AT SETTLEMENT TO/FROM SELLER
30 I. Gross amount due from borrower (line 120) 71 795.83 60 I. Gross amount due to seller (Jine 420) 65517.08
302.Less amounts naid by/for borrower (]ine 220) 72 000.00 602. Less reductions in amount due seller (line 520) 9915.67
303.CASH 0 From IXJ To BORROWER ~ 204.17 603. CASH IX! To o From SELLER ., 55,601.41
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02004 Dilpb1 SJ*ma. IDe. (863) 7D-55S5 ~ Luer GeDented
HUD-! (3-86) RESPA, HB 4305.2
PAGE 1
L. Settlement Chmes
700. TOTAL SALES/BROKER'S COM~ based on nrice 65 000.00 ~ %~ Paid From Paid From
Division of Commission nine 700) as follows: Borrower's Seller's
70) to Funds At Funds At
702. to Settlement Settlement
703. Commission naid at Settlement
704. to
800. ItelDll Pavable In Connection With Loan
801. Loan Origination Fee % to Firs' Prpfe~ Financi'l In~ 2 2~00
802 Loan Di.count % to
803. An"r~~ to r;:;;;;::J Penn Annroi.~ In~. ,ilooo
804. p;.n~p..inO' p;;: to FiNt P;eferrecl Finan~ial Inc 49<;.00
R~ to l1;ro+' 60.00
806. Flood r;rtification Fee to LSI 7:00
807. MERSPee to l\.rnRC;: 1: Q-;;
R08. Br ,1 5%POCL <$1.0RO.00> to ~t Pr~~an~i'l In". (p.O. c.)
809. IJnd~in~p to "'U'\"A CTAD'KQRmAnD.....:;;::;- 7Q~' 00
810. to
81 I. tn-
812. to
Rn: to
m tn
815. to
900. ItelDll RMuired BV Lender To Be Paid In Advance
90 I. Interest frnm 1:VfV~ to 12/1/?00<; IiiJ ~OQ M;;;; r;.:-_~ (1i1iii)
Q'02. MortO'aO'e Insllronce P~emium for month. to
Q(l3. H.7'rd Insurance Premium for years to
904. years tn
905. years to
1000. Reserves DenMited With Lender
1001. H.;;;;:;l'in.nrnn"e ? ~nn~ ?~oil npr mn-;;;;;- 'iQori'
1002. Mortgage insurance mo;;';:; ner mnnth
iOOi Citv nronertv taxes 10~ 10.71 ner month 107,11l
1004. Countv ':'ronertv taxe. 10 -:- 15:14 -:- lRLlIl
1005. Annual '.sessments ;'pr mnnth
1 006. S~ T~. r. mn";;k n.41 npr mnnth 4L1041;
1007. ~nn~
1008. months ner month
1009. h (~nA~'~\
1100. Tlte llh.~
1 101. ~tt1ement Or closing fee to Emnire Settlement LLC 29(00
I 102 Abstnlct or title .earch to
Ii01: Title examinatinn to
1104 'Title in.urance binder to
1 105 Document nrenaration to
11 06. Not.;;:;;[ees to
1 107. Attornev's fees to
{lnclurl;;s above items numbers:
1110R' Ti I . ;;; 11'r ItiIiii
(includes above items numbers: F~rsement.: 100"100 Qon 710
11109. Lender'. rn~ernO'e: IN~ AMY:
1110. Owner's rnvemge: INS AMT:
III0a
1 III T.v"p_.;=tJ 'e"T:PttPr. to -:- rir' 50.00
1 I 12. EXDress Mail to Emnire Settlement. LLC 46.50
liB. , Tpttpr to TTn;+pA IWe ,<;'on
1200. Government ReCordlnu and Transfer Chanes
11201 . n..-::i' ~<o IlO. T'_ .Q.: ,Rel~ I,Q 00
1202. Ci'''/co s: Deecl$650.00: T :-Mortgaae{s) . S-Mo;'n~.::Is\ '25.00 '25.00
12tR 'Ita . nppdt'''Il.OIl. T -MnrinaO'..to\ - '25.00 32';.00
1204.
1205.
1300. Additional Settlement Chanes
'nOI. l1;n.1 .C;:p,,,pr to r'nwpr .ll)pn 31.00'
1302. F~ -r;:;;-;h In ".P- IIp- Tn~n 5429
1303. tn-
i304 tn
1105. to
130r.- to
1307. tn
1308. to
1309. to
1400. Total Settlement Charges (enter on lines 103, Section J and 502, SectionK) ~ 6,278.75 737.29
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
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PAGE 2
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BUD-I Settlement Statement Signature Page
Certification
I have carefully reviewed the HUn-I Settlement Statement and to the best of
my knowledge and belief, it is a true and accurate statement of all receipts and
disbursements made on my account or by me in this transaction. I further certifY that I
have received a copy of the HUn-I Settlement Statement.
John Sterling Helwig
The HUn-I Settlement Statement which I have prepared is a true and accurate
account of this transaction. I have caused or will cause the funds to be disbursed in
accordance with this statement.
UNIVERSAL CLOSING SERVICES, LLC
Settlement Agent
12/08/05
Date
WARNING: It is a crime to knowingly make false statements to the United
States on this or any other similar form. Penalties upon conviction can include a fine
and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010.
File #:
FP-2341
Loan #:
05-077235
Mortgage Ins. Case #:
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Rev-1508 EX+ (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WEAR, VERNA A.
Include the proceeds of litigation and the dale the proceeds were received by the estate.
All property jolntly-owned with the right of survivorship must be disclosed on schedule F.
FILE NUMBER
21-05-00026
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Members 1st FCU Savings Account: 25.00
2 Refund (Insurance): 51.00
3 Refund (Leffler Energy): 49.00
4 Refund (Water Company): 47.53
5 Sale of personal property: 3.288.59
(If more space is needed, additional pages of the same size)
Copyright (C) 2002 form software only The Lackner Group, Inc.
TOTAL (Also enter on Line 5, Recapitulation)
3.461.12
Form PA-1500 Schedule E (Rev. 6-98)
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
PERSONAL SERVICE LOAN:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Daily Interest Accrual
Date of Last Payment
Due Date
Payment Amount/Frequency
Name of Co-Borrower
Collateral
HOME EQUITY LOAN:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Daily Interest Accrual
Date of Last Payment
Due Date
Payment Amount
Name of Co-Borrower
Collateral
Estate of: VERNA A. WEAR
Date of Death: 12/31/2004
Social Security Number: 201-18-8581
~1~
MEMBERS 1st
FEDERAL CREDIT UNION
7707 -00
10/01/1974
$25.00
$.00
$25.00
None
7707 -11
07/24/1984
$.00
$.00
$.00
None
7707 -03
12/07/1979
$4,826.79
$1.4547
12/01/2004
01/15/2005
$130.00/Monthly
None
Signature/ Contractual Pledge of Shares
7707 -15
09/01/2001
$3,388.60
$.6731
01/03/2005
02/01/2005
$165. 12/Monthfy
None
Property: 3907 Rosemont Avenue
Camp Hill, PA 17011
:nB~RS~T/~F.FD AL CREDIT UNION
~(wd4
nise A. Wolfe
Insurance Servi es Supervisor
February 1, 2005
5000 Louise Drive · Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717)697-1161. wwwmemberslst.org
Rev-1502 EX+ (5-98)
*
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WEAR, VERNA A.
FILE NUMBER
21-05-00026
ITEM
NUMBER
DESCRIPTION
1
Cocklin Funeral Home:
AMOUNT
4.343.71
Subtotal
4.343.71
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
-
REV.1151 EX+ (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRA TIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WEAR, VERNA A.
FILE NUMBER
21-05-00026
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
See continuation schedule(s) attached
4,343.71
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State _ Zip
2.
Attorney's Fees
Wiley, Lenox, Colgan, & Marzzacco, P.C.
3,400.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
Register of Wills:
268.00
5. Accountant's Fees
6.
Tax Return Preparer's Fees
David J. Lenox
175.00
7.
Other Administrative Costs
See continuation schedule(s) attached
10,750.67
TOTAL (Also enter on line 9, Recapitulation)
18,937.38
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
.
Rev-1502 EX+ (6-98)
.
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WEAR, VERNA A.
FILE NUMBER
21-05-00026
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Central PA Appraisers (real estate):
300.00
2
Chad Burgard (yard work):
90.00
3
Closing Costs from sale of real estate, including Members 1st payoffs:
9.915.67
4
Cumberland Law Journal (advertise estate):
75.00
5
Lifeline Systems, Inc.:
37.00
6
Mary Holstine:
105.00
7
Register of Wills (filing fee):
30.00
8
The Sentinel (advertise estate):
198.00
Subtotal
10.750.67
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
I
Rev-1512 EX+ (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WEAR, VERNA A.
FILE NUMBER
21-05-00026
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Bonnie Miller, Treasurer:
VALUE AT DATE
OF DEATH
2 Leffler Energy:
3 Lower Allen Township:
4 Madeline Harbold, Tax Collector:
5 Motorists Insurance Group:
6 PA American Water:
7 PP&L Electric:
8 Tabak's Health Products:
1.308.23
252.24
247.33
35.08
162.30
68.83
370.65
35.97
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
TOTAL (Also enter on Line 10, Recapitulation)
2,480.63
Form PA-1500 Schedule I (Rev. 6-98)
.
REV 1513 EX+ (9-00)
.
SCHEDULE .J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
WEAR, VERNA A. 21-05-00026
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trustee/sl
I. TAXABLE DISTRIBUTIONS [include outright sProusal
distributions, and ransfers
under Sec. 9116(a)(1.2)]
1 Nancy L. Burgard Daughter-in-Law one-half
328 Coffeetown Road
DiIIsburg, PA 17019
2 Ronald L. Burgard Son one-half
328 Coffeetown Road
DiIIsburg, PA 17019
Total
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
Form PA-1500 Schedule J (Rev. 6-98)
Copyright (c) 2002 form software only The Lackner Group, Inc.