HomeMy WebLinkAbout02-09-06 (2)
REV-1500 EX + (8-00)
w
...
ll:::$U)
(J 1II::ll::
W 11.(J
::cOO
(J 11I::....1
~ID
c(
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 1712~1
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
I-
Z
W
C
W
o
w
c
GUTSHALL VERNA C.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DO-Year)
~ 1. Original Return
D 4. Limited Estate
~ 6. Decedent Died Testate (Alta:hcopyolWil)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (dale of death aIler 12-12-82)
D 7. Decedent Maintained a Living Trust (Alta:hcopyofTrusl)
D 10. Spousal Poverty Credit (daleofdealhbelween 12-31-91 aMI 1-1.95)
FILE NUMBER
2 1 -05 0 8 1 3
"C(j(jifly"COOE ---vEAA- - - NuMBER- -
SOCIAL SECURITY NUMBER
1 70- 1 2 - 7 4 3 1
THIS RETURN MUST BE FLED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (daleoldealh prior 10 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) (Atlach 8th 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
WILLIAM A DUNCAN 1 IRVINE ROW
FIRM NAME (If Applicable)
DUNCAN & HARTMAN P.C.
TELEPHONE NUMBER
717-249-7780 CARLISLE PA 17013
80,680.51
z
o
i=
:s
:;:)
I-
0::
c(
o
w
0::
z
o
i=
c(
I-
:;:)
Q.
:IE
o
o
><
c(
I-
74,028.85 X .045 (15)
X _(16)
X .12 (17)
X .15 (18)
(19)
05/1712005 05110/1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
...
z
w
o
z
o
11.
U)
W
III::
III::
o
(J
1. Real Estate (Schedule A) (1)
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 (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under See. 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
(8)
(14)
20.0
CHECK HERE:F YOU ARE REQUESTit.G '" Rt~UND OF "'N OVERPAYr.1ENT
)
, _.~
l.."'"
9,694.98
.-q
10'1
'0 oj
I
',~~
~:,'.-~
i i
c.)
CD
90,375.49
7,427.27
8,919.37
(11)
(12)
(13)
16,346.64
74,028.85
74,028.85
3,331.30
3,331.30
> > 81=' SURI=' TO ANSWI='R ALL OlJl='SnONS ON RI='VI='RSI=' SIOI=' ANO RI='CHI='CK MATH < <
~
Decedent's Com lete Address:
STREET ADDRESS 344 GREASON ROAD
CITY
CARLISLE
STATE
PA
ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
3,331.30
Total Credits (A + B + C) (2)
3. Interest/Penalty it applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + E) (3)
4. If Une 2 is greater than Line 1 + Une 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 o( Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
3,331.30
3,331.30
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 ofthe 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 lite 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.
PA 17013
DATE
?-q-O
PA 17013
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. ~9116 (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. ~9116 (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. ~9116(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. ~9116(1.2) [72 P.S. ~9116(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. ~9116(a)(1.3)). A sibling is defined, under Section 9102, as an
irv.ai"i,.h ...,,1 uth" ~'"'t'" ""+ I",",,,",,, """" n.........n.. in ~rnrn^n u';+'" +h" '"'^""""'"....+ \11"'''"""" h" hl^^.... I'It.,. ,","'"nf.in"
REV-1502 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GUTSHALL VERNA C. 21 05 0813
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 DlOoertv which is iointlv-owned with riaht of survivorshiD must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
80,680.51
344 GREASON ROAD
CARLISLE, PA 17013
Gross Proceeds of Sale 10/3/05 (See attached HUD-1)
TOTAL (Also enter on line 1, Recapitulation) $
80680.51
REV-1508 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GUTSHALL VERNA C
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
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.
0813
DESCRIPTION
PROCEEDS FROM SALE OF 1988 PONTIAC 6000
VALUE AT DATE
OF DEATH
900.00
CASH & CURRENCY
1,000.00
PROCEEDS OF YARD SALE
1,571.60
REBATE CHECK FROM STATE OF PA (REAL ESTATE TAXES)
500.00
M&T BANK CHECKING ACCOUNT # 611727
239.21
COMCAST REFUND CHECK
21.57
STATE FARM INSURANCE COMPANY REFUND
52.47
STATE FARM INSURANCE COMPANY REFUND CHECK
296.63
STATE FARM INSURANCE COMPANY PREMIUM REFUND
184.00
PROCEEDS FROM SALE OF ANTIQUES
791.00
GUARDIAN LIFE INSURANCE - PRE-PAYMENT OF FUNERAL EXPENSES
4,138.50
TOTAL (Also enter on line 5, Recapitulation) $
9694.98
IIf mnrP "I'll"'" icl nPAriArl in....rt MtlitinnAI "hAP+<: nf th.. ~1TlA """"
REV-1511 EX + (12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GUTSHALL. VERNA C.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FilE NUMBER
21
05
0813
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1. HOFFMAN-ROTH FUNERAL HOME, INC. 4,138.50
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)JEIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. AttorneyFees DUNCAN & HARTMAN, P.C. 2,711.26
3. Family Exemption: (If decedenfs address is not the same as claimanfs. attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills - Cumberland County - $280.00 380.00
In Reserve - $100.00
5. Accountanfs Fees
6. Tax Retum Preparer's Fees
7. The Sentinel - Legal Notice 122.51
8. Cumberland Law Journal - Legal Ad 75.00
TOTAL (Also enter on line 9, Recapitulation) $ 7,427.27
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
.
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GUTSHALL. VERNA C.
FILE NUMBER
21 05
0813
Include unrelmbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
See Attachment Page(s)
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of ltle same size)
9 116.88
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GUTSHALL, VERNA C.
Decedent's Name
Page 1
21 05 0813
File Number
Schedule I - Debts of Decedent, Mortgage Liabilities, & liens
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
DESCRIPTION
AMOUNT
14.30
PPL ELECTRIC BILL
M&T BANK CREDIT CARD PAYMENT
250.68
M&T BANK CREDIT CARD PAYMENT
45.69
PPL FINAL BILLING
22.41
ECO TECH
230.42
BOHMUELLER LAW OFFICES, P.C. LEGAL FEE
225.00
ADVANCED SEPTIC SERVICES
135.00
CAPITAL ONE CREDIT CARD
3,447.68
M&T CREDIT CARD PAYMENT
2.26
LOWE'S CREDIT CARD PAYMENT
1,938.12
ANDORRA RADIOLOGY CRMC
10.47
NOTARY FEES - SALE OF HOUSE (See attached HUD-1)
10.00
ATTORNEY'S FEES - SALE OF HOUSE (See attached HUD-1)
850.00
TRANSFER TAX - SALE OF HOUSE (See attached HUD-1)
800.00
DEBORAH W. PIPER TAX COLLECTOR - REAL ESTATE TAXES DUE (See HUD-1)
882.34
SUBTOTAL SCHEDULE I
8,864.37
.Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GUTSHALL, VERNA C.
Decedent's Name
Page 2
21 05 0813
File Number
Schedule I . Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. RECORDING FEE - SALE OF HOUSE (See attached HUD-1) 55.00
SUBTOTAl SCHEDULE I 55.00
GRAND TOTAl SCHEDULE I $ 8,919.37
LAST WILL AND TESTAMENT
(Pour-Over Will)
OF
VERNA C. GUTSHALL
IDENTITY
I, VERNA C. GUTSHALL, residing in the County of Cumberland, Commonwealth of Pennsylvania,
being of sound mind and memory, and not acting under duress or undue influence of any person
whomsoever, hereby declare this to be my Last Will and Testament, and I do hereby revoke all other former
Wills and Codicils to Wills heretofore made by me. My Social Security Number is 170-12-7431.
I have the following children: RUBIN W. FENSTERBUSH born May 21, 1941 and currently
residing in Carlisle, PA; JUDY C. MONNETT born July 30, 1945 and currently residing in Carlisle, PA;
GLORIA J. POPP born January 22, 1947 and currently residing in Newville, PA; and KENNETH D.
FENSTERBUSH born December 30, 1951 and currently residing in Carlisle, PA.
DEBTS, TAXES AND ADMINISTRATION EXPENSES
I have provided for the payment of all my debts, expenses of administration of property wherever
situated passing under this Will or otherwise, and estate, inheritance, transfer, and succession taxes, other
than any tax on a generation-skipping transfer that is not a liability of my Estate (including interest and
penalties, if any) that become due by reason of my death, under THE VERNA C. GUTSHALL
REVOCABLE LIVING TRUST executed on even date herewith (the "Revocable Trust"). If the Revocable
Trust assets should be insufficient for these purposes, my Executor shall pay any unpaid items from the
residue of my Estate passing under this Will, without any apportionment or reimbursement. In the
alternative, my Executor may demand in a writing addressed to the Trustee of the Trust an amount necessary
to pay all or part of these items, plus claims, pecuniary legacies, and family allowances by court order.
PERSONAL AND HOUSEHOLD EFFECTS
It is my intent that all my personal and household effects were transferred to the Revocable Trust
as a result of the Declaration ofIntent signed this date. If there are any questions regarding the ownership
or disposition of these assets, it is my desire that such assets pour into the Revocable Trust, signed by me this
date in accordance with the provisions of the section titled "Residue of Estate."
RESIDUE OF ESTATE
I give, devise and bequeath all the rest, residue and remainder of my property of every kind and
description (including lapsed legacies and devices), wherever situated and whether acquired before or after
the execution of this Will, to the Trustee under that certain Trust executed by me on the same date of the
execution of this Will. The Trustee shall add the property bequeathed and devised by this item to the corpus
of the above described Trust and shall hold, administer and distribute said property in accordance with the
provisions of the said Trust, including any amendments thereto made before my death.
POUR-OVER WILLS
Page I
tJ <:1:1
(Testatrix)
If for any reason the said Trust shall not be in existence at the time of death, or if for any reason a
court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under said
Trust as it exists at the time of my death to be invalid, then I give all of my Estate including the residue and
remainder thereof to that person who would have been the Trustee under the Trust, as Trustee, and to their
substitutes and successors under the Trust, described herein above, to be held, managed, invested, reinvested
and distributed by the Trustee upon the terms and conditions pertaining to the period beginning with the date
of my death as are constituted in the Trust as at present constituted giving effect to amendments, if any,
hereafter made and for that purpose I do hereby incorporate such Trust by reference into this my Will.
EXECUTOR
I hereby nominate and appoint JUDY C. MONNETT to serve without bond as my Executor of this
my Last Will and Testament.
In the event the first named Executor shall predecease me or is unable or unwilling to act as my
Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint WILLIAM A.
MONNETT to serve without bond as my Independent Executor.
In the event the second named Executor shall predecease me or is unable or unwilling to act as my
Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint RUBIN W.
FENS TERBUSH to serve without bond as my Independent Executor.
In the event the third named Executor shall predecease me or is unable or unwilling to act as my
Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint CARL
WHISTLER to serve without bond as my Independent Executor.
Whenever the word "Executor" or any modifYing or substituted pronoun therefore is used in this my
Will, such words and respective pronouns shall be held and taken to include both the singular and the plural,
the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named herein and
to any successor to substitute Executor acting hereunder, and such successor or substitute Executor shall
possess all the rights, powers, duties, authority, and responsibility conferred upon the Executor originally
named herein.
EXECUTOR POWERS
By way of Illustration and not of limitation and in addition to any inherent, implied or statutory
powers granted to executors generally, my Executor is specifically authorized and empowered with respect
to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate
between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with
respect to, continue any business of mine, convert, deal with, dispose of, enter into, exchange, hold, improve,
incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect
to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash or in kind of
partly in each without regard to the income tax basis of such asset and in general, exercise all of the powers
in the management of my Estate which any individual could exercise in the management of similar property
owned in its own right upon such terms and conditions as to my Executor may seem best, and execute and
deliver any and all instruments and do all acts which my Executor may deem proper or necessary to carry
POUR-OVER WILLS
Page 2
(Testatrix)
out the purpose of this my Will, without being limited in any way by the specific grants or power made, and
without the necessity of a court order.
My Executor shall have absolute discretion, but shall not be required, to make adjustments in the
rights of any Beneficiaries, or among the principal and income accounts to compensate for the consequences
of any tax decision or election, or of any investment or administrative decision, that my executor believes
has had the effect, directly or indirectly, of preferring one Beneficiary or group of Beneficiaries over others.
In determining the Federal Estate and Income Tax liabilities of my Estate, my Executor shall have discretion
to select the valuation date and to determine whether any or all of the allowable administration expenses in
my Estate shall be used as Federal Estate Tax deductions or as Federal Income Tax deductions.
SPECIFIC OMISSIONS
I have intentionally omitted any and all persons and entities from this, my Last Will and Testament,
except those persons and entities specifically named herein. If any person or entity shall challenge any term
or condition of this Will, or of the Living Trust to which I have made reference in the sections "Household
and Personal Effects" and "Residue of Estate," then, to that person or entity, I give and bequeath the sum of
only one dollar ($1.00) only in lieu and in place of any other benefit, grant, bequest or interest which that
person or interest may have in my Estate or the Living Trust and its Estate.
SIMULTANEOUS DEATH
If any other Beneficiary should not survive me for sixty (60) days, then it shall be conclusively
presumed for the purpose of this my Will that said Beneficiary predeceased me.
a!vrAfIl'~ ,JL~f
VERNA C. GUTSHALL
Testatrix
This instrument consists of 5 typewritten pages, including the Attestation Clause, Self-Proving
Clause, signature of Witnesses, and acknowledgment of officer. I have signed my name at t,~~m of each
of the n.. ing.. pages. "T~s instrument is being signed by me on this tf ~. day of
/6 '" K- r:"';/.
POUR-OVER WILLS
Page 3
affP-E
(Testatrix)
ATTESTATION CLAUSE
The Testatrix whose name appears above declared to us, the undersigned, that the foregoing
instrument was his Last Will and Testament, and she requested us to act as witnesses to such instrument and
to his signature thereon. The Testatrix thereupon signed such instrument in our presence. At the Testatrix's
request, the undersigned then subscribed our names to the instrument in our own handwriting in the presence
of the Testatrix. The undersigned hereby declare, in the presence of each of us, that we believe the Testatrix
to be of sound and disposing mind and memory.
Signed by us on the same day and year as this Last Will and Testament was signed by the Testatrix.
WITNESS~
iL- j)
....
73 ~ I I> ~ R t=;. U kJ (..~ ~L-l(
(Printed Name of Witness)
ADDRESSES:
112.(,
..
,vi. '-J 1/1 /~
/<,}
l4R 1.~/-,
pI}-
I ?o 1.3
KvmQ~~ Jl:x&'lF'
(~~~~eS;n()~
~C\ t..nst ~L.tt-in <;t
(flY 1)) ~ 'Po. ) 'it) 13
POUR-OVER WILLS
Page 4
Q! C:? E
(Testatrix)
. .
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
SELF-PROYING CLAUSE
b .. "~ t;E, t~ndersigned authori~ this qa~erl>0'fl~Il~~red VERNA C. GUTSHALL,
~/RB~ ~~ ~#- and /~~ J,J /<~O/lAA/A~ , known to me to be the
Testatrix and the witnesses, respectively, whose names are subscribed to the foregoing instrument in their
respective capacities, and all of them being by me duly sworn, VERNA C. GUTSHALL, Testatrix, declared
to me and to the witnesses, in my presence, that the instrument is her Will and that she had willingly made
and executed it as her free act and deed for the purposes therein expressed; and the Witnesses, each on his
or her oath, stated to me in the presence and hearing of the Testatrix, that the Testatrix had declared to them
that the instrument is her Will and that she executed the same as such and wanted each of them to sign it as
a witness; and upon her oaths, each witness stated further that she did the same as a witness in the presence
of the Testatrix, and at her request and that she was at that time eighteen (18) years of age or over and was
of sound mind, and that each of the witnesses was then at least fourteen (14) years of age.
tJ)~c~
VERNA C. GUTSHALL
Testatrix
~~~
(Printed Name of Wi ess)
i}.., ~~
Witness(
D It , 4 '- R f;. ,",(lJ~::'-I.ec.. ~
(Printed Name of Witness)
SUBSCRIBED AND ACKNO~
subscribed and sw07fore me b~~
witnesses, this the day of
-"
Notary Pub" mmonwealth of Pennsylvania
'1~'-'-"~~'~f~(?fJ{R1Ai SEAL . I
TODD fl. C:iA~iFil'.WLE, ~'~ou.!rl P.!J.bllC !
., l \1\J\!er ~':lutr1grrHl'i{)(' T'Mj.. Btie,'.!> \.ounty !
t~!~)L f~;!~~~,~~:~~'if)~i:E~i>\E;1;llSl~ ~~L.?~~Q~, ..i\
POUR-OYER WILLS
Page 5
Dfa~
(Testatrix)
r J I. FHA
( I 2. FmHA
r ) 3. Conv. Unins.
( )4.VA RE2583
) 5. Conv. Ins. ABST#6194
C. This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.a.c.)" were paid outside of
the closino; they ore shown here for informational purposes and ore not included in the totals.
D. Name and Address of Borrower: E. Name and Address of Seller:
Settlement Statement - U. S. Department of Housina and Urban Develooment Form US HUD ~ 1
6. Rle Number 7. loan Number 8. Mortgage Insurance
Case Number
1004002468
ERIN M. STAnER
2234 RITNER HIGHWAY
CARLISLE, PA 17013
THE VERNA C. GUTSHAll REVOCABLE LIVING TRUST
ESTATE OF VERNA C. GUTSHAll
C/O DUNCAN & HARTMAN, P.C.
1 IRVINE ROW, CARLISLE, PA 17013
F. Name and Address of lender
GATEWAY FUNDING DIVERSIFIED MORTGAGE SERVICES, L.P.
ISAOA ATIMA
3900 TRINDLE ROAD
CAMP Hill, PA 17011
H. Buyer's Settlement Agent:
TIN
G. Property Location
344 GREASON ROAD, CARLISLE, PA 17013
WEST PENNSBORO TOWNSHIP
CUMBERLAND COUNTY
PARCEL NO. 46.20.1778.016
TIN 25-1730538
Frey & Tiley Law Office
5 South Hanover St.
Carlisle, PA 17013
Place of Settlement:
5 South Hanover Street
Carlisle, PA 17013
I. Settlement Date:
October 3, 2005
@2:00 P.M.
J. SUMMARY OF BORROWER'S TRANSACTION
K. SUMMARY OF SEllER'S TRANSACTION
1 00 Gross Amount Due From Borrower
101 Contract sales price
102 Personal property
103 Settlement chOfges from (line 1400)
104
105
400 Gross Amount Due To SeDer
80,000.00 401 Controct Sales price
402 Personal property
4,978.76 403
404
40S
Adjustments for items paid by set/er in advance:
106 City/town taxes 10/3/05 to 12/31/05
107 County taxes
108 Assessments
Adjustments for items paid by sefler in advance:
40.B8 406 City/town taxes 10/3/05 to 12/3t/05
407 County taxes
408 Assessments
409
639.63 410 School taxes 10/3/05
411
412
109
110 School taxes 10/3/05
111
112
120 Gross Amount Due From Borrower
to 6/30/06
to 6/30/06
85,659.27 420 Gross Amount Due to Seller
200 Amounts Paid By Or In BehaN 01 Borrowe,
20 I Deposit or earnest money
202 Principal omount of new loan(s)'" Ck $74,845.99
203 Existing loan Is) taken subject to
204
205
206
207
208
209
500 Reductions 'In Amount DueToSelJer
1,000.00 501 Excess deposit (see instructions)
78,000.00 502 Settlement charges to seller (line 1400)
503 Existing loan Is) taken subject to
504 Payoff of first mortgage loan
505 Payoff of second mortgage loan
506
507
508
509
Adjustments for items upa;d by seller
210 City/town taxes 1/1/05
211 County taxes
212 Assessments
213
214 School taxes 7/1/05
215
216
217
218
219
220 Total Paid By/For Borrower
Adjustments for items upoid by seifer
to 10/3/05 510 City/town toxes 1/1/05
511 County taxes
512 Assessments
513
to 10/3/05 514 Schoollaxes 7/1/05
515
516
517
518
519
79.000.00 520 Total Reductions to Amt Due Sener
to 10/3/05
to 10/3/05
300 Cash At Settlement From{To Borrower.
301 Gross amount due from borrower (line 120)
302 less amounts paid by/for borrower (from line 220)
303 Cash (XI F,om ( I lo Borrower
I
600 Cash At Settlement To/From SeHer.
85,659.27 601 Gross omount to seller from lline 420)
(79.000.001 602 less reductions in amount due seller (from line 520):
6,659.27 603 Cash ( I From (XIloSeller
Paae No. 1
80,000.00
40.88
639.63
80,680.51
2,597.34
2,597.34
80,680.51
(2,597.34)
78.083.17
IHUD-I
700 Total Sales/Broker', Comm. based on price:
Division of Commission (line 70G) os follows:
to
to
L. SETTlEMENT CHARGES
80.000.00
@% =
0.00
701
702
703
704
705
800
Commission paid at Settlement
3154.01
Items Payable In Connecllon With Loan:
(Mortgage AmI: 78.000.00)
loan Origination Fee
loan Discount
805.00
Total charges. Lines 801 through 81
801
802
803
804
805
806
807
808
809
810
811
900
901
902
903
904
905
1000 Reserves Deposited With Lender:
.000 % to
.000 % to
Appraisal Fee to
Credit Report to
lender's Inspection Fee to
Applicotion Fee to GATEWAY fUNDING DIVERSifiED MORTGAGE SERVICES, L.P.
FLOOD CERTIFICATION FEE TO FIRST AMERICAN FLOOD
LENDER INSPECTION FEE TO GATEWAY FUNDING DIVERSIFIED MORTGAGE SERVICES, L.P.
EXPRESS MAIL/COURIER FEES TO FIRST AMERICAN FLOOD
ADMINISTRATION FEE TO GATEWAY FUNDING DIVERSIFIED MORTGAGE SERVICES, L.P.
AUTOMATED UNDERWRITING SYSTEM FEE TO GATEWAY FUNDING DIVERSIFIED MORTGAGE SERVICES, L.P.
Items Required By Lender To Be Paid In Advance:
InlerestFrom 3-0ct-05 10 31-0ct-05 @11.91660 perdoy=
Mortgage Insurance Premium lor monlhs 10 GATEWAY FUNDING
Hazard Insurance Premium for 1 years to
years to
Tool Resl!fVe.. UneslOOI Ihorugh 1008:
4 mos. @ $24.83 per monlh
mos. @ per month
mos. @ per month
10 mos. @ $13.97 per month
mos. @ per month
mos. @ per month
5 mos. @ $72.06 per monlh
443.43
1001 Hazard insurance
1002 Mortgage insurance
1003 City property taxes
1004 County property taxes
1005 Annual assessments
1006
1007 School taxes
1008 Aggregate Selllement Adjustment
1100 Tille Charges:
1101 Settlement or closing fee
1102 Abstract or title search
1103 Title examination
10
to
to
1104 Title insurance binder to
1105 Document preparation to
1106 Notary fees 10 DUNCAN & HARTMAN. P.C. (SEPARATE CHECK)
1107 Allorney's fees 10 DUNCAN & HARTMAN. P.C.
(includes above items numbers: I
1108 nile Insurance 10 FREY & TILEY (COMMONWEALTH LAND TITLE INS. CO.)
lincludes above items numbers: Short Form I
1109 Lende(s Coverage $ 78.000 Endorsements: 100.300.8.1
1110 Owners Coverage $ 80.000
1111 CLOSING SERVICE LETTER TO COMMONWEALTH LAND TITLE INSURANCE CO.
1112
1113 OVERNIGHT DELIVERY FEES TO FREY & TILEY
1200 Government Recording and Transfer Charge Deed Pages: 0 Mlg pages.:
120 I Recording fees: Deed $38.50 : M()(tgage: $62.50 : Releases $
1202 Cily/county/stamp' Deed $800.00 : M()(tgage: $
1203 Slale tax/stomps: Deed $800.00 M()(lgage: $
1204
1205 AFFIDAVIT W/TRUST AGREEMENT RECORDING FEE TO RECORDING OF DEEDS
1300 Additional Settlement Charges:
1301 Survey to
1302 Pest inspection to
1303 Current Taxes due from Borrower/SeUer to Deborah W. Piper, Tax Collector
1304 WATER TEST AND PROPERTY INSPECTION FEE TO LLOYD'S HOME INSPECTION - $375
1305 WOOD INFESTATION FEE TO GILBERTS PEST CONTROL - $85
1306 WATER RE-TEST FEETO FRANKLIN ANALYTICAL
1307 SEPTIC INSPECTION FEE TO ADVANCE SEPTIC SERVICE
1400 Total Selllement Charges (enter onlines 103. Section J and 502, Section K)
Pold From
Borrower's
Funds at
Settlement
350.00
25.00
75.00
35.00
300.00
20.00
345.58
1.560.00
P.O.C.
99.32
139.70
360.30
(155.89)
888.75
35.00
101.00
800.00
P.O.C.
P.O.C.
P.O.C,
4.978.76
0.00
0.00
Page No. 2
Paid from 700
Selle(s
Fundsct 701
Settlement 702
703
704
705
800
801
802
803
804
805
806
807
808
809
810
811
900
901
902
903
904
905
1000
1001
1002
1003
1004
1005
1006
1007
1008
1100
1101
1102
1103
1104
1105
10.00 1106
850.00 1107
1108
1109
1110
1111
1112
1113
1200
1201
1202
800.00 1203
1204
55.00 1205
1300
1301
1302
882.34 1303
1304
1305
1306
P.O.C. 1307
2.597.34 1400
FD-I
CERTifiCATION
I direct and authorize the Company to make distributions indicated for my account on the attached HUO-l Settlement Statement. approving the tax prorations
indicated therein. and understand that prorations were based on figures for the preceding year. or estimates for the current year. and in the event of any change
for the current year. all necessary adjestments must be mode between Seller and Borrower direct; Iik.ewise any DEFICIT in delinquent taxes will be reimbursed to
Attorney/ntle by SeUer.
I have carefully reviewed the HUD-l 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 HUD-I Settlement Statement.
f"\ ,"
]'" 1 ~ tz 't
" " /" -" -"-, '
( , it' a, ?' A~~ / Itl:'~{{
ERIN M. STATLER ,/ "
(
ESTATE OF VERNA C. GUTSHALL
To the best of my knowledge. the HUD-I Settlement Statement which I have prepared is a true and accurate account of the funds which were received and have
been or will be disbursed by the undersigned as part of the settlement of this transaction.
~/
Lv
SeHI ent A nt
"'4)
---; -/~
October 3, 2005
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 fine and
imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010.
INfORMATION REPORTING ON REAL ESTATE TRANSACTIONS
THIS HUD SETTLEMENT STATEMENT CONTAINS IMPORTANT TAX INFORMATION (BOXES E. G, H. I. M AND LINE 4011 AND IS BEING FURNISHED TO
THE INTERNAL REVENUE SERVICE, IF YOU ARE REQUIRED TO FILE A RETURN. A NEGLIGENCE PENALTY OR OTHER SANCTION WILL BE IMPOSED
ON YOU IF THIS ITEM IS REQUIRED TO BE REPORTED AND THE INTERNAL REVENUE SERVICE DETERMINES THAT IT HAS NOT BEEN REPORTED.
Solicitation of TIN
Seller is required by low to provide the Attorney/Company with his/her correct taxpayer identification number. If correct taxpayer identification number is not
provided. he/she may be subject to civil or criminal penalties imposed by law.
Certification of TIN
Under penalties of pe~ury, I certify that the taxpayer identification number shown in this statement is my correct taxpayer identification number.
Seller
Seller
TAX PRO-RATION ADDENDUM
Dote of Pro-RaHon:
Borrower
Seller
October 3, 2005
SCHOOL REAL ESTATE TAX
from July I. 2005 to June 30. 2006
School Real Estate Tox- Face
School Real Estate Tox- Per Day
Owes:
12.375 mills
$882.34
$2.41736
BB2.34
ASSESSMENT:
$71,300.00
Parcel No.:
COUNTY & MUNICIPAL TAX
from January 1. 2005 to December 31. 2005
Co. & Munic. Real Estate Tax- Face
Co. & Munic. Real Estate Tox- Per Day
Owes:
2.3995 mills
$171.08
$0.46B71
P.Q,C.
See Settlement Sheet
lines
106 & 406.110 & 410.
210 & 510. 214 & 514.
ond 1303 fOf
Results 0' thIs Addendum.
School taxes P,Q.C. or chorped to Seller: o\xes
School taxes P.O.C. or charged to Borrower
Co. & Munic. P .O.C. or charQed to SeHer:
Co. & Munic. P.O.C. or charged to Borrower