HomeMy WebLinkAbout02-14-06
. REV 1500 EX 16-(0)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Zeigler, James A.
DATE OF DEATH (MM-DD-YEAR)
05-17-05
OFFICIAL USE ONLY
FILE NUMBER
21_05
o 5 3 4
DATE OF BIRTH (MM-DD-YEAR)
01-16-58
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
o 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copyofTNst)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
193 52
9264
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P. O. Box 984
Harrisburg, PA
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Rernainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Retum Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
COMPLETE MAILING ADDRESS
17108
OF-fICIAL USE ONLY
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King, Esquire
Friedman & King, P.C.
FIRM NAME (If Applicable)
TELEPHONE NUMBER
(717) 236-8000
If
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7,146.09
(11)
(12)
(13)
17,184. 72
INSOLVENT
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
(14)
INSOLVENT
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
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)
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)
x .0_ (15)
(19)
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16. Amount of Line 14 taxable at lineal rate
x .0_ (16)
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17. Amount of Line 14 taxable at sibling rate
x .12 (17)
x .15 (18)
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18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS
CITY
1395 Letchworth Rd.
CaITlP Hi 11
PA
STATE
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits ( A + 8 + C ) (2)
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)
(5A)
{58)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
<<
ZIP 17011
INSOLVENT
INSOLVENT
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ............................................ D
c. retain a reversionary interest; or.......................................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ ~
No
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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 relum. including accompanying schedules and statements. and to the best of my knowledge and belief, it is true. correct and complete.
Declaration of pre parer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSI8L~ J;PR~ILI G R!=TU N .
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ADDRESS TracY 1. Zeigler, - Lr .ix
6309 Stanford Court, ~chanicsburg, PA 17050
EP SENTATIVE
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ADDRESS
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Harrisburg, PA 17108
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For dates of death on or after July 1, 1994 and before Janual
[72 P.S. 99116 (a) (1.1) (i)].
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I the net value of transfers to or for the use of the surviving spouse is 3%
For dates of death on or after January 1, 1995, the tax rate
The statute does not exemot a transfer to a surviving spous
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 de
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)].
niijJ~x rate imposed on the net value of transfers to or for the
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The tax rate imposed on the net value of transfers to or for
individual who has at least one parent in common with the deCE
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lsfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
Jirements for disclosure of assets and filing a tax retum are still applicable even if
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age or younger at death to or for the use of a natural parent, an adoptive parent,
iciaries is 4.5%, except as noted in 72 P.S. ~9116(1}) [72P.S. ~9~1g(~)(1)].
. , ' ' , _ ~ - .",:; - -:.'I)1f"'- '-, ' ~ 0" 1\ ';
i is 12% [72 P.S. ~9116(a)(1.3)]. Asiblingisdefine?.. tinderS:cti?n ~1o?,.asan
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REV.l508 EX. (l-91)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Janes A. Zeigler
21-05-0534
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. tvBmbers 1st Federal Credit Union Savings (Acct. #195102-00) 25.25
2.
~mbers 1st Federal Credit Union Olecking (Acct. #195102-11)
31.80
3.
Donegal Insurance Co. (Hone owners ' refund)
415.00
4.
Darrell Dethlefs, Esq. (tax bill refund)
663.50
365.10
5.
6.
7.
Haar's Auction (sale of personalty)
Barl)' Beers (motor)
Jacob F. Windemaker, Jr. (sale of 1989 Camaro)
75.00
200.00
8.
Pennsy Supply (2 paychecks; $573.40 & $208.62)
9.
1981 Jeep Grand Olerokee Lorado
(cost of storage charges at Becker's Towing were greater than
value of vehicle, and title to vehicle was given in lieu
of storage charges)
782.02
o
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2,557.67
. REV.1:.J9 EX + (1-97)
COMMONWEALTH OF PENNS, LVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
James A. Zeigler
SCHEDULE F
JOINTLY-OWNED PROPERTY
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
A. Tracy L. Zeigler
B.
c.
JOINTLY-OWNED PROPERTY:
ADDRESS
6309 Stanford Court
Jvbchanicsburg, PA 17050
FILE NUMBER
21-05-0534
RELATIONSHIP TO DECEDENT
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 8/12/9~ 1395 Letchworth Rd. , Camp Hi 11 , PA 17011 $8,176.85 50% $4,588.42
C copy of deed and SettleJrent StateJrent
are attached)
TOTAL (Also enter on line 6, Recapitulation) $ 4,588.42
(If more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
James A. Zeigler
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21-05-0534
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
iTEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST 'IF APPlICABLE)
NUMBER
1. Pennsy Supply, Inc. 40l(k) retirerrent plan $1,055.08 100% 0
paid to beneficiary, Jesse Zeigler, son of
decedent, on 8/10/05 ($847.98)
TOTAL (Also enter on line 7, Recapitulation) $ 0
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) F,
"k
ESTATE OF
ITEM
NUMBER
A.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
James A. Zeigler
Debts of decedent must be reported on Schedule I.
DESCRIPTION
1.
FUNERAL EXPENSES:
MUsselman Funeral Home
2.
Stone Church Cemetery (burial)
B. ADMINISTRATIVE COSTS:
2.
1. Personal Representative's Commissions
Name of Personal Representative(s)
Tracy L. Zeigler, Adrrrrnistratrix
194-64-6729
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 6309 Stanford Court
City ~Bchanicsbuyg
Year(s) Commission Paid: 2006
State ~ Zip
17050
Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4.
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
5. Accountant's Fees
Probate Fees
6. Tax Return Preparer's Fees
7.
8.
9.
10.
ll.
12.
13.
Cumberland Law Journal (advertising)
Carlisle Sentinel (advertising)
Bob I s Lock & Access System (change locks on house)
Cumberland County :Register of Wills (filing of :Renunciation)
Penncorp Service Group (vehicle search)
Peters Pest Control Service
Cumberland County Register of Wills (filing of Inheritance Tax re .)
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
21-05-0534
AMOUNT
1,935.00
180.00
2,400.00
2,400.00
65.00
75.00
107. 79
95.60
5.00
25.00
90.10
15.00
7,393.49
REV-1512 EX. {1-97)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
":if
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21-05-0534
ESTATE OF
James A. Zeigler
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1. 2002 Honda Accord (Sovereign Bank) - repossessed 4,389.58
2. UGr 293.97
3. Di rect ~rchant Bank 2,553.01
4. Lowe's 274.00
5. Verizon Wireless 620.21
6. Capi tol Che 1,353.77
7. PPL Uti li ties 221. 83
8. PA American Water 84.86
TOTAL (Also enter on line 10, Recapitulation) $ 9,791.23
(If more space is needed, insert additional sheets of the same size)
REV.1SIJ EX ",1-97)
ESTATE OF
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Ja.n-es A. Zeigler
NL~,18ER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
1. TAXABLE DISTRIBUTIONS (inClude outright spousal distributions)
1. Jesse A. Zeigler
c/o Tracy L. Zeigler
6309 Stanford Court
1v'echanicsburg, PA 17050
2. Jennifer A. Zeigler
1362-A MOlmt Vernon Ave.
Williamsburg, VA 23185
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Son
Daughter
21-05-0534
AMOUNT OR SHARE
OF ESTATE
50%
50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(tf more space lS needed, msert addiUonal sheets of the same size)
ATTACHMENTS TO
SCHEDULE F
~8/15/2005 08:22
71 72580862
TRI COUNTY ABSTRACT
PAGE 02
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CDUlIty hr~al NII.~ :13-~215 -~
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NINETEEN HUNDRED Ind NINETV EIGHT 09991
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in till y~ ~ iiI ;.;:
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BETWEEN
OAVID J. HENWOOD ami ~ARIBETH S. HENWDOD. husband aqd wife.. sf CJlll\p H"~ Cumb.r1.nd
CO\ll\ly. PamIJl-larlia. parllas olllul Ilrst pltlllolllMllar r.'1m!II ta 18lh. GAMltORS
AND
JAM!S A. 2Elll~ER a"" TRACY L ZEIGLER, InJsbud and lYife..' CaVil. YIIlk County.
"-'oviwIni.. p..liu If lha sllt:llI1d parI. balllinafllll' ""Iud la 8slh. GRANTEES
WITNESSETH. Thllt in CDlWdll":Illo11 D/...---.------.......-.....-.-........---..---------....--....
.........--..........-....---.DNE HUNDREO FOURTEEN THOUSAND Bnd OD/100.........----...---......
-..--.---.---.----..-........---.-....----1' 1 1 4.ll11D.Da'..--...---...---.---~............_........-.
Dollars. in hant! pllld. ths rBl:llipt wbar8Qf is hereby aC~l\OlIU'gdllgd. Iho nid grflntors'do hBl'llby
granl and convey ID Ihl! salll grantggs..
ALL THAT CERTAIN lalar IrIlCI 81 ~ sllmo In ~awer "nan Tawp,hlp. CIDlbar/and Caunly. Plnn,'(i~ll1Iia..l!llIr.
p8I'1icuJ..ly uonlldld Ind dncrib.d ~.Ialla~. 18 lIIIil:
lIEOINNIMG II a poi~l an tho ....llrly IiJItI II Lltenwollh Reld..uld p~lnl boln~ th. dlvltllna IInl hetwllJlllat. NOI.
a IIId g, Bille. L, on 1111 hll'1lllllller IJll!llliant!d plan pI 11I11; lh0ne81n 1 sooth,.. dir.etion alona SlId dWldlng
Ina 12D fut to lal Mo. 34. ElIIR:k L. Gn .lld plan; lhanell In I CIa1h_leJly dirllCtll111l11Png ..id tal Na. :J4. hlal:~
L. 55 1..111 lot Na. 7, Black~: Ihlll\l:8iru allJthwulIrIy d...e1lon Ilang Aid I.IIH~. 7. Blocll!. 120 'BBllO
lllcbwlll1b AOld; lhanCllIn I narlhoulnrly dlIactlnn _long lhrllatch....n.. R.ld, 55 ml In Ihl PI.ell If
BEGINNIN&. .
BEING lol No. B. Block l. In Ih. ro.;~8lI pIaII II HiahllM Park II rlennlrd In Cumbarlnnd Caunly PIIIII Book 3.
Plgl 35.
8PQK 184 /'AGE SBt
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71 7258~852
TRI COUNTY ABSTRACT
PAGE ~3
HAlliNG THI;REUN alJ;!:TR1 . 'wa !lQry bIlIik IDd II1Il1lI d....uing known and num~llI1ld as 139SlGlchwallh
Rolli. C,"'p HIli. I'1lnn5Yl_i..
BEING nfE SAME PREMISES WHI!:H JOlnl\ll M.l3anllo" si"~IG WOllIGn, "lJ...d dRIed lJeCl!ndlnr 6, 1993 and
rn..md in ThIllJllite af Tho Recanl.r II Dutb iii God hI ClIIIbwrl,.d C..n1,. p.nllBVlunnill,lo Dalld 8aak S.::tI!.
PlI\le 9D,IJ'llI'IHII Md tllllvnvfll IIl1la OIlYld J.IlanwODd GllIJ ~.ribBth S. Han_ad, htablllld Gmt IrIift, G.Rnlnr.
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71 725B~B52
TRI COUNTY ABSTRACT
PAGE ~4
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AND the Rllld grantars will Ipsci&lly WARRANT AND FUREVER DEFEND tha propulY h&raby
tDnnysd.
IN WITNESS WHEREDF, seid llrantul'J 11m hllfsU1JtD JBt thalr Illllds sod :10811, till dlV lIIld yBar
first a"Dvl.wrHtSI1.
~;/~
1')~M J.JO"; .~ .....~.--J:J
Mil h S. Hun",gDd
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f:J1~~ltd'f ~i
llli,O 'tQ ("-O~
-
Cummonwealth Df P~'''II"ia
Caunty Df Cu..rnb. ~~
Dnlhis,IM 1~ dlVDf ~ ,199Bh.fal1lmalh,
undlrBiVllad officII', . /IlIflry public, plll'SDnally !lPP d IIlvld J. HII"WIlB~ and M,rihsth S.
Henwnnd, husband and wifB, krlnwn tel mBlar .IUllflctorir proven) la III Ills perlDllI whDI.
urnell 8rs $lIb,crjlmd 1a the \\Iithin IlIItlUlTl8llt,. and scknawllldgld 11181 thllY IXlCllted the '1mB for
tha ~Ul'JIQI8 tharsin cantllinBd.
IN WIT~E5:S THEREOF,I havlIl1erBUnla set IlIV hend and nDtariat SlIII.
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J tlOTARIAL SEAl. I
"!MeT illl.UplIjJ3. ........,,..,,...
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B1I0k 1B4. r~r,. 8 3U}'e..._....._"......'M
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71 725B~B52
TRI COUNTY ABSTRACT
PAGE ~5
We;><t'~ho..t'e ~~.1?akn.-c,e
I h8r1by emiry. Ihal thll "Jacm. ,esidlllCB of Ihll grtnlggs hUIB;" jf llS follows:
f 39 5 )...ek.h worff-J Rd. _....____.__._.
Camp /-J.; II .7//1 170(/
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=
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ClImmonwB rl\ of PonnlivlYlInil!
ClIMly IIf . """ b
RECORDElJ Oil \hb C}. dlY oJ 5 ~rl . A.D. \q~\l . ill
Ibl Rg~s Offic., of said CllunlV. in 0_ Book I ~'l- / Vlllt.nlB - .
f111!111 1 . IiIvlIn undllr my hnc! enc!lhe ,uloJ till $Rill officlI, the datI Ibm writtlln.
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,,':;"iiltJ:rt !c,!.~";I:'.~.
r Fleeamar.
800K 184 ,,^&E 884
A. Se'iJlement Statement
u.s. Department of HousinQ
and Urban Development ~
,r
OMB No. 2502-0265
B. Type of Loan
1. 0 FHA
4. OVA
2. 0 FmHA
5. 0 Cony. Ins.
.. 3. 0 Cony. Unins File Number
841059-LAW (Casb)
Loan Number
NIA
Mortgage Insurance Case Number
N/A
C. NOTE:This fonn is furnished to giJe you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked .p.o.c. were paid outside of closing; they are shown here for informational purposes and are not included in the totals.
D. NAME AND'ADtJRESS'OFBIllRROWER(~M..../Jtth... ,'W'I;,W.I'in..a..lIi.$~... ............" .... ..... '. ..:..... '. :.' '. .
.; .. '11'!r2If;'Wi!lU1ll~gq.~e,;H!lcr!SPLlC!"J?lt1'lJ12
E. NAME AND ADDRESS OF SELLER;
Tracy L. Zeigler, single person
1395 Letchworth Road, Camp Hill, PA 17011
Estate of James A. Zeigler
1395 Letchworth Road, Camp Hill, PA 17011
F. NAMEAND'ADJ!,l~~$,'0j;\gl;t-l~~i ,.,,1f1y";.F, \t,~~:j~;Wfi' ,'_
. 'i"t,: ~,
G. PROPERTY 1395 Letchworth Road
LOCATION: Camp Hill, PA 1]011
H. SETrLEMENTWSBN'Ii:
PLACB'OF'SETTEEM!;N'/":
TIN:
I. SETTLEMENT DATE: 0Bl2~005
J. SUMMARY OF BORR WBR'S TRANSACTION
100;GROSSt~{M!!>1ll~~'P~~~~j1.~''''-;S;t0'T"> .:
101.C-ontra6!safOS':Prtce'
102. Personal Property
103. SeWements charges to borrowe~
109. Sewer:
110. !Z'rash:
111.
112.
RESCISSiON DATE:
K. SUMMARY OF SELLER'S TRANSACTION
. ..... ,,~ ~~t',~$~~~f;J,J!.lIDllR~p.TE),SELLER.:
i1l'f.'!~I,'iJ1F.iilf$~f&l;Prt&j ., $120 000. 00
402. Personal property
403.
(from line 1400)
104.
105.
,?'Z,C3A'J.}O" :
404.
~Q5.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
:!--4qjl.PI!X.It~III;D,(~~. to
$204.38 407. County Taxes 08/26/2005 to 12/31/2005
....g~~'""!liSJd1!Hij2;;j{dgji~~~Rg!t'tOR9:t.~ql::~q.6
409. Sewer: 0812612005 to 0913012005
w "",:f',~f_)l$,~Q1;!~~;g~4:!',O:5'
$204.38
$1,123.41
$12.91
$21.24
120. GROSS AMOUNT DUE FROM BORROWER:
200: AM0IiJNTS;R*I13'~~~Biifji[B!~J;i~~g@gE!;l!t~W~g';:.""',
$121,361. 94
201. Deposit or earnest money
202. Principal amounfof'neviloan:(~)
203. Existing loan(s) taken subject to
204.
205.
206.
207.
20B.
209.
ADJUSTMENTS FOR ITEMS UNPA1D BY SELLER:
t>
$1,000.00
$2,789.29
1f!\o!fu~g~)16an .
505. Payoff of second mortgage loan
~OB.
507.
~Q~}
509.
ADJUSTMENTS FOR ITEIMS UNPAID BY SELLER:
$109,395.80
210. City/town taxes
211. County 1aJ</is
212. Assessments
213,
214.
215.
216.
217.
218.
219.
fu
40
510. City/town taxes
Ei~1i'~jiii9I~~~F'
512. Assessments
,":"~~~~}'7T'
514.
fV~'1:~f, ..
516.
:'MIL
516.
to
to"
to
'::,!!
220. TOTAL PAID BY/FOR
BORROWER: ~
300. 'CASj;rkl',s~~f,!Jj!.~~~~'I,"!(!)~~\!ly\!'~\J;';"r'~:.:7f'T::...:
301. Gross amount due from borrower iline 120)
302. LeSl;;IrTlOuntpiiicl;lJ~Lf()f:!1qdO~fl~!I1j~9):' ..
303. CASH ( ~ FROM) (0 Toll BORROWER:
$1,000.00 520. TOTAL REDUCTIONS
IN AMOUNT DUE TO SEILLER:
"..T7'jj ~gq;;;:~'[I!I!6~~IEElM5Nil'.'1'G'/fF{0MJ5);I;LE1.R?
$113,185.09
$123, 703. 00 ~01..Gr~samo.unt due to selle r(line 420)
~Q~;::~~~~~fl~G,l!O~iIJ~n:lt:.qUe;~~II~r(ll~!l5~O)'
$122,703.00 603. CASH (0 FROM) (~ TO ) SELLER:
$121,361.94
$113,185.09
$8,176.85
HUD-1 (3-86) .. RESPA, HB 4305.2
,.
f,
PAGE 1
HUD.1 (Re\{.3/86)
L.
SETTLEMENT CHARGES
'7Oci.'"i-OTAL SALES/BROKER'S COMMISSION
BASED DN PRICE $120,000.00
@
%=
DIVISION OF COMMISSION (LINE 700) AS FOLLOWS:
701.
702.
703.
704.
705. Commission peid et settlement
706.
to
to
to
to
800. ITEMS PAYABLE IN CONNECTION WITH LOAN:
801. Loan origination fee % to l'!/A
802. Loan discount % to N/A
803. Appraisal fee to: N/A
804. Credit report to: N/A
805. Lender's inspection fee N/A
806. Mortgage insurance application fee to N/A
807. Assumption fee N/A
.,
900. ITEMS REQUIRED BY LENDER m BE PAID IN ADVANCE:
901. Interest from 08/26/20IJS to 0'9/01/2005
@
Iday
902. Mortgage insurance premium for
903. Hazard insurance premium for
904. Flood insurance premium for
mas. to
yrs. to
yrs. to
905
1000. RESERVES DEPOSITED WITH,LENDER:
1001. Hazard insurance months @
1002. Mortgage insurance months @:
1003. City property taxes _y months,@
1004, County property taxes months @
1005. Annual assassmenls W' months @
1006. Flood insurance months@
1007 months@
1MB. moo~@
1009. Aggregate Accounting fEscrow Adjustment
1100, TITLE CHARGES: }.
1101. Settlement or dosing fee to LAW OFFICE OF DARRELL C. DETHLEFS
1102. Abstract or title search to
1103. Tille examination to
1104. Title insurance binder to
per month
per month
per month
per month
per manth
per month
per month
per month
1105. DocumenLpreparation to Friedman l4- King, P.C.
1106. Notary fees to
1107. Attorney's fees to
(includes above items Numbers:
1108. Title insurance to Security 1'"i.t.leILaw O:ffice of ,Darrel.l ,C . DetbJ.ers
(includes above items Numbers: BaSic ~]HP) - No End .
1109. Lender's coverage
1110. Owner's coverage $3.20,000.-00
1111. Approved AttOXI1&y Fee to "Lee Cohen, Esquire
1112.
'"
(
$~20, 000,00 )
1113.
1200, GOVERNMENT RECORDING AND TRANSFER HAR ES:
1201. RBcordingfees: Deed $3B.~0 ;Mortgage
1202. City/county tax/stamps: Deed $1,200.00; Mortgage
1203. Stale tax/stamps: Deed $1,200.00 : Mortgage
12M. ~
1205.
1300, ADDITIONAL SETTLEMENT CHAR ES:
; ReleasBs
; Other
1301. Survey to
1302. Pest inspection 10 T
1303, OveInight Fee to Law Offi:pe of Da:r:re1~ C, Det:hl.efs (UPS)
13M. Bonnie K. Mi.~~er ('J!ax Cert Fee)
1305, BoZlIlie K. Mi1~e:r, Treasti:ifer (2005-06 SChoo~ Tax)
1306. Lower A1~en Township (Selfer/Trash: .:Tul.y th.ru Sept 2005)
1307. ri
1400, TOTAL SETTLEMENT CHARGEiS
OMB No. 2502-0265
PAID FROM
BORROWER'S
FUNDS
AT
SETTLEMENT
PAID FROM
SELLER'S
FUNDS
AT
SETTLEMENT
$150,00
$38.50
$1,200,00
$1,200.00
$15.00
$10,00
$1,327,00
$87,29
$2,341,06
$2,789.29
I have carefully reviewed the HUD-1 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. IJurther certify that I have received a copy of the HUD-1 Settlement Statement.
~
?4~L ~~
Matthew I. Linnan~ ...
"
~ Seller or "IT t ~~
z ~ S- Agent ..d-e<{' .
~ Tracy L. Zeigler, single on
AI,JIflt5 (1k~Date g/zb/~
nlstratrix
Borrower:
Date:
Borrower:
Date:
Ii
a
The HUD-1 SeWement Statement which I haxe prepared is a true and accurate account of this transaction. I have caused or
with this statemenl ~
"
Date:
SettleMent Agent:
ghb/as-
Date:
use the funds to be disbursed in accordance
Date: J-.lC-CS
.. . Dethlefs, Esquire
WARNING: It is a crime to knowingly make~lse statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprison.
menl For details see: TiUe 18 U.S. Code Sadien 1001 and Section 1010.
I