HomeMy WebLinkAbout02-24-06
'.EV.1SOO EX 16-001
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
BJ..855/;(Il J /YBJ.L/8 .L
DATE O~ ~TH (~-~-YEA;S- DATE OF oT2M/;Y~R/d /
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach ccpy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (data of death aner 12.12-821
D 7. Decedent Maintained a living Trust (Attach ccpy of Trust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-'.95)
OFFICIAL USE ONLY
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FILE NUMBER
COUNTY CODE
NUMBER
YEAR
SOCIAL SECURITY NUMBER
J.O f.s, - J 6
93/8
THIS RETURN MUST BE FILED IN DUPLICATE WITH'
REGISTER OF WillS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (dete of death prior to 12-13-82)
D 5. Federal Estate Tax Retum Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch
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FIRM NAME (If Applicable)
COMPLETE MAILING ADDRESS
/ 53 Rc:.1J/~9 rO/fl A{/~Ala.s
~()VJ PA /fpqif7
TELEPHONE NUMBER5 7 0 ;2 q 7 - J q '-13
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
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)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus line 11)
(9)
(10)
>1' g j 7 ()'-f
4 / I; 7 gO
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 Sec. 9116 (a)(1.2)
OFfICIAL USE ONLY
(8)
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If /5 7. :l.. 901 00
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(11)
(12)
(13)
$ ~ l.f 6>'7
$/ . : / 'f 3
(14)
~/86;,) ~CJ{P
l-/S"2
x .0_ (15)
~.
x .0 _ (16) 0; I S-&'.CtJ
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at siblin9 rate
x .12 (17)
18. Amount of Line 14 taxable at collateral rate
x .15 (18)
10 T-'5v nll.eto
(19)
1/1; ) / ~- (y , 0 rJ
G
REV-1502 EX + (12-85) r
~i~ SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA L REAL ESTATE
INHERITANCE TAX RETURN '
RESIDENT DECEDENT .-O~ Z)'
ESTATE OF FILE NUMBER V.-
AI ,/)001 -O()O,~9
JV e.-L l- IE.. J:. 13LE.,S'srN' g 0< 19 '"'"
(Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value
which 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.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
--1> /I Lf) 9'00 i 00
1.
Sl /V~l- E- . DlI.) g. t-. LJ.l1Jj Hc).t1l~
is-iS cH.,q II+Am D..eluL
CA ()1 P 14: I LI-) fA. ~ 10 II
C Lk lVl 6 ~.~ LA IV [) GOLL ,'\j T ~
TOTAL (Also enter on line 1. Recapitulation)
(If more space ;s needed, insert additional sheets of same size.)
s j J 4 , q c()
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REV-l509 EX + (1-97)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNS, LVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
/1/el-.!-..! e, -r. AA~S5I/Z1q
',/
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
FILE NUMBER C/O. -(;' 1:::)
,;On :1f8 / -oC; -OOc!J. r
SURVIVING JOINT TENANT(S) NAME ADDRESS
RELATIONSHIP TO DECEDENT
A./)1/1./f. r /iJ.Jce &u/g,e /53 ~8()//1I;jTC1A/ AtlUttE.
'7?PoY/ fJ/l / wr'l7
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B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for joinOy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. J..oo !) C.b GO ~(;; i QS3 c.J./lJ B4m'-< ) ..{:tydf"j ~,q. 561, 1J)~3t,O
.{iT. ;1jI!..LtJ~B/.E5Y/Jt1 J-1}1/t!('1',4J-1 c:..8 I30w g;.z <<3 (p ~ :2.. , I w
I
:], .7'1. .2 C05 c ~60 wI Q5';). C it- j'J &4/IJ1< ( T((o<( I p(t- 5; 11:3 ~ /. 01 50b tf ~&GC15'
j r, 1\Je-J.J-1 ~ljU!-95/;(fq J;M-,€ y.4.t, (C~ /30 ()J e ~
3c A ;).,605 c j) ~51cr 0 ~ 7~ c. J(\J t3/11Jk, ~Ot', fit t3~ 785-; .gCJ ..50-2 4/%;61'1 J 9
tiT /t~u:r~8Li5S,irq,f.. ~r'Ai-(c.e ~wer(.
If. .4 iqgfv ' c.fj 310v3q/q8~ oQ7;),"07J'T t?AllJk PI..j-J; ) ~ / ') g 7 3, ~8 11 5; q r!~, <?
Lem()yl\J~, PA (iA esr SIft7?!E- 2Pr 5'01,
j -r.Il>e-I-L \ ~ ~:J..eSS/tV( ~ (YI1i/Gy Auc€ t>c>uJe~
s: A- i9 qt, 5IJv(llJqs. IhJ-T ~K \L~(y)OYJ1J81 P.A ,
I W85T Stt61Q3 P;"'A2.rt 1r Cf/i<-)' {, Il(' 5"62 tI ~q1(JiO
~;; Itk!ld-\e. ~t!..8:;)IN.\'j... /)'\ARVIfL\cf ~""
~ A /0dtP 54vf;tJAS) . . .' .' . 4( ( ) 5<6&,2 i j6l ~ 7 q_i, I
jT: 1V~l-L\e. (3l~55 \ 1) (1. ,-,\. (f\A.R..Yk.(C2&uPt '--
5C'08t2.'9.tV 8A-A..il< \ wes,slfc.'1li:; (')..A2A
. . t-.1? mcy /0 g I f'A
;; It I qf!,r;. C H eCK/1\iq j (1} ~ T f3..q~ i~ w<! S T F?i:t~A~lA c- -tI 4-': ;)-
' L....2JY1(;'Y' '& L,... 11> s:H 7 (); 27 ~6~ ) ].:;)'),
..jr: J\J e u... (E LSLE.S'SI.10\ J- 4'\A,€l(,~1 ce &<<.;&(
TOTAL (Also enter on line 6, Recapitulation) $ ~/ J) 3gf.4-1
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(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
ESTATE OF
~hLIg.
L. .&eSSl/Cjd
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FILE NUMBER c;;:2 (J c.J~, -CJct"J.;7 9
f!4 #,2/- (l~ ~O'c) .2 q
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
A.
1.
DESCRIPTION
FUNERAL EXPENSES: /Yl rgA?s rl<.A/e/C'4L /-IO/j!Ef..
.41~c/fA/tI%~Au,,-ec; J 17-4
Ii? Oill A/g g;(,88# ~i.-r~r
C4 /J1;J H/1-L \ fJ,4
;%Io..e k 8N'AJ8tf( ;11 A~I'i- L
o tAl A/ B"e Ar1ttf ~tt I{) BAAl...
AMOUNT
.ffC;;) (; ,?O.. eYer
if / ) / q ~- i O()
c21
'-~
~ !JOO': 00
1i
l/ 3:;>.Q,33
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
fYlt$' .
Claimant ...... AlA 12. \" A L I c8 Row~.R..
-
Street Address i 5 :sf:? 2.. 0 i!1J(fro rJ AU &JlJ.E
City ~O Y State ilL Zip I '" q If 1
Relationship of Claimant to Decedent '/)Au. l' H-r ~R
4.
Probate Fees
CU../Vl,ee.-e1-4/tJD Ce, GCi,L;Ql I-\:Ou..-~g,
t '~OG.OO
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ S-j '10 Lf ,33
(If more space is needed, insert additional sheets of the same size)
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SHORT CERTIFICATE
I,
GLENDA FARNER STRASBAUGH
es ta te of NELLIE I BLESSING
Register for the Probate of Wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
the 11th day of January, Two Thousand and Six,
Letters TESTAMENTARY
in common form were granted by the Register of
said County, on the
, la te of LOWER ALLEN TOWNSHIP
(Fitst, Middle, Lastl
in said county, deceased, to MARY ALICE BOWER
(Fitst, Middle, Lastl
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 11 th day of January
Two Thousand and Six.
File No.
PA File No.
Date of Death
S.S. #
2006-00029
21- 06- 0029
12/23/2005
206-10-9318
G~ ~~~,,~~ ~
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~ \ Deputy
REGISTER OF WILLS
CUMBERLAND County I Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
No. 2006-00029 PA No. 21-06-0029
Es ta te Of: NELLIE I BLESSING
{First, Middle, Lastl
Late Of:
LOWER ALLEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Securi ty No: 206-10-9318
WHEREAS, on the 11th day of January 2006 an instrument dated
October 29th 1999 was admitted to probate as the last will of
NELLIE I BLESSING
(First. Middle. Lastl
late of LOWER ALLEN TOWNSHIP, CUMBERLAND County,
who died on the 23rd day of December 2005 and
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH Register of wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
MARY ALICE BOWER
who has duly qualified as EXECUTOR{RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 11th day of January 2006.
G~~ \~~" ~~~\\.~
Register of Wills .~
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,'\ I Deputy ,\,
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I, NELLIE I. BLESSING, of Lower Allen Township, Cumberland County,
Pennsylvania, declare tIns to be my last will and revoke any will previously made by me.
ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker
and all expenses of my last illness, and any and all taxes and assessments imposed by any
governmental body as a result of my death, whether on property passing under this will or
otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a
part of the expense of the administration of my estate.
ITEM n. I give and bequeath all of my household goods, automobiles, jewelry, and all
other articles of household and personal use, equipment and ornament, together with all
insurance thereon and relating thereto, to my daughter, MARY ALICE BOWER, provided she
survives my death by thirty (30) days. Should my said daughter predecease me or be deceased
on the thirty-first day after my death, I give and bequeath all such items and insurance thereon to
those of her issue, per stirpes, as survive my death by thirty (30) days.
ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my
possessions and estate of every nature and wherever situate to my daughter, 1vlARY ALICE
BOWER, provided she survives my death by thirty (30) days. Should my said daughter '-
predecease me or be deceased 011 the thirty-first day after my death, I giv;:, devise,-ind beqaeath
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all the rest, residue, and remainder of my possessions and estate of every nature and wherever
situate to those of her issue, per stirpes, as survive my death by thirty (30) days.
ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to
anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or
attachment.
ITEM V. ! appoint my daughter, :MARY ALICE BO\\'ER., executrix ohms my last
will.
ITEM VI. In addition to the other powers and authorities granted to my personal
representatives by PelIDsylvania law and by the other terms and provisions of this will, I hereby
give to my personal representatives the following powers and authorities effective without court
approval and until actual distribution of all property: to compromise any claim or controversy;
to make distribution in cash or in kind, 0. partly in cash and partly in kind, and in such manner as
my personal representatives may determine and at valuations fInally to be fIxed by them; to
invest in all forms of property, including any stock or other securities in any corporate fiduciary
or its successor without restriction to investments authorized for Pennsylvania fIduciaries, as my
personal representatives deem proper, without regard to any principle of risk or diversification;
to retain any or all assets of my estate, real or personal, without regard to any principle of risk or
diversification; to sell at public or private sale, to exchange, or to lease for any period of time,
any real or personal property and to give options for sales, excJ:l...anges, or leases, for such prices
and upon such terms or conditions as my personal representatives deem proper; and to allocate
2
receipts and expenses to principal or income or partly to each as my personal representatives
deem proper in their sole discretion.
ITEM VII. I direct that my personal representatives and fiduciaries shall not be required
to give bond for the faithful performance of their duties in any jurisdiction.
"
IN WITNESS WHEREOF, I have hereunto set my hand this &l: ~/-
day of
, 1999.
/!tit.; X.~
NELLIE I. BLESSING d
.,
.J
The preceding instrument, consisting of this and THREE other typewritten pages, each
identified by the signature of the testatrix was on the date thereof signed, published, and declared
by NELLIE 1. BLESSING, the testatrix therein named, as and for her last will, in the presence of
us, who at her request, in her presence, and in the presence of each other, have subscribed our
names as witnesses hereto.
4
COMMONWEALTH OF PENNSYL V ANlA )
( SS:
COUNTY OF CUMBERLAND )
The undersigned, being the testatrix whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, does hereby acknowledge that I signed and
executed the foregoing instrument as my last wiIJ, that I signed it wiIlingly; and that I signed it as my free
and voluntary act for the purposes therein expressed. ,
11 < i
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'l/. v., -I- ,..;;q
LLIE I. BLES G
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( ss:
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COUNTY OF CUMBERLAND
WE, ff.J~~r./1 L ~rJ4J and , the witnesses whose
names are signed to the ,attached or foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw the testatrix sign and execute the instrument as her last will;
that she signed it 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; and that to
the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind, and
under no constraint or undue influence.
Sworn or affirmed to and
ac~owled~ff.\!fore me this
'C1day of U~Y\\' 19991
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Hl05.105 Rev. Hlf69
Thi~ is tu
LQc<ll Rtgistr~r.
th,~t Lh~.
~1e-r~ gl\'en l,) ~orrecti) trcHl1 .'.In ccrC:>~~-lLc'
certificate will be forwarded to the State Vitcd Records Office for
de~i.Lh :~iuh' filed -,\,~,tb
rnc:
Tllf r,)riginal
pern1iJ.nellrl fdlng.
Wft.RN!NG: It is mega! to duplicate th1s copy by photostat or photograph.
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Local Reglstrar
Fee
fur thi~ Certificate.. $6.0C.1
No,
__~.e e~NJ ~ et ~~ I e..D!!S
Date
P 12211670
Hl0S lU Re.... 2187
COMMONWEALTH Of PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
TYPEJPRlNT
IN
peRMANENT
Blo\CK INK
NAME OF DeCEDENT (Firl~ Middle, LMI)
1.
AGE Ct.-eM BirttGay)
SEX SOCIAL SECURITY NUMBfR
femal e a. 206-
84
..-0 =..., C
RACE._ -.. 8Iod<,1
(~hite
10.
SURVIVING SPOuse
(i.......,.lNIilOfnnwnlll
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25.
; AppfOlUme.te
I In&etv.. betwoe
: onwl and death
D,tPnqf7 h;.1i ('
J.l-t)D,.t.r~;O'"
SequenliaU)' At f;OfldlUonl
. any. leacmg to Jmmediale
. ;;auMl. Emf UNDERLYlMG
CAUSE (DiseaM or injury
that initiated ."'.nt$
re$UlUng on dealh ) LAST
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAll.A8LE PRIOR TO
COMPlETlON OF CAUSE
OF DEATH?
E
OUE TO (OR AS A CONSEQUENCE OF);
MANNER OF DEATH
DATE OF lNJURY
(MoNtI. OIly, v....1
TIME OF INJUR~
INJURY AT WORK1 OESCRI8E HOW INJURY OCCUAAEO.
NalWill
Accidont
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Homicide
Pending klve$ti9a'kxl
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CERTlFIER (Ched< only one)
.l~uI::~~,GJ::.~~~tr:l'=r.r~=i~~: 3::~:::~(= ,g:=~.h:~~~.~~.~~.~~~,~.~~.~~.).................. 0
NoD
Suicide
Could nul be determined
30.. 3Ob. M
PlACE OF INJURY. Al home. 1ann, weel, 'ac:wry. omco
tll..Iding.a&t,(S~1
30..
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LOCATION (Street, CiryfTown. Slale)
301,
21,
L.I I ,
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DATE ~GNED (M9f"", CoY. V-I
'14" (l..,,^ -.L.#u' ~ ,,.,..
SIGNA TU
.P!':.~~~~~.G_~~ ~~.~!J!.YI~_~.~~~~I~~t:'(~~~ ~.PJo~~ ~~~ ~~.~~~_~.~~~~~~~1._. _ .'d.~
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REGIONAL OFFICE (717) 737-6113
1996-2003
Statement of Estimated Seller's Cost
1996- 2003
(0(0 SALE PRICE ,,:);' \', ClI c}c."o:;c,.;:
( '''-'j (r.? \. .l' ~, .f- I ....,. ~,'; , .14 .~ /':..~ . .,,,,. i ;~':'i -~,,;'-: ,:",~ ~'" " ,". ....r~..,-.., -,'., ...:'.'I~...
'::;:>1 if",.r' SELLER ;'..J\/L'i.J1, f"\,.,!' ,.I.iC',ij;( " : 1'1.. ". ·
I .,,,,. .. . t-;t,~""'\'" ...jl,---
Salesperson . ?.J';:'/t. I;;:' ~..
, PROPERTY i b; (d <: ~ 1t1..n"'tl.\1-'1 1'"..:, \ :fi.. ('";,\f"':,.? ~,-t".l,. pA :",'0
The following es#mate, showing the amounts to be paid, supersedes all previous agreements, oral or written, and is provided so that the Sellers will
understand what costs will be deducted from the Gross Sale Price at the time of settlement.
DATE PREPARED
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':~..'';.''''......- -(I. ..... ,."..."
.b...~-,,(j:: "'''"
PREPARED BY
;.".:. ...-. ......".,.
1. Real Estate Commission (~;. % of $ 1 i \.f"i' :::: . . . . . . . . . . . . . . . . : . $
2. Transfer Tax: to of $ \ \ q q ,:;..;, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
3. Preparation of Deed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
4. Notary Fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
5. Settlement Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
6. Wood Infestation. . . . . . . . . '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
7. Septic System Inspection (Access/Pumping)..... . . . . . . . . . . . . . . . . . . . . . $
8. Buyers Settlement/Closing Costs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
9. Home Warranty Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
10. Municipal Code Enforcement Inspection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
11. Repairs....................................." . . . . . . . . . . . . . . . . . . $
12. V A1FHA Tax Escrow Service Fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
13. V A1FHA of Other Document Preparation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
14. Domestic Lien Search. .. . . . . . . . . . . . . . .., . . . .. . . . . . . . . . . . . . . . . . . . . $
15. Century 21 Piscioneri Foundation. . . . . . .$20. . . . .$50. . . . . Other. . . . . . . $
(Your agent and Century 21 Piscioneri both contribute from every
commission earned to help improve the quality of life locally. We would
welcome your tax deductible contribution.)
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$195.00
TOTAL COSTS. . . . . . . . . . . . . '" " . . .. . . . ;". . . . . . .. . ., .'<. . . . . .. . . . $
~> :~~F :~ \~q t f;::,~'_~2.-
These. are approximate figures. Exact figures will be provided at the time of settlement.
Based on the above figures, Sellers hereby fully understand that they will net approximately $ { C\ (O;;(~~1 '2' . .:?;;;~
from which deduction will be made or credit given, as the case may be, for payment of existing mortgage(s), judgment(s), prepayment penalty,
satisfaction fee, escrow adjustment and any other liens or encumbrances, tax or insurance adjustments, sewer, water, or rent adjustments, and any
other items to which the parties agreed in their contract.
I/We hereby acknowledge receipt of a copy of this Statement of Estimated Sellers' Settlement Costs and approve the above Estimated charges.
Fax Statement: This Document and any amendments thereto. may be executed in multiple counterparts by the parties and delivered by
way of transmission through a facsimile (FAX) machine and such counterparts shall have the same legal enforceability and binding
effect as though it were signed by all parties in original form.
....,
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WITNESS
WITNESS
SELLER
SELLER
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Thank you, we appreciate your business.
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7174321169
RAI..PH DIlLER
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Pr:GE: el2
Diller & Rupp Builders
1960 Ridge Road, WeUsvi11l:i Pa 17365
PROPOSAL .
PnJperqr at: 1811 Chatham Dri-.n:
Cemp HUl, Pa 17011
01 February 2006
<. Pace 5. . 11 - b-JDOrter ft)p aeotio'O of chimney and. inall c:ap
AI Tear dawn =-cy to roofpcak
bl Rdl.y bridt. itJ,J'l:l1t 1 J1J!W fiue,& irutall ctfJ ~---~-- S 400.00
<: Pace 7 ~ ;ne - llcscal roof on 110m ~rcb
at Colt llc p-.n of roof 'W1rh fiber cement
hi Check and callk ftaahins----------------- 130,00
< pqe'. to! - Cenmcd plumber to evaluate and. fix leek 01 leaks at mower
AI Remove 144 replaGe tub drain Ac pipm, ~ ....--- 350,00
< rap I, '17- InataJl su Une drip leg &; down pipeo on bot watll' boater - 175,00
.:. r.p It, N36-....aUD,~~..=. '" ,..... '. ---...---..-..;.:~........-:t10lltt:
<: Pap 11~ IJ.U- ComlCt reverse polarity on kite)1en out~ GFCf's to
be i~ed ill bath de. ldtcbet;--...;------
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$ 1..3'5.01,)
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COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CO 006366
BOWER MARY ALICE
153 REDINGTON A VENUE
TROY, PA 16947
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
___nn_ fold ---------- --------
101 I $6,156.00
ESTATE INFORMATION: SSN: 206-10-9318 I
FILE NUMBER: 2106-0029 I
DECEDENT NAME: BLESSING NELLIE I I
DATE OF PAYMENT: 02/24/2006 I
POSTMARK DATE: 02/24/2006 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 12/23/2005 I
I
TOTAL AMOUNT PAID: $6,156.00
REMARKS: WI LLlAM A BOWER
MARY ALICE BOWER
CHECK# 4568
INITIALS: CM
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
I