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REV-1500 EX + (6-00)
OFFICIAL USE ONLY
COMMONWEALTH OF REV -1500
* PENNSYLVANIA----------------______
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN I FILE NUMBER
. .. DEPT. 280601 II 05 0338
_____._~~RRlsBu~c;~A_~~~-o6~____I'!~SIQENT DECEDENT ______~plliTYCOOE YEAR NUMBER
~-~~_.~---~_._--_._~_.~._-------~._-~-----~----~-------.--.- ----_._-------~._--_.-
DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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Surfield, Kathryn F 196-14-3170
:DATE OF DEATH(MM~DD:YEAR)~- - ---OA TE OF B1RTH(MM-DD-YEARj--------- --- ,.';'ISRETURN-;UST BE FILED IN DUPUCATE WITH THE
~E~-~1-=-20_0~.________ ._~~.:!>.2-!!14____________~_._ _.__ ~EGISTER OF WILLS
I (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER -~ --~
Surfield, Robert L. Sr.
------------.------~---_._.._--_._-- -----~_._._-- --- --~---~----~----_._~._,--~------ ~---_._--_.~-~_._._._-
----. -
,- 4a. Future Interest Compromise (dale of death after
12.12-82)
2' : 6. Decedent Died Testate (Attach 7. Decedent Maintained a Living Trust (Attach
copy of Will) copy of Trust)
9. Litigation Proceeds Received 10. Spousal PovertY Credit (dale of death between 11,Election to tax under See 9113(A) (Attach Sch 0)
12-31-91 and 1.1-~5)
--l'iHIS-seCTiONMUSTite-cQMpL.ETED~Aill:_cORRESP_ISNCEA'ND'~ONFI~..:tAXtNFORMATIONSWG"'UD~,_EeTso@;. .
!z NAME I COMPLETE MAILING ADDRESS
~ ~.a_n1~~~_tiughe~_~sq_____________;
~ i FIRM NAME (If applicable) I
~ . SALZMANN HUGHES PC I
~ jTELEPHONENUMBER------~------:
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i X . 1. Original Return
2. Supplemental Return
3. Remainder Retum (date of death pnor to 12-13-82)
4. Limited Estate
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
354 Alexander Spring Road, Suite 1
Carlisle, PA 17013
----r---------- -. --~---.------.---------------.-.--------.----
1. Real Estate (Schedule A) (1) 240,350.00 OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
(2)
(3)
(4)
None
None
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4, Mortgages & Notes Receivable (Schedule D)
5, Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6, J~~tly Owned Property (Schedule F)
~J Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(9) 7,794.00
------_._~-
(10) 196,527.93
None
(5) None c:
(6) None
(7) None
(8) 240,350.00
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(11 )
204,321.93
36,028.07
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)
I 14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
0.00
(14)
36,028.07
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)
36,028.07 x .00 (15) 0.00
--'-~~~~~--
0.00 x .045 (16) 0.00
_._--_._---~.-
0.00 x .12 (17) 0.00
0.00 x .15 (18) 0.00
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
(19)
0.00
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
>> BE SURE TO ANSWER ALL QUES110NS ON REVERSE SIDE AND RECHECK MATH<<
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Copyright 2002 form software only The Lackner Group. Inc.
Form REV-1500 EX (Rev. 6-00;
1".-
L-
Rev-150:& EX+ (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Surfield, Kathryn F
FILE NUMBER
21-05-0338
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 pnce 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 relevan! facts.
Real property which Is jointly-owned with right of survivorship must be disclosed on schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
544 Mohawk Road, Upper Frankford Township, Newville, Cumbo County - sold
September 14,2005
240.350.00
TOTAL (Also enter on Line 1, Recapitulation)
240.350.00
(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)
REV-115.1 EX" (12-99j
~
~
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Surfield, Kathryn F
FILE NUMBER
21-05-0338
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State _ Zip
2.
Attorney's Fees
SALZMANN HUGHES PC
2,500.00
3
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Robert L. Surfield Sr.
:>44 .Mohawk Road
3,500.00
Street Address
City Newville
Relationship of Claimant to Decedent
State
Spouse
PA
Zip
17241
4.
Probate Fees
294.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
Irwin & McKnight, attorney fees
1,500,00
TOTAL (Also enter on line 9, Recapitulation)
7,794.00
Ipyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1S1~ EX+ (6-98) .
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Surfield, Kathryn F
FILE NUMBER
21-05-0338
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 DPW, lien against real estate
VALUE AT DATE
OF DEATH
196,527.93
TOTAL (Also enter on Line 10, Recapitulation)
196,527.93
(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 I (Rev. 6-98)
REV-1513 EX" (9-00).
~.
~
SCHEDULE ~
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
Surfield, Kathryn F
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
00 Not List Trustee(s)
FILE NUMBER
21-05-0338
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
I.
1
Robert L. Surfield
210 Big Spring Road
Newville, PA 17241
Spouse
remainder
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
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
I
LAST ly7LL Al\TD TESTA~1ELVT
OF
K4THRYLV F. SURFIELD
I, KATHRYN F. SURFIELD, of Upper Frankford Township, Cumberland County,
Pennsylwmia, being of sound and disposinq mind, memory and understanding, do hereby
make, publish and declare this as and for my Last \Nill and Testament, hereby revoking
and making void any and all former wills, codicils or writings in the nature thereof by me
at anytime heretofore made.
FIRST:
I hereby order and direct my executor, hereinafter named, to pay all
my just debts, funeral expenses, testamentary expenses and all inheritance, estate,
transfer and succession taxes, as soon as may be conveniently done after my death, out
of my residuary estate.
SECOND: I devise and bequeath the remainder of my estate to my husband,
ROBERT L. SURfjELD, SR., provjdjr~g he survives me.
I survive me, I devise and bequeath the remainder of my estata of every nature and where
I
THIRD:
In the event my husband, ROBERT L. SURFIELD, SR., fails to
ever situate to my friends, JAMES E. ARMOLD and SHIRLEY J. ARMOLD, of 650
. 1
Mohawk Road, Newville, Pennsylvania, as tenants by the entireties; and to the survivor
thereof if either are then deceased; upon condition that they perform and comply with the
following:
A. Furnish living quarters in my residence at my death, free of
charge, to my nephew, Paul E. Neidigh, for the term of his life.
B. Maintain and care for my dogs until their natural death.
FOURTH: I nominate and appoint my husband, ROBERT L. SURFIELD, SR.,
as Executor of this my Last v'JiII and Testament; and as substitute Executors I nominate
and appoint JAMES E. ARMOLD and SHIRLEY J. ARMOLD. I further direct that my
personal representative shall not be required to file bond or security in any jurisdiction.
, /"':
IN ~/lTNESS WHEREOF, I heieunto set my hand and seal this _:: c t.. <-,.
day of July, 1997.
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, l<sthrj'n F. Surfield
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
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COMMONvVEAL TH OF PENNSYLVANIA
55
COUNTY OF CUMBERLAND
I, KATHRYN F. SURFIELD, Testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that I signed it
willingly; and that J signed it as my free and voluntary act for the purposes therein
expressed.
Sworn or affirmed to and acknowledged before me, by Kathryn F. Surfield, the
Testatrix, this ;'\, :.~ ('; tr.. day of July, 1997.
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Kathryn F. Surfielg, Testatrix
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Nota(y!Public
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: T.:i:;E:'3A j SURJ<.I-<ClDER, "'C(3I)'~ue,le 1
i Gi111~tal (;.;.urt';~rmrd C')U1!11, P.A . j
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COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
We, James D. Flower, Jr. and Merlene Marhevka
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
Testatrix sign and execute the instrument as her Last ,Will; that Kathryn F. Surtield,
signed willingly and that she executed it as her free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testatrix signed the \^Ji!l
as wirnesses; and triat to the best of our i<nowiedge the Testatrix was at that time 1 B or
more years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by James D. Flower, Jr.
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and Merlene ~1arhevka this \,~(-', -tJ' \ day of July, 1997.
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.\fade the
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, in tit (' !lrar
.\'inetr:Prl- hundred ulId fi.fty-seven
l\ehut't'lt CRP.~:'::' c. ~~;:lD:(,:;:, \lJldowe;", of' U??e:- rranttfc)J'j Township,
~;e\lf\o'i lIe, Ft.. ~.. J.. C',.lmbetland County, ?e:-:~syt\lanI3., :Jart.y of t.!"'.C
first part,
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N\T:rRY;-'! F.. SURFI~LJ, of t:'1c same ?lace, party of th~ sec:>nd ?Lli"t;
~nitn('gst"H!, That in t'rillsid,'ra!i"" of 0;;::: l ::1.0" ~;C:"L',:(
fmffrrr ~ ,-
in hund paid. t hp r('('('I/>( It'll en'of is 7J "ff'hy ((CkfllJli'll'f! jl',l, till' sllid ~nl n I or tlo e s
}u"'ri'hy fff<lnt I1Ji,.j C(Jln'f'(l to the ,".;{lid granter t r.cr
h(';rs rU/i/ as,'\i1ns,
1\11 that certair. t:-ast 0: land, f'of)aerly co;~si~;tin:; of two aMJacent
t';~act5 or lanG, sttuale in the Towr,;:;ti~j :':f J:;;;r::r Fr2r~i\f~)['d, Coun:.'/ of
[umbel'land and State of Penilsylvan!a, toundcd a~d d~~crihed as fu~low3,
to:.wi t: '
Beginning at a limestone at the intsfs8ctIon of the Pu~lic F{oad
leading from the Dric;( Church to Doublin'J Gap, witt~ a cross-roads
le<ldl~r; to Bloscrvi lIe .:Jt corner of la:;J.:; fD;";:1e..ly ,jf ?crkcr Sr:1l ~;l,
now Of-George }~dberLlJ; thence by the ctoss-ruaJ i~orttl 6) deJr~~3 40
minutes East 106.3 nerchcs to a st~ne; the~Ge by lhe same North 79~
de!J:-ecs East 32 pcr~he:; t.o u stone; LiC;"iC.? r:,: lanc:s Qr C;i~rle$
Burkholder now of Webster Ar~old, 50Ut~1 de]rees ~~!st pe~ches
t.o a stone ij. t:-:(' road afQ['es.aid; t.hc:1cf? th: '..>ul;'h~ nDrth l'..:.'~ JefJr~es
Last 2 pe,.,;:H1S to a stone; t.:'1er.:ce bj' th~ ~a;;l.; ;;orth ce~lr,'.e::; .~=ast
(L~..~'" perches to :] st ; thc;1ce t:1e lan(ls now of S~.i:nuel ;.'/.~i ie,
Soutrl .:J cieJ;'''ees l,fl~St...J U whitl! 0(1;(; t~en:::e: :';y ':;j2 .iands
~fi~~ .'lC.! "~l~~;{:~;~ ~ ~~; ~ d ~~ ;~: ~:; ,",,<~'~~ t ,:,,\. i I ~)~~,~~~: 5 t ~ Q <1 a s ~ ~~~ ~ ;
~~:~~~ ~~~ ~~~~ ~:~~ ~~~~~ (:~~~~:~:3".~,~~~t:;_:.~J~,.;r~~~~~s t~oaaS~~~;~;;
ther..cc r;y t;':e sa:71C ::JOU"i..:l .:, jC~.:-;-2es \'/est J.f.} ':;crcLC3 v_~ <J corn<:::r ir.
t:1e road; t.;--.snce l:1\' lrl.;','.:s. :lO"'l o;~ ':,)f:~:C; l~; ,,1' ~'r-i':c t':icL.:lrd3'~)["'J r<.:J::--t.h
;9 d;~~]rccs '"lest .9 perc~lcs to ;::.. st,);iC; r.:'H~.""'JCC j:; t:~ sa:-n.2 So<..r.::: lil
de'Jrel~s West :lerc:1E:S to a 1 irn~5 in tr-,a rC)i]::; thC:1C<::: by t:iC
same Nart~ degrees 20 minutc5 ~est pC~rc!1e5 to t:12 i)l~ce of
he'Jinr:1nu.
~,.. _~o:(tat;-;~:l2 .l~lracr;s~~~~i.l?:l P:,:,ch(~~:;''"1nr:; ,""\:-:e:~s, ,L"Hi bel;,;',": in
o.C,-O...l).lCP. 1,l/lLI. ,i.alt <1.:> \..v,..:;lle.J f..orr'i L._~,l~'5 v. rzC')i:"'U t.O('.~t:l€'r wit:; t.~l>.~
A.:]riceltural Aerli11 ;',~2.~ 2.r:.,: j~ladc !-y 'l"'J,'11 :.Ji,?tsc~J h.,~~
Being the 3ame premises \l,,'h:C~i ',j/l1b'~1" ~~. Salisbur':l
SalIsbur':1, his wifp" by deed dated S,;:ptl:<::J;C;- en, '/:
in the Hccorder's Cf:'ic:e <1t Car-Irs le, 2<:':'.J i01 Ge\~
r"3r;C, lr--, <J:~;.tec and"co~"'C_'iC~~ t~ ,;-)r~le C: :'i?iJi
his wile. .M..ld the. sal'': l..ary C. ~...~td1']n, ii.JVlil(] ci c~i
t:-t,.; e.ntire tItle vested in Orrie C. :'Jci:iiSl1, ,:..iran or
a:1d :,~yrt 1 e ;..1.
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THIS INDENTURE
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iVIADE this 14th day of September, 2005,
BETWEEN
Robert L. Surfield, Sr" Administrator of the Estate of Kathryn F. Surfield, late of
Upper Frankford Township, Cumberland County, Pennsylvania, by and through his
agent, James D. Hughes;
GRANTOR
AND
Robert L. Surfield, Sr., of West Pennsboro Township, Newville, Cumberland
County, Pennsylvania;
GRANTEE
WHEREAS Kathryn F. Surfield died February 21, 2005, testate seized of certain
land situate in the Township of Upper Frankford, Cumberland County, Pennsylvania; and
WHEREAS the Estate of Kathryn F. Surfield was duly entered in the Office of the
Register of Wills in and for Cumberland County, Pennsylvania, on April 12, 2005, and
Letters of Administration were granted to Robert L. Surfield, Sr., to Estate #21-05-338;
and
WHEREAS a Last Will and Testament was located and filed with the Cumberland
County Register of Wills on August 18, 2005. It was decreed that the Last Will and
Testament dated July 30, 1997 be admitted to probate and filed of record as the Last Will
of Kathryn F. Surfield and that the said Administrator of the Estate shall be permitted to
concluded administration of decedent's Estate without amendment of Letters of
Administration,
WHEREAS Section 3351 of the Probate, Estates and Fiduciaries Code (20 PS.
3351) confers upon Executor/Administrator(s) the power to sell at public or private sale,
any real estate not specifically devised; and
WHEREAS the hereinafter described premises were not specifically devised; and
WHEREAS the said Administrator was not required to file any bond to secure
faithful performance of his duties.
NOW THIS INDENTURE WITNESSETH that Robert L. Suriield, Sr., Administrator
of the Estate of Kathryn F. Surfield, deceased, by and through his agent, James D.
Hughes, for and in consideration of the sum of One Dollar ($1.00) in lawful money of the
United States, to him in hand paid by the said GRANTEE at and before the sealing and
delivery hereof, the receipt whereof is hereby acknowledged he has granted, bargained,
sold, aliened, released and confirmed, and by these presents does grant, bargain, sell,
alien, release and confirm unto the said GRANTEE, his heirs and assigns:
ALL THAT CERTAIN tract of land situated in Upper Frankford Township,
Cumberland County, Pennsylvania, pursuant to a survey by Eric L. Diffenbaugh PLS as
follows:
BEGINNING at a set Parker-Kalan Nail in the center of Mohawk Road, thence
along lands now or formerly of Gary Crum, North 35 degrees 18 minutes 16 seconds
West 391.27 feet to an existing iron pin, thence along lands now or formerly of Karen
Marston and Deborah Gast, North 35 degrees 14 minutes 24 seconds West 821.65 feet
to an existing iron pin; thence along lands now or formerly of Douglas Gast, North 35
degrees 29 minutes 04 seconds West 199.84 feet to an existing corner post; thence
along lands now or formerly of Doreen Bowring and Michael Yaggie, North 68 degrees 50
minutes .05 seconds East 415.83 feet to an existing axle; thence along lands now or
formerly of Lisa Addington North 69 degrees 10 minutes 10 seconds East 404.91 feet to
an ex~sting iron pin; thence along the same North 12 degrees 06 minutes 12 seconds
West 126.67 feet to an existing iron fence post; thence along lands now or formerly of
Thomas Rodas, North 89 degrees 56 minutes 02 seconds East 326.14 feet to a 48 inch
twin trunk willow tree; thence along the same South 76 degrees 39 minutes 15 seconds
East 741.00 feet to an existing railroad spike in the center of Mohawk Road; thence along
tho t"'ontor Af I\ill'\h~'^'k Roari tho fl'\llo,^,inr< ten ""OUrSClS ~""'Uth ')Q rl,....,...,~,...."''"' 3') ""':...., ,+"''"' '"'A
"11'-' '"-',-"11"'-'1 VI IVIVII(,..4VV l U 1.11'-' IVII YVIII~ L II v I c;;; '-lV \.II L...U UC:;;:8'C;;VV v IIJIIIULC;~ v-r-
seconds West 43.81 feet to a point; thence South 41 degrees 39 minutes 58 seconds
West 72.79 feet to an existing Parker-Kalan Nail; thence South 45 degrees 33 minutes 08
seconds West 69.81 feet to an existing Parker-Kalan Nail; thence South 49 degrees 36
minutes 50 seconds West 227.44 feet to an existing Parker-Kalan Nail; thence South 40
degrees 01 minutes 25 seconds West 147.98 feet to an existing Parker-Kalan Nail;
thence South 30 degrees 35 minutes 52 seconds West 83.55 feet to an existing Parker-
Kalon Nail; thence South 30 degrees 37 minutes 24 seconds West 78.18 feet to a set
Parker-Kalon Nail; thence South 29 degrees 08 minutes 02 seconds West 868.18 feet to
a set Parker-Kalan Nail; thence South 32 degrees 11 minutes 48 seconds 'Nest 50.04
feet to a set Parker-Kalan Nail, thence South 41 degrees 26 minutes 39 seconds West
77.54 feet to a set Parker-Kalan Nail, the place of BEGINNING.
CONTAINING 30.3871 acres.
BEING part of the same property which Orrie C. Neidigh, Widower, granted and
conveyed unto Kathryn F. Surfield, by Deed dated January 2, 1957, and recorded in the
Office of the Recorder of Deeds of Cumberland County in Deed Book 0, Volume 17,
Page 533.
2
The said GRANTOR having granted a Power of Attorney to James D. Hughes
dated July 6, 2005, and recorded August 31, 2005, in the office of the Cumberland
County Recorder of Deeds in Miscellaneous Book 720, Page 1703.
THIS TRANSFER IS BEING MADE FROM ESTATE OF WIFE TO HUSBAND PURSUANT TO THE
DECEDENT'S LAST WILL AND TESTAMENT AND IS THEREFORE EXEMPT FROM REALTY TRANSFER
TAX.
TOGETHER with all and singular ways, waters, water-courses, rights, liberties,
privileges, hereditaments and appurtenances whatsoever thereunto belonging, or in
anywise appertaining, and the reversions and remainders, rents, issues and profits
thereof; and also, all the estate right, title, interest, use trust, property, possession, claim
and demand whatsoever, in law, equity or otherwise howsoever, of, in, to or out of the
same.
TO HAVE AND TO HOLD, the said hereditaments and premises hereby granted
and released, or mentioned and intended so to be, with the appurtenances, unto the said
GRANTEE and his heirs and assigns, to and for the only proper use and behoof of the
s~id GRANTEE his heirs and assigns, forever.
AND the said Administrator of the Estate of Kathryn F. Surfield, deceased,
covenant, promise, and agree to and with the said GRANTEE his heirs and assigns, by
these presents, that he, the said Administrator has not done, committed, knowingly or
willingly suffered to be done or committed, any act, matter or thing whatsoever whereby
the premises hereby granted, or any part thereof, is, are, shall or may be impeached,
charged or encumbered, in title, charge, estate, or otherwise howsoever.
WITNESS the due execution hereof the day, month and year first above written.
Signed, Sealed and Delivered
in th~ Presence of:
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Estate of Kathryn F. Surfield
(SEAL)
ughes, as agent for
. Surfield Sr., Administrator
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COMMONWEALTH OF PENNSYLVANIA )
: ss
COUNTY OF CUMBERLAND )
On this, the 14th day of September, 2005, before me, the undersigned officer,
personally appeared James D. Hughes, Agent for Robert L. Surfield, Sr., Administrator of
the Estate of Kathryn F. Surfield, known to me (or satisfactorily proven) to be the person
whose name is subscribed to the within instrument, and acknowledged that he executed
same as Agent for Robert L. Surfield, Sr., Administrator of the Estate of Kathryn F.
Surfield, for the purposes therein contained.
(SEAL)
I do hereby certify that the precise residence and complete post office address of
the within named Grantee is: 95 Alexander Sprinq Road. Suite 3. Carlisle. PA17013.
Date
7/ty~r
, {
IRWIN & McKNIGHT
Attorneys
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I :II.FHA Settlement statement. U. S. Department of Housinn and Urban Development Form US HUD - t Poae No. t
( ! 'Z.FmHA . 6. Rle Number 7. Loon Number 8. Mortgage Insurance
I ;\3 Canv. Unins. Case Number
[ ) 4.VA RE2554
5. Conv.lns. ABST#6183
Items mar1<ed "(p.o.c.}" were paid outside of
D. Name and Addce5S of Borrower:
DARRYL E. JONES
MELANIE M. JONES
235 PEACH GLEN ROAD
GARDNERS, PA 17324
E. Name and Address of Seller:
ROBERT L. SUR FIELD, SR.
BY: JAMES D. HUGHES, AGENT
I rl. Buye(s Setllement Agent:
";N 25-1730538
Frey &. TIley Law Office
5 South Hanover St.
Carlisle, PA 17013
TIN
, G. Property locolion
544 MOHAWK ROAD, NEWVlllE, PA 17241
UPPER FRANKFORD TOWNSHIP
CUMBERLAND COUNTY
PARCEL NO. 43-05-0417-024
I. Settlement Dale:
September 16. 2005
2:30 P.M.
Place of Selllement:
5 South Hanover Street
Carllsle,PA 17013
F. Name and Address of lender
AGCHOICE FARM CREDIT, ACA
ISAOA ATIMA
109 FARM CREDIT DRIVE
CHAMBERSBURG. PA 17201
J SUMMARY OF BORROWER'S TRANSACTION
K
SUMMARY OF SELLER'S TRANSACTION
;':0 Grass Amount Due from &crrower 400 Gross Amount Due To Seller
101 Contract soles price 240,350.00 401 Contract Sales price 240,350.00
102 Personal properly 402 Personal property
103 Setllemenl charges from [line 1400) 6,149.00 403
h)4 404
105 405
Adjustments for items paid oy seller in odvonce: Adjustments lor items paid by seller in advance:
Ie; City/lawn taxes 9116/05 to 12/31/05 96.24 406 Clty/lown taxes 9/16/05 101'Z/31/05 96.24
107 County taxes 407 County taxes
1 ',8 Assessments 408 Assessments
<9 409
i i 0 5chaplloxes 9/16/05 to 6/30/06 1.557.78 410 Schoolloxes 9116105 10 6130106 1,557.78
t:I 411
11 ~ 412
120 GfO" Amount Due From 80ffowec 248,153.02 420 Gross Amount Due 10 Seller 242,004.02
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2VJ Amounts PaId By Or In Behall Of Borrower 500 Reducllons In Amount Due To Seller.
20\ Deposit Of eamest money 2,350.00 50 I Excess deposit Isee instructions)
~'02 Principal amount of new loan(s)..... CK $160,000.00 160,000.00 502 Settlement charges 10 leller Iline 1400) 28,184.58
.-:' Existing loan(s) taken subject to 503 Exisling toan(s) token subject 10
: . 2ND MORTGAGE CK $79,000.00 79,000.00 504 Payoff of first mortgage loan
:Ci 505 Payoff 01 second mortgage loon
2~ 506
20, 507
10:3 508
20,9 SELLERS ASSISTANCE 5.000.00 509 SELLERS ASSISTANCE 5.000.00
Adjustments for items upojd by seller Adjustments for items upoid by seller
210 City/town taxes 1/1105 10 9/16105 510 City!lown taxes 111/05 109/16/05
211 County taxes 5 t I Caunty taxel
2;2 Assessments 512 Assessments
213 513
2 i 4 Schaal taxes 7/1/05 to 9/16105 514 Schoolloxes 711105 to 9/16/05
215 515
216 516
217 517
21D 518
21" 519
2;:() Total Paid By/for Borrowe' 246,350.00 520 Total Reducllons to Amt Due Setter 33,184.58
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:'X Cash At Setllement From/To Borrower: I 600 Cash At Sellfemenl To/From Sener. I
30' Grass amount due tram borrower (line 120) 248,153.02 601 Gross amount to seller from (line 420) 242,004.02
30''; less amounts paid by/for borrower {[rom tine 2'20} (246.350.00) 602 leIS reduclions in amounl due sener (from fine 5201: (33,184.58)
3C Cash (X) from ( ) To Borrowe, 1,803.02 603 Cosh ( ) From (X) To Seller 208,819.44
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CERTIFICATION
I direcl and aulhorize Ihe Company to make distributions indicated lor my accounl on Ihe altached HUD-l Settlemenl Stotement. approving the tax prorations
indicated therein. and understand that prorations were bosed 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 odjestmenls must be mode between Seller and Borrower direct: likewise any DEFICIT in delinquent tQ)Ces will be reimbursed to
A It omey /Ti lie by Seller.
I have carefully reviewed the HUD-I Settlement Statement and to the best of my knowledge and belief. it is a true and accurate statement of all receipts and
disbursemenls made on my account or by me in this trcmsoction. I further certify that I have received a copy of the HUD~ 1 Settlement Statement.
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DARRYL E. J NES (/ .
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MEL NI . JONES
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To the best of my knowledge, Ihe f1UD-l Settlement Slatement which I have prepared i! a true and aC5'urale account of the funds which were received and have
been or will be disbursed by the undersigned as pari of the settlement of this transaction. ./
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Se ment Agent
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September 16, 2005
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WARNING: II is a crime 10 knawingly make false statements ta the Unile~9~lon this or any other similar torm. Penalties upan convictian can include fine ond
imprisonment. For delails 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 IBOXES E, G. H,I, M AND LINE 401) 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 law 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.
Certiflcatlon of TIN
Under penalties of perjury, I certify that the taxpayer idenliOcation number shown in this statement is my correct taxpayer identification number.
Seller
Seller
TAX PRO.RATlON ADDENDUM
Date of Pro-RoHan: Borrower Seller l
SCHOOL REAL ESTATE TAX Owes:
Seplember 16, 2005 tram July I, 2005 ta June 30. 2006 12.375 mills
Schoot Real Estate Tax- Face $2.021.58 2.021.58
School Real Eslate Tax- Per Day $5.S385B
ASSESSMENT:
$163.360.00 COUNTY & MUNICIPAL TAX Owes:
from January 1. 2005 la December 31, 2005 2.39728 mills
Ca. a. Munic. Real Eslate Tax- Face $338.15 P.O.C.
Parcel No.: Co. &. Munic. Real Estate Tax~ Per Day $0.92644
See Selllement Sheet
lines Yes
106&406.110&410. Schaol taxes P.O.C. or charQed 10 Seller: D
210 & 510, 214 & 514, Schoollaxes P.O.C. or charged to Borrower
and 1303 lor Co. a. Munic. P.O.C. or charQed to Seller:
Results 01 this Addendum. Ca. &. Munic. P.O.C. or charged to Borrower
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LI.ABllITY
ESTATE RECOVERY PROGRMI
PO BOX 8486
HARRISBURG, PA 17105.8486
September 30, 2005
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IRWIN & MCKNIGHT LAW OFFICES
MARCUS A MCKNIGHT III ESQ
WEST POMFRET PROFSSIONAL BLDG
60 WEST POMFRET STREET
CARLISLE PA 17013-3222
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Re: KATHRYN SURFIELD
CIS #: 690152600
SSN: 196-14-3170
Date of ' Death: 02/21/2005
Dear Mr. McKnight:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $196,527.93 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to ~eimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $29,501.86, was incurred
during the last six months of the decedent's life; th~refore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $167,026.07,
is to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
a~~j;(~41
Carol J. Zellers
TPL Program Investigator
717-772-6266
717-772-6553 F&~
Enclosure