HomeMy WebLinkAbout03-28-06
REV.1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
OEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
II
__L__ CPUNILCODE _ ___YJ~~R_ ~_ _NLJIItlE3ER_ __
_____ __...__ __ ___ _____ ______~____... ~._______. ___n__
SOCIAL SECURITY NUMBER
05
0134
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! DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
i Lauver, David D.
f--OATE6i=-OEA TH(MM~DD:YEAR)-~--- ----I OATE-OFBIl~TH (MM-..OO-YEAR)------ -----
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01-31-2005 i 06-05-1955
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( lAST, FIRST AND MIDDLE INITIAL)
x 1. Original Return
2_ Supplemental Return
196-48-1940
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
3. Remainder Return (date of death prior to 12-13-82)
x 6. Decedent Died Testate (Attach
copy of Will)
:- 1 9 _ Litigation Proceeds Received
i~ 4a. Future Interest Compromise (date of death after 5. Federal Estate Tax Return Required
12-12-82)
7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes
copy of Trust)
10 Spousal Poverty Credit (date of death between 11. Election to tax under Sec. 9113(A) (Attach Sch O)
. 12-31-91 and 1-1-~5}
-----..---- -- ------------- ------~ ~~~-_._--- -~----_.__.. ---~---~-- ----- ~--- - ----~---~--------~,,---~-----
TELEPHONE NUMBER
717-249-6333
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) Separate Billing Requested
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
4. Limited Estate
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! THIS SECTION. MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA TIONSHOlJlD BE DIRECTED "l'O~
-- --~----,------_.----~-------------~----------~~--~--------------~-- -
! NAME COMPLETE MAILING ADDRESS
E. R a I p !1~o d f~~y,_ E~9-"_
FIRM NAME (If applicable)
SALZMANN HUGHES PC
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)
354 Alexander Spring Road, Suite 1
Carlisle, PA 17013 ..~
(1 )
(2)
(3)
(4)
(5)
(6)
(7)
63,000.00
None
None
None
1,577.78
None
None
(9)
(10)
4,014.50
53,009.07
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
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15. Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
0.00
0.00
0.00
7,554.21
x .00 (15)
x .045 (16)
x .12 (17)
x .15 (18)
(19)
20. [K]
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
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
OFFiGIAL,USE ONLY l
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(8)
64,577.78
(11 )
57,023.57
7,554.21
0.00
(12)
(13)
(14)
7,554.21
0.00
0.00
0.00
1,133.13
1,133.13
>> BE SURE TO ANSWER ALL QUESnONSON REVERSE SIDE AND RECHECK MATH <<
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6@
Decedent's Complete Address:
STREET ADDRESS
207 Fry town Road
!
i STATE PA
ZIP 17013
CITY Carlisle
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
1,133.13
j~ ~~863~.O O~
56.66
Total Credits (A + B + C)
(2)
3,919.66
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(3)
(4)
2,786.53
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(58)
Make Check Payable to: REGISTER OF WILLS, AGENT
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 of the property transferred;.................................................................................. ,~?<-
b. retain the right to designate who shall use the property transferred or its income;.................................... :Xl
c. retain a reversionary interest; or.................................................................................................................. x:
d. receive the promise for life of either payments, benefits or care?............................................................. x!
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?................................................ .....................................................................;. x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
conta ins a be neficia ry des ig nation? . .... . .. .. .... . .. .. .. .... .. . .. .. . ..... ..... .. .... ... . .. . .. .. .. . .. .. .. .... .. . . .. .... ... .... ... .... .. . .. . . .. ... .., .. . . . ' x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, Including accompanYing schedules and statements, and to the best of my knowledge and belief, it is true, correct and
~o!TIplet~ ._Q~c1a~~ti~m ofJ?r~parer o_thert~~n the_personc.~1 repre~entative_ is based o~ aU inforrnation,?f Wh.IC~ prep'~_n~r h"scmy ~~oV\lI~edge_
SIGNATURE OF PERSON RESPONSIBLE F~OFILlN RETURN ADDRESS
Carolyn . Neidigh 148 North East Street
Carlisle, PA 17013
SIG~ATU~~~ . RETURN ADDRESS
SIGNATURE OF PREP RU ~fERTHAN. PRESENTATIVE- ADDRESS
E. Ralph Godfrey
x
DATE
3-!MLo (R
DATE
3/U It:xo
DATE
354 Alexander Spring Road, Suite 1
Carlisle, 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. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (a) (1.2)].
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 .5.
99116 1.2) [72 P.S. 99116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (a) (1.3)]. A sibling is
defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev.1502 EX+ (6-98)
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SCHEDULE A
REAL ESTATE
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lauver, David D.
FILE NUMBER
21-05-0134
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
residence - 207 Fry town Road, Upper Frankford Township, Cumberland County
(settlement sheet attached)
63.000.00
TOTAL (Also enter on Line 1, Recapitulation)
63.000.00
(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-1508 EX+ (6-98)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lauver, David D.
FILE NUMBER
21-05-0134
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
NUMBER DESCRIPTION
1 IRS - 2004 income tax refund
VALUE AT DATE
OF DEATH
652.00
2 Members First Federal Credit Union - checking/savings accounts
925.78
TOTAL (Also enter on Line 5, Recapitulation)
1,577.78
(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 E (Rev. 6-98)
I REV-1151 EX+ (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Lauver, David D.
FILE NUMBER
21-05-0134
ESTATE OF
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION
NUMBER AMOUNT
A. FUNERAL EXPENSES:
8. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees 3,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 256.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 258.50
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 4,014.50
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
21-05-0134
Lauver, David D.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland Law Journal - estate notice publication
75.00
2
Register of Wills - filing fees
45.00
3
The Sentinel - Legal - estate notice publication
138.50
Subtotal
258.50
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE liABiliTIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
21-05-0134
Lauver, David D.
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Adams Electric
404.59
2
American General - mortgages due
46.376.93
3
AT&T Wireless
19.84
4
Baxter D. Wellmon II, D.O.
63.00
5
Capital Tax Collection Bureau - 2004 income tax due
180.35
6
Carlisle Propane
575.53
7
Carlisle Regional Medic~1 Center
478.00
8
Carlisle Regional Medical Center
95.65
9
1.541.18
ritil'nrn _ I'rorlit I':!:Irrl h:ll:lnl'o
10
Dish Network
68.93
11
Graham Medical Clinic
57.56
12
H&R Block
341.00
13
Holy Spirit Hospital
217.48
14
Silver Spring Ambulance
79.88
15
Tax Claim Bureau - deliquent taxes due
2.185.28
16
Waste Management
257.24
17
West Shore Advanced Life Support
66.63
Total of Continuation Schedule(s)
See attached page
TOTAL (Also enter on Line 10, Recapitulation)
53,009.07
<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 .J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
Lauver, David D.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
FILE NUMBER
21-05-0134
ESTATE OF
RELATIONSHIP TO
DECEDENT
00 Not List Trustee(s)
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
Carolyn J. Neidigh
148 North East Street
Carlisle, PA 17013
Niece
1/2 remainder
Ronald L. Neidigh
148 North East Street
Carlisle, PA 17013
Nephew
1/2 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)
LAST WILL AND TEST A~fENT
OF
DA T/ID DAl\lIEL LA UVER
I, DAVID DANIEL LAu\rER, of 207 Frytown Road, Carlisle, Cumberland county,
Pennsylvania 17013, declare this to be my Last vVill and Testament and hereby revoke all Wills
and Codicils previously made by me.
ITEM 1.
I direct my Executrix hereinafter named to pay all my legal debts and
funeral expenses, including the cost of my gravemarker and administration expenses of my
estate, as soon as practicable aHer my death.
ITEM 2.
I give and bequeath my tangible property inclLld~ng automobiles,
motorcycles, jewelry, wearing apparel, books, pictures, household furniture and furnishings, and
all 'other articles of household and personal adornment, together \vith any insurance existing
thereon, equally to my niece Carolyn J. Neidigh and nephevv Ronald L. Neidigh, per stirpes. The
share of my niece of nephew deceased at my death, vvithout issue surviving, shall lapse in favor of
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,
the other surviving sibling and should that other sibling not survive, unto their issue surviving, per
stirpes.
ITEM 3.
I give, devise and bequeath the rest, residue and remainder of my estate, real,
personal or mixed, of whatever nature and wheresoever situate, including all lapsed legacies and
bequests including any property over which I may have a power of appointment at the time of my
death equally to my niece Carolyn J. Neidigh and nephe\v Ronald L. Neidigh, per stirpes. The
share of my niece of nephe\v deceased at my death, \vithout issue surviving, shall lapse in favor of
the other surviving sibling and should that bther sibling not survive;' unto their issue surviving, per
stirpes.
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ITEM 4. Should any beneficiary of my estate be under T\venty-five (25) years of
age, I direct that the share of such beneficiary shall be paid unto Carolyn J. Neidigh, as Trustee
for said beneficiary, on the following terms and conditions:
(a) My Trustee shall divide this sum into equal shares corresponding in
number to my beneficiaries surviving me, and each share shall be held in a separate trust
for each of my surviving beneficiaries.
(b) My Trustee shall hold, manage, invest and reinvest the shares so received, .
and the accumulation of interest, and use and apply from time to time such portion of
income and principal thereof as he deems necessary for such beneficiary's health,
maintenance, comfortable support and education, or to make payment to any personal
guardian of such beneficiary. The term "education" means technical, preparatory,
college, graduate and professional education while enrolled in good standing in a
recognized educational institution.
(c) Any principal or income not so applied shall be distributed to such
beneficiary when he/she attains the age of-1"wenty-five (25) years.
(d) All shares of principal and income hereby given shall be free from
anticipation, assignment, pledge or obligation of the beneficiaries and shall not be subject
to any execution or attachment.
(e) Should any beneficiary die prior to the termination of the trust fund, I
direct that any balance remaining in his fund shall be distributed to the issue of said
beneficiary. If said beneficiary is not survived by issue, I direct that any balance
remaining in his fund shall be distributed to my surviving beneficiaries in accordance
with the ratios set forth in this my Last Will.
_L). L), L I
(f) In the event Carolyn J. Neidigh, shall prede"cease me, cease or be unable to
act as my Trustee, I appoint Ronald L. Neidigh, to act in that capacity.
ITEM 5.
In addition to po\vers granted by la\v or by other parts of this vVill, my
Executrix hereinafter named shall have the following po\vers.
(a) To retain any and all assets of my estate, real, personal, or mixed, without
regard to any principle of diversification, risk, or productivity, except as may be othenvise
expressly provided herein;
(b) To sell at public or private sale, to exchange, to lease, to pledge, to
mortgage, to transfer, to convert, or othenvise dispose of, and to grant options with respect
to, any and all property, real, personal, or mixed, at any time forming part of my estate in
such manner, at such time or times, for such purposes, for such price or prices and upon
such terms, credits, and conditions as may be deemed advisable or necessary under the
circumstances;
(c) To invest and reinvest the property in stocks, bonds, mortgages, notes,
insurance policies, annuities, conunon ~t fund participation, or other property of any
kind, real, personal, or mixed, irrespective of any statute, case, nIle, or custom limiting the
investment of trust funds, except as expressly provided othenvise herein;
(d) To settle, compromise, contest, prosecute, or abandon claims in favor of or
against my estate as may be deemed advisable;
(e) To allocate receipts and disbursements to principal or income or partly to
both and to ascertain principal or income in accordance with the la\vs of the Commonwealth
of Pennsylvania;
I) I j.). ;:,
(f) To make distribution or division of the estate in cash, in kind, or partly in
both; and to postpone distribution by agreement with a beneficiary;
(g) To exercise any law-given option to treat administration expenses either as
income tax or estate tax deductions, without regard to \vhether the expenses were paid from
principal or income, and without requiring reimbursement; and
(h)
To disclaim any inheritance or transfer.
ITEM 6.
No bond shall be required by my Executrix, but ifbond is nevertheless
required, it shall be \vithout surety.
ITE~l 7.
All estate, inheritance, legacy, succession or transfer taxes, including any
interest and penalties thereon, imposed by any domestic or foreign law \vith respect to all
property taxable under such laws by reason of my death, whether or not such property passes
under this Will, by operation of law, by contract or otherwise, shall be paid from my estate as a
part of the expenses of administration thereof without any right of reimbursement from any
recipient of any such property, without any right of apportionment and \vithout po~tponement.
ITEM 8.
I appoint Carolyn 1. Neidigh as the EXECUTRIX of this my Last Will and
Testament. If Carolyn J. Neidigh predeceases me, ceases or is unable to act as my EXECUTRIX, I
appoint Ronald L. Neidigh, as EXECUTOR of this my Last Will and Testament.
IN WITNESS 'vVHEREOF, I have hereunto set my hand this .:-A~ i'- day of 'J'G.~'-A.{~
2005.
fC (/ ". / '--_/
I/..,- C':.-t-.:-<</" A >. .'l c-:' '- <.. .: '- c' L...
DAVID DANIEL LAUVER
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The preceding instrument consisting of this and four (4) other type\vritten pages identified by the
signature of the Testator was on the date thereof signed, published and declared by DAVID
DANIEL LAUVER, the Testator therein named, as and for his Last \Vill and Testament, in the
presence of us \vho, at his request, in his presence and in the presence of each other, have
subscribed our names as witnesses hereto.
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COMMONWEALTH OF PENNSYLVANIA
. SS
COUNTY OF CUMBERLAND
We, DAVID DANIEL LAUVER, f - ~ ~-'-~ ~ C ~:n} k, and tl-t(.l.-... (,0..-) , the
Testator and the witnesses, respectively, whose names are signed to the attached or foregoing
instnlment, being first duly sworn, do hereby declare to the undersigned authority that the Testator
signed and executed the instrument as his last Will and that he had signed willingly (or willingly
directed another to sign for his), and that he executed it as his free and voluntary act for the
purposes therein expressed, and that each of the witnesses, in the presence an-d hearing of the
Testator, signed the \Vill as witness and that to the best of our knowledge the Testator \vas at that
time eighteen years of age or older, of sOllnd mind and under no constraint or undue influence.
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Testator
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SWORN to or affirmed and ackno\vledged before me by the above named Testator and witnesses
this ~"S4- day of--x~~.) , 2005.
NOTARIAL SEAL
DONNA L. GODfREY, NOTARY PUBLIC
CITY OF CARLISLE, CUMBERLAND COUNTY
MY COMMISSION EXPIRES DEC, 02, 200~
~
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Notary Public
My Commission Expires:
(SEAL)
A Settlelllent Statement U.S. Department of Housing and Urban Development
lLIYillLQt~- OMB No. 2502,0@BE,V HUl2Jj3/86\
\ l. OFIIA.. 2. .llFll1tlA 3. Denn\'. Un ins. I 6. File Numb<:r .. i 7. Loan Numbo:r II ll. t\lortgage Iflsuran.:c Case Number
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r c. Note' ~~;;;o~~r~Se~r.'!'~s~ec\!'o,,~~: ~~,~ ~~tl;i~;l~~t ~~;I~t~a;!~eByttl~~\~~~~,~s~er~~o~~~:~t~~;,~~ ~~~p~s:~ea~~t~~~'~~\ ~g~~~:~~~i;i~:~t3Is
I V\..\ I,rmJG I~ IS a c"me 10 knowingly make lalse statelliei1\S;o the Un:ted Slates en thiS or allY other Similar form Pena,tles upon
- 'v" tlC-'i Gan InCl~Je a fllle alld ImDIISQ!illl\illL~\il1:~ ~~ 18 IJ S CoeJe Soctlon J 00 1 and Section 1 C 1'1
D N.\i\H-' III nUl{\{t)\\TR Carolyn Jo Neidigh :l1ld Jimmie Lee George
t~.~~{t~l~~/2~~~~--'--:rhe Esta~I:DaVid.D. Lauver
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fl'" NMvll' OF I LNDER: Philadelphia Financial Mortgage ADO Let:sport Bank
__l.\ldlJH.c;2) .' 1767 Sentry Parkway W. Suite 2. Blue Bell. PA 19422 I
l.. PIWI'!II.TY AD!)Jl.rSS 207 Fry town Road, Ca.rlisle, PA 17013 I
_______________~l'r Frankford Township _
IL Sl:TTU1\llNT A(jLNT P A Real Estate Settlement Services, LLC
~.P!.d.\.1.:-U.1l'-5kLlllJ.. MINT 354 Alexander Sprinc Road. Ste, Carlisle. PA 170] 3_~__~_-=_~~~~~j
L_Lill,ULlillJ{UHJL:.... ____._.01/31/2006 ------
~_. __... _. ~2ldMMARY OF BORROWER'S TRANSACTION~' K SUMMARY OF S~LL~R'S TRANSACTIQN..:.._.____u.-.~
~~~~~~~~.'::;::O,~~~ROM 80. RR. OVVERl_ -63.000 0.0-. II. ~~"_~:~;,~~JLUJJ=mfL~= 63~q;;Q.:gQ'.ll.
_H12 .J:'.;;!S,Q.[11ll E'J9Jl~Ll'L____-~- _______f_4QL......P.es,SQ[@l2IQ,WLrty . -----.---
I.JQL_s.CllJl;meIll<,;tLarges...!QJ2QII~14QQJ.._--- ~4.?E~!. LAQJ~-_--- ------- ---- 1
1....JJ)1~- .----t--- -----"------t:WL----------- --- I
~5~-__--- __.L-- 4(& :
1________ __,______A9j\J~tm~ for itern.~_paiQ.~l!m.jn advanc-L-- Adiustments for Items oaid bugller i~ ~dVanC5L___j
~QO _ Ci"aQwnJ@,,'- I 406 CIN!low,'"'' ~. ~I
~~~f~~~~:~~=_~W!L~~t~QWQ/~f ._ 445~=:'::~ill&~~~-=f~_= 44~=~
~lf~~~:~~-~:~~~~-=~:R~:=:.~--- _~6~B72~3 :~:OSSAMOUNCWUQ:~_ 1- ~3~~~1~1
t' _~QCL..t\..MQu.tn~fALQe"y'Q..R ON.~t1ALLOF BORRQIIVER 1_500 REDUCTIONS IN A1It1Ql.J..NLQUE...IQ...SELLElL. -~----'--
-ZQ..L._~Q.Q.sJLQf...eMILe.51JnQIlU.... I' I 501 EX(;.~.tlL~JW.uc1JQD.5.L-~---r-------
1_:Q~_---PIlllQP.aL.il.!I1.Q1!DlJjJle.~nL-_~ I 56.500.00 LO? Settlement Qjarges to seller (line 1-'&91-- 2..L84~.:..~
>--.~~._f'><,L~JiDilJ'~gOi~.Ll~r1SJ.JQjQctJQ... :r=---- 5S)~~i~~Lll!!s..eIUU-~.- --'
f_2Q1~___---_.- __------L-- I ~5lL.....P..sw.tLQt..E.lLsl~an ..----------l~.~...&.~.J.Q.
I~_=~ .=. --+--- -=-__ '"'- ::~;~-=~~LO" ~86~~6:
r.-2..9.~L. .' . t- -=-::T 506 ~-~
r-:~~~_GllLQlE.QuI1L- i 1~QJ2~Q.+.5..QL.....~\.llty________ __l.9. 400---,_QQ1
~----~------ I r~-- ---------1
l..2Q2.--- __ 5')9 '
i______.__---1IJlli!stments fo' ,Iems u,paIDy.sell~' =4; Ad,,,,,,.n,, fo' ,'em' unpard~e' ----1
~~:::~~~::=-_QJJ~~.1_l~/06 ~---'l13 5~: ::"'- Q!L01l06(oQ!DUQ.~ -=- '17::131
r 2.1L-".'''''''1'''' ---~-- , 512 5,hOQIIIDti___ --_.- --- I
r:Z1~---- ___________ 1513 ---------)
f- 2.14...__ - ~ - - ----t~1.L - -- ----I
rl~-~=~-=====-~=1--~~ :~~ _~~~-I
~2.1L-_------.__. -t --j
l-.~2~__lQ.Ti\~.f'8.IP.llY lEQ!UlQEEQ\lIffi..1 6 ~ 1 7 . 13 ~~~. TOTAL R EDUCT]ON AMQJ.1!iL!l\.!E S E L R-52..&iL iil
I 300. C&H AT S.EJTLEMHJT FROM OR TO BORROWER --- I 600. CASH AT SETTLEMENT TO OR FROM SELLER I
":::;;L~~~om ~~~~LU.ln.e..120\ ~ _~ 6 r 872 . 03 i ~..i1IllilJ.illt due \0 seller (\jIN 4~0) t=63 , 4 4 2-,~0J
..2Ql._J.J:;.~~jlm9u[llsPQllLt1y{~&Lllin.e 22ID- 66 917.. 13, 60 ~m'=~ -'<oe "0) _ . . . _ 53 , .6U---'-l.7 -II
,_:;ill:t_QI\::JJLTQJ,30RR.QWER_..i.?.:..!.Ql603 CASH TO SELLER____~~833 "~~-
--'1
!
Title Express Settlement System
SUBSTITUTE FORM 10>;" SELLER ST,l..TEMEtH The Inform811cn contaIned herein IS Important lax I,,'ormat,on and IS belr1g furniShed \e the "lternal Re/enlJe Service If you ale required to file a return.
a I.Ag!lq€nce pell31ty or elher S3<\CI\On will be imposed on you If IrllS Ilem IS requ;rea 10 be reportea ana IIle IRS deter""'dnes that ',I nas not been lep~rtecJ The Contraot Sales Price descrlbea on
line 4C1 alJOve cunstltules the Gross ProceeJs oll'1ls trans8ction
YD'.' are
fldfno€r
IaN t,.: crovide thp.: settiement agent trea Tax In No' ___)wlth your ccrrect ta:t.payer IdentificatIon n..m"":Der If 'Iou. de. not prJ'.;ide your correct taxpayer identlflcat!on.
sUble.c': t~ c'vll or cnmlf,al penalties lmpo5e~ toy law Under penalt~es of perjury. I 2ertlfy that the number sr,cwn on IhlS s:awtnent IS my correct la:<payel IdentificatIon number
rn, _,_,__1_-__,___ SELLt:R(S)SIGN.\TL!RE(S)
Si:.LiERiSJ NEN fN,IUW'; ADDRESS
SfLLER(S) PII.>! IE NlA1lJERS
(Hi
___(>Iv)
tJ .s, m;PAln~le. I OF [J(JUSP;(; :\"<11 t TIL\'.' lJL\TUJI'\IJ::'<T Fil" ;-;\Il11bCi S ](1(>--\<.) 1 P..'\GE 2
r____--..S_ETT L E ME NT_STAlE:: MEN L-_._.-.EL'{_.lJUD-=.lliSw_______________ Lt&E'Q.Jess~I!~l!illj S~CILl' riDle.Q.Q1Q.ja:Jill,-"jl!rl1.K:;;.~.__ ___ ___ _-OJ
i., L. SETTLEMENT CHARGES. . ~ PAID FROM i PAID FROM I
I--J.Q9=lQTAL SALES/BBOKE~COMMiSSi.QI'1-Q-a~~g.QlLQJj.G~~?~~.Q..,.QQ-:=----------------J' BORROWER'S I SELLER'S ,
1_._.___--12rilSlQ_Q.QLCQffi~Q[Ul1n~HQj!QY!.:L __ , FUNDS AT ! FU~mS AT .
.__ZQL_.2___, --------19-----..---------------------.--isETTLEMENT 1 SETTLEl'v1an I
1___IQ~_______.1Q____ . -----J----------1i
"~:~~-'C;O:::~~:~~~'~~~~CTI;N WITHLO~~U _=-==-~=-=_=__====_==__- -=-__~===I ===_=-
_~Q.J~Q!l_~.fiL.__~'.____ '-" . _ _ ;1= r
U;~~:~::EL .~~-~",~:~~~~f~~~ ~~~~~:i-"l=~QE~ro~c~~~~:~ :;::=t~l _~~56~~QQ~--~~~-~~3
[.._.!2Q_.'j-_6ill2J!@ilQI1L~-.- to Ph11ade~.E~~a...Y_1.:-~_ an.ci?-_LM~.E:S~~' O. c.) 77 ~~~._R i _,1..--.----..-. _.__....,-. i
~QG_Q\&J?NJLf~L ________--..JQ_.Rl1_:!: ~_ad~).2.h:b~_F.io.!'@.r:!Cia__!_J1Q:r.1.9:..~g~___.__.____._~~___J 5 0 -,_QQ. L_ ____ __ _ _ ______
(_Jl!,iZ~_M~l.LrrwJiDDbiL________________ --------__1.________ _____
1.~1QP..Q,_8!"~"BVES.ill'PQSITE'.D V\lLl~l.~DEIlE.QR_~._ ~.~-~~----~_ .. ~ ... _ . _~__~~_~__ .._ ::::-J
r-~1j~?~~~---~-~~~=}~~~~~i~~~~~...~-~~;;~;r~~~-~~~.-.~~I
l~-~~~~~~~~~:~~.QjI.!~~]L-!Q.~1.~~~J21~~<! F~!1~~j_~b..J-fortg<!9~__________..L_RJ___=__~~,.~iL--=_-~__"Q~Q"9l
~-~lLQ~_Q\'meliEQlic.i!..._.__ 63 ! 000 . 00 --, 636. 75 _ __ _ I I !
1~;;~~:~T:~~~~;~:MENTC~::r~<!-"O~~~-"-P"'C9E<!'!-~LQ~ooiS-_~--_.~ I .-I==~~LQ91
[f~~~:~--~~ ;:;Jf~:=:;~~: p~__ -~~=~- -----=~~~~-=-Ln _=2Q~~F-~1~:~t~~j
I ' . I i I
L_14QQ~IQJhL S U:n..I;..M..ENI CHARG_E_S___Li;nteL.QuJL~5.1.Q.LSfill!Q1LU,jlld__2Q2~_c.ttQ.oJ5L~___________L__=L._4_~6_:_~~ L___._ LB _4'?..:..2E3)
HdD CERTIFICATimJ OF BUYER NJD SELLEr,
I ',ave carefully reViewed Hle HUD-1 Seltlemert Stateme~t
'~1 this transactIOn I (urUl€t certtt1lhat I have receIved, acopy:
J~d~k~~ ~" I~,(;t-~~-
Caro!J'f1 Jo NeIdIgh / /-
ar1d bei',ef. it ~s a t~lJe and'iI:::CLrate stater.1Ant of all rerelpts o11(J i.~jsburser-:ler~ts made en m~l aeco/_I'lt or Cy '118
/ "
___c.-,~c<~{~::--;~.' !~_.c:' 0/ ( ________~_
Jirnn'je Lee Ge2lr'J8
the htate of David lJ Laun~~
) ,
/. '\1.-1 t-{ J // -c,~ <" ,;- L. / I
-~"--~!'L~~+--t------'I C
/
C~}:' r:~~iJ.,:J;/ ___
I
\-'JMlNING II IS A CRIME TO KNOWINGLY MAKE FALSE STl\l EMENTS TO THE
UNn LD SlA TFS ON THIS OR ANY SIMILAf< FORM PENAL liES UPON CorNIC liON
C!\N INeL LJDE A FINE AND IMPRISONMENT FOr< DETAILS SF F TITLE 18
US CODE SECTION 1001 !\NO SECl1or, 1010
The HUD.1 Settlement Statement wh'ch I have pepaleo is a
I have caused Or will ca~jse the funds to be disbursed III
~~... (c;c=-.l)~--:--DATE ~-
tlljs t!8~iC;(i{J!':jr~
st
MEMBERS 1st
FEDERAL CREDIT UNION
SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Tota! Principal and .A.ccrued Interest
Interest Earned from 1/1/05 to Date of Death
Name of Joint Owner
CHECKING ACCOUNT:
AccountNumbe~Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/1/05 to Date of Death
Name of Joint Owner
Estate of: DAVID D. LAUVER
Date of Death: 01/31/2005
Social Security Number: 196-48-1940
161524 -00
08/26/1996
$25.00
$.00
$25.00
$.00
None
161524-11
09/08/1997
$900.78
$.00
$900.78
$.00
None
Mr),8~RS 1;~~D~R._.~~ CREDIT UNION
! 1/ / / L I -{rt..A:::_- .
/.. ..f I;. i,r.., L ..... ..-
Denise A. Wolfe (/'
Insurance Services Supervisor
May 9,2005
5000 Louise Drive · PO. Box 40 · Mechanicsburg, Pennsylvania 17()55 · (717) 697-1161 · WW\V.illclllberslst.org
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
, Deceased
No. 21-05-0134
Date of Death 01/31/2005
Social Security No. 196-48-1940
Estate of David D. Lauver
also known as
Carolyn J. Neidigh
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of
the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except
that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory
are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S.
Section 4904 relating to unsworn falsification to authorities.
Attorney: E. Ralph Godfrey, Esq. Signature:
1.0. No.: TIoS-2.. Signature:
Signature: ~,---
Firm: _SALZMANN HUGHES PC
Address: 354 Alexander Spring Road, Suite 1 Address: 148 North East Street
Carlisle, PA 17013 Carlisle, PA 17013
----~._._-
Telephone: 717 -249-6333 Telephone:
Dated: 03/23/2006
Personal ProDertv
Cas h...............................................................................................
Personal Property............................. ....... ...... ....... ..... ....... ..... .......
Stocks/Listed............................................................................... ..
Stocks/C losely Held......................................................................
80 nds.............................................................................................
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable...............................................
All Other Property. ............. ................... ........................................
1,577.78
Total Personal Property.........................................
1,577.78
Total Real Property................................................
63,000.00
64,~!7.781
Total Personal and Real Property.........................
Total Out-of-State Real Property..........................