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Home My WebLink About04-11-06 REAGER & ADLER, PC ATTORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET CAMP Hill, PENNSYLVANIA 17011-4642 717-763-1383 TElEFAX 717-730-7366 WEBSITE: ReagerAdlerPC.com THEODORE A. ADLER + DAVID W. REAGER CHARLES E. ZALESKI LINUS E. FENICLE THOMAS O. WILLIAMS SUSAN J. SMITH SUSAN H. CON FAIR TIFFANY M. CARTWRIGHT PETER R. WILSON JOHN H. PIETRZAK RICHARD J. JOYCE Writer's E-Mail Address:MZercher@ReagerAdlerPC.com +Certified Civil Trial Specialist April 11, 2006 VIA HAND DELIVERY Cumberland County Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013 RE: THE ESTATE OF JAMES B. DAY ESTATE NO.: 2006-00020 PA NO.: 21-06-0020 c:::' To Whom It May Concern: Enclosed please find an original and two copies of the Inheritance Tax Return with regard to the Estate of James B. Day. Please file the originals and return the time-stamped copies to me in the self- addressed, stamped envelope, which I have enclosed for your convenience. I have also enclosed a check in the amount of $30.00 for the filing fees related to this matter. Also enclosed is the Inventory as required. Thank you very much for your courtesy in this matter. If you have any questions regarding the enclosed, please do not hesitate to contact me. Very truly yours, ~~ Monica D. Zercher Legal Assistant MDZ/sam Enclosures cc: Diana C. Simonton (w/enclosures) REV.1500 EX + (6-00) .~.' ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 6 0 0 2 0 COUNTYCOoE" ---vEA~ - - NUMBER- - t- Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DAY JAMES B. DATE OF DEATH (MM-DD-Year) SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD- Year) 1 89- 1 8 - 6 945 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 12/18/2005 04/03/1912 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [X] 1. Original Return D 4. Limited Estate [X] 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received I- Z w C Z o a. Ul w r:t: r:t: o U 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1 .2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due SOCIAL SECURITY NUMBER D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copyofTrust) D 10. Spousal Poverty Credit (date of death between 12-31.91 and 1-1-95) D 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) W l- ll<: ~Ul ur:t:ll<: w~u :J:r:t:g Ua.!O a. < THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS SUSAN H. CONFAIR REAGER & ADLER, P.C. FIRM NAME (If Applicable) REAGER & ADLER P.C. 2331 MARKET STREET TELEPHONE NUMBER 717-763-1383 CAMP HILL PA 17011 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) z o i= <( ..J ~ t- a:: <( u w 0:: 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) (6) D Separate Billing Requested OFFICIAL USE ONLY (1) (2) (3) (4) (5) 5,047.69 ( c-.) 132,500.00 i (8) 137,547.69 13,484.04 (11) (12) (13) 13,484.04 124,063.65 14. Net Value Subjectto Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= <( t- ~ Q. :E o U >< <( t- (14) 124,063.65 0.00 X _ (15) 124,063.66 X .045 (16) 0.00 X .12 (17) 0.00 5,582.86 0.00 0.00 5,582.86 0.00 X .15 (18) (19) 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~~ > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS 1924 KENT DRIVE CITY I STATE I ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2, Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5,582.86 278,94 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 278.94 Total Interest/Penalty ( 0 + 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) A. Enter the interest on the tax due, (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0,00 5,303.92 5,303.92 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; ........................................................................... IZJ 0 b. retain the right to designate who shall use the property transferred or its income; ........................................ IZJ 0 c, retain a reversionary interest; or ...................................................................................................... 0 IZJ d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IZJ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................... 0 IZJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 IZJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 IZJ 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 complete, Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ~I_GNATUR F PERS, ON RESPONY. ,LE FO~, FI~I,~.R R. ETURN D~T7 Q. 0 ., " A./fJ. ~'" ,-.t 'Vy1--f1 uG 3 ,;l 7 Co <L ADDRESS _l SIGNATURE h, F FR~Rj:R OTHER THAN REPRESENTATIVE L f) ~L , ADDRESS [,','! : Z~-~J I I LtiV1tG,f ShULJ:- , (t U h j/' /!--l /1 ? I/- I 71' ( I , Dh !-/1 /(i/J 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. S9116 (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. S9116 (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 PS, s9116(a)(1.2)], The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4,5%, except as noted in 72 P,S. S9116(1.2) [72 P,S, s9116(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. s9116(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-1508 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF DAY. JAMES B. ITEM NUMBER 1. FILE NUMBER 21 06 Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0020 DESCRIPTION VALUE AT DATE OF DEATH 5,047.69 PNC checking account account # 51-4001-5127 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5047.69 REV-1510 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF DAY. JAMES B. FilE NUMBER 21 06 0020 DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER AITACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST VALUE (IF APPLICABLE) 1, Life Estate in real property known as 132,500.00 100. 132,500.00 1924 Kent Drive, Camp Hill, PA 17011 TOTAL (Also enter on line 7 Recapitulation) $ 132500.00 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. (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 DAY. JAMES B. FILE NUMBER 21 06 0020 ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1. MUSSELMAN FUNERAL HOME & CREMATION SERVICES, INC. 7,086.00 2. GINGRICH MEMORIALS 2,315.00 B. ADMINISTRA TIVE 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 Reager & Adler, P.C. 750.00 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 Cumberland County Register of Wills 84.00 5, Accountant's Fees 6. Tax Return Prepare~s Fees 7. Help-U-Sel/ - Real Estate Commission 1,500.00 8. Reager & Adler, P.C. - Attorney's fees in connection with real estate closing 125.00 9. Notary Fee 5.00 10. Realty Transfer Tax 1,325.00 11. Tax Certification 10.00 12. Net 2006 County/Twp taxes due from estate 93.79 13. Cumberland Law Journal - Legal advertising 75.00 14. The Sentinel - Legal advertising 115.25 TOTAL (Also enter on line 9, Recapitulation) $ 13484.04 Debts of decedent must be reported on Schedule I. (If more space is needed, insert additional sheets of the same size) '''"''''''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER DAY JAMES B. 21 _06 0020 RELA TIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1,2)] 1. Diana C. Simonton Lineal 62,031.83 2. Jacqueline M. Gloss n/k/a Jacqueline Fetterolf Lineal 62,031.83 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 1. B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: Q,~QO.OO Discount: 278.94 Interest Table Year Days Delinquent I this time period I Balance Due this year -r Before 1981 1982 1983 1984 1985 1986 1987 1988 through 1991 1992 1993 through 1994 199~ through 1~98 1999 2000 2001 2002 2003 2004 Interest this period - J T ! 1 TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17,1996: Penalty: -' ~ I~,!' mi ..HW-' i1'~ ~i~ i!L&!.it lIDI~11 cttta ill~stct1tttttt OF JAMES B _ DAY I, JAMES B. DAY, of Lower Allen Township, cumberland i County, Pennsylvania, make, publish and declare this as and f~r my i ! Last will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I give and bequeath my household furniture ~nd f I furnishings, my personal effects, jewelry, clothing, automobiles i and all other tangible personal property, including all insur~nce I i policies covering those items, to my wife, EVA M. DAY, provided ! she survives me by sixty (60) days; or, if she does not so survive me, to my children who survive me, to be divided between or among them equally as they may agree. SECOND: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, unto my wife, EVA M. DAY, provided she survives me by sixty (60) days. THIRD: Should my wife, Eva M. Day, predecease me or die on or before the sixty-first (61st) day following my death, I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any roperty over which I hold power of appointment and together with any insurance policies thereon, in equal shares, to my children, DIANA C. SIMONTON, and JACQUELINE M. GLOSS, provided that should r -y-J ~ any of my children predecease me, I give and bequeath ,such child's share unto his or her issue per stirpes by representation, and if there be a failure of same, then I give and bequeath such deceased child's share to my surviving children as provided herein. -......""'''...-..........) ---- /' ---.... law and by other provisions of this Will, I give the fiduciaries FOURTH: In addition to all powers granted to them by acting hereunder the following powers, applica,ble to all property, exercisable without court approval and effective. until actual -- _._____~~...l_"___"_~,. ._..,...~__.._~ ..1________ distribution of all prop~rty: (A) To sell at public or private sale, or to lease for any period of time, any ~eal or personal property and to give options for sales, exchaqges or leases, for such prices and u~on such terms (including cr~dit, with or without security) or COID- ditions as are deemed prqper. This includes the power to giv~ i I , legally sufficient instrUments for transfer of the property and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estat. and to enter into agreements concerning the partition, subdivisio~, improvement, zoning or management of real estate and to impos~ or I i extinguish restrictions on real estate. (e) To compromise any claim or controversy and to i abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduci- aries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and o~her tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance.tax laws. ,/0 (G) To make distributions to my herein named benefici- =- aries in cash or in kind or partly in each. ~ (H) To borrow money from themselves or others in order <::> to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for . ----.---.-'-----., ~-in~tment purposes. (1) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock 2 !:i 1\ ., ;! ~ I 1\ ~ I ~ \ ~,\ ~ j ,Ai ;'i ,n - ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise any other rights which they may have under the plan, in whatever manner they consider advisable. FIFTH: I direct that all inheritance, estate, transfer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the princi- pal of my residuary estate. SIXTH: All interests hereunder, whether principal or income, which are undistributed and in the possession of the fiduciaries acting hereunder, even though vested or distributable, shall not be subject to attachment, execution or sequestration for any debt, contract, obligation or liability of any beneficiary, and furthermore, shall not be subject to pledge, assignment, conveyance or anticipation. SEVENTH: I nominate and appoint my wife, EVA M. DAY, Executrix of this, my Last Will and Testament. In the event of the qeath, resignation or inability to serve for any reason what~oever of the said Eva M. Day, I nominate and appoint my , chilqren, DIANA C. SIMONTON and JACQUELINE M. GLOSS, or the , surv~vor thereof, Co-Executrixes of this, my Last Will and Test~ment. I direct that my Executor or Executrix, as the case may fue, and their successors, shall not be required to post i i secutity or a bond for the performance of their duties in any J jurisdiction. I IN WITNESS WHEREOF, I have hereunto set my hand and seal to tilis, my Last Will and Testament, this ;20 day of jV!O\.'Yc.. h 19891. rvL~P-/ A ~q,Aj B. D~y (SEAL) ...... 3 ~",' Signed, sealed, published and declared by the above- named Testator as and for his Last Will and Testament In our presence, who, at his request, in his presence and in the presence of each other, have hereunto subsc~ibed our names as attesting witnesses. Address ?~~ [ . It}~o~e~} c~/? -i--,; _€' jJ ,(9a'2~4 - Address 4 ulChoice TM " PART I Pre-Need and Indivi~ual'Jrust Agreement ("The Agreement") and the ~ur~haser (hereinafter "You") '. , """ . , J This Agreement is made this 'i Musselman FuneralH & Crematio Se olDe 324 Hummef~Jbs,lnC. P.O. ~ 137 lenroyne, R6J~~,~~r~ , ~I,~ tt~, :~l'~ 'T .:..) i;.;'" t...i(~\,\-l /"'\1 {~~~t!1', ,.,}"~' J ~:'J ~ :)J : ;:"'>NAME. . ,.,.", ,. ,." , 0/0/8 1 q ,j~ \,! ' t,<,~- \\T- iJ k' , <.' {( ~,;,\ r'; ~4; (l t", H . ' 'ADDRESS I by and between DATE Funeral Home Address f, ,,'~.,-;-/"',',; _,_ ~, ,(,\, ' , j', ' , '. ,- ,,' ,/,:." ("',l.' ..;t'".,.';~ ~ (,: ~ ~ ~,~~ ~',' ,~-+ . ',SOCIAL SECURITY# ; '-'"{ /' ;' j , l t.' , , (M). (F) for the Benefit of (if Beneficiary is different from the Purchaser) NAME 0/0/8 SOCIAL SECURITY # (M) (F) ADDRESS ~ ANNUAL FINANCE Amount Financed Total of Payments Total Sale Price PERCENTAGE CHARGE The amount of credit The amount You will have paid after The total cost of Your purchase RATE The dollar amount the provided to You or on You have made all payments as on credit, including Your down,., credit will cost You. Your behalf. scheduled. payment of $ l ..,' ,"j' "1 ,;", The cost of Your credit (". " .' 'c' . as a yearly rate. 0.00% $0.00 / ','.", $ $ $ " t: .' t '" . If not';paid in full, Yo;ur ,~(wment Sctldule will bJ: No. of payments Amount of Pa ment~ When Payments:'Are Due Itemization of Amount Fin~anced Cash Price $ Monthly beginning ~ ----o;:,y- ~ $ -;.-'_Cl' in:; ,_'r";~"'" ~..,_. <--",~,"'. _.-'...:,:. ,.... T otaLDownpayment -$ See reverse side for any additional information about nonpayment and default Unpaid Balance of Cash Price & Amount Financed = $ You hereby agree to buy and the Funeral Home hereby agrees to sell the funeral goods, ('~~rchan9ise") and funeral services ("Services") which are described in itemized list attached as Exhibit A for a Total Sale Price of $/.' ,,:i ''t _r, :;,:::. r- .~.,., , --- Arrangement Fee: $ t:';:, . This fee is separate and distinct from the Total Sale Price and will be deposited in the Trust. After payment of the Total Sale Price and all other payments required to be made, the Funeral Home will render, upon the death of the Beneficiary, all the Merchandise and Services described on attached Exhibit A. This Agreement is subject to the terms and conditions shown above and on the. reverse side of this page, which You have read and accepted. You hereby elect that this Agreement shall be: "t'lJ Irrevocable upon payment in full of the Total Sale Price 0 Revocable by You at Your option at all times You and the Funeral Home agree that the prices shown on Exhibit A are: ~, Guaranteed by the Funeral Home upon timely payment of the Total Sale Price 0 Not guaranteed by the Funeral Home EXCLUSION OF WARRANTIES: THE FUNERAL HOME IS NOT PROVIDING TO YOU ANY WARRANTY OF MERCHANTABILITY OR WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE FOR THE MERCHANDISE. The only warranties You are receiving for the Merchandise are the express written warranties, if any, which are provided by the manufacturers of the Merchandise sold to You under this Agreement. Only the manufacturer shall have any liability to You under such warranties. You and the Funeral Home have signed this Agreement on the day and year written above and intend to be legally bound. By signing this Agreement, the Funeral Home, as agent for the Purchaser, hereby agrees to establish an individual trust with the Trustee under the Master Pre-Need Trust Agreement (the "Master Trust") between the Funeral Home and the Trustee (the "Trust"). . ' ,,OJ i;~ .,.,.,.,,:".~ ;:,--.., .',J ',(. .~ t..f:......:..._...' '.I,. l., 'f t ,', ,~ " ~ /': ,IL,,} (_. .,"/ j FUNERAL HOME NAME / rf ~ '~. ~" , PURCHASER by l:)/'t:i;;,::f I ::! ~i~-rl:! ,., P~,.,~{ )!.A:A . LICENSED FUNERAi.:DIRECTOR '~.,..~_. """....,1. } 11-' ~ ';, ~' j' I ,:';' " ,i t.J""''' ~,..\",' ~- ;'~~ _ r ~.~.c' LICENSE NO. .',-. <1""-, ... .~'li." l +", SUBJECT TO TERMS AND CONDITIONS ON REVERSE SIDE You acknowledge receipt of a completed copy hereof. You, the buyer, may cancel this transaction at any time prior to midnight of the third business day after the day of this transaction. See the attached Notice of Cancellation form for an explanation of this right. P ART II FOR OFFICE USE ONLY The Trustee hereby accepts the Trust herein created for the Beneficiary under the Master Pre-Need Trust Agreement with the Funeral Home. By: AUTHORIZED PERSON DATE BANK White Copy - PFDA Yellow Copy - Funeral Home Pink Copy - Purchaser (PFT Form 501-97-11) li'p.._ - j, OMS NO 2502 026 ....:-. - 5 ,r A. B. :: OF LOAN: "~.'fI_ 1.DFHA 2.DFmHA 3. ~CONV. UNINS. U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 4.DVA 5. DCONv. INS. 6. FILE NUMBER: . r 7. LOAN NUMBER: SETTLEMENT STATEMENT 06-089 0000155325 8. MORTGAGE INS CASE NUMBER: OLD MORTGAGE INS CASE NUMBER: 661/F/6.375% SKS C, NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1,0 3/98 (GREEN.JW.PFD/06-089/11 ) D, NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Jeffrey W. Green Diana C. Simonton American Home Bank 1924 Kent Drive Jacqueline M. Fetterolf Camp Hill, PA 17011 G, PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1857112 I. SETTLEMENT DATE: 1924 Kent Drive Midstate Abstract Company Camp Hill, PA 17011 March 9, 2006 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 2331 Market Street Camp Hill, PA 17011 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 1DO. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 132,500.00 401. Contract Sales Price 132,500.00 1 D2. Personal Property 402. Personal Prooerty 103. Settlement Charqes to Borrower (Line 1400) 4,814.20 403. 104, 404. 105. 405. Adiustments For Items Paid Bv Seller in advance Adiustments For Items Paid By Seller in advance 106. Cityrrown Taxes to 406. Citvrrown Taxes to 107, County Taxes 03/09/06 to 01/01/07 417.17 407. Countv Taxes 03/09/06 to 01/01/07 417,17 108. School Taxes 03/09/06 to 07/01/06 352.64 408. School Taxes 03/09/06 to 07/01/06 352.64 109. SewerlRefuse Proration 03/09/06 to 04/01/06 21.85 409. Sewer/Refuse Proration 03/09/06 to 04/01/06 21,85 110, 410. 111, 411. 112. 412. 120, GROSS AMOUNT DUE FROM BORROWER 138,105.86 420. GROSS AMOUNT DUE TO SELLER 133,291,66 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest monev 1,000.00 501. Excess Deoosit<See InstructionS) 202. Principal Amount of New Loan(s) 106,000.00 502. Settlement Charaesto Seller (Line 1400) 3,475.96 203. Existing loan(s) taken subject to 503. Existinqloan(s) taken subiect to 204. 504. Payoff of first Mortgage 205. 505. Payoff of second Mortaaae 206. 506. 207. 507. (Deposit disb. as oroceeds) 208. 508. 209. 509. Adjustments For Items Uno aid By Seller Adiustments For Items Unoaid By Seller 210, Citvrrown Taxes to 510. Cityrrown Taxes to 211. County Taxes to 511. County Taxes to 212. School Taxes to 512. School Taxes to 213, 513. 214. 514. 215. 515. 216. 516. 217. 517. Escrow for Inheritance Taxes to Reaaer & Adler, P. 10,000.00 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 107,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 13,475.96 30D. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower (Line 120) 138,105.86 601. Gross Amount Due To Seller(Line 420) 133,291.66 302. Less Amount Paid By/For Borrower (Line 220) ( 107,000.00) 602. Less Reductions Due Seller (Line 520) ( 13,475.96 303. CASH ( X FROM) ( TO) fJORROWER 31,105.66 603. CASH ( X TO) ( FROM) SELLlER 119,815.70 The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein. Borrowe' ~t()hj) Jeff(J .' re n I Sell" ~C~ Diana C. Simonton ~I~ ~~..U./ " Jacqu . e M. Fetterolf ~-<..{ ~ - L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price ,-. $ @ % 1,500.00 PAID FROM PAIO,FROM Division of Commission (line 700) as Follows: BORROWER'S SELLER'S 701. $ 1,500.00 to Help-U-Sell FUNDS AT FUNOS AT 702.$ to Help-U-Sell SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 1,500.00 704. to /,lOD. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Oriaination Fee % to 802. Loan Discount % to 803, Appraisal Fee - $350,00 to Julie A. Stoffer POC: Buyer $325.00 25.00 804. Credit Report to Credco Instant Merge 21.00 805. Lender Administration Fee to American Home Bank 390.00 806, WebPostina to SwiftView POC:Lender $5.00 807. Flood Certification Fee to 1 st American POC:Lender $14.50 808, AUS to FHLMC POC:Lender $21.20 809. Fraud Guard to Sysdome POC:Lender $11.00 810, Tax Service Fee to 1 st American 96.00 811. Yield Spread Premium by AHB to Integrity Bank POC:Lender $1643.00 812, Broker Application Fee to Integrity Bank 345.00 813. 814. 815. 816. 817. 818. 819. 820. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 03/09/06 to 04/01/06 @ $ 18.770000/day ( 23 days %) 431 .71 902, Mortgage Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 years to Insurance Co. POC $331.00b 904, 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 3.000 months u ~ $ 27.58 per month 82.74 1002. Mortaaae Insurance months '~ $ per month 1003. CitvfTown Taxes months ~ $ per month 1004, County Taxes 2.000 months (I $ 42.58 oer month 85.16 1005. School Taxes 10.000 months @ $ 92.21 per month 922.1 0 1006, months ~ $ oer month 1007. months ( $ ner month 1008, Aagregate Adjustment months I $ oer month -308.26 1100. TITLE CHARGES 1101. Settlement or Closing Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104, Title Insurance Binder to 1105, Electronic Document Prep. to Midstate Abstract Company 50.00 1106. Closinq Service Letter to Midstate Abstract Company 35.00 1107. Attorney's Fees to Reager & Adler, P.C. Deed Prep 125.00 (includes above item numbers: ) 1108, Title Insurance to MIDSTATE ABSTRACT 1 023,75 (includes above item numbers.1102, 1103 & 1104 ) 1109. Lender's Coverage $ 106,000.00 1110. Owner's Coverage $ 132,500.00 1,023.75 1111. Endorsements 100, 300, 8,1 to Midstate Abstract Company 150.00 1112. Notary Fee to Midstate Abstract Company. 10.00 1113. Notary Fee to Midstate Abstract Coinpany 5.00 1114. Overnight Fees & Handling to Midstate Abstract Company 15.00 1115. Wire Transfer Fee to Midstate Abstract Company 10.00 1116. 1117. 1118, 12DD. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 40.50; Mortgage $ 64.50; Releases $ 105.00 1202. City/County Tax/Stamos: Deed 1,325.00' Mortaaae 1,325.00 1203. State Tax/Stamps: Deed 1,325.00; Mortgage 1,325.00 1204, 1205. . 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survev to 1302. Pest Inspection to Sudden Death - Treatment POC:Seller $948.70 1303. Tax Certification Fee to Bonnie K. Miller, Treasurer 13-23-0547-165 10.00 1304. 2006 CountvfTownshio Taxes to Bonnie K. Miller, Treasurer 13-23-0547-165 510.96 1305. 140D. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 4,814.20 3,475.96 By signing page 1 of this statement, the signatories acknowledge receipt or a completed copy of page 2 of this two page statement. ]jj, ~ Midstate Abstract c7any . . Settlement Agent Certified to be a true copy. ( 06-089 I 06-089 /11 ) Cumberland County, Pennsylvania INVENTORY Estate of DAY, JAMES B. No.21 06 0020 also known as , Deceased Date of Death 12/18/2005 Social Security No. 189186945 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 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 Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IfWe verify that the statements made in this inventory are true and correct. IfWe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: SUSAN H. CONFAIR 1.0. No,: 70241 Address: REAGER & ADLER, P.C. CAMP HILL Person"', Representativa: -h <1"} , ,/- - .; / - "- J' _ /li,' --<'.4~ ~ . L IVi/L() C. ' ,(,1')'[.,1', ~ / (, \ (IJft(.~z,-('l.<--k"~ /l{ ~L&':&Y~r ~ J Dated 3, <-.:::).. c; - (~ ~ PA 17011 Telephone: 717-763-1383 Description Value Stocks & Bonds Closely-Held Corporation, Partnership or Sole-Proprietorship Mortgages & Notes Receivable \, r:') Cash, Bank Deposits, & Misc. Personal Property Ul co PNC checking account account # 51-4001-5127 5,047.69 Real Estate Total (Attach Additional Sheets if necessary) 5,047.69 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Continuation of Inventory DAY, JAMES B. 21 06 0020 Description of Inventory PaQe 1 Description Value Re Subtotal $ Grand Total $ 5,047.69