HomeMy WebLinkAbout08-22-06 (2)
217 REV-1 500 OFFICIAL USE ONLY
REV-1500 EX (6-00) COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN I \)01\ VJ
DEPT,280601 FILE NUMBER 21-05-~
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT -
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I- Zeiqler Sara J. 168-24-2765
z DATE OF DEATH (MM-DD-YEAR) IDATE OF BIRTH (MM-DD-YEAR)
w THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
C
W 11/17/2005 4/5/1915 REGISTER OF WILLS
0
w (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
C
w 0 1. Original Return 0 2. Supplemental Return 03 Remainder Return (date of death prior 10 12-13-82)
....
<C en 0 04a 05
I<: ;;: I<: 4. Future Interest Compromise (date of death after 12-12-82)
u Q. U Limited Estate Federal Estate Tax Return Required
w 0 0
:r 0:: ....J 0 0
U Q. m 6. Decedent Died Testate (Attach copy of Will) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 1 8 Total Number of Safe Deposit Boxes
Q.
<C 0 010 011. Election to tax under Sec. 9113(A) (Attach Sch 0)
9, Litigation Proceeds Received Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
I- ....i.tHI$.$gQf@f.lMQ$'t~gqQI\IlAl..gt~q;A@Q9RRg$eQf.lQ~Nq~.ANqqQNf@~N'tIAl...fA*iNfQRMAT@N.$l-lQQW:).$~t#R~gT~()fQ;.....'"
z NAME
w COMPLETE MAILING ADDRESS
c 5 South Hanover Street
z Robert G. Frev
0 NAME (If Applicable)
D.. FIRM Carlisle, PA 17013
en
w Tilev
0:: Frev &
0:: TELEPHONE NUMBER
0
0
717 -243-5838
OFFICIAL USE ONLY
1. Real Estate (Schedule A) (1) 179,000 r- ,
2. Stocks and Bonds (Schedule B) (2) NONE -
3 Closely Held Corporation, Partnership or Sole-Proprietorship (3) NONE ---.
4, Mortgages & Notes Receivable (Schedule D) (4) NONE
5. Cash, Bank Deposits & Miscellaneous Personal Property ...-
(5) 425,552 )
(Schedule E)
6, Jointly Owned Property (Schedule F) (6) NONE ,
z Dseparate Billing Requested " )
0 . .._-
i= ,.t'; 'f
<( 7. Inter-Vivos Transfer & Miscellaneous Non-Probate Property
...J (7) NONE
::l (Schedule G or L)
l-
ii:
<( 8, TOTAL GROSS ASSETS (total Lines 1-7) (8) 604,552
0
w
0:: 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 42,038
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1,085
11, TOTAL DEDUCTIONS (total Lines 9 & 10) (11) 43,123
12. NET VALUE OF ESTATE (Line 8 minus Line 11) (12) 561 ,429
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not
been made (Schedule J) (13) 0
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 561 ,429
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate ,or transfers under Sec.9116 (a)(1.2) X .0 - (15) 0
Z
0
i= 16. Amount of Line 14 taxable at lineal rate 561 ,429 X .0 45 (16) 25,264
<
I-
::l
D.. .12 0
::!: 17. Amount of Line 14 taxable at sibling rate x (17)
0
0
>< rate x .15 (18) 0
< 18. Amount of Line 14 taxable at collateral
I-
19, Tax Due (19) 25,264
200 !1~~~~~I~~~E[II~Iy'cjQ~~E['~E[QQE[$TIIN~~It{E[f~N~I~fl~NI,~~E~~~~Ni~N't,
??aJ;~QRE:TQAN~WI;RAl..;L.:Q.l.)J;$J]QN~QNRI5VI;RSE:SU)gANPRI;QHgQKMA"H~~
ece en s omple e ress:
STREET ADDRESS
20 Dewalt Drive
CITY I~TATE IZIP
Mechanicsburg PA 17055
217
Zeigler, Sara J.
o
d
t' C
I t Add
Tax Payments and Credits:
1.
2.
Tax Due (Page 1 Line 19)
Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
(1)
22,000
1,100
C. Discount
Total Credits (A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
4.
Total Interest/Penalty ( D + E)
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 r;::fund
(3)
o
5.
(4)
(5)
(5A)
(5B)
AGENT
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
168-24-2765
25,264
23,100
o
2,164
Make Check
to: REGISTER OF
2,164
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1.
Did decedent make a transfer and:
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;
c. retain a reversionary interest; or
d. receive the promise for life of either payments, benefits or care?
If death occurred after December 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?
Did decedent own an "in trust fo(' or payable upon death bank account or security at his or her death?
Yes
o
o
o
o
o
o
2.
3.
4.
Did decedent own an Individual Retirement Account, annuity or other non-probate property which
contains a beneficiary designation?
o
o
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
No
o
o
o
o
o
o
ADDRESS
DATE
f~JI,.tJ~
5 South Hanover Street 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 PS. Section 9116 (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. Seclion 9116 (a)(1.1 )(il)]
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. Section 9116(a)(1.2)).
c "C' (,
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 PS Section 9116(1.2) (72 PS Section 9116(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 PS Section 9116(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
217
REV-1502 EX.. (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
ZeiQler, Sara J. 21-05-126
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
1.
DESCRIPTION
House and lot of ground known as 20 Dewalt Drive, Mechanicsburg, PA 17055
VALUE AT DATE
OF DEATH
179,000
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
179,000
217
REV-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ZeiQler, Sara J.
FILE NUMBER
21-05-126
Include the proceeds of litigation and the date the proceeds were received by the estate.
All prooertv iointlv-owned with riaht of survivorshio must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1 Cash on hand and safe deposit box
2 PNC Certificate of Deposit No. 40-0172999 (Account #21001010560)
3 PNC Certificate of Deposit No. 40-0172734 (Account #21001010561)
4 PNC Certificate of Deposit No. 40-0172593 (Account #21001010564)
5 PNC checking acct. No. 5070073531
6 PNC savings acct. No. 5080016696
7 Liie insurance payable on the life of Clyde D. Zeigler
8 Insurance proceeds on 1984 Chevrolet (destroyed in automobile accident)
9 Unclaimed property held by State of Delaware (MetLife stock proceeds)
10 Real Estate tax proration from HUD-1 settlement statement
11 Miscellaneous personal property sold at auction
12 Highmark Blue Shield refund
13 Automobile insurance refund
14 Disability payment received prior to death
15 Certificate of deposit interest paid prior to death
16 Insurance payable on claim against Clyde Zeigler
32,313
40,018
25,057
40,093
860
229,518
2,500
1,810
621
528
987
159
121
558
409
50,000
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
425,552
217
REV-1511 EX+(12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Zeiqler, Sara J.
21-05-126
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers Funeral Home 13,680
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees 10,000
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 487
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Expenses in connection with real estate sold 17,768
8. Advertising, Cumberland Law Journal 75
9. Advertising, The Sentinel
10. Bank fee for checks 28
11.
TOTAL (Also enter on line 9 Recapitulation) $ 42 038
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03) 217
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
ZeiQler, Sara J. 21-05-126
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Delinqent bill to Penn Waste, Inc.
1,085
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,085
217
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Zeialer Sara J.
NUMBER
I.
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
Do Not List Trustee(s)
21-05-126
AMOUNT OR SHARE
OF ESTATE
1 Nancy J. Dellinger
Daughter
100%
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
$
o
(If more space is needed, insert additional sheets of the same size)
Expenses of Real Estate Sold
Expenses of sale from HUD-1 settlement statement
Cleaning supplies and miscellaneous repairs
Oppel Oil
Repairs
Pumping septic tank, termite & water test/treatment
Total Expenses
14840.68
114
589
178
2046
17767.68
JAN-30-2006 21:06
PNCBANK
412 768 3458
P.Ol
o PNCBAl'K
January 31, 2006
Frey & Tiley
Attn: Robert G Frey
5 S Hanover St.
Carlisle, PA 17013
scp
RE: Estate of Sara Jane Zeigler (Deceased)
SSN: 168.24-2765
DOD: 11-17-2005
Dear Sara Jane Zeigler:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Certificate of Deposit
Account #21001010560 Established 12-30-1991
CLYDE D ZEIGLER OR
SARA JANE ZEIGLER
DOD balance: $40,000.00 + $] 8.35 accrued interest
Account #21001010561 Established 01-10-1992
CL YDE D ZEIGLER OR
SARA JANE ZEIGLER
DOD balance: $25,000.00 + $57.36 accrued interest
Account #21001010564 Established 02-10-1992
CL YDE D ZEIGLER OR
SARA JANE ZEIGLER
DOD balance: $40,000.00 .jo $93. \0 accrued interest
CheckJng Account
Account #5070073531 Established 04-06-1992
CLYDE D ZEIGLER
SARA J ZEIGLER
DOD balance: $860.06 + $0.00 accrued interest
Page lof2
JAN-30-2006 21:06
PNCBANK
412 768 3458
P.02
Savings Account
Account #5080016696 Established 10-01-1993
CLYDE D ZEIGLER OR
SARA JANE ZEIGLER
DOD balance: $229,517.54 + $1.89 accrued interest
Safe deposit box
The decedent maintained safe deposit box #1514. It was in two names.
CL YDE D ZEIGLER
SARA JANE ZEIGLER
It is located at:
~echanicsburgBranch
2 East Main St.
Mechanicsburg, P A 17055
717-691-4011
Please note that this office only provides date of death balances for deposit accoWlts
(lRAs, CDs, Checking and Savings accounts). We do Dot process any financial
transactioDs or provide statements. If you need assistance with any of these items,
please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
Erica L Schlegel
1-800-762-1775
P7-PFSC-04-F
500 First Ave.
Pittsburgh PA 15219
Mc:mber FDIC
Page 20f2
TOTAL P.02
OMB NO. 2502"'()265 =it
A. B. TYPE OF LOAN:
U.S. DEPARTMENT OF HOUSING'" URBAN DEVELOPMENT f.OFHA ZDFrnHA 3. ~CONV. UNINS. ".OVA 5. DcoNV. INS.
6. ALE NUMBER 17. LOAN NUMBER:
SETTLEMENT STATEMENT 20060f0297.PFD 851886622
8. MORTGAGE INS C\SE NUMBER:
C NOTE: ihia ronn is fumishftd to giIIs)OU a B1atement of actual stlltlamGllt 00BIa. Amounts paid 10 and by the llelltarnent agent 8lU shoW/),
Items mar#c&{l '1POC:r ~Ie pBid outside /tl& dOllIng; they 8Ie shown hem for InfbtmsJional putp0S8S and am nor lrIc1uded in "'8 Iobl/s.
1.0 ~ {i00801CI25J1.PF'Ilt2llIlII01ll217.P1'OI:lIl1
O. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF' LENDER:
Ro!Jert F. O'Brien Estal8 ot Sara Jane Zeigler ABN AMRO MortgagA Group. Inc.
13 Dewalt Drive 6300 fnlel1il'$t Dnve
Mechanicsburg. PA 17055 Ann Amor, Ml 48108
SSN: 158--44-2276
G. PROPERTY Loc...\110N: H. SETTlEMENT AGENT: 20.1747090 I. SETTLJ;MENT DATE:
20 Dewalt Drille ~de Abstract & Settlements. U.c
Cartisle, PA 17013 Janu8/}' 27. 2006
Cumberland County. Pennaytvanla PLACE OF SETTLEMENT
Parcel No. 3S-16-107()'{)65 101 Front Street PO Box 426
Boiling Springs. PA 17007
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. CoI'Itrac:;t Sales Price 179.000.00 401. Contract Sales Prioe 179.000.00
102. Personal Prooertv 402. P8~naIP~bertv
103. Settlement Ct\:J-rtiM to BCIn'O'Ner lline 1400\- 5745.35 403.
104. 4M.
105. 405.
Adjustments For Imms Paid BII Saller In adwooe Adiustments For ItGms Paid 8vSellerin Bdvanoo
106. CitvtTmm Taxes 10 406. CilvfTown T_ to
107. CounlvT8lIIlS to 407. CounlV Taxes to
108. Sehoo/ T8lCell 01nTI08 to 07IU1106 528.10 408. School T alC.M 01127106 10 07101106 528.10
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM 8ORROWER 185.273.4S 420. GROSS AMOUNT DUE TO SEL~ 179.~28.10
200. AMOUNTS PAID BY OR .. 8BWJ' OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deoosit or earnest money 1.500.00 501. EJ<<:ess Deoosit (See Instructions)
202. Principal Amount of N4IloIII...o<InI'\ 95 ooo.OD 502. Settlement CfI&roes 10 Saller (Une 1400\ 14815.00
203. ElIis1ina !oan(G\ taken subiect to 603. existinG !oan(s}lal<eo llubied to
204. 504. P8~ of first Mongage
205. 505. PSl/Off of second Llol1llaae
208. 506
207. 507. IDeoolil diBb. as DrcceecI&f
208. 508.
209. 609.
Adiusfmtlntl For It9ms UIIIJIJid BII Seller Adiuslmflnts For Items Unaald Bv- Seller
210. CltvlTown TBlCies to 610. CitvfTown TaleS to
211 Counlll T&Xe6 01101106 10 01/27106 25.68 511. Counl\lT~ 01101106 to 01/27/06 25.68
212. School TalC8& to 512. School TfJllell to
213. 513.
214. 614.
215. 515.
216. 516.
217. 617.
218. 618.
219. 519.
220. TOTAL PAID BY1FOR BORROWER 96.525.68 520. TOTAL REDUCTION AMOUNT DUE SEilER 14.640.68
300. CASH AT sem...ellENT FROIIITO BORROWER: 100. CASH AT 8ET11...EIIENT TOJFROM SELLER:
301. Gro6& Amount Due From 8on'cw8r rUne 120\ 185.273.46 601. Gross Amount Due To Seller CUne 4201 179.526.10
302. Less AmoLlllt Paid Bv/For ~r Cline 220) ( 96,525.88 802. Less Reductions 0.... Seller rLine 520\ 14,840.68
303. CASH ( X FROM J( TO) BORROWER 88.7A7.77 603. CASH ( X TO)( FROM J SELLER 164.687.42
The unde(signed hereby acl<nowledge receipt of 8 oompl8lBd copy of pageG 1&1 of tlis sta\ement & ~y attachmenbs retemx/ to herein.
Borrower !?~i1({~/I/(~
Robert F. C1 . .
Sel~r;hSaraJan:r~ .~
/~ Nantfi..J~tv>. '&zlf
P.;.2
L. SETTLEMENT CHARGES
700. TOTAl COMMISSION 8aMd OCt Pnc. $ ft % 12 530.00 PAID FROM PAIOFIlOU
DNiSlOfl of n (rille 700J as Follows: IlORROWER'8 8alER'S
701. S 12,530.00 tQ Cenb'D1 Stille Really FUNOSA'r' FlJIlD6 AT
702.$ to S811ElolENT 8ETn.ElMENT
703. Co/Mlission Paid al Settlen&1t 12,530.00
704. Transaction Fee to Central Slate ReoIIty 100.00
800. /TEII8 PAYABle IN CONNECTION WIllI LOAN
1801. loan Orioination Fee " to
802. Loan Discount 1.??oo % to Cody Financial Servioae. Inc;. 950.00
803. Appraisal Fee to Cody FlI1lII'IcIaI MoI1gage ServicM, Ine 300.00
804. Credit Report to Cody Financial Mor1gage Services, Ine 60.00
806. Proceaaing Fee to Cody Fil'\8llci81 MortQege SelviGee, Inc 200.00
806. lender Admin Fee to ABH AMRO MOl1IlllOe Gmuo, Inc. 550.00
807. EsaowWlliverFee to ASN AMRO MOItgaae G/1)f.Ip.lne. 237.50
80s. De, Prom Pd BvABN AMRO to Codv Financial Mortgage ServicM, Ine POC:B 1900.00
809.
810.
811. ,
toO. ITEMS REQUIRED BY U:NDER TO BE PAlO IN ADVAHCE
901. l~reGCFR)l1l 01J27J06 10 D2J01106 @ $ 16.820000/day ( 5 days %) 84.10
902. Morm_ Insurance Pnlmium for monlh6 10
903. Hazard In~ranoe PllWIium for 1.0 veal'5 to
9004.
905.
1000. RESERVES DEP08fJB) WITH lENDeR
1001.~ln6~ months $ per monltl
1002. Uorfn_ln$~ce monthtt $ per monlh
1003. Ci1vTTown T_ monltls $ Del' mon'"
1004. County T<<xee months $ Der monlt1
1005. School T~ months @ $ per monlh
1006. months C S ocr monUt
1007. monlhs @ S per month
1008. AnaI'l!lQ3Ie AdiuS1ment months a s permonlh
1100. nne CHARGES
1101. Settlement or Closing Fee to
1102. Ab6tr.lCt or Title Seetch to
1103. TItle EYamination lD
1104. Tille Insurance Binder to
1105. I)o(;ument PreDlll"lltiorl 10
1106. NotanI Fee6 ID NO CHARGE
1107. Attorney. Fees to
finciUde8 above item numbers: J
1108. TIUe Insurance .... l$ltAI:itIe A.b$lrGct & SetlIemenIu llC 1 263.76
(jnr;ludes abo1te item numbers: )
1109.lendel"t; COWt&ge S 95.000.00
1110.~('Cove~ $ 179.000.00 1,253.75
1111. Al TA EndofgemenlB lD LakMide A.b&tract & S8lIJemenlz, LlC 100,300,8.1,710 200.00
1112. lalc88ide AbsIract & Seltlemenlz, LlC
1113.
1114.
1115. OVemiCIfit Dellverv to lakeside Abalract & 5etI1ements, LlC 15.00
1116.
1117. HeeIlng Oil 10 S.M. 00Del POC:S588.89
1118. El8dricaJ R8f)air to HerSIloc::lW PI.)l;:~.DO
1200. GOVEANIIENT RECORDING AND TRANSfER CHARGES
1201. Reoordlng Fees: Deed $ 38.fiO; S 76.50; ReJeases $ 115.00
12.02. CitvlCou"'" TaxIS/amQ$; Deed 1,790.nn. 1.790.00
1203. Slate TaxlSlilmos: Deed 1,790.00; MoltQ8Qe 1 790.00
1204.
1205.
'300. ADDI110NAL BET1l..BIIEHT CHARGES
1301. SWVQ\f to
1302. Pest I 10 PRnv Pest POC:S975.20
1303. Home Wamantv 110 f1rstAmeric:an Home- Buvers ProIedion 395.00
1304. WaaetTesl 10 Car1i8Ie Region Waw POC:S20.oo
1305. SeptIc 10 Aaocialild Product SeNicM, Inc. POC:S0409.00
\400. TOTAL 8ETT1.EIENT CHARGES (en. on Li_ 103. SectIon J.....102. SectIon Kl 5,7.45.$ 1",815.00
e"....-.a _1 ......--....,..-- _ f " .1'-- 01. -......... _of_ 2 of""'....~ ~l
CllrtifiecllD be a true c:opv.
l.&keside ~ & SeIlIements, llC
Settlement Agent