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HomeMy WebLinkAbout09-08-06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT IRWIN ROGER B ESQ 60 W POMFRET ST CARLISLE, PA 17013 ___u_u fold ESTATE INFORMATION: SSN: 182-01-2019 FILE NUMBER: 2106-0539 DECEDENT NAME: HURLEY MILDRED E DATE OF PAYMENT: 09/08/2006 POSTMARK DATE: 09/08/2006 COUNTY: CUMBERLAND DATE OF DEATH: 05/18/2006 NO. CD 007186 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $21,890.13 I I I I I I I I TOTAL AMOUNT PAID: $21,890.13 REMARKS: IRWIN AND MCKNIGHT CHECK# 023419 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEAL TH OF PENNSYLVANIA : SS COUNTY OF CUMBERLAND Raymond H. Hurley. Jr. , being duly sworn according to law, deposes and says that he is the Executor of the Estate of Mildred E. Hurley , late of Upper Frankford Township , Cumberland County, Pennsylvania, deceased and that the within is an inventory made by Raymond H. Hurley, Jr. , the said Executor of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of dece nt's death. Sworn and subscribed before me, } this ~ day of September , 2006. l ~.} ,\ r ___ {~~~ L,~ /" i} ~~'3 .l k;/i"iVi.ONWEALTH OF PENNS VANIA Notarial Seal . ~ten S. Noel, Notary Public Date of Death _hI ,ISle Bo~o, m'?er1andCoun 2 Westfield Lane Newville, P A 17241 Address 05 Month 2006 o Year :,.c:::g ~~}! G _!~;:o.~ .~"{7 r",,) = c::;::) ,~ 1. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty. 4. See Article IV, Fiduciaries Act of 1949. '.J') /"., "';J , CD INSTRUCTIONS /, c'"? , j -v (,:J a -J -ci <l.l I '" '" <l.l I u <l.l 0 >- :.a oi f- >- '" '2 ;;0... W c:: <l.l ~ I:G f- W ~ '" .... ~ u..l < .....l 0 > .::; 0... I:G f- ;>, <l.l 0 0 f- ::J '" OJ) r/J u..l r:/J "'=' c:: o:l u..l ~ I:G UJ ::r:: .... c:: 0... >> ::r:: 0... ~ c2 <l.l c:: <l.l Z f- , .....l u.i ~ 0... .~ c:: 0\ - < 0 c:: >.. .... C') ~ ~ < UJ 0 oj .... 8 C - V) 0 Z UJ .... .~ > IX ~ 0 0 I:G ::l co -.0 0 .... 0 Z r:/J 0 <l.l CJ .... 9 IX ~ .....l <l.l ~ ~ u..l - "'=' ~ ::J c:: fA 0 ~ N 0... oj I:G 0 4-> i: I z 0 <l.l ..c ~ Q) E "'=' II 'ii:i .2 0 ::l 0 II .....l CJ Li: co Inventory of the real an personal estate of MILDRED E. HURLEY , deceased 1. 6 Westfield Lane, Newville, Pennsylvania 2. Series E Savings Bonds 3. Cash on Hand 4. Personal Property 5. M&T Bank - Savings Account #3021000001191337 6. M&T Bank - Certificate of Deposit #031003914379051 7. M&T Bank - Certificate of Deposit - #031003914379069 8. . Adams County National Bank - Checking Account #120642 9. Adams County National Bank - Savings Account #9639357 10. Adams County National Bank - Certificate of Deposit #165107 11. Adams County national Bank - Certificate of Deposit #165108 12. Adams County National Bank - Certificate of Deposit #3990510 13. Adams County National Bank - Certificate of Deposit #3990512 14. Adams County National Bank - Certificate of Deposit #3990935 15. Adams County National Bank - Certificate of Deposit #4990222 16. Adams County National Bank - Certificate of Deposit #4990223 17. Adams County National Bank - Certificate of Deposit #4991048 $110,000.00 10,407.24 349.00 1,400.00 1,164.62 1,832.42 1,501.15 5,193.73 16,003.87 5,040.00 5,030.14 5,034.52 5,034.52 5,030.41 5,035.45 5,035.45 5,042.96 TOTAL 188,135.48 AEV-l500 lOX + (EHlO) '* 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 5 3 9 COuNTY"CoDE -vE~ - - NUMBER- - I- Z W C W o W C DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) HURLEY MILDRED DATE OF DEATH (MM.DD-Year) E. DATE OF BIRTH (MM-DD-Year) SOCIAL SECURITY NUMBER 1 82- 0 1 - 2 0 1 9 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- ~ ::Sill ul:t~ w~g :c 1:t..J u Q.lD Q. '" 05/18/2006 OS/24/1915 (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL) [Xl 1. Original Return o 4. Limited Estate [Xl 6. Decedent Died Testate (Attach copy 01 Will) o 9. Litigation Proceeds Received D 2. Supplemental Return o 4a. Future Interest Compromise (date 01 death aher 12-12.82) o 7. Decedent Maintained a Living Trust (Attach copy 01 Trust) o 10. Spousal Poverty Credit (date of death between 12-31.91 and 1-1.95) D 3. Remainder Return (date of death pnor to 12.13.82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Depqsit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS ROGER B. IRWIN 60 WEST POMFRET STREET FIRM NAME (If Applicable) IRWIN & McKNIGHT TELEPHONE NUMBER 717 249-2353 CARLISLE PA 17013 I- Z W o z ~ III W I:t I:t o U z o i= c( ...J :::) l- e:: c( o w a: 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Nan-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/See 9113 Trusts for which an election to tax has not been made (Schedule J) OFFICIAL USE ONLY 110,000.00 10,407.24 n r-;) n:l ,~ (.J~ :.-:0 -, ,,'1 ~ ~-~:~5 -)., 'J ",'1 " ../ 67,728.24 -'f""'II - -\ 'T1 . ('-) c,) r'll 'oj i-'-' '-' co ,~) (8) c") -.J 188,135.48 29,326.81 450.60 (11) (12) (13) 29,777.41 158,358.07 2,000.00 0.00 X _(15) 0.00 0.00 X _(16) 0.00 52,119.36 X .12 (17) 6,254.32 104,238.71 X .15 (18) 15,635.81 (19) 21,890.13 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ I- :::) c. ::E o o ~ I- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1,2) (14) 156,358.07 16. Amount of Line 14 taxable at lineal rate 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT >>.aESURE TO ANSWERiALLOlJESTIONS ON REVERSE SIDE AND RECHECK MATH < <: 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due -~.;-~,,:<, REV-1502 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER HURLEY MILDRED E. 21 06 0539 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 proDertv which is iointlv-owned with riaht of survivorshiD must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION 6 WESTFIELD LANE, NEWVILLE, PA SOLD - SETTLEMENT SHEET ATTACHED VALUE AT DATE OF DEATH 110,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 110000.00 REV-1503 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF HURLEY MILDRED E. FILE NUMBER 21 06 0539 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Series E Savings Bonds - Inventory Attached VALUE AT DATE OF DEATH 10,407.24 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 10407.24 REV-15G8 EX + (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HURLEY MILDRED FILE NUMBER E. 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. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 0539 DESCRIPTION Personal Property - Appraisal Attached VALUE AT DATE OF DEATH 1,400.00 M& T Bank - Savings Account - #3021000001191337 1,164.62 M&T Bank - Certificate of Deposit #031003914379051 1,832.42 M&T Bank - Certificate of Deposit - #031003914379069 1 ,501 .15 Adams County National Bank - Checking Account #120642 5,193.73 Adams County National Bank - Savings Account #9639357 16,003.87 Adams County National Bank ~ Certificate of Deposit #165107 5,040.00 Adams County National Bank - Certificate of Deposit #165108 5,030.14 Adams County National Bank - Certificate of Deposit #3990510 5,034.52 Adams County National Bank - Certificate of Deposit #3990512 5,034.52 Adams County National Bank - Certificate of Deposit #3990935 5,030.41 Adams County National Bank - Certificate of Deposit #4990222 5,035.45 Adams County National Bank - Certificate of Deposit #4990223 5,035.45 Adams County National Bank - Certificate of Deposit #4991048 5,042.96 Cash on Hand 349.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 67 728.24 REV-1511 EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF HURLEY ITEM NUMBER A. 1. B. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. FilE NUMBER MILDRED E. 21 06 0539 Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT FUNERAL EXPENSES: Egger Funeral Home 6,538.50 8,500.00 Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 2 Westfield Lane City Newville State PA Zip 17241 Year(s) Commission Paid: Attorney Fees Irwin & McKnight Family Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant Street Address 9,275.42 City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills 310.00 Accountant's Fees Tax Retum Preparer's Fees Patricia A. Rosendale, CPA 350.00 Register of Wills, Filing Fee Notary Fees Raymond H. Hurley, Jr. - Reimbursement Roy D. Gottshall, Appraisal on Personal Property S.W. Barrett Real Estate - Appraisal on Real Estate Cumberland Law Journal - Estate Notice The Sentinel - Estate Notice Calaman's Lawn Service - Lawn Care Robert Zies - Remove Tree Stumps From Property Closing Costs from Sale of Real Estate 30.00 50.00 41.64 45.00 300.00 75.00 137.03 742.27 500.00 2,431.95 TOTAL (Also enter on line 9, Recapitulation) $ 29 326.81 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) '* SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HURLEY FILE NUMBER MILDRED E. 21 06 0539 Include unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Embarq - Telephone 103.45 2. Continuing Care RX - Medical 105.01 3. Adams Electric Cooperative, Inc. - Electric 242.14 TOTAL (Also enter on line 10, Recapitulation) $ 450.60 (If more space is needed, insert additional sheets of the same size) ""'."""'1* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Raymond H,. Hurley, Jr 2 Westfield Lane Newville, PA 17241 David S. Miller 107 Race Street Boiling Springs, PA 17007 Ethan T. Miller 2801 Enola Road Carlisle, PA 17013 Clarence E. Miller, II 4 Texaco Road Mechanicsburg, PA 17055 Robert B. Miller 815 Pennsylvania Avenue Lemoyne, PA 17043 Mark M. Miller 331 Easy Road Carlisle, PA 17013 Bonnie Jo Adams 281 Wagner Drive Carlisle, PA 17013 FILE NUMBER 1 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE NUMBER 1. 1. 2. 3. 4. 5. 6. 7. Sibling Collateral Collateral Collateral Collateral Collateral Collateral 1/3 Remainder Remainder Remainder \/ . /3 Remainder Remainder Remainder '~"l Remainder .J( 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. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS S1. Marys United Methodist Church of Bloserville Bloserville, PA 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) 2,000.00 $ 2 000.00 Continuation of REV-1500 Inheritance Tax Return Resident Decedent Page 1 21 06 0539 File Number HURLEY MILDRED Decedent's Name E. Schedule J - Beneficiaries - 1 RELATIONSHIP 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) 8. Connie Lou Heckard Collateral 54 Old Stonehouse Road Remainder Carlisle, PA 17013 LAST WILL AND TESTA.MENT I, :MILDRED E. HURLEY, of Upper Frankford Township, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly all Wills and Codicils heretofore made by me. 1. I direct my executors to pay all of my debts, funeral and administrative expenses, as soon as may be done conveniently after my decease. 2. I authorize and empower my executors to sell any realty owned by me at my death and not specifically devised or bequeathed herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I give, devise and bequeath all of my estate of every nature and wherever situate as follows: (a) All my genealogy records and books to Mark M. Miller, (b) The sum of $2,000.00 to 51. Marys Upjted Methodist Church of Bloserville, Pennsylvania, and (c) All the rest, residue and remainder as follows: 1/3rd to my sister, Gladys R. Miller, and if she is not living, to her children, share and share alike, 1/3rd to my brother, Raymond H. Hurley, Jr., and ifhe is not living, to his children, share and share alike, and 1I3rd to the two daughters of my deceased brother, Maurice E. Hurley, share and share alike. 4. I nominate and appoint Gladys R. Miller and Raymond H. Hurley, Jr., to be the executors of this my Last Will and Testament; they are to serve as such without bond. 5. I hereby suggest that my personal representatives retain the services of Irwin, McKnight & Hughes, as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 2c ~ day of March, 1996. (SEAL) Signed, sealed, published and declared by .MILDRED E. HURLEY, the above named testatrix. as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence and in the presence of each other have subscribed our names as witnesses hereto. 2 ACK1VOrVLEDGiltfENT AND AFFIDA VIT WE, :MILDRED E. HURLEY, TERESA M. HENRY and CHERYL L. CLELAND, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. \. ~-t) ~ (/ ----..' /1 .! /--::7/ I '{ , ;' / / U---Z--c 'y_" Y'i '-r,-~...1::. v"'-\/ / .MILDRED E. 'HURLEY {~' / COMMONWEALTH OF PENNSYL V ANL-\ SS: COUNTY OF CUl\'lBERLAND Subscribed, sworn to and acknowledged before me by MILDRED E. HURLEY, the testatrix herein and subscribed and sworn to before me by TERESA M. HENRY and CHERYL L. CLELAND, witnesses, this 2," day of March, 1996. /~\ " 1 /3 // /~!1 / C1!3( "'- !'Nodry Public ( J / NolariaJ Seal cZ~~~ My COrl'ln'1ssIon ExJjres O:t 3. 19116 <""'.b0r. . eI Notaries U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 10MB # 2502-0265) A. HUD.1 UNIFORM SETTLEMENT STATEMENT B. Type of Loan 1.[] FHA 2.[] FmHA 3.[ ] Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4.[] VA 5.[XJ Conv. Ins. 105-917 0096200394 C. NOTE: This form furnishes a statement of settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown for informational purposes and are not included in the totals D. Name & Address of Borrower: E. Name, Address & TIN of Seller: F. Name & Address of Lender: Christia Van Auken Mildred E. Hurley Estate Sovereign Bank 661 Shippensburg Road 6 Westfield Lane 601 Penn Street Newville PA 17241 Newville PA 17241 Reading PA 19601 G. Property Location: TIN of Seller: I H. Settlement Agent: 6 Westfield Lane Place of Settlement Anthony L. DeLuca, Esquire Newville. PA 17241 61 W. Louther SI. Carlisle, PA 17013 I. Settlement Date: 18/31/06 J. Summary of Borrower's Transaction 100. Gross Amount Due from Borrower: K. Summary of Seller's Transaction 400. Gross Amount Due to Seller: 101. Contract sales price $110,000.00 401. Contract sales price $110,000.00 102. Personal Property 402. Personal Property 103. Borrower's settlement charges (line 1400) 3,548.98 403. 104. 404. 105. 405. Adjustments for items paid by seller in advance Adjustments for items paid by seller In advance 106. City/town taxes 08/31/2006 to 12131/2006 6.94 406. City/town taxes 08/31/2006 to 12131/2006 6.94 107. County taxes 08/31/2006 to 12131/2006 78.12 407. County taxes 08/31/2006 to 12131/2006 78.12 108. Assessments to 408. Assessments to 109. School taxes 08/31/2006 to 06/30/2007 1,107.68 409. School taxes 08/31/2006 to 06/30/2007 1,10768 110. 410. 111. 411. 112. 412. 113. 413. 120. Gross Amount Due from Borrower $114,741.72 420. Gross Amount Due to Seiler $111.192.74 200. Amounts Paid by or in Behalf of Borrower: 500. Reductions in Amount Due to Seller: 201. Deposits or earnest money $5,000.00 501. Excess deposit (see instructions) 202. Principal amount of new loan(s)- Sovereign Bk 110.000.00 502. Settlement charges to seller (line 1400) $2,431.95 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to 204. 504. Payoff of first mortgage 205. 505. Payoff of second mortgage 206. 506. 207. 507. 20B. 508. 209. 509. Adjustments for items unpaid by seller Adjustments for items unpaid by seiler 210. City/town taxes to 510. City/town taxes to 211. County taxes to 511. County taxes to 212. Assessments to 512. Assessments to 213 to 513. to 214 514. 215. 515. 216. 516. 217. 517. 21B. 518. 219. 519. 220. Total Paid By/for Borrower $115,000.00 520. Total Reduction Amount Due Seller $2,431.95 300. Cash at Settlement From/to Borrower 600. Cash at Settlement Tolfrom Seller 301. Gross amount due from borrower (line 120) $114,741.72 601. Gross amount due to seller (line 420) $111.192.74 302. Less amounts paid by/for borrower (line 220) 115.000.00 602. Less reductions in amount due seller (line 520) 2,431.95 303. Cash If " from ~ x II to Borrower $ 258.28 603. Cash I~I to II II from Seller $108,760.79 Substitute Form 1099 Seller Statement The information in Blocks E. G, H, I & line 401 (or, if line 401 is asterisked. line 403 and 404) is important tax information and is being furnished to the Internal Revenue Service. Jf you are required to file a return, a sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. If this real estate is your principal residence. file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of Form 4797, Form 6252 and/or Schedule D (Form 1040). You are required to provide the Settlement Agent (named above) with your correct taxpayer identification number. If you do not provide the Settlement Agent with your taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number. (Seller) (Seller) Mildred E. Hurley Estate Mildred E. Hurley Estate L. Settlement CharQes 700. Total Sales/Broker's Commission: (based on price) (W % Paid from Paid from Division of Commission (line 70m as follows: Borrower's Seller's 701. Funds at Funds at 702. Settlement Settlement 703. Commission paid at Settlement 704. 800. Items Payable in Connection with Loan 801. Loan Origination Fee 802. Loan Discount 803. Accraisal Fee to S W Barrett Real Estate & Appraisal Services 300.00 804. Credit Reoort to eBe Comoanies 26.00 805. lender's Inscection Fee 806. Mortgage Insurance Aoolication Fee 807. Document Preparation Fee to SovereiGn Bank 200.00 808. Application Fee to Sovereian Bank - $299.00 P.O.C. 809. Tax Service Fee to LSI Tax Services 69.00 810. Document Deliverv Fee to Sovereian Bank 19.00 811. Flood Certification Fee to Transamerica Flood Hazard 7.50 812. 813. 814. 900. Items Required by Lender to Be Paid in Advance 901. Interest from I 08/31/06 I to I 09/01/06 I (W $ I $21.36 Iperday 21.36 902. Mortaaae Insurance Premium for 903. Hazard Insurance Premium for 904. 905. 1000. Reserves Deposited with Lender 1001. Hazard insurance 3 months $ 40.17 oer month 120.51 1002. Mortaaae insurance months $ per month 1003. Ci~propertvtaxes months $ per month 1004. County prooertv taxes 7 months $ 21.46 per month 150.22 1005. Annual assessments months $ per month 1006. months $ per month 1007. School Taxes 3 months $ 110.83 per month 332.49 1008. 1009. Aaareaate Adiustment -85.85 1100. Title Charaes 1101. Settlement/closina fee 1102. Abstract/title search 1103. Title examination 1104. Title insurance binder 1105. Document preparation 1106. Notarv fees 8.00 2.00 1107. Attorney's fees to Roaer B. Irwin, Esnuire p.oe. (includes above item numbers 1108. Title insurance to A.L. Deluca, Esa., Aaent for Security Title Guarantee Coro~ of Baltimore 908.75 (includes above item numbers 1101,1102,1103,1104,1105 1109. lender's coveraae - $110,000.00 1110. Owner's coveraae - $110.000.00 1111. Endorsements 100,300,8.1 150.00 1112. Closina Protection Letter to Security Title Guarantee Corp. of Baltimore 35.00 1113. 1200. Government RecordinQ and Transfer Charges 1201. Recordina fees: Deed 38.50 Mortaaae 64.50 Release 103.00 1202. City/county tax/stamps: Deed 1,100.00 Mortaaae 1,100.00 1203. State tax/stamos: Deed 1,100.00 Mortaaae 1,100.00 1204. Right of Wav and Maintenance Aareement 29.00 1205. 1206. 1300. Additional Settlement CharCles 1301. Survey 1302. Pest Inspection 1303. Overnight Mail to Anthonv L. Deluca, Esauire 40.00 1304. Wiring Fee to Anthony L. Deluca, Esouire 15.00 1305.2006-07 School taxes to Shirley J. Armold, Tax Collector 1,329.95 1306. 1307. 1308. 1400. Total Settlement CharCles (This Number Transfers to Lines 103 & 502 Above) $3,548.98 $2,431.95 CERTIFICATION I have carefully reviewed the HUD-1 Settlemenl Statement and to the best of my knowledge and belief, rt is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certi all ~av ;ece'v'td a c yo the HUD-1 Settlement Statement. Seller It . Borrower Christia Van Auken Borrower ~ Christia Van Auken 8131/06 Date L. Deluca, Esq ire WARNING: n is a crime to know! make false statements 10 the United Stales on this or any other similarfolTTl. Penalties UP'Jn cOf'widlon can inctudtl a fine and imprisonment. For details see Title 18 uS Code Seclion 1001 and Section 1010 DISBURSEMENT REPORT Name and Address of Borrower: Christia Van Auken 661 Shippensburg Road Newville PA 17241 File Number: 105-917 Contract Sales Price: Name and Address of Seller: Mildred E. Hurley Estate 6 Westfield Lane Newville $110,000.00 PA 17241 Settlement Date: 8/31/06 PROCEEDS Proceeds from Buyer(s) Christla Van Auken -0- 201. Deposits or earnest money $5,00000 202. Principal amount of new loan(s) 110,000.00 TOTAL: $115,000.00 Item Entity Amount DISBURSEMENTS Disbursements to Seller(s) to Mildred E. Hurley Estate $108,76079 Appraisal Fee to S W Barrett Real Estate & Appraisal Services 300.00 Credit Report to CBC Companies 26.00 Document Preparation Fee to Sovereign Bank 200.00 Tax Service Fee to LSI Tax Services 69.00 Document Delivery Fee to Sovereign Bank 19.00 Flood Certification Fee to Transamerica Flood Hazard 7.50 One Day Interest to Sovereign Bank 21.36 Hazard insurance to Sovereign Bank 120.51 County property taxes to Sovereign Bank 150.22 School Taxes 3 months @ $110.83per month to Sovereign Bank 33249 Aggregate Adjustment to Sovereign Bank -85.85 Notary fees to Notary Public 10.00 Title insurance to AL. DeLuca, Esq., Agent for Security Title 908.75 Guarantee Corp. of Baltimore Endorsements 100,300,8.1 to Security Title Guarantee Corp. of Baltimore 150.00 Closing Protection Letter to Security Tille Guarantee Corp. of Baltimore 35.00 Deed to Recorder of Deeds 103.00 City/county tax/stamps: to Recorder of Deeds 1,100.00 State tax/stamps: to Recorder of Deeds 1,100.00 Right of Way and Maintenance Agreement to Recorder of Deeds 29.00 Ovemight Mail to Anthony L. DeLuca, Esquire 40.00 Wiring Fee to Anthony L. DeLuca, Esquire 15.00 Balance of Proceeds to Buyer 258.28 2006-07 School Taxes to Shirley J. Armold, Tax Collector 1,329.95 to TOTAL: $115,00000 to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to In Item Entity Amount G! 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'-, I ?~a' ." .."". ;; /,I?,~,>d~/L~': .-..-." </ / ,., /' ,~ ,c" ,,' "'/a.----- " y~ ' (, ;' ~/J;' r-; //~ L/~,~~ZJ?Z /a/?/0' .-" ,1:' /~ff~ r~~ / ' /":' ,," /'2:",,"'- ,i /', J "A'" Jc1ldA (' ~<,:.c.U'YL '. _1i1r; - G-V"~ ,- ~ " /' ",/ / <- ( ~ c , ..;.;d"~ 'f -~ .. .;;.-!/rj/~~ -~~ ( By:~ !J M&TBank 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Law Offices Invin & McKnight West Pomfret Professional Building 60 West Pomfret Street Carlisle, Pennsylvania 17013-3222 Re: Estate of Mildred E Hurlev Social Security: 182-01-2019 Date of Death: Mav 18, 2006 Phone (888) 502-4349 Fax (302) 934-2955 June 5, 2006 Dear Sir or Madam: Per your inquiry dated May 30, 2006, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: I. Type of Account Savings Account Account Number 021000001191337 Ownership (Names oj) Mildred E Hurley * Opening Date 07/16/73 Balance on Date of Death $1,164.33 Accrued Interest $ 0.29 Total $1,164.62 2. Type of Account Certificate of Deposit Account Number 031003914379051 Ownership (Names oj) Mildred E Hurley * Opening Date 05/01/90 Balance on Date afDeath $1,829.75 Accrued Interest $ 2.67 Total $1,832.42 '" Type of Account Certificate of Deposit .). Account Number 03/0039/4379069 Ownership (Names oj) Mildred E Hurley * Opening Date 08/10/90 Balance on Date of Death $/,500.00 Accrued Interest $ 1.15 Total $I,50l./5 Please be advised, there was no safe deposit box "found for the above decedent. * For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please call the High Street Carlisle Office # 717-240-4536. Sincerely, ~~ Nancy Clagett Records Management ~ ADAMS COUNIY NATIONAL BANK ~~~~UWlt~ 1\1 June 7, 2006 ~::,.. iC'H'1" . .J < _ Law Offices of Irwin & McKnight 60 West Pomfret Street Carlisle, P A 17013 Re: Estate of Mildred E. Hurley Dear Mr. Irwin: The following information is being provided as per your request: Acct. Type Account Account Accrued Ownership Date Opened No. Principal on Interest to D.O.D. D.O.D. Checking 120642 $5,191.96 $1.77 Indi vidual 1-25-85 Savings 9639357 $15,991.25 $12.62 Individual 3-17-83 C.D. 165107 $5,000.00 $40.00 Individual 5-27-04 C.D. 165108 $5,000.00 $30.14 Individual 5-27-04 C.D. 3990510 $5,000.00 $34.52 Individual 3-9-99 C.D. 3990512 $5,000.00 $34.52 Individual 3-9-99 C.D. 3990935 $5,000.00 $30.41 Individual 9-5-00 C.D. 4990222 $5,000.00 $35.45 Individual 6-4-98 C.D. 4990223 $5,000.00 $35.45 Individual 6-4-98 C.D. 4991048 $5,000.00 $42.96 Individual 2-9-01 Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer Company at 1-800-368-5948. If you need any additional information, please contact me at (717)339-5116. Sincerely, (JL~VJ t( L.VN- Lois Kime Deposit Services