HomeMy WebLinkAbout09-08-06
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15056051058
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~\ Dta
oJ{4 t
Date of Birth
178-07 -3284
12/11/2005
04/19/1914
Decedent's Last Name Suffix
Decedent's First Name
MI
Mikula Mrs
Helen
J
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
N/A
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
... 1. Original Return
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
4. Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
8. Total Number of Safe Deposit Boxes
Jacqueline Verney, Esq,
Firm Name (If Applicable)
(717) 243-9190
REGISTER OF WILLS USE ONLY
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First line of address
44 S. Hanover Street
Second line of address
Carlisle,
PA
17013
:-,~~' (J -ry
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d~u: FILED ~
----I W
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City or Post Office
State
ZIP Code
Correspondent's e-mail address:JMVerney@aol.com
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.
SIGNATU, OF PERSON RESPONSIBLE F~f1 FIll ?,;RETURN
".. rJA-<..~ I {t . ~/~ 7
ADD RES
44 S. Hanover Street Carlisle, PA 17013
------------------------- -------- --------
;::::~ER:HANM~ES~ _. __ _ __ _ ___ _ D;~~8/06_
44 S. Hanover Street Carlisle, PA 17013 '
PLEASE USE ORIGINAL FORM ONLY
DATE
09/08/06
Side 1
L
15056051058
15056051058
~
~
15056052059
REV-1500 EX
Decedent's Name:
Helen
J Mikula
RECAPITULATION
1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . .
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)-' Separate Billing Requested. . . . . . . .
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . . .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10)............................... .... 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . 12.
13. Charitable and Governmental Bequests/Sec 9113 Tlusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal lax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_
16. Amount of Line 14 taxable
at lineal rate X.O 45 76,148.96
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059
Side 2
L
Decedent's Social Security Number
178-07 -3284
2.
3.
4.
5.
6.
7. 76,148.96
8. 76,148.96
9.
76,148.96
15.
16.
3,426.70
17.
18.
3,426.70
15056052059
~
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Helen J Mikula
STREET ADDRESS
496 Connellsville 8t
f----
File Number
DECEDENT'S SOCIAL SECURITY NUMBER
178-07 -3284
-------------.-.----
------------------
f---
CITY
Uniontown
---~-----TSTATE --------
I PA I
ZIP
15401
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
3,426.70
0.00
0.00
0.00
Total Credits ( A + 8 + C ) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
0.00
--- -- Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(SA)
(58)
3,426.70
0.00
3,426.70
A. Enter the interest on the tax due.
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;.......................................................................................... [i] 0
b, retain the right to designate who shall use the property transferred or its income; ............................................ 0 [i]
c. retain a reversionary interest; or......................................................................................................................... 0 [i]
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i]
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 [i]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [i]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 [i]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 three (3) percent [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 zero (0) percen
[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 an(
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, ai
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(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 four and one-half (4.5) percent, except as noted i
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 twelve (12) percent [72 PS. ~9116(a)(1.3)]. A sibling is defined, und:
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1510 EX+ (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mikula, Helen J.
FILE NUMBER
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.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1- Jacqueline M. Verney, dgt, 11/27/89; Caroline Sikora/James Mikula, dgt/ 76,148.96 76,148.96
son,7/25/03 496 Connellsville StUniontown, PA 15401(retained implied life a
estate 72 Pa. C.S. A. 9107(c)(5))
TOTAL (Also enter on line 7 Recapitulation) $ 76,148,96
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mikula, Helen J.
FILE NUMBER
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, and transfers under
Sec. 9116 (a) (1.2)]
1 Caroline A. Sikora 136 Heritage Hills Road Uniontown, PA 15401 daughter 1/3
2 James E. Mikula 27 Matson Road Ligonier, PA 15658 son 1/3
3 Jacqueline M, Verney 650 Rocky Drive Boiling Springs, PA 17007 daughter 1/3
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" - 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)
! I KE\
This is to certify that the information here given is correctly copied from an original certificate of death duly filcd with mc as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee I'm ,6;, ,,"'''cote. $6'" t#tJ1lW.. rf)( fl1..L{l-
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No.
H105.143 Re\!, 2/87
lEG t 3 31&
Date
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
STATE FIl.E ~\UMBER
TYPE/PRINT
'N
PERMANENT
BLACK INK
~;b
Fayette
Be. UniontOlVD
KIND OF BUSINES:3 / IND'.JSTRY
'AS DECEDENT EVER IN
U.S_ I\RMEl) FORCES?
Yes 0 Nog
12, 13.
17.. Slale Pennsylvania
Did
decedent
live in a
township?
Bb.
DECEDENTS U:;;;UA.L OCCUP.ATIGN
(G'lIekll1clofWOrll d~nil;ju.;ng!T'.o5/
ot Wcr~lng I,te. do notlJ$i1 r'l'lred)
11.. Homemaker 11b. Home
DECEOENrs MAILING ADDRESS (Street, CitylTown, Slate, Zip Code)
496 Connellsville Street
16. Uniontovm, PA 15401
FATHER'S NAME (First, Middle, La,,:)
". Andrew Realko Sr.
INFORMANrs NAME (Type/Print)
20.. Mar Strcula
METHOD OF DI$POSITION
Burial G Cremation Gemoval from State 0
Other (Spec!t) 1
DECEDENTS
ACTUAL
RESIDENCE
(See instructions
on other side)
17b. County
Fa)'ette
MOTHER'S NAME (First. Middle, Maiden Surl1ame)
19
o
To the best of my kno.....ledge. death occtJIred at the Lime, date and place stated
(Signature and TiUe)
23a.
TIME OF DEATH /J
2.. I' 5?f ,- M.
27. PART J; Enl.r the dla.aa.., InJurl.. or tompllct,Uona \llthlch caua.d Ih. d.ath. Do n41 .nl.r th. m4c:t. 4f dylnljl, au~h.. cardiac or r..plr. ory an.at, ahock 4' hurt fanur.
U,lonlyon'l;:au..on',d,llna.
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DUE TO (OR AS A CONSEQUENCE 0':)
A')\-\EY<-O s.<...U::~O 1\ <-
DiJE TO (OR AS A CONSe.QUENCE OF)
AI'JCM/... 0(- C''-''-UI''IC
CUE TO (OR PSI.CONSEQUEN.CE. OF)
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Sequel"tially lisl conditions
if an~, leading to immediate
cause. Enter UNDERLYING
CAUSE (DIsease or ifijUry
rt1at initiated events
resulting on dl!oth ) LAST
WERE AUTOPSY r:JNDJNGS
AVA!~LE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
PendH'g lnvf>sti9ation
o
o 30.. 30b. M.
o PLACE OF INJURY At home, f<ifm, 5lrool, l.adory, o/t;CQ
bwll1mg, etc. (Speclt-y)
30e.
30d,
LOCATION (Street City/Town, State)
JOf.
,....
.~
~
MANNER OF DEATH
DATE OF iNJURY
(McI'IUl.Day. Y"ifrJ
~
o
o
Natural
Homicide
Accident
Yes 0 No Q?J
vesO
NoD
Sui.: ide
Could nol be delennined
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28.2. 28b.
CERTIFIER (Check only one)
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......'0
...........0
a
*PRONOUNC'NG AND CERTIFYING PHYSICIAN (physic~an both pronouncing J'Jath and c~rt(fyinSl tc cause of death)
To the best of my knowledge, death occurred at the time, date, and place. and due to the causes!., and r,l.rmeru .tat.d.....
*MEOICAL EXAMINER/CORONER
~:~~:rb::I:::e~~~.I.~~.~I~~. ~~,~~~~ ~~~.~~~~~_~~~~.~: .I.~ .~~ ~~I.~~~.~: ~~~~~ .~~~~~~~.~. ~~. ~~,~. ~I.~~:. ~.~;~:. ~.~~ .~~~.~~'. ~.~,~ ,~~~.;~ .t.~~. .~~~~.~~.{.~~ .~~~.. 0
310. ~ ~
REGISTRAR'S SIGNATU tl'O}';:;7R ~'.,; ( ~
33. "A~1/1I/_~'(;U .,f ~
SOCIAL SECURiTY NUMOER
178 - 07
3284
DATE OF DEATH (Month, Day. Year)
.December 11, 2005
~I~:~,tv) 0
RACE - Arr.erican Indian, Black, While, ~\
(Specify)
White
SURVIVING SPOU~E
("wIM.gille-r.aidtoll"amej
17e. 9- Yes, decedent lived in
North Union 1\"1). Iwp
17d. 0 ~~h~e~~~j~7~i~:~ of
city/bore
23b. 23c.
WAS CASE REFERRED TO A MEDICAL EXAMINER /CORONER?
26. Yes 0 Nol{)Sl
. A~proximate PART II: Other significant conditions contributing to death. but
: jnlefYal between not resulting in the underlying cause given in PART I
: onset and death
: "'t 0'\R.5.
: '( r;;NU.
:'f'~
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED.
y" 0 No 0
30e.
31b. ....-.
LICENSE N~MaER DATE ~IGNED (Month, Day. Year)
31e. \'I.l) I{l.-\ 1(<;3 31d. v€\:e""be~. \1- 1.00;;
NAME AND ADDRESS OF PERSON WHO COMFLETED CAUSE OF DEATH
(Item 27) Type orPrin' 5AN'\+-U1~ Ie.... -S~A.sH-\V
:;l.S .. 'c.,"'L""""..t> P,.."Qor-.!) I!..
32. /Uo..;,,,,,, iO:l,^, -..J P,.. \-'40\
DATE FilED (M')'lt 0 v. Year)
), ~__L3.. ~
3..
~~~
THIS INDENTURE
MADE the ~S-fi-, day of J\r- LV
(2003)
in the year of our Lord two thousand three
BETWEEN HELEN J. MIKULA, widow, and JACQUELINE MIKULA VERNEY,
a married person,
GRANTORS
AND JACQUELINE M. VERNEY, CAROLINE A. SIKORA and JAMES E.
MIKULA,
GRANTEES
WITNESSETH, that the said Grantors, for and in consideration of ONE DOLLAR
($1.00), AND OTHER GOOD AND VALUABLE CONSIDERA nON, lawful money of
the United States of America, unto them well and truly paid by the said Grantees at or
before the sealing and delivery hereof, the receipt whereof is hereby acknowledged, the
said Grantors have granted, bargained and sold, released and confirmed, and by these
presents do grant, bargain and sell, release and confirm unto the said Grantees, as joint
tenants with the right of survivorship and not as tenants in common.
ALL those two certain lots ofland situate in North Union Township, Fayette County,
Pennsylvania, being Lots Nos. forty-nine (49) and fifty (50) in a Plan of Lots laid out by
R. F. Hopwood and O.P. Markle of record in the Recorder's Office of said Fayette
County in Plan Book 1, Page 35 1/2, said two lots being bounded and described together
as follows:
BEGINNING at a point on the southerly line of Connellsville Street at the Northeast
comer of Lot No. 51; thence along the southerly line of said street, North 62 degrees 00
minutes East a distance of 60 feet to a point at the Northwest comer of Lot No. 48; thence
along the westerly line of Lot No. 48, South 28 degrees 00 minutes East a distance of 128
feet to a point in the northerly line of a 15 foot alley; thence along the northerly line of
said alley, South 62 degrees 00 minutes West a distance of 60 feet to a point at the
Southeast comer of Lot No. 51; thence along the easterly line of Lot No. 51, North 28
degrees 00 minutes West a distance of 128 feet to the place of BEGINNING.
HA VING thereon erected a one and one-half story brick dwelling house and two-car
garage, known as No. 496 Connellsville Street.
BEING THE SAME PREMISES which Helen J. Mikula by deed dated November 27,
1989 and recorded January 8, 1990 in the Office of the Recorder of Deeds in and for
Fayette County, Pennsylvania, in Deed Book 643, Page 342, granted and conveyed unto
Helen J. Mikula and Jacqueline Mikula Verney, Grantors herein.
EXCEPTING AND RESERVING, thereout and therefrom, all the nine foot or
Connellsville vein of coking coal together with the mining rights and privileges as
conveyed to the The Stewart Iron Company, Limited, by deed ofR. H. Lindsey et aI,
dated October 1, 1890, and of record in the Recorder's Office of said Fayette County in
Deed Book 97, Page 414.
AND the said Grantors hereby covenant and agree that they will warrant generally the
property hereby conveyed.
IN WITNESS WHEREOF, the said Grantors have hereunto set their hands and seals the
day and year first above \\>ritten.
SIGNED, SEALED AND DELIVERED
IN THE PRESENCE OF
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*~fA~~ (SEAL)
HELEN J. MULA
~~ ~kJL [t':(St;\L)
~. ~C ilELINE ~llKtJLA VERL"IEY lJ
---rr- ~
CONlMONWEAL TH OF PENNSYL VANIA
SS
COUNTY OF CUMBERLAND
ON THIS, the JS- day ofd~ ' 2003, before me, the
undersigned officer, personally appeared-IenJ. MIkula and-Jacquelme- Mikula-Y emey,
known to me (or satisfactorily proven) to be the persons whose names are subscribed to
the within instrument, and acknowledged that they executed the same for the purposes
therein contained.
IN WITNESS WHEREOF I hereurU2 set m hfid and official seal.
NOT.A.Rlftl. GS"",L /I . I
VAlEREF.~PI.tk... ~{U
Cal1iIii Bolo. ~'lty .
My CommI8Ilon e.- Oct 9. 200t Notary Eubh _
4pl'rl./J J 0--(./ -l.J)ot,.;.
I do hereby certify that the precise residence and complete post office address of the
within named Grantees is 496 Connellsville Street, Uniontown, P A 15401
Date: ? -;2) -03
Thomas P. Verney, husband of Jacqueline Mikula Verney, joins in this conveyance to
transfer any marital interest he may have to this property.
SIGNED, SEALED AND DELIVERED
IN THE PRESENCE OF:
~ /[l.I~~J
v u
~ :'-4:
THOMAS P. VERNEY
?
COMMONWEAL TH OF PENNSYL VANIA
SS
COUNTY OF CUMBERLAND
ON THIS, the ~ day of ~ ' 2003, before me, the
undersigned officer, personally appeared omas P. Verney, known to me (or
satisfactorily proven) to be the persons whose names are subscribed to the within
instrument, and acknowledged that they executed the same for the purposes therein
contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~
NOTARlAl SEAL
VALERIE F. ~Pttk '
Csr1lsIa Bciro, Coorny
My CommIe5ion ~ Octet 200S
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B}i06Lt3 PG03L~2
THIS INDENTURE, made the ) 1 fh day of 7~:-1'-{- l-^),~.j
in the year of our Lord One Thousand Nine Hundred and Eighty-Nine
(1989)
Between Helen J. Mikula, (hereinafter called the grantor) of the
one part,
- AND -
Helen J. Mikula and Jacqueline Mikula Verney, (hereinafter called
the grantees) of the other part,
Witnesseth, that said grantor for and in consideration of the sum
of ONE DOLLAR ($1.00) AND OTHER GOOD AND VALUABLE CONSIDERATION,
lawful money of the United states of America, unto her well and
truly paid by the said grantees at or before the sealing and
delivery hereof, the receipt whereof is hereby acknowledged, has
granted, bargained and sold, released and confirmed, and by these
presents does grant, bargain and sell, release and confirm unto
the said grantees, their heirs and assigns, as joint tenants with
right of survivorship and not as tenants in common,
All those two certain lots of land situate in North Union
Township, Fayette County, Pennsylvania, being Lots Nos.
forty-nine (49) and fifty (50) in a Plan of Lots laid out by R.
F. Hopwood and o. P. Markle of record in the Recorder's Office of
said Fayette County in Plan Book 1, Page 35 1/2, said two lots
being bounded and described together as follows:
Beginning at a point on the southerly line of Connellsville
street at the Northeast corner of Lot No. 51; thence along the
southerly line of said street, North 62 degrees 00 minutes East a
distance of 60 feet to a point at the Northwest corner of Lot No.
48; thence along the westerly line of Lot No. 48, South 28
degrees 00 minutes East a distance of 128 feet to a point in the
northerly line of a 15 foot alley; thence along the northerly
line of said alley, South 62 degrees 00 minutes West a distance
of 60 feet to a point at the Southeast corner of Lot No. 51;
thence along the easterly line of Lot No. 51, North 28 degrees 00
minutes West a distance of 128 feet to the place of beginning.
Having thereon erected a one and one-half story brick dwelling
house and two-car garage, known as No. 496 Connellsville Street.
Being the same premises conveyed by Clyde Fike and Mabel M. Fike,
his wife, to Matthew J. Mikula and Helen J. Mikula, his wife, by
deed dated May 11, 1951, and recorded on the same date in the
Office for the Recording of Deeds in and for Fayette County in
Deed Book 725, Page 38. The said Matthew J. Mikula died on
October 3, 1974.
Excepting and Reserving, thereout and therefrom, all the
foot or Connellsville vein of coking coal together with
mining rights and privileges as conveyed to The Stewart
nine
the
Iron
Br\ 05 1.1 3 PGO 3 4 3
Company, Limited, by deed of R. H. Lindsey et al, dated October
1, 1890, and of record in the Recorder's Office of said Fayette
County in Deed Book 97, Page 414.
Together with all and singular the buildings and improvements,
ways, streets, alleys, passages, waters, water-courses, rights,
liberties, privileges, hereditaments and appurtenances,
whatsoever unto the hereby granted premises belonging, or in any
wise appertaining, and the reversions and remainders, rents,
issues and profits thereof; and all the estate, right, title,
interest, property, claim and demand whatsoever of her, the said
Grantor, as well at law as in equity, of, in or to the same.
To have and to hold the said lot or piece of ground above
described, with the messuage or tenement thereon erected,
hereditaments and premises hereby granted, or mentioned and
intended so to be, with the appurtenances, unto the said
Grantees, their heirs and assigns, to and for the only proper use
and behoof of the said Grantees, their heirs and assigns forever.
And the said grantor, does hereby convenant and agree to and with
the said grantees, that the grantor, her heirs, executors and
administrators, shall and will warrant GENERALLY and forever
defend the herein above described premises, with the
heredi taments and appurtenances, unto the said grantees 1 their
heirs and assigns, against the said grantor, and against every
other person lawfully claiming or who shall hereafter claim the
same or any part thereof.
IN WITNESS WHEREOF, the grantor has hereunto set her hand
and seal the day and year first above written.
SEALED AND DELIVERED)
IN THE PRESENCE OF )
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( Ll:l/v-~_.A_~
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; \.~~_,. \......->;./\.....'-_1 .~-. ,/ i \.....-<.. /t~~:....:." L_....;: _I
Helen J. H;ikula
( SEAL)
"
Received on the day '6f the date of the above Indenture of the
above named grantees the sum of One Dollar ($1.00) and other good
and valuable consideration.
Commonwealth of )PA
County of D (tLLf'h 1;\/
)
)
)
ss:
On the 1.'7 TJ+ day of IV':. ~'! m 1)7/- A. D. 19 i(i before me
the subscriber a N(.,~TAR'! ,o~US/..fL..-- residing in th--etourJ-c.u
f
2
8;'\ 06 L} 3 PGO 3 4 4
DF~h,rJ personally appeared the above named 1-/(> feN ::T.
/1), K-u /e,-- and in due form of law acknowledged the
above Indenture to be h e- ,.
act and deed, and desired the same might be
WITNESSETH
','..above wr i t ten.
,(;)lJ:~~{?l:~::;.: "'"
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.': ,<~:~~~_"....,a - }',_~".','.\ ..~~_.. \.
;..~~<~ ,f',:. '" '" '~
my hand
and
Yh7:tJ,-,,;,>- (
recorded a$" such.
",.', '_ :.rf; ~
seal the;,'~~:~r"a'~d '.' year
.: ,-,;,:.:~~i-7;~:-'::r' I.:....
Ann E. TI~Cr.C. ~;c.t:Jrj MU';:-;' '. _: '.. '. ~._
. . rl' I
~i9h.,?i;;; Soro'1q~ph:n...;.oUAty - '. ~
/ rM'~' "" c(~u.? · '" .', - -
, V"",",,',,, ":.7.::2 . . '.' . . -If;fe?l,l)
Merr:.bei, Penr.5Jd'~'::i~:;a .. ~~;ci.:rtlcn..--',i hy<.:~r~ 1) ~'__ ' : 0 iI. .~.... .:,:::
, ~~"~."~~~t;.o""~'~'"
'. ; ''l'he addr;e.ss of the above-named
~:.,~.\ ". str~et,..: )'jniontown, Pennsylvania.
/', ,-;."'.\:~~..::,'>. .:,./< :
-'1'- ;.",'C0ID10NWEALTH OF PENNSYLVANIA
~--.. t:) I . ~ , , . .. . ~', " -
...~ : ~~. ~. -.",,-,
Grantees
is
496
Connellsville
SS:
.. J ;
Fayette
COUNTY
RECORDED in the office for recording of deeds, in and for
the county of FaYf'tte in _ Book (Record)
Vol. 643 Page 342
WITNESS my hand and seal of office,
,)i1nlJi1ry Anno Domini 19~.
iJt,',b
. day of
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3
A. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
B. TYPE OF LOAN
OMS No. 2502.0265
1.0 FHA
:2. 1.__ J FMHA
3. [}J CONV. UNINS
4. \--1 VA
6. FILE NUMBER:
100201958
5 [-'1 CONV.INS.
7. LOAN NUMBER:
8. MORTGAGE INS. CASE NO.:
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 "(p.o.c.)" were paid outside the closing; they are shown here for informational
purposes and are not included in the totals.
-~~~----
D. NAME OF BORROWER: Ralph R. Fazenbaker, Kathy L. Fazenbaker
ADDRESS OF BORROWER: 117 Coolspring Jumonville Rd
Lemont Furnace. Pennsylvania 15456
E. NAME OF SELLER: JAMES E MIKULA, JACQUELINE M VERNEY
ADDRESS OF SELLER: Caroline A Sikora
F. NAME OF LENDER FIRST FEDERAL S&L ASSN OF GREENE COUNTY
ADDRESS OF LENDER: 1 WEST MAIN STREET
UNIONTOWN. PA 15401
G. PROPERTY 496 Connellsville St.
LOCATION: Uniontown, Pennsylvania 15401
H. SEITLEMENT AGENT: First Federal S&I Assn Of Greene County
PLACE OF SEITLEMENT: 1 WEST MAIN STREET
Uniontown, Pennsylvania 15401
I. SEITLEMENT DATE:
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 . Contract sales price 401. Contract sales price 81,900.00
102. Personal property 402. Personal property
103. Settlement charges to borrower: 403.
(from line 1400)
104. 404.
105. 405.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
106. City/town taxes to 406. City/town taxes to
107. County taxes to 407. County taxes 08/07/06 to 12/31/06 111.05
108. Assessments to 408. Assessments to
109. 409.
110. 410.
111 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER: 420. GROSS AMOUNT DUE TO SELLER: ~ 82,011,05
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTION IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money 501_ Excess deposit (see instructions) I
202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400) 7,575.00
203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
204. 504. Payoff of first mortgage loan
205. 505. Payoff of second mortgage loan
206. 506.
207. 507.
208. 508.
209. 509.
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
210. City/town taxes to I 510. City/town taxes to I
211. County taxes to 511. County taxes to
212. Assessments to 512. Assessments to
213. 513. SCH 070106-080706 87.09
214. 514.
215. 515,
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR 520. TOTAL REDUCTIONS IN
BORROWER: AMOUNT DUE SELLER: ~ 7,662.09
300. CASH AT SETTLEMENT FROMrrO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301. Gross amount due from borrower (line 120) 601. Gross amount due to seller (line 420) I ( 82,011.05
302. Less amount paid by/for borrower (line 220) ( ) 602. Less total reductions in amount due seller (line 520) 7 ,662.0~
303. CASH( n FROM) ( n TO) BORROWER: 603. CASH (~~TO) ( [l FROM) SELLER: ~ 74,348.9(
SUBSTITUTE 1099-S: This form may be used as the wri1ten statement to the Transleror. ThiS is important tax Information and IS being furnished to the Internal Revenue SelVlce. If you are reqU<l
to file a return, a negligence penalty Will be imposed on you if this item is required to be reported and the IRS determines thaI if has not been reported See Subslitute 1 099'S Information Sheet.
S5.4.3538-0C
HUD-1 (3-1
r-.'~c::-' " L..':-_? 111"\
L. __$_ETTLEMENT
700.-1'oT AL SALES/BROKER'S COMMISSION:
BASED ON PRICE $81,900.00
DIVISION OF COMMISSION (LINE 700) AS FOLLOWS:
$4,914.00 to Century 21 Frankhouser Ag
S ~
@ 6.000
CHARGES
% = 4914.00
I
~
I
I-
I
--L-
100201958
PAID FROM PAID FROM
BORROWER'S SELLER'S
FUNDS I FUNDS
AT I AT
SETTLEMENT SETTLEMENT
---t-4,914.00
I
I
I
I
I
I
I
1001. Hazard insurance months @ $ per month I
1002. Mortgage insurance months @ $ per month I
1003. City property taxes months @ $ per month I
1004. County property taxes months @ $ per month
1005. Annual assessments months @ $ per month I I
1006. Flood Insurance months @ $ per month I
1007. months @ $ per month I
1008.Aggregate Accounting Adjustment months @ $ per month '.1
1100. TITLE CHARGES: -~----------------~------- - ---
701.
702.
703. Commission paid at settlement
704.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN:
801. Loan Origination fee
802. Loan Discount
803. Appraisal Fee to:
804, Credit Report to
805. Lender's Inspection fee
806. Mortgage Insurance application fee to
807. Assumption fee
808.
80g.SEWAGE BilL to NU TWP
810. ESCROW INHERITANCE to R WEBSTER
811.
812.
813.
814.
815.
900.
901.
902.
903.
904.
905.
1000. RESERVES DEPOSITED WITH LENDER:
0'
10
~/o
42.00
1,800.00
ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE:
Interest from
Mor1gage insurance premium for
Hazard insurance premium for
Flood Insurance Premium for
to
@$
/day
mo. to
yrs. to
yrs. to
"-~-"-----._------~--'- ~--- ---~ ~--"._.._--- --.-----,.-- ._-"-
1101, Settlemen. or closing fee to
1102. Abstract or title search to
1103. Title examination to
1104. Title insurance binder to
1105. Document preparation to
1106. Notary fees to
1107. Attorney's fees to
(incfudes above items Numbers:
1108. Title insurance to
(includes above items Numbers:
1109, Lender's coverage $
1110, Owner's coverage $
1111.
1112,
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES:
.-----~---~.--_..~_.~
1201. Recording fees: Deed $ ; Mortgage $
1202. City/county tax/stamps: Deed $ ; Mortgage $
1203. State tax/stamps Deed $819.00 ; Mortgage $
1204.0THER FEE 1204
1205.0THER FEE 1205
1300. ADDITIONAL SETILEMENT CHARGES:
---~-----_._----~-_.._-_._-_.-._-~--- -- -~- ------ .---- -
1301. Survey to
1302. Pest inspection to
1303.UNDERWRITING FEE
1304.REMODEl FEE
1305.0THER FEE 1305
1306.
1_307~____._ _____________________.__ _.___~______________________j________ _
1~og:_Ig.I AL_ S~_!!.L_!O_~E!H ~_'='ARg~~~~ on l0.eJ23.~~c!iE..n~arJ.cJ~~{]e 52.?,-- Section ~__~.J....._________L_ __ T:575.00
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accur te.state e of eceipts and d'sbursements made 01
my account or by me in this transaction. I further certify that I have received a copy of HUD-1 Settlement Stat en!. ~___
Borrowers . ______.____________.________ Sellers ~
James '~Ia '
-------- -----~----~-- J~~~ ---------
Tile HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in :!ccordance '.'Ii
Ihis statement.
NY'/'x'y'x' ..
;<'/~Xv'.;'
>
...
...
; Releases $
-~l-- --------- T--
I I
819.00
i
______-.1
"
I : ; " I'
Sttl tA t _ t ,\~\:,/ ".,\_\~,I. I'
e emen gen .~- ",~\j ,,-_____ ~T- ___... __.__ ___ ___. ___ .-
WARNING: it is a cri~c to knowinaly make false statements to the United States on this or any other similar form. Penaltips upon conviction CAn include
fine or imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010.
,Tn, 10,0-'1 n 1')<; 11) Gnl'^ TI ^NO . To Order [,II l'ROO~:10'0]O] rJFox 61r,. 791-1131
Dale
PAGE
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
VERNEY JACQUELINE M
44 S HANOVER STREET
CARLISLE, PA 17013
______n fold
ESTATE INFORMATION: SSN: 178-07-3284
FILE NUMBER: 2106-0791
DECEDENT NAME: MIKULA HELEN J
DA TE OF PAYMENT: 10/30/2006
POSTMARK DATE: 10/30/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 12/11/2005
NO. CD 007361
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $261.33
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: JACQUELINE VERNEY
CH ECK# 1 685
SEAL
INITIALS: CM
RECEIVED BY:
REGISTER OF WILLS
$261.33
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
JACQUELINE VERNEY ESQ
44 S HANOVER ST
CARLISLE
CUT ALONG THIS LINE
-..,-_.-.- -
PA 17013
-+
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT I ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
*'
REV-1547 EX AFP (06-05)
10-17-2006
MIKULA
12-11-2005
21 06-0791
CUMBERLAND
101
APPEAL DATE: 12-16-2006
( See reverse side under Objections)
Amount Remittedl;l~/. 33 I
MAKE CHECK PAYABLE AND REMIT PAYMENT
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE1 PA 17013
RETAIN LOWER PO~!ION FOR YOIIP qECO~DS +-
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
HELEN
J
TO: