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Home My WebLink About10-25-06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RI:V-1162 EX(11-96) PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RECEIVED FROM: SHEI<LETSKI GERALD J ESQUIRE STONE LAFA VER & SHEKLETSKI 414 BRIDGE ST PO BOX E NEW CUMBERLAND, PA 17070 .nnn~ fold ESTATE INFORMATION: SSN: 197-40-6272 FILE NUMBER: 2106-0161 DECEDENT NAME: MOHNAL PATRICIA L DATE OF PAYMENT: 10/25/2006 POSTMARK DATE: 10/25/2006 COUNTY: CUMBERLAND DA TE OF DEATH: 02/09/2006 NO. CD 007348 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,013.89 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: ESTATE OF PATRICIA L MOHNAL CHECK#1082 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS $5,013.89 GLENDA FAI~NER STRASBAUGH REGISTER OF WILLS IN THE OFFICE OF THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of Patricia L. Mohnal No.21 06 0161 , Deceased Date of Death,2/9/2006 Social Security No. 197406272 also known as 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. IIWe verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: . . ..-.- /h/J // /J 1m ~~-;7. . / //C~1'0.f ~31, Administratrix /d /~ It, ~ , , Dated Name of Attorney: Gerald J. Shekletski, Esq. ID No. 40486 Address 414 BridQe St., P.O. Box E New Cumberland PA 17070 Telephone: (717) 774-7435 Description Value PERSONAL PROPERTY 1. Prudential Financial, Inc. Stock 825.45 2. United States Savings Bonds ......>',," 7,936.91 r........) ~-:.:J c:::::-> f.::T'\ i-.i"; o "C') ~ ,500:00=3 N i.::,::; U1 .' \"7 " , ,:") ~,983 .5.0=-fj C') o if'l 3. 1995 Chevrolet Lumina Automobile o ~:~~ ..:~C) \'-- rn 4. M& T Bank checking account #61178926 ) ~~3 ~~ , ..J.J ~',-l-..j r:"" 5. PSECU regular share savings 8GGOunt co 244.92 Total 171,239.30 {Attach Additional Sheets if necessary) NOTE The Memorandum of real estate outside the Commonwealth cf Pennsyl',ania may. at the election of the personal representative, include the value of each Item, but such figures should rot te extended into the total of the Inventory R'.V.4 ~-/ Continuation of Inventory Patricia L. Mohnal 21 06 0161 Paqe 1 Description of Inventory Description 7. Postmark Credit Union account number 2855, savings Value 203.23 8. The Bon-Ton refund check. 5.00 9. Prudential Financial Services refund check 21.88 10. Travelers checks 950.00 11 . Com cast refund check 20.68 12. Ladies Home Journal refund check 47.73 REAL ESTATE 1. 5218 Oxford Drive, Mechanicsburg, PA 17055 155.500.00 Subtotal $ 156,748.52 171,239.30 Grand Total $ 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 1 6 1 'COUf:rryCOOE ----vEA~ - - NUMBER-- DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Z W Cl W U w Cl Mohnal, Patricia L. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 02/09/2006 OS/21/1949 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 1 97- 4 0 - 6 2 7 2 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER UJ I- :.:: ::f Ul uc:::':: UJ ~u J:c::g u a..lD a.. <( [X] 1 Original Return o 4. Limited Estate o 6_ Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) [=:J 3. Remainder Return (dale of death prior to 12-13-82) [=:J 5. Federal Estate Tax Return Required !2.... 8. Total Number of Safe Deposit Boxes [=:J 11. Election to tax under Sec. 9113(A) (Attach Sch 0) I- Z UJ o Z o a.. Ul UJ c:: c:: o u THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Gerald J. Shekletski 414 Bridge St. FIRM NAME (If Applicable) Stone LaFaver & Shekletski P.O. Box E TELEPHONE NUMBER 717 774-7435 New Cumberland PA 17070 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) OFFICIAL USE ONLY 155,500.00 8,762.36 (-) :-...., -, , -:'J -., --) C) __J ) ;~ -) 4. Mortgages & Notes Receivable (Schedule D) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o l- e::( ...J ::J ~ a. <( u w e:::: ,-........ ':~ 1 2c) f- .- 1 LT-'.! 7,315.84 (",---) '--f i'l ., 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6 Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) (6) ---, 803.03 --; (~ (7) "-.' - 11,414.97 183,796.20 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 71,531.19 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) (8) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o l- e::( I- ::J a.. :E o u X e::( I- 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 0.00 X _(15) 112,265.01 X .045 (16) 0.00 X _12 (17) 0.00 X _15 (18) (19) 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (11) (12) (13) 71,531.19 112,265.01 (14) 112,265.01 0.00 5,051_93 0.00 0.00 5,051.93 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < \ ~J Decedent's Complete Address: STREET ADDRESS 5218 Oxford Drive CITY Mechanicsburg I STATE PA ZIP 17055 Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 5,051.93 36.14 1.90 Total Credits (A + 8 + C) (2) 38.04 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + 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) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 5,013.89 5,013.89 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; ........................................................................... D !Xl b. retain the right to designate who shall use the property transferred or its income; ........................................ D !Xl c. retain a reversionary interest; or ...................................................................................................... D !Xl d. receive the promise for life of either payments, benefits or care? ................................................ ............. D !Xl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?......................................................... ..................................... D !Xl 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .... ............. D !Xl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... !Xl D 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;;;:;~~ AD RESS Mary T. Mohnal, Ad nistratrix 34 ColQate Dr., Camp Hill SIGNATURE OF PREPA THA E ~TE /17 176 ~~ " , ~) PA 17011 r%~ /0 C/~? ?~ ADORE Ge a tski, Esq. 414 BridQe St., P.O. Box E, New Cumberland PA 17070 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. ~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. 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 foOr the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [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 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1 )J. 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. ~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. -":C'i'llr\i'lu:~..'itML H G~ i-'tl\JN';:,YLV;':"I'-JiA O::r:JAhT\,lENT ,:';F r~EVENUE :':UR::;"U CF ;(\jCivIDUAL TAXES ::,::Pi ::3C60i r~":RP:SEL.,F\:J, P;" '7; :S.CGCl PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RECEIVED FROM: MOHNAL MARY T 34 COLGATE DRIVE CAMP HILL, PA 17011 ESTATE INFORMATION: SSN: 197-40-6272 FILE NUMBER: 2106-0161 DECEDENT NAME: MOHNAL PATRICIA L DA TE OF PAYMENT: 05/02/2006 POSTMARK DATE: 04/18/2006 COUNTY: CUMBERLAND DATE OF DEATH: 02/09/2006 ACN ASSESSMENT CONTROL NUMBER Kt'J-IIIJL tX(ll-:Jbl NO. CD 006644 AMOUNT 06117807 I $36.14 I I I I I I I I I ('/'/ - V ~--'- ~~AM~~~T PAID REMARKS: CHECK# 7281 INITIALS: MG SEAL RECEiVED BY: TAXPAYER ) $36.14 GLENDA FARi\jER STRASBAUGH REGISTER OF WILLS REV-1502 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mohnal. Patricia L. 21 06 0161 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 properly which is iointly-owned with richt of survivorshic must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION All That certain piece or parcel of land with improvements thereon situate in L.ower Allen Township, Cumberland County, Pennsylvania...known as 5218 Oxford Drive, Mechanicsburg, Pennsylvania 17055. Being the same premises which Daniel L. Storm and Lori M. Storm, by deed dated December 9, 1993 and recorded in the Office of the Recorder of Deeds of Cumberland County, Pennsylvania on December 13, 1993 in Deed Book 36R, Page 785, granted and conveyed unto Patricia L. Mohnal, the decedent herein. The property was sold to Robert T. Shumberger and Heather E. Shumberger, and wife, on October 6, 2006. Copies of the deed and settlement sheet for the sale are attached hereto. VALUE AT DATE OF DEATH 155,500.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 155,500.00 ;..~::> . .>.:::.:,:" Parcel #13-24-0793-111 DEED THIS INDENTURE IT,ade the 2 8~h day of SepcE,mber, Hl the year ::::'__"J'J, t:et':iee;-, :-L2..RY ':'. i'lCHNA~, .Z\d!.linistratrix of the Estace of Pat.ricia L. Nchnal, late of Lower Allen Township, County of Cu~berland and :cDfficnwealt.h of Pennsylvania, of the first part, hereinafter called tr~e (';ra~..t,~r, -AND- RCBE~T ~ SHUMBERGER and HEATHER E. SHUMBERGER, husband and wife, husband and wife, of the seccnd part, hereinafter called the Grantees; WHEREAS, the said patricia L. L'lohnal became in her lifetime seised, as at fee, of and in to a certain tract of land, together with the impro'jerrents thereon erected, situate in the Township of Lower Allen, County of Cumberland, and Commonwealth of Pennsylvania, and ~ore particularly described hereinafter; and being so thereof seised, died on February 9, 2006, having not made a Last Will and Testament in ':ir::.. t::..ng; and WHEREAS, ~etters of .~dministraticn ,;,ere upc;-~ her estate duly' ~55~~-=,j t~7 ~:--.c ~"~g~s~er ':: :'7il:s cf <~>~~.terlar~,i (=cc,~.t~- c=--~ ?etr.-'jar:./ 2l, - "- , :3:::" -=-:J. ~'~,::i ~ ~/ ~. >~,= ~-::-. 3._ \ ? ~ ~ ,~ L ~ c . r- ,". "\ ~ :""' '"' - r - , L oJ '..; C - _i_' _ C _ ; NOW THIS INDENTURE WITNESSETH, _ ~ ~.J '~ - . - ~ ~_ E: 5 -:i -=- ,~ ..::: - .:::... ~ -' - , +- I...."Y' G. r. ,j -,~ =:~~~j.~~~:~=~ -- -~~ :::;....... . ~..= ::"_::--_,i~ej ?~:-=~/-?~.:--=- -" . .........' ~ ~'--:::'~..:: 3.:-. J. ::.:.... -.-e ~-:. ~ :-- ~.~ :..- -.~ =~ -.- --, 1.3~::=,=~=.=~) ~ -- _~__~_c, :~~~=~ ~~5 C~8~ C}~~ ...t= _ by the said Grantees at or before the seali~g a~d de~i'iery hereof, receift Nhereof is hereby ack~owledged, has granted, bargained, sold, aliened, released and confirmed, and by these presents does grant, bargain, sell, alien, release and confirm unto the said Grantees, ALL THAT CERTAIN lot of land, situate in the Township of Lower Allen, County of Cumberland, and State of Pennsylvania, mere particularly bounded and described as follows, to wit: BEGINNING at a point on the southern line of Oxford Drive, which point is at the line dividing Lot Nos. 23 and 24, Block "B" on the hereinafter mentioned Plan of Lots; thence along the southern line of Oxford Drive on a curve to the left with a radius of 260 feet an arc distance of 12.50 feet to a point; thence North forty-five (45) degrees fifty-two (52) minutes East, sixty-one and six hundredths (61.06) feet to a point at the line dividing Lots Nos. 24 and 25, Block "B" on said Plan; thence along the same South forty-four (44) degrees eight (08) minutes East, one hundred ten (110) feet to a point; thence South forty-five (45) degrees fifty-tvlo (52) minutes West, seventy-eight and eighty-seven one-hundredths (78.87) feet to a point on the line dividing Lots Nos. 23 and 24, Block "B" on said Plan; thence along said dividing line, North forty-one (41) degrees twenty-two (22) minutes forty-five (45) seconds West, one hundred ten and forty-three one-hu~dredths (110.43) feet to a point, the Place of Beginning. BEING Lot No. 24, Block "B", Plan No. S, Windsor Park, which Plan was recorded in the Cumberland County Recorder's Office in Plan Book 12, Page 24. HAVING THEREON ERECTED 3. one story" brick ar:d fralcie ::::-a;"o..'": d",'iellir:g house known and numbered as 5213 Oxford Drive, Mechanicsburg, Fen ;" s y.l '," ani. a . BEING THE SAME PREMISES WHICH Caniel ~. 2t~r~ ~n~ -., v- - '\ ~ ~- ............>"V". ......... ~ '-" ~..., t-~3b~~.i a~d ~~fe, t~- ~~s~r ,jee,j j~~e,j =~:,~st~~ 9, --' ,-'''' ~ J -' ~ , ::-":--~J. r~,=>:rJ.'='J. ..-. . - - --' e ..: ~ ~..c e ~ ......:, I ...... 'J .... .J....J../-..JI ~~ c~e ~~f~':e:f ~t~ ?ec:rier:~ =~0is ~~ 5~ij .......,,.-., 'r'"" .......'-....ll... -=~--.:~_c -=:- ~ 2:-.j:,~ 'J~ ~ ~/ , ?e ;'.:--. S ~~: ~.- 0:1 ~ ~, '---. ......... - --. ,- -. ~~ ~~=:~,~ ='~2~ ~\)-~, _-.:i.jS - ~ , J':-.:i;,~-:e.J. ::'1.:1 ,_=>::-.-:e',;e<J. '--=~~--=-: t::i~r~':-=--3 ~4 >~<::~~~.::'~, ,'i"==>~:..~-=j4 TOGETHER 'JIli th a:l and singular tr.e bui l::i~r: jS, ~:Tpro'J'=me:1 ts, 'days, streets, alleys, passages, waters, water-courses, rights, litert~es, privileges, hereditaments and appurtenances whatsoe~er, thereunto belonging or in any wise appertaining and the re~ersions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and demand wha~soever of her, the said Patricia L. tvlohnal, at and immediately before the tir.,e of ner decease, in law, equity, or otherwise howsoever, of, ln, to or out of the same. TO HAVE AND TO HOLD the said lot or piece of ground above described, with the buildings and improvements thereon erected, hereditaments and premises hereby granted or mentioned, and intended so to be, with the appurtenances unto the said Grantees, to and for the only proper use and behoof of the said Grantees, forever. And the said Grantor, for herself and her respective heirs, executors and administrators, does covenant, promise and agree to and with the said Grantees, their heirs and assigns, that she, the said Granter, has not heretofore done or committed any act, matter or thing whatsee~er whereby the premises heretj granted, er any part ~heree~, -=-s, - -...- ~ c.._-::::, .s::3....L-L -, " X3~. ce ~~reac~e~, =r_~ r;red, 2''''i'-=--=.=---_tr:::~e,j ~:l ~.:. t.~~, =~ar~e, estate =r ~t~~=~i2~ ~c~~s,:~~er. - ~ - IN WITNESS WHEREOF, the said GraGtcr has h~reL~tc set her ha~d and seal the day and year first abc~e written. G'//--} ;/;7 ~~- .' :~-~- /.". ,---;~./ //~/ ~- .~ -'/.y"'; /:. ,,<- / / ;/.- (t. .! ~ ./' ,;If / '~'Ji t.r;ess . ~ ./ ~ ~-'. - <'7/~tt >i----/' /~))!"J:I~l.i-!..t/rSLr..L) ';',"-'Rv ,..., j-'TO'HV""T n - . ."- . - !Jh ~ 1,(1 c', ~U':,~, 1"'.am~nlSLratrlx c::: the Esiate of Patricia L. Mchr;al corJllvlONI'JEALTH OF PENNSYLVANIA: SS: COUNTY OF CUMBERLAND Cn this, the Ja~ day of ~y~~c. 2006, before me a Notary Public, the undersigned officer, perscnally appeared MARY T. MCHNAL, Administratrix of the Estate of Patricia L. Mahnal, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein ccntained. I~ WITNESS WHEREOF, I have hereto set my hand and notarial seal. ,//----) Q~~._-"_. ," / ar-X. [ub': i:: _/ .......>~ COMMO~iWEALTH OF PENNSYLVANIA NOTARIAL SEAL KATHLEEN KEiM, NotJry Public New Cumberland Borc. Cumberland Co. My CommiSSion Expires Dec. 5, 2006 l :-.ereb'; =ert~=~r tr,a -: r:;re:::.:.se ::. J.':1r>~ s s .-.. +- "'=-:~~ ~~::..::~~-= --,"",'.-Y'-'~_ _----, - ,- . ..'~ ~, -' - .. ,- . A. Settlement Statement U.S. Department of Housing and Urban Development ~ ,r OMB Approval No. 2502-0265 B. Type of Loan 1. 0 FHA 2. 0 FmHA 3. 0 Conv. Unlns. 6. File Number 7. loan Number J:' Mortgage Insurance Case Number 4. 0 VA 5. 0 Conv. Ins. 1249671 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 closing; they are shown here for Informational purposes and not Included In the totals. D. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of lender Robert T. Shumberger Estate of Patricia L. Mohnal New Century Mortgage Corp.. ISAOA Heather E. Shumberger 18400 Von Karman, Suite 1000 111 Lakepolnt Drive 34 Colgate Drive Harrisbura PA 17111 Camo Hill PA 17011 Irvine CA 92612 G. Property Location H. Selllemenl Agenl R. Mark Thomas, Esquire 5218 Oxford Drive Place of Settlement -- I. SettlemenIOatil-- Mechanicsburg PA 17055 101 South Market Street 10/4/2006 Mechanicsburg PA 17055 Disbursement Date lot: Block: J. Summary of Borrower's TransacUon 100. Gross Amount Due From Borrower K. Summary of Seller's Transaction 400. Gross Amount Due To Seller 101. Contract sales price 155500.00 401. Contract sales price 155,500.~Q 102. Personal property 402. Personal property 103. Settlement charges to borrower (line 1400) 10,067.95 403. 104. 404. .105. 405. Adjustments for Items paid by seller In edvance Adjustments for Items paid by $.eller In advance _._~-~ 106. Cltyltown taxes to 406. Cltyltown taxes to 107. County taxes to 0.00 407. County taxes to 0.00 108. Assessments to 0.00 408. Assessments to 0.00 109. to 409. to 110. to 410. to 111. to 411. to 112. to 412. to - 113. to 413. to 114. to 414. to .~- 115. to 415. to 120. Gross Amount Due From Borrower 165,567.95 420. Gross Amount Due To Seller 155,500.00 200. Amounts Pal By I r In Be alf orrower 500. Reductions In Amount Due To Seller 201. Deposit or eamest monev 1,000.00. 501. Excess deposit (see Instructions) 202. Principal amount of new loan(s) 124,400.00 502. Settlement charges to seller (line 1400>- 35.00 203. Existing loanls1taken sublectto 503. Existing loan(s) taken subject to - 204. Second loan 29,968.82 504. Payoff of first mort9age loan National City Mort Co 29,183.16 205. 505. Payoff of second mortga~ 206. Seller help 9,224.05 506. Seller help 9,224~QQ 207. Broker credit 440.84 507. "_.~-~- 208. 508. -- 209. 509. Adjustments for Items unpaid by seller Adjustments for Items unpaid by seller 210. City/town taxes to 510. City/town taxes to 211. County taxes to 511. County taxes 10 --- 212. Assessments to 512. Assessments to .- 213. to 0.00 513.0 to 0.00 214. to 514. to 215. to 515. to 216. to 516. to 217. to 517. to 218. to 518. to 219. to 519. to 220. Total Paid Bylfot Borrower 165,033.71 520. Total ReducUon Amount Due Seller 38,442.21 d 0 h OfB 300. Cash At Settlement FromITo Borrower 301. Gross Amount due from borrower lIlne 1201 165,567.95 601. Gross amount due to seller (line 420) 155,500.00 302. less amount paid bylfor borrower (line 220) 165,033.71) 602. less reductions In amI. due seller (line 520) ( ~8,442~1 ) 303. Cash IRI From o to Borrower 534.24 603. Cash IRI To o From Seller 117,057.79 600. Cash At Settlement Tolfrom Sellllr SUBSTITUTE FORM 1099 SELLER STATEMENT The Information contained In Blocks E, G, H, and I and on line 401 (or, line 403 and 404) Is Important tax Information and Is being furnIshed to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other 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 Resldencll, for any gain, with your Income tax return; for other transactions, complete the applicable parts of Form 4797, Form 6232 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 correct taxpa~(er identification number, you may be ;ubjectto civil or criminal penalties Imposed by law. Under penalties of perjury, I certify that the number shown on Ihls statement Is my correct taxpayer Identiflcation number. (Seller's Signature) L Settlement Chllltge. 700. Total 'a'.t"'Lo:lker'. Commission based on price $ 155,500.00 @ "I. .. 0.00 Paid From Paid From DM.lon of Commission (line 700) as follows: Borrower's Seller's 701. $ to Funds At Funds At 702. $ Settlement Settlement to 703. Commission paid at Settlement 704. , 800. Items Payable In Connection With Loan 801. Loan Origination Fee 124,400.00 2.00 % Mr. Mortgage 2,488.00 802. Loan Olscount % 803. ApprlllsalFee $275.00 to Keith Bolash 275.00 804. Credit Report $15.00 to Mr. Mortgage 15.00 805. lender's Inspectlon Fee 806. Mortgage Insurance Application Fee to 807. Assumption Fee 808. Document Preparation Fee to New Century Mortgage 300.00 809. Flood Certification Fee to New Century Mortgage 11.20 810. Processing Fee to New Century Mortgage 200.00 811. Tax Service Fee to New Century Mortgage 78.00 812. Underwriting Fee to New Century Mortgage 300.00 813. YSP to Mr. Mortgage (POC $1866.00l --- 900. Items ReqUired By Lender To Be Paid In Advance Exclude last day In cales -line 901 901. Interest from 10/6/2006 to 10/31/2006 @$27.10 Iday 704.60 902. Mortgage Insurance Premium for months to 903. Hazard Insurance Premium for homeowners Insurance years to 440.00 904. years to 905. 1006. 1007. 1008. A 1100. Title Charges per month per month per month per month per month per month per month 1101. Settlement or closing fee to -~..~--- 1102. Abstract or title search to 1103. TItle examination to 1104. Tltle Insurance binder to 1105. Document preparation to 1106. Notary fees to Cash 20.00 5.00 1107. Attomey's fees to R. Mark Thomas 1,018.75 (Includes above Items numbers: (1101-1108) ) 1108. Tltle Insurance to (Includes above Items numbers: ) 1109. lender's coverage $ 124,400.00 1110. Owner's coveraae $ 155,500.00 .- 1111. Closino Protection Letter 35.00 1112. --.- 1113. 1200. Government Recor Ing an Trans r C arges 1201. Recording fees: Oeed $ 38.50 ; Mortaage $ 64.50 ; Releases $ 103.00 1202. CltvlcounlY taxlstamps: Oeed $ 1,555.00 ; Mortgage $ 1,555.00 1203. State taxlstamps: Deed $ ; Mortgage $ 1,555.00 1 ,555.00 0.00 1204. 1205. d d fe h Ad IS ttI tCh 1300. d Itlone e emen erg.s 1301. Survey to 1302. Pest Inspection to 1303. Federal Express Charges 40.00 20.00 1304. Tax certification fee to Bonnie Miller, Tax Collector 10.00 1305. Sewer and Trash for 4th quarter to Lower Allen Township 85.50 1306. Reimbursement fOf school taxes 733.98 1307. Reimbursement for county taxes 109.92 1308. 1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) 10067.95 35.00 CERTIFICATION I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, It Is a true and accurate stallement of all receipts and disbursements on my account or by me In thlli) tran~actlgr. I further certify that I have received a copy of the HUD-l S~en! S~tement. /' , .' . , ~ I , ;;;:,%-L/ /~d.-....------ . C Seller Bor.ower Estate of patrlcl L. Mohnal ..(\. l,,:.!1\ tl1.. R~~S~Umberger Seller "'ti:.J ~ u..h \...., ~J.lL 1 rrower - - Heather E. Shumberger Statement which I have prepared Is a true and accurate account of the funds tllch were rece d and have been or will ement of this transaction. / t!? e;7 L A.. .. t-6" Settlement Agent / 'c;~ Date R. Mark Thomas, Esquire WARNING: It Is a crime to knowlngly make false statements to the United States on this or any other similar form. Penalties upon (:cnvlcllon can Include a flne and Imprisonment For details see: Tltle 18 U.S. Code Section 1001 and Secllon 1010. 111 nn~II!"'~VT DDlW'nUl'! 1'lr'rII"~. .-..... .... REV-1503 EX + 16-98) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Mohnal. Patricia L. FILE: NUMBER 21 06 0161 All property jointly-owned with right of survivorship must be disclosed on Schedule F. iTEM NUMBER 1. DESCRIPTION Prudential Financial Inc. Stock - sold March, 2006. VALUE AT DATE OF DEATH 825.45 2. United States Savings Bonds proceeds. 7,936.91 TOTAL (Also enter on line 2, Recapitulation) $ 8.762.36 Ilf more space IS needed. Insert additional sheets of the same size) !M&fBank U,S. Savings Bond Redemption Serial # ~:~~a:ity # / (1 7 1.j D If/ .) " -I} OffIce tI / .;; I 9481 (JJ .~ MD. D, Y Y Date /) ,'/1. / . ,. I ..., ~ Branch Name / . >- a.. o u a::: w ~ ~ en :::::) U Name ~treet City, State Zip .- \ Totallntere.t Paid TOTAL BOND REDEMPTION VALUE " ."'. . ~t I : .. , . . !, I ~ . Oc ~ \ I c · i I ~ " /C1.... 'if" \..' .; '. ,J' , " " J .., .,' c." " ". I # of Bonds Redeemed !.f : rill · I I : \' Ill: f! .. r-- Customer Signature 4.' \! " I ! 'I; : ! " '. IMPORTANT TAX INFORMATION - PLEASE RETAIN FOR TAX FILING n~~nn~_~ nn~~_n_~~J~~~;;;e.'njq~i Lf I/W~!71n~T~n REV-15G8 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Mohnal. Patricia L. 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 Scheduh! F. 0161 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 1,500.00 1995 Chevrolet Lumina automobile Sold March,2006. 2. M& T Bank checking account number 61178926. 3,983.50 3 PSECU S01 regular share savings account 244.92 4 Postmark Credit Union account number 2855, savings. 203.23 5. Proceeds from sale of miscellaneous personal property 338.90 6. The Bon-Ton refund check 5.00 7. Prudential Financial Services refund check 21.88 8. Travelers checks found in home. 950.00 9. Comcast refund check. 20.68 10. Refund/Ladies Home Journal 47.73 TOTAL (Also enter on line 5, Recapitulation) $ ilf more space IS needed, Insert additional sheets of the same size) 7,315.84 mM&rBank 499 Mitchell Street, Millsboro, DE 19966 March 1,2006 Stone, LaFaver & Shekletski Attorneys At Law 414 Bridge Street Post Office Box E New Cumberland, PA 17070 RE: Estate of Patricia Lee Mohnal Date of Death: February 9,21006 Social Security No.: 197-40-6272 Dear Mr. Shekletski: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type........... .......... .. .... Checking Account Account Number.......................61178926 Ownership (Names of}...............Patricia Lee Mohnal Opening Date.... ............. ..........11/28/68 Balance on Date ofDeath.........$3,983.50 Accrued Interest $ 0.00 Total................................... ....$3,983.50 The above named decedent did not have a safe deposit box. For any additional information on the above accounts, including ownership, statements and closures please contact our Highland Park branch at 717-737-3322. Sincerely, '/~u'L)'0l(AIZ;t:?~j ,-,' ,//' Charlene Warrington, Records Management 1-888-502-4349 PSE(~ the financial link,,, March 28, 2006 Account # 0197406272 GERALD J SHEKLETSKI 414 BRIDGE ST PO BOX E NEW CUMBERLAND, P A 17070 Dear MR SHEKLETSKI: The following is the status of PATRICIA L MOHNAL's account with PSECU as of the date of death. Joint Owner's Name Date of Death Date of Birth NONE 02.09.2006 05.21.1949 Share SOl S 50 Description Regular Shares 36 Month Certificate Open date 09. 15. 1974 09.07.2000 Balance $244.87 Closed Accrued Dividend $0.05 09.07.20103 Loan L 09 Description VISA Open Date 01.24.1995 Balance $ 0.00 Accrued Interest $0.00 The dividend earned from January 1, 2006 through the date of death was $0.26. We do not have safe deposit boxes for our members. If you have any questions, please call 234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227. Sincerely, .-{ ~. I - \.... [ tf=j{i.\.-v/ t....f Meacie Fairfax Member Service' Representative Finance Support Unit "~a I k:: _c:o F::-- ?enrs!'ly::>m3 3tat,e E~~ploy.,'''s Cr2dit Un'Gr ,,-_'-.-"-'_ '-.:-i. _'-oJ L~ . "':'---'1 8~~~!~~~~ \)r .irst l:lt7-';:: fi,';illh-:i1l';'l','-~.i~'l': March 23, 2006 STONE LaF AVER & SHEKLETSKI Attn: Gerald J. Shekletski 414 Bridge Street P.O. Box E New Cumberland Re: Estate of Patricia L. Mohnal S.S. # 197-40-6272 Account # 2855 Dear Gerald J. Shekletski The account of Patricia L. Monal with Postmark Credit Union was owned solely. Interest (dividends) is paid on the last day of the month for accounts. The following is an account status on February 9,2006 ~ Opened Balance 02/09/2006 Interest Rate Savings 04/1 0/1969 203.23 1.00 Checking Patricia L. Mohnal was ajoint owner on the savins account of Mary T. Mohnal (6442-00) Effective January 2002 , The amount at time of death was 1606.05. There are no beneficiaries and no safety deposit boxes on the accounts at Postmark Credit Union. This should provide the information for you to handle the estate. If you have any questions please call. Very truly yours, _ ,f '. Debra Johnson Member Services .' , \~ . '.'_' . '- i PI~~y Bank By Phone... Call .\1&T T.:lcphllne B~ln"ill:,! Cc'lll.:r 1-800-7 2~-24~O _.j CHE':"i~IG ~1-~ .-.: DEPOSIT _ PAYMENT __J :3;'" "'J :,"i.~;:3 ~ _'-"'.J _ L':;,\tJ ",-.- 1'3 __ C~\-':::F ~{:~,;:_.~,~:::~,; l:-;-_C_~ ~)~:,{M.[\"J,T H/-lS CEEN r~EC[I'/ED ON THE DATE 'J,AL,Or\TfC ;'8C'jE ,-\~JD i:3 ~;U8,JECT 7"C; THE TEF-~:;~:; ,:rjO ,~, H_ ':~:::' ~<::,,','- ,~m? {OU~, "ICCOUNT CH~r::KS AND OC-HER rlcn.CA.:'H iTDiS RECEI',ED FCR DEPOSIT ,.lRE:::'jOJECT ".J ,L:: I ,t,...~" -Ii. ~JIO.....()LLE:!~TICN BY ~,1&T 8""NK. DEPOSITS MA'{ r~OT BE ;"'/A\LA8LE F''JR Ir,'MFCIATE .,....Il~HCRAV~:,.=:t.L i .\ C~J'::;"r r:~(A..ro [(';C5i m~~ DEPOSIT/PAYMENT RECEIPT Bank By Phone... Call M&T Telephone Banking Center 1-800-724- 2440 o DEPOSIT 0 ~AYMENT o CHECKING o SAVINGS o LOC o LOAN o MTG o OTHER 6113 06 /71')7-1)3QC,'24 1~37}:2?i}.!:<i8 LlnA.-r{ll.~'" :~;:? ~ ~O\O'2 Ii ;9:(i I~;. LL\ 'i\t2 I {.'\..'v~...;,,{> L -k'( [<:> 1-.)." tI \ tl {f (" I THE DEPOSIT OR PAYMENT HAS BEEN RECEIVED ON THE DATE VALIDATED ABOVE AND IS SUBJECT TO THE TERMS AND CONDITIONS GOVERNING YOUR ACCOUNT, CHECKS AND OTHER NON-CASH ITEMS RECEIVED FOR DEPOSIT ARE SUBJECT TO VERIFICATION AND COLLECTION BY M&T BANK, DEPOSITS ~AY NOT BE AVAILABLE FOR IMMEDIATE WITHDRAWAL Member FDIC BA-534AF ',5103) REV-1509 EX + (6-98) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Mohnal. Patricia L. FILE NUMBER 21 06 0161 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Mary T. Mohnal 34 Colgate Dr. Camp Hill, PA 17011 Mother B c JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %01' DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 01-2002 Postmark Credit Union savings account 6442-00 1,606.05 50. 803.03 I I I I TOTAL (Also enter on line 6. Recapitulation) $ 803.03 (II more space is needed. insert additional sheets olthe same size) REV-1510 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY ESTATE OF Mohnal. Patricia L. FILE NUMBER 21 06 0161 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 iNCL.c.:DE IHE ,I,j/.,ME OF TI-<E TR...NSFEF<:EE ThE!R RELA ::'i.~NSl-iIP "TC CECEJEr-.T hNJ DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER Ar;~CH A cCP'>' OF THE ~EEO FOR PE;.... E.3":"ATE VALUE OF ASSET II~TEREST VALUE \ F APPLlCAEilE) 1. PNC Bank IRA account #65001010788 3,342.62 100. 3,342.62 Beneficiary-Mary T. Mohnal, mother 2. PNC Bank IRA account #65001010797 4,173.61 100. 4,173.61 Beneficiary-Mary T. Mohnal, mother 3. PNC Bank IRA account #65001010822 3,898.74 100. 3,898.74 Beneficiary-Mary T. Mohnal, mother TOTAL (Also enter on line 7 Recapitulation) $ 11,414.97 ilf more space IS needed, insert additional sheets of the same size) MAR-12-2006 18:56 Pt'KBANK 412 768 3458 P. 01/12 o PNC13AN< Mareh 13, 2006 Gerald J. Shekletski 414 Bridge Street P.O. Box E New Cumberland, PA 17070 RE: Estate of Patricia L. Mohna!, deceased SSN: 197-40-6272 DOD: 2/9/2006 Dear Mr. Shekletski: In response to your request for Date of Death balances for the customer noted above, our records show the following: IRA Accounts Account #65001010778 Established 04/15/1994 PATRICIA L MOHNAL DOD balance: $3,338.97 + $3.65 accrued interest Account #65001010797 Established 04/09/1994 PATRICIA L MOHNAL DOD balance: $4,169.05 + $4.56 accrued interest Account #65001010822 Established 04/11/1994 PATRICIA L MOHNAL DOD balance: $3,894.47 + $4.27 accrued interest For IRA or Beneficiary information, please calI1-888-PNC-lRAS. Please note that this office only provides date of death balances for deposit accounts (!RAs, CDs, Checking and Savings accounts). We do not process any financial transactions 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, ~n~ nO ~ 00 I, )00 th.- \..-/ )\.AA.../1 ~ ~- - Rachelle Wells 1-800-762-1775 P7-PFSC-04-F 500 fiTs! Ave. pineburgh PA. 15219 Member FDIC "1"',.........1 l""""I'-"A f-\I::V-, tJll I::X + (' L-~~) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mohnal. Patricia L. FILE NUMBER 21 06 0161 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Stone & Murray Funeral Home, 408 Third St., New Cumberland, PA 17070 5,612.00 B. ADMINISTRATIVE 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 Gerald J. Shekletski, Esq. 7,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Letters of Administration 287.00 5. Accountant's Fees Kelly Financial Services - personal income tax return 229.75 6. T ax Return Preparer's Fees 7. Legal Advertising - The Cumberland Law Journal 75.00 8. Legal Advertising - The Patriot-News 116.67 9. Grave Marker ($1,700.00) and Internment ($1,163.25) 2.863.25 10. Bonnie K. Miller. Treasurer - 2006 municipal personal tax !=l.RO 11 . Hammonds Autocamp - state inspection/autoobile 62.49 12. J.J. Skelton heating oil 212.34 13. PNC Bank charge card 1 0 1 .96 14. Oakwood Center (Deductible) 15.00 15. Tiger Trash - House clean up 450.00 16. Pinnacle Health 125.00 17 Verizon 16.99 18. PPL 51.00 TOTAL (Also enter on line 9, Recapitulation) $ 39,932.88 (If more space IS needed Insert additional sheets of the same size) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mohnal. Patricia L. FILE NUMBER 21 06 0161 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Stone & Murray Funeral Home, 408 Third St., New Cumberland, PA 17070 5,612.00 B. ADMINISTRATIVE 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 Gerald J. Shekletski, Esq. 7,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Letters of Administration 287.00 5. Accountant's Fees Kelly Financial Services - personal income tax return 229.75 6. Tax Return Preparer's Fees 7. Legal Advertising - The Cumberland Law Journal 75.00 8. Legal Advertising - The Patriot-News 116.67 9. Grave Marker ($1,700.00) and Internment ($1,163.25) 2,863.25 10. Bonnie K. Miller, Treasurer - 2006 municipal personal tax 9.80 11. Hammonds Autocamp - state inspection/autoobile 62.49 12. J.J. Skelton heating oil 212.34 13. PNC Bank charge card 1 01 .96 14. Oakwood Center (Deductible) 15.00 15. Tiger Trash - House clean up 450.00 16. Pinnacle Health 125.00 17. Verizon 16.99 18. PPL 51.00 TOTAL (Also enter on line 9, Recapitulation) $ 71,531.19 (If more space is needed, insert additional sheets of the same size) Mohnal, Patricia L. Decedent's Name Continuation of REV-1500 Inheritance Tax Return Resident Decedent Page 1 21 06 0161 File Number Schedule H - Funeral Expenses & Administrative Costs - B7. ITEM NUMBER AMOUNT 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. DESCRIPTION A TT WS National City Mortgage - March, 2006 mortgage payment Kemper Auto/Home Personal Ins. Zimmerman Plumbing Heating and Air Conditioning R.F. Fager Company - Thermostat Replacement PPL Pennsylvania American Water Co. IRS - 2005 personal income tax PPL Sewer and Refuse Reader's Digest Don Witmer Tub and Tile Chase credit card Derr's hauling Exterior repair/painting, grading, landscape expenses/5218 Oxford Road Storage unit charge - July and August, 2006 National City Mortgage - monthly mortgage payments of $567.22 for April, May, June, July, August and September, 2006 Lawn Mowing Pennsylvania American Water Co. Carpet Mart Verizon PPL Lawn Mowing (2) Window Repair Pennsylvania American Water Co. Lawn Mowing (2) Verizon PPL Lawn Mowing (2) Bathroom Repair - Don Wimer Erlich Pest Control Pennsylvania American Water Co. PPL Verizon Sewer and Trash Lawn Mowing (3) Pennsylvania American Water Co. Verizon AT&T PPL Rug Cleaning Soffett and Gutter Repair 17.12 631.70 54.34 69.00 25.23 50.99 29.06 210.00 50.93 85.50 35.94 250.00 2,836.84 65.00 4,258.24 375.24 3,403.32 16.00 13.90 21.18 33.15 50.89 35.00 315.00 21.37 35.00 17.40 50.84 35.00 670.00 344.50 22.56 50.87 17.53 85.50 50.00 19.01 17.32 30.37 50.96 300.00 346.00 SUBTOTAL SCHEDULE H.B7 15,097.80 Mohnal, Patricia L. Decedent's Name Continuation of REV-1500 Inheritance Tax Return Resident Decedent Page 2 21 06 0161 File Number Schedule H - Funeral Expenses & Administrative Costs - B7. ITEM NUMBER AMOUNT 52. 53. 54. 55. 56. 57. 58. 59. DESCRIPTION Replace vinyl flooring in kitchen Pennsylvania American Water Co. Verizon PPL Filing Fees - Personal Inventory ($15.00) and Inheritance Tax Return ($15.00) Settlement closing costs of $35.00 (Line 502) + mortgage payoff of $29,183. '16 (Line 504) + seller help of $9,224.05 (Line 506) = $38,442.21. $38,442.21 less reimbursement for school taxes of $733.98 (Line 1306) less reimbursement for county taxes of $109.92 (Line 1307) = $37,598.31 (See settlement sheet provided herewith.) Additional Probate Fee Reserve for closing expenses 620.00 19.60 23.88 63.35 30.00 37,598.31 50.00 300.00 SUBTOTAL SCHEDULE H-B7 38,705.14 REV-1513 EX + (8_nm COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Mohnal Patricia L. 21 06 01R1 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trulitee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (12)J 1. Mary T. Mohnal Lineal 112,265.01 34 Colgate Dr. Camp Hill, PA 17011 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 II - 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)