HomeMy WebLinkAbout11-13-06 (2)
~
15056051047
REV-1500 EX (06-05)
PA Department of Revenue *'
Bureau oflndivtdual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601 ~~ ..
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETU.RN
RESIDENT DECEDENT
OFFICIAL USE ONLY
~u~nty CClde Yea! ...
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Rle Number
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Date of Birth
'rjJ~Jfg]~~t
SuffIX
Decedent's Last Name
Decedent's First Name
Mf
."M'
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Suffix
.~;
,
;:j.io;,rij,.Y'"
MI
~p~use's Social Security Number
I'
"::
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Retum
c::::;)
2. Supplemental Return
c::>
c::::> 4. Limited Estate
c::;) 4a. Future Interest Compromise (date of
death after 12-12-82)
c::::;) 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
o 10. Spousal Poverty Credit (date of death c::> 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
:.W~:;b1' ;:h,.,::,~-'t.';';;;:'
C)
3. Remainder Retum (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
'B:
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
1
8. Total Number of Safe Deposit Boxes
C)
;. '~;';:~:~'~i~ ;i
REGiSTERS.......' ~LLS USE !-Yl. ~;.>.., ~~...I
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Correspondent's a-mall address:
Under penalties of pe~ury, 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 aI/Information of which preparer has any knowledge.
81 R F PE NSI E FOR FILING RETURN DATE
Executor 11/'-'&'
013
01>;
f( , 0'
ADDRESS
44 West Main Street, Mechanicsburg, PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051047
15056051047
-.J
~
15056052048
REV-1500 EX
Decedent's Name:
RECAPITULATION
Decedent's Social Security Number
.:~il;"l'''<~'~-!::.!-'':'~~\', .':it::('<€iQ ";- ';<";':::';'1-*=:';:;:~::::'.;~~4:?~~~"~; :~' ''''~'':'':''
30 1 2!, ; ..
'W-"-""""', "tl;~';"":'" ;}.,.-,,;;,,::;;'~':~:;W"l=<':' '.W"",,-;~.. '
1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 1
1.
2.
3.
4.
5.
6.
7.
8.
9.
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) c::> Separate Billing Requested . . . . . . .
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c.:> 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 Trusts 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.
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .01L5
16. Amount of Line 14 taxable
at lineal rate X.O_
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . '. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
c::>
Side 2
L
15056052048
15056052048
--.J
REV.1500 EX Page 3
Decedent's Complete Address:
DECEDENTS NAME
Robert M. E Ie
STREET ADDRESS
175 West Mi dIe
File Number
21-05-01040
clT'tarlisle
STATE
PA
ZIP17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CredHslPayments
A. Spousal Poverty Credit .
B. Prior Payments
C. Discount
(1)
lQ,L..L..7.7?
--.9..000.00
41)0.00
Total Credits (A + B + C ) (2)
9.450.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty ( 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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(58)
9.997.72
161.28
A. Enter the interest on the tax due.
10.159.00
Make Check Payable to: REGISTER OF WILLS, A GENT
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;.......................................................................................... 0 [iJ
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [Xl
c. retain a reversionary interest; or.......................................................................................................................... 0 [i]
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. CXI D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 lXJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................................................~........................... [XI 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.
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. 99116 (a) (1.1) (i)l.
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) percent
[72 P.S. 99116 (a) (1.1) (ii)). The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiari.es is four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 P.S. 99116(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 P.S. 99116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX- <.....
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT OECEOENT
ESTATE OF FILE NUMBER
Robert M. Eppley 21-05-01040
All real property owned solely or as a tenant In common must be "'ported at fair market value. Fair market value Is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which Is Jointly-owned with right of survivorship must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
VA.LUE AT DATE
DESCRIPTION OF DEATH
All that certain tract of land improved with a .
residential dwelling and accessory structures located
in Middlesex Township, Cumberland County, Pennsylvania,
commonly known as 175 West Middlesex Drive, Carlisle,
Pennsylvania (sale value): $226,000.00
TOTAL (Also enter on /ine 1, Recapitulation) $ 226,000.00
(If more space is needed, insert additional sheets of the same size)
REV.1503 EX> (""*
COMMONINEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Robert M. E~pley
FILE NUMBER
21-0501040
All property Jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Orrstown Bank Account No. 00074375445,
American Funds Tax Exempt Bond Fund
VALUE AT DATE
OF DEATH
$24,517.60
2.
US Savings Bond, series EE, $100 denomination
161. 48
TOTAL (Also enter on line 2, Recapitulation) $ 24,679.08
(If more space Is needed. insert additional sheets of the same size)
REV-1508 EXi- (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Robert M. Eppley
FILE NUMBER
21-05-01040
Include the proceeds of filigatlon and the date the proceeds were received by the estate.
All property Jointly-owned with right of survivorship must be dllclolld on Schedule F.
1.
DESCRIPTION
Orrstown Bank, Checking Account No. 146000245
VALUE AT DATE
OF DEATH
ITEM
NUMBER
$
157.32
2.
M&T Bank, Checking Account NO. 411396
2,552.83
3.
Miscellaneous personalty, furniture and furnishings and
1997 Ford truck, 1979 Ford truck and trailer
20,436.75
4.
Cumberland County FSA crop payment, 2005
356.00
TOTAL (Also enter on line 5, Recapitulation) $ 23,502.90
(If more space Is needed, insert additional sheets of the same size)
REV-151O EX- l.....
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Robert M. Eoolev 21-05-01040
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 INCWDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DeCEDENT AND
NUMBEF THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAl ESTATE.
1. Orrstown Bank Account No. 0075015284 IRA,
American Funds Bond Fund. Date of transfer:
November 22, 2005. Transferee/beneficiary:
Robert M. Eppley, Jr., Cynthia J. Bowermaster
and Brenda C. Eppley, children of Decedent
2. Sovereign Bank, IRA Account No. 1698182340.
Date of Transfer: November 22, 2005;
Transferee: Robert M. Eppley, Jr.
3. M&T Bank IRA Account No. 035004200347571
Date of transfer: November 22, 2005.
Transferee: Estate of Robert M. Eppley
4. Parcel 2C, Preliminary/Final Subdivision Plan
recorded in Plan Book 90, Page 15, consisting
of 28.6675 acres. Transferee: Cynthia J.
Bowermaster, Decedent's daughter, date of
transfer: November 23, 2005
5. Parcel 2B, Preliminary/Final Subdivision Plan
recorded in Plan Book 90, Page 15, consisting
of 29.1404 acres. Transferee: Brenda C.
Eppley, Decedent's daughter, date of
transfer: February 23, 2005
6. Parcel 2D, Preliminary/Final Subdivision Plan
recorded in Plan Book 90, Page 15, consisting
of 35.8963 acres. Transferee: Robert M.
Eppley, Jr., Decedent's son, date of
transfer: February 23, 2005
DATE OF DEATH % OF DECO'S EXCLUSION
VAlUE OF ASSET INTEREST OF APPUCABLEI
13,577 .78
400.73
9,6~~4'7\
57,ero.OO
58,ero.OO
72,ero.OO
100%
101%
lCXJ%
101%
101%
101%
3,ero.OO
3,CXD.OO
3,CXD.OO
TAXABLE
VALUE
$13,557.78
400.73
9,639/47
54,CXD.OO
55,ero.OO
69,CXD.OO
TOTAL (Also enter on line 7 Recapitulation) $ 281.677.98
(If more space is needed, insert additional sheets of the same size)
REV.'S11 EX. (''"'..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEOENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Robert M. Eppley
FILE NUMBER
21-05-01040
Debts of decedent must be reported on Scnedule I.
ITEM'
NUMBER
A.
DESCRIPTION
. AMOUNT
1.
FUNERAL EXPENSES:
Hoffman-Roth Funeral Home
$9 , 786.98
1,245.00
323.94
Westminster Cemetery
Jeffrey's Flowers
Carlisle Memorial Services, Inc.: headstone/lettering
966.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Represenlative(s) Robert M. Eppley, Jr.
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
8.
9.
10.
11.
3,500.00
City
63 Beagle Club Road
Carlisle
2006
State~lip 17013
Year(s) Commission Paid:
2.
AltomeyFees to Snelbaker & Brenneman,P.C.
4,920.00
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.
ProbateFees Initial: $70.00; additional probate fee: $290.00
360.00
5.
~~~~~~ Reserve for misc. expenses, final legal fees and
filing costs
Tax Return Pre parer's Fees
Advertise grant of Letters:
a. Cumberland Law Journal
b. The Patriot News
3,000.00
500.00
6.
7.
$ 75.00
231.92
306.72
Real Estate and personalty auction sales commission
to K. Wickard
Appraisal fees to L. Foote for real estate (items 4-6,
Schedule G
Realty transfer tax paid
ReIEir expenses for sale of real estate, house and outbuiidings
6,284.76
1,050.00
2,260.00
8,347.69
TOTAL (Also enter on line 9, Recapitulation) $ 42.851.09
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABIUTIES, & UENS
ESTATE OF FILE NUMBER
Rohp-rt. M. EppJey 21-05-01040
Report debts inculT8d by the decedent prior to death which remained unpaid as of the date of death, Including unrelmblirsed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PP&L Electric Utilities - payment on account
2. Sprint Telephone Service - payment on account
$ 48.01
59.58
652.06
8.15
38.18
3.05
27.12
3. Sadler Oil Company - payment on account
4. The Patriot News - payment on account
5. Tri-County REC (Electric Cooperative) payment on account
6. Direct TV - payment on account
7. Pinnacle Health ~ payment on account
TOTAL (Also enter on line 10, Recapitulation) $ R1fl.15
(If more space is needed, insert additional sheels of the same size)
REV-f613 EX. (9-00) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIA~IES
ESTATE OF
Robert M. Eppley
FILE NUMBER
21-05-01040
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(l) OF ESTATE
I TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Winifred F. Ruth daughter $l,CID.OO
42A5 D Catalina lane, Harrisburg, PA 17100
2. Cfff'l;;:! Sinkovitz daughter $l,CID.OO
4225 Catalina lane, Harrisburg, PA 17100
3. Robert M. Eppley, Jr. son 1. ___~' '-_ ~ - _u
63 Beagle Club Rood, Carlisle, PA 17013 1/3 of residue
4. Brenda C. Eppley daughter 1/3 of residue
3701 Westerly Drive, Camp Hill, PA 17011
5. Cynthia J. ~ daughter 1/3 of residue
55 Beagle Club Road, Carlisle, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
A. Settlement Statement
U.S. Department of Housing
and Urban Development
~
,r
OMS Approval No. 2502-0265
B. Tvoe of loin
1. 0 FHA 2. 0 FmHA 3. 0 Conv. Unlns.
4.0 VA 5. 0 Conv.lns.
8. File NUIllber
7. u..n Number
8. Mortgage lnturance Cue Number
1246916 0204252366
C. Note: ThIs form Is fumlshed 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 Addr818 of Bo_ E. NmllIancl Add_ Of &.n.r F. Name and AddreH 01 Lanclar
TODD C ECKENRODE EST OF ROBERT M EPPLEY MEMBERS 1ST FEDERAL CREDIT
LINDA G ECKENRODE UNION
G. P.oparty l.llcatlon H. SeIIIemtnt Agent
175 WEST MlDDLESEX ROAD HAROLD S IRWIN III ESQ
CARLISLE PA 17013 Place III SelIIIIIlIIII I. Senlement o.le
IRWIN LAW OFFICE 9/25/2006
CARLISLE PA 17013 Olabu.-l Dale
Lot: Block: Q/?1;./?nnA
J. Summary of Borrower'1 Tranaactlpn
100 GroM Amount Due From BoI'l"OWW
K. Sumllllll')' of SelIe"1 TranaactlCln"
.tOO. Gro.. Amourit Due To Selle,
101. ConlnlcUales Drice 226.00'0.00 40 1. ContrBct _&lime. 226 000.00
102. Personaf Drooertv 402. Pel80nal DI'ODllrtv
103. Selllement chlUll8ll to borrower (lIne 14001 10.986.36 403.
104. 404.
105. 405.
Adluatrn.nts for Ittma Dlld bv ..lIer In advance Adlustrnents for Items Dald bv aeller In advanc.
106. Cltvllowri taxes 9/25/2006 10 12/31/2008 115.43 406. CltvIIown taxes 9125/2006 10 12/31/2008 115.43
107. CountY taxes to 407. County taxes to
108. Assesam.nta to 406. Asseslmenta to
109. School Taxes 9/26/2006 10 613012007 970.22 409. School Taxes 9/2512006 to 5/30/2007 970.22
110. to 410. to
111. to 411. to
112. to 412. to
113. to 413. to
114. 10 414. to
115. to 416. 10
120. GroM Amount Due From Borrower 238,072.01 420. GroM Amount Due To Selllll' 227,085.65
200. Amounts Paid Bv Or In Behalf Of Borrow.r 500. u onan moun ue 0 e r
201. DeDOBIt or .emes! monev 22.600.00 501. Excess deool~ (Ie.lnstructlonsl 22.600.00
202. Prlnc:ioal amount of new Ioan(B) 203,400.00 502. Settlement charaeB to seller (line 1400) 2,260.00
203. Exlstlna Ioan(s) taken sublect to 503. ExIsting loanlsltaken subJect 10
204. 504. PallOlf of first morlDaae loan
205. 505. PallOff of second monoeae loan
206. 506.
207. 507.
208. 508.
209. 509.
Adluatrnentll for Iteme unDlld bv ..1I.r Adlultmentll for Items unDllld bv aelle,
210. Cltvltown taxee 10 510. Cllvllown llIXllll to
211. County taxes to 511. Countv taxes to
212. Ass88smenlL 10 512. Assessments to
213. to 513. to
214. to 514. to
215. to 515. to
216. 10 516. to
217. 10 517. to
21B. to 51B. to
219. 10 519. to
220. Total Paid By/For Borrower 226,000.00 520. Total Reduction AmDunt Du. Seller 24,860.00
Redctl I"A
to T S lie
300. Cash M Settlement FromITo Borrower
600. Cuh At Settlement TolFrom Seller
301. Gross Amount due from borrower IIln. 120\ 238,072.01 601. Groas amount due to seller (line 4201 227.085.65
302. Less amounl Dllld bvlfor borrower nine 2201 226,000.00 602. Less reductions in em\. due seller (line 520) 24.860.00)
303. Ceah 00 From o To Borrower 12,072.01 803. Cesh !&J To o From Selle, 202,225.65
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 Ihe Internal Revenue
Service. If you,re required to file a'retum. , negligence penalty or other sanctlon wlll be Imposed on you If this Item Is required 10 be reported and the IRS delermines
thaI II hes nol been reported. If this real estate Is your principal residence, file Form 2119, Sale or Exchange of Prlnclpsl Residence, tor any geln, wlIh your Income tax
return; for other transactions, complatethe eppllcable parts of Form 4797, Form 6232 and/or Schedule 0, Form 1040). You are required to providelhe Selllement Agent
(named above) with your correct lalCpeyer Identlf1caUon number. If you do not provide the Settlement Agent with your corract taxpayer identification number, you may be
subject to civil or criminal pen.lIles Imposed by lew. Under penalties of perjury, I certify that the number shown on this s1Stement 18 my correct taxpayer ldentlflcatlon number.
(Seller's Signature)
t:
L. Settlement harv..
700. Total SalesIEJroker'a CommJaslon besed on Drfce $ C!l %- Paid From Paid From
OtvIslon of Commission lDne 700) as follows: Sorrower'e Seller'e
701. S to Funds At Funds AI
702. S Settlement Settlement
10
703. Commission 1181d at Settlement
704.
800. It8mII Pevable In Connection WIth Loan
801. Loan OriQInation Fee 203,400,00 1.00 % MEMBERS 1ST FCU 2.034.00
802. Loan Discount 205.400.00 1.50 % MEMBERS 1ST FCU 3.051.00
803. ADDralsal Fee to
804. Credit R8COI1 to
805. Lender's Inspection FIltl
806. Moltoaae Insurance ADolIcatlon Fee to
807. AssuI11llllon Fee
808. ADDIIClltlon Fee to MEMBERS 1ST FCU 350.00
809. Underwrltlna Fee to MEMBERS 1ST FCU 75.00
810. Document Preparation Fee to MEMBERS 1ST FCU 275.00
811.
812.
813.
900. Items teaulrtd BY Lender To Be Pel In Advance Exclude last dsy In cales - line 901
901. Interest from 912512006 to 10/1/2008 0$ 32,4875 I day 6 day. 194.93
902. Monaaae Insurance Premium for months to
903. Hazard Insurance Premium for ONE yeara to POC
904. YIIllrs to
905.
R
d
03 r month 172.74
r month
r month
09 r month 324.81
r month
04 424.84
-322.71 ,.
1100. TItle Clla"",
1 101. Settlement or c10slng fee to IRWIN LAW OFFICE 150.00
1102. Abstract or title searcl1 to CUMBERLAND.PERRY ABSTRACT 150.00
1103. TIlle examination to ,
1 104. TItle Insurance binder to ,
1105. Document Dra08ratlon to ,
1106. Notary fees to HAROLD S IRWIN III 20.00
1107. Attorney's!_ to
(Includes above Items numbers: )
11 DB. TIlle Insurance to PENNA TTORNEYS TITLE INSURANCE COMPANY 1.693.75
(Includes above ~ems numbers: I
1109. Lender's coveraae $ 203 400.00
, 110. Owner's coverage $ 226 000.00
1111. Overnlaht Mall ExDanses to IRWIN LAW OFFICE 30.00
1112. ,
1113.
64.50 ; ReleSses $
103.00
2 260.00
$
$
$
2 260.00
ea
to
to
2 260.00
EPPLEY
Seller
rrower
Settlement Agent
ve prepared Is a tnJe and accurate account of the lunds which were received and heve been or will
on. _
~006
Dele
o the United Slates on thIs or eny other similar form. Penalties upon conviction can Include e flne and
001 and Section 1010.
U.l,fIOVE~_NTP__ ,._
, .
LAW OFFICES
SNELBAKER 8c
3RENNEMAN. P.C.
LAST WILL AND TESTAMENT
OF
ROBERT M. EPPLEY
I, ROBERT M. EPPLEY, of Middlesex Township, Cumberland County, Pennsylvania,
being of sound and disposing mind, memory and understanding, do hereby make, publish and
declare this as and for my Last Will and Testament, hereby revoking and making void any and all
wills by me at any time heretofore made.
1. I direct that all my debts and funeral expenses ~ paid as soon as practical after my
death by my Executor hereinafter named.
I direct that all taxes that may be assessed as a consequence of my death shall be paid
from my residuary estate as part of the expenses of the administration of my estate.
2. I give to my son, ROBERT M. EPPLEY, JR., my 308 Savage rifle and my 3006
Mauser rifle. I give to my children WINIFRED F. RUTH and CECELlA SINKOVITZ each the
sum of $1,000.00.
3. All the rest, residue and remainder of my estate, real, personal and mixed, and
wheresoever the same may be situate, I give, devise and bequeath in equal shares to my children,
ROBERT M. EPPLEY, JR., CYNTIllA J. BOWERMASTER and BRENDA C. EPPLEY.
If any of my children aforementioned should predecease me, I direct that the share such
deceased child would have received hereunder shall be given to his or her issue surviving me per
stirpes and if there should be no such issue, then such share shall be divided between my
surviving children aforementioned.
4. I hereby nominate, constitute and appoint my son, ROBERT M. EPPLEY, JR., as
Executor under this my Last Will and Testament to serve without bond to secure the faithful
performance of his duties in the Commonwealth of Pennsylvania or in any other jurisdiction.
~w OFFICES
!ELBAKER 6:
INEMAN. F.C.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and
estament written on Two (2) pages this 13th day of June, 2005.
~ ~~
o ertM.Ep~ ~ A
(SEAL)
Signed, sealed, published and declared by ROBERT M. EPPLEY, the Testator above
amed, as and for his Last Will and Testament, in our presence, who, in his presence, at his
equest, and in the presence of each other, have hereunto subscribe4 our names as attesting
1/J1rnvL-----
(SEAL)
~~
(SEAL)
-2-
'UMMONWEALTHUF'PENNS YL VANIA)
: SS.
OF CUMBERLAND )
We, ROBERT M. EPPLEY, KEITH O. BRENNEMAN, ESQUIRE and JANE 1.
OONEY, the Testator and the witnesses, respectively, whose names are signed to the attached
r foregoing instrument, being fIrst duly sworn, do hereby declare to the undersigned authority
t the Testator signed and executed the instrument as his Last Will and Testament and that he
signed willingly, and that he executed it as his free and voluntary act for the purposes therein
xpressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the
ill as witness and that to the best ofms or her knowledge the Testator was at that time eighteen
ears of age or older, of sound mind and under no constraint or undue influence.
~t--.~ ~
Testator
l/l~
Witness
f-g.~
ubscribed, sworn to and acknowledged before me by ROBERT M. EPPLEY, Testator, and
ubscribed and sworn to before me by KEITH O. BRENNEMAN, ESQUIRE and JANE 1.
OONEY, witnesses, this 13th day ofJune, 2005.
t, ~ 1!fJq
/' v--NotaryPublic
LAW OFFICES
;NELBAKER Be
::NNEMAN. P .c.
COMMONWEALTH OF PENNSYLVANIA
NoIarlaI Seal
Susan L MalraZi, NotalY Public
Mec;hanlcsburg Boro. CUmbetland County
My ComrTisslon ExpIres Nov. 24. 2007
Member. Pennsylvania Association Of Notaries