HomeMy WebLinkAbout12-19-06
..
z
o
i=
<C
..J
~
l-
n:
<C
u
W
D::
z
o
i=
<C
I-
~
a..
::E
o
U
~
I-
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE D1RECTE TO:
NAME COMPLETE MAILING ADDRESS
David H. Stone Es uire 414 Bridge Street
FIRM NAME (If Applicable)
Stone La Faver & Shekletski
TELEPHONE NUMBER
717 774-7435 New Cumberland p
()
122,000.00::::::;
REV-150~EX + (6-00)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEAL TH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
I-
Z
W
C
W
U
W
C
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Shuler Hazel E
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
5/5/2006 6/3/1916
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
W
l-
ll:: :SU)
<J 1I::ll::
w~<J
J:II::9
<J~lD
<(
[K] 1. Original Return
o 4. Limited Estate
[K] 6. Decedent Died Testate (Attach copy of Will}
o 9_ Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date 01 dealh aher 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy 01 Trusl)
o 10. Spousal Poverty Credit (dateoldealh between 12-31-91 and 1-1-95)
I-
Z
W
Q
Z
o
l1.
U)
w
II::
II::
o
<J
1. Real Estate (Schedule A)
(1)
(2)
(3)
(4)
(5)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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)
8. Total Gross Assets (total Lines 1-7)
(6)
(7)
(8)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(9)
(10)
(11)
(12)
(13)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
0.00 X _(15)
111 ,981.17 X .045 (16)
0.00 X .12 (17)
0.00 X 15 (18)
(19)
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
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
j--
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 6 04 1 7
COUNTYCoEE ---VEA;r-- - - NUMliER- -
SOCIAL SECURITY NUMBER
1 88- 3 2 - 4 8 3 8
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (dale of death poor 1012-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Bdxes
o 11. Election to tax under Sec. 9113~A) (Attach Sch 0)
ciFFICI~SE 0 .t~ 12M
r:J r'-I '- )
1"1 I" ,::..::;
n 1'::; ~~:~
\.0 :::,} C"..:J
>2
;-n
~r}
776.95
~..~j ~~
C
:':0
---,
,..-')
'0=;,
~'J:J
-- C)
n'l
C)
"'1
tJ
~
9,402.32
N
x:-
.&:-
13? 179.27
20,074.10
124.00
2t'198.10
11 ,981.17
,
!
111 981. 1 7
o
d
I C
I t Add
ece ents ampl e e ress:
STREET ADDRESS
166 E. EiQhth Street
CITY I STATE I ZIP
New Cumberland PA 17070-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
5,039.15
4.000.00
210.53
Total Credits (A + B + C)
(2)
4,210.53
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + 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)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
828.62
828.62
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 lliJ
b. retain the right to designate who shall use the property transferred or its income; ........................................ D lliJ
c. retain a reversionary interest; or ...................................................................................................... D lliJ
d. receive the promise for life of either payments, benefits or care? ............................................................. D lliJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. D lliJ
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. D lliJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ... .... ........... ............ .............. ....... .......... ....... ........... .............. ....... ... D lliJ
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 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 all information of wIlich preparer has any knowledge.
SIGNAT RE OF PERSON RESPONSIBLE FOR F. I RETURN DATE
e.{) 'U~
PA
ADDRESS
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 P.S. ~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. ~9116 (a) d.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 for the use of a natural parent, an adopti~e 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)).
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.
.
REV-1502 EX + (6-98)
'*
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Shuler. Hazel. E 21 06 0417
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 ro e which is 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F.
ITEM
NUMBER
1
DESCRIPTION
Property located at 166 Eighth St. New Cumberland, Cumberland County, PA
sold to Bradley D. and Dawn L. Combs on November 8,2006
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
VALUE A DATE
OF DE TH
1 2,000.00
122000.00
.
REV-1508 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Shuler. Hazel. E
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
- ,
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 Schedule F
0417
ITEM VALUE t DATE
NUMBER DESCRIPTION OF DE ATH
1. PA Treasury Dept.-State Retirement check 776..95
TOTAL (Also enter on line 5. Recapitulation) $ 776.95
(If more space is needed, insert additional sheets of the same size)
---,-
REV-1~09 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Shuler. Hazel. E
FILE NUMBER
21 06
0417
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
I
!
RELATIONSHIP Tq DECEDENT
Daughter i
A. Carolyn G Tilder
1341 Sconsett Way
New Cumberland, PA 17070-
B Barbara A Karper
300 Hill Top Road
Daughter
Boiling Springs, PA 17007-
c Ralph E Shuler Jr.
223 South 18th Street
Son
Camp Hill, PA 17011-
JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF OAT OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S V LUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDI NTS INTERES
1 A 08/15/01 PNC Bank-Checking Accl. #5140058119 10,823.05 50. i5,411.53
Joint w/Carolyn Tilder
2 B,C 11/15/n PSECU-Regular Share S01 Accl. 11,968.66 33.34 3,990.35
Joint wi Barbara Karper and Ralph Shuler, Jr., Prine. $11, ~68.66, Dividend ~ 1.31
3 B,C 11/15/7~ PSECU-Regular Share S01 Accl. - Accrued Dividend 1.31 33.34 0.44
TOTAL (Also enter on line 6, Recapitulation) $ 9.402.32
T
(If more space is needed. insert additional sheets of the same size)
.
REV-1511 EX + (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
ESTATE OF
Shuler Hazel. E
Debts of decedent must be reported on Schedule I.
21
06
0417
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Gingrich Memorials-stone 125.00
2. Parthemore Funeral Home-funeral expenses 8,869.75
3. Trinity United Methodist Church-luncheon 333.57
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. Attomey Fees David H. Stone, Esquire 6,550.00
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 Cumberland County Register of Wills 321.00
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. State Employee Retirement System-refund due 647.46
2 Robin Gasperetti-real estate taxes due 883.08
3 Settlement costs ($1436.17) less taxes ($652.81) 783.36
4 PPL Utilities-electric service at property 62.00
5 PAWC-water service at property 17.98
6 Borough of New Cumberland-sewer & trash 64.80
7 UG/-gas service at property 26.02
8 PPL Utilities-electric service at property 92.26
9 PAWC-water service at property 17.39
10 UGI-gas service at property 17.41
11 P A WC-water service at property 17.39
12 PPL Utiltiies-electric service at property 33.51
TOTAL (Also enter on line 9, Recapitulation) S 20074.10
(If more space IS needed, insert additional sheets of the same size)
Shuler, Hazel, E
Decedent's Name
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Page 1
21 06 0417
File Number
Schedule H - Funeral Expenses & Administrative Costs - 87.
ITEM
NUMBER
AMOUNT
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28.
29.
30.
31.
DESCRIPTION
UGI-gas service at property
PPL Utilities-electric service at property
PAWC-water service at property
UGI-gas service at property
PAWC-water service at property
PPL Utilities-electric at property
Verizon-telephone service at property
UGI-gas service at property
UGI-gas service at property
PAWC-water service at property
PPL Utilities-electric service at property
PAWC-water service at property
PPL Utilities-electric service at property
Borough of New Cumberland-sewer & trash
Cumberland Law Journal-adv. grant of letters
The Patriot News Co.-adv. grant of letters
Check written by decedent but not cleared by bank
Register of Wills-filing Inheritance Tax Return and Inventory
Reserve for closing expenses
57.12
20.38
17.53
55.65
17.97
45.88
35.30
15.84
241.56
17.97
41.57
21.63
61.21
64.80
75.00
142.71
50.00
30.00
200.00
SUBTOTAL SCHEDULE H.B7
1,212.12
~
REV.1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Shuler. Hazel E
FILE NUMBER
21 06
0417
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
Central PA Pulmonary Assoc.-debt of last illness
VALUE ATnATE
OF DEATH
124.00
TOTAL (Also enter on line 10, Recapitulation) $
124.00
(If more space is needed, insert additional sheets of the same size)
~
. .".,""'.,..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
~hlllF!r H::I7F!1 F 21 06 0417
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
See, 9116 (a) (1,2)]
1. Thomas Shuler Jr. Lineal 5,332.44
457 Clover Street
Etters PA 17319-
2 Kenneth R Shuler Lineal 5,332.43
706 Cocklin Street
Mechanicsburg PA 17055-
3. Angela Easton Lineal 5,332.44
75 Winter Lane
Enola PA 17025-
4. Erin Shuler Lineal 7,998.66
5211 East Trindle Road 1-R
Mechanicsburgq PA 17050-
5. Ryan Shuler Lineal 7,998.65
5211 E. Trindle Road 1-R
Mechanicsburg PA 17050-
6. Linda K Miller Lineal 31,994.62
1431 Maplewood Drive
New Cumberland PA 17070-
7. Carolyn G Tilder Lineal 15,997.31
1341 Sconsett Way
New Cumberland PA 17070-
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)
- I
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Shuler, Hazel, E
Decedent's Name
Page 2
21 06 0417
File Number
Schedule J - Beneficiaries. 1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (include outright spousal distributions)
8. Ralph E Shuler Jr. Lineal 15,997.31
223 South 18th Street
Camp Hill PA 17011-
9. Barbara A Karper Lineal 15,997.31
300 Hill Top Road
Boiling Springs PA 17007-
.~
,
',,'j
J
','~
~
"
~
\
':"~
ep\wills\shuler.jfl
LAST WILL AND TESTAMENT
OF
HAZEL E. SHULER
I, HAZEL E. SHULER, of the Borough of New Cumberland, County of
Cumberland and State of Pennsylvania, being of sound 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
other wills by me at any time heretofore made.
ITEM I:
I direct that my Coexecutors hereinafter named shall pay
all my just debts and funeral expenses as soon as conveniently may be
done after my decease.
ITEM II: All the rest, residue and remainder of my estate,
whether real, personal or mixed, and wheresoever situate, I hereby
give, devise and bequeath as follows:
A. One-nineteenth (1/19) unto my son, RALPH SHULER, JR.
B. One-nineteenth (1/19) unto my granddaughter, DEBRA REGAN
C. One-nineteenth (1/19) unto my grandson, JEFF SHULER
D. One-nineteenth (1/19) unto my granddaughter, TERESA HUGHES
E. One-nineteenth (1/19) unto my daughter, BARBARA KARPER
F. One-nineteenth (1/19) unto my grandson, GREGORY KARPER
G. One-nineteenth (1/19) unto my grandson, KEITH KARPER
H. One-nineteenth (1/19) unto my granddaughter, ANDREA KARPER
I. One-nineteenth (1/19) unto my son, THOMAS D. SHULER, SR.
Page 1 of 4
ml
J. One-nineteenth (1/19) unto my grandson, THOMAS SHULER
K. One-nineteenth (1/19) unto my grandson, KENNETH SHULER
L. One-nineteenth (1/19) unto my granddaughter, ANGELA SHULER
M. One-nineteenth (1/19) unto my grandson, ERIN SHULER
N. One-nineteenth (1/19) unto my grandson, RYAN SHULER
o. One-nineteenth (1/19) unto my daughter, LINDA K. MILLER
P. One-nineteenth (1/19) unto my daughter, CAROLYN G. TILDER
Q. One-nineteenth (1/19) unto my granddaughter, LISA TILDER
R. One-nineteenth (1/19) unto my grandson, STEVE TILDER
S. One-nineteenth (1/19) unto my grandson, CHAD TILDER
ITEM III: I hereby nominate, constitute and appoint my son,
RALPH E. SHULER, JR., and my daughter, BARBARA A. KARPER, as
Coexecutors of this, my Last Will and Testament.
ITEM IV: No fiduciary acting under this will shall be required
to post bond in this jurisdiction or in any jurisdiction in which he
may act.
IN WITNESS WHEREOF, I, HAZEL E. SHULER, have hereunto set my hand
and seal this ~11l: day of ~ , 1993.
,,~/ J ('
-.../~y-e--.(. - --' (~
HAZEL {/ SHULER
. ..~.~'-L. {L U
Page 2 of 4
-,
SIGNED, SEALED, PUBLISHED and DECLARED by HAZEL E. SHULER, the
Testatrix above named, as and for her Last Will and Testament, and in
the presence of us, who at her request, in her presence and in the
presence of each other, have subscribed our names as witnesses.
~~
:k~:' ~ o/~~
/U; ~~~
Address
~~-/n~~i ~.
Address
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
:SS:
.
.
I, HAZEL E. SHULER, the Testatrix whose name is signed to the at-
tached or foregoing instrument, having been duly qualified according
to law do hereby acknowledge that I signed and executed this instru-
ment as my last will; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
,;;1 / ,(-l 0 (' .
~~ /<0 . _ ~'7~~L-'
HAZEL~. SHULER
Sworn to or affirmed to and acknowledged before me by HAZEL E.
SHULER, the Testatrix, this J ~ 'M day of "rntLtd , 1993.
'~ >n
,J~ry PUbtb-~~
Page, ~_g_~___4
I ~"
!
; . .
L_ __ _ __. u.." .,...___
".i " _."
I
I
.J
\ ':':.:~ ,; "
COMMONWEALTH OF PENNSYLVANIA :
COUNTY OF CUMBERLAND
:SS:
.
.
We,
:)0'Yt C ~c~
and
~ e L. Lvc-(<~
,
the witnesses whose names are signed to the attached or for oing
instrument, being duly qualified according to law, depose and say that
we were present and saw Testatrix sign and execute the instrument as
her last will; that Testatrix signed willingly and that she executed
it as her free and voluntary act for the purposes therein expressed;
that each of us in the hearing and sight of the Testatrix signed the
will as witnesses; that to the best of our knowledge, the Testatrix
was at that time eighteen or more years of age, of sound mind and
under no constraint or undue influence.
~~
~; ~~~
W~tn ss
-
Sworn to or affirmed to and acknowledged before me by
.::r ~ ~ Lc..~........
L.lve-k~
, 1993.
~'~ 12,
V~~ rn bXu./uut
Notary Public ~
,
witnesses, this ~day of
)c" ~
~~
and
,
I
I
/--
N~t~riv.1 SQal
Ti""a ~J F'. '~"~II l.I"'l......,' h"
, l:", . ,. ':.~<.,~; :..<~[~' ~:.':c'C";J j
. ..- ~ .-., -, .....-~
J.. ", _
.......... . "',0:,.,. .I.... '"J .~.......... .r..:.,.... ..:.. io. ...:... ,~.;,i
Page 4 of 4
~
I -
?Lh:_"'-JL A:j Lf- 0.. (2[.)
- a-;tt:J-- ~.4- ..(IJ /-:c..zoc'.)(.,
/7
i.
/ : i d /) I () j
,'/ ~~_.,-.
---L) /J. - I) 'I ,~
lu. ~4 /;d-t'L-<-'- t:.-, 0 tJ- .
/
. i
, I
,du...",UJ - &.,~.-,<,,-.) '1=-:z.y<",~
. i,d-/!u>t <' J _ !M.h~ -<J-! ~. '/ -L'.t.~~u' c1 A. :'-tl...Lf kA<-. )
( d~l.t..L.i'~)
x2k-<-i2.J- .xJA:.L'-ch.J;{~LL)o~J (VL-L~'d~U4(~)
. : t--c;t. ;L~.Jl. ~4....-. -.4 --' )
y>dL J{: .! ~~ (~j~ L K. ~ ?h~ 1 e< ,f_,1
/
/
. i
1 !
I
/J~' ,; .
. ; fr' n.. cit.... -f:- <2..__-1 -
/) , /1 ; .)'1 i / /'
(~ d.-'~ .tJ-.. ~r ./ ~<. ~.d!::..R_A-_--
'~JCk~,lu__.
,
. ,
,.
~) 'ty
It
:/ r 6.'1 --
SHULEr- ,STAP'combs
, "
..):~>: r f", .z;.=GLC~~(
.. ': :~. ~ :.-: i::=;:' :~;:~ c .
'\ '\ .:; ~-'
Parcel # 26-24-0811-411
20D6 NOU 21 Ar111 21
DEED
THIS INDENTURE made the g+n day of ~/ , 2006, betweeo RALPH E.
SHULER, JR. and BARBARA A. KARPER, Co-Executors of the Last Will and Testament of Hazel E.
Shuler, late of the Borough of New Cumberland, County of Cumberland and Commonwealth of
Pennsylvania, of the first part, hereinafter called the Grantor,
-AND-
BRADLEY D. COMBS and DAWN L. COMBS, husband and wife, of the second part,
hereinafter called the Grantees;
WHEREAS, the said Hazel E. Shuler became in her lifetime seised, as of fee, of and in to a
certain tract of land, together with the improvements thereon erected, situate in the Borough of New
Cumberland, County of Cumberland, and Commonwealth of Pennsylvania, and more particularly
described hereinafter; and being so thereof seised, died on May 5, 2006, having first made her Last Will
and Testament in writing dated March 29, 1993, duly probated and registered in the Office of the
Register of Wills of Cumberland County on May 16, 2006, wherein and whereby she appointed as
Executor, the said Ralph E. Shuler, Jr., and Barbara A. Karper, to whom Letters Testamentary were
duly issued by said Register of Wills on May 16, 2006, wherein and whereby said premises hereinafter
described were not specifically devised, all as in and by said Will and the records of said Register of
Wills more fully appears;
1
~..' ,.~.:. :.",: .)..' .' /- ,-'\
--'-'vv
.
II
I[
II
I,
Ii
,I
II
f
I
I
NO.V THIS INDENTURE WITNESSETH, that the said Grantors, for and in consideration of
G1>
the sum of One Hundred Twenty-Two Thousand and NO/100 ($ 12aOOO.00) Dollars, which has been
paid to them by the said Grantees at or before the sealing and delivery hereof, receipt whereof is hereby
acknowledged, 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 piece and parcel ofland situate in the borough of New Cumberland (formerly
Lower Allen Township) Cumberland County, Pennsylvania, more particularly bounded and described as
follows to wit:
BEGINNING at a point on the southern line of Donald, now Eighth Street, and the western side ofa ten
(10) feet wide alley, which point is one hundred ten (110) feet distance from the southwestern
intersection of Eighth, formerly Donald, and Market Street; thence in a southerly direction 105 feet to
another ten (10) feet wide alley; thence in a westerly direction along the last mentioned ten feet wide
alley, thirty-seven (37) feet to the line of Lot No. 168 on the hereinafter mentioned plan oflots; thence
in a northerly direction along the line of Lot No. 168, 105 feet to the southern line of Eighth Street;
thence in an easterly direction along the southerly line of Eighth Street, thirty-seven (37) feet to the
point or place of BEGINNING.
BEING Lot No. 167 in a certain Plan of Lots called Elkwood, laid out for the Wood, Harmon Real
Estate Association by George Roberts, Civil Engineer which said plan is duly filed amongst the records
in the Office of the Recorder of Deeds in and for Cumberland County, Penna, in Deed Book M. Vol.5, at
Page 498.
BEING THE SAME PREMISES WHICH Curvin E. Wasser and Jennie P. Wasser, his wife, by their
Deed dated October 13, 1937, and recorded October 25, 1937, in the Office of the Recorder of Deeds in
and for Cumberland County, Pennsylvania, in Record Book V-II, Page 05, granted and conveyed unto
Ralph Eugene Shuler and Hazel Edna Shuler, his wife. Ralph Eugene Shuler died August 31, 1967, thus
by operation of law vesting title in Hazel Edna Shuler, deceased.
TOGETHER with all and singular the buildings, improvements, ways, streets, alleys, passages,
waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever,
thereunto 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
~2~
;c /./ ~'_,\L:~~t~).JJ1.
,/
said :~Ia,zeJ,E. Shuler, at and immediately before the time of her decease, in law, equity, or otherwise
howsoever, of, in, 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 Grantors, for themselves and their respective heirs, executors and administrators,
does covenant, promise and agree to and with the said Grantees, their heirs and assigns, that they, the
said Grantors, have not heretofore done or committed any act, matter or thing whatsoever whereby the
premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged, or encumbered
in title, charge, estate or otherwise howsoever.
IN WITNESS WHEREOF, the said Grantors have hereunto set their hands and seal the day
and year first above written.
~~2-e ~llJ' (SEAL)
RALPH E. SHULER, JR., Co]~ecutor of the Last
Will and Testament of Hazel E. Shuler
r) r ,/~! _ '
JlA)(L~l1A ll.,~ (l Ie" U// (SEAL)
BARBARA A. KARPER, Co-Ex~ tor of the Last
Will and Testament of Hazel E. S uler
I
I
I
I.~ ("";l ("";l ("";l COo') ("";l :::0 r;-. .:..... = ::oz:: s:: = = r.:;;:r
::!f'::3"'::!f'=~::!f'~C1' rrlrT1rr1,.....Irr1~
......r"Df"Df"Df1)rJ:I(""") a:-:wr-.,a:t:.r:t,.,..,,.,.,.,.,
i'.- '-'.. !-, !-I !~L ~. f--t. _ ~-:t ....... t::J CI r:::::.
I ~::;;::;;~i::#......~~n I :g,,-,., r I
.t::J:t ::x ;:0 ~ x:
In:> r.r r...J r...) t...;J t'..J " CI ....... :J> ro CI ::'1:' :&:
! t :J>.;.." (.J'f 1".J1 VI ;::0 <: ........ f"T'1 :::.:r --I ';I"J
, .~.J:o.':"l1o"-.J~~i;l>:::t::F2rrJ-l~
' -f rr'/ -f ::r> rJ')
:- -.,~L. 6 ~
C> c:.:. --I
C> ~~ rrl
c;;;>
I-f
:::ll
Ln
....,.
....
:#:
r...J
.:::>0
00
r.-) rJ 0"_' 0-.
c;."""!il (
~~~:g
r:n "::r;:I =--- r...;r
C.<I
c-:o <::0 .J:>-.
r-- r...:J N
~:::3
-..,
;::0
ro
..
w
....
::0::-
Ln
("";l
iii
r::r
ro
-.
,~
"'"
:3
r::'_
f -
...J "'-4
~""""...
, 0-. 0"'- ......3 ~ cr.. Go... :-".3
:,~...1 ........ .....- "'~I (-tJ ........ ....... ......1. ........ t....;.
P'\-.!) '0 '0 C:. '1:H- '..0 (..1" t....' <::".1 ~ 10 Ct ,..:.~ t...,
k" " . . . . . . . . . . . .
..tf -::..-:r <:,",;. 00 r..)1 <::'> lOt <::r ..-:::r c:..r1 .:::... <:;. ..:::) r..Jl r:..n
' ..-..~o&-......,~~~..-.~_..-.--."...............
II
,......
"1:1 ....
"" ...,
;.gr:::t
-.......
t...)
(..oJ =
~j :>K
...... .-:.
:::5 0
-~S
c-:l -. IT
=C:'<
~H~:;:z:t
I~:::S fD
c-:'I rt- 1.
-f <:>
0". r..... ....,....
tJ:I =i-;:it
o::g 3 ~- 5' -,
...-. r.o ,:;:,
~,
::>:I
....
"
It!
.....
'"(l
,'1-
"*
.....
1;..11
.3
'0
.1) .' r) r" r'" . ~ . ~ OJ
rll :;:))~)',( I I ,i;: UUU"'"
,::,.. ~
U'I
, .'
~
.
.
COMM0NWEAL TH OF PENNSYL VANIA:
: SS:
COUNTY OF CUMBERLAND
On this, the ~day of November, 2006, before me a Notary Public, the undersigned officer,
personally appeared RALPH E. SHULER, JR. and BARBARA A. KARPER, Co-Executors of the Last
Will and Testament of Hazel E. Shuler, 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 have hereto set my hand and notarial seal.
COMMONWEAlTH OF PENNSYlVANIA
NOTARIAL SEAL
DANIEL M. HARTMAN, Notary Public
New Cumberland Bore., Cumberland Co.
My CommiSSion Expires Jan. 21. 2009
\Q
PJ!r--
otary Public
I Certify this to be recorded
In Cun1berland Countyp A
/'~:"-:~'''-;-'''''7;...._ .........~>:,~2~~. ,.:~_, ,:".-;>"'- ..,~<::I
.,to -, "
.~
~~~~
I hereby certify that the precise address of the Grantees is:
166 8th Street, New Cumberland, Pa. 17070
::>=' 1--;
.'t. ::::I
;:? ,n
.;.. ."'t.
.... ...,
A" ;;p:t
1.0
rv
--::>
.:::>
" .:-, 0-.
~ ~ I
;=:)
.... ;;go .s>- =
en ::>:;1 r..,;, 1'[1
r~J .....
" ..c- rt)
r- r'.,;J ......
....... ..,.,
...,.., .-<-
..,.., ;:p.;
.....
.......
...... 0"-
r'.J t..~
...... ~
'....
....' .J:-.
<:> '..0
8
.... %U,i
.-
..
...-
";'!
C-.,l
^'
.... ("") ....."
.-. :J> L
rtr U').&:- ~
.....=
fii.......
0.. .
. <:>
. <::>
.
.
.
~ 4 ~
~. ~. ~
"".J ,......
.. ...,.. -tM- ... ...-
..J::-. 0". 0'-. r'~""", ~. . f..,)
(..'~oo.o (...~ ..........,.<:.?:bo
....c e:. c:::.. c::.. ....... ...0 .:..~ f'oo.:I <::> ....... c::> rC:> C>
...............
<J'I <::> ''::> <:> CJl = <:> <:> <:> (J'I = = <:> ("... c..11
===<:>===========
~
-:.~ ~ .~
'.-
\.' .
... , ~
, ...." ',j...)
,-.,
,...,
..
"'r'
I'D
""i
......
1:1.1
::::l
CL.
......n
~g
n- ::::l
.... .-T
,- '<
~7
.... :::0
;:::>1:1
.....,.. (..,
c..
-.., ....
t-'- a..
........ ".
..... ..,
:::;
1.iJ 0
-t.
l;'F.,;.::t>'G'"'~J' '13
c.J~'" ..~ ~-:I..!1 [t4' U
'J'.
.
0_- .__ _ ,__
. .-..... --.
,>
~
o PNCBAN<
June 2, 2006
David H. Stone
414 Bridge Street
P.O. Box E
New Cumberland, PA 17070
RE: Estate of Hazel E. Shuler, deceased
SSN: 188-32-4838
DOD: 5/5/2006
Dear Mr. Stone:
In response to yoW' request for Date of Death balances for the customer noted above, our
records show the fOllOwing:
Checking Account
Account_Sl4oo58119
HAZEL SHULER
CAROLYN TILDER,
DOD balance: $10,823.05 (non-interest bearing)
Established 08/15/2001
Please note that this office only provides date of death balances for deposit accounts
(IRAs, CDs, Checking and Savings accounts). We do not process uy financial
transactions Or prOvide statements. If you need assistance with any of these items,
please call 1-888~PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
~ t;JPJh
RacheIJe Wells
1-800-762-1775
P7-PFSC-04_p
500 first Ave.
Pittsburgh PA 15219
Member FDIC
TOTAL P.01
.1
. .
..
PSE(~
the financiallinkTM
May 19,2006
Account # 0188324838
DA VID H STONE
414 BRIDGE ST
POST OFFICE BOX E
NEW CUMBERLAND, P A 17070
Dear MR STONE:
The following is the status of HAZEL SHULER's account with PSECU as of the date of death.
Joint Owner's Name
Date of Death
Date of Birth
BARBARA KARPER, RALPH SHULER JR, JOINT TENANT W/ROS
05.05.2006
06.03.1916
Share
SOl
S 04
Description
Regular Shares
MoneyHandler
Open date
11.15.1979
Balance
$11,968.66
0.00
Accrued Dividend
$1.31
0.00
The dividend earned from January 1,2006 through the date of death was $40.06. The decedent had no loans with us.
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,
'~
Meacie Fairf: x
Member Service Representative
Finance Support Unit
Pennsylvania State Employees Credit Union
Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990 . (717) 234-8484 . (800) 237-7328
· Moiling Address: PO. Box 67013, Harrisburg, PA 17106-7013. (717) 777-2100 (TOO) . (800) 472-1967 (TOO)
Soyings federally Insured up to S] 00,000 by the Notlonol Credit Union Administration WWw.psecu.com
."
Prflll""'!I ,,"hl!'J/l~ .1It! O/!:f>CIllAtft
A Settlement Statement
n_ us __,........'" "-...... '""
OMa ADDrova' No. 2502-0265 (e'Dires 9/30/2()( ~J
2. rJFmHA 3, DConv, Unins, 16, File Number 17. Loan Number f 8, Mortgage Insurance ase Number
. 5 ~fonv.;..lns 28309COMBS 654088615
l'Ji" r""" "..m'i/iiiJ'fog". )<ltJ ...""~ o:~ar.-" co, n, o. .
"ems m."k8(j '(p 0 C )" -. Piod OUlaod.1ho cloklg' lh;;'';.~'~ ""1:1:...:.~~ ..~ o~,., ...._.~:"'"."" ~_~..""'" I, T'fIeE '..
WARNING 111..1.. '''me 10 'now',,"I. mo.. ,.... "'''mon', '0 Ih. Urn,.. 5". ,., on 'h.. or.'o'ro,":' ',~::.. ""i!~~n ~"'. I Xpress ",It/emenf System
;' D. NAME 0 "'",,~ ~.".,.. ~ -_ '. __ ,."" _.... '., _..... ... . ,. ",,,., ""'''. "" """
"""ROWER ........, D. COMBs.IId "'WN,. C.....
ADDRE~S - --~hurch Road Hershev. PA 17033
E NAME OF SElLER: ESTATE OF HAZEL E. SHULER
I ADDRESS, "_
IF. NAME OF LENDER ABN AMRO MORTGAGE GROUP. INC.
ADDRE~L,_ '- 2600 W. BIG BEAVER ROAD TROY MI48084
G, PROPERTY ADDRESS: 166 8th Street. New Cumberland. PA 17070
I New Cumberland Borol/gh
H "mE",,, "GENT "- C"" "'- _. "'. ,_" "'.n~7'" F"" "'.n~,..,
PLACE OfllfJTLEMENT: 414 Brldae Street, New Cumberland PA 17070
-l~ETT~~MENTDATE 11/0812006
I J.,~QAtMARY OF BORROWER'S TRANSACTION:
. '100. G~()~~~M~ DUE FROM BORROWER
I 101_GOntr~s~,~~ 122 000.00
10LJ>~rsonal PrQPeIty
10J_~ItL8fl1~fQes to borrower IIine 14(0)
1..04,-_, '-
105
8. Typeo
1 IIFHA
4 UVA
C. Note
form HUD_1 ( B6j re' H.ndbook 4305 ~
4951.53
K. SUMMARY OF SELLER'STRANSACrlC N:
400. GROSS AMOUNT DUE TO SELLER
401, Contract sales price
402, Personal PrODertv
403,
404,
405.
122 ooioo
- '-. '''- Ag(ustments for ilemspaid by seller in advance
. 'OL~'~~n laxes
10Ze -~.ol!'!f1 t~x~s 11/08/061012/31/06
108. School taxes 11/08/061006130107
I !r;~,,",!:~'"''
,l.1.2,__
120._G~9S~,A"OUNT DUE FROM BORROWER
_2.00. AMOUNTS PAID BY OR ON BEHALF OF BORROWER
,201..:.. ~.!I!.oi.~ money
JO,L_fr;n~moun' of new loans
203,.,~'i.s!i.'!9.loa~J taken sub};;, 10
204
205
206
207 " '_"
20lL___
2,09" , ..
64.46
566.13
22.22
Adjustments for items oa;d bv seller in advance
406, Cityltown taxes
407, Cou!1lY faxes 11/08/06 to 12/31/06
408. School taxes 11/08/061006130/07
409, Refuse - 1 1109106 ' 12/31/06
410,
411,
412,
420. GROSS AMOUNT DUE TO SELLER
SOO. REDUCTIONS IN AMOUNT DUE TO SELLER
SOl, Excess Deoosit (see inslrucUOIls)
502. Seltlement chafQes 10 seller lline 14001
503, EXISUnQ loanls) taken subiect 10
504, P~ff of First Mortaaoe Loan
505,
506,
507,
508,
509.
64.46
566.13
22.22
127 604.34
2000.00
108 500.00
122.652.81
1424.86
I
-, '-.--.- Adjustments for items unDaid bv seller
no c;.'!YItQ~ 1a"s
211 ~lJ.n.tY. ~"-'~~
I.~ 2':J.' .~. ~.. ~.. h.. "'..~
215, Sewer:.09/01/06, 11/08106
I 216
Igt~~~:~~,o._
/30.1.. Gro.s; ~';;;'unt due from borrower (line 120)
302 ll1.ss "-mo.unt.s.palll bvlfor borrower (line 220)
I 30~. CA~lifRO~~ORROWER
11.31
510,
51,.
512,
513.
514,
515. Sewer - 09/01106 _ 11/08/06
516.
517.
518,
519,
520. TOTAL REDUCTION AMOUNT DUE SELLER
600. CASH AT SmLEMENT TO OR FROM SELLER
601, Gross amount due to seifer (line 420)
602, Less reduction amount due seller IIine 520)
Adjustments for Items ul1paid bv seller
City/lown taxes
Cou!1lY taxes
School taxes
i
t--
11.31
110511.31
127604.34
110511.31
1 436 17
~.;(,RS
-t"tto)
It"" 4(
I);), (, Go ('t)
7 ~'] . J,o
----, -
I) 1/) I (, Ie 'I /I/JY fc,
.. / / :: I
-:------.::...:
1:1 j (, , t7
- (,S;f .Jl
-----..----
7S'3.?(,
17093.03 603. CASH TO SELLER
122,652.81
1,436. f7
121 216.~
r"
) "'''' yo" CO"OCI ""PO,.., ,d.nlmqlJon nu.-, "you do no, ",0'''. yo~ ''''"OC' 10'",,,,, odenldQl1On
.-or;;e"ury, I <en", II,,, 'h. nu_ '/>own on 10.. ,..,."""', .. my """",,, .....,., "'.n.<ficohon nu_
-lIS) SIGNATURE(S)
'm_on, 10. ,n'orma'"n Ond .. be,,," '~n'_ '0 'h. In'.mal R".nu. S...,,,. "YOU... '""Uor" 10 "" , ,.Iurn,
. "'port.., dod Ih. IRS del.'m..., mal "ha, no, been '.port... The Cono"" Sale, Poco d.OUIbed on
'(""<I,
n"rnbt
:-)/;ttl
~.lI LJ
- -- --------
_IHJ ____ ___
----~-
-___iW>
'T'l'VIf'U.'1 t;l1,llOn<; dfft ObSfIJetll
us. DEr'~RTMENT OF HOUSING AND URBAN DEVELOPMENT
... ~ ~~ SETTLEMENT STATEMENT
I L. SETTl.g~ENT~-':f~
/ . Zoo,~ :r.~'.::" ":':"" _., "'" """''''
7~1 . $ ~-_ ... ___ to
702 ~. --- to
703 CommisSion ~/(j at Sett/ement
'Illi, IT.... >.rABI.E IN CO'"ClJON """ LOA.
801. Loan Q~abon Fee %
I 802 Loan P'sc.O..lJIlt__ %
803 .Appralsa.l~ to Fairwav ADDra;sa,s
804. Credlt3~/l.Q.rt.
$~~~ .~~~~
If.. ...8.8010..9-....0 Le;., ~.. dp._ er AdministratIOn Fee 10 ASN AMRO MORTGAGE GROUP 'NC.
I . ,;,;;6&....... "". __"""-
I 8 11 Overn~~t E~_ to Mortgaoe Unlimited
I'"';'~.~E""_ 8"_RIO" >'10 IN AI!!IANCE
.,,"'....,,"'" "- . 12""_ .., ,,_ ...
~_901_ ~rt!L~ /nsuranee Premium for to
903. 'iaZil[d Insurance Premium for to
90L_~_
905.
- Jog!, !.E~ERveSiiEPoS'TED W'TH LENDER FOR
J"" """'...~ 3 on i , <J.2'"
'''''' ........-.... on,' , ..
'1lOJ,"""_T~ """, ..
'QQi C""'-",.... T ~ " "",' . 3T... ..
"',s ~.... . "", ~ i "-" ..
'''''''~~- · ... ....,lIORr..... GRa... INC.
1100.T/.TL.ECHARGES
.11Ql. ~f!/enJe_ntQ[s~
. 11~ Ab~to~~~
110! Iitle examination
lJQ.j, !iUe insurance binder
U05 D..Qf~~n
!1ClP._~t~'l'J~_ __
_11Q~c_A_ttorn~~
.- - !!."f1.U!i~ye items No:
U.~ . TiJ~ Insurance to Clelar Cliff Abstract Aoencv 'nc.
-.Line/udes aboVe items No: m. Bas;C!
1 !OJ~[lCiet's.pOlicv 108500.00 .
1110Qw~~&i1fL 122000.00 -968.75
1/1 LE-'IQJQO, End 300 to Cedar Cliff Abstract Aaencv. Inc.
111?End !l()Q to Cedar C"ff Abstract Aoencv 'nc.
11 J..3 G'OSifl~~ to Cedar Cliff Abstract Aoencv. Inc.
12~9" GOVERNMENT RECORDING AND TRANSFER CHARGES
'"" -. '... """3B.so ""'""...... ' ......,
POl.~c:;,ty/C~-I1t1: laxIstamos Deed $ 1 220.00 ' Mortoane $
120J~~a.ttl.a.xf.s~s Deed $1 220.00 : Morta&;; $
i 1204
t 1205--------__
(130fA-9'lftlQ.NALSETTLEMENT CHARGES
t g;~)~~;~tkJn-
i 1303,. TilxCe!!.~ .-. 10 Stone Lafaver & Shek'etski
L~ ;i{;;.,.".'ft : ::::: t::::::::::
I:; ~:%~:c."%-JGiii ::::: t::::::::::::
I~~,:~~~~,_.s -~~:~~~~N~T.C~H~~~:::::::'~~~;':'i".f/;"7of"'Oc."';I'M"' ~nt.m~.::":_rn
'''"'~ 1t""".M "'... ...ea. YOf'hoHUO.tSo""""'fStat""'.rn
~........~ < !\. / -C~_.
7 '----=' L./" ~ '
.k/
/ \ 1/
t~'(,l.. "'
torm HOD- f (if, J fe' HilrtO'booIr 41305 2
File Number: 28309COMSS PAGE 2
r........ "-,,_ ""'''' "_.,, 28~._
PAID FROM I PAID FROM
BORROWER'S
FUNDS AT
SETTLEMENT
LR
$2.305.63 Pac bv Lender
570.00
550,00
23 Dava
LR
467.82
LR
129,75
LR
LR
LR
407.00
441.54
-516.83
to Stone Lafaver & Shek/etskl
to Cash
25.00
)"
968.75
I
100.00
50,00
35.00
99.00
1 220.00
40.00
50.00
1.424.86
~~
.J
!--.t~ '\ l
WAR'''Nl; iT is A t RIME TO kNoW'NGl' MAkE FALSE STATE/,ffNTS TO THE
oINITF I) S rArE S t", THIS ')R ANy S'MllAR FORM PENAL TIES UPON CONVICTION
I .AN INCt UO. A FIN{ AND iMPRISONMENT FOIl OETA'LS SEE TITLE fa
. j S <:l..nr: Sfc rll)N lOUt A.~O SECTION 1010
r' (
~
/ ":"0
DArE {/ J
300.00
SELLER'S
FUNDS AT
SfTTLEMENT
r
I
I
I
I
I
r
I
I
I
r
I
T
I
-,
-,
14.50
!
1
i
-
/1.00
--+--
I
125.
10. f
-'1
----
II
I
1,220.00
5.00
38.60
26.26