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Home My WebLink About12-19-06 --I 15056051058 REV-1500EX(06-05) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128.{)601 ENTER DECEDENT INFORMATION BELOW Social Number Date of Death OFFICIAL USE ONLY County Code Year ~, 00 File Number INHERITANCE TAX RETURN RESIDENT DECEDENT gDL Date of Birth 202-46-5093 08/24/2006 6/1954 Decedent's Last Name Decedent's First Name Gruver Larry (If Applicable) Enter Surviving Spouse's Information Below Last Name First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C., 1. Original Return 2. Supplemental Return c::::> 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c::::> c::::> 4a. Future Interest Compromise (date of death after 12-12-82) c::::;:) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c::::;:) 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 .................--....-----.---.. 4. Limited Estate c::) c::; 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes (',,;:;) LaMar W. Hume Jr. i (717) 236-5263 .......~ REGISTER.OFWi~~aEONI..Y ..~ :') cD , " r"rn ~[~ 0 C? Firm Name CT Land Services Co. First line of address :n =':J /.... ':-:c-) ,(_',~'i ...:.:'~ ,I'.. _ " :::J .--/ m mm[)~T~~,!:~ 300 North Second Street Second line of address Suite 900 State ZI P Code ...............Q N 17101 Harrisburg Correspondent's e-mail address:lhume@ctkeystone.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE L 15056051058 --I 15056051058 MI L MI -+ \.0 -0 Ji; .a .~ :-rj n, ("-') C) ::0 C.J E3 C:) -r'l -.,., c) L:; ~; -1"1 ~ --.J 15056052059 REV-1500 EX Decedent's Name: Larry L Gruver RECAPITULATION 1. Real estate (Schedule A). ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4., 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) c:) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c:) Separate Billing Requested. . . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. r- Decedent's Social Number 202-46-5093 84,550.00 1,000.00 444.82 85,994.82 3,231.14 82,587.85 85,818.99 175.83 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 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. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O 45 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 50.83 100.00 25.00 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . .. . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 15. 16. 2.29 17. 12.00 18. 3.75 18.04 <e> 15056052059 ~ --.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Larry L Gruver STREET ADDRESS 5855 Hillside Lane DECEDENT'S SOCIAL SECURITY NUMBER 202-46-5093 CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount ~ I (1) 49.29 3. InteresVPenalty if applicable D. Interest E. Penalty ~ Total Credits ( A + B + C ) (2) TotallnteresVPenalty ( 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) ~ ~ r- 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) (5A) (5B) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RE 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)). , 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 ass~ts and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. i For dates of death on or after July 1, 2000: i 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 patent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)). i The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as joted 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 define ,under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. i I I REV-1502 EX+ (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Larry L. Gruver FILE NUMBER 2106-0801 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. i Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ' ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 5855 Hillside Lane, Hampden Township, Cumberland County, Pennsylvania TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Larry L. Gruver FILE NUMBER 2106-0801 ITEM NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION 1. 1995 Chevrolet Sedan, value based on sale price (sold to Allen Biehler) 2. 1998 Pontiac Grand Am, 111,921 miles TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE I OF DEATH ' REV-1509 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Larry L. Gruver FILE NUMBER 2106-0801 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 A. Wilma Spotts B. C. JOINTLY-OWNED PROPERTY: ADDRESS 71 Big Oak Road, Dillsburg, PA 17019 LETTER ITEM FOR JOINT NUMBER TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET 1. A. 12131/00 Members First FeU Ace!. # 267767 (statement attached) TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) RELATIONSHIP TO DECEDENT sister %OF DECO'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTERE T st Send Inquires 10: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.members1st.org Statement of Accounts -..... Jul 25, 2006 thru Aug 24, 2006 Account Number: 2677$7 Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TOO: (717) 697-5312 or (800) 283-2328 eX!. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 Account Balances at a Checking: Savings: Certificates: Loans: Money Management: MEMBERS 1st FEDERAL CREDIT UNION 11950 1 AV 0.293 23899-11950 11..111...11111..111111"1..11111'111111111.1'11.1..1.1111,111 LARRY L GRUVER WILMA M SPOTTS 5855 HILLSIDE LANE MECHANICSBURG PA 17055 *- - ;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;; N- - w- ;;;;;;;;;;;;;;; w- 0- * Page: 1 of 2 Have you tried the NEW Members 1 st Online? Please read the enclosed insert regarding the changes and new functionality that this service now has. If you're not currently enrolled in this FREE service, contact Telebranch at (717) 795-6049 or (800) 237-7288 and enroll today! /l'\ IS l ') ~ t-..kl r^.e fl ' ~ ft h er-,0 ~ (" L-- "'-'1 l..VAj' k/{) CHECKING ACCOUNTS ""1 11 - CHECKING Date Ju/ 25 Jul 26 Jul 27 Jul 31 Jul 31 Jul 31 Jul 31 Jul 31 Aug 02 Aug 10 Aug 14 Aug 15 Aug 21 Aug 23 Aug 24 Aug 24 Check # 000198 000211* 000212 Subtractions Transaction Descri tion Additions Balance Forward Withdrawal Check 000211 Tracer 0021286636 Processed Check - VERIZON ARC TYPE: CHECK PYMT ID: 2005022221 Check 000213 Tracer 1465426494 Point of Purchase Check - WAL-MART 7 ECA Terminal City & State - MECH PA TYPE: PURCHASE 10: 9037011886 DATA: TELECHK 800-697-9263 Check 000198 Tracer 0731005008 Check 000214 Tracer 0731002608 Check 000212 Tracer 0731006464 DepOSIt Swipe 5 Rebate 0.20 Deposit Transfer From Share 00 560.48 Check 000215 Tracer 1603893229 Processed Check - HOMECOMINGS-A TYPE: CHECKPMT ID: 8882342756 Deposit by Check 100.00 Withdrawal Debit Card 08/13 676364900540013 HANDYMAN CLUB AMERICA 800- Deposit by Check 842.23 Check 000216 Tracer 0823004154 Check 000217 Tracer 0022053814 Processed Check - VERlZON ARC TYPE: CHECK PYMT ID: 2005022221 Ending Balance 100.00- 36.81- 56.99- 80.01- 109.05- 167.05- 873.82- 30.82- 114.23- 35.75- CHECK SUMMARY Amount 80.01 36.81 167.05 Check # 000213 000214 000215 Amount 56.99 109.05 873.82 Date Jul 31 Jul 27 Jul 31 - - - Continued on following page - - - .63 ___---.L 'r ~~~~~~r!: Send Inquires to: 5000 Louise Drive PO Box 40 Mechanlcsburg, PA 17055 www.members1st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TOO: (717) 697-5312 or (800) 283-2328 ex!. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 23900-11950 Jul 25, 2006 thru Aug 24, 2006 Account Number: 26n67 Page: 2 of 2 Check # Amount Date 000216 114.23 Aug 23 .. Asterisk next to number indicates skip in number sequence 8 Checks Cleared for 1,473.71 Check # 000217 Amount 35.75 Date Aug 2r i _ F=- SAVINGS ACCOUNTS .. ~ N- == N_ - w- ~ w- 00 - REGULAR SAVINGS Date Jul 25 Aug 02 Aug 02 Aug 24 0- .. Additions Subtractions Transaction Descri tion Balance Forward Deposit ACH FRY COMM. 10: 1231885979 Withdrawal Transfer To Share 11 Ending Balance 560.48 5 560.48- YTD SUMMARIES TOTAL DIVIDENDS PAID 00 REGULAR SAVINGS 11 CHECKING 0.00 0.00 Total Year To Date Dividends Paid NOTE: Total includes closed shares 0.00 Don't forget about our new Member Loyalty Rewards Program. The more products you have with us, the more benefits you'" receive. Ask an associate for details or visit our website at www.members1st.org for details. REV-1511 EX+ (12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Larry L. Gruver FILE NUMBER 2106-0801 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION FUNERAL EXPENSES: St. Paul Church, Funeral luncheon 2. Blossom Shop--Flowers 3. Cocklin Funeral Home 1. Pastor Patrick Rooney, funeral service 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 Year(s) Commission Paid: 2. Attorney Fees 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. PP&L, electric bill for 5855 Hillside Lane 8. Post Office, 9. Motorists Insurance-car insurance 10. Marie Huber, School tax for 5855 Hillside Lane TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT REV-1512 EX+ (12-D3) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Larry L. Gruver FILE NUMBER 21 06-0801 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Homecomings Financial Loan #0437455363 2. Personal Loan from Wilma and Thomas Spotts TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Larry L. Gruver FILE NUMBER 2106-0801 AMOUNT OR SHARE OF ESTATE RELATIONSHIP TO DECEDENT Do Not List Trustee(s) NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Brian Gruver, 4B Richland Lane, Camp Hill, PA 17011 2. Wilma Spotts 3. Thomas Spotts 4. Helen Runk 5. Nancy L'Orange 6. William Gruver 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) , . B. ,A LOAN: OMB NO. 2502~0265 ~ A.- U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.DFHA 2.DFmHA 3. ~CONV. UNINS. 4.DVA 5. Dco~v. INS. 6. FILE NUMBER: \7. LOAN NUMBER: SETTLEMENT STATEMENT AS 2006-059 047-156267-8 8. MORTGAGE INS CASE NUMBER: 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 'TPOC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3/98 (AS 2006-o59.PFD/AS 2006-059/41) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Estate of Larry L. Gruver, Homecomings Financial David C. Deyo Wilma M. Spotts, Executrix 9 Sylvan Way, Suite 310 933 Forest Court 5855 Hillside Lane Parsippany, NJ 07054 Carlisle, PA 17402 Mechanicsburg, PA 17050 AS06-059 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLE MEr T DATE: 5855 Hillside Lane Atlantic Settlement Group, LLC Mechanicsburg, PA 17050 November 17, 006 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 300 North Second Street, Suite 900 Harrisburg, PA 17101 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 84,550.00 401. Contract Sales Price 84,550.00 102. Personal Property 402. Personal Prooertv 103. Settlement Charoes to Borrower (Line 1400) 6,081.40 403. 104. 404. 105. 405. Adiustments For Items Paid Bv Seller in advance Adiustments For Items Paid Bv Seller in advance 106. CitvfTown Taxes 11/17/06 to 01/01/07 2.24 406. CltVfTown Taxes 11/17/06 to 01/01/07 2.24 107. CourltVTaxes 11/17/06 to 01/01/07 13.68 407. County Taxes 11/17/06 to 01/01/07 13.68 108. School Taxes 11/17/06 to 07/01/07 298.80 408. School Taxes 11/17/06 to 07/01/07 298.80 109. SewerfTrash Charqes 10/01/06 to 11/17/06 63.35 409. SewerfTrash Charges 10/01/06 to 11/17/06 63.35 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 91,009.47 420. GROSS AMOUNT DUE TO SELLER 84,928.07 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money 1,000.00 501. Excess Deoosit (See Instructions) 202. Princioal Amount of New Loanls) 67,640.00 502. Settlement Charoes to Seller lLine 1400) 6,598.50 203. Existino loanls) taken subject to 503. Existino loanTs) taken subiect to 204. 504. Payoff First Mortgage to MERS Decision One 76,414.25 205. 505. Pavoff Second Mortaaoe 206. Proceeds from Hud 1A 15,814.61 506. Escrow for Inheritance Tax 1,915.32 207. 507.IDeoosit disb. as oroceeds) 208. 508. 209. 509. Adiustments For Items Unpaid Bv Seller Adiustments For Items Unpaid Bv Seller 210. CltVfTown Taxes to 510. CltVfT own Taxes to 211. County Taxes to 511. County Taxes to 212. School Taxes to 512. School Taxes to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 84,454.61 520. TOTAL REDUCTION AMOUNT DUE SELLER 84,928.07 300. CASH AT SETTLEMENT FROMfTO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 301. Gross Amount Due From Borrower (Line 120) 91,009.47 601. Gross Amount Due To Seller (Line 420) 84,928.07 302. Less Amount Paid By/For Borrower (Line 220) ( 84,454.61 ) 602. Less Reductions Due Seller (Line 520) ( 84,928.07 303. CASH ( X FROM) ( TO) BORROWER 6,554.86 603. CASH ( TO)( FROM) SELLER 0.00 The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein. Borrower U~/~ ~ Seller Estate of Larry L. Gruver, Wilma M. S otts, Exec ~trix DaVid C. Deyo ~ By4~.L", ~ /" / /' . .$ L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price 84,550.00 @ 6.0000 % 5,073.00 PAID FROM PAl\) FROM Division of Commission (line 700) as Follows: BORROWER'S SELLER'S . 701. $ 2 586.50 to Jack Gauchen ERA- GAUG12 FUNDS AT FuNDS AT ! 702. $ 2 486.50 to Exit Realty Caoital Area SETTLEMENT SETTLEMENT '170.8. Commission Paid at Settlement 5 073.00 _ _Q4. Transaction Fee to ERT- NRT, Inc 165.00 SOO.ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Orioination Fee % to 802. Loan Discount % to 803. Appraisal Fee to Robert Bolash POC:B300.00 804. Credit Reoort to 805. Broker Origination Fee to Comfort Home Mortcaoe, LLC 1,197.03 806. Lender Loan Charge to Homecomings Financial 665.00 807. Broker Processing Fee to Comfort Home Mortgage, LLC 650.00 808. I 809. 810. 811. Broker Fee from HF to Comfort Home Mortgage POC:L26.38 j gOO. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 11/17/06 to 12/01/06 @ $ 11.582100/day ( 14 days %) 162.15 902. Mortgage Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 years to The Travelers Indemnity Company 486.00 904. Flood Insurance 1.0 vears to Travelers Flood POC $887.00B 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 3.000 months (Q) $ 40.50 ner month 121.50 1002. Mortoaoe Insurance months @ $ per month 1003. CityfTown Taxes 11.000 months@ $ 1.66 Der month 18.26 1004. County Taxes 11.000 months @ $ 9.16 per month 100.76 1005. School Taxes 6.000 months @ $ 41.66 per month 249.96 1006. Flood Insurance months @ $ per month 1007. Flood Insurance 2.000 months (Q) $ 73.92 oer month 147.84 1008. Aggregate Adjustment months @ $ per month -137.66 1100. TITLE CHARGES .- 1101. Settlement or Closing Fee to 1102. Abstract or Title Search to I 1103. Title Examination to 1104. Title Insurance Binder to 1105. Document Preoaration to CT Land Services Company 500.00 1106. Notary Fees to Notary 49.00 15.00 1107. Attorney's Fees to (includes above item numbers: ) 1108. Title Insurance to Atlantic Settlement GrouD. LLC 761.06 (includes above item numbersEnhanced- reissue ) 1109. Lender's Coverage $ 67,640.00 1110. Owner's Coverage $ 84,550.00 761.06 1111. Endorsements to Atlantic Settlement Group, LLC 200.00 1112. Closing Protection Letter to First American Title Insurance Company 35.00 1113. Courier, Wire and Email Fees to CT Land Services Company 95.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 38.50; Mortgage $ 66.50; Releases $ 105.00 1202. CitylCounty Tax/Stamps: Deed 845.50' Mortgaoe 422.75 422.75 1203. State Tax/Stamos: Revenue Stamps 845.50; Mortoaoe 422.75 422.75 1204. Home Inspection to Advance Look 325.00 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survev to 1302. Pest Inspection to \ 1303. Reimbursement for Tax Cert to Atlantic Settlement Group, LLC - \ 5.00 1304. / \ / 1305. '- /"" If' /^' V 1400. TOTAL SETTLEMENT CHARGES. (Enter on Lines 103, Section J and 502, Section K) r \ 6,0jl.t:"40 6,598.50 By signing page 1 of this statement. the signatories acknowledge receipt of a completed copy of page 2 of this two page Slat/ ]\ (\A V \? ~y Certified to be a true copy. [7 C._~"~ r 0 I Page 2 ( AS 2006-059 I AS 2d06-059141 ) * 1 00% Recycl~d fiber 80% Post-Consumer [;1 5" ~ ~ '" '" :: g. ~ g: ~ ;:;; '" =r a :g' ~ 3" => "" ~ z g" g ~ 2 ~I " n ~. ~. Q..~ "' =r g ~ Q. '" ~ <= ~~ '" - ~ ~ ~~ ~ ~ n 0- s:: 'rD" '" " n - o 0 ~ ~ '" '" ~! =r ~ m ::i" '" "" 8 8" ~ ~ o =..: g: ~. ~. ~ , Q. ;;; 0 n - =r =r => '" 2. :. o '" ~ 3 Q ~ ~ => o Q. "",- :; Q !!: n '" 0 :; 5- r'f) ~: ;;:; o' '" 0: f~>" ~ -! ~,(;s' c ~ r---~;'" ~ g r~ => < III R a s. 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