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Home My WebLink About12-26-06 REV-1500 EX (6-00) OFFK:W. USE ONLY COMMONWEAl THOF PENNSYlVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ~L COlMY CODE .....QL 0834 _ __ YEAR MJMBER to- Z W Q W (.) W Q DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) prancis B1sie Mae DAlE OF DEATH (MM-DD-YEAR) DAlE OF BIRTH (MM-DD-YEAR) 9/4/2006 11/5/1932 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAl SECURnv NUMBeR 202-24-7489 THIS REl\JAN MUST BE FILED IN DUPLICATE WITH THE REGISTeR OF WILLS SOCIAL SECURnv NUMB R ~ [i] 1. Original Return M; D 4. Linited Estate G fj [i] 6. Decedent Died Testate (Attach copy of Will) !li D 9. Litigation Proceeds Received D 2. SUpplemental Return D 3. Remainder Return (date of death prior to 12-13-82) D 4a. Future Interest Compromise (dale of death after 12-12-82) D 5. Federal Estate Tax Return Required D 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit (dale of dealh between 12-31.91 ard 1-1-95) D 11. Election to tax under Sec. 9113(A)(AttadlSChO) !z NAME w ~ David W. Prancis, Bs ire ~ FIRM NAME (If Applicable) en i Rhoads & Sinon LLP 8 lEL.EPtIOtE NUMBER 717-233-5731 COMPLETE MAIUNG ADDRESS PO Box 1146 Harrisburg PA 17108-1146 1. Real Estate (Schedule A) (1) 68,363.92 OFFICIAl.. USE '!!!t (') c:::::.;) c 0 CI'" :S: :0 g ~::~ ::-0 (") n .n~, '.' m N :~~~ Q') :'~~f~~ 2i ;--. :'1.] -d -;1 ':> 0 N 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or SoIe-ProprIetorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal property (Schedule E) (5) z o t= ~ ::::J t:: D- c( (.) w ~ 6. J~ Owned Property (Schedule F) U Separate Blling Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) (6) 8. Total Gross Assets (total Lines 1-7) (8) 25,529.28 890.11 423,269.55 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortoage LiablitIes, & Liens (Sc:hedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11 ) (12) (13) 26.419.39 396,850.16 0.00 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts fer 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 (14) 396,850.16 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 0.00 x.O L (15) X.O 45 (16) 19. Tax Due 20. D (19) 0.00 16,950.91 0.00 3.024.49 19,975.40 z o ~ 16. Amount of Line 14 taxable at lineal rate ... ::::l IL ::IE o u ~ 376,686.92 17. Amount of Line 14 taxable at sbIIng rate 0.00 20,163.25 x .12 (17) 18. Amount of Line 14 taxable at c011aterai rate x .15 (18) r-J, ( r ~-1 r t) E . --< ''-.- ,~ ' . ~ J.... , ~ ~) /; ~; \/ r... t"J. 'I' '\1 f "'J T 3W4645 1.000 Decedent's Complete A ress: STREET ADDRESS 30 Buckthorn Drive . ... South Middleton Township CITY I STAle 1~013- Carlisle PA i dd Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 19,975.40 0.00 15.000.00 789.47 Total Credits (A + B + C) (2) 15,789.47 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 Total Interest/Penalty (D + E) (3) 0.00 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) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4,185.93 A. Enter the interest on the tax due. (5A) 0.00 (58) 4,185.93 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 fA the property transferred;. . . . . . . . . . . . . . . . . . . D [j b. retain the right to designate who shall use the property transferred or its income;. . . . . D [j c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [j d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . .. D [j 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 [jI 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 []I 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . ~ . . . . . . . . . . . . .. Ii] 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. _~._~"_dwh"_""""_ SlGNAlURE FOR FILING RE1URN AlDRESS DATE c/o Rhoads & Sinon LLP SlGHAlUOE OF 401HERlHAN REl'RESENTA11VE /1~ AlDRESS , c/o Rhoads & Sinon LLP PO Box 1146 Harrisburg PA 17108-1146 DAle PO Box 1146 Harrisburg PA 17108-1146 For dates of death on or after July 1. 1994 and before January 1. 1995. the tax rate Imposed on the net value oftnmsfers to or for the use of the surviving spouse is 3% [72 P.S.!i 9916 (8) (1.1)(1)]. 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 suNNIng spouse is 0% [72 P.S. g 9116 (a) (1.1) (iI)J The statute does not exemDt a transfer to a survMng spouse from tax, and the stabJtory Iequirements for dlsclo8ure of assets and tIIng a tax I8lum 818 stII applicable ewn , the surviving spouse Is the only beneficiary. . For dates of death on or BIer July 1, 2000: The tax rate imposed on the net value of transfers from a deceased chid twenty-one years of age or younger at death to or for the use of a natural paI1lI1t. an adoptiYe paI1lI1t, or a stepparent of the chid is 0% [72 P.S.!i 9116(a)(1.2)). The tax rate Imposed on the net value oftransf8rs to or for the use of the decedent's lineal benellclarles is 4.5%, except as noted In 72 P.S. g 9116(1.2) [72 P.S. g9116(a)(J )). The tax rate Imposed on the net VlIIue of transfers to or for the use of the decedenrs 8IbIIngs is 12% (72 P.S.!i 9116(a)(1.3)). A sibling Is detlned. under Section 9102, as &r1 Individual who has at least one parent in common with the decedent. whether by blood or adoption. 3W41146 1.000 Estate of 202-24-7489 Bxecutors (Page 1) Name Address Tax J:D David W. Francis 67 Derbyshire Drive Carlisle, PA 17013- 435-31-3708 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIJENT DECEDENT ESTATE OF SCHEDULE A REAL ESTATE REV-1502 EX + (6-98) FILE NUMBER Blsie Mae Francis 21 06 0834 Allrul 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 wining seller, neither being compelled to buy or sell, both having reasonable knolNIedge of the relevant facls. RRI property which Is jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Real property situate at 30 Buckthorn Drive, South Kiddleton Township, cumberland County, Pennsylvania, more fully described in Volume 27, Page 901 *See attached settlement sheet 142,131.50 3W48951.ooo TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 142,131.50 REV-1503 EX + ~98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIJENT DECEDENT ESTATE OF SCHEDULES STOCKS & BONDS FILE NUMBER Blsie Mae prancis 21 06 0834 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. IlEM NUMBER 1.200 Shares Barclays Plc Adr New York Stock Bxchange CUSXP: 06738B204 Dividend accrued on 9/4/2006 DESCRIPTION VALUE AT DATE OF DEATH 10,259.50 159.23 2 3,600 Shares Servicem&ster Co COIIIIIIlOn New York Stock Bxchange CUSXP: 81760N109 Dividend accrued on 9/4/2006 40,941.00 1,857.44 3 420 Shares Public SVc Enterprise Group COIIIIIIlOn New York Stock Bxchange CUSXP: 744573106 29,004.15 3W4696 1.000 TOTAL (Also enter on line 2, Recapitulation) $ (If more space Is needed, Insert additional sheets d the same size) 82,221.32 REV-1508 EX + (~98) COfJIAQNWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT SCHEDULEE CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Blsie Mae Francis FILE NUMBER 21 06 0834 Include the proceeds of litigation and the date the proceeds were received by the estate. AI property Jointly-ownecl with the right of survivorship mu.t be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Refund from Allstate Homeowner's insurance 150.38 2 Refund from Urology of Central PA 24.78 3 Refund from Pinnacle Health 149.74 4 Refund from Shipley Bnergy for fuel oil 478.36 5 Refund from Comeast Cable 25.52 6 Refund from Allstate Automobile insurance 156.74 7 Refund from Bmbarq - for telephone service 54.03 8 Tangible Personal Property, per sale price 2,210.17 9 Refund from Carlisle Sentinel 112.50 10 20,000 Par Treasury Bk Alexandria VA CD CUSIP: 89465AXP8 Interest accrued to 9/4/2006 19,534.23 1.94 11 44,000 Par Netbank Alpharetta GA CD CUSIP: 64109BHR9 Interest accrued to 9/4/2006 44,034.25 396.61 12 Smith Barney Honey Market Account '73H-01207-12 2,348.89 13 1997 Pontiac Grand Am 3,105.00 3W48AO 1.000 TOTAL (Also enter on line 5. RecaDitulationl S (If more space Is needed. Insert additional sheets of the same size) 72,783.14 REV.1509 EX + (6-98) COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Elsie Mae Prancis SCHEDULE F JOINTLY.QVVNED PROPERTY FILE NUMBER 21 06 0834 If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVMNG JOINT TENANT(S) NAME A. Pernandes, Joseph ADDRESS 14 Mallard Court, Mechanicsburg, PA 17055-4364 B. Francis, David Wynne c prancis, Rhys W ," 67 Derbyshire Drive, Carlisle, PA 17013 314 Sandlewood Lane, Ruless, TX 76039 None Son Son RElATIONSHIP 10 DECEDENT JOINTLY-OWNED PROPERTY: ITEM NUMBER IEl1ER FORJOINT TEtWIT DATE MADE JOINT 1. A. DESCRIPTION OF PROPERlY INCLUDE IWE Of FlIW<<:IALINSTlTUnONAKJ BNf( ACCOLNT ItMERORSlMlLAR IDENTIFYING IUoIIER. ATTACH DEED FOR JOlNIly-tBDAEAL ESTATE. DATE OF DEATH VALUE OF ASSET 10/5/2004 40,302.06 Par Kembers 1st Pederal Credit union Certificate of Deposit 1252074-40 Jointly owned w/ friend of decedent, Joseph pernandes Interest accrued to 9/4/2006 1 A %OF DECO'S INTEREST 40,314.28 50.0000 12.22 50.0000 3/21/1984 Members 1st Pedera1 Credit union Checking Acct. 135807-11 Jointly owned w/ Decedent's son, David W. prancis Interest accrued to 9/4/2006 2 B 14,474.83 50.0000 0.30 50.0000 B 11/30/1983 Kembers 1st Pederal Credit union Regular Savings Acct. 135807-00 Jointly owned w/ decedent's son, David W. Prancis 8,456.28 50.0000 Interest accrued to 9/4/2006 0.69 50.0000 Tolal fram cOJtinuation schedules. . . . . . . . . 3 3W46AE 1.000 TOTAL IAlso enter on line 6 RecaoItulatklnl S (If more spacels needed. Insert additi0nai sheets of the same siZe) DATE OF DEATH VALUE OF IECEDENl'S INTEREST 20,157.14 6.11 7,237.42 0.15 4,228.14 0.34 26,140.37 57,769.67 Bstate of: Blsie Mae Francis Name D Francis, Steven H Schedule P Part 1 (Page 2) Address 14511 Ivyford Court, Cypress, TX 77429-5352 202-24-7489 Relation Son I -~-------- --T------~---- Bstate ofa Blsie Mae Prancis 202-24~7489 Schedule P Part 2 (Page 2) I Item Joint DOD Value of Perc DOD va~ue of No. Cot. Date Description Asset Int. Intere~t 4 D 10/30/1986 1,000 Par $1,000 Series BB Savings Bond Serial 1~4563201BB Jointly owned by decedent and son, Steven B. prancis 1,521.60 50.0000 760.80 5 D 10/31/1986 200 Par $200 Series BB Savings Bond Serial IR34438061BB Jointly owned by decedent and son, Steven B. prancis 304.32 50.0000 152.16 6 D 10/31/1986 200 Par $200 Series BB Savings Bond Serial IR34438060BB Jointly owned by decedent and son, Steven B. prancis 304.32 50.0000 152.16 7 D 1/17/2003 5,000 Par $5,000 Series I Savings Bond Serial IVOO14537431 Jointly owned by decedent and son, Steven B prancis 5,844.00 50.0000 2,92~.00 8 D 10/30/1986 1,000 Par $1,000 Series BB Savings Bond Serial IK14563200BB Jointly owned by decedent and son, Steven B. prancis 1,521.60 50.0000 760.80 9 B 7/28/1978 M&T Checking Acct. 134025383, jointly owned w/ decedent's son, David W. prancis. 5,084.08 50.0000 2,542.04 Interest accrued to 9/4/2006 0.12 50.0000 0.06 10 B 6/15/1998 M&T Checking Acct. 198240560 Jointly owned w/ decedent's son, David W. Prancis 6,464.51 50.0000 3,232.25 Interest accrued to 9/4/2006 0.30 49.9999 Q.15 11 B 10/12/2004 21,440.48 Par Kembers 1st Pederal Credit union Certificate of Deposit, mat. 10/12/2006 Joint1y owned w/ decedent's son, David W. prancis 21,446.98 50.0000 10,723.49 Interest accrued to 9/4/2006 6.50 50.0000 3.25 Total (Carry forward to main schedule) 21,249 .16 Bstate of: BlsieMae Francis 202-24-7489 Schedule F Part 2 (Page 3) Item Joint DOD Value of Perc DOD Vallue of No. Cot. Date Description Asset Int. Interest 12 C 10/31/1986 200 Par $200 Series BB Savings Bond Serial #R34438063BB Jointly owned by decedent and son, Rhys W. Francis 304.32 50.0000 152.16 13 B 2/1/2001 Members 1st Federal Credit Union Life Savings Acct. #35807-04 Jointly owned w/ decedent's son, David W. Francis 4,000.00 50.0000 2,000.00 Interest accrued to 9/4/2006 0.33 50.0000 0.17 14 C 10/31/1986 200 Par $200 Series BB Savings Bond Serial #R34438064BB Jointly owned by decedent and son, Rhys W. Francis 304.32 50.0000 152.16 15 C 10/30/1986 1,000 Par $1,000 Series BB Savings Bond Serial 'M14563203BB Jointly owned by decedent and son, Rhys W. Francis 1,521.60 50.0000 760.80 16 B 10/31/1986 200 Par $200 Series BB Savings Bond Serial #R34438057BB Jointly owned by decedent and son, David W. Francis 304.32 50.0000 152.16 17 B 10/31/1986 200 Par $200 Series BB Savings Bond Serial #R34438058BB Jointly owned by decedent and son, David W. Francis 304.32 50.0000 152.16 18 B 10/30/1986 1,000 Par $1,000 Series BB Savings Bond Serial #M14563199BB Jointly owned by decedent and son, David W. Francis 1,521.60 50.0000 760.80 19 B 10/30/1986 1,000 Par $1,000 Series BB Savings Bond Serial #N14563198BB Jointly owned by decedent and son, David W. Prancis 1,521.60 50.0000 76Q.80 Total (Carry forward to main schedule) 4,891.21 REV-1510 EX + (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT ESTATE OF Blsie Mae Francis FILE NUMBER 21 06 0834 This schedule must be completed and filed if the answer to any of Questions 1 through 4 on the reverse side of the REV-1500COVER SHEET is yes. [ESCRIPTlON OF PROPERlY ITEM tD.UJE TtE I\IlIIME OF TtE TRANSFEREE. nElR RElATlONSHP TO DECEDENT Af\D DATE OF DEATH 0/0 OF DECD'S EXCLUSION TAXABlE NUMBER M DllTE OF TIWlSFER. AlTACHA Ct:1f"( OF TtE DEED FOR REAL ESTATE. VAlUE OF ASSET INTEREST IF APFl.lCABLE\ VAlUE 1. Bon Ton Stores IRA *202-24 Owner: Decedent Beneficiaries: David Francis, Rhys Francis, Steven Francis 20,431.49 100.0000 0.00 20,431.49 2 Vanguard IRA *09849257277 Owner: Decedent Beneficiaries: David Francis, Rhys Francis, Steven Francis 40,753.28 100.0000 0.00 40,753.28 3 Janus IRA *306884646 Owner: Decedent Beneficiary: David w. Francis, son of decedent 7,179.15 100.0000 0.00 7,179.15 TOTAL (Also enter on line 7, RecapItulation) $ 68.363.92 (If more space is needed. Insert addlllon8l sheets of the lIM'le size) 3W48AF 1.000 _..~ I ~__ REV-1511 EX + (12-99) COMMONWEALlH OF PENNSYLVANIA INtERlTANCE TAX REllJRN RESIDENT DECEDENT ESTATE OF Elsie Mae Francis SCHEDULE H FUNERAL EXPENSES & ADMINISTRAtiVE COSTS Debts of decedent must be reported on Schedule L FILE NUMBER 21 06 0834 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hell's Market Funeral luncheon 245.14 Total fram continuation schedules . . . . . . . . . 12,505.85 . B. ADMNISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) - - Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 10,000.00 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 384.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 All s Lawncare Lawn maintenance 130.00 2 Derrls Trash Hauling Junk removal 650.00 Total fram continuation schedules . . . . . . . . . 1,614.29 TOTAL (Also enter on line 9, RecaPitulation) $ 25,52'.28 3W4BAG 1.000 (If more space is needed, insert additional sheets d the same size) Bstate of: Blsie Mae prancis :Item No. 2 3 202-24-7489 Schedule H Part 1 (Page 2) Description Amount Westminster Cemetery, LLC Purchase of memorial and plot 2,654.00 Roffman-Roth Puneral Rome, :Inc runeral expenses 9,851.85 Total (Carry forward to main schedule) 12,505.85 Bstate of: Blsie Mae Francis 202-24-7489 Schedule H Part 7 (Page 2) 3 Ket-Bd Pinal electric bill 33.80 4 Al's Lawncare Final lawn maintenance 90.00 5 Waste Management Trash removal 43.65 6 Carlisle Sentinel Legal advertising 187.85 7 RESBRVES: cumberland County Register of Wills Reserve for additional probate fees 100.00 8 RESBRVBS: Rhoads & Sinon LLP OUt of pocket expenses to include: Telephone - $.33; Federal Express - $10.07; Postage - $15.94; Copies - $43.20; Pax - $4.00; Reserves for filing fees and misc expenses - $65.00 138.54 9 Dauphin County Register of Wills Fee for oath 20.00 10 Waste Management Dumpster rental for real estate 625.00 11 Met-Bd Utility 72.63 12 Bmbarq Utility 107.82 13 Al 's Lawncare Property maintenance 120.00 14 cumberland Law Journal 75.00 Total (Carry forward to main schedule) 1,614.29 REV-1512 EX + (12-03) COMMONWEAL nt OF PENNSYLVANIA INHERITANCE TAX RElURN RESIDENT DECEDENT ESTATE OF Blsie Mae ~rancis SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 06 0834 R.port d.bts Incurred by the d.ced.nt prior to d.ath which remained unpaid as of the date of death, Including unrelmbu"" medlcal.xpen.... ITEM NWBER 1. Holy Spirit Hospital Medical co-payments 2 Waste Management Utility 3 Bmbarq Utility 4 Comeast Cable Utility 5 Capital One Credit card balance 6 AI · s Lawncare Lawn maintenance 7 SMTMA Water/sewer 8 pinnacle Health Medical expense 9 Urology of Central PA Medical expense 10 Met-Ed Utility DESCRIPTION VAlUE AT DATE OF DEATH 29.00 43.65 106.45 47.81 280.12 60.00 99.00 149.74 24.78 49.56 3W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space Is needed, insert additional sheets of the same size) 890.11 _ ___ L REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESlDENTDECEDENT ESTATE OF Blsie Mae prancis SCHEDULE J BENEFICIARIES FILE NUMBER 21 06 0834 NUMBER I 1 NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] David Wynne prancis 67 Derbyshire Drive Carlisle, PA 17013 RELATIONSHIP TO DECEDENT Do Not List TrustH(s) AMOUNT OR SHARE OF ESTATE 1,000 Par $1,000 Series BB Savings Bond Serial 'M14563198BB Jointly owned by decedent and SOD, David w. prancis Inventory Value: 760.80 1,000 Par $1,000 Series BB Savings Bond Serial 'K14563199BB Jointly owned by decedent and son, David w. Prancis Inventory Value: 760.80 200 Par $200 Series BB Savings Bond ENTER DOUARAMOUNTS FOR DISTRIBUTIONS SHOWN!>BOVE ON LINES 15 THROUGH 18. AS APPROPRIATE. ONI 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 3W46AI 1.000 TOTAL OF PART I ~ ENTER TOTAL. NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed. insert additional sheets at the same size) s 0.00 ~_~L_ _ Bstate of: Blsie Mae Prancis Schedule J Part 1 (Page 2) Item No. Description 1 Serial 'R34438057BB Jointly owned by decedent and son, David W. Prancis Inventory Value: 152.16 200 Par $200 Series BB Savings Bond Serial 'R34438058BB Jointly owned by decedent and son, David W. Prancis Inventory Value: 152.16 Janus IRA #306884646 OWner: Decedent Beneficiary: David W. prancis, son of decedent Inventory Value: 7,179.15 33% of Residue: 120,621.73 Son 2 Joseph pernandes 14 Mallard Court Kechanicsburg, PA 17055-4364 40,302.06 Par Kembers 1st Pederal Credit Union Certificate of Deposit #252074-40 Jointly owned wi friend of decedent, Joseph Fernandes Inventory Value: 20,157.14 Accrued: 6.11 None 202-24-7489 Relation Amount 129,626.80 20,163.25 Bstate of: Blsie Mae ~rancis Schedule J Part 1 (Page 3) Item No. Description 3 Steven B. ~rancis 14511 Ivyford Court Cypress, TX 77429-5352 1,000 Par $1,000 Series BB Savings Bond Serial #M14563200BB Jointly owned by decedent and son, Steven B. ~rancis Inventory Value: 760.80 1,000 Par $1,000 Series BB Savings Bond Serial #M14563201BB Jointly owned by decedent and son, Steven B. Prancis Inventory Value: 760.80 200 Par $200 Series BE Savings Bond Serial IR34438060BB Jointly owned by decedent and son, Steven B. ~rancis Inventory Value: 152.16 200 Par $200 Series BB Savings Bond Serial #R34438061BB Jointly owned by decedent and son, Steven B. ~rancis Inventory Value: 152.16 5,000 Par $5,000 Series I Savings Bond Serial IV001453743I Jointly owned by decedent and son, Steven B Prancis Inventory Value: 2,922.00 33% of Residue: 120,621.73 Son 202-24-7489 Relation Amount 125,369.65 Bstate of: Blsie Kae Prancis Schedule J Part 1 (Page 4) Item No. Description 4 Rhys W. Prancis 314 Sandlewood Lane Bu1ess, TX 76039 1,000 Par $1,000 Series BB Savings Bond Serial 'K14563203BB Jointly owned by decedent and son, Rhys W. Francis Inventory Value: 760.80 200 Par $200 Series BB Savings Bond Serial 'R34438063BB Jointly owned by decedent and son, Rhys W. Prancis Inventory Value: 152.16 200 Par $200 Series BB Savings Bond Serial'R34438064D Jointly owned by decedent and son, Rhys W. Prancis Inventory Value: 152.16 33% of Residue: 120,625.35 Son 202-24-7489 Relation Amount 121,690.47 I .... m M&fBank I 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888)502-4349 Fax (302) 934-2955 October 5, 2006 Rhoads & Sinon LLP Attorneys At Law Twelfth Floor One South Market Street - POBox 1146 Harrisburg, Pennsylvania 17108-1146 Re: Estate of: Elsie M Francis Social Securitv: 202-24-7489 Date of Death: September 04. 2006 Dear Sir or Madam: Per your inquiry dated September 29t 2006, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 34025383 Ownership (Names of) David W Francis, Elsie M Francis * Opening Date 07128i18 Balance on Date of Death Total $5,083.96 $ 0.12 .--$5:084-:i/i-.-.---.------------.-------------------.- Accrued Interest 2. Typeof Account Checkine 1-cco"9t Account Number 98240560 Ownership (Names of) David W Francis, Elsie M Francis * Opening Date 06115/98 Balance on Date of Death Total $6,464.21 $ 0.30 -$6,7j64.5}-----------...-.---------......- --...-.---- ----. -------. Accrued Interest Please be advised, there was no safe deposit box fowld"for-tiie.abOve-decedeiii------. FOi--fiirtiiej.-accouni-'information, regarding ownenbip, closures and/or reimbursement of funds, eke, please caD the Spring Garden Office # 717-240- 4525. SincerelYt . ~~ Nancy Clagett Records Management , . . Primary Owner: REGULAR SAVINGS ACCOUNT: Account NumberlSuffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership. Established LIFE SAVINGS ACCOUNT: Account NumberlSuffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Certificate Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint, Owner Date Joint Ownership Established MEMBERS. 1st FBDERALCREDlT UNION Elsie M. Francis 35807 -00 11/30/1983 $8,455.59 $.69 $8,456.28 David W. Francis 08/01/1988 35807 -11 03/21/1984 $14,474.83 $.30 $14,475.13 David W. Francis 08/01/1988 35807 -04 02/01/2001 * $4,000.00 $.33 $4,000.33 David W. Francis 02101/2001 35807 -40 10/12/2004 $21,440.48 $6.50 $21,446.98 David W. Francis 1 0/12/2004 * Account established by transfer of funds from 35807-00 "Certificate purchased by transfer of funds from 252074-00, single ownership Estate of: ELSIE M. FRANCIS Date of Death: 09/0412006 Social Security Number: 202-24-7489 'f Joseph Fernandes 252074 -40 10/0512004** $40,302.06 $12.22 $40,314.28 Elsie M. Francis 10/05/2004 ";8 7~L CREOn: UNION I\kt: A. WoWe ~ Insurance Services Supervisor October 27, 2006 5000 Louise Drive · P.O. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · wwvv.members1st.org . 105.805 REV 1/05 This is to certify that the information her.. given is correctly copied from an original certificate of death duly fIled with me as Local Registrar. The original certificate J be forwarded to the State Vital Record.: . "[fIce for permanent fIling. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~~. ~..~~~, Local Registrar Fee for this certificate, $6,00 p 12727210 SEP 8 2006 Date I ! COMMONWEALTH Of PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Hll15.lO REV. GnIlII lll'E IPRIIl' II I'ENWIEHT IIJoCIC II< 1. _oI!lIlIdInItfiII,-."UIoll 5 ...... MllIIWl 1'1t.1iI v.. DooolIIIt lMd -' !=: M; An, Go" I'm 1wp 1711.CGuIIly 17d.D :...o.:t'JMlI..... CIlr'''' 1t.__ -,__1 Margaret Wehry a _-._(11IooI.""__"_ 67 Derbyshire Dr., Carlisle, PA 17013 21.. _0I........l*-0I~. -,._....1 2 LacoIIonCCllr/--.....1 westminster Cemetery Carlisle , PA 17013 22r. _1I'lI_olFdlI Hoffman-Roth Funeral Bane, Inc Hanover S . a CIIo....~dIrt.,.., i 1',-- 21. WIt c.. OVa Penn:EIW_---..-. 2I.IlIdT~(;alIIb*IIlOolll? 1U"'-..In..~_....InPIIII. 0 Va1J~ DNa I:J~. 11.'_ ':i1 NaI"""_~'" I:J ""","",01_01_ o ~..:o.:- but__ ....0...,. o :- =- but........ 43'" III I ,.. ~......... -......,.. 32l:. _oIlnPf._,F_-'Fary. 01oo-...... ($loIll\I/ II. OIF DEATH ,_........-..... ....'0 lWnt &lIIr..~-~... .............,......_. DOIIOl..IInIinII__ ........... ........., -..-B.......... ........,. UIIqllW_llII_lInI. ====....___.. Oy,. H 0 c11i ~ (~1 (.J Lt"7 J...o ~~"- tD(...~iiiI ~III"""'I"', b. ;:a:..",l:.IE Due _Iar -............-= =~':.~ ~-- 0nIII1Il OoIII o.lDcor..-.--DI)" ... WIt.. ,..., - IlL _...,....... 31. _01 3:Ia. ClIo 01"'" (IIIIIe. dirt. ,.., 32Il. ,.,....,..fIllarlll~ W-.... O~ ..c....._ F::::-- OVa 0 Na 0 - 0 FInlIIo8......... I:J- OCUlNolllellololllinod ""-,-' OVa F* I ~ !I I 35. ~ . ClIo SIpII (IIIIIe."'. ,.., 1fJ'"{JAJOt 2!l Tp/PlH f"1,D. /-e-...."i' fA 170 'f-j & ..... ~ ,,; )JJ\ 0'0 LAST WILL AND TESTAMENT OF ELSIE MAE FRANCIS . I, Elsie Mae Francis, a resident of and domiciled in the Commonwealth of Pennsylvania, make, publish and declare this to be my Last Will and Testament, revoking all wills and codicils at any time heretofore made by me. ARTICLE I IDENTIFICATION OF FAMILY The names of my children are: Rhys William Francis; Steven Howell Francis; and David Wynne Francis. All references in this Will to "my children" are references to the above-named children. ARTICLE n PAYMENT OF DEBTS AND EXPENSES I direct that the expenses of my last illness and funeral, the expenses of the administration of my estate, and all estate, inheritance and similar taxes payable with respect to property included in my estate, whether or not passing under this will, and any interest or penalties thereon, shall be paid out of my residuary estate, without apportionment and with no right of reimbursement from any recipient of any such property. ARTICLE ill DISPOSITION OF ESTATE I direct that my residuary estate, including any real estate, personal property of every kind, and insurance proceeds, be distributed to my children in equal shares. If a child of mine does not survive me, such deceased child's share shall be distributed in equal shares to the children of such deceased child who survive me, by right of representation. If a child of mine does not survive me and has no children who survive me, such deceased child's share shall be distributed in equal shares to my other children, if any, or to their respective children by right of representation. If no child of mine survives me, and if none of my deceased children are survived by children, my residuary estate shall be distributed to my heirs-at-Iaw, their identities and respective shares to be determined under the laws of the State of Pennsylvania, then in effect, as if I had died intestate at the time fixed for distribution under this provision. HB:41755.10000-33 1 .?f7lJ; ~ ail.- EMF MAK ASP . .J._ ARTICLE IV APPOINTMENT OF EXECUTOR I appoint my son David Wynne Francis, of Carlisle, Pennsylvania, as th~ Executor of my will. If David Wynne Francis is unable or unwilling to qualify as executor or having qualified is unable or unwilling to act, I appoint my son Rhys William Francis, of Euless, Texas, to be the Executor. I direct that my executor shall not be required to furnish bond or security in any jurisdiction. ARTICLE V EXECUTOR POWERS My Executor, in addition to other powers and authority granted by law or necessary or appropriate for proper administration, shall have the right and power to lease, sell, mortgage, or otherwise encumber any real or personal property that may be included in my estate, without order of court and without notice to anyone. My Executor shall have the right to administer my estate using informal, unsapervised, or independent probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. ARTICLE VI MISCELLANEOUS PROVISIONS A. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and my estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiduciary's good faith actions or nonactions as the fiduciary, except for such actions or nonactions which constitute fraudulent conduct or bad faith. B. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or among two or more beneficiaries, the specific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, and if not, by my Executor. . HB:41755.1000Q..33 2 * 7JJ;' -tnItK. all. EMF MAK ASP I,~r ,~;/ IN WITNESS WHEREOF, I have subscribed my name below, this 23rd day of May, 2001. ~~~ JJ:feu-- ~~ Elsie Mae Francis We, the undersigned, hereby certify that the above instrument, which consists of five (5) pages, including the page(s) which contain the witness signatures, the selfproving clause, and affidavit was signed in our sight and presence by Elsie Mae Francis (the "Testatrix"), who declared this instrument to be her Last Will and Testament and we, at the Testatrix's request and in the Testatrix's sight and presence, and in the sight and presence of each other, do hereby subscribe our names as witnesses on the date shown above. Witness Signature: Name: City: State: ~~ L>4u~J ~ Mary Ann Kane Harrisburg Pennsylvania Witness Signature: Name: City: State: ~~/ . ~. ~~-- Anthop . Potter Harrisburg Pennsylvania HB:41755.10000-33 3 l!7lJiJ 7rJ~ nJp EMF MAK "ASP Pennsylvania Self-Proving Clause Commonwealth of Pennsylvania County of Dauphin ~~J;'-" ~~ Elsie Mae Francis I, Elsie Mae Francis, Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law" do hereby acknowledge that I signed.and executed the instrument as my Last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by Elsie Mae Francis, the Testatrix, this 23rd day of May, 2001 ; ti ...:'.- ~u(;d__-6rt?].'rLj Notary Public My commission expires on Notarial Seal . Judith A. Nordstrom, Notary Public Harrisburg, Dauphin county My Commission Expires Sept. 21 , 2001 Membp.r. Pennsylvania AssocIation of Notaries HB:41755.10000-33 4 ~}JJj vnlJ"/c. .t2JP EMF MAK ASP Affidavit Commonwealth of Pennsylvania County of Dauphin We, Mary Ann Kane and Anthony S. Potter the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute this Will as her Last Will; that the Testatrix signed willingly and 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 a witness; and that to the best of our knowledge the Testatrix waS at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Witness Signature: Name: City: State: On.#~:r 4x--- '-4~" - Mary Ann Kane . Harrisburg Pennsylvania Witness Signature: Name: City: State: .O-~~ Anthony - . Potter Harrisburg Pennsylvania Sworn or affirmed to and subscribed to before me by Mary Ann Kane and Anthony S. Potter, witnesses, this 23rd day of May, 2001. r:;;kcLd-i 61- 7Jl'1ddu~ Notary PublIc My commission expires on Notarial Seal . Judith A. Nordstrom, ~otary PU,bltc Harrisburg, Dauphin County My Commission Expires Sept. 21 , 2001 Member. Pennsylvania Association of Notaries HB:41755.10000-33 5 g 71J~ '-IJJJH::. ~ EMF MAK ASP _____ I. Div: 0.79614 Ex: OS/16/2006 Rec: OS/lS/2006 Pay: 10/02/2006 3600 SBRVICEMASTER CO (S1760N109) COM New York Stock Exchange 09/01/2006 09/05/2006 Estate Valuation Date of Death: 09/04/2006 Valuation Date: 09/04/2006 Processing Date: 12/19/2006 Shares or Par Security Description High/ASk 1) 420 PUBLIC SVC ENTERPRISE GROUP (744573106) COM New York Stock Exchange 09/01/2006. 70.12000 09/05/2006 69.21000 2) 20000 TREASURY BK ALEXANDRIA VA (S9465AXPS) Financial Times Interactive Data DTD: 12/03/2004 Mat: 12/03/2007 3.5t 09/01/2006 09/05/2006 Int: 09/03/2006 to 09/04/2006 44000 NETBANK ALPHARETTA GA (64109EHR9) Financial Times Interactive Data DTD: 07/05/2006 Mat: 07/07/2008 5.5% 09/01/2006 09/05/2006 Int: 07/05/2006 to 09/04/2006 200 BARCLAYS PLC (06738E204) ADR New York Stock Exchange 09/01/2006 09/05/2006 51.75000 51. 42000 3) 4) 5) 11.60000 11.33000 6) 1857.44 Cash (CASH) Citibank Money Market Total Value: Total Accrual: Total: $146,188.35 Low/Bid 68.64000 H/L 6S.26000 H/L 97.66870 Mkt 97.67360 Mkt 100.07790 Mkt 100.077S0 Mkt 50.93000 H/L 51.09000 H/L 11.37000 H/L 11.19000 H/L Estate of: Elsie Francis Account: Smith Barney and PSE certificate Report Type: Date of Death Number of Securities: 6 File ID: Francis, Elsie Mae Mean and/or Div and Int Security Adjustments Accruals Value 69.057500 29,004.15 97.671150 19,534.23 1.94 100.077S50 44,034.25 396.61 51. 297500 10,259.50 159.23 11.372500 40,941. 00 1,857.44 $145,630.57 $557.78 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (S18) 313-6300 or www.evpsys.com. (Revision 7.0.4) Calculated Value of Your Paper Savings Bond(s) Page 1 of 1 Calculated Value of Your Paper Savings Sondes) HOW TO SAVE YOUR INVENTORY Calculator Results for Redemption Date 09/2006 Total Price $8,100.00 Total Value $15,277.92 Total Interest $7,177.92 YTD Interest $453.52 Bonds: 1-12 of 12 . Issue Next Final Issue Interest Serial # Series Denom Date Accrual Maturity Price Interest Rate Value Not. V0014537431 I $5,000 01/200310/200601/2033 $5,000.00 $844.00 2.61% $5,844.00 P5 M14563198EE EE $1,000 10/198610/200610/2016 $500.00 $1,021.604.00% $1,521.60 M14563199EE EE $1,000 10/198610/200610/2016 $500.00 $1,021.604.000/0 $1,521.60 R34438058EE EE $200 10/198610/200610/2016 $100.00 $204.32 4.000/0 $304.32 R34438057EE EE $200 10/198610/200610/2016 $100.00 $204.32 4.00010 $304.32 M14563200EE EE $1,000 10/198610/200610/2016 $500.00 $1,021.604.00% $1,521.60 R34438060EE EE $200 10/198610/200610/2016 $100.00 $204.32 4.00% $304.32 M14563201EE EE $1,000 10/198610/200610/2016 $500.00 $1,021.604.000/0 $1,521.60 M14563203EEEE $1,000 10/198610/200610/2016 $500.00 $1,021.604.00010 $1,521.60 R34438064EE EE $200 10/198610/200610/2016 $100.00 $204.32 4.00% $304.32 R34438063EE EE $200 10/198610/200610/2016 $100.00 $204.32 4.00% $304.32 R34438061EE EE $200 10/198610/200610/2016 $100.00 $204.32 4.000/0 $304.32 http://www . treasurydirect.gov/BC/SBCPrice - 10/6/2006 Kelley Blue Book - Private party Value Pricing Report - Pontiac, Grand Am Page 1 of2 e. ....1II..111t .=-~ : '\ 't ;h' t'-"'! - -;.. advertisement 1997 Pontiac Grand Am SE Sedan 4D BLUE BOOK- PRIVATE PARTY VALUE Condition Value Excellent $3,250 .,/ Good $2,900 (Selected) Fair $2,450 - advertisement - Vehicle Details Mileage: 85,000 Engine: 4-CyI. 2.4 Uter Tran.m....on: 5 Speed Manual Drlvetnlln: FWD - ~---,,-----'--'--~"~--'.---_.'.-' .__...._.~, ...._- - - - "'-'-'--~---->-'-_.'-- --.- ..---- .._-~_....,-_.. ....-..-.--.....---.---- Selected Vechlle StIIndard Air Conditioning Power Steering Power Door Locks AM/FM Stereo Dual Front Air Bags ASS (4-Wheel) Optional Power Windows Tilt Wheel Cruise Control Cassette Power Seat Blue Book Private Party Value Private Party Value Is what a buyer can expect to pay when buying a used car from a private party. The Private Party Value assumes the vehicle is sold RAs IsR and carries no warranty (other than the continuing factory warranty). The final sale price may vary depending on the vehicle's actual condition and local market conditions. This value may also be used to derive Fair Market Value for Insurance and vehicle donation purposes. Vehicle Condition Ratings http://www.kbb.comIKBB/UsedCarslPrintlPricingReport.aspx?QuizConditions=&Manuf... 12/19/2006 Kelley Blue Book - Private party Value Pricing Report - Pontiac, Grand Am Excellent (}OUnu $3,250 "Excellent" condition means that the vehicle looks new, Is in excellent mechanical condition and needs no reconditioning. This vehicle has never had any paint or body work and Is free of rust. The vehicle has a clean title history and will pass a smog and safety inspection. The engine compartment is clean, with no fluid leaks and Is free of any wear or visible defects. The vehicle also has complete and verifiable service records. Less than 5% of all used vehicles fall into this category. ./ Good (Selected) DrlICX1r,,1 $2,900 "Good" condition means that the vehicle Is free of any major defects. This vehicle has a clean title history, the paint, body and Interior have only minor (if any) blemishes, and there are no major mechanical problems. There should be little or no rust on this vehicle. The tires match and have substantial tread wear left. A "good" vehicle will need some reconditioning to be sold at retail. Most consumer owned vehicles fall Into this category. Fair C>"~~:I'..1 $2,450 "Fair" condition means that the vehicle has some mechanical or cosmetic defects and needs servicing but is still in reasonable running condition. This vehicle has a clean title history, the paint, body and/or Interior need work performed by a professional. The tires may need to be replaced. There may be some repairable rust damage. Poor ~'1tXl N/A "PoorR condition means that the vehicle has severe mechanical and/or cosmetic defects and Is In poor running condition. The vehicle may have problems that cannot be readily fixed such as a damaged frame or a rusted- through body. A vehicle with a branded title (salvage, flood, etc.) or unsubstantiated mileage is considered Rpoor." A vehicle in poor condition may require an Independent appraisal to determine Its value. Kelley Blue Book does not attempt to report a value on a "poor" vehicle because the value of cars in this category varies greatly. * Pennsylvania 12/19/2006 Page 2 of2 : ~j - .... '\ 1"" -', Close Window http://www.kbb.com/KBB/UsedCarslPrint/PricingReport.aspx?QuizConditions=&Manuf.. . 12/19/2006 A. Settlement Statement u.s. DeplII1rnent of HouIIng=t: and Urban Development r ~B No. 2502.Q2a5 B. Type of Loan 1. 0 FHA 4. OVA 3. 0 Conv. Unlns File Number 06-47 Loan Number B/ll Mortgage Insurance Case Number B/A BORROWER: SELLER: 1142,131.50 HUD-1 (3-88) - RE8PA, HB 4305.2 PAGE 1 - OMB No. 2502-0265 .;;-:1.(~:~~. ............................................................:.......:.........:-:..:s~~.~~:.:.:.:.:::.:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::;::::;:::::::::;:;:;:;:;:;:;:;:::::;:: .' .' .. .. .. .. .. .. .. .. '. .. .. 700. TOTAL SALESIBROKER'S COMMISSION PAID FROM PAID FROM BASED ON PRICE 8147,000. 00 @ 4 ~ . 85, 880. 00 BORROWER'S SELLER'S FUNDS FUNDS DIVISION OF COMMISSION (LINE 700) AS FOLLOWS: AT AT :r.it1:.:.:.:.:.:.:.:.:.;.:.:.:.:.:.:.:.;::.:.:.;.:.:.:.:.:.:.:.;lO:':':':; ~...:i_:; SETTLEMENT SETTLEMENT 702. to BabbJ.. .AuattODll :ioS::.::::::::::::::;::::::::::::::::::::::::::::::.:::::.::::a(j:;::::::::::::::.:::::::::::::::::::::::::::::::::::::.:.:.:.:.: .:.:.: '. 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L.endw'a~ :4:1jo;~. . . . . . . ::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::: :::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 1111. . . . . . . . ~ . . . .. .. .. .. .. .. .. .. .. . .. . . . . .. .. . . .. . .. . .. . .. .. . .. .. .. . . . .. .. . . .. . .. .. . .. . .. .. .. . .. . . .. .. .. .. .. .. . .. .. . . . . . . . . . . . . . . . . 0 . . 0 . . . 0 . . . . . . . . . . . 0 . . 0 . . . . . . . . . . . . 0 , . 0 . . .. .......... 0 . 0 . . . . .M1~:o:,:':':o:':':':':~':':o:~':':':':~~':':~o:~~':':~.:.:.:.:.:~~.:~_:.:.:o:.:.:o:.:.:.:.:.:.:.:.:.:.:.:.:.:.:~~.:o:~.:~~.:~~.:.:.:.:~~~~~.:.:~.:.:~.;~.:.;.:.:.:.:~~.:.:~.:.:~.:.:.:.:~.:.~.:.:.:~.:.:~.:.:.:.:.:~.:.:.:.: .:.:~.:.:o:o:~o:~.:.:.:~.:.:.: 1113. :~;~M::::::::::::::::::::~:::::::::::::::::::: ...~. ~::~:WtMi!i::::::::::::::::::::::::::::::::::::::::::::::::::::;~~:::::::::.:::::::::::::::::::::::::::::::::::' :::::::::::::::::::: :;I,;: .:cl: 1202.CIlylcounty~ Deed 11,470.00;~ 12,1140.00 :~;:~~::::::::::::::::::~:::::::::::::~~.~.(J~~IJ::.~:::::::::::::::::::::::::::::::::::::::::::::::::;::i~:::::::::::::::::::::::::::::;:::::::::;:::::::::: :::::::::::;::::::::;::::::::::::::: 1204. :~::::::::::::::::::;::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::;::::::::::::::::::::::::::::::::::::::::::::::::::::::::;:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::;:::: ...0.. _.. _...0... .0..........._. o. f' o. 0 _. 0 0...00.0. 'o. 0.....0........ .....00... o. 0... ..... 0" 0......... 0.00.0. 0" 0..... .......000000... . 0.. 0....... o. 0... 00.. 0..... 0 ...... 0.....0..00..... . 00.......0.0..0. :~\::~lP::::::::::::::::::::::::::::::::;:::::::::::::::::::::::::::::::::::::;:::;:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::;:::::;:;:;:;:::::::::::::::::::;:::::;::::::::::::: :::::::::::::;:;:::::;:::::::::::;:: 1302. P.. inepec;tian to '!IOOS:: .:~.:~ 'caUOC:.:.:.: .:-:-:.:.:.:.:.:.:.: .:-:-: .:-:-:.; .:-:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.;.:.:.:.:.:.:.:.:.:.:.:.:.: .:-:.:.:.:.: .:-:.:.:.:.:.:.:.:.:.:.:.:.:.: .:-:.:.:.:. .:-:.:.:.:.:.:.:.:.:.:.:.:.; .:-:.:.: ... - - _. 0" 0... _ _. 0" 0...00... 0............ _ 0 0 0...................0............... _.....o.........o............o........................... 1304. rJD&1 ...ter/Be-.r :fSB5;.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:. :.;.:.:. :.;. :-:.:.:.:.:.:.:.:.;.:.:. ;.:.:.;.:.:.:.:.:.:.:.:.:.:.:.:.:.;.:.:.:.:.:.:.:.:.:.:.;.:.:.:.:.:.:.:.:.;.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.;.:.:.:.:.:.:.:.:. :.:.:.:.: :.:.:.;.:.:.:.:.:.:.:.:;:.:.:.:.:.:. 0_.............. _._.......o.....o........ 0..0.....0.................................................... 0............0 . 0 0.... 0.......... 1306. '}3Ol::':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':':': .:-:.:.:.:.:.:.;.:.:.:.:.:.;.:.:.;.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.;.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.;.:.:.:.:.:.;. .:.;.:.:.:.: .;.:.:.;.: .:-:-:-: .:-:.: ......0. 0" 0...................................000.................................. 0.... 0........................................... ................ , ....0.......... . ..... 0" 0........ ....... .......o... ...........--.,. :.:.:.:.:.:o.:.:.:.:.:.,.,~..:" '57.2 .....o......... .... .....o......o....o. . ............... . .... 0.........0.. .0............. . .o......... _o..... 00.'........... . 0.. 0 _... _....... 1400. TOTAL SETTLEMENT CHARGES 13,17'.50 '5,'52.~ 1 have carefully revlewed the HUD-l 5et11ement Statement and to the beat of my knowledg. and belief, It Is a true and accurate statement of all recelpta and disbursements made on my ~In this l' I ~r certify that Ihave received a copy of the HUD-1 se tatement. . (V . /1 '71 '/Selleror .o.ate.. ~/2J1 {)" Borrower: ~. Oate: 1I"'~{-{}(p'Agent. . Robett C. c.Jrna _,~~/b~~ _:/f-,2j-Oa.:::.,'" "* ry ""'Iea CaI",. Date: SettleMent Agent Date: 1/.. ;2/-DL The HUD-1 Settlement Statement which I have prepared Ie a true and accurate account of this transaction. I have caused with this statement. Andrew Sh.w WARNING: It Ie a atme to knowIngJy make false atatementa to the United States on this. or any other similar form. Penalties upon convIcUon can Include a ftne and Imprtson- menl Ford.lell....: TItle 18 U.S. Code SectIon 1001 and SectIon 1010.