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HomeMy WebLinkAbout12-28-06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17123-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT WERT HEATHER S 1217 MOUNTAIN RD NEWBURG, PA 17240 n_n___ (':lId ESTATE INFORMATION: SSN: 165-56-5013 FILE NUMBER: 2106-0181 DECEDENT NAME: TILDEN CATHY S DA TE OF PAYMENT: 12/28/2006 POSTMARK DATE: 1 2/28/2006 COUNTY: CUMBERLAND DATE OF DEATH: 01/15/2006 NO. CD 007618 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $973.86 I I I I I I I I TOTAL AMOUNT PAID: REMARI<S: ESTATE OF CATHER S TILDEN HEATHER S WERT EXEC CHECI<# 107 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS $973.86 GLENDA FARNER STRASBAUGH REGISTER OF WILLS REV-1500 EX + (6-00) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I- Z W C W () W C TILDEN CATHY S_ DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 01/15/2006 11/10/1958 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) W I- ~Sen UCl:~ wll.U J:OO UCl:...J Il.lD 11. <( ~ 1. Original Return o 4. limited Estate o 6. Decedent Died Testate IAttach copy of Will) o 9. litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (dafe of death after 12-12-82) o 7. Decedent Maintained a living Trust (Attach copy ofTrust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) OFFICIAL USE ONLY FilE NUMBER 2 1 -0 6 0 1 8 1 "'COUNTYCOiif" -VEAP:-- - - NUMBER-- SOCIAL SECURITY NUMBER 1 65- 5 6 - 5 0 1 3 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (date of death prior to 12-13.82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) I- Z W o Z o 11. en w Cl: Cl: o U THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS HUBERT X. GILROY ESQUIRE 4 N_ HANOVER STREET FIRM NAME (If Applicable) BROUJOS & GILROY PC TELEPHONE NUMBER 717 -243-457 4 CARLISLE P A 17013 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) z o i= <( ...J ::> t: D. <( () W 0:: 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) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total lines 1-7) 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/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= <( I- ::> D. :E o () >< <( I- 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(12) X _(15) 21 ,641 .36 X .045 (16) X .12 (17) 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 < < 18,000.00 OFFICIAL USE ONLY 8,804.76 1'.) CO v.'J . -a;--- --l 26,804.76 1 ,958.25 3,205.15 (11) (12) (13) 5,163.40 21 ,641 .36 (14) 21 ,641 .36 973.86 973.86 Decedent's Complete Address: STREET ADDRESS 205 Conodoauinet Mobile Estates CITY I STATE I ZIP Newville PA 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 973.86 Total Credits (A + 8 + C) (2) 3. Interest/Penalty if applicable D. Interest E Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 973.86 973.86 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 00 b. retain the right to designate who shall use the property transferred or its income; ""." ".""""........".".. ....". 0 00 c. retain a reversionary interest; or .""""."......"""..........""".."...""..."....".."".."...".""."..."."".."". 0 00 d. receive the promise for life of either payments, benefits or care? "", ..""""......" ."".... '"'''' """"".. ."..."" 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ""....." ""....." """"'" """." "" """", ""... "". ...".. "..". .."". "".. 0 00 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? "."....".".. 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? """"""""......."...."""""".."....""""""".."".."""...."..""".",,....,,. 0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief, it is true. correct and complete. Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ~~ 3' %~~ /:2'/Y./i-~~ ADDRESS Heather S. Wert 1217 Mountain Road, Newburg SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE PA 17240 DATE ADDRESS Hubert X.Gilroy, Esquire 4 N. Hanover Street, Carlisle PA 17013 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. S9116 (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. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000 The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 PS s9116(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. 99116(1.2) [72 PS S9116(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. S9116(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. ,o".~.".'" .- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER TILDEN. CATHY S. 21 06 0181 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 property which is jointly-owned with right of survivorshio must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION 205 Conodoguinet Mobile Estate, Newville, PA 17241 As per sale price on June 21,2006 (Settlement Sheet attached) VALUE AT DATE OF DEATH 18,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 18.000.00 REV-1508 EX + 11-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TILDEN. CATHY S. FILE NUMBER 21 06 0181 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Sovereign Bank Savings Account #2891035593 4,131.17 2. Income from Ames True Temper 620.70 3. Income from Sid Harveys 452.68 4. Income from Sid Harveys 52.63 5. Income from Ames True Temper 351.30 6. 1998 Malibu Automobile 1,800.00 7. Miscellaneous Household Personal Property 150.00 8. Income Tax Refund 991.84 9. Refund from Nationwide Insurance 72.51 10. Refund from Nationwide Insurance 32.86 11. Refund from Adams Electric 149.07 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 8,804.76 -"""''''''w COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF TILDEN. CATHY S. FILE NUMBER 21 06 0181 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES 1. Lisa's Floral Shoppe - Flower for funeral 201.40 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Hubert X. Gilroy, Esquire 1,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 97.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 2005 & 2006 Federal Income Tax Return 100.00 7. Filing Fees - Pennsylvania Inheritance Tax Return 15.00 8. Filing Fees - Family Settlement Agreement 20.00 9. Estate Checkbook Fee 24.85 TOTAL (Also enter on line 9, Recapitulation) $ 1 958.25 (If more space is needed, insert additional sheets of the same size) """e>.,,'" .- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER ESTATE OF TILDEN. CATHY S. 21 0181 06 Include unreimbursed medical expenses. ITEM NUMBER AMOUNT DESCRIPTION 1. County real estate taxes - paid 2/13/06 to Shelby Winters 66.49 2. 3. 4. 5. 6 7. 8. 9. 10. 11. 12. Sprint telephone bills ($49.11 and $22.70) 71.81 Nationwide - homeowner's insurance 78.86 Nationwide - auto insurance 80.43 Adams Electric ($27.97, $22.69, $21.54, $48.22, $37.65) 158.07 Bender's - auto repair 69.43 Expenses in connection with sale of real estate, including Realtor's commission of $2,000; Transaction fee of $175.00; Notary fee of $5.00; 2,180.00 Baltimore Life Insurance Premium 50.79 Nationwide 80.43 Nationwide 84.43 Nationwide 84.41 Reimbursement to Administratrix for gas and miscellaneous expenses 200.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3 205.15 ",,,,,,,.,,., .- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER TILDEN I"'ATHY S. 21 n6 0181 RELA TrONSHIP 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) 1. Heather S.Wert Daughter 25% 1217 Mountain Road Newburg, PA 17240 2. Matthew H. Tilden Son 25% 401 N. Bedford Street Carlisle, PA 17013 3. Dane S. Tilden Son 25% 22 Buttonwood Lane Carlisle, PA 17013 4. Daneshia S. Tilden Daughter 25% 22 Buttonwood Lane Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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 A. Settlement Statement :,i,.. u.s. Department of Housing and Urban Development ~ '. OMS No. 2502-0265 REV. HUD-1 (3/86) FRANKLIN REAL ESTATE SERVICES AND ABSTRACTING COMPANY, INC. S. TYPE OF LOAN 1035 WAYNE AVENUE. CHAMBERSBURG, PA 17201 1. DFHA 2. DFmHA 3. DConv. Unins. TEl. 717-264-3290 FA,X: 717-264-1985 4. OVA 5. DConv. Ins. 6. FILE NUMBER 17. LOAN NUMBER CT A0649 8. MORTGAGE INSURANCE CASE NUMBER C. Note: I nlS form s urn shed to g ve you a statement 0 ac ua seltlemen cos s. Amounts paid, to and I y tne seltlemen agen are shown. I TitleExpress Settlement System Items marked "(p.o.c.)" were paid outside the closing; they are shown here for Information purposes and are not included In the totals. WARNING: It Is a crime to knowingly make false statements to the United States on this or any other sImilar form. Penalties upon conviction can Include a fine and Imprisonment. For details see: Title 18 U. S. Code Section 1001 and Section 1010. Printed 06/21/2006 at 07:02 RAD D. NAME OF BORROWER: I. Irvin Nelson ADDRESS: 165 Conodoauinet Mobile Estate. Newville PA 17241 E. NAME OF SELLER: Estate of Cathy S. Tilden ADDRESS: 205 Conodoauinet Mobile Estate. Newville PA 17241 F. NAME OF LENDER: CASH ADDRESS: G, PROPERTY ADDRESS: 205 Conodoguinet Mobile Estate, Newville, PA 17241 Lower Mifflin townshio H. SETTLEMENT AGENT: Franklin RE Services and Abstracting Co., Telephone: 717.264.3290 Fax: 717.264.1985 PLACE OF SETTLEMENT: 1035 Wavne Avenue. Chambersbura. PA 17201 I. SETTLEMENT DATE: 06/21/2006 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 orice 18 000.00 401. Contract sales orice 18 000.00 102. Personal Prooertv 402, Personal Prooertv 103. Settlement charoes to borrower (line 1400) 380.00 403. 104. 404, 105. 405. Adjustments for items paid by seller in advance Adiustments for items oaid bv seller in advance 107. County taxes 06/21106 to 12/31/06 35.33 407. County taxes 06/21/06 to 12/31/06 35.33 108. School Taxes 06/21/06 to 06/30/06 9.48 408. School Taxes 06/21/06 to 06/30/06 9.48 109. Lot Rent Proration 68.94 409, Lot Rent Proration 68.94 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 18493.75 420. GROSS AMOUNT DUE TO SELLER 18.113.75 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deoosit or earnest money 500.00 501. Excess Deoosit Isee instructions) 202, Princioal amount of new loans 502. Settlement charaes to seller (line 1400) 2.180.00 203. Existina loanls) taken sUbiect to 503. Existina loan(s) taken subiect to 204. 504. Payoff of First Mortaaae Loan 205. 505, 206. 506. 207. 507. 208. 508. 209. 509. Adiustments for items unpaid bv seller Adiustments for items unoaid bv seller 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 2.180.00 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower (line 120) 18493.75 601. Gross amount due to seller lline 420\ 18.113.75 302. Less amounts oaid by/for borrower (line 220) 500.00 602. Less reduction amount due seller Iline 520\ 2.180.00 303. CASH FROM BORROWER 17993.75 603. CASH TO SELLER 15.933.75 SUBSTITUTE FORM 1099 SELLER STATEMENT: The Information contained herein Is Important tax Information and Is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction will be Imposed on you If this Item Is required to be reported and the IRS determines that It has not been reported. The Contract Sales Price described on line 401 above constitutes the Gross Proceeds of this transaction. You are required by law to provide the settlement agent (Fed. Tax 10 No: ) with your correct taxpayer Identification number. If you do not provide your correct taxpayer Identification number, you may be subject to civil or criminal penalties Imposed by law. Under penalties of perjury, I certify that the number shown on this statement Is my correct taxpayer Identification number. TIN: SELLER(S) SIGNATURE(S): SELLER(S) NEW MAILING ADDRESS: SELLER(S) PHONE NUMBERS: (H) (W) J.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT ME T File Number: CT A0649 PAGE 2 eETTLEMENT STATE N REV. HUD-1 (3/86\ TitleExoress Settlement System Printed 06/21/2006 at 07:02 RAD -- ~15ETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on price $18,000.00 = 2 000.00 BORROWER'S SELLER'S Division of commission (line 7001 as follows: FUNDS AT FUNDS AT 701. $ to Dawn and Associates Realty SETTLEMENT SETTLEMENT 702, $ 2.000.00 to Dawn and Associates Realty 703. Commission oaid at Settlement 2 000.00 704. Transaction Fee to Dawn and Associates Realty 175.00 175.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Oriaination Fee % 802. Loan Discount % II 803. Aooraisal Fee 804. Credit Reoort 805. Lender's Insoection Fee 806, Mortaaae Aoolication Fee 807. Assumotion Fee 808. 809. 810. 811. gOO. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to 1iD$ /day 902. Mortnane Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo. liD $ /mo 1002. Mortaaae Insurance mo. (a) $ /mo 1003. City Prooertv Tax mo. (a) $ /mo 1004. County Prooerty Tax mo. liD $ /mo 1005. School Taxes mo. (a) $ Imo 1009, Aaareaate Analysis Adiustment 0.00 0.00 1100. TITLE CHARGES 1101. Settlement or closina fee to Franklin Real Estate Services 150.00 1102. Judament and Lien search to Franklin Real Estate Services 50.00 1103. Title examination 1104. Title insurance binder 1105. Document Preoaration 1106. Notary Fees to Malina S. Rav 5.00 5.00 1107. Attorney's fees (includes above items No: ) 1108. Title Insurance to NO TITLE INSURANCE (includes above items No: ) 1109. Lender's Coyeraae $ 1110. Owner's Coyeraae $ 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordina Fees Deed $ . Mortnane $ . Release $ 1202. City/County tax/stamos Deed $ . Mortaaae $ 1203. State Tax/stamos Deed $ . Mortnane $ 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey 1302. Pest Insoection 1303. 1304. 1305. 1306. 1307. 1308. 1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Section J and 502 Section K) 380.00 2 180.00 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief. it is a true and accurate statement of all receipts and disbursements made on my account or by ,"... .~~~"- ~-~.. "",., ....... ,_.. J(1~ :~ ",' " I. IIVIn Nelstln q / //~ ~ // /~ fa >1~- ~ ?c::~~ ' I-~';~({ J/ Esta e 0 a . I en ' WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENAL TIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. The HUD-1 settr"-';;~n{ State I have cau~'l~,~(,wlrl ca \ BY:!(~"';.;1I".~""". have prep~red'Js a trtJ9 and accurate account of this transaction e disbursed in accordance with this statement. ~ <: ..71-" r h' ,;; ::::..-... --.;.U.-, del ~{{ CJ(.