HomeMy WebLinkAbout09-28-07 (2)
-.J
15056051047
REV-1500 EX (06-05)
PA Department of Revenue .
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Decedent's Last Name Suffix
Date of Birth
Decedent's First Name
MI
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Return
<:::)
2. Supplemental Return
<:::)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
<:::)
<:::) 4a. Future Interest Compromise (date of
death after 12-12-82)
<:::) 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
<:::) 10. Spousal Poverty Credit (date of death <:::) 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 Da ime hone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
4. Limited Estate
<:::)
<:::)
c:>
Firm Name (If Applicable)
': P hi. ;-';1-r;;f~,;1 ~ f ,
:?
City or Post Office
W A- V'rJ~Ci?,irf!/9
Correspondent's e-mail address:
Under penalties of perjury, I declare that J have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, rrect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
E OF PE 0 spa I E FOR FILING RETURN
~ ~A;E.z,S-o--:t-
t.O. ~4<- ffba., Scoffa.,.~ /A-f 7zs~
.
DATE
ADDRqS :8 (UJ ~ P
if 7 D GYtLwl 0, -.d I ' ~6fM.T ,4
SIGNATU E OF P- ER THAN REPRESENTATIVE
51-I
,
~esbOy7) fA- t7-u/i
PL:EASE USE ORIGINAL FORM ONLY
Side 1
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15056051047
15056051047
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REV-1500 EX
15056052048
Decedent's Name: 10 kil\ 6 Me .s So r.
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::J Separate Billing Requested . . . . . " 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c::J Separate Billing Requested. . . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10.
1 t. 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 ~
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
Decedent's Social Security Number
15.
16.
17.
18.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
~'i~
%~
L
15056052048
Side 2
c::>
15056052048
.-J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
_____...l~_~ -0 M dcJ2s ~ r,
STREET ADDRESS
__~l4fJ~_Ck_fl~~_~~
File Number
;;J.-I-O 7-03S7
CITY Jh,
ZIP
{7z.s- 7
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
~ 99. 7.5'
Total Credits ( A + B + C ) (2)
3. InteresUPenalty if applicable
D. Interest .
E. Penalty
:r: ;-S___
TotallnteresUPenalty ( D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in avalon Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
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
j;j0,-.?lPE'I~l~.IL_~._.,~_~_.___ .J...._Ll1WLLI;;;jJ._.II_~ 1111,- J;;,~""I_'iJi~titt
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 G:(
b. retain the right to designate who shall use the property transferred or its income; ............................................ D B'
c. retain a reversionary interest; or.......................................................................................................................... D ET
d. receive the promise for life of either payments, benefits or care? ...................................................................... D 0'
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D Gt'
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. 99116 (a) (1.1) (i)].
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 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 zero (0) percent [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX+ (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John B. Fields, Sr.
FILE NUMBER
21-07-0357
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 ~urvivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Net proceeds from public sale of vacant land located at
Thorny Grove Road, Shippensburg, Southampton Township,
Cumberland County, Pennsylvania. Copy of HUD-l, deed
attached.
VALUE AT DATE
OF DEATH
12,877 .58
TOTAL (Also enter on line 1, Recapitulation) $ 12.877.58
(If more space is needed, insert additional sheets of the same size)
REV-1oo3 EX' (1-97)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John B. Fields, Sr.
FILE NUMBER
21-07-0357
All property jointly-owned with right of sUNivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
5 1/2 shs of Franklin Feed & Supply Co. with a value of $100.00
per share
550.00
TOTAL (Also enter on line 2, Recapitulation) $
550.00
(If mnr" ..nOll''' i.. n"/>/'I,,rl in.."rt :lrlrlitinn;:J1 ..heets of the same size)
REV-l508 EX+ (1-97) ~
.~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
John B. Fields, Sr.
FILE NUMBER
21-07-0357
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
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
300.00
104.50
2.
Gross proceeds from sale of Van in poor condition
Dividend from Franklin Feed stock
TOTAL (Also enter on line 5, Recapitulation) $ 404.50
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
John B. Fields, Sr.
Debts of decedent must be reported on Schedule 1.
21-07-0357
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
2.
FUNERAL EXPENSES:
9/25/06 Geisel Funeral Home
Shull-Koontz Memorials, stone
5,435.00
100.00
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 Patterson, Kiersz & Murphy, P. c.
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 Glenda Farner Strasbaugh
106.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Glenda Farner Strasbaugh, filing fee
30.00
TOTAL (Also enter on line 9, Recapitulation) $ 7, 171 .00
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
John B. Fields, Sr.
FILE NUMBER
21-07-0357
ESTATE OF
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.
2j
3.
4.
Humphrey Magagement, unp~id rent
Penelec, electric bill
PPL Gas, gas bill
Embarq, phone bill
189.00
88.47
43.14
48.18
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
368.79
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
JohnB. Fields, Sr.
FILE NUMBER
21-07-0357
NUMBER
I
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Penny W. Stoner
2790 Grand Point Road, Chambersburg, PA 17201
2. V. Gay McGwin
P.O. Box 462, Scotland, PA 17254
AMOUNT OR SHARE
OF ESTATE
1.
3. Tracey L. Smith
5455 Treher Road, Fayetteville, PA 17222
4. John B. Fields, Jr.
2872 Lincoln Way West, Chambersburg, PA 17201
5. Richard L. Fields
1105 Anthony Highway, Chambersburg, PA 17201
Daughter 1/5 Residue
Daughter 1/5 Residue
Daughter 1/5 Residue
Son 1/5 Residue
Son 1/5 Residue
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)
A. Settlement Statement
U.S. Departmenl of Housing
and Urban Development
~
,..
B. T e of Loan
1. 0 fHA 2. 0 fmHA 3. 00 Conv. Unlns.
4. 0 VA 5. 0 Conv. Ins.
OMB Approval. No. 2502-0265
6. FPe Number
7. loan Numb~
8. Mortgage Insurance Case Number
07-31-0134
C. Note: This rorm Is rurnlshed 10 give you a statement of actual settlement costs. Amounls paid to and by the settlement agent are
shown. Items marked "(p.o.c.)" were paid outside closing; they are shown here ror InrormaUonal purposes and nol
Included In the lotals.
D. Name and Address of Borrower e. Name and Address of Seller F. Name and Address of lender
DAVIDSON, Robert B
DAVIDSON, Brenda L
165 Oll Road
Shi ensbur
Estate of John B Fields Sr
FIELDS, M Lavonne
none cash
PA 17257
Chambers bur
PA 17201
H. S.IU.menl.....nl Forest N Myers
G. Property locaUon
Thorny Grove Road
Southampton Township, Cumberland County
Shippensburg PA
17257
Place of SelUemenl
137 Park Place West
Shippensburg
PA 17257
07
Lot: Block:
J. Summary of Borrower's TransBctlon
100. Gross Amount Due From Borrower
K. Su'mmary of Seller'. Transaction
400 'Gross Amount DUI To Seller
101. Contract sales Drlco 35 000.00 401 ~ Contract sales Driee 35 000.00
102. Personal nroDertv 402. Personal orooertv
103. Selllementcharoas to borrowerlllne1400l 738.50 403.
104. 404.
105. 405.
Adlustments for Items oeld bv seller In advance Adlustments for Items nald bv seller In advance
106. Cllv/lown laxes to 406. Cllv/town taxes to
107. Countv taxes 10 407. Countv taxes 10
100. Assessments to 408. Assessments to
109. 10 409. to
110. 10 410. to
111. to 411. to
112. to 412. to
113. to 413. 10
114. 10 414. to
115. to 415. to
120. Gross Amount Due From Borrower 35,738.50 420. Gross Amount Due To Seller 35,000.00
200. Amounls Paid Bv Or In Behalf Of Borrower 500. Reductions In Amounl Due To Seller
201. DenosU or earnest monev 2 000.00 501. Excess denosll (see Instructlons1
202. Prlnelnal amount of new loanls1 502. SeUlement chames to seller line 14001 3996.73
203. Exlsllnn loanlsl taken sublecllo 503. Exlsllnn loanlsl taken'sublect 10
204. 504. Pavoff of first mortnane loan
205. 505. Pa~f1 of secon<! mortoaoe loan
206. 506.
207. 507.
206. 508.
209. 509.
Adlustments for Items unpaid bv seller AdJustments for Items unnald bv seller
210. Cllvltown taxes 10 510. _ Clt 'town taxes. 10
211. Countv taxes 10 511. County taxes to
212. Assessments 10 512. Assessmenls , 10
213. to 513. to
214. to 514. to
215. to 515. to
218. 10 516. to
217. 10 517. 10
216. to 518. 10
to 519. - 10
219.
220. Total Paid By/For Borrower 2,000.00 520. Tolal Reductlon Amount Due sell,r 3,996.73
300 Cash At Settlement From/To Borrower
600 Cash At SelUement To/From Seller
301. Gross Amounl due rrom borrower i1lne 1201 35 738.50 601. Gross amounldue to seller IIIne 420\ 35 000.00
302. Less amounl nald bv/for borrower llIne 2201 2 000.00 602. less reductions In Jimt due seller fII~e 520} 3 996.73
00 from o To Borrower 33,738.50 663. Caah 00 To o I \ 31,003.27
303. Cash From Seller
SUBSTITUTE fORM 1099 SELLER STATEMENT i
The Informallon contained In Blocks E, G, H, and I and on line 401 (oJ. tine 403 and 404) Is Important lax Information and Is being fl.rnlshed to the'lnlemal Revenue
SelVlce. If you are requtred 10 file 8 return, a negligence pen.ally or oUler sanction wUl be Imposed on you If this item Is required to ~ reported and the IRS determine.
that Il has not been reported. If this real estale Is your principal resldehee, file Form 211 g, Sale or Exchange of Principal Residence, for any gain, with your Income tax
return; for other transactions, complete lhe appUcable parts of Form 4797, Form 6232 ancl/or Schedule 0, Form 1040). You are req'lJlred 10 provide the Settlement Agent
(named above) with your correct taxpayer idenUflcatlon number. If VOl;' do not provide the Settlement Agent with your correcl18xpaver idenUncatlon number, you may be
subject to civil or criminal penalties Imposed by law. Under Penallles of perJury, I certify that the number shown on this statement Is'my correct taxpayer Identlncatlon number.
(Seller's Slgnalure)
M
I
L. Settlemenl Charaes
700. Total Sales/Broker's Commission based on Drlce $ 35 000.00 iIIl %= 0.00 Paid From Paid Ffom
Division of Commlsslon lllne 700\ as foHows: Borrower's Seller's
701. $ to Funds At Funds At
SeUlement Selllement
702. $ to
703. COlTUTJlsslon oald at SetUement
704.
BOO. Items Pavable In Connection With loan
801. loan Orlnlnallon Faa %
802. Loan Discount %
803. ADDfalsal Fee to
804. Credit ReDOfl 10
805. lender's Insnecllon Fee
806. Mortaaae Insurance ADDllcallon Fee to
807. Assumnllon Fee
808.
809.
810.
811.
812.
813.
900. lIems Reoulred Bv Lender To Be Paid In Advance Exclude last dav In cales -line 901
901. Inlerest from to @$ Idav
902. Mortoane Insurance Premlum for months to
903. Hazard Insurance Premium for vears 10
904. vears to
905.
1000. Reserves Deposited With Lender
1001. Hazard Insurance 1
1002. Mort a e Insurance 1
1003. Clt fO ert taxes 1
1004. Counl ro ert taxe. 1
1005. Annual assessmenls 1
1008. 1
1007. 1
1008. A re ale AccounUn Ad uslmant
month
months
months
months
er month
er month
r month
er month
er month
er month
er month
1100. TIUe Charaes
1101. Settlement or closlna fee to
1102. Abstract or tllle search to
1103. Tille examination 10
1104. Title Insurance binder ta
1105. Document Dreoarallon ta
1108. Nolarv fee. la
1107. AlIornev's fees 10 Forest N Mvers/Pallerson Kierz & Murohv' 350.00 125.00
(Includes above Items numbers: l
1108. Tille Insurance to
[Includes above Items numbers: I
1109. lender's coverage $
1110. Owner's coveraoe $
1111.
1112.
1113.
1200. Government Recordlna and Transfer Charaes
1201. Recordlna rees: Deed $ 38.50 . Mortaaoe S . Releases S 38.50
1202. Cll/counlv lax/stamos: Deed $ 350.00 . Mortaaoa $ 350.00
1203. State lax/slamos: Deed $ 350.00 . Mortoaoe . 350.00
1204.
1205.
1300. Additional Settlement CharDel .
1301. Survey to .
1302. Pest lnsDecllon 10
1303.
1304.
1305. Hurlev Auction Services , .2 455.38
1306. Penny W Stoner reimbursement for delln(]uenttaxes Daid , 666:35
1307.
1308. Escrow Countvrrownshi(] & School Taxes \ 400.00
1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) 738.50 3996.73
"-
Borrower
Borrower
To the besl of my knowledge the HUD.1 Settlement Slalement which I have prepared Is a lrue and accurate account of the funds which were received and have been or will
be disbursed by the undersigned as part of the seUlemenl of Ihls lransacllon. '
~~ - Settlemenl Agenl & -\c:::. -01 Date
Forest N Myers
WARNING: It Is a crlme to knowtngly make false statemenls 10 the United Stales on this or any other similar form. Penalties upon conviction can Include a fine and
Imprisonment. For details see;.'fltle 18 U.S. Code Section 1001 and Section 1010'.
II. I:;lNFRNN':NT"RINTlNRnFflr.J:' t,"ILUL"!r
RECAPITULATION
Net proceeds of settlement
Less M Lavonne Fields, alimony
Net for distribution
Distribution:
Estate of John Fields, deceased
M Lavonne Fields
$31,003.27
$ 5,248.11
$25,755.16
$12,877.58
$12,877.58
THIS DEED
MADE this ih day of August, 2007.
BETWEEN Penny W. Stoner and V. Gay McGwin, Administratrices of the Estate
of JOHN B. FIELDS a/k/a JOHN B. FIELDS, SR., deceased, late of Shippensburg,
Cumberland County, Pennsylvania; and M. LA VONNE FIELDS, single, of
Chambersburg, Franklin County, Pennsylvania....................... ............. . GRANTORS
AND ROBERT B. DAVIDSON and BRENDA L. DAVIDSON, husband and
wife, of Shippensburg, Pennsylvania, as tenants by the entireties................ . GRANTEES
WHEREAS, John B. Fields a/k/a John B. Fields, Sr. died September 5, 2006,
intestate, seized of the hereinafter described real estate; and
WHEREAS, the estate of John B. Fields, Sr.. was duly probated by the Register of
Wills of Cumberland County, Pennsylvania, on April 12, 2007, and docketed to No: 21-
07-0357; and
WHEREAS, Letters of Administration were duly granted to Penny W. Stoner and
V. Gay McGwin by the Register of Wills of Cumberland County, Pennsylvania, on April
12,2007; and
WHEREAS, all federal and state inheritance and estate taxes have been or will be
paid and will not be permitted to become liens upon the real estate herein conveyed;
neither shall Grantors permit any lien to exist or remain upon the real estate herein
conveyed as a result of the Pennsylvania Department of Welfare Estate Recovery
Program; and
WHEREAS, a federal estate tax return will not need to be filed, and Pennsylvania
I
inheritance taxes have or will be paid in full in the decedent's estate.
NOW, THIS DEED WITNESSETH, that the said Grantors for and in
consideration of the sum of Thirty-Five Thousand ($35,000.00) Dollars to them in hand
paid by the said Grantees at or before the sealing and delivery hereof, receipt whereof is
hereby acknowledged, have granted, bargained, sold, aliened, released and confirmed,
and by these presents do grant, bargain, sell, alien, release and confirm unto the said
Grantees, their heirs and assigns, ALL the following described real estate, lying and
being situate in Southampton Township, Cumberland County, Pennsylvania, bounded
and described as follows:
BEGINNING at a point at the southeast comer ofland now or formerly of Ronald
R. Hill and Naomi A. Hill, his wife, and land now or formerly of Charles M.
White, and land now or formerly of Thomas Fuller: thence along the land now or
formerly of White, north 47 degrees west, a distance of 186 feet to a point; thence
along other land now or formerly of Ronald R. Hill and Naomi A. Hill, in a
northeasterly direction, a distance of 225 feet to a point near a mountain road;
thence in a southeasterly direction a distance of 264 feet to a point on line of land
now or formerly of Ronald R. Hill and Naomi A. Hill, and line ofland of the
Commonwealth of Pennsylvania; thence in a southwesterly direction a distance of
366 feet to a point, the place of beginning.
BEING the same real estate conveyed by deed of John B. Fields, Jr. and Sherry L.
Fields, husband and wife, to John B. Fields and M. Lavonne Fields, husband and wife,
dated February 15, 1990 and recorded February 16, 1990 in Cumberland County Deed
Book K34, Page 492. A divorce decree was granted to John B. Fields and M. Lavonne
Fields on September 28, 1995. John B. Fields died September 5, 2006.
SUBJECT, HOWEVER, to the restrictions and conditions of record which are
made a part hereof as fully as if written out herein.
TOGETHER with all and singular the rights, liberties, privileges, hereditaments
and appurtenances whatsoever thereunto belonging, or in any wise appertaining, and the
reversions and remainders, rents, issues and profits thereof from and after the date of this
deed, and all the estate, right, title, interest, property, claims, and demands whatsoever of
the said John B. Fields a/kIa John B. Fields, Sr. at and immediately before the time of his
decease, in law or equity, or otherwise howsoever, of, in, to or out of the same.
TO HAVE AND TO HOLD the said real estate 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, their
heirs and assigns, forever.
AND the said Grantors, for themselves, their heirs, executors, administrators and
assigns, do 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.
The fiduciary makes no representations or warranties as to the condition of the
property, that the Grantees accept the property "as is" and that the Grantees waive any
claims for any liability imposed through any environmental actions.
IN WITNESS WHEREOF, the said Grantors have hereunto set their hands and
seals the day and year first above written.
Witness:
~~d k~
~~ 9! ~ (SEAL)
Penny W. toner, AdmmIstratnx
v----:>
(SEAL)
V. Gay McGwi Administratrix
~ i!#1~,e-rf~4!5EAL)
M. Lavonne FIelds, mdIvIdually .
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF FRANKLIN
On this ~ day of August, 2007, before me, a notary public, the undersigned
officer, personally appeared Penny W. Stoner and V. Gay McGwin, administratrices
known to me to be the person described in the foregoing instrument, and acknowledged
that they executed the same in the capacity therein stated and for the purposes therein
contained.
In witness whereof, I hereunto set my hand and official seal.
~cu~ A [~e-L
Notary Public
COMMONWEALTH OF PENNSYLVANIA
Notarial &aJ
Barbara A. Henlcle, Notary Public
Waynesboro Bore, Franklin County
My Commission Expires Aug. 10,2010
Member, P~nnsylvanla Association of Notaries
COMMONWEALTH OF PENNSYL VANIA
SS
COUNTY OF FRANKLIN
On this ~ day of August, 2007, before me, a notary public, the undersigned
officer, personally appeared M. Lavonne Fields known to me to be the person described
in the foregoing instrument, and acknowledged that she executed the same in the capacity
therein stated and for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
~u.J J-eu Ci ~ l~ c--4
Notary Public
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Barbara A. Henlole, Notary Public
WaynesbOm 80m, Franklin County
My Commlsalon expires Aug. 10,2010
Member, Penneylvanla A..oolallon of Notaries
Certificate of Residence
I hereby certify that the precise residence of the Grantees is:
ugus,
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96. Tpj m-mn~
J7f:: !l1A[i9i-lJAttomey for Gran~ . ~s
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